Lower extremities peripheral arterial disease among patients admitted to cardiac rehabilitation: the THINKPAD registry.

BACKGROUND/OBJECTIVES: Lower extremities peripheral arterial disease (LE-PAD) across the wide range of conditions for Cardiac Rehabilitation (CR) is poorly understood. The "ATHerosclerosis of the lower extremIties as a liNKed comorbidity in Patients Admitted for carDiac rehabilitation" (THINKPAD) registry explored LE-PAD in CR patients in terms of prevalence and interventions delivered. METHODS: Multicenter, consecutive case series of 1506 patients discharged from 16 CR Units in Italy from May 1 to June 30, 2012. RESULTS: LE-PAD constituted a primary indication for CR and a comorbidity on admission in 2.6% and 9.3% of patients respectively. LE-PAD patients were significantly older (72 ± 9 vs. 67 ± 12 years, p<0.001) and displayed a worse cardiovascular risk profile (diabetes 38% vs. 23%, hypertension 86% vs. 63%, hypercholesterolemia 74% vs. 52%, smoking 72% vs. 50%, low level of physical activity 84% vs. 69%, impaired diet habits 69% vs. 55%, p<0.01 for all). COPD (17% vs. 11%, p<0.05), CKD (20% vs. 10%, p<0.01), and past history of coronary revascularization (29% vs. 14%, p<0.001) were also more represented in the LE-PAD group. Half of LE-PAD patients received a formal staging, with low provision of ABI (18%) and color Doppler (48%) investigation. Secondary prevention targets at the end of CR for blood pressure and lipid control were accomplished in 83% and 46% of patients respectively (strongly correlated with the presence of CAD), while other guideline-recommended drugs for LE-PAD were prescribed in less than 4% of cases. CONCLUSION: LE-PAD represents an uncommon referral indication for CR. Our data confirm its systematic underassessment and undertreatment.

[Postoperative atrial fibrillation: etiopathogenesis, prevention and therapy]. / La fibrillazione atriale post-operatoria: inquadramento nosologico e opzioni per la terapia e la profilassi.

Atrial fibrillation is the most frequent complication after cardiac surgery. Its onset leads to a threefold higher risk for stroke compared with patients in sinus rhythm and other adverse events such as thromboembolic events and heart failure. The direct consequence is an increased length of hospital stays with obvious economic implications. These reasons have led the attention of many investigators to point out the rule of possible predisposing factors and underlining mechanisms in order to establish an effective preventive treatment. The present paper is aimed to review the state-of-the-art knowledge about post-operative atrial fibrillation and its complex etiopathogenesis which is in turn responsible for the lack of consensus regarding routine prophylaxis.

[Role of echocardiography after cardiac surgery during rehabilitation]. / La valutazione ecocardiografica del paziente cardio-operato in cardiologia riabilitativa: aspetti specifici ed implicazioni cliniche.

In this review, specific aspects and implications of echocardiography in patients who had undergone recent cardiac surgery will be analysed. This imaging method, which is fully effective in clinical practice, actually possesses diagnostic characteristics, which during assessments of patients, are found to be noninvasive and easily repeatable. They are of great value amongst this particular group of patients for discovering any possible complications from the surgical procedures. Technical problems and methodology will be described regarding the specificity of the patient during the early days after cardiac surgery (for instance the difficulties of executing in certain post-operative conditions such as pain, injuries or worsening of acoustic window). Informative contribution and specific assessment in patients following myocardial revascularisation surgery, reconstructive or valvular replacement surgery, and left ventricle or thoracic aorta surgery will be analysed. The role of echocardiography in the identification and monitoring of the main complications related to the operation will also be described. The increasing diagnostic potential and assessment of the investigation is thanks to its systematic use which lasts for the intensive phase of cardiac rehabilitation, but assumes specific and adequate operator competence for optimum use in clinical examinations.