Laoutaris Ioannis D, Gkouziouta Aggeliki, Bonios Michael J, Katelouzos George, Kogerakis Nektarios, Chamogeorgakis Themistocles, Adamopoulos Stamatis
Cardiac Rehabilitation Department, Onassis Cardiac Surgery Center, 356 Sygrou Blvd, 17674 Athens, Greece.
Heart Failure, Mechanical Support and Transplant Unit, Onassis Cardiac Surgery Center, 356 Sygrou Blvd, 17674 Athens, Greece.
Eur Heart J Case Rep. 2024 Aug 7;8(8):ytae401. doi: 10.1093/ehjcr/ytae401. eCollection 2024 Aug.
Skeletal muscle wasting (SMW) is highly prevalent in patients with heart failure (HF) at left ventricular assist device (LVAD) implantation and is associated with morbidity and mortality. At the same time, SMW is clinically under-recognized, while exercise training (ET) studies in weak LVAD patients are lacking.
A 60-year-old man with advanced HF, SMW, cardiac cachexia, and frailty was confined in bed for 6 months initially supported with intravenous inotropes and subsequently with an intra-aortic balloon pump. His frailty was recognized as an LVAD-responsive frailty, and patient was successfully implanted with a HeartWare (Medtronic). Post-surgery, patient was very weak, unable even to move in bed without assistance. We evaluated skeletal muscle using simple tools such as the Oxford scale, mid-thigh circumference, hand-held dynamometry, and maximum inspiratory pressure. Physical performance was assessed with the sit to stand test, gait speed test, pedal bike timing, and the 6 min walk test. On top of routine physiotherapy, patient underwent an 8-week modified aerobic/resistance/inspiratory (ARIS) ET programme at moderate intensity and showed significant improvements in skeletal muscle mass and strength and physical and functional capacity.
We want to emphasize the importance of skeletal muscle evaluation at LVAD implantation and the feasibility and effectiveness of early ARIS training in very weak patients.
骨骼肌萎缩（SMW）在植入左心室辅助装置（LVAD）的心力衰竭（HF）患者中非常普遍，并且与发病率和死亡率相关。与此同时，SMW在临床上未得到充分认识，而针对虚弱LVAD患者的运动训练（ET）研究也很缺乏。
一名60岁患有晚期HF、SMW、心源性恶病质和虚弱的男性患者，最初卧床6个月，最初接受静脉注射正性肌力药物支持，随后使用主动脉内球囊泵。他的虚弱被认为是对LVAD有反应的虚弱，患者成功植入了HeartWare（美敦力公司）。术后，患者非常虚弱，甚至在没有帮助的情况下无法在床上移动。我们使用牛津量表、大腿中部周长、手持测力计和最大吸气压力等简单工具评估骨骼肌。通过坐立试验、步态速度试验、踏板自行车计时和6分钟步行试验评估身体表现。除了常规物理治疗外，患者还接受了为期8周的中等强度改良有氧/抗阻/吸气（ARIS）ET计划，并在骨骼肌质量和力量以及身体和功能能力方面取得了显著改善。
我们想强调在LVAD植入时进行骨骼肌评估的重要性，以及早期ARIS训练对非常虚弱患者的可行性和有效性。
