Improvement of heart rate recovery after exercise training in older people.

Twenty-four subjects aged 70 and older were retrospectively selected from our archives and screened for symptoms of cardiovascular disease. Baseline exercise test was negative for myocardial ischemia in all subjects. All subjects had completed an 8-week program, performed for a variety of indications and consisting of an aerobic physical training program including 30 minutes of cycling three times per week at 65% to 75% of maximum heart rate achieved at peak exercise test performed at enrollment, an educational intervention, dietary advice, and psychological support. All subjects underwent a cardiopulmonary exercise test (CPX) before and at the end of exercise training. At the end of each CPX, peak oxygen uptake (VO2peak), the rate of increase of ventilation per unit of increase of carbon dioxide production (VE/VCO2slope), and HRR were recorded. Twenty-five healthy subjects younger than 60 with no evidence of exercise-induced myocardial ischemia and not enrolled in any exercise training program were also retrospectively selected from our archives and used as a control group for analyzing HRR. These patients performed two exercise tests several weeks apart. Several studies have shown that changes in vagal tone can be used as an outcome tool that helps identify patients or subjects with or without cardiovascular disease at risk for a cardiovascular event, although the evidence of a prognostic value of HRR in older subjects without cardiovascular disease is rather poor. In this study, exercise training resulted in HRR improvement in healthy elderly subjects, suggesting that exercise training improves vagal/sympathetic balance in older subjects without cardiovascular disease as well. Whether the observed improvement in HRR may have long-term beneficial prognostic effects was not the aim of the study, although a beneficial effect might be postulated, in light of the Framingham dat

Vulnerable personality and Takotsubo cardiomyopathy consequent to emotional stressful events: a clinical case report

Introduction: Although the onset of Takotsubo cardiomyopathy (TTC) can be triggered by an acute, intense emotional stress, the exact pathogenic mechanisms still remain undefined. Presentation: A 58-year-old female was sent by ambulance to the Emergency Department (ED) for chest pain and ST elevations on ECG. Her chest pain began 3 hours before on admission after a domestic argument. Transthoracic echocardiogram showed severe systolic dysfunction with an ejection fraction of 20%. Cardiac catheterization revealed no significant coronary artery disease. The left ventriculogram showed apical ballooning with hyperdynamic proximal segments. A diagnosis of Takotsubo Cardiomyophaty (TTC) was made according to the Mayo Clinic 2008 criteria. The patient evolved with improvement of her condition and, therefore, was discharged from the hospital. Follow-up echocardiogram seven days later showed normal LV size and function with ejection fraction (EF) of 43%. Paykel Life Stress Event Scale identified as emotional trigger a domestic argument occurred 3 hours before symptom onset. History showed a major life stress event, death of a loved one, six months before symptoms. The patient underwent psychological assessment after hospital discharge by Emotional Regulation Questionnaire and BDI showing high suppression/ low reappraisal profile and moderate depression. Conclusion: This case highlights the hypothesis of a possible link between cognitive emotional processing and vulnerability to Takotsubo syndrome

Arterial stiffness and Vitamin D levels: the Baltimore Longitudinal Study of Aging

CONTEXT: The importance of vitamin D for bone health has long been acknowledged. Recent evidence suggests that vitamin D can also play a role in reducing the risk of several other diseases, including cardiovascular disease. OBJECTIVE: The aim of this study is to test the hypothesis that 25-hydroxyvitamin D (25-OH D) is an independent cross-sectional correlate of central arterial stiffness in a normative aging study population. DESIGN AND SETTINGS: We conducted a cross-sectional analysis. SUBJECTS: We studied 1228 healthy volunteers (50% males; age, 70\ub112 yr) of the Baltimore Longitudinal Study of Aging. MAIN OUTCOME MEASURES: We measured carotid-femoral pulse wave velocity (PWV) and 25-OH D levels. RESULTS: We found a significant inverse association between PWV and 25-OH D levels (adjusted r2=0.27; \u3b2=-0.43; P=0.001). After adjusting for age, gender, ethnicity, season of blood draw, estimated glomerular filtration rate, physical activity level, cardiovascular risk factors score (smoking, visceral obesity, hypercholesterolemia, hypertension, and diabetes), calcium/vitamin D supplementation, serum calcium, and PTH levels, the association between PWV and 25-OH D levels was only slightly reduced and remained statistically significant (adjusted r2=0.34; \u3b2=-0.34; P=0.04). CONCLUSIONS: Vitamin D levels are inversely associated with increased arterial stiffness in a normative aging population, irrespective of traditional risk factor burden. Further research is needed to understand the mechanism of this association and to test the hypothesis that vitamin D supplementation can reduce arterial stiffness

