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Christou GA, Pagourelias ED, Anifanti MA, Sotiriou PG, Koutlianos NA, Tsironi MP, Andriopoulos PI, Christou KA, Kouidi EJ, Deligiannis AP. An echocardiographic study of acute, progressive cardiac changes following a 246 km running race. J Sports Med Phys Fitness 2023; 63:1010-1013. [PMID: 37212826 DOI: 10.23736/s0022-4707.23.14350-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
We describe the case of an ultra-marathon runner who finished first the "Spartathlon", a 246 km running race. The finishing time was the second fastest time ever in "Spartathlon". After finishing the race, the athlete suffered non-cardiac syncope and was administered intravenously 3 L of fluids for 5 hours. He underwent two echocardiographic assessments, one immediately after the finish of the race and the second 5 h later. Post-exercise fluid administration led to an increase in dimensions of all cardiac cavities, accompanied by a decrease in left ventricular (LV) end-diastolic interventricular septum thickness and posterior wall thickness of 0.1 cm. Dimensions and the respiratory profile of inferior vena cava improved after the race, reflecting alleviation of exercise-related hypovolaemia. Additionaly, LV global longitudinal strain improved, but right ventricular (RV) systolic function continued to deteriorate, mainly due to impairment of basal and medial RV free wall longitudinal strain. Study of this case offers a unique model for understanding the successive changes of cardiac structure and function following an ultra-marathon running race.
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Affiliation(s)
- Georgios A Christou
- Laboratory of Sports Medicine, Sports Medicine Division, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Efstathios D Pagourelias
- Laboratory of Sports Medicine, Sports Medicine Division, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Maria A Anifanti
- Laboratory of Sports Medicine, Sports Medicine Division, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Panagiota G Sotiriou
- Laboratory of Sports Medicine, Sports Medicine Division, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Nikolaos A Koutlianos
- Laboratory of Sports Medicine, Sports Medicine Division, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Maria P Tsironi
- Department of Nursing, Faculty of Human Movement and Quality of Life Sciences, University of Peloponnese, Sparta, Greece
| | - Panagiotis I Andriopoulos
- Department of Nursing, Faculty of Human Movement and Quality of Life Sciences, University of Peloponnese, Sparta, Greece
| | - Konstantinos A Christou
- Laboratory of Sports Medicine, Sports Medicine Division, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Evangelia J Kouidi
- Laboratory of Sports Medicine, Sports Medicine Division, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Asterios P Deligiannis
- Laboratory of Sports Medicine, Sports Medicine Division, Aristotle University of Thessaloniki, Thessaloniki, Greece -
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Bakogiannis C, Mouselimis D, Tsarouchas A, Papadopoulos CE, Theofillogiannakos EK, Lechat E, Antoniadis AP, Pagourelias ED, Kelemanis I, Tzikas S, Fragakis N, Efthimiadis GK, Karamitsos TD, Doumas M, Vassilikos VP. Iron therapy and severe arrhythmias in HFrEF: rationale, study design, and baseline results of the RESAFE-HF trial. ESC Heart Fail 2023; 10:1184-1192. [PMID: 36647691 PMCID: PMC10053179 DOI: 10.1002/ehf2.14276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 08/11/2022] [Accepted: 12/15/2022] [Indexed: 01/18/2023] Open
Abstract
AIMS The Iron Intravenous Therapy in Reducing the burden of Severe Arrhythmias in HFrEF (RESAFE-HF) registry study aims to provide real-word evidence on the impact of intravenous ferric carboxymaltose (FCM) on the arrhythmic burden of patients with heart failure with reduced ejection fraction (HFrEF), iron deficiency (ID), and implanted cardiac implantable electronic devices (CIEDs). METHODS AND RESULTS The RESAFE-HF (NCT04974021) study was designed as a prospective, single-centre, and open-label registry study with baseline, 3, 6, and 12 month visits. Adult patients with HFrEF and CIEDs scheduled to receive IV FCM as treatment for ID as part of clinical practice were eligible to participate. The primary endpoint is the composite iron-related endpoint of haemoglobin ≥ 12 g/dL, ferritin ≥ 50 ng/L, and transferrin saturation > 20%. Secondary endpoints include unplanned HF-related hospitalizations, ventricular tachyarrhythmias detected by CIEDs and Holter monitors, echocardiographic markers, functional status (VO2 max and 6 min walk test), blood biomarkers, and quality of life. In total, 106 patients with a median age of 72 years (14.4) were included. The majority were male (84.9%), whereas 92.5% of patients were categorized to New York Heart Association II/III. Patients' arrhythmic burden prior to FCM administration was significant-19 patients (17.9%) received appropriate CIED therapy for termination of ventricular tachyarrhythmia in the preceding 12 months, and 75.5% of patients have frequent, repetitive multiform premature ventricular contractions. CONCLUSIONS The RESAFE-HF trial is expected to provide evidence on the effect of treating ID with FCM in HFrEF based on real-world data. Special focus will be given on the arrhythmic burden post-FCM administration.
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Affiliation(s)
- Constantinos Bakogiannis
- Third Cardiology Department, School of MedicineHippokration General Hospital, Aristotle University of ThessalonikiThessalonikiGreece
| | - Dimitrios Mouselimis
- Third Cardiology Department, School of MedicineHippokration General Hospital, Aristotle University of ThessalonikiThessalonikiGreece
| | - Anastasios Tsarouchas
- Third Cardiology Department, School of MedicineHippokration General Hospital, Aristotle University of ThessalonikiThessalonikiGreece
| | - Christodoulos E. Papadopoulos
- Third Cardiology Department, School of MedicineHippokration General Hospital, Aristotle University of ThessalonikiThessalonikiGreece
| | - Efstratios K. Theofillogiannakos
- Third Cardiology Department, School of MedicineHippokration General Hospital, Aristotle University of ThessalonikiThessalonikiGreece
| | | | - Antonios P. Antoniadis
- Third Cardiology Department, School of MedicineHippokration General Hospital, Aristotle University of ThessalonikiThessalonikiGreece
| | - Efstathios D. Pagourelias
- Third Cardiology Department, School of MedicineHippokration General Hospital, Aristotle University of ThessalonikiThessalonikiGreece
| | - Ioannis Kelemanis
- Third Cardiology Department, School of MedicineHippokration General Hospital, Aristotle University of ThessalonikiThessalonikiGreece
| | - Stergios Tzikas
- Third Cardiology Department, School of MedicineHippokration General Hospital, Aristotle University of ThessalonikiThessalonikiGreece
| | - Nikolaos Fragakis
- Third Cardiology Department, School of MedicineHippokration General Hospital, Aristotle University of ThessalonikiThessalonikiGreece
| | - Georgios K. Efthimiadis
- First Cardiology Department, School of MedicineAHEPA University Hospital, Aristotle University of ThessalonikiThessalonikiGreece
| | - Theodoros D. Karamitsos
- First Cardiology Department, School of MedicineAHEPA University Hospital, Aristotle University of ThessalonikiThessalonikiGreece
| | - Michael Doumas
- Second Propaedeutics Department of Internal MedicineHippokration General Hospital, Aristotle University of ThessalonikiThessalonikiGreece
- Georgetown University and VAMC and George Washington UniversityWashingtonDCUSA
| | - Vassilios P. Vassilikos
- Third Cardiology Department, School of MedicineHippokration General Hospital, Aristotle University of ThessalonikiThessalonikiGreece
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Triantafyllis AS, van Nunen LX, Lesizza P, Pagourelias ED, Kalogeris A, Bouwmeester S, Tsinivizov P, Kontogiannis N, Giannakopoulos A, Poulimenos LE, Bennett J, Teeuwen K, Kyfnidis K, Desmet W, Tonino PAL, McCutcheon K. Angiographic predictors of aberrant circumflex artery during cardiac catheterization. Catheter Cardiovasc Interv 2022; 100:378-386. [PMID: 35819134 DOI: 10.1002/ccd.30322] [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: 04/12/2022] [Revised: 06/13/2022] [Accepted: 06/26/2022] [Indexed: 11/09/2022]
Abstract
OBJECTIVES To identify angiographic predictors of aberrant left circumflex artery (LCx) by comparing left main (LM) length and bifurcation angle between patients with aberrant LCx and normal anatomy. BACKGROUND Failure to recognize aberrant LCx during a cardiac catheterization may hamper correct diagnosis, delay intervention in acute coronary syndromes, and result in increased contrast volume, radiation exposure, and infarct size. METHODS We retrospectively analyzed angiograms of aberrant LCx patients and normal anatomy matched controls, in three-participating centers. LM-length, bifurcation angle between the left anterior descending (LAD) and the first non-LAD branch of the LM, and procedural data were compared. RESULTS Between 2003 and 2020, 136 patients with aberrant LCx and 135 controls were identified. More catheters (2.4 ± 0.6 vs. 2.2 ± 0.9, p = 0.009), larger contrast volumes (169 ± 94 ml vs. 129 ± 68 ml, p < 0.0005), and prolonged fluoroscopy time (652.9 ± 623.7 s vs. 393.1 ± 332.1 s, p < 0.0005), were required in the aberrant LCx-group compared with controls. Patients with aberrant LCx had a longer LM-length and a more acute bifurcation angle, both in caudal and cranial views, compared with controls (24.7 ± 8.1 vs. 10.8 ± 4.5 mm, p < 0.0005 and 26.7 ± 7.4 vs. 12 ± 5.5 mm, p < 0.0005, respectively, and 45.2° ± 12° vs. 88.8° ± 23°, p < 0.0005 and 51.9° ± 21° vs. 68.2° ± 28.3°, p < 0.0005, respectively). In ROC analysis, LM-length showed the best diagnostic accuracy for detecting aberrant LCx. In multiple logistic regression analysis, a cranially measured LM-length > 17.7 mm was associated with a 5.3 times greater probability of predicting aberrant LCx [95% CI (3.4-8.1), p < 0.0001]. CONCLUSIONS Our study suggests that a long LM-length and an acute bifurcation angle can indicate the presence of aberrant LCx. We present a practical algorithm for its rapid identification.
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Affiliation(s)
- Andreas S Triantafyllis
- Department of Cardiology, Asklepeion General Hospital, Athens, Greece.,Department of Cardiology, Catharina Hospital Eindhoven, Eindhoven, The Netherlands.,Department of Cardiovascular Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Lokien X van Nunen
- Department of Cardiology, Catharina Hospital Eindhoven, Eindhoven, The Netherlands
| | - Pierluizi Lesizza
- Department of Cardiovascular Medicine, University Hospitals Leuven, Leuven, Belgium
| | | | | | - Sjoerd Bouwmeester
- Department of Cardiology, Catharina Hospital Eindhoven, Eindhoven, The Netherlands
| | - Pavlos Tsinivizov
- Department of Cardiology, Asklepeion General Hospital, Athens, Greece
| | | | | | | | - Johan Bennett
- Department of Cardiovascular Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Koen Teeuwen
- Department of Cardiology, Catharina Hospital Eindhoven, Eindhoven, The Netherlands
| | | | - Walter Desmet
- Department of Cardiovascular Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Pim A L Tonino
- Department of Cardiology, Catharina Hospital Eindhoven, Eindhoven, The Netherlands
| | - Keir McCutcheon
- Department of Cardiovascular Medicine, University Hospitals Leuven, Leuven, Belgium
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Christou GA, Pagourelias ED, Deligiannis AP, Kouidi EJ. Exploring the Anthropometric, Cardiorespiratory, and Haematological Determinants of Marathon Performance. Front Physiol 2021; 12:693733. [PMID: 34539429 PMCID: PMC8446630 DOI: 10.3389/fphys.2021.693733] [Citation(s) in RCA: 3] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Accepted: 08/11/2021] [Indexed: 11/13/2022] Open
Abstract
Aim We aimed to investigate the main anthropometric, cardiorespiratory and haematological factors that can determine marathon race performance in marathon runners. Methods Forty-five marathon runners (36 males, age: 42 ± 10 years) were examined during the training period for a marathon race. Assessment of training characteristics, anthropometric measurements, including height, body weight (n = 45) and body fat percentage (BF%) (n = 33), echocardiographic study (n = 45), cardiopulmonary exercise testing using treadmill ergometer (n = 33) and blood test (n = 24) were performed. We evaluated the relationships of these measurements with the personal best marathon race time (MRT) within a time frame of one year before or after the evaluation of each athlete. Results The training age regarding long-distance running was 9 ± 7 years. Training volume was 70 (50-175) km/week. MRT was 4:02:53 ± 00:50:20 h. The MRT was positively associated with BF% (r = 0.587, p = 0.001). Among echocardiographic parameters, MRT correlated negatively with right ventricular end-diastolic area (RVEDA) (r = -0.716, p < 0.001). RVEDA was the only independent echocardiographic predictor of MRT. With regard to respiratory parameters, MRT correlated negatively with maximum minute ventilation indexed to body surface area (VEmax/BSA) (r = -0.509, p = 0.003). Among parameters of blood test, MRT correlated negatively with haemoglobin concentration (r = -0.471, p = 0.027) and estimated haemoglobin mass (Hbmass) (r = -0.680, p = 0.002). After performing multivariate linear regression analysis with MRT as dependent variable and BF% (standardised β = 0.501, p = 0.021), RVEDA (standardised β = -0.633, p = 0.003), VEmax/BSA (standardised β = 0.266, p = 0.303) and Hbmass (standardised β = -0.308, p = 0.066) as independent variables, only BF% and RVEDA were significant independent predictors of MRT (adjusted R2 = 0.796, p < 0.001 for the model). Conclusions The main physiological determinants of better marathon performance appear to be low BF% and RV enlargement. Upregulation of both maximum minute ventilation during exercise and haemoglobin mass may have a weaker effect to enhance marathon performance. Clinical Trial Registration www.ClinicalTrials.gov, identifier NCT04738877.
