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Koutalas E, Kallergis E, Nedios S, Kochiadakis G, Kanoupakis E. P-wave duration as a marker of atrial remodeling in patients referred to ablation for atrial fibrillation: A new stratification tool emerging? Hellenic J Cardiol 2023; 73:53-60. [PMID: 36863411 DOI: 10.1016/j.hjc.2023.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Revised: 02/07/2023] [Accepted: 02/24/2023] [Indexed: 03/04/2023] Open
Abstract
Ablation of atrial fibrillation is one of the most widely applied invasive procedures in cardiovascular medicine, and populations with atrial fibrillation continuously rise. Recurrence rates are, however, consistently high, even in patients without severe comorbidities. Robust stratification algorithms to distinguish patients suitable for ablation are generally lacking. This is a fact caused by the inability to incorporate evidence of atrial remodeling and fibrosis, e.g., atrial remodeling, in the decision pathways. Cardiac magnetic resonance is a powerful tool in identifying fibrosis; however, it is costly and not routinely used. Electrocardiography has been generally underutilized in clinical practice during pre-ablative screening. One of the characteristics of the electrocardiogram that can give us valuable data depicting the existence and the extent of atrial remodeling and fibrosis is the duration of the P-wave. Currently, many studies support the implementation of P-wave duration in the routine practice of patient evaluation as a surrogate marker of existing atrial remodeling, that in turn predicts recurrence after ablation of atrial fibrillation. Further research is guaranteed to establish this electrocardiographic characteristic in our stratification quiver.
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Affiliation(s)
- Emmanuel Koutalas
- Department of Cardiology University Hospital of Heraklion, Crete, Greece.
| | | | - Sotirios Nedios
- Department of Arrhythmology, Leipzig Heart Center, Leipzig, Germany
| | - George Kochiadakis
- Department of Cardiology University Hospital of Heraklion, Crete, Greece
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Vassilikos VP, Giannopoulos G, Billis A, Efremidis M, Andrikopoulos G, Katsivas A, Kossyvakis C, Kallergis E, Letsas K, Kanoupakis E, Ioannidis P, Tzeis S, Deftereos S, Tsiachris D, Theodorakis G, Maounis T, Lysitsas D, Chatzinikolaou E, Fragakis N, Paraskevaidis S, Mezilis N, Kourouklis S, Pastromas S, Apostolopoulos T, Avramidis D, Chatzidou S, Papagiannis I, Kostopoulou A, Symeonidou E, Rassias I, Mantziari L, Leventopoulos G, Kourgiannidis G, Stavropoulos G, Katritsis D, Chiladakis I, Xydonas S, Ginos C, Kotsakis A, Baltogiannis G, Manolis AS, Sideris S, Gatzoulis K. Effect of the COVID-19 pandemic on cardiac electrophysiological ablation procedures in Greece - data from the Hellenic Society of Cardiology Ablation Registry. Hellenic J Cardiol 2022; 67:76-78. [PMID: 35811060 PMCID: PMC9263686 DOI: 10.1016/j.hjc.2022.07.002] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 07/03/2022] [Accepted: 07/03/2022] [Indexed: 11/04/2022] Open
Affiliation(s)
- Vassilios P Vassilikos
- Third Department of Cardiology, Hippokration General Hospital, Aristotle University of Thessaloniki, Thessaloniki
| | - Georgios Giannopoulos
- Third Department of Cardiology, Hippokration General Hospital, Aristotle University of Thessaloniki, Thessaloniki.
| | - Antonis Billis
- Lab of Medical Physics, Aristotle University of Thessaloniki, Thessaloniki
| | - Michalis Efremidis
- Onassis Cardiothoracic Center, Department of Electrophysiology and Pacing, Athens
| | | | | | | | - Eleftherios Kallergis
- Department of Cardiology, University Hospital of Heraklion, University of Crete, Heraklion
| | - Konstantinos Letsas
- Onassis Cardiothoracic Center, Department of Electrophysiology and Pacing, Athens
| | - Emmanouel Kanoupakis
- Department of Cardiology, University Hospital of Heraklion, University of Crete, Heraklion
| | | | | | - Spyridon Deftereos
- Second Department of Cardiology, Attikon University Hospital, National and Kapodistrian University of Athens, Athens
| | | | | | - Themistoklis Maounis
- Onassis Cardiothoracic Center, Department of Electrophysiology and Pacing, Athens
| | | | | | - Nikolaos Fragakis
- Third Department of Cardiology, Hippokration General Hospital, Aristotle University of Thessaloniki, Thessaloniki
| | - Stylianos Paraskevaidis
- First Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki
| | | | | | | | | | | | - Sophia Chatzidou
- Alexandra University Hospital, National and Kapodistrian University of Athens, Athens
| | | | - Anna Kostopoulou
- Onassis Cardiothoracic Center, Department of Electrophysiology and Pacing, Athens
| | - Eftychia Symeonidou
- Second Department of Cardiology, Attikon University Hospital, National and Kapodistrian University of Athens, Athens
| | | | | | | | | | - George Stavropoulos
- Second Department of Cardiology, Hippokration General Hospital, Aristotle University of Thessaloniki, Thessaloniki
| | | | - Ioannis Chiladakis
- Department of Cardiology, Rio University Hospital, University of Patras, Patras
| | | | | | | | - Giannis Baltogiannis
