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Briasoulis A, Bampatsias D, Petropoulos I, Rempakos A, Patras R, Theodorakakou F, Makris N, Dimopoulos MA, Stamatelopoulos K, Kastritis E. Left ventricular myocardial work improves in response to treatment and is associated with survival among patients with light chain cardiac amyloidosis. Eur Heart J Cardiovasc Imaging 2024; 25:698-707. [PMID: 38142437 DOI: 10.1093/ehjci/jead351] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 11/18/2023] [Accepted: 12/13/2023] [Indexed: 12/26/2023] Open
Abstract
AIMS Complete haematologic response to treatment for light chain cardiac amyloidosis (AL-CA) may lead to improvement of myocardial function and better outcomes. We sought to evaluate the effect of response to treatment for AL-CA on echocardiographic indices of myocardial deformation and work and their prognostic significance. METHODS AND RESULTS Sixty-one patients treated for AL were enrolled and underwent echocardiographic assessment at baseline and at 1 year. Patients were stratified according to haematologic response as complete or not complete responders. A significant reduction in median N-terminal pro-brain natriuretic peptide (NT-proBNP) (2771-1486 pg/mL; P < 0.001) and posterior wall thickness (13-12 mm; P = 0.002) and an increase in global work index (GWI) (1115-1356 mmHg%; P = 0.018) was observed at 1 year. Patients with complete response (CR) had a more pronounced decrease in intraventricular septum thickness (14.2-12.0 mm; P = 0.006), improved global longitudinal strain (GLS) (-11.6 to -13.1%; P for interaction = 0.045), increased global constructive work (1245-1436 mmHg%; P = 0.008), and GWI (926-1250 mmHg%, P = 0.002) compared with non-CR. Furthermore, deltaGLS (ρspearman = 0.35; P < 0.001) and deltaGWI (ρspearman = -0.32; P = 0.02) correlated with delta NT-proBNP. Importantly, patients with GLS and GWI response had a better prognosis (log-rank P = 0.048 and log-rank P = 0.007, respectively). After adjustment for Mayo stage, gender, and response status, deltaGLS [hazard ratio (HR) = 1.404, P = 0.046 per 1% increase] and deltaGWI (HR = 0.996, P = 0.042 per 1mmHg% increase) were independent predictors of survival. CONCLUSION Complete haematologic response to treatment is associated with improved left ventricular myocardial work indices, and their change is associated with improved survival in AL-CA.
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Affiliation(s)
- Alexandros Briasoulis
- Department of Clinical Therapeutics, Faculty of Medicine, National and Kapodistrian University of Athens, Vassilisis Sofias 80, Athens 11528, Greece
| | - Dimitrios Bampatsias
- Department of Clinical Therapeutics, Faculty of Medicine, National and Kapodistrian University of Athens, Vassilisis Sofias 80, Athens 11528, Greece
| | - Ioannis Petropoulos
- Department of Clinical Therapeutics, Faculty of Medicine, National and Kapodistrian University of Athens, Vassilisis Sofias 80, Athens 11528, Greece
| | - Athanasios Rempakos
- Department of Clinical Therapeutics, Faculty of Medicine, National and Kapodistrian University of Athens, Vassilisis Sofias 80, Athens 11528, Greece
| | - Raphael Patras
- Department of Clinical Therapeutics, Faculty of Medicine, National and Kapodistrian University of Athens, Vassilisis Sofias 80, Athens 11528, Greece
| | - Foteini Theodorakakou
- Department of Clinical Therapeutics, Faculty of Medicine, National and Kapodistrian University of Athens, Vassilisis Sofias 80, Athens 11528, Greece
| | - Nikolaos Makris
- Department of Clinical Therapeutics, Faculty of Medicine, National and Kapodistrian University of Athens, Vassilisis Sofias 80, Athens 11528, Greece
| | - Meletios Athanasios Dimopoulos
- Department of Clinical Therapeutics, Faculty of Medicine, National and Kapodistrian University of Athens, Vassilisis Sofias 80, Athens 11528, Greece
| | - Kimon Stamatelopoulos
- Department of Clinical Therapeutics, Faculty of Medicine, National and Kapodistrian University of Athens, Vassilisis Sofias 80, Athens 11528, Greece
| | - Efstathios Kastritis
- Department of Clinical Therapeutics, Faculty of Medicine, National and Kapodistrian University of Athens, Vassilisis Sofias 80, Athens 11528, Greece
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2
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Bampatsias D, Theodorakakou F, Briasoulis A, Georgiopoulos G, Dimoula A, Papantoniou V, Papantoniou I, Skiadaresi C, Valsamaki P, Repasos E, Petropoulos I, Delialis D, Papathoma A, Koutsis G, Tselegkidi ME, Stamatelopoulos K, Kastritis E. Transthyretin Amyloidosis Cardiomyopathy in Greece: Clinical Insights from the National Referral Center. Hellenic J Cardiol 2023:S1109-9666(23)00190-2. [PMID: 37805173 DOI: 10.1016/j.hjc.2023.09.019] [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: 06/17/2023] [Revised: 09/29/2023] [Accepted: 09/29/2023] [Indexed: 10/09/2023] Open
Abstract
BACKGROUND Clinical characteristics and outcomes of patients with transthyretin amyloidosis cardiomyopathy (ATTR-CM) vary by region, necessitating the acquisition of country-specific evidence for proper management. METHODS This is an observational study including sequential patients presenting in the Amyloidosis Reference Center of Greece, from 01/2014 to 12/2022. ATTR-CM was diagnosed by positive scintigraphy and exclusion of light-chain amyloidosis or positive biopsy typing. Genetic testing was performed in all cases. RESULTS One-hundred and nine ATTR-CM patients were included (median age, 81 years) of which 15 carried TTR mutations (27% Val30Met). Most patients (82%) presented with heart failure and 59% with atrial fibrillation, while 10% had aortic stenosis. Importantly, 78 (71.6%) had clinically significant extracardiac manifestations (45% musculoskeletal disorder, 40% peripheral neuropathy and 33% gastrointestinal symptoms). Sixty-five (60%) received disease-specific treatment with tafamidis. Estimated median survival was 48 months; advanced NYHA class, National Amyloidosis Center stage, eGFR<45 ml/kg/1.73m2, NT-pro-BNP>5000 pg/mL were associated with worse survival, while tafamidis treatment was associated with improved survival in patients with IVS≥ 12 mm. DISCUSSION These are the first data describing the characteristics, management, and outcomes of patients with ATTR-CM in Greece, which could influence local guidelines. SHORT TITLE Transthyretin cardiomyopathy in Greece.
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Affiliation(s)
- Dimitrios Bampatsias
- Amyloidosis Center, Department of Clinical Therapeutics, Alexandra General Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Foteini Theodorakakou
- Amyloidosis Center, Department of Clinical Therapeutics, Alexandra General Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Alexandros Briasoulis
- Amyloidosis Center, Department of Clinical Therapeutics, Alexandra General Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Georgios Georgiopoulos
- Amyloidosis Center, Department of Clinical Therapeutics, Alexandra General Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Anna Dimoula
- Amyloidosis Center, Department of Clinical Therapeutics, Alexandra General Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | | | | | - Chaido Skiadaresi
- Nuclear Medicine Department, Alexandra General Hospital, Athens, Greece
| | - Pipitsa Valsamaki
- Nuclear Medicine Department, Alexandra General Hospital, Athens, Greece; Nuclear Medicine Department, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Evangelos Repasos
- Amyloidosis Center, Department of Clinical Therapeutics, Alexandra General Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Ioannis Petropoulos
- Amyloidosis Center, Department of Clinical Therapeutics, Alexandra General Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Dimitrios Delialis
- Amyloidosis Center, Department of Clinical Therapeutics, Alexandra General Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | | | - Georgios Koutsis
- Neurogenetics Unit, 1st Department of Neurology, Eginitio University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Maria-Eirini Tselegkidi
- Amyloidosis Center, Department of Clinical Therapeutics, Alexandra General Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Kimon Stamatelopoulos
- Amyloidosis Center, Department of Clinical Therapeutics, Alexandra General Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece.
| | - Efstathios Kastritis
- Amyloidosis Center, Department of Clinical Therapeutics, Alexandra General Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
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3
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Theodorakakou F, Briasoulis A, Fotiou D, Petropoulos I, Georgiopoulos G, Lama N, Kelekis N, Repasos E, Migkou M, Stamatelopoulos K, Dimopoulos MA, Kastritis E. Outcomes for patients with systemic light chain amyloidosis and Mayo stage 3B disease. Hematol Oncol 2023; 41:725-732. [PMID: 36974438 DOI: 10.1002/hon.3135] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 12/12/2022] [Revised: 03/13/2023] [Accepted: 03/17/2023] [Indexed: 03/29/2023]
Abstract
Patients with cardiac light chain amyloidosis and Mayo stage 3b disease define a high-risk population with very poor prognosis. Here, we report treatment outcomes of 80 consecutive patients with newly diagnosed AL and Mayo 3b who received novel regimens. Early mortality (<1 month) rate was 12.5%. On intention-to-treat, overall hematologic response rate was 40%, with complete response (CR)/very good partial response (VGPR) in 25% and partial response (PR) in 15%. At 1- and 3- month landmark analysis CR or VGPR/PR rates were 25%/23.5% and 34%/25.5%, respectively. Among patients that were treated with daratumumab-based therapies, 52.6% and 85.7% achieved at least VGPR within one 1 and 3 months, respectively. Three-month cardiac response rate was 11.3% and 6-month was 18.8%. At least hemVGPR at 3 months was associated with cardiac response at 6 months (p = 0.034). Median overall survival (OS) was 6.3 months. At 1-month landmark at least hemPR was associated with better median OS (24.1 vs. 4.9 months, p = 0.017) and at 3-month landmark, at least hemVGPR was associated with a median OS of 40.7 versus 17 months for hemPR and 7.4 months for those without hematologic response (p = 0.028). Cardiac response at 3 months was associated with longer median OS (59.7 vs. 10.9 months, p = 0.044). Factors associated with poorer survival were κ-light chain amyloidosis (median OS 2.9 vs. 7.4 months, p = 0.028), peripheral nerve involvement (3.4 vs. 10.45 months, p = 0.024), systolic blood pressure <90 mmHg (2 vs. 8 months, p = 0.002), baseline LVEF <55% (median OS 3.4 vs. 32 months, p = 0.29) and New York Heart Association (NYHA) class (2.7 months for NYHA 3B-4 vs. 8 months for NYHA 2-3A, p = 0.02). Twenty-one patients (26.3%) received salvage therapy and ORR was 57.1%. Median OS for patients who received second line therapy was 24 months. In conclusion, patients with Mayo 3b disease benefit from early hematologic response but cardiac response rates remain low.
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Affiliation(s)
- Foteini Theodorakakou
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Alexandros Briasoulis
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Despina Fotiou
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Ioannis Petropoulos
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Georgios Georgiopoulos
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Niki Lama
- 2nd Department of Radiology, Research Unit of Radiology and Medical Imaging, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Nikolaos Kelekis
- 2nd Department of Radiology, Research Unit of Radiology and Medical Imaging, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Evangelos Repasos
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Magdalini Migkou
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Kimon Stamatelopoulos
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Meletios A Dimopoulos
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Efstathios Kastritis
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
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4
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Repasos E, Kondylis M, Petropoulos I, Konstantinou G, Briasoulis A, Kanakakis I. Recurrent Takotsubo Cardiomyopathy Precipitated by Inhaled b2 Adrenergic Receptor Agonists. Am J Ther 2023; 30:e473-e475. [PMID: 37713700 DOI: 10.1097/mjt.0000000000001551] [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: 11/25/2022]
Affiliation(s)
- Evangelos Repasos
- Department of Clinical Therapeutics, University of Athens, Alexandra Hospital, Athens, Greece; and
| | - Marios Kondylis
- Department of Clinical Therapeutics, University of Athens, Alexandra Hospital, Athens, Greece; and
| | - Ioannis Petropoulos
- Department of Clinical Therapeutics, University of Athens, Alexandra Hospital, Athens, Greece; and
| | - Georgios Konstantinou
- Department of Clinical Therapeutics, University of Athens, Alexandra Hospital, Athens, Greece; and
| | - Alexandros Briasoulis
- Department of Clinical Therapeutics, University of Athens Medical School, Athens, Greece
| | - Ioannis Kanakakis
- Department of Clinical Therapeutics, University of Athens Medical School, Athens, Greece
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5
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Patras R, Georgiopoulos G, Petropoulos I, Theodorakakou F, Delialis D, Angelidakis L, Gavriatopoulou M, Dimopoulou MA, Sianis A, Maneta E, Neofytou O, Terpos E, Dimopoulos MA, Kastritis E, Stamatelopoulos K. Sustained vasodilation after cold pressor test is an independent predictor of poor survival in primary AL amyloidosis. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1790] [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
Primary AL amyloidosis is a rare yet lethal systemic disorder. Dysfunction of the autonomous nervous system due to disease-related nerve infiltration is a common manifestation of AL amyloidosis. Previously published own work indicated that AL patients present sustained paradoxical vasodilation in response to sympathetic stimulus, as assessed by cold pressor test (CPT). The clinical relevance of this finding is unknown.
Purpose
We sought to investigate the relationship between CPT-induced vascular response and mortality in AL amyloidosis.
Methods
We consecutively recruited 97 newly diagnosed patients with AL amyloidosis. CPT of the brachial artery was performed before treatment initiation. All measurements were assessed using high resolution ultrasonography (14.0Mhz multifrequency linear array probe, Vivid 7 Pro; General Electric Healthcare, Milwaukee, Wisconsin, USA). The maximum vasodilation of the brachial artery was measured during the sympathetic stimulus and 3 minutes after withdrawal (sustained response). All-cause mortality was defined as the primary end-point of the study.
Results
Mean age was 66 years with prevalence of male gender. Sustained vasodilation (but not vasodilation during CPT) was associated with heart failure, NYHA stage, BNP and peripheral vascular involvement (p<0.05 for all). Sustained vasodilation after withdrawal of the sympathetic stimulus was significantly associated with mortality as assessed by Cox regression analysis (HR: 1.149, 95% CI 1.042–1.269, p=0.005). This association remained significant after adjustment for age, sex, systolic blood pressure (SBP), nerve involvement and Mayo stage (HR: 1.123, 95% CI 1.014–1.243, p=0.026). A sustained vasodilation ≥3.35% from pre-stimulus diameter was associated with shorter survival (log-rank test, p=0.022, Figure 1). No association between vasodilation during sympathetic stress and mortality was observed.
Conclusions
In AL amyloidosis, sustained paradoxical vasodilation in response to sympathetic stimulus was associated with poor survival. The clinical utility of this index of vascular autonomic dysfunction as a potential prognostic and therapeutic biomarker in AL amyloidosis merits further investigation.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- R Patras
- University of Athens Medical School, Department of Clinical Therapeutics , Athens , Greece
| | - G Georgiopoulos
- University of Athens Medical School, Department of Clinical Therapeutics , Athens , Greece
| | - I Petropoulos
- University of Athens Medical School, Department of Clinical Therapeutics , Athens , Greece
| | - F Theodorakakou
- University of Athens Medical School, Department of Clinical Therapeutics , Athens , Greece
| | - D Delialis
- University of Athens Medical School, Department of Clinical Therapeutics , Athens , Greece
| | - L Angelidakis
- University of Athens Medical School, Department of Clinical Therapeutics , Athens , Greece
| | - M Gavriatopoulou
- University of Athens Medical School, Department of Clinical Therapeutics , Athens , Greece
| | - M A Dimopoulou
- University of Athens Medical School, Department of Clinical Therapeutics , Athens , Greece
| | - A Sianis
- University of Athens Medical School, Department of Clinical Therapeutics , Athens , Greece
| | - E Maneta
- University of Athens Medical School, Department of Clinical Therapeutics , Athens , Greece
| | - O Neofytou
- University of Athens Medical School, Department of Clinical Therapeutics , Athens , Greece
| | - E Terpos
- University of Athens Medical School, Department of Clinical Therapeutics , Athens , Greece
| | - M A Dimopoulos
- University of Athens Medical School, Department of Clinical Therapeutics , Athens , Greece
| | - E Kastritis
- University of Athens Medical School, Department of Clinical Therapeutics , Athens , Greece
| | - K Stamatelopoulos
- University of Athens Medical School, Department of Clinical Therapeutics , Athens , Greece
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6
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Simistiras A, Delialis D, Georgiopoulos G, Bampatsias D, Maneta E, Dimoula A, Petropoulos I, Neofytou O, Oikonomou E, Kontogiannis C, Ioannou S, Miliotou A, Kanakakis I, Evangelou E, Stamatelopoulos K. Lp(a) is not associated with arterial stiffness: a Mendelian randomization study. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2310] [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
Deeper understanding of the potential causal relationship between Lp(a) and vascular injury will provide further insight to related pathways to be monitored and targeted by emerging treatments. Accumulating evidence supports the causal association of lipoprotein(a) [Lp(a)] with cardiovascular disease and calcific aortic valve disease (AVD). Arterial stiffening is mechanistically linked with cardiovascular disease and AVD severity. We hypothesized that Lp(a) may be causally associated with pulse-wave velocity (PWV) as the gold-standard marker of arterial stiffness.
