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Samaras A, Papazoglou A, Balomenakis C, Rampidis G, Bekiaridou A, Moysidis D, Giannakoulas G. Prognostic impact of secondary prevention treatment following myocardial infarction with non-obstructive coronary arteries: Bayesian versus frequentist meta-analysis. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1457] [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
Myocardial infarction with non-obstructive coronary arteries (MINOCA) is a clinical entity with a plethora of causes and pathophysiologic mechanisms. Traditional secondary prevention medications may not offer benefit for patients with MINOCA, calling into question the routine use of such therapies in this population.
Material and methods
Literature search was conducted in MEDLINE (PubMed), Scopus by ELSEVIER and Cochrane Central Register of Controlled Trials (CENTRAL) databases until 08 March 2022. Random-effects frequentist and hierarchical Bayesian meta-analyses were performed to assess the prognostic impact of secondary prevention medications (β-blockers, RAAS inhibitors, statins, DAPT, ASA and P2Y12 inhibitors) on the occurrence of major adverse cardiovascular events (MACE) and all-cause mortality in MINOCA patients. Sensitivity analyses accounted for the effect of: i. small sample size, ii. limited study follow-up period, and iii. different ethnicity.
Results
Of 2,569 articles initially retrieved, 9 observational studies were deemed eligible for this analysis, encompassing a total of 14,003 patients suffering from MINOCA (mean follow-up range from 6 to 90 months, mean age = 64.9±10.4 years).Administration of ASA, DAPT and P2Y12 inhibitors was not significantly linked with MACE [pooled adjusted hazard ratios (aHRs) = 0.94, 0.88, and 0.97, with 95% confidence intervals (CIs): 0.56–1.59, 0.47–1.65, and 0.562–1.53, respectively]. RAAS inhibitors and statins were independently associated with lower risk of MACE (pooled aHRs = 0.61 and 0.55 with 95% Cis: 0.46–0.82, and 0.34–0.90, respectively) and all-cause mortality (pooled aHRs = 0.58 and 0.55 with 95% Cis: 0.37–0.91, and 0.43–0.72, respectively). B-blockers were associated with significantly lower risk of all-cause death according to the frequentist analysis (pooled aHR = 0.80, 95% CI: 0.67–0.96) and with non-significantly lower risk of MACE (pooled aHR = 0.81, 95% CI: 0.65–1.01) [Figure 1]. The results deriving from the Bayesian analyses were generally consistent with the frequentist analyses, with the exceptions of the Bayesian analyses on statin and β-blocker effects, which were affected by the pre-test probabilities set herein [Figure 2]. The overall heterogeneity observed in our analyses was relatively small, and there was not substantial publication bias. Furthermore, the performed sensitivity analyses supported the robustness of the observed outcomes.
Conclusion
In this meta-analysis, it appeared that predominantly RAAS inhibitors and statins across secondary prevention medications were consistently associated with lower risk of MACE or all-cause death during the follow-up period of patients that experienced MINOCA.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- A Samaras
- Ahepa University Hospital, 1st Cardiology Department , Thessaloniki , Greece
| | - A Papazoglou
- Ahepa University Hospital, 1st Cardiology Department , Thessaloniki , Greece
| | - C Balomenakis
- Ahepa University Hospital, 1st Cardiology Department , Thessaloniki , Greece
| | - G Rampidis
- Ahepa University Hospital, 1st Cardiology Department , Thessaloniki , Greece
| | - A Bekiaridou
- Ahepa University Hospital, 1st Cardiology Department , Thessaloniki , Greece
| | - D Moysidis
- Ahepa University Hospital, 1st Cardiology Department , Thessaloniki , Greece
| | - G Giannakoulas
- Ahepa University Hospital, 1st Cardiology Department , Thessaloniki , Greece
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Samaras A, Papazoglou A, Balomenakis C, Bekiaridou A, Moysidis D, Patsiou V, Orfanidis A, Feidakis A, Giannakoulas G, Tzikas A. Clinical impact of peri-device leaks following percutaneous left atrial appendage occlusion: a systematic review and meta-analysis. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2135] [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
Peri-device leaks (PDL) are quite common after left-atrial appendage occlusion (LAAO) given the complex anatomy of LAA and surrounding structures. However, there is uncertainty regarding the prognostic implications of PDL.
Material and methods
Literature search was conducted in MEDLINE (PubMed), EMBASE, Scopus by ELSEVIER and Cochrane Central Register of Controlled Trials (CENTRAL) databases until 12 October 2021. A random-effects meta-analysis was performed to assess the effect of PDL presence on thromboembolism, all-cause mortality and major bleeding occurrence. Sensitivity analyses accounted for: i. the combined AF ablation performance, ii. the anticoagulation strategy followed after LAAO, iii. mean PDL size, and iv. mean female percentage.
Results
Of 699 articles initially retrieved, 46 were deemed eligible for this analysis (9,184 AF patients undergoing LAAO out of whom 1,446 had PDL). PDL presence was significantly associated with elevated odds of thromboembolism (FIgure 1) [pooled odds ratio (pOR) 3.05, 95% confidence interval (CI) 1.94–4.81; I2=37%]; yet PDL was not significantly linked with mortality (pOR=0.86, 95% CI: 0.25–2.95; I2=69%) and major bleeding rates (0.95, 95% CI: 0.27–3.35; I2=72%). AF-ablation did not significantly interact with the prognostic impact of PDL when performed in conjunction with LAAO (p for subgroup= 0.17). Antiplatelet discharge medication affected the prognostic value of PDL (p for subgroup <0.01 and =0.04, respectively). The prognostic significance of mean PDL size [peri-procedural or at 1–3 months or D(mean size)/D(time of follow-up)] on the risk of thromboembolism did not yield any significant association (p values >0.05). Meta-regression analysis of the mean female percentage demonstrated a non-significant trend towards a positive linear correlation between female percentage and risk of thromboembolism (p=0.10) (FIgure 2).
Conclusions
This is the first meta-analysis on the prognostic impact of PDL after LAAO. The findings highlighted a significant association between PDL and thromboembolic events, warranting careful post-LAAO device surveillance.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- A Samaras
- Ahepa University Hospital, 1st Cardiology department , Thessaloniki , Greece
| | - A Papazoglou
- Ahepa University Hospital, 1st Cardiology department , Thessaloniki , Greece
| | - C Balomenakis
- Ahepa University Hospital, 1st Cardiology department , Thessaloniki , Greece
| | - A Bekiaridou
- Ahepa University Hospital, 1st Cardiology department , Thessaloniki , Greece
| | - D Moysidis
- Ahepa University Hospital, 1st Cardiology department , Thessaloniki , Greece
| | - V Patsiou
- Ahepa University Hospital, 1st Cardiology department , Thessaloniki , Greece
| | - A Orfanidis
- Ahepa University Hospital, 1st Cardiology department , Thessaloniki , Greece
| | - A Feidakis
- Ahepa University Hospital, 1st Cardiology department , Thessaloniki , Greece
| | - G Giannakoulas
- Ahepa University Hospital, 1st Cardiology department , Thessaloniki , Greece
| | - A Tzikas
- Ahepa University Hospital, 1st Cardiology department , Thessaloniki , Greece
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Balomenakis C, Papazoglou A, Vlachopoulou D, Kartas A, Moysidis D, Vouloagkas I, Tsagkaris C, Samaras A, Krystalli C, Karagiannidis E, Giannakoulas G. Risk of arterial thromboembolism in patients with concomitant atrial fibrillation and cancer: a systematic review and meta-analysis. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.550] [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/Introduction
Atrial fibrillation (AF) and cancer often co-exist and have been independently associated with increased risk of arterial thromboembolism (TE), all cause death and bleeding; however, no cumulative data exist regarding the clinical course of AF patients with comorbid cancer.
Purpose
The aim of this systematic review and meta-analysis is to synthesize the available data regarding the incidence of major adverse cardiovascular events in AF patients in association with concurrent cancer.
Methods
The composite outcome of any TE (ischemic stroke, transient ischemic attack, or arterial thrombosis) was defined as the primary study outcome, while all-cause mortality and major or clinically relevant non-major bleeding occurrence as the secondary ones. Literature search was conducted in PubMed (MEDLINE), WebOfScience, Scopus, CENTRAL, OpenGrey, and EThOS databases. A random-effects model meta-analysis was performed. Subgroup analyses were conducted assessing the effect of active cancer history and various cancer subtypes on the outcomes of interest. Meta-regression analyses were also performed to examine the relative impact of CHA2DS2VASC and HASBLED prognostic scores on the risk of TE and bleeding, respectively.