- Department of Cardiology, University Hospital of Ioannina, University of Ioannina, Ioannina
| | - Antonis S Manolis
- First Department of Cardiology, Hippokration University Hospital, National and Kapodistrian University of Athens, Athens
| | - Skevos Sideris
- First Department of Cardiology, Hippokration University Hospital, National and Kapodistrian University of Athens, Athens
| | - Konstantinos Gatzoulis
- First Department of Cardiology, Hippokration University Hospital, National and Kapodistrian University of Athens, Athens
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Bouloukaki I, Fanaridis M, Stathakis G, Ermidou C, Kallergis E, Moniaki V, Mauroudi E, Schiza SE. Characteristics of Patients with Obstructive Sleep Apnea at High Risk for Cardiovascular Disease. Medicina (Kaunas) 2021; 57:medicina57111265. [PMID: 34833483 PMCID: PMC8622270 DOI: 10.3390/medicina57111265] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 11/11/2021] [Accepted: 11/15/2021] [Indexed: 11/16/2022]
Abstract
Background and Objectives: To evaluate the influence of obstructive sleep apnea (OSA)-related symptoms on prevalent cardiovascular disease (CVD) in a large clinical population of patients. Materials and Methods: A total of 2127 patients (mean age 55 years, 24% women) underwent diagnostic polysomnography and were evaluated using the Epworth sleepiness scale (ESS), the Athens Insomnia Scale (AIS), and the Beck Depression Inventory (BDI). We investigated the predictive value of OSA-associated symptoms for prevalent cardiovascular disease, after adjustment for relevant confounding factors including age, obesity, and co-morbidities. Results: Patients with OSA and CVD were older and had a higher Body Mass Index (BMI); the percentage of obese patients was also higher (83% vs. 70%, p < 0001). They also had greater neck, waist, and hip circumferences and a higher waist-to-hip ratio. Excessive daytime sleepiness (ESS ≥ 10) [odds ratio (95% CI) 1.112 (0.708–1.748), p = 0.64], insomnia symptoms (AIS ≥ 6) [odds ratio (95% CI) 0.748 (0.473–1.184), p = 0.21], frequent awakenings [odds ratio (95% CI) 1.599 (1.019–2.508), p = 0.06], and nocturia [odds ratio (95% CI) 1.359 (0.919–2.009), p = 0.124] were not associated with CVD after adjustment for the previous confounders. On the other hand, depressive symptoms (BDI ≥ 10) independently predicted prevalent CVD [odds ratio (95% CI) 1.476 (1.154–1.887), p = 0.002]. Further analysis in subgroups stratified by age, BMI, and gender demonstrated that depressive symptoms predicted prevalent CVD but only in the subgroup of younger (age group < 60 years), obese (BMI group ≥ 30), and male (OR = 1.959, 95% CI = 1.209–3.175, p = 0.006) OSA patients. Conclusions: OSA patients with CVD were more likely to complain of less typical OSA symptoms and depressive symptoms compared to patients without CVD in this large clinical patient cohort, supportingthecomplexity and heterogeneityof OSA.
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Affiliation(s)
- Izolde Bouloukaki
- Sleep Disorders Center, Department of Respiratory Medicine, Medical School, University of Crete, 71110 Heraklion, Greece; (M.F.); (G.S.); (C.E.); (V.M.); (E.M.); (S.E.S.)
- Correspondence: ; Tel.: +30-2810394824
| | - Michail Fanaridis
- Sleep Disorders Center, Department of Respiratory Medicine, Medical School, University of Crete, 71110 Heraklion, Greece; (M.F.); (G.S.); (C.E.); (V.M.); (E.M.); (S.E.S.)
| | - Georgios Stathakis
- Sleep Disorders Center, Department of Respiratory Medicine, Medical School, University of Crete, 71110 Heraklion, Greece; (M.F.); (G.S.); (C.E.); (V.M.); (E.M.); (S.E.S.)
| | - Christina Ermidou
- Sleep Disorders Center, Department of Respiratory Medicine, Medical School, University of Crete, 71110 Heraklion, Greece; (M.F.); (G.S.); (C.E.); (V.M.); (E.M.); (S.E.S.)
| | - Eleftherios Kallergis
- Department of Cardiology, University Hospital of Heraklion, 71110 Heraklion, Greece;
| | - Violeta Moniaki
- Sleep Disorders Center, Department of Respiratory Medicine, Medical School, University of Crete, 71110 Heraklion, Greece; (M.F.); (G.S.); (C.E.); (V.M.); (E.M.); (S.E.S.)
| | - Eleni Mauroudi
- Sleep Disorders Center, Department of Respiratory Medicine, Medical School, University of Crete, 71110 Heraklion, Greece; (M.F.); (G.S.); (C.E.); (V.M.); (E.M.); (S.E.S.)
| | - Sophia E. Schiza
- Sleep Disorders Center, Department of Respiratory Medicine, Medical School, University of Crete, 71110 Heraklion, Greece; (M.F.); (G.S.); (C.E.); (V.M.); (E.M.); (S.E.S.)
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Marketou M, Kontaraki J, Patrianakos A, Kanoupakis E, Plevritaki A, Kallergis E, Mavrakis H, Koutalas E, Anastasiou I, Papadaki S, Kochiadakis G, Parthenakis F. Long term prognostic value of myocardin expression levels in non-ischemic dilated cardiomyopathy. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
We The mortality of patients with non-ischemic dilated cardiomyopathy (NIDCM) remains substantial. We evaluated gene expression levels of myocardin, an early cardiac gene, in the peripheral blood cells of NIDCM patients as a prognostic biomarker in their long-term outcome and mortality from congestive HF (CHF).
