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Lazzeroni D, Bini M, Mari C, Camaiora U, Battistini E, Geroldi S, Ugolotti PT, Pigazzani F, Paglialonga L, Marazzi PL, Brambilla L, Brambilla V, Coruzzi P. 4951Long-term prognostic value of adherence to leisure time physical activity prescription in patients undergoing exercise-based cardiac rehabilitation: an inverse dose-response relationship. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0021] [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: 11/13/2022] Open
Abstract
Abstract
Background
The benefits associated with leisure time physical activity (LTPA) in primary and secondary cardiovascular prevention has been known for decades. Although several studies demonstrated that exercise-based cardiac rehabilitation (CR) programs reduce mortality, the long-term prognostic value of adherence to LTPA presciption after exercise-based CR has not been well estrablished.
Purpose
Evaluate the long-term prognostic value of adherence to LTPA presciption after exercise-based CR in patients undergoing myocardial revascularization and/or cardiac valve surgery.
Methods
A prospective registry of 2.340 consecutive patients, admitted to the Cardiovascular Prevention and Rehabilitation Unit was created. All patients completed a standard in-hospital CR program. Data regarding LTPA and outcomes were collected. End points were: overall and cardiovascular (CV) mortality and major adverse cardiovascular and cerebrovascular events (MACCEs). The population has been classified into: 1) Physical inactivity: almost completely sedentary or occasional physical activity; 2) Physical activity: regular aerobic LTPA. The amount of LTPA was further collected according to minutes per week.
Results
A total of 1.892 patients with available data on LTPA and outcomes were included in the study; mean follow-up was 50±23 months. One-thousand and twenty-two (54%) patients underwent myocardial revascularization (CABG), 662 (35%) cardiac valve surgery, 208 (11%) combined valve and CABG surgery. Adherence to a regular LTPA was found in the 42% (792 participants) of the population, while 58% (1.100 patients) reported occasional LTPA or a complete physical inactivity. Kaplan-Meier survival curve showed a lower overall mortality (p<0.0001), CV mortality (p<0.0001), and MACCEs (p<0.0001) in LTPA group (figure). After adjustment for age, gender, arterial hypertension, diabetes, type of intervention, glomerular filtration rate and left ventricular ejection fraction, both overall and CV mortality were significantly lower in the LTPA groups (OR=0.24; p<0.0001 and OR=0.35; p<0.046, respectively), as well as combined MACCEs (OR=0.36; p<0.0001). Moreover, an inverse relationship between the increase of minutes per week of LTPA and the decrease of overall (HR 0.990; p<0.0001), CV mortality (HR 0.991; p<0.0001) and MACCEs (HR 0.996; p<0.0001) was found, with 1% reduction of relative risk of events for each minute per week increase of physical activity. Finally, comparing LTPA to standard medical therapy in our population, LTPA showed the lowest number needed to treat (NNT) to save a life (NTT=12).
Central figure
Conclusion
Adherence to leisure time physical activity prescription is independently associated with significant reduction of overall mortality, CV mortality and MACCEs on top of exercise-based CR program after myocardial revascularization and/or cardiac valve surgery.
