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Blessing R, Drosos I, Molitor M, Münzel T, Wenzel P, Gori T, Dimitriadis Z. Evaluation of right-ventricular function by two-dimensional echocardiography and two-dimensional speckle-tracking echocardiography in patients with successful RCA CTO recanalization. Clin Res Cardiol 2023; 112:1454-1462. [PMID: 37526696 PMCID: PMC10562279 DOI: 10.1007/s00392-023-02259-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 06/26/2023] [Indexed: 08/02/2023]
Abstract
OBJECTIVES Chronic total occlusion (CTO) of the right coronary artery (RCA) is common in patients with coronary artery disease. Although revascularization techniques and success rates have improved significantly in recent years, there are still no studies investigating possible effects of successful recanalization of RCA CTO on the right-ventricular (RV) function. With this study, we aimed to evaluate RV function after recanalization of the RCA by two-dimensional transthoracic echocardiography (2DE) and additional two-dimensional speckle-tracking echocardiography (2DSTE). METHODS AND RESULTS Our analysis included 102 patients undergoing successful RCA CTO recanalization at the University Medical Center of Mainz. All patients underwent 2DE and 2DSTE to assess RV function before PCI procedure and 6 months after successful revascularization. We found an altered RV function in our collective at baseline assessed by 2DSTE with a significant improvement at 6 month follow-up (baseline RV free wall strain: - 20.7 [- 6.3 to - 32.0] % vs. - 23.4 [- 8.3 to - 39.3] % at follow-up, p < 0.001 and baseline RV global strain - 15.9 [- 6.0 to - 25.7] % vs. - 17.9 [- 7.0 to - 29.5] % at follow-up, p < 0.001). CONCLUSION RV function was altered in patients with RCA CTO and showed significant improvement after successful recanalization. We also noticed an improvement in patient-reported clinical symptoms. Our study suggests that CTO procedure is a beneficial treatment option in symptomatic patients with RCA CTO.
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Affiliation(s)
- Recha Blessing
- Department of Cardiology, University Medical Center Mainz, Johannes Gutenberg University, Langenbeckstr. 1, 55131, Mainz, Germany.
| | - Ioannis Drosos
- Division of Cardiology, Department of Medicine III, Center of Internal Medicine, University Hospital Frankfurt, Goethe University Frankfurt am Main, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
| | - Michael Molitor
- Department of Cardiology, University Medical Center Mainz, Johannes Gutenberg University, Langenbeckstr. 1, 55131, Mainz, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Mainz, Germany
| | - Thomas Münzel
- Department of Cardiology, University Medical Center Mainz, Johannes Gutenberg University, Langenbeckstr. 1, 55131, Mainz, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Mainz, Germany
| | - Philip Wenzel
- Department of Cardiology, University Medical Center Mainz, Johannes Gutenberg University, Langenbeckstr. 1, 55131, Mainz, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Mainz, Germany
- Center for Thrombosis and Hemostasis (CTH), Johannes Gutenberg University, Mainz, Germany
| | - Tommaso Gori
- Department of Cardiology, University Medical Center Mainz, Johannes Gutenberg University, Langenbeckstr. 1, 55131, Mainz, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Mainz, Germany
| | - Zisis Dimitriadis
- Division of Cardiology, Department of Medicine III, Center of Internal Medicine, University Hospital Frankfurt, Goethe University Frankfurt am Main, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany.
