Cardiopulmonary Exercise Research Articles

36 Direct Measurement of Cardiac Compensation in Valvular Heart Disease

<h3>Purpose</h3> The natural history of valvular heart disease (VHD) suggests that the heart initially adapts to compensate for valve lesions and thereby maintain physiological function. When these compensatory mechanisms become exhausted, cardiac decompensation commences. We tested the hypothesis that all VHD patients with normal exercise capacity are in the compensatory phase with no symptoms and normal cardiac reserve. <h3>Methods</h3> Unselected consecutive male patients with VHD performed cardiopulmonary exercise (CPX) testing with non-invasive central haemodynamic measurements during symptom-limited treadmill exercise. Exercise capacity was represented by peak oxygen consumption (VO_2max) and cardiac pumping capability by peak exercise cardiac power output (CPO_max). Data are given as mean±SD. <h3>Results</h3> Of the entire VHD patient cohort (n = 215), 81.4% (n = 175) had VO_2max which were within or above the reference range of healthy male sedentary controls (n = 101). This is shown in Figure 1A where individual patient VO_2max is expressed as a percentage of the average VO_2max of age- and sex-matched controls. These 175 patients with normal VO_2max had a mean age of 63.1 ± 14.0 years, and consisted of 98 (56%) who were asymptomatic (NYHA class I) and 77 (44%) who were discordantly symptomatic in NYHA II+ (.001). As shown in Figure 1B, 117 patients (66.9%) had CPO_max within the normal range, of whom 80 (45.7%) were asymptomatic, but 37 (21.1%) were in NYHA II+ despite having normal VO_2max and CPO_max (.001). Conversely, 58 (33.1%) had CPO_max below the normal range, and yet 18 (10.3%) of these were discordantly still in NYHA I (P &lt; 0.001). These patients were classified asymptomatic by their responsible clinicians but our results revealed they had early, objective evidence of cardiac decompensation. <h3>Conclusions</h3> This investigation demonstrates that it is now possible to directly and objectively measure whether patients are in the compensated or decompensated phases of VHD. There were discrepancies between subjective symptomatic statuses and objectively measured cardiac and physical functional statuses. The possibility to determine whether patients are in the compensatory phase or not, might help in the management of difficult VHD cases.

Upper limb aerobic training improves aerobic fitness and all-out performance of America's Cup grinders

This research on “America's Cup” grinders investigated the effects of a specific eight-week long-arm cranking ergometer (ACE) training on upper body (UB) aerobic fitness (ventilatory threshold – Tvent, respiratory compensation point- RCP, –oxygen uptake peak – O2peak) and high intensity working capacity. The training consisted of sessions carried out for 20–30 mins, three times per week, at an intensity between the UB-Tvent and UB-RCP, and replaced part of a typical lower limb aerobic training whilst maintaining the usual weekly schedule of callisthenics, resistance training and sailing. Seven sailors, including four grinders and three mastmen (age 30 ± 5.5 years, height 1.9 ± 0.04 m, body mass 102 ± 3.6 kg), were evaluated through both an ACE cardiopulmonary maximal exercise test (CPET) and an ACE all-out up to exhaustion exercise test, before and after the ACE training. UB aerobic fitness improved significantly: UB-O2peak increased from 4.29 ± 0.442 to 4.52 ± 0.522 l·min−1 (6.4 ± 3.66%), O2 at UB-Tvent from 2.42 ± 0.282 to 2.97 ± 0.328 l·min−1 (22.8 ± 5.09%) and O2 at UB-RCP from 3.25 ± 0.402 to 3.75 ± 0.352 l·min−1 (16.1 ± 10.83%). Peak power at the ACE CPET increased from 351 ± 27.5 to 387 ± 33.5 W (10.5 ± 6.93%). The all-out test total mechanical work increased from 28.9 ± 2.35 to 40.1 ± 3.76 kJ (72.1 ± 4.67%). In conclusion, a high intensity aerobic ACE training can be effective in improving grinding performance by increasing UB aerobic fitness and all-out working capacity.

