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Lo BD, Chen SY, Stem M, Papanikolaou A, Gabre-Kidan A, Safar B, Efron JE, Atallah C. Prevalence of cannabis use disorder and perioperative outcomes in adult colectomy patients: A propensity score-matched analysis. World J Surg 2024; 48:701-712. [PMID: 38342773 DOI: 10.1002/wjs.12085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 01/06/2024] [Indexed: 02/13/2024]
Abstract
BACKGROUND The decriminalization of cannabis across the United States has led to an increased number of patients reporting cannabis use prior to surgery. However, it is unknown whether preoperative cannabis use disorder (CUD) increases the risk of postoperative complications among adult colectomy patients. METHODS Adult patients undergoing an elective colectomy were retrospectively analyzed from the National Inpatient Sample database (2004-2018). To control for potential confounders, patients with CUD, defined using ICD-9/10 codes, were propensity score matched to patients without CUD in a 1:1 ratio. The association between preoperative CUD and composite morbidity, the primary outcome of interest, was assessed. Subgroup analyses were performed after stratification by age (≥50 years). RESULTS Among 432,018 adult colectomy patients, 816 (0.19%) reported preoperative CUD. The prevalence of CUD increased nearly three-fold during the study period from 0.8/1000 patients in 2004 to 2.0/1000 patients in 2018 (P-trend<0.001). After propensity score matching, patients with CUD exhibited similar rates of composite morbidity (140 of 816; 17.2%) as those without CUD (151 of 816; 18.5%) (p = 0.477). Patients with CUD also had similar anastomotic leak rates (CUD: 5.64% vs. No CUD: 6.25%; p = 0.601), hospital lengths of stay (CUD: 5 days, IQR 4-7 vs. No CUD: 5 days, IQR 4-7) (p = 0.415), and hospital charges as those without CUD. Similar findings were seen among patients aged ≥50 years in the subgroup analysis. CONCLUSIONS Though the prevalence of CUD has increased drastically over the past 15 years, preoperative CUD was not associated with an increased risk of composite morbidity among adult patients undergoing an elective colectomy.
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Affiliation(s)
- Brian D Lo
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Sophia Y Chen
- Colorectal Research Unit, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Miloslawa Stem
- Colorectal Research Unit, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Angelos Papanikolaou
- Colorectal Research Unit, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Alodia Gabre-Kidan
- Colorectal Research Unit, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Bashar Safar
- Division of Colon and Rectal Surgery, Department of Surgery, NYU Grossman School of Medicine, New York City, New York, USA
| | - Jonathan E Efron
- Colorectal Research Unit, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Chady Atallah
- Division of Colon and Rectal Surgery, Department of Surgery, NYU Grossman School of Medicine, New York City, New York, USA
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Chatzikonstantinou AV, Bellou MG, Spyrou S, Papanikolaou A, Simos YV, Peschos D, Stamatis H. Enhancement of the biological activity of hydroxytyrosol through its oxidation by laccase from Trametes versicolor. J Biotechnol 2024; 385:30-41. [PMID: 38403132 DOI: 10.1016/j.jbiotec.2024.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 02/21/2024] [Accepted: 02/21/2024] [Indexed: 02/27/2024]
Abstract
The laccase-catalyzed oxidation of hydroxytyrosol (HT) towards the formation of its bioactive oligomer derivatives was investigated. The biocatalytic oligomerization was catalyzed by laccase from Trametes versicolor in aqueous or various water-miscible organic solvents and deep eutectic solvent (DES)-based media. Mass Spectroscopy and Nuclear Magnetic Resonance were used for the characterization of the products. The solvent system used significantly affects the degree of HT oligomerization. The use of 50 % v/v methanol favored the production of the HT dimer, while other organic solvents as well as DESs led to the formation of hydroxytyrosol trimer and other oligomers. In vitro studies showed that the HT dimer exhibits 3- to 4-fold enhanced antibacterial activity against Gram-positive and Gram-negative bacteria compared to the parent compound. Moreover, the ability of HT dimer to inhibit the activity of soybean lipoxygenase and Candida rugosa lipase was 1.5-fold higher than HT, while molecular docking supported these results. Furthermore, HT dimer showed reduced cytotoxicity against HEK293 cells and exhibited a strong ability to inhibit ROS formation. The enhanced bioactivity of HT dimer indicates that this compound could be considered for use in cosmetics, skin-care products, and nutraceuticals.
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Affiliation(s)
- Alexandra V Chatzikonstantinou
- Biotechnology Laboratory, Department of Biological Applications and Technologies, University of Ioannina, Ioannina 45110, Greece; Nanomedicine and Nanobiotechnology Research Group, University of Ioannina, Ioannina 45110, Greece
| | - Myrto G Bellou
- Biotechnology Laboratory, Department of Biological Applications and Technologies, University of Ioannina, Ioannina 45110, Greece
| | - Stamatia Spyrou
- Biotechnology Laboratory, Department of Biological Applications and Technologies, University of Ioannina, Ioannina 45110, Greece
| | - Angelos Papanikolaou
- Biotechnology Laboratory, Department of Biological Applications and Technologies, University of Ioannina, Ioannina 45110, Greece
| | - Yannis V Simos
- Department of Physiology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina 45110, Greece; Nanomedicine and Nanobiotechnology Research Group, University of Ioannina, Ioannina 45110, Greece
| | - Dimitrios Peschos
- Department of Physiology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina 45110, Greece; Nanomedicine and Nanobiotechnology Research Group, University of Ioannina, Ioannina 45110, Greece
| | - Haralambos Stamatis
- Biotechnology Laboratory, Department of Biological Applications and Technologies, University of Ioannina, Ioannina 45110, Greece; Nanomedicine and Nanobiotechnology Research Group, University of Ioannina, Ioannina 45110, Greece.
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Papanikolaou A, Chen SY, Radomski SN, Stem M, Brown LB, Obias VJ, Graham AE, Chung H. Short-Stay Left Colectomy for Colon Cancer: Is It Safe? J Am Coll Surg 2024; 238:172-181. [PMID: 37937826 DOI: 10.1097/xcs.0000000000000908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2023]
Abstract
BACKGROUND Advances in surgical practices have decreased hospital length of stay (LOS) after surgery. This study aimed to determine the safety of short-stay (≤24-hour) left colectomy for colon cancer patients in the US. STUDY DESIGN Adult colon cancer patients who underwent elective left colectomies were identified using the American College of Surgeons NSQIP database (2012 to 2021). Patients were categorized into 4 LOS groups: LOS 1 day or less (≤24-hour short stay), 2 to 4, 5 to 6, and 7 or more. Primary outcomes were 30-day postoperative overall and serious morbidity. Secondary outcomes were 30-day mortality and readmission. Multivariable logistic regression was performed to explore the association between LOS and overall and serious morbidity. RESULTS A total of 15,745 patients who underwent left colectomies for colon cancer were identified with 294 (1.87%) patients undergoing short stay. Short-stay patients were generally younger and healthier with lower 30-day overall morbidity rates (LOS ≤1 day: 3.74%, 2 to 4: 7.38%, 5 to 6: 16.12%, and ≥7: 37.64%, p < 0.001). Compared with patients with LOS 2 to 4 days, no differences in mortality and readmission rates were observed. On adjusted analysis, there was no statistical difference in the odds of overall (LOS 2 to 4 days: odds ratio 1.90, 95% CI 1.01 to 3.60, p = 0.049) and serious morbidity (LOS 2 to 4 days: odds ratio 0.86, 95% CI 1.42 to 1.76, p = 0.672) between the short-stay and LOS 2 to 4 days groups. CONCLUSIONS Although currently performed at low rates in the US, short-stay left colectomy is safe for a select group of patients. Attention to patient selection, refinement of clinical pathways, and close follow-up may enable short-stay colectomies to become a more feasible reality.
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Affiliation(s)
- Angelos Papanikolaou
- From the Colorectal Research Unit, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD
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Chen SY, Radomski SN, Stem M, Papanikolaou A, Gabre-Kidan A, Gearhart SL, Efron JE, Atallah C. Factors associated with not undergoing surgery for locally advanced rectal cancers: An NCDB propensity-matched analysis. Surgery 2023; 174:1323-1333. [PMID: 37852832 DOI: 10.1016/j.surg.2023.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 08/01/2023] [Accepted: 09/05/2023] [Indexed: 10/20/2023]
Abstract
BACKGROUND The traditional treatment paradigm for patients with locally advanced rectal cancers has been neoadjuvant chemoradiation followed by curative intent surgery and adjuvant chemotherapy. This study aimed to assess surgery trends for locally advanced rectal cancers, factors associated with forgoing surgery, and overall survival outcomes. METHODS Adults with locally advanced rectal cancers were retrospectively analyzed using the National Cancer Database (2004-2019). Propensity score matching was performed. Factors associated with not undergoing surgery were identified using multivariable logistic regression. Kaplan-Meier and log-rank tests were used for 5-year overall survival analysis, stratified by stage and treatment type. RESULTS A total of 72,653 patients were identified, with 64,396 (88.64%) patients undergoing neoadjuvant + surgery ± adjuvant therapy, 579 (0.80%) chemotherapy only, 916 (1.26%) radiation only, and 6,762 (9.31%) chemoradiation only. The proportion of patients who underwent surgery declined over the study period (95.61% in 2006 to 92.29% in 2019, P trend < .001), whereas the proportion of patients who refused surgery increased (1.45%-4.48%, P trend < .001). Factors associated with not undergoing surgery for locally advanced rectal cancers included older age, Black race (odds ratio 1.47, 95% CI 1.35-1.60, P < .001), higher Charlson-Deyo score (score ≥3: 1.79, 1.58-2.04, P < .001), stage II cancer (1.22, 1.17-1.28, P < .001), lower median household income, and non-private insurance. Neoadjuvant + surgery ± adjuvant therapy was associated with the best 5-year overall survival, regardless of stage, in unmatched and matched cohorts. CONCLUSION Despite surgery remaining an integral component in the management of locally advanced rectal cancers, there is a concerning decline in guideline-concordant surgical care for rectal cancer in the United States, with evidence of persistent socioeconomic disparities. Providers should seek to understand patient perspectives/barriers and guide them toward surgery if appropriate candidates. Continued standardization, implementation, and evaluation of rectal cancer care through national accreditation programs are necessary to ensure that all patients receive optimal treatment.
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Affiliation(s)
- Sophia Y Chen
- Colorectal Research Unit, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Shannon N Radomski
- Colorectal Research Unit, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Miloslawa Stem
- Colorectal Research Unit, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Angelos Papanikolaou
- Colorectal Research Unit, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD; Department of Surgery, NYU Langone Health, NYC, NY
| | - Alodia Gabre-Kidan
- Colorectal Research Unit, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Susan L Gearhart
- Colorectal Research Unit, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Jonathan E Efron
- Colorectal Research Unit, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Chady Atallah
- Colorectal Research Unit, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD; Department of Surgery, NYU Langone Health, NYC, NY.
