- Email: [email protected]
Trainability of Patients with Severe Heart Failure after LVAS Implantation
The 10th Annual Scientific Meeting not difference at end of exercise. dcHb did not show the significant difference before and after training. Conclusion: It is suggested that the improvement of exercise capacity in patient with LVAS was caused by improvement of oxygen uptake in skeletal muscle, but not increase of peripheral circulatory blood volume.
1105 Physiological Outcomes as a Predictor of Depression in Patients with Chronic Heart Failure KAZUHIRO IZAWA1, SATOSHI WATANABE1, NAOHIKO OSADA2, KAZUTO OMIYA2 1 Department of Rehabilitation Medicine, St. Marianna University School of Medicine Hospital, 2Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine Chronic heart failure (CHF) is a serious condition that is associated with impaired physical and mental status. To date, little is known about the determinants of depressive symptoms and related to physiological outcomes in CHF. The purpose of the present study was to determine the depression status and relationship between physiological outcomes and depression status in patients with chronic heart failure (CHF). Seventy-four out-patients with stable CHF (69 men, 5 women, mean age 59.2612.2 years) with left ventricular ejection fraction (LVEF) of less than 40% were enrolled in the study. We used Hospital Anxiety and Depression (HAD) as an index of depression. In all patients, physiological outcome measures included peak oxygen uptake (peak VO2), knee extensor muscles and grip strength. Of the 74 patients, 12 patients (16.2%) was recognized depression. The outcome was defined by depression (group A, n512) or non-depression (group B, n562). The peak VO2 and grip strength were not significant comparable in both groups (NS). In contrast, a cut-off point using ROC curve of 1.61 Nm/kg in the strength index of the knee extensor muscle was used to establish a significant difference between groups (p!0.05). These findings suggest that knee extensor muscle strength is related to depression status and to improve muscle strength may improve subjective outcome in patients with CHF.
1106 The Starting Date or Critical in-Hospital Events Would not Affect Final Outcome of Cardiac Rehabilitation (CR) in Patients with Heart Failure (HF) TABATA MINORU, HASEGAWA TASUKU, NAKAGAWA SUSUMU, UI SUSUMU, MITAMURA HIDEO Cardiovascular Center, Saiseikai Central Hospital, Tokyo, Japan In order to clarify the prohibiting factors of CR outcome in patients with HF, 248 patients (152 men and 96 women) who were admitted due to HF were divided into 2 groups (Group A: those who started CR within 3 days after admission, Group B: those who started CR beyond 3 days after admission). Total CR period (22.3 vs 15.7 days, p!0.001) and hospital stay (28.2 vs 17.8 days, p!0.001) were longer in Group B than in Group A. Critical events, determined as fatal arrhythmia, administration of continuous hemofiltration, Swan-Ganz catheter, inotropic agents, or intratracheal intubation, were more frequent in group B than in group A (58.3% vs. 8.5%, p!0.0001). On the other hand, age, plasma BNP level, 6-minute walk distance, complications of dementia, orthopedic disorders and gait disturbance, were all similar in both groups. Compared to those who could go upstairs at discharge (n5127), patients who could not go upstairs (n5121) were older (79.2 vs. 66.9 year-old, p!0.0001) and more frequently associated with dementia (46.3% vs. 14.5%, p!0.0001), orthopedic disorders (47.1% vs. 21.1%, p!0.0001), and gait disturbance (86.8% vs. 37.5%, p!0.0001), though the starting date or duration of CR and critical event rate were all similar. Critical in-hospital events definitely prolong CR period and total hospital stay, however, they would never affect final outcome of CR. Aging, co-existing dementia or orthopedic disorders are major prohibiting factors of CR outcome.