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Blessing R, Drosos I, Münzel T, Wenzel P, Gori T, Dimitriadis Z. Evaluation of right atrial function by two-dimensional echocardiography and strain imaging in patients with RCA CTO recanalization. BMC Cardiovasc Disord 2023; 23:85. [PMID: 36774496 PMCID: PMC9922456 DOI: 10.1186/s12872-023-03108-y] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 02/02/2023] [Indexed: 02/13/2023] Open
Abstract
OBJECTIVES The right heart is mainly supplied with blood by the right coronary artery (RCA). The impact of RCA chronic total occlusion (CTO) on the function of the right heart [right atrium (RA) and ventricle (RV)] and whether successful recanalization of a RCA CTO improves the function of the right heart is not clearly understood yet. We aimed to evaluate right atrial function after recanalization of the RCA using transthoracic echocardiography with additional strain imaging. METHODS AND RESULTS Fifty-five patients undergoing RCA CTO recanalization at the University Medical Center of Mainz were included in the study. Right atrial strain was assessed before and 6 months after successful CTO revascularization. The median age of the total collective was 66 (50-90) years. We did not find difference in our analysis of RA Volume (p 0.086), RA area (p 0.093), RA major dimension (p 0.32) and RA minor dimension (p 0.139) at baseline and follow-up. Mean RA reservoir strain at baseline was 30.9% (21.1-43.0) vs. 33.4% (20.7-47.7) at follow up (p < 0.001). Mean RA conduit strain was - 17.5% (- 10.7-(- 29.7)) at baseline vs. - 18.2% (- 9.6-(- 31.7)) at follow-up (p = 0.346). Mean RA contraction strain was - 12.9% (- 8.0- (- 21.3)) at baseline vs. - 15.5% (- 8.7-(- 26.6)) at follow-up (p < 0.001). CONCLUSION Right atrial function was altered in patients with RCA CTO. Successful revascularisation of an RCA CTO improved RA function assessed by strain imaging at follow-up.
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Affiliation(s)
- Recha Blessing
- University Medical Center Mainz - Center of Cardiology, Johannes Gutenberg University, Mainz, Germany. .,Department of Cardiology, University Medical Center Mainz, Langenbeckstr.1, 55131, Mainz, Germany.
| | - Ioannis Drosos
- grid.7839.50000 0004 1936 9721Division of Cardiology, Department of Medicine III, University Hospital Frankfurt, Goethe University Frankfurt am Main, Frankfurt, Germany
| | - Thomas Münzel
- grid.5802.f0000 0001 1941 7111University Medical Center Mainz - Center of Cardiology, Johannes Gutenberg University, Mainz, Germany ,grid.452396.f0000 0004 5937 5237German Center for Cardiovascular Research (DZHK), Mainz Partner Site Rhine-Main, Mainz, Germany
| | - Philip Wenzel
- grid.5802.f0000 0001 1941 7111University Medical Center Mainz - Center of Cardiology, Johannes Gutenberg University, Mainz, Germany ,grid.452396.f0000 0004 5937 5237German Center for Cardiovascular Research (DZHK), Mainz Partner Site Rhine-Main, Mainz, Germany ,grid.5802.f0000 0001 1941 7111Center for Thrombosis and Hemostasis (CTH), Johannes Gutenberg University, Mainz, Germany
| | - Tommaso Gori
- grid.5802.f0000 0001 1941 7111University Medical Center Mainz - Center of Cardiology, Johannes Gutenberg University, Mainz, Germany ,grid.452396.f0000 0004 5937 5237German Center for Cardiovascular Research (DZHK), Mainz Partner Site Rhine-Main, Mainz, Germany
| | - Zisis Dimitriadis
- Division of Cardiology, Department of Medicine III, University Hospital Frankfurt, Goethe University Frankfurt am Main, Frankfurt, Germany. .,Department of Cardiology, Center of Internal Medicine, Goethe University Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany.
