Entity

Time filter

Source Type


Mezzani A.,Salvatore Maugeri Foundation IRCCS Scientific Institute of Veruno | Pistono M.,Salvatore Maugeri Foundation IRCCS Scientific Institute of Veruno | Corra U.,Salvatore Maugeri Foundation IRCCS Scientific Institute of Veruno | Giordano A.,IRCCS Scientific Institute of Veruno | And 7 more authors.
IJC Heart and Vessels | Year: 2014

In continuous-flow left ventricular assist device (LVAD) recipients, little is known about the relative pump- and left ventricle-generated blood flow (PBF and LVBF, respectively) contribution to peak systemic perfusion during incremental exercise and about how PBF/LVBF interplay and exercise capacity may be affected by pump speed increase. Methods: Twenty-two LVAD recipients underwent ramp cardiopulmonary exercise tests at fixed and increasing pump speed (+1.5% of baseline speed/10W workload increase), echocardiography and NT-proBNP dosage. Peak systemic perfusion was peak VO2/estimated peak arterio-venous O2 difference, and LVBF was systemic perfusion minus PBF provided by LVAD controller. A change of peak percentage of predicted VO2max (δpeak%VO2) ≥3 in increasing- vs. fixed-speed test was considered significant. Results: Tricuspid annular plane systolic excursion (TAPSE) and NT-proBNP were significantly lower and higher, respectively, in δpeak%VO2<3 than ≥3. A LVBF contribution to systemic perfusion significantly larger than that of PBF was observed in δpeak%VO2≥3 vs. <3 in fixed-speed test, which was further amplified in increasing-speed test (2.4±1.7l/min vs. 2.0±1.5l/min and 0.8±2.2l/min vs. 1.3±2.3l/min, respectively, p for trend <0.0005). Among several clinical-instrumental parameters, logistic regression selected only TAPSE >13mm as a predictor of δpeak%VO2≥3. Conclusions: A significant LVBF contribution to peak systemic perfusion and pump speed increase-induced peak VO2 improvement was detectable only in patients with a more preserved right ventricular systolic function and stable hemodynamic picture. These findings should be taken into consideration when designing LVAD controllers aiming to increase pump speed according to increasing exercise demands. © 2014 The Authors. Published by Elsevier Ireland Ltd. Source


Piepoli M.F.,Heart Failure Unit | Piepoli M.F.,CNR Institute of Neuroscience | Binno S.,Heart Failure Unit | Corra U.,IRCCS Scientific Institute of Veruno | And 6 more authors.
European Journal of Heart Failure | Year: 2015

Aims In heart failure (HF), exercise training programmes (ETPs) are a well-recognized intervention to improve symptoms, but are still poorly implemented. The Heart Failure Association promoted a survey to investigate whether and how cardiac centres in Europe are using ETPs in their HF patients. Methods and results The co-ordinators of the HF working groups of the countries affiliated to the European Society of Cardiology (ESC) distributed and promoted the 12-item web-based questionnaire in the key cardiac centres of their countries. Forty-one country co-ordinators out of the 46 contacted replied to our questionnaire (89%). This accounted for 170 cardiac centres, responsible for 77 214 HF patients. The majority of the participating centres (82%) were general cardiology units and the rest were specialized rehabilitation units or local health centres. Sixty-seven (40%) centres [responsible for 36 385 (48%) patients] did not implement an ETP. This was mainly attributed to the lack of resources (25%), largely due to lack of staff or lack of financial provision. The lack of a national or local pathway for such a programme was the reason in 13% of the cases, and in 12% the perceived lack of evidence on safety or benefit was cited. When implemented, an ETP was proposed to all HF patients in only 55% of the centres, with restriction according to severity or aetiology. Conclusions With respect to previous surveys, there is evidence of increased availability of ETPs in HF in Europe, although too many patients are still denied a highly recommended therapy, mainly due to lack of resources or logistics. © 2015 The Authors. European Journal of Heart Failure © 2015 European Society of Cardiology. Source


Piepoli M.F.,Cardiology Unit | Corra U.,IRCCS Scientific Institute of Veruno | Abreu A.,Hospital Santa Marta | Cupples M.,Queens University of Belfast | And 8 more authors.
International Journal of Cardiology | Year: 2015

With the changing demography of populations and increasing prevalence of co-morbidity, frail patients and more complex cardiac conditions, the modern medicine is facing novel challenges leading to rapid innovation where evidence and experiences are lacking. This scenario is also evident in cardiovascular disease prevention, which continuously needs to accommodate its ever changing strategies, settings, and goals. The present paper summarises actual challenges of secondary prevention, and discusses how this intervention should not only be effective but also efficient. By this way the paper tries to bridge the gaps between research and real-world findings and thereby may find ways to improve standard care. © 2014 Elsevier Ireland Ltd. All rights reserved. Source


Despite major improvements in diagnostics and interventional therapies, cardiovascular diseases remain a major health care and socio-economic burden both in western and developing countries, in which this burden is increasing in close correlation to economic growth. Health authorities and the general population have started to recognize that the fight against these diseases can only be won if their burden is faced by increasing our investment on interventions in lifestyle changes and prevention. There is an overwhelming evidence of the efficacy of secondary prevention initiatives including cardiac rehabilitation in terms of reduction in morbidity and mortality. However, secondary prevention is still too poorly implemented in clinical practice, often only on selected populations and over a limited period of time. The development of systematic and full comprehensive preventive programmes is warranted, integrated in the organization of national health systems. Furthermore, systematic monitoring of the process of delivery and outcomes is a necessity. Cardiology and secondary prevention, including cardiac rehabilitation, have evolved almost independently of each other and although each makes a unique contribution it is now time to join forces under the banner of preventive cardiology and create a comprehensive model that optimizes long term outcomes for patients and reduces the future burden on health care services. These are the aims that the Cardiac Rehabilitation Section of the European Association for Cardiovascular Prevention & Rehabilitation has foreseen to promote secondary preventive cardiology in clinical practice. © The European Society of Cardiology 2012 Reprints and permissions: sagepub.co.uk/ journalsPermissions.nav. Source


Piepoli M.F.,Cardiology Unit | Corra U.,IRCCS Scientific Institute of Veruno | Adamopoulos S.,Onassis Cardiac Surgery Center | Benzer W.,Academic Hospital | And 14 more authors.
Kardiologiya | Year: 2014

Despite major improvements in diagnostics and interventional therapies, cardiovascular diseases remain a major health care and socio-economic burden both in western and developing countries, in which this burden is increasing in close correlation to economic growth. Health authorities and the general population have started to recognize that the fight against these diseases can only be won if their burden is faced by increasing our investment on interventions in lifestyle changes and prevention. There is an overwhelming evidence of the efficacy of secondary prevention initiatives including cardiac rehabilitation in terms of reduction in morbidity and mortality. However, secondary prevention is still too poorly implemented in clinical practice, often only on selected populations and over a limited period of time. The development of systematic and full comprehensive preventive programmes is warranted, integrated in the organization of national health systems. Furthermore, systematic monitoring of the process of delivery and outcomes is a necessity Cardiology and secondary prevention, including cardiac rehabilitation, have evolved almost independently of each other and although each makes a unique contribution it is now time to join forces under the banner of preventive cardiology and create a comprehensive model that optimizes long term outcomes for patients and reduces the future burden on health care services. These are the aims that the Cardiac Rehabilitation Section of the European Association for Cardiovascular Prevention & Rehabilitation has foreseen to promote secondary preventive cardiology in clinical practice. Source

Discover hidden collaborations