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Pagourelias ED, Kouidi E, Efthimiadis GK, Deligiannis A, Geleris P, Vassilikos V. Right Atrial and Ventricular Adaptations to Training in Male Caucasian Athletes: An Echocardiographic Study. J Am Soc Echocardiogr 2013; 26:1344-52. [DOI: 10.1016/j.echo.2013.07.019] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2012] [Indexed: 11/30/2022]
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Efthimiadis GK, Pagourelias ED, Parcharidou D, Gossios T, Kamperidis V, Theofilogiannakos EK, Pappa Z, Meditskou S, Hadjimiltiades S, Pliakos C, Karvounis H, Styliadis IH. Clinical characteristics and natural history of hypertrophic cardiomyopathy with midventricular obstruction. Circ J 2013; 77:2366-74. [PMID: 23728066 DOI: 10.1253/circj.cj-12-1561] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND The prevalence, clinical characteristics and natural history of patients with hypertrophic cardiomyopathy (HCM) and midventricular obstruction (MVO) have not been adequately studied. METHODS AND RESULTS A single-center cohort consisting of 423 patients (mean age, 49.3±17.2 years; 66.2% male) was thoroughly followed up for a median of 84 months (7 years; range, 6-480 months). MVO, characterized by the echocardiographic appearance of midventricular muscular apposition with a simultaneous mid-cavitary gradient ≥30mmHg, was identified in 34 patients (8%). Patients with MVO tended to be more symptomatic during their initial evaluation (>90% presented with NYHA class ≥II) compared to the rest of the HCM cohort. Apical aneurysm formation was identified in more than one-fourth of patients with MVO (26.5%), being a characteristic of the group. On multivariate Cox regression hazard analysis, presence of MVO strongly predicted progression to end-stage (burnt out) HCM and related heart failure (HF) deaths (hazard ratio, [HR], 2.62; 95% confidence interval [CI]: 1.2-8.8; P=0.047), as well as sudden death and associated lethal arrhythmic events (HR, 3.3; 95% CI: 1.26-8.85; P=0.016). CONCLUSIONS MVO is a distinct phenotype of HCM associated with unfavorable prognosis in terms of end-stage HCM, sudden death and lethal arrhythmic events. The high adverse outcome rate necessitates early recognition of MVO and appropriate therapeutic interventions.
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Efthimiadis GK, Theofilogiannakos EK, Gossios TD, Paraskevaidis S, Vassilikos VP, Styliadis IH. Hypertrophic cardiomyopathy associated with an anomalous origin of right coronary artery. Case report and review of the literature. Herz 2012; 38:427-30. [PMID: 23263245 DOI: 10.1007/s00059-012-3713-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2012] [Revised: 08/22/2012] [Accepted: 10/05/2012] [Indexed: 11/28/2022]
Abstract
We present a case of patient with hypertrophic cardiomyopathy and an anomalous right coronary artery with left main artery origin and an interarterial course. The coexistence of these two different entities is extremely rare but of major clinical significance because both are associated with an increased risk of sudden cardiac death. In addition, a review of the literature comprising 14 other cases with this combination is provided.
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Pagourelias ED, Efthimiadis GK, Kouidi E, Zorou P, Giannoglou G, Deligiannis A, Athyros VG, Karagiannis A, Geleris P. Efficacy of Various “Classic” Echocardiographic and Laboratory Indices in Distinguishing the “Gray Zone” between Athlete's Heart and Hypertrophic Cardiomyopathy: A Pilot Study. Echocardiography 2012; 30:131-9. [DOI: 10.1111/echo.12014] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Pagourelias ED, Efthimiadis GK, Kouidi E, Fragakis N, Athyros VG, Geleris P. Athlete's heart or hypertrophic cardiomyopathy: the dilemma is still there. Am J Cardiol 2011; 108:1841-2. [PMID: 22133136 DOI: 10.1016/j.amjcard.2011.09.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2011] [Revised: 09/13/2011] [Accepted: 09/14/2011] [Indexed: 02/07/2023]
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Pagourelias ED, Zorou PG, Tsaligopoulos M, Athyros VG, Karagiannis A, Efthimiadis GK. Carbon dioxide balneotherapy and cardiovascular disease. INTERNATIONAL JOURNAL OF BIOMETEOROLOGY 2011; 55:657-63. [PMID: 20967468 DOI: 10.1007/s00484-010-0380-7] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2010] [Revised: 09/26/2010] [Accepted: 10/02/2010] [Indexed: 05/24/2023]
Abstract
Carbon dioxide (CO(2)) balneotherapy is a kind of remedy with a wide spectrum of applications which have been used since the Middle Ages. However, its potential use as an adjuvant therapeutic option in patients with cardiovascular disease is not yet fully clarified. We performed a thorough review of MEDLINE Database, EMBASE, ISI WEB of Knowledge, COCHRANE database and sites funded by balneotherapy centers across Europe in order to recognize relevant studies and aggregate evidence supporting the use of CO(2) baths in various cardiovascular diseases. The three main effects of CO(2) hydrotherapy during whole body or partial immersion, including decline in core temperature, an increase in cutaneous blood flow, and an elevation of the score on thermal sensation, are analyzed on a pathophysiology basis. Additionally, the indications and contra-indications of the method are presented in an evidence-based way, while the need for new methodologically sufficient studies examining the use of CO(2) baths in other cardiovascular substrates is discussed.
