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Papageorgiou ST, Damdoumis S, Goulis D, Tzikas S, Giannakoulas G. The Effect of Pulmonary Hypertension on Mortality and Intensive Care Unit Admission in Patients With SARS-CoV-2 Infection: A Systematic Review and Meta-Analysis. Heart Lung Circ 2024:S1443-9506(24)00076-3. [PMID: 38600017 DOI: 10.1016/j.hlc.2024.01.036] [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: 05/29/2023] [Revised: 12/05/2023] [Accepted: 01/29/2024] [Indexed: 04/12/2024]
Abstract
AIM Severe COVID-19 can cause acute respiratory distress syndrome, hypoxia, systemic complications, and increased mortality. Pulmonary hypertension (PH) is a major global health issue associated with worsening symptoms and increased mortality. This systematic review aimed to assess the influence of PH onset among COVID-19 patients on all-cause mortality and intensive care unit (ICU) admission. METHOD An unrestricted search of five databases up to June 2022 was undertaken. Pulmonary hypertension was assessed using transthoracic echocardiogram, computed tomography, or right heart catheterisation. After duplicate screening, data extraction, and risk of bias assessment, random effects meta-analyses of odds ratios (OR) and their 95% confidence intervals (CI) were performed for all-cause mortality and ICU admission. RESULTS From the 26 studies that were included (3,373 patients, 76% males, median age 62.6 years), PH in COVID-19 patients was significantly associated with higher odds for all-cause mortality (26 studies; OR 3.89; 95% CI 2.85-5.31; p<0.001) and higher odds for ICU admission (six studies; OR 2.50; 95% CI 1.69-3.70; p<0.001). Meta-regression/subgroup analyses by patient demographics, comorbidities, or therapeutic regimens, and sensitivity analyses did not find any differences. CONCLUSION Evidence from observational studies indicates that PH in COVID-19 patients is associated with increased odds of mortality and ICU admission.
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Affiliation(s)
- Stefanos T Papageorgiou
- Department of Cardiology I: Coronary and Peripheral Vascular Disease, Heart Failure, University Hospital Muenster, Muenster, Germany.
| | - Savvas Damdoumis
- Aristotle University of Thessaloniki, Faculty of Sciences, School of Biology, Department of Genetics, Development and Molecular Biology, Thessaloniki, Greece
| | - Dimitrios Goulis
- Unit of Reproductive Endocrinology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Stergios Tzikas
- Third Department of Cardiology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Georgios Giannakoulas
- First Department of Cardiology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Vassilikou A, Xenitopoulou MP, Ziampa K, Evangeliou AP, Mitsiadis S, Syrnioti A, Petrakis G, Tossios P, Vassilikos V, Tzikas S. Acute myocardial infarction due to giant coronary artery aneurysm and arteriovenous fistula: a challenging case report and review of the literature. BMC Cardiovasc Disord 2024; 24:187. [PMID: 38561678 PMCID: PMC10986014 DOI: 10.1186/s12872-024-03851-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 03/19/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND A coronary artery aneurysm (CAA) is an abnormal dilation of a coronary artery segment often accompanied by coronary artery fistula (CAF), leading to communication between a coronary artery and a cardiac chamber or a part of the coronary venous system. Both CAAs and CAFs can present with symptoms and signs of myocardial ischemia and infarction. CASE PRESENTATION We describe the case of a 46-year-old woman with non-ST-elevation myocardial infarction (NSTEMI) caused by a "giant" CAA. Various imaging modalities revealed a thrombus-containing aneurysm located at the right-posterior cardiac border, with established arteriovenous communication with the distal part of left circumflex artery (LCx). After initial treatment with dual antiplatelet therapy, a relapse of pain was reported along with a new increase in troponin levels, electrocardiographic abnormalities, reduced left ventricular ejection fraction (LVEF) and thrombus enlargement. Surgical excision of the aneurysm was favored, revealing its true size of 6 cm in diameter. Τhe aneurysm was excised without complications. The patient remained asymptomatic during follow-up. CONCLUSIONS Management of rare entities such as "giant" CAAs and CAFs can be challenging. Cases such as this can serve as precedents to facilitate treatment plans and develop consistent recommendations, emphasizing the importance of personalized strategies for future patients.
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Affiliation(s)
- A Vassilikou
- 3rd Department of Cardiology, "Hippokration" General Hospital of Thessaloniki, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - M P Xenitopoulou
- 3rd Department of Cardiology, "Hippokration" General Hospital of Thessaloniki, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - K Ziampa
- 3rd Department of Cardiology, "Hippokration" General Hospital of Thessaloniki, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - A P Evangeliou
- 3rd Department of Cardiology, "Hippokration" General Hospital of Thessaloniki, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - S Mitsiadis
- 3rd Department of Cardiology, "Hippokration" General Hospital of Thessaloniki, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - A Syrnioti
- Pathology Department, "AHEPA" University Hospital of Thessaloniki, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - G Petrakis
- Pathology Department, "AHEPA" University Hospital of Thessaloniki, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - P Tossios
- Cardiothoracic Surgery Department, "Hippokration" General Hospital of Thessaloniki, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - V Vassilikos
- 3rd Department of Cardiology, "Hippokration" General Hospital of Thessaloniki, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - S Tzikas
- 3rd Department of Cardiology, "Hippokration" General Hospital of Thessaloniki, Aristotle University of Thessaloniki, Thessaloniki, Greece.
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3
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Alevroudis I, Kotoulas SC, Tzikas S, Vassilikos V. Congestion in Heart Failure: From the Secret of a Mummy to Today's Novel Diagnostic and Therapeutic Approaches: A Comprehensive Review. J Clin Med 2023; 13:12. [PMID: 38202020 PMCID: PMC10779505 DOI: 10.3390/jcm13010012] [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: 11/10/2023] [Revised: 12/04/2023] [Accepted: 12/14/2023] [Indexed: 01/12/2024] Open
Abstract
This review paper presents a review of the evolution of this disease throughout the centuries, describes and summarizes the pathophysiologic mechanisms, briefly discusses the mechanism of action of diuretics, presents their role in decongesting heart failure in patients, and reveals the data behind ultrafiltration in the management of acutely or chronically decompensated heart failure (ADHF), focusing on all the available data and advancements in this field. Acutely decompensated heart failure (ADHF) presents a critical clinical condition characterized by worsening symptoms and signs of heart failure, necessitating prompt intervention to alleviate congestion and improve cardiac function. Diuretics have traditionally been the mainstay for managing fluid overload in ADHF. Mounting evidence suggests that due to numerous causes, such as coexisting renal failure or chronic use of loop diuretics, an increasing rate of diuretic resistance is noticed and needs to be addressed. There has been a series of trials that combined diuretics of different categories without the expected results. Emerging evidence suggests that ultrafiltration may offer an alternative or adjunctive approach.
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Affiliation(s)
- Ioannis Alevroudis
- Third Department of Cardiology, Ippokratio General Hospital, Aristotle University of Thessaloniki, 54642 Thessaloniki, Greece (V.V.)
- Intensive Care Medicine Clinic, Ippokratio General Hospital, Aristotle University of Thessaloniki, 54642 Thessaloniki, Greece;
| | | | - Stergios Tzikas
- Third Department of Cardiology, Ippokratio General Hospital, Aristotle University of Thessaloniki, 54642 Thessaloniki, Greece (V.V.)
| | - Vassilios Vassilikos
- Third Department of Cardiology, Ippokratio General Hospital, Aristotle University of Thessaloniki, 54642 Thessaloniki, Greece (V.V.)
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Mitsis A, Avraamides P, Lakoumentas J, Kyriakou M, Sokratous S, Karmioti G, Drakomathioulakis M, Theodoropoulos KC, Nasoufidou A, Evangeliou A, Vassilikos V, Fragakis N, Ziakas A, Tzikas S, Kassimis G. Role of inflammation following an acute myocardial infarction: design of INFINITY. Biomark Med 2023; 17:971-981. [PMID: 38235565 DOI: 10.2217/bmm-2023-0491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2024] Open
Abstract
After a myocardial infarction, the inflammatory response is connected to major adverse outcomes such as ischemia-reperfusion injury, adverse cardiac remodeling, infarct size and poor prognosis. INFlammatIoN amI sTudY (INFINITY) is a multicenter, prospective, observational, cohort study designed to investigate the prognostic role of the cytokines IL-6, IL-10, IL-18 and IL-17 and the adipokines leptin, apelin and chemerin in patients with acute coronary syndrome. The study will test if these inflammatory biomarkers reflect different clinical manifestations of coronary artery disease and have a prognostic role in a 6-month follow-up period. This study represents an opportunity to investigate further the prognostic role of a selected combination of proinflammatory and anti-inflammatory biomarkers in the prognosis and risk stratification of acute coronary syndrome patients.
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Affiliation(s)
- Andreas Mitsis
- Cardiology Department, Nicosia General Hospital, Nicosia, 2029, Cyprus
| | | | - John Lakoumentas
- Department of Medical Physics, School of Medicine, University of Patras, Patras, 26504, Greece
| | - Michaela Kyriakou
- Cardiology Department, Nicosia General Hospital, Nicosia, 2029, Cyprus
| | | | - Georgia Karmioti
- Cardiology Department, Nicosia General Hospital, Nicosia, 2029, Cyprus
| | | | - Konstantinos C Theodoropoulos
- First Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, 54636, Greece
| | - Athina Nasoufidou
- Second Department of Cardiology, Aristotle University of Thessaloniki, Thessaloniki, 54642, Greece
| | - Alexandros Evangeliou
- Third Department of Cardiology, Aristotle University of Thessaloniki, Thessaloniki, 54642, Greece
| | - Vassilios Vassilikos
- Third Department of Cardiology, Aristotle University of Thessaloniki, Thessaloniki, 54642, Greece
| | - Nikolaos Fragakis
- Second Department of Cardiology, Aristotle University of Thessaloniki, Thessaloniki, 54642, Greece
| | - Antonios Ziakas
- First Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, 54636, Greece
| | - Stergios Tzikas
- Third Department of Cardiology, Aristotle University of Thessaloniki, Thessaloniki, 54642, Greece
| | - George Kassimis
- Second Department of Cardiology, Aristotle University of Thessaloniki, Thessaloniki, 54642, Greece
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5
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Siamkouris D, Offers E, Schloesser M, Ilieski G, Tzikas S. Ischemia Possibly Associated with High Degree Atrioventricular Block. Case Rep Cardiol 2023; 2023:6676757. [PMID: 37637853 PMCID: PMC10460276 DOI: 10.1155/2023/6676757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 02/13/2023] [Accepted: 07/03/2023] [Indexed: 08/29/2023] Open
Abstract
Conduction restoration in second- and third-degree atrioventricular (AV) block after revascularization in acute coronary syndrome (ACS) setting is well established, however this is not the case in non-ACS setting. We present a case of a patient referred for permanent pacemaker implantation, due to high degree AV block (HAVB), who restored his conduction possibly due to targeted revascularization. Thus, this case sheds insight in the reversibility potential of HAVB after revascularization in non-ACS patients, which although signified in current literature, is still far from being a recommendation, due to lack of robust scientific confirmation.
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Affiliation(s)
- Dimitrios Siamkouris
- Department of Cardiology, Dreifaltigkeits Hospital Lippstadt, Germany, Academic Teaching Hospital of Westfaelische Wilhelms University Muenster, Muenster, Germany
| | - Elmar Offers
- Department of Cardiology, Dreifaltigkeits Hospital Lippstadt, Germany, Academic Teaching Hospital of Westfaelische Wilhelms University Muenster, Muenster, Germany
| | - Marc Schloesser
- Department of Cardiology, Dreifaltigkeits Hospital Lippstadt, Germany, Academic Teaching Hospital of Westfaelische Wilhelms University Muenster, Muenster, Germany
| | - Gjoko Ilieski
- Department of Cardiology, Dreifaltigkeits Hospital Lippstadt, Germany, Academic Teaching Hospital of Westfaelische Wilhelms University Muenster, Muenster, Germany
| | - Stergios Tzikas
- 3rd Department of Cardiology, Ippokrateio General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
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6
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Bakogiannis C, Mouselimis D, Tsarouchas A, Papadopoulos CE, Theofillogiannakos EK, Lechat E, Antoniadis AP, Pagourelias ED, Kelemanis I, Tzikas S, Fragakis N, Efthimiadis GK, Karamitsos TD, Doumas M, Vassilikos VP. Iron therapy and severe arrhythmias in HFrEF: rationale, study design, and baseline results of the RESAFE-HF trial. ESC Heart Fail 2023; 10:1184-1192. [PMID: 36647691 PMCID: PMC10053179 DOI: 10.1002/ehf2.14276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 08/11/2022] [Accepted: 12/15/2022] [Indexed: 01/18/2023] Open
Abstract
AIMS The Iron Intravenous Therapy in Reducing the burden of Severe Arrhythmias in HFrEF (RESAFE-HF) registry study aims to provide real-word evidence on the impact of intravenous ferric carboxymaltose (FCM) on the arrhythmic burden of patients with heart failure with reduced ejection fraction (HFrEF), iron deficiency (ID), and implanted cardiac implantable electronic devices (CIEDs). METHODS AND RESULTS The RESAFE-HF (NCT04974021) study was designed as a prospective, single-centre, and open-label registry study with baseline, 3, 6, and 12 month visits. Adult patients with HFrEF and CIEDs scheduled to receive IV FCM as treatment for ID as part of clinical practice were eligible to participate. The primary endpoint is the composite iron-related endpoint of haemoglobin ≥ 12 g/dL, ferritin ≥ 50 ng/L, and transferrin saturation > 20%. Secondary endpoints include unplanned HF-related hospitalizations, ventricular tachyarrhythmias detected by CIEDs and Holter monitors, echocardiographic markers, functional status (VO2 max and 6 min walk test), blood biomarkers, and quality of life. In total, 106 patients with a median age of 72 years (14.4) were included. The majority were male (84.9%), whereas 92.5% of patients were categorized to New York Heart Association II/III. Patients' arrhythmic burden prior to FCM administration was significant-19 patients (17.9%) received appropriate CIED therapy for termination of ventricular tachyarrhythmia in the preceding 12 months, and 75.5% of patients have frequent, repetitive multiform premature ventricular contractions. CONCLUSIONS The RESAFE-HF trial is expected to provide evidence on the effect of treating ID with FCM in HFrEF based on real-world data. Special focus will be given on the arrhythmic burden post-FCM administration.
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Affiliation(s)
- Constantinos Bakogiannis
- Third Cardiology Department, School of MedicineHippokration General Hospital, Aristotle University of ThessalonikiThessalonikiGreece
| | - Dimitrios Mouselimis
- Third Cardiology Department, School of MedicineHippokration General Hospital, Aristotle University of ThessalonikiThessalonikiGreece
| | - Anastasios Tsarouchas
- Third Cardiology Department, School of MedicineHippokration General Hospital, Aristotle University of ThessalonikiThessalonikiGreece
| | - Christodoulos E. Papadopoulos
- Third Cardiology Department, School of MedicineHippokration General Hospital, Aristotle University of ThessalonikiThessalonikiGreece
| | - Efstratios K. Theofillogiannakos
- Third Cardiology Department, School of MedicineHippokration General Hospital, Aristotle University of ThessalonikiThessalonikiGreece
| | | | - Antonios P. Antoniadis
- Third Cardiology Department, School of MedicineHippokration General Hospital, Aristotle University of ThessalonikiThessalonikiGreece
| | - Efstathios D. Pagourelias
- Third Cardiology Department, School of MedicineHippokration General Hospital, Aristotle University of ThessalonikiThessalonikiGreece
| | - Ioannis Kelemanis
- Third Cardiology Department, School of MedicineHippokration General Hospital, Aristotle University of ThessalonikiThessalonikiGreece
| | - Stergios Tzikas
- Third Cardiology Department, School of MedicineHippokration General Hospital, Aristotle University of ThessalonikiThessalonikiGreece
| | - Nikolaos Fragakis
- Third Cardiology Department, School of MedicineHippokration General Hospital, Aristotle University of ThessalonikiThessalonikiGreece
| | - Georgios K. Efthimiadis
- First Cardiology Department, School of MedicineAHEPA University Hospital, Aristotle University of ThessalonikiThessalonikiGreece
| | - Theodoros D. Karamitsos
- First Cardiology Department, School of MedicineAHEPA University Hospital, Aristotle University of ThessalonikiThessalonikiGreece
| | - Michael Doumas
- Second Propaedeutics Department of Internal MedicineHippokration General Hospital, Aristotle University of ThessalonikiThessalonikiGreece
- Georgetown University and VAMC and George Washington UniversityWashingtonDCUSA
| | - Vassilios P. Vassilikos
- Third Cardiology Department, School of MedicineHippokration General Hospital, Aristotle University of ThessalonikiThessalonikiGreece
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7
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Fragakis N, Antoniadis A, Sotiriadou M, Virgiliou C, Ballauri I, Gika H, Boulmpou A, Triantafyllou K, Vergopoulos S, Bakogiannis C, Papadopoulos C, Tzikas S, Karamitsos T, Vassilikos V. Syncopal patients without prodromes exhibit a diverse pattern of adenosine release during head-up tilt test. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background/Introduction
In a significant proportion of patients with neurally-mediated syncope (NMS), the mechanism of syncope remains largely undetermined. Adenosine has been proposed as a central humoral factor in various forms of NMS: high Adenosine Plasma Levels (ADP) are encountered in patients with vasovagal syncope (VVS), low ADP in non-prodromes syncope (NPS), while ADP in patients with situational syncope SS are less well determined.
Purpose
We sought to assess ADP in patients with different clinical forms of syncope, with an emphasis on the presence or absence of prodromal symptoms, as well as the relation between ADP and the outcomes of Head-Up Tilt Table Test (HUTT) and Adenosine test (ADT).
Methods
Patients with different clinical types of NMS (n=124), i.e., VVS, NPS, or SS, were investigated using a standard protocol including HUTT and ADT. During HUTT, ADP was measured in the supine position, at table tilting, and in syncope.
Results
Baseline ADP did not differ among groups. ADP at syncope were higher in NPS compared to VVS (1.55±1.29 vs 0.16±0.05 μM, p=0.03) and SS (0.15±0.05 μM, p=0.02). In NPS, ADP increased from the supine position to the time of syncope (0.47±0.25 to 1.55±1.29 μM, p=0.04). In VVS, ADP increased only from the supine to the tilt position (0.23±0.04 to 0.35±0.10 μMu, p=0.02), while in SS ADP did not change in any stage of HUTT. SS was associated with cardioinhibitory HUTT (OR 3.40, 95% CI 1.05 to 9.56, p=0.04) and positive ADT (OR 4.22, 95% CI 1.47 to 11.46, p=0.012).
Conclusion(s)
A distinct pattern of ADP increase is noted during HUTT in NPS, suggesting that an excessive increase of ADP may play the key role in triggering this type of clinical presentation of syncope independently of the baseline ADP. Cardioinhibition prevails in patients with SS without clear adenosine involvement. Such observations contribute to an enhanced understanding of the pathophysiology of different clinical forms of syncope which may offer the possibility to tailor the management approach appropriately.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- N Fragakis
- Hippokration General Hospital, 3rd Cardiology Department, Aristotle University Medical School , Thessaloniki , Greece
| | - A Antoniadis
- Hippokration General Hospital, 3rd Cardiology Department, Aristotle University Medical School , Thessaloniki , Greece
| | - M Sotiriadou
- Hippokration General Hospital, 3rd Cardiology Department, Aristotle University Medical School , Thessaloniki , Greece
| | - C Virgiliou
- Laboratory of Analytical Chemistry, Department of Chemistry, Aristotle University of Thessaloniki , Thessaloniki , Greece
| | - I Ballauri
- Analysi Iatriki A.E. Diagnostic Research Clinics , Thessaloniki , Greece
| | - H Gika
- Laboratory of Forensic Medicine and Toxicology, Aristotle University Medical School , Thessaloniki , Greece
| | - A Boulmpou
- Hippokration General Hospital, 3rd Cardiology Department, Aristotle University Medical School , Thessaloniki , Greece
| | - K Triantafyllou
- Hippokration General Hospital, 3rd Cardiology Department, Aristotle University Medical School , Thessaloniki , Greece
| | - S Vergopoulos
- Hippokration General Hospital, 3rd Cardiology Department, Aristotle University Medical School , Thessaloniki , Greece
| | - C Bakogiannis
- Hippokration General Hospital, 3rd Cardiology Department, Aristotle University Medical School , Thessaloniki , Greece
| | - C Papadopoulos
- Hippokration General Hospital, 3rd Cardiology Department, Aristotle University Medical School , Thessaloniki , Greece
| | - S Tzikas
- Hippokration General Hospital, 3rd Cardiology Department, Aristotle University Medical School , Thessaloniki , Greece
| | - T Karamitsos
- AHEPA University General Hospital, 1st Department of Cardiology, Aristotle University Medical School , Thessaloniki , Greece
| | - V Vassilikos
- Hippokration General Hospital, 3rd Cardiology Department, Aristotle University Medical School , Thessaloniki , Greece
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8
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Pagourelias E, Boulmpou A, Evangeliou A, Zormpas G, Alexandridis G, Kotzadamis D, Vergopoulos S, Tsavousoglou C, Antoniadis A, Mavroudi M, Papadopoulos CE, Tzikas S, Fragakis N, Vassilikos VP. Prevalence of atrial myopathy among hypertrophic cardiomyopathy patients without atrial fibrillation. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Atrial myopathy (AM) is an entity reflecting left atrial (LA) structural and electrical remodeling, connected to atrial fibrillation (AF) development and heart failure progression in various substrates. In hypertrophic cardiomyopathy (HCM), prevalence of AM beyond AF and its correlations are not fully investigated.
Purpose
Aim of this study was to estimate the prevalence of AM in a cohort of HCM patients without AF history through assessment of LA volume index (LAVI), LA reservoir strain (LARS) and total atrial conduction time (TACT) (estimated by tissue Doppler imaging). Additionally, to investigate AM indices' correlation with other phenotypic and functional characteristics of HCM.
Methods
We included 50 HCM patients (60±16 years, 80% male, maximum wall thickness 18.6±4.1mm) without history of AF who have consecutively undergone 2D-speckle tracking echocardiography and cardiovascular magnetic resonance (CMR) with late gadolinium enhancement (LGE). TACT and LARS measurement is shown on left panel. Burden of fibrosis (percentage of LV mass) was defined by LGE extent (>5 standard deviations compared to nulled myocardium) in CMR slices. Cut-off points for TACT, LAVI and LARS were adopted by literature (≥115 msec, ≥34 mL/m2 and <21.3% respectively).
Results
All HCM patients had preserved EF (61.8±8%), while 13 (26%) presented outflow tract obstruction and 4 (8%) diastolic dysfunction stage≥2. LGE was observed in 32 patients (64%) occupying 7.2±5% of left ventricular (LV) mass. Mean TACT was 139.9±22 msec, with LAVI being 30.8±16.1 mL/m2 and LARS 27.6±13.9%. After assessing prevalence of AM parameters, 41 patients (82%) presented a prolonged (≥115 msec) TACT with only 13 of them having also a significantly dilated LA (≥34 mL/m2) and 16 an impaired LARS. Among HCM demographic, phenotypic and functional characteristics tested, age and LV mass index were found to be the only independent regressors of TACT (r=0.54, p<0.0005 and r=0.44, p=0.002 respectively, right panels), while E/E' (r=−0.44, p=0.003) and fibrosis extent (r=0.36, p=0.02) were the strongest predictors of LARS and LAVI values respectively.
