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1. Clinical characteristics and management of patients with diabetes mellitus and stable coronary artery disease in daily clinical practice. The SCAD–DM Registry

Author

Maria E. Marketou, Charalambos Vlachopoulos, George Hahalis, Kristalenia Kafkala, Nikolaos Kouvelas, Ioannis Mantas, Antonios Sideris, Evaggelos Pisimisis, Emmanouel P. Vardas, Stylianos Tzeis, Panos E. Vardas, Vassiliki Dimitroula, Christos Hatjielefteriou, Nikolaos Kampouridis, Georgios Karakostas, Athanasios Karanasios, Stylianos Lambropoulos, Fotios Papalisandrou, Emmanouil Scoubourdis, Nikolaos Smirnioudis, Eleftherios Adamopoulos, Georgios Aggelopoulos, Charalampos Albanis, Alexandros Amaslidis, Maria Andreopoulou, Ilias Antoniou, Ilias Apostolou, Georgios Afaras, Vasileios Arfaras, Konstantinos Aronis, Georgios Askar, Christos Athanasiou, Sokratis Avlonitis Antonios Beroukas, Emmanouil Chorozopoulos, Nikolaos Chrysomallis, Konstantinos Davos, Eftichia Demerouti, Vasileios Dimopoulos, Nikolaos Dimoulis, Vasileios Drakoulidis, Kiriaki Faka, Dimitrios Fotiadis, Alexandros Galapis, Antonios Giakoumis, Ioannis Goupios, Christos Harbas, Vasileios Hatjiioakeimidis, Georgios Hondrokoukis, Panagiotis Kalaras, Marina Kanakaraki, Konstantinos Kapetanios, Vasileios Karasavvidis, Theodoros Karonis, Andreas Karydakis, Christos Katsaris, Christos Katsikas, Konstantinos Katsas, Sokratis Kazantzidis, Nikolaos Kipouridis, Eirini Kokani, Georgios Kolios, Ilias Konstantinidis, Themistoklis Konstantinou, Marios Konstantinou, Georgios Kontopoulos, Georgios Kontoroupis, Georgios Koroniotis, Apostolos Kotidis, Chrysanthi Koukosi, Mihail Kouremetis, Christos Kouris, Georgios Kouskos, Konstantinos Koutras, Georgios Koutsibanis, Harikleia Krontira, Konstantinos Lalenis, Christos Liatas, Leonidas Lillis, Grigorios Limperatos, Emmanouil Liodakis, Stavros Liropoulos, Ioannis Livaditis, Dimitrios Logothetis, Maria Lolaka, Georgios Loukidelis, Georgios Mablekos, Antonios Manousakis, Nikolaos Marinakis, Dimitrios Markou, Virginia Markou, Anestis Matziridis, Panagiotis Mavraganis, Vasileios Mavridis, Ioannis Mavrodimitrakis, Georgios Migias, Dimitrios Mitropoulos, Christos Mitroulas, Savvas Nikiforos, Vasileios Nikolaidis, Christos Nikopoulos, Nikoloaos Oikonomidis, Konstantinos Panagiotopoulos, Georgios Panagoulias, Anna Panou, Ioannis Pantelakis, Achilleas Papadopoulos, Apostolos Papadopoulos, Georgios Papaioannou, Andreas Papamichail, Soultana Papanastasiou, Panagiotis Papas, Eleftherios Papavasileiou, Vasileios Papavasileiou, Athanasios Patialiakas, Alexandros Patsilinakos, Georgios Pechlivanidis, Spiridon Petrogiannis, Nikolaos Pontikakis, Charalampos Parissis, Fotios Patsourakos, Evangelos Pisimisis, Andreas Pittaras, Sotirios Plastiras, Athanasios Platis, Panagiotis Poulikarakos, Markos Prionidis, Paraskevi Psarogianni, Emmanouil Psathakis, Dimitrios Psirropoulos, Maria Riga, Ali Risgits, Evangelos Rosmarakis, Maria Samartzi, Isidoros Sarris, Konstantinos Sassalos, Dimitrios Savvalas, Georgios Siliogas, David Simeonidis, Loukas Sinos, Andreas Skanavis, Achilleas Skordas, Vassiliki Sklirou, Iason Skotiniotis, Anastasios Spanos, Dimitrios Sratech, Christos Stathopoulos, Rafail Stavropoulos, Christos Stavrotheodoros, Emmanouil Stefanakis, Konstantinos Stefanis, Christos Stefopoulos, Dimitrios Stergiou, Konstantinos Svolis, Konstantinos Toulis, Kallinikos Tsakonas, Nikolaos Tsamis, Eleni Tzamtzi-Mastaka, Georgios Tzeltzes, Ioannis Tsiantis, Theodora Tsiotika, Vasileios Vachliotis, Ioannis Vakalis, Konstantinos Vardakis, Alexandros Vassilopoulos, Georgia Vlahou, Vasileios Vogas, Evropia Voukelatou, Nikiforos Vrettos, Dionisios Xenos, Konstantinos Zagoridis, Tsilla Zafiriou, Christos Zafiris, Maria Zaharia, Fanourios Zampetakis, and Vasileios Zouganelis

Subjects
diabetes mellitus, coronary artery disease, angina, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract

Background: Patients with diabetes mellitus (DM) and coronary artery disease (CAD) represent a high-risk population, where comorbidities are common and the progression of coronary heart disease is relatively rapid and extensive. The present survey, conducted nationwide in a Eurozone country, Greece, with a properly organized national health system, aimed to record specific data from a significant number of patients with diabetes and documented stable CAD (SCAD). Methods and results: We conducted our survey across the country, in private and public primary, secondary, and tertiary care centers. A total of 1900 patients aged 71 ± 10 years old who suffered from both DM and chronic coronary syndromes were registered. Of the patients registered, 574 (30.24%) were women. It was found that 506 (26.6%) of the 1900 surveyed patients showed typical angina symptoms, while another 560 (29.5%) patients had developed angina-equivalent symptoms according to their history. Additionally, 324 (17%) patients had atypical symptoms that could not easily be attributed to existing CAD and the remaining 510 (26.8%) of the 1900 patients did not exhibit any angina symptoms during their daily activities. Functional testing for myocardial ischemia was not performed in 833 patients (43.8%). Myocardial scintigraphy was the most commonly used noninvasive technique (644 patients, 34%), while 492 patients (25.9%) had an exercise test and 159 (8.4%) underwent stress echocardiography. Conclusion: Real-world data in this specific high-risk population of diabetic patients with SCAD offer the opportunity to identify and improve diagnostic and therapeutic practice in the healthcare system of a European Union country.

Published
2021
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2. Arrhythmic risk stratification in nonischemic dilated cardiomyopathy: The ReCONSIDER study design – A two-step, multifactorial, electrophysiology-inclusive approach

Author

Konstantinos A. Gatzoulis, Polychronis Dilaveris, Petros Arsenos, Dimitrios Tsiachris, Christos-Konstantinos Antoniou, Skevos Sideris, Theofilos Kolettis, Emmanuel Kanoupakis, Antonios Sideris, Panagiota Flevari, Vassilios Vassilikos, Konstantinos Kappos, Themistoklis Maounis, Apostolos Katsivas, Athanasios Kotsakis, Haralambos Karvounis, Charalampos Kossyvakis, Georgios Leventopoulos, Dionysios Kalpakos, Dimitrios Tousoulis, Aris Anastasakis, Georgios Efthimiadis, Nikolaos Fragakis, Emmanouil Simantirakis, Panagiotis Korantzopoulos, George Hahalis, Athanasios Kordalis, Michael Efremidis, Anna Kostopoulou, Ioannis Skiadas, Panagiotis Margos, Stylianos Paraskevaidis, Konstantinos Paravolidakis, Dimitrios Klettas, Sophie Mavrogeni, Athanasios Kranidis, Efstathios Iliodromitis, Kyriakos Lazaridis, Vlasios Pyrgakis, Aristides Androulakis, and Charalambos Vlachopoulos

Subjects
Nonischemic dilated cardiomyopathy, sudden cardiac death risk stratification, tiered two-step approach, noninvasive risk factors, cardiac magnetic resonance imaging, programmed ventricular stimulation, Diseases of the circulatory (Cardiovascular) system, RC666-701
Published
2021
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3. HEllenic Registry on Myocarditis SyndromES on behalf of Hellenic Heart Failure Association: The HERMES‐HF Registry

Author

Stamatis Adamopoulos, Dimitrios Miliopoulos, Apostolis Karavidas, Maria Nikolaou, George Lazaros, Angeliki Gkouziouta, Athanassios Manginas, George Sevastos, Haralambos Karvounis, Theodoros D. Karamitsos, George Hahalis, Marianna Leopoulou, Konstantinos Grigoriou, Despoina Balta, Catherine C. Avgeropoulou, Alexandros Kasiakogias, Ioannis Mantas, Nikolaos Daskalopoulos, Dimitrios Varvarousis, Fragiskos I. Parthenakis, Alexandros P. Patrianakos, Sotirios Patsilinakos, Stavros Karanikas, Stavros V. Konstantinides, Dimitrios N. Tziakas, Nikolaos Kouvelas, Paraskevi Ntoliou, Athanasios J. Manolis, Pavlos Tsinivizov, Efstathios K. Iliodromitis, Agathi‐Rosa Vrettou, Stavros N. Kakouros, Alexandros Douras, Nikoleta Mpaka, Pantelis Makridis, Eleni Karapatsoudi, Neofytos Papoulidis, Antonios Sideris, John T. Parissis, Filippos Triposkiadis, Athanasios Trikas, and Gerasimos Filippatos

Subjects
Registry, Myocarditis, Cardiac magnetic resonance, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract

Abstract Aims Despite the existence of many studies, there are still limited data about the characteristics of myocarditis in Greece. This led to the creation of the Greek Myocarditis Registry aiming to document the different symptoms and treatment of myocarditis, assess possible prognostic factors, and find similarities and differences to what is already published in literature. This paper is a preliminary descriptive analysis of this Registry. Methods and results We analysed data for the hospitalization period of all patients included in the Registry from December 2015 until November 2017. Statistics are reported as frequency (%) or median and inter‐quartile range (IQR) as appropriate. In total, 146 patients were included; 83.3% of the patients reported an infection during the last 3 months. The most common symptom, regardless of the underlying infection, was chest pain (82.2%) followed by dyspnoea (18.5%), while the most common finding in clinical examination was tachycardia (26.7%). Presentation was more frequent in the winter months. ECG findings were not specific, with the repolarization abnormalities being the most frequent (60.3%). Atrial fibrillation was observed in two patients, both of whom presented with a reduced ventricular systolic function. Left ventricular ejection fraction changed significantly during the hospitalization [55% (IQR: 50–60%) on admission vs. 60% (IQR: 55–60%) on discharge, P = 0.0026]. Cardiac magnetic resonance was performed in 88 patients (61%), revealing mainly subepicardial and midcardial involvement of the lateral wall. Late gadolinium enhancement was present in all patients, while oedema was found in 39 of them. Only 11 patients underwent endomyocardial biopsy. Discharge medication consisted mainly of beta‐blockers (71.9%) and angiotensin‐converting enzyme inhibitors (41.8%), while 39.7% of the patients were prescribed both. Conclusions This preliminary analysis describes the typical presentation of myocarditis patients in Greece. It is a first step in developing a better prognostic model for the course of the disease, which will be completed after the incorporation of the patients' follow‐up data.

Published
2020
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5. Anaphylaxis-induced atrial fibrillation and anesthesia: Pathophysiologic and therapeutic considerations

Author

Nicholas G Kounis, Ioanna Koniari, George Tzanis, George D Soufras, Dimitrios Velissaris, and George Hahalis

Subjects
anaphylaxis, anesthesia, antihistamines, atrial fibrillation, histamine, kounis syndrome, Anesthesiology, RD78.3-87.3, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract

Atrial fibrillation is the most common cardiac arrhythmia in western society affecting more than 35 million individuals worldwide annually. It is a common postoperative complication and may also occur spontaneously during general and local anesthesia administration. Aging, diabetes mellitus, hypertension, and cardiovascular diseases including cardiomyopathies, congenital cardiac anomalies, heart failure, myocardial ischemia, pericarditis, previous cardiac surgery, vascular disease, and valvular heart disease are some correlated factors. Beyond age, increased incidence of atrial fibrillation has been correlated to autoimmune system activation as it is the underlying mechanism of persistent atrial fibrillation development. Current research supports an association between the complement system activation and lymphocyte-pro-inflammatory cytokines release with the cardiac conduction system and atrial fibrosis. The loss of CD28 antigen from CD4+ CD28+ T lymphocytes seems to play a major role in atrial fibrillation development and prognosis. Except atrial fibrillation, a variety of additional electrocardiographic changes, resembling those with digitalis intoxication may accompany anaphylaxis and particularly Kounis syndrome. Histamine is one well-known mediator in allergic and inflammatory conditions as physiologically regulates several cardiovascular and endothelial functions with arrhythmogenic potential. The increased oxidative stress, measured by the redox potentials of glutathione, has been correlated with atrial fibrillation incidence and prevalence. The use of antazoline, a first-generation antihistamine agent used for rapid conversion of recent-onset atrial fibrillation in patients with preserved left ventricular function and for rapid atrial fibrillation termination during accessory pathway ablation denotes that anaphylaxis-induced histamine production could be the cause of atrial fibrillation at least in some instances. The anaphylaxis diagnosis in anesthesia can be challenging owing to the absence of cutaneous manifestetions such as flushing, urticaria, or angioedema. Anticoagulation for stroke prevention, rate and rhythm control medications, invasive methods such as radiofrequency ablation or cryoablation of pulmonary veins as well surgical ablation constitute the treatment basis of atrial fibrillation. Understanding the underlying mechanisms of atrial fibrillation by cardiologists, anesthesiologists and surgeons, as well as potential treatments, to optimize care is of paramount importance.

