1
|
Kole C, Stefanou Ε, Karvelas N, Schizas D, Toutouzas KP. Acute and Post-Acute COVID-19 Cardiovascular Complications: A Comprehensive Review. Cardiovasc Drugs Ther 2023:10.1007/s10557-023-07465-w. [PMID: 37209261 DOI: 10.1007/s10557-023-07465-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/02/2023] [Indexed: 05/22/2023]
Abstract
PURPOSE OF REVIEW The risk of cardiovascular complications due to SARS-CoV-2 are significantly increased within the first 6 months of the infection. Patients with COVID-19 have an increased risk of death, and there is evidence that many may experience a wide range of post-acute cardiovascular complications. Our work aims to provide an update on current clinical aspects of diagnosis and treatment of cardiovascular manifestations during acute and long-term COVID-19. RECENT FINDINGS SARS-CoV-2 has been shown to be associated with increased incidence of cardiovascular complications such as myocardial injury, heart failure, and dysrhythmias, as well as coagulation abnormalities not only during the acute phase but also beyond the first 30 days of the infection, associated with high mortality and poor outcomes. Cardiovascular complications during long-COVID-19 were found regardless of comorbidities such as age, hypertension, and diabetes; nevertheless, these populations remain at high risk for the worst outcomes during post-acute COVID-19. Emphasis should be given to the management of these patients. Treatment with low-dose oral propranolol, a beta blocker, for heart rate management may be considered, since it was found to significantly attenuate tachycardia and improve symptoms in postural tachycardia syndrome, while for patients on ACE inhibitors or angiotensin-receptor blockers (ARBs), under no circumstances should these medications be withdrawn. In addition, in patients at high risk after hospitalization due to COVID-19, thromboprophylaxis with rivaroxaban 10 mg/day for 35 days improved clinical outcomes compared with no extended thromboprophylaxis. In this work we provide a comprehensive review on acute and post-acute COVID-19 cardiovascular complications, symptomatology, and pathophysiology mechanisms. We also discuss therapeutic strategies for these patients during acute and long-term care and highlight populations at risk. Our findings suggest that older patients with risk factors such as hypertension, diabetes, and medical history of vascular disease have worse outcomes during acute SARS-CoV-2 infection and are more likely to develop cardiovascular complications during long-COVID-19.
Collapse
Affiliation(s)
- Christo Kole
- Cardiology Department, Sismanoglio General Hospital of Attica, Faculty of Medicine, National and Kapodistrian University of Athens, Athens, Greece.
| | - Εleni Stefanou
- Artificial Kidney Unit, General Hospital of Messinia, Kalamata, Greece
| | - Nikolaos Karvelas
- Faculty of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios Schizas
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | | |
Collapse
|
2
|
Apostolos A, Gregoriou S, Drakopoulou MI, Trantalis G, Mastraftsi S, Synetos AG, Papanikolaou A, Aggeli C, Stratigos A, Rigopoulos D, Tsioufis KP, Toutouzas KP. ASSOCIATION BETWEEN CLINICAL MANIFESTATIONS AND NICKEL SKIN PATCH RESULTS IN PATIENTS UNDERGOING PATENT FORAMEN OVALE CLOSURE: PRELIMINARY RESULTS FROM INSPIRE TRIAL. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)01331-1] [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: 03/06/2023]
|
3
|
Apostolos A, Drakopoulou MI, Trantalis G, Simopoulou C, Katsaros O, Korovesis T, Oikonomou G, Papanikolaou A, Aggeli C, Tsioufis KP, Toutouzas KP. TRANSCATHETER PATENT FORAMEN OVALE CLOSURE: REAL WORLD DATA FROM A TERTIARY HOSPITAL. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)01330-x] [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]
|
4
|
Anousakis-Vlachochristou N, Barla I, Gikas E, Mavroidis M, Katsa M, Panara A, THOMAIDIS NIKOLAOS, Cokkinos DV, Toutouzas KP. METABOLOMIC SIGNATURE OF AORTIC VALVE STENOSIS IN THE RABBIT MODEL. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)02385-9] [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]
|
5
|
Bompotis GC, Giannopoulos G, Karakanas AI, Meletidou M, Vrachatis D, Lazaridis I, Toutouzas KP, Styliadis I, Tziakas D, Deftereos SG. Left Distal Radial Artery Access for Coronary Angiography and Interventions: A 12-Month All-Comers Study. J Invasive Cardiol 2022; 34:E505-E509. [PMID: 35714225] [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] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND Interventional cardiologists prefer the right radial artery (RA) approach for coronary angiography and interventions, mainly for ergonomic reasons. However, the use of the left RA presents certain advantages, and the snuffbox approach has further potential advantages, including lower probability for RA occlusion, avoidance of direct puncture of the RA (thus maintaining its suitability for use as a graft), as well as easier and faster hemostasis. METHODS Consecutive patients scheduled for coronary catheterization were included, using the left distal RA (ldRA) in the anatomical snuffbox as the default vascular access site. RESULTS Out of 2034 consecutive cases, the ldRA was used as initial vascular access in 1977 patients (97.2%). The procedural failure rate was 9.9% (21.9% inability to puncture the artery, 75.0% inability to advance the wire, 3.1% other reasons). There was a sharp decrease in failure rate after about the first 200 cases (20.8% in the first decile vs 8.7% throughout the rest of the caseload; P<.001). No or very weak palpable pulse was the most important predictor of failure (odds ratio, 16.0; 95% confidence interval, 11.2-23.1; P<.001), in addition to older age, small stature, and female gender (although, after adjustment for height, the latter was no longer significant). CONCLUSION In a large series of consecutive patients scheduled for left heart catheterization, through a period of 12 months, with virtually no exclusions except those few imposed by anatomy or compelling clinical needs, the ldRA arterial access approach was shown to be highly effective, feasible, and safe.
