1
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Pagourelias E, Boulmpou A, Evangeliou A, Zormpas G, Alexandridis G, Kotzadamis D, Vergopoulos S, Tsavousoglou C, Antoniadis A, Mavroudi M, Papadopoulos CE, Tzikas S, Fragakis N, Vassilikos VP. Prevalence of atrial myopathy among hypertrophic cardiomyopathy patients without atrial fibrillation. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.152] [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
Atrial myopathy (AM) is an entity reflecting left atrial (LA) structural and electrical remodeling, connected to atrial fibrillation (AF) development and heart failure progression in various substrates. In hypertrophic cardiomyopathy (HCM), prevalence of AM beyond AF and its correlations are not fully investigated.
Purpose
Aim of this study was to estimate the prevalence of AM in a cohort of HCM patients without AF history through assessment of LA volume index (LAVI), LA reservoir strain (LARS) and total atrial conduction time (TACT) (estimated by tissue Doppler imaging). Additionally, to investigate AM indices' correlation with other phenotypic and functional characteristics of HCM.
Methods
We included 50 HCM patients (60±16 years, 80% male, maximum wall thickness 18.6±4.1mm) without history of AF who have consecutively undergone 2D-speckle tracking echocardiography and cardiovascular magnetic resonance (CMR) with late gadolinium enhancement (LGE). TACT and LARS measurement is shown on left panel. Burden of fibrosis (percentage of LV mass) was defined by LGE extent (>5 standard deviations compared to nulled myocardium) in CMR slices. Cut-off points for TACT, LAVI and LARS were adopted by literature (≥115 msec, ≥34 mL/m2 and <21.3% respectively).
Results
All HCM patients had preserved EF (61.8±8%), while 13 (26%) presented outflow tract obstruction and 4 (8%) diastolic dysfunction stage≥2. LGE was observed in 32 patients (64%) occupying 7.2±5% of left ventricular (LV) mass. Mean TACT was 139.9±22 msec, with LAVI being 30.8±16.1 mL/m2 and LARS 27.6±13.9%. After assessing prevalence of AM parameters, 41 patients (82%) presented a prolonged (≥115 msec) TACT with only 13 of them having also a significantly dilated LA (≥34 mL/m2) and 16 an impaired LARS. Among HCM demographic, phenotypic and functional characteristics tested, age and LV mass index were found to be the only independent regressors of TACT (r=0.54, p<0.0005 and r=0.44, p=0.002 respectively, right panels), while E/E' (r=−0.44, p=0.003) and fibrosis extent (r=0.36, p=0.02) were the strongest predictors of LARS and LAVI values respectively.
Conclusions
Atrial electro-mechanical delay assessed through TDI based TACT, is the most frequent AM parameter among HCM patients irrespective of AF and even before LA dilatation and LA strain impairment. AM parameters seem to correlate with various morphological and functional characteristics of HCM, their significance, however, in predicting progression towards AF development or HF presentation remains to be elucidated.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- E Pagourelias
- Aristotle University of Thessaloniki, Third Cardiology Department, Hippokrateion University Hospital , Thessaloniki , Greece
| | - A Boulmpou
- Aristotle University of Thessaloniki, Third Cardiology Department, Hippokrateion University Hospital , Thessaloniki , Greece
| | - A Evangeliou
- Aristotle University of Thessaloniki, Third Cardiology Department, Hippokrateion University Hospital , Thessaloniki , Greece
| | - G Zormpas
- Aristotle University of Thessaloniki, Third Cardiology Department, Hippokrateion University Hospital , Thessaloniki , Greece
| | - G Alexandridis
- Aristotle University of Thessaloniki, Third Cardiology Department, Hippokrateion University Hospital , Thessaloniki , Greece
| | - D Kotzadamis
- Aristotle University of Thessaloniki, Third Cardiology Department, Hippokrateion University Hospital , Thessaloniki , Greece
| | - S Vergopoulos
- Aristotle University of Thessaloniki, Third Cardiology Department, Hippokrateion University Hospital , Thessaloniki , Greece
| | - C Tsavousoglou
- Aristotle University of Thessaloniki, Third Cardiology Department, Hippokrateion University Hospital , Thessaloniki , Greece
| | - A Antoniadis
- Aristotle University of Thessaloniki, Third Cardiology Department, Hippokrateion University Hospital , Thessaloniki , Greece
| | - M Mavroudi
- Aristotle University of Thessaloniki, Third Cardiology Department, Hippokrateion University Hospital , Thessaloniki , Greece
| | - C E Papadopoulos
- Aristotle University of Thessaloniki, Third Cardiology Department, Hippokrateion University Hospital , Thessaloniki , Greece
| | - S Tzikas
- Aristotle University of Thessaloniki, Third Cardiology Department, Hippokrateion University Hospital , Thessaloniki , Greece
| | - N Fragakis
- Aristotle University of Thessaloniki, Third Cardiology Department, Hippokrateion University Hospital , Thessaloniki , Greece
| | - V P Vassilikos
- Aristotle University of Thessaloniki, Third Cardiology Department, Hippokrateion University Hospital , Thessaloniki , Greece
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2
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Pagourelias E, Boulmpou A, Alexandridis G, Tsarouchas A, Mouselimis D, Bakogiannis K, Karamanolis A, Vergopoulos S, Tsavousoglou C, Antoniadis A, Fragakis N, Papadopoulos CE, Vassilikos V. Total atrial conduction time and its relationship with morphological & functional characteristics in hypertrophic cardiomyopathy. Eur Heart J Cardiovasc Imaging 2022. [DOI: 10.1093/ehjci/jeab289.067] [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
Funding Acknowledgements
Type of funding sources: None.
Background
Total atrial conduction time (TACT), estimated by tissue Doppler imaging (TDI), is an index reflecting left atrial (LA) structural and electrical remodeling, connected to atrial fibrillation (AF) development and heart failure progression in various substrates. In hypertrophic cardiomyopathy (HCM), the significance of TACT beyond AF and its determinants are not fully investigated.
Purpose
Aim of this study was to estimate TACT in a cohort of HCM patients without AF history and to examine its relationship with other parameters of atrial myopathy, such as LA volume index (LAVI) or LA reservoir strain (LARS). Additionally, to investigate TACT correlation with other phenotypic and functional characteristics of HCM.
Methods
We included 50 HCM patients (60 ± 16 years, 80% male, maximum wall thickness 18.6 ± 4.1mm) without history of AF who have consecutively undergone 2D-speckle tracking echocardiography and cardiovascular magnetic resonance (CMR) with late gadolinium enhancement (LGE). TACT was measured from the onset P wave on electrocardiogram to the peak A’ wave of the lateral LA wall using TDI (left panel). Burden of fibrosis (percentage of LV mass) was defined by LGE extent (>5 standard deviations compared to nulled myocardium) in CMR slices. Cut-off points for TACT, LAVI and LARS were adopted by literature (≥115 msec, ≥34 mL/m2 and <21.3 % respectively).
Results
All HCM patients had preserved EF (61.8 ± 8%), while 13 (26%) presented outflow tract obstruction and 4 (8%) diastolic dysfunction stage≥2. LGE was observed in 32 patients (64%) occupying 7.2 ± 5% of left ventricular (LV) mass. Mean TACT was 139.9 ± 22 msec, with LAVI being 30.8 ± 16.1 mL/m2 and LARS 27.6 ± 13.9%. After assessing prevalence of atrial myopathy parameters, 41 patients (82%) presented a prolonged (≥115 msec) TACT with only 13 of them having also a significantly dilated LA (≥34 mL/m2) and 16 an impaired LARS. Among HCM demographic, phenotypic and functional characteristics tested, age and LV mass index were found to be the only independent regressors of TACT (r = 0.54, p < 0.0005 and r = 0.44, p = 0.002 respectively, right panels). On the contrary, no significant correlation was established between TACT and traditional diastolic dysfunction indices such as E/E’ or fibrosis extent.
Conclusions
Atrial electro-mechanical delay assessed through TDI based TACT, is very frequent among HCM patients irrespective of AF and even before LA dilatation and LA strain impairment. Age and hypertrophy magnitude are the main determinants of TACT, the prognostic significance of which remains to be further elucidated. Abstract Figure.
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Affiliation(s)
- E Pagourelias
- Aristotle University of Thessaloniki, Third Cardiology Department, Hippokrateion University Hospital, Thessaloniki, Greece
| | - A Boulmpou
- Aristotle University of Thessaloniki, Third Cardiology Department, Hippokrateion University Hospital, Thessaloniki, Greece
| | - G Alexandridis
- Aristotle University of Thessaloniki, Third Cardiology Department, Hippokrateion University Hospital, Thessaloniki, Greece
| | - A Tsarouchas
- Aristotle University of Thessaloniki, Third Cardiology Department, Hippokrateion University Hospital, Thessaloniki, Greece
| | - D Mouselimis
- Aristotle University of Thessaloniki, Third Cardiology Department, Hippokrateion University Hospital, Thessaloniki, Greece
| | - K Bakogiannis
- Aristotle University of Thessaloniki, Third Cardiology Department, Hippokrateion University Hospital, Thessaloniki, Greece
| | - A Karamanolis
- Aristotle University of Thessaloniki, Third Cardiology Department, Hippokrateion University Hospital, Thessaloniki, Greece
| | - S Vergopoulos
- Aristotle University of Thessaloniki, Third Cardiology Department, Hippokrateion University Hospital, Thessaloniki, Greece
| | - C Tsavousoglou
- Aristotle University of Thessaloniki, Third Cardiology Department, Hippokrateion University Hospital, Thessaloniki, Greece
| | - A Antoniadis
- Aristotle University of Thessaloniki, Third Cardiology Department, Hippokrateion University Hospital, Thessaloniki, Greece
| | - N Fragakis
- Aristotle University of Thessaloniki, Third Cardiology Department, Hippokrateion University Hospital, Thessaloniki, Greece
| | - CE Papadopoulos
- Aristotle University of Thessaloniki, Third Cardiology Department, Hippokrateion University Hospital, Thessaloniki, Greece
| | - V Vassilikos
- Aristotle University of Thessaloniki, Third Cardiology Department, Hippokrateion University Hospital, Thessaloniki, Greece
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3
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Pagourelias E, Boulmpou A, Alexandridis G, Tsarouchas A, Mouselimis D, Bakogiannis K, Karamanolis A, Vergopoulos S, Tsavousoglou C, Antoniadis A, Fragakis N, Papadopoulos CE, Vassilikos V. Strain-volume loops for assessment of diastolic function in hypertrophic cardiomyopathy. Eur Heart J Cardiovasc Imaging 2022. [DOI: 10.1093/ehjci/jeab289.424] [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
Funding Acknowledgements
Type of funding sources: None.
Background
Diastolic function assessment in patients with hypertrophic hearts and preserved ejection fraction (EF) is a rather challenging task, necessitating the introduction of new parameters. Strain-volume loops (SVLs), based on simultaneous frame-by-frame strain and volume changes’ recordings acquired by means of three-dimensional (3D) speckle tracking imaging, is an innovative tool which has been applied in various substrates. The ability of SVLs to assess diastolic function in hypertrophic cardiomyopathy (HCM) has not been investigated until now.
Purpose
Aim of this study was to investigate potential correlations between SVLs, traditional diastolic function indices and phenotypic features of HCM (thickness, obstruction and fibrosis) that may also reflect myocardial "stiffness".
Methods
We included 40 HCM patients (54.1 ± 14.3 years, 82.5% male, maximum wall thickness 19.3 ± 4.8mm) who have consecutively undergone 3D-speckle tracking echocardiography (panel A) and cardiovascular magnetic resonance (CMR) with late gadolinium enhancement (LGE). Values of 3D strain were plotted vs. volume for each frame to build an SVL. Peak of radial, longitudinal and circumferential systolic strain (Rsp, Lsp, and Csp, respectively), systolic slopes of the loops (RsSl, LsSl, CsSl), strain to end-diastolic volume (EDV) ratios (Rs/V, Ls/V, Cs/V) as well as the extent of systolic-diastolic uncoupling (difference between systolic and diastolic strain for the same volume) were computed for the analysis. Left atrial volume index (LAVI), E/E’ and tricuspid regurgitation velocity (TRvel) were measured to define diastolic dysfunction (DD) stage. Burden of fibrosis was evaluated by LGE extent in CMR slices.
Results
All HCM patients had preserved EF (60.5 ± 5,7%), while 16 (40%) had LV outflow tract obstruction (LVOTO > 30 mm Hg at rest). Mean LV mass index was 78.9 ± 14.5 g (evaluated by 3D echocardiography). LGE was observed in 23 patients (57.5%) occupying 5.2 ± 4.5% of LV mass. Concerning SVLs the following values were recorded for radial (Rsp 30.8 ± 9.8%, RsSl 0.4 ± 0.13 and Rs/V 0.25 ± 0.09), longitudinal (Lsp -9.4 ± 3.7%, LsSl 0.12 ± 0.06 and Ls/V 0.08 ± 0.04) and circumferential deformation (Csp -14.2 ± 3.5%, CsSl 0.18 ± 0.05 and Cs/V 0.11 ± 0.03). Traditional isolated diastolic indices (E/E’, LAVI, TRvel and DD stage) did not present significant correlations with SVL parameters or HCM phenotypic features. However, potentially "stiffer" hearts (combination of increased LVMI and fibrosis) presented a leftward transition of longitudinal SVLs, which also became wider (greater uncoupling) (panel B).
Conclusions
Traditional diastolic indices show modest only correlations with SVLs or HCM phenotypic characteristics, necessitating new approaches to DD of HCM patients. SVLs seem to be a promising-innovative tool for indirect assessment of myocardial "stiffness" and diastolic function. Abstract Figure.
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Affiliation(s)
- E Pagourelias
- Aristotle University of Thessaloniki, Third Cardiology Department, Hippokrateion University Hospital, Thessaloniki, Greece
| | - A Boulmpou
- Aristotle University of Thessaloniki, Third Cardiology Department, Hippokrateion University Hospital, Thessaloniki, Greece
| | - G Alexandridis
- Aristotle University of Thessaloniki, Third Cardiology Department, Hippokrateion University Hospital, Thessaloniki, Greece
| | - A Tsarouchas
- Aristotle University of Thessaloniki, Third Cardiology Department, Hippokrateion University Hospital, Thessaloniki, Greece
| | - D Mouselimis
- Aristotle University of Thessaloniki, Third Cardiology Department, Hippokrateion University Hospital, Thessaloniki, Greece
| | - K Bakogiannis
- Aristotle University of Thessaloniki, Third Cardiology Department, Hippokrateion University Hospital, Thessaloniki, Greece
| | - A Karamanolis
- Aristotle University of Thessaloniki, Third Cardiology Department, Hippokrateion University Hospital, Thessaloniki, Greece
| | - S Vergopoulos
- Aristotle University of Thessaloniki, Third Cardiology Department, Hippokrateion University Hospital, Thessaloniki, Greece
| | - C Tsavousoglou
- Aristotle University of Thessaloniki, Third Cardiology Department, Hippokrateion University Hospital, Thessaloniki, Greece
| | - A Antoniadis
- Aristotle University of Thessaloniki, Third Cardiology Department, Hippokrateion University Hospital, Thessaloniki, Greece
| | - N Fragakis
- Aristotle University of Thessaloniki, Third Cardiology Department, Hippokrateion University Hospital, Thessaloniki, Greece
| | - CE Papadopoulos
- Aristotle University of Thessaloniki, Third Cardiology Department, Hippokrateion University Hospital, Thessaloniki, Greece
| | - V Vassilikos
- Aristotle University of Thessaloniki, Third Cardiology Department, Hippokrateion University Hospital, Thessaloniki, Greece
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4
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Pagourelias E, Boulmpou A, Vergopoulos S, Bakogiannis C, Toumpourleka M, Antoniadis A, Karamanolis A, Kelemanis I, Mavroudi M, Papadopoulos C, Fragakis N, Vassilikos V, Voigt J. Utility of volume-strain loops in diastolic function assessment of patients with hypertrophic cardiomyopathy. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.074] [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
Diastolic function assessment in patients with hypertrophic hearts and preserved ejection fraction (EF) is a rather challenging task. Combined plotting of deformation parameters against other indices, especially left ventricular (LV) volume, may reflect diastolic function components of the hypertrophic myocardium.
