G.F. Gensini

Left-ventricular function and physical performance on the 6-min walk test in older patients after inpatient cardiac rehabilitation.

Polcaro P, Molino Lova R, Guarducci L, Conti AA, Zipoli R, Papucci M, Garuglieri S, Raimo D, Fattirolli F, Macchi C, Gensini GF: Left-ventricular function and physical performance on the 6-min walk test in older patients after inpatient cardiac rehabilitation. Am J Phys Med Rehabil 2008;87:46–55. Objective:The 6-min walk test (6mWT) is widely used to assess physical performance in cardiac rehabilitation settings. Factors affecting the walked distance before starting physical training have been described, whereas information on factors affecting the increase of the walked distance after physical training is still scant. The aim of this study was to verify, in a large sample of elderly patients soon after cardiac surgery, the role of left-ventricular function (LVF) in increases in distances walked after an intensive rehabilitation program. Design:We enrolled 459 patients (300 males and 159 females, mean [±SD] age 70 ± 11 yrs). According to the echographic ejection fraction, patients were classed into two categories, LVF ≥ 40% and LVF < 40%. All patients performed the 6mWT at the beginning and end of the rehabilitation program. Results:Longer walked distances before and after the rehabilitation program were significantly associated with preserved or moderately depressed LVF, whereas greater relative increases of the distance walked after the rehabilitation program were significantly associated with poor LVF (P < 0.001 for all). Conclusions:Among elderly patients admitted as inpatients to an intensive rehabilitation program soon after cardiac surgery, those with poor LVF are most likely to respond more favorably to physical training. Therefore, instead of considering poor LVF a risk for starting physical training in these patients, it should be considered a strong indication, to avoid further physical deconditioning and disability.

Interactive databases for cardiac rehabilitation: the "CardioDB" electronic archive elaborated by the Don Carlo Gnocchi foundation

The main aim of Cardiac Rehabilitation is the reduction of new clinical events through cardiovascular risk factors control. In the Florence Cardiologic Unit of the Don Gnocchi Foundation Institute approximately 350 patients are managed each year. To perform a full follow-up analysis of the patients the data included in a traditional database are currently being transferred into the newly developed electronic archive of the Don Gnocchi Foundation. Through the insertion of the maximum possible quantity of numerical information as soon as it is available, clinical work is speeded up and a quality control of inserted data is possible. Such a system guarantees the possibility of producing complete diagnostic records by introducing numerical data; it also provides reports accounting for the outcome of treatments and even the discharge letter. The CardioDB is also functional for scientific research purposes since its quantitative content may be immediately accessed, processed and analyzed in statistical terms

Extended-Length ECG in Patients who Undergo Cardiac Surgery and Early Rehabilitation: 6 Months Follow-Up

The aim of the study was to investigate sympathetic and parasympathetic balance and arrhythmic risk in patients undergoing bypass surgery (CABG) and early Rehabilitation using “Extended-length electrocardiogram” (XL-ECG).nnMethods 48 patients undergoing CABG (13 women-68.6 yrs) were investigated using five-min XL-ECG at their admission to the Rehabilitation and after three and six months. Echographic systolic and diastolic function was also recorded.nnResults R-R interval (ms) increased only between baseline (B) and 6-months (6) (p<0.05), QT interval dispersion (QTd-ms) decreased only between B and 3-months (3) (p<0.05), Activation-Recovery Interval dispersion (ARId-ms) decreased between B and 3 (p<0.05), between 3 and 6 (p<0.01) and between B and 6 (p<0.01). A wave peak velocity (A) increased only between B and 3. Results remained unchanged after multivariate regression.nnConclusions The decrease of QTd and ARId, suggests that early cardiac rehabilitation after revascularization, increase repolarization homogeneity thus reducing arrhythmic risk. The increase of A suggests an improvement in left atrial booster pump function. XL-ECG is a low time-consuming and low cost tool useful for a quick evaluation of autonomic balance and arrhythmologic risk.