Collapse
Affiliation(s)
- Georgios C Bompotis
- General Hospital Papageorgiou, Ring Road of Thessaloniki, Nea Efkarpia, Thessaloniki, 56403, Greece.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
6
|
Karanasos A, Tyrovolas K, Tsiachris D, Efremidis M, Kordalis A, Karmpalioti M, Prappa E, Karagiannis S, Aggeli C, Gatzoulis K, Tousoulis D, Tsioufis C, Toutouzas KP. Left Atrial Function Post Radiofrequency and Cryoballoon Ablation Assessed by Volume-Pressure Loops. Front Cardiovasc Med 2022; 9:830055. [PMID: 35355975 PMCID: PMC8959489 DOI: 10.3389/fcvm.2022.830055] [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: 12/06/2021] [Accepted: 01/28/2022] [Indexed: 12/01/2022] Open
Abstract
Background Left atrial (LA) function is linked to atrial fibrillation (AF) pathogenesis. AF catheter ablation decreases disease burden with potentially favorable effects on cardiac function. Atrial volume-pressure loops can optimally assess the LA function. Objective To investigate changes in LA function by volume-pressure loops after paroxysmal AF ablation and explored potential differences between the radiofrequency and cryoballoon ablation. Methods We analyzed 44 patients undergoing paroxysmal AF ablation from 2 centers, 22 treated with radiofrequency and 22 with cryoablation. Pre- and post-procedure, all patients underwent a real-time three-dimensional transthoracic ECG to evaluate LA volume, while simultaneously recording LA pressure following transseptal puncture. Volume-pressure loops pre- and post-procedure were created by paired data. Areas of A-loop (LA booster pump function) and V-loop (LA reservoir function), and the stiffness constant determining the slope of the exponential curve during LA filling were calculated. Results Average LA pressure, A-wave amplitude, and V-wave amplitude were increased post-procedurally (p < 0.001). Overall, A-loop area decreased (p = 0.001) and V-loop area tended to increase (p = 0.07). The change in both A-loop and V-loop areas was similar between radiofrequency- and cryoballoon-treated patients (p = 0.18 and p = 0.52, respectively). However, compared with cryoballoon-treated patients, radiofrequency-treated patients had higher increase in the stiffness constant (b = 0.059; 95% CI: 0.022–0.096; p = 0.006). Conclusion AF catheter ablation by the radiofrequency or cryoballoon is associated with the decrease of the booster pump function and increase of the reservoir function. Moreover, there is a post-procedural increase of LA pressure which is associated with an acute increase in LA stiffness in radiofrequency ablation, but not in cryoablation.
Collapse
Affiliation(s)
- Antonios Karanasos
- 1st Department of Cardiology, Athens Medical School, Hippokration Hospital, Athens, Greece
| | - Konstantinos Tyrovolas
- Second Department of Cardiology, “Evangelismos” General Hospital of Athens, Athens, Greece
| | | | - Michalis Efremidis
- Second Department of Cardiology, “Evangelismos” General Hospital of Athens, Athens, Greece
| | - Athanasios Kordalis
- 1st Department of Cardiology, Athens Medical School, Hippokration Hospital, Athens, Greece
- Athens Heart Centre, Athens Medical Centre, Athens, Greece
| | - Maria Karmpalioti
- 1st Department of Cardiology, Athens Medical School, Hippokration Hospital, Athens, Greece
| | - Efstathia Prappa
- Second Department of Cardiology, “Evangelismos” General Hospital of Athens, Athens, Greece
| | | | - Constantina Aggeli
- 1st Department of Cardiology, Athens Medical School, Hippokration Hospital, Athens, Greece
| | - Konstantinos Gatzoulis
- 1st Department of Cardiology, Athens Medical School, Hippokration Hospital, Athens, Greece
| | - Dimitrios Tousoulis
- 1st Department of Cardiology, Athens Medical School, Hippokration Hospital, Athens, Greece
| | - Costas Tsioufis
- 1st Department of Cardiology, Athens Medical School, Hippokration Hospital, Athens, Greece
| | - Konstantinos P. Toutouzas
- 1st Department of Cardiology, Athens Medical School, Hippokration Hospital, Athens, Greece
- *Correspondence: Konstantinos P. Toutouzas
| |
Collapse
|
7
|
Oikonomou G, Simopoulou C, Drakopoulou MI, Toskas P, apostolos A, Karmpalioti M, Synetos AG, Latsios G, Toutouzas KP. LOW FLOW LOW GRADIENT SEVERE AORTIC STENOSIS. IMPACT ON OUTCOMES AFTER TAVR. J Am Coll Cardiol 2022. [DOI: 10.1016/s0735-1097(22)01728-4] [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: 10/18/2022]
|
8
|
Karmpalioti M, Drakopoulou M, Oikonomou G, Simopoulou C, Soulaidopoulos S, Apostolos A, Toskas P, Stathogiannis K, Synetos AG, Latsios G, Tsioufis K, Toutouzas KP. IMPACT OF SIGNIFICANT PREPROCEDURAL MITRAL REGURGITATION ON MORTALITY AFTER TRANSCATHETER AORTIC VALVE IMPLANTATION. J Am Coll Cardiol 2022. [DOI: 10.1016/s0735-1097(22)01677-1] [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: 11/29/2022]
