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1. Heart failure in COVID‐19: the multicentre, multinational PCHF‐COVICAV registry

Author

Mateusz Sokolski, Sander Trenson, Justyna M. Sokolska, Domenico D'Amario, Philippe Meyer, Nana K. Poku, Tor Biering‐Sørensen, Mats C. Højbjerg Lassen, Kristoffer G. Skaarup, Eduardo Barge‐Caballero, Anne‐Catherine Pouleur, Davide Stolfo, Gianfranco Sinagra, Klemens Ablasser, Viktoria Muster, Peter P. Rainer, Markus Wallner, Alessandra Chiodini, Pascal S. Heiniger, Fran Mikulicic, Judith Schwaiger, Stephan Winnik, Huseyin A. Cakmak, Margherita Gaudenzi, Massimo Mapelli, Irene Mattavelli, Matthias Paul, Irina Cabac‐Pogorevici, Claire Bouleti, Marzia Lilliu, Chiara Minoia, Jeroen Dauw, Jérôme Costa, Ahmet Celik, Nathan Mewton, Carlos E.L. Montenegro, Yuya Matsue, Goran Loncar, Michal Marchel, Aris Bechlioulis, Lampros Michalis, Marcus Dörr, Edgard Prihadi, Felix Schoenrath, Daniel R. Messroghli, Wilfried Mullens, Lars H. Lund, Giuseppe M.C. Rosano, Piotr Ponikowski, Frank Ruschitzka, and Andreas J. Flammer

Subjects
COVID‐19, SARS‐CoV2, Heart failure, Cardiovascular disease, Risk factors, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract

Abstract Aims We assessed the outcome of hospitalized coronavirus disease 2019 (COVID‐19) patients with heart failure (HF) compared with patients with other cardiovascular disease and/or risk factors (arterial hypertension, diabetes, or dyslipidaemia). We further wanted to determine the incidence of HF events and its consequences in these patient populations. Methods and results International retrospective Postgraduate Course in Heart Failure registry for patients hospitalized with COVID‐19 and CArdioVascular disease and/or risk factors (arterial hypertension, diabetes, or dyslipidaemia) was performed in 28 centres from 15 countries (PCHF‐COVICAV). The primary endpoint was in‐hospital mortality. Of 1974 patients hospitalized with COVID‐19, 1282 had cardiovascular disease and/or risk factors (median age: 72 [interquartile range: 62–81] years, 58% male), with HF being present in 256 [20%] patients. Overall in‐hospital mortality was 25% (n = 323/1282 deaths). In‐hospital mortality was higher in patients with a history of HF (36%, n = 92) compared with non‐HF patients (23%, n = 231, odds ratio [OR] 1.93 [95% confidence interval: 1.44–2.59], P

Published
2021
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2. Transcatheter Aortic Valve Implantation with the Portico Valve: 2-Year Outcomes of a Multicenter, Real-World Registry

Author

Matthaios Didagelos, Vlasis Ninios, Charalampos Kakderis, Lampros Lakkas, Antonios Kouparanis, Dimitrios Nikas, Katerina K. Naka, Aidonis Rammos, Thomas Zegkos, Vasileios Kamperidis, Ilias Ninios, Sotirios Evangelou, Dimitrios G. Tsalikakis, Lampros Michalis, and Antonios Ziakas