Purpose
Aim of this study was i) to apply strain-volume loops (SVLs) in hypertrophic cardiomyopathy (HCM) patients based on simultaneous frame-by-frame strain and volume changes' recordings acquired by means of three-dimensional (3D) speckle tracking imaging and ii) to investigate potential correlations between these loops, traditional diastolic function indices and phenotypic features of HCM (thickness, obstruction and fibrosis) that may also reflect myocardial “stiffness”.
Methods
We included 40 HCM patients (54.1±14.3 years, 82.5% male, maximum wall thickness 19.3±4.8mm) who have consecutively undergone 3D-speckle tracking echocardiography and cardiovascular magnetic resonance (CMR) with late gadolinium enhancement (LGE). Values of 3D strain were plotted vs. volume for each frame to build an SVL. Peak of radial, longitudinal and circumferential systolic strain (Rsp, Lsp, and Csp, respectively), systolic slopes of the loops (RsSl, LsSl, CsSl), strain to end-diastolic volume (EDV) ratios (Rs/V, Ls/V, Cs/V) as well as the extent of systolic-diastolic uncoupling (difference between systolic and diastolic strain for the same volume) (panel A) were computed for the analysis. Left atrial volume index (LAVI), E/E' and tricuspid regurgitation velocity (TRvel) were measured to define diastolic dysfunction (DD) stage. Burden of fibrosis was evaluated by LGE extent in CMR slices.
Results
All HCM patients had preserved EF (60.5±5,7%), while 16 (40%) had LV outflow tract obstruction (LVOTO>30 mm Hg at rest). Mean LV mass index was 78.9±14.5 g (evaluated by 3D echocardiography). LGE was observed in 23 patients (57.5%) occupying 5.2±4.5% of LV mass. Concerning SVLs the following values were recorded for radial (Rsp 30.8±9.8%, RsSl 0.4±0.13 and Rs/V 0.25±0.09), longitudinal (Lsp −9.4±3.7%, LsSl 0.12±0.06 and Ls/V 0.08±0.04) and circumferential deformation (Csp −14.2±3.5%, CsSl 0.18±0.05 and Cs/V 0.11±0.03). Traditional isolated diastolic indices (E/E', LAVI, TRvel and DD stage) did not present significant correlations with SVL parameters or HCM phenotypic features. However, potentially “stiffer” hearts (combination of increased LVMI and fibrosis) presented a leftward transition of longitudinal SVLs, which also became wider (greater uncoupling) (panel B).
Conclusions
Traditional diastolic indices show modest only correlations with SVLs or HCM phenotypic characteristics, necessitating new approaches to DD of HCM patients. SVLs seem to be a promising-innovative tool for indirect assessment of myocardial “stiffness” and diastolic function.
Funding Acknowledgement
Type of funding sources: None. Figure 1
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Affiliation(s)
- E Pagourelias
- Hippokration General Hospital of Thessloniki, Thessaloniki, Greece
| | - A Boulmpou
- Aristotle University of Thessaloniki, Third Cardiology Department, Hippokrateion University Hospital, Thessaloniki, Greece
| | - S Vergopoulos
- Aristotle University of Thessaloniki, Third Cardiology Department, Hippokrateion University Hospital, Thessaloniki, Greece
| | - C Bakogiannis
- Aristotle University of Thessaloniki, Third Cardiology Department, Hippokrateion University Hospital, Thessaloniki, Greece
| | - M Toumpourleka
- Aristotle University of Thessaloniki, Third Cardiology Department, Hippokrateion University Hospital, Thessaloniki, Greece
| | - A Antoniadis
- Aristotle University of Thessaloniki, Third Cardiology Department, Hippokrateion University Hospital, Thessaloniki, Greece
| | - A Karamanolis
- Aristotle University of Thessaloniki, Third Cardiology Department, Hippokrateion University Hospital, Thessaloniki, Greece
| | - I Kelemanis
- Aristotle University of Thessaloniki, Third Cardiology Department, Hippokrateion University Hospital, Thessaloniki, Greece
| | - M Mavroudi
- Aristotle University of Thessaloniki, Third Cardiology Department, Hippokrateion University Hospital, Thessaloniki, Greece
| | - C.E Papadopoulos
- Aristotle University of Thessaloniki, Third Cardiology Department, Hippokrateion University Hospital, Thessaloniki, Greece
| | - N Fragakis
- Aristotle University of Thessaloniki, Third Cardiology Department, Hippokrateion University Hospital, Thessaloniki, Greece
| | - V Vassilikos
- Aristotle University of Thessaloniki, Third Cardiology Department, Hippokrateion University Hospital, Thessaloniki, Greece
| | - J.U Voigt
- KU Leuven, Department of Cardiovascular Diseases, University Hospital Leuven, Leuven, Belgium
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5
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Pagourelias E, Vassilikos VP, Katsos K, Zaggelidou E, Raikos N, Tzikas S, Tsavousoglou C, Kouparanis A, Anastasakis A, Kassimis G, Ziakas A, Sianos G, Karvounis H, Kanonidis I, Spiliopoulou C. Impact of the first coronavirus-disease pandemic wave on cardiovascular admissions and sudden cardiac death rates in Greece. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2410] [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
Various studies suggest a decrease of hospital admissions for acute coronary syndromes (ACS) during COVID-19 outbreak, implying an increase in ACS related pre-hospital-care deaths as a cause of this phenomenon.
Purpose
Aim of this study was to investigate the impact of social containment measures on ACS admission and acute coronary deaths (ACDs) rates in Greece, during COVID-19 first pandemic wave in 2020.
Methods
Data for this analysis were retrieved by the official records of University Forensic and Cardiology Departments and the Forensic Science Services of the most crowded metropolitan areas of Greece (almost 25% of the entire Greek population ≈ 2.5 million people). The study period was defined as the time between March 15 2020, when the Greek state started to implement strict lock-down measures to contain COVID-19 pandemics, until April 14 2020. To compare admission and SCD rates, a corresponding control period a year earlier was chosen. Incidence rates (IRs) (events over days) of ACSs and ACDs in each time-period were assessed along with IRs ratios (IRRs) and 95% CI intervals. Secondary analysis for non-ischemic cardiovascular deaths (CVDs) or violent deaths (VDs) (including road traffic accident deaths) was also performed.
Results
There has been a relative 38.9% reduction in ACS admissions in 2020 [1.8, 95% CI (1.35–2.34) in 2019 vs 1.1, 95% CI (0.76–1.54) in 2020, p=0.02], concordant with a 66% relative reduction of total admissions (p<0.005). Overall, 171 deaths in 2020 vs 208 in 2019 were referred for autopsies in the enrolled forensic departments. Gender and age distribution were not significantly different between case and control periods. There were no statistically significant differences in the frequency of deaths between the two periods examined, with the exception of deaths secondary to road traffic accidents [IR 0.13, 95% CI (0.04–0.34) in 2020 vs 0.67, 95% CI (0.41–1.03) in 2019, p=0.001] and CVDs [IR 0.43, 95% CI (0.23–0.74) in 2020 vs 1.03, 95% CI (0.70–1.47) in 2019, p=0.007] which significantly decreased during COVID-19 pandemic wave. Absolute numbers, percentile changes and IRs are demonstrated in Figure 1 and Table 1.
Conclusions
Our analysis offers evidence over a significant decrease in ACS-related hospitalization rates during COVID-19 first pandemic wave. This decrease is not linked to an increase in pre-hospital, autopsy defined ACDs, as previously thought, implying that many ACS patients may not ask for help on time due to infection fear, being prone however to late-onset complications. Pre-hospital triage and care services, should be appropriately transformed to facilitate and speed-up access of cardiovascular patients to health-care systems during the pandemic.
Funding Acknowledgement
Type of funding sources: None. Figure 1
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Affiliation(s)
- E Pagourelias
- Hippokration General Hospital of Thessloniki, Thessaloniki, Greece
| | - V P Vassilikos
- Aristotle University of Thessaloniki, Third Cardiology Department, Hippokrateion University Hospital, Thessaloniki, Greece
| | - K Katsos
- National & Kapodistrian University of Athens Medical School, Department of Forensic Medicine and Toxicology, Athens, Greece
| | - E Zaggelidou
- Laboratory of Forensic Service of Ministry of Justice of Thessaloniki, Thessaloniki, Greece
| | - N Raikos
- Aristotle University of Thessaloniki, Laboratory of Forensic Medicine & Toxicology, Thessaloniki, Greece
| | - S Tzikas
- Aristotle University of Thessaloniki, Third Cardiology Department, Hippokrateion University Hospital, Thessaloniki, Greece
| | - C Tsavousoglou
- Aristotle University of Thessaloniki, Third Cardiology Department, Hippokrateion University Hospital, Thessaloniki, Greece
| | - A Kouparanis
- Aristotle University of Thessaloniki, First Cardiology Department, AHEPA University Hospital, Thessaloniki, Greece
| | - A Anastasakis
- Onassis Cardiac Surgery Center, Department of Cardiology, Athens, Greece
| | - G Kassimis
- Hippokration General Hospital of Thessloniki, Thessaloniki, Greece
| | - A Ziakas
- Aristotle University of Thessaloniki, First Cardiology Department, AHEPA University Hospital, Thessaloniki, Greece
| | - G Sianos
- Aristotle University of Thessaloniki, First Cardiology Department, AHEPA University Hospital, Thessaloniki, Greece
| | - H Karvounis
- Aristotle University of Thessaloniki, First Cardiology Department, AHEPA University Hospital, Thessaloniki, Greece
| | - I Kanonidis
- Hippokration General Hospital of Thessloniki, Thessaloniki, Greece
| | - C Spiliopoulou
- National & Kapodistrian University of Athens Medical School, Department of Forensic Medicine and Toxicology, Athens, Greece
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6
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Boulmpou A, Patoulias D, Teperikidis E, Papadopoulos CE, Sarafidis P, Doumas M, Fragakis N, Pagourelias E, Vassilikos V. Sodium-glucose co-transporter-2 inhibitors and the risk of major arrhythmias: a meta-analysis of the cardiovascular and renal outcome trials. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2953] [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
Type 2 diabetes mellitus is closely associated with cardiovascular disease and evidence already exists on its arrhythmogenic action. Sodium-glucose cotransporter 2 inhibitors (SGLT2i) are a unique class of oral antidiabetic medications which recently attracted attention for reducing the total risk of major adverse cardiovascular events in a series of recent, large placebo-controlled randomized clinical trials (RCTs). Dapagliflozin and empagliflozin additionally seem to improve survival and outcomes in patients with heart failure with reduced ejection fraction (HFrEF), irrespective of the presence of diabetes mellitus. Whether antidiabetic treatment with sodium-glucose co-transporter inhibitors could reduce the arrhythmic burden in diabetic patients still is to be clarified.
Purpose
The purpose of the present meta-analysis was to report the impact of SGLT2i on the risk for several types of cardiac arrhythmias, pooling data from all relevant cardiovascular and renal outcome, placebo-controlled, RCTs, comparing SGLT2i to placebo.
Methods
We searched PubMed for all available cardiovascular and renal outcome RCTs utilizing SGLT2i, along with grey literature sources. We sought to determine the risk of the following arrhythmias/cardiac disorders with the use of SGLT2i versus placebo: atrial fibrillation, atrial flutter, supraventricular tachycardia, ventricular tachycardia, ventricular fibrillation, ventricular extrasystoles, sinus bradycardia, sinus node dysfunction, second degree atrioventricular block, complete atrioventricular block.
Results
We extracted relevant data from 8 trials (5 dedicated cardiovascular outcome trials, 2 dedicated renal outcome trials, 1 trial enrolling patients with HFrEF), pooling data in a total of 55,966 patients. SGLT-2i treatment compared to placebo produced a significant reduction in the risk of atrial fibrillation equal to 21% (RR=0.79, 95% CI: 0.67–0.93, I2=0%) (Figure 1). A non-significant reduction in the risk of atrial flutter equal to 9% (RR=0.91, 95% CI: 0.64–1.29, I2=0%) was also observed with SGLT2i (Figure 2). No significant effect on the rest major arrhythmias was observed.
Conclusions
Antidiabetic therapy with SGLT2i seems to hold a significant impact on antiarrhythmic burden in type 2 diabetes mellitus, reducing the risk of atrial fibrillation development.
Funding Acknowledgement
Type of funding sources: None. Figure 1Figure 2
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Affiliation(s)
- A Boulmpou
- Hippokration General Hospital of Thessaloniki, Third Department of Cardiology, Thessaloniki, Greece
| | - D Patoulias
- Hippokration General Hospital of Thessaloniki, Second Propedeutic Department of Internal Medicine, Thessaloniki, Greece
| | - E Teperikidis
- Hippokration General Hospital of Thessaloniki, Third Department of Cardiology, Thessaloniki, Greece
| | - C E Papadopoulos
- Hippokration General Hospital of Thessaloniki, Third Department of Cardiology, Thessaloniki, Greece
| | - P Sarafidis
- Hippokration General Hospital of Thessaloniki, Department of Nephrology, Thessaloniki, Greece
| | - M Doumas
- Hippokration General Hospital of Thessaloniki, Second Propedeutic Department of Internal Medicine, Thessaloniki, Greece
| | - N Fragakis
- Hippokration General Hospital of Thessaloniki, Third Department of Cardiology, Thessaloniki, Greece
| | - E Pagourelias
- Hippokration General Hospital of Thessaloniki, Third Department of Cardiology, Thessaloniki, Greece
| | - V Vassilikos
- Hippokration General Hospital of Thessaloniki, Third Department of Cardiology, Thessaloniki, Greece
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7
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Christou G, Pagourelias E, Deligiannis A, Kouidi E. Exploring the physiological determinants of marathon performance. Eur J Prev Cardiol 2021. [DOI: 10.1093/eurjpc/zwab061.370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Public grant(s) – EU funding. Main funding source(s): ESPA 2014-2020
Background/Introduction: Long-time endurance exercise training leads to cardiovascular, respiratory, haematological and neuromuscular adaptations. The relative contribution of these adaptations to running performance in long-distance races remains to be elucidated in an integrative manner.
Purpose
The study of the relationship of marathon performance with anthropometric, cardiorespiratory and haematological adaptations.
Methods
Thirty-one marathon runners (26 males, age: 42 ± 9 years) were examined within 3 weeks before Athens marathon race (42.195 km). Assessment of training characteristics, anthropometric measurements, including height, body weight and body fat percentage, echocardiographic study, cardiopulmonary exercise testing using treadmill ergometer and blood test were performed.
Results
Training age was 11(1-39) years. Body fat percentage(BFP) was 17.3 ± 7.1% and body weight-indexed maximum oxygen uptake(VO2max) was 52.6 ± 8.9 mL/kg/min. Marathon race time(MRT) was 3:59:01(2:47:17-5:31:32). Among anthropometric measurements, MRT was positively associated with BFP(r= 0.561, p = 0.002) and body fat mass(r = 0.514, p = 0.005), even after adjustment for VO2max or oxygen uptake at first(VO2-VT1) or second(VO2-VT2) ventilatory threshold, implying an effect of BFP on running economy. Among echocardiographic parameters, MRT correlated negatively with right ventricular end-diastolic area(RVEDA) (r = -0.707, p < 0.001) and ratio of early to late diastolic transtricuspid flow velocity(TVE/A) (r= -0.430, p = 0.025). MRT correlated negatively with body weight-indexed VO2max (r= -0.692, p < 0.001), VO2-VT1 (r= -0.426, p = 0.019) and VO2-VT2 (r= -0.688, p < 0.001). MRT correlated negatively with maximum minute ventilation(VEmax) (r= -0.418, p = 0.022), VEmax indexed for body surface area(BSA) (r= -0.456, p= 0.011), maximum tidal volume(Vtmax) indexed for BSA(r= -0.436, p = 0.018) and oxygen uptake efficiency slope(OUES) (r= -0.529, p = 0.003). MRT was not associated with haemoglobin concentration. RVEDA correlated positively with maximum oxygen pulse (r = 0.653, p = 0.001), which is an estimate of stroke volume during exercise, and OUES(r = 0.534, p = 0.009). After performing multivariate linear regression analysis with MRT as dependent variable and BFP(standardized β=0.495, p = 0.001), RVEDA(standardized β= -0.550, p = 0.001) and Vtmax indexed for BSA(standardized β= -0.110, p = 0.418) as independent variables, only BFP and RVEDA were significant independent predictors of MRT(adjusted R2 = 0.667, p < 0.001 for the model).
