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Markousis-Mavrogenis G, Belegrinos A, Giannakopoulou A, Karanasios E, Vartela V, Patsilinakou E, Samantis P, Pons RM, Papavasiliou A, Mavrogeni SI. Heart Failure Post-SARS-CoV-2 Infection in Children with Duchenne Muscular Dystrophy: The Additive Value of Cardiovascular Magnetic Resonance. Children (Basel) 2023; 10:children10050894. [PMID: 37238442 DOI: 10.3390/children10050894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 05/06/2023] [Accepted: 05/08/2023] [Indexed: 05/28/2023]
Abstract
In this case series, we describe the diagnosis of post-COVID-19 myocarditis in asymptomatic patients with Duchenne Muscular Dystrophy (DMD) and a mild COVID-19 disease course. These patients were referred for CMR due to electrocardiographic and echocardiographic alterations, which did not exist before COVID-19 infection. CMR identified the presence of severe myocardial inflammation in all patients based on abnormally elevated myocardial T2 ratio, late gadolinium enhancement, native T1 mapping, T2 mapping, and extracellular volume fraction. This was paired with concurrent impairment of left ventricular function. Appropriate treatment was initiated in all cases. Two of the four patients developed episodes of ventricular tachycardia during the following 6 months, and a defibrillator was implanted. Despite the mild clinical presentation, this case series demonstrates the diagnostic strength of CMR in the diagnosis and evaluation of post-COVID-19 myocarditis and serves to increase awareness of this potential complication amongst treating physicians.
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Affiliation(s)
| | - Antonios Belegrinos
- Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | | | | | | | | | - Paul Samantis
- Olympic Diagnostic Research Center, 18543 Piraeus, Greece
| | - Roser-Marie Pons
- Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | | | - Sophie I Mavrogeni
- Onassis Cardiac Surgery Center, 17674 Athens, Greece
- Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
- Aghia Sophia Children's Hospital, 11527 Athens, Greece
- University Research Institute of Maternal and Child Health and Precision Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece
- Center for Adolescent Medicine and UNESCO Chair in Adolescent Health Care, National and Kapodistrian University of Athens, 11527 Athens, Greece
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2
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Markousis-Mavrogenis G, Belegrinos A, Giannakopoulou A, Papavasiliou A, Koulouri V, Marketos N, Patsilinakou E, Lazarioti F, Bacopoulou F, Mavragani CP, Chrousos GP, Mavrogeni SI. Cardiovascular Magnetic Resonance Demonstrates Myocardial Inflammation of Differing Etiologies and Acuities in Patients with Genetic and Inflammatory Myopathies. J Clin Med 2023; 12:jcm12041575. [PMID: 36836108 PMCID: PMC9961874 DOI: 10.3390/jcm12041575] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Revised: 01/03/2023] [Accepted: 02/09/2023] [Indexed: 02/18/2023] Open
Abstract
INTRODUCTION Myopathies are heterogeneous neuromuscular diseases of genetic and/or inflammatory etiology that affect both cardiac and skeletal muscle. We investigated the prevalence of cardiac inflammation in patients with myopathies, cardiovascular symptoms, and normal echocardiography using cardiovascular magnetic resonance (CMR). METHODS We prospectively evaluated 51 patients with various genetic (n = 23) and inflammatory (n = 28) myopathies (median age, IQR: 12 (11-15) years, 22% girls; 61 (55-65) years, 46% women, respectively) and compared their CMR findings to corresponding age- and sex-matched controls (n = 21 and 20, respectively) and to each other. RESULTS Patients with genetic myopathy had similar biventricular morphology and function to healthy controls but showed higher late gadolinium enhancement (LGE), native T1 mapping, extracellular volume fraction (ECV), and T2 mapping values. Collectively, 22 (95.7%) patients with genetic myopathy had a positive T1-criterion and 3 (13.0%) had a positive T2-criterion according to the updated Lake Louise criteria. Compared with healthy controls, patients with inflammatory myopathy showed preserved left ventricular (LV) function and reduced LV mass, while all CMR-derived tissue characterization indices were significantly higher (p < 0.001 for all). All patients had a positive T1-criterion, and 27 (96.4%) had a positive T2-criterion. A positive T2-criterion or T2-mapping > 50 ms could discriminate between patients with genetic and inflammatory myopathies with a sensitivity of 96.4% and a specificity of 91.3% (AUC = 0.9557). CONCLUSIONS The vast majority of symptomatic patients with inflammatory myopathies and normal echocardiography show evidence of acute myocardial inflammation. In contrast, acute inflammation is rare in patients with genetic myopathies, who show evidence of chronic low-grade inflammation.
