Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria (Messrs Schlöglhofer and Neumayer and Drs Gross, Laufer, Wiedemann, Schima, Zimpfer, and Marko); Ludwig Boltzmann Institute for Cardiovascular Research, Vienna, Austria (Messrs Schlöglhofer and Neumayer and Drs Moscato, Schima, and Zimpfer); Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria (Mr Schlöglhofer and Drs Moscato and Schima); Austrian Cluster for Tissue Regeneration, Vienna, Austria (Dr Moscato); and Center for Outpatient Rehabilitation Vienna, Vienna, Austria (Drs Kandioler and Skoumal and Ms Leithner).
J Cardiopulm Rehabil Prev. 2023 Sep 1;43(5):346-353. doi: 10.1097/HCR.0000000000000789. Epub 2023 Apr 5.
Exercise performance and quality of life (QoL) of left ventricular assist device (LVAD) patients improve after early cardiac rehabilitation (CR). The purpose of this study was to examine the efficacy of multiprofessional long term phase 3 outpatient CR, and whether cardiopulmonary exercise testing (CPX) and 6-min walk testing (6MWT) post-LVAD implantation predict hospital readmission.
This retrospective observational cohort study included 29 LVAD patients (58.6 ± 7.7 yr, female: 13.8%, body mass index: 29.4 ± 3.3 kg/m 2 ). Functional performance tests (CPX, 6MWT, sit-to-stand test), QoL, and psychological surveys (Kansas City Cardiomyopathy Questionnaire, hospital anxiety and depression scale, and Control Convictions about Disease and Health [KKG]) were performed at baseline and at the end of CR.
The CR was initiated at a median (IQR) of 159 (130-260) d after LVAD implantation for a duration of 340 (180-363) d with 46.8 ± 23.2 trainings. The 6MWT (408.4 ± 113.3 vs 455.4 ± 115.5 m, P = .003) and sit-to-stand test (16.7 ± 6.9 vs 19.0 ± 5.3 repetitions, P = .033) improved, but relative peak oxygen uptake (V˙ o2peak : 9.4 [8.2-14.4] vs 9.3 [7.8-13.4] mL/min/kg, P = .57) did not change. Using receiver operating characteristic curve analysis, baseline V˙ o2peak values were associated with readmission 1-yr after CR onset (C-statistic = 0.88) with a cutoff value of V˙ o2peak < 9.15 mL/min/kg (100% sensitivity, 78% specificity, P < .001). The Kansas City Cardiomyopathy Questionnaire self-efficacy and knowledge (+6.3 points), QoL (+5.0 points), and social limitation (+7.1 points) demonstrated clinically important changes. In addition, the hospital anxiety and depression scale showed a significant reduction in anxiety (4.6 ± 3.2 vs 2.6 ± 2.4, P = .03).
Long-term CR is safe and LVAD outpatients showed improvement of QoL, anxiety, and submaximal exercise performance. In addition, V˙ o2peak and 6MWT have prognostic value for readmission.
左心室辅助装置（LVAD）患者在早期心脏康复（CR）后运动表现和生活质量（QoL）得到改善。本研究的目的是检验多专业长期 3 期门诊 CR 的疗效，以及 LVAD 植入后心肺运动试验（CPX）和 6 分钟步行试验（6MWT）是否可预测住院再入院。
本回顾性观察队列研究纳入了 29 名 LVAD 患者（58.6±7.7 岁，女性：13.8%，体重指数：29.4±3.3 kg/m2）。在基线和 CR 结束时进行功能测试（CPX、6MWT、从座位到站立测试）、QoL 和心理调查（堪萨斯城心肌病问卷、医院焦虑和抑郁量表以及疾病和健康控制信念量表[KKG]）。
LVAD 植入后中位数（IQR）159（130-260）d 开始 CR，持续时间为 340（180-363）d，训练次数为 46.8±23.2 次。6MWT（408.4±113.3 比 455.4±115.5 m，P=0.003）和从座位到站立测试（16.7±6.9 比 19.0±5.3 次，P=0.033）改善，但相对峰值摄氧量（V˙o2peak：9.4[8.2-14.4]比 9.3[7.8-13.4]mL/min/kg，P=0.57）没有变化。使用受试者工作特征曲线分析，基线 V˙o2peak 值与 CR 开始后 1 年的再入院相关（C 统计量=0.88），V˙o2peak 值<9.15 mL/min/kg 为截断值（敏感性 100%，特异性 78%，P<0.001）。堪萨斯城心肌病问卷自我效能和知识（+6.3 分）、QoL（+5.0 分）和社会限制（+7.1 分）表现出具有临床意义的变化。此外，医院焦虑和抑郁量表显示焦虑显著降低（4.6±3.2 比 2.6±2.4，P=0.03）。
长期 CR 是安全的，LVAD 门诊患者的 QoL、焦虑和亚极量运动表现得到改善。此外，V˙o2peak 和 6MWT 对再入院有预后价值。
