[Show abstract][Hide abstract] ABSTRACT: Left ventricular surgical remodelling (LVSR) can be targeted to volume reduction (VR), (independently of the final shape) or to conical shape (CS). The aim of this study was to evaluate the long-term clinical and echocardiographic results of these two surgical strategies.
From January 1988 to December 2012, 401 patients underwent LVSR: 107 in Group VR (1988-2001) and 294 in Group CS (1998-2012). The latter group of patients had lower ejection fraction (EF) and higher mitral and tricuspid regurgitation grade, with higher incidence of pulmonary hypertension. A propensity score model was built to adjust long-term results for preoperative and operative profiles.
Thirty-day mortality was 6.0%. Median follow-up interval time was 100 (3-300) months. Overall 20-year and event-free survival were 36.1 ± 7.8 and 19.4 ± 7.2, respectively. No differences were found regarding 10-year survival (Group VR: 55.1 ± 4.8 vs Group CS: 64.2 ± 4.2, P = 0.16) and event-free survival (Group VR: 41.1 ± 4.8 vs Group CS: 50.5 ± 4.8, P = 0.12). However, Group CS provided better 10-year freedom from cardiac deaths (74.5 ± 3.7 vs 60.4 ± 4.8, P = 0.03) and from cardiac events (55.6 ± 5.0 vs 45.0 ± 4.9, P = 0.04). After propensity score adjustment, all the main outcomes were significantly better in Group CS. Multivariate Cox analysis confirmed this result; furthermore, to avoid any bias related to improved experience, 30-day mortality being higher in Group VR, we excluded the first month from Cox analysis: left ventricle VR (independently of the final shape) was still confirmed as the wrong approach. At the follow-up, Group CS showed significant improvement in EF (+18 vs +8%), end-systolic volume index (-35 vs -20%) and sphericity index (-6 vs +9%).
LVSR should aim to provide a more physiological shape (conical) rather than simple VR.
European journal of cardio-thoracic surgery: official journal of the European Association for Cardio-thoracic Surgery 05/2014; · 2.40 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Asymmetric dimethylarginine (ADMA) is an endogenous nitric oxide synthase (NOS) inhibitor known as a mediator of endothelial dysfunction and atherosclerosis. Circulating ADMA levels are correlated with cardiovascular risk factors such as hypercholesterolemia, arterial hypertension, diabetes mellitus, hyperhomocysteinemia, age and smoking. We assessed the relationship between ADMA values and site-specific association of asymptomatic carotid atherosclerosis (intima-media thickness (CIMT) and plaque) in elderly subjects. One hundred and eighty subjects underwent a complete history and physical examination, determination of serum chemistries and ADMA levels, and carotid ultrasound investigation (CUI). All subjects had no acute or chronic symptoms of carotid atherosclerosis. Statistical analyses showed that high plasma levels of ADMA/SDMA were positively correlated to carotid atherosclerosis (CIMT and plaque) (p < 0.001), with significant site-specific association. Total cholesterol, low density lipoprotein cholesterol, triglycerides and C-reactive protein plasma concentrations were significantly associated with asymptomatic carotid atherosclerosis (p < 0.001). High serum concentrations of ADMA and SDMA were associated with carotid atherosclerotic lesions as measured by CIMT ad plaque and may represent a new marker of asymptomatic carotid atherosclerosis in elderly subjects.
International Journal of Molecular Sciences 01/2014; 15(4):6391-8. · 2.46 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: High-intensity aerobic interval training (AIT) has been reported to be more effective than continuous aerobic training (CoAT) to improve metabolic health. The aim of our study was to investigate whether moderate-intensity AIT is more effective than CoAT on metabolic health, when applied to a walking training program.
Thirty-two postmenopausal women (55.37 ±3.46 years) were investigated for body composition, plasma glucose, insulin, lipids, adiponectin, HOMA-IR, HOMA-AD, aerobic fitness, dietary habits and spontaneus physical activity, and randomly assigned to one of two different walking training programs: CoAT or AIT.