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Done JZ, Papanikolaou A, Stem M, Radomski SN, Chen SY, Atallah C, Efron JE, Safar B. Impact of preoperative chemotherapy on perioperative morbidity in combined resection of colon cancer and liver metastases. J Gastrointest Surg 2023; 27:2380-2387. [PMID: 37468732 DOI: 10.1007/s11605-023-05758-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 06/11/2023] [Indexed: 07/21/2023]
Abstract
BACKGROUND Preoperative chemotherapy, or neoadjuvant therapy (NAC) can be used to improve resectability but can also have hepatotoxic effects on the future liver remnant. The purpose of this study was to investigate the impact of NAC on 30-day morbidity among patients undergoing a resection of primary colon cancer and synchronous liver metastases (sLM). METHODS This was a retrospective study using the National Surgical Quality Improvement Program database (2012-2020). The association between NAC and 30-day overall morbidity, the primary outcome, was assessed. Subgroup analyses for low and high-risk procedures were performed. RESULTS Among 968 patients who underwent the combined resection, 571 (58.99%) received NAC. There was a lower rate of 30-day overall morbidity among patients who received NAC (34.50% vs. 41.56%, p = 0.026) and no difference in rates of postoperative liver failure, bile leak, need for invasive intervention for hepatic procedure, and anastomotic leak. On adjusted analyses, patients who received NAC had decreased odds of overall morbidity (OR 0.73, 95% CI 0.55-0.97, p = 0.031) compared to patients who did not receive NAC. On subgroup analyses, patients who received NAC prior to a low risk combined resection had lower rates of overall morbidity on both adjusted and unadjusted analyses. Among those undergoing high-risk combined resections, there was no difference in overall morbidity. DISCUSSION AND CONCLUSION Patients who are deemed to be candidates for preoperative chemotherapy can proceed with planned neoadjuvant chemotherapy prior to combined resection of primary colon cancer and sLM as preoperative neoadjuvant chemotherapy does not appear to be associated with increased postoperative morbidity.
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Affiliation(s)
- Joy Z Done
- Colorectal Research Unit, Department of Surgery, Johns Hopkins University, Baltimore, USA
| | - Angelos Papanikolaou
- Colorectal Research Unit, Department of Surgery, Johns Hopkins University, Baltimore, USA
| | - Miloslawa Stem
- Colorectal Research Unit, Department of Surgery, Johns Hopkins University, Baltimore, USA
| | - Shannon N Radomski
- Colorectal Research Unit, Department of Surgery, Johns Hopkins University, Baltimore, USA
| | - Sophia Y Chen
- Colorectal Research Unit, Department of Surgery, Johns Hopkins University, Baltimore, USA
| | - Chady Atallah
- Colorectal Research Unit, Department of Surgery, Johns Hopkins University, Baltimore, USA
| | - Jonathan E Efron
- Colorectal Research Unit, Department of Surgery, Johns Hopkins University, Baltimore, USA
| | - Bashar Safar
- Colorectal Research Unit, Department of Surgery, Johns Hopkins University, Baltimore, USA.
- Division of Colon and Rectal Surgery, Department of Surgery, New York University Grossman School of Medicine, NYU Langone Health, 530 First Ave, Suite 7V, New York, NY, 10016, USA.
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Kakos CD, Papanikolaou A, Ziogas IA, Tsoulfas G. Global dissemination of minimally invasive living donor hepatectomy: What are the barriers? World J Gastrointest Surg 2023; 15:776-787. [PMID: 37342850 PMCID: PMC10277954 DOI: 10.4240/wjgs.v15.i5.776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 01/16/2023] [Accepted: 03/16/2023] [Indexed: 05/26/2023] Open
Abstract
Minimally invasive donor hepatectomy (MIDH) is a relatively novel procedure that can potentially increase donor safety and contribute to faster rehabilitation of donors. After an initial period in which donor safety was not effectively validated, MIDH currently seems to provide improved results, provided that it is conducted by experienced surgeons. Appropriate selection criteria are crucial to achieve better outcomes in terms of complications, blood loss, operative time, and hospital stay. Beyond a pure laparoscopic technique, various approaches have been recommended such as hand-assisted, laparoscopic-assisted, and robotic donation. The latter has shown equal outcomes compared to open and laparoscopic approaches. A steep learning curve seems to exist in MIDH, mainly due to the fragility of the liver parenchyma and the experience needed for adequate control of bleeding. This review investigated the challenges and the opportunities of MIDH and the barriers to its global dissemination. Surgeons need expertise in liver transplantation, hepatobiliary surgery, and minimally invasive techniques to perform MIDH. Barriers can be categorized into surgeon-related, institutional-related, and accessibility. More robust data and the creation of international registries are needed for further evaluation of the technique and the acceptance from more centers worldwide.
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Affiliation(s)
- Christos Dimitrios Kakos
- Surgery Working Group, Society of Junior Doctors, Athens 15123, Greece
- Department of Transplant Surgery, Aristotle University of Thessaloniki, School of Medicine, Thessaloniki 54622, Greece
| | - Angelos Papanikolaou
- Surgery Working Group, Society of Junior Doctors, Athens 15123, Greece
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD 21287, United States
| | - Ioannis A Ziogas
- Surgery Working Group, Society of Junior Doctors, Athens 15123, Greece
- Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, United States
| | - Georgios Tsoulfas
- Department of Transplant Surgery, Aristotle University of Thessaloniki, School of Medicine, Thessaloniki 54622, Greece
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Papanikolaou A, Chatzikonstantinou AV, Zarafeta D, Kourkoumelis N, Skretas G, Pavlidis ΙV, Stamatis H. Substrate Specificity of the Highly Thermostable Esterase EstDZ3. Chembiochem 2023; 24:e202200642. [PMID: 36545817 DOI: 10.1002/cbic.202200642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 12/18/2022] [Accepted: 12/21/2022] [Indexed: 12/24/2022]
Abstract
Esterases are among the most studied enzymes, and their applications expand into several branches of industrial biotechnology. Yet, despite the fact that information on their substrate specificity is crucial for selecting or designing the best fitted biocatalyst for the desired application, it cannot be predicted from their amino acid sequence. In this work, we studied the substrate scope of the newly discovered hydrolytic extremozyme, EstDZ3, against a library of esters with variable carbon chain lengths in an effort to understand the crucial amino acids for the substrate selectivity of this enzyme. EstDZ3 appears to be active against a wide range of esters with high selectivity towards medium- to long-carbon chain vinyl esters. In-silico studies of its 3D structure revealed that the selectivity might arise from the mainly hydrophobic nature of the active site's environment.
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Affiliation(s)
- Angelos Papanikolaou
- Biotechnology Laboratory, Department of Biological Applications and Technologies, University of Ioannina, 45110, Ioannina, Greece
| | - Alexandra V Chatzikonstantinou
- Biotechnology Laboratory, Department of Biological Applications and Technologies, University of Ioannina, 45110, Ioannina, Greece
| | - Dimitra Zarafeta
- Institute of Chemical Biology, National Hellenic Research Foundation, 11635, Athens, Greece
| | - Nikolaos Kourkoumelis
- Department of Medical Physics, School of Health Sciences, University of Ioannina, 45110, Ioannina, Greece
| | - Georgios Skretas
- Institute of Chemical Biology, National Hellenic Research Foundation, 11635, Athens, Greece.,Institute for Bio-innovation, Biomedical Sciences Research Center "Alexander Fleming", 16672, Vari, Greece
| | - Ιoannis V Pavlidis
- Department of Chemistry, University of Crete Voutes, University Campus, 70013, Heraklion, Greece
| | - Haralambos Stamatis
- Biotechnology Laboratory, Department of Biological Applications and Technologies, University of Ioannina, 45110, Ioannina, Greece
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Apostolos A, Gregoriou S, Drakopoulou MI, Trantalis G, Mastraftsi S, Synetos AG, Papanikolaou A, Aggeli C, Stratigos A, Rigopoulos D, Tsioufis KP, Toutouzas KP. ASSOCIATION BETWEEN CLINICAL MANIFESTATIONS AND NICKEL SKIN PATCH RESULTS IN PATIENTS UNDERGOING PATENT FORAMEN OVALE CLOSURE: PRELIMINARY RESULTS FROM INSPIRE TRIAL. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)01331-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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Apostolos A, Drakopoulou MI, Trantalis G, Simopoulou C, Katsaros O, Korovesis T, Oikonomou G, Papanikolaou A, Aggeli C, Tsioufis KP, Toutouzas KP. TRANSCATHETER PATENT FORAMEN OVALE CLOSURE: REAL WORLD DATA FROM A TERTIARY HOSPITAL. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)01330-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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Latsios G, Leopoulou M, Synetos A, Karanasos A, Papanikolaou A, Bounas P, Stamatopoulou E, Toutouzas K, Tsioufis K. Cardiac arrest and cardiopulmonary resuscitation in “hostile” environments: Using automated compression devices to minimize the rescuers’ danger. World J Cardiol 2023; 15:45-55. [PMID: 36911750 PMCID: PMC9993930 DOI: 10.4330/wjc.v15.i2.45] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Revised: 01/25/2023] [Accepted: 02/15/2023] [Indexed: 02/21/2023] Open
Abstract
Mechanical automated compression devices are being used in cardiopulmonary resuscitation instead of manual, “hands-on”, rescuer-delivered chest compressions. The -theoretical- advantages include high-quality non-stop compressions, thus freeing the rescuer performing the compressions and additionally the ability of the rescuer to stand reasonably away from a potentially “hazardous” victim, or from hazardous and/or difficult resuscitation conditions. Such circumstances involve cardiopulmonary resuscitation (CPR) in the Cardiac Catheterization Laboratory, especially directly under the fluoroscopy panel, where radiation is well known to cause detrimental effects to the rescuer, and CPR during/after land or air transportation of cardiac arrest victims. Lastly, CPR in a coronavirus disease 2019 patient/ward, where the danger of contamination and further serious illness of the health provider is very existent. The scope of this review is to review and present literature and current guidelines regarding the use of mechanical compressions in these “hostile” and dangerous settings, while comparing them to manual compressions.
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Affiliation(s)
- George Latsios
- 1st University Department of Cardiology, "Hippokration" University Hospital, Athens Medical School, Athens 11527, Greece
| | - Marianna Leopoulou
- 1st Cardiology Clinic, 'Hippokration' University Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens 11527, Greece
- Department of Cardiology, "Elpis" Athens General Hospital, Athens 11522, Greece
| | - Andreas Synetos
- 1st Department of Cardiology, Athens Medical School, University Athens, Hippokrat Hospital, Athens 11527, Greece
| | - Antonios Karanasos
- 1st University Department of Cardiology, "Hippokration" University Hospital, Athens Medical School, Athens 11527, Greece
| | - Angelos Papanikolaou
- 1st Cardiology Department Athens Medical School, Hippokration General Hospital, Athens 11527, Greece
| | - Pavlos Bounas
- Department of Cardiology, “Thriasio” General Hospital, Thriasio General Hospital, Elefsina 19600, Greece
| | - Evangelia Stamatopoulou
- CathLab, 2nd Department of Cardiology, Medical School, National and Kapodistrian University of Athens, “Attikon” University Hospital, Attikon University Hospital, Athens 12462, Greece
| | | | - Kostas Tsioufis
- 1st Department of Cardiology, Medical School, National and Kapodistrian University of Athens, “Hippokration” General Hospital, "Hippokration" University Hospital, Athens 11527, Greece
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Chen SY, Radomski SN, Stem M, Papanikolaou A, Gabre-Kidan A, Atallah C, Efron JE, Safar B. Colorectal Surgery Outcomes in the United States During the COVID-19 Pandemic. J Surg Res 2023; 287:95-106. [PMID: 36893610 PMCID: PMC9868386 DOI: 10.1016/j.jss.2022.12.041] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 12/02/2022] [Accepted: 12/25/2022] [Indexed: 01/24/2023]
Abstract
INTRODUCTION The purpose of this study was to assess colorectal surgery outcomes, discharge destination, and readmission in the United States during the COVID-19 pandemic. METHODS Adult colorectal surgery patients in the American College of Surgeons National Surgical Quality Improvement Program database (2019-2020) and its colectomy and proctectomy procedure-targeted files were included. The prepandemic time period was defined from April 1, 2019 to December 31, 2019. The pandemic time period was defined from April 1, 2020 to December 31, 2020 in quarterly intervals (Q2 April-June; Q3 July-September; Q4 October-December). Factors associated with morbidity and in-hospital mortality were assessed using multivariable logistic regression. RESULTS Among 62,393 patients, 34,810 patients (55.8%) underwent colorectal surgery prepandemic and 27,583 (44.2%) during the pandemic. Patients who had surgery during the pandemic had higher American Society of Anesthesiologists class and presented more frequently with dependent functional status. The proportion of emergent surgeries increased (12.7% prepandemic versus 15.2% pandemic, P < 0.001), with less laparoscopic cases (54.0% versus 51.0%, P < 0.001). Higher rates of morbidity with a greater proportion of discharges to home and lesser proportion of discharges to skilled care facilities were observed with no considerable differences in length of stay or worsening readmission rates. Multivariable analysis demonstrated increased odds of overall and serious morbidity and in-hospital mortality, during Q3 and/or Q4 of the 2020 pandemic. CONCLUSIONS Differences in hospital presentation, inpatient care, and discharge disposition of colorectal surgery patients were observed during the COVID-19 pandemic. Pandemic responses should emphasize balancing resource allocation, educating patients and providers on timely medical workup and management, and optimizing discharge coordination pathways.
