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Liontou C, Kalogera V, Oikonomou D, Stalikas D, Pappas L, Triantafyllou K. Diagnostic performance of quantitative flow ratio in non-ST elevation acute coronary syndromes in comparison to non-hyperemic pressure ratios: a prospective study. Int J Cardiovasc Imaging 2023; 39:2567-2574. [PMID: 37882959 DOI: 10.1007/s10554-023-02967-y] [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] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 09/21/2023] [Indexed: 10/27/2023]
Abstract
Quantitative flow ratio (QFR) is a new angiography-based coronary physiology tool aimed to evaluate functional relevance of intermediate coronary lesions. Aim of the study is to assess diagnostic performance of QFR in patients with non-ST-elevation acute coronary syndrome (NSTE-ACS) in comparison to currently used non-hyperaemic pressure ratios (NHPRs). In this prospective, single-centre study, coronary physiology of intermediate coronary stenoses of non-culprit vessels in patients presenting with NSTE-ACS was evaluated using NHPRs (iFR, DFR or RFR). Subsequently, QFR was computed offline by a QFR analyst blinded to the NHPR results. Diagnostic performance of QFR was assessed in comparison to NHPRs as reference standard. A total of 60 vessels with intermediate coronary stenoses was investigated. The NHPRs were used as follows: RFR 38%, DFR 47% and iFR 15% of the cases. The NHPR result was positive, showing significant lesion, in 19 cases. A significant correlation was found between NHPR and QFR (r = 0.84, p < 0.001). Classification agreement of the two methods (95%) and diagnostic performance of QFR in comparison to NHPR (AUC: 0.962 [0.914-1.00]) were both high. Sensitivity, specificity, positive and negative predictive value of QFR in comparison to NHPR were 84.2%, 100%, 100% and 93.2% respectively. QFR has high diagnostic performance in detecting functionally significant lesions of non-culprit arteries in patients with NSTE-ACS and multivessel disease. Due to its high negative predictive value, it can be used to safely avoid unnecessary invasive physiological assessment of these lesions.
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Affiliation(s)
- Catherine Liontou
- 1st Cardiology Department, Evaggelismos General Hospital, Ipsilantou Str. 45-47, 10676, Athens, Greece.
| | - Vasiliki Kalogera
- 1st Cardiology Department, Evaggelismos General Hospital, Ipsilantou Str. 45-47, 10676, Athens, Greece
| | - Dimitrios Oikonomou
- 1st Cardiology Department, Evaggelismos General Hospital, Ipsilantou Str. 45-47, 10676, Athens, Greece
| | - Dimitrios Stalikas
- 1st Cardiology Department, Evaggelismos General Hospital, Ipsilantou Str. 45-47, 10676, Athens, Greece
| | - Loukas Pappas
- 1st Cardiology Department, Evaggelismos General Hospital, Ipsilantou Str. 45-47, 10676, Athens, Greece
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Koenig JL, Pappas L, Yeap BY, Clark JW, Allen JN, Wo JY, Ryan DP, Blaszkowsky LS, Giantonio B, Weekes C, Klempner S, Roberts HJ, Drapek LC, Ly L, Meurer J, Corcoran R, Mehta A, Ting D, Hong TS, Parikh AR. Association between Liver Metastases and Treatment Response in Patients with Metastatic, Microsatellite Stable Colorectal Cancer Treated with Radiation Therapy and Dual Immune Checkpoint Blockade. Int J Radiat Oncol Biol Phys 2023; 117:e308-e309. [PMID: 37785117 DOI: 10.1016/j.ijrobp.2023.06.2333] [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: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Most patients with metastatic colorectal cancer (CRC) have microsatellite stable (MSS) disease with a limited response to immune checkpoint inhibitors (ICIs). In our phase 2 trial (NCT03104439), 27 patients with metastatic MSS CRC received ipilimumab, nivolumab, and RT (24 Gy/3 fractions) on C2D1 with a disease control rate (DCR) of 37% (10/27) and overall response rate (ORR) of 15% (4/27). Our follow up phase 2 study with ipilimumab, nivolumab, and RT moved to C1D1 (NCT04361162) showed a DCR of 33% (10/30) and an ORR of 13% (4/30). Clinical and preclinical data suggest liver metastases are less responsive to systemic ICIs and complementary liver-directed RT can potentially overcome this effect. To address this, we investigated the association between liver metastases and response rates among patients treated with and without liver-directed RT in a pooled analysis of our phase 2 studies of nivolumab and ipilimumab with RT. MATERIALS/METHODS In this pooled secondary analysis of two open-label, single-arm, phase 2 studies, eligible patients had metastatic MSS CRC, ECOG PS 0-1, and progressed on at least one line of chemotherapy. Treatment consisted of ipilimumab 1 mg/kg q6weeks for 4 cycles, nivolumab 240 mg q2weeks on a 6-week cycle, and RT (24 Gy/3 fractions) on C1D1 or C2D1 to one site. Responses were defined outside of the RT