Aim
To investigate the potential causal association of Lp(a) levels with PWV.
Methods
We performed a two sample Mendelian randomization (MR) analysis of LP(a) on PWV by combining the summary data of two independent Genetic-Wide Association Study (GWASs). Genetic variants associated with Lp(a) were retrieved from the UK Biobank (N=220,497). A GWAS based on a cohort in Germany (N=7,000) was used to obtain genetic associations for PWV index (outcome). We assessed two different measures of arterial stiffness, brachial ankle (baPWV) and carotid femoral pulse (cfPWV) wave velocity. In total, we used 170 SNPs as Instrument Variables (IV's) and applied a two sample MR with the main technique of Inverse Variance Weighting method (IVW). We conducted sensitivity analyses (MR-Egger and Median based) to detect pleiotropy of the causal variants and to test for robustness of our findings.
Results
Our analyses based on all 170 SNP's did not find evidence for causal relationship between Lp(a) and PWV for neither measurement [bivw (baPWV) = −0.0005, CI (−0.0043, 0.0034), P=0.8 and bivw (cfPWV) = −0.006, CI (−0.013, 0.002), P=0.16 for brachial ankle and carotid-femoral PWV, respectively]. Sensitivity analyses, including weighted median and mode-based estimation, did not show significant association of Lp (a) with neither baPWV nor cfPWV.
Conclusions
Lp(a) is not causally associated with arterial stiffness. These findings suggest that arterial stiffening is not involved Lp(a)-mediated cardiovascular and aortic valve disease.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- A Simistiras
- University of Athens Medical School, Department of Clinical Therapeutics , Athens , Greece
| | - D Delialis
- University of Athens Medical School, Department of Clinical Therapeutics , Athens , Greece
| | - G Georgiopoulos
- University of Athens Medical School, Department of Clinical Therapeutics , Athens , Greece
| | - D Bampatsias
- University of Athens Medical School, Department of Clinical Therapeutics , Athens , Greece
| | - E Maneta
- University of Athens Medical School, Department of Clinical Therapeutics , Athens , Greece
| | - A Dimoula
- University of Athens Medical School, Department of Clinical Therapeutics , Athens , Greece
| | - I Petropoulos
- University of Athens Medical School, Department of Clinical Therapeutics , Athens , Greece
| | - O Neofytou
- University of Athens Medical School, Department of Clinical Therapeutics , Athens , Greece
| | - E Oikonomou
- University of Athens Medical School, Department of Clinical Therapeutics , Athens , Greece
| | - C Kontogiannis
- University of Athens Medical School, Department of Clinical Therapeutics , Athens , Greece
| | - S Ioannou
- University of Athens Medical School, Department of Clinical Therapeutics , Athens , Greece
| | - A Miliotou
- University of Athens Medical School, Department of Clinical Therapeutics , Athens , Greece
| | - I Kanakakis
- University of Athens Medical School, Department of Clinical Therapeutics , Athens , Greece
| | - E Evangelou
- University of Ioannina Medical School, Department of Hygiene and Epidemiology , Ioannina , Greece
| | - K Stamatelopoulos
- University of Athens Medical School, Department of Clinical Therapeutics , Athens , Greece
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7
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Delialis D, Mavraganis G, Dimoula A, Ajdini E, Bampatsias D, Dimopoulou AM, Sianis A, Maneta E, Neofytou O, Petropoulos I, Konstantinou G, Misegiannidis A, Kokras N, Stamatelopoulos K, Georgiopoulos G. A systematic review and meta-analysis on the effect of selective serotonin reuptake inhibitors on endothelial function. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2630] [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
Depression and atherosclerotic cardiovascular disease (ASCVD) are commonly clustered in affected patients. Endothelial dysfunction is an early marker of ASCVD while also reported in patients with depression. Emerging evidence suggests that selective serotonin receptor inhibitors (SSRIs) may improve endothelial function. However, clinical studies assessing flow-mediated dilation (FMD), the gold-standard method to evaluate conduit artery endothelial function, in response to SSRIs treatment included limited number of patients and did not provide consistent results.
Purpose
In the present study we aim to evaluate the effect of SSRIs treatment on endothelial function assessed by longitudinal changes in FMD.
Methods
We performed a systematic review to retrieve and subsequently meta-analyze eligible studies in patients with depression who received SSRIs and had available measurements of FMD change before and after treatment.
Results
In 5 studies and 323 individuals in total, SSRIs were associated with increased FMD at the end of follow-up compared to baseline measurement (pooled mean change 1.97%, 95% CI 0.17, 3.77, P=0.032, I2=87.4%). These results did not substantially change when analysis was restricted to patients with history of atherosclerotic cardiovascular disease (ASCVD). Similarly, FMD changes were higher in individuals receiving SSRIs compared to not-treated subjects (pooled mean difference 2.5%. 95% CI 0.7, 4.2, P<0.001, I2=82.7%). Substantial heterogeneity regarding with respect to follow-up duration, demographics, and SSRIs agents.
Conclusion
SSRIs significantly improve FMD, the gold-standard marker of endothelial function. Further investigation is warranted for the role of FMD as a possible therapeutic biomarker in patients with depression and established or subclinical ASCVD.
Prospero registration: CRD42021252241
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- D Delialis
- University of Athens Medical School, Department of Clinical Therapeutics , Athens , Greece
| | - G Mavraganis
- University of Athens Medical School, Department of Clinical Therapeutics , Athens , Greece
| | - A Dimoula
- University of Athens Medical School, Department of Clinical Therapeutics , Athens , Greece
| | - E Ajdini
- University of Athens Medical School, Department of Clinical Therapeutics , Athens , Greece
| | - D Bampatsias
- University of Athens Medical School, Department of Clinical Therapeutics , Athens , Greece
| | - A M Dimopoulou
- University of Athens Medical School, Department of Clinical Therapeutics , Athens , Greece
| | - A Sianis
- University of Athens Medical School, Department of Clinical Therapeutics , Athens , Greece
| | - E Maneta
- University of Athens Medical School, Department of Clinical Therapeutics , Athens , Greece
| | - O Neofytou
- University of Athens Medical School, Department of Clinical Therapeutics , Athens , Greece
| | - I Petropoulos
- University of Athens Medical School, Department of Clinical Therapeutics , Athens , Greece
| | - G Konstantinou
- University of Athens Medical School, Department of Clinical Therapeutics , Athens , Greece
| | - A Misegiannidis
- University of Athens Medical School, Department of Clinical Therapeutics , Athens , Greece
| | - N Kokras
- National & Kapodistrian University of Athens , Athens , Greece
| | - K Stamatelopoulos
- University of Athens Medical School, Department of Clinical Therapeutics , Athens , Greece
| | - G Georgiopoulos
- University of Athens Medical School, Department of Clinical Therapeutics , Athens , Greece
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8
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Mavraganis G, Georgiopoulos G, Delialis D, Aivalioti E, Patras R, Petropoulos I, Dimopoulou AM, Angelidakis L, Sianis A, Bampatsias D, Dimoula A, Maneta E, Kosmopoulos M, Stellos K, Stamatelopoulos K. Carotid ultrasonography improves residual risk stratification in guidelines-defined high cardiovascular risk patients. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2317] [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
The clinical value of carotid atherosclerosis markers for residual risk stratification in high atherosclerotic cardiovascular disease (ASCVD) risk patients is not established.
Purpose
In the present study we aimed to derive and validate optimal values of markers of carotid subclinical atherosclerosis improving risk stratification in guidelines-defined high ASCVD risk patients.
Methods
We consecutively analysed high or very high ASCVD risk patients from a cardiovascular (CV) prevention registry (n=751, derivation cohort) and from the Atherosclerosis Risk in Communities (ARIC) study (n=2,897, validation cohort). Baseline ASCVD risk was defined using the 2021 European Society of Cardiology (ESC) guidelines (clinical ESCrisk). Intima-media thickness (IMT) excluding plaque, average maximal (avg.maxWT), maximal wall thickness (maxWT) and number of sites with carotid plaque were assessed. As endpoint of the study was defined the composite of CV death, acute myocardial infarction (MI) and revascularization after a median of 3.4 years in both cohorts and additionally for 16.7 years in the ARIC cohort.
Results
MaxWT >2.00mm and avg.maxWT >1.39mm provided incremental prognostic value, improved discrimination and correctly reclassified risk over the clinical ESCrisk both in the derivation and the validation cohort (p<0.05 for net reclassification index, integrated discrimination index and Delta Harrell's C index). MaxWT <0.9mm predicted very low probability of CV events (negative predictive value = 97% and 92% in the derivation and validation cohort, respectively). These findings were additionally confirmed for very long-term events in the validation cohort.
Conclusion
Integration of carotid ultrasonography in guidelines-defined risk stratification may identify very high risk patients in need for further residual risk reduction or at very low probability
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- G Mavraganis
- University of Athens Medical School, Department of Clinical Therapeutics , Athens , Greece
| | - G Georgiopoulos
- University of Athens Medical School, Department of Clinical Therapeutics , Athens , Greece
| | - D Delialis
- University of Athens Medical School, Department of Clinical Therapeutics , Athens , Greece
| | - E Aivalioti
- University of Athens Medical School, Department of Clinical Therapeutics , Athens , Greece
| | - R Patras
- University of Athens Medical School, Department of Clinical Therapeutics , Athens , Greece
| | - I Petropoulos
- University of Athens Medical School, Department of Clinical Therapeutics , Athens , Greece
| | - A M Dimopoulou
- University of Athens Medical School, Department of Clinical Therapeutics , Athens , Greece
| | - L Angelidakis
- University of Athens Medical School, Department of Clinical Therapeutics , Athens , Greece
| | - A Sianis
- University of Athens Medical School, Department of Clinical Therapeutics , Athens , Greece
| | - D Bampatsias
- University of Athens Medical School, Department of Clinical Therapeutics , Athens , Greece
| | - A Dimoula
- University of Athens Medical School, Department of Clinical Therapeutics , Athens , Greece
| | - E Maneta
- University of Athens Medical School, Department of Clinical Therapeutics , Athens , Greece
| | - M Kosmopoulos
- University of Athens Medical School, Department of Clinical Therapeutics , Athens , Greece
| | - K Stellos
- University of Heidelberg , Heidelberg , Germany
| | - K Stamatelopoulos
- University of Athens Medical School, Department of Clinical Therapeutics , Athens , Greece
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9
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Makris N, Georgiopoulos G, Laina A, Tselegkidi ME, Fotiou D, Kanellias N, Eleftherakis-Papaiakovou E, Migkou M, Papanagnou ED, Katogiannis K, Petropoulos I, Anninos H, Bampatsias D, Maneta E, Samouilidou E, Nikas D, Ciliberti G, Stellos K, Terpos E, Gavriatopoulou M, Trougakos IP, Ikonomidis I, Dimopoulos MA, Kastritis E, Stamatelopoulos K. Cardiac mechanics in response to proteasome inhibition: a prospective study. Eur Heart J Cardiovasc Imaging 2022; 24:643-652. [PMID: 35980754 DOI: 10.1093/ehjci/jeac168] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 07/19/2022] [Accepted: 07/31/2022] [Indexed: 11/13/2022] Open
Abstract
AIM Ubiquitin-Proteasome System (UPS) is of paramount importance regarding the function of the myocardial cell. Consistently, inhibition of this system has been found to affect myocardium in experimental models; yet, the clinical impact of UPS inhibition on cardiac function has not been comprehensively examined. Our aim was to gain insight into the effect of proteasome inhibition on myocardial mechanics in humans. METHODS AND RESULTS We prospectively evaluated 48 patients with multiple myeloma and an indication to receive carfilzomib, an irreversible proteasome inhibitor. All patients were initially evaluated and underwent echocardiography with speckle tracking analysis. Carfilzomib was administered according to Kd treatment protocol. Follow-up echocardiography was performed at the 3rd and 6th month. Proteasome activity (PrA) was measured in peripheral blood mononuclear cells.At 3 months after treatment, we observed early left ventricular (LV) segmental dysfunction and deterioration of left atrial (LA) remodelling, which was sustained and more pronounced than that observed in a cardiotoxicity control group. At 6 months, LV and right ventricular functions were additionally attenuated (P < 0.05 for all). These changes were independent of blood pressure, endothelial function, inflammation, and cardiac injury levels. Changes in PrA were associated with changes in global longitudinal strain (GLS), segmental LV strain, and LA markers (P < 0.05 for all). Finally, baseline GLS < -18% or LA strain rate > 1.71 were associated with null hypertension events. CONCLUSION Inhibition of the UPS induced global deterioration of cardiac function.
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Affiliation(s)
- Nikolaos Makris
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens 11528, Greece
| | - Georgios Georgiopoulos
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens 11528, Greece
| | - Aggeliki Laina
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens 11528, Greece
| | - Maria-Eirini Tselegkidi
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens 11528, Greece
| | - Despoina Fotiou
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens 11528, Greece
| | - Nikolaos Kanellias
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens 11528, Greece
| | | | - Magda Migkou
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens 11528, Greece
| | - Eleni Dimitra Papanagnou
- Department of Cell Biology and Biophysics, Faculty of Biology, National and Kapodistrian University of Athens, Athens 15772, Greece
| | - Konstantinos Katogiannis
- 2nd Cardiology Department of School of Medicine, National and Kapodistrian University of Athens, Athens 12461, Greece
| | - Ioannis Petropoulos
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens 11528, Greece
| | - Hector Anninos
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens 11528, Greece
| | - Dimitrios Bampatsias
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens 11528, Greece
| | - Eleni Maneta
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens 11528, Greece
| | | | - Dimitris Nikas
- Department of Biochemistry, Alexandra Hospital, Athens 11528, Greece
| | - Giorgia Ciliberti
- Department of Cardiovascular Research, European Center for Angioscience (ECAS), Medical Faculty Mannheim, Heidelberg University, Mannheim 68167, Germany
| | - Konstantinos Stellos
- Department of Cardiovascular Research, European Center for Angioscience (ECAS), Medical Faculty Mannheim, Heidelberg University, Mannheim 68167, Germany
| | - Evaggelos Terpos
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens 11528, Greece
| | - Maria Gavriatopoulou
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens 11528, Greece
| | - Ioannis P Trougakos
- Department of Cell Biology and Biophysics, Faculty of Biology, National and Kapodistrian University of Athens, Athens 15772, Greece
| | - Ignatios Ikonomidis
- 2nd Cardiology Department of School of Medicine, National and Kapodistrian University of Athens, Athens 12461, Greece
| | - Meletios-Athanasios Dimopoulos
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens 11528, Greece
| | - Efstathios Kastritis
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens 11528, Greece
| | - Kimon Stamatelopoulos
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens 11528, Greece
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10
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Stamatelopoulos K, Delialis D, Georgiopoulos G, Tselegkidi MI, Theodorakakou F, Dialoupi I, Bambatsias D, Petropoulos I, Vergaro G, Ikonomidis I, Tzortzis S, Briasoulis A, Kanakakis J, Trougakos I, Dimopoulos MA, Kastritis E. Determining patterns of vascular function and structure in wild-type transthyretin cardiac amyloidosis. A comparative study. Int J Cardiol 2022; 363:102-110. [PMID: 35716935 DOI: 10.1016/j.ijcard.2022.06.035] [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] [Received: 01/28/2022] [Revised: 05/26/2022] [Accepted: 06/10/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND The impact of wild-type transthyretin-related cardiac amyloidosis (ATTRwt) on functional and structural peripheral vascular measures is unknown. In the present study, we explored patterns of vascular dysfunction in patients with ATTRwt in comparison to diseases with similar cardiac phenotype. METHODS Treatment-naïve patients with ATTRwt (n = 32) were compared to: 1. Age-and sex-matched reference population without amyloidosis (n = 32), 2. Age-and sex-matched patients with systemic AL amyloidosis (n = 32), and 3. patients with cardiac AL amyloidosis (AL-HF, n = 23) or elderly patients with heart failure with preserved ejection fraction (HFpEF) (n = 16). All subjects underwent peripheral vascular assessment using carotid artery ultrasonography, brachial artery flow-mediated dilation (FMD), measurement of arterial stiffness and aortic hemodynamics including heart rate-adjusted time of return of reflected waves (Tr/HR). RESULTS After adjustment for traditional cardiovascular risk factors and coronary artery disease (core model), peripheral and aortic blood pressures (BP) were lower in patients with ATTRwt (p < 0.05) whereas other vascular markers were preserved compared to the reference non-amyloidosis group. ATTRwt was independently associated with lower BP and longer Tr/HR compared to AL. Compared to AL-HF, FMD was lower in ATTRwt (p = 0.033). ATTRwt patients had lower BP and higher Tr/HR than HFpEF (p < 0.05). By ROC analysis, Tr/HR discriminated ATTRwt vs. AL-HF (sensitivity 93%, specificity 75%) and HFpEF (sensitivity 100%, specificity 94%) and lower FMD increased the likelihood for ATTRwt at low Tr/HR values. CONCLUSION ATTRwt patients present a distinct peripheral vascular fingerprint which is different from AL-HF or HFpEF, consisting of lower peripheral and aortic BP, prolonged Tr/HR and FMD at reference-population range.
