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Gianfranco Piccirillo,1 Federica Moscucci,1 Matteo Pascucci,1 Maria Antonella Pappadà,1 Gaetana D’Alessandro,1 Pietro Rossi,2 Raffaele Quaglione,1 Daniele Di Barba,1 Francesco Barillà,1 Damiano Magrì3 1Department of Cardiovascular, Respiratory, Nephrological and Geriatric Sciences, Policlinico Umberto I, “Sapienza” University of Rome, Rome, Italy; 2Division of Cardiology, S. Giovanni Calabita Fatebenefratelli Hospital, Rome, Italy; 3Department of Clinical and Molecular Medicine, Sant’Andrea Hospital, “Sapienza” University of Rome, Rome, Italy Background and purpose: QT and Tpeak-Tend (Te) intervals are associated with sudden cardiac death in patients with chronic heart failure (CHF). We studied age-dependent influence on short-term temporal dispersion of these two variables in patients with postischemic CHF. Method: We grouped 75 CHF and 53 healthy control subjects into three age subsets: ≤50 years, >50 years and ≤65 years, and >65 years. We then calculated the following indices: QT and Te variability index (QTVI and TeVI), the ratio between the short-term variability (STV) of QT or Te, and the STV of resting rate (RR) (QT/RR STV and Te/RR STV). Results: In all different age subgroups, patients with CHF showed a higher level of QTVI than age-matched control subjects (≤50 years: P < 0.0001; >50 years and ≤65 years: P < 0.05; >65 years: P

Background: In congestive heart failure (CHF), autonomic nervous system (ANS) activity is known to modulate arrhythmic risk through its effects on myocardial repolarization. An increased interval between the peak and the end of the T wave (T(peak)-T(end)) has been reported to increase the incidence of sudden cardiac death. However, the ANS influence on the T(peak)-T(end) interval remains unclear.Objective: We directly measured ANS nerve activity in ambulatory dogs with pacing-induced CHF to test the hypothesis that ANS activity modulates the T(peak)-T(end) variability index (T(peak)-T(end)VI), the short-term variability of the T(peak)-T(end) interval obtained on 30 beats (T(peak)-T(end)STV(30)), and the short-term variability of the T(peak)-T(end) interval obtained on 5-minute ECG recording (T(peak)-T(end)STV(T)).Methods: By using data previously recorded in 6 ambulatory dogs before and after pacing-induced CHF, we assessed ANS activity recorded with an implanted radiotransmitter that monitored integrated left stellate ganglion nervous activity (iSGNA), integrated vagus nerve activity (iVNA), and electrocardiogram (ECG). We selected for analysis 36 segments recorded at baseline and 36 after pacing-induced CHF with similar iSGNA.Results: During CHF, T(peak)-T(end)STV(30) (P<.001) and T(peak)-T(end)STV(T) (P<.05) were significantly higher than those at baseline. The multiple linear mixed regression analysis disclosed a significant positive correlation between iSGNA and T(peak)-T(end)STV(T) (baseline: β 2.92, P<.001; CHF: β 1.13, P<.001) and a significant negative correlation between iVNA and T(peak)-T(end)STV(T) (baseline: β-6.74, P<.001; CHF: β-1.42, P< .001).Conclusions: In a canine model of pacing-induced CHF, iSGNA correlates positively while iVNA correlates negatively with T(peak)-T(end)STV(T). These findings suggest that SGNA increases while VNA decreases the dispersion of ventricular repolarization in ambulatory dogs with CHF. [ABSTRACT FROM AUTHOR]

Background: To date, the comprehensive geriatric assessment (CGA) does not include an evaluation tool for handicap., Aim: To develop a new instrument for assessing handicap in the elderly: the Geriatric Handicap Scale (GHS)., Methods: 656 community-dwelling elderly were enrolled in this study. We identified the thematic areas investigated by the CGA which showed a significant correlation with the handicap condition (handicap yes/not) to be included in our scale (Phase 1). Afterwards, we evaluated the possible correlations between: (1) the score obtained in each area of GHS and those obtained in CGA tests investigating similar dimensions, (2) GHS total score and the Multidimensional Prognostic Index (MPI) total score (Phase 2)., Results: In Phase 1, data analysis showed several significant correlations between the handicap condition and the scores obtained to the CGA tests exploring cognition, mood, functional impairment, comorbidity, social and environmental variables. Thus, we developed a tool considering five variables: (1) cognition and mood; (2) functional impairment; (3) hearing/visual impairment; (4) any additional comorbidity factors; (5) environmental/social risk factors. In Phase 2, data analysis showed significant correlations between the score obtained in each area of GHS and those obtained in the CGA tests investigating similar dimensions. A positive correlation between GHS total score and MPI total score (r = 68; p = 0.001) was also reported. Cut-off score for the GHS was established. Psychometric properties of GHS were also investigated and adequate estimates of internal reliability were demonstrated., Conclusions: Our tool could prove useful to correctly categorize the disadvantageous condition related to patient's disability.

Sudden cardiac death is the main cause of mortality in patients affected by chronic heart failure (CHF) and with history of myocardial infarction. No study yet investigated the intra-QT phase spectral coherence as a possible tool in stratifying the arrhythmic susceptibility in patients at risk of sudden cardiac death (SCD). We, therefore, assessed possible difference in spectral coherence between the ECG segment extending from the q wave to the T wave peak (QTp) and the one from T wave peak to the T wave end (Te) between patients with and without Holter ECG-documented sustained ventricular tachycardia (VT). None of the QT variability indexes as well as most of the coherences and RR power spectral variables significantly differed between the two groups except for the QTp-Te spectral coherence. The latter was significantly lower in patients with sustained VT than in those without (0.508 ± 0.150 versus 0.607 ± 0.150, P < 0.05). Although the responsible mechanism remains conjectural, the QTp-Te spectral coherence holds promise as a noninvasive marker predicting malignant ventricular arrhythmias.