|
9
|
Bounas P, Karanasos A, Synetos AG, Papanikolaou A, Latsios G, Drakopoulou MI, Trantalis G, Olympios CD, Tousoulis D, Toutouzas KP. CAROTID THERMAL HETEROGENEITY DETECTED BY MICROWAVE RADIOMETRY IS ASSOCIATED WITH THIN CAP FIBROATHEROMA AND PLAQUE RUPTURE IN PATIENTS PRESENTING WITH ACUTE MYOCARDIAL INFARCTION. J Am Coll Cardiol 2022. [DOI: 10.1016/s0735-1097(22)01941-6] [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: 10/18/2022]
|
10
|
Thanopoulos BVD, Soendergaard L, Ngugen HL, Marasini M, Giannopoulos A, Bompotis GC, Thonghong T, Krishnamoorthy KM, Placid S, Deleanou D, Toutouzas KP. International experience with the use of Cocoon septal occluder for closure of atrial septal defects. Hellenic J Cardiol 2021; 62:206-211. [PMID: 33484876 DOI: 10.1016/j.hjc.2020.12.009] [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: 09/11/2020] [Revised: 12/14/2020] [Accepted: 12/17/2020] [Indexed: 10/22/2022] Open
Abstract
BACKGROUND The Cocoon septal occluder (CSO) is a new generation double disk occluder device for catheter closure of the secundum atrial septal defect (ASD). Initial clinical evaluations with the use of this device have shown quite satisfactory results but large follow-up studies are missing. In this international multicenter study, we present procedural and follow-up data from 4008 patients with secundum ASD who underwent catheter closure with the use of CSO. METHODS The study cohort consisted of 1853 pediatric and 2155 adult patients with secundum ASD treated with the CSO. Patients were enrolled retrospectively from 11 international centers and were followed for a mean period of 43 months (range 12-84 months), postprocedural. Clinical, electrocardiographic, echocardiographic, procedural, and follow-up data were collected from each collaborating hospital. RESULTS The CSO was permanently implanted in 3983 patients (99.4%). Echocardiographic evaluation at one month follow-up revealed complete closure in 99.6% of those patients who had a device implanted. Thrombus formation in one adult patient was the only major device related to procedural complication. During the follow-up period, no patient developed cardiac erosions, allergic reactions to nickel, or other major complications. CONCLUSIONS Implantation of CSO provided satisfactory procedural and follow-up results with high success and no device-related cardiac erosions and nickel allergy.
Collapse
Affiliation(s)
| | - Lars Soendergaard
- Department of Cardiology Copenhagen University Hospital, Rigshospitalet, Denmark
| | | | | | - Andreas Giannopoulos
- Department of Pediatric Cardiology AHEPA University General Hospital of Thessaloniki, Greece
| | - Georgios C Bompotis
- Department of Cardiology Papageorgiou General Hospital of Thessaloniki, Greece
| | - Tasalac Thonghong
- Department of Cardiology Chiang Mai University Hospital, Chiang Mai, Thailand
| | | | - Sebastian Placid
- Department of Cardiology Sakaharna Hrudayalaya Hospital, Kerala, India
| | - Dan Deleanou
- Institute for Cardiovascular Diseases C.C. Iliescu, Bucharest, Romania
| | - Konstantinos P Toutouzas
- First Department of Cardiology Hippokration General Hospital, National and Kapodistrian University of Athens, Greece
| |
Collapse
|
11
|
Deftereos SG, Giannopoulos G, Vrachatis DA, Siasos GD, Giotaki SG, Gargalianos P, Metallidis S, Sianos G, Baltagiannis S, Panagopoulos P, Dolianitis K, Randou E, Syrigos K, Kotanidou A, Koulouris NG, Milionis H, Sipsas N, Gogos C, Tsoukalas G, Olympios CD, Tsagalou E, Migdalis I, Gerakari S, Angelidis C, Alexopoulos D, Davlouros P, Hahalis G, Kanonidis I, Katritsis D, Kolettis T, Manolis AS, Michalis L, Naka KK, Pyrgakis VN, Toutouzas KP, Triposkiadis F, Tsioufis K, Vavouranakis E, Martinèz-Dolz L, Reimers B, Stefanini GG, Cleman M, Goudevenos J, Tsiodras S, Tousoulis D, Iliodromitis E, Mehran R, Dangas G, Stefanadis C. Effect of Colchicine vs Standard Care on Cardiac and Inflammatory Biomarkers and Clinical Outcomes in Patients Hospitalized With Coronavirus Disease 2019: The GRECCO-19 Randomized Clinical Trial. JAMA Netw Open 2020; 3:e2013136. [PMID: 32579195 PMCID: PMC7315286 DOI: 10.1001/jamanetworkopen.2020.13136] [Citation(s) in RCA: 287] [Impact Index Per Article: 71.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
