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Hansen D, Beckers P, Neunhäuserer D, Bjarnason-Wehrens B, Piepoli MF, Rauch B, Völler H, Corrà U, Garcia-Porrero E, Schmid JP, Lamotte M, Doherty P, Reibis R, Niebauer J, Dendale P, Davos CH, Kouidi E, Spruit MA, Vanhees L, Cornelissen V, Edelmann F, Barna O, Stettler C, Tonoli C, Greco E, Pedretti R, Abreu A, Ambrosetti M, Braga SS, Bussotti M, Faggiano P, Takken T, Vigorito C, Schwaab B, Coninx K. Standardised Exercise Prescription for Patients with Chronic Coronary Syndrome and/or Heart Failure: A Consensus Statement from the EXPERT Working Group. Sports Med 2023; 53:2013-2037. [PMID: 37648876 DOI: 10.1007/s40279-023-01909-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/08/2023] [Indexed: 09/01/2023]
Abstract
Whereas exercise training, as part of multidisciplinary rehabilitation, is a key component in the management of patients with chronic coronary syndrome (CCS) and/or congestive heart failure (CHF), physicians and exercise professionals disagree among themselves on the type and characteristics of the exercise to be prescribed to these patients, and the exercise prescriptions are not consistent with the international guidelines. This impacts the efficacy and quality of the intervention of rehabilitation. To overcome these barriers, a digital training and decision support system [i.e. EXercise Prescription in Everyday practice & Rehabilitative Training (EXPERT) tool], i.e. a stepwise aid to exercise prescription in patients with CCS and/or CHF, affected by concomitant risk factors and comorbidities, in the setting of multidisciplinary rehabilitation, was developed. The EXPERT working group members reviewed the literature and formulated exercise recommendations (exercise training intensity, frequency, volume, type, session and programme duration) and safety precautions for CCS and/or CHF (including heart transplantation). Also, highly prevalent comorbidities (e.g. peripheral arterial disease) or cardiac devices (e.g. pacemaker, implanted cardioverter defibrillator, left-ventricular assist device) were considered, as well as indications for the in-hospital phase (e.g. after coronary revascularisation or hospitalisation for CHF). The contributions of physical fitness, medications and adverse events during exercise testing were also considered. The EXPERT tool was developed on the basis of this evidence. In this paper, the exercise prescriptions for patients with CCS and/or CHF formulated for the EXPERT tool are presented. Finally, to demonstrate how the EXPERT tool proposes exercise prescriptions in patients with CCS and/or CHF with different combinations of CVD risk factors, three patient cases with solutions are presented.
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Affiliation(s)
- Dominique Hansen
- Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium.
- UHasselt, BIOMED (Biomedical Research Institute) and REVAL (Rehabilitation Research Centre) (REVAL/BIOMED), Hasselt University, Agoralaan Building A, 3590, Diepenbeek, Belgium.
| | - Paul Beckers
- Department of Cardiology, Antwerp University Hospital, Edegem, Belgium
- Translational Pathophysiological Research, Antwerp University, Antwerp, Belgium
| | - Daniel Neunhäuserer
- Sport and Exercise Medicine Division, Department of Medicine, University of Padova, Padua, Italy
| | - Birna Bjarnason-Wehrens
- Department of Preventive and Rehabilitative Sport and Exercise Medicine, Institute for Cardiology and Sports Medicine, German Sports University, Cologne, Germany
| | - Massimo F Piepoli
- Clinical Cardiology, IRCCS Policlinico San Donato, Milan, Italy
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Bernhard Rauch
- Institut für Herzinfarktforschung Ludwigshafen, Ludwigshafen am Rhein/Stiftung Institut für Herzinfarktforschung Ludwigshafen, Ludwigshafen am Rhein/Zentrum für Ambulante Rehabilitation, ZAR Trier, Trier, Germany
| | - Heinz Völler
- Department of Cardiology, Klinik am See, Rüdersdorf, Germany
- Center of Rehabilitation Research, University of Potsdam, Potsdam, Germany
| | - Ugo Corrà
- Cardiologic Rehabilitation Department, Istituti Clinici Scientifici Salvatore Maugeri, SPA, SB, Scientific Institute of di Veruno, IRCCS, Veruno, NO, Italy
| | | | - Jean-Paul Schmid
- Department of Cardiology, Clinic Barmelweid, Barmelweid, Switzerland
| | | | | | - Rona Reibis
- Cardiological Outpatient Clinics at the Park Sanssouci, Potsdam, Germany
| | - Josef Niebauer
- Institute of Sports Medicine, Prevention and Rehabilitation, Research Institute of Molecular Sports Medicine and Rehabilitation, Rehab-Center Salzburg, Ludwig Boltzmann Institute for Digital Health and Prevention, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Paul Dendale
- Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium
- UHasselt, BIOMED (Biomedical Research Institute) and REVAL (Rehabilitation Research Centre) (REVAL/BIOMED), Hasselt University, Agoralaan Building A, 3590, Diepenbeek, Belgium
| | - Constantinos H Davos
- Cardiovascular Research Laboratory, Biomedical Research Foundation, Academy of Athens, Athens, Greece
| | - Evangelia Kouidi
- Laboratory of Sports Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Martijn A Spruit
- UHasselt, BIOMED (Biomedical Research Institute) and REVAL (Rehabilitation Research Centre) (REVAL/BIOMED), Hasselt University, Agoralaan Building A, 3590, Diepenbeek, Belgium
- Department of Research & Education; CIRO+, Centre of Expertise for Chronic Organ Failure, Horn/Department of Respiratory Medicine, Maastricht University Medical Centre, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht, The Netherlands
| | - Luc Vanhees
- Research Group of Cardiovascular Rehabilitation, Department of Rehabilitation Sciences, Faculty of Kinesiology and Rehabilitation Sciences, KU Leuven, Leuven, Belgium
- Department Rehabilitation Sciences, University Leuven, Leuven, Belgium
| | - Véronique Cornelissen
- Research Group of Cardiovascular Rehabilitation, Department of Rehabilitation Sciences, Faculty of Kinesiology and Rehabilitation Sciences, KU Leuven, Leuven, Belgium
- Department Rehabilitation Sciences, University Leuven, Leuven, Belgium
| | - Frank Edelmann
- Department of Cardiology, Angiology and Intensive Care, Deutsches Herzzentrum der Charité (DHZC), Charité-Universitaetsmedizin Berlin, Campus Virchow Klinikum, Berlin, Germany
| | - Olga Barna
- Family Medicine Department, National O.O. Bogomolets Medical University, Kiev, Ukraine
| | - Christoph Stettler
- Division of Endocrinology, Diabetes and Clinical Nutrion, University Hospital/Inselspital, Bern, Switzerland
| | - Cajsa Tonoli
- Movement Control and Neuroplasticity Research Group, Department of Movement Sciences, Faculty of Movement and Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | | | | | - Ana Abreu
- Centre of Cardiovascular RehabilitationCardiology Department, Centro Universitário Hospitalar Lisboa Norte & Faculdade de Medicina da Universidade Lisboa/Instituto Saúde Ambiental & Instituto Medicina Preventiva, Faculdade Medicina da Universidade Lisboa/CCUL/CAML, Lisbon, Portugal
| | - Marco Ambrosetti
- Cardiovascular Rehabilitation Unit, Le Terrazze Clinic, Cunardo, Italy
| | | | - Maurizio Bussotti
- Unit of Cardiorespiratory Rehabilitation, Instituti Clinici Maugeri, IRCCS, Institute of Milan, Milan, Italy
| | | | - Tim Takken
- Division of Pediatrics, Child Development & Exercise Center, Wilhelmina Children's Hospital, UMC Utrecht, Utrecht, The Netherlands
| | - Carlo Vigorito
- Department of Translational Medical Sciences, Internal Medicine and Cardiac Rehabilitation, University of Naples Federico II, Naples, Italy
| | - Bernhard Schwaab
- Curschmann Clinic, Rehabilitation Center for Cardiology, Vascular Diseases and Diabetes, Timmendorfer Strand/Medical Faculty, University of Lübeck, Lübeck, Germany
| | - Karin Coninx
- UHasselt, Faculty of Sciences, Human-Computer Interaction and eHealth, Hasselt University, Hasselt, Belgium
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Krychtiuk KA, Ahrens I, Drexel H, Halvorsen S, Hassager C, Huber K, Kurpas D, Niessner A, Schiele F, Semb AG, Sionis A, Claeys MJ, Barrabes J, Montero S, Sinnaeve P, Pedretti R, Catapano A. Acute LDL-C reduction post ACS: strike early and strike strong: from evidence to clinical practice. A clinical consensus statement of the Association for Acute CardioVascular Care (ACVC), in collaboration with the European Association of Preventive Cardiology (EAPC) and the European Society of Cardiology Working Group on Cardiovascular Pharmacotherapy. Eur Heart J Acute Cardiovasc Care 2022; 11:939-949. [PMID: 36574353 DOI: 10.1093/ehjacc/zuac123] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 10/02/2022] [Indexed: 12/28/2022]
Abstract
After experiencing an acute coronary syndrome (ACS), patients are at a high risk of suffering from recurrent ischaemic cardiovascular events, especially in the very early phase. Low density lipoprotein-cholesterol (LDL-C) is causally involved in atherosclerosis and a clear, monotonic relationship between pharmacologic LDL-C lowering and a reduction in cardiovascular events post-ACS has been shown, a concept termed 'the lower, the better'. Current ESC guidelines suggest an LDL-C guided, step-wise initiation and escalation of lipid-lowering therapy (LLT). Observational studies consistently show low rates of guideline-recommended LLT adaptions and concomitant low rates of LDL-C target goal achievement, leaving patients at residual risk, especially in the vulnerable post-ACS phase. In addition to the well-established 'the lower, the better' approach, a 'strike early and strike strong' approach in the early post-ACS phase with upfront initiation of a combined lipid-lowering approach using high-intensity statins and ezetimibe seems reasonable. We discuss the rationale, clinical trial evidence and experience for such an approach and highlight existing knowledge gaps. In addition, the concept of acute initiation of PCSK9 inhibition in the early phase is reviewed. Ultimately, we focus on hurdles and solutions to provide high-quality, evidence-based follow-up care in post-ACS patients.
