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Angelopoulos A, Oikonomou E, Antonopoulos A, Theofilis P, Zisimos K, Katsarou O, Gazouli M, Lazaros G, Papanikolaou P, Siasos G, Tousoulis D, Tsioufis K, Vlachopoulos C. Expression of Circulating miR-21 and -29 and their Association with Myocardial Fibrosis in Hypertrophic Cardiomyopathy. Curr Med Chem 2024; 31:CMC-EPUB-138201. [PMID: 38299392 DOI: 10.2174/0109298673286017240103073130] [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: 10/07/2023] [Revised: 12/05/2023] [Accepted: 12/12/2023] [Indexed: 02/02/2024]
Abstract
BACKGROUND Hypertrophic Cardiomyopathy (HCM) is characterized by myocardial hypertrophy, fibrosis, and sarcomeric disarray. OBJECTIVE To evaluate the expression levels of circulating miR-21 and -29 in patients with HCM and their association with clinical characteristics and myocardial fibrosis. METHODS In this case-control study, 27 subjects with HCM, 13 subjects with hypertensive cardiomyopathy, and 10 control subjects were enrolled. Evaluation of patients' functional capacity was made by the six-minute walk test. Echocardiographic measurements of left ventricle systolic and diastolic function were conducted. Cardiac magnetic resonance late gadolinium enhancement (LGE) -through a semiquantitative evaluation- was used in the assessment of myocardial fibrosis extent in HCM patients. The expression of miR-21 and -29 in peripheral blood samples of all patients was measured via the method of quantitative reverse transcription polymerase chain reaction. RESULTS Circulating levels of miR-21 were higher in both hypertensive and HCM (p<0.001) compared to controls, while expression of miR-29 did not differ between the three studied groups. In patients with HCM and LGE-detected myocardial fibrosis in more than 4 out of 17 myocardial segments, delta CT miR-21 values were lower than in patients with myocardial LGE in 3 or fewer myocardial segments (2.71 ± 1.06 deltaCT vs. 3.50 ± 0.55 deltaCT, p=0.04), indicating the higher expression of circulating miR-21 in patients with more extensive myocardial fibrosis. CONCLUSION MiR-21 was overexpressed in patients with HCM and hypertensive cardiomyopathy. Importantly, in patients with HCM, more extensive myocardial fibrosis was associated with higher levels of miR-21.
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Affiliation(s)
- Andreas Angelopoulos
- Unit for Inherited and Rare Cardiovascular Diseases, 1st Department of Cardiology, Hippokration Hospital, University of Athens Medical School, Athens, Greece
| | - Evangelos Oikonomou
- 3rd Department of Cardiology, Sotiria Chest Disease Hospital, University of Athens Medical School, Athens, Greece
| | - Alexios Antonopoulos
- Unit for Inherited and Rare Cardiovascular Diseases, 1st Department of Cardiology, Hippokration Hospital, University of Athens Medical School, Athens, Greece
| | - Panagiotis Theofilis
- Unit for Inherited and Rare Cardiovascular Diseases, 1st Department of Cardiology, Hippokration Hospital, University of Athens Medical School, Athens, Greece
| | - Konstantinos Zisimos
- 3rd Department of Cardiology, Sotiria Chest Disease Hospital, University of Athens Medical School, Athens, Greece
| | - Ourania Katsarou
- 3rd Department of Cardiology, Sotiria Chest Disease Hospital, University of Athens Medical School, Athens, Greece
| | - Maria Gazouli
- Unit for Inherited and Rare Cardiovascular Diseases, 1st Department of Cardiology, Hippokration Hospital, University of Athens Medical School, Athens, Greece
| | - George Lazaros
- Unit for Inherited and Rare Cardiovascular Diseases, 1st Department of Cardiology, Hippokration Hospital, University of Athens Medical School, Athens, Greece
| | - Paraskevi Papanikolaou
- Unit for Inherited and Rare Cardiovascular Diseases, 1st Department of Cardiology, Hippokration Hospital, University of Athens Medical School, Athens, Greece
| | - Gerasimos Siasos
- 3rd Department of Cardiology, Sotiria Chest Disease Hospital, University of Athens Medical School, Athens, Greece
| | - Dimitrios Tousoulis
- Unit for Inherited and Rare Cardiovascular Diseases, 1st Department of Cardiology, Hippokration Hospital, University of Athens Medical School, Athens, Greece
| | - Konstantinos Tsioufis
- Unit for Inherited and Rare Cardiovascular Diseases, 1st Department of Cardiology, Hippokration Hospital, University of Athens Medical School, Athens, Greece
| | - Charalambos Vlachopoulos
- Unit for Inherited and Rare Cardiovascular Diseases, 1st Department of Cardiology, Hippokration Hospital, University of Athens Medical School, Athens, Greece
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Angelopoulos A, Oikonomou E, Antonopoulos AS, Theofilis P, Kalogeras K, Papanikolaou P, Lazaros G, Siasos G, Tousoulis D, Tsioufis K, Vlachopoulos C. The Role of Right Ventriculo-Arterial Coupling in Symptoms Presentation of Patients with Hypertrophic Cardiomyopathy. J Clin Med 2023; 12:4796. [PMID: 37510912 PMCID: PMC10381822 DOI: 10.3390/jcm12144796] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Revised: 07/16/2023] [Accepted: 07/19/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND Hypertrophic cardiomyopathy (HCM) is the most common inherited cardiomyopathy. The hallmark of HCM is myocardial fibrosis which contributes to heart failure, arrhythmias, and sudden cardiac death (SCD). OBJECTIVE To identify the factors implicated in heart failure symptoms and functional capacity of patients with HCM. METHODS In this cohort study, 43 patients with HCM were recruited. According to functional capacity and symptoms presentation, patients were categorized according to New York Heart Association (NYHA) classification, and echocardiographic measurements of left ventricle systolic and diastolic function were conducted. The echocardiographic assessment of right ventriculo-arterial coupling (RVAC) was made by calculating the tricuspid annular peak systolic tissue Doppler velocity (TASV)/estimated RV systolic pressure (RVSP) ratio. RESULTS Almost half (51%) of our study population present symptoms of heart failure and were categorized as the symptomatic group-NYHA 2 or higher. Maximum LVOT gradient, RVSP, and the ratio of E/e' were higher in the symptomatic group compared with the asymptomatic group. TASV was lower in the symptomatic group compared with the asymptomatic group (11 ± 1 cm/s vs. 13 ± 2 cm/s, p = 0.04). However, there was no difference in other potentially influential factors, such as heart rate or systemic blood pressure. The SCD risk score does not differ between the two studied groups. The RVAC (estimated with the TASV/RVSP ratio) was lower in the symptomatic group compared with the asymptomatic group (0.32 ± 0.09 vs. 0.46 ± 0.11, p < 0.001). CONCLUSION A low RVAC (as estimated with TASV/RVSP ratio) value could represent an echocardiographic marker of right ventricular-arterial uncoupling in patients with HCM and impaired functional status.