Conclusions
The results of the present study demonstrated that the main cardiorespiratory adaptation that could predict a better marathon performance was right ventricular dilatation, through the increase in stroke volume during exercise, whereas upregulation of tidal volume during exercise was found to be a weaker predictor. The principal anthropometric determinant of marathon performance appears to be body fat percentage, via the influence on running economy.
Abstract Figure 1
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Affiliation(s)
- G Christou
- Aristotle University of Thessaloniki, Laboratory of Sports Medicine, Sports Medicine Division, Thessaloniki, Greece
| | - E Pagourelias
- Aristotle University of Thessaloniki, Laboratory of Sports Medicine, Sports Medicine Division, Thessaloniki, Greece
| | - A Deligiannis
- Aristotle University of Thessaloniki, Laboratory of Sports Medicine, Sports Medicine Division, Thessaloniki, Greece
| | - E Kouidi
- Aristotle University of Thessaloniki, Laboratory of Sports Medicine, Sports Medicine Division, Thessaloniki, Greece
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8
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Pagourelias E, Vassilikos V, Blomstrom-Lundqvist C, Kautzner J, Maggioni A, Tavazzi L, Dagres N, Brugada J, Arbelo E. Impact of procedural volume on complication and recurrence rate after atrial fibrillation ablation in European centers. An ESC EORP Registry: Atrial Fibrillation Long-Term. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0599] [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
Catheter ablation has emerged as an effective therapy in patients with atrial fibrillation (AF). Despite high success rates of the method, there is still heterogeneity of outcomes and complications across Europe. A center's volume of AF ablations performed per year might also play an important role in the success rate of the procedure as compared to other confounding factors which may be different among centers (such as type of AF ablated, patient selection criteria, referral bias and/or ablation strategy).
Purpose
Aim of the study was to investigate differences in clinical outcomes and complication rates among European AF ablation centers related to the volume of ablations performed annually.
Methods
Data for this analysis were extracted from the European AF Ablation Long-Term Study, a prospective registry designed to describe the clinical epidemiology of patients undergoing AF ablation. Based on 33th and 67th percentiles of number of AF ablations performed, the participating centers were classified into high volume (HV) (≥180 procedures/year), medium volume (MV) (<180 and ≥74/year) and low volume (LV) (<74/year). One-year success was defined as patient survival free from any atrial arrhythmia, from the end of the 3-month blanking period to 12 months following the ablation procedure.
Results
A total of 91 centers in 26 European countries enrolled 3368 patients. There was a significantly higher reporting of cardiovascular complications in LV centers (5.2%), especially pericarditis and cardiac perforation, while the HV and MV centers reported cardiovascular complications in 3.0 and 4.3% of cases, respectively (p=0.039). Additionally, stroke incidence after ablation was significantly higher in LV centers (0.5% of cases vs 0% in HV and MV centers, p=0.008). One-year success after AF ablation ranged from 77.8% in HV vs 70.5% in LV vs 77.3% in MV centers (p<0.001). Despite these unadjusted differences, Kaplan-Meier survival analysis based on adjusted data demonstrated, however, that there were not significant differences in complication and recurrence rates according to volume's center (p=0.328 and p=0.476 accordingly, Figure A). This result was mainly driven by a proportional increase in severity/risk of cases ablated (as evidenced by CHA2DS2-VASc score and AF type) in relation to a center's procedural volume (Figure B).
Conclusions
Low volume centers present slightly higher cardiovascular complications' and stroke incidence and a lower unadjusted success rate after AF ablation. On the other hand, adjusted overall complication and recurrence rates are non-significantly different among different volume centers, a fact reflecting inhomogeneity of patient and procedural profiles and a counterbalance between expertise and risk level among participating centers.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- E Pagourelias
- Hippokration General Hospital of Thessloniki, Thessaloniki, Greece
| | - V Vassilikos
- Hippokration General Hospital of Thessloniki, Thessaloniki, Greece
| | | | - J Kautzner
- Institute for Clinical and Experimental Medicine (IKEM), Department of Cardiology, Prague, Czechia
| | - A.P Maggioni
- ANMCO Foundation For Your Heart, Florence, Italy
| | - L Tavazzi
- Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy
| | - N Dagres
- Heart Center of Leipzig, Department of Electrophysiology, Leipzig, Germany
| | - J Brugada
- Barcelona Hospital Clinic, Department of Cardiology, Barcelona, Spain
| | - E Arbelo
- Barcelona Hospital Clinic, Department of Cardiology, Barcelona, Spain
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9
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Pagourelias E, Antoniadis A, Boulmpou A, Tsarouchas A, Mouselimis D, Bakogiannis C, Papadopoulos C, Vassilikos V, Voigt J. Three-dimensional volume-strain loops may reflect fibrosis in hypertrophic cardiomyopathy. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0324] [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
Combined plotting of deformation parameters against other indices [e.g. arterial pressure, left ventricular (LV) volume] might offer additional information about different diseases. Especially in hypertrophic cardiomyopathy (HCM) this approach might offer new insights into the various phenotypic and pathophysiologic features of this entity.
Purpose
Aim of this study was i) to apply strain-volume loops in HCM based on simultaneous frame-by-frame strain and volume changes' recordings acquired by means of three-dimensional (3D) speckle tracking imaging and ii) to investigate potential correlations between these loops and phenotypic features of HCM (including thickness, obstruction and fibrosis).
Methods
We included 40 HCM patients (54.1±14.3 years, 82.5% male, maximum wall thickness 19.3±4.8mm) who have consecutively undergone 3D-speckle tracking echocardiography and cardiovascular magnetic resonance (CMR) with late gadolinium enhancement (LGE). Values of 3D strain were plotted vs. volume for each frame to build a strain–volume loop. Peak of radial, longitudinal, and circumferential systolic strain (Rsp, Lsp, and Csp, respectively), systolic slopes of the loops (RsSl, LsSl, CsSl), and strain to end-diastolic volume (EDV) ratio (Rs/V, Ls/V, Cs/V) were computed for the analysis (panel A). Additionally, burden of fibrosis (percentage of LV mass) was defined by LGE extent (>5 standard deviations compared to nulled myocardium) in CMR slices.
Results
All HCM patients had preserved EF (60.5±5,7%), while 16 (40%) had LV outflow tract obstruction (LVOTO>30 mm Hg at rest). Mean LV mass index was 78.9±14.5 g (evaluated by 3D echocardiography). LGE was observed in 23 patients (57.5%) occupying 5.2±4.5% of LV mass. Concerning strain-volume loops the following values were recorded for radial (Rsp 30.8±9.8%, RsSl 0.4±0.13 and Rs/V 0.25±0.09), longitudinal (Lsp −9.4±3.7%, LsSl 0.12±0.06 and Ls/V 0.08±0.04) and circumferential deformation (Csp −14.2±3.5%, CsSl 0.18±0.05 and Cs/V 0.11±0.03). Among typical HCM characteristics tested (LV mass, LVOTO and LGE), only LV mass presented significant correlations with LsSl (r=−0.41, p<0.01). Interestingly, HCM patients with smaller LVMI and without LGE presented steeper and narrower (difference between systolic and diastolic strain for the same volume) longitudinal strain-volume loops compared to patients with larger LVMIs and fibrosis (panel B).
Conclusions
Strain-volume loop is an innovative application of 3D deformation imaging in HCM. According to this new non-invasive method, increase of LVMI in HCM is accompanied by less longitudinal contribution to stroke volume, whereas better systolic-diastolic coupling may exclude the presence of underlying fibrosis.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- E Pagourelias
- Hippokration General Hospital of Thessloniki, Thessaloniki, Greece
| | - A Antoniadis
- Hippokration General Hospital of Thessloniki, Thessaloniki, Greece
| | - A Boulmpou
- Hippokration General Hospital of Thessloniki, Thessaloniki, Greece
| | - A Tsarouchas
- Hippokration General Hospital of Thessloniki, Thessaloniki, Greece
| | - D Mouselimis
- Hippokration General Hospital of Thessloniki, Thessaloniki, Greece
| | - C Bakogiannis
- Hippokration General Hospital of Thessloniki, Thessaloniki, Greece
| | - C.E Papadopoulos
- Hippokration General Hospital of Thessloniki, Thessaloniki, Greece
| | - V Vassilikos
- Hippokration General Hospital of Thessloniki, Thessaloniki, Greece
| | - J.U Voigt
- KU Leuven, Department of Cardiovascular Diseases, University Hospital Leuven, Leuven, Belgium
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10
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Pagourelias E, Christou G, Anifanti M, Sotiriou P, Christou K, Koutlianos N, Deligiannis A, Vassilikos V, Kouidi E. Impact of a 246 km ultra-marathon race on global and segmental longitudinal deformation of all cardiac chambers and on inter-chamber relationships. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.3128] [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
It is well documented that prolonged intense exercise such as a marathon, transitorily alters cardiac function. However, the impact of ultra-endurance (UE) exercise on global and segmental longitudinal deformation of all cardiac chambers and on inter-chamber functional relationships has not yet been thoroughly investigated.
Purpose
The aim of the study was the evaluation of the acute effects of UE exercise on longitudinal deformation of all cardiac chambers and on intra-, inter- and atrioventricular functional relationships.
Methods
Echocardiographic assessment was performed the day before and at the finish line of “Spartathlon”: a 246 Km ultra-marathon. 2D speckle-tracking echocardiography was performed in all 4 chambers during the same cardiac cycle, allowing a simultaneous strain-time data display of all cardiac chambers (Figure 1). Peak global deformation values and temporal parameters adjusted for the heart rate were extracted from the derived curves, while a segmental analysis for left (LV) and right ventricle (RV) was also performed.
Results
Out of 60 participants initially screened, 27 athletes (17 male, age 45±7 years) finished the race in 33:34±1:59 hours. Both LV (−20.9±2.3 pre- to −18.8±2% post-, p=0.009) and RV global strains (−22.9±3.6 pre- to −21.2±3% post-, p=0.04) decreased post-race, even though remained within normal range for the 85% of the participants. Peak atrial strains [right (RA) and left (LA)] did not change (p=0.12 and 0.95). Basal and mid segmental strain values significantly decreased post-race, while both LV and RV apical strain values remained unaffected (p=0.899 and p=0.46, accordingly) (Figure). Concerning interchamber relationships, RV and RA strain curves were constantly larger in magnitude than those of the LV and LA, with RV/LV, LV/LA, RV/RA and RA/LA peak values' ratios remaining unchanged from pre- to post-race. Finally, although right chambers' time-to-peak values were shorter compared to the left ones, all chambers' strain curves peaked later post-race (p<0.001 for all).
Conclusions
Despite subtle changes in LV and RV strain, 4-chamber deformation values remained within normal range even after running a 246 km ultra-marathon. Following a segmental analysis, this finding could be explained for both ventricles by a preservation of apical deformation. Additionally, inter- and atrioventricular concordance was also maintained.
Figure 1
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- E Pagourelias
- Hippokration General Hospital of Thessloniki, Thessaloniki, Greece
| | - G Christou
- Aristotle University of Thessaloniki, Sports Medicine Laboratory, Department of Physical Education and Sports Science, Thessaloniki, Greece
| | - M Anifanti
- Aristotle University of Thessaloniki, Sports Medicine Laboratory, Department of Physical Education and Sports Science, Thessaloniki, Greece
| | - P Sotiriou
- Aristotle University of Thessaloniki, Sports Medicine Laboratory, Department of Physical Education and Sports Science, Thessaloniki, Greece
| | - K Christou
- Aristotle University of Thessaloniki, Sports Medicine Laboratory, Department of Physical Education and Sports Science, Thessaloniki, Greece
| | - N Koutlianos
- Aristotle University of Thessaloniki, Sports Medicine Laboratory, Department of Physical Education and Sports Science, Thessaloniki, Greece
| | - A Deligiannis
- Aristotle University of Thessaloniki, Sports Medicine Laboratory, Department of Physical Education and Sports Science, Thessaloniki, Greece
| | - V Vassilikos
- Hippokration General Hospital of Thessloniki, Thessaloniki, Greece
| | - E Kouidi
- Aristotle University of Thessaloniki, Sports Medicine Laboratory, Department of Physical Education and Sports Science, Thessaloniki, Greece
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11
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Pagourelias E, Mirea O, Duchenne J, Unlu S, Van Cleemput J, Papadopoulos CE, Bogaert J, Vassilikos V, Voigt JU. 1181 A novel insight into pathophysiology of hypertrophic cardiomyopathy using simultaneous three-dimensional volume-strain loops. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.680] [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
Funding Acknowledgements
Supported with a scholarship by the Greek State Scholarship Foundation (IKY).
Background
Strain assessment offers a robust evaluation of myocardial mechanics and systolic function, however reporting only peak strain values in hypertrophic cardiomyopathy (HCM) may impose limitations in the conception of its complex remodeling. Therefore, combined plotting of deformation parameters against other indices [e.g. arterial pressure, left ventricular (LV) volume] might offer additional insights into the pathophysiology of the disease.
Purpose
Aim of this study was i) to apply strain-volume loops in HCM based on simultaneous frame-by-frame strain and volume changes’ recordings acquired by means of three-dimensional (3D) speckle tracking imaging and ii) to take advantage of the previous methodology to gain further insights into HCM pathophysiology.
Methods
We included 40 HCM patients (54.1 ± 14.3 years, 82.5% male, maximum wall thickness 19.3 ± 4.8mm) who have consecutively undergone 3D-speckle tracking echocardiography and cardiovascular magnetic resonance (CMR) with late gadolinium enhancement (LGE). Values of 3D strain were plotted vs. volume for each frame to build a strain–volume loop. Peak of radial, longitudinal, and circumferential systolic strain (Rsp, Lsp, and Csp, respectively), systolic slopes of the loops (RsSl, LsSl, CsSl), and strain to end-diastolic volume (EDV) ratio (Rs/V, Ls/V, Cs/V) were computed for the analysis (panel A). Additionally, burden of fibrosis (percentage of LV mass) was defined by LGE extent (>5 standard deviations compared to nulled myocardium) in CMR slices.
Results
All HCM patients had preserved EF (60.5 ± 5,7%), while 16 (40%) had LV outflow tract obstruction (LVOTO > 30 mm Hg at rest). Mean LV mass index was 78.9 ± 14.5 g (evaluated by 3D echocardiography). LGE was observed in 23 patients (57.5%) occupying 5.2 ± 4.5% of LV mass. Concerning strain-volume loops the following values were recorded for radial (Rsp 30.8 ± 9.8%, RsSl 0.4 ± 0.13 and Rs/V 0.25 ± 0.09), longitudinal (Lsp -9.4 ± 3.7%, LsSl 0.12 ± 0.06 and Ls/V 0.08 ± 0.04) and circumferential deformation (Csp -14.2 ± 3.5%, CsSl 0.18 ± 0.05 and Cs/V 0.11 ± 0.03). Among typical HCM characteristics tested (LV mass, LVOTO and LGE), only LV mass presented significant correlations with LsSl (r=-0.41, p < 0.01). Interestingly, HCM patients with smaller LVMI and without LGE presented steeper and narrower (difference between systolic and diastolic strain for the same volume) longitudinal strain-volume loops compared to patients with larger LVMIs and fibrosis (panel B).
Conclusions
Strain-volume loop is an innovative application of 3D deformation imaging in HCM. According to this new non-invasive method, increase of LVMI in HCM is accompanied by less longitudinal contribution to stroke volume, whereas absence of fibrosis and severe hypertrophy is accompanied by better systolic-diastolic coupling.