Conclusions
Atrial electro-mechanical delay assessed through TDI based TACT, is the most frequent AM parameter among HCM patients irrespective of AF and even before LA dilatation and LA strain impairment. AM parameters seem to correlate with various morphological and functional characteristics of HCM, their significance, however, in predicting progression towards AF development or HF presentation remains to be elucidated.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- E Pagourelias
- Aristotle University of Thessaloniki, Third Cardiology Department, Hippokrateion University Hospital , Thessaloniki , Greece
| | - A Boulmpou
- Aristotle University of Thessaloniki, Third Cardiology Department, Hippokrateion University Hospital , Thessaloniki , Greece
| | - A Evangeliou
- Aristotle University of Thessaloniki, Third Cardiology Department, Hippokrateion University Hospital , Thessaloniki , Greece
| | - G Zormpas
- Aristotle University of Thessaloniki, Third Cardiology Department, Hippokrateion University Hospital , Thessaloniki , Greece
| | - G Alexandridis
- Aristotle University of Thessaloniki, Third Cardiology Department, Hippokrateion University Hospital , Thessaloniki , Greece
| | - D Kotzadamis
- Aristotle University of Thessaloniki, Third Cardiology Department, Hippokrateion University Hospital , Thessaloniki , Greece
| | - S Vergopoulos
- Aristotle University of Thessaloniki, Third Cardiology Department, Hippokrateion University Hospital , Thessaloniki , Greece
| | - C Tsavousoglou
- Aristotle University of Thessaloniki, Third Cardiology Department, Hippokrateion University Hospital , Thessaloniki , Greece
| | - A Antoniadis
- Aristotle University of Thessaloniki, Third Cardiology Department, Hippokrateion University Hospital , Thessaloniki , Greece
| | - M Mavroudi
- Aristotle University of Thessaloniki, Third Cardiology Department, Hippokrateion University Hospital , Thessaloniki , Greece
| | - C E Papadopoulos
- Aristotle University of Thessaloniki, Third Cardiology Department, Hippokrateion University Hospital , Thessaloniki , Greece
| | - S Tzikas
- Aristotle University of Thessaloniki, Third Cardiology Department, Hippokrateion University Hospital , Thessaloniki , Greece
| | - N Fragakis
- Aristotle University of Thessaloniki, Third Cardiology Department, Hippokrateion University Hospital , Thessaloniki , Greece
| | - V P Vassilikos
- Aristotle University of Thessaloniki, Third Cardiology Department, Hippokrateion University Hospital , Thessaloniki , Greece
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9
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Kanakakis I, Stafylas P, Tsigkas G, Nikas D, Synetos A, Avramidis D, Tsiafoutis I, Dagre A, Tzikas S, Latsios G, Patsourakos N, Sanidas I, Skalidis E, Pipilis A, Bamidis P, Davlouros P, Kanakakis I, Tselegkidi M, Sertedaki E, Mamarelis I, Fraggos E, Mantzouranis E, Karvounis C, Manolis A, Chatzilymperis G, Chiotelis I, Gryllis D, Poulimenos L, Triantafyllis A, Alexopoulos D, Varlamos C, Almpanis G, Aggeli A, Sakkas A, Trikas A, Tsiamis S, Triantafylloy K, Mpenia D, Oikonomou D, Papadopoulou E, Avramidis D, Kousta M, Moulianitaki E, Poulianitis G, Mavrou G, Latsios G, Synetos A, Tousoulis D, Kafkas N, Godwin S, Mertzanos G, Koytouzis M, Tsiafoutis I, Papadopoulos A, Tsoumeleas A, Barbetseas I, Sanidas I, Athanasiou A, Paizis I, Kakkavas A, Papafanis T, Mantas I, Neroutsos G, Gkoliopoulou A, Tafrali V, Diakakis G, Grammatikopoulos K, Sinanis T, Kartalis A, Afendoulis D, Voutas P, Kardamis C, Doulis A, Kalantzis N, Vergis K, Chasikidis C, Armatas G, Damelou A, Ntogka M, Serafetinidis I, Zagkas K, Tselempis T, Makridis P, Karantoumanis I, Karapatsoudi E, Oikonomou K, Foukarakis E, Kafarakis P, Pitarokoilis M, Rogdakis E, Stavrakis S, Koudounis G, Karampetsos V, Lionakis N, Panotopoulos C, Svoronos D, Tsorlalis I, Tsatiris K, Beneki E, Papadopoulos N, Sawafta A, Kozatsani D, Spyromitros G, Bostanitis I, Dimitriadis G, Nikoloulis N, Kampouridis N, Giampatzis V, Patsilinakos S, Andrikou E, Katsiadas N, Papanagnou G, Kotsakis A, Ioannidis E, Platogiannis N, Psychari S, Pissimissis E, Gavrielatos G, Maritsa D, Papakonstantinou N, Patsourakos N, Oikonomou G, Katsanou K, Lazaris E, Moschos N, Giakoumakis T, Papagiannis N, Goudis C, Daios S, Devliotis K, Dimitriadis F, Giannadaki M, Savvidis M, Tsinopoulos G, Zarifis I, Askalidou T, Vasileiadis I, Kleitsiotou P, Sidiropoulos S, Tsaousidis A, Tzikas S, Vassilikos V, Papadopoulos C, Zarvalis Ε, Gogos C, Moschovidis V, Styliadis I, Laschos V, Spathoulas K, Vogiatzis I, Kasmeridis C, Papadopoulos A, Pittas S, Sdogkos E, Dagre A, Mpounas P, Rodis I, Pipilis A, Konstantinidis S, Makrygiannis S, Masdrakis A, Magginas A, Sevastos G, Katsimagklis G, Skalidis E, Petousis S, Davlouros P, Tsigkas G, Hahalis G, Koufou E, Tziakas D, Chalikias G, Thomaidi A, Stakos D, Chotidis A, Nikas D, Sakellariou X, Skoularigkis I, Dimos A, Iakovis N, Mpourazana A, Zagouras A, Lygkouri G, Bamidis P, Lagakis P, Spachos D, Stafylas P, Chalitsios C, Karaiskou M, Tychala C. Epidemiology, reperfusion management and outcomes of patients with myocardial infarction in Greece: The ILIAKTIS study. Hellenic J Cardiol 2022; 67:1-8. [DOI: 10.1016/j.hjc.2022.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 01/20/2022] [Accepted: 03/08/2022] [Indexed: 11/26/2022] Open
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10
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Chatzinikolaou A, Tzikas S, Lavdaniti M. Assessment of Quality of Life in Patients With Cardiovascular Disease Using the SF-36, MacNew, and EQ-5D-5L Questionnaires. Cureus 2021; 13:e17982. [PMID: 34667665 PMCID: PMC8517455 DOI: 10.7759/cureus.17982] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/14/2021] [Indexed: 11/05/2022] Open
Abstract
Background Cardiovascular disease (CVD) is responsible for 18 million annual deaths worldwide. CVD affects patients' Quality of Life (QoL) mainly in physical, emotional and social dimension. Aim To assess the QoL of patients with CVD in Northern Greece, using three different instruments. Methods The study was conducted in one large hospital located in a major Greek city. A convenience sample of 80 patients participated. A questionnaire including Short Form-36 Health Survey (SF-36), EuroQoL 5-dimensions 5-levels (EQ-5D-5L), MacNew, demographic, and clinical characteristics was used to collect data. Results The mean age of the patients was 63.31±14.07. Analysis revealed statistically significant main effects of age on the physical limitations, emotional limitations, social functioning, and pain. Also, the analysis showed significant main effects of education on the MacNew Physical, MacNew Social, and the EQ-5D-5L index (p< 0.05). Participants who had graduated primary school had significantly lower quality of life scores than higher education graduates in the MacNew physical (p< 0.02). Furthermore, in the SF-36 pain subscale, the heart failure group had a significantly lower quality of life than the other heart diseases (p= 0.03). Conclusion Quality of life is affected by factors such as age, type of heart disease, therapy, and comorbidities. Health care providers should be knowledgeable of the factors that affect the quality of life sectors (physical, emotional, and social life) of patients with CVD in order to meet their needs and have the most suitable treatment.
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Affiliation(s)
| | - Stergios Tzikas
- Third Department of Cardiology, Ippokratio General Hospital, Aristotle University of Thessaloniki, Thessaloniki, GRC
| | - Maria Lavdaniti
- Nursing Department, International Hellenic University, Thessaloniki, GRC
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11
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Pagourelias E, Vassilikos VP, Katsos K, Zaggelidou E, Raikos N, Tzikas S, Tsavousoglou C, Kouparanis A, Anastasakis A, Kassimis G, Ziakas A, Sianos G, Karvounis H, Kanonidis I, Spiliopoulou C. Impact of the first coronavirus-disease pandemic wave on cardiovascular admissions and sudden cardiac death rates in Greece. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Various studies suggest a decrease of hospital admissions for acute coronary syndromes (ACS) during COVID-19 outbreak, implying an increase in ACS related pre-hospital-care deaths as a cause of this phenomenon.
Purpose
Aim of this study was to investigate the impact of social containment measures on ACS admission and acute coronary deaths (ACDs) rates in Greece, during COVID-19 first pandemic wave in 2020.
Methods
Data for this analysis were retrieved by the official records of University Forensic and Cardiology Departments and the Forensic Science Services of the most crowded metropolitan areas of Greece (almost 25% of the entire Greek population ≈ 2.5 million people). The study period was defined as the time between March 15 2020, when the Greek state started to implement strict lock-down measures to contain COVID-19 pandemics, until April 14 2020. To compare admission and SCD rates, a corresponding control period a year earlier was chosen. Incidence rates (IRs) (events over days) of ACSs and ACDs in each time-period were assessed along with IRs ratios (IRRs) and 95% CI intervals. Secondary analysis for non-ischemic cardiovascular deaths (CVDs) or violent deaths (VDs) (including road traffic accident deaths) was also performed.
Results
There has been a relative 38.9% reduction in ACS admissions in 2020 [1.8, 95% CI (1.35–2.34) in 2019 vs 1.1, 95% CI (0.76–1.54) in 2020, p=0.02], concordant with a 66% relative reduction of total admissions (p<0.005). Overall, 171 deaths in 2020 vs 208 in 2019 were referred for autopsies in the enrolled forensic departments. Gender and age distribution were not significantly different between case and control periods. There were no statistically significant differences in the frequency of deaths between the two periods examined, with the exception of deaths secondary to road traffic accidents [IR 0.13, 95% CI (0.04–0.34) in 2020 vs 0.67, 95% CI (0.41–1.03) in 2019, p=0.001] and CVDs [IR 0.43, 95% CI (0.23–0.74) in 2020 vs 1.03, 95% CI (0.70–1.47) in 2019, p=0.007] which significantly decreased during COVID-19 pandemic wave. Absolute numbers, percentile changes and IRs are demonstrated in Figure 1 and Table 1.
Conclusions
Our analysis offers evidence over a significant decrease in ACS-related hospitalization rates during COVID-19 first pandemic wave. This decrease is not linked to an increase in pre-hospital, autopsy defined ACDs, as previously thought, implying that many ACS patients may not ask for help on time due to infection fear, being prone however to late-onset complications. Pre-hospital triage and care services, should be appropriately transformed to facilitate and speed-up access of cardiovascular patients to health-care systems during the pandemic.
Funding Acknowledgement
Type of funding sources: None. Figure 1
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Affiliation(s)
- E Pagourelias
- Hippokration General Hospital of Thessloniki, Thessaloniki, Greece
| | - V P Vassilikos
- Aristotle University of Thessaloniki, Third Cardiology Department, Hippokrateion University Hospital, Thessaloniki, Greece
| | - K Katsos
- National & Kapodistrian University of Athens Medical School, Department of Forensic Medicine and Toxicology, Athens, Greece
| | - E Zaggelidou
- Laboratory of Forensic Service of Ministry of Justice of Thessaloniki, Thessaloniki, Greece
| | - N Raikos
- Aristotle University of Thessaloniki, Laboratory of Forensic Medicine & Toxicology, Thessaloniki, Greece
| | - S Tzikas
- Aristotle University of Thessaloniki, Third Cardiology Department, Hippokrateion University Hospital, Thessaloniki, Greece
| | - C Tsavousoglou
- Aristotle University of Thessaloniki, Third Cardiology Department, Hippokrateion University Hospital, Thessaloniki, Greece
| | - A Kouparanis
- Aristotle University of Thessaloniki, First Cardiology Department, AHEPA University Hospital, Thessaloniki, Greece
| | - A Anastasakis
- Onassis Cardiac Surgery Center, Department of Cardiology, Athens, Greece
| | - G Kassimis
- Hippokration General Hospital of Thessloniki, Thessaloniki, Greece
| | - A Ziakas
- Aristotle University of Thessaloniki, First Cardiology Department, AHEPA University Hospital, Thessaloniki, Greece
| | - G Sianos
- Aristotle University of Thessaloniki, First Cardiology Department, AHEPA University Hospital, Thessaloniki, Greece
| | - H Karvounis
- Aristotle University of Thessaloniki, First Cardiology Department, AHEPA University Hospital, Thessaloniki, Greece
| | - I Kanonidis
- Hippokration General Hospital of Thessloniki, Thessaloniki, Greece
| | - C Spiliopoulou
- National & Kapodistrian University of Athens Medical School, Department of Forensic Medicine and Toxicology, Athens, Greece
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Mouselimis D, Tsarouchas A, Bakogiannis C, Mitsas A, Tsalikakis D, Tsavousoglou C, Vergopoulos S, Kelemanis I, Theofillogiannakos E, Antoniadis A, Tzikas S, Fragakis N, Doumas M, Papadopoulos C, Vassilikos V. How intravenous iron therapy affects arrhythmia burden and functional status in patients with advanced heart failure and implantable devices. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Heart failure with reduced ejection fraction (HFrEF) is a disease that confers significant morbidity and mortality to patients. Patients suffer from increased arrhythmia burden; lethal ventricular arrhythmias are frequent. Iron deficiency (ID) is increasingly recognized as a common comorbidity that constitutes a further detriment to patients' cardiorespiratory capacity and an independent prognosticator of mortality. ID treatment with intravenous ferric carboxymaltose (IV FCM) has proven beneficial, improving QoL and exercise capacity in HFrEF patients with ID. Iron depletion is linked to disturbed myocyte electromechanical balance, especially in HF. However, the role of IV FCM arrhythmic burden in HFrEF patients with ID has not been examined.
Purpose
Investigate the effect of IV FCM treatment on the functional capacity, QoL and arrhythmic burden of in HFrEF patients with ID and cardiac implantable electronic devices (CIED).
Methods
HFrEF patients with ID and CIEDs were recruited from our outpatient HF clinic. CIED telemetry revealed their arrhythmic burden for the 6 months preceding IV FCM administration. Patients underwent physical examination, blood testing, 6-minute walk testing, 24-hour Holter monitoring, QoL quantification with the KCCQ and EQ-5D-5L questionnaires and repeat CIED telemetry at study baseline (IV FCM administration) and 6-months. Microvolt T-wave alternans (MTWA) and heart rate turbulence (HRT) slope and onset were quantified through the 24-hour ECG recordings. HRT results are reported as HRT0, HRT1 or HRT2 based on the number of abnormal HRT parameters.
Results
So far, 83 (aged 68.3±8.7 years, 82% male) out of a total of 96 recruited patients have completed the 6-month follow-up (3 of 83 died before the 6-month mark). Picture 1 contains patients' baseline characteristics and 6-month results. Patients received a mean of 1.43±0.61g of IV FCM during the follow-up period, which significantly ameliorated iron status (Picture 1). The 6MWD increased by 32.4m (95% CI: 14.7–47.2, P<0.001), as did the KCCQ total score (P=0.008). Patients' CIEDs recorded significantly more nsVTs in the 6 months preceding IV FCM administration (2.2±15.7 per month) opposed to the subsequent period (0.06±3.1 per month, P=0.006). Patients' MTWA improved at 6-months over baseline (P=0.004), and a trend for improvement in HRT scores was observed (P=0.06). Hospitalization-free survival curves of these time periods reveal a non-significant trend for lower hospitalization risk following IV FCM (HR=1.9, P=0.09).
Conclusions
After 6 months of IV FCM treatment, HFrEF patients with ID had significantly better exercise capacity and quality of life. Regarding arrhythmias, a tentative improvement in CIED- and Holter-derived arrhythmic markers was observed. Extended follow-up of a larger sample size will provide further insight for the effect of IV FCM in these patients' arrhythmic burden.
Funding Acknowledgement
Type of funding sources: None. Baseline and 6-month resultsHospitalization curves pre-post IV FCM
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Affiliation(s)
- D Mouselimis
- Hippokration General Hospital of Thessaloniki, Third Cardiology Department AUTh, Thessaloniki, Greece
| | - A Tsarouchas
- Hippokration General Hospital of Thessaloniki, Third Cardiology Department AUTh, Thessaloniki, Greece
| | - C Bakogiannis
- Hippokration General Hospital of Thessaloniki, Third Cardiology Department AUTh, Thessaloniki, Greece
| | - A Mitsas
- Hippokration General Hospital of Thessaloniki, Third Cardiology Department AUTh, Thessaloniki, Greece
| | - D Tsalikakis
- University of Western Macedonia, Department of Informatics and Telecommunications Engineering, Kozani, Greece
| | - C Tsavousoglou
- Hippokration General Hospital of Thessaloniki, Third Cardiology Department AUTh, Thessaloniki, Greece
| | - S Vergopoulos
- Hippokration General Hospital of Thessaloniki, Third Cardiology Department AUTh, Thessaloniki, Greece
| | - I Kelemanis
- Hippokration General Hospital of Thessaloniki, Third Cardiology Department AUTh, Thessaloniki, Greece
| | - E.K Theofillogiannakos
- Hippokration General Hospital of Thessaloniki, Third Cardiology Department AUTh, Thessaloniki, Greece
| | - A.P Antoniadis
- Hippokration General Hospital of Thessaloniki, Third Cardiology Department AUTh, Thessaloniki, Greece
| | - S Tzikas
- Hippokration General Hospital of Thessaloniki, Third Cardiology Department AUTh, Thessaloniki, Greece
| | - N Fragakis
- Hippokration General Hospital of Thessaloniki, Third Cardiology Department AUTh, Thessaloniki, Greece
| | - M Doumas
- Hippokration General Hospital of Thessaloniki, Third Cardiology Department AUTh, Thessaloniki, Greece
| | - C.E Papadopoulos
- Hippokration General Hospital of Thessaloniki, Third Cardiology Department AUTh, Thessaloniki, Greece
| | - V.P Vassilikos
- Hippokration General Hospital of Thessaloniki, Third Cardiology Department AUTh, Thessaloniki, Greece
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13
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Tsarouchas A, Bakogiannis C, Mouselimis D, Pagourelias E, Kelemanis I, Boulmpou A, Vergopoulos S, Vassilikou A, Tzikas S, Fragakis N, Papadopoulos C, Vassilikos V. Left atrial coupling index versus left atrial function index in heart failure with reduced ejection fraction and iron deficiency. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Left atrial (LA) form and function has been the focus of extensive research in heart failure with reduced ejection fraction (HFrEF). The LA coupling index (LACI, see Picture 1 for definition) and the LA function Index (LAFI) have both been proposed as potent predictors of morbidity and mortality in HFrEF. Albeit promising, both parameters have drawbacks that could limit their usefulness in clinical settings - LACI can only be measured during sinus rhythm (SR), while LAFI calculation is arguably more involved. A side-by-side comparison of the two indices has not yet been performed.
Purpose
Investigate and compare the feasibility and efficacy of using LACI and LAFI as prognostic factors in HFrEF.
Methods
HFrEF patients that visited our outpatient HF clinic were invited to participate in the study. Clinical examination, 6-minute walk testing, and a full echocardiographic study were performed, the latter enabling quantification of LACI, LAFI, as well as most traditional echocardiographic predictors of HF prognosis (Picture 1). LACI and LAFI cut-offs of 6 and 25 respectively were defined in accordance with the relevant literature. Cox regression was performed to assess each parameter's correlation with risk of HF-related hospitalization and mortality over a 6-month follow-up period.
Results
In the end, 63 patients were included in the study (aged 69.3±9.7 years, 84% male). LACI could not be measured in 19 patients due to atrial tachycardia. The median LACI was 6.2 (8.7) while the median LAFI of the entire sample was 24.8 (44.5). LACI and LAFI correlated strongly (r=−0.813, p<0.001). Neither correlated significantly with the risk of HF-related hospitalization (Picture 1) or death in our sample (Picture 2). 6MWD was the only parameter to independently correlate with increased risk of hospitalization (HR=0.39, p<0.001) or death (HR=0.42, p=0.02).
Conclusions
The collinearity detected between LACI and LAFI indicate that both quantify similar aspects of left atrial (dys)function. That said, neither index had significant capability to predict hospitalization or death in our sample of HFrEF patients. Although a non-significant trend for higher LACI in patients with poorer prognosis was detected in our sample, it was also incalculable in 30% of patients, who were not in SR during echocardiography. Extended follow-up of an expanded sample size will enable more refined investigation of LACI's and LAFI's prognostic capacity.
Funding Acknowledgement
Type of funding sources: None. Hospitalization Cox regression resultsLACI and LAFI survival curves
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Affiliation(s)
- A Tsarouchas
- Hippokration General Hospital of Thessaloniki, Third Cardiology Department AUTh, Thessaloniki, Greece
| | - C Bakogiannis
- Hippokration General Hospital of Thessaloniki, Third Cardiology Department AUTh, Thessaloniki, Greece
| | - D Mouselimis
- Hippokration General Hospital of Thessaloniki, Third Cardiology Department AUTh, Thessaloniki, Greece
| | - E.D Pagourelias
- Hippokration General Hospital of Thessaloniki, Third Cardiology Department AUTh, Thessaloniki, Greece
| | - I Kelemanis
- Hippokration General Hospital of Thessaloniki, Third Cardiology Department AUTh, Thessaloniki, Greece
| | - A Boulmpou
- Hippokration General Hospital of Thessaloniki, Third Cardiology Department AUTh, Thessaloniki, Greece
| | - S Vergopoulos
- Hippokration General Hospital of Thessaloniki, Third Cardiology Department AUTh, Thessaloniki, Greece
| | - A Vassilikou
- Hippokration General Hospital of Thessaloniki, Third Cardiology Department AUTh, Thessaloniki, Greece
| | - S Tzikas
- Hippokration General Hospital of Thessaloniki, Third Cardiology Department AUTh, Thessaloniki, Greece
| | - N Fragakis
- Hippokration General Hospital of Thessaloniki, Third Cardiology Department AUTh, Thessaloniki, Greece
| | - C.E Papadopoulos
- Hippokration General Hospital of Thessaloniki, Third Cardiology Department AUTh, Thessaloniki, Greece
| | - V.P Vassilikos
- Hippokration General Hospital of Thessaloniki, Third Cardiology Department AUTh, Thessaloniki, Greece
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Sotiriadou M, Papadopoulos CE, Antoniadis AP, Roumelis P, Vergopoulos S, Konstantinidis P, Pagkourelias ED, Tzikas S, Fragakis N, Vassilikos V. The impact of atrial mechanical function on age-dependent presentation of neurocardiogenic syncope. Clin Cardiol 2021; 44:1440-1447. [PMID: 34374094 PMCID: PMC8495094 DOI: 10.1002/clc.23704] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Accepted: 07/19/2021] [Indexed: 12/20/2022] Open
Abstract
Background The contribution of atrial and ventricular function in neurocardiogenic syncope (NCS) pathophysiology is elusive. Hypothesis We assessed the influence of echocardiographic properties to the age of presentation and NCS recurrences. Methods We assigned 124 patients with symptoms suggesting NCS, to those with syncope initiation at age <35 (group A, n = 56) and >35 years (group B, n = 68). Echocardiographic indices were measured before head‐up tilt test (HUTT). Results A total of 55 had positive HUTT (44%) with a trend favoring group A (p = .08). Group A exhibited lower left atrial (LA) volume index (17 ± 6 vs. 22 ± 11 ml/m2, p = .015), higher LA ejection fraction (69 ± 10 vs. 63 ± 11%, p = .008), LA peak strain (reservoir phase 41 ± 13 vs. 31 ± 14%, p = .001, contraction phase 27 ± 11 vs. 15 ± 10%, p < .001) and LA peak strain rate (reservoir phase 1.83 ± 1.04 vs. 1.36 ± 0.96 1/s, p = .012, conduit phase 2.36 ± 1.25 vs. 1.36 ± 0.78 1/s, p = .001). Group A showed smaller minimum right atrial (RA) volume, better RA systolic function, superior left ventricular diastolic indices, and lower filling pressures. Group A patients were more likely to have >3 recurrences (82.0% vs. 50.1%, p < .05). Conclusions Patients with younger age of NCS onset and more syncopal recurrences manifest smaller LA and RA dimensions with distinct patterns of systolic and diastolic function and better LA reservoir and contraction properties. These findings may indicate an increased susceptibility to preload reduction, thereby triggering the NCS mechanism.
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Affiliation(s)
- Melani Sotiriadou
- Third Department of Cardiology, Hippokration General Hospital, Aristotle University Medical School, Thessaloniki, Greece
| | - Christodoulos E Papadopoulos
- Third Department of Cardiology, Hippokration General Hospital, Aristotle University Medical School, Thessaloniki, Greece
| | - Antonios P Antoniadis
- Third Department of Cardiology, Hippokration General Hospital, Aristotle University Medical School, Thessaloniki, Greece
| | - Panagiotis Roumelis
- Third Department of Cardiology, Hippokration General Hospital, Aristotle University Medical School, Thessaloniki, Greece
| | - Stavros Vergopoulos
- Third Department of Cardiology, Hippokration General Hospital, Aristotle University Medical School, Thessaloniki, Greece
| | - Periklis Konstantinidis
- Third Department of Cardiology, Hippokration General Hospital, Aristotle University Medical School, Thessaloniki, Greece
| | - Efstathios D Pagkourelias
- Third Department of Cardiology, Hippokration General Hospital, Aristotle University Medical School, Thessaloniki, Greece
| | - Stergios Tzikas
- Third Department of Cardiology, Hippokration General Hospital, Aristotle University Medical School, Thessaloniki, Greece
| | - Nikolaos Fragakis
- Third Department of Cardiology, Hippokration General Hospital, Aristotle University Medical School, Thessaloniki, Greece
| | - Vassilios Vassilikos
- Third Department of Cardiology, Hippokration General Hospital, Aristotle University Medical School, Thessaloniki, Greece
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15
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Lazaridis C, Mouselimis D, Bakogiannis C, Tsarouchas A, Antoniadis A, Papadopoulos CE, Tzikas S, Fragakis N, Vassilikos VP. The role of the novel MyAlgos e-medicine Platform in promoting patient-centered self-care management in patients with atrial fibrillation: The emPOWERD trial. Eur J Prev Cardiol 2021. [DOI: 10.1093/eurjpc/zwab061.432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
The emergence of digital health has revolutionized most aspects of healthcare. Meanwhile, atrial fibrillation (AF) remains the most common sustained arrhythmia associated with high morbidity and impaired quality of life. Patient-perceived treatment burden can be further optimized by digital health interventions utilizing smartphone technology.
The MyAlgos platform is an integrated software system designed to enhance the remote management and communication between the patient and the healthcare practitioner. The mobile application encourages patient self-management through educational modules and tools to improve medication adherence. The web-based platform allows the health care practitioner to receive live updates on patient status and design personalized self-care management plans.
Purpose
To investigate whether the use of the MyAlgos platform by AF patients is safe and improves the quality of self-care, quality of life (QoL), and hospitalization rate.
