title: Exercise training with a heart device: a hemodynamic, metabolic, and hormonal study.
abstract: OBJECTIVE
  The mechanisms of the training-induced improvements in left ventricular assist (LVAD) patients are unknown.
  
  
  METHODS
  We measured the hemodynamic, gas exchange, and metabolic and hormonal effects of 6-wk exercise training in a cardiogenic shock patient who was assisted by an LVAD.
  
  
  RESULTS
  After training, the peak power and VO2 increased by 166% and 56%, respectively (80 W and 16.1 mL x min(-1) x kg(-1)), whereas the ventilatory drive decreased. Although the LVAD output increased little with exercise, the systemic cardiac output rose (adequately for the VO2) from 5.91 and 4.90 L x min(-1) at rest to 9.75 and 9.47 L x min(-1) at peak work rate, before and after training, respectively. Thus, the left ventricle ejected again through the aortic valve. Unloading and/or retraining resulted in a left ventricular filling pressure decrease. Although the right ventricular ejection fraction increased with exercise, it decreased again at the maximal load after training. For a given work rate the arterial lactate, the norepinephrine (NE) and epinephrine (E) concentrations fell after training, but the enhanced maximal work rate elicited higher NE and E concentrations (4396 and 1848 pg x mL(-1), respectively). The lack of right ventricular unloading might have kept the atrial natriuretic peptide higher after training, but the blood cyclic GMP and endothelin were lower after training.
  
  
  CONCLUSIONS
  In an LVAD patient, retraining returns the exercise capacity to the class III level by peripheral and left ventricular hemodynamic improvements, but the safety of maximal exercise remains to be proven in terms of right ventricular function and orthosympathetic drive.
authors.affiliation: Jeune Equipe 2105, Faculté de Médecine, Strasbourg, France. Bertrand.Mettauer@physio-ulp.u-strasbg.fr
authors.forename: B
authors.initials: B
authors.lastname: Mettauer
authors.forename: B
authors.initials: B
authors.lastname: Geny
authors.forename: E
authors.initials: E
authors.lastname: Lonsdorfer-Wolf
authors.forename: A
authors.initials: A
authors.lastname: Charloux
authors.forename: Q M
authors.initials: QM
authors.lastname: Zhao
authors.forename: B
authors.initials: B
authors.lastname: Heitz-Naegelen
authors.forename: E
authors.initials: E
authors.lastname: Epailly
authors.forename: E
authors.initials: E
authors.lastname: Lampert
authors.forename: F
authors.initials: F
authors.lastname: Levy
authors.forename: J
authors.initials: J
authors.lastname: Lonsdorfer
mesh_terms: D009202:Cardiomyopathies / Q000378:metabolism / Q000503:physiopathology / Q000628:therapy*; D015444:Exercise / Q000502:physiology*; D006353:Heart-Assist Devices; D006439:Hemodynamics / Q000502:physiology*; D006728:Hormones / Q000378:metabolism / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged
chemical_list: D006728:Hormones