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Pella E, Boulmpou A, Boutou A, Theodorakopoulou MP, Haddad N, Karpetas A, Giamalis P, Papagianni A, Papadopoulos CE, Vassilikos V, Sarafidis P. Different Interdialytic Intervals and Cardiorespiratory Fitness in Patients Undergoing Hemodialysis. Clin J Am Soc Nephrol 2024:01277230-990000000-00359. [PMID: 38407848 DOI: 10.2215/cjn.0000000000000435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 02/20/2024] [Indexed: 02/27/2024]
Abstract
Key Points
This is the first study exploring differences in cardiorespiratory fitness assessed with cardiopulmonary exercise testing between the 2-day and the 3-day interdialytic interval.The 3-day interdialytic interval was associated with further impaired cardiorespiratory fitness.This effect was predominantly driven by excess fluid accumulation during the extra interdialytic day.
Background
Long interdialytic interval in thrice-weekly hemodialysis is associated with excess cardiovascular and all-cause mortality risk. Impaired cardiorespiratory fitness is a strong predictor of mortality in hemodialysis. This study investigated differences in cardiorespiratory fitness assessed with cardiopulmonary exercise testing (CPET) between the end of the 2-day and the 3-day interdialytic interval.
Methods
A total of 28 hemodialysis patients, randomized in two different sequences of evaluation, underwent CPET and spirometry examination at the end of the 2-day and the 3-day intervals. The primary outcome was the difference in oxygen uptake at peak exercise (VO2peak [ml/kg per minute]) assessed with CPET. Volume status was assessed with interdialytic weight gain, lung ultrasound, bioimpedance spectroscopy, and inferior vena cava measurements. A total of 14 age-matched and sex-matched controls were also evaluated. Comparisons of changes in parameters of interest were performed with paired or independent t-tests or relevant nonparametric tests, as appropriate. Bivariate correlation analyses and generalized linear mixed models were used to examine associations between changes in CPET parameters and volume indices.
Results
Hemodialysis patients at the end of both 2-day and 3-day intervals presented lower values in all major CPET parameters than controls. VO2peak (ml/kg per minute) was significantly higher at the end of the 2-day than the 3-day interval (15.2±4.2 versus 13.6±2.8; P < 0.001); the results were similar for VO2peak (ml/min) (1188±257 versus 1074±224; P < 0.001) and VO2peak (% predicted) (58.9±9.2 versus 52.3±8.6; P < 0.001). Numerical but no statistically significant differences were detected in VO2 anaerobic threshold (ml/kg per minute) and VO2 anaerobic threshold (ml/min) between the two time points. Maximal work load (90.1±23.2 versus 79.3±25.1; P < 0.001), exercise duration, heart rate at peak exercise, and oxygen pulse also showed lower values at the end of the 3-day interval. Forced expiratory volume in 1-second levels were similar between the two evaluations. Generalized linear mixed model analysis, including interdialytic weight gain as random covariate, attenuated the observed differences in VO2peak (ml/kg per minute). Changes in bioimpedance spectroscopy–derived overhydration indexes were moderately correlated with changes of VO2peak (ml/kg per minute).
Conclusions
The 3-day interval was associated with further impairment of VO2 at peak exercise. This effect was predominantly driven by excess fluid accumulation during the extra interdialytic day.
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Affiliation(s)
- Eva Pella
- First Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Aristi Boulmpou
- Third Department of Cardiology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Afroditi Boutou
- Department of Respiratory Medicine, Hippokration Hospital, Thessaloniki, Greece
| | - Marieta P Theodorakopoulou
- First Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Nasra Haddad
- First Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Panagiotis Giamalis
- First Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Aikaterini Papagianni
- First Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Christodoulos E Papadopoulos
- Third Department of Cardiology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Vassilios Vassilikos
- Third Department of Cardiology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Pantelis Sarafidis
- First Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Mouselimis D, Tsarouchas A, Vassilikos VP, Mitsas AC, Lazaridis C, Androulakis E, Briasoulis A, Kampaktsis P, Papadopoulos CE, Bakogiannis C. The role of patient-oriented mHealth interventions in improving heart failure outcomes: A systematic review of the literature. Hellenic J Cardiol 2023:S1109-9666(23)00199-9. [PMID: 37926237 DOI: 10.1016/j.hjc.2023.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 10/26/2023] [Accepted: 11/02/2023] [Indexed: 11/07/2023] Open
Abstract
Heart failure (HF) is a debilitating disease with 26 million patients worldwide. Consistent and complex self-care is required on the part of patients to adequately adhere to medication and to the lifestyle changes that the disease necessitates. Mobile health (mHealth) is being increasingly incorporated in patient interventions in HF, as smartphones prove to be ideal platforms for patient education and self-help assistance. This systematic review aims to summarize and report on all studies that have tested the effect of mHealth on HF patient outcomes. Our search yielded 17 studies, namely 11 randomized controlled trials and six non-randomized prospective studies. In these, patients with the assistance of an mHealth intervention regularly measured their blood pressure and/or body weight and assessed their symptoms. The outcomes were mostly related to hospitalizations, clinical biomarkers, patients' knowledge about HF, quality of life (QoL) and quality of self-care. QoL consistently increased in patients who received mHealth interventions, while study results on all other outcomes were not as ubiquitously positive. The first mHealth interventions in HF were not universally successful in improving patient outcomes but provided valuable insights for patient-oriented application development. Future trials are expected to build on these insights and deploy applications that measurably assist HF patients.
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Affiliation(s)
- Dimitrios Mouselimis
- Third Cardiology Department, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Anastasios Tsarouchas
- Third Cardiology Department, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Angelos C Mitsas
- Third Cardiology Department, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Charalampos Lazaridis
- Third Cardiology Department, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Emmanuel Androulakis
- Heart Imaging Centre, Royal Brompton, and Harefield Hospitals, London, United Kingdom
| | - Alexandros Briasoulis
- University of Iowa Hospitals & Clinics and the National and Kapodistrian University of Athens, Athens, Greece
| | - Polydoros Kampaktsis
- Division of Cardiology, New York University Langone Medical Center, New York, NY, USA
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Boulmpou A, Boutou AK, Pella E, Sarafidis P, Papadopoulos CE, Vassilikos V. Cardiopulmonary Exercise Testing in Heart Failure With Preserved Ejection Fraction: Technique Principles, Current Evidence, and Future Perspectives. Cardiol Rev 2023; 31:299-317. [PMID: 36723460 DOI: 10.1097/crd.0000000000000454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Heart failure with preserved ejection fraction (HFpEF) is a multifactorial clinical syndrome involving a rather complex pathophysiologic substrate and quite a challenging diagnosis. Exercise intolerance is a major feature of HFpEF, and in many cases, diagnosis is suspected in subjects presenting with exertional dyspnea. Cardiopulmonary exercise testing (CPET) is a noninvasive, dynamic technique that provides an integrative evaluation of cardiovascular, pulmonary, hematopoietic, neuropsychological, and metabolic functions during maximal or submaximal exercise. The assessment is based on the principle that system failure typically occurs when the system is under stress, and thus, CPET is currently considered to be the gold standard for identifying exercise intolerance, allowing the differential diagnosis of underlying causes. CPET is used in observational studies and clinical trials in HFpEF; however, in most cases, only a few from a wide variety of CPET parameters are examined, while the technique is largely underused in everyday cardiology practice. This article discusses the basic principles and methodology of CPET and studies that utilized CPET in patients with HFpEF, in an effort to increase awareness of CPET capabilities among practicing cardiologists.
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Affiliation(s)
- Aristi Boulmpou
- From the Third Department of Cardiology, Ippokratio General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Afroditi K Boutou
- Department of Respiratory Medicine, G. Papanikolaou Hospital, Thessaloniki, Greece
| | - Eva Pella
- Department of Nephrology, Ippokratio General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Pantelis Sarafidis
- Department of Nephrology, Ippokratio General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Christodoulos E Papadopoulos
- From the Third Department of Cardiology, Ippokratio General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Vassilios Vassilikos
- From the Third Department of Cardiology, Ippokratio General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Bakogiannis C, Mouselimis D, Tsarouchas A, Papadopoulos CE, Theofillogiannakos EK, Lechat E, Antoniadis AP, Pagourelias ED, Kelemanis I, Tzikas S, Fragakis N, Efthimiadis GK, Karamitsos TD, Doumas M, Vassilikos VP. Iron therapy and severe arrhythmias in HFrEF: rationale, study design, and baseline results of the RESAFE-HF trial. ESC Heart Fail 2023; 10:1184-1192. [PMID: 36647691 PMCID: PMC10053179 DOI: 10.1002/ehf2.14276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 08/11/2022] [Accepted: 12/15/2022] [Indexed: 01/18/2023] Open
Abstract
AIMS The Iron Intravenous Therapy in Reducing the burden of Severe Arrhythmias in HFrEF (RESAFE-HF) registry study aims to provide real-word evidence on the impact of intravenous ferric carboxymaltose (FCM) on the arrhythmic burden of patients with heart failure with reduced ejection fraction (HFrEF), iron deficiency (ID), and implanted cardiac implantable electronic devices (CIEDs). METHODS AND RESULTS The RESAFE-HF (NCT04974021) study was designed as a prospective, single-centre, and open-label registry study with baseline, 3, 6, and 12 month visits. Adult patients with HFrEF and CIEDs scheduled to receive IV FCM as treatment for ID as part of clinical practice were eligible to participate. The primary endpoint is the composite iron-related endpoint of haemoglobin ≥ 12 g/dL, ferritin ≥ 50 ng/L, and transferrin saturation > 20%. Secondary endpoints include unplanned HF-related hospitalizations, ventricular tachyarrhythmias detected by CIEDs and Holter monitors, echocardiographic markers, functional status (VO2 max and 6 min walk test), blood biomarkers, and quality of life. In total, 106 patients with a median age of 72 years (14.4) were included. The majority were male (84.9%), whereas 92.5% of patients were categorized to New York Heart Association II/III. Patients' arrhythmic burden prior to FCM administration was significant-19 patients (17.9%) received appropriate CIED therapy for termination of ventricular tachyarrhythmia in the preceding 12 months, and 75.5% of patients have frequent, repetitive multiform premature ventricular contractions. CONCLUSIONS The RESAFE-HF trial is expected to provide evidence on the effect of treating ID with FCM in HFrEF based on real-world data. Special focus will be given on the arrhythmic burden post-FCM administration.
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Affiliation(s)
- Constantinos Bakogiannis
- Third Cardiology Department, School of MedicineHippokration General Hospital, Aristotle University of ThessalonikiThessalonikiGreece
| | - Dimitrios Mouselimis
- Third Cardiology Department, School of MedicineHippokration General Hospital, Aristotle University of ThessalonikiThessalonikiGreece
| | - Anastasios Tsarouchas
- Third Cardiology Department, School of MedicineHippokration General Hospital, Aristotle University of ThessalonikiThessalonikiGreece
| | - Christodoulos E. Papadopoulos
- Third Cardiology Department, School of MedicineHippokration General Hospital, Aristotle University of ThessalonikiThessalonikiGreece
| | - Efstratios K. Theofillogiannakos
- Third Cardiology Department, School of MedicineHippokration General Hospital, Aristotle University of ThessalonikiThessalonikiGreece
| | | | - Antonios P. Antoniadis
- Third Cardiology Department, School of MedicineHippokration General Hospital, Aristotle University of ThessalonikiThessalonikiGreece
| | - Efstathios D. Pagourelias
- Third Cardiology Department, School of MedicineHippokration General Hospital, Aristotle University of ThessalonikiThessalonikiGreece
| | - Ioannis Kelemanis
- Third Cardiology Department, School of MedicineHippokration General Hospital, Aristotle University of ThessalonikiThessalonikiGreece
| | - Stergios Tzikas
- Third Cardiology Department, School of MedicineHippokration General Hospital, Aristotle University of ThessalonikiThessalonikiGreece
| | - Nikolaos Fragakis
- Third Cardiology Department, School of MedicineHippokration General Hospital, Aristotle University of ThessalonikiThessalonikiGreece
| | - Georgios K. Efthimiadis
- First Cardiology Department, School of MedicineAHEPA University Hospital, Aristotle University of ThessalonikiThessalonikiGreece
| | - Theodoros D. Karamitsos
- First Cardiology Department, School of MedicineAHEPA University Hospital, Aristotle University of ThessalonikiThessalonikiGreece
| | - Michael Doumas
- Second Propaedeutics Department of Internal MedicineHippokration General Hospital, Aristotle University of ThessalonikiThessalonikiGreece
- Georgetown University and VAMC and George Washington UniversityWashingtonDCUSA
| | - Vassilios P. Vassilikos
- Third Cardiology Department, School of MedicineHippokration General Hospital, Aristotle University of ThessalonikiThessalonikiGreece
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Pella E, Boutou A, Boulmpou A, Papadopoulos CE, Papagianni A, Sarafidis P. Cardiopulmonary exercise testing in patients with end-stage kidney disease: principles, methodology and clinical applications of the optimal tool for exercise tolerance evaluation. Nephrol Dial Transplant 2022; 37:2335-2350. [PMID: 33823012 DOI: 10.1093/ndt/gfab150] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [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: 11/29/2020] [Indexed: 12/31/2022] Open
Abstract
Chronic kidney disease (CKD), especially end-stage kidney disease (ESKD), is associated with an increased risk for cardiovascular events and all-cause mortality. Exercise intolerance as well as reduced cardiovascular reserve is extremely common in patients with CKD. Cardiopulmonary exercise testing (CPET) is a non-invasive, dynamic technique that provides an integrative evaluation of cardiovascular, pulmonary, neuropsychological and metabolic function during maximal or submaximal exercise, allowing the evaluation of functional reserves of these systems. This assessment is based on the principle that system failure typically occurs when the system is under stress and thus CPET is currently considered to be the gold standard for identifying exercise limitation and differentiating its causes. It has been widely used in several medical fields for risk stratification, clinical evaluation and other applications, but its use in everyday practice for CKD patients is scarce. This article describes the basic principles and methodology of CPET and provides an overview of important studies that utilized CPET in patients with ESKD, in an effort to increase awareness of CPET capabilities among practicing nephrologists.
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Affiliation(s)
- Eva Pella
- Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Afroditi Boutou
- Department of Respiratory Medicine, G. Papanikolaou Hospital, Thessaloniki, Greece
| | - Aristi Boulmpou
- Third Department of Cardiology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Christodoulos E Papadopoulos
- Third Department of Cardiology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Aikaterini Papagianni
- Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Pantelis Sarafidis
- Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Voultsos P, Bazmpani MA, Papanastasiou CA, Papadopoulos CE, Efthimiadis G, Karvounis H, Kalogeropoulos AP, Karamitsos TD. Magnesium Disorders and Prognosis in Heart Failure: A Systematic Review. Cardiol Rev 2022; 30:281-285. [PMID: 34001688 DOI: 10.1097/crd.0000000000000397] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Magnesium is an essential mineral for the human body and plays an important role in cardiovascular health. Hypomagnesaemia has been linked with increased cardiovascular mortality in heart failure; however, previous studies have yielded conflicting results. Even fewer studies have addressed the association between hypermagnesemia and prognosis in heart failure. The aim of the present systematic review was to investigate the association of serum magnesium levels with cardiovascular and all-cause mortality in patients with heart failure and reduced ejection fraction (HFrEF). Cardiovascular morbidity, referring to heart failure rehospitalizations and ventricular arrhythmias, was also investigated. Eligible studies were identified by searching PubMed and Scopus. The Quality in Prognosis (QUIPS) tool was used to assess the quality of included studies. Eight studies (total of 13,539 patients with HFrEF) that assessed the effects of serum magnesium levels on cardiovascular mortality, all-cause mortality, and cardiovascular morbidity met inclusion criteria. In half of the studies, hypomagnesemia was found to be an independent risk factor for cardiovascular mortality, including sudden cardiac death. Only 1 study reported that hypermagnesemia (serum magnesium levels above 2.4 mg/dL) is a prognostic factor for noncardiac mortality suggesting that hypermagnesemia is more likely an indicator of comorbidities rather than a true independent prognostic marker. Finally, low serum magnesium levels were not associated with readmissions for heart failure or ventricular arrhythmias in patients with HFrEF.
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Affiliation(s)
- Petros Voultsos
- From the 1st Department of Cardiology, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - Maria-Anna Bazmpani
- From the 1st Department of Cardiology, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - Christos A Papanastasiou
- From the 1st Department of Cardiology, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | | | - Georgios Efthimiadis
- From the 1st Department of Cardiology, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - Haralambos Karvounis
- From the 1st Department of Cardiology, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - Andreas P Kalogeropoulos
- Division of Cardiovascular Medicine, Stony Brook University, Stony Brook, NY
- Division of Cardiovascular Medicine, University of Patras, Rio, Greece
| | - Theodoros D Karamitsos
- From the 1st Department of Cardiology, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
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Pagourelias E, Boulmpou A, Evangeliou A, Zormpas G, Alexandridis G, Kotzadamis D, Vergopoulos S, Tsavousoglou C, Antoniadis A, Mavroudi M, Papadopoulos CE, Tzikas S, Fragakis N, Vassilikos VP. Prevalence of atrial myopathy among hypertrophic cardiomyopathy patients without atrial fibrillation. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Atrial myopathy (AM) is an entity reflecting left atrial (LA) structural and electrical remodeling, connected to atrial fibrillation (AF) development and heart failure progression in various substrates. In hypertrophic cardiomyopathy (HCM), prevalence of AM beyond AF and its correlations are not fully investigated.
Purpose
Aim of this study was to estimate the prevalence of AM in a cohort of HCM patients without AF history through assessment of LA volume index (LAVI), LA reservoir strain (LARS) and total atrial conduction time (TACT) (estimated by tissue Doppler imaging). Additionally, to investigate AM indices' correlation with other phenotypic and functional characteristics of HCM.
Methods
We included 50 HCM patients (60±16 years, 80% male, maximum wall thickness 18.6±4.1mm) without history of AF who have consecutively undergone 2D-speckle tracking echocardiography and cardiovascular magnetic resonance (CMR) with late gadolinium enhancement (LGE). TACT and LARS measurement is shown on left panel. Burden of fibrosis (percentage of LV mass) was defined by LGE extent (>5 standard deviations compared to nulled myocardium) in CMR slices. Cut-off points for TACT, LAVI and LARS were adopted by literature (≥115 msec, ≥34 mL/m2 and <21.3% respectively).