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Affiliation(s)
- Andreas Angelopoulos
- Unit for Inherited and Rare Cardiovascular Diseases, 1st Department of Cardiology, Hippokration Hospital, Medical School of National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Evangelos Oikonomou
- 3rd Department of Cardiology, Sotiria Chest Disease Hospital, Medical School of National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Alexios S Antonopoulos
- Unit for Inherited and Rare Cardiovascular Diseases, 1st Department of Cardiology, Hippokration Hospital, Medical School of National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Panagiotis Theofilis
- Unit for Inherited and Rare Cardiovascular Diseases, 1st Department of Cardiology, Hippokration Hospital, Medical School of National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Konstantinos Kalogeras
- 3rd Department of Cardiology, Sotiria Chest Disease Hospital, Medical School of National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Paraskevi Papanikolaou
- Unit for Inherited and Rare Cardiovascular Diseases, 1st Department of Cardiology, Hippokration Hospital, Medical School of National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - George Lazaros
- Unit for Inherited and Rare Cardiovascular Diseases, 1st Department of Cardiology, Hippokration Hospital, Medical School of National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Gerasimos Siasos
- 3rd Department of Cardiology, Sotiria Chest Disease Hospital, Medical School of National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Dimitris Tousoulis
- Unit for Inherited and Rare Cardiovascular Diseases, 1st Department of Cardiology, Hippokration Hospital, Medical School of National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Konstantinos Tsioufis
- Unit for Inherited and Rare Cardiovascular Diseases, 1st Department of Cardiology, Hippokration Hospital, Medical School of National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Charalambos Vlachopoulos
- Unit for Inherited and Rare Cardiovascular Diseases, 1st Department of Cardiology, Hippokration Hospital, Medical School of National and Kapodistrian University of Athens, 11527 Athens, Greece
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Sagris M, Antonopoulos AS, Angelopoulos A, Papanikolaou P, Simantiris S, Vamvakaris K, Koumpoura A, Farmaki M, Antoniades C, Tsioufis Κ, Tousoulis D. High-Sensitivity Troponin (hs-Tn) for Cardiovascular Risk Prognostication: A Systematic Review and Meta-Analysis. Curr Med Chem 2023; 31:CMC-EPUB-130176. [PMID: 36924099 DOI: 10.2174/0929867330666230315152045] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 01/12/2023] [Accepted: 01/19/2023] [Indexed: 03/18/2023]
Abstract
BACKGROUND Chronic low-grade inflammation is involved in coronary atherosclerosis progression whereas recent research efforts suggest that preventative methods should be tailored to the "residual inflammatory risk". As such, modalities for the early identification of the risk have to be investigated. METHODS We performed a systematic review and meta-analysis according to the PRISMA guidelines. Any study that presented the prognostic value of high sensitivity troponin (hs-cTn) of vascular inflammation in stable patients without known cardiac heart disease was considered to be potentially eligible. The Medline (PubMed) database was searched up to April 22, 2021. The main endpoint was the difference in c-index (Δ[c-index]) with the use of hs-cTn for major adverse cardiovascular events (MACEs), cardiovascular and all-cause mortality. We calculated I² to test heterogeneity. RESULTS In total, 44 studies and 112,288 stable patients without known coronary heart disease were included in this meta-analysis. The mean follow-up duration of the whole cohort was 6.8 ± 1.1 years. 77,004 (68.5%) of the patients presented with low cardiovascular risk while 35,284 (31.5%) in high. The overall pooled estimate of Δ[c-index] for MACE was 1.4% (95%CI: 0.7-2.1, I2=0%) and for cardiovascular death 1.3% (95%CI: 0.3-2.3, I2=0%). Finally, the overall pooled estimate of Δ[c-index] for all-cause mortality was 3% (95%CI: 1.9-3.9, I2=86%), while high heterogeneity was observed between the studies. CONCLUSION The predictive usefulness of changes in hs-cTn measures in stable individuals with either high or low cardiovascular risk, demonstrates that assessing vascular inflammation in addition to clinical risk factors enhances risk prediction for cardiovascular events and all-cause mortality. Further prospective studies are necessary to confirm these findings and assist clinical decision-making regarding the most optimal prevention strategy.
