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Apostolos A, Tsiachris D, Drakopoulou M, Trantalis G, Oikonomou G, Ktenopoulos N, Simopoulou C, Katsaros O, Tsalamandris S, Aggeli C, Tsivgoulis G, Tsioufis C, Toutouzas K. Atrial Fibrillation After Patent Foramen Ovale Closure: Incidence, Pathophysiology, and Management. J Am Heart Assoc 2024:e034249. [PMID: 38639354 DOI: 10.1161/jaha.124.034249] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Accepted: 02/06/2024] [Indexed: 04/20/2024]
Abstract
This comprehensive review explores the incidence, pathophysiology, and management of atrial fibrillation (AF) following percutaneous closure of patent foramen ovale (PFO). Although AF is considered a common adverse event post PFO closure, its incidence, estimated at <5%, varies based on monitoring methods. The review delves into the challenging task of precisely estimating AF incidence, given subclinical AF and diverse diagnostic approaches. Notably, a temporal pattern emerges, with peak incidence around the 14th day after closure and a subsequent decline after the 45th day, mimicking general population AF trends. The pathophysiological mechanisms behind post PFO closure AF remain elusive, with proposed factors including local irritation, device-related interference, tissue stretch, and nickel hypersensitivity. Management considerations encompass rhythm control, with flecainide showing promise, and anticoagulation tailored to individual risk profiles. The authors advocate for a personalized approach, weighing factors like age, comorbidities, and device characteristics. Notably, postclosure AF is generally considered benign, often resolving spontaneously within 45 days, minimizing thromboembolic risks. Further studies are required to refine understanding and provide evidence-based guidelines.
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Affiliation(s)
- Anastasios Apostolos
- First Department of Cardiology, Medical School National and Kapodistrian University of Athens, Hippokration General Hospital Athens Greece
| | - Dimitrios Tsiachris
- First Department of Cardiology, Medical School National and Kapodistrian University of Athens, Hippokration General Hospital Athens Greece
| | - Maria Drakopoulou
- First Department of Cardiology, Medical School National and Kapodistrian University of Athens, Hippokration General Hospital Athens Greece
| | - Georgios Trantalis
- First Department of Cardiology, Medical School National and Kapodistrian University of Athens, Hippokration General Hospital Athens Greece
| | - Georgios Oikonomou
- First Department of Cardiology, Medical School National and Kapodistrian University of Athens, Hippokration General Hospital Athens Greece
| | - Nikolaos Ktenopoulos
- First Department of Cardiology, Medical School National and Kapodistrian University of Athens, Hippokration General Hospital Athens Greece
| | - Chrysavgi Simopoulou
- First Department of Cardiology, Medical School National and Kapodistrian University of Athens, Hippokration General Hospital Athens Greece
| | - Odysseas Katsaros
- First Department of Cardiology, Medical School National and Kapodistrian University of Athens, Hippokration General Hospital Athens Greece
| | - Sotirios Tsalamandris
- First Department of Cardiology, Medical School National and Kapodistrian University of Athens, Hippokration General Hospital Athens Greece
| | - Constantina Aggeli
- First Department of Cardiology, Medical School National and Kapodistrian University of Athens, Hippokration General Hospital Athens Greece
| | - Georgios Tsivgoulis
- Second Department of Neurology, Medical School National and Kapodistrian University of Athens, Attikon University Hospital of Athens Athens Greece
| | - Costas Tsioufis
- First Department of Cardiology, Medical School National and Kapodistrian University of Athens, Hippokration General Hospital Athens Greece
| | - Konstantinos Toutouzas
- First Department of Cardiology, Medical School National and Kapodistrian University of Athens, Hippokration General Hospital Athens Greece
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Apostolos A, Ktenopoulos N, Chlorogiannis DD, Katsaros O, Konstantinou K, Drakopoulou M, Tsalamandris S, Karanasos A, Synetos A, Latsios G, Aggeli C, Panoulas V, Tsioufis C, Toutouzas K. Mortality Rates in Patients Undergoing Urgent Versus Elective Transcatheter Aortic Valve Replacement: A Meta-analysis. Angiology 2024:33197241245733. [PMID: 38613209 DOI: 10.1177/00033197241245733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2024]
Abstract
Patients with severe aortic stenosis (AoS) often present with acute heart failure and compensation, frequently leading to cardiogenic shock. Transcatheter Aortic Valve Replacement (TAVR) has been recently performed as a bailout treatment in such patients. The aim of our meta-analysis is to compare urgent TAVR with elective procedures. We systematically screened three databases searching for studies comparing urgent vs elective TAVR. Primary endpoint is the 30-days mortality. Secondary endpoints included in-hospital mortality, device success, periprocedural vascular complications, 30-days stroke, 30-days acute kidney injury (AKI), permanent pacemaker implantation (PPM), moderate or severe paravalvular leakage, and 30-days bleeding. Seventeen studies were included, with a total of 84,495 patients. Urgent TAVR was associated with an increased risk for 30-days mortality [Risk Ratio (RR): 2.53, 95% Confidence Intervals (CI): 1.81-3.54)], in-hospital mortality (RR: 2.67, 95% CI: 1.94-3.68), periprocedural vascular complications (RR: 1.91, 95% CI: 1.28-2.85) and AKI (RR: 2.83, 95% CI: 1.93-4.14), compared with elective procedure. No differences were observed in the other secondary endpoints. Urgent TAVR was associated with higher in-hospital and 30-days mortality, possibly driven by the increased incidence of AKI and vascular complications in urgent TAVR. The results highlight the importance of early TAVR in stable AoS patients.
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Affiliation(s)
- Anastasios Apostolos
- First Department of Cardiology, Medical School, Hippokration General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Nikolaos Ktenopoulos
- First Department of Cardiology, Medical School, Hippokration General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Odysseas Katsaros
- First Department of Cardiology, Medical School, Hippokration General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Konstantinos Konstantinou
- Department of Cardiology, Royal Brompton and Harefield Hospitals, Guy's & St Thomas' NHS Foundation Trust, London, UK
| | - Maria Drakopoulou
- First Department of Cardiology, Medical School, Hippokration General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Sotirios Tsalamandris
- First Department of Cardiology, Medical School, Hippokration General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Antonios Karanasos
- First Department of Cardiology, Medical School, Hippokration General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Andreas Synetos
- First Department of Cardiology, Medical School, Hippokration General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Georgios Latsios
- First Department of Cardiology, Medical School, Hippokration General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Constantina Aggeli
- First Department of Cardiology, Medical School, Hippokration General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Vasileios Panoulas
- Department of Cardiology, Royal Brompton and Harefield Hospitals, Guy's & St Thomas' NHS Foundation Trust, London, UK
| | - Costas Tsioufis
- First Department of Cardiology, Medical School, Hippokration General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Konstantinos Toutouzas
- First Department of Cardiology, Medical School, Hippokration General Hospital, National and Kapodistrian University of Athens, Athens, Greece
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Sagris M, Apostolos A, Theofilis P, Ktenopoulos N, Katsaros O, Tsalamandris S, Tsioufis K, Toutouzas K, Tousoulis D. Myocardial Ischemia-Reperfusion Injury: Unraveling Pathophysiology, Clinical Manifestations, and Emerging Prevention Strategies. Biomedicines 2024; 12:802. [PMID: 38672157 DOI: 10.3390/biomedicines12040802] [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: 01/30/2024] [Revised: 03/02/2024] [Accepted: 03/29/2024] [Indexed: 04/28/2024] Open
Abstract
Myocardial ischemia-reperfusion injury (MIRI) remains a challenge in the context of reperfusion procedures for myocardial infarction (MI). While early revascularization stands as the gold standard for mitigating myocardial injury, recent insights have illuminated the paradoxical role of reperfusion, giving rise to the phenomenon known as ischemia-reperfusion injury. This comprehensive review delves into the intricate pathophysiological pathways involved in MIRI, placing a particular focus on the pivotal role of endothelium. Beyond elucidating the molecular intricacies, we explore the diverse clinical manifestations associated with MIRI, underscoring its potential to contribute substantially to the final infarct size, up to 50%. We further navigate through current preventive approaches and highlight promising emerging strategies designed to counteract the devastating effects of the phenomenon. By synthesizing current knowledge and offering a perspective on evolving preventive interventions, this review serves as a valuable resource for clinicians and researchers engaged in the dynamic field of MIRI.
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Affiliation(s)
- Marios Sagris
- 1st Cardiology Clinic, 'Hippokration' General Hospital, School of Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Anastasios Apostolos
- 1st Cardiology Clinic, 'Hippokration' General Hospital, School of Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Panagiotis Theofilis
- 1st Cardiology Clinic, 'Hippokration' General Hospital, School of Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Nikolaos Ktenopoulos
- 1st Cardiology Clinic, 'Hippokration' General Hospital, School of Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Odysseas Katsaros
- 1st Cardiology Clinic, 'Hippokration' General Hospital, School of Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Sotirios Tsalamandris
- 1st Cardiology Clinic, 'Hippokration' General Hospital, School of Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Konstantinos Tsioufis
- 1st Cardiology Clinic, 'Hippokration' General Hospital, School of Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Konstantinos Toutouzas
- 1st Cardiology Clinic, 'Hippokration' General Hospital, School of Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Dimitris Tousoulis
- 1st Cardiology Clinic, 'Hippokration' General Hospital, School of Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece
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Apostolos A, Drakopoulou M, Trantalis G, Ioakeimidis M, Koroboki E, Tsalamandris S, Aggeli C, Ntaios G, Tsioufis C, Tsivgoulis G, Toutouzas K. Management of patent foramen ovale; findings from a nationwide survey. J Stroke Cerebrovasc Dis 2024; 33:107551. [PMID: 38241951 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107551] [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: 09/21/2023] [Revised: 12/16/2023] [Accepted: 12/20/2023] [Indexed: 01/21/2024] Open
Abstract
OBJECTIVES Several clinical trials have provided evidence supporting the transcatheter closure of patent foramen ovale (PFO) in selected patients following a cryptogenic stroke. However, it remains unknown to what extent these guidelines have been implemented in everyday clinical practice and the familiarity of physicians from different specialties with PFO closure. The aim of our nationwide survey is to explore the implementation of transcatheter PFO occlusion in Greek clinical practice. MATERIALS AND METHODS Attending level cardiologists, internal medicine physicians and neurologists involved in the management of PFO-related strokes working in Greece were invited to complete an online questionnaire. The questionnaire consisted of 19 questions and was designed to obtain comprehensive data on provider demographics, PFO characteristics, and specific clinical scenarios. RESULTS A total of 51 physicians (56.9 % cardiologists, 25.5 % neurologists and 17.6 % internal medicine physicians) completed the survey, resulting in a response rate of 53 %. Cardiologists, internal medicine physicians and neurologists agree on several issues regarding PFO closure, such as PFO closure as first line treatment, management of patients with DVT or prior decompression sickness, and post-closure antithrombotic treatment, but different approaches were reported regarding closure in patients with thrombophilia treated with oral anticoagulation (p=0.012) and implantable loop recorder placement for atrial fibrillation exclusion (p=0.029 and p=0.020). CONCLUSIONS Our findings show that cardiologists, internal medicine physicians and neurologists agree in numerous issues, but share different views in the management of patients with thrombophilia and rhythm monitoring duration. These results highlight the significance of collaboration among physicians from different medical specialties for achieving optimal results.
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Affiliation(s)
- Anastasios Apostolos
- First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, Athens, Greece.
| | - Maria Drakopoulou
- First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, Athens, Greece
| | - Georgios Trantalis
- First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, Athens, Greece
| | - Michael Ioakeimidis
- Second Department of Neurology, School of Medicine, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - Eleni Koroboki
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Sotirios Tsalamandris
- First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, Athens, Greece
| | - Constantina Aggeli
- First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, Athens, Greece
| | - Georgios Ntaios
- Department of Internal Medicine, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Costas Tsioufis
- First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, Athens, Greece
| | - Georgios Tsivgoulis
- Second Department of Neurology, School of Medicine, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - Konstantinos Toutouzas
- First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, Athens, Greece
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Katsaros O, Apostolos A, Ktenopoulos N, Koliastasis L, Kachrimanidis I, Drakopoulou M, Korovesis T, Karanasos A, Tsalamandris S, Latsios G, Synetos A, Tsioufis K, Toutouzas K. Transcatheter Aortic Valve Implantation Access Sites: Same Goals, Distinct Aspects, Various Merits and Demerits. J Cardiovasc Dev Dis 2023; 11:4. [PMID: 38248874 PMCID: PMC10817029 DOI: 10.3390/jcdd11010004] [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: 11/14/2023] [Revised: 12/03/2023] [Accepted: 12/20/2023] [Indexed: 01/23/2024] Open
Abstract
Transcatheter aortic valve implantation (TAVI) has been established as a safe and efficacious treatment for patients with severe symptomatic aortic stenosis (AS). Despite being initially developed and indicated for high-surgical-risk patients, it is now offered to low-risk populations based on the results of large randomized controlled trials. The most common access sites in the vast majority of patients undergoing TAVI are the common femoral arteries; however, 10-20% of the patients treated with TAVI require an alternative access route, mainly due to peripheral atherosclerotic disease or complex anatomy. Hence, to achieve successful delivery and implantation of the valve, several arterial approaches have been studied, including transcarotid (TCr), axillary/subclavian (A/Sc), transapical (TAp), transaortic (TAo), suprasternal-brachiocephalic (S-B), and transcaval (TCv). This review aims to concisely summarize the most recent literature data and current guidelines as well as evaluate the various access routes for TAVI, focusing on the indications, the various special patient groups, and the advantages and disadvantages of each technique, as well as their adverse events.
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Affiliation(s)
- Odysseas Katsaros
- First Department of Cardiology, National and Kapodistrian University of Athens, Hippokration General Hospital of Athens, 11527 Athens, Greece; (A.A.); (N.K.); (L.K.); (I.K.); (M.D.); (T.K.); (A.K.); (G.L.); (A.S.); (K.T.)
| | - Anastasios Apostolos
- First Department of Cardiology, National and Kapodistrian University of Athens, Hippokration General Hospital of Athens, 11527 Athens, Greece; (A.A.); (N.K.); (L.K.); (I.K.); (M.D.); (T.K.); (A.K.); (G.L.); (A.S.); (K.T.)
| | - Nikolaos Ktenopoulos
- First Department of Cardiology, National and Kapodistrian University of Athens, Hippokration General Hospital of Athens, 11527 Athens, Greece; (A.A.); (N.K.); (L.K.); (I.K.); (M.D.); (T.K.); (A.K.); (G.L.); (A.S.); (K.T.)
| | - Leonidas Koliastasis
- First Department of Cardiology, National and Kapodistrian University of Athens, Hippokration General Hospital of Athens, 11527 Athens, Greece; (A.A.); (N.K.); (L.K.); (I.K.); (M.D.); (T.K.); (A.K.); (G.L.); (A.S.); (K.T.)
- Department of Cardiology, University of Brussels, CHU Saint-Pierre, 1000 Brussels, Belgium
| | - Ioannis Kachrimanidis
- First Department of Cardiology, National and Kapodistrian University of Athens, Hippokration General Hospital of Athens, 11527 Athens, Greece; (A.A.); (N.K.); (L.K.); (I.K.); (M.D.); (T.K.); (A.K.); (G.L.); (A.S.); (K.T.)
| | - Maria Drakopoulou
- First Department of Cardiology, National and Kapodistrian University of Athens, Hippokration General Hospital of Athens, 11527 Athens, Greece; (A.A.); (N.K.); (L.K.); (I.K.); (M.D.); (T.K.); (A.K.); (G.L.); (A.S.); (K.T.)
| | - Theofanis Korovesis
- First Department of Cardiology, National and Kapodistrian University of Athens, Hippokration General Hospital of Athens, 11527 Athens, Greece; (A.A.); (N.K.); (L.K.); (I.K.); (M.D.); (T.K.); (A.K.); (G.L.); (A.S.); (K.T.)
| | - Antonios Karanasos
- First Department of Cardiology, National and Kapodistrian University of Athens, Hippokration General Hospital of Athens, 11527 Athens, Greece; (A.A.); (N.K.); (L.K.); (I.K.); (M.D.); (T.K.); (A.K.); (G.L.); (A.S.); (K.T.)
| | - Sotirios Tsalamandris
- Department of Cardiology, Hippokration General Hospital of Athens, 11527 Athens, Greece;
| | - George Latsios
- First Department of Cardiology, National and Kapodistrian University of Athens, Hippokration General Hospital of Athens, 11527 Athens, Greece; (A.A.); (N.K.); (L.K.); (I.K.); (M.D.); (T.K.); (A.K.); (G.L.); (A.S.); (K.T.)
| | - Andreas Synetos
- First Department of Cardiology, National and Kapodistrian University of Athens, Hippokration General Hospital of Athens, 11527 Athens, Greece; (A.A.); (N.K.); (L.K.); (I.K.); (M.D.); (T.K.); (A.K.); (G.L.); (A.S.); (K.T.)
| | - Konstantinos Tsioufis
- First Department of Cardiology, National and Kapodistrian University of Athens, Hippokration General Hospital of Athens, 11527 Athens, Greece; (A.A.); (N.K.); (L.K.); (I.K.); (M.D.); (T.K.); (A.K.); (G.L.); (A.S.); (K.T.)
| | - Konstantinos Toutouzas
- First Department of Cardiology, National and Kapodistrian University of Athens, Hippokration General Hospital of Athens, 11527 Athens, Greece; (A.A.); (N.K.); (L.K.); (I.K.); (M.D.); (T.K.); (A.K.); (G.L.); (A.S.); (K.T.)