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Efthimiadis GK, Parcharidou D, Pagourelias ED, Meditskou S, Spanos G, Hadjimiltiades S, Pliakos C, Gavrielides S, Karvounis H, Styliadis IH, Parcharidis GE. Prevalence and clinical outcomes of incidentally diagnosed hypertrophic cardiomyopathy. Am J Cardiol 2010; 105:1445-50. [PMID: 20451692 DOI: 10.1016/j.amjcard.2009.12.066] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2009] [Revised: 12/28/2009] [Accepted: 12/28/2009] [Indexed: 12/16/2022]
Abstract
The purpose of the present study was to evaluate the prevalence and prognosis of patients incidentally diagnosed with hypertrophic cardiomyopathy (HC). We studied 380 consecutive patients with HC (49.3 +/- 17.2 years; 65% men) for a median of 58 months (range 6 to 454). The patients were divided into 2 groups: those incidentally diagnosed from routine examination findings (precordial murmur and/or abnormal electrocardiographic findings) and those diagnosed either because of symptomatic status or by screening because of a family history of HC. Those patients who had been incidentally diagnosed constituted 29.2% of our study cohort. Although overall mortality did not differ between the 2 groups (p = 0.12), the patients diagnosed either because of symptoms or a family history tended to have at least a 4.5-fold greater risk of cardiovascular death (relative risk 4.5, 95% confidence interval 1.04 to 19.6, p = 0.04) and a 4.22 greater risk of sudden death (relative risk 4.22, 95% confidence interval 1.0 to 18.22, p = 0.04). Despite the greater sudden death mortality among the nonincidentally diagnosed patients, no statistically significant difference was found concerning the sudden death risk factor frequency (p = 0.96) between the 2 groups. In conclusion, the discrepancy between the low numbers of patients reported by published registries and the relatively high prevalence of the disease in the general population can be attributed to the large number of patients who remain asymptomatic, even throughout their life, awaiting an accidental diagnosis. Those patients with an incidental diagnosis have a more benign course, as shown by the total cardiovascular and composite sudden death mortality. A high level of awareness and suspicion for HC among physicians is essential for clinical recognition of such patients.
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Pagourelias ED, Efthimiadis GK, Parcharidou DG, Pliakos C, Styliadis IH. Prognostic implications of the Doppler restrictive filling pattern in hypertrophic cardiomyopathy. Am J Cardiol 2010; 105:1358. [PMID: 20403495 DOI: 10.1016/j.amjcard.2010.01.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2010] [Revised: 01/06/2010] [Accepted: 01/13/2010] [Indexed: 11/17/2022]
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Pagourelias ED, Giannoglou G, Kouidi E, Efthimiadis GK, Zorou P, Tziomalos K, Karagiannis A, Athyros VG, Geleris P, Mikhailidis DP. Brain natriuretic peptide and the athlete's heart: a pilot study. Int J Clin Pract 2010; 64:511-7. [PMID: 20456196 DOI: 10.1111/j.1742-1241.2009.02184.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND The role of brain natriuretic peptide (BNP) in differentiating the athlete's heart from maladaptive cardiac hypertrophy is unclear. METHODS To address this issue, an integrated M mode, two-dimensional B mode and Doppler echocardiographical study were performed and plasma BNP levels were measured in 25 strength athletes, 25 patients with established hypertrophic cardiomyopathy (HCM) and 25 healthy volunteers. RESULTS Among athletes, BNP levels correlated negatively with the total training time (r = -0.79, p = 0.002) and positively with ejection fraction (r = 0.58, p = 0.049) and fractional shortening (r = 0.57, p = 0.049). A BNP cut-off value of 11.8 pg/ml had 88% specificity and 74% negative predictive value for the exclusion of HCM. CONCLUSIONS Brain natriuretic peptide might be useful as a preparticipation screening test in athletes.
