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Armario X, Carron J, Simpkin AJ, Elhadi M, Kennedy C, Abdel-Wahab M, Bleiziffer S, Lefèvre T, Wolf A, Pilgrim T, Villablanca PA, Blackman DJ, Van Mieghem NM, Hengstenberg C, Swaans MJ, Prendergast BD, Patterson T, Barbanti M, Webb JG, Behan M, Resar J, Chen M, Hildick-Smith D, Spence MS, Zweiker D, Bagur R, Teles R, Ribichini FL, Jagielak D, Park DW, Kornowski R, Wykrzykowska JJ, Bunc M, Estévez-Loureiro R, Poon K, Götberg M, Jeger RV, Ince H, Packer EJS, Angelillis M, Nombela-Franco L, Guo Y, Savontaus M, Al-Moghairi AM, Parasca CA, Kliger C, Roy D, Molnár L, Silva M, White J, Yamamoto M, Carrilho-Ferreira P, Toggweiler S, Voudris V, Ohno Y, Rodrigues I, Parma R, Ojeda S, Toutouzas K, Regueiro A, Grygier M, AlMerri K, Cruz-González I, Fridrich V, de la Torre Hernández JM, Noble S, Kala P, Asmarats L, Kurt IH, Bosmans J, Erglis M, Casserly I, Iskandarani D, Bhindi R, Kefer J, Yin WH, Rosseel L, Kim HS, O'Connor S, Hellig F, Sztejfman M, Mendiz O, Pineda AM, Seth A, Pllaha E, de Brito FS, Bajoras V, Balghith MA, Lee M, Eid-Lidt G, Vandeloo B, Vaz VD, Alasnag M, Ussia GP, Tay E, Mayol J, Gunasekaran S, Sardella G, Buddhari W, Kao HL, Dager A, Tzikas A, Gudmundsdottir IJ, Edris A, Gutiérrez Jaikel LA, Arias EA, Al-Hijji M, Ertürk M, Conde-Vela C, Boljević D, Ferrero Guadagnoli A, Hermlin T, ElGuindy AM, Lima-Filho MDO, de Moura Santos L, Perez L, Maluenda G, Akyüz AR, Alhaddad IA, Amin H, So CY, Al Nooryani AA, Vaca C, Albistur J, Nguyen QN, Arzamendi D, Grube E, Modine T, Tchétché D, Hayashida K, Latib A, Makkar RR, Piazza N, Søndergaard L, McEvoy JW, Mylotte D. Impact of the COVID-19 Pandemic on Global TAVR Activity: The COVID-TAVI Study. JACC Cardiovasc Interv 2024; 17:374-387. [PMID: 38180419 DOI: 10.1016/j.jcin.2023.10.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 10/12/2023] [Accepted: 10/16/2023] [Indexed: 01/06/2024]
Abstract
BACKGROUND The COVID-19 pandemic adversely affected health care systems. Patients in need of transcatheter aortic valve replacement (TAVR) are especially susceptible to treatment delays. OBJECTIVES This study sought to evaluate the impact of the COVID-19 pandemic on global TAVR activity. METHODS This international registry reported monthly TAVR case volume in participating institutions prior to and during the COVID-19 pandemic (January 2018 to December 2021). Hospital-level information on public vs private, urban vs rural, and TAVR volume was collected, as was country-level information on socioeconomic status, COVID-19 incidence, and governmental public health responses. RESULTS We included 130 centers from 61 countries, including 65,980 TAVR procedures. The first and second pandemic waves were associated with a significant reduction of 15% (P < 0.001) and 7% (P < 0.001) in monthly TAVR case volume, respectively, compared with the prepandemic period. The third pandemic wave was not associated with reduced TAVR activity. A greater reduction in TAVR activity was observed in Africa (-52%; P = 0.001), Central-South America (-33%; P < 0.001), and Asia (-29%; P < 0.001). Private hospitals (P = 0.005), urban areas (P = 0.011), low-volume centers (P = 0.002), countries with lower development (P < 0.001) and economic status (P < 0.001), higher COVID-19 incidence (P < 0.001), and more stringent public health restrictions (P < 0.001) experienced a greater reduction in TAVR activity. CONCLUSIONS TAVR procedural volume declined substantially during the first and second waves of the COVID-19 pandemic, especially in Africa, Central-South America, and Asia. National socioeconomic status, COVID-19 incidence, and public health responses were associated with treatment delays. This information should inform public health policy in case of future global health crises.
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Affiliation(s)
- Xavier Armario
- Department of Cardiology, Galway University Hospital, Galway, Ireland; Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Jennifer Carron
- Department of Cardiology, Galway University Hospital, Galway, Ireland
| | - Andrew J Simpkin
- School of Mathematical and Statistical Sciences, University of Galway, Galway, Ireland
| | - Mohamed Elhadi
- Department of Cardiology, Galway University Hospital, Galway, Ireland
| | - Ciara Kennedy
- Department of Cardiology, Galway University Hospital, Galway, Ireland
| | | | - Sabine Bleiziffer
- Heart and Diabetes Center Northrhine-Westfalia, Clinic for Thoracic and Cardiovascular Surgery, Bad Oeynhausen, Germany
| | | | | | | | | | | | | | | | | | | | | | | | - John G Webb
- St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Miles Behan
- Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - Jon Resar
- John Hopkins Hospital, Baltimore, Maryland, USA
| | - Mao Chen
- West China Hospital, Sichuan University, Chengdu, China
| | | | | | | | - Rodrigo Bagur
- University Hospital, London Health Sciences Center, London, Ontario, Canada
| | - Rui Teles
- Hospital de Santa Cruz, CHLO, Nova Medical School, CEDOC, Lisbon, Portugal
| | | | | | | | | | | | - Matjaz Bunc
- Ljubljana University Medical Center, Ljubljana, Slovenia
| | | | - Karl Poon
- The Prince Charles Hospital, Brisbane, Australia
| | - Matthias Götberg
- Clinical Sciences, Lund University, Skane University Hospital, Lund, Sweden
| | | | | | | | | | | | - Yingqiang Guo
- West China Hospital, Sichuan University, Chengdu, China
| | | | | | | | - Chad Kliger
- Lenox Hill/Northwell Health, New York, New York, USA
| | - David Roy
- St. Vincent's Hospital, Sydney, Australia
| | - Levente Molnár
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Mariana Silva
- Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | | | - Masanori Yamamoto
- Toyohashi Heart Center, Toyohashi, Japan; Nagoya Heart Center, Nagoya, Japan; Gifu Heart Center, Gifu, Japan
| | | | | | | | - Yohei Ohno
- Tokai University School of Medicine, Isehara, Japan
| | | | | | - Soledad Ojeda
- Hospital Universitario Reina Sofía, Universidad de Córdoba, Instituto Maimónides de Investigación Biomédica de Córdoba, Córdoba, Spain
| | | | | | - Marek Grygier
- Poznan University School of Medical Sciences, Poznan, Poland
| | | | | | - Viliam Fridrich
- National Institute of Cardiovascular Diseases, Bratislava, Slovakia
| | | | | | - Petr Kala
- Centrum Kardiovaskulární a Transplantační Chirurgie, Brno, Czechia
| | | | | | | | | | - Ivan Casserly
- Mater Misericordiae University Hospital, Dublin, Ireland; Mater Private Hospital, Dublin, Ireland
| | | | | | - Joelle Kefer
- Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | | | | | - Hyo-Soo Kim
- Seoul National University Hospital, Seoul, South Korea
| | | | | | | | | | - Andres M Pineda
- University of Florida College of Medicine Jacksonville, Jacksonville, Florida, USA
| | - Ashok Seth
- Fortis Escorts Heart Institute, New Delhi, India
| | | | | | - Vilhelmas Bajoras
- Division of Cardiology and Vascular Diseases, Vilnius University Hospital Santaros Clinics, Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | | | - Michael Lee
- Queen Elizabeth Hospital, Hong Kong, Hong Kong
| | - Guering Eid-Lidt
- Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico
| | - Bert Vandeloo
- Department of Cardiology, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Belgium
| | | | | | - Gian Paolo Ussia
- Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Edgar Tay
- National University Heart Center, Singapore, Singapore
| | | | | | | | | | - Hsien-Li Kao
- National Taiwan University Hospital, Taipei, Taiwan
| | | | | | | | - Ahmad Edris
- Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | | | | | | | - Mehmet Ertürk
- Istanbul Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, University of Health Science, Istanbul, Turkey
| | | | | | | | | | | | - Moysés de Oliveira Lima-Filho
- Hospital das Clínicas de Ribeirão Preto, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, Brazil
| | | | - Luis Perez
- Hospital Clínico Regional Guillermo Grant Benavente, Concepción, Chile
| | - Gabriel Maluenda
- Hospital San Borja Arriaran, Santiago, Chile; Clínica Alemana, Santiago, Chile
| | - Ali Rıza Akyüz
- Ahi Evren Thoracic and Cardiovascular Surgery Training and Research Hospital, Health Sciences University, Trabzon, Turkey
| | | | - Haitham Amin
- Mohammed Bin Khalifa Cardiac Center, Royal Medical Services, Awali, Bahrain
| | - Chak-Yu So
- Prince of Wales Hospital, Hong Kong, Hong Kong
| | | | - Carlos Vaca
- Instituto de Cardiología Intervencionista Cardiovida SRL, Santa Cruz, Bolivia
| | - Juan Albistur
- Hospital de Clínicas Dr Manuel Quintela, Montevideo, Uruguay
| | | | | | | | | | | | | | - Azeem Latib
- Montefiore Medical Center, Bronx, New York, USA
| | - Raj R Makkar
- Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Nicolo Piazza
- McGill University Health Center, Montréal, Quebec, Canada
| | | | - John William McEvoy
- Department of Cardiology, Galway University Hospital, Galway, Ireland; School of Medicine, University of Galway, Galway, Ireland
| | - Darren Mylotte
- Department of Cardiology, Galway University Hospital, Galway, Ireland; School of Medicine, University of Galway, Galway, Ireland.
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2
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Chlorogiannis DD, Synetos A, Doulamis I, Chatzigeorgiou G, Karabinos I, Mastrokostopoulos A, Panagopoulos Z, Toutouzas K, Chlorogiannis I. The safety and efficacy of a modified Wrapping technique for the treatment of ascending aortic dilatation. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Current data are unclear in terms of the simultaneous treatment of Ascending Aorta Aneurysms (AAD) with a coexisting surgical pathology requiring open heart surgery (OHS), since replacement of the ascending aorta in all of those AAD patients may increase morbidity and mortality in respect with longer time in extracorporeal circulation. To overcome the aforementioned complications in patients with ADD and a concomitant indication for OHS, we have applied a less invasive technique, in contrast to the conventional method of replacement of the ascending aorta with a supracoronary synthetic tubular graft interposition
Purpose
We tested the safety and the efficacy of the Wrapping Ascending Aorta Dilatation (WAAD) technique that is based on the wrapping of the dilated ascending aorta with a synthetic graft from the sinotubular junction to the origin of innominate artery.
Methods
We retrospectively studied 254 patients who underwent ascending aorta surgery from 2000 to 2020 at Euroclinic Hospital of Athens Greece, from the same senior Cardiac Surgeon. Patients with an AAD with a diameter of 40–45mm in combination with a coexisting cardiac surgical pathology requiring OHS were treated with the wrapping technique, while patients with AAD diameter more than 45mm were treated with replacement. The WAAD technique was applied during patient's rewarming period using a longitudinally opened synthetic tubular Dacron graft around the AAD, without increasing the patient's time on extracorporeal circulation. The mean follow-up interval was 12.2±4.5 years.
Results
Two hundred and three patients (80%) were treated with OHS with replacement of the ascending aorta. Fifty one patients (20%) had an AAD with a diameter of 40–45mm (mean diameter 43±3.3mm) in combination with a coexisting cardiac surgical pathology requiring OHS and were treated with the WAAD technique. due to concomitant aortic valve surgery in 34 patients (67%), coronary artery bypass Graft in 10 patients (19.6%) and mitral valve surgery in 7 (14%). One of the patients who underwent mitral valve surgery exhibited AAD as well as dilation of the common pulmonary trunk extending to the right pulmonary artery and had both treated with the wrapping technique. During follow up no AAD recurrence or any other event concerning the ascending aorta or pulmonary artery were observed.
Conclusion
In patients with AAD undergoing OHS for a different cardiac pathology, WAAD is safe and effective and may be beneficial for patients with AAD with an aortic diameter of 40–45mm. Further randomized control studies are needed to confirm our results.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
| | - A Synetos
- University of Athens Medical School, 1st Department of Cardiology , Athens , Greece
| | - I Doulamis
- Johns Hopkins University School of Medicine , Baltimore , United States of America
| | | | | | | | | | - K Toutouzas
- University of Athens Medical School, 1st Department of Cardiology , Athens , Greece
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Apostolos A, Trigka A, Chlorogiannis D, Vasilagkos G, Chamakioti M, Spyropoulou P, Karamasis G, Dimitriadis K, Moulias A, Katsanos K, Tsioufis C, Toutouzas K, Alexopoulos D, Davlouros P, Tsigkas G. Thirty-days versus standard duration of dual antiplatelet treatment after percutaneous coronary interventions: a systematic review and meta-analysis. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background/Introduction
Abbreviation of duration of dual antiplatelet therapy (DAPT) (one or three months) has been recently proposed, especially for high-bleeding risk patients, after percutaneous coronary intervention (PCI) with drug-eluting stent (DES).
Purpose
The purpose of the specific systematic review and meta-analysis was to compare 30-days versus longer duration (≥3 months) of DAPT in patients undergoing PCI with DES, focusing on ischemic and bleeding events.
Methods
Three databases were screened for eligible randomized-control trials. The primary endpoint was the incidence of net adverse clinical events (NACE), as they were defined in each trial. Secondary endpoints consisted of major adverse cardiovascular events (MACE), all-cause and cardiovascular mortality, myocardial infraction, stroke, stent-thrombosis, repeat revascularization and major bleeding.
Results
We included 4 RCTs with a total of 26,576 patients; 13,282 patients were grouped in 30-days DAPT, while the remaining 13,294 were allocated in longer period of DAPT. One-month of DAPT did not significantly reduce NACE (odds ratio [OR]: 0.87, 95% confidence intervals [Cl]: 0.74–1.03); however major bleedings were significantly reduced by 22% (OR: 0.78, 95% Cl: 0.65–0.94). Mortality or ischemic events (stroke, myocardial infraction, revascularization and stent thrombosis) were not affected.
Conclusions
Thirty-days DAPT did not significantly affect NACEs. However, odds of major bleedings were reduced significantly by 22%. Mortality and ischemic events did not differ between the two arms. Thus, 30-days DAPT could be considered as a safe and feasible after PCI with DES in selected patients, especially those in high-bleeding risk. Forthcoming RCTs could shed light on the optimal duration of DAPT.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- A Apostolos
- University Hospital of Patras, Department of Cardiology , Patras , Greece
| | - A Trigka
- University Hospital of Patras, Department of Cardiology , Patras , Greece
| | - D Chlorogiannis
- University Hospital of Patras, Department of Cardiology , Patras , Greece
| | - G Vasilagkos
- University Hospital of Patras, Department of Cardiology , Patras , Greece
| | - M Chamakioti
- University Hospital of Patras, Department of Cardiology , Patras , Greece
| | - P Spyropoulou
- University Hospital of Patras, Department of Cardiology , Patras , Greece
| | - G Karamasis
- Attikon University Hospital, att , Athens , Greece
| | | | - A Moulias
- University Hospital of Patras, Department of Cardiology , Patras , Greece
| | - K Katsanos
- University Hospital of Patras , Patras , Greece
| | - C Tsioufis
- Hippokration General Hospital , Athens , Greece
| | - K Toutouzas
- Hippokration General Hospital , Athens , Greece
| | | | - P Davlouros
- University Hospital of Patras, Department of Cardiology , Patras , Greece
| | - G Tsigkas
- University Hospital of Patras, Department of Cardiology , Patras , Greece
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Anousakis-Vlachochristou N, Ktenopoulos N, Paschalidis N, Giannouli C, Vlasopoulou K, Miliou A, Divani M, Alexopoulou M, Kentepozidi E, Charitos D, Cokkinos D, Tsioufis C, Toutouzas K. Novel peripheral blood immune cell populations correlate with disease progression and reveal systemic interactions in severe aortic valve stenosis patients. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Osteoblastic differentiation is the key driver phenomenon underlying degenerative aortic valve stenosis (AS). It is characterized by a complex cellular interplay and infiltration by circulating immune cells. Moreover, AS demonstrates a diverse natural course, which is understudied.
Purpose
We sought to investigate the presence of AS clinical progression subphenotypes in the context of “AthenaValve” trial (NCT04312139).
Methods
Consecutive patients with severe AS undergoing TAVI or SAVR with complete clinical data, echocardiographic history (≥3 past years, corresponding from moderate to severe AS), along with matched healthy volunteers, were included. The median transaortic Vmax increase/month (Vi/m) was calculated and cluster analysis was used to reveal AS progression subgroups. Whole blood peripheral mononuclear cells (PBMCs) were isolated with density gradient centrifugation and cryopreserved into FBS-10% DMSO. PBMC populations were investigated with mass cytometry (CyTOF, Helios, Fluidigm) using a 30-marker antibody panel (Direct Immune Profiling Assay, Fluidigm) and analyzed with Flowjo and Cytobank software.
Results
A total of 67 patients fulfilling criteria were included (mean age 77.2±10 years, 61.2% males). Two-step cluster algorithm identified 2 clusters of AS progression: C1: 80%, mean Vi/m = 0.03±0.01 vs C2: 20%, Vi/m = 0.07±0.1 m/s/month, average silhouette = 0.7. Mean time to progression to severe AS differed significantly: C1: 59.5 (48.9,70.1) vs C2: 40.2 (29.2, 51.2) months, log rank p=0.05. Among those, 20 patients (C1: 10, C2: 10) and 10 healthy volunteers were included in CyTOF. Demographics, atherosclerotic clinical factors and renal function did not differ among patients-volunteers and C1-C2 groups. B cells, B-memory, B-naïve and pDendritic cells discriminated patients from healthy volunteers: ROC curve (AUC: 0.885, p=0.001), (0.913, p<0.001), (0.770, p=0.018), (0.282, p=0.056), profile (%): (5.3±3 vs 10.2±4), (0.86±0.4 vs 2.6±2), (4.4±3 vs 7.6±4), and (0.48±0.2 vs 0.3±0.1), respectively (mean live cells analyzed: 284028.8±52213.8). pDendritic cells and CD4-Th17-like cells discriminated C1 from C2 patients: ROC curve AUC: (0.804, p=0.005) and (0.268, p=0.031), profile (%): (0.6±0.2 vs 0.3±0.2) and (0.9±0.5 vs 2.6±0.9), respectively).
Conclusions
Aortic valve stenosis patients demonstrate two distinct phenotypes of disease progression from moderate to severe stage. Patients demonstrate reduced circulating B-cells and increased plasmatocytoid dendritic cells. The rapid progression subgroup of patients demonstrates reduced pDendritic and increased CD4-Th17-like cells. Further works are needed to expand and validate these results.
Funding Acknowledgement
Type of funding sources: Public grant(s) – EU funding. Main funding source(s): Co-Funded by Hellenic Ministry of Development and European Regional Development Fund in the context of an open call of “EATRIS-GR project: Infrastructure for preclinical and early-phase clinical development of drugs, therapeutics, and biomedical devices”
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Affiliation(s)
| | - N Ktenopoulos
- National & Kapodistrian University of Athens Medical School , Athens , Greece
| | - N Paschalidis
- Academy of Athens Biomedical Research Foundation, CyTOF Lab , Athens , Greece
| | - C Giannouli
- Academy of Athens Biomedical Research Foundation, CyTOF Lab , Athens , Greece
| | - K Vlasopoulou
- National & Kapodistrian University of Athens Medical School , Athens , Greece
| | - A Miliou
- National & Kapodistrian University of Athens Medical School , Athens , Greece
| | - M Divani
- National & Kapodistrian University of Athens Medical School , Athens , Greece
| | - M Alexopoulou
- National & Kapodistrian University of Athens Medical School , Athens , Greece
| | - E Kentepozidi
- National & Kapodistrian University of Athens Medical School , Athens , Greece
| | - D Charitos
- National & Kapodistrian University of Athens Medical School , Athens , Greece
| | - D Cokkinos
- Academy of Athens Biomedical Research Foundation, Cardiovascular Translational Research Unit , Athens , Greece
| | - C Tsioufis
- National & Kapodistrian University of Athens Medical School , Athens , Greece
| | - K Toutouzas
- National & Kapodistrian University of Athens Medical School , Athens , Greece
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5
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Chlorogiannis DD, Synetos A, Doulamis I, Chatzigeorgiou G, Karabinos I, Mastrokostopoulos A, Panagopoulos Z, Toutouzas K, Chlorogiannis I. The wrapping technique as an alternative method for the treatment of ascending aortic dilatation. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
The natural history of Ascending Aorta Dilatations (AAD) is unpredictable because acute dissections and ruptures have been observed even at aortic diameter sizes as small as 40s mm. Current data are unclear in terms of the simultaneous treatment of Ascending Aorta Aneurysms (AAD) with a coexisting surgical pathology requiring open heart surgery (OHS). To overcome the aforementioned complications in patients with ADD and a concomitant indication for OHS, we have applied a less invasive technique, in contrast to the conventional method of replacement of the ascending aorta with a supracoronary synthetic tubular graft interposition.
