1
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Gnudi L, Fountoulakis N, Panagiotou A, Corcillo A, Maltese G, Rife MF, Ntalas I, Franks R, Chiribiri A, Ayis S, Karalliedde J. Effect of active vitamin-D on left ventricular mass index: Results of a randomized controlled trial in type 2 diabetes and chronic kidney disease. Am Heart J 2023; 261:1-9. [PMID: 36934979 DOI: 10.1016/j.ahj.2023.03.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Revised: 03/03/2023] [Accepted: 03/12/2023] [Indexed: 05/26/2023]
Abstract
BACKGROUND Active vitamin-D deficiency is a potential modifiable risk factor for increased ventricular mass. We explored the effects of active vitamin-D (calcitriol) treatment on left ventricular mass in patients with type-2 diabetes (T2D) and chronic kidney disease (CKD). METHODS We performed a 48-week duration single center randomized double-blind parallel group trial examining the impact of calcitriol, 0.5 mcg once daily, as compared to placebo on a primary endpoint of change from baseline in left ventricular mass index (LVMI) measured by magnetic resonance imaging . Patients with T2D, CKD stage-3 and raised left ventricular mass on stable renin angiotensin aldosterone system blockade, who all had elevated intact parathyroid hormone were eligible. Secondary endpoints included interstitial myocardial fibrosis, assessed with cardiac magnetic resonance imaging. In total, 45 (male 73%) patients with T2D and stage-3 CKD were studied (calcitriol n = 19, placebo n = 26). RESULTS Following 48-weeks calcitriol treatment, the median difference and the (95% CI) of LVMI between the 2 treatment arms was 1.84 (-1.28, 4.96), similar between the 2 groups studied. Intact parathyroid hormone fell only in the calcitriol group from 142 pg/mL (80-293) to 76 pg/mL (41-204)(median, interquartile range, P= .04). No significant differences were observed in interstitial myocardial fibrosis or other secondary endpoints. CONCLUSIONS The study did not provide evidence that treatment with calcitriol as compared to placebo might improve LVMI in patients with T2D, mild left ventricular hypertrophy and stable CKD. Our data does not support the routine use of active vitamin-D for LVMI regression and cardiovascular protection in patients with T2D and stage-3 CKD.
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Affiliation(s)
- Luigi Gnudi
- School of Cardiovascular and Metabolic Medicine & Sciences, Faculty of Life Sciences & Medicine, King's College London, London, United Kingdom.
| | - Nikolaos Fountoulakis
- School of Cardiovascular and Metabolic Medicine & Sciences, Faculty of Life Sciences & Medicine, King's College London, London, United Kingdom
| | - Angeliki Panagiotou
- School of Cardiovascular and Metabolic Medicine & Sciences, Faculty of Life Sciences & Medicine, King's College London, London, United Kingdom
| | - Antonella Corcillo
- School of Cardiovascular and Metabolic Medicine & Sciences, Faculty of Life Sciences & Medicine, King's College London, London, United Kingdom
| | - Giuseppe Maltese
- School of Cardiovascular and Metabolic Medicine & Sciences, Faculty of Life Sciences & Medicine, King's College London, London, United Kingdom
| | - Maria Flaquer Rife
- School of Cardiovascular and Metabolic Medicine & Sciences, Faculty of Life Sciences & Medicine, King's College London, London, United Kingdom
| | - Ioannis Ntalas
- School of Biomedical Engineering & Imaging Sciences, Faculty of Life Sciences & Medicine, King's College London, London, United Kingdom
| | - Russell Franks
- School of Biomedical Engineering & Imaging Sciences, Faculty of Life Sciences & Medicine, King's College London, London, United Kingdom
| | - Amedeo Chiribiri
- School of Biomedical Engineering & Imaging Sciences, Faculty of Life Sciences & Medicine, King's College London, London, United Kingdom
| | - Salma Ayis
- School of Population Health & Environmental Sciences, Faculty of Life Sciences & Medicine, King's College London, London, United Kingdom
| | - Janaka Karalliedde
- School of Cardiovascular and Metabolic Medicine & Sciences, Faculty of Life Sciences & Medicine, King's College London, London, United Kingdom
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2
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Makrydakis G, Markaki L, Manikas ED, Ntalas I, Spernovasilis N. Handling Post-COVID-19 Sequelae: A Need for Multispecialty Approach. Front Public Health 2022; 10:843329. [PMID: 35223749 PMCID: PMC8863660 DOI: 10.3389/fpubh.2022.843329] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2021] [Accepted: 01/17/2022] [Indexed: 12/30/2022] Open
Affiliation(s)
| | - Lamprini Markaki
- First Department of Pediatrics, "Agia Sophia" Children's Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | | | | | - Nikolaos Spernovasilis
- School of Medicine, University of Crete, Heraklion, Greece.,German Oncology Center, Limassol, Cyprus
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3
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Kadoglou NPE, Papadopoulos CH, Papadopoulos KG, Karagiannis S, Karabinos I, Loizos S, Theodosis-Georgilas A, Aggeli K, Keramida K, Klettas D, Kounas S, Makavos G, Ninios I, Ntalas I, Ikonomidis I, Sahpekidis V, Stefanidis A, Zaglavara T, Athanasopoulos G, Karatasakis G, Kyrzopoulos S, Kouris N, Patrianakos A, Paraskevaidis I, Rallidis L, Savvatis K, Tsiapras D, Nihoyannopoulos P. Updated knowledge and practical implementations of stress echocardiography in ischemic and non-ischemic cardiac diseases: an expert consensus of the Working Group of Echocardiography of the Hellenic Society of Cardiology. Hellenic J Cardiol 2021; 64:30-57. [PMID: 34329766 DOI: 10.1016/j.hjc.2021.07.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 05/24/2021] [Accepted: 07/15/2021] [Indexed: 12/15/2022] Open
Abstract
Stress echocardiography (SE) is a well-established and valid technique, widely-used for the diagnostic evaluation of patients with ischemic and non-ischemic cardiac diseases. This statement of the Echocardiography Working Group of the Hellenic Society of Cardiology summarizes the consensus of the writing group regarding the applications of SE, based on the expertise of their members and on a critical review of current medical literature. The main objectives of the consensus document include a comprehensive review of SE methodology and training, focusing on the preparation, the protocols used and the analysis of the SE images and an updated, evidence-based knowledge about SE applications on ischemic and non-ischemic heart diseases, such as in cardiomyopathies, heart failure and valvular heart disease.
