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Milaras N, Kordalis A, Tsiachris D, Sakalidis A, Ntalakouras I, Pamporis K, Dourvas P, Apostolos A, Sotiriou Z, Arsenos P, Archontakis S, Tsioufis K, Gatzoulis K, Sideris S. Ischemia testing and revascularization in patients with monomorphic ventricular tachycardia: A relic of the past? Curr Probl Cardiol 2024; 49:102358. [PMID: 38169203 DOI: 10.1016/j.cpcardiol.2023.102358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Accepted: 12/18/2023] [Indexed: 01/05/2024]
Abstract
Testing for myocardial ischemia in patients presenting with sustained monomorphic Ventricular Tachycardia(VT) even without evidence of acute myocardial infarction is a tempting strategy that is frequently utilized in clinical practice. Monomorphic VT is mainly caused by re-entry around chronic myocardial scar and active ischemia has no role in its pathogenesis, thus making testing for ischemia futile, at least in theory. This systematic literature review sought to address the usefulness of ischemia testing (mainly coronary angiography) in patients presenting with monomorphic VT through 8 selected studies after evaluating a total of 130 published manuscripts. Particularly, we sought to unveil whether coronary angiography and possibly concomitant revascularization leads to lesser tachycardia recurrence. Our conclusion can be summarized as follows: this approach whether combined with revascularization or not, does not seem to reduce VT recurrence nor does it affect mortality in such patients. Even though most of the published literature points at this direction, validation from randomized controlled trials is imperative.
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Affiliation(s)
- Nikias Milaras
- State Department of Cardiology, "Hippokration" General Hospital of Athens, Greece; School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, Vasilissis Sofias 114, Athens 11527, Greece.
| | - Athanasios Kordalis
- School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, Vasilissis Sofias 114, Athens 11527, Greece
| | - Dimitrios Tsiachris
- School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, Vasilissis Sofias 114, Athens 11527, Greece
| | - Athanasios Sakalidis
- School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, Vasilissis Sofias 114, Athens 11527, Greece
| | - Ioannis Ntalakouras
- State Department of Cardiology, "Hippokration" General Hospital of Athens, Greece
| | | | - Panagiotis Dourvas
- State Department of Cardiology, "Hippokration" General Hospital of Athens, Greece
| | - Anastasios Apostolos
- School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, Vasilissis Sofias 114, Athens 11527, Greece
| | - Zoi Sotiriou
- School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, Vasilissis Sofias 114, Athens 11527, Greece
| | - Petros Arsenos
- School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, Vasilissis Sofias 114, Athens 11527, Greece
| | - Stefanos Archontakis
- State Department of Cardiology, "Hippokration" General Hospital of Athens, Greece
| | - Konstantinos Tsioufis
- School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, Vasilissis Sofias 114, Athens 11527, Greece
| | - Konstantinos Gatzoulis
- School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, Vasilissis Sofias 114, Athens 11527, Greece
| | - Skevos Sideris
- State Department of Cardiology, "Hippokration" General Hospital of Athens, Greece
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Leontsinis I, Farmakis D, Avramidis D, Andrikou E, Valatsou A, Gartzonikas E, Doundoulakis I, Zarifis I, Karpouzis I, Kafkala K, Kouvelas N, Kourek C, Koufou E, Kochiadakis G, Kifnidis K, Liori S, Manolis G, Marketou M, Moschos N, Bampatsias D, Bibis G, Bonou M, Naka A, Davlouros P, Ntalakouras I, Papakonstantinou PΕ, Pappa E, Patsilinakos S, Plaitis A, Sideris A, Sideris S, Skoularigis J, Stamatelopoulos K, Stefanou G, Tziakas D, Chatzieleftheriou C, Chrysochoou C, Filippatos G, Tsioufis C. Cardiorenal multimorbidity in hospitalized cardiology patients: The Hellenic Cardiorenal Morbidity Snapshot (HECMOS) study. Hellenic J Cardiol 2023; 74:8-17. [PMID: 37146905 DOI: 10.1016/j.hjc.2023.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 03/21/2023] [Accepted: 03/23/2023] [Indexed: 05/07/2023] Open
Abstract
