1
|
Vardas PE. Leadless and scarless pacing: towards symbiotic nanogenerators. Eur Heart J 2024; 45:1252-1254. [PMID: 38442144 DOI: 10.1093/eurheartj/ehae124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/07/2024] Open
Affiliation(s)
- Panos E Vardas
- Medical School, University of Crete, Heraklion, Greece
- Biomedical Research Foundation Academy of Athens, Heart Sector, Hygeia Hospitals Group, HHG, 5, Erithrou Stavrou, Marousi, Athens 15123, Greece
| |
Collapse
|
2
|
Vardas EP, Theofilis P, Oikonomou E, Vardas PE, Tousoulis D. MicroRNAs in Atrial Fibrillation: Mechanisms, Vascular Implications, and Therapeutic Potential. Biomedicines 2024; 12:811. [PMID: 38672166 PMCID: PMC11048414 DOI: 10.3390/biomedicines12040811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 03/27/2024] [Accepted: 04/03/2024] [Indexed: 04/28/2024] Open
Abstract
Atrial fibrillation (AFib), the most prevalent arrhythmia in clinical practice, presents a growing global health concern, particularly with the aging population, as it is associated with devastating complications and an impaired quality of life. Its pathophysiology is multifactorial, including the pathways of fibrosis, inflammation, and oxidative stress. MicroRNAs (miRNAs), small non-coding RNA molecules, have emerged as substantial contributors in AFib pathophysiology, by affecting those pathways. In this review, we explore the intricate relationship between miRNAs and the aforementioned aspects of AFib, shedding light on the molecular pathways as well as the potential diagnostic applications. Recent evidence also suggests a possible role of miRNA therapeutics in maintenance of sinus rhythm via the antagonism of miR-1 and miR-328, or the pharmacological upregulation of miR-27b and miR-223-3p. Unraveling the crosstalk between specific miRNA profiles and genetic predispositions may pave the way for personalized therapeutic approaches, setting the tone for precision medicine in atrial fibrillation.
Collapse
Affiliation(s)
- Emmanouil P. Vardas
- 1st Cardiology Department, General Hospital of Athens “Hippokration”, University of Athens Medical School, 11528 Athens, Greece; (E.P.V.); (P.T.)
- Department of Cardiology, General Hospital of Athens “G. Gennimatas”, 11527 Athens, Greece
| | - Panagiotis Theofilis
- 1st Cardiology Department, General Hospital of Athens “Hippokration”, University of Athens Medical School, 11528 Athens, Greece; (E.P.V.); (P.T.)
| | - Evangelos Oikonomou
- 3rd Cardiology Department, Sotiria Regional Hospital for Chest Diseases, University of Athens Medical School, 11527 Athens, Greece;
| | - Panos E. Vardas
- Biomedical Research Foundation Academy of Athens, Heart Sector, Hygeia Hospitals Group, Attica, 15123 Athens, Greece;
| | - Dimitris Tousoulis
- 1st Cardiology Department, General Hospital of Athens “Hippokration”, University of Athens Medical School, 11528 Athens, Greece; (E.P.V.); (P.T.)
| |
Collapse
|
3
|
Vardas PE, Vardas EP, Tzeis S. Medicine at the dawn of the metaclinical era. Eur Heart J 2023; 44:4729-4730. [PMID: 37794638 DOI: 10.1093/eurheartj/ehad599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/06/2023] Open
Affiliation(s)
- Panos E Vardas
- Biomedical Research Foundation Academy of Athens, Heart Sector, Hygeia Hospitals Group, HHG, Erithrou Stavrou 5, Attica, Athens 15123, Greece
| | - Emmanouil P Vardas
- Department of Cardiology, Athens General Hospital G. Gennimatas, Leoforos Mesogeion 154, Attica, Athens 11527, Greece
| | - Stylianos Tzeis
- Department of Cardiology, Mitera Hospital, Hygeia Group, Erythrou Stavrou 6, Attica, Athens 15123, Greece
| |
Collapse
|
4
|
Vardas PE. Large-scale digital population screening for atrial fibrillation: swinging around the uncertainties. Cardiovasc Res 2023; 119:e120-e121. [PMID: 36869671 DOI: 10.1093/cvr/cvad032] [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: 12/30/2022] [Accepted: 01/05/2023] [Indexed: 03/05/2023] Open
Affiliation(s)
- Panos E Vardas
- Heart Sector, Hygeia Hospitals Group, HHG, 5, Erithrou Stavrou, Marousi, 15123 Athens, Greece.,European Heart Agency, ESC, 1000 Bruxelles, Belgium
| |
Collapse
|
5
|
Kotecha D, Asselbergs FW, Achenbach S, Anker SD, Atar D, Baigent C, Banerjee A, Beger B, Brobert G, Casadei B, Ceccarelli C, Cowie MR, Crea F, Cronin M, Denaxas S, Derix A, Fitzsimons D, Fredriksson M, Gale CP, Gkoutos GV, Goettsch W, Hemingway H, Ingvar M, Jonas A, Kazmierski R, Løgstrup S, Thomas Lumbers R, Lüscher TF, McGreavy P, Piña IL, Roessig L, Steinbeisser C, Sundgren M, Tyl B, van Thiel G, van Bochove K, Vardas PE, Villanueva T, Vrana M, Weber W, Weidinger F, Windecker S, Wood A, Grobbee DE. CODE-EHR best practice framework for the use of structured electronic healthcare records in clinical research. Eur Heart J 2022; 43:3578-3588. [PMID: 36208161 PMCID: PMC9452067 DOI: 10.1093/eurheartj/ehac426] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/21/2022] [Indexed: 11/29/2022] Open
Abstract
Big data is central to new developments in global clinical science aiming to improve the lives of patients. Technological advances have led to the routine use of structured electronic healthcare records with the potential to address key gaps in clinical evidence. The covid-19 pandemic has demonstrated the potential of big data and related analytics, but also important pitfalls. Verification, validation, and data privacy, as well as the social mandate to undertake research are key challenges. The European Society of Cardiology and the BigData@Heart consortium have brought together a range of international stakeholders, including patient representatives, clinicians, scientists, regulators, journal editors and industry. We propose the CODE-EHR Minimum Standards Framework as a means to improve the design of studies, enhance transparency and develop a roadmap towards more robust and effective utilisation of healthcare data for research purposes.
Collapse
Affiliation(s)
- Dipak Kotecha
- Institute of Cardiovascular Sciences, University of Birmingham, Medical School, Birmingham, UK
- University Hospitals Birmingham NHS Foundation Trust and Health Data Research UK Midlands, Birmingham, UK
- Department of Cardiology, Division of Heart and Lungs, University Medical Centre Utrecht, University of Utrecht, Utrecht, Netherlands
| | - Folkert W Asselbergs
- Department of Cardiology, Division of Heart and Lungs, University Medical Centre Utrecht, University of Utrecht, Utrecht, Netherlands
- Institute of Cardiovascular Science, Faculty of Population Health Sciences, University College London, London, UK
- Health Data Research UK and Institute of Health Informatics, University College London, London, UK
| | - Stephan Achenbach
- Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Stefan D Anker
- Department of Cardiology and Berlin Institute of Health Centre for Regenerative Therapies, German Centre for Cardiovascular Research (DZHK) partner site Berlin; Charité Universitätsmedizin Berlin, Germany
| | - Dan Atar
- Department of Cardiology, Oslo University Hospital, Ulleval, Oslo, Norway
- University of Oslo, Institute of Clinical Medicine, Oslo, Norway
| | - Colin Baigent
- MRC Population Health Research Unit, Nuffield Department of Population Health, Oxford, UK
- Clinical Trial Service Unit and Epidemiological Studies Unit, University of Oxford, Oxford, UK
| | - Amitava Banerjee
- Health Data Research UK and Institute of Health Informatics, University College London, London, UK
- University College London Hospitals NHS Trust, London, UK
| | | | | | - Barbara Casadei
- Division of Cardiovascular Medicine, John Radcliffe Hospital, University of Oxford NIHR Oxford Biomedical Research Centre, Oxford, UK
| | | | - Martin R Cowie
- Royal Brompton Hospital, Division of Guy’s St Thomas’ NHS Foundation Trust, London, UK
- School of Cardiovascular Medicine Sciences, King’s College London, London, UK
| | - Filippo Crea
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
- European Heart Journal, Oxford University Press, University of Oxford, Oxford, UK
| | - Maureen Cronin
- Vifor Pharma, Glattbrugg, Switzerland and Ava AG, Zurich, Switzerland
| | - Spiros Denaxas
- Health Data Research UK and Institute of Health Informatics, University College London, London, UK
- Alan Turing Institute, London, UK
- British Heart Foundation Data Science Centre, London, UK
| | | | - Donna Fitzsimons
- School of Nursing and Midwifery, Queen’s University Belfast, Northern Ireland
| | - Martin Fredriksson
- Late Clinical Development, Cardiovascular, Renal and Metabolism (CVRM), Biopharmaceuticals RD, AstraZeneca, Gothenburg, Sweden
| | - Chris P Gale
- Leeds Institute of Cardiovascular and Metabolic Medicine and Leeds Institute for Data Analytics, University of Leeds, Leeds, UK
- Leeds Institute for Data Analytics, University of Leeds, Leeds, UK
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Georgios V Gkoutos
- University Hospitals Birmingham NHS Foundation Trust and Health Data Research UK Midlands, Birmingham, UK
- College of Medical and Dental Sciences, Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Wim Goettsch
- National Health Care Institute (ZIN), Diemen, Netherlands
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, Netherlands
| | - Harry Hemingway
- Health Data Research UK and Institute of Health Informatics, University College London, London, UK
| | - Martin Ingvar
- Department of Clinical Neuroscience, Karolinska Institutet, Solna, Sweden
- Department of Neuroradiology, Karolinska University Hospital Stockholm, Stockholm, Sweden
| | - Adrian Jonas
- Data and Analytics Group, National Institute for Health and Care Excellence, London, UK
| | - Robert Kazmierski
- Office of Cardiovascular Devices, US Food and Drug Administration, Silver Spring, MD, USA
| | | | - R Thomas Lumbers
- Health Data Research UK and Institute of Health Informatics, University College London, London, UK
- Barts Health NHS Trust and University College London Hospitals NHS Trust
| | - Thomas F Lüscher
- Centre for Molecular Cardiology, University of Zurich, Zurich, Switzerland
- Research, Education & Development, Royal Brompton and Harefield Hospitals, London, UK
- Faculty of Medicine, Imperial College London, London, UK
| | - Paul McGreavy
- European Society of Cardiology Patient Forum, European Society of Cardiology, Brussels, Belgium
| | - Ileana L Piña
- Central Michigan University College of Medicine, Midlands, MI, USA
- Centre for Devices and Radiological Health, US Food and Drug Administration, Silver Spring, MD, USA
| | | | - Carl Steinbeisser
- Bayer AG, Leverkusen, Germany
- Steinbeisser Project Management, Munich, Germany
| | - Mats Sundgren
- Data Science AI, Biopharmaceuticals RD, AstraZeneca, Gothenburg, Sweden
| | - Benoît Tyl
- Centre for Therapeutic Innovation, Cardiovascular and Metabolic Disease, Institut de Recherches Internationales Servier, Suresnes, France
| | - Ghislaine van Thiel
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, Netherlands
| | | | - Panos E Vardas
- Hygeia, Mitera, Hospitals Hellenic Health Group, Athens, Greece
- European Heart Agency, European Society of Cardiology, Brussels, Belgium
| | | | | | | | | | - Stephan Windecker
- Department of Cardiology, Inselspital, University Hospital Bern, Bern, Switzerland
| | - Angela Wood
- Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Diederick E Grobbee
- Department of Epidemiology, University Medical Centre Utrecht, Division Julius Centrum, Utrecht, Netherlands
| |
Collapse
|
6
|
Kotecha D, Asselbergs FW, Achenbach S, Anker SD, Atar D, Baigent C, Banerjee A, Beger B, Brobert G, Casadei B, Ceccarelli C, Cowie MR, Crea F, Cronin M, Denaxas S, Derix A, Fitzsimons D, Fredriksson M, Gale CP, Gkoutos GV, Goettsch W, Hemingway H, Ingvar M, Jonas A, Kazmierski R, Løgstrup S, Lumbers RT, Lüscher TF, McGreavy P, Piña IL, Roessig L, Steinbeisser C, Sundgren M, Tyl B, Thiel GV, Bochove KV, Vardas PE, Villanueva T, Vrana M, Weber W, Weidinger F, Windecker S, Wood A, Grobbee DE. CODE-EHR best-practice framework for the use of structured electronic health-care records in clinical research. Lancet Digit Health 2022; 4:e757-e764. [PMID: 36050271 DOI: 10.1016/s2589-7500(22)00151-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 07/20/2022] [Indexed: 11/16/2022]
Abstract
Big data is important to new developments in global clinical science that aim to improve the lives of patients. Technological advances have led to the regular use of structured electronic health-care records with the potential to address key deficits in clinical evidence that could improve patient care. The COVID-19 pandemic has shown this potential in big data and related analytics but has also revealed important limitations. Data verification, data validation, data privacy, and a mandate from the public to conduct research are important challenges to effective use of routine health-care data. The European Society of Cardiology and the BigData@Heart consortium have brought together a range of international stakeholders, including representation from patients, clinicians, scientists, regulators, journal editors, and industry members. In this Review, we propose the CODE-EHR minimum standards framework to be used by researchers and clinicians to improve the design of studies and enhance transparency of study methods. The CODE-EHR framework aims to develop robust and effective utilisation of health-care data for research purposes.
