Exercise in heart failure patients supported with a left ventricular assist device
Exercise in heart failure patients supported with a left ventricular assist device
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DOI：
10.1016/j.healun.2014.11.001
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发表时间：
2015-04-01
影响因子：
8.9
通讯作者：
Gustafsson, Finn
中科院分区：
文献类型：
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作者：
Jung, Mette Holme;Gustafsson, Finn
在植入连续流左心室辅助装置（CF-LVAD）后，心力衰竭患者的运动能力仍然降低，峰值摄氧量（峰值VO 2）平均值从II到20 ml/kg/min。CF-LVAD患者在运动期间的总心输出量主要取决于泵速、泵压差以及在某些情况下通过主动脉瓣的射血。CF-LVAD中使用的固定泵速可能无法提供足够的支持，导致身体紧张增加期间心输出量中度增加。正在进行的研究正在评估泵速变化是否能够响应不同的负载条件，使LVAD即使在剧烈运动期间也能提供足够的支持。在目前使用的器械中，有证据表明，重点优化非心脏外周参数至关重要。心外潜在可逆因素是贫血伴携氧能力低、肥胖和全身失调伴肌肉质量低。此外，CF-LVAD患者的运动训练可改善峰值VO 2。为了设计干预措施来改善接受现代耐用LVAD治疗的患者的功能能力，有必要详细了解连续流动循环系统中的运动生理学。在这篇综述中，我们讨论了LVAD患者运动生理学的不同组成部分，并指出了潜在的解决方案或未来的研究领域。(C)2015年国际心肺移植学会。All rights reserved.
After implantation of a continuous-flow left ventricular assist device (CF-LVAD), exercise capacity in heart failure patients remains reduced with peak oxygen uptake (peak VO2) values averaging from II to 20 ml/kg/min. Total cardiac output in CF-LVAD patients during exercise is predominantly determined by pump speed, the pressure difference across the pump, and in some cases ejection through the aortic valve. Fixed pump speed utilized in CF-LVADs may provide insufficient support, resulting in a moderate cardiac output increase during increased physical strain. Ongoing studies are evaluating whether pump speed changes in response to varied loading conditions may enable LVADs to provide sufficient support even during strenuous exercise. In the currently used devices, evidence suggests that focus on optimizing non-cardiac peripheral parameters is vital. Extra-cardiac potentially reversible factors are anemia with low oxygen-carrying capacity, obesity and general deconditioning with low muscle mass. In addition, exercise training in CF-LVAD patients can improve peak VO2. To design interventions to improve functional capacity in patients treated with modem durable LVADs, a detailed understanding of exercise physiology in a continuous-flow circulatory system is necessary. In this review we address the different components of exercise physiology in LVAD patients and point out potential solutions or areas of future research. (C) 2015 International Society for Heart and Lung Transplantation. All rights reserved.