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Vlachakis PK, Tsiachris D, Doundoulakis I, Tsioufis P, Kordalis A, Botis M, Leontsinis I, Antoniou CK, Papachrysostomou C, Dimitroula V, Maneta E, Chalkitis V, Kotsakis T, Skantzikas P, Kafkas N, Sidiropoulos G, Roussos D, Trikas A, Koudounis G, Kolettis TM, Smyrnioudis N, Christakos D, Chasikidis C, Gatzoulis KA, Tsioufis K. Therapeutic inertia in rhythm control strategies in hospitalized patients with fibrillation: Insights from Hellenic Cardiorenal Morbidity Snapshot (HECMOS) study. J Cardiol 2024; 83:313-317. [PMID: 37979719 DOI: 10.1016/j.jjcc.2023.11.004] [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: 06/03/2023] [Revised: 11/10/2023] [Accepted: 11/10/2023] [Indexed: 11/20/2023]
Abstract
BACKGROUND Current guidelines recommend a rhythm control strategy in patients with symptomatic atrial fibrillation (AF) while catheter ablation has been shown to be a safer and more efficacious approach than antiarrhythmic medications. METHODS HECMOS was a nationwide snapshot survey of cardiorenal morbidity in hospitalized cardiology patients. In this sub-study, we included 276 cases who had a history of AF, particularly on the rhythm strategy, and catheter ablation procedures had been performed before the index admission. RESULTS Among 276 AF patients (mean age: 76.4 ± 11.5 years, 58 % male), 60.9 % (N = 168) had persistent AF and 39.1 % (N = 108) had paroxysmal AF. Heart failure was the main cause of admission in 54.3 % (N = 145) of the patients, while 14.1 % (N = 39) were admitted due to paroxysmal AF, 7.3 % (N = 20) due to bradyarrhythmic reasons, and 6.5 % (N = 18) suffered from acute coronary syndrome. Most importantly, heart failure with reduced ejection fraction was present in 76 (27 %) patients. Only 10 patients out of the total (3 %, mean age 59.7 years) had undergone AF ablation while electrical cardioversion had been attempted in 37 (13.4 %) patients. Interestingly, in this AF population with heart failure, 3.6 % (N = 10) had a defibrillator implanted (4 single-chamber), and only 1.5 % (N = 4) had a cardiac resynchronization therapy defibrillator (CRT-D). CONCLUSION High prevalence of persistent AF was detected in hospitalized patients, with heart failure being the leading cause of admission and main co-morbidity. Rhythm control strategies are notably underused, along with CRT-D implantation in patients with AF and heart failure.
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Affiliation(s)
- Panayotis K Vlachakis
- First Department of Cardiology, National and Kapodistrian University, "Hippokration" Hospital, Athens, Greece
| | - Dimitris Tsiachris
- First Department of Cardiology, National and Kapodistrian University, "Hippokration" Hospital, Athens, Greece; Athens Heart Center, Athens Medical Center, Athens, Greece.
| | - Ioannis Doundoulakis
- First Department of Cardiology, National and Kapodistrian University, "Hippokration" Hospital, Athens, Greece
| | - Panagiotis Tsioufis
- First Department of Cardiology, National and Kapodistrian University, "Hippokration" Hospital, Athens, Greece
| | - Athanasios Kordalis
- First Department of Cardiology, National and Kapodistrian University, "Hippokration" Hospital, Athens, Greece
| | - Michail Botis
- First Department of Cardiology, National and Kapodistrian University, "Hippokration" Hospital, Athens, Greece
| | - Ioannis Leontsinis
- First Department of Cardiology, National and Kapodistrian University, "Hippokration" Hospital, Athens, Greece
| | - Christos-Konstantinos Antoniou
- First Department of Cardiology, National and Kapodistrian University, "Hippokration" Hospital, Athens, Greece; Athens Heart Center, Athens Medical Center, Athens, Greece
| | | | - Vasiliki Dimitroula
- Department of Cardiology, G. Hatzikosta General Hospital of Ioannina, Ioannina, Greece
| | - Eleni Maneta
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | | | - Theodoros Kotsakis
- Department of Cardiology, Democritus University of Thrace, Medical School, Alexandroupoli, Greece
| | | | - Nikolaos Kafkas
- Department of Cardiology, General Hospital of Attica "KAT", Athens, Greece
| | - Georgios Sidiropoulos
- Department of Cardiology, Georgios Papanikolaou General Hospital, Thessaloniki, Greece
| | - Dimitris Roussos
- Department of Cardiology, Argos General Hospital, Nafplio, Argolis, Greece
| | | | - Georgios Koudounis
- Cardiology Department & Department of Cardiac Catheterization, General Hospital of Messinia, Kalamata, Greece
| | | | | | | | - Christos Chasikidis
- First Department of Cardiology, National and Kapodistrian University, "Hippokration" Hospital, Athens, Greece
| | - Konstantinos A Gatzoulis
- First Department of Cardiology, National and Kapodistrian University, "Hippokration" Hospital, Athens, Greece
| | - Konstantinos Tsioufis
- First Department of Cardiology, National and Kapodistrian University, "Hippokration" Hospital, Athens, Greece