Results
All HCM patients had preserved EF (61.8±8%), while 13 (26%) presented outflow tract obstruction and 4 (8%) diastolic dysfunction stage≥2. LGE was observed in 32 patients (64%) occupying 7.2±5% of left ventricular (LV) mass. Mean TACT was 139.9±22 msec, with LAVI being 30.8±16.1 mL/m2 and LARS 27.6±13.9%. After assessing prevalence of AM parameters, 41 patients (82%) presented a prolonged (≥115 msec) TACT with only 13 of them having also a significantly dilated LA (≥34 mL/m2) and 16 an impaired LARS. Among HCM demographic, phenotypic and functional characteristics tested, age and LV mass index were found to be the only independent regressors of TACT (r=0.54, p<0.0005 and r=0.44, p=0.002 respectively, right panels), while E/E' (r=−0.44, p=0.003) and fibrosis extent (r=0.36, p=0.02) were the strongest predictors of LARS and LAVI values respectively.
Conclusions
Atrial electro-mechanical delay assessed through TDI based TACT, is the most frequent AM parameter among HCM patients irrespective of AF and even before LA dilatation and LA strain impairment. AM parameters seem to correlate with various morphological and functional characteristics of HCM, their significance, however, in predicting progression towards AF development or HF presentation remains to be elucidated.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- E Pagourelias
- Aristotle University of Thessaloniki, Third Cardiology Department, Hippokrateion University Hospital , Thessaloniki , Greece
| | - A Boulmpou
- Aristotle University of Thessaloniki, Third Cardiology Department, Hippokrateion University Hospital , Thessaloniki , Greece
| | - A Evangeliou
- Aristotle University of Thessaloniki, Third Cardiology Department, Hippokrateion University Hospital , Thessaloniki , Greece
| | - G Zormpas
- Aristotle University of Thessaloniki, Third Cardiology Department, Hippokrateion University Hospital , Thessaloniki , Greece
| | - G Alexandridis
- Aristotle University of Thessaloniki, Third Cardiology Department, Hippokrateion University Hospital , Thessaloniki , Greece
| | - D Kotzadamis
- Aristotle University of Thessaloniki, Third Cardiology Department, Hippokrateion University Hospital , Thessaloniki , Greece
| | - S Vergopoulos
- Aristotle University of Thessaloniki, Third Cardiology Department, Hippokrateion University Hospital , Thessaloniki , Greece
| | - C Tsavousoglou
- Aristotle University of Thessaloniki, Third Cardiology Department, Hippokrateion University Hospital , Thessaloniki , Greece
| | - A Antoniadis
- Aristotle University of Thessaloniki, Third Cardiology Department, Hippokrateion University Hospital , Thessaloniki , Greece
| | - M Mavroudi
- Aristotle University of Thessaloniki, Third Cardiology Department, Hippokrateion University Hospital , Thessaloniki , Greece
| | - C E Papadopoulos
- Aristotle University of Thessaloniki, Third Cardiology Department, Hippokrateion University Hospital , Thessaloniki , Greece
| | - S Tzikas
- Aristotle University of Thessaloniki, Third Cardiology Department, Hippokrateion University Hospital , Thessaloniki , Greece
| | - N Fragakis
- Aristotle University of Thessaloniki, Third Cardiology Department, Hippokrateion University Hospital , Thessaloniki , Greece
| | - V P Vassilikos
- Aristotle University of Thessaloniki, Third Cardiology Department, Hippokrateion University Hospital , Thessaloniki , Greece
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8
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Patoulias D, Boulmpou A, Doumas M, Papadopoulos CE. Another brick in the wall of cardioprotection? A meta-analysis addressing the effect of sodium-glucose co-transporter 2 inhibitors on left ventricular mass assessed by cardiovascular magnetic resonance in patients with heart failure with reduced ejection fraction. J Cardiovasc Med (Hagerstown) 2022; 23:570-572. [PMID: 35905005 DOI: 10.2459/jcm.0000000000001328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
| | - Aristi Boulmpou
- Third Department of Cardiology, General Hospital Hippokration, Aristotle University of Thessaloniki, Greece
| | - Michael Doumas
- Second Propaedeutic Department of Internal Medicine
- Veterans Affairs Medical Center, George Washington University, Washington, District of Columbia, USA
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9
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Boulmpou A, Patoulias D, Papadopoulos CE, Teperikidis E, Doumas M, Vassilikos V. Meta-analysis of cardiovascular outcome trials assessing the impact of glucagon-like peptide-1 receptor agonists on major cardiac arrhythmias. Acta Cardiol 2022:1-6. [PMID: 35699112 DOI: 10.1080/00015385.2022.2087839] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
OBJECTIVE Glucagon-like peptide-1 receptor agonists (GLP-1RAs), a group of novel antidiabetic agents, demonstrated beneficial cardiovascular effects in recent large, placebo-controlled randomised clinical trials (RCTs); their clear antiarrhythmic benefit has not been yet underlined. The purpose of the present meta-analysis is to clarify the impact of GLP-1RAs on different types of cardiac arrhythmias. METHODS We searched PubMed from its inception up to 8 October 2020 for all available cardiovascular and renal outcome, placebo-controlled RCTs utilising GLP-1RAs versus placebo. The present meta-analysis is reported according to the Preferred Reporting Items for Systematic reviews and Meta-analyses (PRISMA) statement. RESULTS We included data from 7 RCTs with GLP-1RAs in a total of 55,943 participants. Treatment with GLP-1RAs did not provide significant benefit in the risk for atrial fibrillation (RR = 0.81, 95%CI; 0.78-1.15, I2 = 51%), atrial flutter (RR = 0.79, 95%CI; 0.53-1.16, I2 = 0%), ventricular fibrillation (RR = 0.99, 95%CI; 0.48-2.04, I2 = 0%), ventricular tachycardia (RR = 1.41, 95%CI; 0.87-2.28, I2 = 10%), atrial tachycardia (RR = 0.63, 95%CI; 0.10-3.90, I2 = 24%), sinus node dysfunction (RR = 0.70, 95%CI; 0.40-1.23, I2 = 0%), ventricular extrasystoles (RR = 1.37, 95%CI; 0.56-3.30, I2 = 0%), second-degree atrioventricular block (RR = 0.96, 95%CI; 0.52-1.74, I2 = 0%) or complete atrioventricular block (RR = 0.78, 95%CI; 0.39-1.54, I2 = 38%). CONCLUSIONS In patients with type 2 diabetes mellitus, treatment with GLP-1RAs does not significantly affect the risk for major cardiac arrhythmias.
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Affiliation(s)
- Aristi Boulmpou
- Third Department of Cardiology, Ippokratio General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Dimitrios Patoulias
- Second Propaedeutic Department of Internal Medicine, Ippokratio General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Christodoulos E Papadopoulos
- Third Department of Cardiology, Ippokratio General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Eleftherios Teperikidis
- Third Department of Cardiology, Ippokratio General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Michael Doumas
- Second Propaedeutic Department of Internal Medicine, Ippokratio General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece.,Veterans Affairs Medical Center, George Washington University, Washington, DC, USA
| | - Vassilios Vassilikos
- Third Department of Cardiology, Ippokratio General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
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10
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Pagourelias E, Boulmpou A, Alexandridis G, Tsarouchas A, Mouselimis D, Bakogiannis K, Karamanolis A, Vergopoulos S, Tsavousoglou C, Antoniadis A, Fragakis N, Papadopoulos CE, Vassilikos V. Total atrial conduction time and its relationship with morphological & functional characteristics in hypertrophic cardiomyopathy. Eur Heart J Cardiovasc Imaging 2022. [DOI: 10.1093/ehjci/jeab289.067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Total atrial conduction time (TACT), estimated by tissue Doppler imaging (TDI), is an index reflecting left atrial (LA) structural and electrical remodeling, connected to atrial fibrillation (AF) development and heart failure progression in various substrates. In hypertrophic cardiomyopathy (HCM), the significance of TACT beyond AF and its determinants are not fully investigated.
Purpose
Aim of this study was to estimate TACT in a cohort of HCM patients without AF history and to examine its relationship with other parameters of atrial myopathy, such as LA volume index (LAVI) or LA reservoir strain (LARS). Additionally, to investigate TACT correlation with other phenotypic and functional characteristics of HCM.
Methods
We included 50 HCM patients (60 ± 16 years, 80% male, maximum wall thickness 18.6 ± 4.1mm) without history of AF who have consecutively undergone 2D-speckle tracking echocardiography and cardiovascular magnetic resonance (CMR) with late gadolinium enhancement (LGE). TACT was measured from the onset P wave on electrocardiogram to the peak A’ wave of the lateral LA wall using TDI (left panel). Burden of fibrosis (percentage of LV mass) was defined by LGE extent (>5 standard deviations compared to nulled myocardium) in CMR slices. Cut-off points for TACT, LAVI and LARS were adopted by literature (≥115 msec, ≥34 mL/m2 and <21.3 % respectively).
Results
All HCM patients had preserved EF (61.8 ± 8%), while 13 (26%) presented outflow tract obstruction and 4 (8%) diastolic dysfunction stage≥2. LGE was observed in 32 patients (64%) occupying 7.2 ± 5% of left ventricular (LV) mass. Mean TACT was 139.9 ± 22 msec, with LAVI being 30.8 ± 16.1 mL/m2 and LARS 27.6 ± 13.9%. After assessing prevalence of atrial myopathy parameters, 41 patients (82%) presented a prolonged (≥115 msec) TACT with only 13 of them having also a significantly dilated LA (≥34 mL/m2) and 16 an impaired LARS. Among HCM demographic, phenotypic and functional characteristics tested, age and LV mass index were found to be the only independent regressors of TACT (r = 0.54, p < 0.0005 and r = 0.44, p = 0.002 respectively, right panels). On the contrary, no significant correlation was established between TACT and traditional diastolic dysfunction indices such as E/E’ or fibrosis extent.
Conclusions
Atrial electro-mechanical delay assessed through TDI based TACT, is very frequent among HCM patients irrespective of AF and even before LA dilatation and LA strain impairment. Age and hypertrophy magnitude are the main determinants of TACT, the prognostic significance of which remains to be further elucidated. Abstract Figure.
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Affiliation(s)
- E Pagourelias
- Aristotle University of Thessaloniki, Third Cardiology Department, Hippokrateion University Hospital, Thessaloniki, Greece
| | - A Boulmpou
- Aristotle University of Thessaloniki, Third Cardiology Department, Hippokrateion University Hospital, Thessaloniki, Greece
| | - G Alexandridis
- Aristotle University of Thessaloniki, Third Cardiology Department, Hippokrateion University Hospital, Thessaloniki, Greece
| | - A Tsarouchas
- Aristotle University of Thessaloniki, Third Cardiology Department, Hippokrateion University Hospital, Thessaloniki, Greece
| | - D Mouselimis
- Aristotle University of Thessaloniki, Third Cardiology Department, Hippokrateion University Hospital, Thessaloniki, Greece
| | - K Bakogiannis
- Aristotle University of Thessaloniki, Third Cardiology Department, Hippokrateion University Hospital, Thessaloniki, Greece
| | - A Karamanolis
- Aristotle University of Thessaloniki, Third Cardiology Department, Hippokrateion University Hospital, Thessaloniki, Greece
| | - S Vergopoulos
- Aristotle University of Thessaloniki, Third Cardiology Department, Hippokrateion University Hospital, Thessaloniki, Greece
| | - C Tsavousoglou
- Aristotle University of Thessaloniki, Third Cardiology Department, Hippokrateion University Hospital, Thessaloniki, Greece
| | - A Antoniadis
- Aristotle University of Thessaloniki, Third Cardiology Department, Hippokrateion University Hospital, Thessaloniki, Greece
| | - N Fragakis
- Aristotle University of Thessaloniki, Third Cardiology Department, Hippokrateion University Hospital, Thessaloniki, Greece
| | - CE Papadopoulos
- Aristotle University of Thessaloniki, Third Cardiology Department, Hippokrateion University Hospital, Thessaloniki, Greece
| | - V Vassilikos
- Aristotle University of Thessaloniki, Third Cardiology Department, Hippokrateion University Hospital, Thessaloniki, Greece
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11
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Pagourelias E, Boulmpou A, Alexandridis G, Tsarouchas A, Mouselimis D, Bakogiannis K, Karamanolis A, Vergopoulos S, Tsavousoglou C, Antoniadis A, Fragakis N, Papadopoulos CE, Vassilikos V. Strain-volume loops for assessment of diastolic function in hypertrophic cardiomyopathy. Eur Heart J Cardiovasc Imaging 2022. [DOI: 10.1093/ehjci/jeab289.424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Diastolic function assessment in patients with hypertrophic hearts and preserved ejection fraction (EF) is a rather challenging task, necessitating the introduction of new parameters. Strain-volume loops (SVLs), based on simultaneous frame-by-frame strain and volume changes’ recordings acquired by means of three-dimensional (3D) speckle tracking imaging, is an innovative tool which has been applied in various substrates. The ability of SVLs to assess diastolic function in hypertrophic cardiomyopathy (HCM) has not been investigated until now.
Purpose
Aim of this study was to investigate potential correlations between SVLs, traditional diastolic function indices and phenotypic features of HCM (thickness, obstruction and fibrosis) that may also reflect myocardial "stiffness".
Methods
We included 40 HCM patients (54.1 ± 14.3 years, 82.5% male, maximum wall thickness 19.3 ± 4.8mm) who have consecutively undergone 3D-speckle tracking echocardiography (panel A) and cardiovascular magnetic resonance (CMR) with late gadolinium enhancement (LGE). Values of 3D strain were plotted vs. volume for each frame to build an SVL. Peak of radial, longitudinal and circumferential systolic strain (Rsp, Lsp, and Csp, respectively), systolic slopes of the loops (RsSl, LsSl, CsSl), strain to end-diastolic volume (EDV) ratios (Rs/V, Ls/V, Cs/V) as well as the extent of systolic-diastolic uncoupling (difference between systolic and diastolic strain for the same volume) were computed for the analysis. Left atrial volume index (LAVI), E/E’ and tricuspid regurgitation velocity (TRvel) were measured to define diastolic dysfunction (DD) stage. Burden of fibrosis was evaluated by LGE extent in CMR slices.
Results
All HCM patients had preserved EF (60.5 ± 5,7%), while 16 (40%) had LV outflow tract obstruction (LVOTO > 30 mm Hg at rest). Mean LV mass index was 78.9 ± 14.5 g (evaluated by 3D echocardiography). LGE was observed in 23 patients (57.5%) occupying 5.2 ± 4.5% of LV mass. Concerning SVLs the following values were recorded for radial (Rsp 30.8 ± 9.8%, RsSl 0.4 ± 0.13 and Rs/V 0.25 ± 0.09), longitudinal (Lsp -9.4 ± 3.7%, LsSl 0.12 ± 0.06 and Ls/V 0.08 ± 0.04) and circumferential deformation (Csp -14.2 ± 3.5%, CsSl 0.18 ± 0.05 and Cs/V 0.11 ± 0.03). Traditional isolated diastolic indices (E/E’, LAVI, TRvel and DD stage) did not present significant correlations with SVL parameters or HCM phenotypic features. However, potentially "stiffer" hearts (combination of increased LVMI and fibrosis) presented a leftward transition of longitudinal SVLs, which also became wider (greater uncoupling) (panel B).
Conclusions
Traditional diastolic indices show modest only correlations with SVLs or HCM phenotypic characteristics, necessitating new approaches to DD of HCM patients. SVLs seem to be a promising-innovative tool for indirect assessment of myocardial "stiffness" and diastolic function. Abstract Figure.
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Affiliation(s)
- E Pagourelias
- Aristotle University of Thessaloniki, Third Cardiology Department, Hippokrateion University Hospital, Thessaloniki, Greece
| | - A Boulmpou
- Aristotle University of Thessaloniki, Third Cardiology Department, Hippokrateion University Hospital, Thessaloniki, Greece
| | - G Alexandridis
- Aristotle University of Thessaloniki, Third Cardiology Department, Hippokrateion University Hospital, Thessaloniki, Greece
| | - A Tsarouchas
- Aristotle University of Thessaloniki, Third Cardiology Department, Hippokrateion University Hospital, Thessaloniki, Greece
| | - D Mouselimis
- Aristotle University of Thessaloniki, Third Cardiology Department, Hippokrateion University Hospital, Thessaloniki, Greece
| | - K Bakogiannis
- Aristotle University of Thessaloniki, Third Cardiology Department, Hippokrateion University Hospital, Thessaloniki, Greece
| | - A Karamanolis
- Aristotle University of Thessaloniki, Third Cardiology Department, Hippokrateion University Hospital, Thessaloniki, Greece
| | - S Vergopoulos
- Aristotle University of Thessaloniki, Third Cardiology Department, Hippokrateion University Hospital, Thessaloniki, Greece
| | - C Tsavousoglou
- Aristotle University of Thessaloniki, Third Cardiology Department, Hippokrateion University Hospital, Thessaloniki, Greece
| | - A Antoniadis
- Aristotle University of Thessaloniki, Third Cardiology Department, Hippokrateion University Hospital, Thessaloniki, Greece
| | - N Fragakis
- Aristotle University of Thessaloniki, Third Cardiology Department, Hippokrateion University Hospital, Thessaloniki, Greece
| | - CE Papadopoulos
- Aristotle University of Thessaloniki, Third Cardiology Department, Hippokrateion University Hospital, Thessaloniki, Greece
| | - V Vassilikos
- Aristotle University of Thessaloniki, Third Cardiology Department, Hippokrateion University Hospital, Thessaloniki, Greece
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Teperikidis E, Boulmpou A, Charalampidis P, Tsavousoglou C, Giannakoulas G, Papadopoulos CE, Vassilikos V. 5-Fluorouracil, capecitabine and vasospasm: a scoping review of pathogenesis, management options and future research considerations. Acta Cardiol 2022; 77:1-13. [PMID: 33683181 DOI: 10.1080/00015385.2021.1873548] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND 5-Fluorouracil (5-FU) is a widely used chemotherapeutic agent that can cause cardiotoxicity manifesting, among others, as chest pain. Capecitabine is an oral prodrug of 5-FU, with reported preferential activation in malignant cells that may also cause cardiotoxic reactions. Standard treatment of 5-FU and capecitabine induced chest pain with vasodilators is mostly effective, but there are several cases of patients unresponsive to these agents. METHODS We performed a PubMed search on 31st May 2020. We used a three keyword search strategy using Boolean search operators. More specifically, we included fluorouracil or 5-FU or capecitabine and chest pain or angina and mechanism or treatment or management. We included primary reports of clinical and non-clinical data, as well as systematic reviews. Narrative reviews, expert opinions, letters to the editor and other forms of non-primary literature were excluded. RESULTS Our search yielded a total of 1595 reports. Of these, 1460 were narrative reviews or irrelevant to the topic and were excluded. A total of 135 reports were used for our review. We used 81 reports for data extraction, which included 13 clinical trials, 4 retrospective reports, 61 case reports, and 3 systematic reviews. CONCLUSION We report the incidence and predisposing factors, the value of available diagnostic procedures, and standard medical and invasive treatments. We also speculate on the potential benefit of arginine as a promising option both in prevention as well as treatment of 5-FU-induced chest pain. Finally, gaps of evidence are identified and proposals are made in terms of future research.