1107 Trainability of Patients with Severe Heart Failure after LVAS Implantation MAKITA SHIGERU1, HANAFUSA YUSUKE1, KYO SHUNEI2 1 Department of Rehabilitation Medicine, Saitama Medical University, Saitama, Japan, 2Department of Cardiovascular Surgery, Saitama Medical University, Saitama, Japan Purpose: Cardiac rehabilitation for patients who received LVAS (left ventricular assist system) is important because those patients have extreme low level exercise capacity due to severe heart failure. The purpose of this study is to evaluate the trainability of LVAS patients. Subjects and Method: 10 (38.1þ/-10.2 years old , male/female 8/2, DCM / fulminant myocarditis 9/1) endstage severe heart failure patients who received LVAS (Toyobo Ltd. Japan) participated in exercise training program using cycle ergometer
JHFS
S183
at the intensity of 68.5þ/-11.1 % of peak VO2. Endurance exercise training was carried out 3 times weekly for 30 minutes. Four patients of the subjects added the mild resistance training every day. Before the training (A) and 1 month (B) and 3 months (C) after the beginning of exercise training, symptom-limited cardiopulmonary exercise tests (CPX) were done. During CPX capillary blood was taken for the measurement of blood lactate concentration every one minute. Results: peak VO2 (12.4þ/-2.7(A), 14.8þ/-2.7(B), 15.3þ/-3.0(C) mL/kg/min; p50.064 ANOVA) and peak workload (52.4þ/-9.8(A), 69.1þ/-16.8(B), 74.0þ/16.3(C) watt; p50.007) increased during training period. Blood lactate concentration showed the tendency of decrease at the 40watt during CPX (p50.086). The improvement rate of peak VO2 between AB was 21.3% and that of peak workload between AB was 32.8% respectively. Conclusion: Exercise tolerance improvement of first one month of exercise training start is remarkable for LVAS patients.
1108 Relationship Between the Exercise-induced ST-segment Elevation in Infarctrelated Leads and Parameters of Cardiopulmonary Exercise Test on Acute Myocardial Infarction MASAHIKO KIMURA1, MASAYUKI YOTSUKURA2, HIDEAKI YOSHINO3, TAKUMI YAMADA4 1 Department of Rehabilitation Medicine, Kyorin University Hospital, Tokyo, Japan, 2 Faculty of Health Sciences, Kyorin University, Tokyo, Japan, 3Second Department of Internal Medicine, Kyorin University, Faculty of Medeicine, Tokyo, Japan, 4 Graduate School of Tokyo Metropolitan University of Health Science; Tokyo, Japan Purpose: Exercise-induced ST-segment elevation in infarct-related leads is often seen in the treadmill exercise test of patients with myocardial infarction (MI). The purpose of this study is to evaluate the relationship between this phenomenon and parameters of cardiopulmonary exercise test during cardiac rehabilitation on acute MI. Methods: A total of 71 patients (56.169.5 years) were enrolled in this study. They had acute anterior wall MI without intraventricular conduction disturbance and participated in cardiac rehabilitation program with cardiopulmonary exercise test (CPET) within one month after MI. The exercise-induced ST-segment elevation and CPET and clinical parameters were compared. Results: All patients were divided into two groups (ST-segment elevation group (n514) and no ST-segment elevation group (n557)) according to exercise-induced of ST-segment changes in infarct-related leads. Anaerobic Threshold (AT) were 13.462.3 in ST-segment elevation group and 13.262.4 ml/min/kg in no ST-segment elevation group. Heart rate at AT were 108.068.4 and 105.8610.1 beats/min and left ventricular ejection fraction were 54.9610.6 and 52.6613.2%, respectively. In these parameters there were not significant differences been these two groups. Conclusion: ST-segment elevation during exercise testing with who suffered MI will not become an inhibition factor of therapeutic exercise.
1109 Exercise Tolerance and Diastolic Dysfunction in Patients with Insulin Resistance HITOSHI ADACHI1, TOMIO OHNO2, OSHIMA SHIGERU1, TANIGUCHI KOICHI1 1 Division of Cardiology, Gunma Prefectural Cardiovascular Center, Gunma, Japan, 2 Division of Internal Medicine, Gunma Prefectural Cardiovascular Center, Gunma Japan Purpose: Metabolic syndrome is characterized as an augmentation of insulin resistance (IR). Experimentally, IR is reported to deteriorate the cardiac performance through the interference of calcium exclusion from the cytosol. Therefore, clinically, cardiac diastolic dysfunction is assumed to occur at first. Recently, diastolic dysfunction is recognized to be not a rare feature in heart failure and related with exercise performance. However, relationship between IR and diastolic dysfunction as well as the exercise tolerance is not well studied yet. We attempted to assess the relationship between them. Method: We examined 17 patients with heart disease (5767 y.o., LVEF 39.5627.9%, peak VO2 18.864.5 mL/min/kg). IR was determined with the euglycemic hyperinsulinemic clamp technique. Glucose infusion rate (GIR) was used as an index of IR. Cardiopulmonary exercise testing was used to determine the exercise tolerance. Tissue Doppler echocardiography was used to evaluate the diastolic function. Results: GIR showed negative correlation with body fat ratio detected by impedance method (r5-0.40). GIR and exercise tolerance was positively correlated (vs. anaerobic threshold; r50.37, vs. peak VO2; r50.40). GIR was also related with cardiac function during exercise (vs. peak VO2/HR; r50.43) and VE/VCO2 slope (r50.40). GIR did not relate with LVEF. It showed weak negative correlation with diastolic dysfunction (vs. E/Eprime r5-0.25, E/A r5-0.40). Conclusion: IR was moderately correlated with diastolic dysfunction and exercise tolerance.
