Schmidt Thomas, Bjarnason-Wehrens Birna, Mommertz Stephanie, Hannig Meike, Schulte-Eistrup Sebastian, Willemsen Detlev, Reiss Nils
Schüchtermann-Klinik Bad Rothenfelde, Bad Rothenfelde, Cologne, Germany.
Department for Preventive and Rehabilitative Sport and Exercise Medicine, Institute for Cardiology and Sports Medicine, German Sports University Cologne, Cologne, Germany.
Artif Organs. 2018 Jul;42(7):686-694. doi: 10.1111/aor.13102. Epub 2018 Feb 12.
Following implantation of a left ventricular assist device (LVAD), acceptable functional performance is now being achieved; however, peak VO and peak work load (watts) remain considerably limited. Maximum physical capacity is essentially dependent on generated cardiac output (CO) and arteriovenous oxygen difference (avDO ). We investigated the changes in CO and avDO during exercise in LVAD patients with an HVAD pump (HeartWare Inc., Framingham, MA, USA). Approximately 6 weeks after implantation, 20 patients (100% male, 60.8 ± 7.3 years old, BMI 25.7 ± 3.3) underwent a six-minute walk test (6MWT), a cardiopulmonary exercise test (CPET), and noninvasive hemodynamic measurement. The mean six-minute walking distance (6MWD) was 403 m (68% of predicted), and mean peak VO was 10.9 mL/kg/min (39% of predicted). Mean total CO improved from 3.8 L at rest to 7.0 L at maximum exercise. The mean avDO increased from 7.4 mL/dL (44% of oxygen content) at rest to 13.2 mL/dL (75% of oxygen content) at maximum exercise. There was a significant increase in both total CO (P < 0.01) and avDO (P < 0.05) between rest and sub-maximum exercise. As exercise levels increased, however, no further significant changes were achieved. Long-term studies, especially in combination with exercise programs, would be desirable in order to observe the development of these parameters.
植入左心室辅助装置（LVAD）后，目前已实现了可接受的功能表现；然而，峰值摄氧量（VO）和峰值工作负荷（瓦特）仍然受到很大限制。最大身体能力基本上取决于心输出量（CO）和动静脉氧差（avDO）。我们研究了使用HVAD泵（美国马萨诸塞州弗雷明汉市HeartWare公司）的LVAD患者在运动过程中CO和avDO的变化。植入后约6周，20名患者（100%为男性，年龄60.8±7.3岁，体重指数25.7±3.3）接受了六分钟步行试验（6MWT）、心肺运动试验（CPET）和无创血流动力学测量。平均六分钟步行距离（6MWD）为403米（预测值的68%），平均峰值VO为10.9毫升/千克/分钟（预测值的39%）。平均总CO从静息时的3.8升增加到最大运动时的7.0升。平均avDO从静息时的7.4毫升/分升（氧含量的44%）增加到最大运动时的13.2毫升/分升（氧含量的75%）。静息和次最大运动之间，总CO（P<0.01）和avDO（P<0.05）均有显著增加。然而，随着运动水平的提高，未实现进一步的显著变化。为了观察这些参数的发展，进行长期研究，尤其是结合运动计划的研究将是可取的。