Purpose
The safety and efficacy of the Wrapping Ascending Aorta Dilatation (WAAD) technique that is based on the wrapping of the dilated ascending aorta with a synthetic graft from the sinotubular junction to the origin of innominate artery.
Methods
We studied 254 patients who underwent ascending aorta surgery from 2000 to 2020 at a Euroclinic Hospital Greece, from the same senior Cardiac Surgeon. Patients with an AAD with a diameter of 40–45mm in combination with a coexisting cardiac surgical pathology requiring OHS were treated with the wrapping technique, while patients with AAD diameter more than 45mm were treated with replacement. The WAAD technique was applied during patient's rewarming period using a longitudinally opened synthetic tubular Dacron graft around the AAD, without increasing the patient's time on extracorporeal circulation. The mean follow-up interval was 12.2±4.5 years.
Results
Two hundred and three patients (80%) were treated with OHS with replacement of the ascending aorta. Fifty one patients (20%) had an AAD with a diameter of 40–45mm (mean diameter 43±3.3mm) in combination with a coexisting cardiac surgical pathology requiring OHS and were treated with the WAAD technique. due to concomitant aortic valve surgery in 34 patients (67%), coronary artery bypass Graft in 10 patients (19.6%) and mitral valve surgery in 7 (14%). One of the patients who underwent mitral valve surgery exhibited AAD as well as dilation of the common pulmonary trunk extending to the right pulmonary artery and had both treated with the wrapping technique. During follow up no AAD recurrence or any other event concerning the ascending aorta or pulmonary artery were observed.
Conclusion
In patients with AAD undergoing OHS for a different cardiac pathology, WAAD is safe and effective and may be beneficial for patients with AAD with an aortic diameter of 40–45mm. Further randomized control studies are needed to confirm our results.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
| | - A Synetos
- University of Athens Medical School, 1st Department of Cardiology , Athens , Greece
| | - I Doulamis
- Johns Hopkins University School of Medicine , Baltimore , United States of America
| | | | | | | | | | - K Toutouzas
- University of Athens Medical School, 1st Department of Cardiology , Athens , Greece
| | - I Chlorogiannis
- University of Athens Medical School, 1st Department of Cardiology , Athens , Greece
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6
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Frountzas M, Karampetsou N, Nikolaou C, Schizas D, Tsapralis D, Avgerinos D, Toutouzas K. Combined heart and liver transplantation: an updated systematic review. Ann R Coll Surg Engl 2022; 104:88-94. [PMID: 34482766 PMCID: PMC10335029 DOI: 10.1308/rcsann.2021.0103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/20/2020] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Combined heart and liver transplantation (CHLT) is one of the most complex procedures of surgery that has been implemented in the last 35 years. The aim of our meta-analysis was to investigate the safety and efficacy of CHLT. MATERIALS The meta-analysis was designed according to PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) and AMSTAR (A MeaSurement Tool to Assess systematic Reviews) recommendations. A literature search was conducted up to April 2020 using the MEDLINE,® SCOPUS,® ClinicalTrials.gov, Embase™, Cochrane Central Register of Controlled Trials and Google Scholar™ databases. RESULTS Our meta-analysis included 16 studies with 860 patients. The mortality rate following CHLT was 14.1%. One and five-year survival rates were 85.3% and 71.4% while the heart and liver rejection rates were 6.1% and 9.1% respectively. The hospital stay was 25.8 days and the intensive care unit stay was 9.9 days. Pooled values were also calculated for cardiopulmonary bypass duration, units of transfused red blood cells and fresh frozen plasma, postoperative infection rate, mechanical ventilation rate and follow-up duration. CONCLUSIONS Despite its complexity, CHLT is a safe and effective procedure for the management of lethal diseases that lead to progressive heart and/or liver failure. Nevertheless, there must be strict adherence to the indications for surgery, and future studies should compare CHLT with isolated cardiac and hepatic transplantations.
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Affiliation(s)
- M Frountzas
- National and Kapodistrian University of Athens, Greece
| | - N Karampetsou
- National and Kapodistrian University of Athens, Greece
| | - C Nikolaou
- National and Kapodistrian University of Athens, Greece
| | - D Schizas
- National and Kapodistrian University of Athens, Greece
| | | | | | - K Toutouzas
- National and Kapodistrian University of Athens, Greece
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7
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Spartalis M, Siasos G, Mastrogeorgiou M, Spartalis E, Kaminiotis VV, Mylonas KS, Kapelouzou A, Kontogiannis C, Doulamis IP, Toutouzas K, Nikiteas N, Iliopoulos DC. The effect of per os colchicine administration in combination with fenofibrate and N-acetylcysteine on triglyceride levels and the development of atherosclerotic lesions in cholesterol-fed rabbits. Eur Rev Med Pharmacol Sci 2021; 25:7765-7776. [PMID: 34982438 DOI: 10.26355/eurrev_202112_27623] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 12/07/2022]
Abstract
OBJECTIVE Atherosclerosis is a chronic inflammatory disease promoted by pro-inflammatory cytokines produced by NOD-, LRR- and pyrin domain-containing protein 3 (NLRP 3) inflammasome. Colchicine is an anti-inflammatory agent that inhibits inflammasome's action and stabilizes atherosclerotic lesions. N-acetylcysteine (NAC) reduces low-density lipoprotein (LDL) oxidation, metalloproteinase levels, and foam cell count and volume. Fenofibrate also has antioxidant, anti-inflammatory, and anticoagulant properties while also having a beneficial effect on the vasomotor function of the endothelium. The purpose of this study is to investigate the effect of per os colchicine administration in combination with fenofibrate and NAC on triglyceride levels and the development of atherosclerotic lesions in cholesterol-fed rabbits. MATERIALS AND METHODS Twenty-eight male, 2 months old New Zealand White rabbits were separated into four groups and were fed with different types of diet for 7 weeks: standard, cholesterol 1% w/w, cholesterol 1% w/w plus colchicine 2 mg/kg body weight plus 250 mg/kg body weight/day fenofibrate, and cholesterol 1% w/w plus colchicine 2 mg/kg body weight plus 15 mg/kg body weight/day NAC. Blood samples were drawn from all animals. Lipid profiles were assessed, and interleukin 6 (IL-6) measurements were performed using an enzyme-linked immunosorbent assay (ELISA) kit. Histologic examination was performed on aorta specimens stained with eosin and hematoxylin. Aortic intimal thickness was evaluated using image analysis. RESULTS Colchicine administration in combination with fenofibrate or NAC statistically significantly reduced the extent of atherosclerotic lesions in aortic preparations. Co-administration of colchicine with NAC has a stronger anti-atherogenic effect than the colchicine plus fenofibrate regimen. Triglerycide levels were decreased in the colchicine plus fenofibrate group and the colchicine plus NAC group at the end of the experiment (p < 0.05), whereas the Cholesterol group had increased levels. A favorable significant lower concentration of IL-6 was detected in the colchicine plus NAC group vs. the other groups. CONCLUSIONS In an experimental rabbit model, it appears that colchicine statistically significantly reduces the development of atherosclerosis of the aorta, especially in combination with NAC. Colchicine, as an NLRP3 inflammasome inhibitor, and NAC, as an agent that directly targets IL-6 signaling, can reduce the inflammatory risk. Fenofibrate enhances the attenuating role of colchicine on triglyceride levels. Clinical studies should investigate whether similar effects can be observed in humans.
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Affiliation(s)
- M Spartalis
- Division of Cardiology, IRCCS San Raffaele Scientific Institute, San Raffaele University Hospital, Milan, Italy.
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8
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Oikonomou G, Simopoulou C, Drakopoulou M, Synetos A, Latsios G, Stathogiannis K, Toskas P, Karmpalioti M, Apostolos A, Soulaidopoulos S, Toutouzas K, Tsioufis K. TAVI for low-flow, low-gradient severe aortic stenosis: impact on outcome. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Several factors have been identified as predictors of events after transcatheter aortic valve implantation (TAVI) but the impact of transaortic flow (F) and mean transaortic gradient (MG) upon outcomes is controversial. This study aimed to clarify the prognostic role of low FL and low MG after TAVI.
Methods
Patients with severe and symptomatic aortic stenosis [effective orifice area (EOA) ≤1cm2], referred for TAVR at our institution were consecutively enrolled. Given the aim of this analysis, patients were divided according to F and MG into four groups: 1) LF-LG Patients with low flow (SVi <35ml/m2) and low mean gradient (MG <40mmHg), 2) NF-LG Patients with normal flow (SVi ≥35ml/m2) and low mean gradient (MG <40mmHg), 3) LF-HG Patients with low flow (SVi <35ml/m2) and high mean gradient (MG ≥40mmHg) and 4) NF-HG patients with normal flow (SVi ≥35ml/m2) and high mean gradient (MG ≥40mmHg). Prospectively collected demographic, laboratory and echocardiographic data were retrospectively analyzed. One-year outcomes were compared between the 4 groups of patients. Primary clinical endpoint was all-cause mortality at long term follow up, as defined by the criteria proposed by the Valve Academic Research Consortium2.
Results
In total 255 patients undergoing TAVI at our institution were included in our study: 35 (13.7%) patients with LF-LG, 17 (6.7%) with NF-LG, 108 (42.4%) with LF-HG and 95 (37.3%) with NF-HG. There was a statistically significant difference in gender distribution between the groups with most females being represented in the NF-HG group (64.2%) vs the LF-LG (31.4%), the NF-LG (47.1%) or the LF-HG group (50.9%) (p=0.008). Moreover, LF-LG patients were younger than NF-LG, LF-HG or NF-HG patients (ANOVA, p=0.037). There was a greater prevalence of prior myocardial infarction (MI) in the LF-LG group (34.5%) vs 20% in the NF-LG, 16.1% in the LF-HG and 20.2% in the NF-HG group (p=0.005). At 1 year follow up there were no statistically significant differences in major vascular complication, major bleeding complication or permanent pacemaker implantation rates between the groups, (all p>0.05). At a median follow up of 36 months IQR (17, 56) all-cause mortality was significantly higher in the LF-LG group as opposed to the NF-LG, LF-HG and NF-HG groups (77.41% vs 60% vs 55.67% vs 46.15% respectively, p=0.005). These results were confirmed by multivariate logistic regression analysis, as the combination of low flow and low mean gradient emerged as the strongest long term all cause mortality predictor (HR: 5.39, 95% confidence intervals: 1.72–16.83; p=0.004)
Conclusion
Combination of low flow and low mean transaortic gradient portends a worse prognosis after TAVI.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- G Oikonomou
- Athens School of Medicine, 1st Department of Cardiology, Hippocration General Hospital of Athens, Athens, Greece
| | - C Simopoulou
- Athens School of Medicine, 1st Department of Cardiology, Hippocration General Hospital of Athens, Athens, Greece
| | - M Drakopoulou
- Athens School of Medicine, 1st Department of Cardiology, Hippocration General Hospital of Athens, Athens, Greece
| | - A Synetos
- Athens School of Medicine, 1st Department of Cardiology, Hippocration General Hospital of Athens, Athens, Greece
| | - G Latsios
- Athens School of Medicine, 1st Department of Cardiology, Hippocration General Hospital of Athens, Athens, Greece
| | - K Stathogiannis
- Athens School of Medicine, 1st Department of Cardiology, Hippocration General Hospital of Athens, Athens, Greece
| | - P Toskas
- Athens School of Medicine, 1st Department of Cardiology, Hippocration General Hospital of Athens, Athens, Greece
| | - M Karmpalioti
- Athens School of Medicine, 1st Department of Cardiology, Hippocration General Hospital of Athens, Athens, Greece
| | - A Apostolos
- Athens School of Medicine, 1st Department of Cardiology, Hippocration General Hospital of Athens, Athens, Greece
| | - S Soulaidopoulos
- Athens School of Medicine, 1st Department of Cardiology, Hippocration General Hospital of Athens, Athens, Greece
| | - K Toutouzas
- Athens School of Medicine, 1st Department of Cardiology, Hippocration General Hospital of Athens, Athens, Greece
| | - K Tsioufis
- Athens School of Medicine, 1st Department of Cardiology, Hippocration General Hospital of Athens, Athens, Greece
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9
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Karmpalioti M, Drakopoulou M, Oikonomou G, Simopoulou C, Soulaidopoulos S, Apostolos A, Toskas P, Stathogiannis K, Synetos A, Latsios G, Tsioufis C, Toutouzas K. Impact of significant preprocedural mitral regurgitation on mortality after transcatheter aortic valve implantation. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Mitral regurgitation (MR) is commonly encountered in patients with severe aortic stenosis scheduled for transcatheter aortic valve implantation (TAVI). The presence of significant pre-procedural MR, however, has not been accounted in pivotal trials of TAVI and data regarding its independent impact on outcome are contradictory.
Methods
Patients with severe and symptomatic aortic stenosis [effective orifice area (EOA) ≤1cm2] referred for TAVI at our institution were consecutively enrolled. Prospectively collected demographic, laboratory and echocardiographic data were retrospectively analysed. Patients were stratified into two groups according to MR severity: ≤ grade 1 were defined as non-significant and ≥ grade 2 as significant. Change in MR was determined by comparison between baseline and 30-day echocardiogram. Primary clinical endpoint was all-cause mortality, as defined by the criteria proposed by the Valve Academic Research Consortium2.
Results
A total of 331 consecutive patients were enrolled in the study: 247 (74.6%) had non-significant MR and 84 (25.4%) patients had significant MR at baseline. Patients with significant pre-procedural MR had lower baseline ejection fraction (47.7±10.4% versus 51.2±8.4%, p=0.002), higher pulmonary artery systolic pressure (52±14.3mmHg versus 42.5±11.1mmHg, p<0.0001) and higher rates of moderate or severe tricuspid regurgitation (TR) (50% versus 19.4%) compared to patients with non-significant MR. Of all patients, mitral regurgitation improved in 9.5%, remained the same in 83.9%, and worsened in 6.6% 30 days after TAVR. In a multivariable analysis, pre-procedural TR severity was predictor of improved mitral regurgitation [OR 3.003,(95% CI 1.216–7.417, p=0.017)].
The primary clinical end point occurred in 44.7% of all patients during a follow-up period of 36.6.±25.9 months. Patients with significant pre-procedural MR had significantly higher rates of all-cause mortality compared to patients with non-significant (54.7% and 41.3%, respectively; log rank p=0.015). Performing a multivariable analysis demonstrated that preprocedural MR severity could independently predict cumulative mortality [OR 0.480, (95% CI 0.247–0.932, p=0.03)].
Conclusion
Significant pre-procedural MR is common in patients undergoing TAVI and is associated with increased all-cause mortality. TAVI is associated with a significant improvement in MR, especially in severe types. These data provide new insights in the crucial role of mitral regurgitation in the risk assessment of TAVI candidates.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
| | | | - G Oikonomou
- Hippokration General Hospital, Athens, Greece
| | | | | | - A Apostolos
- Hippokration General Hospital, Athens, Greece
| | - P Toskas
- Hippokration General Hospital, Athens, Greece
| | | | - A Synetos
- Hippokration General Hospital, Athens, Greece
| | - G Latsios
- Hippokration General Hospital, Athens, Greece
| | - C Tsioufis
- Hippokration General Hospital, Athens, Greece
| | - K Toutouzas
- Hippokration General Hospital, Athens, Greece
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10
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Gardikioti V, Terentes-Printzios D, Aznaouridis K, Christoforatou E, Benetos G, Drakopoulou M, Latsios G, Oikonomou E, Siasos G, Toutouzas K, Vavuranakis M, Tsioufis K, Vlachopoulos C. Arterial stiffness and valvular calcifications in aortic stenosis: caught between a rock and a hard place. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background/Introduction
Arterial stiffness and aortic hemodynamics are independent predictors of adverse cardiovascular events. Indications for transcatheter aortic valve implantation (TAVI) are expanding and aortic valve calcifications (AVC) are an important prognostic factor of the success of TAVI.
Purpose
We sought to investigate the associations between AVC and aortic vascular function/hemodynamics.
Methods
Fifty-two high-risk patients (mean age 80.4±8.5 years, 27 male) with severe symptomatic aortic stenosis undergoing TAVI were included. Arterial stiffness was estimated through carotid-femoral pulse wave velocity (cfPWV) and brachial-ankle pulse wave velocity (baPWV). Aortic hemodynamics (aortic pressures, aortic augmentation index corrected for heart rate [AIx@75]) were also measured. Measurements were conducted prior to the implantation and at discharge. In all patients, a native and contrast-enhanced multislice cardiac computed tomography were performed pre-interventionally. AVC were then graded semi-quantitatively as follows: grade 1 – no calcification; grade 2 – mildly calcified (small isolated spots); grade 3 – moderately calcified (multiple larger spots); grade 4 – severely calcified (extensive calcification of all cusps).
Results
Group 1 (subjects with none/mild AVC, n=29) did not significantly differ in age, gender and body-mass index compared to group 2 (subjects with moderate/severe AVC, n=23). As far as the traditional cardiovascular risk factors were concerned, only hypertension (p=0.008), coronary artery disease (p=0.016), atrial fibrillation (p=0.075) and insulin-dependent diabetes mellitus (p=0.068) were found to be more prevalent in group 2. Group 2 had significantly higher both cfPWV and baPWV (8.3±1.7 vs 7.2±1.2 m/s and 1750±484 cm/s vs. 2101±590 cm/s with p=0.008 and p=0.022 respectively) compared to Group 1 (Figure 1). Even after adjustment for age, gender and systolic blood pressure, aortic stiffness indices were higher in Group 2 compared to Group 1 (p=0.038 and p=0.048, respectively). There was no statistically significant difference in peripheral or aortic pressures as well as in wave reflections indices between the two groups.
Conclusion
Our study shows that in patients with aortic valve stenosis there is a correlation between increased aortic stiffness and a greater extent of damage of aortic valvular leaflets as well as calcifications.
Funding Acknowledgement
Type of funding sources: None. Figure 1. PWV and aortic valve calcifications
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Affiliation(s)
- V Gardikioti
- Hippokration General Hospital, National & Kapodistrian University of Athens, Athens, Greece
| | - D Terentes-Printzios
- Hippokration General Hospital, National & Kapodistrian University of Athens, Athens, Greece
| | - K Aznaouridis
- Hippokration General Hospital, National & Kapodistrian University of Athens, Athens, Greece
| | - E Christoforatou
- Hippokration General Hospital, National & Kapodistrian University of Athens, Athens, Greece
| | - G Benetos
- Hippokration General Hospital, National & Kapodistrian University of Athens, Athens, Greece
| | - M Drakopoulou
- Hippokration General Hospital, National & Kapodistrian University of Athens, Athens, Greece
| | - G Latsios
- Hippokration General Hospital, National & Kapodistrian University of Athens, Athens, Greece
| | - E Oikonomou
- Hippokration General Hospital, National & Kapodistrian University of Athens, Athens, Greece
| | - G Siasos
- Hippokration General Hospital, National & Kapodistrian University of Athens, Athens, Greece
| | - K Toutouzas
- Hippokration General Hospital, National & Kapodistrian University of Athens, Athens, Greece
| | - M Vavuranakis
- Hippokration General Hospital, National & Kapodistrian University of Athens, Athens, Greece
| | - K Tsioufis
- Hippokration General Hospital, National & Kapodistrian University of Athens, Athens, Greece
| | - C Vlachopoulos
- National & Kapodistrian University of Athens, Athens, Greece
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11
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Drakopoulou M, Karmpalioti M, Simopoulou C, Oikonomou G, Apostolos A, Toskas P, Soulaidopoulos S, Stathogiannis K, Synetos A, Latsios G, Tsioufis C, Toutouzas K. Effect of concomitant atrioventricular valve regurgitation on the outcome after transcatheter aortic-valve implantation. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Many patients undergoing transcatheter aortic valve implantation (TAVI) have concomitant mitral regurgitation (MR) of moderate grade or more. The impact of coexistent tricuspid regurgitation (TR) remains to be determined.
Methods
Patients with severe and symptomatic aortic stenosis [effective orifice area (EOA)≤1cm2] referred for TAVI at our institution were consecutively enrolled. Prospectively collected demographic, laboratory and echocardiographic data were retrospectively analysed. Patients were divided into 4 groups according to MR and TR severity pre-procedurally: no/mild MR and TR, moderate/severe MR, moderate/severe TR, moderate/severe MR and TR. Primary clinical endpoint was all-cause mortality, as defined by the criteria proposed by the Valve Academic Research Consortium2.
