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Rallidis LS, Iordanidis D, Papathanasiou KA, Simitsis P, Varounis C, Simou A, Kosmas N. NT-proBNP/cardiac troponin T ratio >7.5 on the second day of admission can differentiate Takotsubo from acute coronary syndrome with good accuracy. Hellenic J Cardiol 2024; 76:22-30. [PMID: 37269943 DOI: 10.1016/j.hjc.2023.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 05/01/2023] [Accepted: 05/28/2023] [Indexed: 06/05/2023] Open
Abstract
BACKGROUND Takotsubo syndrome (TTS) is not usually diagnosed until patients with suspected acute coronary syndrome (ACS) and echocardiographically detected apical aneurysm are found to have "normal" coronary angiography (CA). Our aim was to explore whether cardiac biomarkers can contribute to the early diagnosis of TTS. METHODS Ratios of N-terminal-pro brain natriuretic peptide (NT-proBNP) and high-sensitivity cardiac troponin T (cTnT) both expressed in pg/mL [admission and the 3 following days] were compared in 38 patients with TTS and 114 ACS patients of whom 58 had non-ST-elevation myocardial infarction (NSTEMI). RESULTS NT-proBNP/cTnT ratio at admission and during the following 3 days was significantly higher in TTS compared to patients with ACS [18.4 (8.7-41.7) vs 2.9 (0.8-6.8), 29.6 (14.3-53.7) vs 1.2 (0.5-2.7), 30.0 (11.6-50.9) vs 1.7 (0.5-3.0), 27.8 (11.3-42.6) vs 1.4 (0.6-2.8), respectively, all <0.001]. Βest discrimination of TTS from ACS was possible with the ratio of NT-proBNP/cTnT on the 2nd day. A cut-off value of NT-proBNP/cTnT ratio >7.5 had a sensitivity of 97.3%, a specificity of 95.4% and an accuracy of ∼96% in detecting TTS as opposed to ACS. Furthermore, the ratio of NT-proBNP/cTnT preserved its discriminatory value in the subgroup of patients with NSTEMI. In particular, an NT-proBNP/cTnT ratio >7.5 on the 2nd day had a sensitivity of 97.3%, a specificity of 91.4%, and an accuracy of 93.7% in differentiating TTS from NSTEMI. CONCLUSIONS An NT-proBNP/cTnT ratio >7.5 on the 2nd day of admission can be useful for the early identification of TTS among selected patients initially presenting with ACS, a ratio more clinically useful in the setting of NSTEMI.
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Affiliation(s)
- Loukianos S Rallidis
- Second Department of Cardiology, National & Kapodistrian University of Athens, School of Medicine, University General Hospital ATTIKON, Athens, 12462, Greece
| | - Dimitrios Iordanidis
- Second Department of Cardiology, National & Kapodistrian University of Athens, School of Medicine, University General Hospital ATTIKON, Athens, 12462, Greece
| | - Konstantinos A Papathanasiou
- Second Department of Cardiology, National & Kapodistrian University of Athens, School of Medicine, University General Hospital ATTIKON, Athens, 12462, Greece.
| | - Panagiotis Simitsis
- Second Department of Cardiology, National & Kapodistrian University of Athens, School of Medicine, University General Hospital ATTIKON, Athens, 12462, Greece
| | - Christos Varounis
- Second Department of Cardiology, National & Kapodistrian University of Athens, School of Medicine, University General Hospital ATTIKON, Athens, 12462, Greece
| | - Aggeliki Simou
- Second Department of Cardiology, National & Kapodistrian University of Athens, School of Medicine, University General Hospital ATTIKON, Athens, 12462, Greece
| | - Nikolaos Kosmas
- Second Department of Cardiology, National & Kapodistrian University of Athens, School of Medicine, University General Hospital ATTIKON, Athens, 12462, Greece
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2
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Castagna F, Simitsis P, Mehra MR. Overcoming vulnerability in heart failure: Transitional tactical toughness. Eur J Heart Fail 2023; 25:2018-2020. [PMID: 37823250 DOI: 10.1002/ejhf.3054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 10/10/2023] [Indexed: 10/13/2023] Open
Affiliation(s)
- Francesco Castagna
- Center for Advanced Heart Disease, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Panagiotis Simitsis
- Center for Advanced Heart Disease, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Mandeep R Mehra
- Center for Advanced Heart Disease, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
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3
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Bezati S, Velliou M, Ventoulis I, Simitsis P, Parissis J, Polyzogopoulou E. Infection as an under-recognized precipitant of acute heart failure: prognostic and therapeutic implications. Heart Fail Rev 2023:10.1007/s10741-023-10303-8. [PMID: 36897491 PMCID: PMC9999079 DOI: 10.1007/s10741-023-10303-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/20/2023] [Indexed: 03/11/2023]
Abstract
As the prevalence of heart failure (HF) continues to rise, prompt diagnosis and management of various medical conditions, which may lead to HF exacerbation and result in poor patient outcomes, are of paramount importance. Infection has been identified as a common, though under-recognized, precipitating factor of acute heart failure (AHF), which can cause rapid development or deterioration of HF signs and symptoms. Available evidence indicates that infection-related hospitalizations of patients with AHF are associated with higher mortality, protracted length of stay, and increased readmission rates. Understanding the intricate interaction of both clinical entities may provide further therapeutic strategies to prevent the occurrence of cardiac complications and improve prognosis of patients with AHF triggered by infection. The purpose of this review is to investigate the incidence of infection as a causative factor in AHF, explore its prognostic implications, elucidate the underlying pathophysiological mechanisms, and highlight the basic principles of the initial diagnostic and therapeutic interventions in the emergency department.
