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Drakopoulou M, Vlachakis PK, Tsioufis C, Tousoulis D. Congenital heart “Challenges” in Down syndrome. World J Cardiol 2024; 16:217-220. [DOI: 10.4330/wjc.v16.i5.217] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 04/18/2024] [Accepted: 05/13/2024] [Indexed: 05/23/2024] Open
Abstract
In this editorial, we comment on the article by Kong et al published in the recent issue of the World Journal of Cardiology. In this interesting case, the authors present the challenges faced in managing a 13-year-old patient with Down syndrome (DS) and congenital heart disease (CHD) associated with pulmonary arterial hypertension. In this distinct population, the Authors underscore the need for early diagnosis and management as well as the need of a multidisciplinary approach for decision making. It seems that the occurrence of CHD in patients with DS adds layers of complexity to their clinical management. This editorial aims to provide a comprehensive overview of the intricate interplay between DS and congenital heart disorders, offering insights into the nuanced diagnostic and therapeutic considerations for physicians.
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Affiliation(s)
- Maria Drakopoulou
- Department of First Cardiology, Hippokration General Hospital, Athens Medical School, National and Kapodistrian University of Athens, Athens 11527, Greece
| | - Panayotis K Vlachakis
- Department of First Cardiology, Hippokration General Hospital, Athens Medical School, National and Kapodistrian University of Athens, Athens 11527, Greece
| | - Costas Tsioufis
- Department of First Cardiology, Hippokration General Hospital, Athens Medical School, National and Kapodistrian University of Athens, Athens 11527, Greece
| | - Dimitris Tousoulis
- Department of First Cardiology, Hippokration General Hospital, Athens Medical School, National and Kapodistrian University of Athens, Athens 11527, Greece
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Panagiotakos D, Sigala E, Damigou E, Loukina A, Dalmyras D, Mentzantonakis G, Barkas F, Adamidis PS, Kravvariti E, Liberopoulos E, Sfikakis PP, Tsioufis C, Pitsavos C, Chrysohoou C. The burden of cardiovascular disease and related risk factors, in Greece; the ATTICA epidemiological study (2002-2022). Hellenic J Cardiol 2024:S1109-9666(24)00113-1. [PMID: 38734306 DOI: 10.1016/j.hjc.2024.05.009] [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: 04/30/2024] [Accepted: 05/04/2024] [Indexed: 05/13/2024] Open
Abstract
AIM The aim of this study was to present the burden of cardiovascular disease (CVD) and its related risk factors based on a 20-year observation period (2002-2022). METHODS In 2002, 3,042 Greek adults (aged: 45 (12) years) free of CVD, cancer, or any other chronic infections were enrolled. In 2022, the 20-year follow-up was performed on 2,169 participants (1,988 had complete data for CVD). Lifetime risk for CVDs and Disability-Adjusted-Life-Years (DALYs) lost were also calculated. RESULTS The 20-year CVD incidence was 3,600 cases/10,000 individuals (man-to-woman ratio 5:4). At the index age of 40 years, the lifetime risk for developing CVD was 68% for men and 63% for women; as the participants were getting older, the lifetime risk declined by approximately 19% and 13% for men and women, respectively, but remained at high levels, reaching 55% for both sexes. Participants between 45-55 years exhibited the highest CVD burden concerning aggregated DALYs. The burden was greater in men than in women, at ages below 35 years; beyond this age threshold, this trend shifted, and women exhibited a higher CVD burden. CONCLUSION The burden of CVD in Greece has shown increasing trends over the past 20 years as a result of the accumulative growth of the prevalence of modifiable CVD risk factors. The disability-adjusted life-years lost are the most observed ever before, urging for efficient public health strategies and measures.
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Affiliation(s)
- Demosthenes Panagiotakos
- Department of Nutrition and Dietetics, School of Health Sciences and Education, Harokopio University, 17671, Athens, Greece.
| | - Evangelia Sigala
- Department of Nutrition and Dietetics, School of Health Sciences and Education, Harokopio University, 17671, Athens, Greece
| | - Evangelia Damigou
- Department of Nutrition and Dietetics, School of Health Sciences and Education, Harokopio University, 17671, Athens, Greece
| | - Asimina Loukina
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, 15772, Athens, Greece
| | - Dimitriοs Dalmyras
- Department of Nutrition and Dietetics, School of Health Sciences and Education, Harokopio University, 17671, Athens, Greece
| | - Georgios Mentzantonakis
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, 15772, Athens, Greece
| | - Fotios Barkas
- Department of Internal Medicine, Medical School, University of Ioannina, 45500 Ioannina, Greece
| | - Petros S Adamidis
- First Department of Propaedeutic Internal Medicine, Medical School, Laiko General Hospital, National and Kapodistrian University of Athens, 15772, Athens, Greece
| | - Evrydiki Kravvariti
- First Department of Propaedeutic Internal Medicine, Medical School, Laiko General Hospital, National and Kapodistrian University of Athens, 15772, Athens, Greece
| | - Evangelos Liberopoulos
- First Department of Propaedeutic Internal Medicine, Medical School, Laiko General Hospital, National and Kapodistrian University of Athens, 15772, Athens, Greece
| | - Petros P Sfikakis
- First Department of Propaedeutic Internal Medicine, Medical School, Laiko General Hospital, National and Kapodistrian University of Athens, 15772, Athens, Greece
| | - Costas Tsioufis
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, 15772, Athens, Greece
| | - Christos Pitsavos
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, 15772, Athens, Greece
| | - Christina Chrysohoou
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, 15772, Athens, Greece
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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; 13: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] [MESH Headings] [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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Tsartsalis D, Dimitroglou Y, Kalompatsou A, Koukos M, Patsourakos D, Tolis E, Tzoras S, Petras D, Tsioufis C, Aggeli C. Resting strain analysis to identify myocardial ischemia in patients with advanced chronic kidney disease. Clin Physiol Funct Imaging 2024; 44:240-250. [PMID: 38314900 DOI: 10.1111/cpf.12871] [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: 07/05/2023] [Revised: 01/14/2024] [Accepted: 01/18/2024] [Indexed: 02/07/2024]
Abstract
BACKGROUND Chronic kidney disease (CKD) is associated with higher incidence of cardiovascular death. Screening for coronary artery disease in asymptomatic or mildly symptomatic patients is challenging. OBJECTIVE The aim of this study was to investigate the incremental value of resting deformation analysis in predicting positive results for myocardial ischemia during stress transthoracic echocardiography in patients with end-stage CKD. METHODS Sixty-one patients (mean age: 62.3 ± 11.8, 65.7% men) with end-stage CKD were included in the study. Patients underwent a resting transthoracic echocardiogram and a dobutamine stress contrast echo (DSE) protocol. Positive results of DSE were defined as stress-induced left ventricular (LV) wall motion abnormalities. RESULTS The study cohort had normal or mildly impaired systolic function: mean LV ejection fraction (EF) was 49.2% (±10.4) and mean LV global longitudinal strain (GLS) was 14.4% (±4.5). Half of our population had impaired left atrial (LA) strain: mean LA reservoir, conduit, and contractile reserve were 24.1% (±12.6), 10.6% (±5.9), and 13.6% (±9.2), respectively. DSE was positive for ischemia in 55.7%. A significant negative association with DSE results was found for LV EF, LV GLS and the conduit phase of LA strain. Both LV and LA dimensions showed positive correlation with presence of ischemia in DSE. Multivariate logistic regression analysis showed that LV GLS was independently associated with DSE (p = 0.007), after controlling for covariates, with high diagnostic accuracy. CONCLUSION Resting LV deformation could predict positive results during DSE, thus may be useful to better identify renal patients who might benefit from coronary artery screening.
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Affiliation(s)
- Dimitrios Tsartsalis
- First Department of Cardiology, 'Hippokration' Hospital, University of Athens, Medical School, Athens, Greece
| | - Yannis Dimitroglou
- First Department of Cardiology, 'Hippokration' Hospital, University of Athens, Medical School, Athens, Greece
| | - Argyro Kalompatsou
- First Department of Cardiology, 'Hippokration' Hospital, University of Athens, Medical School, Athens, Greece
| | - Markos Koukos
- First Department of Cardiology, 'Hippokration' Hospital, University of Athens, Medical School, Athens, Greece
| | - Dimitrios Patsourakos
- First Department of Cardiology, 'Hippokration' Hospital, University of Athens, Medical School, Athens, Greece
| | - Elias Tolis
- First Department of Cardiology, 'Hippokration' Hospital, University of Athens, Medical School, Athens, Greece
| | - Spiros Tzoras
- Department of Clinical Physiology, Akademiska Sjukhuset, Uppsala, Sweden
| | - Dimitrios Petras
- Department of Nephrology, 'Hippokration' Hospital, Athens, Greece
| | - Costas Tsioufis
- First Department of Cardiology, 'Hippokration' Hospital, University of Athens, Medical School, Athens, Greece
| | - Constantina Aggeli
- First Department of Cardiology, 'Hippokration' Hospital, University of Athens, Medical School, 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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Damigou E, Georgoulis M, Chrysohoou C, Barkas F, Vlachopoulou E, Adamidis PS, Kravvariti E, Tsioufis C, Pitsavos C, Liberopoulos E, Sfikakis PP, Panagiotakos D. Mediterranean-Type Diet Adherence and Body Mass Index through 20 Years of Follow-Up: Results from the ATTICA Cohort Study (2002-2022). Nutrients 2024; 16:1128. [PMID: 38674819 PMCID: PMC11054262 DOI: 10.3390/nu16081128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Revised: 03/28/2024] [Accepted: 04/09/2024] [Indexed: 04/28/2024] Open
Abstract
Evidence of the association between dietary habits and long-term body weight status is scarce. This study aimed to evaluate changes in Mediterranean-type diet (MTD) adherence in relation to body weight during 20 years of follow-up. Data from n = 1582 participants from the ATTICA cohort study (2002-2022) were used. MTD adherence was assessed via MedDietScore, and body weight status via body mass index (BMI) by 3 different measurements. We found that MTD adherence and changes in this adherence were inversely related to BMI at 20 years and the mean BMI during the 20-year follow-up. In multi-adjusted linear regression models, a 1/55 increase in baseline, 10-year, and 20-year MedDietScore was associated with a decrease of 0.05-0.13 kg/m2 in BMI at 20 years and of 0.08-0.09 kg/m2 in the mean BMI. Being consistently close to the MTD for 20 years was associated with a >90% decreased risk of maintaining overweight/obesity during the 20-year period. Strong, protective, long-lasting effects of the MTD were observed, even in those who deviated from the MTD in the follow-up (41% of the sample). Our results highlight the need to focus on the overall diet quality to minimize the risk of maintaining an excessive body weight during the life-course.
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Affiliation(s)
- Evangelia Damigou
- Department of Nutrition and Dietetics, School of Health Sciences and Education, Harokopio University, 17676 Athens, Greece; (E.D.); (M.G.)
| | - Michael Georgoulis
- Department of Nutrition and Dietetics, School of Health Sciences and Education, Harokopio University, 17676 Athens, Greece; (E.D.); (M.G.)
| | - Christina Chrysohoou
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, 15772 Athens, Greece
| | - Fotios Barkas
- Department of Internal Medicine, Medical School, University of Ioannina, 45500 Ioannina, Greece
| | - Elpiniki Vlachopoulou
- Department of Nutrition and Dietetics, School of Health Sciences and Education, Harokopio University, 17676 Athens, Greece; (E.D.); (M.G.)
| | - Petros S. Adamidis
- First Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, 15772 Athens, Greece
| | - Evrydiki Kravvariti
- First Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, 15772 Athens, Greece
| | - Costas Tsioufis
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, 15772 Athens, Greece
| | - Christos Pitsavos
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, 15772 Athens, Greece
| | - Evangelos Liberopoulos
- First Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, 15772 Athens, Greece
| | - Petros P. Sfikakis
- First Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, 15772 Athens, Greece
| | - Demosthenes Panagiotakos
- Department of Nutrition and Dietetics, School of Health Sciences and Education, Harokopio University, 17676 Athens, Greece; (E.D.); (M.G.)
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Georgoulis M, Damigou E, Derdelakou E, Kosti RI, Chrysohoou C, Barkas F, Kravvariti E, Tsioufis C, Pitsavos C, Liberopoulos E, Sfikakis PP, Panagiotakos DB. Adherence to the Mediterranean diet and 20-year incidence of hypertension: the ATTICA prospective epidemiological study (2002-2022). Eur J Clin Nutr 2024:10.1038/s41430-024-01440-w. [PMID: 38605190 DOI: 10.1038/s41430-024-01440-w] [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: 07/03/2023] [Revised: 04/03/2024] [Accepted: 04/05/2024] [Indexed: 04/13/2024]
Abstract
BACKGROUND/OBJECTIVES Dietary habits are a significant predictor of hypertension (HTN). We aimed to evaluate the long-term association between adherence to the Mediterranean diet and HTN incidence. SUBJECTS/METHODS This was a prospective study among 1415 non-hypertensive adults (44% men, age: 41 ± 13 years) followed up for 20 years. Anthropometric, lifestyle, and clinical parameters were evaluated at baseline. Adherence to the Mediterranean diet was evaluated both at baseline and 10 years through the MedDietScore (range: 0-55, higher values indicate greater adherence). RESULTS At the 20-year follow-up, 314 new HTN cases were recorded. HTN incidence was 35.5%, 22.5%, and 8.7% in the lowest, middle, and upper tertile of baseline MedDietScore, respectively (p < 0.001). For each 1-point increase in baseline MedDietScore, the 20-year HTN risk decreased by 7% [relative risk (RR): 0.925, 95% confidence interval (CI): 0.906, 0.943], and this effect remained significant after adjustment for age, sex, and baseline lifestyle and clinical confounders, i.e., body mass index, physical activity, smoking, systolic and diastolic blood pressure, family history of HTN, and presence of hypercholesterolemia and diabetes mellitus (RR: 0.973, 95%CI: 0.949, 0.997). In a similar multiadjusted model, compared to subjects who were consistently away from the Mediterranean diet (in the lowest MedDietScore tertile both at baseline and 10 years), only those who were consistently close (in the middle and upper MedDietScore tertiles both at baseline and 10 years) exhibited a 47% lower 20-year HTN risk. CONCLUSION A high adherence to the Mediterranean diet, particularly when longitudinally sustained, is associated with lower incidence of HTN.
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Affiliation(s)
- Michael Georgoulis
- Department of Nutrition and Dietetics, School of Health Sciences and Education, Harokopio University of Athens, 17676, Athens, Greece
| | - Evangelia Damigou
- Department of Nutrition and Dietetics, School of Health Sciences and Education, Harokopio University of Athens, 17676, Athens, Greece
| | - Evgenia Derdelakou
- Department of Nutrition and Dietetics, School of Health Sciences and Education, Harokopio University of Athens, 17676, Athens, Greece
| | - Rena I Kosti
- Department of Nutrition and Dietetics, School of Physical Education, Sports and Dietetics, University of Thessaly, 38221, Trikala, Greece
| | - Christina Chrysohoou
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, 11527, Athens, Greece
| | - Fotios Barkas
- Department of Internal Medicine, Medical School, University of Ioannina, 45500, Ioannina, Greece
| | - Evrydiki Kravvariti
- First Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, 15772, Athens, Greece
| | - Costas Tsioufis
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, 11527, Athens, Greece
| | - Christos Pitsavos
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, 11527, Athens, Greece
| | - Evangelos Liberopoulos
- First Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, 15772, Athens, Greece
| | - Petros P Sfikakis
- First Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, 15772, Athens, Greece
| | - Demosthenes B Panagiotakos
- Department of Nutrition and Dietetics, School of Health Sciences and Education, Harokopio University of Athens, 17676, Athens, Greece.
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8
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Sagris M, Ktenopoulos N, Dimitriadis K, Papanikolaou A, Tzoumas A, Terentes-Printzios D, Synetos A, Soulaidopoulos S, Lichtenberg M, Korosoglou G, Honton B, Tousoulis D, Tsioufis C, Toutouzas K. Efficacy of intravascular lithotripsy (IVL) in coronary stenosis with severe calcification: A multicenter systematic review and meta-analysis. Catheter Cardiovasc Interv 2024; 103:710-721. [PMID: 38482928 DOI: 10.1002/ccd.31006] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 12/08/2023] [Accepted: 02/26/2024] [Indexed: 04/14/2024]
Abstract
BACKGROUND With heavily calcified coronary and peripheral artery lesions, lesion preparation is crucial before stent placement to avoid underexpansion, associated with stent thrombosis or restenosis and patency failure in the long-term. Intravascular lithotripsy (IVL) technology disrupts superficial and deep calcium by using localized pulsative sonic pressure waves, making it to a promising tool for patients with severe calcification in coronary bed. AIMS The aim of the study is to systematically review and summarize available data regarding the safety and efficacy of IVL for lesion preparation in severely calcified coronary arteries before stenting. METHODS This study was conducted according to the PRISMA guidelines. We systematically searched PubMed, SCOPUS, and Cochrane databases from their inception to February 23, 2023, for studies assessing the characteristics and outcomes of patients undergoing IVL before stent implantation. The diameter of the vessel lumen before and after IVL, as well as stent implantation, were analyzed. The occurrence of major adverse cardiovascular events (MACE) was assessed using a random-effects model. RESULTS This meta-analysis comprised 38 studies including 2977 patients with heavily calcified coronary lesions. The mean age was 72.2 ± 9.1 years, with an overall IVL clinical success of 93% (95% confidence interval [CI]: 91%-95%, I2 = 0%) and procedural success rate of 97% (95% CI: 95%-98%, I2 = 73.7%), while the in-hospital and 30-days incidence of MACE, myocardial infarction (MI), and death were 8% (95% CI: 6%-11%, I2 = 84.5%), 5% (95% CI: 2%-8%, I2 = 85.6%), and 2% (95% CI: 1%-3%, I2 = 69.3%), respectively. There was a significant increase in the vessel diameter (standardized mean difference [SMD]: 2.47, 95% CI: 1.77-3.17, I2 = 96%) and a decrease in diameter stenosis (SMD: -3.44, 95% CI: -4.36 to -2.52, I2 = 97.5%) immediately after IVL application, while it was observed further reduction in diameter stenosis (SMD: -6.57, 95% CI: -7.43 to -5.72, I2 = 95.8%) and increase in the vessel diameter (SMD: 4.37, 95% CI: 3.63-5.12, I2 = 96.7%) and the calculated lumen area (SMD: 3.23, 95% CI: 2.10-4.37, I2 = 98%), after stent implantation. The mean acute luminal gain following IVL and stent implantation was estimated to be 1.27 ± 0.6 and 1.94 ± 1.1 mm, respectively. Periprocedural complications were rare, with just a few cases of perforations, dissection, or no-reflow phenomena recorded. CONCLUSIONS IVL seems to be a safe and effective strategy for lesion preparation in severely calcified lesions before stent implantation in coronary arteries. Future prospective studies are now warranted to compare IVL to other lesion preparation strategies.