Methods
We retrospectively analyzed 101 consecutives optimally treated NIDCM patients of Cretan origin who were enrolled from the HF clinic of our hospital from November 2005 to December 2008. Our patient data were either taken from their medical files or recorded during visits to the HF unit or hospitalizations. Follow-up was carried out by telephone interview and by accessing information from general practitioners and cardiologists in private practice.
Results
The median follow up period was 8 years (mean follow-up 7±3.4 years). The overall mortality during follow-up was 61.4%, while mortality due to congestive heart failure (CHF) was 49.5%. Higher CHF and all-cause mortality were observed in patients with myocardin levels >14.26 (p<0.001 for both CHF and all-cause mortality). A multivariate Cox regression analysis showed that myocardin level of expression had independent significant prognostic value for the risk of death from CHF (HR: 14.5, 95% confidence interval (CI): 5.3–39). in those patients.
Conclusions
Peripheral blood cells gene expression of myocardin, an early myocardial marker, may serve as prognostic biomarkers of the long-term outcome of patients with NIDCM. Our findings open new prospects in the risk stratification of these patients.
Funding Acknowledgement
Type of funding sources: None. Figure 1
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Affiliation(s)
- M Marketou
- Heraklion University Hospital, Heraklion, Greece
| | - J Kontaraki
- Heraklion University Hospital, Heraklion, Greece
| | | | - E Kanoupakis
- Heraklion University Hospital, Heraklion, Greece
| | - A Plevritaki
- Heraklion University Hospital, Heraklion, Greece
| | - E Kallergis
- Heraklion University Hospital, Heraklion, Greece
| | - H Mavrakis
- Heraklion University Hospital, Heraklion, Greece
| | - E Koutalas
- Heraklion University Hospital, Heraklion, Greece
| | - I Anastasiou
- Heraklion University Hospital, Heraklion, Greece
| | - S Papadaki
- Heraklion University Hospital, Heraklion, Greece
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Tsigkas G, Apostolos A, Despotopoulos S, Vasilagkos G, Kallergis E, Leventopoulos G, Mplani V, Davlouros P. Heart failure and atrial fibrillation: new concepts in pathophysiology, management, and future directions. Heart Fail Rev 2021; 27:1201-1210. [PMID: 34218400 DOI: 10.1007/s10741-021-10133-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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] [Accepted: 06/22/2021] [Indexed: 12/11/2022]
Abstract
A bidirectional pathophysiological link connects heart failure and atrial fibrillation, creating a frequent and challenging comorbidity, which includes neurohormonal hyperactivation, fibrosis development, and electrophysiologic remodeling, while they share mutual risk factors. Management for these devastating comorbidities includes most of the established treatment measures for heart failure as well as rhythm or rate control and anticoagulation mostly for atrial fibrillation, which can be achieved with either pharmaceutical or non-pharmaceutical approaches. The current manuscript aims to review the existing literature regarding the underlying pathophysiology, to present the novel trends of treatment, and to predict the future perspective of these two linked diseases with the numerous unanswered questions.
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Affiliation(s)
- Grigorios Tsigkas
- Department of Cardiology, University Hospital of Patras, Patras, Greece.
| | | | | | | | | | | | - Virginia Mplani
- Department of Cardiology, University Hospital of Patras, Patras, Greece
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Papakonstantinou PE, Malliou A, Chlouverakis G, Kallergis E, Mavrakis H, Parthenakis F, Vardas PE, Simantirakis EN. Impact of Sustained Cardiac Tachyarrhythmias Recorded in Coronary Intensive Care Unit on Short- and Long-Term Mortality and Duration of Hospitalization. J Intensive Care Med 2020; 36:775-782. [PMID: 32274959 DOI: 10.1177/0885066620918790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Studies conducted in coronary intensive care units (CICUs) have demonstrated that tachyarrhythmias are associated with increased mortality after acute coronary syndromes (ACSs). However, the data for tachyarrhythmias occurred in CICUs due to a variety of cardiovascular disorders are limited. METHODS We conducted a single-center prospective observational study, which included consecutive CICU patients (January 1, 2014 to May 31, 2018). We recorded the ventricular arrhythmias (VAs), supraventricular tachycardias (SVTs), and days of CICU hospitalization. The patients were followed up for 6 months after CICU discharge. RESULTS A total of 943 patients (age: 66.37 ±15.4 years; 673 males [71.4%]) were included. Patients with tachyarrhythmias had higher in-CICU mortality (8.0% vs 4.1%, P = .029, odds ratio [OR]: 2.04, 95% confidence interval [CI]: 1.08-3.86) and higher 6-month all-cause mortality (12.8% vs 6.1%, P = .002, OR: 2.27, 95% CI: 1.35-3.83) than those who did not develop tachyarrhythmias. Ventricular arrhythmias was significantly associated with higher all-cause mortality than no tachyarrhythmia (15.4% vs 6.1%; P = .001) or SVTs (15.4% vs 7.0%; P = .001). The mean duration of hospitalization for the patients with tachyarrhythmias was 3.89 ± 4.90 days, while for the patients without was 2.79 ± 3.31 days (P < .001). Patients without ACS had higher short- and long-term mortality compared to patients with ACS (9.2% vs 2.9%, P < .001 and 12.9% vs 4.9%, P < .001). CONCLUSIONS Tachyarrhythmias were associated with prolonged CICU hospitalization, while non-ACS cardiovascular disorders and the occurrence of VAs were associated with increased short- and long-term mortality.