1105 Physiological Outcomes as a Predictor of Depression in Patients with Chronic Heart Failure KAZUHIRO IZAWA1, SATOSHI WATANABE1, NAOHIKO OSADA2, KAZUTO OMIYA2 1 Department of Rehabilitation Medicine, St. Marianna University School of Medicine Hospital, 2Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine Chronic heart failure (CHF) is a serious condition that is associated with impaired physical and mental status. To date, little is known about the determinants of depressive symptoms and related to physiological outcomes in CHF. The purpose of the present study was to determine the depression status and relationship between physiological outcomes and depression status in patients with chronic heart failure (CHF). Seventy-four out-patients with stable CHF (69 men, 5 women, mean age 59.2612.2 years) with left ventricular ejection fraction (LVEF) of less than 40% were enrolled in the study. We used Hospital Anxiety and Depression (HAD) as an index of depression. In all patients, physiological outcome measures included peak oxygen uptake (peak VO2), knee extensor muscles and grip strength. Of the 74 patients, 12 patients (16.2%) was recognized depression. The outcome was defined by depression (group A, n512) or non-depression (group B, n562). The peak VO2 and grip strength were not significant comparable in both groups (NS). In contrast, a cut-off point using ROC curve of 1.61 Nm/kg in the strength index of the knee extensor muscle was used to establish a significant difference between groups (p!0.05). These findings suggest that knee extensor muscle strength is related to depression status and to improve muscle strength may improve subjective outcome in patients with CHF.
1106 The Starting Date or Critical in-Hospital Events Would not Affect Final Outcome of Cardiac Rehabilitation (CR) in Patients with Heart Failure (HF) TABATA MINORU, HASEGAWA TASUKU, NAKAGAWA SUSUMU, UI SUSUMU, MITAMURA HIDEO Cardiovascular Center, Saiseikai Central Hospital, Tokyo, Japan In order to clarify the prohibiting factors of CR outcome in patients with HF, 248 patients (152 men and 96 women) who were admitted due to HF were divided into 2 groups (Group A: those who started CR within 3 days after admission, Group B: those who started CR beyond 3 days after admission). Total CR period (22.3 vs 15.7 days, p!0.001) and hospital stay (28.2 vs 17.8 days, p!0.001) were longer in Group B than in Group A. Critical events, determined as fatal arrhythmia, administration of continuous hemofiltration, Swan-Ganz catheter, inotropic agents, or intratracheal intubation, were more frequent in group B than in group A (58.3% vs. 8.5%, p!0.0001). On the other hand, age, plasma BNP level, 6-minute walk distance, complications of dementia, orthopedic disorders and gait disturbance, were all similar in both groups. Compared to those who could go upstairs at discharge (n5127), patients who could not go upstairs (n5121) were older (79.2 vs. 66.9 year-old, p!0.0001) and more frequently associated with dementia (46.3% vs. 14.5%, p!0.0001), orthopedic disorders (47.1% vs. 21.1%, p!0.0001), and gait disturbance (86.8% vs. 37.5%, p!0.0001), though the starting date or duration of CR and critical event rate were all similar. Critical in-hospital events definitely prolong CR period and total hospital stay, however, they would never affect final outcome of CR. Aging, co-existing dementia or orthopedic disorders are major prohibiting factors of CR outcome.
1107 Trainability of Patients with Severe Heart Failure after LVAS Implantation MAKITA SHIGERU1, HANAFUSA YUSUKE1, KYO SHUNEI2 1 Department of Rehabilitation Medicine, Saitama Medical University, Saitama, Japan, 2Department of Cardiovascular Surgery, Saitama Medical University, Saitama, Japan Purpose: Cardiac rehabilitation for patients who received LVAS (left ventricular assist system) is important because those patients have extreme low level exercise capacity due to severe heart failure. The purpose of this study is to evaluate the trainability of LVAS patients. Subjects and Method: 10 (38.1þ/-10.2 years old , male/female 8/2, DCM / fulminant myocarditis 9/1) endstage severe heart failure patients who received LVAS (Toyobo Ltd. Japan) participated in exercise training program using cycle ergometer
JHFS
S183
at the intensity of 68.5þ/-11.1 % of peak VO2. Endurance exercise training was carried out 3 times weekly for 30 minutes. Four patients of the subjects added the mild resistance training every day. Before the training (A) and 1 month (B) and 3 months (C) after the beginning of exercise training, symptom-limited cardiopulmonary exercise tests (CPX) were done. During CPX capillary blood was taken for the measurement of blood lactate concentration every one minute. Results: peak VO2 (12.4þ/-2.7(A), 14.8þ/-2.7(B), 15.3þ/-3.0(C) mL/kg/min; p50.064 ANOVA) and peak workload (52.4þ/-9.8(A), 69.1þ/-16.8(B), 74.0þ/16.3(C) watt; p50.007) increased during training period. Blood lactate concentration showed the tendency of decrease at the 40watt during CPX (p50.086). The improvement rate of peak VO2 between AB was 21.3% and that of peak workload between AB was 32.8% respectively. Conclusion: Exercise tolerance improvement of first one month of exercise training start is remarkable for LVAS patients.