Published
2020
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6. The Greek study in the effects of colchicine in COvid-19 complications prevention (GRECCO-19 study): Rationale and study design

Author

Spyridon G. Deftereos, Gerasimos Siasos, Georgios Giannopoulos, Dimitrios A. Vrachatis, Christos Angelidis, Sotiria G. Giotaki, Panagiotis Gargalianos, Helen Giamarellou, Charalampos Gogos, Georgios Daikos, Marios Lazanas, Pagona Lagiou, Georgios Saroglou, Nikolaos Sipsas, Sotirios Tsiodras, Dimitrios Chatzigeorgiou, Nikolaos Moussas, Anastasia Kotanidou, Nikolaos Koulouris, Evangelos Oikonomou, Andreas Kaoukis, Charalampos Kossyvakis, Konstantinos Raisakis, Katerina Fountoulaki, Mihalis Comis, Dimitrios Tsiachris, Eleni Sarri, Andreas Theodorakis, Luis Martinez-Dolz, Jorge Sanz-Sánchez, Bernhard Reimers, Giulio G. Stefanini, Michael Cleman, Dimitrios Filippou, Christoforos D. Olympios, Vlasios N. Pyrgakis, John Goudevenos, George Hahalis, Theofilos M. Kolettis, Efstathios Iliodromitis, Dimitrios Tousoulis, and Christodoulos Stefanadis

Subjects
COVID, Cardiac, Troponin, CRP, Complications, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract

Objective: Colchicine has been utilized safely in a variety of cardiovascular clinical conditions. Among its potential mechanisms of action is the non-selective inhibition of NLRP3 inflammasome which is thought to be a major pathophysiologic component in the clinical course of patients with COVID-19. GRECCO-19 will be a prospective, randomized, open-labeled, controlled study to assess the effects of colchicine in COVID-19 complications prevention. Methods: Patients with laboratory confirmed SARS-CoV-2 infection (under RT PCR) and clinical picture that involves temperature >37.5 oC and at least two out of the: i. sustained coughing, ii. sustained throat pain, iii. Anosmia and/or ageusia, iv. fatigue/tiredness, v. PaO2

Published
2020
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7. Kounis Syndrome—not a Single-organ Arterial Disorder but a Multisystem and Multidisciplinary Disease

Author

Nicholas G. Kounis, Ioanna Koniari, Dimitrios Velissaris, George Tzanis, and George Hahalis

Subjects
anaphylaxis, hypersensitivity, Allergy, Kounis syndrome, Medicine
Abstract

Coronary symptoms associated with conditions related to mast cell activation and inflammatory cell interactions, such as those involving T-lymphocytes and macrophages, further inducing allergic, hypersensitivity, anaphylactic, or anaphylactic insults, are currently referred to as the Kounis syndrome. Kounis syndrome is caused by inflammatory mediators released during allergic insults, post-inflammatory cell activation, and interactions via multidirectional stimuli. A platelet subset of 20% with high- and low-affinity IgE surface receptors is also involved in this process. Kounis syndrome is not just a single-organ but also a complex multisystem and multi-organ arterial clinical condition; it affects the coronary, mesenteric, and cerebral arteries and is accompanied by allergy–hypersensitivity–anaphylaxis involving the skin, respiratory, and vascular systems in the context of anesthesia, surgery, radiology, oncology, or even dental and psychiatric medicine; further, it has significantly influences both morbidity and mortality. Kounis syndrome might be caused by numerous and continuously increasing causes, with broad clinical symptoms and signs, via multi-organ arterial system involvement, in patients of any age, thereby demonstrating predominant anaphylactic features in terms of a wide spectrum of mast cell-association disorders. Cardiac symptoms, such as chest pain, coronary vasospasm, angina pectoris, myocardial infarction, stent thrombosis, acute cardiac failure, and sudden cardiac death associated with subclinical, clinical, acute, or chronic allergic reactions, constitute the clinical manifestations of this syndrome. Since its first description, a common pathway between allergic and non-allergic coronary events has been demonstrated. The hypothesis is based on the existence of a much higher degree of mast cell degranulation at plaque erosion or rupture sites compared with at the adjacent areas or even more distant segments in post-acute myocardial infarction of non-allergic etiology. Although mast cell activation, differentiation, and mediator release takes days or weeks, the mast cell degranulation may occur just before any acute coronary event, further resulting in coronary artery vasoconstriction and atheromatous plaque rupture. It seems that medications and natural molecules stabilizing the mast cell membrane as well as monoclonal antibodies protecting the mast cell surface can emerge as novel therapeutic modalities for acute coronary and cerebrovascular event prevention.

Published
2019
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9. Percutaneous coronary intervention vs. cardiac surgery in diabetic patients. Where are we now and where should we be going?

Author

George Kassimis, Christos V. Bourantas, Raina Tushar, Giovanni Luigi de Maria, Periklis Davlouros, George Hahalis, Dimitrios Alexopoulos, and Adrian P. Banning

Subjects
Diabetic patients, Revascularization, CABG, PCI, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract

Patients with diabetes mellitus are at increased risk of developing coronary artery disease (CAD) and have an increased incidence of recurrent events following revascularization. Choosing the most appropriate strategy to revascularize these high-risk patients is crucial for improving the clinical outcomes. Several studies, randomized trials and meta-analyses have compared short- and long-term outcomes following coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) in diabetic patients suffering from CAD. The aim of this article is to review the currently available evidence on the role of PCI and CABG in the management of diabetic patients with CAD.

Published
2017
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10. Late Infective Endocarditis After Transcatheter Mitral Valve Reconstruction (MitraClip): A Case Report and a Review of the Literature

Author

Emmanouil Chourdakis, Ioanna Koniari, Neriman Osman, Nicholas Kounis, George Hahalis, and Nikos Werner

Subjects
Cardiology and Cardiovascular Medicine
Abstract

Percutaneous transcatheter mitral valve reconstruction in edge to edge fashion is a well-established option in inoperable or high peri-operative risk patients with severe, symptomatic mitral valve regurgitation. MitraClip in combination with medical treatment improves survival and reduces hospitalization rates compared with optimal medical therapy alone in well selected patients. Clip-associated endocarditis is a rare complication with only few reported cases in the literature. We present a case of late infective endocarditis post Mitral Clip implantation and also review the literature regarding this new rare condition.

Published
2022
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14. The burden of atrial fibrillation and heart failure in hospitalized patients. A real-world survey in a nationwide snapshot

Author

Konstantinos Iliodromitis, Stylianos Tzeis, Anastasia Xintarakou, Vlasios Pyrgakis, Ioannis Zarifis, Sotirios Patsilinakos, Antonios Draganigos, Filippos Triposkiadis, George Hahalis, Athanasios Karanasios, Ioannis Goudevenos, Lampros Michalis, Charalampos Karvounis, Fraggiskos Parthenakis, Ioannis Kanakakis, Dimitrios Tousoulis, Efstathios Iliodromitis, and Panos Vardas

Subjects
Cardiology and Cardiovascular Medicine
Published
2023
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15. Ulnar artery: The Ulysses ultimate resort for coronary procedures

Author

George Hahalis, MD, PhD, Spyridon Deftereos, MD, PhD, and Olivier F. Bertrand, MD, PhD, FSCAI

Subjects
Ulnar artery, Radial artery, Transulnar, Transradial, Coronary catheterization, Transfemoral approach, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract

Despite the increasing worldwide adoption of the transradial access site, the ulnar artery (UA) only very infrequently serves as a primary option for coronary procedures. In contrast to the uncertainty surrounding previous reports regarding the feasibility and safety, recent data from larger registries and randomized trials provide more conclusive evidence that the transulnar route may be safely selected as an alternative arterial access approach. However, a default transulnar strategy appears time-consuming and is associated with higher crossover rates compared with the radial artery (RA). Once arterial access is obtained, the likelihood of a successful coronary procedure is high and similar between the two forearm arteries. The UA has similar flow-mediating vasodilating properties with and seems at least as vulnerable as the RA with regard to incident occlusion, with UA occlusion (UAO) rates being probably higher than previously anticipated. A learning curve effect may not be apparent for crossover rates among experienced radialists, but increasing experience is associated with reduction in the fluoroscopy time, contrast volume and frequency of large hematoma formation. The UA may represents an important alternative access site for coronary procedures, and experienced radial operators should obtain additional skills to perform the transulnar approach. Nevertheless, in view of this method's lower feasibility compared to the RA, an initial ulnar access strategy should be reserved for carefully selected patients to ensure satisfactory cannulation rates.

Published
2016
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16. Prevalence and Impact of Atrial Fibrillation on Prognosis in Takotsubo Cardiomyopathy Patients

Author

Ioanna Koniari, Angeliki Papageorgiou, Eleni Artopoulou, Dimitrios Velissaris, Virginia Mplani, Nicholas Kounis, George Hahalis, and Grigorios Tsigkas

Subjects
Catecholamines, Takotsubo Cardiomyopathy, Atrial Fibrillation, Prevalence, Humans, cardiovascular diseases, Prognosis, Cardiology and Cardiovascular Medicine
Abstract

The purpose of this review is to describe the impact of atrial fibrillation (AF) on the cardiovascular outcomes and prognosis in patients with Takotsubo Cardiomyopathy (TTC). The pathophysiological basis of TTC is set on the release of catecholamines, occurring post an emotional or stressful event. The cardiovascular system of patients with TTC is affected by the high concentrations of catecholamines, creating the ideal background for the development of AF: inflammation, myocardial stress, and excessive sympathetic activity. AF is considered to be the most frequent arrhythmia in TTC patients and is associated with higher rates of cardiovascular and all-cause mortality. AF is also linked with a worse prognosis concerning the hemodynamic status, cardiac fibrosis, lethal arrhythmias, thromboembolic events, and adverse heart failure associated outcomes. The early diagnosis of AF in these patients plays significant role in the prevention of adverse events, the reversibility of left ventricular function, and the restoration of sinus rhythm.

Published
2022
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20. Inferior myocardial wall ischemia on SPECT-MPI in patients with non dominant right coronary artery and non significant coronary artery disease

Author

Virginia, Mplani, Dimitrios, Apostolopoulos, Eleni, Koufou, Trifon, Spyridonidis, Grigorios, Tsigkas, George, Hahalis, Dimitrios, Alexopoulos, and Periklis, Davlouros

Subjects
Male, Tomography, Emission-Computed, Single-Photon, Myocardial Ischemia, Myocardial Perfusion Imaging, Humans, Coronary Artery Disease, Middle Aged, Coronary Angiography, Cardiology and Cardiovascular Medicine, Aged
Abstract

The impact of a non-dominant right coronary artery (NDRCA), on single photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI)has not been clarified.We compared SPECT-MPI results of consecutive patients without significant (diameter stenosis ≥50%)coronary artery disease (CAD) and a NDRCA (Group-1), with those of patients from our database without CAD and a dominant RCA (Group-2). All patients were subjected to SPECT-MPI with I.V. infusion of adenosine, and TCA relatively high rate of reversible SPECT-MPI perfusion defects may be anticipated in patients with an unobstructed NDRCA compared to patients with a dominant RCA.

Published
2022
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21. Estimation of the economic burden of atrial fibrillation-related stroke in Greece

Author

Panagiotis Stafylas, Frangiskos Parthenakis, Haralampos Milionis, Konstantinos Tsioufis, Elli Vitsou, N. Boubouchairopoulou, George Ntaios, George Hahalis, Konstantinos Vemmos, and George Giannakoulas

Subjects
Estimation, medicine.medical_specialty, Greece, business.industry, Total cost, Health Policy, Anticoagulants, Financial Stress, Atrial fibrillation, General Medicine, medicine.disease, Hospitalization, Stroke, Indirect costs, Environmental health, Atrial Fibrillation, Epidemiology, medicine, Humans, Pharmacology (medical), business, Socioeconomic status, Cause of death
Abstract

Background: Stroke is aleading cause of death and disability, with atrial fibrillation (AF) being among key risk factors and AF-related stroke inflicting significant burden on healthcare systems and society. The present study was undertaken for estimating the total annual socioeconomic burden of AF-related stroke in Greece and identifying the key cost contributors.Research design and methods: A cost-of-illness model was developed for estimating the total annual economic burden of AF-related stroke in Greece, from asocietal perspective (year 2018). Atargeted literature review and an advisory board consisting of key experts in the management of AF and AF-related stroke were performed for collecting local resource use and epidemiological data.Results: The total annual socioeconomic burden of AF-related stroke was estimated at €175million, in 2018. Direct and indirect costs accounted for 59% and 41%, respectively. Main contributors were informal care (21.1%), patients' productivity losses (19.7%) and hospitalizations (15.0%), accounting for more than half of the total costs of AF-related stroke events.Conclusion: A F-related stroke imposes asignificant socioeconomic burden in Greece. Despite results relying on estimations, it seems that ensuring efficient reallocation of resources in appropriate prevention and early intervention strategies could decrease AF-related stroke's burden but also enhance healthcare systems' efficiency.Abbreviations: AF=atrial fibrillation.