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Affiliation(s)
- Nikolaos P E Kadoglou
- Medical School, University of Cyprus, Nicosia, Cyprus; Second Cardiology Department, "Hippokration" Hospital, Aristotle University ofThessaloniki, Greece.
| | | | | | | | | | | | | | - Konstantina Aggeli
- 1st Cardiology Department, Hippokration University Hospital, Athens, Greece
| | - Kalliopi Keramida
- 2nd Cardiology Department, Attikon University Hospital, Athens, Greece
| | | | | | - George Makavos
- 3rd Cardiology Department, Sotiria University Hospital, Athens, Greece
| | - Ilias Ninios
- 2nd Cardiology Department, Interbalkan Center, Thessaloniki, Greece
| | | | | | | | | | | | | | - George Karatasakis
- 1st Cardiology Department, Onassis Cardiosurgical Center, Piraeus, Greece
| | | | - Nikos Kouris
- Cardiology Department, Thriasio Hospital, Elefsina, Greece
| | | | | | | | | | - Dimitrios Tsiapras
- 2nd Cardiology Department, Onassis Cardiosurgical Center, Piraeus, Greece
| | - Petros Nihoyannopoulos
- Metropolitan Hospital Center, Piraeus, Greece; Imperial College London, Hammersmith Hospital, London, UK
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4
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Aziz W, Claridge S, Ntalas I, Gould J, de Vecchi A, Razeghi O, Toth D, Mountney P, Preston R, Rinaldi CA, Razavi R, Niederer S, Rajani R. Emerging role of cardiac computed tomography in heart failure. ESC Heart Fail 2019; 6:909-920. [PMID: 31400060 PMCID: PMC6816076 DOI: 10.1002/ehf2.12479] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [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: 01/01/2019] [Revised: 05/20/2019] [Accepted: 05/30/2019] [Indexed: 11/27/2022] Open
Abstract
Despite medical advancements, the prognosis of patients with heart failure remains poor. While echocardiography and cardiac magnetic resonance imaging remain at the forefront of diagnosing and monitoring patients with heart failure, cardiac computed tomography (CT) has largely been considered to have a limited role. With the advancements in scanner design, technology, and computer processing power, cardiac CT is now emerging as a valuable adjunct to clinicians managing patients with heart failure. In the current manuscript, we review the current applications of cardiac CT to patients with heart failure and also the emerging areas of research where its clinical utility is likely to extend into the realm of treatment, procedural planning, and advanced heart failure therapy implementation.
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Affiliation(s)
- Waqar Aziz
- Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust, London, UK.,School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Simon Claridge
- Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Ioannis Ntalas
- Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Justin Gould
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Adelaide de Vecchi
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Orod Razeghi
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Daniel Toth
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Peter Mountney
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Rebecca Preston
- Department of Radiology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Christopher A Rinaldi
- Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust, London, UK.,School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Reza Razavi
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Steven Niederer
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Ronak Rajani
- Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust, London, UK.,School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
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Holtackers RJ, Van De Heyning CM, Nazir MS, Rashid I, Ntalas I, Rahman H, Botnar RM, Chiribiri A. Clinical value of dark-blood late gadolinium enhancement cardiovascular magnetic resonance without additional magnetization preparation. J Cardiovasc Magn Reson 2019; 21:44. [PMID: 31352900 PMCID: PMC6661833 DOI: 10.1186/s12968-019-0556-1] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 06/14/2019] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND For two decades, bright-blood late gadolinium enhancement (LGE) cardiovascular magnetic resonance (CMR) has been considered the reference standard for the non-invasive assessment of myocardial viability. While bright-blood LGE can clearly distinguish areas of myocardial infarction from viable myocardium, it often suffers from poor scar-to-blood contrast, making subendocardial scar difficult to detect. Recently, we proposed a novel dark-blood LGE approach that increases scar-to-blood contrast and thereby improves subendocardial scar conspicuity. In the present study we sought to assess the clinical value of this novel approach in a large patient cohort with various non-congenital ischemic and non-ischemic cardiomyopathies on both 1.5 T and 3 T CMR scanners of different vendors. METHODS Three hundred consecutive patients referred for clinical CMR were randomly assigned to a 1.5 T or 3 T scanner. An entire short-axis stack and multiple long-axis views were acquired using conventional phase sensitive inversion recovery (PSIR) LGE with TI set to null myocardium (bright-blood) and proposed PSIR LGE with TI set to null blood (dark-blood), in a randomized order. The bright-blood LGE and dark-blood LGE images were separated, anonymized, and interpreted in a random order at different time points by one of five independent observers. Each case was analyzed for the type of scar, per-segment transmurality, papillary muscle enhancement, overall image quality, observer confidence, and presence of right ventricular scar and intraventricular thrombus. RESULTS Dark-blood LGE detected significantly more cases with ischemic scar compared to conventional bright-blood LGE (97 vs 89, p = 0.008), on both 1.5 T and 3 T, and led to a significantly increased total scar burden (3.3 ± 2.4 vs 3.0 ± 2.3 standard AHA segments, p = 0.015). Overall image quality significantly improved using dark-blood LGE compared to bright-blood LGE (81.3% vs 74.0% of all segments were of highest diagnostic quality, p = 0.006). Furthermore, dark-blood LGE led to significantly higher observer confidence (confident in 84.2% vs 78.4%, p = 0.033). CONCLUSIONS The improved detection of ischemic scar makes the proposed dark-blood LGE method a valuable diagnostic tool in the non-invasive assessment of myocardial scar. The applicability in routine clinical practice is further strengthened, as the present approach, in contrast to other recently proposed dark- and black-blood LGE techniques, is readily available without the need for scanner adjustments, extensive optimizations, or additional training.