Collapse
Affiliation(s)
- Dipak Kotecha
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK; Health Data Research UK Midlands, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK; Department of Cardiology, Division of Heart and Lungs, University of Utrecht, Utrecht, Netherlands.
| | - Folkert W Asselbergs
- Health Data Research UK London, London, UK; Institute of Cardiovascular Science and Institute of Health Informatics, Faculty of Population Health Sciences, University College London, London, UK
| | - Stephan Achenbach
- Department of Cardiology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Stefan D Anker
- Department of Cardiology and Berlin Institute of Health Centre for Regenerative Therapies, German Centre for Cardiovascular Research, Charité Universitätsmedizin, Berlin, Germany
| | - Dan Atar
- Department of Cardiology, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Colin Baigent
- Medical Research Council Population Health Research Unit, Nuffield Department of Population Health, Oxford, UK; Clinical Trial Service Unit and Epidemiological Studies Unit, University of Oxford, Oxford, UK
| | - Amitava Banerjee
- Health Data Research UK London, London, UK; University College London Hospitals NHS Trust, London, UK
| | | | | | - Barbara Casadei
- Division of Cardiovascular Medicine, John Radcliffe Hospital, University of Oxford National Institute for Health and Care Research Oxford Biomedical Research Centre, Oxford, UK
| | | | - Martin R Cowie
- Royal Brompton Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK; School of Cardiovascular Medicine Sciences, King's College London, London, UK
| | - Filippo Crea
- European Heart Journal, Oxford University Press, University of Oxford, Oxford, UK; Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Maureen Cronin
- Vifor Pharma, Glattbrugg, Switzerland; Ava, Zurich, Switzerland
| | - Spiros Denaxas
- Health Data Research UK London, London, UK; Alan Turing Institute, London, UK; British Heart Foundation Data Science Centre, London, UK
| | | | - Donna Fitzsimons
- School of Nursing and Midwifery, Queen's University Belfast, Northern Ireland
| | - Martin Fredriksson
- Late Clinical Development, Cardiovascular, Renal and Metabolism, Biopharmaceuticals, AstraZeneca, Gothenburg, Sweden
| | - Chris P Gale
- Leeds Institute of Cardiovascular and Metabolic Medicine and Leeds Institute for Data Analytics, University of Leeds, Leeds, UK; Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Georgios V Gkoutos
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK; Health Data Research UK Midlands, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Wim Goettsch
- University Medical Centre Utrecht, and Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, University of Utrecht, Utrecht, Netherlands; National Health Care Institute, Diemen, Netherlands
| | | | - Martin Ingvar
- Department of Clinical Neuroscience, Karolinska Institutet, Solna, Sweden; Department of Neuroradiology, Karolinska University Hospital Stockholm, Stockholm, Sweden
| | - Adrian Jonas
- Data and Analytics Group, National Institute for Health and Care Excellence, London, UK
| | - Robert Kazmierski
- Office of Cardiovascular Devices, US Food and Drug Administration, Silver Spring, MD, USA
| | | | - R Thomas Lumbers
- Health Data Research UK London, London, UK; Institute of Health Informatics, Barts Health NHS Trust and University College London Hospitals NHS Trust, London, UK
| | - Thomas F Lüscher
- Centre for Molecular Cardiology, University of Zurich, Zurich, Switzerland; Research, Education and Development, Royal Brompton and Harefield Hospitals, London, UK; Faculty of Medicine, Imperial College London, London, UK
| | - Paul McGreavy
- European Society of Cardiology Patient Forum, European Society of Cardiology, Brussels, Belgium
| | - Ileana L Piña
- Centre for Devices and Radiological Health, US Food and Drug Administration, Silver Spring, MD, USA; College of Medicine, Central Michigan University, Midlands MI, USA
| | | | - Carl Steinbeisser
- Bayer, Leverkusen, Germany; Steinbeisser Project Management, Munich, Germany
| | - Mats Sundgren
- Data Science and Artificial Intelligence, Biopharmaceuticals, AstraZeneca, Gothenburg, Sweden
| | - Benoît Tyl
- Centre for Therapeutic Innovation, Cardiovascular and Metabolic Disease, Institut de Recherches Internationales Servier, Suresnes, France
| | - Ghislaine van Thiel
- Julius Center for Health Sciences and Primary Care, University of Utrecht, Utrecht, Netherlands
| | | | - Panos E Vardas
- Hygeia, Mitera, Hospitals Hellenic Health Group, Athens, Greece; European Heart Agency, European Society of Cardiology, Brussels, Belgium
| | | | | | - Wim Weber
- The British Medical Journal, London, UK
| | | | - Stephan Windecker
- Department of Cardiology, Inselspital, University Hospital Bern, Bern, Switzerland
| | - Angela Wood
- Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | | | | |
Collapse
|
7
|
Kotecha D, Asselbergs FW, Achenbach S, Anker SD, Atar D, Baigent C, Banerjee A, Beger B, Brobert G, Casadei B, Ceccarelli C, Cowie MR, Crea F, Cronin M, Denaxas S, Derix A, Fitzsimons D, Fredriksson M, Gale CP, Gkoutos GV, Goettsch W, Hemingway H, Ingvar M, Jonas A, Kazmierski R, Løgstrup S, Lumbers RT, Lüscher TF, McGreavy P, Piña IL, Roessig L, Steinbeisser C, Sundgren M, Tyl B, van Thiel G, van Bochove K, Vardas PE, Villanueva T, Vrana M, Weber W, Weidinger F, Windecker S, Wood A, Grobbee DE. CODE-EHR best practice framework for the use of structured electronic healthcare records in clinical research. BMJ 2022; 378:e069048. [PMID: 36562446 PMCID: PMC9403753 DOI: 10.1136/bmj-2021-069048] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/21/2022] [Indexed: 12/27/2022]
Affiliation(s)
- Dipak Kotecha
- Institute of Cardiovascular Sciences, University of Birmingham, Medical School, Birmingham, UK
- Department of Cardiology, Division of Heart and Lungs, University Medical Centre Utrecht, University of Utrecht, Utrecht, Netherlands
| | - Folkert W Asselbergs
- Department of Cardiology, Division of Heart and Lungs, University Medical Centre Utrecht, University of Utrecht, Utrecht, Netherlands
- Health Data Research UK and Institute of Health Informatics, University College London, London, UK
| | - Stephan Achenbach
- Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Stefan D Anker
- Department of Cardiology and Berlin Institute of Health Centre for Regenerative Therapies, German Centre for Cardiovascular Research (DZHK) partner site Berlin; Charité Universitätsmedizin Berlin, Germany
| | - Dan Atar
- Department of Cardiology, Oslo University Hospital, Ulleval, Oslo, Norway
- University of Oslo, Institute of Clinical Medicine, Oslo, Norway
| | - Colin Baigent
- MRC Population Health Research Unit, Nuffield Department of Population Health, Oxford, UK
- Clinical Trial Service Unit and Epidemiological Studies Unit, University of Oxford, Oxford, UK
| | - Amitava Banerjee
- Health Data Research UK and Institute of Health Informatics, University College London, London, UK
- University College London Hospitals NHS Trust, London, UK
| | | | | | - Barbara Casadei
- Division of Cardiovascular Medicine, John Radcliffe Hospital, University of Oxford NIHR Oxford Biomedical Research Centre, Oxford, UK
| | | | - Martin R Cowie
- Royal Brompton Hospital, Division of Guy's St Thomas' NHS Foundation Trust, London, UK
- School of Cardiovascular Medicine Sciences, King's College London, London, UK
| | - Filippo Crea
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
- European Heart Journal, Oxford University Press, University of Oxford, Oxford, UK
| | - Maureen Cronin
- Vifor Pharma, Glattbrugg, Switzerland and Ava AG, Zurich, Switzerland
| | - Spiros Denaxas
- Health Data Research UK and Institute of Health Informatics, University College London, London, UK
- Alan Turing Institute, London, UK
- British Heart Foundation Data Science Centre, London, UK
| | | | - Donna Fitzsimons
- School of Nursing and Midwifery, Queen's University Belfast, Northern Ireland
| | - Martin Fredriksson
- Late Clinical Development, Cardiovascular, Renal and Metabolism (CVRM), Biopharmaceuticals RD, AstraZeneca, Gothenburg, Sweden
| | - Chris P Gale
- Leeds Institute of Cardiovascular and Metabolic Medicine and Leeds Institute for Data Analytics, University of Leeds, Leeds, UK
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Georgios V Gkoutos
- University Hospitals Birmingham NHS Foundation Trust and Health Data Research UK Midlands, Birmingham, UK
- College of Medical and Dental Sciences, Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Wim Goettsch
- National Health Care Institute (ZIN), Diemen, Netherlands
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, Netherlands
| | - Harry Hemingway
- Health Data Research UK and Institute of Health Informatics, University College London, London, UK
| | - Martin Ingvar
- Department of Clinical Neuroscience, Karolinska Institutet, Solna, Sweden
- Department of Neuroradiology, Karolinska University Hospital Stockholm, Stockholm, Sweden
| | - Adrian Jonas
- Data and Analytics Group, National Institute for Health and Care Excellence, London, UK
| | - Robert Kazmierski
- Office of Cardiovascular Devices, US Food and Drug Administration, Silver Spring, MD, USA
| | | | - R Thomas Lumbers
- Health Data Research UK and Institute of Health Informatics, University College London, London, UK
- Barts Health NHS Trust and University College London Hospitals NHS Trust
| | - Thomas F Lüscher
- Centre for Molecular Cardiology, University of Zurich, Zurich, Switzerland
- Faculty of Medicine, Imperial College London, London, UK
| | - Paul McGreavy
- European Society of Cardiology Patient Forum, European Society of Cardiology, Brussels, Belgium
| | - Ileana L Piña
- Central Michigan University College of Medicine, Midlands, MI, USA
- Centre for Devices and Radiological Health, US Food and Drug Administration, Silver Spring, MD, USA
| | | | - Carl Steinbeisser
- Bayer AG, Leverkusen, Germany
- Steinbeisser Project Management, Munich, Germany
| | - Mats Sundgren
- Data Science AI, Biopharmaceuticals RD, AstraZeneca, Gothenburg, Sweden
| | - Benoît Tyl
- Centre for Therapeutic Innovation, Cardiovascular and Metabolic Disease, Institut de Recherches Internationales Servier, Suresnes, France
| | - Ghislaine van Thiel
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, Netherlands
| | | | - Panos E Vardas
- Hygeia, Mitera, Hospitals Hellenic Health Group, Athens, Greece
- European Heart Agency, European Society of Cardiology, Brussels, Belgium
| | | | | | | | | | - Stephan Windecker
- Department of Cardiology, Inselspital, University Hospital Bern, Bern, Switzerland
| | - Angela Wood
- Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Diederick E Grobbee
- Department of Epidemiology, University Medical Centre Utrecht, Division Julius Centrum, Utrecht, Netherlands
| |
Collapse
|
8
|
van Smeden M, Heinze G, Van Calster B, Asselbergs FW, Vardas PE, Bruining N, de Jaegere P, Moore JH, Denaxas S, Boulesteix AL, Moons KGM. Critical appraisal of artificial intelligence-based prediction models for cardiovascular disease. Eur Heart J 2022; 43:2921-2930. [PMID: 35639667 PMCID: PMC9443991 DOI: 10.1093/eurheartj/ehac238] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [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: 11/09/2021] [Revised: 03/29/2022] [Accepted: 04/26/2022] [Indexed: 11/12/2022] Open
Abstract
The medical field has seen a rapid increase in the development of artificial intelligence (AI)-based prediction models. With the introduction of such AI-based prediction model tools and software in cardiovascular patient care, the cardiovascular researcher and healthcare professional are challenged to understand the opportunities as well as the limitations of the AI-based predictions. In this article, we present 12 critical questions for cardiovascular health professionals to ask when confronted with an AI-based prediction model. We aim to support medical professionals to distinguish the AI-based prediction models that can add value to patient care from the AI that does not.
