High-Intensity Interval Training for Severe Left Ventricular Dysfunction Treated with Left Ventricular Assist Device

Abstract

SummaryAerobic training based on anaerobic threshold (AT) is well-known to improve cardiac function, exercise capacity, and long-term outcomes of patients with heart failure. Recent reports suggested that high-intensity interval training (HIIT) for patients with cardiovascular disease may improve cardiopulmonary exercise capacity. We present a 61-year-old male patient of severe left ventricular dysfunction with left ventricular assisted device (LVAD). Following HIIT for 8 weeks, exercise capacity and muscle strength have improved without worsening left ventricular function. Our case showed the possibility that HIIT was feasible and effective even in patients with LVAD.(Int Heart J 2018; 59: 216-219) Key words: Exercise training, Left ventricular assist device, Peak oxygen uptake, Muscle strength S everal controlled trials have demonstrated that exercise training improved exercise capacity and quality of life of patients with heart failure.1-8) And a metaanalysis of randomized trials showed that exercise training for patients with heart failure improved exercise capacity and reduced cardiovascular events.1,9-11) However, continuous moderate-intensity aerobic training is only limited to patients with preserved exercise capacity and muscle strength. Patients with severe deconditioning or muscle weakness are intolerant to continuous moderate-intensity aerobic training.Recently high-intensity interval training (HIIT) has been reported to improve exercise capacity of patients with severely impaired left ventricular function.12,13) HIIT may be feasible for patients who are intolerant to continuous moderate-intensity aerobic training because of deconditioning. It may be difficult for the patient with implantable left ventricular assist device (LVAD) to perform continuous moderate-intensity aerobic training because of longstanding deconditioning, but the patient with LVAD may be a good candidate for HIIT. We present a case of patients with LVAD that was treated by HIIT. Case ReportA 61-year-old male, who was diagnosed with dilated cardiomyopathy (DCM) and treatment-refractory heart failure dependent on inotropic agent, was transferred to our institute for left ventricular assist device (LVAD) implantation. During admission, the patient was 166.3 cm tall and weighed 68.5 kg, with a BMI of 24.9, blood pressure 94/74 mmHg, resting heart rate 105/minute, and body temperature of 36.2°C. Blood biochemistry showed T.P. 7.1 g/dL, albumin 3.8 g/dL, T-bil 3.7 mg/dL, D-bil 2.5 mg/dL, AST 43 IU/mL, ALT 35 IU/mL, LDH 378 mg/dL, CK 168 mg/dL, ALP 324 mg/dL, gamma-GTP 60 mg/dL, CRP 0.69 mg/dL, Na 137 mEq/L, K 4.4 mEq/L, Cl 97 mEq/L, BUN 43 mg/dL, Cr 1.45 mg/dL, UA 10.7 mg/dL, T-chol 154 mg/dL, HDL-C 34 mg/dL, TG 83 mg/ dL, WBC 5490/mm 3 , RBC 493 10 6 /mm 3 , Hb 15.5 g/ dL, Ht 48%, Plt 15.7 104/mm 3 . The plasma glucose level was 210 mg/dL and the BNP level was 3085 pg/mL. Chest X-ray on admission showed slight pleural effusion and cardiomegaly. Echocardiography (ECG) on admission showed sinus tachycardia with a heart rate of 110 BPM, ...

Changes in Autophagy Levels in Rat Myocardium During Exercise Preconditioning-Initiated Cardioprotective Effects

“…1) Exercise preconditioning (EP) established by an acute bout of highintensity intermittent exercise before a severe, sustained myocardial ischemia episode could initiate remarkable intrinsic cardioprotective effects for strenuous and repetitive stimulations to cardiovascular systems. [2][3][4][5][6][7] EP can be divided into EP-initiated cardioprotective effects and cardioprotective phase. Although the EP-initiated cardioprotective effects have been widely recognized, 2,8,9) and the evidences show the cardioprotective phase can last a long time, 10,11) the potential mechanisms during EP-initiated cardioprotective effects and phase still need to be investigated.…”

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

“…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 Our findings open a pathway for the systematic application of this training modality in LVAD patients.…”

“…18 This training modality has not been systematically applied to the LVAD population, with only rare reports available in the literature. 19,20 The effects of HIIT on skeletal muscle metabolism are well described and can be seen after training programmes as short as 2 weeks. 16,21 HIIT was also shown to induce reverse left ventricular (LV) remodelling in one study of patients with ischaemic cardiomyopathy.…”

“…However, adherence to the training schedule can limit its widespread use in HF patients, as demonstrated by larger studies 18 . This training modality has not been systematically applied to the LVAD population, with only rare reports available in the literature 19,20 …”

A szívbetegek rehabilitációjának sportos arca

“…A bal kamrai assistkészülékkel élők is részt vehetnek a nagy intenzitású interval edzésben -állítják Ugata és mtsai a Jichi Orvosegyetemről, egy 61 éves, súlyos bal kamrai elégtelenséggel élő férfi nyolchetes HIIT-edzése során szerzett tapasztalataik alapján. Nőtt a terhelhetőség és az izomerő anélkül, hogy a balkamra-funkció romlott volna [24].…”