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Metabolic and cardiac endurance exercise response in heart transplant recipients is not influenced by denervation
The Journal of Heart and Lung Transplantation Volume 21, Number 1 of renal function and infection rates. Higher C2 levels were associated with significantly fewer rejection episodes when both phases of the study were pooled.
132 METABOLIC AND CARDIAC ENDURANCE EXERCISE RESPONSE IN HEART TRANSPLANT RECIPIENTS IS NOT INFLUENCED BY DENERVATION U. Tegtbur,1 K. Pethig,2 H. Machold,1 A. Haverich,2 M. Busse,3 1 Sportsmedicine, Medical School, Hannover, Germany; 2Thoracic Surgery, Medical School, Hannover, Germany; 3Institute of Sportsmedicine, University of Leipzig, Leipzig, Germany Due to the cardiac denervation, metabolic and cardiac response at onset of exercise is reduced in heart transplant recipients [HTR]. Despite the relative muscle fiber shift from lactate oxidizing type I to lactate producing type II, the response to constant load exercise [CT] at the anaerobic threshold [AT] is never been estimated in HTR. Therefore, aim of the study was to identify the intensity of a lactate equilibrium between production and catabolism and to validate this as the AT during 30 min CT in HTR. Methods: In 20 HTR and in 13 patients with coronary artery disease [CAD] without b-blockade ((CAD results in parenthesis) age 55⫾7 (58⫾8) years, BMI 28.2⫾3.8 (23.8⫾3.7; p⬍0.05) kg m2, 4.9⫾2.2 years after transplantation) the lactate equilibrium between production and catabolism [i.e. AT] was estimated in an incremental ergometer test [IT] initiated during high lactic acidosis. At least one week later, the patients performed 30 min CT. Results: In the IT the maximal workload was 106⫾25 (163⫾41; p⬍0.01) W and 1.2⫾0.3 (2.2⫾0.5; p⬍0.01) W kg-1 bodyweight with a maximum heart rate [HR] of 134⫾12 (159⫾12; p⬍0.01) b min-1 and blood lactate concentration [Lac] of 4.9⫾1.9 (7.3⫾2.1; p⬍0.05) mmol l-1. In the CT with the estimated AT of 55⫾16 (97⫾34; p⬍0.01) W or 52⫾8 (58⫾8; p⬍0.05)% of maximum workload 19 of 20 heart transplant recipients reached the 30min (mean CT time 29.5⫾2.2 (29.5⫾1.1) min). HR increased from 100⫾12 (91⫾15; p⬍0.01) at rest to 120⫾12 (126⫾11) after 10 min and to 125⫾12 (133⫾11) b min-1 after 30min (Lac: Rest 0.9⫾0.2 (1.0⫾0.2), 10min 2.9⫾1.3 (3.3⫾1.3), 30min 3.1⫾1.6 (3.4⫾1.5; n.s.) mmol l-1. In conclusion the small but significant Lac increase during the last 20min in CT confirms that the estimated Lac equlilibrium reflects the AT as the upper limit of the lactate steady state. Although the exercise capacity after HTX is significantly reduced as compared to CAD the constant load kinetics after the initial transient of HR and Lac are comparable, demonstrating that constant exercise kinetics are not influenced by cardiac denervation. These results are of essential importance regarding prescription and supervision of exercise training in HTR. 133 THE EFFECT OF DIFFERENT FORMS OF DIABETES MELLITUS ON CLINICAL OUTCOMES AFTER CARDIAC TRANSPLANTATION S. Azmoon, D. Beltramo, H.J. Eisen, Advanced Heart Failure and Transplant Center, Temple University School of Medicine, Philadelphia, PA
Abstracts
103
Diabetes mellitus was formerly an absolute contraindication to cardiac transplantation but in recent years, patients with diabetes mellitus have been successfully transplanted. The outcomes of diabetic patients undergoing cardiac transplantation in terms of survival, frequency of allograft rejection and of infection are not well defined. Further, the relationship of different forms of diabetes to post-transplant outcomes is unknown. To further understand these issues, we reviewed the charts and outcomes of 514 patients who underwent cardiac transplantation at our institution. Diabetic patients were divided into three groups: those requiring insulin prior to transplant (n⫽54), those being managed with medical therapy for diabetes prior to transplant (n⫽37) and those without clinically evident diabetes prior to transplant who developed diabetes requiring insulin or oral therapy after transplant (n⫽45). 378 did not have diabetes pre- or post-transplant. Our immunosuppression protocol consisted of triple therapy with a calcineurin antagonist, an anti-proliferative agent and corticosteroids. Steroids were rapidly weaned after transplant to 2.5 mg/day of prednisone at 6 months and off by one year after transplant if possible. One year survival for the patient groups were: 87.04% for pre-transplant insulin -requiring diabetics; 64.86% for non-insulin requiring pre-transplant diabetics (p⬍0.05 vs. other groups);88.89% for new onset diabetics; 81.61% for all diabetics; and 83.60% for non-diabetics. Only the non-insulin requiring pre-transplant diabetics had a lower survival than non-diabetics though this in part was accounted for by increased pre-transplant acuity from other co-morbidities compared to the other groups. There was no difference in rejection or infections between the diabetic groups and nondiabetic patients. We conclude that outcomes between all diabetics and non-diabetics are similar after transplant. For analysis of diabetic subgroups, only the non-insulin requiring pre-transplant diabetics had a worse outcome though the reasons for this may be related to pre-transplant co-morbidities independent of diabetes in this particular group.