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Affiliation(s)
- Kimon Stamatelopoulos
- Department of Clinical Therapeutics, University of Athens Medical School, Athens, Greece..
| | - Dimitrios Delialis
- Department of Clinical Therapeutics, University of Athens Medical School, Athens, Greece.; Department of Clinical Therapeutics, University of Athens Medical School, Athens, Greece.; Institute of Life Sciences, Scuola Superiore Sant'Anna, Pisa, Italy; Cardiology Division, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Georgios Georgiopoulos
- Department of Clinical Therapeutics, University of Athens Medical School, Athens, Greece.; Institute of Life Sciences, Scuola Superiore Sant'Anna, Pisa, Italy; Cardiology Division, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Maria-Irini Tselegkidi
- Department of Clinical Therapeutics, University of Athens Medical School, Athens, Greece.; Institute of Life Sciences, Scuola Superiore Sant'Anna, Pisa, Italy; Cardiology Division, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Foteini Theodorakakou
- Department of Clinical Therapeutics, University of Athens Medical School, Athens, Greece.; Institute of Life Sciences, Scuola Superiore Sant'Anna, Pisa, Italy; Cardiology Division, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Ioanna Dialoupi
- Department of Clinical Therapeutics, University of Athens Medical School, Athens, Greece.; Institute of Life Sciences, Scuola Superiore Sant'Anna, Pisa, Italy; Cardiology Division, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Dimitrios Bambatsias
- Department of Clinical Therapeutics, University of Athens Medical School, Athens, Greece.; Institute of Life Sciences, Scuola Superiore Sant'Anna, Pisa, Italy; Cardiology Division, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Ioannis Petropoulos
- Department of Clinical Therapeutics, University of Athens Medical School, Athens, Greece.; Institute of Life Sciences, Scuola Superiore Sant'Anna, Pisa, Italy; Cardiology Division, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Giuseppe Vergaro
- Institute of Life Sciences, Scuola Superiore Sant'Anna, Pisa, Italy; Cardiology Division, Fondazione Toscana Gabriele Monasterio, Pisa, Italy.; Institute of Life Sciences, Scuola Superiore Sant'Anna, Pisa, Italy; Cardiology Division, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Ignatios Ikonomidis
- 2(nd) Department of Cardiology, School of Medicine of the National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece.; Institute of Life Sciences, Scuola Superiore Sant'Anna, Pisa, Italy; Cardiology Division, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Stavros Tzortzis
- 2(nd) Department of Cardiology, School of Medicine of the National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece.; Institute of Life Sciences, Scuola Superiore Sant'Anna, Pisa, Italy; Cardiology Division, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Alexandros Briasoulis
- Department of Clinical Therapeutics, University of Athens Medical School, Athens, Greece.; Institute of Life Sciences, Scuola Superiore Sant'Anna, Pisa, Italy; Cardiology Division, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - John Kanakakis
- Department of Clinical Therapeutics, University of Athens Medical School, Athens, Greece.; Institute of Life Sciences, Scuola Superiore Sant'Anna, Pisa, Italy; Cardiology Division, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Ioannis Trougakos
- Department of Cell Biology and Biophysics, Faculty of Biology, National and Kapodistrian University of Athens; Institute of Life Sciences, Scuola Superiore Sant'Anna, Pisa, Italy; Cardiology Division, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Meletios A Dimopoulos
- Department of Clinical Therapeutics, University of Athens Medical School, Athens, Greece.; Institute of Life Sciences, Scuola Superiore Sant'Anna, Pisa, Italy; Cardiology Division, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Efstathios Kastritis
- Department of Clinical Therapeutics, University of Athens Medical School, Athens, Greece.; Institute of Life Sciences, Scuola Superiore Sant'Anna, Pisa, Italy; Cardiology Division, Fondazione Toscana Gabriele Monasterio, Pisa, Italy..
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11
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Delialis D, Georgiopoulos G, Aivalioti E, Mavraganis G, Dimopoulou AM, Sianis A, Aggelidakis L, Patras R, Petropoulos I, Ioannou S, Syrigou R, Chatzidou S, Kanakakis I, Stellos K, Stamatelopoulos K. Remnant cholesterol and atherosclerotic disease in high cardiovascular risk patients. Beyond LDL cholesterol and hypolipidemic treatment. Hellenic J Cardiol 2022; 66:26-31. [PMID: 35667617 DOI: 10.1016/j.hjc.2022.05.011] [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: 03/12/2022] [Revised: 05/03/2022] [Accepted: 05/29/2022] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Remnant cholesterol (RC) is an emerging factor contributing to residual risk for the development of atherosclerotic cardiovascular disease (ASCVD). We aimed to investigate the association of RC with ASCVD in high ASCVD risk patients. METHODS RC was calculated in 906 participants (178 low/moderate-risk and 728 high-risk) consecutively recruited from a vascular registry. Subclinical carotid atherosclerosis was assessed by B-mode carotid ultrasonography. Maximal carotid wall thickness (maxWT) and carotid atherosclerotic burden (n≥2 atherosclerotic plaques) were set as the vascular outcomes. An independent cohort of 87 consecutively recruited high-risk patients who were followed for their lipid profile for 3 months, was also analyzed. RESULTS RC was increased in the high-risk group as compared to controls (26±17 vs. 21±11mg/dl, respectively, p<0.001). Increased RC levels were independently associated with increased maxWT and carotid atherosclerotic burden (p<0.05), after adjustment for traditional cardiovascular risk factors (TRF) and ASCVD. RC levels were associated with the presence of flow-limiting ASCVD and coronary artery disease (p<0.05), after adjustment for TRFs. These associations remained significant in those not receiving hypolipidemic treatment and in treated individuals achieving LDL-C<100 mg/dl. In the prospective cohort, there was no significant interaction between change in RC levels and hypolipidemic status, as contrasted to LDL-C levels (p <0.001). CONCLUSION In a high-risk population, RC was associated with subclinical and clinically overt ASCVD particularly in patients with the most adverse lipid phenotype (untreated) or in treated patients with low LDL-related risk profile. These findings support a residual pro-atherosclerotic role of RC in high-risk patients.
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Affiliation(s)
- Dimitrios Delialis
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Georgios Georgiopoulos
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Evmorfia Aivalioti
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Georgios Mavraganis
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Angeliki-Maria Dimopoulou
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Alexandros Sianis
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Lasthenis Aggelidakis
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Raphael Patras
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Ioannis Petropoulos
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Sofia Ioannou
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Rodanthi Syrigou
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Sofia Chatzidou
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Ioannis Kanakakis
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Konstantinos Stellos
- Biosciences Institute, Vascular Biology and Medicine Theme, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, UK; Department of Cardiovascular Research, European Center for Angioscience (ECAS), Heidelberg University, Mannheim, Germany; German Centre for Cardiovascular Research (Deutsches Zentrum für Herz-Kreislauf-Forschung, DZHK), Heidelberg/Mannheim Partner Site, Mannheim, Germany
| | - Kimon Stamatelopoulos
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens Medical School, Athens, Greece; Biosciences Institute, Vascular Biology and Medicine Theme, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, UK.
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12
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Georgiopoulos G, Mavraganis G, Delialis D, Georgiou S, Aivalioti E, Patras R, Petropoulos I, Dimopoulou MA, Angelidakis L, Sianis A, Bampatsias D, Dimoula A, Maneta E, Kosmopoulos M, Vardavas C, Stellos K, Stamatelopoulos K. Carotid ultrasonography improves residual risk stratification in guidelines-defined high cardiovascular risk patients. Eur J Prev Cardiol 2022; 29:1773-1784. [PMID: 35580589 DOI: 10.1093/eurjpc/zwac095] [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] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 04/12/2022] [Accepted: 05/11/2022] [Indexed: 11/13/2022]
Abstract
BACKGROUND The clinical value of carotid atherosclerosis markers for residual risk stratification in high atherosclerotic cardiovascular disease (ASCVD) risk patients is not established. AIMS We aimed to derive and validate optimal values of markers of carotid subclinical atherosclerosis improving risk stratification in guidelines-defined high ASCVD risk patients. METHODS We consecutively analysed high or very high ASCVD risk patients from a cardiovascular (CV) prevention registry (n = 751, derivation cohort) and from the Atherosclerosis Risk in Communities (ARIC) study (n = 2,897, validation cohort). Baseline ASCVD risk was defined using the 2021 European Society of Cardiology (ESC) guidelines (clinical ESCrisk). Intima-media thickness (IMT) excluding plaque, average maximal (avg.maxWT), maximal wall thickness (maxWT) and number of sites with carotid plaque were assessed. As primary endpoint of the study was defined the composite of cardiac death, acute myocardial infarction (MI) and revascularization after a median of 3.4 years in both cohorts and additionally for 16.7 years in the ARIC cohort. RESULTS MaxWT > 2.00 mm and avg.maxWT > 1.39 mm provided incremental prognostic value, improved discrimination and correctly reclassified risk over the clinical ESCrisk both in the derivation and the validation cohort (p < 0.05 for NRI, IDI, and Delta Harrell's C index). MaxWT < 0.9 mm predicted very low probability of cardiovascular events (negative predictive value = 97% and 92% in the derivation and validation cohort, respectively). These findings were additionally confirmed for very long-term events in the validation cohort. CONCLUSION Integration of carotid ultrasonography in guidelines-defined risk stratification may identify very high risk patients in need for further residual risk reduction or at very low probability for events.
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Affiliation(s)
- Georgios Georgiopoulos
- Department of Clinical Therapeutics, Alexandra Hospital, National and Kapodistrian University of Athens Medical School, 80 Vas. Sofias Str, Athens 11528, Greece.,Department of Cardiovascular Imaging, School of Biomedical Engineering and Imaging Sciences, Guy's and St Thomas' NHS Foundation Trust, Westminster Bridge Road, SE1 7EH, London, UK
| | - Georgios Mavraganis
- Department of Clinical Therapeutics, Alexandra Hospital, National and Kapodistrian University of Athens Medical School, 80 Vas. Sofias Str, Athens 11528, Greece
| | - Dimitrios Delialis
- Department of Clinical Therapeutics, Alexandra Hospital, National and Kapodistrian University of Athens Medical School, 80 Vas. Sofias Str, Athens 11528, Greece
| | - Stelios Georgiou
- Department of Clinical Therapeutics, Alexandra Hospital, National and Kapodistrian University of Athens Medical School, 80 Vas. Sofias Str, Athens 11528, Greece
| | - Evmorfia Aivalioti
- Department of Clinical Therapeutics, Alexandra Hospital, National and Kapodistrian University of Athens Medical School, 80 Vas. Sofias Str, Athens 11528, Greece
| | - Raphael Patras
- Department of Clinical Therapeutics, Alexandra Hospital, National and Kapodistrian University of Athens Medical School, 80 Vas. Sofias Str, Athens 11528, Greece
| | - Ioannis Petropoulos
- Department of Clinical Therapeutics, Alexandra Hospital, National and Kapodistrian University of Athens Medical School, 80 Vas. Sofias Str, Athens 11528, Greece
| | - Maria-Angeliki Dimopoulou
- Department of Clinical Therapeutics, Alexandra Hospital, National and Kapodistrian University of Athens Medical School, 80 Vas. Sofias Str, Athens 11528, Greece
| | - Lasthenis Angelidakis
- Department of Clinical Therapeutics, Alexandra Hospital, National and Kapodistrian University of Athens Medical School, 80 Vas. Sofias Str, Athens 11528, Greece
| | - Alexandros Sianis
- Department of Clinical Therapeutics, Alexandra Hospital, National and Kapodistrian University of Athens Medical School, 80 Vas. Sofias Str, Athens 11528, Greece
| | - Dimitrios Bampatsias
- Department of Clinical Therapeutics, Alexandra Hospital, National and Kapodistrian University of Athens Medical School, 80 Vas. Sofias Str, Athens 11528, Greece
| | - Anna Dimoula
- Department of Clinical Therapeutics, Alexandra Hospital, National and Kapodistrian University of Athens Medical School, 80 Vas. Sofias Str, Athens 11528, Greece
| | - Eleni Maneta
- Department of Clinical Therapeutics, Alexandra Hospital, National and Kapodistrian University of Athens Medical School, 80 Vas. Sofias Str, Athens 11528, Greece
| | - Marinos Kosmopoulos
- Division of Cardiology, Department of Medicine, University of Minnesota School of Medicine, 401 East River Parkway, Minneapolis, MN 55455, USA
| | - Constantine Vardavas
- Department of Social Medicine, Faculty of Medicine, University of Crete, University Campus of Voutes, 700 13, Heraklion, Crete.,Center for Global Tobacco Control, Department of Society, Human Development and Health, Harvard School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA
| | - Konstantinos Stellos
- Biosciences Institute, Vascular Biology and Medicine Theme, Faculty of Medical Sciences, Newcastle University, NE1 7RU, Newcastle upon Tyne, UK.,Department of Cardiology, Freeman Hospital, Newcastle Hospitals NHS Foundation Trust, Freeman Rd, High Heaton, NE7 7DN, Newcastle Upon Tyne, UK.,German Center of Cardiovascular Research (DZHK), Rhein-Main Partner Site, Frankfurt am Main, Germany.,Department of Cardiovascular Research, European Center for Angioscience, University of Heidelberg, Ludolf-Krehl-Straße 13-17, D-68167 Mannheim, Germany
| | - Kimon Stamatelopoulos
- Department of Clinical Therapeutics, Alexandra Hospital, National and Kapodistrian University of Athens Medical School, 80 Vas. Sofias Str, Athens 11528, Greece.,Biosciences Institute, Vascular Biology and Medicine Theme, Faculty of Medical Sciences, Newcastle University, NE1 7RU, Newcastle upon Tyne, UK
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13
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Briasoulis A, Stamatelopoulos K, Petropoulos I, Patras R, Theodorakakou F, Gavriatopoulou M, Ntalianis A, Dimopoulos MA, Kastritis E. Utilization and tolerance of beta-blockers among patients with AL amyloidosis. Amyloid 2022; 29:31-37. [PMID: 34549676 DOI: 10.1080/13506129.2021.1981281] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND The utilization and clinical impact of beta-blockers (BBs) in cardiac amyloidosis (CA) is largely unexplored. METHODS We conducted a retrospective, single-center analysis of indications, timing of initiation, types and doses of BB used, reasons to discontinue BB and association between BB tolerance and outcomes in a cohort of patients with immunoglobulin light chain amyloidosis (AL). RESULTS We reviewed 236 patients with AL CA and identified 53 patients taking BB (22.5%). Most patients presented in New York Heart Association Class (NYHA) II or III (74.5%) and 24% presented in Mayo stage IIIB. The most frequent indications for BB initiation were atrial fibrillation (AF) and coronary artery disease (CAD). In most cases (59%) BB was started before the diagnosis of CA. The median duration of BB treatment was 9 months (interquartile range [IQR] 3-24 months). Among patients receiving BB, 28 tolerated BB during follow-up whereas 25 patients discontinued BB. The main causes of BB discontinuation were hypotension and heart failure (HF) exacerbation. Patients intolerant to BB presented with more advanced NYHA class, worse performance status and lower median left ventricular ejection fraction (LVEF) at baseline. At median follow-up duration of 17.7 months, patients who did not tolerate BB had a poor survival. CONCLUSIONS Although some patients with CA may have indications for treatment with BB, their use is uncommon and those with more advanced disease tolerate BB poorly. Intolerance to BB in patients with cardiac AL is an indicator of poorer outcome.