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Affiliation(s)
- George Markousis-Mavrogenis
- Olympic Diagnostic/Research Center, 17674 Athens, Greece
- Onassis Cardiac Surgery Center, 17674 Athens, Greece
| | - Antonios Belegrinos
- Faculty of Medicine, National and Kapodistrian University of Athens, 15772 Athens, Greece
| | | | | | - Vasiliki Koulouri
- Department of Physiology “Molecular Physiology and Clinical Applications Unit”, Faculty of Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Nikolaos Marketos
- Department of Physiology “Molecular Physiology and Clinical Applications Unit”, Faculty of Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | | | | | - Flora Bacopoulou
- University Research Institute for Maternal and Child Health and Precision Medicine, School of Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece
- Center for Adolescent Medicine and UNESCO Chair in Adolescent Health Care, First Department of Pediatrics, School of Medicine, National and Kapodistrian University of Athens, Aghia Sophia Children’s Hospital, 11527 Athens, Greece
| | - Clio P. Mavragani
- Department of Physiology “Molecular Physiology and Clinical Applications Unit”, Faculty of Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece
- Attikon Hospital, 12462 Athens, Greece
| | - George P. Chrousos
- University Research Institute for Maternal and Child Health and Precision Medicine, School of Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece
- Center for Adolescent Medicine and UNESCO Chair in Adolescent Health Care, First Department of Pediatrics, School of Medicine, National and Kapodistrian University of Athens, Aghia Sophia Children’s Hospital, 11527 Athens, Greece
| | - Sophie I. Mavrogeni
- Olympic Diagnostic/Research Center, 17674 Athens, Greece
- Onassis Cardiac Surgery Center, 17674 Athens, Greece
- University Research Institute for Maternal and Child Health and Precision Medicine, School of Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece
- Center for Adolescent Medicine and UNESCO Chair in Adolescent Health Care, First Department of Pediatrics, School of Medicine, National and Kapodistrian University of Athens, Aghia Sophia Children’s Hospital, 11527 Athens, Greece
- Correspondence:
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Markousis-Mavrogenis G, Giannakopoulou A, Belegrinos A, Pons MR, Bonou M, Vartela V, Papavasiliou A, Christidi A, Kourtidou S, Kolovou G, Bacopoulou F, Chrousos GP, Mavrogeni SI. Cardiovascular Magnetic Resonance Imaging Patterns in Rare Cardiovascular Diseases. J Clin Med 2022; 11:6403. [PMID: 36362632 PMCID: PMC9657782 DOI: 10.3390/jcm11216403] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 10/25/2022] [Accepted: 10/26/2022] [Indexed: 08/27/2023] Open
Abstract
Rare cardiovascular diseases (RCDs) have low incidence but major clinical impact. RCDs' classification includes Class I-systemic circulation, Class II-pulmonary circulation, Class III-cardiomyopathies, Class IV-congenital cardiovascular diseases (CVD), Class V-cardiac tumors and CVD in malignancy, Class VI-cardiac arrhythmogenic disorders, Class VII-CVD in pregnancy, Class VIII-unclassified rare CVD. Cardiovascular Magnetic Resonance (CMR) is useful in the diagnosis/management of RCDs, as it performs angiography, function, perfusion, and tissue characterization in the same examination. Edema expressed as a high signal in STIRT2 or increased T2 mapping is common in acute/active inflammatory states. Diffuse subendocardial fibrosis, expressed as diffuse late gadolinium enhancement (LGE), is characteristic of microvascular disease as in systemic sclerosis, small vessel vasculitis, cardiac amyloidosis, and metabolic disorders. Replacement fibrosis, expressed as LGE, in the inferolateral wall of the left ventricle (LV) is typical of neuromuscular disorders. Patchy LGE with concurrent edema is typical of myocarditis, irrespective of the cause. Cardiac hypertrophy is characteristic in hypertrophic cardiomyopathy (HCM), cardiac amyloidosis (CA) and Anderson-Fabry Disease (AFD), but LGE is located in the IVS, subendocardium and lateral wall in HCM, CA and AFD, respectively. Native T1 mapping is increased in HCM and CA and reduced in AFD. Magnetic resonance angiography provides information on aortopathies, such as Marfan, Turner syndrome and Takayasu vasculitis. LGE in the right ventricle is the typical finding of ARVC, but it may involve LV, leading to the diagnosis of arrhythmogenic cardiomyopathy. Tissue changes in RCDs may be detected only through parametric imaging indices.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Flora Bacopoulou
- University Research Institute for Maternal and Child Health and Precision Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece
- Center for Adolescent Medicine and UNESCO Chair on Adolescent Health Care, First Department of Pediatrics, “Agia Sophia” Children’s Hospital, School of Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - George P. Chrousos
- University Research Institute for Maternal and Child Health and Precision Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece
- Center for Adolescent Medicine and UNESCO Chair on Adolescent Health Care, First Department of Pediatrics, “Agia Sophia” Children’s Hospital, School of Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Sophie I. Mavrogeni
- Onassis Cardiac Surgery Center, 17674 Athens, Greece
- University Research Institute for Maternal and Child Health and Precision Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece
- Center for Adolescent Medicine and UNESCO Chair on Adolescent Health Care, First Department of Pediatrics, “Agia Sophia” Children’s Hospital, School of Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece
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Markousis‑Mavrogenis G, Bacopoulou F, Kolovou G, Pons MR, Giannakopoulou A, Papavasiliou A, Kitas G, Chrousos G, Mavrogeni S. Pathophysiology of cognitive dysfunction and the role of combined brain/heart magnetic resonance imaging (Review). Exp Ther Med 2022; 24:569. [DOI: 10.3892/etm.2022.11506] [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] [Received: 02/16/2022] [Accepted: 04/08/2022] [Indexed: 11/06/2022] Open
Affiliation(s)
| | - Flora Bacopoulou
- Clinic for Assessment of Adolescent Learning Difficulties, Center for Adolescent Medicine and UNESCO Chair in Adolescent Health Care, First Department of Pediatrics, Medical School, National and Kapodistrian University of Athens, Aghia Sophia Children's Hospital, Athens 11527, Greece
| | | | - Maria-Roser Pons
- Department of Neurology, First Department of Pediatrics, Medical School, National and Kapodistrian University of Athens, Aghia Sophia Children's Hospital, Athens 11527, Greece
| | | | | | | | - George Chrousos
- University Research Institute of Maternal and Child Health and Precision Medicine and UNESCO Chair in Adolescent Health Care, Medical School, National and Kapodistrian University of Athens, Aghia Sophia Children's Hospital, Athens 11527, Greece
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Oikonomopoulou C, Paisiou A, Ioannidou ED, Komitopoulou A, Kaisari A, Zisaki K, Kastamoulas M, Stavroulaki G, Giannakopoulou A, Vessalas G, Kitra-Roussou V, Goussetis E, Peristeri I. Allogeneic hematopoietic stem cell transplantation in infants is associated with significant morbidity and mortality. Pediatr Transplant 2022; 26:e14239. [PMID: 35122456 DOI: 10.1111/petr.14239] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 01/15/2022] [Accepted: 01/19/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Infants are subjected to hematopoietic stem cell transplantation (HSCT) due to malignant and non-malignant diseases. However, specific data concerning the outcome and transplantation-related complications in infants, as a separate age group, are limited. Our aim was to evaluate the impact of infancy on the outcome, toxicity, and complications after HSCT. METHODS We retrospectively analyzed data of 55 infants that underwent HSCT in our unit from May 1997 until February 2020, emphasizing on the probability of overall survival (OS) and the cumulative incidence (CI) of transplantation-related mortality (TRM) and complications. RESULTS We report a probability of OS of 61%, a CI of TRM at day 100 and 365 post transplantation of 22% and 30%, respectively, and additionally a CI of graft failure, acute graft-versus-host disease (GvHD), and infectious complications, 18%, 44%, and 39%, respectively. No statistically significant association was detected between the above mentioned parameters and diagnosis, the use of myeloablative or non-myeloablative/reduced toxicity conditioning regimens or the type of donor. CONCLUSIONS We conclude that HSCT in infancy is associated with significant mortality and morbidity. This is possibly attributed to endogenous, age-related factors. More specifically, infants may be at a higher risk of toxicities due to the immaturity of developing vital organs and the deficiency of the newly adopted immune system that predisposes them to infectious complications. The development of GvHD further augments the danger of infections, in a potential vice-versa relationship. Moreover, there are few data on pharmacokinetics of chemotherapy agents, making safe and efficacious drug administration hard.
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Affiliation(s)
| | - Anna Paisiou
- Stem Cell Transplant Unit, Agia Sofia Children's Hospital, Athens, Greece
| | | | - Anna Komitopoulou
- Stem Cell Transplant Unit, Agia Sofia Children's Hospital, Athens, Greece
| | - Aikaterini Kaisari
- Stem Cell Transplant Unit, Agia Sofia Children's Hospital, Athens, Greece
| | - Kalliopi Zisaki
- Transfusion Department, Agia Sofia Children's Hospital, Athens, Greece
| | | | | | - Aikaterini Giannakopoulou
- First Department of Paediatrics, National and Kapodistrian University of Athens, Agia Sophia Children's Hospital, Athens, Greece
| | - George Vessalas
- Stem Cell Transplant Unit, Agia Sofia Children's Hospital, Athens, Greece
| | | | - Evgenios Goussetis
- Stem Cell Transplant Unit, Agia Sofia Children's Hospital, Athens, Greece
| | - Ioulia Peristeri
- Stem Cell Transplant Unit, Agia Sofia Children's Hospital, Athens, Greece
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Giannakopoulou A, Chrysikos D, Spartalis E, Protogerou V, Troupis T. Left Coronary Artery Circumflex Branch Arising From Main Stem of Pulmonary Artery: An Uncommon Anatomical Variation. Cureus 2021; 13:e15751. [PMID: 34178552 PMCID: PMC8221646 DOI: 10.7759/cureus.15751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
The left circumflex coronary artery anatomy is considered highly variable. Herein, we present a case of a 9-year-old male child with a remarkable medical history of a spontaneously closed interventricular septal defect, without residual regurgitation, who was referred for cardiological evaluation in view of orthopedic surgery. During the preoperative examination, echocardiography was performed, which showed multiple flows in the interventricular septum as well as a diastolic flow at the level of the pulmonary valve. Due to these findings, it was decided to perform a cardiac catheterization. On cardiac catheterization, it was diagnosed an anatomical variation of the circumflex branch of the left coronary artery arising from the main stem of the pulmonary artery. Significant stenosis was remarkable, as well as collateral circulation of both the circumflex and the left anterior descending artery with the right coronary artery. The child finally at the age of 11 underwent cardiothoracic surgery. To conclude, during asymptomatic cardiological evaluation, we should always think about the possibility of anatomic variations of the coronary arteries. Missing these types of anomalies may predispose to inadvertent life-threatening complications or sudden death.