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Affiliation(s)
- Georgios A Christou
- Laboratory of Sports Medicine, Sports Medicine Division, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Efstathios D Pagourelias
- Laboratory of Sports Medicine, Sports Medicine Division, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Asterios P Deligiannis
- Laboratory of Sports Medicine, Sports Medicine Division, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Evangelia J Kouidi
- Laboratory of Sports Medicine, Sports Medicine Division, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Pagourelias ED, Mirea O, Duchenne J. Diastolic function assessment based on a semi-automated computing of strain-volume loops. Eur Heart J Cardiovasc Imaging 2021; 22:597-598. [PMID: 33495784 DOI: 10.1093/ehjci/jeab004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Efstathios D Pagourelias
- Third Cardiology Department, Hippokrateion University Hospital, Medical School, Aristotle University of Thessaloniki, Konstantinoupoleos 49, 54649, Thessaloniki, Greece
| | - Oana Mirea
- Department of Cardiology, University of Medicine and Pharmacy of Craiova, Romania
| | - Jürgen Duchenne
- Department of Cardiovascular Diseases, University Hospitals Leuven, KU Leuven, Leuven, Belgium
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Vassilikos VP, Pagourelias ED, Laroche C, Blomström-Lundqvist C, Kautzner J, Maggioni AP, Tavazzi L, Dagres N, Brugada J, Stühlinger M, Arbelo E. Impact of centre volume on atrial fibrillation ablation outcomes in Europe: a report from the ESC EHRA EORP Atrial Fibrillation Ablation Long-Term (AFA LT) Registry. Europace 2021; 23:49-58. [PMID: 33141150 DOI: 10.1093/europace/euaa236] [Citation(s) in RCA: 3] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 07/05/2020] [Accepted: 07/12/2020] [Indexed: 11/13/2022] Open
Abstract
AIMS The aim of the study was to investigate differences in clinical outcomes and complication rates among European atrial fibrillation (AF) ablation centres related to the volume of AF ablations performed. METHODS AND RESULTS Data for this analysis were extracted from the ESC EHRA EORP European AF Ablation Long-Term Study Registry. Based on 33rd and 67th percentiles of number of AF ablations performed, the participating centres were classified into high volume (HV) (≥ 180 procedures/year), medium volume (MV) (<180 and ≥74/year), and low volume (LV) (<74/year). A total of 91 centres in 26 European countries enrolled in 3368 patients. There was a significantly higher reporting of cardiovascular complications and stroke incidence in LV centres compared with HV and MV (P = 0.039 and 0.008, respectively) and a lower success rate after AF ablation (55.3% in HV vs. 57.2% in LV vs. 67.4% in MV centres, P < 0.001), despite lower CHA2DS2-VASc score of patients, enrolled in LVs and less complex ablation techniques used. Adjustments of confounding factors (including type of AF ablation) led to elimination of these differences. CONCLUSION Low-volume centres tended to present slightly higher cardiovascular complications' and stroke incidence and a lower unadjusted success rate after AF ablation, despite the fact that ablation procedures and patients were of lower risk compared with MV and HV centres. On the other hand, adjusted overall complication and recurrence rates were non-significantly different among different volume centres, a fact reflecting the heterogeneity of patient and procedural profiles, and a counterbalance between expertise and risk level among participating centres.
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Affiliation(s)
- Vassilios P Vassilikos
- Third Department of Cardiology, Hippokrateion General Hospital, Medical School, Aristotle University of Thessaloniki, 49 Konstantinoupoleos str, 54642 Thessaloniki, Greece
| | - Efstathios D Pagourelias
- Third Department of Cardiology, Hippokrateion General Hospital, Medical School, Aristotle University of Thessaloniki, 49 Konstantinoupoleos str, 54642 Thessaloniki, Greece
| | - Cécile Laroche
- EURObservational Research Programme (EORP), European Society of Cardiology, Sophia-Antipolis, France
| | | | - Josef Kautzner
- Department of Cardiology, Institute for Clinical and Experimental Medicine (ΙΚΕΜ), Prague, Czech Republic
| | - Aldo P Maggioni
- EURObservational Research Programme (EORP), European Society of Cardiology, Sophia-Antipolis, France.,ANMCO Research Centre, Florence, Italy
| | - Luigi Tavazzi
- Cardiovascular Department, Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy
| | - Nikolaos Dagres
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Josep Brugada
- Hospital Clínic Pediatric Arrhythmia Unit, Cardiovascular Institute, Hospital Sant Joan de Déu University of Barcelona, Barcelona, Spain
| | - Markus Stühlinger
- Clinic of Internal Medicine III/Cardiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Elena Arbelo
- Department of Cardiology, Cardiovascular Institut, Hospital Clinic de Barcelona, Universitat de Barcelona, Barcelona, Spain.,Instit d'Investigació August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
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Pagourelias ED, Christou GA, Sotiriou PG, Anifanti MA, Koutlianos NA, Tsironi MP, Christou KA, Vassilikos VP, Deligiannis AP, Kouidi EJ. Impact of a 246 Km ultra-marathon running race on heart: Insights from advanced deformation analysis. Eur J Sport Sci 2021; 22:1287-1295. [PMID: 33980129 DOI: 10.1080/17461391.2021.1930194] [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] [Indexed: 10/21/2022]
Abstract
Although previous studies suggest that prolonged intense exercise such as marathon running transitorily alters cardiac function, there is little information regarding ultramarathon races. Aim of this study was to investigate the acute impact of ultra-endurance exercise (UEE) on heart, applying advanced strain imaging. Echocardiographic assessment was performed the day before and at the finish line of "Spartathlon": A 246 Km ultra-marathon running race. 2D speckle-tracking echocardiography was performed in all four chambers, evaluating longitudinal strain (LS) for both ventricles and atria. Peak strain values and temporal parameters adjusted for heart rate were extracted from the derived curves. Out of 60 participants initially screened, 27 athletes (19 male, age 45 ± 7 years) finished the race in 33:34:27(28:50:38-35:07:07) hours. Absolute values of right (RV) and left ventricular (LV) LS (RVLS -22.9 ± 3.6 pre- to -21.2 ± 3.0% post-, p=0.04 and LVLS -20.9 ± 2.3 pre- to -18.8 ± 2.0 post-, p=0.009) slightly decreased post-race, whereas atrial strain did not change. RV and LV LS decrease was caused mainly by strain impairment of basal regions with apical preservation. Inter-chamber relationships assessed through RV/LV, LV/LA, RV/RA and RA/LA peak values' ratios remained unchanged from pre to post-race. Finally, UEE caused an extension of the systolic phase of cardiac cycle with concomitant diastole reduction (p<0.001 for all strain curves). Conclusively, ventricular LS strain as well as effective diastolic period slightly decreased, whereas atrial strain and inter-chamber relationships remained unchanged after running a 246-km-ultra-marathon race. These changes may be attributed to concomitant pre- and afterload alterations following UEE.
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Affiliation(s)
- Efstathios D Pagourelias
- Sports Medicine Laboratory, Department of Physical Education and Sports Science, Aristotle University of Thessaloniki, Thessaloniki, Greece.,Third Cardiology Department, Hippokrateion University Hospital, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Georgios A Christou
- Sports Medicine Laboratory, Department of Physical Education and Sports Science, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Panagiota G Sotiriou
- Sports Medicine Laboratory, Department of Physical Education and Sports Science, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Maria A Anifanti
- Sports Medicine Laboratory, Department of Physical Education and Sports Science, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Nikolaos A Koutlianos
- Sports Medicine Laboratory, Department of Physical Education and Sports Science, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Maria P Tsironi
- Faculty of Human Movement and Quality of Life Sciences, Department of Nursing, University of Peloponnese, Sparta, Greece
| | - Konstantinos A Christou
- Sports Medicine Laboratory, Department of Physical Education and Sports Science, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Vasileios P Vassilikos
- Third Cardiology Department, Hippokrateion University Hospital, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Asterios P Deligiannis
- Sports Medicine Laboratory, Department of Physical Education and Sports Science, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Evangelia J Kouidi
- Sports Medicine Laboratory, Department of Physical Education and Sports Science, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Tsarouchas A, Bakogiannis C, Mouselimis D, Lazaridis C, Kelemanis I, Theofillogiannakos EK, Pagourelias ED, Papadopoulos CE, Fragakis N, Vassilikos VP. HFrEF patient activity levels during COVID-19 lockdown: A comparison between physical activity questionnaires and implantable devices data. Eur J Prev Cardiol 2021. [PMCID: PMC8136071 DOI: 10.1093/eurjpc/zwab061.032] [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: 11/18/2022]
Abstract
Funding Acknowledgements Type of funding sources: None. Background The ongoing COVID-19 pandemic is a major public health crisis of great risk to patients with cardiovascular comorbidities. Heart failure (HF) is a deadly chronic disease, a leading cause of hospitalizations worldwide and a great detriment to patients’ quality of life. HF therapy guidelines suggest prescribing physical activity to improve long-term outcomes. Self- or government- imposed behavioral modifications in response to COVID-19 ranging from avoiding social interactions to outright restrictions of movement (lockdowns) could compromise regular PA in HF patients, who constitute an extremely high-risk group. Purpose Investigate the effect of the national lockdown in Greece 23rd March – 4th May 2020) on the PA levels of patients suffering from HF with reduced ejection fraction (HFrEF) and cardiac implantable electronic devices (CIEDs). Methods HFrEF patients with CIEDs were included in the study. Participants answered the Physical Activity Questionnaire (PAQ) regarding the period before, during and after the 42-day national lockdown. CIED-derived daily activity levels for the corresponding periods were recorded through CIED telemetry. The differences in PAQ- and CIED-derived PA levels and sedentary time before, during and after the lockdown period were investigated. Results 67 HFrEF patients participated in the study (mean age 69 ± 10.2y, 85% male). Activity levels fell in 55 (82%) of patients. The median PAQ-derived PA level decreased by 28% during lockdown, from 840.5 (944) METmin/week to 602 (1054) METmin/week during the lockdown (p = 0.01). A 53% increase was observed after the lockdown, to 924 (1214) METmin/week (p = 0.004). The CIED-derived activity level was 2.38 (1.3) hours/day pre-lockdown, 1.78 (1.1) hours/day during the lockdown (25% decrease, p < 0.001) and 2.69 (1.5) hours/day post-lockdown (51% increase, p < 0.001). Time spent on sedentary activities also increased to 9 (3) hours per day during the lockdown, up from 6.5 (4) hours before lockdown (p = 0.001). Conclusions All measures examined in this study indicate that the COVID-19 lockdown period was associated with a significant decrease in HFrEF patients’ PA. All efforts must be made on the part of clinicians and public health organizations to promote safe exercise in this subgroup of the population that is particularly vulnerable to the effects of a sedentary lifestyle. Abstract Figure. Patient activity around COVID lockdown ![]()
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Affiliation(s)
- A Tsarouchas
- Hippokration General Hospital of Thessaloniki, Third Cardiology Department AUTh, Thessaloniki, Greece
| | - C Bakogiannis
- Hippokration General Hospital of Thessaloniki, Third Cardiology Department AUTh, Thessaloniki, Greece
| | - D Mouselimis
- Hippokration General Hospital of Thessaloniki, Third Cardiology Department AUTh, Thessaloniki, Greece
| | - C Lazaridis
- Hippokration General Hospital of Thessaloniki, Third Cardiology Department AUTh, Thessaloniki, Greece
| | - I Kelemanis
- Hippokration General Hospital of Thessaloniki, Third Cardiology Department AUTh, Thessaloniki, Greece
| | - EK Theofillogiannakos
- Hippokration General Hospital of Thessaloniki, Third Cardiology Department AUTh, Thessaloniki, Greece
| | - ED Pagourelias
- Hippokration General Hospital of Thessaloniki, Third Cardiology Department AUTh, Thessaloniki, Greece
| | - CE Papadopoulos
- Hippokration General Hospital of Thessaloniki, Third Cardiology Department AUTh, Thessaloniki, Greece
| | - N Fragakis
- Hippokration General Hospital of Thessaloniki, Third Cardiology Department AUTh, Thessaloniki, Greece
| | - VP Vassilikos
- Hippokration General Hospital of Thessaloniki, Third Cardiology Department AUTh, Thessaloniki, Greece
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Pagourelias ED, Boulmpou AC, Fragakis N, Mavroudi M, Foroulis CN, Vassilikos VP. Echo(e)s of an invasion: a rare pericardial synovial sarcoma. Hellenic J Cardiol 2021; 63:99-101. [PMID: 33839284 DOI: 10.1016/j.hjc.2021.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 03/08/2021] [Accepted: 03/19/2021] [Indexed: 11/04/2022] Open
Affiliation(s)
- Efstathios D Pagourelias
- Third Cardiology Department, Hippokrateion University Hospital, Medical School, Aristotle University Thessaloniki, Thessaloniki, Greece.
| | - Aristi C Boulmpou
- Third Cardiology Department, Hippokrateion University Hospital, Medical School, Aristotle University Thessaloniki, Thessaloniki, Greece
| | - Nikolaos Fragakis
- Third Cardiology Department, Hippokrateion University Hospital, Medical School, Aristotle University Thessaloniki, Thessaloniki, Greece
| | - Melachrini Mavroudi
- Third Cardiology Department, Hippokrateion University Hospital, Medical School, Aristotle University Thessaloniki, Thessaloniki, Greece
| | - Christoforos N Foroulis
- Department of Cardiothoracic Surgery, AHEPA University Hospital, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Vasileios P Vassilikos
- Third Cardiology Department, Hippokrateion University Hospital, Medical School, Aristotle University Thessaloniki, Thessaloniki, Greece
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Unlu S, Mirea O, Bezy S, Duchenne J, Pagourelias ED, Bogaert J, Thomas JD, Badano LP, Voigt JU. Vendor-independent software shows limited variability in speckle tracking strain measurements on images of different vendors. Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeaa356.148] [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
Funding Acknowledgements
Type of funding sources: None.
Background
Vendors use proprietary speckle tracking software algorithms for echocardiographic strain measurements, which results in high inter-vendor variability. Little is known about potential advantages or disadvantages of using vendor-independent software in clinical practice.
Purpose
We therefore investigated the reproducibility, accuracy, and ability to identify scar of strain measurements on images from different vendors by using a vendor-independent software.
Methods
A vendor-independent software (TomTec Image Arena) was used to analyze datasets of 63 patients which were obtained on four ultrasound machines from different vendors (GE, Philips, Siemens, Toshiba). We measured the tracking feasibility, inter-vendor bias, the relative and absolute test-re-test variability of strain measurements and their ability to detect scar. Cardiac magnetic resonance delayed enhancement images were used as the reference standard of scar definition.
Results
Tracking feasibility differed depending on the image source (p < 0.05). Variability of global longitudinal strain (GLS) (Figure 1A) was similar (ANOVA p = 0.124) among the images of different vendors whereas variability of segmental longitudinal strain (SLS) (Figure 1B) showed modest difference (ANOVA- peak systolic strain (PS); p = 0.077, end-systolic strain (ES); p = 0.171, post-systolic strain (PSS); p = 0.020). Relative test-re-test variability of GLS showed no differences (ANOVA p = 0.360). Absolute test-re-test errors of SLS measurements showed modest differences among images of different vendors (ANOVA- PS; p = 0.018, ES; p = 0.001, PSS; p = 0.090). No relevant difference in scar detection capability was observed (Figure 1C).