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Affiliation(s)
- Marios Sagris
- 1st Cardiology Clinic, 'Hippokration' General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Alexios S Antonopoulos
- 1st Cardiology Clinic, 'Hippokration' General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
- RDM Division of Cardiovascular Medicine, University of Oxford, UK
| | - Andreas Angelopoulos
- 1st Cardiology Clinic, 'Hippokration' General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Paraskevi Papanikolaou
- 1st Cardiology Clinic, 'Hippokration' General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Spyridon Simantiris
- 1st Cardiology Clinic, 'Hippokration' General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Konstantinos Vamvakaris
- 1st Cardiology Clinic, 'Hippokration' General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Alkmini Koumpoura
- 1st Cardiology Clinic, 'Hippokration' General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Maria Farmaki
- 1st Cardiology Clinic, 'Hippokration' General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | | | - Κonstantinos Tsioufis
- 1st Cardiology Clinic, 'Hippokration' General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Dimitris Tousoulis
- 1st Cardiology Clinic, 'Hippokration' General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
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Antonopoulos AS, Angelopoulos A, Papanikolaou P, Simantiris S, Oikonomou EK, Vamvakaris K, Koumpoura A, Farmaki M, Trivella M, Vlachopoulos C, Tsioufis K, Antoniades C, Tousoulis D. Biomarkers of Vascular Inflammation for Cardiovascular Risk Prognostication: A Meta-Analysis. JACC Cardiovasc Imaging 2022; 15:460-471. [PMID: 34801448 DOI: 10.1016/j.jcmg.2021.09.014] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 09/08/2021] [Accepted: 09/10/2021] [Indexed: 12/23/2022]
Abstract
OBJECTIVES The purpose of this study was to systematically explore the added value of biomarkers of vascular inflammation for cardiovascular prognostication on top of clinical risk factors. BACKGROUND Measurement of biomarkers of vascular inflammation is advocated for the risk stratification for coronary heart disease (CHD). METHODS We systematically explored published reports in MEDLINE for cohort studies on the prognostic value of common biomarkers of vascular inflammation in stable patients without known CHD. These included common circulating inflammatory biomarkers (ie, C-reactive protein, interleukin-6 and tumor necrosis factor-a, arterial positron emission tomography/computed tomography and coronary computed tomography angiography-derived biomarkers of vascular inflammation, including anatomical high-risk plaque features and perivascular fat imaging. The main endpoint was the difference in c-index (Δ[c-index]) with the use of inflammatory biomarkers for major adverse cardiovascular events (MACEs) and mortality. We calculated I2 to test heterogeneity. This study is registered with PROSPERO (CRD42020181158). RESULTS A total of 104,826 relevant studies were screened and a final of 39 independent studies (175,778 individuals) were included in the quantitative synthesis. Biomarkers of vascular inflammation provided added prognostic value for the composite endpoint and for MACEs only (pooled estimate for Δ[c-index]% 2.9, 95% CI: 1.7-4.1 and 3.1, 95% CI: 1.8-4.5, respectively). Coronary computed tomography angiography-related biomarkers were associated with the highest added prognostic value for MACEs: high-risk plaques 5.8%, 95% CI: 0.6 to 11.0, and perivascular adipose tissue (on top of coronary atherosclerosis extent and high-risk plaques): 8.2%, 95% CI: 4.0 to 12.5). In meta-regression analysis, the prognostic value of inflammatory biomarkers was independent of other confounders including study size, length of follow-up, population event incidence, the performance of the baseline model, and the level of statistical adjustment. Limitations in the published literature include the lack of reporting of other metrics of improvement of risk stratification, the net clinical benefit, or the cost-effectiveness of such biomarkers in clinical practice. CONCLUSIONS The use of biomarkers of vascular inflammation enhances risk discrimination for cardiovascular events.
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Affiliation(s)
- Alexios S Antonopoulos
- 1(st) Cardiology Department, School of Health Sciences, National and Kapodistrian University of Athens, Greece; RDM Division of Cardiovascular Medicine, University of Oxford, United Kingdom.
| | - Andreas Angelopoulos
- 1(st) Cardiology Department, School of Health Sciences, National and Kapodistrian University of Athens, Greece
| | - Paraskevi Papanikolaou
- 1(st) Cardiology Department, School of Health Sciences, National and Kapodistrian University of Athens, Greece
| | - Spyridon Simantiris
- 1(st) Cardiology Department, School of Health Sciences, National and Kapodistrian University of Athens, Greece
| | - Evangelos K Oikonomou
- RDM Division of Cardiovascular Medicine, University of Oxford, United Kingdom; Department of Internal Medicine, Yale School of Medicine, Yale-New Haven Hospital, Connecticut, USA
| | - Konstantinos Vamvakaris
- 1(st) Cardiology Department, School of Health Sciences, National and Kapodistrian University of Athens, Greece
| | - Alkmini Koumpoura
- 1(st) Cardiology Department, School of Health Sciences, National and Kapodistrian University of Athens, Greece
| | - Maria Farmaki
- 1(st) Cardiology Department, School of Health Sciences, National and Kapodistrian University of Athens, Greece
| | | | - Charalambos Vlachopoulos
- 1(st) Cardiology Department, School of Health Sciences, National and Kapodistrian University of Athens, Greece
| | - Konstantinos Tsioufis
- 1(st) Cardiology Department, School of Health Sciences, National and Kapodistrian University of Athens, Greece
| | | | - Dimitris Tousoulis
- 1(st) Cardiology Department, School of Health Sciences, National and Kapodistrian University of Athens, Greece
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Papanikolaou P, Swanson G, Stathakis S, Fakhreddine M, Mavroidis P. Estimation of Dose-Response Correlations Regarding Significant Blood Count Drops After Radiotherapy for Prostate Cancer. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Papanikolaou P, Swanson G, Stathakis S, Fakhreddine M, Mavroidis P. PO-1324 dose-volume correlation of pelvic bone normal tissue and hematocrit in patients with prostate cancer. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)07775-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Simantiris S, Antonopoulos AS, Angelopoulos A, Papanikolaou P, Oikonomou EK, Vamvakaris K, Koumpoura A, Farmaki M, Trivella M, Vlachopoulos C, Tsioufis K, Antoniades C, Tousoulis D. Prognostic value of vascular inflammation biomarkers over clinical risk factors for cardiovascular risk : a meta-analysis. Eur J Prev Cardiol 2021. [DOI: 10.1093/eurjpc/zwab061.243] [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]
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Measurement of vascular inflammation biomarkers is supported for estimation of residual inflammatory risk and cardiovascular risk stratification, but to date there is no systematic assessment of the added value of such biomarkers in predicting cardiovascular events and their comparative performance.
Methods
We systematically searched in MEDLINE published literature before Apr 14, 2020 for prospective cohort studies assessing the prognostic value of common biomarkers of vascular inflammation in stable patients with or without cardiovascular disease. The primary outcome was the difference in the c-index (Δ[c-index]) of the best clinical model with the use of inflammatory biomarkers for the prediction of the composite endpoint of major adverse cardiovascular events (MACEs) and mortality. The secondary outcome was the Δ[c-index] for MACEs only. We calculated I² to test heterogeneity. We used random-effects modelling for the meta-analyses to assess the primary and secondary outcome.