Results
Overall 17 studies were included in our analysis, encompassing a total of 3,151,861 AF patients. Comorbid cancer was non-significantly associated with lower odds of TE than AF alone (pooled odds ratio (pOR) = 0.85, 95% confidence interval (CI): 0.69–1.03, I2=87%). The likelihood for all-cause death and bleeding occurrence was significantly higher in AF patients with cancer (pOR = 2.27, 95% CI: 1.69–3.06, I2=99%); pOR = 1.58, 95% CI: 1.26–1.97, I2=97% respectively) compared to those without cancer. Subgroup analysis on active cancer status did not yield any substantial difference, marginally improving the heterogeneity of our analysis. The highest all-cause mortality likelihood was observed in Liver-Pancreas-Gallbladder category (pOR = 10.58, 95% CI: 4.69–23.88, I2=98%) while the highest bleeding likelihood was encountered in Genitourinary cancer (pOR = 1.90, 95% CI: 1.42–2.55, I2=71.9%). The performed meta-regression analyses did not yield any significant results.
Conclusions
Our meta-analysis of 17 eligible studies demonstrated that cancer does not seem to be associated with increased risk of TE, while with increased all-cause death and bleeding occurrence in AF patients. This correlation might be explained by higher cancer-driven mortality rates (competing risk), many cases of TE being left undiagnosed within the scope of palliative cancer care, misdiagnosed episodes of TE due to the presence of brain metastases, optimal cardio-oncology monitoring, and more frequent usage of prophylactic anticoagulation treatment for cancer-associated venous thromboembolism. Nonetheless, further competing-risk survival analyses are warranted before reaching definite conclusions.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- C Balomenakis
- Aristotle University of Thessaloniki, First Department of Cardiology, AHEPA University Hospital , Thessaloniki , Greece
| | - A Papazoglou
- Aristotle University of Thessaloniki, First Department of Cardiology, AHEPA University Hospital , Thessaloniki , Greece
| | - D Vlachopoulou
- Aristotle University of Thessaloniki, First Department of Cardiology, AHEPA University Hospital , Thessaloniki , Greece
| | - A Kartas
- Aristotle University of Thessaloniki, First Department of Cardiology, AHEPA University Hospital , Thessaloniki , Greece
| | - D Moysidis
- Aristotle University of Thessaloniki, First Department of Cardiology, AHEPA University Hospital , Thessaloniki , Greece
| | - I Vouloagkas
- Aristotle University of Thessaloniki, First Department of Cardiology, AHEPA University Hospital , Thessaloniki , Greece
| | - C Tsagkaris
- Aristotle University of Thessaloniki, First Department of Cardiology, AHEPA University Hospital , Thessaloniki , Greece
| | - A Samaras
- Aristotle University of Thessaloniki, First Department of Cardiology, AHEPA University Hospital , Thessaloniki , Greece
| | - C Krystalli
- Aristotle University of Thessaloniki, First Department of Cardiology, AHEPA University Hospital , Thessaloniki , Greece
| | - E Karagiannidis
- Aristotle University of Thessaloniki, First Department of Cardiology, AHEPA University Hospital , Thessaloniki , Greece
| | - G Giannakoulas
- Aristotle University of Thessaloniki, First Department of Cardiology, AHEPA University Hospital , Thessaloniki , Greece
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Tsarouhas K, Tsitsimpikou C, Samaras A, Saravanis C, Kolovou G, Bacopoulou F, Spandidos D, Kouretas D. Cardiovascular adaptations and inflammation in marathon runners. Exp Ther Med 2022; 24:699. [PMID: 36277142 PMCID: PMC9535392 DOI: 10.3892/etm.2022.11635] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 08/17/2022] [Indexed: 11/06/2022] Open
Abstract
Long-distance running has become increasingly popular. Cardiovascular adaptations to exercise are relevant to the specific sports and this is also the case in long-distance running. Significant changes regarding inflammatory and endothelial markers along with indices of oxidative stress are observed in marathon and ultra-marathon runners. However, data linking inflammatory marker levels with cardiovascular adaptations to marathon running are limited. The aim of the present study was to describe the cardiovascular adaptations observed in a group of ultra-marathon runners and the association with a series of inflammatory and endothelial markers measured in their plasma. A total of 43 ultra-marathon runners were assessed by echocardiography and a treadmill exercise test. Blood samples were used for tumor necrosis factor-α (TNF-α), asymmetric dimethylarginine (ADMA), interleukin (IL)-6, IL-10, C-reactive protein, creatine phosphokinase (CPK) and oxidative stress indice measurements. Ultra-marathon runners who presented augmented left ventricular (LV) end diastolic diameters >55 mm had higher ADMA values (1.07±0.07 vs. 0.99±0.08 µmol/ml, P<0.01) and lower CPK values (192.5±21.3 vs. 219.1±37.3 mg/dl, P<0.05) compared with those with normal LV diameters. Runners with a moderate and severe abnormal indexed LV mass >131 g/m2 had statistically significant higher TNF-α values compared with runners, with mildly elevated and a normal LV mass indexed (16.2±1.42 vs. 14.0+1.16 pg/ml, P<0.05). Runners with an abnormal left atrial volume index (LAVI; >29 ml/m2) had higher IL-6 values compared with runners with a normal LAVI (1.09+0.19 vs. 0.99±0.08 pg/ml, P<0.05). ROC curves analysis revealed that ADMA values were able to predict an abnormal LV diameter detected by echocardiography [P<0.05; area under the curve (AUC), 0.763], while TNF-α values could predict an abnormal LV mass in marathon runners (P<0.05; AUC, 0.78). On the whole, the present study demonstrates that, in ultra-marathon runners, cardiovascular adaptations to running are characterized by a specific pattern of changes in inflammatory and endothelial markers, which in turn can be used to predict the occurrence of the observed adaptations.
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Affiliation(s)
| | | | - Antonios Samaras
- Department of Cardiology, General Hospital of Veria, 59100 Veria, Greece
| | | | - Genovefa Kolovou
- Cardiometabolic Center, Metropolitan Hospital, 18547 Piraeus, Greece
| | - Flora Bacopoulou
- Center for Adolescent Medicine and UNESCO Chair on Adolescent Health Care, First Department of Pediatrics, National and Kapodistrian University of Athens, Aghia Sophia Children's Hospital, 11527 Athens, Greece
| | - Demetrios Spandidos
- Laboratory of Clinical Virology, School of Medicine, University of Crete, 71003 Heraklion, Greece
| | - Dimitrios Kouretas
- Department of Biochemistry‑Biotechnology, School of Health Sciences, University of Thessaly, 41500 Larissa, Greece
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Rampidis GP, Kampaktsis PΝ, Kouskouras K, Samaras A, Benetos G, Giannopoulos AΑ, Karamitsos T, Kallifatidis A, Samaras A, Vogiatzis I, Hadjimiltiades S, Ziakas A, Buechel RR, Gebhard C, Smilowitz NR, Toutouzas K, Tsioufis K, Prassopoulos P, Karvounis H, Reynolds H, Giannakoulas G. Role of cardiac CT in the diagnostic evaluation and risk stratification of patients with myocardial infarction and non-obstructive coronary arteries (MINOCA): rationale and design of the MINOCA-GR study. BMJ Open 2022; 12:e054698. [PMID: 35110321 PMCID: PMC8811605 DOI: 10.1136/bmjopen-2021-054698] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
INTRODUCTION Myocardial infarction with non-obstructive coronary arteries (MINOCA) occurs in 5%-15% of all patients with acute myocardial infarction. Cardiac MR (CMR) and optical coherence tomography have been used to identify the underlying pathophysiological mechanism in MINOCA. The role of cardiac CT angiography (CCTA) in patients with MINOCA, however, has not been well studied so far. CCTA can be used to assess atherosclerotic plaque volume, vulnerable plaque characteristics as well as pericoronary fat tissue attenuation, which has not been yet studied in MINOCA. METHODS AND ANALYSIS MINOCA-GR is a prospective, multicentre, observational cohort study based on a national registry that will use CCTA in combination with CMR and invasive coronary angiography (ICA) to evaluate the extent and characteristics of coronary atherosclerosis and its correlation with pericoronary fat attenuation in patients with MINOCA. A total of 60 consecutive adult patients across 4 participating study sites are expected to be enrolled. Following ICA and CMR, patients will undergo CCTA during index hospitalisation. The primary endpoints are quantification of extent and severity of coronary atherosclerosis, description of high-risk plaque features and attenuation profiling of pericoronary fat tissue around all three major epicardial coronary arteries in relation to CMR. Follow-up CCTA for the evaluation of changes in pericoronary fat attenuation will also be performed. MINOCA-GR aims to be the first study to explore the role of CCTA in combination with CMR and ICA in the underlying pathophysiological mechanisms and assisting in diagnostic evaluation and prognosis of patients with MINOCA. ETHICS AND DISSEMINATION The study protocol has been approved by the institutional review board/independent ethics committee at each site prior to study commencement. All patients will provide written informed consent. Results will be disseminated at national meetings and published in peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT4186676.