Conclusions
Vendor independent software leads to low bias among strain measurements on images from different vendors. Likewise, measurement variability and the ability to identify scar becomes similar. Our findings suggest that a vendor independent speckle tracking software could help to overcome inter-vendor bias. To which extend such measurements would be more accurate compared to vendor specific software remains to be determined.
Abstract Figure 1
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Affiliation(s)
- S Unlu
- Gazi University, Ankara, Turkey
| | - O Mirea
- University of Leuven, Department of Cardiovascular Diseases, Leuven, Belgium
| | - S Bezy
- University of Leuven, Department of Cardiovascular Diseases, Leuven, Belgium
| | - J Duchenne
- University of Leuven, Department of Cardiovascular Diseases, Leuven, Belgium
| | - ED Pagourelias
- University of Leuven, Department of Cardiovascular Diseases, Leuven, Belgium
| | - J Bogaert
- University Hospitals (UZ) Leuven, Department of Radiology, Leuven, Belgium
| | - JD Thomas
- Northwestern University, Bluhm Cardiovascular Institute, Chicago, United States of America
| | - LP Badano
- Istituto Auxologico Italiano, Milan, Italy
| | - JU Voigt
- University of Leuven, Department of Cardiovascular Diseases, Leuven, Belgium
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11
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Ünlü S, Mirea O, Bézy S, Duchenne J, Pagourelias ED, Bogaert J, Thomas JD, Badano LP, Voigt JU. Inter-vendor variability in strain measurements depends on software rather than image characteristics. Int J Cardiovasc Imaging 2021; 37:1689-1697. [PMID: 33454899 DOI: 10.1007/s10554-020-02155-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 11/30/2020] [Accepted: 12/31/2020] [Indexed: 11/26/2022]
Abstract
Despite standardization efforts, vendors still use specific proprietary software algorithms for echocardiographic strain measurements, which result in high inter-vendor variability. Using vendor-independent software could be one solution. Little is known, however, how vendor specific image characteristics can influence tracking results of such software. We therefore investigated the reproducibility, accuracy, and scar detection ability of strain measurements on images from different vendors by using a vendor-independent software. A vendor-independent software (TomTec Image Arena) was used to analyse datasets of 63 patients which were obtained on machines from four different ultrasound machine vendors (GE, Philips, Siemens, Toshiba). We measured the tracking feasibility, inter-vendor bias, the relative test-re-test variability and scar discrimination ability of strain measurements. Cardiac magnetic resonance delayed enhancement images were used as the reference standard of scar definition. Tracking feasibility on vendor datasets were significantly different (p < 0.001). Variability of global longitudinal strain (GLS) measurements was similar among the vendors whereas variability of segmental longitudinal strain (SLS) showed modest difference. Relative test-re-test variability of GLS and SLS showed no relevant differences. No significant difference in scar detection capability was observed. Average GLS and SLS values were similar among vendors. Reproducibility of GLS measurements showed no difference among vendors and was in acceptable range. SLS reproducibility was high but similar for all vendors. No relevant difference was found for identifying regional dysfunction. Tracking feasibility showed a substantial difference among images from different vendors. Our findings demonstrate that tracking results depend mainly on the software used and show little influence from vendor specific image characteristics.
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Affiliation(s)
- Serkan Ünlü
- Department of Cardiovascular Diseases, University Hospital Leuven, Herestraat 49, 3000, Leuven, Belgium
- Department of Cardiology, Gazi University, Ankara, Turkey
| | - Oana Mirea
- Department of Cardiovascular Diseases, University Hospital Leuven, Herestraat 49, 3000, Leuven, Belgium
- Department of Cardiology, University of Medicine and Pharmacy, Craiova, Romania
| | - Stéphanie Bézy
- Department of Cardiovascular Diseases, University Hospital Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Jürgen Duchenne
- Department of Cardiovascular Diseases, University Hospital Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Efstathios D Pagourelias
- Department of Cardiovascular Diseases, University Hospital Leuven, Herestraat 49, 3000, Leuven, Belgium
- Third Cardiology Department, Hippokrateion University Hospital, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Jan Bogaert
- Department of Radiology, University Hospital Leuven, Leuven, Belgium
| | - James D Thomas
- Bluhm Cardiovascular Institute, Northwestern University, Chicago, IL, USA
| | - Luigi P Badano
- IRCCS, Istituto Auxologico Italiano, S. Luca Hospital, University of Milano-Bicocca, Milan, Italy
| | - Jens-Uwe Voigt
- Department of Cardiovascular Diseases, University Hospital Leuven, Herestraat 49, 3000, Leuven, Belgium.
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12
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Pagourelias ED, Mirea O, Duchenne J, Unlu S, Van Cleemput J, Papadopoulos CE, Bogaert J, Vassilikos VP, Voigt JU. Speckle tracking deformation imaging to detect regional fibrosis in hypertrophic cardiomyopathy: a comparison between 2D and 3D echo modalities. Eur Heart J Cardiovasc Imaging 2020; 21:1262-1272. [PMID: 32294170 DOI: 10.1093/ehjci/jeaa057] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [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: 01/05/2020] [Accepted: 03/07/2020] [Indexed: 11/12/2022] Open
Abstract
AIMS We aimed at directly comparing three-dimensional (3D) and two-dimensional (2D) deformation parameters in hypertrophic hearts and depict which may best reflect underlying fibrosis in hypertrophic cardiomyopathy (HCM), defined by late gadolinium enhancement (LGE) in cardiac magnetic resonance (CMR). METHODS AND RESULTS We included 40 HCM [54.1 ± 14.3 years, 82.5% male, maximum wall thickness (MWT) 19.3 ± 4.8 mm] and 15 hypertensive (HTN) patients showing myocardial hypertrophy (58.1 ± 15.6 years, 80% male, MWT 12.8 ± 1.4 mm) who have consecutively undergone 2D-, 3D-speckle tracking echocardiography and LGE CMR. Deformation parameters (2D and 3D) presented overall poor to moderate correlations, with 3D_longitudinal strain (LS) and 3D_circumferential strain (CS) values being constantly higher compared to 2D derivatives. By regression analysis, hypertrophy substrate (HCM vs. hypertension) and hypertrophy magnitude were the parameters to influence 2D-3D LS and CS strain correlations (R2 = 0.66, P < 0.001 and R2 = 0.5, P = 0.001 accordingly). Among segmental deformation indices, 2D_LS showed the best area under the curve [AUC = 0.78, 95% confidence intervals (CI) (0.75-0.81), P < 0.0005] to detect fibrosis, with 3D deformation parameters showing similar AUC (0.65) and 3D_LS presenting the highest specificity [93.1%, 95% CI (90.6-95.1)]. CONCLUSIONS In hypertrophic hearts, 2D and 3D deformation parameters are not interchangeable, showing modest correlations. Thickness, substrate, and tracking algorithm calculating assumptions seem to induce this variability. Nevertheless, among HCM patients 2D_peak segmental longitudinal strain remains the best strain parameter for tissue characterization and fibrosis detection.
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Affiliation(s)
- Efstathios D Pagourelias
- Department of Cardiovascular Diseases, University Hospital Leuven, Catholic University Leuven, Herestraat 49, 3000 Leuven, Belgium.,Third Cardiology Department, Hippokrateion University Hospital, Aristotle University of Thessaloniki, Konstantinoupoleos 49, 54642 Thessaloniki, Greece
| | - Oana Mirea
- Department of Cardiovascular Diseases, University Hospital Leuven, Catholic University Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Jürgen Duchenne
- Department of Cardiovascular Diseases, University Hospital Leuven, Catholic University Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Serkan Unlu
- Department of Cardiovascular Diseases, University Hospital Leuven, Catholic University Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Johan Van Cleemput
- Department of Cardiovascular Diseases, University Hospital Leuven, Catholic University Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Christodoulos E Papadopoulos
- Third Cardiology Department, Hippokrateion University Hospital, Aristotle University of Thessaloniki, Konstantinoupoleos 49, 54642 Thessaloniki, Greece
| | - Jan Bogaert
- Department of Radiology, University Hospital Leuven, Catholic University Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Vasilios P Vassilikos
- Third Cardiology Department, Hippokrateion University Hospital, Aristotle University of Thessaloniki, Konstantinoupoleos 49, 54642 Thessaloniki, Greece
| | - Jens-Uwe Voigt
- Department of Cardiovascular Diseases, University Hospital Leuven, Catholic University Leuven, Herestraat 49, 3000 Leuven, Belgium
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13
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Vassilikos VP, Pagourelias ED, Katsos K, Zaggelidou E, Raikos N, Tzikas S, Tsavousoglou C, Kouparanis A, Anastasakis A, Papatheodorou E, Kassimis G, Ziakas A, Sianos G, Karvounis H, Kanonidis I, Spiliopoulou C. Impact of social containment measures on cardiovascular admissions and sudden cardiac death rates during Coronavirus Disease (COVID-19) outbreak in Greece. Hellenic J Cardiol 2020; 62:318-319. [PMID: 32947022 PMCID: PMC7491429 DOI: 10.1016/j.hjc.2020.09.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 08/23/2020] [Accepted: 09/07/2020] [Indexed: 01/17/2023] Open
Affiliation(s)
- Vassilios P Vassilikos
- Third Cardiology Department, Hippokrateion University Hospital, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece.
| | - Efstathios D Pagourelias
- Third Cardiology Department, Hippokrateion University Hospital, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Konstantinos Katsos
- Department of Forensic Medicine and Toxicology, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Eleni Zaggelidou
- Laboratory of Forensic Service of Ministry of Justice of Thessaloniki, Greece
| | - Nikolaos Raikos
- Laboratory of Forensic Medicine & Toxicology, Medical School, Aristotle University Thessaloniki, Greece
| | - Stergios Tzikas
- Third Cardiology Department, Hippokrateion University Hospital, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Chalil Tsavousoglou
- Third Cardiology Department, Hippokrateion University Hospital, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Antonios Kouparanis
- First Cardiology Department, AHEPA University Hospital, Medical School, Aristotle University of Thessaloniki, Greece
| | | | | | - George Kassimis
- Second Cardiology Department, Hippokrateion University Hospital, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Antonios Ziakas
- First Cardiology Department, AHEPA University Hospital, Medical School, Aristotle University of Thessaloniki, Greece
| | - Georgios Sianos
- First Cardiology Department, AHEPA University Hospital, Medical School, Aristotle University of Thessaloniki, Greece
| | - Haralampos Karvounis
- First Cardiology Department, AHEPA University Hospital, Medical School, Aristotle University of Thessaloniki, Greece
| | - Ioannis Kanonidis
- Second Cardiology Department, Hippokrateion University Hospital, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Chara Spiliopoulou
- Department of Forensic Medicine and Toxicology, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
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Duchenne J, Aalen JM, Cvijic M, Larsen CK, Galli E, Bézy S, Beela AS, Ünlü S, Pagourelias ED, Winter S, Hopp E, Kongsgård E, Donal E, Fehske W, Smiseth OA, Voigt JU. Acute redistribution of regional left ventricular work by cardiac resynchronization therapy determines long-term remodelling. Eur Heart J Cardiovasc Imaging 2020; 21:619-628. [DOI: 10.1093/ehjci/jeaa003] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [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] [Received: 09/09/2019] [Revised: 11/29/2019] [Accepted: 01/08/2020] [Indexed: 12/13/2022] Open
Abstract
Abstract
Aims
Investigating the acute impact of cardiac resynchronization therapy (CRT) on regional myocardial work distribution in the left ventricle (LV) and to which extent it is related to long-term reverse remodelling.
Methods and results
One hundred and thirty heart failure patients, referred for CRT implantation, were recruited in our prospective multicentre study. Regional myocardial work was calculated from non-invasive segmental stress–strain loop area before and immediately after CRT. The magnitude of volumetric reverse remodelling was determined from the change in LV end-systolic volume, 11 ± 2 months after implantation. CRT caused acute redistribution of myocardial work across the LV, with an increase in septal work, and decrease in LV lateral wall work (all P < 0.05). Amongst all LV walls, the acute change in work in the septum and lateral wall of the four-chamber view correlated best and significantly with volumetric reverse remodelling (r = 0.62, P < 0.0001), with largest change seen in patients with most volumetric reverse remodelling. In multivariate linear regression analysis, including conventional parameters, such as pre-implant QRS morphology and duration, LV ejection fraction, ischaemic origin of cardiomyopathy, and the redistribution of work across the septal and lateral walls, the latter appeared as the strongest determinant of volumetric reverse remodelling after CRT (model R2 = 0.414, P < 0.0001).
Conclusion
The acute redistribution of regional myocardial work between the septal and lateral wall of the LV is an important determinant of reverse remodelling after CRT implantation. Our data suggest that the treatment of the loading imbalance should, therefore, be the main aim of CRT.
