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Anagnostopoulos I, Kousta M, Kossyvakis C, Paraskevaidis NT, Schizas N, Vrachatis D, Deftereos S, Giannopoulos G. Atrial strain and occult atrial fibrillation in cryptogenic stroke patients: a systematic review and meta-analysis. Clin Res Cardiol 2023; 112:1600-1609. [PMID: 37154833 DOI: 10.1007/s00392-023-02218-z] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 04/27/2023] [Indexed: 05/10/2023]
Abstract
BACKGROUND Cryptogenic stroke (CS) remains a significant cause of morbidity. Failure to identify the underlying pathology increases the rate of recurrence. Atrial fibrillation (AF) seems to be responsible for a substantial proportion of CS. Thus, there is an unmet need to identify and properly treat those with silent AF. PURPOSE To investigate the association between left atrial strain and newly diagnosed AF in CS patients. OBJECTIVES We searched major electronic databases for articles assessing the relationship between either peak left atrial longitudinal (PALS) or peak contractile (PACS) strain-quantified using speckle tracking echocardiography-and the incidence of occult AF during the diagnostic work-up of CS patients. RESULTS Eleven studies (two thousand and eighty-one patients) were analyzed. Incidence of occult AF was 19%. Both PALS and PACS were significantly lower in patients with newly diagnosed AF (MD - 8.6%, 95%CI - 10.7 to - 6.4, I2 86.4% and MD - 5.5, 95%CI - 6.8 to - 4.2, I2 80.8%). According to the diagnostic accuracy meta-analysis, PALS < 20% present 71% (95%CI 47-87%) sensitivity and 71% (95%CI 60-81%) specificity for the diagnosis of occult AF, assuming a prevalence of 20%. The corresponding values for PACS < 11% are 83% (95%CI 57-94%) and 78% (95%CI 56-91%). CONCLUSION Both PALS and PACS are significantly lower in patients with CS and silent AF. It seems that the cut-off values mentioned above could help physicians in identifying patients who may benefit more from prolonged rhythm monitoring. More studies are needed to confirm these findings.
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Affiliation(s)
- Ioannis Anagnostopoulos
- Cardiology Department, Athens General Hospital "G. Gennimatas", 154 Mesogion Avenue, 11527, Athens, Greece.
| | - Maria Kousta
- Cardiology Department, Athens General Hospital "G. Gennimatas", 154 Mesogion Avenue, 11527, Athens, Greece
| | - Charalampos Kossyvakis
- Cardiology Department, Athens General Hospital "G. Gennimatas", 154 Mesogion Avenue, 11527, Athens, Greece
| | | | - Nikolaos Schizas
- Department of Cardiothoracic Surgery, Hygeia Hospital, Athens, Greece
| | - Dimitrios Vrachatis
- 2nd Department of Cardiology, National and Kapodistrian University of Athens, Athens, Greece
| | - Spyridon Deftereos
- 2nd Department of Cardiology, National and Kapodistrian University of Athens, Athens, Greece
| | - Georgios Giannopoulos
- 3rd Department of Cardiology, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Anagnostopoulos I, Kousta M, Kossyvakis C, Paraskevaidis NT, Vrachatis D, Deftereos S, Giannopoulos G. Epicardial Adipose Tissue and Atrial Fibrillation Recurrence following Catheter Ablation: A Systematic Review and Meta-Analysis. J Clin Med 2023; 12:6369. [PMID: 37835012 PMCID: PMC10573952 DOI: 10.3390/jcm12196369] [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: 09/08/2023] [Revised: 09/29/2023] [Accepted: 10/02/2023] [Indexed: 10/15/2023] Open
Abstract
(1)Introduction: Catheter ablation has become a cornerstone for the management of patients with atrial fibrillation (AF). Nevertheless, recurrence rates remain high. Epicardial adipose tissue (EAT) has been associated with AF pathogenesis and maintenance. However, the literature has provided equivocal results regarding the relationship between EAT and post-ablation recurrence.(2) Purpose: to investigate the relationship between total and peri-left atrium (peri-LA) EAT with post-ablation AF recurrence. (3) Methods: major electronic databases were searched for articles assessing the relationship between EAT, quantified using computed tomography, and the recurrence of AF following catheter ablation procedures. (4) Results: Twelve studies (2179 patients) assessed total EAT and another twelve (2879 patients) peri-LA EAT. Almost 60% of the included patients had paroxysmal AF and recurrence was documented in 34%. Those who maintained sinus rhythm had a significantly lower volume of peri-LA EAT (SMD: -0.37, 95%; CI: -0.58-0.16, I2: 68%). On the contrary, no significant difference was documented for total EAT (SMD: -0.32, 95%; CI: -0.65-0.01; I2: 92%). No differences were revealed between radiofrequency and cryoenergy pulmonary venous isolation. No publication bias was identified. (5) Conclusions: Only peri-LA EAT seems to be predictive of post-ablation AF recurrence. These findings may reflect different pathophysiological roles of EAT depending on its location. Whether peri-LA EAT can be used as a predictor and target to prevent recurrence is a matter of further research.
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Affiliation(s)
| | - Maria Kousta
- Cardiology Department, Athens General Hospital “G. Gennimatas”, 11527 Athens, Greece (C.K.)
| | - Charalampos Kossyvakis
- Cardiology Department, Athens General Hospital “G. Gennimatas”, 11527 Athens, Greece (C.K.)
| | | | - Dimitrios Vrachatis
- 2nd Department of Cardiology, National and Kapodistrian University of Athens, 15772 Athens, Greece
| | - Spyridon Deftereos
- 2nd Department of Cardiology, National and Kapodistrian University of Athens, 15772 Athens, Greece
| | - Georgios Giannopoulos
- 3rd Department of Cardiology, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
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Iliodromitis K, Balogh Z, Triposkiadis F, Deftereos S, Vrachatis D, Bimpong-Buta NY, Schiedat F, Bogossian H. Assessing physical activity with the wearable cardioverter defibrillator in patients with newly diagnosed heart failure. Front Cardiovasc Med 2023; 10:1176710. [PMID: 37252123 PMCID: PMC10213313 DOI: 10.3389/fcvm.2023.1176710] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 04/24/2023] [Indexed: 05/31/2023] Open
Abstract
Background The wearable cardioverter defibrillator (WCD), (LifeVest, ZOLL, Pittsburgh, PA, USA) is a medical device designed for the temporary detection and treatment of malignant ventricular tachyarrhythmias. WCD telemonitoring features enable the evaluation of the physical activity (PhA) of the patients. We sought to assess with the WCD the PhA of patients with newly diagnosed heart failure. Methods We collected and analyzed the data of all patients treated with the WCD in our clinic. Patients with newly diagnosed ischemic, or non-ischemic cardiomyopathy and severely reduced ejection fraction, who were treated with the WCD for at least 28 consecutive days and had a compliance of at least 18 h the day were included. Results Seventy-seven patients were eligible for analysis. Thirty-seven patients suffered from ischemic and 40 from non-ischemic heart disease. The average days the WCD was carried was 77.3 ± 44.6 days and the mean wearing time was 22.8 ± 2.1 h. The patients showed significantly increased PhA measured by daily steps between the first two and the last two weeks (Mean steps in the first 2 weeks: 4,952.6 ± 3,052.7 vs. mean steps in the last 2 weeks: 6,119.6 ± 3,776.2, p-value: < 0.001). In the end of the surveillance period an increase of the ejection fraction was observed (LVEF-before: 25.8 ± 6.6% vs. LVEF-after: 37.5 ± 10.6%, p < 0.001). Improvement of the EF did not correlate with the improvement of PhA. Conclusion The WCD provides useful information regarding patient PhA and may be additionally utilized for early heart failure treatment adjustment.
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Affiliation(s)
- Konstantinos Iliodromitis
- Clinic for Cardiology and Electrophysiology, Evangelical Hospital Hagen-Haspe, Hagen, Germany
- School of Medicine, Witten/Herdecke University, Witten, Germany
| | - Zsuzsanna Balogh
- Clinic for Cardiology and Electrophysiology, Evangelical Hospital Hagen-Haspe, Hagen, Germany
| | | | - Spyridon Deftereos
- Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios Vrachatis
- Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Nana-Yaw Bimpong-Buta
- Clinic for Cardiology and Electrophysiology, Evangelical Hospital Hagen-Haspe, Hagen, Germany
- School of Medicine, Witten/Herdecke University, Witten, Germany
| | - Fabian Schiedat
- Clinic for Cardiology, Marienhospital Gelsenkirchen Academic Hospital of the Ruhr University Bochum, Bochum, Germany
| | - Harilaos Bogossian
- Clinic for Cardiology and Electrophysiology, Evangelical Hospital Hagen-Haspe, Hagen, Germany
- School of Medicine, Witten/Herdecke University, Witten, Germany
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Anagnostopoulos I, Kousta M, Kossyvakis C, Lakka E, Vrachatis D, Deftereos S, Vassilikos VP, Giannopoulos G. Weekly physical activity and incident atrial fibrillation in females - A dose-response meta-analysis. Int J Cardiol 2023; 370:191-196. [PMID: 36356696 DOI: 10.1016/j.ijcard.2022.11.007] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 10/16/2022] [Accepted: 11/02/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND For years, physical activity (PA) has been considered a mixed blessing in terms of the risk of incident atrial fibrillation (AF). Previous analyses have had equivocal results regarding the cut-off of PA level beyond which AF risk increases, if such a limit really does exist. Data regarding females in particular have been scarce. METHODS We performed a dose-response meta-analysis to investigate the relationship between weekly PA and the risk for AF in females. Major electronic databases were searched for studies assessing the association between leisure time PA and the risk for incident AF in females from the general population. The linearity of the dose-response curve was assessed using the restricted cubic spline model. RESULTS A total of 15 studies, which involved 1,821,422 females, were included in the final analysis. AF incidence was 3.7%. Dose-response analysis revealed an inverse nonlinear relationship between weekly PA and the risk for incident AF (p for linearity <0.0001). No significant heterogeneity was documented (I2 = 37%). Cautious interpretation is needed for PA exceeding 50 metabolic equivalents of task- hours per week (METs- h/w), due to limited available data for these high levels of PA. CONCLUSION According to this analysis, physicians can safely advise females to perform up to 50METs- h/w of moderate or vigorous PA, to reduce the risk for future AF. Interestingly, significant benefit can be attained even at low levels of regular weekly PA.