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Affiliation(s)
- Georgios P Rampidis
- First Department of Cardiology, University General Hospital of Thessaloniki AHEPA, Thessaloniki, Greece
- Cardiac Imaging Unit, Diagnostic Center "PANAGIA", Veroia, Greece
| | | | - Konstantinos Kouskouras
- Department of Radiology, University General Hospital of Thessaloniki AHEPA, Thessaloniki, Greece
| | - Athanasios Samaras
- First Department of Cardiology, University General Hospital of Thessaloniki AHEPA, Thessaloniki, Greece
| | - Georgios Benetos
- First Department of Cardiology, Hippokration Hospital, Athens, Greece
| | - Andreas Α Giannopoulos
- Department of Nuclear Medicine - Cardiac Imaging Unit, University Hospital Zurich, Zurich, Switzerland
| | - Theodoros Karamitsos
- First Department of Cardiology, University General Hospital of Thessaloniki AHEPA, Thessaloniki, Greece
| | | | - Antonios Samaras
- Department of Cardiology, General Hospital of Veroia, Veroia, Greece
| | - Ioannis Vogiatzis
- Department of Cardiology, General Hospital of Veroia, Veroia, Greece
| | - Stavros Hadjimiltiades
- First Department of Cardiology, University General Hospital of Thessaloniki AHEPA, Thessaloniki, Greece
| | - Antonios Ziakas
- First Department of Cardiology, University General Hospital of Thessaloniki AHEPA, Thessaloniki, Greece
| | - Ronny R Buechel
- Department of Nuclear Medicine - Cardiac Imaging Unit, University Hospital Zurich, Zurich, Switzerland
| | - Catherine Gebhard
- Department of Nuclear Medicine - Cardiac Imaging Unit, University Hospital Zurich, Zurich, Switzerland
| | | | | | | | - Panagiotis Prassopoulos
- Department of Radiology, University General Hospital of Thessaloniki AHEPA, Thessaloniki, Greece
| | - Haralambos Karvounis
- First Department of Cardiology, University General Hospital of Thessaloniki AHEPA, Thessaloniki, Greece
| | - Harmony Reynolds
- Sarah Ross Soter Center for Women's Cardiovascular Research, Leon H. Charney Division of Cardiology, Department of Medicine, NYU Grossman School of Medicine, New York, New York, USA
| | - George Giannakoulas
- First Department of Cardiology, University General Hospital of Thessaloniki AHEPA, Thessaloniki, Greece
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Samaras A, Vrana E, Kartas A, Rampidis G, Doundoulakis I, Fotos G, Efthimiadis G, Karvounis H, Tzikas A, Giannakoulas G. Prognostic implications of valvular heart disease in patients with non-valvular atrial fibrillation. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0421] [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
Atrial fibrillation (AF) and valvular heart disease (VHD) are frequently encountered in clinical practice, and often coexist, especially in the elderly population. Both conditions are associated with increased mortality and morbidity. Recent guidelines suggest careful evaluation of patients with AF and VHD due to the puzzling nature of their coexistence.
Purpose
To evaluate the prognostic effect of significant valvular heart disease (sVHD) among patients with non-valvular AF.
Methods
This is a post-hoc analysis of the MISOAC-AF trial (NCT02941978). Consecutive inpatients with non-valvular AF who underwent echocardiography were included. sVHD was defined as the presence of at least moderate aortic stenosis (AS) or aortic/mitral/tricuspid regurgitation (AR/MR/TR). Cox regression analyses with covariate adjustments were used for outcome prediction.
Results
In total, 983 patients with non-valvular AF (median age 76 years) were analyzed over a median follow-up period of 32 months. sVHD was diagnosed in 575 (58.5%) AF patients. sVHD was associated with all-cause mortality (21.6%/yr vs. 1.6%/yr; adjusted HR [aHR] 1.55, 95% confidence interval [CI] 1.17–2.06; p=0.02), cardiovascular mortality (16%/yr vs. 4%/yr; aHR1.70, 95% CI 1.09–2.66; p=0.02) and heart failure-hospitalization (5.8%/yr vs. 1.8%/yr; aHR 2.53, 95% CI 1.35–4.63; p=0.02). The prognostic effect of sVHD was particularly evident in patients aged <80 years and in those without history of heart failure (p for interaction <0.05, in both subgroups) [Figure 1]. After multivariable adjustment, moderate/severe AS and TR were associated with mortality, while AS and MR with heart failure-hospitalization [Figure 2]. AS was the only independent predictor of valve intervention during follow-up (aHR 10.78, 95% CI 4.80–24.22; p<0.001). Mixed aortic valve disease (AS+AR) had superior prognostic power across patterns of combined VHD.
Conclusions
Among patients with non-valvular AF, sVHD was highly prevalent, and beared high prognostic value across a wide spectrum of clinical outcomes. AS, MR, TR and mixed aortic valve disease were associated with worse prognosis.
Funding Acknowledgement
Type of funding sources: None. Subgroup analyses by VHD statusPrognostic impact of valve lesions
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Affiliation(s)
- A Samaras
- Ahepa University Hospital, 1st Cardiology department, Thessaloniki, Greece
| | - E Vrana
- Ahepa University Hospital, 1st Cardiology department, Thessaloniki, Greece
| | - A Kartas
- Ahepa University Hospital, 1st Cardiology department, Thessaloniki, Greece
| | - G Rampidis
- Ahepa University Hospital, 1st Cardiology department, Thessaloniki, Greece
| | - I Doundoulakis
- Ahepa University Hospital, 1st Cardiology department, Thessaloniki, Greece
| | - G Fotos
- Ahepa University Hospital, 1st Cardiology department, Thessaloniki, Greece
| | - G Efthimiadis
- Ahepa University Hospital, 1st Cardiology department, Thessaloniki, Greece
| | - H Karvounis
- Ahepa University Hospital, 1st Cardiology department, Thessaloniki, Greece
| | - A Tzikas
- Ahepa University Hospital, 1st Cardiology department, Thessaloniki, Greece
| | - G Giannakoulas
- Ahepa University Hospital, 1st Cardiology department, Thessaloniki, Greece
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Papazoglou A, Kartas A, Samaras A, Vouloagkas I, Vrana E, Moysidis D, Akrivos E, Kotzampasis G, Papanastasiou A, Baroutidou A, Botis M, Tsagkaris C, Karagiannidis E, Tzikas A, Giannakoulas G. Prognostic significance of diabetes mellitus in patients with atrial fibrillation. Europace 2021. [DOI: 10.1093/europace/euab116.136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Despite the plethora of studies on atrial fibrillation (AF) and diabetes mellitus (DM), there is still no sufficient data on the blood glucose regulation as a prognostic modifier in DM patients with AF.
Purpose
The purpose of this study was to investigate the association of DM and levels of glycated hemoglobin (HbA1c) with outcomes in patients with AF.
Methods
This retrospective cohort study included patients who were recently hospitalized with a primary or secondary diagnosis of AF from December 2015 through June 2018. Kaplan-Meier curves and Cox-regression adjusted hazard ratios (aHR) were calculated for the primary outcome of all-cause mortality and for the secondary outcomes of cardiovascular (CV) mortality, stroke and the composite outcome of CV death or hospitalization. Spline curve models were fitted to investigate associations of HbA1c values and mortality among patients with AF and DM.