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Nevras V, Milaras N, Katsioulis C, Sotiriou Z, Tsalamandris S, Gkounti G, Skevos S. Acute Coronary Syndromes in Antiphospholipid Syndrome-above Suspicion: A Systematic Review. Curr Probl Cardiol 2023; 48:101503. [PMID: 36402221 DOI: 10.1016/j.cpcardiol.2022.101503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 11/11/2022] [Indexed: 11/18/2022]
Abstract
Antiphospholipid syndrome(APS) is an autoimmune disorder characterized clinically by vascular thrombosis and/or pregnancy morbidity, associated with persistently elevated titers of antiphospholipid antibodies on at least two measurements over 12 weeks apart. In this study, we conducted a systematic review of the literature utilizing the Pubmed platform, in order to acquire clinical information about acute coronary syndromes in patients with APS. The obtained articles were reviewed in order to register the clinical characteristics, the rate of occurrence, the prognosis and the therapeutic approach of these patients. APS should be considered in young patients with acute myocardial infarction, even in patients with normal coronary arteries. The pharmaceutical approach is mainly based on the vitamin K antagonists, and in certain occasions aspirin, without any definite guidelines on the subject. Further randomized clinical trials are imperative for a better understanding of the particular characteristics of this group of patients, so that a more complete therapeutic approach to be obtained.
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Affiliation(s)
- Vasileios Nevras
- Cardiology Department, General Hospital of Thessaloniki G.Gennimatas, Thessaloniki, Thessaloniki, Greece
| | - Nikias Milaras
- Cardiology Department, General Hospital of Athens Hippokration, Athens, Athens, Greece.
| | - Christos Katsioulis
- Cardiology Department, General Hospital of Thessaloniki G.Gennimatas, Thessaloniki, Thessaloniki, Greece
| | - Zoi Sotiriou
- Pediatrics Department, General Hospital of Karditsa, Karditsa, Karditsa, Greece
| | - Sotirios Tsalamandris
- Cardiology Department, General Hospital of Athens Hippokration, Athens, Athens, Greece
| | - Georgia Gkounti
- Cardiology Department, General Hospital of Thessaloniki G.Gennimatas, Thessaloniki, Thessaloniki, Greece
| | - Sideris Skevos
- Cardiology Department, General Hospital of Athens Hippokration, Athens, Athens, Greece
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Tsigkas G, Apostolos A, Chlorogiannis DD, Bousoula E, Vasilagkos G, Tsalamandris S, Tsiafoutis I, Katsanos K, Toutouzas K, Aminian A, Alexopoulos D, Davlouros P. Thirty-Days versus Longer Duration of Dual Antiplatelet Treatment after Percutaneous Coronary Interventions with Newer Drug-Eluting Stents: A Systematic Review and Meta-Analysis. Life (Basel) 2023; 13:666. [PMID: 36983821 PMCID: PMC10056726 DOI: 10.3390/life13030666] [Citation(s) in RCA: 2] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Revised: 01/21/2023] [Accepted: 02/24/2023] [Indexed: 03/04/2023] Open
Abstract
Abbreviation of the duration of dual antiplatelet therapy (DAPT) (one or three months) has been recently proposed, especially for high bleeding risk patients, after percutaneous coronary intervention (PCI) with drug-eluting stent (DES). Three databases were screened for eligible randomized control trials. The primary endpoint was the incidence of net adverse clinical events (NACE). Secondary endpoints consisted of major adverse cardiovascular events (MACE), all-cause and cardiovascular mortality, myocardial infarction, stroke, stent-thrombosis, repeat revascularization and major bleeding. We included four RCTs with a total of 26,576 patients; 13,282 patients were grouped in 30-days DAPT, while the remaining 13,294 were allocated in a longer period of DAPT. One month of DAPT did not significantly reduce NACE (odds ratio [OR]: 0.87, 95% confidence intervals [Cl]: 0.74-1.03); however, major bleedings were significantly reduced by 22% (OR: 0.78, 95% Cl: 0.65-0.94). Mortality or ischemic events (stroke, myocardial infarction, revascularization and stent thrombosis) were not affected. Thus, 30-days DAPT could be considered as safe and feasible after PCI with DES in selected patients, especially those with high bleeding risk. Forthcoming RCTs could shed light on the optimal duration of DAPT.
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Affiliation(s)
- Grigorios Tsigkas
- Department of Cardiology, University Hospital of Patras, 265 04 Patras, Greece
| | - Anastasios Apostolos
- Department of Cardiology, University Hospital of Patras, 265 04 Patras, Greece
- First Department of Cardiology, University of Athens, Hippokration General Hospital, 115 27 Athens, Greece
| | | | - Elena Bousoula
- Department of Cardiology, General Hospital of Piraeus “Tzaneio”, 185 36 Piraeus, Greece
| | - Georgios Vasilagkos
- Department of Cardiology, University Hospital of Patras, 265 04 Patras, Greece
| | - Sotirios Tsalamandris
- First Department of Cardiology, University of Athens, Hippokration General Hospital, 115 27 Athens, Greece
| | - Ioannis Tsiafoutis
- First Department of Cardiology, Red Cross Hospital, 115 26 Athens, Greece
| | - Konstantinos Katsanos
- Department of Radiology, School of Medicine, University of Patras, 265 04 Patras, Greece
| | - Konstantinos Toutouzas
- First Department of Cardiology, University of Athens, Hippokration General Hospital, 115 27 Athens, Greece
| | - Adel Aminian
- Department of Cardiology, Centre Hospitalier Universitaire de Charleroi, 6042 Charleroi, Belgium
| | - Dimitrios Alexopoulos
- Second Department of Cardiology, University of Athens, Attikon University Hospital, 124 62 Athens, Greece
| | - Periklis Davlouros
- Department of Cardiology, University Hospital of Patras, 265 04 Patras, Greece
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8
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Theofilis P, Oikonomou E, Lazaros G, Vogiatzi G, Niarchou P, Goliopoulou A, Anastasiou M, Mistakidi VC, Tsalamandris S, Fountoulakis P, Papamikroulis GA, Tousoulis D. The Association of Depression With QT Duration: A Comparison Between Individuals Younger or Older Than 65 Years. Psychosom Med 2023; 85:18-25. [PMID: 36516316 DOI: 10.1097/psy.0000000000001152] [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: 12/15/2022]
Abstract
OBJECTIVE The electrocardiogram-derived corrected QT (QTc) interval is an indicator of cardiac autonomic activity that has been proposed as a biological measure to investigate the interplay between depression and cardiovascular diseases. This study assesses whether depression is associated with a longer QTc interval across age groups. METHODS Assessment of depressive symptoms was performed in 1637 participants of the cross-sectional Corinthia study with the Zung Self-Rating Depression Scale in those younger than 65 years (group 1) and with the Geriatric Depression Scale in elderly individuals (≥65 years, group 2). The QT interval was obtained from electrocardiogram recordings and corrected for heart rate (QTc). RESULTS Individuals in group 1 with depression were predominantly women and had a higher prevalence of coronary artery disease and diabetes mellitus. Group 1 individuals with depression had longer QTc duration (no depression versus depression, 389.3 [27.0] versus 401.1 [32.9] milliseconds; p < .001) and percentage of abnormal QTc (no depression versus depression, 2.0% versus 10.8%; p = .001) compared with those without depression. Elderly individuals (group 2) had similar values of QTc and percentage of abnormal QTc irrespective of depression status. Even after adjustment for known QT-prolonging factors, the presence of depression in younger individuals was associated with an increased QTc by 11.1 milliseconds and with an approximately 10.6-fold higher prevalence of abnormal QTc duration. CONCLUSIONS Depression was associated with a longer QTc interval especially in individuals younger than 65 years. These findings may indicate an interrelationship between depression and autonomic dysregulation as potential risk factors for cardiovascular disease and sudden cardiac death.
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Affiliation(s)
- Panagiotis Theofilis
- From the 1st Cardiology Clinic, Hippokration General Hospital, University of Athens Medical School, Athens, Greece
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Sagris M, Antonopoulos AS, Theofilis P, Oikonomou E, Siasos G, Tsalamandris S, Antoniades C, Brilakis ES, Kaski JC, Tousoulis D. Risk factors profile of young and older patients with myocardial infarction. Cardiovasc Res 2022; 118:2281-2292. [PMID: 34358302 DOI: 10.1093/cvr/cvab264] [Citation(s) in RCA: 37] [Impact Index Per Article: 18.5] [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: 12/18/2020] [Accepted: 08/03/2021] [Indexed: 12/18/2022] Open
Abstract
Myocardial infarction (MI) among young adults (<45 years) represents a considerable proportion of the total heart attack incidents. The underlying pathophysiologic characteristics, atherosclerotic plaque features, and risk factors profile differ between young and older patients with MI. This review article discusses the main differences between the younger and elderly MI patients as well as the different pathogenic mechanisms underlying the development of MI in the younger. Young patients with MI often have eccentric atherosclerotic plaques with inflammatory features but fewer lesions, and are more likely to be smokers, obese, and have poor lifestyle, such as inactivity and alcohol intake. Compared to older MI patients, younger are more likely to be men, have familial-combined hyperlipidaemia and increased levels of lipoprotein-a. In addition, MI in younger patients may be related to use of cannabis, cocaine use, and androgenic anabolic steroids. Genomic differences especially in the pathways of coagulation and lipid metabolism have also been identified between young and older patients with MI. Better understanding of the risk factors and the anatomic and pathophysiologic processes in young adults can improve MI prevention and treatment strategies in this patient group. Awareness could help identify young subjects at increased risk and guide primary prevention strategies. Additional studies focusing on gene pathways related to lipid metabolism, inflammation, and coagulation are needed.
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Affiliation(s)
- Marios Sagris
- Division of Cardiovascular Medicine, 1st Cardiology Clinic, 'Hippokration' General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens 115 27, Greece
| | - Alexios S Antonopoulos
- Division of Cardiovascular Medicine, 1st Cardiology Clinic, 'Hippokration' General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens 115 27, Greece
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford OX3 9DU, UK
| | - Panagiotis Theofilis
- Division of Cardiovascular Medicine, 1st Cardiology Clinic, 'Hippokration' General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens 115 27, Greece
| | - Evangelos Oikonomou
- Division of Cardiovascular Medicine, 1st Cardiology Clinic, 'Hippokration' General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens 115 27, Greece
| | - Gerasimos Siasos
- Division of Cardiovascular Medicine, 1st Cardiology Clinic, 'Hippokration' General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens 115 27, Greece
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Sotirios Tsalamandris
- Division of Cardiovascular Medicine, 1st Cardiology Clinic, 'Hippokration' General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens 115 27, Greece
| | - Charalambos Antoniades
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford OX3 9DU, UK
- Division of Cardiovascular Medicine, Oxford Centre of Research Excellence, British Heart Foundation, Oxford, OX3 9DU, UK
- Division of Cardiovascular Medicine, Oxford Biomedical Research Centre, National Institute of Health Research, Oxford, OX3 9DU, UK
| | - Emmanouil S Brilakis
- Division of Cardiovascular Medicine, Center for Coronary Artery Disease, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, MN 55407, USA
| | - Juan C Kaski
- Division of Cardiovascular Medicine, Molecular and Clinical Sciences Research Institute, St George's University of London, London SW17 0RE, UK
| | - Dimitris Tousoulis
- Division of Cardiovascular Medicine, 1st Cardiology Clinic, 'Hippokration' General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens 115 27, Greece
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10
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Theofilis P, Oikonomou E, Lazaros G, Vogiatzi G, Goliopoulou A, Chasikidis C, Mystakidi VX, Fountoulakis P, Christoforatou E, Tsalamandris S, Anastasiou M, Papakonstantinou M, Vavouranaki G, Siasos G, Tousoulis D. The impact of diabetes mellitus on carotid atherosclerosis and arterial stiffness; results from the Corinthia study. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2620] [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
Evaluation of arterial stiffness and carotid atherosclerotic burden can provide important prognostic information regarding the risk for future cardiovascular events. In that context, we tried to determine those vascular properties of diabetic individuals compared to non-diabetics.
Methods
In this analysis of the observational “Corinthia” study, we included 1757 participants with determined diabetic status. Propensity scores were employed to match diabetics to non-diabetics with regards to known cardiovascular risk factors. Carotid ultrasonography was performed to evaluate intima-media thickness (cIMT) across the common carotid arteries and the carotid bulbs as well as carotid plaque burden. Arterial stiffness was estimated via assessment of carotid-to-femoral pulse wave velocity (cfPWV).
Results
Diabetic individuals had increased mean cIMT (diabetics: 1.12±0.50mm vs. 0.94±0.38mm, p<0.001) and maximum cIMT (diabetics: 1.50±0.93mm vs. 1.20±0.71mm, p<0.001) when compared to non-diabetics (Figure 1, Panel A and B). Carotid plaque burden was also increased in diabetics (34.4% vs. 19.4% in non-diabetics, p<0.001) while bilateral plaques were observed in 14.2% of diabetics opposed to 8.2% of non-diabetics (p<0.001). Concerning arterial stiffness, individuals with DM had significantly higher values of cfPWV (10.6±3.4m/s vs. 8.8±2.5m/s in non-diabetics, p<0.001) (Figure 1, Panel C). In the propensity-matched cohort, mean cIMT (diabetics: 1.13±0.51mm vs. 0.98±0.38mm, p<0.001) and maximum cIMT (diabetics: 1.53±0.95mm vs. 1.24±0.73mm, p<0.001) were significantly higher in diabetics (Figure 2, Panel A and B), as well as carotid plaque burden (36.6% vs. 21.9% in non-diabetics, p<0.001). Analysis according to territory of cIMT measurement displayed substantial differences in left (diabetics: 1.30±0.76mm vs. non-diabetics: 1.06±0.58mm, p<0.001) and right carotid bulbs (diabetics: 1.30±0.82mm vs. non-diabetics: 1.07±0.57mm, p<0.001) with respect to DM (Figure 2, Panel C) but, unexpectedly, non-significant variations were observed in left (diabetics: 0.97±0.48mm vs. non-diabetics: 0.90±0.42mm, p=0.06) and right common carotid artery (diabetics: 0.95±0.50mm vs. non-diabetics: 0.90±0.40mm, p=0.21) (Figure 2, Panel D).
Conclusion
We observed increased carotid artery intima-media thickness and cfPWV in individuals with diabetes mellitus. As opposed to non-diabetics, carotid lesions in diabetics were more pronounced in the carotid bulb and not in the common carotid artery. Our findings may raise awareness regarding the focus of atherosclerotic echocardiographic examination in subjects with diabetes mellitus while the impact of glucose-lowering therapies on these specific vascular lesions merits further assessment.
