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Biomedical subjects

F Cobelli

Publications and source records attributed to F Cobelli.

At least 91 records · Page 5Linked to original sources
PubMed1984

Is old age a contraindication to cardiac rehabilitation after acute myocardial infarction?

Fifty male patients older than 65 years of age (mean 66.3) underwent a symptom-limited exercise test on an average of 34 days after acute myocardial infarction. After 4 weeks of supervised rehabilitation training and after one-year follow-up, the patients underwent controlled exercise tests. The ergometric parameters were compared with respective values in 10 healthy males (mean age 66.4, range 65-75). The rehabilitation training induced a substantial improvement in physical capacity (total work from 3149 +/- 1326 to 4791 +/- 1403 kg; P less than 0.001) with a better cardiovascular response: increased maximum oxygen pulse (from 8.97 +/- 2 to 10.7 +/- 2; P less than 0.001), decreased heart rate (from 120.5 +/- 16.1 to 111.3 +/- 14.7 beats min-1; P less than 0.05) and a decreased double product at a 75 W work load (from 22 866 +/- 4005 to 20 472 +/- 3982 beats min-1 mmHg; P less than 0.05). The recovery of physical capacity and cardiovascular tolerance in the physical exercise was nearly complete as compared with healthy subjects of the same age. During the training period one patient died from heart failure. In all the other patients the same improvement was still maintained one-year later. In conclusion, old age does not seem to be per se a contraindication to cardiac rehabilitation. Physiological beneficial effects from cardiac rehabilitation can also be received by patients older than 65 years of age.

Age Factors↗
PubMed1984

Incidence and prognostic significance of symptomatic and asymptomatic exercise-induced ischemia in patients with recent myocardial infarction.

To determine the incidence and the significance of anginal chest pain during abnormal exercise testing (S-T greater than or equal to 0.1 mV) in patients with recent myocardial infarction we reviewed a series of 353 patients who underwent maximal bicycle exercise stress 4-8 weeks following acute myocardial infarction. Of the 353 patients, 26 had ischemic ECG changes and chest pain (group A); 85 patients had ischemic ECG changes but no chest pain (group B). The two groups differ significantly only in the frequency of a history of typical angina pectoris more than 6 months prior to acute myocardial infarction (group A 42.3% vs. group B 15.2%, p less than 0.01). Typical chest pain is more frequent in anterior versus inferior myocardial infarction (50 vs. 14.4%, p less than 0.001). The patients were followed up for 28.8 +/- 8.7 months with clinical and exercise testing controls. The incidence of exertional angina during the follow-up was significantly more frequent in group A patients than in group B patients (80.7 vs. 24.7%, p less than 0.001). Unstable angina pectoris was more frequent in group A (34.6 vs. 11.8%, p less than 0.01). There was no statistically significant difference in mortality (group A 3.8% vs. group B 5.9%) and cardiac events (group A 3.8% vs. group B 5.9%) between the two groups. Thus, we concluded that the occurrence of anginal pain associated with S-T segment depression during exercise testing does not increase the prognostic risk.

Adult↗
PubMed1984

Exertional hypotension after myocardial infarction.

A retrospective study was conducted on 488 patients admitted in our rehabilitation center after a recent acute myocardial infarction. Purpose of the study was to assess the incidence and prognostic value of exertional hypotension in these patients. Of 488 patients admitted to the study 33 (6%) were found to have exertional hypotension; 14 patients had an inferior myocardial infarction, 18 patients had an anterior myocardial infarction, 3 patients had a history of previous myocardial infarction. In the follow-up period (28.3 +/- 13.2 months) the worse prognosis (death or pulmonary oedema) was associated with the presence during exercise of hypotension, ST segment elevation in leads were Q waves were present and no ST depression in other leads. In conclusion, recent anterior myocardial infarctions associated with hypotension and ST segment elevation during exercise appear to be at risk for future cardiac events.

Exercise Test↗
PubMed1984

[Left ventricular aneurysm in recent myocardial infarction. Echocardiographic study].

UNLABELLED: Detection of post-infarction left ventricular aneurysm may have important clinical and therapeutic consequences. Differences in selection and in diagnostic criteria account for the wide range of incidence of left ventricular aneurysm in angiographic and autopsy series. To assess the incidence and related pathological features of ventricular aneurysm, 410 consecutive patients were studied by two-dimensional echocardiography 3 to 8 weeks after the onset of an acute myocardial infarction. In 395 patients (96.3%) technically adequate echograms were obtained: 42 patients (10.6%) had evidence of left ventricular aneurysm defined as a well demarcated bulge in diastole and in systole with a thinned, a-diskinetic walls. The incidence rate of left ventricular aneurysm was 17% in 188 anterior myocardial infarctions, 1.9% in 157 inferior ones, 25.9% in 27 anterior plus inferior infarctions; ventricular aneurysms were not found in any of 15 lateral and 8 posterior myocardial infarctions. Aneurysms were apical or apical-anterior in 25 patients (59.5%), apical-septal in 8 (19%), apical-diaphragmatic in 3 (7.1%), apical-septal-diaphragmatic in 3 (7.1%) and postero-basal in 3 (7.1%). Intraaneurysmal thrombi were detected in 24 patients (57.1%). In 12 cases echograms showed pericardial effusion; this was more frequent (28.6%) than in patients without an aneurysm (7.9%; p less than 0.001). Among patients with an aneurysm, heart failure was present in 19 (45.2%), mitral regurgitation in 3 (7.1%), of systemic emboly in 4 (9.5%), severe ventricular arrhythmias in 4 (9.5%) and angina in 5 (11.9%). IN CONCLUSION: left ventricular aneurysm is a frequent early complication of myocardial infarction. Two-dimensional echocardiography provides non-invasive direct information on localization, extent and related pathological features of ventricular aneurysm and thus appears to be a useful screening technique.