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Blessing R, Buono A, Ahoopai M, Geyer M, Knorr M, Brandt M, Steven S, Drosos I, Muenzel T, Wenzel P, Gori T, Dimitriadis Z. Use of intravascular ultrasound for optimal vessel sizing in chronic total occlusion percutaneous coronary intervention. Front Cardiovasc Med 2022; 9:922366. [PMID: 35990972 PMCID: PMC9381831 DOI: 10.3389/fcvm.2022.922366] [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] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Accepted: 07/11/2022] [Indexed: 11/13/2022] Open
Abstract
AimThe aim of this study is to provide evidence on how use of standardized intravascular ultrasound (IVUS) use impacts stent size choice in the setting of chronic total occlusion (CTO) percutaneous coronary intervention (PCI) compared to visual estimation.Methods and resultsData of 82 consecutive patients who had successfully undergone IVUS-guided revascularization of CTO at the University Medical Center Mainz were analyzed. Angiography-based stent size prediction for the proximal and distal vessels was compared to the implanted stent diameter after IVUS assessment. Angiography-based stent size prediction for the proximal vessel was 3.09 ± 0.41, whereas IVUS use demonstrated larger vessel diameter, resulting in larger implanted stent diameter (3.24 ± 0.45, p < 0.001). Proximal vessel stent size prediction was underestimated in the majority of patients by angiographic estimation. Angiography-based stent size prediction for the distal vessel was 2.79 ± 0.38, whereas IVUS use demonstrated larger vessel diameter, resulting in larger implanted stent diameter (2.92 ± 0.39, p < 0.001).ConclusionPre-stent IVUS assessment in CTO PCI provides important information on vessel morphology and size. Angiography-based stent size prediction for the proximal and distal vessels was frequently underestimated, IVUS use demonstrated larger vessel diameter, resulting in significantly larger implanted stent diameter.
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Affiliation(s)
- Recha Blessing
- University Medical Center Mainz, Center of Cardiology, Johannes Gutenberg University, Mainz, Germany
- *Correspondence: Recha Blessing,
| | - Andrea Buono
- Interventional Cardiology Unit, Fondazione Poliambulanza, Brescia, Italy
| | - Majid Ahoopai
- University Medical Center Mainz, Center of Cardiology, Johannes Gutenberg University, Mainz, Germany
| | - Martin Geyer
- University Medical Center Mainz, Center of Cardiology, Johannes Gutenberg University, Mainz, Germany
| | - Maike Knorr
- University Medical Center Mainz, Center of Cardiology, Johannes Gutenberg University, Mainz, Germany
| | - Moritz Brandt
- University Medical Center Mainz, Center of Cardiology, Johannes Gutenberg University, Mainz, Germany
- Center for Thrombosis and Hemostasis, Johannes Gutenberg University, Mainz, Germany
| | - Sebastian Steven
- University Medical Center Mainz, Center of Cardiology, Johannes Gutenberg University, Mainz, Germany
- Center for Thrombosis and Hemostasis, Johannes Gutenberg University, Mainz, Germany
- German Center for Cardiovascular Research (DZHK), Mainz Partner Site Rhine-Main, Mainz, Germany
| | - Ioannis Drosos
- Division of Cardiology, Department of Medicine III, University Hospital Frankfurt, Goethe University Frankfurt am Main, Frankfurt, Germany
| | - Thomas Muenzel
- University Medical Center Mainz, Center of Cardiology, Johannes Gutenberg University, Mainz, Germany
- German Center for Cardiovascular Research (DZHK), Mainz Partner Site Rhine-Main, Mainz, Germany
| | - Philip Wenzel
- University Medical Center Mainz, Center of Cardiology, Johannes Gutenberg University, Mainz, Germany
- Center for Thrombosis and Hemostasis, Johannes Gutenberg University, Mainz, Germany
- German Center for Cardiovascular Research (DZHK), Mainz Partner Site Rhine-Main, Mainz, Germany
| | - Tommaso Gori
- University Medical Center Mainz, Center of Cardiology, Johannes Gutenberg University, Mainz, Germany
- German Center for Cardiovascular Research (DZHK), Mainz Partner Site Rhine-Main, Mainz, Germany
| | - Zisis Dimitriadis
- Division of Cardiology, Department of Medicine III, University Hospital Frankfurt, Goethe University Frankfurt am Main, Frankfurt, Germany
- Zisis Dimitriadis,