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Affiliation(s)
- Eleftherios Teperikidis
- Third Department of Cardiology, Ιppokratio General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Aristi Boulmpou
- Third Department of Cardiology, Ιppokratio General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Panagiotis Charalampidis
- Third Department of Cardiology, Ιppokratio General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
- St Luke’s Hospital, Thessaloniki, Greece
| | - Chalil Tsavousoglou
- Third Department of Cardiology, Ιppokratio General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - George Giannakoulas
- First Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Christodoulos E. Papadopoulos
- Third Department of Cardiology, Ιppokratio General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Vassilios Vassilikos
- Third Department of Cardiology, Ιppokratio General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
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13
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Boulmpou A, Theodorakopoulou MP, Alexandrou ME, Boutou AK, Papadopoulos CE, Pella E, Sarafidis P, Vassilikos V. Meta-analysis addressing the impact of cardiovascular-acting medication on peak oxygen uptake of patients with HFpEF. Heart Fail Rev 2022; 27:609-623. [DOI: 10.1007/s10741-021-10207-5] [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] [Accepted: 12/09/2021] [Indexed: 11/28/2022]
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14
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Patoulias DI, Boulmpou A, Teperikidis E, Katsimardou A, Siskos F, Doumas M, Papadopoulos CE, Vassilikos V. Cardiovascular efficacy and safety of dipeptidyl peptidase-4 inhibitors: A meta-analysis of cardiovascular outcome trials. World J Cardiol 2021; 13:585-592. [PMID: 34754403 PMCID: PMC8554356 DOI: 10.4330/wjc.v13.i10.585] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 07/08/2021] [Accepted: 09/10/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Dipeptidyl peptidase-4 (DPP-4) inhibitors are a generally safe and well tolerated antidiabetic drug class with proven efficacy in type 2 diabetes mellitus (T2DM). Recently, a series of large, randomized controlled trials (RCTs) addressing cardiovascular outcomes with DPP-4 inhibitors have been published.
AIM To pool data from the aforementioned trials concerning the impact of DPP-4 inhibitors on surrogate cardiovascular efficacy outcomes and on major cardiac arrhythmias.
METHODS We searched PubMed and grey literature sources for all published RCTs assessing cardiovascular outcomes with DPP-4 inhibitors compared to placebo until October 2020. We extracted data concerning the following “hard” efficacy outcomes: fatal and non-fatal myocardial infarction, fatal and non-fatal stroke, hospitalization for heart failure, hospitalization for unstable angina, hospitalization for coronary revascularization and cardiovascular death. We also extracted data regarding the risk for major cardiac arrhythmias, such as atrial fibrillation, atrial flutter, ventricular fibrillation and ventricular tachycardia.
RESULTS We pooled data from 6 trials in a total of 52520 patients with T2DM assigned either to DPP-4 inhibitor or placebo. DPP-4 inhibitors compared to placebo led to a non-significant increase in the risk for fatal and non-fatal myocardial infarction [risk ratio (RR) = 1.02, 95%CI: 0.94-1.11, I2 = 0%], hospitalization for heart failure (RR = 1.09, 95%CI: 0.92-1.29, I2 = 65%) and cardiovascular death (RR = 1.02, 95%CI: 0.93-1.11, I2 = 0%). DPP-4 inhibitors resulted in a non-significant decrease in the risk for fatal and non-fatal stroke (RR = 0.96, 95%CI: 0.85-1.08, I2 = 0%) and coronary revascularization (RR = 0.99, 95%CI: 0.90-1.09, I2 = 0%), Finally, DPP-4 inhibitors demonstrated a neutral effect on the risk for hospitalization due to unstable angina (RR = 1.00, 95%CI: 0.85-1.18, I2 = 0%). As far as cardiac arrhythmias are concerned, DPP-4 inhibitors did not significantly affect the risk for atrial fibrillation (RR = 0.95, 95%CI: 0.78-1.17, I2 = 0%), while they were associated with a significant increase in the risk for atrial flutter, equal to 52% (RR = 1.52, 95%CI: 1.03-2.24, I2 = 0%). DPP-4 inhibitors did not have a significant impact on the risk for any of the rest assessed cardiac arrhythmias.
CONCLUSION DPP-4 inhibitors do not seem to confer any significant cardiovascular benefit for patients with T2DM, while they do not seem to be associated with a significant risk for any major cardiac arrhythmias, except for atrial flutter. Therefore, this drug class should not be the treatment of choice for patients with established cardiovascular disease or multiple risk factors, except for those cases when newer antidiabetics (glucagon-like peptide-1 receptor agonists and sodium-glucose co-transporter-2 inhibitors) are not tolerated, contraindicated or not affordable for the patient.
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Affiliation(s)
- Dimitrios Ioannis Patoulias
- Second Propedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, Hippokration General Hospital, Thessaloniki 54642, Greece
| | - Aristi Boulmpou
- Third Department of Cardiology, Aristotle University of Thessaloniki, Hippokration General Hospital, Thessaloniki 54642, Greece
| | - Eleftherios Teperikidis
- Third Department of Cardiology, Aristotle University of Thessaloniki, Hippokration General Hospital, Thessaloniki 54642, Greece
| | - Alexandra Katsimardou
- Second Propedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, Hippokration General Hospital, Thessaloniki 54642, Greece
| | - Fotios Siskos
- Second Propedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, Hippokration General Hospital, Thessaloniki 54642, Greece
| | - Michael Doumas
- Second Propedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, Hippokration General Hospital, Thessaloniki 54642, Greece
| | - Christodoulos E Papadopoulos
- Third Department of Cardiology, Aristotle University of Thessaloniki, Hippokration General Hospital, Thessaloniki 54642, Greece
| | - Vassilios Vassilikos
- Third Department of Cardiology, Aristotle University of Thessaloniki, Hippokration General Hospital, Thessaloniki 54642, Greece
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15
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Boulmpou A, Patoulias D, Teperikidis E, Tsavousoglou C, Vergopoulos S, Toumpourleka M, Doumas M, Fragakis N, Vassilikos V, Papadopoulos CE. Impact of antidiabetic treatment with dipeptidyl peptidase-4 inhibitors on the risk of cardiac arrhythmias among patients with type 2 diabetes mellitus. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
Type 2 diabetes mellitus (T2DM) is considered as a global pandemic, comprising a significant, independent cardiovascular risk factor. Besides major adverse cardiovascular events, patients with T2DM experience an increased risk of heart rhythm disorders, nevertheless the exact mechanisms of arrhythmogenesis in the context of diabetes mellitus are still being under investigation. Dipeptidyl peptidase-4 (DPP-4) inhibitors represent a novel class of antidiabetic regimens with proved safety and efficacy among patients with T2DM and a series of randomized controlled trials (RCTs) addressing cardiovascular outcomes with DPP-4 inhibitors have been published. The exact effect of DPP-4 inhibitors on the arrhythmic burden among diabetic individuals is yet to be identified.
Purpose
In the present meta-analysis, we sought to determine the impact of antidiabetic treatment with DPP-4 inhibitors on the risk of various cardiac arrhythmias.
Methods
We searched PubMed for all published RCTs assessing cardiovascular outcomes after antidiabetic treatment with DPP-4 inhibitors. We extracted data regarding the risk for the following cardiac arrhythmias: atrial fibrillation, atrial flutter, atrial tachycardia, ventricular fibrillation, ventricular tachycardia, ventricular extrasystoles, supraventricular tachycardia, sinus node dysfunction, second degree atrioventricular block, complete atrioventricular block.
Results
Following a meticulous assessment of the available literature, we pooled data from 6 trials in a total of 52,520 patients. Antidiabetic treatment with DPP-4 inhibitors did not significantly affect the risk for atrial fibrillation (RR=0.95, 95% CI: 0.78–1.17, I2=0%) (Figure 1a). Of note, DPP-4 inhibitors were associated with a significant increase in the risk for atrial flutter, equal to 52% (RR=1.52, 95% CI: 1.03–2.24, I2=0%), as shown in Figure 2. Finally, DPP-4 inhibitors did not have a significant impact on the risk for any of the rest assessed major cardiac arrhythmias.
Conclusions
DPP-4 inhibitors do not seem to be associated with a significant risk for any major cardiac arrhythmias, except for atrial flutter.
Funding Acknowledgement
Type of funding sources: None. Figure 1Figure 2
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Affiliation(s)
- A Boulmpou
- Hippokration General Hospital of Thessaloniki, Third Department of Cardiology, Thessaloniki, Greece
| | - D Patoulias
- Hippokration General Hospital of Thessaloniki, Second Propedeutic Department of Internal Medicine, Thessaloniki, Greece
| | - E Teperikidis
- Hippokration General Hospital of Thessaloniki, Third Department of Cardiology, Thessaloniki, Greece
| | - C Tsavousoglou
- Hippokration General Hospital of Thessaloniki, Third Department of Cardiology, Thessaloniki, Greece
| | - S Vergopoulos
- Hippokration General Hospital of Thessaloniki, Third Department of Cardiology, Thessaloniki, Greece
| | - M Toumpourleka
- Hippokration General Hospital of Thessaloniki, Third Department of Cardiology, Thessaloniki, Greece
| | - M Doumas
- Hippokration General Hospital of Thessaloniki, Second Propedeutic Department of Internal Medicine, Thessaloniki, Greece
| | - N Fragakis
- Hippokration General Hospital of Thessaloniki, Third Department of Cardiology, Thessaloniki, Greece
| | - V Vassilikos
- Hippokration General Hospital of Thessaloniki, Third Department of Cardiology, Thessaloniki, Greece
| | - C E Papadopoulos
- Hippokration General Hospital of Thessaloniki, Third Department of Cardiology, Thessaloniki, Greece
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Patoulias D, Boulmpou A, Tranidou A, Nikolaidis A, Mouselimis D, Papadopoulos CE, Vassilikos V, Doumas M. Risk of death with sodium-glucose co-transporter-2 inhibitors across the hallmark cardiovascular and renal outcome trials: an updated meta-analysis. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2951] [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
Patients with type 2 diabetes mellitus (T2DM) experience a 15% increase in the risk for death compared to the general population, with age less than 55 years, insufficient glycemic control and albuminuria representing the major risk factors for all-cause and cardiovascular mortality. Despite progression in diagnosis and treatment, mortality remains elevated among affected individuals. Sodium-glucose co-transporter 2 (SGLT-2) inhibitors are considered as the optimal treatment option for patients with T2DM and concomitant cardiovascular or renal disease, while these regimens demonstrated a clear benefit in all-cause and cardiovascular mortality compared to placebo.
Purpose
As we recently welcomed the publication of large-scale randomized controlled trials (RCTs) with SGLT-2 inhibitors addressing surrogate, hard endpoints, we sought to perform an updated meta-analysis, investigating the effect of SGLT-2 inhibitors on all-cause, cardiovascular and renal death among the high- or very-high risk patients enrolled in those trials.
Methods
We pooled data from the relevant, recent hallmark RCTs; 10 trials were included in our analysis encompassing a total of 71,533 enrolled participants, assigned either to SGLT-2 inhibitor treatment or placebo. We set cardiovascular death as the primary efficacy outcome, while we assessed all-cause death and renal death as secondary efficacy outcomes.
Results
Treatment with SGLT-2 inhibitors resulted in a significant decrease in the risk of cardiovascular death, equal to 14% (RR = 0.86, 95% CI; 0.80 to 0.93, I2=22%). Only canagliflozin produced a significant result, while dapagliflozin led to a marginally non-significant reduction in cardiovascular mortality (Figure 1). Notably, SGLT-2 inhibitors led to a significant decrease in the risk for all-cause death, equal to 14% (RR=0.86, 95% CI; 0.81 to 0.92, I2=34%) the result was significant only for canagliflozin and dapagliflozin, while none of the rest SGLT-2 inhibitors resulted in a significant decrease in the risk for all-cause death (Figure 1). SGLT-2 inhibitors also produced a non-significant decrease in the risk for renal death (RR=0.36, 95% CI; 0.12 to 1.14, I2=0%). Neither canagliflozin nor dapagliflozin had a significant impact on risk reduction for renal death, while no cases of renal death were reported in VERTIS CV trial. No subgroup differences were identified for any of the three comparisons (Figure 2).
Conclusions
Antidiabetic treatment with SGLT-2 inhibitors provides a clear benefit in terms of cardiovascular and all-cause mortality for the very high-risk patients enrolled in the cardiovascular and renal outcome trials. Canagliflozin seems to be associated with the greatest impact on risk reduction for all-cause and cardiovascular death, followed by dapagliflozin.
Funding Acknowledgement
Type of funding sources: None. Figure 1Figure 2
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Affiliation(s)
- D Patoulias
- Hippokration General Hospital of Thessaloniki, Second Propedeutic Department of Internal Medicine, Thessaloniki, Greece
| | - A Boulmpou
- Hippokration General Hospital of Thessaloniki, Third Department of Cardiology, Thessaloniki, Greece
| | - A Tranidou
- Hippokration General Hospital of Thessaloniki, Fourth Department of Internal Medicine, Thessaloniki, Greece
| | - A Nikolaidis
- Hippokration General Hospital of Thessaloniki, Second Propedeutic Department of Internal Medicine, Thessaloniki, Greece
| | - D Mouselimis
- Hippokration General Hospital of Thessaloniki, Second Propedeutic Department of Internal Medicine, Thessaloniki, Greece
| | - C E Papadopoulos
- Hippokration General Hospital of Thessaloniki, Third Department of Cardiology, Thessaloniki, Greece
| | - V Vassilikos
- Hippokration General Hospital of Thessaloniki, Third Department of Cardiology, Thessaloniki, Greece
| | - M Doumas
- Hippokration General Hospital of Thessaloniki, Second Propedeutic Department of Internal Medicine, Thessaloniki, Greece
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17
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Kassimis G, Patoulias D, Theodoropoulos K, Papadopoulos CE, Davlouros P, Alexopoulos D, Sianos G, Ziakas A, Kanonidis I, Banning A. Shockwave intravascular lithotripsy facilitated percutaneous coronary intervention in patients with calcified coronary artery disease: a systematic review and meta-analysis of observational studies. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1234] [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
Percutaneous coronary intervention (PCI) outcomes for patients with significant coronary artery calcification (CAC) have been consistently inferior compared to patients without significant CAC. Shockwave Intravascular Lithotripsy (S-IVL) system offers a novel option for lesion modification of severely calcified plaques but supporting evidence on safety and efficacy of this technology is narrow. The aim of this study is to assess S-IVL safety and efficacy in patients with severe CAC undergoing PCI.
Methods
We systematically searched MEDLINE, ClinicalTrials.gov and the Cochrane Library to identify studies assessing the efficacy and safety of S-IVL in adult patients with calcified coronary artery disease undergoing PCI. We excluded those studies assessing the effect of S-IVL in patients with under-expanded coronary stents and/or in-stent restenosis.
Results
The largest meta-analysis to date was performed. All studies were observational since no relevant randomized controlled trials have been published so far. Nine studies were included in our qualitative synthesis, while 7 of them, in a total of 794 enrolled patients, were used in the quantitative synthesis. Frequency of peri-procedural outcomes of interest was low: a) coronary dissection: 2.52%, b) coronary perforation: 3.0%, c) MI: 3.51%. Relative frequency of 1-month MACE was 5.59% and cardiovascular death 1.01%. S-IVL resulted in a significant increase in the in-stent post-IVL minimum lumen diameter by 1.67 mm, a significant decrease in the in-stent post-IVL vessel diameter stenosis by 53.60%, and a significant increase in the in-stent post-IVL acute gain by 1.68 mm. OCT analysis confirmed a significant decrease in area stenosis post-IVL by 19.71% and calcium angle by 22.14o and a significant increase in lumen area by 1.62 mm2, without however affecting maximum calcium thickness. When we compared post-stent post-IVL vs. pre-stent post-IVL OCT results, we demonstrated a further significant decrease in area stenosis by 35.89% and in calcium angle by 20.33o, a significant increase in lumen area by 2.74 mm2 and a neutral effect on maximum calcium thickness.
Conclusion
Shockwave Intravascular lithotripsy offers a significant improvement in coronary lumen to facilitate stent delivery and deployment in severely calcified coronary arteries. Although S-IVL appears to be associated with a low incidence of complications and MACE based on our present findings, further evidence from RCTs and longer-term follow-up is required to advocate its routine use in patients with severe CAC.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- G Kassimis
- Hippokration General Hospital of Thessloniki, Thessaloniki, Greece
| | - D Patoulias
- Hippokration General Hospital of Thessloniki, Thessaloniki, Greece
| | - K Theodoropoulos
- Hippokration General Hospital of Thessloniki, Thessaloniki, Greece
| | - C E Papadopoulos
- Hippokration General Hospital of Thessloniki, Thessaloniki, Greece
| | - P Davlouros
- General University Hospital of Patras, Patra, Greece
| | - D Alexopoulos
- Attikon University Hospital, Second Department of Cardiology, Athens, Greece
| | - G Sianos
- Ahepa General Hospital of Aristotle University, First Department of Cardiology, Thessaloniki, Greece
| | - A Ziakas
- Ahepa General Hospital of Aristotle University, First Department of Cardiology, Thessaloniki, Greece
| | - I Kanonidis
- Hippokration General Hospital of Thessloniki, Thessaloniki, Greece
| | - A Banning
- Oxford University Hospitals NHS Foundation Trust, Department of Cardiology, Oxford, United Kingdom
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Boulmpou A, Patoulias D, Teperikidis E, Toumpourleka M, Vergopoulos S, Tsavousoglou C, Doumas M, Fragakis N, Vassilikos V, Papadopoulos CE. Meta-analysis of cardiovascular outcome trials assessing the impact of glucagon-like peptide-1 receptor agonists on major cardiac arrhythmias. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2952] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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
Type 2 diabetes mellitus poses a significant health burden, whereas growing attention has been focused on the novel classes of antidiabetic drugs. Glucagon-like peptide-1 receptor agonists (GLP-1RAs) constitute such a group of antidiabetic agents. In recent large, placebo-controlled randomized clinical trials (RCTs), GLP-1RAs have demonstrated beneficial cardiovascular effects. Nevertheless, the clear antiarrhythmic benefit has not been underlined yet.