Results
In total 1140 AF patients were included, of whom 373 (32.7%) had DM. During a median follow-up of 2.6 years, 414 (37.3%) patients died. The presence of DM was associated with a higher risk of all-cause mortality (aHR = 1.44, 95% confidence intervals [CI]: 1.12-1.85), CV mortality (aHR = 1.44, 95% CI: 1.08-1.93), stroke (aHR = 2.62, 95% CI: 1.24-5.53) and the composite outcome of hospitalization or CV death (aHR = 1.28, 95% CI: 1.06-1.54). In AF patients with comorbid DM, the spline curves showed a positive linear association between HbA1c levels and outcomes, with values <6.2% predicting significantly decreased all-cause and CV mortality.
Conclusions
The presence of DM on top of AF was associated with a 1.5-fold increased risk for all-cause or CV mortality and excess morbidity. HbA1c levels lower than 6.2% were independently related to better survival rates. Follow-up outcomes by presence of DMOutcomeDMNon-DMAdjusted HR(95% CI)p-valueAll-cause death171/373 (45.8%)243/736 (33%)1.44 (1.12-1.85)<0.001CV-death130/373 (34.9%)173/736 (23.5%)1.44 (1.08-1.93)<0.001Major bleeding18/340 (5.3%)29/644 (4.5%)1.53 (0.71-3.28)0.291Stroke24/340 (7.1%)28/645 (4.3%)2.62 (1.24-5.53)0.013AF-related hospitalization59/340 (17.4%)115/645 (17.8%)1.20 (0.78-1.85)0.281HF-related hospitalization35/333 (10.5%)46/640 (7.2%)1.34 (0.83-2.19)0.235Hospitalization or CV-death243/373 (65.1%)399/736(54.2%)1.28 (1.06-1.54)<0.001*Adjusted for: age, gender, smoking, BMI, history of hypertension, eGFR (CKD-EPI) and use of statin, ACEI-ARB, OAC and rate control medication after discharge.DM, diabetes mellitus; HR, hazard ratio; AF, atrial fibrillation; CV, cardiovascular; HF, heart failure.Abstract Figure. Visual overview of the study
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Affiliation(s)
- A Papazoglou
- University General Hospital of Thessaloniki AHEPA, Thessaloniki, Greece
| | - A Kartas
- University General Hospital of Thessaloniki AHEPA, Thessaloniki, Greece
| | - A Samaras
- University General Hospital of Thessaloniki AHEPA, Thessaloniki, Greece
| | - I Vouloagkas
- University General Hospital of Thessaloniki AHEPA, Thessaloniki, Greece
| | - E Vrana
- University General Hospital of Thessaloniki AHEPA, Thessaloniki, Greece
| | - D Moysidis
- University General Hospital of Thessaloniki AHEPA, Thessaloniki, Greece
| | - E Akrivos
- Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - G Kotzampasis
- University General Hospital of Thessaloniki AHEPA, Thessaloniki, Greece
| | - A Papanastasiou
- University General Hospital of Thessaloniki AHEPA, Thessaloniki, Greece
| | - A Baroutidou
- University General Hospital of Thessaloniki AHEPA, Thessaloniki, Greece
| | - M Botis
- University General Hospital of Thessaloniki AHEPA, Thessaloniki, Greece
| | | | - E Karagiannidis
- University General Hospital of Thessaloniki AHEPA, Thessaloniki, Greece
| | - A Tzikas
- University General Hospital of Thessaloniki AHEPA, Thessaloniki, Greece
| | - G Giannakoulas
- University General Hospital of Thessaloniki AHEPA, Thessaloniki, Greece
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8
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Tsagkaris C, Kartas A, Samaras A, Papazoglou A, Moysidis D, Vrana E, Vouloagkas I, Papanastasiou A, Kotzampasis G, Baroutidou A, Karagiannidis E, Louka AM, Matiashova L, Tzikas A, Giannakoulas G. Polypharmacy and major adverse events in atrial fibrillation. Europace 2021. [DOI: 10.1093/europace/euab116.187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Polypharmacy has been defined as the daily use of more than 4 drugs, by an individual, regardless of the condition(s) they have been prescribed for and their efficacy. The burden of polypharmacy pertains to adverse drug reactions, disability, frequent and longtime hospitalization and long-term mortality. The prevalence of polypharmacy exceeds 10% in most adult age groups and particularly in the elderly. At the same time, atrial fibrillation (AF) is the most prevalent sustained cardiac arrhythmia, afflicting more than 8% of the elderly and those with multiple comorbidities.
Purpose
The purpose of this study was to examine the association between the presence of polypharmacy and outcomes among AF patients.
Methods
This is a retrospective analysis among 1140 patients enrolled in the MISOAC-AF trial. All cause- and cardiovascular- mortality have been defined as primary endpoints. Independent clinical predictors of polypharmacy and of major adverse outcomes were identified via bootstrapped multivariate logistic and Cox regression analysis, respectively.
Results
The mean number of prescribed medications at patients’ discharge was 3.9 ± 1.6 and polypharmacy (use of more than 4 medications daily) was found in 36.9% of the patients. Smoking (p = 0.036), dyslipidemia (p < 0.001), coronary artery disease (p < 0.001), heart failure (HF; p = 0.003) and chronic kidney disease (p < 0.001) were independent predictors of polypharmacy among AF paients. Kaplan–Meier survival analysis showed that AF patients with polypharmacy have significantly greater risk of CV death (p = 0.040), while Cox regression analysis indicated polypharmacy as an independent predictor for all-cause and CV- mortality [adjusted hazard ratios: 1.31(1.03 - 1.67) and 1.39(1.05 - 1.84), respectively] and for the composite outcome of AF- or HF- related hospitalization or CV death [adjusted hazard ratio: 1.31 (1.05 - 1.63)].
Conclusion
This study highlights the implications of polypharmacy in the context of AF, a prevalent, chronic, life-threatening condition. Investigating polypharmacy is quite relevant in the era of pharmacovigilance, contributing to rational pharmacotherapy with regard to cardiovascular conditions and beyond. Abstract Figure. Mortality rates by polypharmacy presence
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Affiliation(s)
| | - A Kartas
- University General Hospital of Thessaloniki, AHEPA, Thessaloniki, Greece
| | - A Samaras
- University General Hospital of Thessaloniki, AHEPA, Thessaloniki, Greece
| | - A Papazoglou
- University General Hospital of Thessaloniki, AHEPA, Thessaloniki, Greece
| | - D Moysidis
- University General Hospital of Thessaloniki, AHEPA, Thessaloniki, Greece
| | - E Vrana
- University General Hospital of Thessaloniki, AHEPA, Thessaloniki, Greece
| | - I Vouloagkas
- University General Hospital of Thessaloniki, AHEPA, Thessaloniki, Greece
| | - A Papanastasiou
- University General Hospital of Thessaloniki, AHEPA, Thessaloniki, Greece
| | - G Kotzampasis
- University General Hospital of Thessaloniki, AHEPA, Thessaloniki, Greece
| | - A Baroutidou
- University General Hospital of Thessaloniki, AHEPA, Thessaloniki, Greece
| | - E Karagiannidis
- University General Hospital of Thessaloniki, AHEPA, Thessaloniki, Greece
| | - A-M Louka
- Novel Global Community Educational Foundation, Hebersham, Australia
| | - L Matiashova
- Government Institution L.T. Malaya Therapy National Institute of the National Academy of Medical Sci, Kharkiv, Ukraine
| | - A Tzikas
- University General Hospital of Thessaloniki, AHEPA, Thessaloniki, Greece
| | - G Giannakoulas
- University General Hospital of Thessaloniki, AHEPA, Thessaloniki, Greece
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9
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Mpotis M, Kartas A, Samaras A, Akrivos E, Vrana E, Liampas E, Papazoglou A, Moysidis D, Papanastasiou A, Baroutidou A, Karvounis H, Tzikas A, Giannakoulas G. Digoxin and association with mortality in patients discharged from hospital with atrial fibrillation, with or without heart failure. Europace 2021. [DOI: 10.1093/europace/euab116.183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
OnBehalf
MISOAC- AF study group
BACKGROUND
Digoxin is widely used in atrial fibrillation (AF) and heart failure (AF). However, established evidence is conflicting regarding its association with clinical outcomes.
AIM
To investigate the relation between digoxin and adverse outcomes in patients with AF, with or without HF, in a contemporary AF cohort.
METHODS
We performed a retrospective analysis of data from 698 patients, originating from the MISOAC- AF (Motivational Interviewing to Support Oral AntiCoagulation Adherence in patients with non-valvular Atrial Fibrillation) trial, and followed over a median of 2.5 years. HF was denoted at baseline. The primary outcome was all-cause mortality and the secondary outcome was all-cause hospitalization, in a time-to-event analysis. Propensity scores were used to derive matched populations, balanced on key baseline covariates. To limit potential confounding, we also implemented inverse probability of treatment weighting (IPTW) analysis.
