Cerebral blood flow responses to exercise are enhanced in left ventricular assist device patients after an exercise rehabilitation program

Smith, Kurt J.; Moreno-Suarez, Ignacio; Scheer, Anna; Dembo, L.; Naylor, Louise H.; Maiorana, Andrew; Green, Daniel

doi:10.1152/japplphysiol.00604.2019

Cited by 11 publications

(11 citation statements)

References 47 publications

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“…Moreover, two studies reported a 43% and 53% increase of cerebral blood flow in patients with NYHA class III/IV heart failure following cardiac transplantation 21,22 . Similarly patients with heart failure treated with left ventricular assist devices experienced an increase of cerebral blood flow 23,24 . Finally, a large population‐based study in healthy older adults demonstrated that a lower cardiac index (cardiac output normalized for body surface area) was related to lower blood flow of the temporal lobes 25 .…”

Section: Discussionmentioning

confidence: 99%

Cerebral Blood Flow in Patients with Severe Aortic Valve Stenosis Undergoing Transcatheter Aortic Valve Implantation

Vlastra

Nieuwkerk

Bronzwaer

et al. 2020

J American Geriatrics Society

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BACKGROUND Transcatheter aortic valve implantation (TAVI) is a minimally invasive, life‐saving treatment for patients with severe aortic valve stenosis that improves quality of life. We examined cardiac output and cerebral blood flow in patients undergoing TAVI to test the hypothesis that improved cardiac output after TAVI is associated with an increase in cerebral blood flow. DESIGN Prospective cohort study. SETTING European high‐volume tertiary multidisciplinary cardiac care. PARTICIPANTS Thirty‐one patients (78.3 ± 4.6 years; 61% female) with severe symptomatic aortic valve stenosis. MEASUREMENTS Noninvasive prospective assessment of cardiac output (L/min) by inert gas rebreathing and cerebral blood flow of the total gray matter (mL/100 g per min) using arterial spin labeling magnetic resonance imaging in resting state less than 24 hours before TAVI and at 3‐month follow‐up. Cerebral blood flow change was defined as the difference relative to baseline. RESULTS On average, cardiac output in patients with severe aortic valve stenosis increased from 4.0 ± 1.1 to 5.4 ± 2.4 L/min after TAVI (P = .003). The increase in cerebral blood flow after TAVI strongly varied between patients (7% ± 24%; P = .41) and related to the increase in cardiac output, with an 8.2% (standard error = 2.3%; P = .003) increase in cerebral blood flow per every additional liter of cardiac output following the TAVI procedure. CONCLUSION Following TAVI, there was an association of increase in cardiac output with increase in cerebral blood flow. These findings encourage future larger studies to determine the influence of TAVI on cerebral blood flow and cognitive function.

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Section: Discussionmentioning

confidence: 99%

Cerebral Blood Flow in Patients with Severe Aortic Valve Stenosis Undergoing Transcatheter Aortic Valve Implantation

Vlastra

Nieuwkerk

Bronzwaer

et al. 2020

J American Geriatrics Society

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“…20 In another study, 12 patients completed an unspecified HIIT protocol as part of a multimodal cardiac rehabilitation programme with improvement in cerebral blood flow during CPX. 30 Our findings open a pathway for the systematic application of this training modality in LVAD patients. Future studies should directly compare HIIT with MCT in patients with the lowest aerobic capacity and investigate its effects on peripheral and central determinants of oxygen consumption.…”

Section: Discussionmentioning

confidence: 62%

“…In one case report, a severely deconditioned patient, unable to tolerate MCT, improved after a short heart rate‐guided HIIT programme 20 . In another study, 12 patients completed an unspecified HIIT protocol as part of a multimodal cardiac rehabilitation programme with improvement in cerebral blood flow during CPX 30 …”

Section: Discussionmentioning

confidence: 99%

“…All were on a beta-blocker, while only one was on angiotensin-converting enzyme inhibitor. HIIT resulted in a significant reduction in LV end-diastolic volume [168 (144, 216) to 159 (124, 212) mL, P = 0.02] but no improvements in LV end-systolic volume [118 (94, 152) to 99 (90, 147) mL, P = 0.08] or ejection fraction [30 (23, 31) to 28 (27,30), P = 0.3] ( Table 3 and Supporting Information, Figure S1). Importantly, all seven subjects showed some reduction in LV end-diastolic volume.…”

Section: Left Ventricular Remodelling After High-intensity Interval Tmentioning

confidence: 99%

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Feasibility of high‐intensity interval training in patients with left ventricular assist devices: a pilot study

