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1. Quality of Anticoagulation Control in Preventing Adverse Events in Patients With Heart Failure in Sinus Rhythm

Author

S. Shaw, Conrado J. Estol, Biykem Bozkurt, B. Donelly, R. Berkowitz, L. Berente, M. Jurczok, J. Simon, Sami Khella, A. Travis, M. Schoenauer, Ronald S. Freudenberger, Anikó Ilona Nagy, G. Marcinek, M. Hajkova, T. Siebert, R. Breedveld, W. Baker, P. Avellana, S. Kozhukhov, M. Diek, J. Jaros, R. Vicari, S. Timar, C. Schanz, J. Povolny, M. van Zagten, Shelley Zieroth, G. Rex, M. Apelian, M. Dzaiy, K. Hayward, A. Warner, L. Baliko, Piotr Ponikowski, S. Mathus, Arthur J. Labovitz, C. DeMers, E. Péterfai, Mariana Bolos, B. Stephens, F. Tito, Denise L. Janosik, N. Molakala, J. Dizes, R. van der Loo, A. van Bujisen-Nutters, K. Wolf, S. Nawaz, A. Boguschewski, D. Ferguson, A. McPhail, M. Rohwedder, M. Malkowski, R. Prodhan, P. Miekus, R. Pellegrino, M. Rossi, Michelle Bierig, E. Wirkowski, Zbigniew Gaciong, F. Guerlloy, D. Chupka, O. Kovtun, M. Padour, D. Horak, Elly M.C.J. Wajon, J. Carda, P. Gregor, M. Tilem, P. Kosolcharoen, R. Wensel, V. Garman, N. Torok, B. Benczur, E. Peña, G. Moe, B.M. Massie, S. Slomiak, C. Benesch, V. Orlyk, K. Greenan, M. Ogorek, I. Jedlinski, Shun Kohsaka, R. Haynes, Z. Lorenc, M. Kuchar, R. Pauer, T. Dugan, A. Juszczak, T. Schrader, A. Henriquez, K. Toth, M. Varga, J. Herman, M. Lee, M. Dunaj, L. Krizova, M. Bonora, P. Loviska, D. Aubin, M. Kokles, J. D. Easton, J. Meschia, A. Bruno, Steven Goldman, S. Voigt, D. Malchik, A. Tierney, Demetrios J. Sahlas, N. Elzebroek, Richard J. Hobbs, M. Charlet, B. Hattler, L. Regos, Dennis Wolf, A. Peljto, C. Lindsey, R. Winkler, J. Arredondo, B. Oze, C. Schuler, D. Bruck, E. Jones, G. Torre, S. Nabhan, G. Mallis, Jindřich Špinar, W. Graettinger, A. Ruiz, N. Holwerda, R. Katz, J. Gonzalez, Christine Gerula, P. Jansky, H. V. Anderson, B. Krizova, Andreas König, M. Moussavian, M. Konarzewski, G. Jakab, M. Liston, Elizabeth O. Ofili, L. Nikolaidis, Susan E. Ammon, Rebekka K. Schneider, M. Krauze-Wielicka, M. Zimmermann, J. Lynch, J. Minuk, F. Sokn, Douglas L. Mann, R. Sawyer, J. Partridge, D. Leifer, M. Bohdanowicz-Zazula, D. Barratt, C. Dewar, S. Kolomiets, T. Noonan, D. Beran, M. Jeserich, J. Wong, R. Bessoudo, M. Lichtenberger, E. Bednarova, R. Serafin, M. Scullin, I. Kosa, M. Hranai, E. Duverger, L. Joseph, A. M. Sindilar, I. Edes, E. Yakimenko, J. Hobbs-Williams, F. Novoa, A. Szczepanska, R. Wachter, P. A. de Milliano, L. Golan, Gregory W. Albers, K. Ammerman, Alexandra R. Sanford, W. Burgin, A. Richmond, A. Kleinrok, B. Dandapani, Laurie Gutmann, M. Houra, Udho Thadani, P. Schygiel, A. van Hessen, Christian Weber, S. Mehešová, P. Stein-Beal, E. Flanagan, R. Khadouri, P. Chang, Thomas P. Cappola, L. Konczarek, B. Mangariello, L. Atkins, C. McKay, J. Svoboda, O. Lesniak, L. Westbrook, S. J. Kim, C. Moy, M. Kuch, M. Nemec, M. Krobot, B. Kozlowski, M. Applegate, M. Kiorwantsi, J. Thierer, K. Craig, A. Slim, Y. Besaga, R. Kuba, P. Fulop, K. Crotto, R. Porcile, E. Falgout, E. Olgren, K. Kuc, Marcus F. Stoddard, W. Almeida, L. Pas, L. Williams, I. Sorokina, J. Rodl, S. Sparr, A. Coppes, E. Ronner, A. Jurczyk, S. Gass, John R. Teerlink, P. Kucera, H. J. Barnett, B. McGinnis, L. Wilson, Y. Tutov, R. MacFadyen, Gregory Y.H. Lip, V. Sorrell, T. Ochalek, J. Turner, M. Modzelewski, Matthew Wilson, A. Ogorodnichuk, C. Anderson, P. de Kort, B. Palossy, Alan