RESULTS
Among patients with HF, 10.5% (n = 39) were administered digoxin at baseline, whereas 89.5% (n = 331) were not. Digoxin administration was not associated with an increased risk of death (hazard ratio (HR) in the digoxin group, 1.21; 95% Confidence Interval (CI), 0.69 to 2.13, p = 0.5) or hospitalization of any cause (HR 1.15; 95% CI, 0.67 to 1.96; p = 0.6). Among patients without HF, 3.5% (n = 11) were administered digoxin, with neutral effects on all-cause mortality (HR: 3.25; 95% CI, 0.98 to 10.70), p = 0.06) and all-cause hospitalization (HR, 1.15; 95% CI, 0.67 to 1.96, p = 0.60). Consistent qualitatively results were observed using IPTW.
CONCLUSIONS
Among patients with AF, digoxin administration was not associated with an increased risk of death and hospitalization of any cause, irrespective of HF status. Abstract Figure.
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Affiliation(s)
- M Mpotis
- 251 Hellenic Air Force General Hospital, Athens, Greece
| | - A Kartas
- Ahepa General Hospital of Aristotle University, First Department of Cardiology, Thessaloniki, Greece
| | - A Samaras
- Ahepa General Hospital of Aristotle University, First Department of Cardiology, Thessaloniki, Greece
| | - E Akrivos
- Aristotle University of Thessaloniki, Laboratory of Computing, Medical Informatics and Biomedical Imaging Technologies, Thessaloniki, Greece
| | - E Vrana
- Ahepa General Hospital of Aristotle University, First Department of Cardiology, Thessaloniki, Greece
| | - E Liampas
- Ahepa General Hospital of Aristotle University, First Department of Cardiology, Thessaloniki, Greece
| | - A Papazoglou
- Ahepa General Hospital of Aristotle University, First Department of Cardiology, Thessaloniki, Greece
| | - D Moysidis
- Ahepa General Hospital of Aristotle University, First Department of Cardiology, Thessaloniki, Greece
| | - A Papanastasiou
- Ahepa General Hospital of Aristotle University, First Department of Cardiology, Thessaloniki, Greece
| | - A Baroutidou
- Ahepa General Hospital of Aristotle University, First Department of Cardiology, Thessaloniki, Greece
| | - H Karvounis
- Ahepa General Hospital of Aristotle University, First Department of Cardiology, Thessaloniki, Greece
| | - A Tzikas
- Interbalkan Medical Center, Thessaloniki, Greece
| | - G Giannakoulas
- Ahepa General Hospital of Aristotle University, First Department of Cardiology, Thessaloniki, Greece
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10
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Kartas A, Samaras A, Vasdeki D, Dividis G, Fotos G, Paschou E, Forozidou E, Tsoukra P, Kotsi E, Goulas I, Karagiannidis E, Karvounis H, Tzikas A, Giannakoulas G. Mortality in patients with atrial fibrillation with or without heart failure following hospital discharge. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0362] [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
The association of heart failure (HF) with the prognosis of atrial fibrillation (AF) remains unclear.
OBJECTIVES
To assess all-cause mortality in patients following hospitalization with comorbid AF in relation to the presence of HF.
Methods
We performed a cross-sectional analysis of data from 977 patients discharged from the cardiology ward of a single tertiary center between 2015 and 2018 and followed for a median of 2 years. The association between HF and the primary endpoint of death from any cause was assessed using multivariable Cox regression.
Results
HF was documented in 505 (51.7%) of AF cases at discharge, including HFrEF (17.9%), HFmrEF (16.5%) and HFpEF (25.2%). A primary endpoint event occurred in 212 patients (42%) in the AF-HF group and in 86 patients (18.2%) in the AF-no HF group (adjusted hazard ratio [aHR] 2.27; 95% confidence interval [CI], 1.65 to 3.13; P<0.001). HF was associated with a higher risk of the composite secondary endpoint of death from any cause, AF or HF-specific hospitalization (aHR 1.69; 95% CI 1.32 to 2.16 p<0.001). The associations of HF with the primary and secondary endpoints were significant and similar for AF-HFrEF, AF-HFmrEF, AF-HFpEF.
Conclusions
HF was present in half of the patients discharged from the hospital with comorbid AF. The presence of HF on top of AF was independently associated with a significantly higher risk of all-cause mortality than did absence of HF, irrespective of HF subtype.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- A Kartas
- Ahepa University Hospital, Cardiology, Thessaloniki, Greece
| | - A Samaras
- Ahepa University Hospital, Cardiology, Thessaloniki, Greece
| | - D Vasdeki
- Ahepa University Hospital, Cardiology, Thessaloniki, Greece
| | - G Dividis
- Ahepa University Hospital, Cardiology, Thessaloniki, Greece
| | - G Fotos
- Ahepa University Hospital, Cardiology, Thessaloniki, Greece
| | - E Paschou
- Ahepa University Hospital, Cardiology, Thessaloniki, Greece
| | - E Forozidou
- Ahepa University Hospital, Cardiology, Thessaloniki, Greece
| | - P Tsoukra
- Ahepa University Hospital, Cardiology, Thessaloniki, Greece
| | - E Kotsi
- Ahepa University Hospital, Cardiology, Thessaloniki, Greece
| | - I Goulas
- Ahepa University Hospital, Cardiology, Thessaloniki, Greece
| | | | - H Karvounis
- Ahepa University Hospital, Cardiology, Thessaloniki, Greece
| | - A Tzikas
- Ahepa University Hospital, Cardiology, Thessaloniki, Greece
| | - G Giannakoulas
- Ahepa University Hospital, Cardiology, Thessaloniki, Greece
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11
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Tzikas A, Samaras A, Kartas A, Vasdeki D, Fotos G, Dividis G, Paschou E, Forozidou E, Tsoukra P, Kotsi E, Goulas I, Karvounis H, Giannakoulas G. Motivational Interviewing to Support Oral AntiCoagulation adherence in patients with non-valvular Atrial Fibrillation (MISOAC-AF): a randomised clinical trial. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0641] [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
Oral anticoagulation (OAC) is paramount to effective thromboprophylaxis; yet adherence to OAC remains largely suboptimal in patients with atrial fibrillation (AF).
Purpose
We aimed to assess the impact of an educational, motivational intervention on the adherence to OAC in patients with non-valvular AF.
Methods
Hospitalised patients with non-valvular AF who received OAC were randomly assigned to usual medical care or a proactive intervention, comprising motivational interviewing and tailored counseling on medication adherence. The primary study outcome was adherence to OAC at 1-year, evaluated as Proportion of Days Covered (PDC) by OAC regimens and assessed through nationwide prescription registers. Secondary outcomes included the rate of persistence to OAC, gaps in treatment, proportion of VKA-takers with labile INR (defined as time to therapeutic range<70%) and clinical events.
Results
A total of 1009 patients were randomised, 500 in the intervention group and 509 in the control group. At 1-year follow-up, 77.2% (386/500) of patients in the intervention group had good adherence (PDC>80%), compared with 55% (280/509) in the control group (adjusted odds ratio 2.84, 95% confidence interval 2.14–3.75; p<0.001). Mean PDC±SD was 0.85±0.26 and 0.75±0.31, respectively (p<0.001). Patients that received the intervention were more likely to persist in their OAC therapy at 1 year, while usual medical care was associated with more major (≥3 months) treatment gaps [Figure]. Among 212 VKA-takers, patients in the intervention group were less likely to have labile INR compared with those in the control group [21/120 (17.1%) vs 34/92 (37.1%), OR 0.33 95% CI 1.15–0.72, p=0.005]. Clinical events over a median follow-up period of 2 years occurred at a numerically lower, yet non-significant, rate in the intervention group [Table].
Conclusions
In patients receiving OAC therapy for non-valvular AF, a motivational intervention significantly improved patterns of medication adherence, without significantly affecting clinical outcomes.
