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Introduction Cardiac rehabilitation (CR) is an effective tool for secondary prevention after acute coronary syndrome (ACS). Aim Aim of our study was to find the significant determinants of exercise capacity (evaluated with the six-minute walking test—6-MWT) and functional improvement in patients undergoing CR after an ACS. Methods The study group included 298 patients (mean age 61.6 ± 10.2 years; males 80.2%) who, after ACS, were enrolled in CR program at Niguarda Hospital in Milan from 2015 to 2018. For all patients, we collected anamnestic, clinical and instrumental cardiological data. All patients performed a 6-MWT at the beginning (6-MWT-1) and at the end (6-MWT-2) of CR program. Δ meters were used to represent functional improvement. Results Multiple linear regression models were carried out for 6-MWT-1, 6-MWT-2, Δ meters and % Δ meters. Standardized regression coefficients showed that age (β = − 0.237; p < 0.001), BMI (β = − 0.116; p = 0.006) and heart rate (β = − 0.082; p = 0.040) were determinants of exercise capacity (6MWT-1 and 2), whereas age (β = −.231; p = 0.004), sex (β = − 0.187; p = 0.008) and BMI (β = − 0.164; p = 0.022) were determinants of functional improvement (Δ meters). Conclusions Our data showed that functional improvement after CR in ACS patients is mainly related to non-cardiological variables. Instead it is related to intrinsic factors, both modifiable (BMI) and non-modifiable (age, sex). Supplementary Information The online version contains supplementary material available at 10.1007/s40292-021-00473-7.

BACKGROUND In multiethnic societies, it has frequently and repeatedly been shown that some minority groups have higher rates of traditional coronary artery disease (CAD) risk factors, different rates of treatment with revascularization procedures, and excess morbidity and mortality from CAD when compared with the white population. In the last two decades, Italy is becoming a diverse society with more than five millions of inhabitants from minority ethnic groups: for this reason, we decided to investigate whether ethnic differences in our metropolitan area are similar compared with the experience of Western countries. METHODS AND RESULTS We performed a retrospective cohort study of 1285 patients with acute coronary syndromes (ACS) hospitalized at Intensive Cardiac Care Unit (ICCU), Heart Center of ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy between 2014 and the end of 2019. Six percent of these patients were South-Asian, North-African, and South-American. Despite the younger age of nonwhite patients, their comorbid conditions and traditional cardiovascular risk factors showed peculiar differences. We did not observe any difference in terms of the number of coronary arteries involved at the enrollment, patients candidate to coronary artery bypass graft and either intra-hospital or at follow-up mortality. Nevertheless, the rate of re-infarction at follow-up was significantly higher in the nonwhite group. CONCLUSION We believe that a better knowledge and understanding of epidemiological changes in Italian society could improve our clinical practice, in particular, in order to better customize treatments and therapies.

Objective The role of resting Heart Rate on the progression of arterial stiffness has not yet been extensively evaluated. The aim of this study is to investigate the relationship between resting HR and baseline arterial stiffness (evaluated by cfPWV) as well as its progression in a population of hypertensive patients over a 3.7 years follow–up period. Methods We enrolled 572 hypertensive outpatients 18–80 aged, followed by the Hypertension Unit of St. Gerardo Hospital (Monza, Italy). Anamnestic, clinical and laboratory data, BP and cfPWV (complior) were assessed at baseline and after a median follow–up time of 3.7 ± 0.5 years. Results At baseline the mean age was 53.9 ± 12.7 years, SBP and DBP were 141.2 ± 17.8 and 86.5 ± 10.5 mmHg, HR was 65.6 ± 10.9 bpm and PWV was 8.6 ± 2.0 m/s. Despite an improvement in BP values (from 141.2/86.5 to 132.6/79.2 mmHg, p Conclusions In hypertensive patients there is a significant relationship between basal resting HR and basal PWV as well as between the increase of HR and the increase of PWV during the follow–up period. Beyond age and BP, resting HR must be considered as an independent determinant of arterial stiffness. This represents a possible mechanism through which HR contributes to the increase in CV risk.