Abstract 1181 Figure.
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Affiliation(s)
- E Pagourelias
- Hippokration General Hospital of Thessloniki, Thessaloniki, Greece
| | - O Mirea
- KU Leuven, Department of Cardiovascular Diseases, University Hospital Leuven, Leuven, Belgium
| | - J Duchenne
- KU Leuven, Department of Cardiovascular Diseases, University Hospital Leuven, Leuven, Belgium
| | - S Unlu
- KU Leuven, Department of Cardiovascular Diseases, University Hospital Leuven, Leuven, Belgium
| | - J Van Cleemput
- KU Leuven, Department of Cardiovascular Diseases, University Hospital Leuven, Leuven, Belgium
| | - C E Papadopoulos
- Hippokration General Hospital of Thessloniki, Thessaloniki, Greece
| | - J Bogaert
- KU Leuven, Department of Cardiovascular Diseases, University Hospital Leuven, Leuven, Belgium
| | - V Vassilikos
- Hippokration General Hospital of Thessloniki, Thessaloniki, Greece
| | - J U Voigt
- KU Leuven, Department of Cardiovascular Diseases, University Hospital Leuven, Leuven, Belgium
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12
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Pagourelias E, Mirea O, Duchenne J, Unlu S, Van Cleemput J, Papadopoulos CE, Bogaert J, Vassilikos V, Voigt JU. P984 A head-to-head comparison between 2D and 3D segmental strain parameters in hypertrophic cardiomyopathy. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.613] [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
Funding Acknowledgements
Supported with a scholarship by the Greek State Scholarship Foundation (IKY).
Background
Previous studies have suggested that in normal and ischemic hearts three- (3D) and two-dimensional (2D) strain values present a moderate agreement which is prone to technical considerations. However, the level of agreement between 2D and 3D-strain imaging has never been adequately addressed in hypertrophic hearts, nor has it been validated against a "ground truth". Especially in hypertrophic cardiomyopathy (HCM), the magnitude and eccentricity of hypertrophy set additional challenges in standardization and measurement of regional 3D deformation parameters.
Purpose
Aims of this study were i) to investigate the consistency between 3D and 2D regional deformation parameters in HCM and ii) to test their accuracy in identifying regional fibrosis as this is defined by late gadolinium enhancement (LGE) in cardiac magnetic resonance (CMR).
Methods
We included 40 HCM patients (54.1 ± 14.3 years, 82.5% male, maximum wall thickness 19.3 ± 4.8mm) who have consecutively undergone 2D-,3D-speckle tracking echocardiography and CMR. Segmental circumferential (SCS) and longitudinal (SLS) strain have been calculated from 2D acquisitions and 3D full volume data, where additionally radial (SRS) and area (SAS) strain have been extracted using an 18 segment left ventricle model. Accordingly, segmental fibrosis was defined by LGE in corresponding CMR slices.
Results
Out of 720 segments evaluated, 134 (19.7%) were enhanced and 95(13.2%) thickened (thickness > 12 mm). Two dimensional LS and CS analysis was feasible in 719 (99.9%) and 678 (94.2%) segments respectively, while 686 segments (95.3%) were appropriate for 3D tracking. 3D_SLS values were -7.9 ± 6.8% less negative compared to 2D_SLS values [level of agreement (LOA)(-21.1-5.4%)], while the bias for SCS values was even higher -8.5 ± 8.6 [LOA(-25.4-8.4%)]. Absolute agreement between 2D and 3D deformation imaging modalities was poor to moderate [Intra-class Correlation Coefficient (ICC)= 0.46, 95%CI (0.15-0.68), p < 0.0005 for SLS and ICC = 0.19, 95%CI(0.07-0.38), p < 0.0005 for SCS] (Panel A). Following regression analysis, regional thickness was the only segmental factor to influence the correlation between 3D and 2D_SLS [R2 = 0.504, B = 0.33, 95%CI(0.22-0.44), p < 0.0005)], without, however, being a significant regressor for the other 2D vs 3D correlations. Among deformation indices, 2D_SLS showed the best area under the curve [(AUC)=0.78, 95%CI(0.75-0.81), p < 0.0005] to detect segmental fibrosis identified by CMR LGE, with 3D_SLS, 3D_SAS and 3D_SRS showing similar AUC (0.65) and 3D_SLS presenting the highest specificity [93.1%, 95%CI(90.6-95.1)] (Panel B).
Conclusions
In HCM, 2D and 3D deformation parameters are not interchangeable, showing modest agreement. Thickness and tracking algorithm calculating assumptions seem to induce this inconsistency. Among HCM patients, 2D_SLS remains the most accurate strain parameter to detect regional fibrosis.
Abstract P984 Figure.
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Affiliation(s)
- E Pagourelias
- Hippokration General Hospital of Thessloniki, Thessaloniki, Greece
| | - O Mirea
- KU Leuven, Department of Cardiovascular Diseases, University Hospital Leuven, Leuven, Belgium
| | - J Duchenne
- KU Leuven, Department of Cardiovascular Diseases, University Hospital Leuven, Leuven, Belgium
| | - S Unlu
- KU Leuven, Department of Cardiovascular Diseases, University Hospital Leuven, Leuven, Belgium
| | - J Van Cleemput
- KU Leuven, Department of Cardiovascular Diseases, University Hospital Leuven, Leuven, Belgium
| | - C E Papadopoulos
- Hippokration General Hospital of Thessloniki, Thessaloniki, Greece
| | - J Bogaert
- KU Leuven, Department of Cardiovascular Diseases, University Hospital Leuven, Leuven, Belgium
| | - V Vassilikos
- Hippokration General Hospital of Thessloniki, Thessaloniki, Greece
| | - J U Voigt
- KU Leuven, Department of Cardiovascular Diseases, University Hospital Leuven, Leuven, Belgium
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13
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Pagourelias E, Vassilikos V, Blomstrom-Lundqvist C, Kautzner J, Maggioni AP, Pokushalov E, Tavazzi L, Dagres N, Brugada J, Arbelo E. P4762What do atrial fibrillation ablation procedural volume differences across European centers reflect? An ESC EORP registry: atrial fibrillation long-term. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.1138] [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
Data from the European Atrial Fibrillation (AF) Ablation Long-Term Registry suggest that there are significant differences in the volume of AF ablation procedures performed across different centers even in the same country. If these differences in AF ablation volume between centers reflect regional, socioeconomic, infrastructural/technical or other disparities has not been addressed till now.
Purpose
The aim of this study was to investigate patient and non-patient related differences among European AF ablation centers according to the volume of AF ablations performed.
Methods
Data for this analysis originate from the European AF Ablation Long-Term Study, a prospective registry designed to describe the clinical epidemiology of patients undergoing AF ablation. Based on 25th and 75th percentiles of AF ablation numbers performed, the participating centers were classified into high volume (HV) (≥250 procedures/year), medium volume (MV) (<250 and ≥58/year) and low volume (LV) (<58/year). Patient (demographics, comorbidities) and non-patient (center infrastructure, procedural characteristics) related differences were assessed.
Results
A total of 91 centers in 26 European countries enrolled 3368 patients. There were no significant differences concerning regional distribution, hospital/cardiology facilities or services provided among centers with the exception of electrophysiology procedures and labs which were more abundant in HV centers (p=0.02 and <0.001 respectively). HV and MV centers ablate twice more cases of long-standing persistent and persistent AF compared to LV centers, in which paroxysmal AF reaches 78.9% of all cases (Figure A). Accordingly, first AF ablation procedure was far more frequent in LV centers compared to MV and HV (85.8% vs 76.0% vs 76.1% respectively, p<0.001). Even though HV centers ablate significantly more high risk patients (CHA2DS2-VASc score ≥2 51.4% in HV vs 46.5% in MV vs 37.2% in LV, p<0.001) (Figure B) with accompanying comorbidities, applying more elaborate ablation techniques, fluoroscopy time and radiation dose were higher among patients undergoing AF ablation in LV centers (p<0.001 for all). Despite the above-mentioned dissimilarities, Kaplan-Meier survival analysis, based on adjusted data, demonstrated non-significant differences in complication rate (p=0.402) or AF recurrence rate (p=0.363) among HV, MV and LV centers.
Conclusions
Volume of AF ablations in a center is not correlated with regional or infrastructural characteristics. The higher volume in HV centers consists mainly by more long-term persistent AF and higher risk patients, suggesting that differences in volume reflect differences in experience and personnel's commitment towards AF ablation.
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Affiliation(s)
- E Pagourelias
- Hippocration General Hospital of Thessaloniki, Thessaloniki, Greece
| | - V Vassilikos
- Hippocration General Hospital of Thessaloniki, Thessaloniki, Greece
| | | | - J Kautzner
- Institute for Clinical and Experimental Medicine (IKEM), Department of Cardiology, Prague, Czechia
| | - A P Maggioni
- ANMCO Foundation For Your Heart, Florence, Italy
| | - E Pokushalov
- State Research Institute of Circulation Pathology, 5Arrhythmia Department and Electrophysiology Laboratory, Novosibirsk, Russian Federation
| | - L Tavazzi
- Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy
| | - N Dagres
- Heart Center of Leipzig, Department of Electrophysiology, Leipzig, Germany
| | - J Brugada
- University of Barcelona, Department of Cardiology, Cardiovascular Institute, Hospital Clinic de Barcelona, Barcelona, Spain
| | - E Arbelo
- University of Barcelona, Department of Cardiology, Cardiovascular Institute, Hospital Clinic de Barcelona, Barcelona, Spain
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14
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Pagourelias E, Mirea O, Duchenne J, Unlu S, Van Cleemput J, Papadopoulos CE, Bogaert J, Vassilikos V, Voigt JU. P4364A direct comparison between 2D and 4D deformation imaging in hypertrophic hearts. An agreement of disagreement. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0769] [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
Previous studies have directly compared 2-dimensional (2D) and 4-dimensional (4D) deformation imaging in normal and ischemic hearts suggesting a moderate agreement prone to technical considerations. However, the level of agreement between 2D and 4D-strain imaging has never been adequately addressed in hypertrophic hearts, nor has it been validated against a “ground truth”.
Purpose
We aimed at directly comparing 4D and 2D global and regional deformation parameters and depict which may best reflect underlying segmental fibrosis in hypertrophic cardiomyopathy (HCM), as defined by late gadolinium enhancement (LGE) in cardiac magnetic resonance (CMR).
Methods
We included 40 HCM patients (54.1±14.3 years, 82.5% male, maximum wall thickness 19.3±4.8mm) who have consecutively undergone 2D-,4D-speckle tracking echocardiography and CMR. Global and segmental circumferential (CS) and longitudinal (LS) strain have been calculated from 2D acquisitions and 4D full volume data, where additionally radial (RS) and area (AS) strain have been extracted using an 18 segment left ventricle model. Accordingly, segmental fibrosis was defined by LGE in corresponding CMR slices.
Results
Deformation parameters (2D and 4D, global and regional) presented overall poor to moderate agreement (Figure A+B) with regional 4D_LS and 4D_CS values being constantly less negative compared to 2D derivatives (−7.29±6.94% and −8.53±8.8% accordingly). In regional analysis, 720 segments were evaluated of which 134 (19.7%) were enhanced and 95 of them thickened (68.8%) (thickness>12 mm), with segments presenting both characteristics showing the greatest impairment both in 2D and 4D strain values. Among segmental deformation indices, 2D_SLS showed the best area under the curve [(AUC)=0.78, 95% CI (0.75–0.81), p<0.0005] to detect segmental fibrosis, with 2D_SCS and all 4D deformation indices presenting significantly lower AUC (Figure C).
Conclusions
In HCM, 2D and 4D deformation parameters are not interchangeable, showing modest agreement. Thickness and tracking algorithm calculating assumptions seem to induce this variability. Nevertheless, among HCM patients 2D_SLS remains the best strain parameter for tissue characterization and fibrosis detection.
Acknowledgement/Funding
Supported with a scholarship by the Greek State Scholarship Foundation (IKY).
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Affiliation(s)
- E Pagourelias
- Hippocration General Hospital of Thessaloniki, Thessaloniki, Greece
| | - O Mirea
- University of Leuven, Department of Cardiovascular Diseases, University Hospital Leuven, Leuven, Belgium
| | - J Duchenne
- University of Leuven, Department of Cardiovascular Diseases, University Hospital Leuven, Leuven, Belgium
| | - S Unlu
- University of Leuven, Department of Cardiovascular Diseases, University Hospital Leuven, Leuven, Belgium
| | - J Van Cleemput
- University of Leuven, Department of Cardiovascular Diseases, University Hospital Leuven, Leuven, Belgium
| | - C E Papadopoulos
- Hippocration General Hospital of Thessaloniki, Thessaloniki, Greece
| | - J Bogaert
- University of Leuven, Department of Cardiovascular Diseases, University Hospital Leuven, Leuven, Belgium
| | - V Vassilikos
- Hippocration General Hospital of Thessaloniki, Thessaloniki, Greece
| | - J U Voigt
- University of Leuven, Department of Cardiovascular Diseases, University Hospital Leuven, Leuven, Belgium
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15
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Pagourelias E, Vassilikos V, Blomstrom-Lundqvist C, Kautzner J, Maggioni AP, Pokushalov E, Tavazzi L, Dagres N, Brugada J, Arbelo E. P1028Impact of atrial fibrillation ablation procedural volume on complication and recurrence rate across European centers. An ESC EORP registry: atrial fibrillation long-term. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0619] [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
Background
Catheter ablation has emerged as an effective therapy in patients with symptomatic and drug refractory atrial fibrillation (AF). Despite high success rates of the method, there is still heterogeneity of outcomes and complication rate across Europe. The impact of the annual procedural volume per center on success and complication rate of AF ablation, based on real-life data, has not been addressed till now.
Purpose
The aim of the study was to investigate if center AF ablation volume might be associated with one-year success or complication rate after the procedure.
Methods
Data for this analysis were extracted from the European AF Ablation Long-Term Study, a prospective registry designed to describe the clinical epidemiology of patients undergoing AF ablation. Based on 25th and 75th percentiles of AF ablation numbers performed, the participating centers were classified into high volume (HV) (≥250 procedures/year), medium volume (MV) (<250 and ≥58/year) and low volume (LV) (<58/year). One-year success was defined as patient survival free from any atrial arrhythmia, from the end of the 3-month blanking period to 12 months following the ablation procedure.
Results
A total of 91 centers in 26 European countries enrolled 3368 patients. There was a significantly higher reporting of cardiovascular complications in LV centers (5.2%), especially pericarditis (0.6%) and cardiac perforation (1.4%), while the HV and MV centers reported cardiovascular complications in 3.0 and 4.3% of cases, respectively (p=0.039). Additionally, stroke incidence after ablation was significantly higher in LV centers (0.5% of cases vs 0% in HV and MV centers, p=0.008). Kaplan-Meier survival analysis based on adjusted data of all complications demonstrated, however, that there was not a significant difference in complication rate according to volume's center (p=0.402, Figure A). One-year success after AF ablation ranged from 77.8% in HV vs 70.5% in LV vs 77.3% in MV centers (p<0.001). Nonetheless, adjusted recurrence rate was not significantly different among centers (p=0.363, Figure B), a result driven by differences both in ablation technical characteristics and risk/severity of cases ablated in different volume centers.
Conclusions
Despite the notion that “the higher, the better”, our results suggest that AF ablation is a safe procedure with high success rates in all European centers, independent of the AF ablation procedural volume. Differences in patients and procedural characteristics may justify the equality of complication and recurrence rate among centers, since expertise level counterbalances the risk of each case.
