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Leopoulou M, Theofilis P, Kordalis A, Papageorgiou N, Sagris M, Oikonomou E, Tousoulis D. Diabetes mellitus and atrial fibrillation-from pathophysiology to treatment. World J Diabetes 2023; 14:512-527. [PMID: 37273256 PMCID: PMC10236990 DOI: 10.4239/wjd.v14.i5.512] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 02/21/2023] [Accepted: 04/07/2023] [Indexed: 05/15/2023] Open
Abstract
Type 2 diabetes mellitus (T2DM) is a leading risk factor for cardiovascular complications around the globe and one of the most common medical conditions. Atrial fibrillation (AF) is the most common supraventricular arrhythmia, with a rapidly increasing prevalence. T2DM has been closely associated with the risk of AF development, identified as an independent risk factor. Regarding cardio-vascular complications, both AF and T2DM have been linked with high mortality. The underlying pathophysiology has not been fully determined yet; however, it is multifactorial, including structural, electrical, and autonomic pathways. Novel therapies include pharmaceutical agents in sodium-glucose cotransporter-2 inhibitors, as well as antiarrhythmic strategies, such as cardioversion and ablation. Of interest, glucose-lowering therapies may affect the prevalence of AF. This review presents the current evidence regarding the connection between the two entities, the pathophysiological pathways that link them, and the therapeutic options that exist.
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Affiliation(s)
- Marianna Leopoulou
- 1st Cardiology Clinic, ‘Hippokration’ General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens 11527, Greece
| | - Panagiotis Theofilis
- 1st Cardiology Clinic, ‘Hippokration’ General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens 11527, Greece
| | - Athanasios Kordalis
- 1st Cardiology Clinic, ‘Hippokration’ General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens 11527, Greece
| | - Nikolaos Papageorgiou
- 1st Cardiology Clinic, ‘Hippokration’ General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens 11527, Greece
| | - Marios Sagris
- 1st Cardiology Clinic, ‘Hippokration’ General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens 11527, Greece
| | - Evangelos Oikonomou
- 3rd Cardiology Clinic, ‘Sotiria’ Chest Diseases Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens 11527, Greece
| | - Dimitris Tousoulis
- 1st Cardiology Clinic, ‘Hippokration’ General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens 11527, Greece
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2
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Latsios G, Leopoulou M, Synetos A, Karanasos A, Papanikolaou A, Bounas P, Stamatopoulou E, Toutouzas K, Tsioufis K. Cardiac arrest and cardiopulmonary resuscitation in “hostile” environments: Using automated compression devices to minimize the rescuers’ danger. World J Cardiol 2023; 15:45-55. [PMID: 36911750 PMCID: PMC9993930 DOI: 10.4330/wjc.v15.i2.45] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Revised: 01/25/2023] [Accepted: 02/15/2023] [Indexed: 02/21/2023] Open
Abstract
Mechanical automated compression devices are being used in cardiopulmonary resuscitation instead of manual, “hands-on”, rescuer-delivered chest compressions. The -theoretical- advantages include high-quality non-stop compressions, thus freeing the rescuer performing the compressions and additionally the ability of the rescuer to stand reasonably away from a potentially “hazardous” victim, or from hazardous and/or difficult resuscitation conditions. Such circumstances involve cardiopulmonary resuscitation (CPR) in the Cardiac Catheterization Laboratory, especially directly under the fluoroscopy panel, where radiation is well known to cause detrimental effects to the rescuer, and CPR during/after land or air transportation of cardiac arrest victims. Lastly, CPR in a coronavirus disease 2019 patient/ward, where the danger of contamination and further serious illness of the health provider is very existent. The scope of this review is to review and present literature and current guidelines regarding the use of mechanical compressions in these “hostile” and dangerous settings, while comparing them to manual compressions.