Funding Acknowledgement
Type of funding sources: None. Figure 1Figure 2
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Affiliation(s)
- P Theofilis
- Hippokration General Hospital, 1st Department of Cardiology, Athens, Greece
| | - E Oikonomou
- Hippokration General Hospital, 1st Department of Cardiology, Athens, Greece
| | - G Lazaros
- Hippokration General Hospital, 1st Department of Cardiology, Athens, Greece
| | - G Vogiatzi
- Hippokration General Hospital, 1st Department of Cardiology, Athens, Greece
| | - A Goliopoulou
- Hippokration General Hospital, 1st Department of Cardiology, Athens, Greece
| | - C Chasikidis
- Hippokration General Hospital, 1st Department of Cardiology, Athens, Greece
| | - V X Mystakidi
- Hippokration General Hospital, 1st Department of Cardiology, Athens, Greece
| | - P Fountoulakis
- Hippokration General Hospital, 1st Department of Cardiology, Athens, Greece
| | - E Christoforatou
- Hippokration General Hospital, 1st Department of Cardiology, Athens, Greece
| | - S Tsalamandris
- Hippokration General Hospital, 1st Department of Cardiology, Athens, Greece
| | - M Anastasiou
- Hippokration General Hospital, 1st Department of Cardiology, Athens, Greece
| | - M Papakonstantinou
- Hippokration General Hospital, 1st Department of Cardiology, Athens, Greece
| | - G Vavouranaki
- Hippokration General Hospital, 1st Department of Cardiology, Athens, Greece
| | - G Siasos
- Hippokration General Hospital, 1st Department of Cardiology, Athens, Greece
| | - D Tousoulis
- Hippokration General Hospital, 1st Department of Cardiology, Athens, Greece
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Theofilis P, Oikonomou E, Vogiatzi G, Lazaros G, Mystakidi VX, Goliopoulou A, Anastasiou M, Tsalamandris S, Chasikidis C, Papakonstantinou M, Fountoulakis P, Christoforatou E, Siasos G, Tousoulis D. The impact of physical activity on arterial stiffness and inflammation; results from the “Corinthia” study. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2440] [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
Diminished physical activity (PA) is associated with cardiovascular morbidity and mortality. Arterial stiffness and inflammation are associated with atherosclerosis and are established risk factors for cardiovascular disease.
Purpose
We investigated the association of PA status on arterial stiffness and inflammation.
Methods
Classification of PA was performed in 2053 participants of the cross-sectional “Corinthia” study using the International Physical Activity Questionnaire (IPAQ). In accordance with the standard IPAQ scoring procedures, participants were classified into one of the following groups: upper tertile: “vigorous” PA-IPAQ 2, middle tertile: “moderate” PA-IPAQ 1 or lower tertile: “low” PA-IPAQ 0. Arterial stiffness was estimated via carotid-femoral pulse wave velocity (cfPWV) estimation and inflammatory burden was assessed via high sensitivity C reactive protein (hsCRP) measurement.
Results
Participants with low PA had impaired cfPWV values (IPAQ 0: 9.5±3.2 m/s vs. IPAQ 1: 8.7±2.4 m/s vs. IPAQ 2: 8.7±2.2 m/s, p<0.001) (Figure 1, Panel A) while abnormal cfPWV –adjusted for age and blood pressure- were more frequently encountered in low PA individuals (IPAQ 0: 14% vs. IPAQ 1: 7.8% vs. IPAQ 2: 7.3%, p=0.001) (Figure 1, Panel B). Participants characterized as having vigorous physical activity had the lowest inflammatory burden, as estimated by hsCRP (IPAQ 0: 4.8±6.4 g/l vs. IPAQ 1: 4.6±5.2 g/l vs. IPAQ 2: 3.6±4.2 g/l, p=0.001) (Figure 1, Panel C). Importantly, results remained unaffected even after adjustment for confounders (Figure 1, Panel D). A correlation analysis between the total weekly physical activity (expressed as MET minutes/week) and arterial stiffness was performed demonstrating a statistically significant negative correlation was noted (r=−0.120, p<0.001) (Figure 1, Panel E).
Conclusion
A significant association between physical activity, arterial stiffness and inflammation was observed, even after adjusting for known cardiovascular risk factors. Our findings should raise public awareness about the beneficial effects of exercise on cardiovascular health.
Funding Acknowledgement
Type of funding sources: None. Figure 1
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Affiliation(s)
- P Theofilis
- Hippokration General Hospital, 1st Department of Cardiology, Athens, Greece
| | - E Oikonomou
- Hippokration General Hospital, 1st Department of Cardiology, Athens, Greece
| | - G Vogiatzi
- Hippokration General Hospital, 1st Department of Cardiology, Athens, Greece
| | - G Lazaros
- Hippokration General Hospital, 1st Department of Cardiology, Athens, Greece
| | - V X Mystakidi
- Hippokration General Hospital, 1st Department of Cardiology, Athens, Greece
| | - A Goliopoulou
- Hippokration General Hospital, 1st Department of Cardiology, Athens, Greece
| | - M Anastasiou
- Hippokration General Hospital, 1st Department of Cardiology, Athens, Greece
| | - S Tsalamandris
- Hippokration General Hospital, 1st Department of Cardiology, Athens, Greece
| | - C Chasikidis
- Hippokration General Hospital, 1st Department of Cardiology, Athens, Greece
| | - M Papakonstantinou
- Hippokration General Hospital, 1st Department of Cardiology, Athens, Greece
| | - P Fountoulakis
- Hippokration General Hospital, 1st Department of Cardiology, Athens, Greece
| | - E Christoforatou
- Hippokration General Hospital, 1st Department of Cardiology, Athens, Greece
| | - G Siasos
- Hippokration General Hospital, 1st Department of Cardiology, Athens, Greece
| | - D Tousoulis
- Hippokration General Hospital, 1st Department of Cardiology, Athens, Greece
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Theofilis P, Oikonomou E, Lazaros G, Vogiatzi G, Tsalamandris S, Chasikidis C, Fountoulakis P, Anastasiou M, Goliopoulou A, Mystakidi VX, Papakonstantinou M, Christoforatou E, Siasos G, Tousoulis D. Emotional and cardiovascular health: the impact of depression on cardiac autonomic activity. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
The coexistence of depression and cardiovascular diseases is frequently accompanied by an increased risk of adverse outcomes. QTc, an indicator of ventricular depolarization and cardiac autonomic activity, has been proposed as a biomarker of this interplay.
Purpose
We aimed to investigate the possible association of depression with QTc interval.
Methods
Assessment of depressive symptoms was performed in 1637 participants of the cross-sectional Corinthia study with the Zung self-rating depression scale in those younger than 65 years of age (Group 1) and with the geriatric depression scale in elderly individuals (>65 years, Group 2). Moreover, electrocardiogram was performed and measurement of the QT interval was derived after correction for heart rate (QTc) using the Bazett's formula. Abnormal QTc was present when QTc duration exceeded 440 ms.
Results
Group 1 individuals classified as having depression had longer QTc duration (No depression: 389.3±27.0 ms vs. Depression: 401.1±32.9 ms, p<0.001) and percentage of abnormal QTc (No depression: 2.0% vs. Depression: 10.8%, p=0.001) (Figure 1, Panels A and B). Elderly individuals had similar values of QTc (No depression: 409.9±29.6 ms vs. Depression: 405.2±46.4 ms, p=0.37) and percentage of abnormal QTc (No depression: 13.2% vs. Depression: 12.3%, p=0.78) irrespective of depression status (Figure 1, Panels C and D). The presence of depression in Group 1 subjects was associated with an increased QTc- by 10.8 ms and with an approximately 7-fold higher prevalence of abnormal QTc duration, even after adjustment for confounders (). Such finding was not detected in elderly individuals (Figure 1, Panel F).
Conclusion
Depression might adversely affect ventricular repolarization especially in middle-aged subjects. These findings highlight the interrelationship between emotional and cardiovascular health and the role of depression as a cardiovascular risk factor.
Funding Acknowledgement
Type of funding sources: None. Figure 1
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Affiliation(s)
- P Theofilis
- Hippokration General Hospital, 1st Department of Cardiology, Athens, Greece
| | - E Oikonomou
- Hippokration General Hospital, 1st Department of Cardiology, Athens, Greece
| | - G Lazaros
- Hippokration General Hospital, 1st Department of Cardiology, Athens, Greece
| | - G Vogiatzi
- Hippokration General Hospital, 1st Department of Cardiology, Athens, Greece
| | - S Tsalamandris
- Hippokration General Hospital, 1st Department of Cardiology, Athens, Greece
| | - C Chasikidis
- Hippokration General Hospital, 1st Department of Cardiology, Athens, Greece
| | - P Fountoulakis
- Hippokration General Hospital, 1st Department of Cardiology, Athens, Greece
| | - M Anastasiou
- Hippokration General Hospital, 1st Department of Cardiology, Athens, Greece
| | - A Goliopoulou
- Hippokration General Hospital, 1st Department of Cardiology, Athens, Greece
| | - V X Mystakidi
- Hippokration General Hospital, 1st Department of Cardiology, Athens, Greece
| | - M Papakonstantinou
- Hippokration General Hospital, 1st Department of Cardiology, Athens, Greece
| | - E Christoforatou
- Hippokration General Hospital, 1st Department of Cardiology, Athens, Greece
| | - G Siasos
- Hippokration General Hospital, 1st Department of Cardiology, Athens, Greece
| | - D Tousoulis
- Hippokration General Hospital, 1st Department of Cardiology, Athens, Greece
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Stathogiannis K, Synetos A, Latsios G, Karanasos A, Trantalis G, Toskas P, Drakopoulou M, Xanthopoulou M, Karmpalioti M, Simopoulou C, Soulaidopoulos S, Oikonomou G, Benetos G, Tsalamandris S, Kosmas I, Voudris V, Mastrokostopoulos A, Katsimagklis G, Halvatsiotis P, Deftereos S, Tsioufis C, Toutouzas K. Long-Term Outcomes and Valve Performance in Patients Undergoing Transcatheter Aortic Valve Implantation. Am J Cardiol 2021; 147:80-87. [PMID: 33621524 DOI: 10.1016/j.amjcard.2021.02.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 01/29/2021] [Accepted: 02/02/2021] [Indexed: 11/26/2022]
Abstract
Transcatheter aortic valve implantation (TAVI) is an established method for treating patients with aortic valve stenosis. We sought to determine the long-term clinical outcomes and performance of a self-expanding bioprosthesis beyond 5 years. Consecutive patients scheduled for TAVI were included in the analysis. Primary end points were all-cause and cardiovascular mortality, structural valve deterioration (SVD) and bioprosthetic valve failure (BVF), based on the VARC-2 criteria and consensus statement by ESC/EAPCI. The study prospectively evaluated 273 patients (80.61 ± 7.00 years old, 47% females) who underwent TAVI with CoreValve/Evolut-R (Medtronic Inc.). The median follow-up duration was 5 years (interquartile range: 2.9 to 6; longest: 8 years). At 1, 5, and 8 years, estimated survival rates were 89.0%, 61.1%, and 56.0%, respectively, while cardiovascular mortality was 8% at the end of follow-up. Regarding valve performance, 5% of patients had early BVF and 1% had late BVF. Concerning SVD, 16 patients (6% of the total population) had moderate SVD (91% had an increase in mean gradient), with no severe SVD cases. Five patients with SVD died during follow-up. Actual analysis of the 8-year cumulative incidence of function of moderate SVD was 5.9% (2.5% to 16.2%). At multivariate analysis, the factor that emerged as an independent predictor for future SVD, was smaller bioprosthetic valve size (HR 0.58, 95% CI 0.41 to 0.82, p = 0.002). Long-term evaluation beyond 5 years after TAVI with a self-expanding bioprosthesis demonstrated low rates of cardiovascular mortality and structural valve deterioration. Valve size was an independent predictor for SVD.
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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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15
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Oikonomou E, Theofilis P, Vogiatzi G, Lazaros G, Tsalamandris S, Mystakidi VC, Goliopoulou A, Anastasiou M, Fountoulakis P, Chasikidis C, Christoforatou E, Tousoulis D. The impact of sleeping duration on atherosclerosis in the community: insights from the Corinthia study. Sleep Breath 2021; 25:1813-1819. [PMID: 33411185 DOI: 10.1007/s11325-020-02267-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 11/22/2020] [Accepted: 11/28/2020] [Indexed: 01/21/2023]
Abstract
PURPOSE Sleep is an essential physiologic process whose disturbances have been regarded as a risk factor in various pathophysiologic processes, including atherosclerosis and cardiovascular disease. Although the negative influence of short sleep duration has been well-established, recent data suggest a possible harmful effect of prolonged sleeping pattern. METHODS In the setting of the Corinthia cross-sectional study, self-reported night sleep duration was recorded in 1752 apparently healthy individuals and was classified as normal sleep duration (NSD, 7-8 h), short sleep duration (SSD, 6-7 h), very short sleep duration (VSSD, < 6 h), and long sleep duration (LSD, > 8 h). Carotid duplex ultrasonography was performed in order to measure the mean and maximum carotid intima-media thickness (cIMT) as a non-invasive marker of atherosclerosis. RESULTS Subjects with LSD and VSSD had significantly higher mean cIMT (VSSD: 1.02 ± 0.45 mm, SSD: 0.95 ± 0.35, NSD: 0.96 ± 0.38 mm, LSD: 1.07 ± 0.52 mm; p < 0.001) and maximum cIMT (VSSD: 1.39 ± 0.9 mm, SSD: 1.25 ± 0.71 mm, NSD: 1.23 ± 0.76 mm, LSD: 1.41 ± 0.93 mm). Following a regression analysis adjusting for known cardiovascular risk factors, individuals with LSD and VSSD had higher mean cIMT by 0.054 mm and 0.067 mm respectively compared to those with NSD. CONCLUSION A balanced sleeping duration of 6-8 h is associated with decreased mean and maximum IMT while both very short sleep duration and long sleep duration are associated with increased carotid intima-media thickness, a marker of subclinical atherosclerosis.
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Affiliation(s)
- Evangelos Oikonomou
- 1st Cardiology Clinic, 'Hippokration' General Hospital, National and Kapodistrian University of Athens, School of Medicine, Vasilissis Sofias 114, 115 28, Athens, Greece
| | - Panagiotis Theofilis
- 1st Cardiology Clinic, 'Hippokration' General Hospital, National and Kapodistrian University of Athens, School of Medicine, Vasilissis Sofias 114, 115 28, Athens, Greece
| | - Georgia Vogiatzi
- 1st Cardiology Clinic, 'Hippokration' General Hospital, National and Kapodistrian University of Athens, School of Medicine, Vasilissis Sofias 114, 115 28, Athens, Greece.
| | - George Lazaros
- 1st Cardiology Clinic, 'Hippokration' General Hospital, National and Kapodistrian University of Athens, School of Medicine, Vasilissis Sofias 114, 115 28, Athens, Greece
| | - Sotirios Tsalamandris
- 1st Cardiology Clinic, 'Hippokration' General Hospital, National and Kapodistrian University of Athens, School of Medicine, Vasilissis Sofias 114, 115 28, Athens, Greece
| | - Vasiliki Chara Mystakidi
- 1st Cardiology Clinic, 'Hippokration' General Hospital, National and Kapodistrian University of Athens, School of Medicine, Vasilissis Sofias 114, 115 28, Athens, Greece
| | - Athina Goliopoulou
- 1st Cardiology Clinic, 'Hippokration' General Hospital, National and Kapodistrian University of Athens, School of Medicine, Vasilissis Sofias 114, 115 28, Athens, Greece
| | - Maria Anastasiou
- 1st Cardiology Clinic, 'Hippokration' General Hospital, National and Kapodistrian University of Athens, School of Medicine, Vasilissis Sofias 114, 115 28, Athens, Greece
| | - Petros Fountoulakis
- 1st Cardiology Clinic, 'Hippokration' General Hospital, National and Kapodistrian University of Athens, School of Medicine, Vasilissis Sofias 114, 115 28, Athens, Greece
| | - Christos Chasikidis
- 1st Cardiology Clinic, 'Hippokration' General Hospital, National and Kapodistrian University of Athens, School of Medicine, Vasilissis Sofias 114, 115 28, Athens, Greece
| | - Evangelia Christoforatou
- 1st Cardiology Clinic, 'Hippokration' General Hospital, National and Kapodistrian University of Athens, School of Medicine, Vasilissis Sofias 114, 115 28, Athens, Greece
| | - Dimitris Tousoulis
- 1st Cardiology Clinic, 'Hippokration' General Hospital, National and Kapodistrian University of Athens, School of Medicine, Vasilissis Sofias 114, 115 28, Athens, Greece
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Fountoulakis P, Oikonomou E, Papaioannou T, Tsalamandris S, Papamikroulis G, Pallantza Z, Pavlou E, Milliou A, Assimakopoulou M, Barbaresos N, Giannarakis I, Siamata P, Tousoulis D. Implications of diesel exhaust fumes exposure on vascular wall properties, endothelial function and inflammatory process. Atherosclerosis 2020. [DOI: 10.1016/j.atherosclerosis.2020.10.690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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17
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Theofilis P, Oikonomou E, Vogiatzi G, Lazaros G, Tsalamandris S, Mystakidi V, Goliopoulou A, Chasikidis C, Miliou A, Fountoulakis P, Papaioannou N, Papakonstantinou M, Tousoulis D. Association of habitual alcohol consumption with carotid atherosclerotic lesions: results from the Corinthia study. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2863] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Alcohol is implicated in the pathophysiology of cardiovascular diseases. However, it is also believed to play a cardioprotective role if consumed in appropriate amounts.