B. Miller, T. Giles, H. Brown, Andrew H. Baker, P. Czaja, Roman Szełemej, J. Hanna, P. Gilbert, A. Metcalf, R. Piotrowski, D. Yip, B. Coull, P. Gitelman, Burkert Pieske, C. Rapallo, M. Morgil, M. Resch, A. Zachar, Jan Biegus, W. Watson, J. A. Hinchey, E. Polland, L. Caufield, D. Kopcik, E. Pechackova, M. Calderon, Stefan D. Anker, V. Virkud, R. Rothbart, L. Rudenko, W. Wicha, B. Jacques, Susan Graham, J. Donaldson, O. Girina, L. Guillory, S. Khoury, I. Padourova, Haissam Haddad, L. Kowalczyk, J. A. Swain, G. Prokop-Lewicka, R. Mattessich, K. Remmel, S. Tikhonova, S. Klochkov, J. Leppo, K. C. Johnston, D. Gohs, Peter K. Smith, Eric E. Smith, V. Hart, J. Vanyi, L. Voronkov, G. Allam, M. Klapholz, T. Varadyova, S. Daugherty, L. Witkin, K. Panizzon, B. Drachman, S. Locke, Ann‐Katrin Mojica Munoz, J. Love, T. Winder, P. Bailey, T. Huynh, G. A. Verheul, Tomasz J. Pasierski, J. Borbola, R. Liu, A. Elizalde, C. Walker, R. Kelley, Robert Côté, P. Frey, J. McGee, Peter E. Carson, T. Bator, Donald L. Patrick, K. Karsay, J. Plomp, O. Novikova, J. Vuijsters, Jay P. Mohr, A. Parkhomenko, A. Ducharme, C. Alteri, S. Borden, Siqin Ye, W. Felton, K. Peterson, M. Satori, N. Polenova, D. Karia, G. Turhan, R. Nagy, K. Amosova, J. Michalska, R. Libman, E. Frey, O. Najmanova, R. Yufe, O. Montaña, S. Bailey, M. Bodi, A. Ellis, J. Tarchalski, L. Sitwell, M. Del Valle, John P. Boehmer, J. Marler, P. Romia, K. Tea, E. Hartmann, R. Lebedova, V. Yurlov, O. Karpenko, Malcolm Arnold, P. Berkowski, J. Johnson, P. Ramappa, R. Ferkl, Dirk J. Lok, N. Bayer, S. Bezucha, A. Mercando, H. Tworek, R. Longaker, P. Jinkins, J. Kirmani, L. Svoboda, David Spence, Min Qian, John L.P. Thompson, N. Brodi, Y. Prokopovych, Sedat Sen, M. Nanna, S. T. Palmeri, M. Michalova, L. Giron, K. Wolkowska, D. Borts, K. Hamroui, G. Linssen, L. Arcement, A. McNulty, C. Jakobs, F. Bleyer, W. Lo, J. Bisognano, J. Kosits, Steven R. Levine, G. Berry, P. Heidrich, G. Kiss, G. Tullio, J. Yasen, G. Ortiz, B. O'Hare, P. Jackson, T. Rennie, Z. Davidovits, G. v Buchem-Damming, H. Dvorakova, W. Hermans, Zbigniew Kalarus, H. Morgil, C. Harris, M. Vissiennon, Shunichi Homma, André P. Gabriel, J. Aiub, I. Katzan, C. Zaidman, S. Sassone, A. Duszanska, J. Litvinova, P. Kralicek, M. Natour, E. Nagy, E. Nishime, M. J. Bos, S. Nowakowska, J. Beebe, B. Watson, N. Jacek, Ralph L. Sacco, A. Cwynar, S. Pezzella, B. George, B. Hott, T. Vegh, V. Mejia, E. Janzen, M. Eliasziw, Heribert Schunkert, L. Swydan, J. Gora, D. Drazek, C. Landau, L. Roffidal, L. Casazza, Andrew M Penn, Richard L. Hughes, V. Schumann, R. Santi, I. Sakharchuk, A. Adler, D. Taylor, C. F. Peerenboom-Fey, M. Dluzniewski, L. Cape, Attila Kovacs, E. Ziekenhuis, A. Bujdoso, L. Fischer, Richard Buchsbaum, Petr Arenberger, L. Pollak, J. Vosmerova, B. Donley, Patrick M. Pullicino, B. Darrow, A. Minagar, N. Jarmukli, J. Dissin, M. Daniels, L. Csuros, G. J. del Zoppo, E. Anthony, B. Metzkier-Wyrwa, A. Ronaszeki, I. Malek, R. Arbing, Gilberto Levy, D. Mauceri, Carlos J. Rodriguez, V. Kovalenko, J. Smith, O. Yaremenko, R. de Graaf Gasthuis, C. Donato, L. Spinarova, Martin M. Brown, F. Padour, O. Lovasz, Marco R. Di Tullio, K. Balaban, S. Donovan, S. Genth-Zotz, M. Maruskova, I. Varga, T. Drasnar, V. Berchou, R. Davies, Robert G. Hart, M. Lebedynska, G. Hageman, D. Disantis, W. Schneider, M. Frankel, A. Hajnalne, S. Baumann, P. Karpati, L. C. Pettigrew, Johnston Grier, A. Ellenberg, Bruce Levin, and Stephanie Hope Dunlap