Collapse
Affiliation(s)
- Maarten van Smeden
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Universiteitsweg 100, 3584 CG Utrecht, The Netherlands
| | - Georg Heinze
- Section for Clinical Biometrics, Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria
| | - Ben Van Calster
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium.,EPI Centre, KU Leuven, Leuven, Belgium.,Department of Biomedical Data Sciences, Leiden University Medical Centre, Leiden, The Netherlands
| | - Folkert W Asselbergs
- Department of Cardiology, Division Heart and Lungs, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.,Institute of Cardiovascular Science, Faculty of Population Health Sciences, University College London, London, UK.,Health Data Research UK and Institute of Health Informatics, University College London, London, UK
| | - Panos E Vardas
- Department of Cardiology, Heraklion University Hospital, Heraklion, Greece.,Heart Sector, Hygeia Hospitals Group, Athens, Greece
| | - Nico Bruining
- Department of Cardiology, Erasmus MC , Thorax Center, Rotterdam, The Netherlands
| | - Peter de Jaegere
- Department of Cardiology, Erasmus MC, Thorax Center, Rotterdam, The Netherlands
| | - Jason H Moore
- Department of Computational Biomedicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Spiros Denaxas
- Health Data Research UK and Institute of Health Informatics, University College London, London, UK.,The Alan Turing Institute, London, UK
| | - Anne Laure Boulesteix
- Institute for Medical Information Processing, Biometry and Epidemiology, LMU Munich, Germany
| | - Karel G M Moons
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Universiteitsweg 100, 3584 CG Utrecht, The Netherlands
| |
Collapse
|
9
|
Xintarakou A, Sousonis V, Asvestas D, Vardas PE, Tzeis S. Remote Cardiac Rhythm Monitoring in the Era of Smart Wearables: Present Assets and Future Perspectives. Front Cardiovasc Med 2022; 9:853614. [PMID: 35299975 PMCID: PMC8921479 DOI: 10.3389/fcvm.2022.853614] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 02/08/2022] [Indexed: 12/14/2022] Open
Abstract
Remote monitoring and control of heart function are of primary importance for patient evaluation and management, especially in the modern era of precision medicine and personalized approach. Breaking technological developments have brought to the frontline a variety of smart wearable devices, such as smartwatches, chest patches/straps, or sensors integrated into clothing and footwear, which allow continuous and real-time recording of heart rate, facilitating the detection of cardiac arrhythmias. However, there is great diversity and significant differences in the type and quality of the information they provide, thus impairing their integration into daily clinical practice and the relevant familiarization of practicing physicians. This review will summarize the different types and dominant functions of cardiac smart wearables available in the market. Furthermore, we report the devices certified by official American and/or European authorities and the respective sources of evidence. Finally, we comment pertinent limitations and caveats as well as the potential answers that flow from the latest technological achievements and future perspectives.
Collapse
Affiliation(s)
| | | | | | - Panos E Vardas
- Heart Sector, Hygeia Hospitals Group, HHG, Athens, Greece.,European Heart Agency, European Society of Cardiology, Brussels, Belgium
| | - Stylianos Tzeis
- Department of Cardiology, Hygeia Group, Mitera Hospital, Athens, Greece
| |
Collapse
|
10
|
Vardas PE, Asselbergs FW, van Smeden M, Friedman P. The year in cardiovascular medicine 2021: digital health and innovation. Eur Heart J 2022; 43:271-279. [PMID: 34974610 DOI: 10.1093/eurheartj/ehab874] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 11/15/2021] [Accepted: 11/23/2021] [Indexed: 12/15/2022] Open
Abstract
This article presents some of the most important developments in the field of digital medicine that have appeared over the last 12 months and are related to cardiovascular medicine. The article consists of three main sections, as follows: (i) artificial intelligence-enabled cardiovascular diagnostic tools, techniques, and methodologies, (ii) big data and prognostic models for cardiovascular risk protection, and (iii) wearable devices in cardiovascular risk assessment, cardiovascular disease prevention, diagnosis, and management. To conclude the article, the authors present a brief further prospective on this new domain, highlighting existing gaps that are specifically related to artificial intelligence technologies, such as explainability, cost-effectiveness, and, of course, the importance of proper regulatory oversight for each clinical implementation.
Collapse
Affiliation(s)
- Panos E Vardas
- Heart Sector, Hygeia Hospitals Group, HHG, 5, Erithrou Stavrou, Marousi, Athens 15123, Greece.,European Heart Agency, ESC, Brussels, Belgium
| | - Folkert W Asselbergs
- Department of Cardiology, Division of Heart & Lungs, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.,Health Data Research UK and Institute of Health Informatics, University College London, London, UK
| | - Maarten van Smeden
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Paul Friedman
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| |
Collapse
|
11
|
de Vries TI, Cooney MT, Selmer RM, Hageman SHJ, Pennells LA, Wood A, Kaptoge S, Xu Z, Westerink J, Rabanal KS, Tell GS, Meyer HE, Igland J, Ariansen I, Matsushita K, Blaha MJ, Nambi V, Peters R, Beckett N, Antikainen R, Bulpitt CJ, Muller M, Emmelot-Vonk MH, Trompet S, Jukema W, Ference BA, Halle M, Timmis AD, Vardas PE, Dorresteijn JAN, De Bacquer D, Di Angelantonio E, Visseren FLJ, Graham IM. SCORE2-OP risk prediction algorithms: estimating incident cardiovascular event risk in older persons in four geographical risk regions. Eur Heart J 2021; 42:2455-2467. [PMID: 34120185 PMCID: PMC8248997 DOI: 10.1093/eurheartj/ehab312] [Citation(s) in RCA: 165] [Impact Index Per Article: 55.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 03/09/2021] [Accepted: 05/07/2021] [Indexed: 12/21/2022] Open
Abstract
AIMS The aim of this study was to derive and validate the SCORE2-Older Persons (SCORE2-OP) risk model to estimate 5- and 10-year risk of cardiovascular disease (CVD) in individuals aged over 70 years in four geographical risk regions. METHODS AND RESULTS Sex-specific competing risk-adjusted models for estimating CVD risk (CVD mortality, myocardial infarction, or stroke) were derived in individuals aged over 65 without pre-existing atherosclerotic CVD from the Cohort of Norway (28 503 individuals, 10 089 CVD events). Models included age, smoking status, diabetes, systolic blood pressure, and total- and high-density lipoprotein cholesterol. Four geographical risk regions were defined based on country-specific CVD mortality rates. Models were recalibrated to each region using region-specific estimated CVD incidence rates and risk factor distributions. For external validation, we analysed data from 6 additional study populations {338 615 individuals, 33 219 CVD validation cohorts, C-indices ranged between 0.63 [95% confidence interval (CI) 0.61-0.65] and 0.67 (0.64-0.69)}. Regional calibration of expected-vs.-observed risks was satisfactory. For given risk factor profiles, there was substantial variation across the four risk regions in the estimated 10-year CVD event risk. CONCLUSIONS The competing risk-adjusted SCORE2-OP model was derived, recalibrated, and externally validated to estimate 5- and 10-year CVD risk in older adults (aged 70 years or older) in four geographical risk regions. These models can be used for communicating the risk of CVD and potential benefit from risk factor treatment and may facilitate shared decision-making between clinicians and patients in CVD risk management in older persons.
Collapse
|
12
|
Angelaki E, Marketou ME, Barmparis GD, Patrianakos A, Vardas PE, Parthenakis F, Tsironis GP. Detection of abnormal left ventricular geometry in patients without cardiovascular disease through machine learning: An ECG-based approach. J Clin Hypertens (Greenwich) 2021; 23:935-945. [PMID: 33507615 PMCID: PMC8678829 DOI: 10.1111/jch.14200] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 01/07/2021] [Accepted: 01/10/2021] [Indexed: 01/19/2023]
Abstract
Cardiac remodeling is recognized as an important aspect of cardiovascular disease (CVD) progression. Machine learning (ML) techniques were applied to basic clinical parameters and electrocardiographic features, in order to detect abnormal left ventricular geometry (LVG) even before the onset of left ventricular hypertrophy (LVH), in a population without established CVD. The authors enrolled 528 patients with and without essential hypertension, but no other indications of CVD. All patients underwent a full echocardiographic evaluation and were classified into 3 groups; normal geometry (NG), concentric remodeling without LVH (CR), and LVH. Abnormal LVG was identified as increased relative wall thickness (RWT) and/or left ventricular mass index (LVMi). The authors trained supervised ML models to classify patients with abnormal LVG and calculated SHAP values to perform feature importance and interaction analysis. Hypertension, age, body mass index over the Sokolow‐Lyon voltage, QRS‐T angle, and QTc duration were some of the most important features. Our model was able to distinguish NG from CR+LVH combined, with 87% accuracy on an unseen test set, 75% specificity, 97% sensitivity, and area under the receiver operating curve (AUC/ROC) equal to 0.91. The authors also trained our model to classify NG and CR (NG + CR) against those with LVH, with 89% test set accuracy, 93% specificity, 67% sensitivity, and an AUC/ROC value of 0.89, for a 0.4 decision threshold. Our ML algorithm effectively detects abnormal LVG even at early stages. Innovative solutions are needed to improve risk stratification of patients without established CVD, and ML may enable progress in this direction.
Collapse
Affiliation(s)
- Eleni Angelaki
- Institute of Theoretical and Computational Physics and Department of Physics, University of Crete, Heraklion, Greece.,Harvard John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA, USA
| | - Maria E Marketou
- Department of Cardiology, Heraklion University Hospital, Heraklion, Greece
| | - Georgios D Barmparis
- Institute of Theoretical and Computational Physics and Department of Physics, University of Crete, Heraklion, Greece
| | | | - Panos E Vardas
- Department of Cardiology, Heraklion University Hospital, Heraklion, Greece.,Heart Sector, Hygeia Hospitals Group, Athens, Greece
| | | | - Giorgos P Tsironis
- Institute of Theoretical and Computational Physics and Department of Physics, University of Crete, Heraklion, Greece.,Harvard John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA, USA
| |
Collapse
|
13
|
Marketou ME, Vlachopoulos C, Hahalis G, Kafkala K, Kouvelas N, Mantas I, Sideris A, Pisimisis E, Vardas EP, Tzeis S, Vardas PE. Clinical characteristics and management of patients with diabetes mellitus and stable coronary artery disease in daily clinical practice. The SCAD-DM Registry. Hellenic J Cardiol 2021; 62:408-415. [PMID: 33412238 DOI: 10.1016/j.hjc.2020.12.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 12/05/2020] [Accepted: 12/29/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Patients with diabetes mellitus (DM) and coronary artery disease (CAD) represent a high-risk population, where comorbidities are common and the progression of coronary heart disease is relatively rapid and extensive. The present survey, conducted nationwide in a Eurozone country, Greece, with a properly organized national health system, aimed to record specific data from a significant number of patients with diabetes and documented stable CAD (SCAD). METHODS AND RESULTS We conducted our survey across the country, in private and public primary, secondary, and tertiary care centers. A total of 1900 patients aged 71 ± 10 years old who suffered from both DM and chronic coronary syndromes were registered. Of the patients registered, 574 (30.24%) were women. It was found that 506 (26.6%) of the 1900 surveyed patients showed typical angina symptoms, while another 560 (29.5%) patients had developed angina-equivalent symptoms according to their history. Additionally, 324 (17%) patients had atypical symptoms that could not easily be attributed to existing CAD and the remaining 510 (26.8%) of the 1900 patients did not exhibit any angina symptoms during their daily activities. Functional testing for myocardial ischemia was not performed in 833 patients (43.8%). Myocardial scintigraphy was the most commonly used noninvasive technique (644 patients, 34%), while 492 patients (25.9%) had an exercise test and 159 (8.4%) underwent stress echocardiography. CONCLUSION Real-world data in this specific high-risk population of diabetic patients with SCAD offer the opportunity to identify and improve diagnostic and therapeutic practice in the healthcare system of a European Union country.
Collapse
Affiliation(s)
| | - Charalambos Vlachopoulos
- 1(st) Cardiology Clinic, National and Kapodistrian University of Athens, School of Medicine, Hippokration General Hospital, Athens, Greece
| | - George Hahalis
- Cardiology Dpt., Patras University School of Medicine, Patras, Greece
| | | | | | - Ioannis Mantas
- Cardiology Dpt., Chalkida General Hospital, Chalkida, Greece
| | - Antonios Sideris
- Second State Department of Cardiology, "Evangelismos" Hospital, Athens, Greece
| | | | | | - Stylianos Tzeis
- Cardiology Dpt., Mitera Hospital, Hygeia Group, Athens, Greece
| | - Panos E Vardas
- Cardiology Dpt., Mitera Hospital, Hygeia Group, Athens, Greece
| |
Collapse
|
14
|
Kapelios CJ, Naci H, Vardas PE, Mossialos E. Study design, result posting and publication of late-stage cardiovascular trials. Eur Heart J Qual Care Clin Outcomes 2020; 8:277-288. [PMID: 33098422 DOI: 10.1093/ehjqcco/qcaa080] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 10/07/2020] [Accepted: 10/09/2020] [Indexed: 12/13/2022]
Abstract
AIMS Pre-registration of study protocols in accessible databases is required for publication of study results in high-impact medical journals. Nonetheless, data on characteristics of clinical trials registered in these databases and their outcome, in terms of result reporting and publication are limited. METHODS AND RESULTS We searched for interventional, late-phase cardiovascular disease (CVD) studies in adults registered in Clinicaltrials.gov. first posted after 1/1/2013 and completed up to 31/12/2018. Data on study design, result reporting and publication were collected, and potential associations with a pre-defined set of explanatory factors were examined.In total, 250 CVD trials were included in the analysis. Of these, 193 (77.2%) were randomized studies, 99 (39.6%) open label designs, and 126 (50.4%) had industry as main sponsor. 179 trials (71.6%) evaluated the effect of drugs and 27 (10.8%) evaluated devices. The most common primary outcomes were non-clinical endpoints (76.0%), with only 17% of studies evaluating clinical endpoints. Industry-funded trials focused on patent-protected drugs and devices more often than non-industry-funded trials (72.0% vs. 30.6%, P < 0.001 and 55.0% vs. 26.3%, P = 0.033, respectively). Sixty three studies (25.2%) had results posted on clinicaltrials.gov, and 116 (46.4%) had results published in the scientific literature. In multivariate analysis, industry sponsorship was statistically significantly associated with results posting (OR: 3.38; 95% CI: 1.56-7.30, P = 0.002) and publication (OR: 0.41; 95% CI: 0.23-0.75, P = 0.004). CONCLUSION Among late-stage cardiovascular trials only 1/4 had results posted on clinicaltrials.gov and <50% had results published. Industry sponsors were more likely to invest in research on patent-protected drugs and devices than were non-industry sponsors. Industry-sponsored studies were more likely to have their results posted, but less likely to have their results published in the scientific literature.