Purpose
To assess the association between alcohol consumption and carotid atherosclerosis.
Methods
In the setting of the cross-sectional Corinthia study, volunteers filled in questionnaires regarding drinking habits and were characterized as social drinkers (SD) or habitual alcohol consumers (HAC). Furthermore, they underwent carotid ultrasonography examination to evaluate the carotid intima-media thickness (cIMT). Thickness of cIMT>1.5 mm or protrusion >50% compared to adjacent segments was considered as atherosclerotic plaque.
Results
HAC consumers were usually male (HAC: 61.1%, SD: 24.9%, p<0.001), smokers (HAC: 33.3%, SD: 23.5%, p<0.001) and frequently had a history of hypertension (HAC: 72.8%, SD: 67.5%, p=0.02) when compared to SD (Table 1). However, no significant differences were noted regarding other risk factors of atherosclerosis (Table). Notably, HAC had a greater extent of carotid atherosclerosis as demonstrated by an increased cIMT (HAC: 1.03±0.45mm, SD: 0.96±0.39mm, p<0.001) and carotid plaque burden (HAC: 27.7%, SD: 21.3%, p=0.004). Importantly, when taking into account the number of alcoholic drinks (in wine glasses), alcohol consumption of more than 1 wine glass resulted in significantly higher values of cIMT (1 wine glass: 1.00±0.42mm, >1 wine glass: 1.06±0.45mm, p=0.04) (Figure 1A) and extensive amount of carotid plaques (1 wine glass: 22.7%, >1 wine glass: 30.4%, p=0.02) when compared to consumption of 1 wine glass (Figure 1B).
Conclusion
Habitual alcohol consumption of more than one wine glass is associated with a higher carotid atherosclerotic burden.
Figure 1
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- P Theofilis
- National & Kapodistrian University of Athens Medical School, 1st Cardiology Clinic, Hippokration Hospital, Athens, Greece
| | - E Oikonomou
- National & Kapodistrian University of Athens, Athens, Greece
| | - G Vogiatzi
- National & Kapodistrian University of Athens Medical School, 1st Cardiology Clinic, Hippokration Hospital, Athens, Greece
| | - G Lazaros
- National & Kapodistrian University of Athens Medical School, 1st Cardiology Clinic, Hippokration Hospital, Athens, Greece
| | - S Tsalamandris
- National & Kapodistrian University of Athens Medical School, 1st Cardiology Clinic, Hippokration Hospital, Athens, Greece
| | - V.C Mystakidi
- National & Kapodistrian University of Athens Medical School, 1st Cardiology Clinic, Hippokration Hospital, Athens, Greece
| | - A Goliopoulou
- National & Kapodistrian University of Athens Medical School, 1st Cardiology Clinic, Hippokration Hospital, Athens, Greece
| | - C Chasikidis
- National & Kapodistrian University of Athens Medical School, 1st Cardiology Clinic, Hippokration Hospital, Athens, Greece
| | - A Miliou
- National & Kapodistrian University of Athens Medical School, 1st Cardiology Clinic, Hippokration Hospital, Athens, Greece
| | - P Fountoulakis
- National & Kapodistrian University of Athens Medical School, 1st Cardiology Clinic, Hippokration Hospital, Athens, Greece
| | - N Papaioannou
- National & Kapodistrian University of Athens Medical School, 1st Cardiology Clinic, Hippokration Hospital, Athens, Greece
| | - M Papakonstantinou
- National & Kapodistrian University of Athens Medical School, 1st Cardiology Clinic, Hippokration Hospital, Athens, Greece
| | - D Tousoulis
- National & Kapodistrian University of Athens Medical School, 1st Cardiology Clinic, Hippokration Hospital, Athens, Greece
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18
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Theofilis P, Oikonomou E, Vogiatzi G, Lazaros G, Mystakidi V, Barbaresos N, Tasios P, Tsalamandris S, Fountoulakis P, Miliou A, Papaioannou N, Asimakopoulos M, Tousoulis D. Increased exposure to air pollutants leads to greater atherosclerotic burden mediated by systemic inflammation. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.3075] [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
Introduction
Air pollution has been a well-described environmental factor contributing significantly to the global disease burden.
Purpose
To examine the association of gaseous air pollutants with atherosclerosis, especially in subjects with coronary artery disease (CAD).
Methods
2053 individuals enrolled in the Corinthia study underwent clinical and biochemical assessment followed by carotid ultrasonography to evaluate carotid intima-media thickness (cIMT) and plaque burden. Inflammation was estimated via measurement of C-Reactive protein (CRP). Air pollutants concentration analysis was performed in prespecified regions with respect to their proximity to heavy industries, highways and shipyards.
Results
A higher concentration of gaseous air pollutants was observed in Region 4 when compared to other regions (Table). Mean cIMT, maximum cIMT and carotid plaque burden were significantly increased in individuals of Region 4 (Table, Figure A and B), a result which remained unaffected after adjustment for cardiovascular confounders (Figure C). In parallel, inhabitants of Region 4 had higher levels of CRP (Region 1: 4.60±5.01mg/l; Region 2: 3.08±3.26mg/l; Region 3: 4.37±4.70mg/l, Region 4: 6.78±9.77mg/l, p<0.001). To examine the effect of air pollution on atherosclerosis in CAD, propensity scores were applied to match healthy controls with CAD subjects in terms of atherosclerosis risk factors resulting in two matched groups; one in regions 1, 2 and 3 -low air pollution areas (LAPA)- and another in region 4 -high air pollution area (HAPA). Interestingly, we noted substantially higher inter-area differences in mean cIMT of CAD individuals (Figure D).
Conclusion
Air pollution may significantly contribute to atherosclerosis progression, potentially via the induction of inflammation. A more pronounced effect was noted in CAD individuals exposed to high air pollution.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- P Theofilis
- National & Kapodistrian University of Athens Medical School, 1st Cardiology Clinic, Hippokration Hospital, Athens, Greece
| | - E Oikonomou
- National & Kapodistrian University of Athens Medical School, 1st Cardiology Clinic, Hippokration Hospital, Athens, Greece
| | - G Vogiatzi
- National & Kapodistrian University of Athens Medical School, 1st Cardiology Clinic, Hippokration Hospital, Athens, Greece
| | - G Lazaros
- National & Kapodistrian University of Athens Medical School, 1st Cardiology Clinic, Hippokration Hospital, Athens, Greece
| | - V.C Mystakidi
- National & Kapodistrian University of Athens Medical School, 1st Cardiology Clinic, Hippokration Hospital, Athens, Greece
| | - N Barbaresos
- University of Athens, Department of Applied Physics, Faculty of Physics, Athens, Greece
| | - P Tasios
- University of Athens, Department of Applied Physics, Faculty of Physics, Athens, Greece
| | - S Tsalamandris
- National & Kapodistrian University of Athens Medical School, 1st Cardiology Clinic, Hippokration Hospital, Athens, Greece
| | - P Fountoulakis
- National & Kapodistrian University of Athens Medical School, 1st Cardiology Clinic, Hippokration Hospital, Athens, Greece
| | - A Miliou
- National & Kapodistrian University of Athens Medical School, 1st Cardiology Clinic, Hippokration Hospital, Athens, Greece
| | - N Papaioannou
- National & Kapodistrian University of Athens Medical School, 1st Cardiology Clinic, Hippokration Hospital, Athens, Greece
| | - M.N Asimakopoulos
- University of Athens, Department of Applied Physics, Faculty of Physics, Athens, Greece
| | - D Tousoulis
- National & Kapodistrian University of Athens Medical School, 1st Cardiology Clinic, Hippokration Hospital, Athens, Greece
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Theofilis P, Oikonomou E, Vogiatzi G, Lazaros G, Tsalamandris S, Mystakidi V, Goliopoulou A, Fountoulakis P, Miliou A, Chasikidis C, Tousoulis D. Depression in young adults is associated with increased carotid atherosclerotic burden: insights from the Corinthia study. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
Depression appears to have a detrimental effect not only on mental health but also in the progression of various diseases.
Purpose
The examination of a potential association between depression and atherosclerosis progression in a rural population.
Methods
In the context of the cross-sectional Corinthia study, volunteers fulfilled a questionnaire concerning emotional health. The Geriatric Depression Scale was used for individuals aged 60 or more while the Zung self-rating depression score was preferred in younger adults. Carotid ultrasonography examination was performed to evaluate the mean carotid intima-media thickness (cIMT). Thickness of cIMT>1.5 mm or protrusion >50% compared to adjacent segments was considered as atherosclerotic plaque.
Results
Young adults with significant depression were usually female and did not differ significantly on other risk factors of atherosclerosis compared to those with mild or no depressive disorder. Importantly, those with moderate-severe depression appeared to have increased mean cIMT (Mild-No depression: 0.85±0.30mm, Moderate-severe depression: 0.91±0.42mm, p=0.04) and a higher carotid plaque burden (Mild-No depression: 12.8%, Moderate-severe depression: 20.3%, p=0.04). With regards to the elderly, those with moderate-severe depression were usually smokers (Mild-No depression: 13.9%, Moderate-severe depression: 24.2%, p=0.01). However, mean cIMT (Mild-No depression: 1.11±0.47mm, Moderate-severe depression: 1.09±0.39mm, p=0.69) and carotid plaques (Mild-No depression: 31.1%, Moderate-severe depression: 36.1%, p=0.36) did not differ according to depression status in this subgroup.
Conclusion
Significant depressive disorder is associated with accelerated carotid atherosclerosis in young individuals.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- P Theofilis
- National & Kapodistrian University of Athens Medical School, 1st Cardiology Clinic, Hippokration Hospital, Athens, Greece
| | - E Oikonomou
- National & Kapodistrian University of Athens Medical School, 1st Cardiology Clinic, Hippokration Hospital, Athens, Greece
| | - G Vogiatzi
- National & Kapodistrian University of Athens Medical School, 1st Cardiology Clinic, Hippokration Hospital, Athens, Greece
| | - G Lazaros
- National & Kapodistrian University of Athens Medical School, 1st Cardiology Clinic, Hippokration Hospital, Athens, Greece
| | - S Tsalamandris
- National & Kapodistrian University of Athens Medical School, 1st Cardiology Clinic, Hippokration Hospital, Athens, Greece
| | - V.C Mystakidi
- National & Kapodistrian University of Athens Medical School, 1st Cardiology Clinic, Hippokration Hospital, Athens, Greece
| | - A Goliopoulou
- National & Kapodistrian University of Athens Medical School, 1st Cardiology Clinic, Hippokration Hospital, Athens, Greece
| | - P Fountoulakis
- National & Kapodistrian University of Athens Medical School, 1st Cardiology Clinic, Hippokration Hospital, Athens, Greece
| | - A Miliou
- National & Kapodistrian University of Athens Medical School, 1st Cardiology Clinic, Hippokration Hospital, Athens, Greece
| | - C Chasikidis
- National & Kapodistrian University of Athens Medical School, 1st Cardiology Clinic, Hippokration Hospital, Athens, Greece
| | - D Tousoulis
- National & Kapodistrian University of Athens Medical School, 1st Cardiology Clinic, Hippokration Hospital, Athens, Greece
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Anastasiou M, Oikonomou E, Vogiatzi G, Siasos G, Flora Z, Antonopoulos A, Tsalamandris S, Bamias A, Dimopoulos M, Tousoulis D. Differential effect of anthracycline and trastuzumab cancer therapeutic related vascular toxicity in patients with breast cancer. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.3287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
Both anthracyclines and trastuzumab are key regiments for the treatment of breast cancer, but their concurrent use is contraindicated because of their cardiotoxicity. Their effects on vascular function have been less well studied.
Purpose
We explored the effects of the anthracycline-based chemotherapy followed by trastuzumab-based treatment on endothelial function and arterial stiffness in patients with breast cancer.
Methods
46 female patients (54.56±11.5 years old) with breast cancer scheduled for anthracycline-based chemotherapy followed by the combination of trastuzumab and taxane were enrolled. Trastuzumab was continued until the completion of one-year treatment. All participants underwent assessment of the brachial flow mediated dilatation (FMD), endothelial independent dilatation (EID), carotid-femoral pulse wave velocity (PWV) and augmentation index (AIx) at baseline (BL), at the end of anthracycline treatment (FU1), 3 months following initiation of trastuzumab with taxane (FU2) and at the completion of treatment with trastuzumab (FU3).
Results
Over the follow-up period (15 months) there was significant deterioration in FMD (p=0.04) (Table 1, Figure 1). Importantly, while there was no significant difference in FMD between BL vs FU1 (p=0.6), FMD has been significantly deteriorated over the treatment with trastuzumab with taxane FU1 vs FU2 (p=0.01) and FU2 vs FU3 (p=0.01) (Table 1, Figure 1). EID did not change over the follow-up period (Figure 1). Similarly, PWV has been significantly increased over the follow up period (p=0.03). There was no significant difference in PWV BL vs FU1 (p=0.1), however PWV has been significantly increased over the treatment with trastuzumab with taxane FU1 vs FU 2 (p=0.02) and FU2 vs FU3 (p=0.01) (Table 1, Figure 1). A similar pattern of impairment was observed with AIx (Table 1, Figure 1).
Conclusion
We report a significant adverse effect of the anthracycline- and trastuzumab-based therapy on the arterial stiffness and endothelial function. This effect is more considerable after the exposure to trastuzumab.
Figure 1. Changes of FMD, PWV, Alx, EID during FU
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- M Anastasiou
- National & Kapodistrian University of Athens Medical School, 1st Cardiology Clinic, Hippokration Hospital, Athens, Greece
| | - E Oikonomou
- National & Kapodistrian University of Athens Medical School, 1st Cardiology Clinic, Hippokration Hospital, Athens, Greece
| | - G Vogiatzi
- National & Kapodistrian University of Athens Medical School, 1st Cardiology Clinic, Hippokration Hospital, Athens, Greece
| | - G Siasos
- National & Kapodistrian University of Athens Medical School, 1st Cardiology Clinic, Hippokration Hospital, Athens, Greece
| | - Z Flora
- National & Kapodistrian University of Athens Medical School, Department of Clinical Therapeutics, Alexandra General Hospital, Athens, Greece
| | - A.S Antonopoulos
- National & Kapodistrian University of Athens Medical School, 1st Cardiology Clinic, Hippokration Hospital, Athens, Greece
| | - S Tsalamandris
- National & Kapodistrian University of Athens Medical School, 1st Cardiology Clinic, Hippokration Hospital, Athens, Greece
| | - A Bamias
- National & Kapodistrian University of Athens Medical School, Department of Clinical Therapeutics, Alexandra General Hospital, Athens, Greece
| | - M.A Dimopoulos
- National & Kapodistrian University of Athens Medical School, Department of Clinical Therapeutics, Alexandra General Hospital, Athens, Greece
| | - D Tousoulis
- National & Kapodistrian University of Athens Medical School, 1st Cardiology Clinic, Hippokration Hospital, Athens, Greece
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21
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Oikonomou E, Vogiatzi G, Lazaros G, Tsalamandris S, Goliopoulou A, Mystakidou V, Theofilis P, Christoforatou E, Chasikidis C, Tousoulis D. Relationship of depressive symptoms with arterial stiffness and carotid atherosclerotic burden in the Corinthia study. QJM 2020; 113:633-642. [PMID: 32125429 DOI: 10.1093/qjmed/hcaa079] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 12/26/2019] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND It has been long hypothesized that emotional factors and depression may play role in the development of cardiovascular diseases. AIM The aim of this study was to examine the association between depression, arterial stiffness and atheromatic burden in carotid arteries. DESIGN AND METHODS Corinthia study is a cross-sectional epidemiological study conducted in subjects aged 40-99 years, inhabitants of the homonym region of Greece. Intima media thickness (IMT) was measured in the left and right common carotid artery, carotid bulb and internal carotid artery. The average of the measurements (mean IMT) and the maximum IMT were determined as the representative value of carotid atherosclerosis burden. Pulse wave velocity was used to evaluate arterial stiffness. The Zung Self-Rating Depression Scale was used to evaluate depressive symptoms in subjects <65 years and the Geriatric Depression Scale in those >65 years. RESULTS In this analysis, we included data from 1510 participants. In older subjects (i.e. >65 years), maximum IMT was significantly increased in subjects with depression compared to those without (1.57 ± 0.97 mm vs. 1.74 ± 1.05 mm, P = 0.04). Similarly, the prevalence of atheromatic plaques was higher in subjects with depression (46% vs. 34%, P = 0.005). In the younger subgroup (<65years), there was no difference in mean and maximum IMT. Pulse wave velocity was found higher in the presence of depression (8.35 ± 2.36m/s vs. 7.88 ± 1.77m/s, P = 0.007). No differences emerged for the rest of the variables assessed in the individual subgroups. CONCLUSIONS There is an age-dependent association between depression, arterial stiffness and carotid atheromatic burden highlighting the interplay between cardiovascular diseases and emotional status.
