1
|
Zakynthinos GE, Tsolaki V, Oikonomou E, Vavouranakis M, Siasos G, Zakynthinos E. New-Onset Atrial Fibrillation in the Critically Ill COVID-19 Patients Hospitalized in the Intensive Care Unit. J Clin Med 2023; 12:6989. [PMID: 38002603 PMCID: PMC10672690 DOI: 10.3390/jcm12226989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 10/28/2023] [Accepted: 11/06/2023] [Indexed: 11/26/2023] Open
Abstract
New-onset atrial fibrillation (NOAF) is the most frequently encountered cardiac arrhythmia observed in patients with COVID-19 infection, particularly in Intensive Care Unit (ICU) patients. The purpose of the present review is to delve into the occurrence of NOAF in COVID-19 and thoroughly review recent, pertinent data. However, the causality behind this connection has yet to be thoroughly explored. The proposed mechanisms that could contribute to the development of AF in these patients include myocardial damage resulting from direct virus-induced cardiac injury, potentially leading to perimyocarditis; a cytokine crisis and heightened inflammatory response; hypoxemia due to acute respiratory distress; disturbances in acid-base and electrolyte levels; as well as the frequent use of adrenergic drugs in critically ill patients. Additionally, secondary bacterial sepsis and septic shock have been suggested as primary causes of NOAF in ICU patients. This notion gains strength from the observation of a similar prevalence of NOAF in septic non-COVID ICU patients with ARDS. It is plausible that both myocardial involvement from SARS-CoV-2 and secondary sepsis play pivotal roles in the onset of arrhythmia in ICU patients. Nonetheless, there exists a significant variation in the prevalence of NOAF among studies focused on severe COVID-19 cases with ARDS. This discrepancy could be attributed to the inclusion of mixed populations with varying degrees of illness severity, encompassing not only patients in general wards but also those admitted to the ICU, whether intubated or not. Furthermore, the occurrence of NOAF is linked to increased morbidity and mortality. However, it remains to be determined whether NOAF independently influences outcomes in critically ill COVID-19 ICU patients or if it merely reflects the disease's severity. Lastly, the management of NOAF in these patients has not been extensively studied. Nevertheless, the current guidelines for NOAF in non-COVID ICU patients appear to be effective, while accounting for the specific drugs used in COVID-19 treatment that may prolong the QT interval (although drugs like lopinavir/ritonavir, hydrochlorothiazide, and azithromycin have been discontinued) or induce bradycardia (e.g., remdesivir).
Collapse
Affiliation(s)
- George E. Zakynthinos
- 3rd Department of Cardiology, “Sotiria” Chest Diseases Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece; (G.E.Z.); (E.O.); (M.V.); (G.S.)
| | - Vasiliki Tsolaki
- Critical Care Department, University Hospital of Larissa, Faculty of Medicine, University of Thessaly, 41110 Larissa, Greece;
| | - Evangelos Oikonomou
- 3rd Department of Cardiology, “Sotiria” Chest Diseases Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece; (G.E.Z.); (E.O.); (M.V.); (G.S.)
| | - Manolis Vavouranakis
- 3rd Department of Cardiology, “Sotiria” Chest Diseases Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece; (G.E.Z.); (E.O.); (M.V.); (G.S.)
| | - Gerasimos Siasos
- 3rd Department of Cardiology, “Sotiria” Chest Diseases Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece; (G.E.Z.); (E.O.); (M.V.); (G.S.)
- Cardiovascular Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Epaminondas Zakynthinos
- Critical Care Department, University Hospital of Larissa, Faculty of Medicine, University of Thessaly, 41110 Larissa, Greece;
| |
Collapse
|
2
|
Zakynthinos GE, Tsolaki V, Oikonomou E, Vavouranakis M, Siasos G, Zakynthinos E. Metabolic Syndrome and Atrial Fibrillation: Different Entities or Combined Disorders. J Pers Med 2023; 13:1323. [PMID: 37763092 PMCID: PMC10533132 DOI: 10.3390/jpm13091323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 08/21/2023] [Accepted: 08/24/2023] [Indexed: 09/29/2023] Open
Abstract
Obesity, hypertension, insulin resistance, and dyslipidemia are all clusters of an entity called "Metabolic Syndrome". The global trends of this syndrome's incidence/prevalence continue to increase reciprocally, converting it into a massive epidemic problem in the medical community. Observing the risk factors of atrial fibrillation, a medical condition that is also converted to a scourge, almost all parts of the metabolic syndrome are encountered. In addition, several studies demonstrated a robust correlation between metabolic syndrome and the occurrence of atrial fibrillation. For atrial fibrillation to develop, a combination of the appropriate substrate and a trigger point is necessary. The metabolic syndrome affects the left atrium in a multifactorial way, leading to atrial remodeling, thus providing both the substrate and provoking the trigger needed, which possibly plays a substantial role in the progression of atrial fibrillation. Due to the remodeling, treatment of atrial fibrillation may culminate in pernicious sequelae, such as repeated catheter ablation procedures. A holistic approach of the patient, with simultaneous treatment of both entities, is suggested in order to ensure better outcomes for the patients.
Collapse
Affiliation(s)
- George E. Zakynthinos
- 3rd Department of Cardiology, “Sotiria” Chest Diseases Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece; (E.O.); (M.V.); (G.S.)
| | - Vasiliki Tsolaki
- Critical Care Department, University Hospital of Larissa, Faculty of Medicine, University of Thessaly, Mezourlo, 41335 Larissa, Greece; (V.T.); (E.Z.)
| | - Evangelos Oikonomou
- 3rd Department of Cardiology, “Sotiria” Chest Diseases Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece; (E.O.); (M.V.); (G.S.)
| | - Manolis Vavouranakis
- 3rd Department of Cardiology, “Sotiria” Chest Diseases Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece; (E.O.); (M.V.); (G.S.)
| | - Gerasimos Siasos
- 3rd Department of Cardiology, “Sotiria” Chest Diseases Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece; (E.O.); (M.V.); (G.S.)
- Cardiovascular Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Epaminondas Zakynthinos
- Critical Care Department, University Hospital of Larissa, Faculty of Medicine, University of Thessaly, Mezourlo, 41335 Larissa, Greece; (V.T.); (E.Z.)
| |
Collapse
|
3
|
Bletsa E, Oikonomou E, Dimitriadis K, Stampouloglou PK, Fragoulis C, Lontou SP, Korakas E, Beneki E, Kalogeras K, Lambadiari V, Tsioufis K, Vavouranakis M, Siasos G. Exercise Effects on Left Ventricular Remodeling in Patients with Cardiometabolic Risk Factors. Life (Basel) 2023; 13:1742. [PMID: 37629599 PMCID: PMC10456116 DOI: 10.3390/life13081742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Revised: 08/08/2023] [Accepted: 08/12/2023] [Indexed: 08/27/2023] Open
Abstract
Left ventricular (LV) remodeling is a dynamic process, which is characterized by changes in ventricular size, shape, and wall thickness, thus altering myocardial geometry and function, and is considered as a negative prognostic factor in patients with heart failure (HF). Hypertension, type 2 diabetes (T2D), and obesity are strongly correlated with the development and the progression of LV remodeling, LV hypertrophy, and LV systolic and/or diastolic dysfunction. Indeed, the beneficial impact of exercise training on primary and secondary prevention of cardiovascular disease (CVD) has been well-established. Recent studies have highlighted that exercise training enhances functional capacity, muscle strength and endurance, cardiac function, and cardiac-related biomarkers among patients with established coronary artery disease (CAD) or HF, thus substantially improving their cardiovascular prognosis, survival rates, and need for rehospitalization. Therefore, in this review article, we discuss the evidence of LV remodeling in patients with cardiometabolic risk factors, such as hypertension, T2D, and obesity, and also highlight the current studies evaluating the effect of exercise training on LV remodeling in these patients.
Collapse
Affiliation(s)
- Evanthia Bletsa
- 3rd Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Sotiria Chest Disease Hospital, 11527 Athens, Greece; (E.B.); (P.K.S.); (K.K.); (M.V.); (G.S.)
- Cardiometabolic Disease Unit, 3rd Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Sotiria Chest Disease Hospital, 11527 Athens, Greece; (E.K.); (V.L.)
| | - Evangelos Oikonomou
- 3rd Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Sotiria Chest Disease Hospital, 11527 Athens, Greece; (E.B.); (P.K.S.); (K.K.); (M.V.); (G.S.)