Primary and secondary outcomes
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- A Tzikas
- Ahepa University Hospital, 1st Cardiology department, Thessaloniki, Greece
| | - A Samaras
- Ahepa University Hospital, 1st Cardiology department, Thessaloniki, Greece
| | - A Kartas
- Ahepa University Hospital, 1st Cardiology department, Thessaloniki, Greece
| | - D Vasdeki
- Ahepa University Hospital, 1st Cardiology department, Thessaloniki, Greece
| | - G Fotos
- Ahepa University Hospital, 1st Cardiology department, Thessaloniki, Greece
| | - G Dividis
- Ahepa University Hospital, 1st Cardiology department, Thessaloniki, Greece
| | - E Paschou
- Ahepa University Hospital, 1st Cardiology department, Thessaloniki, Greece
| | - E Forozidou
- Ahepa University Hospital, 1st Cardiology department, Thessaloniki, Greece
| | - P Tsoukra
- Ahepa University Hospital, 1st Cardiology department, Thessaloniki, Greece
| | - E Kotsi
- Ahepa University Hospital, 1st Cardiology department, Thessaloniki, Greece
| | - I Goulas
- Ahepa University Hospital, 1st Cardiology department, Thessaloniki, Greece
| | - H Karvounis
- Ahepa University Hospital, 1st Cardiology department, Thessaloniki, Greece
| | - G Giannakoulas
- Ahepa University Hospital, 1st Cardiology department, Thessaloniki, Greece
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12
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Samaras A, Kartas A, Vasdeki D, Dividis G, Forozidou E, Fotos G, Kotsi E, Paschou E, Tsoukra P, Goulas I, Karvounis H, Giannakoulas G, Tzikas A. Rationale and design of a randomized study comparing Motivational Interviewing to Support Oral Anticoagulation adherence versus usual care in patients with nonvalvular atrial fibrillation: The MISOAC-AF trial. Hellenic J Cardiol 2020; 61:453-454. [PMID: 32259588 DOI: 10.1016/j.hjc.2020.02.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 02/18/2020] [Accepted: 02/27/2020] [Indexed: 02/05/2023] Open
Affiliation(s)
- A Samaras
- First Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, St. Kiriakidi 1, 54636, Thessaloniki, Greece
| | - A Kartas
- First Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, St. Kiriakidi 1, 54636, Thessaloniki, Greece
| | - D Vasdeki
- First Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, St. Kiriakidi 1, 54636, Thessaloniki, Greece
| | - G Dividis
- First Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, St. Kiriakidi 1, 54636, Thessaloniki, Greece
| | - E Forozidou
- First Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, St. Kiriakidi 1, 54636, Thessaloniki, Greece
| | - G Fotos
- First Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, St. Kiriakidi 1, 54636, Thessaloniki, Greece
| | - E Kotsi
- First Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, St. Kiriakidi 1, 54636, Thessaloniki, Greece
| | - E Paschou
- First Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, St. Kiriakidi 1, 54636, Thessaloniki, Greece
| | - P Tsoukra
- First Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, St. Kiriakidi 1, 54636, Thessaloniki, Greece
| | - I Goulas
- First Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, St. Kiriakidi 1, 54636, Thessaloniki, Greece
| | - H Karvounis
- First Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, St. Kiriakidi 1, 54636, Thessaloniki, Greece
| | - G Giannakoulas
- First Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, St. Kiriakidi 1, 54636, Thessaloniki, Greece
| | - A Tzikas
- First Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, St. Kiriakidi 1, 54636, Thessaloniki, Greece; Interbalkan European Medical Center, Asklipiou 10, Pylaia, Thessaloniki, Greece.
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13
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Samaras A, Kartas A, Fotos G, Vasdeki D, Dividis G, Paschou E, Tsoukra P, Forozidou E, Kotsi E, Goulas I, Karvounis H, Giannakoulas G, Tzikas A. P1869A novel risk score to predict mortality in patients with atrial fibrillation: the BLACCK (AF) death risk score. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0619] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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
Prior risk stratification schemes for atrial fibrillation (AF) have extensively focused on stroke as the principal outcome. However, an accurate estimation of the risk of death in patients with AF has received disproportional attention.
Purpose
The aim of this study was to develop and validate a risk score for predicting mortality in patients with AF who underwent a hospitalization for cardiac reasons.
Methods
The new risk score was developed and internally validated in 887 patients with AF, who were followed up for a median of 2 years. The outcome measure was all-cause mortality. Biomarker samples, echocardiographic data and renal function values were obtained at the date closest to hospital discharge. A Cox-model that determined the variables that significantly contributed to the prediction of all-cause mortality, was adapted to a risk points system through weighting of the model coefficients. The model was internally validated by bootstrapping, assessing both discrimination and calibration.
Results
311 all-cause deaths were reported during 1755 person-years of follow-up (incidence rate 17.7 events per 100 person-years). The most important predictors of death were N-terminal pro B-type natriuretic peptide (NT-proBNP), high-sensitivity troponin-T (hs-TnT), left atrial area indexed to body surface area (LAAi), prior cardiac arrest, kidney impairment, congestive heart failure and age, and were included in the BLACCK (AF) death risk score. The score was well-calibrated (observed probabilities adjusted to predicted probabilities) and showed good discriminative ability [c-index 0.87 (95% CI 0.85–0.90)]. The internal validation of the score reported minimal over-fitting (optimism-corrected c-index of 0.85). The 1, 2 and 3-year risk of death derived by the score's total points may be calculated immediately through the nomogram (Figure 1).
BLACCK (AF) risk score nomogram
Conclusions
We developed a simple, well-calibrated and internally validated novel risk score for predicting 1, 2 and 3-year risk of death in patients with AF after a hospitalization for cardiac reasons. The BLACCK (AF) death risk score included both cardiac biomarkers and clinical information, performed well and may assist physicians in decision-making when treating patients with AF.
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Affiliation(s)
- A Samaras
- Ahepa University Hospital, 1st Cardiology department, Thessaloniki, Greece
| | - A Kartas
- Ahepa University Hospital, 1st Cardiology department, Thessaloniki, Greece
| | - G Fotos
- Ahepa University Hospital, 1st Cardiology department, Thessaloniki, Greece
| | - D Vasdeki
- Ahepa University Hospital, 1st Cardiology department, Thessaloniki, Greece
| | - G Dividis
- Ahepa University Hospital, 1st Cardiology department, Thessaloniki, Greece
| | - E Paschou
- Ahepa University Hospital, 1st Cardiology department, Thessaloniki, Greece
| | - P Tsoukra
- Ahepa University Hospital, 1st Cardiology department, Thessaloniki, Greece
| | - E Forozidou
- Ahepa University Hospital, 1st Cardiology department, Thessaloniki, Greece
| | - E Kotsi
- Ahepa University Hospital, 1st Cardiology department, Thessaloniki, Greece
| | - I Goulas
- Ahepa University Hospital, 1st Cardiology department, Thessaloniki, Greece
| | - H Karvounis
- Ahepa University Hospital, 1st Cardiology department, Thessaloniki, Greece
| | - G Giannakoulas
- Ahepa University Hospital, 1st Cardiology department, Thessaloniki, Greece
| | - A Tzikas
- Ahepa University Hospital, 1st Cardiology department, Thessaloniki, Greece
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14
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Paschou E, Samaras A, Goulas I, Dividis G, Fotos G, Vasdeki D, Forozidou E, Tsoukra P, Kotsi E, Kartas A, Karvounis H, Tzikas A, Giannakoulas G. P6232ABC-death risk score predicts mortality better than CHA2DS2-VASc score in a contemporary population of hospitalised patients with atrial fibrillation. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p6232] [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: 11/15/2022] Open
Affiliation(s)
- E Paschou
- AHEPA General Hospital, Thessaloniki, Greece
| | - A Samaras
- AHEPA General Hospital, Thessaloniki, Greece
| | - I Goulas
- AHEPA General Hospital, Thessaloniki, Greece
| | - G Dividis
- AHEPA General Hospital, Thessaloniki, Greece
| | - G Fotos
- AHEPA General Hospital, Thessaloniki, Greece
| | - D Vasdeki
- AHEPA General Hospital, Thessaloniki, Greece
| | - E Forozidou
- AHEPA General Hospital, Thessaloniki, Greece
| | - P Tsoukra
- AHEPA General Hospital, Thessaloniki, Greece
| | - E Kotsi
- AHEPA General Hospital, Thessaloniki, Greece
| | - A Kartas
- AHEPA General Hospital, Thessaloniki, Greece
| | - H Karvounis
- AHEPA General Hospital, Thessaloniki, Greece
| | - A Tzikas
- AHEPA General Hospital, Thessaloniki, Greece
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Samaras A, Efthimiou K, Roumeliotis E, Karaoglanidis G. Biocontrol potential and plant-growth-promoting effects of Bacillus amyloliquefaciens MBI 600 against Fusarium oxysporum f. sp. radicis-lycopersici on tomato. ACTA ACUST UNITED AC 2018. [DOI: 10.17660/actahortic.2018.1207.18] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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16
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Samaras A, Fotos G, Dividis G, Paschou E, Thomaidou E, Goulas J, Vasdeki D, Forozidou E, Tsoukra P, Kotsi E, Kartas A, Giannakoulas G, Karvounis H, Tzikas A. P386Factors associated with the prescription practices of non-vitamin K antagonists in non valvular atrial fibrillation in daily clinical practice. Europace 2018. [DOI: 10.1093/europace/euy015.197] [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: 11/13/2022] Open