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Dardas P, Mezilis N, Ninios V, Efthimiadis GK, Tsikaderis D, Pagourelias E, Pliakos C. Rheolytic thrombectomy in patients with acute coronary syndrome and large thrombus burden: initial and mid-term results from a single centre experience. Hellenic J Cardiol 2010; 51:27-36. [PMID: 20118041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023] Open
Abstract
INTRODUCTION The presence of a large intracoronary thrombus burden is a major complicating factor during percutaneous coronary intervention (PCI) in patients with an acute coronary syndrome (ACS). The use of rheolytic thrombectomy (RT) has been proposed to prevent thrombus-related complications, with conflicting results. The purpose of this study was to identify the feasibility and safety of this approach. METHODS We conducted a single-centre, retrospective, observational case-control study, comparing the outcomes of PCI in 26 consecutive patients with ACS and a large thrombus burden who underwent RT to those of a control group of 26 patients, matched with regard to artery location and initial TIMI flow grade. RESULTS Despite the higher prevalence of acute ST-elevation myocardial infarction and the larger thrombus burden in the RT group, there was less incidence of distal embolisation/no-reflow and less use of vasoactive intracoronary agents. The final TIMI flow was identical in both groups. There was no difference between the two groups in the in-hospital and mid-term incidence of major adverse coronary events. CONCLUSIONS In this study, the use of RT in patients with a large thrombus burden during acute PCI was both feasible and safe and reduced the incidence of initial no-reflow phenomenon.
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Efthimiadis GK, Pagourelias ED, Meditskou S, Pliakos C, Styliadis IH, Parcharidis GE. Sudden death after alcohol septal ablation in hypertrophic cardiomyopathy. Am J Cardiol 2009; 104:743. [PMID: 19699364 DOI: 10.1016/j.amjcard.2009.06.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2009] [Accepted: 06/16/2009] [Indexed: 10/20/2022]
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Efthimiadis GK, Parcharidou DG, Giannakoulas G, Pagourelias ED, Charalampidis P, Savvopoulos G, Ziakas A, Karvounis H, Styliadis IH, Parcharidis GE. Left ventricular outflow tract obstruction as a risk factor for sudden cardiac death in hypertrophic cardiomyopathy. Am J Cardiol 2009; 104:695-9. [PMID: 19699347 DOI: 10.1016/j.amjcard.2009.04.039] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2009] [Revised: 04/19/2009] [Accepted: 04/19/2009] [Indexed: 10/20/2022]
Abstract
The effect of left ventricular outflow tract obstruction (LVOTO) at rest on the incidence of sudden death (SD) in patients with hypertrophic cardiomyopathy is rather conflicting. The aim of this study was the evaluation of LVOTO at rest as a new potential risk factor for SD in hypertrophic cardiomyopathy. A total of 166 patients (112 men, 51.8 +/- 15.6 years) were studied; 50 patients (30.1%) had peak instantaneous LVOTO gradients of > or = 30 mm Hg at rest. During the follow-up period (median 32.4 months, range 1 to 209), 13 patients either died suddenly, or had cardiac arrest, documented sustained ventricular tachycardia, or implantable cardioverter defibrillator discharge. The cumulative event-free survival rate was 92% in patients with LVOTO, and 92% in patients without obstruction (p = NS). LVOTO at rest was associated with a particularly low positive predictive value for SD (8%), although a high negative predictive value (92%) was recorded. Patients having syncope or presenting with a maximum wall thickness > or =3 cm in echocardiography were more sensitive to SD emergence because they had a 13.07 (95% confidence interval 4.00 to 46.95, p <0.0001) and a 10.07 (95% confidence interval 2.92 to 34.79, p = 0.003) greater relative risk, respectively. In conclusion, our cohort study results do not support LVOTO as an independent risk factor for SD in patients with hypertrophic cardiomyopathy.
