Cardiac rehabilitation outcome after transcatheter aortic valve implantation.

Patients with severe aortic stenosis are increasingly treated with transcatheter aortic valve implantation (TAVI) as a safer option to surgical aortic valve replacement (sAVR).  Similar to many other heart diseases, after the specific therapeutic intervention patients are eligible for cardiac rehabilitation (CR) for the purpose of functional recovery. Thus far, CR after both sAVR and TAVI has been used to a limited extent, as shown by the availability of only two meta-analyses including 5 studies and 6 studies, respectively. Recent observational studies reported a significant improvement in functional indexes such as the Barthel scale and the 6-minute walk test (6MWT). We evaluated the outcome of CR in patients after TAVI treatment by measuring changes in the commonly used Barthel scale and 6MWT and adding the short physical performance battery (SPPB) scale as an index to assess lower extremity function. All indexes demonstrated a significant improvement, namely p<0.001 with the Barthel scale, p=0.043 for the 6MWT, and p=0.002 for SPPB. These results confirm the significant improvement of the Barthel scale and 6MWT reported in the previous meta-analysis and suggest the utility of SPPB as a further index of efficacy of CR in patients with severe aortic stenosis treated with TAVI.

[Spontaneous rectus sheath hematoma as a complication of anticoagulant and antiplatelet therapy: a case report.] / Ematoma spontaneo del retto addominale nell'anziano, complicanza di terapia anticoagulante e antiaggregante piastrinica: caso clinico.

Spontaneous rectus sheath hematoma (RSH) is an uncommon and often clinically misdiagnosed cause of abdominal pain, characterized by a presence of blood within rectus muscle sheath, with palpable mass. Hemorrhage may originate from the epigastric artery and branches or directly from rectus sheath rupture. The most frequent cause of hematoma is anticoagulant therapy. Diagnosis is based on ultrasonography and computed tomography. Conservative treatment and, in case of active bleeding, intravascular embolization is the treatment of choice, while surgery is indicated in case of failure of endovascular procedure or in patients with intra-abdominal rupture causing hemodynamic instability and abdominal compartment syndrome. Here we present a case of RSH that developed after hip replacement surgery in a patient on anticoagulant therapy and dual antiplatelet therapy.

Validity of the Talk Test for exercise prescription after myocardial revascularization.

BACKGROUND: For exercise prescription, rating of perceived exertion is the subjective tool most frequently used in addition to methods based on percentage of peak exercise variables. The aim of this study was the validation of a subjective method widely called the Talk Test (TT) for optimization of training intensity in patients with recent myocardial revascularization. DESIGN AND METHODS: Fifty patients with recent myocardial revascularization (17 by coronary artery bypass grafting and 33 by percutaneous coronary intervention) were enrolled in a cardiac rehabilitation programme. Each patient underwent three repetitions of the TT during three different exercise sessions to evaluate the within-patient and between-operators reliability in assessing the workload (WL) at TT thresholds. These parameters were then compared with the data of a final cardiopulmonary exercise testing, and the WL range between the individual aerobic threshold (AeT) and anaerobic threshold (AnT) was considered as the optimal training zone. RESULTS: The within-patient and between-operators reliability in assessing TT thresholds were satisfactory. No significant differences were found between patients' and physiotherapists' evaluations of WL at different TT thresholds. WL at Last TT+ was between AeT and AnT in 88% of patients and slightly

Training prescription in patients on beta-blockers: percentage peak exercise methods or self-regulation?

BACKGROUND: Exercise prescription based on percentage of peak exercise variables has many limitations in patients taking beta-blockers. The aim of this study was to evaluate efficacy and safety of a training protocol based on the rating of perceived exercise (RPE) in patients taking beta-blockers after cardiac surgical revascularization. DESIGN AND METHODS: 71 patients treated with beta-blockers after recent coronary artery bypass grafting were randomly allocated to two different programmes with training intensity adjusted to keep heart rate close to first ventilatory threshold (36 subjects, AeT group) or RPE between grades 4 and 5 of 10-point category-ratio BORG scale (35 subjects, RPE group). RESULTS: In the RPE group, mean training workloads and heart rate values were significantly higher than in the AeT group; during the last week of the programme, six RPE patients were training very close to anaerobic threshold. Aerobic peak capacity increased similarly in the two groups. Considering the potential effects on training intensity of prescriptions based on percentages of peak exercise variables, we found that only percentage heart rate reserve and peak workload methods were reliable in defining a safe upper limit of training intensity, with values of 50% and 65% respectively. CONCLUSIONS: Self-regulation of exercise training intensity between grades 4 and 5 of the 10-point category-ratio BORG scale is effective but may promote overtraining in some patients without significant functional advantages. For these reasons, RPE method should be integrated with objective indices based on percentage of heart rate reserve or of peak workload.