134 COMBINED ENDURANCE/RESISTANCE TRAINING REDUCES PLASMA TNF-ALPHA RECEPTOR LEVELS IN PATIENTS WITH CHRONIC HEART FAILURE AND CORONARY ARTERY DISEASE V.M. Conraads,1 P. Beckers,1 J.M. Bosmans,1 L.S. De Clerck,2 W.J. Stevens,2 C.J. Vrints,1 D.L. Brutsaert,1 1Cardiology, University Hospital Antwerp, Edegem, Belgium; 2Immunology, University Hospital Antwerp, Edegem, Belgium Objectives: The effects of a 4 month combined endurance/ resistance exercise training on cytokines and cytokine receptors in patients with chronic heart failure were studied. In addition, changes in submaximal and maximal exercise performance were addressed. Background: Physical reconditioning of patients with chronic heart failure improves exercise capacity and restores endothelial function and skeletal muscle changes. Combined endurance/ resistance training has been demonstrated to improve submaximal exercise capacity and to enhance muscular strength and mass in these patients. Recently, beneficial effects of endurance training on inflammatory changes in chronic heart failure have been shown.
132 METABOLIC AND CARDIAC ENDURANCE EXERCISE RESPONSE IN HEART TRANSPLANT RECIPIENTS IS NOT INFLUENCED BY DENERVATION U. Tegtbur,1 K. Pethig,2 H. Machold,1 A. Haverich,2 M. Busse,3 1 Sportsmedicine, Medical School, Hannover, Germany; 2Thoracic Surgery, Medical School, Hannover, Germany; 3Institute of Sportsmedicine, University of Leipzig, Leipzig, Germany Due to the cardiac denervation, metabolic and cardiac response at onset of exercise is reduced in heart transplant recipients [HTR]. Despite the relative muscle fiber shift from lactate oxidizing type I to lactate producing type II, the response to constant load exercise [CT] at the anaerobic threshold [AT] is never been estimated in HTR. Therefore, aim of the study was to identify the intensity of a lactate equilibrium between production and catabolism and to validate this as the AT during 30 min CT in HTR. Methods: In 20 HTR and in 13 patients with coronary artery disease [CAD] without b-blockade ((CAD results in parenthesis) age 55⫾7 (58⫾8) years, BMI 28.2⫾3.8 (23.8⫾3.7; p⬍0.05) kg m2, 4.9⫾2.2 years after transplantation) the lactate equilibrium between production and catabolism [i.e. AT] was estimated in an incremental ergometer test [IT] initiated during high lactic acidosis. At least one week later, the patients performed 30 min CT. Results: In the IT the maximal workload was 106⫾25 (163⫾41; p⬍0.01) W and 1.2⫾0.3 (2.2⫾0.5; p⬍0.01) W kg-1 bodyweight with a maximum heart rate [HR] of 134⫾12 (159⫾12; p⬍0.01) b min-1 and blood lactate concentration [Lac] of 4.9⫾1.9 (7.3⫾2.1; p⬍0.05) mmol l-1. In the CT with the estimated AT of 55⫾16 (97⫾34; p⬍0.01) W or 52⫾8 (58⫾8; p⬍0.05)% of maximum workload 19 of 20 heart transplant recipients reached the 30min (mean CT time 29.5⫾2.2 (29.5⫾1.1) min). HR increased from 100⫾12 (91⫾15; p⬍0.01) at rest to 120⫾12 (126⫾11) after 10 min and to 125⫾12 (133⫾11) b min-1 after 30min (Lac: Rest 0.9⫾0.2 (1.0⫾0.2), 10min 2.9⫾1.3 (3.3⫾1.3), 30min 3.1⫾1.6 (3.4⫾1.5; n.s.) mmol l-1. In conclusion the small but significant Lac increase during the last 20min in CT confirms that the estimated Lac equlilibrium reflects the AT as the upper limit of the lactate steady state. Although the exercise capacity after HTX is significantly reduced as compared to CAD the constant load kinetics after the initial transient of HR and Lac are comparable, demonstrating that constant exercise kinetics are not influenced by cardiac denervation. These results are of essential importance regarding prescription and supervision of exercise training in HTR. 133 THE EFFECT OF DIFFERENT FORMS OF DIABETES MELLITUS ON CLINICAL OUTCOMES AFTER CARDIAC TRANSPLANTATION S. Azmoon, D. Beltramo, H.J. Eisen, Advanced Heart Failure and Transplant Center, Temple University School of Medicine, Philadelphia, PA