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Affiliation(s)
- Aikaterini Giannakopoulou
- Department of Anatomy, School of Medicine, National and Kapodistrian University of Athens, Athens, GRC
| | - Dimosthenis Chrysikos
- Department of Anatomy, School of Medicine, National and Kapodistrian University of Athens, Athens, GRC
| | - Eleftherios Spartalis
- Department of Anatomy, School of Medicine, National and Kapodistrian University of Athens, Athens, GRC.,Propaedeutic Surgery, Laiko Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, GRC
| | - Vasileios Protogerou
- Department of Anatomy, National and Kapodistrian University of Athens, Athens, GRC
| | - Theodore Troupis
- Department of Anatomy, National and Kapodistrian University of Athens, Athens, GRC
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7
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Markousis-Mavrogenis G, Sfikakis PP, Koutsogeorgopoulou L, Dimitroulas T, Katsifis G, Giannakopoulou A, Voulgari P, Kolovou G, Kitas GD, Mavrogeni SI. Cardiovascular Magnetic Resonance Reveals Cardiac Pathophysiology in Autoimmune Rheumatic Diseases. Mediterr J Rheumatol 2021; 32:15-20. [PMID: 34386698 PMCID: PMC8314875 DOI: 10.31138/mjr.32.1.15] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 11/26/2020] [Accepted: 01/15/2020] [Indexed: 02/06/2023] Open
Abstract
Background/Aims The high incidence of cardiovascular disease (CVD) in patients with autoimmune rheumatic diseases (ARDs) is the main driver towards increased mortality in this patient group. Cardiovascular magnetic resonance (CMR) can non-invasively and robustly detect CVD in ARD patients at an early stage of development. The review summarises the diagnostic information provided by CMR in ARD patients. Summary CMR uses a strong magnetic field combined with radio-frequency pulses (pulse sequences) to generate images. Firstly, balanced steady-state free precession (bSSFP) can be used for evaluating cardiac anatomy, mass, wall motion, atrial/ventricular function. Secondly, T2-weighted imaging (T2-W) can be used for oedema detection, which appears as a high signal intensity area on STIR (short tau inversion recovery) images. T2 mapping is a newer T2-W technique that can provide more optimal identification of myocardial oedema. Lastly, late gadolinium enhanced (LGE) T1-W images, taken 15 min. after injection of contrast agent, allow the detection of myocardial replacement fibrosis, which appears as a bright area in a background of black myocardium. However, LGE has inherent disadvantages for the assessment of diffuse myocardial fibrosis. Therefore, T1 mapping and extracellular volume fraction (ECV) have been developed to quantify diffuse myocardial fibrosis. Results Although multicentre studies are still missing, the CMR parameters have been extensively applied for the identification of oedema/fibrosis and treatment decision making in ARDs. Conclusions Tissue characterisation with CMR allows early and robust identification of CVD in ARD patients and contributes to personalized management in the patients.
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Affiliation(s)
| | - Petros P Sfikakis
- Joint Rheumatology, Laikon Hospital, Athens, Greece.,Department of Pathophysiology, Laikon Hospital, National Kapodistrian University of Athens, Athens, Greece
| | - Loukia Koutsogeorgopoulou
- Department of Pathophysiology, Laikon Hospital, National Kapodistrian University of Athens, Athens, Greece
| | - Theodoros Dimitroulas
- Department of Internal Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | | | | | | | - George D Kitas
- Arthritis Research UK Epidemiology Unit, Manchester University, Manchester, United Kingdom
| | - Sophie I Mavrogeni
- Onassis Cardiac Surgery Center, Athens, Greece.,Department of Pathophysiology, Laikon Hospital, National Kapodistrian University of Athens, Athens, Greece
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8
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Markousis-Mavrogenis G, Poulos G, Dimitroulas T, Giannakopoulou A, Mavragani C, Vartela V, Manolopoulou D, Kolovou G, Voulgari P, Sfikakis PP, Kitas GD, Mavrogeni SI. Ventricular Tachycardia Has Mainly Non-Ischaemic Substrates in Patients with Autoimmune Rheumatic Diseases and a Preserved Ejection Fraction. Diagnostics (Basel) 2021; 11:diagnostics11030519. [PMID: 33804066 PMCID: PMC8001227 DOI: 10.3390/diagnostics11030519] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 02/16/2021] [Accepted: 03/12/2021] [Indexed: 12/30/2022] Open
Abstract
Non-sustained ventricular tachycardia (NSVT) is a potentially lethal arrhythmia that is most commonly attributed to coronary artery disease. We hypothesised that among patients with NSVT and preserved ejection fraction, cardiovascular magnetic resonance (CMR) would identify a different proportion of ischaemic/non-ischaemic arrhythmogenic substrates in those with and without autoimmune rheumatic diseases (ARDs). In total, 80 consecutive patients (40 with ARDs, 40 with non-ARD-related cardiac pathology) with NSVT in the past 15 days and preserved left ventricular ejection fraction were examined using a 1.5-T system. Evaluated parameters included biventricular volumes/ejection fractions, T2 signal ratio, early/late gadolinium enhancement (EGE/LGE), T1 and T2 mapping and extracellular volume fraction (ECV). Mean age did not differ across groups, but patients with ARDs were more often women (32 (80%) vs. 15 (38%), p < 0.001). Biventricular systolic function, T2 signal ratio and EGE and LGE extent did not differ significantly between groups. Patients with ARDs had significantly higher median native T1 mapping (1078.5 (1049.0–1149.0) vs. 1041.5 (1014.0–1079.5), p = 0.003), higher ECV (31.0 (29.0–32.0) vs. 28.0 (26.5–30.0), p = 0.003) and higher T2 mapping (57.5 (54.0–61.0) vs. 52.0 (48.0–55.5), p = 0.001). In patients with ARDs, the distribution of cardiac fibrosis followed a predominantly non-ischaemic pattern, with ischaemic patterns being more common in those without ARDs (p < 0.001). After accounting for age and cardiovascular comorbidities, most findings remained unaffected, while only tissue characterisation indices remained significant after additionally correcting for sex. Patients with ARDs had a predominantly non-ischaemic myocardial scar pattern and showed evidence of diffuse inflammatory/ischaemic changes (elevated native T1-/T2-mapping and ECV values) independent of confounding factors.