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Affiliation(s)
- Robert J. Holtackers
- Department of Radiology, Maastricht University Medical Centre, Maastricht, the Netherlands
- Department of Cardiovascular Imaging, School of Biomedical Engineering and Imaging Sciences, King’s College London, 4th Floor, Lambeth Wing, St Thomas’ Hospital, London, SE1 7EH UK
- CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, the Netherlands
| | - Caroline M. Van De Heyning
- Department of Cardiovascular Imaging, School of Biomedical Engineering and Imaging Sciences, King’s College London, 4th Floor, Lambeth Wing, St Thomas’ Hospital, London, SE1 7EH UK
- Department of Cardiology, St Thomas’ Hospital, London, UK
- Department of Cardiology, Antwerp University Hospital, Edegem, Belgium
- Cardiovascular Diseases, University of Antwerp, Antwerp, Belgium
| | - Muhummad Sohaib Nazir
- Department of Cardiovascular Imaging, School of Biomedical Engineering and Imaging Sciences, King’s College London, 4th Floor, Lambeth Wing, St Thomas’ Hospital, London, SE1 7EH UK
- Department of Cardiology, St Thomas’ Hospital, London, UK
| | - Imran Rashid
- Department of Cardiovascular Imaging, School of Biomedical Engineering and Imaging Sciences, King’s College London, 4th Floor, Lambeth Wing, St Thomas’ Hospital, London, SE1 7EH UK
- Department of Cardiology, St Thomas’ Hospital, London, UK
| | - Ioannis Ntalas
- Department of Cardiovascular Imaging, School of Biomedical Engineering and Imaging Sciences, King’s College London, 4th Floor, Lambeth Wing, St Thomas’ Hospital, London, SE1 7EH UK
- Department of Cardiology, St Thomas’ Hospital, London, UK
| | - Haseeb Rahman
- Department of Cardiovascular Imaging, School of Biomedical Engineering and Imaging Sciences, King’s College London, 4th Floor, Lambeth Wing, St Thomas’ Hospital, London, SE1 7EH UK
- Department of Cardiology, St Thomas’ Hospital, London, UK
| | - René M. Botnar
- Department of Cardiovascular Imaging, School of Biomedical Engineering and Imaging Sciences, King’s College London, 4th Floor, Lambeth Wing, St Thomas’ Hospital, London, SE1 7EH UK
- Escuela de Ingeniería, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Amedeo Chiribiri
- Department of Cardiovascular Imaging, School of Biomedical Engineering and Imaging Sciences, King’s College London, 4th Floor, Lambeth Wing, St Thomas’ Hospital, London, SE1 7EH UK
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6
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Ntalas I, Freitas D, Gowland A, Rajani R. A Kaleidoscope heart. Echocardiography 2019; 36:1017-1018. [DOI: 10.1111/echo.14345] [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: 12/29/2018] [Accepted: 04/02/2019] [Indexed: 11/30/2022] Open
Affiliation(s)
- Ioannis Ntalas
- Department of Echocardiography Guy's and St Thomas’ NHS Foundation Trust London UK
- School of Biomedical Engineering and Imaging Sciences King's College London London UK
| | - Dario Freitas
- Department of Echocardiography Guy's and St Thomas’ NHS Foundation Trust London UK
| | - Abigail Gowland
- Department of Echocardiography Guy's and St Thomas’ NHS Foundation Trust London UK
| | - Ronak Rajani
- Department of Echocardiography Guy's and St Thomas’ NHS Foundation Trust London UK
- School of Biomedical Engineering and Imaging Sciences King's College London London UK
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7
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Villa ADM, Corsinovi L, Ntalas I, Milidonis X, Scannell C, Di Giovine G, Child N, Ferreira C, Nazir MS, Karady J, Eshja E, De Francesco V, Bettencourt N, Schuster A, Ismail TF, Razavi R, Chiribiri A. Importance of operator training and rest perfusion on the diagnostic accuracy of stress perfusion cardiovascular magnetic resonance. J Cardiovasc Magn Reson 2018; 20:74. [PMID: 30454074 PMCID: PMC6245890 DOI: 10.1186/s12968-018-0493-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 10/09/2018] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Clinical evaluation of stress perfusion cardiovascular magnetic resonance (CMR) is currently based on visual assessment and has shown high diagnostic accuracy in previous clinical trials, when performed by expert readers or core laboratories. However, these results may not be generalizable to clinical practice, particularly when less experienced readers are concerned. Other factors, such as the level of training, the extent of ischemia, and image quality could affect the diagnostic accuracy. Moreover, the role of rest images has not been clarified. The aim of this study was to assess the diagnostic accuracy of visual assessment for operators with different levels of training and the additional value of rest perfusion imaging, and to compare visual assessment and automated quantitative analysis in the assessment of coronary artery disease (CAD). METHODS We evaluated 53 patients with known or suspected CAD referred for stress-perfusion CMR. Nine operators (equally divided in 3 levels of competency) blindly reviewed each case twice with a 2-week interval, in a randomised order, with and without rest images. Semi-automated Fermi deconvolution was used for quantitative analysis and estimation of myocardial perfusion reserve as the ratio of stress to rest perfusion estimates. RESULTS Level-3 operators correctly identified significant CAD in 83.6% of the cases. This percentage dropped to 65.7% for Level-2 operators and to 55.7% for Level-1 operators (p < 0.001). Quantitative analysis correctly identified CAD in 86.3% of the cases and was non-inferior to expert readers (p = 0.56). When rest images were available, a significantly higher level of confidence was reported (p = 0.022), but no significant differences in diagnostic accuracy were measured (p = 0.34). CONCLUSIONS Our study demonstrates that the level of training is the main determinant of the diagnostic accuracy in the identification of CAD. Level-3 operators performed at levels comparable with the results from clinical trials. Rest images did not significantly improve diagnostic accuracy, but contributed to higher confidence in the results. Automated quantitative analysis performed similarly to level-3 operators. This is of increasing relevance as recent technical advances in image reconstruction and analysis techniques are likely to permit the clinical translation of robust and fully automated quantitative analysis into routine clinical practice.