PURPOSE Cardiovascular disease is commonly accompanied by renal dysfunction. Multimorbidity in hospitalized patients impacts unfavorably on prognosis and hospital stay. We aimed to illustrate the contemporary burden of cardiorenal morbidity across inpatient cardiology care in Greece. METHODS The Hellenic Cardiorenal Morbidity Snapshot (HECMOS) used an electronic platform to collect demographic and clinically relevant information about all patients hospitalized on March 3, 2022, in Greece. The participating institutions covered all levels of inpatient cardiology care and most of the country's territories to collect a real-world, nation representative sample. RESULTS A total of 923 patients (men 68.4%, median age 73 ± 14.8 years) were admitted to 55 different cardiology departments. 57.7% of the participants were aged >70 years. Hypertension was highly prevalent and present in 66% of the cases. History of chronic HF, diabetes mellitus, atrial fibrillation, and chronic kidney disease was present in 38%, 31.8%, 30%, and 26%, respectively. Furthermore, 64.1% of the sample exhibited at least one of these 4 entities. Accordingly, a combination of ≥2 of these morbid conditions was recorded in 38.7%, of ≥3 in 18.2%, whereas 4.3% of the sample combined all 4 in their medical history. The most common combination was the coexistence of heart failure-atrial fibrillation accounting for 20.6% of the sample. Nine of 10 nonelectively admitted patients were hospitalized due to acute HF (39.9%), acute coronary syndrome (33.5%), or tachyarrhythmias (13.2%). CONCLUSION HECMOS participants carried a remarkable burden of cardio-reno-metabolic disease. HF in conjunction with atrial fibrillation was found to be the most prevalent combination among the studied cardiorenal nexus of morbidities in the whole study population.
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Affiliation(s)
- Ioannis Leontsinis
- First Cardiology Department, School of Medicine, Hippokration General Hospital, National and Kapodistrian University of Athens, Greece
| | | | | | - Eirini Andrikou
- Cardiology Department, Konstantopoulio General Hospital, Athens, Greece
| | - Angeliki Valatsou
- First Cardiology Department, School of Medicine, Hippokration General Hospital, National and Kapodistrian University of Athens, Greece
| | - Elias Gartzonikas
- University Cardiology Clinic, University of Ioannina, Ioannina, Greece
| | - Ioannis Doundoulakis
- First Cardiology Department, School of Medicine, Hippokration General Hospital, National and Kapodistrian University of Athens, Greece
| | - Ioannis Zarifis
- Cardiology Department, G. Papanicolaou Hospital, Thessaloniki, Greece
| | | | | | - Nikos Kouvelas
- Cardiology Dpt, 251 Hellenic Airforce General Hospital, Athens, Greece
| | - Christos Kourek
- Cardiology Dpt, 417 Veterans Army Hospital (NIMTS), Athens, Greece
| | - Eleni Koufou
- Cardiology Department, Patras University Hospital, Rio, Greece
| | - George Kochiadakis
- Department of Cardiology, Heraklion University Hospital, Iraklio, Crete, Greece
| | | | - Sotiria Liori
- Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - George Manolis
- Department of Cardiology, Hellenic Red Cross Hospital, Athens, Greece
| | - Maria Marketou
- Department of Cardiology, Heraklion University Hospital, Iraklio, Crete, Greece
| | | | - Dimitrios Bampatsias
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens School of Medicine, Athens, Greece
| | - George Bibis
- Cardiology Dpt, General Hospital of Argos, Greece
| | - Maria Bonou
- Cardiology Department, Laiko General Hospital, Athens, Greece
| | - Aikaterini Naka
- University Cardiology Clinic, University of Ioannina, Ioannina, Greece
| | | | - Ioannis Ntalakouras
- Department of Cardiology, Heraklion University Hospital, Iraklio, Crete, Greece
| | | | - Evgenia Pappa
- Department of Cardiology, General Hospital "G. Hatzikosta", Ioannina, Greece
| | | | | | - Antonios Sideris
- Second Cardiology Department, Evangelismos Hospital, Athens, Greece
| | - Skevos Sideris
- Department of Cardiology, Hippokration General Hospital, Athens, Greece
| | - John Skoularigis
- Department of Cardiology, University General Hospital of Larissa, Greece
| | - Kimon Stamatelopoulos
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens School of Medicine, Athens, Greece
| | | | - Dimitrios Tziakas
- Department of Cardiology, Democritus University of Thrace, Alexandroupolis, Greece
| | | | - Christina Chrysochoou
- First Cardiology Department, School of Medicine, Hippokration General Hospital, National and Kapodistrian University of Athens, Greece
| | - Gerasimos Filippatos
- Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - Costas Tsioufis
- First Cardiology Department, School of Medicine, Hippokration General Hospital, National and Kapodistrian University of Athens, Greece.