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Drosos I, De Rosa R, Cremer S, Seppelt PC, Hemmann K, Oppermann J, Blessing R, Mas-Peiro S, Vasa-Nicotera M, Zeiher AM, Dimitriadis Z. Percutaneous left atrial appendage occlusion in a frail, high-risk, octogenarian patient population, after having undergone transcatheter aortic valve implantation. BMC Cardiovasc Disord 2022; 22:349. [PMID: 35918658 PMCID: PMC9344699 DOI: 10.1186/s12872-022-02786-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Accepted: 07/22/2022] [Indexed: 11/16/2022] Open
Abstract
Background Percutaneous left atrial appendage occlusion (LAAO) represents an alternative stroke prevention method in patients with atrial fibrillation and an increased bleeding risk, chronic kidney disease or contraindications to oral anticoagulants. Aim of our study was to evaluate the feasibility and safety of percutaneous LAAO in high-risk, frail patients having undergone transcatheter aortic valve implantation (TAVI). Methods Thirty-one patients having undergone TAVI and scheduled for LAAO were prospectively included in our study. Results Implantation was successful in 29 of 31 cases (93.5%).There were no patients that developed a major acute cardiovascular event, stroke, or device dislocation/embolization. There was a single case of major bleeding (3.2%) and 3 cases of acute kidney injury (9.7%). At 3 months, no patients experienced a stroke, one patient had a device-related thrombus (3.4%), one patient showed a significant peri-device leak, and one patient had a persistent iatrogenic atrial septal defect. Conclusions Our study shows that percutaneous LAAO may represent a feasible alternative strategy for stroke prevention, that can be safely performed in high-risk, multimorbid patients with high bleeding risk or contraindications to oral anticoagulation.
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Affiliation(s)
- Ioannis Drosos
- Division of Cardiology, Department of Medicine III, University Hospital Frankfurt, Goethe University Frankfurt Am Main, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany.
| | - Roberta De Rosa
- Division of Cardiology, Department of Medicine III, University Hospital Frankfurt, Goethe University Frankfurt Am Main, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
| | - Sebastian Cremer
- Division of Cardiology, Department of Medicine III, University Hospital Frankfurt, Goethe University Frankfurt Am Main, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
| | - Philipp C Seppelt
- Division of Cardiology, Department of Medicine III, University Hospital Frankfurt, Goethe University Frankfurt Am Main, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
| | - Katrin Hemmann
- Division of Cardiology, Department of Medicine III, University Hospital Frankfurt, Goethe University Frankfurt Am Main, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
| | - Jana Oppermann
- Division of Cardiology, Department of Medicine III, University Hospital Frankfurt, Goethe University Frankfurt Am Main, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
| | - Recha Blessing
- Center of Cardiology, Cardiology 1, University Medical Center Mainz, Mainz, Germany
| | - Silvia Mas-Peiro
- Division of Cardiology, Department of Medicine III, University Hospital Frankfurt, Goethe University Frankfurt Am Main, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany.,German Center for Cardiovascular Research (DZHK), Berlin, Germany.,Cardiopulmonary Institute (CPI), Frankfurt, Germany
| | - Mariuca Vasa-Nicotera
- Division of Cardiology, Department of Medicine III, University Hospital Frankfurt, Goethe University Frankfurt Am Main, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
| | - Andreas M Zeiher
- Division of Cardiology, Department of Medicine III, University Hospital Frankfurt, Goethe University Frankfurt Am Main, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
| | - Zisis Dimitriadis
- Division of Cardiology, Department of Medicine III, University Hospital Frankfurt, Goethe University Frankfurt Am Main, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
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5