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Affiliation(s)
- Adriana D. M. Villa
- School of Biomedical Engineering & Imaging Sciences, King’s College London, King’s Health Partners, 4th Floor Lambeth Wing, St Thomas’ Hospital, London, SE1 7EH UK
| | - Laura Corsinovi
- School of Biomedical Engineering & Imaging Sciences, King’s College London, King’s Health Partners, 4th Floor Lambeth Wing, St Thomas’ Hospital, London, SE1 7EH UK
- Cardiology Department of the Basingstoke and North Hampshire Hospital, Basingstoke, UK
| | - Ioannis Ntalas
- School of Biomedical Engineering & Imaging Sciences, King’s College London, King’s Health Partners, 4th Floor Lambeth Wing, St Thomas’ Hospital, London, SE1 7EH UK
- Cardiology Department, St. Thomas’ Hospital, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Xenios Milidonis
- School of Biomedical Engineering & Imaging Sciences, King’s College London, King’s Health Partners, 4th Floor Lambeth Wing, St Thomas’ Hospital, London, SE1 7EH UK
| | - Cian Scannell
- School of Biomedical Engineering & Imaging Sciences, King’s College London, King’s Health Partners, 4th Floor Lambeth Wing, St Thomas’ Hospital, London, SE1 7EH UK
| | - Gabriella Di Giovine
- School of Biomedical Engineering & Imaging Sciences, King’s College London, King’s Health Partners, 4th Floor Lambeth Wing, St Thomas’ Hospital, London, SE1 7EH UK
| | - Nicholas Child
- School of Biomedical Engineering & Imaging Sciences, King’s College London, King’s Health Partners, 4th Floor Lambeth Wing, St Thomas’ Hospital, London, SE1 7EH UK
| | | | - Muhummad Sohaib Nazir
- School of Biomedical Engineering & Imaging Sciences, King’s College London, King’s Health Partners, 4th Floor Lambeth Wing, St Thomas’ Hospital, London, SE1 7EH UK
| | - Julia Karady
- School of Biomedical Engineering & Imaging Sciences, King’s College London, King’s Health Partners, 4th Floor Lambeth Wing, St Thomas’ Hospital, London, SE1 7EH UK
| | | | - Viola De Francesco
- School of Biomedical Engineering & Imaging Sciences, King’s College London, King’s Health Partners, 4th Floor Lambeth Wing, St Thomas’ Hospital, London, SE1 7EH UK
| | - Nuno Bettencourt
- Cardiovascular R&D Unit, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Andreas Schuster
- Department of Cardiology, Royal North Shore Hospital, The Kolling Institute, Northern Clinical School, University of Sydney, Sydney, Australia
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Tevfik F. Ismail
- School of Biomedical Engineering & Imaging Sciences, King’s College London, King’s Health Partners, 4th Floor Lambeth Wing, St Thomas’ Hospital, London, SE1 7EH UK
| | - Reza Razavi
- School of Biomedical Engineering & Imaging Sciences, King’s College London, King’s Health Partners, 4th Floor Lambeth Wing, St Thomas’ Hospital, London, SE1 7EH UK
| | - Amedeo Chiribiri
- School of Biomedical Engineering & Imaging Sciences, King’s College London, King’s Health Partners, 4th Floor Lambeth Wing, St Thomas’ Hospital, London, SE1 7EH UK
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De Vecchi A, Marlevi D, Nordsletten DA, Ntalas I, Leipsic J, Bapat V, Rajani R, Niederer SA. Left ventricular outflow obstruction predicts increase in systolic pressure gradients and blood residence time after transcatheter mitral valve replacement. Sci Rep 2018; 8:15540. [PMID: 30341365 PMCID: PMC6195528 DOI: 10.1038/s41598-018-33836-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 10/01/2018] [Indexed: 11/14/2022] Open
Abstract
Left ventricular outflow tract (LVOT) obstruction is a relatively common consequence of transcatheter mitral valve replacement (TMVR). Although LVOT obstruction is associated with heart failure and adverse remodelling, its effects upon left ventricular hemodynamics remain poorly characterised. This study uses validated computational models to identify the LVOT obstruction degree that causes significant changes in ventricular hemodynamics after TMVR. Seven TMVR patients underwent personalised flow simulations based on pre-procedural imaging data. Different virtual valve configurations were simulated in each case, for a total of 32 simulations, and the resulting obstruction degree was correlated with pressure gradients and flow residence times. These simulations identified a threshold LVOT obstruction degree of 35%, beyond which significant deterioration of systolic function was observed. The mean increase from baseline (pre-TMVR) in the peak systolic pressure gradient rose from 5.7% to 30.1% above this threshold value. The average blood volume staying inside the ventricle for more than two cycles also increased from 4.4% to 57.5% for obstruction degrees above 35%, while the flow entering and leaving the ventricle within one cycle decreased by 13.9%. These results demonstrate the unique ability of modelling to predict the hemodynamic consequences of TMVR and to assist in the clinical decision-making process.
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Affiliation(s)
- Adelaide De Vecchi
- Department of Biomedical Engineering, School of Imaging Sciences & Biomedical Engineering, King's College London, King's Health Partners, St Thomas Hospital, London, SE1 7EH, UK.
| | - David Marlevi
- School of Technology and Health, KTH Royal Institute of Technology, Hälsovägen 11C, 141 52, Huddinge, Sweden
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, 17177, Stockholm, Sweden
| | - David A Nordsletten
- Department of Biomedical Engineering, School of Imaging Sciences & Biomedical Engineering, King's College London, King's Health Partners, St Thomas Hospital, London, SE1 7EH, UK
| | - Ioannis Ntalas
- Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Jonathon Leipsic
- Department of Radiology and Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Vinayak Bapat
- Department of Surgery, Columbia University Medical Center, New York, NY, 10032, USA
| | - Ronak Rajani
- Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Steven A Niederer
- Department of Biomedical Engineering, School of Imaging Sciences & Biomedical Engineering, King's College London, King's Health Partners, St Thomas Hospital, London, SE1 7EH, UK
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9
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Ntalas I, Niederer S, Aziz W, Chambers JB, Rajani R. Giant left atrium: Adaptive or maladaptive? Hellenic J Cardiol 2018; 60:400-401. [PMID: 29990541 DOI: 10.1016/j.hjc.2018.06.017] [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: 05/23/2018] [Revised: 06/16/2018] [Accepted: 06/20/2018] [Indexed: 11/26/2022] Open
Affiliation(s)
- Ioannis Ntalas
- Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom.