Acknowledgement/Funding
None
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Affiliation(s)
- D Lazzeroni
- Foundation Don Carlo Gnocchi Onlus, Milan, Italy
| | - M Bini
- Foundation Don Carlo Gnocchi Onlus, Milan, Italy
| | - C Mari
- Foundation Don Carlo Gnocchi Onlus, Milan, Italy
| | - U Camaiora
- Foundation Don Carlo Gnocchi Onlus, Milan, Italy
| | - E Battistini
- Foundation Don Carlo Gnocchi Onlus, Milan, Italy
| | - S Geroldi
- Foundation Don Carlo Gnocchi Onlus, Milan, Italy
| | - P T Ugolotti
- Foundation Don Carlo Gnocchi Onlus, Milan, Italy
| | - F Pigazzani
- Foundation Don Carlo Gnocchi Onlus, Milan, Italy
| | | | - P L Marazzi
- Foundation Don Carlo Gnocchi Onlus, Milan, Italy
| | - L Brambilla
- Foundation Don Carlo Gnocchi Onlus, Milan, Italy
| | - V Brambilla
- Foundation Don Carlo Gnocchi Onlus, Milan, Italy
| | - P Coruzzi
- University of Parma, Department of Medicine and Surgery, Parma, Italy
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Lazzeroni D, Castiglioni P, Camaiora U, Bini M, Garibaldi S, Geroldi S, Ugolotti P, Brambilla L, Brambilla V, Parati G, Coruzzi P. IN HOSPITAL DAY-BY-DAY BLOOD PRESSURE VARIABILITY. J Hypertens 2019. [DOI: 10.1097/01.hjh.0000571152.45483.43] [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: 11/25/2022]
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Parati G, Coruzzi P, Brambilla V, Brambilla L, Gualerzi M, Di Rienzo M, Castiglioni P. The sodium resistance index: a new measure of salt-sensitivity risk from 24h Ambulatory Blood Pressure Monitoring (ABPM) in hypertensives under habitual diet. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht310.p5655] [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: 11/14/2022] Open
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Cademartiri F, Romano M, Seitun S, Maffei E, Palumbo A, Fusaro M, Aldrovandi A, Messalli G, Tresoldi S, Malagò R, La Grutta L, Runza G, Brambilla V, Tedeschi C, Casolo G, Midiri M, Mollet NR. Prevalence and characteristics of coronary artery disease in a population with suspected ischemic heart disease using CT coronary angiography: correlations with cardiovascular risk factors and clinical presentation. Radiol Med 2008; 113:363-72. [PMID: 18493773 DOI: 10.1007/s11547-008-0257-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2007] [Accepted: 08/29/2007] [Indexed: 10/22/2022]
Abstract
PURPOSE This study was undertaken to describe the correlation between the distribution of coronary artery disease (CAD) in a symptomatic population with suspected ischaemic heart disease, cardiovascular risk factors (RF) and clinical presentation. MATERIALS AND METHODS we studied 163 patients (mean age 65.5 years; 101 men and 62 women) referred for multidetector computed tomography coronary angiography (MDCT-CA) to rule out CAD. The patients had no prior history of revascularisation or myocardial infarction. We analysed how the characteristics of CAD (severity and type of plaque) can change with the increase in RF and how they are related to different clinical presentations. RESULTS patients were divided into three groups according to the number of RF: zero or one, two or three, and four or more. The percentage of coronary arteries with no plaque, nonsignificant disease and significant disease was 55%, 41% and 4%, respectively, in patients with zero or one RF; 27%, 51% and 22%, respectively, in patients with two or three RF; and 19%, 38% and 44%, respectively, in patients with four or more RF. Plaque in patients with nonsignificant disease was mixed in 65%, soft in 18% and calcified in 17%. The percentage of coronaries with no plaque in the three RF groups was 50%, 20% and 0% in patients with typical chest pain and 46%, 24% and 12% in those with atypical pain. The percentage of significant disease in patients with typical pain was 0%, 47% and 86% and in those with atypical pain 4%, 20% and 29%. CONCLUSIONS MDCT plays an important role in the identification of CAD in patients with suspected ischaemic heart disease. Severity and type of disease is highly correlated with RF number and assumes different characteristics according to clinical presentation.
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Affiliation(s)
- F Cademartiri
- Dipartimento di Radiologia e Cardiologia, Erasmus Medical Center, Rotterdam, The Netherlands.
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Cademartiri F, Seitun S, Romano M, Maffei E, Fusaro M, Palumbo A, Aldrovandi A, Messalli G, Tresoldi S, Malagò R, Brambilla V. Prognostic value of 64-slice coronary angiography in diabetes mellitus patients with known or suspected coronary artery disease compared with a nondiabetic population. Radiol Med 2008; 113:627-43. [DOI: 10.1007/s11547-008-0268-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2007] [Accepted: 09/06/2007] [Indexed: 11/28/2022]
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Cademartiri F, Malagò R, La Grutta L, Alberghina F, Palumbo A, Maffei E, Brambilla V, Pugliese F, Runza G, Midiri M, Mollet NR, Krestin GP. Coronary variants and anomalies: methodology of visualisation with 64-slice CT and prevalence in 202 consecutive patients. Radiol Med 2007; 112:1117-31. [PMID: 18080097 DOI: 10.1007/s11547-007-0210-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2006] [Accepted: 03/19/2007] [Indexed: 12/25/2022]
Abstract
PURPOSE This paper aims to provide the tools for a complete anatomical evaluation of the coronary tree using 64-slice computed tomography (CT) and evaluate the prevalence of anatomical variants and anomalies in a population of 202 consecutive patients. MATERIALS AND METHODS Two hundred and two patients with suspected coronary artery disease underwent 64-slice CT with a standard protocol. Two observers working in consensus evaluated and collected the data regarding anatomical variants and anomalies of the coronary vessels. RESULTS In the 202 consecutive patients, the prevalence of anatomical variants was: left dominant circulation (7%), absent left main (5%), presence of intermediate branch (17%), aortic origin of conus branch (13%) and circumflex origin of sinus node branch (15%). Coronary anomalies (origin and course, intrinsic and termination) showed an overall prevalence of 25%. CONCLUSIONS CT is the ideal method for the three-dimensional evaluation of the coronary tree. Anatomical variants and anomalies of the coronary arteries are quite common and should be known and recognised promptly by the operators.