Collapse
Affiliation(s)
- Chris J Kapelios
- Laiko General Hospital, Athens, Greece.,Department of Health Policy, London School of Economics and Political Science, London, U.K
| | - Huseyin Naci
- Department of Health Policy, London School of Economics and Political Science, London, U.K
| | | | - Elias Mossialos
- Department of Health Policy, London School of Economics and Political Science, London, U.K
| |
Collapse
|
15
|
Papakonstantinou PE, Malliou A, Chlouverakis G, Kallergis E, Mavrakis H, Parthenakis F, Vardas PE, Simantirakis EN. Impact of Sustained Cardiac Tachyarrhythmias Recorded in Coronary Intensive Care Unit on Short- and Long-Term Mortality and Duration of Hospitalization. J Intensive Care Med 2020; 36:775-782. [PMID: 32274959 DOI: 10.1177/0885066620918790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Studies conducted in coronary intensive care units (CICUs) have demonstrated that tachyarrhythmias are associated with increased mortality after acute coronary syndromes (ACSs). However, the data for tachyarrhythmias occurred in CICUs due to a variety of cardiovascular disorders are limited. METHODS We conducted a single-center prospective observational study, which included consecutive CICU patients (January 1, 2014 to May 31, 2018). We recorded the ventricular arrhythmias (VAs), supraventricular tachycardias (SVTs), and days of CICU hospitalization. The patients were followed up for 6 months after CICU discharge. RESULTS A total of 943 patients (age: 66.37 ±15.4 years; 673 males [71.4%]) were included. Patients with tachyarrhythmias had higher in-CICU mortality (8.0% vs 4.1%, P = .029, odds ratio [OR]: 2.04, 95% confidence interval [CI]: 1.08-3.86) and higher 6-month all-cause mortality (12.8% vs 6.1%, P = .002, OR: 2.27, 95% CI: 1.35-3.83) than those who did not develop tachyarrhythmias. Ventricular arrhythmias was significantly associated with higher all-cause mortality than no tachyarrhythmia (15.4% vs 6.1%; P = .001) or SVTs (15.4% vs 7.0%; P = .001). The mean duration of hospitalization for the patients with tachyarrhythmias was 3.89 ± 4.90 days, while for the patients without was 2.79 ± 3.31 days (P < .001). Patients without ACS had higher short- and long-term mortality compared to patients with ACS (9.2% vs 2.9%, P < .001 and 12.9% vs 4.9%, P < .001). CONCLUSIONS Tachyarrhythmias were associated with prolonged CICU hospitalization, while non-ACS cardiovascular disorders and the occurrence of VAs were associated with increased short- and long-term mortality.
Collapse
Affiliation(s)
- Panteleimon E Papakonstantinou
- Department of Cardiology, University Hospital of Heraklion, School of Medicine, University of Crete, Heraklion, Crete, Greece
| | - Angelliki Malliou
- Department of Cardiology, University Hospital of Heraklion, School of Medicine, University of Crete, Heraklion, Crete, Greece
| | - Gregory Chlouverakis
- Biostatistics Lab, School of Medicine, 37777University of Crete, Heraklion, Crete, Greece
| | - Eleftherios Kallergis
- Department of Cardiology, University Hospital of Heraklion, School of Medicine, University of Crete, Heraklion, Crete, Greece
| | - Hercules Mavrakis
- Department of Cardiology, University Hospital of Heraklion, School of Medicine, University of Crete, Heraklion, Crete, Greece
| | - Frangiskos Parthenakis
- Department of Cardiology, University Hospital of Heraklion, School of Medicine, University of Crete, Heraklion, Crete, Greece
| | - Panos E Vardas
- Department of Cardiology, University Hospital of Heraklion, School of Medicine, University of Crete, Heraklion, Crete, Greece
| | - Emmanuel N Simantirakis
- Department of Cardiology, University Hospital of Heraklion, School of Medicine, University of Crete, Heraklion, Crete, Greece
| |
Collapse
|
16
|
Nakou ES, Marketou ME, Patrianakos A, Protonotarios A, Vardas PE, Parthenakis FI. Short-term effects of angiotensin receptor-neprilysin inhibitors on diastolic strain and tissue doppler parameters in heart failure patients with reduced ejection fraction: A pilot trial. Hellenic J Cardiol 2019; 61:415-418. [PMID: 31866286 DOI: 10.1016/j.hjc.2019.12.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Revised: 12/03/2019] [Accepted: 12/05/2019] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE Although sacubitril/valsartan has recently shown its long-term benefits on morbidity and mortality in symptomatic patients with chronic heart failure with reduced ejection fraction (HFrEF), its short-term effects on diastolic function remain uncertain. We sought to assess 30-day effects of sacubitril/valsartan on left ventricular (LV) diastolic paremeters determined by speckle tracking and tissue Doppler imaging (STI and TDI respectively) as well as their association with functional capacity change evaluated by peak oxygen uptake (VO2max) in stable patients with symptomatic HFrEF. METHODS A total of 35 patients (aged 61 ± 9 years) eligible for sacubitril/valsartan underwent a complete two-dimension (2D) echocardiographic study and a cardiopulmonary exercise test at baseline and 30 days after the initiation of therapy. RESULTS Significant improvements in ratio of trans-mitral inflow early diastolic velocity E to mitral annulus early diastolic velocity E' (ΔΕ//Ε' = -35.9%, p = 0.001), peak early diastolic strain rate SRE (ΔSRE = +22.5%, p = 0.024) and ratio E/SRE (ΔE/SRE = -33.2%, p = 0.025) were observed after 1-month therapy. Compared with baseline, VO2max also increased significantly by 16.7 % (p = 0.001). Baseline E/SRE and ΔE/SRE were the strongest independent predictors of VO2max improvement (beta = -0.43, p = 0.004 and beta = 0.45, p = 0.021 respectively) in the multivariate analysis. CONCLUSION Sacubitril/valsartan was associated with early improvement in LV diastolic function determined by TDI and 2D STI. Baseline E/SRE was stronger than standard echocardiographic parameters in predicting the early benefit of sacubitril/valsartan therapy.
Collapse
Affiliation(s)
- Eleni S Nakou
- Department of Cardiology, King's College Hospital NHS Foundation Trust, London, United Kingdom; Barts Heart Centre, St Bartholomew's Hospital, Institute of Cardiovascular Science, United Kingdom.
| | | | | | - Alexandros Protonotarios
- Barts Heart Centre, St Bartholomew's Hospital, Institute of Cardiovascular Science, United Kingdom
| | - Panos E Vardas
- Department of Cardiology, Heraklion University Hospital, Greece
| | | |
Collapse
|
17
|
Marketou ME, Maragkoudakis S, Fragiadakis K, Konstantinou J, Patrianakos A, Kassotakis S, Anastasiou I, Alevizaki A, Kostaki A, Chlouverakis G, Vardas PE, Parthenakis FI. Long‐term outcome of hypertensive patients with heart failure with mid‐range ejection fraction: The significance of blood pressure control. J Clin Hypertens (Greenwich) 2019; 21:1124-1131. [DOI: 10.1111/jch.13626] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Revised: 05/01/2019] [Accepted: 05/21/2019] [Indexed: 12/28/2022]
Affiliation(s)
| | | | | | | | | | | | | | | | - Artemis Kostaki
- Department of Cardiology Heraklion University Hospital Crete Greece
| | | | - Panos E. Vardas
- Department of Cardiology Heraklion University Hospital Crete Greece
| | | |
Collapse
|
18
|
Kotecha D, Bax JJ, Carrera C, Casadei B, Merkely B, Anker SD, Vardas PE, Kearney PP, Roffi M, Ros M, Vahanian A, Weidinger F, Beeri R, Budaj A, Calabrò P, Czerwińska-Jelonkiewicz K, D'Ascenzi F, De Potter T, Fox KF, Hartikainen J, McAdam B, Milicic D, Pasquet AA, Sionis A, Sohaib SMA, Tsioufis C, Verhorst PMJ, Kirchhof P. Roadmap for cardiovascular education across the European Society of Cardiology: inspiring better knowledge and skills, now and for the future. Eur Heart J 2019; 40:1728-1738. [PMID: 30226525 DOI: 10.1093/eurheartj/ehy058] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 11/14/2017] [Accepted: 01/24/2018] [Indexed: 11/13/2022] Open
Abstract
AIMS The provision of high-quality education allows the European Society of Cardiology (ESC) to achieve its mission of better cardiovascular practice and provides an essential component of translating new evidence to improve outcomes. METHODS AND RESULTS The 4th ESC Education Conference, held in Sophia Antipolis (December 2016), brought together ESC education leaders, National Directors of Training of 43 ESC countries, and representatives of the ESC Young Community. Integrating national descriptions of education and cardiology training, we discussed innovative pathways to further improve knowledge and skills across different training programmes and health care systems. We developed an ESC roadmap supporting better cardiology training and continued medical education (CME), noting: (i) The ESC provides an excellent framework for unbiased and up-to-date cardiovascular education in close cooperation with its National Societies. (ii) The ESC should support the harmonization of cardiology training, curriculum development, and professional dialogue and mentorship. (iii) ESC congresses are an essential forum to learn and discuss the latest developments in cardiovascular medicine. (iv) The ESC should create a unified, interactive educational platform for cardiology training and continued cardiovascular education combining Webinars, eLearning Courses, Clinical Cases, and other educational programmes, along with ESC Congress content, Practice Guidelines and the next ESC Textbook of Cardiovascular Medicine. (v) ESC-delivered online education should be integrated into National and regional cardiology training and CME programmes. CONCLUSION These recommendations support the ESC to deliver excellent and comprehensive cardiovascular education for the next generation of specialists. Teamwork between international, national and local partners is essential to achieve this objective.
Collapse
|
19
|
Marketou ME, Maragkoudakis S, Anastasiou I, Nakou H, Plataki M, Vardas PE, Parthenakis FI. Salt-induced effects on microvascular function: A critical factor in hypertension mediated organ damage. J Clin Hypertens (Greenwich) 2019; 21:749-757. [PMID: 31002481 DOI: 10.1111/jch.13535] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 03/07/2019] [Accepted: 03/19/2019] [Indexed: 12/17/2022]
Abstract
Salt has been linked very closely to the occurrence and complications of arterial hypertension. A large percentage of patients with essential hypertension are salt-sensitive; that is, their blood pressure increases with increased salt intake and decreases with its reduction. For this reason, emphasis is placed on reducing salt intake to better regulate blood pressure. In day-to-day clinical practice this is viewed as mandatory for hypertensive patients who are judged to be salt-sensitive. Previous studies have highlighted the negative effect of high-salt diets on macrovascular function, which also affects blood pressure levels by increasing peripheral resistances. More recent studies provide a better overview of the pathophysiology of microvascular disorders and show that they are largely due to the overconsumption of salt. Microvascular lesions, which have a major impact on the functioning of vital organs, are often not well recognized in clinical practice and are not paid sufficient attention. In general, the damage caused by hypertension to the microvascular network is likely to be overlooked, while reversion of the damage is only rarely considered as a therapeutic target by the treating physician. The purpose of this review is to summarize the impact and the harmful consequences of increased salt consumption in the microvascular network, their significance and pathophysiology, and at the same time to place some emphasis on their treatment and reversion, mainly through diet.
