Ruolo del test da sforzo cardiopolmonare nei pazienti affetti da cardiomiopatia ipertrofica in età pediatrica

Background Decreased exercise capacity, and reduction in peak oxygen uptake are present in most patients affected by hypertrophic cardiomyopathy (HCM) . In addition an abnormal blood pressure response during a maximal exercise test was seen to be associated with high risk for sudden cardiac death in adult patients affected by HCM. Therefore exercise test (CPET) has become an important part of the evaluation of the HCM patients, but data on its role in patients with HCM in the pediatric age are quite limited. Methods and results Between 2004 and 2010, using CPET and echocardiography, we studied 68 children (mean age 13.9 ± 2 years) with HCM. The exercise test was completed by all the patients without adverse complications. The mean value of achieved VO2 max was 31.4 ± 8.3 mL/Kg/min which corresponded to 77.5 ± 16.9 % of predicted range. 51 patients (75%) reached a subnormal value of VO2max. On univariate analysis the achieved VO2 as percentage of predicted and the peak exercise systolic blood pressure (BP) Z score were inversely associated with max left ventricle (LV) wall thickness, with E/Ea ratio, and directly related with Ea and Sa wave velocities No association was found with the LV outflow tract gradient. During a mean follow up of 2.16 ± 1.7 years 9 patients reached the defined clinical end point of death, transplantation, implanted cardioverter defibrillator (ICD) shock, ICD implantation for secondary prevention or myectomy. Patients with peak VO2 < 52% or with peak systolic BP Z score < -5.8 had lower event free survival at follow up. Conclusions Exercise capacity is decreased in patients with HCM in pediatric age and global ventricular function seems being the most important determinant of exercise capacity in these patients. CPET seems to play an important role in prognostic stratification of children affected by HCM.

Cross-population radio galaxies as a test of the jet-accretion relationship

Radio galaxies (RGs) are extremely relevant in addressing important unknowns concerning the interaction among black hole accretion, radio jets, and the environment. In the classical scheme, their accretion rate and ejection of relativistic jets are directly linked: efficient accretion (HERG) is associated with powerful edge-brightened jets (FRIIs); inefficient accretion (LERG) is associated with weak edge-darkened jets (FRIs). The observation of RGs with an inefficient engine associated with edge-brightened radio emission (FRII-LERGs) broke this scheme. FRII-LERGs constitute a suitable population to explore how accretion and ejection are linked and evaluate the environment's role in shaping jets. To this aim, we performed a multiwavelength study of different RGs catalogs spanning from Jy to mJy flux densities. At first, we investigated the X-ray properties of a sample of 51 FRIIs belonging to the 3CR catalog at z<0.3. Two hypotheses were invoked to explain FRII-LERGs behavior: evolution from classical FRIIs; the role of the environment. Next, we explored the mJy sky by studying the optical-radio properties of hundreds of RGs at z<0.15 (Best & Heckman 2012 sample). FRII-LERGs appear more similar to the old FRI-LERGs than to the young FRII-HERGs. These results point towards an evolutive scenario, however, nuclear time scale changes, star population aging, and kpc-Mpc radio structure modification do not agree. The role of the Mpc environment was then investigated. The Wen et al. 2015 galaxy clusters sample, built exploiting the SDSS survey, allowed us to explore the habitat of 7219 RGs at z<0.3. Most RGs are found to live in outside clusters. For these sources, differences among RG classes are still present. Thus, the environment is not the key parameter, and the possibility of intrinsic differences was reconsidered: we speculated that different black hole properties (spin and magnetic field at its horizon) could determine the observed spread in jet luminosity.