Cardiac rehabilitation after transcatheter versus surgical prosthetic valve implantation for aortic stenosis in the elderly.

Background: Transcatheter aortic valve implantation plays a leading role in the management of aortic stenosis in patients with comorbidities but no data are available about cardiac rehabilitation in these subjects. This study aimed to compare safety and efficacy of an early, exercise-based, cardiac rehabilitation programme in octogenarians after a traditional surgical aortic valve replacement versus transcatheter aortic valve implantation.

Methods: Seventy-eight consecutive transcatheter aortic valve implantation patients were studied in order to evaluate the effect of an exercise-based cardiac rehabilitation programme in comparison to 80 of a similar age having surgical aortic valve replacement.

Haemodynamic effects of acute intravenous metoprolol in apical ballooning syndrome with dynamic left ventricular outflow tract obstruction.

Takotsubo syndrome, also called apical ballooning syndrome, is a clinical entity characterized by transient hypokinesis, akinesis, or dyskinesis of the left ventricular mid-segments with or without apical involvement, and without obstructive coronary lesions. The contemporary presence of left ventricular outflow tract obstruction (LVOTO), systolic anterior motion of the anterior mitral leaflet, and acute mitral regurgitation might explain the worsening of the heart failure or the occurrence of cardiogenic shock in some patients with apical ballooning syndrome. The use of beta-blockers should improve the LVOTO gradient by reducing basal hypercontractility, increasing left ventricular filling and size, and reducing heart rate.

Drug-eluting stents for the treatment of coronary lesions in cardiac transplant vasculopathy: acute and mid-term clinical and angiographic outcomes.

Background: Cardiac allograft vasculopathy (CAV) is the major cause of graft failure and death in cardiac transplant recipients after transplantation. We aimed to evaluate the clinical and angiographic outcomes of patients with evidence of CAV who were treated percutaneously with drug-eluting stents (DES-PCI).

Methods: Between December 2002 and September 2005, we reviewed the baseline procedural characteristics and the clinical outcome of consecutive cardiac transplanted recipients with evidence of CAV treated with DES-PCI, eligible for at least 9 months of follow-up.

Interventional approach to reduce thromboembolic risk in patients with atrial fibrillation ineligible for oral anticoagulation.

The annual incidence of stroke in patients with nonrheumatic atrial fibrillation averages 5% per year and increases with age, left ventricular dysfunction, hypertension, diabetes or prior stroke. Since in nonrheumatic atrial fibrillation 91% of left atrial thrombi are located in the left atrial appendage, in patients ineligible for oral anticoagulation it was suggested the percutaneous closure of left atrial appendage as a therapeutic option to reduce embolic risk. In this article we report our initial experience with this procedure, which was uneventful and efficacious at short-term follow-up.

Time delay-adjusted survival benefit of angioplasty over thrombolysis in acute myocardial infarction: influence of time from symptom onset.

Background: The time-to-treatment is a critical determinant of outcome after acute myocardial infarction. We investigated the relationship between the primary angioplasty (PCI)-related time delay and the benefit of PCI over thrombolytic therapy (TT), considering the time elapsing from symptom onset in 21 randomized trials comparing PCI to TT.

Methods: PCI-related time delay was calculated as the median of the "door-to-balloon" time minus the median of the "door-to-needle" time.

Myocardial perfusion grade and survival after percutaneous transluminal coronary angioplasty in patients with cardiogenic shock.

We sought to evaluate myocardial reperfusion and its prognostic value after percutaneous transluminal coronary angioplasty (PTCA) in patients admitted for cardiogenic shock. Lack of myocardial reperfusion despite restored coronary flow affects the survival of patients with acute myocardial infarction (AMI). Myocardial blush grade (MBG) is an angiographic measure of myocardial perfusion.

Pressure response to vasopressors and mortality after direct angioplasty for cardiogenic shock.

Background: There is very little known about the relationship between pre-intervention arterial pressure response to vasopressor therapy (PRV) and death rate, after primary angioplasty for immediate cardiogenic shock (CS) complicating acute myocardial infarction (AMI).

Methods: We examined data from 32 consecutive cases, admitted to our department within 12 h after the onset of MI and in CS, treated with direct PTCA, from May 1995 to March 2001. Intravenous administration of dobutamine and vasopressor agents was required in all patients before intervention.