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  1. Article: Can Seismocardiogram Fiducial Points Be Used for the Routine Estimation of Cardiac Time Intervals in Cardiac Patients?

    Işilay Zeybek, Zeynep Melike / Racca, Vittorio / Pezzano, Antonio / Tavanelli, Monica / Di Rienzo, Marco

    Frontiers in physiology

    2022  Volume 13, Page(s) 825918

    Abstract: The indexes of cardiac mechanics can be derived from the cardiac time intervals, CTIs, i.e., the timings among the opening and closure of the aortic and mitral valves and the Q wave in the ECG. Traditionally, CTIs are estimated by ultrasound (US) ... ...

    Abstract The indexes of cardiac mechanics can be derived from the cardiac time intervals, CTIs, i.e., the timings among the opening and closure of the aortic and mitral valves and the Q wave in the ECG. Traditionally, CTIs are estimated by ultrasound (US) techniques, but they may also be more easily assessed by the identification of specific fiducial points (FPs) inside the waveform of the seismocardiogram (SCG), i.e., the measure of the thorax micro-accelerations produced by the heart motion. While the correspondence of the FPs with the valve movements has been verified in healthy subjects, less information is available on whether this methodology may be routinely employed in the clinical practice for the monitoring of cardiac patients, in which an SCG waveform distortion is expected because of the heart dysfunction. In this study we checked the SCG shape in 90 patients with myocardial infarction (MI), heart failure (HF), or transplanted heart (TX), referred to our hospital for rehabilitation after an acute event or after surgery. The SCG shapes were classified as traditional (T) or non-traditional (NT) on whether the FPs were visible or not on the basis of nomenclature previously proposed in literature. The T shape was present in 62% of the patients, with a higher ∓ prevalence in MI (79%). No relationship was found between T prevalence and ejection fraction (EF). In 20 patients with T shape, we checked the FPs correspondence with the real valve movements by concomitant SCG and US measures. When compared with reference values in healthy subjects available in the literature, we observed that the Echo vs. FP differences are significantly more dispersed in the patients than in the healthy population with higher differences for the estimation of the mitral valve closure (-17 vs. 4 ms on average). Our results indicate that not every cardiac patient has an SCG waveform suitable for the CTI estimation, thus before starting an SCG-based CTI monitoring a preliminary check by a simultaneous SCG-US measure is advisable to verify the applicability of the methodology.
    Language English
    Publishing date 2022-03-18
    Publishing country Switzerland
    Document type Journal Article
    ZDB-ID 2564217-0
    ISSN 1664-042X
    ISSN 1664-042X
    DOI 10.3389/fphys.2022.825918
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: Inflammatory Cytokines During Cardiac Rehabilitation After Heart Surgery and Their Association to Postoperative Atrial Fibrillation.

    Racca, Vittorio / Torri, Anna / Grati, Paola / Panzarino, Claudia / Marventano, Ivana / Saresella, Marina / Castiglioni, Paolo

    Scientific reports

    2020  Volume 10, Issue 1, Page(s) 8618

    Abstract: Inflammation is associated with atrial fibrillation (AF), but little is known about the association of AF with the inflammatory serum cytokines after the acute postoperative phase. Thus, we aimed to explore how plasma cytokines concentrations modify ... ...