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Affiliation(s)
- Sophia Y Chen
- Department of Surgery, The Johns Hopkins University School of Medicine, Colorectal Research Unit, Baltimore, Maryland
| | - Shannon N Radomski
- Department of Surgery, The Johns Hopkins University School of Medicine, Colorectal Research Unit, Baltimore, Maryland
| | - Miloslawa Stem
- Department of Surgery, The Johns Hopkins University School of Medicine, Colorectal Research Unit, Baltimore, Maryland
| | - Angelos Papanikolaou
- Department of Surgery, The Johns Hopkins University School of Medicine, Colorectal Research Unit, Baltimore, Maryland
| | - Alodia Gabre-Kidan
- Department of Surgery, The Johns Hopkins University School of Medicine, Colorectal Research Unit, Baltimore, Maryland
| | - Chady Atallah
- Department of Surgery, The Johns Hopkins University School of Medicine, Colorectal Research Unit, Baltimore, Maryland; Department of Surgery, NYU Langone Health, New York, New York
| | - Jonathan E Efron
- Department of Surgery, The Johns Hopkins University School of Medicine, Colorectal Research Unit, Baltimore, Maryland
| | - Bashar Safar
- Department of Surgery, The Johns Hopkins University School of Medicine, Colorectal Research Unit, Baltimore, Maryland; Department of Surgery, NYU Langone Health, New York, New York.
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Sagris M, Theofilis P, Papanikolaou A, Antonopoulos AS, Tsioufis C, Tousoulis D. Direct Oral Anticoagulants use in Patients with Stable Coronary Artery Disease, Acute Coronary Syndrome or Undergoing Percutaneous Coronary Intervention. Curr Pharm Des 2023; 29:2787-2794. [PMID: 38038010 DOI: 10.2174/0113816128259508231118141831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 10/27/2023] [Accepted: 11/06/2023] [Indexed: 12/02/2023]
Abstract
The investigation for the optimal anticoagulation strategy for patients with stable coronary artery disease, acute coronary syndromes, and undergoing percutaneous coronary intervention constitutes a great challenge for physicians and is a field of extensive research. Although aspirin is commonly recommended as a protective measure for all patients with coronary artery disease and dual antiplatelet therapy for those undergoing procedures, such as percutaneous coronary intervention or coronary artery bypass graft surgery, the risk of recurrent cardiovascular events remains significant. In this context, the shortcomings associated with the use of vitamin K antagonists have led to the assessment of direct oral anticoagulants as promising alternatives. This review will explore and provide a comprehensive analysis of the existing data regarding the use of direct oral anticoagulants in patients with stable coronary artery disease or acute coronary syndrome, as well as their effectiveness in those undergoing percutaneous coronary intervention or coronary artery bypass graft surgery.
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Affiliation(s)
- Marios Sagris
- 1st Cardiology Department, "Hippokration" General Hospital, University of Athens Medical School, Athens, Greece
| | - Panagiotis Theofilis
- 1st Cardiology Department, "Hippokration" General Hospital, University of Athens Medical School, Athens, Greece
| | - Angelos Papanikolaou
- 1st Cardiology Department, "Hippokration" General Hospital, University of Athens Medical School, Athens, Greece
| | - Alexios S Antonopoulos
- 1st Cardiology Department, "Hippokration" General Hospital, University of Athens Medical School, Athens, Greece
| | - Constantinos Tsioufis
- 1st Cardiology Department, "Hippokration" General Hospital, University of Athens Medical School, Athens, Greece
| | - Dimitris Tousoulis
- 1st Cardiology Department, "Hippokration" General Hospital, University of Athens Medical School, Athens, Greece
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13
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Vatopoulou A, Margioula-Siarkou C, Papanikolaou A. 118 Contraception practice and knowledge of IUD among teenagers and young women. Eur J Obstet Gynecol Reprod Biol 2022. [DOI: 10.1016/j.ejogrb.2022.02.147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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14
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Vatopoulou A, Daniilidis A, Dampali R, Fotas A, Papanikolaou A, Dinas K. 402 A case of acute renal failure from bilateral ureteral obstruction due to endometriosis. Eur J Obstet Gynecol Reprod Biol 2022. [DOI: 10.1016/j.ejogrb.2021.11.090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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15
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Bounas P, Karanasos A, Synetos AG, Papanikolaou A, Latsios G, Drakopoulou MI, Trantalis G, Olympios CD, Tousoulis D, Toutouzas KP. CAROTID THERMAL HETEROGENEITY DETECTED BY MICROWAVE RADIOMETRY IS ASSOCIATED WITH THIN CAP FIBROATHEROMA AND PLAQUE RUPTURE IN PATIENTS PRESENTING WITH ACUTE MYOCARDIAL INFARCTION. J Am Coll Cardiol 2022. [DOI: 10.1016/s0735-1097(22)01941-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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16
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Karanikas I, Karayiannis D, Kournidakis A, Papanikolaou A, Mastora Z, Almperti A, Katsagoni C, Chourdakis M, Kakavas S. Increased waist circumference as a predictor of outcome among hospitalized patients with acute exacerbation of chronic obstructive pulmonary disease. Clin Nutr ESPEN 2021. [DOI: 10.1016/j.clnesp.2021.09.169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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17
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Soulaidopoulos S, Drakopoulou M, Stathogiannis K, Oikonomou G, Toskas P, Xanthopoulou M, Synetos A, Latsios G, Karanasos A, Papanikolaou A, Sideris S, Tsioufis K, Toutouzas K. IMPORTANCE OF THE ELECTROCARDIOGRAPHIC STRAIN PATTERN IN PATIENTS UNDERGOING TAVI. J Am Coll Cardiol 2021. [DOI: 10.1016/s0735-1097(21)02527-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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18
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Vardas EP, Oikonomou E, Siasos G, Theofilis P, Dilaveris P, Papanikolaou A, Tousoulis D. Sex differences in clinical outcomes of patients with stable coronary artery disease after percutaneous coronary intervention. Curr Pharm Des 2021; 27:3180-3185. [PMID: 33655852 DOI: 10.2174/1381612827666210303142901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Accepted: 01/29/2021] [Indexed: 11/22/2022]
Abstract
Potential sex-related differences in the periprocedural and long-term postprocedural outcomes of coronary angioplasty in patients with stable coronary artery disease have been studied thoroughly over the last few decades, to determine whether female sex should be regarded as an independent risk factor that affects clinical outcomes. Based on a significant number of observational studies and meta-analyses, sex has not yet emerged as an independent risk factor for either mortality or major cardiac and cerebrovascular events, despite the fact that in the early 1980s, for several reasons, female sex was associated with unfavourable outcomes. Therefore, it remains debatable whether female sex should be considered as an independent risk factor for periprocedural and long-term bleeding events. The pharmacological and technological advancements that support current coronary angioplasty procedures, as well as the non-delayed treatment of coronary artery disease in females have certainly lessened the outcome differences between the two sexes. However, females show fluctuations in blood coagulability through their lifetime and higher prevalence of bleeding episodes associated with the antithrombotic treatment, following transcatheter coronary reperfusion interventions. In conclusion, the clinical results of percutaneous coronary intervention in patients with stable coronary artery disease, during the periprocedural and long-term postprocedural periods, appear to show no significant differences between the two sexes, except for bleeding rates, which seem to be higher in females, a difference that mandates further systematic research.
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Affiliation(s)
- Emmanuel P Vardas
- 1st Cardiology Clinic, 'Hippokration' General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens. Greece
| | - Evangelos Oikonomou
- 1st Cardiology Clinic, 'Hippokration' General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens. Greece
| | - Gerasimos Siasos
- 1st Cardiology Clinic, 'Hippokration' General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens. Greece
| | - Panagiotis Theofilis
- 1st Cardiology Clinic, 'Hippokration' General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens. Greece
| | - Polychronis Dilaveris
- 1st Cardiology Clinic, 'Hippokration' General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens. Greece
| | - Angelos Papanikolaou
- 1st Cardiology Clinic, 'Hippokration' General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens. Greece
| | - Dimitris Tousoulis
- 1st Cardiology Clinic, 'Hippokration' General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens. Greece
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19
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Forte E, Perkins B, Sintou A, Kalkat HS, Papanikolaou A, Jenkins C, Alsubaie M, Chowdhury RA, Duffy TM, Skelly DA, Branca J, Bellahcene M, Schneider MD, Harding SE, Furtado MB, Ng FS, Hasham MG, Rosenthal N, Sattler S. Cross-Priming Dendritic Cells Exacerbate Immunopathology After Ischemic Tissue Damage in the Heart. Circulation 2020; 143:821-836. [PMID: 33297741 PMCID: PMC7899721 DOI: 10.1161/circulationaha.120.044581] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Supplemental Digital Content is available in the text. Background: Ischemic heart disease is a leading cause of heart failure and despite advanced therapeutic options, morbidity and mortality rates remain high. Although acute inflammation in response to myocardial cell death has been extensively studied, subsequent adaptive immune activity and anti-heart autoimmunity may also contribute to the development of heart failure. After ischemic injury to the myocardium, dendritic cells (DC) respond to cardiomyocyte necrosis, present cardiac antigen to T cells, and potentially initiate a persistent autoimmune response against the heart. Cross-priming DC have the ability to activate both CD4+ helper and CD8+ cytotoxic T cells in response to necrotic cells and may thus be crucial players in exacerbating autoimmunity targeting the heart. This study investigates a role for cross-priming DC in post–myocardial infarction immunopathology through presentation of self-antigen from necrotic cardiac cells to cytotoxic CD8+ T cells. Methods: We induced type 2 myocardial infarction–like ischemic injury in the heart by treatment with a single high dose of the β-adrenergic agonist isoproterenol. We characterized the DC population in the heart and mediastinal lymph nodes and analyzed long-term cardiac immunopathology and functional decline in wild type and Clec9a-depleted mice lacking DC cross-priming function. Results: A diverse DC population, including cross-priming DC, is present in the heart and activated after ischemic injury. Clec9a−/− mice deficient in DC cross-priming are protected from persistent immune-mediated myocardial damage and decline of cardiac function, likely because of dampened activation of cytotoxic CD8+ T cells. Conclusion: Activation of cytotoxic CD8+ T cells by cross-priming DC contributes to exacerbation of postischemic inflammatory damage of the myocardium and corresponding decline in cardiac function. Importantly, this provides novel therapeutic targets to prevent postischemic immunopathology and heart failure.
