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Effect of High Intensity Interval Training on Health Related Quality of Life in De Novo Heart Transplant Recipients-The HITTS Study
S196
The Journal of Heart and Lung Transplantation, Vol 38, No 4S, April 2019
Conclusion: Although TMAO levels have been associated with pro-thrombotic potentials, no association was found between pre- and post-LVAD levels of TMAO and the risk of GIB in our cohort of LVAD patients.
464 Gastrointestinal Bleeding Ceases after Heart Transplantation in Patients Bridged on Continuous-Flow LVAD Support A. Critsinelis,1 J. Kraus,2 H. Lamba,1 F. Cheema,1 A. Civitello,1 R. Delgado,1 A. Nair,1 A. Shafii,1 G. Loor,1 T. Rosengart,1 O. Frazier,1 and J. Morgan.1 1Division of Cardiothoracic Transplantation and Mechanical Circulatory Support, Texas Heart Institute at Baylor College of Medicine, Houston, TX; and the 2Baylor College of Medicine, Houston, TX. Purpose: Continuous flow left ventricular assist device (CF-LVAD) support has been associated with gastrointestinal bleeding (GIB), primarily from arteriovenous malformations or ulcers, and exacerbated by the requirement for anticoagulation. In this report, we explore whether GIB persisted after heart transplant in patients who experienced GIB events while on CF-LVAD support. Methods: We performed a retrospective review of 701 patients who underwent implantation of CF-LVADs from August 2002 through August 2017 at our center, and identified patients who underwent CF-LVAD implantation as a Bridge-to-Transplant, experienced at least one GIB event during CF-LVAD support, and were successfully bridged to heart transplantation. We evaluated the incidence of GIB events in these patients after heart transplantation. Results: A total of 46 heart transplant recipients fit the inclusion criteria. There were a total of 63 total GIB events while on CF-LVAD support. Locations of GIB events included esophagus (N=3), stomach (N=21), duodenum (N=7), jejunum (N=3), small intestine not-otherwise-specified (N=12), colon (N=14), and rectum (N=3). Etiologies included gastritis (N=10), ulcer (N=11), arteriovenous malformation (N=13), angiodysplasia (N=3), polyp (N=2), diverticulosis (N=8), and Mallory Wiess tear (N=2). Mean LVAD support time was 1.4§1.5 years (65.4 cumulative patientyears). Mean follow-up time after transplantation was 4.0§3.5 years (183.3 cumulative patient-years after transplantation). There was only 1 GIB event after heart transplantation (events per patient-year: 0.005). The etiology was non-specific acute colitis in a patient who had prior GIB from a gastric ulcer while on LVAD therapy. Time from transplant to GIB event was 3.9 years. The patient was taking aspirin 81mg daily at the time of GIB. Conclusion: GIB during CF-LVAD therapy did not persist after heart transplantation. This may be due to restoration of pulsatile flow. Introduction of a greater degree of pulsatility into LVAD flow technology may improve the incidence of GIB while on CF-LVAD support. 465 Associations between Self-Reported Physical Function and Exercise Capacity in De Novo Heart Transplant Recipients K. Rolid,1 A.K. Andreassen,1 M. Yardley,1 E. Gude,1 E. Bjørkelund,1 A.R. Authen,1 I. Grov,1 K.I. Pettersen,1 C. Dall,2 E. Prescott,2 K. Karason,3 L. Gullestad,1 and K. Nytrøen.1 1Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway; 2Department of Cardiology, Bispebjerg University Hospital, Copenhagen, Denmark; and the 3 Department of Cardiology, Sahlgrenska University Hospital, Gothenborg, Sweden. Purpose: Physical capacity, as assessed by peak oxygen consumption (VO2peak) or self-reported physical function (PF) from Short Form-36
(SF-36), is a strong predictor of long-term survival in heart transplant (HTx) recipients. VO2peak and SF36-PF are highly correlated in maintenance HTx, but their association has previously not been examined in de novo HTx recipients. Methods: Seventy-eight patients who completed the HITTS study (Highintensity Interval Training in de novo heart Transplant recipients in Scandinavia) were included in the analyses. Patients were tested at baseline (mean 11 weeks after surgery) and at 12 months follow-up, with self-reported PF (SF-36v2), cardiopulmonary exercise test with measurement of VO2peak, and lower limb isokinetic muscle strength. Pearsons correlation was used to compare the association between PF and VO2peak (L/min) and PF and muscular strength; early (mean 11 weeks after HTx) and later (1 year after HTx). Results: Mean § SD age was 49 § 13 years, 73% were men. Both at 11 weeks and after 1 year, there were statistically significant positive correlations indication moderate association between PF and VO2peak (r=0.482 vs. 0.401) (Fig 1), PF and muscular exercise capacity (r= 0.494 vs. 0.388), and PF and maximal muscular strength (r = 0.443 vs. 0.414). Conclusion: De novo HTx patientsself-reported PF is associated with both VO2peak and muscular strength, also found 1 year after HTx. While measuring VO2peak is the preferred method of examining physical capacity and prognosis, self-reported PF is an easy, less resource-demanding assessment that could be considered as a clinical substitute.