field by RECIST 1.1 with centrally reviewed imaging q3months. ORR/DCR and PFS/OS were compared between patients with and without liver metastases with the Fisher's exact and log-rank tests, respectively. P-values are two-sided. RESULTS We treated 57 patients (median age 57 years [range, 26-85], 61% male, 88% white, 65% with liver metastases) from 07/2017 to 05/2022. Patients received a median of 3 (range, 1-10) prior lines of systemic therapy. The combined ORR was 14% (8/57; 95% CI, 6-26%) and DCR was 35% (20/57; 95% CI, 23-49%). The ORR was 30% (6/20; 95% CI, 12-54%) in patients without liver metastases and 5% (2/37; 95% CI, 1-18%) in patients with liver metastases (p = 0.017). The DCR was 55% (11/20; 95% CI, 32-77%) in patients without liver metastases and 24% (9/37; 94% CI, 12-41%) in patients with liver metastases (p = 0.040). 76% (28/37) of patients with liver metastases received liver-directed RT including 2/2 (100%) patients with a PR. The ORR was 0% in patients with liver metastases without liver-directed RT. The median PFS was 1.8 months (95% CI, 1.2-2.4 months) and OS was 9.8 months (95% CI, 6.8-12.8). OS was longer in patients without liver metastases (median 13.6 v 6.8 months, p = 0.010) and in patients treated with liver-directed RT among those with liver metastases (median 7.5 months v 4.5 months, p = 0.025). CONCLUSION Among patients with metastatic MSS CRC treated with ICIs and RT in two phase 2 studies, ORR, DCR, and OS are significantly higher in patients without liver metastases. Liver-directed RT may improve ICI efficacy and OS in patients with liver metastases. Further analysis of PFS and prospective study of ICIs with comprehensive liver-directed RT are warranted.
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Affiliation(s)
- J L Koenig
- Harvard Radiation Oncology Program, Boston, MA
| | - L Pappas
- Department of Medicine, Division of Hematology & Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - B Y Yeap
- Department of Medicine, Division of Hematology & Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA; Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA
| | - J W Clark
- Department of Medicine, Division of Hematology & Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - J N Allen
- Department of Medicine, Division of Hematology & Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - J Y Wo
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - D P Ryan
- Department of Medicine, Division of Hematology & Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - L S Blaszkowsky
- Department of Medicine, Division of Hematology & Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - B Giantonio
- Department of Medicine, Division of Hematology & Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - C Weekes
- Department of Medicine, Division of Hematology & Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - S Klempner
- Department of Medicine, Division of Hematology & Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - H J Roberts
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - L C Drapek
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - L Ly
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA
| | - J Meurer
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA
| | - R Corcoran
- Department of Medicine, Division of Hematology & Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - A Mehta
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA; The Broad Institute, Cambridge, MA
| | - D Ting
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA
| | - T S Hong
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - A R Parikh
- Department of Medicine, Division of Hematology & Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
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Tsigkas G, Apostolos A, Synetos A, Latsios G, Toutouzas K, Xenogiannis I, Hamilos M, Sianos G, Ziakas A, Tsiafoutis I, Koutouzis M, Toulgaridis F, Moulias A, Sideris A, Patsilinakos S, Kanakakis I, Zampakis P, Tsioufis K, Kochiadakis G, Alexopoulos D, Davlouros P, Kalogeropoulou C, Vasilagkos G, Koufou EE, Papanikolaou A, Spanou E, Gerakaris A, Chlorogiannis D, Spiropoulou P, Miliordos I, Benetos G, Pappas C, Argentos S, Skalidis E, Kladou E, Skiadas C, Karagiannidis E, Mylona S, Zacharoulis A, Pappas L, Mantis C, Fagrezos D, Manouvelou S, Sertedaki E. Computed tomoGRaphy guidEd invasivE Coronary angiography in patiEnts with a previous coronary artery bypass graft surgery trial (GREECE trial): Rationale and design of a multicenter, randomized control trial. Hellenic J Cardiol 2021; 62:470-472. [PMID: 33482363 DOI: 10.1016/j.hjc.2021.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Revised: 12/12/2020] [Accepted: 01/05/2021] [Indexed: 11/18/2022] Open
Affiliation(s)
- Grigorios Tsigkas
- Department of Cardiology, University Hospital of Patras, Patras, Greece.