| | - Steven Niederer
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Waqar Aziz
- Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - John B Chambers
- Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Ronak Rajani
- Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
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10
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Ntalas I, Chambers JB, Karády J, Rajani R. Simultaneous Dual Coronary Fistulas. Arq Bras Cardiol 2018; 110:397-398. [PMID: 29791581 PMCID: PMC5941967 DOI: 10.5935/abc.20180057] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Accepted: 07/06/2017] [Indexed: 11/20/2022] Open
Affiliation(s)
- Ioannis Ntalas
- Department of Cardiology, St Thomas' Hospital, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - John B Chambers
- Department of Cardiology, St Thomas' Hospital, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Júlia Karády
- Department of Cardiology, St Thomas' Hospital, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Ronak Rajani
- Department of Cardiology, St Thomas' Hospital, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
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Korantzopoulos P, Bechlioulis A, Ntalas I, Nikas D, Goudevenos I. P418Contemporary diagnostic yield of implantable loop recorders in patients from Northwestern Greece in the setting of economic crisis. Europace 2018. [DOI: 10.1093/europace/euy015.229] [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] [Indexed: 11/14/2022] Open
Affiliation(s)
- P Korantzopoulos
- University of Ioannina Medical School, Department of Cardiology, Ioannina, Greece
| | - A Bechlioulis
- University of Ioannina Medical School, Department of Cardiology, Ioannina, Greece
| | - I Ntalas
- University of Ioannina Medical School, Department of Cardiology, Ioannina, Greece
| | - D Nikas
- University of Ioannina Medical School, Department of Cardiology, Ioannina, Greece
| | - I Goudevenos
- University of Ioannina Medical School, Department of Cardiology, Ioannina, Greece
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Pawade T, Clavel MA, Tribouilloy C, Dreyfus J, Mathieu T, Tastet L, Renard C, Gun M, Jenkins WSA, Macron L, Sechrist JW, Lacomis JM, Nguyen V, Galian Gay L, Cuéllar Calabria H, Ntalas I, Cartlidge TRG, Prendergast B, Rajani R, Evangelista A, Cavalcante JL, Newby DE, Pibarot P, Messika Zeitoun D, Dweck MR. Computed Tomography Aortic Valve Calcium Scoring in Patients With Aortic Stenosis. Circ Cardiovasc Imaging 2018; 11:e007146. [DOI: 10.1161/circimaging.117.007146] [Citation(s) in RCA: 191] [Impact Index Per Article: 31.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Accepted: 01/26/2018] [Indexed: 11/16/2022]
Affiliation(s)
- Tania Pawade
- From the Centre for Cardiovascular Science, University of Edinburgh, United Kingdom (T.P., W.S.A.J., T.R.G.C., D.E.N., M.R.D.); Institut Universitaire de Cardiology et de Pneumologie de Québec (Quebec Heart and Lung Institute), Laval University, Canada (M.-A.C., L.T., P.P.); Department of Cardiology, Centre Hospitalier Universitaire d’Amiens, Picardie, France (C.T., M.G.); Centre Cardiologique du Nord, Saint-Denis, France (J.D., L.M.); Department of Cardiology, Bichat Hospital, Paris, France (T.M.,
| | - Marie-Annick Clavel
- From the Centre for Cardiovascular Science, University of Edinburgh, United Kingdom (T.P., W.S.A.J., T.R.G.C., D.E.N., M.R.D.); Institut Universitaire de Cardiology et de Pneumologie de Québec (Quebec Heart and Lung Institute), Laval University, Canada (M.-A.C., L.T., P.P.); Department of Cardiology, Centre Hospitalier Universitaire d’Amiens, Picardie, France (C.T., M.G.); Centre Cardiologique du Nord, Saint-Denis, France (J.D., L.M.); Department of Cardiology, Bichat Hospital, Paris, France (T.M.,
| | - Christophe Tribouilloy
- From the Centre for Cardiovascular Science, University of Edinburgh, United Kingdom (T.P., W.S.A.J., T.R.G.C., D.E.N., M.R.D.); Institut Universitaire de Cardiology et de Pneumologie de Québec (Quebec Heart and Lung Institute), Laval University, Canada (M.-A.C., L.T., P.P.); Department of Cardiology, Centre Hospitalier Universitaire d’Amiens, Picardie, France (C.T., M.G.); Centre Cardiologique du Nord, Saint-Denis, France (J.D., L.M.); Department of Cardiology, Bichat Hospital, Paris, France (T.M.,
| | - Julien Dreyfus
- From the Centre for Cardiovascular Science, University of Edinburgh, United Kingdom (T.P., W.S.A.J., T.R.G.C., D.E.N., M.R.D.); Institut Universitaire de Cardiology et de Pneumologie de Québec (Quebec Heart and Lung Institute), Laval University, Canada (M.-A.C., L.T., P.P.); Department of Cardiology, Centre Hospitalier Universitaire d’Amiens, Picardie, France (C.T., M.G.); Centre Cardiologique du Nord, Saint-Denis, France (J.D., L.M.); Department of Cardiology, Bichat Hospital, Paris, France (T.M.,
| | - Tiffany Mathieu
- From the Centre for Cardiovascular Science, University of Edinburgh, United Kingdom (T.P., W.S.A.J., T.R.G.C., D.E.N., M.R.D.); Institut Universitaire de Cardiology et de Pneumologie de Québec (Quebec Heart and Lung Institute), Laval University, Canada (M.-A.C., L.T., P.P.); Department of Cardiology, Centre Hospitalier Universitaire d’Amiens, Picardie, France (C.T., M.G.); Centre Cardiologique du Nord, Saint-Denis, France (J.D., L.M.); Department of Cardiology, Bichat Hospital, Paris, France (T.M.,
| | - Lionel Tastet
- From the Centre for Cardiovascular Science, University of Edinburgh, United Kingdom (T.P., W.S.A.J., T.R.G.C., D.E.N., M.R.D.); Institut Universitaire de Cardiology et de Pneumologie de Québec (Quebec Heart and Lung Institute), Laval University, Canada (M.-A.C., L.T., P.P.); Department of Cardiology, Centre Hospitalier Universitaire d’Amiens, Picardie, France (C.T., M.G.); Centre Cardiologique du Nord, Saint-Denis, France (J.D., L.M.); Department of Cardiology, Bichat Hospital, Paris, France (T.M.,
