1
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Kalogeras K, Jabbour RJ, Pracon R, Kabir T, Shannon J, Duncan A, Quarto C, Heng EL, Rahbi H, Oikonomou E, Katsianos E, Patel N, Chandra N, Vavuranakis MA, Cadiz S, Bougiakli M, Smith RD, Siasos G, Vavuranakis M, Davies S, Dalby M, Panoulas V. Midterm Outcomes in Patients With Aortic Stenosis Treated With Contemporary Balloon-Expandable and Self-Expanding Valves: Does Valve Size Have an Impact on Outcome? J Am Heart Assoc 2023:e028038. [PMID: 37232270 PMCID: PMC10382012 DOI: 10.1161/jaha.122.028038] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Background No data currently exist comparing the contemporary iterations of balloon-expandable (BE) Edwards SAPIEN 3/Ultra and the self-expanding (SE) Medtronic Evolut PRO/R34 valves. The aim of the study was the comparison of these transcatheter heart valves with emphasis on patients with small aortic annulus. Methods and Results In this retrospective registry, periprocedural outcomes and midterm all-cause mortality were analyzed. A total of 1673 patients (917 SE versus 756 BE) were followed up for a median of 15 months. A total of 194 patients died (11.6%) during follow-up. SE and BE groups showed similar survival at 1 (92.6% versus 90.6%) and 3 (80.3% versus 85.2%) years (Plog-rank=0.136). Compared with the BE group, patients treated with the SE device had lower peak (16.3±8 mm Hg SE versus 21.9±8 mm Hg BE) and mean (8.8±5 mm Hg SE versus 11.5±5 mm Hg BE) gradients at discharge. Conversely, the BE group demonstrated lower rates of at least moderate paravalvular regurgitation postoperatively (5.6% versus 0.7% for SE and BE valves, respectively; P<0.001). In patients treated with small transcatheter heart valves (≤26 mm for SE and ≤23 mm for BE; N=284 for SE and N=260 for BE), survival was higher among patients treated with SE valves at both 1 (96.7% SE versus 92.1% BE) and 3 (91.8% SE versus 82.2% BE) years (Plog-rank=0.042). In propensity-matched patients treated with small transcatheter heart valve, there remained a trend for higher survival among the SE group at both 1 (97% SE versus 92.3% BE) and 3 years (91.8% SE versus 78.7% BE), Plog-rank=0.096). Conclusions Real-world comparison of the latest-generation SE and BE devices demonstrated similar survival up to 3 years' follow-up. In patients with small transcatheter heart valves, there may be a trend for improved survival among those treated with SE valves.
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Affiliation(s)
- Konstantinos Kalogeras
- Department of Cardiology, Royal Brompton and Harefield Hospitals Guy's and St Thomas' National Health Service Foundation Trust London UK
- 3rd Department of Cardiology, Sotiria Hospital, Medical School National and Kapodistrian University of Athens Athens Greece
| | - Richard J Jabbour
- Department of Cardiology, Royal Brompton and Harefield Hospitals Guy's and St Thomas' National Health Service Foundation Trust London UK
- Cardiovascular Sciences, National Heart and Lung Institute Imperial College London London UK
| | - Radoslaw Pracon
- Department of Cardiology, Royal Brompton and Harefield Hospitals Guy's and St Thomas' National Health Service Foundation Trust London UK
| | - Tito Kabir
- Department of Cardiology, Royal Brompton and Harefield Hospitals Guy's and St Thomas' National Health Service Foundation Trust London UK
| | - Joanne Shannon
- Department of Cardiology, Royal Brompton and Harefield Hospitals Guy's and St Thomas' National Health Service Foundation Trust London UK
| | - Alison Duncan
- Department of Cardiology, Royal Brompton and Harefield Hospitals Guy's and St Thomas' National Health Service Foundation Trust London UK
| | - Cesare Quarto
- Department of Cardiology, Royal Brompton and Harefield Hospitals Guy's and St Thomas' National Health Service Foundation Trust London UK
| | - Ee-Ling Heng
- Department of Cardiology, Royal Brompton and Harefield Hospitals Guy's and St Thomas' National Health Service Foundation Trust London UK
| | - Hazim Rahbi
- Department of Cardiology, Royal Brompton and Harefield Hospitals Guy's and St Thomas' National Health Service Foundation Trust London UK
| | - Evangelos Oikonomou
- 3rd Department of Cardiology, Sotiria Hospital, Medical School National and Kapodistrian University of Athens Athens Greece
| | - Efstratios Katsianos
- 3rd Department of Cardiology, Sotiria Hospital, Medical School National and Kapodistrian University of Athens Athens Greece
| | - Niket Patel
- Department of Cardiology, Royal Brompton and Harefield Hospitals Guy's and St Thomas' National Health Service Foundation Trust London UK
| | - Navin Chandra
- Department of Cardiology, Royal Brompton and Harefield Hospitals Guy's and St Thomas' National Health Service Foundation Trust London UK
| | - Michael-Andrew Vavuranakis
- 3rd Department of Cardiology, Sotiria Hospital, Medical School National and Kapodistrian University of Athens Athens Greece
| | - Suzane Cadiz
- Department of Cardiology, Royal Brompton and Harefield Hospitals Guy's and St Thomas' National Health Service Foundation Trust London UK
| | - Maria Bougiakli
- Department of Cardiology, Royal Brompton and Harefield Hospitals Guy's and St Thomas' National Health Service Foundation Trust London UK
| | - Robert D Smith
- Department of Cardiology, Royal Brompton and Harefield Hospitals Guy's and St Thomas' National Health Service Foundation Trust London UK
| | - Gerasimos Siasos