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Sakalidis A, Dimitriadis K, Dri E, Mantzouranis EK, Leontsinis I, Doundoulakis I, Ntalakouras I, Vlachakis PK, Bora M, Beneki E, Tsioufis P, Mavroudis A, Tsiamis E, Tsioufis K. CORONARY MICROVASCULAR DYNSFUNCTION IS ASSOCIATED WITH INCREASED ARTERIAL STIFNESS IN PATIENTS WITH ISCHEMIA AND NON OBSTRUCTIVE CORONARY ARTERY DISEASE. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)01705-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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Archontakis S, Oikonomou E, Sideris K, Laina A, Tirovola D, Paraskevopoulou D, Kostakis P, Doundoulakis I, Arsenos P, Ntalakouras I, Charitakis E, Gatzoulis K, Tsioufis K, Sideris S. Safety of same-day discharge versus overnight stay strategy following cardiac device implantations: a high-volume single-centre experience. J Interv Card Electrophysiol 2023; 66:471-481. [PMID: 36063282 PMCID: PMC9442569 DOI: 10.1007/s10840-022-01319-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 07/21/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND The strategy of cardiac implantable electronic device (CIED) implantations performed as day-case admissions has gained a wider acceptance overtime; however, data on safety are still limited. This study aims to investigate the safety of a same-day discharge protocol introduced in our hospital for the postprocedural management of patients undergoing CIED implantation. METHODS Α prospective, non-interventional, non-randomised study performed in a single high-volume implanting centre for a 16-month period (March 2020 to June 2021). At total of 821 of 965 (85.1%) patients scheduled for elective CIED implantation were considered to be eligible for inclusion in the Short-stay Device Management Protocol. These patients were compared with a historical group of 932 patients, meeting the same inclusion criteria. RESULTS Procedure was successful in 812 patients (98.9%), committed to same-day discharge versus 921 of 932 patients (98.8%) admitted for overnight stay (p = 0.87). Overall, 90-day complication rate was comparable in both groups (4.14% vs 4.07%, p = 0.95), as was major (1.46% vs. 1.82%, p = 0.55) and minor (2.67% vs. 2.25%, p = 0.64) complication rates. The composite early post-procedural complication rates and late post-procedural complication rates were comparable among groups (0.97 vs 1.18%, p = 0.70 and 0.73% vs 0.64%, p = 0.83, respectively). Six hundred sixty-seven patients (84%) preferred the same-day discharge strategy. Finally, a reduction of 792 bed-days was recorded, resulting in possible financial Health System benefits. CONCLUSIONS Same-day discharge is feasible and safe in the majority of patients referred for CIED implantation. Additionally, same-day discharge is preferred by patients and may reduce procedure-related costs due to significant bed-day reductions.