IMPORTANCE Severe acute respiratory syndrome coronavirus 2 infection has evolved into a global pandemic. Low-dose colchicine combines anti-inflammatory action with a favorable safety profile. OBJECTIVE To evaluate the effect of treatment with colchicine on cardiac and inflammatory biomarkers and clinical outcomes in patients hospitalized with coronavirus disease 2019 (COVID-19). DESIGN, SETTING, AND PARTICIPANTS In this prospective, open-label, randomized clinical trial (the Greek Study in the Effects of Colchicine in COVID-19 Complications Prevention), 105 patients hospitalized with COVID-19 were randomized in a 1:1 allocation from April 3 to April 27, 2020, to either standard medical treatment or colchicine with standard medical treatment. The study took place in 16 tertiary hospitals in Greece. INTERVENTION Colchicine administration (1.5-mg loading dose followed by 0.5 mg after 60 min and maintenance doses of 0.5 mg twice daily) with standard medical treatment for as long as 3 weeks. MAIN OUTCOMES AND MEASURES Primary end points were (1) maximum high-sensitivity cardiac troponin level; (2) time for C-reactive protein to reach more than 3 times the upper reference limit; and (3) time to deterioration by 2 points on a 7-grade clinical status scale, ranging from able to resume normal activities to death. Secondary end points were (1) the percentage of participants requiring mechanical ventilation, (2) all-cause mortality, and (3) number, type, severity, and seriousness of adverse events. The primary efficacy analysis was performed on an intention-to-treat basis. RESULTS A total of 105 patients were evaluated (61 [58.1%] men; median [interquartile range] age, 64 [54-76] years) with 50 (47.6%) randomized to the control group and 55 (52.4%) to the colchicine group. Median (interquartile range) peak high-sensitivity cardiac troponin values were 0.0112 (0.0043-0.0093) ng/mL in the control group and 0.008 (0.004-0.0135) ng/mL in the colchicine group (P = .34). Median (interquartile range) maximum C-reactive protein levels were 4.5 (1.4-8.9) mg/dL vs 3.1 (0.8-9.8) mg/dL (P = .73), respectively. The clinical primary end point rate was 14.0% in the control group (7 of 50 patients) and 1.8% in the colchicine group (1 of 55 patients) (odds ratio, 0.11; 95% CI, 0.01-0.96; P = .02). Mean (SD) event-free survival time was 18.6 (0.83) days the in the control group vs 20.7 (0.31) in the colchicine group (log rank P = .03). Adverse events were similar in the 2 groups, except for diarrhea, which was more frequent with colchicine group than the control group (25 patients [45.5%] vs 9 patients [18.0%]; P = .003). CONCLUSIONS AND RELEVANCE In this randomized clinical trial, participants who received colchicine had statistically significantly improved time to clinical deterioration. There were no significant differences in high-sensitivity cardiac troponin or C-reactive protein levels. These findings should be interpreted with caution. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04326790.
Collapse
Affiliation(s)
- Spyridon G. Deftereos
- Second Department of Cardiology, Attikon Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | | | | | - Gerasimos D. Siasos
- First Department of Cardiology, Hippokration Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Sotiria G. Giotaki
- Second Department of Cardiology, Attikon Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Simeon Metallidis
- First Department of Internal Medicine, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - George Sianos
- First Department of Cardiology, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Periklis Panagopoulos
- Second Department of Internal Medicine, General Hospital of Alexandroupoli, Democritus University of Thrace, Alexandroupoli, Greece
| | - Konstantinos Dolianitis
- Department of Internal Medicine, Mpodosakio General Hospital of Ptolemaida, Ptolemaida, Greece
| | - Efthalia Randou
- Department of Internal Medicine, General Hospital of Kozani, Kozani, Greece
| | - Konstantinos Syrigos
- Third Department of Internal Medicine, General Hospital Sotiria, National and Kapodistrian University of Athens, Athens, Greece
| | - Anastasia Kotanidou
- First Intensive Care Unit, General Hospital Evangelismos, National and Kapodistrian University of Athens, Athens, Greece
| | - Nikolaos G. Koulouris
- First Department of Pneumonology, General Hospital Sotiria, National and Kapodistrian University of Athens, Athens, Greece
| | - Haralampos Milionis
- First Department of Internal Medicine, Ioannina University Hospital, University of Ioannina, Ioannina, Greece
| | - Nikolaos Sipsas
- Infectious Diseases Unit, Laiko General Hospital, Athens, Greece
| | - Charalampos Gogos
- Internal Medicine Department, University Hospital of Patras, Patras, Greece
| | - George Tsoukalas
- Fourth Department of Pneumonology, General Hospital Sotiria, Athens, Greece
| | | | | | - Ilias Migdalis
- Second Medical Department, NIMTS Hospital, Athens, Greece
| | - Styliani Gerakari
- Department of Internal Medicine, General Hospital of West Attica Agia Varvara, Athens, Greece
| | - Christos Angelidis
- Second Department of Cardiology, Attikon Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios Alexopoulos