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Affiliation(s)
- Sofia Bezati
- Emergency Medicine Department, Attikon University Hospital, Rimini 1, Chaidari, 12462, Athens, Greece.
| | - Maria Velliou
- Emergency Medicine Department, Attikon University Hospital, Rimini 1, Chaidari, 12462, Athens, Greece
| | - Ioannis Ventoulis
- Department of Occupational Therapy, University of Western Macedonia, Keptse Area, Ptolemaida, 50200, Greece
| | - Panagiotis Simitsis
- National and Kapodistrian University of Athens, 2nd Department of Cardiology, Heart Failure Unit, Attikon University Hospital, Athens, Greece
| | - John Parissis
- Emergency Medicine Department, Attikon University Hospital, Rimini 1, Chaidari, 12462, Athens, Greece.,Emergency Medicine Department, National and Kapodistrian University of Athens, Athens, Greece
| | - Effie Polyzogopoulou
- Emergency Medicine Department, Attikon University Hospital, Rimini 1, Chaidari, 12462, Athens, Greece.,Emergency Medicine Department, National and Kapodistrian University of Athens, Athens, Greece
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4
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Ikonomidis I, Thymis J, Koliou GA, Simitsis P, Katsanos S, Pavlidis G, Kousathana F, Kostelli G, Katogiannis K, Kountouri A, Triantafyllidi H, Parissis J, Lekakis J, Filippatos G. The additive predictive value of arterial stiffness for outcome to endothelial glycocalyx and SCORE in middle age individuals: 6 years follow-up. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1945] [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/Aim
Arterial stiffness is involved in the clinical course of atherogenesis. We have previously shown that PBR, a marker of glycocalyx integrity is predictor of cardiovascular events in patients without established cardiovascular disease. The purpose of this study was to investigate whether altered arterial properties of the vessels confers predictively and additively to estimation of cardiovascular risk.
Methods
Pulse wave velocity carotid-femoral (PWVc-f), the gold standard method to assess arterial stiffness, was measured non-invasively by Complior device. Increased PWV(c-f), especially above 10 m/s, indicates increased arterial stiffness. We measured baseline PWV(c-f) in 600 apparently healthy subjects (47.61±13.84 years old, 50.1% males), without established cardiovascular disease. We prospectively monitored the occurrence of major cardiovascular events (MACE-death, myocardial infarction, stroke and heart failure hospitalization) during a 6-year follow-up period using electronic records and clinic visits.
Results
Fifty-seven MACEs were documented during follow-up. In univariate analysis, subjects with increased PWV were found to exert greater risk for MACEs (hazard ratio (HR): 1.09, 95% CI: 1.02–1.17, p=0.01). In all subjects, PWV predicted higher risk for MACEs in a model including PBR, sex, age, hyperlipidemia, diabetes, hypertension, current smoking, family history of coronary artery disease and treatment with ACEi/ARBs or lipid lowering agents (HR: 1.12; 95% CI: 1.04–1.17, p=0.029,net reclassification improvement (NRI): 23%; C-statistic: from 0.644 to 0.697). However, only in participants older than 50 years old, PWV was an independent and additive predictor of outcome when added in a model including PBR, SCORE, those risk factors not included in SCORE (diabetes, family history of CAD) and medication (HR: 1.09; 95% CI: 1.02–1.13, NRI: 23.8%, C-statistic increase from 0.703 to 0.762, p<0.01).
Conclusion
Arterial stiffness is an independent and additive predictor to endothelial glycocalyx and SCORE for adverse outcome at 6 years follow-up in individuals over 50 years old.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- I Ikonomidis
- National & Kapodistrian University of Athens , Athens , Greece
| | - J Thymis
- National & Kapodistrian University of Athens , Athens , Greece
| | - G A Koliou
- National & Kapodistrian University of Athens, Attikon University Hospital, 2nd Cardiology Department , Athens , Greece
| | - P Simitsis
- National & Kapodistrian University of Athens, Attikon University Hospital, 2nd Cardiology Department , Athens , Greece
| | - S Katsanos
- National & Kapodistrian University of Athens, Attikon University Hospital, 2nd Cardiology Department , Athens , Greece
| | - G Pavlidis
- National & Kapodistrian University of Athens, Attikon University Hospital, 2nd Cardiology Department , Athens , Greece
| | - F Kousathana
- Attikon University Hospital, 2nd Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School , Athens , Greece
| | - G Kostelli
- National & Kapodistrian University of Athens , Athens , Greece
| | - K Katogiannis
- National & Kapodistrian University of Athens , Athens , Greece
| | - A Kountouri
- Attikon University Hospital, 2nd Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School , Athens , Greece
| | - H Triantafyllidi
- National & Kapodistrian University of Athens, Attikon University Hospital, 2nd Cardiology Department , Athens , Greece
| | - J Parissis
- National & Kapodistrian University of Athens , Athens , Greece
| | - J Lekakis
- National & Kapodistrian University of Athens , Athens , Greece
| | - G Filippatos
- National & Kapodistrian University of Athens, Attikon University Hospital, 2nd Cardiology Department , Athens , Greece
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5
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Ikonomidis I, Thymis J, Simitsis P, Koliou GA, Katsanos S, Triantafyllou C, Kousathana F, Pavlidis G, Kountouri A, Polyzogopoulou E, Katogiannis K, Vlastos D, Kostelli G, Triantafyllidi H, Parissis J, Papadavid E, Lekakis J, Filippatos G, Lambadiari V. Impaired Endothelial Glycocalyx Predicts Adverse Outcome in Subjects Without Overt Cardiovascular Disease: a 6-Year Follow-up Study. J Cardiovasc Transl Res 2022; 15:890-902. [PMID: 34713396 DOI: 10.1007/s12265-021-10180-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 10/17/2021] [Indexed: 01/15/2023]
Abstract
We investigated whether disturbance of glycocalyx integrity is related with increased cardiovascular risk. In 600 healthy subjects, we measured perfused boundary region (PBR), a marker of glycocalyx integrity, in sublingual microvessels with diameter ranging 5-25 µm using a dedicated camera (Sideview Darkfield Imaging). Increased PBR indicates reduced glycocalyx thickness. We prospectively monitored the occurrence of cardiovascular events (MACE-death, myocardial infarction, and stroke) during a 6-year follow-up. Fifty-seven MACE were documented. Increased values of PBR5-25 predicted higher risk for MACE in a model including sex, age, hyperlipidemia, diabetes, hypertension, smoking, family history of coronary disease, treatment with ACEi/ARBs, or lipid-lowering agents (hazard ratio (HR), 6.44, p = 0.011; net reclassification improvement (NRI), 28%; C-statistic: 0.761). PBR5-25 was an independent and additive predictor of outcome when added in a model including the European Heart SCORE, diabetes, family history of CAD, and medication (HR, 4.71; NRI: 39.7%, C-statistic from 0.653 to 0.693; p < 0.01).Glycocalyx integrity is an independent and additive predictor to risk factors for MACE at 6-year follow-up in individuals without cardiovascular disease. ClinicalTrials.govIdentifier:NCT04646252. PBR5-25 was an independent and additive predictor of adverse cardiovascular events in a model including the European Heart SCORE, diabetes, family history of coronary disease, and medication (HR: 4.71, NRI: 39.7%, C-statistic from 0.653 to 0.693; p < 0.01, NRI:37.9%).
