We observed abrupt changes in sympathovagal balance in the last 5 minutes preceding an episode of atrial fibrillation. This can be related to a double behavior in the neurogenic drive: in Type A episodes there is an increase of the LF spectrum, LF:HF ratio, and a decrease of the HF spectrum consistent with an increase of neurogenic sympathetic drive; in Type B episodes there is a reduction of the LF spectrum, LF/HF ratio, and an increase of HF spectrum consistent with an enhancement of the neurogenic parasympathetic drive. In some patients, we found that the two mechanisms operate during different hours of the day and that sometimes there is an increase of sympathetic tone, and in the same instances an increase of parasympathetic tone. Heart-rate variability measures fluctuation in autonomic inputs to the heart rather than the mean level of autonomic impulse; autonomic imbalance is probably more important than the vagal or sympathetic drive alone.

The use of a simple HCU device in the outpatient cardiology clinic allowed reliable diagnosis in one third of the patients referred for echocardiography, which translates into cost and time saving benefits.

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Cardiac rehabilitation is able to reduce cardiovascular mortality, and improves functional capacity and quality of life. However, cardiac rehabilitation participation rates are low and the current evidence has demonstrated sex differences for the access to cardiac rehabilitation programs. In this review, we discuss the benefits of cardiac rehabilitation in women with a specific focus on ischemic heart disease, heart failure, cardiac rehabilitation after cardiac surgery and after transcatheter aortic valve implantation, and peripheral artery disease. We also analyse the current limitations to cardiac rehabilitation for women in terms of accessibility and indications, reporting general, sex-specific, and healthcare-related barriers. Finally, we discuss the potential solutions and areas of development for the coming years.

BackgroundB-type natriuretic peptide (BNP) is increased in post-cardiac surgery patients, however the mechanisms underlying BNP release are still unclear. In the current study, we aimed to assess the relationship between postoperative BNP levels and left ventricular filling pressures in post-cardiac surgery patients.MethodsWe prospectively enrolled 134 consecutive patients referred to our Center 8 ± 5 days after cardiac surgery. BNP was sampled at hospital admission and related to the following echocardiographic parameters: left ventricular (LV) diastolic volume (DV), LV systolic volume (SV), LV ejection fraction (EF), LV mass, relative wall thickness (RWT), indexed left atrial volume (iLAV), mitral inflow E/A ratio, mitral E wave deceleration time (DT), ratio of the transmitral E wave to the Doppler tissue early mitral annulus velocity (E/E').ResultsA total of 124 patients had both BNP and echocardiographic data. The BNP values were significantly elevated (mean 353 ± 356 pg/ml), with normal value in only 17 patients (13.7%). Mean LVEF was 59 ± 10% (LVEF ≥50% in 108 pts). There was no relationship between BNP and LVEF (p = 0.11), LVDV (p = 0.88), LVSV (p = 0.50), E/A (p = 0.77), DT (p = 0.33) or RWT (p = 0.50). In contrast, BNP was directly related to E/E' (p < 0.001), LV mass (p = 0.006) and iLAV (p = 0.026). At multivariable regression analysis, age and E/E' were the only independent predictors of BNP levels.ConclusionIn post-cardiac surgery patients with overall preserved LV systolic function, the significant increase in BNP levels is related to E/E', an echocardiographic parameter of elevated LV filling pressures which indicates left atrial pressure as a major determinant in BNP release in this clinical setting.

IntroduzioneL'Italia è un paese di anziani. Lo afferma l'I-STAT nel suo rapporto annuale 2005 (A) precisando che l'indice di vecchiaia, cioè il rapporto tra la popolazione ≥ 65 anni e quella < 15 anni è del 137 per cento, con un costante aumento rispetto agli anni precedenti. In particolare gli ultraottantenni sono uno su venti. Se da un lato l'invecchiamento della popolazione testimonia il miglioramento delle condizioni di vita, dall'altro pone l'accento sull'aumento dell'incidenza delle malattie cronico-degenerative e sulla prevalenza con cui queste ultime si osservano contemporaneamente nella stessa persona [1].Dati ISTAT [A] dimostrano che gli anziani (≥65anni) determinano il 37% dei ricoveri ospedalieri ordinari ed il 49% delle giornate di degenza e dei relativi costi stimati. Inoltre, con l'avanzare dell'età si riscontra un aumento del grado di disabilità e quasi il 38% dei disabili è ultraottantenne. Non bisogna stupirsi quindi se, in un simile scenario, la tipologia di pazienti che afferisce alle nostre cardiologie riabilitative sia notevolmente cambiata rispetto agli anni precedenti. Ciò è dovuto anche all'aumento delle patologie cardiovascolari che rimangono la principale causa di morbilità e mortalità nella popolazione anziana, determinando così un atteggiamento terapeutico più aggressivo ed un più frequente ricorso ad interventi cardiochirurgici [2,3]. Questo approccio ha portato con sé una maggior richiesta di ricoveri a scopo riabilitativo per questa particolare tipologia di pazienti, verso la quale, solo negli ultimi tempi, è Methods. We selected 108 consecutive patients ≥ 80 years (M = 53, mean age 82.5 ± 2.7 years, after cardiac surgery n = 72, heart failure n = 36) enrolled to our cardiac rehabilitation unit. All patients were evaluated with the RMI and underwent 6MWT both at admission (RMI 1 and 6MWT 1 ) and after a period of daily physical training (RMI 2 and 6MWT 2 ). The RMI 2 /RMI 1 and 6MWT 2 /6MWT 1 ratios were calculated as indexes of functional improvement (IM).Results. The average in hospital stay was 20 ± 11 days with an average of 11.9 training sessions per patient. The average distance walked at 6MWT 1 and 6MWT 2 was 193 ± 116 and 278 ± 122 m, respectively (p <0.001). The average score of RMI 1 and RMI 2 was 8.5 ± 3.4 and 13.1 ± 2.9, respectively (p <0.001). The values of 6MWT 1 and RMI 1 results were significantly correlated (r = 0.56, p <0.001). The RMI IM was significantly correlated to 6MWT IM (r = 0.309, p = 0.002). At multivariate analysis, RMI IM was found to be predictive of 6MWT IM even after correction for age, gender, length of hospitalization and number of sessions of training.Conclusions. In octogenarians, cardiac rehabilitation results in a significant improvement of both RMI and 6MWT. RMI IM is independently correlated to 6MWT IM. Therefore, RMI could be a useful tool for evaluating the improvement of functional capacity even in patients who cannot undergo 6MWT.

Early after cardiac surgery, in patients without clinical or laboratory signs of acute infection, CRP levels are significantly elevated, do not correlate with clinical variables, and decrease at discharge. These findings suggest a systemic inflammatory response to surgery-related stress, which carries a favorable prognosis at follow-up.

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