Purpose
The purpose of the present analysis was to clarify the impact of antidiabetic treatment with GLP-1RAs on the several different types of cardiac arrhythmias, based on data extracted from relevant cardiovascular outcome trials.
Methods
We searched PubMed plus grey literature for all available cardiovascular and renal outcome, placebo-controlled RCTs utilizing GLP-1RAs versus placebo.
Results
We pooled data from 7 cardiovascular outcome trials with GLP-1RAs in a total of 55,943 randomized participants patients. When compared to placebo, treatment with GLP-1RAs did not provide a significant benefit in the risk for atrial fibrillation (RR = 0.81, 95% CI: 0.78–1.15, I2=51%) (Figure 1a), atrial flutter (RR=0.79, 95% CI: 0.53–1.16, I2=0%) (Figure 1b), ventricular fibrillation (RR=0.99, 95% CI: 0.48–2.04, I2=0%) (Figure 1c), ventricular tachycardia (RR=1.41, 95% CI: 0.87–2.28, I2=10%) (Figure 1d), atrial tachycardia (RR=0.63, 95% CI: 0.10–3.90, I2=24%) (Figure 2a), sinus node dysfunction (RR=0.70, 95% CI: 0.40–1.23, I2=0%) (Figure 2b), ventricular extrasystoles (RR=1.37, 95% CI: 0.56–3.30, I2=0%) (Figure 2c), second-degree atrioventricular block (RR=0.96, 95% CI: 0.52–1.74, I2=0%) (Figure 2d) or complete atrioventricular block (RR=0.78, 95% CI: 0.39–1.54, I2=38%) (Figure 2e).
Conclusions
In patients with type 2 diabetes mellitus, treatment with GLP-1RAs does not significantly affect the risk for major cardiac arrhythmias.
Funding Acknowledgement
Type of funding sources: None. Figure 1Figure 2
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Affiliation(s)
- A Boulmpou
- Hippokration General Hospital of Thessaloniki, Third Department of Cardiology, Thessaloniki, Greece
| | - D Patoulias
- Hippokration General Hospital of Thessaloniki, Second Propedeutic Department of Internal Medicine, Thessaloniki, Greece
| | - E Teperikidis
- Hippokration General Hospital of Thessaloniki, Third Department of Cardiology, Thessaloniki, Greece
| | - M Toumpourleka
- Hippokration General Hospital of Thessaloniki, Third Department of Cardiology, Thessaloniki, Greece
| | - S Vergopoulos
- Hippokration General Hospital of Thessaloniki, Third Department of Cardiology, Thessaloniki, Greece
| | - C Tsavousoglou
- Hippokration General Hospital of Thessaloniki, Third Department of Cardiology, Thessaloniki, Greece
| | - M Doumas
- Hippokration General Hospital of Thessaloniki, Second Propedeutic Department of Internal Medicine, Thessaloniki, Greece
| | - N Fragakis
- Hippokration General Hospital of Thessaloniki, Third Department of Cardiology, Thessaloniki, Greece
| | - V Vassilikos
- Hippokration General Hospital of Thessaloniki, Third Department of Cardiology, Thessaloniki, Greece
| | - C E Papadopoulos
- Hippokration General Hospital of Thessaloniki, Third Department of Cardiology, Thessaloniki, Greece
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19
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Patoulias D, Boulmpou A, Papadopoulos CE, Siskos F, Stavropoulos K, Tranidou A, Mouselimis D, Bakatselos S, Damianidis G, Doumas M. The effect of glucagon-like peptide-1 receptor agonists on 24-hour ambulatory blood pressure: a meta-analysis. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2950] [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
Hypertension augments overall cardiovascular risk in patients with type 2 diabetes mellitus (T2DM), constituting a major additional burden for diabetic subjects; however, control rates of hypertension remain suboptimal. Glucagon-like peptide-1 receptor agonists (GLP-1RAs), second-line treatment option for diabetics, have revolutionized the field of T2DM therapeutic management due to their pleiotropic effects, while they seem to hold multiple cardiovascular benefits. A few randomized controlled trials (RCTs) evaluated the effect of GLP-1RAs on ambulatory blood pressure (ABP). Ambulatory blood pressure monitoring (ABPM) provides a better method to predict long-term cardiovascular outcomes than office blood pressure.
Purpose
We sought to determine the effect of GLP-1RAs on ABPM, pooling data from relevant randomized controlled trials (RCTs).
Methods
We searched 2 major electronic databases, namely PubMed and Cochrane/CENTRAL, along with grey literature sources, for RCTs assessing the effect of various GLP-1RAs on ABP in patients with T2DM.
Results
After screening of the potentially eligible records, 7 RCTs were finally included in our meta-analysis (4 parallel-group and 3 cross-over). GLP-1RA treatment compared to placebo or active control resulted in a nonsignificant decrease in 24-h systolic blood pressure (MD=−1.57 mm Hg, 95% CI: −4.12 to 0.98, I2=63%) (Figure 1) and in 24-h diastolic blood pressure (MD=1.28 mmHg, 95% CI: −0.31 to 2.87, I2=49%) (Figure 2). No subgroup differences between the various GLP-1RAs were identified. More specifically, it was demonstrated that liraglutide once daily produced a non-significant decrease in 24-h systolic blood pressure (MD=−1.43 mm Hg, 95% CI: −5.24 to 2.38, I2=72%) and a non-significant increase in 24-h diastolic blood pressure (MD=1.47 mm Hg, 95% CI: −1.12 to 4.05, I2=61%), while data concerning the effect of once weekly dulaglutide and twice daily exenatide on ABPM were pooled from one RCT respectively (Figures 1, 2).
Conclusions
Antidiabetic treatment with GLP-1RAs does not influence either systolic or diastolic ABP in patients with T2DM.
Funding Acknowledgement
Type of funding sources: None. Figure 1Figure 2
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Affiliation(s)
- D Patoulias
- Hippokration General Hospital of Thessaloniki, Second Propedeutic Department of Internal Medicine, Thessaloniki, Greece
| | - A Boulmpou
- Hippokration General Hospital of Thessaloniki, Third Department of Cardiology, Thessaloniki, Greece
| | - C E Papadopoulos
- Hippokration General Hospital of Thessaloniki, Third Department of Cardiology, Thessaloniki, Greece
| | - F Siskos
- Hippokration General Hospital of Thessaloniki, Second Propedeutic Department of Internal Medicine, Thessaloniki, Greece
| | - K Stavropoulos
- Hippokration General Hospital of Thessaloniki, Second Propedeutic Department of Internal Medicine, Thessaloniki, Greece
| | - A Tranidou
- Hippokration General Hospital of Thessaloniki, Fourth Department of Internal Medicine, Thessaloniki, Greece
| | - D Mouselimis
- Hippokration General Hospital of Thessaloniki, Second Propedeutic Department of Internal Medicine, Thessaloniki, Greece
| | - S Bakatselos
- Hippokration General Hospital of Thessaloniki, First Department of Internal Medicine, Thessaloniki, Greece
| | - G Damianidis
- Hippokration General Hospital of Thessaloniki, First Department of Internal Medicine, Thessaloniki, Greece
| | - M Doumas
- Hippokration General Hospital of Thessaloniki, Second Propedeutic Department of Internal Medicine, Thessaloniki, Greece
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Patoulias D, Boulmpou A, Tranidou A, Nikolaidis A, Papadopoulos CE, Vassilikos V, Bakatselos S, Damianidis G, Doumas M. Meta-analysis assessing cardiovascular outcomes with febuxostat versus allopurinol for patients with gout. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.3264] [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
Gout, the most common inflammatory arthritis in the USA, represents an established risk factor for cardiovascular disease and coronary artery disease mortality. In addition, patients with gout experience an increased risk for non-fatal myocardial infarction, while they might also feature increased risk for stroke. Recent real-world data also highlight the association between gout and atrial fibrillation, which inevitably augments cardiovascular burden. Allopurinol, a xanthine oxidase inhibitor, remains the uric acid-lowering treatment option of first choice, while febuxostat is prescribed, when allopurinol is contraindicated or not tolerated. Unfortunately, medication adherence among gout patients is poor, associated with age and related co-morbidities.
Purpose
We sought to determine the comparative efficacy of febuxostat versus allopurinol across surrogate cardiovascular outcomes of interest, by pooling data from the 2 dedicated cardiovascular outcome trials available so far. The motive for this analysis was the U.S. Food and Drug Administration (FDA) warning raised after the publication of the CARES trial, regarding the increased risk for cardiovascular and all-cause death with febuxostat compared to allopurinol.
Methods
We pooled data from the 2 dedicated cardiovascular outcome trials (CARES and FAST) and we assessed the following cardiovascular outcomes of interest: cardiovascular death, all-cause death, non-fatal myocardial infarction (MI), non-fatal stroke, fatal MI, fatal stroke, transient ischemic attack, hospitalization for heart failure, coronary revascularization, cerebrovascular revascularization and atrial fibrillation. Risk of bias was low across the included studies.
Results
Our analysis in a total of 12,318 patients with gout showed that febuxostat compared to allopurinol treatment does not confer significant risk reduction for any of the assessed, prespecified surrogate outcomes in a study population with significant cardiovascular co-morbidities (Figure 1). One third of patients enrolled in the FAST trial and 40% of the patients enrolled in the CARES trial had pre-existing cardiovascular disease, as depicted in Figure 2. Heterogeneity was low for the vast majority of the assessed outcomes, except for cardiovascular and all-cause death and fatal MI.
Conclusions
There is no significant difference across surrogate cardiovascular outcomes of interest between febuxostat and allopurinol in patients with gout and cardiovascular co-morbidities. Febuxostat seems to be a safe treatment alternative to allopurinol, despite initial concerns in terms of its cardiovascular safety.
Funding Acknowledgement
Type of funding sources: None. Figure 1Figure 2
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Affiliation(s)
- D Patoulias
- Hippokration General Hospital of Thessaloniki, Second Propedeutic Department of Internal Medicine, Thessaloniki, Greece
| | - A Boulmpou
- Hippokration General Hospital of Thessaloniki, Third Department of Cardiology, Thessaloniki, Greece
| | - A Tranidou
- Hippokration General Hospital of Thessaloniki, Fourth Department of Internal Medicine, Thessaloniki, Greece
| | - A Nikolaidis
- Hippokration General Hospital of Thessaloniki, Second Propedeutic Department of Internal Medicine, Thessaloniki, Greece
| | - C E Papadopoulos
- Hippokration General Hospital of Thessaloniki, Third Department of Cardiology, Thessaloniki, Greece
| | - V Vassilikos
- Hippokration General Hospital of Thessaloniki, Third Department of Cardiology, Thessaloniki, Greece
| | - S Bakatselos
- Hippokration General Hospital of Thessaloniki, First Department of Internal Medicine, Thessaloniki, Greece
| | - G Damianidis
- Hippokration General Hospital of Thessaloniki, First Department of Internal Medicine, Thessaloniki, Greece
| | - M Doumas
- Hippokration General Hospital of Thessaloniki, Second Propedeutic Department of Internal Medicine, Thessaloniki, Greece
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Boulmpou A, Patoulias D, Teperikidis E, Papadopoulos CE, Sarafidis P, Doumas M, Fragakis N, Pagourelias E, Vassilikos V. Sodium-glucose co-transporter-2 inhibitors and the risk of major arrhythmias: a meta-analysis of the cardiovascular and renal outcome trials. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Type 2 diabetes mellitus is closely associated with cardiovascular disease and evidence already exists on its arrhythmogenic action. Sodium-glucose cotransporter 2 inhibitors (SGLT2i) are a unique class of oral antidiabetic medications which recently attracted attention for reducing the total risk of major adverse cardiovascular events in a series of recent, large placebo-controlled randomized clinical trials (RCTs). Dapagliflozin and empagliflozin additionally seem to improve survival and outcomes in patients with heart failure with reduced ejection fraction (HFrEF), irrespective of the presence of diabetes mellitus. Whether antidiabetic treatment with sodium-glucose co-transporter inhibitors could reduce the arrhythmic burden in diabetic patients still is to be clarified.
Purpose
The purpose of the present meta-analysis was to report the impact of SGLT2i on the risk for several types of cardiac arrhythmias, pooling data from all relevant cardiovascular and renal outcome, placebo-controlled, RCTs, comparing SGLT2i to placebo.
Methods
We searched PubMed for all available cardiovascular and renal outcome RCTs utilizing SGLT2i, along with grey literature sources. We sought to determine the risk of the following arrhythmias/cardiac disorders with the use of SGLT2i versus placebo: atrial fibrillation, atrial flutter, supraventricular tachycardia, ventricular tachycardia, ventricular fibrillation, ventricular extrasystoles, sinus bradycardia, sinus node dysfunction, second degree atrioventricular block, complete atrioventricular block.
Results
We extracted relevant data from 8 trials (5 dedicated cardiovascular outcome trials, 2 dedicated renal outcome trials, 1 trial enrolling patients with HFrEF), pooling data in a total of 55,966 patients. SGLT-2i treatment compared to placebo produced a significant reduction in the risk of atrial fibrillation equal to 21% (RR=0.79, 95% CI: 0.67–0.93, I2=0%) (Figure 1). A non-significant reduction in the risk of atrial flutter equal to 9% (RR=0.91, 95% CI: 0.64–1.29, I2=0%) was also observed with SGLT2i (Figure 2). No significant effect on the rest major arrhythmias was observed.
Conclusions
Antidiabetic therapy with SGLT2i seems to hold a significant impact on antiarrhythmic burden in type 2 diabetes mellitus, reducing the risk of atrial fibrillation development.
Funding Acknowledgement
Type of funding sources: None. Figure 1Figure 2
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Affiliation(s)
- A Boulmpou
- Hippokration General Hospital of Thessaloniki, Third Department of Cardiology, Thessaloniki, Greece
| | - D Patoulias
- Hippokration General Hospital of Thessaloniki, Second Propedeutic Department of Internal Medicine, Thessaloniki, Greece
| | - E Teperikidis
- Hippokration General Hospital of Thessaloniki, Third Department of Cardiology, Thessaloniki, Greece
| | - C E Papadopoulos
- Hippokration General Hospital of Thessaloniki, Third Department of Cardiology, Thessaloniki, Greece
| | - P Sarafidis
- Hippokration General Hospital of Thessaloniki, Department of Nephrology, Thessaloniki, Greece
| | - M Doumas
- Hippokration General Hospital of Thessaloniki, Second Propedeutic Department of Internal Medicine, Thessaloniki, Greece
| | - N Fragakis
- Hippokration General Hospital of Thessaloniki, Third Department of Cardiology, Thessaloniki, Greece
| | - E Pagourelias
- Hippokration General Hospital of Thessaloniki, Third Department of Cardiology, Thessaloniki, Greece
| | - V Vassilikos
- Hippokration General Hospital of Thessaloniki, Third Department of Cardiology, Thessaloniki, Greece
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Patoulias D, Boulmpou A, Teperikidis E, Katsimardou A, Siskos F, Tranidou A, Nikolaidis A, Mouselimis D, Doumas M, Papadopoulos CE, Vassilikos V. Meta-analysis of cardiovascular outcome trials assessing the cardiovascular efficacy and safety of dipeptidyl peptidase-4 inhibitors in patients with type 2 diabetes mellitus. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background
Type 2 diabetes mellitus (T2DM) represents an independent risk factor for the development of cardiovascular disease, which accounts for half of deaths among the affected patients. Patients with T2DM experience higher incidence of vascular interventions compared to high-risk patients without T2DM or cardiovascular disease at baseline, underscoring the necessity for targeted therapeutic interventions. Dipeptidyl peptidase-4 (DPP-4) inhibitors constitute a safe treatment option with fair glycemic efficacy in T2DM whose cardiovascular efficacy has been doubted over recent years. A series of randomized controlled trials (RCTs) addressing cardiovascular outcomes with DPP-4 inhibitors have been recently published, while previous meta-analyses failed to show any cardiovascular benefit with their use in patients with T2DM.
Purpose
The purpose of our analysis was to report the impact of antidiabetic treatment with DPP-4 inhibitors on different cardiovascular efficacy outcomes.
Methods
We searched PubMed for all published RCTs assessing cardiovascular outcomes after antidiabetic treatment with DPP-4 inhibitors. We extracted data related to the following efficacy outcomes: fatal and non-fatal myocardial infarction, fatal and non-fatal stroke, hospitalization for heart failure, hospitalization for unstable angina, hospitalization for coronary revascularization and cardiovascular death.
Results
We pooled data from a total of 6 trials in a total of 52,520 patients. Antidiabetic treatment with DPP-4 inhibitors did not significantly affect any of the prespecified cardiovascular efficacy outcomes. More specifically, DPP-4 inhibitors compared to control led to a non-significant increase in the risk for fatal and non-fatal myocardial infarction (RR=1.02, 95% CI: 0.94–1.11, I2=0%), hospitalization for heart failure (RR=1.09, 95% CI: 0.92–1.29, I2=65%) and cardiovascular death (RR=1.02, 95% CI: 0.93–1.11, I2=0%), as shown in figures 1a, 1c and 1f. In addition, DPP-4 inhibitors produced a non-significant decrease in the risk for fatal and non-fatal stroke (RR=0.96, 95% CI: 0.85–1.08, I2=0%) and coronary revascularization (RR=0.99, 95% CI: 0.90–1.09, I2=0%), as depicted in figures 1b and 1e. Finally, DPP-4 inhibitors demonstrated a neutral effect on the risk for hospitalization due to unstable angina (RR=1.00, 95% CI: 0.85–1.18, I2=0%), as shown in figure 1d.
Conclusions
Antidiabetic treatment with DPP-4 inhibitors does not seem to confer any significant cardiovascular benefit for patients with T2DM.