Results
A total of 244 consecutive patients were enrolled in the study: 148 (60.7%) patients no/mild MR and TR, 32 (13.1%) moderate/severe MR, 35 (14.3%) moderate/severe TR, 29 (11.9%) moderate/severe MR and TR pre-procedurally. There was significant difference in pre-procedural pulmonary artery systolic pressure (PASP) among groups (no/mild MR and TR: 40.8±10 mmHg, moderate/severe MR: 46.6±11.2 mmHg, moderate/severe TR: 49.9±13mmHg, moderate/severe MR and TR: 59.8±15.2mmHg, p<0.0001). The Kaplan–Meier curves for 2 year mortality showed that the severity of TR was associated with poor survival. Interestingly, patients with moderate/severe MR and TR had the worse survival (no/mild MR and TR (91.2%), moderate/severe MR (78.1%), moderate/severe TR (62.9%), moderate/severe MR and TR (62.1%), p<0.0001).
Conclusion
The presence of concomitant moderate or severe mitral and tricuspid valve regurgitation was associated with the higher mortality. This suggests that a thorough evaluation of the mechanisms underlying concomitant mitral and tricuspid valve regurgitation should be performed to determine the best strategy for avoiding TAVI-related futility.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
| | | | | | - G Oikonomou
- Hippokration General Hospital, Athens, Greece
| | - A Apostolos
- Hippokration General Hospital, Athens, Greece
| | - P Toskas
- Hippokration General Hospital, Athens, Greece
| | | | | | - A Synetos
- Hippokration General Hospital, Athens, Greece
| | - G Latsios
- Hippokration General Hospital, Athens, Greece
| | - C Tsioufis
- Hippokration General Hospital, Athens, Greece
| | - K Toutouzas
- Hippokration General Hospital, Athens, Greece
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12
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Vlad D, Bouki P, Nakas A, Diamantakis E, Kotsakis A, Baroutsi K, Toutouzas K. Prediction of the functional significance of the left main stenosis using frequency domain optical coherence tomography. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Frequency domain optical coherence tomography (FD-OCT) has been used for the assessment of non-ostial left main coronary artery stenosis (LM). However, no study has evaluated the use of this imaging technique for the prediction of functional significance of LM lesions determined by the fractional flow reserve (FFR).
Purpose
The aim of this study was to assess the safety and diagnostic efficacy of FD-OCT in identifying functional severity of the LM stenosis determined by (FFR).
Methods
One hundred one patients with LM lesion (20–70% diameter stenosis angiographically) underwent FFR measurement and FD-OCT imaging of the LM. The following parameters were measured by FD-OCT in the LM: reference lumen area (RLA), reference lumen diameter (RLD), minimum lumen area (MLA), minimum lumen diameter (MLD), % lumen area stenosis, % diameter stenosis.
Results
The LM lesions were visible and measurable by FD-OCT in 88/101 (87.1%) patients. However lesions with ostial location were analyzable by FD-OCT only in 17/30 (56.4%) patients (Figure 1). FFR at maximum hyperemia was ≤0.80 in 39/88 (44.3%) patients. FFR values were correlated significantly with FD-OCT derived LM lumen parameters. Receiver operating characteristic curves showed that an MLA cutoff value of 5,38 mm2 had the highest sensitivity and specificity of 82% and 81% respectively (Figure 2A), followed by an MLD of 2.43 mm (sensitivity 77%, specificity 72%) (Figure 2B) and an %AS of 60% (sensitivity 72%, specificity 72%) (Figure 2C) for predicting FFR ≤0.80.
Conclusions
FD-OCT is safe and feasible imaging technique for the assessment of a LM stenosis except the ostial LM lesions which are analyzable in half of the cases. An FD-OCT derived MLA of ≤5.38 mm2 strongly predicts the functional severity of a LM lesion.
Funding Acknowledgement
Type of funding sources: None. Angiography and OCT image of LM stenosisROC curves of MLA, MLD and AS
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Affiliation(s)
- D Vlad
- Nikea General Hospital, Secon Department of Cardiology, Athens, Greece
| | - P Bouki
- Nikea General Hospital, Secon Department of Cardiology, Athens, Greece
| | - A Nakas
- Nikea General Hospital, Secon Department of Cardiology, Athens, Greece
| | - E Diamantakis
- Nikea General Hospital, Secon Department of Cardiology, Athens, Greece
| | - A Kotsakis
- Nikea General Hospital, Secon Department of Cardiology, Athens, Greece
| | - K Baroutsi
- Nikea General Hospital, Medical Imaging, Pireas, Greece
| | - K Toutouzas
- University of Athens, First Department of Cardiology, Athens, Greece
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13
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Benetos G, Delakis I, Charitos D, Drakopoulou M, Soulaidopoulos S, Karmpalioti M, Oikonomou G, Stathogiannis K, Synetos A, Latsios G, Tsioufis K, Toutouzas K. Novel computed-tomography derived prognostic markers in patients undergoing TAVI with a self-expanding valve. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
Transcatheter aortic valve implantation is the treatment of choice in a consistently expanding group of patients with severe aortic valve stenosis. Tricuspid and mitral annular dilatation with consequent valvular regurgitation are associated with adverse outcome. Computed tomography angiography (CTA) is routinely performed for preprocedural evaluation of vascular access and prosthesis sizing.
Purpose
To evaluate the impact of mitral and tricuspid annular dimensions in preprocedural CTA on prognosis of patients undergoing TAVI with a self-expanding valve.
Methods
CTAs of consecutive patients undergoing TAVI in a single high-volume center between 2016 and 2019 were retrospectively evaluated. Maximal septolateral tricuspid annular diameters (TAD) and mitral annular diameters (MAD) were obtained and measured from properly angulated three dimensional CTA datasets. Moreover, maximal pulmonary artery diameter perpendicular to the long axis was measured in every patient. Patients were followed up by clinical visits or telephone contacts. As clinical events were defined all-cause mortality, stroke and heart failure hospitalization.
Results
In total 123 patients were included in the study. The mean follow-up duration was 875±383 days and 21 clinical events were recorded. There was a moderate but statistical significant correlation between TAD and both pulmonary artery diameter (r=0.39, p<0.001) and pulmonary artery systolic pressure by echocardiography (r=0.23, p=0.015). In univariate logistic regression analysis pulmonary artery diameter and TAD were both associated with heart failure hospitalization (p=0.03 and 0.02 respectively). In addition, MAD was associated with total events (OR: 0.43, 95% CI 0.19–0.99, p=0.048). The relationship of MAD with events remained significant after adjustment for sex, age and tricuspid annular dimensions (OR: 0.28, 95% CI 0.1–0.79, p=0.02).
Conclusions
TAD and MAD were associated with heart failure rehospitalization and clinical events respectively in patients undergoing TAVI with a self-expanding valve. Further larger prospective studies are warranted to evaluate the prognostic value of these CTA markers.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- G Benetos
- University of Athens Medical School, Athens, Greece
| | - I Delakis
- University of Athens Medical School, Athens, Greece
| | - D Charitos
- University of Athens Medical School, Athens, Greece
| | | | | | | | - G Oikonomou
- University of Athens Medical School, Athens, Greece
| | | | - A Synetos
- University of Athens Medical School, Athens, Greece
| | - G Latsios
- University of Athens Medical School, Athens, Greece
| | - K Tsioufis
- University of Athens Medical School, Athens, Greece
| | - K Toutouzas
- University of Athens Medical School, Athens, Greece
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14
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Anousakis-Vlachochristou N, Mavroidis M, Makridakis M, Miliou A, Kontostathi G, Agapaki A, Mouchtouri E, Zigouri L, Konstantinou G, Lampas E, Kalogera S, Vlahou A, Cokkinos D, Tsioufis K, Toutouzas K. Phenotypic characterization of rabbit model for aortic valve stenosis: a novel medial calcification paradigm. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Calcific aortic valve stenosis (CAVS) is the result of subtle, chronic inflammation and osteoblastic differentiation. As we lack human specimens of the early stages, reliable and reproducible animal models are needed to facilitate research. We previously demonstrated the ability of a novel rabbit CAVS vitamin D2 toxicity protocol to produce calcification and valve stenosis (1). We sought to characterize the phenotype of the model at the final stage.
Methods
Twelve New Zealand Rabbits were randomized 1:1 to control (normal chaw) and experimental group (normal chaw+1% cholesterol+3.500 I.U.s Vitamin D2, in oil in a biscuit) for 7 weeks. Animals were sacrificed and aortic valve cusps were snap frozen or formalin-fixed paraffin embedded. Cusps were then mechanically homogenized in buffer optimized for protein extraction and total protein measured with Bradford method. Part of the extract was subjected to trypsinization, in-gel digestion and untargeted LC-MS/MS. The rest was used to quantitate BMP-2 with total protein-normalized sandwitch competitive ELISA. Thin tissue sections were stained with Masson's trichrome, Von Kossa and H&E. Osteopontin, Bone sialoprotein II (BSPII), tissue non-specific alkaline phosphatase (TNAP) and osteocalcin (OCN) were detected on tissue with immunohistochemistry. Femoral bones from the same animals served as positive controls.
Results
Aortic valve cusp demonstrate large areas of collagen degradation and calcification in the medial layer, almost sparing the intima. Osteopontin deposits were colocalized with the calcification area in the media, whereas BSPII, TNAP and OCN were not expressed in the lesion, although present in bones. Similarly, BMP-2 levels were not significantly different between groups (experimental = 43.45 vs controls = 62.75 pg/ml, Mann-Whitney U test p=0.496). Proteomic analysis revealed a set of 96 differentially expressed proteins between cases and controls, interestingly including sortilin, osteonectin, beta-crystallin A2, Matrix Gla protein, Na/H exchanger 3, V-type H ATPase subunit D, Y-box binding protein.
Conclusion
The novel rabbit vitamin D2 toxicity protocol leads to excessive medial calcification of the aortic valve, with overexpression of osteopontin but without other classic markers of CAVS. Proteomics analysis reveals novel pathways with pathophysiological implications for the model and medial calcification.
Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Hellenic Cardiology Society, Hellenic Heart Foundation
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Affiliation(s)
- N Anousakis-Vlachochristou
- National & Kapodistrian University of Athens Medical School, First Department of Cardiology, Athens, Greece
| | - M Mavroidis
- Academy of Athens Biomedical Research Foundation, Center for Clinical, Experimental Surgery & Translational Research, Athens, Greece
| | - M Makridakis
- Academy of Athens Biomedical Research Foundation, Center for Clinical, Experimental Surgery & Translational Research, Athens, Greece
| | - A Miliou
- National & Kapodistrian University of Athens Medical School, First Department of Cardiology, Athens, Greece
| | - G Kontostathi
- Academy of Athens Biomedical Research Foundation, Center for Clinical, Experimental Surgery & Translational Research, Athens, Greece
| | - A Agapaki
- Academy of Athens Biomedical Research Foundation, Center for Clinical, Experimental Surgery & Translational Research, Athens, Greece
| | - E Mouchtouri
- Academy of Athens Biomedical Research Foundation, Center for Clinical, Experimental Surgery & Translational Research, Athens, Greece
| | - L Zigouri
- Academy of Athens Biomedical Research Foundation, Center for Clinical, Experimental Surgery & Translational Research, Athens, Greece
| | - G Konstantinou
- National & Kapodistrian University of Athens Medical School, First Department of Cardiology, Athens, Greece
| | - E Lampas
- National & Kapodistrian University of Athens Medical School, First Department of Cardiology, Athens, Greece
| | - S Kalogera
- National & Kapodistrian University of Athens Medical School, First Department of Cardiology, Athens, Greece
| | - A Vlahou
- Academy of Athens Biomedical Research Foundation, Center for Clinical, Experimental Surgery & Translational Research, Athens, Greece
| | - D Cokkinos
- Academy of Athens Biomedical Research Foundation, Center for Clinical, Experimental Surgery & Translational Research, Athens, Greece
| | - K Tsioufis
- National & Kapodistrian University of Athens Medical School, First Department of Cardiology, Athens, Greece
| | - K Toutouzas
- National & Kapodistrian University of Athens Medical School, First Department of Cardiology, Athens, Greece
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15
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Lazarou E, Lazaros G, Antonopoulos AS, Imazio M, Vasileiou P, Karavidas A, Toutouzas K, Vassilopoulos D, Tsioufis C, Tousoulis D, Vlachopoulos C. Development of a risk-score for pericarditis recurrence in patients with a first episode of acute pericarditis. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1832] [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: 11/15/2022] Open
Abstract
Abstract
Background/Introduction
Currently we remain uncertain about which patients are at increased risk for recurrent pericarditis.
Purpose
We developed a risk score for pericarditis recurrence in patients with acute pericarditis.
Methods
We prospectively recruited 262 patients with acute pericarditis. Patients' demographics, clinical, imaging and laboratory data at presentation, were collected. Patients were followed-up for a median of 51 months (interquartile range 21–71) for recurrence. Variables with <10% missingness were entered into multivariable logistic regression models with stepwise elimination to explore independent predictors of recurrence. The performance of the final model was assessed by the c-index and model's calibration and the optimism corrected c-index were evaluated after 10-fold cross-validation.
Results
We identified six independent predictors for pericarditis recurrence i.e., age, effusion size, platelet count (negative predictors) and reduced inferior vena cava collapse, in-hospital use of corticosteroids, and heart rate (positive predictors). The final model had good performance for recurrence, c-index 0.783 (95% CI 0.725–0.842), while the optimism corrected c-index after cross-validation was 0.752. Based on these variables we developed a risk score point system for recurrence (0–22 points) with equally good performance (c-index 0.740, 95% CI 0.677–0.803). Patients with a low score (0–7 points) had 21.3% risk for recurrence, while those with high score (≥12 points) had a 69.8% risk for recurrence (Figure 1). The score was predictive of recurrence among most patient subgroups.
Conclusions
A simple risk score point system based on 6 variables can be used to predict the individualized risk for pericarditis recurrence among patients with a first episode of acute pericarditis.
Funding Acknowledgement
Type of funding sources: None. Figure 1
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Affiliation(s)
- E Lazarou
- National & Kapodistrian University of Athens Medical School, Athens, Greece
| | - G Lazaros
- National & Kapodistrian University of Athens Medical School, Athens, Greece
| | - A S Antonopoulos
- National & Kapodistrian University of Athens Medical School, Athens, Greece
| | - M Imazio
- AOU Città della Salute e della Scienza di Torino, Torino 10126, Cardiology, Torino, Italy
| | - P Vasileiou
- Hippokration General Hospital, Athens, Greece
| | - A Karavidas
- General Hospital of Athens “G. Gennimatas”, Athens, Greece
| | - K Toutouzas
- National & Kapodistrian University of Athens Medical School, Athens, Greece
| | | | - C Tsioufis
- National & Kapodistrian University of Athens Medical School, Athens, Greece
| | - D Tousoulis
- National & Kapodistrian University of Athens Medical School, Athens, Greece
| | - C Vlachopoulos
- National & Kapodistrian University of Athens Medical School, Athens, Greece
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16
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Stathogiannis K, Latsios G, Oikonomou G, Synetos A, Drakopoulou M, Soulaidopoulos S, Toskas P, Xanthopoulou M, Lalou E, Kolyviras A, Tzifos V, Benetos G, Karmpalioti M, Tsioufis C, Toutouzas K. Percutaneous access versus surgical cutdown in TAVI: vascular and bleeding complications. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2253] [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: 11/15/2022] Open
Abstract
Abstract
Background
Access options for transcatheter aortic valve implantation (TAVI) are vital, since use of large sheaths may lead to access-related complications and bleeding.
Purpose
To determine the access-related vascular and bleeding complications of patients undergoing transfemoral TAVI.
Methods
Consecutive patients scheduled for transfemoral TAVI were retrospectively grouped according to vascular access [percutaneous access (p-TAVI) and surgical cutdown (sc-TAVI)]. Primary end points were vascular and bleeding complications, based on the VARC-II criteria.
Results
Totally, 187 patients were included in the analysis (p-TAVI: 124 patients; sc-TAVI: 63 patients). Mean procedure time was shorter in the p-TAVI group compared to the sc-TAVI group (45.65±6.17 min versus 64.05±15.73 min, p<0.001). Contrast use was lower in the p-TAVI group compared to the sc-TAVI group (81.18±15.96 ml versus 106.75±25.67 ml, p<0.001), which resulted in higher rates of acute kidney injury in the sc-TAVI group (13% versus 1%, p=0.01). Vascular access complications occurred numerically but not statistically more often in the p-TAVI group compared to the sc-TAVI group (11% versus 5% for minor complications and 6% versus 3% for major complications respectively, p=0.10). Patients in the p-TAVI group had the same minor and major bleeding complications compared to the sc-TAVI group (11% versus 8% for minor, 10% versus 6% for major bleeding complications respectively, p=0.49), but no life-threatening bleeding (0% versus 1.5%).
Conclusions
Transfemoral access options in TAVI (surgical cutdown or percutaneous) have similar efficacy and should be offered in TAVI patients if and when appropriate.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
| | - G Latsios
- Hippokration General Hospital, Athens, Greece
| | - G Oikonomou
- Hippokration General Hospital, Athens, Greece
| | - A Synetos
- Hippokration General Hospital, Athens, Greece
| | | | | | - P Toskas
- Hippokration General Hospital, Athens, Greece
| | | | - E Lalou
- Hippokration General Hospital, Athens, Greece
| | - A Kolyviras
- Henry Dunant Hospital Center, Athens, Greece
| | - V Tzifos
- Henry Dunant Hospital Center, Athens, Greece
| | - G Benetos
- Hippokration General Hospital, Athens, Greece
| | | | - C Tsioufis
- Hippokration General Hospital, Athens, Greece
| | - K Toutouzas
- Hippokration General Hospital, Athens, Greece
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17
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Soulaidopoulos S, Drakopoulou M, Stathogiannis K, Oikonomou G, Toskas P, Benetos G, Synetos A, Latsios G, Tsioufis K, Toutouzas K. Impact of severe mitral annular calcification on paravalvular leak after transcatheter aortic valve implantation. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Aims
Paravalvular leak (PVL) remains a frequent complication after transcatheter aortic valve implantation (TAVI) and seems to affect short- and long-term survival.
Purpose
The aim of this study was: 1) to identify anatomical predictors of PVL after TAVI and 2) assess the impact of PVL on cumulative survival.
Methods and results
Patients with severe and symptomatic aortic stenosis [effective orifice area (EOA) ≤1cm2] referred for TAVI at our institution were consecutively enrolled. Prospectively collected demographic, laboratory and echocardiographic data were retrospectively analyzed. Patients were stratified into two groups according to the presence of PVL after TAVI and were followed up postoperatively with clinical and echocardiographic assessment. Primary clinical endpoint was all-cause mortality, as defined by the criteria proposed by the Valve Academic Research Consortium 2. In total, 291 patients were included (male: 50.2%, mean age: 80±7.6 years) in our study. Of these, 165 (56,8%) presented at least mild PVL after TAVI (mild: 85,5%, moderate: 13.3% and severe: 1.2%). The median follow-up period was 27.3 [min. 0, max 113 months. Two patients with severe PVL were excluded from the analysis. In the follow up period, there was no significant difference regarding all-cause mortality between patients with and those without PVL after TAVI, independently from the degree of PVL (log rank: 0.991 - Figure 1). Severe aortic annulus calcification, the presence of a bicuspid aortic valve and aortic root angulation, as assessed by computed tomography (CT), were found to associate with PVL after TAVI in univariate analysis. In the multivariate analysis, severe aortic annulus calcification was found to be the only independent predictor of mild or moderate PVL after TAVI [Exp(B): 1.540, 95% Confidence Interval: 1.067–2.224, B=0.432, p=0.021].