Results
We identified 92,507 studies in MEDLINE after duplicates were removed, of which 90,882 (96%) studies were excluded after screening the titles and abstracts, and 1,507 (93%) of the 1,625 remaining studies were excluded after assessment of the full texts. We included 93 (6%) studies in our quantitative evaluation, in which 351,628 individuals participated. The combination of high-risk plaque features and Fat attenuation Index (FAI) by CCTA was associated with the highest prognostic value i.e. Δ[c-index] for the composite endpoint per biomarker type (A). In meta-analysis, both plasma and imaging biomarkers of vascular inflammation offered incremental prognostic value for the primary outcome (pooled estimate for Δ[c-index]% 2.9, 95%CI 2.1-3.6, B) and for MACEs only (pooled estimate for Δ[c-index]% 2.9, 95%CI 2.1-3.8). The prognostic value of imaging biomarkers significantly surpassed that of plasma biomarkers for the primary outcome (Δ[c-index]% 11.3, 95%CI 8.3-14.3 vs. 1.4, 95%CI 0.9-1.8 respectively, p = 1.7x10-10, C). Notably, biomarkers of vascular inflammation offered higher incremental prognostic value in studies with a shorter duration of follow-up (i.e. <5 years), in primary CHD prevention setting and lower cardiovascular risk populations i.e. (studies with <5% cumulative event incidence, D)
Conclusions
The combination of HRP features and FAI by CCTA imaging had the highest prognostic value for cardiovascular events among plasma or imaging biomarkers of vascular inflammation. CCTA imaging to detect residual inflammatory risk and the vulnerable patient at risk for events is a rational approach to improve risk stratification and prognostication.
Abstract Figure.
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Affiliation(s)
- S Simantiris
- Ippokrateio General Hospital of Athens, Athens, Greece
| | | | | | | | - EK Oikonomou
- Yale University, New Haven, United States of America
| | - K Vamvakaris
- Ippokrateio General Hospital of Athens, Athens, Greece
| | - A Koumpoura
- Ippokrateio General Hospital of Athens, Athens, Greece
| | - M Farmaki
- Ippokrateio General Hospital of Athens, Athens, Greece
| | - M Trivella
- University of Oxford, Oxford, United Kingdom of Great Britain & Northern Ireland
| | | | - K Tsioufis
- Ippokrateio General Hospital of Athens, Athens, Greece
| | - C Antoniades
- University of Oxford, Oxford, United Kingdom of Great Britain & Northern Ireland
| | - D Tousoulis
- Ippokrateio General Hospital of Athens, Athens, Greece
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Angelopoulos A, Oikonomou E, Vogiatzi G, Antonopoulos A, Tsalamandris S, Georgakopoulos C, Papanikolaou P, Lazaros G, Charalambous G, Siasos G, Vlachopoulos C, Tousoulis D. MiRNAs as Biomarkers in Hypertrophic Cardiomyopathy: Current State of the Art. Curr Med Chem 2021; 28:7400-7412. [PMID: 33820510 DOI: 10.2174/0929867328666210405122703] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 03/02/2021] [Accepted: 03/09/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Hypertrophic Cardiomyopathy (HCM) is the most common inherited Cardiomyopathy. The hallmark of HCM is myocardial fibrosis that contributes to heart failure, arrhythmias and sudden cardiac death. OBJECTIVE Currently there are no reliable serum biomarkers for detection of myocardial fibrosis, while cardiac magnetic resonance (CMR) is an imaging technique to detect myocardial fibrosis. MicroRNAs (miRNAs) have been increasingly suggested as biomarkers in cardiovascular diseases. However, in HCM there is as yet no identified and verified specific circulating miRNA signature. METHODS We conducted a review of literature to identify the studies that indicate the possible roles of miRNAs in HCM. RESULTS From studies in transgenic mice with HCM, miR-1, -133 may identify HCM in the early asymptomatic phase. Human miR-29a could be used as a circulating biomarker for detection of both myocardial hypertrophy and fibrosis in HCM, while it could also have a possible additional role in discrimination of hypertrophic obstructive cardiomyopathy from non-obstructive HCM. Additionally, miR-29a-3p is associated with diffuse myocardial fibrosis in HCM while miR-1-3p could discriminate end-stage HCM from dilated cardiomyopathy and left ventricle dilation. Another role of miRNAs could also be the contribution in differential diagnosis between HCM and phenocopies. Moreover, miRNA-targeted therapy (miR-133 mimics) is promising in inhibiting cardiac hypertrophy but this is still in the early stages. CONCLUSION A more reliable and specific signature of miRNAs is expected with forthcoming studies in samples from HCM patients and correlation of miRNAs with CMR and serum markers of fibrosis may implicate novel diagnostic and therapeutic pathways.
