Unlike the ascending aorta and aortic arch, there was no association between the descending aorta and APOE*E4. Potential reasons for this include the fact that the progression of atherosclerosis in the aorta is influenced by the flow dynamics and wall shear stress within the segments of the aorta. 4 For example, the higher ejection velocity in the ascending aorta might limit formation of plaques in this region. More importantly, the influence of age on atherosclerosis is very strong, with an incidence rising steadily with age. 5 Because patients undergoing cardiac surgery are increasingly elderly, the effect of APOE*E4 might be masked by the dominating influence of age on atherosclerosis, particularly in the descending aorta.Limitations to our study include the fact that our technique uses a 2-dimensional, rather than 3-dimensional, image of a specific aortic segment. Nevertheless, the percentage of atheroma method that we used does at least account for total plaque area that can be visualized. Finally, epiaortic imaging is a more sensitive measure of assessing plaque in the ascending aorta, and it is possible that a greater degree of atherosclerosis might have been detected, with its use potentially improving the link between atheroma burden and the APOE*E4 allele.

The increasing use of ventricular assist devices (VADs) in terminal heart failure patients provides new challenges to cardiac rehabilitation physicians. Structured cardiac rehabilitation strategies are still poorly implemented for this special patient group. Clear guidance and more evidence for optimal modalities are needed. Thereby, attention has to be paid to specific aspects, such as psychological and social support and education (e.g., device management, INR self-management, drive-line care, and medication).In Germany, the post-implant treatment and rehabilitation of VAD Patients working group was founded in 2012. This working group has developed clear recommendations for the rehabilitation of VAD patients according to the available literature. All facets of VAD patients' rehabilitation are covered. The present paper is unique in Europe and represents a milestone to overcome the heterogeneity of VAD patient rehabilitation.

Background: Although cardiovascular rehabilitation (CR) is well accepted in general, CR-attendance and delivery still considerably vary between the European countries. Moreover, clinical and prognostic effects of CR are not well established for a variety of cardiovascular diseases. Methods: The guidelines address all aspects of CR including indications, contents and delivery. By processing the guidelines, every step was externally supervised and moderated by independent members of the “Association of the Scientific Medical Societies in Germany” (AWMF). Four meta-analyses were performed to evaluate the prognostic effect of CR after acute coronary syndrome (ACS), after coronary bypass grafting (CABG), in patients with severe chronic systolic heart failure (HFrEF), and to define the effect of psychological interventions during CR. All other indications for CR-delivery were based on a predefined semi-structured literature search and recommendations were established by a formal consenting process including all medical societies involved in guideline generation. Results: Multidisciplinary CR is associated with a significant reduction in all-cause mortality in patients after ACS and after CABG, whereas HFrEF-patients (left ventricular ejection fraction <40%) especially benefit in terms of exercise capacity and health-related quality of life. Patients with other cardiovascular diseases also benefit from CR-participation, but the scientific evidence is less clear. There is increasing evidence that the beneficial effect of CR strongly depends on “treatment intensity” including medical supervision, treatment of cardiovascular risk factors, information and education, and a minimum of individually adapted exercise volume. Additional psychologic interventions should be performed on the basis of individual needs. Conclusions: These guidelines reinforce the substantial benefit of CR in specific clinical indications, but also describe remaining deficits in CR-delivery in clinical practice as well as in CR-science with respect to methodology and presentation.

The prevalence of skeletal muscle deconditioning, physical limitations, and frailty in elderly entering cardiac rehabilitation is high. Efficacy and safety of resistance training (RT) in this cohort is insufficiently studied. Individually tailored exercise concepts including RT are needed. The assessment of frailty and physical performance should be emphasized.