Effects of Metformin With or Without Supplementation With Folate on Homocysteine Levels and Vascular Endothelium of Women With Polycystic Ovary Syndrome

OBJECTIVE: To evaluate whether the administration of metformin exerts any effects on serum homocysteine (Hcy) levels in patients with polycystic ovary syndrome (PCOS) and whether supplementation with folate enhances the positive effects of metformin on the structure and function of the vascular endothelium. RESEARCH DESIGN AND METHODS: A total of 50 patients affected by PCOS, without additional metabolic or cardiovascular diseases, were enrolled in a prospective nonrandomized placebo-controlled double-blind clinical study. They were grouped into two treatment arms that were matched for age and BMI. Patients were treated with a 6-month course of metformin (1,700 mg daily) plus folic acid (400 microg daily; experimental group, n = 25) or placebo (control group, n = 25). Complete hormonal and metabolic patterns, serum Hcy, folate, vitamin B12, endothelin-1 levels, brachial artery diameter at the baseline (BAD-B) and after reactive hyperemia (BAD-RH), flow-mediated dilation, and intima-media thickness in both common carotid arteries were evaluated. RESULTS: After treatment, a significant increase in serum Hcy levels was observed in the control group compared with the baseline values and the experimental group. A beneficial effect was observed in the concentrations of BAD-B, BAD-RH, flow-mediated dilation, intima-media thickness, and serum endothelin-1 in both groups. However, the results were improved more significantly in the experimental group than in the control subjects. CONCLUSIONS: Metformin exerts a slight but significant deleterious effect on serum Hcy levels in patients with PCOS, and supplementation with folate is useful to increase the beneficial effect of metformin on the vascular endothelium

Short-term treatment of iron deficiency anemia after cardiac surgery

Iron deficiency anemia (IDA) is frequent after cardiac surgery and is associated with increased morbidity and mortality. In a retrospective study, we analyzed 106 patients with IDA (hemoglobin [Hb] ≤ 12 g/dl in women and ≤ 13 g/dl in men, transferrin saturation [TSAT] ≤ 20%) on admission to a Cardiac Rehabilitation Unit after cardiac surgery. The patients were divided into two groups, one was treated with oral sucrosomial iron (SI) and the other with intravenous ferric carboxymaltose (FCM). Patients received a single 1000 mg dose of FCM from the day after admission to rehabilitation (T1), or a 120 mg/day dose of SI from T1 until discharge (T2); after discharge, SI was reduced to 30 mg/day until the end of follow-up (T3). Hb was evaluated at T1, T2 and T3; the other hematological parameters at T1 and T3; natriuretic peptides at T1, T2 and T3; 6-minute walk test (6MWT) at T1 and T2. Folate, vitamin B12 and reticulocytes were sampled on admission. Folate deficiency was documented in 60.4% of patients. Hb increased in both groups with no significant differences between the two treatments (p = 0.397). The other iron metabolism parameters (sideremia, transferrin, TSAT) displayed similar behavior, showing a significant increase at T3 (p < 0.001) with both therapies, although the increase was faster with FCM. Ferritin - high on admission - decreased at T3 in the SI group and rose significantly in the FCM group (SI 219.5 vs. FCM 689 ng/ml p < 0.0001). The 6MWT increased significantly at T2, with an overlap between SI and FCM. In conclusion, the results of this study show that SI and FCM exhibit the same effectiveness on IDA; the response time to therapy of both treatments is also equally fast. SI and FCM induce a similar increase in functional capacity. The study shows that SI can be a viable alternative to FCM after cardiac surgery in terms of effectiveness and tolerability