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Affiliation(s)
- Konstantin A Krychtiuk
- Department of Internal Medicine II-Division of Cardiology, Medical University of Vienna, 1180 Vienna, Austria.,Duke Clinical Research Institute, Durham, NC 27701, USA
| | - Ingo Ahrens
- Department of Cardiology and Medical Intensive Care, Augustinerinnen Hospital Cologne, Academic Teaching Hospital University of Cologne, 50678 Cologne, Germany
| | - Heinz Drexel
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Carinagasse 47, AT-6800 Feldkirch, Austria.,Private University of the Principality of Liechtenstein, Dorfstrasse 24, FL-9495 Triesen, Liechtenstein.,Department of Medicine I, Academic Teaching Hospital Feldkirch, Carinagasse 47, AT-6800 Feldkirch, Austria
| | - Sigrun Halvorsen
- Institute of Clinical Medicine, University of Oslo, 0372 Oslo, Norway.,Department of Cardiology, Oslo University Hospital Ullevål, Oslo, Norway
| | - Christian Hassager
- Department of Cardiology, Rigshospitalet and Department of Clinical Medicine, University of Copenhagen, 2100 Copenhagen, Denmark
| | - Kurt Huber
- 3rd Department of Internal Medicine, Cardiology and Intensive Care Unit, Wilhelminenhospital, 1160 Vienna, Austria.,Ludwig Boltzmann Institute for Cardiovascular Research, 1090 Vienna, Austria.,Medical School, Sigmund Freud University, 1020 Vienna, Austria
| | - Donata Kurpas
- Family Medicine Department, Wroclaw Medical University, 50-367 Wroclaw, Poland
| | - Alexander Niessner
- Department of Internal Medicine II-Division of Cardiology, Medical University of Vienna, 1180 Vienna, Austria
| | - Francois Schiele
- Department of Cardiology, University Hospital Besancon, University of Franche-Comté, France and EA3920, Besancon, France
| | - Anne Grete Semb
- Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Division of Innovation and Research, Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
| | - Alessandro Sionis
- Intensive Cardiac Care Unit, Cardiology Department, Hospital de Sant Pau, IIB-Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain.,CIBER-CV, Centro de investigación Biomédica en Red de Enfermedades Cardiovasculares, 28029 Madrid, Spain
| | - Marc J Claeys
- Department of Cardiology, Antwerp University Hospital, 2650 Edegem, Belgium
| | - José Barrabes
- Acute Cardiac Care Unit, Cardiology Service, Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Barcelona, Spain.,CIBERC-V, Centro de investigación Biomédica en Red de Enfermedades Cardiovasculares, Madrid, Spain
| | - Santiago Montero
- Acute Cardiovascular Care Unit, Cardiology, Hospital Germans Trias i Pujol. Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Peter Sinnaeve
- Department of Cardiology, University Hospital Leuven, Leuven, Belgium
| | - Roberto Pedretti
- Director of Cardiovascular Department, Head of Cardiology Unit, IRCCS MultiMedica, Milan, Italy
| | - Alberico Catapano
- Professor of Pharmacology, Director Center of Epidemiology and Preventive Pharmacology, Director Laboratory of Lipoproteins, Immunity and Atherosclerosis Department of Pharmacological and Biomolecular Sciences Director Center for the Study of Atherosclerosis at Bassini Hospital University of Milan, Milan, Italy
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3
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Hansen D, Abreu A, Ambrosetti M, Cornelissen V, Gevaert A, Kemps H, Laukkanen JA, Pedretti R, Simonenko M, Wilhelm M, Davos CH, Doehner W, Iliou MC, Kränkel N, Völler H, Piepoli M. Exercise intensity assessment and prescription in cardiovascular rehabilitation and beyond: why and how: a position statement from the Secondary Prevention and Rehabilitation Section of the European Association of Preventive Cardiology. Eur J Prev Cardiol 2022; 29:230-245. [PMID: 34077542 DOI: 10.1093/eurjpc/zwab007] [Citation(s) in RCA: 97] [Impact Index Per Article: 48.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 01/02/2021] [Accepted: 01/08/2021] [Indexed: 12/12/2022]
Abstract
A proper determination of the exercise intensity is important for the rehabilitation of patients with cardiovascular disease (CVD) since it affects the effectiveness and medical safety of exercise training. In 2013, the European Association of Preventive Cardiology (EAPC), together with the American Association of Cardiovascular and Pulmonary Rehabilitation and the Canadian Association of Cardiac Rehabilitation, published a position statement on aerobic exercise intensity assessment and prescription in cardiovascular rehabilitation (CR). Since this publication, many subsequent papers were published concerning the determination of the exercise intensity in CR, in which some controversies were revealed and some of the commonly applied concepts were further refined. Moreover, how to determine the exercise intensity during resistance training was not covered in this position paper. In light of these new findings, an update on how to determine the exercise intensity for patients with CVD is mandatory, both for aerobic and resistance exercises. In this EAPC position paper, it will be explained in detail which objective and subjective methods for CR exercise intensity determination exist for aerobic and resistance training, together with their (dis)advantages and practical applications.
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Affiliation(s)
- Dominique Hansen
- Department of Cardiology, Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium
- UHasselt, Faculty of Rehabilitation Sciences, BIOMED-REVAL-Rehabilitation Research Centre, Hasselt University, Agoralaan, Building A, 3590 Hasselt, Belgium
| | - Ana Abreu
- Cardiology Department, Hospital Universitário de Santa Maria/Centro Académico de Medicina de Lisboa (CAML), Exercise and Cardiovascular Rehabilitation Laboratory, Centro Cardiovascular da Universidade de Lisboa (CCUL), Lisbon, Portugal
| | - Marco Ambrosetti
- Cardiac Rehabilitation Unit, ASST Ospedale Maggiore Crema, Crema, Italy
| | - Veronique Cornelissen
- Research Unit of Cardiovascular Exercise Physiology, Department of Rehabilitation Sciences, Faculty of Kinesiology and Rehabilitation Sciences, KU Leuven, Belgium
| | - Andreas Gevaert
- Research Group Cardiovascular Diseases, GENCOR Department, University of Antwerp, Antwerp, Belgium
- Department of Cardiology, Antwerp University Hospital (UZA), Belgium
| | - Hareld Kemps
- Department of Cardiology, Maxima Medical Centre, Veldhoven, The Netherlands
- Department of Industrial Design, Eindhoven University of Technology, Eindhoven, The Netherlands
- Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Jari A Laukkanen
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
- Cardiovascular Department, IRCCS MultiMedica, Care and Research Institute, Sesto San Giovanni, Milano, Italy
| | - Roberto Pedretti
- Heart Transplantation Outpatient Department, Cardiopulmonary Exercise Test Research Department, Almazov National Medical Research Centre, St. Petersburg, Russia
| | - Maria Simonenko
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Matthias Wilhelm
- Cardiovascular Research Laboratory, Biomedical Research Foundation, Academy of Athens, Athens, Greece
| | - Constantinos H Davos
- BCRT-Berlin Institute of Health Center for Regenerative Therapies, Department of Cardiology (Virchow Klinikum), Charité - Universitätsmedizin Berlin, Partner Site Berlin, Germany
| | - Wolfram Doehner
- Cardiac Rehabilitation and Secondary Prevention Department, Corentin Celton Hospital, Assistance Publique Hopitaux de Paris Centre Université de Paris, Paris, France
- German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin D-1220, Germany
| | - Marie-Christine Iliou
- Charité - University Medicine Berlin, Campus Benjamin Franklin, Department of Cardiology, Hindenburgdamm 30, 12203 Berlin, Germany
| | - Nicolle Kränkel
- German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin D-1220, Germany
- Klinik am See, Rehabilitation Centers for Internal Medicine, Berlin, Germany
| | - Heinz Völler
- Department of Rehabilitation Medicine, University of Potsdam, Potsdam, Germany
- Heart Failure Unit, G. da Saliceto Hospital, AUSL Piacenza and University of Parma, Parma, Italy
| | - Massimo Piepoli
- Heart Failure Unit, G. da Saliceto Hospital, AUSL Piacenza and University of Parma, Parma, Italy
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4
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Mureddu GF, Ambrosetti M, Venturini E, La Rovere MT, Mazza A, Pedretti R, Sarullo F, Fattirolli F, Faggiano P, Giallauria F, Vigorito C, Angelino E, Brazzo S, Ruzzolini M. Cardiac rehabilitation activities during the COVID-19 pandemic in Italy. Position Paper of the AICPR (Italian Association of Clinical Cardiology, Prevention and Rehabilitation). Monaldi Arch Chest Dis 2020; 90. [DOI: 10.4081/monaldi.2020.1439] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 06/10/2020] [Indexed: 11/23/2022] Open
Abstract
The COVID-19 outbreak is having a significant impact on both cardiac rehabilitation (CR) inpatient and outpatient healthcare organization. The variety of clinical and care scenarios we are observing in Italy depends on the region, the organization of local services and the hospital involved. Some hospital wards have been closed to make room to dedicated beds or to quarantine the exposed health personnel. In other cases, CR units have been converted or transformed into COVID-19 units. The present document aims at defining the state of the art of CR during COVID-19 pandemic, through the description of the clinical and management scenarios frequently observed during this period and the exploration of the future frontiers in the management of cardiac rehabilitation programs after the COVID-19 outbreak.