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Affiliation(s)
- E Pagourelias
- Hippocration General Hospital of Thessaloniki, Thessaloniki, Greece
| | - V Vassilikos
- Hippocration General Hospital of Thessaloniki, Thessaloniki, Greece
| | | | - J Kautzner
- Institute for Clinical and Experimental Medicine (IKEM), Department of Cardiology, Prague, Czechia
| | - A P Maggioni
- ANMCO Foundation For Your Heart, Florence, Italy
| | - E Pokushalov
- State Research Institute of Circulation Pathology, 5Arrhythmia Department and Electrophysiology Laboratory, Novosibirsk, Russian Federation
| | - L Tavazzi
- Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy
| | - N Dagres
- Heart Center of Leipzig, Department of Electrophysiology, Leipzig, Germany
| | - J Brugada
- University of Barcelona, Department of Cardiology, Cardiovascular Institute,, Barcelona, Spain
| | - E Arbelo
- University of Barcelona, Department of Cardiology, Cardiovascular Institute,, Barcelona, Spain
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16
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Loutradis C, Sarafidis P, Mayer C, Karpetas A, Bikos A, Papadopoulos CE, Pagourelias E, Wassertheurer S, Vassilikos V, Schmaderer C, Papagianni A, London G. P1584The prognostic significance of the blood pressure-pulse wave velocity association for cardiovascular outcomes and mortality in hemodialysis patients. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction and purpose
Hemodialysis patients have premature arterial stiffness, and the relationship between pulse wave velocity (PWV) and blood pressure (BP) may be different than in other hypertensives. Previous studies showed that when BP decrease is accompanied by PWV decrease the survival is improved. The aim of this study is to examine the prognostic significance of BP sensitivity of PWV for major cardiovascular outcomes and all-cause mortality in hemodialysis patients.
Methods
This is a prospective cohort study including 242 hemodialysis patients [age, 62.6±14.2 years; female, 91 (37.6%); hemodialysis vintage, 41.53±43.46]. All subjects underwent 48-hour-ABPM with Mobil-O-Graph-NG and followed-up for 33.17±19.68 months. The within-individual MBP-PWV association (MBP, dependent and PWV independent variable) was evaluated using the beta-coefficient value from simple linear regression analysis for each patient. The primary end-point was first occurrence of all-cause death, non-fatal myocardial infarction or non-fatal stroke. Secondary end-points were: (i) all-cause mortality; (ii) cardiovascular mortality; (iii) a combination of cardiovascular events.
Results
Patients who experienced the primary end-point during follow-up had significantly lower beta-coefficient levels (primary end-point: 19.877±3.975 vs 18.483±3.550, p=0.008). Higher quartiles of beta-coefficients (indicating dependency of PWV on MBP) were associated with higher cumulative freedom from the primary end-point (50.8%, 60.0%, 70.0% and 80.3% for quartiles 1 to 4 respectively; logrank-p=0.001), higher overall survival (60.7%, 61.7%, 73.3%, 86.9%; logrank-p=0.002) and higher cardiovascular survival (78.7%, 75.0%, 81.7%, 91.8% for quartiles 1 to 4; logrank-p=0.044). The future risk for the primary end-point, all-cause and cardiovascular mortality and the combined outcome was progressively increasing for lower quartiles of beta-coefficients (HR for all-cause mortality 3.395; 95% CI: 1.524–7.563, p=0.003 for quartile 1 vs quartile 4). Age (OR: 1.046, 95% CI: 1.016–1.077 per year increase, p=0.003) and 48h heart rate (OR: 0.949, 95% CI: 0.916–0.982 per bpm increase, p=0.003) were independently associated with weaker relationship between 48h-MBP and 48h-PWV.
Conclusions
Lower within-individual MBP-PWV association, based on AMBP recordings, is associated with higher risk of death and cardiovascular events in hemodialysis. These findings support that BP-independent arterial stiffness may be the underlying factor for adverse outcomes in these individuals.
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Affiliation(s)
- C Loutradis
- Aristotle University of Thessaloniki, Hippokration Hospital, Department of Nephrology, Thessaloniki, Greece
| | - P Sarafidis
- Aristotle University of Thessaloniki, Hippokration Hospital, Department of Nephrology, Thessaloniki, Greece
| | - C Mayer
- AIT Austrian Institute of Technology, Center for Health & Bioresources, Biomedical Systems, Vienna, Austria
| | - A Karpetas
- Therapeutiki Hemodialysis Unit, Thessaloniki, Greece
| | - A Bikos
- Aristotle University of Thessaloniki, Hippokration Hospital, Department of Nephrology, Thessaloniki, Greece
| | - C E Papadopoulos
- Aristotle University of Thessaloniki, Hippokration Hospital, 3rd Department of Cardiology, Thessaloniki, Greece
| | - E Pagourelias
- Aristotle University of Thessaloniki, Hippokration Hospital, 3rd Department of Cardiology, Thessaloniki, Greece
| | - S Wassertheurer
- AIT Austrian Institute of Technology, Center for Health & Bioresources, Biomedical Systems, Vienna, Austria
| | - V Vassilikos
- Aristotle University of Thessaloniki, Hippokration Hospital, 3rd Department of Cardiology, Thessaloniki, Greece
| | - C Schmaderer
- Technische Universität München, Klinikum rechts der Isar, Munich, Germany
| | - A Papagianni
- Aristotle University of Thessaloniki, Hippokration Hospital, Department of Nephrology, Thessaloniki, Greece
| | - G London
- Hospital and FCRIN INI-CRCTC, Manhes, France
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17
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Loutradis C, Papadopoulos CE, Sachpekidis V, Pagourelias E, Ekart R, Krunic B, Toumpourleka M, Theodorakopoulou M, Pateinakis P, Zoccali C, London G, Vassilikos V, Sarafidis P, Papagianni A. P2640The effect of dry-weight reduction guided by lung ultrasound on ambulatory aortic blood pressure and arterial stiffness parameters in hemodialysis patients. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction and purpose
Arterial stiffness and aortic blood pressure (BP) augmentation are significantly increased in hemodialysis patients. Recent studies suggest that the prognostic significance of ambulatory recordings of arterial stiffness is high in hemodialysis. This study examines for the first time the effect of dry weight reduction with a standardized lung-ultrasound-guided strategy on ambulatory aortic BP and arterial stiffness parameters in hypertensive hemodialysis patients.
Methods
A total 71 hemodialysis patients with hypertension (mean home BP ≥135/85 mmHg), that were clinically euvolemic, were included in this single-blind randomized clinical trial. Patients were randomized in a 1:1 ratio in the active group (n=35), following a strategy for dry-weight reduction guided by the total number of US-B lines (US-B lines score) prior to a mid-week dialysis session and the control group (n=), following standard-of-care treatment. All patients underwent 48-hour ABPM with the Mobil-O-Graph monitor (IEM, Stolberg, Germany) and PWV measurement in office with SphygmoCor (ArtCor, Sydney, Australia) at baseline and after 8-weeks.
Results
Overall, the US-B lines change during follow-up were −5.3±12.5 in active versus +2.2±7.6 in control group (p<0.001), which corresponded to dry-weight changes of −0.71±1.39 versus +0.51±0.98 kg (p<0.001). The change in 48-hour cSBP was significantly greater in the active group (−6.30±8.90 vs −0.50±12.46, p=0.027); the relevant cDBP fall was marginally greater (−3.85±6.61 vs −0.63±8.36, p=0.077) in the active group. 48-hour cPP (41.51±9.63 vs 39.06±9.61 mmHg, p=0.004) and 48-hour PWV (9.30±2.00 vs 9.08±2.04 m/sec, p=0.032) were significantly reduced from baseline to study-end in the active group but remained unchanged in controls. In contrast, 48-hour AIx and AIx(75) did not change between baseline and study-end in both groups; changes in AIx(75) were similar in the two groups (−0.97±3.51 vs −0.36±4.25, p=0.517). PWV measured in office was decreased from baseline to study-end in the active (10.07±2.66 vs 9.79±2.81, p=0.038) but not in the control group.
Conclusions
A lung-ultrasound-guided strategy for dry-weight reduction reduces ambulatory aortic BP and ambulatory or office PWV, but not ambulatory AIx(75). These results suggest that dry-weight reduction can primarily reduce aortic BP levels and large arteries stiffness but not wave reflections from the periphery.
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Affiliation(s)
- C Loutradis
- Aristotle University of Thessaloniki, Hippokration Hospital, Department of Nephrology, Thessaloniki, Greece
| | - C E Papadopoulos
- Aristotle University of Thessaloniki, Hippokration Hospital, 3rd Department of Cardiology, Thessaloniki, Greece
| | - V Sachpekidis
- Hospital Papageorgiou, Department of Cardiology, Thessaloniki, Greece
| | - E Pagourelias
- Aristotle University of Thessaloniki, Hippokration Hospital, 3rd Department of Cardiology, Thessaloniki, Greece
| | - R Ekart
- University Medical Centre Maribor, Clinic for Internal Medicine, Department of Dialysis, Maribor, Slovenia
| | - B Krunic
- University Medical Centre Maribor, Clinic for Internal Medicine, Department of Cardiology, Maribor, Slovenia
| | - M Toumpourleka
- Hospital Papageorgiou, Department of Cardiology, Thessaloniki, Greece
| | - M Theodorakopoulou
- Aristotle University of Thessaloniki, Hippokration Hospital, Department of Nephrology, Thessaloniki, Greece
| | - P Pateinakis
- Hospital Papageorgiou, Department of Nephrology, Thessaloniki, Greece
| | - C Zoccali
- CNR-IFC Clinical Epidemiology of Renal Diseases and Hypertension, Reggio Calabria, Italy
| | - G London
- Hospital and FCRIN INI-CRCTC, Manhes, France
| | - V Vassilikos
- Aristotle University of Thessaloniki, Hippokration Hospital, 3rd Department of Cardiology, Thessaloniki, Greece
| | - P Sarafidis
- Aristotle University of Thessaloniki, Hippokration Hospital, Department of Nephrology, Thessaloniki, Greece
| | - A Papagianni
- Aristotle University of Thessaloniki, Hippokration Hospital, Department of Nephrology, Thessaloniki, Greece
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18
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Loutradis C, Papadopoulos CE, Sachpekidis V, Pagourelias E, Ekart R, Krunic B, Toumpourleka M, Tsouchnikas I, Vassilikos V, Papagianni A, Zoccali C, Sarafidis PA. 4308Lung ultrasound guided dry-weight probing reduces left and right atrial dimensions and left ventricular filling pressures in hemodialysis patients with hypertension. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0153] [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 and purpose
Left ventricular hypertrophy and dysfunction is tightly associated with adverse outcome in hemodialysis. Hypertension and increased preload due to hypervolemia are major factors for these cardiac anomalies in hemodialysis. This study examined the effect of lung-ultrasound-guided dry-weight reduction on echocardiographic indices of left and right cardiac size, systolic and diastolic function in hypertensive hemodialysis patients.
Methods
This pilot, single-blind trial randomised 71 clinically euvolemic hypertensive hemodialysis patients in an active group (n=35), following a strategy for dry-weight reduction guided by the total number of US-B lines (US-B lines score) prior to a mid-week dialysis session, and a control group (n=36), following standard-of-care treatment. Among others, patients underwent two-dimensional and tissue-Doppler echocardiographic (TDI) at baseline and after 8-weeks.
Results
Overall, 19 (54.3%) patients in the active and 5 (13.9%) in the control group had UF intensification (p<0.001) during follow-up (US-B lines 5.3±12.5 vs +2.2±7.6, p<0.001, dry-weight: −0.71±1.39 vs +0.51±0.98 kg, p<0.001). Inferior vena cava diameter was reduced to a greater extend in the active compared to control group (−0.43±4.00 vs 0.71±4.82, p=0.033) at study-end. Reductions in LA and RA sizing parameters were greater in the active group (LA Surface: −1.09±4.61 vs 0.93±3.06 cm2, p=0.034; RA surface: −1.56±6.17 vs 0.47±2.31, p=0.024; LAVi: −2.43±13.14 vs 2.95±9.42 ml/m2, p=0.052). Reductions in LV end-diastolic diameter and volume were marginally greater in the active group. LV filling pressures significantly decreased in the active compared to the control group (E/e' LV: −0.38±3.14 vs 1.36±3.54, p=0.034; DT: 35.43±85.25 vs −18.44±50.69, p=0.002). Systolic function indices were unchanged in both groups. In multivariate analysis, US-B lines reduction was a powerful predictor (OR: 4.542, 95% CI: 1.266–16.292, p=0.020) of E/e' LV ratio decrease, among various factors examined.
Conclusions
A lung-ultrasound-guided strategy for dry-weight reduction can effectively reduce cardiac chambers dimensions and LV filling pressures without changing systolic performance during an 8-week follow-up in hypertensive hemodialysis patients.