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Affiliation(s)
- Panteleimon E Papakonstantinou
- Department of Cardiology, University Hospital of Heraklion, School of Medicine, University of Crete, Heraklion, Crete, Greece
| | - Angelliki Malliou
- Department of Cardiology, University Hospital of Heraklion, School of Medicine, University of Crete, Heraklion, Crete, Greece
| | - Gregory Chlouverakis
- Biostatistics Lab, School of Medicine, 37777University of Crete, Heraklion, Crete, Greece
| | - Eleftherios Kallergis
- Department of Cardiology, University Hospital of Heraklion, School of Medicine, University of Crete, Heraklion, Crete, Greece
| | - Hercules Mavrakis
- Department of Cardiology, University Hospital of Heraklion, School of Medicine, University of Crete, Heraklion, Crete, Greece
| | - Frangiskos Parthenakis
- Department of Cardiology, University Hospital of Heraklion, School of Medicine, University of Crete, Heraklion, Crete, Greece
| | - Panos E Vardas
- Department of Cardiology, University Hospital of Heraklion, School of Medicine, University of Crete, Heraklion, Crete, Greece
| | - Emmanuel N Simantirakis
- Department of Cardiology, University Hospital of Heraklion, School of Medicine, University of Crete, Heraklion, Crete, Greece
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Marketou M, Kochiadakis G, Kontaraki J, Zacharis E, Kanoupakis E, Kallergis E, Mavrakis H, Lempidakis D, Fragiadakis K, Katsouli E, Vardas P, Parthenakis F. P5597Increased adipose tissue microRNA-133a gene expression in patients with coronary artery disease: the effect of body mass index. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p5597] [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)
- M Marketou
- Heraklion University Hospital, Heraklion, Greece
| | | | - J Kontaraki
- Heraklion University Hospital, Heraklion, Greece
| | - E Zacharis
- Heraklion University Hospital, Heraklion, Greece
| | - E Kanoupakis
- Heraklion University Hospital, Heraklion, Greece
| | - E Kallergis
- Heraklion University Hospital, Heraklion, Greece
| | - H Mavrakis
- Heraklion University Hospital, Heraklion, Greece
| | - D Lempidakis
- Heraklion University Hospital, Heraklion, Greece
| | | | - E Katsouli
- Heraklion University Hospital, Heraklion, Greece
| | - P Vardas
- Heraklion University Hospital, Heraklion, Greece
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Brieudes V, Kallergis E, Papada E, Gioxari A, Kaliora A, Mitakou S, Skaltsounis L, Halabalaki M. Bioavailability study and impact of Chios mastic supplementation on oxidative stress in healthy humans. Am J Transl Res 2017. [DOI: 10.1055/s-0037-1608487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- V Brieudes
- Divisionof Pharmacognosy and Natural Products Chemistry, Department of Pharmacy, National and Kapodistrian University of Athens, Athens, Greece
| | - E Kallergis
- Divisionof Pharmacognosy and Natural Products Chemistry, Department of Pharmacy, National and Kapodistrian University of Athens, Athens, Greece
| | - E Papada
- Laboratory of Food Chemistry-Biochemistry, School of Health Science and Education, Department of Dietetics and Nutritional Science, Athens, Greece
| | - A Gioxari
- Laboratory of Food Chemistry-Biochemistry, School of Health Science and Education, Department of Dietetics and Nutritional Science, Athens, Greece
| | - A Kaliora
- Laboratory of Food Chemistry-Biochemistry, School of Health Science and Education, Department of Dietetics and Nutritional Science, Athens, Greece
| | - S Mitakou
- Divisionof Pharmacognosy and Natural Products Chemistry, Department of Pharmacy, National and Kapodistrian University of Athens, Athens, Greece
| | - L Skaltsounis
- Divisionof Pharmacognosy and Natural Products Chemistry, Department of Pharmacy, National and Kapodistrian University of Athens, Athens, Greece
| | - M Halabalaki
- Divisionof Pharmacognosy and Natural Products Chemistry, Department of Pharmacy, National and Kapodistrian University of Athens, Athens, Greece
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9
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Kanoupakis E, Fanourgiakis J, Mavrakis H, Kallergis E, Petousis S, Vernardos M, Chlouverakis G, Vardas P. Long Term Follow up of Primary and Secondary Prevention Implantable Cardioverter Defibrillator Patients: "Real-World" Data from the Island of Crete. Value Health 2014; 17:A757. [PMID: 27202762 DOI: 10.1016/j.jval.2014.08.238] [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] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
| | | | | | | | | | | | | | - P Vardas
- University Hospital, Heraklion, Greece
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Maragkoudakis S, Patrianakos A, Kallergis E, Parthenakis F, Vardas P. Echocardiographic demonstration of coronary artery to left ventricle fistulas: case report and review of the literature. Hellenic J Cardiol 2014; 55:171-173. [PMID: 24681797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
Abstract
We describe the case of a 45-year-old female patient with coronary fistulas arising from both the left and right coronary artery system and emptying in the left ventricle. Only sporadically do coronary artery fistulas drain into the left ventricle. In our patient, the most likely explanation of the fistulous communications was a congenital cause. We review the literature on coronary cameral fistulas and discuss the etiology of the diagnostic findings. Small coronary artery fistulas are generally well-tolerated and should impose no significant restriction on daily routine and activities. Nevertheless, small fistulas may under certain conditions produce a "steal" phenomenon and shunt blood flow away from the myocardial capillary network, causing ischemia.