    Abstract Inflammation is associated with atrial fibrillation (AF), but little is known about the association of AF with the inflammatory serum cytokines after the acute postoperative phase. Thus, we aimed to explore how plasma cytokines concentrations modify during a 3-week cardiac rehabilitation after heart surgery, comparing patients who developed postoperative AF (POAF) and those with permanent AF with patients free from AF (NoAF group). We enrolled 100 consecutive patients and 40 healthy volunteers as a control group. At the beginning of cardiac rehabilitation, 11 days after surgery, serum levels of MPO, PTX3, ADAM17, sST2, IL-25, and IL-33 were dramatically higher, whereas TNFα and IL-37 levels were much lower in NoAF, POAF, and permanent AF patients than in the healthy volunteers. After rehabilitation, most of the cytokines changed tending towards normalization. POAF patients (35% of the total) had higher body mass index and abdominal adiposity than NoAF patients, but similar general characteristics and risk factors for POAF. However, ADAM-17 and IL-25 were always lower in POAF than in NoAF patients, suggesting a protective role of IL-25 and ADAM 17 against POAF occurrence. This finding could impact on therapeutic strategies focusing on the postoperative prophylactic antiarrhythmic interventions.
    MeSH term(s) ADAM17 Protein/blood ; Aged ; Atrial Fibrillation/diagnosis ; Atrial Fibrillation/etiology ; Body Mass Index ; C-Reactive Protein/analysis ; Cardiac Rehabilitation ; Cardiac Surgical Procedures/adverse effects ; Case-Control Studies ; Coronary Artery Bypass/adverse effects ; Cytokines/blood ; Female ; Humans ; Interleukin-17/blood ; Male ; Middle Aged ; Postoperative Complications ; Prospective Studies ; Risk Factors ; Serum Amyloid P-Component/analysis ; Tumor Necrosis Factor-alpha/blood
    Chemical Substances Cytokines ; IL25 protein, human ; Interleukin-17 ; Serum Amyloid P-Component ; Tumor Necrosis Factor-alpha ; PTX3 protein (148591-49-5) ; C-Reactive Protein (9007-41-4) ; ADAM17 Protein (EC 3.4.24.86)
    Language English
    Publishing date 2020-05-25
    Publishing country England
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 2615211-3
    ISSN 2045-2322 ; 2045-2322
    ISSN (online) 2045-2322
    ISSN 2045-2322
    DOI 10.1038/s41598-020-65581-1
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article ; Online: Hypomagnesemia after heart transplantation or left ventricular assist device implant for end-stage heart failure.

    Racca, Vittorio / Scaglione, Anna / De Maria, Renata / Panzarino, Claudia / Santangelo, Maria Antonia / Cipriani, Manlio

    Clinical transplantation

    2020  Volume 34, Issue 8, Page(s) e13902

    Abstract: Background: Patients with advanced heart failure undergoing heart transplant (HTx) or left ventricular assist device (LVAD) implant are at high risk of magnesium deficiency, that may favor development of diabetes. We aimed to comparatively assess ... ...

    Abstract Background: Patients with advanced heart failure undergoing heart transplant (HTx) or left ventricular assist device (LVAD) implant are at high risk of magnesium deficiency, that may favor development of diabetes. We aimed to comparatively assess prevalence and correlates of hypomagnesemia during cardiac rehabilitation between 51 HTx and 46 LVAD recipients.
    Methods and results: We measured serum magnesium and correlated it to clinical and laboratory findings upon admission (T
    Conclusion: Hypomagnesemia is rare in LVAD recipients, but common within 1 month from HTx, worsens during rehabilitation, despite immunosuppression tapering and magnesium supplements, and is independently associated to increasing glucose levels. Studies evaluating whether correcting hypomagnesemia improves outcome are warranted.
    MeSH term(s) Heart Failure/surgery ; Heart Transplantation/adverse effects ; Heart-Assist Devices/adverse effects ; Humans ; Magnesium ; Tacrolimus ; Treatment Outcome
    Chemical Substances Magnesium (I38ZP9992A) ; Tacrolimus (WM0HAQ4WNM)
    Language English
    Publishing date 2020-05-25
    Publishing country Denmark
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 639001-8
    ISSN 1399-0012 ; 0902-0063
    ISSN (online) 1399-0012
    ISSN 0902-0063
    DOI 10.1111/ctr.13902
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  4. Article: Acute Fingolimod Effects on Baroreflex and Cardiovascular Autonomic Control in Multiple Sclerosis.