| | | | - Andreas Synetos
- First Department of Cardiology, University of Athens, Hippokration General Hospital, Athens, Greece
| | - George Latsios
- First Department of Cardiology, University of Athens, Hippokration General Hospital, Athens, Greece
| | - Konstantinos Toutouzas
- First Department of Cardiology, University of Athens, Hippokration General Hospital, Athens, Greece
| | - Iosif Xenogiannis
- Second Department of Cardiology, University of Athens, Attikon University Hospital, Athens, Greece
| | - Michalis Hamilos
- Department of Cardiology, University Hospital of Heraklion, Heraklion, Greece
| | - Georgios Sianos
- First Department of Cardiology, Aristotle University of Thessaloniki, AHEPA University Hospital, Greece
| | - Antonios Ziakas
- First Department of Cardiology, Aristotle University of Thessaloniki, AHEPA University Hospital, Greece
| | | | | | - Fotios Toulgaridis
- Second Department of Cardiology, Evaggelismos General Hospital, Athens, Greece
| | | | - Antonios Sideris
- Second Department of Cardiology, Evaggelismos General Hospital, Athens, Greece
| | | | - Ioannis Kanakakis
- Department of Clinical Therapeutics, University of Athens, Alexandra General Hospital, Athens, Greece
| | - Petros Zampakis
- Department of Radiology, University Hospital of Patras, Patras, Greece
| | - Konstantinos Tsioufis
- First Department of Cardiology, University of Athens, Hippokration General Hospital, Athens, Greece
| | | | - Dimitrios Alexopoulos
- Second Department of Cardiology, University of Athens, Attikon University Hospital, Athens, Greece
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Papafaklis MI, Katsouras CS, Tsigkas G, Toutouzas K, Davlouros P, Hahalis GN, Kousta MS, Styliadis IG, Triantafyllou K, Pappas L, Tsiourantani F, Varytimiadi E, Anyfantakis ZA, Iakovis N, Grammata P, Karvounis H, Ziakas A, Sianos G, Tziakas D, Pappa E, Dagre A, Patsilinakos S, Trikas A, Lamprou T, Mamarelis I, Katsimagklis G, Karmpaliotis D, Naka K, Michalis LK. "Missing" acute coronary syndrome hospitalizations during the COVID-19 era in Greece: Medical care avoidance combined with a true reduction in incidence? Clin Cardiol 2020; 43:1142-1149. [PMID: 32691901 PMCID: PMC7404667 DOI: 10.1002/clc.23424] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 07/07/2020] [Indexed: 01/06/2023] Open
Abstract
Background Reports from countries severely hit by the COVID‐19 pandemic suggest a decline in acute coronary syndrome (ACS)‐related hospitalizations. The generalizability of this observation on ACS admissions and possible related causes in countries with low COVID‐19 incidence are not known. Hypothesis ACS admissions were reduced in a country spared by COVID‐19. Methods We conducted a nationwide study on the incidence rates of ACS‐related admissions during a 6‐week period of the COVID‐19 outbreak and the corresponding control period in 2019 in Greece, a country with strict social measures, low COVID‐19 incidence, and no excess in mortality. Results ACS admissions in the COVID‐19 (n = 771) compared with the control (n = 1077) period were reduced overall (incidence rate ratio [IRR]: 0.72, P < .001) and for each ACS type (ST‐segment elevation myocardial infarction [STEMI]: IRR: 0.76, P = .001; non‐STEMI: IRR: 0.74, P < .001; and unstable angina [UA]: IRR: 0.63, P = .002). The decrease in STEMI admissions was stable throughout the COVID‐19 period (temporal correlation; R2 = 0.11, P = .53), whereas there was a gradual decline in non‐STEMI/UA admissions (R2 = 0.75, P = .026) following the progressively stricter social measures. During the COVID‐19 period, patients admitted with ACS presented more frequently with left ventricular systolic impairment (22.2 vs 15.5% control period; P < .001). Conclusions We observed a reduction in ACS hospitalizations during the COVID‐19 outbreak in a country with strict social measures, low community transmission, and no excess in mortality. Medical care avoidance behavior is an important factor for these observations, while a true reduction of the ACS incidence due to self‐isolation/quarantining may have also played a role.
