Prognostic value of new left atrial volume index severity partition cutoffs after cardiac rehabilitation program in patients undergoing cardiac surgery

Background: Previous studies showed that left atrial enlargement is an independent marker of adverse outcomes in both primary and secondary cardiovascular prevention. However, no data are available on long-term outcomes in patients undergoing valve surgery and/or coronary artery by-pass graft (CABG) surgery. Aim of the study was to evaluate long-term prognostic role of left atrial volume index (LAVi) after cardiac surgery, using the cutoff values recently proposed by the European Association of Cardiovascular Imaging and American Society of Echocardiography. Methods: We created a retrospective registry of 1703 consecutive patients who underwent cardiovascular rehabilitation program after cardiac surgery, including CABG, valve surgery and valve + CABG surgery. LAVi was calculated as ratio of left atrium volume to body surface area, in ml/m2 at discharge; 563 patients with available LAVi data were included in the study. Results: In the whole population LAVi was 36 ± 14 ml/m2 (mean ± SD) and the follow-up time was 5 ± 1. 5 years. Increased LAVi (>34 ml/m2) predicted major adverse cardiovascular and cerebrovascular events (MACCEs) (HR = 2.1; CI95 %: 1.4–3.1; p < 0.001) and cardiovascular mortality (HR = 2.2; CI95 %: 1.0–4.5; p = 0.032). An increased LAVi remained MACCEs predictor after adjustement for age, gender, diabetes, atrial fibrillation at discharge, echocardiographic E/A ratio and left ventricular ejection fraction (HR = 1.8; CI95 %: 1.0–3.0; p = 0. 036). When the study population was split according to increasing LAVi values, left atrium enlargement resulted a predictor of progressively worse adverse outcome. Conclusions: LAVi is a predictor of long-term adverse cardiovascular outcome after cardiac surgery, even after correction for main clinical and echocardiographic variables. The recently recommended LAVi severity cutoffs appear adequate to effectively stratify outcome in patients undergoing rehabilitation after cardiac surgery

Interaction of Skeletal and Left Ventricular Mass in Older Adults with Low Muscle Performance

BACKGROUND: It was recently hypothesized the existence of “cardiac-skeletal muscle axis.” However, the relationship between skeletal muscle mass (SMM) and left ventricular mass (LVM) has never been investigated in the specific group of older individuals with low skeletal mass and physical performance. We tested this hypothesis in the SPRINT-T (Sarcopenia and Physical Frailty IN older people: multicomponenT Treatment strategies Trial) population using LVM as independent variable and SMM as dependent variable. METHODS: SMM was assessed by dual-energy X-ray absorptiometry scan and expressed as appendicular lean mass (ALM), and LVM was estimated through echocardiography. Low ALM was defined according to Foundation for the National Institutes of Health Sarcopenia Project criteria, and Short Physical Performance Battery (SPPB) was used to assess physical performance.RESULTS: The population consisted of 100 persons (33 men and 67 women), aged 70 years or older (mean age = 79 5 years) with low ALM and SPPB ranged between 3 and 9, suggestive of physical frailty. Charlson Comorbidity Index median score was 0. Mean value of LVM was 193 67 g, indexed LVM/body surface area (LVM/BSA) was 112 33 g/m2, and cardiac output (CO) was 65 19 L/min. ALM was strongly and positively correlated with LVM (r = 0.54602; P &lt; .0001), LVM/BSA (r = 0.30761; P &lt; .002), CO (r = 0.49621; P &lt; .0001), body mass index (BMI) (r = 0.52461; P &lt; .0001), sex (r = 0.77; P &lt; .001), fat mass (r = 0.38977; P &lt; .0001), and hemoglobin (Hb) (r = 0.26001; P &lt; .01). In the multivariate analysis, LVM (β = .019 .005; P &lt; .0001), CO (β = .038 .016; P = .019), BMI (β = .286 .051; P &lt; .0001), and Hb (β = .544 .175; P = .0025) remained associated to ALM. CONCLUSIONS: In a sample of older persons with low muscle mass and physical performance, LVM was positively and significantly correlated with ALM, independently from blood pressure, physical activity, and other potential confounders. Future studies are needed to address the effect of interventions targeting LVM and SMM

Assembly of Gold Nanoparticles on Functionalized Si(100) Surfaces through Pseudorotaxane Formation