- 3rd Department of Cardiology, Sotiria Hospital, Medical School National and Kapodistrian University of Athens Athens Greece
| | - Manolis Vavuranakis
- 3rd Department of Cardiology, Sotiria Hospital, Medical School National and Kapodistrian University of Athens Athens Greece
| | - Simon Davies
- Department of Cardiology, Royal Brompton and Harefield Hospitals Guy's and St Thomas' National Health Service Foundation Trust London UK
| | - Miles Dalby
- Department of Cardiology, Royal Brompton and Harefield Hospitals Guy's and St Thomas' National Health Service Foundation Trust London UK
| | - Vasileios Panoulas
- Department of Cardiology, Royal Brompton and Harefield Hospitals Guy's and St Thomas' National Health Service Foundation Trust London UK
- Cardiovascular Sciences, National Heart and Lung Institute Imperial College London London UK
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2
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Tsigkou V, Oikonomou E, Anastasiou A, Lampsas S, Zakynthinos GE, Kalogeras K, Katsioupa M, Kapsali M, Kourampi I, Pesiridis T, Marinos G, Vavuranakis MA, Tousoulis D, Vavuranakis M, Siasos G. Molecular Mechanisms and Therapeutic Implications of Endothelial Dysfunction in Patients with Heart Failure. Int J Mol Sci 2023; 24:ijms24054321. [PMID: 36901752 PMCID: PMC10001590 DOI: 10.3390/ijms24054321] [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: 12/31/2022] [Revised: 02/06/2023] [Accepted: 02/15/2023] [Indexed: 02/25/2023] Open
Abstract
Heart failure is a complex medical syndrome that is attributed to a number of risk factors; nevertheless, its clinical presentation is quite similar among the different etiologies. Heart failure displays a rapidly increasing prevalence due to the aging of the population and the success of medical treatment and devices. The pathophysiology of heart failure comprises several mechanisms, such as activation of neurohormonal systems, oxidative stress, dysfunctional calcium handling, impaired energy utilization, mitochondrial dysfunction, and inflammation, which are also implicated in the development of endothelial dysfunction. Heart failure with reduced ejection fraction is usually the result of myocardial loss, which progressively ends in myocardial remodeling. On the other hand, heart failure with preserved ejection fraction is common in patients with comorbidities such as diabetes mellitus, obesity, and hypertension, which trigger the creation of a micro-environment of chronic, ongoing inflammation. Interestingly, endothelial dysfunction of both peripheral vessels and coronary epicardial vessels and microcirculation is a common characteristic of both categories of heart failure and has been associated with worse cardiovascular outcomes. Indeed, exercise training and several heart failure drug categories display favorable effects against endothelial dysfunction apart from their established direct myocardial benefit.
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Affiliation(s)
- Vasiliki Tsigkou
- 3rd Department of Cardiology, Medical School, National and Kapodistrian University of Athens, Sotiria Chest Disease Hospital, 11527 Athens, Greece
| | - Evangelos Oikonomou
- 3rd Department of Cardiology, Medical School, National and Kapodistrian University of Athens, Sotiria Chest Disease Hospital, 11527 Athens, Greece
- Correspondence: ; Tel.: +30-69-4770-1299
| | - Artemis Anastasiou
- 3rd Department of Cardiology, Medical School, National and Kapodistrian University of Athens, Sotiria Chest Disease Hospital, 11527 Athens, Greece
| | - Stamatios Lampsas
- 3rd Department of Cardiology, Medical School, National and Kapodistrian University of Athens, Sotiria Chest Disease Hospital, 11527 Athens, Greece
| | - George E. Zakynthinos
- 3rd Department of Cardiology, Medical School, National and Kapodistrian University of Athens, Sotiria Chest Disease Hospital, 11527 Athens, Greece
| | - Konstantinos Kalogeras
- 3rd Department of Cardiology, Medical School, National and Kapodistrian University of Athens, Sotiria Chest Disease Hospital, 11527 Athens, Greece
| | - Maria Katsioupa
- 3rd Department of Cardiology, Medical School, National and Kapodistrian University of Athens, Sotiria Chest Disease Hospital, 11527 Athens, Greece
| | - Maria Kapsali
- 3rd Department of Cardiology, Medical School, National and Kapodistrian University of Athens, Sotiria Chest Disease Hospital, 11527 Athens, Greece
| | - Islam Kourampi
- 3rd Department of Cardiology, Medical School, National and Kapodistrian University of Athens, Sotiria Chest Disease Hospital, 11527 Athens, Greece
| | - Theodoros Pesiridis
- 3rd Department of Cardiology, Medical School, National and Kapodistrian University of Athens, Sotiria Chest Disease Hospital, 11527 Athens, Greece
| | - Georgios Marinos
- 3rd Department of Cardiology, Medical School, National and Kapodistrian University of Athens, Sotiria Chest Disease Hospital, 11527 Athens, Greece
| | - Michael-Andrew Vavuranakis
- 3rd Department of Cardiology, Medical School, National and Kapodistrian University of Athens, Sotiria Chest Disease Hospital, 11527 Athens, Greece
| | - Dimitris Tousoulis
- 1st Department of Cardiology, Medical School, National and Kapodistrian University of Athens, Hippokration General Hospital, 11527 Athens, Greece
| | - Manolis Vavuranakis
- 3rd Department of Cardiology, Medical School, National and Kapodistrian University of Athens, Sotiria Chest Disease Hospital, 11527 Athens, Greece
| | - Gerasimos Siasos