Published
2021
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22. Combined etiology of anaphylactic cardiogenic shock: Amiodarone, epinephrine, cardioverter defibrillator, left ventricular assist devices and the Kounis syndrome

Author

Nicholas G Kounis, George D Soufras, Periklis Davlouros, Grigorios Tsigkas, and George Hahalis

Subjects
Anaphylactic shock, amiodarone, cardioverter defibrillator, epinephrine, Kounis syndrome, left ventricular assist device, Anesthesiology, RD78.3-87.3, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract

Anaphylactic shock is a life-threatening condition which needs detailed and mediculous clinical assessment and thoughtful treatment. Several causes can join forces in order to degranulate mast cells. Amiodarone which is an iodine-containing highly lipophilic benzofuran can induce allergic reactions and anaphylactic shock in sensitized patients. Epinephrine is a life saving drug, but in sulfite allergic patients it should be given with caution due its metabisulfite preservative. Metals covering cardiac defibrillators and pacemakers can act as antigens attached to serum proteins and induce allergic reactions. In anaphylactic shock, myocardial involvement due to vasospasm-induced coronary blood flow reduction manifesting as Kounis syndrome should be always considered. Clinically, combined treatment targeting the primary cause of anaphylaxis together with protection of cardiac tissue seems to be of paramount importance.

Published
2015
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23. Radial Artery and Ulnar Artery Occlusions Following Coronary Procedures and the Impact of Anticoagulation: ARTEMIS (Radial and Ulnar ARTEry Occlusion Meta‐AnalysIS) Systematic Review and Meta‐Analysis

Author

George Hahalis, Konstantinos Aznaouridis, Gregory Tsigkas, Periklis Davlouros, Ioanna Xanthopoulou, Nikolaos Koutsogiannis, Ioanna Koniari, Marianna Leopoulou, Olivier Costerousse, Dimitris Tousoulis, and Olivier F. Bertrand

Subjects
coronary angiography, radial occlusion, transradial, transulnar, ulnar occlusion, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract

BackgroundIncidence of radial artery occclusions (RAO) and ulnar artery occclusions (UAO) in coronary procedures, factors predisposing to forearm arteries occlusion, and the benefit of anticoaggulation vary significantly in existing literature. We sought to determine the incidence of RAO/UAO and the impact of anticoagulation intensity. Methods and ResultsMeta‐analysis of 112 studies assessing RAO and/or UAO (N=46 631) were included. Overall, there was no difference between crude RAO and UAO rates (5.2%; 95% confidence interval [CI], 4.4–6.0 versus 4.0%; 95% CI, 2.8–5.8; P=0.171). The early occlusion rate (in‐hospital or within 7 days after procedure) was higher than the late occlusion rate. The detection rate of occlusion was higher with vascular ultrasonography compared with clinical evaluation only. Low‐dose heparin was associated with a significantly higher RAO rate compared with high‐dose heparin (7.2%; 95% CI, 5.5–9.4 versus 4.3%; 95% CI, 3.5–5.3; Q=8.81; P=0.003). Early occlusions in low‐dose heparin cohorts mounted at 8.0% (95% CI, 6.1–10.6). The RAO rate was higher after diagnostic angiographies compared with coronary interventions, presumably attributed to the higher intensity of anticoagulation in the latter group. Hemostatic techniques (patent versus nonpatent hemostasis), geography (US versus non‐US cohorts) and sheath size did not impact on vessel patency. ConclusionsRAO and UAO occur with similar frequency and in the order of 7% to 8% when evaluated early by vascular ultrasonography following coronary procedures. More‐intensive anticoagulation is protective. Late recanalization occurs in a substantial minority of patients.

Published
2017
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26. Preeclampsia Emerging as a Risk Factor of Cardiovascular Disease in Women

Author

Sotirios Fouzas, George Hahalis, Ageliki A. Karatza, Emmanouil Chourdakis, and Nikos Oikonomou

Subjects
0301 basic medicine, Acute coronary syndrome, medicine.medical_specialty, Time Factors, Population, Blood Pressure, Disease, Risk Assessment, Preeclampsia, 03 medical and health sciences, Vascular Stiffness, 0302 clinical medicine, Pharmacotherapy, Pre-Eclampsia, Pregnancy, Placenta, Internal Medicine, medicine, Humans, Risk factor, education, reproductive and urinary physiology, education.field_of_study, Fetus, business.industry, Obstetrics, Prognosis, medicine.disease, female genital diseases and pregnancy complications, 030104 developmental biology, medicine.anatomical_structure, Cardiovascular Diseases, Heart Disease Risk Factors, embryonic structures, Female, Cardiology and Cardiovascular Medicine, business, Biomarkers, 030217 neurology & neurosurgery
Abstract

The objective of this literature review was to explore the long-term cardiovascular effects of preeclampsia in women. The primary goal was to determine which organs were most commonly affected in this population. Although it was previously believed that preeclampsia is cured after the delivery of the fetus and the placenta current evidence supports an association between preeclampsia and cardiovascular disease later in life, many years after the manifestation of this hypertensive pregnancy related disorder. Therefore preeclampsia may be emerging as a novel cardiovascular risk factor for women, which requires long-term follow up.

Published
2021
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27. Arrhythmic risk stratification in nonischemic dilated cardiomyopathy: The ReCONSIDER study design – A two-step, multifactorial, electrophysiology-inclusive approach

Author

Georgios Leventopoulos, Nikolaos Fragakis, Haralambos Karvounis, Dimitrios Tousoulis, Efstathios K. Iliodromitis, Emmanuel M. Kanoupakis, Antonios Sideris, Athanasios Kordalis, Dimitrios Tsiachris, S. Paraskevaidis, Kyriakos Lazaridis, Polychronis Dilaveris, Vlasios Pyrgakis, Dionysios Kalpakos, Panagiotis Korantzopoulos, Ioannis Skiadas, Emmanouil Simantirakis, George Hahalis, Aris Anastasakis, Dimitrios Klettas, Charalampos Kossyvakis, Sophie Mavrogeni, Panagiota Flevari, Aristides Androulakis, Georgios K. Efthimiadis, Michael Efremidis, Konstantinos Kappos, Christos-Konstantinos Antoniou, Apostolos Katsivas, Petros Arsenos, Skevos Sideris, Athanasios Kranidis, Charalambos Vlachopoulos, Athanasios Kotsakis, Anna Kostopoulou, Vassilios Vassilikos, Theofilos M. Kolettis, Panagiotis N. Margos, Konstantinos Paravolidakis, Themistoklis Maounis, and Konstantinos Gatzoulis

Subjects
Cardiomyopathy, Dilated, medicine.medical_specialty, tiered two-step approach, Two step, cardiac magnetic resonance imaging, Stratification (water), Dilative cardiomyopathy, noninvasive risk factors, Risk Assessment, Risk Factors, Cardiac magnetic resonance imaging, Internal medicine, medicine, Humans, Diseases of the circulatory (Cardiovascular) system, programmed ventricular stimulation, medicine.diagnostic_test, Arrhythmic risk, business.industry, Defibrillators, Implantable, Nonischemic dilated cardiomyopathy, Electrophysiology, Death, Sudden, Cardiac, RC666-701, Cardiology, sudden cardiac death risk stratification, Cardiology and Cardiovascular Medicine, business
Published
2021

28. Ticagrelor versus clopidogrel in patients with STEMI treated with thrombolysis: the MIRTOS trial

Author

Lampros K. Michalis, Charalambos Karvounis, Vasilios Vasilikos, Dimitrios Stakos, Michalis Hamilos, Ioannis Anastasiou, Ioannis Tsiafoutis, Panos E. Vardas, John Kanakakis, George Hahalis, John A. Goudevenos, Konstantinos Raisakis, and Michalis Koutouzis

Subjects
medicine.medical_specialty, business.industry, medicine.medical_treatment, Percutaneous coronary intervention, Thrombolysis, 030204 cardiovascular system & hematology, Clopidogrel, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, Conventional PCI, medicine, Clinical endpoint, Cardiology, cardiovascular diseases, 030212 general & internal medicine, Cardiology and Cardiovascular Medicine, business, Ticagrelor, Mace, TIMI, medicine.drug
Abstract

AIMS We aimed to demonstrate whether coronary microvascular function is improved after ticagrelor administration compared to clopidogrel administration in STEMI subjects undergoing thrombolysis. METHODS AND RESULTS MIRTOS is a multicentre study of ticagrelor versus clopidogrel in STEMI subjects treated with fibrinolysis. We enrolled 335 patients

Published
2021
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29. Distribution, infrastructure, and expertise of heart failure and cardio‐oncology clinics in a developing network: temporal evolution and challenges during the coronavirus disease 2019 pandemic

Author

Theodoros D. Karamitsos, Vassilios Vassilikos, Ioannis Tsounos, Dimitrios Christakos, Alexandra Frogoudaki, Antonis Sideris, Athanasios Anadiotis, Nikoleta Baka, Christina Chrysohoou, Vasileios Sousonis, Filippos Triposkiadis, Vasiliki Dimitroula, Tsampikos Giakoumakis, Panagiotis Kliridis, Konstantina Toli, Ilias Sichlimiris, Nikolaos Karamichalakis, Georgios Almpanis, John Parissis, Anastasia Kitsiou, Peggy Kostakou, George Hahalis, Georgios Chalikias, Katerina Avgeropoulou, Lina Zitiridou, Stauroula Kosmopoulou, Efstratios Theofilogiannakos, John Christodoulou, Evangelos Sdogkos, Elias Tsougos, Apostolos Karavidas, Maria Georgopoulou, Georgios Spyropoulos, Eftychios Siniorakis, Argyrios Ntalianis, Christoforos Olympios, Christos Katsikas, Stylianos Lampropoulos, Maria Nikolaou, Petros Stravopodis, Pavlos Stougiannos, Gerasimos Filippatos, Konstantinos Tsioufis, Maria Sifaki, Konstantinos Tsatiris, Kalliopi Keramida, Konstantinos Kyrlas, Dimosthenis Drosos, Grigorios Oikonomou, Katerina Fountoulaki, Georgios Kalogiannis, Gerasimos Gavrielatos, Constantinos Bakogiannis, Alexandros Katranis, Dimitrios Farmakis, Sotirios Xydonas, Niki Vlassopoulou, Maria Marketou, Anna Kotsia, Chris Adamopoulos, Nikolaos Kouvelas, Anastasios Theodosis‐Georgilas, Vassilios Giannaris, Maria Bonou, Maria Thodi, Michael Bonios, Soultana Bakaimi, Dimitrios Chrissos, Gregory Giamouzis, Spyridon Maragkoudakis, Evangelos Pisimisis, Nikolaos Kampouridis, Paraskevi Ntoliou, Theodore Bischiniotis, Petros Voutas, Ioannis Kanonidis, Katerina K. Naka, Chris Kapelios, Helena Michalopoulou, Athanasios Trikas, Christos Chatzieleftheriou, Elias Andreanides, Vasiliki Matzaraki, Ioannis Alexanian, Athanasios Vasilopoulos, Emmanouil Lamprogiannakis, Alaa Aboushamala, Eftychia Polyzogopoulou, Panagiotis Koudounis, Eleni Karapatsoudi, Vasiliki Bistola, Eftychia Chamodraka, Antonios Marsonis, Adina Thomaidi, John Zarifis, Gerasimos Siasos, Ioannis Kogias, Athanasios Manginas, Anastastios Spanos, Paraskevi Veneti, Konstantinos Polymeropoulos, Lilika Pappa, Ioannis Mantas, Athanasios Kranidis, E. Leontiadis, Dimitrios Karatzas, Minas Pappas, Sotirios Patsilinakos, Konstantinos Tsitlakidis, Georgios Tsinopoulos, Metaxia Driva, Costas H. Papadopoulos, Konstantina Katsanou, Angeliki Gkouziouta, Stefanos Papastefanou, Alexia Stavrati, Antonios Draganigos, Anastasia Stella Perpinia, Alexandros Douras, Aris Bechlioulis, Nikos Kouris, Georgios Soufras, Georgios Spyromitros, Eleni Angelopoulou, Spyridon Papamentzelopoulos, Evangelos Lazaris, Dionysios Kalpakos, George Giannakoulas, Fragkiskos Parthenakis, Georgios Katsimagklis, Ioannis Paraskevaidis, Dimitrios Tziakas, and Stamatios Adamopoulos

Subjects
medicine.medical_specialty, Cardiac Care Facilities, Coronavirus disease 2019 (COVID-19), National network, Short Communication, Short Communications, Cancer Care Facilities, Cardio‐oncology clinic, Heart Neoplasms, COVID‐19, Surveys and Questionnaires, Pandemic, medicine, Diseases of the circulatory (Cardiovascular) system, Humans, Distribution (pharmacology), Cardio oncology, Intensive care medicine, Heart failure clinic, Severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2), Heart Failure, Infection Control, business.industry, COVID-19, medicine.disease, Telemedicine, RC666-701, Heart failure, Cardiology and Cardiovascular Medicine, business, Delivery of Health Care
Abstract

The Hellenic Heart Failure Association has undertaken the initiative to develop a national network of heart failure clinics (HFCs) and cardio‐oncology clinics (COCs). We conducted two questionnaire surveys among these clinics within 17 months and another during the coronavirus disease 2019 outbreak to assess adjustments of the developing network to the pandemic. Out of 68 HFCs comprising the network, 52 participated in the first survey and 55 in the second survey. The median number of patients assessed per week is 10. Changes in engaged personnel were encountered between the two surveys, along with increasing use of advanced echocardiographic techniques (23.1% in 2018 vs. 34.5% in 2020). Drawbacks were encountered, concerning magnetic resonance imaging and ergospirometry use (being available in 14.6% and 29% of HFCs, respectively), exercise rehabilitation programmes (applied only in 5.5%), and telemedicine applications (used in 16.4%). There are 13 COCs in the country with nine of them in the capital region; the median number of patients being assessed per week is 10. Platforms for virtual consultations and video calls are used in 38.5%. Coronavirus disease 2019 outbreak affected provision of HFC services dramatically as only 18.5% continued to function regularly, imposing hurdles that need to be addressed, at least temporarily, possibly by alternative methods of follow‐up such as remote consultation. The function of COCs, in contrast, seemed to be much less affected during the pandemic (77% of them continued to follow up their patients). This staged, survey‐based procedure may serve as a blueprint to help building national HFC/COC networks and provides the means to address changes during healthcare crises.