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11
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Mermigkis C, Bouloukaki I, Mermigkis D, Kallergis E, Mavroudi E, Varouchakis G, Tzortzaki E, Siafakas N, Schiza SE. CRP evolution pattern in CPAP-treated obstructive sleep apnea patients. Does gender play a role? Sleep Breath 2011; 16:813-9. [PMID: 21881894 DOI: 10.1007/s11325-011-0580-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2011] [Revised: 07/25/2011] [Accepted: 08/19/2011] [Indexed: 02/08/2023]
Abstract
BACKGROUND-AIM C-reactive protein (CRP) is directly implicated in atherogenesis and associated cardiovascular morbidity in patients with obstructive sleep apnea (OSA). Effective continuous positive airway pressure (CPAP) treatment has been shown to gradually decrease CRP levels and thus consequently improve disease-related cardiovascular morbidity. However, the influence of gender on the CRP evolution pattern has never been assessed before. The aim of our study was to investigate possible gender differences in CRP evolution in OSA patients 3 and 6 months after the start of effective CPAP treatment. METHODS The study population consisted of 436 patients (252 males/184 females) with newly diagnosed moderate to severe OSA and good CPAP compliance assessed by a thorough follow up. High-sensitivity C-reactive protein (hs-CRP) was assessed before CPAP initiation and at the third and sixth month of the follow-up period. RESULTS C-reactive protein values showed a statistically significant decrease at the third and sixth month of CPAP therapy [initial values 0.79 ± 0.65 mg/dL versus 0.70 ± 0.52 mg/dL (p < 0.05) after 3 months and 0.30 ± 0.33 mg/dL (p < 0.001) after 6 months of CPAP therapy]. When patients were divided into males and females, the above evolution pattern was changed. At the third month time point, the CRP values showed a statistically significant decrease only in males (from 0.74 ± 0.53 mg/dL to 0.61 ± 0.5 mg/dL, p < 0.01) while females showed only minimal and insignificant changes (from 0.87 ± 0.79 mg/dL to 0.83 ± 0.51 mg/dL, p > 0.05). After 6 months' treatment, CRP decreased significantly in both genders (males from 0.74 ± 0.53 mg/dL to 0.28 ± 0.32 mg/dL, p < 0.001 and females from 0.87 ± 0.79 mg/dL to 0.34 ± 0.36 mg/dL, p < 0.001). CONCLUSION Our results suggest a delay in the normalization of CRP levels in females despite effective CPAP treatment. A time period of at least 6 months appeared to be required in women in order to reduce CRP levels and consequent cardiovascular risk. In contrast, CPAP's protective role in males is achieved at an earlier time point. Gender-related hormonal and genetic factors may influence the above CRP evolution pattern.
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Affiliation(s)
- Charalampos Mermigkis
- Sleep Disorders Center, Pulmonary Department, 401 General Army Hospital, Athens, Greece.
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Andersson T, Magnusson A, Bryngelsson IL, Frobert O, Henriksson KM, Edvardsson N, Poci D, Polovina M, Potpara T, Licina M, Mujovic N, Kocijancic A, Simic D, Ostojic MC, Providencia RA, Botelho A, Trigo J, Nascimento J, Quintal N, Mota P, Leitao-Marques AM, Bosch RF, Kirch W, Rosin L, Willich SN, Pittrow D, Bonnemeier H, Valenza MC, Martin L, Munoz Casaubon T, Valenza G, Botella M, Serrano M, Valenza B, Cabrera I, Anderson K, Benzaquen BS, Koziolova N, Nikonova J, Shilova Y, Scherr D, Narayan S, Wright M, Krummen D, Jadidi A, Jais P, Haissaguerre M, Hocini M, Hunter R, Liu Y, Lu Y, Wang W, Schilling RJ, Bernstein S, Wong B, Rooke R, Vasquez C, Shah R, Rosenberg S, Chinitz L, Morley G, Bashir Choudhary M, Holmqvist F, Carlson J, Nilsson HJ, Platonov PG, Jadidi AS, Cochet H, Miyazaki S, Shah AJ, Scherr D, Marrouche N, Haissaguerre M, Jais P, Calvo N, Nadal M, Andreu D, Tamborero D, Diaz FE, Berruezo A, Brugada J, Mont L, Fichtner S, Hessling G, Estner HL, Jilek C, Reents T, Ammar S, Wu J, 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Ziglio F, Kacet S, Mohamed Fereig Hamed H, Hamdy AMAL, Abd El Aziz AHMED, Nabih MRVAT, Hamdy REHAB, Yaminisaharif A, Davoudi GH, Kasemisaeid A, Sadeghian S, Vasheghani Farahani