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Affiliation(s)
- Elvira Forte
- The Jackson Laboratory, Bar Harbor, ME (E.F., B.P., T.M.D., D.A.S., J.B., M.B.F., M.G.H., N.R.)
| | - Bryant Perkins
- The Jackson Laboratory, Bar Harbor, ME (E.F., B.P., T.M.D., D.A.S., J.B., M.B.F., M.G.H., N.R.)
| | - Amalia Sintou
- National Heart and Lung Institute, Imperial College London, UK (A.S., H.S.K., A.P., C.J., M.A., R.A.C., M.B., M.D.S., S.E.H., F.S.N., N.R., S.S.)
| | - Harkaran S Kalkat
- National Heart and Lung Institute, Imperial College London, UK (A.S., H.S.K., A.P., C.J., M.A., R.A.C., M.B., M.D.S., S.E.H., F.S.N., N.R., S.S.)
| | - Angelos Papanikolaou
- National Heart and Lung Institute, Imperial College London, UK (A.S., H.S.K., A.P., C.J., M.A., R.A.C., M.B., M.D.S., S.E.H., F.S.N., N.R., S.S.)
| | - Catherine Jenkins
- National Heart and Lung Institute, Imperial College London, UK (A.S., H.S.K., A.P., C.J., M.A., R.A.C., M.B., M.D.S., S.E.H., F.S.N., N.R., S.S.)
| | - Mashael Alsubaie
- National Heart and Lung Institute, Imperial College London, UK (A.S., H.S.K., A.P., C.J., M.A., R.A.C., M.B., M.D.S., S.E.H., F.S.N., N.R., S.S.)
| | - Rasheda A Chowdhury
- National Heart and Lung Institute, Imperial College London, UK (A.S., H.S.K., A.P., C.J., M.A., R.A.C., M.B., M.D.S., S.E.H., F.S.N., N.R., S.S.)
| | - Theodore M Duffy
- The Jackson Laboratory, Bar Harbor, ME (E.F., B.P., T.M.D., D.A.S., J.B., M.B.F., M.G.H., N.R.)
| | - Daniel A Skelly
- The Jackson Laboratory, Bar Harbor, ME (E.F., B.P., T.M.D., D.A.S., J.B., M.B.F., M.G.H., N.R.)
| | - Jane Branca
- The Jackson Laboratory, Bar Harbor, ME (E.F., B.P., T.M.D., D.A.S., J.B., M.B.F., M.G.H., N.R.)
| | - Mohamed Bellahcene
- National Heart and Lung Institute, Imperial College London, UK (A.S., H.S.K., A.P., C.J., M.A., R.A.C., M.B., M.D.S., S.E.H., F.S.N., N.R., S.S.)
| | - Michael D Schneider
- National Heart and Lung Institute, Imperial College London, UK (A.S., H.S.K., A.P., C.J., M.A., R.A.C., M.B., M.D.S., S.E.H., F.S.N., N.R., S.S.)
| | - Sian E Harding
- National Heart and Lung Institute, Imperial College London, UK (A.S., H.S.K., A.P., C.J., M.A., R.A.C., M.B., M.D.S., S.E.H., F.S.N., N.R., S.S.)
| | - Milena B Furtado
- The Jackson Laboratory, Bar Harbor, ME (E.F., B.P., T.M.D., D.A.S., J.B., M.B.F., M.G.H., N.R.).,Amgen Biotechnology, Thousand Oaks, CA (M.B.F.)
| | - Fu Siong Ng
- National Heart and Lung Institute, Imperial College London, UK (A.S., H.S.K., A.P., C.J., M.A., R.A.C., M.B., M.D.S., S.E.H., F.S.N., N.R., S.S.)
| | - Muneer G Hasham
- The Jackson Laboratory, Bar Harbor, ME (E.F., B.P., T.M.D., D.A.S., J.B., M.B.F., M.G.H., N.R.)
| | - Nadia Rosenthal
- The Jackson Laboratory, Bar Harbor, ME (E.F., B.P., T.M.D., D.A.S., J.B., M.B.F., M.G.H., N.R.).,National Heart and Lung Institute, Imperial College London, UK (A.S., H.S.K., A.P., C.J., M.A., R.A.C., M.B., M.D.S., S.E.H., F.S.N., N.R., S.S.)
| | - Susanne Sattler
- National Heart and Lung Institute, Imperial College London, UK (A.S., H.S.K., A.P., C.J., M.A., R.A.C., M.B., M.D.S., S.E.H., F.S.N., N.R., S.S.)
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20
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Papanikolaou A, Barkas F, Liberopoulos E. Effect of estradiol E2 on serum PCSK9 levels and lipid profile in women undergoing in vitro fertilization. Atherosclerosis 2020. [DOI: 10.1016/j.atherosclerosis.2020.10.683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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21
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Soulaidopoulos S, Drakopoulou M, Stathogiannis K, Xanthopoulou M, Oikonomou G, Toskas P, Kouroutzoglou A, Synetos A, Papanikolaou A, Latsios G, Sideris S, Tousoulis D, Toutouzas K. The effect of permanent pacemaker implantation following transcatheter aortic valve implantation upon survival. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Purpose
Transcatheter aortic valve implantation (TAVI) is often followed by conduction abnormalities, leading to a permanent pacemaker implantation (PPI). Data regarding the clinical impact of PPI following TAVI is yet to be established.
Methods
Patients with severe and symptomatic aortic stenosis [effective orifice area (EOA) ≤1cm2] referred for TAVI at our institution were consecutively enrolled. Prospectively collected demographic, laboratory and echocardiographic data were retrospectively analyzed. Patients were stratified into two groups according to the need for PPI after TAVI and were followed up postoperatively with clinical and echocardiographic assessment. Primary clinical endpoint was all-cause mortality, as defined by the criteria proposed by the Valve Academic Research Consortium 2.
Results
In total, 292 patients were included (male: 50.2%, mean age: 80±7.6 years) in our study. Of these, 109 (37.5%) underwent PPI simultaneously or shortly after TAVI. The median follow-up period was 27.3 In this period, all-cause mortality showed no significant difference between patients with and those without PPI after TAVI (log-rank p=0.756), even after excluding patients with a pre-existing pacemaker from the analysis. Subgroup analysis also showed no difference in survival between patients with low ejection fraction (<50%) and those with preserved (≥50%) receiving a permanent pacemaker after TAVR (log-rank p=0.269). Taking into consideration factors that were found to associate to PPI in univariate analysis (pre TAVI - ejection fraction, pulmonary artery systolic pressure and New York Heart Association functional class) in a multivariate model, pre TAVI pulmonary artery systolic pressure was found to be an independent predictor of peri-procedural PPI [Exp(B): 0.977, 95% Confidence Interval: 0.957–0.998, B=−0.023, p=0.029]. Pre-TAVI conduction abnormalities and the degree of aortic annulus calcification, as assessed by computed-tomography, were not found to predict PPI after TAVI.
Conclusion
PPI following TAVI was not associated with survival at 27 months of follow-up, independently from the pre TAVI ejection fraction.
Figure 1
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- S Soulaidopoulos
- Hippokration General Hospital, First Department of Cardiology, Medical School of Athens, Athens, Greece
| | - M Drakopoulou
- Hippokration General Hospital, First Department of Cardiology, Medical School of Athens, Athens, Greece
| | - K Stathogiannis
- Hippokration General Hospital, First Department of Cardiology, Medical School of Athens, Athens, Greece
| | - M Xanthopoulou
- Hippokration General Hospital, First Department of Cardiology, Medical School of Athens, Athens, Greece
| | - G Oikonomou
- Hippokration General Hospital, First Department of Cardiology, Medical School of Athens, Athens, Greece
| | - P Toskas
- Hippokration General Hospital, First Department of Cardiology, Medical School of Athens, Athens, Greece
| | - A Kouroutzoglou
- Hippokration General Hospital, First Department of Cardiology, Medical School of Athens, Athens, Greece
| | - A Synetos
- Hippokration General Hospital, First Department of Cardiology, Medical School of Athens, Athens, Greece
| | - A Papanikolaou
- Hippokration General Hospital, First Department of Cardiology, Medical School of Athens, Athens, Greece
| | - G Latsios
- Hippokration General Hospital, First Department of Cardiology, Medical School of Athens, Athens, Greece
| | - S Sideris
- Hippokration General Hospital, First Department of Cardiology, Medical School of Athens, Athens, Greece
| | - D Tousoulis
- Hippokration General Hospital, First Department of Cardiology, Medical School of Athens, Athens, Greece
| | - K Toutouzas
- Hippokration General Hospital, First Department of Cardiology, Medical School of Athens, Athens, Greece
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Bounas P, Karanasos A, Synetos A, Papanikolaou A, Latsios G, Drakopoulou M, Trantalis G, Olympios C, Tousoulis D, Toutouzas K. Thin cap fibroatheroma and plaque rupture is associated with carotid thermal heterogeneity in patients presenting with acute myocardial infarction. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Microwave radiometry (MWR) has been applied successfully in the evaluation of carotid atherosclerosis, measuring reliably temperature heterogeneity of atherosclerotic plaques. Recent studies have shown an association between increased carotid temperature heterogeneity (ΔT) detected by MWR and cardiovascular events. Vulnerable plaques of the coronary arteries, share common characteristics such as the thin cap fibrous cap, that make the prone to rupture in the presence of stimulus such as shear stress or inflammation. Optical coherence tomography (OCT) is an imaging method, by which the fibrous cap and the presence of plaque rupture can be accurately in vivo visualized.
Purpose
To evaluate the impact of carotid temperature heterogeneity on the culprit plaque morphology on patients presenting with acute myocardial infarction.
Method
A total of 37 patients undergoing percutaneous coronary intervention (PCI) for an acute myocardial infarction who had an identifiable de novo culprit lesion in a native coronary artery, were enrolled in this study. All patients underwent PCI and Optical Coherence Study (OCT) within 12 hours since symptom onset. The OCT study was performed according to the standard techniques and acquired images were analyzed by 2 independent investigators., After the completion of the PCI all patients underwent MWR of both carotid arteries and ΔT was defined as maximal temperature detected along each carotid artery minus minimum.
Results
Thirty four patients with acute myocardial infarction 21 with STEMI (61.76%) and 13 (38.23%) with NSTEMI were included in the study. Thin cap fibroatheroma (TCFA) was present in 31 patients (91.1%), while all ruptured plaques had a TCFA compared to 11 TCFA (78.57%) observed in plaques that had no rupture (p=0.03). HsCRP was significantly increased in ruptured plaques compared to non ruptured ones (14.41±4.02 versus 9.9±2.5, p<0.005). Mean ΔT was significantly increased in ruptured plaques compared to no ruptured ones (1.01±0.31 versus 0.51±0.14°C, p<0.005), as well as in plaques with TCFA compared to those without a TCFA (0.82±0.37 versus 0.60±0.05°C, p=0.001). In the multivariate analysis DM, hsCRP, and ΔT were entered from which DM (OR 4.12; 95% CI 0.77–22.07; P=0.07) and ΔTau ((OR for 0.1°C increase 1.43; 95% CI 1.03–1.98; P=0.03) remained in the final model, with ΔT being the only variable independently associated with the presence of TCFA. Similarly regarding plaque rupture, STEMI, hsCRP, and ΔT were entered in the multivariate analysis from which hsCRP (OR 1.51; 95% CI 0.99–2.28; P=0.051) and ΔTau ((OR for 0.1°C increase 3.40; 95% CI 1.29–8.96; P=0.013) remained in the final model, with ΔT being the only variable independently associated with the presence of rupture.
Conclusions
Carotid thermal heterogeneity is associated with TCFA and plaque rupture in patients with acute myocardial infarction.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- P Bounas
- Thriassio General Hospital, Athens, Greece
| | - A Karanasos
- University of Athens Medical School, 1st Department of Cardiology, Athens, Greece
| | - A Synetos
- University of Athens Medical School, 1st Department of Cardiology, Athens, Greece
| | - A Papanikolaou
- University of Athens Medical School, 1st Department of Cardiology, Athens, Greece
| | - G Latsios
- University of Athens Medical School, 1st Department of Cardiology, Athens, Greece
| | - M Drakopoulou
- University of Athens Medical School, 1st Department of Cardiology, Athens, Greece
| | - G Trantalis
- University of Athens Medical School, 1st Department of Cardiology, Athens, Greece
| | - C Olympios
- Thriassio General Hospital, Athens, Greece
| | - D Tousoulis
- University of Athens Medical School, 1st Department of Cardiology, Athens, Greece
| | - K Toutouzas
- University of Athens Medical School, 1st Department of Cardiology, Athens, Greece
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23
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Bounas P, Synetos A, Karanasos A, Papanikolaou A, Drakopoulou M, Latsios G, Trantalis G, Olympios C, Tousoulis D, Toutouzas K. Coronary plaque rupture is associated with carotid thermal heterogeneity in patients presenting with acute myocardial infarction. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Vulnerable plaques of the coronary arteries, share common characteristics such as the thin cap fibrous cap, that make the prone to rupture in the presence of stimulus such as shear stress or inflammation. Optical coherence tomography (OCT) is an imaging method, by which the fibrous cap and the presence of plaque rupture can be accurately in vivo visualized. Recent studies have shown an association between increased carotid temperature heterogeneity (ΔT) detected by microwave radiometry (MWR) and cardiovascular events.