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Affiliation(s)
- Stefanos Archontakis
- Department of Cardiology, Hippokration General Hospital, 114 VasilisisSofias str, Athens, Greece
| | - Evangelos Oikonomou
- First Cardiology Division, Medical School, Hippokration General Hospital, University of Athens, 114 VasilisisSofias str, Athens, Greece
| | - Konstantinos Sideris
- Department of Cardiology, Hippokration General Hospital, 114 VasilisisSofias str, Athens, Greece
| | - Ageliki Laina
- First Cardiology Division, Medical School, Hippokration General Hospital, University of Athens, 114 VasilisisSofias str, Athens, Greece
| | - Dimitra Tirovola
- Department of Cardiology, Hippokration General Hospital, 114 VasilisisSofias str, Athens, Greece
| | - Dimitra Paraskevopoulou
- Department of Cardiology, Hippokration General Hospital, 114 VasilisisSofias str, Athens, Greece
| | - Panagiotis Kostakis
- Department of Cardiology, Hippokration General Hospital, 114 VasilisisSofias str, Athens, Greece
| | - Ioannis Doundoulakis
- First Cardiology Division, Medical School, Hippokration General Hospital, University of Athens, 114 VasilisisSofias str, Athens, Greece
| | - Petros Arsenos
- First Cardiology Division, Medical School, Hippokration General Hospital, University of Athens, 114 VasilisisSofias str, Athens, Greece
| | - Ioannis Ntalakouras
- First Cardiology Division, Medical School, Hippokration General Hospital, University of Athens, 114 VasilisisSofias str, Athens, Greece
| | - Emmanouil Charitakis
- Department of Cardiology, Hippokration General Hospital, 114 VasilisisSofias str, Athens, Greece
| | - Konstantinos Gatzoulis
- First Cardiology Division, Medical School, Hippokration General Hospital, University of Athens, 114 VasilisisSofias str, Athens, Greece
| | - Konstantinos Tsioufis
- First Cardiology Division, Medical School, Hippokration General Hospital, University of Athens, 114 VasilisisSofias str, Athens, Greece
| | - Skevos Sideris
- Department of Cardiology, Hippokration General Hospital, 114 VasilisisSofias str, Athens, Greece.
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Sakalidis A, Dimitriadis K, Dri E, Leontsinis I, Mantzouranis EK, Ntalakouras I, Doundoulakis I, Iliakis P, Siafi E, Beneki E, Tsioufis P, Manta E, Tsiamis E, Tsioufis K. CORONARY MICROVASCULAR DYSFUNCTION IS RELATED TO REDUCED SKIN CAPILLARY DENSITY IN PATIENTS WITH ISCHEMIA AND NON OBSTRUCTIVE CORONARY ARTERY DISEASE. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)01672-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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6
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Archontakis S, Oikonomou E, Sideris K, Laina A, Tirovola D, Paraskevopoulou D, Kostakis P, Doundoulakis I, Arsenos P, Ntalakouras I, Charitakis E, Gatzoulis K, Tsioufis K, Sideris S. Correction to: Safety of same-day discharge versus overnight stay strategy following cardiac device implantations: a high-volume single-centre experience. J Interv Card Electrophysiol 2023; 66:483. [PMID: 36542314 PMCID: PMC10074511 DOI: 10.1007/s10840-022-01458-9] [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: 12/24/2022]
Affiliation(s)
- Stefanos Archontakis
- Department of Cardiology, Hippokration General Hospital, 114 VasilisisSofias str, Athens, Greece
| | - Evangelos Oikonomou
- First Cardiology Division, Medical School, Hippokration General Hospital, University of Athens, 114 VasilisisSofias str, Athens, Greece
| | - Konstantinos Sideris
- Department of Cardiology, Hippokration General Hospital, 114 VasilisisSofias str, Athens, Greece
| | - Ageliki Laina
- First Cardiology Division, Medical School, Hippokration General Hospital, University of Athens, 114 VasilisisSofias str, Athens, Greece
| | - Dimitra Tirovola
- Department of Cardiology, Hippokration General Hospital, 114 VasilisisSofias str, Athens, Greece
| | - Dimitra Paraskevopoulou
- Department of Cardiology, Hippokration General Hospital, 114 VasilisisSofias str, Athens, Greece
| | - Panagiotis Kostakis
- Department of Cardiology, Hippokration General Hospital, 114 VasilisisSofias str, Athens, Greece
| | - Ioannis Doundoulakis
- First Cardiology Division, Medical School, Hippokration General Hospital, University of Athens, 114 VasilisisSofias str, Athens, Greece
| | - Petros Arsenos
- First Cardiology Division, Medical School, Hippokration General Hospital, University of Athens, 114 VasilisisSofias str, Athens, Greece
| | - Ioannis Ntalakouras
- First Cardiology Division, Medical School, Hippokration General Hospital, University of Athens, 114 VasilisisSofias str, Athens, Greece
| | - Emmanouil Charitakis
- Department of Cardiology, Hippokration General Hospital, 114 VasilisisSofias str, Athens, Greece
| | - Konstantinos Gatzoulis
- First Cardiology Division, Medical School, Hippokration General Hospital, University of Athens, 114 VasilisisSofias str, Athens, Greece
| | - Konstantinos Tsioufis
- First Cardiology Division, Medical School, Hippokration General Hospital, University of Athens, 114 VasilisisSofias str, Athens, Greece
| | - Skevos Sideris
- Department of Cardiology, Hippokration General Hospital, 114 VasilisisSofias str, Athens, Greece.
