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Kontogeorgos G, Markussis V, Thodou E, Kyrodimou E, Choreftaki T, Nomikos P, Lampropoulos KI, Tsagarakis S. Association of Pathology Markers with Somatostatin Analogue Responsiveness in Acromegaly. Int J Endocrinol 2022; 2022:8660470. [PMID: 36199813 PMCID: PMC9529452 DOI: 10.1155/2022/8660470] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 08/25/2022] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Somatotroph adenomas (SAs) exhibit a variable responsiveness to somatostatin analogue (SS-a) treatment, a process that is not well understood. We investigated established and novel histological markers as predictors of SS-a responsiveness. METHODS We retrospectively investigated pathology samples from 36 acromegalic patients that underwent transsphenoidal surgery. Clinical, hormonal, and imaging data were available in 24/36 patients, before and after SS-a treatment. Specimens were semiquantitatively analyzed with immunocytochemistry for Ki-67, KER, SSTR-2, SSTR-5, ZAC-1, E-cadherin, and AIP. RESULTS Collectively, 18 (50%) adenomas were each classified as densely/sparsely granulated somatotroph adenomas (DGSAs/SGSAs), respectively. Patients that received preoperative SS-a had lower expression of SSTR-2 compared to those that did not (2.0 (1.0, 3.0) vs. 3.0 (3.0, 3.0), p = 0.042). Compared with DGSAs, SGSAs had higher Ki-67 labeling index (LI) (1.0 (0.5, 1.0) vs. 2.0 (1.0, 3.5), p = 0.013), and a higher proportion of high MR T2 signal (1 (6%) vs. 6 (33%), p = 0.035), and tended to express less ZAC-1 (p = 0.061) and E-cadherin (p = 0.067). In linear regression corrected for baseline growth hormone (GH), ZAC-1 immunostaining was significantly associated with a decrease in GH levels after SS-a treatment (beta (95% confidence interval): -1.53 (-2.80, -0.26), p = 0.021). No markers were associated with changes in circulating insulin-like growth factor-I (IGF-I) after treatment with SS-a. CONCLUSION The novel marker ZAC-1 was associated with GH response to medical treatment with SS-a. The SGSA cases were characterized by higher Ki-67 values and MR T2 signals indicative of an inferior response to SS-a. These findings improve our understanding of the mechanisms underlying SA response to medical treatment.
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Affiliation(s)
- George Kontogeorgos
- First Propaedeutic Department of Internal Medicine, Division of Endocrinology, Laikon Hospital, National and Kapodistrian University of Athens, Athens, Greece
- Department of Pathology and Pituitary Tumor Reference Center, “G. Gennimatas” General Hospital of Athens, Athens, Greece
| | | | - Eleni Thodou
- Department of Pathology, University of Thessaly, Larissa, Greece
| | - Efi Kyrodimou
- Department of Pathology and Pituitary Tumor Reference Center, “G. Gennimatas” General Hospital of Athens, Athens, Greece
| | - Theodossia Choreftaki
- Department of Pathology and Pituitary Tumor Reference Center, “G. Gennimatas” General Hospital of Athens, Athens, Greece
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Mitropoulos D, Chlosta P, Häggman M, Ström T, Markussis V. Androgen deprivation monotherapy usage in non-metastatic prostate cancer: results from eight European countries. Cent European J Urol 2021; 74:161-168. [PMID: 34336233 PMCID: PMC8318023 DOI: 10.5173/ceju.2021.0343.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 02/27/2021] [Accepted: 03/10/2021] [Indexed: 11/22/2022] Open
Abstract
Introduction The aim of this study was to investigate the attitudes towards use of androgen deprivation therapy (ADT) as monotherapy for localized or locally advanced prostate cancer (PC). Material and methods A survey using a 28-item, structured, quantitative questionnaire about the management of patients with PC was conducted in eight European countries between February and May 2018. Survey recipients were selected from a private database of healthcare providers. Results Overall, 375 physicians completed the survey (response rate, 58%). Participants were urologists (71.2%) or medical oncologists (28.8%), with a mean practice duration of 19.9 years and with university hospital or cancer center (41.6%), non-teaching hospital (38.4%) or private-sector clinic (20.0%) affiliations. Median proportions of physicians considering ADT as monotherapy to treat patients with PC in different risk groups varied between countries, but overall were: high/very high-risk, 60%; intermediate-risk, 30%; low-risk, 7.5%. The use of ADT monotherapy in the different risk groups also varied by medical specialty and type of affiliation. Proportions of participants applying different target thresholds for testosterone (T) levels also varied by country, but overall were: <50 ng/dL, 29.9%; <32 ng/dL, 4.8%; <20 ng/dL, 54.3%; castration but no specific target, 11%. More than half of participants (58.7%) determined target T levels only when prostate-specific antigen level was increased. Conclusions Our multinational survey provides evidence that PC management varies across European countries and with clinical context, and frequently diverges from European Association of Urology (EAU) - European Society for Radiotherapy and Oncology (ESTRO) - European Society of Urogenital Radiology (ESUR) - International Society of Geriatric Oncology (SIOG) guidelines. Strategies for effective implementation of evidence-based recommendations in clinical practice may be needed to optimize patient outcomes.