Methods
We designed a single-center, randomized, controlled, prospective, open-label, pilot study to compare the effect of the use of the full-feature MyAlgos platform version versus a stripped-down control version of the platform on the QoL, medication adherence and hospitalization rate in patients with paroxysmal AF. The full version of the e-medicine platform includes active patient education, communication with the medical team, medication reminders as well as the full record of clinically significant data such as heart rate and blood pressure. Specialized algorithms monitor patient data and alert physicians for potential AF episodes. The control version only allows the recording of patient’s heart rate.
Results
A total of 80 patients with paroxysmal AF were randomized in a 1:1 ratio to receive either the full or the control version of the MyAlgos Platform. The mean age of all patients, 53 (66%) male, was 58.1 ± 9.1 years. Hypertension and diabetes were present in 47 (59%) and 7 (9%) respectively. At baseline, the majority of patients had AF-related symptoms classified as European Heart Rhythm Association (EHRA) I (45%) or EHRA II (24%), while the mean Atrial Fibrillation Effect on QualiTy-of-Life (AFEQT) score was 70.1 ± 17.0. Between the two groups, there were no statistically significant differences in the baseline characteristics of the participants.
Conclusion
The emPOWERD trial will provide data on the impact of a novel e-medicine platform on the QoL, medication adherence and hospitalizations of patients with paroxysmal AF. We anticipate better outcomes for the subjects receiving the full version of the MyAlgos platform, allowing it to positively affect the further management of paroxysmal AF.
Abstract Figure. The MyAlgos e-medicine Platform
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Affiliation(s)
- C Lazaridis
- Hippokration University Hospital, Aristotle University of Thessaloniki, Third Cardiology Department, Thessaloniki, Greece
| | - D Mouselimis
- Hippokration University Hospital, Aristotle University of Thessaloniki, Third Cardiology Department, Thessaloniki, Greece
| | - C Bakogiannis
- Hippokration University Hospital, Aristotle University of Thessaloniki, Third Cardiology Department, Thessaloniki, Greece
| | - A Tsarouchas
- Hippokration University Hospital, Aristotle University of Thessaloniki, Third Cardiology Department, Thessaloniki, Greece
| | - A Antoniadis
- Hippokration University Hospital, Aristotle University of Thessaloniki, Third Cardiology Department, Thessaloniki, Greece
| | - CE Papadopoulos
- Hippokration University Hospital, Aristotle University of Thessaloniki, Third Cardiology Department, Thessaloniki, Greece
| | - S Tzikas
- Hippokration University Hospital, Aristotle University of Thessaloniki, Third Cardiology Department, Thessaloniki, Greece
| | - N Fragakis
- Hippokration University Hospital, Aristotle University of Thessaloniki, Third Cardiology Department, Thessaloniki, Greece
| | - VP Vassilikos
- Hippokration University Hospital, Aristotle University of Thessaloniki, Third Cardiology Department, Thessaloniki, Greece
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16
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Bakogiannis C, Tsarouchas A, Mouselimis D, Lazaridis C, Theofillogianakos EK, Billis A, Tzikas S, Fragakis N, Bamidis PD, Papadopoulos CE, Vassilikos VP. A Patient-Oriented App (ThessHF) to Improve Self-Care Quality in Heart Failure: From Evidence-Based Design to Pilot Study. JMIR Mhealth Uhealth 2021; 9:e24271. [PMID: 33847599 PMCID: PMC8080140 DOI: 10.2196/24271] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 12/05/2020] [Accepted: 03/02/2021] [Indexed: 01/01/2023] Open
Abstract
Background Heart failure (HF) remains a major public health challenge, while HF self-care is particularly challenging. Mobile health (mHealth)–based interventions taking advantage of smartphone technology have shown particular promise in increasing the quality of self-care among these patients, and in turn improving the outcomes of their disease. Objective The objective of this study was to co-develop with physicians, patients with HF, and their caregivers a patient-oriented mHealth app, perform usability assessment, and investigate its effect on the quality of life of patients with HF and rate of hospitalizations in a pilot study. Methods The development of an mHealth app (The Hellenic Educational Self-care and Support Heart Failure app [ThessHF app]) was evidence based, including features based on previous clinically tested mHealth interventions and selected by a panel of HF expert physicians and discussed with patients with HF. At the end of alpha development, the app was rated by mHealth experts with the Mobile Application Rating Scale (MARS). The beta version was tested by patients with HF, who rated its design and content by means of the Post-Study System Usability Questionnaire (PSSUQ). Subsequently, a prospective pilot study (THESS-HF [THe Effect of a Specialized Smartphone app on Heart Failure patients’ quality of self-care, quality of life and hospitalization rate]) was performed to investigate the effect of app use on patients with HF over a 3-month follow-up period. The primary endpoint was patients’ quality of life, which was measured with the Kansas City Cardiomyopathy Questionnaire (KCCQ) and the 5-level EQ-5D version (EQ-5D-5L). The secondary endpoints were the European Heart Failure Self-care Behavior Scale (EHFScBS) score and the hospitalization rate. Results A systematic review of mHealth-based HF interventions and expert panel suggestions yielded 18 separate app features, most of which were incorporated into the ThessHF app. A total of 14 patients and 5 mHealth experts evaluated the app. The results demonstrated a very good user experience (overall PSSUQ score 2.37 [SD 0.63], where 1 is the best, and a median MARS score of 4.55/5). Finally, 30 patients (male: n=26, 87%) participated in the THESS-HF pilot study (mean age 68.7 [SD 12.4] years). A significant increase in the quality of self-care was noted according to the EHFScBS, which increased by 4.4% (SD 7.2%) (P=.002). The mean quality of life increased nonsignificantly after 3 months according to both KCCQ (mean increase 5.8 [SD 15] points, P=.054) and EQ-5D-5L (mean increase 5.6% [SD 15.6%], P=.06) scores. The hospitalization rate for the follow-up duration was 3%. Conclusions The need for telehealth services and remote self-care management in HF is of vital importance, especially in periods such as the COVID-19 pandemic. We developed a user-friendly mHealth app to promote remote self-care support in HF. In this pilot study, the use of the ThessHF app was associated with an increase in the quality of self-care. A future multicenter study will investigate the effect of the app use on long-term outcomes in patients with HF.
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Affiliation(s)
- Constantinos Bakogiannis
- Cardiovascular Prevention and Digital Cardiology Lab, Third Cardiology Department, Aristotle University of Thessaloniki, Thessaloniki, Greece.,Third Cardiology Department, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Anastasios Tsarouchas
- Cardiovascular Prevention and Digital Cardiology Lab, Third Cardiology Department, Aristotle University of Thessaloniki, Thessaloniki, Greece.,Third Cardiology Department, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Dimitrios Mouselimis
- Cardiovascular Prevention and Digital Cardiology Lab, Third Cardiology Department, Aristotle University of Thessaloniki, Thessaloniki, Greece.,Third Cardiology Department, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Charalampos Lazaridis
- Cardiovascular Prevention and Digital Cardiology Lab, Third Cardiology Department, Aristotle University of Thessaloniki, Thessaloniki, Greece.,Third Cardiology Department, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Antonios Billis
- Lab of Medical Physics, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Stergios Tzikas
- Third Cardiology Department, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Nikolaos Fragakis
- Third Cardiology Department, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Panagiotis D Bamidis
- Lab of Medical Physics, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Christodoulos E Papadopoulos
- Cardiovascular Prevention and Digital Cardiology Lab, Third Cardiology Department, Aristotle University of Thessaloniki, Thessaloniki, Greece.,Third Cardiology Department, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Vassilios P Vassilikos
- Cardiovascular Prevention and Digital Cardiology Lab, Third Cardiology Department, Aristotle University of Thessaloniki, Thessaloniki, Greece.,Third Cardiology Department, Aristotle University of Thessaloniki, Thessaloniki, Greece
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17
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Tzikas S, Loufopoulos G, Evangeliou AP, Boulmpou A, Fragakis N, Vassilikos V. Acute aortic dissection type A: case series and insights on incidence, management and outcomes. Hippokratia 2021; 25:42-46. [PMID: 35221655 PMCID: PMC8877926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND Acute aortic dissection (AAD) is a life-threatening condition with high mortality rates, despite significant advances in surgical approaches. The understanding of the clinical presentation and outcomes is crucial in order to upgrade management strategies. However, epidemiological data regarding AAD occurrence are scarce in Europe, highlighting the gap of evidence in the existing guidelines. CASE SERIES We investigated 197 consecutive patients admitted to our institution from January 2018 to December 2019 with suspicion of type A AAD, conducting a retrospective case series. All demographic characteristics, as well as the outcomes of these patients, were recorded and further analyzed to deliver data on the epidemiology of AAD. A total of 197 patients were admitted to our hospital with a suspected AAD. Forty-one (25.9 %) patients presented with a dilated aortic lumen or with a previously repaired aortic dissection, while 28 patients (14.2 %) were diagnosed with AAD (14 patients with type A AAD, 13 with type B AAD and 1 with intramural hematoma). Among 14 patients with type A AAD, nine patients (64.0 %) were treated surgically, while the rest were managed conservatively due to futile clinical status or inability for immediate transportation to a surgical facility. The most frequent initial symptom was chest pain in 86.0 % of patients, followed by dyspnea in 42.9 %. Post-surgical mortality was 33.0 %, while all patients that were managed conservatively did not survive. D-dimers on arrival were significantly lower among patients who survived compared to those who did not. CONCLUSION The incidence of type A AAD in our case series was consistent with the one demonstrated in other international cohorts; however, the mortality in our patient group was higher. Our results encourage surgical treatment due to a lower in-hospital mortality rate when compared to conservative treatment. HIPPOKRATIA 2021, 25 (1):42-46.
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Affiliation(s)
- S Tzikas
- Third Department of Cardiology, Ippokratio General Hospital, Aristotle University of Thessaloniki, Greece
| | - G Loufopoulos
- Third Department of Cardiology, Ippokratio General Hospital, Aristotle University of Thessaloniki, Greece
| | - A P Evangeliou
- Third Department of Cardiology, Ippokratio General Hospital, Aristotle University of Thessaloniki, Greece
| | - A Boulmpou
- Third Department of Cardiology, Ippokratio General Hospital, Aristotle University of Thessaloniki, Greece
| | - N Fragakis
- Third Department of Cardiology, Ippokratio General Hospital, Aristotle University of Thessaloniki, Greece
| | - V Vassilikos
- Third Department of Cardiology, Ippokratio General Hospital, Aristotle University of Thessaloniki, Greece
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18
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Evangeliou A, Tzinas A, Papadopoulos C, Tzikas S. Comparison of warfarin and aspirin for secondary prevention of intracranial arterial stenosis. a systematic review and meta-analysis. Atherosclerosis 2020. [DOI: 10.1016/j.atherosclerosis.2020.10.736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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19
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Tzinas A, Evangeliou A, Papadopoulos C, Tzikas S. Comparison of aspirin versus aspirin plus clopidogrel / dipyridamole for secondary prevention of intracranial arterial stenosis. A systematic review and meta-analysis. Atherosclerosis 2020. [DOI: 10.1016/j.atherosclerosis.2020.10.737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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20
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Tsigkas G, Moulias A, Xaplanteris P, Bousoula E, Tzikas S, Toutouzas K, Davlouros P. Application and clinical implications of revascularization on chronic coronary syndromes: From COURAGE to ISCHEMIA trial. Hellenic J Cardiol 2020; 62:447-451. [PMID: 33176210 DOI: 10.1016/j.hjc.2020.10.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Accepted: 10/16/2020] [Indexed: 01/09/2023] Open
Affiliation(s)
- Grigorios Tsigkas
- Department of Cardiology, University Hospital of Patras, Patras, Greece.
| | | | - Panagiotis Xaplanteris
- Department of Cardiology, CHU Saint-Pierre, Université Libre de Bruxelles, Brussels, Belgium
| | - Eleni Bousoula
- Department of Invasive Cardiology, Onaseio Cardiothoracic Surgery Center, Athens, Greece
| | - Stergios Tzikas
- 3rd Department of Cardiology, Aristotle University of Thessaloniki, Ippokrateio Hospital, Thessaloniki, Greece
| | - Konstantinos Toutouzas
- First Department of Cardiology, 'Hippokration' Hospital, University of Athens, Medical School, Athens, Greece
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21
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Vassilikos VP, Pagourelias ED, Katsos K, Zaggelidou E, Raikos N, Tzikas S, Tsavousoglou C, Kouparanis A, Anastasakis A, Papatheodorou E, Kassimis G, Ziakas A, Sianos G, Karvounis H, Kanonidis I, Spiliopoulou C. Impact of social containment measures on cardiovascular admissions and sudden cardiac death rates during Coronavirus Disease (COVID-19) outbreak in Greece. Hellenic J Cardiol 2020; 62:318-319. [PMID: 32947022 PMCID: PMC7491429 DOI: 10.1016/j.hjc.2020.09.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 08/23/2020] [Accepted: 09/07/2020] [Indexed: 01/17/2023] Open
Affiliation(s)
- Vassilios P Vassilikos
- Third Cardiology Department, Hippokrateion University Hospital, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece.
| | - Efstathios D Pagourelias
- Third Cardiology Department, Hippokrateion University Hospital, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Konstantinos Katsos
- Department of Forensic Medicine and Toxicology, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Eleni Zaggelidou
- Laboratory of Forensic Service of Ministry of Justice of Thessaloniki, Greece
| | - Nikolaos Raikos
- Laboratory of Forensic Medicine & Toxicology, Medical School, Aristotle University Thessaloniki, Greece
| | - Stergios Tzikas
- Third Cardiology Department, Hippokrateion University Hospital, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Chalil Tsavousoglou
- Third Cardiology Department, Hippokrateion University Hospital, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Antonios Kouparanis
- First Cardiology Department, AHEPA University Hospital, Medical School, Aristotle University of Thessaloniki, Greece
| | | | | | - George Kassimis
- Second Cardiology Department, Hippokrateion University Hospital, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Antonios Ziakas
- First Cardiology Department, AHEPA University Hospital, Medical School, Aristotle University of Thessaloniki, Greece
| | - Georgios Sianos
- First Cardiology Department, AHEPA University Hospital, Medical School, Aristotle University of Thessaloniki, Greece
| | - Haralampos Karvounis
- First Cardiology Department, AHEPA University Hospital, Medical School, Aristotle University of Thessaloniki, Greece
| | - Ioannis Kanonidis
- Second Cardiology Department, Hippokrateion University Hospital, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Chara Spiliopoulou
- Department of Forensic Medicine and Toxicology, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
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22
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Kanakakis I, Stafylas P, Avramidis D, Dagre A, Latsios G, Nikas D, Patsourakos N, Pipilis A, Sanidas I, Skalidis E, Synetos A, Tziakas D, Tzikas S, Tsiafoutis I, Tsigkas G, Bamidis P. Electronic medical registry of acute coronary syndromes in Greece. (ILIAKTIS study): Rationale and study design. Hellenic J Cardiol 2020; 62:244-247. [PMID: 32673758 DOI: 10.1016/j.hjc.2020.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 06/18/2020] [Indexed: 11/30/2022] Open
Affiliation(s)
- Ioannis Kanakakis
- Catheterization Laboratory, Alexandra General Hospital, Athens, Greece.
| | | | | | - Anna Dagre
- General Hospital of Elefsina "Thriasio", Elefsina, Greece
| | - George Latsios
- First Department of Cardiology, Hippocratio Hospital, Athens Medical School, Athens, Greece
| | - Dimitris Nikas
- 1st Cardiology Clinic, Ioannina University Hospital, Ioannina, Greece
| | - Nikos Patsourakos
- Cardiology Department, "Tzaneio" General Hospital of Piraeus, Greece
| | | | - Ilias Sanidas
- Department of Cardiology, LAIKO General Hospital, Athens, Greece
| | - Emmanouil Skalidis
- Department of Cardiology, Heraklion University Hospital, University of Crete Medical School, Heraklion, Greece
| | - Andreas Synetos
- First Department of Cardiology, Hippocratio Hospital, Athens Medical School, Athens, Greece
| | - Dimitrios Tziakas
- University Cardiology Department & Cardiac Catheterization Laboratory, Democritus University of Thrace, Greece
| | - Stergios Tzikas
- 3rd Department of Cardiology, Aristotle University of Thessaloniki, Ippokrateio General Hospital, Thessaloniki, Greece
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23
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Tzikas S, Papadopoulos CH, Evangeliou AP, Vassilikos V. First implantation of the pulsatile left ventricular assist device iVAC2L in a heart failure patient infected with influenza type A. Hellenic J Cardiol 2020; 62:326-328. [PMID: 32470561 DOI: 10.1016/j.hjc.2020.05.002] [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] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Revised: 04/29/2020] [Accepted: 05/07/2020] [Indexed: 11/29/2022] Open
Affiliation(s)
- S Tzikas
- 3rd Department of Cardiology, Ippokrateio General Hospital, Aristotle University of Thessaloniki, Greece.
| | - C H Papadopoulos
- 3rd Department of Cardiology, Ippokrateio General Hospital, Aristotle University of Thessaloniki, Greece
| | - A P Evangeliou
- 3rd Department of Cardiology, Ippokrateio General Hospital, Aristotle University of Thessaloniki, Greece
| | - V Vassilikos
- 3rd Department of Cardiology, Ippokrateio General Hospital, Aristotle University of Thessaloniki, Greece
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24
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Boulmpou A, Kassimis G, Zioutas D, Meletidou M, Mouselimis D, Tsarouchas A, Tzikas S, Vassilikos V, Kanonidis I, Tsounos I, Papadopoulos CE. Spontaneous Coronary Artery Dissection (SCAD): Case Series and Mini Review. Cardiovasc Revasc Med 2020; 21:1450-1456. [PMID: 32173331 DOI: 10.1016/j.carrev.2020.03.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Revised: 02/18/2020] [Accepted: 03/05/2020] [Indexed: 12/18/2022]
Abstract
Spontaneous coronary artery dissection (SCAD) has gained recognition in recent years as a non-atherosclerotic cause of acute coronary syndrome (ACS), especially in young and middle-aged women without any of the classic risk factors for cardiovascular disease. The booming use of coronary angiography in patients presenting with ACS combined with new, revolutionary methods of intravascular imaging, have led to increased rates of SCAD diagnosis. We aim to present a brief, up-to-date review of the existing literature, along with our experience as reflected in the recent management of nine SCAD cases in three tertiary care hospitals.
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Affiliation(s)
- Aristi Boulmpou
- 3rd Cardiology Department, Hippokration University Hospital, Aristotle University of Thessaloniki, Greece
| | - George Kassimis
- 2nd Cardiology Department, Hippokration University Hospital, Aristotle University of Thessaloniki, Greece
| | | | - Magdalini Meletidou
- 3rd Cardiology Department, Hippokration University Hospital, Aristotle University of Thessaloniki, Greece
| | - Dimitrios Mouselimis
- 3rd Cardiology Department, Hippokration University Hospital, Aristotle University of Thessaloniki, Greece
| | - Anastasios Tsarouchas
- 3rd Cardiology Department, Hippokration University Hospital, Aristotle University of Thessaloniki, Greece
| | - Stergios Tzikas
- 3rd Cardiology Department, Hippokration University Hospital, Aristotle University of Thessaloniki, Greece
| | - Vassilios Vassilikos
- 3rd Cardiology Department, Hippokration University Hospital, Aristotle University of Thessaloniki, Greece
| | - Ioannis Kanonidis
- 2nd Cardiology Department, Hippokration University Hospital, Aristotle University of Thessaloniki, Greece
| | - Ioannis Tsounos
- Cardiology Department, Agios Pavlos General Hospital, Thessaloniki, Greece
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25
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Ali M, Rigopoulos AG, Mammadov M, Torky A, Auer A, Matiakis M, Abate E, Bakogiannis C, Tzikas S, Bigalke B, Sedding D, Noutsias M. Systematic review on left atrial appendage closure with the LAmbre device in patients with non-valvular atrial fibrillation. BMC Cardiovasc Disord 2020; 20:78. [PMID: 32050904 PMCID: PMC7017553 DOI: 10.1186/s12872-020-01349-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 08/02/2019] [Accepted: 01/20/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Percutaneous closure (LAAC) of the left atrial appendage (LAA) is an efficacious preventive procedure for patients with non-valvular atrial fibrillation (NVAF) and considerable bleeding risk. We sought to systematically review the available LAAC data on the novel occluder device LAmbre™. METHODS For this systematic review, a search of the literature was conducted by 3 independent reviewers, reporting the safety and therapeutic success of LAAC in patients being treated with a LAmbre™. Publications reporting the safety and therapeutic success of LAAC using LAmbre™ in n > 5 patients were included. RESULTS The literature search retrieved n = 10 publications, encompassing n = 403 NVAF patients treated with a LAmbre™ LAAC, with relevant data regarding safety and therapeutic success of the procedure. The mean CHA2DS2-VASc Score was 4.0 + 0.9, and the mean HAS-BLED score was 3.4 + 0.5. The implantation success was 99.7%, with a mean procedure time of 45.4 ± 18.7 min, and a fluoroscopy time of 9.6 ± 5.9 min, and a contrast agent volume of 96.7 ± 0.7 ml. The anticoagulation regimen was switched to DAPT post procedure in the majority of the patients (96.8%). Partial and full recapture were done in 45.5% and in 25.6%, respectively. Major complications were reported in 2.9%, with 0.3% mortality, 1.7% pericardial tamponade, 0.3% stroke, and 0.6% major bleeding complications; no device embolization was observed. During follow up at 6 or 12 months, major adverse cardiovascular events were reported in 3.3%: Stroke or TIA in 1.7%, thrombus formation on the device in 0.7%, and residual flow > 5 mm in 1.0%. In some publications, the favorable implantion properties of the LAmbre™ for difficult anatomies such as shallow or multilobular LAA anatomies were described. CONCLUSIONS This systematic review on the LAmbre™ LAA-occluder including n = 403 NVAF patients demonstrates an excellent implantion success rate, promising follow-up clinical data, and favorable properties for also challenging LAA anatomies,. While its design seems to be helpful in preventing device embolization, pericardial tamponade may not be substantially reduced by the LAmbre™ as compared with other established LAAC devices. Further larger prospective multicenter registries and randomized trials are needed to scrutinize the value of the LAmbre™ compared with established LAAC devices.
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Affiliation(s)
- Muhammad Ali
- Mid-German Heart Center, Department of Internal Medicine III (KIM-III), Division of Cardiology, Angiology and Intensive Medical Care, University Hospital Halle, Martin-Luther-University Halle, Ernst-Grube-Strasse 40, D-06120, Halle (Saale), Germany
| | - Angelos G Rigopoulos
- Mid-German Heart Center, Department of Internal Medicine III (KIM-III), Division of Cardiology, Angiology and Intensive Medical Care, University Hospital Halle, Martin-Luther-University Halle, Ernst-Grube-Strasse 40, D-06120, Halle (Saale), Germany
| | - Mammad Mammadov
- Mid-German Heart Center, Department of Internal Medicine III (KIM-III), Division of Cardiology, Angiology and Intensive Medical Care, University Hospital Halle, Martin-Luther-University Halle, Ernst-Grube-Strasse 40, D-06120, Halle (Saale), Germany
| | - Abdelrahman Torky
- Mid-German Heart Center, Department of Internal Medicine III (KIM-III), Division of Cardiology, Angiology and Intensive Medical Care, University Hospital Halle, Martin-Luther-University Halle, Ernst-Grube-Strasse 40, D-06120, Halle (Saale), Germany
| | - Andrea Auer
- Mid-German Heart Center, Department of Internal Medicine III (KIM-III), Division of Cardiology, Angiology and Intensive Medical Care, University Hospital Halle, Martin-Luther-University Halle, Ernst-Grube-Strasse 40, D-06120, Halle (Saale), Germany
| | - Marios Matiakis
- Mid-German Heart Center, Department of Internal Medicine III (KIM-III), Division of Cardiology, Angiology and Intensive Medical Care, University Hospital Halle, Martin-Luther-University Halle, Ernst-Grube-Strasse 40, D-06120, Halle (Saale), Germany
| | - Elena Abate
- Mid-German Heart Center, Department of Internal Medicine III (KIM-III), Division of Cardiology, Angiology and Intensive Medical Care, University Hospital Halle, Martin-Luther-University Halle, Ernst-Grube-Strasse 40, D-06120, Halle (Saale), Germany
| | - Constantinos Bakogiannis
- 3rd Department of Cardiology, Ippokrateio Hospital, Aristotle University of Thessaloniki, Konstantinoupoleos 49, 54642, Thessaloniki, Greece
| | - Stergios Tzikas
- 3rd Department of Cardiology, Ippokrateio Hospital, Aristotle University of Thessaloniki, Konstantinoupoleos 49, 54642, Thessaloniki, Greece
| | - Boris Bigalke
- Department of Cardiology, Charité, Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - Daniel Sedding
- Mid-German Heart Center, Department of Internal Medicine III (KIM-III), Division of Cardiology, Angiology and Intensive Medical Care, University Hospital Halle, Martin-Luther-University Halle, Ernst-Grube-Strasse 40, D-06120, Halle (Saale), Germany
| | - Michel Noutsias
- Mid-German Heart Center, Department of Internal Medicine III (KIM-III), Division of Cardiology, Angiology and Intensive Medical Care, University Hospital Halle, Martin-Luther-University Halle, Ernst-Grube-Strasse 40, D-06120, Halle (Saale), Germany.