Subjects
Intracerebral hemorrhage, medicine.medical_specialty, Aspirin, Ejection fraction, business.industry, Warfarin, 030204 cardiovascular system & hematology, medicine.disease, 3. Good health, Surgery, 03 medical and health sciences, 0302 clinical medicine, Interquartile range, Heart failure, Internal medicine, medicine, Cardiology, Sinus rhythm, 030212 general & internal medicine, Cardiology and Cardiovascular Medicine, business, Stroke, medicine.drug
Abstract

Background— The aim of this study is to examine the relationship between time in the therapeutic range (TTR) and clinical outcomes in heart failure patients in sinus rhythm treated with warfarin. Methods and Results— We used data from the Warfarin versus Aspirin in Reduced Cardiac Ejection Fraction (WARCEF) trial to assess the relationship of TTR with the WARCEF primary outcome (ischemic stroke, intracerebral hemorrhage, or death), with death alone, ischemic stroke alone, major hemorrhage alone, and net clinical benefit (primary outcome and major hemorrhage combined). Multivariable Cox models were used to examine how the event risk changed with TTR and to compare the high TTR, low TTR, and aspirin-treated patients, with TTR being treated as a time-dependent covariate. A total of 2217 patients were included in the analyses; among whom 1067 were randomized to warfarin and 1150 were randomized to aspirin. The median (interquartile range) follow-up duration was 3.6 (2.0–5.0) years. Mean (±SD) age was 61±11.3 years, with 80% being men. The mean (±SD) TTR was 57% (±28.5%). Increasing TTR was significantly associated with reduction in primary outcome (adjusted P P =0.001), and improved net clinical benefit (adjusted P P =0.082 for ischemic stroke and adjusted P =0.109 for major hemorrhage). Conclusions— In patients with heart failure in sinus rhythm, increasing TTR is associated with better outcome and improved net clinical benefit. Patients in whom good quality anticoagulation can be achieved may benefit from the use of anticoagulants. Clinical Trial Registration— URL: http://www.clinicaltrials.gov . Unique identifier: NCT00041938.

