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Tsigkou V, Siasos G, Oikonomou E, Zaromitidou M, Mourouzis K, Dimitropoulos S, Bletsa E, Gouliopoulos N, Stampouloglou PK, Panoilia ME, Marinos G, Tsioufis K, Vavuranakis M, Tousoulis D. The prognostic role of galectin-3 and endothelial function in patients with heart failure according to left ventricular ejection fraction classification HF group. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.904] [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
Heart failure (HF) is nowadays classified in HF with reduced ejection fraction (HFrEF), HF with mildly-reduced EF (HFmrEF) and HF with preserved EF (HFpEF). Endothelial dysfunction, increased arterial stiffness and galectin-3, a biomarker of myocardial fibrosis, have been linked to major adverse cardiovascular events (MACE) in patients with ischemic HF.
Purpose
The purpose of this prospective, follow-up study was to investigate in patients with stable ischemic HF the prognostic role of circulating galectin-3 levels, endothelial function and arterial stiffness according to left ventricular ejection fraction classification.
Methods
In this study we prospectively enrolled 340 patients with stable ischemic HF. Patients were categorized in HFrEF (when EF below or equal to 40%), HFmrEF (when EF is more than 40%<ef≤49%)> and below/equal to 49%) and HFpEF (when EF is more/equal to 50% along with the presence of structural or functional dysfunction and/or elevated natriuretic peptides) according to recent guidelines upon 2D echocardiographic assessment. We evaluated flow-mediated dilatation (FMD) of brachial artery as a marker of endothelial function, carotid-femoral pulse-wave velocity (PWV) as a marker of arterial stiffness and galectin-3 levels as a biomarker of fibrosis. Patients were followed-up for MACE and the primary endpoint was defined as cardiovascular death, myocardial infarction, coronary revascularization, stroke, and hospitalization due to HF. <ef≤49%)>
Results
Interestingly, FMD values exhibited a stepwise improvement according to LVEF (HFrEF: 4.74±2.35% vs. HFmrEF: 4.97±2.81% vs. HFpEF: 5.94±3.46%, p=0.01) which remained statistically significant after the evaluation of possible confounders including age, sex, cardiovascular risk factors and number of significantly stenosed epicardial coronary arteries (b coefficient: 0.990, 95% CI: 0.166–1.814, p=0.019). Multivessel coronary artery disease (CAD) was more frequent in the group of HFrEF (HFrEF: 56% vs. HFmrEF: 64% vs. HFpEF: 73%, p=0.049). Nevertheless, PWV did not display any association with LVEF. Patients who presented MACE exhibited worse FMD values (4.51±2.35% vs. 5.32±2.67%, p=0.02) and the highest tertile of galectin-3 was linked to more MACEs (36% vs. 5.9%, p=0.01).
Conclusions
FMD values have a linear improvement according to LVEF increase in patients with ischemic HF and worse values are linked to more MACEs. Higher levels of galectin-3 might be used for risk stratification of patients with ischemic HF.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- V Tsigkou
- Hippokration General Hospital, Cardiology , Athens , Greece
| | - G Siasos
- Hippokration General Hospital, Cardiology , Athens , Greece
| | - E Oikonomou
- Hippokration General Hospital, Cardiology , Athens , Greece
| | - M Zaromitidou
- Hippokration General Hospital, Cardiology , Athens , Greece
| | - K Mourouzis
- Hippokration General Hospital, Cardiology , Athens , Greece
| | | | - E Bletsa
- Hippokration General Hospital, Cardiology , Athens , Greece
| | - N Gouliopoulos
- Hippokration General Hospital, Cardiology , Athens , Greece
| | | | - M E Panoilia
- Hippokration General Hospital, Cardiology , Athens , Greece
| | - G Marinos
- Hippokration General Hospital, Cardiology , Athens , Greece
| | - K Tsioufis
- Hippokration General Hospital, Cardiology , Athens , Greece
| | - M Vavuranakis
- Sotiria Thoracic Diseases Hospital of Athens, Cardiology , Athens , Greece
| | - D Tousoulis
- Hippokration General Hospital, Cardiology , Athens , Greece
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Mourouzis K, Siasos G, Oikonomou E, Zaromitidou M, Tsigkou V, Antonopoulos A, Bletsa E, Stampouloglou P, Vlassis K, Vavouranakis M, Tousoulis D. Lipoprotein-associated phospholipase A2 levels, endothelial dysfunction and arterial stiffness in patients with stable coronary artery disease. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1264] [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
Lipoprotein-associated Phospholipase A2 (Lp-PLA2), has inflammatory and atherogenic actions in the vascular wall. We investigate the impact of high Lp-PLA2 levels on endothelial function and arterial stiffness on patients with coronary artery disease (CAD).