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Georgopoulou V, Gouridou E, Pyrpasopoulou A, Kozanidou A, Papadopoulos C, Tzikas S, Sidiropoulou M. An unusual cause of epigastric pain and diaphoresis. Heliyon 2020; 6:e03509. [PMID: 32140607 PMCID: PMC7049636 DOI: 10.1016/j.heliyon.2020.e03509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Revised: 12/24/2019] [Accepted: 02/25/2020] [Indexed: 12/04/2022] Open
Abstract
The median arcuate ligament, or celiac artery compression syndrome is a rare syndrome, caused by extrinsic compression of the celiac trunk by the median arcuate ligament. Its symptomatology mainly comprises of visceral angina. Differential diagnosis includes cardiovascular angina, other vascular events and causes of vagotonia. The case reported here refers to a middle aged male patient who presented with intermittent epigastric pain and diaphoresis after a long drive. Diagnosis was made radiologically, during computed tomography scan angiography, which revealed a hook-like appearance of the celiac artery partially loosened during inspiration. Careful history and cautious reviewing of the imaging may refrain from further, unnecessary, diagnostic investigations.
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Kraus D, von Jeinsen B, Tzikas S, Palapies L, Zeller T, Bickel C, Fette G, Lackner KJ, Drechsler C, Neumann JT, Baldus S, Blankenberg S, Münzel T, Wanner C, Zeiher AM, Keller T. Cardiac Troponins for the Diagnosis of Acute Myocardial Infarction in Chronic Kidney Disease. J Am Heart Assoc 2019; 7:e008032. [PMID: 30371308 PMCID: PMC6404905 DOI: 10.1161/jaha.117.008032] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Patients with chronic kidney disease ( CKD ) are at high risk of myocardial infarction. Cardiac troponins are the biomarkers of choice for the diagnosis of acute myocardial infarction ( AMI ) without ST -segment elevation ( NSTE ). In patients with CKD , troponin levels are often chronically elevated, which reduces their diagnostic utility when NSTE - AMI is suspected. The aim of this study was to derive a diagnostic algorithm for serial troponin measurements in patients with CKD and suspected NSTE - AMI . Methods and Results Two cohorts, 1494 patients from a prospective cohort study with high-sensitivity troponin I (hs- cTnI ) measurements and 7059 cases from a clinical registry with high-sensitivity troponin T (hs- cTnT ) measurements, were analyzed. The prospective cohort comprised 280 CKD patients (estimated glomerular filtration rate <60 mL/min/1.73 m2). The registry data set contained 1581 CKD patients. In both cohorts, CKD patients were more likely to have adjudicated NSTE - AMI than non- CKD patients. The specificities of hs- cTnI and hs- cTnT to detect NSTE - AMI were reduced with CKD (0.82 versus 0.91 for hs- cTnI and 0.26 versus 0.73 for hs- cTnT ) but could be restored by applying optimized cutoffs to either the first or a second measurement after 3 hours. The best diagnostic performance was achieved with an algorithm that incorporates serial measurements and rules in or out AMI in 69% (hs- cTnI ) and 55% (hs- cTnT ) of CKD patients. Conclusions The diagnostic performance of high-sensitivity cardiac troponins in patients with CKD with suspected NSTE - AMI is improved by use of an algorithm based on admission troponin and dynamic changes in troponin concentration.
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Affiliation(s)
- Daniel Kraus
- 1 Division of Nephrology 1st Department of Medicine University of Würzburg Germany
| | - Beatrice von Jeinsen
- 2 Division of Cardiology Department of Internal Medicine III Goethe University Frankfurt Frankfurt Germany.,10 German Centre for Cardiovascular Research (DZHK), partner site RheinMain Frankfurt Germany
| | - Stergios Tzikas
- 3 3rd Department of Cardiology Ιppokrateio Hospital Aristotle University of Thessaloniki Greece
| | - Lars Palapies
- 2 Division of Cardiology Department of Internal Medicine III Goethe University Frankfurt Frankfurt Germany
| | - Tanja Zeller
- 4 Clinic for General and Interventional Cardiology University Heart Center Hamburg Hamburg Germany.,11 German Centre for Cardiovascular Research (DZHK), partner site Hamburg/Lübeck/Kiel Hamburg Germany
| | - Christoph Bickel
- 5 Department of Internal Medicine Federal Armed Forces Hospital Koblenz Germany
| | - Georg Fette
- 6 Department for Artificial Intelligence and Applied Computer Science University of Würzburg Germany
| | - Karl J Lackner
- 7 Department of Laboratory Medicine University Medical Center Johannes Gutenberg University Mainz Germany
| | - Christiane Drechsler
- 1 Division of Nephrology 1st Department of Medicine University of Würzburg Germany
| | - Johannes T Neumann
- 4 Clinic for General and Interventional Cardiology University Heart Center Hamburg Hamburg Germany.,11 German Centre for Cardiovascular Research (DZHK), partner site Hamburg/Lübeck/Kiel Hamburg Germany
| | - Stephan Baldus
- 8 Department of Internal Medicine III University of Cologne Germany
| | - Stefan Blankenberg
- 4 Clinic for General and Interventional Cardiology University Heart Center Hamburg Hamburg Germany.,11 German Centre for Cardiovascular Research (DZHK), partner site Hamburg/Lübeck/Kiel Hamburg Germany
| | - Thomas Münzel
- 9 Department of Internal Medicine II University Medical Center Johannes Gutenberg University Mainz Germany
| | - Christoph Wanner
- 1 Division of Nephrology 1st Department of Medicine University of Würzburg Germany.,12 Comprehensive Heart Failure Center (CHFC) University Hospital Würzburg Germany
| | - Andreas M Zeiher
- 2 Division of Cardiology Department of Internal Medicine III Goethe University Frankfurt Frankfurt Germany.,10 German Centre for Cardiovascular Research (DZHK), partner site RheinMain Frankfurt Germany
| | - Till Keller
- 2 Division of Cardiology Department of Internal Medicine III Goethe University Frankfurt Frankfurt Germany.,10 German Centre for Cardiovascular Research (DZHK), partner site RheinMain Frankfurt Germany.,13 Department of Cardiology Kerckhoff Heart and Thorax Center Bad Nauheim Germany
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Affiliation(s)
- Stergios Tzikas
- 3rd Department of Cardiology, Aristotle University of Thessaloniki, Thessaloniki, Greece.
| | - Vassilios Vassilikos
- 3rd Department of Cardiology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Till Keller
- Division of Cardiology, Department of Internal Medicine III, Goethe University Frankfurt, Frankfurt, Germany
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Zeymer U, Ludman P, Danchin N, Kala P, Maggioni AP, Weidinger F, Gale CP, Beleslin B, Budaj A, Chioncel O, Dagres N, Danchin N, Emberson J, Erlinge D, Glikson M, Gray A, Kayikcioglu M, Maggioni AP, Nagy VK, Nedoshivin A, Petronio AS, Roos-Hesselink J, Wallentin L, Zeymer U, Weidinger F, Zeymer U, Danchin N, Ludman P, Sinnaeve P, Kala P, Ferrari R, Maggioni AP, Goda A, Zelveian P, Weidinger F, Karamfilov K, Motovska Z, Zeymer U, Raungaard B, Marandi T, Shaheen SM, Lidon RM, Karjalainen PP, Kereselidze Z, Alexopoulos D, Becker D, Quinn M, Iakobishvili Z, Al-Farhan H, Sadeghi M, Caporale R, Romeo F, Mirrakhimov E, Serpytis P, Erglis A, Kedev S, Balbi MM, Moore AM, Dudek D, Legutko J, Mimoso J, Tatu-Chitoiu G, Stojkovic S, Shlyakhto E, AlHabib KF, Bunc M, Studencan M, Mourali MS, Bajraktari G, Konte M, Larras F, Lefrancq EF, Mekhaldi S, Laroche C, Maggioni AP, Goda A, Shuka N, Pavli E, Tafaj E, Gishto T, Dibra A, Duka A, Gjana A, Kristo A, Knuti G, Demiraj A, Dado E, Hasimi E, Simoni L, Siqeca M, Sisakian H, Hayrapetyan H, Markosyan S, Galustyan L, Arustamyan N, Kzhdryan H, Pepoyan S, Zirkik A, Von Lewinski D, Paetzold S, Kienzl I, Matyas K, Neunteufl T, Nikfardjam M, Neuhold U, Mihalcz A, Glaser F, Steinwender C, Reiter C, Grund M, Hrncic D, Hoppe U, Hammerer M, Hinterbuchner L, Hengstenberg C, Delle Karth G, Lang I, Weidinger F, Winkler W, Hasun M, Kastner J, Havel C, Derntl M, Oberegger G, Hajos J, Adlbrecht C, Publig T, Leitgeb MC, Wilfing R, Jirak P, Ho CY, Puskas L, Schrutka L, Spinar J, Parenica J, Hlinomaz O, Fendrychova V, Semenka J, Sikora J, Sitar J, Groch L, Rezek M, Novak M, Kramarikova P, Stasek J, Dusek J, Zdrahal P, Polasek R, Karasek J, Seiner J, Sukova N, Varvarovsky I, Lazarák T, Novotny V, Matejka J, Rokyta R, Volovar S, Belohlavek J, Motovska Z, Siranec M, Kamenik M, Kralik R, Raungaard B, Ravkilde J, Jensen SE, Villadsen A, Villefrance K, Schmidt Skov C, Maeng M, Moeller K, Hasan-Ali H, Ahmed TA, Hassan M, ElGuindy A, Farouk Ismail M, Ibrahim Abd El-Aal A, El-sayed Gaafar A, Magdy Hassan H, Ahmed Shafie M, Nabil El-khouly M, Bendary A, Darwish M, Ahmed Y, Amin O, AbdElHakim A, Abosaif K, Kandil H, Galal MAG, El Hefny EE, El Sayed M, Aly K, Mokarrab M, Osman M, Abdelhamid M, Mantawy S, Ali MR, Kaky SD, Khalil VA, Saraya MEA, Talaat A, Nabil M, Mounir WM, Mahmoud K, Aransa A, Kazamel G, Anwar S, Al-Habbaa A, Abd el Monem M, Ismael A, Amin Abu-Sheaishaa M, Abd Rabou MM, Hammouda TMA, Moaaz M, Elkhashab K, Ragab T, Rashwan A, Rmdan A, AbdelRazek G, Ebeid H, Soliman Ghareeb H, Farag N, Zaki M, Seleem M, Torki A, Youssef M, AlLah Nasser NA, Rafaat A, Selim H, Makram MM, Khayyal M, Malasi K, Madkour A, Kolib M, Alkady H, Nagah H, Yossef M, Wafa A, Mahfouz E, Faheem G, Magdy Moris M, Ragab A, Ghazal M, Mabrouk A, Hassan M, El-Masry M, Naseem M, Samir S, Marandi T, Reinmets J, Allvee M, Saar A, Ainla T, Vaide A, Kisseljova M, Pakosta U, Eha J, Lotamois K, Sia J, Myllymaki J, Pinola T, Karjalainen PP, Paana T, Mikkelsson J, Ampio M, Tsivilasvili J, Zurab P, Kereselidze Z, Agladze R, Melia A, Gogoberidze D, Khubua N, Totladze L, Metreveli I, Chikovani A, Eitel I, Pöss J, Werner M, Constantz A, Ahrens C, Zeymer U, Tolksdorf H, Klinger S, Sack S, Heer T, Lekakis J, Kanakakis I, Xenogiannis I, Ermidou K, Makris N, Ntalianis A, Katsaros F, Revi E, Kafkala K, Mihelakis E, Diakakis G, Grammatikopoulos K, Voutsinos D, Alexopoulos D, Xanthopoulou I, Mplani V, Foussas S, Papakonstantinou N, Patsourakos N, Dimopoulos A, Derventzis A, Athanasiou K, Vassilikos VP, Papadopoulos C, Tzikas S, Vogiatzis I, Datsios A, Galitsianos I, Koutsampasopoulos K, Grigoriadis S, Douras A, Baka N, Spathis S, Kyrlidis T, Hatzinikolaou H, Kiss RG, Becker D, Nowotta F, Tóth K, Szabó S, Lakatos C, Jambrik Z, Ruzsa J, Ruzsa Z, Róna S, Toth J, Vargane Kosik A, Toth KSB, Nagy GG, Ondrejkó Z, Körömi Z, Botos B, Pourmoghadas M, Salehi A, Massoumi G, Sadeghi M, Soleimani A, Sarrafzadegan N, Roohafza H, Azarm M, Mirmohammadsadeghi A, Rajabi D, Rahmani Y, Siabani S, Najafi F, Hamzeh B, Karim H, Siabani H, Saleh N, Charehjoo H, Zamzam L, Al-Temimi G, Al-Farhan H, Al-Yassin A, Mohammad A, Ridha A, Al-Saedi G, Atabi N, Sabbar O, Mahmood S, Dakhil Z, Yaseen IF, Almyahi M, Alkenzawi H, Alkinani T, Alyacopy A, Kearney P, Twomey K, Iakobishvili Z, Shlomo N, Beigel R, Caldarola P, Rutigliano D, Sublimi Saponetti L, Locuratolo N, Palumbo V, Scherillo M, Formigli D, Canova P, Musumeci G, Roncali F, Metra M, Lombardi C, Visco E, Rossi L, Meloni L, Montisci R, Pippia V, Marchetti MF, Congia M, Cacace C, Luca G, Boscarelli G, Indolfi C, Ambrosio G, Mongiardo A, Spaccarotella C, De Rosa S, Canino G, Critelli C, Caporale R, Chiappetta D, Battista F, Gabrielli D, Marziali A, Bernabò P, Navazio A, Guerri E, Manca F, Gobbi M, Oreto G, Andò G, Carerj S, Saporito F, Cimmino M, Rigo F, Zuin G, Tuccillo B, Scotto di Uccio F, Irace L, Lorenzoni G, Meloni I, Merella P, Polizzi GM, Pino R, Marzilli M, Morrone D, Caravelli P, Orsini E, Mosa S, Piovaccari G, Santarelli A, Cavazza C, Romeo F, Fedele F, Mancone M, Straito M, Salvi N, Scarparo P, Severino P, Razzini C, Massaro G, Cinque A, Gaudio C, Barillà F, Torromeo C, Porco L, Mei M, Iorio R, Nassiacos D, Barco B, Sinagra G, Falco L, Priolo L, Perkan A, Strana M, Bajraktari G, Percuku L, Berisha G, Mziu B, Beishenkulov M, Abdurashidova T, Toktosunova A, Kaliev K, Serpytis P, Serpytis R, Butkute E, Lizaitis M, Broslavskyte M, Xuereb RG, Moore AM, Mercieca Balbi M, Paris E, Buttigieg L, Musial W, Dobrzycki S, Dubicki A, Kazimierczyk E, Tycinska A, Wojakowski W, Kalanska-Lukasik B, Ochala A, Wanha W, Dworowy S, Sielski J, Janion M, Janion-Sadowska A, Dudek D, Wojtasik-Bakalarz J, Bryniarski L, Peruga JZ, Jonczyk M, Jankowski L, Klecha A, Legutko J, Michalowska J, Brzezinski M, Kozmik T, Kowalczyk T, Adamczuk J, Maliszewski M, Kuziemka P, Plaza P, Jaros A, Pawelec A, Sledz J, Bartus S, Zmuda W, Bogusz M, Wisnicki M, Szastak G, Adamczyk M, Suska M, Czunko P, Opolski G, Kochman J, Tomaniak M, Miernik S, Paczwa K, Witkowski A, Opolski MP, Staruch AD, Kalarus Z, Honisz G, Mencel G, Swierad M, Podolecki T, Marques J, Azevedo P, Pereira MA, Gaspar A, Monteiro S, Goncalves F, Leite L, Mimoso J, Manuel Lopes dos Santos W, Amado J, Pereira D, Silva B, Caires G, Neto M, Rodrigues R, Correia A, Freitas D, Lourenco A, Ferreira F, Sousa F, Portugues J, Calvo L, Almeida F, Alves M, Silva A, Caria R, Seixo F, Militaru C, Ionica E, Tatu-Chitoiu G, Istratoaie O, Florescu M, Lipnitckaia E, Osipova O, Konstantinov S, Bukatov V, Vinokur T, Egorova E, Nefedova E, Levashov S, Gorbunova A, Redkina M, Karaulovskaya N, Bijieva F, Babich N, Smirnova O, Filyanin R, Eseva S, Kutluev A, Chlopenova A, Shtanko A, Kuppar E, Shaekhmurzina E, Ibragimova M, Mullahmetova M, Chepisova M, Kuzminykh M, Betkaraeva M, Namitokov A, Khasanov N, Baleeva L, Galeeva Z, Magamedkerimova F, Ivantsov E, Tavlueva E, Kochergina A, Sedykh D, Kosmachova E, Skibitskiy V, Porodenko N, Namitokov A, Litovka K, Ulbasheva E, Niculina S, Petrova M, Harkov E, Tsybulskaya N, Lobanova A, Chernova A, Kuskaeva A, Kuskaev A, Ruda M, Zateyshchikov D, Gilarov M, Konstantinova E, Koroleva O, Averkova A, Zhukova N, Kalimullin D, Borovkova N, Tokareva A, Buyanova M, Khaisheva L, Pirozhenko A, Novikova T, Yakovlev A, Tyurina T, Lapshin K, Moroshkina N, Kiseleva M, Fedorova S, Krylova L, Duplyakov D, Semenova Y, Rusina A, Ryabov V, Syrkina A, Demianov S, Reitblat O, Artemchuk A, Efremova E, Makeeva E, Menzorov M, Shutov A, Klimova N, Shevchenko I, Elistratova O, Kostyuckova O, Islamov R, Budyak V, Ponomareva E, Ullah Jan U, Alshehri AM, Sedky E, Alsihati Z, Mimish L, Selem A, Malik A, Majeed O, Altnji I, AlShehri M, Aref A, AlHabib K, AlDosary M, Tayel S, Abd AlRahman M, Asfina KN, Abdin Hussein G, Butt M, Markovic Nikolic N, Obradovic S, Djenic N, Brajovic M, Davidovic A, Romanovic R, Novakovic V, Dekleva M, Spasic M, Dzudovic B, Jovic Z, Cvijanovic D, Veljkovic S, Ivanov I, Cankovic M, Jarakovic M, Kovacevic M, Trajkovic M, Mitov V, Jovic A, Hudec M, Gombasky M, Sumbal J, Bohm A, Baranova E, Kovar F, Samos M, Podoba J, Kurray P, Obona T, Remenarikova A, Kollarik B, Verebova D, Kardosova G, Studencan M, Alusik D, Macakova J, Kozlej M, Bayes-Genis A, Sionis A, Garcia Garcia C, Lidon RM, Duran Cambra A, Labata Salvador C, Rueda Sobella F, Sans Rosello J, Vila Perales M, Oliveras Vila T, Ferrer Massot M, Bañeras J, Lekuona I, Zugazabeitia G, Fernandez-Ortiz A, Viana Tejedor A, Ferrera C, Alvarez V, Diaz-Castro O, Agra-Bermejo RM, Gonzalez-Cambeiro C, Gonzalez-Babarro E, Domingo-Del Valle J, Royuela N, Burgos V, Canteli A, Castrillo C, Cobo M, Ruiz M, Abu-Assi E, Garcia Acuna JM. The ESC ACCA EAPCI EORP acute coronary syndrome ST-elevation myocardial infarction registry. European Heart Journal - Quality of Care and Clinical Outcomes 2019; 6:100-104. [DOI: 10.1093/ehjqcco/qcz042] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Accepted: 07/24/2019] [Indexed: 12/20/2022]
Abstract
Abstract
Aims
The Acute Cardiac Care Association (ACCA)–European Association of Percutaneous Coronary Intervention (EAPCI) Registry on ST-elevation myocardial infarction (STEMI) of the EurObservational programme (EORP) of the European Society of Cardiology (ESC) registry aimed to determine the current state of the use of reperfusion therapy in ESC member and ESC affiliated countries and the adherence to ESC STEMI guidelines in patients with STEMI.
Methods and results
Between 1 January 2015 and 31 March 2018, a total of 11 462 patients admitted with an initial diagnosis of STEMI according to the 2012 ESC STEMI guidelines were enrolled. Individual patient data were collected across 196 centres and 29 countries. Among the centres, there were 136 percutaneous coronary intervention centres and 91 with cardiac surgery on-site. The majority of centres (129/196) were part of a STEMI network. The main objective of this study was to describe the demographic, clinical, and angiographic characteristics of patients with STEMI. Other objectives include to assess management patterns and in particular the current use of reperfusion therapies and to evaluate how recommendations of most recent STEMI European guidelines regarding reperfusion therapies and adjunctive pharmacological and non-pharmacological treatments are adopted in clinical practice and how their application can impact on patients’ outcomes. Patients will be followed for 1 year after admission.
Conclusion
The ESC ACCA-EAPCI EORP ACS STEMI registry is an international registry of care and outcomes of patients hospitalized with STEMI. It will provide insights into the contemporary patient profile, management patterns, and 1-year outcome of patients with STEMI.
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Affiliation(s)
- Uwe Zeymer
- Hospital of the City of Ludwigshafen, Medical Clinic B and Institute of Heart Attack Research, Ludwigshafen on the Rhine, Germany
| | - Peter Ludman
- Institute of Cardiovascular Sciences, Birmingham University, Birmingham, UK
| | - Nicolas Danchin
- Cardiology Department, Georges Pompidou European Hospital, Paris, France
| | - Petr Kala
- Internal Cardiology Department, University Hospital Brno, Czech Republic
| | - Aldo P Maggioni
- EURObservational Research Programme, ESC, Sophia Antipolis, France
- ANMCO Research Center, Florence, Italy
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von Jeinsen B, Liebetrau C, Palapies L, Tzikas S, Zeller T, Bickel C, Schmidt A, Tubaro M, Lackner KJ, Sar F, Baldus S, Zeiher AM, Blankenberg S, Gori T, Münzel T, Hamm CW, Wild PS, Keller T. Identification of acute myocardial infarction in elderly patients using optimized highly sensitive troponin I thresholds. Biomarkers 2019; 24:549-555. [PMID: 31159594 DOI: 10.1080/1354750x.2019.1606276] [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: 10/26/2022]
Abstract
Purpose: Established diagnostic thresholds for high-sensitivity cardiac troponins (hs-cTn) might not apply for elderly patients as they are elevated irrespective of the presence of an acute myocardial infarction (AMI). Aim of the present study was to investigate hs-cTnI in elderly patients with suspected AMI and to calculate optimized diagnostic cutoffs. Material and methods: Data from a prospective multi-centre study and from a second independent prospective single-centre cohort study were analysed. A number of 2903 patients were eligible for further analysis. Patients > 70 years were classified as elderly. hs-cTnI was measured upon admission. Results: Around 34.7% of 2903 patients were classified as elderly. Around 22.5% of elderly patients were finally diagnosed with AMI. Elderly patients had higher hs-cTnI levels at admission irrespective of the final diagnosis (p < 0.001). According to the AUROC, hs-cTnI was a strong marker for detection of AMI in elderly patients. Application of the 99th percentile cutoffs showed a substantially lower specificity in elderly. By using optimized thresholds, specificity was improved to levels as in younger patients in both cohorts but accompanied with a decrease in sensitivity. Conclusions: hs-cTnI levels have a lower specificity for detecting AMI in elderly patients. This lower specificity can be improved by using hs-cTnI thresholds optimized for elderly patients.