Published
2020
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30. HEllenic Registry on Myocarditis SyndromES on behalf of Hellenic Heart Failure Association: The HERMES‐HF Registry

Author

Haralambos Karvounis, Sotirios Patsilinakos, Agathi-Rosa Vrettou, Alexandros P. Patrianakos, Athanasios Trikas, George Sevastos, Konstantinos Grigoriou, Despoina Balta, Fragiskos I. Parthenakis, George Lazaros, Alexandros Kasiakogias, Eleni Karapatsoudi, Theodoros D. Karamitsos, Stavros Karanikas, Athanasios J. Manolis, Catherine C. Avgeropoulou, Dimitrios Tziakas, Paraskevi Ntoliou, Athanassios Manginas, Marianna Leopoulou, Stavros Konstantinides, John Parissis, Nikolaos Daskalopoulos, George Hahalis, Angeliki Gkouziouta, Gerasimos Filippatos, Efstathios K. Iliodromitis, Pantelis Makridis, Nikolaos Kouvelas, Ioannis Mantas, Maria Nikolaou, Dimitrios Miliopoulos, Dimitrios Varvarousis, Alexandros Douras, Apostolis Karavidas, Stamatis Adamopoulos, Pavlos Tsinivizov, Neofytos Papoulidis, Nikoleta Mpaka, Antonios Sideris, Stavros N. Kakouros, and Filippos Triposkiadis

Subjects
Tachycardia, medicine.medical_specialty, Registry, Myocarditis, Cardiac magnetic resonance, Physical examination, Disease, 030204 cardiovascular system & hematology, Chest pain, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, Original Research Articles, medicine, Diseases of the circulatory (Cardiovascular) system, 030212 general & internal medicine, Original Research Article, Ejection fraction, medicine.diagnostic_test, business.industry, Atrial fibrillation, medicine.disease, Heart failure, RC666-701, medicine.symptom, Cardiology and Cardiovascular Medicine, business
Abstract

Aims Despite the existence of many studies, there are still limited data about the characteristics of myocarditis in Greece. This led to the creation of the Greek Myocarditis Registry aiming to document the different symptoms and treatment of myocarditis, assess possible prognostic factors, and find similarities and differences to what is already published in literature. This paper is a preliminary descriptive analysis of this Registry. Methods and results We analysed data for the hospitalization period of all patients included in the Registry from December 2015 until November 2017. Statistics are reported as frequency (%) or median and inter‐quartile range (IQR) as appropriate. In total, 146 patients were included; 83.3% of the patients reported an infection during the last 3 months. The most common symptom, regardless of the underlying infection, was chest pain (82.2%) followed by dyspnoea (18.5%), while the most common finding in clinical examination was tachycardia (26.7%). Presentation was more frequent in the winter months. ECG findings were not specific, with the repolarization abnormalities being the most frequent (60.3%). Atrial fibrillation was observed in two patients, both of whom presented with a reduced ventricular systolic function. Left ventricular ejection fraction changed significantly during the hospitalization [55% (IQR: 50–60%) on admission vs. 60% (IQR: 55–60%) on discharge, P = 0.0026]. Cardiac magnetic resonance was performed in 88 patients (61%), revealing mainly subepicardial and midcardial involvement of the lateral wall. Late gadolinium enhancement was present in all patients, while oedema was found in 39 of them. Only 11 patients underwent endomyocardial biopsy. Discharge medication consisted mainly of beta‐blockers (71.9%) and angiotensin‐converting enzyme inhibitors (41.8%), while 39.7% of the patients were prescribed both. Conclusions This preliminary analysis describes the typical presentation of myocarditis patients in Greece. It is a first step in developing a better prognostic model for the course of the disease, which will be completed after the incorporation of the patients' follow‐up data.

Published
2020

31. Right drug, wrong dosage: insights from the PAVE-AF antithrombotic study in older patients with atrial fibrillation

Author

George Giannakoulas, George Hahalis, Sotirios Kyrikos, Stylianos Tzeis, Paraskevi Savvari, Konstantinos Tsatiris, Kimon Stamatelopoulos, Ioannis Skiadas, Sotirios Patsilinakos, Spyridon Kourouklis, and Damianos Menegas

Subjects
Male, medicine.medical_specialty, Administration, Oral, Article, Dabigatran, Anticoagulation, Antithrombotic, Dosage, Internal medicine, Medicine, Humans, Dosing, NOAC, Prospective Studies, Medical prescription, Stroke, Aged, 80 and over, Rivaroxaban, Dose-Response Relationship, Drug, business.industry, Age Factors, Anticoagulants, Atrial fibrillation, Hematology, medicine.disease, Older, Cross-Sectional Studies, Apixaban, Female, Cardiology and Cardiovascular Medicine, business, Platelet Aggregation Inhibitors, medicine.drug
Abstract

Optimal antithrombotic treatment of older patients is usually impeded by several prevailing misconceptions. The aim of our study was to assess the type, dosage and predictors of antithrombotic therapy in older patients with non-valvular atrial fibrillation (NVAF). PAVE-AF was a prospective, cross-sectional study, including NVAF patients ≥ 80 years from 30 participating centers. Demographic data, comorbidities and treatment patterns were documented in a single visit. Patients treated with non-vitamin K oral anticoagulants (NOACs) were further classified into three dosing categories (recommended, underdosing and overdosing). Among 1018 patients (85.4±4.0 years), 88.4% received anticoagulants (AC), 8% antiplatelets (AP) and 3.6% no treatment. The primary reason for AP administration was physician concern of bleeding followed by patient denial. Patients ≥90 years had two times greater probability to receive AP therapy compared to patients

Published
2020

35. Plasma levels of lipoprotein-associated phospholipase A2 are increased in patients with β-thalassemia

Author

Alexandros D. Tselepis, George Hahalis, Constantinos C. Tellis, Eleni C. Papavasiliou, Panagiota T. Mylona, Alexandra Kourakli, and Dimitrios C. Alexopoulos

Subjects
low density lipoprotein, high density lipoprotein, oxidative stress, atherosclerosis, Biochemistry, QD415-436
Abstract

Lipoprotein-associated phospholipase A2 (Lp-PLA2) is an independent cardiovascular risk factor. We investigated the plasma levels of Lp-PLA2 activity and mass as a function of plasma lipid levels, LDL subclass profile, and oxidative stress in patients with β-thalassemia. Thirty-five patients with β-thalassemia major (β-TM) and 25 patients with β-thalassemia intermedia (β-TI) participated in the study. Lp-PLA2 activity and mass were measured in total plasma, in apolipoprotein (apo)B-depleted plasma (HDL-Lp-PLA2), and in LDL subclasses. Lp-PLA2 activity produced and secreted from peripheral blood monocytes in culture was also determined. Patients with β-thalassemia are characterized by a predominance of small-dense LDL particles, increased oxidative stress, and very high plasma levels of Lp-PLA2 mass and activity, despite low LDL-cholesterol levels. A significant positive correlation between plasma Lp-PLA2 activity or mass and 8-isoprostane (8-epiPGF2a) and ferritin levels as well as intima-media thickness (IMT) values was observed. An increase in secreted and cell-associated Lp-PLA2 activity from monocytes in culture was observed in both patient groups. The HDL-Lp-PLA2 activity and mass as well as the ratio of HDL-Lp-PLA2/plasma Lp-PLA2 were significantly higher in both patient groups compared with the control group. In conclusion, patients with β-thalassemia exhibit high plasma Lp-PLA2 levels, attributed to increased enzyme secretion from monocytes/macrophages and to the predominance of sdLDL particles in plasma. Plasma Lp-PLA2 is correlated with carotid IMT, suggesting that this enzyme may be implicated in premature carotid atherosclerosis observed in β-thalassemia.

Published
2010
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36. Contemporary Management of Severe Symptomatic Aortic Stenosis