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Efthimiadis GK, Pliakos C, Pagourelias ED, Parcharidou DG, Giannakoulas G, Kamperidis V, Hadjimiltiades S, Karvounis C, Gavrielidis S, Styliadis IH, Parcharidis G. Identification of high risk patients with hypertrophic cardiomyopathy in a northern Greek population. Cardiovasc Ultrasound 2009; 7:37. [PMID: 19631000 PMCID: PMC2724406 DOI: 10.1186/1476-7120-7-37] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2009] [Accepted: 07/26/2009] [Indexed: 12/28/2022] Open
Abstract
Background The percentage of hypertrophic cardiomyopathy (HCM) patients who are in high risk for Sudden Death (SD) constitutes only a minority of all HCM population but the incidence of SD in this subset is high (at least 5% annually). The identification of this small but important proportion of high risk HCM patients has been the clue in the clinical evaluation of these patients. Methods Our study cohort consisted from 123 patients with HCM who are currently followed up in our Institution. Five clinical risk factors were assessed: a family history of premature SD, unexplained syncope, Non Sustained Ventricular Tachycardia (NSVT) on 24-h ECG monitoring, Abnormal Blood Pressure Response (ABPR) during upright exercise testing and Maximum left ventricular Wall Thickness (MWT) ≥30 mm. The purpose of our study was the identification of high risk HCM patients coming from Northern Greece. Results Fifteen patients (12.2%) of the whole cohort had MWT ≥ 30 mm, 30 patients (24.4%) had an ABPR to exercise, 17 patients (13.8%) had episodes of NSVT in 24-h Holter monitoring, 17 patients (13.8%) suffered from syncope, and 8 patients (6.5%) had a positive family history of premature SD. Data analysis revealed that 74 patients (60.1%) had none risk factor. Twenty four patients (19.5%) had 1 risk factor, 17 patients (13.8%) had 2 risk factors, 4 patients (3.25%) had 3 risk factors, and 4 patients (3.25%) had 4 risk factors, while none patient had 5 risk factors. Twenty five patients (20.3%) had 2 or more risk factors. Conclusion This study for the first time confirms that, although a 60% of patients with HCM coming from a regional Greek population are in low risk for SD, a substantial proportion (almost 20%) carries a high risk for SD justifying prophylactic therapy with amiodaron or ICD implantation.
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Efthimiadis GK, Pliakos C, Pagourelias ED, Parcharidou DG, Spanos G, Paraskevaidis S, Styliadis IH, Parcharidis G. Hypertrophic cardiomyopathy with midventricular obstruction and apical aneurysm formation in a single family: case report. Cardiovasc Ultrasound 2009; 7:26. [PMID: 19527529 PMCID: PMC2706214 DOI: 10.1186/1476-7120-7-26] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2009] [Accepted: 06/16/2009] [Indexed: 12/13/2022] Open
Abstract
Background Hypertrophic cardiomyopathy (HCM) is an extremely heterogeneous disease. An under recognized and very often missed subgroup within this broad spectrum concerns patients with left ventricular (LV) apical aneurysms in the absence of coronary artery disease. Case presentation We describe a case of HCM with midventricular obstruction and apical aneurysm formation in 3 patients coming from a single family. This HCM pattern was detected by 2D-echocardiography and confirmed by cardiac magnetic resonance imaging. A cardioverter defibrillator was implanted in one of the patients because of non-sustained ventricular tachycardia detected in 24-h Holter monitoring and an abrupt drop in systolic blood pressure during maximal exercise test. The defibrillator activated 8 months after implantation by suppression of a ventricular tachycardia providing anti-tachycardia pacing. The patient died due to refractory heart failure 2 years after initial evaluation. The rest of the patients are stable after a 2.5-y follow-up period. Conclusion The detection of apical aneurysm by echocardiography in HCM patients may be complicated. Ventricular tachycardia arising from the scarred aneurysm wall may often occur predisposing to sudden death.