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Affiliation(s)
- Marios Sagris
- School of Medicine, "Hippokration" General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Nikolaos Ktenopoulos
- School of Medicine, "Hippokration" General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Kyriakos Dimitriadis
- School of Medicine, "Hippokration" General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Angelos Papanikolaou
- School of Medicine, "Hippokration" General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Andreas Tzoumas
- Department of Internal Medicine, University of Cincinnati Medical Center, Cincinnati, Ohio, USA
| | - Dimitrios Terentes-Printzios
- School of Medicine, "Hippokration" General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Andreas Synetos
- School of Medicine, "Hippokration" General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Stergios Soulaidopoulos
- School of Medicine, "Hippokration" General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Michael Lichtenberg
- Department of Cardiology, Vascular Medicine and Pneumology, GRN Hospital, Weinheim, Germany
| | | | - Benjamin Honton
- Department of Interventional Cardiology, Clinique Pasteur, Toulouse, France
| | - Dimitris Tousoulis
- School of Medicine, "Hippokration" General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Costas Tsioufis
- School of Medicine, "Hippokration" General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Konstantinos Toutouzas
- School of Medicine, "Hippokration" General Hospital, National and Kapodistrian University of Athens, Athens, Greece
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9
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Kechagia I, Tsiampalis T, Damigou E, Barkas F, Anastasiou G, Kravvariti E, Liberopoulos E, Sfikakis PP, Chrysohoou C, Tsioufis C, Pitsavos C, Panagiotakos D. Long-Term Adherence to the Mediterranean Diet Reduces 20-Year Diabetes Incidence: The ATTICA Cohort Study (2002-2022). Metabolites 2024; 14:182. [PMID: 38668310 PMCID: PMC11051724 DOI: 10.3390/metabo14040182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 03/19/2024] [Accepted: 03/20/2024] [Indexed: 04/28/2024] Open
Abstract
This study aimed to evaluate the association between adherence to the Mediterranean diet and the 20-year incidence of type II diabetes mellitus (T2DM) among adults from the ATTICA study. This study involved a prospective cohort of 3042 men and women recruited at baseline from the Attica region in Greece. Sociodemographic, anthropometric, lifestyle, and clinical characteristics were evaluated at baseline and follow-up examinations; adherence to the Mediterranean diet was assessed through the MedDietScore (range 0-55); four Mediterranean diet trajectories were identified (i.e., increasing, decreasing, and sustained high and sustained low adherence levels). For the present analysis, data from 2000 individuals with complete information were used (age 43 ± 13 years; 49% men). Over the 20-year period, 26.3% (95%CI 24.4%, 28.3%) of participants developed T2DM; men exhibited a 1.5-times higher incidence compared to women (p < 0.001). Individuals consistently close to the Mediterranean diet throughout the studied period had an improved glycemic and lipidemic profile (at baseline and at 10-y follow-up) (all p-values < 0.001) and showed a 21% reduction in their 20-year risk of developing T2DM compared to those who were consistently away (RR = 0.79, 95%CI 0.47, 0.86). A long-term adherence to the Mediterranean diet is protective against the onset of T2DM and, therefore, could be incorporated in public health actions for the prevention of the disease.
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Affiliation(s)
- Ioanna Kechagia
- Department of Nutrition and Dietetics, School of Health Sciences & Education, Harokopio University, 17676 Athens, Greece
- Department of Clinical Dietetics-Nutrition, HYGEIA Hospital, 15123 Athens, Greece
| | - Thomas Tsiampalis
- Department of Nutrition and Dietetics, School of Health Sciences & Education, Harokopio University, 17676 Athens, Greece
| | - Evangelia Damigou
- Department of Nutrition and Dietetics, School of Health Sciences & Education, Harokopio University, 17676 Athens, Greece
| | - Fotios Barkas
- Department of Internal Medicine, Medical School, University of Ioannina, 45500 Ioannina, Greece
| | - Georgia Anastasiou
- First Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, 15772 Athens, Greece
| | - Evrydiki Kravvariti
- First Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, 15772 Athens, Greece
| | - Evangelos Liberopoulos
- First Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, 15772 Athens, Greece
| | - Petros P. Sfikakis
- First Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, 15772 Athens, Greece
| | - Christina Chrysohoou
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, 11527 Athens, Greece
| | - Costas Tsioufis
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, 11527 Athens, Greece
| | - Christos Pitsavos
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, 11527 Athens, Greece
| | - Demosthenes Panagiotakos
- Department of Nutrition and Dietetics, School of Health Sciences & Education, Harokopio University, 17676 Athens, Greece
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10
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Kouvari M, Chrysohoou C, Damigou E, Barkas F, Kravvariti E, Liberopoulos E, Tsioufis C, Sfikakis PP, Pitsavos C, Panagiotakos D, Mantzoros CS. Non-invasive tools for liver steatosis and steatohepatitis predict incidence of diabetes, cardiovascular disease and mortality 20 years later: The ATTICA cohort study (2002-2022). Clin Nutr 2024; 43:900-908. [PMID: 38387279 DOI: 10.1016/j.clnu.2024.02.006] [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: 08/21/2023] [Revised: 01/11/2024] [Accepted: 02/04/2024] [Indexed: 02/24/2024]
Abstract
BACKGROUND & AIMS Non-alcoholic fatty liver disease (NAFLD) or, as recently renamed, metabolic dysfunction-associated steatotic liver disease (MASLD), has common metabolic pathways with diabetes and cardiovascular disease (CVD). Non-invasive tools (NITs) for liver steatosis and steatohepatitis (MASH) were studied as potential predictors of diabetes, cardiovascular disease (CVD) and mortality over a 20-year period. METHODS In 2001-02, 3042 individuals from the Attica region of Greece were recruited randomly, and were stratified by subgroups of sex, age and region to reflect the general urban population in Athens, Greece. Validated NITs for hepatic steatosis (Hepatic Steatosis Index (HIS), Fatty Liver Index (FLI), Lipid Accumulation Product (LAP), NAFLD liver fat score (NAFLD-LFS)) and steatohepatitis (Index of non-alcoholic steatohepatitis (ION), aminotransferase-creatinine-clearance non-alcoholic steatohepatitis (acNASH)) were calculated. Incidence of diabetes, CVD and mortality were recorded 5, 10 and 20 years later. RESULTS Within a 20-year observation period, the diabetes and CVD incidence was 26.3% and 36.1%, respectively. All hepatic steatosis and steatohepatitis NITs were independently associated with diabetes incidence. ION and acNASH presented independent association with CVD incidence [(Hazard Ratio (HR)per 1 standard deviation (SD) = 1.33, 95% Confidence Interval (95% CI) (1.07, 1.99)) and (HRper 1 SD = 1.77, 95% CI (1.05, 2.59)), respectively]. NAFLD-LFS which is a steatosis NIT indicating features of steatohepatitis, was linked with increased CVD mortality (HRper 1 SD = 1.35, 95% CI (1.00, 2.30)) and all-cause mortality (HRper 1 SD = 1.43, 95% CI (1.08, 2.01)). Overall, steatohepatitis NITs (i.e., ION and acNASH) presented stronger associations with the outcomes of interest compared with steatosis NITs. Clinically important trends were observed in relation to diabetes and CVD incidence progressively over time, i.e. 5, 10 and 20 years after baseline. CONCLUSIONS Easily applicable and low-cost NITs representing steatohepatitis may be early predictors of diabetes and CVD onset. More importantly, these NITs increased the attributable risk conveyed by conventional CVD risk factors by 10%. Thus, their potential inclusion in clinical practice and guidelines should be studied further.
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Affiliation(s)
- Matina Kouvari
- Department of Medicine, Devision of Endocrinology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, 02215, USA
| | - Christina Chrysohoou
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, 15772, Athens, Greece
| | - Evangelia Damigou
- Department of Nutrition and Dietetics, School of Health Sciences and Education, Harokopio University, 17671, Athens, Greece
| | - Fotios Barkas
- Department of Internal Medicine, Faculty of Medicine, School of Health Sciences, University of Ioannina, 45110, Ioannina, Greece
| | - Evrydiki Kravvariti
- First Department of Propaedeutic Internal Medicine, Medical School, Laiko General Hospital, National and Kapodistrian University of Athens, 15772, Athens, Greece
| | - Evangelos Liberopoulos
- First Department of Propaedeutic Internal Medicine, Medical School, Laiko General Hospital, National and Kapodistrian University of Athens, 15772, Athens, Greece
| | - Costas Tsioufis
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, 15772, Athens, Greece
| | - Petros P Sfikakis
- First Department of Propaedeutic Internal Medicine, Medical School, Laiko General Hospital, National and Kapodistrian University of Athens, 15772, Athens, Greece
| | - Christos Pitsavos
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, 15772, Athens, Greece
| | - Demosthenes Panagiotakos
- Department of Nutrition and Dietetics, School of Health Sciences and Education, Harokopio University, 17671, Athens, Greece.
| | - Christos S Mantzoros
- Department of Medicine, Devision of Endocrinology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, 02215, USA; Department of Medicine, Boston VA Healthcare System, Boston, MA, 02215, USA.
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11
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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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12
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Damigou E, Detopoulou P, Antonopoulou S, Chrysohoou C, Barkas F, Vlachopoulou E, Vafia C, Tsioufis C, Liberopoulos E, Sfikakis PP, Pitsavos C, Panagiotakos D. Food Compass Score predicts incident cardiovascular disease: The ATTICA cohort study (2002-2022). J Hum Nutr Diet 2024; 37:203-216. [PMID: 37908110 DOI: 10.1111/jhn.13247] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 09/19/2023] [Indexed: 11/02/2023]
Abstract
BACKGROUND The Food Compass Score (FCS) is a novel nutrient profiling system, which evaluates food and diet quality. The present study aimed to prospectively assess the relationship of FCS with short-term (10 years) and long-term (20 years) cardiovascular disease (CVD) incidence and to explore whether this relationship is modified by long-term adherence to a Mediterranean type diet (MTD). METHODS Volunteers of the ATTICA cohort study, with complete data for the calculation of FCS and incident CVD were included (n = 759). Development of CVD was determined at 10 and 20 years after baseline. Dietary intake was assessed through a validated food frequency questionnaire. The FCS was calculated for each participant based on the published algorithm. Long-term adherence to a MTD was evaluated through MedDietScore. RESULTS FCS was inversely associated with CVD incidence (hazard ratio [HR] for 20-year follow-up = 0.97, 95% confidence interval [CI] = 0.95-0.99; HR for 10-year follow-up = 0.98, 95% CI = 0.96-1.01) in the total sample, as well as in those with a high baseline adherence to a MTD (HR for 20-year follow-up = 0.96, 95% CI = 0.93-0.99; HR for 10-year follow-up = 0.98, 95% CI = 0.95-1.02). FCS was also inversely associated with CVD risk in those who went away from the MTD (HR = 0.97, 95% CI = 0.96-0.99). CONCLUSIONS FCS, a novel tool for assessing overall diet quality, was also found to be useful in identifying potential CVD candidates in a long-term period, even in populations with good background dietary habits, such as those following a MTD.
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Affiliation(s)
- Evangelia Damigou
- Department of Nutrition and Dietetics, School of Health Sciences and Education, Harokopio University of Athens, Athens, Greece
| | - Paraskevi Detopoulou
- Department of Nutrition and Dietetics, School of Health Sciences and Education, Harokopio University of Athens, Athens, Greece
| | - Smaragdi Antonopoulou
- Department of Nutrition and Dietetics, School of Health Sciences and Education, Harokopio University of Athens, Athens, Greece
| | - Christina Chrysohoou
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
| | - Fotios Barkas
- Department of Internal Medicine, Medical School, University of Ioannina, Ioannina, Greece
| | - Elpiniki Vlachopoulou
- Department of Nutrition and Dietetics, School of Health Sciences and Education, Harokopio University of Athens, Athens, Greece
| | - Christina Vafia
- Department of Nutrition and Dietetics, School of Health Sciences and Education, Harokopio University of Athens, Athens, Greece
| | - Costas Tsioufis
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
| | - Evangelos Liberopoulos
- First Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece
| | - Petros P Sfikakis
- First Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece
| | - Christos Pitsavos
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
| | - Demosthenes Panagiotakos
- Department of Nutrition and Dietetics, School of Health Sciences and Education, Harokopio University of Athens, Athens, Greece
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13
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Georgoulis M, Damigou E, Chrysohoou C, Barkas F, Anastasiou G, Kravvariti E, Tsioufis C, Liberopoulos E, Sfikakis PP, Pitsavos C, Panagiotakos DB. Mediterranean diet trajectories and 20-year incidence of cardiovascular disease: The ATTICA cohort study (2002-2022). Nutr Metab Cardiovasc Dis 2024; 34:153-166. [PMID: 38007352 DOI: 10.1016/j.numecd.2023.09.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Revised: 09/19/2023] [Accepted: 09/20/2023] [Indexed: 11/27/2023]
Abstract
BACKGROUND AND AIMS Only few studies have assessed longitudinal dietary trends in relation to cardiovascular disease (CVD) risk. We aimed to evaluate the association between adherence to the Mediterranean diet, both baseline and longitudinal, and 20-year CVD incidence. METHODS AND RESULTS This was a prospective study among 1988 Greek adults (50% men, age: 45 ± 14years). Adherence to the Mediterranean diet was evaluated at baseline and 10 years through the MedDietScore, based on which longitudinal Mediterranean diet trajectories were identified. CVD incidence was recorded at 20 years. Each one-unit increase in baseline MedDietScore was associated with an 8% reduction in 20-year CVD incidence. Compared to subjects in the lowest tertile of baseline MedDietScore, those in the highest exhibited a 44% lower 20-year CVD risk (relative risk: 0.56, 95% confidence interval: 0.32, 0.97) adjusted for age, sex, baseline body mass index, smoking, physical activity, presence of hypercholesterolemia, hypertension and diabetes mellitus, and family history of CVD; further adjustment for high-sensitivity C-reactive protein, uric acid and estimated glomerular filtration rate attenuated this association. Results were similar in models adjusted for longitudinal changes in body weight, physical activity and smoking, and 10-year medical status. Mediterranean diet trajectory analysis revealed that 24.7%, 8.6%, 45.8% and 20.9% of participants longitudinally sustained a low adherence, moved closer, moved away or sustained a high adherence, respectively; among those, the corresponding CVD incidence was 63.3%, 65.5%, 28.1% and 9.4% (p-value<0.001). CONCLUSION The Mediterranean diet offers long-term protection against CVD, part of which is mediated by inflammation, uricemia and renal function.
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Affiliation(s)
- Michael Georgoulis
- Department of Nutrition and Dietetics, School of Health Sciences and Education, Harokopio University of Athens, 17676 Athens, Greece
| | - Evangelia Damigou
- Department of Nutrition and Dietetics, School of Health Sciences and Education, Harokopio University of Athens, 17676 Athens, Greece
| | - Christina Chrysohoou
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, 11527 Athens, Greece
| | - Fotios Barkas
- First Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, 15772 Athens, Greece
| | - Georgia Anastasiou
- First Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, 15772 Athens, Greece
| | - Evridiki Kravvariti
- First Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, 15772 Athens, Greece
| | - Costas Tsioufis
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, 11527 Athens, Greece
| | - Evangelos Liberopoulos
- First Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, 15772 Athens, Greece
| | - Petros P Sfikakis
- First Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, 15772 Athens, Greece
| | - Christos Pitsavos
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, 11527 Athens, Greece
| | - Demosthenes B Panagiotakos
- Department of Nutrition and Dietetics, School of Health Sciences and Education, Harokopio University of Athens, 17676 Athens, Greece.
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14
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Kallistratos M, Konstantinidis D, Dimitriadis K, Sanidas E, Katsi V, Androulakis E, Vlachopoulos C, Toutouzas K, Kanakakis J, Sideris S, Kafkas N, Mavrogianni AD, Papadopoulos CH, Stefanidis A, Patsourakos N, Kachrimanidis I, Papaioannou N, Tsioufis C, Kochiadakis G, Marketou M. Exercise and cardiac rehabilitation in hypertensive patients with heart failure with preserved ejection fraction: A position statement on behalf of the Working Group of Arterial Hypertension of the Hellenic Society of Cardiology. Hellenic J Cardiol 2024; 75:82-92. [PMID: 37619947 DOI: 10.1016/j.hjc.2023.08.008] [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: 04/24/2023] [Revised: 08/10/2023] [Accepted: 08/11/2023] [Indexed: 08/26/2023] Open
Abstract
Arterial hypertension is a major cause of cardiovascular morbidity and mortality and the most common cause of comorbidity in heart failure (HF) with preserved ejection fraction (HFpEF). As an adjunct to medication, healthy lifestyle modifications with emphasis on regular exercise are strongly recommended by both the hypertension and the HF guidelines of the European Society of Cardiology. Several long-term studies have shown that exercise is associated with a reduction in all-cause mortality, a favorable cardiac and metabolic risk profile, mental health, and other non-cardiovascular benefits, as well as an improvement in overall quality of life. However, the instructions for the prescriptive or recommended exercise in hypertensive patients and, more specifically, in those with HFpEF are not well defined. Moreover, the evidence is based on observational or small randomized studies, while well-designed clinical trials are lacking. Despite the proven benefit and the guidelines' recommendations, exercise programs and cardiac rehabilitation in patients with hypertensive heart disease and HFpEF are grossly underutilized. This position statement provides a general framework for exercise and exercise-based rehabilitation in patients with hypertension and HFpEF, guides clinicians' rehabilitation strategies, and facilitates clinical practice. It has been endorsed by the Working Group of Arterial Hypertension of the Hellenic Society of Cardiology and is focused on the Health Care System in Greece.