Subjects
TAVI, Portico, aortic stenosis, valvular disease, Science
Abstract

Introduction: The self-expanding, resheathable, repositionable transcatheter aortic heart valve Portico is being used successfully for transcatheter aortic valve implantation procedures (TAVI) in patients with severe aortic stenosis. The aim of this study was to evaluate outcomes at 2 years after TAVI with the Portico valve. Methods: Multicenter registry of clinical, echocardiographic and survival data from consecutive patients treated with the Portico TAVI system (Abbott, Chicago, IL, USA) in three cath labs in Northern Greece and Epirus during 2017–2020. The primary end point was all-cause mortality at 24 months. Secondary end points included procedural outcomes (efficacy and safety) and echocardiographic measurements. Results: A total of 90 patients (81 ± 6 years, 50% females, mean age 81 ± 6 years) were included in the registry. The indication for implantation was severe, symptomatic aortic stenosis (NYHA III, IV) in eighty-two (91.1%) and degeneration of a prosthetic aortic valve in eight (8.9%) patients. All patients were categorized as high surgical risk (mean Logistic Euroscore 25.9 ± 10, Euroscore II 7.7 ± 4.4 and STS score 10.8 ± 8.9). The procedure was performed transfemorally in all patients, under general anesthesia in 95.6%, under TOE guidance in 21.1%, with native valve predilatation in 46.7%, and the “resheath” option was used in 31.1% of the cases. The implantation was successful in 97.8% and there was a need for a second valve in 2.2% of the cases. Complications included permanent pacemaker implantation (16.7%), access cite complications (15.6%), arrythmias (23.3%), paravalvular leak (moderate 7.8%, severe 1.1%), acute kidney injury (7.8%), no strokes and one death during the procedure. Aortic valve peak velocity, peak and mean pressure gradients, were significantly reduced after the procedure. All-cause mortality at 1, 12 and 24 months was 4.4%, 6.7% and 7.8%, respectively. Conclusions: TAVI with the Portico system comprises an effective and safe solution for the management of severe, symptomatic aortic stenosis in high-risk surgical patients.

Published
2023
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3. A Novel Approach to Generate a Virtual Population of Human Coronary Arteries for In Silico Clinical Trials of Stent Design

Author

Dimitrios Pleouras, Antonis Sakellarios, George Rigas, Georgia S. Karanasiou, Panagiota Tsompou, Gianna Karanasiou, Vassiliki Kigka, Savvas Kyriakidis, Vasileios Pezoulas, George Gois, Nikolaos Tachos, Aidonis Ramos, Gualtiero Pelosi, Silvia Rocchiccioli, Lampros Michalis, and Dimitrios I. Fotiadis

Subjects
Cardiovascular virtual population, clinical data augmentation, plaque growth modeling, in-silico clinical trials, Computer applications to medicine. Medical informatics, R858-859.7, Medical technology, R855-855.5
Abstract

Goal: To develop a cardiovascular virtual population using statistical modeling and computational biomechanics. Methods: A clinical data augmentation algorithm is implemented to efficiently generate virtual clinical data using a real clinical dataset. An atherosclerotic plaque growth model is employed to 3D reconstructed coronary arterial segments to generate virtual coronary arterial geometries (geometrical data). Last, the combination of the virtual clinical and geometrical data is achieved using a methodology that allows for the generation of a realistic virtual population which can be used in in silico clinical trials. Results: The results show good agreement between real and virtual clinical data presenting a mean gof 0.1 ± 0.08. 400 virtual coronary arteries were generated, while the final virtual population includes 10,000 patients. Conclusions: The virtual arterial geometries are efficiently matched to the generated clinical data, both increasing and complementing the variability of the virtual population.

Published
2021
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4. IVUS Longitudinal and Axial Registration for Atherosclerosis Progression Evaluation

Author

Nikos Tsiknakis, Constantinos Spanakis, Panagiota Tsompou, Georgia Karanasiou, Gianna Karanasiou, Antonis Sakellarios, George Rigas, Savvas Kyriakidis, Michael Papafaklis, Sotirios Nikopoulos, Frank Gijsen, Lampros Michalis, Dimitrios I. Fotiadis, and Kostas Marias

Subjects
atherosclerosis, IVUS, stent, longitudinal registration, axial registration, image registration, Medicine (General), R5-920
Abstract

Intravascular ultrasound (IVUS) imaging offers accurate cross-sectional vessel information. To this end, registering temporal IVUS pullbacks acquired at two time points can assist the clinicians to accurately assess pathophysiological changes in the vessels, disease progression and the effect of the treatment intervention. In this paper, we present a novel two-stage registration framework for aligning pairs of longitudinal and axial IVUS pullbacks. Initially, we use a Dynamic Time Warping (DTW)-based algorithm to align the pullbacks in a temporal fashion. Subsequently, an intensity-based registration method, that utilizes a variant of the Harmony Search optimizer to register each matched pair of the pullbacks by maximizing their Mutual Information, is applied. The presented method is fully automated and only required two single global image-based measurements, unlike other methods that require extraction of morphology-based features. The data used includes 42 synthetically generated pullback pairs, achieving an alignment error of 0.1853 frames per pullback, a rotation error 0.93° and a translation error of 0.0161 mm. In addition, it was also tested on 11 baseline and follow-up, and 10 baseline and post-stent deployment real IVUS pullback pairs from two clinical centres, achieving an alignment error of 4.3±3.9 for the longitudinal registration, and a distance and a rotational error of 0.56±0.323 mm and 12.4°±10.5°, respectively, for the axial registration. Although the performance of the proposed method does not match that of the state-of-the-art, our method relies on computationally lighter steps for its computations, which is crucial in real-time applications. On the other hand, the proposed method performs even or better that the state-of-the-art when considering the axial registration. The results indicate that the proposed method can support clinical decision making and diagnosis based on sequential imaging examinations.

