Development of exercise-related values in heart failure patients supported with a left ventricular assist device

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Abstract
Following implantation of a left ventricular assist device, the build-up and long-term maintenance of adequate exercise capacity and functional performance become crucial. The aim of this study was to observe the development of exercise-related values at different times, as well as to detect possible influencing factors. We performed a prospective single-centre study: 10 patients (63 years, 100% male, body mass index = 27.5, 100% HeartWare) underwent the following diagnostic tests during cardiac rehabilitation and during two subsequent ambulatory visits: 6-min walking test, handgrip strength test, cardiopulmonary exercise test and Minnesota Living with Heart Failure questionnaire. Mean follow-up was 482 days after left ventricular assist device implantation. Significant improvements could be observed between the end of cardiac rehabilitation and ambulatory visit 1; 6-min walking distance increased from 367 to 449 m (p < 0.01), peak VO2 from 10.0 to 11.9 mL/kg/min (p < 0.05) and peak load from 62.4 to 83.0 W (p < 0.01). However, there were no further improvements between ambulatory visit 1 and ambulatory visit 2. In the long term, a significant mean weight gain of more than 10 kg could be observed (p < 0.01). A negative linear correlation between weight gain and absolute improvement in peak load (r = −0.77, p < 0.01) and peak VO2 (r = −0.75, p < 0.05) could be demonstrated. In conclusion, exercise-related values following left ventricular assist device implantation initially improve significantly. Later, however, no further improvements can be observed. In the long term, pronounced weight gain is conspicuous, concomitant with a significantly lower increase in exercise values of the patients. In the future, both dietary and structured physical activity follow-up interventions should be integrated in patient routines.

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