Heart Rate Control in Non-Paroxysmal Atrial Fibrillation. A New Indication for Ivabradine?

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Glyco-metabolic Effects of Ranolazine: A truly Multifaceted Drug?

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Testosterone Therapy in Women With Chronic Heart Failure A Pilot Double-Blind, Randomized, Placebo-Controlled Study

ObjectivesThe primary objective of this study was to assess the effect of a 6-month testosterone supplementation therapy on functional capacity and insulin resistance in female patients with chronic heart failure (CHF).BackgroundPatients with CHF show decreased exercise capacity and insulin sensitivity. Testosterone supplementation improves these variables in men with CHF. No study has evaluated the effects of testosterone supplementation on female patients with CHF.MethodsThirty-six elderly female patients with stable CHF, (ejection fraction 32.9 ± 6) were randomly assigned (2:1 ratio) to receive testosterone transdermal patch (T group, n = 24) or placebo (P group, n = 12), both on top of optimal medical therapy. At baseline and after 6 months, patients underwent 6-min walking test (6MWT), cardiopulmonary exercise test, echocardiogram, quadriceps maximal isometric voluntary contraction, dynamic quadriceps isokinetic strength (peak torque), and insulin resistance assessment by homeostasis model.ResultsDistance walked at 6MWT as well as peak oxygen consumption significantly improved in the T group, whereas they were unchanged in the P group (p < 0.05 for all comparisons). The homeostasis model was significantly reduced in the T group in comparison with the P group (−16.5% vs. +5%, respectively; p < 0.05). Maximal voluntary contraction and peak torque increased significantly in the T group but did not change in the P group. Increase in distance walked at 6MWT was related to the increase in free testosterone levels (r = 0.593, p = 0.01). No significant changes in echocardiographic parameters were observed in either group. No side effects requiring discontinuation of T were detected.ConclusionsTestosterone supplementation improves functional capacity, insulin resistance, and muscle strength in women with advanced CHF. Testosterone seems to be an effective and safe therapy for elderly women with CHF

Tai Chi Enhances the Effects of Endurance Training in the Rehabilitation of Elderly Patients with Chronic Heart Failure

Purpose. To assess if Tai Chi added to endurance training (ET) is more effective than ET alone in improving exercise tolerance and quality of life (QOL) of elderly patients with chronic heart failure (CHF). Design. Sixty CHF patients, age 73.8 ± 6 years, M/F 51/9, were enlisted. Thirty pts were randomized to combined training (CT) performing Tai Chi +ET and 30 patients to ET (ET only). Methods. At baseline and after 12 weeks all patients underwent 6-minute walking test (6MWT), assessment of amino terminal probrain natriuretic peptide (NT-pro BNP), quadriceps maximal voluntary contraction (MVC) and peak torque (PT), QOL questionnaire (MacNewQLMI), blood pressure (BP), and heart rate (HR). All patients performed 4 sessions of exercise/week. Results. Distance at 6mwt improved in both groups with significant between-groups differences (P = .031). Systolic BP and NT-proBNP decreased significant in the CT group compared to ET (P = .025) and P = .015), resp.). CT group had a greater significant improvement in physical perception (P = .026) and a significant increase of PT compared to ET group. Conclusions. The association of Tai Chi and ET improves exercise tolerance and QOL of patients with CHF more efficiently than ET

Covid-19 And Rheumatic Autoimmune Systemic Diseases: Role of Pre-Existing Lung Involvement and Ongoing Treatments

The Covid-19 pandemic may have a deleterious impact on patients with autoimmune systemic diseases (ASD) due to their deep immune-system alterations

Geographical heterogeneity of clinical and serological phenotypes of systemic sclerosis observed at tertiary referral centres. The experience of the Italian SIR-SPRING registry and review of the world literature