Published
2021
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5. European Board for Accreditation in Cardiology (EBAC) 2015 CME/CPD Survey Summary

Author

Julie Simper, Robert Schaefer, Reinhard Griebenow, Lampros Michalis, and Heinz Weber

Subjects
Survey, CME/CPD, provider, EBAC, accreditation, needs assessment, conflict of interest, evaluation, respondents, Special aspects of education, LC8-6691, Medicine (General), R5-920
Abstract

In the spring of 2015, the European Board for Accreditation in Cardiology (EBAC) collaborated with International CME/CPD Consulting to design and administer a survey to approximately 1,171 professionals active in the field of European CME/CPD, with a focus on cardiology. With a nearly 5% response rate, the results herewith are non-representative, but do express current behaviours and attitudes of those active in European accredited CME/CPD.

Published
2016
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6. Proposal for a graded approach to disclosure of interests in accredited CME/CPD

Author

Reinhard Griebenow, Craig Campbell, Amir Qaseem, Sean Hayes, Jennifer Gordon, Lampros Michalis, Heinz Weber, Eugene Pozniak, and Robert Schäfer

Subjects
conflict of interest, disclosure, CME, CPD, graded approach, bias, unifying disclosure form, score, Special aspects of education, LC8-6691, Medicine (General), R5-920
Abstract

Disclosing conflicts of interest (COIs) is an important step in the management of COIs and is considered to be crucial to the trustworthiness of presenters. There are significant variations in disclosure procedures regarding the following:a. How COI is assessed in declaration forms (e.g. type of question, respondent awareness)b. Type of relationshipsc. Detailing of information to program committee membersThese variations in procedures have in effect led toa. Underreporting of COIb. Reducing the informational value of declared COI to participantsThus, it has been the aim of the authors to propose a basic formula for a minimum standard declaration of financial COI, with the potential to be applicable to all types of accredited continuing medical education (CME) as well as to all individuals (e.g. speakers, authors) involved in planning and conduct of CME activities. This approach should also serve as basis for more elaborate disclosures as well as strategies for management of conflict of interests adapted to the risk of bias.Furthermore, we also propose a basic set of items to be declared as nonfinancial interests.

Published
2015
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7. Position paper on current aspects of sponsoring in accredited CME

Author

Daiana Stolz, Reinhard Griebenow, Andre Tichelli, Andrew J. Ullmann, Richard W. Costello, Lampros Michalis, Margarita Guenova, Sandy Sutter, Fabiola De Andrade, and Robert Schaefer

Subjects
European Specialty Accreditation Boards, independent CME, sponsoring, transparency, professional congress organiser (PCO), medical education company, information material, Special aspects of education, LC8-6691, Medicine (General), R5-920
Abstract

This position paper is the result of a collaborative approach of several European Specialty Accreditation Boards (ESABs) and, has been stimulated by their current experience in accreditation regarding roles and responsibilities assumed by sponsors of accredited continuing medical education (CME). The suggestions made in this paper aim to preserve the fundamental principle in CME accreditation that the physician in charge of the programme has sole responsibility for the selection of topics, speakers, content and format, as well as mode of presentation, and that sponsors will under no circumstances interfere with this principle. This is considered as a responsibility of an individual physician (or physicians), which cannot be delegated, even in part, to third parties. This responsibility has been extended to include all communication before and after the event. The paper also identifies undecided issues, about which ESABs are committed to elaborate proposals in the future.