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Affiliation(s)
- George Latsios
- 1st University Department of Cardiology, "Hippokration" University Hospital, Athens Medical School, Athens 11527, Greece
| | - Marianna Leopoulou
- 1st Cardiology Clinic, 'Hippokration' University Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens 11527, Greece
- Department of Cardiology, "Elpis" Athens General Hospital, Athens 11522, Greece
| | - Andreas Synetos
- 1st Department of Cardiology, Athens Medical School, University Athens, Hippokrat Hospital, Athens 11527, Greece
| | - Antonios Karanasos
- 1st University Department of Cardiology, "Hippokration" University Hospital, Athens Medical School, Athens 11527, Greece
| | - Angelos Papanikolaou
- 1st Cardiology Department Athens Medical School, Hippokration General Hospital, Athens 11527, Greece
| | - Pavlos Bounas
- Department of Cardiology, “Thriasio” General Hospital, Thriasio General Hospital, Elefsina 19600, Greece
| | - Evangelia Stamatopoulou
- CathLab, 2nd Department of Cardiology, Medical School, National and Kapodistrian University of Athens, “Attikon” University Hospital, Attikon University Hospital, Athens 12462, Greece
| | | | - Kostas Tsioufis
- 1st Department of Cardiology, Medical School, National and Kapodistrian University of Athens, “Hippokration” General Hospital, "Hippokration" University Hospital, Athens 11527, Greece
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Soulaidopoulos S, Latsios G, Karanasos A, Synetos A, Lazaris G, Leopoulou M, Tsalamandris S, Toutouzas K, Tsioufis K. TCT-243 Effective Measures for Radiation Protection in the Cath Lab. J Am Coll Cardiol 2022. [DOI: 10.1016/j.jacc.2022.08.286] [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]
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Latsios G, Synetos A, Leopoulou M, Stamatopoulou E, Koukopoulos P, Parisis C, Karanasos A, Fragkou P, Toutouzas K, Kanakakis J, Tsioufis K. Greek BLS Certified Providers’ CPR Willingness and Skill Retention During the Pre-Vaccine Covid-19 Pandemic Period. A Survey of the Hellenic Society of Cardiology. Open Access Emerg Med 2022; 14:63-75. [PMID: 35210874 PMCID: PMC8860398 DOI: 10.2147/oaem.s340567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 12/30/2021] [Indexed: 11/23/2022] Open
Abstract
Objective Methods Results Conclusion
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Affiliation(s)
- George Latsios
- First Department of Cardiology, National and Kapodistrian University of Athens, “Hippocration” General Hospital, Athens, Greece
- Correspondence: George Latsios, 1st Department of Cardiology, National and Kapodistrian University of Athens, Medical School, AlexAndroupoleos 9, Athens, 11527, Email
| | - Andreas Synetos
- First Department of Cardiology, National and Kapodistrian University of Athens, “Hippocration” General Hospital, Athens, Greece
| | | | - Evaggelia Stamatopoulou
- Catheterization Laboratory, University of Athens Medical School, “Attikon” University Hospital, Athens, Greece
| | | | | | - Antonios Karanasos
- First Department of Cardiology, National and Kapodistrian University of Athens, “Hippocration” General Hospital, Athens, Greece
| | - Paraskevi Fragkou
- First Department of ICU, National and Kapodistrian University of Athens, “Evaggelismos” General Hospital, Athens, Greece
| | - Konstantinos Toutouzas
- First Department of Cardiology, National and Kapodistrian University of Athens, “Hippocration” General Hospital, Athens, Greece
| | - John Kanakakis
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, “Alexandra” Hospital, Athens, Greece
| | - Kostas Tsioufis
- First Department of Cardiology, National and Kapodistrian University of Athens, “Hippocration” General Hospital, Athens, Greece
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Chatzis DG, Kolokathis K, Magounaki K, Chatzidakis S, Avramidis K, Leopoulou M, Angelopoulos TP, Doupis J. Changing the Concept: From the Traditional Glucose-centric to the New Cardiorenal-metabolic Approach for the Treatment of Type 2 Diabetes. touchREV Endocrinol 2021; 17:92-101. [PMID: 35118454 PMCID: PMC8676106 DOI: 10.17925/ee.2021.17.2.92] [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] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 06/29/2021] [Indexed: 11/24/2022]
Abstract
Type 2 diabetes mellitus (T2DM) is a chronic disease with a constantly increasing prevalence worldwide. It is well established that T2DM affects both the macro- and microvasculature, and its presence is associated with a high risk of acute and chronic cardiovascular events. Traditionally, the management of T2DM has been mainly focused on the optimization of blood glucose levels with the use of antidiabetic medications. During recent years, however, an impressive accumulation of evidence has arisen from studies designed to explore the plausible effects of new antidiabetic drugs on cardiovascular outcomes in patients with diabetes. This review article aims to emphasize the findings of these studies and to highlight the substantial role of the newer classes of antidiabetic drugs in treating T2DM in a holistic, cardiorenal-metabolic approach, thus shifting the paradigm from the traditional, simplistic, glucose-lowering approach.