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Kallistratos M, Konstantinidis D, Dimitriadis K, Sanidas E, Katsi V, Androulakis E, Vlachopoulos C, Toutouzas K, Kanakakis J, Sideris S, Kafkas N, Mavrogianni AD, Papadopoulos CH, Stefanidis A, Patsourakos N, Kachrimanidis I, Papaioannou N, Tsioufis C, Kochiadakis G, Marketou M. Exercise and cardiac rehabilitation in hypertensive patients with heart failure with preserved ejection fraction: A position statement on behalf of the Working Group of Arterial Hypertension of the Hellenic Society of Cardiology. Hellenic J Cardiol 2024; 75:82-92. [PMID: 37619947 DOI: 10.1016/j.hjc.2023.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 08/10/2023] [Accepted: 08/11/2023] [Indexed: 08/26/2023] Open
Abstract
Arterial hypertension is a major cause of cardiovascular morbidity and mortality and the most common cause of comorbidity in heart failure (HF) with preserved ejection fraction (HFpEF). As an adjunct to medication, healthy lifestyle modifications with emphasis on regular exercise are strongly recommended by both the hypertension and the HF guidelines of the European Society of Cardiology. Several long-term studies have shown that exercise is associated with a reduction in all-cause mortality, a favorable cardiac and metabolic risk profile, mental health, and other non-cardiovascular benefits, as well as an improvement in overall quality of life. However, the instructions for the prescriptive or recommended exercise in hypertensive patients and, more specifically, in those with HFpEF are not well defined. Moreover, the evidence is based on observational or small randomized studies, while well-designed clinical trials are lacking. Despite the proven benefit and the guidelines' recommendations, exercise programs and cardiac rehabilitation in patients with hypertensive heart disease and HFpEF are grossly underutilized. This position statement provides a general framework for exercise and exercise-based rehabilitation in patients with hypertension and HFpEF, guides clinicians' rehabilitation strategies, and facilitates clinical practice. It has been endorsed by the Working Group of Arterial Hypertension of the Hellenic Society of Cardiology and is focused on the Health Care System in Greece.
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Affiliation(s)
| | - Dimitriοs Konstantinidis
- First Department of Cardiology, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
| | - Kyriakos Dimitriadis
- First Department of Cardiology, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
| | - Elias Sanidas
- Cardiology Department, LAIKO General Hospital, Athens, Greece
| | - Vasiliki Katsi
- First Department of Cardiology, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
| | | | - Charalambos Vlachopoulos
- First Department of Cardiology, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
| | - Konstantinos Toutouzas
- First Department of Cardiology, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
| | - John Kanakakis
- Department of Clinical Therapeutics, University of Athens Medical School, 11528 Athens, Greece
| | - Skevos Sideris
- First Department of Cardiology, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
| | | | | | | | | | - Nikolaos Patsourakos
- Department of Cardiology, "Tzaneio" General Hospital of Piraeus, Piraeus, Greece
| | - Ioannis Kachrimanidis
- First Department of Cardiology, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
| | - Nikolaos Papaioannou
- Department of Cardiology, Asklepeion General Hospital Cardiology, Athens, Greece
| | - Costas Tsioufis
- First Department of Cardiology, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
| | - George Kochiadakis
- Cardiology Department, Heraklion University General Hospital, Crete, Greece
| | - Maria Marketou
- Cardiology Department, Heraklion University General Hospital, Crete, Greece.
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Dragasis S, Vlachos K, Frontera A, Mililis P, Saplaouras A, Zygouri A, Zymatoura ME, Kontonika M, Kafkas N, Efremidis M, Letsas KP. Modern mapping and ablation of idiopathic outflow tract ventricular arrhythmias. Rev Cardiovasc Med 2022; 23:103. [DOI: 10.31083/j.rcm2303103] [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] [Received: 11/27/2021] [Revised: 12/13/2021] [Accepted: 12/20/2021] [Indexed: 11/06/2022] Open
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Mantis C, Papadakis E, Anadiotis A, Kafkas N, Patsilinakos S. Factors affecting radiation exposure during transradial cardiac catheterisation and percutaneous coronary intervention. Clin Radiol 2022; 77:e387-e393. [DOI: 10.1016/j.crad.2022.02.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 02/02/2022] [Indexed: 12/26/2022]