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Affiliation(s)
- Dionysios Mitropoulos
- National and Kapodistrian University of Athens Medical School, 1 Department of Urology, Athens, Greece
| | - Piotr Chlosta
- Jagiellonian University, Department of Urology, Cracow, Poland
| | - Michael Häggman
- Uppsala University Hospital, Department of Urology, Uppsala, Sweden
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Nikou GC, Pazaitou-Panayiotou K, Dimitroulopoulos D, Alexandrakis G, Papakostas P, Vaslamatzis M, Kaldrymidis P, Markussis V, Koumarianou A. Results of a prospective multicenter neuroendocrine tumor registry reporting on clinicopathologic characteristics of Greek patients. BMC Endocr Disord 2016; 16:8. [PMID: 26872616 PMCID: PMC4752769 DOI: 10.1186/s12902-016-0089-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Accepted: 02/05/2016] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND The rare incidence of neuroendocrine neoplasms (NENs) has contributed to a paucity of large epidemiologic studies of patients with this condition. We investigated the occurrence and clinicopathologic features of NENs in Greece. METHODS Between October 2010 and November 2012 we collected data on 246 newly diagnosed patients from a broad-based multi-institutional registry that comprises eight academic and hospital sites in Greece. The WHO 2010 pathologic classification and the 7th AJCC Staging system was applied in all cases. RESULTS Of all patients 94 % had a sporadic and 6 % a multiple endocrine neoplasia tumor; 63.4 % were gastroenteropancreatic-(GEP)-NENs, 17.9 % Head & Neck NENs, 9.8 % NENs of Unknown Primary, 6.5 % Lung NENs and 2.4 % Pheochromocytomas. Gastric and pancreatic NENs were the most common primary sites. Poorly differentiated neuroendocrine carcinomas (NEC) were 9.3 %, all sporadic. Fifteen percent of patients were asymptomatic at presentation, 24 % had a first symptom of the disease related to endocrine syndrome and 61 % had symptoms related to locally advanced or metastatic disease. Metastatic disease was established in 25 % of tumors most frequently in the GEP NEN group. Findings are presented according to Ki-67 distribution. MRI had a higher diagnostic positive yield than Octreoscan. Somatostatin analogs, lanreotide and octreotide acetate, were prescribed at 38.5 & 61.5 % of NEN patients respectively and were found to be equally effective at providing symptomatic relief. CONCLUSIONS This is to our knowledge the first study of a Greek tumor registry and one of the few European Registries providing information regarding clinicopathologic characteristics and therapies in patients with neuroendocrine tumors of various origin sites, beyond GEP NENs.
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Affiliation(s)
- George C. Nikou
- />Neuroendocrinology Section, 1st Department of Propaedeutic Internal Medicine, Laiko University Hospital, Athens, Greece
| | | | | | | | | | | | | | | | - Anna Koumarianou
- />Hematology-Oncology Unit, Fourth Department of Internal Medicine, Attikon University Hospital, Medical School, National and Kapodestrian University of Athens, Rimini 1, 12462, Haidari, Athens, Greece
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Mavrogeni S, Markousis-Mavrogenis G, Markussis V, Kolovou G. The Emerging Role of Cardiovascular Magnetic Resonance Imaging in the Evaluation of Metabolic Cardiomyopathies. Horm Metab Res 2015. [PMID: 26197853 DOI: 10.1055/s-0035-1555913] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The aim of this review is to discuss the role of Cardiovascular Magnetic Resonance (CMR) in the diagnosis, risk stratification, and follow-up of metabolic cardiomyopathies. The classification of myocardial diseases, proposed by WHO/ISFC task force, distinguished specific cardiomyopathies, caused by metabolic disorders, into 4 types: 1) endocrine disorders, 2) storage or infiltration disorders (amyloidosis, hemochromatosis and familial storage disorders), 3) nutritional disorders (Kwashiorkor, beri-beri, obesity, and alcohol), and 4) diabetic heart. Thyroid disease, pheochromocytoma, and growth hormone excess or deficiency may contribute to usually reversible dilated cardiomyopathy. Glucogen storage diseases can be presented with myopathy, liver, and heart failure. Lysosomal storage diseases can provoke cardiac hypertrophy, mimicking hypertrophic cardiomyopathy and arrhythmias. Hereditary hemochromatosis, an inherited disorder of iron metabolism, leads to tissue iron overload in different organs, including the heart. Cardiac amyloidosis is the result of amyloid deposition in the heart, formed from breakdown of normal or abnormal proteins that leads to increased heart stiffness, restrictive cardiomyopathy, and heart failure. Finally, nutritional disturbances and metabolic diseases, such as Kwashiorkor, beri-beri, obesity, alcohol consumption, and diabetes mellitus may also lead to severe cardiac dysfunction. CMR, through its capability to reliably assess anatomy, function, inflammation, rest-stress myocardial perfusion, myocardial fibrosis, aortic distensibility, iron and/or fat deposition can serve as an excellent tool for early diagnosis of heart involvement, risk stratification, treatment evaluation, and long term follow-up of patients with metabolic cardiomyopathies.