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Affiliation(s)
- E Oikonomou
- 1st Cardiology Clinic, 'Hippokration' General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - G Vogiatzi
- 1st Cardiology Clinic, 'Hippokration' General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - G Lazaros
- 1st Cardiology Clinic, 'Hippokration' General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - S Tsalamandris
- 1st Cardiology Clinic, 'Hippokration' General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - A Goliopoulou
- 1st Cardiology Clinic, 'Hippokration' General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - V Mystakidou
- 1st Cardiology Clinic, 'Hippokration' General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - P Theofilis
- 1st Cardiology Clinic, 'Hippokration' General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - E Christoforatou
- 1st Cardiology Clinic, 'Hippokration' General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - C Chasikidis
- 1st Cardiology Clinic, 'Hippokration' General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - D Tousoulis
- 1st Cardiology Clinic, 'Hippokration' General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
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Oikonomou E, Aznaouridis K, Barbetseas J, Charalambous G, Gastouniotis I, Fotopoulos V, Gkini KP, Katsivas A, Koudounis G, Koudounis P, Koutouzis M, Lamprinos D, Lazaris E, Lazaris E, Lazaros G, Marinos G, Platogiannis N, Platogiannis D, Siasos G, Terentes-Printzios D, Theodoropoulou A, Theofilis P, Toutouzas K, Tsalamandris S, Tsiafoutis I, Vavouranakis M, Vogiatzi G, Zografos T, Baka E, Tousoulis D, Vlachopoulos C. Hospital attendance and admission trends for cardiac diseases during the COVID-19 outbreak and lockdown in Greece. Public Health 2020; 187:115-119. [PMID: 32949881 PMCID: PMC7434308 DOI: 10.1016/j.puhe.2020.08.007] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 07/29/2020] [Accepted: 08/12/2020] [Indexed: 11/25/2022]
Abstract
Objectives The coronavirus disease 2019 (COVID-19) outbreak, along with implementation of lockdown and strict public movement restrictions, in Greece has affected hospital visits and admissions. We aimed to investigate trends of cardiac disease admissions during the outbreak of the pandemic and possible associations with the applied restrictive measures. Study design This is a retrospective observational study. Methods Data for 4970 patients admitted via the cardiology emergency department (ED) across 3 large-volume urban hospitals in Athens and 2 regional/rural hospitals from February 3, 2020, up to April 12 were recorded. Data from the equivalent (for the COVID-19 outbreak) time period of 2019 and from the postlockdown time period were also collected. Results A falling trend of cardiology ED visits and hospital admissions was observed starting from the week when the restrictive measures due to COVID-19 were implemented. Compared with the pre–COVID-19 outbreak time period, acute coronary syndrome (ACS) [145 (29/week) vs. 60 (12/week), −59%, P < 0.001], ST elevation myocardial infarction [46 (9.2/week) vs. 21 (4.2/week), −54%, P = 0.002], and non-ST elevation ACS [99 cases (19.8/week) vs. 39 (7.8/week), −60% P < 0.001] were reduced at the COVID-19 outbreak time period. Reductions were also noted for heart failure worsening and arrhythmias. The ED visits in the postlockdown period were significantly higher than in the COVID-19 outbreak time period (1511 vs 660; P < 0.05). Conclusion Our data show significant drops in cardiology visits and admissions during the COVID-19 outbreak time period. Whether this results from restrictive measures or depicts a true reduction of cardiac disease cases warrants further investigation. The coronavirus disease 2019 (COVID-19) outbreak has led to an unprecedented health system overload. The restrictive measures in Greece resulted in a low number of COVID-19 cases. Hospital visits and cardiovascular events have diminished after implementation of restrictive measures. Acute coronary syndromes reduced by approximately 55%, despite limited incidence of COVID-19. The multifactorial etiology of this finding should be thoroughly investigated.
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Affiliation(s)
- E Oikonomou
- 1st Cardiology Clinic, 'Hippokration' General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece; Emergency Department, Hippokration' General Hospital, Athens, Greece.
| | - K Aznaouridis
- 1st Cardiology Clinic, 'Hippokration' General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - J Barbetseas
- Department of Cardiology, Laiko General Hospital, Athens, Greece
| | - G Charalambous
- Emergency Department, Hippokration' General Hospital, Athens, Greece
| | - I Gastouniotis
- Emergency Department, Hippokration' General Hospital, Athens, Greece
| | - V Fotopoulos
- Emergency Department, Laiko General Hospital, Athens, Greece
| | - K-P Gkini
- Athens Red Cross Hospital, 2nd Department of Cardiology, Athens, Greece
| | - A Katsivas
- Athens Red Cross Hospital, 1st Department of Cardiology, Athens, Greece
| | - G Koudounis
- General Hospital of Kalamata, Department of Cardiology, Kalamata, Greece
| | - P Koudounis
- General Hospital of Kalamata, Department of Cardiology, Kalamata, Greece
| | - M Koutouzis
- Athens Red Cross Hospital, 2nd Department of Cardiology, Athens, Greece
| | - D Lamprinos
- Emergency Department, Laiko General Hospital, Athens, Greece
| | - E Lazaris
- Athens Red Cross Hospital, 2nd Department of Cardiology, Athens, Greece
| | - E Lazaris
- Athens Red Cross Hospital, 2nd Department of Cardiology, Athens, Greece
| | - G Lazaros
- 1st Cardiology Clinic, 'Hippokration' General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - G Marinos
- Emergency Department, Laiko General Hospital, Athens, Greece
| | - N Platogiannis
- General Hospital of Trikala, Department of Cardiology, Trikala, Greece
| | - D Platogiannis
- General Hospital of Trikala, Department of Cardiology, Trikala, Greece
| | - G Siasos
- 1st Cardiology Clinic, 'Hippokration' General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece; Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - D Terentes-Printzios
- 1st Cardiology Clinic, 'Hippokration' General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - A Theodoropoulou
- Emergency Department, Hippokration' General Hospital, Athens, Greece
| | - P Theofilis
- 1st Cardiology Clinic, 'Hippokration' General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - K Toutouzas
- 1st Cardiology Clinic, 'Hippokration' General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - S Tsalamandris
- 1st Cardiology Clinic, 'Hippokration' General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - I Tsiafoutis
- Athens Red Cross Hospital, 1st Department of Cardiology, Athens, Greece
| | - M Vavouranakis
- 1st Cardiology Clinic, 'Hippokration' General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - G Vogiatzi
- 1st Cardiology Clinic, 'Hippokration' General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece; Emergency Department, Laiko General Hospital, Athens, Greece
| | - T Zografos
- 1st Cardiology Clinic, 'Hippokration' General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece; Athens Red Cross Hospital, 1st Department of Cardiology, Athens, Greece
| | - E Baka
- Emergency Department, Hippokration' General Hospital, Athens, Greece
| | - D Tousoulis
- 1st Cardiology Clinic, 'Hippokration' General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - C Vlachopoulos
- 1st Cardiology Clinic, 'Hippokration' General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
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Vavouranaki G, Oikonomou E, Vavuranakis MA, Vavuranakis E, Vogiatzi G, Lazaros G, Tsalamandris S, Galiatsatos N, Theofilis P, Santouri M, Tousoulis D. Relationship between whole grain consumption and arterial stiffness. Results of the Corinthia cross-sectional study. Hellenic J Cardiol 2020; 62:219-220. [PMID: 32534110 DOI: 10.1016/j.hjc.2020.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 05/07/2020] [Accepted: 05/15/2020] [Indexed: 10/24/2022] Open
Affiliation(s)
- Georgia Vavouranaki
- 1st Department of Cardiology, 'Hippokration' Hospital, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Evangelos Oikonomou
- 1st Department of Cardiology, 'Hippokration' Hospital, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Michael Andrew Vavuranakis
- 1st Department of Cardiology, 'Hippokration' Hospital, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Emmanuel Vavuranakis
- 1st Department of Cardiology, 'Hippokration' Hospital, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Georgia Vogiatzi
- 1st Department of Cardiology, 'Hippokration' Hospital, National and Kapodistrian University of Athens, Medical School, Athens, Greece.
| | - George Lazaros
- 1st Department of Cardiology, 'Hippokration' Hospital, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Sotirios Tsalamandris
- 1st Department of Cardiology, 'Hippokration' Hospital, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Nikolaos Galiatsatos
- 1st Department of Cardiology, 'Hippokration' Hospital, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Panagiotis Theofilis
- 1st Department of Cardiology, 'Hippokration' Hospital, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Mina Santouri
- 1st Department of Cardiology, 'Hippokration' Hospital, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Dimitris Tousoulis
- 1st Department of Cardiology, 'Hippokration' Hospital, National and Kapodistrian University of Athens, Medical School, Athens, Greece
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24
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Tsalamandris S, Oikonomou E, Vogiatzi G, Miliou A, Lazaros G, Georgakopoulos C, Gialafos E, Sideris S, Vlachopoulos C, Tousoulis D. X-linked dilated cardiomyopathy: the important role of genetic tests and imaging in the early diagnosis and treatment. Future Cardiol 2020; 16:629-634. [PMID: 32508136 DOI: 10.2217/fca-2020-0030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Familial dilated cardiomyopathy predominantly affects younger adults and may cause advanced heart failure and sudden cardiac death. Therefore, detailed family history, family members screening, appropriate genetic testing and counselling may allow correct identification of cardiac remodeling etiology, as well as earlier disease detection. Accordingly, we present a case with an early diagnosis of an X-linked dilated cardiomyopathy guided by clinical features, cardiac MRI and genetic testing. The diagnostic workup was guided by the positive family history of cardiomyopathy and sudden cardiac deaths. Clinical implications including early management, better arrythmia risk stratification and the revealing of a potential endemic entity clustering in several male subjects of a community on Crete island are further discussed.
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Affiliation(s)
- Sotirios Tsalamandris
- Unit for Athletes & Hereditary Cardiovascular Diseases (EKKAN), 1st Cardiology Department, National & Kapodistrian University of Athens University Medical School, Hippokration Hospital, Athens, Greece
| | - Evangelos Oikonomou
- Unit for Athletes & Hereditary Cardiovascular Diseases (EKKAN), 1st Cardiology Department, National & Kapodistrian University of Athens University Medical School, Hippokration Hospital, Athens, Greece
| | - Georgia Vogiatzi
- Unit for Athletes & Hereditary Cardiovascular Diseases (EKKAN), 1st Cardiology Department, National & Kapodistrian University of Athens University Medical School, Hippokration Hospital, Athens, Greece
| | - Antigoni Miliou
- Unit for Athletes & Hereditary Cardiovascular Diseases (EKKAN), 1st Cardiology Department, National & Kapodistrian University of Athens University Medical School, Hippokration Hospital, Athens, Greece
| | - George Lazaros
- Unit for Athletes & Hereditary Cardiovascular Diseases (EKKAN), 1st Cardiology Department, National & Kapodistrian University of Athens University Medical School, Hippokration Hospital, Athens, Greece
| | - Christos Georgakopoulos
- Unit for Athletes & Hereditary Cardiovascular Diseases (EKKAN), 1st Cardiology Department, National & Kapodistrian University of Athens University Medical School, Hippokration Hospital, Athens, Greece
| | - Elias Gialafos
- Unit for Athletes & Hereditary Cardiovascular Diseases (EKKAN), 1st Cardiology Department, National & Kapodistrian University of Athens University Medical School, Hippokration Hospital, Athens, Greece
| | - Skevos Sideris
- Unit for Athletes & Hereditary Cardiovascular Diseases (EKKAN), 1st Cardiology Department, National & Kapodistrian University of Athens University Medical School, Hippokration Hospital, Athens, Greece
| | - Charalampos Vlachopoulos
- Unit for Athletes & Hereditary Cardiovascular Diseases (EKKAN), 1st Cardiology Department, National & Kapodistrian University of Athens University Medical School, Hippokration Hospital, Athens, Greece
| | - Dimitris Tousoulis
- Unit for Athletes & Hereditary Cardiovascular Diseases (EKKAN), 1st Cardiology Department, National & Kapodistrian University of Athens University Medical School, Hippokration Hospital, Athens, Greece
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25
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Tousoulis D, Fountoulakis P, Oikonomou E, Antoniades C, Siasos G, Tsalamandris S, Georgiopoulos G, Pallantza Z, Pavlou E, Milliou A, Assimakopoulos MN, Barmparesos N, Giannarakis I, Siamata P, Kaski JC. Acute exposure to diesel affects inflammation and vascular function. Eur J Prev Cardiol 2020; 28:1192-1200. [PMID: 34551088 DOI: 10.1177/2047487319898020] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 10/30/2019] [Accepted: 12/10/2019] [Indexed: 12/13/2022]
Abstract
Abstract
Background
Diesel exhaust fumes represent one of the most common toxic pollutants. The prolonged effects of acute exposure to this pollutant on inflammatory status and vascular properties are unknown.
Methods
During a 2-h session, 40 healthy subjects were exposed to diesel exhaust fumes and/or filtered air. Endothelial function was assessed with flow mediated dilation, arterial stiffness with pulse wave velocity and reflected waves with augmentation index. C-reactive protein, fibrinogen, protein C levels and protein S activity were also measured. Standard deviation of normal to normal R–R intervals (SDNN) was used to assess heart rate variability. Measurements were assessed before exposure and 2 and 24 h after diesel exposure.
Results
Compared with filtered air, exposure to diesel exhaust fumes decreased flow mediated dilation and increased pulse wave velocity and augmentation index up to 24 h after the exposure (p < 0.001 for all). Similarly, compared with filtered air, diesel exhaust exposure impaired SDNN during the 24-h study period (p = 0.007). C-reactive protein and fibrinogen levels were significantly increased after diesel exhaust exposure while protein C levels and protein S activity decreased (p < 0.01 for all). Exposure to diesel exhaust fumes resulted in higher C-reactive protein concentration in smokers compared with non-smokers (p < 0.001).
Conclusion
Short-term exposure to diesel exhaust fumes has a prolonged adverse impact on endothelial function and vascular wall properties, along with impaired heart rate variability, abnormal fibrinolytic activity and increased markers of inflammation. These findings give insights into the mechanisms underlining the increased cardiovascular risk of subjects regularly exposed to diesel exhaust fumes.