Abstracts
103
Diabetes mellitus was formerly an absolute contraindication to cardiac transplantation but in recent years, patients with diabetes mellitus have been successfully transplanted. The outcomes of diabetic patients undergoing cardiac transplantation in terms of survival, frequency of allograft rejection and of infection are not well defined. Further, the relationship of different forms of diabetes to post-transplant outcomes is unknown. To further understand these issues, we reviewed the charts and outcomes of 514 patients who underwent cardiac transplantation at our institution. Diabetic patients were divided into three groups: those requiring insulin prior to transplant (n⫽54), those being managed with medical therapy for diabetes prior to transplant (n⫽37) and those without clinically evident diabetes prior to transplant who developed diabetes requiring insulin or oral therapy after transplant (n⫽45). 378 did not have diabetes pre- or post-transplant. Our immunosuppression protocol consisted of triple therapy with a calcineurin antagonist, an anti-proliferative agent and corticosteroids. Steroids were rapidly weaned after transplant to 2.5 mg/day of prednisone at 6 months and off by one year after transplant if possible. One year survival for the patient groups were: 87.04% for pre-transplant insulin -requiring diabetics; 64.86% for non-insulin requiring pre-transplant diabetics (p⬍0.05 vs. other groups);88.89% for new onset diabetics; 81.61% for all diabetics; and 83.60% for non-diabetics. Only the non-insulin requiring pre-transplant diabetics had a lower survival than non-diabetics though this in part was accounted for by increased pre-transplant acuity from other co-morbidities compared to the other groups. There was no difference in rejection or infections between the diabetic groups and nondiabetic patients. We conclude that outcomes between all diabetics and non-diabetics are similar after transplant. For analysis of diabetic subgroups, only the non-insulin requiring pre-transplant diabetics had a worse outcome though the reasons for this may be related to pre-transplant co-morbidities independent of diabetes in this particular group.
134 COMBINED ENDURANCE/RESISTANCE TRAINING REDUCES PLASMA TNF-ALPHA RECEPTOR LEVELS IN PATIENTS WITH CHRONIC HEART FAILURE AND CORONARY ARTERY DISEASE V.M. Conraads,1 P. Beckers,1 J.M. Bosmans,1 L.S. De Clerck,2 W.J. Stevens,2 C.J. Vrints,1 D.L. Brutsaert,1 1Cardiology, University Hospital Antwerp, Edegem, Belgium; 2Immunology, University Hospital Antwerp, Edegem, Belgium Objectives: The effects of a 4 month combined endurance/ resistance exercise training on cytokines and cytokine receptors in patients with chronic heart failure were studied. In addition, changes in submaximal and maximal exercise performance were addressed. Background: Physical reconditioning of patients with chronic heart failure improves exercise capacity and restores endothelial function and skeletal muscle changes. Combined endurance/ resistance training has been demonstrated to improve submaximal exercise capacity and to enhance muscular strength and mass in these patients. Recently, beneficial effects of endurance training on inflammatory changes in chronic heart failure have been shown.