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Kanakakis I, Stafylas P, Tsigkas G, Nikas D, Synetos A, Avramidis D, Tsiafoutis I, Dagre A, Tzikas S, Latsios G, Patsourakos N, Sanidas I, Skalidis E, Pipilis A, Bamidis P, Davlouros P, Kanakakis I, Tselegkidi M, Sertedaki E, Mamarelis I, Fraggos E, Mantzouranis E, Karvounis C, Manolis A, Chatzilymperis G, Chiotelis I, Gryllis D, Poulimenos L, Triantafyllis A, Alexopoulos D, Varlamos C, Almpanis G, Aggeli A, Sakkas A, Trikas A, Tsiamis S, Triantafylloy K, Mpenia D, Oikonomou D, Papadopoulou E, Avramidis D, Kousta M, Moulianitaki E, Poulianitis G, Mavrou G, Latsios G, Synetos A, Tousoulis D, Kafkas N, Godwin S, Mertzanos G, Koytouzis M, Tsiafoutis I, Papadopoulos A, Tsoumeleas A, Barbetseas I, Sanidas I, Athanasiou A, Paizis I, Kakkavas A, Papafanis T, Mantas I, Neroutsos G, Gkoliopoulou A, Tafrali V, Diakakis G, Grammatikopoulos K, Sinanis T, Kartalis A, Afendoulis D, Voutas P, Kardamis C, Doulis A, Kalantzis N, Vergis K, Chasikidis C, Armatas G, Damelou A, Ntogka M, Serafetinidis I, Zagkas K, Tselempis T, Makridis P, Karantoumanis I, Karapatsoudi E, Oikonomou K, Foukarakis E, Kafarakis P, Pitarokoilis M, Rogdakis E, Stavrakis S, Koudounis G, Karampetsos V, Lionakis N, Panotopoulos C, Svoronos D, Tsorlalis I, Tsatiris K, Beneki E, Papadopoulos N, Sawafta A, Kozatsani D, Spyromitros G, Bostanitis I, Dimitriadis G, Nikoloulis N, Kampouridis N, Giampatzis V, Patsilinakos S, Andrikou E, Katsiadas N, Papanagnou G, Kotsakis A, Ioannidis E, Platogiannis N, Psychari S, Pissimissis E, Gavrielatos G, Maritsa D, Papakonstantinou N, Patsourakos N, Oikonomou G, Katsanou K, Lazaris E, Moschos N, Giakoumakis T, Papagiannis N, Goudis C, Daios S, Devliotis K, Dimitriadis F, Giannadaki M, Savvidis M, Tsinopoulos G, Zarifis I, Askalidou T, Vasileiadis I, Kleitsiotou P, Sidiropoulos S, Tsaousidis A, Tzikas S, Vassilikos V, Papadopoulos C, Zarvalis Ε, Gogos C, Moschovidis V, Styliadis I, Laschos V, Spathoulas K, Vogiatzis I, Kasmeridis C, Papadopoulos A, Pittas S, Sdogkos E, Dagre A, Mpounas P, Rodis I, Pipilis A, Konstantinidis S, Makrygiannis S, Masdrakis A, Magginas A, Sevastos G, Katsimagklis G, Skalidis E, Petousis S, Davlouros P, Tsigkas G, Hahalis G, Koufou E, Tziakas D, Chalikias G, Thomaidi A, Stakos D, Chotidis A, Nikas D, Sakellariou X, Skoularigkis I, Dimos A, Iakovis N, Mpourazana A, Zagouras A, Lygkouri G, Bamidis P, Lagakis P, Spachos D, Stafylas P, Chalitsios C, Karaiskou M, Tychala C. Epidemiology, reperfusion management and outcomes of patients with myocardial infarction in Greece: The ILIAKTIS study. Hellenic J Cardiol 2022; 67:1-8. [DOI: 10.1016/j.hjc.2022.03.003] [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] [Received: 07/21/2021] [Revised: 01/20/2022] [Accepted: 03/08/2022] [Indexed: 11/26/2022] Open
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Kafkas N, Dragasis S, Mantis C, Floros G. Myocardial infarction with non obstructive coronary arteries complicated with ventricular septal rupture: A case report and literature review. Catheter Cardiovasc Interv 2021; 99:1125-1128. [PMID: 34851551 DOI: 10.1002/ccd.30028] [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: 08/11/2021] [Accepted: 11/17/2021] [Indexed: 11/07/2022]
Abstract
Ventricular septal rupture represents one of the most serious complications after an acute coronary syndrome. Nowadays this condition is rare due to early revascularization, but is still associated with high mortality rate. In this case report, we present an unusual case of a woman suffering an acute myocardial infarction with normal coronary arteries complicated with a ventricular septal rupture, which required surgical correction.
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Affiliation(s)
- Nikolaos Kafkas
- Department of Cardiology, General Hospital of Attica "KAT", Athens, Greece
| | - Stylianos Dragasis
- Department of Cardiology, General Hospital of Attica "KAT", Athens, Greece
| | - Christos Mantis
- Department of Cardiology, General Hospital of Attica "KAT", Athens, Greece
| | - Georgios Floros
- Department of Cardiology, General Hospital of Attica "KAT", Athens, Greece
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Abstract
AbstractOral P2Y12 receptor inhibitors represent a mainstay treatment in patients with acute coronary syndrome and those undergoing percutaneous coronary intervention. In the setting of ST-elevation myocardial infarction, when early platelet inhibition is highly desirable, the onset of action of oral P2Y12 receptor inhibitors is, however, delayed, likely due to delayed drug absorption. Crushing the tablets, which are to be used for patient loading with an oral P2Y12 receptor inhibitor, has been shown to provide earlier platelet inhibition than standard, integral tablets administration. Chewed ticagrelor tablets may also result in a similar effect. Such findings should be interpreted with caution, mainly due to the small number of patients enrolled and the nature (pharmacodynamic/pharmacokinetic) of the respective studies. Furthermore, in patients with out-of-hospital cardiac arrest, who remain comatose, crushing tablets is commonly applied in clinical practice for platelet P2Y12 receptor inhibition. In this review, we focus on current evidence regarding the role of crushed P2Y12 receptor inhibitor pills, analyzing clinical scenarios where most of the promise exists along with future expectations from this type of formulation. Large randomized studies are needed to draw firm conclusions regarding the clinical benefit of ‘crushing’ over the usual ‘not-crushing’ practice.