CoAT and AIT elicited the same physiological benefits, including: reduction of plasma glucose, insulin, HOMA-IR and HOMA-AD, and increase of plasma HDL-C, adiponectin and aerobic fitness.
An AIT scheme as part of an outdoor walking training program elicits the same physiological adaptations as a CoAT scheme, probably because walking does not promote exercise intensities that elicit greater effects.
[Show abstract][Hide abstract] ABSTRACT: Context:Estrogen deficiency, systemic low-grade inflammation, and reduction of adrenal gland function have central roles in noncommunicable chronic disease (NCD) development. With angiotensin-converting enzyme (ACE) insertion/deletion (I/D) polymorphism, the deletion variant (DD) is related to higher levels of circulating angiotensin II, which might interact with all of these molecular pathways to increase NCD risk. On the other hand, physical exercise counteracts the occurrence of NCDs, potentially acting on the same pathways.Objectives:The aim of the study was to investigate the effects of walking training on adrenal steroid and cytokine levels and on cardiovascular parameters in postmenopausal women with ACE I/D genotypes.Methods:Thirty-six (DD = 15, II/ID = 21) sedentary postmenopausal women (mean age, 56 ± 4 y) participated in a 13-week program of walking training at moderate intensity. Heart rate, blood pressure, double product, TNF-α, dehydroepiandrosterone sulfate (DHEA-S), and cortisol were evaluated before and after the intervention program.Results:Before walking training, the ACE DD genotype showed significantly higher TNF-α (P = .007) and lower DHEA-S concentrations (P = .022) than the ACE II/ID individuals. After walking training, both subgroups significantly decreased TNF-α plasma levels and cortisol/DHEA-S ratio (P = .001 and P = .016, respectively) and significantly increased DHEA-S levels (P < .001). Moreover, all the cardiovascular parameters were significantly reduced in the ACE DD participants (P ≤ .05), whereas the ACE I-allele carriers showed a decrease in heart rate (P ≤ .05) and the double product (P ≤ .05).Conclusion:ACE I/D polymorphism is linked to different adrenal steroid and cytokine levels, and ACE I-allele carriers show a better adrenal activity and systemic inflammatory profile. The introduction of walking training positively influences the menopause immune-neuroendocrine changes, independent of ACE I/D genotype.
The Journal of clinical endocrinology and metabolism 08/2013; · 6.50 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: This review article focuses on functional tricuspid regurgitation (FTR) that has long been a neglected and underestimated entity. FTR is defined as leakage of the tricuspid valve during systole in the presence of structurally normal leaflets and chordae. FTR may be secondary to several heart diseases, more commonly mitral valve disease, pulmonary hypertension, atrial fibrillation, cardiomyopathies, right ventricular dysplasia, and idiopathic annular dilatation. The reported prevalence of moderate or greater FTR is roughly 16%, but it rises up to 89% when considering FTR of any grade. According to the recommendations of the European Association of Echocardiography, two-dimensional transthoracic echocardiography (TTE) is the first-line imaging modality for the assessment of valvular regurgitation, whereas three-dimensional TTE may provide additional information in patients with complex valve lesions. Transesophageal echocardiography may be used when TTE results are inconclusive. The natural history of FTR is unfavorable, even in less than severe tricuspid regurgitation. Data from the literature suggest that moderate or greater FTR is a risk factor for worse survival. In addition, FTR of any grade may worsen over time, which makes it reasonable to consider the correction of FTR at an early stage, preferably at the time of mitral valve surgery. Tricuspid valve annuloplasty is the gold standard surgical treatment for FTR and is associated with a recurrence rate, defined as postoperative moderate or severe FTR, ranging from 2.5 to 5.5% at 1-year follow-up.