Collapse
Affiliation(s)
- Maria E Marketou
- Department of Cardiology, Heraklion University Hospital, Heraklion, Greece
| | | | - Ioannis Anastasiou
- Department of Cardiology, Heraklion University Hospital, Heraklion, Greece
| | - Helen Nakou
- Barts Heart Centre, St Bartholomew's Hospital, London, UK
| | - Marina Plataki
- Department of Cardiology, Heraklion University Hospital, Heraklion, Greece
| | - Panos E Vardas
- Department of Cardiology, Heraklion University Hospital, Heraklion, Greece
| | | |
Collapse
|
20
|
Kontaraki JE, Marketou ME, Kochiadakis GE, Maragkoudakis S, Konstantinou J, Vardas PE, Parthenakis FI. The long non-coding RNAs MHRT
,FENDRR
and CARMEN
, their expression levels in peripheral blood mononuclear cells in patients with essential hypertension and their relation to heart hypertrophy. Clin Exp Pharmacol Physiol 2018; 45:1213-1217. [DOI: 10.1111/1440-1681.12997] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 05/23/2018] [Accepted: 06/17/2018] [Indexed: 12/16/2022]
Affiliation(s)
- Joanna E. Kontaraki
- Molecular Cardiology Laboratory; School of Medicine; University of Crete; Heraklion Greece
| | - Maria E. Marketou
- Department of Cardiology; Heraklion University Hospital; Heraklion Greece
| | | | | | - John Konstantinou
- Department of Cardiology; Heraklion University Hospital; Heraklion Greece
| | - Panos E. Vardas
- Department of Cardiology; Heraklion University Hospital; Heraklion Greece
| | | |
Collapse
|
21
|
Nakou ES, Marketou ME, Chlouverakis GI, Patrianakos AP, Vardas PE, Parthenakis FI. Troponin-I levels as a potential prognostic biomarker of sacubitril/valsartan treatment response in heart failure with reduced ejection fraction: Who will benefit most? Clin Cardiol 2018; 41:1548-1554. [PMID: 30324615 DOI: 10.1002/clc.23099] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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: 04/04/2018] [Revised: 09/29/2018] [Accepted: 10/10/2018] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Despite robust data on the benefits of sacubitril/valsartan (LCZ696) in patients with chronic heart failure with reduced ejection fraction (HFrEF), there is no evidence yet on prespecified predictive markers of its efficacy. Hypothesis The objective of this study was to identify potential prognostic factors of LCZ696 treatment response. METHODS We included 48 symptomatic patients with chronic HFrEF (left ventricular ejection fraction ≤35%) and New York Heart Association (NYHA) class II/III: Group A (N = 23) received LCZ696 (105 ± 30 mg twice daily), whereas it was not prescribed in group B (N = 25) according to physician's judgment. Analysis of biochemical parameters, cardiopulmonary exercise testing, and echocardiographic evaluation was performed at baseline and 6 months later. RESULTS The baseline serum troponin-I levels (TnI) and peak oxygen uptake (VO2 max) were positively associated with the increase in VO2 max (ΔVO2 max = +14.11%, P < 0.05 vs group B) after sacubitril/valsartan treatment (r = 0.68, P = 0.001 and r = 0.57, P = 0.004, respectively). Positive correlations were reported between ΔVO2 max and the improvements in the ratio of early diastolic filling to myocardial tissue velocity (ΔE/E') and the tricuspid annular peak systolic velocity (ΔSa) in group A (r = 0.58, P = 0.004 and r = 0.60, P = 0.002, respectively). In multiple regression analysis, ΔVO2 max was correlated significantly with TnI (beta = 0.35, P = 0.048), ΔE/E' (beta = 0.36, P = 0.031) and ΔSa (beta = 0.37, P = 0.035). CONCLUSIONS TnI levels may be an independent predictive marker of sacubitril/valsartan efficacy in HFrEF.
Collapse
Affiliation(s)
- Eleni S Nakou
- Department of Cardiology, Heraklion University Hospital, University of Crete, Crete, Greece
| | - Maria E Marketou
- Department of Cardiology, Heraklion University Hospital, University of Crete, Crete, Greece
| | | | | | - Panos E Vardas
- Department of Cardiology, Heraklion University Hospital, University of Crete, Crete, Greece
| | | |
Collapse
|
22
|
Simantirakis EN, Papakonstantinou PE, Kanoupakis E, Chlouverakis GI, Tzeis S, Vardas PE. Recurrence rate of atrial fibrillation after the first clinical episode: A prospective evaluation using continuous cardiac rhythm monitoring. Clin Cardiol 2018; 41:594-600. [PMID: 29761516 DOI: 10.1002/clc.22904] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [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: 12/06/2017] [Revised: 01/09/2018] [Accepted: 01/17/2018] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Decision making regarding a patient who has experienced a first clinical episode of atrial fibrillation (AF) is challenging, and the AF recurrences should be a significant consideration. Continuous long-term rhythm monitoring via implantable loop recorders (ILRs) has enabled us to evaluate the AF recurrence profile after the first clinical episode and to investigate clinical parameters associated with the course of the arrhythmia. HYPOTHESIS Continuous rhythm monitoring via ILRs in AF patients after the first clinical episode is of clinical significance and precisely evaluate the AF recurrence profile. METHODS Thirty consecutive patients with paroxysmal AF received an ILR after their first symptomatic episode. We evaluated the maximum duration of episodes and the recurrence rate of the arrhythmia during a follow-up period of 3 years. RESULTS Three patients (10%) had no AF recurrence, whereas 4 patients (13.3%) presented only 1 episode. Almost half of the patients (46.7%) had a low recurrence rate (<5 episodes/year), whereas the majority of patients (19/30) suffered from episodes with maximum duration ≤24 hours. Eleven patients (36.7%) presented either no episode or a low recurrence rate with episodes lasting ≤24 hours. The use of statins was greater in patients with a low recurrence rate (P = 0.025). CONCLUSIONS A significant percentage of patients either suffer no AF recurrence after their first symptomatic episode or show a low recurrence rate. Most patients present episodes of short duration. If these findings are confirmed in larger studies, they could have clinical implications ensuring individualized management of the arrhythmia in the future.
Collapse
Affiliation(s)
- Emmanuel N Simantirakis
- Department of Cardiology, University Hospital of Heraklion, School of Medicine, University of Crete, Heraklion, Crete, Greece
| | - Panteleimon E Papakonstantinou
- Department of Cardiology, University Hospital of Heraklion, School of Medicine, University of Crete, Heraklion, Crete, Greece
| | - Emmanuel Kanoupakis
- Department of Cardiology, University Hospital of Heraklion, School of Medicine, University of Crete, Heraklion, Crete, Greece
| | | | - Stylianos Tzeis
- Pacing and Electrophysiology Department, Henry Dunant Hospital Center, Athens, Greece
| | - Panos E Vardas
- Department of Cardiology, University Hospital of Heraklion, School of Medicine, University of Crete, Heraklion, Crete, Greece
| |
Collapse
|
23
|
Marketou ME, Kontaraki JE, Maragkoudakis S, Patrianakos A, Konstantinou J, Nakou H, Vougia D, Logakis J, Chlouverakis G, Vardas PE, Parthenakis FI. MicroRNAs in Peripheral Mononuclear Cells as Potential Biomarkers in Hypertensive Patients With Heart Failure With Preserved Ejection Fraction. Am J Hypertens 2018; 31:651-657. [PMID: 29506053 DOI: 10.1093/ajh/hpy035] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2017] [Accepted: 02/27/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND MicroRNAs (miRs) regulate gene expression and play an important role in ventricular and vascular remodeling. However, there are limited data regarding their role in heart failure with preserved ejection fraction (HFpEF). The aim of this study was to assess gene expression of miR-1, miR-133a, miR-21, miR-208b, miR-499, and miR-26b in peripheral blood mononuclear cells (PBMCs) in hypertensive patients with HFpEF and to evaluate their association with their exercise capacity. METHODS We included 56 hypertensive patients with HFpEF (age 67.29 ± 7.75 years). Forty-two hypertensive patients without HFpEF (age 66.83 ± 7.17 years) served as controls. All subjects underwent a cardiopulmonary exercise test (CPXT). PBMCs were isolated and levels of miRs were determined by quantitative real-time reverse transcription polymerase chain reaction. RESULTS For hypertensive patients with HFpEF, higher expression levels in PBMCs were found only for miR-26b (7.6 ± 7.3 vs. 4.0 ± 3.6, P = 0.002), miR-208b (28.8 ± 35.3 vs. 7.5 ± 13.3, P < 0.001), and miR-499 (14.2 ± 22.4 versus 3.5 ± 2.9, P = 0.001). The strongest correlations with CPXT parameters were found for miR-208b levels, which had a positive correlation with maximal oxygen uptake (peakVO2) (r = 0.671, P < 0.001), exercise duration (r = 0.445, P = 0.001), and minute ventilation-carbon dioxide production relationship (VE/VCO2) (r = 0.437, P = 0.001) in the HFpEF group. CONCLUSIONS miR-26b, miR-208b, and miR-499 show a distinct in profile in hypertensive patients with HFpEF that is related with functional capacity. Further studies are needed to assess the role of miRs as prognostic tools or as therapeutic targets in those patients.
Collapse
Affiliation(s)
- Maria E Marketou
- Department of Cardiology, Heraklion University Hospital, Crete Greece
| | - Joanna E Kontaraki
- Molecular Cardiology Laboratory, School of Medicine, University of Crete, Crete Greece
| | | | | | - John Konstantinou
- Department of Cardiology, Heraklion University Hospital, Crete Greece
| | - Helen Nakou
- Division of Biostatisctics, School of Medicine, University of Crete, Crete, Greece
| | - Despoina Vougia
- Department of Cardiology, Heraklion University Hospital, Crete Greece
| | - John Logakis
- Department of Cardiology, Heraklion University Hospital, Crete Greece
| | - Gregory Chlouverakis
- Division of Biostatisctics, School of Medicine, University of Crete, Crete, Greece
| | - Panos E Vardas
- Department of Cardiology, Heraklion University Hospital, Crete Greece
| | | |
Collapse
|
24
|
Nakou ES, Simantirakis EN, Kallergis EM, Nakos KS, Vardas PE. Cardiac resynchronization therapy (CRT) device replacement considerations: upgrade or downgrade? A complex decision in the current clinical setting. Europace 2018; 19:705-711. [PMID: 28011795 DOI: 10.1093/europace/euw317] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Accepted: 09/19/2016] [Indexed: 11/13/2022] Open
Abstract
There are limited data about the management of patients presenting for elective generator replacements in the setting of previously implanted cardiac resynchronization therapy (CRT) devices that are nearing end-of-life. The individual patient's clinical status and concomitant morbidities may evolve so that considerations may include not only replacement of the pulse generator, but also potentially changing the type of device [e.g. downgrading CRT-defibrillator (CRT-D) to CRT-pacemaker (CRT-P) or ICD or upgrading of CRT-P to CRT-D]. Moreover, the clinical evidence for CRT-D/CRT-P implantation may change over time, with ongoing research and availability of new trial data. In this review we discuss the ethical, clinical and financial implications related to CRT generator replacements and the need for additional clinical trials to better understand which patients should undergo CRT device downgrading or upgrading at the time of battery depletion.
Collapse
Affiliation(s)
- Eleni S Nakou
- University Hospital of Heraklion, PO box 1352, Stavrakia, Heraklion Crete, Greece
| | | | | | - Konstantinos S Nakos
- University Hospital of Heraklion, PO box 1352, Stavrakia, Heraklion Crete, Greece
| | - Panos E Vardas
- University Hospital of Heraklion, PO box 1352, Stavrakia, Heraklion Crete, Greece
| |
Collapse
|
25
|
Karakitsos DN, Patrianakos AP, Paraskevopoulos A, Parthenakis FI, Tzenakis N, Fourtounas C, Daphnis EK, Vardas PE. Impedance Cardiography Derived Cardiac Output in Hemodialysis Patients: A Study of Reproducibility and Comparison with Echocardiography. Int J Artif Organs 2018; 29:564-72. [PMID: 16841284 DOI: 10.1177/039139880602900604] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Hemodialysis patients experience a variety of hemodynamic abnormalities that contribute to cardiovascular disease mortality which is the leading cause of death in these patients. Impedance cardiography has been utilized in order to monitor cardiac hemodynamics with lower cost and inconvenience, but it has not been appropriately validated in the hemodialysis population. Aim We repeatedly used impedance cardiography to assess short- (48 hours) and long-term (15 days) reproducibility of cardiac output measurements and we compared baseline impedance cardiography measurements with echocardiographic measurements. Patients and Methods We studied 109 stable hemodialysis patients, aged 59.70 ± 11.97 years being on hemodialysis for 67.59 ± 40.15 months, on a non-dialysis day. Cardiac output was obtained with the BioZ impedance cardiography system (Cardiodynamics, San Diego, Ca, USA). Baseline echocardiography was performed using a Hewlett-Packard Sonos 2500 (Andover, Mass., USA). Results The values of impedance cardiography derived cardiac output were 5.28 ± 0.79, 5.27 ± 0.75 and 5.25 ± 0.74 l/min at baseline (107 patients), 48 hours (107 patients) and 15 days (98 patients) respectively, showing high reproducibility. Bland and Altman analysis estimated that bias at 48 hours and at 15 days were: −0.013 (95% confidence intervals = −0.045 to 0.019) and 0.028, (95% confidence intervals = −0.044 to 0.101), respectively. In addition baseline impedance cardiography derived cardiac output was significantly correlated with the echocardiographic derived cardiac output (r = 0.9, p < 0.0001). Conclusion Impedance cardiography is a simple non invasive technique for cardiac output estimation in hemodialysis patients which has high reproducibility when performed under controlled conditions, and is closely correlated with echocardiographic measurements of cardiac output.