- Cardiometabolic Disease Unit, 3rd Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Sotiria Chest Disease Hospital, 11527 Athens, Greece; (E.K.); (V.L.)
| | - Kyriakos Dimitriadis
- 1st Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Hippokrateion General Hospital, 11527 Athens, Greece; (K.D.); (C.F.); (E.B.); (K.T.)
| | - Panagiota K. Stampouloglou
- 3rd Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Sotiria Chest Disease Hospital, 11527 Athens, Greece; (E.B.); (P.K.S.); (K.K.); (M.V.); (G.S.)
| | - Christos Fragoulis
- 1st Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Hippokrateion General Hospital, 11527 Athens, Greece; (K.D.); (C.F.); (E.B.); (K.T.)
- Heart and Diabetes Center, National and Kapodistrian University of Athens, Medical School, Hippokrateion General Hospital, 11527 Athens, Greece;
| | - Stavroula P. Lontou
- Heart and Diabetes Center, National and Kapodistrian University of Athens, Medical School, Hippokrateion General Hospital, 11527 Athens, Greece;
| | - Emmanouil Korakas
- Cardiometabolic Disease Unit, 3rd Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Sotiria Chest Disease Hospital, 11527 Athens, Greece; (E.K.); (V.L.)
- 2nd Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, Attikon University Hospital, 12462 Athens, Greece
| | - Eirini Beneki
- 1st Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Hippokrateion General Hospital, 11527 Athens, Greece; (K.D.); (C.F.); (E.B.); (K.T.)
| | - Konstantinos Kalogeras
- 3rd Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Sotiria Chest Disease Hospital, 11527 Athens, Greece; (E.B.); (P.K.S.); (K.K.); (M.V.); (G.S.)
| | - Vaia Lambadiari
- Cardiometabolic Disease Unit, 3rd Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Sotiria Chest Disease Hospital, 11527 Athens, Greece; (E.K.); (V.L.)
- 2nd Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, Attikon University Hospital, 12462 Athens, Greece
| | - Konstantinos Tsioufis
- 1st Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Hippokrateion General Hospital, 11527 Athens, Greece; (K.D.); (C.F.); (E.B.); (K.T.)
- Heart and Diabetes Center, National and Kapodistrian University of Athens, Medical School, Hippokrateion General Hospital, 11527 Athens, Greece;
| | - Manolis Vavouranakis
- 3rd Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Sotiria Chest Disease Hospital, 11527 Athens, Greece; (E.B.); (P.K.S.); (K.K.); (M.V.); (G.S.)
| | - Gerasimos Siasos
- 3rd Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Sotiria Chest Disease Hospital, 11527 Athens, Greece; (E.B.); (P.K.S.); (K.K.); (M.V.); (G.S.)
- Cardiometabolic Disease Unit, 3rd Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Sotiria Chest Disease Hospital, 11527 Athens, Greece; (E.K.); (V.L.)
| |
Collapse
|
4
|
Pantelidis P, Oikonomou E, Lampsas S, Zakynthinos GE, Lysandrou A, Kalogeras K, Katsianos E, Theofilis P, Siasos G, Vavuranakis MA, Antonopoulos AS, Tousoulis D, Vavouranakis M. Lipoprotein(a) and calcific aortic valve disease initiation and progression: a systematic review and meta-analysis. Cardiovasc Res 2023; 119:1641-1655. [PMID: 37078819 DOI: 10.1093/cvr/cvad062] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [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: 10/24/2022] [Revised: 02/18/2023] [Accepted: 03/01/2023] [Indexed: 04/21/2023] Open
Abstract
Although evidence indicates the association of lipoprotein(a) [Lp(a)] with atherosclerosis, the link with calcific aortic valve disease (CAVD) is unclear. This systematic review and meta-analysis explores the connection between Lp(a) and aortic valve calcification and stenosis (AVS). We included all relevant studies, indexed in eight databases, up to February 2023. A total of 44 studies (163 139 subjects) were included, with 16 of them being further meta-analysed. Despite considerable heterogeneity, most studies support the relationship between Lp(a) and CAVD, especially in younger populations, with evidence of early aortic valve micro-calcification in elevated-Lp(a) populations. The quantitative synthesis showed higher Lp(a) levels, by 22.63 nmol/L (95% CI: 9.98-35.27), for patients with AVS, while meta-regressing the data revealed smaller Lp(a) differences for older populations with a higher proportion of females. The meta-analysis of eight studies providing genetic data, revealed that the minor alleles of both rs10455872 and rs3798220 LPA gene loci were associated with higher risk for AVS (pooled odds ratio 1.42; 95% CI: 1.34-1.50 and 1.27; 95% CI: 1.09-1.48, respectively). Importantly, high-Lp(a) individuals displayed not only faster AVS progression, by a mean difference of 0.09 m/s/year (95% CI: 0.09-0.09), but also a higher risk of serious adverse outcomes, including death (pooled hazard ratio 1.39; 95% CI: 1.01-1.90). These summary findings highlight the effect of Lp(a) on CAVD initiation, progression and outcomes, and support the early onset of Lp(a)-related subclinical lesions before clinical evidence.
Collapse
Affiliation(s)
- Panteleimon Pantelidis
- 3rd Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Sotiria Chest Disease Hospital, 152 Mesogeion St, Athens 11527, Greece
| | - Evangelos Oikonomou
- 3rd Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Sotiria Chest Disease Hospital, 152 Mesogeion St, Athens 11527, Greece
| | - Stamatios Lampsas
- 3rd Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Sotiria Chest Disease Hospital, 152 Mesogeion St, Athens 11527, Greece
| | - Georgios E Zakynthinos
- 3rd Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Sotiria Chest Disease Hospital, 152 Mesogeion St, Athens 11527, Greece
| | - Antonios Lysandrou
- 3rd Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Sotiria Chest Disease Hospital, 152 Mesogeion St, Athens 11527, Greece
| | - Konstantinos Kalogeras
- 3rd Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Sotiria Chest Disease Hospital, 152 Mesogeion St, Athens 11527, Greece
| | - Efstratios Katsianos
- 3rd Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Sotiria Chest Disease Hospital, 152 Mesogeion St, Athens 11527, Greece
| | - Panagiotis Theofilis
- 3rd Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Sotiria Chest Disease Hospital, 152 Mesogeion St, Athens 11527, Greece
| | - Gerasimos Siasos
- 3rd Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Sotiria Chest Disease Hospital, 152 Mesogeion St, Athens 11527, Greece
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115, USA
| | - Michael Andrew Vavuranakis
- 3rd Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Sotiria Chest Disease Hospital, 152 Mesogeion St, Athens 11527, Greece
| | - Alexios S Antonopoulos
- Clinical, Experimental Surgery & Translational Research Center, Biomedical Research Foundation of the Academy of Athens, 4 Soranou Ephessiou St, Athens 11527, Greece
| | - Dimitris Tousoulis
- 1st Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Ippokrateio Hospital, 114 Vasilissis Sofias St, Athina 11527, Greece
| | - Manolis Vavouranakis
- 3rd Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Sotiria Chest Disease Hospital, 152 Mesogeion St, Athens 11527, Greece
| |
Collapse
|
5
|
Theofilis P, Oikonomou E, Vogiatzi G, Sagris M, Antonopoulos AS, Siasos G, Iliopoulos DC, Perrea D, Vavouranakis M, Tsioufis K, Tousoulis D. The Role of MicroRNA-126 in Atherosclerotic Cardiovascular Diseases. Curr Med Chem 2023; 30:1902-1921. [PMID: 36043750 DOI: 10.2174/0929867329666220830100530] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Revised: 05/02/2022] [Accepted: 05/31/2022] [Indexed: 11/22/2022]
Abstract
Atherosclerotic cardiovascular diseases remain the leading cause of morbidity and mortality worldwide despite all efforts made towards their management. Other than targeting the traditional risk factors for their development, scientific interest has been shifted towards epigenetic regulation, with microRNAs (miRs) being at the forefront. MiR-126, in particular, has been extensively studied in the context of cardiovascular diseases. Downregulated expression of this miR has been associated with highly prevalent cardiovascular risk factors such as arterial hypertension and diabetes mellitus. At the same time, its diagnostic and prognostic capability concerning coronary artery disease is still under investigation, with up-to-date data pointing towards a dysregulated expression in a stable disease state and acute myocardial infarction. Moreover, a lower expression of miR-126 may indicate a higher disease complexity, as well as an increased risk for future major adverse cardiac and cerebrovascular events. Ultimately, overexpression of miR-126 may emerge as a novel therapeutic target in atherosclerotic cardiovascular diseases due to its potential in promoting therapeutic angiogenesis and anti-inflammatory effects. However, the existing challenges in miR therapeutics need to be resolved before translation to clinical practice.