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5
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Giardini A, Traversi E, Paneroni M, Mazza A, Passantino A, Traversoni S, Pedretti R, Spanevello A, Vitacca M. Cardio-respiratory International Classification of Functioning, Disability and Health sets for inpatient rehabilitation: from theory to practice. Eur J Phys Rehabil Med 2019; 56:252-254. [PMID: 31797657 DOI: 10.23736/s1973-9087.19.05384-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Anna Giardini
- Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy -
| | | | - Mara Paneroni
- Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy
| | - Antonio Mazza
- Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy
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Paneroni M, Scalvini S, Simonelli C, Rivadossi F, Pavesi C, Rainoldi F, Lovagnini M, La Rovere MT, Ambrosetti M, Pedretti R. P2261The impact of a short-term cardiac rehabilitation program on activities of daily living in elderly patients with chronic heart failure. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
A high proportion of elderly patients with Chronic Heart Failure (CHF) experience dyspnea and fatigue during the activities of daily living (ADLs).
Purpose
We aimed to determine 1) the VO2 peak of some basic ADLs comparing it to VO2 peak at CardioPulmonary Exercise Test (CPET) and 2) the effects of 3-week inpatient cardiac rehabilitation program on ADLs' performance.
Methods
At entry and at the end of a 20-day cardiac rehabilitation program patients performed an ADL-test consisting of five task-related ADL activities and two time-related ADL activities while wearing a metabolimeter mobile device (K5, Cosmed). Task-related activities were: 1) to put on and take off socks, shoes and jacket (ADL 1); 2) to fold eight towels (ADL 2); 3) to put 6 bottles on a shelve (ADL 3); 4) to make a bed (ADL 4); 5) to go up and down 1-floor stairs (ADL 5). Time-related ADL activities were: 1) to sweep the floor for 4 minutes (ADL 6) and 2) to walk for six minute (6MWT). Metabolic load, oxygen uptake, ventilation, heart rate and symptom of dyspnea were computed for each ADL. During the program, patients performed a CPET.
Results
Fifty-six CHF patients [89% men; age 72±6 years; Ejection Fraction (EF) 38±12%; 66% with EF<40%] were enrolled. At entry, the least demanding ADL [expressed as proportion of peak oxygen uptake (VO2 peak) reached at CPET] was ADL 3 with 53,14±18.53%, while the most challenging was the 6MWT with 116.81±34.48%. Forty-two (75%) patients reached the VO2peak of CPET during 6MWT. After rehabilitation, there was a significant decrease in the time required to perform the task-related activities (ADL 1–5) [from 382.25±114.90 to 354.48±116.92 seconds, p=0.0175] and a significant increase in the distance covered during 6MWT [from 421.35±81.64 to 448.84±89.69 meters, p=0.000]. Moreover, following rehabilitation a significant decrease of heart rate in ADL1, ADL 3 and ADL 5 and a significant decrease of dyspnea in ADL 5, ADL 6 and 6MWT was recorded.
Conclusion
A comprehensive cardiac rehabilitation program can improve ADL performance due to the change of some physiological variables during effort. Further studies about the role of dedicated rehabilitation program (i.e. occupational rehab) are necessary.
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7
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Giardini A, Vitacca M, Pedretti R, Nardone A, Chiovato L, Spanevello A. [Linking the ICF codes to clinical real-life assessments: the challenge of the transition from theory to practice]. G Ital Med Lav Ergon 2019; 41:78-104. [PMID: 31170337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 05/31/2019] [Indexed: 06/09/2023]
Abstract
According to the latest WHO guidelines, the ICD-ICF joint use currently represents the most agreed method to portray a patient's Care Pathway during a hospitalization. On this note, ICS Maugeri carried out an internal project aiming to identify the ICF codes that better describe the rehabilitation pathways in its Italian Institutes. 2 main goals so far have been achieved: 1. To re-conceptualize the Care Pathways thought the lenses of the ICD-ICF frameworks; 2. To link, whenever possible and by means of the WHO-ICF linking rules, each pertinent ICF code to the most appropriate assessment method, harmonizing its outputs to the 0-4 ICF Likert scale. The current project represents a first attempt towards the creation of a standard functioning assessment methodology to be implemented in rehabilitation settings. Despite being referred to the Maugeri group only, the ICD-ICF procedure described could hopefully be extended to other settings, representing a support for health information technologies.
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8
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Scalvini S, Grossetti F, Paganoni AM, La Rovere MT, Pedretti R, Frigerio M. P6060Cardiac rehabilitation referral in lombardy region: a population study on incident cases from 2005 to 2012. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p6060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- S Scalvini
- Istituti Clinici Scientifici Maugeri, IRCCS, Cardiology Rehabilitation Department, Lumezzane, Brescia, Italy
| | - F Grossetti
- Università Bocconi, Department of Accounting, Milan, Italy
| | - A M Paganoni
- Politecnico di Milano, Department of Mathematics, Milan, Italy
| | - M T La Rovere
- Istituti Clinici Scientifici Maugeri, IRCCS, Cardiology Rehabilitation Department, Montescano, Pavia, Italy
| | - R Pedretti
- Istituti Clinici Scientifici Maugeri, IRCCS, Pavia, Italy
| | - M Frigerio
- Niguarda Ca' Granda Hospital, De Gasperis Cardiocenter, Milan, Italy
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9
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Ferlini M, Musumeci G, Grieco N, Rossini R, Demarchi A, Cornara S, Somaschini A, Colombo P, Cardile A, Calchera I, Marino M, Ielasi A, Pedretti R, Lettieri C, Oltrona Visconti L. 2227Perceived or calculated bleeding risk in patients undergoing percutaneous coronary intervention: inside the post-pci prospective registry. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.2227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- M Ferlini
- Policlinic Foundation San Matteo IRCCS, Pavia, Italy
| | - G Musumeci
- Santa Croce E Carle Hospital, Cuneo, Italy
| | - N Grieco
- Niguarda Ca' Granda Hospital, Milan, Italy
| | - R Rossini
- Santa Croce E Carle Hospital, Cuneo, Italy
| | - A Demarchi
- Foundation IRCCS Polyclinic San Matteo - University of Pavia, Pavia, Italy
| | - S Cornara
- Foundation IRCCS Polyclinic San Matteo - University of Pavia, Pavia, Italy
| | - A Somaschini
- Foundation IRCCS Polyclinic San Matteo - University of Pavia, Pavia, Italy
| | - P Colombo
- Niguarda Ca' Granda Hospital, Milan, Italy
| | - A Cardile
- AO Ospedale Treviglio, Treviglio, Italy
| | | | - M Marino
- Maggiore Hospital of Crema, Crema, Italy
| | - A Ielasi
- Bolognini Hospital, Seriate, Italy
| | - R Pedretti
- Fondazione Salvatore Maugeri, Tradate, Italy
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Poli A, Barbagallo CM, Cicero AF, Corsini A, Manzato E, Trimarco B, Bernini F, Visioli F, Bianchi A, Canzone G, Crescini C, de Kreutzenberg S, Ferrara N, Gambacciani M, Ghiselli A, Lubrano C, Marelli G, Marrocco W, Montemurro V, Parretti D, Pedretti R, Perticone F, Stella R, Marangoni F. Nutraceuticals and functional foods for the control of plasma cholesterol levels. An intersociety position paper. Pharmacol Res 2018; 134:51-60. [DOI: 10.1016/j.phrs.2018.05.015] [Citation(s) in RCA: 70] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Accepted: 05/29/2018] [Indexed: 12/14/2022]
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Fattirolli F, Bettinardi O, Angelino E, da Vico L, Ferrari M, Pierobon A, Temporelli D, Agostini S, Ambrosetti M, Biffi B, Borghi S, Brazzo S, Faggiano P, Iannucci M, Maffezzoni B, Masini ML, Mazza A, Pedretti R, Sommaruga M, Barro S, Griffo R, Piepoli M. What constitutes the ‘Minimal Care’ interventions of the nurse, physiotherapist, dietician and psychologist in Cardiovascular Rehabilitation and secondary prevention: A position paper from the Italian Association for Cardiovascular Prevention, Rehabilitation and Epidemiology. Eur J Prev Cardiol 2018; 25:1799-1810. [DOI: 10.1177/2047487318789497] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Background In cardiovascular prevention and rehabilitation, care activities are carried out by different professionals in coordination, each with their own specific competence. This GICR–IACPR position paper has analysed the interventions performed by the nurse, physiotherapist, dietician and psychologist in order to identify what constitutes minimal care, and it lists the activities that are fundamental and indispensable for each team member to perform in clinical practice. Results In analysing each type of intervention, the following dimensions were considered: the level of clinical care complexity, determined both by the disease and by environmental factors; the ‘area’ complexity, i.e. the specific level of competence required of the professional in each professional section; organisational factors, i.e. whether the care is performed in an inpatient or outpatient setting; duration of the rehabilitation intervention. The specific contents of minimal care have been identified for each professional area together with the specific goals, the assessment tools and the main essential interventions. For the assessments, only a few validated tools have been indicated, leaving the choice of which instrument to use to the individual professional based on experience and usual practice. Conclusion For the interventions, attention has been focused on conditions of major complexity requiring special care, taking into account the different care settings, the clinical conditions secondary to the disease event, and the distinct tasks of each area according to the operator's specific role. The final report performed by each professional has also been included.
