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Ikonomidis I, Prentza V, Kountouri A, Pavlidis G, Katogiannis K, Thymis J, Pliouta L, Korakas E, Kostelli G, Mixalopoulou E, Balampanis K, Palaiodimou L, Zompola C, Tsivgoulis G, Lambadiari V. Four-month treatment with long-acting glucagon-like peptide-1 receptor agonists (GLP-1) or sodium-glucose co-trasporter-2 inhibitors (SGLT-2i) improves vascular function in type 2 diabetes mellitus. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background/Introduction
Patients with type 2 diabetes mellitus (T2DM) and ischemic stroke present impaired markers of vascular and endothelial function. Glucagon-like peptide-1 receptor agonists (GLP-1) and sodium-glucose contrasporter-2 inhibitors (SGLT-2) are novel antidiabetic agents reducing the risk of cardiovascular complications.
Purpose
The aim of the study is to investigate the effect of treatment with GLP-1 or SGLT2 on arterial stiffness and endothelial glycocalyx in patients with T2DM and ischemic stroke.
Methods
We recruited in total 81 patients with T2DM and ischemic stroke who received dulaglutide (n=27), dapagliflozin (n=27) or insulin (n=27). We measured at baseline and at four months post-treatment the: a) Carotid-femoral pulse wave velocity (PWV-Complior; ALAM Medical), b) Augmentation index (Aix), c) Central systolic blood pressure (cSBP), and d) Perfused boundary region (PBR) of the sublingual arterial microvessels(marker of endothelial glycocalyx thickness), e) Left ventricular global longitudinal strain (GLS) using speckle-tracking echocardiography.
Results
At baseline, patients among the three groups had similar age, sex, HbA1c and markers of endothelial and cardiovascular function (p>0.05). Dapagliflozin and dulaglutide showed a greater reduction of PBR, PWV and central SBP than insulin, despite a similar HbA1c reduction (p<0.05). After four months treatment, patients on dapagliflozin and on dulaglutide displayed a greater reduction of PWV (−10% and −8% vs −1%), of cSBP (−9% and −8% vs +1%), of Aix (−65% and −13% vs −3%) and of GLS (+11% and +7% vs +5%) compared to patients on insulin (p<0.05 for all comparisons) (Table 1). PBR values were improved only in patients who received dulaglutide (−4% vs dapagliflozin: −2% vs insulin +1%).
Conclusions
Dulaglutide and dapagliflozin improve cardiovascular function, but only dulaglutide improves endothelial glycocalyx in patients with T2DM and ischemic stroke after four months treatment.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- I Ikonomidis
- National & Kapodistrian University of Athens , Athens , Greece
| | - V Prentza
- National & Kapodistrian University of Athens, Attikon University Hospital, 2nd Cardiology Department , Athens , Greece
| | - A Kountouri
- Attikon University Hospital, 2nd Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School , Athens , Greece
| | - G Pavlidis
- National & Kapodistrian University of Athens, Attikon University Hospital, 2nd Cardiology Department , Athens , Greece
| | - K Katogiannis
- National & Kapodistrian University of Athens, Attikon University Hospital, 2nd Cardiology Department , Athens , Greece
| | - J Thymis
- National & Kapodistrian University of Athens, Attikon University Hospital, 2nd Cardiology Department , Athens , Greece
| | - L Pliouta
- Attikon University Hospital, 2nd Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School , Athens , Greece
| | - E Korakas
- Attikon University Hospital, 2nd Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School , Athens , Greece
| | - G Kostelli
- National & Kapodistrian University of Athens, Attikon University Hospital, 2nd Cardiology Department , Athens , Greece
| | - E Mixalopoulou
- National & Kapodistrian University of Athens, Attikon University Hospital, 2nd Cardiology Department , Athens , Greece
| | - K Balampanis
- Attikon University Hospital, 2nd Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School , Athens , Greece
| | - L Palaiodimou
- Attikon University Hospital, Second department of Neurology, Medical School, National and Kapodistrian University of Athens , Athens , Greece
| | - C Zompola
- Attikon University Hospital, Second department of Neurology, Medical School, National and Kapodistrian University of Athens , Athens , Greece
| | - G Tsivgoulis
- Attikon University Hospital, Second department of Neurology, Medical School, National and Kapodistrian University of Athens , Athens , Greece
| | - V Lambadiari
- Attikon University Hospital, 2nd Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School , Athens , Greece
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Ikonomidis I, Pavlidis G, Tsoumani M, Kousathana F, Katogiannis K, Tsilivarakis D, Thymis J, Kountouri A, Korakas E, Pliouta L, Parissis J, Bamias A, Filippatos G, Andreadou I, Lambadiari V. Endothelial dysfunction due to decreased nitric oxide bioavailability in dysglycaemic subjects and first-degree relatives of type 2 diabetic patients. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background/Introduction
Oxidative stress plays an important role in the pathogenesis of type 2 diabetes mellitus.
Purpose
We aimed to investigate oxidative stress and nitrites/nitrates concentrations at baseline and during postprandial hyperglycaemia in 40 first-degree relatives (FDR) of type 2 diabetic patients with normal oral glucose test (OGTT), 40 subjects with abnormal OGTT (dysglycaemic) and 20 subjects with normal OGTT without parental history of diabetes (normoglycaemic).
Methods
Perfused boundary region (PBR) of the sublingual microvessels with a diameter 5–25μm (Microscan, Glycocheck), a marker of endothelial glycocalyx integrity, coronary flow reserve (CFR) in the distal left anterior descending coronary artery, left ventricular global longitudinal strain (GLS), malondialdehyde (MDA), protein carbonyls (PC) and nitrites/nitrates plasma levels were assessed at 0 and 120 min of a 2-hour OGTT. Insulin sensitivity was evaluated using Matsuda and insulin sensitivity index (ISI).
Results
In all subjects, there were no significant changes in MDA and PC at 120 min after OGTT (p>0.05). Compared with normoglycaemic subjects, in FDR and dysglycaemic subjects, nitrites/nitrates levels were significantly decreased at 120 min (−24% versus −30% versus −3%, respectively) with a parallel increase in PBR (+7% versus +10% versus −3%) and a reduction in CFR (−11% versus −14% versus −6%) and GLS (−4% versus −4% versus +0.1%) (p<0.05 for all comparisons). The percent reduction of nitrites/nitrates levels was associated with abnormal values of Matsuda and ISI, reversely related with the percent increase of PBR (r=−0.60, p=0.001) and positively related with the percent decrease of CFR (r=0.39, p=0.038) and GLS (r=0.48, p=0.008).
Conclusion
Insulin resistance determines acute endothelial responses during OGTT leading to reduced nitric oxide production with resultant coronary and myocardial dysfunction in FDR and dysglycaemic subjects.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- I Ikonomidis
- National & Kapodistrian University of Athens , Athens , Greece
| | - G Pavlidis
- National & Kapodistrian University of Athens, Attikon University Hospital, 2nd Cardiology Department , Athens , Greece
| | - M Tsoumani
- National & Kapodistrian University of Athens, Laboratory of Pharmacology, Faculty of Pharmacy , Athens , Greece
| | - F Kousathana
- Attikon University Hospital, 2nd Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School , Athens , Greece
| | - K Katogiannis
- National & Kapodistrian University of Athens, Attikon University Hospital, 2nd Cardiology Department , Athens , Greece
| | - D Tsilivarakis
- National & Kapodistrian University of Athens, Attikon University Hospital, 2nd Cardiology Department , Athens , Greece
| | - J Thymis
- National & Kapodistrian University of Athens, Attikon University Hospital, 2nd Cardiology Department , Athens , Greece
| | - A Kountouri
- Attikon University Hospital, 2nd Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School , Athens , Greece
| | - E Korakas
- Attikon University Hospital, 2nd Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School , Athens , Greece
| | - L Pliouta
- Attikon University Hospital, 2nd Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School , Athens , Greece
| | - J Parissis
- National & Kapodistrian University of Athens, Attikon University Hospital, 2nd Cardiology Department , Athens , Greece
| | - A Bamias
- Attikon University Hospital, 2nd Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School , Athens , Greece
| | - G Filippatos
- National & Kapodistrian University of Athens, Attikon University Hospital, 2nd Cardiology Department , Athens , Greece
| | - I Andreadou
- National & Kapodistrian University of Athens, Laboratory of Pharmacology, Faculty of Pharmacy , Athens , Greece
| | - V Lambadiari
- Attikon University Hospital, 2nd Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School , Athens , Greece
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Ikonomidis I, Kountouri A, Pavlidis G, Katogiannis K, Thymis J, Pliouta L, Korakas E, Balampanis K, Bamias A, Lambadiari V. Four-months treatment with dapagliflozin improves endothelial glycocalyx and cardiovascular function in patients with type 1 diabetes mellitus. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background/Introduction
Patients with type 1 diabetes mellitus (T1DM) present signs of vascular and endothelial dysfunction earlier compared to healthy individuals. According to clinical studies, SGLT-2i favorably affect cardiovascular outcomes in patients with type 2 diabetes mellitus (T2DM). However, the data regarding the efficacy of SGLT-2i on cardiovascular markers in patients with T1DM are scarce.
Purpose
We investigated the effects of dapagliflozin on endothelial and cardiovascular function in patients with T1DM.
Methods
We recruited in total 30 patients with T1DM and pour glycemic control who were under medication with insulin and received dapagliflozin (n=15) or intensification of insulin treatment (n=15) (control group). We measured at baseline and at four months post-treatment the: a) Carotid-femoral pulse wave velocity (PWV-Complior; ALAM Medical) b) Central systolic blood pressure (cSBP) c) Perfused boundary region (PBR) of the sublingual arterial microvessels (marker of endothelial glycocalyx thickness) and d) Left ventricular global longitudinal strain (GLS) using speckle-tracking echocardiography.