Collapse
Affiliation(s)
- D N Karakitsos
- Department of Nephrology, Heraklion University Hospital, Crete - Greece
| | | | | | | | | | | | | | | |
Collapse
|
26
|
Nakou ES, Marketou ME, Vardas PE, Parthenakis FI. The clinical relevance of drug-drug interaction between co-trimoxazole and sacubitril/valsartan treatment in a heart failure patient: a case report and overview of mechanisms and management in clinical practice. Clin Res Cardiol 2018; 107:524-526. [PMID: 29335802 DOI: 10.1007/s00392-018-1201-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Accepted: 01/11/2018] [Indexed: 12/11/2022]
Affiliation(s)
- Eleni S Nakou
- Department of Cardiology, Heraklion University Hospital, Voutes, 7100, Heraklion-Crete, Greece.
| | - Maria E Marketou
- Department of Cardiology, Heraklion University Hospital, Voutes, 7100, Heraklion-Crete, Greece
| | - Panos E Vardas
- Department of Cardiology, Heraklion University Hospital, Voutes, 7100, Heraklion-Crete, Greece
| | - Fragiskos I Parthenakis
- Department of Cardiology, Heraklion University Hospital, Voutes, 7100, Heraklion-Crete, Greece
| |
Collapse
|
27
|
Simantirakis EN, Nakou ES, Vardas PE. Upgrading or downgrading a cardiac resynchronization therapy device (CRT) device? Gaps and dilemmas in current clinical practice. Europace 2018; 20:217-218. [DOI: 10.1093/europace/eux266] [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: 11/14/2022] Open
|
28
|
|
29
|
Marketou ME, Kontaraki JE, Papadakis JA, Vrentzos GE, Patrianakos A, Fragkiadakis K, Tsiverdis P, Lempidakis D, Chlouverakis G, Vardas PE, Parthenakis FI. Increased platelet alpha 2B-adrenergic receptor gene expression in well-controlled hypertensives: the effect of arterial stiffness. ACTA ACUST UNITED AC 2017; 11:762-768. [PMID: 28923554 DOI: 10.1016/j.jash.2017.08.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 08/07/2017] [Accepted: 08/18/2017] [Indexed: 11/16/2022]
Abstract
Catecholamines play a major role in atherothrombotic mechanisms in essential hypertension. Alpha2B-adrenergic receptors (α2B-ARs) are implicated in the pathophysiology of platelet aggregation. In this study, we evaluated platelet α2B-AR gene expression levels in patients with well-controlled essential hypertension compared with normal individuals and investigated their association with increased arterial stiffness. Fifty-nine patients with well-controlled essential hypertension (34 men, mean age 65 ± 9 years) and 26 normotensives (19 men, mean age 64 ± 8 years) were included in the study. For each patient, carotid-femoral pulse wave velocity (PWV) and carotid-radial PWV were evaluated. In addition, blood samples were obtained and platelets were isolated. The α2B-AR gene expression levels in platelets were examined by real-time polymerase chain reaction for each participant. Well-controlled hypertensive patients showed significantly higher gene expression levels of α2B-Rs in platelets compared with normotensives (34.7 ± 29.5 vs 17.6 ± 12.5, respectively, P = .005). Interestingly, we found that carotid-femoral PWV and carotid-radial PWV were positively correlated with platelet α2B-R gene expression levels (r = 0.59, P < .001, and r = 0.39, P = .002, respectively).Platelet α2B-R gene expression levels are increased in patients with well-controlled essential hypertension compared with normotensives and are correlated with increased PWV in those patients. Our data indicate an association of arterial stiffness and platelet α2B-Rs gene expression and indicate the need for further research.
Collapse
Affiliation(s)
- Maria E Marketou
- Department of Cardiology, Heraklion University Hospital, Heraklion, Crete, Greece.
| | - Joanna E Kontaraki
- Division of Biostatistics, Department of Social Medicine, Molecular Cardiology Laboratory, School of Medicine, University of Crete, Heraklion, Crete, Greece
| | - John A Papadakis
- Department of Internal Medicine, Heraklion University Hospital, Crete, Heraklion, Crete, Greece
| | - George E Vrentzos
- Department of Internal Medicine, Heraklion University Hospital, Crete, Heraklion, Crete, Greece
| | | | | | - Panagiotis Tsiverdis
- Department of Cardiology, Heraklion University Hospital, Heraklion, Crete, Greece
| | - Dimitris Lempidakis
- Department of Cardiology, Heraklion University Hospital, Heraklion, Crete, Greece
| | - Gregory Chlouverakis
- Division of Biostatistics, School of Medicine, University of Crete, Heraklion, Crete, Greece
| | - Panos E Vardas
- Department of Cardiology, Heraklion University Hospital, Heraklion, Crete, Greece
| | | |
Collapse
|
30
|
Marketou M, Kochiadakis GE, Giaouzaki A, Sfiridaki K, Petousis S, Maragoudakis F, Roufas K, Vougia D, Logakis J, Chlouverakis G, Vardas PE. Long-term serial changes in platelet activation indices following sirolimus elution and bare metal stent implantation in patients with stable coronary artery disease. Hellenic J Cardiol 2017; 58:43-48. [PMID: 28185978 DOI: 10.1016/j.hjc.2017.01.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2015] [Accepted: 09/01/2016] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Platelet activation is crucial in the development of stent thrombosis following percutaneous coronary intervention (PCI). We carried out a long-term assessment of multiple factors implicated in the thrombotic process and monitored markers of platelet activation after the implantation of sirolimus-eluting stents (SES) in patients with stable coronary artery disease (CAD). Additionally, we compared these findings with those after bare-metal stent (BMS) implantation. METHODS A cohort of 47 consecutive patients, aged <70 years, with severe stenosis (>70% narrowing of the lumen) of one major epicardial coronary artery and stable CAD underwent successful elective PCI. Patients were randomly allocated to SES (n = 25) or BMS (n = 22). Venous blood was obtained 24 hours before and 24 hours, 48 hours, 1 month, and 6 months after PCI for measurements of plasma levels of sP-selectin, von Willebrand Factor (vWF), fibrinogen, d-dimer, sCD40, factor VIII, b-thromboglobulin (b-TG) and platelet factor 4 (PF-4). RESULTS There were no significant differences between the two groups in levels of fibrinogen or d-dimers in peripheral blood. However, we observed a significant kinetic effect (p<0.001) and stent-effect (p<0.015) on vWF levels and a significant kinetic effect (p = 0.012) on factor VIII, sP-selectin (p = 0.04), b-TG (p<0.001), and PF4 (p = 0.016). A trend towards a significant stent effect on sCD40 was also detected (p = 0.06). CONCLUSIONS SES and BMS did not show significant differences in relationship to markers of platelet activation and coagulation in patients with stable CAD. Although some markers showed an increase after stent implantation, they returned to the initial levels 6 months later.
Collapse
Affiliation(s)
- Maria Marketou
- Cardiology Dept, Heraklion University Hospital, Crete, Greece.
| | | | | | | | | | | | | | - Despoina Vougia
- Cardiology Dept, Heraklion University Hospital, Crete, Greece
| | - John Logakis
- Cardiology Dept, Heraklion University Hospital, Crete, Greece
| | | | - Panos E Vardas
- Cardiology Dept, Heraklion University Hospital, Crete, Greece
| |
Collapse
|
31
|
Patrianakos AP, Zacharaki AA, Skalidis EI, Hamilos MI, Parthenakis FI, Vardas PE. The growing role of echocardiography in interventional cardiology: The present and the future. Hellenic J Cardiol 2017; 58:17-31. [PMID: 28163148 DOI: 10.1016/j.hjc.2017.01.008] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Accepted: 09/01/2016] [Indexed: 10/20/2022] Open
Abstract
As structural heart disease interventions continue to evolve to a sophisticated level, accurate and reliable imaging is required for pre-procedural selection of cases, intra-procedural guidance, post-procedural evaluation, and long-term follow-up of patients. Traditionally, cardiovascular procedures in the catheterization laboratory are guided by fluoroscopy and angiography. Advances in echocardiography can overcome most limitations of conventional imaging modalities and provide successful completion of each step of any catheter-based treatment. Echocardiography's unique characteristics rendered it the ideal technique for percutaneous catheter-based procedures. The purpose of this review is to demonstrate the use of the most common and up-to-date echocardiographic techniques in recent non-coronary percutaneous interventional procedures, underlining its inevitable and growing role, as well as illustrating areas of weakness and limitations, and to provide future perspectives.
Collapse
Affiliation(s)
- A P Patrianakos
- Heraklion University Hospital, Cardiology Department, Crete, Greece.
| | - A A Zacharaki
- Heraklion University Hospital, Cardiology Department, Crete, Greece
| | - E I Skalidis
- Heraklion University Hospital, Cardiology Department, Crete, Greece
| | - M I Hamilos
- Heraklion University Hospital, Cardiology Department, Crete, Greece
| | - F I Parthenakis
- Heraklion University Hospital, Cardiology Department, Crete, Greece
| | - P E Vardas
- Heraklion University Hospital, Cardiology Department, Crete, Greece
| |
Collapse
|
32
|
Simantirakis EN, Papakonstantinou PE, Chlouverakis GI, Kanoupakis EM, Mavrakis HE, Kallergis EM, Arkolaki EG, Vardas PE. Asymptomatic versus symptomatic episodes in patients with paroxysmal atrial fibrillation via long-term monitoring with implantable loop recorders. Int J Cardiol 2016; 231:125-130. [PMID: 28041713 DOI: 10.1016/j.ijcard.2016.12.025] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Revised: 12/06/2016] [Accepted: 12/10/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND The presentation of atrial fibrillation (AF) varies remarkably, from totally asymptomatic to symptomatic patients, while the same individual may present symptomatic and asymptomatic episodes. We aimed to identify electrocardiographic differences between symptomatic and asymptomatic episodes and to find parameters related to the appearance of symptoms. METHODS Thirty consecutive patients (age 66.9±10years) with paroxysmal AF received an implantable loop recorder. Three types of episodes were defined: asymptomatic (ASx), symptomatic (Sx), and mixed asymptomatic-symptomatic (AS-Sx). The heart rate (HR) and heart rate variability (HRV) were recorded during the first 2min of each ASx or Sx episode, and during the first 2min of both the symptomatic and asymptomatic periods in AS-Sx. RESULTS Eighty-two episodes from twenty-five patients were evaluated. Mean HR was 142.48±25.84bpm for Sx and 95.71±19.29bpm for ASx (p<0.001). Mean HRV was 92.62±42.29ms for Sx and 150.06±49.68ms for ASx (p<0.001). In AS-Sx, mean HR was 102.91±24.54bpm for the asymptomatic and 141.88±23.43bpm for the symptomatic period (p<0.001). Mean HRV was 173.55±61.30ms for the asymptomatic and 87.33±30.65ms for the symptomatic period (p=0.003). There were no significant correlations between patients' characteristics and the clinical presentation of the arrhythmia. CONCLUSIONS The ASx were characterized by a lower HR and higher HRV compared to Sx. In As-Sx, the asymptomatic period was characterized by a lower HR and higher HRV compared to the symptomatic. These findings suggest a possible contribution of variations in the autonomic nervous system activity to the perception of the arrhythmia.
Collapse
Affiliation(s)
- E N Simantirakis
- Department of Cardiology, University Hospital of Heraklion, School of Medicine, University of Crete, Heraklion, Crete, Greece.
| | - P E Papakonstantinou
- Department of Cardiology, University Hospital of Heraklion, School of Medicine, University of Crete, Heraklion, Crete, Greece
| | - G I Chlouverakis
- Biostatistics Lab, School of Medicine, University of Crete, Heraklion, Crete, Greece
| | - E M Kanoupakis
- Department of Cardiology, University Hospital of Heraklion, School of Medicine, University of Crete, Heraklion, Crete, Greece
| | - H E Mavrakis
- Department of Cardiology, University Hospital of Heraklion, School of Medicine, University of Crete, Heraklion, Crete, Greece
| | - E M Kallergis
- Department of Cardiology, University Hospital of Heraklion, School of Medicine, University of Crete, Heraklion, Crete, Greece
| | - E G Arkolaki
- Department of Cardiology, University Hospital of Heraklion, School of Medicine, University of Crete, Heraklion, Crete, Greece
| | - P E Vardas
- Department of Cardiology, University Hospital of Heraklion, School of Medicine, University of Crete, Heraklion, Crete, Greece
| |
Collapse
|
33
|
Marketou ME, Zacharis EA, Nikitovic D, Ganotakis ES, Parthenakis FI, Maliaraki N, Vardas PE. Early Effects of Simvastatin versus Atorvastatin on Oxidative Stress and Proinflammatory Cytokines in Hyperlipidemic Subjects. Angiology 2016; 57:211-8. [PMID: 16518530 DOI: 10.1177/000331970605700212] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The authors investigated the time-dependent action of atorvastatin and simvastatin on oxidative stress and cytokine levels immediately after the start of treatment. These factors play a role in endothelial dysfunction. Hyperlipidemic patients (n=132) were assigned to treatment with 40 mg atorvastatin, 40 mg simvastatin, or placebo. Blood samples were taken before, 2 hours, 24 hours, 7 days, and 3 weeks after the administration of the statin or placebo to evaluate serum concentrations of total peroxides (TP), interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-a) and soluble intercellular vascular adhesion molecule 1 (sICAM 1). In the atorvastatin group the TP changes were significantly different at 2 hours and 24 hours (p=0.005), whereas in the simvastatin group there was a gradual, more or less linear decline in TP until 7 days (p=0.006) and then a plateau. Simvastatin exhibited a faster statistically significant decrease over time in IL-6 and sICAM 1 levels (at 7 days, p=0.014 and p=0.001, respectively). TNF-a demonstrated a faster linear trend in the simvastatin group, but the significant effect appeared late (p=0.006). Both simvastatin and atorvastatin exerted early beneficial effects on oxidative stress, proinflammatory cytokines, and endothelial activation in hyperlipidemic subjects. These effects became significant 2 hours following the initiation of therapy.