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Wegner J, Karbach S, Drosos I, Schnorbus B, Muxel S, Schmidt F, Wenzel P, Waisman A, Münzel T, Gori T, von Stebut E. TNF-α blockade may lead to improvement of vascular function in psoriasis patients. Exp Dermatol 2021; 31:237-241. [PMID: 34432926 DOI: 10.1111/exd.14452] [Citation(s) in RCA: 5] [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] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 06/28/2021] [Accepted: 08/13/2021] [Indexed: 01/01/2023]
Abstract
Psoriasis is one of the most common chronic inflammatory skin diseases and at the same time a risk factor for cardiovascular disease. Interleukin-17A (IL-17A)-mediated inflammation in psoriasis may lead to vascular dysfunction. This study aimed at investigating whether anti-inflammatory treatment by tumor necrosis factor (TNF)-α blockade alters vascular function in psoriasis patients. A total of 11 patients with psoriasis who underwent treatment with either adalimumab (n = 8) or etanercept (n = 3), 10 healthy control individuals and 14 patients with coronary artery disease (CAD) were included in this study. Treatment response was assessed using the Psoriasis Area and Severity Index (PASI) score. Endothelial reactivity and resting endothelium-dependent vascular tone were assessed by ultrasound measurement of flow-mediated dilation (FMD) and low-flow-mediated constriction (l-FMC), respectively. FMD was slightly impaired in psoriasis patients compared to healthy controls. Anti-TNF-α treatment did not significantly change FMD levels. Psoriasis patients showed a trend towards increased baseline vascular activity compared to healthy controls. Anti-TNF-α treatment significantly improved l-FMC in psoriasis patients. Noteworthy, both FMD and l-FMC in psoriasis patients were comparable to those in patients with CAD; however, an important influence of age differences between the groups or co-existent classical cardiovascular risk factors on FMD and l-FMC cannot be ruled out by our small study. The results suggest that anti-inflammatory treatment with TNF-α blockade improves vascular function in patients with psoriasis, mainly by altering baseline vascular tone. Further studies will be necessary to establish the potentially protective impact of anti-inflammatory therapy on vascular function in patients with chronic inflammatory diseases.
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Affiliation(s)
- Joanna Wegner
- Department of Dermatology, University Medical Center Mainz, Mainz, Germany
| | - Susanne Karbach
- Center of Cardiology, Cardiology 1, University Medical Center Mainz, Mainz, Germany.,Center of Thrombosis and Hemostasis, University Medical Center Mainz, Mainz, Germany.,German Center for Cardiovascular Research (DZHK, Greifswald, Germany
| | - Ioannis Drosos
- Center of Cardiology, Cardiology 1, University Medical Center Mainz, Mainz, Germany
| | - Boris Schnorbus
- Center of Cardiology, Cardiology 1, University Medical Center Mainz, Mainz, Germany
| | - Selina Muxel
- Center of Cardiology, Cardiology 1, University Medical Center Mainz, Mainz, Germany
| | - Frank Schmidt
- Center of Cardiology, Cardiology 1, University Medical Center Mainz, Mainz, Germany
| | - Philip Wenzel
- Center of Cardiology, Cardiology 1, University Medical Center Mainz, Mainz, Germany.,Center of Thrombosis and Hemostasis, University Medical Center Mainz, Mainz, Germany.,German Center for Cardiovascular Research (DZHK, Greifswald, Germany
| | - Ari Waisman
- Institute of Molecular Medicine, University Medical Center Mainz, Mainzm, Germany
| | - Thomas Münzel
- Center of Cardiology, Cardiology 1, University Medical Center Mainz, Mainz, Germany.,Center of Thrombosis and Hemostasis, University Medical Center Mainz, Mainz, Germany.,German Center for Cardiovascular Research (DZHK, Greifswald, Germany
| | - Tommaso Gori
- Center of Cardiology, Cardiology 1, University Medical Center Mainz, Mainz, Germany.,German Center for Cardiovascular Research (DZHK, Greifswald, Germany
| | - Esther von Stebut
- Department of Dermatology, University of Cologne, University Hospital Cologne and Faculty of Medicine Cologne, Cologne, Germany
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Tziakas DN, Chalikias G, Pavlaki M, Kareli D, Gogiraju R, Hubert A, Böhm E, Stamoulis P, Drosos I, Kikas P, Mikroulis D, Giatromanolaki A, Georgiadis GS, Konstantinou F, Argyriou C, Münzel T, Konstantinides SV, Schäfer K. Lysed Erythrocyte Membranes Promote Vascular Calcification. Circulation 2020; 139:2032-2048. [PMID: 30717607 DOI: 10.1161/circulationaha.118.037166] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [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] [Indexed: 01/05/2023]