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Affiliation(s)
- Dimitris Tousoulis
- 1st Cardiology Clinic, ‘Hippokration’ General Hospital, National and Kapodistrian University of Athens, School of Medicine, Greece
| | - Petros Fountoulakis
- 1st Cardiology Clinic, ‘Hippokration’ General Hospital, National and Kapodistrian University of Athens, School of Medicine, Greece
| | - Evangelos Oikonomou
- 1st Cardiology Clinic, ‘Hippokration’ General Hospital, National and Kapodistrian University of Athens, School of Medicine, Greece
| | - Charalambos Antoniades
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, UK
- Oxford Centre of Research Excellence, British Heart Foundation, UK
- Oxford Biomedical Research Centre, National Institute of Health Research, UK
| | - Gerasimos Siasos
- 1st Cardiology Clinic, ‘Hippokration’ General Hospital, National and Kapodistrian University of Athens, School of Medicine, Greece
- Brigham and Women’s Hospital, Harvard Medical School, Boston, USA
| | - Sotirios Tsalamandris
- 1st Cardiology Clinic, ‘Hippokration’ General Hospital, National and Kapodistrian University of Athens, School of Medicine, Greece
| | - Georgios Georgiopoulos
- 1st Cardiology Clinic, ‘Hippokration’ General Hospital, National and Kapodistrian University of Athens, School of Medicine, Greece
| | - Zoi Pallantza
- 1st Cardiology Clinic, ‘Hippokration’ General Hospital, National and Kapodistrian University of Athens, School of Medicine, Greece
| | - Efthimia Pavlou
- 1st Cardiology Clinic, ‘Hippokration’ General Hospital, National and Kapodistrian University of Athens, School of Medicine, Greece
| | - Antigoni Milliou
- 1st Cardiology Clinic, ‘Hippokration’ General Hospital, National and Kapodistrian University of Athens, School of Medicine, Greece
| | | | | | | | - Pinelopi Siamata
- National and Kapodistrian University of Athens, Physics Department, Greece
| | - Juan C Kaski
- Molecular and Clinical Sciences Research Institute, St George’s University of London, UK
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26
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Oikonomou E, Theofilis P, Mpahara A, Lazaros G, Niarchou P, Vogiatzi G, Tsalamandris S, Fountoulakis P, Christoforatou E, Mystakidou V, Anastasiou M, Goliopoulou A, Tousoulis D. Diagnostic performance of electrocardiographic criteria in echocardiographic diagnosis of different patterns of left ventricular hypertrophy. Ann Noninvasive Electrocardiol 2019; 25:e12728. [PMID: 31724804 PMCID: PMC7358819 DOI: 10.1111/anec.12728] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2019] [Revised: 10/04/2019] [Accepted: 10/13/2019] [Indexed: 01/19/2023] Open
Abstract
Background Electrocardiogram (ECG) is considered the initial screening method for the detection of left ventricular hypertrophy (LVH) despite its low sensitivity. However, there are no data on how ECG criteria for LVH perform in patients with concentric (cLVH) and eccentric LVH (eLVH). Methods In the setting of the Corinthia cross‐sectional study, ECGs were analyzed in 1,570 participants of the study. Seven ECG LVH criteria were calculated (Sokolow–Lyon voltage, index, and product, sex‐specific Cornell voltage and product, Lewis voltage, and the Framingham), whereas LVH was defined, based on echocardiographic data, as left ventricular mass indexed for body surface area (BSA) of at least 125 g/m2 in men and at least 110 g/m2 in women. Results Regarding the frequency encountered for each ECG LVH criterion, there was no difference between eLVH and cLVH. However, when ECG criteria were compared as continuous variables between LVH groups, Cornell voltage and product were higher in cLVH individuals, with a value of Cornell voltage >13.95 mV having 61% sensitivity and 62% specificity to differentiate cLVH from eLVH (p = .05). Even after adjustment for age, sex, body mass index, and hypertension, the occurrence of Cornell voltage or product increased the odds of cLVH by 1.6 times (p = .001). Conclusion Cornell voltage and product criteria disclosed a superior discriminative ability for the detection of LVH via ECG. When further categorizing LVH as concentric and eccentric, Cornell product depicted the higher discriminative ability for cLVH.
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Affiliation(s)
- Evangelos Oikonomou
- First Cardiology Clinic, "Hippokration" General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Panagiotis Theofilis
- First Cardiology Clinic, "Hippokration" General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Aikaterini Mpahara
- First Cardiology Clinic, "Hippokration" General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - George Lazaros
- First Cardiology Clinic, "Hippokration" General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Panagioula Niarchou
- First Cardiology Clinic, "Hippokration" General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Georgia Vogiatzi
- First Cardiology Clinic, "Hippokration" General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Sotirios Tsalamandris
- First Cardiology Clinic, "Hippokration" General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Petros Fountoulakis
- First Cardiology Clinic, "Hippokration" General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Evangelia Christoforatou
- First Cardiology Clinic, "Hippokration" General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Vasiliki Mystakidou
- First Cardiology Clinic, "Hippokration" General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Maria Anastasiou
- First Cardiology Clinic, "Hippokration" General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Athina Goliopoulou
- First Cardiology Clinic, "Hippokration" General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Dimitris Tousoulis
- First Cardiology Clinic, "Hippokration" General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
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27
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Oikonomou E, Lazaros G, Tsalamandris S, Vogiatzi G, Christoforatou E, Papakonstantinou M, Goliopoulou A, Tousouli M, Chasikidis C, Tousoulis D. Reply: Possible Effect of Alcohol Consumption on Aortic Dilatation by Inducing the Renin–Angiotensin–Aldosterone System. Angiology 2019; 70:980-981. [DOI: 10.1177/0003319719865671] [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] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Evangelos Oikonomou
- 1st Cardiology Clinic, “Hippokration” General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - George Lazaros
- 1st Cardiology Clinic, “Hippokration” General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Sotirios Tsalamandris
- 1st Cardiology Clinic, “Hippokration” General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Georgia Vogiatzi
- 1st Cardiology Clinic, “Hippokration” General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Evangelia Christoforatou
- 1st Cardiology Clinic, “Hippokration” General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Margenti Papakonstantinou
- 1st Cardiology Clinic, “Hippokration” General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Athina Goliopoulou
- 1st Cardiology Clinic, “Hippokration” General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Maria Tousouli
- 1st Cardiology Clinic, “Hippokration” General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Christos Chasikidis
- 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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28
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Papaioannou T, Oikonomou E, Lazaros G, Christoforatou E, Vogiatzi G, Tsalamandris S, Chasikidis C, Kalambogias A, Mystakidi VX, Galiatsatos N, Santouri M, Latsios G, Deftereos S, Tousoulis D. P3450Aortic stiffness is significantly associated with left ventricular mass in females but not in males: insights from the CORINTHIA study. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0323] [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
Introduction
Arterial stiffening may contribute to the increase of left ventricular mass (LVM) and the development of left ventricular hypertrophy (LVH). Although male gender has been also found to be an independent determinant of LVH, it is unknown if the adverse effect of increased aortic stiffening on LVM differs between males and females.
Aim
To evaluate the association of aortic stiffness as assessed by carotid-to-femoral pulse wave velocity (cf-PWV) with LVM and LVH in a general population and compare these associations between males and females.
Methods
Demographic, laboratory and clinical data of 1686 subjects (693 males and 993 females) from the cross-sectional, observational study “Corinthia” were analyzed. All subjects underwent applanation tonometry and pulse wave analysis for the measurement of cf-PWV and echocardiography examination for the computation of LVM which was adjusted by body surface area providing the LVM index (LVMI). Multivariate linear regression analysis was performed for the determination of independent factors related with LVMI. Receiver operator curve analysis (ROC) was used to compare the ability of cf-PWV to predict LVH, in males and females separately.
Results
In the female population, significant and independent determinants of LVMI were: age (beta=0.243, p<0.001), urea (beta=0.119, p=0.001), hypertension (beta=0.089, p=0.028) and cf-PWV (beta=0.096, p=0.021). In contrast, in the male population, LVMI was independently related with age (beta=0.242, p<0.001), systolic blood pressure (beta=0.095, p=0.027), LDL (beta=-0.087, p=0.047) and creatinine (beta=0.092, p=0.031). ROC analysis showed that cf-PWV is a stronger predictor of LVH in females than in males (figure).
Conclusion
Increased aortic stiffness measured by cf-PWV is significantly related with increased LVMI regardless from age and other risk factors only in females. Moreover cf-PWV was a stronger predictor of left-ventricular hypertrophy in females than males. These findings should be further explored in prospective studies.
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Affiliation(s)
- T Papaioannou
- National & Kapodistrian University of Athens, First Department of Cardiology, Hippokration Hospital, Medical School, Athens, Greece
| | - E Oikonomou
- National & Kapodistrian University of Athens, First Department of Cardiology, Hippokration Hospital, Medical School, Athens, Greece
| | - G Lazaros
- National & Kapodistrian University of Athens, First Department of Cardiology, Hippokration Hospital, Medical School, Athens, Greece
| | - E Christoforatou
- National & Kapodistrian University of Athens, First Department of Cardiology, Hippokration Hospital, Medical School, Athens, Greece
| | - G Vogiatzi
- National & Kapodistrian University of Athens, First Department of Cardiology, Hippokration Hospital, Medical School, Athens, Greece
| | - S Tsalamandris
- National & Kapodistrian University of Athens, First Department of Cardiology, Hippokration Hospital, Medical School, Athens, Greece
| | - C Chasikidis
- National & Kapodistrian University of Athens, First Department of Cardiology, Hippokration Hospital, Medical School, Athens, Greece
| | - A Kalambogias
- National & Kapodistrian University of Athens, First Department of Cardiology, Hippokration Hospital, Medical School, Athens, Greece
| | - V.-X Mystakidi
- National & Kapodistrian University of Athens, First Department of Cardiology, Hippokration Hospital, Medical School, Athens, Greece
| | - N Galiatsatos
- National & Kapodistrian University of Athens, First Department of Cardiology, Hippokration Hospital, Medical School, Athens, Greece
| | - M Santouri
- National & Kapodistrian University of Athens, First Department of Cardiology, Hippokration Hospital, Medical School, Athens, Greece
| | - G Latsios
- National & Kapodistrian University of Athens, First Department of Cardiology, Hippokration Hospital, Medical School, Athens, Greece
| | - S Deftereos
- National & Kapodistrian University of Athens, Second Department of Cardiology, Athens, Greece
| | - D Tousoulis
- National & Kapodistrian University of Athens, Second Department of Cardiology, Athens, Greece
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29
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Fountoulakis P, Oikonomou E, Papaioannou T, Psaltopoulou T, Tsalamandris S, Papamikroulis GA, Kalampogias A, Pallantza Z, Pavlou E, Milliou A, Asimakopoulou MN, Barbaresos N, Giannarakis I, Siamata P, Tousoulis D. 405Acute and short-term effects of diesel exhaust fumes exposure on arterial wall properties, inflammatory process and fibrosis-fibrinolysis status. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0101] [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
Introduction
Exhaust fumes from diesel engines are a complex mixture of toxic compounds with a wide variety of harmful effects. The acute effects of diesel exhaust fumes on the cardiovascular system are well-known. However, their short-term impact has not been thoroughly studied.
Purpose
To study the acute and short-term (24 h) effects of diesel exhaust particles (DEPs) on endothelial function, arterial wall properties, inflammatory process and fibrosis-fibrinolysis status.
Methods
In this blind cross over study, 40 healthy volunteers (median age 40 years old) have been exposed to diesel exhaust particles (DEPs) and then to filtered air (FA) over a 2-hour session with a wash out period of 4 weeks. Exposure to DEPs was calibrated based on the mass of microparticles less than 2,5 microns in diameter (PM 2,5). Flow-mediated-dilation (FMD) was used to estimate endothelial function. Pulse wave velocity (PWV) and augmentation index (AIx) assessed central aortic stiffness and arterial reflected waves respectively. C reactive protein (CRP) was measured to determine the inflammatory status, as well as fibrinogen and protein C levels to evaluate the impact on the coagulation cascade. All measurements were performed before each session (T0), at the end of the 2 hours exposure session (T2) and 24 hours after completion of each session (T24). Variables with normal distribution are presented as mean±SD otherwise as median±SEM.
Results
At T0 of DEP and FA exposure there was no significant difference in FMD, PWV, AIX, CRP, protein C and fibrinogen levels. Exposure to DEP decreased significantly FMD (T0: 11.97±4.61% vs T2: 7.71±3.36% vs. T24: 6.17±3.19%, p<0.001) and increased PWV (T0: 6.09±1.03m/sec vs T2: 7.22±1.31m/sec vs. T24: 6.90±1.03m/sec, p<0.001), AIx (T0: 8.17±3.19% vs T2: 12.71±3.36% vs. T24: 13.17±4.61%, p<0.001), CRP (T0: 1.41±0.18 mg/L vs T2: 1.99±0.21mg/L vs. T24: 2.08±0.24mg/L, p=0.04) and fibrinogen levels (T0: 269±44 mg/dL vs T2: 331±75 mg/dL vs. T24: 307±51 mg/dL, p=0.002). Protein C was significantly reduced (T0: 121±26% vs T2: 104±21% vs. T24: 105±20%, p=0.003). Exposure to FA had no significant impact on the study parameters.
Graph of results
Conclusion
Exposure to diesel exhaust fumes may have significant adverse effects on the cardiovascular system with impairment of endothelial function, arterial wall properties, inflammatory status and fibrosis-fibrinolysis parameters not only during the exposure period but as far as 24 hours after exposure.
Acknowledgement/Funding
None
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Affiliation(s)
| | - E Oikonomou
- Hippokration General Hospital, Athens, Greece
| | | | | | | | | | | | - Z Pallantza
- Hippokration General Hospital, Athens, Greece
| | - E Pavlou
- Hippokration General Hospital, Athens, Greece
| | - A Milliou
- Hippokration General Hospital, Athens, Greece
| | - M N Asimakopoulou
- National and Kapodistrian University of Athens, Physics, Athens, Greece
| | - N Barbaresos
- National and Kapodistrian University of Athens, Physics, Athens, Greece
| | - I Giannarakis
- National and Kapodistrian University of Athens, Physics, Athens, Greece
| | - P Siamata
- National and Kapodistrian University of Athens, Physics, Athens, Greece
| | - D Tousoulis
- Hippokration General Hospital, Athens, Greece
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30
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Oikonomou E, Tsalamandris S, Vogiatzi G, Lazaros G, Christoforatou E, Chasikidis C, Mistakidi CV, Galiatsatos N, Asimakopoulou M, Papamikroulis GA, Zacharia E, Anastasiou M, Mavrantzas T, Papakonstantinou M, Tousoulis D. P5312Sleep duration and carotid atheromatic burden. Insights from the Corinthia study. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0283] [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
Sleep is an essential physiological process and disturbance of sleeping pattern may be associated with cardiovascular risk profile and atheromatosis. Short but also long sleep duration (LSD) may be adversely affect cardiovascular parameters.
Purpose
To study how sleep duration is associated with cardiovascular risk profile and carotid atherosclerotic burden.
Methods
Corinthia study is a cross sectional epidemiological study based on 2043 inhabitants (age 40–99 years) of Corinthia region in Greece. Ultrasonography was used to measure intima media thickness (IMT) in the left and right common carotid artery, carotid bulb and internal carotid artery. The mean IMT (meanIMT) were determined as representative values of carotid atherosclerosis burden. Thickness of IMT>1.5 mm or protrusion >50% compared to adjacent segments was considered as atherosclerotic plaque. Based on questionnaires of Corinthia study, total sleeping time per day was recorded. A sleep duration of 7 to 8 h was consider normal (NSD), sleep duration <6 h was consider very short (VSSD), 6–7 h sleep duration was considered short (SSD) and participants with >8 h sleep duration was categorized as LSD.
Results
Concerning gender more men than women were categorized in the NSD (26% vs. 21%, p<0.001). Subjects in the NSD were also younger compared to subjects categorized in other sleeping patterns (VSSD: 66±12 y vs. SSD: 63±12 y vs. NSD: 62±12 y vs. LSD: 66±12 y, p<0.001), have less prevalence of diabetes mellitus (p<0.05). There was no difference according to sleeping pattern in body mass index, prevalence of hypertension, cardiovascular disease, hyperlipidemia and on current smoking habits according to sleeping patterns. Interestingly, meanIMT (VSSD: 1.08±0.51 mm vs. SSD: 0.97±0.42 mm vs. NSD: 0.97±0.41 mm vs. LSD: 1.14±1.64 mm, p=0.04) and carotid atherosclerotic plaque (VSSD: 35% vs. SSD: 25% vs. NSD: 20% vs. LSD: 30%, p=0.006) was decreased in NSD subjects. Importantly, even after adjustment for the confounders logistic regression analysis revealed that subjects in the NSD group have 50% less odds of carotid atheromatic plaque than subjects in the VSSD (Odds ratio: 0.5, 95% CI 0.28–0.90, p=0.02) (Figure).