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Affiliation(s)
| | - Maria Kousta
- Cardiology Department, Athens General Hospital "G. Gennimatas", Athens, Greece
| | | | - Eleni Lakka
- Cardiology Department, Athens General Hospital "G. Gennimatas", Athens, Greece
| | - Dimitrios Vrachatis
- 2nd Department of Cardiology, National and Kapodistrian University of Athens, Athens, Greece
| | - Spyridon Deftereos
- 2nd Department of Cardiology, National and Kapodistrian University of Athens, Athens, Greece
| | - Vassilios P Vassilikos
- 3rd Department of Cardiology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Georgios Giannopoulos
- 3rd Department of Cardiology, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Bompotis GC, Giannopoulos G, Karakanas AI, Meletidou M, Vrachatis D, Lazaridis I, Toutouzas KP, Styliadis I, Tziakas D, Deftereos SG. Left Distal Radial Artery Access for Coronary Angiography and Interventions: A 12-Month All-Comers Study. J Invasive Cardiol 2022; 34:E505-E509. [PMID: 35714225] [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: 06/15/2023]
Abstract
BACKGROUND Interventional cardiologists prefer the right radial artery (RA) approach for coronary angiography and interventions, mainly for ergonomic reasons. However, the use of the left RA presents certain advantages, and the snuffbox approach has further potential advantages, including lower probability for RA occlusion, avoidance of direct puncture of the RA (thus maintaining its suitability for use as a graft), as well as easier and faster hemostasis. METHODS Consecutive patients scheduled for coronary catheterization were included, using the left distal RA (ldRA) in the anatomical snuffbox as the default vascular access site. RESULTS Out of 2034 consecutive cases, the ldRA was used as initial vascular access in 1977 patients (97.2%). The procedural failure rate was 9.9% (21.9% inability to puncture the artery, 75.0% inability to advance the wire, 3.1% other reasons). There was a sharp decrease in failure rate after about the first 200 cases (20.8% in the first decile vs 8.7% throughout the rest of the caseload; P<.001). No or very weak palpable pulse was the most important predictor of failure (odds ratio, 16.0; 95% confidence interval, 11.2-23.1; P<.001), in addition to older age, small stature, and female gender (although, after adjustment for height, the latter was no longer significant). CONCLUSION In a large series of consecutive patients scheduled for left heart catheterization, through a period of 12 months, with virtually no exclusions except those few imposed by anatomy or compelling clinical needs, the ldRA arterial access approach was shown to be highly effective, feasible, and safe.
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Affiliation(s)
- Georgios C Bompotis
- General Hospital Papageorgiou, Ring Road of Thessaloniki, Nea Efkarpia, Thessaloniki, 56403, Greece.
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Papathanasiou K, Giotaki S, Kossyvakis C, Kazantzis D, Vrachatis D, Deftereos G, Raisakis K, Kaoukis A, Avramides D, Siasos G, Giannopoulos G, Deftereos S. Hot balloon versus cryoballoon ablation in patients with atrial fibrillation: a systematic review and meta-analysis. Europace 2022. [DOI: 10.1093/europace/euac053.197] [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] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Atrial fibrillation (AF) incidence is expected to increase more than 60% in the following 30 years. Catheter ablation is the treatment of choice for medically intractable AF with arrhythmia recurrence remaining an unsolved issue.
Purpose
We systematically reviewed existing literature to compare the efficacy of hot balloon (HBA) versus cryoballoon ablation (CBA).
Methods
PubMed, Scopus, ClinicalTrials.gov, medRxiv and Cochrane Library (according to PRISMA guidelines) were scrutinized for relevant articles up to 2 December 2021. Eligible studies had to compare clinical outcomes (arrhythmia recurrence rates or/and procedural data or/and safety outcomes) between patients undergoing HBA and CBA for AF. Quality assessment of studies was conducted via the Newcastle-Ottawa Scale (high quality≥ 7, moderate 4-6, poor <4). Statistical pooling was performed according to a random-effect model with generic inverse-variance weighting of odds ratios and mean differences computing risk estimates with 95% confidence intervals. The presence of heterogeneity among studies was evaluated under the Cochran Q chi-square test. I² values of 25%, 50% and 75% have been assigned adjectives of low, moderate, and high heterogeneity. Publication biases were assessed by visual inspection of funnel plots.
Results
PRISMA study search and individual study characteristics are presented in Figure 1. Literature search identified 131 studies, 5 of which (evaluating 513 patients) met inclusion criteria. Patients undergoing HBA demonstrated similar long term recurrence rate as compared to CBA treated controls (OR: 0.68; 95% CI: 0.38-1.22; p-value: 0.19; I2: 0%). Procedural aspects, such as touch-up radiofrequency ablation (per pulmonary vein), procedure time (min) and fluoroscopic time (min) did not differ among treatment arms (OR: 1.79; 95% CI: 0.84-3.83; p-value: 0.13, I2: 80%, MD: 9.69; 95% CI: -2.78-22.16; p-value: 0.13, I2: 63%, and OR: 1.03; 95% CI: -9.50-7.44; p-value: 0.81, I2: 87%, respectively). Regarding safety outcomes (Figure 1), the small number of the reported events precluded us from analyzing these data. Yet, tamponade and phrenic nerve injury were infrequent in both modalities; pulmonary vein stenosis of at least moderate severity (>50% luminal narrowing) was reported in 18 instances in the HBA arm as compared to zero events in the CBA arm. Of note, all events were asymptomatic. Quality assessment scores are shown in Figure 1. Four studies were of high quality and one study was of moderate quality. Funnel-plot distributions of the pre-specified outcomes indicated absence of publication bias for all outcomes. High statistical heterogeneity and the small number of patients included are the main limitations of this study.
Conclusion
Hotballoon ablation is a promising therapeutic option for patients suffering from AF, featuring comparable efficacy and procedural outcomes with cryoablation. Safety outcomes, especially PV stenosis, mandate further evaluation.
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Affiliation(s)
| | - S Giotaki
- Attikon University Hospital, Athens, Greece
| | - C Kossyvakis
- Athens General Hospital - G. Gennimatas, Athens, Greece
| | - D Kazantzis
- University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom of Great Britain & Northern Ireland
| | | | - G Deftereos
- Athens General Hospital - G. Gennimatas, Athens, Greece
| | - K Raisakis
- Athens General Hospital - G. Gennimatas, Athens, Greece
| | - A Kaoukis
- Athens General Hospital - G. Gennimatas, Athens, Greece
| | - D Avramides
- Athens General Hospital - G. Gennimatas, Athens, Greece
| | - G Siasos
- National & Kapodistrian University of Athens Medical School, Athens, Greece
| | - G Giannopoulos
- Aristotle University of Thessaloniki, Thessaloniki, Greece
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Anagnostopoulos I, Kossyvakis C, Kousta M, Verikokkou C, Lakka E, Karakanas A, Deftereos G, Spanou P, Giotaki S, Vrachatis D, Avramidis D, Deftereos S, Giannopoulos G. Different venous approaches for implantation of cardiac electronic devices. A network meta-analysis. Pacing Clin Electrophysiol 2022; 45:717-725. [PMID: 35554947 DOI: 10.1111/pace.14510] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 03/17/2022] [Accepted: 04/01/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Many of the complications arising from cardiac device implantation are associated to the venous access used for lead placement. Previous analyses reported that cephalic vein cutdown (CVC) is safer but less effective than subclavian vein puncture (SVP). However, comparisons between these techniques and axillary vein puncture (AVP) -guided either by ultrasound or fluoroscopy- are lacking. Thus, we aimed to compare safety and efficacy of these approaches. METHODS We searched for articles assessing at least two different approaches regarding the incidence of pneumothorax and/ or lead failure (LF). When available, bleeding and infectious complications as well as procedural success were analyzed. A frequentist random effects network meta-analysis model was adopted. RESULTS 36 studies were analyzed. Most articles assessed SVP versus CVC. Compared to SVP, both CVC and AVP were associated with reduced odds of pneumothorax (OR: 0.193, 95%CI: 0.136-0.275 and OR: 0.128, 95%CI: 0.050- 0.329; respectively) and LF (OR: 0.63, 95%CI: 0.406-0.976 and OR: 0.425, 95%CI: 0.286-0.632; respectively). No significant differences between AVP and CVC were demonstrated. Limited data suggest no major impact of different approaches on infectious and bleeding complications. Initial CVC approach required significantly more often an alternate/ additional venous access for lead placement, compared to both AVP and SVP. No differences between these two were identified. CONCLUSION Both AVP and CVC seem to decrease incident pneumothorax and LF, compared to SVP. Initial AVP approach seems to decrease the need of alternate venous access, compared to CVC. These results suggest that AVP should be further clinically tested. This article is protected by copyright. All rights reserved.
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Affiliation(s)
| | | | - Maria Kousta
- Cardiology Department, Athens General Hospital "G. Gennimatas", Athens, Greece
| | | | - Eleni Lakka
- Cardiology Department, Athens General Hospital "G. Gennimatas", Athens, Greece
| | - Asterios Karakanas
- 2nd Department of Cardiology, General Hospital Papageorgiou, Thessaloniki, Greece
| | - Gerasimos Deftereos
- Cardiology Department, Athens General Hospital "G. Gennimatas", Athens, Greece
| | - Polixeni Spanou
- Cardiology Department, Athens General Hospital "G. Gennimatas", Athens, Greece
| | - Sotiria Giotaki
- 2nd Department of Cardiology, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios Vrachatis
- 2nd Department of Cardiology, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios Avramidis
- Cardiology Department, Athens General Hospital "G. Gennimatas", Athens, Greece
| | - Spyridon Deftereos
- 2nd Department of Cardiology, National and Kapodistrian University of Athens, Athens, Greece
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Chalkia M, Kouloulias V, Tousoulis D, Deftereos S, Tsiachris D, Vrachatis D, Platoni K. Stereotactic Arrhythmia Radioablation as a Novel Treatment Approach for Cardiac Arrhythmias: Facts and Limitations. Biomedicines 2021; 9:biomedicines9101461. [PMID: 34680578 PMCID: PMC8533522 DOI: 10.3390/biomedicines9101461] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Revised: 09/29/2021] [Accepted: 10/11/2021] [Indexed: 11/24/2022] Open
Abstract
Stereotactic ablative radiotherapy (SABR) is highly focused radiation therapy that targets well-demarcated, limited-volume malignant or benign tumors with high accuracy and precision using image guidance. Stereotactic arrhythmia radioablation (STAR) applies SABR to treat cardiac arrhythmias, including ventricular tachycardia (VT) and atrial fibrillation (AF), and has recently been a focus in research. Clinical studies have demonstrated electrophysiologic conduction blockade and histologic fibrosis after STAR, which provides a proof of principle for its potential for treating arrhythmias. This review will present the basic STAR principles, available clinical study outcomes, and how the technique has evolved since the first pre-clinical study. In addition to the clinical workflow, focus will be given on the process for stereotactic radiotherapy Quality Assurance (QA) tests, as well as the need for establishing a standardized QA protocol. Future implications and potential courses of research will also be discussed.