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Affiliation(s)
| | - Dimitriοs Konstantinidis
- First Department of Cardiology, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
| | - Kyriakos Dimitriadis
- First Department of Cardiology, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
| | - Elias Sanidas
- Cardiology Department, LAIKO General Hospital, Athens, Greece
| | - Vasiliki Katsi
- First Department of Cardiology, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
| | | | - Charalambos Vlachopoulos
- First Department of Cardiology, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
| | - Konstantinos Toutouzas
- First Department of Cardiology, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
| | - John Kanakakis
- Department of Clinical Therapeutics, University of Athens Medical School, 11528 Athens, Greece
| | - Skevos Sideris
- First Department of Cardiology, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
| | | | | | | | | | - Nikolaos Patsourakos
- Department of Cardiology, "Tzaneio" General Hospital of Piraeus, Piraeus, Greece
| | - Ioannis Kachrimanidis
- First Department of Cardiology, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
| | - Nikolaos Papaioannou
- Department of Cardiology, Asklepeion General Hospital Cardiology, Athens, Greece
| | - Costas Tsioufis
- First Department of Cardiology, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
| | - George Kochiadakis
- Cardiology Department, Heraklion University General Hospital, Crete, Greece
| | - Maria Marketou
- Cardiology Department, Heraklion University General Hospital, Crete, Greece.
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Georgoulis M, Damigou E, Chrysohoou C, Barkas F, Kravvariti E, Tsioufis C, Pitsavos C, Liberopoulos E, Sfikakis PP, Panagiotakos DB. Increased body weight and central adiposity markers are positively associated with the 20-year incidence of cardiovascular disease: The ATTICA epidemiological study (2002-2022). Nutr Res 2024; 121:1-15. [PMID: 37995411 DOI: 10.1016/j.nutres.2023.10.008] [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: 10/08/2023] [Revised: 10/31/2023] [Accepted: 10/31/2023] [Indexed: 11/25/2023]
Abstract
Increased adiposity predisposes to cardiovascular disease (CVD). We hypothesized that the presence of obesity would be positively associated with CVD risk, and that the co-presence of central obesity would modify/enhance this association. This was a prospective study (2002-2022) among 1845 Greek adults (mean age, 44.8 ± 13.5 years; men, 49.8%). At baseline, the presence of overweight/obesity was assessed via body mass index (BMI), whereas central obesity was defined as waist circumference ≥102/88 cm, waist-to-hip-ratio ≥0.95/0.80, or waist-to-height-ratio ≥0.50 in men/women. BMI was reevaluated at 10 years and longitudinal BMI trajectories (2002-2012) were identified. CVD incidence was recorded at 20 years (ratio of new cases to the number of participants assessed). Compared with participants with normal weight at baseline, those with obesity exhibited a 27% higher 20-year CVD risk after adjustment for age, sex, lifestyle habits, and medical status (hazard ratio, 1.271; 95% confidence interval, 1.012-1.597). In similar multiadjusted models, compared with participants who were always non-overweight/obese, those who were always overweight/obese exhibited a 40% higher 20-year CVD risk (hazard ratio, 1.403; 95% confidence interval, 1.018-1.936). Additional control for high-sensitivity C-reactive protein attenuated the associations. In the combined baseline body weight classification analysis, CVD incidence was the lowest in participants with normal weight without central obesity, moderate in those with overweight/obesity without central obesity, and highest in those with normal weight and central obesity and overweight/obesity and central obesity (P < .001). Obesity leads to increased CVD risk, partly mediated by inflammation. The combination of BMI with simple measures of abdominal adiposity is superior for CVD risk screening.
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Affiliation(s)
- Michael Georgoulis
- Department of Nutrition and Dietetics, School of Health Sciences and Education, Harokopio University of Athens, 17676 Athens, Greece
| | - Evangelia Damigou
- Department of Nutrition and Dietetics, School of Health Sciences and Education, Harokopio University of Athens, 17676 Athens, Greece
| | - Christina Chrysohoou
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, 11527 Athens, Greece
| | - Fotios Barkas
- Department of Internal Medicine, Medical School, University of Ioannina, Ioannina, Greece
| | - Evrydiki Kravvariti
- First Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, 15772, Athens, Greece
| | - Costas Tsioufis
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, 11527 Athens, Greece
| | - Christos Pitsavos
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, 11527 Athens, Greece
| | - Evangelos Liberopoulos
- First Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, 15772, Athens, Greece
| | - Petros P Sfikakis
- First Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, 15772, Athens, Greece
| | - Demosthenes B Panagiotakos
- Department of Nutrition and Dietetics, School of Health Sciences and Education, Harokopio University of Athens, 17676 Athens, Greece.
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16
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Damigou E, Chrysohoou C, Vafia C, Barkas F, Kravvariti E, Vlachopoulou E, Kyrili K, Tsioufis C, Pitsavos C, Liberopoulos E, Sfikakis PP, Panagiotakos D. Mediterranean Diet and Cardiovascular Disease: The Moderating Role of Adequate Sleep-Results from the ATTICA Cohort Study (2002-2022). Nutrients 2023; 16:12. [PMID: 38201842 PMCID: PMC10780793 DOI: 10.3390/nu16010012] [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: 11/03/2023] [Revised: 12/15/2023] [Accepted: 12/18/2023] [Indexed: 01/12/2024] Open
Abstract
The relationship between diet, sleep duration and cardiovascular disease (CVD) has not been well understood. The aim of the present study was to test the potential modifying role of sleep duration in the association between adherence to the Mediterranean-type diet (MD) and CVD risk. The study consisted of n = 313 initially free-of-CVD adults, from the ATTICA cohort study (2002-2022), with available information on sleep habits. Sleep habits were categorized as inadequate and adequate sleep duration (< or ≥7 h/day, respectively). In multi-adjusted analysis, MD adherence was inversely associated with CVD risk [Hazard Ratio-HR per 1/55 in MedDietScore: 0.80, 95% Confidence Interval-CI: 0.65, 0.98]. A significant interaction between sleep duration and MedDietScore was observed (p < 0.001). In subgroup analysis, the protective association between MD adherence and CVD risk was found only in participants who slept adequately, i.e., >7 h/day [HR:0.80, 95%CI: 0.65, 0.98]. Those who had a high adherence to the MD along with adequate sleep habits, had a 70% reduced 20-year CVD risk [HR:0.30, 95%CI: 0.11, 0.80], compared to those who had a low MD adherence and inadequate sleep habits. Sleep duration should be a part of an individual's lifestyle, together with dietary and other habits, to effectively evaluate CVD risk for future events.
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Affiliation(s)
- Evangelia Damigou
- Department of Nutrition and Dietetics, School of Health Sciences and Education, Harokopio University, 17676 Athens, Greece; (E.D.)
| | - Christina Chrysohoou
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, 15772 Athens, Greece
| | - Christina Vafia
- Department of Nutrition and Dietetics, School of Health Sciences and Education, Harokopio University, 17676 Athens, Greece; (E.D.)
| | - Fotios Barkas
- Department of Internal Medicine, Medical School, University of Ioannina, 45500 Ioannina, Greece
| | - Evrydiki Kravvariti
- First Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, 15772 Athens, Greece
| | - Elpiniki Vlachopoulou
- Department of Nutrition and Dietetics, School of Health Sciences and Education, Harokopio University, 17676 Athens, Greece; (E.D.)
| | - Konstantina Kyrili
- First Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, 15772 Athens, Greece
| | - Costas Tsioufis
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, 15772 Athens, Greece
| | - Christos Pitsavos
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, 15772 Athens, Greece
| | - Evangelos Liberopoulos
- First Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, 15772 Athens, Greece
| | - Petros P. Sfikakis
- First Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, 15772 Athens, Greece
| | - Demosthenes Panagiotakos
- Department of Nutrition and Dietetics, School of Health Sciences and Education, Harokopio University, 17676 Athens, Greece; (E.D.)
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Papoutsis D, Mourouzis K, Bozini N, Aznaouridis K, Oikonomou E, Chatzimichael K, Brountzos E, Vavuranakis M, Tsioufis C, Lekakis J, Siasos G, Tousoulis D. Ultrasonographic assessment and clinical outcomes after deployment of a suture-mediated femoral vascular closure device. Cardiovasc J Afr 2023; 34:1-6. [PMID: 38032689 DOI: 10.5830/cvja-2023-054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Accepted: 10/30/2023] [Indexed: 12/01/2023] Open
Abstract
INTRODUCTION Data regarding changes in the arterial vascular wall after the deployment of suture-mediated vascular closure devices (VCD) at the femoral site in patients undergoing percutaneous coronary angiography (CAG) or percutaneous coronary intervention (PCI) are sparse. This study investigated the occurrence of structural vascular changes or adverse vascular complications at the access site in the short term after the deployment of a suture-mediated intravascular VCD. METHODS Ninety-three patients (72% males) with a mean age of 62 ± 11 years were enrolled. Duplex sonography was conducted at the access site at baseline, 24 hours and 30 days after femoral puncture in patients with successful VCD deployment. Vessel diameter, flow velocities, the severity of atherosclerosis, and the intravascular or perivascular tissue alterations in both the right common femoral artery (RCFA) and right external iliac artery (REILA) were assessed. Vascular complications were documented. RESULTS There were no significant changes regarding the diameter of the RCFA in the transverse and longitudinal view, peak systolic velocity (PSV) of the RCFA, PSV ratio of the RCFA to REILA, the resistive index of the RFCA and the severity of arterial wall abnormalities before femoral puncture, the day following VCD deployment and 30 days after (p = NS for all) in the general population and in patients with diabetes mellitus, on oral anticoagulants or with mild peripheral artery disease (p = NS for all markers). Device failure was observed in four cases. Few (4.4%) patients had vascular complications, which included exclusively major or minor haematomas, most of which did not persist at the 30-day follow up. CONCLUSION The use of a suture-mediated VCD was safe and was not associated with adverse vascular wall changes at the femoral access site 30 days after deployment in patients undergoing CAG and/or PCI.
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Affiliation(s)
- Dimitrios Papoutsis
- First Department of Cardiology, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece; Second Department of Cardiology, Medical School, Attikon Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Konstantinos Mourouzis
- First Department of Cardiology, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece; Medizinische Klinik und Poliklinik I, LMU Universiy Hospital Munich, Munich, Germany.
| | - Nikoleta Bozini
- First Department of Cardiology, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece; Department of Cardiovascular Surgery, German Heart Centre, Technical University, Munich, Germany
| | - Konstantinos Aznaouridis
- First Department of Cardiology, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
| | - Evangelos Oikonomou
- First Department of Cardiology, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece; Third Department of Cardiology, Medical School, National and Kapodistrian University of Athens, Sotiria Chest Disease Hospital, Athens, Greece
| | - Katerina Chatzimichael
- Second Department of Radiology, Medical School, University General Hospital, ATTIKON, National and Kapodistrian University of Athens, Athens, Greece
| | - Elias Brountzos
- Second Department of Radiology, Medical School, University General Hospital, ATTIKON, National and Kapodistrian University of Athens, Athens, Greece
| | - Manolis Vavuranakis
- First Department of Cardiology, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece; Third Department of Cardiology, Medical School, National and Kapodistrian University of Athens, Sotiria Chest Disease Hospital, Athens, Greece
| | - Costas Tsioufis
- First Department of Cardiology, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
| | - John Lekakis
- Second Department of Cardiology, Medical School, Attikon Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Gerasimos Siasos
- First Department of Cardiology, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece; Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Dimitris Tousoulis
- First Department of Cardiology, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
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Drakopoulou M, Tsioufis C, Toutouzas K. Transcatheter atrial septal defect closure in the elderly: the decisive role of balloon testing. Heart 2023; 109:1729-1730. [PMID: 37463728 DOI: 10.1136/heartjnl-2023-322898] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/20/2023] Open
Affiliation(s)
- Maria Drakopoulou
- First Cardiology Department, School of Medicine, Hippokration General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Costas Tsioufis
- First Cardiology Department, School of Medicine, Hippokration General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Konstantinos Toutouzas
- First Cardiology Department, School of Medicine, Hippokration General Hospital, National and Kapodistrian University of Athens, Athens, Greece
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Damigou E, Kosti RI, Anastasiou C, Chrysohoou C, Barkas F, Adamidis PS, Kravvariti E, Pitsavos C, Tsioufis C, Liberopoulos E, Sfikakis PP, Panagiotakos D. Associations between meat type consumption pattern and incident cardiovascular disease: The ATTICA epidemiological cohort study (2002-2022). Meat Sci 2023; 205:109294. [PMID: 37544259 DOI: 10.1016/j.meatsci.2023.109294] [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: 01/07/2023] [Revised: 06/27/2023] [Accepted: 07/31/2023] [Indexed: 08/08/2023]
Abstract
BACKGROUND Meat consumption has shown from detrimental to beneficial effects against cardiovascular disease (CVD) incidence, mainly depending on the type of meat studied (i.e., red/white, processed/unprocessed) and quantity consumed. OBJECTIVE To examine the associations between meat type consumption patterns and incident CVD among apparently healthy adults. DESIGN ATTICA study was conducted in the greater metropolitan Athens area, Greece, during 2001-2002 studying adults free-of-CVD at baseline. Twenty-year follow-up was performed in n = 1988 participants (n = 718 incident cases). Meat consumption during the follow-up period was categorized as: never/rare meat consumption (i.e., <1 time/week), mostly red meat (i.e., compared to other types of meat or processed meat), mostly white meat, and mostly processed meat products (e.g., bacon, sausage). RESULTS Approximately 38% of the participants reported rare or no consumption of any type of meat, 31% consumed mostly red meat, 19% mostly white meat and the remainder 12% mostly processed meat. In multivariate analysis, compared to never/rarely consuming any type of meat, consuming mostly processed meat [HR: 2.89, 95%CI: 1.05, 7.89], but not red meat [HR: 1.22, 95%CI: 0.81, 1.82], was positively associated with incident CVD during 20 years of follow-up, while consuming mostly white meat was inversely associated with incident CVD [HR: 0.35, 95%CI: 0.17, 0.71]. CONCLUSIONS The findings of this study suggest that the type of meat, irrespective of the frequency of consumption, plays a role in the risk of developing CVD. In clinical practice, emphasis should be placed on avoiding processed meat and replacing it with white unprocessed meat.
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Affiliation(s)
- Evangelia Damigou
- Department of Nutrition and Dietetics, School of Health Sciences and Education, Harokopio University, Athens 17676, Greece
| | - Rena I Kosti
- Department of Nutrition and Dietetics, School of Physical Education, Sports and Dietetics, University of Thessaly, Trikala 38221, Greece
| | - Costas Anastasiou
- Department of Nutrition and Dietetics, School of Health Sciences and Education, Harokopio University, Athens 17676, Greece
| | - Christina Chrysohoou
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens 15772, Greece
| | - Fotios Barkas
- First Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, Athens 15772, Greece
| | - Petros S Adamidis
- First Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, Athens 15772, Greece
| | - Evrydiki Kravvariti
- First Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, Athens 15772, Greece
| | - Christos Pitsavos
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens 15772, Greece
| | - Costas Tsioufis
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens 15772, Greece
| | - Evangelos Liberopoulos
- First Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, Athens 15772, Greece
| | - Petros P Sfikakis
- First Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, Athens 15772, Greece
| | - Demosthenes Panagiotakos
- Department of Nutrition and Dietetics, School of Health Sciences and Education, Harokopio University, Athens 17676, Greece.
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Panagiotakos D, Chrysohoou C, Damigou E, Barkas F, Liberopoulos E, Tsioufis C, Sfikakis PP, Pitsavos C. Prediction of lifetime risk for cardiovascular disease, by risk factors level: the ATTICA epidemiological cohort study (2002-2022). Ann Epidemiol 2023; 87:17-24. [PMID: 37866102 DOI: 10.1016/j.annepidem.2023.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Revised: 09/17/2023] [Accepted: 09/27/2023] [Indexed: 10/24/2023]
Abstract
PURPOSE We aimed to predict lifetime risk for cardiovascular disease (CVD). METHODS The sample consisted of 1988 participants with complete CVD data during the 20-year follow-up (50% men, 45 ± 14 years) of the ATTICA study. Lifetime risk for CVD was predicted at specific index ages (40, 50, and 60 years), based on the life-table method, with death free-of-CVD treated as a competing event. RESULTS 718 participants experienced a fatal or nonfatal CVD event, corresponding to a crude CVD incidence of 36.1% (men: 40.2%, women: 32.1%, P-value < .001). Overall, women and men had similar lifetime CVD risk (P-value = .245); at index age of 40, the lifetime risk for CVD was 68% for men and 63% for women, with a progressive decline to 56% and 50% at the index age of 50, and to 55% for both men and women, at the index age of 60 years, respectively. CONCLUSIONS These results on lifetime risk for CVD can guide the allocation of resources to improve public health and preventive services, especially in ages below 50 years, in both men and women.