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Affiliation(s)
| | | | - Grigorios Tsigkas
- Department of Cardiology, Patras University Hospital, Patras, Greece
| | | | | | - George N Hahalis
- Department of Cardiology, Patras University Hospital, Patras, Greece
| | - Maria S Kousta
- Cardiology Department, General Hospital "G. Gennimatas", Athens, Greece
| | - Ioannis G Styliadis
- 2nd Department of Cardiology, "Papageorgiou" General Hospital, Thessaloniki, Greece
| | | | - Loukas Pappas
- 2nd Department of Cardiology, "Evaggelismos" General Hospital, Athens, Greece
| | | | | | | | - Nikolaos Iakovis
- Department of Cardiology, University Hospital of Larissa, Larissa, Greece
| | - Paraskevi Grammata
- Department of Cardiology, "Sismanogleio" General Hospital, Athens, Greece
| | | | - Antonios Ziakas
- Department of Cardiology, "AHEPA" University Hospital, Thessaloniki, Greece
| | - George Sianos
- Department of Cardiology, "AHEPA" University Hospital, Thessaloniki, Greece
| | - Dimitrios Tziakas
- Department of Cardiology, University Hospital of Alexandroupolis, Thrace, Greece
| | - Evgenia Pappa
- Department of Cardiology, General Hospital "G. Hatzikosta", Ioannina, Greece
| | - Anna Dagre
- Department of Cardiology, "Thriasion" General Hospital of Elefsina, Attiki, Greece
| | | | | | - Thomais Lamprou
- 2nd Department of Cardiology, General Hospital of Nikea-Piraeus "Agios Panteleimon", Piraeus, Greece
| | | | | | - Dimitri Karmpaliotis
- Department of Cardiology, New York Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, USA
| | - Katerina Naka
- 2nd Department of Cardiology, University Hospital of Ioannina, Ioannina, Greece
| | - Lampros K Michalis
- 2nd Department of Cardiology, University Hospital of Ioannina, Ioannina, Greece
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Samadder NJ, Smith KR, Mineau GP, Pimentel R, Wong J, Boucher K, Pappas L, Singh H, Ahnen D, Burt RW, Curtin K. Familial colorectal cancer risk by subsite of primary cancer: a population-based study in Utah. Aliment Pharmacol Ther 2015; 41:573-80. [PMID: 25604623 DOI: 10.1111/apt.13086] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [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: 07/16/2014] [Revised: 08/27/2014] [Accepted: 01/01/2015] [Indexed: 12/12/2022]
Abstract
BACKGROUND Familial occurrence is common in colorectal cancer (CRC), but whether this increased familial risk differs by colonic subsite of the index patients CRC is not well understood. AIM To quantify the risk of CRC in first-degree (FDR), second-degree (SDR) and first cousin (FC) relatives of individuals with CRC, stratified by subsite in the colorectum and age at diagnosis. METHODS Colorectal cancers diagnosed between 1980 and 2010 were identified from the Utah Cancer Registry and linked to pedigrees from the Utah Population Database. Age and gender-matched CRC-free controls were selected to form the comparison group for determining CRC risk in relatives using Cox regression analysis. RESULTS Of the 18,208 index patients diagnosed with CRC, 6584 (36.2%) were located in the proximal colon, 5986 (32.9%) in the distal colon and 5638 (31%) in the rectum. The elevated risk of CRC in relatives was similar in analysis stratified for CRC colorectal subsites in the index cases. FDR had similarly elevated risk of all site CRC, whether the index patient had cancer in the proximal colon [hazards ratio (HR): 1.85; 95% CI: 1.70-2.02], distal colon (HR: 1.90; 95% CI: 1.73-2.08) or rectum (HR: 1.83; 95% CI: 1.66-2.02) compared to relatives of controls. This risk was consistently greater for FDR when cases developed CRC below the age of 60 years. CONCLUSIONS Relatives of CRC patients have a similarly elevated risk of CRC regardless of colonic tumour subsite in the index patient, and it is greatest for relatives of younger age index cases.
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Affiliation(s)
- N J Samadder
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA; Department of Medicine (Gastroenterology), University of Utah, Salt Lake City, UT, USA
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Anthopoulos P, Alexanian I, Karabela G, Pappas L, Antonellis I, Salahas A, Polydorou A. Impact on myocardial reperfusion using the M-Guard stent in primary percutaneous coronary intervention for ST-elevation myocardial infarction. Int J Cardiol 2014; 176:546-7. [PMID: 25074557 DOI: 10.1016/j.ijcard.2014.07.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2014] [Accepted: 07/05/2014] [Indexed: 11/26/2022]
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Giannopoulos G, Pappas L, Synetos A, Hahalis G, Raisakis K, Papadimitriou C, Kossyvakis C, Alexopoulos D, Tousoulis D, Stefanadis C, Cleman MW, Deftereos S. Association of virtual histology characteristics of the culprit plaque with post-fibrinolysis flow restoration in ST-elevation myocardial infarction. Int J Cardiol 2014; 174:678-82. [PMID: 24809918 DOI: 10.1016/j.ijcard.2014.04.211] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2014] [Revised: 04/15/2014] [Accepted: 04/18/2014] [Indexed: 11/16/2022]
Affiliation(s)
- Georgios Giannopoulos
- Department of Cardiology, Athens General Hospital "G. Gennimatas", Athens, Greece; Hellenic Center for Disease Control and Prevention, Athens, Greece; Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT, USA.