Funding Acknowledgement
Type of funding sources: None. Figure 1
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Affiliation(s)
- D Patoulias
- Hippokration General Hospital of Thessaloniki, Second Propedeutic Department of Internal Medicine, Thessaloniki, Greece
| | - A Boulmpou
- Hippokration General Hospital of Thessaloniki, Third Department of Cardiology, Thessaloniki, Greece
| | - E Teperikidis
- Hippokration General Hospital of Thessaloniki, Third Department of Cardiology, Thessaloniki, Greece
| | - A Katsimardou
- Hippokration General Hospital of Thessaloniki, Second Propedeutic Department of Internal Medicine, Thessaloniki, Greece
| | - F Siskos
- Hippokration General Hospital of Thessaloniki, Second Propedeutic Department of Internal Medicine, Thessaloniki, Greece
| | - A Tranidou
- Hippokration General Hospital of Thessaloniki, Fourth Department of Internal Medicine, Thessaloniki, Greece
| | - A Nikolaidis
- Hippokration General Hospital of Thessaloniki, Second Propedeutic Department of Internal Medicine, Thessaloniki, Greece
| | - D Mouselimis
- Hippokration General Hospital of Thessaloniki, Second Propedeutic Department of Internal Medicine, Thessaloniki, Greece
| | - M Doumas
- Hippokration General Hospital of Thessaloniki, Second Propedeutic Department of Internal Medicine, Thessaloniki, Greece
| | - C E Papadopoulos
- Hippokration General Hospital of Thessaloniki, Third Department of Cardiology, Thessaloniki, Greece
| | - V Vassilikos
- Hippokration General Hospital of Thessaloniki, Third Department of Cardiology, Thessaloniki, Greece
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Patoulias D, Boulmpou A, Papadopoulos CE, Doumas M. Glucagon-like Peptide-1 Receptor Agonists and the Risk of Acute Kidney Injury: Alarming, or Not? Kidney Med 2021; 3:674-675. [PMID: 34401735 PMCID: PMC8350837 DOI: 10.1016/j.xkme.2021.02.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Affiliation(s)
- Dimitrios Patoulias
- Second Propaedeutic Department of Internal Medicine, General Hospital "Hippokration," Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Aristi Boulmpou
- Third Department of Cardiology, General Hospital "Hippokration," Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Christodoulos E Papadopoulos
- Third Department of Cardiology, General Hospital "Hippokration," Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Michael Doumas
- Second Propaedeutic Department of Internal Medicine, General Hospital "Hippokration," Aristotle University of Thessaloniki, Thessaloniki, Greece.,Veterans Affairs Medical Center, George Washington University, Washington, District of Columbia
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Sotiriadou M, Papadopoulos CE, Antoniadis AP, Roumelis P, Vergopoulos S, Konstantinidis P, Pagkourelias ED, Tzikas S, Fragakis N, Vassilikos V. The impact of atrial mechanical function on age-dependent presentation of neurocardiogenic syncope. Clin Cardiol 2021; 44:1440-1447. [PMID: 34374094 PMCID: PMC8495094 DOI: 10.1002/clc.23704] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Accepted: 07/19/2021] [Indexed: 12/20/2022] Open
Abstract
Background The contribution of atrial and ventricular function in neurocardiogenic syncope (NCS) pathophysiology is elusive. Hypothesis We assessed the influence of echocardiographic properties to the age of presentation and NCS recurrences. Methods We assigned 124 patients with symptoms suggesting NCS, to those with syncope initiation at age <35 (group A, n = 56) and >35 years (group B, n = 68). Echocardiographic indices were measured before head‐up tilt test (HUTT). Results A total of 55 had positive HUTT (44%) with a trend favoring group A (p = .08). Group A exhibited lower left atrial (LA) volume index (17 ± 6 vs. 22 ± 11 ml/m2, p = .015), higher LA ejection fraction (69 ± 10 vs. 63 ± 11%, p = .008), LA peak strain (reservoir phase 41 ± 13 vs. 31 ± 14%, p = .001, contraction phase 27 ± 11 vs. 15 ± 10%, p < .001) and LA peak strain rate (reservoir phase 1.83 ± 1.04 vs. 1.36 ± 0.96 1/s, p = .012, conduit phase 2.36 ± 1.25 vs. 1.36 ± 0.78 1/s, p = .001). Group A showed smaller minimum right atrial (RA) volume, better RA systolic function, superior left ventricular diastolic indices, and lower filling pressures. Group A patients were more likely to have >3 recurrences (82.0% vs. 50.1%, p < .05). Conclusions Patients with younger age of NCS onset and more syncopal recurrences manifest smaller LA and RA dimensions with distinct patterns of systolic and diastolic function and better LA reservoir and contraction properties. These findings may indicate an increased susceptibility to preload reduction, thereby triggering the NCS mechanism.
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Affiliation(s)
- Melani Sotiriadou
- Third Department of Cardiology, Hippokration General Hospital, Aristotle University Medical School, Thessaloniki, Greece
| | - Christodoulos E Papadopoulos
- Third Department of Cardiology, Hippokration General Hospital, Aristotle University Medical School, Thessaloniki, Greece
| | - Antonios P Antoniadis
- Third Department of Cardiology, Hippokration General Hospital, Aristotle University Medical School, Thessaloniki, Greece
| | - Panagiotis Roumelis
- Third Department of Cardiology, Hippokration General Hospital, Aristotle University Medical School, Thessaloniki, Greece
| | - Stavros Vergopoulos
- Third Department of Cardiology, Hippokration General Hospital, Aristotle University Medical School, Thessaloniki, Greece
| | - Periklis Konstantinidis
- Third Department of Cardiology, Hippokration General Hospital, Aristotle University Medical School, Thessaloniki, Greece
| | - Efstathios D Pagkourelias
- Third Department of Cardiology, Hippokration General Hospital, Aristotle University Medical School, Thessaloniki, Greece
| | - Stergios Tzikas
- Third Department of Cardiology, Hippokration General Hospital, Aristotle University Medical School, Thessaloniki, Greece
| | - Nikolaos Fragakis
- Third Department of Cardiology, Hippokration General Hospital, Aristotle University Medical School, Thessaloniki, Greece
| | - Vassilios Vassilikos
- Third Department of Cardiology, Hippokration General Hospital, Aristotle University Medical School, Thessaloniki, Greece
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25
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Alexandrou ME, P Theodorakopoulou M, Boutou A, Pella E, Boulmpou A, Papadopoulos CE, Zafeiridis A, Papagianni A, Sarafidis P. Cardiorespiratory fitness assessed by cardiopulmonary exercise testing between different stages of pre-dialysis chronic kidney disease: A systematic review and meta-analysis. Nephrology (Carlton) 2021; 26:972-980. [PMID: 34288260 DOI: 10.1111/nep.13951] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 07/08/2021] [Accepted: 07/12/2021] [Indexed: 12/18/2022]
Abstract
AIM The burden of several cardiovascular risk factors increases in parallel to renal function decline. Exercise intolerance is common in patients with chronic kidney disease (CKD) and has been associated with increased risk of adverse outcomes. Whether indices of cardiorespiratory capacity deteriorate with advancing CKD stages is unknown. METHODS We conducted a systematic review and meta-analysis of studies assessing cardiorespiratory capacity in adult patients with pre-dialysis CKD using cardiopulmonary exercise testing (CPET) and reporting data for different stages. Our primary outcome was differences in peak oxygen uptake (VO2 peak) between patients with CKD Stages 2-3a and those with Stages 3b-5(pre-dialysis). Literature search was undertaken in PubMed, Web of Science and Scopus databases, and abstract books of relevant meetings. Quality assessment was undertaken with Newcastle-Ottawa-Scale. RESULTS From 4944 records initially retrieved, six studies with 512 participants fulfilling our inclusion criteria were included in the primary meta-analysis. Peak oxygen uptake (VO2 peak) was significantly higher in patients with CKD Stages 2-3a versus those with Stages 3b-5(pre-dialysis) [weighted-mean-difference, WMD: 2.46, 95% CI (1.15, 3.78)]. Oxygen consumption at ventilatory threshold (VO2 VT) was higher in Stages 2-3a compared with those in Stages 3b-5(pre-dialysis) [standardized-mean-difference, SMD: 0.59, 95% CI (0.06, 1.1)], while no differences were observed for maximum workload and respiratory-exchange-ratio. A secondary analysis comparing patients with CKD Stages 2-3b and Stages 4-5(pre-dialysis), yielded similar results [WMD: 1.78, 95% CI (1.34, 2.22)]. Sensitivity analysis confirmed the robustness of these findings. CONCLUSION VO2 peak and VO2 VT assessed with CPET are significantly lower in patients in CKD Stages 3b-5 compared with Stages 2-3a. Reduced cardiorespiratory fitness may be another factor contributing to cardiovascular risk increase with advancing CKD.
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Affiliation(s)
- Maria-Eleni Alexandrou
- Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Marieta P Theodorakopoulou
- Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Afroditi Boutou
- Department of Respiratory Medicine, G. Papanikolaou Hospital, Thessaloniki, Greece
| | - Eva Pella
- Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Aristi Boulmpou
- Third Department of Cardiology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Christodoulos E Papadopoulos
- Third Department of Cardiology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Andreas Zafeiridis
- Exercise Physiology and Biochemistry Laboratory, Department of Sports Science, Aristotle University, Serres, Greece
| | - Aikaterini Papagianni
- Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Pantelis Sarafidis
- Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
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26
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Kassimis G, Karamasis GV, Katsikis A, Abramik J, Kontogiannis N, Didagelos M, Petroglou D, Papadopoulos CE, Poulimenos L, Vassilikos V, Kanonidis I, Raina T, Ziakas A. Should Percutaneous Coronary Intervention be the Standard Treatment Strategy for Significant Coronary Artery Disease in all Octogenarians? Curr Cardiol Rev 2021; 17:244-259. [PMID: 32885757 PMCID: PMC8640858 DOI: 10.2174/1573403x16666200903153823] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Revised: 06/01/2020] [Accepted: 06/12/2020] [Indexed: 11/22/2022] Open
Abstract
Coronary artery disease (CAD) remains the leading cause of cardiovascular death in octogenarians. This group of patients represents nearly a fifth of all patients treated with percutaneous coronary intervention (PCI) in real-world practice. Octogenarians have multiple risk factors for CAD and often greater myocardial ischemia than younger counterparts, with a potential of an increased benefit from myocardial revascularization. Despite this, octogenarians are routinely under-treated and belittled in clinical trials. Age does make a difference to PCI outcomes in older people, but it is never the sole arbiter of any clinical decision, whether in relation to the heart or any other aspect of health. The decision when to perform revascularization in elderly patients and especially in octogenarians is complex and should consider the patient on an individual basis, with clarification of the goals of the therapy and the relative risks and benefits of performing the procedure. In ST-segment elevation myocardial infarction (MI), there is no upper age limit regarding urgent reperfusion and primary PCI must be the standard of care. In non-ST-segment elevation acute coronary syndromes, a strict conservative strategy must be avoided; whereas the use of a routine invasive strategy may reduce the occurrence of MI and the need for revascularization at follow-up, with no established benefit in terms of mortality. In stable CAD patients, invasive therapy on top of optimal medical therapy seems better in symptom relief and quality of life. This review summarizes the available data on percutaneous revascularization in the elderly patients and particularly in octogenarians, including practical considerations on PCI risk secondary to ageing physiology. We also analyse technical difficulties met when considering PCI in this cohort and the ongoing need for further studies to ameliorate risk stratification and eventually outcomes in these challenging patients.
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Affiliation(s)
- George Kassimis
- 2nd Cardiology Department, Hippokration Hospital, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Athanasios Katsikis
- Department of Cardiology, Essex Cardiothoracic Centre, Basildon, United Kingdom
| | - Joanna Abramik
- Department of Cardiology, Cheltenham General Hospital, Gloucestershire Hospitals NHS Foundation Trust, Cheltenham, United Kingdom
| | - Nestoras Kontogiannis
- Department of Cardiology, Cheltenham General Hospital, Gloucestershire Hospitals NHS Foundation Trust, Cheltenham, United Kingdom
| | - Matthaios Didagelos
- 1st Cardiology Department, AHEPA General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Dimitrios Petroglou
- 1st Cardiology Department, AHEPA General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | | | - Vassilios Vassilikos
- 3rd Cardiology Department, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Ioannis Kanonidis
- 2nd Cardiology Department, Hippokration Hospital, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Tushar Raina
- Department of Cardiology, Cheltenham General Hospital, Gloucestershire Hospitals NHS Foundation Trust, Cheltenham, United Kingdom
| | - Antonios Ziakas
- 1st Cardiology Department, AHEPA General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
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27
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Karkos CD, Papadopoulos CE. A Large Floating Thrombus in the Ascending Aorta: to Treat or not to Treat? Eur J Vasc Endovasc Surg 2021; 62:63. [PMID: 34024710 DOI: 10.1016/j.ejvs.2021.04.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 04/05/2021] [Accepted: 04/17/2021] [Indexed: 11/25/2022]
Affiliation(s)
- Christos D Karkos
- Vascular Unit, 5(th) Department of Surgery, Hippocratio Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece.
| | - Christodoulos E Papadopoulos
- 3(rd) Department of Cardiology, Hippocratio Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
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28
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Tsarouchas A, Bakogiannis C, Mouselimis D, Lazaridis C, Kelemanis I, Theofillogiannakos EK, Pagourelias ED, Papadopoulos CE, Fragakis N, Vassilikos VP. HFrEF patient activity levels during COVID-19 lockdown: A comparison between physical activity questionnaires and implantable devices data. Eur J Prev Cardiol 2021. [PMCID: PMC8136071 DOI: 10.1093/eurjpc/zwab061.032] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Funding Acknowledgements Type of funding sources: None. Background The ongoing COVID-19 pandemic is a major public health crisis of great risk to patients with cardiovascular comorbidities. Heart failure (HF) is a deadly chronic disease, a leading cause of hospitalizations worldwide and a great detriment to patients’ quality of life. HF therapy guidelines suggest prescribing physical activity to improve long-term outcomes. Self- or government- imposed behavioral modifications in response to COVID-19 ranging from avoiding social interactions to outright restrictions of movement (lockdowns) could compromise regular PA in HF patients, who constitute an extremely high-risk group. Purpose Investigate the effect of the national lockdown in Greece 23rd March – 4th May 2020) on the PA levels of patients suffering from HF with reduced ejection fraction (HFrEF) and cardiac implantable electronic devices (CIEDs). Methods HFrEF patients with CIEDs were included in the study. Participants answered the Physical Activity Questionnaire (PAQ) regarding the period before, during and after the 42-day national lockdown. CIED-derived daily activity levels for the corresponding periods were recorded through CIED telemetry. The differences in PAQ- and CIED-derived PA levels and sedentary time before, during and after the lockdown period were investigated. Results 67 HFrEF patients participated in the study (mean age 69 ± 10.2y, 85% male). Activity levels fell in 55 (82%) of patients. The median PAQ-derived PA level decreased by 28% during lockdown, from 840.5 (944) METmin/week to 602 (1054) METmin/week during the lockdown (p = 0.01). A 53% increase was observed after the lockdown, to 924 (1214) METmin/week (p = 0.004). The CIED-derived activity level was 2.38 (1.3) hours/day pre-lockdown, 1.78 (1.1) hours/day during the lockdown (25% decrease, p < 0.001) and 2.69 (1.5) hours/day post-lockdown (51% increase, p < 0.001). Time spent on sedentary activities also increased to 9 (3) hours per day during the lockdown, up from 6.5 (4) hours before lockdown (p = 0.001). Conclusions All measures examined in this study indicate that the COVID-19 lockdown period was associated with a significant decrease in HFrEF patients’ PA. All efforts must be made on the part of clinicians and public health organizations to promote safe exercise in this subgroup of the population that is particularly vulnerable to the effects of a sedentary lifestyle. Abstract Figure. Patient activity around COVID lockdown ![]()
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Affiliation(s)
- A Tsarouchas
- Hippokration General Hospital of Thessaloniki, Third Cardiology Department AUTh, Thessaloniki, Greece
| | - C Bakogiannis
- Hippokration General Hospital of Thessaloniki, Third Cardiology Department AUTh, Thessaloniki, Greece
| | - D Mouselimis
- Hippokration General Hospital of Thessaloniki, Third Cardiology Department AUTh, Thessaloniki, Greece
| | - C Lazaridis
- Hippokration General Hospital of Thessaloniki, Third Cardiology Department AUTh, Thessaloniki, Greece
| | - I Kelemanis
- Hippokration General Hospital of Thessaloniki, Third Cardiology Department AUTh, Thessaloniki, Greece
| | - EK Theofillogiannakos
- Hippokration General Hospital of Thessaloniki, Third Cardiology Department AUTh, Thessaloniki, Greece
| | - ED Pagourelias
- Hippokration General Hospital of Thessaloniki, Third Cardiology Department AUTh, Thessaloniki, Greece
| | - CE Papadopoulos
- Hippokration General Hospital of Thessaloniki, Third Cardiology Department AUTh, Thessaloniki, Greece
| | - N Fragakis
- Hippokration General Hospital of Thessaloniki, Third Cardiology Department AUTh, Thessaloniki, Greece
| | - VP Vassilikos
- Hippokration General Hospital of Thessaloniki, Third Cardiology Department AUTh, Thessaloniki, Greece
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29
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Lazaridis C, Mouselimis D, Bakogiannis C, Tsarouchas A, Antoniadis A, Papadopoulos CE, Tzikas S, Fragakis N, Vassilikos VP. The role of the novel MyAlgos e-medicine Platform in promoting patient-centered self-care management in patients with atrial fibrillation: The emPOWERD trial. Eur J Prev Cardiol 2021. [DOI: 10.1093/eurjpc/zwab061.432] [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]
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
The emergence of digital health has revolutionized most aspects of healthcare. Meanwhile, atrial fibrillation (AF) remains the most common sustained arrhythmia associated with high morbidity and impaired quality of life. Patient-perceived treatment burden can be further optimized by digital health interventions utilizing smartphone technology.
The MyAlgos platform is an integrated software system designed to enhance the remote management and communication between the patient and the healthcare practitioner. The mobile application encourages patient self-management through educational modules and tools to improve medication adherence. The web-based platform allows the health care practitioner to receive live updates on patient status and design personalized self-care management plans.
Purpose
To investigate whether the use of the MyAlgos platform by AF patients is safe and improves the quality of self-care, quality of life (QoL), and hospitalization rate.
Methods
We designed a single-center, randomized, controlled, prospective, open-label, pilot study to compare the effect of the use of the full-feature MyAlgos platform version versus a stripped-down control version of the platform on the QoL, medication adherence and hospitalization rate in patients with paroxysmal AF. The full version of the e-medicine platform includes active patient education, communication with the medical team, medication reminders as well as the full record of clinically significant data such as heart rate and blood pressure. Specialized algorithms monitor patient data and alert physicians for potential AF episodes. The control version only allows the recording of patient’s heart rate.
Results
A total of 80 patients with paroxysmal AF were randomized in a 1:1 ratio to receive either the full or the control version of the MyAlgos Platform. The mean age of all patients, 53 (66%) male, was 58.1 ± 9.1 years. Hypertension and diabetes were present in 47 (59%) and 7 (9%) respectively. At baseline, the majority of patients had AF-related symptoms classified as European Heart Rhythm Association (EHRA) I (45%) or EHRA II (24%), while the mean Atrial Fibrillation Effect on QualiTy-of-Life (AFEQT) score was 70.1 ± 17.0. Between the two groups, there were no statistically significant differences in the baseline characteristics of the participants.