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Affiliation(s)
- Jürgen Duchenne
- Department of Cardiovascular Sciences, KU Leuven, Herestraat 49, 3000 Leuven, Belgium
- Department of Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium
| | - John M Aalen
- Institute for Surgical Research, Oslo University Hospital, University of Oslo, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Cardiology, Oslo University Hospital, Oslo, Norway
| | - Marta Cvijic
- Department of Cardiovascular Sciences, KU Leuven, Herestraat 49, 3000 Leuven, Belgium
- Department of Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium
- Department of Cardiology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Camilla K Larsen
- Institute for Surgical Research, Oslo University Hospital, University of Oslo, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Cardiology, Oslo University Hospital, Oslo, Norway
| | - Elena Galli
- LTSI, Inserm 1099, University of Rennes, Rennes, France
- Department of Cardiology, CHU Rennes, France
| | - Stéphanie Bézy
- Department of Cardiovascular Sciences, KU Leuven, Herestraat 49, 3000 Leuven, Belgium
- Department of Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium
| | - Ahmed S Beela
- Department of Cardiovascular Sciences, KU Leuven, Herestraat 49, 3000 Leuven, Belgium
- Department of Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium
- Department of Cardiovascular Diseases, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Serkan Ünlü
- Department of Cardiovascular Sciences, KU Leuven, Herestraat 49, 3000 Leuven, Belgium
- Department of Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium
| | - Efstathios D Pagourelias
- Department of Cardiovascular Sciences, KU Leuven, Herestraat 49, 3000 Leuven, Belgium
- Department of Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium
- Third Cardiology Department, Hippokrateion University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Stefan Winter
- Klinik für Innere Medizin und Kardiologie, St. Vinzenz Hospital, Cologne, Germany
| | - Einar Hopp
- Division of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
| | - Erik Kongsgård
- Institute for Surgical Research, Oslo University Hospital, University of Oslo, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Erwan Donal
- LTSI, Inserm 1099, University of Rennes, Rennes, France
- Department of Cardiology, CHU Rennes, France
| | - Wolfgang Fehske
- Klinik für Innere Medizin und Kardiologie, St. Vinzenz Hospital, Cologne, Germany
| | - Otto A Smiseth
- Institute for Surgical Research, Oslo University Hospital, University of Oslo, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Cardiology, Oslo University Hospital, Oslo, Norway
| | - Jens-Uwe Voigt
- Department of Cardiovascular Sciences, KU Leuven, Herestraat 49, 3000 Leuven, Belgium
- Department of Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium
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Christou GA, Pagourelias ED, Anifanti MA, Sotiriou PG, Koutlianos NA, Tsironi MP, Andriopoulos PI, Christou KA, Kouidi EJ, Deligiannis AP. Exploring the determinants of the cardiac changes after ultra-long duration exercise: The echocardiographic Spartathlon study. Eur J Prev Cardiol 2020; 27:1467-1477. [DOI: 10.1177/2047487319898782] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [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: 01/05/2023]
Abstract
Aim The investigation of the pathophysiological determinants of cardiac changes following ultra-long duration exercise. Methods Twenty-seven runners who finished a 246 km running race were examined both before and after the finish of the race. Examinations included echocardiography and measurement of body weight and blood biochemical parameters. Results Exercise increased left ventricular end-diastolic interventricular septum thickness (LVIVSd) ( p < 0.001) and posterior wall thickness (LVPWTd) ( p = 0.001) and right ventricular end-diastolic area ( p = 0.005), while reduced tricuspid annular plane systolic excursion (TAPSE) ( p = 0.004). A minor decrease in the peak absolute values of both left ventricular (from −20.9 ± 2.3% to −18.8 ± 2.0%, p = 0.009) and right ventricular (from −22.9 ± 3.6% to −21.2 ± 3.0%, p = 0.040) global longitudinal strains occurred. There was decrease in body weight ( p < 0.001) and increase in both circulating high-sensitivity troponin I ( p = 0.028) and amino-terminal pro-B type natriuretic peptide (NT-proBNP) ( p = 0.018). The change in the sum of LVIVSd and LVPWTd correlated negatively with percentage change of body weight ( r = −0.416, p = 0.049). The only independent determinant of post-exercise NT-proBNP was pulmonary artery systolic pressure ( r = 0.797, p = 0.002). Post-exercise NT-proBNP correlated positively with percentage changes of basal (RVbas) ( r = 0.582, p = 0.037) and mid-cavity (RVmid) ( r = 0.618, p = 0.043) right ventricular diameters and negatively with percentage change of TAPSE ( r = −0.720, p = 0.008). Similar correlations with RVbas, RVmid and TAPSE were found for pulmonary artery systolic pressure. Post-exercise high-sensitivity troponin I correlated negatively with percentage change of body weight ( r = −0.601, p = 0.039), but was not associated with any cardiac parameter. Conclusion The main cardiac effects of ultra-long duration exercise were the decrease in left ventricular end-diastolic dimensions and increase in left ventricular wall thickness, as well as minimal dilatation and alteration in systolic function of right ventricle, possibly due to the altered exercise-related right ventricular afterload.
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Affiliation(s)
- Georgios A Christou
- Laboratory of Sports Medicine, Sports Medicine Division, Aristotle University of Thessaloniki, Greece
| | - Efstathios D Pagourelias
- Laboratory of Sports Medicine, Sports Medicine Division, Aristotle University of Thessaloniki, Greece
| | - Maria A Anifanti
- Laboratory of Sports Medicine, Sports Medicine Division, Aristotle University of Thessaloniki, Greece
| | - Panagiota G Sotiriou
- Laboratory of Sports Medicine, Sports Medicine Division, Aristotle University of Thessaloniki, Greece
| | - Nikolaos A Koutlianos
- Laboratory of Sports Medicine, Sports Medicine Division, Aristotle University of Thessaloniki, Greece
| | - Maria P Tsironi
- Department of Nursing, Faculty of Human Movement and Quality of Life Sciences, University of Peloponnese, Sparta, Greece
| | - Panagiotis I Andriopoulos
- Department of Nursing, Faculty of Human Movement and Quality of Life Sciences, University of Peloponnese, Sparta, Greece
| | - Konstantinos A Christou
- Laboratory of Sports Medicine, Sports Medicine Division, Aristotle University of Thessaloniki, Greece
| | - Evangelia J Kouidi
- Laboratory of Sports Medicine, Sports Medicine Division, Aristotle University of Thessaloniki, Greece
| | - Asterios P Deligiannis
- Laboratory of Sports Medicine, Sports Medicine Division, Aristotle University of Thessaloniki, Greece
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Duchenne J, Aalen J, Cvijic M, Larsen K, Galli E, Bezy S, Beela AS, Unlu S, Pagourelias ED, Winter S, Hopp E, Fehske W, Donal E, Smiseth OA, Voigt JU. P1238Acute re-distribution of myocardial work by cardiac resynchronization therapy determines long-term remodelling of the left ventricle. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0196] [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
In patients with dilated cardiomyopathy and left bundle branch block (LBBB), different regions of the left ventricle (LV) have been shown to perform different amounts of work. In this study, we investigate the acute impact of cardiac resynchronization therapy (CRT) on regional LV work distribution and its relation to long-term reverse-remodelling.
Methods
We recruited 130 heart failure patients, referred for CRT. Regional myocardial work was calculated from non-invasive echocardiographic segmental stress-strain-loop-area before and immediately after CRT. The magnitude of volumetric reverse-remodelling was determined from the change in LV end-systolic volume (ESV), 11±2 months after implantation. Characteristics of patients with the lowest and highest quartile of LV ESV reverse remodelling (ΔLV ESV <−9% and ΔLV ESV >−48%) were compared.
Results
Before CRT, myocardial work showed significant differences among the walls of the LV (Figure 1A). CRT caused an acute re-distribution of myocardial work, on average with most increase in the septum and most decrease laterally (all walls p<0.05) and lead to a homogeneous work distribution (Figure 1B). The acute change in the difference between lateral and septal wall work (Δlateral − septal work) correlated best and significantly with LV ESV reverse-remodelling (r=0.62, p<0.0001). The smallest changes in work were seen in the patients with the least LV ESV reverse remodelling (Figure 1C, red markers), while patients with the most LV ESV reverse remodelling showed the largest changes in work (Figure 1C, green markers). In a multivariate-linear-regression-analysis, including pre-implant QRS duration, LVEF, LV EDV and GLS, the re-distribution of work remained as the strongest determinant of volumetric reverse-remodelling after CRT (r=0.63, p<0.0001).
Figure 1
Conclusions
The acute re-distribution of regional myocardial work between the septal and lateral wall of the left ventricle is the main determinant of long term reverse-remodelling after CRT-implantation. Our data suggest that modification of regional loading is the mode of action of CRT treatment.
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Affiliation(s)
- J Duchenne
- KU Leuven, Cardiovascular Sciences, Leuven, Belgium
| | - J Aalen
- Oslo University Hospital, Cardiology, Oslo, Norway
| | - M Cvijic
- KU Leuven, Cardiovascular Sciences, Leuven, Belgium
| | - K Larsen
- Oslo University Hospital, Cardiology, Oslo, Norway
| | - E Galli
- University Hospital of Rennes, Cardiology, Rennes, France
| | - S Bezy
- KU Leuven, Cardiovascular Sciences, Leuven, Belgium
| | - A S Beela
- KU Leuven, Cardiovascular Sciences, Leuven, Belgium
| | - S Unlu
- KU Leuven, Cardiovascular Sciences, Leuven, Belgium
| | | | - S Winter
- St Vinzenz-Hospital, Cardiology, Koln, Germany
| | - E Hopp
- Oslo University Hospital, Radiology, Oslo, Norway
| | - W Fehske
- St Vinzenz-Hospital, Cardiology, Koln, Germany
| | - E Donal
- University Hospital of Rennes, Cardiology, Rennes, France
| | - O A Smiseth
- Oslo University Hospital, Cardiology, Oslo, Norway
| | - J U Voigt
- KU Leuven, Cardiovascular Sciences, Leuven, Belgium
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Duchenne J, Cvijic M, Turco A, Unlu S, Pagourelias ED, Bezy S, Vunckx K, Nuyts J, Claus P, Gheysens O, Rega F, Voigt JU. P619Stress-strain loop area better represents regional myocardial work than pressure-strain loop area in the dyssynchronous and remodelled left ventricle. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0227] [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
Pressure-strain-loops (PSL) have been suggested as surrogate parameter of regional myocardial work. However, in left ventricles (LV) with inhomogeneous remodelling, e.g. due to left bundle branch block (LBBB), wall stress may be unevenly distributed. Stress-strain loops (SSL) include information on both regional wall thickness and curvature, and may therefore provide a better surrogate.
Study plan
We therefore compared the correlation of segmental myocardial work estimated through both PSL and SSL to segmental myocardial glucose metabolism as a gold standard, in an animal model of pacing-induced LV remodelling.
Methods
Twelve sheep developed LV dilatation, thinned septum and thickened lateral wall, due to eight weeks of rapid right-atrial and right-ventricular free wall (DDD) pacing (at 180 bpm), causing a LBBB-like dyssynchrony. Invasive LV pressure and echocardiographic speckle tracking based circumferential strain were used to construct PSL. SSL were calculated by considering in addition dynamic changes in segmental myocardial wall thickness and curvature using the formula of Laplace. 18F-fluorodeoxyglucose (FDG)-uptake was measured by positron emission tomography (PET) in absolute values as standardised uptake ratio (SUR). Spatial resolution of PET was improved by ECG- and breathing-gating and using anatomical priors. All imaging was performed during dyssynchronous DDD-pacing and synchronous AAI-pacing (right-atrial pacing only), at baseline (n=3 animals), and after eight weeks of pacing induced remodelling (n=12 animals).
Results
Both at baseline (Fig. A+B) and after 8 weeks (Fig. D+E), switching between AAI and DDD-pacing caused an acute re-distribution of regional myocardial work as measured by both PSL and SSL. In contrast to PSL, however, SSL identified more regional differences among walls in remodelled hearts and showed clearer regional changes when switching between AAI and DDD-pacing. The correlation between regional work, assessed by PSL and SSL, and metabolism by PET, was comparable at baseline (r=0.65 and r=0.64, respectively) (Fig. C). In remodelled hearts after 8 weeks, however, the correlation of regional work assessed by SSL and glucose uptake by PET was significantly higher compared to PSL (r=0.73 vs. r=0.59, respectively; p<0.05) (Fig. F).
Conclusions
Regional myocardial work assessed by stress-strain loops correlates significantly better to regional metabolism as measured by PET glucose uptake, particularly after remodelling. Our findings therefore suggest that integrating information on wall thickness and curvature is essential for the reliable assessment of regional myocardial work, especially in dyssynchronous and remodelled left ventricles.
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Affiliation(s)
- J Duchenne
- KU Leuven, Cardiovascular Sciences, Leuven, Belgium
| | - M Cvijic
- KU Leuven, Cardiovascular Sciences, Leuven, Belgium
| | - A Turco
- KU Leuven, Nuclear Medicine, Leuven, Belgium
| | - S Unlu
- KU Leuven, Cardiovascular Sciences, Leuven, Belgium
| | | | - S Bezy
- KU Leuven, Cardiovascular Sciences, Leuven, Belgium
| | - K Vunckx
- KU Leuven, Nuclear Medicine, Leuven, Belgium
| | - J Nuyts
- KU Leuven, Nuclear Medicine, Leuven, Belgium
| | - P Claus
- KU Leuven, Cardiovascular Sciences, Leuven, Belgium
| | - O Gheysens
- KU Leuven, Nuclear Medicine, Leuven, Belgium
| | - F Rega
- KU Leuven, Cardiovascular Sciences, Leuven, Belgium
| | - J U Voigt
- KU Leuven, Cardiovascular Sciences, Leuven, Belgium
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Pagourelias ED, Kouidi E, Vassilikos VP. Recommendations for participation in competitive sport in athletes with hypertrophic cardiomyopathy: opening the sacks of Aeolus. Eur Heart J 2019; 40:3064. [PMID: 31292626 DOI: 10.1093/eurheartj/ehz475] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 11/12/2022] Open
Affiliation(s)
- Efstathios D Pagourelias
- Cardiomyopathy & Neuromuscular Disease Unit, Third Cardiology Department, Hippokrateion University Hospital, Medical School, Aristotle University of Thessaloniki, 49 Konstantinoupoleos Str., 54642 Thessaloniki, Greece
| | - Evaggelia Kouidi
- Sport Medicine Laboratory, Department of Physical Education and Sports Science, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Vassilios P Vassilikos
- Cardiomyopathy & Neuromuscular Disease Unit, Third Cardiology Department, Hippokrateion University Hospital, Medical School, Aristotle University of Thessaloniki, 49 Konstantinoupoleos Str., 54642 Thessaloniki, Greece
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Ünlü S, Duchenne J, Mirea O, Pagourelias ED, Bézy S, Cvijic M, Beela AS, Thomas JD, Badano LP, Voigt JU, Badano LP, Thomas JD, Hamilton J, Pedri S, Lysyansky P, Hansen G, Ito Y, Chono T, Vogel J, Prater D, Song JH, Lee JY, Houle H, Georgescu B, Baumann R, Mumm B, Abe Y, Gorissen W. Impact of apical foreshortening on deformation measurements: a report from the EACVI-ASE Strain Standardization Task Force. Eur Heart J Cardiovasc Imaging 2019; 21:337-343. [DOI: 10.1093/ehjci/jez189] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [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] [Received: 03/15/2019] [Revised: 06/05/2019] [Accepted: 06/27/2019] [Indexed: 11/14/2022] Open
Abstract
Abstract
Aims
Foreshortening of apical views is a common problem in echocardiography. It results in an abnormally thick false apex and a shortened left ventricular (LV) long axis. We sought to evaluate the impact of foreshortened (FS) on LV ejection fraction (LVEF) and layer-specific 2D speckle tracking based segmental (S) and global (G) longitudinal strain (LS) measurements.