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Affiliation(s)
- Dimitrios Alexopoulos
- 2nd Department of Cardiology, Attikon University Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Stylianos Dragasis
- Department of Cardiology, General Hospital of Attica ''KAT'', Athens, Greece
| | - Nikolaos Kafkas
- Department of Cardiology, General Hospital of Attica ''KAT'', Athens, Greece
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Hahalis GN, Leopoulou M, Tsigkas G, Xanthopoulou I, Patsilinakos S, Patsourakos NG, Ziakas A, Kafkas N, Koutouzis M, Tsiafoutis I, Athanasiadis I, Koniari I, Almpanis G, Anastasopoulou M, Despotopoulos S, Kounis N, Dapergola A, Aznaouridis K, Davlouros P. Multicenter Randomized Evaluation of High Versus Standard Heparin Dose on Incident Radial Arterial Occlusion After Transradial Coronary Angiography. JACC Cardiovasc Interv 2018; 11:2241-2250. [DOI: 10.1016/j.jcin.2018.08.009] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 07/16/2018] [Accepted: 08/14/2018] [Indexed: 11/30/2022]
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Abstract
INTRODUCTION Acute right ventricular myocardial infarction (RVMI) is observed in 30-50% of patients presenting with inferior wall myocardial infarction (MI) and, occasionally, with anterior wall MI. The clinical consequences vary from no hemodynamic compromise to severe hypotension and cardiogenic shock depending on the extent of RV ischemia. Areas covered: The pathophysiological mechanisms, diagnostic steps, and novel therapeutic approaches of acute RVMI are described. Expert commentary: Diagnosis of acute RVMI is based on physical examination, cardiac biomarkers, electrocardiography, and coronary angiography, whereas noninvasive imaging modalities (echocardiography, cardiac magnetic resonance imaging) play a complementary role. Early revascularization, percutaneous or pharmacological, represents key step in the management of RMVI. Maintenance of reasonable heart rate and atrioventricular synchrony is essential to sustain adequate cardiac output in these patients. When conventional treatment is not successful, mechanical circulatory support, including right ventricle assist devices, percutaneous cardiopulmonary support, and intra-aortic balloon pump, might be considered. The prognosis associated with RVMI is worse in the short term, compared to non-RVMI, but those patients who survive hospitalization have a relatively good long-term prognosis.
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Affiliation(s)
- Arif Albulushi
- a Cardiovascular Division , University of Nebraska Medical Center , Omaha , NE , USA
| | - Andreas Giannopoulos
- b Cardiac Imaging, Department of Nuclear Medicine , University Hospital Zurich , Zurich , Switzerland
| | - Nikolaos Kafkas
- c Cardiology Department , General Hospital KAT , Athens , Greece
| | | | - Gregory Pavlides
- a Cardiovascular Division , University of Nebraska Medical Center , Omaha , NE , USA
| | - Yiannis S Chatzizisis
- a Cardiovascular Division , University of Nebraska Medical Center , Omaha , NE , USA
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Hahalis G, Tsigkas G, Kounis N, Patsilinakos S, Kafkas N, Ziakas A, Patsourakos N, Almpanis G, Koniari I, Xanthopoulou I, Koutsogiannis N, Despotopoulos S, Leopoulou M, Tassi V, Miliordos I, Anastasopoulou M, Roumeliotis A, Dapergola A, Aznaouridis K, Chatzis D, Davlouros P. Prevention of Radial Artery Occlusions Following Coronary Procedures: Forward and Backward Steps in Improving Radial Artery Patency Rates. Angiology 2018; 69:755-762. [DOI: 10.1177/0003319718754466] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Radial artery (RA) occlusion (RAO) remains the Achilles heel of transradial coronary procedures. Although of silent nature, RAO is relatively frequent, results in graft shortage for future coronary artery bypass surgery, and may occur even after short-lasting, 5F coronary angiography (CAG). The most frequent predictors of RAO are RA size, body size, female gender, and periprocedural anticoagulation intensity. Methods to detect RAO are variable, of which the Barbeau test and ultrasonography have similar diagnostic accuracy. Data indicate that late RAO recanalization may occur. Meticulous handling of RA and the use of appropriate hemostatic devices and techniques along with sufficient heparin dose appear important measures to reduce RAO rates. Recent contradictory studies indicate that the decreasing incidence of RAO overtime is not as uniform as previously thought. In 2 meta-analyses, the benefit of higher over lower anticoagulation intensity became evident. As “it may all be appropriate anticoagulation” for a simplified approach against RAO, the results of an ongoing trial comparing 100 with 50 IU/kg body weight in transradial CAG are eagerly awaited.