    Racca, Vittorio / Rovaris, Marco / Cavarretta, Rosella / Vaini, Emanuele / Toccafondi, Anastasia / Di Rienzo, Marco

    Journal of central nervous system disease

    2019  Volume 11, Page(s) 1179573519849945

    Abstract: Background: Fingolimod, an oral drug used in multiple sclerosis (MS) treatment, exerts its action through S1P-receptor engagement. These receptors are also expressed in heart and endothelial cells. The engagement of receptors on the atrial heart ... ...

    Abstract Background: Fingolimod, an oral drug used in multiple sclerosis (MS) treatment, exerts its action through S1P-receptor engagement. These receptors are also expressed in heart and endothelial cells. The engagement of receptors on the atrial heart myocytes may cause a slowing effect on heart rate (HR). We aimed to explore the acute effect of fingolimod on the cardiac autonomic control, a side-effect of the drug that still needs to be clarified.
    Methods: In 10 MS patients, we investigated the influence of the first administration of fingolimod (0.5 mg) on sympathetic and parasympathetic indexes via the analysis of the HR variability, and on the baroreflex sensitivity via sequence and alpha coefficient techniques.
    Results: Fingolimod produced an average HR maximal drop of 12.7 (7.8) beats/min and the minimal HR occurred after 2.73 (0.38) hours from the dose administration. The pulse interval (PI) mean value and the pNN50 and RMSSD indexes of parasympathetic drive to the heart significantly increased. Interestingly, in 6 out of 10 patients also the power in the low-frequency band (LF) increased. The baroreflex sensitivity was not modified by the first dose of the drug.
    Conclusions: Our findings indicate that although the first dose of fingolimod invariably activates the parasympathetic system, in several subjects, it may induce also a surge in the sympathetic cardiac drive. This suggests that not only the vagal, as usually assumed, but also the sympathetic autonomic branch should be considered in the risk profile assessment of MS patients starting treatment with fingolimod.
    Language English
    Publishing date 2019-05-16
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2586873-1
    ISSN 1179-5735
    ISSN 1179-5735
    DOI 10.1177/1179573519849945
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  5. Article ; Online: Osteopathic Manipulative Treatment Improves Heart Surgery Outcomes: A Randomized Controlled Trial.

    Racca, Vittorio / Bordoni, Bruno / Castiglioni, Paolo / Modica, Maddalena / Ferratini, Maurizio

    The Annals of thoracic surgery

    2017  Volume 104, Issue 1, Page(s) 145–152

    Abstract: Background: Controlling sternal pain after heart surgery is important to reduce the risk of postoperative complications, but pain is often undertreated because of contraindications and side effects of analgesic drugs. Recently, osteopathic manipulative ... ...

    Abstract Background: Controlling sternal pain after heart surgery is important to reduce the risk of postoperative complications, but pain is often undertreated because of contraindications and side effects of analgesic drugs. Recently, osteopathic manipulative treatment (OMT) was demonstrated to reduce pain in different clinical contexts, suggesting its potential utility after cardiac surgery. The aim of this open-label, controlled study is to assess whether OMT contributes to sternal pain relief and improves postoperative outcomes.
    Methods: Eighty post-sternotomy adult inpatients were randomly allocated one to one to receive a standardized cardiorespiratory rehabilitation program alone (control group) or combined with OMT. Pain intensity and respiratory functional capacity were quantified by the Visual Analogue Scale score and by a standardized breathing test, at the start and end of rehabilitation.
    Results: At the start of rehabilitation, the control group and the OMT group had similar Visual Analogue Scale median scores (controls 4, interquartile range [IQR]: 2 to 5; OMT 4, IQR: 3 to 5; p = not significant) and mean inspiratory volumes (controls 825 ± 381 mL; OMT 744 ± 291 mL; p = not significant). At the end of rehabilitation, the OMT group had a lower Visual Analogue Scale median score (controls 3, IQR: 2 to 4; OMT 1, IQR: 1 to 2; p < 0.01) and higher mean inspiratory volume (controls 1,400 ± 588 mL; OMT 1,781 ± 633 mL; p < 0.01). The analgesic drug intake was similar in the two groups. The hospitalization was shorter in the OMT group than in the control group (19.1 ± 4.8 versus 21.7 ± 6.3 days; p < 0.05).
    Conclusions: The combination of standard care with OMT is effective in inducing pain relief and functional recovery, and significantly improves the management of patients after heart surgery with sternotomy.
    MeSH term(s) Aged ; Cardiac Surgical Procedures ; Chest Pain/diagnosis ; Chest Pain/rehabilitation ; Female ; Follow-Up Studies ; Heart Diseases/surgery ; Humans ; Inpatients ; Male ; Manipulation, Osteopathic/methods ; Middle Aged ; Pain Measurement ; Pain, Postoperative/diagnosis ; Pain, Postoperative/rehabilitation ; Recovery of Function ; Retrospective Studies ; Single-Blind Method ; Sternotomy/adverse effects ; Treatment Outcome
    Language English
    Publishing date 2017-07
    Publishing country Netherlands
    Document type Journal Article ; Randomized Controlled Trial
    ZDB-ID 211007-6
    ISSN 1552-6259 ; 0003-4975
    ISSN (online) 1552-6259
    ISSN 0003-4975
    DOI 10.1016/j.athoracsur.2016.09.110
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  6. Article ; Online: Psychological Profile in Coronary Artery By-Pass Graft Patients vs. Valve Replacement Patients Entering Cardiac Rehabilitation after Surgery.