Published
2015
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2. Immunosuppressant Regimen over Time and Their Association with Rejection, Graft Failure, and Mortality

Author

L. Nikolaidis, Bryan A. Whitson, Yazhini Ravi, R.C. Scott, S. Bansal, Chittoor B. Sai-Sudhakar, P.C. Rosas, Ayesha Hasan, and E.M. Stock

Subjects
Pulmonary and Respiratory Medicine, Transplantation, medicine.medical_specialty, Regimen, Graft failure, business.industry, Internal medicine, Medicine, Surgery, Cardiology and Cardiovascular Medicine, business
Published
2016
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3. Pathogenesis of osteoporosis in liver cirrhosis

Author

Olga I, Giouleme, Timoleon A, Vyzantiadis, Nikolaos L, Nikolaidis, Themistoklis G, Vasiliadis, Athanasios A, Papageorgiou, Nikolaos P, Eugenidis, and Fedon I, Harsoulis

Subjects
Adult, Liver Cirrhosis, Male, Adolescent, Middle Aged, Hormones, Bone Density, Case-Control Studies, Prevalence, Humans, Osteoporosis, Female, Gonads, Biomarkers, Aged
Abstract

Osteoporosis has been recognized in patients with liver cirrhosis, although the prevalence and the exact mechanisms vary considerably in the literature. We have studied the prevalence of bone disease in cirrhotic patients, the pathogenesis and the relation to the etiology and the severity of liver failure.The study included 83 hospitalized patients with various types of cirrhosis, where 25 healthy individuals served as controls. Patients were classified according to Child-Pugh's stages as follows: Child A: 49, Child B: 20, Child C: 14. Serum levels of iPTH, 250HD, LH, FSH, SHBG, testosterone, estradiol, IGF-I, osteocalcin and urine levels of cross-linked N-telopeptides of collagen type 1 (NTX) were measured in all patients. Bone mineral density (BMD) was measured by DEXA at the spine of both patients and controls.The prevalence of osteoporosis was higher in patients (26/83) 31.3% than in controls (4/25) 16%. Osteopenia was positively related with the elevated levels of crosslinked N-telopeptides (p=0.048). There were no differences in BMD between the types of cirrhosis. BMD was found to be significantly lower in Child B and C male patients than in Child A (p=0.043). Patients' groups B, and C had lower testosterone levels with a trend to contribute to the low BMD (p=0.15). 250HD and IGF-1 were significantly lower in decompensated cirrhosis (p0.002), but did not correlate with BMD.Cirrhosis is a major cause of osteoporosis and the degree of osteopenia is related to the severity and not the etiology of the liver disease. The biochemical markers of bone remodeling suggest a high-turnover osteoporosis in cirrhosis.

Published
2006

4. An open system for ECG telemedicine and telecare

Author

A Thanos, George Economakos, L. Nikolaidis, George K. Papakonstantinou, and Panayotis Tsanakas

Subjects
Public switched telephone network, Telemedicine, business.industry, Telecare, Computer security, computer.software_genre, Medical services, DICOM, Information system, Cellular network, Open system (computing), Medicine, Telecommunications, business, computer
Abstract

A novel system for ECG Telemedicine and Telecare is presented. It exhibits a low cost performance ratio and thus can provide advanced telemedicine services in remote or isolated areas. It can be used as a fundamental telemedicine platform, offering essential medical services, allowing a referred physician from far away to offer assistance without traveling to the referred medical site. The communication infrastructure used covers a wide range of media including public switched telephone network and cellular networks. The system is open with respect to the hardware it uses. The system is also open to Generalized Hospital Information Systems due to its DICOM compliance.