Results
At baseline, patients among the two groups had similar age, sex, HbA1c and markers of endothelial and cardiovascular function (p>0.05). After four months treatment, patients who received dapagliflozin displayed an improvement in PBR5–25 (−41%, p<0.05), in PWV (−10%, p<0.05), in cSBP (−6%, p<0.05) and in GLS (+5%, P<0.05) compared to baseline. However, no statistically significant changes in PBR5–25, in PWV, in cSBP and in GLS were observed after intensification of insulin treatment (PBR5–25: +3%, PWV: +2%, cSBP: −2%, GLS: −3% at 4 months, P>0.05), despite a similar HbA1c reduction (Table 1). Changes of PBR after four months treatment with dapagliflozin correlated with a concomitant reduction of PWV and cSBP (P<0.05).
Conclusions
Four-months treatment with dapagliflozin improves endothelial glycocalyx and cardiovascular function in patients with T1DM, independently of glycemic control.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- I Ikonomidis
- National & Kapodistrian University of Athens , Athens , Greece
| | - A Kountouri
- Attikon University Hospital, 2nd Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School , Athens , Greece
| | - G Pavlidis
- National & Kapodistrian University of Athens, Attikon University Hospital, 2nd Cardiology Department , Athens , Greece
| | - K Katogiannis
- National & Kapodistrian University of Athens, Attikon University Hospital, 2nd Cardiology Department , Athens , Greece
| | - J Thymis
- National & Kapodistrian University of Athens, Attikon University Hospital, 2nd Cardiology Department , Athens , Greece
| | - L Pliouta
- Attikon University Hospital, 2nd Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School , Athens , Greece
| | - E Korakas
- Attikon University Hospital, 2nd Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School , Athens , Greece
| | - K Balampanis
- Attikon University Hospital, 2nd Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School , Athens , Greece
| | - A Bamias
- Attikon University Hospital, 2nd Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School , Athens , Greece
| | - V Lambadiari
- Attikon University Hospital, 2nd Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School , Athens , Greece
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Oikonomou E, Lampsas S, Lampadiari V, Korakas E, Bletsa E, Souvaliotis N, Theofilis P, Tsatsaragkou A, Poulakou G, Tsoukalas D, Pantelidis P, Kyvelou SM, Siasos G, Tousoulis D, Vavuranakis M. The role of cardiometabolic risk factors and endothelial dysfunction in serum albumin levels and capillary leak syndrome of patients with COVID-19. Eur Heart J 2022. [PMCID: PMC9619523 DOI: 10.1093/eurheartj/ehac544.1955] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background Growing evidence focuses on the role of hypoalbuminemia in the COVID-19 course and the role of vascular inflammation in the progression to Capillary Leak Syndrome (CLS). CLS may be mediated by a derangement of endothelial barrier following vascular endothelial dysfunction. We investigated the role of cardiometabolic risk factors in the association of hypoalbuminemia with endothelial dysfunction of hospitalized COVID-19 patients. Methods In this cross-sectional study, patients hospitalized for COVID-19 at the medical ward or Intensive Care Unit (ICU) were enrolled. Medical history and laboratory examinations were collected while the endothelial function was assessed by brachial artery flow-mediated dilation (FMD) between the first 24–72 hours of their admission to the hospital. According to the body mass index, history of hypertension, dyslipidemia, and diabetes mellitus, COVID-19 patients were categorized in those with Cardiometabolic Risk Factors (CRFact) or without CRFact (no-CRFact). From the study population, we excluded subjects with established cardiovascular disease. Results Sixty-six patients with COVID-19 (37% admitted in ICU) were recruited. From the study population, 41 were in the group of CRFact and 25 in the no-CRFact. Patients with CFRact were older (65±9 years vs. 53±14 years, p<0.001), had more impaired FMD (1.16±2.13% vs. 2.60±2.44%, p=0.01), and lower serum albumin levels (3.10±0.68 g/dL vs. 3.52±0.26 g/dL, p=0.006) compared to the no-CRFact group. Between CRFact and no-CRFact, there was no difference in CRP and IL-6 levels. Interestingly, serum albumin in patients with CRFact was significantly lower than the lower reference limit (LRL) (=3.5 g/dl) of albumin (p=0.001), while no such finding was noted in subjects with no CRFact (p=0.64). Furthermore, regression analysis revealed that, even after adjustment for age, the presence of CRFact was associated with decreased serum albumin levels by 0.31mg/dl (95% CI 0.08 to 0.63, p=0.04). In the CRFact population, there was a correlation of albumin with FMD (R=0.29, p=0.05) and an inverse correlation with CRP (rho=−0.48, p=0.02) and IL-6 (rho=−0.66, p<0.001), while in the no-CRFact group no such correlation were observed (p=NS for all). Conclusion COVID-19 patients with cardiometabolic risk factors present with low serum albumin levels early at the course of the disease, which may be driven by endothelial dysfunction and vascular inflammation. This data gives insights into the potential association of a dysfunctional endothelial layer and the progression to capillary leak syndrome. Funding Acknowledgement Type of funding sources: None.
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Affiliation(s)
- E Oikonomou
- National & Kapodistrian University of Athens Medical School, 3rd Department of Cardiology, Sotiria Chest Disease Hospital , Athens , Greece
| | - S Lampsas
- National & Kapodistrian University of Athens Medical School, 3rd Department of Cardiology, Sotiria Chest Disease Hospital , Athens , Greece
| | - V Lampadiari
- National and Kapodistrian University of Athens Medical School, Second Department of Internal Medicine, Research Unit and Diabetes Centre , Athens , Greece
| | - E Korakas
- National and Kapodistrian University of Athens Medical School, Second Department of Internal Medicine, Research Unit and Diabetes Centre , Athens , Greece
| | - E Bletsa
- National & Kapodistrian University of Athens Medical School, 3rd Department of Cardiology, Sotiria Chest Disease Hospital , Athens , Greece
| | - N Souvaliotis
- National & Kapodistrian University of Athens Medical School, 3rd Department of Cardiology, Sotiria Chest Disease Hospital , Athens , Greece
| | - P Theofilis
- National & Kapodistrian University of Athens Medical School, 1st Department of Cardiology, Hippokration General Hospital , Athens , Greece
| | - A Tsatsaragkou
- National & Kapodistrian University of Athens Medical School, 1st Department of Cardiology, Hippokration General Hospital , Athens , Greece
| | - G Poulakou
- Sotiria Thoracic Diseases Hospital of Athens, Third Department of Internal Medicine , Athens , Greece
| | - D Tsoukalas
- Sotiria Thoracic Diseases Hospital of Athens, Third Department of Internal Medicine , Athens , Greece
| | - P Pantelidis
- National & Kapodistrian University of Athens Medical School, 3rd Department of Cardiology, Sotiria Chest Disease Hospital , Athens , Greece
| | - S M Kyvelou
- National & Kapodistrian University of Athens Medical School, 1st Department of Cardiology, Hippokration General Hospital , Athens , Greece
| | - G Siasos
- National & Kapodistrian University of Athens Medical School, 3rd Department of Cardiology, Sotiria Chest Disease Hospital , Athens , Greece
| | - D Tousoulis
- National & Kapodistrian University of Athens Medical School, 1st Department of Cardiology, Hippokration General Hospital , Athens , Greece
| | - M Vavuranakis
- National & Kapodistrian University of Athens Medical School, 3rd Department of Cardiology, Sotiria Chest Disease Hospital , Athens , Greece
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5
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Ikonomidis I, Kountouri A, Mitrakou A, Thymis J, Katogiannis K, Korakas E, Varlamos C, Bamias A, Thomas K, Andreadou I, Tsoumani M, Kavatha D, Antoniadou A, Dimopoulos MA, Lambadiari V. SARS-CoV-2 is associated withabnormal biomarkers of oxidative stress,and endothelial function linked with cardiovascular dysfunction four months after the infection. Eur Heart J 2022. [PMCID: PMC9619520 DOI: 10.1093/eurheartj/ehac544.153] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Introduction COVID-19 infection has been associated with increase arterial stiffness, endothelialdysfunction, and impairment in coronary and cardiac performance. Inflammation and oxidative stress have beensuggested as possible pathophysiological mechanisms leading to vascular and endothelial deregulation afterCOVID-19 infection. Purpose The objective of our study is to evaluate premature alterations in arterial stiffness, endothelial,coronary, and myocardial function markers four months after SARS-CoV-2 infection. Methods In a case-control prospective study, we included 70 patients 4 months after COVID-19 infection, 70 age- and sex-matched untreated hypertensive patients (positive control) and 70 healthy individuals. We measured (i) perfused boundary region (PBR) of the sublingual arterial microvessels (increased PBR indicates reduced endothelial glycocalyx thickness), (ii) flow-mediated dilatation (FMD), (iii) coronary flow reserve (CFR) by Doppler echocardiography, (iv) pulse wave velocity (PWV) and central systolic blood pressure (cSBP), (v) global left and right ventricular longitudinal strain (GLS), (vi) malondialdehyde (MDA), an oxidative stress marker, thrombomodulin and von Willebrand factor as endothelial biomarkers. Results COVID-19 patients had similar CFR and FMD with hypertensives (2.48±0.41 vs 2.58±0.88, p=0.562, 5.86±2.82% vs 5.80±2.07%, p=0.872 respectively) but lower values than controls (3.42±0.65, p=0.0135, 9.06±2.11%, p=0.002 respectively). Compared to controls, both COVID-19 and hypertensives had greater PBR5–25 (2.07±0.15μm and 2.07±0.26μm p=0.8 vs 1.89±0.17μm, p=0.001), higher PWV, (12.09±2.50 vs 11.92±2.94, p=0.7 vs 10.04±1.80m/sec, p=0.036) increased cSBP (128.43±17.39 vs 135.17±16.83 vs 117.89±18.85) and impaired LV and RV GLS (−19.50±2.56% vs −19.23±2.67%, p=0.864 vs −21.98±1.51%, p=0.020 and −16.99±3.17% vs −18.63±3.20%, p=0.002 vs −20.51±2.28%, p<0.001). MDA and thrombomodulin were higher in COVID-19 patients than both hypertensives and controls (10.67±2.75 vs 1.76±0.30, p=0.003 vs 1.01±0.50nmole/L, p=0.001 and 3716.63±188.36 vs 3114.46±179.18, p=0.017 vs 2590.02±156.51pg/ml, p<0.001). COVID-19 patients displayed similar vWF values with hypertensives but higher compared with healthy controls (4018.03±474.31 vs 3756.65±293.28 vs 2079.33±855.10 ng/ml, p=0.718 and p=0.016 respectively). Conclusions SARS-CoV-2 infection is associated with oxidative stress, endothelial and vascular dysfunction, which are linked to impaired longitudinal myocardial deformation 4 months after COVID-19 infection. Funding Acknowledgement Type of funding sources: None.