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Affiliation(s)
| | - George Poulos
- Onassis Cardiac Surgery Center, 17674 Athens, Greece; (G.M.-M.); (G.P.); (V.V.); (D.M.); (G.K.)
| | - Theodoros Dimitroulas
- Department of Internal Medicine, Rheumatology, Aristotle University, 54124 Thessaloniki, Greece;
| | | | - Clio Mavragani
- Pathophysiology Department, Laikon Hospital, 11527 Athens, Greece;
- First Department of Propaedeutic Internal Medicine and Joint Rheumatology Program, Medical School, National and Kapodistrian University of Athens, 15772 Athens, Greece;
| | - Vasiliki Vartela
- Onassis Cardiac Surgery Center, 17674 Athens, Greece; (G.M.-M.); (G.P.); (V.V.); (D.M.); (G.K.)
| | - Dionysia Manolopoulou
- Onassis Cardiac Surgery Center, 17674 Athens, Greece; (G.M.-M.); (G.P.); (V.V.); (D.M.); (G.K.)
| | - Genovefa Kolovou
- Onassis Cardiac Surgery Center, 17674 Athens, Greece; (G.M.-M.); (G.P.); (V.V.); (D.M.); (G.K.)
| | | | - Petros P. Sfikakis
- First Department of Propaedeutic Internal Medicine and Joint Rheumatology Program, Medical School, National and Kapodistrian University of Athens, 15772 Athens, Greece;
- First Department of Propeudeutic and Internal Medicine, Laikon Hospital, 11527 Athens, Greece
| | - George D. Kitas
- Dudley Group NHS Foundation Trust, Dudley DY1 2HQ, UK;
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham B15 2TT, UK
| | - Sophie I. Mavrogeni
- Onassis Cardiac Surgery Center, 17674 Athens, Greece; (G.M.-M.); (G.P.); (V.V.); (D.M.); (G.K.)
- First Department of Propaedeutic Internal Medicine and Joint Rheumatology Program, Medical School, National and Kapodistrian University of Athens, 15772 Athens, Greece;
- Correspondence: ; Tel./Fax: +30-210-98-82-797
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Mavrogeni SI, Bacopoulou F, Markousis-Mavrogenis G, Giannakopoulou A, Kariki O, Vartela V, Kolovou G, Charmandari E, Chrousos G. Cardiovascular Magnetic Resonance as Pathophysiologic Tool in Diabetes Mellitus. Front Endocrinol (Lausanne) 2021; 12:672302. [PMID: 34194393 PMCID: PMC8237858 DOI: 10.3389/fendo.2021.672302] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 05/12/2021] [Indexed: 01/02/2023] Open
Abstract
Diabetes mellitus can independently contribute to cardiovascular disease and represents a severe risk factor for premature development of cardiovascular disease. A three-fold higher mortality than the general population has been observed in type 1 diabetes mellitus whereas a two- to four-fold increased probability to develop cardiovascular disease has been observed in type 2 diabetes mellitus. Cardiovascular magnetic resonance, a non-radiative modality, is superior to all other modalities in detecting myocardial infarction. The main cardiovascular magnetic resonance sequences used include a) balanced steady-state free precession (bSSFP) for function evaluation; b) T2-W for oedema detection; c) T1 W for ischemia detection during adenosine stress; and d) late gadolinium enhanced T1-W images (LGE), evaluated 15 min after injection of paramagnetic contrast agent gadolinium, which permit the diagnosis of replacement fibrosis, which appears white in the middle of suppressed, nulled myocardium. Although LGE is the technique of choice for diagnosis of replacement fibrosis, it cannot assess diffuse myocardial fibrosis. The application of T1 mapping (native or pre contrast and post contrast) allows identification of diffuse myocardial fibrosis, which is not detectable my other means. Native T1 and Contrast-enhanced T1 mapping are involved in the extracellular volume fraction (ECV) calculation. Recently, 1H-cardiovascular magnetic resonance spectroscopy has been applied to calculate the amount of myocardial triglycerides, but at the moment it is not part of the routine assessment of diabetes mellitus. The multifaceted nature of cardiovascular magnetic resonance has the great potential of concurrent evaluation of function and myocardial ischemia/fibrosis in the same examination and represents an indispensable tool for accurate diagnosis of cardiovascular disease in diabetes mellitus.