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Affiliation(s)
- Ignatios Ikonomidis
- Laboratory of Preventive Cardiology, 2nd Department of Cardiology, Attikon Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece.
- EACVI, Laboratory of Preventive Cardiology, 2nd Cardiology Department, Attikon Hospital, National and Kapodistrian University of Athens, Rimini 1, Athens, 12462, Haidari, Greece.
| | - John Thymis
- Laboratory of Preventive Cardiology, 2nd Department of Cardiology, Attikon Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Panagiotis Simitsis
- Laboratory of Preventive Cardiology, 2nd Department of Cardiology, Attikon Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Georgia-Angeliki Koliou
- Laboratory of Preventive Cardiology, 2nd Department of Cardiology, Attikon Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Spiridon Katsanos
- Laboratory of Preventive Cardiology, 2nd Department of Cardiology, Attikon Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Charilaos Triantafyllou
- Laboratory of Preventive Cardiology, 2nd Department of Cardiology, Attikon Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Foteini Kousathana
- 2nd Department of Internal Medicine, Research Unit and Diabetes Centre, Attikon Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - George Pavlidis
- Laboratory of Preventive Cardiology, 2nd Department of Cardiology, Attikon Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Aikaterini Kountouri
- 2nd Department of Internal Medicine, Research Unit and Diabetes Centre, Attikon Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Eftihia Polyzogopoulou
- Laboratory of Preventive Cardiology, 2nd Department of Cardiology, Attikon Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Konstantinos Katogiannis
- Laboratory of Preventive Cardiology, 2nd Department of Cardiology, Attikon Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios Vlastos
- Laboratory of Preventive Cardiology, 2nd Department of Cardiology, Attikon Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Gavriella Kostelli
- Laboratory of Preventive Cardiology, 2nd Department of Cardiology, Attikon Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Helen Triantafyllidi
- Laboratory of Preventive Cardiology, 2nd Department of Cardiology, Attikon Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - John Parissis
- Laboratory of Preventive Cardiology, 2nd Department of Cardiology, Attikon Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Evangelia Papadavid
- 2nd Department of Dermatology and Venereology, Attikon Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - John Lekakis
- Laboratory of Preventive Cardiology, 2nd Department of Cardiology, Attikon Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Gerasimos Filippatos
- Laboratory of Preventive Cardiology, 2nd Department of Cardiology, Attikon Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Vaia Lambadiari
- 2nd Department of Internal Medicine, Research Unit and Diabetes Centre, Attikon Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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6
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Bistola V, Simitsis P, Parissis J, Ouwerkerk W, van Veldhuisen DJ, Cleland JG, Anker SD, Samani NJ, Metra M, Zannad F, Polyzogopoulou E, Keramida K, Farmakis D, Voors AA, Filippatos G. Association between up-titration of medical therapy and total hospitalizations and mortality in patients with recent worsening heart failure across the ejection fraction spectrum. Eur J Heart Fail 2021; 23:1170-1181. [PMID: 33998113 DOI: 10.1002/ejhf.2219] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 01/06/2021] [Revised: 05/06/2021] [Accepted: 05/08/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND The role of neurohormonal inhibition in chronic heart failure (HF) is well established. There are limited data on the effect of up-titration of renin-angiotensin inhibitors (RASi) and beta-blockers (BBs) on clinical outcomes of patients with worsening HF across the left ventricular ejection fraction (LVEF) spectrum. METHODS AND RESULTS We analysed data from 2345 patients from BIOSTAT-CHF (80.9% LVEF <40%), who completed a 3-month up-titration period after recent worsening of HF. Patients were classified by achieved dose (% of recommended): ≥100%, 50-99%, 1-49%, and none. Recurrent event analysis using joint and shared frailty models was used to examine the association between RASi/BB dose and all-cause and HF hospitalizations. In the 21 months following up-titration, 512 patients died and 879 (37.5%) had ≥1 hospitalization. RASi up-titration was associated, incrementally, with reduced risk of all-cause hospitalization at all achieved dose levels compared to no treatment [hazard ratio (95% confidence interval): ≥100%: 0.60 (0.49-0.74), P < 0.001; 50-99%: 0.56 (0.46-0.68), P < 0.001; 1-49%: 0.71 (0.59-0.86), P < 0.001]. This association was consistent up to an LVEF of 49% (P < 0.001), and when considering only HF hospitalizations. Up-titration of BBs was associated with fewer all-cause hospitalizations only when LVEF was <40% (overall P < 0.001), but with more HF hospitalizations when LVEF was ≥50%. Up-titration of both RASi/BBs was associated with lower mortality in LVEF up to 49%. CONCLUSION After recent worsening of HF, up-titration of RASi and BBs was associated with a better prognosis in patients with LVEF ≤49%. Up-titration of BBs was associated with a greater risk of HF hospitalization when LVEF was ≥50%.