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Affiliation(s)
- Andreas Angelopoulos
- EKKAN (Unit for the athletes and for hereditary cardiovascular diseases), 1st Department of Cardiology, Hippokration Hospital, Medical School of National and Kapodistrian University of Athens, Athens. Greece
| | - Evangelos Oikonomou
- EKKAN (Unit for the athletes and for hereditary cardiovascular diseases), 1st Department of Cardiology, Hippokration Hospital, Medical School of National and Kapodistrian University of Athens, Athens. Greece
| | - Georgia Vogiatzi
- EKKAN (Unit for the athletes and for hereditary cardiovascular diseases), 1st Department of Cardiology, Hippokration Hospital, Medical School of National and Kapodistrian University of Athens, Athens. Greece
| | - Alexios Antonopoulos
- EKKAN (Unit for the athletes and for hereditary cardiovascular diseases), 1st Department of Cardiology, Hippokration Hospital, Medical School of National and Kapodistrian University of Athens, Athens. Greece
| | - Sotirios Tsalamandris
- EKKAN (Unit for the athletes and for hereditary cardiovascular diseases), 1st Department of Cardiology, Hippokration Hospital, Medical School of National and Kapodistrian University of Athens, Athens. Greece
| | - Christos Georgakopoulos
- EKKAN (Unit for the athletes and for hereditary cardiovascular diseases), 1st Department of Cardiology, Hippokration Hospital, Medical School of National and Kapodistrian University of Athens, Athens. Greece
| | - Paraskevi Papanikolaou
- EKKAN (Unit for the athletes and for hereditary cardiovascular diseases), 1st Department of Cardiology, Hippokration Hospital, Medical School of National and Kapodistrian University of Athens, Athens. Greece
| | - George Lazaros
- EKKAN (Unit for the athletes and for hereditary cardiovascular diseases), 1st Department of Cardiology, Hippokration Hospital, Medical School of National and Kapodistrian University of Athens, Athens. Greece
| | - Georgios Charalambous
- EKKAN (Unit for the athletes and for hereditary cardiovascular diseases), 1st Department of Cardiology, Hippokration Hospital, Medical School of National and Kapodistrian University of Athens, Athens. Greece
| | - Gerasimos Siasos
- EKKAN (Unit for the athletes and for hereditary cardiovascular diseases), 1st Department of Cardiology, Hippokration Hospital, Medical School of National and Kapodistrian University of Athens, Athens. Greece
| | - Charalambos Vlachopoulos
- EKKAN (Unit for the athletes and for hereditary cardiovascular diseases), 1st Department of Cardiology, Hippokration Hospital, Medical School of National and Kapodistrian University of Athens, Athens. Greece
| | - Dimitris Tousoulis
- EKKAN (Unit for the athletes and for hereditary cardiovascular diseases), 1st Department of Cardiology, Hippokration Hospital, Medical School of National and Kapodistrian University of Athens, Athens. Greece
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Angelopoulos A, Kirkilesis G, Kakavia K, Papanikolaou P. Diagnosis of Evans syndrome. Pan Afr Med J 2021; 38:314. [PMID: 34285737 PMCID: PMC8265255 DOI: 10.11604/pamj.2021.38.314.22410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 04/11/2020] [Indexed: 11/30/2022] Open
Abstract
This manuscript concerns the case of a patient hospitalized and diagnosed with Evans syndrome. She was hospitalized with signs of thrombocytopenia induced purpura, petechiae, ecchymosis and anemia. She was successfully treated with corticoids and blood transfusions. Our purpose is to explain her clinical presentation and the exams, we used in order to make the diagnosis of Evans syndrome, which requires great suspicion. Moreover, other diseases causing hemolytic anemia and thrombocytopenia must be excluded. We used laboratory tests (blood samples, Coombs examination and virologic test). Bone marrow examination took place twice. Evans syndrome is an autoimmune disease which is characterized by the coexistence of hemolytic anemia and immune-mediated thrombocytopenia. There is no typical clinical presentation. Its etiology is unknown and its therapy is generally poor. Diagnosis of Evans syndrome is very difficult and requires the exclusion of other diseases causing anemia and thrombocytopenia.
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Affiliation(s)
| | | | - Kiriaki Kakavia
- Department of Vascular Surgery, Laikon General Hospital, Athens, Greece
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Papanikolaou P, Antonopoulos AS, Mastorakou I, Angelopoulos A, Kostoula E, Mystakidi XV, Simantiris S, Galiatsatos N, Oikonomou E, Tousoulis D. Antithrombotic Therapy in Carotid Artery Disease. Curr Pharm Des 2020; 26:2725-2734. [PMID: 32418521 DOI: 10.2174/1381612826666200518111359] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 05/08/2020] [Indexed: 12/19/2022]
Abstract
The management of asymptomatic atherosclerotic carotid artery disease and the role of antithrombotic therapy is of increasing importance for stroke prevention. Non-invasive imaging of carotid plaques can identify high-risk plaque features that are associated with the risk of plaque rupture. Carotid plaque necrosis, hemorrhage, fibrous cap thinning, and the presence of foam cells have all been correlated with the risk of rupture and onset of neurological symptoms in patients with carotid stenosis. Antiplatelets are currently recommended for patients with a history of ischemic stroke and/or significant carotid artery stenosis, with aspirin and clopidogrel being the most widely used and studied agents. The role of dual antiplatelet therapy remains controversial. Moreover, there is scarce evidence on the role of newer anticoagulant agents in stable patients with carotid artery stenosis. In this review article, we discuss the pathophysiology of carotid atherosclerosis, the use of non-invasive imaging for detecting the vulnerable carotid plaque and summarize the existing clinical evidence on the use of antiplatelet and antithrombotic agents in carotid artery disease.
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Affiliation(s)
- Paraskevi Papanikolaou
- First Department of Cardiology, Hippokration Hospital, Athens Medical School, Athens, Greece
| | - Alexios S Antonopoulos
- First Department of Cardiology, Hippokration Hospital, Athens Medical School, Athens, Greece
| | - Irene Mastorakou
- Imaging Department - Onassis Cardiac Surgery Centre, Athens, Greece
| | - Andreas Angelopoulos