Methods and results
We examined 72 participants using a GE Vivid E9 system. FS apical views were collected from an imaging window one rib-space higher than the optimal images. Ejection fraction as well as layer-specific GLS and SLS measurements were analysed by GE EchoPAC v201 and TomTec Image Arena 4.6 and compared between optimal and FS images. On average, LV long axis was 10% shorter in FS images than in optimal images. FS induced a relative change in LVEF of 3.3% and 6.9% for GE and TomTec, respectively (both, P < 0.001). Endocardial GLS was 9.0% higher with GE and 23.2% with TomTec (P < 0.001). Midwall GLS measurements were less affected (7.8% for GE and 14.1% for TomTec, respectively, both P < 0.001). Segmental strain analysis revealed that the mid-ventricular and apical segments were more affected by foreshortening, and endocardial measurements were more affected than midwall.
Conclusion
Optimal image geometry is crucial for accurate LV function assessment. Foreshorhening of apical views has a substantial impact on longitudinal strain measurements, predominantly in the apex and in the endocardial layer. Our data suggest that measuring midwall strain might therefore be the more robust approach for clinical routine use.
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Affiliation(s)
- Serkan Ünlü
- Department of Cardiovascular Diseases, University Hospital Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Jürgen Duchenne
- Department of Cardiovascular Diseases, University Hospital Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Oana Mirea
- Department of Cardiovascular Diseases, University Hospital Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Efstathios D Pagourelias
- Department of Cardiovascular Diseases, University Hospital Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Stéphanie Bézy
- Department of Cardiovascular Diseases, University Hospital Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Marta Cvijic
- Department of Cardiovascular Diseases, University Hospital Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Ahmed Salem Beela
- Department of Cardiovascular Diseases, University Hospital Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - James D Thomas
- Bluhm Cardiovascular Institute, Northwestern University, 675 N St Clair St 19th Fl, Suite 100, Chicago, IL 60611, USA
| | - Luigi P Badano
- IRCCS, Istituto Auxologico Italiano, SAN. Luca Hospital, University of Milano-Bicocca, Piazzale Brescia, 20, Milano, MI 20149, Italy
| | - Jens-Uwe Voigt
- Department of Cardiovascular Diseases, University Hospital Leuven, Herestraat 49, 3000 Leuven, Belgium
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Duchenne J, Turco A, Ünlü S, Pagourelias ED, Vunckx K, Degtiarova G, Bézy S, Cvijic M, Nuyts J, Claus P, Rega F, Gheysens O, Voigt JU. Left Ventricular Remodeling Results in Homogenization of Myocardial Work Distribution. Circ Arrhythm Electrophysiol 2019; 12:e007224. [DOI: 10.1161/circep.118.007224] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [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: 11/16/2022]
Affiliation(s)
- Jürgen Duchenne
- Department of Cardiovascular Sciences (J.D., S.Ü., E.D.P., S.B., M.C., P.C., F.R., J.-U.V.), KU Leuven, Belgium
- Department of Cardiovascular Diseases (J.D., S.Ü., E.D.P., S.B., M.C., J.-U.V.), University Hospitals Leuven, Belgium
| | - Anna Turco
- Department of Imaging and Pathology (A.T., K.V., G.D., J.N., O.G.), KU Leuven, Belgium
- Department of Nuclear Medicine (A.T., K.V., G.D., J.N., O.G.), University Hospitals Leuven, Belgium
| | - Serkan Ünlü
- Department of Cardiovascular Sciences (J.D., S.Ü., E.D.P., S.B., M.C., P.C., F.R., J.-U.V.), KU Leuven, Belgium
- Department of Cardiovascular Diseases (J.D., S.Ü., E.D.P., S.B., M.C., J.-U.V.), University Hospitals Leuven, Belgium
| | - Efstathios D. Pagourelias
- Department of Cardiovascular Sciences (J.D., S.Ü., E.D.P., S.B., M.C., P.C., F.R., J.-U.V.), KU Leuven, Belgium
- Department of Cardiovascular Diseases (J.D., S.Ü., E.D.P., S.B., M.C., J.-U.V.), University Hospitals Leuven, Belgium
| | - Kathleen Vunckx
- Department of Imaging and Pathology (A.T., K.V., G.D., J.N., O.G.), KU Leuven, Belgium
- Department of Nuclear Medicine (A.T., K.V., G.D., J.N., O.G.), University Hospitals Leuven, Belgium
| | - Ganna Degtiarova
- Department of Imaging and Pathology (A.T., K.V., G.D., J.N., O.G.), KU Leuven, Belgium
- Department of Nuclear Medicine (A.T., K.V., G.D., J.N., O.G.), University Hospitals Leuven, Belgium
| | - Stéphanie Bézy
- Department of Cardiovascular Sciences (J.D., S.Ü., E.D.P., S.B., M.C., P.C., F.R., J.-U.V.), KU Leuven, Belgium
- Department of Cardiovascular Diseases (J.D., S.Ü., E.D.P., S.B., M.C., J.-U.V.), University Hospitals Leuven, Belgium
| | - Marta Cvijic
- Department of Cardiovascular Sciences (J.D., S.Ü., E.D.P., S.B., M.C., P.C., F.R., J.-U.V.), KU Leuven, Belgium
- Department of Cardiovascular Diseases (J.D., S.Ü., E.D.P., S.B., M.C., J.-U.V.), University Hospitals Leuven, Belgium
| | - Johan Nuyts
- Department of Imaging and Pathology (A.T., K.V., G.D., J.N., O.G.), KU Leuven, Belgium
- Department of Nuclear Medicine (A.T., K.V., G.D., J.N., O.G.), University Hospitals Leuven, Belgium
| | - Piet Claus
- Department of Cardiovascular Sciences (J.D., S.Ü., E.D.P., S.B., M.C., P.C., F.R., J.-U.V.), KU Leuven, Belgium
| | - Filip Rega
- Department of Cardiovascular Sciences (J.D., S.Ü., E.D.P., S.B., M.C., P.C., F.R., J.-U.V.), KU Leuven, Belgium
- Department of Cardiothoracic Surgery (F.R.), University Hospitals Leuven, Belgium
| | - Olivier Gheysens
- Department of Imaging and Pathology (A.T., K.V., G.D., J.N., O.G.), KU Leuven, Belgium
- Department of Nuclear Medicine (A.T., K.V., G.D., J.N., O.G.), University Hospitals Leuven, Belgium
| | - Jens-Uwe Voigt
- Department of Cardiovascular Sciences (J.D., S.Ü., E.D.P., S.B., M.C., P.C., F.R., J.-U.V.), KU Leuven, Belgium
- Department of Cardiovascular Diseases (J.D., S.Ü., E.D.P., S.B., M.C., J.-U.V.), University Hospitals Leuven, Belgium
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Pagourelias ED, Mirea O, Vovas G, Duchenne J, Michalski B, Van Cleemput J, Bogaert J, Vassilikos VP, Voigt JU. Relation of regional myocardial structure and function in hypertrophic cardiomyopathy and amyloidois: a combined two-dimensional speckle tracking and cardiovascular magnetic resonance analysis. Eur Heart J Cardiovasc Imaging 2018; 20:426-437. [DOI: 10.1093/ehjci/jey107] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [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: 05/04/2018] [Revised: 06/12/2018] [Accepted: 07/10/2018] [Indexed: 11/13/2022] Open
Affiliation(s)
- Efstathios D Pagourelias
- Department of Cardiovascular Diseases, University Hospital Leuven, Catholic University Leuven, Herestraat 49, Leuven, Belgium
- Third Cardiology Department, Hippokrateion University Hospital, Aristotle University of Thessaloniki, 49 Konstantinoupoleos Str, Thessaloniki, Greece
| | - Oana Mirea
- Department of Cardiovascular Diseases, University Hospital Leuven, Catholic University Leuven, Herestraat 49, Leuven, Belgium
- Department of Cardiology, University of Medicine and Pharmacy of Craiova, University County Hospital of Craiova, 1 Tabaci Str, Craiova, Romania
| | - Georgios Vovas
- Department of Radiology, University Hospital Leuven, Catholic University Leuven, Herestraat 49, Leuven, Belgium
| | - Jürgen Duchenne
- Department of Cardiovascular Diseases, University Hospital Leuven, Catholic University Leuven, Herestraat 49, Leuven, Belgium
| | - Blazej Michalski
- Department of Cardiovascular Diseases, University Hospital Leuven, Catholic University Leuven, Herestraat 49, Leuven, Belgium
| | - Johan Van Cleemput
- Department of Cardiovascular Diseases, University Hospital Leuven, Catholic University Leuven, Herestraat 49, Leuven, Belgium
| | - Jan Bogaert
- Department of Radiology, University Hospital Leuven, Catholic University Leuven, Herestraat 49, Leuven, Belgium
| | - Vasilios P Vassilikos
- Third Cardiology Department, Hippokrateion University Hospital, Aristotle University of Thessaloniki, 49 Konstantinoupoleos Str, Thessaloniki, Greece
| | - Jens-Uwe Voigt
- Department of Cardiovascular Diseases, University Hospital Leuven, Catholic University Leuven, Herestraat 49, Leuven, Belgium
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Duchenne J, Claus P, Pagourelias ED, Mada RO, Van Puyvelde J, Vunckx K, Verbeken E, Gheysens O, Rega F, Voigt JU. Sheep can be used as animal model of regional myocardial remodeling and controllable work. Cardiol J 2018; 26:375-384. [PMID: 29570208 DOI: 10.5603/cj.a2018.0007] [Citation(s) in RCA: 6] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Accepted: 12/31/2017] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Pacing the right heart has been shown to induce reversible conduction delay and subse-quent asymmetric remodeling of the left ventricle (LV) in dogs and pigs. Both species have disadvantages in animal experiments. Therefore the aim of this study was to develop a more feasible and easy-to-use animal model in sheep. METHODS Dual-chamber (DDD) pacemakers with epicardial leads on the right atrium and right ven-tricular free wall were implanted in 13 sheep. All animals underwent 8 weeks of chronic rapid pacing at 180 bpm. Reported observations were made at 110 bpm. RESULTS DDD pacing acutely induced a left bundle branch block (LBBB) - like pattern with almost doubling in QRS width and the appearance of a septal flash, indicating mechanical dyssynchrony. Atrial pacing (AAI) resulted in normal ventricular conduction and function. During 8 weeks of rapid DDD pacing, animals developed LV remodeling (confirmed with histology) with septal wall thinning (-30%, p < 0.05), lateral wall thickening (+22%, p < 0.05), LV volume increase (+32%, p < 0.05), decrease of LV ejection fraction (-31%, p < 0.05), and functional mitral regurgitation. After 8 weeks, segmental pressure-strain-loops, representing regional myocardial work, were recorded. Switching from AAI to DDD pacing decreased immediately work in the septum and increased it in the lateral wall (-69 and +41%, respectively, p < 0.05). Global LV stroke work and dP/dtmax decreased (-27% and -25%, respectively, p < 0.05). CONCLUSIONS This study presents the development a new sheep model with an asymmetrically remod-eled LV. Simple pacemaker programing allows direct modulation of regional myocardial function and work. This animal model provides a new and valuable alternative for canine or porcine models and has the potential to become instrumental for investigating regional function and loading conditions on regional LV remodeling.
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Affiliation(s)
- Jürgen Duchenne
- Department of Cardiovascular Sciences and Department of Cardiovascular Diseases, KU Leuven - University of Leuven and University Hospitals Leuven, Leuven, Belgium.