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Affiliation(s)
- Marina Chalkia
- Radiotherapy Unit, Second Department of Radiology, School of Medicine, Rimini 1, National and Kapodistrian University of Athens, 124 62 Athens, Greece; (V.K.); (K.P.)
- Correspondence: ; Tel.: +30-2105326418
| | - Vassilis Kouloulias
- Radiotherapy Unit, Second Department of Radiology, School of Medicine, Rimini 1, National and Kapodistrian University of Athens, 124 62 Athens, Greece; (V.K.); (K.P.)
| | - Dimitris Tousoulis
- First Department of Cardiology, ‘Hippokration’ General Hospital, Vasilissis Sofias 114, 115 27 Athens, Greece;
| | - Spyridon Deftereos
- Second Department of Cardiology, “Attikon” University Hospital, School of Medicine, Rimini 1, National and Kapodistrian University of Athens, 124 62 Athens, Greece; (S.D.); (D.V.)
| | | | - Dimitrios Vrachatis
- Second Department of Cardiology, “Attikon” University Hospital, School of Medicine, Rimini 1, National and Kapodistrian University of Athens, 124 62 Athens, Greece; (S.D.); (D.V.)
| | - Kalliopi Platoni
- Radiotherapy Unit, Second Department of Radiology, School of Medicine, Rimini 1, National and Kapodistrian University of Athens, 124 62 Athens, Greece; (V.K.); (K.P.)
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Vavuranakis MA, Kalantzis C, Voudris V, Kosmas E, Kalogeras K, Katsianos E, Oikonomou E, Siasos G, Aznaouridis K, Toutouzas K, Stasinopoulou M, Tountopoulou A, Bei E, Moldovan CM, Vrachatis D, Iakovou I, Papaioannou TG, Tousoulis D, Leucker TM, Vavuranakis M. Comparison of Ticagrelor Versus Clopidogrel on Cerebrovascular Microembolic Events and Platelet Inhibition during Transcatheter Aortic Valve Implantation. Am J Cardiol 2021; 154:78-85. [PMID: 34243938 DOI: 10.1016/j.amjcard.2021.05.047] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 05/18/2021] [Accepted: 05/21/2021] [Indexed: 12/22/2022]
Abstract
The impact of the antiplatelet regimen and the extent of associated platelet inhibition on cerebrovascular microembolic events during transcatheter aortic valve implantation (TAVI) are unknown. Our aim was to evaluate the effects of ticagrelor versus clopidogrel and of platelet inhibition on the number of cerebrovascular microembolic events in patients undergoing TAVI. Patients scheduled for TAVI were randomized previous to the procedure to either aspirin and ticagrelor or to aspirin and clopidogrel. Platelet inhibition was expressed in P2Y12 reaction units (PRU) and percentage of inhibition. High intensity transient signals (HITS) were assessed with transcranial Doppler (TCD). Safety outcomes were recorded according to the VARC-2 definitions. Among 90 patients randomized, 6 had an inadequate TCD signal. The total number of procedural HITS was lower in the ticagrelor group (416.5 [324.8, 484.2]) (42 patients) than in the clopidogrel group (723.5 [471.5, 875.0]) (42 patients), p <0.001. After adjusting for the duration of the procedure, diabetes, extra-cardiac arteriopathy, BMI, hypertension, aortic valve calcium content, procedural ACT, and pre-implantation balloon valvuloplasty, patients on ticagrelor had on average 256.8 (95% CI: [-335.7, -176.5]) fewer total procedural HITS than patients on clopidogrel. Platelet inhibition was greater with ticagrelor 26 [10, 74.5] PRU than with clopidogrel 207.5 (120 to 236.2) PRU, p <0.001, and correlated significantly with procedural HITS (r = 0.5, p <0.05). In conclusion, ticagrelor resulted in fewer procedural HITS, compared with clopidogrel, in patients undergoing TAVI, while achieving greater platelet inhibition.
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Giannopoulos G, Karageorgiou S, Vrachatis D, Anagnostopoulos I, Kousta MS, Lakka E, Giotaki S, Raisakis K, Sianos G, Toutouzas K, Cleman M, Deftereos S. A stand-alone structured educational programme after myocardial infarction: a randomised study. Heart 2021; 107:1047-1053. [PMID: 33483355 DOI: 10.1136/heartjnl-2020-318414] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 12/27/2020] [Accepted: 12/30/2020] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Acute myocardial infarction (MI) is a major clinical manifestation of coronary artery disease. Post-MI morbidity and mortality can be reduced by lifestyle changes and aggressive risk factor modification. These changes can be applied more effectively if the patient is actively involved in the process. The hypothesis of this study was that an educational programme in post-MI patients could lead to reduced incidence of cardiovascular events. METHODS Post-MI patients were prospectively randomised into two groups. Patients in the intervention arm were scheduled to attend an 8-week-long educational programme on top of usual treatment, while controls received optimal treatment. The primary endpoint was the composite of all-cause death, MI, cerebrovascular event and unscheduled hospitalisation for cardiovascular causes. Endpoint adjudication was blinded. RESULTS 329 patients (238 men) were included, with a mean follow-up time of 17±4 months. In the primary analysis, mean primary end point-free survival time was 597 days (95% CI 571 to 624) in controls, compared with 663 days (95% CI 638 to 687) in the intervention group (p<0.001). The HR in the univariate Cox regression analysis was 0.48 (95% CI 0.32 to 0.73; p=0.001). The raw rates of the primary endpoint were 20.8% (6 deaths, 13 MIs, 2 strokes and 14 hospitalisations) vs 36.6% (8 deaths, 22 MIs, 7 strokes and 22 hospitalisations), respectively (OR 0.46, 95% CI 0.28 to 0.74; p=0.002). CONCLUSION These results suggest that a relatively short adult education programme offered to post-MI patients has beneficial effects, resulting in reduced risk of cardiovascular events. TRIAL REGISTRATION NUMBER NCT04007887.
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Affiliation(s)
| | - Sofia Karageorgiou
- 2nd Department of Cardiology, National and Kapodistrian University of Athens, Faculty of Medicine, Athens, Greece
| | - Dimitrios Vrachatis
- 2nd Department of Cardiology, National and Kapodistrian University of Athens, Faculty of Medicine, Athens, Greece
| | | | - Maria S Kousta
- Department of Cardiology, Athens General Hospital "G. Gennimatas", Athens, Greece
| | - Eleni Lakka
- Department of Cardiology, Athens General Hospital "G. Gennimatas", Athens, Greece
| | - Sotiria Giotaki
- 2nd Department of Cardiology, National and Kapodistrian University of Athens, Faculty of Medicine, Athens, Greece
| | | | - Georgios Sianos
- 1st Department of Cardiology, Aristotle University of Thessaloniki, School of Medicine, Thessaloniki, Greece
| | - Konstantinos Toutouzas
- 1st Department of Cardiology, National and Kapodistrian University of Athens, Faculty of Medicine, Athens, Greece
| | - Michael Cleman
- Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Spyridon Deftereos
- 2nd Department of Cardiology, National and Kapodistrian University of Athens, Faculty of Medicine, Athens, Greece
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Michalakeas C, Katsi V, Soulaidopoulos S, Dilaveris P, Vrachatis D, Lekakis I, Vlachopoulos C, Tsioufis K, Tousoulis D. Mobile phones and applications in the management of patients with arterial hypertension. Am J Cardiovasc Dis 2020; 10:419-431. [PMID: 33224593 PMCID: PMC7675159] [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] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 09/06/2020] [Indexed: 06/11/2023]
Abstract
The use of mobile health (mHealth) in the field of medicine is constantly evolving and advancing. Arterial hypertension, a major modifiable cardiovascular risk factor with a high prevalence in the general population, frequently remains underdiagnosed and thus untreated. Furthermore, the majority of hypertensive patients fail to achieve blood pressure target levels. The purpose of this review is to identify and evaluate current use of mHealth strategies, with focus on mobile phones, smartphones and applications, in the management of patients with arterial hypertension. Current mobile technology has the capacity to inform and motivate the general public for timely diagnosis of hypertension, to facilitate communication between physicians and patients, to aid in the monitoring of blood pressure levels and the optimization of treatment and to promote, in general, a healthy lifestyle and assist in the management of other cardiovascular risk factors. There is potential for positive impact of mHealth technology in the management of arterial hypertension, as well as probable detrimental effects that warrant caution. The research in this field is ongoing and future well-conducted studies are needed in order to establish the use of mobile technology in arterial hypertension management.