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Affiliation(s)
| | - Konstantinos Kolokathis
- Department of Internal Medicine and Diabetes, Salamis Naval and Veterans Hospital, Salamis Naval Base, Salamis, Attiki, Greece
| | | | | | - Konstantinos Avramidis
- Department of Internal Medicine and Diabetes, Salamis Naval and Veterans Hospital, Salamis Naval Base, Salamis, Attiki, Greece
| | | | | | - John Doupis
- Department of Internal Medicine and Diabetes, Salamis Naval and Veterans Hospital, Salamis Naval Base, Salamis, Attiki, Greece
- Iatriko Paleou Falirou Medical Center, Athens, Greece
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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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7
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Latsios G, Synetos A, Leopoulou M, Stamatopoulou E, Vogiatzi G, Parisis C, Papanikolaou A, Kanakakis J, Toutouzas K, Tousoulis D, Tsioufis K. Retention of knowledge after basic training in cardiopulmonary resuscitation: a cumulative 3-year experience of certified ERC seminars of the Hellenic Society of Cardiology. Hellenic J Cardiol 2021; 63:82-85. [PMID: 33845202 DOI: 10.1016/j.hjc.2021.04.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Accepted: 04/01/2021] [Indexed: 12/19/2022] Open
Affiliation(s)
- George Latsios
- First Department of Cardiology, National and Kapodistrian University of Athens - Medical School, "Hippokration" General Hospital, Athens, Greece
| | - Andreas Synetos
- First Department of Cardiology, National and Kapodistrian University of Athens - Medical School, "Hippokration" General Hospital, Athens, Greece.
| | | | - Evangelia Stamatopoulou
- Catheterization Laboratory, National and Kapodistrian University of Athens - Medical School, "Attikon" University Hospital, Athens, Greece
| | - Georgia Vogiatzi
- Third Department of Cardiology, National and Kapodistrian University of Athens - Medical School, "Sotiria" Hospital for Respiratory Diseases, Athens, Greece
| | | | - Aggelos Papanikolaou
- First Department of Cardiology, National and Kapodistrian University of Athens - Medical School, "Hippokration" General Hospital, Athens, Greece
| | - John Kanakakis
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens - Medical School, "Alexandra" General Hospital, Athens, Greece
| | - Konstantinos Toutouzas
- First Department of Cardiology, National and Kapodistrian University of Athens - Medical School, "Hippokration" General Hospital, Athens, Greece
| | - Dimitris Tousoulis
- First Department of Cardiology, National and Kapodistrian University of Athens - Medical School, "Hippokration" General Hospital, Athens, Greece
| | - Kostas Tsioufis
- First Department of Cardiology, National and Kapodistrian University of Athens - Medical School, "Hippokration" General Hospital, Athens, Greece
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8
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Stougiannos P, Michas G, Leopoulou M, Evdoridis C, Mitropoulos F, Trikas A. Primary cardiac liposarcoma arising from the left atrium in an elderly female patient; the value of multimodality imaging. Hellenic J Cardiol 2021; 62:173-174. [DOI: 10.1016/j.hjc.2020.05.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 05/06/2020] [Accepted: 05/15/2020] [Indexed: 10/24/2022] Open
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Abstract
INTRODUCTION Naxos disease is a rare entity that manifests with woolly hair, keratosis of extremities, and cardiac manifestations that resemble arrhythmogenic right ventricular cardiomyopathy. It is inherited in an autosomal recessive pattern and mutations affecting plakoglobin and desmoplakin have been identified. There is an increased risk of arrhythmias, including sudden cardiac death at a young age. Right ventricular systolic dysfunction often progresses and left ventricular involvement may also occur. AREAS COVERED This article reviews historic background, epidemiology, clinical characteristics, genetics, and pathogenesis as well as therapeutic management and future perspectives. EXPERT OPINION The principles of evaluation and treatment are based on arrhythmogenic right ventricular cardiomyopathy (ARVC) and general heart failure guidelines, because specific data on Naxos disease are limited. Therefore, larger registries on Naxos disease are welcome in order to gain more knowledge about clinical course and risk stratification. Translational research on pathophysiological mechanisms has evolved, including promising approaches using stem cells for novel targets.