| | - Piet Claus
- Department of Cardiovascular Sciences and Department of Cardiovascular Diseases, KU Leuven - University of Leuven and University Hospitals Leuven, Leuven, Belgium
| | - Efstathios D Pagourelias
- Department of Cardiovascular Sciences and Department of Cardiovascular Diseases, KU Leuven - University of Leuven and University Hospitals Leuven, Leuven, Belgium
| | - Razvan O Mada
- Department of Cardiovascular Sciences and Department of Cardiovascular Diseases, KU Leuven - University of Leuven and University Hospitals Leuven, Leuven, Belgium
| | - Joeri Van Puyvelde
- Department of Cardiovascular Sciences and Department of Cardiothoracic Surgery, KU Leuven - University of Leuven and University Hospitals Leuven, Leuven, Belgium
| | - Kathleen Vunckx
- Department of Imaging and Pathology and Department of Nuclear Medicine, KU Leuven - University of Leuven and University Hospitals Leuven, Leuven, Belgium
| | - Eric Verbeken
- Department of Imaging and Pathology and Department of Pathology, KU Leuven - University of Leuven and University Hospitals Leuven, Leuven, Belgium
| | - Olivier Gheysens
- Department of Imaging and Pathology and Department of Nuclear Medicine, KU Leuven - University of Leuven and University Hospitals Leuven, Leuven, Belgium
| | - Filip Rega
- Department of Cardiovascular Sciences and Department of Cardiothoracic Surgery, KU Leuven - University of Leuven and University Hospitals Leuven, Leuven, Belgium
| | - Jens-Uwe Voigt
- Department of Cardiovascular Sciences and Department of Cardiovascular Diseases, KU Leuven - University of Leuven and University Hospitals Leuven, Leuven, Belgium
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Duchenne J, Turco A, Bézy S, Ünlü S, Pagourelias ED, Beela AS, Degtiarova G, Vunckx K, Nuyts J, Coudyzer W, Claus P, Rega F, Gheysens O, Voigt JU. Papillary muscles contribute significantly more to left ventricular work in dilated hearts. Eur Heart J Cardiovasc Imaging 2018; 20:84-91. [DOI: 10.1093/ehjci/jey043] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 02/27/2018] [Indexed: 11/13/2022] Open
Affiliation(s)
- Jürgen Duchenne
- Department of Cardiovascular Sciences, KU Leuven—University of Leuven, Herestraat 49, Leuven, Belgium
- Department of Cardiovascular Diseases, University Hospitals Leuven, Herestraat 49, Leuven, Belgium
| | - Anna Turco
- Department of Imaging and Pathology, KU Leuven—University of Leuven, Herestraat 49, Leuven, Belgium
- Department of Nuclear Medicine and Molecular Imaging, University Hospitals Leuven, Herestraat 49, Leuven, Belgium
| | - Stéphanie Bézy
- Department of Cardiovascular Sciences, KU Leuven—University of Leuven, Herestraat 49, Leuven, Belgium
- Department of Cardiovascular Diseases, University Hospitals Leuven, Herestraat 49, Leuven, Belgium
| | - Serkan Ünlü
- Department of Cardiovascular Sciences, KU Leuven—University of Leuven, Herestraat 49, Leuven, Belgium
- Department of Cardiovascular Diseases, University Hospitals Leuven, Herestraat 49, Leuven, Belgium
| | - Efstathios D Pagourelias
- Department of Cardiovascular Sciences, KU Leuven—University of Leuven, Herestraat 49, Leuven, Belgium
- Department of Cardiovascular Diseases, University Hospitals Leuven, Herestraat 49, Leuven, Belgium
| | - Ahmed S Beela
- Department of Cardiovascular Sciences, KU Leuven—University of Leuven, Herestraat 49, Leuven, Belgium
- Department of Cardiovascular Diseases, University Hospitals Leuven, Herestraat 49, Leuven, Belgium
| | - Ganna Degtiarova
- Department of Imaging and Pathology, KU Leuven—University of Leuven, Herestraat 49, Leuven, Belgium
- Department of Nuclear Medicine and Molecular Imaging, University Hospitals Leuven, Herestraat 49, Leuven, Belgium
| | - Kathleen Vunckx
- Department of Imaging and Pathology, KU Leuven—University of Leuven, Herestraat 49, Leuven, Belgium
- Department of Nuclear Medicine and Molecular Imaging, University Hospitals Leuven, Herestraat 49, Leuven, Belgium
| | - Johan Nuyts
- Department of Imaging and Pathology, KU Leuven—University of Leuven, Herestraat 49, Leuven, Belgium
- Department of Nuclear Medicine and Molecular Imaging, University Hospitals Leuven, Herestraat 49, Leuven, Belgium
| | - Walter Coudyzer
- Department of Radiology, University Hospitals Leuven, Herestraat 49, Leuven, Belgium
| | - Piet Claus
- Department of Cardiovascular Sciences, KU Leuven—University of Leuven, Herestraat 49, Leuven, Belgium
- Department of Cardiovascular Diseases, University Hospitals Leuven, Herestraat 49, Leuven, Belgium
| | - Filip Rega
- Department of Cardiovascular Sciences, KU Leuven—University of Leuven, Herestraat 49, Leuven, Belgium
- Department of Cardiothoracic Surgery, University Hospitals Leuven, Herestraat 49, Leuven, Belgium
| | - Olivier Gheysens
- Department of Imaging and Pathology, KU Leuven—University of Leuven, Herestraat 49, Leuven, Belgium
- Department of Nuclear Medicine and Molecular Imaging, University Hospitals Leuven, Herestraat 49, Leuven, Belgium
| | - Jens-Uwe Voigt
- Department of Cardiovascular Sciences, KU Leuven—University of Leuven, Herestraat 49, Leuven, Belgium
- Department of Cardiovascular Diseases, University Hospitals Leuven, Herestraat 49, Leuven, Belgium
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Mirea O, Pagourelias ED, Duchenne J, Bogaert J, Thomas JD, Badano LP, Voigt JU, Badano LP, Thomas JD, Hamilton J, Pedri S, Lysyansky P, Hansen G, Ito Y, Chono T, Vogel J, Prater D, Park S, Lee JY, Houle H, Georgescu B, Baumann R, Mumm B, Abe Y, Gorissen W. Variability and Reproducibility of Segmental Longitudinal Strain Measurement. JACC Cardiovasc Imaging 2018; 11:15-24. [DOI: 10.1016/j.jcmg.2017.01.027] [Citation(s) in RCA: 116] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Revised: 01/24/2017] [Accepted: 01/26/2017] [Indexed: 11/30/2022]
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Ünlü S, Mirea O, Duchenne J, Pagourelias ED, Bézy S, Thomas JD, Badano LP, Voigt JU. Comparison of Feasibility, Accuracy, and Reproducibility of Layer-Specific Global Longitudinal Strain Measurements Among Five Different Vendors: A Report from the EACVI-ASE Strain Standardization Task Force. J Am Soc Echocardiogr 2017; 31:374-380.e1. [PMID: 29246512 DOI: 10.1016/j.echo.2017.11.008] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [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: 06/04/2017] [Indexed: 12/20/2022]
Abstract
BACKGROUND Despite standardization efforts, vendors still use information from different myocardial layers to calculate global longitudinal strain (GLS). Little is known about potential advantages or disadvantages of using these different layers in clinical practice. The authors therefore investigated the reproducibility and accuracy of GLS measurements from different myocardial layers. METHODS Sixty-three subjects were prospectively enrolled, in whom the intervendor bias and test-retest variability of endocardial GLS (E-GLS) and midwall GLS (M-GLS) were calculated, using software packages from five vendors that allow layer-specific GLS calculation (GE, Hitachi, Siemens, Toshiba, and TomTec). The impact of tracking quality and the interdependence of strain values from different layers were assessed by comparing test-retest errors between layers. RESULTS For both E-GLS and M-GLS, significant bias was found among vendors. Relative test-retest variability of E-GLS values differed significantly among vendors, whereas M-GLS showed no significant difference (range, 5.4%-9.5% [P = .032] and 7.0%-11.2% [P = .200], respectively). Within-vendor test-retest variability was similar between E-GLS and M-GLS for all but one vendor. Absolute test-retest errors were highly correlated between E-GLS and M-GLS for all vendors. CONCLUSIONS E-GLS and M-GLS measurements showed no relevant differences in robustness among vendors, although intervendor bias was higher for M-GLS compared with E-GLS. These data provide no technical argument in favor of a certain myocardial layer for global left ventricular functional assessment. Currently, the choice of which layer to use should therefore be based on the available clinical evidence in the literature.
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Affiliation(s)
- Serkan Ünlü
- Department of Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium
| | - Oana Mirea
- Department of Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium
| | - Jürgen Duchenne
- Department of Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium
| | | | - Stéphanie Bézy
- Department of Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium
| | - James D Thomas
- Bluhm Cardiovascular Institute, Northwestern University, Chicago, Illinois
| | - Luigi P Badano
- Cardiac, Thoracic and Vascular Sciences, University Padua, Padua, Italy
| | - Jens-Uwe Voigt
- Department of Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium.
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Pagourelias ED, Mirea O, Duchenne J, Van Cleemput J, Delforge M, Bogaert J, Kuznetsova T, Voigt JU. Echo Parameters for Differential Diagnosis in Cardiac Amyloidosis: A Head-to-Head Comparison of Deformation and Nondeformation Parameters. Circ Cardiovasc Imaging 2017; 10:e005588. [PMID: 28298286 DOI: 10.1161/circimaging.116.005588] [Citation(s) in RCA: 172] [Impact Index Per Article: 24.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Accepted: 01/12/2017] [Indexed: 12/22/2022]
Abstract
BACKGROUND A plethora of echo parameters has been suggested for distinguishing cardiac amyloidosis (CA) from other causes of myocardial thickening with, however, scarce data on their head-to-head comparison. This study aimed at comparing the diagnostic accuracy of various deformation and conventional echo parameters in differentiating CA from other hypertrophic substrates, especially in the gray zone of mild hypertrophy (maximum wall thickness ≤16 mm) or normal ejection fraction (EF). METHODS AND RESULTS =0.0002, respectively) independent of the CA type. CONCLUSIONS Our study demonstrated that in patients with thickened hearts, EF global longitudinal strain ratio has the best accuracy in detecting CA, even among the most "challenging" patient subgroups as those with mild hypertrophy and normal EF.
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Affiliation(s)
- Efstathios D Pagourelias
- From the Departments of Cardiovascular Diseases (E.D.P., O.M., J.D., J.V.C., J.-U.V.), Hematology (M.D.), Radiology (J.B.), Cardiovascular Sciences (T.K.), University Hospital Leuven, Catholic University Leuven, Belgium
| | - Oana Mirea
- From the Departments of Cardiovascular Diseases (E.D.P., O.M., J.D., J.V.C., J.-U.V.), Hematology (M.D.), Radiology (J.B.), Cardiovascular Sciences (T.K.), University Hospital Leuven, Catholic University Leuven, Belgium
| | - Jürgen Duchenne
- From the Departments of Cardiovascular Diseases (E.D.P., O.M., J.D., J.V.C., J.-U.V.), Hematology (M.D.), Radiology (J.B.), Cardiovascular Sciences (T.K.), University Hospital Leuven, Catholic University Leuven, Belgium
| | - Johan Van Cleemput
- From the Departments of Cardiovascular Diseases (E.D.P., O.M., J.D., J.V.C., J.-U.V.), Hematology (M.D.), Radiology (J.B.), Cardiovascular Sciences (T.K.), University Hospital Leuven, Catholic University Leuven, Belgium
| | - Michel Delforge
- From the Departments of Cardiovascular Diseases (E.D.P., O.M., J.D., J.V.C., J.-U.V.), Hematology (M.D.), Radiology (J.B.), Cardiovascular Sciences (T.K.), University Hospital Leuven, Catholic University Leuven, Belgium
| | - Jan Bogaert
- From the Departments of Cardiovascular Diseases (E.D.P., O.M., J.D., J.V.C., J.-U.V.), Hematology (M.D.), Radiology (J.B.), Cardiovascular Sciences (T.K.), University Hospital Leuven, Catholic University Leuven, Belgium
| | - Tatyana Kuznetsova
- From the Departments of Cardiovascular Diseases (E.D.P., O.M., J.D., J.V.C., J.-U.V.), Hematology (M.D.), Radiology (J.B.), Cardiovascular Sciences (T.K.), University Hospital Leuven, Catholic University Leuven, Belgium
| | - Jens-Uwe Voigt
- From the Departments of Cardiovascular Diseases (E.D.P., O.M., J.D., J.V.C., J.-U.V.), Hematology (M.D.), Radiology (J.B.), Cardiovascular Sciences (T.K.), University Hospital Leuven, Catholic University Leuven, Belgium.
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Pagourelias ED, Daraban AM, Mada RO, Duchenne J, Mirea O, Cools B, Heying R, Boshoff D, Bogaert J, Budts W, Gewillig M, Voigt JU. Right ventricular remodelling after transcatheter pulmonary valve implantation. Catheter Cardiovasc Interv 2017; 90:407-417. [PMID: 28296032 DOI: 10.1002/ccd.26966] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [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: 06/12/2016] [Revised: 12/13/2016] [Accepted: 01/16/2017] [Indexed: 12/24/2022]
Abstract
OBJECTIVES To define the optimal timing for percutaneous pulmonary valve implantation (PPVI) in patients with severe pulmonary regurgitation (PR) after Fallot's Tetralogy (ToF) correction. BACKGROUND PPVI among the aforementioned patients is mainly driven by symptoms or by severe right ventricular (RV) dilatation/dysfunction. The optimal timing for PPVI is still disputed. METHODS Twenty patients [age 13.9 ± 9.2 years, (range 4.3-44.9), male 70%] with severe PR (≥3 grade) secondary to previous correction of ToF, underwent Melody valve (Medtronic, Minneapolis, MN) implantation, after a pre-stent placement. Full echocardiographic assessment (traditional and deformation analysis) and cardiovascular magnetic resonance evaluation were performed before and at 3 months after the intervention. 'Favorable remodelling' was considered the upper quartile of RV size decrease (>20% in 3 months). RESULTS After PPVI, indexed RV effective stroke volume increased from 38.4 ± 9.5 to 51.4 ± 10.7 mL/m2 , (P = 0.005), while RV end-diastolic volume and strain indices decreased (123.1 ± 24.1-101.5 ± 18.3 mL/m2 , P = 0.005 and -23.5 ± 2.5 to -21 ± 2.5%, P = 0.002, respectively). After inserting pre-PPVI clinical, RV volumetric and deformation parameters in a multiple regression model, only time after last surgical correction causing PR remained as significant regressor of RV remodelling [R2 = 0.60, beta = 0.387, 95%CI(0.07-0.7), P = 0.019]. Volume reduction and functional improvement were more pronounced in patients treated with PPVI earlier than 7 years after last RV outflow tract (RVOT) correction, reaching close-to-normal values. CONCLUSIONS Early PPVI (<7 years after last RVOT operation) is associated with a more favorable RV reverse remodelling toward normal range and should be considered, before symptoms or RV damage become apparent. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
| | - Ana M Daraban
- Department of Cardiovascular Diseases, University Hospital Leuven, Leuven, 3000, Belgium
| | - Razvan O Mada
- Department of Cardiovascular Diseases, University Hospital Leuven, Leuven, 3000, Belgium
| | - Jürgen Duchenne
- Department of Cardiovascular Diseases, University Hospital Leuven, Leuven, 3000, Belgium
| | - Oana Mirea
- Department of Cardiovascular Diseases, University Hospital Leuven, Leuven, 3000, Belgium
| | - Bjorn Cools
- Department of Pediatric Cardiology, University Hospital Leuven, Leuven, 3000, Belgium
| | - Ruth Heying
- Department of Pediatric Cardiology, University Hospital Leuven, Leuven, 3000, Belgium
| | - Derize Boshoff
- Department of Pediatric Cardiology, University Hospital Leuven, Leuven, 3000, Belgium
| | - Jan Bogaert
- Department of Radiology, University Hospital Leuven, Leuven, 3000, Belgium
| | - Werner Budts
- Department of Cardiovascular Diseases, University Hospital Leuven, Leuven, 3000, Belgium
| | - Marc Gewillig
- Department of Pediatric Cardiology, University Hospital Leuven, Leuven, 3000, Belgium
| | - Jens-Uwe Voigt
- Department of Cardiovascular Diseases, University Hospital Leuven, Leuven, 3000, Belgium
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Pagourelias ED, Ciarka A, Van Cleemput J, Voigt JU. Hypertrophic cardiomyopathies: similar but not quite the same! Eur Heart J 2016; 37:2203. [DOI: 10.1093/eurheartj/ehw177] [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: 11/15/2022] Open
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Athyros VG, Pagourelias ED, Gossios TD, Vasilikos VG. Treating Heart Failure with Preserved Ejection Fraction Related to Arterial Stiffness. Can we Kill Two Birds With One Stone? Curr Vasc Pharmacol 2016; 13:368-80. [PMID: 25426732 DOI: 10.2174/1570161112666141126150948] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2014] [Revised: 10/15/2014] [Accepted: 11/25/2014] [Indexed: 11/22/2022]
Abstract
Heart failure with preserved ejection fraction (HFpEF). Arterial hypertension (AH), arterial stiffness (AS), older age, and female gender are the main determinants of HFpEF, but several cardiac or extra-cardiac pathologies are also possible causes. The combined ventricular-vascular stiffening (abnormal left atrium-left ventricle coupling related to AS) is the main contributor of the increased prevalence of HFpEF in elderly persons, particularly elderly women, and in younger persons with AH. The hospitalization and mortality rates of HFpEF are similar to those of heart failure with reduced EF (HFrEF). However, although the prognosis of HFrEF has been substantially improved during the last 2 decades, the effective treatment of HFpEF remains an unmet need. Regimens effective in HFrEF have no substantial effect on HFpEF, because of different pathophysiologies of the 2 syndromes. Pipeline drugs seem promising, but it will take some years before they are commercially available. Aggressive treatment of noncardiac comorbidities seems to be the only option at hand. Treatment of anaemia, sleep disorders, chronic kidney disease (CKD), non-alcoholic fatty liver (NAFLD), atrial fibrillation, diabetes, and careful use of diuretics to reduce preload are effective to some degree. Statin treatment, despite the presence of dyslipidaemia, deserves special attention because it has been proven, mainly in small studies or post hoc analyses of trials, that it offers a substantial improvement in quality of life and a reduction in mortality rates. We need to urgently utilize these recourses to relieve a considerable part of the general population suffering from HFpEF, a deadly disease.