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Affiliation(s)
- Christos Michalakeas
- Second Department of Cardiology, Attikon Hospital, Athens Medical School, National and Kapodistrian University of AthensAthens, Greece
| | - Vasiliki Katsi
- First Department of Cardiology, Hippokration Hospital, Athens Medical School, National and Kapodistrian University of AthensGreece
| | - Stergios Soulaidopoulos
- First Department of Cardiology, Hippokration Hospital, Athens Medical School, National and Kapodistrian University of AthensGreece
| | - Polychronis Dilaveris
- First Department of Cardiology, Hippokration Hospital, Athens Medical School, National and Kapodistrian University of AthensGreece
| | - Dimitrios Vrachatis
- Department of Cardiology, General Hospital of Athens “G. Gennimatas”Athens, Greece
| | - Ioannis Lekakis
- Second Department of Cardiology, Attikon Hospital, Athens Medical School, National and Kapodistrian University of AthensAthens, Greece
| | - Charalambos Vlachopoulos
- First Department of Cardiology, Hippokration Hospital, Athens Medical School, National and Kapodistrian University of AthensGreece
| | - Konstantinos Tsioufis
- First Department of Cardiology, Hippokration Hospital, Athens Medical School, National and Kapodistrian University of AthensGreece
| | - Dimitrios Tousoulis
- First Department of Cardiology, Hippokration Hospital, Athens Medical School, National and Kapodistrian University of AthensGreece
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Giannopoulos G, Karageorgiou S, Vrachatis D, Kousta M, Tsoukala S, Letsas K, Siasos G, Deftereos S. Usefulness of a Structured Adult Education Program in Modifying Markers of Cardiovascular Risk After Acute Myocardial Infarction. Am J Cardiol 2020; 125:845-850. [PMID: 31924318 DOI: 10.1016/j.amjcard.2019.12.033] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 12/02/2019] [Accepted: 12/09/2019] [Indexed: 12/12/2022]
Abstract
Patient involvement in therapeutic strategies leading to lifestyle changes and increasing adherence to beneficial treatment is important for high risk coronary artery disease patients. The hypothesis of the present substudy was that a program of education specifically structured to educate postmyocardial infarction patients would lead to measurable differences in specific indices of cardiovascular risk. Post-MI patients were randomly assigned to 2 groups. Patients in the intervention arm attended an 8-week long educational program in addition to usual treatment and controls received standard treatment. Low-density lipoprotein cholesterol, systolic blood pressure, body-mass index, and glycosylated hemoglobin were assessed at baseline and at 12 months (values are reported as median [interquartile range]). One hundred ninety-eight consecutively randomized patients were included in the present substudy. The median change in Low-density lipoprotein cholesterol was -54 (-45 to [-62]) mg/dl in the intervention group as compared with -35 (-28 to [-43]) mg/dl in controls (p <0.001). Systolic blood pressure change was -7.5 (-15.3 to 0.3) mm Hg and -3.0 (-11.8 to 2.8) mm Hg, respectively (p = 0.011). The median change in body-mass index was 0.0 (-3.0 to 3.0) kg/m2 as compared with 2.0 (-1.0 to 3.9) kg/m2, respectively (p = 0.002). The reduction in glycosylated hemoglobin was significant in both groups with a median absolute change of -0.29 (-1.11 to 0.09) % in the intervention group and -0.24 (-0.69 to 0.06) % in controls (p = 0.168). If only diabetic patients were considered, the change was -0.65 (-1.3 to [-0.23]) % in the intervention group versus -0.41 (-0.74 to [-0.07]) % in controls (p = 0.021). In conclusion, a relatively short patient education program may have long-lasting effects on established modifiable markers of cardiovascular risk.
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Affiliation(s)
| | - Sofia Karageorgiou
- Second Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios Vrachatis
- Cardiology Department, Athens General Hospital "G. Gennimatas", Athens, Greece
| | - Maria Kousta
- Cardiology Department, Athens General Hospital "G. Gennimatas", Athens, Greece
| | - Styliani Tsoukala
- Cardiology Department, Athens General Hospital "G. Gennimatas", Athens, Greece
| | - Konstantinos Letsas
- Second Department of Cardiology, Evangelismos General Hospital, Athens, Greece
| | - Gerasimos Siasos
- First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Spyridon Deftereos
- Second Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
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13
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Affiliation(s)
| | - Dimitrios Vrachatis
- First Department of Cardiology, Hippokration Hospital, Medical School, National and Kapodistrian University of Athens, Greece
| | - Dimitrios Tousoulis
- First Department of Cardiology, Hippokration Hospital, Medical School, National and Kapodistrian University of Athens, Greece
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14
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Giannopoulos G, Kossyvakis C, Vrachatis D, Aggeli C, Tsitsinakis G, Letsas K, Tsiachris D, Tsoukala S, Efremidis M, Katritsis D, Deftereos S. Effect of cryoballoon and radiofrequency ablation for pulmonary vein isolation on left atrial function in patients with nonvalvular paroxysmal atrial fibrillation: A prospective randomized study (Cryo-LAEF study). J Cardiovasc Electrophysiol 2019; 30:991-998. [PMID: 30938914 DOI: 10.1111/jce.13933] [Citation(s) in RCA: 10] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 03/06/2019] [Accepted: 03/24/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND Isolation of the pulmonary veins (PVI) has become a mainstay in atrial fibrillation (AFib) therapy. Lesions in left atrial tissue lead to scar formation and this may affect left atrial function. METHODS Patients with paroxysmal AFib were randomly assigned in a 1:2 allocation scheme to radiofrequency (RF) ablation or cryoballoon. Real-time three-dimensional echocardiography was performed (under sinus rhythm in all cases) before ablation and at 1 and 3 months to evaluate the left atrial functional indices. The primary outcome measure was change in left atrial ejection fraction (LAEF) at 1 month. RESULTS 120 patients were randomized (80 to cryoballoon, 40 to RF). The absolute change in LAEF at 1 month was 4.0 (Q1-Q3, -0.1to 7.6)% in the cryoballoon group and -0.8 (Q1-Q3, -1.9 to 0.9)% in the RF group (P < 0.001 for the comparison between groups). At 3 months, the corresponding changes were 6.7 (Q1-Q3, 3.4-11.2)% and 0.7 (Q1-Q3, -0.7 to 3.5)%, respectively (P < 0.001). Overall, the rate of patients with lower LAEF at 3 months compared to baseline was 2.5% in the cryoballoon group and 32.5% in the RF group (P < 0.001). AFib recurrence rate at 6 months was higher in patients with decreased LAEF (odds ratio, 6.2; 95% confidence interval, 2.0-19.5; P = 0.002). CONCLUSION The Cryo-LAEF study prospectively compared the effects of RF and cryoballoon ablation on left atrial function. Both at 1 and 3 months postablation, LAEF was either improved or stable in both ablation groups.
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Affiliation(s)
| | | | - Dimitrios Vrachatis
- Department of Cardiology, Athens General Hospital "G. Gennimatas", Athens, Greece
| | - Constadina Aggeli
- 1st Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Georgios Tsitsinakis
- Department of Cardiology, Athens General Hospital "G. Gennimatas", Athens, Greece
| | | | | | - Styliani Tsoukala
- Department of Cardiology, Athens General Hospital "G. Gennimatas", Athens, Greece
| | - Michalis Efremidis
- 2nd Department of Cardiology, Evangelismos General Hospital, Athens, Greece
| | | | - Spyridon Deftereos
- 1st Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
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15
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Vrachatis D, Deftereos S, Kekeris V, Tsoukala S, Giannopoulos G. Catheter Ablation for Atrial Fibrillation in Systolic Heart Failure Patients: Stone by Stone, a CASTLE. Arrhythm Electrophysiol Rev 2018; 7:265-272. [PMID: 30588315 DOI: 10.15420/aer.2018.41.2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 10/28/2018] [Indexed: 11/04/2022] Open
Abstract
Heart failure (HF) and AF frequently coexist and are involved in a vicious cycle of adverse pathophysiologic interactions. Applying treatment algorithms that have been validated in the general AF population to patients with AF and HF may be fraught with risks and lack effectiveness. While firm recommendations on using catheter ablation for AF do exist, the subset of patients also suffering from HF needs to be further evaluated. Observational data indicate that a significant number of ablation procedures are performed in patients with coexistent HF. Initial randomised data on outcomes are encouraging. Apart from sinus rhythm maintenance, benefits have been observed in terms of other significant endpoints, including left ventricular ejection fraction, quality of life, exercise capacity and hospital readmissions for HF. Limited existing data on survival are also promising. In the present article, observational and randomised studies along with current practice guidelines are summarised.
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Affiliation(s)
| | - Spyridon Deftereos
- Section of Cardiovascular Medicine, Yale University School of Medicine CT, USA.,Second Department of Cardiology, Medical School, Attikon Hospital, National and Kapodistrian University of Athens Greece
| | - Vasileios Kekeris
- Department of Cardiology, 'G Gennimatas' General Hospital of Athens Greece
| | - Styliani Tsoukala
- Department of Cardiology, 'G Gennimatas' General Hospital of Athens Greece
| | - Georgios Giannopoulos
- Department of Cardiology, 'G Gennimatas' General Hospital of Athens Greece.,Section of Cardiovascular Medicine, Yale University School of Medicine CT, USA
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16
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Katsi V, Marketou M, Antonopoulos AS, Vrachatis D, Parthenakis F, Tousoulis D. B-type natriuretic peptide levels and benign adiposity in obese heart failure patients. Heart Fail Rev 2018; 24:219-226. [DOI: 10.1007/s10741-018-9739-3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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17
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Elefsiniotis I, Tsakiris SA, Barla G, Tasovasili A, Vrachatis D, Mavrogiannis C. Presepsin levels in cirrhotic patients with bacterial infections and/or portal hypertension-related bleeding, presenting with or without acute kidney injury. Ann Gastroenterol 2018; 31:604-612. [PMID: 30174398 PMCID: PMC6102455 DOI: 10.20524/aog.2018.0292] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [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: 03/28/2018] [Accepted: 06/25/2018] [Indexed: 12/28/2022] Open
Abstract
Background Bacterial infections in cirrhotic patients remain a challenge. Presepsin has been proposed as a valuable sepsis biomarker. We aimed to assess plasma presepsin levels in uncomplicated cirrhotic patients and to correlate them with liver disease severity and complicating events, defined as documented bacterial infection with or without concomitant portal hypertension-related bleeding, or bleeding without documented bacterial infection, with or without acute kidney injury. Methods We prospectively evaluated the presepsin levels of 108 consecutive uncomplicated cirrhotic patients with compensated (55, 50.9%) or decompensated (53, 49.1%) cirrhosis. During the follow up, 20 patients were reevaluated for a complicating event. Results Mean baseline presepsin levels of the entire population were 440.4 pg/mL. Patients with decompensated cirrhosis exhibited significantly higher baseline levels than patients with compensated cirrhosis (599.1±492.2 vs. 287.5±130.5 pg/mL, P<0.001). In complicated cirrhotic patients, admission levels were remarkably higher than baseline (1438.0±1247.2 vs. 725.3±602.8 pg/mL, P<0.001), especially in those who developed acute kidney injury compared to those who did not (1827.3±1118.8 vs. 1048.7±1302.1 pg/mL, P<0.05). Baseline presepsin levels, using a cutoff of 607.5 pg/mL, could predict liver disease-related 3-month mortality with 77.8% sensitivity and 86.9% specificity: area under the receiver operating characteristic curve 0.825; 95% confidence interval 0.684-0.967; P<0.01. Conclusions Plasma presepsin levels are elevated in uncomplicated cirrhotic patients, especially in those with advanced liver disease, and rise further in those complicated by an event. Baseline presepsin levels in cirrhotic patients could be used as an additional marker, along with the model for end-stage liver disease score, to predict short-term outcomes.