19. Sudden Death: ECG and Biological Risk Factors19.3 Extended-Length ECG in Patients who Undergo Cardiac Surgery and Early Rehabilitation: 6 Months Follow-Up

The aim of the study was to investigate sympathetic and parasympathetic balance and arrhythmic risk in patients undergoing bypass surgery (CABG) and early Rehabilitation using “Extended-length electrocardiogram” (XL-ECG).nnMethods 48 patients undergoing CABG (13 women-68.6 yrs) were investigated using five-min XL-ECG at their admission to the Rehabilitation and after three and six months. Echographic systolic and diastolic function was also recorded.nnResults R-R interval (ms) increased only between baseline (B) and 6-months (6) (p<0.05), QT interval dispersion (QTd-ms) decreased only between B and 3-months (3) (p<0.05), Activation-Recovery Interval dispersion (ARId-ms) decreased between B and 3 (p<0.05), between 3 and 6 (p<0.01) and between B and 6 (p<0.01). A wave peak velocity (A) increased only between B and 3. Results remained unchanged after multivariate regression.nnConclusions The decrease of QTd and ARId, suggests that early cardiac rehabilitation after revascularization, increase repolarization homogeneity thus reducing arrhythmic risk. The increase of A suggests an improvement in left atrial booster pump function. XL-ECG is a low time-consuming and low cost tool useful for a quick evaluation of autonomic balance and arrhythmologic risk.

6. AVNRT: Electrophysiological Aspects and Ablation Results6.8 Localisa System for Safe and Effective Radiofrequency Ablation of Atrioventricular Nodal Re-Entrant Tachycardia in Younger Patients

Aim of this study was to evaluate usefulness of LOCALISA system for safe and effective RF ablations in younger pts.nnMethods Twenty-one pts. with AVNRT and treated by RF ablation were divided into two groups according to age: group A, ≤ 15 years and group B, > 15 years. LOCALISA system was used to localize triangle of Kock.nnResults In group A triangle of Kocks showed a significantly smaller area and a larger number of RF pulses was needed to achieve successful procedure (p<0.001). In the same group, RF ablations were performed in regions closer to the His bundle (p<0.001). ![Graphic][1] nnConclusions LOCALISA allowed safe and effective RF ablations of AVNRT in younger pts. RF ablations were safely performed very close to the His bundle due to the better vision of the Kock triangle.nn [1]: /embed/graphic-1.gif

6. AVNRT: Electrophysiological Aspects and Ablation Results

Aim of this study was to evaluate usefulness of LOCALISA system for safe and effective RF ablations in younger pts.nnMethods Twenty-one pts. with AVNRT and treated by RF ablation were divided into two groups according to age: group A, ≤ 15 years and group B, > 15 years. LOCALISA system was used to localize triangle of Kock.nnResults In group A triangle of Kocks showed a significantly smaller area and a larger number of RF pulses was needed to achieve successful procedure (p<0.001). In the same group, RF ablations were performed in regions closer to the His bundle (p<0.001). ![Graphic][1] nnConclusions LOCALISA allowed safe and effective RF ablations of AVNRT in younger pts. RF ablations were safely performed very close to the His bundle due to the better vision of the Kock triangle.nn [1]: /embed/graphic-1.gif

Cardiovascular risk functions, and their practical relevance: to be trusted or not to be trusted

The practical reliability of the 20% risk threshold is examined, as fixed by the Italian Health Ministry using the European Joint Task Force(JES) chart of coronary risk. Two different risk functions, one derived from the Framingham study and one from the PROCAM study, are compared. The comparison has been carried out in a homogeneous way. The data base is represented by 4584 Italian subjects (2067 males, 2517 females) on primary prevention, who participated in the RAI (Registro ANCE Ipertensione) study. The results show that there are 131 subjects (out of 271; 48.3%) who have a larger that 20% risk using the JES/Framingham algorithm, but are below threshold using the PROCAM one. Although any cut introduces a subjective measure, the choice of different risk functions is relevant in a high percentage of borderline cases, thus changing the status from high risk to lower risk and vice versa.