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Affiliation(s)
- Beatrice von Jeinsen
- a Department of Cardiology, Kerckhoff Heart Center , Bad Nauheim , Germany.,b Department of Internal Medicine III, Division of Cardiology, Goethe University Frankfurt , Frankfurt , Germany.,c German Centre for Cardiovascular Research (DZHK), Partner Site Center Rhein-Main , Germany
| | - Christoph Liebetrau
- a Department of Cardiology, Kerckhoff Heart Center , Bad Nauheim , Germany.,c German Centre for Cardiovascular Research (DZHK), Partner Site Center Rhein-Main , Germany
| | - Lars Palapies
- b Department of Internal Medicine III, Division of Cardiology, Goethe University Frankfurt , Frankfurt , Germany
| | - Stergios Tzikas
- d 3rd Department of Cardiology, ιppokrateio Hospital of Thessaloniki, Aristotle University of Thessaloniki , Thessaloniki , Greece
| | - Tanja Zeller
- e Clinic for General and Interventional Cardiology, University Heart Center Hamburg , Hamburg , Germany.,f German Centre for Cardiovascular Research (DZHK), German Partner Site Hamburg/Kiel/Lübeck partner , Hamburg , Germany
| | - Christoph Bickel
- g Department of Internal Medicine, Federal Armed Forces Hospital , Koblenz , Germany
| | - Alexander Schmidt
- h Preventive Cardiology, Center for Cardiology, University Medical Center , Johannes Gutenberg University , Mainz , Germany
| | - Marco Tubaro
- i Ospedale San Filippo Neri Hospital , Rome , Italy
| | - Karl J Lackner
- j Department of Laboratory Medicine, University Medical Center, Johannes Gutenberg University , Mainz , Germany
| | - Fachrie Sar
- h Preventive Cardiology, Center for Cardiology, University Medical Center , Johannes Gutenberg University , Mainz , Germany
| | - Stephan Baldus
- k Department of Internal Medicine III, University of Cologne , Cologne , Germany
| | - Andreas M Zeiher
- b Department of Internal Medicine III, Division of Cardiology, Goethe University Frankfurt , Frankfurt , Germany.,c German Centre for Cardiovascular Research (DZHK), Partner Site Center Rhein-Main , Germany
| | - Stefan Blankenberg
- e Clinic for General and Interventional Cardiology, University Heart Center Hamburg , Hamburg , Germany.,f German Centre for Cardiovascular Research (DZHK), German Partner Site Hamburg/Kiel/Lübeck partner , Hamburg , Germany
| | - Tommaso Gori
- c German Centre for Cardiovascular Research (DZHK), Partner Site Center Rhein-Main , Germany.,l Cardiology I, Center for Cardiology , University Medical Center, Johannes Gutenberg University , Mainz , Germany
| | - Thomas Münzel
- c German Centre for Cardiovascular Research (DZHK), Partner Site Center Rhein-Main , Germany.,l Cardiology I, Center for Cardiology , University Medical Center, Johannes Gutenberg University , Mainz , Germany
| | - Christian W Hamm
- b Department of Internal Medicine III, Division of Cardiology, Goethe University Frankfurt , Frankfurt , Germany.,c German Centre for Cardiovascular Research (DZHK), Partner Site Center Rhein-Main , Germany
| | - Philipp S Wild
- c German Centre for Cardiovascular Research (DZHK), Partner Site Center Rhein-Main , Germany.,h Preventive Cardiology, Center for Cardiology, University Medical Center , Johannes Gutenberg University , Mainz , Germany.,m Center for Thrombosis and Hemostasis, University Medical Center, Johannes Gutenberg University , Mainz , Germany
| | - Till Keller
- a Department of Cardiology, Kerckhoff Heart Center , Bad Nauheim , Germany.,b Department of Internal Medicine III, Division of Cardiology, Goethe University Frankfurt , Frankfurt , Germany.,c German Centre for Cardiovascular Research (DZHK), Partner Site Center Rhein-Main , Germany
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Bakogiannis C, Theofilogiannakos E, Papadopoulos C, Lazaridis C, Bikakis I, Tzikas S, Vassilikos V. A translational approach to the renin-angiotensin-aldosterone system in heart failure. ACTA ACUST UNITED AC 2019. [DOI: 10.21037/arh.2019.05.01] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Tzikas S, Bakogiannis C, Doundoulakis I, Akrivos E, Zeller T, Sinning CR, Baldus S, Bickel C, Vassilikos V, Lackner KJ, Munzel T, Blankenberg S, Keller T. P6456Neopterin for risk stratification of patients with acute chest pain. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p6456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- S Tzikas
- Aristotle University of Thessaloniki, 3rd Department of Cardiology, Thessaloniki, Greece
| | - C Bakogiannis
- Aristotle University of Thessaloniki, 3rd Department of Cardiology, Thessaloniki, Greece
| | - I Doundoulakis
- Aristotle University of Thessaloniki, 3rd Department of Cardiology, Thessaloniki, Greece
| | - E Akrivos
- Aristotle University of Thessaloniki, 3rd Department of Cardiology, Thessaloniki, Greece
| | - T Zeller
- University Heart Center Hamburg, Clinic for General and Interventional Cardiology, Hamburg, Germany
| | - C R Sinning
- University Heart Center Hamburg, Clinic for General and Interventional Cardiology, Hamburg, Germany
| | - S Baldus
- University of Cologne, Department of Internal Medicine III, Cologne, Germany
| | - C Bickel
- Federal Armed Forces Hospital, Department of Internal Medicine, Koblenz, Germany
| | - V Vassilikos
- Aristotle University of Thessaloniki, 3rd Department of Cardiology, Thessaloniki, Greece
| | - K J Lackner
- University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - T Munzel
- University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - S Blankenberg
- University Heart Center Hamburg, Clinic for General and Interventional Cardiology, Hamburg, Germany
| | - T Keller
- Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany
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Boeckel JN, Palapies L, Klotsche J, Zeller T, von Jeinsen B, Perret MF, Kleinhaus SL, Pieper L, Tzikas S, Leistner D, Bickel C, Stalla GK, Lehnert H, Lindahl B, Wittchen HU, Silber S, Baldus S, Maerz W, Dimmeler S, Blankenberg S, Münzel T, Zeiher AM, Keller T. Adjusted Troponin I for Improved Evaluation of Patients with Chest Pain. Sci Rep 2018; 8:8087. [PMID: 29799020 PMCID: PMC5967336 DOI: 10.1038/s41598-018-26120-1] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 05/03/2018] [Indexed: 11/29/2022] Open
Abstract
The use of cardiac troponins (cTn) is the gold standard for diagnosing myocardial infarction. Independent of myocardial infarction (MI), however, sex, age and kidney function affect cTn levels. Here we developed a method to adjust cTnI levels for age, sex, and renal function, maintaining a unified cut-off value such as the 99th percentile. A total of 4587 individuals enrolled in a prospective longitudinal study were used to develop a model for adjustment of cTn. cTnI levels correlated with age and estimated glomerular filtration rate (eGFR) in males/females with rage = 0.436/0.518 and with reGFR = -0.142/-0.207. For adjustment, these variables served as covariates in a linear regression model with cTnI as dependent variable. This adjustment model was then applied to a real-world cohort of 1789 patients with suspected acute MI (AMI) (N = 407). Adjusting cTnI showed no relevant loss of diagnostic information, as evidenced by comparable areas under the receiver operator characteristic curves, to identify AMI in males and females for adjusted and unadjusted cTnI. In specific patients groups such as in elderly females, adjusting cTnI improved specificity for AMI compared with unadjusted cTnI. Specificity was also improved in patients with renal dysfunction by using the adjusted cTnI values. Thus, the adjustments improved the diagnostic ability of cTnI to identify AMI in elderly patients and in patients with renal dysfunction. Interpretation of cTnI values in complex emergency cases is facilitated by our method, which maintains a single diagnostic cut-off value in all patients.
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Affiliation(s)
- Jes-Niels Boeckel
- Department of Internal Medicine III, Cardiology, University Hospital, Goethe University Frankfurt, Frankfurt, Germany
- German Center for Cardiovascular Disease (DZHK), Berlin, Germany
- Institute of Cardiovascular Regeneration, Centre for Molecular Medicine, Goethe University Frankfurt, Frankfurt, Germany
- Department of Internal Medicine, Cardiology, University Hospital Leipzig, Leipzig, Germany
| | - Lars Palapies
- Department of Internal Medicine III, Cardiology, University Hospital, Goethe University Frankfurt, Frankfurt, Germany
| | - Jens Klotsche
- Clinical Psychology und Psychotherapy, Technical University Dresden, Dresden, Germany
| | - Tanja Zeller
- German Center for Cardiovascular Disease (DZHK), Berlin, Germany
- Clinic for General and Interventional Cardiology, University Heart Centre Hamburg, Hamburg, Germany
| | - Beatrice von Jeinsen
- Department of Internal Medicine III, Cardiology, University Hospital, Goethe University Frankfurt, Frankfurt, Germany
- German Center for Cardiovascular Disease (DZHK), Berlin, Germany
| | - Maya F Perret
- Department of Internal Medicine III, Cardiology, University Hospital, Goethe University Frankfurt, Frankfurt, Germany
| | - Soeren L Kleinhaus
- Institute of Cardiovascular Regeneration, Centre for Molecular Medicine, Goethe University Frankfurt, Frankfurt, Germany
| | - Lars Pieper
- Clinical Psychology und Psychotherapy, Technical University Dresden, Dresden, Germany
| | - Stergios Tzikas
- 3rd Department of Cardiology, Ippokrateio Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
- Department of Medicine II, University Medical Center, Johannes Gutenberg University, Mainz, Germany
| | - David Leistner
- Department of Internal Medicine III, Cardiology, University Hospital, Goethe University Frankfurt, Frankfurt, Germany
- German Center for Cardiovascular Disease (DZHK), Berlin, Germany
| | - Christoph Bickel
- Department of Internal Medicine, Federal Armed Forces Hospital, Koblenz, Germany
| | - Günter K Stalla
- Max Plank Institute for Psychiatry, Neuroendocrinology, Munich, Munich, Germany
| | - Hendrik Lehnert
- Department of Internal Medicine I, University Hospital Schleswig-Holstein, Lübeck, Germany
| | - Bertil Lindahl
- Department of Medical Sciences and Uppsala Clinical Research Center, Uppsala, Sweden
| | - Hans-Ulrich Wittchen
- Clinical Psychology und Psychotherapy, Technical University Dresden, Dresden, Germany
| | - Sigmund Silber
- Praxisklinik, Kardiologische Gemeinschaftspraxis, Munich, Germany
| | - Stephan Baldus
- Clinic for General and Interventional Cardiology, University Heart Centre Hamburg, Hamburg, Germany
- Heart Center, University of Cologne, Cologne, Germany
| | - Winfried Maerz
- Synlab Akademie für ärztliche Fortbildung, Synlab Services GmbH, Mannheim, Germany
| | - Stefanie Dimmeler
- German Center for Cardiovascular Disease (DZHK), Berlin, Germany
- Institute of Cardiovascular Regeneration, Centre for Molecular Medicine, Goethe University Frankfurt, Frankfurt, Germany
| | - Stefan Blankenberg
- German Center for Cardiovascular Disease (DZHK), Berlin, Germany
- Clinic for General and Interventional Cardiology, University Heart Centre Hamburg, Hamburg, Germany
| | - Thomas Münzel
- German Center for Cardiovascular Disease (DZHK), Berlin, Germany
- Department of Medicine II, University Medical Center, Johannes Gutenberg University, Mainz, Germany
| | - Andreas M Zeiher
- Department of Internal Medicine III, Cardiology, University Hospital, Goethe University Frankfurt, Frankfurt, Germany
- German Center for Cardiovascular Disease (DZHK), Berlin, Germany
| | - Till Keller
- Department of Internal Medicine III, Cardiology, University Hospital, Goethe University Frankfurt, Frankfurt, Germany.
- German Center for Cardiovascular Disease (DZHK), Berlin, Germany.
- Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany.
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Tzikas S, Bompotis G, Sarantzis N, Toutouzas K, Lazaridis I, Styliadis I, Tousoulis D, Vassilikos V. Transcarotid approach for TAVI: Presentation of a challenging case. Hellenic J Cardiol 2018; 60:64-65. [PMID: 29733912 DOI: 10.1016/j.hjc.2018.04.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 04/18/2018] [Accepted: 04/24/2018] [Indexed: 11/24/2022] Open
Affiliation(s)
- Stergios Tzikas
- 3rd Department of Cardiology, Ippokrateio Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece.
| | - Georgios Bompotis
- Department of Cardiology, Papageorgiou Hospital, Thessaloniki, Greece
| | - Nikolaos Sarantzis
- Vascular Unit, 1(st) Department of Surgery, Papageorgiou Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Konstantinos Toutouzas
- First Department of Cardiology, 'Hippokration' Hospital, University of Athens, Medical School, Athens, Greece
| | - Ioannis Lazaridis
- Vascular Unit, 1(st) Department of Surgery, Papageorgiou Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Ioannis Styliadis
- Department of Cardiology, Papageorgiou Hospital, Thessaloniki, Greece
| | - Dimitrios Tousoulis
- First Department of Cardiology, 'Hippokration' Hospital, University of Athens, Medical School, Athens, Greece
| | - Vassilios Vassilikos
- 3rd Department of Cardiology, Ippokrateio Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
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von Jeinsen B, Kraus D, Palapies L, Tzikas S, Zeller T, Schauer A, Drechsler C, Bickel C, Baldus S, Lackner KJ, Münzel T, Blankenberg S, Zeiher AM, Keller T. Urinary neutrophil gelatinase-associated lipocalin and cystatin C compared to the estimated glomerular filtration rate to predict risk in patients with suspected acute myocardial infarction. Int J Cardiol 2017; 245:6-12. [PMID: 28778467 DOI: 10.1016/j.ijcard.2017.07.086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2016] [Revised: 06/02/2017] [Accepted: 07/21/2017] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Impaired renal function, reflected by estimated glomerular filtration rate (eGFR) or cystatin C, is a strong risk predictor in the presence of acute myocardial infarction (AMI). Urinary neutrophil gelatinase-associated lipocalin (uNGAL) is an early marker of acute kidney injury. uNGAL might also be a good predictor of outcome in patients with cardiovascular disease. Aim of the present study was to evaluate the prognostic value of uNGAL compared to eGFR and cystatin C in patients with suspected AMI. METHODS 1818 patients were enrolled with suspected AMI. Follow-up information on the combined endpoint of death or non-fatal myocardial infarction was obtained 6months after enrolment and was available in 1804 patients. 63 events (3.5%) were registered. RESULTS While cystatin C and eGFR were strong risk predictors for the primary endpoint even adjusted for several variables, uNGAL was not independently associated with outcome: When applied continuously uNGAL was associated with outcome but did not remain a statistically significant predictor after several adjustments (i.e. eGFR). By adding cystatin C or uNGAL to GRACE risk score variables, only cystatin C could improve the predictive value while uNGAL showed no improvement. CONCLUSION We could show that cystatin C is an independent risk predictor in patients with suspected AMI and cystatin C can add improvement to the commonly used GRACE risk score. In contrast uNGAL is not independently associated with outcome and seems not to add further prognostic information to GRACE risk score.
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Affiliation(s)
- Beatrice von Jeinsen
- Division of Cardiology, Department of Internal Medicine III, Goethe University Frankfurt, Germany; German Centre for Cardiovascular Research (DZHK), partner site RheinMain, Frankfurt, Germany
| | - Daniel Kraus
- Division of Nephrology, Department of Medicine, University of Würzburg, Germany
| | - Lars Palapies
- Division of Cardiology, Department of Internal Medicine III, Goethe University Frankfurt, Germany
| | - Stergios Tzikas
- 3rd Department of Cardiology, Aristotle University of Thessaloniki, Ιppokrateio Hospital, Thessaloniki, Greece; Department of Internal Medicine II, University Medical Center, Johannes Gutenberg University, Mainz, Germany
| | - Tanja Zeller
- Clinic for General and Interventional Cardiology, University Heart Center Hamburg, Germany; German Centre for Cardiovascular Research (DZHK), partner site Hamburg/Lübeck/Kiel, Hamburg, Germany
| | - Anne Schauer
- Department of Internal Medicine II, University Medical Center, Johannes Gutenberg University, Mainz, Germany
| | | | - Christoph Bickel
- Department of Internal Medicine, Federal Armed Forces Hospital, Koblenz, Germany
| | - Stephan Baldus
- Department of Internal Medicine III, University of Cologne, Germany
| | - Karl J Lackner
- Department of Laboratory Medicine, University Medical Center, Johannes Gutenberg University, Mainz, Germany
| | - Thomas Münzel
- Department of Internal Medicine II, University Medical Center, Johannes Gutenberg University, Mainz, Germany
| | - Stefan Blankenberg
- Clinic for General and Interventional Cardiology, University Heart Center Hamburg, Germany; German Centre for Cardiovascular Research (DZHK), partner site Hamburg/Lübeck/Kiel, Hamburg, Germany
| | - Andreas M Zeiher
- Division of Cardiology, Department of Internal Medicine III, Goethe University Frankfurt, Germany; German Centre for Cardiovascular Research (DZHK), partner site RheinMain, Frankfurt, Germany
| | - Till Keller
- Division of Cardiology, Department of Internal Medicine III, Goethe University Frankfurt, Germany; German Centre for Cardiovascular Research (DZHK), partner site RheinMain, Frankfurt, Germany; Kerckhoff Heart and Thorax Center, Department of Cardiology, Bad Nauheim, Germany.
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Tzikas S, Palapies L, Bakogiannis C, Zeller T, Sinning C, Baldus S, Bickel C, Vassilikos V, Lackner KJ, Zeiher A, Münzel T, Blankenberg S, Keller T. GDF-15 predicts cardiovascular events in acute chest pain patients. PLoS One 2017; 12:e0182314. [PMID: 28771550 PMCID: PMC5542604 DOI: 10.1371/journal.pone.0182314] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Accepted: 07/17/2017] [Indexed: 01/27/2023] Open
Abstract
Background Treatment of patients presenting with possible acute myocardial infarction (AMI) is based on timely diagnosis and proper risk stratification aided by biomarkers. We aimed at evaluating the predictive value of GDF-15 in patients presenting with symptoms suggestive of AMI. Methods Consecutive patients presenting with suspected AMI were enrolled in three study centers. Cardiovascular events were assessed during a follow-up period of 6 months with a combined endpoint of death or MI. Results From the 1818 enrolled patients (m/f = 1208/610), 413 (22.7%) had an acute MI and 63 patients reached the combined endpoint. Patients with MI and patients with adverse outcome had higher GDF-15 levels compared with non-MI patients (967.1pg/mL vs. 692.2 pg/L, p<0.001) and with event-free patients (1660 pg/mL vs. 756.6 pg/L, p<0.001). GDF-15 levels were lower in patients with SYNTAX score ≤ 22 (797.3 pg/mL vs. 947.2 pg/L, p = 0.036). Increased GDF-15 levels on admission were associated with a hazard ratio of 2.1 for death or MI (95%CI: 1.67–2.65, p<0.001) in a model adjusted for age and sex and of 1.57 (1.13–2.19, p = 0.008) adjusted for the GRACE score variables. GDF-15 showed a relevant reclassification with regards to the GRACE score with an overall net reclassification index (NRI) of 12.5% and an integrated discrimination improvement (IDI) of 14.56% (p = 0.006). Conclusion GDF-15 is an independent predictor of future cardiovascular events in patients presenting with suspected MI. GDF-15 levels correlate with the severity of CAD and can identify and risk-stratify patients who need coronary revascularization.
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Affiliation(s)
- Stergios Tzikas
- 3rd Department of Cardiology, Ippokrateio Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
- Department of Internal Medicine II, University Medical Center, Johannes Gutenberg University, Mainz, Germany
- * E-mail:
| | - Lars Palapies
- Division of Cardiology, Department of Medicine III, Goethe University Frankfurt, Frankfurt, Germany
| | - Constantinos Bakogiannis
- 3rd Department of Cardiology, Ippokrateio Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Tanja Zeller
- Clinic for General and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany
- German Center for Cardiovascular Research (DZHK), Berlin, Germany
| | - Christoph Sinning
- Clinic for General and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany
| | - Stephan Baldus
- Department of Internal Medicine III, University of Cologne, Cologne, Germany
| | - Christoph Bickel
- Department of Internal Medicine, Federal Armed Forces Hospital, Koblenz, Germany
| | - Vassilios Vassilikos
- 3rd Department of Cardiology, Ippokrateio Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Karl J. Lackner
- Institute for Clinical Chemistry and Laboratory Medicine, University Medical Center Mainz, Mainz, Germany
| | - Andreas Zeiher
- Division of Cardiology, Department of Medicine III, Goethe University Frankfurt, Frankfurt, Germany
- German Center for Cardiovascular Research (DZHK), Berlin, Germany
| | - Thomas Münzel
- Department of Internal Medicine II, University Medical Center, Johannes Gutenberg University, Mainz, Germany
- German Center for Cardiovascular Research (DZHK), Berlin, Germany
| | - Stefan Blankenberg
- Clinic for General and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany
- German Center for Cardiovascular Research (DZHK), Berlin, Germany
| | - Till Keller
- Division of Cardiology, Department of Medicine III, Goethe University Frankfurt, Frankfurt, Germany
- German Center for Cardiovascular Research (DZHK), Berlin, Germany
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Tzikas S, Doundoulakis I, Zeller T, Sinning C, Baldus S, Bickel C, Vassilikos V, Lackner K, Munzel T, Blankenberg S, Keller T. P4698Adding the predictive value of BNP to the GRACE Score in patients presenting with acute chest pain. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx504.p4698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Kraus D, von Jeinsen B, Tzikas S, Palapies L, Zeller T, Bickel C, Fette G, Lackner K, Drechsler C, Neumann J, Baldus S, Blankenberg S, Münzel T, Wanner C, Zeiher A, Keller T. SP308INTRA-INDIVIDUAL CHANGES IN HIGH-SENSITIVE TROPONIN I AND T LEVELS IMPROVE DIAGNOSTIC PERFORMANCE FOR ACUTE MYOCARDIAL INFARCTION IN PATIENTS WITH CHRONIC KIDNEY DISEASE. Nephrol Dial Transplant 2017. [DOI: 10.1093/ndt/gfx146.sp308] [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
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Schofer N, Brunner FJ, Schlüter M, Ojeda F, Zeller T, Baldus S, Bickel C, Lackner KJ, Münzel T, Tzikas S, Genth-Zotz S, Warnholtz A, Post F, Keller T, Goldmann BU, Blankenberg S. Gender-specific diagnostic performance of a new high-sensitivity cardiac troponin I assay for detection of acute myocardial infarction. European Heart Journal: Acute Cardiovascular Care 2016; 6:60-68. [DOI: 10.1177/2048872615626660] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Niklas Schofer
- Department of General and Interventional Cardiology, University Heart Center, Germany
| | - Fabian J Brunner
- Department of General and Interventional Cardiology, University Heart Center, Germany
| | - Michael Schlüter
- Department of General and Interventional Cardiology, University Heart Center, Germany
| | - Francisco Ojeda
- Department of General and Interventional Cardiology, University Heart Center, Germany
| | - Tanja Zeller
- Department of General and Interventional Cardiology, University Heart Center, Germany
| | | | - Christoph Bickel
- Department of Internal Medicine, Federal Armed Forces Hospital Koblenz, Germany
| | - Karl J Lackner
- Department of Laboratory Medicine, Johannes Gutenberg University, Germany
| | - Thomas Münzel
- Department of Medicine II University Medical Center, Johannes Gutenberg University, Germany
| | - Stergios Tzikas
- Department of Medicine II University Medical Center, Johannes Gutenberg University, Germany
- 3rd Department of Cardiology, Aristotle University of Thessaloniki, Greece
| | - Sabine Genth-Zotz
- Department of Internal Medicine I, Katholisches Klinikum Mainz, Germany
| | | | - Felix Post
- Department of Medicine II University Medical Center, Johannes Gutenberg University, Germany
- Department of Internal Medicine I, Katholisches Klinikum Mainz, Germany
| | - Till Keller
- Department of Cardiology, Johann Wolfgang Goethe University Hospital, Germany
| | - Britta U Goldmann
- Department of General and Interventional Cardiology, University Heart Center, Germany
- Department of Cardiology, Asklepios Klinik Harburg, Germany
| | - Stefan Blankenberg
- Department of General and Interventional Cardiology, University Heart Center, Germany
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von Jeinsen B, Tzikas S, Pioro G, Palapies L, Zeller T, Bickel C, Lackner KJ, Baldus S, Blankenberg S, Muenzel T, Zeiher AM, Keller T. Troponin I Assay for Identification of a Significant Coronary Stenosis in Patients with Suspected Acute Myocardial Infarction and Wide QRS Complex. PLoS One 2016; 11:e0154724. [PMID: 27148734 PMCID: PMC4858235 DOI: 10.1371/journal.pone.0154724] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Accepted: 04/18/2016] [Indexed: 12/02/2022] Open
Abstract
Background Common ECG criteria such as ST-segment changes are of limited value in patients with suspected acute myocardial infarction (AMI) and bundle branch block or wide QRS complex. A large proportion of these patients do not suffer from an AMI, whereas those with ST-elevation myocardial infarction (STEMI) equivalent AMI benefit from an aggressive treatment. Aim of the present study was to evaluate the diagnostic information of cardiac troponin I (cTnI) in hemodynamically stable patients with wide QRS complex and suspected AMI. Methods In 417 out of 1818 patients presenting consecutively between 01/2007 and 12/2008 in a prospective multicenter observational study with suspected AMI a prolonged QRS duration was observed. Of these, n = 117 showed significant obstructive coronary artery disease (CAD) used as diagnostic outcome variable. cTnI was determined at admission. Results Patients with significant CAD had higher cTnI levels compared to individuals without (median 250ng/L vs. 11ng/L; p<0.01). To identify patients needing a coronary intervention, cTnI yielded an area under the receiver operator characteristics curve of 0.849. Optimized cut-offs with respect to a sensitivity driven rule-out and specificity driven rule-in strategy were established (40ng/L/96ng/L). Application of the specificity optimized cut-off value led to a positive predictive value of 71% compared to 59% if using the 99th percentile cut-off. The sensitivity optimized cut-off value was associated with a negative predictive value of 93% compared to 89% provided by application of the 99th percentile threshold. Conclusion cTnI determined in hemodynamically stable patients with suspected AMI and wide QRS complex using optimized diagnostic thresholds improves rule-in and rule-out with respect to presence of a significant obstructive CAD.