Published
2017
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8. Roles and Responsibilities in the Provision of Accredited Continuing Medical Education/Continuing Professional Development

Author

Reinhard Griebenow, Craig Campbell, Graham T. McMahon, Kate Regnier, Jennifer Gordon, Eugene Pozniak, Daiana Stolz, Amir Qaseem, Gerd Antes, Samar Aboulsoud, Helmut König, Dirk Schulenburg, Hans Gehle, Peter Mills, Lampros Michalis, Heinz Weber, and Robert Schaefer

Subjects
Providers in CME, accredited CME, components constituent to accredited CME, procedural description of roles and responsibilities, Special aspects of education, LC8-6691, Medicine (General), R5-920
Abstract

The Cologne Consensus Conference 2015 has focused on “Providers in accredited CME[continuing medical education]/CPD [continuing professional development]”. As an outcome of the CCC 2015, the authors of this paper, who were part of the faculty, propose a contemporary definition of the roles and responsibilities of stakeholders involved in the different stages of planning, delivery and evaluation of CME/CPD.

Published
2017
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9. 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

10. OCT sequence registration before and after percutaneous coronary intervention (stent implantation)

Author

Nikos Tsiknakis, Constantinos Spanakis, Panagiota Tsoumpou, Georgia Karanasiou, Gianna Karanasiou, Antonis Sakellarios, George Rigas, Savvas Kyriakidis, Michail I. Papafaklis, Sotirios Nikopoulos, Frank Gijsen, Lampros Michalis, Dimitrios I. Fotiadis, Kostas Marias, and Cardiology

Subjects
Signal Processing, Biomedical Engineering, Health Informatics
Abstract

To assess the progression of coronary artery disease, Optical Coherence Tomography (OCT) pullbacks acquired at different timepoints should be compared. However, the assessment of temporal sequences is a difficult task, as motion artifacts in the longitudinal and axial plane can decrease the quality of the manual inspection. To address this challenge, the current study presents a two-stage computational framework for the longitudinal and axial registration of two OCT pullbacks. During the first stage of the process, we focus on the accurate detection of the matching image pairs from the respective series, while during the second stage we focus on the axial registration of the matched pairs so that their common features are aligned. The dataset used includes 19 patients from two clinical centers, with two OCT pullbacks per patient: one before the stent implantation procedure and one after it. We applied our method on a synthetic dataset of OCT pullbacks, which was generated based on the in-vivo OCT pullbacks to reproduce the motion artifacts across the planes. In addition, the proposed method was validated on the 19 pairs of in-vivo OCT pullbacks with annotated pre/post stent deployment data. The method was able to reduce the alignment error from 32.17±26.14 to 5.6±6.6 frames, the rotational error from 11.59°±11.22° to 1.18°±0.81° and the distance error from 3.07mm±1.52mm to 0.46mm±0.44mm. In addition, the mean Mutual Information similarity increased by 13.47% after the longitudinal registration and an additional 123.33% after the axial registration on top of the previous one.