Author

Marc Eugène, Piotr Duchnowski, Bernard Prendergast, Olaf Wendler, Cécile Laroche, Jean-Luc Monin, Yannick Jobic, Bogdan A. Popescu, Jeroen J. Bax, Alec Vahanian, Bernard Iung, Jeroen Bax, Michele De Bonis, Victoria Delgado, Michael Haude, Gerhard Hindricks, Aldo P. Maggioni, Luc Pierard, Susanna Price, Raphael Rosenhek, Frank Ruschitzka, Stephan Windecker, Souad Mekhaldi, Katell Lemaitre, Sébastien Authier, Magdy Abdelhamid, Astrid Apor, Gani Bajraktari, Branko Beleslin, Alexander Bogachev-Prokophiev, Daniela Cassar Demarco, Agnes Pasquet, Sait Mesut Dogan, Andrejs Erglis, Arturo Evangelista, Artan Goda, Nikolaj Ihlemann, Huseyin Ince, Andreas Katsaros, Katerina Linhartova, Julia Mascherbauer, Erkin Mirrakhimov, Vaida Mizariene, Shelley Rahman-Haley, Regina Ribeiras, Fuad Samadov, Antti Saraste, Iveta Simkova, Elizabeta Srbinovska Kostovska, Lidia Tomkiewicz-Pajak, Christophe Tribouilloy, Eliverta Zera, Mimoza Metalla, Ervina Shirka, Elona Dado, Loreta Bica, Jorida Aleksi, Gerti Knuti, Lidra Gjyli, Rudina Pjeci, Eritinka Shuperka, Erviola Lleshi, Joana Rustemaj, Marsjon Qordja, Mirald Gina, Senada Husi, Daniel Basic, Regina Steringer-Mascherbauer, Charlotte Huber, Christian Ebner, Elisabeth Sigmund, Andrea Ploechl, Thomas Sturmberger, Veronica Eder, Tanja Koppler, Maria Heger, Andreas Kammerlander, Franz Duca, Christina Binder, Matthias Koschutnik, Leonard Perschy, Lisa Puskas, Chen-Yu Ho, Farid Aliyev, Vugar Guluzada, Galib Imanov, Firdovsi Ibrahimov, Abbasali Abbasaliyev, Tahir Ahmedov, Fargana Muslumova, Jamil Babayev, Yasmin Rustamova, Tofig Jahangirov, Rauf Samadov, Muxtar Museyibov, Elnur Isayev, Oktay Musayev, Shahin Xalilov, Saleh Huseynov, Madina Yuzbashova, Vuqar Zamanov, Vusal Mammadov, Gery Van Camp, Martin Penicka, Hedwig Batjoens, Philippe Debonnaire, Daniel Dendooven, Sebastien Knecht, Mattias Duytschaever, Yves Vandekerckhove, Luc Missault, Luc Muyldermans, René Tavernier, Tineke De Grande, Patrick Coussement, Joyce DeTroyer, Katrien Derycker, Kelly De Jaegher, Antoine Bondue, Christophe Beauloye, Céline Goffinet, Daniela Corina Mirica, Frédéric Vanden Eynden, Philippe Van de Borne, Béatrice Van Frachen, David Vancraeynest, Jean Louis Vanoverschelde, Sophie Pierard, Mihaela Malanca, Florence Sinnaeve, Séverine Tahon, Marie De Clippel, Frederic Gayet, Jacques Loiseau, Nico Van de Veire, Veronique Moerman, Anne-Marie Willems, Bernard Cosyns, Steven Droogmans, Andreea Motoc, Dirk Kerkhove, Daniele Plein, Bram Roosens, Caroline Weytjens, Patrizio Lancellotti, Elena Raluca Dulgheru, Ilona Parenicova, Helena Bedanova, Frantisek Tousek, Stepanka Sindelarova, Julia Canadyova, Milos Taborsky, Jiri Ostransky, null Ivona simkova, Marek Vicha, Libor Jelinek, Irena Opavska, Miroslav Homza, Miriam Kvrayola, Radim Brat, Dan Mrozek, Eva Lichnerova, Iveta Docekalova, Marta Zarybnicka, Marketa Peskova, Patrik Roucka, Vlasta Stastna, Dagmar Jungwirtova Vondrackova, Alfred Hornig, Matus Niznansky, Marian Branny, Alexandra Vodzinska, Miloslav Dorda, Libor Snkouril, Krystyna Kluz, Jana Kypusova, Radka Nezvalova, Niels Thue Olsen, Hosam Hasan Ali, Salma Taha, Mohamed Hassan, Ahmed Afifi, Hamza Kabil, Amr Mady, Hany Ebaid, Yasser Ahmed, Mohammad Nour, Islam Talaat, CairoMaiy El Sayed, Ahmad Elsayed Mostafa, CairoYasser Sadek, CairoSherif Eltobgi, Sameh Bakhoum, Ramy Doss, Mahmoud Sheashea, Abd Allah Elasry, Ahmed Fouad, Mahmoud Baraka, Sameh Samir, Alaa Roshdy, Yasmin AbdelRazek, Mostafa M. Abd Rabou, Ahmed Abobakr, Moemen Moaaz, Mohamed Mokhtar, Mohamed Ashry, Khaled Elkhashab, Haytham Soliman Ghareeb, Mostafa Kamal, Gomaa AbdelRazek, GizaNabil Farag, Giza:Ahmed Elbarbary, Evette Wahib, Ghada Kazamel, Diaa Kamal, Mahmoud Tantawy, Adel Alansary, Mohammed Yahia, Raouf Mahmoud, Tamer El Banna, Mohamed Atef, Gamela Nasr, Salah Ahmed, Ehab E. El Hefny, Islam Saifelyazal, Mostafa Abd El Ghany, Abd El Rahman El Hadary, Ahmed Khairy, Jyri Lommi, Mika Laine, Minna Kylmala, Katja Kankanen, Anu Turpeinen, Juha Hartikainen, Lari Kujanen, Juhani Airaksinen, Tuija Vasankari, Catherine Szymanski, Yohann Bohbot, Mesut Gun, Justine Rousseaux, Loic Biere, Victor Mateus, Martin Audonnet, Jérémy Rautureau, Charles Cornet, Emmanuel Sorbets, BourgesKarine Mear, Adi Issa, Florent Le Ven, Marie-Claire Pouliquen, Martine Gilard, Alice Ohanessian, Ali Farhat, Alina Vlase, Fkhar Said, Caroline Lasgi, Carlos Sanchez, Romain Breil, Marc Peignon, Jean-Philippe Elkaim, Virginie Jan-Blin, Sylvain Ropars BertrandM'Ban, Hélène Bardet, Samuel Sawadogo, Aurélie Muschoot, Dieudonné Tchatchoua, Simon Elhadad, Aline Maubert, Tahar Lazizi, Kais Ourghi, Philippe Bonnet, Clarisse Menager-Gangloff, Sofiene Gafsi, Djidjiga Mansouri, Victor Aboyans, Julien Magne, Elie Martins, Sarah Karm, Dania Mohty, Guillaume Briday, Amandine David, Sylvestre Marechaux, Caroline Le Goffic, Camille Binda, Aymeric Menet, Francois Delelis, Anne Ringlé, Anne-Laure Castel, Ludovic Appert, Domitille Tristram, Camille Trouillet, Yasmine Nacer, Lucas Ngoy, MarseilleGilbert Habib, Franck Thuny, Julie Haentjens, Jennifer Cautela, Cécile Lavoute, Floriane Robin, Pauline Armangau, Ugo Vergeylen, Khalil Sanhadji, Nessim Hamed Abdallah, Hassan Kerzazi, Mariana Perianu, François Plurien, Chaker Oueslati, Mathieu Debauchez, Zannis Konstantinos, Alain Berrebi, Alain Dibie, Emmanuel Lansac, Aurélie Veugeois, Christelle Diakov, Christophe Caussin, Daniel Czitrom, Suzanna Salvi, Nicolas Amabile, Patrice Dervanian, Stéphanie Lejeune, Imane Bagdadi, Yemmi Mokrane, Gilles Rouault, Jerome Abalea, Marion Leledy, Patrice Horen, Erwan Donal, Christian Bosseau, Elise Paven, Elena Galli, Edouard Collette, Jean-Marie Urien, Valentin Bridonneau, Renaud Gervais, Fabrice Bauer, Houzefa Chopra, Arthur Charbonnier, David Attias, Nesrine Dahouathi, Moukda Khounlaboud, Magalie Daudin, Christophe Thebault, Cécile Hamon, Philippe Couffon, Catherine Bellot, Maelle Vomscheid, Anne Bernard, Fanny Dion, Djedjiga Naudin, Mohammed Mouzouri, Mathilde Rudelin, Alain Berenfeld, Thibault Vanzwaelmen, Tarik Alloui, Marija Gjerakaroska Radovikj, Slavica Jordanova, Werner Scholtz, Eva Liberda-Knoke, Melanie Wiemer, Andreas Mugge, Georg Nickenig, Jan-Malte Sinning, Alexander Sedaghat, Matthias Heintzen, Jan Ballof, Daniel Frenk, Rainer Hambrecht, Harm Wienbergen, Annemarie Seidel, Rico Osteresch, Kirsten Kramer, Janna Ziemann, Ramona Schulze, Wolfgang Fehske, Clarissa Eifler, Bahram Wafaisade, Andreas Kuhn, Sören Fischer, Lutz Lichtenberg, Mareike Brunold, Judith Simons, Doris Balling, Thomas Buck, Bjoern Plicht, Wolfgang Schols, Henning Ebelt, Marwan Chamieh, Jelena Anacker, Tienush Rassaf, Alexander Janosi, Alexander Lind, Julia Lortz, Peter Lüdike, Philipp Kahlert, Harald Rittger, Gabriele Eichinger, Britta Kuhls, Stephan B. Felix, Kristin Lehnert, Ann-Louise Pedersen, Marcus Dorr, Klaus Empen, Sabine Kaczmarek, Mathias Busch, Mohammed Baly, Fikret Er, Erkan Duman, Linda Gabriel, Christof Weinbrenner, Johann Bauersachs, Julian Wider, Tibor Kempf, Michael Bohm, Paul-Christian Schulze, C. Tudor Poerner, Sven Möbius-Winkler, Karsten Lenk, Kerstin Heitkamp, Marcus Franz, Sabine Krauspe, Burghard Schumacher, Volker Windmuller, Sarah Kurwitz, Holger Thiele, Thomas Kurz, Roza Meyer-Saraei, Ibrahim Akin, Christian Fastner, Dirk Lossnitzer, Ursula Hoffmann, Martin Borggrefe, Stefan Baumann, Brigitte Kircher, Claudia Foellinger, Heike Dietz, Bernhard Schieffer, Feraydoon Niroomand, Harald Mudra, Lars Maier, Daniele Camboni, Christoph Birner, Kurt Debl, Michael Paulus, Benedikt Seither, Nour Eddine El Mokhtari, Alper Oner, Evren Caglayan, Mohammed Sherif, Seyrani Yucel, Florian Custodis, Robert Schwinger, Marc Vorpahl, Melchior Seyfarth, Ina Nover, Till Koehler, Sarah Christiani, David Calvo Sanchez, Barbel Schanze, Holger Sigusch, Athir Salman, Jane Hancock, John Chambers, Camelia Demetrescue, Claire Prendergast, Miles Dalby, Robert Smith, Paula Rogers, Cheryl Riley, Dimitris Tousoulis, Ioannis Kanakakis, Konstantinos Spargias, Konstantinos Lampropoulos, Tolis Panagiotis, Athanasios Koutsoukis, Lampros Michalis, Ioannis Goudevenos, Vasileios Bellos, Michail Papafaklis, Lampros Lakkas, George Hahalis, Athanasios Makris, Haralampos Karvounis, Vasileios Kamperidis, Vlasis Ninios, Vasileios Sachpekidis, Pavlos Rouskas, Leonidas Poulimenos, Georgios Charalampidis, Eftihia Hamodraka, Athanasios Manolis, Robert Gabor Kiss, Tunde Borsanyi, Zoltan Jarai, Andras Zsary, Elektra Bartha, Annamaria Kosztin, Alexandra Doronina, Attila Kovacs, Barabas Janos Imre, Chun Chao, Kalman Benke, Istvan Karoczkai, Kati Keltai, Zsolt Förchécz, Zoltán Pozsonyi, Zsigmond Jenei, Adam Patthy, Laszlo Sallai, Zsuzsanna Majoros, Tamás Pál, Jusztina Bencze, Ildiko Sagi, Andrea Molnar, Anita Kurczina, Gabor Kolodzey, Istvan Edes, Valeria Szatmari, Zsuzsanna Zajacz, Attila Cziraki, Adam Nemeth, Reka Faludi, Laszlone Vegh, Eva Jebelovszki, Geza Karoly Lupkovics, Zsofia Kovacs, Andras Horvath, Gezim Berisha, Pranvera Ibrahimi, Luan Percuku, Rano Arapova, Elmira Laahunova, Kseniia Neronova, Zarema Zhakypova, Gulira Naizabekova, Gulnazik Muratova, Iveta Sime, Nikolajs Sorokins, Ginta Kamzola, Irina Cgojeva-Sproge, Gita Rancane, Ramune Valentinaviciene, Laima Rudiene, Rasa Raugaliene, Aiste Bardzilauske, Regina Jonkaitiene, Jurate Petrauskaite, Monika Bieseviciene, Raimonda Verseckaite, Ruta Zvirblyte, Danute Kalibatiene, Greta Radauskaite, Gabija Janaviciute-Matuzeviciene, Dovile Jancauskaite, Deimile Balkute, Juste Maneikyte, Ingrida Mileryte, Monika Vaisvilaite, Lina Gedvilaite, Mykolas Biliukas, Vaiva Karpaviciene, Robert George Xuereb, Elton Pllaha, Roxana Djaberi, Klaudiusz Komor, Agnieszka Gorgon-Komor, Beata Loranc, Jaroslaw Myszor, Katarzyna Mizia-Stec, Adrianna Berger-Kucza, Magdalena Mizia, Mateusz Polak, Piotr Bogacki, Piotr Podolec, Monika Komar, Ewa Sedziwy, Dorota Sliwiak, Bartosz Sobien, Beata Rog, Marta Hlawaty, Urszula Gancarczyk, Natasza Libiszewska, Danuta Sorysz, Andrzej Gackowski, Malgorzata Cieply, Agnieszka Misiuda, Franciszek Racibor, Anna Nytko, Kazimierz Widenka, Maciej Kolowca, Janusz Bak, Andrzej Curzytek, Mateusz Regulski, Malgorzata Kamela, Mateusz Wisniowski, Tomasz Hryniewiecki, Piotr Szymanski, Monika Rozewicz, Maciej Grabowski, Andrzej Budaj, Beata Zaborska, Ewa Pilichowska-Paskiet, Malgorzata Sikora-Frac, Tomasz Slomski, Isabel Joao, Ines Cruz, Hélder Pereira, Rita Cale, Ana Marques, Ana Rita Pereira, Carlos Morais, Antonio Freitas, David Roque, Nuno Antunes, Antonio Costeira Pereira, Catarina Vieira, Nuno Salome, Juliana Martins, Isabel Campos, Goncalo Cardoso, Claudia Silva, Afonso Oliveira, Mariana Goncalves, Rui Martins, Nuno Quintal, Bruno Mendes, Joseline Silva, Joao Ferreira, James Milner, Patricia Alves, Vera Marinho, Paula Gago, Jose Amado, Joao Bispo, Dina Bento, Inocencia Machado, Margarida Oliveira, Lucy Calvo, Pedro von Hate, Bebiana Faria, Ana Galrinho, Luisa Branco, Antonio Goncalves, Tiago Mendonca, Mafalda Selas, Filipe Macedo, Carla Sousa, Sofia Cabral, Filomena Oliveira, Maria Trepa, Marta Fontes-Oliveira, Alzira Nunes, Paulo Araújo, Vasco Gama Ribeiro, Joao Almeida, Alberto Rodrigues, Pedro Braga, Sonia Dias, Sofia Carvalho, Catarina Ferreira, Alberto Ferreira, Pedro Mateus, Miguel Moz, Silvia Leao, Renato Margato, Ilidio Moreira, Jose Guimanaes, Joana Ribeiro, Fernando Goncalves, Jose Cabral, Ines Almeida, Luisa Goncalves, Mariana Tarusi, Calin Pop, Claudia Matei, Diana Tint, Sanziana Barbulescu, Sorin Micu, Ioana Pop, Costica Baba, Doina Dimulescu, Maria Dorobantu, Carmen Ginghina, Roxana Onut, Andreea Popescu, Brandusa Zamfirescu, Raluca Aflorii, Mihaela Popescu, Liviu Ghilencea, Andreeea Rachieru, Monica Stoian, Nicoleta Oprescu, Silvia Iancovici, Iona Petre, Anca Doina Mateescu, Andreea Calin, Simona Botezatu, Roxana Enache, Monica Rosca, Daniela Ciuperca, Evelyn Babalac, Ruxandra Beyer, Laura Cadis, Raluca Rancea, Raluca Tomoaia, Adela Rosianu, Emese Kovacs, Constantin Militaru, Alina Craciun, Oana Mirea, Mihaela Florescu, Lucica Grigorica, Daniela Dragusin, Luiza Nechita, Mihai Marinescu, Teodor Chiscaneanu, Lucia Botezatu, Costela Corciova, Antoniu Octavian Petris, Catalina Arsenescu-Georgescu, Delia Salaru, Dan Mihai Alexandrescu, Carmjen Plesoianu, Ana Tanasa, Ovidiu Mitu, Irina Iuliana Costache, Ionut Tudorancea, Catalin Usurelu, Gabriela Eminovici, Ioan Manitiu, Oana Stoia, Adriana Mitre, Dan-Octavian Nistor, Anca Maier, Silvia Lupu, Mihaela Opris, Adina Ionac, Irina Popescu, Simina Crisan, Cristian Mornos, Flavia Goanta, Liana Gruescu, Oana Voinescu, Madalina Petcu, Ramona Cozlac, Elena Damrina, Liliya Khilova, Irina Ryazantseva, Dmitry Kozmin, Maria Kiseleva, Marina Goncharova, Kamila Kitalaeva, Victoria Demetskay, Artem Verevetinov, Mikhail Fomenko, Elena Skripkina, Viktor Tsoi, Georgii Antipov, Yuri Schneider, Denis Yazikov, Marina Makarova, Aleksei Cherkes, Natalya Ermakova, Aleksandr Medvedev, Anastasia Sarosek, Mikhail Isayan, Tatyana Voronova, Oleg Kulumbegov, Alina Tuchina, Sergei Stefanov, Margarita Klimova, Konstantin Smolyaninov, Zhargalma Dandarova, Victoriya Magamet, Natalia Spiropulos, Sergey Boldyrev, Kirill Barbukhatty, Dmitrii Buyankov, Vladimir Yurin, Yuriy Gross, Maksim Boronin, Mariya Mikhaleva, Mariya Shablovskaya, Alex Zotov, Daniil Borisov, Vasily Tereshchenko, Ekaterina Zubova, A. Kuzmin, Ivan Tarasenko, Alishir Gamzaev, Natalya Borovkova, Tatyana Koroleva, Svetlana Botova, Ilya Pochinka, Vera Dunaeva, Victoria Teplitskaya, Elena I. Semenova, Olga V. Korabel'Nikova, Denis S. Simonov, Elena Denisenko, Natalia Harina, Natalia Yarohno, Svetlana Alekseeva, Julia Abydenkova, Lyubov Shabalkina, Olga Mayorova, Valeriy Tsechanovich, Igor Medvedev, Michail Lepilin, PenzaEvgenii Nemchenko, Vadim Karnahin, Vasilya Safina, Yaroslav Slastin, Venera Gilfanova, Roman Gorbunov, Ramis Jakubov, Aigul Fazylova, Mansur Poteev, Laysan Vazetdinova, Indira Tarasova, Rishat Irgaliyev, Olga Moiseeva, Mikhail Gordeev, Olga Irtyuga, Raisa Moiseeva, Nina Ostanina, Dmitry Zverev, Patimat Murtazalieva, Dmitry Kuznetsov, Mariya Skurativa, Larisa Polyaeva, Kirill Mihaiilov, Biljana Obrenovic-Kircanski, Svetozar Putnik, Dragan Simic, Milan Petrovic, Natasa Markovic Nikolic, Ljiljana Jovovic, Dimitra Kalimanovska Ostric, Milan Brajovic, Milica Dekleva Manojlovic, Vladimir Novakovic, Danijela Zamaklar-Trifunovic, Bojana Orbovic, Olga Petrovic, Marija Boricic-Kostic, Kristina Andjelkovic, Marko Milanov, Maja Despotovic-Nikolic, Sreten Budisavljevic, Sanja Veljkovic, Nataša Cvetinovic, Daniijela Lepojevic, Aleksandra Todorovic, Aleksandra Nikolic, Branislava Borzanovic, Ljiljana Trkulja, Slobodan Tomic, Milan Vukovic, Jelica Milosavljevic, Mirjana Milanovic, Vladan Stakic, Aleksandra Cvetkovic, Suzana Milutinovic, Olivera Bozic, Miodrag Miladinovic, Zoran Nikolic, Dinka Despotovic, Dimitrije Jovanovic, Anastazija Stojsic-Milosavljevic, Aleksandra Ilic, Mirjana Sladojevic, Stamenko Susak, Srdjan Maletin, Salvo Pavlovic, Vladimir Kuzmanovic, Nikola Ivanovic, Jovana Dejanovic, Dusan Ruzicic, Dragana Drajic, Danijel Cvetanovic, Marija Mirkovic, Jon Omoran, Roman Margoczy, Katarina Sedminova, Adriana Reptova, Eva Baranova, Tatiana Valkovicova, Gabriel Valocik, Marian Kurecko, Marianna Vachalcova, Alzbeta Kollarova, Martin Studencan, Daniel Alusik, Marek Kozlej, Jana Macakova, Sergio Moral, Merce Cladellas, Daniele Luiso, Alicia Calvo, Jordi Palet, Juli Carballo, Gisela Teixido Tura, Giuliana Maldonado, Laura Gutierrez, Teresa Gonzalez-Alujas, Rodriguez Palomares Jose Fernando, Nicolas Villalva, Ma Jose Molina-Mora, Ramon Rubio Paton, Juan Jose Martinez Diaz, Pablo Ramos Ruiz, Alfonso Valle, Ana Rodriguez, Edgardo Alania, Emilio Galcera, Julia Seller, Gonzalo de la Morena Valenzuela, Daniel Saura Espin, Dolores Espinosa Garcia, Maria Jose Oliva Sandoval, Josefa Gonzalez, Miguel Garcia Navarro, Maria Teresa Perez-Martinez, Jose Ramon Ortega Trujillo, Irene Menduina Gallego, Daniel San Roman, Eliu David Perez Nogales, Olga Medina, Rodolfo Antonio Montiel Quintero, Pablo Felipe Bujanda Morun, Marta Lopez Perez, Jimmy Plasencia Huaripata, Juan Jose Morales Gonzalez, Veronica Quevedo Nelson, Jose Luis Zamorano, Ariana Gonzalez Gomez, Alfonso Fraile, Maria Teresa Alberca, Joaquin Alonso Martin, Covadonga Fernandez-Golfin, Javier Ramos, Sergio Hernandez Jimenez, Cristina Mitroi, Pedro L. Sanchez Fernandez, Elena Diaz-Pelaez, Beatriz Garde, Luis Caballero, Fermin Martinez Garcia, Francisco Cambronero, Noelia Castro, Antonio Castro, Alejandro De La Rosa, Pastora Gallego, Irene Mendez, David Villagomez Villegas, Manuel Gonzalez Correa, Roman Calvo, Francisco Florian, Rafael Paya, Esther Esteban, Francisco Buendia, Andrés Cubillos, Carmen Fernandez, Juan Pablo Cárdenas, José Leandro Pérez-Boscá, Joan Vano, Joaquina Belchi, Cristina Iglesia-Carreno, Francisco Calvo Iglesias, Aida Escudero-Gonzalez, Sergio Zapateria-Lucea, Juan Sterling Duarte, Lara Perez-Davila, Rafael Cobas-Paz, Rosario Besada-Montenegro, Maribel Fontao-Romeo, Elena Lopez-Rodriguez, Emilio Paredes-Galan, Berenice Caneiro-Queija, Alba Guitian Gonzalez, Abdi Bozkurt, Serafettin Demir, Durmus Unlu, Caglar Emre Cagliyan, Muslum Firat Ikikardes, Mustafa Tangalay, Osman Kuloglu, Necla Ozer, Ugur Canpolat, Melek Didem Kemaloglu, Abdullah Orhan Demirtas, Didar Elif Akgün, Eyup Avci, Gokay Taylan, Mustafa Adem Yilmaztepe, Fatih Mehmet Ucar, Servet Altay, Muhammet Gurdogan, Naile Eris Gudul, Mujdat Aktas, Mutlu Buyuklu, Husnu Degirmenci, Mehmet Salih Turan, Kadir Ugur Mert, Gurbet Ozge Mert, Muhammet Dural, Sukru Arslan, Nurten Sayar, Batur Kanar, Beste Ozben Sadic, Ahmet Anil Sahin, Ahmet Buyuk, Onur Kilicarslan, Cem Bostan, Tarik Yildirim, Seda Elcim Yildirim, Kahraman Cosansu, Perihan Varim, Ersin Ilguz, Recep Demirbag, Asuman Yesilay, Abdullah Cirit, Eyyup Tusun, Emre Erkus, Muhammet Rasit Sayin, Zeynep Kazaz, Selim Kul, Turgut Karabag, Belma Kalayci, Clinical sciences, Cardio-vascular diseases, and Cardiology