Adult↗
PubMed1984

[History of pre-existing angina and post-infarct myocardial ischemia (symptomatic and asymptomatic)].

353 patients enrolled in a cardiac rehabilitation program underwent a bicycle-ergometric test 28-60 days after an acute myocardial infarction. Twenty-nine patients (8.2%) had a previous history of chronic angina pectoris (more than 6 months before an acute myocardial infarction): 3 of these subjects did not develop myocardial ischemia after infarction; 26 (89.6%) (Group A) had an ischemic response on effort with horizontal or downsloping S-T segment depression of 2 mV. Ninety-four of 324 Patients without history of chronic angina pectoris had an ischemic response at exercise test (Group B) (p less than 0.001). In Group A the association of ischemic electrocardiographic changes and pain during the test was more frequent than in Group B (42.3% vs. 16%) p less than 0.01). During rehabilitation and follow up period (27.2 +/- 14 months) we observed that only 11.5% of Group A Patients remained symptomatic compared to 69.1% Group B Patients (p less than 0.001). In conclusion, a history of chronic pre-infarction angina pectoris appears to be a predictor of symptomatic ischemia after myocardial infarction.

Adult↗
PubMed1983

Short-term reproducibility of ergometric parameters in functional stress test after recent myocardial infarction.

In order to assess the short-term reproducibility of the most important ergometric parameters, 108 males (mean age 50.3 +/- 7.8 years) underwent a functional stress test (FST) on average 35 days after myocardial infarction. The exercise test was repeated 3 days later in the same conditions. Patients were fasting and in pharmacological washout. The following parameters were analyzed: total work performed (TWP), VO2, heart rate (HR), systolic blood pressure (SBP), arrhythmias and S-T segment depression and elevation. TWP and VO2 values did not show any significant difference during the two tests under the various workloads. HR and SBP responses proved to be well reproducible in patients with HR and SBP not exceeding the mean values obtained from 222 normal subjects who underwent the same exercise test by more than +/- 1 SD; reproducibility was significantly lower in the other patients, particularly in patients with HR and SBP exceeding normal values by more than +/- 1 SD. Therefore, in this case, further FST are necessary to obtain more reliable parameters to decide on individual pharmacological and exercise prescriptions. Arrhythmias were reproducible up to 67% (p less than 0.01) regardless of Lown's class and the presence of S-T segment depression or elevation. S-T segment depression or elevation was reproducible up to 100%.

Adult↗
PubMed1983

[Hypotensive response to the exercise test after recent myocardial infarct: prognostic implications].

The incidence and the prognostic value of exertional hypotension was studied in 488 consecutive patients admitted to the Montescano Rehabilitation Center after acute myocardial infarction. During a symptom-limited bicycle ergometric test performed 28 to 60 days after acute myocardial infarction 33 patients (6.8%) showed exertional hypotension. These patients were grouped according to effort S-T segment modifications: Group A (n = 13) with S-T segment depression in ECG-leads without Q waves; Group B (n = 11) with S-T segment elevation in leads where Q waves were present; Group C (n = 9) with no exercise S-T changes. Group B patients had a larger infarct size by ECG criteria and a lower maximal work capacity at the functional stress test. The follow-up of the patients after discharge was 28.3 +/- 13.2 months. During rehabilitation and follow-up, 2 patients of Group B died and 5 suffered an acute pulmonary oedema; 3 patients of Group A and 1 of Group B had angina at rest. Group C patients had no complications. Thus, exertional hypotension and S-T elevation appear to be predictive of future cardiac event.

Exercise Test↗
PubMed1983

[Ergospirometric evaluation of 53 physical exercises used in cardiological rehabilitation].