Conclusion
The presence of mild or moderate PVL after TAVI was not found to affect cumulative survival in the 27 months of follow up period. Severe annulus calcification assessed by CT-scan, was found to be the only independent predictor of PVL after TAVI.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- S Soulaidopoulos
- Hippokration General Hospital, First Department of Cardiology, Medical School of Athens, Athens, Greece
| | - M Drakopoulou
- Hippokration General Hospital, First Department of Cardiology, Medical School of Athens, Athens, Greece
| | - K Stathogiannis
- Hippokration General Hospital, First Department of Cardiology, Medical School of Athens, Athens, Greece
| | - G Oikonomou
- Hippokration General Hospital, First Department of Cardiology, Medical School of Athens, Athens, Greece
| | - P Toskas
- Hippokration General Hospital, First Department of Cardiology, Medical School of Athens, Athens, Greece
| | - G Benetos
- Hippokration General Hospital, First Department of Cardiology, Medical School of Athens, Athens, Greece
| | - A Synetos
- Hippokration General Hospital, First Department of Cardiology, Medical School of Athens, Athens, Greece
| | - G Latsios
- Hippokration General Hospital, First Department of Cardiology, Medical School of Athens, Athens, Greece
| | - K Tsioufis
- Hippokration General Hospital, First Department of Cardiology, Medical School of Athens, Athens, Greece
| | - K Toutouzas
- Hippokration General Hospital, First Department of Cardiology, Medical School of Athens, Athens, Greece
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18
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Bouras G, Giannainas N, Lourmpa V, Tsounis D, Adreanides E, Antoniadis D, Lazaridis K, Kalpakos D, Toutouzas K. Evaluation of the prophylactic role of pethidine in avoiding radial artery spasm during transradial cardiac interventions. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
Prophylactic use of benzodiazepine and opioids (fentanyl, morphine) is an established method for tackling radial artery spasm, in patients undergoing left cardiac catheterization procedures. Meperidine (Pethidine) is a synthetic opioid with elimination half life of 2–4 hours and duration of action of only 2–3 hours, making it ideal for in-lab administration.
Purpose
We aimed to test primarily the role of pethidine administration in preventing radial artery spasm and secondarily to assess patient discomfort during transradial coronary interventions.
Methods
This is a prospective, randomized, double blinded study. Patients were randomized to either pethidine 0,25mg administration (Group A) or normal saline (Group B) i.v. 10 minutes before the beginning of the procedure. As standard prophylactic measures against spasm, both groups received verapamil 5mg and nitroglycerin 100μg, after sheath introduction in the radial artery. Artery spasm was assessed clinically by the difficulty in advancing or exchanging catheters, as reported by the operator (CHUGH scale). A Visual Analog Scale (VAS) was used to estimate the patient-perceived discomfort, one hour after the end of the procedure.
Results
66 patients were included, 42 in Group A and 24 in Group B. Mean age of the patients was 65.9 years, mean duration of the procedure was 27 minutes and 24% of patients proceeded to PTCA overall. Operators reported no problems in catheter manipulations (CHUGH 0) in 67% of patients from Group A vs 38% of pts from Group B. 64% Group A patients and 21% Group B patients reported no symptoms (VAS 0). Pethidine administration had a negative correlation with VAS (r: −0.418, p: 0.001) and CHUGH Scale (r: −0.295, p: 0.016) scores.
Conclusion
Pethidine low dose administration before radial artery catheterization, shows a positive trend in preventing spasm and reducing procedure-related patient discomfort. Larger studies are required to evaluate the role of pethidine as an alternative prophylactic measure against artery spasm in transradial cardiac interventions.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- G Bouras
- NIMTS Veterans Hospital, Athens, Greece
| | | | - V Lourmpa
- NIMTS Veterans Hospital, Athens, Greece
| | - D Tsounis
- NIMTS Veterans Hospital, Athens, Greece
| | - E Adreanides
- 401 Army General Hospital of Athens, Athens, Greece
| | - D Antoniadis
- 401 Army General Hospital of Athens, Athens, Greece
| | | | | | - K Toutouzas
- Ippokrateio General Hospital of Athens, Athens, Greece
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19
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Terentes-Printzios D, Gardikioti V, Latsios G, Drakopoulou M, Siasos G, Oikonomou E, Mpei E, Xanthopoulou M, Christoforatou E, Toutouzas K, Vavuranakis M, Tsioufis K, Vlachopoulos C. Aortic systolic blood pressure predicts periprocedural myocardial injury after transcatheter aortic valve implantation. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background/Introduction
Periprocedural myocardial injury (PPMI) is a complication of transcatheter aortic valve implantation (TAVI) associated with worse outcome. Central (aortic) systolic blood pressure (SBP) is an independent predictor of cardiovascular events.
Purpose
We sought to investigate the effect of TAVI on peripheral and central hemodynamics, as well as the predictive ability of brachial and aortic SBP for PPMI.
Methods
We enrolled 70 patients (mean age 79.9±8.7 years, 50% males) with severe symptomatic aortic valve stenosis (AVS) undergoing TAVI. Brachial pressures were measured with an oscillometric device and central pressures were assessed by arterial tonometry at baseline and after the procedure at discharge. PPMI was identified based on Valve Academic Research Consortium (VARC-2) criteria. Biomarkers for MI (cardiac troponin and creatinine kinase MB) were analyzed and signs and symptoms according to VARC-2 criteria were collected from clinical records. Stepwise multivariable regression analysis was performed for the prediction of PPMI.
Results
According to VARC-2 definition, 38 (54%) patients had PPMI. In stepwise multivariable regression analysis, brachial SBP at baseline was not predictive of PPMI (p=0.07) after adjusting for age, sex and history of coronary artery disease. On the contrary, aortic SBP predicted PPMI even after adjustment for the abovementioned confounders (Odds ratio [OR]=1.032, 95% Confidence Interval [CI] 1.004–1.061, p=0.026). Interestingly, both SBP and aortic SBP were higher at discharge in patients with PPMI compared to patients without PPMI after adjustment (p=0.021 and p=0.006, respectively). On the contrary, the periprocedural changes of aortic SBP and SBP were not different between patients with PPMI and without PPMI.
Conclusions
Aortic SBP, as assessed by tonometry, is an independent predictor stronger than brachial SBP for PPMI in AVS patients treated with TAVI. This finding suggests the possible clinical role of aortic pressures as a risk stratification tool for PPMI prior to TAVI, as well as, warrants further investigation on their role as therapeutic targets to decrease the incidence of PPMI.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- D Terentes-Printzios
- Hippokration General Hospital, National & Kapodistrian University of Athens, Athens, Greece
| | - V Gardikioti
- Hippokration General Hospital, National & Kapodistrian University of Athens, Athens, Greece
| | - G Latsios
- Hippokration General Hospital, National & Kapodistrian University of Athens, Athens, Greece
| | - M Drakopoulou
- Hippokration General Hospital, National & Kapodistrian University of Athens, Athens, Greece
| | - G Siasos
- Hippokration General Hospital, National & Kapodistrian University of Athens, Athens, Greece
| | - E Oikonomou
- Hippokration General Hospital, National & Kapodistrian University of Athens, Athens, Greece
| | - E Mpei
- Hippokration General Hospital, National & Kapodistrian University of Athens, Athens, Greece
| | - M Xanthopoulou
- Hippokration General Hospital, National & Kapodistrian University of Athens, Athens, Greece
| | - E Christoforatou
- Hippokration General Hospital, National & Kapodistrian University of Athens, Athens, Greece
| | - K Toutouzas
- Hippokration General Hospital, National & Kapodistrian University of Athens, Athens, Greece
| | - M Vavuranakis
- Hippokration General Hospital, National & Kapodistrian University of Athens, Athens, Greece
| | - K Tsioufis
- Hippokration General Hospital, National & Kapodistrian University of Athens, Athens, Greece
| | - C Vlachopoulos
- National & Kapodistrian University of Athens, Athens, Greece
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20
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Mavroudeas S, Tzalas D, Kyriakopoulou D, Stasinopoulou M, Feskou I, Sotirakou K, Drakopoulou M, Konstantakopoulou O, Mountaki V, Tsioufis C, Toutouzas K. Correlation between mitral valve calcification and routine laboratory test results in patients with aortic valve sclerosis. Atherosclerosis 2021. [DOI: 10.1016/j.atherosclerosis.2021.06.329] [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: 10/20/2022]
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21
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Mavroudeas S, Tzalas D, Kyriakopoulou D, Feskou I, Stasinopoulou M, Sotirakou K, Theiopoulos I, Fragkos D, Rapti E, Zoumpou F, Konstantakopoulou O, Mavroudeas D, Mountaki V, Tsioufis C, Toutouzas K. Agatston score LAD VS Baseline characteristics in patients with aortic valve sclerosis. Atherosclerosis 2021. [DOI: 10.1016/j.atherosclerosis.2021.06.331] [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: 10/20/2022]
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22
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Christopoulou G, Sigala E, Aragiannis D, Stamatopoulou E, Manthou P, Gkiata P, Vlachopoulos C, Trantalis G, Drakopoulou M, Toutouzas K, Tsioufis K. Short-term health-related quality of life in patients with ischaemic stroke after PFO closure. Eur J Cardiovasc Nurs 2021. [DOI: 10.1093/eurjcn/zvab060.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Introduction/Purpose: Patent foramen ovale (PFO) is common in asymptomatic adults and is associated with cryptogenic stroke (CS). We sought to evaluate the impact of PFO closure in health-related quality of life (HRQoL) in PFO patients with CS.
Method
In this pilot study, 19 patients (mean age 47 ± 7.7; 13 male) who underwent PFO closure at our center were invited to a short-term clinical follow up (mean follow-up period 6-10 months). All patients had suffered an ischaemic stroke and their disability level was assessed using the Modified Rankin Scale (MRS, no significant disability 63%). HRQoL was assessed using the 36-Item Short Form Survey (SF-36) and the European Quality of Life-5 Dimensions Questionnaire (EQ-5D) preoperatively and at follow-up.
Results
Both SF36 and EQ-5D scores improved after the operation as shown by the self-rating scores (20,67% and 40,52% higher scores, respectively). Patients with major mobility problems were more likely to be current smokers (r = 0.481) and those who had lower scores on the MRS scale (r=-0.571) rated higher their scale diagram. The categories of energy/fatigue (r = 0.459; p = 0.048), social functioning (r = 0.547; p = 0.015) and pain (r = 0.550; p = 0.015) were positively correlated with physical function. Finally, there was a positive correlation between role limitations due to emotional problems and energy/fatigue (r = 0,519; p = 0.023), and between energy/fatigue and emotional well-being (r = 0.519; p = 0,023).
Conclusions
The results of our study indicate that shortly after PFO, subjects perceive improvements in their QoL. However, it seems that poorly rated physical function was more common in active smokers, and affects patients" social life and their emotional state. Health care professionals should encourage these patients to participate in rehabilitation and psychological support programs postoperatively.
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Affiliation(s)
| | - E Sigala
- Ippokrateio General Hospital of Athens, Athens, Greece
| | - D Aragiannis
- Ippokrateio General Hospital of Athens, Athens, Greece
| | | | - P Manthou
- Sotiria Regional Chest Diseases Hospital, Athens, Greece
| | - P Gkiata
- Ippokrateio General Hospital of Athens, Athens, Greece
| | | | - G Trantalis
- Ippokrateio General Hospital of Athens, Athens, Greece
| | - M Drakopoulou
- Ippokrateio General Hospital of Athens, Athens, Greece
| | - K Toutouzas
- Ippokrateio General Hospital of Athens, Athens, Greece
| | - K Tsioufis
- Ippokrateio General Hospital of Athens, Athens, Greece
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23
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Latsios G, Leopoulou M, Synetos A, Karanasos A, Melidi E, Toutouzas K, Tsioufis K. The role of automated compression devices in out-of- and in- hospital cardiac arrest. Can we spare rescuers’ hands? Emerg Care J 2021. [DOI: 10.4081/ecj.2021.9525] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Research regarding the use of mechanical compressions in the setting of a cardiac arrest, either outside of or inside the hospital environment has produced mixed results. The debate whether they can replace manual compressions still remains. The aim of this review is to present current literature contemplating the application of mechanical compressions in both settings, data comparing them to manual compressions as well as current guidelines regarding their implementation in everyday clinical use. Currently, their implementation in the resuscitation protocol seems to benefit the victims of an in-hospital cardiac arrest rather than the victims that sustain a cardiac arrest outside of the hospital.
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24
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Frountzas M, Stergios K, Nikolaou C, Bellos I, Schizas D, Linardoutsos D, Kontzoglou K, Vaos G, Williams AB, Toutouzas K. Could FiLaC™ be effective in the treatment of anal fistulas? A systematic review of observational studies and proportional meta-analysis. Colorectal Dis 2020; 22:1874-1884. [PMID: 32445614 DOI: 10.1111/codi.15148] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Accepted: 04/30/2020] [Indexed: 02/08/2023]
Abstract
AIM Fistula Laser Closure (FiLaC™) is a novel sphincter-preserving technique that is based on new technologies and shows promising results in repairing anal fistulas whilst maintaining external sphincter function. The aim of the present meta-analysis is to present the efficacy and the safety of FiLaC™ in the management of anal fistula disease. METHOD The present proportional meta-analysis was designed using the PRISMA and AMSTAR guidelines. We searched MEDLINE, Scopus, clinicaltrials.gov, Embase, Cochrane Central Register of Controlled Trials CENTRAL and Google Scholar databases from inception until November 2019. RESULTS Overall, eight studies were included that recruited 476 patients. The pooled success rate of the technique was 63% (95% CI 50%-75%). The pooled complication rate was 8% (95% CI 1%-18%). Sixty-six per cent of patients had a transsphincteric fistula and 60% had undergone a previous surgical intervention, mainly the insertion of a seton (54%). The majority had a cryptoglandular fistula. Operation time and follow-up period were described for each study. CONCLUSION FiLaC™ seems to be an efficient therapeutic option for perianal fistula disease with an adequate level of safety that preserves quality of life. Nevertheless, randomized trials need to be designed to compare FiLaC™ with other procedures for the management of anal fistulas such as ligation of intersphincteric fistula tract, anal advancement flaps, fibrin glue, collagen paste, autologous adipose tissue, fistula plug and video-assisted anal fistula treatment.
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Affiliation(s)
- M Frountzas
- Laboratory of Experimental Surgery and Surgical Research, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.,First Propaedeutic Department of Surgery, School of Medicine, Hippocration General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - K Stergios
- Laboratory of Experimental Surgery and Surgical Research, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - C Nikolaou
- Laboratory of Experimental Surgery and Surgical Research, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - I Bellos
- Laboratory of Experimental Surgery and Surgical Research, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - D Schizas
- First Department of Surgery, School of Medicine, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - D Linardoutsos
- First Propaedeutic Department of Surgery, School of Medicine, Hippocration General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - K Kontzoglou
- Laboratory of Experimental Surgery and Surgical Research, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - G Vaos
- Department of Paediatric Surgery, School of Medicine, Attikon University General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - A B Williams
- Department of Colorectal Surgery, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - K Toutouzas
- First Propaedeutic Department of Surgery, School of Medicine, Hippocration General Hospital, National and Kapodistrian University of Athens, Athens, Greece
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25
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Soulaidopoulos S, Drakopoulou M, Stathogiannis K, Xanthopoulou M, Oikonomou G, Toskas P, Kouroutzoglou A, Synetos A, Papanikolaou A, Latsios G, Sideris S, Tousoulis D, Toutouzas K. The effect of permanent pacemaker implantation following transcatheter aortic valve implantation upon survival. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Purpose
Transcatheter aortic valve implantation (TAVI) is often followed by conduction abnormalities, leading to a permanent pacemaker implantation (PPI). Data regarding the clinical impact of PPI following TAVI is yet to be established.
Methods
Patients with severe and symptomatic aortic stenosis [effective orifice area (EOA) ≤1cm2] referred for TAVI at our institution were consecutively enrolled. Prospectively collected demographic, laboratory and echocardiographic data were retrospectively analyzed. Patients were stratified into two groups according to the need for PPI after TAVI and were followed up postoperatively with clinical and echocardiographic assessment. Primary clinical endpoint was all-cause mortality, as defined by the criteria proposed by the Valve Academic Research Consortium 2.
Results
In total, 292 patients were included (male: 50.2%, mean age: 80±7.6 years) in our study. Of these, 109 (37.5%) underwent PPI simultaneously or shortly after TAVI. The median follow-up period was 27.3 In this period, all-cause mortality showed no significant difference between patients with and those without PPI after TAVI (log-rank p=0.756), even after excluding patients with a pre-existing pacemaker from the analysis. Subgroup analysis also showed no difference in survival between patients with low ejection fraction (<50%) and those with preserved (≥50%) receiving a permanent pacemaker after TAVR (log-rank p=0.269). Taking into consideration factors that were found to associate to PPI in univariate analysis (pre TAVI - ejection fraction, pulmonary artery systolic pressure and New York Heart Association functional class) in a multivariate model, pre TAVI pulmonary artery systolic pressure was found to be an independent predictor of peri-procedural PPI [Exp(B): 0.977, 95% Confidence Interval: 0.957–0.998, B=−0.023, p=0.029]. Pre-TAVI conduction abnormalities and the degree of aortic annulus calcification, as assessed by computed-tomography, were not found to predict PPI after TAVI.
Conclusion
PPI following TAVI was not associated with survival at 27 months of follow-up, independently from the pre TAVI ejection fraction.
Figure 1
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- S Soulaidopoulos
- Hippokration General Hospital, First Department of Cardiology, Medical School of Athens, Athens, Greece
| | - M Drakopoulou
- Hippokration General Hospital, First Department of Cardiology, Medical School of Athens, Athens, Greece
| | - K Stathogiannis
- Hippokration General Hospital, First Department of Cardiology, Medical School of Athens, Athens, Greece
| | - M Xanthopoulou
- Hippokration General Hospital, First Department of Cardiology, Medical School of Athens, Athens, Greece
| | - G Oikonomou
- Hippokration General Hospital, First Department of Cardiology, Medical School of Athens, Athens, Greece
| | - P Toskas
- Hippokration General Hospital, First Department of Cardiology, Medical School of Athens, Athens, Greece
| | - A Kouroutzoglou
- Hippokration General Hospital, First Department of Cardiology, Medical School of Athens, Athens, Greece
| | - A Synetos
- Hippokration General Hospital, First Department of Cardiology, Medical School of Athens, Athens, Greece
| | - A Papanikolaou
- Hippokration General Hospital, First Department of Cardiology, Medical School of Athens, Athens, Greece
| | - G Latsios
- Hippokration General Hospital, First Department of Cardiology, Medical School of Athens, Athens, Greece
| | - S Sideris
- Hippokration General Hospital, First Department of Cardiology, Medical School of Athens, Athens, Greece
| | - D Tousoulis
- Hippokration General Hospital, First Department of Cardiology, Medical School of Athens, Athens, Greece
| | - K Toutouzas
- Hippokration General Hospital, First Department of Cardiology, Medical School of Athens, Athens, Greece
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26
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Anousakis-Vlachochristou N, Katsa M, Panara A, Varela A, Kyriakidou M, Kapelouzou A, Nitsa A, Galiatsatos N, Toutouza M, Anastassopoulou I, Thomaidis N, Anagnostopoulos C, Cokkinos D, Tousoulis D, Toutouzas K. Investigation of the optimal rabbit model for aortic valve stenosis. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background/Purpose
Anatomically, hemodynamically relevant and validated animal models for aortic valve stenosis are of great need. Drolet rabbit model with tricuspid anatomy produced conflicting results for unclear reasons. We hypothesized that limitations concentrate in the regimen administration. We sought to evaluate multiple doses, ways of administration and time periods.
Methods
We included New Zealand rabbits in 4 groups: Group A (Drolet): was fed with normal chaw (nc)+0.5% cholesterol (chol)+3500 IUs Vitamin D2/kg (VD2, ergocalciferol, Sigma) in water daily for 12 weeks (wks), Group B: nc+0.5%chol+3500 IUs/kg VD2 in oil incorporated in a bisquit daily for 8 wks, Group C: nc+0.5%chol+8750 IUs/kg VD2 in oil-biscuit for 8 wks, Group D: nc+0.5%chol+17500 IUs VD2 in oil-biscuit for 8 wks vs controls (fed only with nc). After 12 and 8 wks the rabbits were sacrificed. Aortic valve area (AVA) and mean gradient (meanGr) were assessed with echocardiography (Vivid 7, M3S transducer, GE) and serum obtained, at baseline and before sacrifice. VD2 levels were evaluated through Chemiluminescent Microparticle Immuno Assay (CMIA, Abbott) and liquid chromatography – tandem mass spectrometry (LC-APCI-MS/MS). Animals received i.v. 18F-NaF one hour before sacrifice and valve was ex-vivo imaged with microPET/CT (Mediso nanoScan). Aortic cusps were analyzed with Fourier-Transformed Infrared Spectroscopy (FT-IR, Nicolet 6700 spectrometer, OMNIC 7.3 software). Valves from surgical patients with severe stenosis served for comparison purposes.
Results
In Group A at 12 wks AVA and meanGr remained unchanged but biomineralization was detected with FT-IR with vibrations in the region of 1800–800 cm–1 demonstrating the deposition of CaCO3 and non-hydroxyapatite Ca3(PO4)2 identical to human lesion. Calcification was detected on cusps with 18F-NaF. VD2 levels were out of upper detection range with CMIA due to cross reaction, whereas all samples measured through LC-MS/MS were below the detection limit of the method (<19,1 ng/mL). Significant Assessment heterogeneity (RSD=27%) was observed on VD2 water regimen. In Group B, AVA changed from 0.5 cm2 to 0.4 cm2 and meanGr increased from 1.1 to 2.1 mmHg, p<0.05 and in Group C AVA: 0.5 cm2 to 0.3 cm2 and meanGr: 1 to 2.95 mmHg, p<0.05, while VD2 serum concentration were 511 ng/mL. In Group D animals die unexpectedly at 2 weeks, with autopsy revealing massive myocardial hypertrophy of the left ventricle (LVH) without compromise of the aortic valve.