- Second Department of Cardiology, Attikon Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Pericles Davlouros
- Department of Cardiology, University of Patras Medical School, Patras, Greece
| | - George Hahalis
- Department of Cardiology, University of Patras Medical School, Patras, Greece
| | - Ioannis Kanonidis
- Second Department of Cardiology, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Theofilos Kolettis
- Department of Cardiology, Ioannina University Hospital, University of Ioannina, Ioannina, Greece
| | - Antonios S. Manolis
- First Department of Cardiology, Hippokration Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Lampros Michalis
- Department of Cardiology, Ioannina University Hospital, University of Ioannina, Ioannina, Greece
| | - Katerina K. Naka
- Department of Cardiology, Ioannina University Hospital, University of Ioannina, Ioannina, Greece
| | - Vlasios N. Pyrgakis
- Department of Cardiology, G. Gennimatas General Hospital of Athens, Athens, Greece
| | - Konstantinos P. Toutouzas
- First Department of Cardiology, Hippokration Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Konstantinos Tsioufis
- First Department of Cardiology, Hippokration Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Emmanouil Vavouranakis
- Third Department of Cardiology, General Hospital Sotiria, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Bernhard Reimers
- Cardio Center, Humanitas Clinical and Research Hospital IRCCS, Rozzano-Milan, Italy
| | - Giulio G. Stefanini
- Cardio Center, Humanitas Clinical and Research Hospital IRCCS, Rozzano-Milan, Italy
| | - Michael Cleman
- Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - John Goudevenos
- Department of Cardiology, Ioannina University Hospital, University of Ioannina, Ioannina, Greece
| | - Sotirios Tsiodras
- Fourth Department of Internal Medicine, Attikon Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios Tousoulis
- First Department of Cardiology, Hippokration Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Efstathios Iliodromitis
- Second Department of Cardiology, Attikon Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Roxana Mehran
- Icahn School of Medicine at Mount Sinai, New York, New York
| | - George Dangas
- Icahn School of Medicine at Mount Sinai, New York, New York
| | - Christodoulos Stefanadis
- First Department of Cardiology, Hippokration Hospital, National and Kapodistrian University of Athens, Athens, Greece
- Athens Medical Center, Athens, Greece
| | | |
Collapse
|
12
|
Doulamis IP, Tzani AI, Konstantopoulos PS, Samanidis G, Georgiopoulos G, Toutouzas KP, Perrea DN, Perreas KG. A sirtuin 1/MMP2 prognostic index for myocardial infarction in patients with advanced coronary artery disease. Int J Cardiol 2017; 230:447-453. [PMID: 28043667 DOI: 10.1016/j.ijcard.2016.12.086] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Revised: 11/12/2016] [Accepted: 12/16/2016] [Indexed: 12/13/2022]
|
13
|
Galyfos G, Toutouzas KP, Benetos G, Konstadoulakis M, Theodorou D, Katsaragakis S, Stefanadis C, Zografos G, Filis K. The prognostic role of carotid plaque ultrasonography in cardiac damage after carotid endarterectomy: carotid plaque and cardiac risk. Minerva Cardioangiol 2016; 64:534-541. [PMID: 25881874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND This study evaluates the correlation of ultrasound determined carotid plaque morphology with coronary risk and cardiac damage after carotid endarterectomy. METHODS Fifty patients (in a series of 162) scheduled for carotid endarterectomy had the indication for coronary CT-angiography preoperatively and were included in this study. Patients were classified according to ultrasonographic characteristics of carotid plaque. The Duke Criteria were used to assess the degree of coronary risk (low, medium and high risk). Cardiac damage after carotid endarterectomy was evaluated based on symptoms, cardiac Troponin I measurement and electrocardiographic findings. RESULTS There were no deaths, strokes or symptomatic myocardial infarctions postoperatively (30-day results). Ten patients (20%) showed asymptomatic cardiac damage postoperatively. Cardiac damage after surgery did not show any difference between the three cardiac risk groups. Echogenic and specifically Type IV carotid artery plaques (Gray-Weale Criteria) were associated with high cardiac risk preoperatively and with postoperative cardiac damage. The degree of carotid artery stenosis, and echolucent carotid plaques were not associated with postoperative cardiac damage. CONCLUSIONS Asymptomatic postoperative cardiac damage occurs often after carotid endarterectomy and presents independently from coronary risk. Carotid plaques of higher echogenicity are associated with severity of coronary artery disease and cardiac damage after carotid endarterectomy.