- 3rd Department of Cardiology, Medical School, National and Kapodistrian University of Athens, Sotiria Chest Disease Hospital, 11527 Athens, Greece
- Cardiovascular Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
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3
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Bei E, Voudris V, Kalogeras K, Oikonomou E, Iakovou I, Kosmas I, Kalantzis C, Vavuranakis MA, Pantelidis P, Lazaros G, Tousoulis D, Tsioufis C, Vavuranakis M. Impact of Evolution of Self-Expandable Aortic Valve Design: Peri-Operative and Short-Term Outcomes. J Clin Med 2023; 12:jcm12051739. [PMID: 36902526 PMCID: PMC10003529 DOI: 10.3390/jcm12051739] [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: 12/21/2022] [Revised: 02/19/2023] [Accepted: 02/20/2023] [Indexed: 02/24/2023] Open
Abstract
A few data exist on the differences of implantable aortic valve bio-prostheses. We investigate three generations of self-expandable aortic valves in terms of the outcomes. Patients undergoing transcatheter aortic valve implantation (TAVI) were allocated into three groups according to the valve type: group A (CoreValveTM), group B (EvolutTMR) and group C (EvolutTMPRO). The implantation depth, device success, electrocardiographic parameters, need for permanent pacemaker (PPM), and paravalvular leak (PVL) were assessed. In the study, 129 patients were included. The final implantation depth did not differ among the groups (p = 0.07). CoreValveTM presented greater upward jump of the valve at release (2.88 ± 2.33 mm vs. 1.48 ± 1.09 mm and 1.71 ± 1.35 mm, for groups A, B, and C, respectively, p = 0.011). The device success (at least 98% for all groups, p = 1.00) and PVL rates (67% vs. 58%, vs. 60% for groups A, B, and C, respectively, p = 0.64) did not differ. PPM implantation within 24 h (33% vs. 19% vs. 7% for groups A, B, and C, respectively, p = 0.006) and until discharge (group A: 38% vs. group B: 19% and group C: 9%, p = 0.005) was lower in the newer generation valves. Newer generation valves present better device positioning, more predictable deployment, and fewer rates of PPM implantation. No significant difference in PVL was observed.
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Affiliation(s)
- Evangelia Bei
- First Department of Cardiology, Hippokration Hospital, Medical School, National and Kapodistrian University of Athens, 11528 Athens, Greece
| | - Vasileios Voudris
- Interventional Department of Cardiology, Onassis Cardiac Surgery Center, 17674 Athens, Greece
| | - Konstantinos Kalogeras
- Third Department of Cardiology, Sotiria General Hospital for Chest Diseases, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Evangelos Oikonomou
- Third Department of Cardiology, Sotiria General Hospital for Chest Diseases, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
- Correspondence: ; Tel.: +30-210-776-3492
| | - Ioannis Iakovou
- Interventional Department of Cardiology, Onassis Cardiac Surgery Center, 17674 Athens, Greece
| | - Ilias Kosmas
- Interventional Department of Cardiology, Onassis Cardiac Surgery Center, 17674 Athens, Greece
| | - Charalampos Kalantzis
- First Department of Cardiology, Hippokration Hospital, Medical School, National and Kapodistrian University of Athens, 11528 Athens, Greece
| | - Michael-Andrew Vavuranakis
- Third Department of Cardiology, Sotiria General Hospital for Chest Diseases, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Panteleimon Pantelidis
- Third Department of Cardiology, Sotiria General Hospital for Chest Diseases, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - George Lazaros
- First Department of Cardiology, Hippokration Hospital, Medical School, National and Kapodistrian University of Athens, 11528 Athens, Greece
| | - Dimitrios Tousoulis
- First Department of Cardiology, Hippokration Hospital, Medical School, National and Kapodistrian University of Athens, 11528 Athens, Greece
| | - Constantinos Tsioufis
- First Department of Cardiology, Hippokration Hospital, Medical School, National and Kapodistrian University of Athens, 11528 Athens, Greece
| | - Manolis Vavuranakis
- Third Department of Cardiology, Sotiria General Hospital for Chest Diseases, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
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4
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Katsianos E, Oikonomou E, Kalogeras K, Manousaki A, Kalantzis C, Pantelidis P, Vavuranakis MA, Aggeli K, Siasos G, Tsioufis C, Vavuranakis M. Residual Right-to-Left-Shunt Following Transcatheter Patent Foramen Ovale Closure: The Role of Antithrombotic Treatment. Curr Pharm Des 2022; 28:3305-3312. [PMID: 36306457 DOI: 10.2174/1381612829666221028095839] [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: 04/18/2022] [Accepted: 09/26/2022] [Indexed: 01/28/2023]
Abstract