Published
2002
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5. Animation techniques for real time ECG monitoring

Author

George Economakos, L. Nikolaidis, and George K. Papakonstantinou

Subjects
Telemedicine, Multimedia, Computer science, Remote patient monitoring, business.industry, Mobile broadband, Mobile computing, Animation techniques, computer.software_genre, Mobile telephony, business, computer, Computer animation, Data transmission
Abstract

Telemedicine applications are tools that aid doctors perform their duty without being physically present. This can be accomplished provided that some kind of communications infrastructure can convey the same amount of information and in the same way as if the doctor was present. It is also desirable for that communications infrastructure to support mobile communications so as to be applicable in mobile units (like ambulances). Today mobile voice communications are widely spread all over the world. The same means can be used for mobile data communications. However, the data transmission rate is not regular and so telemedicine information is presented in a non-regular rate, which can be very annoying for the remote doctor. This paper discusses animation techniques that keep viewing rate constant regardless of the transmission rate. These techniques have been tested in a mobile ECG telemonitoring system.

Published
2002
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6. On minimum-energy broadcasting in all-wireless networks

Author

Fulu Li and L. Nikolaidis

Subjects
Mobile radio, business.industry, Computer science, Wireless network, Distributed computing, Broadcast domain, Broadcasting, Atomic broadcast, Intelligent Network, Broadcast communication network, Computer Science::Networking and Internet Architecture, Mobile telephony, business, Broadcast radiation, Computer network
Abstract

We study the construction of the source-initiated (one-to-all) wireless broadcast tree to minimize the total required power for a given source node, a group of intended destination nodes and a given propagation constant, ie, the power attenuation constant /spl lambda/. The minimum energy broadcasting (MEB) problem has received much attention recently due to the two main challenges of mobile communication: the limited bandwidth of wireless networks and the limited power supply of mobile units. In a limited-bandwidth environment, push-based techniques, ie, broadcast schemes, appear to be a very effective way to allow mobile units to share the broadcast data on air. In a limited-energy environment, energy- efficient communication architectures and techniques are essential. We first give an insight analysis on the MEB problem and prove the NP-hardness of this problem. We then present an efficient heuristic called iterative maximum-branch minimization (IMBM) to approximate the construction of the minimum-energy broadcast tree, which fully utilizes the wireless broadcast advantage and demonstrates better performance compared with the related approaches. Due to the power-efficient way of the construction of the broadcast tree, the lifetime of the networks can be maximized.

Published
2002
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7. Optical Packet Access Protocols for WDM Networks [Book Review]

Author

l. Nikolaidis

Subjects
Java, Computer Networks and Communications, business.industry, Computer science, Quality of service, Optical packet, Network topology, Microarchitecture, Hardware and Architecture, Wavelength-division multiplexing, business, Optical add-drop multiplexer, computer, Software, Information Systems, Computer network, computer.programming_language
Published
2002
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10. Content Distribution Networks, An Engineering Approach [Book Review]

Author

l. Nikolaidis

Subjects
Web server, Computer Networks and Communications, business.industry, Computer science, IP forwarding, Overlay network, computer.software_genre, Network topology, Data science, World Wide Web, Hardware and Architecture, Content distribution, Scalability, The Internet, business, computer, Software, Information Systems
Published
2002
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11. Design and Implementation of DSL-Based Access Solutions [Book Review]

Author

l. Nikolaidis

Subjects
Java, Computer Networks and Communications, computer.internet_protocol, Computer science, business.industry, Multiprotocol Label Switching, Encapsulation (networking), Microarchitecture, Digital subscriber line, Hardware and Architecture, Asynchronous Transfer Mode, Embedded system, business, computer, Software, Information Systems, computer.programming_language
Published
2002
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13. Small-Duct Primary Sclerosing Cholangitis. A Single-Center Seven-Year Experience.