    Modica, Maddalena / Castiglioni, Paolo / Minotti, Anna / Faini, Andrea / Racca, Vittorio / Ferratini, Maurizio

    Scientific reports

    2018  Volume 8, Issue 1, Page(s) 14381

    Abstract: Anxiety and depression are thought to influence the genesis of ischemic diseases and not of valvular diseases, but little is known on the psychological profile of cardiac patients after surgery. Aim of this study was to investigate differences in disease ...

    Abstract Anxiety and depression are thought to influence the genesis of ischemic diseases and not of valvular diseases, but little is known on the psychological profile of cardiac patients after surgery. Aim of this study was to investigate differences in disease experience and mood between patients undergoing cardiac rehabilitation after coronary artery by-pass graft (CABG) or after valve replacement (VR). We studied 1,179 CABG and 737 VR patients who completed the Illness Behaviour Questionnaire and the Hospital Anxiety and Depression Scale after surgery. We tested the independent effect of the type of surgery by multivariate analysis and between-group differences in prevalence of clinically relevant scores. Relevant scores in the psychosomatic concern scale were more frequent in CABG than in VR patients. After correction by age, sex, education and marital status, scores of disease conviction and psychosomatic concern were higher in CABG patients, scores of denial were higher in VR patients. Unexpectedly, anxiety and depression scores did not differ between groups. Results suggest providing psychological support for anxiety and depression to both VR and CABG patients during cardiac rehabilitation, and planning differentiated interventions of cardiac rehabilitation and secondary prevention tailored to the specific psychological reactions of CABG and VR patients.
    MeSH term(s) Affect ; Aged ; Anxiety/etiology ; Anxiety/psychology ; Cardiac Rehabilitation/psychology ; Coronary Artery Bypass/psychology ; Depression/etiology ; Depression/psychology ; Female ; Heart Valve Prosthesis ; Heart Valve Prosthesis Implantation/psychology ; Heart Valves/surgery ; Humans ; Male ; Middle Aged
    Language English
    Publishing date 2018-09-26
    Publishing country England
    Document type Journal Article
    ZDB-ID 2615211-3
    ISSN 2045-2322 ; 2045-2322
    ISSN (online) 2045-2322
    ISSN 2045-2322
    DOI 10.1038/s41598-018-32696-5
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  7. Article ; Online: End-stage heart failure: Two surgical approaches with different rehabilitative outcomes.

    Racca, Vittorio / Castiglioni, Paolo / Panzarino, Claudia / Oliva, Fabrizio / Perna, Enrico / Ferratini, Maurizio

    PloS one

    2017  Volume 12, Issue 10, Page(s) e0185717

    Abstract: Background: A rising number of patients are surgically treated for heart failure at the more advanced stage, thanks to the increasing use of left ventricular assist device (LVAD) as a reliable alternative to heart transplantation (HTx). However, it is ... ...