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Affiliation(s)
- S Mavrogeni
- Onassis Cardiac Surgery Center, Athens, Greece
| | | | - V Markussis
- Onassis Cardiac Surgery Center, Athens, Greece
| | - G Kolovou
- Onassis Cardiac Surgery Center, Athens, Greece
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Koumarianou A, Nikou G, Dimitroulopoulos D, Angelopoulos T, Papamichelakis M, Mandanas S, Chrisoulidou A, Vlachou E, Alexandrakis G, Papakostas P, Vaslamatzis M, Kaldrymidis P, Malachias A, Alevizopoulos N, Katsaounis P, Markussis V, Pazaitou K. Clinicopathologic considerations of neuroendocrine tumors (NETs) in Greece: A registry experience. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.e15191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - George Nikou
- Gastrenterology Department, Laiko University Hospital, Athens, Greece
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Kousoulakou H, Panayiotou-Pazaitou K, Pantazi E, Tsentidis C, Tzanela M, Vryonidou A, Markussis V, Eleftheriou C, Geitona M. Economic Evaluation of Lanreotide Autogel in the Management of Acromegaly in Greece. Value Health 2014; 17:A348-A349. [PMID: 27200668 DOI: 10.1016/j.jval.2014.08.718] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
| | | | | | | | - M Tzanela
- Evangelismos Hospital, Athens, Greece
| | | | | | | | - M Geitona
- University of Peloponnese, Corinth, Greece
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Mavrogeni S, Bratis K, Gavra P, Fousteris E, Markussis V, Kolovou G, van Wijk K, Hautemann D, Reiber JH, Melidonis A. Stress cardiac magnetic resonance reveals myocardial perfusion impairment in asymptomatic diabetes mellitus type I, missed by the routine non-invasive evaluation. Int J Cardiol 2013; 167:e167-9. [DOI: 10.1016/j.ijcard.2013.04.170] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2013] [Accepted: 04/20/2013] [Indexed: 12/31/2022]
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Mavrogeni S, Bratis K, Markussis V, Spargias C, Papadopoulou E, Papamentzelopoulos S, Constadoulakis P, Matsoukas E, Kyrou L, Kolovou G. The diagnostic role of cardiac magnetic resonance imaging in detecting myocardial inflammation in systemic lupus erythematosus. Differentiation from viral myocarditis. Lupus 2013; 22:34-43. [DOI: 10.1177/0961203312462265] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Abstract
Objective The objective of this paper is to evaluate the diagnostic role of cardiac magnetic resonance imaging (CMR) in detecting myocardial inflammation in systemic lupus erythematosus (SLE) and its differentiation from viral myocarditis. Patients and methods Fifty patients with suspected infective myocarditis (IM), with chest pain, dyspnoea or altered ECG, increase in troponin I and/or NT-pro BNP, with or without a history of flu-like syndrome or gastroenteritis and elevated C-reactive protein (CRP) within three to five (median four) weeks before admission, 25 active SLE patients, aged 38 ± 3 years, and 20 age-matched controls were prospectively evaluated by clinical assessment, ECG, echocardiogram and CMR. All patients underwent coronary angiography, and those with significant coronary artery disease (CAD) were excluded. CMR was performed using STIR T2-W (T2W), early T1-W (EGE) and late T1-W (LGE). Endomyocardial biopsies were performed when clinically indicated by current guidelines. Specimens were examined by immunohistological and polymerase chain reaction (PCR) analysis. Results Positive coronary angiography for CAD excluded 10/50 suspected IM and 5/25 active SLE. Positive clinical criteria for acute myocarditis were fulfilled by 28/40 suspected IM and only 5/20 active SLE. CMR was positive for myocarditis in 35/40 suspected IM and in 16/20 active SLE. Endomyocardial biopsy (EMB), performed in 25/35 suspected IM and 7/16 active SLE with positive CMR, showed positive immunohistology in 18/25 suspected IM and 3/7 active SLE. Infectious genomes were identified in 24/25 suspected IM and 1/7 active SLE. Conclusions CMR-positive IM patients were more symptomatic than active SLE. More than half of CMR-positive patients also had positive EMB. PCR was positive in almost all IM, but unusual in SLE. Due to the subclinical presentation of SLE myocarditis and the limitations of EMB, CMR presents the best alternative for the diagnosis of SLE myocarditis.