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Affiliation(s)
- George Hahalis
- Department of Cardiology, Patras University Hospital, Rio, Patras, Greece
| | - Grigorios Tsigkas
- Department of Cardiology, Patras University Hospital, Rio, Patras, Greece
| | - Nikos Kounis
- Department of Cardiology, Patras University Hospital, Rio, Patras, Greece
| | | | | | - Antonios Ziakas
- Department of Cardiology, “AHEPA” University Hospital, Thessaloniki, Greece
| | | | - George Almpanis
- Department of Cardiology, Patras University Hospital, Rio, Patras, Greece
| | - Ioanna Koniari
- Department of Cardiology, Patras University Hospital, Rio, Patras, Greece
| | | | | | | | - Marianna Leopoulou
- Department of Cardiology, Patras University Hospital, Rio, Patras, Greece
| | - Vasiliky Tassi
- Department of Cardiology, Patras University Hospital, Rio, Patras, Greece
| | - Ioannis Miliordos
- Department of Cardiology, Patras University Hospital, Rio, Patras, Greece
| | | | | | - Athina Dapergola
- Department of Cardiology, Patras University Hospital, Rio, Patras, Greece
| | - Konstantinos Aznaouridis
- Department of Cardiology, “Hippokration” University Hospital, Athens, Greece
- Department of Cardiology, “Castle Hill” Hospital, Cottingham, UK
| | | | - Periklis Davlouros
- Department of Cardiology, Patras University Hospital, Rio, Patras, Greece
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Katsanos S, Mavrogenis AF, Kafkas N, Sardu C, Kamperidis V, Katsanou P, Farmakis D, Parissis J. Cardiac Biomarkers Predict 1-Year Mortality in Elderly Patients Undergoing Hip Fracture Surgery. Orthopedics 2017; 40:e417-e424. [PMID: 28075435 DOI: 10.3928/01477447-20170109-02] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2016] [Accepted: 12/05/2016] [Indexed: 02/03/2023]
Abstract
This prospective study included 152 elderly patients (mean age, 80 years; range, 72-88 years) with a hip fracture treated surgically. Comorbidities were evaluated, and B-type natriuretic peptide was measured at baseline and at postoperative days 4 and 5 in addition to troponin I. Major cardiac events were recorded, and 1-year mortality was assessed. Comorbidity models with the important multivariate predictors of 1-year mortality were analyzed. Overall, 9 patients (6%) experienced major cardiac events postoperatively during their hospitalization. Three patients (2%) died postoperatively, at days 5, 7, and 10, from autopsy-confirmed myocardial infarction. Three patients (2%) experienced a nonfatal myocardial infarction, and 3 patients (2%) experienced acute heart failure. At 1-year follow-up, 37 patients (24%) had died. Age older than 80 years (P=.000), renal failure (P=.016), cardiovascular disease (P=.003), respiratory disease (P=.010), Parkinson disease (P=.024), and dementia (P=.000) were univariate predictors of 1-year mortality. However, in the multivariate model, only age older than 80 years (P=.000) and dementia (P=.024) were important predictors of 1-year mortality. In all comorbidity models, age older than 80 years and dementia were important predictors of 1-year mortality. Postoperative increase in B-type natriuretic peptide was the most important predictor of 1-year mortality. Receiver operating characteristic curve analysis showed a threshold of 90 ng/mL of preoperative B-type natriuretic peptide (area under the curve=0.773, 95% confidence interval, 0.691-0.855, P<.001) had 82% sensitivity and 62% specificity to predict 1-year mortality. Similarly, a threshold of 190 ng/mL of postoperative B-type natriuretic peptide (area under the curve=0.753, 95% confidence interval, 0.662-0.844, P<.001) had 70% sensitivity and 77% specificity to predict the study endpoint. [Orthopedics. 2017; 40(3):e417-e424.].
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Kafkas N, Dragasis S, Georgopoulos S, Floros G. Double Infarction after Acute Multivessel Coronary Artery Occlusion. Hellenic J Cardiol 2017; 58:89-92. [PMID: 28163149 DOI: 10.1016/j.hjc.2017.01.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Accepted: 09/01/2016] [Indexed: 11/25/2022] Open
Affiliation(s)
- Nikolaos Kafkas
- Department of Cardiology, General Hospital of Attica "KAT", Athens, Greece.
| | - Stylianos Dragasis
- Department of Cardiology, General Hospital of Attica "KAT", Athens, Greece
| | | | - George Floros
- Department of Cardiology, General Hospital of Attica "KAT", Athens, Greece
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Vlastou E, Antonakos J, Efstathopoulos E, Kafkas N, Makris N, Besios C, Raptou P. A comparison of dose area product from different angiography procedures. Phys Med 2016. [DOI: 10.1016/j.ejmp.2016.07.160] [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: 11/28/2022] Open
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Kafkas N, Liakos C, Zoubouloglou F, Dagadaki O, Dragasis S, Makris K. Neutrophil Gelatinase-Associated Lipocalin as an Early Marker of Contrast-Induced Nephropathy After Elective Invasive Cardiac Procedures. Clin Cardiol 2016; 39:464-70. [PMID: 27175937 DOI: 10.1002/clc.22551] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [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: 01/09/2016] [Revised: 04/05/2016] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Contrast-induced nephropathy (CIN) is an acute kidney injury (AKI) defined as serum creatinine (sCr) increase 48 to 72 hours after contrast administration. Because most subjects undergoing invasive cardiac procedures are discharged within 24 hours, sCr is unsuitable for CIN detection. HYPOTHESIS In the present study we tested the hypothesis that neutrophil gelatinase-associated lipocalin (NGAL) is superior compared with sCr and other established nephropathy markers in early CIN diagnosis after elective invasive cardiac procedures. METHODS Serum creatinine, urine creatinine, serum cystatin C, urine albumin, urine NGAL (uNGAL), and plasma NGAL were measured at 0, 6, 24, and 48 hours after contrast administration in 100 elective invasive cardiac procedures. Estimated glomerular filtration rate and albumin-to-creatinine ratio were calculated. Changes from baseline were considered statistically significant at P < 0.05 and clinically significant when > the biomarker's reference change value. Participants were divided into those with and without clinically significant uNGAL changes (uNGAL positive and negative for AKI, respectively). RESULTS Thirty-three individuals were uNGAL positive for AKI. Serum cystatin C changes were statistically and clinically nonsignificant in both groups. Serum creatinine and plasma NGAL were statistically but not clinically elevated 48 hours postcatheterization in the AKI group. Except for contrast volume (higher in AKI group), groups were comparable at baseline (P not significant) regarding cardiovascular risk factors, coronary heart disease, coronary interventions performed, and renal biomarkers. Baseline uNGAL was significantly correlated to estimated glomerular filtration rate and albumin-to-creatinine ratio. CONCLUSIONS Urine NGAL is potentially superior compared with conventional nephropathy markers in early CIN diagnosis after elective invasive cardiac procedures. Definition of clinically significant uNGAL changes with reference change value is probably a valuable supplement to statistically defined significant variations.
