Gobbo Stefano, Favro Francesco, Bullo Valentina, Cugusi Lucia, Blasio Andrea Di, Bortoletto Alessandro, Bocalini Danilo Sales, Gasperetti Andrea, Ermolao Andrea, Bergamin Marco
Department of Medicine, University of Padova, Padova, Italy.
Department of Biomedical Sciences, University of Sassari, Sassari, Italy.
Front Physiol. 2022 Aug 8;13:967817. doi: 10.3389/fphys.2022.967817. eCollection 2022.
Left ventricular assist devices (LVAD) are increasingly being used as a therapy for advanced heart failure, both as a bridge to heart transplant and, given the rapid advances in the LVAD's functionality and safety, and constant lack in availability of donor organs, as long-term destination therapy. With the diffusion of such therapy, it is crucial to assess patients' muscle strength, aerobic capacity and exercise tolerance, to improve their functional capacity. 38 LVAD recipients (33 men and five women) were included. Exercise testing including a maximal cardiopulmonary exercise test (CPET), handgrip, isometric and isokinetic strength testing of knee and ankle flexion/extension, and Romberg balance test in three conditions (eyes open, eyes closed, double task). Given the small and heterogeneous final sample size, a mostly descriptive statistical approach was chosen. 12 participants were classified as "Obese" (BMI>29.9). The most common comorbidities were type II diabetes and chronic kidney disease. Only 12 participants were able to successfully complete all the assessments. CPET and isokinetic strength trials were the least tolerated tests, and the handgrip test the best tolerated. Mean VO peak was 12.38 ± 3.43 ml/kg/min, with 15 participants below 50% of predicted VO max, of which 6 below 30% VOmax. Mean handgrip strength was 30.05 ± 10.61 Kg; 25 participants were below the 25° percentile of their population's normative reference values for handgrip strength, 10 of which were below the 5° percentile. Issues with the management of the external pack of the LVAD and its influence on the test limited the validity of the balance tests data, therefore, no solid conclusions could be drawn from them. VO peak did not correlate with handgrip strength or with any of the lower limb strength measures. LVAD recipients show greatly reduced functional capacity and tolerance to exercise and exercise testing, with low overall strength levels. As strength variables appear to be independent from VO peak, different lower limbs strength tests should be explored to find a tolerable alternative in this population, which is subjected to muscle wasting due to old age, reduced tissue perfusion, side effects from the pharmacological therapies, and prolonged periods of bedrest.
左心室辅助装置（LVAD）越来越多地被用作晚期心力衰竭的一种治疗手段，既作为心脏移植的桥梁，又鉴于LVAD在功能和安全性方面的迅速进展以及供体器官的持续短缺，还作为长期的终末期治疗手段。随着这种治疗方法的普及，评估患者的肌肉力量、有氧能力和运动耐量以提高其功能能力至关重要。纳入了38名LVAD接受者（33名男性和5名女性）。进行了运动测试，包括最大心肺运动测试（CPET）、握力测试、膝关节和踝关节屈伸的等长和等速力量测试，以及在三种情况下（睁眼、闭眼、双重任务）的罗姆伯格平衡测试。鉴于最终样本量小且异质性大，选择了主要是描述性的统计方法。12名参与者被归类为“肥胖”（BMI>29.9）。最常见的合并症是II型糖尿病和慢性肾病。只有12名参与者能够成功完成所有评估。CPET和等速力量测试是耐受性最差的测试，而握力测试是耐受性最好的测试。平均VO峰值为12.38±3.43毫升/千克/分钟，15名参与者低于预测VO最大值的50%，其中6名低于VO最大值的30%。平均握力为30.05±10.61千克；25名参与者低于其人群握力规范参考值的第25百分位数，其中10名低于第5百分位数。LVAD外部组件的管理问题及其对测试的影响限制了平衡测试数据的有效性，因此，无法从中得出确凿结论。VO峰值与握力或任何下肢力量测量值均无相关性。LVAD接受者的功能能力以及对运动和运动测试的耐受性大大降低，总体力量水平较低。由于力量变量似乎与VO峰值无关，应该探索不同的下肢力量测试，以便在这个因年老、组织灌注减少、药物治疗副作用和长期卧床而遭受肌肉萎缩的人群中找到一种可耐受的替代方法。