Abstract
BACKGROUND Intraplaque hemorrhage promotes atherosclerosis progression, and erythrocytes may contribute to this process. In this study we examined the effects of red blood cells on smooth muscle cell mineralization and vascular calcification and the possible mechanisms involved. METHODS Erythrocytes were isolated from human and murine whole blood. Intact and lysed erythrocytes and their membrane fraction or specific erythrocyte components were examined in vitro using diverse calcification assays, ex vivo by using the murine aortic ring calcification model, and in vivo after murine erythrocyte membrane injection into neointimal lesions of hypercholesterolemic apolipoprotein E-deficient mice. Vascular tissues (aortic valves, atherosclerotic carotid artery specimens, abdominal aortic aneurysms) were obtained from patients undergoing surgery. RESULTS The membrane fraction of lysed, but not intact human erythrocytes promoted mineralization of human arterial smooth muscle cells in culture, as shown by Alizarin red and van Kossa stain and increased alkaline phosphatase activity, and by increased expression of osteoblast-specific transcription factors (eg, runt-related transcription factor 2, osterix) and differentiation markers (eg, osteopontin, osteocalcin, and osterix). Erythrocyte membranes dose-dependently enhanced calcification in murine aortic rings, and extravasated CD235a-positive erythrocytes or Perl iron-positive signals colocalized with calcified areas or osteoblast-like cells in human vascular lesions. Mechanistically, the osteoinductive activity of lysed erythrocytes was localized to their membrane fraction, did not involve membrane lipids, heme, or iron, and was enhanced after removal of the nitric oxide (NO) scavenger hemoglobin. Lysed erythrocyte membranes enhanced calcification to a similar extent as the NO donor diethylenetriamine-NO, and their osteoinductive effects could be further augmented by arginase-1 inhibition (indirectly increasing NO bioavailability). However, the osteoinductive effects of erythrocyte membranes were reduced in human arterial smooth muscle cells treated with the NO scavenger 2-phenyl-4,4,5,5-tetramethylimidazoline-1-oxyl 3-oxide or following inhibition of NO synthase or the NO receptor soluble guanylate cyclase. Erythrocytes isolated from endothelial NO synthase-deficient mice exhibited a reduced potency to promote calcification in the aortic ring assay and after injection into murine vascular lesions. CONCLUSIONS Our findings in cells, genetically modified mice, and human vascular specimens suggest that intraplaque hemorrhage with erythrocyte extravasation and lysis promotes osteoblastic differentiation of smooth muscle cells and vascular lesion calcification, and also support a role for erythrocyte-derived NO.
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Affiliation(s)
- Dimitrios N Tziakas
- Department of Cardiology (D.N.T., G.C., M.P., D.K., P.S., I.D., P.K., S.V.K.), Democritus University of Thrace, Alexandroupolis, Greece
| | - Georgios Chalikias
- Department of Cardiology (D.N.T., G.C., M.P., D.K., P.S., I.D., P.K., S.V.K.), Democritus University of Thrace, Alexandroupolis, Greece
| | - Maria Pavlaki
- Department of Cardiology (D.N.T., G.C., M.P., D.K., P.S., I.D., P.K., S.V.K.), Democritus University of Thrace, Alexandroupolis, Greece
| | - Dimitra Kareli
- Department of Cardiology (D.N.T., G.C., M.P., D.K., P.S., I.D., P.K., S.V.K.), Democritus University of Thrace, Alexandroupolis, Greece
| | - Rajinikanth Gogiraju
- Center for Cardiology, Cardiology I (R.G., A.H., E.B., I.D., T.M., K.S.), University Medical Center of the Johannes Gutenberg University Mainz, Germany
| | - Astrid Hubert
- Center for Cardiology, Cardiology I (R.G., A.H., E.B., I.D., T.M., K.S.), University Medical Center of the Johannes Gutenberg University Mainz, Germany
| | - Elsa Böhm
- Center for Cardiology, Cardiology I (R.G., A.H., E.B., I.D., T.M., K.S.), University Medical Center of the Johannes Gutenberg University Mainz, Germany
| | - Petros Stamoulis
- Department of Cardiology (D.N.T., G.C., M.P., D.K., P.S., I.D., P.K., S.V.K.), Democritus University of Thrace, Alexandroupolis, Greece
