Search

Abstract Background B-type natriuretic peptide (BNP) is increased in post-cardiac surgery patients, however the mechanisms underlying BNP release are still unclear. In the current study, we aimed to assess the relationship between postoperative BNP levels and left ventricular filling pressures in post-cardiac surgery patients. Methods We prospectively enrolled 134 consecutive patients referred to our Center 8 ± 5 days after cardiac surgery. BNP was sampled at hospital admission and related to the following echocardiographic parameters: left ventricular (LV) diastolic volume (DV), LV systolic volume (SV), LV ejection fraction (EF), LV mass, relative wall thickness (RWT), indexed left atrial volume (iLAV), mitral inflow E/A ratio, mitral E wave deceleration time (DT), ratio of the transmitral E wave to the Doppler tissue early mitral annulus velocity (E/E'). Results A total of 124 patients had both BNP and echocardiographic data. The BNP values were significantly elevated (mean 353 ± 356 pg/ml), with normal value in only 17 patients (13.7%). Mean LVEF was 59 ± 10% (LVEF ≥50% in 108 pts). There was no relationship between BNP and LVEF (p = 0.11), LVDV (p = 0.88), LVSV (p = 0.50), E/A (p = 0.77), DT (p = 0.33) or RWT (p = 0.50). In contrast, BNP was directly related to E/E' (p < 0.001), LV mass (p = 0.006) and iLAV (p = 0.026). At multivariable regression analysis, age and E/E' were the only independent predictors of BNP levels. Conclusion In post-cardiac surgery patients with overall preserved LV systolic function, the significant increase in BNP levels is related to E/E', an echocardiographic parameter of elevated LV filling pressures which indicates left atrial pressure as a major determinant in BNP release in this clinical setting.

Background: There is an increasing need for admission of octogenarians to cardiac rehabilitation programs. The aim of this study was to evaluate if the Rivermead Mobility Index (RMI) (scale of mobility) is related to the functional capacity assessed by the 6 Minute Walking Test (6MWT)., Methods: We selected 108 consecutive patients > 80 years (M = 53, mean age 82.5 +/- 2.7 years, after cardiac surgery n = 72, heart failure n = 36) enrolled to our cardiac rehabilitation unit. All patients were evaluated with the RMI and underwent 6MWT both at admission (RMI(1) and 6MWT(1) and after a period of daily physical training (RMI2 and 6MWT(2)). The RMI(2)/RMI(1) and 6MWT(2)/6MWT(1) ratios were calculated as indexes of functional improvement (IM)., Results: The average in hospital stay was 20 +/- 11 days with an average of 11.9 training sessions per patient. The average distance walked at 6MWT(1) and 6MWT(2) was 193 +/- 116 and 278 +/- 122 m, respectively (p <0.001). The average score of RMI1 and RMI2 was 8.5 +/- 3.4 and 13.1 +/- 2.9, respectively (p <0.001). The values of 6MWT(1) and RMI(1) results were significantly correlated (r = 0.56, p <0.001). The RMI IM was significantly correlated to 6MWT IM (r = 0.309, p = 0.002). At multivariate analysis, RMI IM was found to be predictive of 6MWT IM even after correction for age, gender, length of hospitalization and number of sessions of training., Conclusions: In octogenarians, cardiac rehabilitation results in a significant improvement of both RMI and 6MWT. RMI IM is independently correlated to 6MWT IM. Therefore, RMI could be a useful tool for evaluating the improvement of functional capacity even in patients who cannot undergo 6MWT.

Background: Car driving is one of the most perceived problems by patients after cardiac surgery. The aim of this study was to evaluate the influence of cardiac surgery and median sternotomy on driving performance after a cardiac rehabilitation program., Methods: Seventy-four consecutive patients, usual car drivers, admitted to our Cardiac Rehabilitation Center after cardiac surgery, were evaluated 60 days from discharge using a five-item questionnaire. Questions were related to resume of car driving, problems related to car driving, and seatbelt wearing., Results: The analysis of the answers indicated that 36% of patients (62% females, 26% males; p = 0.01) stopped car driving after cardiac surgery, owing to the lack of security or fear of either the patients or their relatives. Sixty-four patients continued to drive, however 39% of them reported problems related to driving (irritation, poor concentration, fear, parking maneuvers). Because of persistent post-surgical chest pain, 15% of patients avoided wearing seatbelts, and 7% asked for exclusion following unconventional procedures., Conclusions: After cardiac surgery, 1 out of 3 patients stops car driving, particularly among female gender; 1 out of 7 patients is seatbelt no wearers and about half of them claim for exemption following procedures not codified. Thus, common rules and recommendations from Scientific Societies are highly warranted.