SARS-CoV-2 infection determines a disease that predominantly affects lungs. However the cytokines storms, determined by the huge immune response to the infection, could affect also other organs and apparatus such as heart and vessels. Beyond the acute inflammation itself also hypercoagulative status has been linked to SARSCoV-2 infection and this surely relates to the increase seen in prevalence of pulmonary embolism and myocardial infarction. A number of cardiac abnormalities and pathologies have been observed, with special attention to cardiac arrhythmias and myocardial involvement. Furthermore, indirect damages determined by the reduction in acute and chronic cardiovascular care, results in a strong mortality and morbidity outcomes in cardiological patients. In this review we will summarise current knowledge on both direct and indirect cardiovascular damages determined by the SARS-CoV-2 pandemia.

Background The role of resting Heart Rate on the progression of arterial stiffness has not yet been extensively evaluated. The aim of this study is to investigate the relationship between resting HR and baseline arterial stiffness (evaluated by cfPWV) as well as its progression in a population of hypertensive patients over a 3.7 years follow-up period. Methods We enrolled 572 hypertensive outpatients 18–80 aged, followed by one hospital in Northern Italy. Anamnestic, clinical and laboratory data, BP and cfPWV were assessed at baseline and after a median follow-up time of 3.7±0.5 years Results At baseline the mean age was 53.9±12.7 years, SBP and DBP were 141.2±17.8 and 86.5±10.5 mmHg, HR was 65.6±10.9 bpm and PWV was 8.6±2.0 m/s. Despite an improvement in BP values (from 141.2/86.5 to 132.6/79.2 mmHg, p Conclusions in hypertensive patients there is a significant relationship between basal resting HR and basal PWV as well as between the increase of HR and the increase of PWV during the follow-up period. Beyond age and BP, resting HR must be considered as an independent determinant of arterial stiffness. This represents a possible mechanism through which HR contributes to the increase in CV risk. Funding Acknowledgement Type of funding sources: Public hospital(s). Main funding source(s): Niguarda Hospital, Milan, Italy

Uric acid (UA) is the final product of the catabolism of endogenous and exogenous purine nucleotides. While its association with articular gout and kidney disease has been known for a long time, new data have demonstrated that UA is also related to cardiovascular (CV) diseases. UA has been identified as a significant determinant of many different outcomes, such as all-cause and CV mortality, and also of CV events (mainly Acute Coronary Syndromes (ACS) and even strokes). Furthermore, UA has been related to the development of Heart Failure, and to a higher mortality in decompensated patients, as well as to the onset of atrial fibrillation. After a brief introduction on the general role of UA in CV disorders, this review will be focused on UA’s relationship with CV outcomes, as well as on the specific features of patients with ACS and Chronic Coronary Syndrome. Finally, two issues which remain open will be discussed: the first is about the identification of a CV UA cut-off value, while the second concerns the possibility that the pharmacological reduction of UA is able to lower the incidence of CV events.

Background Heterogeneous results have been obtained regarding the presence of Target Organe Damage (TOD) in subjects with high-normal Blood Pressure (BP) value (sistoly 130–139, diastolic 85–89 mmHg). Purpose Aim of our study was to assess the prevalence of TOD in healthy subjects with high-normal BP comparing them with subjects with BP values that are considered normal ( Methods 755 otherwise healthy subjects participated at the present analysis. TOD was evaluated as Pulse Wave Velocity (PWV), Left Ventricular Mass Index (LVMI) and carotid Intima-Media Thickness (IMT) and plaque. Results When subjects were classified according to BP levels we found that high-normal BP group showed intermediate values of PWV and LMVI with higher value of IMT. This corresponds to intermediate prevalence of arterial stiffness (PWV>10 m/s: 3.4% vs 2.3% for normal and 9.6% for high BP groups, p=0.0014), Left Ventricular Hypertrophy – LVH (32.4% vs 25.7% for normal and 46.6% for high BP groups, p=0.0001) while there were no differences for IMT>0.9 or carotid plaque. At multivariable analysis the odds of having a PWV>10 m/s (OR=1.75, 95% C.I. 0.59–5.16), an IMT>0.9 mm (OR=1.81, 95% C.I. 0.60–5.00) or a LVH (OR=1.1, 95% C.I. 0.72–1.67) in the high-normal group resulted not different to the normal group. Conclusions In our otherwise healthy population, high-normal BP values were not related to aortic, carotid or cardiac TOD. Funding Acknowledgement Type of funding sources: None.