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Affiliation(s)
- Vasilios G Athyros
- Head of Metabolic Disease and Atherosclerosis Units, Second Prop. Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Hippokration Hospital, Thessaloniki, Greece, 15 Marmara St, Thessaloniki, 55132, Greece.
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Pagourelias ED, Duchenne J, Mirea O, Vovas G, Van Cleemput J, Delforge M, Kuznetsova T, Bogaert J, Voigt JU. The Relation of Ejection Fraction and Global Longitudinal Strain in Amyloidosis: Implications for Differential Diagnosis. JACC Cardiovasc Imaging 2016; 9:1358-1359. [PMID: 26897665 DOI: 10.1016/j.jcmg.2015.11.013] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [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: 10/13/2015] [Revised: 11/17/2015] [Accepted: 11/19/2015] [Indexed: 11/29/2022]
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Pagourelias ED, Papadopoulos CE. Evaluation of myocardial function in pediatric patients with the transposition of great arteries after arterial switch operation. Anatol J Cardiol 2015; 16:62. [PMID: 26645267 PMCID: PMC5336707 DOI: 10.5152/akd.2015.16406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Efstathios D Pagourelias
- Department of Cardiovascular Diseases, Medical Imaging Research Center; UZ Gasthuisberg, Leuven-Belgium; Third Cardiology Department, Hippokratio Hospital, Aristotle University; Thessaloniki-Greece.
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Pagourelias ED, Sotiriou P, Papadopoulos CE, Cholongitas E, Giouleme O, Vassilikos V. Left Ventricular Myocardial Mechanics in Cirrhosis: A Speckle Tracking Echocardiographic Study. Echocardiography 2015; 33:223-32. [DOI: 10.1111/echo.13010] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Affiliation(s)
- Efstathios D. Pagourelias
- Third Cardiology Department; Hippokration University Hospital; Medical School; Aristotle University of Thessaloniki; Thessaloniki Greece
| | - Panagiota Sotiriou
- Third Cardiology Department; Hippokration University Hospital; Medical School; Aristotle University of Thessaloniki; Thessaloniki Greece
| | - Christodoulos E. Papadopoulos
- Third Cardiology Department; Hippokration University Hospital; Medical School; Aristotle University of Thessaloniki; Thessaloniki Greece
| | - Evaggelos Cholongitas
- Fourth Department of Internal Medicine, Liver and Transplantation Unit; Hippokration University Hospital; Medical School; Aristotle University of Thessaloniki; Thessaloniki Greece
| | - Olga Giouleme
- Second Propedeutic Department of Internal Medicine, Gastroenterology Unit; Hippokration University Hospital; Medical School; Aristotle University of Thessaloniki; Thessaloniki Greece
| | - Vassilios Vassilikos
- Third Cardiology Department; Hippokration University Hospital; Medical School; Aristotle University of Thessaloniki; Thessaloniki Greece
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Critoph CH, Pantazis A, Tome Esteban MT, Salazar-Mendiguchía J, Pagourelias ED, Moon JC, Elliott PM. The influence of aortoseptal angulation on provocable left ventricular outflow tract obstruction in hypertrophic cardiomyopathy. Open Heart 2014; 1:e000176. [PMID: 25371813 PMCID: PMC4216933 DOI: 10.1136/openhrt-2014-000176] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [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] [Received: 07/25/2014] [Revised: 08/27/2014] [Accepted: 10/01/2014] [Indexed: 02/06/2023] Open
Abstract
Objectives Aortoseptal angulation (AoSA) can predict provocable left ventricular outflow tract obstruction (LVOTO) in patients with symptomatic hypertrophic cardiomyopathy (HCM). Lack of a standardised measurement technique in HCM without the need for complex three-dimensional (3D) imaging limits its usefulness in routine clinical practice. This study aimed to validate a simple measurement of AoSA using 2D echocardiography and cardiac MR (CMR) imaging as a predictor of LVOTO. Methods We retrospectively assessed 160 patients with non-obstructive HCM, referred for exercise stress echocardiography. AoSA was measured using resting 2D echocardiography in all patients, and CMR in 29. Twenty-five controls with normal echocardiograms were used for comparison. Results Patients with HCM had a reduced AoSA compared with controls (113°±12 vs 126°±6), p<0.0001. Sixty (38%) patients had provocable LVOTO, with smaller angles than non-obstructive patients (108°±12 vs 116°±12, p<0.0001). AoSA, degree of mitral valvular regurgitation and incomplete systolic anterior motion (SAM) were associated with peak left ventricular outflow tract gradient (r=0.508, p<0.0001). An angle ≤100° had 27% sensitivity, 91% specificity and 59% positive predictive value for predicting provocable LVOTO. When combined with SAM, specificity was 99% and positive predictive value 88%. Intraclass correlation coefficient of AoSA measured by two observers was 0.901 (p<0.0001). Bland-Altman analysis of echocardiographic AoSA showed good agreement with the CMR-derived angle. Conclusions Measurement of AoSA using echocardiography in HCM is easy, reproducible and comparable to CMR. Patients with provocable LVOTO have reduced angles compared with non-obstructive patients. AoSA is highly specific for provocable LVOTO and should prompt further evaluation in symptomatic patients without resting obstruction.
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Affiliation(s)
- Christopher Howell Critoph
- Department of Inherited Cardiovascular Disease , The Heart Hospital, University College London , London , UK
| | - Antonios Pantazis
- Department of Inherited Cardiovascular Disease , The Heart Hospital, University College London , London , UK
| | - Maria Teresa Tome Esteban
- Department of Inherited Cardiovascular Disease , The Heart Hospital, University College London , London , UK
| | - Joel Salazar-Mendiguchía
- Cardiomyopathies, Advanced Heart Failure and Transplant Unit , Hospital Universitari de Bellvitge , Barcelona , Spain
| | - Efstathios D Pagourelias
- Department of Inherited Cardiovascular Disease , The Heart Hospital, University College London , London , UK
| | - James C Moon
- Department of Inherited Cardiovascular Disease , The Heart Hospital, University College London , London , UK
| | - Perry Mark Elliott
- Department of Inherited Cardiovascular Disease , The Heart Hospital, University College London , London , UK
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Efthimiadis GK, Zegkos T, Pagourelias ED, Karvounis H. Myocardial crypts as a preclinical sign of hypertrophic cardiomyopathy. Hippokratia 2014; 18:359-361. [PMID: 26052206 PMCID: PMC4453813] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND The identification by cardiac magnetic resonance of myocardial crypts in the left ventricle (LV) of individuals carrying hypertrophic cardiomyopathy causative mutations, but without overt hypertrophy, has been proposed as an early sign of the disease. Myocardial crypts are usually identified in the offsprings of patients with a complete penetrance of the disease. CASE DESCRIPTION We present a case of familial hypertrophic cardiomyopathy displaying an unusual pattern of disease distribution; the 14-year-old child was affected, demonstrating a typical LV asymmetrical hypertrophy, his grandfather, and the 2 brothers of his mother were also affected, but the 41-year-old mother was unaffected (no hypertrophy) displaying 3 myocardial crypts in inferior LV wall, suggesting a preclinical involvement. CONCLUSION The findings underscore the diverse clinical spectrum of the disease, even in a single family and also the need to revise the diagnostic criteria of hypertrophic cardiomyopathy.Hippokratia 2014; 18 (4): 359-361.
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Affiliation(s)
- G K Efthimiadis
- 1 Cardiology Department, AHEPA Hospital, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - T Zegkos
- 1 Cardiology Department, AHEPA Hospital, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - E D Pagourelias
- 1 Cardiology Department, AHEPA Hospital, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - H Karvounis
- 1 Cardiology Department, AHEPA Hospital, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Efthimiadis GK, Pitsis A, Pagourelias ED, Kamperidis V, Kelpis T, Meditskou S, Hadjimiltiades S, Ninios V, Mezilis N, Maron BJ, Styliadis IH. Surgical septal myectomy for hypertrophic cardiomyopathy in Greece: a single-center initial experience. Hellenic J Cardiol 2014; 55:132-138. [PMID: 24681791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
Abstract
INTRODUCTION Surgical septal myectomy is thought to be the gold standard of treatment for obstructive hypertrophic cardiomyopathy (HCM) with obstruction symptoms refractory to optimal medical therapy. In Europe, during the last 2 decades, myectomy has been set aside, while alcohol septal ablation has been widely promoted. In this paper, we analyze our first experience of surgical septal myectomy in a small cohort of patients with HCM coming from a single tertiary center. METHODS Thirty-two patients (16 male, 50%) with a mean age of 58.1 ± 14.4 (range 12-79 years) underwent myectomy for HCM symptoms refractory to negative inotropic agents. The technique used for the myectomy was the one introduced by Andrew Morrow. Mean follow-up time after procedure was 16.8 ± 13.3 months with a median of 13 months (range 4-58 months). RESULTS Post-myectomy, there was a significant improvement in patients' NYHA class (from 3.3 ± 0.46 to 1.38 ± 0.49, p<0.0005), while interventricular septum thickness was reduced from 2.3 ± 0.4 cm to 1.6 ± 0.4 cm (p<0.0005), and peak gradient at the site of obstruction from 94.9 ± 29 to 16.7 ± 7.9 mmHg (p<0.0005). During the follow-up period, only 1 out of 32 patients died, from non-cardiovascular causes, with the overall survival post-myectomy being 97.2% (95%CI: 94.5-99.9%) at 1-year follow up. CONCLUSIONS Surgical septal myectomy in patients with HCM and drug-refractory symptoms is a safe procedure that greatly improves symptoms and quality of life. Further follow-up of our patients is mandatory in order to determine whether the good survival rate achieved at 1 year will persist.
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Affiliation(s)
- Georgios K Efthimiadis
- Cardiomyopathies Center, First Cardiology Department, AHEPA University Hospital, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Efthimiadis GK, Pagourelias ED, Gossios T, Zegkos T. Hypertrophic cardiomyopathy in 2013: Current speculations and future perspectives. World J Cardiol 2014; 6:26-37. [PMID: 24575171 PMCID: PMC3935059 DOI: 10.4330/wjc.v6.i2.26] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Revised: 12/04/2013] [Accepted: 01/14/2014] [Indexed: 02/06/2023] Open
Abstract
Hypertrophic cardiomyopathy (HCM), the most variable cardiac disease in terms of phenotypic presentation and clinical outcome, represents the most common inherited cardiomyopathic process with an autosomal dominant trait of inheritance. To date, more than 1400 mutations of myofilament proteins associated with the disease have been identified, most of them “private” ones. This striking allelic and locus heterogeneity of the disease certainly complicates the establishment of phenotype-genotype correlations. Additionally, topics pertaining to patients’ everyday lives, such as sudden cardiac death (SCD) risk stratification and prevention, along with disease prognosis, are grossly related to the genetic variation of HCM. This review incorporates contemporary research findings and addresses major aspects of HCM, including preclinical diagnosis, genetic analysis, left ventricular outflow tract obstruction and SCD. More specifically, the spectrum of genetic analysis, the selection of the best method for obstruction alleviation and the need for a unique and accurate factor for SCD risk stratification are only some of the controversial HCM issues discussed. Additionally, future perspectives concerning HCM and myocardial ischemia, as well as atrial fibrillation, are discussed. Rather than enumerating clinical studies and guidelines, challenging problems concerning the disease are critically appraised by this review, highlighting current speculations and recommending future directions.