Conclusions
The modified diet produces aortic valve stenosis and biomineralization detectable with 18F-NaF, chemically identical to human lesion. Very high doses of Vitamin D2 directly produce LVH, possibly leading to arrythmiogenesis. The modified high-fat-vitamin D2 rabbit model proved suitable for translational research of aortic valve stenosis disease.
Funding Acknowledgement
Type of funding source: Public Institution(s). Main funding source(s): National and Kapodistrian University of Athens
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Affiliation(s)
- N Anousakis-Vlachochristou
- National & Kapodistrian University of Athens Medical School, First Department of Cardiology, Athens, Greece
| | - M Katsa
- National and Kapodistrian University of Athens, Analytical Chemistry lab, Chemistry department, Athens, Greece
| | - A Panara
- National and Kapodistrian University of Athens, Analytical Chemistry lab, Chemistry department, Athens, Greece
| | - A Varela
- Academy of Athens Biomedical Research Foundation, Center for Clinical, Experimental Surgery & Translational Research, Athens, Greece
| | - M Kyriakidou
- International Anticancer Research Institute, Athens, Greece
| | - A Kapelouzou
- Academy of Athens Biomedical Research Foundation, Center for Clinical, Experimental Surgery & Translational Research, Athens, Greece
| | - A Nitsa
- National & Kapodistrian University of Athens Medical School, First Department of Cardiology, Athens, Greece
| | - N Galiatsatos
- National & Kapodistrian University of Athens Medical School, First Department of Cardiology, Athens, Greece
| | - M Toutouza
- National & Kapodistrian University of Athens Medical School, First Department of Cardiology, Athens, Greece
| | | | - N Thomaidis
- National and Kapodistrian University of Athens, Analytical Chemistry lab, Chemistry department, Athens, Greece
| | - C Anagnostopoulos
- Academy of Athens Biomedical Research Foundation, Center for Clinical, Experimental Surgery & Translational Research, Athens, Greece
| | - D Cokkinos
- Academy of Athens Biomedical Research Foundation, Center for Clinical, Experimental Surgery & Translational Research, Athens, Greece
| | - D Tousoulis
- National & Kapodistrian University of Athens Medical School, First Department of Cardiology, Athens, Greece
| | - K Toutouzas
- National & Kapodistrian University of Athens Medical School, First Department of Cardiology, Athens, Greece
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27
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Karmpalioti M, Benetos G, Drakopoulou M, Xanthopoulou M, Stathogiannis K, Latsios G, Synetos A, Kalantzis C, Voudris V, Kosmas E, Mastrokostopoulos A, Katsimagklis G, Danenberg H, Tousoulis D, Toutouzas K. One-year echocardiographic outcomes of transcatheter aortic valve implantation with or without predilatation of the aortic valve: insights from the multicenter, randomized DIRECT trial. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Transcatheter aortic valve implantation (TAVI) has become the standard of care for high-risk and inoperable surgical patients and a valid alternative in intermediate-risk patients with severe aortic stenosis.The DIRECT trial (Predilatation in Transcatheter Aortic Valve Implantation Trial) was a multicenter, randomized, clinical trial designed to evaluate the safety and efficacy of TAVI with or without balloon aortic valvuloplasty (BAV) in patients with symptomatic, severe aortic valve stenosis.
Purpose
To compare the one year echocardiographic findings among patients, who underwent TAVI using a self-expanding valve with or without BAV.
Methods
A total of 171 patients with severe aortic stenosis were randomly assigned at 4 tertiary centers to undergo TAVI with the use of self-expanding prostheses with (pre-BAV) or without pre-dilatation (no-BAV). Follow up transthoracic echocardiography was performed 1 year after TAVI.
Results
Of 171 patients, 86 patients were randomized to pre-BAV group and 85 to no-BAV group. One year echocardiographic follow up was available in 146 patients. In one year follow up there was no significant difference between pre-BAV and no-BAV group in aortic valve area (1.84±0.39cm2 vs. 1.85±0.44cm2, p=0.79), peak aortic valve gradient (15.95±9.97 mmHg vs. 14.51±6.60 mmHg, p=0.35), mean aortic valve gradient (8.37±5.01 mmHg vs. 7.99±4.04 mmHg, p=0.64), aortic valve peak velocity (1.90±0.51 m/s vs. 1.80±0.42m/s, p=0.24), ejection fraction (54.19±8.36% vs. 53.19±9.58%, p=0.52) and pulmonary artery systolic pressure (41.86±14.34 mmHg vs. 40.71±12.40 mmHg, p=0.64). The incidence of moderate or severe paravalvular regurgitation (PVL) in 1 year follow up was 6.2% without significant difference between the 2 study groups (5.7% in the no-BAV group vs. 6.6% in the pre-BAV group, p=0.83).
Conclusions
Direct transcatheter aortic valve implantation has no impact on one-year prosthesis function and PVL in patients undergoing TAVI with self-expanding valve
Funding Acknowledgement
Type of funding source: Private company. Main funding source(s): Medtronic
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Affiliation(s)
| | - G Benetos
- Hippokration General Hospital, Athens, Greece
| | | | | | | | - G Latsios
- Hippokration General Hospital, Athens, Greece
| | - A Synetos
- Hippokration General Hospital, Athens, Greece
| | - C Kalantzis
- Hippokration General Hospital, Athens, Greece
| | - V Voudris
- Onassis Cardiac Surgery Center, Department of Cardiology, Athens, Greece
| | - E Kosmas
- Onassis Cardiac Surgery Center, Department of Cardiology, Athens, Greece
| | | | - G Katsimagklis
- Naval Hospital of Athens, Department of Cardiology, Athens, Greece
| | - H Danenberg
- Hadassah-Hebrew University Medical Center, Department of Cardiology, Jerusalem, Israel
| | - D Tousoulis
- Hippokration General Hospital, Athens, Greece
| | - K Toutouzas
- Hippokration General Hospital, Athens, Greece
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28
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Papageorgiou C, Zagouri F, Dimopoulos M, Manios E, Kafouris P, Tousoulis D, Anagnostopoulos C, Toutouzas K. Vascular inflammation and cardiovascular burden in metastatic breast cancer female patients receiving hormonal treatment and CDK 4/6 inhibitors or everolimus. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.3270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Chemotherapy regimens for breast cancer treatment can promote vascular dysfunction and lead to high cardiovascular risk.
Purpose
The aim of this study was to investigate the cardiovascular burden and vascular inflammation in metastatic breast cancer patients receiving either CDK 4/6 inhibitors and hormonal treatment or standard everolimus and hormonal treatment.
Methods
22 consecutive female patients with metastatic breast cancer that expressed estrogen and /or progesteron receptor and were HER2-negative were enrolled. Patients with active infection, chronic autoimmune disease and history of chemotherapy for the metastatic disease and/or adjuvant chemotherapy during the past 3 years were excluded. All subjects received hormonal treatment and of those, 10 received everolimus and 12 received therapy with CDK 4/6 inhibitors. The two groups were matched for age, history of hypertension, diabetes, dyslipidemia, smoking and all were free of major cardiovascular events for the past 6 months. Regional wall thickness (RWT) and left ventricle mass (LVM) measurements by transthoracic echocardiographic study were obtained followed by 24 hour ambulatory blood pressure monitoring, and 18F-fluorodeoxyglucose positron-emission tomography/computed tomography imaging. Radiotracer uptake in the aortic wall (ascending, arch, descending, abdominal), was quantified as tissue-to-background ratio (TBR).Each patient was assessed for the aforementioned parameters before the initiation and after 6 months of treatment.
Results
At follow up, patients assigned to CDK4/6 treatment demonstrated increased measurements of 24 hour systolic blood pressure (SBP) (p=0.004), daytime SBP(p=0.004) and night time SBP (p=0.012) (Group effect). The 24 hour mean arterial pressure measurements were also higher in CDK 4/6 population, in comparison to everolimus that displayed firm values. (Group effect- p=0.035, Interaction effect-p=0.023).Additionally, 24 hour diastolic blood pressure recordings in CDK 4/6 therapy were higher opposed to everolimus that remained consistent (Interaction effect- p=0.010). In CDK 4/6 group, TBR aorta measurements also increased significantly, whereas TBR values in everolimus remained stable. (Interaction effect-p=0.049). Both therapeutic regimens displayed statistically significant damaging effect with regards to the following variables: Night-time SBP (p=0.032), RWT (p<0.001), and LVM (p<0.001).
Conclusion
Chemotherapy with novel CDK 4/6 inhibitors and hormonal treatment can lead to increased vascular inflammation, and higher blood pressure values compared to the combination of everolimus and hormonal treatment in female patients with HR-positive HER2-negative metastatic breast cancer. Moreover, both treatment strategies promote remodelling of the left ventricle by means of increased RWT and mass. Further research and longitudinal studies in this field are required to validate the above findings.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- C Papageorgiou
- Alexandra University Hospital, Department of Clinical Therapeutics, Athens, Greece
| | - F Zagouri
- Alexandra University Hospital, Department of Clinical Therapeutics, Athens, Greece
| | - M Dimopoulos
- Alexandra University Hospital, Department of Clinical Therapeutics, Athens, Greece
| | - E Manios
- Alexandra University Hospital, Department of Clinical Therapeutics, Athens, Greece
| | - P Kafouris
- Academy of Athens Biomedical Research Foundation, Athens, Greece
| | - D Tousoulis
- Hippokration General Hospital, Athens, Greece
| | | | - K Toutouzas
- Hippokration General Hospital, Athens, Greece
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29
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Toutouzas K, Karmpalioti M, Benetos G, Drakopoulou M, Xanthopoulou M, Stathogiannis K, Latsios G, Synetos A, Bei E, Voudris V, Kosmas E, Mastrokostopoulos A, Katsimagklis G, Danenberg H, Tousoulis D. Echocardiographic assessment of functional changes of prosthetic valve after transcatheter aortic valve implantation in one year follow up: insights from the multicenter, randomized DIRECT trial. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1951] [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: 11/15/2022] Open
Abstract
Abstract
Introduction
The DIRECT trial (Predilatation in Transcatheter Aortic Valve Implantation (TAVI) Trial) was a multicenter, randomized, clinical trial designed to evaluate the safety and efficacy of TAVI with or without balloon aortic valvuloplasty (BAV) in patients with symptomatic, severe aortic valve stenosis.
Purpose
To investigate by echocardiography the functional changes of self-expanding prosthetic valves during the first year after TAVI with or without BAV.
Methods
One hundred seventy one consecutive patients with severe aortic stenosis were enrolled at 4 centers and randomized to TAVI using self-expanding prostheses with (pre-BAV) or without pre-dilatation (no-BAV). Transthoracic echocardiography was obtained at baseline, 30 days and 1 year after TAVI.
Results
Of 171 patients, 86 patients were randomized to pre-BAV group and 85 to no-BAV group. Over the one year, 7 (4%) patients died and in 18 (10%) there was no available paired 30 day/1 year echo. At baseline echocardiography the peak and mean aortic valve gradient and the aortic valve area (AVA) in no-BAV group were 77.31±22.56 mmHg, 47.23±14.98 mmHg and 0.69±0.16cm2 and in pre-BAV group 81.97±23.17 mmHg, 49.39±14.78 mmHg and 0.65±0.15cm2 respectively. One year after TAVI, patients in no-BAV and pre-BAV group showed stable peak and mean aortic valve gradients similar to those at 30 days (from 16.36±7.88 to 14.51±6.6 mmHg vs. 17.17±8.88 to 15.95±9.97 mmHg and from 8.87±4.23 to 7.99±4.04 mmHg vs. 9.39±4.79 to 8.38±5.02 mmHg respectively, P<0.001 vs. baseline). The AVA was similarly stable in one year follow up in no-BAV group (from 1.85±0.43cm2 to 1.85±0.44cm2, P<0.001 vs. baseline) and in pre-BAV group (from 1.86±0.49cm2 to 1.84±0.39cm2, P<0.001 vs. baseline). The incidence of moderate or severe paravalvular regurgitation remained unchanged in both groups (from 4.7% to 5.7% in no-BAV group and from 5.8% to 6.6% in pre-BAV group).
Conclusions
In both pre-BAV and no-BAV groups the improvement in hemodynamics of self-expanding prosthetic valves remained durable during the one year echocardiographic follow up assessment.
Funding Acknowledgement
Type of funding source: Private company. Main funding source(s): MEDTRONIC
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Affiliation(s)
- K Toutouzas
- Hippokration General Hospital, Athens, Greece
| | | | - G Benetos
- Hippokration General Hospital, Athens, Greece
| | | | | | | | - G Latsios
- Hippokration General Hospital, Athens, Greece
| | - A Synetos
- Hippokration General Hospital, Athens, Greece
| | - E Bei
- Hippokration General Hospital, Athens, Greece
| | - V Voudris
- Onassis Cardiac Surgery Center, Department of Cardiology, Athens, Greece
| | - E Kosmas
- Onassis Cardiac Surgery Center, Department of Cardiology, Athens, Greece
| | | | - G Katsimagklis
- Naval Hospital of Athens, Department of Cardiology, Athens, Greece
| | - H Danenberg
- Hadassah-Hebrew University Medical Center, Department of Cardiology, Jerusalem, Israel
| | - D Tousoulis
- Hippokration General Hospital, Athens, Greece
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30
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Toutouzas K, Benetos G, Drakopoulou M, Karmpalioti M, Xanthopoulou M, Stathogiannis K, Latsios G, Synetos A, Voudris V, Kosmas E, Mastrokostopoulos A, Katsimagklis G, Danenberg H, Vavuranakis M, Tousoulis D. No impact of direct implantation of a self-expanding valve on one-year clinical outcomes. Insights from the multicenter, randomized DIRECT trial. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
The DIRECT trial (Predilatation in Transcatheter Aortic Valve Implantation Trial) evaluated in a randomized fashion the safety and efficacy of direct (without balloon pre-dilatation) implantation of a self-expanding valve in all comers undergoing TAVI.
Purpose
To investigate the impact of direct implantation of a self-expanding valve on one-year clinical outcomes.
Methods
DIRECT trial randomized consecutive patients with severe aortic stenosis at 4 tertiary centers to undergo TAVI with the use of self-expanding prostheses with (pre-BAV) or without pre-dilatation (no-BAV). The primary endpoint was device success according to the VARC-2 criteria. Secondary endpoints included periprocedural mortality and stroke, new permanent pacemaker implantation and vascular complications.
All cause death, cardiac death, stroke and heart failure hospitalizations were recorded at one year and compared between the two groups using Kaplan-Meier plots.
Results
In total 171 patients were randomized in 4 centers. In the intention to treat analysis 86 patients were randomized to the pre-BAV group and 85 patients to the no-BAV TAVI group.
The device success according to the VARC-2 criteria was non-inferior in the no-BAV group compared to the pre-BAV group (65/85 - 76.5% for no-BAV versus 64/86 – 74.4% for pre-BAV, mean difference = 2.1%, 90% CI: −8.9 to 13). In the no-BAV group 25 (29.4%) patients underwent post balloon dilatation and in the pre-BAV group 13 patients (15.1%) (p=0.03).
At one year 4 deaths were recorded in pre-BAV group (4.7%) and 3 deaths in no-BAV group (3.5%). There was no difference in Kaplan-Meier plots between the two groups in all-cause mortality (log-rank p=0.72, figure). Similarly, there was no difference in one-year incidence of stroke (1 in pre-BAV and 2 in no-BAV group, log-rank p=0.55), cardiac death (log-rank p=0.66), non-cardiac death (log-rank p=0.98) and heart failure hospitalizations (1 in pre-BAV versus 3 in no-BAV group, log-rank p=0.31). Lastly, there was no difference in the incidence of permanent pacemaker implantation between the two groups at one year (27/67 in no-BAV group versus 20/69 in pre-BAV group, log-rank p=0.24)
Conclusions
Direct transcatheter aortic valve implantation is non-inferior to the procedure with pre-dilatation in self-expanding valve. Despite the overall low rate of events, direct procedure has no impact on clinical outcomes at one year.
Funding Acknowledgement
Type of funding source: Private company. Main funding source(s): Medtronic
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Affiliation(s)
- K Toutouzas
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
| | - G Benetos
- University of Athens Medical School, Athens, Greece
| | - M Drakopoulou
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
| | - M Karmpalioti
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
| | - M Xanthopoulou
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
| | - K Stathogiannis
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
| | - G Latsios
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
| | - A Synetos
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
| | - V Voudris
- Onassis Cardiac Surgery Center, Athens, Greece
| | - E Kosmas
- Onassis Cardiac Surgery Center, Athens, Greece
| | | | | | - H Danenberg
- Hadassah University Medical Center, Jerusalem, Israel
| | | | - D Tousoulis
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
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31
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Bounas P, Karanasos A, Synetos A, Papanikolaou A, Latsios G, Drakopoulou M, Trantalis G, Olympios C, Tousoulis D, Toutouzas K. Thin cap fibroatheroma and plaque rupture is associated with carotid thermal heterogeneity in patients presenting with acute myocardial infarction. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Microwave radiometry (MWR) has been applied successfully in the evaluation of carotid atherosclerosis, measuring reliably temperature heterogeneity of atherosclerotic plaques. Recent studies have shown an association between increased carotid temperature heterogeneity (ΔT) detected by MWR and cardiovascular events. Vulnerable plaques of the coronary arteries, share common characteristics such as the thin cap fibrous cap, that make the prone to rupture in the presence of stimulus such as shear stress or inflammation. Optical coherence tomography (OCT) is an imaging method, by which the fibrous cap and the presence of plaque rupture can be accurately in vivo visualized.
Purpose
To evaluate the impact of carotid temperature heterogeneity on the culprit plaque morphology on patients presenting with acute myocardial infarction.
Method
A total of 37 patients undergoing percutaneous coronary intervention (PCI) for an acute myocardial infarction who had an identifiable de novo culprit lesion in a native coronary artery, were enrolled in this study. All patients underwent PCI and Optical Coherence Study (OCT) within 12 hours since symptom onset. The OCT study was performed according to the standard techniques and acquired images were analyzed by 2 independent investigators., After the completion of the PCI all patients underwent MWR of both carotid arteries and ΔT was defined as maximal temperature detected along each carotid artery minus minimum.
Results
Thirty four patients with acute myocardial infarction 21 with STEMI (61.76%) and 13 (38.23%) with NSTEMI were included in the study. Thin cap fibroatheroma (TCFA) was present in 31 patients (91.1%), while all ruptured plaques had a TCFA compared to 11 TCFA (78.57%) observed in plaques that had no rupture (p=0.03). HsCRP was significantly increased in ruptured plaques compared to non ruptured ones (14.41±4.02 versus 9.9±2.5, p<0.005). Mean ΔT was significantly increased in ruptured plaques compared to no ruptured ones (1.01±0.31 versus 0.51±0.14°C, p<0.005), as well as in plaques with TCFA compared to those without a TCFA (0.82±0.37 versus 0.60±0.05°C, p=0.001). In the multivariate analysis DM, hsCRP, and ΔT were entered from which DM (OR 4.12; 95% CI 0.77–22.07; P=0.07) and ΔTau ((OR for 0.1°C increase 1.43; 95% CI 1.03–1.98; P=0.03) remained in the final model, with ΔT being the only variable independently associated with the presence of TCFA. Similarly regarding plaque rupture, STEMI, hsCRP, and ΔT were entered in the multivariate analysis from which hsCRP (OR 1.51; 95% CI 0.99–2.28; P=0.051) and ΔTau ((OR for 0.1°C increase 3.40; 95% CI 1.29–8.96; P=0.013) remained in the final model, with ΔT being the only variable independently associated with the presence of rupture.
Conclusions
Carotid thermal heterogeneity is associated with TCFA and plaque rupture in patients with acute myocardial infarction.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- P Bounas
- Thriassio General Hospital, Athens, Greece
| | - A Karanasos
- University of Athens Medical School, 1st Department of Cardiology, Athens, Greece
| | - A Synetos
- University of Athens Medical School, 1st Department of Cardiology, Athens, Greece
| | - A Papanikolaou
- University of Athens Medical School, 1st Department of Cardiology, Athens, Greece
| | - G Latsios
- University of Athens Medical School, 1st Department of Cardiology, Athens, Greece
| | - M Drakopoulou
- University of Athens Medical School, 1st Department of Cardiology, Athens, Greece
| | - G Trantalis
- University of Athens Medical School, 1st Department of Cardiology, Athens, Greece
| | - C Olympios
- Thriassio General Hospital, Athens, Greece
| | - D Tousoulis
- University of Athens Medical School, 1st Department of Cardiology, Athens, Greece
| | - K Toutouzas
- University of Athens Medical School, 1st Department of Cardiology, Athens, Greece
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Anousakis-Vlachochristou N, Varela A, Kyriakidou M, Parimalam S, Badilescu S, Agapaki A, Lali D, Kapelouzou A, Anastassopoulou I, Packirisamy M, Anagnostopoulos C, Cokkinos D, Tousoulis D, Toutouzas K. Modified New Zealand rabbit model produces severe aortic valve calcification and stenosis via extracellular membranous particles. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.3722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background/Purpose
In aortic valve stenosis calcification begins with nucleation on extracellular vesicles. In order to study early-stage disease, validated animal models are needed. The Drolet rabbit model is relevant due to tricuspid valve, but failed to consistently produce stenosis probably due to regimen administration. We compared a modified rabbit model and investigated the mechanisms and patterns of calcification.