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Affiliation(s)
- F Cademartiri
- Dipartimento di Radiologia e Dipartimento Cuore, Imaging Cardiovascolare Non invasivo, Azienda Ospedaliera di Parma, Parma, Italy.
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Coruzzi P, Castiglioni P, Parati G, Brambilla V, Brambilla L, Gualerzi M, Cademartiri F, Franzè A, De Angelis G, Di Rienzo M, Di Mario F. Autonomic cardiovascular regulation in quiescent ulcerative colitis and Crohn's disease. Eur J Clin Invest 2007; 37:964-70. [PMID: 18036030 DOI: 10.1111/j.1365-2362.2007.01887.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [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: 12/22/2022]
Abstract
BACKGROUND In inflammatory bowel diseases, changes in autonomic enteric regulation may also affect neural cardiovascular control. However, while cardiac autonomic modulation has been shown to be impaired in active ulcerative colitis, the occurrence of cardiovascular autonomic alterations, also in the quiescent phase of inflammatory bowel diseases, is still a matter of debate. The aim of our study was thus to explore the features of cardiovascular autonomic regulation in ulcerative colitis and Crohn's disease during their remission phase. MATERIALS AND METHODS Autonomic cardiovascular control was evaluated by time- and frequency-domain indexes of spontaneous heart rate and blood pressure variability and by assessing the baroreflex heart rate control (sequence technique) in 26 patients with ulcerative colitis, in 26 patients with Crohn's disease and in 23 healthy controls. RESULTS The groups were matched for age, gender and body mass index. They had similar blood pressure mean levels and variability. By contrast, mean heart rate, its overall variability (standard deviation), and baroreflex sensitivity were lower in ulcerative colitis patients than in controls. Moreover, all indexes related to cardiac vagal control were significantly lower in ulcerative colitis patients with respect not only to controls but also to Crohn's disease patients. CONCLUSIONS Cardiac vagal control is impaired in quiescent ulcerative colitis only, and not in Crohn's disease, while in both bowel diseases vascular control appears preserved. Since cardiovagal modulation seems related to anti-inflammatory mechanisms, the reduced parasympathetic cardiac regulation in apparently quiescent ulcerative colitis suggests that such systemic derangement is accompanied by local subclinical inflammations, even in the absence of clinically active inflammatory processes.
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Affiliation(s)
- P Coruzzi
- University of Parma, Department of Radiology, Azienda Ospedaliero-Universitaria Parma, Italy.
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Cademartiri F, Maffei E, Palumbo A, Malagò R, Alberghina F, Aldrovandi A, Brambilla V, Runza G, La Grutta L, Menozzi A, Vignali L, Casolo G, Midiri M, Mollet NR. Diagnostic accuracy of 64-slice computed tomography coronary angiography in patients with low-to-intermediate risk. Radiol Med 2007; 112:969-81. [PMID: 17952682 DOI: 10.1007/s11547-007-0198-5] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2006] [Accepted: 01/25/2007] [Indexed: 10/22/2022]
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Cademartiri F, Runza G, Luccichenti G, Galia M, Mollet NR, Alaimo V, Brambilla V, Gualerzi M, Coruzzi P, Midiri M, Lagalla R. Coronary artery anomalies: incidence, pathophysiology, clinical relevance and role of diagnostic imaging. Radiol Med 2006; 111:376-91. [PMID: 16683085 DOI: 10.1007/s11547-006-0036-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [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: 08/28/2004] [Accepted: 03/05/2005] [Indexed: 10/24/2022]
Abstract
Conventional coronary angiography is the gold standard for the diagnosis of coronary artery anomalies. Coronary anomalies are relatively rare findings in patients undergoing conventional coronary angiography for suspected obstructive coronary artery disease. Recently, the increasing performance of diagnostic techniques, such as electron beam tomography (EBT), magnetic resonance (MR) and, more recently, multislice computed tomography (MSCT), has enabled their application to cardiac imaging. MSCT, in particular, has a prominent role in coronary imaging due to its spatial and temporal resolution and three-dimensional capabilities. We report the incidence and pathophysiology of coronary artery anomalies based on the capabilities of recent diagnostic tools with the aim of improving an accurate and noninvasive diagnostic approach.