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Papadopoulou K, Giannakoulas G, Karvounis H, Dalamanga E, Karamitsos T, Parcharidou D, Damvopoulou E, Efthimiadis GK, Styliadis I, Parcharidis G. Differences in echocardiographic characteristics of functional mitral regurgitation in ischaemic versus idiopathic dilated cardiomyopathy: a pilot study. Hellenic J Cardiol 2009; 50:37-44. [PMID: 19196619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023] Open
Abstract
INTRODUCTION Functional mitral regurgitation (FMR) is a common complication in patients with ischaemic (ICM) or idiopathic dilated cardiomyopathy (DCM), as a consequence of left ventricular (LV) remodelling. The aim of this study was to elucidate the differences in FMR between patients with ICM and DCM utilising conventional and tissue Doppler echocardiography. METHODS We studied 21 patients with ICM and 17 with DCM using conventional and tissue Doppler echocardiography. The severity of FMR was assessed quantitatively and by the PISA method. The 2 groups were similar in terms of NYHA class, LV ejection fraction and pharmacological treatment. RESULTS Patients with ICM had higher pulmonary artery systolic pressures (48 +/- 16 vs. 38 +/- 10 mmHg, p=0.04), more severe FMR as assessed by colour Doppler (1.9 +/- 0.9 vs. 1.1 +/- 0.5, p=0.006), and a larger effective regurgitant orifice (0.17 +/- 0.07 vs. 0.1 +/- 0.05 cm(2), p=0.003) and tenting area (2.3 +/- 0.8 vs. 1.7 +/- 0.7 cm(2), p=0.02). In addition, ICM subjects had lower mitral annular systolic (Sm 2.3 +/- 0.8 vs. 3.4 +/- 0.9 cm/s, p<0.001) and diastolic (Em 2.5 +/- 1 vs. 3.8 +/- 1.5 cm/s, p=0.005; Am 3.1 +/- 1.4 vs. 4.3 +/- 1.7 cm/s, p=0.02) myocardial velocities, and a higher ratio of early transmitral filling velocity to early mitral annular diastolic velocity (LV E/Em 42 +/- 29 vs. 22.7 +/- 7.6, p=0.008) compared to DCM patients. Systolic and diastolic mitral annular velocities were significantly correlated with effective regurgitant orifice. Tenting area >1.27 cm(2) exhibited the highest sensitivity and regurgitant volume >24 ml the highest specificity for predicting ischaemic aetiology of LV dysfunction. However, only age and Sm were independent predictors of the diagnosis of ICM rather than DCM. CONCLUSIONS Mitral apparatus deformity, incomplete closure of mitral leaflets and global remodelling are more prominent in patients with ICM and lead to more severe FMR than in patients with DCM.
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Efthimiadis GK, Parcharidou DG, Vassilikos V, Giannakoulas G, Pliakos C, Parcharidis GE. Triple type of obstruction in hypertrophic cardiomyopathy. J Cardiovasc Med (Hagerstown) 2008; 9:1156-8. [PMID: 18852593 DOI: 10.2459/jcm.0b013e3283108803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Efthimiadis GK, Meditskou S, Vassilikos V, Hadjimiltiades S, Styliadis IH, Parcharidis GE. Surgical septal myectomy versus septal alcohol ablation for hypertrophic obstructive cardiomyopathy. Swiss Med Wkly 2008; 138:322; author reply 322-3. [PMID: 18578089 DOI: 10.4414/smw.2008.12218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
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Efthimiadis GK, Meditskou S, Parcharidis GE. Athletes with repolarization abnormalities. N Engl J Med 2008; 358:2296; author reply 2297-8. [PMID: 18499580 DOI: 10.1056/nejmc080209] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Efthimiadis GK, Giannakoulas G, Hassapopoulou HP, Karvounis HI, Parcharidis GE. Prognostic Value of Doppler-Demonstrated Left versus Biventricular Restrictive Filling Pattern in Thalassemia Major. Echocardiography 2008; 25:553; author reply 554. [DOI: 10.1111/j.1540-8175.2008.00641.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Efthimiadis GK, Spanos GP, Giannakoulas G, Boufidou A, Parcharidou DG, Karvounis H, Styliadis I, Parcharidis GE. Hypertrophic cardiomyopathy with late enhancement of the non-hypertrophied left ventricular segments. Hellenic J Cardiol 2008; 49:114-116. [PMID: 18459471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023] Open
Abstract
A 56-year-old asymptomatic man was referred for further evaluation because he displayed a rapid T-wave change on the ECG, from positive T waves to giant negative T waves in the anterolateral precordial leads, within 2 years. Transthoracic echocardiography revealed mild left ventricular apical hypertrophy without obstruction. Cardiac magnetic resonance imaging showed apical hypertrophic cardiomyopathy with focal hyperenhancement of the non-hypertrophic basal lateral segment of the left ventricle and absence of hyperenhancement of the hypertrophied apical segments.