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Affiliation(s)
- Vasiliki Bistola
- National and Kapodistrian University of Athens, Department of Cardiology, Heart Failure Unit, Attikon University Hospital, Athens, Greece
| | - Panagiotis Simitsis
- National and Kapodistrian University of Athens, Department of Cardiology, Heart Failure Unit, Attikon University Hospital, Athens, Greece
| | - John Parissis
- National and Kapodistrian University of Athens, Department of Cardiology, Heart Failure Unit, Attikon University Hospital, Athens, Greece
| | - Wouter Ouwerkerk
- National Heart Centre Singapore, Singapore.,Department of Dermatology, Amsterdam UMC, University of Amsterdam, Amsterdam Infection & Immunity Institute, Amsterdam, The Netherlands
| | - Dirk J van Veldhuisen
- Department of Cardiology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - John G Cleland
- National Heart and Lung Institute, Royal Brompton and Harefield Hospitals, Imperial College, London, UK.,Robertson Centre for Biostatistics and Clinical Trials, University of Glasgow, Glasgow, UK
| | - Stefan D Anker
- Department of Cardiology (CVK); and Berlin Institute of Health Center for Regenerative Therapies (BCRT); German Centre for Cardiovascular Research (DZHK) partner site Berlin; Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Nilesh J Samani
- Department of Cardiovascular Sciences, University of Leicester, Glenfield Hospital, Leicester, UK.,NIHR Leicester Cardiovascular Biomedical Research Unit, Glenfield Hospital, Leicester, UK
| | - Marco Metra
- Institute of Cardiology, ASST Spedali Civili di Brescia and Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Faiez Zannad
- Centre d'Investigations Cliniques-Plurithématique 1433, and Institut National de la Santé et de la Recherche Médicale U1116, Centre Hospitalier Regional Universitaire, French Clinical Research Infrastructure Network, Investigation Network Initiative Cardiovascular and Renal Clinical Trialists, Nancy, France
| | - Eftihia Polyzogopoulou
- National and Kapodistrian University of Athens, Department of Cardiology, Heart Failure Unit, Attikon University Hospital, Athens, Greece
| | - Kalliopi Keramida
- National and Kapodistrian University of Athens, Department of Cardiology, Heart Failure Unit, Attikon University Hospital, Athens, Greece
| | - Dimitrios Farmakis
- National and Kapodistrian University of Athens, Department of Cardiology, Heart Failure Unit, Attikon University Hospital, Athens, Greece
| | - Adriaan A Voors
- Department of Cardiology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Gerasimos Filippatos
- National and Kapodistrian University of Athens, Department of Cardiology, Heart Failure Unit, Attikon University Hospital, Athens, Greece
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7
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Karamichalakis N, Ikonomidis I, Parissis J, Simitsis P, Filippatos G. Association of ventricular-arterial interaction with the response to cardiac resynchronization therapy. Eur J Heart Fail 2021; 23:1238-1240. [PMID: 33837617 DOI: 10.1002/ejhf.2186] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
| | - Ignatios Ikonomidis
- 2nd Cardiology Department, Attikon Hospital, University of Athens, Athens, Greece
| | - John Parissis
- 2nd Cardiology Department, Attikon Hospital, University of Athens, Athens, Greece
| | - Panagiotis Simitsis
- 2nd Cardiology Department, Attikon Hospital, University of Athens, Athens, Greece
| | - Gerasimos Filippatos
- 2nd Cardiology Department, Attikon Hospital, University of Athens, Athens, Greece
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8
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Bacharaki D, Chrysanthopoulou E, Grigoropoulou S, Giannakopoulos P, Simitsis P, Frantzeskaki F, Flevari A, Karagiannis M, Sardeli A, Kavatha D, Antoniadou A, Vlahakos D. Siblings with coronavirus disease 2019 infection and opposite outcome—the hemodialysis’s better outcome paradox: Two case reports. World J Nephrol 2021; 10:21-28. [PMID: 33816154 PMCID: PMC8008982 DOI: 10.5527/wjn.v10.i2.21] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 10/01/2020] [Revised: 12/05/2020] [Accepted: 12/27/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) is a highly contagious infection caused by the severe acute respiratory syndrome coronavirus 2 virus and has a unique underlying pathogenesis. Hemodialysis (HD) patients experience high risk of contamination with COVID-19 and are considered to have higher mortality rates than the general population by most but not all clinical series. We aim to highlight the peculiarities in the immune state of HD patients, who seem to have both immune-activation and immune-depression affecting their outcome in COVID-19 infection.
CASE SUMMARY We report the opposite clinical outcomes (nearly asymptomatic course vs death) of two diabetic elderly patients infected simultaneously by COVID-19, one being on chronic HD and the other with normal renal function. They were both admitted in our hospital with COVID-19 symptoms and received the same treatment by protocol. The non-HD sibling deteriorated rapidly and was intubated and transferred to the Intensive Care Unit, where he died despite all supportive care. The HD sibling, although considered more “high-risk” for adverse outcome, followed a benign course and left the hospital alive and well.
CONCLUSION These cases may shed light on aspects of the immune responses to COVID-19 between HD and non-HD patients and stimulate further research in pathophysiology and treatment of this dreadful disease.
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Affiliation(s)
- Dimitra Bacharaki
- Department of Nephrology, B Propaideutiki Internal Medicine Clinic, Attikon University Hospital, Chaidari 12064, Greece
| | | | | | - Panagiotis Giannakopoulos
- Department of Nephrology, B Propaideutiki Internal Medicine Clinic, Attikon University Hospital, Chaidari 12064, Greece
| | | | | | - Aikaterini Flevari
- Intensive Care Unit, Attikon University Hospital, Chaidari 12064, Greece
| | - Minas Karagiannis
- Department of Nephrology, B Propaideutiki Internal Medicine Clinic, Attikon University Hospital, Chaidari 12064, Greece
| | - Aggeliki Sardeli
- Department of Nephrology, B Propaideutiki Internal Medicine Clinic, Attikon University Hospital, Chaidari 12064, Greece
| | - Dimitra Kavatha
- D Internal Medicine Clinic, Attikon University Hospital, Chaidari 12064, Greece
| | | | - Demetrios Vlahakos
- Department of Nephrology, B Propaideutiki Internal Medicine Clinic, Attikon University Hospital, Chaidari 12064, Greece
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9
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Kalogeropoulos AP, Simitsis P, Skopicki HA. Secrets of spironolactone: continuing insights from TOPCAT Americas. Eur J Heart Fail 2020; 22:1625-1627. [PMID: 32628354 DOI: 10.1002/ejhf.1959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 07/02/2020] [Indexed: 11/08/2022] Open
Affiliation(s)
| | - Panagiotis Simitsis
- Heart Failure Unit, Departments of Cardiology & Critical Care Medicine, Attikon University Hospital, University of Athens Medical School, Athens, Greece
| | - Hal A Skopicki
- Division of Cardiology, Department of Medicine, Stony Brook University, Stony Brook, NY, USA
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10
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Karamichalakis N, Ikonomidis I, Parissis J, Simitsis P, Xydonas S, Letsas K, Manolatos D, Vlachos K, Georgopoulos S, Efremidis M, Sideris A, Filippatos G. 414 Ventricular-arterial interaction predicts response to cardiac resynchronization therapy: a link with improvement of endothelial function and arterial elastic properties. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.228] [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
Endothelial dysfunction (ED) is a hall mark of chronic heart failure and has been linked to disease progression, hospitalizations and mortality.