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Affiliation(s)
| | - Ornella Bettinardi
- Psychiatric Emergency and Urgency Service, Department of Mental Health, Italy
| | | | - Letizia da Vico
- Department of Health Professions, Azienda Ospedaliero Universitaria Careggi, Italy
| | - Marina Ferrari
- Cardiovascular Rehabilitation Unit, Istituti Clinici Scientifici Maugeri, Italy
| | | | - Daniele Temporelli
- Cardiovascular Rehabilitation, Istituti Clinici Scientifici Maugeri, Italy
| | | | | | - Barbara Biffi
- Dietology and Clinical Nutrition Service, Don Carlo Gnocchi Foundation, Italy
| | | | - Silvia Brazzo
- Dietology and Clinical Nutrition, Istituti Clinici Scientifici Maugeri, Italy
| | | | - Manuela Iannucci
- Cardiac Rehabilitation Unit, S Filippo Neri Hospital Salus Infirmorum, Italy
| | | | - Maria Luisa Masini
- Department of Health Professions, Azienda Ospedaliero Universitaria Careggi, Italy
| | - Antonio Mazza
- Department of Cardiac Rehabilitation, Istituti Clinici Scientifici Maugeri IRCCS, Italy
| | - Roberto Pedretti
- Department of Cardiac Rehabilitation, Istituti Clinici Scientifici Maugeri IRCCS, Italy
| | - Marinella Sommaruga
- Clinical Psychology and Social Support, Istituti Clinici Scientifici Maugeri, Italy
| | | | - Raffaele Griffo
- Italian Association for Cardiovascular Prevention and Rehabilitation (GICR-IACPR), Research and Educational Centre, Italy
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Faggiano P, Pirillo A, Griffo R, Ambrosetti M, Pedretti R, Scorcu G, Werren M, Febo O, Malfatto G, Favretto G, Sarullo F, Antonini-Canterin F, Zobbi G, Temporelli P, Catapano AL. Prevalence and management of familial hypercholesterolemia in patients with coronary artery disease: The heredity survey. Int J Cardiol 2018; 252:193-198. [PMID: 29249427 DOI: 10.1016/j.ijcard.2017.10.105] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Revised: 10/25/2017] [Accepted: 10/26/2017] [Indexed: 11/18/2022]
Abstract
BACKGROUND AND AIMS Familial hypercholesterolemia (FH) is a genetic disorder characterized by high levels of low density lipoprotein cholesterol (LDL-C) predisposing to premature cardiovascular disease. Its prevalence varies and has been estimated around 1 in 200-500. The Heredity survey evaluated the prevalence of potential FH and the therapeutic approaches among patients with established coronary artery disease (CAD) or peripheral artery disease (PAD) in which it is less well documented. METHODS Data were collected in patients admitted to programs of rehabilitation and secondary prevention in Italy. Potential FH was estimated using Dutch Lipid Clinic Network (DLCN) criteria. Potential FH was defined as having a total score≥6. RESULTS Among the 1438 consecutive patients evaluated, the prevalence of potential FH was 3.7%. The prevalence was inversely related to age, with a putative prevalence of 1:10 in those with <55yrs of age (male) and <60yrs (female). Definite FH (DLCN score>8) had the highest percentages of patients after an ACS (75% vs 52.5% in the whole study population). At discharge, most patients were on high intensity statin therapy, but despite this, potential FH group still had a higher percentage of patients with LDL-C levels not at target and having a distance from the target higher than 50%. CONCLUSIONS Among patients with established coronary heart disease, the prevalence of potential FH is higher than in the general population; the results suggest that a correct identification of potential FH, especially in younger patients, may help to better manage their high cardiovascular risk.
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Affiliation(s)
| | - Angela Pirillo
- Centro per lo Studio dell'Aterosclerosi, E. Bassini Hospital, Cinisello Balsamo, Milan, Italy
| | | | - Marco Ambrosetti
- U.O. Cardiologia e Angiologia Riabilitativa, Clinica Le Terrazze, Cunardo, VA, Italy
| | | | - Giampaolo Scorcu
- SSD valutazione e consulenza cardiologica AO Brotzu, Cagliari, Italy
| | - Marika Werren
- U.O. Cardiologia Riabilitativa - IMFR Gervasutta, Udine, Italy
| | - Oreste Febo
- U.O. Cardiologia Riabilitativa, Rivolta D'Adda, Italy
| | | | - Giuseppe Favretto
- Cardiologia Riabilitativa Alta Specializzazione Motta di Livenza. Italy
| | | | | | - Gianni Zobbi
- Centro Riabilitazione Cardiologica Ospedale S.Anna Castelnovo nè Monti, Reggio Emilia, Italy
| | | | - Alberico L Catapano
- Dipartimento Scienze Farmacologiche e Biomolecolari and IRCCS Multimedica Milano, Italy
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13
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Rossini R, Lina D, Ferlini M, Belotti G, Caico SI, Caravati F, Faggiano P, Iorio A, Lauri D, Lettieri C, Locati ET, Maggi A, Massari F, Mortara A, Moschini L, Musumeci G, Nassiacos D, Negri F, Pecora D, Pierini S, Pedretti R, Ravizza P, Romano M, Oliva F. [Management of outpatients with cardiac disease: follow-up timing and modalities]. G Ital Cardiol (Rome) 2017. [PMID: 28631761 DOI: 10.1714/2700.27608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The increasing rate of cardiovascular diseases, the improved survival after the acute phase, the aging of the population and the implementation of primary prevention caused an exponential increase in outpatient cardiac performance, thereby making it difficult to maintain a balance between the citizen-patient request and the economic sustainability of the healthcare system. On the other side, the prescription of many diagnostic tests with a view to defensive medicine and the related growth of patients' expectations, has led several scientific societies to educational campaigns highlighting the concept that "less is more".The present document is aimed at providing the general practitioner with practical information about a prompt diagnosis of signs/symptoms (angina, dyspnea, palpitations, syncope) of the major cardiovascular diseases. It will also provide an overview about appropriate use of diagnostic exams (echocardiogram, stress test), about the appropriate timing of their execution, in order to ensure effectiveness, efficiency, and equity of the health system.
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Affiliation(s)
- Roberta Rossini
- Dipartimento Cardiovascolare, ASST Papa Giovanni XXIII, Bergamo
| | - Daniela Lina
- U.O. Cardiologia, Azienda Ospedaliero-Universitaria, Parma
| | - Marco Ferlini
- S.C. Cardiologia, Fondazione IRCCS Policlinico San Matteo, Pavia
| | | | - Salvatore Ivan Caico
- U.O. Cardiologia, Ospedale S. Antonio Abate di Gallarate, ASST Valle Olona, Varese
| | - Fabrizio Caravati
- U.O. Cardiologia 1, Dipartimento Cardiovascolare, Ospedale di Circolo e Fondazione Macchi, ASST dei Sette Laghi, Varese
| | | | - Annamaria Iorio
- Dipartimento Cardiovascolare, ASST Papa Giovanni XXIII, Bergamo
| | - Davide Lauri
- Medico di Medicina Generale, Presidente Cooperativa Medici Milano Centro
| | | | - Emanuela Teresa Locati
- Dipartimento Cardiotoracovascolare "A. De Gasperis", ASST Grande Ospedale Metropolitano Niguarda, Milano
| | | | - Ferdinando Massari
- U.O.C. Malattie Cardiovascolari, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Milano
| | - Andrea Mortara
- Dipartimento di Cardiologia Clinica, Policlinico di Monza, Monza (MB)
| | | | | | | | - Fabrizio Negri
- ATS 312 di Pavia, Distretto di Casteggio, Casteggio (PV)
| | | | - Simona Pierini
- U.O.C. Cardiologia, ASST Nord Milano, Cinisello Balsamo (MI)
| | - Roberto Pedretti
- U.O. Cardiologia, IRCCS Fondazione Salvatore Maugeri, Istituto Scientifico di Tradate, Tradate (VA)
| | | | - Michele Romano
- Dipartimento Cardiotoracovascolare, ASST Carlo Poma, Mantova
| | - Fabrizio Oliva
- Dipartimento Cardiotoracovascolare "A. De Gasperis", ASST Grande Ospedale Metropolitano Niguarda, Milano
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Hansen D, Dendale P, Coninx K, Vanhees L, Piepoli MF, Niebauer J, Cornelissen V, Pedretti R, Geurts E, Ruiz GR, Corrà U, Schmid JP, Greco E, Davos CH, Edelmann F, Abreu A, Rauch B, Ambrosetti M, Braga SS, Barna O, Beckers P, Bussotti M, Fagard R, Faggiano P, Garcia-Porrero E, Kouidi E, Lamotte M, Neunhäuserer D, Reibis R, Spruit MA, Stettler C, Takken T, Tonoli C, Vigorito C, Völler H, Doherty P. The European Association of Preventive Cardiology Exercise Prescription in Everyday Practice and Rehabilitative Training (EXPERT) tool: A digital training and decision support system for optimized exercise prescription in cardiovascular disease. Concept, definitions and construction methodology. Eur J Prev Cardiol 2017; 24:1017-1031. [DOI: 10.1177/2047487317702042] [Citation(s) in RCA: 113] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Dominique Hansen
- Heart Centre Hasselt, Jessa Hospital, Belgium
- BIOMED-REVAL-Rehabilitation Research Centre, Hasselt University, Belgium
| | - Paul Dendale
- Heart Centre Hasselt, Jessa Hospital, Belgium
- BIOMED-REVAL-Rehabilitation Research Centre, Hasselt University, Belgium
| | - Karin Coninx
- Expertise Centre for Digital Media, Hasselt University, Belgium
| | - Luc Vanhees
- Department of Rehabilitation Sciences, University Leuven, Belgium
| | | | - Josef Niebauer
- Institute of Sports Medicine, Prevention and Rehabilitation, Paracelsus Medical University Salzburg, Austria
| | | | - Roberto Pedretti
- Department of Medicine and Cardiorespiratory Rehabilitation, Istituti Clinici Scientifici Maugeri, Italy
| | - Eva Geurts
- Expertise Centre for Digital Media, Hasselt University, Belgium
| | - Gustavo R Ruiz