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Styliadis I, Ziakas A, Karvounis H, Giannakoulas G, Efthimiadis GK, Parisiadou A, Anifanti M, Dalamanga E, Parcharidis G, Louridas G. The utility of the standard 12-lead electrocardiogram in the prediction of proximal right coronary artery occlusion in acute inferior myocardial infarction. J Emerg Med 2008; 35:67-72. [PMID: 18296012 DOI: 10.1016/j.jemermed.2007.08.065] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2006] [Revised: 04/20/2007] [Accepted: 08/07/2007] [Indexed: 11/28/2022]
Abstract
Prior studies have proposed several electrocardiogram criteria for identifying patients with acute inferior ST-segment elevation myocardial infarction (iSTEMI) caused by obstruction of the proximal part of the right coronary artery (RCA). We applied 11 of these criteria and three new ones to the admission electrocardiograms of 80 patients admitted with an acute iSTEMI in order to evaluate their utility. All patients received thrombolytic treatment and underwent coronary angiography during the hospitalization. Four previously described criteria (ST-segment depression in lead V1, ST-segment depression in leads V1-V3, maximum ST-segment depression in the precordial leads, and ST-segment depression in lead V3 of <or= 50% of the magnitude of ST-segment elevation in lead III) and two new used criteria (the absence of ST-segment depression in lead V1 in combination with ST-segment depression in lead V2 and the arithmetic sum of the ST-segment: III + V3 > 1) were useful in identifying patients with obstruction of the proximal part of the RCA. Among the six criteria, ST depression in V1-V3 had the highest specificity (77.2%) and positive predictive value (56.5%), and a new criterion-the arithmetic sum of the ST-elevation in V3/ST-elevation in III < 0.5--had the highest sensitivity (80.9%) and negative predictive value (86.7%). Six criteria were helpful in identifying patients with acute iSTEMI caused by obstruction of the proximal part of the RCA. One of these has not been previously reported and has the higher specificity and negative predictive value.
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Efthimiadis GK, Giannakoulas G, Hassapopoulou HP, Karvounis HI, Tsikaderis DD, Styliadis IH, Parcharidis GE. Prognostic significance of right ventricular diastolic function in thalassaemia major. Swiss Med Wkly 2008; 138:52-4. [PMID: 18224497 DOI: 10.4414/smw.2008.12039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
While left ventricular (LV) restrictive filling pattern is an ominous echocardiographic finding in thalassaemia major (TM), the prognostic significance of right ventricular (RV) diastolic function in patients with TM has not been thoroughly investigated. We studied 45 TM asymptomatic transfusion-dependent patients with normal LV systolic function by Doppler echocardiography. The 15-year cumulative survival rate was 34% in patients with RV restrictive filling pattern (RFP) and 82% in patients with RV non-RFP (log-rank = 10.41, p = 0.0013). Doppler estimation of RV filling pattern is very important in evaluating the prognosis of TM patients and should be performed routinely and using a standardised followup protocol.