Subjects
Male, medicine.medical_specialty, Multivariate analysis, Clinical Decision-Making, Risk Assessment, Severity of Illness Index, decision making, surgery, Risk Factors, Internal medicine, Intervention (counseling), medicine, Clinical endpoint, Humans, 03.02. Klinikai orvostan, guidelines, Symptomatic aortic stenosis, Aged, Retrospective Studies, Aged, 80 and over, business.industry, valvular heart disease, Disease Management, aortic stenosis, Aortic Valve Stenosis, Odds ratio, medicine.disease, Europe, Stenosis, Treatment Outcome, Echocardiography, Aortic Valve, Charlson comorbidity index, transcatheter aortic valve replacement, Female, Morbidity, Cardiology and Cardiovascular Medicine, business, Follow-Up Studies, surgical aortic valve replacement
Abstract

BACKGROUND There were gaps between guidelines and practice when surgery was the only treatment for aortic stenosis (AS). OBJECTIVES This study analyzed the decision to intervene in patients with severe AS in the EORP VHD (EURObservational Research Programme Valvular Heart Disease) II survey. METHODS Among 2,152 patients with severe AS, 1,271 patients with high-gradient AS who were symptomatic fulfilled a Class I recommendation for intervention according to the 2012 European Society of Cardiology guidelines; the primary end point was the decision for intervention. RESULTS A decision not to intervene was taken in 262 patients (20.6%). In multivariate analysis, the decision not to intervene was associated with older age (odds ratio [OR]: 1.34 per 10-year increase; 95% CI: 1.11 to 1.61; P = 0.002), New York Heart Association functional classes I and II versus III (OR: 1.63; 95% CI: 1.16 to 2.30; P = 0.005), higher age adjusted Charlson comorbidity index (OR: 1.09 per 1-point increase; 95% CI: 1.01 to 1.17; P = 0.03), and a lower transaortic mean gradient (OR: 0.81 per 10-mm Hg decrease; 95% CI: 0.71 to 0.92; P < 0.001). During the study period, 346 patients (40.2%, median age 84 years, median EuroSCORE II [European System for Cardiac Operative Risk Evaluation II] 3.1%) underwent transcatheter intervention and 515 (59.8%, median age 69 years, median EuroSCORE II 1.5%) underwent surgery. A decision not to intervene versus intervention was associated with lower 6-month survival (87.4%; 95% CI: 82.0 to 91.3 vs 94.6%; 95% CI: 92.8 to 95.9; P < 0.001). CONCLUSIONS A decision not to intervene was taken in 1 in 5 patients with severe symptomatic AS despite a Class I recommendation for intervention and the decision was particularly associated with older age and combined comorbidities. Transcatheter intervention was extensively used in octogenarians. (J Am Coll Cardiol 2021;78:2131-2143) (c) 2021 by the American College of Cardiology Foundation.

