Functional evaluation of ultra-octogenarian patients undergoing Cardiac Rehabilitation: correlation between Six minute Walking Test and Rivermead Mobility Index

Background. There is an increasing need for admission of octogenarians to cardiac rehabilitation programs. The aim of this study was to evaluate if the Rivermead Mobility Index (RMI) (scale of mobility) is related to the functional capacity assessed by the 6 Minute Walking Test (6MWT). 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 (RMI1 and 6MWT1) and after a period of daily physical training (RMI2 and 6MWT2). The RMI2/RMI1 and 6MWT2/6MWT1 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 6MWT1 and 6MWT2 was 193 ± 116 and 278 ± 122 m, respectively (p <0.001). The average score of RMI1 and RMI2 was 8.5 ± 3.4 and 13.1 ± 2.9, respectively (p <0.001). The values of 6MWT1 and RMI1 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

Relationship between B-type natriuretic peptide levels and echocardiographic indices of left ventricular filling pressures in post-cardiac surgery patients

<p>Abstract</p> <p>Background</p> <p>B-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.</p> <p>Methods</p> <p>We 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').</p> <p>Results</p> <p>A 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.</p> <p>Conclusion</p> <p>In 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.</p

Immunodetection of human atherosclerotic plaque with 125I-labeled monoclonal antifibrin antibodies

To test the affinity of a new F(ab′)2 monoclonal antibody (TRF1) against human fragment D dimer of cross-linked fibrin for atherosclerotic plaques free of detectable thrombi, 6 atherosclerotic segments of carotid and femoral artery, and as a control 5 segments of atherosclerosis-free internal mammary artery, were drawn from 11 male patients undergoing bypass surgery. All segments were carefully washed in order to remove possible endoluminal thrombi, and cut to obtain pairs of intimal fragments of similar weight, containing either plaques (n = 16), or fatty streaks (n = 12), or normal endothelium (n = 20). Each fragment underwent a direct binding test to TRFI, or to a non-specific antibody, both labeled with 125I. The activity in each fragment was measured after 3 h of incubation at 37°C, and after washing the fragments every hour for 3 h. TRF1 binding (as percentage of initial activity) was significantly higher (P &lt; 0.001) in atherosclerotic than in normal fragments (26% ± 11.5%, vs. 9.2% ± 3.9% in fatty streaks, and 1.9% ± 0.6% in normal endothelium), and indirect immunofluorescence confirmed TRF1 uptake within the plaque wall. By contrast, the non-specific antibody did not show any significant binding. These preliminary results demonstrate the high specific affinity of TRF1 for atherosclerotic plaques, probably due to the hemorheologic phenomena that activate platelets and provoke the formation of fragment D dimers of cross-linked fibrin on the plaque surface. © 1993

Trimetazidine improves exercise performance in patients with peripheral arterial disease

Trimetazidine, an inhibitor of free fatty acids (FFA) oxidation, shifts cardiac and muscle metabolism from FFA to glucose utilization. This effect results in a greater production of high energy phosphates and ultimately into an anti-ischemic effect. Whether the anti-ischemic cardiac effects of trimetazidine (TMZ) can be translated to skeletal muscle in patients with claudication is unknown. We investigated the effectiveness of TMZ on functional performance in patients with peripheral arterial disease (PAD) and claudication. One hundred patients with claudication were enrolled in a parallel, double-blind, 3 months study. Patients were randomized to receive TMZ or matching placebo and were included in a domiciliary exercise program, consisting in daily sessions of aerobic and isotonic exercise for at least five days a week. All patients underwent a treadmill test, evaluating maximal walking distance (MWD), and ankle-brachial index (ABI) at baseline and after 3 months. ABI was similar in the two groups at baseline and did not significantly change at the end of the study in either groups (0.83+0.04 vs 0.85+0.03, TMZ vs placebo, respectively). MWD improved in all patients with exercise training; however, a greater improvement in MWD was observed with TMZ compared to placebo (23% vs 14%, p<0.0001). Physical training ameliorates functional performance in PAD. The adjunct of TMZ to exercise induces a greater improvement in MWD, suggesting that the inhibition of FFA oxidation improves functional capacity in patients with PAD and claudication

AIM (Artery In Microgravity): An ICE Cubes Mission by University Students

The ICE Cubes Facility is a capable experiment platform on board the Columbus Module of the International Space Station that offers flexibility to host many different experiments. The ICE Cubes Facility is suited for any scientific research and technological demonstrator that requires the study of the effects of microgravity and radiation exposure in a pressurised volume. The ICE Cube Service is also open to different schooling levels (primary, secondary, universities) and to different STEAM curricula and offers University students (Master and PhD) the opportunity to design, develop, test and operate a real experiment for the ISS under the supervision of experts from the ICE Cube Service.The Artery In Microgravity (AIM) project is a 2U ICE Cubes experiment cube and the first experiment to be selected for the Orbit Your Thesis! programme of ESA Academy. The cube is expected to be launched on SpaceX-20 in early 2020. The project is being developed by an international group of students from ISAE-Supaero and Politecnico di Torino. The experiment will investigate coronary heart disease, the most common form of cardiovascular disease and the cause of approximately 9 million deaths every year. In view of the very long duration missions to come, such diseases may also affect healthy astronauts in space. The AIM cube is a test-bench for investigating haemodynamics in microgravity and will study the effects of microgravity on blood flow in the coronary artery with and without an implanted coronary stent and the impact of augmented radiation levels on metallic ion release from coronary stents.The experimental setup consists of a closed hydraulic loop containing two models of a coronary artery in series. An electric pump and reservoir will control the flow of a blood-mimicking fluid through the system. One model of the coronary artery will contain a coronary stent. The pressure of the fluid will be studied along its path using a series of pressure sensors and a camera will visualise the flow. Ground tests will be conducted concurrently in order to perform a comparison between the on-ground behaviour and the behaviour in microgravity.The paper will showcase the design and development of the AIM experiment cube, the results of testing and the educational applications of theICE Cubes Facility. The full data and results will be available after the completion of the mission which is expected to be between March and June 2020