Conclusion
A balanced sleeping pattern with 8h of sleep daily can act as an additive cardioprotective factor in the modern western type societies. Short especially less than 6 hours and long (>8 hours) sleeping duration may act as a cardiovascular risk factor.
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Affiliation(s)
- E Oikonomou
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
| | - S Tsalamandris
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
| | - G Vogiatzi
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
| | - G Lazaros
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
| | - E Christoforatou
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
| | - C Chasikidis
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
| | - C V Mistakidi
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
| | - N Galiatsatos
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
| | - M Asimakopoulou
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
| | - G A Papamikroulis
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
| | - E Zacharia
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
| | - M Anastasiou
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
| | - T Mavrantzas
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
| | - M Papakonstantinou
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
| | - D Tousoulis
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
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Oikonomou E, Siasos G, Marinos G, Zaromitidou M, Athanasiou D, Foundoulakis P, Tsalamandris S, Antonopoulos A, Mistakidi CV, Vlachopoulos C, Tousoulis D. 4099High intensity endurance and strength training in water polo Olympic team players: impact on arterial wall properties. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Regular physical activity is recommended for health improvement. However the upper intensity threshold associated with best health outcome is difficult to determine. Water polo (WP) Olympic athletes present unique characteristics with very high intensity work, long training sessions and a combination of endurance and strength training.
Purpose
To examine how long term, intense mixed endurance and strength training affect peripheral and central hemodynamics and biomarkers of cardiovascular health.
Methods
The study population consisted of 20 WP Olympic team player's, 20 matched recreational active subjects (RA) and 20 sedentary control subjects (Cl). Reflected waves were assessed with the Augmentation index (AIx), central aortic stiffness with pulse wave velocity (PWV) and endothelial function with flow mediated dilation (FMD).
Results
From Cl subjects to RA active subjects and to WP players there was a stepwise decrease in aortic systolic pressure (116±16 mmHg vs. 107±14 mmHg vs. 106±6 mmHg, p=0.03) while there was no difference in branchial systolic pressure (p=0.52). There was also a stepwise improvement in AIx (−4.22±9.97% vs. −6.97±11.28% vs. −12.14±6.62%, p=0.03) and FMD (6.61±1.78% vs. 7.78±1.98% vs. 8.3±2.05%, p=0.04) according to the intensity of exercise and WP players had lower AIx and higher FMD compared to RA subjects and to Cl subjects.
Conclusions
In young WP Olympic team players intense mixed endurance and strength training has no adverse impact on arterial wall properties and endothelial function with a parallel improvement in central hemodynamics. These findings highlight that there are no definitive data to support on any adverse vascular related impact of ultra-endurance training while mixed endurance and strength training may be associated with a favorable vascular profile.
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Affiliation(s)
- E Oikonomou
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
| | - G Siasos
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
| | - G Marinos
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
| | - M Zaromitidou
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
| | - D Athanasiou
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
| | - P Foundoulakis
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
| | - S Tsalamandris
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
| | - A Antonopoulos
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
| | - C V Mistakidi
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
| | - C Vlachopoulos
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
| | - D Tousoulis
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
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Anastasiou M, Antonopoulos AS, Oikonomou E, Zagouri F, Siasos G, Vogiatzi G, Tsalamandris S, Mistakidi CV, Psaltopoulou T, Bamias A, Dimopoulos M, Tousoulis D. P1573Chemotherapy-induced vasotoxicity in patients undergoing therapy for breast cancer. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0333] [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
Cardiotoxicity is a well-known adverse effect of anthracycline and HER-2 monoclonal antibodies, however the vascular effects of these agents remain less-well studied.
Purpose
To explore the effects of breast chemotherapy on vascular function.
Methods
A total of 57 female patients undergoing breast diagnosed with breast cancer and scheduled for anthracycline-based and HER-2 chemotherapy were included in this study. At baseline, at 3, 6 and 12 months, patients underwent assessment of cardiac function by transthoracic echocardiography, endothelial function assessment by brachial flow mediated dilation (FMD) and assessment of arterial stiffness by carotid-radial pulse wave velocity (PWV) and augmentation index (Aix).
Results
There was a significant decrease in left ventricular ejection fraction (LVEF) overtime compared to baseline (A). This was paralleled by a significant decrease in brachial FMD at 6 months (B) and a significant increase in PWV compared to baseline (C). There was no significant change in Aix compared to baseline levels (D). Chemotherapy-induced cardiotoxicity (expressed by the change in LVEF) was not associated with either the change in FMD or PWV at 6 months.
Conclusions
Breast chemotherapy-induced cardiotoxicity is paralleled by vasotoxicity, which is manifested as endothelial dysfunction and increased arterial stiffness. Systemic vasotoxicity is not directly related to cardiotoxicity, suggesting that monitoring of both cardiac and vascular function could be useful in identifying early signs of cardiovascular toxicity.
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Affiliation(s)
- M Anastasiou
- Hippokration General Hospital, 1st Cardiology Department, Athens Medical School, Athens, Greece
| | - A S Antonopoulos
- Hippokration General Hospital, 1st Cardiology Department, Athens Medical School, Athens, Greece
| | - E Oikonomou
- Hippokration General Hospital, 1st Cardiology Department, Athens Medical School, Athens, Greece
| | - F Zagouri
- Hippokration General Hospital, 1st Cardiology Department, Athens Medical School, Athens, Greece
| | - G Siasos
- Hippokration General Hospital, 1st Cardiology Department, Athens Medical School, Athens, Greece
| | - G Vogiatzi
- Hippokration General Hospital, 1st Cardiology Department, Athens Medical School, Athens, Greece
| | - S Tsalamandris
- Hippokration General Hospital, 1st Cardiology Department, Athens Medical School, Athens, Greece
| | - C V Mistakidi
- Hippokration General Hospital, 1st Cardiology Department, Athens Medical School, Athens, Greece
| | - T Psaltopoulou
- Hippokration General Hospital, 1st Cardiology Department, Athens Medical School, Athens, Greece
| | - A Bamias
- Hippokration General Hospital, 1st Cardiology Department, Athens Medical School, Athens, Greece
| | - M Dimopoulos
- Hippokration General Hospital, 1st Cardiology Department, Athens Medical School, Athens, Greece
| | - D Tousoulis
- Hippokration General Hospital, 1st Cardiology Department, Athens Medical School, Athens, Greece
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Vavouranaki G, Oikonomou E, Vogiatzi G, Lazaros G, Tsalamandris S, Siasos G, Chasikidis C, Theofilis P, Mistakidi CV, Anastasiou M, Galiastatos N, Santouri M, Tousoulis D. P6255Impact of whole grain consumption on arterial stiffness. Results of the Corinthian cross-sectional survey. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0855] [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
Introduction
The benefits of certain dietary patterns on cardiovascular diseases has been questioned over the last years. Whole grain consumption has been one of the controversial issues regarding the effect on cardiovascular disease. In Greek rural population consumptions of bread is part of the daily meal and a possible source of whole grain.
Purpose
To investigated the effect of whole grain bread consumption on arterial stiffness in Mediterranean population.
Methods
In a cross-sectional survey (Corinthia study) volunteers subjects completed a food frequency questioner (FFQ), including a question of consumption of bread on regular basis, whole grain (group I) or not (group II). Medical history, lifestyle habits, anthropometric and vital signs, as well as, laboratory blood test were performed. All patients underwent carotid-femoral pulse wave velocity (C-F PWV) measurements which were obtained noninvasively by SphygmoCor devise.
Results
Among the 2043 volunteers 1389 patients had adequate quality of pulse wave velocity recordings and were regular consumers of bread. Whole grain bread was consumed by 473 subjects (male 37%, female 63%,) but 916 (male 43.1%, female 56.9%) did not consume. Subjects consuming whole grain bread were younger compare to those who were not (group I: 62±11 years vs. group II: 64±12 years, p=0.02), have lower C-F PWV (group I: 9.04±2.93 m/sec vs. group II: 9.57±2.76 m/sec, p=0.01) but no other statistical difference were observe among other parameters (i.e. hypertension, diabetes mellitus, BMI, smoking etc). Hierarchical multiple regression showed that whole grain consumption predicted pulse wave velocity statistically significantly (b=−0.33, 95% CI: −0.62, −0.17, p=0.03) in addition to age (b=0.09, 95% CI 0.08–0.10, p<0.001), systolic blood pressure (b=0.02, 95% CI 0.01, 0.03, p<0.001) beta=0.157) and diabetes mellitus (b=0.75, 95% CI 0.40, 1.09, p<0.001).
Conclusion
Whole grain bread consumption has a beneficial effect on arterial stiffness as detected by better carotid femoral pulse wave velocity. This may have a positively effect on cardiovascular diseases.
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Affiliation(s)
- G Vavouranaki
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
| | - E Oikonomou
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
| | - G Vogiatzi
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
| | - G Lazaros
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
| | - S Tsalamandris
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
| | - G Siasos
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
| | - C Chasikidis
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
| | - P Theofilis
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
| | - C V Mistakidi
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
| | - M Anastasiou
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
| | - N Galiastatos
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
| | - M Santouri
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
| | - D Tousoulis
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
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Oikonomou E, Lazaros G, Christoforatou E, Chasikidis C, Vavouranaki G, Vogiatzi G, Papamikroulis GA, Tsalamandris S, Gergiopoulos G, Mazaris S, Theofilis P, Anastasiou M, Galiatsatos N, Tousoulis D. Breakfast association with arterial stiffness and carotid atherosclerotic burden. Insights from the 'Corinthia' study. Nutr Metab Cardiovasc Dis 2019; 29:744-750. [PMID: 31138498 DOI: 10.1016/j.numecd.2019.04.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 09/19/2018] [Revised: 02/27/2019] [Accepted: 04/23/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND AND AIMS The role of dietary patterns, in cardiovascular diseases has been challenged. The role of breakfast as an element of balance energy intake has gained research interest. However, the effects of dietary patterns related to breakfast consumption on vascular function are unknown. We explored the association of breakfast consumption habits with arterial wall elastic properties and carotid atherosclerosis. METHODS AND RESULTS In this cross-sectional study we enrolled 2043 inhabitants of the Corinthia region in Greece. Carotid-femoral pulse wave velocity (cf-PWV) was used to assess arterial stiffness. Carotid intima-media thickness (cIMT) was measured and the mean and the maximum cIMT were calculated. According to food frequency questionnaires, breakfast contribution in total daily energy intake (>20%; 5-20% and <5%) was estimated. Subjects were categorized as high-energy breakfast consumers (HeBC), low-energy breakfast consumers (LeBC) and those skipping breakfast (SBf) respectively. From the study population 240 subjects were categorized as HeBC, 897 as LeBC, and 681 as SBf. The mean cf-PWV was significantly higher in subjects SBf compared to LeBC and HeBC (9.35 ± 2.82 m/s vs. 9.09 ± 2.77 m/s vs. 8.76 ± 2.69 m/s, p = 0.02). The mean cIMT was significantly higher in subjects SBf compared to LeBC and HeBC (1.04 ± 0.46 mm vs. 0.99 ± 0.43 mm vs. 0.92 ± 0.39 mm, p = 0.01). Even after adjustment for potential confounders and cardiovascular risk factors SBf subjects have significantly increased mean cIMT and cf-PWV. CONCLUSION Skipping breakfast has an adverse effect on arterial stiffness and carotid atheromatic burden. Increased breakfast total energy intake may act protectively against atherosclerosis, a finding worth of further pathophysiologic exploration with potential clinical implications.
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Affiliation(s)
- Evangelos Oikonomou
- 1st Cardiology Clinic, 'Hippokration' General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - George Lazaros
- 1st Cardiology Clinic, 'Hippokration' General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Evangelia Christoforatou
- 1st Cardiology Clinic, 'Hippokration' General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Christos Chasikidis
- 1st Cardiology Clinic, 'Hippokration' General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Georgia Vavouranaki
- 1st Cardiology Clinic, 'Hippokration' General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Georgia Vogiatzi
- 1st Cardiology Clinic, 'Hippokration' General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece.
| | - George A Papamikroulis
- 1st Cardiology Clinic, 'Hippokration' General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Sotirios Tsalamandris
- 1st Cardiology Clinic, 'Hippokration' General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Georgios Gergiopoulos
- 1st Cardiology Clinic, 'Hippokration' General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Savvas Mazaris
- 1st Cardiology Clinic, 'Hippokration' General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Panagiotis Theofilis
- 1st Cardiology Clinic, 'Hippokration' General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Myriam Anastasiou
- 1st Cardiology Clinic, 'Hippokration' General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Nikos Galiatsatos
- 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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Oikonomou E, Vogiatzi G, Karlis D, Siasos G, Chrysohoou C, Zografos T, Lazaros G, Tsalamandris S, Mourouzis K, Georgiopoulos G, Toutouza M, Tousoulis D. Effects of omega-3 polyunsaturated fatty acids on fibrosis, endothelial function and myocardial performance, in ischemic heart failure patients. Clin Nutr 2019; 38:1188-1197. [DOI: 10.1016/j.clnu.2018.04.017] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Revised: 04/11/2018] [Accepted: 04/25/2018] [Indexed: 12/28/2022]
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Oikonomou E, Lazaros G, Tsalamandris S, Vogiatzi G, Christoforatou E, Papakonstantinou M, Goliopoulou A, Tousouli M, Chasikidis C, Tousoulis D. Alcohol Consumption and Aortic Root Dilatation: Insights from the Corinthia Study. Angiology 2019; 70:969-977. [DOI: 10.1177/0003319719848172] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Aortic diameter and progression to thoracic aortic aneurysm are influenced by several factors. In this study, we investigated the association of alcohol consumption with aortic root and ascending aorta dilatation. In the context of the Corinthia study, we examined 1751 patients with echocardiography. Several demographic and clinical characteristics were recorded. Alcohol consumption was assessed based on a questionnaire of frequency, type, and quantity. Accordingly, patients were categorized as everyday alcohol consumers (EDACs) and as social drinkers (SoD). Everyday alcohol consumers were further categorized to group 1: 0 to 1 drink/d; group 2: 1 to 2 drinks/d; and group 3: ≥3 drinks/d. From the study population, 40% were categorized as EDAC and had an increased aortic root diameter (AoRD) and an elevated AoRD index compared with SoD. Interestingly, there was a stepwise increase in aortic root and ascending aorta diameter according to daily alcohol consumption. Specifically, patients consuming ≥3 drinks of alcohol/d had increased indexed aortic by 1.4 mm/m2 compared with SoD even after adjustment for possible confounders. Daily alcohol consumption is associated with increased aortic root diameter. These findings may have important clinical implications, especially in patients with borderline or dilated aortic root, and merit further investigation.
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Affiliation(s)
- Evangelos Oikonomou
- First Cardiology Clinic, ‘Hippokration’ General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - George Lazaros
- First Cardiology Clinic, ‘Hippokration’ General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Sotirios Tsalamandris
- First Cardiology Clinic, ‘Hippokration’ General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Georgia Vogiatzi
- First Cardiology Clinic, ‘Hippokration’ General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Evangelia Christoforatou
- First Cardiology Clinic, ‘Hippokration’ General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Margenti Papakonstantinou
- First Cardiology Clinic, ‘Hippokration’ General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Athina Goliopoulou
- First Cardiology Clinic, ‘Hippokration’ General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Maria Tousouli
- First Cardiology Clinic, ‘Hippokration’ General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Christos Chasikidis
- First Cardiology Clinic, ‘Hippokration’ General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Dimitris Tousoulis
- First Cardiology Clinic, ‘Hippokration’ General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
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Tsalamandris S, Antonopoulos AS, Oikonomou E, Papamikroulis GA, Vogiatzi G, Papaioannou S, Deftereos S, Tousoulis D. The Role of Inflammation in Diabetes: Current Concepts and Future Perspectives. Eur Cardiol 2019; 14:50-59. [PMID: 31131037 PMCID: PMC6523054 DOI: 10.15420/ecr.2018.33.1] [Citation(s) in RCA: 574] [Impact Index Per Article: 114.8] [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] [Indexed: 02/06/2023] Open
Abstract
Diabetes is a complex metabolic disorder affecting the glucose status of the human body. Chronic hyperglycaemia related to diabetes is associated with end organ failure. The clinical relationship between diabetes and atherosclerotic cardiovascular disease is well established. This makes therapeutic approaches that simultaneously target diabetes and atherosclerotic disease an attractive area for research. The majority of people with diabetes fall into two broad pathogenetic categories, type 1 or type 2 diabetes. The role of obesity, adipose tissue, gut microbiota and pancreatic beta cell function in diabetes are under intensive scrutiny with several clinical trials to have been completed while more are in development. The emerging role of inflammation in both type 1 and type 2 diabetes (T1D and T1D) pathophysiology and associated metabolic disorders, has generated increasing interest in targeting inflammation to improve prevention and control of the disease. After an extensive review of the possible mechanisms that drive the metabolic pattern in T1D and T2D and the inflammatory pathways that are involved, it becomes ever clearer that future research should focus on a model of combined suppression for various inflammatory response pathways.