466 Effect of High Intensity Interval Training on Health Related Quality of Life in De Novo Heart Transplant Recipients-The HITTS Study K. Rolid,1 A.K. Andreassen,1 M. Yardley,1 E. Gude,1 E. Bjørkelund,1 A.R. Authen,1 I. Grov,1 K.I. Pettersen,1 C.H. Dall,2 E. Prescott,2 K. Karason,3 L. Gullestad,1 and K. Nytrøen.1 1Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway; 2Department of Cardiology, Bispebjerg University Hospital, Copenhagen, Denmark; and the 3Department of Cardiology, Sahlgrenska University Hospital, Gothenborg, Sweden. Purpose: A main goal after heart transplantation (HTx) is to achieve good health related quality of life (HRQoL). Exercise training after heart transplantation (HTx) is recommended and high-intensity interval training (HIT) seem to be more effective than moderate continuous training (MICT). Studies on the effect of HIT vs. MICT on HRQoL is scarce, and no studies among de novo HTx recipients exist. Methods: Eighty-one de novo HTx recipients were included and were randomized 1:1 to either HIT or MICT. HRQoL was assessed by the Short Form-36 (SF-36v2), the Hospital Anxiety and Depression Scale (HADS) at baseline (mean 11 weeks after surgery) and at 1-yr follow- up, additionally, participants reported their overall health on a numeric visual analouge scale after the intervention period. SF-36 scores were calculated using norm based values with a standardized mean of 50§10. All patients underwent a clinical examination and physical tests. Results: At 1-yr follow-up 78 patients were retested. Both groups had significant improvements on the physical function components of HRQoL the
Abstracts first year after HTx, while mental health, anxiety and depression scores remain unchanged. There were no serious adverse events related to exercise in either of the groups during the intervention period. Mean § SD age for the total population was 49§13 years, 73% were men. There was no significant difference between HIT and MICT in seven of the eight SF-36 subscales, in physical component summary score (PCS) or mental component summary score (MCS). However, there was a statistical significant positive change in the role emotional (RE) subscale mean score in the HIT group compared to the MICT group (Table 1). Conclusion: From baseline to 1-yr follow-up HIT vs. MICT resulted in similar mean changes in HRQoL, except from on the SF-36 RE subscale. Both groups had significant improvements in PF, RP and PCS,suggesting that exercise training improves some areas of the multidimensional concept of HRQoL.
S197 pulmonary disease (COPD), 39 idiopathic pulmonary fibrosis) were studied. Pre-transplant 6MWD was 380.5 § 138.6m and QS% was 98.8 § 26.4%. Three months post-transplant 6MWD was 503.3 § 116.2m. In a multivariate linear regression analysis, increased QS% pre-transplant (b=0.81, p=0.001), younger age(b=-1.59, p=0.011), male recipients (b=29.24, p=0.011), and reduced length of stay post-transplant (b=-2.77, p=0.001) were identified as independent predictors of increased 6MWD. In addition, a diagnosis of COPD (b=-64.47, p=0.001) or idiopathic pulmonary fibrosis (b=-51.96, p=0.017) independently predicted reduced 6MWD at three months post-transplant. Conclusion: Pre-transplant quadriceps strength, age, sex, and diagnosis are independent predictors of post-transplant six-minute walk distance. Of these identified measures, onlypre-transplant quadriceps strength is potentially modifiable. Quadriceps strength should be considered when assessing candidacy and should be a key outcome measure when assessing efficacy of interventions designed to improve post-transplant outcomes. 468 What Happens to Frailty in the First Year after Lung Transplantation? L.M. Fuller,1 H. Whitford,2 Y. Cristiano,2 R. Robinson,1 R. Steward,1 M. Poulsen,1 W. Shi,3 and G.M. Snell.4 1Physiotherapy, Alfred Hospital, Melbourne, Australia; 2Respiratory Unit, Alfred Hospital, Melbourne, Australia; 3Cardiothoracic Surgery, Alfred Hospital, Melbourne, Australia; and the 4Lung Transplant Unit, Alfred Hospital, Melbourne, Australia.