Published
2023

11. List of contributors

Author

Nidal Abi Rafeh, Pierfrancesco Agostoni, Sukru Akyuz, Khaldoon Alaswad, Ziad A. Ali, Salman S. Allana, Chadi Alraies, Mario Araya, Alexandre Avran, Lorenzo Azzalini, Avtandil Babunashvili, Subhash Banerjee, Sripal Bangalore, Baktash Bayani, Michael Behnes, Ravinay Bhindi, Nicolas Boudou, Nenad Ž. Božinović, Leszek Bryniarski, Alexander Bufe, Christopher E. Buller, M. Nicholas Burke, Pedro Pinto Cardoso, Mauro Carlino, Joao L. Cavalcante, Tarek Chami, Raj H. Chandwaney, Konstantinos Charitakis, Victor Y. Cheng, James W. Choi, Evald Høj Christiansen, Yashasvi Chugh, Antonio Colombo, Claudia Cosgrove, Kevin Croce, Ramesh Daggubati, Félix Damas de los Santos, Rustem Dautov, Rhian E. Davies, Tony de Martini, Ali E. Denktas, Joseph Dens, Carlo di Mario, Roberto Diletti, Zisis Dimitriadis, Darshan Doshi, Parag Doshi, Kefei Dou, Mohaned Egred, Basem Elbarouni, Ahmed M. ElGuindy, Amr Elhadidy, Stephen Ellis, Javier Escaned, Panayotis Fasseas, Farshad Forouzandeh, Sergey Furkalo, Andrea Gagnor, Alfredo R. Galassi, Robert Gallino, Roberto Garbo, Santiago Garcia, Gabriele Gasparini, Junbo Ge, Lei Ge, Pravin Kumar Goel, Omer Goktekin, Nieves Gonzalo, Sevket Gorgulu, Luca Grancini, J. Aaron Grantham, Raviteja Guddeti, Elias V. Haddad, Allison B. Hall, Jack J. Hall, Sean Halligan, Franklin Leonardo Hanna Quesada, Colm Hanratty, Stefan Harb, Scott A. Harding, Raja Hatem, David Hildick-Smith, Jonathan M. Hill, Taishi Hirai, Mario Iannaccone, Wissam Jaber, Farouc A. Jaffer, Yangsoo Jang, Brian K. Jefferson, Allen Jeremias, Risto Jussila, Nikolaos Kakouros, Artis Kalnins, Sanjog Kalra, Arun Kalyanasundaram, David E. Kandzari, Hsien-Li Kao, Judit Karacsonyi, Dimitri Karmpaliotis, Hussien Heshmat Kassem, Kathleen Kearney, Jimmy Kerrigan, Jaikirshan Khatri, Dmitrii Khelimskii, Ajay J. Kirtane, Paul Knaapen, Spyridon Kostantinis, Michalis Koutouzis, Mihajlo Kovacic, Oleg Krestyaninov, A.V. Ganesh Kumar, Prathap Kumar N., Katherine J. Kunkel, Pablo Manuel Lamelas, Seung-Whan Lee, Thierry Lefevre, Gregor Leibundgut, Nicholas J. Lembo, Martin Leon, John R. Lesser, Raymond Leung, Soo-Teik Lim, Sidney Tsz Ho Lo, William Lombardi, Michael Luna, Ehtisham Mahmud, Madeline K. Mahowald, Anbukarasi Maran, Konstantinos Marmagkiolis, Evandro Martins Filho, Kambis Mashayekhi, Margaret B. McEntegart, Michael Megaly, Perwaiz Meraj, Lampros Michalis, Anastasios N. Milkas, Owen Mogabgab, Jeffrey Moses, Muhammad Munawar, Bilal Murad, Alexander Nap, Andres Navarro, William J. Nicholson, Anja Øksnes, Göran Olivecrona, Mohamed A. Omer, Jacopo Andrea Oreglia, Lucio Padilla, Mitul P. Patel, Rajan A.G. Patel, Taral Patel, Ashish Pershad, Duane Pinto, Paul Poommipanit, Marin Postu, Srini Potluri, Stylianos Pyxaras, Alexandre Schaan de Quadros, Michael Ragosta, Sunil V. Rao, Vithala Surya Prakasa Rao, Sudhir Rathore, Joerg Reifart, Athanasios Rempakos, Jeremy Rier, Robert Riley, Stéphane Rinfret, Juan J. Russo, Meruzhan Saghatelyan, Gurpreet S. Sandhu, Yader Sandoval, Ricardo Santiago, James Sapontis, Alpesh Shah, Evan Shlofmitz, Kendrick A. Shunk, George Sianos, Bahadir Simsek, Elliot J. Smith, Anthony Spaedy, James Spratt, Julian W. Strange, Bradley Strauss, Péter Tajti, Hector Tamez, Khalid O. Tammam, Craig A. Thompson, Aurel Toma, Catalin Toma, Ioannis Tsiafoutis, Etsuo Tsuchikane, Imre Ungi, Barry F. Uretsky, Georgios J. Vlachojannis, Minh Nhat Vo, Hoang Vu Vu, Simon Walsh, Daniel Weilenmann, Gerald Werner, Jarosław Wójcik, Jason Wollmuth, Eugene B. Wu, R. Michael Wyman, Iosif Xenogiannis, Bo Xu, Masahisa Yamane, Luiz F. Ybarra, and Robert W. Yeh

Published
2023

12. An in silico trials platform for the evaluation of stent design effect in post-implantation outcomes

Author

Georgia S. Karanasiou, Panagiota I. Tsompou, Nikolaos Tachos, Gianna E. Karanasiou, Antonis Sakellarios, Savvas Kyriakidis, Luca Antonini, Giancarlo Pennati, Lorenza Petrini, Frank Gijsen, Ted Vaughan, Christos Katsouras, Lampros Michalis, Dimitrios I. Fotiadis, and Cardiology

Subjects
Percutaneous Coronary Intervention, Tissue Scaffolds, Absorbable Implants, Stents
Abstract