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Affiliation(s)
- F Cademartiri
- Dipartimento di Radiologia, Erasmus Medical Center, Rotterdam, The Netherlands.
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Coruzzi P, Brambilla L, Brambilla V, Gualerzi M, Rossi M, Parati G, Di Rienzo M, Tadonio J, Novarini A. Potassium depletion and salt sensitivity in essential hypertension. J Clin Endocrinol Metab 2001; 86:2857-62. [PMID: 11397900 DOI: 10.1210/jcem.86.6.7601] [Citation(s) in RCA: 27] [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: 11/19/2022]
Abstract
To evaluate the actual role of potassium depletion on blood pressure, 11 hypertensive patients were placed on a 10-day isocaloric diet providing a daily potassium intake of either 18 or 80 mmol, with each subject serving as his or her own control; the intake of sodium (220 mmol/day) and other minerals was kept constant. On day 11 each patient was also subjected to central volume expansion by water immersion associated with either normal or low potassium intake. After a 10-day period of low potassium intake, systolic blood pressure increased (P < 0.02) by 5 mm Hg, whereas serum potassium decreased (P < 0.001) by 0.9 mmol/L; no significant changes in urinary sodium and a marked increase in urinary calcium excretion (P < 0.001) were found during the 10-day low potassium intake. PRA (P < 0.02) and plasma aldosterone (P < 0.04) concentrations also decreased during low potassium intake in hypertensive patients. Even though an identical natriuretic response was found during the water immersion experiments with either high or low potassium in the whole hypertensive group, the evaluation of hypertensive subjects in relation to salt sensitivity enabled us to disclose pronounced differences in the natriuretic and calciuretic response. In fact, although an impaired natriuretic ability and moderate calcium loss were particularly found during water immersion in those hypertensive subjects exhibiting a lower salt sensitivity index, a predominant calcium depletion appeared to be the most important consequence of potassium depletion in the hypertensive subjects with a higher salt sensitivity index. By confirming that potassium depletion may exacerbate essential hypertension, our data also suggest that not only sodium restriction, but also potassium and calcium supplementation, could be particularly advisable in salt-sensitive hypertensive patients.
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Affiliation(s)
- P Coruzzi
- Unità Cardiovascolare, Istituto di Semeiotica Medica-Fondazione Don C. Gnocchi-ONLUS, University of Parma, I 43100 Parma, Italy.
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Bressi C, Taylor G, Parker J, Bressi S, Brambilla V, Aguglia E, Allegranti I, Bongiorno A, Giberti F, Bucca M, Todarello O, Callegari C, Vender S, Gala C, Invernizzi G. Cross validation of the factor structure of the 20-item Toronto Alexithymia Scale: an Italian multicenter study. J Psychosom Res 1996; 41:551-9. [PMID: 9032718 DOI: 10.1016/s0022-3999(96)00228-0] [Citation(s) in RCA: 427] [Impact Index Per Article: 15.3] [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] [Indexed: 02/03/2023]
Abstract
The 20-item Toronto Alexithymia Scale (TAS-20) has been shown in previous research to measure a general dimension of alexithymia with three intercorrelated factors. This study evaluated the reliability and factorial validity of an Italian translation of the TAS-20 in a group of normal adults (N = 206) and in a mixed group of medical and psychiatric outpatients (N = 642). Using confirmatory factor analyses, the previously established three-factor model of the TAS-20 was found to be replicable in both groups. In addition, the Italian TAS-20 demonstrated adequate estimates of internal reliability and test-retest reliability. Although evaluation of the convergent, discriminant, and concurrent validity of the TAS-20 is required in Italian populations, the present results support the use of the Italian translation of the scale for clinical and research purposes.
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Affiliation(s)
- C Bressi
- IRCCS, Ospedale Maggiore of Milan, Department of Psychiatry, University of Milan, Italy
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