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Affiliation(s)
- I Ikonomidis
- National & Kapodistrian University of Athens , Athens , Greece
| | - A Kountouri
- Attikon University Hospital, 2nd Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School , Athens , Greece
| | - A Mitrakou
- Alexandra University Hospital, Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Medical School , Athens , Greece
| | - J Thymis
- National & Kapodistrian University of Athens, Attikon University Hospital, 2nd Cardiology Department , Athens , Greece
| | - K Katogiannis
- National & Kapodistrian University of Athens, Attikon University Hospital, 2nd Cardiology Department , Athens , Greece
| | - E Korakas
- Attikon University Hospital, 2nd Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School , Athens , Greece
| | - C Varlamos
- National & Kapodistrian University of Athens, Attikon University Hospital, 2nd Cardiology Department , Athens , Greece
| | - A Bamias
- Attikon University Hospital, 2nd Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School , Athens , Greece
| | - K Thomas
- Attikon University Hospital, Forth Department of Internal Medicine , Athens , Greece
| | - I Andreadou
- National & Kapodistrian University of Athens, Laboratory of Pharmacology, Faculty of Pharmacy , Athens , Greece
| | - M Tsoumani
- National & Kapodistrian University of Athens, Laboratory of Pharmacology, Faculty of Pharmacy , Athens , Greece
| | - D Kavatha
- Attikon University Hospital, Forth Department of Internal Medicine , Athens , Greece
| | - A Antoniadou
- Attikon University Hospital, Forth Department of Internal Medicine , Athens , Greece
| | - M A Dimopoulos
- Alexandra University Hospital, Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Medical School , Athens , Greece
| | - V Lambadiari
- Attikon University Hospital, 2nd Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School , Athens , Greece
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6
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Ikonomidis I, Kountouri A, Mitrakou A, Katogiannis K, Thymis J, Korakas E, Pavlidis G, Andreadou I, Chania C, Bamias A, Thomas K, Antoniadou A, Lambadiari V, Filippatos G. Impaired endothelial glycocalyx, vascular dysfunction and myocardial deformation four months after COVID-19 infection are partially improved at twelve months. Eur Heart J 2022. [PMCID: PMC9619591 DOI: 10.1093/eurheartj/ehac544.2645] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Introduction COVID-19 patients present impaired subclinical markers of cardiovascular and endothelial function. Subclinical myocardial and vascular dysfunction during COVID-19 disease have been associated with worse outcomes and higher mortality risk. Purpose We investigated the effect of COVID-19 infection on markers of endothelial, vascular and myocardial function at four and twelve months after the infection Methods We recruited 70 patients who were examined in a dedicated post-COVID-19 outpatient clinic during a scheduled follow-up visit at four and twelve months after a confirmed COVID-19 infection and 70 healthy individuals with similar clinical characteristics. At four and twelve months we measured (i) perfused boundary region (PBR) of the sublingual arterial microvessels (increased PBR indicates reduced endothelial glycocalyx thickness), (ii) flow-mediated dilatation (FMD), (iii) coronary flow reserve (CFR) by Doppler echocardiography, (iv) pulse wave velocity (PWV) and central systolic blood pressure (cSBP), (v) global left and right ventricular longitudinal strain (GLS), (vi) myocardial global work index (GWI) global constructive work (GCW), global wasted work (GWW) and the myocardial global work efficiency (GWE) and v) malondialdehyde (MDA), an oxidative stress marker. Results At four months, COVID-19 patients displayed higher values of PBR5–25 compared to control group (p<0.001) which increased at twelve months (p<0.001). FMD, PWV and cSBP values were similar between 4 and 12 months (p>0.05 for all the comparisons) and higher than those in controls (p<0.001, p=0.057, p=0.003 respectively). At four months, COVID-19 patients presented impaired CFR and LVGLS values which were improved at twelve months (p=0.002, p=0.069 respectively), though remained impaired compared to controls (p=0.003 for all the comparisons). At four months, COVID-19 patients had impaired RVGLS values which were significantly improved at twelve months (p=0.001,) and showed no statistically significant difference compared to controls (p>0.05). COVID-19 patients at four months display higher myocardial wasted work and decreased myocardial efficiency compared to controls (p=0.01, p=0.006 respectively). There was a modest improvement in GWW and GWE at twelve months,(p=0.043, p=0.001, respectively); however, these markers remained impaired compared to controls (p>0.05). At four months, MDA was higher in COVID-19 patients compared to control group and significantly decreased at twelve months (p<0.001); however, these values remain higher than in controls (p=0.002) (Table 1). Conclusions SARS-CoV-2 causes endothelial and cardiovascular dysfunction which are partially restored at twelve months after the infection. Funding Acknowledgement Type of funding sources: None.
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Affiliation(s)
- I Ikonomidis
- National & Kapodistrian University of Athens , Athens , Greece
| | - A Kountouri
- Attikon University Hospital, 2nd Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School , Athens , Greece
| | - A Mitrakou
- Alexandra University Hospital, Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Medical School , Athens , Greece
| | - K Katogiannis
- National & Kapodistrian University of Athens, Attikon University Hospital, 2nd Cardiology Department , Athens , Greece
| | - J Thymis
- National & Kapodistrian University of Athens, Attikon University Hospital, 2nd Cardiology Department , Athens , Greece
| | - E Korakas
- Attikon University Hospital, 2nd Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School , Athens , Greece
| | - G Pavlidis
- National & Kapodistrian University of Athens, Attikon University Hospital, 2nd Cardiology Department , Athens , Greece
| | - I Andreadou
- National & Kapodistrian University of Athens, Laboratory of Pharmacology, Faculty of Pharmacy , Athens , Greece
| | - C Chania
- National & Kapodistrian University of Athens, Laboratory of Pharmacology, Faculty of Pharmacy , Athens , Greece
| | - A Bamias
- Attikon University Hospital, 2nd Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School , Athens , Greece
| | - K Thomas
- Attikon University Hospital, Forth Department of Internal Medicine , Athens , Greece
| | - A Antoniadou
- Attikon University Hospital, Forth Department of Internal Medicine , Athens , Greece
| | - V Lambadiari
- Attikon University Hospital, 2nd Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School , Athens , Greece
| | - G Filippatos
- National & Kapodistrian University of Athens, Attikon University Hospital, 2nd Cardiology Department , Athens , Greece
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7
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Ikonomidis I, Katogiannis K, Frogoudaki A, Vrettou AR, Pavlidis G, Thymis J, Kostelli G, Kountouri A, Korakas E, Michalopoulou A, Koliou GA, Stamoulis K, Lambadiari V, Tsivgoulis G. Differences in Left atrial stain, endothelial glycocalyx, arterial elasticity and myocardial efficiency between ESUS, lacunar and atherosclerotic type of stroke. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background and aims
Patients with stroke are at high risk to develop cardiovascular complications. We assessed endothelial glycocalyx, aortic elastic properties, left atrial and ventricular function in patients with lacunar, atherosclerotic and stroke of undetermined source (ESUS).
Patients and methods
In 111 patients (age 57,1±10.6) with acute cerebral stroke (37 lacunar, 36 atherosclerotic and 38 ESUS) and 20 controls with similar risk factors, we measured: (1) perfused boundary region (PBR) of the sublingual arterial microvessels (range 5–25 μm), a marker inversely related with glycocalyx thickness, (2) pulse wave velocity (PWV), central systolic blood pressure (cSBP), and augmentation index (AIx), (3) Left atrial (LA) strain using speckle-tracking imaging, (4) left ventricular global longitudinal strain and (5) left ventricular myocardial work index (GWI), constructive work (GCW), wasted work (GWW) and work efficiency (GWE).
Results
Compared with controls, patients with stroke had higher PWV (11.74±3.18 vs 9.61±1.28 m/sec, p=0.003), PBR (2.16±0.28 vs 1.94±0.20, p=0.029) and central SBP (142±25 vs 121±17 mmHg, p=0.025), while ventricular (−18.31±3.21 vs −20.89±2.45%, p=0.001) and atrial deformation (28.59±6.99 vs 37.05±5.08%, p<0.001) were impaired in patients with stroke (p<0.05). GWI and GCW were similar between two groups and GWW and GWE were worse in patients with stroke (106.98±81.52 vs 68.92±36.52 mmHg%, p=0.022, 94.00±4.51 vs 96.46±1.75%, p=0.007, respectively).