GW25-e3545 The Effects of moderate-intensity exercise on Cardiopulmonary Function on Undergraduate Students

The function of cardiopulmonary system is to take in and transport oxygen into the body and remove waste from the body in the form of carbon dioxide. It interacts closely with every other system in the body. Cardiopulmonary exercise can fully work the heart and lungs while people can mean

Improved performance on cardiopulmonary exercise testing following DDDR pacemaker adjustment: a case report

We report a case of improved cardiopulmonary exercise (CPX) test outcomes measured 48 h after initial CPX testing and immediately after alterations were made to the settings of a dual chamber, dual sensing pacemaker with exercise detection. The changes allowed successful abdominal surgery to be completed.

97 Value of Cardiopulmonary Exercise and Non-invasive Haemodynamic assessment during Exercise in Patients with Asymptomatic Severe Aortic Stenosis

BackgroundTiming of aortic valve replacement in patients with severe asymptomatic aortic stenosis (VD) is controversial. Exercise testing may uncover symptoms and early cardiac dysfunction. However there is little information on...

Is there a relationship between right-ventricular and right atrial mechanics and functional capacity in hypertensive patients?

We sought to assess right-ventricular and right atrial deformation in patients with arterial hypertension by two-dimensional speckle tracking imaging and three-dimensional echocardiography (3DE), and define the relationship between right-ventricular mechanics and exercise capacity in the study population. This cross-sectional study included recently diagnosed untreated hypertensive patients, well controlled hypertensive patients, treated patients with unsatisfactory controlled blood pressure and control individuals adjusted by sex and age. All the patients underwent complete two-dimensional echocardiography and 3DE examination, as well as cardiopulmonary exercise testing. Right-ventricular strain, and systolic and early diastolic strain rates were significantly decreased in the untreated and the uncontrolled hypertensive patients in comparison with the controls and the well controlled participants. Similar results were obtained for right atrial strain and strain rates. 3DE right-ventricular volumes were increased, whereas 3DE right-ventricular ejection fraction was decreased in the uncontrolled hypertensive patients in comparison with the controls and the well treated patients. Differences in 3DE right-ventricular volumes disappeared after adjustment for body surface area. Considering the whole study population, global right-ventricular strain (β = 0.29, P = 0.018) and 3D right-ventricular stroke volume (β = 0.22, P = 0.041) were independently associated with peak oxygen uptake (VO(2max)) which was significantly decreased in the untreated and the uncontrolled hypertensive patients in comparison with the remaining two groups. Our study showed that right-ventricular and right atrial mechanics, as well as exercise capacity, are significantly deteriorated in the hypertensive patients who are untreated or ineffectively treated. Global right-ventricular strain and 3DE right-ventricular stroke volume are independently associated with functional capacity in the whole study population.

VALIDATION OF A DIAGNOSTIC ALGORITHM FOR CARDIOPULMONARY EXERCISE TESTING: USEFULNESS IN CLINICAL CARDIOLOGY

Only cardiopulmonary exercise (CPX) testing provides information on the ability of the cardiovascular system to meet the body's metabolic demands in terms of oxygen consumption (VO2) and carbon dioxide production (VCO2). However, CPX testing is underutilized by cardiologists due to complex

The Relationships between Using the Rating of Perceived Exertion, Metabolic Equivalent and Maximum Heart Rate at Ventilatory Threshold into Determine Appropriate Exercise Prescription for Intensity in Obese Diabetic Patients: A Preliminary Study