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Affiliation(s)
| | - Gustav Mattsson
- Centre for Research and Development, Uppsala University/Region Gävleborg , Gävle, Sweden
| | | | - Joseph V Pergolizzi
- NEMA Research, Inc , Naples, Florida, USA.,Native Cardio, Inc , Naples, Florida, USA
| | - Giustino Varrassi
- Paolo Procacci Foundation , Rome, Italy.,President, World Institute of Pain , California, USA
| | - Marita Wallhagen
- Faculty of Engineering and Sustainable Development, University of Gävle , Gävle, Sweden
| | - Peter Magnusson
- Centre for Research and Development, Uppsala University/Region Gävleborg , Gävle, Sweden.,Cardiology Research Unit, Department of Medicine, Karolinska Institutet , Stockholm, Sweden
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10
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Adamopoulos S, Miliopoulos D, Karavidas A, Nikolaou M, Lazaros G, Gkouziouta A, Manginas A, Sevastos G, Karvounis H, Karamitsos TD, Hahalis G, Leopoulou M, Grigoriou K, Balta D, Avgeropoulou CC, Kasiakogias A, Mantas I, Daskalopoulos N, Varvarousis D, Parthenakis FI, Patrianakos AP, Patsilinakos S, Karanikas S, Konstantinides SV, Tziakas DN, Kouvelas N, Ntoliou P, Manolis AJ, Tsinivizov P, Iliodromitis EK, Vrettou AR, Kakouros SN, Douras A, Mpaka N, Makridis P, Karapatsoudi E, Papoulidis N, Sideris A, Parissis JT, Triposkiadis F, Trikas A, Filippatos G. HEllenic Registry on Myocarditis SyndromES on behalf of Hellenic Heart Failure Association: The HERMES-HF Registry. ESC Heart Fail 2020; 7:3676-3684. [PMID: 32935475 PMCID: PMC7754904 DOI: 10.1002/ehf2.12894] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 05/29/2020] [Accepted: 06/24/2020] [Indexed: 01/05/2023] Open
Abstract
AIMS Despite the existence of many studies, there are still limited data about the characteristics of myocarditis in Greece. This led to the creation of the Greek Myocarditis Registry aiming to document the different symptoms and treatment of myocarditis, assess possible prognostic factors, and find similarities and differences to what is already published in literature. This paper is a preliminary descriptive analysis of this Registry. METHODS AND RESULTS We analysed data for the hospitalization period of all patients included in the Registry from December 2015 until November 2017. Statistics are reported as frequency (%) or median and inter-quartile range (IQR) as appropriate. In total, 146 patients were included; 83.3% of the patients reported an infection during the last 3 months. The most common symptom, regardless of the underlying infection, was chest pain (82.2%) followed by dyspnoea (18.5%), while the most common finding in clinical examination was tachycardia (26.7%). Presentation was more frequent in the winter months. ECG findings were not specific, with the repolarization abnormalities being the most frequent (60.3%). Atrial fibrillation was observed in two patients, both of whom presented with a reduced ventricular systolic function. Left ventricular ejection fraction changed significantly during the hospitalization [55% (IQR: 50-60%) on admission vs. 60% (IQR: 55-60%) on discharge, P = 0.0026]. Cardiac magnetic resonance was performed in 88 patients (61%), revealing mainly subepicardial and midcardial involvement of the lateral wall. Late gadolinium enhancement was present in all patients, while oedema was found in 39 of them. Only 11 patients underwent endomyocardial biopsy. Discharge medication consisted mainly of beta-blockers (71.9%) and angiotensin-converting enzyme inhibitors (41.8%), while 39.7% of the patients were prescribed both. CONCLUSIONS This preliminary analysis describes the typical presentation of myocarditis patients in Greece. It is a first step in developing a better prognostic model for the course of the disease, which will be completed after the incorporation of the patients' follow-up data.
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Affiliation(s)
- Stamatis Adamopoulos
- Heart Failure and Transplant Unit, Onassis Cardiac Surgery Centre, 356 Syngrou Avenue, 176 74 Kallithea, Athens, Greece
| | - Dimitrios Miliopoulos
- Heart Failure and Transplant Unit, Onassis Cardiac Surgery Centre, 356 Syngrou Avenue, 176 74 Kallithea, Athens, Greece
| | | | - Maria Nikolaou
- Cardiology Department, General Hospital 'Sismanogleio-Amalia Fleming', Athens, Greece
| | - George Lazaros
- 1st Cardiology Clinic, 'Hippokration' General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Angeliki Gkouziouta
- Heart Failure and Transplant Unit, Onassis Cardiac Surgery Centre, 356 Syngrou Avenue, 176 74 Kallithea, Athens, Greece
| | - Athanassios Manginas
- Interventional Cardiology and Cardiology Department, Mediterraneo Hospital, Athens, Greece
| | - George Sevastos
- Interventional Cardiology and Cardiology Department, Mediterraneo Hospital, Athens, Greece
| | - Haralambos Karvounis
- 1st Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Theodoros D Karamitsos
- 1st Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - George Hahalis
- Department of Cardiology, University of Patras Medical School, Patras, Greece
| | - Marianna Leopoulou
- Department of Cardiology, University of Patras Medical School, Patras, Greece
| | | | - Despoina Balta
- Cardiology Department, General Hospital 'G. Gennimatas', Athens, Greece
| | | | - Alexandros Kasiakogias
- 1st Cardiology Clinic, 'Hippokration' General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Ioannis Mantas
- Department of Cardiology, General Hospital of Chalkida, Chalkida, Greece
| | | | | | | | | | | | - Stavros Karanikas
- Department of Cardiology, Konstantopoulio General Hospital, Athens, Greece