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Affiliation(s)
- S Mavrogeni
- Onassis Cardiac Surgery Center, Athens, Greece
| | - K Bratis
- Onassis Cardiac Surgery Center, Athens, Greece
| | - V Markussis
- Onassis Cardiac Surgery Center, Athens, Greece
| | - C Spargias
- Onassis Cardiac Surgery Center, Athens, Greece
| | | | | | | | | | - L Kyrou
- Bioiatriki MRI Unit, Athens, Greece
| | - G Kolovou
- Onassis Cardiac Surgery Center, Athens, Greece
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Mavrogeni S, Markussis V, Bratis K, Mastorakos G, Sidiropoulou EJ, Papadopoulou E, Kolovou G. Hyperthyroidism induced autoimmune myocarditis. Evaluation by Cardiovascular Magnetic Resonance and endomyocardial biopsy. Int J Cardiol 2012; 158:166-8. [DOI: 10.1016/j.ijcard.2012.04.089] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2012] [Revised: 04/10/2012] [Accepted: 04/14/2012] [Indexed: 11/25/2022]
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Mavrogeni S, Spargias C, Bratis C, Kolovou G, Markussis V, Papadopoulou E, Constadoulakis P, Papadimitropoulos M, Douskou M, Pavlides G, Cokkinos D. Myocarditis as a precipitating factor for heart failure: evaluation and 1-year follow-up using cardiovascular magnetic resonance and endomyocardial biopsy. Eur J Heart Fail 2011; 13:830-7. [PMID: 21632580 DOI: 10.1093/eurjhf/hfr052] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.8] [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
AIMS The aim of this study was to evaluate myocarditis as a precipitating factor for heart failure using cardiovascular magnetic resonance (CMR) and endomyocardial biopsy. METHODS AND RESULTS Eighty-five patients with suspected myocarditis and 20 controls were evaluated. Seventy-one patients with positive CMR were referred for endomyocardial biopsy and re-evaluation after 1 year. Cardiovascular magnetic resonance was performed using STIR T2-weighted (T2W), early T1-weighted (EGE), and late gadolinium-enhanced (LGE) images. Immunohistological and polymerase chain reaction (PCR) analysis of myocardial specimens was employed. In patients with myocarditis, T2 and EGE were increased compared with controls (2.6 ± 0.9 vs. 1.57 ± 0.13, P < 0.001 and 7.9 ± 5.5 vs. 3.59 ± 0.08, P < 0.001, respectively). Late gadolinium enhancement was found in all myocarditis patients. Endomyocardial biopsy performed in 50 of 71 patients with positive CMR showed positive immunohistology in 48% and presence of infectious genomes in 80% (mainly Chlamydia, Herpes, and Parvovirus B19). Left ventricular ejection fraction (LVEF) was significantly decreased compared with controls (47.7 ± 19.2 vs. 64 ± 0.2, P < 0.001). After 1 year, CMR showed normalization of T2 and EGE, and decreased LGE. Left ventricular ejection fraction increased in 36.5% of patients, remained stable in 56.5% and decreased in 7% of patients, in whom biopsy showed persistence of the initial infective agents. A negative correlation was identified between EGE, LGE, and LVEF. Patients with positive biopsies had lower LVEFs. CONCLUSION In a Greek population with myocarditis, Chlamydia with viruses was a common finding. Cardiovascular magnetic resonance and PCR proved useful for the detection of myocarditis; EGE and LGE had the best correlation for the development of heart failure. Persistence of the initially detected infective agents was identified in patients who deteriorated further.
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Affiliation(s)
- Sophie Mavrogeni
- Onassis Cardiac Surgery Center, 50 Esperou Street, 175-61 P.Faliro, Athens, Greece.
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Mavrogeni S, Papavasiliou A, Spargias K, Constandoulakis P, Papadopoulos G, Karanasios E, Georgakopoulos D, Kolovou G, Demerouti E, Polymeros S, Kaklamanis L, Magoutas A, Papadopoulou E, Markussis V, Cokkinos DV. Myocardial inflammation in Duchenne Muscular Dystrophy as a precipitating factor for heart failure: a prospective study. BMC Neurol 2010; 10:33. [PMID: 20492678 PMCID: PMC2885327 DOI: 10.1186/1471-2377-10-33] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2009] [Accepted: 05/21/2010] [Indexed: 12/04/2022] Open
Abstract
Background In patients with Duchenne Muscular Dystrophy (DMD), the absent or diminished dystrophin leads to progressive skeletal muscle and heart failure. We evaluated the role of myocardial inflammation as a precipitating factor in the development of heart failure in DMD. Methods 20 DMD patients (aged 15-18 yrs) and 20 age-matched healthy volunteers were studied and followed-up for 2 years. Evaluation of myocarditis with cardiovascular magnetic resonance imaging (CMR) was performed using STIR T2-weighted (T2W), T1-weighted (T1W) before and after contrast media and late enhanced images (LGE). Left ventricular volumes and ejection fraction were also calculated. Myocardial biopsy was performed in patients with positive CMR and immunohistologic and polymerase chain reaction (PCR) analysis was employed. Results In DMD patients, left ventricular end-diastolic volume (LVEDV) was not different compared to controls. Left ventricular end-systolic volume (LVESV) was higher (45.1 ± 6.6 vs. 37.3 ± 3.8 ml, p < 0.001) and left ventricular ejection fraction (LVEF) was lower (53.9 ± 2.1 vs. 63 ± 2.4%, p < 0.001). T2 heart/skeletal muscle ratio and early T1 ratio values in DMD patients presented no difference compared to controls. LGE areas were identified in six DMD patients. In four of them with CMR evidence of myocarditis, myocardial biopsy was performed. Active myocarditis was identified in one and healing myocarditis in three using immunohistology. All six patients with CMR evidence of myocarditis had a rapid deterioration of left ventricular function during the next year. Conclusions DMD patients with myocardial inflammation documented by CMR had a rigorous progression to heart failure.