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Affiliation(s)
- Alexandros Briasoulis
- Department of Clinical Therapeutics, National Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Kimon Stamatelopoulos
- Department of Clinical Therapeutics, National Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Ioannis Petropoulos
- Department of Clinical Therapeutics, National Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Raphael Patras
- Department of Clinical Therapeutics, National Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Foteini Theodorakakou
- Department of Clinical Therapeutics, National Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Maria Gavriatopoulou
- Department of Clinical Therapeutics, National Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Argyrios Ntalianis
- Department of Clinical Therapeutics, National Kapodistrian University of Athens, Medical School, Athens, Greece
| | | | - Efstathios Kastritis
- Department of Clinical Therapeutics, National Kapodistrian University of Athens, Medical School, Athens, Greece
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14
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Khan A, AKHTAR NAVEED, Wadiwala MUF, Al Qurashi A, fatima Al-Khawaja FAK, Gad H, Ponirakis G, Petropoulos I, Saqqur M, Shuaib A, Malik R. Abstract WMP120: Vascular Risk Factor Reduction Is Associated With Corneal Nerve Regeneration In Patients With Tia And Ischemic Stroke. Stroke 2022. [DOI: 10.1161/str.53.suppl_1.wmp120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose:
Vascular risk factors are associated with transient ischemic attack (TIA), acute ischemic stroke (AIS) and corneal nerve damage. We have assessed if an improvement in vascular risk factors in patients with TIA and AIS is associated with corneal nerve regeneration.
Methods:
Patients with TIA or AIS and control subjects underwent assessment of clinical and vascular risk factors and corneal confocal microscopy (CCM) at baseline and 1-year follow up.
Results:
Eighty-one patients with TIA (n=28), AIS (n=53) and control subjects (n=56) were studied. Systolic blood pressure (SBP)(
P
=0.000), diastolic blood pressure (DBP) (
P
=0.000) and HbA1
c
(P=0.000) were significantly higher and HDL (
P
=0.000), corneal nerve fiber length (CNFL) (P=0.000), corneal nerve fiber density (CNFD) (P=0.000) and corneal nerve branch density (CNBD) (P=0.003) were significantly lower in patients with TIA/AIS compared to controls. At follow up, there was a significant decrease in triglycerides (-0.37 mmol/l, P=0.005), total cholesterol (-1.12 mmol/l, P=0.000); LDL-cholesterol (-1.08 mmol/l, P=0.000), SBP (-24.76 mmHg, P=0.000), DBP (-14.24 mmHg, P=0.000) and HbA1
c
(-0.50 mmol/l, P=0.027) and an increase in HDL (0.10 mmol/l, P=0.010), CNFL (1.48 mm/mm
2
, P=0.018), CNFD (1.66 no./mm
2
, P=0.024), and CNBD (26.90 no./mm
2
, P=0.000). The improvement in lipids and blood pressure was associated with an increase in corneal nerve parameters (
P
<0.05).
Conclusions:
An improvement in vascular risk factors in patients with TIA or AIS is associated with corneal nerve regeneration. CCM could be used to assess the effectiveness of risk factor reduction in patients with TIA or AIS.
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Affiliation(s)
- Adnan Khan
- WEILL CORNELL MEDICINE in Qatar, Doha, Qatar
| | | | | | | | | | - Hoda Gad
- WEILL CORNELL MEDICINE in Qatar, Doha, Qatar
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15
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Burgess J, Petropoulos I, Gad H, Nevitt SJ, Ponirakis G, Ferdousi M, Kalteniece A, Azmi S, Kaye S, Malik RA, Alam U. Corneal confocal microscopy for the diagnosis of diabetic sensorimotor polyneuropathy in people with type 1 and 2 diabetes mellitus. Hippokratia 2021. [DOI: 10.1002/14651858.cd014675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Jamie Burgess
- Department of Cardiovascular & Metabolic Medicine and the Pain Research Institute, Institute of Life Course and Medical Sciences; University of Liverpool and Liverpool University Hospital NHS Trust; Liverpool UK
| | - Ioannis Petropoulos
- Weill Cornell Medicine-Qatar, Research Division; Qatar Foundation, Education City; Doha Qatar
| | - Hoda Gad
- Weill Cornell Medicine-Qatar, Research Division; Qatar Foundation, Education City; Doha Qatar
| | - Sarah J Nevitt
- Department of Health Data Science; University of Liverpool; Liverpool UK
| | - Georgios Ponirakis
- Weill Cornell Medicine-Qatar, Research Division; Qatar Foundation, Education City; Doha Qatar
| | - Maryam Ferdousi
- Division of Cardiovascular Sciences, Cardiac Centre, Faculty of Biology, Medicine and Health; The University of Manchester; Manchester UK
| | - Alise Kalteniece
- Division of Cardiovascular Sciences, Cardiac Centre, Faculty of Biology, Medicine and Health; The University of Manchester; Manchester UK
| | - Shazli Azmi
- Division of Cardiovascular Sciences, Cardiac Centre, Faculty of Biology, Medicine and Health; The University of Manchester; Manchester UK
| | - Stephen Kaye
- Department of Ophthalmology; Royal Liverpool University Hospital Trust and University of Liverpool; Liverpool UK
| | - Rayaz A Malik
- Weill Cornell Medicine-Qatar, Research Division; Qatar Foundation, Education City; Doha Qatar
- Institute of Cardiovascular Sciences; University of Manchester; Manchester UK
| | - Uazman Alam
- Department of Ophthalmology; Royal Liverpool University Hospital Trust and University of Liverpool; Liverpool UK
- Division of Endocrinology, Diabetes and Gastroenterology; University of Manchester; Manchester UK
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16
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Stamatelopoulos K, Delialis D, Bampatsias D, Tselegkidi ME, Petropoulos I, Theodorakakou F, Gavriatopoulou M, Patras R, Pamboucas C, Kanakakis J, Ikonomidis I, Terpos E, Trougakos IP, Dimopoulos MA, Kastritis E. Peripheral vascular involvement in transthyretin cardiac amyloidosis. A comparative analysis with AL amyloidosis. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1798] [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
The pattern of peripheral vascular involvement in the wild type transthyretin-related cardiac amyloidosis (ATTRwt) and its diagnostic utility in differentiating this infiltrating cardiomyopathy from light chain (AL) cardiac amyloidosis (AL-CA) and heart failure with preserved ejection fraction (HFpEF) of different origin have not been explored.
Aims
To characterize the pattern of peripheral vascular involvement in ATTRwt and evaluate its value in differentiating ATTRwt from AL-CA and HFpEF.
Methods
Newly diagnosed patients with ATTRwt (n=42) were consecutively recruited from our amyloidosis center. These patients were matched 1:1 for age and sex to patients with AL-CA (n=32) and subjects without amyloidosis (n=32) and also matched 2:1 to HFpEF patients (n=16). All subjects underwent a series of non-invasive vascular examinations for the assessment of: 1. subclinical carotid atherosclerosis with B-mode ultrasonography, 2. Arterial stiffness with measurement of carotid-femoral pulse wave velocity, 3. Reactive vasodilation with flow-mediated dilation (FMD) and 4. Aortic blood pressures and arterial wave reflections with augmentation index (AI) and return time of reflected wave (Tr).
Results
ATTRwt patients had lower peripheral (pBP) and aortic blood pressure (aBP) markers compared to non-AL controls (p<0.05 for all). ATTRwt grouping was an independent determinant of these markers, after adjustment for cardiovascular risk factors (CVRF), including history of hypertension, hyperlipidemia and diabetes, glomerular filtration rate, body mass index and smoking status (core model). ATTRwt had lower aDBP and increased Tr compared to AL subjects. In a comparison between ATTRwt and AL patients with cardiac involvement, AI and Tr were higher and FMD lower in ATTRwt patients. ATTRwt was an independent determinant of these markers, after adjustment for the core model (p<0.05 for all). Compared to HFpEF, patients with ATTRwt had lower peripheral and central BP and higher Tr (p<0.05 for all). By ROC analysis, Tr provided high diagnostic value for ATTRwt vs. AL-CA (Area Under the Curve, AUC=0.809, CI: 0.65–0.96) and for ATTRwt vs combined AL-CA and HFpEF (AUC=0.880, CI: 0.79–0.97). Finally, AI was closely correlated with posterior (Spearman's Rho=−0.30) and intraventricular wall thickness (Rho=−0.329) and left ventricular global longitudinal strain (Rho=−0.4) and lower cDBP with higher Gilmore and New York Heart Association stage (p<0.05).
Conclusion
ATTRwt patients present differential characteristics of peripheral vascular function and aortic hemodynamics as compared to AL, HFpEF and healthy controls. The clinical value of these characteristics merit further investigation since differential diagnosis among amyloidosis types is clinically challenging, while it may have prognostic implications.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
| | - D Delialis
- University of Athens Medical School, Department of Clinical Therapeutics, Athens, Greece
| | - D Bampatsias
- University of Athens Medical School, Department of Clinical Therapeutics, Athens, Greece
| | - M E Tselegkidi
- University of Athens Medical School, Department of Clinical Therapeutics, Athens, Greece
| | - I Petropoulos
- University of Athens Medical School, Department of Clinical Therapeutics, Athens, Greece
| | - F Theodorakakou
- University of Athens Medical School, Department of Clinical Therapeutics, Athens, Greece
| | - M Gavriatopoulou
- University of Athens Medical School, Department of Clinical Therapeutics, Athens, Greece
| | - R Patras
- University of Athens Medical School, Department of Clinical Therapeutics, Athens, Greece
| | - C Pamboucas
- University of Athens Medical School, Department of Clinical Therapeutics, Athens, Greece
| | - J Kanakakis
- University of Athens Medical School, Department of Clinical Therapeutics, Athens, Greece
| | - I Ikonomidis
- Attikon University Hospital, Second Cardiology Department, Athens, Greece
| | - E Terpos
- University of Athens Medical School, Department of Clinical Therapeutics, Athens, Greece
| | - I P Trougakos
- National & Kapodistrian University of Athens, Department of Cell Biology and Biophysics, Faculty of Biology, Athens, Greece
| | - M A Dimopoulos
- University of Athens Medical School, Department of Clinical Therapeutics, Athens, Greece
| | - E Kastritis
- University of Athens Medical School, Department of Clinical Therapeutics, Athens, Greece
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17
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Delialis D, Aivalioti E, Mavraganis G, Dimopoulou AM, Sianis A, Angelidakis L, Patras R, Petropoulos I, Ioannou S, Syrigou R, Kanakakis J, Georgiopoulos G, Stellos K, Stamatelopoulos K. Remnant cholesterol is an independent determinant of the presence and extent of subclinical carotid atherosclerosis in statin-naive individuals. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2561] [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
Despite continuous improvements of diagnostic and therapeutic algorithms for cardiovascular disease (CVD), mortality from CVD remains high suggesting unaddressed residual risk. Remnant cholesterol (RC) consists the cholesterol content of triglyceride-rich lipoproteins, which along with LDL cholesterol infiltrate the arterial wall, accumulate and cause atherosclerosis. Increased remnant cholesterol (RC) levels have been previously associated with future adverse cardiac events despite hypolipidemic therapy. However, a mechanistic association of RC levels with human atherosclerosis in vivo has not been proven in a clinical setting.
Purpose
To evaluate the association of RC levels with the presence and extend of subclinical carotid atherosclerosis.
Methods
In this retrospective cohort study, 438 subjects from the Athens Vascular Registry without clinically overt CVD or treatment with statin were recruited. Atherosclerotic burden was assessed by B-mode carotid ultrasonography using: 1. Maximal carotid wall thickness [maxWT, the highest intima-media thickness (IMT) or highest atherosclerotic plaque thickness (PLQ) if present derived from all carotid sites], 2. Total thickness (sumWT, sum of maximal wall thickness), 3) high plaque burden (PLQ ≥2) and 4) average carotid IMT (avgIMT). RC was calculated using the formula RC=total cholesterol-LDL-C-HDL-C.
Results
Mean (SD) age was 54.8±12.4 years old with 41% being males. Subjects with RC>median (=18mg/dl) had higher sumWT (6.12±0.7 vs 5.57±1.7, p=0.002), maxWT (1.61±0.7 vs 1.43±0.7, p=0.008) and avgIMT (0.88±0.16 vs 0.83±0.16, p=0.003) vs RC<median.>median was associated with higher odds for increased sumWT (highest tertile, OR: 2.15 95% CI 1.26–3.66, p=0.006) and maxWT (OR: 2.15 95% CI: 1.38–3.33, p=0.001), and a higher plaque burden (≥2 plaques, OR: 2.1 95% CI 1.93–3.1, p<0.001) after adjustment for age, gender and systolic blood pressure, glomerular filtration rate, smoking, diabetes mellitus, body mass index and LDL-C
Conclusion
In a statin-naive population without clinically overt CVD, increased RC levels were associated with the presence and extend of subclinical carotid atherosclerosis. These findings provide novel mechanistic insight into mechanisms associated with increased CVD risk in individuals with high RC levels.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- D Delialis
- University of Athens Medical School, Department of Clinical Therapeutics, Athens, Greece
| | - E Aivalioti
- University of Athens Medical School, Department of Clinical Therapeutics, Athens, Greece
| | - G Mavraganis
- University of Athens Medical School, Department of Clinical Therapeutics, Athens, Greece
| | - A M Dimopoulou
- University of Athens Medical School, Department of Clinical Therapeutics, Athens, Greece
| | - A Sianis
- University of Athens Medical School, Department of Clinical Therapeutics, Athens, Greece
| | - L Angelidakis
- University of Athens Medical School, Department of Clinical Therapeutics, Athens, Greece
| | - R Patras
- University of Athens Medical School, Department of Clinical Therapeutics, Athens, Greece
| | - I Petropoulos
- University of Athens Medical School, Department of Clinical Therapeutics, Athens, Greece
| | - S Ioannou
- University of Athens Medical School, Department of Clinical Therapeutics, Athens, Greece
| | - R Syrigou
- University of Athens Medical School, Department of Clinical Therapeutics, Athens, Greece
| | - J Kanakakis
- University of Athens Medical School, Department of Clinical Therapeutics, Athens, Greece
| | - G Georgiopoulos
- University of Athens Medical School, Department of Clinical Therapeutics, Athens, Greece
| | - K Stellos
- Newcastle University, Biosciences Institute, Vascular Biology and Medicine Theme, Faculty of Medical Sciences, Newcastle-Upon-Tyne, United Kingdom
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18
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Mavraganis G, Georgiopoulos G, Delialis D, Aivalioti E, Dimopoulou AM, Sianis A, Angelidakis L, Patras R, Petropoulos I, Ioannou S, Syrigou R, Kanakakis J, Stellos K, Stamatelopoulos K. Clinical utility of readily available novel markers of carotid atherosclerotic burden for reclassification and discrimination of very high cardiovascular risk. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2524] [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
Among high cardiovascular (CV) risk patients, there is emerging need to recognize those who will benefit from new treatments targeting residual risk. Readily available modalities providing reclassification value would be clinically useful in this setting. Preliminary data suggest that carotid ultrasonography using plaque burden but not intima-media thickness (IMT) is associated with very high risk.
Objectives
We aimed to assess the reclassification ability of two markers of carotid atherosclerosis in high-risk patients, reflecting total atherosclerotic burden and the most severe lesion and to compare them with the routinely used carotid indices IMT and number of carotid plaques.