| | - Cedric Renard
- From the Centre for Cardiovascular Science, University of Edinburgh, United Kingdom (T.P., W.S.A.J., T.R.G.C., D.E.N., M.R.D.); Institut Universitaire de Cardiology et de Pneumologie de Québec (Quebec Heart and Lung Institute), Laval University, Canada (M.-A.C., L.T., P.P.); Department of Cardiology, Centre Hospitalier Universitaire d’Amiens, Picardie, France (C.T., M.G.); Centre Cardiologique du Nord, Saint-Denis, France (J.D., L.M.); Department of Cardiology, Bichat Hospital, Paris, France (T.M.,
| | - Mesut Gun
- From the Centre for Cardiovascular Science, University of Edinburgh, United Kingdom (T.P., W.S.A.J., T.R.G.C., D.E.N., M.R.D.); Institut Universitaire de Cardiology et de Pneumologie de Québec (Quebec Heart and Lung Institute), Laval University, Canada (M.-A.C., L.T., P.P.); Department of Cardiology, Centre Hospitalier Universitaire d’Amiens, Picardie, France (C.T., M.G.); Centre Cardiologique du Nord, Saint-Denis, France (J.D., L.M.); Department of Cardiology, Bichat Hospital, Paris, France (T.M.,
| | - William Steven Arthur Jenkins
- From the Centre for Cardiovascular Science, University of Edinburgh, United Kingdom (T.P., W.S.A.J., T.R.G.C., D.E.N., M.R.D.); Institut Universitaire de Cardiology et de Pneumologie de Québec (Quebec Heart and Lung Institute), Laval University, Canada (M.-A.C., L.T., P.P.); Department of Cardiology, Centre Hospitalier Universitaire d’Amiens, Picardie, France (C.T., M.G.); Centre Cardiologique du Nord, Saint-Denis, France (J.D., L.M.); Department of Cardiology, Bichat Hospital, Paris, France (T.M.,
| | - Laurent Macron
- From the Centre for Cardiovascular Science, University of Edinburgh, United Kingdom (T.P., W.S.A.J., T.R.G.C., D.E.N., M.R.D.); Institut Universitaire de Cardiology et de Pneumologie de Québec (Quebec Heart and Lung Institute), Laval University, Canada (M.-A.C., L.T., P.P.); Department of Cardiology, Centre Hospitalier Universitaire d’Amiens, Picardie, France (C.T., M.G.); Centre Cardiologique du Nord, Saint-Denis, France (J.D., L.M.); Department of Cardiology, Bichat Hospital, Paris, France (T.M.,
| | - Jacob W. Sechrist
- From the Centre for Cardiovascular Science, University of Edinburgh, United Kingdom (T.P., W.S.A.J., T.R.G.C., D.E.N., M.R.D.); Institut Universitaire de Cardiology et de Pneumologie de Québec (Quebec Heart and Lung Institute), Laval University, Canada (M.-A.C., L.T., P.P.); Department of Cardiology, Centre Hospitalier Universitaire d’Amiens, Picardie, France (C.T., M.G.); Centre Cardiologique du Nord, Saint-Denis, France (J.D., L.M.); Department of Cardiology, Bichat Hospital, Paris, France (T.M.,
| | - Joan M. Lacomis
- From the Centre for Cardiovascular Science, University of Edinburgh, United Kingdom (T.P., W.S.A.J., T.R.G.C., D.E.N., M.R.D.); Institut Universitaire de Cardiology et de Pneumologie de Québec (Quebec Heart and Lung Institute), Laval University, Canada (M.-A.C., L.T., P.P.); Department of Cardiology, Centre Hospitalier Universitaire d’Amiens, Picardie, France (C.T., M.G.); Centre Cardiologique du Nord, Saint-Denis, France (J.D., L.M.); Department of Cardiology, Bichat Hospital, Paris, France (T.M.,
| | - Virginia Nguyen
- From the Centre for Cardiovascular Science, University of Edinburgh, United Kingdom (T.P., W.S.A.J., T.R.G.C., D.E.N., M.R.D.); Institut Universitaire de Cardiology et de Pneumologie de Québec (Quebec Heart and Lung Institute), Laval University, Canada (M.-A.C., L.T., P.P.); Department of Cardiology, Centre Hospitalier Universitaire d’Amiens, Picardie, France (C.T., M.G.); Centre Cardiologique du Nord, Saint-Denis, France (J.D., L.M.); Department of Cardiology, Bichat Hospital, Paris, France (T.M.,
| | - Laura Galian Gay
- From the Centre for Cardiovascular Science, University of Edinburgh, United Kingdom (T.P., W.S.A.J., T.R.G.C., D.E.N., M.R.D.); Institut Universitaire de Cardiology et de Pneumologie de Québec (Quebec Heart and Lung Institute), Laval University, Canada (M.-A.C., L.T., P.P.); Department of Cardiology, Centre Hospitalier Universitaire d’Amiens, Picardie, France (C.T., M.G.); Centre Cardiologique du Nord, Saint-Denis, France (J.D., L.M.); Department of Cardiology, Bichat Hospital, Paris, France (T.M.,
| | - Hug Cuéllar Calabria
- From the Centre for Cardiovascular Science, University of Edinburgh, United Kingdom (T.P., W.S.A.J., T.R.G.C., D.E.N., M.R.D.); Institut Universitaire de Cardiology et de Pneumologie de Québec (Quebec Heart and Lung Institute), Laval University, Canada (M.-A.C., L.T., P.P.); Department of Cardiology, Centre Hospitalier Universitaire d’Amiens, Picardie, France (C.T., M.G.); Centre Cardiologique du Nord, Saint-Denis, France (J.D., L.M.); Department of Cardiology, Bichat Hospital, Paris, France (T.M.,
| | - Ioannis Ntalas
- From the Centre for Cardiovascular Science, University of Edinburgh, United Kingdom (T.P., W.S.A.J., T.R.G.C., D.E.N., M.R.D.); Institut Universitaire de Cardiology et de Pneumologie de Québec (Quebec Heart and Lung Institute), Laval University, Canada (M.-A.C., L.T., P.P.); Department of Cardiology, Centre Hospitalier Universitaire d’Amiens, Picardie, France (C.T., M.G.); Centre Cardiologique du Nord, Saint-Denis, France (J.D., L.M.); Department of Cardiology, Bichat Hospital, Paris, France (T.M.,
| | - Timothy Robert Graham Cartlidge
- From the Centre for Cardiovascular Science, University of Edinburgh, United Kingdom (T.P., W.S.A.J., T.R.G.C., D.E.N., M.R.D.); Institut Universitaire de Cardiology et de Pneumologie de Québec (Quebec Heart and Lung Institute), Laval University, Canada (M.-A.C., L.T., P.P.); Department of Cardiology, Centre Hospitalier Universitaire d’Amiens, Picardie, France (C.T., M.G.); Centre Cardiologique du Nord, Saint-Denis, France (J.D., L.M.); Department of Cardiology, Bichat Hospital, Paris, France (T.M.,