- Expertise Centre for Digital Media, Hasselt University, Belgium
| | - Ugo Corrà
- Cardiologic Rehabilitation Department, Istituti Clinici Scientifici Salvatore Maugeri, Italy
| | - Jean-Paul Schmid
- Cardiology Clinic, Tiefenau Hospital, Switzerland
- University of Bern, Switzerland
| | | | | | - Frank Edelmann
- Department of Internal Medicine with Cardiology, Charité-Universitaetsmedizin Berlin, Germany
- Department of Cardiology and Pneumology, University of Göttingen, Germany
| | - Ana Abreu
- Cardiology Department, Hospital Santa Marta, Portugal
| | | | | | - Simona S Braga
- Department of Medicine and Cardiorespiratory Rehabilitation, Istituti Clinici Scientifici Maugeri, Italy
| | - Olga Barna
- Family Medicine Department, National O.O. Bogomolets Medical University, Ukraine
| | - Paul Beckers
- Antwerp University Hospital, Department of Cardiology, Belgium
| | - Maurizio Bussotti
- Unit of Cardiorespiratory Rehabilitation, Istituti Clinici Maugeri, Italy
| | - Robert Fagard
- Hypertension and Cardiovascular Rehabilitation Unit, KU Leuven University, Belgium
| | | | | | - Evangelia Kouidi
- Laboratory of Sports Medicine, Aristotle University of Thessaloniki, Greece
| | | | - Daniel Neunhäuserer
- Institute of Sports Medicine, Prevention and Rehabilitation, Paracelsus Medical University Salzburg, Austria
- Sport and Exercise Medicine Division, University of Padova, Italy
| | - Rona Reibis
- Cardiological Outpatient Clinics, Park Sanssouci, Germany
| | - Martijn A Spruit
- BIOMED-REVAL-Rehabilitation Research Centre, Hasselt University, Belgium
- Department of Research and Education, CIRO+, the Netherlands
- Department of Respiratory Medicine, Maastricht University Medical Centre, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht, the Netherlands
| | - Christoph Stettler
- Division of Endocrinology, Diabetes and Clinical Nutrition, University Hospital/Inselspital, Switzerland
| | - Tim Takken
- Division of Pediatrics, Child Development & Exercise Center, Wilhelmina Children's Hospital, the Netherlands
| | - Cajsa Tonoli
- Department of Rehabilitation Science and Physiotherapy, Ghent University, Belgium
| | - Carlo Vigorito
- Internal Medicine and Cardiac Rehabilitation, University of Naples Federico II, Italy
| | - Heinz Völler
- Department of Cardiology, Klinik am See, Germany
- Center of Rehabilitation Research, University of Potsdam, Germany
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Rossini R, Oltrona Visconti L, Musumeci G, Filippi A, Pedretti R, Lettieri C, Buffoli F, Campana M, Capodanno D, Castiglioni B, Cattaneo MG, Colombo P, De Luca L, De Servi S, Ferlini M, Limbruno U, Nassiacos D, Piccaluga E, Raisaro A, Ravizza P, Senni M, Tabaglio E, Tarantini G, Trabattoni D, Zadra A, Riccio C, Bedogni F, Febo O, Brignoli O, Ceravolo R, Sardella G, Bongo S, Faggiano P, Cricelli C, Greco C, Gulizia MM, Berti S, Bovenzi F. A multidisciplinary consensus document on follow-up strategies for patients treated with percutaneous coronary intervention. Catheter Cardiovasc Interv 2014; 85:E129-39. [DOI: 10.1002/ccd.25724] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Accepted: 11/03/2014] [Indexed: 12/31/2022]
Affiliation(s)
- Roberta Rossini
- Dipartimento Cardiovascolare; AO Papa Giovanni XXIII; Bergamo Italia
| | | | - Giuseppe Musumeci
- Dipartimento Cardiovascolare; AO Papa Giovanni XXIII; Bergamo Italia
| | | | - Roberto Pedretti
- UO di Cardiologia Riabilitativa, IRCCS Fondazione Salvatore Maugeri; Istituto Scientifico di Tradate; Tradate Italia
| | - Corrado Lettieri
- UO di Cardiologia; Azienda Ospedaliera Carlo Poma; Mantova Italia
| | | | - Marco Campana
- UO Cardiologia, Fondazione Poliambulanza; Brescia Italia
| | - Davide Capodanno
- Dipartimento di Cardiologia; Ospedale Ferrarotto, Università di Catania; Catania Italia
| | | | | | - Paola Colombo
- Dipartimento Cardiotoracovascolare; Ospedale Niguarda; Milano Italia
| | - Leonardo De Luca
- Department of Cardiovascular Sciences; European Hospital; Roma Italia
| | - Stefano De Servi
- Unita' Coronarica; IRCCS Fondazione Policlinico San Matteo; Pavia Italia
| | - Marco Ferlini
- Divisione di Cardiologia; IRCCS Fondazione Policlinico S. Matteo; Pavia Italia
| | - Ugo Limbruno
- Divisione di Cardiologia; Ospedale della Misericordia; Grosseto Italia
| | | | | | - Arturo Raisaro
- Divisione di Cardiologia; IRCCS Fondazione Policlinico S. Matteo; Pavia Italia
| | | | - Michele Senni
- Dipartimento Cardiovascolare; AO Papa Giovanni XXIII; Bergamo Italia
| | | | - Giuseppe Tarantini
- Dipartimento di Scienze Cardiache; Toraciche e Vascolari, Università di Padova; Padova Italia
| | - Daniela Trabattoni
- Dipartimento di Scienze Cardiovascolari; Centro Cardiologico Monzino, IRCCS; Milano Italia
| | | | - Carmine Riccio
- UOC Cardiologia e Riabilitazione Cardiologica, Azienda Ospedaliera Sant'Anna e San Sebastiano; Caserta Italia
| | - Francesco Bedogni
- Department of Cardiology; Istituto Clinico S. Ambrogio; Milano Italia
| | - Oreste Febo
- UO Cardiologia Riabilitativa, Fondazione Salvatore Maugeri, IRCCS Istituto Scientifico di Montescano (PV); Pavia Italia
| | | | - Roberto Ceravolo
- Dipartimento di Cardiologia, Ospedale Civile Pugliese; Catanzaro Italia
| | - Gennaro Sardella
- Department of Cardiovascular; Respiratory and Morphologic Sciences, Policlinico Umberto I, “Sapienza” University of Rome; Italia
| | - Sante Bongo
- Divisione di Cardiologia; Azienda Ospedaliero Universitaria Maggiore della Carità; Novara Italia
| | | | | | - Cesare Greco
- UOC Cardiologia - Azienda ospedaliera San Giovanni Addolorata Roma; Italia
| | - Michele Massimo Gulizia
- UOC Cardiologia; Azienda Rilievo Nazionale e Alta Specializzazione, Ospedale Garibaldi-Nesima; Catania Italia
| | - Sergio Berti
- Operative Unit of Cardiology, G. Pasquinucci Heart Hospital, Fondazione Toscana G. Monasterio; Massa Italia
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16
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Vergara G, Brignole M, Alboni P, Curnis A, Feraco E, Gulizia MM, Lunati M, Pedretti R, Raviele A, Salerno-Uriarte J, Berisso MZ. [Structure and functional organization of arrhythmology]. G Ital Cardiol (Rome) 2010; 11:604-624. [PMID: 21033340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Affiliation(s)
- Giuseppe Vergara
- Divisione di Cardiologia Ospedale Garibaldi-Nesima, Via Palermo, 636 95122 Catania
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17
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Guazzi M, Vicenzi M, Raimondo R, Sarzi S, Pedretti R, Arena R. Ventilatory Abnormalities during Exercise Are Associated with Doppler-Estimated Left Ventricular Filling Pressure and Ejection Fraction in Patients with Heart Failure. J Card Fail 2007. [DOI: 10.1016/j.cardfail.2007.06.351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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18
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Guazzi M, Vicenzi M, Raimondo R, Sarzi S, Pedretti R, Arena R. A Prognostic Comparison of Echocardiography vs. Cardiopulmonary-Derived Variables in Patients with Heart Failure. J Card Fail 2007. [DOI: 10.1016/j.cardfail.2007.06.585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Guazzi M, Raimondo R, Vicenzi M, Arena R, Proserpio C, Sarzi Braga S, Pedretti R. Exercise oscillatory ventilation may predict sudden cardiac death in heart failure patients. J Am Coll Cardiol 2007; 50:299-308. [PMID: 17659196 DOI: 10.1016/j.jacc.2007.03.042] [Citation(s) in RCA: 90] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2007] [Revised: 02/26/2007] [Accepted: 03/05/2007] [Indexed: 01/27/2023]
Abstract
OBJECTIVES The purpose of this study was to test the ability of cardiopulmonary exercise testing (CPET)-derived variables as sudden cardiac death (SCD) predictors. BACKGROUND The CPET variables, such as peak oxygen uptake (VO2), ventilatory requirement to carbon dioxide (CO2) production (VE/VCO2) slope, and exercise oscillatory breathing (EOB), are strong predictors of overall mortality in chronic heart failure (CHF) patients. Even though up to 50% of CHF patients die from SCD, it is unknown whether any of these variables predicts SCD. METHODS One hundred fifty-six CHF patients (mean age: 60.9 +/- 9.4 years; mean ejection fraction: 34.9 +/- 10.6%) underwent CPET. Subjects were tracked for sudden versus pump-failure cardiac mortality over 27.8 +/- 25.2 months. RESULTS Seventeen patients died from SCD, and 17 died from cardiac pump failure. Survivors showed significantly higher peak VO2 (16.8 +/- 4.5 ml x kg(-1) x min(-1)) and lower VE/VCO2 slope (32.8 +/- 6.4) and prevalence of EOB (20.3%), compared with subjects who experienced arrhythmic (13.5 +/- 3.2 ml x kg(-1) x min(-1); 41.5 +/- 11.4; 100%) or nonarrhythmic (14.1 +/- 4.7 ml x kg(-1) x min(-1); 38.1 +/- 7.3; 47.1%) deaths (p < 0.05). At Cox regression analysis, all variables were significant univariate predictors of both sudden and pump failure death (p < 0.01). Multivariate analysis, including left ventricular (LV) ejection fraction, LV end systolic volume, and LV mass selected EOB, was the strongest predictor of both overall mortality (chi-square: 38.7, p < 0.001) and SCD (chi-square: 44.7, p < 0.001), whereas VE/VCO2 slope was the strongest ventilatory predictor of pump failure death (chi-square: 11.8, p = 0.001). CONCLUSIONS Exercise oscillatory breathing is an independent predictor of SCD in patients with CHF and might help as an additional marker for prioritization of antiarrhythmic strategies.