467 Pre Transplant Quadriceps Strength is a Modifiable Predictor of Functional Outcomes Following Lung Transplantation J.R. Walsh,1 D.C. Chambers,2 S.T. Yerkovich,2 N.R. Morris,3 and P.M. Hopkins.2 1Physiotherapy, The Prince Charles Hospital, Brisbane, Australia; 2Queensland Lung Transplant Unit, The Prince Charles Hospital, Brisbane, Australia; and the 3School of Allied Health Sciences, Griffith University, Gold Coast, Australia. Purpose: Severely limited functional status with poor rehabilitation potential is considered an absolute contraindication to lung transplantation. However, defining a threshold of functional status or rehabilitation potential suitable for active listing is complex. Therefore, the study aim was to determine if candidates pre-transplant quadriceps strength along with demographics and respiratory function can predict six-minute walk distance (6MWD) at three months post-transplant. Methods: This study used a prospective observational repeated measures design. All lung transplant recipients at a single institution between Dec 2006 and May 2018 were considered for inclusion. Candidates’ demographics (age, sex, lung condition) and transplant hospital admission length of stay were recorded.6MWD, and quadriceps strength corrected for body weight (QS%) were recorded pre- and three months post-transplant. Results: 278 lung transplant recipients (142 male; mean age 45.7 § 14.2 years; FEV133.6 § 18.6%; 92 cystic fibrosis, 83 chronic obstructive
Purpose: Frailty is prevalent in lung transplant (LTX) candidates. Frailty can be associated with death before and after LTX, it is unclear if frailty trajectory persists for the first year. The study aimed to investigate frailty over the first year of LTX. Methods: LTX candidates aged over 18 years were consented at listing time. All post LTX recipients completed thrice weekly, 12 week exercise rehabilitation program consisting of cardiovascular training on bike and treadmill and upper and lower limb strength training. Clinical data was collected. Edmonton frail scale (EFS) was used to assess frailty. Grip strength was also tested. Primary outcome was 6minute walk distance (6MWD) measured at 4 time-points: pre LTX, pre-rehabilitation, post-rehabilitation and 1 year. Results: Of 103 participants, 90 (87%) were transplanted. Mean age was 58§11 yrs, 48 % were male, 52% had primary diagnosis of COPD. Frailty scores pre LTX were mean 5.54 § 2.4 and at one year mean 3.28 §1.5. Amongst all participants, 6WMD improved significantly over time: prerehabilitation (mean 326m) compared to post-rehabilitation (mean 523m (p<0.001) and 1 year (mean 512m, p<0.001). Those who required ≥ 7 day ICU admission post LTX entered the rehabilitation program with a lower mean 6MWD (276m vs. 350m, p=0.001), but this difference disappeared by 1 year (489m vs. 522m, p=0.24). Those with an EFS > 8 had shorter 6MWD preLTX compared to those with EFS ≤ 8 (245m vs. 305m, p=0.085) and similarly at pre-rehabilitation (277m vs. 331m, p=0.077). There were no differences in 6MWD comparing EFS > 8 vs ≤ 8 post-rehabilitation (523m vs. 520m, p=0.93) or at 1 year (497m vs. 510m, p=0.80). Participants with poorer EFS functional performance domain had shorter 6MWD pre LTX and pre-rehabilitation, but this difference disappeared by 1 year. Those with baseline grip strength < 25kg had shorter 6MWD preLTX (252m vs. 320m, p=0.006) and pre-rehabilitation (268m vs. 354m, p <0.001)and this persisted post-rehabilitation (480m vs. 544m, p=0.002) and at 1 year (458m vs. 537m, p=0.003). Conclusion: Participants in a structured post-LTX rehabilitation program improved in functional exercise capacity (6MWD). The program improves 6MWD in frail patients to a point comparable to less frail patients, with poor pre-rehabilitation functional capacity being successfully managed during the program. Grip strength may serve as an important predictor of the trajectory of improvement.