Collapse
Affiliation(s)
- George Galyfos
- 1st Department of Propedeutic Surgery, University of Athens Medical School, Hippocration Hospital, Athens, Greece -
| | | | | | | | | | | | | | | | | |
Collapse
|
14
|
Liakos CI, Vyssoulis GP, Markou MI, Kafkas NV, Toutouzas KP, Tousoulis D. Twenty-Four-Hour Urine α 1 -Microglobulin as a Marker of Hypertension-Induced Renal Impairment and Its Response on Different Blood Pressure-Lowering Drugs. J Clin Hypertens (Greenwich) 2016; 18:1000-1006. [PMID: 26992096 DOI: 10.1111/jch.12811] [Citation(s) in RCA: 8] [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] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Revised: 01/20/2016] [Accepted: 01/27/2016] [Indexed: 11/30/2022]
Abstract
The purpose of this study was to assess the role of urine α1 -microglobulin as a marker of hypertension-induced renal damage compared with estimated glomerular filtration rate, (eGFR), urine albumin, and urine albumin-to-creatinine ratio (ACR). Its response on different blood pressure (BP)-lowering drugs was also studied. Sixty never-treated hypertensive patients (65.0% men, 46.9 years, BP 141.4/94.0 mm Hg) were randomized to an irbesartan (an angiotensin receptor blocker [ARB]) or a diltiazem (a nondihydropyridine calcium channel blocker [CCB])-based regimen. Patients with diabetes or established cardiovascular, renal, or liver disease were excluded. Blood samples and 24-hour urine were analyzed at baseline and 6 months after pharmaceutical BP normalization. Serum creatinine was measured and eGFR was calculated. Urine albumin, creatinine, and α1 -microglobulin were measured and ACR was calculated. Minor changes (P=not significant [NS]) in eGFR were noted during follow-up in both groups (from 111.0 mL/min/1.73 m2 to 108.4 mL/min/1.73 m2 in the ARB group and from 111.3 mL/min/1.73 m2 to 114.0 mL/min/1.73 m2 in the CCB group). Twenty-four-hour urine indices were all significantly improved (P<.01) in the ARB group (albumin from 19.4 mg/L to 8.2 mg/L, ACR from 21.5 mg/g to 10.0 mg/g, α1 -microglobulin from 5.06 mg/L to 3.64 mg/L) but not (P=NS) in the CCB group (albumin from 15.6 mg/L to 13.9 mg/L, ACR from 17.6 mg/g to 17.1 mg/g, α1 -microglobulin from 4.94 mg/L to 4.79 mg/L). These differences between groups remained significant (P<.05) after adjusting for office heart rate and BP. α1 -Microglobulin was significantly correlated (P<.05) with albumin and ACR both at baseline (r=0.283 and 0.299, respectively) and at the end of follow-up (r=0.432 and 0.465, respectively) but not (P=NS) with eGFR. It was also significantly related (P<.05) to cardiovascular risk scores (Framingham and HeartScore) both at baseline (r=0.264 and 0.436, respectively) and at the end of follow-up (r=0.308 and 0.472, respectively). Urine α1 -microglobulin emerges as a potentially usable marker of hypertension-induced renal impairment. Its excretion rate and its response to treatment appears similar to that of albumin. Irbesartan but not diltiazem seems to be associated with reduced excretion of α1 -microglobulin in urine.
Collapse
Affiliation(s)
- Charalampos I Liakos
- 1st Cardiology Department, Hippokration Hospital, University of Athens Medical School, Athens, Greece.
| | - Gregory P Vyssoulis
- 1st Cardiology Department, Hippokration Hospital, University of Athens Medical School, Athens, Greece
| | - Maria I Markou
- 1st Cardiology Department, Hippokration Hospital, University of Athens Medical School, Athens, Greece
| | - Nikolaos V Kafkas
- Cardiology Department, "KAT" General Hospital of Attica, Athens, Greece
| | - Konstantinos P Toutouzas
- 1st Cardiology Department, Hippokration Hospital, University of Athens Medical School, Athens, Greece
| | - Dimitrios Tousoulis
- 1st Cardiology Department, Hippokration Hospital, University of Athens Medical School, Athens, Greece
| |
Collapse
|
15
|
Bouki KP, Vlad D, Riga M, Stergiouli I, Toutouzas KP. Improved vascular healing after the successful treatment of very late sirolimus-eluting stent thrombosis with a bare metal stent implantation – A serial optical coherence tomography study. Hellenic J Cardiol 2016; 57:129-33. [DOI: 10.1016/j.hjc.2016.03.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2014] [Accepted: 05/30/2015] [Indexed: 11/17/2022] Open
|
16
|
Iliescu CA, Grines CL, Herrmann J, Yang EH, Cilingiroglu M, Charitakis K, Hakeem A, Toutouzas KP, Leesar MA, Marmagkiolis K. SCAI Expert consensus statement: Evaluation, management, and special considerations of cardio-oncology patients in the cardiac catheterization laboratory (endorsed by the cardiological society of india, and sociedad Latino Americana de Cardiologıa intervencionista). Catheter Cardiovasc Interv 2016; 87:E202-23. [PMID: 26756277 DOI: 10.1002/ccd.26379] [Citation(s) in RCA: 121] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Accepted: 11/28/2015] [Indexed: 12/24/2022]
Abstract
In the United States alone, there are currently approximately 14.5 million cancer survivors, and this number is expected to increase to 20 million by 2020. Cancer therapies can cause significant injury to the vasculature, resulting in angina, acute coronary syndromes (ACS), stroke, critical limb ischemia, arrhythmias, and heart failure, independently from the direct myocardial or pericardial damage from the malignancy itself. Consequently, the need for invasive evaluation and management in the cardiac catheterization laboratory (CCL) for such patients has been increasing. In recognition of the need for a document on special considerations for cancer patients in the CCL, the Society for Cardiovascular Angiography and Interventions (SCAI) commissioned a consensus group to provide recommendations based on the published medical literature and on the expertise of operators with accumulated experience in the cardiac catheterization of cancer patients.