Published
2021
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37. The L-RECORD Study

Author

Michalis Hamilos, George Hahalis, Grigorios Tsigkas, Ioannis Tsiafoutis, Michael Koutouzis, Konstantinos Katsanos, Periklis Davlouros, Athanasios Makris, Antonios Ziakas, and Emmanouil S. Brilakis

Subjects
Coronary angiography, medicine.medical_specialty, business.industry, MEDLINE, Femoral artery, 030204 cardiovascular system & hematology, 03 medical and health sciences, 0302 clinical medicine, Multicenter study, Equivalence Trial, medicine.artery, Internal medicine, medicine, Cardiology, In patient, 030212 general & internal medicine, Radial artery, Cardiology and Cardiovascular Medicine, business, Prospective cohort study
Abstract

L-RECORD (Left Radial Compared to Femoral Approach for Coronary Angiography in Patients With Previous CABG) is a randomized, prospective, multicenter study comparing coronary angiography (CAG) procedural parameters between left transradial access (L-TRA) and transfemoral access (TFA) in coronary

Published
2020
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38. Best Practices for the Prevention of Radial Artery Occlusion After Transradial Diagnostic Angiography and Intervention

Author

Avtandil Babunashvili, Sunil V. Rao, George Hahalis, Mamas A. Mamas, Gregory A. Sgueglia, Ian C. Gilchrist, Maarten A.H. van Leeuwen, Gilles Montalescot, Mario Gaudino, Marco Valgimigli, Olivier F. Bertrand, Adel Aminian, Antonio Ziakas, Ivo Bernat, Samir Pancholy, Shigeru Saito, Yves Louvard, and James Nolan

Subjects
medicine.medical_specialty, Bypass grafting, business.industry, Best practice, Arteriovenous fistula, 030204 cardiovascular system & hematology, medicine.disease, 03 medical and health sciences, 0302 clinical medicine, Diagnostic angiography, medicine.artery, Intervention (counseling), Occlusion, medicine, In patient, 030212 general & internal medicine, Radial artery, Cardiology and Cardiovascular Medicine, Intensive care medicine, business
Abstract

Highlights •RAO remains the most frequent post-procedural complication of transradial access, restricting the use of the same radial artery for future procedures, as a conduit for coronary artery bypass grafting or for arteriovenous fistula creation in patients requiring hemodialysis. •The real-world reported incidence of RAO remains high, with wide variability in the uptake of RAO prevention strategies. •The paper reviews the main recent advances in the field of RAO prevention and provides a series of expert recommendations to prevent RAO. •This consensus document is meant to provide guidance to increase the adoption of simple and effective methods to achieve an institutional rate of RAO

Published
2019
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39. Kounis Syndrome—not a Single-organ Arterial Disorder but a Multisystem and Multidisciplinary Disease

Author

Ioanna Koniari, George Hahalis, George Tzanis, Nicholas G. Kounis, and Dimitrios Velissaris

Subjects
medicine.medical_specialty, Allergy, lcsh:Medicine, Kounis syndrome, Coronary Disease, 030204 cardiovascular system & hematology, Chest pain, Sudden cardiac death, Angina, 03 medical and health sciences, 0302 clinical medicine, Kounis Syndrome, Internal medicine, medicine, anaphylaxis, Humans, 030212 general & internal medicine, Myocardial infarction, Mast Cells, Invited Review, business.industry, lcsh:R, General Medicine, medicine.disease, Mast cell, medicine.anatomical_structure, Coronary vasospasm, Cardiology, medicine.symptom, hypersensitivity, Cell activation, business, Mastocytosis
Abstract

Coronary symptoms associated with conditions related to mast cell activation and inflammatory cell interactions, such as those involving T-lymphocytes and macrophages, further inducing allergic, hypersensitivity, anaphylactic, or anaphylactic insults, are currently referred to as the Kounis syndrome. Kounis syndrome is caused by inflammatory mediators released during allergic insults, post-inflammatory cell activation, and interactions via multidirectional stimuli. A platelet subset of 20% with high- and low-affinity IgE surface receptors is also involved in this process. Kounis syndrome is not just a single-organ but also a complex multisystem and multi-organ arterial clinical condition; it affects the coronary, mesenteric, and cerebral arteries and is accompanied by allergy–hypersensitivity–anaphylaxis involving the skin, respiratory, and vascular systems in the context of anesthesia, surgery, radiology, oncology, or even dental and psychiatric medicine; further, it has significantly influences both morbidity and mortality. Kounis syndrome might be caused by numerous and continuously increasing causes, with broad clinical symptoms and signs, via multi-organ arterial system involvement, in patients of any age, thereby demonstrating predominant anaphylactic features in terms of a wide spectrum of mast cell-association disorders. Cardiac symptoms, such as chest pain, coronary vasospasm, angina pectoris, myocardial infarction, stent thrombosis, acute cardiac failure, and sudden cardiac death associated with subclinical, clinical, acute, or chronic allergic reactions, constitute the clinical manifestations of this syndrome. Since its first description, a common pathway between allergic and non-allergic coronary events has been demonstrated. The hypothesis is based on the existence of a much higher degree of mast cell degranulation at plaque erosion or rupture sites compared with at the adjacent areas or even more distant segments in post-acute myocardial infarction of non-allergic etiology. Although mast cell activation, differentiation, and mediator release takes days or weeks, the mast cell degranulation may occur just before any acute coronary event, further resulting in coronary artery vasoconstriction and atheromatous plaque rupture. It seems that medications and natural molecules stabilizing the mast cell membrane as well as monoclonal antibodies protecting the mast cell surface can emerge as novel therapeutic modalities for acute coronary and cerebrovascular event prevention.

Published
2019

40. Sodium-glucose co-transporter-2 inhibitors (SGLT2i) use and risk of amputation: an expert panel overview of the evidence

Author

Dimitri P. Mikhailidis, Costas Tsioufis, George Dimitriadis, Filippos Triposkiadis, Vasilios Tsimihodimos, Christos S. Mantzoros, George Hahalis, Niki Katsiki, Nikolaos Tentolouris, and Nikolaos Papanas

Subjects
0301 basic medicine, medicine.medical_specialty, Side effect, Endocrinology, Diabetes and Metabolism, medicine.medical_treatment, 030209 endocrinology & metabolism, Risk Assessment, Amputation, Surgical, 03 medical and health sciences, chemistry.chemical_compound, 0302 clinical medicine, Endocrinology, Glucosides, Internal medicine, Pharmacovigilance, medicine, Empagliflozin, Humans, Hypoglycemic Agents, Benzhydryl Compounds, Canagliflozin, Dapagliflozin, Data reporting, Adverse effect, Intensive care medicine, Sodium-Glucose Transporter 2 Inhibitors, business.industry, 030104 developmental biology, Diabetes Mellitus, Type 2, chemistry, Amputation, business, medicine.drug
Abstract

Sodium-glucose co-transporter-2 inhibitors (SGLT2i) are oral antidiabetic agents that exert their glucose-lowering effect by increasing renal excretion of glucose. These drugs have been reported to beneficially affect cardiovascular (CV) and renal outcomes. However, concerns have recently been raised in relation to increased risk of lower-extremities amputation with canagliflozin and it remains unclear whether and to what extent this side effect could also occur with other SGLT2i. The present expert panel overview focuses on the three SGLT2i available and widely used in the US and Europe, i.e. empagliflozin, canagliflozin and dapagliflozin and only refers briefly to other SGLT2i for which less data are available. The results of large CV outcome trials with these SGLT2i are presented, focusing specifically on the data in relation to amputation risk. The potential pathophysiological mechanisms involved in this side effect are discussed. Furthermore, available data reporting amputation cases in SGLT2i users are critically reviewed. The expert panel concludes that, based on current data, increased amputation risk seems to be related only to canagliflozin, thus representing a drug-effect rather than a SGLT2i class-effect. The exact pathways underlying this drug-induced adverse event, possibly related to off-target drug effects rather than SGLT2 inhibition per se, should be elucidated in future studies. Continuous monitoring and pharmacovigilance is necessary and head to head trials would also be essential to provide definitive conclusions.

Published
2019
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41. Stent Hypersensitivity and Infection in Sinus Cavities

Author

Nicholas G. Kounis M.D., Ph.D., George D. Soufras M.D., Ph.D., and George Hahalis M.D., Ph.D.

Subjects
Otorhinolaryngology, RF1-547, Immunologic diseases. Allergy, RC581-607
Abstract

Persistent mucosal inflammation, granulation tissue formation, hypersensitivity, and multifactorial infection are newly described complications of retained drug-eluting stents from endoscopic sinus surgery for refractory rhinosinusitis. In an important report published in Allergy and Rhinology, a 45-year-old male patient suffering from recalcitrant chronic rhinosinusitis underwent functional endoscopic sinus surgery and was found, for the first time, to have steroid-eluting catheters that were inadvertently left in the ethmoid and frontal sinuses. The retained catheters had caused persistent mucosal inflammation and formation of granulation tissue denoting hypersensitivity reaction. These consequences had induced perpetuation of symptoms of chronic rhinosinusitis. Meticulous removal of the retained stents with the nitinol wings from inflamed tissues of the frontal, ethmoidal, and sphenoethmoidal recesses in which they were completely imbedded was successfully performed without polypoid regrowth. Cultures of specimens taken from both left and right stents showed heavy growth of Stenotrophomonas maltophilia and moderate growth of Klebsiella oxytoca, coagulase negative Staphylococcus, and beta-hemolytic Streptococcus anginosus. Fungal infection was not detected. The current knowledge and experience regarding stent hypersensitivity and infection in relation with the use of stents in sinus cavities is reviewed.

Published
2013
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43. Bee sting-induced acute ischemic stroke: A new manifestation of kounis syndrome?

Author

George Hahalis, Ioanna Koniari, Andreas A. Argyriou, George D. Soufras, Periklis Davlouros, Nicholas G. Kounis, Grigorios Tsigkas, and Panagiotis Plotas

Subjects
medicine.medical_specialty, business.industry, MEDLINE, Kounis syndrome, medicine.disease, lcsh:RC346-429, Sting, Internal medicine, Cardiology, Medicine, Neurology (clinical), Letters to the Editor, business, Acute ischemic stroke, lcsh:Neurology. Diseases of the nervous system
Published
2021
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44. Clinical characteristics and management of patients with diabetes mellitus and stable coronary artery disease in daily clinical practice. The SCAD-DM Registry

Author

Evaggelos Pisimisis, Alexandros Amaslidis, Maria Samartzi, Christos Nikopoulos, Alexandros Vassilopoulos, Eleftherios Adamopoulos, Leonidas Lillis, Nikolaos Kipouridis, Emmanouil Chorozopoulos, Vasileios Drakoulidis, Christos Liatas, Georgia Vlahou, Emmanouil Psathakis, Konstantinos Kapetanios, Dimitrios Markou, Emmanouil Liodakis, Marios Konstantinou, Christos Athanasiou, Panos E. Vardas, Loukas Sinos, Vasileios Vogas, Paraskevi Psarogianni, Georgios I Papaioannou, Evangelos Rosmarakis, Chrysanthi Koukosi, Georgios Askar, Panagiotis Mavraganis, Konstantinos Panagiotopoulos, Ioannis Mavrodimitrakis, Soultana Papanastasiou, Nikolaos Kouvelas, Andreas Skanavis, Vasileios Vachliotis, Fotios Patsourakos, Spiridon Petrogiannis, Nikolaos Pontikakis, Dimitrios Mitropoulos, Stylianos Lambropoulos, Panagiotis Poulikarakos, Kristalenia Kafkala, Anestis Matziridis, Dimitrios Savvalas, Emmanouil Stefanakis, Isidoros Sarris, Andreas Papamichail, Nikolaos Marinakis, Virginia Markou, Konstantinos Koutras, Christos Katsikas, Mihail Kouremetis, Dimitrios I. Fotiadis, Vasileios Zouganelis, Ilias Antoniou, Savvas Nikiforos, Christos Kouris, Athanasios Karanasios, Andreas Pittaras, Emmanouel P. Vardas, Charalampos Albanis, Vasileios Mavridis, Theodora Tsiotika, Ioannis Tsiantis, Georgios Kontoroupis, Christos Hatjielefteriou, Nikolaos Kampouridis, Evropia Voukelatou, Grigorios Limperatos, Nikolaos Chrysomallis, Christos Stefopoulos, Kallinikos Tsakonas, Themistoklis Konstantinou, Nikiforos Vrettos, Achilleas Skordas, Ioannis Pantelakis, Harikleia Krontira, Eirini Kokani, Charalampos Parissis, George Hahalis, David Simeonidis, Konstantinos Vardakis, Georgios Pechlivanidis, Ioannis Vakalis, Maria Riga, Nikoloaos Oikonomidis, Alexandros Patsilinakos, Ioannis Mantas, Georgios Hondrokoukis, Apostolos Papadopoulos, Georgios Panagoulias, Vassiliki Sklirou, Konstantinos Davos, Theodoros Karonis, Stylianos Tzeis, Sokratis Avlonitis Antonios Beroukas, Konstantinos Katsas, Apostolos Kotidis, Vasileios Arfaras, Ioannis Goupios, Christos Zafiris, Maria Lolaka, Georgios Migias, Konstantinos Lalenis, Christos Harbas, Panagiotis Kalaras, Fotios Papalisandrou, Markos Prionidis, Dionisios Xenos, Maria E. Marketou, Konstantinos Svolis, Georgios Mablekos, Stavros Liropoulos, Georgios Tzeltzes, Ali Risgits, Dimitrios Sratech, Ilias Konstantinidis, Tsilla Zafiriou, Nikolaos Tsamis, Georgios Afaras, Christos Stathopoulos, Konstantinos Toulis, Evangelos Pisimisis, Georgios Kontopoulos, Maria Zaharia, Vasileios Hatjiioakeimidis, Antonios Giakoumis, Athanasios Patialiakas, Fanourios Zampetakis, Vasileios Karasavvidis, Vasileios Dimopoulos, Vassiliki Dimitroula, Antonios Manousakis, Christos Katsaris, Dimitrios Stergiou, Nikolaos Dimoulis, Kiriaki Faka, Georgios Koroniotis, Christos Stavrotheodoros, Panagiotis Papas, Konstantinos Zagoridis, Konstantinos Stefanis, Georgios Kolios, Iason Skotiniotis, Dimitrios Logothetis, Marina Kanakaraki, Achilleas Papadopoulos, Georgios Loukidelis, Vasileios Papavasileiou, Antonios Sideris, Konstantinos Aronis, Alexandros Galapis, Georgios Kouskos, Eftichia Demerouti, Vasileios Nikolaidis, Maria Andreopoulou, Anastasios Spanos, Konstantinos Sassalos, Eleni Tzamtzi-Mastaka, Charalambos Vlachopoulos, Georgios Karakostas, Georgios Koutsibanis, Nikolaos Smirnioudis, Georgios Siliogas, Sotirios Plastiras, Eleftherios Papavasileiou, Ioannis Livaditis, Andreas Karydakis, Ilias Apostolou, Emmanouil Scoubourdis, Sokratis Kazantzidis, Anna Panou, Rafail Stavropoulos, Dimitrios Psirropoulos, Georgios Aggelopoulos, Athanasios Platis, and Christos Mitroulas