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Affiliation(s)
- Sotirios Tsalamandris
- First Cardiology Clinic, Hippokration General Hospital, National and Kapodistrian University of Athens, School of Medicine Athens, Greece
| | - Alexios S Antonopoulos
- First Cardiology Clinic, Hippokration General Hospital, National and Kapodistrian University of Athens, School of Medicine Athens, Greece
| | - Evangelos Oikonomou
- First Cardiology Clinic, Hippokration General Hospital, National and Kapodistrian University of Athens, School of Medicine Athens, Greece
| | - George-Aggelos Papamikroulis
- First Cardiology Clinic, Hippokration General Hospital, National and Kapodistrian University of Athens, School of Medicine Athens, Greece
| | - Georgia Vogiatzi
- First Cardiology Clinic, Hippokration General Hospital, National and Kapodistrian University of Athens, School of Medicine Athens, Greece
| | - Spyridon Papaioannou
- First Cardiology Clinic, Hippokration General Hospital, National and Kapodistrian University of Athens, School of Medicine Athens, Greece
| | - Spyros Deftereos
- First Cardiology Clinic, Hippokration General Hospital, National and Kapodistrian University of Athens, School of Medicine Athens, Greece
| | - Dimitris Tousoulis
- First Cardiology Clinic, Hippokration General Hospital, National and Kapodistrian University of Athens, School of Medicine Athens, Greece
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Lazaros G, Oikonomou E, Vogiatzi G, Christoforatou E, Tsalamandris S, Goliopoulou A, Tousouli M, Mystakidou V, Chasikidis C, Tousoulis D. The impact of sedentary behavior patterns on carotid atherosclerotic burden: Implications from the Corinthia epidemiological study. Atherosclerosis 2019; 282:154-161. [DOI: 10.1016/j.atherosclerosis.2019.01.026] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 12/27/2018] [Accepted: 01/15/2019] [Indexed: 02/07/2023]
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Tsalamandris S, Oikonomou E, Vavuranaki T, Lazaros G, Vogiatzi G, Chasikidis C, Christoforatou E, Papamikroulis GA, Mourouzis K, Mystakidou V, Papakonstantinou M, Theofilis P, Mazaris S, Galiatsatos N, Tousoulis D. BREAKFAST ASSOCIATION WITH ARTERIAL STIFFNESS AND CAROTID ATHEROSCLEROTIC BURDEN: INSIGHTS FROM THE CORINTHIA STUDY. J Am Coll Cardiol 2019. [DOI: 10.1016/s0735-1097(19)33779-9] [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: 10/27/2022]
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40
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Tsalamandris S, Oikonomou E, Lazaros G, Christoforatou E, Vogiatzi G, Zacharia E, Chasikidis C, Goliopoulou A, Papamikroulis GA, Ververeli CL, Anastasiou M, Galiatsatos N, Tousoulis D. THE ASSOCIATION AMONG DEPRESSIVE SYMPTOMS, EMOTIONAL STATUS, AND CAROTID ATHEROSCLEROTIC BURDEN OF THE CORINTHIA STUDY POPULATION. J Am Coll Cardiol 2019. [DOI: 10.1016/s0735-1097(19)32729-9] [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: 10/27/2022]
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Siasos G, Stampouloglou P, Bletsa E, Tsigkou V, Mourouzis K, Gouliopoulos N, Zaromytidou M, Mazaris S, Oikonomou E, Antonopoulos A, Tsalamandris S, Vogiatzi G, Thanopoulou A, Vryonidou A, Paschou SA, Politou M, Tentolouris N, Tousoulis D. THE ASSOCIATION OF VASCULAR DYSFUNCTION AND PLATELET REACTIVITY IS REGULATED BY THE INTERACTION BETWEEN ANTIDIABETIC AND ANTIPLATELET TREATMENT IN PATIENTS WITH TYPE 2 DIABETES MELLITUS. J Am Coll Cardiol 2019. [DOI: 10.1016/s0735-1097(19)30766-1] [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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Skotsimara G, Antonopoulos AS, Oikonomou E, Siasos G, Ioakeimidis N, Tsalamandris S, Charalambous G, Galiatsatos N, Vlachopoulos C, Tousoulis D. Cardiovascular effects of electronic cigarettes: A systematic review and meta-analysis. Eur J Prev Cardiol 2019; 26:1219-1228. [PMID: 30823865 DOI: 10.1177/2047487319832975] [Citation(s) in RCA: 77] [Impact Index Per Article: 15.4] [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] [Indexed: 11/17/2022]
Abstract
AIMS The electronic cigarette is marketed as a safe alternative to tobacco smoking, but electronic cigarette cardiovascular effects remain largely unknown. We systematically reviewed and meta-analysed published literature to investigate the cardiovascular effects and associated risk from electronic cigarette use. METHODS AND RESULTS We searched PubMed from January 2000 to November 2017 for published studies assessing the cardiovascular effects of the electronic cigarette. Evidence suggests that the electronic cigarette negatively affects endothelial function, arterial stiffness and the long-term risk for coronary events, but these findings are from single study reports and have not been confirmed in additional studies. Conflicting evidence exists on the effects of the electronic cigarette on heart rate and blood pressure, which is mainly based on non-randomized clinical studies of moderate quality. The meta-analysis of 14 studies (N + 441 participants) suggested that despite the negative acute effects of the electronic cigarette on heart rate (pooled mean difference (MD) + 2.27, 95% confidence interval (CI): 1.64 to 2.89, p < 0.001), diastolic (pooled MD + 2.01 mmHg, 95% CI: 0.62 to 3.39, p + 0.004) and systolic blood pressure (pooled MD + 2.02 mmHg, 95% CI: 0.07 to 3.97, p + 0.042), benefits may be observed in terms of blood pressure regulation when switching from tobacco smoking to chronic electronic cigarette use (systolic blood pressure pooled MD + -7.00, 95% CI: -9.63 to -4.37, p < 0.001; diastolic blood pressure pooled MD + -3.65, 95% CI: -5.71 to -1.59, p + 0.001). CONCLUSIONS The existing evidence on the cardiovascular effects of the electronic cigarette is concerning, with several unexplored issues. Unless supported by stronger evidence, the electronic cigarette should not be labelled as a cardiovascular safe product. Future studies should delineate whether electronic cigarette use is less hazardous to cardiovascular health than conventional cigarette smoking.
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Affiliation(s)
- Georgia Skotsimara
- 1st Department of Cardiology, Hippokration Hospital, National and Kapodistrian University of Athens Medical School, Greece
| | - Alexios S Antonopoulos
- 1st Department of Cardiology, Hippokration Hospital, National and Kapodistrian University of Athens Medical School, Greece
| | - Evangelos Oikonomou
- 1st Department of Cardiology, Hippokration Hospital, National and Kapodistrian University of Athens Medical School, Greece
| | - Gerasimos Siasos
- 1st Department of Cardiology, Hippokration Hospital, National and Kapodistrian University of Athens Medical School, Greece
| | - Nikolaos Ioakeimidis
- 1st Department of Cardiology, Hippokration Hospital, National and Kapodistrian University of Athens Medical School, Greece
| | - Sotirios Tsalamandris
- 1st Department of Cardiology, Hippokration Hospital, National and Kapodistrian University of Athens Medical School, Greece
| | - Georgios Charalambous
- 1st Department of Cardiology, Hippokration Hospital, National and Kapodistrian University of Athens Medical School, Greece
| | - Nikos Galiatsatos
- 1st Department of Cardiology, Hippokration Hospital, National and Kapodistrian University of Athens Medical School, Greece
| | - Charalambos Vlachopoulos
- 1st Department of Cardiology, Hippokration Hospital, National and Kapodistrian University of Athens Medical School, Greece
| | - Dimitris Tousoulis
- 1st Department of Cardiology, Hippokration Hospital, National and Kapodistrian University of Athens Medical School, Greece
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Tsalamandris S, Oikonomou E, Lazaros G, Christoforatou E, Vogiatzi G, Zacharia E, Chasikidis C, Goliopoulou A, Santouri A, Papamikroulis GA, Ververeli CH, Anastasopoulou P, Anastasiou M, Galiatsatos N, Tousoulis D. P5403The Relationship between depressive symptom, emotional status, carotid atherosclerotic burden in Corinthia Study. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p5403] [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: 11/14/2022] Open
Affiliation(s)
- S Tsalamandris
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
| | - E Oikonomou
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
| | - G Lazaros
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
| | - E Christoforatou
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
| | - G Vogiatzi
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
| | - E Zacharia
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
| | - C Chasikidis
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
| | - A Goliopoulou
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
| | - A Santouri
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
| | - G A Papamikroulis
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
| | - C H Ververeli
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
| | - P Anastasopoulou
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
| | - M Anastasiou
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
| | - N Galiatsatos
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
| | - D Tousoulis
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
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Vogiatzi G, Oikonomou E, Lazaros G, Papamikroulis GA, Chasikidis C, Christoforatou E, Tsalamandris S, Mpourouki E, Papakonstantinou M, Fountoulakis P, Kalampogias A, Tousouli M, Mourouzis C, Anastasiou M, Tousoulis D. P6278Effects of habitual coffee consumption on vascular function: the corinthia study. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p6278] [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)
- G Vogiatzi
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
| | - E Oikonomou
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
| | - G Lazaros
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
| | - G A Papamikroulis
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
| | - C Chasikidis
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
| | - E Christoforatou
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
| | - S Tsalamandris
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
| | - E Mpourouki
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
| | - M Papakonstantinou
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
| | - P Fountoulakis
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
| | - A Kalampogias
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
| | - M Tousouli
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
| | - C Mourouzis
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
| | - M Anastasiou
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
| | - D Tousoulis
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
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45
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Oikonomou E, Vavuranaki G, Vogiatzi G, Lazaros G, Chasikidis C, Christoforatou E, Tsalamandris S, Papamikroulis GA, Mourouzis C, Mystakidou V, Papakonstantinou M, Mazaris S, Anastasopoulou P, Galiatsatos N, Tousoulis D. P6277Breakfast Consumption: association with arterial stiffness and atherosclerotic burden. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p6277] [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)
- E Oikonomou
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
| | - G Vavuranaki
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
| | - G Vogiatzi
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
| | - G Lazaros
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
| | - C Chasikidis
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
| | - E Christoforatou
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
| | - S Tsalamandris
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
| | - G A Papamikroulis
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
| | - C Mourouzis
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
| | - V Mystakidou
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
| | - M Papakonstantinou
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
| | - S Mazaris
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
| | - P Anastasopoulou
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
| | - N Galiatsatos
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
| | - D Tousoulis
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
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46
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Oikonomou E, Lazaros G, Christoforatou E, Chasikidis C, Stofa E, Papamikroulis GA, Vogiatzi G, Tsalamandris S, Bourouki E, Zacharia E, Anastasiou M, Mavrantzas T, Papakonstantinou M, Anastasopoulou P, Tousoulis D. P722Association of alcohol consumption with aortic root dilatation: Corinthia study. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy564.p722] [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: 11/12/2022] Open
Affiliation(s)
- E Oikonomou
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
| | - G Lazaros
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
| | - E Christoforatou
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
| | - C Chasikidis
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
| | - E Stofa
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
| | - G A Papamikroulis
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
| | - G Vogiatzi
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
| | - S Tsalamandris
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
| | - E Bourouki
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
| | - E Zacharia
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
| | - M Anastasiou
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
| | - T Mavrantzas
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
| | - M Papakonstantinou
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
| | - P Anastasopoulou
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
| | - D Tousoulis
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
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Oikonomou E, Dimitropoulos E, Siasos G, Miliou A, Kalampogias A, Giannaki A, Mourouzis K, Tsigkou V, Antonopoulos A, Vogiatzi G, Mpourouki E, Tsalamandris S, Papamikroulis GA, Tousoulis D. P3757Association of adrenomedulin and atrial natriuretic peptide with endothelial function and peripheral vascular resistance in heart failure subjects. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p3757] [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: 11/14/2022] Open
Affiliation(s)
- E Oikonomou
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
| | - E Dimitropoulos
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
| | - G Siasos
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
| | - A Miliou
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
| | - A Kalampogias
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
| | - A Giannaki
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
| | - K Mourouzis
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
| | - V Tsigkou
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
| | - A Antonopoulos
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
| | - G Vogiatzi
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
| | - E Mpourouki
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
| | - S Tsalamandris
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
| | - G A Papamikroulis
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
| | - D Tousoulis
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
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48
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Anastasiou M, Oikonomou E, Zagouri F, Siasos G, Antonopoulos AS, Tsalamandris S, Papakostas P, Psaltopoulou T, Bamias A, Dimopoulos MA, Tousoulis D. P1577Cancer therapeutic related vaso- and cardio-toxicity in patients receiving chemotherapy for breast cancer. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p1577] [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)
- M Anastasiou
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
| | - E Oikonomou
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
| | - F Zagouri
- Alexandra University Hospital, Department of Clinical Therapeutics, University of Athens Medical School, Athens, Greece
| | - G Siasos
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
| | - A S Antonopoulos
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
| | - S Tsalamandris
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
| | - P Papakostas
- Hippokration General Hospital, Department of Internal Medicine, Athens, Greece
| | - T Psaltopoulou
- National & Kapodistrian University of Athens, Department of Hygiene, Epidemiology and Medical Statistics, Athens, Greece
| | - A Bamias
- Alexandra University Hospital, Department of Clinical Therapeutics, University of Athens Medical School, Athens, Greece
| | - M A Dimopoulos
- Alexandra University Hospital, Department of Clinical Therapeutics, University of Athens Medical School, Athens, Greece
| | - D Tousoulis
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
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49
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Oikonomou E, Lazaros G, Christoforatou E, Chasikidis C, Vogiatzi G, Mourouzis C, Tsalamandris S, Papamikroulis GA, Mavrantzas T, Stofa E, Goliopoulou A, Papakonstantinou M, Anastasiou M, Galiatsatos N, Tousoulis D. P238Sedentary lifestyle patterns and their impact on carotid arterial atherosclerotic burden: insights from the Corinthia study. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy564.p238] [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)
- E Oikonomou
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
| | - G Lazaros
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
| | - E Christoforatou
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
| | - C Chasikidis
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
| | - G Vogiatzi
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
| | - C Mourouzis
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
| | - S Tsalamandris
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
| | - G A Papamikroulis
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
| | - T Mavrantzas
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
| | - E Stofa
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
| | - A Goliopoulou
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
| | - M Papakonstantinou
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
| | - M Anastasiou
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
| | - N Galiatsatos
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
| | - D Tousoulis
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
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50
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Oikonomou E, Lazaros G, Christoforatou E, Chasikidis C, Tsalamandris S, Papamikroulis GA, Vogiatzi G, Papakonstantinou M, Goliopoulou A, Anastasiou M, Tousouli M, Stofa E, Georgiopoulos G, Theofilis P, Tousoulis D. THE RELATIONSHIP BETWEEN EMOTIONAL STATUS, DEPRESSION AND CAROTID ATHEROMATIC BURDEN: THE CORINTHIA STUDY. J Am Coll Cardiol 2018. [DOI: 10.1016/s0735-1097(18)32636-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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