LA reservoir strain and contraction strain were more impaired in patients with thromboembolic strain compared to other 2 stroke types (ESUS 30.55±6.02%, −15.57±3.57%, Lacunar 28.19±6.92%, −13.76±3,74%, atherosclerotic 24.73±7.86%, −12.65±2,53%, p<0.05).
Regarding endothelial glycocalyx, PBR5–25 was similar between all stroke types (ESUS 2.12±0.21 μm, LACUNAR 2.23±0.32 μm, ATHEROSCLEROTIC 2.11±0.30 μm, p>0.05).
PWV was significantly higher in patients with atherosclerotic stroke (13.50±3.83 m/sec, p=0.007), while in patients with lacunar (11.31±3.01 m/sec) and in ESUS patients it was mildly elevated (11.66±2.63 m/sec).
Despite there was no significant difference in GWI, GCW and GWW between patients with different types of stroke, GWE was higher in patients with ESUS (95.41±2.32%) than in patients with lacunar 92.86±6.13%) and atherothrombotic stoke (92.27±6.21%) (p<0.05).
Conclusions
Patients with stroke have impaired atrial strain, endothelial glycocalyx and arterial elasticity, compared with controls. Arterial stiffness and LA deformation are more affected in atherosclerotic stroke, while GWE is preserved in ESUS patients.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- I Ikonomidis
- National & Kapodistrian University of Athens, Attikon University Hospital, 2nd Cardiology Department , Athens , Greece
| | - K Katogiannis
- National & Kapodistrian University of Athens, Attikon University Hospital, 2nd Cardiology Department , Athens , Greece
| | - A Frogoudaki
- National & Kapodistrian University of Athens, Attikon University Hospital, 2nd Cardiology Department , Athens , Greece
| | - A R Vrettou
- National & Kapodistrian University of Athens, Attikon University Hospital, 2nd Cardiology Department , Athens , Greece
| | - G Pavlidis
- National & Kapodistrian University of Athens, Attikon University Hospital, 2nd Cardiology Department , Athens , Greece
| | - J Thymis
- National & Kapodistrian University of Athens, Attikon University Hospital, 2nd Cardiology Department , Athens , Greece
| | - G Kostelli
- National & Kapodistrian University of Athens, Attikon University Hospital, 2nd Cardiology Department , Athens , Greece
| | - A Kountouri
- Attikon University Hospital, 2nd Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School , Athens , Greece
| | - E Korakas
- Attikon University Hospital, 2nd Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School , Athens , Greece
| | - A Michalopoulou
- National & Kapodistrian University of Athens, Attikon University Hospital, 2nd Cardiology Department , Athens , Greece
| | - G A Koliou
- National & Kapodistrian University of Athens, Attikon University Hospital, 2nd Cardiology Department , Athens , Greece
| | - K Stamoulis
- National & Kapodistrian University of Athens, Attikon University Hospital, 2nd Cardiology Department , Athens , Greece
| | - V Lambadiari
- Attikon University Hospital, 2nd Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School , Athens , Greece
| | - G Tsivgoulis
- National & Kapodistrian University of Athens, Attikon University Hospital, 2nd Department of Neurology , Athens , Greece
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8
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Katogiannis K, Ikonomidis I, Stamoulis K, Frogoudaki A, Vrettou AR, Thymis J, Kostelli G, Kountouri A, Korakas E, Michalopoulou E, Vythoulkas D, Koliou GA, Benas D, Lambadiari V, Tsivgoulis G. Differences in Left atrial stain, endothelial glycocalyx and arterial elasticity between ESUS, lacunar and atherosclerotic type of stroke. Eur Heart J Cardiovasc Imaging 2022. [DOI: 10.1093/ehjci/jeab289.295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background and Aims
Patients with stroke are at high risk to develop cardiovascular complications. We assessed endothelial glycocalyx, aortic elastic properties, left atrial and ventricular function in patients with lacunar, atherosclerotic and stroke of undetermined source (ESUS).
Patients and methods
In 75 patients (age 55.2 ± 10.6) with acute cerebral stroke (25 lacunar, 20 atherosclerotic and 30 ESUS) and 20 controls with similar risk factors, we measured: (1) perfused boundary region (PBR) of the sublingual arterial microvessels (range 5–25 µm), a marker inversely related with glycocalyx thickness, (2) pulse wave velocity (PWV), central systolic blood pressure (cSBP), and augmentation index (AIx), (3) Left atrial (LA) strain using speckle-tracking imaging, and (4) left ventricular global longitudinal strain.
Results
Compared with controls, patients with stroke had higher PWV (11.38 ± 3.62 vs 9.51 ± 1.57 m/sec, p = 0.045), PBR (2.10 ± 0.27 vs 1.94 ± 0.20, p = 0.039) and central SBP (139.64 ± 26.31 vs 116.36 ± 37.23 mmHg, p = 0.039), while ventricular (-17.902 ± 3.77 vs - 19.87 ± 1.17%, p = 0.025) and atrial deformation (24.8 ± 9.99 vs 39.05 ± 2.08%, p < 0.001) were impaired in patients with stroke (p < 0.05).
LA reservoir strain was more reduced in ESUS patients compared to other 2 stroke types (ESUS 21.7 ± 6.6%, Lacunar 25.6 ± 13.2%, atherosclerotic 22.3 ± 7.8%, P < 0.05).
Regarding endothelial glycocalyx, PBR5-9 (the smallest vessels with diameter 5-9 μm) was higher in patients with ESUS than in the other two types of stroke (ESUS 1.22 ± 0.12 μm, LACUNAR 1.19 ± 0.12 μm, ATHEROSCLEROTIC 1.15 ± 0.09 μm, p < 0.05), despite the fact that PBR5-25 was similar between all stroke types (ESUS 2.09 ± 0.23 μm, LACUNAR 2.13 ± 0.33 μm, ATHEROSCLEROTIC 2.09 ± 0.24 μm, p = 0.8).
PWV was significantly higher in patients with atherosclerotic stroke (15.57 ± 5.50 m/sec, p = 0.007), while in patients with lacunar it was mildly elevated (10.53 ± 3.22 m/sec) and in ESUS patients it was moderately increased (11.7 ± 3 m/sec).
Conclusions
Patients with stroke have impaired atrial strain, endothelial glycocalyx and arterial elasticity, compared with controls. Arterial stiffness is more affected in atherosclerotic stroke, while LA deformation and glycocalyx of small size micro vessels are more affected in ESUS patients.
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Affiliation(s)
- K Katogiannis
- National & Kapodistrian University of Athens, Attikon University Hospital, 2nd Cardiology Department, Athens, Greece
| | - I Ikonomidis
- National & Kapodistrian University of Athens, Attikon University Hospital, 2nd Cardiology Department, Athens, Greece
| | - K Stamoulis
- National & Kapodistrian University of Athens, Attikon University Hospital, 2nd Cardiology Department, Athens, Greece
| | - A Frogoudaki
- National & Kapodistrian University of Athens, Attikon University Hospital, 2nd Cardiology Department, Athens, Greece
| | - AR Vrettou
- National & Kapodistrian University of Athens, Attikon University Hospital, 2nd Cardiology Department, Athens, Greece
| | - J Thymis
- National & Kapodistrian University of Athens, Attikon University Hospital, 2nd Cardiology Department, Athens, Greece
| | - G Kostelli
- National & Kapodistrian University of Athens, Attikon University Hospital, 2nd Cardiology Department, Athens, Greece
| | - A Kountouri
- Attikon University Hospital, 2nd Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - E Korakas
- Attikon University Hospital, 2nd Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - E Michalopoulou
- National & Kapodistrian University of Athens, Attikon University Hospital, 2nd Cardiology Department, Athens, Greece
| | - D Vythoulkas
- National & Kapodistrian University of Athens, Attikon University Hospital, 2nd Cardiology Department, Athens, Greece
| | - GA Koliou
- National & Kapodistrian University of Athens, Attikon University Hospital, 2nd Cardiology Department, Athens, Greece
| | - D Benas
- National & Kapodistrian University of Athens, Attikon University Hospital, 2nd Cardiology Department, Athens, Greece
| | - V Lambadiari
- Attikon University Hospital, 2nd Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - G Tsivgoulis
- National & Kapodistrian University of Athens, Attikon University Hospital, 2nd Department of Neurology, Athens, Greece
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9
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Katogiannis K, Ikonomidis I, Thymis J, Mitrakou A, Kountouri A, Stamoulis K, Korakas E, Varlamos C, Andreadou I, Tsoumani M, Bamias A, Thomas K, Antoniadou A, Dimopoulos MA, Lambadiari V. Association of COVID-19 with impaired endothelial glycocalyx, vascular function and myocardial efficiency four months after infection. Eur Heart J Cardiovasc Imaging 2022. [PMCID: PMC9383395 DOI: 10.1093/ehjci/jeab289.065] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Aims
SARS-CoV-2 infection may lead to endothelial and vascular dysfunction. We
investigated alterations of arterial stiffness, endothelial coronary and myocardial
function markers four months after COVID-19 infection.
Methods
In a case-control prospective study, we included 100 patients four months after COVID-19 infection, 50 age- and sex-matched healthy individuals. We measured a) pulse wave velocity (PWV), b) flow-mediated dilation (FMD) of brachial artery, c) coronary Flow Reserve (CFR) by Doppler echocardiography d) left ventricular (LV) global longitudinal strain (GLS), e) left ventricular myocardial work index, constructive work, wasted work and work efficiency and e) von-Willenbrand factor and thrombomodulin as endothelial biomarkers.