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Pagourelias ED, Kouidi E, Efthimiadis GK, Deligiannis A, Geleris P, Vassilikos V. Right Atrial and Ventricular Adaptations to Training in Male Caucasian Athletes: An Echocardiographic Study. J Am Soc Echocardiogr 2013; 26:1344-52. [DOI: 10.1016/j.echo.2013.07.019] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2012] [Indexed: 11/30/2022]
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Athyros VG, Tziomalos K, Katsiki N, Gossios TD, Giouleme O, Anagnostis P, Pagourelias ED, Theocharidou E, Karagiannis A, Mikhailidis DP, for the GREACE Study Collaborative Group. The Impact of Smoking on Cardiovascular Outcomes and Comorbidities in Statin-treated Patients with Coronary Artery Disease: A Post hoc Analysis of the GREACE Study. Curr Vasc Pharmacol 2013; 11:779-84. [DOI: 10.2174/1570161111311050016] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2012] [Revised: 11/05/2012] [Accepted: 11/07/2012] [Indexed: 11/22/2022]
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - for the GREACE Study Collaborative Group
- Academic Head, Department of Clinical Biochemistry, Royal Free Hospital Campus, University College London Medical School, University College London (UCL), Pond Street, London NW3 2QG, UK
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Karagiannis A, Tziomalos K, Mikhailidis DP, Semertzidis P, Kountana E, Kakafika AI, Pagourelias ED, Athyros VG. Seasonal variation in the occurrence of stroke in Northern Greece: a 10 year study in 8204 patients. Neurol Res 2013; 32:326-31. [DOI: 10.1179/174313208x331608] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Athyros VG, Katsiki N, Tziomalos K, Gossios TD, Theocharidou E, Gkaliagkousi E, Anagnostis P, Pagourelias ED, Karagiannis A, Mikhailidis DP. Statins and cardiovascular outcomes in elderly and younger patients with coronary artery disease: a post hoc analysis of the GREACE study. Arch Med Sci 2013; 9:418-26. [PMID: 23847661 PMCID: PMC3701988 DOI: 10.5114/aoms.2013.35424] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [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: 03/30/2013] [Revised: 04/03/2013] [Accepted: 04/04/2013] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION The effect of cardiovascular disease (CVD) prevention measures aimed at elderly patients requires further evidence. We investigated the effect of statin treatment (targeted to achieve guideline goals) on CVD outcomes in different age groups to determine whether statins are more beneficial in the elderly. MATERIAL AND METHODS The primary endpoint of this post hoc analysis of the GREek Atorvastatin and Coronary-heart-disease Evaluation (GREACE) study (n = 1,600 patients with established coronary heart disease (CHD), mean follow-up 3 years) was the absolute and relative CVD event (a composite of death, myocardial infarction, revascularization, unstable angina, heart failure and stroke) risk reduction in age quartiles (each n = 200). Patients on "structured care" with atorvastatin (n = 800) followed up by the university clinic and treated to lipid goal were compared with the corresponding quartiles on "usual care" (n = 800) followed up by specialists or general practitioners of the patient's choice outside the hospital. RESULTS In the elderly (mean age 69 ±4 and 70 ±3 years in the "structured" and "usual care", respectively) the absolute CVD event reduction between "structured" and "usual care" was 16.5% (p < 0.0001), while in the younger patients (mean age 51 ±3 years and 52 ±3 years in the "structured" and "usual care", respectively) this was 8.5% (p = 0.016); relative risk reduction (RRR) 60% (p < 0.0001) vs. 42% respectively (p = 0.001). The elderly had higher rates of chronic kidney disease and higher uric acid levels, plus an increased prevalence of diabetes, metabolic syndrome and non-alcoholic fatty liver disease. These factors might contribute to the increased CVD risk in older patients. CONCLUSIONS All age groups benefited from statin treatment, but the elderly on "structured care" had a greater absolute and relative CVD risk reduction than the younger patients when compared with the corresponding patients assigned to "usual care". These findings suggest that we should not deprive older patients of CVD prevention treatment and lipid target achievement.
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Affiliation(s)
- Vasilios G. Athyros
- Second Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Hippokration Hospital, Thessaloniki, Greece
| | - Niki Katsiki
- Second Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Hippokration Hospital, Thessaloniki, Greece
| | - Konstantinos Tziomalos
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece
| | - Thomas D. Gossios
- First Cardiology Clinic, Medical School, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece
| | - Eleni Theocharidou
- Second Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Hippokration Hospital, Thessaloniki, Greece
| | - Eygenia Gkaliagkousi
- Second Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Hippokration Hospital, Thessaloniki, Greece
| | | | - Efstathios D. Pagourelias
- Second Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Hippokration Hospital, Thessaloniki, Greece
| | - Asterios Karagiannis
- Second Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Hippokration Hospital, Thessaloniki, Greece
| | - Dimitri P. Mikhailidis
- Department of Clinical Biochemistry (Vascular Prevention Clinic), Royal Free Campus, University College London Medical School, University College London (UCL), London, UK
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Efthimiadis GK, Pagourelias ED, Parcharidou D, Gossios T, Kamperidis V, Theofilogiannakos EK, Pappa Z, Meditskou S, Hadjimiltiades S, Pliakos C, Karvounis H, Styliadis IH. Clinical characteristics and natural history of hypertrophic cardiomyopathy with midventricular obstruction. Circ J 2013; 77:2366-74. [PMID: 23728066 DOI: 10.1253/circj.cj-12-1561] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND The prevalence, clinical characteristics and natural history of patients with hypertrophic cardiomyopathy (HCM) and midventricular obstruction (MVO) have not been adequately studied. METHODS AND RESULTS A single-center cohort consisting of 423 patients (mean age, 49.3±17.2 years; 66.2% male) was thoroughly followed up for a median of 84 months (7 years; range, 6-480 months). MVO, characterized by the echocardiographic appearance of midventricular muscular apposition with a simultaneous mid-cavitary gradient ≥30mmHg, was identified in 34 patients (8%). Patients with MVO tended to be more symptomatic during their initial evaluation (>90% presented with NYHA class ≥II) compared to the rest of the HCM cohort. Apical aneurysm formation was identified in more than one-fourth of patients with MVO (26.5%), being a characteristic of the group. On multivariate Cox regression hazard analysis, presence of MVO strongly predicted progression to end-stage (burnt out) HCM and related heart failure (HF) deaths (hazard ratio, [HR], 2.62; 95% confidence interval [CI]: 1.2-8.8; P=0.047), as well as sudden death and associated lethal arrhythmic events (HR, 3.3; 95% CI: 1.26-8.85; P=0.016). CONCLUSIONS MVO is a distinct phenotype of HCM associated with unfavorable prognosis in terms of end-stage HCM, sudden death and lethal arrhythmic events. The high adverse outcome rate necessitates early recognition of MVO and appropriate therapeutic interventions.
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Pagourelias ED, Rossios K, Kyriakou P, Mavroudi M, Tanos D, Vassilikos V. Atypical presentation of the most typical cardiac tumor. Herz 2013; 39:400-2. [PMID: 23712826 DOI: 10.1007/s00059-013-3832-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2013] [Accepted: 04/09/2013] [Indexed: 11/30/2022]
Affiliation(s)
- E D Pagourelias
- Third Cardiology Department, Hippokration Hospital, Medical School, Aristotle University of Thessaloniki, 49 Konstantinoupoleos Str., 54642, Thessaloniki, Greece,
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Pagourelias ED, Efthimiadis GK, Kouidi E, Zorou P, Giannoglou G, Deligiannis A, Athyros VG, Karagiannis A, Geleris P. Efficacy of Various “Classic” Echocardiographic and Laboratory Indices in Distinguishing the “Gray Zone” between Athlete's Heart and Hypertrophic Cardiomyopathy: A Pilot Study. Echocardiography 2012; 30:131-9. [DOI: 10.1111/echo.12014] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
| | - Georgios K. Efthimiadis
- First Cardiology Department; AHEPA Hospital, Medical School, Aristotle University of Thessaloniki; Thessaloniki; Greece
| | - Evangelia Kouidi
- Sports Medicine Laboratory; Department of Physical Education and Sport Science; Aristotle University of Thessaloniki; Thessaloniki; Greece
| | - Paraskevi Zorou
- First Laboratory of Microbiology; Medical School, Aristotle University of Thessaloniki; Thessaloniki; Greece
| | - Georgios Giannoglou
- First Cardiology Department; AHEPA Hospital, Medical School, Aristotle University of Thessaloniki; Thessaloniki; Greece
| | - Asterios Deligiannis
- Sports Medicine Laboratory; Department of Physical Education and Sport Science; Aristotle University of Thessaloniki; Thessaloniki; Greece
| | - Vasilis G Athyros
- Second Propedeutic Department of Internal Medicine; Hippokration Hospital, Medical School, Aristotle University of Thessaloniki; Thessaloniki; Greece
| | - Asterios Karagiannis
- Second Propedeutic Department of Internal Medicine; Hippokration Hospital, Medical School, Aristotle University of Thessaloniki; Thessaloniki; Greece
| | - Paraschos Geleris
- Third Cardiology Department; Hippokration Hospital, Medical School, Aristotle University of Thessaloniki; Thessaloniki; Greece
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Fragakis N, Koskinas KC, Katritsis DG, Pagourelias ED, Zografos T, Geleris P. Comparison of effectiveness of ranolazine plus amiodarone versus amiodarone alone for conversion of recent-onset atrial fibrillation. Am J Cardiol 2012; 110:673-7. [PMID: 22621799 DOI: 10.1016/j.amjcard.2012.04.044] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.1] [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: 03/19/2012] [Revised: 04/26/2012] [Accepted: 04/26/2012] [Indexed: 12/19/2022]
Abstract
Ranolazine, an antianginal agent with antiarrhythmic properties, prevents atrial fibrillation (AF) in patients with acute coronary syndrome. In experimental models, the combination of ranolazine and amiodarone has marked synergistic effects that potently suppress AF. Currently, the clinical effect of the ranolazine-amiodarone combination for the conversion of AF is unknown. This prospective randomized pilot study compared the safety and efficacy of ranolazine plus amiodarone versus amiodarone alone for the conversion of recent-onset AF. We enrolled 51 consecutive patients with AF (<48-hour duration) eligible for pharmacologic cardioversion. Patients (33 men, 63 ± 8 years of age) were randomized to intravenous amiodarone for 24 hours (group A, n = 26) or to intravenous amiodarone plus oral ranolazine 1,500 mg at time of randomization (group A + R, n = 25). The 2 groups were well balanced with respect to clinical characteristics and left atrial diameter. Conversion within 24 hours (primary end point) was achieved in 22 patients (88%) in group A + R versus 17 patients (65%) in group A (p = 0.056). Time to conversion was shorter in group A + R than in group A (9.8 ± 4.1 vs 14.6 ± 5.3 hours, p = 0.002). According to Cox regression analysis, left atrial diameter and A + R treatment were the only independent predictors of time to conversion (hazard ratio 5.35, 95% confidence interval 2.37 to 12.11, p <0.001; hazard ratio 0.81, 95% confidence interval 0.74 to 0.88, p <0.001, respectively). There were no proarrhythmic events in either group. In conclusion, addition of ranolazine to standard amiodarone therapy is equally safe and appears to be more effective compared to amiodarone alone for conversion of recent-onset AF.
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Affiliation(s)
- Nikolaos Fragakis
- 3rd Cardiology Department, Hippokrateion Hospital, Aristotle University Medical School, Thessaloniki, Greece
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Pagourelias ED, Fragakis N, Rossios K, Avramidou A, Geleris P. Right atrial thrombus as a complication of supraventricular tachycardia ablation resolved by anticoagulation. Echocardiography 2012; 29:E243-4. [PMID: 22747592 DOI: 10.1111/j.1540-8175.2012.01772.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- Efstathios D Pagourelias
- Cardiac Electrophysiology Laboratory, Third Cardiology Department, Hippokration General Hospital, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece.
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Pagourelias ED, Fragakis N, Koskinas KC, Geleris P. Brugada syndrome masked by ibutilide treatment in a patient with atrial flutter. Cardiology 2012; 122:89-92. [PMID: 22739533 DOI: 10.1159/000338735] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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] [Received: 04/04/2012] [Accepted: 04/04/2012] [Indexed: 11/19/2022]
Abstract
We present a case of Brugada syndrome in a young patient whose typical ECG pattern was 'masked' after ibutilide was administered for atrial flutter cardioversion. Ibutilide, a class III antiarrhythmic agent used for the treatment of atrial fibrillation and flutter, prolongs the action potential duration plateau phase by augmenting the slow component of the inward Na(+) current and by blocking the rapid component of the delayed rectifier potassium current. Insights into the pathophysiology of Brugada syndrome and this first-reported action of ibutilide are supplied, providing a plausible scientific basis for the masking effect of ibutilide. Furthermore, issues concerning the safety of ibutilide administration in patients with Brugada syndrome along with the importance of programmed ventricular stimulation and especially short-long-short sequence protocol in inducing ventricular fibrillation in these patients are also discussed.
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Affiliation(s)
- Efstathios D Pagourelias
- Third Cardiology Department, Hippokration Hospital, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece.
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Pagourelias ED, Efthimiadis GK, Kouidi E, Fragakis N, Athyros VG, Geleris P. Athlete's heart or hypertrophic cardiomyopathy: the dilemma is still there. Am J Cardiol 2011; 108:1841-2. [PMID: 22133136 DOI: 10.1016/j.amjcard.2011.09.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2011] [Revised: 09/13/2011] [Accepted: 09/14/2011] [Indexed: 02/07/2023]
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Rouska E, Charokopos N, Pagourelias ED, Artemiou P, Ziakas A, Papadopoulos N. Aortic root replacement in case of isolated aortitis and previous coronary artery bypass. Hellenic J Cardiol 2011; 52:444-447. [PMID: 21940293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023] Open
Abstract
The surgical management of aortic regurgitation in a patient with aortitis is potentially of high risk, especially if it is a reoperation. We present the case of a 59-year-old man for whom coronary artery bypass surgery was not feasible due to structural abnormalities of the aorta and hybrid management was applied. The histopathological examination showed aortitis. One year later, the same patient developed severe aortic regurgitation. In order to minimize the surgical risk of the reoperation we considered all the surgical options. The modified Bentall procedure still seems to be the gold standard in these cases.
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Affiliation(s)
- Efthymia Rouska
- Second Cardiology Department, Evaggelismos General Hospital, Athens, Greece.
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Pagourelias ED, Zorou PG, Tsaligopoulos M, Athyros VG, Karagiannis A, Efthimiadis GK. Carbon dioxide balneotherapy and cardiovascular disease. Int J Biometeorol 2011; 55:657-63. [PMID: 20967468 DOI: 10.1007/s00484-010-0380-7] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2010] [Revised: 09/26/2010] [Accepted: 10/02/2010] [Indexed: 05/24/2023]
Abstract
Carbon dioxide (CO(2)) balneotherapy is a kind of remedy with a wide spectrum of applications which have been used since the Middle Ages. However, its potential use as an adjuvant therapeutic option in patients with cardiovascular disease is not yet fully clarified. We performed a thorough review of MEDLINE Database, EMBASE, ISI WEB of Knowledge, COCHRANE database and sites funded by balneotherapy centers across Europe in order to recognize relevant studies and aggregate evidence supporting the use of CO(2) baths in various cardiovascular diseases. The three main effects of CO(2) hydrotherapy during whole body or partial immersion, including decline in core temperature, an increase in cutaneous blood flow, and an elevation of the score on thermal sensation, are analyzed on a pathophysiology basis. Additionally, the indications and contra-indications of the method are presented in an evidence-based way, while the need for new methodologically sufficient studies examining the use of CO(2) baths in other cardiovascular substrates is discussed.
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Affiliation(s)
- Efstathios D Pagourelias
- First Cardiology Department, AHEPA University Hospital, Medical School, Aristotle University of Thessaloniki, Greece.
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Pagourelias ED, Gossios TD, Tziomalos K, Karagiannis A, Geleris P, Athyros VG. Residual cardiac risk reduction beyond lipid lowering. Hellenic J Cardiol 2011; 52:197-203. [PMID: 21642067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023] Open
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