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Affiliation(s)
- Sophie Mavrogeni
- A Cardiology Department, Onassis Cardiac Surgery Center, Athens, Greece.
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Mavrogeni S, Spargias K, Markussis V, Kolovou G, Demerouti E, Papadopoulou E, Stavridis G, Kaklamanis L, Douskou M, Constantoulakis P, Cokkinos D. Myocardial Inflammation in Autoimmune Diseases: Investigation by Cardiovascular Magnetic Resonance and Endomyocardial Biopsy. ACTA ACUST UNITED AC 2009; 8:390-7. [DOI: 10.2174/1871528110908050390] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Mavrogeni SI, Markussis V, Kaklamanis L, Tsiapras D, Paraskevaidis I, Karavolias G, Karagiorga M, Douskou M, Cokkinos DV, Kremastinos DT. A comparison of magnetic resonance imaging and cardiac biopsy in the evaluation of heart iron overload in patients with beta-thalassemia major. Eur J Haematol 2005; 75:241-7. [PMID: 16104881 DOI: 10.1111/j.1600-0609.2005.00474.x] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To apply magnetic resonance imaging (MRI) for the assessment of myocardial iron deposition in patients with beta-thalassemia and compare the results with cardiac biopsy data. BACKGROUND Myocardial iron accumulation is the main cause for cardiac complications in beta-thalassemia. METHODS Twenty-five consecutive thalassemic patients were studied using a 0.5-T (Tesla) system, ECG-gated, with echo time (TE) = 17-68 ms. T2 relaxation time of the interventricular septum was calculated assuming simple monoexponential decay. A heart T2 relaxation time value of 32 ms was used for the discrimination between high and low iron deposition. Heart biopsy was performed within a week after the MRI study. Patients with stainable iron in more than 50% of the myofibrils were graded as having severe iron deposition. A serum ferritin level below 2000 ng/mL was considered as an indication of successful chelation. RESULTS Seven of the 25 patients had heart biopsy indicative of low iron deposition (Group L) and the remaining 18 patients had heart biopsy indicative of high iron deposition (Group H). T2 relaxation time of the heart (T2H) was lower in Group H compared to Group L (31.5 +/- 3.9 (range: 28-40) ms vs. 35.7 +/- 3.7 (range: 29-40) ms, P = 0.026). The T2H was in agreement with heart biopsy in 86% of the patients in Group L and in 78% of the patients in Group H (overall agreement 80%). Similarly, serum ferritin levels were in agreement with heart biopsy in 28% and 88%, respectively (overall agreement 72%). In Group L, MRI was in better agreement with biopsy compared to serum ferritin (86% vs. 28%, P < 0.05). A receiver operating characteristic curve (ROC) analysis confirmed that a T2 relaxation time of 32 ms had the highest discriminating ability for the corresponding biopsy outcome. CONCLUSIONS Heart T2 relaxation time appears in agreement with cardiac biopsy, both in high and low iron deposition, and may become a useful non-invasive index in beta-thalassemia.
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Mavrogeni S, Kaklamanis L, Tsiapras D, Paraskevaidis I, Karavolias G, Markussis V, Karagiorga M, Douskou M, Cokkinos D, Kremastinos D. 1169-158 Magnetic resonance imaging can reliably identify heart iron overload in patients with B-thalassemia major. J Am Coll Cardiol 2004. [DOI: 10.1016/s0735-1097(04)91552-5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Kanelopoulos N, Dendrinos S, Oikonomou A, Panagopoulos P, Markussis V. Doppler-ultrasound as a predictor of uterine fibroid response to GnRH therapy. Int J Gynaecol Obstet 2003; 82:41-7. [PMID: 12834940 DOI: 10.1016/s0020-7292(03)00127-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES GnRH agonists (GnRHa) are able to reduce the bleeding and size of fibroids. We monitored the response of fibroids to GnRHa with power-Doppler ultrasound. METHODS Thirty-five women with fibroids, aged 32-48, received a 6-month course with the GnRHa triptorelin (Decapeptyl, Ipsen, France). The resistance index (RI) of the uterine artery was measured with power-Doppler ultrasound. RESULTS The uterine volume reduced from 470+/-347 to 297+/-295 cm3 (P<0.01) at the 6th month of treatment. The fibroid volume reduced after 3 months of treatment from 62+/-81 to 44+/-78 cm3 (P<0.05) and after 6 months of treatment to 30+/-70 cm3 (P<0.001 from baseline). Uterine artery RI increased from 0.73+/-0.16 to 1.05+/-0.27 at the 3rd month of treatment (P<0.001). The percent reduction of fibroid volume at the 6th month correlated with the percent increase of uterine RI at the 3rd month of treatment (r=0.45, P=0.01). CONCLUSIONS The administration of triptorelin reduced fibroid dimensions. The increase of the uterine artery resistance index (RI) at the 3rd month correlated with fibroid shrinkage at the 6th month of treatment and may be used to predict the response to this therapeutic maneuver.