International journal of cardiology 05/2013; · 6.18 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The aim of this study was to investigate the effects of acute pharmacological treatment on the plasma levels of l-arginine, asymmetrical dimethylarginine (ADMA), and symmetrical dimethylarginine (SDMA). We also investigated the related effects on endothelial nitric oxide synthase (eNOS) expression and activity and cytochrome c oxidase activity in the primary blood mononuclear cells (PBMCs) isolated from patients with acute congestive heart failure (ACHF). Compared to pre-treatment values, ADMA, SDMA, and l-arginine plasma levels were significantly higher after pharmacological treatment (ADMA, 0.82 versus 0.43 µM; SDMA, 1.52 versus 1.12 µM; l-arginine, 1.78 versus 1.29 µM; p < 0.01. In addition, the levels of eNOS expression and activity were decreased after pharmacological treatment, while cytochrome c oxidase activity resulted in higher O2-production. In the PBMCs isolated from patients with acute congestive heart failure (ACHF) and impaired renal function, higher SDMA and ADMA levels were more evident after therapy, as were reduced expression and activity of eNOS. Increased O2- produced after treatment may be involved in impaired recovery of cardiac function associated with higher plasma levels of SDMA.
Frontiers in bioscience (Elite edition) 01/2013; E5:551-557.
[Show abstract][Hide abstract] ABSTRACT: OBJECTIVE: We hypothesized that physical exercise in postmenopausal women could interfere with the molecular interrelationship of the immune-endocrine system and be effective even in women in whom training determined a reduction of spontaneous physical activity (SPA). For this reason, we investigated the effects of an aerobic program on plasma dehydroepiandrosterone sulfate (DHEA-S) and cytokine levels in relationship to SPA modification. METHODS: Thirty-two postmenopausal women (mean [SD] age, 56.38 [4.33] y) were enrolled in the study. Inclusion criteria were as follows: age younger than 65 years, body mass index higher than 18.5 and lower than 35 kg/m, no pharmacological treatments, and no history of chronic, cardiovascular, or orthopedic diseases. Before and after 3 months of walking training at moderate intensity (40-50 min, 4 d/wk), they were evaluated for SPA, body composition, energy intake, and levels of plasma cytokines (tumor necrosis factor α [TNF-α], interleukin [IL]-1α, IL-1β, IL-2, IL-8, and IL-10), C-reactive protein, DHEA-S, cortisol, and estrogen. RESULTS: At baseline, SPA did not correlate with either DHEA-S level or cytokine levels. There was negative correlation between DHEA-S and both TNF-α and IL-2. After the intervention program, 16 women showed increased SPA, and 16 women showed decreased SPA. Independent of these changes in SPA, both TNF-α levels and cortisol-to-DHEA-S ratio decreased, whereas DHEA-S levels increased. CONCLUSIONS: In postmenopausal women, walking training, rather than SPA, influences DHEA-S and cytokine concentrations and their correlations, thus interfering with adrenal steroids and the inflammatory markers network. Physical exercise acts in parallel on menopausal neuroendocrine alterations and on the systemic inflammatory profile independent of SPA changes.
Menopause (New York, N.Y.) 12/2012; · 3.08 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Objective - Several studies support, during menopause, an impact of endogenous sex hormone levels on thrombotic potential parameters. Fibrinogen plays several key roles in the maintenance of hemostasis and its levels seem to be a marker or mediator of CVD. The aim of our study was to assess the role of intensity of physical activity on fibrinogen levels in post-menopause women.
Design and Methods - Forty-five post-menopausal (57.88±5.15) non-obese healthy women without history of physical exercise and pharmacological treatment were recruited. Expert researchers assessed anthropometry, blood samples and weekly physical activity of participants. After 12 hour overnight fasting body composition were assessed by Electrical Bioimpedance (BIA) Tanita BC-418. Fibrinogen concentration (mg/dl) in plasma was measured with Human Fibrinogen ELISA quantification kit. Physical activity characteristics and mean intensity of daily physical activities (METs) assessed by SenseWear Pro 3 Armband.