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Affiliation(s)
- Marco Guazzi
- Cardiopulmonary Unit, Cardiology Division, University of Milano, San Paolo Hospital, Milano, Italy.
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20
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Guasti L, Simoni C, Scamoni C, Sarzi Braga S, Crespi C, Cimpanelli M, Grandi AM, Pedretti R, Mainardi LT, Tomei G, Venco A. An unusual case presenting with hypertensive crisis. Intern Emerg Med 2007; 2:29-32. [PMID: 17551681 PMCID: PMC2780609 DOI: 10.1007/s11739-007-0006-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- L Guasti
- Department of Clinical Medicine, University of Insubria Ospedale di Circolo, Viale Borri 57, I-21100, Varese, Italy.
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21
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Guasti L, Simoni C, Scamoni C, Sarzi Braga S, Crespi C, Cimpanelli M, Gaudio G, Pedretti R, Mainardi LT, Grandi AM, Tomei G, Venco A. Mixed cranial nerve neuroma revealing itself as baroreflex failure. Auton Neurosci 2006; 130:57-60. [PMID: 16798103 DOI: 10.1016/j.autneu.2006.04.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2005] [Revised: 02/27/2006] [Accepted: 04/28/2006] [Indexed: 10/24/2022]
Abstract
We report here the first case of baroreflex failure due to a mixed cranial nerve neuroma in which the clinical manifestations (recurrent severe hypertensive crisis, hypotension) due to baroreflex arc impairment preceded the clinical diagnosis of brain tumour and neurosurgery by a few months. Given the clinical suspicion of baroreflex failure, even in the absence of iatrogenic clues, we propose that the patient's study should include neuroradiologic evaluation of the ponto-cerebellar angulus.
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Affiliation(s)
- Luigina Guasti
- Internal Medicine, Department of Clinical Medicine-University of Insubria, Ospedale di Circolo Viale Borri 57, 21100 Varese, Italy.
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Ferrara N, Corbi G, Bosimini E, Cobelli F, Furgi G, Giannuzzi P, Giordano A, Pedretti R, Scrutinio D, Rengo F. Cardiac rehabilitation in the elderly: patient selection and outcomes. ACTA ACUST UNITED AC 2006; 15:22-7. [PMID: 16415643 DOI: 10.1111/j.1076-7460.2006.05289.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
In Western countries, the aging and improving survival of patients with coronary heart disease are responsible for an increasing number of older adults (65 years of age and older) who are eligible for cardiac rehabilitation. The elderly with coronary heart disease represent a special population with changes induced by aging and lifestyle, comorbidity, cognitive dysfunction, and high risk of disability. Although the elderly account for the majority of cardiac admissions and procedures, studies on cardiac rehabilitation have traditionally focused on younger patients. In aged experimental animals, there is evidence that exercise training is able to improve hemodynamic parameters and biologic markers. Moreover, in older patients, exercise improves functional capacity and reduces myocardial work, similar to that seen in younger patients. As for younger patients, cardiac rehabilitation requires a multidisciplinary approach, including comprehensive assessment, treatment of risk factors and comorbidity, and psychosocial assessment. Cardiac rehabilitation is safe and helpful for elderly coronary patients. Physicians must be encouraged to prescribe cardiac rehabilitation programs for the elderly following major coronary events and coronary revascularization procedures.
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Opasich C, De Feo S, Pinna GD, Furgi G, Pedretti R, Scrutinio D, Tramarin R. Distance walked in the 6-minute test soon after cardiac surgery: toward an efficient use in the individual patient. Chest 2005; 126:1796-801. [PMID: 15596676 DOI: 10.1378/chest.126.6.1796] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
STUDY OBJECTIVES To describe the results of the 6-min walking test performed on admission to an intensive rehabilitation program after cardiac surgery and to develop, through an algorithm based on a few clinical indicators, reference tables in order to apply distance walked values more efficiently in the individual patient at his/her entry into a cardiac rehabilitation program. SETTING Intensive cardiac rehabilitation units. PATIENTS AND INTERVENTION A total of 2,555 consecutive patients admitted between January 2001 and December 2002 to the Cardiac Rehabilitation Department of the S. Maugeri Foundation early after cardiac surgery performed a 6-min walking test within the fourth day of hospital admission. RESULTS The mean walked distance was 296 +/- 111 m (+/- SD). At multiple regression analysis, age, sex, and comorbidity were independent predictors of walking test performance. The left ventricular ejection fraction only influenced the walked distance in men. Starting from these variables, we propose an algorithm and specific reference tables. CONCLUSIONS Reference values for gender-, age-, comorbidity-, and systolic function-related test performance in patients after cardiac surgery at the beginning of the rehabilitative phase are provided. Once a new patient has been categorized through simple parameters, the actual distance walked could be compared with the matched reference value, thus making the interpretation of the result more efficient. The walked distance might be used to define different levels of disability and to personalize therapeutic exercise prescriptions.
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Affiliation(s)
- Cristina Opasich
- IRCCS Salvatore Maugeri Foundation, Cardiology Department, Via Ferrata 8, I-27100 Pavia, Italy.
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Sarzi Braga S, Vaninetti R, Pedretti R. 12.4 Long term prognostic value of electrophysiologic study after myocardial infarction: a ten year follow-up study. Europace 2003. [DOI: 10.1016/eupace/4.supplement_1.a20-c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
Affiliation(s)
- S. Sarzi Braga
- Fondazione Salvatore Maugeri, Centro Medico di Tradate, Italy
| | - R. Vaninetti
- Fondazione Salvatore Maugeri, Centro Medico di Tradate, Italy
| | - R. Pedretti
- Fondazione Salvatore Maugeri, Centro Medico di Tradate, Italy
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25
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Ambrosetti M, Salerno M, Zambelli M, Mastropasqua F, Scrutinio D, Tramarin R, Pedretti R. Deep vein thrombosis is frequent in asymptomatic patients entering a cardiac rehabilitation program after coronary artery bypass surgery. J Am Coll Cardiol 2002. [DOI: 10.1016/s0735-1097(02)80942-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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26
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Bernardi L, Porta C, Spicuzza L, Bellwon J, Spadacini G, Frey AW, Yeung LYC, Sanderson JE, Pedretti R, Tramarin R. Slow breathing increases arterial baroreflex sensitivity in patients with chronic heart failure. Circulation 2002; 105:143-5. [PMID: 11790690 DOI: 10.1161/hc0202.103311] [Citation(s) in RCA: 184] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND It is well established that a depressed baroreflex sensitivity may adversely influence the prognosis in patients with chronic heart failure (CHF) and in those with previous myocardial infarction. METHODS AND RESULTS We tested whether a slow breathing rate (6 breaths/min) could modify the baroreflex sensitivity in 81 patients with stable (2 weeks) CHF (age, 58+/-1 years; NYHA classes I [6 patients], II [33], III [27], and IV [15]) and in 21 controls. Slow breathing induced highly significant increases in baroreflex sensitivity, both in controls (from 9.4+/-0.7 to 13.8+/-1.0 ms/mm Hg, P<0.0025) and in CHF patients (from 5.0+/-0.3 to 6.1+/-0.5 ms/mm Hg, P<0.0025), which correlated with the value obtained during spontaneous breathing (r=+0.202, P=0.047). In addition, systolic and diastolic blood pressure decreased in CHF patients (systolic, from 117+/-3 to 110+/-4 mm Hg, P=0.009; diastolic, from 62+/-1 to 59+/-1 mm Hg, P=0.02). CONCLUSIONS These data suggest that in patients with CHF, slow breathing, in addition to improving oxygen saturation and exercise tolerance as has been previously shown, may be beneficial by increasing baroreflex sensitivity.
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Affiliation(s)
- Luciano Bernardi
- Department of Internal Medicine, University of Pavia and IRCCS Ospedale S Matteo, Pavia, Italy.
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Bonelli R, Picozzi A, Laporta A, Pedretti R. Exercise capacity after heart transplantation: comparison with heart failure patients. J Card Fail 1999. [DOI: 10.1016/s1071-9164(99)91484-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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28
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Raviele A, Bongiorni MG, Brignole M, Cappato R, Capucci A, Gaita F, Mangiameli S, Montenero A, Pedretti R, Salerno J, Sermasi S. Which strategy is "best" after myocardial infarction? The Beta-blocker Strategy plus Implantable Cardioverter Defibrillator Trial: rationale and study design. Am J Cardiol 1999; 83:104D-111D. [PMID: 10089851 DOI: 10.1016/s0002-9149(98)01040-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The Beta-blocker Strategy plus Implantable Cardioverter Defibrillator (BEST-ICD) Trial is a multicenter prospective randomized trial that started in June 1998, in 95 centers in Italy and Germany. The trial will test the hypothesis whether, in high-risk post myocardial infarction (MI) patients already treated with beta blockers, electrophysiologic study (EPS)-guided therapy (including the prophylactic implantation of implantable cardioverter defibrillator [ICD] in inducible patients) will improve survival compared with conventional therapy. Patients eligible for the study are survivors of recent MI (> or = 5 and < or = 21 days), aged < or = 80 years, with left ventricular ejection fraction < or = 35% and > or = 1 of the following additional risk factors: (1) ventricular premature beats > or = 10/hour; (2) decreased heart rate variability (standard deviation of unusual RR intervals < 70 msec); and (3) presence of ventricular late potentials. Furthermore, all enrolled patients must be able to tolerate at least 25 mg of metoprolol per day. These patients constitute about 9% of all patients with recent MI and are expected to have a 2-year all-cause mortality > 25% of which 50% is anticipated to be from sudden death. The main criteria of exclusion from the study are (1) a history of sustained ventricular arrhythmia; (2) documentation of nonsustained ventricular tachycardia during the screening phase; and (3) the need for myocardial revascularization and contraindications or intolerance to beta-blocker therapy. Eligible patients will be randomized to 2 different therapeutic strategies: conventional strategy or EPS/ICD strategy. Patients allocated to the EPS/ICD strategy will undergo further risk stratification, and electrophysiologically inducible patients (approximately 35%) will receive prophylactic ICDs, in addition to the conventional therapy, whereas noninducible patients will be only conventionally treated. The primary endpoint of the study will be death from all causes. By hypothesizing a 30% reduction in the 2-year mortality (from 20% to 14%) in the EPS/ICD group compared with conventionally treated patients, 1,200 patients will have to be included. A triangular, 2-sided sequential design with preset boundaries, for a 5% significance level and 90% power to detect a reduction in 2-year mortality from 20% to 14%, will be used to permit early termination of the trial if the strategy is found to be efficacious, no difference, or inefficacious.