Author

Nikolaos L. Nikolaidis, Olga I. Giouleme, Konstantinos A. Tziomalos, Kalliopi Patsiaoura, Eirini Kazantzidou, Anastasios D. Voutsas, Themistoklis Vassiliadis, and Nikolaos P. Eugenidis

Abstract

Patients with cholestatic liver function tests and histological features of primary sclerosing cholangitis (PSC) but without the typical cholangiographic changes are considered to have small-duct PSC. The incidence of small-duct PSC and the natural history still is not known. We performed a retrospective search for patients diagnosed with small-duct PSC between January 1997 and December 2003. The diagnosis of small-duct PSC was based on biochemical features of chronic cholestasis, liver biopsy findings consistent with PSC, and a normal cholangiogram on endoscopic retrograde cholangiography. Six patients fulfilled the diagnostic criteria for small-duct PSC. All patients received medical therapy. After a mean follow-up time of 26.0 ± 29.8 months (range, 7–84 months), all patients are alive. Repeated liver biopsy was performed in one patient, 58 months after the initial one, and disclosed amelioration of histological findings (reduction in the Ludwig fibrosis score from 4 to 2). During follow-up symptoms disappeared in all patients who were symptomatic at diagnosis; none of those who were asymptomatic at diagnosis developed symptoms. At the time of last follow-up all patients showed significant improvement of their biochemical variables compared to baseline. Administration of aminosalicylates seemed to be of benefit irrespective of the presence of inflammatory bowel disease. No patients underwent liver transplantation or developed cholangiocarcinoma. Even though our study included a low number of patients and the follow-up time was relatively short, we can suggest that small-duct PSC rarely progresses to large-duct PSC and does not seem to be associated with development of cholangiocarcinoma. It thus seems to represent a separate entity with a favorable prognosis. [ABSTRACT FROM AUTHOR]

Published
2005

14. International Society for Heart and Lung Transplantation Guidelines for the Evaluation and Care of Cardiac Transplant Candidates-2024.

Author

Peled Y, Ducharme A, Kittleson M, Bansal N, Stehlik J, Amdani S, Saeed D, Cheng R, Clarke B, Dobbels F, Farr M, Lindenfeld J, Nikolaidis L, Patel J, Acharya D, Albert D, Aslam S, Bertolotti A, Chan M, Chih S, Colvin M, Crespo-Leiro M, D'Alessandro D, Daly K, Diez-Lopez C, Dipchand A, Ensminger S, Everitt M, Fardman A, Farrero M, Feldman D, Gjelaj C, Goodwin M, Harrison K, Hsich E, Joyce E, Kato T, Kim D, Luong ML, Lyster H, Masetti M, Matos LN, Nilsson J, Noly PE, Rao V, Rolid K, Schlendorf K, Schweiger M, Spinner J, Townsend M, Tremblay-Gravel M, Urschel S, Vachiery JL, Velleca A, Waldman G, and Walsh J

Subjects
Humans, Societies, Medical, Heart-Lung Transplantation standards, Waiting Lists, Practice Guidelines as Topic, Patient Selection, Heart Transplantation standards
Abstract

The "International Society for Heart and Lung Transplantation Guidelines for the Evaluation and Care of Cardiac Transplant Candidates-2024" updates and replaces the "Listing Criteria for Heart Transplantation: International Society for Heart and Lung Transplantation Guidelines for the Care of Cardiac Transplant Candidates-2006" and the "2016 International Society for Heart Lung Transplantation Listing Criteria for Heart Transplantation: A 10-year Update." The document aims to provide tools to help integrate the numerous variables involved in evaluating patients for transplantation, emphasizing updating the collaborative treatment while waiting for a transplant. There have been significant practice-changing developments in the care of heart transplant recipients since the publication of the International Society for Heart and Lung Transplantation (ISHLT) guidelines in 2006 and the 10-year update in 2016. The changes pertain to 3 aspects of heart transplantation: (1) patient selection criteria, (2) care of selected patient populations, and (3) durable mechanical support. To address these issues, 3 task forces were assembled. Each task force was cochaired by a pediatric heart transplant physician with the specific mandate to highlight issues unique to the pediatric heart transplant population and ensure their adequate representation. This guideline was harmonized with other ISHLT guidelines published through November 2023. The 2024 ISHLT guidelines for the evaluation and care of cardiac transplant candidates provide recommendations based on contemporary scientific evidence and patient management flow diagrams. The American College of Cardiology and American Heart Association modular knowledge chunk format has been implemented, allowing guideline information to be grouped into discrete packages (or modules) of information on a disease-specific topic or management issue. Aiming to improve the quality of care for heart transplant candidates, the recommendations present an evidence-based approach., (Copyright © 2024 International Society for the Heart and Lung Transplantation. Published by Elsevier Inc. All rights reserved.)