Background: The rating of perceived exertion (RPE), metabolic equivalent (MET) and maximum heart rate (HRmax) at ventilatory threshold (VT) are commonly used methods as physiological parameters for monitoring exercise intensity. However, the appropriate levels of training intensity for obese type 2 diabetic diabetes mellitus (type 2 DM) patients have not been established.Purpose: To examine the parameters in obese Type 2 DM patients at ventilatory threshold, the exercise capacity of obese Type 2 DM patients, and to determine the appropriate levels of exercise intensity for exercise prescription in obese type 2 DM patients was investigated.Methods: Twenty obese type 2 DM patients (body mass index ＞27) were recruited. The physiological parameters (maximum oxygen uptake, maximum heart rate [or simply HRmax], and RPE at ventilatory threshold) of these patients were measured and compared during the cardiopulmonary exercise test.Results: The mean age of the subjects was 54.3±10.9 years, and the mean body mass index was 30.3±3.7. There was no difference on gender, the maximum oxygen uptake, maximum heart rate, and RPE by gender effect (p＞0.05). At ventilatory threshold level, the mean metabolic equivalent was 4.1±0.9, and the mean RPE was 13.0±1.7. The mean heart rate at VT was 117.3±14.5 beats/min, which is corresponded to 70.6±8.3% of the age-predicted HRmax, and the heart rate reserve was 36.3±14.7%.Conclusion: Our results indicate that the appropriate levels of exercise intensity for obese type 2 DM patients are 70% of the age-predicted HRmax, 30-40% of the heart rate reserve, MET of 4, and RPE of 13.

Abstract 18671: Exercise Training Associated With Testosterone Replacement Decreases Muscle Sympathetic Nerve Activity in Heart Failure Patients With Hypogonadism

Purpose: Heart failure (HF) is characterized by increase in muscle sympathetic nerve activity (MSNA). Advanced HF can be associated to testosterone deficiency. Study with HF patients and testosterone therapy showed improvement in VO2 and baroreflex sensitivity. The role of exercise with or without testosterone is unknown. Therefore, the aim of the study was to investigate if aerobic exercise with or without testosterone replacement decreases MSNA. Methods: 24 HF patients (52±2 yr) with low testosterone, FC III (NYHA) and LVEF 26±2%, were divided: Exercise Training (ET,n=9) Testosterone (Testo,n=8) and Exercise Training+Testosterone (ET+Testo,n=7). Total (TT) and free (FT) testosterone and SHBG were measured. Testosterone deficiency was characterized as TT &lt;350 ng/dL and FT &lt;131 pmol/L. Cardiopulmonary exercise was performed on bike. MSNA was measured by microneurography. Both groups Testo and ET+Testo were treated with undecilate of testosterone (intramuscular) at the beginning of the protocol and were monitored monthly. The exercise consisted in three 40-minutes sessions per week on an ergometer bike. Exercise intensity was between anaerobic threshold and respiratory compensation point. Results: After 4 months, TT and FT were restored in ET (307±40 to 429±93 ng/dL; p&lt;.001 and 160±26 to 246±50 pmol/L; p&lt;.001), Testo (279±33 to 575±66 ng/dL; p&lt;.001 and 137±18 to 381±55 pmol/L; p&lt;.001) and ET+Testo (223±18 to 497±82 ng/dL; p&lt;.001 and 135±22 to 353±49 pmol/L; p&lt;.001) groups. Peak VO2 increased in ET (14.76±1.60 to 18.06±2.26 ml/kg/min; p=.01), Testo (19.33±1.87 to 20.34±2.08 ml/kg/min; p=.01) and ET+Testo (17.61±1.37 to 20.63±2.72 ml/kg/min; p=.01). Maximal power (watts) was increased only within ET+Testo (75±8 to 129±21 watts; p&lt;.001). MSNA decreased in ET (49±4 to 34±1 bursts/min; p=.02) and ET+Testo (61±4 to 32±2 bursts/min; p&lt;.001) but was not different within Testo (39±4 to 34±3 bursts/min; p=.89). Conclusion: Functional capacity increased in all groups, but only ET+Testo improved muscle strength. Interestingly, exercise alone was able to restore testosterone. In addition, ET and ET+Testo reduced MSNA. These findings emphasize that ET and testosterone together should be included in the treatment of HF patients with hypogonadism.