Conclusion
The emPOWERD trial will provide data on the impact of a novel e-medicine platform on the QoL, medication adherence and hospitalizations of patients with paroxysmal AF. We anticipate better outcomes for the subjects receiving the full version of the MyAlgos platform, allowing it to positively affect the further management of paroxysmal AF.
Abstract Figure. The MyAlgos e-medicine Platform
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Affiliation(s)
- C Lazaridis
- Hippokration University Hospital, Aristotle University of Thessaloniki, Third Cardiology Department, Thessaloniki, Greece
| | - D Mouselimis
- Hippokration University Hospital, Aristotle University of Thessaloniki, Third Cardiology Department, Thessaloniki, Greece
| | - C Bakogiannis
- Hippokration University Hospital, Aristotle University of Thessaloniki, Third Cardiology Department, Thessaloniki, Greece
| | - A Tsarouchas
- Hippokration University Hospital, Aristotle University of Thessaloniki, Third Cardiology Department, Thessaloniki, Greece
| | - A Antoniadis
- Hippokration University Hospital, Aristotle University of Thessaloniki, Third Cardiology Department, Thessaloniki, Greece
| | - CE Papadopoulos
- Hippokration University Hospital, Aristotle University of Thessaloniki, Third Cardiology Department, Thessaloniki, Greece
| | - S Tzikas
- Hippokration University Hospital, Aristotle University of Thessaloniki, Third Cardiology Department, Thessaloniki, Greece
| | - N Fragakis
- Hippokration University Hospital, Aristotle University of Thessaloniki, Third Cardiology Department, Thessaloniki, Greece
| | - VP Vassilikos
- Hippokration University Hospital, Aristotle University of Thessaloniki, Third Cardiology Department, Thessaloniki, Greece
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30
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Bakogiannis C, Tsarouchas A, Mouselimis D, Lazaridis C, Theofillogianakos EK, Billis A, Tzikas S, Fragakis N, Bamidis PD, Papadopoulos CE, Vassilikos VP. A Patient-Oriented App (ThessHF) to Improve Self-Care Quality in Heart Failure: From Evidence-Based Design to Pilot Study. JMIR Mhealth Uhealth 2021; 9:e24271. [PMID: 33847599 PMCID: PMC8080140 DOI: 10.2196/24271] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 12/05/2020] [Accepted: 03/02/2021] [Indexed: 01/01/2023] Open
Abstract
Background Heart failure (HF) remains a major public health challenge, while HF self-care is particularly challenging. Mobile health (mHealth)–based interventions taking advantage of smartphone technology have shown particular promise in increasing the quality of self-care among these patients, and in turn improving the outcomes of their disease. Objective The objective of this study was to co-develop with physicians, patients with HF, and their caregivers a patient-oriented mHealth app, perform usability assessment, and investigate its effect on the quality of life of patients with HF and rate of hospitalizations in a pilot study. Methods The development of an mHealth app (The Hellenic Educational Self-care and Support Heart Failure app [ThessHF app]) was evidence based, including features based on previous clinically tested mHealth interventions and selected by a panel of HF expert physicians and discussed with patients with HF. At the end of alpha development, the app was rated by mHealth experts with the Mobile Application Rating Scale (MARS). The beta version was tested by patients with HF, who rated its design and content by means of the Post-Study System Usability Questionnaire (PSSUQ). Subsequently, a prospective pilot study (THESS-HF [THe Effect of a Specialized Smartphone app on Heart Failure patients’ quality of self-care, quality of life and hospitalization rate]) was performed to investigate the effect of app use on patients with HF over a 3-month follow-up period. The primary endpoint was patients’ quality of life, which was measured with the Kansas City Cardiomyopathy Questionnaire (KCCQ) and the 5-level EQ-5D version (EQ-5D-5L). The secondary endpoints were the European Heart Failure Self-care Behavior Scale (EHFScBS) score and the hospitalization rate. Results A systematic review of mHealth-based HF interventions and expert panel suggestions yielded 18 separate app features, most of which were incorporated into the ThessHF app. A total of 14 patients and 5 mHealth experts evaluated the app. The results demonstrated a very good user experience (overall PSSUQ score 2.37 [SD 0.63], where 1 is the best, and a median MARS score of 4.55/5). Finally, 30 patients (male: n=26, 87%) participated in the THESS-HF pilot study (mean age 68.7 [SD 12.4] years). A significant increase in the quality of self-care was noted according to the EHFScBS, which increased by 4.4% (SD 7.2%) (P=.002). The mean quality of life increased nonsignificantly after 3 months according to both KCCQ (mean increase 5.8 [SD 15] points, P=.054) and EQ-5D-5L (mean increase 5.6% [SD 15.6%], P=.06) scores. The hospitalization rate for the follow-up duration was 3%. Conclusions The need for telehealth services and remote self-care management in HF is of vital importance, especially in periods such as the COVID-19 pandemic. We developed a user-friendly mHealth app to promote remote self-care support in HF. In this pilot study, the use of the ThessHF app was associated with an increase in the quality of self-care. A future multicenter study will investigate the effect of the app use on long-term outcomes in patients with HF.
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Affiliation(s)
- Constantinos Bakogiannis
- Cardiovascular Prevention and Digital Cardiology Lab, Third Cardiology Department, Aristotle University of Thessaloniki, Thessaloniki, Greece.,Third Cardiology Department, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Anastasios Tsarouchas
- Cardiovascular Prevention and Digital Cardiology Lab, Third Cardiology Department, Aristotle University of Thessaloniki, Thessaloniki, Greece.,Third Cardiology Department, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Dimitrios Mouselimis
- Cardiovascular Prevention and Digital Cardiology Lab, Third Cardiology Department, Aristotle University of Thessaloniki, Thessaloniki, Greece.,Third Cardiology Department, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Charalampos Lazaridis
- Cardiovascular Prevention and Digital Cardiology Lab, Third Cardiology Department, Aristotle University of Thessaloniki, Thessaloniki, Greece.,Third Cardiology Department, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Antonios Billis
- Lab of Medical Physics, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Stergios Tzikas
- Third Cardiology Department, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Nikolaos Fragakis
- Third Cardiology Department, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Panagiotis D Bamidis
- Lab of Medical Physics, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Christodoulos E Papadopoulos
- Cardiovascular Prevention and Digital Cardiology Lab, Third Cardiology Department, Aristotle University of Thessaloniki, Thessaloniki, Greece.,Third Cardiology Department, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Vassilios P Vassilikos
- Cardiovascular Prevention and Digital Cardiology Lab, Third Cardiology Department, Aristotle University of Thessaloniki, Thessaloniki, Greece.,Third Cardiology Department, Aristotle University of Thessaloniki, Thessaloniki, Greece
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31
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Sarafidis P, Papadopoulos CE, Kamperidis V, Giannakoulas G, Doumas M. Cardiovascular Protection With Sodium-Glucose Cotransporter-2 Inhibitors and Mineralocorticoid Receptor Antagonists in Chronic Kidney Disease: A Milestone Achieved. Hypertension 2021; 77:1442-1455. [PMID: 33775130 DOI: 10.1161/hypertensionaha.121.17005] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [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: 12/13/2022]
Abstract
Chronic kidney disease (CKD) and cardiovascular disease are intimately linked. They share major risk factors, including age, hypertension, and diabetes, and common pathogenetic mechanisms. Furthermore, reduced renal function and kidney injury documented with albuminuria are independent risk factors for cardiovascular events and mortality. In major renal outcome trials and subsequent meta-analyses in patients with CKD, ACE (angiotensin-converting enzyme) inhibitors and ARBs (angiotensin II receptor blockers) were shown to effectively retard CKD progression but not to significantly reduce cardiovascular events or mortality. Thus, a high residual risk for cardiovascular disease progression under standard-of-care treatment is still present for patients with CKD. In contrast to the above, several outcome trials with SGLT-2 (sodium-glucose cotransporter-2) inhibitors and MRAs (mineralocorticoid receptor antagonists) clearly suggest that these agents, apart from nephroprotection, offer important cardioprotection in this population. This article discusses existing evidence on the effects of SGLT-2 inhibitors and MRAs on cardiovascular outcomes in patients with CKD that open new roads in cardiovascular protection of this heavily burdened population.
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Affiliation(s)
- Pantelis Sarafidis
- Department of Nephrology (P.S.), Aristotle University of Thessaloniki, Greece
| | | | - Vasilios Kamperidis
- Hippokration Hospital and First Department of Cardiology, AHEPA Hospital (V.K., G.G.), Aristotle University of Thessaloniki, Greece
| | - George Giannakoulas
- Hippokration Hospital and First Department of Cardiology, AHEPA Hospital (V.K., G.G.), Aristotle University of Thessaloniki, Greece
| | - Michael Doumas
- Second Propaedeutic Department of Internal Medicine (M.D.), Aristotle University of Thessaloniki, Greece
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32
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Pagourelias ED, Mirea O, Duchenne J, Unlu S, Van Cleemput J, Papadopoulos CE, Bogaert J, Vassilikos VP, Voigt JU. Speckle tracking deformation imaging to detect regional fibrosis in hypertrophic cardiomyopathy: a comparison between 2D and 3D echo modalities. Eur Heart J Cardiovasc Imaging 2020; 21:1262-1272. [PMID: 32294170 DOI: 10.1093/ehjci/jeaa057] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Accepted: 03/07/2020] [Indexed: 11/12/2022] Open
Abstract
AIMS We aimed at directly comparing three-dimensional (3D) and two-dimensional (2D) deformation parameters in hypertrophic hearts and depict which may best reflect underlying fibrosis in hypertrophic cardiomyopathy (HCM), defined by late gadolinium enhancement (LGE) in cardiac magnetic resonance (CMR). METHODS AND RESULTS We included 40 HCM [54.1 ± 14.3 years, 82.5% male, maximum wall thickness (MWT) 19.3 ± 4.8 mm] and 15 hypertensive (HTN) patients showing myocardial hypertrophy (58.1 ± 15.6 years, 80% male, MWT 12.8 ± 1.4 mm) who have consecutively undergone 2D-, 3D-speckle tracking echocardiography and LGE CMR. Deformation parameters (2D and 3D) presented overall poor to moderate correlations, with 3D_longitudinal strain (LS) and 3D_circumferential strain (CS) values being constantly higher compared to 2D derivatives. By regression analysis, hypertrophy substrate (HCM vs. hypertension) and hypertrophy magnitude were the parameters to influence 2D-3D LS and CS strain correlations (R2 = 0.66, P < 0.001 and R2 = 0.5, P = 0.001 accordingly). Among segmental deformation indices, 2D_LS showed the best area under the curve [AUC = 0.78, 95% confidence intervals (CI) (0.75-0.81), P < 0.0005] to detect fibrosis, with 3D deformation parameters showing similar AUC (0.65) and 3D_LS presenting the highest specificity [93.1%, 95% CI (90.6-95.1)]. CONCLUSIONS In hypertrophic hearts, 2D and 3D deformation parameters are not interchangeable, showing modest correlations. Thickness, substrate, and tracking algorithm calculating assumptions seem to induce this variability. Nevertheless, among HCM patients 2D_peak segmental longitudinal strain remains the best strain parameter for tissue characterization and fibrosis detection.
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Affiliation(s)
- Efstathios D Pagourelias
- Department of Cardiovascular Diseases, University Hospital Leuven, Catholic University Leuven, Herestraat 49, 3000 Leuven, Belgium.,Third Cardiology Department, Hippokrateion University Hospital, Aristotle University of Thessaloniki, Konstantinoupoleos 49, 54642 Thessaloniki, Greece
| | - Oana Mirea
- Department of Cardiovascular Diseases, University Hospital Leuven, Catholic University Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Jürgen Duchenne
- Department of Cardiovascular Diseases, University Hospital Leuven, Catholic University Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Serkan Unlu
- Department of Cardiovascular Diseases, University Hospital Leuven, Catholic University Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Johan Van Cleemput
- Department of Cardiovascular Diseases, University Hospital Leuven, Catholic University Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Christodoulos E Papadopoulos
- Third Cardiology Department, Hippokrateion University Hospital, Aristotle University of Thessaloniki, Konstantinoupoleos 49, 54642 Thessaloniki, Greece
| | - Jan Bogaert
- Department of Radiology, University Hospital Leuven, Catholic University Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Vasilios P Vassilikos
- Third Cardiology Department, Hippokrateion University Hospital, Aristotle University of Thessaloniki, Konstantinoupoleos 49, 54642 Thessaloniki, Greece
| | - Jens-Uwe Voigt
- Department of Cardiovascular Diseases, University Hospital Leuven, Catholic University Leuven, Herestraat 49, 3000 Leuven, Belgium
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Loutradis C, Papadopoulos CE, Sarafidis P. Longer Dialysis Sessions Improve Cardiac Systolic Function by Reducing Myocardial Stunning. J Card Fail 2020; 26:1026-1027. [PMID: 32512217 DOI: 10.1016/j.cardfail.2020.06.001] [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] [Received: 05/26/2020] [Revised: 05/30/2020] [Accepted: 06/02/2020] [Indexed: 10/24/2022]
Affiliation(s)
- Charalampos Loutradis
- Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece; Department of Renal Medicine, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom.
| | | | - Pantelis Sarafidis
- Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Mouselimis D, Tsarouchas AS, Pagourelias ED, Bakogiannis C, Theofilogiannakos EK, Loutradis C, Fragakis N, Vassilikos VP, Papadopoulos CE. Left atrial strain, intervendor variability, and atrial fibrillation recurrence after catheter ablation: A systematic review and meta-analysis. Hellenic J Cardiol 2020; 61:154-164. [DOI: 10.1016/j.hjc.2020.04.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 03/22/2020] [Accepted: 04/06/2020] [Indexed: 12/24/2022] Open
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Boulmpou A, Kassimis G, Zioutas D, Meletidou M, Mouselimis D, Tsarouchas A, Tzikas S, Vassilikos V, Kanonidis I, Tsounos I, Papadopoulos CE. Spontaneous Coronary Artery Dissection (SCAD): Case Series and Mini Review. Cardiovasc Revasc Med 2020; 21:1450-1456. [PMID: 32173331 DOI: 10.1016/j.carrev.2020.03.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 12/14/2019] [Revised: 02/18/2020] [Accepted: 03/05/2020] [Indexed: 12/18/2022]
Abstract
Spontaneous coronary artery dissection (SCAD) has gained recognition in recent years as a non-atherosclerotic cause of acute coronary syndrome (ACS), especially in young and middle-aged women without any of the classic risk factors for cardiovascular disease. The booming use of coronary angiography in patients presenting with ACS combined with new, revolutionary methods of intravascular imaging, have led to increased rates of SCAD diagnosis. We aim to present a brief, up-to-date review of the existing literature, along with our experience as reflected in the recent management of nine SCAD cases in three tertiary care hospitals.
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Affiliation(s)
- Aristi Boulmpou
- 3rd Cardiology Department, Hippokration University Hospital, Aristotle University of Thessaloniki, Greece
| | - George Kassimis
- 2nd Cardiology Department, Hippokration University Hospital, Aristotle University of Thessaloniki, Greece
| | | | - Magdalini Meletidou
- 3rd Cardiology Department, Hippokration University Hospital, Aristotle University of Thessaloniki, Greece
| | - Dimitrios Mouselimis
- 3rd Cardiology Department, Hippokration University Hospital, Aristotle University of Thessaloniki, Greece
| | - Anastasios Tsarouchas
- 3rd Cardiology Department, Hippokration University Hospital, Aristotle University of Thessaloniki, Greece
| | - Stergios Tzikas
- 3rd Cardiology Department, Hippokration University Hospital, Aristotle University of Thessaloniki, Greece
| | - Vassilios Vassilikos
- 3rd Cardiology Department, Hippokration University Hospital, Aristotle University of Thessaloniki, Greece
| | - Ioannis Kanonidis
- 2nd Cardiology Department, Hippokration University Hospital, Aristotle University of Thessaloniki, Greece
| | - Ioannis Tsounos
- Cardiology Department, Agios Pavlos General Hospital, Thessaloniki, Greece
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Tsarouchas A, Mouselimis D, Bakogiannis C, Gkasdaris G, Dimitriadis G, Zioutas D, Papadopoulos CE. Spontaneous Epidural Hematoma of the Cervical Spine Following Thrombolysis in a Patient with STEMI-Two Medical Specialties Facing a Rare Dilemma. J Neurosci Rural Pract 2020; 11:191-195. [PMID: 32140027 PMCID: PMC7055631 DOI: 10.1055/s-0039-3400182] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Spontaneous spinal epidural hematoma (SSEH) is a rare, albeit well-documented complication following thrombolysis treatment in ST elevation myocardial infarction (STEMI). A SSEH usually manifests with cervical pain and neurologic deficits and may require surgical intervention. In this case report, we present the first reported SSEH to occur following thrombolysis with reteplase. In this case, the SSEH manifested with cervical pain shortly after the patient emerged from his rescue percutaneous coronary intervention (PCI). Although magnetic resonance imaging reported spinal cord compression, the lack of neurologic symptoms prompted the treating clinicians to delay surgery. A dangerous dilemma emerged, as the usual antithrombotic regimen that was necessary to avoid stent thrombosis post-PCI, was also likely to exacerbate the bleeding. As a compromise, the patient only received aspirin as a single antiplatelet therapy. Ultimately, the patient responded well to conservative treatment, with the hematoma stabilizing a week later, without residual neurologic deficits. In conclusion, the conservative treatment of SSEH appears to be an acceptable option for carefully selected patients, but the risks of permanent neurologic deficits and stent thrombosis have to be weighted for each patient.
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Affiliation(s)
- Anastasios Tsarouchas
- 3rd Cardiology Department, Hippokrateio University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Dimitrios Mouselimis
- 3rd Cardiology Department, Hippokrateio University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Constantinos Bakogiannis
- 3rd Cardiology Department, Hippokrateio University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | | | | | - Christodoulos E Papadopoulos
- 3rd Cardiology Department, Hippokrateio University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Pagourelias E, Mirea O, Duchenne J, Unlu S, Van Cleemput J, Papadopoulos CE, Bogaert J, Vassilikos V, Voigt JU. 1181 A novel insight into pathophysiology of hypertrophic cardiomyopathy using simultaneous three-dimensional volume-strain loops. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Supported with a scholarship by the Greek State Scholarship Foundation (IKY).
Background
Strain assessment offers a robust evaluation of myocardial mechanics and systolic function, however reporting only peak strain values in hypertrophic cardiomyopathy (HCM) may impose limitations in the conception of its complex remodeling. Therefore, combined plotting of deformation parameters against other indices [e.g. arterial pressure, left ventricular (LV) volume] might offer additional insights into the pathophysiology of the disease.