A, Yazdanifard P, Shafiee A, Alonso C, Grimard C, Jauvert G, Lazarus A, Fernandez-Armenta J, Berruezo A, Mont LL, Sitges M, Andreu D, Ortiz-Perez J, Caralt T, Brugada J, Escudero J, Perez F, Griffith KM, Ferreyra R, Urena P, Demas M, Muratore C, Mazzetti H, Guardado J, Sanfins V, Fernandes M, Pereira VH, Canario-Almeida F, Ferreira F, Rodrigues B, Almeida J, Sokal A, Jedrzejczyk E, Lenarczyk R, Pluta S, Kowalski O, Pruszkowska P, Swiatkowski A, Kalarus Z, Heinke M, Ismer B, Kuehnert H, Heinke T, Surber R, Osypka N, Prochnau D, Figulla HR, Iacopino S, Landolina M, Proclemer A, Padeletti L, Calvi V, Pierantozzi A, Di Stefano P, Boriani G, Bauer A, Bode F, Le Gal F, Deharo JC, Delay M, Nitzsche R, Clementy J, Kawamura M, Munetsugu Y, Tanno K, Kobayashi Y, Cannom D, Hosoda J, Ishikawa T, Andoh K, Nobuyoshi M, Fujii S, Shizuta S, Kimura T, Isshiki T, Castel MA, Tolosana JM, Perez-Villa F, Mont L, Sitges M, Vidal B, Brugada J, Pluta S, Lenarczyk R, Kowalski O, Pruszkowska-Skrzep P, Sokal A, Szulik M, Kukulski T, Kalarus Z, Gianfranchi L, Bettiol K, Pacchioni F, Alboni P, Abu Sham'a R, Buber J, Nof E, Kuperstein R, Feinberg M, Luria D, Eldar M, Glikson M, Parks K, Stone JR, Singh JP, Hatzinikolaou-Kotsakou E, Kotsakou M, Beleveslis TH, Moschos G, Reppas E, Latsios P, Tsakiridis K, Kazemisaeid A, Davoodi G, Yamini Sharif A, Sadeghian S, Sheikhvatan M, Toniolo M, Zanotto G, Rossi A, Tomasi L, Vassanelli C, Versteeg H, Van Den Broek KC, Theuns DAMJ, Mommersteeg PMC, Alings M, Van Der Voort PH, Jordaens L, Pedersen SS, Vergara G, Blauer J, Ranjan R, Vijayakumar S, Kholmovski E, Volland N, Macleod R, Marrouche N, Aguinaga Arrascue LE, Bravo A, Garcia Freire P, Gallardo P, Hasbani E, Dantur J, Quintana R, Adragao PP, Cavaco D, Parreira L, Reis Santos K, Carmo P, Miranda R, Marcelino S, Cabrita D, Sommer P, Gaspar T, Rolf S, Arya A, Piorkowski C, Hindricks G, Valles Gras E, Bazan V, Portillo L, Suarez F, Bruguera J, Marti J, Huo Y, Arya A, Richter S, Schoenbauer R, Sommer P, Hindricks G, Piorkowski C, Rivas N, Casaldaliga J, Roca I, Dos L, Perez-Rodon J, Pijuan A, Garcia-Dorado D, Moya A, Carter HB, Garg A, Hegrenes J, Sih HJ, Teplitsky LR, Kuroki K, Tada H, Seo Y, Ishizu T, Igawa M, Sekiguchi Y, Kuga K, Aonuma K, Rodriguez A C, Mejias J, Hidalgo P, Hidalgo L JA, Orczykowski M, Derejko P, Walczak F, Szufladowicz E, Urbanek P, Bodalski R, Bieganowska K, Szumowski L, Peichl P, Wichterle D, Cihak R, Skalsky I, Kautzner J, Kubus P, Vit P, Zaoral L, Peichl P, Gebauer RA, Fiala M, Janousek J, Hiroshima K, Goya M, Ohe M, Hayashi K, Makihara Y, Nagashima M, An Y, Nobuyoshi M, Schloesser M, Lawrenz T, Meyer Zu Vilsendorf D, Strunk-Mueller C, Stellbrink C, Papagiannis J, Avramidis D, Kokkinakis C, Kirvassilis G, Eidelman G, Arenal A, Datino T, Atienza F, Gonzalez Torrecilla E, Miracle A, Hernandez J, Fernandez Aviles F, Ene E, Caldararu C, Iorgulescu C, Dorobantu M, Vatasescu RG, Insulander P, Bastani H, Braunschweig F, Drca N, Kenneback G, Schwieler J, Tapanainen J, Jensen-Urstad M, Andrea B, Andrea EMA, Maciel WM, Siqueira LS, Cosenza RC, Mittidieri FM, Farah SF, Atie JA, Kanoupakis E, Kallergis E, Mavrakis H, Goudis C, Saloustros I, Malliaraki N, Chlouverakis G, Vardas P, Bonnes JL, Jaspers Focks J, Westra SW, Brouwer MA, Smeets JLRM, Inama G, Pedrinazzi C, Landolina M, Oliva F, Senni M, Proclemer A, Zoni Berisso M, Mostov S, Haim M, Nevzorov R, Hasadi D, Starsberg B, Porter A, Kuschyk J, Schoene A, Streitner F, Veltmann CG, Schimpf R, Borggrefe M, Luesebrink U, Gardiwal A, Oswald H, Koenig T, Duncker D, Klein G, Bastiaenen R, Batchvarov V, Atty O, Cheng JH, Behr ER, Gallagher MM, Starrenburg AH, Kraaier K, Pedersen SS, Scholten MF, Van Der Palen J, Adhya S, Smith LA, Zhao T, Bannister C, Kamdar RH, Martinelli M, Siqueira S, Greco R, Nishioka SAD, Pedrosa AAA, Alkmim-Teixeira R, Peixoto GL, Costa R, Pedersen SS, Versteeg H, Nielsen JC, Mortensen PT, Johansen JB, Kwasniewski W, Filipecki A, Urbanczyk-Swic D, Orszulak W, Trusz - Gluza M, Jimenez-Candil J, Hernandez J, Morinigo J, Ledesma C, Martin-Luengo C, Vogtmann T, Gomer M, Stiller S, Kuehlkamp V, Zach G, Loescher S, Kespohl S, Baumann G, Snell JD, Korsun N, Rooke R, Snell JR, Morley