Purpose
To evaluate the impact of carotid temperature heterogeneity on the culprit plaque morphology on patients presenting with acute myocardial infarction.
Method
A total of 37 patients undergoing percutaneous coronary intervention (PCI) for an acute myocardial infarction who had an identifiable de novo culprit lesion in a native coronary artery, were enrolled in this study. All patients underwent PCI and Optical Coherence Study (OCT) within 12 hours since symptom onset. The culprit lesion of the angiogram was clearly identified by a combination of ECG, wall motion abnormalities seen in cardiac ultrasound, and coronary angiogram. The OCT study was performed using the LightLab OCT wire, and acquired images were analyzed by 2 independent investigators using previously validated criteria for OCT plaque characterization. After the completion of the PCI all patients underwent MWR of both carotid arteries and ΔT was defined as maximal temperature detected along each carotid artery minus minimum.
Results
Thirty four patients with acute myocardial infarction 21 with STEMI (61.76%) and 13 (38.23%) with NSTEMI were included in the study. STEMI patients had more ruptured plaques compared to NSTEMI patients (71.41 versus 38.46%, p=0.053). Thin cap fibroatheroma (TCFA) was present in 31 patients (91.1%), while all ruptured plaques had a TCFA compared to 11 TCFA (78.57%) observed in plaques that had no rupture (p=0.03). HsCRP was significantly increased in ruptured plaques compared to non ruptured ones (14.41±4.02 versus 9.9±2,5, p<0.005). Mean ΔT was significantly increased in ruptured plaques compared to no ruptured ones (1.01±0.31 versus 0.51±0.14°C, p<0.005), as well as in plaques with TCFA compared to those without a TCFA (0.82±0.37 versus 0.60±0.05°C, p=0.001). In the multivariate analysis, STEMI, hsCRP, and ΔT were entered from which hsCRP (OR 1.51; 95% CI 0.99–2.28; P=0.051) and ΔT ((OR for 0.1°C increase 3.40; 95% CI 1.29–8.96; P=0.013) remained in the final model, with ΔT being the only variable independently associated with the presence of rupture.
Conclusions
Carotid thermal heterogeneity is associated with the presence of plaque rupture in patients with acute myocardial infarction. Further studies are needed in order to assess the possible prognostic impact of carotid ΔT on such population.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- P Bounas
- Thriassio General Hospital, Athens, Greece
| | - A Synetos
- University of Athens Medical School, 1st Department of Cardiology, Athens, Greece
| | - A Karanasos
- University of Athens Medical School, 1st Department of Cardiology, Athens, Greece
| | - A Papanikolaou
- University of Athens Medical School, 1st Department of Cardiology, Athens, Greece
| | - M Drakopoulou
- University of Athens Medical School, 1st Department of Cardiology, Athens, Greece
| | - G Latsios
- University of Athens Medical School, 1st Department of Cardiology, Athens, Greece
| | - G Trantalis
- University of Athens Medical School, 1st Department of Cardiology, Athens, Greece
| | - C Olympios
- Thriassio General Hospital, Athens, Greece
| | - D Tousoulis
- University of Athens Medical School, 1st Department of Cardiology, Athens, Greece
| | - K Toutouzas
- University of Athens Medical School, 1st Department of Cardiology, Athens, Greece
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Drakopoulou M, Soulaidopoulos S, Stathogiannis K, Oikonomou G, Toskas P, Kouroutzoglou A, Papanikolaou A, Synetos A, Latsios G, Sideris S, Tousoulis D, Toutouzas K. Prognostic implication of electrocardiographic left ventricular strain in patients undergoing Transcatheter Aortic Valve Implantation. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Electrocardiographic (ECG) strain has been linked to excess cardiovascular morbidity and mortality in asymptomatic patients with aortic stenosis.
Purpose
We aim to determine the differential impact of baseline ECG-strain on long-term mortality after transcatheter aortic valve implantation (TAVI).
Methods
Patients with severe and symptomatic aortic stenosis (effective orifice area [EOA]≤1cm2), who were scheduled for TAVI with a self-expanding valve between May 2015 and May 2018 were consecutively enrolled. Left ventricular strain was defined as the presence of ≥1mm convex ST-segment depression with asymmetrical T-wave inversion in leads V5 to V6 on baseline ECG. Patients were excluded, if they had bundle branch block or a permanent pacemaker at baseline. Baseline parameters were compared, and multivariate Cox proportional hazard regression models were generated to assess outcome difference. The primary clinical endpoint was cumulative mortality defined according to the criteria proposed by the Valve Academic Research Consortium-2.
Results
Of the 171 patients screened, 56 patients were excluded due to left bundle branch block or paced rhythm. In the 115 included patients (mean age: 81.4±7), 36 patients (31.3%) had strain pattern on pre-TAVI ECG. There were no differences in baseline characteristics between the two groups. During a median follow-up of 2.32 years (IQR 1.62 to 3), 11 patients (9.6%) reached the primary clinical endpoint. Patients in the strain group had higher incidence of all-cause mortality compared to patients without left ventricular strain (25% vs 2.5%, χ2=14.4, p<0.001). Kaplan-Meier survival analysis showed a significantly decreased cumulative probability of survival at 3 years in patients with LV-strain compared with patients without LV-strain (log-rank p=0.002, Figure 1). In the multivariate analysis, left ventricular strain [Exp(B): 8.952, 95% Confidence Interval (CI): 1.215–65.938, B=2.192, p=0.031] and QRS duration [Exp(B): 1.058, 95% CI: 1.022–1.095, B=0.056, p<0.001] were found to be independent predictors of all-cause mortality after TAVI.
Conclusion
Baseline ECG left ventricular strain was an independent predictor of long-term mortality post TAVI. Systematic strain measurements might aid in risk-stratifying patients scheduled for TAVI.
Figure 1
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- M Drakopoulou
- Hippokration General Hospital, First Department of Cardiology, Medical School of Athens, Athens, Greece
| | - S Soulaidopoulos
- Hippokration General Hospital, First Department of Cardiology, Medical School of Athens, Athens, Greece
| | - K Stathogiannis
- Hippokration General Hospital, First Department of Cardiology, Medical School of Athens, Athens, Greece
| | - G Oikonomou
- Hippokration General Hospital, First Department of Cardiology, Medical School of Athens, Athens, Greece
| | - P Toskas
- Hippokration General Hospital, First Department of Cardiology, Medical School of Athens, Athens, Greece
| | - A Kouroutzoglou
- Hippokration General Hospital, First Department of Cardiology, Medical School of Athens, Athens, Greece
| | - A Papanikolaou
- Hippokration General Hospital, First Department of Cardiology, Medical School of Athens, Athens, Greece
| | - A Synetos
- Hippokration General Hospital, First Department of Cardiology, Medical School of Athens, Athens, Greece
| | - G Latsios
- Hippokration General Hospital, First Department of Cardiology, Medical School of Athens, Athens, Greece
| | - S Sideris
- Hippokration General Hospital, First Department of Cardiology, Medical School of Athens, Athens, Greece
| | - D Tousoulis
- Hippokration General Hospital, First Department of Cardiology, Medical School of Athens, Athens, Greece
| | - K Toutouzas
- Hippokration General Hospital, First Department of Cardiology, Medical School of Athens, Athens, Greece
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25
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Paschali A, Panagiotidis E, Triantafyllou T, Palaska V, Tsirou K, Verrou E, Υiannaki E, Markala D, Papanikolaou A, Pouli A, Konstantinidou P, Chatzipavlidou V, Terpos E, Katodritou E. A proposed index of diffuse bone marrow [18F]-FDG uptake and PET skeletal patterns correlate with myeloma prognostic markers, plasma cell morphology, and response to therapy. Eur J Nucl Med Mol Imaging 2020; 48:1487-1497. [PMID: 33099659 DOI: 10.1007/s00259-020-05078-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 10/15/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE The investigation of a semi-quantitative index in the pelvis to assess for diffuse bone marrow (BM) [18F]-FDG uptake and the investigation of PET skeletal patterns in multiple myeloma (MM) patients, in accordance with prognostic markers, clonal plasma cell (cPC) morphology, and response to therapy. METHODS We prospectively analyzed [18F]-FDG PET/CT in 90 MM patients (newly diagnosed, 60; relapsed/refractory, 30). Among other PET/CT parameters, we calculated the ratio SUVmax pelvis/liver and examined for correlations with known MM prognostic parameters, cPC morphology (good vs. low/intermediate differentiation), and response to therapy. RESULTS SUVmax pelvis/liver ratio was significantly lower for the group of good differentiation vs. intermediate/low differentiation cPCs (p < 0.001) and showed a positive correlation with BM infiltration rate, β2 microglobulin, serum ferritin, international staging system (ISS), and revised ISS; no significant correlation was found with hemoglobin. A cutoff value of 1.1 showed an excellent specificity (99%) and high sensitivity (76%) for diffuse BM involvement (AUC 0.94; p < 0.001). Mixed pattern and appendicular involvement correlated with poor prognostic features while normal pattern, found in 30% of patients, correlated with good prognostic features. Presence of ≥ 10 focal lesions negatively predicted for overall response (p < 0.05; OR 4.8). The CT component improved the diagnostic performance of PET. CONCLUSION This study showed, for the first time, that cPC morphology and markers related with MM biology, correlate with SUVmax pelvis/liver index, which could be used as a surrogate marker for BM assessment and disease prognosis; PET patterns correlate with MM prognostic features and response rates.