1108 Relationship Between the Exercise-induced ST-segment Elevation in Infarctrelated Leads and Parameters of Cardiopulmonary Exercise Test on Acute Myocardial Infarction MASAHIKO KIMURA1, MASAYUKI YOTSUKURA2, HIDEAKI YOSHINO3, TAKUMI YAMADA4 1 Department of Rehabilitation Medicine, Kyorin University Hospital, Tokyo, Japan, 2 Faculty of Health Sciences, Kyorin University, Tokyo, Japan, 3Second Department of Internal Medicine, Kyorin University, Faculty of Medeicine, Tokyo, Japan, 4 Graduate School of Tokyo Metropolitan University of Health Science; Tokyo, Japan Purpose: Exercise-induced ST-segment elevation in infarct-related leads is often seen in the treadmill exercise test of patients with myocardial infarction (MI). The purpose of this study is to evaluate the relationship between this phenomenon and parameters of cardiopulmonary exercise test during cardiac rehabilitation on acute MI. Methods: A total of 71 patients (56.169.5 years) were enrolled in this study. They had acute anterior wall MI without intraventricular conduction disturbance and participated in cardiac rehabilitation program with cardiopulmonary exercise test (CPET) within one month after MI. The exercise-induced ST-segment elevation and CPET and clinical parameters were compared. Results: All patients were divided into two groups (ST-segment elevation group (n514) and no ST-segment elevation group (n557)) according to exercise-induced of ST-segment changes in infarct-related leads. Anaerobic Threshold (AT) were 13.462.3 in ST-segment elevation group and 13.262.4 ml/min/kg in no ST-segment elevation group. Heart rate at AT were 108.068.4 and 105.8610.1 beats/min and left ventricular ejection fraction were 54.9610.6 and 52.6613.2%, respectively. In these parameters there were not significant differences been these two groups. Conclusion: ST-segment elevation during exercise testing with who suffered MI will not become an inhibition factor of therapeutic exercise.
1109 Exercise Tolerance and Diastolic Dysfunction in Patients with Insulin Resistance HITOSHI ADACHI1, TOMIO OHNO2, OSHIMA SHIGERU1, TANIGUCHI KOICHI1 1 Division of Cardiology, Gunma Prefectural Cardiovascular Center, Gunma, Japan, 2 Division of Internal Medicine, Gunma Prefectural Cardiovascular Center, Gunma Japan Purpose: Metabolic syndrome is characterized as an augmentation of insulin resistance (IR). Experimentally, IR is reported to deteriorate the cardiac performance through the interference of calcium exclusion from the cytosol. Therefore, clinically, cardiac diastolic dysfunction is assumed to occur at first. Recently, diastolic dysfunction is recognized to be not a rare feature in heart failure and related with exercise performance. However, relationship between IR and diastolic dysfunction as well as the exercise tolerance is not well studied yet. We attempted to assess the relationship between them. Method: We examined 17 patients with heart disease (5767 y.o., LVEF 39.5627.9%, peak VO2 18.864.5 mL/min/kg). IR was determined with the euglycemic hyperinsulinemic clamp technique. Glucose infusion rate (GIR) was used as an index of IR. Cardiopulmonary exercise testing was used to determine the exercise tolerance. Tissue Doppler echocardiography was used to evaluate the diastolic function. Results: GIR showed negative correlation with body fat ratio detected by impedance method (r5-0.40). GIR and exercise tolerance was positively correlated (vs. anaerobic threshold; r50.37, vs. peak VO2; r50.40). GIR was also related with cardiac function during exercise (vs. peak VO2/HR; r50.43) and VE/VCO2 slope (r50.40). GIR did not relate with LVEF. It showed weak negative correlation with diastolic dysfunction (vs. E/Eprime r5-0.25, E/A r5-0.40). Conclusion: IR was moderately correlated with diastolic dysfunction and exercise tolerance.