Purpose
Aim of this study was i) to apply strain-volume loops in HCM based on simultaneous frame-by-frame strain and volume changes’ recordings acquired by means of three-dimensional (3D) speckle tracking imaging and ii) to take advantage of the previous methodology to gain further insights into HCM pathophysiology.
Methods
We included 40 HCM patients (54.1 ± 14.3 years, 82.5% male, maximum wall thickness 19.3 ± 4.8mm) who have consecutively undergone 3D-speckle tracking echocardiography and cardiovascular magnetic resonance (CMR) with late gadolinium enhancement (LGE). Values of 3D strain were plotted vs. volume for each frame to build a strain–volume loop. Peak of radial, longitudinal, and circumferential systolic strain (Rsp, Lsp, and Csp, respectively), systolic slopes of the loops (RsSl, LsSl, CsSl), and strain to end-diastolic volume (EDV) ratio (Rs/V, Ls/V, Cs/V) were computed for the analysis (panel A). Additionally, burden of fibrosis (percentage of LV mass) was defined by LGE extent (>5 standard deviations compared to nulled myocardium) in CMR slices.
Results
All HCM patients had preserved EF (60.5 ± 5,7%), while 16 (40%) had LV outflow tract obstruction (LVOTO > 30 mm Hg at rest). Mean LV mass index was 78.9 ± 14.5 g (evaluated by 3D echocardiography). LGE was observed in 23 patients (57.5%) occupying 5.2 ± 4.5% of LV mass. Concerning strain-volume loops the following values were recorded for radial (Rsp 30.8 ± 9.8%, RsSl 0.4 ± 0.13 and Rs/V 0.25 ± 0.09), longitudinal (Lsp -9.4 ± 3.7%, LsSl 0.12 ± 0.06 and Ls/V 0.08 ± 0.04) and circumferential deformation (Csp -14.2 ± 3.5%, CsSl 0.18 ± 0.05 and Cs/V 0.11 ± 0.03). Among typical HCM characteristics tested (LV mass, LVOTO and LGE), only LV mass presented significant correlations with LsSl (r=-0.41, p < 0.01). Interestingly, HCM patients with smaller LVMI and without LGE presented steeper and narrower (difference between systolic and diastolic strain for the same volume) longitudinal strain-volume loops compared to patients with larger LVMIs and fibrosis (panel B).
Conclusions
Strain-volume loop is an innovative application of 3D deformation imaging in HCM. According to this new non-invasive method, increase of LVMI in HCM is accompanied by less longitudinal contribution to stroke volume, whereas absence of fibrosis and severe hypertrophy is accompanied by better systolic-diastolic coupling.
Abstract 1181 Figure.
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Affiliation(s)
- E Pagourelias
- Hippokration General Hospital of Thessloniki, Thessaloniki, Greece
| | - O Mirea
- KU Leuven, Department of Cardiovascular Diseases, University Hospital Leuven, Leuven, Belgium
| | - J Duchenne
- KU Leuven, Department of Cardiovascular Diseases, University Hospital Leuven, Leuven, Belgium
| | - S Unlu
- KU Leuven, Department of Cardiovascular Diseases, University Hospital Leuven, Leuven, Belgium
| | - J Van Cleemput
- KU Leuven, Department of Cardiovascular Diseases, University Hospital Leuven, Leuven, Belgium
| | - C E Papadopoulos
- Hippokration General Hospital of Thessloniki, Thessaloniki, Greece
| | - J Bogaert
- KU Leuven, Department of Cardiovascular Diseases, University Hospital Leuven, Leuven, Belgium
| | - V Vassilikos
- Hippokration General Hospital of Thessloniki, Thessaloniki, Greece
| | - J U Voigt
- KU Leuven, Department of Cardiovascular Diseases, University Hospital Leuven, Leuven, Belgium
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Loutradis C, Papadopoulos CE, Sachpekidis V, Ekart R, Krunic B, Karpetas A, Bikos A, Tsouchnikas I, Mitsopoulos E, Papagianni A, Zoccali C, Sarafidis P. Lung Ultrasound–Guided Dry Weight Assessment and Echocardiographic Measures in Hypertensive Hemodialysis Patients: A Randomized Controlled Study. Am J Kidney Dis 2020; 75:11-20. [DOI: 10.1053/j.ajkd.2019.07.025] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 07/30/2019] [Indexed: 12/15/2022]
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Pagourelias E, Mirea O, Duchenne J, Unlu S, Van Cleemput J, Papadopoulos CE, Bogaert J, Vassilikos V, Voigt JU. P984 A head-to-head comparison between 2D and 3D segmental strain parameters in hypertrophic cardiomyopathy. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Supported with a scholarship by the Greek State Scholarship Foundation (IKY).
Background
Previous studies have suggested that in normal and ischemic hearts three- (3D) and two-dimensional (2D) strain values present a moderate agreement which is prone to technical considerations. However, the level of agreement between 2D and 3D-strain imaging has never been adequately addressed in hypertrophic hearts, nor has it been validated against a "ground truth". Especially in hypertrophic cardiomyopathy (HCM), the magnitude and eccentricity of hypertrophy set additional challenges in standardization and measurement of regional 3D deformation parameters.
Purpose
Aims of this study were i) to investigate the consistency between 3D and 2D regional deformation parameters in HCM and ii) to test their accuracy in identifying regional fibrosis as this is defined by late gadolinium enhancement (LGE) in cardiac magnetic resonance (CMR).
Methods
We included 40 HCM patients (54.1 ± 14.3 years, 82.5% male, maximum wall thickness 19.3 ± 4.8mm) who have consecutively undergone 2D-,3D-speckle tracking echocardiography and CMR. Segmental circumferential (SCS) and longitudinal (SLS) strain have been calculated from 2D acquisitions and 3D full volume data, where additionally radial (SRS) and area (SAS) strain have been extracted using an 18 segment left ventricle model. Accordingly, segmental fibrosis was defined by LGE in corresponding CMR slices.
Results
Out of 720 segments evaluated, 134 (19.7%) were enhanced and 95(13.2%) thickened (thickness > 12 mm). Two dimensional LS and CS analysis was feasible in 719 (99.9%) and 678 (94.2%) segments respectively, while 686 segments (95.3%) were appropriate for 3D tracking. 3D_SLS values were -7.9 ± 6.8% less negative compared to 2D_SLS values [level of agreement (LOA)(-21.1-5.4%)], while the bias for SCS values was even higher -8.5 ± 8.6 [LOA(-25.4-8.4%)]. Absolute agreement between 2D and 3D deformation imaging modalities was poor to moderate [Intra-class Correlation Coefficient (ICC)= 0.46, 95%CI (0.15-0.68), p < 0.0005 for SLS and ICC = 0.19, 95%CI(0.07-0.38), p < 0.0005 for SCS] (Panel A). Following regression analysis, regional thickness was the only segmental factor to influence the correlation between 3D and 2D_SLS [R2 = 0.504, B = 0.33, 95%CI(0.22-0.44), p < 0.0005)], without, however, being a significant regressor for the other 2D vs 3D correlations. Among deformation indices, 2D_SLS showed the best area under the curve [(AUC)=0.78, 95%CI(0.75-0.81), p < 0.0005] to detect segmental fibrosis identified by CMR LGE, with 3D_SLS, 3D_SAS and 3D_SRS showing similar AUC (0.65) and 3D_SLS presenting the highest specificity [93.1%, 95%CI(90.6-95.1)] (Panel B).
Conclusions
In HCM, 2D and 3D deformation parameters are not interchangeable, showing modest agreement. Thickness and tracking algorithm calculating assumptions seem to induce this inconsistency. Among HCM patients, 2D_SLS remains the most accurate strain parameter to detect regional fibrosis.
Abstract P984 Figure.
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Affiliation(s)
- E Pagourelias
- Hippokration General Hospital of Thessloniki, Thessaloniki, Greece
| | - O Mirea
- KU Leuven, Department of Cardiovascular Diseases, University Hospital Leuven, Leuven, Belgium
| | - J Duchenne
- KU Leuven, Department of Cardiovascular Diseases, University Hospital Leuven, Leuven, Belgium
| | - S Unlu
- KU Leuven, Department of Cardiovascular Diseases, University Hospital Leuven, Leuven, Belgium
| | - J Van Cleemput
- KU Leuven, Department of Cardiovascular Diseases, University Hospital Leuven, Leuven, Belgium
| | - C E Papadopoulos
- Hippokration General Hospital of Thessloniki, Thessaloniki, Greece
| | - J Bogaert
- KU Leuven, Department of Cardiovascular Diseases, University Hospital Leuven, Leuven, Belgium
| | - V Vassilikos
- Hippokration General Hospital of Thessloniki, Thessaloniki, Greece
| | - J U Voigt
- KU Leuven, Department of Cardiovascular Diseases, University Hospital Leuven, Leuven, Belgium
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Pagourelias E, Mirea O, Duchenne J, Unlu S, Van Cleemput J, Papadopoulos CE, Bogaert J, Vassilikos V, Voigt JU. P4364A direct comparison between 2D and 4D deformation imaging in hypertrophic hearts. An agreement of disagreement. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Previous studies have directly compared 2-dimensional (2D) and 4-dimensional (4D) deformation imaging in normal and ischemic hearts suggesting a moderate agreement prone to technical considerations. However, the level of agreement between 2D and 4D-strain imaging has never been adequately addressed in hypertrophic hearts, nor has it been validated against a “ground truth”.
Purpose
We aimed at directly comparing 4D and 2D global and regional deformation parameters and depict which may best reflect underlying segmental fibrosis in hypertrophic cardiomyopathy (HCM), as defined by late gadolinium enhancement (LGE) in cardiac magnetic resonance (CMR).
Methods
We included 40 HCM patients (54.1±14.3 years, 82.5% male, maximum wall thickness 19.3±4.8mm) who have consecutively undergone 2D-,4D-speckle tracking echocardiography and CMR. Global and segmental circumferential (CS) and longitudinal (LS) strain have been calculated from 2D acquisitions and 4D full volume data, where additionally radial (RS) and area (AS) strain have been extracted using an 18 segment left ventricle model. Accordingly, segmental fibrosis was defined by LGE in corresponding CMR slices.
Results
Deformation parameters (2D and 4D, global and regional) presented overall poor to moderate agreement (Figure A+B) with regional 4D_LS and 4D_CS values being constantly less negative compared to 2D derivatives (−7.29±6.94% and −8.53±8.8% accordingly). In regional analysis, 720 segments were evaluated of which 134 (19.7%) were enhanced and 95 of them thickened (68.8%) (thickness>12 mm), with segments presenting both characteristics showing the greatest impairment both in 2D and 4D strain values. Among segmental deformation indices, 2D_SLS showed the best area under the curve [(AUC)=0.78, 95% CI (0.75–0.81), p<0.0005] to detect segmental fibrosis, with 2D_SCS and all 4D deformation indices presenting significantly lower AUC (Figure C).
Conclusions
In HCM, 2D and 4D deformation parameters are not interchangeable, showing modest agreement. Thickness and tracking algorithm calculating assumptions seem to induce this variability. Nevertheless, among HCM patients 2D_SLS remains the best strain parameter for tissue characterization and fibrosis detection.
Acknowledgement/Funding
Supported with a scholarship by the Greek State Scholarship Foundation (IKY).
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Affiliation(s)
- E Pagourelias
- Hippocration General Hospital of Thessaloniki, Thessaloniki, Greece
| | - O Mirea
- University of Leuven, Department of Cardiovascular Diseases, University Hospital Leuven, Leuven, Belgium
| | - J Duchenne
- University of Leuven, Department of Cardiovascular Diseases, University Hospital Leuven, Leuven, Belgium
| | - S Unlu
- University of Leuven, Department of Cardiovascular Diseases, University Hospital Leuven, Leuven, Belgium
| | - J Van Cleemput
- University of Leuven, Department of Cardiovascular Diseases, University Hospital Leuven, Leuven, Belgium
| | - C E Papadopoulos
- Hippocration General Hospital of Thessaloniki, Thessaloniki, Greece
| | - J Bogaert
- University of Leuven, Department of Cardiovascular Diseases, University Hospital Leuven, Leuven, Belgium
| | - V Vassilikos
- Hippocration General Hospital of Thessaloniki, Thessaloniki, Greece
| | - J U Voigt
- University of Leuven, Department of Cardiovascular Diseases, University Hospital Leuven, Leuven, Belgium
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Loutradis C, Sarafidis P, Mayer C, Karpetas A, Bikos A, Papadopoulos CE, Pagourelias E, Wassertheurer S, Vassilikos V, Schmaderer C, Papagianni A, London G. P1584The prognostic significance of the blood pressure-pulse wave velocity association for cardiovascular outcomes and mortality in hemodialysis patients. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction and purpose
Hemodialysis patients have premature arterial stiffness, and the relationship between pulse wave velocity (PWV) and blood pressure (BP) may be different than in other hypertensives. Previous studies showed that when BP decrease is accompanied by PWV decrease the survival is improved. The aim of this study is to examine the prognostic significance of BP sensitivity of PWV for major cardiovascular outcomes and all-cause mortality in hemodialysis patients.
Methods
This is a prospective cohort study including 242 hemodialysis patients [age, 62.6±14.2 years; female, 91 (37.6%); hemodialysis vintage, 41.53±43.46]. All subjects underwent 48-hour-ABPM with Mobil-O-Graph-NG and followed-up for 33.17±19.68 months. The within-individual MBP-PWV association (MBP, dependent and PWV independent variable) was evaluated using the beta-coefficient value from simple linear regression analysis for each patient. The primary end-point was first occurrence of all-cause death, non-fatal myocardial infarction or non-fatal stroke. Secondary end-points were: (i) all-cause mortality; (ii) cardiovascular mortality; (iii) a combination of cardiovascular events.
Results
Patients who experienced the primary end-point during follow-up had significantly lower beta-coefficient levels (primary end-point: 19.877±3.975 vs 18.483±3.550, p=0.008). Higher quartiles of beta-coefficients (indicating dependency of PWV on MBP) were associated with higher cumulative freedom from the primary end-point (50.8%, 60.0%, 70.0% and 80.3% for quartiles 1 to 4 respectively; logrank-p=0.001), higher overall survival (60.7%, 61.7%, 73.3%, 86.9%; logrank-p=0.002) and higher cardiovascular survival (78.7%, 75.0%, 81.7%, 91.8% for quartiles 1 to 4; logrank-p=0.044). The future risk for the primary end-point, all-cause and cardiovascular mortality and the combined outcome was progressively increasing for lower quartiles of beta-coefficients (HR for all-cause mortality 3.395; 95% CI: 1.524–7.563, p=0.003 for quartile 1 vs quartile 4). Age (OR: 1.046, 95% CI: 1.016–1.077 per year increase, p=0.003) and 48h heart rate (OR: 0.949, 95% CI: 0.916–0.982 per bpm increase, p=0.003) were independently associated with weaker relationship between 48h-MBP and 48h-PWV.
Conclusions
Lower within-individual MBP-PWV association, based on AMBP recordings, is associated with higher risk of death and cardiovascular events in hemodialysis. These findings support that BP-independent arterial stiffness may be the underlying factor for adverse outcomes in these individuals.
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Affiliation(s)
- C Loutradis
- Aristotle University of Thessaloniki, Hippokration Hospital, Department of Nephrology, Thessaloniki, Greece
| | - P Sarafidis
- Aristotle University of Thessaloniki, Hippokration Hospital, Department of Nephrology, Thessaloniki, Greece
| | - C Mayer
- AIT Austrian Institute of Technology, Center for Health & Bioresources, Biomedical Systems, Vienna, Austria
| | - A Karpetas
- Therapeutiki Hemodialysis Unit, Thessaloniki, Greece
| | - A Bikos
- Aristotle University of Thessaloniki, Hippokration Hospital, Department of Nephrology, Thessaloniki, Greece
| | - C E Papadopoulos
- Aristotle University of Thessaloniki, Hippokration Hospital, 3rd Department of Cardiology, Thessaloniki, Greece
| | - E Pagourelias
- Aristotle University of Thessaloniki, Hippokration Hospital, 3rd Department of Cardiology, Thessaloniki, Greece
| | - S Wassertheurer
- AIT Austrian Institute of Technology, Center for Health & Bioresources, Biomedical Systems, Vienna, Austria
| | - V Vassilikos
- Aristotle University of Thessaloniki, Hippokration Hospital, 3rd Department of Cardiology, Thessaloniki, Greece
| | - C Schmaderer
- Technische Universität München, Klinikum rechts der Isar, Munich, Germany
| | - A Papagianni
- Aristotle University of Thessaloniki, Hippokration Hospital, Department of Nephrology, Thessaloniki, Greece
| | - G London
- Hospital and FCRIN INI-CRCTC, Manhes, France
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Loutradis C, Papadopoulos CE, Sachpekidis V, Pagourelias E, Ekart R, Krunic B, Toumpourleka M, Theodorakopoulou M, Pateinakis P, Zoccali C, London G, Vassilikos V, Sarafidis P, Papagianni A. P2640The effect of dry-weight reduction guided by lung ultrasound on ambulatory aortic blood pressure and arterial stiffness parameters in hemodialysis patients. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction and purpose
Arterial stiffness and aortic blood pressure (BP) augmentation are significantly increased in hemodialysis patients. Recent studies suggest that the prognostic significance of ambulatory recordings of arterial stiffness is high in hemodialysis. This study examines for the first time the effect of dry weight reduction with a standardized lung-ultrasound-guided strategy on ambulatory aortic BP and arterial stiffness parameters in hypertensive hemodialysis patients.
Methods
A total 71 hemodialysis patients with hypertension (mean home BP ≥135/85 mmHg), that were clinically euvolemic, were included in this single-blind randomized clinical trial. Patients were randomized in a 1:1 ratio in the active group (n=35), following a strategy for dry-weight reduction guided by the total number of US-B lines (US-B lines score) prior to a mid-week dialysis session and the control group (n=), following standard-of-care treatment. All patients underwent 48-hour ABPM with the Mobil-O-Graph monitor (IEM, Stolberg, Germany) and PWV measurement in office with SphygmoCor (ArtCor, Sydney, Australia) at baseline and after 8-weeks.