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7
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Mantzouranis E, Leontsinis I, Sakalidis A, Ntalakouras I, Kordalis A, Antonopoulos A, Dagre A, Poulimenos L, Mamarelis I, Tsioufis K. Distinctive characteristics among MINOCA and Takotsubo patients and their prognostic value in a multicenter prospective cohort. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background/Introduction
In the acute care setting, the working diagnosis of MINOCA exhibits increasing recognition and includes a broad spectrum of conditions, most of them yet not adequately understood. TakoTsubo syndrome (TTS) represents a significant proportion of such cases and despite its predominance on female gender as well as its imaging characteristics on the typical apical form it is not easily distinguishable from other MINOCA causes without the contribution of cardiac magnetic resonance (CMR).
Purpose
The aim of our study is to investigate for distinctive characteristics related to the index event among MINOCA cases from a multi-center prospective cohort with a mean follow up period of 18 months.
Methods
We divided our study population (n=74) into TTS (n=30) and non-TTS (n=44) according to multimodality imaging results. Information regarding the index event (Sep 2019-Feb 2021) were retracted from the medical notes.
Results
CMR results led to a post-discharge diagnosis reconsideration in 12 cases (16.2%). Female gender (n=29; 96.7% vs n=22; 50%, P<0.001), older age (mean age 66±11 vs 59±11, P=0.04) and history of hypertension (n=21; 70% vs n=19; 44.3%, p=0.035) were more frequent in TTS group. There was no statistically significant difference in body mass index, baseline renal function, history of dyslipidemia, diabetes and smoking between the two groups. During the index event, peak troponin levels 576 pg/ml (IQR: 184–9915) vs 767 pg/ml (IQR: 47–47000), P=0.005], were lower in the TTS group, whereas NSTEMI presentation was the commonest among all patients. Angina was the dominant symptom for both groups. However, severe angina expressed as more than 2 episodes within 24 hours was more frequent among the TTS population (n=19; 65.5% vs n=10; 22.7%, P=0.001). TTS probability assessed with the INTERTAK score was higher among the TTS group (68±10 vs 38±21, P<0.001). In hospital major cardiovascular events incidence was higher in the non-TTS group (n=2 vs n=11, P=0.06). Multivariate analysis revealed that the presence of severe angina (OR, 8.118, 95% CI: 1.173–56.157, P=0.038) is highly predictive of TTS in the acute care setting even independently of INTERTAK probability.