Post-traumatic stress disorder, emotional processing and Inappropriate Implantable Cardioverter-Defibrillator Shocks: clinical consideration by a single case report = Disturbo post-traumatico da stress, profilo cognitivo-emotivo e shocks inappropriati del defibrillatore cardiaco impiantabile: Considerazioni cliniche attraverso un single case report

Introduction. Even though an overwhelming amount of evidence supports the clinical efficacy and safety of the implantable cardioverter defibrillator (ICD), inappropriate shocks for atrial arrhythmias with rapid ventricular conduction or for abnormal sensing results in multiple adverse effects Presentation. In this study we present the case of a 59- year-old woman who was admitted to hospital for ICD implantation with a past medical history that was positive for non-ischemic dilated cardiomyopathy, congestive heart failure (NYHA class III), atrial fibrillation, essential hypertension and a recent episode of syncope. Since in the 18 months follow-up the patient suffered many inappropriate shocks, we investigated the association of the presence of a PTSD (Post- Traumatic-Stress-Disorder) prior to implantation and a specific profile of cognitive processing emotions, with the effectiveness of the ICD. Emotional distress states and cognitive thoughts preceding ICD shock inappropriate episode were recorded by structured mobile diary (eMotional-ICDiary). We outlined how the presence of a highly traumatic event which had occurred 6 years previously was related to a recurrence of a combination of moderate distress and cognitive thoughts, associated with episodes of Inappropriate Shock. A psycho-diagnostic examination and the administration of the Emotional Processing Scale (EPS-25) and Emotional Regulation Questionnaire (ERQ) outlined that the patient presented a profile of cognitive processing of emotions characterized by elevated levels of unprocessed emotions, low appraisal and high suppression emotional regulation strategy. Conclusion. The observations gathered in this single case are a good starting point for further research in order to check if the post-traumatic stress disorder and a specific cognitive profile connected to the processing of emotions are associated with the presence of inappropriate ICD shocks. Further larger sample studies are required in this area

Exercise training improves erectile dysfunction (ED) in patients with metabolic syndrome on phosphodiesterase-5 (PDE-5) inhibitors

Introduction. Erectile dysfunction (ED) affects about 50% of males aged 40-70 years old. ED shares with atherosclerotic disease several common risk factors; therefore, it may be considered a surrogate marker of atherosclerosis. Sincephosphodiesterase-5 inhibitors are well known pharmacologic agents capable of significant improvement in ED, we designed this study to evaluate whether exercise training is of added value in patients with ED who are already on PDE-5 inhibitors. Methods. We recruited 20 male patients affected by ED with metabolic syndrome.At baseline, all patients underwent Cardio-Pulmonary Exercise Testing (CPET) and the International Index of Erectile Function (IIEF) test.After the initial evaluation, patients were subdivided into two groups: tadalafil group (group T, n=10), who were maintained only on tadalafil therapy, and a tadalafil/exercise training group (T/E group, n=10)who continued tadalafil but in addition underwent a2-month structured exercise training program. Results. Basal anthropometric characteristics of study population showed no significant differences. Although bothgroups showed at 2 months an improvement of the IIEF score, thiswas more evident in the T/E group (T group: 11.2 vs 14.2, P=0.02; T/E group: 10.8 vs 20.1, P&lt;0.001). There was an improvement of oxygen consumption at peak exercise (VO2peak) only in the T/E group patients (T group: 13.63±2.03 vs 14.24±2.98 mL/kg/min; P=0.521; T/E group: 13.41±2.97 vs 16.58±3.17 mL/kg/min; P=0.006). A significant correlation was found between the changes in VO2peak and the modifications in IIEF score (r=0.575; P=0.001). Conclusion. Exercise training in ED patients treated with PDE-5 inhibitors is of added valuesincefurther improves ED, as evaluated by IIEF score, and increases functional capacity

Post-traumatic stress disorder, emotional processing and Inappropriate Implantable Cardioverter-Defibrillator Shocks: clinical consideration by a single case report

