Introduction)
Heart transplantation (HT) is known to be the treatment of choice for advanced heart failure patients, but their exercise capacity remains under aged-predicted value after HT. Cardiac rehabilitation (CR) is a multifactorial rehabilitation program and many current studies described the effectiveness of CR in HT recipients. However, in Korea, there is a lack of research on CR in HT recipients. Moreover, recent systematic review of CR shows that long-term follow-up data is insufficient. Therefore, an evidence for the long-term effects of CR is lack in HT recipients. In this case report, we present objective findings of the benefits of CR in a HT recipient and the serial follow-up data for 1 year.
Case report)
A 48-year old female visited our CR clinic, due to dyspnea on exertion after HT. She was diagnosed with dilated cardiomyopathy and received HT on June 22, 2018. When she first visited our CR clinic at one month after HT, she needed a wheel chair for travelling a long distance and had to stop for breath when walking at her own pace. We prescribed phase I CR program for 1 month and each CR session was performed five times per week with 10 minutes warm-up exercise, 30 minutes main aerobic and 10 minutes cool-down exercise. The exercise intensity corresponded to 60% of heart rate reserve (HRR) measured by initial cardiopulmonary exercise test (CPX). We used both bicycle and treadmill with moderate intensity continuous training (MICT) protocol. After 1 month CR, we changed the protocol to high intensity interval training (HAIT). HAIT protocol was performed for 50 minutes using treadmill and consisted of 4 minutes interval training period at 85% of HRR and 3 minutes active rest period at 40-60% of HRR. After phase I CR period for 67 days, we recommended the phase II CR, but the patient refused outpatient CR. So we prescribed a home exercise CR program five times a week, once a day. One year after HT, VO2max increased from 12.3 ml/kg/min to 22.8 ml/kg/min and chronotropic incompetence recovered after CR. The 6-minute walk test result increased from 281 meters to 520 meters (Table 1). Furthermore, pulmonary function parameters, grip power, leg strength, skeletal muscle mass and phase angle value improved after the CR program (Table 2, 3).
Conclusion)
This case showed that CR programs with the HAIT protocol can be successfully performed in HT recipients and showed objective improvements in muscle strength, pulmonary function and exercise capacity. In the future, we need a large-scale, prospective study of CR in Korean HT recipients.
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