Results
COVID-19 patients had lower CFR and FMD values than controls (2.39 ± 0.39 vs 3.31 ± 0.59, p = 0.0122, 5.12 ± 2.95% vs 8.12 ± 2.23%, p = 0.006 respectively). Compared to controls, COVID-19 patients had higher PWV (PWVc-f 12.32 ± 2.44 vs 10.11 ± 1.85 m/sec, p = 0.033) and impaired LV GLS (-19.11 ± 2.14% vs -20.41 ± 1.61%, p = 0.001). Compared to controls, COVID-19 patients had higher myocardial work index, and wasted work (2067.7 ± 325.9 mmHg% vs 1929.4 ± 312.7 mmHg%, p = 0.026, 104.6 ± 58.9 mmHg% vs 75.1 ± 52.6 mmHg%, p = 0.008, respectively), while myocardial efficiency was lower (94.8 ± 2.5% vs 96.06 ± 2.3%, p = 0.008). and thrombomodulin were higher in COVID-19 patients than controls (3716.63 ± 188.36 vs 2590.02 ± 156.51pg/ml, p < 0.001). MDA was higher in COVID-19 patients than controls (10.55 ± 2.45 vs 1.01 ± 0.50 nmole/L, p = 0.001). Residual cardiovascular symptoms at 4 months were associated with oxidative stress markers. Myocardial work efficiency was related with PWV (F=-0.309, p = 0.016) and vWillenbrand (F=-0.541, p = 0.037). Myocardial wasted work was related with PWV (F = 0.255, p = 0.047) and vWillenbrand (F = 0.610, p = 0.016).
Conclusions
SARS-CoV-2 may cause vascular dysfunction, followed by a waste of cardiac work, in order to compensate for increased arterial stiffness 4 months after infection.
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Affiliation(s)
- K Katogiannis
- National & Kapodistrian University of Athens, Attikon University Hospital, 2nd Cardiology Department, Athens, Greece
| | - I Ikonomidis
- National & Kapodistrian University of Athens, Attikon University Hospital, 2nd Cardiology Department, Athens, Greece
| | - J Thymis
- National & Kapodistrian University of Athens, Attikon University Hospital, 2nd Cardiology Department, Athens, Greece
| | - A Mitrakou
- National & Kapodistrian University of Athens, Alexandra Hospital, Department of Clinical Therapeutics, Athens, Greece
| | - A Kountouri
- Attikon University Hospital, 2nd Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - K Stamoulis
- National & Kapodistrian University of Athens, Attikon University Hospital, 2nd Cardiology Department, Athens, Greece
| | - E Korakas
- Attikon University Hospital, 2nd Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - C Varlamos
- National & Kapodistrian University of Athens, Attikon University Hospital, 2nd Cardiology Department, Athens, Greece
| | - I Andreadou
- National and Kapodistrian University of Athens, Faculty of Pharmacy, Laboratory of Pharmacology, Athens, Greece
| | - M Tsoumani
- National and Kapodistrian University of Athens, Faculty of Pharmacy, Laboratory of Pharmacology, Athens, Greece
| | - A Bamias
- Attikon University Hospital, 2nd Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - K Thomas
- National and Kapodistrian University of Athens, Attikon University Hospital, 4th Department of Internal Medicine, Athens, Greece
| | - A Antoniadou
- National and Kapodistrian University of Athens, Attikon University Hospital, 4th Department of Internal Medicine, Athens, Greece
| | - MA Dimopoulos
- National & Kapodistrian University of Athens, Alexandra Hospital, Department of Clinical Therapeutics, Athens, Greece
| | - V Lambadiari
- Attikon University Hospital, 2nd Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
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10
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Ikonomidis I, Katogiannis K, Mitrakou A, Kountouri A, Thymis J, Korakas E, Varlamos C, Andreadou I, Tsoumani M, Bamias A, Kazakou P, Grigoropoulou S, Kavatha D, Dimopoulos MA, Lambadiari V. Association of COVID-19 with impaired endothelial glycocalyx, coronary flow and longitudinal strain four months after infection. Eur Heart J Cardiovasc Imaging 2022. [DOI: 10.1093/ehjci/jeab289.313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Aims
SARS-CoV-2 infection may lead to endothelial and vascular dysfunction. We
investigated alterations of arterial stiffness, endothelial coronary and myocardial
function markers four months after COVID-19 infection.
Methods
In a case-control prospective study, we included 100 patients four months after COVID-19 infection, 50 age- and sex-matched healthy individuals. We measured a) perfused boundary region (PBR) of the sublingual arterial microvessels (increased PBR indicates reduced endothelial glycocalyx thickness), b) flow-mediated dilation (FMD), c) coronary Flow Reserve (CFR) by Doppler echocardiography d) pulse wave velocity (PWV) e) global left (LV) and right (RV) ventricular longitudinal strain (GLS), f) malondialdehyde (MDA), an oxidative stress marker, von-Willenbrand factor and thrombomodulin as endothelial biomarkers.
Results
COVID-19 patients had lower CFR and FMD values than controls (2.39 ± 0.39 vs 3.31 ± 0.59, p = 0.0122, 5.12 ± 2.95% vs 8.12 ± 2.23%, p = 0.006 respectively). Compared to controls, COVID-19 had greater PBR5-25 (2.11 ± 0.14μm vs 1.87 ± 0.16μm, p = 0.002), higher PWV (PWVc-f 12.32 ± 2.44 vs 10.11 ± 1.85 m/sec, p = 0.033) and impaired LV and RV GLS (-19.11 ± 2.14% vs -20.41 ± 1.61%, p = 0.001 and -16.45 ± 3.33% vs -20.11 ± 2.48%, p < 0.001). MDA and thrombomodulin were higher in COVID-19 patients than controls (10.55 ± 2.45 vs 1.01 ± 0.50 nmole/L, p = 0.001 and 3716.63 ± 188.36 vs 2590.02 ± 156.51pg/ml, p < 0.001). Residual cardiovascular symptoms at 4 months were associated with oxidative stress and endothelial dysfunction markers.
Conclusions
SARS-CoV-2 may cause endothelial and vascular dysfunction linked to
impaired cardiac performance four months after infection.
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Affiliation(s)
- I Ikonomidis
- National & Kapodistrian University of Athens, Attikon University Hospital, 2nd Cardiology Department, Athens, Greece
| | - K Katogiannis
- National & Kapodistrian University of Athens, Attikon University Hospital, 2nd Cardiology Department, Athens, Greece
| | - A Mitrakou
- National & Kapodistrian University of Athens, Alexandra Hospital, Department of Clinical Therapeutics, Athens, Greece
| | - A Kountouri
- Attikon University Hospital, 2nd Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - J Thymis
- National & Kapodistrian University of Athens, Attikon University Hospital, 2nd Cardiology Department, Athens, Greece
| | - E Korakas
- Attikon University Hospital, 2nd Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - C Varlamos
- National & Kapodistrian University of Athens, Attikon University Hospital, 2nd Cardiology Department, Athens, Greece
| | - I Andreadou
- National and Kapodistrian University of Athens, Faculty of Pharmacy, Laboratory of Pharmacology, Athens, Greece
| | - M Tsoumani
- National and Kapodistrian University of Athens, Faculty of Pharmacy, Laboratory of Pharmacology, Athens, Greece
| | - A Bamias
- Attikon University Hospital, 2nd Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - P Kazakou
- National and Kapodistrian University of Athens, Attikon University Hospital, 4th Department of Internal Medicine, Athens, Greece
| | - S Grigoropoulou
- National and Kapodistrian University of Athens, Attikon University Hospital, 4th Department of Internal Medicine, Athens, Greece
| | - D Kavatha
- National and Kapodistrian University of Athens, Attikon University Hospital, 4th Department of Internal Medicine, Athens, Greece
| | - MA Dimopoulos
- National & Kapodistrian University of Athens, Alexandra Hospital, Department of Clinical Therapeutics, Athens, Greece
| | - V Lambadiari
- Attikon University Hospital, 2nd Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
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11
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Korakas E, Ikonomidis I, Thymis J, Kountouri A, Katogiannis K, Benas D, Prentza V, Balampanis K, Pliouta L, Kousathana F, Kostelli G, Dimitriadis G, Raptis A, Lambadiari V. The combination of dulaglutide and dapagliflozin improves arterial stiffness, endothelial glycocalyx and albuminuria vs DPP-4 inhibitors independently of glycemic control. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Studies in recent years have shown that dulaglutide, a glucagon-like peptide-1 receptor agonist (GLP-1RA), and dapagliflozin, a sodium-glucose cotransporter-2 inhibitor (SGLT-2i), improve or prevent diabetic nephropathy and macrovascular complications in patients with type 2 diabetes mellitus (T2DM).
Purpose
The aim of this study is to determine whether the combination of dulaglutide and dapagliflozin exerts improves arterial stiffness, endothelial glycocalyx and albuminuria in T2DM compared to dipeptidyl-peptidase 4 inhibitors (DPP-4is).
Methods
Overall 37 patients with T2DM were included in our study. 21 patients were transitioned from DPP-4is to dulaglutide and dapagliflozin (treatment group) and were followed immediately prior (baseline) and 4 months after the initiation of treatment. 16 patients, matched for sex, age and glycemic control, remained on treatment with DPP-4is (control group). In each visit we measured a) Carotid-femoral PWV b) central systolic blood pressure (cSBP) c) perfused boundary region (PBR) of the sublingual arterial microvessels, d) urinary albumin-to-creatinine ratio (UACR), e) glycosylated hemoglobin (HbA1c).