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Affiliation(s)
- Ioannis Elefsiniotis
- Academic Department of Internal Medicine, Hepatogastroenterology Unit, "Agioi Anargyroi" General and Oncology Hospital of Kifisia, National and Kapodistrian University of Athens, Greece, The study was partially supported by an unrestricted research grant from AbbVie Pharmaceuticals S.A. The authors state that AbbVie Pharmaceuticals S.A. had no involvement in the study design, collection, analysis, interpretation of data, writing of the report or the decision to submit the manuscript for publication
| | - Stefanos A Tsakiris
- Academic Department of Internal Medicine, Hepatogastroenterology Unit, "Agioi Anargyroi" General and Oncology Hospital of Kifisia, National and Kapodistrian University of Athens, Greece, The study was partially supported by an unrestricted research grant from AbbVie Pharmaceuticals S.A. The authors state that AbbVie Pharmaceuticals S.A. had no involvement in the study design, collection, analysis, interpretation of data, writing of the report or the decision to submit the manuscript for publication
| | - Georgia Barla
- Academic Department of Internal Medicine, Hepatogastroenterology Unit, "Agioi Anargyroi" General and Oncology Hospital of Kifisia, National and Kapodistrian University of Athens, Greece, The study was partially supported by an unrestricted research grant from AbbVie Pharmaceuticals S.A. The authors state that AbbVie Pharmaceuticals S.A. had no involvement in the study design, collection, analysis, interpretation of data, writing of the report or the decision to submit the manuscript for publication
| | - Athanasia Tasovasili
- Academic Department of Internal Medicine, Hepatogastroenterology Unit, "Agioi Anargyroi" General and Oncology Hospital of Kifisia, National and Kapodistrian University of Athens, Greece, The study was partially supported by an unrestricted research grant from AbbVie Pharmaceuticals S.A. The authors state that AbbVie Pharmaceuticals S.A. had no involvement in the study design, collection, analysis, interpretation of data, writing of the report or the decision to submit the manuscript for publication
| | - Dimitrios Vrachatis
- Academic Department of Internal Medicine, Hepatogastroenterology Unit, "Agioi Anargyroi" General and Oncology Hospital of Kifisia, National and Kapodistrian University of Athens, Greece, The study was partially supported by an unrestricted research grant from AbbVie Pharmaceuticals S.A. The authors state that AbbVie Pharmaceuticals S.A. had no involvement in the study design, collection, analysis, interpretation of data, writing of the report or the decision to submit the manuscript for publication
| | - Christos Mavrogiannis
- Academic Department of Internal Medicine, Hepatogastroenterology Unit, "Agioi Anargyroi" General and Oncology Hospital of Kifisia, National and Kapodistrian University of Athens, Greece, The study was partially supported by an unrestricted research grant from AbbVie Pharmaceuticals S.A. The authors state that AbbVie Pharmaceuticals S.A. had no involvement in the study design, collection, analysis, interpretation of data, writing of the report or the decision to submit the manuscript for publication
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Giannopoulos G, Kekeris V, Vrachatis D, Kossyvakis C, Ntavelas C, Tsitsinakis G, Koutivas A, Tolis C, Angelidis C, Deftereos S. Effect of pulmonary vein isolation on left atrial appendage flow in paroxysmal atrial fibrillation. Pacing Clin Electrophysiol 2018; 41:1129-1135. [PMID: 30028029 DOI: 10.1111/pace.13436] [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] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 06/16/2018] [Accepted: 06/18/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Left atrial appendage (LAA) functional modification in the context of pulmonary vein isolation has been a focus point of research and LAA emptying flow velocity (LAAEFV) is considered to reflect LAA contractility, stunning, and fibrosis. OBJECTIVE In the present study, we sought to prospectively evaluate short-term LAAEFV changes after radiofrequency (RF) or cryoballoon ablation in paroxysmal AF. METHODS This was a prospective substudy of the Effect of Cryoballoon and RF Ablation on Left Atrial Function (CryoLAEF) study (ClinicalTrials.gov Identifier: NCT02611869). Thirty patients, randomly assigned to RF or cryoablation, were prospectively followed. Transesophageal echocardiograms were performed at baseline and at 3 months postablation to measure LAAEFV. RESULTS All measurements were performed in sinus rhythm. Overall, LAAEFV was 44.2 [38.5-62.8] cm/s at baseline and was increased to 70.8 [64.8-77.6] cm/s at 3 months' postablation (P < 0.001). Baseline LAAEFV was 52.5 [37.7-68.0] cm/s in the RF group and 42.8 [38.7-52.9] cm/s in the CryoBalloon group (P = 0.653). At 3 months, the corresponding values were 68.5 [61.9-76.6] cm/s and 73.9 [69.2-79.9] cm/s, respectively (P = 0.081 for the difference between the two groups at 3 months). The median change in LAAEFV was 11.0 [4.7-26.2] cm/s in the RF group versus 29.6 [15.8-37.0] cm/s in the CryoBalloon group (P = 0.033). CONCLUSION LAA function is improved after catheter ablation with RF or balloon cryoablation in patients with paroxysmal AF, evaluated while in sinus rhythm both at baseline and on follow-up.
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Affiliation(s)
- Georgios Giannopoulos
- Department of Cardiology, Athens General Hospital "G. Gennimatas", Athens, Greece.,2nd Department of Cardiology, National and Kapodistrian University of Athens Medical School, Attikon Hospital, Athens, Greece
| | - Vasileios Kekeris
- Department of Cardiology, Athens General Hospital "G. Gennimatas", Athens, Greece
| | - Dimitrios Vrachatis
- Department of Cardiology, Athens General Hospital "G. Gennimatas", Athens, Greece
| | | | - Charalampos Ntavelas
- Department of Cardiology, Athens General Hospital "G. Gennimatas", Athens, Greece
| | - Georgios Tsitsinakis
- Department of Cardiology, Athens General Hospital "G. Gennimatas", Athens, Greece
| | - Athanasios Koutivas
- Department of Cardiology, Athens General Hospital "G. Gennimatas", Athens, Greece
| | - Christos Tolis
- Department of Cardiology, Athens General Hospital "G. Gennimatas", Athens, Greece
| | - Christos Angelidis
- Department of Cardiology, Athens General Hospital "G. Gennimatas", Athens, Greece
| | - Spyridon Deftereos
- 2nd Department of Cardiology, National and Kapodistrian University of Athens Medical School, Attikon Hospital, Athens, Greece
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Vavuranakis M, Kariori M, Scott L, Kalogeras K, Siasos G, Vrachatis D, Lavda M, Kalantzis C, Vavuranakis M, Bei E, Moldovan CM, Oikonomou E, Stefanadis C, Tousoulis D. Impact of “high” implantation on functionality of self-expandable bioprosthesis during the short- and long-term outcome of patients who undergo transcatheter aortic valve implantation: Is high implantation beneficial? Cardiovasc Ther 2018; 36:e12330. [DOI: 10.1111/1755-5922.12330] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2017] [Revised: 02/02/2018] [Accepted: 03/26/2018] [Indexed: 11/29/2022] Open
Affiliation(s)
- Manolis Vavuranakis
- 1st Department of Cardiology; Medical School; Hippokration Hospital; National and Kapodistrian University of Athens; Athens Greece
| | - Maria Kariori
- 1st Department of Cardiology; Medical School; Hippokration Hospital; National and Kapodistrian University of Athens; Athens Greece
| | - Lilly Scott
- Department of Medicine; Division of Cardiovascular Medicine; The Ohio State University; Columbus OH USA
| | - Konstantinos Kalogeras
- 1st Department of Cardiology; Medical School; Hippokration Hospital; National and Kapodistrian University of Athens; Athens Greece
| | - Gerasimos Siasos
- 1st Department of Cardiology; Medical School; Hippokration Hospital; National and Kapodistrian University of Athens; Athens Greece
| | - Dimitrios Vrachatis
- 1st Department of Cardiology; Medical School; Hippokration Hospital; National and Kapodistrian University of Athens; Athens Greece
| | - Maria Lavda
- 1st Department of Cardiology; Medical School; Hippokration Hospital; National and Kapodistrian University of Athens; Athens Greece
| | - Charalampos Kalantzis
- 1st Department of Cardiology; Medical School; Hippokration Hospital; National and Kapodistrian University of Athens; Athens Greece
| | - Michael Vavuranakis
- 1st Department of Cardiology; Medical School; Hippokration Hospital; National and Kapodistrian University of Athens; Athens Greece
| | - Evangelia Bei
- 1st Department of Cardiology; Medical School; Hippokration Hospital; National and Kapodistrian University of Athens; Athens Greece
| | - Carmen-Maria Moldovan
- 1st Department of Cardiology; Medical School; Hippokration Hospital; National and Kapodistrian University of Athens; Athens Greece
| | - Evangelos Oikonomou
- 1st Department of Cardiology; Medical School; Hippokration Hospital; National and Kapodistrian University of Athens; Athens Greece
| | - Christodoulos Stefanadis
- 1st Department of Cardiology; Medical School; Hippokration Hospital; National and Kapodistrian University of Athens; Athens Greece
| | - Dimitrios Tousoulis
- 1st Department of Cardiology; Medical School; Hippokration Hospital; National and Kapodistrian University of Athens; Athens Greece
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20
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Siasos G, Zaromitidou M, Oikonomou E, Vavuranakis M, Tsigkou V, Papageorgiou N, Chaniotis DA, Vrachatis D, Stefanadis C, Papavassiliou AG, Tousoulis D. Genetics in the Clinical Decision of Antiplatelet Treatment. Curr Pharm Des 2017; 23:1307-1314. [DOI: 10.2174/1381612822666161226152529] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Accepted: 12/20/2016] [Indexed: 11/22/2022]
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Giannopoulos G, Kossyvakis C, Panagopoulou V, Tsiachris D, Doudoumis K, Mavri M, Vrachatis D, Letsas K, Efremidis M, Katsivas A, Lekakis J, Deftereos S. Permanent pacemaker implantation in octogenarians with unexplained syncope and positive electrophysiologic testing. Heart Rhythm 2017; 14:694-699. [PMID: 28089877 DOI: 10.1016/j.hrthm.2017.01.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Syncope is a common problem in the elderly, and a permanent pacemaker is a therapeutic option when a bradycardic etiology is revealed. However, the benefit of pacing when no association of symptoms to bradycardia has been shown is not clear, especially in the elderly. OBJECTIVE The aim of this study was to evaluate the effect of pacing on syncope-free mortality in patients aged 80 years or older with unexplained syncope and "positive" invasive electrophysiologic testing (EPT). METHODS This was an observational study. A positive EPT for the purposes of this study was defined by at least 1 of the following: a corrected sinus node recovery time of >525 ms, a basic HV interval of >55 ms, detection of infra-Hisian block, or appearance of second-degree atrioventricular block on atrial decremental pacing at a paced cycle length of >400 ms. RESULTS Among the 2435 screened patients, 228 eligible patients were identified, 145 of whom were implanted with a pacemaker. Kaplan-Meier analysis determined that time to event (syncope or death) was 50.1 months (95% confidence interval 45.4-54.8 months) with a pacemaker vs 37.8 months (95% confidence interval 31.3-44.4 months) without a pacemaker (log-rank test, P = .001). The 4-year time-dependent estimate of the rate of syncope was 12% vs 44% (P < .001) and that of any-cause death was 41% vs 56% (P = .023), respectively. The multivariable odds ratio was 0.25 (95% confidence interval 0.15-0.40) after adjustment for potential confounders. CONCLUSION In patients with unexplained syncope and signs of sinus node dysfunction or impaired atrioventricular conduction on invasive EPT, pacemaker implantation was independently associated with longer syncope-free survival. Significant differences were also shown in the individual components of the primary outcome measure (syncope and death from any cause).