Collapse
Affiliation(s)
- Panagiotis Theofilis
- 1st Cardiology Department, "Hippokration" General Hospital, University of Athens Medical School, Athens, Greece
| | - Evangelos Oikonomou
- 1st Cardiology Department, "Hippokration" General Hospital, University of Athens Medical School, Athens, Greece.,3rd Cardiology Department, "Sotiria" Chest Diseases Hospital, University of Athens Medical School, Athens, Greece
| | - Georgia Vogiatzi
- 1st Cardiology Department, "Hippokration" General Hospital, University of Athens Medical School, Athens, Greece.,3rd Cardiology Department, "Sotiria" Chest Diseases Hospital, University of Athens Medical School, Athens, Greece
| | - Marios Sagris
- 1st Cardiology Department, "Hippokration" General Hospital, University of Athens Medical School, Athens, Greece
| | - Alexios S Antonopoulos
- 1st Cardiology Department, "Hippokration" General Hospital, University of Athens Medical School, Athens, Greece
| | - Gerasimos Siasos
- 1st Cardiology Department, "Hippokration" General Hospital, University of Athens Medical School, Athens, Greece.,3rd Cardiology Department, "Sotiria" Chest Diseases Hospital, University of Athens Medical School, Athens, Greece
| | - Dimitrios C Iliopoulos
- Laboratory of Experimental Surgery and Surgical Research "N.S. Christeas", University of Athens Medical School, Athens, Greece
| | - Despoina Perrea
- Laboratory of Experimental Surgery and Surgical Research "N.S. Christeas", University of Athens Medical School, Athens, Greece
| | - Manolis Vavouranakis
- 1st Cardiology Department, "Hippokration" General Hospital, University of Athens Medical School, Athens, Greece.,3rd Cardiology Department, "Sotiria" Chest Diseases Hospital, University of Athens Medical School, Athens, Greece
| | - Konstantinos Tsioufis
- 1st Cardiology Department, "Hippokration" General Hospital, University of Athens Medical School, Athens, Greece
| | - Dimitris Tousoulis
- 1st Cardiology Department, "Hippokration" General Hospital, University of Athens Medical School, Athens, Greece
| |
Collapse
|
6
|
Oikonomou E, Xenou M, Zakynthinos GE, Tsaplaris P, Lampsas S, Bletsa E, Gialamas I, Kalogeras K, Goliopoulou A, Gounaridi MI, Pesiridis T, Tsatsaragkou A, Vavouranakis M, Siasos G, Tousoulis D. Novel Approaches to the Management of Diabetes Mellitus in Patients with Coronary Artery Disease. Curr Pharm Des 2023; 29:1844-1862. [PMID: 37403390 DOI: 10.2174/1381612829666230703161058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 05/20/2023] [Accepted: 05/29/2023] [Indexed: 07/06/2023]
Abstract
Cardiovascular disease (CVD) is the leading cause of morbidity and mortality in individuals with diabetes mellitus (DM). Although benefit has been attributed to the strict control of hyperglycemia with traditional antidiabetic treatments, novel antidiabetic medications have demonstrated cardiovascular (CV) safety and benefits by reducing major adverse cardiac events, improving heart failure (HF), and decreasing CVD-related mortality. Emerging data underline the interrelation between diabetes, as a metabolic disorder, and inflammation, endothelial dysfunction, and oxidative stress in the pathogenesis of microvascular and macrovascular complications. Conventional glucose-lowering medications demonstrate controversial CV effects. Dipeptidyl peptidase- 4 inhibitors have not only failed to prove to be beneficial in patients with coronary artery disease, but also their safety is questionable for the treatment of patients with CVD. However, metformin, as the first-line option for type 2 DM (T2DM), shows CVD protective properties for DM-induced atherosclerotic and macrovascular complications. Thiazolidinedione and sulfonylureas have questionable effects, as evidence from large studies shows a reduction in the risk of CV events and deaths, but with an increased rate of hospitalization for HF. Moreover, several studies have revealed that insulin monotherapy for T2DM treatment increases the risk of major CV events and deaths from HF, when compared to metformin, although it may reduce the risk of myocardial infarction. Finally, this review aimed to summarize the mechanisms of action of novel antidiabetic drugs acting as glucagon-like peptide-1 receptor agonists and sodium-glucose co-transporter-2 inhibitors that show favorable effects on blood pressure, lipid levels, and inflammation, leading to reduced CVD risk in T2DM patients.
Collapse
Affiliation(s)
- Evangelos Oikonomou
- 3rd Department of Cardiology, Medical School, "Sotiria" Chest Diseases Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Maria Xenou
- 3rd Department of Cardiology, Medical School, "Sotiria" Chest Diseases Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - George E Zakynthinos
- 3rd Department of Cardiology, Medical School, "Sotiria" Chest Diseases Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Paraskevas Tsaplaris
- 3rd Department of Cardiology, Medical School, "Sotiria" Chest Diseases Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Stamatios Lampsas
- 3rd Department of Cardiology, Medical School, "Sotiria" Chest Diseases Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Evanthia Bletsa
- 3rd Department of Cardiology, Medical School, "Sotiria" Chest Diseases Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Ioannis Gialamas
- 3rd Department of Cardiology, Medical School, "Sotiria" Chest Diseases Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Konstantinos Kalogeras
- 3rd Department of Cardiology, Medical School, "Sotiria" Chest Diseases Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Athina Goliopoulou
- 3rd Department of Cardiology, Medical School, "Sotiria" Chest Diseases Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Maria I Gounaridi
- 3rd Department of Cardiology, Medical School, "Sotiria" Chest Diseases Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Theodoros Pesiridis
- 3rd Department of Cardiology, Medical School, "Sotiria" Chest Diseases Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Aikaterini Tsatsaragkou
- 3rd Department of Cardiology, Medical School, "Sotiria" Chest Diseases Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Manolis Vavouranakis
- 3rd Department of Cardiology, Medical School, "Sotiria" Chest Diseases Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Gerasimos Siasos
- 3rd Department of Cardiology, Medical School, "Sotiria" Chest Diseases Hospital, National and Kapodistrian University of Athens, Athens, Greece
- Cardiovascular Division, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA
| | - Dimitris Tousoulis
- 3rd Department of Cardiology, Medical School, "Sotiria" Chest Diseases Hospital, National and Kapodistrian University of Athens, Athens, Greece
- 1st Department of Cardiology, Medical School, Hippokration General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| |
Collapse
|
7
|
Oikonomou E, Souvaliotis N, Lampsas S, Siasos G, Theofilis P, Korakas E, Lambadiari V, Ikonomidis I, Pesiridis T, Zakynthinos G, Katsarou O, Tousoulis D, Vavouranakis M. The role of cardiometabolic risk factors and endothelial dysfunction in serum albumin levels of patients with COVID-19. Cardiol J 2022; 29:1037-1039. [PMID: 36117293 PMCID: PMC9788738 DOI: 10.5603/cj.a2022.0088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 07/24/2022] [Accepted: 08/24/2022] [Indexed: 01/04/2023] Open
Affiliation(s)
- Evangelos Oikonomou
- 3rd Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Sotiria Chest Disease Hospital, Athens, Greece,1st Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Hippokration General Hospital, Athens, Greece
| | - Nektarios Souvaliotis
- 3rd Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Sotiria Chest Disease Hospital, Athens, Greece
| | - Stamatios Lampsas
- 3rd Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Sotiria Chest Disease Hospital, Athens, Greece
| | - Gerasimos Siasos
- 3rd Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Sotiria Chest Disease Hospital, Athens, Greece,Cardiovascular Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States
| | - Panagiotis Theofilis
- 1st Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Hippokration General Hospital, Athens, Greece
| | - Emmanouil Korakas
- 2nd Cardiology Department, Echocardiography Department and Laboratory of Preventive Cardiology, Athens University Hospital Attikon, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Vaia Lambadiari
- 2nd Cardiology Department, Echocardiography Department and Laboratory of Preventive Cardiology, Athens University Hospital Attikon, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Ignatios Ikonomidis
- 2nd Cardiology Department, Echocardiography Department and Laboratory of Preventive Cardiology, Athens University Hospital Attikon, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Theodoros Pesiridis
- 3rd Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Sotiria Chest Disease Hospital, Athens, Greece
| | - Georgios Zakynthinos
- 3rd Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Sotiria Chest Disease Hospital, Athens, Greece
| | - Ourania Katsarou
- 3rd Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Sotiria Chest Disease Hospital, Athens, Greece
| | - Dimitris Tousoulis
- 1st Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Hippokration General Hospital, Athens, Greece
| | - Manolis Vavouranakis
- 3rd Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Sotiria Chest Disease Hospital, Athens, Greece
| |
Collapse
|
8
|
Jabbour R, Pracon R, Kabir T, Shannon J, Duncan A, Heng EL, Oikonomou E, Katsianos E, Patel N, Chandra N, Smith R, Vavouranakis M, Dalby M, Panoulas V, Kalogeras K. TCT-461 Improved Mid-term Survival in Aortic Stenosis Patients Treated With Small Self-Expanding vs Balloon-Expandable Transcatheter Heart Valves. J Am Coll Cardiol 2022. [DOI: 10.1016/j.jacc.2022.08.544] [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: 10/14/2022]
|
9
|
Kalampogias A, Oikonomou E, Siasos G, Theofilis P, Dimitropoulos S, Gazouli M, Gennimata V, Marinos G, Charalambous G, Vavouranakis M, Tsioufis K, Tousoulis D. Differential Expression of microRNAs in acute and chronic heart Failure. Curr Med Chem 2022; 29:5130-5138. [PMID: 35473531 DOI: 10.2174/0929867329666220426095655] [Citation(s) in RCA: 1] [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: 12/28/2021] [Revised: 02/23/2022] [Accepted: 03/09/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND MicroRNAs modify protein expression at a post-transcriptional level and their circulating levels may express the underlying molecular pathways. OBJECTIVE The purpose of this study was to assess the differential expression of microRNAs related to myocardial cell energy substrate, autophagy, and ischaemia in chronic and acute heart failure (HF). METHODS In this case-control study, we studied 19 patients with acute HF (AHF) and 19 patients with chronic HF (CHF). Basic demographic and clinical characteristics were collected from the patients upon arrival, at 48 hours, and at 120 hours. Blood samples for microRNAs measurements (miR-22, -92a, and -499), b type natriuretic peptide (BNP), C reactive protein, and high sensitivity cardiac troponin I were collected in all study points. In this study, we included subjects with a left ventricular ejection fraction of <40%. RESULTS At baseline circulating miR-22 levels were 1.9-fold higher (p<0.001), miR-92a levels were 1.25-fold higher (p=0.003), and miR-499 were 5-times lower (p<0.001) in AHF compared to CHF. Interestingly, circulating miR-499 was found to be associated with BNP levels (r=0.47, p=0.01). At follow-up there was a stepwise increase in the levels of all three examined microRNAs (miR-22, p=0.001, miR-92a, p=0.001, and miR-499, p<0.001) for AHF but not for CHF subjects. CONCLUSIONS MicroRNAs -22, -92a, and -499 are differentially expressed in chronic and acute HF subjects. MicroRNAs signatures are also differentially expressed up to the patients' discharge. These findings may have important implications in diagnosis, progression, and treatment in patients with chronic and acute heart failure.