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Affiliation(s)
- Demosthenes Panagiotakos
- Department of Nutrition and Dietetics, School of Health Sciences and Education, Harokopio University of Athens, Greece.
| | - Christina Chrysohoou
- First Cardiology Clinic, School of Medicine, National and Kapodistrian University of Athens, Hippokration Hospital, Greece
| | - Evangelia Damigou
- Department of Nutrition and Dietetics, School of Health Sciences and Education, Harokopio University of Athens, Greece
| | - Fotios Barkas
- Department of Internal Medicine, School of Medicine, University of Ioannina, Greece
| | - Evangelos Liberopoulos
- First Department of Propaedeutic Internal Medicine, School of Medicine, National and Kapodistrian University of Athens, Laiko General Hospital, Greece
| | - Costas Tsioufis
- First Cardiology Clinic, School of Medicine, National and Kapodistrian University of Athens, Hippokration Hospital, Greece
| | - Petros P Sfikakis
- First Department of Propaedeutic Internal Medicine, School of Medicine, National and Kapodistrian University of Athens, Laiko General Hospital, Greece
| | - Christos Pitsavos
- First Cardiology Clinic, School of Medicine, National and Kapodistrian University of Athens, Hippokration Hospital, Greece
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Leontsinis I, Farmakis D, Avramidis D, Andrikou E, Valatsou A, Gartzonikas E, Doundoulakis I, Zarifis I, Karpouzis I, Kafkala K, Kouvelas N, Kourek C, Koufou E, Kochiadakis G, Kifnidis K, Liori S, Manolis G, Marketou M, Moschos N, Bampatsias D, Bibis G, Bonou M, Naka A, Davlouros P, Ntalakouras I, Papakonstantinou PΕ, Pappa E, Patsilinakos S, Plaitis A, Sideris A, Sideris S, Skoularigis J, Stamatelopoulos K, Stefanou G, Tziakas D, Chatzieleftheriou C, Chrysochoou C, Filippatos G, Tsioufis C. Cardiorenal multimorbidity in hospitalized cardiology patients: The Hellenic Cardiorenal Morbidity Snapshot (HECMOS) study. Hellenic J Cardiol 2023; 74:8-17. [PMID: 37146905 DOI: 10.1016/j.hjc.2023.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 03/21/2023] [Accepted: 03/23/2023] [Indexed: 05/07/2023] Open
Abstract
PURPOSE Cardiovascular disease is commonly accompanied by renal dysfunction. Multimorbidity in hospitalized patients impacts unfavorably on prognosis and hospital stay. We aimed to illustrate the contemporary burden of cardiorenal morbidity across inpatient cardiology care in Greece. METHODS The Hellenic Cardiorenal Morbidity Snapshot (HECMOS) used an electronic platform to collect demographic and clinically relevant information about all patients hospitalized on March 3, 2022, in Greece. The participating institutions covered all levels of inpatient cardiology care and most of the country's territories to collect a real-world, nation representative sample. RESULTS A total of 923 patients (men 68.4%, median age 73 ± 14.8 years) were admitted to 55 different cardiology departments. 57.7% of the participants were aged >70 years. Hypertension was highly prevalent and present in 66% of the cases. History of chronic HF, diabetes mellitus, atrial fibrillation, and chronic kidney disease was present in 38%, 31.8%, 30%, and 26%, respectively. Furthermore, 64.1% of the sample exhibited at least one of these 4 entities. Accordingly, a combination of ≥2 of these morbid conditions was recorded in 38.7%, of ≥3 in 18.2%, whereas 4.3% of the sample combined all 4 in their medical history. The most common combination was the coexistence of heart failure-atrial fibrillation accounting for 20.6% of the sample. Nine of 10 nonelectively admitted patients were hospitalized due to acute HF (39.9%), acute coronary syndrome (33.5%), or tachyarrhythmias (13.2%). CONCLUSION HECMOS participants carried a remarkable burden of cardio-reno-metabolic disease. HF in conjunction with atrial fibrillation was found to be the most prevalent combination among the studied cardiorenal nexus of morbidities in the whole study population.
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Affiliation(s)
- Ioannis Leontsinis
- First Cardiology Department, School of Medicine, Hippokration General Hospital, National and Kapodistrian University of Athens, Greece
| | | | | | - Eirini Andrikou
- Cardiology Department, Konstantopoulio General Hospital, Athens, Greece
| | - Angeliki Valatsou
- First Cardiology Department, School of Medicine, Hippokration General Hospital, National and Kapodistrian University of Athens, Greece
| | - Elias Gartzonikas
- University Cardiology Clinic, University of Ioannina, Ioannina, Greece
| | - Ioannis Doundoulakis
- First Cardiology Department, School of Medicine, Hippokration General Hospital, National and Kapodistrian University of Athens, Greece
| | - Ioannis Zarifis
- Cardiology Department, G. Papanicolaou Hospital, Thessaloniki, Greece
| | | | | | - Nikos Kouvelas
- Cardiology Dpt, 251 Hellenic Airforce General Hospital, Athens, Greece
| | - Christos Kourek
- Cardiology Dpt, 417 Veterans Army Hospital (NIMTS), Athens, Greece
| | - Eleni Koufou
- Cardiology Department, Patras University Hospital, Rio, Greece
| | - George Kochiadakis
- Department of Cardiology, Heraklion University Hospital, Iraklio, Crete, Greece
| | | | - Sotiria Liori
- Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - George Manolis
- Department of Cardiology, Hellenic Red Cross Hospital, Athens, Greece
| | - Maria Marketou
- Department of Cardiology, Heraklion University Hospital, Iraklio, Crete, Greece
| | | | - Dimitrios Bampatsias
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens School of Medicine, Athens, Greece
| | - George Bibis
- Cardiology Dpt, General Hospital of Argos, Greece
| | - Maria Bonou
- Cardiology Department, Laiko General Hospital, Athens, Greece
| | - Aikaterini Naka
- University Cardiology Clinic, University of Ioannina, Ioannina, Greece
| | | | - Ioannis Ntalakouras
- Department of Cardiology, Heraklion University Hospital, Iraklio, Crete, Greece
| | | | - Evgenia Pappa
- Department of Cardiology, General Hospital "G. Hatzikosta", Ioannina, Greece
| | | | | | - Antonios Sideris
- Second Cardiology Department, Evangelismos Hospital, Athens, Greece
| | - Skevos Sideris
- Department of Cardiology, Hippokration General Hospital, Athens, Greece
| | - John Skoularigis
- Department of Cardiology, University General Hospital of Larissa, Greece
| | - Kimon Stamatelopoulos
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens School of Medicine, Athens, Greece
| | | | - Dimitrios Tziakas
- Department of Cardiology, Democritus University of Thrace, Alexandroupolis, Greece
| | | | - Christina Chrysochoou
- First Cardiology Department, School of Medicine, Hippokration General Hospital, National and Kapodistrian University of Athens, Greece
| | - Gerasimos Filippatos
- Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - Costas Tsioufis
- First Cardiology Department, School of Medicine, Hippokration General Hospital, National and Kapodistrian University of Athens, Greece.
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Damigou E, Kouvari M, Chrysohoou C, Barkas F, Kravvariti E, Dalmyras D, Koutsogianni AD, Tsioufis C, Pitsavos C, Liberopoulos E, Sfikakis PP, Panagiotakos D. Diet Quality and Consumption of Healthy and Unhealthy Foods Measured via the Global Diet Quality Score in Relation to Cardiometabolic Outcomes in Apparently Healthy Adults from the Mediterranean Region: The ATTICA Epidemiological Cohort Study (2002-2022). Nutrients 2023; 15:4428. [PMID: 37892503 PMCID: PMC10610374 DOI: 10.3390/nu15204428] [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: 09/20/2023] [Revised: 10/16/2023] [Accepted: 10/17/2023] [Indexed: 10/29/2023] Open
Abstract
The Global Diet Quality Score (GDQS) is a novel food-based score that assesses both nutrient adequacy and chronic disease risk, by evaluating healthy (GDQS+) and unhealthy foods (GDQS-). The aim of this study was to evaluate the association among GDQS, GDQS+, and GDQS- against the 20-year risk of cardiometabolic outcomes in a Mediterranean population. The sample was n = 2169 initially free of cardiovascular disease (CVD) participants of the ATTICA study (2002-2022) that participated in the 20-year follow-up. The incidence of CVD, hypertension, hypercholesterolemia, and type 2 diabetes mellitus (T2DM) was defined according to WHO-ICD-10 criteria. The GDQS was computed based on previously published instructions. In multivariate analyses, a higher diet quality, per 1/49 of the GDQS, was associated with an 8% [95% Confidence Interval-CI: 6-9%] and 2% [95% CI: 1-3%] lower CVD and T2DM risk, respectively. A higher consumption of healthy foods, per 1/32 of GDQS+, was associated with a 9% [95% CI: 7-11%] and 2% [95% CI: 1-3%] lower CVD and T2DM risk, respectively. Contrarily, a lower consumption of unhealthy foods (GDQS-) was not associated with cardiometabolic events in the adjusted models (all p value< 0.05). In clinical practice or future public health actions to ameliorate dietary habits and prevent CVD and T2DM, more attention should be focused on healthy foods that should be included in our diets.
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Affiliation(s)
- Evangelia Damigou
- Department of Nutrition and Dietetics, School of Health Sciences and Education, Harokopio University, 17676 Athens, Greece
| | - Matina Kouvari
- Department of Nutrition and Dietetics, School of Health Sciences and Education, Harokopio University, 17676 Athens, Greece
| | - Christina Chrysohoou
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, 15772 Athens, Greece
| | - Fotios Barkas
- Department of Internal Medicine, Medical School, University of Ioannina, 45500 Ioannina, Greece
| | - Evrydiki Kravvariti
- First Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, 15772 Athens, Greece
| | - Dimitrios Dalmyras
- Department of Nutrition and Dietetics, School of Health Sciences and Education, Harokopio University, 17676 Athens, Greece
| | - Amalia D. Koutsogianni
- First Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, 15772 Athens, Greece
| | - Costas Tsioufis
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, 15772 Athens, Greece
| | - Christos Pitsavos
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, 15772 Athens, Greece
| | - Evangelos Liberopoulos
- First Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, 15772 Athens, Greece
| | - Petros P. Sfikakis
- First Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, 15772 Athens, Greece
| | - Demosthenes Panagiotakos
- Department of Nutrition and Dietetics, School of Health Sciences and Education, Harokopio University, 17676 Athens, Greece
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23
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Lazaros G, Vlachakis PK, Theofilis P, Dasoula FE, Imazio M, Lazarou E, Vlachopoulos C, Tsioufis C. D-dimer as a diagnostic and prognostic plasma biomarker in patients with a first episode of acute pericarditis. Eur J Intern Med 2023; 116:58-64. [PMID: 37357033 DOI: 10.1016/j.ejim.2023.06.017] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 06/07/2023] [Accepted: 06/19/2023] [Indexed: 06/27/2023]
Abstract
OBJECTIVES The impact of plasma biomarkers on diagnosis and prognosis of patients with acute pericarditis (AP) has been poorly investigated. This study aims to assess the diagnostic and prognostic role of d-dimer (DD), an easily obtainable biomarker, in patients with AP. PATIENTS AND METHODS This is a prospective clinical study enrolling 265 consecutive patients hospitalized between September 2010 and May 2019 with a first episode of AP. At baseline, demographics, clinical features, laboratory and imaging findings were recorded. All patients were followed-up for a minimum of 18 months. Endpoints included cardiac tamponade, new-onset atrial fibrillation, pericardial drainage, recurrent/constrictive pericarditis and death. RESULTS DD was measured in 165 out of 265 patients (62.3%, median levels 1456 ng/mL) Among them, 121 patients (73.3%) presented with elevated age-adjusted DD levels. Patients with elevated DD depicted a higher rate of pleural (69.4%, vs 38.6%, p<0.001) and pericardial effusions (89.3% vs 72.7%, p = 0.009). Elevated DD correlated with admission (rho=0.37) and peak (rho=0.36) C-reactive protein values. Patients with elevated DD depicted a trend towards a greater prevalence of pericardial tamponade vs those without (14.9% vs 4.5% respectively, p = 0.07). In the 43.8% of patients with elevated DD who underwent computed tomography pulmonary angiography (CTPA), no case of pulmonary embolism or aortic syndrome was unveiled. CONCLUSION DD elevation is detected in the majority of AP cases at presentation and may herald cardiac tamponade. In patients with chest pain not attributable to alternative causes, elevated DD denotes an inflammatory condition and should not prompt unnecessary investigations, such as CTPA.
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Affiliation(s)
- George Lazaros
- First Cardiology Department, School of Medicine, Hippokration General Hospital, National and Kapodistrian University of Athens, Vas. Sofias 114, Athens 11527, Greece.
| | - Panagiotis K Vlachakis
- First Cardiology Department, School of Medicine, Hippokration General Hospital, National and Kapodistrian University of Athens, Vas. Sofias 114, Athens 11527, Greece
| | - Panagiotis Theofilis
- First Cardiology Department, School of Medicine, Hippokration General Hospital, National and Kapodistrian University of Athens, Vas. Sofias 114, Athens 11527, Greece
| | - Foteini E Dasoula
- First Cardiology Department, School of Medicine, Hippokration General Hospital, National and Kapodistrian University of Athens, Vas. Sofias 114, Athens 11527, Greece
| | - Massimo Imazio
- Cardiology, Cardiothoracic Department, University Hospital "Santa Maria della Misericordia", ASUFC, Udine, Italy
| | - Emilia Lazarou
- First Cardiology Department, School of Medicine, Hippokration General Hospital, National and Kapodistrian University of Athens, Vas. Sofias 114, Athens 11527, Greece
| | - Charalambos Vlachopoulos
- First Cardiology Department, School of Medicine, Hippokration General Hospital, National and Kapodistrian University of Athens, Vas. Sofias 114, Athens 11527, Greece
| | - Costas Tsioufis
- First Cardiology Department, School of Medicine, Hippokration General Hospital, National and Kapodistrian University of Athens, Vas. Sofias 114, Athens 11527, Greece
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24
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Lazarou E, Tsioufis P, Oikonomou V, Kondi L, Tsioufis C, Lazaros G. Cholesterol pericarditis following COVID-19 vaccination. Hellenic J Cardiol 2023; 73:86-87. [PMID: 36681119 PMCID: PMC9850644 DOI: 10.1016/j.hjc.2023.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Revised: 01/14/2023] [Accepted: 01/15/2023] [Indexed: 01/20/2023] Open
Affiliation(s)
- Emilia Lazarou
- 1st Cardiology Clinic, National and Kapodistrian University of Athens, School of Medicine, Hippokration General Hospital, Athens, Greece
| | - Panagiotis Tsioufis
- 1st Cardiology Clinic, National and Kapodistrian University of Athens, School of Medicine, Hippokration General Hospital, Athens, Greece
| | - Vasiliki Oikonomou
- Department of Clinical Cytopathology, Hippokration General Hospital, Athens, Greece
| | - Ledjana Kondi
- 1st Cardiology Clinic, National and Kapodistrian University of Athens, School of Medicine, Hippokration General Hospital, Athens, Greece
| | - Costas Tsioufis
- 1st Cardiology Clinic, National and Kapodistrian University of Athens, School of Medicine, Hippokration General Hospital, Athens, Greece
| | - George Lazaros
- 1st Cardiology Clinic, National and Kapodistrian University of Athens, School of Medicine, Hippokration General Hospital, Athens, Greece.
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25
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Apostolos A, Drakopoulou M, Trantalis G, Tsioufis C, Toutouzas K. PFO Closure in Patients With Thrombophilia: Closing the Chapter or Leaving Room for More? JACC Cardiovasc Interv 2023; 16:2056. [PMID: 37648349 DOI: 10.1016/j.jcin.2023.06.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 06/27/2023] [Indexed: 09/01/2023]
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26
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Lazaros G, Imazio M, Tsioufis P, Lazarou E, Vlachopoulos C, Tsioufis C. Chronic Pericardial Effusion: Causes and Management. Can J Cardiol 2023; 39:1121-1131. [PMID: 36773704 DOI: 10.1016/j.cjca.2023.02.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 01/10/2023] [Accepted: 02/01/2023] [Indexed: 02/11/2023] Open
Abstract
Chronic pericardial effusion is a common pericardial syndrome whose approach has been well standardised in recent years. The main challenge associated with this condition is the progression (sometimes unheralded) to cardiac tamponade. Pericardial effusions may present either as an isolated finding or in the context of a specific etiology including autoimmune, neoplastic, or metabolic disease. Among investigations used during diagnostic work-up, echocardiography is of paramount importance for the diagnosis, sizing, and serial evaluation of the hemodynamic impact of effusions on heart diastolic function. In an individualised manner, advanced imaging including computed tomography and cardiac magnetic resonance imaging should be performed, especially if baseline tests are inconclusive. Triage of these patients according to the most recent 2015 European Society of Cardiology Guidelines for the diagnosis and management of pericardial diseases should take into account the presence of hemodynamic compromise as well as suspicion of malignant or purulent pericarditis as first step, C-reactive protein serum level measurement as second step, investigations for a specific condition known to be associated with pericardial effusion as third step, and finally the size and the duration of the effusion. Treatment depends on the evaluation of the above-mentioned parameters and should ideally be tailored to the individual patient. Prognosis of chronic pericardial effusions depends largely on the underlying etiology. According to novel data, the prognosis of individuals with idiopathic, chronic (> 3 months), large (> 2 cm), asymptomatic pericardial effusions is usually benign and a watchful waiting strategy seems more reasonable and cost-effective than routine drainage as previously recommended.
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Affiliation(s)
- George Lazaros
- First Cardiology Clinic, Hippokration General Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.
| | - Massimo Imazio
- Cardiology, Cardiothoracic Department, University Hospital "Santa Maria della Misericordia", ASUFC, Udine, Italy
| | - Panagiotis Tsioufis
- First Cardiology Clinic, Hippokration General Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Emilia Lazarou
- First Cardiology Clinic, Hippokration General Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Charalambos Vlachopoulos
- First Cardiology Clinic, Hippokration General Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Costas Tsioufis
- First Cardiology Clinic, Hippokration General Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
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27
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Nomikos T, Georgoulis M, Chrysohoou C, Damigou E, Barkas F, Skoumas I, Liberopoulos E, Pitsavos C, Tsioufis C, Sfikakis PP, Tselepis A, Panagiotakos DB. Comparative performance of equations to estimate low-density lipoprotein cholesterol levels and cardiovascular disease incidence: The ATTICA study (2002-2022). Lipids 2023; 58:159-170. [PMID: 37153959 DOI: 10.1002/lipd.12371] [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: 03/09/2023] [Revised: 04/21/2023] [Accepted: 04/26/2023] [Indexed: 05/10/2023]
Abstract
Accurate estimation of low-density lipoprotein cholesterol (LDL-C) is important for monitoring cardiovascular disease (CVD) risk and guiding lipid-lowering therapy. This study aimed to evaluate the magnitude of discordance of LDL-C levels calculated by different equations and its effect on CVD incidence. The study sample consisted of 2354 CVD-free individuals (49% males, mean age 45 ± 14 years); 1600 were re-evaluated at 10 years and 1570 at 20 years. LDL-C was estimated using the Friedewald, Martin/Hopkins, and Sampson equations. Participants were categorized as discordant if estimated LDL-C was below the CVD-risk specific cut-off for one equation and equal/above for its comparator. The Friedewald and Martin/Hopkins equations presented a similar performance in estimating LDL-C; however, both yielded lower values compared to the Sampson. In all pairwise comparisons, differences were more pronounced at lower LDL-C levels, while the Friedewald equation significantly underestimated LDL-C in hypertriglyceridemic participants. Discordance was evident in 11% of the study population, and more specifically 6%, 22%, and 20% for Friedewald versus Martin/Hopkins, Friedewald versus Sampson and Martin/Hopkins versus Sampson equations, respectively. Among discordant participants, median (1st, 3rd quartile) difference in LDL-C was -4.35 (-10.1, 1.95), -10.6 (-12.3, -9.53) and -11.3 (-11.9, -10.6) mg/dL for Friedewald versus Martin/Hopkins, Friedewald versus Sampson and Martin/Hopkins versus Sampson equations, respectively. The 10- and 20-year CVD survival model that included LDL-C values of the Martin-Hopkins equation outperformed the predictive ability of those based on the Friedewald or Sampson equations. Significant differences in estimated LDL-C exist among equations, which may result in LDL-C underestimation and undertreatment.