B, Bharmi R, Nabutovsky Y, Mollerus M, Naslund L, Meyer A, Lipinski M, Libey B, Dornfeld K, Jimenez-Candil J, Hernandez J, Martin A, Gallego M, Morinigo J, Ledesma C, Martin-Luengo C, De Bie MK, Van Rees JB, Borleffs CJ, Thijssen J, Jukema JW, Schalij MJ, Van Erven L, Van Der Velde ET, Witteman TA, Foeken H, Van Erven L, Schalij MJ, Szili-Torok T, Akca F, Caliskan K, Ten Cate F, Jordaens L, Michels M, Cozma DC, Petrescu L, Mornos C, Dragulescu SI, Groeneweg JA, Velthuis BK, Cox MGPJ, Loh P, Dooijes D, Cramer MJ, De Bakker JMT, Hauer RNW, Park SD, Shin SH, Woo SI, Kwan J, Park KS, Kim DH, Kwan J, Iorio A, Vitali Serdoz L, Brun F, Daleffe E, Zecchin M, Dal Ferro M, Santangelo S, Sinagra GF, Ouali S, Hammemi R, Hammas S, Kacem S, Gribaa R, Neffeti E, Remedi F, Boughzela E, Korantzopoulos P, Letsas K, Christogiannis Z, Kalantzi K, Ntorkos A, Goudevenos J, Foley PWX, Yung L, Barnes E, Munetsugu Y, Tanno K, Kikuchi M, Ito H, Miyoshi F, Kawamura M, Kobayashi Y, Pecini R, Marott JM, Jensen GB, Theilade J, Mine T, Kodani T, Masuyama T, Mozos IM, Serban C, Costea C, Susan L, Barthel P, Mueller A, Malik M, Schmidt G, Schmidt G, Barthel P, Mueller A, Malik M, Karakurt O, Kilic H, Munevver Sari DR, Mroczek-Czernecka D, Pietrucha AZ, Borowiec A, Wnuk M, Bzukala I, Kruszelnicka O, Konduracka E, Nessler J, Kikuchi Y, Meireles A, Gomes C, Anjo D, Roque C, Pinheiro Vieira A, Lagarto V, Hipolito Reis A, Torres S, Nof E, Miller L, Kuperstein R, Eldar M, Glikson M, Luria D, Vedrenne G, Bruguiere E, Redheuil A. Poster Session 2. Europace 2011. [DOI: 10.1093/europace/eur222] [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: 11/15/2022] Open
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Deshmukh A, Sharma SS, Gobal FG, Singla SS, Hebbar PH, Paydak HP, Igarashi M, Tada H, Sekiguchi Y, Yamasaki H, Kuroki K, Machino T, Yoshida K, Aonuma K, Shavadia J, Otieno H, Yonga G, Jinah A, Qvist JF, Soerensen PH, Dixen U, Ramirez-Marrero MA, Perez-Villardon B, Gaitan-Roman D, Jimenez-Navarro M, Delgado-Prieto JL, De Teresa-Galvan E, De Mora-Martin M, Deshmukh A, Hebbar PB, Wei WX, Gobal FG, Singla SS, Sharma SS, Paydak HP, Bardari S, Zecchin M, Salame' R, Vitali Serdoz L, Di Lenarda A, Guerrini N, Barbati G, Sinagra G, Hanazawa K, Kaitani K, Nakagawa Y, Lenaerts I, Driesen R, Hermida N, Heidbuchel H, Janssens S, Balligand JL, Sipido KR, Willems R, Sehra R, Krummen D, Briggs C, Narayan S, Tanaka Y, Hirao K, Nakamura T, Inaba O, Yagishita A, Higuchi K, Hachiya H, Isobe M, Kallergis E, Kanoupakis EM, Mavrakis HE, Goudis CA, Maliaraki NE, Vardas PE, Sehra R, Krummen D, Briggs C, Narayan S, Kiuchi K, Piorkowski C, Kircher S, Gaspar T, Watanabe N, Bollmann A, Hindricks G, Wauters K, Grosse A, Raffa S, Brunelli M, Geller JC, Maggioni AP, Gonzini L, Gussoni G, Vescovo G, Gulizia M, Pirelli S, Mathieu G, Di Pasquale G, Zecchin M, Bardari S, Vitali Serdoz L, Salame R, Buja G, Rovai N, Gargaro A, Sperzel J, Knops RE, Meine M, Speca G, Santini L, Haarbo J, Dubin K, Di Lenarda A, Carlson M, Garcia Quintana A, Mendoza-Lemes H, Garcia Perez L, Led Ramos S, Caballero Dorta E, Matinez De Espronceda M, Piro Mastracchio V, Serrano Arriezu L, Sciarra L, Barbati G, Marziali M, Marras E, Rebecchi M, Allocca G, Lioy E, Delise P, Calo' L, Santobuono VE, Iacoviello M, Nacci F, Magnani S, Luzzi G, Puzzovivo A, Memeo M, Quadrini F, Favale S, Trucco ME, Arce M, Palazzolo J, Uribe W, Baranchuk A, Sinagra G, Femenia F, Maggi R, Furukawa T, Croci F, Solano A, Brignole M, Lebreiro A, Sousa A, Correia AS, Lourenco P, Sakamoto T, Oliveira S, Paiva M, Freitas J, Maciel MJ, Linker N, Rieger G, Garutti C, Edvardsson N, Salguero Bodes R, De Riva Silva M, Kumagai K, Fontenla Cerezuela A, Lopez Gil M, Mejia Martinez E, Jurado Roman A, Garcia Alvarez S, Arribas Ynsaurriaga F, Petix NR, Del Rosso A, Guarnaccia V, Zipoli A, Fuke E, Rabajoli F, Foglia Manzillo G, Tolardo C, Checchinato C, Chiaravallotti S, Santarone M, Spinnler MT, Podoleanu C, Maggi R, Brignole M, Nishiuchi S, Frigy A, Dobreanu D, Ginghina C, Carasca E, Hayashi T, Miki Y, Naito S, Oshima S, Hof IE, Vonken E, Velthuis BK, Meine M, Hauer RNW, Loh KP, Na JO, Choi CU, Kim EJ, Rha SW, Park CG, Seo HS, Oh DJ, Lim HE, Igarashi