| | - Bernard Prendergast
- From the Centre for Cardiovascular Science, University of Edinburgh, United Kingdom (T.P., W.S.A.J., T.R.G.C., D.E.N., M.R.D.); Institut Universitaire de Cardiology et de Pneumologie de Québec (Quebec Heart and Lung Institute), Laval University, Canada (M.-A.C., L.T., P.P.); Department of Cardiology, Centre Hospitalier Universitaire d’Amiens, Picardie, France (C.T., M.G.); Centre Cardiologique du Nord, Saint-Denis, France (J.D., L.M.); Department of Cardiology, Bichat Hospital, Paris, France (T.M.,
| | - Ronak Rajani
- From the Centre for Cardiovascular Science, University of Edinburgh, United Kingdom (T.P., W.S.A.J., T.R.G.C., D.E.N., M.R.D.); Institut Universitaire de Cardiology et de Pneumologie de Québec (Quebec Heart and Lung Institute), Laval University, Canada (M.-A.C., L.T., P.P.); Department of Cardiology, Centre Hospitalier Universitaire d’Amiens, Picardie, France (C.T., M.G.); Centre Cardiologique du Nord, Saint-Denis, France (J.D., L.M.); Department of Cardiology, Bichat Hospital, Paris, France (T.M.,
| | - Arturo Evangelista
- From the Centre for Cardiovascular Science, University of Edinburgh, United Kingdom (T.P., W.S.A.J., T.R.G.C., D.E.N., M.R.D.); Institut Universitaire de Cardiology et de Pneumologie de Québec (Quebec Heart and Lung Institute), Laval University, Canada (M.-A.C., L.T., P.P.); Department of Cardiology, Centre Hospitalier Universitaire d’Amiens, Picardie, France (C.T., M.G.); Centre Cardiologique du Nord, Saint-Denis, France (J.D., L.M.); Department of Cardiology, Bichat Hospital, Paris, France (T.M.,
| | - João L. Cavalcante
- From the Centre for Cardiovascular Science, University of Edinburgh, United Kingdom (T.P., W.S.A.J., T.R.G.C., D.E.N., M.R.D.); Institut Universitaire de Cardiology et de Pneumologie de Québec (Quebec Heart and Lung Institute), Laval University, Canada (M.-A.C., L.T., P.P.); Department of Cardiology, Centre Hospitalier Universitaire d’Amiens, Picardie, France (C.T., M.G.); Centre Cardiologique du Nord, Saint-Denis, France (J.D., L.M.); Department of Cardiology, Bichat Hospital, Paris, France (T.M.,
| | - David E. Newby
- From the Centre for Cardiovascular Science, University of Edinburgh, United Kingdom (T.P., W.S.A.J., T.R.G.C., D.E.N., M.R.D.); Institut Universitaire de Cardiology et de Pneumologie de Québec (Quebec Heart and Lung Institute), Laval University, Canada (M.-A.C., L.T., P.P.); Department of Cardiology, Centre Hospitalier Universitaire d’Amiens, Picardie, France (C.T., M.G.); Centre Cardiologique du Nord, Saint-Denis, France (J.D., L.M.); Department of Cardiology, Bichat Hospital, Paris, France (T.M.,
| | - Philippe Pibarot
- From the Centre for Cardiovascular Science, University of Edinburgh, United Kingdom (T.P., W.S.A.J., T.R.G.C., D.E.N., M.R.D.); Institut Universitaire de Cardiology et de Pneumologie de Québec (Quebec Heart and Lung Institute), Laval University, Canada (M.-A.C., L.T., P.P.); Department of Cardiology, Centre Hospitalier Universitaire d’Amiens, Picardie, France (C.T., M.G.); Centre Cardiologique du Nord, Saint-Denis, France (J.D., L.M.); Department of Cardiology, Bichat Hospital, Paris, France (T.M.,
| | - David Messika Zeitoun
- From the Centre for Cardiovascular Science, University of Edinburgh, United Kingdom (T.P., W.S.A.J., T.R.G.C., D.E.N., M.R.D.); Institut Universitaire de Cardiology et de Pneumologie de Québec (Quebec Heart and Lung Institute), Laval University, Canada (M.-A.C., L.T., P.P.); Department of Cardiology, Centre Hospitalier Universitaire d’Amiens, Picardie, France (C.T., M.G.); Centre Cardiologique du Nord, Saint-Denis, France (J.D., L.M.); Department of Cardiology, Bichat Hospital, Paris, France (T.M.,
| | - Marc R. Dweck
- From the Centre for Cardiovascular Science, University of Edinburgh, United Kingdom (T.P., W.S.A.J., T.R.G.C., D.E.N., M.R.D.); Institut Universitaire de Cardiology et de Pneumologie de Québec (Quebec Heart and Lung Institute), Laval University, Canada (M.-A.C., L.T., P.P.); Department of Cardiology, Centre Hospitalier Universitaire d’Amiens, Picardie, France (C.T., M.G.); Centre Cardiologique du Nord, Saint-Denis, France (J.D., L.M.); Department of Cardiology, Bichat Hospital, Paris, France (T.M.,
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Karády J, Ntalas I, Prendergast B, Blauth C, Niederer S, Maurovich-Horvat P, Rajani R. Transcatheter mitral valve replacement in mitral annulus calcification – “The art of computer simulation”. J Cardiovasc Comput Tomogr 2018; 12:153-157. [DOI: 10.1016/j.jcct.2017.12.007] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Revised: 10/06/2017] [Accepted: 12/29/2017] [Indexed: 11/25/2022]
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de Vecchi A, Niederer S, Karády J, Ntalas I, Maurovich-Horvat P, Rajani R. Computational fluid dynamic modelling to determine the hemodynamic effects of implanting a transcatheter mitral valve within the left ventricle. Int J Cardiovasc Imaging 2017; 34:803-805. [PMID: 29134390 DOI: 10.1007/s10554-017-1276-y] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Accepted: 11/11/2017] [Indexed: 11/30/2022]
Affiliation(s)
| | - Steven Niederer
- Department of Biomedical Engineering, King's College London, London, UK
| | - Júlia Karády
- Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust, London, UK.,MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Ioannis Ntalas
- Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Pál Maurovich-Horvat
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Ronak Rajani
- Department of Biomedical Engineering, King's College London, London, UK. .,Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust, London, UK.