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Affiliation(s)
- Tzortzis Nomikos
- Department of Nutrition and Dietetics, School of Health Sciences and Education, Harokopio University of Athens, Athens, Greece
| | - Michael Georgoulis
- Department of Nutrition and Dietetics, School of Health Sciences and Education, Harokopio University of Athens, Athens, Greece
| | - Christina Chrysohoou
- First Cardiology Clinic, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Evangelia Damigou
- Department of Nutrition and Dietetics, School of Health Sciences and Education, Harokopio University of Athens, Athens, Greece
| | - Fotios Barkas
- First Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece
| | - Ioannis Skoumas
- First Cardiology Clinic, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Evangelos Liberopoulos
- First Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece
| | - Christos Pitsavos
- First Cardiology Clinic, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Costas Tsioufis
- First Cardiology Clinic, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Petros P Sfikakis
- First Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece
| | - Alexandros Tselepis
- Department of Chemistry, Atherothrombosis Research Centre/Laboratory of Biochemistry, University of Ioannina, Ioannina, Greece
| | - Demosthenes B Panagiotakos
- Department of Nutrition and Dietetics, School of Health Sciences and Education, Harokopio University of Athens, Athens, Greece
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28
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Dri E, Lampas E, Lazaros G, Lazarou E, Theofilis P, Tsioufis C, Tousoulis D. Inflammatory Mediators of Endothelial Dysfunction. Life (Basel) 2023; 13:1420. [PMID: 37374202 DOI: 10.3390/life13061420] [Citation(s) in RCA: 7] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 06/15/2023] [Accepted: 06/16/2023] [Indexed: 06/29/2023] Open
Abstract
Endothelial dysfunction (ED) is characterized by imbalanced vasodilation and vasoconstriction, elevated reactive oxygen species (ROS), and inflammatory factors, as well as deficiency of nitric oxide (NO) bioavailability. It has been reported that the maintenance of endothelial cell integrity serves a significant role in human health and disease due to the involvement of the endothelium in several processes, such as regulation of vascular tone, regulation of hemostasis and thrombosis, cell adhesion, smooth muscle cell proliferation, and vascular inflammation. Inflammatory modulators/biomarkers, such as IL-1α, IL-1β, IL-6, IL-12, IL-15, IL-18, and tumor necrosis factor α, or alternative anti-inflammatory cytokine IL-10, and adhesion molecules (ICAM-1, VCAM-1), involved in atherosclerosis progression have been shown to predict cardiovascular diseases. Furthermore, several signaling pathways, such as NLRP3 inflammasome, that are associated with the inflammatory response and the disrupted H2S bioavailability are postulated to be new indicators for endothelial cell inflammation and its associated endothelial dysfunction. In this review, we summarize the knowledge of a plethora of reviews, research articles, and clinical trials concerning the key inflammatory modulators and signaling pathways in atherosclerosis due to endothelial dysfunction.
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Affiliation(s)
- Eirini Dri
- 1st Department of Cardiology, Hippokration General Hospital, Kapodistrian University of Athens Medical School, Vas. Sofias 114, 11528 Athens, Greece
| | - Evangelos Lampas
- Department of Cardiology, Konstantopouleio General Hospital, 14233 Athens, Greece
| | - George Lazaros
- 1st Department of Cardiology, Hippokration General Hospital, Kapodistrian University of Athens Medical School, Vas. Sofias 114, 11528 Athens, Greece
| | - Emilia Lazarou
- 1st Department of Cardiology, Hippokration General Hospital, Kapodistrian University of Athens Medical School, Vas. Sofias 114, 11528 Athens, Greece
| | - Panagiotis Theofilis
- 1st Department of Cardiology, Hippokration General Hospital, Kapodistrian University of Athens Medical School, Vas. Sofias 114, 11528 Athens, Greece
| | - Costas Tsioufis
- 1st Department of Cardiology, Hippokration General Hospital, Kapodistrian University of Athens Medical School, Vas. Sofias 114, 11528 Athens, Greece
| | - Dimitris Tousoulis
- 1st Department of Cardiology, Hippokration General Hospital, Kapodistrian University of Athens Medical School, Vas. Sofias 114, 11528 Athens, Greece
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29
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Drakopoulou M, Oikonomou G, Apostolos A, Karmpalioti M, Simopoulou C, Koliastasis L, Latsios G, Synetos A, Benetos G, Trantalis G, Sideris S, Dilaveris P, Tsioufis C, Toutouzas K. The Role of ECG Strain Pattern in Prognosis after TAVI: A Sub-Analysis of the DIRECT Trial. Life (Basel) 2023; 13:1234. [PMID: 37374017 DOI: 10.3390/life13061234] [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: 03/27/2023] [Revised: 05/13/2023] [Accepted: 05/22/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND The presence of an electrocardiographic (ECG) strain pattern-among other ECG features-has been shown to be predictive of adverse cardiovascular outcomes in asymptomatic patients with aortic stenosis. However, data evaluating its impact on symptomatic patients undergoing TAVI are scarce. Therefore, we tried to investigate the prognostic impact of baseline ECG strain pattern on clinical outcomes after TAVI. METHODS A sub-group of patients of the randomized DIRECT (Pre-dilatation in Transcatheter Aortic Valve Implantation Trial) trial with severe aortic stenosis who underwent TAVI with a self-expanding valve in one single center were consecutively enrolled. Patients were categorized into two groups according to the presence of ECG strain. Left ventricular strain was defined as the presence of ≥1 mm convex ST-segment depression with asymmetrical T-wave inversion in leads V5 to V6 on the baseline 12-lead ECG. Patients were excluded if they had paced rhythm or left bundle branch block at baseline. Multivariate Cox proportional hazard regression models were generated to assess the impact on outcomes. The primary clinical endpoint was all-cause mortality at 1 year after TAVI. RESULTS Of the 119 patients screened, 5 patients were excluded due to left bundle branch block. Among the 114 included patients (mean age: 80.8 ± 7), 37 patients (32.5%) had strain pattern on pre-TAVI ECG, while 77 patients (67.5%) did not exhibit an ECG strain pattern. No differences in baseline characteristics were found between the two groups. At 1 year, seven patients reached the primary clinical endpoint, with patients in the strain group demonstrating significantly higher mortality in Kaplan-Meier plots compared to patients without left ventricular strain (five vs. two, log-rank p = 0.022). There was no difference between the strain and no strain group regarding the performance of pre-dilatation (21 vs. 33, chi-square p = 0.164). In the multivariate analysis, left ventricular strain was found to be an independent predictor of all-cause mortality after TAVI [Exp(B): 12.2, 95% Confidence Intervals (CI): 1.4-101.9]. CONCLUSION Left ventricular ECG strain is an independent predictor of all-cause mortality after TAVI. Thus, baseline ECG characteristics may aid in risk-stratifying patients scheduled for TAVI.
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Affiliation(s)
- Maria Drakopoulou
- First Cardiology Department, Hippokration Hospital, Athens Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Georgios Oikonomou
- First Cardiology Department, Hippokration Hospital, Athens Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Anastasios Apostolos
- First Cardiology Department, Hippokration Hospital, Athens Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Maria Karmpalioti
- First Cardiology Department, Hippokration Hospital, Athens Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Chryssa Simopoulou
- First Cardiology Department, Hippokration Hospital, Athens Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Leonidas Koliastasis
- First Cardiology Department, Hippokration Hospital, Athens Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - George Latsios
- First Cardiology Department, Hippokration Hospital, Athens Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Andreas Synetos
- First Cardiology Department, Hippokration Hospital, Athens Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Georgios Benetos
- First Cardiology Department, Hippokration Hospital, Athens Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - George Trantalis
- First Cardiology Department, Hippokration Hospital, Athens Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
- State Department of Cardiology, Hippokration General Hospital, 11256 Athens, Greece
| | - Skevos Sideris
- State Department of Cardiology, Hippokration General Hospital, 11256 Athens, Greece
| | - Polychronis Dilaveris
- First Cardiology Department, Hippokration Hospital, Athens Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Costas Tsioufis
- First Cardiology Department, Hippokration Hospital, Athens Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Konstantinos Toutouzas
- First Cardiology Department, Hippokration Hospital, Athens Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
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30
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Damigou E, Kouvari M, Chrysohoou C, Barkas F, Kravvariti E, Pitsavos C, Skoumas J, Michelis E, Liberopoulos E, Tsioufis C, Sfikakis PP, Panagiotakos DB. Lifestyle Trajectories Are Associated with Incidence of Cardiovascular Disease: Highlights from the ATTICA Epidemiological Cohort Study (2002-2022). Life (Basel) 2023; 13:life13051142. [PMID: 37240787 DOI: 10.3390/life13051142] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [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: 03/24/2023] [Revised: 05/02/2023] [Accepted: 05/06/2023] [Indexed: 05/28/2023] Open
Abstract
The study aimed to assess the trajectories of lifestyle characteristics and their association with 20-year cardiovascular disease (CVD) incidence. In 2002, 3042 Greek adults (aged: 45 (12) years) free of CVD were enrolled. In 2022, the 20-year follow-up was performed on 2169 participants; of those, 1988 had complete data for CVD. The 20-year CVD incidence was 3600 cases/10,000 individuals; the man-to-woman ratio was 1.25, with the peak difference in the 35-45 age group (i.e., 2.1); however, a reversal of the trend was observed in the age-groups 55-65 and 65-75, with a resumption of an almost equal incidence in those >75 years. In multi-adjusted analysis, age, sex, abnormal waist circumference, hypercholesterolemia, hypertension, and diabetes were positively associated with 20-year CVD risk, explaining 56% of the excess CVD risk, whereas an additional 30% was attributed to lifestyle trajectories; being physically active throughout life-course and being close to the Mediterranean diet were protective, while continuous smoking was detrimental against CVD risk. Mediterranean diet adherence protected against CVD development even if not sustained, while quitting smoking or engaging in physical activities during the 20-year observation did not offer any significant protection. A life-course personalized approach that is cost-effective and long-term sustained is needed to prevent CVD burden.
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Affiliation(s)
- Evangelia Damigou
- Department of Nutrition and Dietetics, School of Health Sciences and Education, Harokopio University, 17676 Athens, Greece
| | - Matina Kouvari
- Department of Nutrition and Dietetics, School of Health Sciences and Education, Harokopio University, 17676 Athens, Greece
| | - Christina Chrysohoou
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, 15772 Athens, Greece
| | - Fotios Barkas
- Department of Nutrition and Dietetics, School of Health Sciences and Education, Harokopio University, 17676 Athens, Greece
- First Department of Propaedeutic Internal Medicine, Medical School, Laiko General Hospital, National and Kapodistrian University of Athens, 15772 Athens, Greece
| | - Evrydiki Kravvariti
- First Department of Propaedeutic Internal Medicine, Medical School, Laiko General Hospital, National and Kapodistrian University of Athens, 15772 Athens, Greece
| | - Christos Pitsavos
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, 15772 Athens, Greece
| | - John Skoumas
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, 15772 Athens, Greece
| | - Evangelinos Michelis
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, 15772 Athens, Greece
| | - Evangelos Liberopoulos
- First Department of Propaedeutic Internal Medicine, Medical School, Laiko General Hospital, National and Kapodistrian University of Athens, 15772 Athens, Greece
| | - Costas Tsioufis
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, 15772 Athens, Greece
| | - Petros P Sfikakis
- First Department of Propaedeutic Internal Medicine, Medical School, Laiko General Hospital, National and Kapodistrian University of Athens, 15772 Athens, Greece
| | - Demosthenes B Panagiotakos
- Department of Nutrition and Dietetics, School of Health Sciences and Education, Harokopio University, 17676 Athens, Greece
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31
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Critselis E, Tsiampalis T, Damigou E, Georgousopoulou E, Barkas F, Chrysohoou C, Skoumas J, Pitsavos C, Liberopoulos E, Tsioufis C, Sfikakis PP, Panagiotakos D. High fish intake rich in n-3 polyunsaturated fatty acids reduces cardiovascular disease incidence in healthy adults: The ATTICA cohort study (2002-2022). Front Physiol 2023; 14:1158140. [PMID: 37057185 PMCID: PMC10086327 DOI: 10.3389/fphys.2023.1158140] [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: 02/03/2023] [Accepted: 03/07/2023] [Indexed: 03/30/2023] Open
Abstract
Background: The long-term effects of high fish intake rich in n-3 fatty acids for deterring cardiovascular disease (CVD) and related adverse outcomes in healthy individuals have not been yet elucidated.Purpose: To evaluate the association between total seafood, as well as small fish, intake on 10- and 20-year CVD incidence and mortality in healthy adults.Methods: A prospective cohort study (n = 2,020) was conducted in healthy community dwelling adults in Athens, Greece, selected following age- and sex-based random multistage sampling (mean ± SD age at baseline: 45.2 ± 14.0 years). Seafood (high (>2 servings/week) vs. low (≤2 servings/week) intake), including small fish rich in n-3 fatty acids (high (>1 serving/week) vs. low (≤1 serving/week) intake), consumption was evaluated by semi-quantitative food frequency questionnaire at baseline. The occurrence of non-fatal and/or fatal CVD events (ICD-10) was assessed during 10- and 20-year follow-up periods.Results: Only 32.7% and 9.6% of participants had high seafood and small fish intakes, respectively. Participants with high seafood intake had 27% decreased 10-year CVD risk (adj. HR:0.73; 95% CI:0.55-0.98) and 74% lower attributable mortality (adj. HR:0.26; 95% CI:0.11-0.58). Participants with high seafood intake also sustained a 24% lower 20-year risk of CVD mortality (adj. HR: 0.76; 95% CI: 0.55-0.98). Moreover, participants with high small fish intake had a lower 10-year CVD risk and 76% decreased risk of 10-year CVD mortality (adj. HR:0.24; 95% CI:0.06-0.99), even among normotensive individuals (adj. HR:0.31; 95% CI:0.13-0.73). When analogous analyses focused on 20-year CVD incidence and mortality, similar but not significant associations were observed (all p-values >0.10).Conclusion: High intake of seafood, and particularly small fish rich in n-3 fatty acids, was associated with a lower risk of 10-year fatal and non-fatal CVD. Thus, public health interventions aimed at enhancing small fish consumption may most effectively deter long-term CVD outcomes, particularly among low risk normotensive individuals.
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Affiliation(s)
- Elena Critselis
- Department of Nutrition and Dietetics, School of Health Sciences and Education, Harokopio University, Athens, Greece
- Department of Primary Care and Population Health, University of Nicosia Medical School, Nicosia, Cyprus
| | - Thomas Tsiampalis
- Department of Nutrition and Dietetics, School of Health Sciences and Education, Harokopio University, Athens, Greece
| | - Evangelia Damigou
- Department of Nutrition and Dietetics, School of Health Sciences and Education, Harokopio University, Athens, Greece
| | - Ekavi Georgousopoulou
- Discipline of Nutrition & Dietetics, Faculty of Health, University of Canberra, Canberra, ACT, Australia
| | - Fotios Barkas
- Department of Nutrition and Dietetics, School of Health Sciences and Education, Harokopio University, Athens, Greece
| | - Christina Chrysohoou
- First Cardiology Clinic, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - John Skoumas
- First Cardiology Clinic, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Christos Pitsavos
- First Cardiology Clinic, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Evangelos Liberopoulos
- First Department of Propaedeutic Internal Medicine, School of Medicine, Laiko General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Costas Tsioufis
- First Cardiology Clinic, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Petros P. Sfikakis
- First Department of Propaedeutic Internal Medicine, School of Medicine, Laiko General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Demosthenes Panagiotakos
- Department of Nutrition and Dietetics, School of Health Sciences and Education, Harokopio University, Athens, Greece
- Discipline of Nutrition & Dietetics, Faculty of Health, University of Canberra, Canberra, ACT, Australia
- *Correspondence: Demosthenes Panagiotakos,
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32
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Barbato E, Azizi M, Schmieder RE, Lauder L, Böhm M, Brouwers S, Bruno RM, Dudek D, Kahan T, Kandzari DE, Lüscher TF, Parati G, Pathak A, Ribichini FL, Schlaich MP, Sharp ASP, Sudano I, Volpe M, Tsioufis C, Wijns W, Mahfoud F. Renal denervation in the management of hypertension in adults. A clinical consensus statement of the ESC Council on Hypertension and the European Association of Percutaneous Cardiovascular Interventions (EAPCI). EUROINTERVENTION 2023; 18:1227-1243. [PMID: 36789560 PMCID: PMC10020821 DOI: 10.4244/eij-d-22-00723] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 11/19/2022] [Indexed: 02/16/2023]
Abstract
Since the publication of the 2018 European Society of Cardiology/European Society of Hypertension (ESC/ESH) Guidelines for the Management of Arterial Hypertension, several high-quality studies, including randomised, sham-controlled trials on catheter-based renal denervation (RDN) were published, confirming both the blood pressure (BP)-lowering efficacy and safety of radiofrequency and ultrasound RDN in a broad range of patients with hypertension, including resistant hypertension. A clinical consensus document by the ESC Council on Hypertension and the European Association of Percutaneous Cardiovascular Interventions (EAPCI) on RDN in the management of hypertension was considered necessary to inform clinical practice. This expert group proposes that RDN is an adjunct treatment option in uncontrolled resistant hypertension, confirmed by ambulatory BP measurements, despite best efforts at lifestyle and pharmacological interventions. RDN may also be used in patients who are unable to tolerate antihypertensive medications in the long term. A shared decision-making process is a key feature and preferably includes a patient who is well informed on the benefits and limitations of the procedure. The decision-making process should take (i) the patient's global cardiovascular (CV) risk and/or (ii) the presence of hypertension-mediated organ damage or CV complications into account. Multidisciplinary hypertension teams involving hypertension experts and interventionalists evaluate the indication and facilitate the RDN procedure. Interventionalists require expertise in renal interventions and specific training in RDN procedures. Centres performing these procedures require the skills and resources to deal with potential complications. Future research is needed to address open questions and investigate the impact of BP-lowering with RDN on clinical outcomes and potential clinical indications beyond hypertension.