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Affiliation(s)
- Georgios Giannopoulos
- Cardiology Department, Athens General Hospital "G. Gennimatas," Athens, Greece; 2nd Department of Cardiology, National and Kapodistrean University of Athens Medical School, Attikon University Hospital, Athens, Greece.
| | | | - Vasiliki Panagopoulou
- 2nd Department of Cardiology, National and Kapodistrean University of Athens Medical School, Attikon University Hospital, Athens, Greece
| | | | | | - Maria Mavri
- Cardiology Department, Athens General Hospital "G. Gennimatas," Athens, Greece
| | - Dimitrios Vrachatis
- Cardiology Department, Athens General Hospital "G. Gennimatas," Athens, Greece
| | | | - Michael Efremidis
- 2nd Department of Cardiology, Evangelismos General Hospital, Athens, Greece
| | - Apostolos Katsivas
- 1st Department of Cardiology, Hellenic Red Cross Hospital, Athens, Greece
| | - John Lekakis
- 2nd Department of Cardiology, National and Kapodistrean University of Athens Medical School, Attikon University Hospital, Athens, Greece
| | - Spyridon Deftereos
- 2nd Department of Cardiology, National and Kapodistrean University of Athens Medical School, Attikon University Hospital, Athens, Greece
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Vavuranakis M, Kalogeras K, Lavda M, Kolokathis MA, Papaioannou T, Oikonomou E, Stasinopoulou M, Vrachatis D, Moldovan C, Kariori M, Bei E, Vaina S, Lazaros G, Katsarou O, Siasos G, Tousoulis D. Correlation of CoreValve implantation 'true cover index' with short and mid-term aortic regurgitation: A novel index. Int J Cardiol 2016; 223:482-487. [PMID: 27544611 DOI: 10.1016/j.ijcard.2016.08.114] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Revised: 07/28/2016] [Accepted: 08/05/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND 'Cover index' has been proposed to appraise the congruence between the aortic annulus and the device, with the assumption of not taking into account the actual device implantation depth. The aim of this study was to investigate whether the annulus-prosthesis mismatch, as expressed with the new proposed 'true cover index' according to actual implantation depth, can predict aortic regurgitation (AR) after transcatheter aortic valve implantation (TAVI). METHODS Patients who had undergone TAVI with the self-expandable CoreValve device, were retrospectively studied. All available prosthesis sizes were ex-vivo scanned and the precise diameter at 0.3mm intervals along each device was measured. The 'true cover index' was evaluated, as a ratio of the following: 100×([prosthesis actual diameter at implantation depth-annulus diameter]/prosthesis actual diameter at implantation depth). AR was echocardiographically evaluated at discharge and 30days and classified as prominent if moderate, or trivial if none or mild. RESULTS Overall, 120 patients who had undergone TAVI, were considered eligible for the study. 'True cover index' was statistically significantly lower among patients with prominent AR in comparison with trivial AR at discharge (5.7±4.8mm vs 9±5.1, p=0.025), as well as at one month post-TAVI (5.4±5.1mm vs 9.0±5.1, p=0.023), indicating increased AR for smaller index. After adjustment for severe annulus calcification, impaired baseline LVEF and previous valvuloplasty, it remained an independent predictor of one month prominent AR (OR: 0.854, CI: 0.730-0.999; p=0.048). 'True cover index' of <4.3 was shown to predict one-month prominent AR with sensitivity =75% and specificity =82.5%. CONCLUSIONS 'True cover index' is strongly and independently correlated with the short and mid-term AR after CoreValve implantation.
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Affiliation(s)
- Manolis Vavuranakis
- 1st Dept. of Cardiology, Hippokration Hospital, Medical School, National & Kapodistrian University of Athens, Greece.
| | - Konstantinos Kalogeras
- 1st Dept. of Cardiology, Hippokration Hospital, Medical School, National & Kapodistrian University of Athens, Greece.
| | - Maria Lavda
- 1st Dept. of Cardiology, Hippokration Hospital, Medical School, National & Kapodistrian University of Athens, Greece
| | - Michail-Aggelos Kolokathis
- 1st Dept. of Cardiology, Hippokration Hospital, Medical School, National & Kapodistrian University of Athens, Greece
| | - Theodoros Papaioannou
- 1st Dept. of Cardiology, Hippokration Hospital, Medical School, National & Kapodistrian University of Athens, Greece
| | - Euaggelos Oikonomou
- 1st Dept. of Cardiology, Hippokration Hospital, Medical School, National & Kapodistrian University of Athens, Greece
| | | | - Dimitrios Vrachatis
- 1st Dept. of Cardiology, Hippokration Hospital, Medical School, National & Kapodistrian University of Athens, Greece
| | - Carmen Moldovan
- 1st Dept. of Cardiology, Hippokration Hospital, Medical School, National & Kapodistrian University of Athens, Greece
| | - Maria Kariori
- 1st Dept. of Cardiology, Hippokration Hospital, Medical School, National & Kapodistrian University of Athens, Greece
| | - Evelina Bei
- 1st Dept. of Cardiology, Hippokration Hospital, Medical School, National & Kapodistrian University of Athens, Greece
| | - Sophia Vaina
- 1st Dept. of Cardiology, Hippokration Hospital, Medical School, National & Kapodistrian University of Athens, Greece
| | - Georgios Lazaros
- 1st Dept. of Cardiology, Hippokration Hospital, Medical School, National & Kapodistrian University of Athens, Greece
| | - Ourania Katsarou
- 1st Dept. of Cardiology, Hippokration Hospital, Medical School, National & Kapodistrian University of Athens, Greece
| | - Gerasimos Siasos
- 1st Dept. of Cardiology, Hippokration Hospital, Medical School, National & Kapodistrian University of Athens, Greece; Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - Dimitrios Tousoulis
- 1st Dept. of Cardiology, Hippokration Hospital, Medical School, National & Kapodistrian University of Athens, Greece
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Filis K, Toufektzian L, Galyfos G, Sigala F, Kourkoveli P, Georgopoulos S, Vavuranakis M, Vrachatis D, Zografos G. Assessment of the vulnerable carotid atherosclerotic plaque using contrast-enhanced ultrasonography. Vascular 2016; 25:316-325. [PMID: 27580821 DOI: 10.1177/1708538116665734] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Carotid atherosclerosis represents a primary cause for cerebrovascular ischemic events and its contemporary management includes surgical revascularization for moderate to severe symptomatic stenoses. However, the role of invasive therapy seems to be questioned lately for asymptomatic cases. Numerous reports have suggested that the presence of neovessels within the atherosclerotic plaque remains a significant vulnerability factor and over the last decade imaging modalities have been used to identify intraplaque neovascularization in an attempt to risk-stratify patients and offer management guidance. Contrast-enhanced ultrasonography of the carotid artery is a relatively novel diagnostic tool that exploits resonated ultrasound waves from circulating microbubbles. This property permits vascular visualization by producing superior angiography-like images, and allows the identification of vasa vasorum and intraplaque microvessels. Moreover, plaque neovascularization has been associated with plaque vulnerability and ischemic symptoms lately as well. At the same time, attempts have been made to quantify contrast-enhanced ultrasonography signal using sophisticated software packages and algorithms, and to correlate it with intraplaque microvascular density. The aim of this review was to collect all recent data on the characteristics, performance, and prognostic role of contrast-enhanced ultrasonography regarding carotid stenosis management, and to produce useful conclusions for clinical practice.