Conclusions
These preliminary results indicate that the presence of several anginal attacks may strengthen the predictive value of the INTERTAK score during MINOCA evaluation in the acute setting. Confirmation in a larger population is warranted.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- E Mantzouranis
- Hippokration Hospital, First Department of Cardiology, University of Athens , Athens , Greece
| | - I Leontsinis
- Hippokration Hospital, First Department of Cardiology, University of Athens , Athens , Greece
| | - A Sakalidis
- Hippokration Hospital, First Department of Cardiology, University of Athens , Athens , Greece
| | - I Ntalakouras
- Hippokration Hospital, First Department of Cardiology, University of Athens , Athens , Greece
| | - A Kordalis
- Hippokration Hospital, First Department of Cardiology, University of Athens , Athens , Greece
| | - A Antonopoulos
- Hippokration Hospital, First Department of Cardiology, University of Athens , Athens , Greece
| | - A Dagre
- Hippokration Hospital, First Department of Cardiology, University of Athens , Athens , Greece
| | - L Poulimenos
- Hippokration Hospital, First Department of Cardiology, University of Athens , Athens , Greece
| | - I Mamarelis
- Hippokration Hospital, First Department of Cardiology, University of Athens , Athens , Greece
| | - K Tsioufis
- Hippokration Hospital, First Department of Cardiology, University of Athens , Athens , Greece
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Manta E, Konstantinidis D, Dimitriadis K, Tatakis F, Drogkaris S, Polyzos D, Ntalakouras I, Leontsinis I, Thomopoulos C, Tsioufis K. Correlations between sympathetic nervous system activity and smoking, as well as unattended blood pressure in essential hypertension. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2599] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background/Introduction
It is a well-known fact that the sympathetic nervous system is involved with the pathophysiology of hypertension. Smoking, which is one of the most significant risk factors for cardiovascular morbidity and mortality, also contributes to the development of hypertension mainly through the stimulation of the sympathetic nervous system. Moreover, measurement of unattended blood pressure (BP) may provide additional information compared to conventionally attended BP.
Purpose
The aim of this study was to demonstrate the impact of smoking on sympathetic nervous system stimulation, and on BP measurement variations with and without medical supervision.
Methods
We studied patients with essential hypertension, who were separated into two groups, depending on their smoking habits (Group I: non-smokers, Group II: smokers). In all participants, sympathetic drive was assessed by MSNA estimations based on established methodology (microneurography). Both unattended (patient alone in the room, an oscillometric device programmed to perform 3 BP measurements, at 1-minute intervals, after 5 minutes of rest) and attended BP measurements were conducted with the same device, on the same day of MSNA recording, in random order. Then, we compared the two BP measurement values of each patient to assess which of the two was higher.
Results
Ninety-two consecutive patients (58±11 years, 50 males) were evaluated. Smokers (n=19) did not differ as regards 24-h ambulatory BP levels, glucose levels, renal function and left ventricular mass index when compared to non-smokers (n=73). However, higher levels of MSNA were recorded to smokers (73.16±13.42 vs. 61.04±18.10 bursts per 100 heartbeats, p<0.01). Furthermore, higher percentage of smokers recorded to have unattended BP values higher than attended (73.7% vs. 47.9% of them respectively, p=0.045). In particular, in smokers unattended BP was higher than attended by 10.07±6.7 mmHg, while in non-smokers unattended BP was lower than attended by 6.6±7.14 mmHg. No correlation was found between the MSNA and the differences observed in the two values resulting from the two different measurements of BP, maybe due to the small size of the sample.