Collapse
Affiliation(s)
- Aimilios Kalampogias
- 1st Department of Cardiology, 'Hippokration' General Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Evangelos Oikonomou
- 1st Department of Cardiology, 'Hippokration' General Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.,3rd Department of Cardiology, "Sotiria" Chest Disease Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Gerasimos Siasos
- 1st Department of Cardiology, 'Hippokration' General Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.,3rd Department of Cardiology, "Sotiria" Chest Disease Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Panagiotis Theofilis
- 1st Department of Cardiology, 'Hippokration' General Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Stathis Dimitropoulos
- 1st Department of Cardiology, 'Hippokration' General Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Vasiliki Gennimata
- 1st Department of Cardiology, 'Hippokration' General Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Georgios Marinos
- 1st Department of Cardiology, 'Hippokration' General Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Georgios Charalambous
- 1st Department of Cardiology, 'Hippokration' General Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Manolis Vavouranakis
- 3rd Department of Cardiology, "Sotiria" Chest Disease Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Konstantinos Tsioufis
- 1st Department of Cardiology, 'Hippokration' General Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitris Tousoulis
- 1st Department of Cardiology, 'Hippokration' General Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| |
Collapse
|
10
|
Theofilis P, Vogiatzi G, Oikonomou E, Gazouli M, Siasos G, Katifelis H, Perrea D, Vavouranakis M, Iliopoulos DC, Tsioufis C, Tousoulis D. MicroRNA-126 mimic administration accelerates vascular perfusion recovery and angiogenesis in a hind limb ischemia model. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.3380] [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
Peripheral arterial disease caused mainly by atherosclerosis portent significant morbidity, adverse prognosis and mortality, with localized treatment approaches aiming at symptom alleviation and improvement of circulation. Recently, scientific interest has been shifted towards epigenomics, with microRNAs appearing as a future therapeutic target in ischemic cardiovascular diseases due to their potential in regulating angiogenesis.
Purpose
We investigated the pro-angiogenic effect of miRNA-126 mimic in an in vivo model of hind limb ischemia.
Methods
Ten-week-old male C57Bl/6 mice (n=20) were subjected to left femoral artery ligation and were treated with microRNA-126 mimic at a dose of 5mg/kg (Group A, n=10) or 0.2ml normal saline (Group B, n=10) on days 1, 3 and 7. Laser Doppler imaging was performed to verify successful ligation on day 0 and to evaluate differences in the ischemic-to-normal (I/N) hind limb perfusion ratio on day 7 and 28. Muscle tissue expression of microRNA-126 and vascular endothelial growth factor (VEGF) was determined via PCR.
Results
Following microRNA-126 mimic administration in Group A subjects, we noted a qualitative and quantitative stepwise increase in I/N hind limb perfusion ratio [Day 0: 0.354 (0.276, 0.455) vs. Day 8: 0.775 (0.700, 0.844) vs. Day 28: 0.681 (0.660, 0.896), p=0.001] (Figure 1, Panels A and B). In Group B a stepwise increase of lesser magnitude was observed in I/N hind limb perfusion ratio [Day 0: 0.267 (0.164, 0.383) vs. Day 8: 0.400 (0.338, 0.418) vs. Day 28: 0.539 (0.483, 0.603), p=0.074]. Importantly, over time changes of I/N hind limb perfusion ratio were significantly higher in group A compared to group B (p for interaction=0.005) (Figure 1, Panel B). Muscle tissue expression of microRNA-126 in the ischemic hind limb of Group A was 350-fold lower compared to the ischemic hind limb of Group B (p<0.001) (Figure 1, Panel C). A higher expression (14.2-fold) of VEGF in the ischemic hind limb of microRNA-126-treated mice compared to that of control group was detected (p<0.001) (Figure 1, Panel C). A statistically significant negative correlation was noted between microRNA-126 and VEGF tissue expression levels in the ischemic limbs of both Group A and B subjects whereas no correlation between microRNA-126 and VEGF was observed in the non-ischemic hind limbs of the entire study population (Figure 1, Panel D).
Conclusion
MicroRNA-126 mimic delivery in the ischemic hind limb of mice can accelerate vascular perfusion recovery via angiogenesis, which is mediated by VEGF expression.
Funding Acknowledgement
Type of funding sources: None. Figure 1
Collapse
Affiliation(s)
- P Theofilis
- Hippokration General Hospital, 1st Department of Cardiology, Athens, Greece
| | - G Vogiatzi
- Hippokration General Hospital, 1st Department of Cardiology, Athens, Greece
| | - E Oikonomou
- Hippokration General Hospital, 1st Department of Cardiology, Athens, Greece
| | - M Gazouli
- National & Kapodistrian University of Athens, Department of Basic Medical Sciences, Athens, Greece
| | - G Siasos
- Hippokration General Hospital, 1st Department of Cardiology, Athens, Greece
| | - H Katifelis
- National & Kapodistrian University of Athens, Department of Basic Medical Sciences, Athens, Greece
| | - D Perrea
- National & Kapodistrian University of Athens, Laboratory of Experimental Surgery and Surgical Research “N.S. Christeas”, Athens, Greece
| | - M Vavouranakis
- Sotiria Regional Chest Diseases Hospital, 3rd Department of Cardiology, Athens, Greece
| | - D C Iliopoulos
- National & Kapodistrian University of Athens, Laboratory of Experimental Surgery and Surgical Research “N.S. Christeas”, Athens, Greece
| | - C Tsioufis
- Hippokration General Hospital, 1st Department of Cardiology, Athens, Greece
| | - D Tousoulis
- Hippokration General Hospital, 1st Department of Cardiology, Athens, Greece
| |
Collapse
|
11
|
Kalampogias A, Siasos G, Oikonomou E, Mourouzis K, Bletsa E, Stampouloglou PK, Katsianos E, Vlasis K, Marinos G, Charalambous G, Vavouranakis M, Tousoulis D. MicroRNAs in the Management of Heart Failure. Curr Med Chem 2021; 28:4863-4876. [PMID: 33602070 DOI: 10.2174/0929867328666210218181441] [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] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 01/13/2021] [Accepted: 01/14/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND In recent years much research has been devoted to the deployment of biomarkers in the field of heart failure; Objectives: To study the potential of post-transcriptional regulation by microRNAs on the diagnosis, management and therapy of heart failure. METHODS Literature search focus on the role of microRNAs in heart failure. RESULTS MicroRNAs are expressed and regulated in the course of the pathological manifestations of heart failure (HF). This wide and uncharted area of genetic imprints consisting of small non-coding RNA molecules, is upregulated and released into blood stream from organs under certain conditions and or stress. The use of genetically based strategies for the management of HF have gained great interest in the field of biomedical science because they can be used as biomarkers providing information regarding cardiac status and function. They also appear as promising tools with therapeutic potential because of their ability to induce changes at the cellular level without creating alterations in the gene sequence. In addition, with the advances in genomic sequencing, quantification and synthesis in technologies of microRNAs identification as well as the growing knowledge of the biology of miRNAs and their involvement in HF, it is expected to favorably affect the prognosis of HF patients. CONCLUSION MicroRNAs are involved in the regulation of multi biological processes involved in the progress of heart failure. More studies are needed to achieve a clinical valuable implementation of microRNAs in the management of HF.
