(146) - Angiotensin-Converting Enzyme Inhibitors (ACEIs) or Angiotensin- Receptor Blockers (ARBs) during CF-LVAD Support Are Associated with Sustained Improvement in Renal Function

Abstract

s S59 Austria; 2Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria; 3Center for Med. Phys. & Biomed. Eng. L. B. Cluster for Cardiovasc. Res. Dept of Cardiac Surgery, Medical University of Vienna, Vienna, Austria; 4Rehabilitation Clinic Felbring, Muthmannsdorf, Austria. Purpose: Left ventricular assist devices (LVAD) are increasingly implanted for long support times and destination therapy. Therefore, focus is shifting from pure survival to quality of life and physical performance. The present study was designed to evaluate the development of exercise capacity within the first 2 years of LVAD support. Methods: Data obtained during rehabilitation of 12 patients undergoing LVAD implantation for terminal heart failure between June 2010 and July 2012 were retrospectively analyzed (age 57±10 y, female: 17%, HeartWareHVAD: 58%, Thoratec-HeartmateII: 42%, INTERMACS Level I: 42%, II: 17%, III: 25% and IV-VII: 16%). Patients underwent cardiac rehabilitation including cardiopulmonary stress tests twice, after LVAD implantation and a second time after 1 to 2 years. Study endpoints were peak-workload and peak-VO2 obtained with spiroergometry. Results: Patients were admitted to the rehabilitation clinic the first time 6.1±2.5 weeks after LVAD implantation and the second time at 1.7±0.4 years post-implant. An increase in peak-workload was observed between the two rehabilitation periods (81.6±20.8 vs. 55.1±23.6 W, p= 0.001), which reflected an overall improvement of muscular strength and coordination observed. However, the peak-VO2 did not increase, even slightly decreased although not significantly (11.1±2.0 vs. 12.5±2.9 ml/min/kg, p= 0.223). A probable reason for this decrease was a considerable gain of body weight (95.8±10.9 vs. 84.9±11.1 kg, p< 0.001) in the same observation period. Conclusion: Within the first two years of LVAD support patients show a general improvement in peak exercise workload but no changes in the peak oxygen uptake. The increase in the aerobic capacity seems limited by the still suboptimal pumping function of heart and LVAD combined.