| | - Loukas Pappas
- Department of Cardiology, Athens General Hospital "G. Gennimatas", Athens, Greece
| | - Andreas Synetos
- 1st Department of Cardiology, University of Athens Medical School, Hippokration Hospital, Athens, Greece
| | - George Hahalis
- Department of Cardiology, University of Patras Medical School, Patras, Greece
| | | | | | | | | | - Dimitrios Tousoulis
- 1st Department of Cardiology, University of Athens Medical School, Hippokration Hospital, Athens, Greece
| | - Christodoulos Stefanadis
- 1st Department of Cardiology, University of Athens Medical School, Hippokration Hospital, Athens, Greece
| | - Michael W Cleman
- Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Spyridon Deftereos
- Department of Cardiology, Athens General Hospital "G. Gennimatas", Athens, Greece; Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT, USA
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Alexanian I, Parissis J, Farmakis D, Athanaselis S, Pappas L, Gavrielatos G, Mihas C, Paraskevaidis I, Sideris A, Kremastinos D, Spiliopoulou C, Anastasiou-Nana M, Lekakis J, Filippatos G. Clinical and echocardiographic correlates of serum copper and zinc in acute and chronic heart failure. Clin Res Cardiol 2014; 103:938-49. [PMID: 24908339 DOI: 10.1007/s00392-014-0735-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2014] [Accepted: 06/02/2014] [Indexed: 10/25/2022]
Abstract
AIM Emerging evidence suggests a pathophysiological role of micronutrient dyshomeostasis in heart failure, including promotion of adverse remodeling and clinical deterioration. We sought to evaluate serum copper (Cu) and zinc (Zn) levels in acute (AHF) and chronic (CHF) heart failure. METHODS We studied 125 patients, 71 % male, aged 69 ± 11 years, 37 % with preserved left ventricular ejection fraction (LVEF ≥40 %) (HFPEF), including 81 with AHF and 44 with CHF; 21 healthy volunteers served as controls. Serum Cu and Zn levels were determined using air-acetylene flame atomic absorption spectrophotometry. RESULTS Serum Cu levels were significantly higher in AHF (p = 0.006) and CHF (p = 0.002) patients compared to controls after adjusting for age, gender and comorbidities, whereas they did not differ between AHF and CHF (p = 0.840). Additionally, serum Cu in patients with LVEF <40 % was significantly higher compared to both controls (p < 0.001) and HFPEF patients (p = 0.003). Serum Zn was significantly lower in AHF (p < 0.001) and CHF (p = 0.039) compared to control after adjusting for the above-mentioned variables. Moreover, serum Zn was significantly lower in AHF than in CHF (p = 0.015). In multiple linear regression, LVEF (p = 0.033) and E/e ratio (p = 0.006) were independent predictors of serum Cu in total heart failure population, while NYHA class (p < 0.001) and E/e ratio (p = 0.007) were independent predictors of serum Zn. CONCLUSION Serum Cu was increased both in AHF and CHF and correlated with LV systolic and diastolic function. Serum Zn, in contrast, was decreased both in AHF and CHF and independently predicted by clinical status and LV diastolic function.
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Affiliation(s)
- Ioannis Alexanian
- Department of Cardiology, Athens University Hospital Attikon, Athens, Greece
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Deftereos S, Giannopoulos G, Raisakis K, Hahalis G, Kaoukis A, Kossyvakis C, Avramides D, Pappas L, Panagopoulou V, Pyrgakis V, Alexopoulos D, Stefanadis C, Cleman MW. Moderate procedural sedation and opioid analgesia during transradial coronary interventions to prevent spasm: a prospective randomized study. JACC Cardiovasc Interv 2013; 6:267-73. [PMID: 23517838 DOI: 10.1016/j.jcin.2012.11.005] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [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: 07/31/2012] [Revised: 11/13/2012] [Accepted: 11/21/2012] [Indexed: 12/12/2022]
Abstract
OBJECTIVES The aim of this study was to test the hypothesis that moderate procedural sedation can reduce the incidence of radial artery spasm. BACKGROUND Transradial access for left heart catheterization and percutaneous coronary intervention is increasingly used for emergent and elective procedures, in lieu of the femoral approach. However, increased rates of access site crossover have been reported, with radial artery spasm being a major contributor to this effect. METHODS Patients undergoing elective transradial percutaneous coronary intervention were prospectively randomized to receive fentanyl and midazolam during the procedure or no treatment (control subjects). The primary endpoint was angiographically confirmed radial artery spasm. Patient discomfort was quantified with a visual analogue scale. RESULTS Two thousand thirteen patients (age 64.5 ± 8.4 years) were randomized. Spasm occurred in 2.6% of the treatment group versus 8.3% of control subjects (p < 0.001; odds ratio [OR]: 0.29). The number needed to treat to avoid 1 case of spasm was 18 (95% confidence interval [CI]: 12.9 to 26.6). The access site crossover rate was 34% lower in the treatment group: 9.9% versus 15.0% (OR: 0.62; 95% CI: 0.48 to 0.82). Patient discomfort visual analogue scale score was 18.8 ± 12.5 in the treatment group versus 27.4 ± 17.4 in control subjects (p < 0.001). No significant differences were observed in the 30-day rate of death or repeat hospital stay for any cause: 4.6% versus 4.5% (OR: 1.02; 95% CI: 0.67 to 1.56). CONCLUSIONS Routine administration of relatively low doses of an opioid/benzodiazepine combination during transradial interventional procedures is associated with a substantial reduction in the rate of spasm, the need for access site crossover, and the procedure-related level of patient discomfort.
