[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.

[Resection of unusual atrial mass complicated with fungal endocarditis in a patient undergoing immunosuppressive treatment]. / Resezione di una neoformazione atriale rara complicata da endocardite fungina in paziente in terapia immunosoppressiva.

Nodules of mesothelial and monocytic cells (Mesothelial/Monocytic Incidental Cardiac Excresences; MICE) are rare cardiac lesions, non neoplastic, possibly reactive and in part derived from mesothelium. A 76 years old woman, treated with low dose of steroid and methotrexate for rheumatoid arthritis, underwent surgical excision of cardiac "MICE". Postoperative period was complicated with early and severe fungal endocarditis requiring reintervention. Two aspects are of interest: rarity of both cardiac pathologies and the possible relation to immunosuppressive therapy. Treatment of fungal endocarditis should be aggressive, overall survival is rather poor. Possibility to discontinue immunosuppressive treatment should be considered before cardiac surgery.

[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.