Methods
New Zealand rabbits introduced to normal chaw+1% cholesterol+8750 IUs Vitamin D2/kg (Sigma) daily, in olive oil given in a bisquit vs control animals, for 8 weeks. Aortic valve area (AVA) and mean gradient (meanGr) was assessed with echocardiography (Vivid 7, M3S transducer, GE). At 8 weeks animals were sacrificed and valves were snap-frozen to −80°C. From each animal, one cusp was analyzed with Fourier-Transformed Infrared Spectroscopy (FT-IR, Nicolet 6700 spectrometer, OMNIC 7.3 software), another cusp was processed in alcoholic solution and the third was fixed 0.5 μm thin on 4% PFA; supernatant and tissue respectively examined with multispectral optical imaging. Valves from patients with severe stenosis were used for qualitative comparisons.
Results
At 8 weeks versus baseline, AVA reduced (0.5 cm2 to 0.3 cm2) and meanGr increased (1.1 to 2.95 mmHg, p<0.05), in control was unchanged. FT-IR vibrations in the region of 1800–800 cm–1 demonstrated changes in the protein structure and deposition of CaCO3 and non-hydroxyapatite Ca3(PO4)2 identical to patients' lesions. Multispectral optical imaging of supernatants revealed numerous membranous particles and conductivity analysis indicated calcium cations accumulation on the phospholipids of membrane. The tissue images confirmed the degradations and dendrimer-like depositions of calcium cations most likely on carbonates of amino acids.
Conclusions
The modified high-fat-vitamin D2 rabbit model produces aortic valve stenosis, with chemically identical mineralization to human lesion. Multispectral photonics demonstrate the presence of calcified membranous extracellular particles, a hallmark of cardiovascular calcification. Dendrimer-like depositions correspond to growing deposits. The model is suitable as a research platform purposed for aortic valve stenosis.
Figure 1. A: Image from alcoholic solution supernatant. The bright spots have high conductivity due to Ca 2+ deposition. B: ImageJ surface plot of circulated region confirms calcification. C: 3D-plot illustrates mineralization of membranes. D: 3D-plot of human aortic valve. E: Hypermicroscopic image of rabbit valve tissue: dendrimer-like and mineral cation deposits.
Funding Acknowledgement
Type of funding source: Public Institution(s). Main funding source(s): National and Kapodistrian University of Athens, Greece; Concordia University, Montreal, Canada
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Affiliation(s)
- N Anousakis-Vlachochristou
- National & Kapodistrian University of Athens Medical School, First Department of Cardiology, Athens, Greece
| | - A Varela
- Academy of Athens Biomedical Research Foundation, Center for Clinical, Experimental Surgery & Translational Research, Athens, Greece
| | - M Kyriakidou
- International Anticancer Research Institute, Athens, Greece
| | - S Parimalam
- Concordia University, Optical Bio-Microsystems Laboratory, Montreal, Canada
| | - S Badilescu
- Concordia University, Optical Bio-Microsystems Laboratory, Montreal, Canada
| | - A Agapaki
- Academy of Athens Biomedical Research Foundation, Center for Clinical, Experimental Surgery & Translational Research, Athens, Greece
| | - D Lali
- Academy of Athens Biomedical Research Foundation, Center for Clinical, Experimental Surgery & Translational Research, Athens, Greece
| | - A Kapelouzou
- Academy of Athens Biomedical Research Foundation, Center for Clinical, Experimental Surgery & Translational Research, Athens, Greece
| | | | - M Packirisamy
- Concordia University, Optical Bio-Microsystems Laboratory, Montreal, Canada
| | - C Anagnostopoulos
- Academy of Athens Biomedical Research Foundation, Center for Clinical, Experimental Surgery & Translational Research, Athens, Greece
| | - D Cokkinos
- Academy of Athens Biomedical Research Foundation, Center for Clinical, Experimental Surgery & Translational Research, Athens, Greece
| | - D Tousoulis
- National & Kapodistrian University of Athens Medical School, First Department of Cardiology, Athens, Greece
| | - K Toutouzas
- National & Kapodistrian University of Athens Medical School, First Department of Cardiology, Athens, Greece
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Benetos G, Galanakos S, Koutagiar I, Skoumas I, Oikonomou G, Karanasos A, Drakopoulou M, Stathogiannis K, Plytaria S, Xanthopoulou M, Latsios G, Synetos A, Tousoulis D, Toutouzas K. Carotid artery temperature reduction with statin therapy in patients with familial hyperlipidemia syndromes. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.3000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Familial hypercholesterolemia (FH) syndromes constitute an important risk factor for premature atherosclerosis. Microwave radiometry (MWR) assess non-invasively carotid artery temperatures reflecting inflammation. Recent data support that statin therapy, that constitutes the cornerstone for the treatment of FH, reduces systemic inflammation.
Purpose
To investigate the impact of statin therapy either with simvastatin or with combination simvastatin plus ezetimibe on carotid artery temperatures.
Methods
Consecutive patients with diagnosis of either heterozygous hypercholesterolemia (hFH) or combined hyperlipidemia (FCH) not under statin therapy for at least 6 months were included in the study. FH pts were assigned to either simvastatin 40 mg or simvastatin 40 mg plus ezetimibe 10mg according to the discretion of the physician. FH patients who refused statin therapy were used as control group for the assessment of statins effect. In all subjects, common carotid intima-media thickness (ccIMT) was measured in the last 2 cm of the far wall of both common carotids close to the carotid bifurcation and ΔT (maximum-minimum) temperature measurements were performed across each carotid during MWR evaluation. Examinations were performed at baseline and after 6 months. Blood's lipid profile was also obtained in all patients.
Results
In total 115 patients were included in the study. Of them 40 patients received simvastatin (19 hFH and 11 FCH), 41 simvastatin + ezetimibe (31hFH and 10 FCH) and 34 (21 hFH and 13 FCH) no statin. There was no difference at baseline in ccIMT and ΔT measurements between hFH and FCH patients (0.10±0.03 vs 0.10±0.02, p=0.74 and 0.88±0.38 vs 0.84±0.32, p=0.52, respectively). Patients who refused statin therapy did not show any reduction in ccIMT and ΔT measurements between baseline and follow up (ccIMT: 0.10±0.02 vs 0.09±0.02, p=0.06 and ΔT: 0.72±0.26 vs 0.70±0.26). In contrast, there was a significant reduction in ccIMT and ΔT for patients under both simvastatin (0.10±0.03 vs 0.09±0.01, p=0.004 for ccIMT and 0.83±0.34 vs 0.63±0.24, p=0.04 for ΔT) and simvastatin + ezetimibe therapy (0.11±0.03 vs 0.09±0.02, p<0.001 and 1.00±0.38 vs 0.69±0.23, p<0.001 for ΔT). Patients under combination therapy reduced more significantly their carotid artery temperatures compared to patients under simvastatin monotherapy or patients without statin (−0.31±0.46 vs −0.2±0.40 vs −0.01±0.37, ANOVA p=0.04, Figure 1).
Conclusions
Both simvastatin and simvastatin + ezetimibe therapy among the beneficial effect on IMT, reduced carotid wall inflammation in FH pts.
Figure 1
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- G Benetos
- University of Athens Medical School, Athens, Greece
| | - S Galanakos
- University of Athens Medical School, Athens, Greece
| | - I Koutagiar
- University of Athens Medical School, Athens, Greece
| | - I Skoumas
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
| | - G Oikonomou
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
| | - A Karanasos
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
| | - M Drakopoulou
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
| | - K Stathogiannis
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
| | - S Plytaria
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
| | - M Xanthopoulou
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
| | - G Latsios
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
| | - A Synetos
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
| | - D Tousoulis
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
| | - K Toutouzas
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
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Bounas P, Synetos A, Karanasos A, Papanikolaou A, Drakopoulou M, Latsios G, Trantalis G, Olympios C, Tousoulis D, Toutouzas K. Coronary plaque rupture is associated with carotid thermal heterogeneity in patients presenting with acute myocardial infarction. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Vulnerable plaques of the coronary arteries, share common characteristics such as the thin cap fibrous cap, that make the prone to rupture in the presence of stimulus such as shear stress or inflammation. Optical coherence tomography (OCT) is an imaging method, by which the fibrous cap and the presence of plaque rupture can be accurately in vivo visualized. Recent studies have shown an association between increased carotid temperature heterogeneity (ΔT) detected by microwave radiometry (MWR) and cardiovascular events.
Purpose
To evaluate the impact of carotid temperature heterogeneity on the culprit plaque morphology on patients presenting with acute myocardial infarction.
Method
A total of 37 patients undergoing percutaneous coronary intervention (PCI) for an acute myocardial infarction who had an identifiable de novo culprit lesion in a native coronary artery, were enrolled in this study. All patients underwent PCI and Optical Coherence Study (OCT) within 12 hours since symptom onset. The culprit lesion of the angiogram was clearly identified by a combination of ECG, wall motion abnormalities seen in cardiac ultrasound, and coronary angiogram. The OCT study was performed using the LightLab OCT wire, and acquired images were analyzed by 2 independent investigators using previously validated criteria for OCT plaque characterization. After the completion of the PCI all patients underwent MWR of both carotid arteries and ΔT was defined as maximal temperature detected along each carotid artery minus minimum.
Results
Thirty four patients with acute myocardial infarction 21 with STEMI (61.76%) and 13 (38.23%) with NSTEMI were included in the study. STEMI patients had more ruptured plaques compared to NSTEMI patients (71.41 versus 38.46%, p=0.053). Thin cap fibroatheroma (TCFA) was present in 31 patients (91.1%), while all ruptured plaques had a TCFA compared to 11 TCFA (78.57%) observed in plaques that had no rupture (p=0.03). HsCRP was significantly increased in ruptured plaques compared to non ruptured ones (14.41±4.02 versus 9.9±2,5, p<0.005). Mean ΔT was significantly increased in ruptured plaques compared to no ruptured ones (1.01±0.31 versus 0.51±0.14°C, p<0.005), as well as in plaques with TCFA compared to those without a TCFA (0.82±0.37 versus 0.60±0.05°C, p=0.001). In the multivariate analysis, STEMI, hsCRP, and ΔT were entered from which hsCRP (OR 1.51; 95% CI 0.99–2.28; P=0.051) and ΔT ((OR for 0.1°C increase 3.40; 95% CI 1.29–8.96; P=0.013) remained in the final model, with ΔT being the only variable independently associated with the presence of rupture.
Conclusions
Carotid thermal heterogeneity is associated with the presence of plaque rupture in patients with acute myocardial infarction. Further studies are needed in order to assess the possible prognostic impact of carotid ΔT on such population.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- P Bounas
- Thriassio General Hospital, Athens, Greece
| | - A Synetos
- University of Athens Medical School, 1st Department of Cardiology, Athens, Greece
| | - A Karanasos
- University of Athens Medical School, 1st Department of Cardiology, Athens, Greece
| | - A Papanikolaou
- University of Athens Medical School, 1st Department of Cardiology, Athens, Greece
| | - M Drakopoulou
- University of Athens Medical School, 1st Department of Cardiology, Athens, Greece
| | - G Latsios
- University of Athens Medical School, 1st Department of Cardiology, Athens, Greece
| | - G Trantalis
- University of Athens Medical School, 1st Department of Cardiology, Athens, Greece
| | - C Olympios
- Thriassio General Hospital, Athens, Greece
| | - D Tousoulis
- University of Athens Medical School, 1st Department of Cardiology, Athens, Greece
| | - K Toutouzas
- University of Athens Medical School, 1st Department of Cardiology, Athens, Greece
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35
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Matsoukis I, Karanasos A, Patsa C, Anousakis-Vlachochristou N, Triantafyllou K, Kantzanou M, Drakopoulou M, Tsiamis E, Latsios G, Synetos A, Petridou E, Tousoulis D, Toutouzas K. Percutaneous coronary intervention with everolimus-eluting stents versus coronary artery bypass surgery in patients with stable angina and an isolated proximal left anterior descending artery disease. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background/Introduction
Revascularization of the proximal segment of left anterior descending artery (pLAD) demonstrates an additional prognostic significance in survival for patients with multivessel disease. It is also indicated for symptomatic relief in patients with stable angina who are receiving optimal medical treatment in the presence of limiting angina or angina equivalent. Both coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) are still commonly needed as therapeutic options for pLAD disease.
Moreover, Everolimus-eluting stents (EES) have demonstrated superiority in safety and efficacy among other types of second or new generation drug-eluting stents.
Purpose
We aim to evaluate the long-term outcomes of PCI with EES compared to CABG surgery with left internal mammary artery, in patients with stable angina and an isolated single vessel pLAD disease.
Methods
The sample consisted of 824 patients with isolated pLAD and chronic stable angina; 445 participants were included in the EES-PCI group, and 379 were included in the CABG group. The study's primary endpoint was the occurrence of major adverse cardiac events (MACEs), namely, cardiac death, myocardial infarction (MI) not attributed to a non-target vessel and target lesion revascularization as a composite index. Secondary endpoints were Patient-Related Outcome (PRO; a composite index of all-cause mortality, any MI related to any coronary artery, any revascularization conducted to any coronary artery), individual components of MACEs, recurrence of stable or unstable angina or a nonfatal arrhythmia and disease progression of other lesions. For the comparisons between the two groups, chi-square tests and Fisher's exact tests, were used, as appropriate.
Results
During the 4.6 years of follow-up period, no statistically significant difference was observed between the two study groups in respect to the primary endpoint MACE (8.1% versus 7.4%, p=0.71). Concerning secondary endpoints, repeat revascularization (3.6% versus 2.9%, p=0.58), cardiac death (2.9% versus 3.2%, p=0.84), MI (1.6% versus 1.3%, p=0.76) and PRO (16.9% versus 17.7%, p=0.76) did not significantly differ between the two groups. Recurrence of angina was more frequent in the EES-PCI group (14.9% versus 8.4%, p=0.005) even though higher Class of angina was found less common in EES patients than in CABG patients (p<0.001). Patients treated with EES-PCI had lower rates of onset of arrhythmias compared to those treated with CABG (6.3% versus 11.9%, p=0.005). Finally, revascularization in other than target lesion was more frequent in the stent than in the surgery arm (6.3% versus 3.2%, p=0.04); as a consequence, higher rates of revascularization in any vessel was recorded in the PCI group than the CABG one (9.9% versus 5.8%, p=0.03).
Conclusion
PCI with EES seem to have similar long-term clinical outcomes compared with CABG in patients with isolated pLAD disease.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- I Matsoukis
- University of Athens Medical School, Department of Hygiene, Epidemiology and Medical Statistics and First Cardiology Department, Athens, Greece
| | - A Karanasos
- Hippokration General Hospital, First Cardiology Department, Athens Medical School, Athens, Greece
| | - C Patsa
- Hippokration General Hospital, First Cardiology Department, Athens Medical School, Athens, Greece
| | | | - K Triantafyllou
- Hippokration General Hospital, Cardiac Surgery Departments, Athens, Greece
| | - M Kantzanou
- University of Athens, Department of Hygiene, Epidemiology and Medical Statistics, Athens, Greece
| | - M Drakopoulou
- Hippokration General Hospital, First Cardiology Department, Athens Medical School, Athens, Greece
| | - E Tsiamis
- Hippokration General Hospital, First Cardiology Department, Athens Medical School, Athens, Greece
| | - G Latsios
- Hippokration General Hospital, First Cardiology Department, Athens Medical School, Athens, Greece
| | - A Synetos
- Hippokration General Hospital, First Cardiology Department, Athens Medical School, Athens, Greece
| | - E.T.H Petridou
- University of Athens, Department of Hygiene, Epidemiology and Medical Statistics, Athens, Greece
| | - D Tousoulis
- Hippokration General Hospital, First Cardiology Department, Athens Medical School, Athens, Greece
| | - K Toutouzas
- Hippokration General Hospital, First Cardiology Department, Athens Medical School, Athens, Greece
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36
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Stathogiannis K, Drakopoulou M, Oikonomou G, Soulaidopoulos S, Toskas P, Xanthopoulou M, Synetos A, Latsios G, Kosmas E, Voudris V, Tousoulis D, Toutouzas K. Long-term outcomes after transcatheter aortic valve implantation. An analysis of 5-year survival and beyond. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.3222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Transcatheter aortic valve implantation (TAVI) has seen an unprecedented rise in the past decade and has become the gold-standard therapy for inoperable, high- and intermediate-risk patients with aortic valve stenosis.
Purpose
To investigate the long-term clinical outcomes (5-year survival and beyond) of patients undergoing TAVI.
Methods
Consecutive patients who underwent TAVI with a self-expanding valve between 2012 - 2015 were included in the study. Patients with bicuspid valves and valve-in-valve procedures were excluded. Clinical follow-up was performed at specified time intervals (30-day post TAVI and yearly thereafter). The primary endpoint of this study was to evaluate survival rates in the long-term (≥5 years). Secondary endpoints were echocardiographic findings and clinical status at 5 years. All endpoints were considered as per the VARC-2 criteria and the latest consensus documents.
Results
In total, 267 patients were included in the study. Complete follow-up was complete in 189 (70%) patients. The mean age at implantation was 80.71±6.81 years, 129 (48%) were female, mean logistic EuroSCORE was 24.28±8.64% and 73% of patients were at NYHA Class III. The median follow-up was 4.0±1.5 years.
Before the procedure, ejection fraction (EF) was 49.92±9.37%, mean gradient was 48.83±14.68mmHg, pulmonary artery systolic pressure (PASP) was 44.31±12.72mmHg and aortic valve area was 0.98±5.02cm2.
All patients received the self-expanding valve (mean valve size was 27.60±2.12mm), with the majority of them undergoing transfemoral TAVI (71%). Predilation was performed in 77% of the population and post TAVI dilation was performed in 20%.
Compared to pre TAVI values, EF was higher at 50.66±9.37% (p=0.041), mean gradient was lower at 9.41±4.65mmHg (p<0.001), PASP was lower at 41.55±9.93mmHg (p=0.005) and aortic valve area was higher at 1.69±0.81cm2 (p<0.001) post TAVI.
At the end of the fifth year, 160 (60%) patients were alive. Mean survival post TAVI was 32 months (median: 32.2 months, range: 0–91.2 months) and the majority of deaths were non-cardiac in nature (78%). Also, 43% patients of patients were at NYHA Class I, 50% were at NYHA Class II and 7% were at NYHA Class III. At multivariate analysis, sole independent predictor of death at 5 years was baseline PASP levels (OR 1.027, 95% CI: 1–1.054, p=0.049).
Conclusion
Transcatheter aortic valve implantation offers a viable solution for aortic stenosis patients and long-term results beyond 5 years are reassuring. Further studies are necessary in order to shed a light for very long-term outcomes.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
| | - M Drakopoulou
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
| | - G Oikonomou
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
| | - S Soulaidopoulos
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
| | - P Toskas
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
| | - M Xanthopoulou
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
| | - A Synetos
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
| | - G Latsios
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
| | - E Kosmas
- Onassis Cardiac Surgery Center, Athens, Greece
| | - V Voudris
- Onassis Cardiac Surgery Center, Athens, Greece
| | - D Tousoulis
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
| | - K Toutouzas
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
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37
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Gardikioti V, Terentes-Printzios D, Aznaouridis K, Latsios G, Siasos G, Drakopoulou M, Oikonomou E, Christoforatou E, Tsigou V, Xanthopoulou M, Toutouzas K, Vavuranakis M, Tousoulis D, Vlachopoulos C. The long-term impact of transcatheter aortic valve implantation on arterial stiffness and central hemodynamics. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background/Introduction
The study of arterial properties in patients with aortic valve stenosis who undergo transcatheter aortic valve implantation (TAVI) remains challenging and results so far seem equivocal.
Purpose
We sought to investigate the acute and long-term effect of TAVI on arterial stiffness and wave reflections opting for a global approach.