Purpose
to evaluate the impact of cardiac resynchronization therapy (CRT) in ED and to determine predictors of response to CRT
Methods
CRT recipients from 19/07/2016 until 19/10/2018 were studied at baseline and 3 months after. In each visit we evaluated a 12 lead ECG, carotid to femoral pulse wave velocity (cfPWV), flow-mediated dilatation of the brachial artery (FMD), left ventricle ejection fraction (LVEF) and left ventricle (LV) global longitudinal strain (GLS). We evaluated arterial elastance (Ea) to ventricular elastance (Ees) ratio (Ea/Ees) by echocardiography and the ratio of cfPWV to GLS, as valid markers of ventricular-arterial interaction. We also assessed the layer of endothelial glycocalyx by measurement of Perfused Boundary Region (PBR) of the sublingual microvessel range:5-25 microns.
Results
32 patients with a mean age 65.5 (±10.9) years and severe LV systolic dysfunction were enrolled. During follow-up, LVEF, GLS, LVESV and all ED markers exhibited significant improvement (table 1). 23 patients were responders. Among the baseline vascular function markers, only the ratio cfPWV/GLS predicted response to CRT (OR: 0.245, 95%CI: 0.042-0.759, p = 0.044).Threshold analysis showed that the best threshold of cfPWV/GLS for response to CRT was 2.75 (specificity: 0.67%, sensitivity: 0.94%).
Conclusions
After 3 months of CRT, endothelial function, arterial elasticity and ventricular arterial interaction are improved. The baseline ratio cfPWV/GLS, a novel marker of ventricular arterial interaction, can be applied to predict response to CRT.
table 1 Baseline Follow-up Change Measurement mean (sd) mean (sd) mean (sd) p-value SBP (mmHg) 126 (19) 128 (16) 2.18 (11.98) 0,465 DBP (mmHg) 79 (9) 80 (9) 1.06 (8.58) 0,618 LVEF (%) 27 (7) 35 (9) 7.50 (4.77) <0.001 LVESV (mL) 151 (42) 120 (46) -26.91 (17.20) <0.001 GLS (%) 6.47 (2.89) 9.33 (4.18) 2.85 (2.28) <0.001 FMD (%) 5.88 (2.79) 10.25 (3.67) 4.37 (3.34) <0.001 Ea/Ees 2.81 (1.10) 2.04 (0.99) -0.77 (0.47) <0.001 cfPWV 11.11 (2.61) 10.01 (2.45) -1.10 (1.56) 0,003 PBR 5-25(microns) 2.26 (0.20) 2.14 (0.24) -0.13 (0.25) 0,028 cfPWV/GLS 2.18 (1.46) 1.45 (1.11) -0.73 (0.55) <0.001 Measurements at baseline, follow-up and their change during study
Abstract 414 Figure. picture 1
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Affiliation(s)
- N Karamichalakis
- Evangelismos General Hospital of Athens, 2nd Department of Cardiology, Athens, Greece
| | - I Ikonomidis
- Attikon University Hospital, 2nd Department of Cardiology, Athens, Greece
| | - J Parissis
- Attikon University Hospital, 2nd Department of Cardiology, Athens, Greece
| | - P Simitsis
- Attikon University Hospital, 2nd Department of Cardiology, Athens, Greece
| | - S Xydonas
- Evangelismos General Hospital of Athens, 2nd Department of Cardiology, Athens, Greece
| | - K Letsas
- Evangelismos General Hospital of Athens, 2nd Department of Cardiology, Athens, Greece
| | - D Manolatos
- Evangelismos General Hospital of Athens, 2nd Department of Cardiology, Athens, Greece
| | - K Vlachos
- Evangelismos General Hospital of Athens, 2nd Department of Cardiology, Athens, Greece
| | - S Georgopoulos
- Evangelismos General Hospital of Athens, 2nd Department of Cardiology, Athens, Greece
| | - M Efremidis
- Evangelismos General Hospital of Athens, 2nd Department of Cardiology, Athens, Greece
| | - A Sideris
- Evangelismos General Hospital of Athens, 2nd Department of Cardiology, Athens, Greece
| | - G Filippatos
- Attikon University Hospital, 2nd Department of Cardiology, Athens, Greece
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11
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Karamichalakis ND, Ikonomidis I, Parissis J, Simitsis P, Xydonas S, Letsas K, Manolatos D, Efremidis M, Sideris A, Filippatos G. P709Improvement in endothelial function and arterial elastic properties facilitates response to cardiac resynchronization therapy. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0314] [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
Cardiac resynchronization therapy (CRT) is a well-established therapy in heart failure (HF) patients with prolonged QRS. In HF patients, reduced nitric oxide availability and increased oxidative stress promote endothelial dysfunction (ED) and arterial stiffness.
Purpose
To investigate the pathophysiologic changes in endothelium and arterial elastic properties in CRT patients and their correlation to therapy.
Methods
We studied 32 HF patients before and 3 months after CRT implantation. In each visit we performed a 12-lead ECG and assessed markers of endothelial function. Specifically, we examined flow-mediated dilatation of the brachial artery (FMD), carotid to femoral pulse wave velocity (cfPWV), as well as the layer of endothelial glycocalyx using the Perfused Boundary Region (PBR) of the sublingual microvessel range: 5–25 microns. We also evaluated left ventricle ejection fraction (LVEF), left ventricle (LV) global longitudinal strain (GLS) and arterial elastance (Ea) to ventricular elastance (Ees) ratio (Ea/Ees) by echocardiography.