Results
There were no statistically significant differences in cardiovascular markers, UACR and HbA1c at baseline (p>0.05). After 4 months, patients on dulaglutide and dapagliflozin combination improved HbA1c (7.9±1.5% vs 6.59±0.6%, p<0.001), PBR (2.3±0.3 vs. 2.1±0.2 μm, p<0.05), PWV (11.9±0.3.5 vs. 10.9±2.2m/s, p<0.05), cSBP (128.5±23.6 vs. 121.1±15.7 mmHg, p<0.05) and UACR (413.66±352.57 vs. 248.06±203.5 mg/g, p<0.001). There were no statistically significant differences in PBR (2.1±0.3 vs. 2.2±0.3 μm, p>0.05), PWV (10.7±3.4 vs. 12±3.3m/s, p>0.05), cSBP (125.4±21.2 vs. 127±20.1 mmHg, p>0.05) and UACR (240.8±103.6 vs. 204.9±119.6 mg/g), in the control group, despite a statistically significant improvement of HbA1c (8.2±1.9% vs 7.3±1.3%, p<0.01).
Conclusions
The combination of dulaglutide and dapagliflozin improves arterial stiffness, endothelial glycocalyx and albuminuria compared to DPP-4is in patients with T2DM.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- E Korakas
- Attikon University Hospital, Second Department of Internal Medicine,National and Kapodistrian University of Athens, Athens, Greece
| | - I Ikonomidis
- Attikon University Hospital, Laboratory of Preventive Cardiology, Second Cardiology Department, Athens, Greece
| | - J Thymis
- Attikon University Hospital, Laboratory of Preventive Cardiology, Second Cardiology Department, Athens, Greece
| | - A Kountouri
- Attikon University Hospital, Second Department of Internal Medicine,National and Kapodistrian University of Athens, Athens, Greece
| | - K Katogiannis
- Attikon University Hospital, Laboratory of Preventive Cardiology, Second Cardiology Department, Athens, Greece
| | - D Benas
- Attikon University Hospital, Laboratory of Preventive Cardiology, Second Cardiology Department, Athens, Greece
| | - V Prentza
- Attikon University Hospital, Second Department of Internal Medicine,National and Kapodistrian University of Athens, Athens, Greece
| | - K Balampanis
- Attikon University Hospital, Second Department of Internal Medicine,National and Kapodistrian University of Athens, Athens, Greece
| | - L Pliouta
- Attikon University Hospital, Second Department of Internal Medicine,National and Kapodistrian University of Athens, Athens, Greece
| | - F Kousathana
- Attikon University Hospital, Second Department of Internal Medicine,National and Kapodistrian University of Athens, Athens, Greece
| | - G Kostelli
- Attikon University Hospital, Laboratory of Preventive Cardiology, Second Cardiology Department, Athens, Greece
| | - G Dimitriadis
- Attikon University Hospital, Second Department of Internal Medicine,National and Kapodistrian University of Athens, Athens, Greece
| | - A Raptis
- Attikon University Hospital, Second Department of Internal Medicine,National and Kapodistrian University of Athens, Athens, Greece
| | - V Lambadiari
- Attikon University Hospital, Second Department of Internal Medicine,National and Kapodistrian University of Athens, Athens, Greece
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12
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Ikonomidis I, Pavlidis G, Tsoumani M, Tsakalidi F, Thymis J, Birba D, Kousathana F, Kountouri A, Balampanis K, Korakas E, Parissis J, Bamias A, Andreadou I, Katogiannis K, Lambadiari V. First-degree relatives of type-2 diabetic patients and dysglycaemic patients have impaired endothelial function due to decreased bioavailability of nitric oxide. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background/Introduction
Oxidative stress plays an important role in the pathogenesis of type 2 diabetes.
Purpose
We investigated oxidative stress in first-degree relatives of type-2 diabetes patients (FDR) since they are more prone to develop type-2 diabetes, at baseline and during postprandial hyperglycemia in comparison with dysglycaemic or normoglycaemic subjects. We evaluated these results in relation to vascular function.
Methods
We studied 40 FDR with normal oral glucose test (OGTT), 40 subjects with abnormal OGTT (dysglycaemic) and 20 subjects with normal OGTT without parental history of diabetes (normoglycaemic) with similar demographical and clinical characteristics. Glucose and insulin levels, pulse wave velocity (PWV-Complior, ALAM), central systolic blood pressure (cSBP) and augmentation index (AI) were measured at baseline, 30, 60, 90 and 120min during OGTT. Perfused boundary region (PBR-Microscan, Glycocheck) of the sublingual arterial microvessels (high PBR values represent reduced glycocalyx thickness), plasma concentrations of malondialdehyde (MDA) and protein carbonyls (PCs) as markers of lipid peroxidation and protein oxidation, respectively, and nitrite/nitrates levels as markers for NO biosynthesis, were assessed at baseline and at 120min of OGTT. Insulin sensitivity was evaluated using Matsuda and insulin sensitivity index (ISI).
Results
FDR and dysglycaemics patients had higher fasting insulin, reduced ISI, Matsuda index as well as increased PBR (2.5±0.5 vs. 2.5±0.6 vs. 2.4±0.3μm), increased PWV (8.9±1.1 vs. 10.3±2.4 vs. 8.0±1.5m/s), AI, MDA, PCs and nitrite/nitrate than normoglycaemic subjects (p<0.05 for all comparisons). ISI was negatively related with PBR and MDA (r=−0.35 and r=−0.34, p<0.05) at baseline in FDR and dysglycaemics. During OGTT, AI was similarly reduced in both normoglycaemics and FDR whereas AI was significantly increased in dysglycaemics at 120min (p<0.05). PBR was increased by 7.5% and 4% at 120min in dysglycaemics and FDR, respectively, while remained unchanged in normoglycaemics (p<0.05). In dysglycaemics and FDR, nitrite/nitrate levels were significantly decreased at 120min (52.85±8.22 vs. 36.31±4.36 and 48.23±7.20 vs. 34.70±4.71nmol/ml, respectively, p<0.05) while they were remained unchanged in normoglycaemics likely leading to a greater decrease of MDA (−83% vs. −40% vs. −48%) and of PCs (−28% vs. −7% vs. −16%) in normoglycaemics compared with dysglycaemics and FDR (p<0.05).
Conclusions
Insulin resistance determines acute endothelial responses during postprandial hyperglycemia leading to reduced NO production and thus facilitating augmentation of oxidative stress during postprandial hyperglycemia in dysglycaemic patients and FDR of diabetic patients.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- I Ikonomidis
- National & Kapodistrian University of Athens, Athens, Greece
| | - G Pavlidis
- Attikon University Hospital, 2nd Cardiology Department, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - M Tsoumani
- National & Kapodistrian University of Athens, Laboratory of Pharmacology, Faculty of Pharmacy, Athens, Greece
| | - F Tsakalidi
- National & Kapodistrian University of Athens, Laboratory of Pharmacology, Faculty of Pharmacy, Athens, Greece
| | - J Thymis
- Attikon University Hospital, 2nd Cardiology Department, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - D Birba
- Attikon University Hospital, 2nd Cardiology Department, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - F Kousathana
- Attikon University Hospital, 2nd Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - A Kountouri
- Attikon University Hospital, 2nd Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - K Balampanis
- Attikon University Hospital, 2nd Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - E Korakas
- Attikon University Hospital, 2nd Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - J Parissis
- Attikon University Hospital, 2nd Cardiology Department, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - A Bamias
- Attikon University Hospital, 2nd Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - I Andreadou
- National & Kapodistrian University of Athens, Laboratory of Pharmacology, Faculty of Pharmacy, Athens, Greece
| | - K Katogiannis
- Attikon University Hospital, 2nd Cardiology Department, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - V Lambadiari
- Attikon University Hospital, 2nd Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
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13
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Ikonomidis I, Thymis J, Pavlidis G, Birba D, Kalogeris A, Kousathana F, Kountouri A, Korakas E, Kostelli G, Triantafyllou C, Triantafyllidi H, Andreadou I, Lambadiari V. The effect of one year treatment with GLP1-RA, SGLT2i and their combination on plasma levels of oxidative and antioxidative biomarkers. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background/Introduction
Biomarkers of oxidative stress burden are found increased in Type-2 diabetes mellitus (T2DM) patients. An imbalance between oxidative and antioxidative plasma factors is implicated in the pathway of cardiovascular disease in diabetics. Novel antidiabetic agents with cardioprotective effects are glucagon like peptide-1 receptor agonists (GLP1-RA) and sodium-glucose cotransporter-2 inhibitors (SGLT-2i).
Purpose
We investigated the effect of liraglutide (GLP1-RA),empagliflozin (SGLT-2i) and their combination on plasma levels of oxidative and antioxidative factors.
Methods
A hundred-sixty T2DM patients were randomly assigned and received: a) insulin (n=40), b) liraglutide (n=40), c) empagliflozin (n=40) and d) the combination liraglutide and empagliflozin (n=40) for 1 year. We measured at baseline and after 1 year of treatment the following antioxidative markers: a) Reducing Power (RP), b) 2,2'-azino-bis(3-ethylbenzothiazoline-6-sulfonic acid (ABTS), c) Total Antioxidant Capacity (TAC) and also Thiobarbituric acid reactive substances (TBARS) as a marker of oxidative burden.