et al. 2020

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Aims Patients with left ventricular assist device (LVAD) suffer from persistent exercise limitation despite improvement of their heart failure syndrome. Exercise training (ET) programmes to improve aerobic capacity have shown modest efficacy. High‐intensity interval training (HIIT), as an alternative to moderate continuous training, has not been systematically tested in this population. We examine the feasibility of a short, personalized HIIT programme in patients with LVAD and describe its effects on aerobic capacity and left ventricular remodelling. Methods and results Patients on durable LVAD support were prospectively enrolled in a 15‐session, 5 week HIIT programme. Turndown echocardiogram, Kansas City Cardiomyopathy Questionnaire, and cardiopulmonary exercise test were performed before and after HIIT. Training workloads for each subject were based on pretraining peak cardiopulmonary exercise test work rate (W). Percentage of prescribed training workload completed and adverse events were recorded for each subject. Fifteen subjects were enrolled [10 men, age = 51 (29–71) years, HeartMate II = 12, HeartMate 3 = 3, and time on LVAD = 18 (3–64) months]. Twelve completed post‐training testing. HIIT was well tolerated, and 90% (inter‐quartile range: 78, 99%) of the prescribed workload (W) was completed with no major adverse events. Improvements were seen in aV̇O2 at ventilatory threshold [7.1 (6.5, 9.1) to 8.5 (7.7, 9.3) mL/kg/min, P = 0.04], work rate at ventilatory threshold [44 (14, 54) to 55 (21, 66) W, P = 0.05], and left ventricular end‐diastolic volume [168 (144, 216) to 159 (124, 212) mL, n = 7, P = 0.02]. HIIT had no effect on maximal oxygen consumption (V̇O2peak) or Kansas City Cardiomyopathy Questionnaire score. Conclusions Cardiopulmonary exercise test‐guided HIIT is feasible and can improve submaximal aerobic capacity in stable patients with chronic LVAD support. Further studies are needed on its effects on the myocardium and its potential role in cardiac rehabilitation programmes.

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“…The increased ability of the brain to respond to physiological and regulatory stimuli is important for maintaining a healthy brain throughout life. Although several cross-sectional studies indicate an increase in general cerebrovascular function in people trained in exercise, a more recent study showed that dynamic cerebrovascular self-regulation is slightly attenuated in athletes after 6 weeks of high-intensity training (60). CO2 balneotherapy has long been applied clinically to improve cardiovascular symptoms in European countries.…”

Section: Discussionmentioning

confidence: 99%

Therapeutic gases used in balneotherapy and rehabilitation medicine - scientific relevance in the last ten years (2011 – 2020) - Synthetic literature review

Munteanu

Dogaru

Rotariu

et al. 2021

Balneo and PRM Research Journal

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Background. The medical relevance of therapeutic gases can range from use in burns and stroke victims to hypoxia therapy in children. However, medical gases such as oxygen, hydrogen, helium and xenon have recently come under increased exploration for their potential therapeutic use on various brain disease states, including traumatic brain injuries, hypoxia-ischemia and, cerebral hemorrhages. Objective. This synthetic review aims to rigorously select related articles and identify within their content the main possible uses of therapeutic gases and physiological mechanisms. The objective of this article is to present the various therapeutic mechanisms that have been proposed in the current literature and the medical relevance of various therapeutic gases used in balneotherapy or medical rehabilitation. Methods. To elaborate our synthesis review, we have searched for relevant open access articles in 6 international databases: Cochrane, Elsevier, NCBI/PubMed, NCBI/PMC, PEDro, and ISI Web of Knowledge/Science, published from January 2011 until December 2020. The contextually quested keywords combinations/ syntaxes used specified on this page. The eligible articles were analyzed in detail regarding pathologies addressed by therapeutic gases. All articles with any design (reviews, randomized controlled trials, non-randomized controlled trials, case-control studies, cross-sectional studies), if eligible according to the above-mentioned selection methodology, containing in the title or abstract the above-mentioned combinations, were included in the analysis. Articles were excluded in the second phase if they did not reach the relevance criterion. Results. Our search identified, first, 225 articles. After eliminating the duplicates, remained 180 articles. In the second phase, we applied a relevance criterion. Although our team - including the authors of this paper – have quite long and consistent expertise in achieving systematic literature reviews, the marked heterogeneity of both the item composing the subject we have approached and inherently the wase of presentations in the respective quite vast and diverse domain of medical gases, prevented us to fulfil, at least regarding this initial work, a systematic literature review. Instead, we succeeded to make a hopefully interesting and valuable narrative synthetic-related literature review. At the end of the second phase, 63 articles passed the relevance criterion and were included in this synthetic review. Conclusions. Therapeutic gases are not fully understood and used adequately for sanogenic or medical purposes. More research is needed to fully understand the mechanisms and importance of therapeutic gases. The link between balneotherapy and medical rehabilitation regarding the usage of therapeutical gases emphasises the unity for this medical speciality. Keywords: "Therapeutic gas"/ "Oxygen therapy"/ "Carbon dioxide"/ "CO2 therapy"/ "Carbon monoxide"/ "Mofette"/ "Hydrogen Sulfide"/ "H2S"/ "Helium"/ "Xenon"/ "Ozone therapy"/ "Radon"/ "Hydrogen therapy"/ "Nitric oxide"/ "Heliox" AND "Rehabilitation".

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Cerebral blood flow responses to exercise are enhanced in left ventricular assist device patients after an exercise rehabilitation program

Cited by 11 publications

References 47 publications

Cerebral Blood Flow in Patients with Severe Aortic Valve Stenosis Undergoing Transcatheter Aortic Valve Implantation

Cerebral Blood Flow in Patients with Severe Aortic Valve Stenosis Undergoing Transcatheter Aortic Valve Implantation

Feasibility of high‐intensity interval training in patients with left ventricular assist devices: a pilot study

Therapeutic gases used in balneotherapy and rehabilitation medicine - scientific relevance in the last ten years (2011 – 2020) - Synthetic literature review

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