Short- and Longer-Term Association Between Body Mass Index and Health Status in Cardiac Rehabilitation Patients

The association between body mass index (BMI) and subjective health status before and after cardiac rehabilitation (CR) and 1 year later was compared in patients undergoing primary percutaneous coronary intervention (pPCI) who did (CR group) and did not receive CR (no-CR group). The aim was to investigate the association between BMI and subjective health status based on the Short Form-12 questionnaire. Between 2009 and 2011, 242 patients with pPCI with an acute myocardial infarction completed a CR program and were compared with 115 patients in the no-CR group. All patients completed the Short Form-12 questionnaire at baseline, at 12 weeks, and at 1-year followup. The CR program consisted of a 2 sessions per week for 1.5 hours each for 12 weeks. Patients were categorized into 3 groups based on BMI: normal weight, overweight, and obese. Compared with patients in the no-CR group, CR group patients in the overweight group significantly improved their subjective health status after CR and these improvements were sustained at 1-year followup. CR patients in the normal weight and obese groups did not significantly improve subjective health status. The overweight patients had the highest improvement in subjective health status (OR = 3.4 post-CR and 5.1 at 1 year of followup). After CR, overweight patients showed the best improvement in subjective health status. CR did not significantly improve subjective health status in normal-weight and obese patient

Impaired sublingual microvascular perfusion during surgery with cardiopulmonary bypass: A pilot study

Objective: Complications after cardiac surgery may involve multiple organ failure, which carries a high mortality. Development of multiple organ failure may be related to impaired microcirculatory perfusion as a result of systemic inflammation. Microcirculatory blood flow alterations have been associated with impaired outcome. We investigated whether these alterations occurred before, during, and after coronary artery bypass grafting. Methods: We observed 25 consecutive patients who underwent elective coronary artery bypass grafting with cardiopulmonary bypass. The sublingual microcirculation was investigated using side-stream dark-field imaging. Side-stream dark-field imaging was performed before ( baseline), during, and after surgery. Microvascular blood flow was estimated with a semiquantitative microvascular flow index in small, medium, and large microvessels. Changes in microvascular flow were tested with Wilcoxon signed rank test. Results: Median microvascular flow index of medium blood vessels decreased after starting cardiopulmonary bypass relative to that after anesthetic induction (2.6, interquartile range 1.6-3.0, vs 3.0, interquartile range 2.8-3.0, P = .02). There was a trend toward decreased microvascular flow index of small and large vessels relative to baseline (P = .08 and P = .05, respectively). Decreases in microvascular flow index occurred irrespective of changes in systemic blood pressure. After each patient's return to the intensive care unit, microvascular flow index increased and normalized in all microvessels. Conclusion: For the first time, sublingual microvascular blood flow alterations have been observed during cardiopulmonary bypass-assisted coronary artery bypass grafting

The patron of Hieronymus Bosch’s ‘Last Judgment’ triptych in Vienna

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