Collapse
Affiliation(s)
- Aimilios Kalampogias
- 1st Cardiology Clinic, Hippokration Hospital, National and Kapodistrian University of Athens Medical School, Athens, . Greece
| | - Gerasimos Siasos
- 3rd Cardiology Clinic, Sotiria Chest Diseases Hospital, National and Kapodistrian University of Athens Medical School, Athens, . Greece
| | - Evangelos Oikonomou
- 3rd Cardiology Clinic, Sotiria Chest Diseases Hospital, National and Kapodistrian University of Athens Medical School, Athens, . Greece
| | - Konstantinos Mourouzis
- 1st Cardiology Clinic, Hippokration Hospital, National and Kapodistrian University of Athens Medical School, Athens, . Greece
| | - Evanthia Bletsa
- 1st Cardiology Clinic, Hippokration Hospital, National and Kapodistrian University of Athens Medical School, Athens, . Greece
| | - Panagiota K Stampouloglou
- 1st Cardiology Clinic, Hippokration Hospital, National and Kapodistrian University of Athens Medical School, Athens, . Greece
| | - Efstratios Katsianos
- 3rd Cardiology Clinic, Sotiria Chest Diseases Hospital, National and Kapodistrian University of Athens Medical School, Athens, . Greece
| | - Konstantinos Vlasis
- 1st Cardiology Clinic, Hippokration Hospital, National and Kapodistrian University of Athens Medical School, Athens, . Greece
| | - Georgios Marinos
- 1st Cardiology Clinic, Hippokration Hospital, National and Kapodistrian University of Athens Medical School, Athens, . Greece
| | - Georgios Charalambous
- 1st Cardiology Clinic, Hippokration Hospital, National and Kapodistrian University of Athens Medical School, Athens, . Greece
| | - Manolis Vavouranakis
- 3rd Cardiology Clinic, Sotiria Chest Diseases Hospital, National and Kapodistrian University of Athens Medical School, Athens, . Greece
| | - Dimitris Tousoulis
- 1st Cardiology Clinic, Hippokration Hospital, National and Kapodistrian University of Athens Medical School, Athens, . Greece
| |
Collapse
|
12
|
Mourouzis K, Siasos G, Oikonomou E, Zaromitidou M, Tsigkou V, Antonopoulos A, Bletsa E, Stampouloglou P, Vlassis K, Vavouranakis M, Tousoulis D. Lipoprotein-associated phospholipase A2 levels, endothelial dysfunction and arterial stiffness in patients with stable coronary artery disease. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1264] [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
Lipoprotein-associated Phospholipase A2 (Lp-PLA2), has inflammatory and atherogenic actions in the vascular wall. We investigate the impact of high Lp-PLA2 levels on endothelial function and arterial stiffness on patients with coronary artery disease (CAD).
Methods
We enrolled 374 consecutive patients with stable CAD (mean age 61±11 years). Endothelial function was evaluated by flow-mediated dilation (FMD) and reflected waves with augmentation index (AIx) of the central aortic pressure. Serum levels of Lp-PLA2 were measured with ELISA.
Results
In the studied population the median values of Lp-PLA2 levels was 125 (96–152) μg/L. There was no difference between subjects with Lp-PLA2 levels above and below 125μg/L concerning classical risk factors for CAD. Importantly, subjects with Lp-PLA2 values ≥125μg/L had significantly impaired FMD (4.44±2.19% vs. 4.89±2.07%, p=0.04) and AIx values (25.21±8.70% vs. 23.06±9.47%, p=0.03), compared to participants with lower Lp-PLA2 serum levels. A linear regression analysis revealed that Lp-PLA2 ≥125μg/L negatively relates to impaired FMD [b=−0.54 (95% CI: −1.05 to −0.02), p=0.04] and AIx values [b=2.14 (95% CI: 0.18–4.01), p=0.03] independently of cofounders.
Conclusions
Elevated Lp-PLA2 relates to endothelial dysfunction and arterial stiffness in CAD patients. These findings highlight the significant role of Lp-PlA2 in the process of atherosclerosis.
Funding Acknowledgement
Type of funding source: None
Collapse
Affiliation(s)
- K Mourouzis
- Hippokration General Hospital, First Department of Cardiology, Athens, Greece
| | - G Siasos
- Hippokration General Hospital, First Department of Cardiology, Athens, Greece
| | - E Oikonomou
- Hippokration General Hospital, First Department of Cardiology, Athens, Greece
| | - M Zaromitidou
- Hippokration General Hospital, First Department of Cardiology, Athens, Greece
| | - V Tsigkou
- Hippokration General Hospital, First Department of Cardiology, Athens, Greece
| | - A.S Antonopoulos
- Hippokration General Hospital, First Department of Cardiology, Athens, Greece
| | - E Bletsa
- Hippokration General Hospital, First Department of Cardiology, Athens, Greece
| | - P.K Stampouloglou
- Hippokration General Hospital, First Department of Cardiology, Athens, Greece
| | - K Vlassis
- National & Kapodistrian University of Athens Medical School, Department of Anatomy, Athens, Greece
| | - M Vavouranakis
- Hippokration General Hospital, First Department of Cardiology, Athens, Greece
| | - D Tousoulis
- Hippokration General Hospital, First Department of Cardiology, Athens, Greece
| |
Collapse
|
13
|
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.
Collapse
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
| |
Collapse
|
14
|
Paschou SA, Siasos G, Bletsa E, Stampouloglou PK, Oikonomou E, Antonopoulos AS, Batzias K, Tsigkou V, Mourouzis K, Vryonidou A, Tentolouris N, Vavouranakis M, Tousoulis D. The Effect of DPP-4i on Endothelial Function and Arterial Stiffness in Patients with Type 2 Diabetes: A Systematic Review of Randomized Placebo-controlled Trials. Curr Pharm Des 2020; 26:5980-5987. [PMID: 32303166 DOI: 10.2174/1381612826666200417153241] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 12/04/2019] [Accepted: 03/25/2020] [Indexed: 12/31/2022]
Abstract
We systematically reviewed the literature regarding the impact of dipeptidyl peptidase-4 inhibitors (DPP-4i) on vascular function, including endothelial function and arterial stiffness, as predictors of atherosclerosis progression and cardiovascular disease in patients with type 2 diabetes mellitus (T2DM). We searched PubMed in order to identify clinical trials that investigated the effect of DPP-4i on vascular function in patients with T2DM when compared with placebo. Although 168 articles were initially found, only 6 studies (total 324 patients) investigated the effect of DPP-4i in comparison with placebo, specifically linagliptin and sitagliptin, and satisfied the inclusion criteria. There are scarce data to indicate that linagliptin may enhance endothelial function and exert a slight beneficial effect on arterial wall properties. Sitagliptin seems to have a neutral effect on these variables. Further trials are needed to elucidate the topic. The standards of reporting were in accordance with the PRISMA guidelines.
