Effects of exercise training on systo-diastolic ventricular dysfunction in patients with hypertension: an echocardiographic study with tissue velocity and strain imaging evaluation.

There is a lack of detailed data regarding the effect of exercise training in pharmacologically treated hypertensive patients. Therefore, the aim of this study was to evaluate the effects of exercise training on left and right ventricular morphologic and functional parameters by means of conventional echocardiography and sensitive new echocardiographic techniques including tissue Doppler velocity and strain imaging, that were performed in pharmacologically treated hypertensive patients at baseline and at the end of a specific exercise training protocol for primary prevention of cardiovascular disease. We selected 116 pharmacologically treated hypertensive patients who completed the exercise training protocol. All patients underwent a clinical history and examination; transthoracic echocardiography and exercise testing were performed at baseline and at the end of the exercise training protocol. Conventional echocardiography revealed a mild degree of diastolic dysfunction without significant differences or variations from baseline to the end of the exercise training protocol. In contrast, tissue Doppler velocity and strain imaging measurements demonstrated and highlighted the positive influence of exercise training: for both left and right ventricle myocardial early peak diastolic velocities (Em), the ratio of myocardial early-late peak diastolic velocity (Em/Am), myocardial peak systolic velocities (Sm) and peak strain and strain rate values significantly increased at the end of the exercise training protocol, suggesting a relationship between exercise capacity and both left and right ventricular systo-diastolic function. Our study, by means of newer more sensitive echocardiographic techniques, clearly demonstrated the positive impact of exercise training on both left and right ventricular systo-diastolic function, in terms of adjunctive subclinical improvement, in pharmacologically treated hypertensive patients.

[Italian survey on physical activity of the members of GICR-iACPR 2012]. / Indagine sull'attività fisica dei membri del GICR-iACPR 2012.

BACKGROUND AND AIMS: The International Physical Activity Questionnaire (IPAQ) was issued in 2005 by the WHO as an international standard for the evaluation of physical activity (PA) [1-11]. The Italian Association for Cardiovascular Prevention and Rehabilitation (GICR-IACPR) is promoting nationwide calls for action aimed at the implementation of cardiovascular (CV) prevention guidelines. The awareness of cardiac rehabilitation professionals (CRP) with regards to healthy lifestyle is assumed. METHODS: The IPAQ was submitted to delegates of 2012 IACPR congress. Sex, age, position and geographic location were also asked. We received 136 questionnaires back. The data were analysed using the established scoring protocol by the IPAQ Research Committee and datasets were compared to WHO global recommendations on PA for health. RESULTS: 136 questionnaires were evaluated (years aged 50.5, 42% M), 13 were excluded after cleaning. Thus 123 tests were classified in 3 levels of PA, according to WHO rec. H:45 subjects with higher level of participation and greater health benefits. M:75 subjects who accumulate a moderate level of PA. L:3 subjects who did not meet criteria for category high or moderate. CONCLUSIONS: According to a preliminary analyses of currently available IPAQ, 61% GICR-CRP seems sufficiently active for a health benefit, 37% have additional health benefits, and only 2% is not active enough for health. Comparing these figures with those of the 2010 survey, we found an average age higher in males and an improvement in the time and intensity of PA.

Obesity-related adjunctive systo-diastolic ventricular dysfunction in patients with hypertension: echocardiographic assessment with tissue Doppler velocity and strain imaging.

Very few data exist regarding the effect of obesity on both left and right systo-diastolic ventricular function in hypertensive patients. Therefore, the aim of this study was to determine the existence and extent of an obesity-related adjunctive depressive effect on left- and right-ventricular systo-diastolic dysfunction. This study compared non-obese with obese hypertensive patients and evaluated left- and right-ventricular morphological and functional parameters by means of conventional echocardiography and by two new sensitive echocardiographic techniques: tissue Doppler velocity and strain imaging. We selected 248 hypertensive patients and divided them into four groups according to increasing body mass index (BMI). All patients underwent a clinical history and examination and transthoracic echocardiography, including conventional echocardiographic evaluation and tissue Doppler velocity and strain imaging measurements. Conventional echocardiographic evaluation did not reveal an association between ventricular systo-diastolic dysfunction and increasing BMI. In contrast, tissue Doppler velocity and strain imaging measurements emphasized the negative influence of obesity. For measurements in both the left and right ventricle, myocardial early peak diastolic velocities (E(m)), the ratio of myocardial early-to-late peak diastolic velocity (E(m)/A(m)), myocardial peak systolic velocities (S(m)), and peak strain and strain rate values significantly decreased with increasing BMI (P<0.01 for all parameters measured), even after adjusting for potential confounding variables. In conclusion, by means of new more sensitive echocardiographic techniques, our study clearly demonstrated the negative impact of obesity on both left- and right-ventricular systo-diastolic function, in terms of adjunctive sub-clinical worsening, in hypertensive patients.

[Secondary cardiovascular prevention after acute coronary syndrome in clinical practice]. / Prevenzione cardiovascolare secondaria dopo sindrome coronarica acuta nella pratica clinica.

Secondary prevention after acute coronary syndromes should be aimed at reducing the risk of further adverse cardiovascular events, thereby improving quality of life, and lengthening survival. Despite compelling evidence from large randomized controlled trials, secondary prevention is not fully implemented in most cases after hospitalization for acute coronary syndrome. The Lazio Region (Italy) has about 5.3 million inhabitants (9% of the entire Italian population). Every year about 11 000 patients are admitted for acute coronary syndrome in hospitals of the Lazio Region. Most of these patients receive state-of-the art acute medical and interventional care during hospitalization. However, observational data suggest that after discharge acute coronary syndrome patients are neither properly followed nor receive all evidence-based treatments. This consensus document has been developed by 11 Scientific Societies of Cardiovascular and Internal Medicine in order develop a sustainable and effective clinical approach for secondary cardiovascular prevention after acute coronary syndrome in the local scenario of the Lazio Region. An evidence-based simplified decalogue for secondary cardiovascular prevention is proposed as the cornerstone of clinical intervention, taking into account regional laws and relative shortage of resources. The following appropriate interventions should be consistently applied: smoking cessation, blood pressure control (blood pressure < 130/80 mmHg), optimal lipid management (LDL cholesterol < 80 mmHg), weight and diabetes management, promotion of physical activity and rehabilitation, correct use of antiplatelet agents, beta-blockers, renin-angiotensin-aldosterone system blockers.