BACKGROUND Transcatheter closure of patent foramen ovale (PFO) is a highly effective therapy for patients with left circulation thromboembolism, not attributable to other conditions. OBJECTIVES This retrospective cohort study investigates the impact of baseline foramen ovale anatomy on the severity of the postclosure shunt. METHODS Patients with PFO, who underwent percutaneous closure, were followed up for at least 5 years postimplantation. Patients were classified into two groups based on the presence of high-risk features of the baseline PFO anatomy. At the follow-up follow-up, residual right-to-left shunt was assessed for the high and non-highrisk anatomy groups, via transcranial Doppler at rest and after performing the Valsalva maneuver, with the injection of agitated saline. RESULTS 38 patients were examined after a mean follow-up period of 9 ± 3 years after implantation. After retrospective evaluation of the baseline transthoracic and transesophageal echo studies, 14 patients with high-risk PFO anatomy were identified. The degree of the residual right-to-left shunt, as assessed by the number of microbubbles was higher in the high-risk PFO anatomy group compared to the non-high-risk group, both at rest [1.50 (IQR: 0.00-3.25) vs. 0.00 (IQR: 0.00-0.00), p < 0.001] and post-Valsalva maneuver [7.50 (IQR: 1.50- 10.25) vs. 0.00 (IQR: 0.00-3.75), p = 0.003]. Furthermore, in the high-risk group, more microbubbles were detected at rest (p = 0.008) and post-Valsalva (p = 0.002) in subjects without antiplatelet treatment compared to subjects on prolonged antiplatelet therapy. CONCLUSION Baseline PFO anatomy affects the severity of the residual right-to-left shunt. Prolonged antiplatelet therapy may benefit patients with high-risk anatomical features.
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Affiliation(s)
- Efstratios Katsianos
- 3rd Cardiology Clinic, National and Kapodistrian University of Athens, Medical School, Sotiria Chest Disease Hospital, Athens. Greece
| | - Evangelos Oikonomou
- 3rd Cardiology Clinic, National and Kapodistrian University of Athens, Medical School, Sotiria Chest Disease Hospital, Athens. Greece.,1st Cardiology Clinic, National and Kapodistrian University of Athens, Medical School, "Hippokration" General Hospital, Athens, Greece
| | - Konstantinos Kalogeras
- 3rd Cardiology Clinic, National and Kapodistrian University of Athens, Medical School, Sotiria Chest Disease Hospital, Athens. Greece
| | - Alexandra Manousaki
- 1st Cardiology Clinic, National and Kapodistrian University of Athens, Medical School, "Hippokration" General Hospital, Athens, Greece
| | - Charalambos Kalantzis
- 1st Cardiology Clinic, National and Kapodistrian University of Athens, Medical School, "Hippokration" General Hospital, Athens, Greece
| | - Panteleimon Pantelidis
- 3rd Cardiology Clinic, National and Kapodistrian University of Athens, Medical School, Sotiria Chest Disease Hospital, Athens. Greece
| | | | - Konstantina Aggeli
- 3rd Cardiology Clinic, National and Kapodistrian University of Athens, Medical School, Sotiria Chest Disease Hospital, Athens. Greece
| | - Gerasimos Siasos
- 3rd Cardiology Clinic, National and Kapodistrian University of Athens, Medical School, Sotiria Chest Disease Hospital, Athens. Greece.,1st Cardiology Clinic, National and Kapodistrian University of Athens, Medical School, "Hippokration" General Hospital, Athens, Greece
| | - Costas Tsioufis
- 1st Cardiology Clinic, National and Kapodistrian University of Athens, Medical School, "Hippokration" General Hospital, Athens, Greece
| | - Manolis Vavuranakis
- 3rd Cardiology Clinic, National and Kapodistrian University of Athens, Medical School, Sotiria Chest Disease Hospital, Athens. Greece.,1st Cardiology Clinic, National and Kapodistrian University of Athens, Medical School, "Hippokration" General Hospital, Athens, Greece
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5
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Oikonomou E, Tsaplaris P, Anastasiou A, Xenou M, Lampsas S, Siasos G, Pantelidis P, Theofilis P, Tsatsaragkou A, Katsarou O, Sagris M, Vavuranakis MA, Vavuranakis M, Tousoulis D. Interleukin-1 in Coronary Artery Disease. Curr Top Med Chem 2022:CTMC-EPUB-127032. [PMID: 36263481 DOI: 10.2174/1568026623666221017144734] [Citation(s) in RCA: 2] [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: 06/19/2022] [Revised: 08/22/2022] [Accepted: 09/15/2022] [Indexed: 11/22/2022]
Abstract
Cardiovascular disease is the leading cause of mortality worldwide. Inflammation has long been established as a key component in the pathophysiology of coronary artery disease. The interleukin-1 family consists of 11 members that regulate the inflammatory response through both pro- and anti-inflammatory properties with the Nod-like receptor (NLR) family pyrin domain containing 3 inflammasome having a pivotal role in the process of converting interleukin-1 beta and interleukin-18, two key inflammatory mediators, into their mature forms. Interleukin-1 affects various cell types that participate in the pathogenesis of atherosclerosis as it enhances the expression of leukocyte adhesion molecules on the surface of endothelial cells augment the permeability of the endothelial cell barrier, attracting monocytes and macrophages into the vessel wall and aids the migration of smooth muscle cells toward atheroma. It also enhances the aggregation of low-density lipoprotein particles in endothelium and smooth muscle cells and exhibits procoagulant activity by inducing synthesis, cell-surface expression and release of tissue factor in endothelial cells, promoting platelet adhesion. The value of interleukin-1 as a diagnostic biomarker is currently limited but interleukin-1 beta, interleukin-18 and interleukin-37 have shown promising data regarding their prognostic value in coronary artery disease. Importantly, target anti-inflammatory treatments have shown promising results regarding atherosclerosis progression and cardiovascular events. In this review article we focus on the immense role of interleukin-1 in atherosclerosis progression, inflammation cascade and in the clinical application of target anti-inflammatory treatments.