Results - Cluster analysis on basal values of Fibrinogen showed the presence of two sub-groups: Group+ (n=18) and Group- (n=27). Group- (339.48±29 mg/dl) showed higher Fibrinogen values respect to Group+ (263.33±26 mg/dl). Student’s t-Test evidentiated that sub-groups were significantly different in (METs) (p=0.05), Waist Circumference (WC) (p=0.003), Waist to Hip ratio (W/H) (p=0.027) and Body Mass Index (BMI) (p=0.05) Logistic regression, showed that METs was the only significant predictor of sub-group membership (p=0.013)
Conclusion - In post-menopause, METs has a relationship with Fibrinogen plasma level. Beneficial effects of physical exercise on the prognosis are undoubtedly attributable to several factors even if spontaneous physical activity could be the first step to oppose high fibrinogen plasma level after menopause.
XXXII WORLD CONGRESS OF SPORTS MEDICINE, Rome; 09/2012
[Show abstract][Hide abstract] ABSTRACT: NAD(P)H system represents the major source of superoxide production at cardiovascular (CV) level. It has several genetic variants: in particular, the C242T polymorphism of its p22(phox) subunit is associated with a different oxidase activity, being the T allele related to a lower superoxide production. Although several authors investigated the protective effect of T allele in CV diseases, only few data are available on its functional role in physiological conditions. The aim of our study was to investigate the relationship between the p22(phox) C242T polymorphism and CV function in amateur runners.
Seventy-three male amateur runners were screened for CYBA polymorphism. CV analysis was performed by echocardiographic-Doppler examination and by PulsePen tonometer assessment.
The genetic subgroups (CC and CT/TT) did not differ for VM O(2max) and cardiac dimension. Nevertheless, T carriers (n = 40) were characterized by a more efficient myocardial contraction and left ventricular (LV) filling, as evidenced by significant higher values of the midwall fractional shortening, systolic excursion of the tricuspid annular plane and of early/late diastolic wave velocities ratio and by a lower E wave deceleration time. Pulse wave velocity and augmentation index, parameters related to the arterial stiffness, were higher in CC subjects compared with CT/TT also when the analysis was adjusted for weight and diastolic pressure.
In amateur runners, CYBA variants may influence both systolic and diastolic function and arterial stiffness. We suppose that the lower oxidative activity that characterizes 242T subjects may positively influence the excitation-contraction and arterial-ventricular coupling mechanisms, thus leading to a more efficient CV function.
[Show abstract][Hide abstract] ABSTRACT: Incidence of functional mitral regurgitation (FMR) is increasing due to aging and better survival after acute myocardial infarction, the most frequent cause of FMR. At the basis of FMR there is a displacement of one of both papillary muscle(s) and/or annular enlargement, which can be primitive or, more often, secondary. There is general agreement that its natural history is unfavorable, as witnessed by a considerable body of evidences. However, even if there is no clear evidence that surgical treatment of FMR changes consistently the outcome of patients with this disease, at least in terms of survival, there are some studies which show that function improves, as well as the global quality of life. The guidelines reflect this uncertainty, providing no clear indications, even in the gradation of severity of the FMR. Surgical techniques are variable and are mainly addressed to the annulus (restrictive annuloplasty), which is only a part of the anatomic problem related to FMR. Insertion of a prosthesis inside the native valve is appearing more and more a valuable option rather than a bail out procedure. On the other side, techniques addressed to modify the position of the papillary muscles appear to be still under investigation and not yet in the armamentarium of surgical treatment of FMR. Even after many years, rules are not established and results are fluctuating, but how and when to treat FMR is becoming more and more a topic of interest in cardiac surgery.
International journal of cardiology 05/2012; · 6.18 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Objective: The main objective of the study was to examine the relation of different biological markers to a variety of pleasant and unpleasant psychobiosocial (PBS) states in response to precompetitive stress in sport. Design: A longitudinal design was adopted to assess biological markers and PBS states before several games.
Method: A whole team of high-level professional basketball players (9 men, aged from 23 to 37 years) took part in the study. The biological measures included the salivary concentration of testosterone, cortisol, aamylase, and chromogranin A. The psychological measures involved emotional, cognitive, motivational, bodily, kinesthetic, performance, and communicative components of PBS states assessed according to the dimensions of their intensity, frequency, and direction (i.e., perceived effect on performance). Assessment was conducted within 1 h prior to competition on an approximately weekly basis across the whole championship for a total of 12 games played at the team’s home.