469 QOLVAD Detects Changes in Emotional, Social, Cognitive and Physical Wellbeing after Continuous-Flow LVAD Implant J.A. Cowger,1 C.S. Lee,2 P. Eckman,3 R. Garberich,4 C. Weaver,5 S. Joseph,6 S. Hall,6 S. Carrie,7 S. Chaudhry,8 S.E. Schroeder,9
The Journal of Heart and Lung Transplantation, Vol 38, No 4S, April 2019
Conclusion: Although TMAO levels have been associated with pro-thrombotic potentials, no association was found between pre- and post-LVAD levels of TMAO and the risk of GIB in our cohort of LVAD patients.
464 Gastrointestinal Bleeding Ceases after Heart Transplantation in Patients Bridged on Continuous-Flow LVAD Support A. Critsinelis,1 J. Kraus,2 H. Lamba,1 F. Cheema,1 A. Civitello,1 R. Delgado,1 A. Nair,1 A. Shafii,1 G. Loor,1 T. Rosengart,1 O. Frazier,1 and J. Morgan.1 1Division of Cardiothoracic Transplantation and Mechanical Circulatory Support, Texas Heart Institute at Baylor College of Medicine, Houston, TX; and the 2Baylor College of Medicine, Houston, TX. Purpose: Continuous flow left ventricular assist device (CF-LVAD) support has been associated with gastrointestinal bleeding (GIB), primarily from arteriovenous malformations or ulcers, and exacerbated by the requirement for anticoagulation. In this report, we explore whether GIB persisted after heart transplant in patients who experienced GIB events while on CF-LVAD support. Methods: We performed a retrospective review of 701 patients who underwent implantation of CF-LVADs from August 2002 through August 2017 at our center, and identified patients who underwent CF-LVAD implantation as a Bridge-to-Transplant, experienced at least one GIB event during CF-LVAD support, and were successfully bridged to heart transplantation. We evaluated the incidence of GIB events in these patients after heart transplantation. Results: A total of 46 heart transplant recipients fit the inclusion criteria. There were a total of 63 total GIB events while on CF-LVAD support. Locations of GIB events included esophagus (N=3), stomach (N=21), duodenum (N=7), jejunum (N=3), small intestine not-otherwise-specified (N=12), colon (N=14), and rectum (N=3). Etiologies included gastritis (N=10), ulcer (N=11), arteriovenous malformation (N=13), angiodysplasia (N=3), polyp (N=2), diverticulosis (N=8), and Mallory Wiess tear (N=2). Mean LVAD support time was 1.4§1.5 years (65.4 cumulative patientyears). Mean follow-up time after transplantation was 4.0§3.5 years (183.3 cumulative patient-years after transplantation). There was only 1 GIB event after heart transplantation (events per patient-year: 0.005). The etiology was non-specific acute colitis in a patient who had prior GIB from a gastric ulcer while on LVAD therapy. Time from transplant to GIB event was 3.9 years. The patient was taking aspirin 81mg daily at the time of GIB. Conclusion: GIB during CF-LVAD therapy did not persist after heart transplantation. This may be due to restoration of pulsatile flow. Introduction of a greater degree of pulsatility into LVAD flow technology may improve the incidence of GIB while on CF-LVAD support. 465 Associations between Self-Reported Physical Function and Exercise Capacity in De Novo Heart Transplant Recipients K. Rolid,1 A.K. Andreassen,1 M. Yardley,1 E. Gude,1 E. Bjørkelund,1 A.R. Authen,1 I. Grov,1 K.I. Pettersen,1 C. Dall,2 E. Prescott,2 K. Karason,3 L. Gullestad,1 and K. Nytrøen.1 1Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway; 2Department of Cardiology, Bispebjerg University Hospital, Copenhagen, Denmark; and the 3 Department of Cardiology, Sahlgrenska University Hospital, Gothenborg, Sweden. Purpose: Physical capacity, as assessed by peak oxygen consumption (VO2peak) or self-reported physical function (PF) from Short Form-36
(SF-36), is a strong predictor of long-term survival in heart transplant (HTx) recipients. VO2peak and SF36-PF are highly correlated in maintenance HTx, but their association has previously not been examined in de novo HTx recipients. Methods: Seventy-eight patients who completed the HITTS study (Highintensity Interval Training in de novo heart Transplant recipients in Scandinavia) were included in the analyses. Patients were tested at baseline (mean 11 weeks after surgery) and at 12 months follow-up, with self-reported PF (SF-36v2), cardiopulmonary exercise test with measurement of VO2peak, and lower limb isokinetic muscle strength. Pearsons correlation was used to compare the association between PF and VO2peak (L/min) and PF and muscular strength; early (mean 11 weeks after HTx) and later (1 year after HTx). Results: Mean § SD age was 49 § 13 years, 73% were men. Both at 11 weeks and after 1 year, there were statistically significant positive correlations indication moderate association between PF and VO2peak (r=0.482 vs. 0.401) (Fig 1), PF and muscular exercise capacity (r= 0.494 vs. 0.388), and PF and maximal muscular strength (r = 0.443 vs. 0.414). Conclusion: De novo HTx patientsself-reported PF is associated with both VO2peak and muscular strength, also found 1 year after HTx. While measuring VO2peak is the preferred method of examining physical capacity and prognosis, self-reported PF is an easy, less resource-demanding assessment that could be considered as a clinical substitute.