| | - Ioannis Drosos
- Department of Cardiology (D.N.T., G.C., M.P., D.K., P.S., I.D., P.K., S.V.K.), Democritus University of Thrace, Alexandroupolis, Greece
- Center for Cardiology, Cardiology I (R.G., A.H., E.B., I.D., T.M., K.S.), University Medical Center of the Johannes Gutenberg University Mainz, Germany
| | - Petros Kikas
- Department of Cardiology (D.N.T., G.C., M.P., D.K., P.S., I.D., P.K., S.V.K.), Democritus University of Thrace, Alexandroupolis, Greece
| | - Dimitrios Mikroulis
- Cardiothoracic Surgery Department (D.M., F.K.), Democritus University of Thrace, Alexandroupolis, Greece
| | | | - George S Georgiadis
- Department of Vascular Surgery (G.S.G., C.A.), Democritus University of Thrace, Alexandroupolis, Greece
| | - Fotios Konstantinou
- Cardiothoracic Surgery Department (D.M., F.K.), Democritus University of Thrace, Alexandroupolis, Greece
| | - Christos Argyriou
- Department of Vascular Surgery (G.S.G., C.A.), Democritus University of Thrace, Alexandroupolis, Greece
| | - Thomas Münzel
- Center for Cardiology, Cardiology I (R.G., A.H., E.B., I.D., T.M., K.S.), University Medical Center of the Johannes Gutenberg University Mainz, Germany
| | - Stavros V Konstantinides
- Department of Cardiology (D.N.T., G.C., M.P., D.K., P.S., I.D., P.K., S.V.K.), Democritus University of Thrace, Alexandroupolis, Greece
- Center for Thrombosis and Hemostasis (S.V.K.), University Medical Center of the Johannes Gutenberg University Mainz, Germany
| | - Katrin Schäfer
- Center for Cardiology, Cardiology I (R.G., A.H., E.B., I.D., T.M., K.S.), University Medical Center of the Johannes Gutenberg University Mainz, Germany
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Chalikias G, Samaras A, Kikas P, Thomaidis A, Drosos I, Konstantinides S, Tziakas D. P6300Novel echocardiographic prognostic markers for cardiac tamponade in patients with large malignant pericardial effusions. A paradigm shift from flow to tissue imaging. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx493.p6300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Chalikias G, Samaras A, Ziakas A, Kikas P, Thomaidis A, Drosos I, Giannakoulas G, Karvounis H, Konstantinides S, Tziakas D. Novel echocardiographic prognostic markers for cardiac tamponade in patients with large malignant pericardial effusions: A paradigm shift from flow to tissue imaging. Echocardiography 2017; 34:1315-1323. [PMID: 28685870 DOI: 10.1111/echo.13620] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND With this study, we sought to investigate the prognostic value of echocardiographic tissue imaging markers in predicting tamponade among patients with large malignant pericardial effusion compared to routinely used echocardiographic signs. METHODS A total of 96 consecutive patients with large malignant pericardial effusion, not in clinical cardiac tamponade, underwent an echocardiographic examination and were prospectively assessed for 1 month. Clinically evident cardiac tamponade was considered as the study endpoint. The prognostic performance of tricuspid valve annular plane systolic excursion (TAPSE) and peak systolic annular velocity at the lateral margin of the tricuspid valve annulus (STV ) was assessed and compared to routinely used imaging signs. RESULTS During follow-up, 37 patients (39%) developed clinically evident cardiac tamponade. TAPSE (area under the curve [AUC] 0.958) and STV (AUC 0.948) had excellent predictive accuracy for tamponade. Multivariate analysis showed that TAPSE (Hazard ratio [HR] 3.03; 95% CI 1.60-5.73, P=.001) and STV (HR 1.17; 95% CI 1.05-1.29, P=.005) remained independent significant predictors of cardiac tamponade. Reclassification analysis and decision curve analysis showed additive prognostic value and adjunct clinical benefit of these markers when added to a recently published triage pericardiocentesis score. CONCLUSION Echocardiographic tissue imaging markers such as TAPSE and STV are characterized by an excellent prognostic ability for development of cardiac tamponade and better prognostic value compared to routine echocardiographic signs in patients with large malignant pericardial effusion. Incorporating these markers to a recent triage pericardiocentesis score resulted in additional prognostic value and increased clinical benefit.