Conclusions
Cigarette smoking is accompanied with higher sympathetic nervous system activation. Moreover, smokers exhibit higher unattended blood pressure values than normal measurements. The emerging hypothesis is that the stimulation of the sympathetic system causes this difference in measurements. A larger sample of patients is needed to fully determine the clinical significance of the above observation.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- E Manta
- First Cardiology Clinic, University of Athens,Hippokration Hospital, Athens, Greece
| | - D Konstantinidis
- First Cardiology Clinic, University of Athens,Hippokration Hospital, Athens, Greece
| | - K Dimitriadis
- First Cardiology Clinic, University of Athens,Hippokration Hospital, Athens, Greece
| | - F Tatakis
- First Cardiology Clinic, University of Athens,Hippokration Hospital, Athens, Greece
| | - S Drogkaris
- First Cardiology Clinic, University of Athens,Hippokration Hospital, Athens, Greece
| | - D Polyzos
- First Cardiology Clinic, University of Athens,Hippokration Hospital, Athens, Greece
| | - I Ntalakouras
- First Cardiology Clinic, University of Athens,Hippokration Hospital, Athens, Greece
| | - I Leontsinis
- First Cardiology Clinic, University of Athens,Hippokration Hospital, Athens, Greece
| | - C Thomopoulos
- First Cardiology Clinic, University of Athens,Hippokration Hospital, Athens, Greece
| | - K Tsioufis
- First Cardiology Clinic, University of Athens,Hippokration Hospital, Athens, Greece
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9
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Koumelli A, Konstantinou K, Kasiakogias A, Dimitriadis K, Leontsinis I, Mantzouranis E, Tolis E, Fragkoulis C, Ntalakouras I, Thomopoulos C, Tousoulis D, Tsioufis C. Rationale and Design of the ACS-BP Study: Prognostic Value of In-Hospital Blood Pressure and Indices of Atherosclerosis in Acute Coronary Syndromes. Curr Vasc Pharmacol 2021; 19:438-443. [PMID: 32819248 DOI: 10.2174/1570161118666200820134959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 07/16/2020] [Accepted: 07/24/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND High blood pressure (BP) is a leading risk factor for coronary artery disease and other major cardiovascular events. OBJECTIVE Blood pressure variability (BPV), ambulatory arterial stiffness index (AASI) and ankle- brachial index (ABI) have been proposed as indices that can improve risk stratification for an adverse cardiac outcome. However, their utility in the setting of acute coronary syndromes (ACS) is unclear. METHODS The ACS-BP study is a single-centre observational cohort study designed to investigate the prognostic role of haemodynamic load and arterial stiffness indices for cardio-renal outcomes in patients with acute myocardial infarction (AMI). All consecutive patients admitted with a diagnosis of acute AMI with or without ST segment elevation were screened for inclusion in the study. The management of AMI will follow current guidelines. RESULTS AND DISCUSSION Data from baseline clinical and laboratory parameters during their hospitalization were collected. The haemodynamic load of each patient was determined by clinical BP values as well as 24-h ambulatory BP monitoring. The AASI was calculated from the raw 24-h BP data and ABI was measured after the third day of hospitalization using a certified device. Patients were followed-up for 12 months in order to collect data for hard cardiovascular and renal endpoints. CONCLUSION The study results should clarify the role of these non-invasive tools in secondary risk stratification of such patients.
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Affiliation(s)
- Areti Koumelli
- First Cardiology Clinic, Medical School University of Athens, Hippokration Hospital, Athens, Greece
| | | | - Alexandros Kasiakogias
- First Cardiology Clinic, Medical School University of Athens, Hippokration Hospital, Athens, Greece
| | - Kyriakos Dimitriadis
- First Cardiology Clinic, Medical School University of Athens, Hippokration Hospital, Athens, Greece
| | - Ioannis Leontsinis
- First Cardiology Clinic, Medical School University of Athens, Hippokration Hospital, Athens, Greece
| | - Emmanouil Mantzouranis
- First Cardiology Clinic, Medical School University of Athens, Hippokration Hospital, Athens, Greece
| | - Elias Tolis
- First Cardiology Clinic, Medical School University of Athens, Hippokration Hospital, Athens, Greece
| | - Christos Fragkoulis
- First Cardiology Clinic, Medical School University of Athens, Hippokration Hospital, Athens, Greece
| | - Ioannis Ntalakouras
- First Cardiology Clinic, Medical School University of Athens, Hippokration Hospital, Athens, Greece
| | - Costas Thomopoulos
- First Cardiology Clinic, Medical School University of Athens, Hippokration Hospital, Athens, Greece
| | - Dimitrios Tousoulis
- First Cardiology Clinic, Medical School University of Athens, Hippokration Hospital, Athens, Greece
| | - Costas Tsioufis
- First Cardiology Clinic, Medical School University of Athens, Hippokration Hospital, Athens, Greece
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