Results
After 1 year of treatment all subjects achieved successful glycemic regulation, as estimated by Hemoglobin A1c (HbA1c) levels (8±0.5 vs 6.65±0.5, p<0.05). Patients on the combination GLP1-RA + SGLT2i displayed greater reduction of TBARS (8.66±0.42 μmol/l vs 7.92±0.35 μmol/l, p<0.05) and increase of ABTS (17.49 ±0.63 mmol/l vs 19.14 ±0.64 mmol/l, p<0.05) compared with insulin-treated participants (8.85±0.41 μmol/l vs 8.83±0.44 μmol/l and 17.07 ±0.58 mmol/l vs 17.22 ±0.49 mmol/l, p=NS respectively). Patients treated on GLP1-RA or SGLT2i separately showed the same improving trend with the combination group in the abovementioned biomarkers but the changes were not so prominent. In the insulin group worsening of TAC was also noticed (0.92±0.02 mmol/l vs 0.89±0.01 mmol/l, p<0.05). In the other biomarkers nonsignificant changes were observed for all groups. Furthermore the absolute change of HbA1c was correlated with the relative change of TBARS (r=0.419, p<0.05)
Conclusion
One year treatment with the GLP1-RA liraglutide and SGLT2i empagliflozin resulted in improvement of plasma levels of oxidative and antioxidative biomarkers compared to administration of insulin and the changes were more outstanding in patients that received the combination of GLP1-RA and SGLT2i, despite similar glycemic regulation in all participants. Thus the favorable cardiovascular effects of these novel factors may be partly explained by alterations in equilibrium between oxidative and antioxidative circulating biomarkers.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- I Ikonomidis
- National & Kapodistrian University of Athens, Athens, Greece
| | - J Thymis
- National & Kapodistrian University of Athens, Athens, Greece
| | - G Pavlidis
- National & Kapodistrian University of Athens, Athens, Greece
| | - D Birba
- National & Kapodistrian University of Athens, Athens, Greece
| | - A Kalogeris
- National & Kapodistrian University of Athens, Athens, Greece
| | - F Kousathana
- National & Kapodistrian University of Athens, Athens, Greece
| | - A Kountouri
- National & Kapodistrian University of Athens, Athens, Greece
| | - E Korakas
- National & Kapodistrian University of Athens, Athens, Greece
| | - G Kostelli
- National & Kapodistrian University of Athens, Athens, Greece
| | - C Triantafyllou
- National & Kapodistrian University of Athens, Athens, Greece
| | | | - I Andreadou
- National & Kapodistrian University of Athens, Athens, Greece
| | - V Lambadiari
- National & Kapodistrian University of Athens, Athens, Greece
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14
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Ikonomidis I, Pavlidis G, Thymis J, Rafouli-Stergiou P, Makavos G, Kostelli G, Katsimbri P, Lambadiari V, Parissis J, Kapniari E, Katogiannis K, Kountouri A, Korakas E, Theodoropoulos K, Papadavid E. Apremilast improves endothelial glycocalyx and microvascular perfusion: a possible protective mechanism against COVID-19. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background/Introduction
The phosphodiesterase 4 inhibitor apremilast is an approved treatment option for psoriasis.
Purpose
We aimed to investigate the effects of apremilast on endothelial glycocalyx, vascular and left ventricular (LV) myocardial function in psoriasis.
Methods
Ninety patients with psoriasis were randomized to receive apremilast (n=30), anti-tumor necrosis factor-a (etanercept, n=30), or cyclosporine treatment (n=30). At baseline and 4 months post-treatment, we measured: (1)Perfused boundary region (PBR) of the sublingual microvessels with a diameter 5–25μm using a dedicated camera (Sidestream Dark Field imaging, Microscan, Glycocheck). Increased PBR indicates reduced glycocalyx thickness. Perfused microvascular density (PMD), an index of microvascular perfusion, was also measured. (2)Pulse wave velocity (PWV - Complior; ALAM Medical) and central systolic blood pressure (cSBP), and (3)LV global longitudinal strain (GLS) and percent difference between peak twisting and untwisting at mitral valve opening (%dpTw-UtwMVO) using speckle-tracking echocardiography.
Results
Compared with baseline, PBR20–25 decreased only after apremilast treatment (−13% at 4 months, P<0.05) whereas no statistically significant changes in PBR20–25 were observed after etanercept or cyclosporine. Compared with etanercept and cyclosporine, apremilast resulted in a greater increase of PMD (+12% versus +3% versus +3%) and in a higher reduction of PWV (−10% versus −3% versus +8%) and cSBP (−8% versus −2% versus +7%) at 4 months. Apremilast showed a greater increase of GLS (+12% versus +5% versus +2%) and %dpTw-UtwMVO (+15% versus +3% versus +3%) than etanercept and cyclosporine (P<0.05 for all comparisons). Changes of PBR and PMD post-apremilast treatment correlated with a concomitant reduction of PWV and cSBP (P<0.05).
Conclusions
In psoriasis, apremilast confers a greater improvement of endothelial glycocalyx, microvascular perfusion and LV myocardial function compared with etanercept or cyclosporine treatment. Apremilast restores glycocalyx integrity and thus reduces vascular permeability to pro-inflammatory molecules. This may explain the beneficial effects of apremilast on COVID-19.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- I Ikonomidis
- National & Kapodistrian University of Athens, Athens, Greece
| | - G Pavlidis
- Attikon University Hospital, 2nd Cardiology Department, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - J Thymis
- Attikon University Hospital, 2nd Cardiology Department, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - P Rafouli-Stergiou
- Attikon University Hospital, 2nd Cardiology Department, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - G Makavos
- Attikon University Hospital, 2nd Cardiology Department, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - G Kostelli
- Attikon University Hospital, 2nd Cardiology Department, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - P Katsimbri
- Attikon University Hospital, 4th Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - V Lambadiari
- Attikon University Hospital, 2nd Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - J Parissis
- Attikon University Hospital, 2nd Cardiology Department, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - E Kapniari
- Attikon University Hospital, 2nd Department of Dermatology and Venereology, National and Kapodistrian University of Athens, Athens, Greece
| | - K Katogiannis
- Attikon University Hospital, 2nd Cardiology Department, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - A Kountouri
- Attikon University Hospital, 2nd Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - E Korakas
- Attikon University Hospital, 2nd Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - K Theodoropoulos
- Attikon University Hospital, 2nd Department of Dermatology and Venereology, National and Kapodistrian University of Athens, Athens, Greece
| | - E Papadavid
- Attikon University Hospital, 2nd Department of Dermatology and Venereology, National and Kapodistrian University of Athens, Athens, Greece
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15
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Ikonomidis I, Katogiannis K, Frogoudaki A, Vrettou AR, Thymis J, Kostelli G, Kountouri A, Korakas E, Michalopoulou E, Vythoulkas D, Koliou G, Simou A, Benas D, Lambadiari V, Tsivgoulis G. Differences in left atrial stain, endothelial glycocalyx and arterial elasticity between ESUS, lacunar and atherosclerotic type of stroke. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background and purpose
Patients with stroke are at high risk to develop cardiovascular complications. We assessed endothelial glycocalyx, aortic elastic properties, left atrial and ventricular function in patients with lacunar, atherosclerotic and stroke of undetermined source (ESUS).
Methods
In 68 patients (age 56,1±10.9) with acute cerebral stroke (22 lacunar, 19 atherosclerotic and 27 ESUS) and 20 controls with similar risk factors, we measured: (1) perfused boundary region (PBR) of the sublingual arterial microvessels (range 5–25 μm), a marker inversely related with glycocalyx thickness, (2) pulse wave velocity (PWV), central systolic blood pressure (cSBP), and augmentation index (AIx), (3) LA volume and strain using speckle-tracking imaging, and (4) left ventricular global longitudinal strain.
Results
Compared with controls, patients with stroke had higher PWV (11,38±3,62 vs 9,51±1,57 m/sec, p=0,045), PBR (2,10±0,27 vs 1,94±,020, p=0,039) and central SBP (139,64±26,31 vs 116,36±37,23 mmHg, p=0,039), while ventricular (−17,902±3,77 vs −19,87±1,17%, p=0,025) and atrial deformation (24,8±9,99 vs 39,050±2,08%, p<0.001) were impaired in patients with stroke (p<0.05).
LA reservoir strain was more reduced in ESUS patients compared to other 2 stroke types (ESUS 21,7±6,6%, Lacunar 25,6±13,2%, atherosclerotic 22,3±7,8%, P<0.05).
Regarding endothelial glycocalyx, PBR5–9 (the smallest vessels with diameter 5–9 μm) was higher in patients with ESUS than in the other two types of stroke (ESUS 1,22±0,12 μm, LACUNAR 1,19±0,12 μm, ATHEROSCLEROTIC 1,15±0,09 μm, p<0.05), despite the fact that PBR5–25 was similar between all stroke types (ESUS 2,09±0.23 μm, LACUNAR 2,13±0,33 μm, ATHEROSCLEROTIC 2,09±0,24 μm, p=0.8).
PWV was significantly higher in patients with atherosclerotic stroke (15,57±5,50 m/sec, p=0,007), while in patients with lacunar it was mildly elevated (10,53±3,22 m/sec) and in ESUS patients it was moderately increased (11,7±3 m/sec).
