Cardiac transplant and exercise cardiac rehabilitation.
Ray W SquiresPublished in: Heart failure reviews (2023)
Cardiac transplantation is the final therapeutic option for patients with end-stage heart failure. Most patients experience a favorable functional ability post-transplant. However, episodes of acute rejection, and multiple comorbidities such as hypertension, diabetes mellitus, chronic kidney disease and cardiac allograft vasculopathy are common. The number of transplants has increased steadily over the past two decades with 3,817 operations performed in the United States in 2021. Patients have abnormal exercise physiologic responses related to surgical cardiac denervation, diastolic dysfunction, and the legacy of reduced skeletal muscle oxidative capacity and impaired peripheral and coronary vasodilatory reserve resulting from pre-transplant chronic heart failure. Cardiorespiratory fitness is below normal for most patients with a mean peak VO 2 of approximately 60% of predicted for healthy persons. Cardiac transplant recipients are therefore excellent candidates for Exercise-Based Cardiac Rehabilitation (CR). CR is safe and is a recommendation of professional societies both before (pre-rehabilitation) and after transplantation. CR improves peak VO 2 , autonomic function, quality of life, and skeletal muscle strength. Exercise training reduces the severity of cardiac allograft vasculopathy, stroke risk, percutaneous coronary intervention, hospitalization for either acute rejection or heart failure, and death. However, there are deficits in our knowledge regarding CR for women and children. In addition, the use of telehealth options for the provision of CR for cardiac transplant patients requires additional investigation.
Keyphrases
- end stage renal disease
- chronic kidney disease
- left ventricular
- heart failure
- ejection fraction
- skeletal muscle
- percutaneous coronary intervention
- newly diagnosed
- blood pressure
- peritoneal dialysis
- prognostic factors
- coronary artery disease
- healthcare
- acute myocardial infarction
- physical activity
- patient reported outcomes
- type diabetes
- atrial fibrillation
- high intensity
- heart rate
- traumatic brain injury
- coronary artery bypass grafting
- pregnant women
- liver failure
- aortic stenosis
- drug induced
- pregnancy outcomes
- intensive care unit
- coronary artery
- adipose tissue
- metabolic syndrome
- blood brain barrier
- st segment elevation myocardial infarction
- respiratory failure
- body composition
- palliative care
- st elevation myocardial infarction