Results
Overall, the US-B lines change during follow-up were −5.3±12.5 in active versus +2.2±7.6 in control group (p<0.001), which corresponded to dry-weight changes of −0.71±1.39 versus +0.51±0.98 kg (p<0.001). The change in 48-hour cSBP was significantly greater in the active group (−6.30±8.90 vs −0.50±12.46, p=0.027); the relevant cDBP fall was marginally greater (−3.85±6.61 vs −0.63±8.36, p=0.077) in the active group. 48-hour cPP (41.51±9.63 vs 39.06±9.61 mmHg, p=0.004) and 48-hour PWV (9.30±2.00 vs 9.08±2.04 m/sec, p=0.032) were significantly reduced from baseline to study-end in the active group but remained unchanged in controls. In contrast, 48-hour AIx and AIx(75) did not change between baseline and study-end in both groups; changes in AIx(75) were similar in the two groups (−0.97±3.51 vs −0.36±4.25, p=0.517). PWV measured in office was decreased from baseline to study-end in the active (10.07±2.66 vs 9.79±2.81, p=0.038) but not in the control group.
Conclusions
A lung-ultrasound-guided strategy for dry-weight reduction reduces ambulatory aortic BP and ambulatory or office PWV, but not ambulatory AIx(75). These results suggest that dry-weight reduction can primarily reduce aortic BP levels and large arteries stiffness but not wave reflections from the periphery.
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Affiliation(s)
- C Loutradis
- Aristotle University of Thessaloniki, Hippokration Hospital, Department of Nephrology, Thessaloniki, Greece
| | - C E Papadopoulos
- Aristotle University of Thessaloniki, Hippokration Hospital, 3rd Department of Cardiology, Thessaloniki, Greece
| | - V Sachpekidis
- Hospital Papageorgiou, Department of Cardiology, Thessaloniki, Greece
| | - E Pagourelias
- Aristotle University of Thessaloniki, Hippokration Hospital, 3rd Department of Cardiology, Thessaloniki, Greece
| | - R Ekart
- University Medical Centre Maribor, Clinic for Internal Medicine, Department of Dialysis, Maribor, Slovenia
| | - B Krunic
- University Medical Centre Maribor, Clinic for Internal Medicine, Department of Cardiology, Maribor, Slovenia
| | - M Toumpourleka
- Hospital Papageorgiou, Department of Cardiology, Thessaloniki, Greece
| | - M Theodorakopoulou
- Aristotle University of Thessaloniki, Hippokration Hospital, Department of Nephrology, Thessaloniki, Greece
| | - P Pateinakis
- Hospital Papageorgiou, Department of Nephrology, Thessaloniki, Greece
| | - C Zoccali
- CNR-IFC Clinical Epidemiology of Renal Diseases and Hypertension, Reggio Calabria, Italy
| | - G London
- Hospital and FCRIN INI-CRCTC, Manhes, France
| | - V Vassilikos
- Aristotle University of Thessaloniki, Hippokration Hospital, 3rd Department of Cardiology, Thessaloniki, Greece
| | - P Sarafidis
- Aristotle University of Thessaloniki, Hippokration Hospital, Department of Nephrology, Thessaloniki, Greece
| | - A Papagianni
- Aristotle University of Thessaloniki, Hippokration Hospital, Department of Nephrology, Thessaloniki, Greece
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Loutradis C, Papadopoulos CE, Sachpekidis V, Pagourelias E, Ekart R, Krunic B, Toumpourleka M, Tsouchnikas I, Vassilikos V, Papagianni A, Zoccali C, Sarafidis PA. 4308Lung ultrasound guided dry-weight probing reduces left and right atrial dimensions and left ventricular filling pressures in hemodialysis patients with hypertension. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction and purpose
Left ventricular hypertrophy and dysfunction is tightly associated with adverse outcome in hemodialysis. Hypertension and increased preload due to hypervolemia are major factors for these cardiac anomalies in hemodialysis. This study examined the effect of lung-ultrasound-guided dry-weight reduction on echocardiographic indices of left and right cardiac size, systolic and diastolic function in hypertensive hemodialysis patients.
Methods
This pilot, single-blind trial randomised 71 clinically euvolemic hypertensive hemodialysis patients in an active group (n=35), following a strategy for dry-weight reduction guided by the total number of US-B lines (US-B lines score) prior to a mid-week dialysis session, and a control group (n=36), following standard-of-care treatment. Among others, patients underwent two-dimensional and tissue-Doppler echocardiographic (TDI) at baseline and after 8-weeks.
Results
Overall, 19 (54.3%) patients in the active and 5 (13.9%) in the control group had UF intensification (p<0.001) during follow-up (US-B lines 5.3±12.5 vs +2.2±7.6, p<0.001, dry-weight: −0.71±1.39 vs +0.51±0.98 kg, p<0.001). Inferior vena cava diameter was reduced to a greater extend in the active compared to control group (−0.43±4.00 vs 0.71±4.82, p=0.033) at study-end. Reductions in LA and RA sizing parameters were greater in the active group (LA Surface: −1.09±4.61 vs 0.93±3.06 cm2, p=0.034; RA surface: −1.56±6.17 vs 0.47±2.31, p=0.024; LAVi: −2.43±13.14 vs 2.95±9.42 ml/m2, p=0.052). Reductions in LV end-diastolic diameter and volume were marginally greater in the active group. LV filling pressures significantly decreased in the active compared to the control group (E/e' LV: −0.38±3.14 vs 1.36±3.54, p=0.034; DT: 35.43±85.25 vs −18.44±50.69, p=0.002). Systolic function indices were unchanged in both groups. In multivariate analysis, US-B lines reduction was a powerful predictor (OR: 4.542, 95% CI: 1.266–16.292, p=0.020) of E/e' LV ratio decrease, among various factors examined.
Conclusions
A lung-ultrasound-guided strategy for dry-weight reduction can effectively reduce cardiac chambers dimensions and LV filling pressures without changing systolic performance during an 8-week follow-up in hypertensive hemodialysis patients.
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Affiliation(s)
- C Loutradis
- Aristotle University of Thessaloniki, Hippokration Hospital, Department of Nephrology, Thessaloniki, Greece
| | - C E Papadopoulos
- Aristotle University of Thessaloniki, Hippokration Hospital, 3rd Department of Cardiology, Thessaloniki, Greece
| | - V Sachpekidis
- Hospital Papageorgiou, Department of Cardiology, Thessaloniki, Greece
| | - E Pagourelias
- Aristotle University of Thessaloniki, Hippokration Hospital, 3rd Department of Cardiology, Thessaloniki, Greece
| | - R Ekart
- University Medical Centre Maribor, Clinic for Internal Medicine, Department of Dialysis, Maribor, Slovenia
| | - B Krunic
- University Medical Centre Maribor, Clinic for Internal Medicine, Department of Cardiology, Maribor, Slovenia
| | - M Toumpourleka
- Aristotle University of Thessaloniki, Hippokration Hospital, 3rd Department of Cardiology, Thessaloniki, Greece
| | - I Tsouchnikas
- Aristotle University of Thessaloniki, Hippokration Hospital, Department of Nephrology, Thessaloniki, Greece
| | - V Vassilikos
- Aristotle University of Thessaloniki, Hippokration Hospital, 3rd Department of Cardiology, Thessaloniki, Greece
| | - A Papagianni
- Aristotle University of Thessaloniki, Hippokration Hospital, Department of Nephrology, Thessaloniki, Greece
| | - C Zoccali
- CNR-IFC Clinical Epidemiology of Renal Diseases and Hypertension, Reggio Calabria, Italy
| | - P A Sarafidis
- Aristotle University of Thessaloniki, Hippokration Hospital, Department of Nephrology, Thessaloniki, Greece
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Pagourelias E, Mirea O, Duchenne J, Van Cleemput J, Papadopoulos CE, Fragakis N, Bogaert J, Vassilikos V, Voigt JU. P6492Do segmental deformation parameters reveal regional fibrosis in hypertrophic cardiomyopathy? Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p6492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- E Pagourelias
- Aristotle University of Thessaloniki, Third Cardiology Department, Hippokration University Hospital, Thessaloniki, Greece
| | - O Mirea
- University Hospital Craiova, Department of Cardiology, Craiova, Romania
| | - J Duchenne
- Gasthuisberg University Hospital, Department of Cardiovascular Diseases, Leuven, Belgium
| | - J Van Cleemput
- Gasthuisberg University Hospital, Department of Cardiovascular Diseases, Leuven, Belgium
| | - C E Papadopoulos
- Aristotle University of Thessaloniki, Third Cardiology Department, Hippokration University Hospital, Thessaloniki, Greece
| | - N Fragakis
- Aristotle University of Thessaloniki, Third Cardiology Department, Hippokration University Hospital, Thessaloniki, Greece
| | - J Bogaert
- Gasthuisberg University Hospital, Department of Radiology, Leuven, Belgium
| | - V Vassilikos
- Aristotle University of Thessaloniki, Third Cardiology Department, Hippokration University Hospital, Thessaloniki, Greece
| | - J U Voigt
- Gasthuisberg University Hospital, Department of Cardiovascular Diseases, Leuven, Belgium
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Loutradis C, Sarafidis PA, Papadopoulos CE, Papagianni A, Zoccali C. The Ebb and Flow of Echocardiographic Cardiac Function Parameters in Relationship to Hemodialysis Treatment in Patients with ESRD. J Am Soc Nephrol 2018; 29:1372-1381. [PMID: 29592914 PMCID: PMC5967760 DOI: 10.1681/asn.2017101102] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Cardiovascular disease is the leading cause of mortality in patients receiving hemodialysis. Cardiovascular events in these patients demonstrate a day-of-week pattern; i.e., they occur more commonly during the last day of the long interdialytic interval and the first session of the week. The hemodialysis process causes acute decreases in cardiac chamber size and pulmonary circulation loading and acute diastolic dysfunction, possibly through myocardial stunning and other non-myocardial-related mechanisms; systolic function, in contrast, is largely unchanged. During interdialytic intervals volume overload, acid-base, and electrolyte shifts, as well as arterial and myocardial wall changes, result in dilatation of right cardiac chambers and pulmonary circulation overload. Recent studies suggest that these alterations are more extended during the long interdialytic interval or the first dialysis session of the week and are associated with excess volume overload or removal, respectively, thus adding a mechanism for the day-of-week pattern of mortality in patients receiving hemodialysis. This review summarizes the existing data from echocardiographic studies of cardiac morphology and function during the hemodialysis session, as well as during the interdialytic intervals.
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Affiliation(s)
| | | | - Christodoulos E Papadopoulos
- 3rd Department of Cardiology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece; and
| | | | - Carmine Zoccali
- CNR-IFC, Clinical Epidemiology and Pathophysiology of Hypertension and Renal Diseases Unit, Ospedali Riuniti, Reggio Calabria, Italy
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Karvounis HI, Papadopoulos CE, Zaglavara TA, Nouskas IG, Gemitzis KD, Parharidis GE, Louridas GE. Evidence of Left Ventricular Dysfunction in Asymptomatic Elderly Patients with Non-insulin-dependent Diabetes Mellitus. Angiology 2016; 55:549-55. [PMID: 15378118 DOI: 10.1177/000331970405500511] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [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: 01/19/2023]
Abstract
Diabetic cardiomyopathy is a distinct entity in diabetic patients with congestive heart failure, who have no angiographic evidence of significant coronary artery stenosis. The aim of this study was to evaluate left ventricular (LV) function in 24 elderly patients (mean age 67 ±2 years) with type 2 diabetes, who were asymptomatic and had no history of hypertension, or coronary or valvular heart disease. LV systolic indices (ejection fraction [EF] and fractional shortening [FS]), diastolic indices (E wave, A wave, E/A ratio, isovolumic relaxation time [IVRT] and deceleration time [DT]) and the myocardial performance index (MPI) were evaluated with echocardiography. Compared to controls (24 age- and gender-matched normal subjects), the E wave was reduced (0.60 ±0.10 m/sec vs 0.72 ±0.08 m/sec, p<0.05), the A wave was increased (0.77 ±0.07 m/sec vs 0.68 ±0.06 m/sec, p<0.05), the E/A ratio was decreased (0.78 ±0.20 vs 1.06 ±0.18, p<0.001) and both IVRT and DT were prolonged (0.115 ±0.01 sec vs 0.09 ±0.01 sec, p<0.001 and 0.240 ±0.04 sec vs 0.180 ±0.03 sec, p<0.001, respectively). The MPI was significantly increased (0.640 ±0.170 vs 0.368 ±0.098, p<0.001). LV diastolic function and the MPI are markedly impaired in asymptomatic elderly patients with type 2 diabetes.
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Affiliation(s)
- Haralampos I Karvounis
- 1st Department of Cardiology, Aristotle University of Thessaloniki, AHEPA General Hospital, Greece
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Efthimiadis GK, Parharidis GE, Karvounis HI, Papadopoulos CE, Gemitzis KD, Styliadis IH, Karoulas TN, Louridas GE. Left Ventricular Doppler Characteristics in First-Degree Relatives of Patients with Hypertrophic Cardiomyopathy. Angiology 2016; 56:319-22. [PMID: 15889200 DOI: 10.1177/000331970505600312] [Citation(s) in RCA: 1] [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: 11/15/2022]
Abstract
Left ventricular (LV) diastolic function may be affected early in patients with hypertrophic cardiomyopathy (HCM), regardless of the phenotypic expression of the disease. The aim of the present study was to detect whether LV diastolic performance, evaluated by conventional Doppler echocardiography, is impaired in first-degree relatives of patients with phenotypically expressed HCM, who had no clinical, electrocardiographic, or echocardiographic signs of the disease. Twenty-two young adults having the previously described characteristics comprised the study population and 22 sex- and age-matched healthy individuals served as controls. The 2 groups were compared according to several echocardiographic parameters and the following diastolic function indices: peak velocity of E wave, representing early filling; peak velocity of A wave, representing late filling; ratio of peak early to peak late velocity (E/A); deceleration time of E wave; and LV isovolumic relaxation time. Slower deceleration time of transmitral early filling in first-degree relatives of patients with HCM (192 ±31 vs 149 ±31 msec, p<0.001) was the only variable that significantly differentiated the 2 groups. This study shows that in healthy persons with a family history of HCM, Doppler-derived mitral filling pattern shifted toward that observed in HCM and the slower deceleration time may serve as an early sign of disease development.
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Affiliation(s)
- Georgios K Efthimiadis
- 1st Department of Cardiology, Aristotle University of Thessaloniki, AHEPA Hospital, Greece
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48
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Karvounis HI, Nouskas IG, Farmakis TM, Vrogistinos KM, Papadopoulos CE, Zaglavara TA, Parharidis GE, Louridas GE. Evaluation of a Doppler-Derived Index Combining Systolic and Diastolic Left Ventricular Function in Acute Myocardial Infarction. Angiology 2016; 55:21-8. [PMID: 14759086 DOI: 10.1177/000331970405500104] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [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: 11/15/2022]
Abstract
Assessment of left ventricular (LV) function is crucial in the immediate postinfarction period. The authors evaluated the clinical applicability of the Doppler-derived myocardial performance index (MPI, defined as the sum of isovolumic contraction and relaxation times divided by LV ejection time) in patients with acute myocardial infarction (AMI) as to whether this index reflects the severity of LV dysfunction in this subgroup of patients. Post-AMI patients (n = 33) were compared with age- and sex-matched healthy subjects (n = 35). Within 24 hours of the AMI and 1 month thereafter, patients underwent 2D and Doppler echocardiography. Patients were divided into group A (Killip Class I, n = 22) and group B (Killip Class II-III, n = 11). The authors measured the LV ejection fraction (EF), diastolic indices (transmitral E and A waves, E/A ratio, deceleration time [DT], isovolumic contraction time [IVCT], isovolumic relaxation time [IVRT], MPI, LV end-systolic and end-diastolic volume indices [ESVi and EDVi] and wall motion score index [WMSi]). One-year mortality was also assessed. There was no significant difference concerning E and A waves, E/A ratio, and IVRT between the 2 groups. There were highly statistical differences at day 1 for EF (59.3 ± 6.7% vs 36.8 ± 4.5%, p<0.0001), DT (0.160 ± 0.030 sec vs 0.127 ± 0.022, p < 0.005), MPI (0.344 ± 0.084 vs 0.686 ± 0.120, p < 0.0001), ESVi (28.4 ± 3.9 mL/m2 vs 46.2 ± 8.4, p < 0.001), and WMSi (1.58 ± 0.06 vs 1.88 ± 0.35, p = 0.05), which persisted after 1 month. One-year mortality was significantly (0 vs 27.3%, p<0.01) lower in group A patients. This study shows that the MPI, reliably indicated LV dysfunction post-AMI, significantly correlated with clinically determined functional class, and possibly has some prog nostic implication.
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Affiliation(s)
- Haralambos I Karvounis
- 1st Department of Cardiology, Aristotle University of Thessaloniki, AHEPA General Hospital, Thessaloniki, Greece
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Papadopoulos CE, Fotoglidis A, Pagourelias E, Vassilikos V. A Left Atrial Appendage Phantom Structure. J Cardiovasc Ultrasound 2016; 24:172-3. [PMID: 27358713 PMCID: PMC4925398 DOI: 10.4250/jcu.2016.24.2.172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Revised: 11/14/2015] [Accepted: 05/10/2016] [Indexed: 11/24/2022] Open
Affiliation(s)
- Christodoulos E Papadopoulos
- 3rd Cardiology Department, Hippokrateio University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Athanasios Fotoglidis
- 3rd Cardiology Department, Hippokrateio University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Efstathios Pagourelias
- Department of Cardiovascular Diseases, Medical Imaging Research Center, UZ Gasthuisberg, Leuven, Belgium
| | - Vassilios Vassilikos
- 3rd Cardiology Department, Hippokrateio University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
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50
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Papadopoulos CE, Matsiras S, Vassilikos V. A Rare Case of Lipomatous Hypertrophy of the Interventricular Septum. J Cardiovasc Ultrasound 2016; 24:170-1. [PMID: 27358712 PMCID: PMC4925397 DOI: 10.4250/jcu.2016.24.2.170] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 12/17/2015] [Revised: 03/27/2016] [Accepted: 05/10/2016] [Indexed: 11/30/2022] Open
Abstract
Asymmetrical left ventricular hypertrophy secondary to interventricular septum hypertrophy is usually considered a typical phenotype of hypertrophic cardiomyopathy. In rare cases other conditions such as tumors or lipomatous hypertrophy of the interventricular septum may have a similar presentation. We present a case of a male patient who presented for routine cardiology work up and was diagnosed of having ventricular septal hypertrophy secondary to localized lipomatous hypertrophy.
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Affiliation(s)
- Christodoulos E Papadopoulos
- 3rd Cardiology Department, Hippokrateio University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Sotirios Matsiras
- 3rd Cardiology Department, Hippokrateio University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Vassilios Vassilikos
- 3rd Cardiology Department, Hippokrateio University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
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