Bioresorbable Vascular Scaffolds (BVS), developed to allow drug deliver and mechanical support, followed by complete resorption, have revolutionized atherosclerosis treatment. InSilc is a Cloud platform for in silico clinical trials (ISCT) used in the design, development and evaluation pipeline of stents. The platform integrates beyond the state-of-the-art multi-disciplinary and multiscale models, which predict the scaffold's performance in the short/acute and medium/long term. In this study, a use case scenario of two Bioabsorbable Vascular Stents (BVSs) implanted in the same arterial anatomy is presented, allowing the whole InSilc in silico pipeline to be applied and predict how the different aspects of this intervention affect the success of stenting process.

Published
2022

14. CRT-100.14 Preclinical Study of a Novel Everolimus-Coated Coronary Balloon

Author

Anargyros N. Moulas, Grigorios Tsigkas, Christos S. Katsouras, Alexandros Tousis, Georgios Vasilagkos, Michail Theofanis, Ioannis Spyridonidis, Ioanna Samara, Panagiotis Kitrou, Arsen Semertzioglou, Athanassios Vratimos, Maria Vaiou, Dimitrios I. Fotiadis, Dimitrios Karnabatidis, Periklis Davlouros, and Lampros Michalis

Subjects
Cardiology and Cardiovascular Medicine
Published
2023

15. 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

16. Riociguat treatment in patients with chronic thromboembolic pulmonary hypertension. final safety data from the EXPERT registry