Affiliation(s)
- A Samaras
- Ahepa University Hospital, 1st Cardiology department , Thessaloniki, Greece
| | - G Fotos
- Ahepa University Hospital, 1st Cardiology department , Thessaloniki, Greece
| | - G Dividis
- Ahepa University Hospital, 1st Cardiology department , Thessaloniki, Greece
| | - E Paschou
- Ahepa University Hospital, 1st Cardiology department , Thessaloniki, Greece
| | - E Thomaidou
- Ahepa University Hospital, 1st Cardiology department , Thessaloniki, Greece
| | - J Goulas
- Ahepa University Hospital, 1st Cardiology department , Thessaloniki, Greece
| | - D Vasdeki
- Ahepa University Hospital, 1st Cardiology department , Thessaloniki, Greece
| | - E Forozidou
- Ahepa University Hospital, 1st Cardiology department , Thessaloniki, Greece
| | - P Tsoukra
- Ahepa University Hospital, 1st Cardiology department , Thessaloniki, Greece
| | - E Kotsi
- Ahepa University Hospital, 1st Cardiology department , Thessaloniki, Greece
| | - A Kartas
- Ahepa University Hospital, 1st Cardiology department , Thessaloniki, Greece
| | - G Giannakoulas
- Ahepa University Hospital, 1st Cardiology department , Thessaloniki, Greece
| | - H Karvounis
- Ahepa University Hospital, 1st Cardiology department , Thessaloniki, Greece
| | - A Tzikas
- Ahepa University Hospital, 1st Cardiology department , Thessaloniki, Greece
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17
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Skandalos I, Hatzibaloglou A, Evagelou I, Ntitsias T, Samaras A, Visvardis G, Mavromatidis K, Karamoshos K. Deviations of Placement / Function of Permanent Central Vein Catheters for Hemodialysis. Int J Artif Organs 2018; 28:583-90. [PMID: 16015568 DOI: 10.1177/039139880502800607] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [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: 11/16/2022]
Abstract
Fourteen cases of malposition of a permanent central vein catheter for hemodialysis or poor blood flow associated with thrombosed central veins but correct catheter positioning, in 13 patients suffering from end stage renal disease, presented from September 1991 to December 2003 among 385 permanent central vein catheters for hemodialysis (3.6%). There were 8 episodes of catheter tip malplacement in the azygos vein (1 case), hemiazygos vein (1), left internal thoracic (mammalian) vein (1), contralateral innominate vein (5) and 6 cases with correct anatomical catheter tip placement but with blood inflow from the catheter through the collateral vein system because of thrombosis of a major vein trunk (hemiazygos vein system (2), azygos vein (2), ascending lumbar veins (1), or portal vein system (1)). The malposition was diagnosed using roentgenography, with or without contrast, and computer tomography. In 3 cases the catheter was removed, in 5 cases the position was corrected. In the remaining 6 cases its function was maintained using anticoagulation or/and thrombolytic therapy. In conclusion, the placement of a permanent central vein catheter for hemodialysis must be followed by simple or contrast medium x-ray evaluation of its correct position or function. The malposition must be corrected whereas in the case where there is no alternative solution the function of the catheter may be maintained in the incorrect position using a combination of anticoagulation or/and thrombolytic therapy.
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Affiliation(s)
- I Skandalos
- Second Surgical Department, General Hospital Papageorgiou, Thessaloniki, Greece.
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18
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Chalikias G, Samaras A, Kikas P, Thomaidis A, Drosos I, Konstantinides S, Tziakas D. P6300Novel echocardiographic prognostic markers for cardiac tamponade in patients with large malignant pericardial effusions. A paradigm shift from flow to tissue imaging. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx493.p6300] [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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19
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Chalikias G, Samaras A, Ziakas A, Kikas P, Thomaidis A, Drosos I, Giannakoulas G, Karvounis H, Konstantinides S, Tziakas D. Novel echocardiographic prognostic markers for cardiac tamponade in patients with large malignant pericardial effusions: A paradigm shift from flow to tissue imaging. Echocardiography 2017; 34:1315-1323. [PMID: 28685870 DOI: 10.1111/echo.13620] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND With this study, we sought to investigate the prognostic value of echocardiographic tissue imaging markers in predicting tamponade among patients with large malignant pericardial effusion compared to routinely used echocardiographic signs. METHODS A total of 96 consecutive patients with large malignant pericardial effusion, not in clinical cardiac tamponade, underwent an echocardiographic examination and were prospectively assessed for 1 month. Clinically evident cardiac tamponade was considered as the study endpoint. The prognostic performance of tricuspid valve annular plane systolic excursion (TAPSE) and peak systolic annular velocity at the lateral margin of the tricuspid valve annulus (STV ) was assessed and compared to routinely used imaging signs. RESULTS During follow-up, 37 patients (39%) developed clinically evident cardiac tamponade. TAPSE (area under the curve [AUC] 0.958) and STV (AUC 0.948) had excellent predictive accuracy for tamponade. Multivariate analysis showed that TAPSE (Hazard ratio [HR] 3.03; 95% CI 1.60-5.73, P=.001) and STV (HR 1.17; 95% CI 1.05-1.29, P=.005) remained independent significant predictors of cardiac tamponade. Reclassification analysis and decision curve analysis showed additive prognostic value and adjunct clinical benefit of these markers when added to a recently published triage pericardiocentesis score. CONCLUSION Echocardiographic tissue imaging markers such as TAPSE and STV are characterized by an excellent prognostic ability for development of cardiac tamponade and better prognostic value compared to routine echocardiographic signs in patients with large malignant pericardial effusion. Incorporating these markers to a recent triage pericardiocentesis score resulted in additional prognostic value and increased clinical benefit.
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Affiliation(s)
- George Chalikias
- Cardiology Department, University Hospital of Alexandroupolis, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Antonios Samaras
- Cardiology Department, University Hospital of Alexandroupolis, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Antonios Ziakas
- First Cardiology Department, AHEPA University Hospital, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Petros Kikas
- Cardiology Department, University Hospital of Alexandroupolis, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Adina Thomaidis
- Cardiology Department, University Hospital of Alexandroupolis, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Ioannis Drosos
- Cardiology Department, University Hospital of Alexandroupolis, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - George Giannakoulas
- First Cardiology Department, AHEPA University Hospital, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Haralambos Karvounis
- First Cardiology Department, AHEPA University Hospital, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Stavros Konstantinides
- Cardiology Department, University Hospital of Alexandroupolis, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Dimitrios Tziakas
- Cardiology Department, University Hospital of Alexandroupolis, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
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20
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Samaras A, Dimitroglou A, Sarropoulou E, Papaharisis L, Kottaras L, Pavlidis M. Repeatability of cortisol stress response in the European sea bass (Dicentrarchus labrax) and transcription differences between individuals with divergent responses. Sci Rep 2016; 6:34858. [PMID: 27703277 PMCID: PMC5050510 DOI: 10.1038/srep34858] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [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: 02/18/2016] [Accepted: 09/05/2016] [Indexed: 11/09/2022] Open
Abstract
Understanding the stress responses of organisms is of importance in the performance and welfare of farmed animals, including fish. Especially fish in aquaculture commonly face stressors, and better knowledge of their responses may assist in proper husbandry and selection of breeding stocks. European sea bass (Dicentrarchus labrax), a species with high cortisol concentrations, is of major importance in this respect. The main objectives of the present study were to assess the repeatability and consistency of cortisol stress response and to identify differences in liver transcription profiles of European sea bass individuals, showing a consistent low (LR) or high (HR) cortisol response. The progeny of six full sib families was used, and sampled for plasma cortisol after an acute stress challenge once per month, for four consecutive months. Results suggest that cortisol responsiveness was a repeatable trait with LR and HR fish showing low or high resting, free and post-stress cortisol concentrations respectively. Finally, the liver transcription profiles of LR and HR fish showed some important differences, indicating differential hepatic regulation between these divergent phenotypes. These transcription differences were related to various metabolic and immunological processes, with 169 transcripts being transcribed exclusively in LR fish and 161 exclusively in HR fish.
