From Continuous-Flow Mechanical Circulatory Support to Heart Transplantation: Hemodynamic, Immunometabolic, and Body Composition Determinants of Rehabilitation Outcomes
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Le résumé fourni par la source
Background: Continuous-flow left ventricular assist devices (LVADs) and heart transplantation (HTX) improve survival and quality of life in advanced heart failure. However, restoration of central hemodynamics does not consistently normalize exercise capacity, physical performance, or body composition. Persistent skeletal muscle dysfunction, endothelial abnormalities, metabolic disturbances, and adverse body composition changes frequently limit functional recovery. Methods: This narrative review examines determinants of rehabilitation outcomes across the transition from advanced heart failure to LVAD support and subsequent HTX. Particular emphasis is placed on restoration of pulsatile circulation, vascular and microcirculatory adaptation, immunosuppressive therapy, body composition remodeling, and emerging immunometabolic mechanisms. Results: Rehabilitation outcomes appear to be increasingly determined by peripheral rather than central cardiovascular factors. Continuous-flow LVAD support induces vascular, endothelial, autonomic, and microcirculatory adaptations that may persist after transplantation. Although HTX restores physiological pulsatile circulation and cardiac output, recovery is often limited by skeletal muscle dysfunction, impaired mitochondrial capacity, chronotropic abnormalities, and adverse body composition changes. Immunosuppressive therapies further influence muscle plasticity, adipose tissue distribution, insulin sensitivity, endothelial function, and exercise adaptation, contributing to phenotypes such as sarcopenia, myosteatosis, and sarcopenic obesity. Conclusions: Functional recovery after LVAD support and HTX is a multidimensional process extending beyond restoration of cardiac function. We propose a hemodynamic–immunometabolic framework in which vascular adaptation, skeletal muscle biology, body composition remodeling, and immunosuppressive therapy interact to determine rehabilitation success and may inform personalized rehabilitation strategies.
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Le contrôle bibliographique ouvert
DOI retrouvé dans Crossref DOI retrouvé ; titre concordant.
- Titre Crossref
- From Continuous-Flow Mechanical Circulatory Support to Heart Transplantation: Hemodynamic, Immunometabolic, and Body Composition Determinants of Rehabilitation Outcomes
- Date Crossref
- 07/07/2026
- Éditeur
- MDPI AG
- Type
- journal-article
Ce recoupement confirme des métadonnées liées au DOI. Il ne confirme ni la méthode ni les conclusions de l’étude, et il ne compte pas comme une seconde source scientifique indépendante.
Où se fait cette recherche
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University of Physical Culture in Kraków pays non établi dans la noticeUniversité ou école supérieure
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Hungarian University of Sports Science pays non établi dans la noticeUniversité ou école supérieure
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Postgraduate School of Molecular Medicine pays non établi dans la noticeStructure de recherche
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Poznan University of Medical Sciences Cardiac Surgery and Transplantology Department pays non établi dans la noticeUniversité ou école supérieure
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Faculty of Health Sciences Department of Sport Medicine and Traumatology pays non établi dans la noticeUniversité ou école supérieure
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The Center of Postgraduate Medical Education pays non établi dans la noticeInstitution
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Poznan University of Physical Education Department of Athletics pays non établi dans la noticeUniversité ou école supérieure
University of Physical Culture in Kraków, Hungarian University of Sports Science et Postgraduate School of Molecular Medicine, avec 4 autres affiliations.
Une affiliation ne permet pas de déduire la nationalité d’un auteur.