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Affiliation(s)
- Konstantinos Filis
- First Department of Propaedeutic Surgery, University of Athens Medical School, Hippocration Hospital, Athens, Greece
| | - Levon Toufektzian
- First Department of Propaedeutic Surgery, University of Athens Medical School, Hippocration Hospital, Athens, Greece
| | - George Galyfos
- First Department of Propaedeutic Surgery, University of Athens Medical School, Hippocration Hospital, Athens, Greece
| | - Fragiska Sigala
- First Department of Propaedeutic Surgery, University of Athens Medical School, Hippocration Hospital, Athens, Greece
| | - Panagiota Kourkoveli
- First Department of Propaedeutic Surgery, University of Athens Medical School, Hippocration Hospital, Athens, Greece
| | - Sotirios Georgopoulos
- First Department of Propaedeutic Surgery, University of Athens Medical School, Hippocration Hospital, Athens, Greece
| | - Manolis Vavuranakis
- First Department of Propaedeutic Surgery, University of Athens Medical School, Hippocration Hospital, Athens, Greece
| | - Dimitrios Vrachatis
- First Department of Propaedeutic Surgery, University of Athens Medical School, Hippocration Hospital, Athens, Greece
| | - George Zografos
- First Department of Propaedeutic Surgery, University of Athens Medical School, Hippocration Hospital, Athens, Greece
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24
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Papaioannou TG, Protogerou AD, Vrachatis D, Konstantonis G, Aissopou E, Argyris A, Nasothimiou E, Gialafos EJ, Karamanou M, Tousoulis D, Sfikakis PP. Mean arterial pressure values calculated using seven different methods and their associations with target organ deterioration in a single-center study of 1878 individuals. Hypertens Res 2016; 39:640-7. [PMID: 27194570 DOI: 10.1038/hr.2016.41] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Revised: 02/10/2016] [Accepted: 03/10/2016] [Indexed: 12/29/2022]
Abstract
To assess the differences among seven different methods for the calculation of mean arterial pressure (MAP) and to identify the formula that provides MAP values that are more closely associated with target organ deterioration as expressed by the carotid cross-sectional area (CSA), carotid-to-femoral pulse-wave velocity (cf-PWV) and left ventricular mass (LVM). The study population consisted of 1878 subjects who underwent noninvasive cardiovascular risk assessment. Blood pressure (BP) was assessed in all subjects, and MAP was calculated by direct oscillometry and six different formulas. Carotid artery ultrasound imaging was performed in 1628 subjects. The CSA of the right and left common carotid artery (CCA) were calculated and used as surrogates of arterial wall mass and hypertrophy. Aortic stiffness was evaluated in 1763 subjects by measuring the cf-PWV. Finally, 218 subjects underwent echocardiographic examination for the assessment of LVM. Among the examined methods of MAP calculation, the formula MAP1=[diastolic BP]+0.412 × [pulse pressure] yielded the strongest correlations with the LVM, cf-PWV and CSA of the right and left CCA, even after adjusting for age and gender. The MAP calculation using the 0.412 was superior compared with the traditional formula that uses the 0.33 for the discrimination of subjects with left ventricular and carotid wall hypertrophy, as well as subjects with increased aortic stiffness. MAP estimated with the 0.412 is better correlated with target organ deterioration compared with other formulas. Future studies are needed to explore the accuracy of these formulas for MAP estimation compared with direct intra-arterial BP measurement.
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Affiliation(s)
- Theodore G Papaioannou
- Units of Biomedical Engineering and Biostatistics, First Department of Cardiology, Hippokration Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Athanase D Protogerou
- Cardiovascular Research Lab, First Department of Propaedeutic Internal Medicine, Laikon Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios Vrachatis
- Units of Biomedical Engineering and Biostatistics, First Department of Cardiology, Hippokration Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Giorgos Konstantonis
- Cardiovascular Research Lab, First Department of Propaedeutic Internal Medicine, Laikon Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Evaggelia Aissopou
- Cardiovascular Research Lab, First Department of Propaedeutic Internal Medicine, Laikon Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Antonis Argyris
- Cardiovascular Research Lab, First Department of Propaedeutic Internal Medicine, Laikon Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Efthimia Nasothimiou
- Cardiovascular Research Lab, First Department of Propaedeutic Internal Medicine, Laikon Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Elias J Gialafos
- Aiginition Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Marianna Karamanou
- Units of Biomedical Engineering and Biostatistics, First Department of Cardiology, Hippokration Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitris Tousoulis
- Units of Biomedical Engineering and Biostatistics, First Department of Cardiology, Hippokration Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Petros P Sfikakis
- Cardiovascular Research Lab, First Department of Propaedeutic Internal Medicine, Laikon Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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Vavuranakis M, Kalogeras K, Stasinopoulou M, Lavda M, Kolokathis AM, Vrachatis D, Kariori M, Moldovan C, Bei E, Vaina S, Siasos G, Oikonomou E, Tousoulis D. CORRELATION OF COREVALVE IMPLANTATION ‘TRUE COVER INDEX’ WITH SHORT AND MID-TERM AORTIC REGURGITATION: IMPLANTATION DEPTH REALLY MATTERS. J Am Coll Cardiol 2016. [DOI: 10.1016/s0735-1097(16)30126-7] [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: 11/16/2022]
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26
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Vavuranakis M, Kariori M, Vrachatis D, Siasos G, Kalogeras K, Bei E, Moldovan C, Lavda M, Aznaouridis K, Oikonomou E, Tousoulis D. Novel Inflammatory Indices in Aortic Disease. Curr Med Chem 2015; 22:2762-72. [DOI: 10.2174/0929867322666150630141035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2014] [Revised: 02/10/2015] [Accepted: 06/29/2015] [Indexed: 11/22/2022]
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27
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Vavuranakis M, Kalogeras K, Moldovan C, Vaina S, Vrachatis D, Kariori M, Mpei E, Tousoulis D, Stefanadis C. Percutaneous closure of a large ascending aorta pseudoaneurysm due to mediastinitis using an amplatzer occluder device. JACC Cardiovasc Interv 2015; 8:495-497. [PMID: 25703875 DOI: 10.1016/j.jcin.2014.09.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2014] [Revised: 08/31/2014] [Accepted: 09/10/2014] [Indexed: 11/16/2022]
Affiliation(s)
- Manolis Vavuranakis
- Hippokration Hospital, 1st Department of Cardiology, University of Athens, Athens, Greece.
| | - Konstantinos Kalogeras
- Hippokration Hospital, 1st Department of Cardiology, University of Athens, Athens, Greece.
| | - Carmen Moldovan
- Hippokration Hospital, 1st Department of Cardiology, University of Athens, Athens, Greece
| | - Sophia Vaina
- Hippokration Hospital, 1st Department of Cardiology, University of Athens, Athens, Greece
| | - Dimitrios Vrachatis
- Hippokration Hospital, 1st Department of Cardiology, University of Athens, Athens, Greece
| | - Maria Kariori
- Hippokration Hospital, 1st Department of Cardiology, University of Athens, Athens, Greece
| | - Evelina Mpei
- Hippokration Hospital, 1st Department of Cardiology, University of Athens, Athens, Greece
| | - Dimitrios Tousoulis
- Hippokration Hospital, 1st Department of Cardiology, University of Athens, Athens, Greece
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Elefsiniotis I, Vezali E, Vrachatis D, Hatzianastasiou S, Pappas S, Farmakidis G, Vrioni G, Tsakris A. Post-partum reactivation of chronic hepatitis B virus infection among hepatitis B e-antigen-negative women. World J Gastroenterol 2015; 21:1261-1267. [PMID: 25632200 PMCID: PMC4306171 DOI: 10.3748/wjg.v21.i4.1261] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2014] [Revised: 08/20/2014] [Accepted: 10/15/2014] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the frequency and timing of post-partum chronic hepatitis B virus (HBV) reactivation and identify its pre-partum predictors.
METHODS: Forty-one hepatitis B e antigen (HBeAg)-negative chronic HBV infected pregnant women were prospectively evaluated between the 28th and the 32nd week of gestation. Subjects were re-evaluated at 3-mo intervals during the first post-partum year and every 6 mo during the following years. HBV DNA was determined using real-time reverse transcription polymerase chain reaction (Cobas TaqMan HBV Test) with a lower detection limit of 8 IU/mL. Post-partum reactivation (PPR) was defined as abnormal alanine aminotransaminase (ALT) levels and HBV DNA above 2000 IU/mL.
RESULTS: Fourteen out of 41 women (34.1%) had pre-partum HBV DNA levels > 2000 IU/mL, 18 (43.9%) had levels < 2000 IU/mL and 9 (21.9%) had undetectable levels. Fourteen women were lost to follow-up (failure to return). PPR occurred in 8 of the 27 (29.6%) women evaluated, all within the first 6 mo after delivery (5 at month 3; 3 at month 6). Five of the 6 (83.3%) women with pre-partum HBV DNA > 10000 IU/mL exhibited PPR compared with 3 of the 21 (14.3%) women with HBV DNA < 10000 IU/mL (two with HBV DNA > 2000 and the third with HBV DNA of 1850 IU/mL), P = 0.004. An HBV DNA level ≥ 10000 IU/mL independently predicted post-partum HBV infection reactivation (OR = 57.02, P = 0.033). Mean pre-partum ALT levels presented a non-significant increase in PPR cases (47.3 IU/L vs 22.2 IU/L, respectively, P = 0.094).
CONCLUSION: In the present study, PPR occurred in approximately 30% of HBeAg-negative pregnant women; all events were observed during the first semester after delivery. Pre-partum HBV DNA level > 10000 IU/mL predicted PPR.
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29
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Vavuranakis M, Kalogeras K, Dagres N, Kariori M, Vrachatis D, Moldovan C, Lavda M, Mpei E, Androulakis A, Siasos G, Tousoulis D, Stefanadis C. Residual platelet reactivity after clopidogrel loading in ST-elevation myocardial infarction patients undergoing a delayed catheterization. Impact on long term clinical events. Int J Cardiol 2014; 176:1292-3. [DOI: 10.1016/j.ijcard.2014.07.177] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2014] [Accepted: 07/27/2014] [Indexed: 11/30/2022]
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Vavuranakis M, Kariori M, Vrachatis D, Aznaouridis K, Siasos G, Kokkou E, Mazaris S, Moldovan C, Kalogeras K, Tousoulis D, Stefanadis C. MicroRNAs in aortic disease. Curr Top Med Chem 2014; 13:1559-72. [PMID: 23745808 DOI: 10.2174/15680266113139990105] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2013] [Accepted: 04/29/2013] [Indexed: 11/22/2022]
Abstract
MicroRNAs (miRNAs) are non-coding RNAs of ~22 nucleotides which act as down regulators of gene expression in the post-transcription level and/or in the translation level. Several studies have shown that the process of their maturation is rather crucial for the development of cardiovascular system thus their regulation (up-,down-) is implicated with many cardiac pathologies. This is evaluated through their circulating levels which are reliable, stable and the changes in their serum profiles are representative of tissue alterations serum levels. Furthermore, they have been shown to participate in cardiovascular disease pathogenesis including atherosclerosis, coronary artery disease, myocardial infarction, heart failure cardiac arrhythmias and aortic stenosis. In the present review, we will first describe i) the process of miRNAs' maturation ii) their role in the cardiovascular development, iii) their role as biomarkers of cardiac diseases, iv) the cardiac myo-miR families and the v) their role in cardiac remodeling and the development of cardiac diseases. Second we will review the miRNA families that participate in aortic stenosis separated according to its main pathways (imflammation, fibrosis, calcification). Finally, we will describe the miRNAs that participate in the development of aortic aneurysm and aortic dissection according to their serum levels.