Collapse
Affiliation(s)
- Mary E Marketou
- Department of Cardiology, Heraklion University Hospital, Heraklion, Crete, Greece
| | | | | | | | | | | | | |
Collapse
|
34
|
Kanoupakis EM, Fanourgiakis JA, Mavrakis HE, Kallergis EM, Simantirakis EN, Crysostomakis SI, Saloustros IG, Chlouverakis GI, Vardas PE. Long-term clinical outcomes in implantable cardioverter defibrillator recipients on the island of Crete. Hellenic J Cardiol 2016; 57:S1109-9666(16)30147-6. [PMID: 27639320 DOI: 10.1016/j.hjc.2016.05.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Accepted: 05/31/2016] [Indexed: 11/24/2022] Open
Abstract
PURPOSE The aim of the current study is to disseminate long-term "real-world" data on mortality and device therapies in primary and secondary prevention implantable cardioverter defibrillator (ICD) recipients on the island of Crete. METHODS We analyzed data for all consecutive patients who received an ICD in our tertiary university hospital from 1993 until December 2013. Follow-up visits were performed every 6 months or more frequently when indicated. Survival status was recorded, and all stored episodes during interrogation were registered and classified as appropriate or inappropriate. RESULTS In total, 854 patients received an ICD; 623 (73%) for primary and 231 (27%) for secondary prevention. Most of these patients (490) suffered from ischemic cardiomyopathy. During the mean follow-up of 12.4±7.8 years, 218 (25.5%) patients died; 19.7% in the primary prevention group (p=0.008) and 41.1% in the secondary prevention group. Overall, 248 patients (29%) received appropriate therapy; however, the percentage was significantly higher in the secondary prevention group (44.2%) than in primary prevention group (23.4%). The cumulative incidence of inappropriate therapies during the mean follow-up period was 11.6%. Lead-related complications were noted in 49 patients (5.7%), while only 13 patients (1.5%) suffered device-related infections. CONCLUSIONS The long-term data related to clinical outcomes in ICD recipients in our center are in accordance with those of other international centers and confirm the high efficacy and safety of these devices in preventing sudden cardiac death.
Collapse
Affiliation(s)
| | - John A Fanourgiakis
- Cardiology Department, University Hospital of Heraklion, Heraklion, Crete, Greece
| | - Hercules E Mavrakis
- Cardiology Department, University Hospital of Heraklion, Heraklion, Crete, Greece
| | | | | | | | - Ilias G Saloustros
- Cardiology Department, University Hospital of Heraklion, Heraklion, Crete, Greece
| | | | - Panos E Vardas
- Cardiology Department, University Hospital of Heraklion, Heraklion, Crete, Greece
| |
Collapse
|
35
|
Katsi VK, Marketou ME, Vrachatis DA, Manolis AJ, Nihoyannopoulos P, Tousoulis D, Vardas PE, Kallikazaros I. Essential hypertension in the pathogenesis of age-related macular degeneration: a review of the current evidence. J Hypertens 2016; 33:2382-8. [PMID: 26536087 DOI: 10.1097/hjh.0000000000000766] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Age-related macular degeneration (AMD) is one of the main causes of vision loss, especially in the elderly. The involvement of essential hypertension in its pathogenesis has been well covered in the literature since it was first recognized. Hemodynamic abnormalities appear to contribute to AMD, with the renin-angiotensin system playing a significant role. Many studies have demonstrated that high blood pressure is associated with lower choroidal blood flow and disturbed vascular homeostasis in these patients. In addition, AMD is characterized by abnormal neovascularization, to which angiotensin II and growth factors make a large contribution. Most epidemiological studies have found essential hypertension to be a risk factor for AMD. However, although all agree that the strongest predisposing factors are age and smoking, overall there is some inconsistency regarding the exact role of hypertension in its pathogenesis. In particular, there are no data in the literature to support the view that antihypertensive medication and the successful management of hypertension have a positive effect on the clinical outcome of AMD. This reinforces the data indicating that the cause of AMD is multifactorial and suggests that, although essential hypertension probably plays a role, in itself it is unlikely to be a major contributor to the future occurrence of AMD.
Collapse
Affiliation(s)
- Vasiliki K Katsi
- aDepartment of Cardiology, Hippokration Hospital, Athens bDepartment of Cardiology, Heraklion University Hospital, Crete cFirst Cardiology Department, Hippokration Hospital, National and Kapodistrian University of Athens dDepartment of Cardiology, Asklepieion General Hospital, Athens, Greece
| | | | | | | | | | | | | | | |
Collapse
|
36
|
Parthenakis FI, Marketou ME, Kontaraki JE, Maragoudakis F, Maragkoudakis S, Nakou H, Roufas K, Patrianakos A, Chlouverakis G, Malliaraki N, Vardas PE. Comparative microRNA profiling in relation to urinary albumin excretion in newly diagnosed hypertensive patients. J Hum Hypertens 2016; 30:685-689. [DOI: 10.1038/jhh.2016.15] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Revised: 01/28/2016] [Accepted: 02/11/2016] [Indexed: 01/07/2023]
|
37
|
Nakou ES, Parthenakis FI, Kallergis EM, Marketou ME, Nakos KS, Vardas PE. Healthy aging and myocardium: A complicated process with various effects in cardiac structure and physiology. Int J Cardiol 2016; 209:167-75. [PMID: 26896615 DOI: 10.1016/j.ijcard.2016.02.039] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [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: 09/28/2015] [Revised: 12/25/2015] [Accepted: 02/02/2016] [Indexed: 02/08/2023]
Abstract
It is known that there is an ongoing increase in life expectancy worldwide, especially in the population older than 65years of age. Cardiac aging is characterized by a series of complex pathophysiological changes affecting myocardium at structural, cellular, molecular and functional levels. These changes make the aged myocardium more susceptible to stress, leading to a high prevalence of cardiovascular diseases (heart failure, atrial fibrillation, left ventricular hypertrophy, coronary artery disease) in the elderly population. The aging process is genetically programmed but modified by environmental influences, so that the rate of aging can vary widely among people. We summarized the entire data concerning all the multifactorial changes in aged myocardium and highlighting the recent evidence for the pathophysiological basis of cardiac aging. Keeping an eye on the clinical side, this review will explore the potential implications of the age-related changes in the clinical management and on novel therapeutic strategies potentially deriving from the scientific knowledge currently acquired on cardiac aging process.
Collapse
Affiliation(s)
- E S Nakou
- Department of Cardiology, Heraklion University Hospital, 7100, Voutes, Heraklion-Crete, Greece.
| | - F I Parthenakis
- Department of Cardiology, Heraklion University Hospital, 7100, Voutes, Heraklion-Crete, Greece
| | - E M Kallergis
- Department of Cardiology, Heraklion University Hospital, 7100, Voutes, Heraklion-Crete, Greece
| | - M E Marketou
- Department of Cardiology, Heraklion University Hospital, 7100, Voutes, Heraklion-Crete, Greece
| | - K S Nakos
- Department of Cardiology, Heraklion University Hospital, 7100, Voutes, Heraklion-Crete, Greece
| | - P E Vardas
- Department of Cardiology, Heraklion University Hospital, 7100, Voutes, Heraklion-Crete, Greece
| |
Collapse
|
38
|
Kalyva A, Marketou ME, Parthenakis FI, Pontikoglou C, Kontaraki JE, Maragkoudakis S, Petousis S, Chlouverakis G, Papadaki HA, Vardas PE. Endothelial progenitor cells as markers of severity in hypertrophic cardiomyopathy. Eur J Heart Fail 2015; 18:179-84. [PMID: 26696595 DOI: 10.1002/ejhf.436] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [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: 07/10/2015] [Revised: 10/05/2015] [Accepted: 10/06/2015] [Indexed: 01/05/2023] Open
Abstract
AIMS Endothelial progenitor cells (EPCs) are bone marrow-derived cells that are mobilized into the circulation to migrate and differentiate into mature endothelial cells contributing to post-natal physiological and pathological neovascularization. In this study, we evaluated circulating EPCs in patients with hypertrophic cardiomyopathy (HCM) and examined a potential association with clinical parameters of the disease. METHODS AND RESULTS We included 40 HCM patients and 23 healthy individuals. Using flow cytometry we measured EPCs in peripheral blood as two subpopulations of CD45-/CD34+/VEGFR2+ and CD45-/CD34+/CD133+ cells. Circulating CD45-/CD34+/VEGFR2+ cells were significantly increased in HCM patients in comparison with the controls (0.000238 ± 0.0003136 vs. 0.000057 ± 0.0001316, respectively, P = 0.002). However, there was no significant difference in the number of circulating CD45-/CD34+/CD133+ cells (0.003079 ± 0.0033288 vs. 0.002065 ± 0.0022173, respectively, P = 0.153). The CD45-/CD34+/VEGFR2+ subpopulation revealed a moderate correlation with LV mass index (r = 0.35, P = 0.026), while both EPC subpopulation levels showed strong positive correlations with th E/e' ratio (r = 0.423, P = 0.007 for CD45-/CD34+/VEGFR2+ and r = 0.572, P < 0.001 for CD45-/CD34+/CD133+). CONCLUSION HCM patients showed an increased mobilization of EPCs compared with healthy individuals that correlated with diastolic dysfunction. Our findings may open up new dimensions in the pathophysiology, prognostication, and treatment of HCM.
Collapse
Affiliation(s)
- Athanasia Kalyva
- Molecular Cardiology Laboratory, School of Medicine, University of Crete, Greece
| | - Maria E Marketou
- Department of Cardiology, Heraklion University Hospital, Crete, Greece
| | | | | | - Joanna E Kontaraki
- Molecular Cardiology Laboratory, School of Medicine, University of Crete, Greece
| | | | | | | | - Helen A Papadaki
- Department of Haematology, Heraklion University Hospital, Crete, Greece
| | - Panos E Vardas
- Department of Cardiology, Heraklion University Hospital, Crete, Greece
| |
Collapse
|
39
|
Vardas PE, Skalidis EI. The role of ivabradine in improving myocardial perfusion, adding to the antianginal benefits. Eur Heart J Suppl 2015. [DOI: 10.1093/eurheartj/suv055] [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: 11/12/2022]
|
40
|
Kontaraki JE, Marketou ME, Parthenakis FI, Maragkoudakis S, Zacharis EA, Petousis S, Kochiadakis GE, Vardas PE. Hypertrophic and antihypertrophic microRNA levels in peripheral blood mononuclear cells and their relationship to left ventricular hypertrophy in patients with essential hypertension. ACTA ACUST UNITED AC 2015; 9:802-810. [PMID: 26358152 DOI: 10.1016/j.jash.2015.07.013] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Revised: 07/03/2015] [Accepted: 07/23/2015] [Indexed: 12/22/2022]
Abstract
MicroRNAs regulate several aspects of physiological and pathologic cardiac hypertrophy, and they represent promising therapeutic targets in cardiovascular disease. We assessed the expression levels of the microRNAs miR-1, miR-133a, miR-26b, miR-208b, miR-499, and miR-21, in 102 patients with essential hypertension and 30 healthy individuals. All patients underwent two-dimensional echocardiography. MicroRNA expression levels in peripheral blood mononuclear cells were quantified by real-time reverse transcription polymerase chain reaction. Hypertensive patients showed significantly lower miR-133a (5.06 ± 0.50 vs. 13.20 ± 2.15, P < .001) and miR-26b (6.76 ± 0.53 vs. 9.36 ± 1.40, P = .037) and higher miR-1 (25.99 ± 3.07 vs. 12.28 ± 2.06, P = .019), miR-208b (22.29 ± 2.96 vs. 8.73 ± 1.59, P = .016), miR-499 (10.06 ± 1.05 vs. 5.70 ± 0.91, P = .033), and miR-21 (2.75 ± 0.15 vs. 1.82 ± 0.20, P = .002) expression levels compared with healthy controls. In hypertensive patients, we observed significant negative correlations of miR-1 (r = -0.374, P < .001) and miR-133a (r = -0.431, P < .001) and significant positive correlations of miR-26b (r = 0.302, P = .002), miR-208b (r = 0.426, P < .001), miR-499 (r = 0.433, P < .001) and miR-21 (r = 0.498, P < .001) expression levels with left ventricular mass index. Our data reveal that miR-1, miR-133a, miR-26b, miR-208b, miR-499, and miR-21 show distinct expression profiles in hypertensive patients relative to healthy individuals and they are associated with clinical indices of left ventricular hypertrophy in hypertensive patients. Thus, they may be related to heart hypertrophy in hypertensive patients and are possibly candidate therapeutic targets in hypertensive heart disease.