Conclusion
Patients with stroke have impaired atrial strain, endothelial glycocalyx and arterial elasticity, compared with controls. Arterial stiffness is more affected in atherosclerotic stroke, while LA deformation and glycocalyx of small size micro vessels are more affected in ESUS patients.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- I Ikonomidis
- Attikon University Hospital, 2nd Cardiology Department, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - K Katogiannis
- Attikon University Hospital, 2nd Cardiology Department, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - A Frogoudaki
- Attikon University Hospital, 2nd Cardiology Department, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - A R Vrettou
- Attikon University Hospital, 2nd Cardiology Department, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - J Thymis
- Attikon University Hospital, 2nd Cardiology Department, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - G Kostelli
- Attikon University Hospital, 2nd Cardiology Department, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - A Kountouri
- Attikon University Hospital, 2nd Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - E Korakas
- Attikon University Hospital, 2nd Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - E Michalopoulou
- Attikon University Hospital, 2nd Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - D Vythoulkas
- Attikon University Hospital, 2nd Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - G Koliou
- Attikon University Hospital, 2nd Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - A Simou
- Attikon University Hospital, 2nd Neurology Department, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - D Benas
- Attikon University Hospital, 2nd Neurology Department, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - V Lambadiari
- Attikon University Hospital, 2nd Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - G Tsivgoulis
- Attikon University Hospital, 2nd Neurology Department, National and Kapodistrian University of Athens, Medical School, Athens, Greece
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16
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Ikonomidis I, Kountouri A, Mitrakou A, Thymis J, Katogiannis K, Korakas E, Varlamos C, Bamias A, Thomas K, Andeadou I, Tsoumani M, Kavatha D, Antoniadou A, Dimopoulos M, Lambadiari V. COVID-19 patients present impaired endothelial glycocalyx, vascular dysfunction and myocardial deformation resembling those observed in hypertensives four months after infection. Eur Heart J 2021. [PMCID: PMC8524639 DOI: 10.1093/eurheartj/ehab724.061] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background/Introduction COVID-19 infection has been associated with increase arterial stiffness, endothelial dysfunction, and impairment in coronary and cardiac performance. Inflammation and oxidative stress have been suggested as possible pathophysiological mechanisms leading to vascular and endothelial deregulation after COVID-19 infection. Purpose The objective of our study is to evaluate premature alterations in arterial stiffness, endothelial, coronary, and myocardial function markers four months after SARS-CoV-2 infection. Methods We conducted a case-control prospective study, including 70 patients four months after COVID-19 infection, 70 age- and sex-matched untreated hypertensive patients (positive control) and 70 healthy individuals. We measured a) perfused boundary region (PBR) of the sublingual arterial microvessels (increased PBR indicates reduced endothelial glycocalyx thickness b) flow-mediated dilation (FMD), c) coronary Flow Reserve (CFR) by Doppler echocardiography d) pulse wave velocity (PWV) and central systolic (SBP) e) global LV longitudinal strain (GLS) by speckle tracking imaging and f) malondialdehyde (MDA) as oxidative stress marker. Results COVID-19 patients had similar CFR and FMD with hypertensives (2.48±0.41 vs 2.58±0.88, p=0.562, 5.86±2.82% vs 5.80±2.07%, p=0.872 respectively), but lower CFR and FMD than controls (3.42±0.65, p=0.0135 9.06±2.11%, p=0.002 respectively) Both COVID-19 and hypertensive group had greater PBR than controls (PBR5–25: 2.07±0.15 μm and 2.07±0.26 μm p=0.8 vs 1.89±0.17 μm, p=0.001). COVID-19 patients and hypertensives had higher PWV and central SBP than controls (PWVcf 12.09±2.50 and 11.92±2.94, p=0.7 vs 10.04±1.80 m/sec, p=0.036). COVID-19 patients and hypertensives had impaired values of GLS compared to controls (−19.50±2.56% and −19.23±2.67%, p=0.864 vs −21.98±1.51%, p=0.020). Increased PBR5–25 was associated with increased SBP central which in turn was related with impaired GLS (p<0.05). MDA was found increased in COVID-19 patients compared to both hypertensives and controls (10.67±2.75 vs 1.76±0.30, p=0.003 vs 1.01±0.50 nmole/L, p=0.001). Conclusions SARS-CoV-2 may cause impaired coronary microcirculatory, endothelial and vascular deregulation which remain four months after initial infection and are associated with reduced cardiac performance. The 10-fold increase of MDA compared to healthy individuals four months after COVID-19 infection indicate oxidative stress as possible pathophysiological mechanism. FUNDunding Acknowledgement Type of funding sources: None.
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Affiliation(s)
- I Ikonomidis
- Attikon University Hospital, Laboratory of Preventive Cardiology, Second Cardiology Department, Athens, Greece
| | - A Kountouri
- Attikon University Hospital, Second Department of Internal Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - A Mitrakou
- Alexandra University Hospital, Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - J Thymis
- Attikon University Hospital, Laboratory of Preventive Cardiology, Second Cardiology Department, Athens, Greece
| | - K Katogiannis
- Attikon University Hospital, Laboratory of Preventive Cardiology, Second Cardiology Department, Athens, Greece
| | - E Korakas
- Attikon University Hospital, Second Department of Internal Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - C Varlamos
- Attikon University Hospital, Laboratory of Preventive Cardiology, Second Cardiology Department, Athens, Greece
| | - A Bamias
- Attikon University Hospital, Second Department of Internal Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - K Thomas
- Attikon University Hospital, Forth Department of Internal Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - I Andeadou
- National & Kapodistrian University of Athens Medical School, Laboratory of Pharmacology, Faculty of Pharmacy, Athens, Greece
| | - M Tsoumani
- National & Kapodistrian University of Athens Medical School, Laboratory of Pharmacology, Faculty of Pharmacy, Athens, Greece
| | - D Kavatha
- Attikon University Hospital, Forth Department of Internal Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - A Antoniadou
- Attikon University Hospital, Forth Department of Internal Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - M.A Dimopoulos
- Alexandra University Hospital, Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - V Lambadiari
- Attikon University Hospital, Second Department of Internal Medicine, National and Kapodistrian University of Athens, Athens, Greece
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17
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Ikonomidis I, Katogiannis K, Thymis J, Kousathana F, Pavlidis G, Kountouri A, Balampanis K, Korakas E, Prentza V, Simou A, Tsilivarakis D, Lambadiari V. Effect ofglucagon-like peptide-1 receptor agonists, sodium-glucose cotransporter-2 inhibitors and their combination on left atrial strain and arterial function. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
We investigated the effects of insulin, glucagon-like peptide-1 receptor agonists (GLP-1RA), sodium-glucose cotransporter-2 inhibitors (SGLT-2i) and their combination on left atrial function of patients with type 2 diabetes mellitus and we searched for a relation with arterial function.
Methods
A total of 213 patients (59,5±9,1 year old, 161 male) with type 2 diabetes mellitus treated with metformin were randomized to insulin (n=46 served as controls), liraglutide (n=40), empagliflozin (n=46) or their combination (GLP-1RA + SGLT-2i) (n=50) as add-on. We measured at baseline and 6 months posttreatment: (a) perfused boundary region of the sublingual arterial microvessels (marker of endothelial glycocalyx thickness), (b) pulse wave velocity (PWV) and central systolic blood pressure, (c) global left ventricular Longitudinal strain, (d) left atrial strain.
Results
Six months after intervention, all patients improved left atrial reservoir strain (GLP1RA 30,7±9,3 vs 33,9±9,7%, p=0,011 / SGLT2i 30±8,3 vs 32,3±7,3%, p=0,04 / GLP1 & SGLT2i 29,1±8,7 vs 31,3±8,2, p=0,007) in comparison with controls (33±8,3% vs 32,8±7,4, p=0,829). Also, patients treated with GLP1RA and their combination improved left atrial conduction strain (p<0.05). GLP-1RA or GLP-1RA + SGLT-2i provided a greater improvement in GLS compared with insulin or SGLT-2i (controls −18,5±3,9% vs −19,1±3%, p=0,202 / GLP1RA −18,2±4,1% vs −19,1±3,5%, p=0,03 / SGLT2i −19±4,1% vs −19,1±3,8%, p=0,764 / GLP1 & SGLT2i −16,7±3,9% vs −17,5±4,3%, p=0,026). SGLT-2i or GLP-1RA and SGLT-2i showed a greater decrease of PWV (Controls 12,06±3,02 vs 11,62±2,79 m/sec, p=0,142 / GLP1 11,54±2,91 vs 11,45±2,52 m/sec, p=0,822 / SGLT2 11,86±2,51 vs 11,33±2,28 m/sec, p=0,047 / GLP1 & SGLT2 12,01±2,46 vs 10,85±1,79 m/sec, p=0,021) and central and brachial systolic blood pressure than insulin or GLP-1RA. At baseline, there was a correlation of LA reservoir strain with PWV (r=−0,209, p=0,008), central SBP (r=−0,151, p=0,030), EF (r=0,214, p=0,004), GLS (r=−0,279, p=0,009). At 6 months follow up, there was a correlation of LA reservoir strain with PWV (r=0,217, p=0,003), central SBP (r=0,214, p=0,004), EF (r=−0,221, p=0,049), GLS (r=0,275, p=0,014).
Conclusions
Treatment with GLP-1RA, SGLT-2i, and their combination for 6 months showed a greater improvement of left atrial function compared to insulin treatment in parallel with improvement arterial and myocardial function.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- I Ikonomidis
- Attikon University Hospital, 2nd Cardiology Department, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - K Katogiannis
- Attikon University Hospital, 2nd Cardiology Department, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - J Thymis
- Attikon University Hospital, 2nd Cardiology Department, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - F Kousathana
- Attikon University Hospital, 2nd Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - G Pavlidis
- Attikon University Hospital, 2nd Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - A Kountouri
- Attikon University Hospital, 2nd Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - K Balampanis
- Attikon University Hospital, 2nd Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - E Korakas
- Attikon University Hospital, 2nd Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - V Prentza
- Attikon University Hospital, 2nd Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - A Simou
- Attikon University Hospital, 2nd Cardiology Department, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - D Tsilivarakis
- Attikon University Hospital, 2nd Cardiology Department, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - V Lambadiari
- Attikon University Hospital, 2nd Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
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