Introduction. Even though an overwhelming amount of evidence supports the clinical efficacy and safety of the implantable cardioverter defibrillator (ICD), inappropriate shocks for atrial arrhythmias with rapid ventricular conduction or for abnormal sensing results in multiple adverse effects Presentation. In this study we present the case of a 59- year-old woman who was admitted to hospital for ICD implantation with a past medical history that was positive for non-ischemic dilated cardiomyopathy, congestive heart failure (NYHA class III), atrial fibrillation, essential hypertension and a recent episode of syncope. Since in the 18 months follow-up the patient suffered many inappropriate shocks, we investigated the association of the presence of a PTSD (Post- Traumatic-Stress-Disorder) prior to implantation and a specific profile of cognitive processing emotions, with the effectiveness of the ICD. Emotional distress states and cognitive thoughts preceding ICD shock inappropriate episode were recorded by structured mobile diary (eMotional-ICDiary©). We outlined how the presence of a highly traumatic event which had occurred 6 years previously was related to a recurrence of a combination of moderate distress and cognitive thoughts, associated with episodes of Inappropriate Shock. A psycho-diagnostic examination and the administration of the Emotional Processing Scale (EPS-25) and Emotional Regulation Questionnaire (ERQ) outlined that the patient presented a profile of cognitive processing of emotions characterized by elevated levels of unprocessed emotions, low appraisal and high suppression emotional regulation strategy. Conclusion. The observations gathered in this single case are a good starting point for further research in order to check if the post-traumatic stress disorder and a specific cognitive profile connected to the processing of emotions are associated with the presence of inappropriate ICD shocks. Further larger sample studies are required in this area

Colorectal cancer in the elderly patient: The role of neo-adjuvant therapy

Neoadjuvant chemoradiotherapy has a significant role in downstaging cancer. It improves the local control of the disease and can make conservative resection of rectal cancer possible. We enrolled 114 patients with subperitoneal rectal cancer who underwent neoadjuvant chemoradio-therapy and radical excision with total mesorectal excision (TME). The primary endpoint was oncological outcomes and the secondary endpoint was surgical outcomes.We evaluate the experience of a multidisciplinary team and the role of neoadjuvant chemoradiotherapy in integrated treatment of cancer of the subperitoneal rectum. Surgical procedures performed were abdominal perineal resection in 4 cases (3.5%), anterior resection in 89 cases (78%), Hartmann's procedure in 5 cases (4.4%), and ultralow resection with coloanal anastomosis and diverting stoma in 16 patients (14%). Local recurrence occurred in 6 patients (5.2%), the overall survival was 71.9% at 5 years and disease-free survival was about 60%. The effect of pathological downstaging amounted to 58.8%, including cPR. The pathologic complete remission occurred in 8.8% of cases. The outcomes of neoadjuvant therapy can be achieved when this treatment is associated with correct surgical technique with TME and the prognosis is defined by an anatomopathological examination performed according to Quirke's protocol

Discovery of os cordis in the cardiac skeleton of chimpanzees (Pan troglodytes)

Cardiovascular diseases, especially idiopathic myocardial fibrosis, is one of the most significant causes of morbidity and mortality in captive great apes. This study compared the structure and morphology of 16 hearts from chimpanzees (Pan troglodytes) which were either healthy or affected by myocardial fibrosis using X-ray microtomography. In four hearts, a single, hyperdense structure was detected within the right fibrous trigone of the cardiac skeleton. High resolution scans and histopathology revealed trabecular bones in two cases, hyaline cartilage in another case and a focus of mineralised fibro-cartilaginous metaplasia with endochondral ossification in the last case. Four other animals presented with multiple foci of ectopic calcification within the walls of the great vessels. All hearts affected by marked myocardial fibrosis presented with bone or cartilage formation, and increased collagen levels in tissues adjacent to the bone/cartilage, while unaffected hearts did not present with os cordis or cartilago cordis. The presence of an os cordis has been described in some ruminants, camelids, and otters, but never in great apes. This novel research indicates that an os cordis and cartilago cordis is present in some chimpanzees, particularly those affected by myocardial fibrosis, and could influence the risk of cardiac arrhythmias and sudden death