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Affiliation(s)
- Emanuele Barbato
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | - Michel Azizi
- Paris Centre de Recherche Cardiovasculaire, INSERM, Université Paris Cité, Paris, France
- Hypertension Department, AP-HP, Hôpital Européen Georges-Pompidou, Paris, France and FCRIN INI-CRCT, Université de Lorraine, Nancy, France
| | - Roland E Schmieder
- Department of Nephrology and Hypertension, University Hospital Erlangen, Erlangen, Germany and Friedrich Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Lucas Lauder
- Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes and Saarland University, Homburg, Germany
| | - Michael Böhm
- Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes and Saarland University, Homburg, Germany
| | - Sofie Brouwers
- Cardiovascular Center Aalst, OLV Hospital Aalst, Aalst, Belgium and Department of Experimental Pharmacology, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Rosa Maria Bruno
- Paris Centre de Recherche Cardiovasculaire, INSERM, Université Paris Cité, Paris, France
- Pharmacology Unit, AP-HP, Hôpital Européen Georges-Pompidou, Paris, France
| | - Dariusz Dudek
- Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland and GVM Care & Research, Maria Cecilia Hospital, Cotignola, Italy
| | - Thomas Kahan
- Department of Clinical Sciences, Karolinska Institute, Solna, Sweden and Division of Cardiovascular Medicine, Danderyd Hospital, Stockholm, Sweden and Department of Cardiology, Danderyd University Hospital Corporation, Stockholm, Sweden
| | | | - Thomas F Lüscher
- Department of Cardiology, Royal Brompton and Harefield Hospitals, London, UK, and National Heart and Lung Institute, Imperial College, London, UK, and School of Cardiovascular Medicine and Sciences, Kings College London, London, UK, and Center for Molecular Cardiology, University of Zurich, Schlieren, Switzerland
| | - Gianfranco Parati
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy and Cardiology Unit, Istituto Auxologico Italiano, IRCCS, Milan, Italy
- Department of Cardiovascular Medicine, Centre Hospitalier Princesse Grace, Monte Carlo, Monaco
| | - Atul Pathak
- Department of Cardiovascular Medicine, Centre Hospitalier Princesse Grace, Monte Carlo, Monaco
| | - Flavio L Ribichini
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Markus P Schlaich
- Dobney Hypertension Centre, Medical School, Perth, WA, Australia, and Royal Perth Hospital Unit, Medical Research Foundation, The University of Western Australia, Perth, WA, Australia and Departments of Cardiology and Nephrology, Royal Perth Hospital, Perth, WA, Australia
| | - Andrew S P Sharp
- Department of Cardiology, University Hospital of Wales, Cardiff, UK
| | - Isabella Sudano
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Massimo Volpe
- Department of Cardiology, Sapienza University of Rome, Sant'Andrea Hospital, Rome, Italy
| | - Costas Tsioufis
- 1st Department of Cardiology, National and Kapodistrian University of Athens, Athens, Greece and Hippocratio Hospital, Athens, Greece
| | - William Wijns
- The Lambe Institute for Translational Medicine, Galway, Ireland and University of Galway, Galway, Ireland
- The Smart Sensors Lab, London, UK and CURAM, London, UK
| | - Felix Mahfoud
- Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes and Saarland University, Homburg, Germany
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33
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Tyrovola D, Soulaidopoulos S, Tsioufis C, Lazaros G. The Role of Nutrition in Cardiovascular Disease: Current Concepts and Trends. Nutrients 2023; 15:nu15051064. [PMID: 36904064 PMCID: PMC10005442 DOI: 10.3390/nu15051064] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 02/16/2023] [Indexed: 02/23/2023] Open
Abstract
Cardiovascular disease (CVD) is the leading cause of mortality worldwide [...].
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34
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Barbato E, Azizi M, Schmieder RE, Lauder L, Böhm M, Brouwers S, Bruno RM, Dudek D, Kahan T, Kandzari DE, Lüscher TF, Parati G, Pathak A, Ribichini FL, Schlaich MP, Sharp ASP, Sudano I, Volpe M, Tsioufis C, Wijns W, Mahfoud F. Renal denervation in the management of hypertension in adults. A clinical consensus statement of the ESC Council on Hypertension and the European Association of Percutaneous Cardiovascular Interventions (EAPCI). Eur Heart J 2023; 44:1313-1330. [PMID: 36790101 DOI: 10.1093/eurheartj/ehad054] [Citation(s) in RCA: 30] [Impact Index Per Article: 30.0] [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: 01/25/2023] [Accepted: 01/25/2023] [Indexed: 02/16/2023] Open
Abstract
Since the publication of the 2018 European Society of Cardiology/European Society of Hypertension (ESC/ESH) Guidelines for the Management of Arterial Hypertension, several high-quality studies, including randomised, sham-controlled trials on catheter-based renal denervation (RDN) were published, confirming both the blood pressure (BP)-lowering efficacy and safety of radiofrequency and ultrasound RDN in a broad range of patients with hypertension, including resistant hypertension. A clinical consensus document by the ESC Council on Hypertension and the European Association of Percutaneous Cardiovascular Interventions (EAPCI) on RDN in the management of hypertension was considered necessary to inform clinical practice. This expert group proposes that RDN is an adjunct treatment option in uncontrolled resistant hypertension, confirmed by ambulatory BP measurements, despite best efforts at lifestyle and pharmacological interventions. RDN may also be used in patients who are unable to tolerate antihypertensive medications in the long term. A shared decision-making process is a key feature and preferably includes a patient who is well informed on the benefits and limitations of the procedure. The decision-making process should take (i) the patient's global cardiovascular (CV) risk and/or (ii) the presence of hypertension-mediated organ damage or CV complications into account. Multidisciplinary hypertension teams involving hypertension experts and interventionalists evaluate the indication and facilitate the RDN procedure. Interventionalists require expertise in renal interventions and specific training in RDN procedures. Centres performing these procedures require the skills and resources to deal with potential complications. Future research is needed to address open questions and investigate the impact of BP-lowering with RDN on clinical outcomes and potential clinical indications beyond hypertension.
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Affiliation(s)
- Emanuele Barbato
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | - Michel Azizi
- Paris Centre de Recherche Cardiovasculaire, INSERM, Université Paris Cité, Paris, France.,Hypertension Department, AP-HP, Hôpital Européen Georges-Pompidou, Paris, France.,FCRIN INI-CRCT, Universitéde Lorraine, Nancy, France
| | - Roland E Schmieder
- Department of Nephrology and Hypertension, University Hospital Erlangen, Erlangen, Germany.,Friedrich Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Lucas Lauder
- Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes and Saarland University, Homburg, Germany
| | - Michael Böhm
- Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes and Saarland University, Homburg, Germany
| | - Sofie Brouwers
- Cardiovascular Center Aalst, OLV Hospital Aalst, Aalst, Belgium.,Department of Experimental Pharmacology, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Rosa Maria Bruno
- Paris Centre de Recherche Cardiovasculaire, INSERM, Université Paris Cité, Paris, France.,Pharmacology Unit, AP-HP, Hôpital Européen Georges-Pompidou, Paris, France
| | - Dariusz Dudek
- Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland.,GVM Care &Research, Maria Cecilia Hospital, Cotignola, Italy
| | - Thomas Kahan
- Department of Clinical Sciences, Karolinska Institute, Solna, Sweden.,Division of Cardiovascular Medicine, Danderyd Hospital, Stockholm, Sweden.,Department of Cardiology, Danderyd University Hospital Corporation, Stockholm, Sweden
| | | | - Thomas F Lüscher
- Department of Cardiology, Royal Brompton and Harefield Hospitals, London, UK.,National Heart and Lung Institute, Imperial College, London, UK.,School of Cardiovascular Medicine and Sciences, Kings College London, London, UK.,Center for Molecular Cardiology, University of Zurich, Schlieren, Switzerland
| | - Gianfranco Parati
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.,Cardiology Unit, Istituto Auxologico Italiano, IRCCS, Milan, Italy
| | - Atul Pathak
- Department of Cardiovascular Medicine, Centre Hospitalier Princesse Grace, Monte Carlo, Monaco
| | - Flavio L Ribichini
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Markus P Schlaich
- Dobney Hypertension Centre, Medical School, Perth, WA, Australia.,Royal Perth Hospital Unit, Medical Research Foundation, The University of Western Australia, Perth, WA, Australia.,Departments of Cardiology and Nephrology, Royal Perth Hospital, Perth, WA, Australia
| | - Andrew S P Sharp
- Department of Cardiology, University Hospital of Wales, Cardiff, UK
| | - Isabella Sudano
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Massimo Volpe
- Department of Cardiology, Sapienza University of Rome, Sant'Andrea Hospital, Rome, Italy
| | - Costas Tsioufis
- 1st Department of Cardiology, National and Kapodistrian University of Athens, Athens, Greece.,Hippocratio Hospital, Athens, Greece
| | - William Wijns
- The Lambe Institute for Translational Medicine, Galway, Ireland.,University of Galway, Galway, Ireland.,The Smart Sensors Lab, London, UK.,CURAM, London, UK
| | - Felix Mahfoud
- Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes and Saarland University, Homburg, Germany
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35
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Apostolos A, Drakopoulou M, Gregoriou S, Tsioufis C, Toutouzas K. Supraventricular Arrhythmia After Percutaneous PFO Closure: Is Nickel Hypersensitivity the Missing Piece of the Puzzle? JACC Cardiovasc Interv 2023; 16:359. [PMID: 36792261 DOI: 10.1016/j.jcin.2022.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Accepted: 12/06/2022] [Indexed: 02/15/2023]
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36
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Affiliation(s)
- George Lazaros
- 1st Cardiology Clinic, National and Kapodistrian University of Athens, School of Medicine, Hippokration General Hospital, Athens, Greece
| | - Costas Tsioufis
- 1st Cardiology Clinic, National and Kapodistrian University of Athens, School of Medicine, Hippokration General Hospital, Athens, Greece
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37
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Lauder L, Mahfoud F, Azizi M, Bhatt DL, Ewen S, Kario K, Parati G, Rossignol P, Schlaich MP, Teo KK, Townsend RR, Tsioufis C, Weber MA, Weber T, Böhm M. Hypertension management in patients with cardiovascular comorbidities. Eur Heart J 2022:6808663. [DOI: 10.1093/eurheartj/ehac395] [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] [Received: 02/04/2022] [Revised: 06/23/2022] [Accepted: 07/08/2022] [Indexed: 11/09/2022] Open
Abstract
Abstract
Arterial hypertension is a leading cause of death globally. Due to ageing, the rising incidence of obesity, and socioeconomic and environmental changes, its incidence increases worldwide. Hypertension commonly coexists with Type 2 diabetes, obesity, dyslipidaemia, sedentary lifestyle, and smoking leading to risk amplification. Blood pressure lowering by lifestyle modifications and antihypertensive drugs reduce cardiovascular (CV) morbidity and mortality. Guidelines recommend dual- and triple-combination therapies using renin–angiotensin system blockers, calcium channel blockers, and/or a diuretic. Comorbidities often complicate management. New drugs such as angiotensin receptor-neprilysin inhibitors, sodium–glucose cotransporter 2 inhibitors, glucagon-like peptide-1 receptor agonists, and non-steroidal mineralocorticoid receptor antagonists improve CV and renal outcomes. Catheter-based renal denervation could offer an alternative treatment option in comorbid hypertension associated with increased sympathetic nerve activity. This review summarises the latest clinical evidence for managing hypertension with CV comorbidities.
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Affiliation(s)
- Lucas Lauder
- Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Saarland University , Kirrberger Str. 1, 66421 Homburg , Germany
| | - Felix Mahfoud
- Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Saarland University , Kirrberger Str. 1, 66421 Homburg , Germany
| | - Michel Azizi
- Université Paris Cité, INSERM CIC1418 , F-75015 Paris , France
- AP-HP, Hôpital Européen Georges-Pompidou, Hypertension Department, DMU CARTE , F-75015 Paris , France
- FCRIN INI-CRCT , Nancy , France
| | - Deepak L Bhatt
- Brigham and Women’s Hospital Heart and Vascular Center, Harvard Medical School , Boston, MA , USA
| | - Sebastian Ewen
- Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Saarland University , Kirrberger Str. 1, 66421 Homburg , Germany
| | - Kazuomi Kario
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine , Tochigi , Japan
| | - Gianfranco Parati
- Department of Medicine and Surgery, Cardiology Unit, University of Milano-Bicocca and Istituto Auxologico Italiano, IRCCS , Milan , Italy
| | - Patrick Rossignol
- FCRIN INI-CRCT , Nancy , France
- Université de Lorraine, INSERM, Centre d'Investigations Cliniques - Plurithématique 14-33 and INSERM U1116 , Nancy , France
- CHRU de Nancy , Nancy , France
| | - Markus P Schlaich
- Dobney Hypertension Centre, Medical School—Royal Perth Hospital Unit, Medical Research Foundation, The University of Western Australia , Perth, WA , Australia
- Departments of Cardiology and Nephrology, Royal Perth Hospital , Perth, WA , Australia
| | - Koon K Teo
- Population Health Research Institute, McMaster University , Hamilton, ON , Canada
| | - Raymond R Townsend
- Perelman School of Medicine, University of Pennsylvania , Philadelphia, PA , USA
| | - Costas Tsioufis
- National and Kapodistrian University of Athens, 1st Cardiology Clinic, Hippocratio Hospital , Athens , Greece
| | | | - Thomas Weber
- Department of Cardiology, Klinikum Wels-Grieskirchen , Wels , Austria
| | - Michael Böhm
- Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Saarland University , Kirrberger Str. 1, 66421 Homburg , Germany
- Cape Heart Institute (CHI), Faculty of Health Sciences, University of Cape Town , Cape Town , South Africa
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Katsianos E, Oikonomou E, Kalogeras K, Manousaki A, Kalantzis C, Pantelidis P, Vavuranakis MA, Aggeli K, Siasos G, Tsioufis C, Vavuranakis M. Residual Right-to-Left-Shunt Following Transcatheter Patent Foramen Ovale Closure: The Role of Antithrombotic Treatment. Curr Pharm Des 2022; 28:3305-3312. [PMID: 36306457 DOI: 10.2174/1381612829666221028095839] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 09/26/2022] [Indexed: 01/28/2023]
Abstract
BACKGROUND Transcatheter closure of patent foramen ovale (PFO) is a highly effective therapy for patients with left circulation thromboembolism, not attributable to other conditions. OBJECTIVES This retrospective cohort study investigates the impact of baseline foramen ovale anatomy on the severity of the postclosure shunt. METHODS Patients with PFO, who underwent percutaneous closure, were followed up for at least 5 years postimplantation. Patients were classified into two groups based on the presence of high-risk features of the baseline PFO anatomy. At the follow-up follow-up, residual right-to-left shunt was assessed for the high and non-highrisk anatomy groups, via transcranial Doppler at rest and after performing the Valsalva maneuver, with the injection of agitated saline. RESULTS 38 patients were examined after a mean follow-up period of 9 ± 3 years after implantation. After retrospective evaluation of the baseline transthoracic and transesophageal echo studies, 14 patients with high-risk PFO anatomy were identified. The degree of the residual right-to-left shunt, as assessed by the number of microbubbles was higher in the high-risk PFO anatomy group compared to the non-high-risk group, both at rest [1.50 (IQR: 0.00-3.25) vs. 0.00 (IQR: 0.00-0.00), p < 0.001] and post-Valsalva maneuver [7.50 (IQR: 1.50- 10.25) vs. 0.00 (IQR: 0.00-3.75), p = 0.003]. Furthermore, in the high-risk group, more microbubbles were detected at rest (p = 0.008) and post-Valsalva (p = 0.002) in subjects without antiplatelet treatment compared to subjects on prolonged antiplatelet therapy. CONCLUSION Baseline PFO anatomy affects the severity of the residual right-to-left shunt. Prolonged antiplatelet therapy may benefit patients with high-risk anatomical features.