Results: A series of canonical correlation analyses showed that an increase in the salivary concentration of biological variables was associated with enhanced intensity and frequency scores of pleasant PBS states, as well as enhanced directional values (i.e., perception of facilitative effects) of a range of both pleasant and unpleasant PBS states.
Conclusion: Findings suggest that elevation of testosterone, cortisol, a-amylase, and chromogranin A in basketball players prior to competition can have a perceived functional effect with respect to the upcoming performance.
Psychology of Sport and Exercise 03/2012; 13:509-517. · 1.72 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Heart Failure (HF) is characterized by activation inflammatory mediators that contributes to the disease progression. Brain natriuretic peptide (BNP) plasma levels increase in HF with a prognostic significance. The aim of this study was to evaluate the expression and activity of inducible nitric oxide synthase (iNOS) in peripheral blood mononuclear cell (PBMC) extracted from patients and a possible linear correlation between iNOS and plasma levels of BNP in decompensated chronic HF (DCHF) patients. To establish the DCHF, thirty-five male patients were evaluated. All patients were venesected within 24 h of admission to exclude an inflammatory state through evaluation of c-reactive protein. Only twenty subjects showed symptoms of DCHF were included in the study. Other patients were included in the control group. In DCHF, left ventricular ejection fraction (LVEF) percent was reduced and systolic pulmonary artery pressure (PAPs) was increased. Furthermore, iNOS expression and BNP plasma levels were significantly higher in patients with DCHF as compared to controls group. These findings indicate that in DCHF patients, iNOS activity exhibits a significant linear correlation with plasmatic BNP level.
Frontiers in bioscience (Elite edition) 01/2012; 4:1255-62.
[Show abstract][Hide abstract] ABSTRACT: Mitral valve (MV) is composed of several structures working in synchrony to open during diastole and close in systole within the high-pressure systemic environment. Its morphological features ensure a normal leaflet closure that prevents regurgitation of blood back into the left atrium causing loss of ventricular pressure and forward flow. The complex interactions of the normal MV are reliant on each component playing a complete role for the efficient working of the valve. In this review we firstly discuss the overall MV structure in terms of a complex make up of the annulus, the leaflets, their tendinous cords, and the supporting papillary muscles, and then the anatomical changes of each MV components due to left ventricular geometry and function alterations, underlying functional mitral regurgitation.
International journal of cardiology 12/2011; · 6.18 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Introduction. Menopause is linked with several hormonal changes, in addition to the age-related physiologic
decline of the dehydroepiandrosterone sulphate (DHEA-S) production. Further, a feedback cross-talk with
raising systemic chronic inflammation might play a central role in these events. Women typically participate
in less physical activity (PA) than men do but, even if physical activity has been shown to be correlated both
with systemic inflammation and plasma DHEA-S level, it is difficult to establish whether these changes are
due to both menopause and aging process per se or by lack of PA. Considering that after menopause, DHEA
and DHEA-S are the main component of sex steroids, the aim of our study was to investigate the complex
network among hormonal changes, pro-inflammatory mediators and PA, in post-menopause. Methods.
Thirty-five sedentary post-menopausal women (55.9±4,2 years) were enrolled into the study. Basal plasma
interleukin (IL) 1-alpha, IL1-beta, IL-2, IL-8, IL-10, IL-12p70 and tumor necrosis factor alpha (TNF-a) were
measured by with SearchLight Human Cytokine Array 1. DHEA-S and leptin were measured by ELISA
analysis. Body composition was assessed by electrical bioimpedance technique. Daily physical activity was
measured, under free-living condition and for three consecutive days, through the SenseWear Pro3
Armband, giving information about total daily energy expenditure (TEE), mean daily physical activity
intensity (METs) and both time and energy spent on physical activity with intensity >3 METs (tPA, PAEE).
