Psychological disorders after coronary artery by-pass surgery: a one-year prospective study.

BACKGROUND: Coronary artery by-pass surgery (CABG) is often followed by anxiety and depression that require early identification in order to provide adequate psychological support. The predictive role of tests administered soon after CABG on long-term psychological outcomes has been only incompletely explored. AIM, DESIGN AND METHODS: Aim of this study was to assess post-operative and 12-month persistence of psychological disorders by means of the Minnesota Multiphasic Personality Inventory (MMPI-2) and the depression and state and trait anxiety scales of the Cognitive Behavioural Assessment (CBA-2.0) in 118 male patients admitted to cardiac rehabilitation after CABG. RESULTS: Early after CABG we observed a high prevalence of depression (11.8% by MMPI-2 and 12.7% by CBA) and state anxiety (23.5%). At 1-year the MMPI-2 scale D indicated stable mean score and high scores at entry were predictive of persistent depression. Conversely the CBA-2.0 scale QD score significantly decreased (from 3.86 +/- 3.19 to 2.91 +/- 3.45, p = 0.017). Also ST1 state anxiety significantly decreased (from 35.17 +/- 6.95 to 32.55 +/- 6.72, p = 0.003) whereas ST2 trait anxiety was stable. We found no association between psychometric results and ventricular function, number of grafts or time since diagnosis of coronary artery disease. CONCLUSIONS: State anxiety and depression by CBA significantly decreased 1-year after CABG; conversely trait anxiety and depression, investigated by MMPI-2, a more specific personality questionnaire, were stable. High scores for the depression in the scale D of MMPI-2 early after CABG seem to be predictive of the persistence of the disorder at 1-year.

Applications of a textile-based wearable system for vital signs monitoring.

A new textile-based wearable system, named MagIC (Maglietta Interattiva Computerizzata) has been recently developed for getting unobtrusive recordings of cardiorespiratory and motion signals during spontaneous behavior. The system is composed of a vest, including textile sensors for ECG and breathing frequency detection, and a portable electronic board for motion assessment, signal preprocessing and wireless data transmission to a remote computer. In this study the MagIC System has been used to monitor vital signs 1) in cardiac inpatients in bed and during physical exercise and 2) in healthy subjects during exercise and under gravitational stress. All recordings showed a correct identification of arrhythmic events and a correct estimation of RR Interval. The positive results obtained in this study support the routine use of the system in a clinical setting, experimental environments, daily life conditions and sport.

[Coronary flow reserve assessment by transthoracic color Doppler echocardiography after primary angioplasty: relationship with recovery of left ventricular function]. / Valutazione della riserva di flusso coronarico mediante ecocardiografia color Doppler transtoracica in pazienti sottoposti ad angioplastica primaria: relazioni con il recupero della funzione ventricolare sinistra.

BACKGROUND: The aim of this study was to determine the relationship between coronary flow reserve measurement by transthoracic Doppler echocardiography in recent acute myocardial infarction treated with primary coronary angioplasty (PTCA) and recovery of left ventricular function. METHODS: Forty-one consecutive patients (3 patients excluded for not good quality of the Doppler signal) have been studied with: (1) recent first acute myocardial infarction treated with primary PTCA within 6 hours of pain onset; (2) optimal angioplasty result with stent deployment, anti-IIb/IIIa infusion and TIMI 3 flow; (3) lack of type 1 diabetes and/or hypertension; (4) good tolerance to adenosine. Transthoracic Doppler echocardiography was used to record coronary flow velocities in the distal left anterior descending and posterior descending coronary arteries at rest and after infusion of adenosine. Coronary flow reserve was measured after 11 +/- 1 days from the acute event. The wall motion score index (WMSI) was calculated at baseline, 1 month and 3 months from myocardial infarction. RESULTS: Patients of group A (n = 29 with coronary flow reserve > or = 1.6) showed a progressive and significant recovery of left ventricular function at follow-up. Patients of group B (n = 9 with coronary flow reserve < 1.6) had persistent left ventricular dysfunction at 3 months (ANOVA, p < 0.0001). WMSI was 1.64 +/- 0.26 in group A and 1.81 +/- 0.16 in group B (p = 0.09) at baseline; 1.30 +/- 0.26 in group A and 1.75 +/- 0.16 in group B (p < 0.0001) at 1 month; and 1.20 +/- 0.25 in group A and 1.73 +/- 0.17 in group B at 3 months. There was an inverse correlation between coronary flow reserve and WMSI at 1 month (r = -0.564, p < 0.0001), and at 3 months (r = -0.583, p < 0.0001). On multivariate analysis baseline WMSI and coronary flow reserve were the only predictors of 1-month WMSI recovery and of WMSI recovery at 3 months. CONCLUSIONS: Coronary flow reserve by transthoracic color Doppler echocardiography is a useful method for predicting left ventricular function recovery in patients after primary PTCA.