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Affiliation(s)
- George Chalikias
- Cardiology Department, University Hospital of Alexandroupolis, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Antonios Samaras
- Cardiology Department, University Hospital of Alexandroupolis, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Antonios Ziakas
- First Cardiology Department, AHEPA University Hospital, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Petros Kikas
- Cardiology Department, University Hospital of Alexandroupolis, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Adina Thomaidis
- Cardiology Department, University Hospital of Alexandroupolis, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Ioannis Drosos
- Cardiology Department, University Hospital of Alexandroupolis, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - George Giannakoulas
- First Cardiology Department, AHEPA University Hospital, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Haralambos Karvounis
- First Cardiology Department, AHEPA University Hospital, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Stavros Konstantinides
- Cardiology Department, University Hospital of Alexandroupolis, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Dimitrios Tziakas
- Cardiology Department, University Hospital of Alexandroupolis, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
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Abstract
Contrast-induced acute kidney injury (CI-AKI) is defined as an abrupt deterioration in renal function associated with the administration of iodinated contrast media. This type of acute kidney injury is frequently encountered as a complication of percutaneous coronary intervention (PCI) and is associated with adverse short- and long-term outcomes including mainly mortality, cardiovascular morbidity and prolongation of hospitalization. The incidence of CI-AKI after PCI ranges from 2 to 20 % according to baseline kidney function. It may also range according to the clinical setting, being higher after emergency PCI. The primary manifestation is a small decline in kidney function, occurring 1 to 3 days after the procedure. Kidney function usually returns to preexisting levels within 7 days. Incidence of acute renal failure requiring dialysis following PCI is rare (<1 %). The present article aims to review up-to-date published data concerning diagnosis, definition, epidemiology and prognosis of this novel in-hospital epidemic.
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Affiliation(s)
- George Chalikias
- University Cardiology Department, Medical School, Democritus University of Thrace, Dragana, GR-68131, Alexandroupolis, Greece
| | - Ioannis Drosos
- University Cardiology Department, Medical School, Democritus University of Thrace, Dragana, GR-68131, Alexandroupolis, Greece
| | - Dimitrios N Tziakas
- University Cardiology Department, Medical School, Democritus University of Thrace, Dragana, GR-68131, Alexandroupolis, Greece.
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Drosos I, Tavridou A, Kolios G. New aspects on the metabolic role of intestinal microbiota in the development of atherosclerosis. Metabolism 2015; 64:476-81. [PMID: 25676802 DOI: 10.1016/j.metabol.2015.01.007] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [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: 09/08/2014] [Revised: 01/13/2015] [Accepted: 01/16/2015] [Indexed: 12/21/2022]
Abstract
Gut microbiota remains a very interesting, yet largely unexplored ecosystem inside the human organism. The importance of this ecosystem for the physiology and the pathophysiology of the organism is being slowly unraveled. Recent studies reveal a connection between intestinal microbiota and atherosclerosis development. It seems that alterations in the function and composition of this bacterial population lead through complex mechanisms to a high risk for atherosclerosis. Although these mechanisms remain largely unknown, published studies show that microbiota can lead to atherosclerosis either by augmenting known risk factors or via other, more "direct" mechanisms. This review article summarizes the available literature regarding this matter.
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Affiliation(s)
- Ioannis Drosos
- Laboratory of Pharmacology, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Anna Tavridou
- Laboratory of Pharmacology, Medical School, Democritus University of Thrace, Alexandroupolis, Greece.
| | - George Kolios
- Laboratory of Pharmacology, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
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