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Affiliation(s)
- Evangelos Oikonomou
- 3rd Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Sotiria Chest Disease Hospital, Athens, Greece
| | - Paraskevas Tsaplaris
- 3rd Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Sotiria Chest Disease Hospital, Athens, Greece
| | - Artemis Anastasiou
- 3rd Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Sotiria Chest Disease Hospital, Athens, Greece
| | - Maria Xenou
- 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.,1st Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Hippokration General Hospital, Athens, Greece.,Cardiovascular Division, Brigham and Women\'s Hospital, Harvard Medical School, Boston, MA, USA
| | - Panteleimon Pantelidis
- 3rd Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Sotiria Chest Disease Hospital, Athens, Greece
| | - Panagiotis Theofilis
- 1st Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Hippokration General Hospital, Athens, Greece
| | - Aikaterini Tsatsaragkou
- 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
| | - Marios Sagris
- 1st Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Hippokration General Hospital, Athens, Greece
| | - Michael-Andrew Vavuranakis
- 3rd Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Sotiria Chest Disease Hospital, Athens, Greece
| | - Manolis Vavuranakis
- 3rd Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Sotiria Chest Disease Hospital, Athens, Greece
| | - Dimitris Tousoulis
- 3rd Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Sotiria Chest Disease Hospital, Athens, Greece
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6
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Pantelidis P, Oikonomou E, Lampsas S, Souvaliotis N, Spartalis M, Vavuranakis MA, Bampa M, Papapetrou P, Siasos G, Vavuranakis M. Inside the “brain” of an artificial neural network: an interpretable deep learning approach to paroxysmal atrial fibrillation diagnosis from electrocardiogram signals during sinus rhythm. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2781] [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
With the ongoing, rapid advances in Deep Learning (DL), such solutions can now detect medical conditions even invisible to the human eye. In this direction, efforts have been made to develop DL algorithms that diagnose paroxysmal atrial fibrillation (PAF) from electrocardiogram (ECG) signals in sinus rhythm (SR). However, many of the available approaches function as “black boxes”, with physicians unable to understand and trust their predictions.
Purpose
To train a DL model to detect PAF patients while in SR and apply an algorithm that interprets and visualises its decisions.
Methods
We obtained ECG samples from PAF and non-PAF patients during SR, from the PAF Prediction Challenge Database. After discarding unannotated samples and augmenting the sample size (by dividing each signal into 30-second segments), we split the whole dataset into a train (68%), a validation (16%) and a test (16%) set. No pair of samples belonging to different sets originated from the same patient. We trained the InceptionTime neural network on the train/validation sets and tested on the “unseen” test set after “hiding” the correct answers. Its performance was evaluated with the following metrics: Accuracy, f1-score, precision and recall (sensitivity). After repeating this process 20 times, we obtained a distribution for each score. Finally, we adjusted the Grad-CAM interpretation algorithm to our data and used it to visualise the areas perceived as important by the model.
Results
After pre-processing, 4,080, 30-second, two-lead ECG signals were allocated to the train set, 960 to the validation and 960 to the test set. Each subset contained an equal number of PAF and non-PAF samples. After repeated training and testing, we obtained a median accuracy of 0.84 (interquartile range, IQR: 0.66–0.88), an f1-score of 0.82 (IQR: 0.68–0.88) and a median precision and recall equal to 0.93 (IQR: 0.67–0.99) and 0.77 (IQR: 0.68–0.93), respectively. The Grad-CAM technique highlighted the ECG areas of interest that led to each decision. We selected and present both PAF-positive and -negative samples, perceived either correctly or falsely. Interestingly, correct model decisions tend to focus on the P-wave, while false ones fixate on other regions.