Collapse
Affiliation(s)
- Stavroula A Paschou
- First Department of Cardiology, "Hippokration" General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Gerasimos Siasos
- First Department of Cardiology, "Hippokration" General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Evanthia Bletsa
- First Department of Cardiology, "Hippokration" General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Panagiota K Stampouloglou
- First Department of Cardiology, "Hippokration" General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Evangelos Oikonomou
- First Department of Cardiology, "Hippokration" General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Alexios S Antonopoulos
- First Department of Cardiology, "Hippokration" General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Konstantinos Batzias
- First Department of Cardiology, "Hippokration" General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Vasiliki Tsigkou
- First Department of Cardiology, "Hippokration" General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Konstantinos Mourouzis
- First Department of Cardiology, "Hippokration" General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Andromachi Vryonidou
- Department of Endocrinology and Diabetes, Hellenic Red Cross Hospital, Athens, Greece
| | - Nikolaos Tentolouris
- First Department of Propaedeutic and Internal Medicine, Diabetes Center, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Manolis Vavouranakis
- First Department of Cardiology, "Hippokration" General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios Tousoulis
- First Department of Cardiology, "Hippokration" General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| |
Collapse
|
15
|
Filis K, Galyfos G, Sigala F, Karantzikos G, Vavouranakis M, Toutouzas K, Albanopoulos K, Zografos G. Vascular complications during transcatheter aortic valve implantation: The role of the vascular surgeon. Vascular 2020; 28:421-429. [DOI: 10.1177/1708538120902659] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Introduction This study compares the incidence of vascular complications and other major outcomes between patients undergoing transcatheter aortic valve implantation, with and without a standardized preoperative vascular surgeon consultation. Methods This retrospective study evaluated all patients scheduled for transcatheter aortic valve implantation during a five-year period at a Hellenic University Hospital. Two main periods were evaluated: Group A (early period (2014–2015), without a standardized preoperative vascular surgeon consultation) and Group B (late period (2016–2018), with a standardized preoperative vascular surgeon consultation). All vascular complications as well as other major outcomes (early death, stroke, myocardial infarction, and treatment) were recorded. Univariate and multivariate analyses were also conducted. Results Overall, 382 transcatheter aortic valve implantation procedures were conducted (Group A: n = 115; duration = 19 months; Group B: n = 267; duration = 41 months). Overall, 58 vascular complications were recorded (21 patients in Group A and 37 patients in Group B (18.3% versus 13.9%; P = 0.279)). However, vascular complications that necessitated a vascular surgeon’s interference were more frequent during the first period (13% versus 4.9%; P = 0.009). Among patients with a vascular complication, early mortality was higher during the first period (14.3% versus 0%; P = 0.034) although stroke and myocardial infarction rates were similar. Age >80 years (OR = 1.856 [1.134–3.452]; P = 0.03) and preoperative vascular surgeon consultation (OR = 0.345 [0.132–0.756]; P = 0.015) were the only independent predictors for vascular complications. Conclusions A standardized preoperative evaluation by a vascular surgeon may decrease the risk for vascular complications that necessitate a repair as well as early mortality among patients undergoing transcatheter aortic valve implantation procedures.
Collapse
Affiliation(s)
- Konstantinos Filis
- First Propedeutic Department of Surgery, National and Kapodistrian University of Athens, Hippocration Hospital, Athens, Greece
| | - George Galyfos
- First Propedeutic Department of Surgery, National and Kapodistrian University of Athens, Hippocration Hospital, Athens, Greece
| | - Fragiska Sigala
- First Propedeutic Department of Surgery, National and Kapodistrian University of Athens, Hippocration Hospital, Athens, Greece
| | - Georgios Karantzikos
- First Propedeutic Department of Surgery, National and Kapodistrian University of Athens, Hippocration Hospital, Athens, Greece
| | - Manolis Vavouranakis
- First Cardiology Department, National and Kapodistrian University of Athens, Hippocration Hospital, Athens, Greece
| | - Konstantinos Toutouzas
- First Cardiology Department, National and Kapodistrian University of Athens, Hippocration Hospital, Athens, Greece
| | - Konstantinos Albanopoulos
- First Propedeutic Department of Surgery, National and Kapodistrian University of Athens, Hippocration Hospital, Athens, Greece
| | - Georgios Zografos
- First Propedeutic Department of Surgery, National and Kapodistrian University of Athens, Hippocration Hospital, Athens, Greece
| |
Collapse
|
16
|
Xanthopoulou I, Davlouros P, Deftereos S, Hamilos M, Sitafidis G, Kanakakis I, Vavouranakis M, Goudevenos J, Lekakis J, Alexopoulos D. Gender-related differences in antiplatelet treatment patterns and outcome: Insights from the GReekAntiPlatElet Registry. Cardiovasc Ther 2017; 35. [DOI: 10.1111/1755-5922.12270] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Revised: 04/15/2017] [Accepted: 04/25/2017] [Indexed: 11/29/2022] Open
Affiliation(s)
| | | | - Spyridon Deftereos
- Department of Cardiology; Athens General Hospital “G. Gennimatas”; Athens Greece
- Attikon University Hospital; Athens Greece
| | - Michalis Hamilos
- Department of Cardiology; Iraklion University Hospital; Iraklion Greece
| | - George Sitafidis
- Department of Cardiology; Larissa University Hospital; Larissa Greece
| | - Ioannis Kanakakis
- Department of Clinical Therapeutics; “Alexandra” University Hospital; Athens Greece
| | | | - John Goudevenos
- Department of Cardiology; Ioannina University Hospital; Ioannina Greece
| | | | - Dimitrios Alexopoulos
- Department of Cardiology; Patras University Hospital; Patras Greece
- Attikon University Hospital; Athens Greece
| |
Collapse
|
17
|
Alexopoulos D, Xanthopoulou I, Perperis A, Goudevenos J, Hamilos M, Sitafidis G, Kanakakis I, Vavouranakis M, Giannopoulos G, Barampoutis N, Deftereos S, Lekakis J. Dyspnea in patients treated with P2Y 12 receptor antagonists: insights from the GReek AntiPlatElet (GRAPE) registry. Platelets 2017; 28:691-697. [PMID: 28150522 DOI: 10.1080/09537104.2016.1265919] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
In 'real life' acute coronary syndrome (ACS) patients undergoing percutaneous coronary intervention (PCI) and receiving contemporary antiplatelet treatment, data on dyspnea occurrence and impact on persistence with treatment are scarce. In a prospective, multicenter, cohort study, ACS patients undergoing PCI were recruited into the GReekAntiPlatElet (GRAPE) registry. During 1-year follow up, overall, 249/1989 (12.5%) patients reported dyspnea, more frequently at 1-month and decreasing thereafter. Multivariate analysis showed that ticagrelor administration (n = 738) at discharge was associated with the occurrence of dyspnea: Odds ratio 2.46 (95% confidence interval, CI, 1.87-3.25), p < 0.001. Older age, lower hematocrit, and prior bleeding event were also associated with dyspnea reports. Persistence, switching, and cessation rates were 68.3%, 20.9%, and 10.8% vs 76.7%, 12.5%, and 10.9% among patients reporting dyspnea compared with those who did not, p for trend = 0.002. In conclusion, in ACS patients undergoing PCI and treated with a P2Y12 receptor antagonist, dyspnea occurs commonly, particularly when ticagrelor is administered. Non-persistence with antiplatelet agents at discharge is more frequently observed among dyspnea-reporters.
Collapse
Affiliation(s)
- Dimitrios Alexopoulos
- a Department of Cardiology , Patras University Hospital , Patras , Greece.,b Department of Cardiology , Attikon University Hospital, Athens, Greece , Athens , Greece
| | | | - Angelos Perperis
- a Department of Cardiology , Patras University Hospital , Patras , Greece
| | - John Goudevenos
- c Department of Cardiology , Ioannina University Hospital , Ioannina , Greece
| | - Michalis Hamilos
- d Department of Cardiology , Iraklion University Hospital , Iraklion , Greece
| | - George Sitafidis
- e Department of Cardiology , Larissa University Hospital, Larissa , Greece
| | - Ioannis Kanakakis
- f Department of Clinical Therapeutics , "Alexandra" University Hospital , Athens , Greece
| | - Manolis Vavouranakis
- g 1st University Department of Cardiology, Ippokration Hospital , Athens , Greece
| | - George Giannopoulos
- b Department of Cardiology , Attikon University Hospital, Athens, Greece , Athens , Greece.,h Department of Cardiology , Athens General Hospital "G. Gennimatas" , Athens , Greece
| | | | - Spyridon Deftereos
- b Department of Cardiology , Attikon University Hospital, Athens, Greece , Athens , Greece.,h Department of Cardiology , Athens General Hospital "G. Gennimatas" , Athens , Greece
| | - John Lekakis
- b Department of Cardiology , Attikon University Hospital, Athens, Greece , Athens , Greece
| |
Collapse
|
18
|
Melidi E, Latsios G, Toutouzas K, Vavouranakis M, Tolios I, Gouliami M, Gerckens U, Tousoulis D. Cardio-anesthesiology considerations for the trans-catheter aortic valve implantation (TAVI) procedure. Hellenic J Cardiol 2016; 57:401-406. [PMID: 28375080 DOI: 10.1016/j.hjc.2016.10.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Revised: 10/01/2016] [Accepted: 10/02/2016] [Indexed: 01/29/2023] Open
Abstract
Transcatheter aortic valve implantation (TAVI) has become the mainstay for high-risk or inoperable patients with symptomatic aortic valve stenosis, and research regarding the use of transcatheter valves in intermediate or low-risk patients is currently ongoing. The aim of this article is to provide comprehensive insight into the anesthetic management of patients undergoing TAVI and to highlight possible gaps in the current knowledge. One important procedural characteristic that is imperative to consider is the type of anesthesia being used and its possible complications. Increasingly, experienced centers have changed from general anesthesia with endotracheal intubation to local anesthesia with sedation, especially when the transfemoral access route is used for TAVI. There is still debate regarding what type of anesthesia should be used in the procedure, and the lack of randomized data makes it even more challenging for the operators.