Methods
In an ongoing registry of patients who visited a cardiovascular protection clinic for cardiovascular risk assessment, we enrolled 735 consecutively recruited patients (mean age 63.1 years, 68.8% male) classified as high or very-high CV risk according to 2019 European Society of Cardiology /European Atherosclerosis Society Guidelines. Sum of carotid wall thickness (sumWT) and maximal wall thickness (maxWT) using high-resolution ultrasonography at baseline were used to assess the total burden and the most severe carotid lesion, respectively. These markers integrate maximum plaque height or maximum IMT if no plaque is present. All patients were followed for a median of 41 months and the primary end-point consisted of CV mortality, acute myocardial infarction or coronary revascularization.
Results
After adjustment for traditional CV risk factors, maxWT and sumWT were associated with the primary end-point (hazard ratio [HR]=1.73 (95% confidence interval [CI]:1.39 to 2.17) and 1.19 (95% CI 1.10 to 1.30) respectively). Both markers were superior in terms of reclassification and discrimination to identify very high risk over validated CV risk scores including the Heartscore and the SMART score (net reclassification index [NRI]=0.624, p<0.0001, integrated discrimination index [IDI]=0.060, p<0.0001 and difference in the area under the curve (δAUC) = 0.136, p<0.001 for maxWT and NRI=0.497, p<0.0001, IDI=0.046, p<0.0001 and δAUC = 0.128, p<0.001 for sumWT), IMT (NRI=0.502, p<0.0001, IDI= 0.058, p=0.02 for maxWT and NRI=0.559, p<0.0001, IDI=0.051, p=0.016 for sumWT) and the number of carotid plaques (NRI=0.614, p<0.0001, IDI=0.038, p=0.001 for maxWT and NRI=0.292, p=0.019, IDI=0.022, p=0.009 for sumWT).
Conclusions
The use of two novel cumulative markers of atherosclerotic burden improves risk stratification and discriminates high from very high CV risk. Given that carotid ultrasonography is a readily available modality, its clinical application for risk refinement of high-risk patients to facilitate treatment decisions merits further investigation.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- G Mavraganis
- University of Athens Medical School, Department of Clinical Therapeutics, Athens, Greece
| | - G Georgiopoulos
- University of Athens Medical School, Department of Clinical Therapeutics, Athens, Greece
| | - D Delialis
- University of Athens Medical School, Department of Clinical Therapeutics, Athens, Greece
| | - E Aivalioti
- University of Athens Medical School, Department of Clinical Therapeutics, Athens, Greece
| | - A M Dimopoulou
- University of Athens Medical School, Department of Clinical Therapeutics, Athens, Greece
| | - A Sianis
- University of Athens Medical School, Department of Clinical Therapeutics, Athens, Greece
| | - L Angelidakis
- University of Athens Medical School, Department of Clinical Therapeutics, Athens, Greece
| | - R Patras
- University of Athens Medical School, Department of Clinical Therapeutics, Athens, Greece
| | - I Petropoulos
- University of Athens Medical School, Department of Clinical Therapeutics, Athens, Greece
| | - S Ioannou
- University of Athens Medical School, Department of Clinical Therapeutics, Athens, Greece
| | - R Syrigou
- University of Athens Medical School, Department of Clinical Therapeutics, Athens, Greece
| | - J Kanakakis
- University of Athens Medical School, Department of Clinical Therapeutics, Athens, Greece
| | - K Stellos
- Newcastle University, Biosciences Institute, Vascular Biology and Medicine Theme, Faculty of Medical Sciences, Newcastle-Upon-Tyne, United Kingdom
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19
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Bashir M, Elhadd T, Dabbous Z, Gul W, Salameh O, Siddiqui M, Al-Muhannadi H, Petropoulos I, Khan A, Ponirakis G, Malik RA. Optimal glycaemic and blood pressure but not lipid targets are related to a lower prevalence of diabetic microvascular complications. Diabetes Metab Syndr 2021; 15:102241. [PMID: 34390975 DOI: 10.1016/j.dsx.2021.102241] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 06/27/2021] [Accepted: 08/01/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Diabetic microvascular complications are a major cause of morbidity and are related to glycaemic control and cardiovascular risk factors. AIMS We sought to determine the association of microvascular complications in relation to control of glycemia, blood pressure and lipids in T2DM patients attending secondary care in Qatar. METHODS This is a cross-sectional study undertaken in patients with T2DM attending Qatar's National Diabetes Centres. Patients underwent assessment of glycemia, blood pressure and lipids and prevalence of diabetic peripheral neuropathy (DPN), retinopathy and microalbuminuria. RESULTS We included 1114 subjects aged 52.1 ± 11.3 years with a duration of diabetes 10.0 ± 7.6 years and had a prevalence of 25.8% for DPN, 34.3% for painful DPN, 36.8% for microalbuminuria and 25.1% for retinopathy. Patients who achieved an HbA1c ≤ 7.0% compared to >7% had a significantly lower prevalence of DPN (P < 0.01), painful DPN (P < 0.01), retinopathy (P < 0.01) and microalbuminuria (P < 0.007). Patients who achieved a systolic BP ≤ 140 mmHg compared to >140 mmHg had a significantly lower prevalence of DPN (P < 0.001), painful DPN (P < 0.001), retinopathy (P < 0.001) and microalbuminuria (P < 0.001). Patients who achieved an LDL ≤2.6 mmol/l compared to >2.6 mmol/l had a significantly higher prevalence of DPN (P < 0.03), but no difference in other outcomes. There was no difference in microvascular complications between those who achieved a HDL-C ≥ 1.02 mmol/l, and among those who achieved triglycerides ≤1.7 mmol/l. CONCLUSIONS Optimal control of glycemia and blood pressure, but not lipids is associated with a lower prevalence of diabetic microvascular complications.
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Affiliation(s)
- Mohammad Bashir
- National Diabetes & Endocrine Centre, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Tarik Elhadd
- National Diabetes & Endocrine Centre, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar; National Diabetes & Endocrine Centre, Al-Wakra Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Zeinab Dabbous
- National Diabetes & Endocrine Centre, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Wajiha Gul
- National Diabetes & Endocrine Centre, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Obada Salameh
- National Diabetes & Endocrine Centre, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Mashhood Siddiqui
- National Diabetes & Endocrine Centre, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Hamad Al-Muhannadi
- Weill Cornell Medicine-Qatar, Qatar Foundation, Education City, Doha, Qatar
| | | | - Adnan Khan
- Weill Cornell Medicine-Qatar, Qatar Foundation, Education City, Doha, Qatar
| | - Georgios Ponirakis
- Weill Cornell Medicine-Qatar, Qatar Foundation, Education City, Doha, Qatar
| | - Rayaz A Malik
- Weill Cornell Medicine-Qatar, Qatar Foundation, Education City, Doha, Qatar; Institute of Cardiovascular Science, University of Manchester, Manchester, UK.
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20
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Briasoulis A, Stamatelopoulos K, Petropoulos I, Theodorakakou F, Gavriatopoulou M, Dimopoulos AM, Kastritis E. UTILIZATION AND TOLERANCE OF BETA-BLOCKERS AMONG PATIENTS WITH AL AMYLOIDOSIS. J Am Coll Cardiol 2021. [DOI: 10.1016/s0735-1097(21)02021-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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21
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Dhage S, Ferdousi M, Adam S, Ho JH, Kalteniece A, Azmi S, Alam U, Ponirakis G, Petropoulos I, Atkinson AJ, Marshall A, Jeziorska M, Soran H, Malik RA. Corneal confocal microscopy identifies small fibre damage and progression of diabetic neuropathy. Sci Rep 2021; 11:1859. [PMID: 33479291 PMCID: PMC7820596 DOI: 10.1038/s41598-021-81302-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Accepted: 01/05/2021] [Indexed: 01/25/2023] Open
Abstract
Accurately quantifying the progression of diabetic peripheral neuropathy is key to identify individuals who will progress to foot ulceration and to power clinical intervention trials. We have undertaken detailed neuropathy phenotyping to assess the longitudinal utility of different measures of neuropathy in patients with diabetes. Nineteen patients with diabetes (age 52.5 ± 14.7 years, duration of diabetes 26.0 ± 13.8 years) and 19 healthy controls underwent assessment of symptoms and signs of neuropathy, quantitative sensory testing, autonomic nerve function, neurophysiology, intra-epidermal nerve fibre density (IENFD) and corneal confocal microscopy (CCM) to quantify corneal nerve fibre density (CNFD), branch density (CNBD) and fibre length (CNFL). Mean follow-up was 6.5 years. Glycated haemoglobin (p = 0.04), low-density lipoprotein-cholesterol (LDL-C) (p = 0.0009) and urinary albumin creatinine ratio (p < 0.0001) improved. Neuropathy symptom profile (p = 0.03), neuropathy disability score (p = 0.04), vibration perception threshold (p = 0.02), cold perception threshold (p = 0.006), CNFD (p = 0.03), CNBD (p < 0.0001), CNFL (p < 0.0001), IENFD (p = 0.04), sural (p = 0.02) and peroneal motor nerve conduction velocity (p = 0.03) deteriorated significantly. Change (∆) in CNFL correlated with ∆CPT (p = 0.006) and ∆Expiration/Inspiration ratio (p = 0.002) and ∆IENFD correlated with ∆CNFD (p = 0.005), ∆CNBD (p = 0.02) and ∆CNFL (p = 0.01). This study shows worsening of diabetic neuropathy across a range of neuropathy measures, especially CCM, despite an improvement in HbA1c and LDL-C. It further supports the utility of CCM as a rapid, non-invasive surrogate measure of diabetic neuropathy.
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Affiliation(s)
- Shaishav Dhage
- Department of Medicine, Manchester University NHS Foundation Trust, Manchester, UK
- Cardiovascular Research Group, University of Manchester, Manchester, UK
- The Christie NHS Foundation Trust, Manchester, UK
| | - Maryam Ferdousi
- Cardiovascular Research Group, University of Manchester, Manchester, UK
| | - Safwaan Adam
- Department of Medicine, Manchester University NHS Foundation Trust, Manchester, UK
- Cardiovascular Research Group, University of Manchester, Manchester, UK
- The Christie NHS Foundation Trust, Manchester, UK
| | - Jan Hoong Ho
- Department of Medicine, Manchester University NHS Foundation Trust, Manchester, UK
- Cardiovascular Research Group, University of Manchester, Manchester, UK
- The Christie NHS Foundation Trust, Manchester, UK
| | - Alise Kalteniece
- Cardiovascular Research Group, University of Manchester, Manchester, UK
| | - Shazli Azmi
- Department of Medicine, Manchester University NHS Foundation Trust, Manchester, UK
- Cardiovascular Research Group, University of Manchester, Manchester, UK
| | - Uazman Alam
- Institute of Cardiovascular and Metabolic Medicine and The Pain Research Institute, University of Liverpool & Liverpool University NHS Hospital Trust, Liverpool, UK
| | - Georgios Ponirakis
- Department of Medicine, Weill Cornell Medicine-Qatar, Qatar Foundation, Education City, Doha, Qatar
| | - Ioannis Petropoulos
- Department of Medicine, Weill Cornell Medicine-Qatar, Qatar Foundation, Education City, Doha, Qatar
| | - Andrew J Atkinson
- Cardiovascular Research Group, University of Manchester, Manchester, UK
| | - Andrew Marshall
- Institute of Life Course and Medical Sciences and The Pain Research Institute, University of Liverpool & Liverpool University NHS Hospital Trust, Liverpool, UK
| | - Maria Jeziorska
- Cardiovascular Research Group, University of Manchester, Manchester, UK
| | - Handrean Soran
- Department of Medicine, Manchester University NHS Foundation Trust, Manchester, UK
- Cardiovascular Research Group, University of Manchester, Manchester, UK
| | - Rayaz A Malik
- Department of Medicine, Manchester University NHS Foundation Trust, Manchester, UK.
- Cardiovascular Research Group, University of Manchester, Manchester, UK.
- Department of Medicine, Weill Cornell Medicine-Qatar, Qatar Foundation, Education City, Doha, Qatar.
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22
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Stamatelopoulos K, Delialis D, Bampatsias D, Tselegkidi M, Petropoulos I, Roussou M, Gavriatopoulou M, Aivalioti E, Patras R, Pamboucas C, Kanakakis I, Terpos E, Trougakos I, Dimopoulos M, Kastritis E. Characterization and clinical implications of peripheral arterial involvement in transthyretin cardiac amyloidosis cardiomyopathy. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.3247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
The sporadic form of transthyretin amyloidosis cardiomyopathy (ATTR-CM) is underdiagnosed but its prevalence is increasing due to the aging population. Given the poor prognosis of ATTR-CM understanding the underlying pathophysiologic mechanisms of the disease is imperative in order to improve strategies for early diagnosis and risk stratification and to develop new effective therapeutic options. ATTR-CM is associated with hypotension and there is preliminary experimental evidence of vascular involvement but its presence and clinical significance remains unknown.
Purpose
To characterize peripheral arterial involvement and explore its clinical role in ATTR-CM.
Methods
We consecutively recruited 28 previously untreated patients with newly diagnosed ATTR-CM and 34 elderly controls >70 years old, without ATTR-CM or heart failure. In both groups, flow-mediated dilatation (FMD) and intima-media thickness (IMT) in the carotid arteries were measured by high-resolution ultrasonography as markers of peripheral vascular reactivity and of subclinical atherosclerosis, respectively. Carotid-femoral pulse wave velocity (PWV) was measured as a marker of arterial stiffness. Aortic blood pressure (BP) and augmentation index (AI) using applanation tonometry were measured as markers of arterial wave reflections, peripheral arterial resistance and central hemodynamics. Echocardiography was performed in all ATTR patients. All cardiovascular (CV) measurements were performed before administration of any ATTR-specific therapy.
Results
ATTR patients were older and had lower prevalence of hypertension and male gender (p<0.05 for all) than the control group. Aortic and peripheral BP (p=0.016–0.088) and AI (p=0.003) were lower in ATTR patients. IMT in the common (cc) and internal carotid (ic) as well as in the carotid bulb (cb) were significantly higher in ATTR patients (p=0.001–0.042). After multivariable adjustment for traditional CV disease (CVD) risk factors, the ATTR group was independently associated with AI and IMT in cc, cb and ic (p<0.05 for all). In a subgroup of subjects with similar age between groups (n=13 and n=33 and 74.5±2.9 vs. 75.6±3.6 years, for ATTR vs. controls, respectively) differences in AI and cbIMT remained significant. Interestingly, AI was strongly and inversely associated with interventricular wall thickness (IVwt) in ATTR patients (spearman rho=−0.651, p=0.001). After adjustment for traditional CVD risk factors this association remained significant.
