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Bruno Bordoni,1 Luca Mapelli,1 Anastasia Toccafondi,1 Francesca Di Salvo,1 Gianmarco Cannadoro,1 Matteo Gonella,1 Allan R Escher,2 Nuccia Morici1 1Dipartimento di Cardiologia, Fondazione Don Carlo Gnocchi IRCCS, Istituto di Ricovero e Cura, S Maria Nascente, Milano, 20100, Italy; 2Department of Anesthesiology/Pain Medicine, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, 33612, USACorrespondence: Bruno Bordoni, Email bordonibruno@hotmail.comAbstract: Myocardial infarction (MI) is one of the leading causes of death worldwide. There can be many reasons that cause MI, such as a sedentary lifestyle, a disordered diet, harmful habits such as smoking and alcoholism, concomitant congenital or acquired systemic pathologies. Patients who survive the acute event suffer a functional alteration of multiple body systems. The various cardiology associations recommend starting a rehabilitation process, pursuing the main objective of improving the patient’s health status. A negative consequence that can be linked to MI is the dysfunction of the main breathing muscle, the diaphragm. The diaphragm is essential not only for respiratory mechanisms but also for adequate production of cardiac pressures. Post-MI patients present a reduction in the performance of the diaphragm muscle, and this condition can become a risk factor for further relapses or for the onset of heart failure. The article reviews the rehabilitation path for post-MI patients, to highlight the absence given to the diaphragm in the recovery of the patient’s health status. The text reviews the post-MI diaphragmatic adaptation to highlight the importance of including targeted training for the diaphragm muscle in the rehabilitation process.Keywords: myocardial infarction, diaphragm, cardiovascular disease, breathing, physiotherapy, cardiac rehabilitation

Miriam Stucchi,1 Silvia Cantoni,2 Enrico Piccinelli,3 Stefano Savonitto,4 Nuccia Morici5,6 1Division of Cardiology, ASST Vimercate, Italy; 2Division of Hematology, ASST Grande Ospedale Metropolitano Niguarda Ca’ Granda, Milano, Italy; 3Health Science Department, Milano-Bicocca University, Milano, Italy; 4Division of Cardiology, A. Manzoni Hospital, Lecco, Italy; 5De Gasperis Cardio Center, ASST Grande Ospedale Metropolitano Niguarda Ca’ Granda, Milano, Italy; 6Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milano, Italy Abstract: Reference hemoglobin (Hb) values for the definition of anemia are still largely based on the 1968 WHO Scientific Group report, which established a cutoff value of

Heart failure (HF) constitutes a growing public health problem in aging societies: when pharmacological therapies fail, HF can be sustained intensively if patients are eligible for either orthotopic heart transplantation (OHT) or mechanical ventricular assistance, otherwise additional treatments could be inappropriate. In December 2017 Italian Legislator brought in the provisions regarding the end-of-life choices, including indications for withdrawing and withholding life-sustaining therapies. The aim of our study was to provide an overview of the daily practice of our center with regard to terminally ill HF patients. In April 2019 the 7 intensivist cardiologists and 21 nurses of a tertiary ICCU were asked in, to complete a questionnaire relating to a hypothetical terminally ill HF patient for whom the decision to withdraw active treatment had been made. To assess current practice, we also identified patients who died in the previous 12 months. Out of 29 deceased patients, 18 were identified as terminally ill HF, with no indications for therapy upgrading. We observed a striking disparity between belief and practice. Our survey showed that the care of terminally ill HF patients in our ICCU was characterized by aggressive use of medical therapy and invasive technology. The wide disparity between belief and practice could be in part a consequence of lack of professional training, with regard to law, ethics and communication techniques. • In Italy health professionals lack of adequate training in ethics and bioethics • HF constitutes a growing public health problem in aging societies • There are scant data about terminally ill HF patients in Intensive Cardiac Care Unit [ABSTRACT FROM AUTHOR]

Abstract Background Psoriasis has been associated with a higher prevalence of cardiovascular disease risk factors. However, there is inadequate quantification on the association between psoriasis and acute coronary syndrome (ACS), particularly in the elderly. Therefore, the aim of the present study was to assess the risk of ACS according to history of psoriasis in subjects aged 75 years and older. Methods We carried out a case control study based on 1455 cases and 1108 controls. Cases were all the patients admitted in the randomized Elderly ACS 2 trial. Controls were selected from subjects aged ≥75 years included in the Prevalence of Actinic Keratoses in the Italian Population Study (PraKtis), based on a representative sample of the general Italian population. Odds ratios (OR) of ACS according to history of psoriasis were obtained using a multiple logistic regression model including terms for age, sex and smoking. Results The prevalence of psoriasis was lower among cases (12/1455, 0.8%) than among controls (18/1108, 1.6%). The multivariate OR of ACS according to history of psoriasis was 0.51 (95% confidence interval: 0.23–1.09). Conclusions Our data does not support an association between psoriasis and risk of ACS in the elderly. Highlights • Data on the association between psoriasis and ACS in the elderly are scanty. • In the Elderly ACS 2 trial information regarding psoriasis was prospectively collected. • Careful evaluation of psoriasis severity and treatment was performed. • In the present study psoriasis is not associated with ACS in patients aged 75 or older. • This observation has epidemiological and clinical implications. [ABSTRACT FROM AUTHOR]

Diabetes mellitus (DM) accounts for >25% of all percutaneous coronary interventions. In patients with DM, drug-eluting stent implantation is associated with a reduced risk of restenosis and target lesion revascularization. However, concern has been raised about the incidence of late and very late stent thrombosis and the increased mortality rate, mostly after thienopyridine withdrawal. We evaluated the long-term prognostic effect of thienopyridine discontinuation after drug-eluting stent implantation on the subsequent occurrence of stent thrombosis and all-cause death among a cohort of high-risk "de novo" diabetic patients. From May 2002 to December 2005, 542 consecutive patients with DM underwent drug-eluting stent implantation at 2 hospitals in Milan, Italy. For study purposes, only the 217 patients who had not previously undergone percutaneous or surgical revascularization were considered in the final analysis. The follow-up time was curtailed at 3.5 years. Detailed information about dual antiplatelet therapy (DAT) were collected for all patients included. Of the 217 patients, 15 died (6.9%); in 9 cases, the cause of death was cardiac (4.1%). The incidence of cumulative stent thrombosis was 4.6% (10 patients); 3 stent thromboses were early (1.38%), 5 late (2.3%), and only 2 were very late (0.9%). Of the 10 cases of stent thrombosis, 5 were definite and 5 were probable. Most (80%) of the stent thromboses occurred within the first 6 months during DAT. The median duration of DAT was 420 days (interquartile range 350 to 859). DAT discontinuation was the only independent predictor of the follow-up events (hazard ratio 20.42, 95% confidence interval 4.99 to 83.62). In conclusion, DM remains an independent adverse factor on clinical outcome. In this setting, prolonged DAT, even beyond that recommended in the guidelines, might be beneficial. [ABSTRACT FROM AUTHOR]