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Parcharidou DG, Giannakoulas G, Efthimiadis GK, Karvounis H, Papadopoulou KN, Dalamanga E, Styliadis I, Parcharidis GE. Right Ventricular Function in Ischemic or Idiopathic Dilated Cardiomyopathy. Circ J 2008; 72:238-44. [DOI: 10.1253/circj.72.238] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Efthimiadis GK, Giannakoulas G, Parcharidou DG, Karvounis HI, Mochlas ST, Styliadis IH, Papadopoulos CE, Kounatiadis P, Pliakos CI, Parcharidis GE, Louridas GE. Clinical significance of tissue Doppler imaging in patients with hypertrophic cardiomyopathy. Circ J 2007; 71:897-903. [PMID: 17526987 DOI: 10.1253/circj.71.897] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND A transmitral E/septal Ea ratio > or =15 is a predictor of adverse outcome in cardiac disease, so it was hypothesized that a septal E/Ea >/=15 would predict the risk of adverse outcome, including sustained ventricular tachycardia (VT), cardiac arrest, implantable cardioverter defibrillator (ICD) discharge, or sudden death (SD) in patients with hypertrophic cardiomyopathy (HCM). METHODS AND RESULTS The study group comprised 96 consecutive patients with HCM (median age 53 years) who completed all noninvasive tests for risk stratification. The endpoint of the study was defined as death, cardiac arrest, documented sustained VT, or ICD-discharge. The median follow-up was 20.6 months. All patients were alive at the end of follow-up, although 8 patients had reached the endpoint during the study period. The variables that were predictive of adverse clinical outcome were family history of premature SD (p=0.03), syncope (p<0.001), maximum wall thickness > or =3 cm (p=0.02), and septal E/Ea > or =15 (p<0.001). In a stepwise multivariable model the only independent prognostic indicator was a septal E/Ea > or =15 (relative risk 0.26, 95% confidence interval 0.2-0.58, p<0.001). The cumulative event-free survival rate was 78.9% in patients with septal E/Ea > or =15, and 100% in patients with septal E/Ea <15 (p=0.0003). CONCLUSIONS Septal E/Ea > or =15 predicts patients with HCM who are at risk of sustained VT, cardiac arrest, ICD-discharge, or SD. (Circ J 2007; 71: 897 - 903).
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MESH Headings
- Adult
- Cardiomyopathy, Hypertrophic/complications
- Cardiomyopathy, Hypertrophic/diagnostic imaging
- Cardiomyopathy, Hypertrophic/mortality
- Cardiomyopathy, Hypertrophic/physiopathology
- Death, Sudden, Cardiac/etiology
- Defibrillators, Implantable
- Disease-Free Survival
- Echocardiography, Doppler
- Female
- Follow-Up Studies
- Heart Arrest/diagnostic imaging
- Heart Arrest/etiology
- Heart Arrest/mortality
- Heart Arrest/physiopathology
- Humans
- Male
- Middle Aged
- Risk Assessment
- Risk Factors
- Survival Rate
- Tachycardia, Ventricular/diagnostic imaging
- Tachycardia, Ventricular/etiology
- Tachycardia, Ventricular/mortality
- Tachycardia, Ventricular/physiopathology
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Papadopoulos CE, Pitsiou G, Karamitsos TD, Karvounis HI, Kontakiotis T, Giannakoulas G, Efthimiadis GK, Argyropoulou P, Parharidis GE, Bouros D. Left ventricular diastolic dysfunction in idiopathic pulmonary fibrosis: a tissue Doppler echocardiographic [corrected] study. Eur Respir J 2007; 31:701-6. [PMID: 18057055 DOI: 10.1183/09031936.00102107] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
It was hypothesised that, apart from right ventricular (RV) dysfunction, patients with idiopathic pulmonary fibrosis (IPF) also exhibit left ventricular (LV) impairment, which may affect disease progression and prognosis. The aim of the present study was to evaluate LV performance in a cohort of IPF patients using conventional and tissue Doppler ECG. IPF patients exhibiting mild-to-moderate pulmonary arterial hypertension (mean age 65+/-9 yrs; n = 22) and healthy individuals (mean age 61+/-6 yrs; n = 22) were studied. Conventional and tissue Doppler ECG were used for the evaluation of RV and LV systolic and diastolic function. In addition to the expected impairment in RV function, all patients showed a characteristic reversal of LV diastolic filling to late diastole compared with controls (early diastolic peak filling velocity (E)/late diastolic peak filling velocity 0.7+/-0.2 versus 1.5+/-0.1, respectively). Patients with IPF also exhibited lower peak myocardial velocities in early diastole (E(m); 5.7+/-1.1 versus 10.3+/-1.6 cm x s(-1), respectively), higher in late diastole (A(m); 8.9+/-1.3 versus 5.5+/-0.8 cm x s(-1), respectively), lower E(m)/A(m) ratio (0.6+/-0.1 versus 1.9+/-0.5, respectively) and higher E/E(m) ratio (10.8+/-3 versus 6+/-0.6, respectively), all indicative of LV diastolic dysfunction. Moreover, LV propagation velocity was significantly lower in IPF patients (46+/-13 versus 83+/-21 cm x s(-1), respectively). Physicians should be aware that patients with idiopathic pulmonary fibrosis exhibit early impairment of left ventricular diastolic function.
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