- First Department of Cardiology, Hippokration Hospital, Athens Medical School, Athens, Greece
| | | | - Xara-Vasiliki Mystakidi
- First Department of Cardiology, Hippokration Hospital, Athens Medical School, Athens, Greece
| | - Spyros Simantiris
- First Department of Cardiology, Hippokration Hospital, Athens Medical School, Athens, Greece
| | - Nikolaos Galiatsatos
- First Department of Cardiology, Hippokration Hospital, Athens Medical School, Athens, Greece
| | - Evangelos Oikonomou
- First Department of Cardiology, Hippokration Hospital, Athens Medical School, Athens, Greece
| | - Dimitris Tousoulis
- First Department of Cardiology, Hippokration Hospital, Athens Medical School, Athens, Greece
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Papanikolaou P, Fakhreddine M, Wagner T. Primary Surgery for Early-Stage Oropharyngeal Carcinoma: A Superior Treatment or a Matter of Selection Bias? Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2019.11.222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Oikonomou E, Mourouzis K, Siasos G, Zaromitidou M, Tsigkou V, Bletsa E, Mystakidi VC, Goliopoulou A, Papanikolaou P, Stampouloglou P, Vavuranakis M, Tousoulis D. LIPOPROTEIN-ASSOCIATED PHOSPHOLIPASE A2 LEVELS, ENDOTHELIAL DYSFUNCTION AND ARTERIAL STIFFNESS IN PATIENTS WITH STABLE CORONARY ARTERY DISEASELIPOPROTEIN-ASSOCIATED PHOSPHOLIPASE A2 LEVELS, ENDOTHELIAL DYSFUNCTION AND ARTERIAL STIFFNESS IN PATIENTS WITH STABLE CORONARY ARTERY DISEASE. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)30777-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Antonopoulos AS, Papanikolaou P, Tousoulis D. The Role of Perivascular Adipose Tissue in Microvascular Function and Coronary Atherosclerosis. Microcirculation 2020. [DOI: 10.1007/978-3-030-28199-1_6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Papanikolaou P, Saenz D, Kirby N, Stathakis S, Rasmussen K, Crownover R, Floyd J. SBRT for Spine Lesions: A Novel Optimized Delivery Technique. Int J Radiat Oncol Biol Phys 2018. [DOI: 10.1016/j.ijrobp.2018.07.1068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Oikonomou E, Antonopoulos A, Siasos G, Tsalamandris S, Angelopoulos A, Papanikolaou P, Vogiatzi G, Antoniades C, Tsigkou V, Panoilia MP, Tousoulis D. METABOLICALLY HEALTHY OBESITY IS ASSOCIATED WITH A FAVOURABLE VASCULAR PHENOTYPE AND LOW LEVELS PLASMA IL-6 IN PATIENTS WITH CORONARY ARTERY DISEASE: IMPLICATIONS FOR THE OBESITY PARADOX. J Am Coll Cardiol 2018. [DOI: 10.1016/s0735-1097(18)32588-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Papanikolaou P, Watts L, Pappas E, Kalaitzakis G, Maris T, Kirby N, Rasmussen K, Gutierrez A, Stathakis S, Pappas E. SU-F-T-513: Dosimetric Validation of Spatially Fractionated Radiotherapy Using Gel Dosimetry. Med Phys 2016. [DOI: 10.1118/1.4956698] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Cruz W, Papanikolaou P, Mavroidis P, Stathakis S. SU-E-T-173: Clinical Comparison of Treatment Plans and Fallback Plans for Machine Downtime. Med Phys 2015. [DOI: 10.1118/1.4924535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Papanikolaou P, Tuohy R, Mavroidis P, Eng T, Gutierrez A, Stathakis S. SU-E-J-27: Appropriateness Criteria for Deformable Image Registration and Dose Propagation. Med Phys 2014. [DOI: 10.1118/1.4888078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Stathakis S, Avila G, Mavroidis P, Ha C, Eng T, Shi Z, Papanikolaou P. SU-E-T-597: Composite IMRT Planning: How Does the Initial Plan Dose Distribution Affect the Boost Plan Optimization? Med Phys 2014. [DOI: 10.1118/1.4888933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Winkelmayer W, Liu J, Brookhart A, Wang HY, Kan WC, Chien CC, Fang TC, Lin HF, Li YH, Wang CH, Chou CL, Yazawa M, Shibagaki Y, Kimura K, Ohira S, Ryo K, Hasegawa T, Hanafusa N, Tsubakihara Y, Iseki K, Chen HY, Cheng IC, Pan YJ, Chiu YL, Hsu SP, Pai MF, Yang JY, Peng YS, Tsai TJ, Wu KD, Dzekova-Vidimliski P, Severova-Andreevska G, Pavlevska S, Trajceska L, Selim G, Gelev S, Sikole A, Hecking M, Karaboyas A, Saran R, Sen A, Inaba M, Horl WH, Pisoni R, Robinson B, Sunder-Plassmann G, Port FK, Chiroli S, Perrault L, Mitchell D, Mattin C, Krause R, Roth HJ, Schober-Halstenberg HJ, Edenharter G, Frei U, Wilson R, Adena M, Hodgkins P, Keith M, Smyth M, Couchoud C, Galland R, Man NK, Chanliau J, Lemaitre V, Traeger J, von Gersdorff G, Vega O, Schaller M, Usvyat L, Levin N, Barth C, Kotanko P, Vega O, Usvyat L, Rosales L, Thijssen S, Levin N, Kotanko P, Schmid H, Schiffl H, Romanos A, Lederer S, Chu KH, Lam B, Tang C, Wong S, Cheuk A, Yim KF, Tang HL, Lee W, Fung KS, Chan H, Ng TK, Tong KL, Doyle M, Severn A, Traynor J, Metcalfe W, Boyd J, Cairns S, Reilly J, Henderson A, Simpson K, Tovbin D, Douvdevani A, Novack V, Abd Elkadir A, Zlotnik M, Djuric Z, Dimkovic N, Popovic J, Furumatsu Y, Yamazaki S, Hayashino Y, Takegami M, Yamamoto Y, Kakudate N, Wakita T, Akizawa T, Akiba T, Saito A, Kurokawa K, Fukuhara S, Voronovitsky G, Pinelli L, Paganti L, Silva J, Garofalo R, Reiss E, Gimenez Torrado J, Lafroscia P, Lugo M, Laplante S, Vanovertveld P, Nordio M, Limido A, Maggiore U, Nichelatti M, Postorino M, Quintaliani G, Ebah L, Kanigicherla D, Nikam M, Dutton G, Mitra S, Attipoe L, Baharani J, Pinelli L, Voronovitsky G, Magrini G, Martorell A, Lugo M, Mashima Y, Konta T, Kudo K, Suzuki K, Ikeda A, Takasaki S, Kubota I, Chudek J, Wieczorowska-Tobis K, Wiecek A, Members of the "PolSenior" Study Group, des Grottes JM, Collart F, Lemaitre V, Maheut H, Couchoud C, Goodkin DA, Bieber B, Robinson BM, Jadoul M, Djogan M, Dudar I, Sergeyeva T, Hanafusa N, Yamagata K, Nishi H, Nishi S, Iseki K, Tsubakihara Y, Hommel K, Madsen M, Blicher TM, Kamper AL, Masakane I, Ito S, Seino M, Ito M, Nagasawa J, Rayner HC, Fuller DS, Gillespie BW, Hasegawa T, Morgenstern H, Robinson BM, Saran R, Tentori F, Pisoni RL, Chien CC, Wang JJ, Hwang JC, Wang HY, Kan WC, Trajceska L, Mladenovska D, Severova G, Amitov V, Selim G, Gelev S, Dzekova-Vidimliski P, Sikole A, Yadav P, Baharani J, Attipoe L, Baharani J, Carrero JJ, Jager DJ, Verduijn M, Ravani P, De Meester J, Heaf JG, Finne P, Hoitsma AJ, Pascual J, Jarraya F, Reisaeter AV, Collart F, Dekker FW, Jager KJ, Trajceska L, Mladenovska D, Severova G, Gelev S, Selim G, Amitov V, Sikole A, Sammut H, Ahmed MSA, Sheppard J, Attwood N, Cserep G, Sinnamon K, Pinelli L, Voronovitsky G, Lugo M, Reiss E, Katsipi I, Tatsiopoulos A, Doulgerakis C, Papanikolaou P, Kardouli E, Lamprinoudis G, Kintzoglanakis K, Gennadiou M, Kyriazis J, Granger