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Affiliation(s)
- N Kanelopoulos
- Department of Obstetrics and Gynaecology, Tzaneio General Hospital, Piraeus, Greece
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Mavrogeni SI, Gotsis ED, Markussis V, Tsekos N, Politis C, Vretou E, Kermastinos D. T2 relaxation time study of iron overload in b-thalassemia. MAGMA 1998; 6:7-12. [PMID: 9794284 DOI: 10.1007/bf02662506] [Citation(s) in RCA: 67] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Myocardial iron deposition occurs as a result of blood transfusion therapy in b-thalassemia major patients. Since this deposition causes various cardiac complications, it is of interest to assess the iron content of the myocardium in relation to the clinical picture of the patients. Two different MRI indices were used to achieve this purpose: the T2 relaxation time and the heart/skeletal muscle signal intensity ratio. ECG gated spin echo images were obtained from 54 adult thalassemic patients, with a mean age of 26 (18-44) years, at TE = 22 ms and 60 ms, using a 1.5 T system. Patients were divided into 2 groups (A and B), according to their serum ferritin levels (> or < 2000 ng ml(-1)). Results were compared with nine controls, with a mean age of 25 (18-43) years. Heart T2 relaxation time in controls (44.3 +/- 3.5 ms) was higher than in group A (29.9 +/- 5.7 ms, P < 0.001) and group B (33.4 +/- 6.8 ms, P < 0.01). T2 was measurable in 66% of group A and 83% of group B patients. The heart/muscle signal intensity ratio in group A (0.45 +/- 0.27) was lower than in group B (0.82 +/- 0.33, P < 0.001) and the controls (1.15 +/- 0.20, P < 0.001). The heart/muscle signal intensity ratio was measurable in 94% of the patients and demonstrated an inverse relationship with the serum ferritin levels (r = -0.52, P < 0.01). This study indicates that the heart/muscle ratio is a sensitive index of iron overload and it can be measured in the majority of patients, irrespective of tissue iron concentration, thereby offering an advantage over the use of T2 relaxation time.
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Abstract
OBJECTIVE Although vascular mortality is increased in hypopituitary adults on routine replacement, there are limited data on the atherosclerotic process during life in these patients. Measurement of arterial stiffness may provide an index of early vascular changes that predispose to the development of major vascular accidents. DESIGN Thirty-four hypopituitary adults on conventional replacement therapy and 39 age- and sex-matched controls were studied. They had no history or clinical evidence of macrovascular disease. The common carotid artery distensibility coefficient (DC), compliance coefficient (CC) and arterial stiffness index (beta index) were calculated from high-resolution ultrasonic imaging of the two common carotid arteries and from the brachial blood pressure. RESULTS There was no difference between patients and controls in carotid diastolic diameter (mean +/- S.E.M) (5.55 +/- 0.16 vs 5.45 +/- 0.08 mm) and pulse pressure (6.66 +/- 0.30 vs 6.58 +/- 0.24 kPa). The increase in diameter during systole was significantly lower in the hypopituitary patients (0.39 +/- 0.02 vs 0.50 +/- 0.03 mm, P < 0.001). The DC was significantly lower in patients than in controls (24.2 +/- 2.29 vs 30.1 +/- 2.01 10(-3) kPa-1, P < 0.05). The carotid CC was also significantly lower in patients than in controls (5.7 +/- 0.49 vs 7.0 +/- 0.45 10(-7) m2 kPa-1, P < 0.05). The beta index was higher in the patient group (8.4 +/- 1.3 vs 5.9 +/- 0.37, P < 0.05). When men and women were considered separately, the differences between patients and controls were statistically significant in women but not in men and were more marked in the older women subgroup. CONCLUSIONS Asymptomatic hypopituitary adults (especially women) on conventional replacement therapy have increased stiffness of the common carotid arteries. These findings provide additional evidence for a process leading to premature atherosclerosis in this group of patients.