| | | | - Dimitrios N Tziakas
- Department of Cardiology, Democritus University of Thrace, Alexandroupolis, Greece
| | - Nikolaos Kouvelas
- Department of Cardiology, 251 Airforce General Hospital, Athens, Greece
| | - Paraskevi Ntoliou
- Department of Cardiology, 251 Airforce General Hospital, Athens, Greece
| | | | - Pavlos Tsinivizov
- Department of Cardiology, Asklepeion General Hospital, Athens, Greece
| | | | - Agathi-Rosa Vrettou
- 2nd Department of Cardiology, Attikon University Hospital, University of Athens, Athens, Greece
| | | | - Alexandros Douras
- Department of Cardiology, Achillopouleio General Hospital, Volos, Greece
| | - Nikoleta Mpaka
- Department of Cardiology, Achillopouleio General Hospital, Volos, Greece
| | | | | | | | - Antonios Sideris
- Laboratory of Cardiac Electrophysiology, 'Evangelismos' General Hospital of Athens, Athens, Greece
| | - John T Parissis
- 2nd Department of Cardiology, Attikon University Hospital, University of Athens, Athens, Greece
| | | | - Athanasios Trikas
- Department of Cardiology, 'Elpis' General Hospital of Athens, Athens, Greece
| | - Gerasimos Filippatos
- 2nd Department of Cardiology, Attikon University Hospital, University of Athens, Athens, Greece
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Oikonomou E, Leopoulou M, Theofilis P, Antonopoulos AS, Siasos G, Latsios G, Mystakidi VC, Antoniades C, Tousoulis D. A link between inflammation and thrombosis in atherosclerotic cardiovascular diseases: Clinical and therapeutic implications. Atherosclerosis 2020; 309:16-26. [PMID: 32858395 DOI: 10.1016/j.atherosclerosis.2020.07.027] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [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: 03/17/2020] [Revised: 07/22/2020] [Accepted: 07/29/2020] [Indexed: 12/22/2022]
Abstract
The association between thrombosis and acute coronary syndromes is well established. Inflammation and activation of innate and adaptive immunity are another important factor implicated in atherosclerosis. However, the exact interactions between thrombosis and inflammation in atherosclerosis are less well understood. Accumulating data suggest a firm interaction between these two key pathophysiologic processes. Pro-inflammatory cytokines, such as tumor necrosis factor α, interleukin-6 and interleukin-1, have been implicated in the thrombotic cascade following plaque rupture and myocardial infarction. Furthermore, cell adhesion molecules accelerate not only atheromatosis but also thrombosis formation while activated platelets are able to trigger leukocyte adhesion and accumulation. Additionally, tissue factor, thrombin, and activated coagulation factors induce the release of pro-inflammatory cytokines such as prostaglandin and C reactive protein, which may further induce von Willebrand factor secretion. Treatments targeting immune activation (i.e. interleukin-1 inhibitors, colchicine, statins, etc.) may also beneficially modulate platelet activation while common anti-thrombotic therapies appear to attenuate the inflammatory process. Taken together in the context of cardiovascular diseases, thrombosis and inflammation should be studied and managed as a common entity under the concept of thrombo-inflammation.
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Affiliation(s)
- Evangelos Oikonomou
- 1st Department of Cardiology, Hippokration Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece.
| | - Marianna Leopoulou
- 1st Department of Cardiology, Hippokration Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Panagiotis Theofilis
- 1st Department of Cardiology, Hippokration Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Alexios S Antonopoulos
- 1st Department of Cardiology, Hippokration Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Gerasimos Siasos
- 1st Department of Cardiology, Hippokration Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - George Latsios
- 1st Department of Cardiology, Hippokration Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Vasiliki Chara Mystakidi
- 1st Department of Cardiology, Hippokration Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Charalambos Antoniades
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Dimitris Tousoulis
- 1st Department of Cardiology, Hippokration Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
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Pergolizzi JV, Varrassi G, Magnusson P, LeQuang JA, Leopoulou M, Paladini A, Taylor R, Wollmuth C, Breve F. The concern about ACE/ARB and COVID-19: Time to hold your horses! J Am Pharm Assoc (2003) 2020; 60:e88-e90. [PMID: 32747165 PMCID: PMC7837157 DOI: 10.1016/j.japh.2020.06.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 06/24/2020] [Accepted: 06/30/2020] [Indexed: 01/22/2023]
Abstract
Concern about coronavirus 2019 (COVID-19) morbidity and mortality has drawn attention to the potential role of angiotensin-converting enzyme (ACE) inhibitors and angiotensin-receptor blockers (ARBs) because the SARS-CoV-2 uses the ACE2 receptor as its point of entry into the body. It is not clear if and to what degree the SARS-CoV-2 virus affects the renin-angoiotensin system. Early studies from China which speculated on the role of ACE inhibition and ARBs did not evaluate the drug regimens. A vast body of evidence supports the use of ACE inhibitors and ARBs in hypertensive patients and patients with heart failure, and very little evidence has been acquired about their role in COVID-19. There is good evidence in support of the use of ACE inhibitors and ARBs in indicated patients with hypertension and heart failure, and clinicians should be reticent about abruptly withdrawing these drugs based on a paucity of evidence.