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Affiliation(s)
- A Paschali
- Department of Nuclear Medicine, Theagenion Cancer Hospital, Thessaloniki, Greece.
| | - E Panagiotidis
- Department of Nuclear Medicine, Theagenion Cancer Hospital, Thessaloniki, Greece
| | - T Triantafyllou
- Department of Hematology, Theagenion Cancer Hospital, Thessaloniki, Greece
| | - V Palaska
- Department of Hematology, Theagenion Cancer Hospital, Thessaloniki, Greece
| | - K Tsirou
- Department of Hematology, Theagenion Cancer Hospital, Thessaloniki, Greece
| | - E Verrou
- Department of Hematology, Theagenion Cancer Hospital, Thessaloniki, Greece
| | - E Υiannaki
- Hematology/Flow cytometry Lab, Theagenion Cancer Hospital, Thessaloniki, Greece
| | - D Markala
- Hematology/Flow cytometry Lab, Theagenion Cancer Hospital, Thessaloniki, Greece
| | - A Papanikolaou
- Hematopathology Department, Evangelismos General Hospital, Athens, Greece
| | - A Pouli
- Hematology Department, "St Savvas" Oncology Hospital, Athens, Greece
| | - P Konstantinidou
- Department of Hematology, Theagenion Cancer Hospital, Thessaloniki, Greece
| | - V Chatzipavlidou
- Department of Nuclear Medicine, Theagenion Cancer Hospital, Thessaloniki, Greece
| | - E Terpos
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - E Katodritou
- Department of Hematology, Theagenion Cancer Hospital, Thessaloniki, Greece
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Drakopoulou M, Soulaidopoulos S, Oikonomou G, Kouroutzoglou A, Toskas P, Stathogiannis K, Xanthopoulou M, Synetos A, Latsios G, Papanikolaou A, Sideris S, Tousoulis D, Toutouzas K. TCT CONNECT-102 Early Recovery of Left Ventricular Systolic Function After Transcatheter Aortic Valve Implantation. J Am Coll Cardiol 2020. [DOI: 10.1016/j.jacc.2020.09.116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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27
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Oikonomou E, Papanikolaou A, Anastasakis A, Bournousouzis E, Georgakopoulos C, Goudevenos J, Ioakeimidis N, Kanakakis J, Lazaros G, Papatheodorou S, Tsatsopoulou A, Tsonou P, Vogiatzi G, Panagiotakopoulos G, Tousoulis D, Vlachopoulos C. Proposed algorithm for return to sports in competitive athletes who have suffered COVID-19. Hellenic J Cardiol 2020; 62:175-177. [PMID: 32634475 PMCID: PMC7335237 DOI: 10.1016/j.hjc.2020.06.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 06/17/2020] [Accepted: 06/19/2020] [Indexed: 02/08/2023] Open
Affiliation(s)
- Evangelos Oikonomou
- EKKAN (Unit for the Athletes and for Hereditary Cardiovascular Diseases), 1st Department of Cardiology, Hippokration Hospital, Medical School of National and Kapodistrian University of Athens, Athens 11527, Greece
| | - Angelos Papanikolaou
- EKKAN (Unit for the Athletes and for Hereditary Cardiovascular Diseases), 1st Department of Cardiology, Hippokration Hospital, Medical School of National and Kapodistrian University of Athens, Athens 11527, Greece
| | - Aris Anastasakis
- Unit of Inherited and Rare Cardiovascular Diseases, Onassis Cardiac Surgery Centre, Greece
| | | | - Christos Georgakopoulos
- EKKAN (Unit for the Athletes and for Hereditary Cardiovascular Diseases), 1st Department of Cardiology, Hippokration Hospital, Medical School of National and Kapodistrian University of Athens, Athens 11527, Greece
| | - John Goudevenos
- Department of Cardiology, University of Ioannina Medical School, Greece
| | - Nikolaos Ioakeimidis
- EKKAN (Unit for the Athletes and for Hereditary Cardiovascular Diseases), 1st Department of Cardiology, Hippokration Hospital, Medical School of National and Kapodistrian University of Athens, Athens 11527, Greece
| | - John Kanakakis
- Department of Clinical Therapeutics, University of Athens, Alexandra Hospital, Athens, Greece
| | - George Lazaros
- EKKAN (Unit for the Athletes and for Hereditary Cardiovascular Diseases), 1st Department of Cardiology, Hippokration Hospital, Medical School of National and Kapodistrian University of Athens, Athens 11527, Greece
| | - Stathis Papatheodorou
- Unit of Inherited and Rare Cardiovascular Diseases, Onassis Cardiac Surgery Centre, Greece
| | | | | | - Georgia Vogiatzi
- EKKAN (Unit for the Athletes and for Hereditary Cardiovascular Diseases), 1st Department of Cardiology, Hippokration Hospital, Medical School of National and Kapodistrian University of Athens, Athens 11527, Greece
| | | | - Dimitris Tousoulis
- EKKAN (Unit for the Athletes and for Hereditary Cardiovascular Diseases), 1st Department of Cardiology, Hippokration Hospital, Medical School of National and Kapodistrian University of Athens, Athens 11527, Greece
| | - Charalambos Vlachopoulos
- EKKAN (Unit for the Athletes and for Hereditary Cardiovascular Diseases), 1st Department of Cardiology, Hippokration Hospital, Medical School of National and Kapodistrian University of Athens, Athens 11527, Greece.
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Papaioannou TG, Georgiopoulos G, Stamatelopoulos KS, Protogerou AD, Alexandraki KI, Argyris A, Vrachatis DA, Soulis D, Papanikolaou A, Manolesou D, Daskalopoulou SS, Tousoulis D. Blood pressure variability within a single visit and all-cause mortality. Neth J Med 2020; 78:175-182. [PMID: 32641542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND Within-visit variability of repeated sequential readings of blood pressure (BP) is an important phenomenon that may affect precision of BP measurement and thus decision making concerning BP-related risk and hypertension management. However, limited data exist concerning predictive ability of within-visit BP variability for clinical outcomes. Therefore, we aimed to investigate the association between the variability of three repeated office BP measurements and the risk of all-cause mortality, independent of BP levels. METHODS Data collected through the National Health and Nutrition Examination Survey (NHANES) were analysed. NHANES is a program of studies designed to assess health and nutritional status of adults and children in the United States. A complete set of three sequential BP measurements, together with survival status, were available for 24969 individuals (age 46.8±;19.3 years, 49% males). Multivariable logistic regression models were used to determine the prognostic ability of the examined demographic, clinical, and haemodynamic indices. RESULTS Among various examined indices of variability of systolic (SBP) and diastolic (DBP) blood pressure measurements, the standard deviation of DBP (DBPSD) was the stronger independent predictor of mortality (odds ratio 1.064, 95% Confidence Interval: 1.011-1.12) after adjustment for age, sex, body mass index, smoking, SBP, heart rate, history of hypertension, diabetes mellitus, hypercholesterolaemia, and cardiovascular events. CONCLUSION Within-visit variability of three sequential office DBP readings may allow for the identification of high-risk patients better than mean SBP and DBP levels. The predictive value of within-visit BP variability and methods to improve its clinical application are worthy of further research.
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Affiliation(s)
- T G Papaioannou
- First Department of Cardiology, Biomedical Engineering Unit, Hippokration Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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29
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Boklund A, Dhollander S, Chesnoiu Vasile T, Abrahantes JC, Bøtner A, Gogin A, Gonzalez Villeta LC, Gortázar C, More SJ, Papanikolaou A, Roberts H, Stegeman A, Ståhl K, Thulke HH, Viltrop A, Van der Stede Y, Mortensen S. Risk factors for African swine fever incursion in Romanian domestic farms during 2019. Sci Rep 2020; 10:10215. [PMID: 32576841 PMCID: PMC7311386 DOI: 10.1038/s41598-020-66381-3] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 05/18/2020] [Indexed: 01/06/2023] Open
Abstract
African swine fever (ASF) entered Georgia in 2007 and the EU in 2014. In the EU, the virus primarily spread in wild boar (Sus scrofa) in the period from 2014-2018. However, from the summer 2018, numerous domestic pig farms in Romania were affected by ASF. In contrast to the existing knowledge on ASF transmission routes, the understanding of risk factors and the importance of different transmission routes is still limited. In the period from May to September 2019, 655 Romanian pig farms were included in a matched case-control study investigating possible risk factors for ASF incursion in commercial and backyard pig farms. The results showed that close proximity to outbreaks in domestic farms was a risk factor in commercial as well as backyard farms. Furthermore, in backyard farms, herd size, wild boar abundance around the farm, number of domestic outbreaks within 2 km around farms, short distance to wild boar cases and visits of professionals working on farms were statistically significant risk factors. Additionally, growing crops around the farm, which could potentially attract wild boar, and feeding forage from ASF affected areas to the pigs were risk factors for ASF incursion in backyard farms.
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Affiliation(s)
- A Boklund
- University of Copenhagen, Faculty of Health and Medical Sciences, Section for Animal Welfare and Disease Control, Grønnegårdsvej 8, 1870, Frederiksberg C, Denmark.
| | - S Dhollander
- European Food Safety Authority, Via Carlo Magno 1A, 43126, Parma, Italy
| | - T Chesnoiu Vasile
- The National Sanitary Veterinary and Food Safety Authority, Bucharest, Piata Free Press no. 1 Body D1, District 1, Post Code 013 701, Bucharest, Romania
| | - J C Abrahantes
- European Food Safety Authority, Via Carlo Magno 1A, 43126, Parma, Italy
| | - A Bøtner
- University of Copenhagen, Faculty of Health and Medical Sciences, Section for Veterinary Clinical Microbiology, Stigbøjlen 4, 1870, Frederiksberg C, Denmark
- Statens Serum Institut, Department of Virus and Microbiological Special Diagnostics, Artillerivej 5, 2300, Copenhagen S, Denmark
| | - A Gogin
- Federal Research Center for Virology and Microbiology, 601125, Volginsky, Russia
| | | | - C Gortázar
- SaBio research group at IREC (Universidad de Castilla-La Mancha & CSIC), Ronda de Toledo 12, 13003, Ciudad Real, Spain
| | - S J More
- Centre for Veterinary Epidemiology and Risk Analysis, UCD School of Veterinary Medicine, University College Dublin, Belfield, Dublin, D04 W6F6, Ireland
| | - A Papanikolaou
- European Food Safety Authority, Via Carlo Magno 1A, 43126, Parma, Italy
| | - H Roberts
- Department for Environment Food and Rural Affairs (DEFRA), Exotic Disease Control team, Area 2D, Nobel House, 17 Smith Square, London, SW1P 3JR, England
| | - A Stegeman
- Utrecht University, Faculty of Veterinary Medicine, Yalelaan 7, Utrecht, The Netherlands
| | - K Ståhl
- National Veterinary Institute, 751 89, Uppsala, Sweden
| | - H H Thulke
- Helmholtz Centre for Environmental Research GmbH - UFZ, Department of Ecological Modelling, PG EcoEpi, Permoserstr. 15, Leipzig, Germany
| | - A Viltrop
- Estonian University of Life Sciences, Institute of Veterinary Medicine and Animal Sciences, Kreutzwaldi 62, Tartu, 51006, Estonia
| | - Y Van der Stede
- European Food Safety Authority, Via Carlo Magno 1A, 43126, Parma, Italy
| | - S Mortensen
- Danish Veterinary and Food Administration, Stationsparken 31-33, 2600, Glostrup, Denmark
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30
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Tsioufis K, Chrysohoou C, Kariori M, Leontsinis I, Dalakouras I, Papanikolaou A, Charalambus G, Sambatakou H, Siasos G, Panagiotakos D, Tousoulis D. The mystery of "missing" visits in an emergency cardiology department, in the era of COVID-19.; a time-series analysis in a tertiary Greek General Hospital. Clin Res Cardiol 2020; 109:1483-1489. [PMID: 32506198 PMCID: PMC7275652 DOI: 10.1007/s00392-020-01682-1] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 05/28/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND In the era of the current COVID-19 health crisis, the aim of the present study was to explore population behavior as regards the visits in the Εmergency Cardiology department (ECD) of a tertiary General Hospital that does not hospitalize SARS-CoV-2 infected patients METHODS AND RESULTS: Daily number of visits at the EDC and admissions to Cardiology Wards and Intensive Care Unit of a tertiary General Hospital, in Athens, Greece, were retrieved from hospital's database (January 1st-April 30th 2018, 2019 and 2020). A highly significant reduction in the visits at ECD of the hospital during March and April 2020 was observed as compared with January and February of the same year (p for linear trend < ·001); in particular the number of visits was 41.1% lower in March 2020 and 32.7% lower in April 2020, as compared to January 2020. As the number of confirmed COVID-19 cases throughout the country increased (i.e., from February 26th to April 2nd) the number of visits at ECD decreased (p = 0.01), whereas, the opposite was observed in the period afterwards (p = 0.01).The number of acute Myocardial infarctions (MI) cases in March 2020 was the lowest compared to the entire three year period (p < 0·001); however, the number of acute MI cases in April 2020 was doubled as compared to March 2020, but still was lower than the preceding years (p < 0·001). CONCLUSIONS It is hard to explain the mystery of the "missing" emergency hospital visits. However, if this decline in cardiovascular disease related hospital visits is "true", it is something that needs to be rigorously studied, to learn how to keep these rates down.