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Affiliation(s)
- C Loutradis
- Aristotle University of Thessaloniki, Hippokration Hospital, Department of Nephrology, Thessaloniki, Greece
| | - C E Papadopoulos
- Aristotle University of Thessaloniki, Hippokration Hospital, 3rd Department of Cardiology, Thessaloniki, Greece
| | - V Sachpekidis
- Hospital Papageorgiou, Department of Cardiology, Thessaloniki, Greece
| | - E Pagourelias
- Aristotle University of Thessaloniki, Hippokration Hospital, 3rd Department of Cardiology, Thessaloniki, Greece
| | - R Ekart
- University Medical Centre Maribor, Clinic for Internal Medicine, Department of Dialysis, Maribor, Slovenia
| | - B Krunic
- University Medical Centre Maribor, Clinic for Internal Medicine, Department of Cardiology, Maribor, Slovenia
| | - M Toumpourleka
- Aristotle University of Thessaloniki, Hippokration Hospital, 3rd Department of Cardiology, Thessaloniki, Greece
| | - I Tsouchnikas
- Aristotle University of Thessaloniki, Hippokration Hospital, Department of Nephrology, Thessaloniki, Greece
| | - V Vassilikos
- Aristotle University of Thessaloniki, Hippokration Hospital, 3rd Department of Cardiology, Thessaloniki, Greece
| | - A Papagianni
- Aristotle University of Thessaloniki, Hippokration Hospital, Department of Nephrology, Thessaloniki, Greece
| | - C Zoccali
- CNR-IFC Clinical Epidemiology of Renal Diseases and Hypertension, Reggio Calabria, Italy
| | - P A Sarafidis
- Aristotle University of Thessaloniki, Hippokration Hospital, Department of Nephrology, Thessaloniki, Greece
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19
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Pagourelias E, Christou G, Anifanti M, Sotiriou P, Christou K, Koutlianos N, Kouidi E, Deligiannis A. 2233Simultaneous 4-chamber longitudinal strain assessment before and after a 246 km ultra-marathon race: focus on inter-chamber relationships. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.2233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- E Pagourelias
- Aristotle University of Thessaloniki, Sports Medicine Laboratory, Thessaloniki, Greece
| | - G Christou
- Aristotle University of Thessaloniki, Sports Medicine Laboratory, Thessaloniki, Greece
| | - M Anifanti
- Aristotle University of Thessaloniki, Sports Medicine Laboratory, Thessaloniki, Greece
| | - P Sotiriou
- Aristotle University of Thessaloniki, Sports Medicine Laboratory, Thessaloniki, Greece
| | - K Christou
- Aristotle University of Thessaloniki, Sports Medicine Laboratory, Thessaloniki, Greece
| | - N Koutlianos
- Aristotle University of Thessaloniki, Sports Medicine Laboratory, Thessaloniki, Greece
| | - E Kouidi
- Aristotle University of Thessaloniki, Sports Medicine Laboratory, Thessaloniki, Greece
| | - A Deligiannis
- Aristotle University of Thessaloniki, Sports Medicine Laboratory, Thessaloniki, Greece
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20
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Pagourelias E, Mirea O, Duchenne J, Van Cleemput J, Papadopoulos CE, Fragakis N, Bogaert J, Vassilikos V, Voigt JU. P6492Do segmental deformation parameters reveal regional fibrosis in hypertrophic cardiomyopathy? Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p6492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- E Pagourelias
- Aristotle University of Thessaloniki, Third Cardiology Department, Hippokration University Hospital, Thessaloniki, Greece
| | - O Mirea
- University Hospital Craiova, Department of Cardiology, Craiova, Romania
| | - J Duchenne
- Gasthuisberg University Hospital, Department of Cardiovascular Diseases, Leuven, Belgium
| | - J Van Cleemput
- Gasthuisberg University Hospital, Department of Cardiovascular Diseases, Leuven, Belgium
| | - C E Papadopoulos
- Aristotle University of Thessaloniki, Third Cardiology Department, Hippokration University Hospital, Thessaloniki, Greece
| | - N Fragakis
- Aristotle University of Thessaloniki, Third Cardiology Department, Hippokration University Hospital, Thessaloniki, Greece
| | - J Bogaert
- Gasthuisberg University Hospital, Department of Radiology, Leuven, Belgium
| | - V Vassilikos
- Aristotle University of Thessaloniki, Third Cardiology Department, Hippokration University Hospital, Thessaloniki, Greece
| | - J U Voigt
- Gasthuisberg University Hospital, Department of Cardiovascular Diseases, Leuven, Belgium
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21
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Duchenne J, Bezy S, Turco A, Claus P, Vunckx K, Pagourelias E, Unlu S, Nuyts J, Coudyzer W, Rega F, Gheysens O, Voigt J. 3867Subvalvular geometry and increased sphericity significantly increases papillary muscle contribution to myocardial workload in dilated left ventricles. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx504.3867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Filomena D, Duchenne J, Pradel S, Rodriguez Munoz D, Cimino S, Reali M, Pagliaro M, Tonti G, Pedrizzetti G, Mancone M, Sardella G, Agati L, Turco A, Claus P, Vunckx K, Nuyts J, Pagourelias E, Rega F, Gheysens O, Voigt JU, Brun S, Robin G, Victor G, Ribes D, Cognet T, Galinier M, Carrie D, Berry I, Lairez O, Moya Mur JL, Berlot B, Fernandez-Golfin C, Moreno J, Casas Rojo E, Garcia Martin A, Jimenez Nacher JJ, Matia Frances R, Franco Diez E, Hernandez-Madrid A, Zamorano JL. Young Investigator Award session: Basic Science311Intraventricular flow patterns after percutaneous mitral valve repair with MitraClip implantation312Papillary muscles contribute significantly to shortening of dilated left ventricles313Relationship between cardiac uptake by 99mTc-DPD scintigraphy and left ventricular longitudinal strain in patients with transthyretin-related cardiac amyloidosis314Premature ventricular contraction in resynchronized patients with short atrio-ventricular delay: hemodynamic impact beyond A-wave truncation. Eur Heart J Cardiovasc Imaging 2016. [DOI: 10.1093/ehjci/jew238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Duchenne J, Michalski BW, Valente F, Bianco F, Almeida Morais L, Ricci F, Darmon A, Bezy S, Claus P, Pagourelias E, Gheysens O, Rega F, Voigt JU, Stankovic I, Paqourelias E, Faber L, Ciarka A, Aarones M, Winter S, Aakhus S, Fehske W, Voigt JU, Ruiz-Munoz A, Galian L, Dux-Santoy L, Pizzi N, Aguade S, Otaegui I, Huguet M, Sao-Avilez A, Gutierrez L, Maldonado G, Gonzalez-Alujas T, Garcia-Dorado D, Evangelista A, Rodriguez-Palomares JF, Bucciarelli V, Ricci F, Aquilani R, Di Pace GG, Miniera E, De Caterina R, Gallina S, Santos N, Moura Branco L, Galrinho A, Aguiar Rosa S, Rodrigues I, Portugal G, Pinto-Teixeira P, Viveiros-Monteiro A, Cruz-Ferreira R, Aquilani R, Dipace G, Bucciarelli V, Bianco F, Miniero E, Gallina S, Verdonk C, Lepage L, Cimadevilla C, Nataf P, Vahanian A, Messika-Zeitoun D. HIT moderated posters session: imaging of tomorrowP88Contribution of LV dilatation and left bundle branch block to functional mitral regurgitation in DCM heartsP89Can we predict improvement of secondary mitral regurgitation after CRT?P90Dual-energy computed tomography myocardial perfusion to detect coronary artery disease and predict need of revascularizationP91Prognostic role of ventricular-arterial coupling after cardiac surgeryP93Long-term prognostic determinants in valvular aortic stenosis - is optimized medical therapy an option?P94Diagnostic performance and prognostic value of cardiopulmonary ultrasound for the early diagnosis of postoperative heart failure after cardiac surgeryP95Does tricuspid annuloplasty increases surgical mortality and morbidity during mitral valve replacement? Eur Heart J Cardiovasc Imaging 2016. [DOI: 10.1093/ehjci/jew232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Rosner A, Quattrone A, Ide S, Mata Caballero R, Aragao NFDV, Moustafa TAMER, Cordina R, Pagourelias E, Khalapyan T, Dalen H, Mc Elhinney D, Haeffele C, Chen S, Fernandes S, Bijnens B, Friedberg M, Lui GK, Skeide A, Lindberg H, Letting AS, Langsaeter E, Estensen ME, Yim D, Riesenkampff E, Seed M, Yoo SJ, Grosse-Wortmann L, Hernandez Jimenez V, Saavedra J, Molina L, Alberca Vela MT, L Pais J, Gorriz J, Navea C, Pavon I, Alonso JJ, Borgo JNV, Davoglio TA, Jesus CA, Petisco ACGP, Le Bihan DC, Barreto RBM, Assef JE, Pedra CA, Pedra SRFF, Mahfouz RAGAB, Goda MOHAMD, Gad MARWA, Ministeri M, Celermajer DS, Uebing A, Li W, Mirea O, Duchenne J, Budts W, Bogaert J, Gewillig M, Voigt JU. Moderated Posters: Congenital heart diseaseP374Classic-pattern dyssynchrony in adult patients with a Fontan circulationP375Outcome of pregnancy in patients with coarctation of aortaP376Diffuse myocardial fibrosis is not associated with decreased contractility: a magnetic resonance T1 mapping and feature tracking studyP377Cardiovascular abnormalities in patients with osteogenesis imperfecta: case-control studyP378Serial assessment of left ventricular systolic function by speckle tracking in patients with coarctation of the aorta undergoing stentingP379Longitudinal function and ventricular dyssynchrony are restored in children with pulmonary stenosis after percutaneous balloon pulmonary valvuloplastyP380Evaluation of the relationship between ventricular end-diastolic pressure and echocardiographic measures of cardiac function in adults with a Fontan circulationP381Right ventricular remodelling after percutaneaous pulmonary valve replacement in corrected tetralogy of Fallot with severe pulmonary regurgitation.Time matters. Eur Heart J Cardiovasc Imaging 2016. [DOI: 10.1093/ehjci/jew241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Wassmuth R, Hristova K, Monney P, Olander RFW, Rodriguez Munoz D, Huayan X, Pagourelias E, Loardi C, Moreno J, Miljkovic T, Takase H, Latet SC, Henquin R, America R, Carter-Storch R, Panelo ML, Fernandez-Golfin C, Cho IJ, Petrini J, Buonauro A, Liu B, Mapelli M, Tamulenaite E, De Chiara B, Minden H, Kostova V, Nesheva N, Katova TZ, Bojadzhiev L, Crisinel V, Reverdin S, Conti L, Mach F, Mueller H, Jeanrenaud X, Bochud M, Ehret G, Sundholm JKM, Ojala T, Andersson S, Sarkola T, Moya Mur JL, Berlot B, Fernandez-Golfin C, Moreno Planas J, Casas Rojo E, Garcia Martin A, Jimenez Nacher JJ, Hernandez-Madrid A, Franco Diez E, Matia Frances R, Zamorano JL, Zhigang YANG, Yingkun GUO, Jing CHEN, Duchenne J, Mirea O, Triantafyllis A, Michalski B, Vovas G, Delforge M, Van Cleemput J, Bogaert J, Voigt JU, Saccocci M, Tamborini G, Veglia F, Pepi M, Alamanni F, Zanobini M, Zuniga Sedano JJ, Alexanderson E, Martinez C, Bjelobrk M, Pavlovic K, Ilic A, Colakovic S, Dodic S, Tanaka T, Machii M, Nonaka D, Van Herck PL, Claeys MJ, Haine SE, Miljoen HP, Segers VF, Vandendriessche TR, De Winter BY, Hoymans VY, Vrints CJ, Lombardero M, Perea G, Miele MM, De Amicis DAV, Mannacio VAM, Dahl JS, Christensen NL, Soendergaard EV, Marcussen N, Moeller JE, Fernandez-Palomeque C, Garcia-Vega D, Mont-Girbau L, Pardo A, Izurieta C, Boretti I, Hinojar R, Gonzalez-Gomez A, Garcia Martin A, Casas E, Salido L, Barrios V, Ruiz S, Moya JL, Hernandez Antolin R, Jimenez Nacher JL, Zamorano JL, Chang HJ, Choi HH, Lee SY, Shim CY, Ha JW, Chung N, Ring M, Caidahl K, Eriksson MJ, Esposito R, Santoro C, Monteagudo JM, Trimarco B, Galderisi M, Zamorano JL, Baig S, Hayer M, Steeds R, Edwards N, Fusini L, Zagni P, Muratori M, Agostoni P, Tamborini G, Gripari P, Ghulam Ali S, Pepi M, Fiorentini C, Valuckiene Z, Jurkevicius R, Peritore A, Botta L, Belli O, Musca F, Casadei F, Russo C, Giannattasio C, Moreo A. Poster Session 6Assessment of morphology and functionP1222Multimodality imaging for left atrial appendage occluder sizingP1223Longitudinal left atrial strain is a main predictor for long term prognosis on atrial fibrillation after CABG operation patientsP1224Comparison of 2D and 3D left ventricular volumes measurements: results from the SKIPOGH II studyP1225Adjusting for thoracic circumference is superior to body surface area in the assessment of neonatal cardiac dimensions in foetal growth abnormalityP1226Maximal vortex suction pressure: an equivocal marker for optimization of atrio-ventricular delayP1227Volume-time curve of cardiac magnetic resonance assessed left ventricular dysfunction in coronary artery disease patients with type 2 diabetes mellitusP1228Thickness matters, but not in the same way for all strain parametersP1229Digging deeper in postoperative modifications of right ventricular function: impact of pericardial approach and cardioplegiaP1230Left atrial function evaluated by 2D-speckle tracking echocardiography in diabetes mellitus populationP1231The influence of arterial hypertension duration on left ventricular diastolic parameters in patients with well regulated arterial blood pressureP1232Investigation of factors affecting left ventricular diastolic dysfunction determined using mitral annulus velocityP1233High regulatory T-lymphocytes after ST-elevation myocardial infarction relate with adverse left ventricular remodelling assessed by 3D-echocardiographyP1234Prevalence of paradoxical low flow/low gradient severe aortic stenosis measure with 3 dimensional transesophageal echocardiographyP1235Coronary microvascular and diastolic dysfunctions after aortic valve replacement: comparison between mechanical and biological prosthesesP1236Normal-flow, low gradient aortic stenosis is common in a population of patients with severe aortic valve stenosis undergoing aortic valve replacementP1237Analysis of validity and reproducibility of calcium burden visual estimation by echocardiographyP12383D full automatic software in the evaluation of aortic stenosis severity in TAVI patients. Preliminary resultsP1239Differential impact of net atrioventricular compliance on clinical outcomes in patients with mitral stenosis according to cardiac rhythmP1240Aortic regurgitation affects the intima-media thickness of the right and left common carotid artery differentlyP1241Global longitudinal strain: an hallmark of cardiac damage in mitral valve regurgitation. Experience from the european registry of mitral regurgitationP1242Echocardiographic characterisation of Barlow's disease versus fibroelastic deficiencyP1243Echocardiographic screening for rheumatic heart disease in a ugandan orphanage - feasibility and outcomesP1244Alterations in right ventricular mechanics upon follow-up period in patients with persistent ischemic mitral regurgitation after inferoposterior myocardial infarctionP1245Ten-years conventional mitral surgery in patients with mitral regurgitation and left ventricular dysfunction: clinical and echocardiographic outcomes. Eur Heart J Cardiovasc Imaging 2016. [DOI: 10.1093/ehjci/jew266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Baron T, Kosmala W, Sarvari SI, Garcia Martin A, Dumitrescu SI, Galli E, Pagourelias E, Martinez Santos P, Christersson C, Hedin EM, Johansson K, Flachskampf FA, Rojek A, Przewlocka-Kosmala M, Karolko B, Mysiak A, Marwick TH, Sitges M, Sanz M, Tolosana Viu JM, Edvardsen T, Stokke TM, Mont L, Bijnens B, Moya-Mur JL, Carbonell-San Roman SA, Rodriguez-Munoz D, Garcia-Lledo A, Jimenez-Nacher JJ, Segura-De La Cal T, Fernandez-Golfin C, Zamorano-Gomez JL, Droc I, Neagoe G, Mocanu I, Murgu V, Savoiu D, Crisan I, Dragomir D, Stamate SC, Cristian G, Fournet M, Samset E, Leclercq C, Donal E, Vovas G, Duchenne J, Mirea OC, Van Aelst L, Claus P, Delforge M, Van Cleemput J, Bogaert J, Voigt JU, Batlle Lopez E, Vilacosta I, De La Rosa Riestra A, Sanchez Sauce B, Jimenez Valtierra J, Espana Barrio E, Campuzano Ruiz R, Alonso Bello J, Perez Gonzalez F. Rapid Fire Abstract session: assessment of systolic function: clinical perspectives and future directions782How the echocardiographic parameters of left ventricular function change during the first year after myocardial infarction when the ejection fraction remains normal?783Blunted increase in LV longitudinal deformation during exercise contributes to the transition from an asymptomatic stage to clinically overt HFpEF784A septal flash induced by right ventricular pacing is associated with left ventricular dysfunction and remodeling785Assessment of right ventricular systolic function in patients with significant functional tricuspid regurgitation: longitudinal parameters increase accuracy and predict cardiovascular outcomes786Effect of left ventricular