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Affiliation(s)
- V Markussis
- Unit of Metabolic Medicine, Imperial College of Science, Technology and Medicine, London, UK
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Abstract
The objective of this study was to evaluate whether the degree of suppression of ovarian volume effected by a gonadotropin releasing hormone (GnRH) agonist in patients with polycystic ovary syndrome (PCOS) correlated with basal insulin secretion and insulin secretion provoked by a glucose challenge. Eighteen PCOS patients received the GnRH agonist D-tryptophan-6-LHRH (Decapeptyl, 3.75 mg monthly i.m.) for 6 months and had blood glucose and insulin measured during a 75 g oral glucose tolerance test (OGTT) prior to and at the end of therapy. According to ovarian volume suppression after GnRH agonist therapy, two groups were defined: in group A (n = 10; mean body mass index (BMI) +/- SEM, 25.6 +/- 1.6 kg/m2) ovarian volume regressed from 17.9 +/- 1.6 to 6.7 +/- 0.3 ml (full responders) and in group B (n = 8; mean BMI +/- SEM, 28.1 +/- 2.3 kg/m2) from 21.5 +/- 1.1 to 15.1 +/- 1.0 ml (partial responders). Results showed that GnRH agonist therapy did not affect significantly BMI or fasting levels and area under the curve (AUC) for glucose and insulin in the respective groups. Fasting insulin levels correlated positively with ovarian volume prior to (r = 0.56, p < 0.05) and after 6 months of GnRH agonist therapy (r = 0.80, p < 0.005). The suppressibility of ovarian volume with GnRH agonist therapy correlated negatively with the difference between maximal and basal levels (r = -0.68), the area under the curve (r = -0.62) and maximal levels (r = -0.72) for insulin during the OGTT.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- V Markussis
- Department of Endocrinology, Hippokration Hospital, Athens, Greece
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Goni M, Markussis V, Tolis G. Efficacy of chronic therapy with the gonadotrophin releasing hormone agonist decapeptyl in patients with polycystic ovary syndrome. Hum Reprod 1994; 9:1048-52. [PMID: 7962374 DOI: 10.1093/oxfordjournals.humrep.a138631] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Our objective was to assess the endocrine and morphological response of polycystic ovary syndrome (PCOS) in patients receiving 6 months of therapy with the long-acting gonadotrophin releasing hormone agonist (GnRH agonist) decapeptyl (3.75 mg monthly injections). Eighteen documented PCOS patients were basally evaluated for hirsutism, gonadotrophin and androgen concentrations and ovarian morphology using trans-vaginal ultrasonography. Measurements were repeated at 3 and 6 months. The results (values as mean +/- SD) showed a significant improvement in hirsutism (Ferriman score 11.0 +/- 5.9 versus 6.6 +/- 2.7, P < 0.01), acne and seborrhoea. A significant post-treatment decrease in gonadotrophins [follicle-stimulating hormone (FSH): 5.8 +/- 1.8 versus 3.8 +/- 1.1 IU/l, P < 0.01; luteinizing hormone (LH): 10.8 +/- 8.3 versus 3.4 +/- 3.3 IU/l, P < 0.01], LH/FSH ratio (1.8 +/- 1.1 versus 0.8 +/- 0.6, P < 0.01) and androgen concentrations (free testosterone: 4.0 +/- 1.9 versus 1.9 +/- 0.7 pg/ml, P < 0.01, delta 4-androstenedione: 3.9 +/- 1.2 versus 1.9 +/- 0.6 ng/ml, P < 0.001) was also found, while oestradiol approximated castration concentrations (68.4 +/- 29.5 versus 29.1 +/- 6.7 pg/ml, P < 0.001). Finally, mean ovarian volume (19.7 +/- 6.2 versus 10.9 +/- 4.6 cm3, P < 0.001), capsule thickness (2.5 +/- 0.8 versus 1.9 +/- 0.7 mm, P < 0.05) and stromal density dropped significantly, as did uterine volume (34.2 +/- 10.5 versus 19.9 +/- 8.9 cm3, P < 0.01). In conclusion, treatment of our PCOS patients for 6 months with the GnRH agonist decapeptyl proved efficient in inducing significant clinical, biochemical and ovarian morphological improvement.
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Affiliation(s)
- M Goni
- Department of Endocrinology, Hippokration Hospital, Athens, Greece
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Goni MH, Markussis V, Tolis G. Octreotide effect on ovarian morphology in insulin-resistant PCOS patients following six-month decapeptyl treatment. Am J Reprod Immunol 1994; 31:104-11. [PMID: 8049019 DOI: 10.1111/j.1600-0897.1994.tb00854.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
PROBLEM Regulation of ovarian folliculogenesis involves bidirectional communication between the immune and endocrine systems. Somatostatin analogues have been reported to acutely suppress elevated androgens in polycystic ovary syndrome (PCOS). The aim of our study was to analyze the morphologic and hormonal-metabolic response to octreotide therapy for one month in insulin-resistant PCOS patients in whom luteinizing hormone (LH) effect had formerly been separated by a six-month GnRH-agonist (GnRH-a) course. METHOD Fifteen PCOS patients were studied two months after completing a six-month GnRH-a (decapeptyl 3.75 mg monthly injection) course. Seven of the patients (group A), who were insulin-resistant and gave hyperinsulinemic response to a glucose challenge, received a 50-micrograms subcutaneous injection of octreotide twice a day for one month. The nonhyperinsulinemic patients (group B) received placebo injections. Hormonal measurements, oral glucose tolerance test (OGTT), and transvaginal ovarian ultrasound were performed before and toward the end of the treatment period. RESULTS After octreotide ovarian volume dropped significantly in group A (x +/- SD) (19.2 +/- 5.1 versus 14.7 +/- 5.5 cc, P = .02). LH levels increased (3.25 +/- 1.22 versus 5.95 +/- 4.34 mu/ml, P = .05) as did E2 levels (38.0 +/- 11.4 versus 55.1 +/- 12.7 pg/ml, P = .005). There was no change in follicle-stimulating hormone, 17-hydroxy-progesterone, free testosterone, or androstenedione levels. Insulin secretion during OGTT dropped significantly (555 +/- 294 versus 68 +/- 29 mu u/ml/hr, P = .002). Glucose tolerance was not affected. In contrast, the placebo-treated group B patients showed an increase in ovarian volume (10.9 +/- 3.5 versus 14.8 +/- 3.3 cc, P = .001) while their gonadotropin and steroid profile relapsed, similarly to our patients receiving octreotide. CONCLUSIONS Octreotide has an adjunctive beneficial effect to GnRH-a on ovarian morphology although, at the dose used, there was no suppression of gonadotropin or ovarian steroid levels. The changes in ovarian morphology are probably mediated through suppression of insulin levels and/or other ovarian growth factors.