Conclusion
ATTR-CM is associated with lower aortic wave reflections, which correlate with more advanced structural cardiac disease, as assessed by IVwt. Further, ATTR-CM patients present accelerated subclinical carotid atherosclerosis as compared to elderly control subjects. These findings suggest that in ATTR-CM there is disease-specific peripheral vascular involvement in parallel to cardiac involvement. The clinical significance of these findings merits further investigation.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- K Stamatelopoulos
- University of Athens Medical School, Department of Clinical Therapeutics, Athens, Greece
| | - D Delialis
- University of Athens Medical School, Department of Clinical Therapeutics, Athens, Greece
| | - D Bampatsias
- University of Athens Medical School, Department of Clinical Therapeutics, Athens, Greece
| | - M.E Tselegkidi
- University of Athens Medical School, Department of Clinical Therapeutics, Athens, Greece
| | - I Petropoulos
- University of Athens Medical School, Department of Clinical Therapeutics, Athens, Greece
| | - M Roussou
- University of Athens Medical School, Department of Clinical Therapeutics, Athens, Greece
| | - M Gavriatopoulou
- University of Athens Medical School, Department of Clinical Therapeutics, Athens, Greece
| | - E Aivalioti
- University of Athens Medical School, Department of Clinical Therapeutics, Athens, Greece
| | - R Patras
- University of Athens Medical School, Department of Clinical Therapeutics, Athens, Greece
| | - C Pamboucas
- University of Athens Medical School, Department of Clinical Therapeutics, Athens, Greece
| | - I Kanakakis
- University of Athens Medical School, Department of Clinical Therapeutics, Athens, Greece
| | - E Terpos
- University of Athens Medical School, Department of Clinical Therapeutics, Athens, Greece
| | - I.P Trougakos
- National & Kapodistrian University of Athens, Laboratory of Pharmacology,, Athens, Greece
| | - M.A Dimopoulos
- University of Athens Medical School, Department of Clinical Therapeutics, Athens, Greece
| | - E Kastritis
- University of Athens Medical School, Department of Clinical Therapeutics, Athens, Greece
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Ferdousi M, Kalteniece A, Petropoulos I, Azmi S, Dhage S, Marshall A, Boulton AJM, Efron N, Faber CG, Lauria G, Soran H, Malik RA. Diabetic Neuropathy Is Characterized by Progressive Corneal Nerve Fiber Loss in the Central and Inferior Whorl Regions. Invest Ophthalmol Vis Sci 2020; 61:48. [PMID: 32232351 PMCID: PMC7401481 DOI: 10.1167/iovs.61.3.48] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Purpose We hypothesized that longitudinal changes in corneal nerve morphology would differ between the central cornea and inferior whorl in relation to other measures of diabetic neuropathy. Methods Thirty patients with diabetes (age: 54.08 ± 15.86, duration: 23.95 ± 14.2, HbA1c: 7.51 ± 1.37) and 19 age-matched healthy controls (age: 49.47 ± 13.25) underwent assessment of neuropathy disability score (NDS), vibration perception threshold (VPT), cold (CPT) and warm (WPT) perception thresholds, peroneal motor nerve conduction velocity (PMNCV), corneal nerve fiber density (CNFD), branch density (CNBD), fiber length (CNFL), inferior whorl length (IWL), and the average of CNFL and IWL (ANFL) at baseline and after 1 to 8 years. Results In patients with diabetes, between baseline and follow-up, there was a significant reduction in CNBD (57.72 ± 30.08 vs. 44.04 ± 23.69; P = 0.02), CNFL (21.77 ± 5.19 vs. 15.65 ± 4.7; P < 0.0001), IWL (24.69 ± 8.67 vs. 14.23 ± 6.13; P < 0.0001), ANFL (23.26 ± 5.53 vs. 15.09 ± 4.48; P < 0.0001), and WPT (43.56 ± 4.43 vs. 40.78 ± 4.93; P = 0.01), and an increase in VPT (12.9 ± 8.96 vs. 13.78 ± 8.99; P = 0.02). There was no significant change in CNFD (27.12 ± 8.2 vs. 25.43 ± 7.11; P = 0.2), NDS (3.38 ± 3.35 vs. 2.61 ± 2.8; P = 0.08), CPT (17.7 ± 10.59 vs. 22.45 ± 9.23; P = 0.06), or PMNCV (42.4 ± 4.21 vs. 42.16 ± 6.3; P = 0.2). Conclusions There is evidence of corneal nerve loss in patients with diabetes, particularly at the inferior whorl during follow-up.
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24
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Kamran S, Khan A, Salam A, Akhtar N, Petropoulos I, Ponirakis G, Babu B, George P, Shuaib A, Malik RA. Cornea: A Window to White Matter Changes in Stroke; Corneal Confocal Microscopy a Surrogate Marker for the Presence and Severity of White Matter Hyperintensities in Ischemic Stroke. J Stroke Cerebrovasc Dis 2020; 29:104543. [PMID: 31902645 DOI: 10.1016/j.jstrokecerebrovasdis.2019.104543] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 10/14/2019] [Accepted: 11/18/2019] [Indexed: 12/13/2022] Open
Abstract
PURPOSE The presence of white matter hyperintensities (WMH) on MRI imaging confers an increased risk of stroke, dementia, and death. Corneal confocal microscopy (CCM) can detect nerve injury non-invasively and may be a useful surrogate marker for WMH. The objective is to determine whether corneal nerve pathology identified using CCM is associated with the presence of WMH in patients with acute ischemic stroke. METHODS This is a cross-sectional study where 196 consecutive individuals with acute ischemic stroke were enrolled and underwent neurological examination, MRI brain imaging and CCM. Participants underwent blinded quantification of WMH and corneal nerve fiber density (CNFD), corneal nerve branch density (CNBD) and corneal nerve fiber length (CNFL). RESULTS The prevalence of hypertension [P = .013] was significantly higher and CNFD [P = .031] was significantly lower in patients with WMH compared to those without WMH. CNFD and CNFL were significantly lower in patients with DM without WMH [P = .008, P = .019] and in patients with DM and WMH [P = .042, P = .024] compared to patients without DM or WMH, respectively. In a multivariate model, a 1-unit decrease in the CNFD increased the risk of WMH by 6%, after adjusting for age, DM, gender, dyslipidemia, metabolic syndrome, smoking, and HbA1c. DM was associated with a decrease in all CCM parameters but was not a significant independent factor associated with WMH. CONCLUSIONS CCM demonstrates corneal nerve pathology, which is associated with the presence of WMH in participants with acute ischemic stroke. CCM may be a useful surrogate imaging marker for the presence and severity of WMHs.
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Affiliation(s)
- Saadat Kamran
- Neuroscience Institute, Hamad General Hospital, Doha, Qatar; Weill Cornell Medicine-Qatar, Qatar Foundation, Education City, Doha, Qatar.
| | - Adnan Khan
- Weill Cornell Medicine-Qatar, Qatar Foundation, Education City, Doha, Qatar
| | - Abdul Salam
- Neuroscience Institute, Hamad General Hospital, Doha, Qatar
| | - Naveed Akhtar
- Neuroscience Institute, Hamad General Hospital, Doha, Qatar; Weill Cornell Medicine-Qatar, Qatar Foundation, Education City, Doha, Qatar
| | | | - Georgios Ponirakis
- Weill Cornell Medicine-Qatar, Qatar Foundation, Education City, Doha, Qatar
| | - Blessy Babu
- Neuroscience Institute, Hamad General Hospital, Doha, Qatar
| | - Pooja George
- Neuroscience Institute, Hamad General Hospital, Doha, Qatar
| | - Ashfaq Shuaib
- Neuroscience Institute, Hamad General Hospital, Doha, Qatar
| | - Rayaz A Malik
- Weill Cornell Medicine-Qatar, Qatar Foundation, Education City, Doha, Qatar
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25
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Ponirakis G, Elhadd T, Chinnaiyan S, Dabbous Z, Siddiqui M, Al‐muhannadi H, Petropoulos I, Khan A, Ashawesh KAE, Dukhan KMO, Mahfoud ZR, Murgatroyd C, Slevin M, Malik RA. Prevalence and risk factors for painful diabetic neuropathy in secondary healthcare in Qatar. J Diabetes Investig 2019; 10:1558-1564. [PMID: 30860314 PMCID: PMC6825939 DOI: 10.1111/jdi.13037] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 02/23/2019] [Accepted: 03/03/2019] [Indexed: 01/16/2023] Open
Abstract
AIMS/INTRODUCTION Painful diabetic peripheral neuropathy (PDPN) has a significant impact on the patient's quality of life. The prevalence of PDPN in the Middle East and North Africa region has been reported to be almost double that of populations in the UK. We sought to determine the prevalence of PDPN and its associated factors in type 2 diabetes mellitus patients attending secondary care in Qatar. MATERIALS AND METHODS This was a cross-sectional study of 1,095 participants with type 2 diabetes mellitus attending Qatar's two national diabetes centers. PDPN and impaired vibration perception on the pulp of the large toes were assessed using the Douleur Neuropathique en 4 questionnaire with a cut-off ≥4 and the neurothesiometer with a cut-off ≥15 V, respectively. RESULTS The prevalence of PDPN was 34.5% (95% confidence interval [CI] 31.7-37.3), but 80% of these patients had not previously been diagnosed or treated for this condition. Arabs had a higher prevalence of PDPN compared with South Asians (P < 0.05). PDPN was associated with impaired vibration perception adjusted odds ratio (AOR) 4.42 (95% CI 2.92-6.70), smoking AOR 2.43 (95% CI 1.43-4.15), obesity AOR 1.74 (95% CI 1.13-2.66), being female AOR 1.65 (95% CI: 1.03-2.64) and duration of diabetes AOR 1.08 (95% CI 1.05-1.11). Age, poor glycemic control, hypertension, physical activity and proteinuria showed no association with PDPN. CONCLUSIONS PDPN occurs in one-third of type 2 diabetes mellitus patients attending secondary care in Qatar, but the majority have not been diagnosed. Arabs are at higher risk for PDPN. Impaired vibration perception, obesity and smoking are associated with PDPN in Qatar.
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Affiliation(s)
- Georgios Ponirakis
- Weill Cornell Medicine‐QatarQatar FoundationEducation CityDohaQatar
- Faculty of Science and EngineeringManchester Metropolitan UniversityManchesterUK
| | - Tarik Elhadd
- National Diabetes and Endocrine CentreHamad Medical CorporationHamad General HospitalDohaQatar
- National Diabetes and Endocrine CentreHamad Medical CorporationAl‐Wakra HospitalDohaQatar
| | - Subitha Chinnaiyan
- National Diabetes and Endocrine CentreHamad Medical CorporationHamad General HospitalDohaQatar
| | - Zeinab Dabbous
- National Diabetes and Endocrine CentreHamad Medical CorporationHamad General HospitalDohaQatar
| | - Mashhood Siddiqui
- National Diabetes and Endocrine CentreHamad Medical CorporationHamad General HospitalDohaQatar
| | | | | | - Adnan Khan
- Weill Cornell Medicine‐QatarQatar FoundationEducation CityDohaQatar
| | - Khaled AE Ashawesh
- National Diabetes and Endocrine CentreHamad Medical CorporationAl‐Wakra HospitalDohaQatar
| | - Khaled MO Dukhan
- National Diabetes and Endocrine CentreHamad Medical CorporationAl‐Wakra HospitalDohaQatar
| | - Ziyad R Mahfoud
- Weill Cornell Medicine‐QatarQatar FoundationEducation CityDohaQatar
| | | | - Mark Slevin
- Faculty of Science and EngineeringManchester Metropolitan UniversityManchesterUK
| | - Rayaz A Malik
- Weill Cornell Medicine‐QatarQatar FoundationEducation CityDohaQatar
- Faculty of Science and EngineeringManchester Metropolitan UniversityManchesterUK
- National Diabetes and Endocrine CentreHamad Medical CorporationHamad General HospitalDohaQatar
- Institute of Cardiovascular ScienceUniversity of ManchesterManchesterUK
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26
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Stamatelopoulos K, Georgiopoulos G, Athanasouli F, Nikolaou PE, Lykka M, Roussou M, Gavriatopoulou M, Laina A, Trakada G, Charakida M, Delialis D, Petropoulos I, Pamboukas C, Manios E, Karakitsou M, Papamichael C, Gatsiou A, Lambrinoudaki I, Terpos E, Stellos K, Andreadou I, Dimopoulos MA, Kastritis E. Reactive Vasodilation Predicts Mortality in Primary Systemic Light-Chain Amyloidosis. Circ Res 2019; 125:744-758. [PMID: 31401949 PMCID: PMC6784773 DOI: 10.1161/circresaha.119.314862] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [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] [Indexed: 01/22/2023]
Abstract
Supplemental Digital Content is available in the text. Cardiac involvement and hypotension dominate the prognosis of light-chain amyloidosis (AL). Evidence suggests that there is also peripheral vascular involvement in AL but its prognostic significance is unknown.
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Affiliation(s)
- Kimon Stamatelopoulos
- From the Department of Clinical Therapeutics, National and Kapodistrian University of Athens School of Medicine, Greece (K. Stamatelopoulos, G.G., F.A., M.L., M.R., M.G., A.L., G.T., D.D., I.P., C. Pamboukas, E.M., M.K., C. Papamichael, E.T., M.A.D., E.K.).,Newcastle Cardiovascular Disease Prevention Hub, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, United Kingdom (K. Stamatelopoulos, A.G., K. Stellos)
| | - Georgios Georgiopoulos
- From the Department of Clinical Therapeutics, National and Kapodistrian University of Athens School of Medicine, Greece (K. Stamatelopoulos, G.G., F.A., M.L., M.R., M.G., A.L., G.T., D.D., I.P., C. Pamboukas, E.M., M.K., C. Papamichael, E.T., M.A.D., E.K.).,School of Biomedical Engineering and Imaging Sciences, King's College, London, United Kingdom (G.G., M.C.)
| | - Fani Athanasouli
- From the Department of Clinical Therapeutics, National and Kapodistrian University of Athens School of Medicine, Greece (K. Stamatelopoulos, G.G., F.A., M.L., M.R., M.G., A.L., G.T., D.D., I.P., C. Pamboukas, E.M., M.K., C. Papamichael, E.T., M.A.D., E.K.)
| | - Panagiota-Efstathia Nikolaou
- National and Kapodistrian University of Athens, Faculty of Pharmacy, Department of Pharmaceutical Chemistry, Laboratory of Pharmacology, Panepistimiopolis, Zografou, Athens, Greece (P.E.N., I.A.)
| | - Marita Lykka
- From the Department of Clinical Therapeutics, National and Kapodistrian University of Athens School of Medicine, Greece (K. Stamatelopoulos, G.G., F.A., M.L., M.R., M.G., A.L., G.T., D.D., I.P., C. Pamboukas, E.M., M.K., C. Papamichael, E.T., M.A.D., E.K.)
| | - Maria Roussou
- From the Department of Clinical Therapeutics, National and Kapodistrian University of Athens School of Medicine, Greece (K. Stamatelopoulos, G.G., F.A., M.L., M.R., M.G., A.L., G.T., D.D., I.P., C. Pamboukas, E.M., M.K., C. Papamichael, E.T., M.A.D., E.K.)
| | - Maria Gavriatopoulou
- From the Department of Clinical Therapeutics, National and Kapodistrian University of Athens School of Medicine, Greece (K. Stamatelopoulos, G.G., F.A., M.L., M.R., M.G., A.L., G.T., D.D., I.P., C. Pamboukas, E.M., M.K., C. Papamichael, E.T., M.A.D., E.K.)
| | - Aggeliki Laina
- From the Department of Clinical Therapeutics, National and Kapodistrian University of Athens School of Medicine, Greece (K. Stamatelopoulos, G.G., F.A., M.L., M.R., M.G., A.L., G.T., D.D., I.P., C. Pamboukas, E.M., M.K., C. Papamichael, E.T., M.A.D., E.K.)
| | - Georgia Trakada
- From the Department of Clinical Therapeutics, National and Kapodistrian University of Athens School of Medicine, Greece (K. Stamatelopoulos, G.G., F.A., M.L., M.R., M.G., A.L., G.T., D.D., I.P., C. Pamboukas, E.M., M.K., C. Papamichael, E.T., M.A.D., E.K.)
| | - Marietta Charakida
- School of Biomedical Engineering and Imaging Sciences, King's College, London, United Kingdom (G.G., M.C.)
| | - Dimitris Delialis
- From the Department of Clinical Therapeutics, National and Kapodistrian University of Athens School of Medicine, Greece (K. Stamatelopoulos, G.G., F.A., M.L., M.R., M.G., A.L., G.T., D.D., I.P., C. Pamboukas, E.M., M.K., C. Papamichael, E.T., M.A.D., E.K.)
| | - Ioannis Petropoulos
- From the Department of Clinical Therapeutics, National and Kapodistrian University of Athens School of Medicine, Greece (K. Stamatelopoulos, G.G., F.A., M.L., M.R., M.G., A.L., G.T., D.D., I.P., C. Pamboukas, E.M., M.K., C. Papamichael, E.T., M.A.D., E.K.)
| | - Constantinos Pamboukas
- From the Department of Clinical Therapeutics, National and Kapodistrian University of Athens School of Medicine, Greece (K. Stamatelopoulos, G.G., F.A., M.L., M.R., M.G., A.L., G.T., D.D., I.P., C. Pamboukas, E.M., M.K., C. Papamichael, E.T., M.A.D., E.K.)
| | - Efstathios Manios
- From the Department of Clinical Therapeutics, National and Kapodistrian University of Athens School of Medicine, Greece (K. Stamatelopoulos, G.G., F.A., M.L., M.R., M.G., A.L., G.T., D.D., I.P., C. Pamboukas, E.M., M.K., C. Papamichael, E.T., M.A.D., E.K.)
| | - Marina Karakitsou
- From the Department of Clinical Therapeutics, National and Kapodistrian University of Athens School of Medicine, Greece (K. Stamatelopoulos, G.G., F.A., M.L., M.R., M.G., A.L., G.T., D.D., I.P., C. Pamboukas, E.M., M.K., C. Papamichael, E.T., M.A.D., E.K.)
| | - Christos Papamichael
- From the Department of Clinical Therapeutics, National and Kapodistrian University of Athens School of Medicine, Greece (K. Stamatelopoulos, G.G., F.A., M.L., M.R., M.G., A.L., G.T., D.D., I.P., C. Pamboukas, E.M., M.K., C. Papamichael, E.T., M.A.D., E.K.)
| | - Aikaterini Gatsiou
- Newcastle Cardiovascular Disease Prevention Hub, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, United Kingdom (K. Stamatelopoulos, A.G., K. Stellos)
| | - Irene Lambrinoudaki
- National and Kapodistrian University of Athens 2nd Department of Obstetrics and Gynecology, Menopause Clinic, Aretaieio Hospital, Athens, Greece (I.L.)
| | - Evangelos Terpos
- From the Department of Clinical Therapeutics, National and Kapodistrian University of Athens School of Medicine, Greece (K. Stamatelopoulos, G.G., F.A., M.L., M.R., M.G., A.L., G.T., D.D., I.P., C. Pamboukas, E.M., M.K., C. Papamichael, E.T., M.A.D., E.K.)
| | - Konstantinos Stellos
- Newcastle Cardiovascular Disease Prevention Hub, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, United Kingdom (K. Stamatelopoulos, A.G., K. Stellos).,Department of Cardiology, Freeman Hospital, Newcastle Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK (K. Stellos)
| | - Ioanna Andreadou
- National and Kapodistrian University of Athens, Faculty of Pharmacy, Department of Pharmaceutical Chemistry, Laboratory of Pharmacology, Panepistimiopolis, Zografou, Athens, Greece (P.E.N., I.A.)
| | - Meletios A Dimopoulos
- From the Department of Clinical Therapeutics, National and Kapodistrian University of Athens School of Medicine, Greece (K. Stamatelopoulos, G.G., F.A., M.L., M.R., M.G., A.L., G.T., D.D., I.P., C. Pamboukas, E.M., M.K., C. Papamichael, E.T., M.A.D., E.K.)
| | - Efstathios Kastritis
- From the Department of Clinical Therapeutics, National and Kapodistrian University of Athens School of Medicine, Greece (K. Stamatelopoulos, G.G., F.A., M.L., M.R., M.G., A.L., G.T., D.D., I.P., C. Pamboukas, E.M., M.K., C. Papamichael, E.T., M.A.D., E.K.)