augmentation with alginate biopolymer on right heart function787Left ventricular mechanics: novel tools to evaluate function and dyssynchrony in controls and cardiac resynchronization therapy candidates788How does regional wall thickness influence strain measurements?789TAPSE-estimated right ventricular systolic dysfunction predicts mortality among acute decompensated heart failure with preserved ejection fraction patients: a prospective study in a secondary center. Eur Heart J Cardiovasc Imaging 2015. [DOI: 10.1093/ehjci/jev268] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Duchenne J, Popara-Voica AM, Duchenne J, Aruta P, Teo HK, Onciul S, Miskowiec D, Onciul S, Rumbinaite E, Abellard JA, Turco A, Claus P, Vunckx K, Pagourelias E, Rega F, Gheysens O, Voigt JU, Croitoru A, Alexandru D, Geavlete DO, Popescu BA, Ginghina C, Jurcut R, Claus P, Turco A, Vunckx K, Pagourelias E, Haemers P, Van Puyvelde J, Gheysens O, Rega F, Voigt JU, Muraru D, Janei C, Haertel Miglioranza M, Cavalli G, Romeo G, Peluso D, Cucchini U, Iliceto S, Badano L, Kui SL, Chai SC, Leong KT, Tong KL, Muraru D, Miglioranza MH, Cucchini U, Dorobantu M, Iliceto S, Badano LP, Kupczynska K, Uznanska-Loch B, Kasprzak JD, Kurpesa M, Lipiec P, Muraru D, Miglioranza MH, Cucchini U, Dorobantu M, Iliceto S, Badano LP, Vaskelyte JJ, Lapinskas T, Karuzas A, Zvirblyte R, Viezelis M, Jonauskiene I, Gustiene O, Slapikas R, Trochu JN, Gueffet JP, Cueff C, De Groote P, Bauters C, Millaire A, Polge AS, Le Tourneau T. HIT Moderated Poster session: imaging in everyday practiceP143Relationship of FDG-PET and pressure-strain loops as novel measures of regional myocardial workload in LBBB-like dyssynchronyP144Cardiotoxicity of anti-vascular endothelial growth factor therapies: results of a pilot studyP145A new animal model of rapid pacing-induced dilated cardiomyopathy and LBBBP146Three-dimensional echocardiography assessment of the systolic variation of effective regurgitant orifice area in patients with functional tricuspid regurgitation: implications for quantificationP147Clinical prognostic value of myocardial mechanics using speckle-tracking echocardiography in patients post primary coronary intervention for acute ST- segment elevation myocardial infarctionP148Relationship between left atrial volumes and emptying fractions and parameters of infarct size and left ventricular filling pressures in survivors of st elevation myocardial infarctionP149Left atrial dysfunction assessed by two dimensional speckle tracking echocardiography in patients with impaired left ventricular ejection fraction and sleep-disordered breathingP150Left atrial morphological and functional remodeling early after ST elevation myocardial infarction insights from threedimensional echocardiographyP151Circumferential strain and strain rate at early stages of dobutamine speckle tracking imaging: are they enough to detect ischemia in patients with coronary artery disease?P152Pulmonary hypertension in hypertrophic cardiomyopathy: a rest and exercise echocardiography study. Eur Heart J Cardiovasc Imaging 2015. [DOI: 10.1093/ehjci/jev261] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Winter R, Fazlinezhad A, Martins Fernandes S, Pellegrino M, Iriart X, Moustafa S, Stolfo D, Bieseviciene M, Patel S, Vriz O, Sarvari SI, Santos M, Berezin A, Stoebe S, Benyounes Iglesias N, De Chiara B, Soliman A, Oni O, Ricci F, Tumasyan LR, Kim KH, Popa BA, Yiangou K, Olsen RH, Cacicedo A, Monti L, Holte E, Orlic D, Trifunovic D, Nucifora G, Casalta AC, Cavalcante JL, Keramida K, Calin A, Almeida Morais L, Bandera F, Galli E, Kamal HM, Leite L, Polte CL, Martinez Santos P, Jin CN, Generati G, Reali M, Kalcik M, Cacicedo A, Nascimento H, Ferreiro Quero C, Kazum S, Madeira S, Villagra JM, Muraru D, Gobbo M, Generati G, D'andrea A, Azevedo O, Nucifora G, Cruz I, Lozano Granero VC, Stampfli SF, Marketou M, Bento D, Mohty D, Hernandez Jimenez V, Gascuena R, Ingvarsson A, Cameli M, Werther Evaldsson A, Greiner S, Michelsen MM, El Eraky AZZA, Kamal HM, D'ascenzi F, Spinelli L, Stojanovic S, Mincu RI, Vindis D, Mantovani F, Yi JE, Styczynski G, Battah AHMED, O'driscoll J, Generati G, Velasco Del Castillo S, Voilliot D, Scali MC, Garcia Campos A, Opitz B, Herold IHF, Veiga CESAR, Santos Furtado M, Khan UM, Leite L, Leite L, Leite L, Keramida K, Molnar AA, Rio P, Huang MS, Papadopoulos C, Venneri L, Onut R, Casas Rojo E, Bayat F, Aggeli C, Ben Kahla S, Abid L, Choi JH, Barreiro Perez M, Lindqvist P, Sheehan F, Vojdanparast M, Nezafati P, Teixeira R, Generati G, Bandera F, Labate V, Alfonzetti E, Guazzi M, Dinet ML, Jalal Z, Cochet H, Thambo JB, Ho TH, Shah P, Murphy K, Nelluri BK, Lee H, Wilansky S, Mookadam F, Tonet E, Merlo M, Barbati G, Gigli M, Pinamonti B, Ramani F, Zecchin M, Sinagra G, Vaskelyte JJ, Mizariene V, Lesauskaite V, Verseckaite R, Karaliute R, Jonkaitiene R, Li L, Craft M, Danford D, Kutty S, Pellegrinet M, Zito C, Carerj S, Di Bello V, Cittadini A, Bossone E, Antonini-Canterin F, Rodriguez M, Sitges M, Sepulveda-Martinez A, Gratacos E, Bijnens B, Crispi F, Leite L, Martins R, Baptista R, Barbosa A, Ribeiro N, Oliveira A, Castro G, Pego M, Samura T, Kremzer A, Tarr A, Pfeiffer D, Hagendorff A, Van Der Vynckt C, Gout O, Devys JM, Cohen A, Musca F, D'angelo L, Cipriani MG, Parolini M, Rossi A, Santambrogio GM, Russo C, Giannattasio C, Moreo A, Moharram M, Gamal A, Reda A, Adebiyi A, Aje A, Aquilani R, Dipace G, Bucciarelli V, Bianco F, Miniero E, Scipioni G, De Caterina R, Gallina S, Adamyan KG, Chilingaryan AL, Tunyan LG, Cho JY, Yoon HJ, Ahn Y, Jeong MH, Cho JG, Park JC, Popa A, Cerin G, Azina CH, Yiangou A, Georgiou C, Zitti M, Ioannides M, Chimonides S, Pedersen LR, Snoer M, Christensen TE, Ghotbi AA, Hasbak P, Kjaer A, Haugaard SB, Prescott E, Velasco Del Castillo S, Gomez Sanchez V, Anton Ladislao A, Onaindia Gandarias J, Rodriguez Sanchez I, Jimenez Melo O, Garcia Cuenca E, Zugazabeitia Irazabal G, Romero Pereiro A, Nardi B, Di Giovine G, Malanchini G, Scardino C, Balzarini L, Presbitero P, Gasparini GL, Tesic M, Zamaklar-Trifunovic D, Vujisic-Tesic B, Borovic M, Milasinovic D, Zivkovic M, Kostic J, Belelsin B, Ostojic M, Krljanac G, Savic L, Asanin M, Aleksandric S, Petrovic M, Zlatic N, Lasica R, Mrdovic I, Muser D, Zanuttini D, Tioni C, Bernardi G, Spedicato L, Proclemer A, Galli E, Szymanski C, Salaun E, Lavoute C, Haentjens J, Tribouilloy C, Mancini J, Donal E, Habib G, Delgado-Montero A, Dahou A, Caballero L, Rijal S, Gorcsan J, Monin JL, Pibarot P, Lancellotti P, Kouris N, Kostopoulos V, Giannaris V, Trifou E, Markos L, Mihalopoulos A, Mprempos G, Olympios CD, Mateescu AD, Rosca M, Beladan CC, Enache R, Gurzun MM, Varga P, Calin C, Ginghina C, Popescu BA, Galrinho A, Branco L, Gomes V, Timoteo AT, Daniel P, Rodrigues I, Rosa S, Fragata J, Ferreira R, Generati G, Pellegrino M, Carbone F, Labate V, Alfonzetti E, Guazzi M, Leclercq C, Samset E, Donal E, Oraby MA, Eleraky AZ, Yossuef MA, Baptista R, Teixeira R, Ribeiro N, Oliveira AP, Barbosa A, Castro G, Martins R, Elvas L, Pego M, Gao SA, Lagerstrand KM, Johnsson ÅA, Bech-Hanssen O, Vilacosta I, Batlle Lopez E, Sanchez Sauce B, Jimenez Valtierra J, Espana Barrio E, Campuzano Ruiz R, De La Rosa Riestra A, Alonso Bello J, Perez Gonzalez F, Wan S, Sun JP, Lee AP, Bandera F, Pellegrino M, Carbone F, Labate V, Alfonzetti E, Guazzi M, Cimino S, Salatino T, Silvetti E, Mancone M, Pennacchi M, Giordano A, Sardella G, Agati L, Yesin M, Gunduz S, Gursoy MO, Astarcioglu MA, Karakoyun S, Bayam E, Cersit S, Ozkan M, Velasco Del Castillo S, Gomez Sanchez V, Anton Ladislao A, Onaindia Gandarias J, Rodriguez Sanchez I, Jimenez Melo O, Quintana Razcka O, Romero Pereiro A, Zugazabeitia Irazabal G, Braga M, Flores L, Ribeiro V, Melao F, Dias P, Maciel MJ, Bettencourt P, Mesa Rubio MD, Ruiz Ortiz M, Delgado Ortega M, Sanchez Fernandez J, Duran Jimenez E, Morenate Navio C, Romero M, Pan M, Suarez De Lezo J, Vaturi M, Weisenberg D, Monakier D, Valdman A, Vaknin- Assa H, Assali A, Kornowski R, Sagie A, Shapira Y, Ribeiras R, Abecasis J, Teles R, Castro M, Tralhao A, Horta E, Brito J, Andrade M, Mendes M, Avegliano G, Ronderos R, Matta MG, Camporrotondo M, Castro F, Albina G, Aranda A, Navia D, Siciliano M, Migliore F, Cavedon S, Folino F, Pedrizzetti G, Bertaglia M, Corrado D, Iliceto S, Badano LP, Merlo M, Stolfo D, Losurdo P, Ramani F, Barbati G, Pivetta A, Pinamonti B, Sinagra GF, Di Lenarda A, Bandera F, Pellegrino M, Labate V, Carbone F, Alfonzetti E, Guazzi M, Di Palma E, Baldini L, Verrengia M, Vastarella R, Limongelli G, Bossone E, Calabro' R, Russo MG, Pacileo G, Cruz I, Correia E, Bento D, Teles L, Lourenco C, Faria R, Domingues K, Picarra B, Marques N, Muser D, Gianfagna P, Morocutti G, Proclemer A, Gomes AC, Lopes LR, Stuart B, Caldeira D, Morgado G, Almeida AR, Canedo P, Bagulho C, Pereira H, Pardo Sanz A, Marco Del Castillo A, Monteagudo Ruiz JM, Rincon Diaz LM, Ruiz Rejon F, Casas E, Hinojar R, Fernandez-Golfin C, Zamorano Gomez JL, Erhart L, Staehli BE, Kaufmann BA, Tanner FC, Kontaraki J, Parthenakis F, Maragkoudakis S, Zacharis E, Patrianakos A, Vardas P, Domingues K, Correia E, Lopes L, Teles L, Picarra B, Magalhaes P, Faria R, Lourenco C, Azevedo O, Boulogne C, Magne J, Damy T, Martin S, Boncoeur MP, Aboyans V, Jaccard A, Saavedra Falero J, Alberca Vela MT, Molina Blazquez L, Mata Caballero R, Serrano Rosado JA, Elviro R, Di Gioia C, Fernandez Rozas I, Manzano MC, Martinez Sanchez JI, Molina M, Palma J, Werther Evaldsson A, Radegran G, Stagmo M, Waktare J, Roijer A, Meurling CJ, Righini FM, Sparla S, Di Tommaso C, Focardi M, D'ascenzi F, Tacchini D, Maccherini M, Henein M, Mondillo S, Ingvarsson A, Waktare J, Thilen U, Stagmo M, Roijer A, Radegran G, Meurling C, Jud A, Aurich M, Katus HA, Mereles D, Faber R, Pena A, Mygind ND, Suhrs HE, Zander M, Prescott E, Handoka NESRIN, Ghali MONA, Eldahshan NAHED, Ibrahim AHMED, Al-Eraky AZ, El Attar MA, Omar AS, Pelliccia A, Alvino F, Solari M, Cameli M, Focardi M, Bonifazi M, Mondillo S, Giudice CA, Assante Di Panzillo E, Castaldo D, Riccio E, Pisani A, Trimarco B, Deljanin Ilic M, Ilic S, Magda LS, Florescu M, Velcea A, Mihalcea D, Chiru A, Popescu BO, Tiu C, Vinereanu D, Hutyra M, Cechakova E, Littnerova S, Taborsky M, Lugli R, Bursi F, Fabbri M, Modena MG, Stefanelli G, Mussini C, Barbieri A, Youn HJ, O JH, Yoon HJ, Jung HO, Shin GJ, Rdzanek A, Pietrasik A, Kochman J, Huczek Z, Milewska A, Marczewska M, Szmigielski CA, Abd Eldayem SOHA, El Magd El Bohy ABO, Slee A, Peresso V, Nazir S, Sharma R, Bandera F, Pellegrino M, Labate V, Carbone F, Alfonzetti E, Guazzi M, Anton Ladislao A, Gomez Sanchez V, Cacidedo Fernandez Bobadilla A, Onaindia Gandarias JJ, Rodriguez Sanchez I, Romero Pereira A, Quintana Rackza O, Jimenez Melo O, Zugazabeitia Irazabal G, Huttin O, Venner C, Deballon R, Manenti V, Villemin T, Olivier A, Sadoul N, Juilliere Y, Selton-Suty C, Simioniuc A, Mandoli GE, Dini FL, Marzilli M, Picano E, Martin-Fernandez M, De La Hera Galarza JM, Corros-Vicente C, Leon-Aguero V, Velasco-Alonso E, Colunga-Blanco S, Fidalgo-Arguelles A, Rozado-Castano J, Moris De La Tassa C, Stelzmueller ME, Wisser W, Reichenfelser W, Mohl W, Saporito S, Mischi M, Bouwman RA, Van Assen HC, Van Den Bosch HCM, De Lepper A, Korsten HHM, Houthuizen P, Rodrigues A, Leal G, Silvestre O, Andrade J, Hjertaas JJ, Greve G, Matre K, Teixeira R, Baptista R, Barbosa A, Ribeiro N, Castro G, Martins R, Cardim N, Goncalves L, Pego M, Teixeira R, Baptista R, Barbosa A, Ribeiro N, Castro G, Martins R, Cardim N, Goncalves L, Pego M, Teixeira R, Baptista R, Barbosa A, Oliveira AP, Castro G, Martins R, Cardim N, Goncalves L, Pego M, Kouris N, Kostopoulos V, Markos L, Olympios CD, Kovacs A, Tarnoki AD, Tarnoki DL, Kolossvary M, Apor A, Maurovich-Horvat P, Jermendy G, Sengupta P, Merkely B, Viveiros Monteiro A, Galrinho A, Pereira-Da-Silva T, Moura Branco L, Timoteo A, Abreu J, Leal A, Varela F, Cruz Ferreira R, Yang LT, Tsai WC, Mpaltoumas K, Fotoglidis A, Triantafyllou K, Pagourelias E, Kassimatis E, Tzikas S, Kotsiouros G, Mantzogeorgou E, Vassilikos V, Calicchio F, Manivarmane R, Pareek N, Baksi J, Rosen S, Senior R, Lyon AR, Khattar RS, Marinescu C, Onciul S, Zamfir D, Tautu O, Dorobantu M, Carbonell San Roman A, Rincon Diez LM, Gonzalez Gomez A, Fernandez Santos S, Lazaro Rivera C, Moreno Vinues C, Sanmartin Fernandez M, Fernandez-Golfin C, Zamorano Gomez JL, Alirezaei T, Karimi AS, Kakiouzi V, Felekos I, Panagopoulou V, Latsios G, Karabela M, Petras D, Tousoulis D, Abid L, Abid D, Kammoun S, Ben Kahla S, Lee JW, Martin Fernandez M, Costilla Garcia SM, Diaz Pelaez E, Moris De La Tassa C. Poster session 3The imaging examinationP646Simulator-based testing of skill in transthoracic echoP647Clinical and echocardiographic characteristics of isolated left ventricular non-compactionP648Appropriate use criteria of transthoracic echocardiography and its clinical impact in an aged populationAnatomy and physiology of the heart and great vesselsP649Prevalence and determinants of exercise oscillatory ventilation in the EUROEX trial populationAssessment of diameters, volumes and massP650Left atrial remodeling after percutaneous left atrial appendage closureP651Global atrial performance with tyrosine kinase inhibitors in metastatic renal cell carcinomaP652Early right ventricular response to cardiac resynchronization therapy: impact on clinical outcomesP653Parameters of speckle-tracking echocardiography and biomechanical values of a dilative ascending aortaAssessments of haemodynamicsP654Right atrial hemodynamics in infants and children: observations from 3-dimensional echocardiography derived right atrial volumesAssessment of systolic functionP655One-point carotid wave intensity predicts cardiac mortality in patients with congestive heart failure and reduced ejection fractionP656Persistence of cardiac remodeling in adolescents with previous fetal growth restrictionP6572D speckle tracking-derived left ventricle global longitudinal strain and left ventricular dysfunction stages: a useful discriminator in moderate-to-severe aortic regurgitationP658Global longitudinal strain and strain rate in type two diabetes patients with chronic heart failure: relevance to circulating osteoprotegerinP659Analysis of left ventricular function in patients before and after surgical and interventional mitral valve therapyP660Left ventricular end-diastolic volume is complementary with global longitudinal strain for the prediction of left ventricular ejection fraction in echocardiographic daily practiceP661Left ventricular assist device, right ventricle function, and selection bias: the light side of the moonP662Assessment of right ventricular function in patients with anterior ST elevation myocardial infarction; a 2-d speckle tracking studyP663Right ventricular systolic function assessment in sickle cell anaemia using echocardiographyAssessment of diastolic functionP664Prognostic value of transthoracic cardiopulmonary ultrasound in cardiac surgery intensive care unitP665Comparative efficacy of renin-angiotensin system modulators on prognosis, right heart and left atrial parameters in patients with chronic heart failure and preserved left ventricular systolic functionP666Left atrial volume index is the most significant diastolic functional parameter of hemodynamic burden as measured by NT-proBNP in acute myocardial infarctionP667Preventive echocardiographic screening. preliminary dataP668Assessment of the atrial electromechanical delay and the mechanical functions of the left atrium in patients with diabetes mellitus type IIschemic heart diseaseP669Coronary flow velocity reserve by echocardiography as a measure of microvascular function: feasibility, reproducibility and agreement with PET in overweight patients with coronary artery diseaseP670Influence of cardiovascular risk in the occurrence of events in patients with negative stress echocardiographyP671Prevalence of transmural myocardial infarction and viable myocardium in chronic total occlusion (CTO) patientsP672The impact of the interleukin 6 receptor antagonist tocilizumab on mircovascular dysfunction after non st elevation myocardial infarction assessed by coronary flow reserve from a randomized studyP673Impact of manual thrombus aspiration on left ventricular remodeling: the