M, Tada H, Sekiguchi Y, Yamasaki H, Kuroki K, Machino T, Yoshida K, Aonuma K, Wichterle D, Bulkova V, Fiala M, Chovancik J, Simek J, Peichl P, Cihak R, Kautzner J, Glick A, Viskin S, Belhassen B, Navarrete A, Conte F, Ishti A, Sai D, Moran M, Chitovova Z, Ahmed H, Mares K, Skoda J, Sediva L, Petru J, Reddy VY, Neuzil P, Schmidt M, Dorwarth U, Leber A, Wankerl M, Krieg J, Straube F, Reif S, Hoffmann E, Mikhaylov E, Tikhonenko V, Lebedev D, Lim HE, Shin SY, Yong HS, Choi CU, Choi JI, Kim SH, Kim EJ, Na JO, Matsuo S, Yamane T, Hioki M, Ito K, Narui R, Date T, Sugimoto K, Yoshimura M, Rolf S, Piorkowski C, Gaspar T, Sommer P, Hindricks G, Batalov R, Popov S, Antonchenko I, Suslova T, Fichtner S, Czudnochowsky U, Estner HL, Ammar S, Reents T, Jilek C, Hessling G, Deisenhofer I, Pokushalov E, Romanov A, Corbucci G, Artemenko S, Losik D, Shabanov V, Turov A, Elesin D, Mikhaylov E, Abramov M, Lebedev D, Piorkowski C, Sanders P, Jais P, Roberts-Thomson K, Hindricks G, Fukumoto K, Takatsuki S, Kimura T, Nishiyama N, Aizawa Y, Sato T, Miyoshi S, Fukuda K, Roux Y, Tenkorang J, Carroz P, Schlaepfer J, Pascale P, Forclaz A, Fromer M, Pruvot E, Fiala M, Wichterle D, Bulkova V, Sknouril L, Nevralova R, Chovancik J, Dorda M, Januska J, Brunelli M, Grosse A, Santi R, Wauters K, Geller C, Kumagai K, Nakamura K, Hayashi T, Kasseno K, Naito S, Sakamoto T, Oshima S, Taniguchi K, Wutzler A, Rolf S, Huemer M, Parwani A, Boldt LH, Blaschke D, Dietz R, Haverkamp W, Coutu B, Malanuk R, Ait Said M, 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Sakaguchi T, Itoh H, Horie M, Shimizu W, Miyazaki A, Sakaguchi H, Yamamoto T, Igarashi T, Negishi J, Toyota N, Ohuchi H, Yamada O, Arsenos P, Gatzoulis K, Manis G, Dilaveris P, Gialernios T, Papavasileiou M, Asimakopoulos S, Stefanadis C, Cabrera Bueno F, Molina Mora MJ, Alzueta Rodriguez J, Barrera Cordero A, De Teresa Galvan E, Revishvili AS, Dzhordzhikiya T, Sopov O, Simonyan G, Lyadzhina O, Fetisova E, Kalinin V, Balt JC, Steggerda RC, Boersma LVA, Wijffels MCEF, Wever EFD, Ten Berg JM, Ricci RP, Morichelli L, D'onofrio A, Zanotto G, Vaccari D, Calo' L. Poster Session 1. Europace 2011. [DOI: 10.1093/europace/eur220] [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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Schiza SE, Mermigkis C, Panagiotis P, Bouloukaki I, Kallergis E, Tzanakis N, Tzortzaki E, Vlachaki E, Siafakas NM. C-reactive protein evolution in obstructive sleep apnoea patients under CPAP therapy. Eur J Clin Invest 2010; 40:968-75. [PMID: 20629709 DOI: 10.1111/j.1365-2362.2010.02348.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [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: 01/15/2023]
Abstract
BACKGROUND C-reactive protein (CRP) is recognized as a potential factor implicated in atherogenesis and associated cardiovascular morbidity. The aim of our study was to assess the CRP evolution during 1-year follow-up period in obstructive sleep apnoea (OSA) patients under CPAP treatment. METHODS Five hundred and twenty-eight patients with newly diagnosed moderate to severe OSA were included. CRP was assessed before CPAP initiation and at the 3rd, 6th and 12th month of the follow-up period. Patients were divided into good and poor CPAP compliance groups. RESULTS A significant reduction in CRP levels was observed after CPAP therapy (0·74±0·62mgdL(-1) vs. 0·31±0·29mgdL(-1) , P<0·001) in the whole patient group. The evolution of CRP values showed a gradual decrease at 3months with a steep decline at 6months, reaching a plateau after this time point. When the patients were divided into those with good and poor compliance with CPAP therapy, the above CRP evolution pattern was observed only in the former group. CONCLUSION Good CPAP compliance results in a significant CRP reduction. To achieve the best positive impact on cardiovascular morbidity and mortality, a time period of at least 6months of CPAP use is required.
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Affiliation(s)
- Sophia E Schiza
- Sleep Disorders Unit, Department of Thoracic Medicine, Medical School, University of Crete, Heraklion, Voutes, Greece.
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