Papillary Muscles Abnormalities in Athletes With Otherwise Unexplained T-Wave Inversion in the ECG Lateral Leads.

Background Papillary muscles (PMs) abnormalities may be associated with ECG repolarization abnormalities. We aimed to evaluate the relation between lateral T-wave inversion (TWI) and PMs characteristics in a cohort of athletes with no clinically demonstrable cardiac disease. Methods and Results We included 53 athletes (median age, 20 years; 87% men) with lateral TWI and no evidence of heart disease on clinical and cardiac magnetic resonance evaluation. A group of healthy athletes with normal ECG served as controls. We evaluated the PMs dimensions, such as diameters, area, volume, mass, and ratio between PMs and left ventricular mass, and the prevalence of PMs apical displacement. Compared with controls, athletes with TWI showed PMs hypertrophy with significantly increased PMs diameters, area, volume, and mass. The ratio between PMs and left ventricular mass was 4.4% in athletes with TWI and 3.0% in controls (P<0.001). A PMs/left ventricular mass ratio >3.5% showed 85% sensitivity and 76% specificity for differentiating between athletes with TWI and controls. Apical displacement of PMs was found in 25 (47%) athletes with TWI versus 9 (17%) controls (P=0.001). At multivariable analysis, PMs/left ventricular mass ratio and apical displacement remained independent predictors of TWI. Clinical outcome of the athletes with TWI and PMs abnormalities was uneventful despite continuation of their sports activity. Conclusions PMs hypertrophy and apical displacement may underlie otherwise unexplained lateral TWI in the athlete. Lateral TWI associated with PMs abnormalities appears as a distinct anatomo-clinical condition characterized by a favorable outcome.

Conventional surgery results in patients originally referred for transcatheter aortic valve implantation.

AIMS: Transcatheter aortic valve implantation (TAVI) is increasingly considered as a viable alternative to conventional aortic valve replacement (AVR) in high-risk patients. Long-term results, however, are still scarce and medical community hesitates in enlarging indications to lower-risk patients. Moreover, available devices are expensive and a strict potential candidate selection is necessary. METHODS: From April 2008 to August 2012, a total of 212 patients, originally referred for percutaneous treatment, were thoroughly evaluated by the aortic team of our department in order to choose the optimal procedure. Of them, 55 patients (35 women; 20 men) were considered as still acceptable candidates for conventional AVR. RESULTS: Mean age was 80.7 ±â€Š4.7 years; mean additive and logistic Euroscore I were 9.7 ±â€Š1.8 and 17.8 ±â€Š9.5%, respectively. Mean Euroscore II was 7.9 ±â€Š5.5%. Mean New York Heart Association class was 2.9 ±â€Š0.5. The majority of patients (87.2%) presented a geriatric frailty score of 0-1. Four patients showed a heavily calcified ascending aorta, and five patients (9%) underwent reoperations. Hospital mortality was 10.9% (six patients). Mean follow-up was 535.9 ±â€Š407.4 days (range: 6-1365 days). Six other patients died during this period for a mean survival of 74.4 ±â€Š6.9% at 2 years. Mean New York Heart Association class at 1 year was 1.25 ±â€Š0.5 (P < 0.01 vs. preoperative value). CONCLUSION: AVR should be indicated with caution in high-risk patients originally referred for TAVI. Despite medium-term results being good, with excellent functional status, hospital mortality is not negligible.

Technological approaches to remote monitoring of elderly people in cardiology: a usability perspective.

Moving from the experience gained in home telemonitoring of elderly patients with Congestive Heart Failure, that confirmed a reduction of the rehospitalization rate and an improved monitoring of drugs assumption by the patients, this paper extends the evaluation of technological approaches for remote health monitoring of older adults. Focus of the evaluation is on telemedicine effectiveness and usability, either from a patient's or a medical operator's perspective. The evaluation has been performed by testing three remote health platforms designed according to different technological approaches, in a realistic scenario involving older adults and medical operators (doctors and nurses). The aim of the testing activity was not to benchmark a specific solution with respect to the others, but to evaluate the main positive and negative issues related to the system and service design philosophy each solution was built upon. Though preliminary, the results discussed in the paper can be used as a set of guidelines in the selection of proper technological equipments for services targeted to elderly users, from a usability perspective. These results need to be complemented with more focused discussions of the ethical, medical, and legal aspects of the use of technology in remote healthcare.