echocardiographic substudy of the randomized Physiologic Assessment of Thrombus Aspirtion in patients with ST-segment ElevatioP674Acute heart failure in STEMI patients treated with primary percutaneous coronary intervention is related to transmural circumferential myocardial strainP675Long-term prognostic value of infarct size as assessed by cardiac magnetic resonance imaging after a first st-segment elevation myocardial infarctionHeart valve DiseasesP676Prognostic value of LV global longitudinal strain in aortic stenosis with preserved LV ejection fractionP677Importance of longitudinal dyssynchrony in low flow low gradient severe aortic stenosis patients undergoing dobutamine stress echocardiography. a multicenter study (on behalf of the HAVEC group)P678Predictive value of left ventricular longitudinal strain by 2D Speckle Tracking echocardiography, in asymptomatic patients with severe aortic stenosis and preserved ejection fractionP679Clinical and echocardiographic characteristics of the flow-gradient patterns in patients with severe aortic stenosis and preserved left ventricular ejection fractionP6802D and 3D speckle tracking assessment of left ventricular function in severe aortic stenosis, a step further from biplane ejection fractionP681Functional evaluation in aortic stenosis: determinant of exercise capacityP682Left ventricular mechanics: novel tools to evaluate left ventricular function in patients with primary mitral regurgitationP683Plasma B-type natriuretic peptide level in patients with isolated rheumatic mitral stenosisP684Quantitative assessment of severity in aortic regurgitation and the influence of elastic proprieties of thoracic aortaP685Characterization of chronic aortic and mitral regurgitation using cardiovascular magnetic resonanceP686Functional mitral regurgitation: a warning sign of underlying left ventricular systolic dysfunction in heart failure with preserved ejection fraction.P687Secondary mitral valve tenting in primary degenerative prolapse quantified by three-dimensional echocardiography predicts regurgitation recurrence after mitral valve repairP688Advanced heart failure with reduced ejection fraction and severe mitral insufficiency compensate with a higher oxygen peripheral extraction to a reduced cardiac output vs oxygen uptake response to maxP689Predictors of acute procedural success after percutaneous mitraclip implantation in patients with moderate-to-severe or severe mitral regurgitation and reduced ejection fractionP690The value of transvalvular gradients obtained by transthoracic echocardiography in estimation of severe paravalvular leakage in patients with mitral prosthetic valvesP691Characteristics of infective endocarditis in a non tertiary hospitalP692Infective endocarditis: predictors of severity in a 3-year retrospective analysisP693New echocardiographic predictors of early recurrent mitral functional regurgitation after mitraclip implantationP694Transesophageal echocardiography can be reliably used for the allocation of patients with severe aortic stenosis for tras-catheter aortic valve implantationP695Annular sizing for transcatheter aortic valve selection. A comparison between computed tomography and 3D echocardiographyP696Association between aortic dilatation, mitral valve prolapse and atrial septal aneurysm: first descriptive study.CardiomyopathiesP698Cardiac resynchronization therapy by multipoint pacing improves the acute response of left ventricular mechanics and fluid dynamics: a three-dimensional and particle image velocimetry echo studyP699Long-term natural history of right ventricular function in dilated cardiomyopathy: innocent bystander or leading actor?P700Right to left ventricular interdependence at rest and during exercise assessed by the ratio between pulmonary systolic to diastolic time in heart failure reduced ejection fractionP701Exercise strain imaging demonstrates impaired right ventricular contractile reserve in patients with hypertrophic cardiomyopathyP702Prevalence of overt left ventricular dysfunction (burn-out phase) in a portuguese population of hypertrophic cardiomyopathy, a multicentre studyP703Systolic and diastolic myocardial mechanics in hypertrophic cardiomyopathy and their link to the extent of hypertrophy, replacement fibrosis and interstitial fibrosisP704Multimodality imaging and genotype-phenotype associations in a cohort of patients with hypertrophic cardiomyopathy studied by next generation sequencing and cardiac magnetic resonanceP705Sudden cardiac death risk assessment in apical hypertrophic cardiomyopathy: do we need to add MRI to the equation?P706Prognostic value of left ventricular ejection fraction, proBNP, exercise capacity, and NYHA functional class in patients with left ventricular non-compaction cardiomyopathyP707The anti-hypertrophic microRNAs miR-1, miR-133a and miR-26b and their relationship to left ventricular hypertrophy in patients with essential hypertensionP708Prevalence of left ventricular systolic dysfunction in a portuguese population of left ventricular non-compaction cardiomyopathy, a multicentre studyP709Assessment of systolic and diastolic features in light chain amyloidosis: an echocardiographic and cardiac magnetic resonance studyP710Morbid obesity-associated hypertension identifies bariatric surgery best responders: Clinical and echocardiographic follow up studyP711Echocardiographic markera for overhydration in patients under haemodialysisP712Gender aspects of right ventricular size and function in clinically stable heart transplant patientsP713Evidence of cardiac stem cells from the left ventricular apical tip in patients undergone LVAD implant: a comparative strain-ultrastructural studySystemic diseases and other conditionsP714Speckle tracking assessment of right ventricular function is superior for differentiation of pressure versus volume overloaded right ventricleP715Prognostic value of pulmonary arterial pressure: analysis in a large dataset of timely matched non-invasive and invasive assessmentsP716Effect of the glucagon-like peptide-1 analogue liraglutide on left ventricular diastolic and systolic function in patients with type 2 diabetes: a randomised, single-blinded, crossover pilot studyP717Tissue doppler evaluation of left ventricular functions, left atrial mechanical functions and atrial electromechanical delay in juvenile idiopathic arthritisP718Echocardiographic detection of subclinical left ventricular dysfunction in patients with rheumatoid arthritisP719Left ventricular strain values are unaffected by intense training: a longitudinal, speckle-tracking studyP720Diastolic left ventricular function in autosomal dominant polycystic kidney disease: a matched-cohort, speckle-tracking echocardiographic studyP721Relationship between adiponectin level and left ventricular mass and functionP722Left atrial function is impaired in patients with multiple sclerosisMasses, tumors and sources of embolismP723Paradoxical embolization to the brain in patients with acute pulmonary embolism and confirmed patent foramen ovale with bidirectional shunt, results of prospective monitoringP724Following the European Society of Cardiology proposed echocardiographic algorithm in elective patients with clinical suspicion of infective endocarditis: diagnostic yield and prognostic implicationsP725Metastatic cardiac18F-FDG uptake in patients with malignancy: comparison with echocardiographic findingsDiseases of the aortaP726Echocardiographic measurements of aortic pulse wave velocity correlate well with invasive methodP727Assessment of increase in aortic and carotid intimal medial thickness in adolescent type 1 diabetic patientsStress echocardiographyP728Determinants and prognostic significance of heart rate variability in renal transplant candidates undergoing dobutamine stress echocardiographyP729Pattern of cardiac output vs O2 uptake ratio during maximal exercise in heart failure with reduced ejection fraction: pathophysiological insightsP730Prognostic value and predictive factors of cardiac events in patients with normal exercise echocardiographyP731Right ventricular mechanics during exercise echocardiography: normal values, feasibility and reproducibility of conventional and new right ventricular function parametersP732The added value of exercise-echo in heart failure patients: assessing dynamic changes in extravascular lung waterP733Applicability of appropriate use criteria of exercise stress echocardiography in real-life practice: what have we improved with new documents?Transesophageal echocardiographyP7343D-TEE guidance in percutaneous mitral valve interventions correcting mitral regurgitationContrast echocardiographyP735Pulmonary transit time by contrast enhanced ultrasound as parameter for cardiac performance: a comparison with magnetic resonance imaging and NT-ProBNPReal-time three-dimensional TEEP736Optimal parameter selection for anisotropic diffusion denoising filters applied to aortic valve 4d echocardiographsP737Left ventricle systolic function in non-alcoholic cirrhotic candidates for liver transplantation: a three-dimensional speckle-tracking echocardiography studyTissue Doppler and speckle trackingP738Optimizing speckle tracking echocardiography strain measurements in infants: an in-vitro phantom studyP739Usefulness of vascular mechanics in aortic degenerative valve disease to estimate prognosis: a two dimensional speckle tracking studyP740Vascular mechanics in aortic degenerative valve disease: a two dimensional speckle-tracking echocardiography studyP741Statins and vascular load in aortic valve disease patients, a speckle tracking echocardiography studyP742Is Left Bundle Branch Block only an electrocardiographic abnormality? Study of LV function by 2D speckle tracking in patients with normal ejection fractionP743Dominant inheritance of global longitudinal strain in a population of healthy and hypertensive twinsP744Mechanical differences of left atria in paroxysmal atrial fibrillation: A speckle-tracking study.P745Different distribution of myocardial deformation between hypertrophic cardiomyopathy and aortic stenosisP746Left atrial mechanics in patients with chronic renal failure. Incremental value for atrial fibrillation predictionP747Subclinical myocardial dysfunction in cancer patients: is there a direct effect of tumour growth?P748The abnormal global longitudinal strain predicts significant circumflex artery disease in low risk acute coronary syndromeP7493D-Speckle tracking echocardiography for assessing ventricular funcion and infarct size in young patients after acute coronary syndromeP750Evaluation of left ventricular dyssynchrony by echocardiograhy in patients with type 2 diabetes mellitus without clinically evident cardiac diseaseP751Differences in myocardial function between peritoneal dialysis and hemodialysis patients: insights from speckle tracking echoP752Appraisal of left atrium changes in hypertensive heart disease: insights from a speckle tracking studyP753Left ventricular rotational behavior in hypertensive patients: Two dimensional speckle tracking imaging studyComputed Tomography & Nuclear CardiologyP754Effectiveness of adaptive statistical iterative reconstruction of 64-slice dual-energy ct pulmonary angiography in the patients with reduced iodine load: comparison with standard ct pulmonary angiograP755Clinical prediction model to inconclusive result assessed by coronary computed tomography angiography. Eur Heart J Cardiovasc Imaging 2015. [DOI: 10.1093/ehjci/jev277] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Mihalcea D, Bergler-Klein J, Grogan M, Pagourelias E, Faber L, Ciampi Q, Debonnaire P, Saberniak J, Florescu M, Vladareanu AM, Mihaila S, Vinereanu D, Spannbauer A, Zlabinger K, Macejovska D, Maurer G, Gyongyosi M, Scott C, Lin G, Klarich K, Miller W, Dispenzieri A, Mirea OC, Duchenne J, Vovas G, Van Aelst L, Claus P, Van Cleemput J, Delforge M, Bogaert J, Voigt JU, Burghardt A, Seggewiss H, Van Buuren F, Horstkotte D, Olivotto I, Gardini C, Monserrat L, Peteiro J, Lopes L, Cotrim C, Losi MA, Lazzeroni DE, Picano E, Joyce E, Van Den Brink OVW, Bax JJ, Delgado V, Ajmone Marsan N, Leren IS, Haland TF, Hopp E, Edvardsen T, Haugaa KH. Rapid Fire Abstract session: new insights in cardiomyopthies434The role of 4D echocardiography and cardiac biomarkers for early detection of chemotherapy induced cardiotoxicity in nonHodgkin lymphoma patients435Identification of proto-oncogenes and genes responsible for myocardial fibrosis and diastolic dysfunction after anticancer treatment under experimental conditions436Wild type transthyretin cardiac amyloidosis: clinical characteristics, echocardiographic findings, and predictors of outcome437A novel echocardiographic index for detection of cardiac amyloidosis.438Left ventricular outflow obstruction is a treatable feature rather than a risk marker in patients with hypertrophic cardiomyopathy439The international stress echo registry in hypertrophic cardiomyopathy440Value of left atrial size and function to risk stratify for new onset atrial fibrillation in hypertrophic cardiomyopathy441Right ventricle ejection fraction by cardiac resonance imaging is superior in discrimination between early phase ARVC and right ventricular outflow tract ventricular tachycardia. Eur Heart J Cardiovasc Imaging 2015. [DOI: 10.1093/ehjci/jev254] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Fotoglidis A, Pagourelias E, Kyriakou P, Vassilikos V. Endocarditis caused by unusual Streptococcus species (Streptococcus pluranimalium). Hippokratia 2015; 19:182-185. [PMID: 27418771 PMCID: PMC4938113] [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] [Indexed: 06/06/2023]
Abstract
BACKGROUND Infective endocarditis in intravenous drug abusers is caused mainly by Staphylococcus species and usually affects the right heart valves. CASE DESCRIPTION We report the case of a 37-years-old intravenous drug abuser, who was diagnosed with infective endocarditis of the mitral and aortic valve. An unusual Streptococcus species (Streptococcus pluranimalium) was isolated from surgical specimens (peripheral arterial emboli, valves' vegetations) which, according to the literature, is related to animals' diseases such as infective endocarditis in adult broiler parents, with no references existing regarding causing such disease in humans. This unusual coccus infection caused specific clinical features (sizable vegetation on mitral valve >2cm, smaller vegetations on aortic valve, systemic emboli), resistance to antimicrobial therapy, rapid progression of the disease (despite of medical therapy and surgical replacement of both valves), and finally the death of the patient two months after the initial presentation of infective endocarditis. CONCLUSION Unusual cases of infective endocarditis in intravenous drug abusers are emerging and are characterized by changing microbiological profile and varying clinical characteristics. Clinical doctors must be aware of these cases, especially when their patients present an atypical clinical course, and reappraise their medical management. Hippokratia 2015; 19 (2):182-185.
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Affiliation(s)
- A Fotoglidis
- 3 Cardiology Department, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - E Pagourelias
- 3 Cardiology Department, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - P Kyriakou
- 3 Cardiology Department, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - V Vassilikos
- 3 Cardiology Department, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Efthimiadis GK, Pagourelias E, Parcharidou DG, Gossios T, Karvounis H, Styliadis IH. Prevalence and natural history of left ventricular apical aneurysms in hypertrophic cardiomyopathy. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht309.p2961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Karagiannis A, Tziomalos K, Mikhailidis D, Semertzidis P, Kakafika A, Pagourelias E, Kountana E, Athyros V. SEASONAL VARIATION IN THE OCCURRENCE OF STROKE IN NORTHERN GREECE: A 10 YEAR STUDY IN 8,204 PATIENTS. ATHEROSCLEROSIS SUPP 2008. [DOI: 10.1016/s1567-5688(08)70990-5] [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: 11/26/2022]
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