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Affiliation(s)
- Manolis Vavuranakis
- 1st Dept. of Cardiology, Hippokration Hospital, Medical School, University of Athens, Greece.
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Papaioannou TG, Argyris A, Protogerou AD, Vrachatis D, Nasothimiou EG, Sfikakis PP, Stergiou GS, Stefanadis CI. Non-invasive 24hour ambulatory monitoring of aortic wave reflection and arterial stiffness by a novel oscillometric device: The first feasibility and reproducibility study. Int J Cardiol 2013; 169:57-61. [DOI: 10.1016/j.ijcard.2013.08.079] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2013] [Revised: 06/29/2013] [Accepted: 08/28/2013] [Indexed: 11/16/2022]
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32
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Vavuranakis M, Kariori M, Voudris V, Kalogeras K, Vrachatis D, Aznaouridis C, Moldovan C, Masoura C, Thomopoulou S, Lazaros G, Stefanadis C. Predictive Factors of Vascular Complications after Transcatheter Aortic Valve Implantation in Patients Treated with a Default Percutaneous Strategy. Cardiovasc Ther 2013; 31:e46-54. [DOI: 10.1111/1755-5922.12023] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [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: 11/30/2022] Open
Affiliation(s)
- Manolis Vavuranakis
- 1st Department of Cardiology; Hippokration Hospital; Medical School; National & Kapodistrian University of Athens; Athens; Greece
| | - Maria Kariori
- 1st Department of Cardiology; Hippokration Hospital; Medical School; National & Kapodistrian University of Athens; Athens; Greece
| | - Vassilis Voudris
- 2nd Department of Cardiology; Onassis Cardiac Surgery Center; Athens; Greece
| | - Konstantinos Kalogeras
- 1st Department of Cardiology; Hippokration Hospital; Medical School; National & Kapodistrian University of Athens; Athens; Greece
| | - Dimitrios Vrachatis
- 1st Department of Cardiology; Hippokration Hospital; Medical School; National & Kapodistrian University of Athens; Athens; Greece
| | - Constantinos Aznaouridis
- 1st Department of Cardiology; Hippokration Hospital; Medical School; National & Kapodistrian University of Athens; Athens; Greece
| | - Carmen Moldovan
- 1st Department of Cardiology; Hippokration Hospital; Medical School; National & Kapodistrian University of Athens; Athens; Greece
| | - Constantina Masoura
- 1st Department of Cardiology; Hippokration Hospital; Medical School; National & Kapodistrian University of Athens; Athens; Greece
| | - Sophia Thomopoulou
- 2nd Department of Cardiology; Onassis Cardiac Surgery Center; Athens; Greece
| | - Georgios Lazaros
- 1st Department of Cardiology; Hippokration Hospital; Medical School; National & Kapodistrian University of Athens; Athens; Greece
| | - Christodoulos Stefanadis
- 1st Department of Cardiology; Hippokration Hospital; Medical School; National & Kapodistrian University of Athens; Athens; Greece
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Katsi V, Vamvakou G, Daskalaki M, Vrachatis D, Tousoulis D, Stefanadis C, Kallikazaros I, Makris T. Dipping status is characterized by augmented administration of benzodiazepines and elevated arterial stiffness. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht308.p1427] [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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34
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Katsi V, Vamvakou G, Souretis G, Daskalaki M, Vlasseros I, Vrachatis D, Tousoulis D, Stefanadis C, Makris T, Kallikazaros I. Selective serotonin reuptake inhibitors exert a negative effect on peripheral wave reflections. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht310.p5148] [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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35
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Vavuranakis M, Kariori M, Vrachatis D, Aznaouridis C, Kalogeras K, Moldovan C, Stefanadis C. "Balloon withdrawal technique" to correct prosthesis malposition and treat paravalvular aortic regurgitation during TAVI. J Invasive Cardiol 2013; 25:196-197. [PMID: 23549494] [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] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Transcatheter aortic valve implantation (TAVI) is an emerging technology used to treat high-risk patients with severe aortic stenosis. During TAVI with the CoreValve ReValving System, a balloon is used for the reduction of paravalvular regurgitation. However, in this paper, we describe the "balloon withdrawal" technique through which the positioning of a second valve can be avoided in case of initial malpositioning. The result of the technique was rather encouraging, and minimal paravalvular aortic regurgitation was recorded after echocardiographic assessment.
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Affiliation(s)
- Manolis Vavuranakis
- 1st Department of Cardiology, Hippokration Hospital, National & Kapodistrian University of Athens, Greece.
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Vavuranakis M, Kalogeras K, Vrachatis D, Kariori M, Voudris V, Aznaouridis K, Moldovan C, Vaina S, Lazaros G, Masoura K, Thomopoulou S, Stefanadis C. Inferior epigastric artery as a landmark for transfemoral TAVI. Optimizing vascular access? Catheter Cardiovasc Interv 2013. [PMID: 23197467 DOI: 10.1002/ccd.24765] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [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: 12/19/2022]
Abstract
OBJECTIVES This study sought to investigate whether the site of common femoral artery (CFA) cannulation in regard to the inferior epigastric artery (IEA) is associated with the incidence of vascular complications in patients undergoing transfemoral aortic valve implantation (TAVI). BACKGROUND Vascular access complications are a main issue during TAVI and have been associated with significant increase of morbidity and mortality. The need for establishment of reliable predictors for these serious events remains important. METHODS A total of 90 patients, who had undergone TAVI, were retrospectively studied. Vascular complications were defined as major and minor according to the Valve Academic Research Consortium (VARC) criteria. Patients were divided into high cannulation site (CS) group and low CS group depending on the common femoral artery puncture site position, in regards to the most inferior border of the IEA. RESULTS Vascular complications were significantly more frequent in the high CS group versus the low CS group (32.3% vs. 11.9%, P = 0.039). High cannulation remained an independent predictor of vascular complications after adjustment for known risk factors (OR: 4.827, CI: 1.441-16.168; P = 0.011). CONCLUSIONS In patients undergoing transfemoral TAVI, arterial puncture above the most inferior border of the IEA is associated with vascular complications.
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Affiliation(s)
- Manolis Vavuranakis
- Department of Cardiology, Hippokration Hospital, Medical School, National & Kapodistrian University of Athens, Greece
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Vavuranakis M, Kariori M, Kalogeras K, Vrachatis D, Moldovan C, Tousoulis D, Stefanadis C. Refractory angina pectoris: lessons from the past and current perspectives. Curr Pharm Des 2013; 19:1658-1672. [PMID: 23016723] [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] [Received: 08/31/2012] [Accepted: 09/17/2012] [Indexed: 06/01/2023]
Abstract
Refractory angina pectoris constitutes a manifestation of severe ischemic heart disease that cannot be treated adequately either with conventional medication or with interventional techniques including percutaneous coronary angioplasty (PTCA). As a result, new therapeutic strategies, aiming on angiogenesis, were evolved in order to improve functional class and health related quality of life (HRQOL) indices. Among them, gene therapy constitutes a very promising alternative treatment for these patients. In this review, we will describe i) the definition of refractory angina ii) pathophysiology of angiogenesis, iii) routine as well as novel imaging techniques of neovascularization and iv) current treatment options for refractory angina. Secondly we will review the main angiogenic clinical trials, which will also be commented regarding their effectiveness to reduce the recurrency of angina symptoms and improve health-related quality-of-life, as well as the functional class of patients with chronic ischemic disease.
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Affiliation(s)
- Manolis Vavuranakis
- 1st Dept. of Cardiology, Hippokration Hospital, Medical School, National & Kapodistrian University of Athens, 114 V.Sofia Ave, 115 28, Greece.
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Vavuranakis M, Kariori M, Voudris V, Thomopoulou S, Aznaouridis K, Kalogeras K, Vrachatis D, Moldovan C, Dima I, Milkas A, Tousoulis D, Stefanadis C. Troponin levels after TAVI are related to the development of distinct electrocardiographic changes. Int J Cardiol 2012; 167:606-8. [PMID: 23084110 DOI: 10.1016/j.ijcard.2012.09.229] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2012] [Accepted: 09/30/2012] [Indexed: 11/17/2022]
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Vavuranakis M, Kalogeras K, Vrachatis D, Kariori M, Aznauridis K, Moldovan C, Masoura K, Lazaros G, Katsarou O, Stefanadis C. TCT-838 Using Inferior Epigastric Artery For Vascular Access Optimization During Transcatheter Aortic Valve Implantation. J Am Coll Cardiol 2012. [DOI: 10.1016/j.jacc.2012.08.884] [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: 10/27/2022]
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Vavuranakis M, Kariori M, Voudris V, Moldovan C, Thomopoulou S, Aznaouridis K, Kalogeras K, Vrachatis D, Gravia E, Stefanadis C. TCT-889 Sex-related clinical characteristics and outcome before and after trancatheter aortic valve implantation. J Am Coll Cardiol 2012. [DOI: 10.1016/j.jacc.2012.08.935] [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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Vavuranakis M, Vrachatis D, Stefanadis C. CoreValve Aortic Bioprosthesis. JACC Cardiovasc Interv 2010; 3:565; author reply 565-6. [DOI: 10.1016/j.jcin.2010.03.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2010] [Accepted: 03/03/2010] [Indexed: 11/25/2022]
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