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Affiliation(s)
- M H Goni
- Department of Endocrinology, Hippokration Hospital, Athens, Greece
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Beshyah SA, Markussis V, Harbourne T, Nicolaides AN, Johnston DG. Haemostatic mechanisms are normal despite increased vascular mortality in hypopituitary adults. Horm Metab Res 1993; 25:449-50. [PMID: 8225194 DOI: 10.1055/s-2007-1002144] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Affiliation(s)
- S A Beshyah
- Unit of Metabolic Medicine, St. Mary's Hospital Medical School, London, United Kingdom
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Abstract
Polycystic ovarian syndrome is a heterogeneous disorder characterized by abnormal function of the hypothalamic-pituitary-gonadal axis, excessive production of androgens, aberrant intermediary metabolism, and structural changes in ovarian morphology. Long-term administration of the GnRH agonistic analogues brings about pituitary gonadotroph down-regulation after an initial period of stimulation of FSH/LH release. The resulting decrease in LH output and ovarian androgen production exerts beneficial effects on the clinical and biochemical parameters of the PCO syndrome. Ovarian volume and stroma usually decrease, but the results of treatment are not permanent, since relapse of the syndrome is usually observed a few months after cessation of the agonist. There are no serious side effects, and a small decrease in bone mineral content is recovered after discontinuation of the treatment. Possible indications for this regime include patients with very large ovaries and resistant hyperandrogenemia. On the other hand, the use of GnRH agonists in the preparation of PCOS patients for ovulation induction is already established.
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Affiliation(s)
- V Markussis
- Department of Endocrinology, Hippokrateion Hospital, Athens, Greece
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Markussis V, Beshyah SA, Fisher C, Sharp P, Nicolaides AN, Johnston DG. Detection of premature atherosclerosis by high-resolution ultrasonography in symptom-free hypopituitary adults. Lancet 1992; 340:1188-92. [PMID: 1359261 DOI: 10.1016/0140-6736(92)92892-j] [Citation(s) in RCA: 242] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Retrospective analysis suggests that there is increased mortality from vascular disease in hypopituitary adults, but vascular status before death is unknown. High resolution B-mode ultrasonic imaging of both carotid and femoral arteries was therefore done in 34 adult hypopituitary patients on routine replacement therapy and was compared with that in 39 matched controls. Changes were related to risk factors for vascular disease. Carotid intima-media thickness was greater in patients than in controls (mean [SD] 0.74 [0.16] vs 0.65 [0.13] mm, p < 0.02). This difference was seen in middle-aged and elderly patients. More patients than controls had one or more atheromatous plaques (65% vs 41%, p < 0.05). The percentage of individual arteries with a plaque was also higher in patients (32% vs 18%, p < 0.005). In multiple regression analysis, patients' age was the dominant factor determining carotid intima-media thickness. Symptom-free adults with hypopituitarism show an increased prevalence of atherosclerosis.
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Affiliation(s)
- V Markussis
- Unit of Metabolic Medicine, St Mary's Hospital Medical School, London, UK
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Johnston DG, Beshyah SA, Markussis V, Shahi M, Sharp PS, Foale RA, Skinner EM. Metabolic changes and vascular risk factors in hypopituitarism. Horm Res 1992; 38 Suppl 1:68-72. [PMID: 1295816 DOI: 10.1159/000182573] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Adults with hypopituitarism die prematurely, and the excess mortality is from vascular disease. On echocardiography we have demonstrated abnormalities of myocardial diastolic function in hypopituitary adults, indicating possible early ischaemic change. Peripheral arterial disease is evident on ultrasonography. Vascular risk factors have also been examined. Impaired glucose tolerance and unrecognized diabetes are common in hypopituitary adults. Total cholesterol levels are elevated, particularly in hypopituitary women. The role of growth hormone (GH) deficiency in the vascular disease and in the vascular-risk-factor abnormalities is unknown at present. Prolonged GH therapy causes a decrease in the levels of fasting total cholesterol, without any adverse effects on glucose homeostasis. GH therapy trials in adults will clarify the role of GH in the excess vascular risk of hypopituitarism. Prolonged GH therapy will be necessary for the vascular effects to be defined.
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Affiliation(s)
- D G Johnston
- Unit of Metabolic Medicine, St. Mary's Hospital Medical School, London, UK
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