Collapse
Affiliation(s)
- Cezar A Iliescu
- MD Anderson Cancer Center, University of Texas, Houston, Texas
| | - Cindy L Grines
- Detroit Medical Center, Cardiovascular Institute, Detroit, Michigan
| | - Joerg Herrmann
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Eric H Yang
- Division of Cardiology, University of California at Los Angeles, Los Angeles, California
| | - Mehmet Cilingiroglu
- School of Medicine, Arkansas Heart Hospital, Little Rock, Arkansas.,Department of Cardiology, Koc University, Istanbul, Turkey
| | | | - Abdul Hakeem
- Department of Cardiology, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | | | - Massoud A Leesar
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, Alabama
| | - Konstantinos Marmagkiolis
- Department of Cardiology, Citizens Memorial Hospital, Bolivar, Missouri.,Department of Medicine, University of Missouri, Columbia, Missouri
| |
Collapse
|
17
|
P. Toutouzas K, E. Stathogiannis K, S. Latsios G, G. Synetos A, I. Stefanadis C. Recent Valves used for Transluminal Implantation in Patients with Aortic Valve Stenosis. ACTA ACUST UNITED AC 2012; 7:206-15. [DOI: 10.2174/157489012803832766] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2012] [Revised: 10/25/2012] [Accepted: 10/30/2012] [Indexed: 11/22/2022]
|
18
|
Bouki KP, Katsafados MG, Chatzopoulos DN, Psychari SN, Toutouzas KP, Charalampopoulos AF, Sakkali EN, Koudouri AA, Liakos GK, Apostolou TS. Inflammatory markers and plaque morphology: an optical coherence tomography study. Int J Cardiol 2010; 154:287-92. [PMID: 20974497 DOI: 10.1016/j.ijcard.2010.09.059] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [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: 07/05/2010] [Accepted: 09/25/2010] [Indexed: 10/18/2022]
Abstract
BACKGROUND OCT with its unique image resolution is the ideal method to detect culprit lesion characteristics in different clinical presentations. The identification of inflammatory markers related to plaque characteristics may be of clinical importance. METHODS Thirty-two patients with acute coronary syndromes (ACS) and fourteen patients with stable angina pectoris (SAP) were enrolled in this study. Culprit lesion morphology was assessed by optical coherence tomography (OCT) in patients with ACS and SAP. The possible relations between serum levels of high sensitivity-C reactive protein (hs-CRP) and interleukin-18 (IL-18) with plaque characteristics were investigated in those patients. RESULTS Plaque rupture and thin-cap fibroatheroma (TCFA) were detected more frequently in ACS patients compared with SAP patients, (78.6% vs. 14.3%, p<0.001, 92.9% vs. 14.3%, p<0.001, respectively). Higher levels of serum hs-CRP and IL-18 were found in patients with plaque rupture vs. those with no plaque rupture (median value: 19.2mg/L vs. 1.6 mg/L, p<0.001 and 219.5 pg/ml vs. 127.5 pg/ml, p=0.001 respectively), and TCFA vs. those without TCFA (median value: 15.2mg/L vs. 1.6 mg/L, p=0.004 and 209.0 pg/ml vs.153.2 pg/ml, p=0.03 respectively). Serum hs-CRP was the only independent predictor of plaque rupture (p=0.02, odds ratio 1.1, 95% confidence interval 1.0 to 1.2). A cut-off value of hs-CRP>4.5mg/L could detect ruptured plaque with a sensitivity of 91.7% and a specificity of 77.8%. CONCLUSIONS OCT detected plaque rupture and TCFA more frequent in ACS patients compared with SAP. Elevated hs-CRP and IL-18 were positively related to plaque instability and rupture.
Collapse
Affiliation(s)
- Konstantina P Bouki
- Second Department of Cardiology, General Hospital of Nikea, Pireaus, Greece.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
19
|
Michaelides AP, Liakos CI, Antoniades C, Dilaveris PE, Tsiamis EG, Tsioufis KP, Aggeli KD, Toutouzas KP, Raftopoulos LG, Stefanadis CI. Right-sided chest leads in exercise testing for detection of coronary restenosis. Clin Cardiol 2010; 33:236-40. [PMID: 20162735 DOI: 10.1002/clc.20609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The incorporation of right-sided chest leads (V(3)R through V(5)R) into standard exercise testing has been reported to improve its diagnostic utility. HYPOTHESIS The purpose of this study was to evaluate any improvement in the ability of exercise testing in detecting restenosis, using additional V(3)R through V(5)R leads, in asymptomatic patients undergoing percutaneous coronary intervention (PCI) in the right coronary artery (RCA) or/and left circumflex (LCX). METHODS We studied 172 consecutive patients (54 +/- 7 years old, 106 males) undergoing PCI in RCA or/and LCX. A treadmill test had been performed before PCI. Six months later, all patients underwent a second treadmill test and arteriography in order to detect silent ischemia due to restenosis. Recordings during exercise were obtained with the standard 12-leads plus V(3)R through V(5)R. RESULTS Out of 172 patients, 106 had stenosis in RCA, 35 in LCX, and 31 in both vessels while 6 months later, restenosis was detected in 8 (for RCA), 3 (for LCX), and 3 (for both vessels) patients respectively. Sensitivity, specificity, positive prognostic value, negative prognostic value, and accuracy of exercise testing performed post PCI were ameliorated using V(3)R through V(5)R (79% vs 57%, 97% vs 80%, 69% vs 21%, 98% vs 95%, and 95% vs 78% respectively, P < .05 for all except negative prognostic value). Maximal exercise-induced ST-segment deviation (in mm) was not changed post PCI in 12 leads (1.4 +/- 0.2 vs 1.5 +/- 0.2, P = NS) while it was decreased in V(3)R through V(5)R (0.2 +/- 0.2 vs 1.2 +/- 0.3, P < .01). CONCLUSIONS The addition of V(3)R through V(5)R improves the diagnostic ability of standard exercise testing in detecting silent ischemia due to restenosis in patients undergoing PCI in RCA or/and LCX.