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Affiliation(s)
- Spyridon Deftereos
- Cardiology Department and Cardiac Catheterization Laboratory, Athens General Hospital G. Gennimatas, Athens, Greece
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Alexanian I, Parissis J, Athanaselis S, Pappas L, Gavrielatos G, Michas C, Sideris A, Kremastinos D, Anastasiou-Nana M, Filippatos G. Copper serum levels in patients with heart failure correlate with parameters of left ventricular systolic and diastolic dysfunction. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht307.p625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Deftereos S, Raisakis K, Giannopoulos G, Kossyvakis C, Pappas L, Kaoukis A. Successful retrieval of a coronary stent dislodged in the brachial artery by means of improvised snare and guiding catheter. Int J Angiol 2012; 20:55-8. [PMID: 22532772 DOI: 10.1055/s-0031-1272547] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
This is a case report regarding the retrieval, by means of an improvised snare and guiding catheter, of a stent dislodged in the brachial artery during a transradial coronary intervention. A full-length guiding catheter could not be used to approach the lost stent, which was a mere 30 to 35 cm away from the sheath insertion site at the radial artery, and a commercial snare was not available at the time. Thus, we had to improvise a shortened guiding catheter and a snare, which was formed by folding an angioplasty Whisper guide wire (Abbott Laboratories, Abbott Park, IL) and was used successfully to snare the stent and retrieve it.
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Affiliation(s)
- Spyridon Deftereos
- Department of Cardiology, Athens General Hospital "G. Gennimatas," Athens, Greece
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Powers K, Pappas L, Buchmann L, Anderson L, Gauchay L, Rich A, Agarwal J. P4-15-02: Clinical and Epidemiological Correlates of Elevated Distress Thermometer Scores in Breast Cancer Patients. Cancer Res 2011. [DOI: 10.1158/0008-5472.sabcs11-p4-15-02] [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
Abstract
Objectives: Distress is prevalent in breast cancer patients and can be detrimental to quality of life, performance status, treatment adherence, and satisfaction with medical care. The National Comprehensive Cancer Network (NCCN) developed the Distress Thermometer (DT) as a quick and efficient self-assessment tool for screening distress in cancer patients. While surveys estimate that between 20–40% of patients with cancer have significant levels of distress, fewer than 10% are identified and treated. Given time and monetary constraints, it is important to refine screening criteria to identify patients with elevated risk for distress. In this study, we identify clinical and epidemiological factors that are associated with an increased likelihood of elevated DT scores (≥4 and ≥7) in breast cancer patients.
Methods: We assessed 229 consecutive female patients with the DT at their initial consultation for breast cancer at the Huntsman Cancer Hospital between September 2007 and December 2008. The DT screening tool measures a global level of distress using a visual analogue scale from 0–10 in the shape of a thermometer, with zero identified as “No Distress” and ten labeled as “Extreme Distress.” The DT screening tool also includes a checklist of common emotional, family, physical, practical, and spiritual concerns with instructions for the paitent to indicate which of those concerns contributed to the distress they experienced within the past week. We chose a score ≥4 as our cutoff for a positive screen for “distress” and a score ≥7 as our cutoff for a positive screen for “extreme distress/depression” based on previous studies. Variables included in the analyses were: age, employment status, race/ethnicity, personal history of depression, family history of breast cancer, marital status, estrogen and progesterone receptor status, stage of cancer, time since diagnosis, and recurrence. Descriptive statistics and logistic regression models were used to determine associations between DT and patient data. Results: Emotional and physical concerns were associated with scores ≥4 and scores ≥7. Spiritual concerns were significantly associated with patients reporting scores ≥7. Patients who were non-Caucasian, unemployed, had a prior history of depression, who presented for recurrent disease, or who had been recently diagnosed had a higher likelihood of scores ≥4 and scores ≥7.