Tricuspid Annular Plane Systolic Excursion in the Assessment of Right Ventricular Function in Children and Adolescents after Repair of Tetralogy of Fallot

Assessing right ventricular (RV) performance is essential for patients with tetralogy of Fallot (TOF). The aim of this study was to investigate the reliability and validity of tricuspid annular plane systolic excursion (TAPSE) against cardiac magnetic resonance imaging measures and cardiopulmonary exercise testing. A retrospective study was performed in 125 outpatients with repaired TOF with available protocol-driven echocardiography, cardiac magnetic resonance imaging, and exercise stress testing obtained as part of a cross-sectional study. TAPSE was measured on the two-dimensional apical four-chamber view on echocardiography by two readers. Multivariate linear regression was used to examine the association between TAPSE and measures of RV function and exercise capacity. The mean age was 12.6 ± 3.3 years, 41 patients (33%) were female, and 104 (83%) were white. TAPSE averaged 1.6 ± 0.37 cm, with an interreader intraclass correlation coefficient of 0.78 (n = 18). TAPSE was significantly associated with cardiac magnetic resonance-based RV stroke volume after adjustment for gender and body surface area (β = 13.8; 95% confidence interval, 2.25-25.30; P = .02). TAPSE was not associated with cardiac magnetic resonance-based RV ejection fraction (P = .77). On exercise testing, TAPSE was not associated with peak oxygen consumption, percentage of predicted oxygen consumption, oxygen pulse, or the ventilatory equivalent for carbon dioxide in patients with maximal exercise stress testing (n = 73 [58%]). TAPSE is reproducibly measured by echocardiography in patients with TOF. It is not associated with RV ejection fraction or exercise performance, and its association with RV stroke volume may be confounded by body size. On the basis of these results, TAPSE is not representative of global RV performance in patients with TOF.

Greater prognostic value of peak VO2 after exercise training program completion in heart failure patients

Exercise capacity, best reflected by peak exercise oxygen consumption (peak VO(2)), is a powerful prognostic factor in patients with chronic heart failure (CHF). However, the optimal time to assess exercise capacity for prognosis remains unclear and whether an exercise training program (ETP) to improve exercise capacity alters the prognostic value of cardiopulmonary exercise (CPX) testing variables in CHF is unknown. CHF patients who underwent an ETP in two cardiac rehabilitation centers between 2004 and 2009 were prospectively included, and CPX testing was performed before and after ETP completion. We included 285 consecutive patients who underwent an ETP (19.4 ± 8.7 training sessions in 4 to 10 weeks), including segmental gymnastics and cycling sessions. During follow-up (12 months), 14 patients died, 6 underwent cardiac transplantation and 15 were hospitalized for acute heart failure. Univariate analysis and receiver operating characteristic (ROC) curve analysis showed that CPX variables, especially peak oxygen consumption and circulatory power (product of peak VO(2) × peak systolic blood pressure) before and after ETP completion predicted prognosis. However, CPX data obtained after ETP completion had the best prognostic value (area under the ROC curve = 0.79 ± 0.03 for peak VO(2) after ETP completion vs 0.64 ± 0.04 before ETP completion, p < 0.0001). The results did not change even when considering only deaths. In patients with stable CHF who can exercise, the prognostic value of CPX data seems greater after versus before completion of a hospital-based ETP. Therefore, CPX capacity for prognostic purposes should at best be assessed after cardiac rehabilitation.

Cardiopulmonary exercise and 6-min walk tests as predictors of quality of life and long-term mortality among patients with heart failure due to Chagas disease

Cardiopulmonary exercise and 6-min walk tests as predictors of quality of life and long-term mortality among patients with heart failure due to Chagas disease

Age Dependency of Oxygen Uptake and Related Parameters in Exercise Testing: An Expert Opinion on Reference Values Suitable for Adults

Spiroergometry has been established to determine physical capacity. Reference values collected mostly in a younger population can be obtained from a number of studies and therefore may differ. Regression equations are complex and cannot be transferred easily to clinical practice. Our aim was to obtain reference values for spiroergometric parameters in cardiopulmonary exercise in healthy adult populations. Eighteen studies of healthy adults (>40years) that assessed maximal oxygen uptake (VO2max), oxygen uptake in relation to body weight (VO2max/kg), and oxygen pulse (VO2max/heart rate) were included. After data processing, spiroergometric parameters were correlated to age. Regression analysis was performed separately for each study and also weighted with the number of participants. For all spiroergometric parameters, age dependency was detectable for both males and females. After performing regression analysis, the following linear regression equations were determined: VO2max: Males=-28×age (years)+4,000; females=-20×age (years)+2,700 (ml/min); VO2max/kg: Males=-0.42×age (years)+58; females=-0.35×age (years)+46 (ml/min/kg); VO2max/heart rate: Males=-0.10×age (years)+20.50; females=-0.05×age (years)+13 (ml/min/heart rate). The present study provides practicable reference values for the spiroergometric parameters of adult men and women.