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Affiliation(s)
- Beatrice von Jeinsen
- Division of Cardiology, Department of Internal Medicine III, Goethe University Frankfurt, Frankfurt, Germany
- * E-mail: (TK); (BJ)
| | - Stergios Tzikas
- 3rd Department of Cardiology, Aristotle University of Thessaloniki, Ippokrateio Hospital, Thessaloniki, Greece
- Department of Internal Medicine II, University Medical Center, Johannes Gutenberg University, Mainz, Germany
| | - Gerhard Pioro
- Department of Internal Medicine II, University Medical Center, Johannes Gutenberg University, Mainz, Germany
| | - Lars Palapies
- Division of Cardiology, Department of Internal Medicine III, Goethe University Frankfurt, Frankfurt, Germany
| | - Tanja Zeller
- Department of General and Interventional Cardiology, University Heart Center, Hamburg, Germany
- German Centre for Cardiovascular Research (DZHK), Berlin, Germany
| | - Christoph Bickel
- Department of Internal Medicine, Federal Armed Forces Hospital, Koblenz, Germany
| | - Karl J. Lackner
- Department of Laboratory Medicine, University Medical Center, Johannes Gutenberg University, Mainz, Germany
| | - Stephan Baldus
- Department of Internal Medicine III, University of Cologne, Köln, Germany
| | - Stefan Blankenberg
- Department of General and Interventional Cardiology, University Heart Center, Hamburg, Germany
- German Centre for Cardiovascular Research (DZHK), Berlin, Germany
| | - Thomas Muenzel
- Department of Internal Medicine II, University Medical Center, Johannes Gutenberg University, Mainz, Germany
- German Centre for Cardiovascular Research (DZHK), Berlin, Germany
| | - Andreas M. Zeiher
- Division of Cardiology, Department of Internal Medicine III, Goethe University Frankfurt, Frankfurt, Germany
- German Centre for Cardiovascular Research (DZHK), Berlin, Germany
| | - Till Keller
- Division of Cardiology, Department of Internal Medicine III, Goethe University Frankfurt, Frankfurt, Germany
- German Centre for Cardiovascular Research (DZHK), Berlin, Germany
- * E-mail: (TK); (BJ)
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Winter R, Fazlinezhad A, Martins Fernandes S, Pellegrino M, Iriart X, Moustafa S, Stolfo D, Bieseviciene M, Patel S, Vriz O, Sarvari SI, Santos M, Berezin A, Stoebe S, Benyounes Iglesias N, De Chiara B, Soliman A, Oni O, Ricci F, Tumasyan LR, Kim KH, Popa BA, Yiangou K, Olsen RH, Cacicedo A, Monti L, Holte E, Orlic D, Trifunovic D, Nucifora G, Casalta AC, Cavalcante JL, Keramida K, Calin A, Almeida Morais L, Bandera F, Galli E, Kamal HM, Leite L, Polte CL, Martinez Santos P, Jin CN, Generati G, Reali M, Kalcik M, Cacicedo A, Nascimento H, Ferreiro Quero C, Kazum S, Madeira S, Villagra JM, Muraru D, Gobbo M, Generati G, D'andrea A, Azevedo O, Nucifora G, Cruz I, Lozano Granero VC, Stampfli SF, Marketou M, Bento D, Mohty D, Hernandez Jimenez V, Gascuena R, Ingvarsson A, Cameli M, Werther Evaldsson A, Greiner S, Michelsen MM, El Eraky AZZA, Kamal HM, D'ascenzi F, Spinelli L, Stojanovic S, Mincu RI, Vindis D, Mantovani F, Yi JE, Styczynski G, Battah AHMED, O'driscoll J, Generati G, Velasco Del Castillo S, Voilliot D, Scali MC, Garcia Campos A, Opitz B, Herold IHF, Veiga CESAR, Santos Furtado M, Khan UM, Leite L, Leite L, Leite L, Keramida K, Molnar AA, Rio P, Huang MS, Papadopoulos C, Venneri L, Onut R, Casas Rojo E, Bayat F, Aggeli C, Ben Kahla S, Abid L, Choi JH, Barreiro Perez M, Lindqvist P, Sheehan F, Vojdanparast M, Nezafati P, Teixeira R, Generati G, Bandera F, Labate V, Alfonzetti E, Guazzi M, Dinet ML, Jalal Z, Cochet H, Thambo JB, Ho TH, Shah P, Murphy K, Nelluri BK, Lee H, Wilansky S, Mookadam F, Tonet E, Merlo M, Barbati G, Gigli M, Pinamonti B, Ramani F, Zecchin M, Sinagra G, Vaskelyte JJ, Mizariene V, Lesauskaite V, Verseckaite R, Karaliute R, Jonkaitiene R, Li L, Craft M, Danford D, Kutty S, Pellegrinet M, Zito C, Carerj S, Di Bello V, Cittadini A, Bossone E, Antonini-Canterin F, Rodriguez M, Sitges M, Sepulveda-Martinez A, Gratacos E, Bijnens B, Crispi F, Leite L, Martins R, Baptista R, Barbosa A, Ribeiro N, Oliveira A, Castro G, Pego M, Samura T, Kremzer A, Tarr A, Pfeiffer D, Hagendorff A, Van Der Vynckt C, Gout O, Devys JM, Cohen A, Musca F, D'angelo L, Cipriani MG, Parolini M, Rossi A, Santambrogio GM, Russo C, Giannattasio C, Moreo A, Moharram M, Gamal A, Reda A, Adebiyi A, Aje A, Aquilani R, Dipace G, Bucciarelli V, Bianco F, Miniero E, Scipioni G, De Caterina R, Gallina S, Adamyan KG, Chilingaryan AL, Tunyan LG, Cho JY, Yoon HJ, Ahn Y, Jeong MH, Cho JG, Park JC, Popa A, Cerin G, Azina CH, Yiangou A, Georgiou C, Zitti M, Ioannides M, Chimonides S, Pedersen LR, Snoer M, Christensen TE, Ghotbi AA, Hasbak P, Kjaer A, Haugaard SB, Prescott E, Velasco Del Castillo S, Gomez Sanchez V, Anton Ladislao A, Onaindia Gandarias J, Rodriguez Sanchez I, Jimenez Melo O, Garcia Cuenca E, Zugazabeitia Irazabal G, Romero Pereiro A, Nardi B, Di Giovine G, Malanchini G, Scardino C, Balzarini L, Presbitero P, Gasparini GL, Tesic M, Zamaklar-Trifunovic D, Vujisic-Tesic B, Borovic M, Milasinovic D, Zivkovic M, Kostic J, Belelsin B, Ostojic M, Krljanac G, Savic L, Asanin M, Aleksandric S, Petrovic M, Zlatic N, Lasica R, Mrdovic I, Muser D, Zanuttini D, Tioni C, Bernardi G, Spedicato L, Proclemer A, Galli E, Szymanski C, Salaun E, Lavoute C, Haentjens J, Tribouilloy C, Mancini J, Donal E, Habib G, Delgado-Montero A, Dahou A, Caballero L, Rijal S, Gorcsan J, Monin JL, Pibarot P, Lancellotti P, Kouris N, Kostopoulos V, Giannaris V, Trifou E, Markos L, Mihalopoulos A, Mprempos G, Olympios CD, Mateescu AD, Rosca M, Beladan CC, Enache R, Gurzun MM, Varga P, Calin C, Ginghina C, Popescu BA, Galrinho A, Branco L, Gomes V, Timoteo AT, Daniel P, Rodrigues I, Rosa S, Fragata J, Ferreira R, Generati G, Pellegrino M, Carbone F, Labate V, Alfonzetti E, Guazzi M, Leclercq C, Samset E, Donal E, Oraby MA, Eleraky AZ, Yossuef MA, Baptista R, Teixeira R, Ribeiro N, Oliveira AP, Barbosa A, Castro G, Martins R, Elvas L, Pego M, Gao SA, Lagerstrand KM, Johnsson ÅA, Bech-Hanssen O, Vilacosta I, Batlle Lopez E, Sanchez Sauce B, Jimenez Valtierra J, Espana 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Castro F, Albina G, Aranda A, Navia D, Siciliano M, Migliore F, Cavedon S, Folino F, Pedrizzetti G, Bertaglia M, Corrado D, Iliceto S, Badano LP, Merlo M, Stolfo D, Losurdo P, Ramani F, Barbati G, Pivetta A, Pinamonti B, Sinagra GF, Di Lenarda A, Bandera F, Pellegrino M, Labate V, Carbone F, Alfonzetti E, Guazzi M, Di Palma E, Baldini L, Verrengia M, Vastarella R, Limongelli G, Bossone E, Calabro' R, Russo MG, Pacileo G, Cruz I, Correia E, Bento D, Teles L, Lourenco C, Faria R, Domingues K, Picarra B, Marques N, Muser D, Gianfagna P, Morocutti G, Proclemer A, Gomes AC, Lopes LR, Stuart B, Caldeira D, Morgado G, Almeida AR, Canedo P, Bagulho C, Pereira H, Pardo Sanz A, Marco Del Castillo A, Monteagudo Ruiz JM, Rincon Diaz LM, Ruiz Rejon F, Casas E, Hinojar R, Fernandez-Golfin C, Zamorano Gomez JL, Erhart L, Staehli BE, Kaufmann BA, Tanner FC, Kontaraki J, Parthenakis F, Maragkoudakis S, Zacharis E, Patrianakos A, Vardas P, Domingues K, Correia E, Lopes L, Teles L, Picarra B, Magalhaes P, Faria R, Lourenco C, Azevedo O, Boulogne C, Magne J, Damy T, Martin S, Boncoeur MP, Aboyans V, Jaccard A, Saavedra Falero J, Alberca Vela MT, Molina Blazquez L, Mata Caballero R, Serrano Rosado JA, Elviro R, Di Gioia C, Fernandez Rozas I, Manzano MC, Martinez Sanchez JI, Molina M, Palma J, Werther Evaldsson A, Radegran G, Stagmo M, Waktare J, Roijer A, Meurling CJ, Righini FM, Sparla S, Di Tommaso C, Focardi M, D'ascenzi F, Tacchini D, Maccherini M, Henein M, Mondillo S, Ingvarsson A, Waktare J, Thilen U, Stagmo M, Roijer A, Radegran G, Meurling C, Jud A, Aurich M, Katus HA, Mereles D, Faber R, Pena A, Mygind ND, Suhrs HE, Zander M, Prescott E, Handoka NESRIN, Ghali MONA, Eldahshan NAHED, Ibrahim AHMED, Al-Eraky AZ, El Attar MA, Omar AS, Pelliccia A, Alvino F, Solari M, Cameli M, Focardi M, Bonifazi M, Mondillo S, Giudice CA, Assante Di Panzillo E, Castaldo D, Riccio E, Pisani A, Trimarco B, Deljanin Ilic M, Ilic S, Magda LS, Florescu M, Velcea A, Mihalcea D, Chiru A, Popescu BO, Tiu C, Vinereanu D, Hutyra M, Cechakova E, Littnerova S, Taborsky M, Lugli R, Bursi F, Fabbri M, Modena MG, Stefanelli G, Mussini C, Barbieri A, Youn HJ, O JH, Yoon HJ, Jung HO, Shin GJ, Rdzanek A, Pietrasik A, Kochman J, Huczek Z, Milewska A, Marczewska M, Szmigielski CA, Abd Eldayem SOHA, El Magd El Bohy ABO, Slee A, Peresso V, Nazir S, Sharma R, Bandera F, Pellegrino M, Labate V, Carbone F, Alfonzetti E, Guazzi M, Anton Ladislao A, Gomez Sanchez V, Cacidedo Fernandez Bobadilla A, Onaindia Gandarias JJ, Rodriguez Sanchez I, Romero Pereira A, Quintana Rackza O, Jimenez Melo O, Zugazabeitia Irazabal G, Huttin O, Venner C, Deballon R, Manenti V, Villemin T, Olivier A, Sadoul N, Juilliere Y, Selton-Suty C, Simioniuc A, Mandoli GE, Dini FL, Marzilli M, Picano E, Martin-Fernandez M, De La Hera Galarza JM, Corros-Vicente C, Leon-Aguero V, Velasco-Alonso E, Colunga-Blanco S, Fidalgo-Arguelles A, Rozado-Castano J, Moris De La Tassa C, Stelzmueller ME, Wisser W, Reichenfelser W, Mohl W, Saporito S, Mischi M, Bouwman RA, Van Assen HC, Van Den Bosch HCM, De Lepper A, Korsten HHM, Houthuizen P, Rodrigues A, Leal G, Silvestre O, Andrade J, Hjertaas JJ, Greve G, Matre K, Teixeira R, Baptista R, Barbosa A, Ribeiro N, Castro G, Martins R, Cardim N, Goncalves L, Pego M, Teixeira R, Baptista R, Barbosa A, Ribeiro N, Castro G, Martins R, Cardim N, Goncalves L, Pego M, Teixeira R, Baptista R, Barbosa A, Oliveira AP, Castro G, Martins R, Cardim N, Goncalves L, Pego M, Kouris N, Kostopoulos V, Markos L, Olympios CD, Kovacs A, Tarnoki AD, Tarnoki DL, Kolossvary M, Apor A, Maurovich-Horvat P, Jermendy G, Sengupta P, Merkely B, Viveiros Monteiro A, Galrinho A, Pereira-Da-Silva T, Moura Branco L, Timoteo A, Abreu J, Leal A, Varela F, Cruz Ferreira R, Yang LT, Tsai WC, Mpaltoumas K, Fotoglidis A, Triantafyllou K, Pagourelias E, Kassimatis E, Tzikas S, Kotsiouros G, Mantzogeorgou E, Vassilikos V, Calicchio F, Manivarmane R, Pareek N, Baksi J, Rosen S, Senior R, Lyon AR, Khattar RS, Marinescu C, Onciul S, Zamfir D, Tautu O, Dorobantu M, Carbonell San Roman A, Rincon Diez LM, Gonzalez Gomez A, Fernandez Santos S, Lazaro Rivera C, Moreno Vinues C, Sanmartin Fernandez M, Fernandez-Golfin C, Zamorano Gomez JL, Alirezaei T, Karimi AS, Kakiouzi V, Felekos I, Panagopoulou V, Latsios G, Karabela M, Petras D, Tousoulis D, Abid L, Abid D, Kammoun S, Ben Kahla S, Lee JW, Martin Fernandez M, Costilla Garcia SM, Diaz Pelaez E, Moris De La Tassa C. Poster session 3The imaging examinationP646Simulator-based testing of skill in transthoracic echoP647Clinical and echocardiographic characteristics of isolated left ventricular non-compactionP648Appropriate use criteria of transthoracic echocardiography and its clinical impact in an aged populationAnatomy and physiology of the heart and great vesselsP649Prevalence and determinants of exercise oscillatory ventilation in the EUROEX trial populationAssessment of diameters, volumes and massP650Left atrial remodeling after percutaneous left atrial appendage closureP651Global atrial performance with tyrosine kinase inhibitors in metastatic renal cell carcinomaP652Early right ventricular response to cardiac resynchronization therapy: impact on clinical outcomesP653Parameters of speckle-tracking echocardiography and biomechanical values of a dilative ascending aortaAssessments of haemodynamicsP654Right atrial hemodynamics in infants and children: observations from 3-dimensional echocardiography derived right atrial volumesAssessment of systolic functionP655One-point carotid wave intensity predicts cardiac mortality in patients with congestive heart failure and reduced ejection fractionP656Persistence of cardiac remodeling in adolescents with previous fetal growth restrictionP6572D speckle tracking-derived left ventricle global longitudinal strain and left ventricular dysfunction stages: a useful discriminator in moderate-to-severe aortic regurgitationP658Global longitudinal strain and strain rate in type two diabetes patients with chronic heart failure: relevance to circulating osteoprotegerinP659Analysis of left ventricular function in patients before and after surgical and interventional mitral valve therapyP660Left ventricular end-diastolic volume is complementary with global longitudinal strain for the prediction of left ventricular ejection fraction in echocardiographic daily practiceP661Left ventricular assist device, right ventricle function, and selection bias: the light side of the moonP662Assessment of right ventricular function in patients with anterior ST elevation myocardial infarction; a 2-d speckle tracking studyP663Right ventricular systolic function assessment in sickle cell anaemia using echocardiographyAssessment of diastolic functionP664Prognostic value of transthoracic cardiopulmonary ultrasound in cardiac surgery intensive care unitP665Comparative efficacy of renin-angiotensin system modulators on prognosis, right heart and left atrial parameters in patients with chronic heart failure and preserved left ventricular systolic functionP666Left atrial volume index is the most significant diastolic functional parameter of hemodynamic burden as measured by NT-proBNP in acute myocardial infarctionP667Preventive echocardiographic screening. preliminary dataP668Assessment of the atrial electromechanical delay and the mechanical functions of the left atrium in patients with diabetes mellitus type IIschemic heart diseaseP669Coronary flow velocity reserve by echocardiography as a measure of microvascular function: feasibility, reproducibility and agreement with PET in overweight patients with coronary artery diseaseP670Influence of cardiovascular risk in the occurrence of events in patients with negative stress echocardiographyP671Prevalence of transmural myocardial infarction and viable myocardium in chronic total occlusion (CTO) patientsP672The impact of the interleukin 6 receptor antagonist tocilizumab on mircovascular dysfunction after non st elevation myocardial infarction assessed by coronary flow reserve from a randomized studyP673Impact of manual thrombus aspiration on left ventricular remodeling: the echocardiographic substudy of the randomized Physiologic Assessment of Thrombus Aspirtion in patients with ST-segment ElevatioP674Acute heart failure in STEMI patients treated with primary percutaneous coronary intervention is related to transmural circumferential myocardial strainP675Long-term prognostic value of infarct size as assessed by cardiac magnetic resonance imaging after a first st-segment elevation myocardial infarctionHeart valve DiseasesP676Prognostic value of LV global longitudinal strain in aortic stenosis with preserved LV ejection fractionP677Importance of longitudinal dyssynchrony in low flow low gradient severe aortic stenosis patients undergoing dobutamine stress echocardiography. a multicenter study (on behalf of the HAVEC group)P678Predictive value of left ventricular longitudinal strain by 2D Speckle Tracking echocardiography, in asymptomatic patients with severe aortic stenosis and preserved ejection fractionP679Clinical and echocardiographic characteristics of the flow-gradient patterns in patients with severe aortic stenosis and preserved left ventricular ejection fractionP6802D and 3D speckle tracking assessment of left ventricular function in severe aortic stenosis, a step further from biplane ejection fractionP681Functional evaluation in aortic stenosis: determinant of exercise capacityP682Left ventricular mechanics: novel tools to evaluate left ventricular function in patients with primary mitral regurgitationP683Plasma B-type natriuretic peptide level in patients with isolated rheumatic mitral stenosisP684Quantitative assessment of severity in aortic regurgitation and the influence of elastic proprieties of thoracic aortaP685Characterization of chronic aortic and mitral regurgitation using cardiovascular magnetic resonanceP686Functional mitral regurgitation: a warning sign of underlying left ventricular systolic dysfunction in heart failure with preserved ejection fraction.P687Secondary mitral valve tenting in primary degenerative prolapse quantified by three-dimensional echocardiography predicts regurgitation recurrence after mitral valve repairP688Advanced heart failure with reduced ejection fraction and severe mitral insufficiency compensate with a higher oxygen peripheral extraction to a reduced cardiac output vs oxygen uptake response to maxP689Predictors of acute procedural success after percutaneous mitraclip implantation in patients with moderate-to-severe or severe mitral regurgitation and reduced ejection fractionP690The value of transvalvular gradients obtained by transthoracic echocardiography in estimation of severe paravalvular leakage in patients with mitral prosthetic valvesP691Characteristics of infective endocarditis in a non tertiary hospitalP692Infective endocarditis: predictors of severity in a 3-year retrospective analysisP693New echocardiographic predictors of early recurrent mitral functional regurgitation after mitraclip implantationP694Transesophageal echocardiography can be reliably used for the allocation of patients with severe aortic stenosis for tras-catheter aortic valve implantationP695Annular sizing for transcatheter aortic valve selection. A comparison between computed tomography and 3D echocardiographyP696Association between aortic dilatation, mitral valve prolapse and atrial septal aneurysm: first descriptive study.CardiomyopathiesP698Cardiac resynchronization therapy by multipoint pacing improves the acute response of left ventricular mechanics and fluid dynamics: a three-dimensional and particle image velocimetry echo studyP699Long-term natural history of right ventricular function in dilated cardiomyopathy: innocent bystander or leading actor?P700Right to left ventricular interdependence at rest and during exercise assessed by the ratio between pulmonary systolic to diastolic time in heart failure reduced ejection fractionP701Exercise strain imaging demonstrates impaired right ventricular contractile reserve in patients with hypertrophic cardiomyopathyP702Prevalence of overt left ventricular dysfunction (burn-out phase) in a portuguese population of hypertrophic cardiomyopathy, a multicentre studyP703Systolic and diastolic myocardial mechanics in hypertrophic cardiomyopathy and their link to the extent of hypertrophy, replacement fibrosis and interstitial fibrosisP704Multimodality imaging and genotype-phenotype associations in a cohort of patients with hypertrophic cardiomyopathy studied by next generation sequencing and cardiac magnetic resonanceP705Sudden cardiac death risk assessment in apical hypertrophic cardiomyopathy: do we need to add MRI to the equation?P706Prognostic value of left ventricular ejection fraction, proBNP, exercise capacity, and NYHA functional class in patients with left ventricular non-compaction cardiomyopathyP707The anti-hypertrophic microRNAs miR-1, miR-133a and miR-26b and their relationship to left ventricular hypertrophy in patients with essential hypertensionP708Prevalence of left ventricular systolic dysfunction in a portuguese population of left ventricular non-compaction cardiomyopathy, a multicentre studyP709Assessment of systolic and diastolic features in light chain amyloidosis: an echocardiographic and cardiac magnetic resonance studyP710Morbid obesity-associated hypertension identifies bariatric surgery best responders: Clinical and echocardiographic follow up studyP711Echocardiographic markera for overhydration in patients under haemodialysisP712Gender aspects of right ventricular size and function in clinically stable heart transplant patientsP713Evidence of cardiac stem cells from the left ventricular apical tip in patients undergone LVAD implant: a comparative strain-ultrastructural studySystemic diseases and other conditionsP714Speckle tracking assessment of right ventricular function is superior for differentiation of pressure versus volume overloaded right ventricleP715Prognostic value of pulmonary arterial pressure: analysis in a large dataset of timely matched non-invasive and invasive assessmentsP716Effect of the glucagon-like peptide-1 analogue liraglutide on left ventricular diastolic and systolic function in patients with type 2 diabetes: a randomised, single-blinded, crossover pilot studyP717Tissue doppler evaluation of left ventricular functions, left atrial mechanical functions and atrial electromechanical delay in juvenile idiopathic arthritisP718Echocardiographic detection of subclinical left ventricular dysfunction in patients with rheumatoid arthritisP719Left ventricular strain values are unaffected by intense training: a longitudinal, speckle-tracking studyP720Diastolic left ventricular function in autosomal dominant polycystic kidney disease: a matched-cohort, speckle-tracking echocardiographic studyP721Relationship between adiponectin level and left ventricular mass and functionP722Left atrial function is impaired in patients with multiple sclerosisMasses, tumors and sources of embolismP723Paradoxical embolization to the brain in patients with acute pulmonary embolism and confirmed patent foramen ovale with bidirectional shunt, results of prospective monitoringP724Following the European Society of Cardiology proposed echocardiographic algorithm in elective patients with clinical suspicion of infective endocarditis: diagnostic yield and prognostic implicationsP725Metastatic cardiac18F-FDG uptake in patients with malignancy: comparison with echocardiographic findingsDiseases of the aortaP726Echocardiographic measurements of aortic pulse wave velocity correlate well with invasive methodP727Assessment of increase in aortic and carotid intimal medial thickness in adolescent type 1 diabetic patientsStress echocardiographyP728Determinants and prognostic significance of heart rate variability in renal transplant candidates undergoing dobutamine stress echocardiographyP729Pattern of cardiac output vs O2 uptake ratio during maximal exercise in heart failure with reduced ejection fraction: pathophysiological insightsP730Prognostic value and predictive factors of cardiac events in patients with normal exercise echocardiographyP731Right ventricular mechanics during exercise echocardiography: normal values, feasibility and reproducibility of conventional and new right ventricular function parametersP732The added value of exercise-echo in heart failure patients: assessing dynamic changes in extravascular lung waterP733Applicability of appropriate use criteria of exercise stress echocardiography in real-life practice: what have we improved with new documents?Transesophageal echocardiographyP7343D-TEE guidance in percutaneous mitral valve interventions correcting mitral regurgitationContrast echocardiographyP735Pulmonary transit time by contrast enhanced ultrasound as parameter for cardiac performance: a comparison with magnetic resonance imaging and NT-ProBNPReal-time three-dimensional TEEP736Optimal parameter selection for anisotropic diffusion denoising filters applied to aortic valve 4d echocardiographsP737Left ventricle systolic function in non-alcoholic cirrhotic candidates for liver transplantation: a three-dimensional speckle-tracking echocardiography studyTissue Doppler and speckle trackingP738Optimizing speckle tracking echocardiography strain measurements in infants: an in-vitro phantom studyP739Usefulness of vascular mechanics in aortic degenerative valve disease to estimate prognosis: a two dimensional speckle tracking studyP740Vascular mechanics in aortic degenerative valve disease: a two dimensional speckle-tracking echocardiography studyP741Statins and vascular load in aortic valve disease patients, a speckle tracking echocardiography studyP742Is Left Bundle Branch Block only an electrocardiographic abnormality? Study of LV function by 2D speckle tracking in patients with normal ejection fractionP743Dominant inheritance of global longitudinal strain in a population of healthy and hypertensive twinsP744Mechanical differences of left atria in paroxysmal atrial fibrillation: A speckle-tracking study.P745Different distribution of myocardial deformation between hypertrophic cardiomyopathy and aortic stenosisP746Left atrial mechanics in patients with chronic renal failure. Incremental value for atrial fibrillation predictionP747Subclinical myocardial dysfunction in cancer patients: is there a direct effect of tumour growth?P748The abnormal global longitudinal strain predicts significant circumflex artery disease in low risk acute coronary syndromeP7493D-Speckle tracking echocardiography for assessing ventricular funcion and infarct size in young patients after acute coronary syndromeP750Evaluation of left ventricular dyssynchrony by echocardiograhy in patients with type 2 diabetes mellitus without clinically evident cardiac diseaseP751Differences in myocardial function between peritoneal dialysis and hemodialysis patients: insights from speckle tracking echoP752Appraisal of left atrium changes in hypertensive heart disease: insights from a speckle tracking studyP753Left ventricular rotational behavior in hypertensive patients: Two dimensional speckle tracking imaging studyComputed Tomography & Nuclear CardiologyP754Effectiveness of adaptive statistical iterative reconstruction of 64-slice dual-energy ct pulmonary angiography in the patients with reduced iodine load: comparison with standard ct pulmonary angiograP755Clinical prediction model to inconclusive result assessed by coronary computed tomography angiography. Eur Heart J Cardiovasc Imaging 2015. [DOI: 10.1093/ehjci/jev277] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Boeckel JN, Palapies L, Zeller T, Reis SM, von Jeinsen B, Tzikas S, Bickel C, Baldus S, Blankenberg S, Münzel T, Zeiher AM, Lackner KJ, Keller T. Estimation of Values below the Limit of Detection of a Contemporary Sensitive Troponin I Assay Improves Diagnosis of Acute Myocardial Infarction. Clin Chem 2015. [DOI: 10.1373/clinchem.2015.238949] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abstract
BACKGROUND
The limit of detection (LoD) is the minimal amount of a substance that can be consistently detected. In the diagnosis of acute myocardial infarction (AMI) many patients present with troponin concentrations below the LoD of contemporary sensitive cardiac troponin I (cs-cTnI) assays. These censored values below the LoD influence the diagnostic performance of these assays compared to highly sensitive cTnI (hs-cTnI) assays. Therefore we assessed the impact of a new approach for interpolation of the left-censored data of a cs-cTnI assay in the evaluation of patients with suspected AMI.