Conclusions: The likelihood of scoring ≥4 and ≥7 on the DT screening tool is highest during the first 30 days after receiving a breast cancer diagnosis. Four groups of patients should be targeted for aggressive screening: patients with a prior diagnosis of depression, patients presenting with recurrent disease, unemployed patients, and non-Caucasian patients. Interventions should address physical, emotional and spiritual concerns.
Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P4-15-02.
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Affiliation(s)
- K Powers
- 1University of Utah, Salt Lake City, UT; Huntsman Cancer Institute, Salt Lake City, UT
| | - L Pappas
- 1University of Utah, Salt Lake City, UT; Huntsman Cancer Institute, Salt Lake City, UT
| | - L Buchmann
- 1University of Utah, Salt Lake City, UT; Huntsman Cancer Institute, Salt Lake City, UT
| | - L Anderson
- 1University of Utah, Salt Lake City, UT; Huntsman Cancer Institute, Salt Lake City, UT
| | - L Gauchay
- 1University of Utah, Salt Lake City, UT; Huntsman Cancer Institute, Salt Lake City, UT
| | - A Rich
- 1University of Utah, Salt Lake City, UT; Huntsman Cancer Institute, Salt Lake City, UT
| | - J Agarwal
- 1University of Utah, Salt Lake City, UT; Huntsman Cancer Institute, Salt Lake City, UT
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Page B, Cooke E, Pappas L, Gaffney D. Is the 2009 endometrial cancer staging system more accurate based on survival, stage, grade, and histology? Gynecol Oncol 2011. [DOI: 10.1016/j.ygyno.2011.07.089] [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: 11/16/2022]
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Pappas L, Filippatos G. Pulmonary Congestion in Acute Heart Failure: From Hemodynamics to Lung Injury and Barrier Dysfunction. ACTA ACUST UNITED AC 2011. [DOI: 10.1016/j.rec.2011.05.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Deftereos S, Giannopoulos G, Raisakis K, Kaoukis A, Kossyvakis C, Pappas L, Panagopoulou V, Mavrogianni AD, Theodorakis A, Perpinia A, Michelakakis N, Bobotis G, Pyrgakis V. Transradial access as first choice for primary percutaneous coronary interventions: experience from a tertiary hospital in Athens. Hellenic J Cardiol 2011; 52:111-117. [PMID: 21478120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023] Open
Abstract
INTRODUCTION The transfemoral approach (TFA) has been the mainstay for arterial access during percutaneous coronary intervention (PCI) in the setting of acute ST-segment elevation myocardial infarction (STEMI). However, the transradial approach (TRA) has been shown to be an equally effective and possibly safer way of performing primary PCI (pPCI). METHODS The study population included 98 serially recruited patients who underwent pPCI in our institution. All patients were clinically followed during their hospital stay (6.4 ± 3.1 days). RESULTS In the 98 patients included in the study, 65 procedures (66.3%) were completed via TRA, whereas the remaining 33 procedures (33.7%) used TFA. Door-to-balloon time was similar (57 ± 19 min vs. 54 ± 15 min, p=ns). Patients in the TRA group were mobilized sooner (28 ± 9 hours vs. 36 ± 13 hours, p<0.05). Hospital stay was significantly shorter in the TRA group (6.0 ± 3.2 days vs. 7.1 ± 2.8 days, p<0.05). TRA and TFA did not differ significantly as to the incidence of death, non-fatal myocardial infarction or subacute stent thrombosis, but major access-related vascular complications were significantly more frequent in the TFA group (2% vs. 15%, p<0.01). Cerebrovascular events did not differ between TRA and TFA. CONCLUSIONS Compared to TFA, TRA seems to be associated with a lower incidence of bleeding complications, as well as earlier mobilization and discharge from hospital. It is conceivable that TRA could become the first choice in the treatment of STEMI patients in the near future, while TFA is kept as an alternative.
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Affiliation(s)
- Spyridon Deftereos
- Department of Cardiology, Athens General Hospital G. Gennimatas Athens, Greece.