Collapse
Affiliation(s)
- Joanna E Kontaraki
- Molecular Cardiology Laboratory, Department of Cardiology, School of Medicine, University of Crete, Heraklion, Greece.
| | - Maria E Marketou
- Department of Cardiology, Heraklion University Hospital, Crete, Greece
| | | | | | | | - Stelios Petousis
- Department of Cardiology, Heraklion University Hospital, Crete, Greece
| | | | - Panos E Vardas
- Department of Cardiology, Heraklion University Hospital, Crete, Greece
| |
Collapse
|
41
|
Brignole M, Auricchio A, Baron-Esquivias G, Bordachar P, Boriani G, Breithardt OA, Cleland J, Deharo JC, Delgado V, Elliott PM, Gorenek B, Israel CW, Leclercq C, Linde C, Mont L, Padeletti L, Sutton R, Vardas PE. 2013 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy. ACTA ACUST UNITED AC 2015; 67:58. [PMID: 24774265 DOI: 10.1016/j.rec.2013.11.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2013] [Accepted: 11/04/2013] [Indexed: 10/25/2022]
|
42
|
Kallergis EM, Nakou ES, Simantirakis EN, Vardas PE. Chronotropic incompetence presenting as sudden sinus slowing during exercise stress test: the pathophysiological mechanisms. Clin Res Cardiol 2015; 104:611-3. [DOI: 10.1007/s00392-015-0830-7] [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] [Received: 01/17/2015] [Accepted: 02/17/2015] [Indexed: 10/23/2022]
|
43
|
Arkolaki EG, Simantirakis EN, Kontaraki JE, Chrysostomakis SI, Patrianakos AP, Chlouverakis GI, Nakou ES, Vardas PE. Alterations in the expression of genes related to contractile function and hypertrophy of the left ventricle in chronically paced patients from the right ventricular apex. Europace 2015; 17:1563-70. [PMID: 25851726 DOI: 10.1093/europace/euv071] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2014] [Accepted: 02/27/2015] [Indexed: 12/16/2022] Open
Abstract
AIM Long-term right ventricular apical (RVA) pacing may lead to left ventricular (LV) remodelling and heart failure. This study assessed changes in the expression of genes regulating LV contractile function and hypertrophy, after permanent RVA pacing and investigated whether such changes proceed or even predict LV remodelling. METHODS AND RESULTS We enrolled 52 consecutive patients (age 79.1 ± 7.7 years, 34 males) who underwent pacemaker implantation for bradycardic indications: Group A, 24 individuals with atrioventricular conduction disturbances and group B, 28 patients with sinus node disease. In group A, peripheral blood mRNA levels of gene sarcoplasmic reticulum calcium ATPase decreased at 3, 6, and 12 months' follow-up, while α-myosin heavy chain (MHC) decreased and β-MHC increased until 6 months follow-up. In this group, 25% of patients demonstrated significant LV remodelling. At 4 years, LV end-systolic diameter increased from 29.67 ± 3.39 mm at baseline to 35.38 ± 4.22 mm, LV end-diastolic diameter increased from 50 ± 4.95 to 56.71 ± 5.52 mm, and ejection fraction declined from 63.04 ± 10.22 to 52.83 ± 10.81%. Early alterations in gene expression were associated with a deterioration in LV function and geometry that became apparent months later. In group B, echocardiographic indexes and mRNA levels of the evaluated genes demonstrated no statistically significant changes. CONCLUSIONS Permanent RVA pacing in patients with preserved ejection fraction is associated with alterations in the expression of genes regulating LV contractile function and hypertrophy, measured in the peripheral blood. These alterations are traceable at an early stage, before echocardiographic changes are apparent and are associated with LV remodelling that becomes evident in the long term.
Collapse
Affiliation(s)
- Eva G Arkolaki
- University Hospital of Heraklion, PO box 1352, Stavrakia, Heraklion Crete, Greece
| | | | | | | | | | | | - Eleni S Nakou
- University Hospital of Heraklion, PO box 1352, Stavrakia, Heraklion Crete, Greece
| | - Panos E Vardas
- University Hospital of Heraklion, PO box 1352, Stavrakia, Heraklion Crete, Greece
| |
Collapse
|
44
|
Sbarouni E, Voudris V, Georgiadou P, Hamilos M, Steg G, Fox KM, Greenlaw N, Vardas PE. Heart rate and B-blockade in stable coronary artery disease in Greece. Hellenic J Cardiol 2015; 56:112-117. [PMID: 25854439] [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 Heart rate (HR) is a strong prognostic indicator in patients with coronary artery disease (CAD). However, there is only limited evidence on HR and the use of b-blockers in patients with CAD in contemporary clinical practice. METHODS CLARIFY is an international, prospective, observational, longitudinal registry of outpatients with stable CAD, defined as prior myocardial infarction or revascularization procedure, evidence of coronary stenosis >50%, or chest pain associated with proven myocardial ischemia. A total of 33,283 patients from 45 countries were enrolled between November 2009 and July 2010; of these, 559 patients were enrolled in Greece (age 62.3 ± 10.6 years, 84.44% men). RESULTS HR measured by pulse was 68.3 ± 10.2 bpm and by electrocardiogram 67.6 ± 10.9, with an excellent correlation (r=0.91, p<0.001). Overall, 42.8% had HR70 bpm. B-blockers were prescribed in 74.2% of patients. Resting HR by pulse on b-blocker was 67.8 bpm and without b-blocker 69.6 bpm (p=0.069). HR70 bpm was independently associated with a lack of physical activity, higher systolic blood pressure, and a higher prevalence of asthma or chronic obstructive pulmonary disease and carotid artery disease. CONCLUSION Despite the use of HR lowering agents, the percentage of patients with HR70 bpm was high. It is likely that we can further improve HR control in Greek patients with stable CAD by both increasing the prescription of b-blockers and up-titrating their dose, as well as by using and up-titrating other available HR lowering agents.
Collapse
Affiliation(s)
- Eftihia Sbarouni
- Second Division of Interventional Cardiology, Onassis Cardiac Surgery Center, Athens, Greece
| | | | | | | | | | | | | | | |
Collapse
|
45
|
Vardas PE. Cardiology in the next two decades: just imagine. Hellenic J Cardiol 2015; 56:191-192. [PMID: 25854452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023] Open
Affiliation(s)
- Panos E Vardas
- Department of Cardiology, Heraklion University Hospital, Crete, Greece
| |
Collapse
|
46
|
Patrianakos AP, Zacharaki AA, Kalogerakis A, Solidakis G, Parthenakis FI, Vardas PE. Two-dimensional global and segmental longitudinal strain: are the results from software in different high-end ultrasound systems comparable? Echo Res Pract 2015; 2:29-39. [PMID: 26693313 PMCID: PMC4676462 DOI: 10.1530/erp-14-0070] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Accepted: 02/25/2015] [Indexed: 11/25/2022] Open
Abstract
To compare the peak global longitudinal myocardial strain (PGLS) and peak segmental longitudinal myocardial strain (PSLS) values by speckle-tracking echocardiography (STE) obtained using two different echocardiography devices. STE is an emerging quantitative ultrasound technique that allows an accurate evaluation of global and segmental myocardial function. However, there is a lack of standardization of the acquired data among different manufacturers. Sixty-three subjects, mean age 56.2±10.4 years, underwent complete echocardiographic studies with two different devices (Philips IE33 and General Electric VIVID E9) performed by the same operator. Thirty-one of them had known cardiac disease, with estimated left ventricular ejection fraction <50%, while 32 were free of any cardiovascular disease (control subjects). All images were digitally stored and analyzed using off-line post processing with QLAB 9 and EchoPAC 11 Software packages. PSLS and PGLS were calculated. A strong relationship between QLAB and EchoPAC was found for PGLS (r=0.91, P<0.001), PSLS-4 chamber (CH; r=0.79, P<0.001), PSLS-2CH (r=0.73, P<0.001), and PSLS-3CH (r=0.78, P<0.001) QLAB. Bland–Altman analysis showed absolute differences vs average of −0.16, −0.37, −0.21, and −0.16 for PGLS, PSLS-4CH, PSLS-2CH, and PSLS-apical long-axis views respectively. Segmental analysis showed a good agreement between the apical segments, whereas poor correlations were found for the basal segments. Receiver operating characteristic curve analysis showed that cutoff values for PGLS of −17.5 and −17.75% with Philips or GE systems gave a sensitivity and specificity of 93.5 and 87.5%, and 90 and 87.5%, respectively, in the discrimination of the patients from the controls. Both Philips and GE echo stations were found to give comparable results for PGLS, with approximately the same cutoff values, suggesting that their PGLS results may be interchangeable.
Collapse
Affiliation(s)
- Alexandros P Patrianakos
- Cardiology Department, Heraklion University Hospital , PO Box 1352, Stavrakia, Heraklion, Crete, 71410 , Greece
| | - Aggeliki A Zacharaki
- Cardiology Department, Heraklion University Hospital , PO Box 1352, Stavrakia, Heraklion, Crete, 71410 , Greece
| | - Antonios Kalogerakis
- Cardiology Department, Heraklion University Hospital , PO Box 1352, Stavrakia, Heraklion, Crete, 71410 , Greece
| | - Georgios Solidakis
- Cardiology Department, Heraklion University Hospital , PO Box 1352, Stavrakia, Heraklion, Crete, 71410 , Greece
| | - Fragiskos I Parthenakis
- Cardiology Department, Heraklion University Hospital , PO Box 1352, Stavrakia, Heraklion, Crete, 71410 , Greece
| | - Panos E Vardas
- Cardiology Department, Heraklion University Hospital , PO Box 1352, Stavrakia, Heraklion, Crete, 71410 , Greece
| |
Collapse
|
47
|
Zacharaki A, Patrianakos AP, Pagonidis K, Parthenakis FI, Vardas PE. Localized constrictive pericarditis mimicking a cardiac apex diverticulum. Int J Cardiol 2015; 184:366-368. [PMID: 25745983 DOI: 10.1016/j.ijcard.2015.02.049] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [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: 01/06/2015] [Accepted: 02/21/2015] [Indexed: 10/23/2022]
Affiliation(s)
- A Zacharaki
- Cardiology Department, Heraklion University Hospital, Crete, Greece
| | - A P Patrianakos
- Cardiology Department, Heraklion University Hospital, Crete, Greece.
| | - K Pagonidis
- Radiology Department, Heraklion University Hospital, Crete, Greece
| | - F I Parthenakis
- Cardiology Department, Heraklion University Hospital, Crete, Greece
| | - P E Vardas
- Cardiology Department, Heraklion University Hospital, Crete, Greece
| |
Collapse
|
48
|
Marketou ME, Parthenakis FI, Kalyva A, Pontikoglou C, Maragkoudakis S, Kontaraki JE, Zacharis EA, Patrianakos A, Chlouverakis G, Papadaki HA, Vardas PE. Circulating mesenchymal stem cells in patients with hypertrophic cardiomyopathy. Cardiovasc Pathol 2015; 24:149-53. [PMID: 25744383 DOI: 10.1016/j.carpath.2015.02.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [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: 11/09/2014] [Revised: 02/16/2015] [Accepted: 02/17/2015] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND This study examines the mobilization of mesenchymal stem cells (MSCs) in patients with hypertrophic cardiomyopathy (HCM) compared to healthy individuals. The pathogenesis of myocardial hypertrophy in HCM is not fully understood. MSCs are involved in the process of neovascularization, fibrosis, and ventricular wall remodeling. METHODS AND RESULTS We included 40 patients with HCM and 23 healthy individuals. Using flow cytometry, we measured MSCs in peripheral blood, as a population of CD45-/CD34-/CD90+ cells and also as a population of CD45-/CD34-/CD105+ cells. The resulting MSC counts were expressed as percentages of the total cells. Patients with HCM were found to have a greater percentage of circulating CD45-/CD34-CD34-/CD90+ cells compared to controls (0.0041±0.005% vs. 0.0007±0.001%, respectively, P<.001). No significant difference in circulating CD45-/CD34-/CD105+ cells in the peripheral blood was found between HCM patients and controls (0.016±0.018% vs. 0.012±0.014%, respectively, P=.4). Notably, circulating CD45-/CD34-/CD90+ cells were positively correlated with left ventricular mass index (r=0.54, P<.001). CONCLUSIONS Patients with HCM reveal an increased mobilization of MSCs compared to healthy individuals. Although further research is needed to reveal the clinical significance of our findings, our data open a new dimension in the pathophysiology of the disease and may indicate new future therapeutic possibilities.
Collapse
Affiliation(s)
- Maria E Marketou
- Department of Cardiology, Heraklion University Hospital, Crete, Greece.
| | | | - Athanasia Kalyva
- Molecular Cardiology Laboratory, School of Medicine, University of Crete, Greece
| | | | | | - Joanna E Kontaraki
- Molecular Cardiology Laboratory, School of Medicine, University of Crete, Greece
| | | | | | | | - Helen A Papadaki
- Department of Hematology, Heraklion University Hospital, Crete, Greece
| | - Panos E Vardas
- Department of Cardiology, Heraklion University Hospital, Crete, Greece
| |
Collapse
|
49
|
|
50
|
Zoghbi WA, Duncan T, Antman E, Barbosa M, Champagne B, Chen D, Gamra H, Harold JG, Josephson S, Komajda M, Logstrup S, Jur C, Mayosi BM, Mwangi J, Ralston J, Sacco RL, Sim KH, Smith SC, Vardas PE, Wood DA. Sustainable Development Goals and the future of cardiovascular health. A statement from the Global Cardiovascular Disease Taskforce. Eur Heart J 2014; 35:3238-3239. [PMID: 25629099] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/04/2023] Open
|