Fifty-three calisthenics used in a cardiac rehabilitation program were evaluated in a group of patients who, 30-60 days after myocardial infarction, had undergone a multistage symptom-limited bicycle exercise test without S-T segment modifications or arrhythmias. The following measurements were made oxygen uptake (VO2), oxygen uptake/Kg (VO2/Kg), ventilation/m' (VE), heart rate/m' (HR), systolic blood pressure (sBP) and METS. A good correlation was observed during the physical exercises between HR and VO2 (r = 0.59; p less than 0.001) and between HR and VO2/Kg (r = 0.64; p less than 0.001). Such correlation was similar to that observed during bicycle ergometric test. Lower values were obtained for the correlations between sBP and both VO2 and VO2/Kg, but they were still statistically significant (p less than 0.001). Heart rate and sBP were lower during calisthenics than during bicycle exercise from a VO2 level of 600-800 ml up. It is therefore possible to tailor a safe training program based on calisthenics whose level of energy expenditure is known: HRxsBP reached during such physical exercises will be lower than during bicycle ergometric test, VO2 being equal.

Adult↗
PubMed1981

Tachycardia-dependent and bradycardia-dependent intraventricular conduction defects in acute myocardial infarction: electrocardiographic, electrophysiologic, and clinical correlates.

Presence of rate-dependent (RD) intraventricular conduction defects (IVCD) was documented by inducing variations in heart rate in 30 acute myocardial infarction (AMI) patients (10 right bundle branch block, six left bundle branch block, 13 left anterior hemiblocks, and two left posterior hemiblocks). Five IVCDs were tachycardia-dependent (TD), 20 were bradycardia-dependent (BD), and six were both TD and BD. In TD blocks shortest cycles showing normal intraventricular conduction ranged from 410 to 1330 msec (697 +/- 84 SE); in BD blocks longest cycles with normal intraventricular conduction ranged from 450 to 1450 msec (962 +/- 52). In 60% of cases intermittent incomplete RD blocks were also present. In one patients RD-IVCD intermittency remained until discharge; in the others it lasted from 4 minutes to 10 days. Afterwards 19 RD-IVCDs disappeared and four became stable; six patients died during RD-IVCD intermittency period. Disappearance of RD block was preceded by gradual reduction in cycle length showing TD block and lengthening of cycles stopped beats with BD block. Serial observation of RD-IVCDs provides information about sequence of electrophysiologic effects on the intraventricular conduction system in clinical AMI.

Acute Disease↗
PubMed1981

[Evolution of psychological pattern during rehabilitation in a group of patients with recent myocardial infarction (author's transl)].

The aim of this study was to verify the evolution of the psychological characteristics of a group of patients with recent myocardial infarction, during a supervised physical training procedure. The study group consisted of 70 males, aged from 35 to 65 (mean 50 +/- 9). Every patient underwent a psychometric test battery before and after his rehabilitation program. The following tests were used: - Minnesota Multiphasic Personality Inventory - 16 Personality Factors Inventory - IPAT Anxiety Scale - Eysenck Personality Inventory. No patient had psychotherapic nor pharmacological treatment. Comparing the test results before and after training, a significant reduction of deviances from normal patterns was found. A clear trend towards normal values of both high and low scores was found after rehabilitation. Our data are in agreement with the concept that a supervised physical training program is able to promote psychological benefits in patients with recent myocardial infarction. These benefits can be summarized both in stronger emotional stability and in better adaptative capability. This makes their return to normal life easier.

Adult↗
PubMed1980

[Results of rehabilitation after myocardial infarction in patients more than 60 years of age].

The results of the same rehabilitation protocol are compared in two groups of patients with recent transmural myocardial infarction. The first group consists of 63 males, aged from 40 to 49 (mean 44.5); the second one of 63 males, aged from 60 to 74 (mean 64.7). The age is the only difference between the groups. The training does increase the mean value of the Total Work Performed from 5126 +/- 2201 to 7505 +/- 2455 Kgm (p < 0.001) in the young patients and from 3340 +/- 1414 to 4793 +/- 1598 Kgm (p < 0.001) in the old ones. The amount of increase is 46.4 and 43.5 per cent, respectively. The Heart Rate at fixed level of 75 W decreases from 125 +/- 2 to 119 +/- 1.6 beats per minute (p < 0.001) in the young group and from 119.2 +/- 2.2 to 111.3 +/- 2.2 (p < 0.001) in the old group of patients. The O2 Pulse at 75 W increaes from 8.8 +/- 0.2 to 9.7 +/- 0.25 cc per beat (p < 0.001) in the young subjects and from 9.4 +/- 0.4 to 10.3 +/- 0.4 (p < 0.001) in the old ones. The Double Product at 75 W decreases from 23.6 +/- 0.7 (X 10(3)) to 21.4 +/- 0.5 (p < 0.001) in the young patients and from 24.4 +/- 0.8 to 21.6 +/- 0.7 (p < 0.001) in the old ones. A control performed in 26 subjects of both groups 1 year later, shows a good persistance of the training effect as in young as in old patients. The AA. come to conclusions that: a) The age does not represent a limiting factor for the indication to the rehabilitation after a myocardial infarction; b) the rehabilitation can provide similar results in young and in old patients and the achieved benefits can be similarly maintained; c) the risk of any complication during training is higher in old than in young patients. It compels us to a careful choice of patients and control of the rehabilitation procedure.

Adult↗