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Affiliation(s)
- Sophie I. Mavrogeni
- Department of Cardiology, Onassis Cardiac Surgery Center, Kallithea, Greece
- University Research Institute of Maternal and Child Health and Precision Medicine, and UNESCO Chair on Adolescent Health Care, National and Kapodistrian University of Athens, Aghia Sophia Children’s Hospital, Athens, Greece
- *Correspondence: Sophie I. Mavrogeni,
| | - Flora Bacopoulou
- University Research Institute of Maternal and Child Health and Precision Medicine, and UNESCO Chair on Adolescent Health Care, National and Kapodistrian University of Athens, Aghia Sophia Children’s Hospital, Athens, Greece
| | | | | | - Ourania Kariki
- Department of Cardiology, Onassis Cardiac Surgery Center, Kallithea, Greece
| | - Vasiliki Vartela
- Department of Cardiology, Onassis Cardiac Surgery Center, Kallithea, Greece
| | - Genovefa Kolovou
- Department of Cardiology, Onassis Cardiac Surgery Center, Kallithea, Greece
| | - Evangelia Charmandari
- Division of Endocrinology, Metabolism and Diabetes, First Department of Pediatrics, School of Medicine, National and Kapodistrian University of Athens, Aghia Sophia Children’s Hospital, Athens, Greece
- Division of Endocrinology and Metabolism, Center for Clinical, Experimental Surgery and Translational Research, Biomedical Research Foundation of the Academy of Athens, Athens, Greece
| | - George Chrousos
- University Research Institute of Maternal and Child Health and Precision Medicine, and UNESCO Chair on Adolescent Health Care, National and Kapodistrian University of Athens, Aghia Sophia Children’s Hospital, Athens, Greece
- Division of Endocrinology and Metabolism, Center for Clinical, Experimental Surgery and Translational Research, Biomedical Research Foundation of the Academy of Athens, Athens, Greece
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10
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Mavrogeni S, Giannakopoulou A, Katsalouli M, Pons RM, Papavasiliou A, Kolovou G, Noutsias M, Papadopoulos G, Karanasios E, Chrousos GP. Friedreich's Ataxia: Case series and the Additive Value of Cardiovascular Magnetic Resonance. J Neuromuscul Dis 2020; 7:61-67. [PMID: 31796683 DOI: 10.3233/jnd-180373] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BackgroundFriedreich's ataxia (FA) is an autosomal-recessive neurodegenerative disease characterised by neurologic, cardiac and endocrine abnormalities. Currently, Friedreich cardiomyopathy (FA-CM) staging is based on early ECG findings, high sensitivity troponin (hsTNT) ≥14 ng/ml and echocardiographic left ventricular (LV) morphologic and functional evaluation. However, further parameters, accessible only by cardiovascular magnetic resonance (CMR), such as myocardial oedema, perfusion defects, replacement and/or diffuse myocardial fibrosis, may have a place in the staging of FA-CA. Our aim was to elucidate the additive value of CMR in FA-CM.MethodsThree FA cases were assessed using ECG, 24 h Holter recording, hsTNT, routine ECHO including wall dimension, valvular and ventricular function evaluation and CMR using 1.5T Ingenia system. Ventricular volumes-function, wall dimensions and fibrosis imaging using late gadolinium enhancement (LGE) was performed.ResultsAll FA patients had non-specific ECG changes, almost normal 24 h Holter recording, mild hypertrophy with normal function assessed by echocardiography and increased hsTNT. However, the CMR evaluation revealed the presence of LGE >5% of LV mass, indicative of severe fibrosis. Therefore, the FA patients were re-categorized as having severe FA-CA, although their LVEF remained normal.ConclusionThe combination of classical diagnostic indices and CMR may reveal early asymptomatic FA-CM and motivate the early initiation of cardiac treatment. Furthermore, these indices can be also used to validate specific treatment targets in FA, potentially useful in the prevention of FA-CM.
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Affiliation(s)
| | - Aikaterini Giannakopoulou
- First Department of Paediatrics, National and Kapodistrian University of Athens, Aghia Sophia Children's Hospital, Athens, Greece
| | - Marina Katsalouli
- First Department of Paediatrics, National and Kapodistrian University of Athens, Aghia Sophia Children's Hospital, Athens, Greece
| | - Roser Maria Pons
- First Department of Paediatrics, National and Kapodistrian University of Athens, Aghia Sophia Children's Hospital, Athens, Greece
| | | | | | - Michel Noutsias
- Mid-German Heart Center, Department of Internal Medicine III (KIM-III), Division of Cardiology, Angiology and Intensive Medical Care, University Hospital Halle, Martin-Luther-University Halle, Ernst-Grube-Strasse 40, D-06120 Halle (Saale), Germany
| | - George Papadopoulos
- First Department of Paediatrics, National and Kapodistrian University of Athens, Aghia Sophia Children's Hospital, Athens, Greece
| | - Evangelos Karanasios
- First Department of Paediatrics, National and Kapodistrian University of Athens, Aghia Sophia Children's Hospital, Athens, Greece
| | - George P Chrousos
- First Department of Paediatrics, National and Kapodistrian University of Athens, Aghia Sophia Children's Hospital, Athens, Greece
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11
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Markousis-Mavrogenis G, Giannakopoulou A, Andreou N, Papadopoulos G, Vartela V, Kolovou G, Bacopoulou F, Tsarouhas K, Kanaka-Gantenbein C, A Spandidos D, I Mavrogeni S. Cardiovascular magnetic resonance clarifies arrhythmogenicity in asymptomatic young athletes with ventricular arrhythmias undergoing pre-participation evaluation. Exp Ther Med 2020; 20:561-571. [PMID: 32537014 PMCID: PMC7282016 DOI: 10.3892/etm.2020.8693] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 04/29/2020] [Indexed: 12/14/2022] Open
Abstract