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27
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Kokras N, Papadopoulou E, Georgiopoulos G, Dalla C, Petropoulos I, Kontogiannis C, Laina A, Bampatsias D, Stellos K, Kouzoupis AV, Stamatelopoulos K. The effect of treatment response on endothelial function and arterial stiffness in depression. A prospective study. J Affect Disord 2019; 252:190-200. [PMID: 30986734 DOI: 10.1016/j.jad.2019.04.024] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [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: 10/16/2018] [Revised: 03/03/2019] [Accepted: 04/07/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND Major depression is associated with endothelial dysfunction and arterial stiffening, which may mediate development of hypertension and increased cardiovascular risk. The effect of response to antidepressant treatment on these vascular parameters has not been elucidated. AIMS We aimed to assess the net effect of antidepressant therapy on endothelial function and arterial stiffness in patients with psychotic depression. METHOD Thirty-seven patients with major psychotic depression, according to DSM-IV-TR, were treated with titrated citalopram 20-60 mg and risperidone 0.5-1 mg and were followed for 6 months. Twelve additional patients who denied treatment, or were non-compliant, were also followed for the same time period. Vascular function was assessed by flow-mediated dilatation (FMD), carotid-femoral pulse wave velocity (PWV) and augmentation index (AI), at baseline and at the end of follow-up. RESULTS Aortic and peripheral blood pressure (BP), PWV, FMD and AI (p < 0.05 for all) were significantly improved in the group that received treatment. Overall, only responders to treatment (n = 24) presented significant improvements in all hemodynamic and vascular parameters (p < 0.05 for all), irrespectively of traditional cardiovascular risk factors (TRFs), vasoactive medication and BP lowering. In a secondary analysis, patients with psychotic depression presented worse endothelial function as compared to controls matched for TRFs. LIMITATIONS Non-randomized study. CONCLUSIONS Patients who respond to therapy for major psychotic depression present sustained improvement in vascular function. Given that depressed patients are considered to be at high cardiovascular risk and are often non-compliant with treatment, further research to assess cardiovascular benefits of vigilant monitoring of antidepressant therapy is warranted.
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Affiliation(s)
- Nikolaos Kokras
- First Department of Psychiatry, Eginition Hospital, Medical School, National and Kapodistrian University of Athens, Greece; Department of Pharmacology, Medical School, National and Kapodistrian University of Athens, Greece
| | - Efthymia Papadopoulou
- Department of Clinical Therapeutics, Vascular Laboratory, Alexandra Hospital, Medical School, National and Kapodistrian University of Athens, 80 Vas. Sofias Str, Athens 11528, Greece
| | - Georgios Georgiopoulos
- Department of Clinical Therapeutics, Vascular Laboratory, Alexandra Hospital, Medical School, National and Kapodistrian University of Athens, 80 Vas. Sofias Str, Athens 11528, Greece
| | - Christina Dalla
- Department of Pharmacology, Medical School, National and Kapodistrian University of Athens, Greece
| | - Ioannis Petropoulos
- Department of Clinical Therapeutics, Vascular Laboratory, Alexandra Hospital, Medical School, National and Kapodistrian University of Athens, 80 Vas. Sofias Str, Athens 11528, Greece
| | - Christos Kontogiannis
- Department of Clinical Therapeutics, Vascular Laboratory, Alexandra Hospital, Medical School, National and Kapodistrian University of Athens, 80 Vas. Sofias Str, Athens 11528, Greece
| | - Ageliki Laina
- Department of Clinical Therapeutics, Vascular Laboratory, Alexandra Hospital, Medical School, National and Kapodistrian University of Athens, 80 Vas. Sofias Str, Athens 11528, Greece
| | - Dimitrios Bampatsias
- Department of Clinical Therapeutics, Vascular Laboratory, Alexandra Hospital, Medical School, National and Kapodistrian University of Athens, 80 Vas. Sofias Str, Athens 11528, Greece
| | - Konstantinos Stellos
- Cardiovascular Research Centre, Institute of Genetic Medicine, Newcastle University, Newcastle Upon Tyne, UK; Cardiothoracic Centre, Newcastle upon Tyne Hospitals, NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Anastasios V Kouzoupis
- First Department of Psychiatry, Eginition Hospital, Medical School, National and Kapodistrian University of Athens, Greece
| | - Kimon Stamatelopoulos
- Department of Clinical Therapeutics, Vascular Laboratory, Alexandra Hospital, Medical School, National and Kapodistrian University of Athens, 80 Vas. Sofias Str, Athens 11528, Greece; Cardiovascular Research Centre, Institute of Genetic Medicine, Newcastle University, Newcastle Upon Tyne, UK.
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28
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Georgiopoulos G, Stakos D, Bakogiannis K, Kontogiannis C, Augoulea A, Armeni E, Laina A, Mareti A, Petropoulos I, Kanakakis I, Karapanou L, Bampatsias D, Lambrinoudaki I, Papamichael C, Stamatelopoulos K. P1565Abdominal tissue echogenicity in postmenopausal women. A novel marker of morbid obesity? Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p1565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- G Georgiopoulos
- Alexandra University Hospital, Vascular Laboratory, Department of Clinical Therapeutics, National and Kapodistrian University, Athens, Greece
| | - D Stakos
- Democritus University of Thrace, Cardiology Department, Alexandroupolis, Greece
| | - K Bakogiannis
- Alexandra University Hospital, Vascular Laboratory, Department of Clinical Therapeutics, National and Kapodistrian University, Athens, Greece
| | - C Kontogiannis
- Alexandra University Hospital, Vascular Laboratory, Department of Clinical Therapeutics, National and Kapodistrian University, Athens, Greece
| | - A Augoulea
- Aretaieio Hospital, 2nd Department of Obstetrics and Gynecology, Athens, Greece
| | - E Armeni
- Aretaieio Hospital, 2nd Department of Obstetrics and Gynecology, Athens, Greece
| | - A Laina
- Alexandra University Hospital, Vascular Laboratory, Department of Clinical Therapeutics, Athens, Greece
| | - A Mareti
- Alexandra University Hospital, Vascular Laboratory, Department of Clinical Therapeutics, National and Kapodistrian University, Athens, Greece
| | - I Petropoulos
- Alexandra University Hospital, Vascular Laboratory, Department of Clinical Therapeutics, National and Kapodistrian University, Athens, Greece
| | - I Kanakakis
- Alexandra University Hospital, Vascular Laboratory, Department of Clinical Therapeutics, National and Kapodistrian University, Athens, Greece
| | - L Karapanou
- Alexandra University Hospital, Vascular Laboratory, Department of Clinical Therapeutics, National and Kapodistrian University, Athens, Greece
| | - D Bampatsias
- Alexandra University Hospital, Vascular Laboratory, Department of Clinical Therapeutics, National and Kapodistrian University, Athens, Greece
| | - I Lambrinoudaki
- Aretaieio Hospital, 2nd Department of Obstetrics and Gynecology, Athens, Greece
| | - C Papamichael
- Alexandra University Hospital, Vascular Laboratory, Department of Clinical Therapeutics, National and Kapodistrian University, Athens, Greece
| | - K Stamatelopoulos
- Alexandra University Hospital, Vascular Laboratory, Department of Clinical Therapeutics, National and Kapodistrian University, Athens, Greece
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Dhage S, Azmi S, Adam S, Ferdousi M, Liu Y, Siahmansur T, Ponirakis G, Marshall A, Alam U, Petropoulos I, Pemberton P, Schofield J, Ho J, Syed A, Ammori B, Durrington P, Malik R, Soran H. Obesity related neuropathy is associated with HDL functionality. Atherosclerosis 2018. [DOI: 10.1016/j.atherosclerosis.2018.06.520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Chatterjee N, Petropoulos I, Maldonado-Codina C, Malik R, Morgan P. The relationship between ocular comfort and the confocal microscopic appearance of the eyelid margin in contact lens wear. Cont Lens Anterior Eye 2018. [DOI: 10.1016/j.clae.2018.03.081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Kalteniece A, Ferdousi M, Adam S, Schofield J, Azmi S, Petropoulos I, Soran H, Malik RA. Corneal confocal microscopy is a rapid reproducible ophthalmic technique for quantifying corneal nerve abnormalities. PLoS One 2017; 12:e0183040. [PMID: 28817609 PMCID: PMC5560560 DOI: 10.1371/journal.pone.0183040] [Citation(s) in RCA: 74] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Accepted: 07/28/2017] [Indexed: 02/02/2023] Open
Abstract
PURPOSE To assess the effect of applying a protocol for image selection and the number of images required for adequate quantification of corneal nerve pathology using in vivo corneal confocal microscopy (IVCCM). METHODS IVCCM was performed in 35 participants by a single examiner. For each participant, 4 observers used a standardized protocol to select 6 central corneal nerve images to assess the inter-observer variability. Furthermore, images were selected by a single observer on two occasions to assess intra-observer variability and the effect of sample size was assessed by comparing 6 with 12 images. Corneal nerve fiber density (CNFD), branch density (CNBD) and length (CNFL) were quantified using fully automated software. The data were compared using the intra class correlation coefficient (ICC) and Bland-Altman agreement plots for all experiments. RESULTS The ICC values for CNFD, CNBD and CNFL were 0.93 (P<0.0001), 0.96 (P<0.0001) and 0.95 (P<0.0001) for inter-observer variability and 0.95 (P<0.0001), 0.97 (P<0.001) and 0.97 (P<0.0001) for intra-observer variability. For sample size variability, ICC values were 0.94 (P<0.0001), 0.95 (P<0.0001), and 0.96 (P<0.0001) for CNFD, CNBD and CNFL. Bland-Altman plots showed excellent agreement for all parameters. CONCLUSIONS This study shows that implementing a standardized protocol to select IVCCM images results in high intra and inter-observer reproducibility for all corneal nerve parameters and 6 images are adequate for analysis. IVCCM could therefore be deployed in large multicenter clinical trials with confidence.