Methods
We enrolled 90 patients (mean age 80.2±8.1 years, 50% males) with severe symptomatic aortic stenosis undergoing TAVI. Arterial stiffness was assessed by both carotid-femoral and brachial-ankle pulse wave velocity (cfPWV and baPWV). Augmentation index corrected for heart rate (AIx@75), an index of wave reflections, and central pressures were assessed with arterial tonometry. Measurements were conducted at baseline, after the procedure and at 1 year.
Results
Immediately post-TAVI there was a statistically significant increase in arterial stiffness (7.5±1.5 m/s vs 8.4±1.9 m/s, p=0.001 for cfPWV and 1,773±459 cm/s vs 2,383±645 cm/s, p<0.001 for baPWV) despite no change in systolic blood pressure. At 1-year follow-up, TAVI was still associated with an increase in arterial stiffness compared to pre-TAVI (7.5±1.5 m/s vs 8.7±1.7 m/s, p<0.001 for cfPWV and 1,773±459 cm/s vs 2,286±575 cm/s, p<0.001 for baPWV) but not to post-TAVI values. We also observed a decrease in AIx@75 (32.2±12.9% vs 27.9±8.4%, p=0.016) post-TAVI that was attenuated at 1 year (32.2±12.9% vs 29.8±9.1%, p=0.38).
Conclusions
Our study shows that after TAVI the arterial system exhibits an increase of stiffness in response to the acute relief of the obstruction, which is retained in the long term. Our findings further elucidate the immediate and long-term hemodynamic changes of TAVI to the aorta that may entail prognostic role in this growing population.
Change of vascular biomarkers post-TAVI
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- V Gardikioti
- National & Kapodistrian University of Athens, Athens, Greece
| | | | - K Aznaouridis
- National & Kapodistrian University of Athens, Athens, Greece
| | - G Latsios
- National & Kapodistrian University of Athens, Athens, Greece
| | - G Siasos
- National & Kapodistrian University of Athens, Athens, Greece
| | - M Drakopoulou
- National & Kapodistrian University of Athens, Athens, Greece
| | - E Oikonomou
- National & Kapodistrian University of Athens, Athens, Greece
| | | | - V Tsigou
- National & Kapodistrian University of Athens, Athens, Greece
| | - M Xanthopoulou
- National & Kapodistrian University of Athens, Athens, Greece
| | - K Toutouzas
- National & Kapodistrian University of Athens, Athens, Greece
| | - M Vavuranakis
- National & Kapodistrian University of Athens, Athens, Greece
| | - D Tousoulis
- National & Kapodistrian University of Athens, Athens, Greece
| | - C Vlachopoulos
- National & Kapodistrian University of Athens, Athens, Greece
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38
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Drakopoulou M, Soulaidopoulos S, Stathogiannis K, Oikonomou G, Toskas P, Kouroutzoglou A, Papanikolaou A, Synetos A, Latsios G, Sideris S, Tousoulis D, Toutouzas K. Prognostic implication of electrocardiographic left ventricular strain in patients undergoing Transcatheter Aortic Valve Implantation. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Electrocardiographic (ECG) strain has been linked to excess cardiovascular morbidity and mortality in asymptomatic patients with aortic stenosis.
Purpose
We aim to determine the differential impact of baseline ECG-strain on long-term mortality after transcatheter aortic valve implantation (TAVI).
Methods
Patients with severe and symptomatic aortic stenosis (effective orifice area [EOA]≤1cm2), who were scheduled for TAVI with a self-expanding valve between May 2015 and May 2018 were consecutively enrolled. Left ventricular strain was defined as the presence of ≥1mm convex ST-segment depression with asymmetrical T-wave inversion in leads V5 to V6 on baseline ECG. Patients were excluded, if they had bundle branch block or a permanent pacemaker at baseline. Baseline parameters were compared, and multivariate Cox proportional hazard regression models were generated to assess outcome difference. The primary clinical endpoint was cumulative mortality defined according to the criteria proposed by the Valve Academic Research Consortium-2.
Results
Of the 171 patients screened, 56 patients were excluded due to left bundle branch block or paced rhythm. In the 115 included patients (mean age: 81.4±7), 36 patients (31.3%) had strain pattern on pre-TAVI ECG. There were no differences in baseline characteristics between the two groups. During a median follow-up of 2.32 years (IQR 1.62 to 3), 11 patients (9.6%) reached the primary clinical endpoint. Patients in the strain group had higher incidence of all-cause mortality compared to patients without left ventricular strain (25% vs 2.5%, χ2=14.4, p<0.001). Kaplan-Meier survival analysis showed a significantly decreased cumulative probability of survival at 3 years in patients with LV-strain compared with patients without LV-strain (log-rank p=0.002, Figure 1). In the multivariate analysis, left ventricular strain [Exp(B): 8.952, 95% Confidence Interval (CI): 1.215–65.938, B=2.192, p=0.031] and QRS duration [Exp(B): 1.058, 95% CI: 1.022–1.095, B=0.056, p<0.001] were found to be independent predictors of all-cause mortality after TAVI.
Conclusion
Baseline ECG left ventricular strain was an independent predictor of long-term mortality post TAVI. Systematic strain measurements might aid in risk-stratifying patients scheduled for TAVI.
Figure 1
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- M Drakopoulou
- Hippokration General Hospital, First Department of Cardiology, Medical School of Athens, Athens, Greece
| | - S Soulaidopoulos
- Hippokration General Hospital, First Department of Cardiology, Medical School of Athens, Athens, Greece
| | - K Stathogiannis
- Hippokration General Hospital, First Department of Cardiology, Medical School of Athens, Athens, Greece
| | - G Oikonomou
- Hippokration General Hospital, First Department of Cardiology, Medical School of Athens, Athens, Greece
| | - P Toskas
- Hippokration General Hospital, First Department of Cardiology, Medical School of Athens, Athens, Greece
| | - A Kouroutzoglou
- Hippokration General Hospital, First Department of Cardiology, Medical School of Athens, Athens, Greece
| | - A Papanikolaou
- Hippokration General Hospital, First Department of Cardiology, Medical School of Athens, Athens, Greece
| | - A Synetos
- Hippokration General Hospital, First Department of Cardiology, Medical School of Athens, Athens, Greece
| | - G Latsios
- Hippokration General Hospital, First Department of Cardiology, Medical School of Athens, Athens, Greece
| | - S Sideris
- Hippokration General Hospital, First Department of Cardiology, Medical School of Athens, Athens, Greece
| | - D Tousoulis
- Hippokration General Hospital, First Department of Cardiology, Medical School of Athens, Athens, Greece
| | - K Toutouzas
- Hippokration General Hospital, First Department of Cardiology, Medical School of Athens, Athens, Greece
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Oikonomou E, Aznaouridis K, Barbetseas J, Charalambous G, Gastouniotis I, Fotopoulos V, Gkini KP, Katsivas A, Koudounis G, Koudounis P, Koutouzis M, Lamprinos D, Lazaris E, Lazaris E, Lazaros G, Marinos G, Platogiannis N, Platogiannis D, Siasos G, Terentes-Printzios D, Theodoropoulou A, Theofilis P, Toutouzas K, Tsalamandris S, Tsiafoutis I, Vavouranakis M, Vogiatzi G, Zografos T, Baka E, Tousoulis D, Vlachopoulos C. Hospital attendance and admission trends for cardiac diseases during the COVID-19 outbreak and lockdown in Greece. Public Health 2020; 187:115-119. [PMID: 32949881 PMCID: PMC7434308 DOI: 10.1016/j.puhe.2020.08.007] [Citation(s) in RCA: 28] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 07/29/2020] [Accepted: 08/12/2020] [Indexed: 11/25/2022]
Abstract
Objectives The coronavirus disease 2019 (COVID-19) outbreak, along with implementation of lockdown and strict public movement restrictions, in Greece has affected hospital visits and admissions. We aimed to investigate trends of cardiac disease admissions during the outbreak of the pandemic and possible associations with the applied restrictive measures. Study design This is a retrospective observational study. Methods Data for 4970 patients admitted via the cardiology emergency department (ED) across 3 large-volume urban hospitals in Athens and 2 regional/rural hospitals from February 3, 2020, up to April 12 were recorded. Data from the equivalent (for the COVID-19 outbreak) time period of 2019 and from the postlockdown time period were also collected. Results A falling trend of cardiology ED visits and hospital admissions was observed starting from the week when the restrictive measures due to COVID-19 were implemented. Compared with the pre–COVID-19 outbreak time period, acute coronary syndrome (ACS) [145 (29/week) vs. 60 (12/week), −59%, P < 0.001], ST elevation myocardial infarction [46 (9.2/week) vs. 21 (4.2/week), −54%, P = 0.002], and non-ST elevation ACS [99 cases (19.8/week) vs. 39 (7.8/week), −60% P < 0.001] were reduced at the COVID-19 outbreak time period. Reductions were also noted for heart failure worsening and arrhythmias. The ED visits in the postlockdown period were significantly higher than in the COVID-19 outbreak time period (1511 vs 660; P < 0.05). Conclusion Our data show significant drops in cardiology visits and admissions during the COVID-19 outbreak time period. Whether this results from restrictive measures or depicts a true reduction of cardiac disease cases warrants further investigation. The coronavirus disease 2019 (COVID-19) outbreak has led to an unprecedented health system overload. The restrictive measures in Greece resulted in a low number of COVID-19 cases. Hospital visits and cardiovascular events have diminished after implementation of restrictive measures. Acute coronary syndromes reduced by approximately 55%, despite limited incidence of COVID-19. The multifactorial etiology of this finding should be thoroughly investigated.
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Affiliation(s)
- E Oikonomou
- 1st Cardiology Clinic, 'Hippokration' General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece; Emergency Department, Hippokration' General Hospital, Athens, Greece.
| | - K Aznaouridis
- 1st Cardiology Clinic, 'Hippokration' General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - J Barbetseas
- Department of Cardiology, Laiko General Hospital, Athens, Greece
| | - G Charalambous
- Emergency Department, Hippokration' General Hospital, Athens, Greece
| | - I Gastouniotis
- Emergency Department, Hippokration' General Hospital, Athens, Greece
| | - V Fotopoulos
- Emergency Department, Laiko General Hospital, Athens, Greece
| | - K-P Gkini
- Athens Red Cross Hospital, 2nd Department of Cardiology, Athens, Greece
| | - A Katsivas
- Athens Red Cross Hospital, 1st Department of Cardiology, Athens, Greece
| | - G Koudounis
- General Hospital of Kalamata, Department of Cardiology, Kalamata, Greece
| | - P Koudounis
- General Hospital of Kalamata, Department of Cardiology, Kalamata, Greece
| | - M Koutouzis
- Athens Red Cross Hospital, 2nd Department of Cardiology, Athens, Greece
| | - D Lamprinos
- Emergency Department, Laiko General Hospital, Athens, Greece
| | - E Lazaris
- Athens Red Cross Hospital, 2nd Department of Cardiology, Athens, Greece
| | - E Lazaris
- Athens Red Cross Hospital, 2nd Department of Cardiology, Athens, Greece
| | - G Lazaros
- 1st Cardiology Clinic, 'Hippokration' General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - G Marinos
- Emergency Department, Laiko General Hospital, Athens, Greece
| | - N Platogiannis
- General Hospital of Trikala, Department of Cardiology, Trikala, Greece
| | - D Platogiannis
- General Hospital of Trikala, Department of Cardiology, Trikala, Greece
| | - G Siasos
- 1st Cardiology Clinic, 'Hippokration' General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece; Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - D Terentes-Printzios
- 1st Cardiology Clinic, 'Hippokration' General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - A Theodoropoulou
- Emergency Department, Hippokration' General Hospital, Athens, Greece
| | - P Theofilis
- 1st Cardiology Clinic, 'Hippokration' General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - K Toutouzas
- 1st Cardiology Clinic, 'Hippokration' General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - S Tsalamandris
- 1st Cardiology Clinic, 'Hippokration' General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - I Tsiafoutis
- Athens Red Cross Hospital, 1st Department of Cardiology, Athens, Greece
| | - M Vavouranakis
- 1st Cardiology Clinic, 'Hippokration' General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - G Vogiatzi
- 1st Cardiology Clinic, 'Hippokration' General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece; Emergency Department, Laiko General Hospital, Athens, Greece
| | - T Zografos
- 1st Cardiology Clinic, 'Hippokration' General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece; Athens Red Cross Hospital, 1st Department of Cardiology, Athens, Greece
| | - E Baka
- Emergency Department, Hippokration' General Hospital, Athens, Greece
| | - D Tousoulis
- 1st Cardiology Clinic, 'Hippokration' General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - C Vlachopoulos
- 1st Cardiology Clinic, 'Hippokration' General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
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Benetos G, Charitos D, Delakis I, Karmpalioti M, Xanthopoulou M, Drakopoulou M, Stathogiannis K, Latsios G, Synetos A, Tousoulis D, Toutouzas K. Association Of Baseline Computed-tomography Derived Markers With Events In Patients Undergoing Tavi With A Self-expanding Valve. J Cardiovasc Comput Tomogr 2020. [DOI: 10.1016/j.jcct.2020.06.192] [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: 11/27/2022]
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Latsios G, Toutouzas K, Karanasos A, Synetos A, Drakopoulou M, Aggeli C, Tousoulis D. Trans-femoral TAVI: Successful hemostasis of a totally calcified femoral artery ("calcium tube") with the Manta© device. Hellenic J Cardiol 2020; 62:158-160. [PMID: 32387592 DOI: 10.1016/j.hjc.2020.04.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 04/10/2020] [Accepted: 04/22/2020] [Indexed: 10/24/2022] Open
Abstract
We describe a case of trans-femoral trans-catheter aortic valve implantation (TF-TAVI) wherein the use of a novel collagen plug-based device (i.e. Manta© device) was very successful in arterial 16 French sheath hemostasis despite an extremely hostile peripheral vessel anatomy due to calcification.
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Affiliation(s)
- George Latsios
- 1(st) Department of Cardiology, Athens Medical School, "Hippokration" General Hospital of Athens, Athens, Greece.
| | - Kostas Toutouzas
- 1(st) Department of Cardiology, Athens Medical School, "Hippokration" General Hospital of Athens, Athens, Greece
| | - Antonis Karanasos
- 1(st) Department of Cardiology, Athens Medical School, "Hippokration" General Hospital of Athens, Athens, Greece
| | - Andreas Synetos
- 1(st) Department of Cardiology, Athens Medical School, "Hippokration" General Hospital of Athens, Athens, Greece
| | - Maria Drakopoulou
- 1(st) Department of Cardiology, Athens Medical School, "Hippokration" General Hospital of Athens, Athens, Greece
| | - Constantina Aggeli
- 1(st) Department of Cardiology, Athens Medical School, "Hippokration" General Hospital of Athens, Athens, Greece
| | - Dimitris Tousoulis
- 1(st) Department of Cardiology, Athens Medical School, "Hippokration" General Hospital of Athens, Athens, Greece
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Katsi V, Georgiopoulos G, Oikonomou D, Aggeli C, Grassos C, Papadopoulos DP, Thomopoulos C, Marketou M, Dimitriadis K, Toutouzas K, Nihoyannopoulos P, Tsioufis C, Tousoulis D. Aortic Stenosis, Aortic Regurgitation and Arterial Hypertension. Curr Vasc Pharmacol 2020; 17:180-190. [PMID: 29295699 DOI: 10.2174/1570161116666180101165306] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [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: 11/28/2017] [Revised: 12/19/2017] [Accepted: 12/21/2017] [Indexed: 11/22/2022]
Abstract
BACKGROUND Hypertension (HT) is an important risk factor for cardiovascular disease and might precipitate pathology of the aortic valve. OBJECTIVE To investigate the association of HT with aortic dysfunction (including both aortic regurgitation and stenosis) and the impact of antihypertensive treatment on the natural course of underlying aortic disease. METHODS We performed a systematic review of the literature for all relevant articles assessing the correlation between HT and phenotype of aortic disease. RESULTS Co-existence of HT with aortic stenosis and aortic regurgitation is highly prevalent in hypertensive patients and predicts a worse prognosis. Certain antihypertensive agents may improve haemodynamic parameters (aortic jet velocity, aortic regurgitation volume) and remodeling of the left ventricle, but there is no strong evidence of benefit regarding clinical outcomes. Renin-angiotensin system inhibitors, among other vasodilators, are well-tolerated in aortic stenosis. CONCLUSION Several lines of evidence support a detrimental association between HT and aortic valve disease. Therefore, HT should be promptly treated in aortic valvulopathy. Despite conventional wisdom, specific vasodilators can be used with caution in aortic stenosis.
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Affiliation(s)
- V Katsi
- First Department of Cardiology, 'Hippokration' Hospital, University of Athens, Medical School, Athens, Greece
| | - G Georgiopoulos
- First Department of Cardiology, 'Hippokration' Hospital, University of Athens, Medical School, Athens, Greece
| | - D Oikonomou
- Department of Cardiology, 'Evaggelismos' General Hospital, Athens, Greece
| | - C Aggeli
- First Department of Cardiology, 'Hippokration' Hospital, University of Athens, Medical School, Athens, Greece
| | - C Grassos
- Department of Cardiology, 'KAT' General Hospital, Athens, Greece
| | - D P Papadopoulos
- Department of Cardiology, 'Laiko' General Hospital, Athens, Greece
| | - C Thomopoulos
- Department of Cardiology, Helena Venizelou Hospital, Athens, Greece
| | - M Marketou
- Department of Cardiology, Heraklion University Hospital, Crete, Greece
| | - K Dimitriadis
- First Department of Cardiology, 'Hippokration' Hospital, University of Athens, Medical School, Athens, Greece
| | - K Toutouzas
- First Department of Cardiology, 'Hippokration' Hospital, University of Athens, Medical School, Athens, Greece
| | - P Nihoyannopoulos
- First Department of Cardiology, 'Hippokration' Hospital, University of Athens, Medical School, Athens, Greece
| | - C Tsioufis
- First Department of Cardiology, 'Hippokration' Hospital, University of Athens, Medical School, Athens, Greece
| | - D Tousoulis
- First Department of Cardiology, 'Hippokration' Hospital, University of Athens, Medical School, Athens, Greece
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Schizas D, Frountzas M, Lidoriki I, Spartalis E, Toutouzas K, Dimitroulis D, Liakakos T, Mylonas KS. Sarcopenia does not affect postoperative complication rates in oesophageal cancer surgery: a systematic review and meta-analysis. Ann R Coll Surg Engl 2020; 102:120-132. [PMID: 31508983 PMCID: PMC6996429 DOI: 10.1308/rcsann.2019.0113] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2019] [Indexed: 12/29/2022] Open
Abstract
INTRODUCTION The high morbidity and mortality rates after oesophagectomy indicate the need for rigorous patient selection and preoperative risk assessment. Although muscle mass depletion has been proposed as a potential prognostic factor for postoperative complications and decreased survival in gastrointestinal cancer patients, available data are conflicting. The purpose of the present meta-analysis is to determine whether sarcopenia predicts postoperative outcomes in patients undergoing oesophagectomy. METHODS The databases MEDLINE, SCOPUS, Clinicaltrials.gov, CENTRAL and Google Scholar were searched for studies reporting on the effect of sarcopenia on postoperative outcomes following oesophageal cancer surgery. Outcomes included surgical complications, anastomotic leakage, respiratory complications, cardiovascular complications, postoperative infections, major complications and overall complications. The random effects model (DerSimonian-Laird) was used to calculate pooled effect estimates when high heterogeneity was encountered, otherwise the fixed-effects (Mantel-Haenszel) model was implemented. FINDINGS A total of eight studies involving 1488 patients diagnosed with oesophageal cancer and who underwent oesophagectomy were included in the meta-analysis. The presence of sarcopenia did not significantly increase the rate of surgical complications (odds ratio, OR, 0.86, 95% confidence interval, CI, 0.40-1.85), anastomotic leakage (OR 0.75, 95% CI 0.42-1.35), respiratory complications (OR 0.56, 95% CI 0.21-1.48), cardiovascular complications (OR 0.94, 95% CI 0.31-2.83), postoperative infection (OR 1.14, 95% CI 0.52-2.50), major complications (OR 0.81, 95% CI 0.23-2.82) or overall postoperative complications (OR 0.80, 95% 0.32-1.99). CONCLUSION Sarcopenia does not seem to affect postoperative complication rates of patients undergoing oesophagectomy for oesophageal cancer. Future research should focus on determining whether prognosis differs according to muscle mass in this patient population.