Collapse
Affiliation(s)
- Andreas P Michaelides
- Exercise Laboratory, 1st University Department of Cardiology, Athens Medical School, Hippokration Hospital, Athens, Greece.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
20
|
Tsioufis CP, Kallikazaros IE, Toutouzas KP, Stefanadis CI, Toutouzas PK. Exaggerated carotid sinus massage responses are related to severe coronary artery disease in patients being evaluated for chest pain. Clin Cardiol 2006; 25:161-6. [PMID: 12000073 PMCID: PMC6653916 DOI: 10.1002/clc.4960250406] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [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: 11/05/2022] Open
Abstract
BACKGROUND Previous studies have reported that carotid sinus massage responses are associated with advancing age and carotid or coronary artery disease. HYPOTHESIS This study was undertaken to investigate the potential role of carotid sinus hypersensitivity as a marker for the presence of coronary artery disease, and especially left main stem disease, in patients who were referred for evaluation of chest pain. METHODS Toward this end, carotid sinus stimulation with simultaneous recordings of the electrocardiogram and aortic pressure was performed before coronary arteriography in 150 selected consecutive patients (mean age 59.4+/-9 years) who were referred for evaluation of chest pain. RESULTS Coronary artery disease was present in 118 patients (78.7%); of these, 35 had single-vessel disease, 35 had double-vessel disease, 33 had triple-vessel disease, and 15 had left main stem with or without such vessel disease. Carotid sinus hypersensitivity was found in 40 patients (26.6%). The incidence of hypersensitivity in patients with single-, double-, or triple-vessel disease and left main stem disease was 8.5, 14.2, 57.5, and 73.3%, respectively. Stepwise multiple logistic regression analysis revealed that left main stem disease was significantly and independently related to the presence of carotid sinus hypersensitivity (p < 0.05). In addition, the presence of hypersensitivity had 73.3% sensitivity, 86.2% specificity, and 96.3% negative predictive value for the presence of left main stem disease. CONCLUSION In patients being evaluated for suspected ischemic heart disease, carotid sinus massage responses are related to severe coronary disease. The absence of hypersensitivity may reflect absence of left main stem disease.
Collapse
Affiliation(s)
- Costas P Tsioufis
- Department of Cardiology, Hippokration Hospital, University of Athens, Greece
| | | | | | | | | |
Collapse
|
21
|
Pitsavos CE, Stefanadis CI, Stratos CG, Lambrou SG, Toutouzas KP, Barbetseas ID, Toutouzas PK. Assessment of accuracy of the Doppler pressure half-time method in the estimation of the mitral valve area immediately after balloon mitral valvuloplasty. Eur Heart J 1997; 18:455-63. [PMID: 9076383 DOI: 10.1093/oxfordjournals.eurheartj.a015266] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
AIM The reliability of Doppler echocardiography in determining the mitral valve area after balloon mitral valvuloplasty has been questioned, as discrepancies were noted between measurements obtained by the pressure half-time method and those derived haemodynamically, immediately following completion of the procedure. Recent investigations, however, have indicated that these discrepancies may be attributable to the over-estimation of the mitral valve area by haemodynamic measurements, caused by the presence of the iatrogenic atrial septal defect complicating transseptal catheterization. The aim of the present study was to further test this hypothesis. METHODS AND RESULTS Measurements of the mitral valve area by the Doppler pressure half-time method and the Gorlin formula were obtained and compared in 238 consecutive patients before and immediately after retrograde non-transseptal balloon mitral valvuloplasty, which does not involve puncture and/or dilatation of the inter-atrial septum. No significant difference was found between Doppler- and Gorlin-derived measurements, neither before (1.04 +/- 0.23 vs 1.03 +/- 0.23 cm2, P = ns) nor immediately after (2.14 +/- 0.47 vs 2.12 +/- 0.49 cm2, P = ns) valvuloplasty. Linear regression analysis demonstrated a high degree of correlation between Doppler and Gorlin measurements before (r = 0.778) and after (r = 0.886) the procedure. Good agreement was confirmed by the Bland-Altman method. CONCLUSION Doppler echocardiography yields accurate measurements of the mitral valve area immediately after retrograde non-transseptal balloon mitral valvuloplasty. This finding supports the hypothesis that the creation of an iatrogenic atrial septal defect during transseptal catheterization may contribute to the poor agreement between Doppler and Gorlin data after balloon mitral valvuloplasty.
Collapse
Affiliation(s)
- C E Pitsavos
- Hippokration Hospital, Department of Cardiology, University of Athens, Greece
| | | | | | | | | | | | | |
Collapse
|