Collapse
Affiliation(s)
- Eleni Melidi
- Department of Anesthesiology, Hippokration Hospital, Athens, Greece.
| | - George Latsios
- 1st Department of Cardiology, Medical School, University of Athens, Hippokration Hospital, Athens, Greece
| | - Kostas Toutouzas
- 1st Department of Cardiology, Medical School, University of Athens, Hippokration Hospital, Athens, Greece
| | - Manolis Vavouranakis
- 1st Department of Cardiology, Medical School, University of Athens, Hippokration Hospital, Athens, Greece
| | - Ioannis Tolios
- Department of Anesthesiology, Hippokration Hospital, Athens, Greece
| | - Maria Gouliami
- Department of Anesthesiology, Hippokration Hospital, Athens, Greece
| | - Ulrich Gerckens
- 1st Department of Cardiology, Medical School, University of Athens, Hippokration Hospital, Athens, Greece
| | - Dimitris Tousoulis
- 1st Department of Cardiology, Medical School, University of Athens, Hippokration Hospital, Athens, Greece
| |
Collapse
|
19
|
Alexopoulos D, Xanthopoulou I, Deftereos S, Hamilos M, Sitafidis G, Kanakakis I, Pentara I, Vavouranakis M, Davlouros P, Hahalis G, Goudevenos J. Contemporary antiplatelet treatment in acute coronary syndrome patients undergoing percutaneous coronary intervention: 1-year outcomes from the GReek AntiPlatElet (GRAPE) Registry. J Thromb Haemost 2016; 14:1146-54. [PMID: 26990959 DOI: 10.1111/jth.13316] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2015] [Accepted: 02/10/2016] [Indexed: 11/30/2022]
Abstract
UNLABELLED Essentials The comparative efficacy and safety of antiplatelet agents in 'real life' is not clear. We recruited acute coronary syndrome patients receiving percutaneous coronary intervention. At 1-year follow-up, prasugrel offers better anti-ischemic protection than clopidogrel. Prasugrel and ticagrelor are accompanied by more frequent bleeding events. SUMMARY Background The comparative efficacy and safety of antiplatelet treatment outside randomized trials is not clear. Objectives To investigate long-term efficacy and safety in 'real-life' acute coronary syndrome (ACS) patients treated by percutaneous coronary intervention (PCI) with contemporary use of clopidogrel, prasugrel and ticagrelor. Methods In a prospective, observational, multicenter cohort study, 2047 patients were recruited into the GReek AntiPlatElet (GRAPE) Registry and were followed-up for 1 year for major adverse cardiovascular events (MACE, a composite of death, non-fatal myocardial infarction, urgent revascularization and stroke) and bleeding events (Bleeding Academic Research Consortium [BARC] classification). Results Exposure to clopidogrel, prasugrel and ticagrelor by PCI occurred in 959, 363 and 717 patients, respectively. After adjustment, the rate of MACE (primary outcome endpoint) was lower in prasugrel-treated patients (4.4%) than in clopidogrel-treated patients (10.1%) (hazard ratio [HR], 0.53; 95% confidence interval [CI], 0.30-0.91), although not significantly different between ticagrelor (6.8%) and clopidogrel groups (HR, 0.78; 95% CI, 0.54-1.12). Any type of BARC-classified bleeding (secondary outcome endpoint) was more frequent in prasugrel-treated patients (51.2%) than in clopidogrel-treated patients (37.6%) (HR, 1.61; 95% CI, 1.33-1.95) and more frequent in ticagrelor-treated patients (56.9%) than in clopidogrel-treated patients (HR, 1.81; 95% CI, 1.55-2.10). An adjusted comparison between prasugrel and ticagrelor-treated groups did not reveal differences in any outcome measure. After adjustment, the death rate was more reduced by novel agents in comparison with clopidogrel (2.9% vs. 6.2%). Conclusions In ACS/PCI patients, prasugrel offered better anti-ischemic protection than clopidogrel, whereas use of both novel agents is accompanied by more frequent bleeding events.
Collapse
Affiliation(s)
- D Alexopoulos
- Department of Cardiology, Patras University Hospital, Patras, Greece
| | - I Xanthopoulou
- Department of Cardiology, Patras University Hospital, Patras, Greece
| | - S Deftereos
- Department of Cardiology, Athens General Hospital 'G. Gennimatas', Athens, Greece
| | - M Hamilos
- Department of Cardiology, Iraklion University Hospital, Iraklion, Greece
| | - G Sitafidis
- Department of Cardiology, Larissa University Hospital, Larissa, Greece
| | - I Kanakakis
- Department of Clinical Therapeutics, 'Alexandra' University Hospital, Athens, Greece
| | - I Pentara
- Department of Cardiology, Patras University Hospital, Patras, Greece
| | - M Vavouranakis
- 1st University Department of Cardiology, Ippokration Hospital, Ioannina, Greece
| | - P Davlouros
- Department of Cardiology, Patras University Hospital, Patras, Greece
| | - G Hahalis
- Department of Cardiology, Patras University Hospital, Patras, Greece
| | - J Goudevenos
- Department of Cardiology, Ioannina University Hospital, Ioannina, Greece
| |
Collapse
|
20
|
Aggelopoulos P, Chrysohoou C, Pitsavos C, Panagiotakos DB, Vaina S, Brili S, Lazaros G, Vavouranakis M, Stefanadis C. Sex differences regarding the impact of physical activity on left ventricular systolic function in elderly patients with an acute coronary event. Hellenic J Cardiol 2014; 55:448-456. [PMID: 25432196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023] Open
Abstract
INTRODUCTION Regular physical activity has been associated with less severity of an acute coronary syndrome (ACS), lower in-hospital mortality rates, and an improved short term prognosis. This study evaluated the relationship between physical activity status and the development of left ventricular systolic dysfunction (LVSD) according to inflammation and sex in elderly patients who had had an ACS. METHODS We analyzed prospectively collected data from 355 male (age 74 ± 6 years) and 137 female (76 ± 6 years) patients who were hospitalized with an ACS. LVSD was evaluated by echocardiography on the 5th day of hospitalization and physical activity status was assessed by a self-reported questionnaire. Inflammatory response was evaluated by measuring C-reactive protein levels. Logistic regression models were applied to evaluate the effect of physical activity status on the development of LVSD and inflammatory response at entry. RESULTS Physical inactivity had a higher prevalence in women who developed LVSD than in the female patients with preserved systolic function (46% vs. 20%, p=0.02). There was a significant positive association between physical activity levels and ejection fraction in women (p=0.06), but not in men (p=0.30). Multiadjusted logistic regression showed that women who were physically active had 76% lower odds (95%CI: 1-94%) of developing LVSD compared to their sedentary counterparts. Furthermore, physical activity was inversely associated with C-reactive protein levels in both sexes (p=0.08). CONCLUSIONS Long-term involvement in a physically active lifestyle seems to confer further cardio-protection by reducing the inflammatory response and preserving left ventricular systolic function in elderly female, but not male patients with an ACS.
Collapse
|
21
|
Alexopoulos D, Xanthopoulou I, Deftereos S, Sitafidis G, Kanakakis I, Hamilos M, Angelidis C, Petousis S, Stakos D, Parissis H, Vavouranakis M, Davlouros P, Goudevenos J, Stefanadis C. In-hospital switching of oral P2Y12 inhibitor treatment in patients with acute coronary syndrome undergoing percutaneous coronary intervention: prevalence, predictors and short-term outcome. Am Heart J 2014; 167:68-76.e2. [PMID: 24332144 DOI: 10.1016/j.ahj.2013.10.010] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2013] [Accepted: 10/04/2013] [Indexed: 11/27/2022]
Abstract
BACKGROUND P2Y12 inhibitor switching has appeared in clinical practice as a consequence of prasugrel and ticagrelor availability, apart from clopidogrel, for use in patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI). METHODS In the context of the GReek AntiPlatelet REgistry (GRAPE) we assessed the prevalence, predictive factors and short-term outcome of in-hospital P2Y12 inhibitor switching in 1794 ACS patients undergoing PCI. RESULTS Switching occurred in 636 (35.5%) patients of which in the form of clopidogrel to a novel agent, novel agent to clopidogrel and between prasugrel and ticagrelor in 574 (90.4%), 34 (5.3%) and 27 (4.3%) patients, respectively. Presentation to non PCI-capable hospital, bivalirudin use, age ≥75 years (inverse predictor), and regional trends emerged as predictive factors of switching to a novel agent. At combined in-hospital and one-month follow-up, propensity matched pairs analysis showed no differences in major adverse cardiovascular (MACE) or bleeding events between switching from clopidogrel to a novel agent vs novel agent constant administration. More Bleeding Academic Research Consortium type 1, type 2 and any type events and fewer MACE were seen when switching from clopidogrel to a novel agent vs only clopidogrel administration (23.7%, 3.8%, 30.6%, 1.2% vs 8.9%, 1.2%, 12.0%, 3.8% with P < .001, P = .03, P < .001 and P = .03 respectively). CONCLUSIONS In a real-life experience with contemporary antiplatelet treatment in ACS patients undergoing PCI, in-hospital switching represents common clinical practice. Clinical factors and regional practice differences seem to affect this strategy's choice, while switching to a novel agent may be associated with higher risk of bleeding.