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Antoniou A, Ntalas I, Gupta A, Attia R. Remodelling of the aorta after a catheter-induced acute aortic dissection. Eur J Cardiothorac Surg 2017; 53:479-481. [DOI: 10.1093/ejcts/ezx315] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Revised: 07/03/2017] [Accepted: 08/07/2017] [Indexed: 11/13/2022] Open
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Ntalas I, Karády J, Kapetanakis S, Rajani R. The Doppler paradox. Echocardiography 2017; 34:1965-1966. [PMID: 28856722 DOI: 10.1111/echo.13670] [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: 11/30/2022] Open
Abstract
Obstructive prosthetic valve thrombosis (PVT) is a rare but severe complication that usually occurs in the presence of suboptimal anticoagulation. Although fluoroscopy is commonly used to detect abnormal leaflet motion as a surrogate marker for PVT, its inability to directly visualize adjacent tissue and valve physiology leaves it susceptible to miss clinically important PVT. In this manuscript, we report the case of a 54-year-old woman with a mechanical mitral valve who was admitted to our institute with exertional dyspnea. Although valve fluoroscopy was normal, subsequent 3D echocardiography and ECG-gated multiphase computed tomography confirmed the presence of PVT that was subsequently treated successfully with surgical replacement. Our case demonstrates the utility of multimodality imaging in establishing PVT in patients with abnormal prosthetic valve physiology and progressive symptoms.
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Affiliation(s)
- Ioannis Ntalas
- Department of Cardiology, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
| | - Júlia Karády
- Department of Cardiology, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom.,MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Stam Kapetanakis
- Department of Cardiology, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
| | - Ronak Rajani
- Department of Cardiology, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom.,Division of Imaging Sciences and Bioengineering, King's College London, London, United Kingdom
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Affiliation(s)
- Ronak Rajani
- Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Bhavik Modi
- Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Ioannis Ntalas
- Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Nick Curzen
- Wessex Cardiac Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK
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Alexopoulos D, Xanthopoulou I, Deftereos S, Sitafidis G, Kanakakis I, Hamilos M, Vavuranakis M, Davlouros P, Ntalas I, Angelidis C, Hahalis G, Triposkiadis F, Vardas P, Stefanadis C, Goudevenos JA. Contraindications/special warnings and precautions for use of contemporary oral antiplatelet treatment in patients with acute coronary syndrome undergoing percutaneous coronary intervention. Circ J 2013; 78:180-7. [PMID: 24189502 DOI: 10.1253/circj.cj-13-0795] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The prevalence of contraindications/special warnings and precautions (CON/SWP) for clopidogrel, prasugrel and ticagrelor use is not adequately studied and might affect P2Y12 inhibitor choice in acute coronary syndrome (ACS) patients undergoing percutaneous coronary intervention (PCI). METHODS AND RESULTS In the context of the GReek AntiPlatelet rEgistry (GRAPE) a detailed recording of CON/SWP for use of clopidogrel, prasugrel and ticagrelor was done for 1,280 consecutive, moderate-high-risk ACS patients undergoing PCI. At least 1 CON for use of clopidogrel, prasugrel and ticagrelor was present in 5 (0.4%), 49 (3.8%) and 12 patients (0.9%), respectively. Prevalence of at least 1 CON/SWP to clopidogrel (45.8%) was less frequent compared to prasugrel (49.1%) or ticagrelor (49.1%; P=0.02 and P=0.04, respectively), while 34% of patients had at least 1 CON/SWP to all the 3 P2Y12 inhibitors. At discharge, 482 (38.6%), 301 (24.1%) and 464 patients (37.2%) received clopidogrel, prasugrel and ticagrelor, respectively. Age ≥75 years, co-medication related to increased bleeding risk, and history of asthma/chronic obstructive pulmonary disease favored clopidogrel vs. prasugrel or ticagrelor use as discharge medication, while geographic region also affected this choice (C-statistic, 0.81; 95% CI: 0.78-0.83). CONCLUSIONS In patients with ACS undergoing PCI the prevalence of CON to antiplatelet agents is low, whereas that of SWP is high. Certain SWP, along with regional trends may affect the choice of newer P2Y12 inhibitors vs. clopidogrel.
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Xanthopoulou I, Perperis A, Stavrou K, Siapika A, Ntalas I, Petousis S, Angelidis C, Parissis H, Alexopoulos D. Switching of P2Y12 inhibitor in patients with acute coronary syndrome: Insights from the GReek AntiPlatElet Registry (GRAPE). Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht310.p4857] [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: 11/12/2022] Open
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Alexopoulos D, Xanthopoulou I, Tsoni E, Ntalas I, Deftereos S, Sitafidis G, Davlouros P, Pyrgakis V, Goudevenos I, Triposkiadis F. IN-HOSPITAL SWITCHING OF P2Y12 INHIBITOR IN REAL-LIFE PATIENTS WITH ACUTE CORONARY SYNDROME: INSIGHTS FROM THE GREEK ANTIPLATELET (GRAPE) REGISTRY. J Am Coll Cardiol 2013. [DOI: 10.1016/s0735-1097(13)60043-1] [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: 11/26/2022]
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Samonis G, Falagas ME, Lionakis S, Ntaoukakis M, Kofteridis DP, Ntalas I, Maraki S. Saccharomyces boulardiiandCandida albicansexperimental colonization of the murine gut. Med Mycol 2011; 49:395-9. [DOI: 10.3109/13693786.2010.533203] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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