    Abstract Background: A rising number of patients are surgically treated for heart failure at the more advanced stage, thanks to the increasing use of left ventricular assist device (LVAD) as a reliable alternative to heart transplantation (HTx). However, it is still unknown whether differences exist between the two surgical approaches in the efficacy of rehabilitation programmes. Therefore, aim of this study was to evaluate whether functional capacity and rehabilitative outcomes differ between HTx and implantation of LVAD.
    Methods and results: We enrolled 51 patients with HTx and 46 with LVAD upon admission to our rehabilitation-unit. We evaluated six-minute walking test (6MWT), resting oxygen saturation (SaO2) and nutritional assessment before and after a standardised cardiovascular rehabilitation programme. HTx and LVAD groups differed in age, anthropometric variables, gender distribution. Upon enrolment, 6MWT distance was similar in the two groups, whereas malnutrition was less frequent and the waist circumference/height ratio (WHtR) was greater in LVAD patients. SaO2 was greater in HTx patients. Rehabilitation improved SaO2, 6MWT distance and nutritional status. The difference in malnutrition disappeared, but WHtR remained higher in the LVAD and SaO2 higher in the HTx patients; the 6MWT distance improved more in the HTx patients. Multivariate linear regression analysis confirmed that the type of intervention was independent predictor of 6MWT distance after rehabilitation.
    Conclusions: HTx patients improve more rapidly and perform better after rehabilitation, suggesting the need for more tailored rehabilitation training for LVAD patients.
    MeSH term(s) Aged ; Female ; Heart Failure/rehabilitation ; Heart Failure/surgery ; Heart Transplantation/adverse effects ; Heart Transplantation/methods ; Humans ; Male ; Patient Admission ; Treatment Outcome
    Language English
    Publishing date 2017
    Publishing country United States
    Document type Journal Article ; Observational Study
    ISSN 1932-6203
    ISSN (online) 1932-6203
    DOI 10.1371/journal.pone.0185717
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  8. Article ; Online: The Syntaxin-1A gene single nucleotide polymorphism rs4717806 associates with the risk of ischemic heart disease.

    Guerini, Franca R / Ripamonti, Enrico / Costa, Andrea S / Zanzottera, Milena / Agliardi, Cristina / Bolognesi, Elisabetta / Clerici, Mario / Racca, Vittorio

    Medicine

    2019  Volume 98, Issue 24, Page(s) e15846

    Abstract: Ischemic heart disease (IHD) has a genetic predisposition and a number of cardiovascular risk factors are known to be affected by genetic factors. Development of metabolic syndrome and insulin resistance, strongly influenced by lifestyle and ... ...