466 Effect of High Intensity Interval Training on Health Related Quality of Life in De Novo Heart Transplant Recipients-The HITTS Study K. Rolid,1 A.K. Andreassen,1 M. Yardley,1 E. Gude,1 E. Bjørkelund,1 A.R. Authen,1 I. Grov,1 K.I. Pettersen,1 C.H. Dall,2 E. Prescott,2 K. Karason,3 L. Gullestad,1 and K. Nytrøen.1 1Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway; 2Department of Cardiology, Bispebjerg University Hospital, Copenhagen, Denmark; and the 3Department of Cardiology, Sahlgrenska University Hospital, Gothenborg, Sweden. Purpose: A main goal after heart transplantation (HTx) is to achieve good health related quality of life (HRQoL). Exercise training after heart transplantation (HTx) is recommended and high-intensity interval training (HIT) seem to be more effective than moderate continuous training (MICT). Studies on the effect of HIT vs. MICT on HRQoL is scarce, and no studies among de novo HTx recipients exist. Methods: Eighty-one de novo HTx recipients were included and were randomized 1:1 to either HIT or MICT. HRQoL was assessed by the Short Form-36 (SF-36v2), the Hospital Anxiety and Depression Scale (HADS) at baseline (mean 11 weeks after surgery) and at 1-yr follow- up, additionally, participants reported their overall health on a numeric visual analouge scale after the intervention period. SF-36 scores were calculated using norm based values with a standardized mean of 50§10. All patients underwent a clinical examination and physical tests. Results: At 1-yr follow-up 78 patients were retested. Both groups had significant improvements on the physical function components of HRQoL the
Abstracts first year after HTx, while mental health, anxiety and depression scores remain unchanged. There were no serious adverse events related to exercise in either of the groups during the intervention period. Mean § SD age for the total population was 49§13 years, 73% were men. There was no significant difference between HIT and MICT in seven of the eight SF-36 subscales, in physical component summary score (PCS) or mental component summary score (MCS). However, there was a statistical significant positive change in the role emotional (RE) subscale mean score in the HIT group compared to the MICT group (Table 1). Conclusion: From baseline to 1-yr follow-up HIT vs. MICT resulted in similar mean changes in HRQoL, except from on the SF-36 RE subscale. Both groups had significant improvements in PF, RP and PCS,suggesting that exercise training improves some areas of the multidimensional concept of HRQoL.
S197 pulmonary disease (COPD), 39 idiopathic pulmonary fibrosis) were studied. Pre-transplant 6MWD was 380.5 § 138.6m and QS% was 98.8 § 26.4%. Three months post-transplant 6MWD was 503.3 § 116.2m. In a multivariate linear regression analysis, increased QS% pre-transplant (b=0.81, p=0.001), younger age(b=-1.59, p=0.011), male recipients (b=29.24, p=0.011), and reduced length of stay post-transplant (b=-2.77, p=0.001) were identified as independent predictors of increased 6MWD. In addition, a diagnosis of COPD (b=-64.47, p=0.001) or idiopathic pulmonary fibrosis (b=-51.96, p=0.017) independently predicted reduced 6MWD at three months post-transplant. Conclusion: Pre-transplant quadriceps strength, age, sex, and diagnosis are independent predictors of post-transplant six-minute walk distance. Of these identified measures, onlypre-transplant quadriceps strength is potentially modifiable. Quadriceps strength should be considered when assessing candidacy and should be a key outcome measure when assessing efficacy of interventions designed to improve post-transplant outcomes. 468 What Happens to Frailty in the First Year after Lung Transplantation? L.M. Fuller,1 H. Whitford,2 Y. Cristiano,2 R. Robinson,1 R. Steward,1 M. Poulsen,1 W. Shi,3 and G.M. Snell.4 1Physiotherapy, Alfred Hospital, Melbourne, Australia; 2Respiratory Unit, Alfred Hospital, Melbourne, Australia; 3Cardiothoracic Surgery, Alfred Hospital, Melbourne, Australia; and the 4Lung Transplant Unit, Alfred Hospital, Melbourne, Australia.