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13
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Leopoulou M, Mistakidi VC, Oikonomou E, Latsios G, Papaioannou S, Deftereos S, Siasos G, Antonopoulos A, Charalambous G, Tousoulis D. Acute Coronary Syndrome with Non-ruptured Plaques (NONRUPLA): Novel Ideas and Perspectives. Curr Atheroscler Rep 2020; 22:21. [PMID: 32468244 DOI: 10.1007/s11883-020-00839-7] [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] [Indexed: 12/31/2022]
Abstract
PURPOSE OF REVIEW In this review article, we focus on the mechanisms and features of acute coronary syndromes (ACS) with no ruptured plaque (NONRUPLA) highlighting the uncertainties over diagnostic evaluation and treatment. RECENT FINDINGS The most common cause of ACS is obstruction due to atherosclerotic plaque ruptured or erosion. In 14% of patients who present in the Emergency Department as myocardial infarction, the final diagnosis is ACS with NONRUPLA. Although the clinical presentation of NONRUPLA may mimic myocardial infarction, the underlying pathogenesis is different, and it may guide therapeutic approaches and overall prognosis that vary according to etiology. The possible mechanisms of ACS with NONRUPLA are coronary embolism, acute dissection of the aorta or coronary artery, vasospasm, microvascular dysfunction, the imbalance between oxygen demand and supply, coronary trauma and stent complications, direct cellular toxicity and damage, Takotsubo syndrome, and myocardial infarction with non-obstructive coronary arteries (MINOCA).
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Affiliation(s)
- Marianna Leopoulou
- 1st Cardiology Clinic, 'Hippokration' General Hospital, School of Medicine, National and Kapodistrian University of Athens, Vasilissis Sofias 114, 11528, Athens, Greece
| | - Vasiliki C Mistakidi
- 1st Cardiology Clinic, 'Hippokration' General Hospital, School of Medicine, National and Kapodistrian University of Athens, Vasilissis Sofias 114, 11528, Athens, Greece
| | - Evangelos Oikonomou
- 1st Cardiology Clinic, 'Hippokration' General Hospital, School of Medicine, National and Kapodistrian University of Athens, Vasilissis Sofias 114, 11528, Athens, Greece.
| | - George Latsios
- 1st Cardiology Clinic, 'Hippokration' General Hospital, School of Medicine, National and Kapodistrian University of Athens, Vasilissis Sofias 114, 11528, Athens, Greece
| | - Spyridon Papaioannou
- 1st Cardiology Clinic, 'Hippokration' General Hospital, School of Medicine, National and Kapodistrian University of Athens, Vasilissis Sofias 114, 11528, Athens, Greece
| | - Spyridon Deftereos
- 1st Cardiology Clinic, 'Hippokration' General Hospital, School of Medicine, National and Kapodistrian University of Athens, Vasilissis Sofias 114, 11528, Athens, Greece
| | - Gerasimos Siasos
- 1st Cardiology Clinic, 'Hippokration' General Hospital, School of Medicine, National and Kapodistrian University of Athens, Vasilissis Sofias 114, 11528, Athens, Greece
| | - Alexis Antonopoulos
- 1st Cardiology Clinic, 'Hippokration' General Hospital, School of Medicine, National and Kapodistrian University of Athens, Vasilissis Sofias 114, 11528, Athens, Greece
| | - George Charalambous
- 1st Cardiology Clinic, 'Hippokration' General Hospital, School of Medicine, National and Kapodistrian University of Athens, Vasilissis Sofias 114, 11528, Athens, Greece
| | - Dimitris Tousoulis
- 1st Cardiology Clinic, 'Hippokration' General Hospital, School of Medicine, National and Kapodistrian University of Athens, Vasilissis Sofias 114, 11528, Athens, Greece
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Hahalis GN, Leopoulou M, Tsigkas G, Xanthopoulou I, Patsilinakos S, Patsourakos NG, Ziakas A, Kafkas N, Koutouzis M, Tsiafoutis I, Athanasiadis I, Koniari I, Almpanis G, Anastasopoulou M, Despotopoulos S, Kounis N, Dapergola A, Aznaouridis K, Davlouros P. Multicenter Randomized Evaluation of High Versus Standard Heparin Dose on Incident Radial Arterial Occlusion After Transradial Coronary Angiography. JACC Cardiovasc Interv 2018; 11:2241-2250. [DOI: 10.1016/j.jcin.2018.08.009] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 07/16/2018] [Accepted: 08/14/2018] [Indexed: 11/30/2022]