Pre-participation sports examination (PPE) is a frequent reason for consultation. However, the exact role of cardiovascular magnetic resonance (CMR) in PPE remains undefined. The additive value of CMR in adolescent athletes with ventricular rhythm disturbances (VRDs) was investigated. We prospectively recruited and evaluated with CMR 50 consecutive, asymptomatic young athletes referred to our tertiary center after identification of VRDs on electrocardiogram (ECG) with otherwise normal standard PPE and echocardiography, and 20 age- and sex-matched healthy volunteer athletes who underwent the same evaluations. The primary outcome was case-control status and the secondary outcome was the discrimination between athletes with VRDs with and without non-sustained ventricular tachycardia (VT). CMR identified arrhythmogenic substrates in all athletes with VRDs. The predominant condition was myocarditis and arrhythmogenic right ventricular cardiomyopathy in patients with and without VT, respectively. Based on penalized regression analysis, late gadolinium enhancement (LGE), early gadolinium enhancement (EGE), extracellular volume fraction (ECV), and T2-mapping, best distinguished between case-control status. The aforementioned indices predicted case-control status independent of age and sex: EGE [Odds ratio (95% confidence interval): 6.89 (2.19-21.62) per 0.5-unit, P<0.001], LGE (perfect prediction), ECV [1.66 (1.25-2.22), P<0.001] and T2 mapping [1.40 (1.13-1.72), P=0.002], among other independent CMR-derived predictors. Only indexed ventricular volumes independently discriminated between VRD patients with and without VT. In this study, asymptomatic young athletes with VRDs and normal PPE/echocardiography were optimally discriminated from healthy control athletes by CMR-derived indices, and CMR allowed for the identification of arrhythmogenic substrates in all cases.
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Affiliation(s)
| | | | - Nikolaos Andreou
- Department of Cardiology, Aghia Sophia Children's Hospital, Athens 11527, Greece
| | - George Papadopoulos
- Department of Cardiology, Aghia Sophia Children's Hospital, Athens 11527, Greece
| | | | | | - Flora Bacopoulou
- Exercise Physiology and Sports Medicine Clinic, Center for Adolescent Medicine and UNESCO Chair on Adolescent Health Care, First Department of Pediatrics, Medical School, National and Kapodistrian University of Athens, Aghia Sophia Children's Hospital, Athens 11527, Greece
| | - Konstantinos Tsarouhas
- Exercise Physiology and Sports Medicine Clinic, Center for Adolescent Medicine and UNESCO Chair on Adolescent Health Care, First Department of Pediatrics, Medical School, National and Kapodistrian University of Athens, Aghia Sophia Children's Hospital, Athens 11527, Greece.,Department of Cardiology, University Hospital of Larissa, Larissa 41334, Greece
| | - Christina Kanaka-Gantenbein
- Exercise Physiology and Sports Medicine Clinic, Center for Adolescent Medicine and UNESCO Chair on Adolescent Health Care, First Department of Pediatrics, Medical School, National and Kapodistrian University of Athens, Aghia Sophia Children's Hospital, Athens 11527, Greece
| | - Demetrios A Spandidos
- Laboratory of Clinical Virology, School of Medicine, University of Crete, Heraklion 71003, Greece
| | - Sophie I Mavrogeni
- Onassis Cardiac Surgery Center, Athens 17674, Greece.,Exercise Physiology and Sports Medicine Clinic, Center for Adolescent Medicine and UNESCO Chair on Adolescent Health Care, First Department of Pediatrics, Medical School, National and Kapodistrian University of Athens, Aghia Sophia Children's Hospital, Athens 11527, Greece
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12
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Stamatis H, Giannakopoulou A, Patila M, Gkantzou E, Chatzikonstantinou A, Lyra K, Spyrou K, Polydera A, Gournis D. Nanobiocatalysts for multi-enzymatic cascade reactions. N Biotechnol 2018. [DOI: 10.1016/j.nbt.2018.05.875] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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13
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Giannakopoulou A, Grigoriadis N, Bekiari C, Lourbopoulos A, Dori I, Tsingotjidou AS, Michaloudi H, Papadopoulos GC. Acute inflammation alters adult hippocampal neurogenesis in a multiple sclerosis mouse model. J Neurosci Res 2013; 91:890-900. [PMID: 23606574 DOI: 10.1002/jnr.23226] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2012] [Revised: 02/24/2013] [Accepted: 02/24/2013] [Indexed: 12/31/2022]
Abstract
Neural precursor cells (NPCs) located in the subgranular zone (SGZ) of the dentate gyrus (DG) give rise to thousands of new cells every day, mainly hippocampal neurons, which are integrated into existing neuronal circuits. Aging and chronic degenerative disorders have been shown to impair hippocampal neurogenesis, but the consequence of inflammation is somewhat controversial. The present study demonstrates that the inflammatory environment prevailing in the brain of experimental autoimmune encephalomyelitis (EAE) mice enhances the proliferation of NPCs in SGZ of the dorsal DG and alters the proportion between radial glial cells and newborn neuroblasts. The injection protocol of the cell cycle marker bromodeoxyuridine and the immunohistochemical techniques that were employed revealed that the proliferation of NPCs is increased approximately twofold in the SGZ of the dorsal DG of EAE mice, at the acute phase of the disease. However, although EAE animals exhibited significant higher percentage of newborn radial-glia-like NPCs, the mean percentage of newborn neuroblasts rather was decreased, indicating that the robust NPCs proliferation is not followed by a proportional production of newborn neurons. Significant positive correlations were detected between the number of proliferating cells in the SGZ and the clinical score or degree of brain inflammation of diseased animals. Finally, enhanced neuroproliferation in the acute phase of EAE was not found to trigger compensatory apoptotic mechanisms. The possible causes of altered neurogenesis observed in this study emphasize the need to understand more precisely the mechanisms regulating adult neurogenesis under both normal and pathological conditions.