Conclusions
Although a pilot study with considerable limitations (small sample size, disregard of possible confounding due to comorbidities or other factors), this work shows how DL can be employed to distinguish between PAF and non-PAF patients from SR ECG samples, and confirms the potential of DL-enabled approaches to offer novel diagnostic capabilities. Most importantly, our effort provides a comprehensible, visual interpretation of the model's decisions. Demystifying DL behaviour can, not only improve such efforts by explaining false decisions, but also cultivate trust among clinicians and, possibly, point out directions for future research, since we can now see through the magnifying lens of a neural network.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- P Pantelidis
- Sotiria Regional Chest Diseases Hospital, 3rd University Cardiology Department , Athens , Greece
| | - E Oikonomou
- Sotiria Regional Chest Diseases Hospital, 3rd University Cardiology Department , Athens , Greece
| | - S Lampsas
- Sotiria Regional Chest Diseases Hospital, 3rd University Cardiology Department , Athens , Greece
| | - N Souvaliotis
- Sotiria Regional Chest Diseases Hospital, 3rd University Cardiology Department , Athens , Greece
| | - M Spartalis
- Sotiria Regional Chest Diseases Hospital, 3rd University Cardiology Department , Athens , Greece
| | - M A Vavuranakis
- Sotiria Regional Chest Diseases Hospital, 3rd University Cardiology Department , Athens , Greece
| | - M Bampa
- University of Stockholm, Department of Computer and Systems Sciences , Stockholm , Sweden
| | - P Papapetrou
- University of Stockholm, Department of Computer and Systems Sciences , Stockholm , Sweden
| | - G Siasos
- Sotiria Regional Chest Diseases Hospital, 3rd University Cardiology Department , Athens , Greece
| | - M Vavuranakis
- Sotiria Regional Chest Diseases Hospital, 3rd University Cardiology Department , Athens , Greece
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7
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Goliopoulou A, Oikonomou E, Antonopoulos A, Koumallos N, Gazouli M, Theofilis P, Mystakidi VC, Pantelidis P, Vavuranakis MA, Siasos G, Tousoulis D. Expression of Tissue microRNAs in Ascending Aortic Aneurysms and Dissections. Angiology 2022:33197221098295. [PMID: 35503041 DOI: 10.1177/00033197221098295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Little is known about the role of serum and tissue mediators in the progression of ascending aortic aneurysms and dissections. We examined how the tissue expression of microRNAs and matrix metalloproteinases (MMPs), as well as the serum levels of osteoprotegerin, adiponectin, and high sensitivity C-reactive protein (hsCRP) are associated with these entities. We enrolled 21 patients with ascending aortic aneurysm, 11 with acute Stanford type A aortic dissection and 18 controls. The serum levels of osteoprotegerin, adiponectin, and hsCRP, as well as the tissue expression of MMPs 2 and 9 and tissue microRNAs 29 and 195 were compared among groups. There was no difference regarding serum osteoprotegerin, adiponectin, and tissue MMP2 and MMP9 levels. hsCRP was higher in the dissection group (P = .03). Tissue expression of microRNA 29 was 2.11-fold higher in the dissection (P = .001) and 2.99-fold higher in the aneurysm group (P < .001), compared with the control group. Tissue expression of microRNA 195 was 2.72-fold higher in the dissection (P < .001) and 2.00-fold lower in the aneurysm group (P = .08), compared with to the control group. These findings support the contribution of microRNAs in the progression of aneurysm formation and dissection, suggesting a role as potential biomarkers and future therapeutic targets.
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Affiliation(s)
- Athina Goliopoulou
- 3rd Department of Cardiology, National and Kapodistrian University of Athens, Medical School, 221171"Sotiria" Chest Disease Hospital, Athens, Greece
| | - Evangelos Oikonomou
- 3rd Department of Cardiology, National and Kapodistrian University of Athens, Medical School, 221171"Sotiria" Chest Disease Hospital, Athens, Greece
| | - Alexis Antonopoulos
- 1st Department of Cardiology, "Hippokration" General Hospital of Athens, National & Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Nikolaos Koumallos
- 1st Department of Cardiology, "Hippokration" General Hospital of Athens, National & Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Maria Gazouli
- National & Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Panagiotis Theofilis
- 1st Department of Cardiology, "Hippokration" General Hospital of Athens, National & Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Vasiliki-Chara Mystakidi
- 3rd Department of Cardiology, National and Kapodistrian University of Athens, Medical School, 221171"Sotiria" Chest Disease Hospital, Athens, Greece
| | - Panteleimon Pantelidis
- 3rd Department of Cardiology, National and Kapodistrian University of Athens, Medical School, 221171"Sotiria" Chest Disease Hospital, Athens, Greece
| | - Michael-Andrew Vavuranakis
- 3rd Department of Cardiology, National and Kapodistrian University of Athens, Medical School, 221171"Sotiria" Chest Disease Hospital, Athens, Greece
| | - Gerasimos Siasos
- 3rd Department of Cardiology, National and Kapodistrian University of Athens, Medical School, 221171"Sotiria" Chest Disease Hospital, Athens, Greece
| | - Dimitris Tousoulis
- 1st Department of Cardiology, "Hippokration" General Hospital of Athens, National & Kapodistrian University of Athens, School of Medicine, Athens, Greece
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Stampouloglou PK, Siasos G, Bletsa E, Oikonomou E, Vogiatzi G, Kalogeras K, Katsianos E, Vavuranakis MA, Souvaliotis N, Vavuranakis M. The Role of Cell Derived Microparticles in Cardiovascular Diseases: Current Concepts. Curr Pharm Des 2022; 28:1745-1757. [DOI: 10.2174/1381612828666220429081555] [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] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 03/15/2022] [Indexed: 12/07/2022]
Abstract
Abstract:
Cardiovascular disease remains the main cause of human morbidity and mortality in the developed countries. Microparticles (MPs) are small vesicles originating from the cell membrane as a result of various stimuli and particularly of biological processes that constitute the pathophysiology of atherosclerosis, such as endothelial damage. They form vesicles that can transfer various molecules and signals to remote target cells without direct cell to cell interaction. Circulating microparticles have been associated with cardiovascular diseases. Therefore, many studies have been designed to further investigate the role of microparticles as biomarkers for diagnosis, prognosis, and disease monitoring. To this concept the pro-thrombotic and atherogenic potential of platelets and endothelial derived MPs has gain research interest especially concerning accelerate atherosclerosis and acute coronary syndrome triggering and prognosis. MPs especially of endothelial origin have been investigated in different clinical scenarios of heart failure and in association of left ventricular loading conditions. Finally, most cardiovascular risk factors present unique patterns of circulating MPs population, highlighting their pathophysiologic link to cardiovascular disease progression. In this review article we present a synopsis of the biogenesis and characteristics of microparticles, as well as the most recent data concerning their implication in the cardiovascular settings.
