Right ventricular dyssynchrony and exercise capacity in idiopathic pulmonary arterial hypertension.

Survival in patients with pulmonary arterial hypertension (PAH) is determined by right ventricular (RV) function adaptation to afterload. How altered RV function impacts on exercise capacity in PAH is not exactly known.104 idiopathic PAH (IPAH) patients aged 52±14 years underwent a diagnostic right heart catheterisation, a comprehensive echocardiography including two-dimensional speckle tracking for RV dyssynchrony evaluation and a cardiopulmonary exercise test. Multivariate analyses were performed to identify independent predictors of peak oxygen uptake (peak V'O2 ).A first multivariate analysis of only resting haemodynamic variables identified cardiac index, right atrial (RA) pressure and pulmonary arterial compliance as independent predictors, with low predictive capacity (r2=0.31; p<0.001). A second multivariate analysis model which considered only echocardiographic parameters but without RV dyssynchrony, identified RV fractional area change (FAC) and RA area as independent predictors with still low predictivity (r2=0.35; p<0.001). Adding RV dyssynchrony to the second model increased its predictivity (r2=0.48; p<0.001). Repetition of the three multivariate analyses in patients with preserved RVFAC confirmed that inclusion of RV dyssynchrony results in the highest predictive capability of peak V'O2 (r2=0.53; p=0.001).A comprehensive echocardiography with speckle tracking-derived assessment of the heterogeneity of RV contraction improves the prediction of aerobic exercise capacity in IPAH.

[State of art on the role of ischemic time in ST-segment elevation myocardial infarction treated with PTCA]. / Il ruolo del tempo di ischemia nell'infarto del miocardio STEMI trattato con intervento percutaneo primario coronarico. Attuali conoscenze.

Up till now ST-segment elevation myocardial infarction (STEMI) is an important clinical and epidemiological question because of its high incidence and death rate. In this light, intervention principles continue to be developed to reach a precise diagnosis and a fast transport of the patient towards adequate hospitals. As the only instrument able to modify the natural course of this disease is the early restoration of coronary flow in the myocardial ischemic area, we can understand that time to reperfusion is the driving parameter in defining sanitary and therapeutic ways aimed at facing up to this pathology in its acute phase and limiting the subsequent chronic disfunction. Recently, our group have published a paper demonstrating the fundamental importance of reperfusing the patient within 90 minutes from the onset of the AMI symptoms.The aim of this article is to give a state of art of the international literature about timing question in STEMI and to underline that from our results emerges the necessity of a critical revision of the actual guidelines in order to allow a real optimization and therapy of this pathology.

Update on phase II studies of erythropoietin in acute myocardial infarction. Rationale and design of Exogenous erythroPoietin in Acute Myocardial Infarction: New Outlook aNd Dose Association Study (EPAMINONDAS).

Erythropoietin (Epo) is a hematopoietic hormone produced mainly by the kidneys in response to hypoxia. Recent acquisitions in the fields of hematology, neurology, cardiology, and experimental medicine show cytoprotective, angiogenetic and antiinflammatory effects of Epo. Exogenous erythroPoietin in Acute Myocardial Infarction: New Outlook aNd Dose Association Study (EPAMINONDAS, EudraCTno. 200500485386) is one of four ongoing randomized controlled trials, each testing the effects of Epo in >or=100 patients with STEMI. EPAMINONDAS is a multicenter, prospective, double-blind, placebo-controlled, dose-finding study assessing intravenous moderate doses of human recombinant Epo (epoietin-alpha, 100 or 200 IU/kg/die) versus placebo, given on the first 3 days, in 102 patients with first ST-segment elevation myocardial infarction. Initial dosing is within 12 h of primary percutaneous coronary revascularization. The primary endpoint is infarct size, quantified by CK-MB time-concentration curve, left ventricular wall motion score index, and pattern of contrast-enhanced magnetic resonance imaging. Secondary endpoints are ischemic recurrences, ventricular remodelling, and safety events, assessed in-hospital and at 12 months' follow-up. The results of current phase II studies will help define the safety/efficacy profile of Epo for patients with STEMI.

Visits to figurative art museums may lower blood pressure and stress.

BACKGROUND: The research aimed to assess, through physiological measurements such as blood pressure and heart rate, whether exposure to art museums and to different art styles (figurative vs. modern art) was able to enhance visitors' well-being in terms of relaxing and stress reduction. METHOD: Participants (n = 77) were randomly assigned to one of three conditions, on the basis of the typology of the art style they were exposed to in the museum visit: (1) figurative art, (2) modern art and (3) museum office (as a control condition). Blood pressure and heart rate were measured before and after the visits. RESULTS: Diastolic values of the participants were quite stable, as expected in people who do not suffer hypertension; we therefore considered only variations in systolic blood pressure. The majority of the participants exposed to figurative art significantly decreased systolic blood pressure compared to those exposed to modern art and museum office. No differences were found in the heart rate before and after the visit for the three groups. CONCLUSION: Findings suggest that museum visits can have health benefits, and figurative art may decrease systolic blood pressure.