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Affiliation(s)
- Efstratios Katsianos
- 3rd Cardiology Clinic, National and Kapodistrian University of Athens, Medical School, Sotiria Chest Disease Hospital, Athens. Greece
| | - Evangelos Oikonomou
- 3rd Cardiology Clinic, National and Kapodistrian University of Athens, Medical School, Sotiria Chest Disease Hospital, Athens. Greece.,1st Cardiology Clinic, National and Kapodistrian University of Athens, Medical School, "Hippokration" General Hospital, Athens, Greece
| | - Konstantinos Kalogeras
- 3rd Cardiology Clinic, National and Kapodistrian University of Athens, Medical School, Sotiria Chest Disease Hospital, Athens. Greece
| | - Alexandra Manousaki
- 1st Cardiology Clinic, National and Kapodistrian University of Athens, Medical School, "Hippokration" General Hospital, Athens, Greece
| | - Charalambos Kalantzis
- 1st Cardiology Clinic, National and Kapodistrian University of Athens, Medical School, "Hippokration" General Hospital, Athens, Greece
| | - Panteleimon Pantelidis
- 3rd Cardiology Clinic, National and Kapodistrian University of Athens, Medical School, Sotiria Chest Disease Hospital, Athens. Greece
| | | | - Konstantina Aggeli
- 3rd Cardiology Clinic, National and Kapodistrian University of Athens, Medical School, Sotiria Chest Disease Hospital, Athens. Greece
| | - Gerasimos Siasos
- 3rd Cardiology Clinic, National and Kapodistrian University of Athens, Medical School, Sotiria Chest Disease Hospital, Athens. Greece.,1st Cardiology Clinic, National and Kapodistrian University of Athens, Medical School, "Hippokration" General Hospital, Athens, Greece
| | - Costas Tsioufis
- 1st Cardiology Clinic, National and Kapodistrian University of Athens, Medical School, "Hippokration" General Hospital, Athens, Greece
| | - Manolis Vavuranakis
- 3rd Cardiology Clinic, National and Kapodistrian University of Athens, Medical School, Sotiria Chest Disease Hospital, Athens. Greece.,1st Cardiology Clinic, National and Kapodistrian University of Athens, Medical School, "Hippokration" General Hospital, Athens, Greece
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39
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Lazaros G, Dimitroglou Y, Sakalidis A, Mavroudis A, Kalantzis C, Valatsou A, Andrikou I, Christofi A, Mantzouranis E, Kachrimanidis I, Bei E, Lazarou E, Tsioufis C, Tousoulis D. Lipoprotein-associated phospholipase A2 in coronary artery disease. Curr Top Med Chem 2022:CTMC-EPUB-127246. [DOI: 10.2174/1568026623666221027145545] [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: 06/01/2022] [Revised: 10/03/2022] [Accepted: 10/12/2022] [Indexed: 11/22/2022]
Abstract
Abstract:
Coronary artery disease (CAD) is the leading cause of morbidity and mortality in western societies. Therefore identification of novel biomarkers to be used as diagnostic or therapeutic targets is of significant scientific interest. Lipoprotein-associated phospholipase A2 (Lp-PLA2) is one such protein shown to be involved in endothelial dysfunction, vascular inflammation and atherogenesis. Several epidemiological studies have associated high Lp-PLA2 activity with increased risk for CAD even when other CAD risk factors or inflammation markers were included in the multivariate analysis. These findings were strengthened by the results of relevant meta-analyses. However, randomized trials failed to establish Lp-PLA2 as a therapeutic target. Specifically, pharmaceutical inhibition of Lp-PLA2 when compared to the placebo failed to demonstrate significant association with improved prognosis of patients with stable CAD or after an acute coronary syndrome (ACS). This review focuses on the available data that have investigated the potential role of Lp-PLA2 as a biomarker for CAD.
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Affiliation(s)
- George Lazaros
- First Cardiology Department, Hippokration General Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Yannis Dimitroglou
- First Cardiology Department, Hippokration General Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Athanasios Sakalidis
- First Cardiology Department, Hippokration General Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Andreas Mavroudis
- First Cardiology Department, Hippokration General Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Charalambos Kalantzis
- First Cardiology Department, Hippokration General Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Angeliki Valatsou
- First Cardiology Department, Hippokration General Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Ioannis Andrikou
- First Cardiology Department, Hippokration General Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Angela Christofi
- First Cardiology Department, Hippokration General Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Emmanouil Mantzouranis
- First Cardiology Department, Hippokration General Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Ioannis Kachrimanidis
- First Cardiology Department, Hippokration General Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Evellina Bei
- First Cardiology Department, Hippokration General Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Emilia Lazarou
- First Cardiology Department, Hippokration General Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Costas Tsioufis
- First Cardiology Department, Hippokration General Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Dimitris Tousoulis
- First Cardiology Department, Hippokration General Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
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Lazaros G, Lazarou E, Tsioufis P, Soulaidopoulos S, Valatsou A, Karmpalioti M, Sakalidis A, Vlachakis PK, Vlachopoulos C, Tsioufis C. Incidence and Prevalence of Cardiac Arrhythmias in Pericardial Syndromes. Rev Cardiovasc Med 2022. [DOI: 10.31083/j.rcm2310347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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41
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Papakonstantinou P, Andrikou I, Konstantinidis D, Tsioufis C. PR interval as arisk factor for atrial fibrillation in patients with arterial hypertension. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2229] [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: 11/15/2022] Open
Abstract
Abstract
Introduction
Hypertension (HTN) is one of the most important risk factors associated with atrial fibrillation (AF). Prolongation of the PR interval has been associated with an increased risk of incident AF, while PR interval is a component of the Framingham risk score for AF. However, the results regarding PR prolongation as a risk factor for AF are inconsistent.
Purpose
We aim to evaluate the predictive role of the PR interval for AF development in a large cohort of HTN patients.
Methods
Consecutive patients with essential hypertension without known AF at baseline were followed up for a mean period of 5.3±3.3 years. A 12-lead ECG and an echocardiography study were performed on each patient at baseline and annually, and 24h Holter rhythm monitoring was used in the event of arrhythmia symptoms. Routine clinical and paraclinical examinations as well as medications were implemented during the follow-up period according to the European Society of Cardiology/ European Society of Hypertension guidelines for HTN management. The PR interval and P wave duration were obtained from the baseline ECG.
Results
We included 1807 hypertensives (mean age 57±11 years; 49% males) with office systolic blood pressure (SBP)/ diastolic blood pressure (DBP) 144±17/89±11mmHg. During the follow-up period, 65 cases (3%) of new-onset AF were recorded. Patients with new-onset AF (n=67) compared to those without AF (n=1740) had greater baseline P wave duration (115 vs 110 ms) and PR internal (174 vs 157 ms). Multivariable Cox regression analysis showed that higher baseline PR internal is significantly associated with the development of AF (HR 1.01, 95% CI 1.01–1.02; p=0.01), while there was no significant predictive value for baseline P wave duration on the incidence of new-onset AF. Baseline increased DBP was associated with a higher incidence of AF (HR 1.05, 95% 1.003–1.091; p=0.037).
Conclusions
Baseline PR internal is a significant predictor of new-onset AF in hypertensive patients. The PR prolongation could be considered as a marker for cardiovascular degenerative aging caused by vascular inflammation and myocardial fibrosis.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- P Papakonstantinou
- Hippokration General Hospital, 1st Cardiology Department, School of Medicine, University of Athens , Athens , Greece
| | - I Andrikou
- Hippokration General Hospital, 1st Cardiology Department, School of Medicine, University of Athens , Athens , Greece
| | - D Konstantinidis
- Hippokration General Hospital, 1st Cardiology Department, School of Medicine, University of Athens , Athens , Greece
| | - C Tsioufis
- Hippokration General Hospital, 1st Cardiology Department, School of Medicine, University of Athens , Athens , Greece
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Apostolos A, Trigka A, Chlorogiannis D, Vasilagkos G, Chamakioti M, Spyropoulou P, Karamasis G, Dimitriadis K, Moulias A, Katsanos K, Tsioufis C, Toutouzas K, Alexopoulos D, Davlouros P, Tsigkas G. Thirty-days versus standard duration of dual antiplatelet treatment after percutaneous coronary interventions: a systematic review and meta-analysis. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2717] [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/Introduction
Abbreviation of 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).
Purpose
The purpose of the specific systematic review and meta-analysis was to compare 30-days versus longer duration (≥3 months) of DAPT in patients undergoing PCI with DES, focusing on ischemic and bleeding events.
Methods
Three databases were screened for eligible randomized-control trials. The primary endpoint was the incidence of net adverse clinical events (NACE), as they were defined in each trial. Secondary endpoints consisted of major adverse cardiovascular events (MACE), all-cause and cardiovascular mortality, myocardial infraction, stroke, stent-thrombosis, repeat revascularization and major bleeding.
Results
We included 4 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 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 infraction, revascularization and stent thrombosis) were not affected.
Conclusions
Thirty-days DAPT did not significantly affect NACEs. However, odds of major bleedings were reduced significantly by 22%. Mortality and ischemic events did not differ between the two arms. Thus, 30-days DAPT could be considered as a safe and feasible after PCI with DES in selected patients, especially those in high-bleeding risk. Forthcoming RCTs could shed light on the optimal duration of DAPT.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- A Apostolos
- University Hospital of Patras, Department of Cardiology , Patras , Greece
| | - A Trigka
- University Hospital of Patras, Department of Cardiology , Patras , Greece
| | - D Chlorogiannis
- University Hospital of Patras, Department of Cardiology , Patras , Greece
| | - G Vasilagkos
- University Hospital of Patras, Department of Cardiology , Patras , Greece
| | - M Chamakioti
- University Hospital of Patras, Department of Cardiology , Patras , Greece
| | - P Spyropoulou
- University Hospital of Patras, Department of Cardiology , Patras , Greece
| | - G Karamasis
- Attikon University Hospital, att , Athens , Greece
| | | | - A Moulias
- University Hospital of Patras, Department of Cardiology , Patras , Greece
| | - K Katsanos
- University Hospital of Patras , Patras , Greece
| | - C Tsioufis
- Hippokration General Hospital , Athens , Greece
| | - K Toutouzas
- Hippokration General Hospital , Athens , Greece
| | | | - P Davlouros
- University Hospital of Patras, Department of Cardiology , Patras , Greece
| | - G Tsigkas
- University Hospital of Patras, Department of Cardiology , Patras , Greece
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Lazaros G, Lazarou E, Valatsou A, Vlachopoulos C, Antonopoulos AS, Dimitroglou Y, Sakalidis A, Tsioufis P, Kachrimanidis I, Tsioufis C. The natural history of idiopathic chronic large asymptomatic non-inflammatory pericardial effusions. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1801] [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/Introduction
Pericardial effusions (PEFs) are a challenging and often troublesome pericardial syndrome. The most recent 2015 ESC guidelines on pericardial diseases recommend drainage in cardiac tamponade or suspected bacterial/ neoplastic etiology (class IC), which should also be considered in large, idiopathic chronic PEFs.
Purpose
In this work we assessed the natural history of asymptomatic, idiopathic, chronic, C-reactive protein (CRP) negative, large PEFs.
Methods
We assessed retrospectively consecutive patients referred to the pericardial unit of our institution with idiopathic (without definite underlying etiology after extensive work-up), chronic (>3 months), large (maximal effusion diameter at end-diastole >2cm), asymptomatic, without evidence of ongoing pericardial inflammation (without CRP elevation or evidence of pericardial inflammation with cardiac magnetic resonance imaging) PEFs. To define the natural history of this condition, only patients with a follow-up of at least 2 years were included. The change in the PEF diameter from the first evaluation to the last follow-up namely: regression (complete or decrease from large to moderate/small), progression with symptoms appearance requiring drainage, or stability over time (defined as variation of PEF diameter <5mm, but still in the range of large), was assessed. Follow-up according to our institutional protocols was performed every 3 months and included clinical examination and focused echocardiography.
Results
Thirty patients fulfilled the inclusion criteria and were analyzed. No patient was receiving anti-inflammatory treatment during follow-up. Nevertheless, 12 patients (40%) had received from their attending physicians a course of anti-inflammatory treatment (non-steroidal anti-inflammatory drugs, glucocorticoids, colchicine and combinations) before enrollment, without or with temporary results. The mean age of this study population was 64.9 (±16.1) years and the mean follow-up was 49.8 (±17.8) months. Women were numerically more often affected compared to men (57% vs. 43%, p=0.465). History of pericarditis was reported in 13% of cases. The mean maximal PEF diameter was 24.5mm (±3.3) and the median disease duration at first evaluation was 15.5 (7–57) months. Concerning outcome, the effusion size remained stable in 24 out of 30 patients (80%), regressed in 4 (13%,) and increased in size requiring drainage due to symptoms onset in the remainder 2 (7%). During follow-up 2 patients (7%) with stable in size effusions died from non-cardiac causes.
Conclusions
According to this study results the outcome of idiopathic, chronic, large, asymptomatic and without evidence of inflammation PEFs is overall favorable. Patients should be reassured about the benign course of this condition but at the same time, advised to seek medical care should symptoms appear, for a timely intervention with pericardial drainage.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- G Lazaros
- National & Kapodistrian University of Athens Medical School , Athens , Greece
| | - E Lazarou
- National & Kapodistrian University of Athens Medical School , Athens , Greece
| | - A Valatsou
- National & Kapodistrian University of Athens Medical School , Athens , Greece
| | - C Vlachopoulos
- National & Kapodistrian University of Athens Medical School , Athens , Greece
| | - A S Antonopoulos
- National & Kapodistrian University of Athens Medical School , Athens , Greece
| | - Y Dimitroglou
- National & Kapodistrian University of Athens Medical School , Athens , Greece
| | - A Sakalidis
- National & Kapodistrian University of Athens Medical School , Athens , Greece
| | - P Tsioufis
- National & Kapodistrian University of Athens Medical School , Athens , Greece
| | - I Kachrimanidis
- National & Kapodistrian University of Athens Medical School , Athens , Greece
| | - C Tsioufis
- National & Kapodistrian University of Athens Medical School , Athens , Greece
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Ioakeimidis N, Terentes-Printzios D, Angelis A, Rokkas K, Dima I, Gourgouli I, Chatzistamatiou E, Kalfountzos D, Tsioufis C, Vlachopoulos C. Erectile dysfunction, generalized vascular disease and the long term effects of smoking exposure on arterial properties: time is of the essence. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2556] [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
Erectile dysfunction (ED) is considered an early manifestation of generalized vascular disease and may precede clinically overt cardiovascular disease (CVD) by 2 to 5 years. We examined macrovascular changes according to time of ED onset and the impact of smoking on the severity of penile vascular damage and large artery wall changes.
Methods
We measured carotid-femoral pulse wave velocity (PWV), carotid intima media thickness (cIMT), augmentation index (AIx) and brachial flow-mediated dilation (FMD) in 378 males with ED (age: 54±7 years). All participants had no clinical manifestations or a history of atherosclerotic disease. They were assessed using the Sexual Health in Men (SHIM)-5 score for ED severity and the penile colour Doppler ultrasonography after intracavernous injection of prostaglandin E1 for measurement of peak systolic velocity (PSV). Low PSV values indicate impaired penile blood inflow and severe vasculogenic ED. ED duration was defined as the time interval between age at diagnosis and study entry.
Results
The study population was divided into three groups according to duration of ED. Group 1: <2 years, Group 2: 2–5 years and Group 3: >5 years. Comparison of various parameters among the three groups using one-way ANOVA or the Kruskal–Wallis test did not demonstrate statistically significant differences in age, prevalence of hypertension, diabetes, smoking, peripheral blood pressure (BP) and metabolic parameters (fasting blood glucose, lipid profile, testosterone levels). Total tobacco cigarette exposure was greater in males with ED duration >5 years (Group 3), compared to Group 2 and 1 patients (23.8 vs 22.5 vs 20.7 pack-years, P<0.01). PWV, AIx and cIMT increased and FMD decreased across the three groups (Figure 1). The three groups had comparable PSV value. We then divided the study population into four subgroups according to tobacco exposure (never smokers; light smokers<20 pack-years, moderate smokers 20–40 pack-years and heavy smokers >40 pack-years). The subgroups have similar age and BP. The three smoking subgroups had significantly higher PWV (P<0.001), AIx (P<0.01), cIMT (P<0.01) and lower FMD (P<0.05) and PSV (P<0.05) compared to never smokers. Post hoc analysis revealed higher PWV, AIx and cIMT and lower FMD in heavy smokers compared to moderate and light smokers (all p<0.05). PSV was similar across the three smoking subgroups.
Conclusions
The study shows that longer ED duration is associated with a more pronounced vascular dysfunction and subclinical vascular wall changes and that heavy tobacco cigarette exposure significantly deteriorates macrovascular parameters. Furthermore there was a significant impairment of penile vasculature even in light smokers. These findings may partly explain why the same process that contribute to CVD may cause earlier ED symptoms and imply that smoking cessation should be a premising non pharmacological intervention in men with ED.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- N Ioakeimidis
- National & Kapodistrian University of Athens , Athens , Greece
| | | | - A Angelis
- National & Kapodistrian University of Athens , Athens , Greece
| | - K Rokkas
- National & Kapodistrian University of Athens , Athens , Greece
| | - I Dima
- National & Kapodistrian University of Athens , Athens , Greece
| | - I Gourgouli
- National & Kapodistrian University of Athens , Athens , Greece
| | | | | | - C Tsioufis
- National & Kapodistrian University of Athens , Athens , Greece
| | - C Vlachopoulos
- National & Kapodistrian University of Athens , Athens , Greece
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Tsartsalis D, Kakiouzi V, Aggeli C, Dimitroglou Y, Latsios G, Tsiamis E, Giannou P, Karampela M, Petras D, Vlachopoulos C, Tousoulis D, Tsioufis C. Deformation analysis in advanced chronic kidney disease: an important prognostic indicator. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.034] [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
Chronic kidney disease (CKD) is associated with a higher incidence of cardiovascular manifestations, particularly in patients with advanced renal impairment on long-term dialysis. Cardiac deformation analysis, assessed by speckle tracking echocardiography has been shown to be a significant prognostic index in various specific populations.
Objective
To assess the prognostic value of deformation analysis measurements including both systolic parameters as left ventricular (LV) global longitudinal strain, and diastolic indices as left atrial (LA) strain, in patients with end-stage renal disease.
Methods
We enrolled 67 patients (mean age 62.3±11.8, 65.7% men) with end-stage renal disease. Patients with a confirmed diagnosis of pre/existing cardiac conditions, such as obstructive coronary artery disease, heart failure, severe arrhythmias or severe valvular disease were excluded from the study. A comprehensive transthoracic echocardiography study was performed at baseline. All images were stored digitally and subsequent analysis was performed offline. LV global longitudinal strain (GLS) and LA strain were calculated semi-automatically using dedicated software. The primary endpoints of the study were major adverse cardiovascular events such as all-cause mortality, cardiovascular mortality, myocardial infarction, and hospitalizations for cardiac adverse events. The median follow-up was five years.