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Affiliation(s)
- D Schizas
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - M Frountzas
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
- Laboratory of Experimental Surgery and Surgical Research, National and Kapodistrian University of Athens, Athens, Greece
| | - I Lidoriki
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - E Spartalis
- Laboratory of Experimental Surgery and Surgical Research, National and Kapodistrian University of Athens, Athens, Greece
| | - K Toutouzas
- First Propaedeutic Department of Surgery, National and Kapodistrian University of Athens, Hippocration General Hospital, Athens, Greece
| | - D Dimitroulis
- Second Propedeutic Department of Surgery, National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece
| | - T Liakakos
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - KS Mylonas
- School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Drakopoulou M, Nyktari E, Soulaidopoulos S, Oikonomou G, Toutouzas K, Tousoulis D. P1491 Aneurysm of the membranous septum after spontaneous closure of ventricular septal defect combined with bicuspid aortic valve. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
An 18-year-old asymptomatic patient with a cardiac background of ventricular septal defect (VSD) and bicuspid aortic valve diagnosed in early childhood, was referred to our Adult Congenital Heart Disease (ACHD) outpatient clinic for routine assessment. Imaging by transthoracic echocardiography and Cardiac Magnetic Resonance (CMR) showed a well-developed multilobulated appendiform saccular formation (34x20mm) arising from the right ventricular side of the membranous septum inferior to the anterior aortic cusp and just beneath the septal leaflet of the tricuspid valve, protruding into the right ventricular outflow tract and the body of right ventricle. The fibrous quality and the absence of myocardium in this structure led to the formation of an aneurysm of the membranous septum (AMS) with the characteristic outpouching or ‘windsock’ appearance from its distention during ventricular systole (Figure). There was no shunt between the ventricles. The aortic valve was true bicuspid with severe aortic regurgitation and an eccentric jet towards the anterior leaflet of the mitral valve. The left ventricle was dilated with preserved systolic function. On the basis of the above information the Heart Team decided for surgical management.Both the presence of a true bicuspid valve (embryologically linked to VSD) as well as the pre-existing left-to-right shunting (until the spontaneous VSD closure) seem to have contributed to aortic valve dysfunction in this case. An interesting physical phenomenon concerning fluid dynamics, known as the ‘Venturi effect’, occurs in patients with ‘aneurysmal transformation’ of the ventricular septum, where the VSD becomes smaller creating thus a low-pressure zone that affects the adjacent aortic valve cusp, causing prolapse and, hence, aortic valve regurgitation.
Non-invasive imaging evaluation of patients with AMS is required for optimal diagnosis and treatment as well as for follow-up examinations. Echocardiography is an effective tool for diagnosing AMS, mainly as an incidental finding in asymptomatic subjects whereas CMR is capable of three-dimensional anatomical assessment and provides functional data about the blood flow into the aneurysm and integrity of the ventricular membranous septum.
Abstract P1491 Figure
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Affiliation(s)
| | - E Nyktari
- University Hospital of Heraklion, Heraklion, Greece
| | | | - G Oikonomou
- Hippokration General Hospital, Athens, Greece
| | - K Toutouzas
- Hippokration General Hospital, Athens, Greece
| | - D Tousoulis
- Hippokration General Hospital, Athens, Greece
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Oikonomou G, Drakopoulou M, Soulaidopoulos S, Toskas P, Stathogiannis K, Xanthopoulou M, Toutouzas K, Tousoulis D. P1817 The effect of permanent pacemaker implantation following transcatheter aortic valve replacement upon survival. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.1165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Transcatheter aortic valve replacement (TAVR) is often followed by conduction abnormalities, leading to a permanent pacemaker implantation (PPI). Data regarding the clinical impact of PPI following TAVR is yet to be established.
Purpose
To determine the effect of PPI after TAVR on long-term survival.
Methods : Patients with severe and symptomatic aortic stenosis [effective orifice area (EOA)≤1cm2] referred for TAVI at our institution were consecutively enrolled. Prospectively collected demographic, laboratory and echocardiographic data were retrospectively analyzed. Patients were stratified into two groups according to the need for PPI after TAVR and were followed up postoperatively with clinical and echocardiographic assessment. Primary clinical endpoint was all-cause mortality, as defined by the criteria proposed by the Valve Academic Research Consortium2.
Results : In total, 276 patients were included (male : 48.9%, mean age : 80 ± 7.5years) in our study . Of these, 107 (38.8%) underwent PPI simultaneously or shortly after TAVR. The median follow-up period was 26.6 [min. 0, max 116] months. In this period, all-cause mortality showed no significant difference between patients with and those without PPI after TAVR (log-rank p = 0.862). Subgroup analysis also showed no difference in survival between patients with low ejection fraction (<50%) and those with preserved (≥50%) receiving a permanent pacemaker after TAVR (log-rank p = 0.360). Including factors that were found to associate to PPI in univariate analysis (pre TAVR - ejection fraction, pulmonary artery systolic pressure and New York Heart Association functional class) in a multivariate model, pre TAVR pulmonary artery systolic pressure was found to be an independent predictor of peri-procedural PPI [Exp(B) : 0.974, 95% Confidence Interval : 0.953- 0.995, B= - 0.027, p= 0.015].
Conclusion : PPI following TAVR was not associated with survival at 26 months of follow-up, independently from the pre TAVR ejection fraction.
Abstract P1817 Figure.
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Affiliation(s)
- G Oikonomou
- Hippokration General Hospital, Athens, Greece
| | | | | | - P Toskas
- Hippokration General Hospital, Athens, Greece
| | | | | | - K Toutouzas
- Hippokration General Hospital, Athens, Greece
| | - D Tousoulis
- Hippokration General Hospital, Athens, Greece
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Drakopoulou M, Soulaidopoulos S, Oikonomou G, Toskas P, Xanthopoulou M, Stathogiannis K, Toutouzas K, Tousoulis D. P298 The long-term impact of persistent pulmonary hypertension in patients undergoing TAVR with a self-expanding valve. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Persistent severe pulmonary hypertension (PH) is considered to negatively affect early and late outcomes of patients undergoing aortic valve surgery. There is limited data however, cincerning the incidence of persistent PH after transcatheter aortic valve replacement (TAVR) and its impact on outcome is limited.
Purpose
We sought to investigate the impact of persistent PH on clinical outcomes of patients undergoing TAVR with a self-expanding valve.
Methods
Consecutive patients with severe symptomatic aortic stenosis scheduled for TAVR in our tertiary center were included in the study. Prospectively collected data before and after TAVR were retrospectively analyzed in all patients. Severe PH was defined as systolic pulmonary arterial pressure (sPAP) ≥45mmHg as assessed by echocardiography. For analysis purposes, patients with a sPAP decrease after TAVR to below 45mmHg were compared to patients with persistent PH following TAVR. All outcomes were evaluated according to the VARC-2 criteria.
Results
In total, 258 patients were included in this study (mean age 80.06 ± 7.50 years old, logEuroscore 24.50 ± 9.70%, NYHA III/IV Class 98.6%). Of these, 149 (57.8%) had sPAP less than 45mmHg and 109 (42.2%) had sPAP above or equal to 45mmHg at baseline. Patients with severe PH were older (81.1 ± 7.0 vs 79.1 ± 7.7, p = 0.034), presented with higher logEuroscore (26.9 ± 9.3% vs 22.5 ± 9.9%, p< 0.001), lower ejection fraction (47.9 ± 9.3% vs 52.2 ± 8.5%, p< 0.001) and higher rates of at least moderate mitral regurgitation (36.7% vs 16.2%, p = 0.002) compared to the group without PH. After TAVR, 161 (62.4%) patients had sPAP less than 45mmHg and 97 (37.6%) had sPAP above 45mmHg. There was a significant decrease of 2.4 ± 12.2mmHg in sPAP post TAVR (p < 0.01). Multivariable analysis (univariate analysis: age, logEuroscore, pre TAVR mitral regurgitation, pre TAVR ejection fraction below 40%) identified pre TAVR ejection fraction below 40% to be the most powerful predictor for persistent PH after TAVR (odds ratio 2.4, 95% confidence interval 1.0.9 – 5.26, p = 0.028). During a mean follow up period of 26.6 ± 26.8, the presence of pre TAVR severe PH was not found to be predictive of cumulative mortality[Hazard Ratio(HR) : 1.57, 95% Confidence Intervals (CI) 0.92 – 2.66, p = 0.09). However, in the same follow up period, patients with persistent PH after TAVR had higher cumulative risk of death compared to patients with sPAP < 45mmHg after TAVR (Hazard Ratio 0.49, 95% Confidence Intervals 0.29-0.82, p = 0.007) (Figure).
Conclusions
Our data suggest that TAVR is associated with a significant reduction in sPAP. Persistent PH post TAVR seems to be a predictor of higher cumulative mortality post TAVR.
Abstract P298 Figure.
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Affiliation(s)
| | | | - G Oikonomou
- Hippokration General Hospital, Athens, Greece
| | - P Toskas
- Hippokration General Hospital, Athens, Greece
| | | | | | - K Toutouzas
- Hippokration General Hospital, Athens, Greece
| | - D Tousoulis
- Hippokration General Hospital, Athens, Greece
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47
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Drakopoulou M, Soulaidopoulos S, Oikonomou G, Stathogiannis K, Aggeli K, Toutouzas K, Tousoulis D. P1320 Percutaneous mitral valve leaflet plication to reduce systolic anterior motion and mitral regurgitation using the transcatheter mitral clip system. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
A 72-year-old female patient with a past medical history of severe mitral regurgitation, atrial fibrillation and embolic cerebrovascular events was admitted to our institution. The patient was under optimal medical therapy and complained for progressive worsening of activity-related dyspnea with limitation of physical activity (NYHA III).
Transthoracic echocardiography showed the presence of severe mitral regurgitation with a central jet. There was prolapse of both mitral valve leaflets and interestingly the anterior leaflet presented systolic anterior motion (SAM) at the same time. There was no significant left ventricular outflow tract obstruction (LVOT). Further evaluation of the regurgitant mitral valve with a transesophageal echocardiography (TOE) confirmed the above findings and the mechanism of MV regurgitation was attributed to prolapse in addition to SAM of an elongated anterior leaflet. Laboratory test showed elevated NT-pro-BNP levels. A coronary angiography was performed and excluded significant coronary artery disease.
The findings were assessed by our institution’s HEART TEAM and, in the presence of high surgical risk (LogEuroscore 32,76%), a decision for transcatheter mitral valve repair with a Mitral Clip implantation was taken. The Mitral Clip was succesfully implanted with immediate significant reduction of the regurgitant jet and no signs of stenotic behavior of the repaired valve. There was only mild mitral valve regurgitation. Notably, after the procedure there was elimination of the SAM and no LVOT obstruction (Figure). In accordance to the echocardiography findings, the patient demonstrated a significant clinical improvement and was discharged home 1 day after the procedure. Mitral clip implantation in this case showed improvement of the MR by reducing the SAM of the mitral valve.
Abstract P1320 Figure.
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Affiliation(s)
| | | | - G Oikonomou
- Hippokration General Hospital, Athens, Greece
| | | | - K Aggeli
- Hippokration General Hospital, Athens, Greece
| | - K Toutouzas
- Hippokration General Hospital, Athens, Greece
| | - D Tousoulis
- Hippokration General Hospital, Athens, Greece
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48
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Soulaidopoulos S, Drakopoulou M, Oikonomou G, Stathogiannis K, Toskas P, Xanthopoulou M, Toutouzas K, Tousoulis D. P1812 The effect of pre-procedural significant mitral regurgitation upon mortality after transcatheter aortic valve implantation. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.1163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
The presence of concomitant mitral regurgitation (MR) is a common issue in patients with severe aortic stenosis and negatively affects patient outcome. Available data regarding MR reduction due to aortic gradient reduction and left ventricular reverse remodeling after transcatheter aortic valve implantation (TAVI) are contradictory.
Purpose
To investigate the prognostic impact of both pre- and post-procedural MR in patients undergoing TAVI.
Methods
Patients with severe and symptomatic aortic stenosis stenosis [effective orifice area (EOA)≤1cm2] referred for TAVI at our institution were consecutively enrolled. Prospectively collected demographic, laboratory and echocardiographic data were retrospectively analyzed. Patients were stratified into two groups according to MR severity : ≤ grade 1 were defined as non-significant and ≥ grade 2 as significant. Change in MR was determined by comparison between baseline and 30-day echocardiogram. Primary clinical endpoint was all-cause mortality, as defined by the criteria proposed by the Valve Academic Research Consortium2.
Results
263 consecutive patients (136 men, mean age : 80 ± 7.5 years) were included in the analysis. Significant (grade≥2) MR was present in 65 (24,7%) patients, while 198 (75,3%) patients had mild or no ( ≤ grade 1) MR. Comparing the two groups, patients with significant MR had higher systolic pulmonary pressure (51.3 ± 14.6mmHg versus 42.8 ± 11.2mmHg, p < 0.001), lower ejection fraction (47.4 ± 10.8% versus 51.2 ± 8.2%) and were more dyspnoic (New York Heart Association class IV 18.5% vesrus 2.5%, p < 0.001). The primary clinical end point occurred in 63 (24%) patients during a follow-up period of 26.6 ± 26.8 months. Patients with significant pre-procedural MR displayed greater cumulative mortality (40% versus 18.8%, p = 0.001). Perioperative risk assessed by logistic EuroScore, NYHA class and pre-procedural MR were found to significantly associate to cumulative mortality in a univariate analysis. Performing a multivariable analysis demonstrated that preprocedural MR severity could independently predict cumulative mortality [OR 2.38, B = 0.869 (95% CI 1.2 – 4.6, p = 0.01)] (Figure).
Conclusion
Significant MR is not infrequent in patients undergoing TAVI and appears to independently associate with high increased all-cause mortality.
Abstract P1812 Figure.
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Affiliation(s)
| | | | - G Oikonomou
- Hippokration General Hospital, Athens, Greece
| | | | - P Toskas
- Hippokration General Hospital, Athens, Greece
| | | | - K Toutouzas
- Hippokration General Hospital, Athens, Greece
| | - D Tousoulis
- Hippokration General Hospital, Athens, Greece
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49
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Aggeli C, Dimitroglou I, Kastellanos S, Drakopoulou M, Moldovan K, Latsios G, Vavuranakis M, Toutouzas K, Tousoulis D. P4358The role of the “halo sign” for the accurate quantification of atrial septal defect size by 3D TEE. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
In patients undergoing percutaneous closure of secundum atrial septal defect (ASD), device selection is based on defect sizing by transoesophageal echocardiography (TEE) and in particular 3D measurement as well as 2D balloon-stretched derived measurements. We sought to investigate whether in patients with the presence of the “halo sign”, defined as increased tissue thickness at the edge of the ASD rims, there is an agreement between the aforementioned sizing methods with a view to avoid balloon sizing.
Methods
Consecutive patients referred to our department for single ASD closure without complex anatomy were included in our study. TEE was performed in all patients before and during the intervention. 3D datasets for ASD quantification as well as X-PLANE data sets for measurement of balloon-stretched 2D dimensions were acquired and analysed offline. During the analysis of 3D datasets, researchers were blinded to the 2D balloon-stretched measurements. Patients were stratified according to the presence of the halo sign and the correlation between 3D dimensions and balloon-derived diameter was calculated.
Results
Thirty-eight patients (14 males, 36.8%) with median age 46 [32–56] were included in our study. The “halo sign” was present in 16 patients (42.1%). In the whole study population, the median maximal and median minimal diameter measured by 3D TEE were 1.79cm [1.54–2.10] and 1.57cm [1.15–2.00] respectively while median circumference and area were 5.26cm [4.14–6.44] and 2.20cm2 [1.25–3.30] respectively. Median balloon-stretched diameter was 1.8cm [1.4–2.1]. In patients with the “halo sign” there was no significant difference between the medians of the ASD diameter calculated from 3D measurements and the 2D derived diameter (1.53cm; 1.6cm, p=0.170) whereas in patients with no “halo sign” there was significant difference (1.79cm; 2.0cm, p=0.001) (figure 1). The discrepancy between the aforementioned diameters was significantly lower in patients with the halo sign (0.04cm; 0.19cm, p=0.001). There was a good correlation between closure device size and 3D derived ASD circumference in the whole study population (R2=0.897) which was even higher in patients with the halo sign (R2=0.981). In this subgroup, the selected size of the closure device would not have differed significantly even without balloon sizing (p=0.414).
Figure 1
Conclusion
The ASD sizing by 3D echocardiography is accurate in patients with the “halo sign”. This study justifies further investigation concerning the reliability of 3D imaging in this population for the selection of the ASD device size with a view to avoid balloon sizing, decrease procedural time and thus simplify the procedure.
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Affiliation(s)
- C Aggeli
- Hippokration General Hospital, University of Athens Medical School, Athens, Greece
| | - I Dimitroglou
- Hippokration General Hospital, University of Athens Medical School, Athens, Greece
| | - S Kastellanos
- Hippokration General Hospital, University of Athens Medical School, Athens, Greece
| | - M Drakopoulou
- Hippokration General Hospital, University of Athens Medical School, Athens, Greece
| | - K Moldovan
- Hippokration General Hospital, University of Athens Medical School, Athens, Greece
| | - G Latsios
- Hippokration General Hospital, University of Athens Medical School, Athens, Greece
| | - M Vavuranakis
- Hippokration General Hospital, University of Athens Medical School, Athens, Greece
| | - K Toutouzas
- Hippokration General Hospital, University of Athens Medical School, Athens, Greece
| | - D Tousoulis
- Hippokration General Hospital, University of Athens Medical School, Athens, Greece
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50
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Karanasos A, Toutouzas K, Tsiachris D, Kordalis A, Tyrovolas K, Efremidis M, Karmpalioti M, Aggeli C, Karagiannis S, Prappa E, Stefanadis C, Gatzoulis K, Tousoulis D. P5432Invasive assessment by atrial volume-pressure loops of the acute changes in left atrial function induced by pulmonary vein antral isolation. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Atrial volume-pressure loops are considered the best method to assess left atrium (LA) function. Changes in atrial function induced by pulmonary vein (PV) antral isolation of atrial fibrillation (AF) have not been documented thus far using this approach.
Purpose
We aimed to evaluate changes in LA function in patients with paroxysmal atrial fibrillation (PAF) undergoing catheter ablation by atrial volume-pressure loops.
Methods
Patients undergoing for the first time catheter ablation of PAF by PV antral isolation and PV-LA junction ablation, as clinically indicated, were enrolled from 2 centers. Each center enrolled consecutive patients undergoing PV antral isolation using the same method i.e. radiofrequency or cryoballoon ablation. Patients with severe mitral stenosis or regurgitation, any prosthetic valve, left atrial thrombus or severe systolic or diastolic dysfunction of the left ventricle were excluded. Before and after the procedure, all patients underwent real-time three-dimensional transthoracic echocardiogram to evaluate volume changes of the LA during an entire cardiac cycle, while simultaneously recording LA pressure by a 6F angiographic catheter following transseptal puncture. After the procedure, LA volume and pressure recordings were gated offline by ECG, and were used to plot the LA pressure as a function of LA volume, thus creating a volume-pressure loop. The A loop area is a measure of the booster pump function of the LA. The V loop area expresses the reservoir function of the LA. Pressure and volume data at the clockwise ascending limb of the volume-pressure loop were fitted to the exponential function P = bxea·V, where P = instantaneous LA pressure; V = LA volume; a is the passive elastic chamber stiffness constant (cm–3) that determines the slope of the exponential curve, and b is the elastic constant (mm Hg).
Results
34 patients with PAF were analysed, 12 treated with radiofrequency ablation and 22 with cryoablation. The procedure was uneventful in all cases. Mean LA pressure, A-wave amplitude, and V-wave amplitude were all significantly increased post-procedurally (p<0.001 for all). The area of the A-loop decreased (Post: 40.69 ml·mm Hg [IQR 13.7–71.3] vs. Pre: 64.2 ml·mm Hg [IQR 30.9–86.9]; p=0.001), whereas the area of the V-loop increased (Post: 96.5 ml·mm Hg [IQR 45.1–230.5] vs. Pre: 79.2 ml·mm Hg [IQR 46.9–149.7]; p=0.016). Although the elastic constant increased (p<0.001), there was no significant difference in the passive chamber elastic constant (p=0.30).
Conclusion
Volume-pressure loops can assess procedural changes in LA function. Catheter ablation of AF is associated with a decrease the LA booster pump function of the LA, and in increase in the left atrial reservoir function. Moreover, there is an increase in LA pressures that is observed in the absence of change in LA stiffness.
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Affiliation(s)
- A Karanasos
- Hippokration Hospital, University of Athens, Athens, Greece
| | - K Toutouzas
- Hippokration Hospital, University of Athens, Athens, Greece
| | | | | | - K Tyrovolas
- Evangelismos General Hospital of Athens, Athens, Greece
| | - M Efremidis
- Evangelismos General Hospital of Athens, Athens, Greece
| | - M Karmpalioti
- Hippokration Hospital, University of Athens, Athens, Greece
| | - C Aggeli
- Hippokration Hospital, University of Athens, Athens, Greece
| | | | - E Prappa
- Evangelismos General Hospital of Athens, Athens, Greece
| | | | - K Gatzoulis
- Hippokration Hospital, University of Athens, Athens, Greece
| | - D Tousoulis
- Hippokration Hospital, University of Athens, Athens, Greece
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