    Abstract Ischemic heart disease (IHD) has a genetic predisposition and a number of cardiovascular risk factors are known to be affected by genetic factors. Development of metabolic syndrome and insulin resistance, strongly influenced by lifestyle and environmental factors, frequently occur in subjects with a genetic susceptibility. The definition of genetic factors influencing disease susceptibility would allow to identify individuals at higher risk and thus needing to be closely monitored.To this end, we focused on a complex of soluble-N-ethylmaleimide-sensitive factor attachment protein receptors (SNAREs), playing an important role in metabolic syndrome and insulin resistance, involved in endothelial dysfunction and heart disease. We assessed if genetic variants of the SNARE genes are associated with IHD.SNAP25 rs363050, Stx-1A rs4717806, rs2293489, and VAMP2 26bp ins/del genetic polymorphisms were analyzed in a cohort of 100 participants who underwent heart surgery; 56 of them were affected by IHD, while 44 were not. A statistical association of plasma glycemia and insulin resistance, calculated as Triglyceride glucose (TyG) index, was observed in IHD (P < .001 and P = .03, respectively) after binomial logistic stepwise regression analysis, adjusted by age, gender, diabetes positivity, waist circumference, and cholesterol plasma level. Among genetic polymorphisms, rs4717806(A) and rs2293489(T), as well as the rs4717806 - rs2293489 (A-T) haplotype were associated with higher risk for IHD (Pc = .02; Pc = .02; P = .04, respectively). Finally, a statistical association of rs4717806(AA) genotype with higher TyG index in IHD patients (P = .03) was highlighted by multiple regression analysis considering log-transformed biochemical parameters as dependent variable and presence of coronary artery disease, age, gender, waist circumference, presence of diabetes as predictors. These results point to a role of the Stx-1A rs4717806 SNP in IHD, possibly due to its influence on Stx-1A expression and, as a consequence, on insulin secretion and glucose metabolism.
    MeSH term(s) Aged ; Aged, 80 and over ; Cardiac Surgical Procedures ; Cohort Studies ; Female ; Genetic Association Studies/methods ; Genetic Predisposition to Disease ; Humans ; INDEL Mutation ; Male ; Middle Aged ; Myocardial Ischemia/genetics ; Myocardial Ischemia/surgery ; Polymorphism, Single Nucleotide ; Prospective Studies ; Synaptosomal-Associated Protein 25/genetics ; Syntaxin 1/genetics ; Vesicle-Associated Membrane Protein 2/genetics
    Chemical Substances SNAP25 protein, human ; STX1A protein, human ; Synaptosomal-Associated Protein 25 ; Syntaxin 1 ; VAMP2 protein, human ; Vesicle-Associated Membrane Protein 2
    Language English
    Publishing date 2019-06-11
    Publishing country United States
    Document type Journal Article
    ZDB-ID 80184-7
    ISSN 1536-5964 ; 0025-7974
    ISSN (online) 1536-5964
    ISSN 0025-7974
    DOI 10.1097/MD.0000000000015846
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  9. Article ; Online: Short- and long-term effects of a cardiac rehabilitation program in patients implanted with a left ventricular assist device.

    Scaglione, Anna / Panzarino, Claudia / Modica, Maddalena / Tavanelli, Monica / Pezzano, Antonio / Grati, Paola / Racca, Vittorio / Toccafondi, Anastasia / Bordoni, Bruno / Verde, Alessandro / Cartella, Iside / Castiglioni, Paolo

    PloS one

    2021  Volume 16, Issue 12, Page(s) e0259927

    Abstract: The efficacy of cardiac rehabilitation in heart-failure patients who received a left-ventricular assist device (LVAD) instead of heart transplantation (HTx) is still unclear. This study aims to evaluate whether cardiac rehabilitation is beneficial in ... ...

    Abstract The efficacy of cardiac rehabilitation in heart-failure patients who received a left-ventricular assist device (LVAD) instead of heart transplantation (HTx) is still unclear. This study aims to evaluate whether cardiac rehabilitation is beneficial in LVAD as HTx patients in the short term and whether its effects in LVAD patients persist over time. Twenty-five LVAD patients were evaluated by functional and psychological tests at admission (T0) and discharge (T1) of a 4-week inpatient structured rehabilitation program, and follow-ups 3 (T2), 6 (T3), and 12 months (T4) after discharge. Twenty-five matched HTx patients were also studied from T0 to T1 to compare the improvements in the six-minute walk test (6MWT). The quality-of-life scores substantially improved in LVAD patients and the 6MWT showed the same functional recovery as in HTx patients from T0 to T1. After T1, numerous LVAD patients withdrew from the study. However, the 6MWT outcome increased further from T1 to T3, with a positive trend during the follow-ups. Hemoglobin and the ventilatory performance increased, and the psychological perception of heart-failure symptoms and pain further improved at T2. In conclusion, exercise-based rehabilitation programs provide similar beneficial effects in LVAD and HTx patients, without deterioration in LVAD patients up to 12 months after discharge.
    MeSH term(s) Aged ; Cardiac Surgical Procedures/adverse effects ; Cardiac Surgical Procedures/instrumentation ; Cardiac Surgical Procedures/methods ; Exercise Therapy/methods ; Female ; Heart Failure/rehabilitation ; Heart Failure/surgery ; Heart-Assist Devices ; Humans ; Male ; Middle Aged ; Postoperative Complications/rehabilitation ; Psychotherapy/methods
    Language English
    Publishing date 2021-12-01
    Publishing country United States
    Document type Journal Article ; Observational Study
    ISSN 1932-6203
    ISSN (online) 1932-6203
    DOI 10.1371/journal.pone.0259927
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  10. Article ; Online: Coping, Mood, Quality of Life, and Outcomes in Recipients of Left Ventricular Assist Devices: A Cluster Analysis.