Pulmonary Hypertension in Patients with Idiopathic Pulmonary Fibrosis – The Predictive Value of Exercise Capacity and Gas Exchange Efficiency

Exercise capacity and survival of patients with IPF is potentially impaired by pulmonary hypertension. This study aims to investigate diagnostic and prognostic properties of gas exchange during exercise and lung function in IPF patients with or without pulmonary hypertension.In a multicentre setting, patients with IPF underwent right heart catheterization, cardiopulmonary exercise and lung function testing during their initial evaluation. Mortality follow up was evaluated.Seventy-three of 135 patients [82 males; median age of 64 (56; 72 years)] with IPF had pulmonary hypertension as assessed by right heart catheterization [median mean pulmonary arterial pressure 34 (27; 43) mmHg]. The presence of pulmonary hypertension was best predicted by gas exchange efficiency for carbon dioxide (cut off ≥152% predicted; area under the curve 0.94) and peak oxygen uptake (≤56% predicted; 0.83), followed by diffusing capacity. Resting lung volumes did not predict pulmonary hypertension. Survival was best predicted by the presence of pulmonary hypertension, followed by peak oxygen uptake [HR 0.96 (0.93; 0.98)].Pulmonary hypertension in IPF patients is best predicted by gas exchange efficiency during exercise and peak oxygen uptake. In addition to invasively measured pulmonary arterial pressure, oxygen uptake at peak exercise predicts survival in this patient population.

Effects of Ghrelin Treatment on Exercise Capacity in Underweight COPD Patients: a substudy of a multicenter, randomized, double-blind, placebo-controlled trial of ghrelin treatment

BackgroundThe aim of this substudy of the ghrelin treatment, multicenter, randomized, double-blind, placebo-controlled trial was to investigate the effects of ghrelin administration on exercise capacity and the underlying mechanisms in underweight patients with chronic obstructive pulmonary disease (COPD) using cardiopulmonary exercise testing.MethodsTwenty underweight COPD patients were randomized to pulmonary rehabilitation with intravenous ghrelin (2 μg/kg, n = 10) or placebo (n = 10) twice daily for 3 weeks in a double-blind fashion. The primary outcome was changes in peak oxygen uptake . Secondary outcomes included changes in exertional cardio-respiratory functions: O2-pulse, physiologic dead space/tidal volume-ratio (VD/VT), ventilatory equivalent for oxygen , and ventilatory equivalent for carbon dioxide .ResultsWith incremental exercise, at peak exercise, there was a significant difference in the mean difference (ghrelin minus placebo), i.e., treatment effect in: i) peak (1.2 mL/kg/min, 95% CI: 0.2-2.3 mL/kg/min, between-group p = 0.025); ii) (-4.2, 95% CI: -7.9 to -0.5, between-group p = 0.030); iii) (-4.1, 95% CI: -8.2 to -0.1, between-group p = 0.045); iv) VD/VT (-0.04, 95% CI: -0.08 to -0.00, between-group p = 0.041); and v) O2-pulse (0.7 mL/beat, 95% CI: 0.3 to 1.2 mL/beat, between-group p = 0.003). Additionally, repeated-measures analysis of variance (ANOVA) indicated a significant time-course effect of ghrelin versus placebo in the peak (p = 0.025).ConclusionGhrelin administration was associated with improved exertional capacity and improvements in ventilatory-cardiac parameters.Trial registrationUMIN (University Hospital Medical Information Network in Japan) C000000061