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Affiliation(s)
- Konstantinos Tsioufis
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, 114 Vass Sofias Ave, 11527, Athens, Greece.
| | - Christina Chrysohoou
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, 114 Vass Sofias Ave, 11527, Athens, Greece
| | - Maria Kariori
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, 114 Vass Sofias Ave, 11527, Athens, Greece
| | - Ioannis Leontsinis
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, 114 Vass Sofias Ave, 11527, Athens, Greece
| | - Ioannis Dalakouras
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, 114 Vass Sofias Ave, 11527, Athens, Greece
| | - Angelos Papanikolaou
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, 114 Vass Sofias Ave, 11527, Athens, Greece
| | | | - Helen Sambatakou
- 2nd Department of Internal Medicine, HIV Unit, Medical School, Hippokration General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Gerasimos Siasos
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, 114 Vass Sofias Ave, 11527, Athens, Greece
| | | | - Dimitrios Tousoulis
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, 114 Vass Sofias Ave, 11527, Athens, Greece
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31
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Angelis A, Chrysohoou C, Laina A, Antoniou CK, Konstantinou K, Aznaourides K, Georgakopoulos C, Papanikolaou A, Dilaveris P, Vlachopoulos C, Tousoulis D. P4534The Mediterranean diet benefit in chronic heart failure by decoding central and peripheral vessel rheology, atheroma formation and serum prolactin levels. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Central hemodynamics and especially wave reflection amplification exhibit a vital parameter of chronic heart failure (CHF) physiology. Erectile dysfunction (ED) displays a poor peripheral vessel rheology and serum prolactin role is still debated in CHF mechanisms. The Mediterranean diet (Med-diet) is famous for its vasoprotective and wellbeing properties.
Purpose
To investigate the effect of the Med-diet in central hemodynamics, erectile status, atheroma formation and serum prolactin levels in male patients with chronic heart failure.
Methods
123 CHF male patients under optimal medical therapy enrolled the study (mean age: 65±8 yo, NYHA class II, ejection fraction <40%). All underwent evaluation of the carotid – femoral pulse wave velocity (PWV), estimation of central pressures and augmentation index (AIx) as parameter of wave reflection amplification (sphygmocor device). Ejection fraction (EF) of the left ventricle was estimated by using 2D echocardiography (Simpson method). ED severity and adherence to the Med-diet were assessed by the SHIM-5 (range: 0–25) and the Med-diet (range: 0–55) scores. Higher values point to better erectile function and a great Med-diet compliance respectively. Detection of atheroma was based on the intima- media thickness (IMT) of the common carotid artery. Prolactin levels were assessed in morning blood samples taken before 09:00 am.
Results
The SHIM −5 score (mean: 12±4) was associated to the AIx (p=0,03, r=0,75) and both positively and strongly related to the Med-diet score (p=0,01, r=0,8 and p=0,01, r=0,75 respectively). Med-diet compliance was negatively associated to IMT (p=0,02, r=−0,8) and serum prolactin levels (p=0,03, r=−0,6).Moreover, we notice a positive association between prolactin and the IMT (p=0,04, r=0,7). By multiple linear regression analysis the relation of SHIM-5 and Med-diet score remained significant (p=0,04) after adjustment for BMI, central pulse and mean arterial pressures. We further subdivide our population according to the mean Med-diet value (28) into high and low Med-diet adherence groups. Only in the group with the greater Med-diet adherence (n=73, 60%) AIx was strongly associated to the SHIM-5 score (p=0,02) even after adjustment for PWV, age and BMI. Prolactin levels there were still related to IMT (p=0,04) after adjustment for PWV, AIx, BMI and central pulse pressure. All statistics remained significant when adjusting for ejection fraction of the left ventricle.
Conclusion
High adherence to the Med-diet benefits CHF hemodynamics by enforcing wave reflection amplification, thus generating a stronger pulse signal to peripheral vasculature. Moreover suppresses serum prolactin levels that relates to atheroma formation. Both actions enhance erectile performance independently of the EF of the left ventricle. It is important to advise CHF patients to adopt this dietary pattern in order to improve hemodynamic status and the sense of wellbeing.
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Affiliation(s)
- A Angelis
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
| | - C Chrysohoou
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
| | - A Laina
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
| | - C.-K Antoniou
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
| | - K Konstantinou
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
| | - K Aznaourides
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
| | - C Georgakopoulos
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
| | - A Papanikolaou
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
| | - P Dilaveris
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
| | - C Vlachopoulos
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
| | - D Tousoulis
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
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32
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Foukas P, Koliou GA, Papoudou-Bai A, Charchanti A, Vrettou E, Poulios C, Chatzopoulos K, Kotoula V, Fountzilas E, Zakopoulou R, Visvikis A, Pentheroudakis G, Pectasides D, Aravantinos G, Oikonomopoulos G, Papanikolaou A, Haidopoulos D, Zagouri F, Fountzilas G, Goussia A. Prognostic significance of elements of the adaptive immunity in the microenvironment of epithelial ovarian cancer. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz250.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Baxan N, Papanikolaou A, Salles-Crawley I, Lota A, Chowdhury R, Dubois O, Branca J, Hasham MG, Rosenthal N, Prasad SK, Zhao L, Harding SE, Sattler S. Characterization of acute TLR-7 agonist-induced hemorrhagic myocarditis in mice by multiparametric quantitative cardiac magnetic resonance imaging. Dis Model Mech 2019; 12:dmm040725. [PMID: 31324689 PMCID: PMC6737951 DOI: 10.1242/dmm.040725] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Accepted: 07/12/2019] [Indexed: 12/23/2022] Open
Abstract
Hemorrhagic myocarditis is a potentially fatal complication of excessive levels of systemic inflammation. It has been reported in viral infection, but is also possible in systemic autoimmunity. Epicutaneous treatment of mice with the Toll-like receptor 7 (TLR-7) agonist Resiquimod induces auto-antibodies and systemic tissue damage, including in the heart, and is used as an inducible mouse model of systemic lupus erythematosus (SLE). Here, we show that overactivation of the TLR-7 pathway of viral recognition by Resiquimod treatment of CFN mice induces severe thrombocytopenia and internal bleeding, which manifests most prominently as hemorrhagic myocarditis. We optimized a cardiac magnetic resonance (CMR) tissue mapping approach for the in vivo detection of diffuse infiltration, fibrosis and hemorrhages using a combination of T1, T2 and T2* relaxation times, and compared results with ex vivo histopathology of cardiac sections corresponding to CMR tissue maps. This allowed detailed correlation between in vivo CMR parameters and ex vivo histopathology, and confirmed the need to include T2* measurements to detect tissue iron for accurate interpretation of pathology associated with CMR parameter changes. In summary, we provide detailed histological and in vivo imaging-based characterization of acute hemorrhagic myocarditis as an acute cardiac complication in the mouse model of Resiquimod-induced SLE, and a refined CMR protocol to allow non-invasive longitudinal in vivo studies of heart involvement in acute inflammation. We propose that adding T2* mapping to CMR protocols for myocarditis diagnosis improves diagnostic sensitivity and interpretation of disease mechanisms.This article has an associated First Person interview with the first author of the paper.
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Affiliation(s)
- Nicoleta Baxan
- Biological Imaging Centre, Department of Medicine, Imperial College London, London W12 0NN, UK
| | | | | | - Amrit Lota
- Royal Brompton Hospital, Royal Brompton and Harefield NHS Foundation Trust, London SW3 6NP, UK
| | - Rasheda Chowdhury
- National Heart and Lung Institute, Imperial College London, London W12 0NN, UK
| | - Olivier Dubois
- Biological Imaging Centre, Department of Medicine, Imperial College London, London W12 0NN, UK
| | - Jane Branca
- The Jackson Laboratory, 600 Main Street, Bar Harbor, ME 04609, USA
| | - Muneer G Hasham
- The Jackson Laboratory, 600 Main Street, Bar Harbor, ME 04609, USA
| | - Nadia Rosenthal
- National Heart and Lung Institute, Imperial College London, London W12 0NN, UK
- The Jackson Laboratory, 600 Main Street, Bar Harbor, ME 04609, USA
| | - Sanjay K Prasad
- Royal Brompton Hospital, Royal Brompton and Harefield NHS Foundation Trust, London SW3 6NP, UK
| | - Lan Zhao
- Biological Imaging Centre, Department of Medicine, Imperial College London, London W12 0NN, UK
- National Heart and Lung Institute, Imperial College London, London W12 0NN, UK
| | - Sian E Harding
- National Heart and Lung Institute, Imperial College London, London W12 0NN, UK
| | - Susanne Sattler
- National Heart and Lung Institute, Imperial College London, London W12 0NN, UK
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Kastritis E, Karatrasoglou E, Dialoupi I, Gavriatopoulou M, Roussou M, Fotiou D, Kanellias N, Ntanasis-Stathopoulos I, Eleutherakis-Papaiakovou E, Manios E, Migkou M, Papanota AM, Papadopoulou E, Stamatelopoulos K, Ntalianis A, Papanikolaou A, Psimenou E, Gakiopoulou C, Tsitsilonis O, Tselegkidi M, Trougakos I, Kostopoulos I, Terpos E, Dimopoulos M. PS1378 AN EARLY, WITHIN THE FIRST MONTH, AND DEEP RESPONSE, SHOULD BE THE GOAL OF THERAPY IN AL AMYLOIDOSIS. Hemasphere 2019. [DOI: 10.1097/01.hs9.0000563788.88142.a3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Drakopoulou M, Toutouzas K, Stathogiannis K, Latsios G, Sideris S, Xanthopoulou M, Penesopoulou V, Trantalis G, Synetos A, Papanikolaou A, Aggeli C, Vavuranakis M, Tousoulis D. Impact of Valve Over-Sizing After Transcatheter Aortic Valve Implantation With a Self-Expanding Valve: A Multislice Computed Tomography Study. J Invasive Cardiol 2019; 31:E76-E82. [PMID: 31034438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
BACKGROUND In transcatheter aortic valve implantation (TAVI), prosthesis over-sizing prevents paravalvular leak (PVL). Strategies of over-sizing for self-expanding bioprostheses are not well established at present. METHODS Patients with aortic valve stenosis scheduled for TAVI underwent preprocedural multislice computed tomography. Based on the degree of over-sizing, a ROC curve was drawn to define the optimal value of valve sizing for reducing PVL after TAVI. RESULTS A total of 152 consecutive patients were included in the study (mean age, 79.95 ± 7.71 years; log EuroScore: 23.87 ± 8.93%). Based on the ROC curve, sizing of 14% was the optimal that would lead to less moderate/severe PVL (P<.01). Group 1 was defined as sizing <14% (n = 49 patients) and group 2 was defined as sizing ≥14% (n = 103 patients). During a follow-up period of 36 ± 14 months, a total of 9 patients died from group 1 vs 4 patients from group 2 (P<.01). Two of the patients who died had moderate/severe PVL and 11 had no/mild PVL (P=.27). From the population, a total of 49 patients (32%) were found to be in the "borderline" zone. Patients who received the smaller valve had lower mean left ventricular outflow tract diameter (P=.048), higher rate of calcium load (mild: 10 [32%] vs 13 [72%]; moderate: 16 [52%] vs 3 [17%]; severe: 5 [16%] vs 2 [11%]; P=.02) and lower mean of sinus of Valsalva diameter (P=.046) compared with patients who received the bigger valve. CONCLUSIONS In patients undergoing TAVI, over-sizing the prosthesis at least 14% reduces PVL. In borderline cases, taking into consideration additional anatomical parameters may result in low rates of PVL.
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Affiliation(s)
| | - Konstantinos Toutouzas
- Hippokration Hospital, 26 Karaoli and Dimitriou Streets, 15562 Holargos, Athens, Greece.