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Affiliation(s)
- Nikolaos Kafkas
- Cardiology Department, KAT General Hospital of Attica, Kifissia, Greece
| | | | - Filitsa Zoubouloglou
- Clinical Biochemistry Department, KAT General Hospital of Attica, Kifissia, Greece
| | - Ourania Dagadaki
- Cardiology Department, KAT General Hospital of Attica, Kifissia, Greece
| | | | - Konstantinos Makris
- Clinical Biochemistry Department, KAT General Hospital of Attica, Kifissia, Greece
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Katsanos S, Babalis D, Kafkas N, Mavrogenis A, Leong D, Parissis J, Varounis C, Makris K, van der Heijden A, Anastasiou-Nana M, Filippatos G. B-type natriuretic peptide vs. cardiac risk scores for prediction of outcome following major orthopedic surgery. J Cardiovasc Med (Hagerstown) 2015; 16:465-71. [DOI: 10.2459/jcm.0000000000000210] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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16
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Babalis D, Tritakis V, Floros G, Mouzarou A, Kafkas N, Bampali K, Mertzanos G. Effects of ranolazine on left ventricular diastolic and systolic function in patients with chronic coronary disease and stable angina. Hellenic J Cardiol 2015; 56:237-241. [PMID: 26021246] [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: 06/04/2023] Open
Abstract
INTRODUCTION The present study examined the effect of ranolazine, which acts via the mechanism of selective inhibition of late INa+, on parameters of left ventricular systolic and diastolic function in patients suffering from angiographically confirmed chronic coronary artery disease, presenting with chronic stable angina. METHODS We studied 40 patients (age 67 ± 9 years; 30 men, 10 women) with chronic coronary artery disease who reported angina symptoms on optimal medication and who were not suitable for invasive treatment. Patients were randomized to the ranolazine group (group A, 20 patients taking oral ranolazine 500 mg bid for 3 months) and the control group (group B, 20 patients who did not receive the drug). Left ventricular systolic and diastolic function was assessed echocardiographically at baseline and after the end of the three-month treatment period. Left ventricular ejection fraction by the modified Simpson's method, E and A left ventricular filling velocities, E/A ratio, deceleration time (DT) of E, isovolumic relaxation time (IVRT), E and A waves, and the E/E ratio were measured using 2-dimensional echocardiography, Doppler and tissue Doppler imaging (TDI). RESULTS Group A patients demonstrated a clear improvement of their initial angina symptoms. There were no adverse effects from ranolazine requiring withdrawal from the study. There was no statistically significant change in left ventricular systolic function in either group. A statistically significant change was seen in indexes of diastolic function measured using both conventional Doppler and TDI in Group A patients compared with Group B patients after three months' ranolazine treatment period. The changes in left ventricular diastolic function indexes in Group A patients were as follows: E 0.58 ± 0.11 vs. 0.76 ± 0.12 m/s, p<0.001; A 0.71 ± 0.22 vs. 0.83 ± 0.19 m/s, p<0.001; E/A 0.81 ± 0.14 vs. 0.97 ± 0.17, p<0.005; 5.4 ± 0.7 vs. 6.8 ± 0.9 cm/s, p<0.005; 7.2 ± 0.8 vs. 8.3 ± 1.1 cm/s, p<0.005; E/ 10.7 ± 1.1 vs. 11.1 ± 0.8, p=ns; DT 251 ± 14 vs. 226 ± 17 ms, p<0.004; IVRT 95 ± 11 vs. 74 ± 9 ms, p<0.001. Systolic function did not change: EF 46.3 ± 3.4 vs. 46.7 ± 2.7%, p: ns. CONCLUSIONS The use of ranolazine in patients suffering from chronic coronary artery disease has a favorable impact on diastolic function parameters. Accordingly, a clinical benefit could be observed due to an improvement in patients' symptoms.