The assembly of gold nanoparticles (AuNPs) on a hydrogenated Si(100) surface, mediated by a series of hierarchical and reversible complexation processes, is reported. The proposed multi-step sequence involves a redox-active ditopic guest and suitable calix[n]arene-based hosts, used as functional organic monolayers of the two inorganic components. Surface reactions and controlled release of AuNPs have been monitored by application of XPS, atomic force microscopy (AFM), field-emission scanning electron microscopy (FESEM) and electrochemistry

Interaction of Skeletal and Left Ventricular Mass in Older Adults with Low Muscle Performance

BACKGROUND: It was recently hypothesized the existence of “cardiac-skeletal muscle axis.” However, the relationship between skeletal muscle mass (SMM) and left ventricular mass (LVM) has never been investigated in the specific group of older individuals with low skeletal mass and physical performance. We tested this hypothesis in the SPRINT-T (Sarcopenia and Physical Frailty IN older people: multicomponenT Treatment strategies Trial) population using LVM as independent variable and SMM as dependent variable. METHODS: SMM was assessed by dual-energy X-ray absorptiometry scan and expressed as appendicular lean mass (ALM), and LVM was estimated through echocardiography. Low ALM was defined according to Foundation for the National Institutes of Health Sarcopenia Project criteria, and Short Physical Performance Battery (SPPB) was used to assess physical performance.RESULTS: The population consisted of 100 persons (33 men and 67 women), aged 70 years or older (mean age = 79 5 years) with low ALM and SPPB ranged between 3 and 9, suggestive of physical frailty. Charlson Comorbidity Index median score was 0. Mean value of LVM was 193 67 g, indexed LVM/body surface area (LVM/BSA) was 112 33 g/m2, and cardiac output (CO) was 65 19 L/min. ALM was strongly and positively correlated with LVM (r = 0.54602; P &lt; .0001), LVM/BSA (r = 0.30761; P &lt; .002), CO (r = 0.49621; P &lt; .0001), body mass index (BMI) (r = 0.52461; P &lt; .0001), sex (r = 0.77; P &lt; .001), fat mass (r = 0.38977; P &lt; .0001), and hemoglobin (Hb) (r = 0.26001; P &lt; .01). In the multivariate analysis, LVM (β = .019 .005; P &lt; .0001), CO (β = .038 .016; P = .019), BMI (β = .286 .051; P &lt; .0001), and Hb (β = .544 .175; P = .0025) remained associated to ALM. CONCLUSIONS: In a sample of older persons with low muscle mass and physical performance, LVM was positively and significantly correlated with ALM, independently from blood pressure, physical activity, and other potential confounders. Future studies are needed to address the effect of interventions targeting LVM and SMM

Emotional status and fear in patients scheduled for elective surgery during COVID-19 pandemic: a nationwide cross-sectional survey (COVID-SURGERY)

Background Fragmented data exist on the emotional and psychological distress generated by hospital admission during the pandemic in specific populations of patients, and no data exists on patients scheduled for surgery. The aim of this multicentre nationwide prospective cross-sectional survey was to evaluate the impact of pandemic on emotional status and fear of SARS-CoV-2 contagion in a cohort of elective surgical patients in Italy, scheduled for surgery during the COVID-19 pandemic. Results Twenty-nine Italian centres were involved in the study, for a total of 2376 patients surveyed (mean age of 58 years ± 16.61; 49.6% males). The survey consisted of 28 total closed questions, including four study outcome questions. More than half of patients had at least one chronic disease (54%), among which cardiovascular diseases were the commonest (58%). The most frequent type of surgery was abdominal (20%), under general anaesthesia (64%). Almost half of the patients (46%) declared to be frightened of going to the hospital for routine checkups; 55% to be afraid of getting SARS-CoV-2 infection during hospitalization and 62% were feared of being hospitalised without seeing family members. Having an oncological disease and other patient-related, centre-related or perioperative factors were independently associated with an increased risk of fear of SARS-CoV-2 infection during hospitalization and of being hospitalised without seeing family members. A previous infection due to SARS-COV-2 was associated with a reduced risk of worse emotional outcomes and fear of SARS-CoV-2 infection during hospitalization. Patients who showed the most emotionally vulnerable profile (e.g. use of sleep-inducing drugs, higher fear of surgery or anaesthesia) were at higher risk of worse emotional status towards the hospitalization during COVID-19 pandemic. Being operated in hospitals with lower surgical volume and with COVID-19 wards was associated with worse emotional status and fear of contagion. Conclusions Additional fear and worse emotional status may be frequent in patients scheduled for elective surgery during COVID-19 pandemic. More than half of the participants to the survey were worried about not being able to receive family visits. Psychological support may be considered for patients at higher risk of psychological distress to improve perioperative wellbeing during the pandemic