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Affiliation(s)
- A Giannakopoulou
- Laboratory of Anatomy, Histology and Embryology, Faculty of Veterinary Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
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14
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Zacharaki T, Sophou S, Giannakopoulou A, Dinopoulos A, Antonopoulos J, Parnavelas J, Dori I. Natural and lesion-induced apoptosis in the dorsal lateral geniculate nucleus during development. Brain Res 2010; 1344:62-76. [DOI: 10.1016/j.brainres.2010.05.021] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2009] [Revised: 05/05/2010] [Accepted: 05/05/2010] [Indexed: 12/29/2022]
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15
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Kouerinis IA, Palaiologou MM, Argiriou M, Dedeilias P, Apostolakis E, Giannakopoulou A, Papadopoulos G, Tsilimingas N. “Directed” Cardioplegia: A New Approach in Myocardial Protection in Left Main Coronary Artery Disease. Ann Thorac Surg 2008; 86:2005-7. [DOI: 10.1016/j.athoracsur.2008.05.012] [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] [Received: 02/11/2008] [Revised: 04/09/2008] [Accepted: 05/05/2008] [Indexed: 10/21/2022]
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16
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Kouerinis IA, Kourtesis A, El-Ali M, Sergentanis T, Plagou A, Argiriou M, Theakos N, Giannakopoulou A. Heparin induced thrombocytopenia diagnosis in cardiac surgery: is there a role for thromboelastography? Interact Cardiovasc Thorac Surg 2007; 7:560-3. [PMID: 18056152 DOI: 10.1510/icvts.2007.161679] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
The aim of the present protocol is to investigate the potency of thromboelastography (TEG) to screen postcardiac heparin induced thrombocytopenia (HIT) patients suspicious for HIT type II, and to differentiate which of them are subject to suffer thrombotic complications from those who will suffer hemorrhagic complications.
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Affiliation(s)
- Ilias A Kouerinis
- Department of Cardiac Surgery, Aghia Sophia Children's Hospital, Athens, Greece.
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17
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Zambelis T, Foutsitzi A, Giannakopoulou A, Poulopoulou K, Karandreas N. Lambert-Eaton myasthenic syndrome. Clinical and electrophysiological findings in seven cases. Electromyogr Clin Neurophysiol 2004; 44:289-92. [PMID: 15378868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
We report the clinical and electrophysiological findings in seven patients with Lambert-Eaton myasthenic syndrome (LEMS). All patients were males aged 40-73 years old. Six presented proximal muscle weakness and one both proximal and distal. The tendon reflexes were absent in four patients, depressed in two and normal in one patient. Three patients presented ophthalmic and four autonomic symptoms. The syndrome was diagnosed 3-12 months after the onset of symptoms in six patients and 4 years later in one. Acetylcholine receptor antibodies were negative in all patients. Voltage-gated calcium channel antibodies (VGCC) were measured in five patients and were positive in four. All patients had low compound muscle action potential (CMAP) at rest, a decrement in CMAP amplitude of 20-47% at 3 Hz repetitive nerve stimulation, and an increment of 200-700% at 40 Hz. In three patients the syndrome was associated with histologically verified small-cell lung cancer (SCLC). In the younger patient (40 years old), a lymph node biopsy performed nine years before the diagnosis of LEMS, had shown an atypical microcellular cancer of undetermined origin, which was treated with chemotherapy. LEMS 9 years after the diagnosis of cancer has not been described previously. The fifth patient had a two years history of bladder cancer (grade II). Three years after the diagnosis of LEMS he presented chronic lymphogenic leukemia. No malignancy was found in the remaining 2 patients.
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Affiliation(s)
- Th Zambelis
- Department of Neurology, University of Athens, Aeginition Hospital, Athens, Greece.
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18
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Katsoulis P, Grammatikopoulou B, Bourikis G, Tasiou A, Tselioti P, Giannakopoulou A, Fournogerakis S, Chantzi E, Prekates A. The incidence and mortality rate of ventilator-associated pneumonia in elderly patients. Crit Care 2002. [PMCID: PMC3333654 DOI: 10.1186/cc1695] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- P Katsoulis
- Critical Care Department, Tzanio Hospital, Athens, Greece
| | | | - G Bourikis
- Critical Care Department, Tzanio Hospital, Athens, Greece
| | - A Tasiou
- Critical Care Department, Tzanio Hospital, Athens, Greece
| | - P Tselioti
- Critical Care Department, Tzanio Hospital, Athens, Greece
| | | | | | - E Chantzi
- Critical Care Department, Tzanio Hospital, Athens, Greece
| | - A Prekates
- Critical Care Department, Tzanio Hospital, Athens, Greece
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