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MESH Headings
- Aged
- Angina, Stable/diagnostic imaging
- Angina, Stable/drug therapy
- Angina, Stable/physiopathology
- Coronary Disease/diagnostic imaging
- Coronary Disease/drug therapy
- Coronary Disease/physiopathology
- Echocardiography, Doppler, Pulsed/methods
- Female
- Humans
- Male
- Middle Aged
- Ranolazine/administration & dosage
- Ranolazine/adverse effects
- Sodium Channel Blockers/administration & dosage
- Sodium Channel Blockers/adverse effects
- Stroke Volume/drug effects
- Stroke Volume/physiology
- Treatment Outcome
- Ventricular Dysfunction, Left/diagnostic imaging
- Ventricular Dysfunction, Left/drug therapy
- Ventricular Dysfunction, Left/physiopathology
- Ventricular Function, Left/drug effects
- Ventricular Function, Left/physiology
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17
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Makris K, Rizos D, Kafkas N, Haliassos A. Neurophil gelatinase-associated lipocalin as a new biomarker in laboratory medicine. Clin Chem Lab Med 2013; 50:1519-32. [PMID: 23104835 DOI: 10.1515/cclm-2012-0227] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2012] [Accepted: 05/29/2012] [Indexed: 01/07/2023]
Abstract
Neutrophil gelatinase-associated lipocalin (NGAL) is a 25 kDa protein of the lipocalin superfamily. This protein is expressed and secreted by immune cells, hepatocytes, and renal tubular cells in various pathologic states. NGAL has recently generated great interest as an early biomarker of renal injury. However, like many other endogenous biomarkers it is not produced by just one cell type and it exists in more than one molecular form. As recent research has shown different pathological conditions may involved in the production of this molecule. This review summarizes the current knowledge about the biology of NGAL and examines the role of this molecule of acute renal injury as well as in other pathologic conditions like neoplasia, anemia, pregnancy, cardiovascular disease chronic kidney disease and in cardiorenal syndrome. Commercial and research immunoassays are used to measure NGAL in both plasma and urine but these assays are not standardized. The existence of different molecular forms of NGAL and their expression at various disease states further complicates the interpretation of the results. Pre analytical issues and biological variation are also not fully elucidated.
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Abstract
Acute kidney injury (AKI) is recognized as an independent risk factor for morbidity and mortality. Unfortunately, this syndrome was historically underdiagnosed due to inconsistent definition of AKI as well as insensitive and nonspecific diagnostic tools. Recent advances in defining AKI, understanding its pathophysiology, and improving its diagnostic accuracy have an impact in disease management and clinical outcome. Prompt recognition and treatment of AKI still remains the cornerstone of clinical management of this syndrome. This chapter focuses on the recent advances in diagnosis of AKI using novel serum and urine biomarkers. The role of neutrophil gelatinase-associated lipocalin (NGAL) in pathophysiology and diagnosis of AKI is presented. A detailed analysis of the biology of NGAL and presentation of laboratory methods of measurement is also provided. The role of NGAL as biomarker beyond the boundaries of nephrology is also presented.
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Kafkas N, Patsilinakos S, Makris K, Chlapoutakis G, Christou A, Dagadaki O, Babalis D. Brain natriuretic peptide: a marker of cardiac dysfunction with ventricular or dual-chamber pacing. Acta Cardiol 2011; 66:589-94. [PMID: 22032052 DOI: 10.1080/ac.66.5.2131083] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND/OBJECTIVES The inability of trials to exhibit the superiority in survival of atrioventricular compared to ventricular pacing can be partially explained by the apical stimulation of the right ventricle, which adversely affects both short- and long-term ventricular performance. We evaluated the impact of pacing mode (DDDR vs. VVIR) on the brain natriuretic peptide (BNP) level in patients with sick-sinus syndrome (SSS). METHODS Sixty-seven patients were treated with DDDR pacemaker implantation due to SSS. They were randomized during the first post-implant day either to DDDR or WIR pacing mode and were reevaluated after 30 days. Group A comprised 35 patients on DDDR pacing mode and group B 32 patients on WIR pacing mode. Peripheral blood samples were drawn for BNP measurement at the time of randomization and one month later. RESULTS BNP levels increased significantly in both groups at 30 days (group A: 85.6 +/- 29.5 pg/ml to 107.2 +/- 34.6 pg/ml, group B: 82.7 +/- 27.6 pg/ml to 253.1 +/- 60.2 pg/ml). On day 30, BNP levels in group B were significantly higher than in group A (P < 0.0001). CONCLUSIONS Pacing from the apex of the right ventricle provokes an increase in the BNP levels regardless of the pacing mode. BNP is probably a very early marker predicting the structural and/or functional heart changes after long-term pacing from the apex of the right ventricle.
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Affiliation(s)
- Nikolaos Kafkas
- Department of Cardiology, KAT General Hospital, Athens, Greece
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20
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Kafkas N, Triantafyllou K, Babalis D. An isolated single L-I type coronary artery with severe LAD lesions treated by transradial PCI. J Invasive Cardiol 2011; 23:E216-E218. [PMID: 21891816] [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] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Cases of coronary arteries with anomalous aortic origin are rare. An isolated single coronary artery is a congenital anomaly occurring in approximately 0.024-0.066% of the population. Atherosclerosis of these arteries is not infrequent with potentially severe consequences, but interventional procedures are rarely performed. We report an acute coronary syndrome case due to a subtotal paraostial left anterior descending (LAD) occlusion of a single L-I type coronary artery. Another severe stenosis was also present at mid-LAD. The patient was successfully treated with transradial percutaneous coronary intervention (PCI). Our case shows that when the anatomy is suitable, complex PCI can be performed successfully in single coronary arteries.
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Affiliation(s)
- Nikolaos Kafkas
- Cardiology Department, Kat General Hospital Athens, 10 Zitsis, Marousi Att., Athens, Greece.