Vallee A, Covic E, Morena M, Fournier A, Canaud B, Bolignano D, Rastelli S, Curatola G, Caridi G, Tripepi R, Tripepi G, Politi R, Catalano F, Delfino D, Ciccarelli M, Mallamaci F, Zoccali C. Epidemiology & outcome in CKD 5D (1). Clin Kidney J 2011. [DOI: 10.1093/ndtplus/4.s2.41] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Kuo KL, Hung SC, Tarng DC, Selim G, Stojceva-Taneva O, Tozija L, Gelev S, Stojcev N, Dzekova P, Trajcevska L, Severova G, Pavleska S, Sikole A, Combe C, Thumma J, Gillespie B, De Sequera P, Yamamoto H, Robinson B, Matsushita Y, Tasaki H, Tohara Y, Yamauchi E, Matsuoka K, Arizono K, Bellasi A, Ferramosca E, Ratti C, Block G, Raggi P, Drozdz M, Krasniak A, Chmiel G, Podolec P, Pasowicz M, Tracz W, Kowalczyk-Michalek M, Sulowicz W, Kalantzi K, Korantzopoulos P, Bechlioulis A, Vlachopanou A, Foulidis V, Pagiati E, Nikolopoulos P, Gouva C, Arroyave I, Rodelo J, Cardona M, Garcia A, Henao J, Mejia G, Rico J, Arbelaez M, Fujimori A, Okada S, Yamamoto K, Okamoto S, Kamiura N, Sakai M, Tanikake M, Kutlay S, Sengul S, Keven K, Nergizoglu G, Erturk S, Ates K, Duman N, Karatan O, Erbay B, Sameiro-Faria M, Costa E, Rocha-Pereira P, Borges A, Nascimento H, Mendonca D, Amado L, Reis F, Miranda V, Quintanilha A, Belo L, Santos-Silva A, Oh JS, Kim SM, Sin YH, Kim JK, Ishihara M, Otsubo S, Kimata N, Akiba T, Nitta K, Kim KM, Baek CH, Kim SB, Testa A, Sanguedolce MC, Spoto B, Mallamaci F, Malatino L, Tripepi G, Zoccali C, Lee JE, Moon SJ, Kim JK, An HR, Ha SK, Pakr HC, Bahlmann FH, Becker E, Sperber V, Triem S, Noll C, Zewinger S, Fliser D, Laufs U, Thijssen S, Usvyat LA, Raimann JG, Balter P, Kotanko P, Levin NW, Hornum M, Bay JT, Clausen P, Melchior Hansen J, Mathiesen ER, Feldt-Rasmussen B, Garred P, Sural S, Panja CS, Bhattacharya SK, Cernaro V, Lacquaniti A, Lorenzano G, Romeo A, Donato V, Buemi M, Raimann JG, Usvyat L, Thijssen S, Rogus J, Lacson E, Kotanko P, Levin NW, Robinson BM, Karaboyas A, Sen A, Hecking M, Mendelssohn D, Jadoul M, Kawanishi H, Saran R, Kolarz M, Undas A, Wyroslak J, Malyszko J, Klejna K, Naumnik B, Koc-Zurawska E, Mysliwiec M, Piecha G, Kuczera P, Adamczak M, Fedorova OV, Bagrov AY, Wiecek A, Gungor O, Kircelli F, Asci G, Carrero JJ, Tatar E, Demirci M, Toz H, Ozkahya M, Ok E, Bansal V, Shareain K, Hoppensteadt D, Litinas E, Fareed J, Kim MJ, Lee SW, Song JH, Kweon J, Kim WH, Sasaki K, Yasuda K, Hatanaka M, Hayashi T, Katsipi I, Tatsiopoulos A, Papanikolaou P, Doulgerakis C, Kollia K, Kardouli E, Asmanis E, Gennadiou M, Kyriazis J, Panizo S, Barrio-Vazquez S, Carrillo-Lopez N, Fernandez-Vazquez A, Braga S, Rodriguez-Rebollar A, Naves-Diaz M, Cannata-Andia JB, Nikodimopoulou M, Liakos S, Kapoulas S. Cardiovascular complications in CKD 5D (1). Clin Kidney J 2011. [DOI: 10.1093/ndtplus/4.s2.38] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Kampessis G, Vlastarakos P, Stamatiou G, Kikidis D, Marinakis K, Papanikolaou P, Korres S. Prospective Study on the Effectiveness of Low-Laser Therapy in the Treatment of Tinnitus. Skull Base 2009. [DOI: 10.1055/s-2009-1224396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Papanikolaou P, Karafiloglou P. Extracting Covalent and Ionic Structures from Usual Delocalized Wave Functions: The Electron-Expansion Methodology. J Phys Chem A 2008; 112:8839-48. [DOI: 10.1021/jp8039725] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- P. Papanikolaou
- Department of General and Inorganic Chemistry, Faculty of Chemistry, POB 135, Aristotle University of Thessaloniki, 54124, Thessaloniki, Greece
| | - P. Karafiloglou
- Department of General and Inorganic Chemistry, Faculty of Chemistry, POB 135, Aristotle University of Thessaloniki, 54124, Thessaloniki, Greece
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Abstract
BACKGROUND Alcohol withdrawal syndrome is a cluster of symptoms that occurs in alcohol-dependent people after cessation or reduction in alcohol use. This systematic review focuses on the evidence of anticonvulsants' use in the treatment of alcohol withdrawal symptoms. OBJECTIVES To evaluate the effectiveness and safety of anticonvulsants in the treatment of alcohol withdrawal. SEARCH STRATEGY We searched the Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 3, 2004); MEDLINE (1966 to October 2004); EMBASE (1988 to October 2004) and EU-PSI PSI-Tri database with no language and publication restrictions and references of articles. SELECTION CRITERIA All randomized controlled trials examining the effectiveness, safety and overall risk-benefit of an anticonvulsant in comparison with a placebo or other pharmacological treatment or another anticonvulsant were considered. DATA COLLECTION AND ANALYSIS The authors independently assessed trial quality extracted data. MAIN RESULTS Forty-eight studies, involving 3610 people were included. Despite the considerable number of randomized controlled trials, there was a variety of outcomes and of different rating scales that led to a limited quantitative synthesis of data. For the anticonvulsant versus placebo comparison, therapeutic success tended to be more common among the anticonvulsant-treated patients (relative risk (RR) 1.32; 95% confidence interval (CI) 0.92 to 1.91), and anticonvulsant tended to show a protective benefit against seizures (RR 0.57; 95% CI 0.27 to 1.19), but no effect reached formal statistical significance. For the anticonvulsant versus other drug comparison, CIWA-Ar score showed non-significant differences for the anticonvulsants compared to the other drugs at the end of treatment (weighted mean difference (WMD) -0.73; 95% CI -1.76 to 0.31). For the subgroup analysis of carbamazepine versus benzodiazepine, a statistically significant protective effect was found for the anticonvulsant (WMD -1.04; 95% CI -1.89 to -0.20), p = 0.02), but this was based on only 260 randomized participants. There was a non-significant decreased incidence of seizures (RR 0.50; 95% CI 0.18 to 1.34) favouring the patients that were treated with anticonvulsants than other drugs, and side-effects tended to be less common in the anticonvulsant-group (RR 0.56; 95% CI 0.31 to 1.02). AUTHORS' CONCLUSIONS It is not possible to draw definite conclusions about the effectiveness and safety of anticonvulsants in alcohol withdrawal, because of the heterogeneity of the trials both in interventions and the assessment of outcomes. The extremely small mortality rate in all these studies is reassuring, but data on other safety outcomes are sparse and fragmented.