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Affiliation(s)
- Alise Kalteniece
- Institute of Cardiovascular Sciences, Cardiac Centre, Faculty of Medical and Human Sciences, University of Manchester and NIHR/Wellcome Trust Clinical Research Facility, Manchester, United Kingdom
| | - Maryam Ferdousi
- Institute of Cardiovascular Sciences, Cardiac Centre, Faculty of Medical and Human Sciences, University of Manchester and NIHR/Wellcome Trust Clinical Research Facility, Manchester, United Kingdom
| | - Safwaan Adam
- Institute of Cardiovascular Sciences, Cardiac Centre, Faculty of Medical and Human Sciences, University of Manchester and NIHR/Wellcome Trust Clinical Research Facility, Manchester, United Kingdom
| | - Jonathan Schofield
- Institute of Cardiovascular Sciences, Cardiac Centre, Faculty of Medical and Human Sciences, University of Manchester and NIHR/Wellcome Trust Clinical Research Facility, Manchester, United Kingdom
| | - Shazli Azmi
- Institute of Cardiovascular Sciences, Cardiac Centre, Faculty of Medical and Human Sciences, University of Manchester and NIHR/Wellcome Trust Clinical Research Facility, Manchester, United Kingdom
| | - Ioannis Petropoulos
- Weill Cornell Medicine-Qatar, Research Division, Qatar Foundation, Education City, Doha, Qatar
| | - Handrean Soran
- Institute of Cardiovascular Sciences, Cardiac Centre, Faculty of Medical and Human Sciences, University of Manchester and NIHR/Wellcome Trust Clinical Research Facility, Manchester, United Kingdom
| | - Rayaz A. Malik
- Institute of Cardiovascular Sciences, Cardiac Centre, Faculty of Medical and Human Sciences, University of Manchester and NIHR/Wellcome Trust Clinical Research Facility, Manchester, United Kingdom
- Weill Cornell Medicine-Qatar, Research Division, Qatar Foundation, Education City, Doha, Qatar
- * E-mail: ,
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Katsimpris J, Theoulakis P, Vasilopoulos K, Skourtis G, Papadopoulos G, Petropoulos I. Correlation between Central Corneal Thickness and Intraocular Pressure Measured by Goldmann Applanation Tonometry or Pascal Dynamic Contour Tonometry. Klin Monbl Augenheilkd 2015; 232:414-8. [PMID: 25902089 DOI: 10.1055/s-0035-1545792] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- J. Katsimpris
- Department of Ophthalmology, General Hospital of Patras “Agios Andreas”, Patras, Greece
| | - P. Theoulakis
- Department of Ophthalmology, Royal Free London NHS Foundation Trust, London, United Kingdom
| | - K. Vasilopoulos
- Department of Ophthalmology, General Hospital of Patras “Agios Andreas”, Patras, Greece
| | - G. Skourtis
- Department of Ophthalmology, General Hospital of Patras “Agios Andreas”, Patras, Greece
| | - G. Papadopoulos
- Ophthalmology, Surgical Unit, General Hospital of Aigio, Aigio, Greece
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Katsimpris J, Theoulakis P, Papadopoulos G, Katsimpris A, Lepidas J, Petropoulos I. Ocular Pulse Amplitude Measurement Using Pascal Dynamic Contour Tonometer in Glaucoma Patients. Klin Monbl Augenheilkd 2014; 231:363-7. [DOI: 10.1055/s-0034-1368220] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- J. Katsimpris
- Department of Ophthalmology, General Hospital of Patras “Agios Andreas”, Patras, Greece (Chairman: Dr. G. Vassilopoulos)
| | - P. Theoulakis
- Department of Ophthalmology, Royal Free London NHS Foundation Trust, London, United Kingdom (Chairman: , S. Althauser)
| | - G. Papadopoulos
- Ophthalmology, Surgical Unit, General Hospital of Aigio, Aigio, Greece (Chairman: Dr. G. E. Papadopoulos)
| | - A. Katsimpris
- Department of Ophthalmology, General Hospital of Patras “Agios Andreas”, Patras, Greece (Chairman: Dr. G. Vassilopoulos)
| | - J. Lepidas
- Department of Ophthalmology, General Hospital of Patras “Agios Andreas”, Patras, Greece (Chairman: Dr. G. Vassilopoulos)
| | - I. Petropoulos
- Ophthalmological Center of Rive, Geneva, Switzerland (Chairmen: Dr. P. M. Desmangles, Dr. M. A. Matter)
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Petropoulos I, Voudouris KN, Abd-Alhameed RA, Jones SMR. COUPLING MEASUREMENTS OF AN ANTENNA SYSTEM SUITABLE FOR RELAY-AIDED WIMAX NETWORK. PIER C 2014; 51:1-10. [DOI: 10.2528/pierc14043005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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Petropoulos I, Voudouris K, Abd-Alhameed RA, Jones SMR. Phased array antenna suitable for a relay-aided WiMAX network. 2013 Loughborough Antennas & Propagation Conference (LAPC) 2013. [DOI: 10.1109/lapc.2013.6711964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
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Ugarte N, Ladouce R, Radjei S, Gareil M, Friguet B, Petropoulos I. Proteome modification induced by differential inhibition of MsrA and MsrB in HEK293 cells. Exp Gerontol 2013. [DOI: 10.1016/j.exger.2013.05.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Katsimpris J, Petropoulos I, Zoukas G, Patokos T, Brinkmann C, Theoulakis P. Central Foveal Thickness Before and After Cataract Surgery in Normal and in Diabetic Patients without Retinopathy. Klin Monbl Augenheilkd 2012; 229:331-7. [DOI: 10.1055/s-0031-1299215] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- J. Katsimpris
- Department of Ophthalmology, General Hospital of Patras “Agios Andreas”, Patras, Greece (Chairman: Dr. med. D. Feretis)
| | - I. Petropoulos
- Ophthalmological Centre of Rive, Geneva, Switzerland (Chairmen: Dr. med. P. M. Desmangles, Dr. med. M. A. Matter)
| | - G. Zoukas
- Department of Ophthalmology, General Hospital of Patras “Agios Andreas”, Patras, Greece (Chairman: Dr. med. D. Feretis)
| | - T. Patokos
- Economics Department, Business School, University of Hertfordshire, Hatfield, Hertfordshire, United Kingdom (Head: Mr. J. Easter)
| | - C. Brinkmann
- Department of Ophthalmology, University of Bonn, Bonn, Germany (Chairman: Dr. med. F. G. Holz)
| | - P. Theoulakis
- Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom (Chairman: M. Miller)
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Theoulakis P, Halki A, Petropoulos I, Katsimpris J. Coats Disease in a 14-year-Old Boy Treated with Intravitreal Ranibizumab and Retinal Laser Photocoagulation. Klin Monbl Augenheilkd 2012; 229:447-50. [DOI: 10.1055/s-0031-1299216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- P. Theoulakis
- Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
| | - A. Halki
- Department of Ophthalmology, General Hospital of Patras “Agios Andreas”, Patras, Greece
| | | | - J. Katsimpris
- Department of Ophthalmology, General Hospital of Patras “Agios Andreas”, Patras, Greece
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Katsimpris J, Theoulakis P, Lepidas J, Livieratou A, Petropoulos I. Vogt-Koyanagi-Harada Syndrome Manifestations and Diagnosis. Klin Monbl Augenheilkd 2011; 228:368-71. [DOI: 10.1055/s-0031-1273265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Leclère FM, Petropoulos I, Buys B, Mordon S. Laser assisted septal cartilage reshaping (LASCR): A prospective study in 12 patients. Lasers Surg Med 2011; 42:693-8. [PMID: 20886504 DOI: 10.1002/lsm.20958] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND OBJECTIVES Occurring in one-third of the population, nasal obstruction is the most common complaint in an average rhinologic practice. The etiology is usually a deviation of the nasal septum, although other conditions, such as turbinate hypertrophy, can also cause nasal obstruction. Our team has already demonstrated that laser assisted cartilage reshaping can be used effectively for the correction of ear protrusion. This study aims to evaluate laser assisted septal cartilage reshaping (LASCR) to treat septal deviation. STUDY DESIGN Between March 2009 and September 2009, 12 patients (8 males, 4 females-mean age: 23 years) underwent LASCR for treatment of septal deviation. The mean NOSE score was 11.6. Preoperative examination included rhinomanometry and nasal endoscopy to exclude inferior turbinate or adenoid hypertrophy. Both sides of the septum were irradiated using a 1,540 nm laser connected to a 4 mm spot handpiece with integrated cooling (fluence: 50 J/cm(2)). Contact cooling made the treatment tolerable, but topical anesthesia was still required. Immediately after the procedure, an internal splint was inserted into the nostril and kept for 7 days. The NOSE score was calculated at 1 week, 1 month, and 3 months post-procedure and a rhinomanometry was carried out at 3 months. RESULTS The entire procedure took an average of 20 minutes. For all procedures, there were no lesions of the septal mucosa. Three months post-op, mean NOSE score improved from 11.6 to 5.3. Rhinomanometry assesses an increase in airflow (+19%) and improvement to air inflow resistance (-16%), confirming a subjective improvement. In seven adults, the expected septal reshaping was achieved. In five adults, incomplete septum reshaping was observed. In three patients it was correlated to anatomical variations: a thick septum in two cases and a long septum in one case. In the remaining two patients, it was due to insufficient fluence. In these cases, insufficient local anesthesia did not allow us to finish the procedure and the patients received a fluence of 30 J/cm(2) only. Those patients were re-treated at 3 months at 50 J/cm(2) fluence and all achieved suitable reshaping. CONCLUSION LASCR is a safe and less morbid approach to surgical septoplasty. Since significant variability in the cartilaginous elements of the nose is the rule rather than the exception, some improvements in the technique are still required.
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Affiliation(s)
- Franck M Leclère
- INSERM, U703, Univ. Lille Nord de France, Lille University Hospital, Lille, France
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Noussios G, Chouridis P, Petropoulos I, Karagiannidis K, Kontzoglou G. Alveolar soft part sarcoma of the tongue in a 3-year-old boy: a case report. J Med Case Rep 2010; 4:130. [PMID: 20459684 PMCID: PMC2873458 DOI: 10.1186/1752-1947-4-130] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2009] [Accepted: 05/08/2010] [Indexed: 02/05/2023] Open
Abstract
Introduction Alveolar soft tissue sarcoma of the tongue is a very rare and aggressive tumor which occurs in infancy with a relatively controversial histogenesis. It may mimic benign vascular neoplasms and may metastasize to the lungs, brain or bones. Case presentation We present the case of a three-year-old Caucasian boy who was admitted to our department with a history of dysphagia and two episodes of oral bleeding which had lasted for a period of six months. A thorough histological examination together with imaging techniques form the basis of a reliable diagnosis. Conclusion Alveolar soft tissue sarcoma of the tongue is a rare tumor which occurs in infancy and which is often misdiagnosed pre-operatively. It should therefore be included in the differential diagnosis of oral pediatric lesions.
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Affiliation(s)
- George Noussios
- ENT Department, (Street Konstantinoupoleos 49) Hippokratio General Hospital, Thessaloniki, Greece.
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42
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Theoulakis P, Lepidas J, Petropoulos I, Livieratou A, Brinkmann C, Katsimpris J. Effect of Brimonidine/Timolol Fixed Combination on Preventing the Short-Term Intraocular Pressure Increase after Intravitreal Injection of Ranibizumab. Klin Monbl Augenheilkd 2010; 227:280-4. [DOI: 10.1055/s-0029-1245201] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Leclère FMP, Petropoulos I, Mordon S. Laser-assisted cartilage reshaping (LACR) for treating ear protrusions: a clinical study in 24 patients. Aesthetic Plast Surg 2010; 34:141-6. [PMID: 19484177 DOI: 10.1007/s00266-009-9353-9] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2009] [Accepted: 04/03/2009] [Indexed: 11/29/2022]
Abstract
BACKGROUND Protruding ears are the most common congenital ear deformity, with a frequency of 13.5%. Since 1845 and the first works of Dieffenbach, over 170 classical surgical methods have been proposed to correct it. We introduced laser-assisted cartilage reshaping (LACR) in 2004 as an alternative to invasive surgical otoplasty. METHODS Between January 2008 and June 2008, 24 patients underwent LACR for treatment of bilateral ear protrusion. Fourteen adults and ten children were treated (mean age = 16.0 years, range = 6-45 years). No anesthesia was used. Both sides of the entire helix and the concha were irradiated using a 1540-nm laser connected to a 4-mm spot handpiece with integrated cooling. Fluences varying from 70 up to 84 J/cm(2) were applied. Immediately after the irradiation, silicone elastomer was inserted inside the helix to give it the desired shape. After 3 minutes a solid mold was obtained. Patients were asked to keep this mold in place at all times with a bandage wrapped around the head for the first 3 weeks and then for an additional 3 weeks only during the night. A non-steroidal anti-inflammatory drug (NSAID) was prescribed to the patients for 3 days. At 1, 30, 60, and 90 days after the procedure, ears were checked and photographs were taken. Clinical follow-up at 1 year was obtained via direct patient contact or over the telephone. RESULTS The treatment was well tolerated. No hematomas or skin necrosis occurred. Contact dermatitis was observed in four children and two adults as a result of inappropriate mold design. These patients stopped wearing the mold and the shape of their ear did not improve. For the remaining 18 patients (6 children and 9 adults), the expected ear reshaping was obtained (fluence was 84 J/cm(2)). For three other adults, incomplete reshaping of the ears was observed and can be correlated to a lower fluence (70 J/cm(2)). CONCLUSION LACR, performed without any anesthesia, is a safe and less morbid approach to surgical otoplasty.
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Affiliation(s)
- Franck M P Leclère
- INSERM U703, Pavillon Vancostenobel, Lille University Hospital, Lille Cedex, France
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Dabbah MA, Graham J, Petropoulos I, Tavakoli M, Malik RA. Dual-model automatic detection of nerve-fibres in corneal confocal microscopy images. Med Image Comput Comput Assist Interv 2010; 13:300-7. [PMID: 20879244 DOI: 10.1007/978-3-642-15705-9_37] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
Corneal Confocal Microscopy (CCM) imaging is a non-invasive surrogate of detecting, quantifying and monitoring diabetic peripheral neuropathy. This paper presents an automated method for detecting nerve-fibres from CCM images using a dual-model detection algorithm and compares the performance to well-established texture and feature detection methods. The algorithm comprises two separate models, one for the background and another for the foreground (nerve-fibres), which work interactively. Our evaluation shows significant improvement (p approximately 0) in both error rate and signal-to-noise ratio of this model over the competitor methods. The automatic method is also evaluated in comparison with manual ground truth analysis in assessing diabetic neuropathy on the basis of nerve-fibre length, and shows a strong correlation (r = 0.92). Both analyses significantly separate diabetic patients from control subjects (p approximately 0).
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Affiliation(s)
- M A Dabbah
- Imaging Sciences and Biomedical Engineering (ISBE), The University of Manchester, Oxford Rd, Manchester M13 9PT, UK.
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Mendrinos E, Petropoulos I, Pournaras C. Retinal Angiomatous Proliferations: When Should We Suspect Them and How Should We Detect Them? Klin Monbl Augenheilkd 2009; 226:284-8. [DOI: 10.1055/s-0028-1109311] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Petropoulos I, Ekonomidis P, Theoulakis P, Gatzogias M, Katsimpris J. Acute Massive Suprachoroidal Hemorrhage after Photodynamic Therapy in a Patient Treated with Warfarin. Klin Monbl Augenheilkd 2009; 226:365-7. [DOI: 10.1055/s-0028-1109267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Katsimpris J, Petropoulos I, Kordelou A, Petkou D, Feretis D. Isolated Lateral Rectus Myositis as a Manifestation of Idiopathic Orbital Inflammation. Klin Monbl Augenheilkd 2008; 225:510-3. [DOI: 10.1055/s-2008-1027313] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Cabreiro F, Picot CR, Perichon M, Mary J, Friguet B, Petropoulos I. Identification of proteins undergoing expression level modifications in WI-38 SV40 fibroblasts overexpressing methionine sulfoxide reductase A. Biochimie 2007; 89:1388-95. [PMID: 17624653 DOI: 10.1016/j.biochi.2007.05.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2007] [Accepted: 05/18/2007] [Indexed: 01/15/2023]
Abstract
Methionine sulfoxide reductase A overexpressing WI-38 SV40 human fibroblasts have been previously shown to exhibit higher resistance to oxidative stress by decreasing intracellular reactive oxygen species content and oxidative damage to proteins [C.R. Picot, I. Petropoulos, M. Perichon, M. Moreau, C. Nizard, B. Friguet, Overexpression of MsrA protects WI-38 SV40 human fibroblasts against H(2)O(2)-mediated oxidative stress, Free Radic Biol Med 39 (2005) 1332-1341]. In order to get further insight into the molecular mechanisms underlying this resistance to oxidative stress, proteins that are differentially expressed in methionine sulfoxide reductase A overexpressing cells were identified by 2D gel and Western blot quantitative analyses. Five proteins were shown to be differentially expressed and were identified by mass spectrometry, some of them were related to either cellular protection against oxidative stress, apoptosis or premature ageing.
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Affiliation(s)
- F Cabreiro
- Laboratoire de Biologie et Biochimie Cellulaire du Vieillissement, EA 3106/IFR 117, Université Paris Diderot-Paris 7, 2 place Jussieu, Tour 33-23, 1(er) étage, CC 7128, 75251, Paris Cedex 05, France
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Petropoulos I, Karagiannidis K, Kontzoglou G. Our experience in open rhinoplasty. Hippokratia 2007; 11:35-38. [PMID: 19582175 PMCID: PMC2464261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
AIM The last decade the external approach has gained enormous popularity in rhinoplastic surgery and it is a relatively new technique in Greece for the correction of functional and aesthetic problems of the nose. We introduce our experience in open rhinoplasty, we describe the operative technique, its advantages. MATERIAL-METHODS In a period of two years (2003-2005), 98 patients underwent open rhinoplasty in our department. In 42 of them, breathing problems were existed in combination with nasal deformities. Eighty seven patients underwent septo/rhinoplasty under general anesthesia and the other 11 under local anesthesia. RESULTS The postoperative course was uneventful, painless and without postoperative bleeding in all patients. Postoperative photo documentation was performed in all of them after 1, 3, 6, and 12 months. Only two patients needed to undergo revision surgery (the first patient due to "polly beak" deformity and the second one due to postoperative nasal valve stenosis). The scar of broken columella incision was invisible in all patents some weeks postoperatively. CONCLUSION In open approach in Rhinoplasty, as provides a full exposure of the osseocartilaginous vault, it is much more easier to perform all the modern rhinoplasty techniques with sutures, biological and non biological materials, to modify the nasal tip deformities and asymmetries and to gain an aesthetic result balanced with the other facial components. Its disadvantages are minimal, that's why it becomes every day more popular all over the world.
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Affiliation(s)
- I Petropoulos
- ENT Department, Hipokratio Hospital, Thessaloniki, Greece.
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Stangos A, Zaninetti M, Petropoulos I, Baglivo E, Pournaras C. Multiple evanescent white dot syndrome following simultaneous hepatitis-A and yellow fever vaccination. Ocul Immunol Inflamm 2006; 14:301-4. [PMID: 17056464 DOI: 10.1080/09273940600932311] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.1] [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: 10/24/2022]
Abstract
PURPOSE To report a case of multiple evanescent white dot syndrome (MEWDS) following simultaneous hepatitis-A virus (HAV) and yellow fever (YF) vaccination. METHODS Review of the clinical, laboratory, photographic, and angiographic records of a patient suffering from MEWDS. RESULTS A healthy 50-year-old woman presented with rapidly progressive left-eye visual loss, associated with photopsias and a para-central scotoma, one week after receiving simultaneous HAV and YF vaccination. Both anterior segments and right-eye fundus were unremarkable. Fundus examination of the left-eye disclosed papillitis with multiple, small, white, outer-retinal lesions. Angiographic tests were pathognomonic for MEWDS. Perimetry revealed left-eye blind spot enlargement. Initial inflammatory/infectious work-up was negative. Signs and symptoms resolved spontaneously within 6 weeks, with concomitant normalization of ancillary exams. CONCLUSIONS The clinical presentation and the benign course were consistent with the diagnosis of MEWDS. No other aetiopathogenic factor than simultaneous HAV and YF immunization was identified, suggesting an autoimmune basis for MEWDS in predisposed patients.
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Affiliation(s)
- Alexandros Stangos
- Division of Ophthalmology, Department of Clinical Neurosciences, University Hospitals of Geneva, 22 Rue Alcide-Jentzer, 1211 Geneva, Switzerland.
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