METHODS
Our posthoc analysis used a real world cohort of 1818 patients with suspected MI. Data on cs-cTnI was available in 1786 patients. As a comparator the hs-cTnI version of the assay was used. To reconstruct quantities below the LoD of the cs-cTnI assay, a gamma regression approach incorporating the GRACE (Global Registry of Acute Coronary Events) score variables was used.
RESULTS
Censoring of cs-cTnI data below the LoD yielded weaker diagnostic information [area under the curve (AUC), 0.781; 95% CI, 0.731–0.831] regarding AMI compared to the hs-cTnI assay (AUC, 0.949; CI, 0.936–0.961). Use of our model to estimate cs-cTnI values below the LoD showed an AUC improvement to 0.921 (CI, 0.902–0.940). The cs-cTnI LoD concentration had a negative predictive value (NPV) of 0.950. An estimated concentration that was to be undercut by 25% of patients presenting with suspected AMI was associated with an improvement of the NPV to 0.979.
CONCLUSIONS
Estimation of values below the LoD of a cs-cTnI assay with this new approach improves the diagnostic performance in evaluation of patients with suspected AMI.
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Affiliation(s)
- Jes-Niels Boeckel
- Institute for Cardiovascular Regeneration, Center of Molecular Medicine and
- DZHK (German Centre for Cardiovascular Research), partner site Rhein-Main, Germany
| | - Lars Palapies
- Division of Cardiology, Department of Medicine III, Goethe University Frankfurt, Frankfurt, Germany
| | - Tanja Zeller
- Clinic for General and Interventional Cardiology, University Heart Centre Hamburg, Hamburg, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Hamburg/Kiel/Lübeck, Germany
| | - Sophia M Reis
- Division of Cardiology, Department of Medicine III, Goethe University Frankfurt, Frankfurt, Germany
| | - Beatrice von Jeinsen
- Division of Cardiology, Department of Medicine III, Goethe University Frankfurt, Frankfurt, Germany
| | - Stergios Tzikas
- Department of Medicine II, University Medical Center, Johannes Gutenberg University, Mainz, Germany
- 3rd Department of Cardiology, Aristotle University of Thessaloniki, Ippokrateio Hospital, Thessaloniki, Greece
| | - Christoph Bickel
- Department of Internal Medicine, Federal Armed Forces Hospital, Koblenz, Germany
| | | | - Stefan Blankenberg
- Clinic for General and Interventional Cardiology, University Heart Centre Hamburg, Hamburg, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Hamburg/Kiel/Lübeck, Germany
| | - Thomas Münzel
- Department of Medicine II, University Medical Center, Johannes Gutenberg University, Mainz, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Rhein-Main, Germany
| | - Andreas M Zeiher
- Division of Cardiology, Department of Medicine III, Goethe University Frankfurt, Frankfurt, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Rhein-Main, Germany
| | - Karl J Lackner
- Institute for Clinical Chemistry and Laboratory Medicine, University Medical Center, Johannes Gutenberg University, Mainz, Germany
| | - Till Keller
- Division of Cardiology, Department of Medicine III, Goethe University Frankfurt, Frankfurt, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Rhein-Main, Germany
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Liebetrau C, Weber M, Tzikas S, Palapies L, Möllmann H, Pioro G, Zeller T, Beiras-Fernandez A, Bickel C, Zeiher AM, Lackner KJ, Baldus S, Nef HM, Blankenberg S, Hamm CW, Münzel T, Keller T. Identification of acute myocardial infarction in patients with atrial fibrillation and chest pain with a contemporary sensitive troponin I assay. BMC Med 2015. [PMID: 26212559 PMCID: PMC4515912 DOI: 10.1186/s12916-015-0410-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The introduction of modern troponin assays has facilitated diagnosis of acute myocardial infarction due to improved sensitivity with corresponding loss of specificity. Atrial fibrillation (AF) is associated with elevated levels of troponin. The aim of the present study was to evaluate the diagnostic performance of troponin I in patients with suspected acute coronary syndrome and chronic AF. METHODS Contemporary sensitive troponin I was assayed in a derivation cohort of 90 patients with suspected acute coronary syndrome and chronic AF to establish diagnostic cut-offs. These thresholds were validated in an independent cohort of 314 patients with suspected myocardial infarction and AF upon presentation. Additionally, changes in troponin I concentration within 3 hours were used. RESULTS In the derivation cohort, optimized thresholds with respect to a rule-out strategy with high sensitivity and a rule-in strategy with high specificity were established. In the validation cohort, application of the rule-out cut-off led to a negative predictive value of 97 %. The rule-in cut-off was associated with a positive predictive value of 88 % compared with 71 % if using the 99th percentile cut-off. In patients with troponin I levels above the specificity-optimized threshold, additional use of the 3-hour change in absolute/relative concentration resulted in a further improved positive predictive value of 96 %/100 %. CONCLUSIONS Troponin I concentration and the 3-hour change in its concentration provide valid diagnostic information in patients with suspected myocardial infarction and chronic AF. With regard to AF-associated elevation of troponin levels, application of diagnostic cut-offs other than the 99th percentile might be beneficial.
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Affiliation(s)
- Christoph Liebetrau
- Kerckhoff Heart and Thorax Center, Department of Cardiology, Bad Nauheim, Germany. .,DZHK (German Centre for Cardiovascular Research), partner site RheinMain, Frankfurt am Main, Germany.
| | - Michael Weber
- Department of Internal Medicine II, Hospital Darmstadt-Dieburg, Groß-Umstadt, Germany.
| | - Stergios Tzikas
- 3rd Department of Cardiology, Aristotle University of Thessaloniki, Ippokrateio Hospital, Thessaloniki, Greece. .,Department of Internal Medicine II, University Medical Center, Johannes Gutenberg University, Mainz, Germany.
| | - Lars Palapies
- DZHK (German Centre for Cardiovascular Research), partner site RheinMain, Frankfurt am Main, Germany. .,Division of Cardiology, Department of Internal Medicine III, Goethe University Frankfurt, Frankfurt am Main, Germany.
| | - Helge Möllmann
- Kerckhoff Heart and Thorax Center, Department of Cardiology, Bad Nauheim, Germany. .,DZHK (German Centre for Cardiovascular Research), partner site RheinMain, Frankfurt am Main, Germany.
| | - Gerhard Pioro
- DZHK (German Centre for Cardiovascular Research), partner site RheinMain, Frankfurt am Main, Germany. .,Department of Internal Medicine II, University Medical Center, Johannes Gutenberg University, Mainz, Germany.
| | - Tanja Zeller
- Department of General and Interventional Cardiology, University Heart Center, Hamburg, Germany. .,DZHK (German Centre for Cardiovascular Research), partner site Hamburg, Kiel, Lübeck, Hamburg, Germany.
| | - Andres Beiras-Fernandez
- Department of Cardiothoracic Surgery, Goethe University Frankfurt, Frankfurt am Main, Germany.
| | - Christoph Bickel
- DZHK (German Centre for Cardiovascular Research), partner site RheinMain, Frankfurt am Main, Germany. .,Department of Internal Medicine, Federal Armed Forces Hospital, Koblenz, Germany.
| | - Andreas M Zeiher
- DZHK (German Centre for Cardiovascular Research), partner site RheinMain, Frankfurt am Main, Germany. .,Division of Cardiology, Department of Internal Medicine III, Goethe University Frankfurt, Frankfurt am Main, Germany.
| | - Karl J Lackner
- Department of Laboratory Medicine, University Medical Center, Johannes Gutenberg University, Mainz, Germany.
| | - Stephan Baldus
- Department of Internal Medicine III, University of Cologne, Cologne, Germany.
| | - Holger M Nef
- Department of Cardiology, University of Giessen, Giessen, Germany.
| | - Stefan Blankenberg
- Department of General and Interventional Cardiology, University Heart Center, Hamburg, Germany. .,DZHK (German Centre for Cardiovascular Research), partner site Hamburg, Kiel, Lübeck, Hamburg, Germany.
| | - Christian W Hamm
- Kerckhoff Heart and Thorax Center, Department of Cardiology, Bad Nauheim, Germany. .,DZHK (German Centre for Cardiovascular Research), partner site RheinMain, Frankfurt am Main, Germany. .,Department of Cardiology, University of Giessen, Giessen, Germany.
| | - Thomas Münzel
- DZHK (German Centre for Cardiovascular Research), partner site RheinMain, Frankfurt am Main, Germany. .,Department of Internal Medicine II, University Medical Center, Johannes Gutenberg University, Mainz, Germany.
| | - Till Keller
- DZHK (German Centre for Cardiovascular Research), partner site RheinMain, Frankfurt am Main, Germany. .,Division of Cardiology, Department of Internal Medicine III, Goethe University Frankfurt, Frankfurt am Main, Germany.
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Domingos J, Augustine D, Leeson P, Noble J, Doan HL, Boubrit L, Cheikh-Khalifa R, Laveau F, Djebbar M, Pousset F, Isnard R, Hammoudi N, Lisi M, Cameli M, Di Tommaso C, Curci V, Reccia R, Maccherini M, Henein MY, Mondillo S, Leitman M, Vered Z, Rashid H, Yalcin MU, Gurses KM, Kocyigit D, Evranos B, Yorgun H, Sahiner L, Kaya B, Aytemir K, Ozer N, Bertella E, Petulla' M, Baggiano A, Mushtaq S, Russo E, Gripari P, Innocenti E, Andreini D, Tondo C, Pontone G, Necas J, Kovalova S, Hristova K, Shiue I, Bogdanva V, Teixido Tura G, Sanchez V, Rodriguez-Palomares J, Gutierrez L, Gonzalez-Alujas T, Garcia-Dorado D, Forteza A, Evangelista A, Timoteo AT, Aguiar Rosa S, Cruz Ferreira R, Campbell R, Carrick D, Mccombe C, Tzemos N, Berry C, Sonecki P, Noda M, Setoguchi M, Ikenouchi T, Nakamura T, Yamamoto Y, Murakami T, Katou Y, Usui M, Ichikawa K, Isobe M, Kwon B, Roh J, Kim H, Ihm S, Barron AJ, Francis D, Mayet J, Wensel R, Kosiuk J, Dinov B, Bollmann A, Hindricks G, Breithardt O, Rio P, Moura Branco L, Galrinho A, Cacela D, Pinto Teixeira P, Afonso Nogueira M, Pereira-Da-Silva T, Abreu J, Teresa Timoteo A, Cruz Ferreira R, Pavlyukova E, Tereshenkova E, Karpov R, Piatkowski R, Kochanowski J, Opolski G, Barbier P, Mirea O, Guglielmo M, Savioli G, Cefalu C, Pudil R, Horakova L, Rozloznik M, Balestra C, Rimbas R, Enescu O, Calin S, Vinereanu D, Karsenty C, Hascoet S, Hadeed K, Semet F, Dulac Y, Alacoque X, Leobon B, Acar P, Dharma S, Sukmawan R, Soesanto A, Vebiona K, Firdaus I, Danny S, Driessen MMP, Sieswerda G, Post M, Snijder R, Van Dijk A, Leiner T, Meijboom F, Chrysohoou C, Tsitsinakis G, Tsiachris D, Aggelis A, Herouvim E, Vogiatzis I, Pitsavos C, Koulouris G, Stefanadis C, Erdei T, Edwards J, Braim D, Yousef Z, Fraser A, Avenatti E, Magnino C, Omede' P, Presutti D, Moretti C, Iannaccone A, Ravera A, Gaita F, Milan A, Veglio F, Barbier P, Scali M, Simioniuc A, Guglielmo M, Savioli G, Cefalu C, Mirea O, Fusini L, Dini F, Okura H, Murata E, Kataoka T, Zaroui A, Ben Halima M, Mourali M, Mechmeche R, Rodriguez Palomares JF, Gutierrez L, Maldonado G, Garcia G, Otaegui I, Garcia Del Blanco B, Teixido G, Gonzalez Alujas M, Evangelista A, Garcia Dorado D, Godinho AR, Correia A, Rangel I, Rocha A, Rodrigues J, Araujo V, Almeida P, Macedo F, Maciel M, Rekik B, Mghaieth F, Aloui H, Boudiche S, Jomaa M, Ayari J, Tabebi N, Farhati A, Mourali S, Dekleva M, Markovic-Nikolic N, Zivkovic M, Stankovic A, Boljevic D, Korac N, Beleslin B, Arandjelovic A, Ostojic M, Galli E, Guirette Y, Auffret V, Daudin M, Fournet M, Mabo P, Donal E, Chin CWL, Luo E, Hwan J, White A, Newby D, Dweck M, Carstensen HG, Larsen LH, Hassager C, Kofoed KF, Jensen JS, Mogelvang R, Kowalczyk M, Debska M, Kolesnik A, Dangel J, Kawalec W, Migliore R, Adaniya M, Barranco M, Miramont G, Gonzalez S, Tamagusuku H, Davidsen ES, Kuiper KKJ, Matre K, Gerdts E, Igual Munoz B, Maceira Gonzalez A, Erdociain Perales M, Estornell Erill J, Valera Martinez F, Miro Palau V, Piquer Gil M, Sepulveda Sanchez P, Cervera Zamora A, Montero Argudo A, Placido R, Silva Marques J, Magalhaes A, Guimaraes T, Nobre E Menezes M, Goncalves S, Ramalho A, Robalo Martins S, Almeida A, Nunes Diogo A, Abid L, Ben Kahla S, Charfeddine S, Abid D, Kammoun S, Tounsi A, Abid L, Abid D, Charfeddine S, Hammami R, Triki F, Akrout M, Mallek S, Hentati M, Kammoun S, Sirbu CF, Berrebi A, Huber A, Folliguet T, Yang LT, Shih J, Liu Y, Li Y, Tsai L, Luo C, Tsai W, Babukov R, Bartosh F, Bazilev V, Muraru D, Cavalli G, Addetia K, Miglioranza M, Veronesi F, Mihaila S, Tadic M, Cucchini U, Badano L, Lang R, Miyazaki S, Slavich M, Miyazaki T, Figini F, Lativ A, Chieffo A, Montrfano M, Alfieri O, Colombo A, Agricola E, Liu D, Hu K, Herrmann S, Stoerk S, Kramer B, Ertl G, Bijnens B, Weidemann F, Brand M, Butz T, Tzikas S, Van Bracht M, Roeing J, Wennemann R, Christ M, Grett M, Trappe HJ, Scherzer S, Geroldinger A, Krenn L, Roth C, Gangl C, Maurer G, Rosenhek R, Neunteufl T, Binder T, Bergler-Klein J, Martins E, Pinho T, Leite S, Azevedo O, Belo A, Campelo M, Amorim S, Rocha-Goncalves F, Goncalves L, Silva-Cardoso J, Ahn H, Kim K, Jeon H, Youn H, Haland T, Saberniak J, Leren I, Edvardsen T, Haugaa K, Ziolkowska L, Boruc A, Kowalczyk M, Turska-Kmiec A, Zubrzycka M, Kawalec W, Monivas Palomero V, Mingo Santos S, Goirigolzarri Artaza J, Rodriguez Gonzalez E, Rivero Arribas B, Castro Urda V, Dominguez Rodriguez F, Mitroi C, Gracia Lunar I, Fernadez Lozano I, Palecek T, Masek M, Kuchynka P, Fikrle M, Spicka I, Rysava R, Linhart A, Saberniak J, Hasselberg N, Leren I, Haland T, Borgquist R, Platonov P, Edvardsen T, Haugaa K, Ancona R, Comenale Pinto S, Caso P, Coopola M, Arenga F, Rapisarda O, D'onofrio A, Sellitto V, Calabro R, Rosca M, Popescu B, Calin A, Mateescu A, Beladan C, Jalba M, Rusu E, Zilisteanu D, Ginghina C, Pressman G, Cepeda-Valery B, Romero-Corral A, Moldovan R, Saenz A, Orban M, Samuel S, Fijalkowski M, Fijalkowska M, Gilis-Siek N, Blaut K, Galaska R, Sworczak K, Gruchala M, Fijalkowski M, Nowak R, Gilis-Siek N, Fijalkowska M, Galaska R, Gruchala M, Ikonomidis I, Triantafyllidi H, Trivilou P, Tzortzis S, Papadopoulos C, Pavlidis G, Paraskevaidis I, Lekakis J, Kaymaz C, Aktemur T, Poci N, Ozturk S, Akbal O, Yilmaz F, Tokgoz Demircan H, Kirca N, Tanboga I, Ozdemir N, Greiner S, Jud A, Aurich M, Hess A, Hilbel T, Hardt S, Katus H, D'ascenzi F, Cameli M, Alvino F, Lisi M, Focardi M, Solari M, Bonifazi M, Mondillo S, Konopka M, Krol W, Klusiewicz A, Burkhard K, Chwalbinska J, Pokrywka A, Dluzniewski M, Braksator W, King GJ, Coen K, Gannon S, Fahy N, Kindler H, Clarke J, Iliuta L, Rac-Albu M, Placido R, Robalo Martins S, Guimaraes T, Nobre E Menezes M, Cortez-Dias N, Francisco A, Silva G, Goncalves S, Almeida A, Nunes Diogo A, Kyu K, Kong W, Songco G, Galupo M, Castro M, Shin Hnin W, Ronald Lee C, Poh K, Milazzo V, Di Stefano C, Tosello F, Leone D, Ravera A, Sabia L, Sobrero G, Maule S, Veglio F, Milan A, Jamiel AM, Ahmed AM, Farah I, Al-Mallah MH, Petroni R, Magnano R, Bencivenga S, Di Mauro M, Petroni S, Altorio S, Romano S, Penco M, Kumor M, Lipczynska M, Klisiewicz A, Wojcik A, Konka M, Kozuch K, Szymanski P, Hoffman P, Rimbas R, Rimbas M, Enescu O, Mihaila S, Calin S, Vinereanu D, Donal E, Reynaud A, Lund L, Persson H, Hage C, Oger E, Linde C, Daubert J, Maria Oliveira Lima M, Costa H, Gomes Da Silva M, Noman Alencar M, Carmo Pereira Nunes M, Costa Rocha M, Abid L, Charfeddine S, Ben Kahla S, Abid D, Siala A, Hentati M, Kammoun S, Kovalova S, Necas J, Ozawa K, Funabashi N, Takaoka H, Kobayashi Y, Matsumura Y, Wada M, Hirakawa D, Yasuoka Y, Morimoto N, Takeuchi H, Kitaoka H, Sugiura T, Lakkas L, Naka K, Ntounousi E, Gkirdis I, Koutlas V, Bechlioulis A, Pappas K, Katsouras C, Siamopoulos K, Michalis L, Naka K, Evangelou D, Kalaitzidis R, Bechlioulis A, Lakkas L, Gkirdis I, Tzeltzes G, Nakas G, Katsouras C, Michalis L, Generati G, Bandera F, Pellegrino M, Labate V, Alfonzetti E, Guazzi M, Zagatina A, Zhuravskaya N, Al-Mallah M, Alsaileek A, Qureshi W, Karsenty C, Hascoet S, Peyre M, Hadeed K, Alacoque X, Amadieu R, Leobon B, Dulac Y, Acar P, Yamanaka Y, Sotomi Y, Iwakura K, Inoue K, Toyoshima Y, Tanaka K, Oka T, Tanaka N, Orihara Y, Fujii K, Soulat-Dufour L, Lang S, Boyer-Chatenet L, Van Der Vynckt C, Ederhy S, Adavane S, Haddour N, Boccara F, Cohen A, Huitema M, Boerman S, Vorselaars V, Grutters J, Post M, Gopal AS, Saha S, Toole R, Kiotsekoglou A, Cao J, Reichek N, Meyer CG, Altiok E, Al Ateah G, Lehrke M, Becker M, Lotfi S, Autschbach R, Marx N, Hoffmann R, Frick M, Nemes A, Sepp R, Kalapos A, Domsik P, Forster T, Caro Codon J, Blazquez Bermejo Z, Lopez Fernandez T, Valbuena Lopez SC, Iniesta Manjavacas AM, De Torres Alba F, Dominguez Melcon F, Pena Conde L, Moreno Yanguela M, Lopez-Sendon JL, Nemes A, Lengyel C, Domsik P, Kalapos A, Orosz A, Varkonyi T, Forster T, Rendon J, Saldarriaga CI, Duarte N, Nemes A, Domsik P, Kalapos A, Forster T, Nemes A, Domsik P, Kalapos A, Sepp R, Foldeak D, Borbenyi Z, Forster T, Hamdy A, Fereig H, Nabih M, Abdel-Aziz A, Ali A, Broyd C, Wielandts JY, De Buck S, Michielsen K, Louw R, Garweg C, Nuyts J, Ector J, Maes F, Heidbuchel H, Gillis K, Bala G, Tierens S, Cosyns B, Maurovich-Horvat P, Horvath T, Jermendy A, Celeng C, Panajotu A, Bartykowszki A, Karolyi M, Tarnoki A, Jermendy G, Merkely B. Poster session 2: Thursday 4 December 2014, 08:30-12:30 * Location: Poster area. Eur Heart J Cardiovasc Imaging 2014. [DOI: 10.1093/ehjci/jeu252] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Tzikas S, Keller T, Wild PS, Schulz A, Zwiener I, Zeller T, Schnabel RB, Sinning C, Lubos E, Kunde J, Münzel T, Lackner KJ, Blankenberg S. Midregional pro-atrial natriuretic peptide in the general population/Insights from the Gutenberg Health Study. Clin Chem Lab Med 2014. [PMID: 23183754 DOI: 10.1515/cclm-2012-0541] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The use of biomarkers is firmly established for the assessment of cardiovascular disease. Emerging biomarkers such as midregional pro-atrial natriuretic peptide (MR-proANP) challenge established markers regarding risk prediction and stratification ability. The aim of the present study was to describe the distribution of a contemporary MR-proANP assay in a large population-representative sample and to evaluate the association with prevalent cardiac diseases and cardiovascular risk factors. METHODS MR-proANP was determined by the use of a contemporary commercially available assay (BRAHMS GmbH, Hennigsdorf, Germany) in a representative sample of 5000 participants from the large population-based Gutenberg Health Study. N-terminal pro B-type natriuretic peptide (NT-proBNP) was used as a comparator. RESULTS Mean age was 55.5 ± 10.9 years. Coronary artery disease (CAD) was documented in 4.6%, heart failure (HF) in 1.5% of the study participants. We observed a moderate to strong correlation of the biomarkers with age, diabetes, hypertension, smoking, renal function, prevalence of CAD and HF. Males showed lower MR-proANP concentrations than females. MR-proANP showed no relevant correlation with BMI (ρ=-0.030) and CRP (ρ=0.039). Reference limits for MR-proANP representing the 95th/97.5th/99th percentile were determined for healthy individuals with 116/132/169 pmol/mL. CONCLUSIONS The current analysis in a large population-based sample elucidates the correlations and distribution of MR-proANP. Its concentration in healthy individuals depends on prevalent cardiovascular diseases and classical risk factors. The reported population-based reference values might be useful for distinguishing between healthy and diseased individuals, thus improving risk stratification and triaging in various clinical settings.
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Affiliation(s)
- Stergios Tzikas
- Department of Medicine 2, University Medical Center Mainz, Langenbeckstrasse 1, 55131 Mainz, Germany.
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Zeller T, Keller T, Ojeda F, Reichlin T, Twerenbold R, Tzikas S, Wild PS, Reiter M, Czyz E, Lackner KJ, Munzel T, Mueller C, Blankenberg S. Assessment of microRNAs in patients with unstable angina pectoris. Eur Heart J 2014; 35:2106-14. [PMID: 24727883 DOI: 10.1093/eurheartj/ehu151] [Citation(s) in RCA: 108] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
AIMS While cardiac troponin measurements have significantly improved the early diagnosis of myocardial infarction, the timely biomarker-based diagnosis of unstable angina pectoris (UAP) remains a major unmet clinical challenge. The aim of this study was to assess levels of circulating microRNAs (miRNAs) as possible novel biomarkers in patients with UAP. METHODS AND RESULTS A three-phase approach was conducted, comprising (i) profiling of miRNAs in patients with UAP and controls groups; (ii) replication of significant miRNAs in an independent patient cohort, (iii) validation of a multi-miRNAs panel in a third cohort. Out of 25 miRNAs selected for replication, 8 miRNAs remained significantly associated with UAP. In a validation phase, a miRNA panel including miR-132, miR-150, and miR-186 showed the highest discriminatory power [area under the receiver-operating-characteristic curve (AUC): 0.91; CI: 0.84-0.98]. CONCLUSION Using a profiling-replication-validation model, we identified eight miRNAs, which may facilitate the diagnosis of UAP.