    Modica, Maddalena / Minotti, Anna / De Maria, Renata / Scaglione, Anna / Bordoni, Bruno / Cipriani, Manlio / Russo, Claudio / Racca, Vittorio / Ferratini, Maurizio

    Psychosomatic medicine

    2019  Volume 81, Issue 2, Page(s) 192–199

    Abstract: Objective: Left ventricular assist devices (LVADs) are increasingly used for temporary circulatory support until transplant or as destination therapy for patients with end-stage heart failure. Understanding patients' attitudes and resources is crucial ... ...

    Abstract Objective: Left ventricular assist devices (LVADs) are increasingly used for temporary circulatory support until transplant or as destination therapy for patients with end-stage heart failure. Understanding patients' attitudes and resources is crucial to support them.
    Methods: Sixty-one LVAD recipients (55 [10] years, 10% women, 15% destination therapy) participating in cardiac rehabilitation (CR) postimplant underwent assessment of coping styles (Coping Orientation for Problem Experiences), quality of life (Medical Outcomes Study Short-Form 36, Minnesota Living with Heart Failure Questionnaire), and mood (Hospital Anxiety and Depression Scale).
    Results: Cluster analysis identified two homogeneous groups: C1 (n = 18) patients had higher anxiety (9.6 [5.0] versus 4.0 [2.7], p < .001), depression (10 [3.0] versus 4 [2.7], p < .001), and avoidant coping (29 [5.2] versus 21.2 [3.8], p < .001) scores and worse quality of life (Short-Form 36 of the Medical Outcomes Study Physical Component Scale 31 [5.3] versus 35.6 [6.9], p < .001; Mental Component Scale 34.3 [6.8] versus 50.3 [8], p < .001; MLHFQ physical 26 [7.2] versus 13.9 [8.2], p < .001; emotional 17.7 [3.4] versus 3.86 [3.2], p < .001) than C2 participants (n = 43). During 31 (15-54) months, 20 patients (33%) died. By Cox multivariable analysis, after adjustment for age, sex, Interagency Registry for Mechanically Assisted Circulatory Support level at surgery, and meters walked during 6 minutes at CR discharge, C1 was associated with mortality (hazard ratio = 2.858; 95% confidence interval = 1.102-7.408, p = .031; model χ = 7.286, df = 5, p = .20). Survival was 44% in C1 and 77% in C2 (log-rank p = .033).
    Conclusions: Among patients discharged from CR after LVAD implant, one third show a profile characterized by worse perceived quality of life, mood disorders, and dysfunctional coping that is associated with long-term mortality, and these factors are potential targets for post-LVAD intensive support.
    MeSH term(s) Adaptation, Psychological/physiology ; Anxiety/psychology ; Cluster Analysis ; Depression/psychology ; Female ; Heart Failure/psychology ; Heart Failure/therapy ; Heart Ventricles ; Heart-Assist Devices ; Humans ; Male ; Middle Aged ; Quality of Life/psychology ; Treatment Outcome
    Language English
    Publishing date 2019-01-09
    Publishing country United States
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 3469-1
    ISSN 1534-7796 ; 0033-3174
    ISSN (online) 1534-7796
    ISSN 0033-3174
    DOI 10.1097/PSY.0000000000000658
    Database MEDical Literature Analysis and Retrieval System OnLINE

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