[Complexity of observable psychological distress after surgical myocardial revascularization in male subjects]. / Complessità dei disturbi psicologici osservabili dopo rivascolarizzazione miocardica chirurgica in soggetti di sesso maschile.

BACKGROUND: Psychological disturbances like anxiety, depression, post-traumatic stress disorder are often associated with coronary artery disease and, in some studies, play a prognostic role after a coronary event. Despite some psychological disturbances following coronary artery bypass graft (CABG) have an impact on outcomes of both the surgical intervention and the rehabilitation program, their complexity as well as their clinical and instrumental determinants are still not fully understood. The aim of this study was to determine in male subjects with coronary artery disease the prevalence and complexity of psychological disturbances occurring after CABG as well as their predictors. METHODS: One hundred eighteen males without history of psychological disturbances consecutively admitted to our rehabilitation inpatient service between September 2002 and September 2003 underwent 11 +/- 2 days after CABG extensive psychometric testing including the Minnesota Multiphasic Personality Inventory-2, the Cognitive Behavioral Assessment.2, and the Hamilton test. Cardiac evaluation included coronary risk factors, NYHA class, coronary heart disease history, medical therapy, CABG number, and echocardiography. RESULTS: Mean age 63.7 +/- 8.1 years; ejection fraction 54.6 +/- 10.3%; NYHA class I 92.4%, NYHA class II and III 7.6%; CABG number 1 (11%), 2 (23.7%), 3 (39.8%), 4 (21.8%), 5 (4.2%); coronary artery disease length 64 +/- 85 months, hospital stay 31.3 +/- 8 days. The score was above clinical cut-off on scale for depression in 16-39.8% of the patients, state anxiety in 27.1%, trauma in 16.1%, type A personality in 16.1%. Subjects above clinical cut-off for depression, anxiety and trauma did not differ from subjects below in terms of clinical and instrumental characteristics. Age, ejection fraction, coronary risk factors, coronary heart disease duration, and CABG number did not predict the development of depression, anxiety and trauma. Psychological disturbances often clustered in the same subjects. CONCLUSIONS: In males following CABG, psychological disturbances are extremely frequent, often clustered, and independent of subjects' characteristics and coronary heart disease severity.

MagIC System: a New Textile-Based Wearable Device for Biological Signal Monitoring. Applicability in Daily Life and Clinical Setting.

The paper presents a new textile-based wearable system for the unobtrusive recording of cardiorespiratory and motion signals during spontaneous behavior along with the first results concerning the application of this device in daily life and in a clinical environment. The system, called MagIC (Maglietta Interattiva Computerizzata), is composed of a vest, including textile sensors for detecting ECG and respiratory activity, and a portable electronic board for motion detection, signal preprocessing and wireless data transmission to a remote monitoring station. The MagIC system has been tested in freely moving subjects at work, at home, while driving and cycling and in microgravity condition during a parabolic flight. Applicability of the system in cardiac in-patients is now under evaluation. Preliminary data derived from recordings performed on patients in bed and during physical exercise showed 1) good signal quality over most of the monitoring periods, 2) a correct identification of arrhythmic events, and 3) a correct estimation of the average beat-by-beat heart rate. These positive results supports further developments of the MagIC system, aimed at tuning this approach for a routine use in clinical practice and in daily life.

[Acute embolic myocardial infarction complicating bioprosthetic stentless aortic valve endocarditis]. / Infarto miocardico acuto embolico in corso di endocardite su bioprotesi valvolare aortica stentless.

We describe the case of bioprosthetic stentless aortic valve endocarditis due to Staphylococcus epidermidis in a female patient, who previously underwent mitral and aortic valve replacement: she presented left main coronary artery occlusion due to septic embolus with subsequent myocardial infarction complicated by cardiogenic shock. We discuss the therapeutic strategies, both medical and interventional, and the surgical options.

[Clinical and organizational problems related to cardiological rehabilitation units]. / Problematiche cliniche e gestionali della riabilitazione cardiologica in regime di ricovero.

The characteristics of patients admitted to cardiac rehabilitation units have progressively changed and are now represented by older age and clinical instability, with a higher percentage of females than in the past. Moreover, the demand of admission to cardiac rehabilitation departments has increased as a consequence of the extension of cardiac surgical procedures to older patients with frequent comorbidity. At the same time, the need of a shorter hospitalization in the acute hospital units has contributed to more frequent requests for cardiac rehabilitation admission. Cost factors and problems of organization have also contributed to the typology of the patients now admitted for cardiac rehabilitation. The data of patients admitted to the Cardiac Rehabilitation Unit of the Don Gnocchi Hospital in Milan are reported too: these data confirm the actual change in the typology of patients with respect to the past; the possible explanations and reasons, as well as the increased average age of the population and the increased number of surgical interventions in the elderly and females are also evaluated. Moreover, the programs and the rehabilitative aims have been consequently changed. Finally, even the use of non-invasive alternatives to ergometric tests is here discussed.