Results
32 HF CRT patients, at age 65.5 (±10.9) years, with reduced LVEF (baseline LVEF: 27±7%, LVESV: 151±42 ml, GLS: 6.47±2.89%) were followed-up for a median of 115 days (IQR: 36). During follow up, all markers of ED demonstrated significant change: FMD was increased by 4.37±3.34% (p<0.001), cfPWV and PBR 5–25 were reduced by 1.10±1.56 (p=0.003) and 0.13±0.25 microns (p=0.028) respectively. LVEF was significantly increased (mean change: 7.50±4.77%) and LVESV was significantly reduced (mean change: −26.91±17.20 ml). 16 of 32 patients were responders (LVESV change ≥15% compared to baseline). Among the changes of the examined markers during follow-up, response to CRT correlated with the change of FMD (OR: 3.10, 95% CI: 1.47–15.51, p=0.039) and change of Ea/Ees (OR: 0.000, 95% CI: 0.000–0.061, p=0,0239).
Effect of change in measurements during follow-up on response to CRT Measurement OR (95% CI) Main effect p-value FMD change 3.100 (1.470–15.513) 0.0397 cfPWV change 0.669 (0.295–1.354) 0.0622 PBR 5–25 change 1.773 (0.008–455.458) 0.828 Ea/Ees change 0.000 (0.000–0.061) 0.0239
Conclusion
Improvement in endothelial function and arterial elastic properties evaluated by FMD and Ea/Ees respectively are related with effective CRT.
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Affiliation(s)
- N D Karamichalakis
- Evangelismos General Hospital of Athens, 2nd Department of Cardiology, Athens, Greece
| | - I Ikonomidis
- Attikon University Hospital, 2nd Department of Cardiology, Athens, Greece
| | - J Parissis
- Attikon University Hospital, 2nd Department of Cardiology, Athens, Greece
| | - P Simitsis
- Attikon University Hospital, 2nd Department of Cardiology, Athens, Greece
| | - S Xydonas
- Evangelismos General Hospital of Athens, 2nd Department of Cardiology, Athens, Greece
| | - K Letsas
- Evangelismos General Hospital of Athens, 2nd Department of Cardiology, Athens, Greece
| | - D Manolatos
- Evangelismos General Hospital of Athens, 2nd Department of Cardiology, Athens, Greece
| | - M Efremidis
- Evangelismos General Hospital of Athens, 2nd Department of Cardiology, Athens, Greece
| | - A Sideris
- Evangelismos General Hospital of Athens, 2nd Department of Cardiology, Athens, Greece
| | - G Filippatos
- Attikon University Hospital, 2nd Department of Cardiology, Athens, Greece
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Webb J, Parkin D, Tøndel K, Simitsis P, Roxburgh J, Chambers JB. A comparison of early redo surgery rates in Mosaic porcine and Perimount bovine pericardial valves. Eur J Cardiothorac Surg 2019; 54:724-728. [PMID: 29579171 DOI: 10.1093/ejcts/ezy113] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 02/21/2018] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES The objective of this study was to compare rates of redo surgery for the Medtronic Mosaic 305 A Porcine Prosthesis and the Carpentier-Edwards Perimount Pericardial Aortic Bioprosthesis 2900. METHODS This was a single-centre retrospective observational study. We included all 1018 patients who underwent aortic valve replacement with a Mosaic (n = 216) or Perimount (n = 809) bioprosthesis between October 2000 and August 2008. The total follow-up was 1508 patient-years for the Mosaic valve and 5813 for the Perimount valve. The maximal follow-up and interquartile range were 14.8 and 7.0 years for the Mosaic valve and 15.1 and 5.6 years for the Perimount valve, respectively. A propensity score-weighted version of the Cox model, Kaplan-Meier analysis and multivariate regression model was used. RESULTS Despite no statistical difference in the number of non-structural valve deterioration cases between valves, redo surgery occurred earlier in 10 (4.6%) Mosaic than for 17 (2.1%) Perimount valves (P = 0.02) and was required for structural valve deterioration in 5 (2.3%) Mosaic valves when compared with 7 (0.9%; P = 0.04) Perimount valves. Four of 5 Mosaic failures occurred before 5 years, whereas all Perimount failures occurred after 5 years. Redo surgery for non-structural valve deterioration occurred in 3 patients with Mosaic valves (1.4%) and no patients with Perimount valves. Surgery for the remaining patients with Perimount valves was due to infection or aortic disease. CONCLUSIONS Early redo surgery for structural valve degeneration was uncommon but occurred earlier for the Mosaic porcine than the Perimount bovine pericardial replacement aortic valve.
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Affiliation(s)
- Jessica Webb
- Cardiothoracic Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Division of Imaging Sciences and Biomedical Engineering, King's College London, London, UK
| | - Denise Parkin
- Cardiothoracic Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Kristin Tøndel
- Faculty of Science and Technology, Norwegian University of Life Sciences, Ås, Norway
| | - Panagiotis Simitsis
- Cardiology Department, King's College Hospital NHS Foundation Trust, London, UK
| | - James Roxburgh
- Cardiothoracic Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - John B Chambers
- Cardiothoracic Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Division of Imaging Sciences and Biomedical Engineering, King's College London, London, UK
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13
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Affiliation(s)
- Mohamad Fahed Barakat
- British Heart Foundation Centre of Research Excellence, Cardiovascular Division, King's College London, London SE5 9NU, UK.