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Affiliation(s)
- A Polycarpou
- Department of Hygiene and Epidemiology, University of Ioannina, School of Medicine, 14 Ch Zoidi Str, Ioannina, Greece, GR45444.
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Polycarpou A, Papanikolaou P, Contopoulos-Ioannidis DG, Ioannidis JPA. Anticonvulsants for alcohol withdrawal. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2005. [DOI: 10.1002/14651858.cd005064] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Abstract
During an investigation into the quality of life of people in the year following radical treatment for head and neck cancer, it became apparent that pain was a significant problem. Therefore, the current study was conducted to gain an understanding of the incidence and nature of pain in people who had received radical treatment for head and neck cancer and to explore their attitudes to pain and pain relief. A single cohort study was undertaken using a structured questionnaire designed for people with head and neck cancer (the EORTC QLQ-C30 and the EORTC QLQ H+N35). Fifty questionnaires were received from people who had received radical treatment between 6 and 12 months previously and who were disease-free. Twenty nine of the respondents also consented to a follow-up semi-structured interview. The interviews generated qualitative data about personal experiences of pain and pain management in head and neck cancer. Patient recollections from interviews identified that only nine out of 29 (31%) interviewees had pain at diagnosis. However, 74% (37) of respondents to the questionnaire reported some degree of pain at follow-up. Patients having both surgery and radiotherapy were significantly more likely to have troublesome pain than patients who received radiotherapy only (Fisher's exact test=0.039). The qualitative data identified a wide variety of pain sites, a number of which were not covered by the EORTC tool. A significant number of patients were rejecting regular pharmacological management and using a variety of other pain-relieving measures. We conclude that through an understanding of pain experience and attitudes to pain management, nurses can facilitate the care and support of patients in pain following treatment for head and neck cancer.
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Affiliation(s)
- Z Whale
- School of Nursing Studies, University of Wales College of Medicine, Heath Park, Cardiff CF14 4XN, UK
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Abstract
Despite many improvements in practice, pressure ulcers continue to be a source of concern to nurses and distress to patients. Clearly, there are no simple solutions to this problem and it is necessary to improve our understanding of pressure ulcer epidemiology and the effectiveness of preventive methods to continue to progress. Risk assessment is an important aspect of such work and forms the topic of this article. The authors first consider some of the difficulties associated with risk assessment and suggest that progress requires the use of multivariate statistical methods. They then describe the difficulty of comparing existing studies, which gives rise to the need for further work. A description of the study currently being undertaken follows, together with a presentation of the preliminary findings and a discussion of their implications for practice.
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Affiliation(s)
- P A Lyne
- Health and Social Care Research Centre, School of Nursing and Midwifery Studies, University of Wales College of Medicine, Cardiff
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Davies L, Drummond M, Papanikolaou P. Prioritizing investments in health technology assessment. Can we assess potential value for money? Int J Technol Assess Health Care 2000; 16:73-91. [PMID: 10815355 DOI: 10.1017/s0266462300016172] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.3] [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] [Indexed: 11/07/2022]
Abstract
OBJECTIVE The objective was to develop an economic prioritization model to assist those involved in the selection and prioritization of health technology assessment topics and commissioning of HTA projects. METHODS The model used decision analytic techniques to estimate the expected costs and benefits of the health care interventions that were the focus of the HTA question(s) considered by the NHS Health Technology Assessment Programme in England. Initial estimation of the value for money of HTA was conducted for several topics considered in 1997 and 1998. RESULTS The results indicate that, using information routinely available in the literature and from the vignettes, it was not possible to estimate the absolute value of HTA with any certainty for this stage of the prioritization process. Overall, the results were uncertain for 65% of the HTA questions or topics analyzed. The relative costs of the interventions or technologies compared to existing costs of care and likely levels of utilization were critical factors in most of the analyses. The probability that the technology was effective with the HTA and the impact of the HTA on utilization rates were also key determinants of expected costs and benefits. CONCLUSIONS The main conclusion was that it is feasible to conduct ex ante assessments of the value for money of HTA for specific topics. However, substantial work is required to ensure that the methods used are valid, reliable, consistent, and an efficient use of valuable research time.
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Papanikolaou P, Humble E, Engström L. Phosphorylation of human fibrinogen in vitro with calcium-activated phospholipid-dependent protein kinase and [32P]ATP. FEBS Lett 1982; 143:199-204. [PMID: 6288458 DOI: 10.1016/0014-5793(82)80098-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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