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Affiliation(s)
- A Raviele
- Division of Cardiology, Ospedale Umberto I, Mestre, Italy
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Tarelli G, Maugeri R, Pedretti R, Grossi C, Ornaghi D, Sala A. [The use of bilateral mammary artery in myocardial revascularization. The risk factors emergent from a multivariate analysis conducted on 474 patients]. G Ital Cardiol 1998; 28:1230-7. [PMID: 9866800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
BACKGROUND The internal mammary artery is used as coronary artery graft conduit because of its superior patency. According to some authors, the bilateral IMA can increase perioperative morbidity. The aim of this study was to determine the risk factors increasing perioperative mortality and morbidity in the use of bilateral IMA. METHODS We analyzed the data of 474 patients operated consecutively with the use of bilateral IMA between January 1987 and December 1995 at the Department of Cardiac Surgery of the Varese Hospital. The univariate analysis was done on 17 ordinal variables using a "Fisher exact test" and on 4 continuous variables by "pooled-variance t-test" to investigate risk factors for mortality, mediastinitis, superficial wound infection and aseptic dehiscence of the sternum; a p-value lower than 0.1 was used as cut-off point to introduce the variables into a stepwise multiple logistic regression analysis. RESULTS From the univariate analysis are: postoperative low-output syndrome (p = 0.01), LVEF (p = 0.02) and number of grafts (p = 0.04) are correlated to hospital mortality (1.5%); obesity (p < 0.001) and peripheral arteriopathy (p = 0.009) are correlated to postoperative mediastinitis (5%); obesity (p < 0.001), peripheral arteriopathy (p = 0.009), surgeon (p = 0.001), year of operation (p < 0.001), reoperation for bleeding (p = 0.004) and length of extracorporeal circulation (p = 0.02) are correlated to superficial wound infection (7%); obesity (p = 0.002) and COPD (p = 0.05) are correlated to aseptic dehiscence of the sternum (2%). The multivariate analysis identified low LVEF as the only independent risk factor for hospital mortality (p = 0.03), whereas obesity (p = 0.01) and peripheral vasculopathy (p = 0.03) proved to be correlated to postoperative mediastinitis; obesity (p < 0.001), year of the operation (p < 0.001), low LVEF (p = 0.007) and reoperation for bleeding (p = 0.01) were correlated to superficial infection of the wound and obesity turned out to be the only risk factor for aseptic dehiscence for the sternum (p = 0.003). The infection of the wound did not increase mortality, but it did increase the mean postoperative length of hospital stay (6 days for patients free of any complications of the wound versus 29.7 days for patients with complications of the wound). CONCLUSIONS In patients with bilateral mammary grafts, obesity is the main risk factor for complications of the wound and this event greatly increases the length of the patient's hospital stay. Consequently, we suggest that bilateral mammary artery grafts be used carefully in this subset of patients.
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Affiliation(s)
- G Tarelli
- II Facoltà di Medicina e Chirurgia sede di Varese, Università degli Studi di Pavia
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Abstract
In 41 survivors of acute myocardial infarction (AMI) a prospective study was performed in 2 sequential phases. In phase 1, the role of baroreflex sensitivity and heart rate variability as predictors of inducible and spontaneous sustained ventricular tachyarrhythmias was evaluated. In phase 2, the effects of transdermal scopolamine on baroreflex sensitivity, spectral and nonspectral measures of heart rate variability were investigated. At a mean follow-up of 10 +/- 3 months after AMI, 5 of 41 patients (12%) developed a late arrhythmic event. Of these, all (100%) had inducibility of sustained monomorphic ventricular tachycardia at programmed stimulation compared with 3 of 36 patients (8%) without events (p < 0.0001). At multivariate analysis, baroreflex sensitivity had the strongest relation to both inducibility of sustained monomorphic ventricular tachycardia (p < 0.0001) and occurrence of arrhythmic events (p < 0.0001). Of 41 patients, 28 (68%) consented to undergo phase 2 of the investigation. Baroreflex sensitivity significantly (p < 0.00001) increased after transdermal scopolamine as well as heart rate variability indexes. Of these, the mean of SDs of normal RR intervals for 5-minute segments (p < 0.0001) and the total power (p < 0.0001) had the most significant improvement after scopolamine. The present investigation confirms that assessment of autonomic function is an essential part of arrhythmic risk evaluation after AMI. Transdermal scopolamine, administered to survivors of a recent AMI, reverses the autonomic indexes that independently predict arrhythmic event occurrence. On the basis of these data, transdermal scopolamine could be a potential useful tool in the prophylaxis of life-threatening ventricular arrhythmias after AMI.
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Affiliation(s)
- R Pedretti
- Division of Cardiology, Clinica del Lavoro Foundation, IRCCS, Medical Center of Rehabilitation, Tradate, Italy
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Pedretti R, Etro MD, Laporta A, Sarzi Braga S, Carù B. Prediction of late arrhythmic events after acute myocardial infarction from combined use of noninvasive prognostic variables and inducibility of sustained monomorphic ventricular tachycardia. Am J Cardiol 1993; 71:1131-41. [PMID: 8480637 DOI: 10.1016/0002-9149(93)90635-p] [Citation(s) in RCA: 92] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
A combined use of noninvasive techniques and electrophysiologic study in the prediction of arrhythmic events was prospectively evaluated in 303 surviving patients of acute myocardial infarction (AMI). The most powerful combination of noninvasive prognostic variables in identifying patients suitable for invasive strategies was also assessed. Patients who had > or = 2 variables among left ventricular ejection fraction < 0.4, ventricular late potentials and repetitive ventricular premature complexes (VPCs) were considered eligible for programmed ventricular stimulation. After 15 +/- 7 months of follow-up, 19 patients (6%) had an arrhythmic event. Left ventricular dyskinesia (p < 0.00001) and ejection fraction < 0.4 (p < 0.000001), late potentials (p < 0.001), filtered QRS duration > or = 106 ms (p < 0.00001), VPCs/hour > 6 (p < 0.05), paired VPCs (p < 0.01), > or = 2 runs of unsustained ventricular tachycardia (VT) per monitoring (p < 0.001), heart rate variability index < or = 29 (p < 0.00001) and mean RR interval < or = 750 ms (p < 0.01) were found to be significant univariate predictors of events. At multivariate analysis, only low left ventricular ejection fraction, prolonged filtered QRS duration, reduced heart rate variability index and detection of > or = 2 runs of unsustained VT per monitoring had an independent relation to late arrhythmic events. Of 67 eligible patients, 47 (70%) consented to undergo programmed stimulation. A positive electrophysiologic study was found to be the strongest independent predictor of events among patients preselected by noninvasive techniques. With a good sensitivity (81%), a combined use of noninvasive tests and electrophysiologic study selected a group of post-AMI patients at sufficiently high risk (event rate 65%) to be considered candidates for interventional therapy. The combination of > or = 2 variables among left ventricular ejection fraction < 0.4, filtered QRS duration > or = 106 ms and > or = 2 runs of unsustained VT was superior to the other ones in identifying high-risk subjects (positive and negative predictive values for arrhythmic events of 44 and 99%, respectively). On the basis of the data, this scheme appears to be the most appropriate for selecting patients suitable for electrophysiologic testing and invasive strategies after AMI.