Published
2024
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15. Case Illustration of the Natural History of Left Dominant Arrhythmogenic Cardiomyopathy.

Author

Sanford CB, Fan J, Hua Y, Nikolaidis L, Edmister W, Payne S, Dandapantula H, Veer M, and Nguyen V

Abstract

Background: Arrhythmogenic left ventricular cardiomyopathy is an increasingly recognized cause of recurrent myocarditis, a mimicker of acute coronary syndrome, and an important cause of malignant ventricular arrythmias and heart failure. Desmoplakin is a protein that is critical to maintaining the structural integrity of the myocardium. Disruption of desmoplakin leads to fibrofatty infiltration of the myocardium which leads to congestive heart failure, cardiac arrhythmias, and sudden cardiac death. However, desmoplakin cardiomyopathy is often misdiagnosed, resulting in significant morbidity and mortality. We report 2 contrasting cases illustrating the natural history-hot and cold phases-of arrhythmogenic left ventricular cardiomyopathy. Case Series: The first case demonstrates a common phenotypic presentation of desmoplakin cardiomyopathy manifested as recurrent myocarditis and myocardial injury representing the hot phase. The second case is an undulating course of chronic systolic heart failure and ventricular arrhythmias representing the cold phase. Conclusion: Arrhythmogenic cardiomyopathy manifests as a spectrum of disease processes that involve the right, left, or both ventricles. Mutations in the desmoplakin gene are often associated with a left dominant ventricular cardiomyopathy. Diagnosis remains difficult as the condition has no signature clinical presentation, and imaging findings are variable., (©2024 by the author(s); Creative Commons Attribution License (CC BY).)

Published
2024
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16. Exercise-induced pulmonary artery hypertension in a patient with compensated cardiac disease: hemodynamic and functional response to sildenafil therapy.

Author

Nikolaidis L, Memon N, and O'Murchu B

Subjects
Cardiac Catheterization, Exercise Test, Exercise Tolerance drug effects, Humans, Hypertension, Pulmonary diagnosis, Hypertension, Pulmonary etiology, Hypertension, Pulmonary physiopathology, Male, Middle Aged, Point-of-Care Testing, Predictive Value of Tests, Stroke Volume, Treatment Outcome, Ventricular Dysfunction, Left complications, Ventricular Dysfunction, Left diagnosis, Ventricular Dysfunction, Left drug therapy, Ventricular Function, Left, Antihypertensive Agents therapeutic use, Exercise, Hemodynamics drug effects, Hypertension, Pulmonary drug therapy, Sildenafil Citrate therapeutic use, Vasodilator Agents therapeutic use, Ventricular Dysfunction, Left physiopathology
Abstract

We describe the case of a 54-year-old man who presented with exertional dyspnea and fatigue that had worsened over the preceding 2 years, despite a normally functioning bioprosthetic aortic valve and stable, mild left ventricular dysfunction (left ventricular ejection fraction, 0.45). His symptoms could not be explained by physical examination, an extensive biochemical profile, or multiple cardiac and pulmonary investigations. However, abnormal cardiopulmonary exercise test results and a right heart catheterization-combined with the use of a symptom-limited, bedside bicycle ergometer-revealed that the patient's exercise-induced pulmonary artery hypertension was out of proportion to his compensated left heart disease. A trial of sildenafil therapy resulted in objective improvements in hemodynamic values and functional class.

Published
2015
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