Methods
We enrolled 374 consecutive patients with stable CAD (mean age 61±11 years). Endothelial function was evaluated by flow-mediated dilation (FMD) and reflected waves with augmentation index (AIx) of the central aortic pressure. Serum levels of Lp-PLA2 were measured with ELISA.
Results
In the studied population the median values of Lp-PLA2 levels was 125 (96–152) μg/L. There was no difference between subjects with Lp-PLA2 levels above and below 125μg/L concerning classical risk factors for CAD. Importantly, subjects with Lp-PLA2 values ≥125μg/L had significantly impaired FMD (4.44±2.19% vs. 4.89±2.07%, p=0.04) and AIx values (25.21±8.70% vs. 23.06±9.47%, p=0.03), compared to participants with lower Lp-PLA2 serum levels. A linear regression analysis revealed that Lp-PLA2 ≥125μg/L negatively relates to impaired FMD [b=−0.54 (95% CI: −1.05 to −0.02), p=0.04] and AIx values [b=2.14 (95% CI: 0.18–4.01), p=0.03] independently of cofounders.
Conclusions
Elevated Lp-PLA2 relates to endothelial dysfunction and arterial stiffness in CAD patients. These findings highlight the significant role of Lp-PlA2 in the process of atherosclerosis.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- K Mourouzis
- Hippokration General Hospital, First Department of Cardiology, Athens, Greece
| | - G Siasos
- Hippokration General Hospital, First Department of Cardiology, Athens, Greece
| | - E Oikonomou
- Hippokration General Hospital, First Department of Cardiology, Athens, Greece
| | - M Zaromitidou
- Hippokration General Hospital, First Department of Cardiology, Athens, Greece
| | - V Tsigkou
- Hippokration General Hospital, First Department of Cardiology, Athens, Greece
| | - A.S Antonopoulos
- Hippokration General Hospital, First Department of Cardiology, Athens, Greece
| | - E Bletsa
- Hippokration General Hospital, First Department of Cardiology, Athens, Greece
| | - P.K Stampouloglou
- Hippokration General Hospital, First Department of Cardiology, Athens, Greece
| | - K Vlassis
- National & Kapodistrian University of Athens Medical School, Department of Anatomy, Athens, Greece
| | - M Vavouranakis
- Hippokration General Hospital, First Department of Cardiology, Athens, Greece
| | - D Tousoulis
- Hippokration General Hospital, First Department of Cardiology, Athens, Greece
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Oikonomou E, Siasos G, Marinos G, Zaromitidou M, Athanasiou D, Foundoulakis P, Tsalamandris S, Antonopoulos A, Mistakidi CV, Vlachopoulos C, Tousoulis D. 4099High intensity endurance and strength training in water polo Olympic team players: impact on arterial wall properties. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Regular physical activity is recommended for health improvement. However the upper intensity threshold associated with best health outcome is difficult to determine. Water polo (WP) Olympic athletes present unique characteristics with very high intensity work, long training sessions and a combination of endurance and strength training.
Purpose
To examine how long term, intense mixed endurance and strength training affect peripheral and central hemodynamics and biomarkers of cardiovascular health.
Methods
The study population consisted of 20 WP Olympic team player's, 20 matched recreational active subjects (RA) and 20 sedentary control subjects (Cl). Reflected waves were assessed with the Augmentation index (AIx), central aortic stiffness with pulse wave velocity (PWV) and endothelial function with flow mediated dilation (FMD).