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Affiliation(s)
- Tanja Zeller
- Department of General and Interventional Cardiology, University Heart Center Hamburg, Martinistr. 52, 20246 Hamburg, Germany German Center for Cardiovascular Research (DZHK), Partner Site Hamburg, Lübeck, Kiel, Hamburg, Germany
| | - Till Keller
- Department of General and Interventional Cardiology, University Heart Center Hamburg, Martinistr. 52, 20246 Hamburg, Germany German Center for Cardiovascular Research (DZHK), Partner Site Rhein-Main, Mainz, Germany
| | - Francisco Ojeda
- Department of General and Interventional Cardiology, University Heart Center Hamburg, Martinistr. 52, 20246 Hamburg, Germany
| | - Tobias Reichlin
- Department of Internal Medicine, University Hospital, Basel, Switzerland Department of Cardiology, University Hospital, Basel, Switzerland
| | - Raphael Twerenbold
- Department of Internal Medicine, University Hospital, Basel, Switzerland Department of Cardiology, University Hospital, Basel, Switzerland
| | - Stergios Tzikas
- Department of Medicine II, University Medical Center, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Philipp S Wild
- German Center for Cardiovascular Research (DZHK), Partner Site Rhein-Main, Mainz, Germany Department of Medicine II, University Medical Center, Johannes Gutenberg University Mainz, Mainz, Germany Clinical Epidemiology, Center for Thrombosis and Haemostasis, University Medical Center Mainz, Langenbeckstraße 1, 55131 Mainz, Germany
| | - Miriam Reiter
- Department of Internal Medicine, University Hospital, Basel, Switzerland Department of Cardiology, University Hospital, Basel, Switzerland
| | - Ewa Czyz
- Department of Medicine II, University Medical Center, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Karl J Lackner
- German Center for Cardiovascular Research (DZHK), Partner Site Rhein-Main, Mainz, Germany Department of Laboratory Medicine, University Medical Center, Johannes Gutenberg University Mainz, Germany
| | - Thomas Munzel
- German Center for Cardiovascular Research (DZHK), Partner Site Rhein-Main, Mainz, Germany Department of Medicine II, University Medical Center, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Christian Mueller
- Department of Internal Medicine, University Hospital, Basel, Switzerland Department of Cardiology, University Hospital, Basel, Switzerland
| | - Stefan Blankenberg
- Department of General and Interventional Cardiology, University Heart Center Hamburg, Martinistr. 52, 20246 Hamburg, Germany German Center for Cardiovascular Research (DZHK), Partner Site Hamburg, Lübeck, Kiel, Hamburg, Germany
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Tzikas S, Schlak D, Sopova K, Gatsiou A, Stakos D, Stamatelopoulos K, Stellos K, Laske C. Increased Myeloperoxidase Plasma Levels in Patients with Alzheimer's Disease. ACTA ACUST UNITED AC 2014; 39:557-64. [DOI: 10.3233/jad-131469] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Stergios Tzikas
- Department of Cardiology, Ruhr University Bochum, Marienhospital Herne, Herne, Germany
| | - Dennis Schlak
- Department of Neurology, University of Tübingen, Tübingen, Germany
| | - Kateryna Sopova
- Vascular Inflammation Group, Institute of Cardiovascular Regeneration, Centre of Molecular Medicine, J.W. Goethe University Frankfurt am Main, Frankfurt am Main, Germany
| | - Aikaterini Gatsiou
- Vascular Inflammation Group, Institute of Cardiovascular Regeneration, Centre of Molecular Medicine, J.W. Goethe University Frankfurt am Main, Frankfurt am Main, Germany
| | - Dimitrios Stakos
- Cardiology Clinic, Democritus University of Thrace, Alexandroupolis, Greece
| | - Kimon Stamatelopoulos
- Department of Clinical Therapeutics, Alexandra Hospital, University of Athens, Athens, Greece
| | - Konstantinos Stellos
- Vascular Inflammation Group, Institute of Cardiovascular Regeneration, Centre of Molecular Medicine, J.W. Goethe University Frankfurt am Main, Frankfurt am Main, Germany
- Department of Cardiology, Centre of Internal Medicine III, J.W. Goethe University Frankfurt am Main, Frankfurt am Main, Germany
| | - Christoph Laske
- Department of Psychiatry and Psychotherapy, University of Tübingen, Tübingen, Germany
- Section for Dementia Research, Hertie-Institute of Clinical Brain Research and Department of Psychiatry and Psychotherapy, University of Tübingen, Tübingen, Germany
- DZNE, German Center for Neurodegenerative Diseases, Tübingen, Germany
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Caiani E, Pellegrini A, Carminati M, Lang R, Auricchio A, Vaida P, Obase K, Sakakura T, Komeda M, Okura H, Yoshida K, Zeppellini R, Noni M, Rigo T, Erente G, Carasi M, Costa A, Ramondo B, Thorell L, Akesson-Lindow T, Shahgaldi K, Germanakis I, Fotaki A, Peppes S, Sifakis S, Parthenakis F, Makrigiannakis A, Richter U, Sveric K, Forkmann M, Wunderlich C, Strasser R, Djikic D, Potpara T, Polovina M, Marcetic Z, Peric V, Ostenfeld E, Werther-Evaldsson A, Engblom H, Ingvarsson A, Roijer A, Meurling C, Holm J, Radegran G, Carlsson M, Tabuchi H, Yamanaka T, Katahira Y, Tanaka M, Kurokawa T, Nakajima H, Ohtsuki S, Saijo Y, Yambe T, D'alto M, Romeo E, Argiento P, D'andrea A, Vanderpool R, Correra A, Sarubbi B, Calabro' R, Russo M, Naeije R, Saha SK, Warsame TA, Caelian AG, Malicse M, Kiotsekoglou A, Omran AS, Sharif D, Sharif-Rasslan A, Shahla C, Khalil A, Rosenschein U, Erturk M, Oner E, Kalkan A, Pusuroglu H, Ozyilmaz S, Akgul O, Aksu H, Akturk F, Celik O, Uslu N, Bandera F, Pellegrino M, 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G, Malev E, Reeva S, Vasina L, Pshepiy A, Korshunova A, Timofeev E, Zemtsovsky E, Jorgensen PG, Jensen J, Fritz-Hansen T, Biering-Sorensen T, Jons C, Olsen N, Henri C, Magne J, Dulgheru R, Laaraibi S, Voilliot D, Kou S, Pierard L, Lancellotti P, Tayyareci Y, Dworakowski R, Kogoj P, Reiken J, Kenny C, Maccarthy P, Wendler O, Monaghan M, Song J, Ha T, Jung Y, Seo M, Choi S, Kim Y, Sun B, Kim D, Kang D, Song J, Le Tourneau T, Topilsky Y, Inamo J, Mahoney D, Suri R, Schaff H, Enriquez-Sarano M, Bonaque Gonzalez J, Sanchez Espino A, Merchan Ortega G, Bolivar Herrera N, Ikuta I, Macancela Quinonez J, Munoz Troyano S, Ferrer Lopez R, Gomez Recio M, Dreyfus J, Cimadevilla C, Brochet E, Himbert D, Iung B, Vahanian A, Messika-Zeitoun D, Izumo M, Takeuchi M, Seo Y, Yamashita E, Suzuki K, Ishizu T, Sato K, Aonuma K, Otsuji Y, Akashi Y, Muraru D, Addetia K, Veronesi F, Corsi C, Mor-Avi V, Yamat M, Weinert L, Lang R, Badano L, Minamisawa M, Koyama J, Kozuka A, Motoki H, Izawa A, Tomita T, Miyashita Y, Ikeda U, Florescu C, Niemann M, Liu D, Hu K, Herrmann S, Gaudron P, Scholz F, Stoerk S, Ertl G, Weidemann F, Marchel M, Serafin A, Kochanowski J, Piatkowski R, Madej-Pilarczyk A, Filipiak K, Hausmanowa-Petrusewicz I, Opolski G, Meimoun P, M'barek D, Clerc J, Neikova A, Elmkies F, Tzvetkov B, Luycx-Bore A, Cardoso C, Zemir H, Mansencal N, Arslan M, El Mahmoud R, Pilliere R, Dubourg O, Ikonomidis I, Lambadiari V, Pavlidis G, Koukoulis C, Kousathana F, Varoudi M, Tritakis V, Triantafyllidi H, Dimitriadis G, Lekakis I, Kovacs A, Kosztin A, Solymossy K, Celeng C, Apor A, Faludi M, Berta K, Szeplaki G, Foldes G, Merkely B, Kimura K, Daimon M, Nakajima T, Motoyoshi Y, Komori T, Nakao T, Kawata T, Uno K, Takenaka K, Komuro I, Gabric ID, Vazdar L, Pintaric H, Planinc D, Vinter O, Trbusic M, Bulj N, Nobre Menezes M, Silva Marques J, Magalhaes R, Carvalho V, Costa P, Brito D, Almeida A, Nunes-Diogo A, Davidsen ES, Bergerot C, Ernande L, Barthelet M, Thivolet S, Decker-Bellaton A, Altman M, Thibault H, Moulin P, Derumeaux G, Huttin O, Voilliot D, Frikha Z, Aliot E, Venner C, Juilliere Y, Selton-Suty C, Yamada T, Ooshima M, Hayashi H, Okabe S, Johno H, Murata H, Charalampopoulos A, Tzoulaki I, Howard L, Davies R, Gin-Sing W, Grapsa J, Wilkins M, Gibbs J, Castillo J, Bandeira A, Albuquerque E, Silveira C, Pyankov V, Chuyasova Y, Lichodziejewska B, Goliszek S, Kurnicka K, Dzikowska Diduch O, Kostrubiec M, Krupa M, Grudzka K, Ciurzynski M, Palczewski P, Pruszczyk P, Arana X, Oria G, Onaindia J, Rodriguez I, Velasco S, Cacicedo A, Palomar S, Subinas A, Zumalde J, Laraudogoitia E, Saeed S, Kokorina M, Fromm A, Oeygarden H, Waje-Andreassen U, Gerdts E, Gomez E, Vallejo N, Pedro-Botet L, Mateu L, Nunyez R, Llobera L, Bayes A, Sabria M, Antonini-Canterin F, Mateescu A, La Carrubba S, Vriz O, Di Bello V, Carerj S, Zito C, Ginghina C, Popescu B, Nicolosi G, Mateescu A, La Carrubba S, Vriz O, Di Bello V, Carerj S, Zito C, Ginghina C, Popescu B, Nicolosi G, Antonini-Canterin F, Pudil R, Praus R, Vasatova M, Vojacek J, Palicka V, Hulek P, Pradel S, Mohty D, Damy T, Echahidi N, Lavergne D, Virot P, Aboyans V, Jaccard A, Mateescu A, La Carrubba S, Vriz O, Di Bello V, Carerj S, Zito C, Ginghina C, Popescu B, Nicolosi G, Antonini-Canterin F, Doulaptsis C, Symons R, Matos A, Florian A, Masci P, Dymarkowski S, Janssens S, Bogaert J, Lestuzzi C, Moreo A, Celik S, Lafaras C, Dequanter D, Tomkowski W, De Biasio M, Cervesato E, Massa L, Imazio M, Watanabe N, Kijima Y, Akagi T, Toh N, Oe H, Nakagawa K, Tanabe Y, Ikeda M, Okada K, Ito H, Milanesi O, Biffanti R, Varotto E, Cerutti A, Reffo E, Castaldi B, Maschietto N, Vida V, Padalino M, Stellin G, Bejiqi R, Retkoceri R, Bejiqi H, Retkoceri A, Surdulli S, Massoure P, Cautela J, Roche N, Chenilleau M, Gil J, Fourcade L, Akhundova A, Cincin A, Sunbul M, Sari I, Tigen M, Basaran Y, Suermeci G, Butz T, Schilling I, Sasko B, Liebeton J, Van Bracht M, Tzikas S, Prull M, Wennemann R, Trappe H, Attenhofer Jost CH, Pfyffer M, Scharf C, Seifert B, Faeh-Gunz A, Naegeli B, Candinas R, Medeiros-Domingo A, Wierzbowska-Drabik K, Roszczyk N, Sobczak M, Plewka M, Krecki R, Kasprzak J, Ikonomidis I, Varoudi M, Papadavid E, Theodoropoulos K, Papadakis I, Pavlidis G, Triantafyllidi H, Anastasiou - Nana M, Rigopoulos D, Lekakis J, Tereshina O, Surkova E, Vachev A, Merchan Ortega G, Bonaque Gonzalez J, Sanchez Espino A, Bolivar Herrera N, Bravo Bustos D, Ikuta I, Aguado Martin M, Navarro Garcia F, Ruiz Lopez F, Gomez Recio M, Merchan Ortega G, Bonaque Gonzalez J, Bravo Bustos D, Sanchez Espino A, Bolivar Herrera N, Bonaque Gonzalez J, Navarro Garcia F, Aguado Martin M, Ruiz Lopez M, Gomez Recio M, Eguchi H, Maruo T, Endo K, Nakamura K, Yokota K, Fuku Y, Yamamoto H, Komiya T, Kadota K, Mitsudo K, Nagy AI, Manouras A, Gunyeli E, Shahgaldi K, Winter R, Hoffmann R, Barletta G, Von Bardeleben S, Kasprzak J, Greis C, Vanoverschelde J, Becher H, Hu K, Liu D, Niemann M, Herrmann S, Cikes M, Gaudron P, Knop S, Ertl G, Bijnens B, Weidemann F, Di Salvo G, Al Bulbul Z, Issa Z, Khan A, Faiz A, Rahmatullah S, Fadel B, Siblini G, Al Fayyadh M, Menting ME, Van Den Bosch A, Mcghie J, Cuypers J, Witsenburg M, Van Dalen B, Geleijnse M, Roos-Hesselink J, Olsen F, Jorgensen P, Mogelvang R, Jensen J, Fritz-Hansen T, Bech J, Biering-Sorensen T, Agoston G, Pap R, Saghy L, Forster T, Varga A, Scandura S, Capodanno D, Dipasqua F, Mangiafico S, Caggegi AM, Grasso C, Pistritto AM, Imme' S, Ministeri M, Tamburino C, Cameli M, Lisi M, D'ascenzi F, Cameli P, Losito M, Sparla S, Lunghetti S, Favilli R, Fineschi M, Mondillo S, Ojaghihaghighi Z, Javani B, Haghjoo M, Moladoust H, Shahrzad S, Ghadrdoust B, Altman M, Aussoleil A, Bergerot C, Bonnefoy-Cudraz E, Derumeaux GA, Thibault H, Shkolnik E, Vasyuk Y, Nesvetov V, Shkolnik L, Varlan G, Gronkova N, Kinova E, Borizanova A, Goudev A, Saracoglu E, Ural D, Sahin T, Al N, Cakmak H, Akbulut T, Akay K, Ural E, Mushtaq S, Andreini D, Pontone G, Bertella E, Conte E, Baggiano A, Annoni A, Formenti A, Fiorentini C, Pepi M, Cosgrove C, Carr L, Chao C, Dahiya A, Prasad S, Younger J, Biering-Sorensen T, Christensen L, Krieger D, Mogelvang R, Jensen J, Hojberg S, Host N, Karlsen F, Christensen H, Medressova A, Abikeyeva L, Dzhetybayeva S, Andossova S, Kuatbayev Y, Bekbossynova M, Bekbossynov S, Pya Y, Farsalinos K, Tsiapras D, Kyrzopoulos S, Spyrou A, Stefopoulos C, Romagna G, Tsimopoulou K, Tsakalou M, Voudris V, Cacicedo A, Velasco Del Castillo S, Anton Ladislao A, Aguirre Larracoechea U, Onaindia Gandarias J, Romero Pereiro A, Arana Achaga X, Zugazabeitia Irazabal G, Laraudogoitia Zaldumbide E, Lekuona Goya I, Varela A, Kotsovilis S, Salagianni M, Andreakos V, Davos C, Merchan Ortega G, Bonaque Gonzalez J, Sanchez Espino A, Bolivar Herrera N, Macancela Quinones J, Ikuta I, Ferrer Lopez R, Munoz Troyano S, Bravo Bustos D, Gomez Recio M. Poster session Friday 13 December - PM: 13/12/2013, 14:00-18:00 * Location: Poster area. Eur Heart J Cardiovasc Imaging 2013. [DOI: 10.1093/ehjci/jet206] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Van Dijk K, De Bruin - Bon H, Araki M, Meregalli P, Koch K, Vis M, Mulder B, Baan J, Bouma B, Marciniak A, Elton D, Glover K, Campbell I, Sharma R, Batalha S, Lourenco C, Oliveira Da Silva C, Manouras A, Shahgaldi K, Caballero L, Garcia-Lara J, Gonzalez-Carrillo J, Oliva M, Saura D, Garcia-Navarro M, Espinosa M, Pinar E, Valdes M, De La Morena G, Barreiro Perez M, Lopez Perez M, Roy D, Brecker S, Sharma R, Venkateshvaran A, Dash PK, Sola S, Barooah B, Govind SC, Winter R, Shahgaldi K, Brodin LA, Manouras A, Saura Espin D, Caballero Jimenez L, Gonzalez Carrillo J, Oliva Sandoval M, Lopez Ruiz M, Garcia Navarro M, Espinosa Garcia M, Valdes Chavarri M, De La Morena Valenzuela G, Gatti G, Dell'angela L, Pinamonti B, Benussi B, Sinagra G, Pappalardo A, Hernandez V, Saavedra J, Gonzalez A, Iglesias P, Civantos S, Guijarro G, Monereo S, Ikeda M, Toh N, Oe H, Tanabe Y, Watanabe N, Ito H, Ciampi Q, Cortigiani L, Pratali L, Rigo F, Villari B, Picano E, Sicari R, Yoon J, Sohn J, Kim Y, Chang H, Hong G, Kim T, Ha J, Choi B, Rim S, Choi E, Tibazarwa K, Sliwa K, Wonkam A, Mayosi B, Oryshchyn N, Ivaniv Y, Pavlyk S, Lourenco MR, Azevedo O, Moutinho J, Nogueira I, Fernandes M, Pereira V, Quelhas I, Lourenco A, Sunbul M, Tigen K, Karaahmet T, Dundar C, Ozben B, Guler A, Cincin A, Bulut M, Sari I, Basaran Y, Baydar O, Kadriye Kilickesmez K, Ugur Coskun U, Polat Canbolat P, Veysel Oktay V, Umit Yasar Sinan U, Okay Abaci O, Cuneyt Kocas C, Sinan Uner S, Serdar Kucukoglu S, Zaroui A, Mourali M, Ben Said R, Asmi M, Aloui H, Kaabachi N, Mechmeche R, Saberniak J, Hasselberg N, Borgquist R, Platonov P, Holst A, Edvardsen T, Haugaa K, Lourenco MR, Azevedo O, Nogueira I, Moutinho J, Fernandes M, Pereira V, Quelhas I, Lourenco A, Eran A, Yueksel D, Er F, Gassanov N, Rosenkranz S, Baldus S, Guedelhoefer H, Faust M, Caglayan E, Matveeva N, Nartsissova G, Chernjavskij A, Ippolito R, De Palma D, Muscariello R, Santoro C, Raia R, Schiano-Lomoriello V, Gargiulo F, Galderisi M, Lipari P, Bonapace S, Zenari L, Valbusa F, Rossi A, Lanzoni L, Canali G, Molon G, Campopiano E, Barbieri E, Ikonomidis I, Varoudi M, Papadavid E, Theodoropoulos K, Papadakis I, Pavlidis G, Triantafyllidi H, Anastasiou - Nana M, Rigopoulos D, Lekakis J, Sunbul M, Tigen K, Ozen G, Durmus E, Kivrak T, Cincin A, Ozben B, Atas H, Direskeneli H, Basaran Y, Stevanovic A, Dekleva M, Trajic S, Paunovic N, Simic A, Khan S, Mushemi-Blake S, Jouhra F, Dennes W, Monaghan M, Melikian N, Shah A, Maceira Gonzalez AM, Lopez-Lereu M, Monmeneu J, Igual B, Estornell J, Boraita A, Kosmala W, Rojek A, Bialy D, Mysiak A, Przewlocka-Kosmala M, Popescu I, Mancas S, Mornos C, Serbescu I, Ionescu G, Ionac A, Gaudron P, Niemann M, Herrmann S, Hu K, Liu D, Wojciech K, Frantz S, Bijnens B, Ertl G, Weidemann F, Maceira Gonzalez AM, Cosin-Sales J, Ruvira J, Diago J, Aguilar J, Igual B, Lopez-Lereu M, Monmeneu J, Estornell J, Cruz C, Pinho T, Madureira A, Lebreiro A, Dias C, Ramos I, Silva Cardoso J, Julia Maciel M, De Meester P, Van De Bruaene A, Herijgers P, Voigt JU, Budts W, Franzoso F, Voser E, Wohlmut C, Kellenberger C, Valsangiacomo Buechel E, Carrero C, Benger J, Parcerisa M, Falconi M, Oberti P, Granja M, Cagide A, Del Pasqua A, Secinaro A, Antonelli G, Iacomino M, Toscano A, Chinali M, Esposito C, Carotti A, Pongiglione G, Rinelli G, Youssef Moustafa A, Al Murayeh M, Al Masswary A, Al Sheikh K, Moselhy M, Dardir M, Deising J, Butz T, Suermeci G, Liebeton J, Wennemann R, Tzikas S, Van Bracht M, Prull M, Trappe HJ, Martin Hidalgo M, Delgado Ortega M, Ruiz Ortiz M, Mesa Rubio D, Carrasco Avalos F, Seoane Garcia T, Pan Alvarez-Ossorio M, Lopez Aguilera J, Puentes Chiachio M, Suarez De Lezo Cruz Conde J, Petrovic MT, Giga V, Stepanovic J, Tesic M, Jovanovic I, Djordjevic-Dikic A, Generati G, Pellegrino M, Bandera F, Donghi V, Alfonzetti E, Guazzi M, Piatkowski R, Kochanowski J, Scislo P, Opolski G, Zagatina A, Zhuravskaya N, Krylova L, Vareldzhyan Y, Tyurina T, Clitsenko O, Bombardini T, Gherardi S, Leone O, Picano E, Michelotto E, Ciccarone A, Tarantino N, Ostuni V, Rubino M, Genco W, Santoro G, Carretta D, Romito R, Colonna P, Cameli M, Lunghetti S, Lisi M, Curci V, Cameli P, Focardi M, Favilli R, Galderisi M, Mondillo S, Hoffmann R, Barletta G, Von Bardeleben S, Kasprzak J, Greis C, Vanoverschelde J, Becher H, Machida T, Izumo M, Suzuki K, Kaimijima R, Mizukoshi K, Manabe-Uematsu M, Takai M, Harada T, Akashi Y, Martin Garcia A, Arribas-Jimenez A, Cruz-Gonzalez I, Nieto F, Iscar A, Merchan S, Martin-Luengo C, Brecht A, Theres L, Spethmann S, Dreger H, Baumann G, Knebel F, Jasaityte R, Heyde B, Rademakers F, Claus P, D'hooge J, Lervik Nilsen LC, Lund J, Brekke B, Stoylen A, Giraldeau G, Duchateau N, Gabrielli L, Penela D, Evertz R, Mont L, Brugada J, Berruezo A, Bijnens B, Sitges M, Kordybach M, Kowalski M, Hoffman P, Pilichowska E, Zaborska B, Baran J, Kulakowski P, Budaj A, Wahi S, Vollbon W, Leano R, Thomas A, Bricknell K, Holland D, Napier S, Stanton T, Teferici D, Qirko S, Petrela E, Dibra A, Bajraktari G, Bara P, Sanchis Ruiz L, Gabrielli L, Andrea R, Falces C, Duchateau N, Perez-Villa F, Bijnens B, Sitges M, Sulemane S, Panoulas V, Bratsas A, Tam F, Nihoyannopoulos P, Abduch M, Alencar A, Coracin F, Barban A, Saboya R, Dulley F, Mathias W, Vieira M, Buccheri S, Mangiafico S, Arcidiacono A, Bottari V, Leggio S, Tamburino C, Monte IP, Cruz C, Lebreiro A, Pinho T, Dias C, Silva Cardoso J, Julia Maciel M, Spitzer E, Beitzke D, Kaneider A, Pavo N, Gottsauner-Wolf M, Wolf F, Loewe C, Mushtaq S, Andreini D, Pontone G, Bertella E, Conte E, Baggiano A, Annoni A, Cortinovis S, Fiorentini C, Pepi M, Gustafsson M, Alehagen U, Dahlstrom U, Johansson P, Faden G, Faggiano P, Albertini L, Reverberi C, Gaibazzi N, Taylor RJ, Moody W, Umar F, Edwards N, Townend J, Steeds R, Leyva F, Mihaila S, Muraru D, Piasentini E, Peluso D, Casablanca S, Naso P, Puma L, Iliceto S, Vinereanu D, Badano L, Ciciarello FL, Agati L, Cimino S, De Luca L, Petronilli V, Fedele F, Tsverava M. Poster Session Saturday 14 December - AM: 14/12/2013, 08:30-12:30 * Location: Poster area. Eur Heart J Cardiovasc Imaging 2013. [DOI: 10.1093/ehjci/jet207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Keller T, Ojeda F, Zeller T, Wild PS, Tzikas S, Sinning CR, Peetz D, Münzel T, Blankenberg S, Lackner KJ. Defining a reference population to determine the 99th percentile of a contemporary sensitive cardiac troponin I assay. Int J Cardiol 2013; 167:1423-9. [DOI: 10.1016/j.ijcard.2012.04.063] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2011] [Revised: 02/23/2012] [Accepted: 04/08/2012] [Indexed: 12/01/2022]
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