Results. TEE was found inversely correlated with IL1-alpha and IL1-beta (r=-.375, P<.05; r=-.347, P<.05,
respectively), METs with IL1-alpha (r=-.387, P<.05), tPA with IL1-alpha, IL-2 and IL-10 (r=-.380, P<.05;
r=-.367, P<.05, r=-.347, P<.05, respectively), and PAEE with IL-2 (r=-.358, P<.05). A significant direct
correlation was found among all measured cytokines. Even if neither TNF-a or DHEA-S were correlated with
PA parameters, we found a strong relationship between TNF-a and DHEA-S (r=-.569, P=.001), also
controlling for confounding factors such as age and leptin. Discussion. In conclusion, in sedentary
post-menopausal women, the systemic inflammatory mediator TNF-a and the main adrenal steroid DHEA-S
show an inverse relationship. Poor PA might play a role, affecting systemic inflammation and then DHEA-S
production at various levels through the hypothalamus-pituitary axis, although evidences from other studies
suggest an anti-inflammatory action by DHEA-S.
[Show abstract][Hide abstract] ABSTRACT: Several studies have shown that activation of the sympathetic nervous system results in the increased secretion of α-amylase (sAA), an enzyme produced by salivary glands. Recently, chromogranin A (CgA), a soluble protein costored and coreleased with catecholamines from the adrenal medulla and sympathetic nerve endings, has been proposed as a marker of sympathoadrenal medullary system (SAM) activity. The aim of this study was to investigate the behaviour of salivary chromogranin A (sCgA) and sAA during high-intensity exercise and to analyse their possible correlation with cardiovascular and psychological parameters.
Before and during a standardized treadmill stress test, and at 5, 15 and 30 min during the recovery phase, sCgA and sAA were monitored in 21 healthy men. The double product (DP) of blood pressure and heart rate responses, and the product of the subjective ratings of perceived exertion recorded at the final step (RPE) and the exercise duration were used as indices of cardiovascular and exercise intensity, respectively.
With respect to baseline, significant (P < 0·001) increases in peak sCgA (median 64%) and sAA (median 86%) were observed at the end of exercise. During the recovery phase, sAA levels fell abruptly, whereas sCgA remained elevated (P < 0·001). Significant correlations emerged only for sCgA with respect to %DP (r = 0·84; P < 0·001) and last step-RPE (r = 0·82; P = 0·024).
These data suggest sCgA as a reliable marker of SAM activation. Furthermore, the relationship between sCgA and exercise intensity highlights the potential use of this noninvasive parameter in monitoring the adrenergic response during intense physical stress.
[Show abstract][Hide abstract] ABSTRACT: Whether leptin has positive or negative influences on cardiac structure and function in healthy sedentary overweight postmenopausal women is unknown. We investigated the role of leptin in cardiac health and whether aerobic fitness enhancement influences any relationships revealed between leptin and echocardiographic measurements.
Thirty-nine sedentary postmenopausal women were enrolled after an initial screening. The women underwent blood sampling for hormone levels, anthropometric and echocardiographic measurements, dietary habits investigation, and fitness testing, both before and after 4 months of walking training.
After the intervention, the women who had an adherence to training of 75% or higher showed significantly reduced percentage fat mass (P = 0.006) and plasma leptin levels (P < 0.001), whereas their maximum oxygen consumption increased significantly (P < 0.001). The women showed a significant reduction in left ventricle relative wall thickness (P = 0.039) and significant increases in both left ventricular end-diastolic diameter (P = 0.040) and left ventricular mass index (P = 0.043). At baseline, a negative correlation was seen between plasma leptin levels and left ventricle relative wall thickness (r = -0.553; P = 0.009). Further negative correlations were seen for the changes in left ventricle relative wall thickness with leptin levels (r = -0.456; P = 0.038) and with tricipital skinfold (r = -0.436; P = 0.05).
In healthy overweight sedentary postmenopausal women with low fitness level, high plasma leptin levels seem to have a protective role against left ventricle relative wall thickness hypertrophy and to participate in its remodeling after 4 months of aerobic training.
Menopause (New York, N.Y.) 01/2011; 18(1):77-84. · 3.08 Impact Factor