Results
From Cl subjects to RA active subjects and to WP players there was a stepwise decrease in aortic systolic pressure (116±16 mmHg vs. 107±14 mmHg vs. 106±6 mmHg, p=0.03) while there was no difference in branchial systolic pressure (p=0.52). There was also a stepwise improvement in AIx (−4.22±9.97% vs. −6.97±11.28% vs. −12.14±6.62%, p=0.03) and FMD (6.61±1.78% vs. 7.78±1.98% vs. 8.3±2.05%, p=0.04) according to the intensity of exercise and WP players had lower AIx and higher FMD compared to RA subjects and to Cl subjects.
Conclusions
In young WP Olympic team players intense mixed endurance and strength training has no adverse impact on arterial wall properties and endothelial function with a parallel improvement in central hemodynamics. These findings highlight that there are no definitive data to support on any adverse vascular related impact of ultra-endurance training while mixed endurance and strength training may be associated with a favorable vascular profile.
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Affiliation(s)
- E Oikonomou
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
| | - G Siasos
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
| | - G Marinos
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
| | - M Zaromitidou
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
| | - D Athanasiou
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
| | - P Foundoulakis
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
| | - S Tsalamandris
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
| | - A Antonopoulos
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
| | - C V Mistakidi
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
| | - C Vlachopoulos
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
| | - D Tousoulis
- Hippokration Hospital, University of Athens, 1st Department of Cardiology, Athens, Greece
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Oikonomou E, Tousoulis D, Siasos G, Zaromitidou M, Chrysohoou C, Kokkou E, Tourikis P, Mazaris S, Konsola T, Stefanadis C. The impact of high dose atorvastatin treatment on endothelial progenitor cells, vascular function and inflammatory status in ischemic heart failure. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht310.p5724] [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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Siasos G, Tousoulis D, Oikonomou E, Maniatis K, Kioufis S, Zaromitidou M, Kokkou E, Mazaris S, Konsola T, Stefanadis C. Vitamin D serum levels are associated with cardiovascular outcome in coronary artery disease. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht308.p2486] [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: 11/14/2022] Open
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Oikonomou E, Siasos G, Chrysohoou C, Tousoulis D, Zaromitidou M, Kioufis S, Zisimos K, Mazaris S, Pitsavos C, Stefanadis C. The impact of physical activity on total antioxidant capacity and endothelial function: Ikaria Study. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht310.p5812] [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: 11/13/2022] Open
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Zaromitidou M, Tousoulis D, Siasos G, Kioufis S, Oikonomou E, Maniatis K, Kokkou E, Mazaris S, Tourikis P, Stefanadis C. Effects of CYP2C19 genotype on vascular function in patients with coronary artery disease receiving clopidogrel. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht307.p611] [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: 11/14/2022] Open
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Lazaros G, Oikonomou E, Chrysohoou C, Mazaris S, Tsiachris D, Zaromitidou M, Kioufis S, Kokkou E, Pitsavos C, Stefanadis C. Electrical impulse production and propagation abnormalities in nonagerian hearts. Insights from the Ikaria study. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht309.p4312] [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: 11/13/2022] Open
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Maniatis K, Siasos G, Tousoulis D, Oikonomou E, Zaromitidou M, Kioufis S, Kokkou E, Gouliopoulos N, Mazaris S, Stefanadis C. Osteoprotegerin and osteopontin serum levels are associated with vascular function and inflammatory process in coronary artery disease. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht307.p606] [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: 11/13/2022] Open
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Plastiras A, Siasos G, Tousoulis D, Oikonomou E, Verveniotis A, Zaromitidou M, Kokkou E, Maniatis K, Miliou A, Stefanadis C. Effects of omega-3 polyunsaturated fatty acids administration on vascular function, inflammatory and fibrinolytic status in adults with metabolic syndrome. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht309.p4296] [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: 11/13/2022] Open
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