467 Pre Transplant Quadriceps Strength is a Modifiable Predictor of Functional Outcomes Following Lung Transplantation J.R. Walsh,1 D.C. Chambers,2 S.T. Yerkovich,2 N.R. Morris,3 and P.M. Hopkins.2 1Physiotherapy, The Prince Charles Hospital, Brisbane, Australia; 2Queensland Lung Transplant Unit, The Prince Charles Hospital, Brisbane, Australia; and the 3School of Allied Health Sciences, Griffith University, Gold Coast, Australia. Purpose: Severely limited functional status with poor rehabilitation potential is considered an absolute contraindication to lung transplantation. However, defining a threshold of functional status or rehabilitation potential suitable for active listing is complex. Therefore, the study aim was to determine if candidates pre-transplant quadriceps strength along with demographics and respiratory function can predict six-minute walk distance (6MWD) at three months post-transplant. Methods: This study used a prospective observational repeated measures design. All lung transplant recipients at a single institution between Dec 2006 and May 2018 were considered for inclusion. Candidates’ demographics (age, sex, lung condition) and transplant hospital admission length of stay were recorded.6MWD, and quadriceps strength corrected for body weight (QS%) were recorded pre- and three months post-transplant. Results: 278 lung transplant recipients (142 male; mean age 45.7 § 14.2 years; FEV133.6 § 18.6%; 92 cystic fibrosis, 83 chronic obstructive
Purpose: Frailty is prevalent in lung transplant (LTX) candidates. Frailty can be associated with death before and after LTX, it is unclear if frailty trajectory persists for the first year. The study aimed to investigate frailty over the first year of LTX. Methods: LTX candidates aged over 18 years were consented at listing time. All post LTX recipients completed thrice weekly, 12 week exercise rehabilitation program consisting of cardiovascular training on bike and treadmill and upper and lower limb strength training. Clinical data was collected. Edmonton frail scale (EFS) was used to assess frailty. Grip strength was also tested. Primary outcome was 6minute walk distance (6MWD) measured at 4 time-points: pre LTX, pre-rehabilitation, post-rehabilitation and 1 year. Results: Of 103 participants, 90 (87%) were transplanted. Mean age was 58§11 yrs, 48 % were male, 52% had primary diagnosis of COPD. Frailty scores pre LTX were mean 5.54 § 2.4 and at one year mean 3.28 §1.5. Amongst all participants, 6WMD improved significantly over time: prerehabilitation (mean 326m) compared to post-rehabilitation (mean 523m (p<0.001) and 1 year (mean 512m, p<0.001). Those who required ≥ 7 day ICU admission post LTX entered the rehabilitation program with a lower mean 6MWD (276m vs. 350m, p=0.001), but this difference disappeared by 1 year (489m vs. 522m, p=0.24). Those with an EFS > 8 had shorter 6MWD preLTX compared to those with EFS ≤ 8 (245m vs. 305m, p=0.085) and similarly at pre-rehabilitation (277m vs. 331m, p=0.077). There were no differences in 6MWD comparing EFS > 8 vs ≤ 8 post-rehabilitation (523m vs. 520m, p=0.93) or at 1 year (497m vs. 510m, p=0.80). Participants with poorer EFS functional performance domain had shorter 6MWD pre LTX and pre-rehabilitation, but this difference disappeared by 1 year. Those with baseline grip strength < 25kg had shorter 6MWD preLTX (252m vs. 320m, p=0.006) and pre-rehabilitation (268m vs. 354m, p <0.001)and this persisted post-rehabilitation (480m vs. 544m, p=0.002) and at 1 year (458m vs. 537m, p=0.003). Conclusion: Participants in a structured post-LTX rehabilitation program improved in functional exercise capacity (6MWD). The program improves 6MWD in frail patients to a point comparable to less frail patients, with poor pre-rehabilitation functional capacity being successfully managed during the program. Grip strength may serve as an important predictor of the trajectory of improvement.
469 QOLVAD Detects Changes in Emotional, Social, Cognitive and Physical Wellbeing after Continuous-Flow LVAD Implant J.A. Cowger,1 C.S. Lee,2 P. Eckman,3 R. Garberich,4 C. Weaver,5 S. Joseph,6 S. Hall,6 S. Carrie,7 S. Chaudhry,8 S.E. Schroeder,9