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Affiliation(s)
- R Pedretti
- Fondazione Clinica del Lavoro, Istituto di Ricovero e Cura a Carattere Scientifico, Tradate, Italy
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Bonelli R, Etro MD, Laporta A, Colombo E, Maslowsky F, Pedretti R, Anzà C, Santoro F, Gementi A, Gronda E. Central and peripheral haemodynamic determinants of effort tolerance in patients with heart failure. Rev Port Cardiol 1993; 12:445-53, 405, 407. [PMID: 8323781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
We studied central and peripheral hemodynamics and exercise tolerance in 24 patients with left ventricular dysfunction. All were in NYHA class II or III, and echocardiographic left ventricular ejection fraction was < 35% without pharmacologic influences. Patients underwent to treadmill test (Naughton protocol), cardiopulmonary upright bicycle test, and supine bicycle test with haemodynamic measurements. All tests were exhaustive. Average exercise time was 9 +/- 3.4 min, (range 3-20). Average ejection fraction (.28 +/- 0.65) dis not correlate with working capacity (r = .32), nor did left ventricular filling pressure (pulmonary capillary wedge pressure) at rest and at peak exercise (r = .29 and r = .02). Stroke volume and stroke volume index were on average depressed, with no variations during work; cardiac output and cardiac index were also depressed, with a significant increase at peak exercise (both p < .001). Systemic and pulmonary resistances were increased, but systemic resistances tended to decrease during effort (p < .001), while pulmonary resistances did not (p = NS). We subdivided patients according to systemic vascular resistances lower or higher than 1500 dynes.cm.sec-5 at rest; this identifies two different working capacities (low systemic vascular resistances 11.7 +/- 4.4 min, high systemic vascular resistances 6.9 +/- 3.2 min, p < .05). Patients were then divided in two groups: group I (rest stroke volume > 60 ml) and group II (rest stroke volume < 60 ml). Group I worked 11 +/- 5 min, group II 8.5 +/- 3 min (p < .05). We performed a linear regression analysis between cardiac output and systemic vascular resistances at rest and during exercise in the two groups.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- R Bonelli
- Divisione di Cardiologia, Fondazione Clinica del Lavoro, Pavia, Italia
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33
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Pedretti R, Colombo E, Braga SS, Cant B. Effect of thrombolysis on heart rate variability, induced ventricular arrhythmias and arrhythmic events in survivors of acute myocardial infarction. Resuscitation 1993. [DOI: 10.1016/0300-9572(93)90014-h] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Carú B, Pedretti R, Bonelli R, Etro MD, Laporta A, Gementi A, Casucci R. Late arrhythmic events and patency of the infarct-related coronary artery in survivors of acute myocardial infarction. Rev Port Cardiol 1992; 11:817-21. [PMID: 1285960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
In the present study we evaluated the influence of intravenous thrombolysis and patency of the infarct-related coronary artery on both markers of ventricular electrical instability and incidence of late arrhythmic events after acute myocardial infarction (AMI). Ninety one patients surviving a first AMI who consecutively performed coronary angiography were enrolled in the present study; 44 patients (48%) received thrombolysis, 47 patients (52%) were treated conventionally. Of 91 patients, 90 (99%) had signal-averaged electrocardiogram (SAECG), and 40 (44%) programmed ventricular stimulation. No significant difference was observed between thrombolytic-treated and control group in late potential rate, SAECG determinants and ventricular arrhythmia inducibility. Of 91 patients, 40 (44%) had occlusion of the infarct-related artery: of these, 15 (37%) had late potentials compared with 5 of 51 patients (9%) with a patent artery (p < 0.01). Mean left ventricular ejection fraction was not significantly different between the two groups (0.50 +/- 0.15 vs 0.55 +/- 0.12; p = NS). No significant difference was present between the two groups of patients with regard to inducibility of sustained ventricular tachyarrhythmias, however an odds ratio of 3.5 was observed in the group with a closed vessel.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- B Carú
- Fondazione Clinica del Lavoro, Istituto di Ricovero e Cura a Carattere Scientifico, Centro Medico di Tradate, Italy
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Anzà C, Santoro F, Maslowsky F, Colombo E, Laporta A, Pedretti R, Bonelli R, Radice E, Carù B. [The electrocardiographic anomalies and 2D-echocardiographic findings during the recovery phase of the stress test in the postinfarct patient]. G Ital Cardiol 1992; 22:683-7. [PMID: 1426805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND The appearance or the increase of repolarization abnormalities in the EKG during post exercise (ET) recovery phase (R) is considered a marker of ischemia. METHODS In order to evaluate the real meaning of these changes we compared the EKG data with eventual modifications of left ventricular kinesis analyzed by 2D-ECHO. 10 male patients with previous myocardial infarction, mean age 50 +/- 4.8 y, underwent exercise testing on a treadmill (Bruce's protocol) and continuous 2D-ECHO observation from the end of exercise along the whole R. Patients were divided in two groups: Group A (6 patients) and Group B (4 patients), all free of symptoms. RESULTS Group A showed ischemic EKG markers during exercise which increased during R; Group B showed ischemic EKG markers only during R. The 2D-ECHO showed in Group A an impairment of left ventricular kinesis at peak exercise without increase or extension during R (WMSI at rest 1.32; peak ET 1.60; R 1.60); in Group B the kinetic alterations appeared only in R (WMSI at rest 1.33, peak ET 1.42; R 1.80), strictly related to EKG markers. CONCLUSIONS The data suggest : 1) that the increase of EKG abnormalities already present during exercise do not seem to imply more severe ischemia; 2) that EKG changes appearing during R are markers of ischemia which occur in the R.
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Affiliation(s)
- C Anzà
- Divisione di Cardiologia, Fondazione Clinica del Lavoro, IRCCS, Tradate
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Pedretti R, Laporta A, Etro MD, Gementi A, Bonelli R, Anzà C, Colombo E, Maslowsky F, Santoro F, Carù B. Influence of thrombolysis on signal-averaged electrocardiogram and late arrhythmic events after acute myocardial infarction. Am J Cardiol 1992; 69:866-72. [PMID: 1550014 DOI: 10.1016/0002-9149(92)90784-v] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The influence of intravenous thrombolysis on both prevalence of ventricular late potentials and incidence of late arrhythmic events was evaluated in 174 consecutive patients surviving a first acute myocardial infarction; 106 patients (61%) received thrombolysis (group A) and 68 (34%) had conventional therapy (group B). In group A, 18 patients (17%) had late potentials compared with 23 (34%) in group B (p less than 0.05); mean left ventricular ejection fraction was not different (0.50 +/- 0.09 vs 0.50 +/- 0.10; p = not significant [NS]). Of 63 patients who underwent coronary arteriography because of postinfarction ischemia, 28 (44%) had a closed infarct-related artery; of these, 11 (39%) had late potentials compared with 3 of 35 (9%) with a patent artery (p less than 0.01). Mean left ventricular ejection fraction was not significantly different between the 2 groups (0.49 +/- 0.09 vs 0.53 +/- 0.09; p = NS). At a mean follow-up of 14 +/- 8 months, 8 of 161 patients (5%) had a late arrhythmic event; 6 of 8 (75%) with and 28 of 153 (18%) without events had late potentials (p less than 0.001). In group A, 4 of 99 patients (4%) had events compared with 4 of 62 (6%) in group B (p = NS, relative risk 1.6). Of 24 patients with anterior wall AMI and left ventricular dyskinesia, 6 events occurred. In this group of patients, a higher rate of events was observed (25%); 3 of 16 (19%) treated with thrombolysis had an event compared with 3 of 8 (37%) treated conventionally (p = NS, relative risk 2.6).(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- R Pedretti
- Divisione di Cardiologia, Centro Medico di Tradate, Italy
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37
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Carù B, Bossi M, Bonelli R, Colombo E, Pedretti R, Santoro F, Anzà C, Maslowsky F, Laporta A. Functional evaluation 10 days and 3 weeks after acute myocardial infarction: comparative significance and prognostic value. Eur Heart J 1992; 13:201-6. [PMID: 1555617 DOI: 10.1093/oxfordjournals.eurheartj.a060147] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Early functional evaluation after non-complicated acute myocardial infarction (AMI) is widely recommended because of its prognostic value in the short term. In fact it seems to have a prognostic value within 15-20 days of the AMI, but in this period the patient is particularly controlled and is often still hospitalized. To evaluate the real significance of an early functional evaluation within 10 days of the AMI (mean 8.6 days +/- 1.2) as compared to an identical functional evaluation performed at 3 weeks after AMI (mean 20.16 days +/- 5.38) 25 patients with uncomplicated myocardial infarction were studied. Significant statistical differences were found between the first (ET1) and second (ET2) functional evaluations: they concern the maximal heart rate reached (P less than 0.001), the maximal pressure-rate product (P less than 0.05), the percentage increment of heart rate (P less than 0.01) and the total work performed (P less than 0.001). Agreement between ET1 and ET2 was found in 19 cases; 12 patients showed markers of ischaemia both at ET1 and ET2, while seven were free from ischaemia at both times. In six cases a disagreement between ET1 and ET2 was found: in particular, three cases had ischaemic ET1 and nonischaemic ET2; the reverse was seen in the other three. During follow-up (mean 215.4 days +/- 85.5), the total number of new events (reinfarctions, angina or surgery) among the 25 patients was eight; none occurred within the first 30 days after the AMI.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- B Carù
- Divisione di Cardiologia, Fondazione Clinica del Lavoro, IRCCS, Tradate, Italy
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Terzoli L, Leonetti G, Pedretti R, Bragato R, Sampieri L, Fruscio M, Boselli L, Zanchetti A. Nifedipine does not blunt the aldosterone and cardiovascular response to angiotensin II and potassium infusion in hypertensive patients. J Cardiovasc Pharmacol 1988; 11:317-20. [PMID: 2452924 DOI: 10.1097/00005344-198803000-00008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The antihypertensive response of calcium antagonists of the dihydropyridine series, although accompanied by a significant increase in plasma renin activity (PRA), is generally not associated with a comparably significant rise in plasma aldosterone (PA). This has been suggested to be due to the adrenal glomerular cell responsiveness being dependent on calcium entry. To investigate this hypothesis, angiotensin II (AII; 0.15, 0.375, and 0.750 micrograms/min, each step for 20 min) and KCl (30 mmol/50 min) were infused on separate days in 11 hypertensive patients kept at a constant daily intake of 100 mmol sodium and 40 mmol potassium, before and after 1 week of nifedipine treatment (20 mg b.i.d.). Supine blood pressure (BP) was significantly (p less than 0.01-p less than 0.001) reduced after nifedipine treatment; supine PRA increased significantly (p less than 0.01), while PA did not change significantly. No change in plasma potassium level was seen during nifedipine treatment. The dose-dependent mean BP rises induced by AII were slightly blunted during nifedipine treatment, whereas the PRA decreases and the PA rises after the peak infusion were not significantly different before and during nifedipine administration. Potassium infusion had no significant effect on BP, and caused a significant and similar rise in PA before and during nifedipine administration, while PRA decrease was more pronounced after nifedipine treatment. As previously shown in normotensive subjects, and also in hypertensive patients, aldosterone responses to two major stimulants, such as AII and potassium, do not appear to be blunted by treatment with a calcium antagonist.
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Affiliation(s)
- L Terzoli
- Istituto di Clinica Medica Generale e Terapia Medica, Università di Milano, Italy
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