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Kakavas S, Karayiannis D, Papanikolaou A, Karachaliou A, Mastora Z, Pavlara M, Boulbasakos G. Food group consumption and lung function parameters among hospitalized patients with acute exacerbation of chronic obstructive pulmonary disease. Clin Nutr 2018. [DOI: 10.1016/j.clnu.2018.06.1340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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37
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Panahi M, Papanikolaou A, Torabi A, Zhang JG, Khan H, Vazir A, Hasham MG, Cleland JGF, Rosenthal NA, Harding SE, Sattler S. Immunomodulatory interventions in myocardial infarction and heart failure: a systematic review of clinical trials and meta-analysis of IL-1 inhibition. Cardiovasc Res 2018; 114:1445-1461. [PMID: 30010800 PMCID: PMC6106100 DOI: 10.1093/cvr/cvy145] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 05/26/2018] [Accepted: 06/18/2018] [Indexed: 12/14/2022] Open
Abstract
Following a myocardial infarction (MI), the immune system helps to repair ischaemic damage and restore tissue integrity, but excessive inflammation has been implicated in adverse cardiac remodelling and development towards heart failure (HF). Pre-clinical studies suggest that timely resolution of inflammation may help prevent HF development and progression. Therapeutic attempts to prevent excessive post-MI inflammation in patients have included pharmacological interventions ranging from broad immunosuppression to immunomodulatory approaches targeting specific cell types or factors with the aim to maintain beneficial aspects of the early post-MI immune response. These include the blockade of early initiators of inflammation including reactive oxygen species and complement, inhibition of mast cell degranulation and leucocyte infiltration, blockade of inflammatory cytokines, and inhibition of adaptive B and T-lymphocytes. Herein, we provide a systematic review on post-MI immunomodulation trials and a meta-analysis of studies targeting the inflammatory cytokine Interleukin-1. Despite an enormous effort into a significant number of clinical trials on a variety of targets, a striking heterogeneity in study population, timing and type of treatment, and highly variable endpoints limits the possibility for meaningful meta-analyses. To conclude, we highlight critical considerations for future studies including (i) the therapeutic window of opportunity, (ii) immunological effects of routine post-MI medication, (iii) stratification of the highly diverse post-MI patient population, (iv) the potential benefits of combining immunomodulatory with regenerative therapies, and at last (v) the potential side effects of immunotherapies.
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Affiliation(s)
- Mona Panahi
- National Heart and Lung Institute, Imperial College London, Du Cane Road, London, UK
| | - Angelos Papanikolaou
- National Heart and Lung Institute, Imperial College London, Du Cane Road, London, UK
| | - Azam Torabi
- Royal Brompton Hospital, Royal Brompton and Harefield NHS Foundation Trust, Sydney Street, London, UK
| | - Ji-Gang Zhang
- The Jackson Laboratory, 600 Main Street, Bar Harbor, USA
| | - Habib Khan
- Royal Brompton Hospital, Royal Brompton and Harefield NHS Foundation Trust, Sydney Street, London, UK
| | - Ali Vazir
- Royal Brompton Hospital, Royal Brompton and Harefield NHS Foundation Trust, Sydney Street, London, UK
| | | | - John G F Cleland
- National Heart and Lung Institute, Imperial College London, Du Cane Road, London, UK
- Royal Brompton Hospital, Royal Brompton and Harefield NHS Foundation Trust, Sydney Street, London, UK
| | - Nadia A Rosenthal
- National Heart and Lung Institute, Imperial College London, Du Cane Road, London, UK
- The Jackson Laboratory, 600 Main Street, Bar Harbor, USA
| | - Sian E Harding
- National Heart and Lung Institute, Imperial College London, Du Cane Road, London, UK
| | - Susanne Sattler
- National Heart and Lung Institute, Imperial College London, Du Cane Road, London, UK
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Panahi M, Papanikolaou A, Khan H, Torabi A, Cleland JGF, Vadgama N, Rosenthal NA, Harding S, Sattler S. P2861A systematic review and meta-analysis of anti-cytokine therapies targeting IL-1 and TNF- A in myocardial infarction and heart failure. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p2861] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- M Panahi
- Imperial College London, National Heart and Lung Instutute, Hammersmith Hospital, London, United Kingdom
| | - A Papanikolaou
- Imperial College London, National Heart and Lung Instutute, Hammersmith Hospital, London, United Kingdom
| | - H Khan
- Imperial College Healthcare NHS Trust, London, United Kingdom
| | - A Torabi
- Imperial College Healthcare NHS Trust, London, United Kingdom
| | - J G F Cleland
- Imperial College Healthcare NHS Trust, London, United Kingdom
| | - N Vadgama
- Imperial College London, National Heart and Lung Instutute, Hammersmith Hospital, London, United Kingdom
| | - N A Rosenthal
- The Jackson Laboratory, Bar Harbor, Maine, United States of America
| | - S Harding
- Imperial College London, National Heart and Lung Instutute, Hammersmith Hospital, London, United Kingdom
| | - S Sattler
- Imperial College London, National Heart and Lung Instutute, Hammersmith Hospital, London, United Kingdom
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Stathogiannis K, Toutouzas K, Drakopoulou M, Latsios G, Synetos A, Oikonomou G, Xanthopoulou M, Trantalis G, Papanikolaou A, Peskesis G, Tsiamis E, Tousoulis D. 5250Effect of aortic valve calcification as measured by computed tomography in patients undergoing transcatheter aortic valve implantation. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.5250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- K Stathogiannis
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
| | - K Toutouzas
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
| | - M Drakopoulou
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
| | - G Latsios
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
| | - A Synetos
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
| | - G Oikonomou
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
| | - M Xanthopoulou
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
| | - G Trantalis
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
| | - A Papanikolaou
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
| | - G Peskesis
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
| | - E Tsiamis
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
| | - D Tousoulis
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
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40
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Drakopoulou M, Toutouzas K, Stathogiannis K, Latsios G, Synetos A, Sideris S, Trantalis G, Papanikolaou A, Oikonomou G, Xanthopoulou M, Karmpalioti M, Tsiamis E, Tousoulis D. P6306Impact of aorto-ventricular angulation on clinical outcomes following TAVR with a self-expanding valve. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p6306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- M Drakopoulou
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
| | - K Toutouzas
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
| | - K Stathogiannis
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
| | - G Latsios
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
| | - A Synetos
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
| | - S Sideris
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
| | - G Trantalis
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
| | - A Papanikolaou
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
| | - G Oikonomou
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
| | - M Xanthopoulou
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
| | - M Karmpalioti
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
| | - E Tsiamis
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
| | - D Tousoulis
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
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41
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Synetos A, Toutouzas K, Latsios G, Papanikolaou A, Peskesis G, Sianos G, Tousoulis D. Proximal anchoring distal trapping technique in a chronic total occlusion unable to cross. Cardiovasc Revasc Med 2018; 19:887-889. [PMID: 29631951 DOI: 10.1016/j.carrev.2018.03.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2018] [Revised: 02/22/2018] [Accepted: 03/09/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Andreas Synetos
- First Department of Cardiology, Athens Medical School, Athens, Greece.
| | | | - George Latsios
- First Department of Cardiology, Athens Medical School, Athens, Greece
| | | | - George Peskesis
- First Department of Cardiology, Athens Medical School, Athens, Greece
| | - George Sianos
- Cardiology Department, Papageorgiou General Hospital, Thessaloniki, Greece
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Latsios G, Toutouzas K, Synetos A, Vogiatzi G, Papanikolaou A, Tsiamis E, Tousoulis D. Left distal radial artery for cardiac catheterization: Insights from our first experience. Hellenic J Cardiol 2018; 59:352-353. [PMID: 29307690 DOI: 10.1016/j.hjc.2017.12.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 12/02/2017] [Accepted: 12/02/2017] [Indexed: 12/27/2022] Open
Affiliation(s)
- George Latsios
- 1(st) Department of Cardiology, Athens Medical School, "Hippokration" General Hospital of Athens, Athens, Greece.
| | - Kostas Toutouzas
- 1(st) Department of Cardiology, Athens Medical School, "Hippokration" General Hospital of Athens, Athens, Greece
| | - Andreas Synetos
- 1(st) Department of Cardiology, Athens Medical School, "Hippokration" General Hospital of Athens, Athens, Greece
| | - Georgia Vogiatzi
- 1(st) Department of Cardiology, Athens Medical School, "Hippokration" General Hospital of Athens, Athens, Greece
| | - Angelos Papanikolaou
- 1(st) Department of Cardiology, Athens Medical School, "Hippokration" General Hospital of Athens, Athens, Greece
| | - Elefterios Tsiamis
- 1(st) Department of Cardiology, Athens Medical School, "Hippokration" General Hospital of Athens, Athens, Greece
| | - Dimitris Tousoulis
- 1(st) Department of Cardiology, Athens Medical School, "Hippokration" General Hospital of Athens, Athens, Greece
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43
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Balfousias T, Apostolopoulos AP, Papanikolaou A, Karadimas E, Zouboulis G, Maris I. Scapulothoracic Dissociation and Clavicle Fracture with Associated Brachial Plexus Palsy. J Long Term Eff Med Implants 2018; 28:233-237. [DOI: 10.1615/jlongtermeffmedimplants.2018029212] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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44
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Papakonstantinou N, Zisis C, Balis E, Papanikolaou A, Bouros D. P-186H-TYPE TRACHEO-OESOPHAGEAL FISTULA: A CONGENITAL DEFORMITY FIRST DIAGNOSED 59 YEARS POSTNATALLY. Interact Cardiovasc Thorac Surg 2017. [DOI: 10.1093/icvts/ivx280.186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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45
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Kakavas S, Karayiannis D, Papanikolaou A, Baschali A, Sarantidou M, Karachaliou A, Karli A, Mastora Z, Palavra M, Boulbasakos G. SUN-P126: Bioelectrical Impedance Analysis Phase Angle as a Prognostic Marker for Outcome in Patients Admitted in Hospital with Acute Exacerbation of Chronic Obstructive Pulmonary Disease. Clin Nutr 2017. [DOI: 10.1016/s0261-5614(17)30501-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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46
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Synetos A, Papanikolaou A, Georgiopoulos G, Peskesis G, Drakopoulou M, Galanakos S, Benetos G, Stathogiannis K, Karanasos A, Toutouzas K, Tousoulis D. P4402Metabolic syndrome predicts plaque rupture in patients with acute myocardial Infarction. An optical coherence study. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx504.p4402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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47
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Antonopoulos A, Oikonomou E, Tsalamandris S, Vogiatzi G, Tolis P, Papanikolaou A, Kalogeras K, Latsios G, Syrseloudis D, Aznaouridis K, Vaina S, Siasos G, Vavouranakis E, Toutouzas K, Tousoulis D. P4286Endothelial function post radial artery catheterization: a systematic review and meta-analysis. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx504.p4286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Synetos A, Georgiopoulos G, Pylarinou V, Peskesis G, Papanikolaou A, Karanasos A, Stathogiannis K, Galanakos S, Benetos G, Tsiamis E, Toutouzas K, Drakopoulou M, Tousoulis D. P2484EuroSCORE II has the best predictive ability after successful primary percutaneous coronary intervention for the treatment of acute myocardial infarction. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx502.p2484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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49
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Synetos A, Papanikolaou A, Georgiopoulos G, Peskesis G, Drakopoulou M, Galanakos S, Karanasos A, Stathogiannis K, Koutajiar I, Toutouzas K, Tousoulis D. P3662CRP predicts cap thickness in the culprit lesions of patients with metabolic syndrome and acute myocardial infarction. An Optical Coherence Study. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx504.p3662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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50
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Synetos A, Toutouzas K, Drakopoulou M, Koutajiar I, Stathogiannis K, Peskesis G, Papanikolaou A, Kotronias R, Agrogiannis G, Papalois A, Anagnostopoulos C, Cokkinos D, Patsouris E, Tousoulis D. P1565Attenuation of aortic valve calcification by local delivery of zoledronic acid. A PET/CT study. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx502.p1565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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