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Affiliation(s)
- A Samaras
- Department of Biology, University of Crete, Heraklion, Crete, Greece
| | - A Dimitroglou
- Research and Development Department, Nireus Aquaculture S.A., Greece
| | - E Sarropoulou
- Institute of Marine Biology, Biotechnology and Aquaculture, Hellenic Centre for Marine Research, Heraklion, Greece
| | - L Papaharisis
- Research and Development Department, Nireus Aquaculture S.A., Greece
| | - L Kottaras
- Research and Development Department, Nireus Aquaculture S.A., Greece
| | - M Pavlidis
- Department of Biology, University of Crete, Heraklion, Crete, Greece
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Lika K, Pavlidis M, Mitrizakis N, Samaras A, Papandroulakis N. Do experimental units of different scale affect the biological performance of European sea bass Dicentrarchus labrax larvae? J Fish Biol 2015; 86:1271-85. [PMID: 25846855 DOI: 10.1111/jfb.12636] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Accepted: 12/22/2014] [Indexed: 05/10/2023]
Abstract
The effects of different tank volumes (2000, 500 and 40 l) on European sea bass Dicentrarchus labrax larval rearing, relating to growth, survival, quality and stress variables, were investigated. A dynamic energy budget (DEB) model was used to analyse the results. The hydrodynamics of the tanks exhibited differences, with the water currents in the 2000 l tanks to be almost one order of magnitude stronger than those in the 40 l ones. Important differences in fish growth were observed between small and large tank-rearing volumes, with the smallest tank resulting in the slowest growth. Based on the DEB model analysis, growth differences were related to feeding rates, with growth in the smaller tank limited by food availability. Differences in survival rates were not statistically significant among the tank-rearing volumes. The quality evaluation of the fry (in terms of swimbladder, jaw and skeletal abnormalities) showed differences, with the smallest tank having the highest percentage of deformed individuals. This could be attributed to both the feeding variances and the hydrodynamics in the tanks. No differences were observed in terms of whole-body cortisol at the two developmental stages; flexion, and when the larvae body was fully covered by melanophores; when analysis was performed. This indicates that the allostatic load exerted on fish of different groups was similar and inside the fish-coping abilities range, in terms of the cortisol response axis. The selection of the experimental scale is of importance, especially when the results are to be transferred and applied on an industrial scale.
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Affiliation(s)
- K Lika
- Department of Biology, University of Crete, 70013 Heraklion, Greece
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Samaras A, Tsarouhas K, Paschalidis E, Giamouzis G, Triposkiadis F, Tsitsimpikou C, Becker AT, Goutzourelas N, Kouretas D. Effect of a special carbohydrate-protein bar and tomato juice supplementation on oxidative stress markers and vascular endothelial dynamics in ultra-marathon runners. Food Chem Toxicol 2014; 69:231-6. [PMID: 24705018 DOI: 10.1016/j.fct.2014.03.029] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2014] [Revised: 03/21/2014] [Accepted: 03/22/2014] [Indexed: 02/07/2023]
Abstract
It is well established that exercise induces excessive production of reactive species leading to oxidative stress, which has been implicated in oxidative damage of macromolecules, immune dysfunction, muscle damage and fatigue. The present study examined the effect of supplementation of ultra-marathon runners for a two-months-period with a special whey protein bar containing carbohydrates and protein in a specific ratio (1:1) (N=16), prepared using as starting material the by-products of cheese manufacturing, and supplementation with commercially available tomato juice (N=15). Thiobarbituric-acid reactive substances and protein carbonyls were significantly decreased in both supplementation groups, while a pronounced increased in reduced glutathione was observed in the protein bar group. Total anti-oxidant activity remained unchanged in both groups. Flow-mediated dilatation, used as an estimate of endothelial function, was increased in both groups, with a significant rise observed only in the tomato juice administration group. In conclusion, supplementation of ultra marathon runners for a two-months-period with a special protein bar and tomato juice significantly improved the oxidative status of the subjects, while tomato juice also improved vascular endothelial function in these athletes.
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Affiliation(s)
- Antonios Samaras
- Cardiology Department, General Hospital of Giannitsa, End of Semertzidi, Giannitsa 58100, Greece.
| | - Konstantinos Tsarouhas
- Cardiology Department, General Hospital of Karditsa, End of Tayropos str, Karditsa 43100, Greece.
| | - Eleftherios Paschalidis
- Cardiology Department, General Hospital of Giannitsa, End of Semertzidi, Giannitsa 58100, Greece.
| | - Grigorios Giamouzis
- Department of Cardiology, University Hospital of Larissa, School of Medicine, University of Thessaly, Mezourlo, Larissa 41110, Greece.
| | - Filippos Triposkiadis
- Department of Cardiology, University Hospital of Larissa, School of Medicine, University of Thessaly, Mezourlo, Larissa 41110, Greece.
| | | | - Aphrodite Tousia Becker
- Department of Biochemistry and Biotechnology, University of Thessaly, Ploutonos 26 & Aiolou, Larissa 41221, Greece.
| | - Nikolaos Goutzourelas
- Department of Biochemistry and Biotechnology, University of Thessaly, Ploutonos 26 & Aiolou, Larissa 41221, Greece.
| | - Demetrios Kouretas
- Department of Biochemistry and Biotechnology, University of Thessaly, Ploutonos 26 & Aiolou, Larissa 41221, Greece.
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Undevia-Yedavalli N, Dandade N, Luu T, Samaras A, Sartor O, Nonzee N, Bennett C. Quality-of-life and LhRH agonist therapy among prostate cancer patients following PSA failure. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.e16083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e16083 Background: Growing numbers of prostate cancer patients experience biochemical relapse (PSA failure) after initial treatment. LhRH agonist (hormonal) therapy can reduce PSA levels, but there is no clear evidence that it slows disease progression or reduces mortality. Quality of Life (QoL) issues are essential when deciding between observation (OBS) versus hormonal castration following biochemical relapse. We evaluated health related quality of life and treatment satisfaction among prostate cancer patients who experience PSA failure. Methods: Eligibility criteria were receipt of primary therapy for prostate cancer followed by a PSA nadir and subsequent PSA rise to at least 0.2 ng/ml. Data sources include medical records and interviewer administered surveys on health- related QoL at baseline, 3 and 12 months. Results: Castrated versus observed patients who are satisfied with their sexual activity report similar health-related QoL, with the exception of higher rates of maintaining an erection (73.3% vs. 32.0%) and not having prostate cancer affect sexual activity (66.7% vs. 28.6%). Castrated and expectant management patients with low levels of satisfaction and sexual activity report similar health-related QoL. Conclusions: Among patients with PSA Failure, the only health-related QOL difference is reflected in sexual activity related to erectile dysfunction, but not sexual satisfaction among patients who all have a high level of treatment decision satisfaction and sexual activity. [Table: see text] [Table: see text]
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Affiliation(s)
- N. Undevia-Yedavalli
- University of Illinois at Chicago, Chicago, IL; Northwestern University, Chicago, IL; Tulane University School of Medicine, New Orleans, LA
| | - N. Dandade
- University of Illinois at Chicago, Chicago, IL; Northwestern University, Chicago, IL; Tulane University School of Medicine, New Orleans, LA
| | - T. Luu
- University of Illinois at Chicago, Chicago, IL; Northwestern University, Chicago, IL; Tulane University School of Medicine, New Orleans, LA
| | - A. Samaras
- University of Illinois at Chicago, Chicago, IL; Northwestern University, Chicago, IL; Tulane University School of Medicine, New Orleans, LA
| | - O. Sartor
- University of Illinois at Chicago, Chicago, IL; Northwestern University, Chicago, IL; Tulane University School of Medicine, New Orleans, LA
| | - N. Nonzee
- University of Illinois at Chicago, Chicago, IL; Northwestern University, Chicago, IL; Tulane University School of Medicine, New Orleans, LA
| | - C. Bennett
- University of Illinois at Chicago, Chicago, IL; Northwestern University, Chicago, IL; Tulane University School of Medicine, New Orleans, LA
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