Failing Heart of Patients With Type 2 Diabetes Mellitus Can Adapt to Extreme Short-term Increases in Circulating Lipids and Does Not Display Features of Acute Myocardial Lipotoxicity

Circulating lipid levels and myocardial lipid content (MyLC) is increased in type 2 diabetes mellitus. This may cause a state of lipotoxicity that compromises left ventricular function and aggravate heart failure. We investigated the relationship among circulating lipid levels, MyLC, and cardiac function together with the acute cardiac effects of high as opposed to low circulating free fatty acid (FFA) and triglyceride levels in patients with type 2 diabetes mellitus and heart failure. Eighteen patients underwent 8-hour intralipid/heparin-infusion (high FFA) and hyperinsulinemic-euglycemic clamping (low FFA) in a randomized crossover-designed study. We applied magnetic resonance proton spectroscopy to measure MyLC. Cardiac function was assessed by advanced echocardiography, cardiopulmonary exercise, and MRI. MyLC correlated positively with circulating triglyceride (r=0.47; r(2)=0.22; P=0.003) and FFA (r=0.45; r(2)=0.20; P=0.001) levels and inversely with left ventricular ejection fraction (r=-0.54; r(2)=0.29; P=0.004). Circulating FFA concentrations differed between study arms (0.05 ± 0.04 mmol/L [low FFA] versus 1.04 ± 0.27 mmol/L [high FFA]; P<0.001) and MyLC increased from 0.78 ± 0.59% (low FFA) to 1.16 ± 0.73% (high FFA; P<0.01). Resting left ventricular ejection fraction and global strain did not differ between high and low FFA, whereas resting systolic mitral plane velocity (S'max) was highest during high FFA (3.6±0.8 cm/s [low FFA] versus 3.8±0.7 cm/s [high FFA]; P=0.02). Peak exercise capacity and oxygen consumption did not differ between the study arms, and neither did postexercise measurements of left ventricular ejection fraction, global strain, and S'max. Our findings indicate that the failing heart of patients with type 2 diabetes mellitus can adapt to short-term extreme changes in circulating substrates and does not display features of acute myocardial lipotoxicity. Clinical Trial Registration- URL: http://www.clinicaltrials.gov. Unique identifier: NCT01192373.

OP0226 Expert consensus for performing right heart catheterization in suspicion of pulmonary arterial hypertension associated with systemic sclerosis: A delphi consensus study with cluster analysis from the eposs group

BackgroundPulmonary hypertension (PH) has emerged as a critical cause of death in systemic sclerosis (SSc). Recent data have highlighted the poorer outcomes of SSc associated PAH as compared to the...

Rest and latent obstruction in hypertrophic cardiomyopathy

Most patients with hypertrophic cardiomyopathy (HCM) show a limited exercise capacity. A correlation between exercise tolerance and diastolic dysfunction has already been demonstrated. On the contrary, the role of rest-induced or exercise-induced obstruction as a determinant of exercise capacity is still open to debate. The aim of the present study was to analyse the exertional behaviour of patients with HCM presenting different left ventricle (LV) obstructive profiles. Thirty-five consecutive patients with HCM (mean age 45 ± 14 years, 23 men) underwent echocardiography during cardiopulmonary exercise (CPX) testing. Non-invasive measurement of cardiac output was obtained with an inert gas rebreathing system at the beginning and at peak of exercise. Fifteen patients (43%) had neither resting nor provocable obstruction (group A: non-obstructive profile), 12 patients (34%) showed provocable obstruction during exercise (group B: latent-obstructive profile) and eight patients (23%) presented obstruction at rest (group C: rest-obstructive profile). Group A and B patients showed higher peak oxygen consumption in comparison with group C patients (24 ± 6 and 23 ± 6 vs. 17 ± 3 ml/kg per min; P = 0.016) and a greater increment of cardiac index during exercise (6.6 ± 1.3 and 6.0 ± 1.4 vs. 4.6 ± 0.8 l/min per m; P = 0.004). In comparison with the rest-obstructive profile, latent and non-obstructive HCM patients seem to share a similar exertional behaviour characterized by a greater increment of cardiac index during exercise and a minor impairment of exercise tolerance. Accordingly, in HCM patients not obstructive at rest, latent obstruction cannot be suspected based on exertional behaviour and functional capacity. Echocardiography performed during CPX test providing an important adjunct, may be valuable in guiding treatment in patients with substantial exercise limitation.