Telomere/Telomerase system: a new target of statins pleiotropic effect?

Statins are well established drugs for primary and secondary prevention of coronary artery disease (CAD). Despite the well-known ability of statins to lower cholesterol, it is now clear that clinical benefits are also substantially higher than expected and several clinical trials, like JUPITER (Justification for the Use of Statins in Primary Prevention: An Intervention Trial Evaluating Rosuvastatin trial) have indicated that such clinical effects are independent of cholesterol reduction. These cholesterol-independent actions have been named "pleiotropic effects" and include: anti-oxidation and anti-inflammatory effects, modulation of immune activation, stabilization of atherosclerotic plaque, decreased platelet activation, inhibition of cardiac hypertrophy, reduction of cytokine-mediated vascular smooth muscle cell (VSMC) proliferation and improvement of endothelial function. Recently, additional pleiotropic effects of statins on "cellular senescence" have been seen in different cell types, including endothelial progenitor cells (EPC), endothelial cells (EC), VSMC and chondrocytes. At the molecular level, the effect of statins on cellular senescence could be mediated by their interaction with the telomere/telomerase system. Recent evidence suggests that the anti-aging effects of statins are linked to their ability to inhibit telomere shortening by reducing either directly and indirectly oxidative telomeric DNA damage, as well as by a telomere capping proteins dependent mechanism. In this review, we discuss the pleiotropic effects of statins, focusing on the telomere/telomerase system. We will also present our current findings regarding leukocyte telomere length in very old people with myocardial infarction on statin therapy.

Impact of home patient telemonitoring on use of ß-blockers in congestive heart failure.

INTRODUCTION: Congestive heart failure (CHF), which typically affects older people, is characterized by high short- and mid-term mortality rates. However, despite accumulating evidence showing that administration of ß-blockers (ß-adrenoceptor antagonists) can improve the clinical status of CHF patients, use of these agents in adequate dosages in this setting is not routine. One reason for this appears to be a concern about a possible risk of bradyarrhythmia associated with use of ß-blockers. Telecardiology has recently been investigated as a means of constantly monitoring the heart rate of CHF patients in their homes. Its use may allay concerns about the risk of bradyarrhythmia and facilitate a more widespread use of ß-blockers in this context. OBJECTIVES: The primary objectives of this study were to assess the impact of telemonitoring on patients' adherence to prescribed therapeutic regimens, particularly ß-blockers, and to explore whether use of home telemonitoring reduces mortality and rate of re-admission to hospital in elderly CHF patients compared with normal specialized CHF team care. METHODS: A total of 57 patients with CHF (31 New York Heart Association [NYHA] class II, 23 NYHA class III and 3 NYHA class IV), with a mean ± SD age of 78.2 ± 7.3 years, were randomized to a control group who received standard care, based on routinely scheduled clinic visits, from a team specialized in CHF patient management, or to a home telemonitoring group (TM group), managed by the same specialized CHF team. Patients were followed up over 12 months. RESULTS: Compared with the control group, the TM group had a significant increase in the use of ß-blockers, HMG-CoA reductase inhibitors (statins) and aldosterone receptor antagonists. A reduction in nitrate administration compared with baseline was also seen in the TM group. The 12-month occurrence of the primary combined endpoint of mortality and hospital re-admission for CHF was significantly lower in the TM group than in the control group (p < 0.01). CONCLUSIONS: This study showed that a home-care model including telemonitoring of relevant clinical parameters may provide useful support in the management of patients with CHF. Home telemonitoring in CHF patients was associated with increased use of ß-blockers at appropriate doses, suggesting that this strategy reassured physicians regarding the safety of careful use of these agents in this setting. However, larger studies are required to confirm these findings. Our findings indicate that there is a need to investigate relevant parameters in CHF patients at the point of care (i.e. in patients' daily lives), which can in turn optimize ß-blocker and other drug therapy.