| | - Panagiotis Simitsis
- British Heart Foundation Centre of Research Excellence, Cardiovascular Division, King's College London, London SE5 9NU, UK; King's College Hospital, London, UK
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Webb J, Parkin D, Tøndel K, Simitsis P, Roxburgh J, Chambers JB. Corrigendum to 'A comparison of early redo surgery rates in Mosaic porcine and Perimount bovine pericardial valves' [Eur J Cardiothorac Surg 2018; doi:10.1093/ejcts/ezy113]. Eur J Cardiothorac Surg 2018; 53:1301. [PMID: 29718306 DOI: 10.1093/ejcts/ezy192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Jessica Webb
- Cardiothoracic Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Division of Imaging Sciences and Biomedical Engineering, King's College London, London, UK
| | - Denise Parkin
- Cardiothoracic Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Kristin Tøndel
- Faculty of Science and Technology, Norwegian University of Life Sciences, As, Norway
| | - Panagiotis Simitsis
- Cardiology Department, King's College Hospital NHS Foundation Trust, London, UK
| | - James Roxburgh
- Cardiothoracic Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - John B Chambers
- Cardiothoracic Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Division of Imaging Sciences and Biomedical Engineering, King's College London, London, UK
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15
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Paraskevaidis IA, Ikonomidis I, Simitsis P, Parissis J, Stasinos V, Makavos G, Lekakis J. Multidimensional contractile reserve predicts adverse outcome in patients with severe systolic heart failure: a 4-year follow-up study. Eur J Heart Fail 2017; 19:846-861. [PMID: 28220640 DOI: 10.1002/ejhf.787] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [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: 03/15/2016] [Revised: 12/28/2016] [Accepted: 01/17/2017] [Indexed: 11/10/2022] Open
Abstract
AIMS Left ventricular contractile reserve is a prognostic indicator for adverse outcome in patients with severe chronic heart failure with reduced ejection fraction (HFrEF). We investigated the dobutamine-induced changes of LV multidimensional deformation and their predictive value for cardiac mortality of patients with severe chronic HFrEF. METHODS AND RESULTS In this prospective study, out of 130 patients with severe HFrEF who underwent a low-dose dobutamine stress echocardiography (LDSE) study using speckle tracking imaging, 100 patients were followed up for the occurrence of cardiac death over a period of 4 years. Compared with survivors, non-survivors (n = 32) had lower radial strain (RS) and strain rate (RSR) (10.7 ± 5.9 vs. 20.1 ± 8% and 0.5 ± 0.2 vs. 0.8 ± 0.3 L/s, P < 0.001), a smaller increase of global longitudinal strain (GLS) and strain rate after LDSE (0.9 ± 1.5 vs. -3.3 ± 3.5% and -0.1 ± 0.1 vs. -0.3 ± 0.3 L/s, P < 0.001), and a lack of change in the circumferential and radial deformation. The dobutamine-induced changes of all speckle tracking indices predicted cardiac mortality, while, among resting echocardiographic parameters, only RS and RSR predicted survival, after adjusting for age, sex, cardiomyopathy aetiology, NYHA class, AF, BNP levels, resting LVED, and LV outflow tract velocity-time integral, and their respective changes produced by dobutamine (P < 0.05). The dobutamine-induced change of GLS and resting RS were the best additive predictors of mortality with a net reclassification improvement of 0.518 (P = 0.022) CONCLUSION: In severe chronic HFrEF, resting RS and the dobutamine-induced change of GLS are independent predictors of cardiac mortality.
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Affiliation(s)
- Ioannis A Paraskevaidis
- Second Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Attikon Hospital, Athens, Greece
| | - Ignatios Ikonomidis
- Second Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Attikon Hospital, Athens, Greece
| | - Panagiotis Simitsis
- Second Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Attikon Hospital, Athens, Greece
| | - John Parissis
- Second Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Attikon Hospital, Athens, Greece
| | - Vasilios Stasinos
- Second Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Attikon Hospital, Athens, Greece
| | - George Makavos
- Second Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Attikon Hospital, Athens, Greece
| | - John Lekakis
- Second Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Attikon Hospital, Athens, Greece
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16
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Farmakis D, Simitsis P, Bistola V, Triposkiadis F, Ikonomidis I, Katsanos S, Bakosis G, Hatziagelaki E, Lekakis J, Mebazaa A, Parissis J. Acute heart failure with mid-range left ventricular ejection fraction: clinical profile, in-hospital management, and short-term outcome. Clin Res Cardiol 2016; 106:359-368. [PMID: 27999929 DOI: 10.1007/s00392-016-1063-0] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Accepted: 12/12/2016] [Indexed: 12/28/2022]
Abstract
BACKGROUND Heart failure with mid-range left ventricular ejection fraction (HFmrEF) is a poorly characterized population as it has been studied either in the context of HF with reduced (HFrEF) or preserved (HFpEF) left ventricular ejection fraction (LVEF) depending on applied LVEF cutoffs. We sought to investigate the clinical profile, in-hospital management, and short-term outcome of HFmrEF patients in comparison with those with HFrEF or HFpEF in a large acute HF cohort. METHODS AND RESULTS The Acute Heart Failure Global Registry of Standard Treatment (ALARM-HF) included 4953 patients hospitalized for HF in nine countries in Europe, Latin America, and Australia. Baseline characteristics, clinical presentation, in-hospital therapies, and short-term mortality (all-cause in-hospital or 30-day mortality, whichever first) were compared among HFrEF (LVEF <40%), HFmrEF (LVEF 40-49%), and HFpEF (LVEF ≥50%) patients. Among 3257 patients with documented LVEF, 52% had HFrEF, 25% HFmrEF, and 23% HFpEF. Patients with HFmrEF had a distinct demographic and clinical profile with many intermediate features between HFrEF and HFpEF. In addition, they had a higher prevalence of hypertension (p < 0.001), a lower prevalence of chronic renal disease (p = 0.003), more hospitalizations for acute coronary syndrome (p < 0.001), or infection (p = 0.003), and were more frequently treated with intravenous vasodilators compared to HFrEF or HFpEF. Adjusted short-term mortality in HFmrEF was lower than HFrEF [hazard ratio (HR) = 0.635 (0.419, 0.963), p = 0.033] but similar to HFpEF [HR = 1.026 (0.605, 1.741), p = 0.923]. CONCLUSION Hospitalized HFmrEF patients represent a demographically and clinically diverse group with many intermediate features compared to HFrEF and HFpEF and carry a lower risk of short-term mortality than HFrEF but a similar risk with HFpEF.