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Hahalis G, Tsigkas G, Kounis N, Patsilinakos S, Kafkas N, Ziakas A, Patsourakos N, Almpanis G, Koniari I, Xanthopoulou I, Koutsogiannis N, Despotopoulos S, Leopoulou M, Tassi V, Miliordos I, Anastasopoulou M, Roumeliotis A, Dapergola A, Aznaouridis K, Chatzis D, Davlouros P. Prevention of Radial Artery Occlusions Following Coronary Procedures: Forward and Backward Steps in Improving Radial Artery Patency Rates. Angiology 2018; 69:755-762. [DOI: 10.1177/0003319718754466] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Radial artery (RA) occlusion (RAO) remains the Achilles heel of transradial coronary procedures. Although of silent nature, RAO is relatively frequent, results in graft shortage for future coronary artery bypass surgery, and may occur even after short-lasting, 5F coronary angiography (CAG). The most frequent predictors of RAO are RA size, body size, female gender, and periprocedural anticoagulation intensity. Methods to detect RAO are variable, of which the Barbeau test and ultrasonography have similar diagnostic accuracy. Data indicate that late RAO recanalization may occur. Meticulous handling of RA and the use of appropriate hemostatic devices and techniques along with sufficient heparin dose appear important measures to reduce RAO rates. Recent contradictory studies indicate that the decreasing incidence of RAO overtime is not as uniform as previously thought. In 2 meta-analyses, the benefit of higher over lower anticoagulation intensity became evident. As “it may all be appropriate anticoagulation” for a simplified approach against RAO, the results of an ongoing trial comparing 100 with 50 IU/kg body weight in transradial CAG are eagerly awaited.
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Affiliation(s)
- George Hahalis
- Department of Cardiology, Patras University Hospital, Rio, Patras, Greece
| | - Grigorios Tsigkas
- Department of Cardiology, Patras University Hospital, Rio, Patras, Greece
| | - Nikos Kounis
- Department of Cardiology, Patras University Hospital, Rio, Patras, Greece
| | | | | | - Antonios Ziakas
- Department of Cardiology, “AHEPA” University Hospital, Thessaloniki, Greece
| | | | - George Almpanis
- Department of Cardiology, Patras University Hospital, Rio, Patras, Greece
| | - Ioanna Koniari
- Department of Cardiology, Patras University Hospital, Rio, Patras, Greece
| | | | | | | | - Marianna Leopoulou
- Department of Cardiology, Patras University Hospital, Rio, Patras, Greece
| | - Vasiliky Tassi
- Department of Cardiology, Patras University Hospital, Rio, Patras, Greece
| | - Ioannis Miliordos
- Department of Cardiology, Patras University Hospital, Rio, Patras, Greece
| | | | | | - Athina Dapergola
- Department of Cardiology, Patras University Hospital, Rio, Patras, Greece
| | - Konstantinos Aznaouridis
- Department of Cardiology, “Hippokration” University Hospital, Athens, Greece
- Department of Cardiology, “Castle Hill” Hospital, Cottingham, UK
| | | | - Periklis Davlouros
- Department of Cardiology, Patras University Hospital, Rio, Patras, Greece
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Hahalis G, Aznaouridis K, Tsigkas G, Davlouros P, Xanthopoulou I, Koutsogiannis N, Koniari I, Leopoulou M, Costerousse O, Tousoulis D, Bertrand OF. Radial Artery and Ulnar Artery Occlusions Following Coronary Procedures and the Impact of Anticoagulation: ARTEMIS (Radial and Ulnar ARTEry Occlusion Meta-Analys IS) Systematic Review and Meta-Analysis. J Am Heart Assoc 2017; 6:JAHA.116.005430. [PMID: 28838915 PMCID: PMC5586412 DOI: 10.1161/jaha.116.005430] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Background Incidence of radial artery occclusions (RAO) and ulnar artery occclusions (UAO) in coronary procedures, factors predisposing to forearm arteries occlusion, and the benefit of anticoaggulation vary significantly in existing literature. We sought to determine the incidence of RAO/UAO and the impact of anticoagulation intensity. Methods and Results Meta‐analysis of 112 studies assessing RAO and/or UAO (N=46 631) were included. Overall, there