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The total artificial heart (TAH) consists of two implantable pneumatic pumps that replace the heart and operate at a fixed ejection rate and ejection pressure. We evaluated the blood pressure (BP) response to exercise and exercise performance in patients with a TAH compared to those with a with a continuous-flow left ventricular assist device (LVAD).We conducted a single-center, retrospective study of 37 patients who received a TAH and 12 patients implanted with an LVAD. We measured the BP response during exercise, exercise duration and change in tolerated exercise workload over an 8-week period.In patients with a TAH, baseline BP was 120/69 ± 13/13, exercise BP was 118/72 ± 15/10 and post-exercise BP was 120/72 ± 14/12. Mean arterial BP did not change with exercise in patients with a TAH (88 ± 10 vs 88 ± 11; p = 0.8), but increased in those with an LVAD (87 ± 8 vs 95 ± 13; p0.001). Although the mean arterial BP (MAP) was negatively correlated with metabolic equivalents (METs) achieved during exercise, the association was not statistically significant (β = -0.1, p = 0.4). MAP correlated positively with METs achieved in patients with LVADs (MAP: β = 0.26, p = 0.04). Despite the abnormal response to exercise, patients with a TAH participated in physical therapy (median: 5 days; interquartile range [IQR] 4 to 7 days) and treadmill exercise (19 days; IQR: 13 to 35 days) early after device implantation, with increased exercise intensity and duration over time.During circulatory support with a TAH, the BP response to exercise was blunted. However, aerobic exercise training early after device implantation was found to be safe and feasible in a supervised setting.

Diffusion-weighted imaging (DWI) is an advanced magnetic resonance imaging technique, based on the analysis of thermallydependent movement of water molecules in the extracellular space. This method allows to examine pathological changes at the cellular level which are not visible on conventional magnetic resonance (MR). Apparent diffusion coefficient (ADC) is a mathematically calculated value indicating the diffusion. Reduced ADC value demonstrates a restricted diffusion while increased ADC value indicates a facilitated diffusion. Aim: The aim of this study was to assess changes in ADC values within normal appearing white matter (NAWM) and normal appearing gray matter (NAGM) in patients with MS before initiating the treatment with IFN-Beta and already in the course of treatment, in comparison with a control group. Material and Methods: The study comprised 84 patients divided into three groups: patients with MS before initiating the therapy with IFN-Beta (MS0, n = 28: 22 women, 6 men; average age: 28.8), patients with MS after at least one year of treatment with IFN-Beta (MS1, n = 28: 22 women, 6 men; average age: 30.2) and a control group of patients with no intracranial pathology (CG, n = 28: 20 women, 8 men; average age: 29.8). ADC was measured in 11 regions of interest (ROIs), as follows: 1, 2 − cerebellum at the level of dentate nuclei, 3 − pons, 4, 5 − thalamus, 6, 7 − caudate nuclei, 8, 9 − frontal white matter regions, 10, 11 − fronto-parietal white matter at the convexity. The results were compared between the groups. The study was performed using a 1.5T GE MRI scanner. DWI sequence was performed with the following parametres: b = 0 and b = 1000, TR=8000, TE=81.2, slice thickness = 4mm. Results: In the examined areas of brain, in ROIs: 8 and 9 the ADC values were statistically significantly higher in MS0 group in comparison with CG (p< 0.01). There were no significant differences in ADC values in ROIs: 8 and 9 between MS1 and CG. However, in ROI 6 the ADC values were significantly lower (p< 0.01), while in ROIs: 10 and 11 significantly higher (p< 0.01) in MS1 group in comaprison with CG. No other statistically significant differences were found between groups: MS0 and CG, MS1 and CG, as well as MS0 and MS1. Conclusions: Increased ADC values in NAWM of the frontal lobes in patients with MS before initiating the treatment with IFN-Beta may indicate early axonopathy, in the course of which diffusion is facilitated. Normalization of ADC values in this region after several months of treatment with IFN-Beta as well as decrease in ADC values in NAGM of right caudate nucleus may indicate a decrease of the diffusion and delay in the axonal damage as a result of immunomodulatory treatment.