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Affiliation(s)
- Panagiota K. Stampouloglou
- 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
| | - Evanthia Bletsa
- 3rd Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Sotiria Chest Disease Hospital, Athens. Greece
| | - Evangelos Oikonomou
- 3rd Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Sotiria Chest Disease Hospital, Athens. Greece
| | - Georgia Vogiatzi
- 3rd Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Sotiria Chest Disease Hospital, Athens. Greece
| | - Konstantinos Kalogeras
- 3rd Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Sotiria Chest Disease Hospital, Athens. Greece
| | - Efstratios Katsianos
- 3rd Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Sotiria Chest Disease Hospital, Athens. Greece
| | - Michael-Andrew Vavuranakis
- 3rd Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Sotiria Chest Disease Hospital, Athens. Greece
| | - Nektarios Souvaliotis
- 3rd Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Sotiria Chest Disease Hospital, Athens. Greece
| | - Manolis Vavuranakis
- 3rd Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Sotiria Chest Disease Hospital, Athens. Greece
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Lampsas S, Tsaplaris P, Pantelidis P, Oikonomou E, Marinos G, Charalambous G, Souvaliotis N, Mystakidi VC, Goliopoulou A, Katsianos E, Siasos G, Vavuranakis MA, Tsioufis C, Vavuranakis M, Tousoulis D. The Role of Endothelial Related Circulating Biomarkers in COVID-19. A Systematic Review and Meta-analysis. Curr Med Chem 2021; 29:3790-3805. [PMID: 34702152 DOI: 10.2174/0929867328666211026124033] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 08/26/2021] [Accepted: 09/01/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Several studies have revealed the link between Coronavirus Disease 2019 (COVID-19) and endothelial dysfunction. To better understand the global pattern of this relationship, we conducted a meta-analysis on endothelial biomarkers related to COVID-19 severity. METHODS We systematically searched the literature up to March 10, 2021, for studies investigating the association between COVID-19 severity and the following endothelial biomarkers: Intercellular Adhesion Molecule 1 (ICAM-1), Vascular Cell Adhesion Molecule 1 (VCAM-1), E-selectin, P-selectin, Von Willebrand Factor Antigen (VWF-Ag), soluble Thrombomodulin (sTM), Mid-regional pro-adrenomedullin (MR-proADM), and Angiopoietin-2 (Ang-2). Pooled estimates and mean differences (PMD) for each biomarker were reported. RESULTS A total of 27 studies (n=2213 patients) were included. Critically ill patients presented with higher levels of MR-proADM (PMD: 0.71 nmol/L, 95% CI: 0.22 to 1.20 nmol/L, p=0.02), E-selectin (PMD: 13,32 pg/ml, 95% CI: 4,89 to 21,75 pg/ml, p=0.008), VCAM-1 (PMD: 479 ng/ml, 95% CI: 64 to 896 ng/ml, p=0.03), VWF-Ag (PMD: 110.5 IU/dl, 95% CI: 44.8 to 176.1 IU/dl, p=0.04) and Ang-2 (PMD: 2388 pg/ml, 95% CI: 1121 to 3655 pg/ml, p=0.003), as compared to non-critically ill ones. ICAM-1, P-selectin and thrombomodulin did not differ between the two groups (p>0.05). CONCLUSION Endothelial biomarkers display significant heterogeneity in COVID-19 patients, with higher MR-proADM, E-selectin, VCAM-1, VWF-Ag, and Ang-2 levels being associated with increased severity. These findings strengthen the evidence on the key role of endothelial dysfunction in disease progress.