was no difference between crude RAO and UAO rates (5.2%; 95% confidence interval [CI], 4.4–6.0 versus 4.0%; 95% CI, 2.8–5.8; P=0.171). The early occlusion rate (in‐hospital or within 7 days after procedure) was higher than the late occlusion rate. The detection rate of occlusion was higher with vascular ultrasonography compared with clinical evaluation only. Low‐dose heparin was associated with a significantly higher RAO rate compared with high‐dose heparin (7.2%; 95% CI, 5.5–9.4 versus 4.3%; 95% CI, 3.5–5.3; Q=8.81; P=0.003). Early occlusions in low‐dose heparin cohorts mounted at 8.0% (95% CI, 6.1–10.6). The RAO rate was higher after diagnostic angiographies compared with coronary interventions, presumably attributed to the higher intensity of anticoagulation in the latter group. Hemostatic techniques (patent versus nonpatent hemostasis), geography (US versus non‐US cohorts) and sheath size did not impact on vessel patency. Conclusions RAO and UAO occur with similar frequency and in the order of 7% to 8% when evaluated early by vascular ultrasonography following coronary procedures. More‐intensive anticoagulation is protective. Late recanalization occurs in a substantial minority of patients.
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Affiliation(s)
| | - Konstantinos Aznaouridis
- Hippokration Hospital, Athens Medical School, Athens, Greece.,Castle Hill Hospital, Cottingham, United Kingdom
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Alexopoulos D, Davlouros P, Tsigkas G, Koutsogiannis N, Moulias A, Armilagos S, Salata P, Leopoulou M, Hahalis G, Xanthopoulou I. THE EFFECT OF HIGH (200μG/KG/MIN) VERSUS STANDARD (140μG/KG/MIN) ADENOSINE DOSE IN PATIENTS WITH PD/PA VARIATION DURING STANDARD FFR ASSESSMENT. J Am Coll Cardiol 2016. [DOI: 10.1016/s0735-1097(16)30400-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Hahalis G, Tsigkas G, Kakkos S, Panagopoulos A, Tsota I, Davlouros P, Xanthopoulou I, Koniari I, Grapsas N, Christodoulou I, Almpanis G, Leopoulou M, Kounis N, Alexopoulos D. Vascular Complications Following Transradial and Transulnar Coronary Angiography in 1600 Consecutive Patients. Angiology 2015; 67:438-43. [PMID: 26124493 DOI: 10.1177/0003319715592095] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Major, noncoronary complications are rarely encountered following transradial coronary procedures. METHODS AND RESULTS Among 1600 prospectively studied patients with complete follow-up, 7 patients experienced major complications following coronary forearm procedures corresponding to an incidence of 0.44%. We found inadvertent symptomatic intramyocardial contrast medium injection, 2 cases with compartment syndrome of which 1 was managed surgically, exertional hand ischemia due to radial artery occlusion, a large ulnar artery pseudoaneurysm, an ulnar arteriovenous fistula, and 1 critical hand ischemia due to late occlusion of the distal brachial artery. CONCLUSIONS Although infrequent, surveillance for major complications should be encouraged after forearm coronary procedures.
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Affiliation(s)
- George Hahalis
- Department of Cardiology, Patras University Hospital, Rio, Patras, Greece
| | - Grigorios Tsigkas
- Department of Cardiology, Patras University Hospital, Rio, Patras, Greece
| | - Stavros Kakkos
- Department of Vascular Surgery, Patras University Hospital, Rio, Patras, Greece
| | | | - Irene Tsota
- Department of Radiology, Patras University Hospital, Rio, Patras, Greece
| | - Periklis Davlouros
- Department of Cardiology, Patras University Hospital, Rio, Patras, Greece
| | | | - Ioanna Koniari
- Department of Cardiology, Patras University Hospital, Rio, Patras, Greece
| | - Nikos Grapsas
- Department of Cardiology, Patras University Hospital, Rio, Patras, Greece
| | | | - George Almpanis
- Department of Cardiology, Patras University Hospital, Rio, Patras, Greece
| | - Marianna Leopoulou
- Department of Cardiology, Patras University Hospital, Rio, Patras, Greece
| | - Nicholas Kounis
- Department of Cardiology, Patras University Hospital, Rio, Patras, Greece
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