Collapse
Affiliation(s)
| | | | - Spyridon Deftereos
- Department of Cardiology, Athens General Hospital "G. Gennimatas", Athens, Greece
| | - George Sitafidis
- Department of Cardiology, Larissa University Hospital, Larissa, Greece
| | - Ioannis Kanakakis
- Department of Clinical Therapeutics, "Alexandra" University Hospital, Athens, Greece
| | - Michalis Hamilos
- Department of Cardiology, Iraklion University Hospital, Iraklion, Greece
| | - Christos Angelidis
- Department of Cardiology, Athens General Hospital "G. Gennimatas", Athens, Greece
| | - Stylianos Petousis
- Department of Cardiology, Iraklion University Hospital, Iraklion, Greece
| | - Dimitrios Stakos
- Department of Cardiology, Alexandroupolis University Hospital, Alexandroupolis, Greece
| | | | | | | | - John Goudevenos
- Department of Cardiology, Ioannina University Hospital, Ioannina, Greece
| | | |
Collapse
|
22
|
Aggeli C, Pietri P, Vavouranakis M, Felekos I, Tatsis H, Stefanadis C. Sequential thromboembolic events after primary angioplasty in a patient with acute anterior myocardial infarction. Eur Heart J Acute Cardiovasc Care 2012; 1:341-343. [PMID: 24062925 PMCID: PMC3760563 DOI: 10.1177/2048872612467293] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2012] [Accepted: 10/18/2012] [Indexed: 06/02/2023]
Abstract
A 65 year old man was transferred to our cath lab for primary PCI about two hours after the onset of pain in the context of acute, anterior myocardial infarction. Thrombus aspiration of the proximal LAD and balloon angioplasty with a DES implantation were performed. After a few days, although the patient was under treatment with unfractioned heparin, he sustained a transient ischemic attack. The echocardiographic study revealed a large, mobile, protruding thrombus in the apex. Four days later, the patient complained of mild abdominal pain with a gradual deterioration. Abdominal CT scan revealed embolism of the superior mesenteric artery and urgent embolectomy was scheduled.
Collapse
Affiliation(s)
- Constantina Aggeli
- First Department of Cardiology, Athens Medical School, Hippokration Hospital, Greece
| | | | | | | | | | | |
Collapse
|
23
|
Chrysohoou C, Liontou C, Aggelopoulos P, Kastorini CM, Panagiotakos D, Aggelis A, Tsiamis E, Vavouranakis M, Pitsavos C, Tousoulis D, Stefanadis C. Mediterranean diet mediates the adverse effect of depressive symptomatology on short-term outcome in elderly survivors from an acute coronary event. Cardiol Res Pract 2011; 2011:429487. [PMID: 21629796 PMCID: PMC3099201 DOI: 10.4061/2011/429487] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2010] [Accepted: 02/23/2011] [Indexed: 11/20/2022] Open
Abstract
Aims. We evaluated the interaction effect between depressive symptoms and dietary habits on 30-day development of cardiovascular disease (CVD) (death or rehospitalization) in elderly, acute coronary syndrome (ACS) survivors. Methods. During 2006-2008, we recorded 277 nonfatal, consecutive ACS admissions (75 ± 6 years, 70% males, 70% had diagnosis of myocardial infarction) with complete 30-day follow-up. Assessment of recent depressive symptoms was based on the CES-D scale. Among sociodemographic, bioclinical, lifestyle characteristics, the MedDietScore that assesses the inherent characteristics of the Mediterranean diet was applied. Results. 22% of the ACS pts developed a CVD event during the first 30 days (14.8% rehospitalization and 9.4% death). Patients in the upper tertile of the CES-D scale (i.e., >18) had higher incidence of CVD events as compared with those in the lowest tertile (21% versus 8%, P = .01). Multiple logistic regression analysis revealed that 1-unit increase in CES-D was associated with 4% higher odds (95% CI 1.008-1.076, P = .01) of CVD events; however, when MedDietScore was entered in the model, CES-D lost its significance (P = .20). Conclusion. Short-term depressive symptoms are related to a worsen 30-day prognosis of ACS patients; however, this relationship was mediated by Mediterranean diet adherence.
Collapse
Affiliation(s)
- Christina Chrysohoou
- First Cardiology Clinic, School of Medicine, University of Athens, 46 Paleon Polemiston Street, 166 74 Glyfada, Greece
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
24
|
Triantafyllidi H, Vavouranakis M, Arvaniti C, Stefanadis C, Toutouzas P. Anatomical and functional characteristics of ectatic coronary arteries. An intracoronary ultrasound study. Acta Cardiol 2004; 59:153-8. [PMID: 15139656 DOI: 10.2143/ac.59.2.2005170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Using intracoronary ultrasound we studied the anatomical characteristics and the pulsatile changes of the coronary arterial wall of ectatic coronary arteries in patients with atherosclerotic coronary artery disease who underwent percutaneous transluminal coronary angioplasty. METHODS AND RESULTS Three study groups were formed according to the characteristics of the coronary segments, (a) group CES, coronary segments with ectasia, n = 10, (b) group NES, normal coronary segments adjacent to ectatic sites, n = 10 and (c) group NAS, normal coronary segments adjacent to atherosclerotic sites, n = 30. Pulsatile changes was defined as CSLA(syst)-CSLA(dia)/CSLA(dia) x 100. Coronary segments with ectasia (CES group) had significantly thinner media than the NAS group. Furthermore, increased vessel wall pulsatile changes were found in the ectatic segments. CONCLUSIONS Atherosclerotic ectatic coronary segments reveal diminished media thickness and increased coronary arterial wall pulsatile changes, which may be indicative of a mechanically and structurally weak artery prone to aneurysm formation.
Collapse
Affiliation(s)
- Helen Triantafyllidi
- Department of Cardiology, Medical School, University of Athens, Hippokration Hospital, Athens, Greece.
| | | | | | | | | |
Collapse
|
25
|
Aggeli C, Bonou M, Roussakis G, Chatzos C, Tsiamis E, Brilli S, Vavouranakis M, Pitsavos C, Stefanadis C, Toutouzas P. Triggered harmonic power doppler imaging predicts functional recovery after revascularization in patients with left ventricular dysfunction. J Am Coll Cardiol 2003. [DOI: 10.1016/s0735-1097(03)81302-5] [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: 11/30/2022]
|
26
|
Vavouranakis M, Tsiamis E, Vaina S, Toutouzas K, Gialafos J, Boudoulas H, Toutouzas P, Stefanadis C. Increased coronary sinus temperature in patients with significant atherosclerotic lesions in left coronary artery determined by a new technique: The coronary sinus thermography. J Am Coll Cardiol 2003. [DOI: 10.1016/s0735-1097(03)80178-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
27
|
Toutouzas K, Stefanadis C, Tsiamis E, Vaina S, Kallikazaros I, Vavouranakis M, Tsioufis K, Tousoulis D, Toutouzas P. Stents covered by autologous venous grafts in human coronary arteries: five-year follow-up. J Am Coll Cardiol 2002. [DOI: 10.1016/s0735-1097(02)80104-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
28
|
Stefanadis C, Toutouzas K, Tsiamis E, Kallikazaros I, Vaina S, Vavouranakis M, Tsioufis K, Pitsavos C, Trikas A, Toutouzas P. Treatment with statins results in decreased heat production from the culprit atherosclerotic lesions in patients with stable and unstable angina. J Am Coll Cardiol 2002. [DOI: 10.1016/s0735-1097(02)80076-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
|
29
|
Stefanadis C, Toutouzas K, Tsiamis E, Vavouranakis M, Kallikazaros I, Vaina S, Chrysochoou C, Panagiotakos D, Pitsavos C, Toutouzas P. Patients with coronary artery disease treated with statins have decreased heat production from culprit lesions. J Am Coll Cardiol 2002. [DOI: 10.1016/s0735-1097(02)81520-0] [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]
|
30
|
Toutouzas K, Stefanadis C, Tsiamis E, Vavouranakis M, Kallikazaros I, Vaina S, Chrysochoou C, Panagiotakos D, Toutouza M, Toutouzas P. Correlation of heat production of culprit atherosclerotic lesion with soluble cell adhesion molecules. J Am Coll Cardiol 2002. [DOI: 10.1016/s0735-1097(02)81451-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|