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Deftereos S, Giannopoulos G, Tousoulis D, Raisakis K, Kossyvakis C, Kaoukis A, Synetos A, Latsios G, Pappas L, Panagopoulou V, Toutouzas K, Pyrgakis V, Rentoukas I, Stefanadis C. Feasibility and safety of transulnar access for performing rotational atherectomy. Int J Cardiol 2011; 147:285-6. [DOI: 10.1016/j.ijcard.2010.12.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2010] [Accepted: 12/04/2010] [Indexed: 11/27/2022]
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Deftereos S, Giannopoulos G, Raisakis K, Kossyvakis C, Kaoukis A, Driva M, Pappas L, Panagopoulou V, Ntzouvara O, Karavidas A, Pyrgakis V, Rentoukas I, Aggeli C, Stefanadis C. Comparison of muscle functional electrical stimulation to conventional bicycle exercise on endothelium and functional status indices in patients with heart failure. Am J Cardiol 2010; 106:1621-5. [PMID: 21094364 DOI: 10.1016/j.amjcard.2010.07.040] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2010] [Revised: 07/20/2010] [Accepted: 07/21/2010] [Indexed: 11/29/2022]
Abstract
The aim of this prospective, open-label, cohort study was to compare the effect of muscle functional electrical stimulation (FES) on endothelial function to that of conventional bicycle training. Eligible patients were those with New York Heart Association class II or III heart failure symptoms and ejection fractions ≤ 0.35. Two physical conditioning programs were delivered: FES of the muscles of the lower limbs and bicycle training, each lasting for 6 weeks, with a 6-week washout period between them. Brachial artery flow-mediated dilation (FMD) and other parameters were assessed before and after FES and the bicycle training program. FES resulted in a significant improvement in FMD, which increased from 5.9 ± 0.5% to 7.7 ± 0.5% (95% confidence interval for the difference 1.5% to 2.3%, p < 0.001). Bicycle training also resulted in a substantial improvement of endothelial function. FMD increased from 6.2 ± 0.4% to 9.2 ± 0.4% (95% confidence interval for the difference 2.5% to 3.5%, p < 0.001). FES was associated with a 41% relative increase in FMD, compared to 57% with bicycle exercise (95% confidence interval for the difference between the relative changes 1.2% to 30.5%, p = 0.034). This resulted in attaining a significantly higher FMD value after bicycle training compared to FES (9.2 ± 0.4% vs 7.7 ± 0.5%, p < 0.001). In conclusion, the effect of muscle FES in patients with heart failure on endothelial function, although not equivalent to that of conventional exercise, is substantial. Muscle FES protocols may prove very useful in the treatment of patients with heart failure who cannot or will not adhere to conventional exercise programs.
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Affiliation(s)
- Spyridon Deftereos
- Cardiology Department and Cardiac Catheterization Laboratory, Athens General Hospital G. Gennimatas, Athens, Greece
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Cooke E, Pappas L, Gaffney D. Does the Revised FIGO Staging for Endometrial Cancer Lead to Increased Discrimination in Patient Outcomes? Int J Radiat Oncol Biol Phys 2010. [DOI: 10.1016/j.ijrobp.2010.07.359] [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: 10/19/2022]
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Efremidis M, Pappas L, Sideris A, Filippatos G. Management of atrial fibrillation in patients with heart failure. J Card Fail 2008; 14:232-7. [PMID: 18381187 DOI: 10.1016/j.cardfail.2007.10.023] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2007] [Revised: 07/28/2007] [Accepted: 10/29/2007] [Indexed: 10/22/2022]
Abstract
BACKGROUND There is a well-documented relationship and a complex interaction between atrial fibrillation (AF) and heart failure. The coexistence of these 2 clinical entities renders their management even more challenging. METHODS AND RESULTS We searched current literature to review the management of AF in patients with heart failure. The cornerstones of AF treatment are rate control, cardioversion, and maintenance of sinus rhythm (SR), and prevention of thromboembolism. The issue of rhythm versus rate control remains unresolved. Nonpharmacologic therapies such as radiofrequency catheter ablation of the atrioventricular node with permanent pacemaker implantation, curative catheter ablation of AF, and cardiac resynchronization therapy are emerging and may alter the management of these patients. CONCLUSION Treatment of atrial fibrillation in the setting of heart failure encompasses a variety of approaches including drugs, devices, and ablation. Larger randomized trials are required to clarify the management of such patients.
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Affiliation(s)
- Michael Efremidis
- Evangelismos General Hospital of Athens and the Athens University Hospital, Attikon, Athens Greece
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Letsas K, Kounas S, Pappas L, Efremidis M, Kardaras F. Right atrial thrombosis mimicking myxoma in a patient with primary antiphospholipid syndrome. Minerva Cardioangiol 2005; 53:337-8. [PMID: 16177680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
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Pappas L. Is altruism a motivating force in HIV prevention? Focus 2001; 16:5-6. [PMID: 11548466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
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Kondraske GV, Yomtov BM, Pappas L. Software quality assurance in microprocessor-based medical instrumentation: new challenges. IEEE Eng Med Biol Mag 1985; 4:24-26. [PMID: 19493761 DOI: 10.1109/memb.1985.5006135] [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: 05/27/2023]
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