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Christou A, Kafkas N, Marinakos A, Katsanos S, Papanikitas K, Patsilinakos S. Rapid desensitisation of patients with aspirin allergy who undergo coronary angioplasty. Hellenic J Cardiol 2011; 52:307-310. [PMID: 21933761] [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: 05/31/2023] Open
Abstract
INTRODUCTION Although aspirin is the cornerstone of medication in patients with coronary artery disease, a minority of these patients have aspirin sensitivity. The aim of this study was to evaluate the efficacy and safety of an aspirin desensitisation protocol in patients scheduled for coronary angioplasty and stenting. METHODS We used a challenge-desensitisation protocol in 11 patients (6 men, mean age 56 ± 9.6 years) who reported allergy to aspirin and were to undergo percutaneous coronary intervention with stent implantation. Eight had a history of cutaneous sensitivity, 1 had rhinitis, 1 reported urticaria and rhinitis, while another patient showed a respiratory response in the form of an asthma attack after taking aspirin in the past. Eight successive doses of aspirin were given (0.1, 0.3, 10, 30, 40, 81, 162, 325 mg) at intervals of 15-25 min over a total period of 2 h 15 min. RESULTS All patients with aspirin sensitivity completed the desensitisation therapy successfully, without adverse effects, and subsequently underwent angioplasty and stenting. During follow up, the patients continued to take aspirin over 6-19 months without any problems. CONCLUSIONS Rapid aspirin desensitisation is an effective and safe procedure for patients with aspirin allergy who are to undergo coronary angioplasty and stenting, allowing them to receive the optimum treatment.
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Affiliation(s)
- Apostolos Christou
- Cardiology Department, Konstantopoulio General Hospital, Nea Ionia, Athens, Greece.
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Patsilinakos S, Christou A, Kafkas N, Nikolaou N, Antonatos D, Katsanos S, Spanodimos S, Babalis D. Effect of high doses of magnesium on converting ibutilide to a safe and more effective agent. Am J Cardiol 2010; 106:673-6. [PMID: 20723644 DOI: 10.1016/j.amjcard.2010.04.020] [Citation(s) in RCA: 30] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2010] [Revised: 04/20/2010] [Accepted: 04/20/2010] [Indexed: 11/18/2022]
Abstract
Ibutilide is a class III antiarrhythmic agent indicated for cardioversion of atrial fibrillation and atrial flutter to sinus rhythm (SR). The most serious complication of ibutilide is torsades de pointes (TdP). Magnesium has been successfully used for the treatment of TdP, but its use as a prophylactic agent for this arrhythmia has not yet been established. The present study investigated whether high dose of magnesium would increase the safety and efficacy of ibutilide administration. A total of 476 patients with atrial fibrillation or atrial flutter who were candidates for conversion to SR were divided into 2 groups. Group A consisted of 229 patients who received ibutilide to convert atrial fibrillation or atrial flutter to SR. Group B consisted of 247 patients who received an intravenous infusion of 5 g of magnesium sulfate for 1 hour followed by the administration of ibutilide. Then, another 5 g of magnesium were infused for 2 additional hours. Of the patients in groups A and B, 154 (67.3%) and 189 (76.5%), respectively, were converted to SR (p = 0.033). Ventricular arrhythmias (sustained, nonsustained ventricular tachycardia, and TdP) occurred significantly more often in group A than in group B (7.4% vs 1.2%, respectively, p = 0.002). TdP developed in 8 patients (3.5%) in group A and in none (0%) in group B (p = 0.009). The administration of magnesium (despite the high doses used) was well tolerated. In conclusion, the administration of high doses of magnesium probably makes ibutilide a much safer agent, and magnesium increased the conversion efficacy of ibutilide.
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Kafkas N, Venetsanou K, Patsilinakos S, Voudris V, Antonatos D, Kelesidis K, Baltopoulos G, Maniatis P, Cokkinos DV. Procalcitonin in acute myocardial infarction. ACTA ACUST UNITED AC 2008; 10:30-6. [PMID: 17924232 DOI: 10.1080/17482940701534800] [Citation(s) in RCA: 45] [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] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Procalcitonin (PCT) is released in severe bacterial infections, sepsis and in infection independent cases such as major surgery, multiple trauma, cardiogenic shock, burns, resuscitation, and after cardiac surgery. The aim of this study was to determine the levels and the kinetics of PCT in AMI and to investigate their possible correlation with the release of IL-6 and CRP. DESIGN-PATIENTS: The study included 60 patients (47 men, 63.2+/-14.8 years) with the diagnosis of AMI at admission. In all patients, serum levels of PCT, IL-6, CK-MB, TnI and CRP were measured at admission, at 3, 6, 12, 24, 48 and 72 h and at the seventh day. RESULTS PCT was elevated in all patients with AMI. It was initially detected in serum approximately 2-3 h after the onset of the symptoms. The median value at admission was 1.3 ng/ml (95% CI: 0.89 to 1.80). The value of PCT showed an increase and reached a plateau after 12-24 h. The median value at 24 h was 3.57 ng/ml (95% CI: 2.89 to 4.55). PCT values fell to baseline (<0.5 ng/ml) by the seventh day. PCT was detected in serum earlier than CK-MB or TnI in 56 of the 60 patients (93.3%). The kinetics of PCT was similar to those of CK-MB and TnI. The maximal values of PCT were positively correlated with the maximal values of IL-6 (r = 0.59, P = 0.00) and of CRP (r = 0.65, P = 0.001). The maximal values of IL-6 were positively correlated with max CRP (r = 0.35, P = 0.045). CONCLUSIONS PCT could be considered as a novel sensitive myocardial index. Its release in AMI is probably due to the inflammatory process that occurs during AMI.
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Affiliation(s)
- Nikolaos Kafkas
- Cardiology Department of General Hospital KAT, Athens, Greece.
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