Results
The study population had normal or mildly impaired systolic function with a mean LV ejection fraction (EF) of 49.17% (±10.41) while 70% of patients had reduced LV GLS, mean 14.35% (±4.49). Regarding LA parameters, 50% of our cohort had impaired LA strain: mean LA reservoir, LA conduit, and LA contractile reserve were 24.11% (±12.61), 10.56% (±5.88), and 13.60% (±9.15) respectively. The 5-year cumulative event-free survival was 58.2% (±6.7), while 30% of major events occurred in the first 2 years after baseline. Age had a moderate correlation with poor prognosis (p=0.013). Of the echocardiographic parameters LV EF, LV GLS, the conduit phase of LA strain, LA volume and various doppler parameters related to diastolic function, such as mitral E/A ratio and late mitral diastolic velocity A, were found to have a significant negative association with total prognosis (p=0.003, p=0.02, p=0.048, p=0.045, p=0.008, and p=0.017 respectively). Logistic regression analysis showed that of the different echocardiographic parameters LV EF, LV GLS, and the conduit phase of LA strain were significantly associated with the overall prognosis (p=0.009, p=0.007, p=0.05). The conduit element of LA strain was the strongest predictor among them (OR=0.77 p=0.04).
Conclusion
Left ventricular systolic and diastolic dysfunction is a significant prognostic indicator in patients with end stage renal disease. Assessing cardiac mechanics with speckle tracking echocardiography could provide valuable information in this specific population.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- D Tsartsalis
- Hippokration General Hospital, Department of Emergency Medicine , Athens , Greece
| | - V Kakiouzi
- Hippokration Hospital, University of Athens, 1st Department of Cardiology , Athens , Greece
| | - C Aggeli
- Hippokration Hospital, University of Athens, 1st Department of Cardiology , Athens , Greece
| | - Y Dimitroglou
- Hippokration Hospital, University of Athens, 1st Department of Cardiology , Athens , Greece
| | - G Latsios
- Hippokration Hospital, University of Athens, 1st Department of Cardiology , Athens , Greece
| | - E Tsiamis
- Hippokration Hospital, University of Athens, 1st Department of Cardiology , Athens , Greece
| | - P Giannou
- Hippokration General Hospital, Departmnet of Nephrology , Athens , Greece
| | - M Karampela
- Hippokration General Hospital, Departmnet of Nephrology , Athens , Greece
| | - D Petras
- Hippokration General Hospital, Departmnet of Nephrology , 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
| | - C Tsioufis
- Hippokration Hospital, University of Athens, 1st Department of Cardiology , Athens , Greece
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Solomou E, Terentes-Printzios D, Kafouris P, Pouli A, Sioni A, Giannouli S, Metaxas M, Angelopoulou M, Ioakimidis N, Aggeli C, Voulgarelis M, Tousoulis D, Tsioufis C, Anagnostopoulos CD, Vlachopoulos C. Effect of 1st line treatment on aortic inflammation as assessed by 18 FDG PET/CT in patients with Hodgkin and non-Hodgkin lymphoma. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2589] [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
Despite advances in the treatment of oncology patients, therapy-related side effects may lead to premature morbidity among cancer survivors. Inflammatory activation that has been linked to cardiovascular disease is particularly crucial for the pathogenesis of both Hodgkin (HL) and non-Hodgkin lymphoma (NHL).
Objectives
To assess the vascular effects of chemotherapy in patients with HL and NHL by 18-Fluorodeoxyglucose (FDG PET/CT) and to investigate possible interactions with systemic inflammation as assessed by circulating inflammatory markers.
Methods
Between July 2015 and July 2019, sixty-five consecutive patients (37 males, mean age 56±17.8 years) with histologically confirmed new diagnosis of either HL (n=33) or NHL (n=32), were prospectively studied. PET/CT imaging was performed at baseline, at an interim phase and after 1st line treatment. Aortic FDG uptake was assessed by measuring global aortic TBR. Serum interleukin-6 (IL6) and interleukin-1b (IL1b) were measured at each phase for all patients and served as circulating inflammatory markers.
Results
Patients with HL demonstrated significant reduction in aortic TBR after 1st line treatment (aortic TBRbaseline=1.98, aorticTBR3rdscan=1.75, p=0.001, F=8.335), which remained significant after adjustment for 10-year cardiovascular risk (Framingham risk score), dyslipidemia, hypertension and diabetes (p=0.002, F=7.664). In contrast, patients with NHL did not demonstrate a significant aortic inflammation response (aortic TBRbaseline = 2.13, aorticTBR3rd scan=2.015, p=0.596, F=0.527), Figure 1. Regarding inflammatory markers, after 1st line treatment IL6 levels were reduced significantly in both HL and NHL groups (IL6baseline HL=3.25, IL6 post 1st line treatment HL=0.448, p=0.00; IL6baseline NHL=0.475, IL6 post 1st line treatment NHL=0.144, p=0.001); IL1b levels did not change significantly in either group, Table 1.
Conclusions
We demonstrate for the first time that aortic inflammation as assessed by 18-FDG PET-CT is reduced in HL patients after 1st line treatment but not in NHL patients. These findings imply that different pathophysiological pathways and different therapies might affect the arterial bed in different ways in lymphoma patients. Further, a strong potential role of molecular imaging in cardio-oncology emerges, offering valuable information on disease prognosis and progression with a single examination.
Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): Hellenic Society of Hypertension
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Affiliation(s)
- E Solomou
- Hippokration General Hospital, National & Kapodistrian University of Athens , Athens , Greece
| | - D Terentes-Printzios
- Hippokration General Hospital, National & Kapodistrian University of Athens , Athens , Greece
| | - P Kafouris
- National & Kapodistrian University of Athens, Department of Informatics and Telecommunications , Athens , Greece
| | - A Pouli
- Agios Savvas General Oncology Hospital , Athens , Greece
| | - A Sioni
- Agios Savvas General Oncology Hospital , Athens , Greece
| | - S Giannouli
- Hippokration General Hospital, National & Kapodistrian University of Athens , Athens , Greece
| | - M Metaxas
- Academy of Athens Biomedical Research Foundation , Athens , Greece
| | | | - N Ioakimidis
- Hippokration General Hospital, National & Kapodistrian University of Athens , Athens , Greece
| | - C Aggeli
- Hippokration General Hospital, National & Kapodistrian University of Athens , Athens , Greece
| | | | - D Tousoulis
- Hippokration General Hospital, National & Kapodistrian University of Athens , Athens , Greece
| | - C Tsioufis
- Hippokration General Hospital, National & Kapodistrian University of Athens , Athens , Greece
| | | | - C Vlachopoulos
- National & Kapodistrian University of Athens , Athens , Greece
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Ioakeimidis N, Dima I, Terentes-Printzios D, Xydis P, Angelis A, Solomou E, Gardikioti V, Gourgouli I, Papadatos S, Kalfountzos D, Tsioufis C, Vlachopoulos C. Smoking promotes vascular damage in apparently healthy men with low testosterone and increased subclinical inflammation. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1976] [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
Testosterone deficiency and increased inflammation are both associated with an unfavourable vascular profile. Aim of the study was to examine whether smoking significantly deteriorates the effect of these pathophysiological mechanisms on arterial wall properties.
Methods
Carotid intima media thickness (cIMT) and aortic pulse wave velocity (aPWV) were measured in 87 smokers and 112 aged-matched never smokers (mean age: 49±5 yrs) with no other cardiovascular (CV) risk factors/or manifest CV/atherosclerotic disease. Plasma total testosterone (TT) and high sensitivity reactive protein (hsCRP) levels were measured in the whole study population.
Results
Both smokers and never smokers were divided into four subgroups according to measured low or normal TT levels (low TT<3.5 ng/ml) and high or low hsCRP levels. BMI and LDL-C levels were not different between the subgroups. In smokers the four TT/CRP subgroups had comparable cumulative tobacco smoke exposure. In smokers the low TT/high CRP subgroup had significantly higher aPWV and cIMT compared to the three other subgroups (P<0.01 and P<0.05, respectively by ANOVA, figures A-B) while in never smokers the four TT/CRP subgroups had comparable aPWV and cIMT (all P>0.05, figures C-D). The differences in aPWV and cIMT measurements between TT/CRP subgroups in smokers remained statistically significant after adjustment for age.
Conclusions
The study shows that low TT combined with high CRP are associated with increased carotid IMT and aortic PWV in smokers with no other CV risk factors, while in never smokers the effect of combined low TT and high CRP concentration was not significant. Considering the predictive value of aortic stiffness and carotid thickness, the finding of this study imply interrelationships between tobacco cigarette smoke, subclinical inflammation and low testosterone level regarding changes in arterial wall properties.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- N Ioakeimidis
- National & Kapodistrian University of Athens , Athens , Greece
| | - I Dima
- National & Kapodistrian University of Athens , Athens , Greece
| | | | - P Xydis
- National & Kapodistrian University of Athens , Athens , Greece
| | - A Angelis
- National & Kapodistrian University of Athens , Athens , Greece
| | - E Solomou
- National & Kapodistrian University of Athens , Athens , Greece
| | - V Gardikioti
- National & Kapodistrian University of Athens , Athens , Greece
| | - I Gourgouli
- National & Kapodistrian University of Athens , Athens , Greece
| | - S Papadatos
- Spiliopouleio Pathology Hospital , Athens , Greece
| | | | - C Tsioufis
- National & Kapodistrian University of Athens , Athens , Greece
| | - C Vlachopoulos
- National & Kapodistrian University of Athens , Athens , Greece
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Anousakis-Vlachochristou N, Ktenopoulos N, Paschalidis N, Giannouli C, Vlasopoulou K, Miliou A, Divani M, Alexopoulou M, Kentepozidi E, Charitos D, Cokkinos D, Tsioufis C, Toutouzas K. Novel peripheral blood immune cell populations correlate with disease progression and reveal systemic interactions in severe aortic valve stenosis patients. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1525] [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
Osteoblastic differentiation is the key driver phenomenon underlying degenerative aortic valve stenosis (AS). It is characterized by a complex cellular interplay and infiltration by circulating immune cells. Moreover, AS demonstrates a diverse natural course, which is understudied.
Purpose
We sought to investigate the presence of AS clinical progression subphenotypes in the context of “AthenaValve” trial (NCT04312139).
Methods
Consecutive patients with severe AS undergoing TAVI or SAVR with complete clinical data, echocardiographic history (≥3 past years, corresponding from moderate to severe AS), along with matched healthy volunteers, were included. The median transaortic Vmax increase/month (Vi/m) was calculated and cluster analysis was used to reveal AS progression subgroups. Whole blood peripheral mononuclear cells (PBMCs) were isolated with density gradient centrifugation and cryopreserved into FBS-10% DMSO. PBMC populations were investigated with mass cytometry (CyTOF, Helios, Fluidigm) using a 30-marker antibody panel (Direct Immune Profiling Assay, Fluidigm) and analyzed with Flowjo and Cytobank software.
Results
A total of 67 patients fulfilling criteria were included (mean age 77.2±10 years, 61.2% males). Two-step cluster algorithm identified 2 clusters of AS progression: C1: 80%, mean Vi/m = 0.03±0.01 vs C2: 20%, Vi/m = 0.07±0.1 m/s/month, average silhouette = 0.7. Mean time to progression to severe AS differed significantly: C1: 59.5 (48.9,70.1) vs C2: 40.2 (29.2, 51.2) months, log rank p=0.05. Among those, 20 patients (C1: 10, C2: 10) and 10 healthy volunteers were included in CyTOF. Demographics, atherosclerotic clinical factors and renal function did not differ among patients-volunteers and C1-C2 groups. B cells, B-memory, B-naïve and pDendritic cells discriminated patients from healthy volunteers: ROC curve (AUC: 0.885, p=0.001), (0.913, p<0.001), (0.770, p=0.018), (0.282, p=0.056), profile (%): (5.3±3 vs 10.2±4), (0.86±0.4 vs 2.6±2), (4.4±3 vs 7.6±4), and (0.48±0.2 vs 0.3±0.1), respectively (mean live cells analyzed: 284028.8±52213.8). pDendritic cells and CD4-Th17-like cells discriminated C1 from C2 patients: ROC curve AUC: (0.804, p=0.005) and (0.268, p=0.031), profile (%): (0.6±0.2 vs 0.3±0.2) and (0.9±0.5 vs 2.6±0.9), respectively).
Conclusions
Aortic valve stenosis patients demonstrate two distinct phenotypes of disease progression from moderate to severe stage. Patients demonstrate reduced circulating B-cells and increased plasmatocytoid dendritic cells. The rapid progression subgroup of patients demonstrates reduced pDendritic and increased CD4-Th17-like cells. Further works are needed to expand and validate these results.
Funding Acknowledgement
Type of funding sources: Public grant(s) – EU funding. Main funding source(s): Co-Funded by Hellenic Ministry of Development and European Regional Development Fund in the context of an open call of “EATRIS-GR project: Infrastructure for preclinical and early-phase clinical development of drugs, therapeutics, and biomedical devices”
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Affiliation(s)
| | - N Ktenopoulos
- National & Kapodistrian University of Athens Medical School , Athens , Greece
| | - N Paschalidis
- Academy of Athens Biomedical Research Foundation, CyTOF Lab , Athens , Greece
| | - C Giannouli
- Academy of Athens Biomedical Research Foundation, CyTOF Lab , Athens , Greece
| | - K Vlasopoulou
- National & Kapodistrian University of Athens Medical School , Athens , Greece
| | - A Miliou
- National & Kapodistrian University of Athens Medical School , Athens , Greece
| | - M Divani
- National & Kapodistrian University of Athens Medical School , Athens , Greece
| | - M Alexopoulou
- National & Kapodistrian University of Athens Medical School , Athens , Greece
| | - E Kentepozidi
- National & Kapodistrian University of Athens Medical School , Athens , Greece
| | - D Charitos
- National & Kapodistrian University of Athens Medical School , Athens , Greece
| | - D Cokkinos
- Academy of Athens Biomedical Research Foundation, Cardiovascular Translational Research Unit , Athens , Greece
| | - C Tsioufis
- National & Kapodistrian University of Athens Medical School , Athens , Greece
| | - K Toutouzas
- National & Kapodistrian University of Athens Medical School , Athens , Greece
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Affiliation(s)
- Theodore G Papaioannou
- First Department of Cardiology, 'Hippokration' Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece.
| | - Despina Sanoudou
- Clinical Genomics and Pharmacogenomics Unit, 4th Department of Internal Medicine, 'Attikon' Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
- Center for New Biotechnologies and Precision Medicine, Medical School, National and Kapodistrian University of Athens, Athens, Greece
- Molecular Biology Division, Biomedical Research Foundation of the Academy of Athens, Athens, Greece
| | - Costas Tsioufis
- First Department of Cardiology, 'Hippokration' Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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50
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Charitakis E, Tsartsalis D, Korela D, Stratinaki M, Vanky F, Charitos EI, Alfredsson J, Karlsson LO, Foukarakis E, Aggeli C, Tsioufis C, Walfridsson H, Dragioti E. Risk and protective factors for atrial fibrillation after cardiac surgery and valvular interventions: an umbrella review of meta-analyses. Open Heart 2022; 9:openhrt-2022-002074. [PMID: 36318599 PMCID: PMC9454044 DOI: 10.1136/openhrt-2022-002074] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 08/16/2022] [Indexed: 11/29/2022] Open
Abstract
Objective Postoperative atrial fibrillation (POAF) is a common complication affecting approximately one-third of patients after cardiac surgery and valvular interventions. This umbrella review systematically appraises the epidemiological credibility of published meta-analyses of both observational and randomised controlled trials (RCT) to assess the risk and protective factors of POAF. Methods Three databases were searched up to June 2021. According to established criteria, evidence of association was rated as convincing, highly suggestive, suggestive, weak or not significant concerning observational studies and as high, moderate, low or very low regarding RCTs. Results We identified 47 studies (reporting 61 associations), 13 referring to observational studies and 34 to RCTs. Only the transfemoral transcatheter aortic valve replacement (TAVR) approach was associated with the prevention of POAF and was supported by convincing evidence from meta-analyses of observational data. Two other associations provided highly suggestive evidence, including preoperative hypertension and neutrophil/lymphocyte ratio. Three associations between protective factors and POAF presented a high level of evidence in meta-analyses, including RCTs. These associations included atrial and biatrial pacing and performing a posterior pericardiotomy. Nineteen associations were supported by moderate evidence, including use of drugs such as amiodarone, b-blockers, glucocorticoids and statins and the performance of TAVR compared with surgical aortic valve replacement. Conclusions Our study provides evidence confirming the protective role of amiodarone, b-blockers, atrial pacing and posterior pericardiotomy against POAF as well as highlights the risk of untreated hypertension. Further research is needed to assess the potential role of statins, glucocorticoids and colchicine in the prevention of POAF. PROSPERO registration number CRD42021268268.
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Affiliation(s)
- Emmanouil Charitakis
- Department of Cardiology and Department of Health, Medicine and Caring Sciences, Linköping University, Linkoping, Sweden
| | - Dimitrios Tsartsalis
- Department of Emergency Medicine, Hippokration Hospital, Athens, Greece
- First Department of Cardiology, Hippokration Hospital, Athens Medical School, Athens, Greece
| | - Dafni Korela
- Department of Cardiology, Venizeleio General Hospital, Heraklion, Greece
| | - Maria Stratinaki
- Department of Cardiology, Venizeleio General Hospital, Heraklion, Greece
| | - Farkas Vanky
- Department of Cardiology and Department of Health, Medicine and Caring Sciences, Linköping University, Linkoping, Sweden
| | | | - Joakim Alfredsson
- Department of Cardiology and Department of Health, Medicine and Caring Sciences, Linköping University, Linkoping, Sweden
| | - Lars O Karlsson
- Department of Cardiology and Department of Health, Medicine and Caring Sciences, Linköping University, Linkoping, Sweden
| | | | - Constantina Aggeli
- First Department of Cardiology, Hippokration Hospital, Athens Medical School, Athens, Greece
| | - Costas Tsioufis
- First Department of Cardiology, Hippokration Hospital, Athens Medical School, Athens, Greece
| | - Håkan Walfridsson
- Department of Cardiology and Department of Health, Medicine and Caring Sciences, Linköping University, Linkoping, Sweden
| | - Elena Dragioti
- Pain and Rehabilitation Centre and Department of Health, Medicine and Caring Sciences, Linköping University, Linkoping, Sweden
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