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Affiliation(s)
- Dimitrios Farmakis
- Heart Failure Unit, Department of Cardiology, Attikon University Hospital, National and Kapodistrian University of Athens, 1 Rimini St, 12462, Athens, Greece
| | - Panagiotis Simitsis
- Heart Failure Unit, Department of Cardiology, Attikon University Hospital, National and Kapodistrian University of Athens, 1 Rimini St, 12462, Athens, Greece
| | - Vasiliki Bistola
- Heart Failure Unit, Department of Cardiology, Attikon University Hospital, National and Kapodistrian University of Athens, 1 Rimini St, 12462, Athens, Greece
| | | | - Ignatios Ikonomidis
- Heart Failure Unit, Department of Cardiology, Attikon University Hospital, National and Kapodistrian University of Athens, 1 Rimini St, 12462, Athens, Greece
| | - Spyridon Katsanos
- Heart Failure Unit, Department of Cardiology, Attikon University Hospital, National and Kapodistrian University of Athens, 1 Rimini St, 12462, Athens, Greece
| | - George Bakosis
- Heart Failure Unit, Department of Cardiology, Attikon University Hospital, National and Kapodistrian University of Athens, 1 Rimini St, 12462, Athens, Greece
| | - Erifili Hatziagelaki
- Heart Failure Unit, Department of Cardiology, Attikon University Hospital, National and Kapodistrian University of Athens, 1 Rimini St, 12462, Athens, Greece
| | - John Lekakis
- Heart Failure Unit, Department of Cardiology, Attikon University Hospital, National and Kapodistrian University of Athens, 1 Rimini St, 12462, Athens, Greece
| | - Alexandre Mebazaa
- Department of Anesthesiology and Intensive Care, Lariboisière University Hospital, Assistance Publique-Hôpitaux de Paris, Université Paris Diderot, Paris, France
| | - John Parissis
- Heart Failure Unit, Department of Cardiology, Attikon University Hospital, National and Kapodistrian University of Athens, 1 Rimini St, 12462, Athens, Greece.
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Dagres N, Iliodromitis EK, Lekakis JP, Simitsis P, Karatzas D, Rallidis LS, Simeonidou E, Anastasiou-Nana M. Ranolazine for the prevention or treatment of atrial fibrillation. J Cardiovasc Med (Hagerstown) 2014; 15:254-9. [DOI: 10.2459/jcm.0b013e328365b554] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Leftheriotis D, Flevari P, Theodorakis G, Rigopoulos A, Ikonomidis I, Panou F, Sourides V, Simitsis P, Giannakakis G, Aidonidis I, Rizos I, Anastasiou-Nana M. The Effects of Ranolazine on Paroxysmal Atrial Fibrillation in Patients with Coronary Artery Disease: A Preliminary Observational Study. J Atr Fibrillation 2014; 6:940. [PMID: 27957034 DOI: 10.4022/jafib.940] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2013] [Revised: 01/03/2014] [Accepted: 02/10/2014] [Indexed: 12/19/2022]
Abstract
The impact of ranolazine, an anti-ishemic agent with antiarrhythmic properties, on paroxysmal atrial fibrillation (PAF) in patients with coronary artery disease (CAD) remains unclear. Pacing devices can be useful tools for disclosing even asymptomatic PAF. Purpose of this study is to assess the effect of ranolazine on atrial fibrillation (AF), in patients with CAD, PAF and a dual-chamber pacemaker. We studied 74 patients with CAD, PAF, and sick sinus syndrome or atrio-ventricular block, treated with pacemakers capable to detect PAF episodes. The total time in AF, AF burden, and the number of PAF episodes within the last 6 months before enrolment in the study, mean AF duration per episode, and the QTc interval were initially assessed. Subsequently, patients were randomized into additional treatment with ranolazine (375 mg twice daily) or placebo. Following six months of treatment, all parameters were reassessed and compared to those before treatment. Ranolazine was associated with shorter total AF duration (81.56±45.24 hours versus 68.71±34.84 hours, p=0.002), decreased AF burden (1.89±1.05% versus 1.59±0.81%, p=0.002), and shortened mean AF duration (1.15±0.41 hours versus 0.92±0.35 hours, p=0.01). In the placebo group no such differences were observed. In both groups, no significant differences in the number of PAF episodes and QTc duration were observed. We conclude that in patients with CAD and PAF, ranolazine reduces the total time in AF, AF burden, and mean AF duration. These findings may imply additional antiarrhythmic properties of ranolazine on atrial myocardium and might indicate the necessity of its use in ischemic patients with PAF.
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Affiliation(s)
| | - Panayota Flevari
- "Attikon" University Hospital, Department of Cardiology, Athens, Greece (Hellas)
| | - George Theodorakis
- Onassis Cardiac Surgery Center, Department of Cardiology, Athens, Greece (Hellas)
| | - Angelos Rigopoulos
- "Attikon" University Hospital, Department of Cardiology, Athens, Greece (Hellas)
| | - Ignatios Ikonomidis
- "Attikon" University Hospital, Department of Cardiology, Athens, Greece (Hellas)
| | - Fotis Panou
- "Attikon" University Hospital, Department of Cardiology, Athens, Greece (Hellas)
| | - Vassilios Sourides
- "Attikon" University Hospital, Department of Cardiology, Athens, Greece (Hellas)
| | - Panagiotis Simitsis
- "Attikon" University Hospital, Department of Cardiology, Athens, Greece (Hellas)
| | - Georgios Giannakakis
- "Attikon" University Hospital, Department of Cardiology, Athens, Greece (Hellas)
| | - Isaac Aidonidis
- Medical School of Larissa, Department of Physiology, Larissa, Greece (Hellas)
| | - Ioannis Rizos
- "Attikon" University Hospital, Department of Cardiology, Athens, Greece (Hellas)
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Leftheriotis D, Flevari P, Theodorakis G, Rigopoulos A, Giannakakis G, Simitsis P, Aidonidis I, Rizos I, Anastasiou-Nana M. The effects of ranolazine on paroxysmal atrial fibrillation in patients with coronary artery disease. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht309.p4113] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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20
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Xanthos T, Karatzas T, Stroumpoulis K, Lelovas P, Simitsis P, Vlachos I, Kouraklis G, Kouskouni E, Dontas I. Continuous chest compressions improve survival and neurologic outcome in a swine model of prolonged ventricular fibrillation. Am J Emerg Med 2012; 30:1389-94. [DOI: 10.1016/j.ajem.2011.10.008] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2011] [Revised: 08/15/2011] [Accepted: 10/05/2011] [Indexed: 11/30/2022] Open
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