Subjects
medicine.medical_specialty, Activities of daily living, Population, Myocardial Ischemia, Coronary Artery Disease, 030204 cardiovascular system & hematology, Coronary Angiography, Angina Pectoris, angina, Coronary artery disease, Angina, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, Diabetes mellitus, Stress Echocardiography, Diabetes Mellitus, Diseases of the circulatory (Cardiovascular) system, Medicine, media_common.cataloged_instance, Humans, 030212 general & internal medicine, Registries, European union, education, media_common, Aged, Aged, 80 and over, education.field_of_study, business.industry, Middle Aged, medicine.disease, RC666-701, Female, Cardiology and Cardiovascular Medicine, business, Scad
Abstract

Background Patients with diabetes mellitus and coronary artery disease (CAD) represent a high-risk population, where comorbidities are common, and the progression of coronary heart disease is relatively rapid and extensive. The present survey, conducted nationwide in a Eurozone country, Greece, with a properly organized national health system, aimed to record specific data from a significant number of patients with diabetes and documented stable CAD (SCAD). Methods and Results We conducted our survey across the country, in private and public primary, secondary and tertiary care centers. A total of 1900 patients aged 71±10 years old suffering from both diabetes mellitus and chronic coronary syndromes were registered. Of the patients registered 574 (30.24%) were women. It was found that 506 (26.6%) of the 1900 surveyed patients showed typical angina symptoms, while another 560 (29.5%) patients had developed angina-equivalent symptoms according to their history. Additionally, 324 (17%) patients had atypical symptoms that could not easily be attributed to existing coronary artery disease and the remaining 510 (26.8%) of the 1900 patients did not exhibit any angina symptoms during their daily activities. Functional testing for myocardial ischemia was not performed in 833 patients (43.8%). Myocardial scintigraphy was the most commonly used noninvasive technique (644 patients, 34%), while 492 patients (25.9%) had an exercise test and 159 (8.4%) underwent stress echocardiography. Conclusion Real world data in this specific high-risk population of diabetic patients with SCAD offers the opportunity to identify and improve diagnostic and therapeutic practice in the health-care system of a European Union country.

Published
2020

45. The paradox of heparin induced thrombocytopenia-thrombosis, the role of fondaparinux and the need for new therapeutic strategies

Author

Panagiotis Plotas, George D. Soufras, George Hahalis, Ioanna Koniari, Grigorios Tsigkas, Periklis Davlouros, and Nicholas G. Kounis

Subjects
medicine.medical_specialty, Heparin, business.industry, MEDLINE, Anticoagulants, Thrombosis, Fondaparinux, medicine.disease, Thrombocytopenia, Heparin-induced thrombocytopenia, Humans, Medicine, Cardiology and Cardiovascular Medicine, business, Intensive care medicine, medicine.drug
Published
2020
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46. Inflammation, Thrombosis, and Platelet-to-Lymphocyte Ratio in Acute Coronary Syndromes

Author

George D. Soufras, Periklis Davlouros, Grigorios Tsigkas, Nicholas G. Kounis, Panagiotis Plotas, George Hahalis, and Ioanna Koniari

Subjects
Inflammation, Aging, business.industry, Platelet Count, Lymphocyte, Coronary Thrombosis, medicine.disease, Thrombosis, medicine.anatomical_structure, C-Reactive Protein, Immunology, Medicine, Cytokines, Humans, Platelet, Lymphocyte Count, medicine.symptom, Acute Coronary Syndrome, Cardiology and Cardiovascular Medicine, business, Biomarkers, Transcription Factors
Published
2020

47. 'Missing' acute coronary syndrome hospitalizations during the COVID ‐19 era in Greece: Medical care avoidance combined with a true reduction in incidence?

Author

Ioannis G. Styliadis, Katerina K. Naka, Zacharias‐Alexandros Anyfantakis, Ioannis Mamarelis, Paraskevi Grammata, Haralambos Karvounis, Christos S. Katsouras, Michail I. Papafaklis, Fotini Tsiourantani, George Sianos, Antonios Ziakas, Konstantinos Triantafyllou, George Hahalis, Athanasios Trikas, Grigorios Tsigkas, Thomais Lamprou, Dimitri Karmpaliotis, Sotirios Patsilinakos, Nikolaos Iakovis, Anna Dagre, Efthymia Varytimiadi, Dimitrios Tziakas, Evgenia Pappa, Loukas K. Pappas, Konstantinos Toutouzas, Lampros K. Michalis, Periklis Davlouros, Georgios Katsimagklis, and Maria Kousta

Subjects
Male, medicine.medical_specialty, Acute coronary syndrome, Clinical Investigations, 030204 cardiovascular system & hematology, Coronary Angiography, Rate ratio, acute coronary syndrome, 03 medical and health sciences, 0302 clinical medicine, COVID‐19, acute cardiac care, Humans, Medicine, 030212 general & internal medicine, Myocardial infarction, Pandemics, Aged, Retrospective Studies, Greece, SARS-CoV-2, business.industry, Unstable angina, Incidence, Public health, Incidence (epidemiology), public health, COVID-19, Outbreak, Retrospective cohort study, General Medicine, Middle Aged, medicine.disease, Hospitalization, myocardial infarction, Emergency medicine, Female, business, Cardiology and Cardiovascular Medicine
Abstract

Background Reports from countries severely hit by the COVID‐19 pandemic suggest a decline in acute coronary syndrome (ACS)‐related hospitalizations. The generalizability of this observation on ACS admissions and possible related causes in countries with low COVID‐19 incidence are not known. Hypothesis ACS admissions were reduced in a country spared by COVID‐19. Methods We conducted a nationwide study on the incidence rates of ACS‐related admissions during a 6‐week period of the COVID‐19 outbreak and the corresponding control period in 2019 in Greece, a country with strict social measures, low COVID‐19 incidence, and no excess in mortality. Results ACS admissions in the COVID‐19 (n = 771) compared with the control (n = 1077) period were reduced overall (incidence rate ratio [IRR]: 0.72, P

Published
2020
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48. Gadolinium-induced Kounis syndrome including electrocardiographic considerations

Author

George Hahalis, George D. Soufras, Panagiotis Plotas, Ioanna Koniari, Nicholas G. Kounis, Periklis Davlouros, and Grigorios Tsigkas

Subjects
medicine.medical_specialty, chemistry, business.industry, Gadolinium, Internal medicine, medicine, Cardiology, chemistry.chemical_element, Kounis syndrome, General Medicine, medicine.disease, business, Miscellany
Published
2020

49. Sugammadex-induced atropine-resistant bradycardia: clinical, pathophysiologic, and electrocardiographic considerations

Author

George Hahalis, Nicholas G. Kounis, Ioanna Koniari, Panagiotis Plotas, Grigorios Tsigkas, George D. Soufras, and Periklis Davlouros

Subjects
Bradycardia, medicine.medical_specialty, Pain medicine, MEDLINE, Kounis syndrome, Sugammadex, lcsh:RD78.3-87.3, Anesthesiology, medicine, Anesthesia, Letter to the Editor, Anaphylaxis, business.industry, lcsh:Medical emergencies. Critical care. Intensive care. First aid, lcsh:RC86-88.9, medicine.disease, Atropine, Anesthesiology and Pain Medicine, lcsh:Anesthesiology, medicine.symptom, business, medicine.drug
Published
2020

50. How to develop a national heart failure clinics network: a consensus document of the Hellenic Heart Failure Association

Author

Stamatios Adamopoulos, Ilias Sichlimiris, Eftychios Siniorakis, Dimitrios Chrysos, Michael Bonios, Nikolaos Kouvelas, Alexandra Frogoudaki, Konstantinos Kyrlas, Spyridon Maragkoudakis, Evangelos Pisimisis, Konstantina Toli, Georgios Katsimagklis, Ioannis Mantas, Charalampos Karvounis, Grigorios Oikonomou, Sotirios Floros, Georgios Kalogiannis, Niki Vlasopoulou, Eftratios Apostolou, Chrysoula Nikolaou, Anastasios Spanos, Kontantina Katsanou, Maria Thodi, Ioannis Paraskevaidis, John Parissis, Anastasios Theodosis‐Georgilas, Dimitrios Tziakas, Anastasia Kitsiou, George Hahalis, Eleni Karapatsoudi, Athanasios Anadiotis, Minas Pappas, Vassilios Giannaris, Angeliki Gkouziouta, Eftychia Chamodraka, Konstantinos Sassalos, E. Leontiadis, Konstantinos Tsitlakidis, Georgios Tsinopoulos, Katerina Avgeropoulou, Elefthereos Thireos, Vasiliki Bistola, Maria Marketou, Paraskevi Ntoliou, Peggy Kostakou, Theodoros G. Papaioannou, Georgios Spyropoulos, Konstantinos Polymeropoulos, Emmanouil Lamprogiannakis, Fragkiskos Parthenakis, Efstratios Theofilogiannakos, Vasiliki Panagopoulou, Sotirios Patsilinakos, Dimosthenis Drosos, Filippos Triposkiadis, Niki Mpaka, Costas H. Papadopoulos, Gregory Giamouzis, Christos Katsikas, Takis Xydas, Stauroula Kosmopoulou, Chris Adamopoulos, Georgios Papingiotis, Gerasimos Gavrielatos, Alexandros Douras, Petros Kikas, Alaa Ampoushamala, Stylianos Lampropoulos, Dimitrios Konstantinou, Elias Tsougos, Spyridon Papamentzelopoulos, Alexandros Katranis, John Christodoulou, Athanasios Manginas, Demitrios Karounis, Katerina K. Naka, Maria Nikolaou, Kalliopi Keramida, Vasiliki Matzaraki, Nikolaos Kampouridis, Lina Zitiridou, Evangelos Lazaris, Pavlos Stougiannos, Antonis Sideris, Soultana Bakaimi, Petros Voutas, Ioannis Kanonidis, Christina Chrysohoou, Ioannis Alexanian, Elias Andreanides, Spyridon Papaioannou, Ekaterini Lambrinou, Maria Sifaki, John Zarifis, Petros Stravopodis, Georgios Bakosis, Athanasios Kranidis, Panagiota Naoum, Athanasios Vasilopoulos, Ioannis Kogias, Constantinos Bakogiannis, Gerasimos Siasos, Evangelos Sdogkos, Apostolos Karavidas, Athanasios Trikas, Dimitrios Karatzas, Panagiotis Stafylas, Panagiotis Koudounis, Antonios Marsonis, Polixeni Brika, Nikolaos Karamichalakis, Georgios Almpanis, Konstantinos Tsioufis, Periklis Syros, Nikos Kouris, Elias Gialafos, Gerasimos Filippatos, Eleni Bousoula, Katerina Fountoulaki, Tsampikos Giakoumakis, Sotirios Xydonas, Dionysios Kalpakos, Metaxia Driva, Maria Georgopoulou, John Nanas, Vassilios Vassilikos, Georgios Spyromitros, George Giannakoulas, Ioannis Tsounos, Dimitrios Farmakis, Alexia Stavrati, Antonios Draganigos, Georgios Nikitas, Argyrios Ntalianis, Christoforos Olympios, and Maria Bonou

Subjects
Heart Failure, Heart failure clinics, lcsh:Diseases of the circulatory (Cardiovascular) system, medicine.medical_specialty, Consensus, business.industry, Association (object-oriented programming), Heart failure, Review, Electronic health care record, Multidisciplinary team, medicine.disease, Medical and Health Sciences, Heart failure network, Discharge letter, lcsh:RC666-701, Emergency medicine, medicine, Humans, Clinical Medicine, Cardiology and Cardiovascular Medicine, business
Abstract

Heart failure (HF) is rapidly growing, conferring considerable mortality, morbidity, and costs. Dedicated HF clinics improve patient outcomes, and the development of a national HF clinics network aims at addressing this need at national level. Such a network should respect the existing health care infrastructures, and according to the capacities of hosting facilities, it can be organized into three levels. Establishing the continuous communication and interaction among the components of the network is crucial, while supportive actions that can enhance its efficiency include involvement of multidisciplinary health care professionals, use of structured HF‐specific documents, such as discharge notes, patient information leaflets, and patient booklets, and implementation of an HF‐specific electronic health care record and database platform.

Published
2020

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