Impaired Post Exercise Heart Rate Recovery in Anabolic Steroid Users

Previous study showed that muscle sympathetic nerve activity (MSNA) was augmented in anabolic steroids users (AASU). In the present study, we tested the hypothesis that the heart rate (HR) responses after maximal exercise testing would be reduced in AASU. 10 male AASU and 10 AAS nonusers (AASNU) were studied. Cardiopulmonary exercise was performed to assess the functional capacity and heart rate recovery. MSNA was recorded directly from the peroneal nerve by microneurography technique. Peak oxygen consumption (VO₂) was lower in AASU compared to AASNU (43.66±2.24 vs. 52.70±1.68 ml/kg/min, P=0.005). HR recovery (HRR) at first and second minute was lower in AASU than AASNU (21±2 vs. 27±2 bpm, P=0.02 and 37±4 vs. 45±2 bpm, P=0.05, respectively). MSNA was higher in AASU than AASNU (29±3 vs. 20±1 bursts/min, P=0.01). Further analysis showed a correlation between HRR and MSNA (r=- 0.64, P=0.02), HRR at first minute and peak VO₂ (r=0.70, P=0.01) and HRR at second minute and peak VO₂ (r=0.62, P=0.02). The exacerbated sympathetic outflow associated with a lower parasympathetic activation after maximal exercise, which impairs heart rate recovery, strengthens the idea of autonomic imbalance in AASU.

Does Regular Exercise after Heart Transplantation Have Any Benefit? Real Life Experience

Purpose Exercise(EX) after heart transplant(HTx) improves cardiac function and EX capacity as noted from cardiopulmonary EX studies. EX may also prevent obesity, decrease diabetes(DM), and further reduce metabolic endpoints such as osteoporosis, hyperlipidemia, and hypertension. We determined whether routine exercise was beneficial to HTx patients(pts) using a survey. Methods and Materials Between 8/2011-5/2012, we evaluated 70 HTx pts by survey performed at routine clinic visits. Pts were asked about type and frequency of EX performed, including aerobic activity, yoga/pilates and weight/resistance training. Pts were divided by EX frequency: 0-2, 3-4 and 5-7 times/week. End points included 1-year change in weight, lipid levels, number of antihypertensive medications, number of new onset DM. Results Pts in the 0-2 group(grp) had significantly less aerobic EX compared to the other 2 grps (60% vs 96% vs 100%, p Conclusions No or little exercise after HTx is associated with increased weight gain and elevated lipid levels. Exercise should be recommended for HTx pts to achieve these metabolic benefits. EndpointsEX 0-2/Wk (n=15)EX 3-4/Wk (n=28)EX 5-7/Wk (n=27)Mean Change in Weight Baseline to 1 Yr, Lbs ± SEM20.3 ± 7.49.4 ± 4.9 * 8.1 ± 3.6 * Mean Change in Cholesterol Baseline to 1 Yr, mg/dL ± SEM33.1 ± 13.79.4 ± 5.9 * 10.3 ± 8.0 * Mean Change in Triglycerides Baseline to 1 Yr, mg/dL ± SEM57.9 ± 24.525.4 ± 12.917.2 ± 18.5 * Mean Change in LDL Baseline to 1 Yr, mg/dL ± SEM21.6 ± 10.54.3 ± 4.4 * 8.9 ± 6.9 * , ** Mean # of HTN Meds at Baseline, Meds ± SD-0.1 ± 0.90.1 ± 0.90.1 ± 0.9Mean # of HTN Meds at 1 Yr FollowUp, Meds ± SD-0.1 ± 0.30.1 ± 0.20.1 ± 0.2DM at Baseline, n (%)4 (27%)6 (21%)7 (26%)DM at 1 Yr FollowUp, n (%)7 (47%)9 (32%)9 (33%)*p