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Affiliation(s)
- Stamatios Lampsas
- 3rd Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Sotiria Chest Disease Hospital, Athens. Greece
| | - Paraskevas Tsaplaris
- 3rd Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Sotiria Chest Disease Hospital, Athens. Greece
| | - Panteleimon Pantelidis
- 3rd Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Sotiria Chest Disease Hospital, Athens. Greece
| | - Evangelos Oikonomou
- 3rd Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Sotiria Chest Disease Hospital, Athens. Greece
| | - Georgios Marinos
- 1st Department of Cardiology, 'Hippokration' General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece; General Practice Department, Laiko Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens. Greece
| | - Georgios Charalambous
- 3rd Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Sotiria Chest Disease Hospital, Athens. Greece
| | - Nektarios Souvaliotis
- 3rd Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Sotiria Chest Disease Hospital, Athens. Greece
| | - Vasiliki-Chara Mystakidi
- 3rd Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Sotiria Chest Disease Hospital, Athens. Greece
| | - Athina Goliopoulou
- 3rd Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Sotiria Chest Disease Hospital, Athens. Greece
| | - Efstratios Katsianos
- 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
| | - Michael-Andrew Vavuranakis
- 3rd Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Sotiria Chest Disease Hospital, Athens. Greece
| | - Costas Tsioufis
- 1st Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Hippokration General Hospital, Athens. Greece
| | - Manolis Vavuranakis
- 3rd Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Sotiria Chest Disease Hospital, Athens. Greece
| | - Dimitrios Tousoulis
- 1st Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Hippokration General Hospital, Athens. Greece
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10
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Kalantzis C, Vavuranakis MA, Voudris V, Kosmas E, Kalogeras K, Bei E, Katsianos E, Siasos G, Tousoulis D, Tsioufis C, Vavuranakis M. Effectiveness of atrial fibrillation on high-intensity transient signals to cerebral circulation during TAVI. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Cerebral microemboliazations remain a major concern peri-operatively and following Transcatheter Aortic Valve Implantation (TAVI). We evaluated whether atrial fibrillation may predispose to an increased number of cerebrovascular emboli during the procedure.
Purpose
The aim of the study was to evaluate, using a transcranial doppler, the effect of atrial fibrillation on transient high-intensity signals to middle cerebral arteries during transcatheter aortic valve implantation.
Methods
Consecutive patients who underwent transfemoral TAVI with Evolut™ R bioprosthesis, were categorized into two groups. Group A patients with permanent atrial fibrillation (AF) on anticoagulation, Group B patients with sinus rhythm (SR). Dual antiplatelet therapy with aspirin and clopidogrel was administered to all patients 24 hours prior to the procedure at loading dose, with patients in Group A receiving in addition low-molecular-weight-heparin. The number of detected High Intensity Transient Signals (HITS) was assessed using Rimed Digi-Lite™ Transcranial Doppler on both cerebral arteries during the following phases of the procedure; Phase 0: 30 minutes prior to procedure initiation, Phase I: between access site puncture and introduction of the delivery system, Phase II: during the implantation of the bioprosthesis, until the removal of the delivery system. All implantations were performed without predilation. Furthermore, patients were evaluated by neurologist before TAVI and on discharge day. Safety was evaluated according to VARC-2 criteria.
Results
Twenty-eight patients were evaluated (81±6 years, 16 males (57.1%)). Group A had higher number of total (786±95 vs. 604±103, p=0.002) as well as Phase I HITS (393±94 vs. 285±86, p=0.002). One cerebrovascular event was recorded in Group A and one patient categorized to Group B developed major bleeding due to conversion to femoral surgical cut-down. The average number of received blood units, was higher in AF compared to SR Group (Group 1: 0.8±1.9 vs. Group 2: 0.5±0.7, p: 0.886), without however, reaching statistical significance.
Conclusion
Patients with atrial fibrillation had larger burden of embolic HITS during TAVI indicating high risk patients for embolic cerebrovascular events. This may has implications for future strategies for cerebral embolic protection.
Funding Acknowledgement
Type of funding sources: Public hospital(s). Main funding source(s): Ippokrateio General Hospital of Athens
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Affiliation(s)
- C Kalantzis
- Hippokration General Hospital, 1st Department of Cardiology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - M A Vavuranakis
- Hippokration General Hospital, 1st Department of Cardiology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - V Voudris
- Onassis Cardiac Surgery Center, Athens, Greece
| | - E Kosmas
- Onassis Cardiac Surgery Center, Athens, Greece
| | - K Kalogeras
- Sotiria Regional Chest Diseases Hospital, 3rd Department of Cardiology, Medical School, National and Kapodistrian University of Athens, Athens, Athens, Greece
| | - E Bei
- Hippokration General Hospital, 1st Department of Cardiology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - E Katsianos
- Sotiria Regional Chest Diseases Hospital, 3rd Department of Cardiology, Medical School, National and Kapodistrian University of Athens, Athens, Athens, Greece
| | - G Siasos
- Hippokration General Hospital, 1st Department of Cardiology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - D Tousoulis
- Hippokration General Hospital, 1st Department of Cardiology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - C Tsioufis
- Hippokration General Hospital, 1st Department of Cardiology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - M Vavuranakis
- Sotiria Regional Chest Diseases Hospital, 3rd Department of Cardiology, Medical School, National and Kapodistrian University of Athens, Athens, Athens, Greece
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