Introduction: Systemic sclerosis (SSc) is characterized by a complex etiopathogenesis encompassing both host genetic and environmental -infectious/toxic- factors responsible for altered fibrogenesis and diffuse microangiopathy. A wide spectrum of clinical phenotypes may be observed in patients' populations from different geographical areas. We investigated the prevalence of specific clinical and serological phenotypes in patients with definite SSc enrolled at tertiary referral centres in different Italian geographical macro-areas. The observed findings were compared with those reported in the world literature.Materials and methods: The clinical features of 1538 patients (161 M, 10.5%; mean age 59.8 +/- 26.9 yrs.; mean disease duration 8.9 +/- 7.7 yrs) with definite SSc recruited in 38 tertiary referral centres of the SPRING (Systemic sclerosis Progression INvestiGation Group) registry promoted by Italian Society of Rheumatology (SIR) were obtained and clustered according to Italian geographical macroareas.Results: Patients living in Southern Italy were characterized by more severe clinical and/or serological SSc phenotypes compared to those in Northern and Central Italy; namely, they show increased percentages of diffuse cutaneous SSc, digital ulcers, sicca syndrome, muscle involvement, arthritis, cardiopulmonary symptoms, interstitial lung involvement at HRCT, as well increased prevalence of serum anti-Scl70 autoantibodies. In the same SSc population immunusppressive drugs were frequently employed. The review of the literature underlined the geographical heterogeneity of SSc phenotypes, even if the observed findings are scarcely comparable due to the variability of methodological approaches.Conclusion: The phenotypical differences among SSc patients' subgroups from Italian macro-areas might be correlated to genetic/environmental co-factors, and possibly to a not equally distributed national network of information and healthcare facilities

Heart Rate Control in Non-Paroxysmal Atrial Fibrillation. A New Indication for Ivabradine?

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Prolonged Post-Exercise Hypotension: Effects of Different Exercise Modalities and Training Statuses in Elderly Patients with Hypertension

Background: In this study, we aimed at comparing the effects of three different exercise modalities on post-exercise hypotension (PEH) in elderly hypertensive patients and at investigating whether PEH responses to the same exercises are affected by their training status. Methods: Thirty-six male sedentary hypertensive patients over 60 years old, were included. They were divided into three groups each one corresponding to a different exercise modality, i.e., aerobic continuous exercise (ACE), high-intensive interval exercise (HIIE), and combined (aerobic and resistance) exercise (CE). PEH was assessed in each group by ambulatory blood pressure monitoring (ABPM) in two different conditions as follows: (1) sedentary status and (2) trained status, at the end of a 12 week of ACE training program. A cardiopulmonary test was performed before and at the end of the training program. Results: In the sedentary status, 24-h and nocturnal systolic and diastolic blood pressure (BP) decreased in all groups as compared with top pre-exercise, with a greater but not significant reduction in the ACE and CE groups as compared with HIIE. ACE and HIIE groups presented a more sustained PEH than CE. In the trained status, 24-h and nighttime systolic and diastolic BP decreased significantly only after HIIE, but were unchanged as compared with pre-exercise in the ACE and CE groups. Conclusions: ACE and CE produced greater PEH than HIIE in sedentary elderly hypertensive patients. However, after training, HIIE produced the greater and more sustained PEH. The training status appears to exert significant effects on PEH produced by different exercise modalities

Intensive cardiac rehabilitation improves glucometabolic state of non-diabetic patients with recent coronary artery bypass grafting

Background: The aim of this study is to examine the effect of an intensive CR program early after coronary artery bypass grafting on glucometabolic state of non-diabetic patients with CAD. Methods: 60 patients were included in the study. All patients underwent Oral Glucose Tolerance Test (OGTT), Homeostasis Model Assessment (HOMA) Index and Six Minutes Walking Test at baseline and at the end of CR. The patients were then included in a 3-month follow-up program. Results: At baseline 61% of the patients had normal fasting glucose, while after OGTT 28.3% had normal glucose tolerance, 41.6% had impaired glucose tolerance (IGT), and 30.1% had type 2 diabetes mellitus (T2DM). At the end of the CR program the number of patients with T2DM was significantly lower (−22%, p < 0.05) while the number of normal glucose tolerance patients had significantly increased (+26%; p < 0.05). T2DM and IGT patients showed worse performances at Six Minutes Walking Test than normal glucose tolerance patients at baseline but had a similar improvement after 4 weeks of training. After 3 months follow-up fasting blood glucose, insulin levels and HOMA index were increased compared to 4 week values, but were lower than baseline. Conclusion: OGTT is important to evaluate glucometabolic state of CAD patients. Intensive CR improves glucometabolic state and insulin resistance in CAD patients with impaired glucose metabolism