Author

Hossein-Ardeschir Ghofrani, Miguel-Angel Gomez Sanchez, Marc Humbert, David Pittrow, Gérald Simonneau, Henning Gall, Ekkehard Grünig, Hans Klose, Michael Halank, David Langleben, Repke J. Snijder, Pilar Escribano Subias, Lisa M. Mielniczuk, Tobias J. Lange, Jean-Luc Vachiéry, Hubert Wirtz, Douglas S. Helmersen, Iraklis Tsangaris, Joan A. Barberá, Joanna Pepke-Zaba, Anco Boonstra, Stephan Rosenkranz, Silvia Ulrich, Regina Steringer-Mascherbauer, Marion Delcroix, Pavel Jansa, Iveta Šimková, George Giannakoulas, Jens Klotsche, Evgenia Williams, Christian Meier, Marius M. Hoeper, Jorge Caneva, Graciela Tuhay, Mirta Diez, Maria Lujan Talavera, Adriana Acosta, Norberto Vulcano, Martin Bosio, Lorena Maldonado, Sabino Deleo, Luciano Melatini, Anne Keogh, Eugene Kotlyar, John Feenstra, Nathan Dwyer, Heath Adams, Wendy Stevens, Peter Steele, Susanna Proudman, Robert Minson, Glenn Reeves, Melanie Lavender, Benjamin Ng, Michele Mackenzie, Lisa Barry, Margarethe Gruenberger, Charlotte Huber, Irene Lang, Ioana Tilea, Roela Sadushi-Kolici, Judith Löffler-Ragg, Lisa-Theresa Feistmantl, Patrick Evrard, Renaud Louis, Julien Guiot, Marco Naldi, Michel De Pauw, Sanjay Mehta, Rafael Conde Camacho, Patricia Parada Tovar, Alejandro Londoño, Felipe Campo, Paula Garcia, Camila Lema, Mauricio Orozco-Levi, William Martinez, Juan Esteban Gomez, Jens Erik Nielsen-Kudsk, Soren Mellemkjaer, Ly Anton, Alan Altraja, Tapani Vihinen, Tuija Vasankari, Olivier Sitbon, Vincent Cottin, Laurent Têtu, Elise Noël-Savina, Nicole Shearman, Susanne Tayler, Ilona Olzik, Christine Kulka, Jan Grimminger, Marcel Simon, Anna Nolde, Tim Oqueka, Lars Harbaum, Benjamin Egenlauf, Ralf Ewert, Christian Schulz, Sabine Regotta, Tilmann Kramer, Susanne Knoop-Busch, Felix Gerhardt, Stavros Konstantinides, Georgia Pitsiou, Ioannis Stanopoulos, Evdokia Sourla, Sofia Mouratoglou, Haralambos Karvounis, Athanasios Pappas, Dimitrios Georgopoulos, Michail Fanaridis, Ioanna Mitrouska, Lampros Michalis, Konstantinos Pappas, Anna Kotsia, Sean Gaine, Carmine Dario Vizza, Giovanna Manzi, Roberto Poscia, Roberto Badagliacca, Piergiuseppe Agostoni, Noemi Bruno, Stefania Farina, Michele D'Alto, Paola Argiento, Anna Correra, Giovanni Maria Di Marco, Chiara Cresci, Vieri Vannucchi, Elena Torricelli, Alessio Garcea, Alberto Pesci, Luca Sardella, Giuseppe Paciocco, Federico Pane, Andrea Maria D'Armini, Maurizio Pin, Valentina Grazioli, Giulia Massola, Antonio Sciortino, Renato Prediletto, Carolina Bauleo, Edoardo Airò, Rudina Ndreu, Ivana Pavlickova, Claudio Lunardi, Massimiliano Mulè, Silvia Farruggio, Serena Costa, Giuseppe Galgano, Mario Petruzzi, Anna De Luca, Francesco Lombardi, Loris Roncon, Luca Conte, Claudio Picariello, Gil Wirtz, Myriam Alexandre, A. Vonk-Noordegraaf, H. Boogaard, J. Mager, H. Reesink, Leon M. van den Toorn, Karin Boomars, Arne K. Andreassen, Graça Castro, Gonçalves Tania, Rui Baptista, António Marinho, Teresa Shiang, Ana Oliveira, Daniel Coutinho, Joana Sousa, Maria José Loureiro, Débora Repolho, Susana Maria Martins Jesus, Marta Capinha, João Agostinho, Tania Cardoso, Andreia Rocha, Mafalda Espinha, Kyundyul Ivanovich Ivanov, Dalyana Eduardovna Alexeeva, Marina Vadimovna Batalina, Daria Viktorovna Hegya, Tatyana Nikolaevna Zvereva, Sergey Nikolaevich Avdeev, Natalia Anatolievna Tsareva, Albert Sarvatovich Galyavich, Bykov Aleksander Nikolaevich, Evgeny Vladimirovich Filippov, Olga Eduardovna Yakovleva, Olga Borisovna Pavlova, Elena Sergeevna Skripkina, Tamila Vitalievna Martynyuk, Irina Fedorovna Bukatova, Anna Viktorovna Tregubova, Dmitry Yurievich Platonov, Tatyana Mikhaylovna Kolomeytseva, Abdullah Al Dalaan, Abeer Abeer Abdelsayed, Ihab Weheba, Sarferaz Saleemi, Hussam Sakkijha, Marcela Bohacekova, Tatiana Valkovicova, Iveta Farkasova, Carlos Andres Quezada, Lucilla Piccari, Isabel Blanco, Laura Sebastian, Antonio Roman, Manuel Lopez, Remedios Otero, Teresa Elias, Luis Jara, Isabel Asencio, Josefa Jiménez Arjona, Raúl Menor Almagro, Salvador López Cárdenas, Salvador Alcaraz García, Patricia Villanueva Rodríguez, Raquel Lopez, Alberto Garcia, Francisco Fernandez Avilés, Sebastian De La Pava, Raquel Yotti, Gregorio Pérez Peñate, Fernando León Marrero, José Manuel Cifrián Martínez, Amaya Martinez-Meñaca, Lecue Pilar Alonso, Sonia Fernandez Rozas, David Iturbe Fernandez, Victor Mora Cuesta, Stefan Söderberg, Sven-Erik Bartfay, Bengt Rundqvist, Monthir Alfetlawi, Peter Wodlin, Esther Irene Schwarz, Rudolf Speich, Frédéric Lador, Thierry Rochat, Paola Gasche-Soccal, Chih-Hsin Hsu, Tsung-Hsien Lin, Ho-Ming Su, Wen-Ter Lai, Chun Yuan Chu, Po-Chao Hsu, Wen-Chol Voon, Hsueh-Wei Yen, Jacob Yih-Jer Wu, Shu-Hao Wu, Wen-Pin Huang, Man-Cai Fong, Chien-Lung Huang, Ping-Hung Kuo, Yen-Hung Lin, Jiunn-Lee Lin, Chi-Sheng Hung, Cho-Kai Wu, Shih-Hsien Sung, Wei-Chun Huang, Chin-Chang Cheng, Shu-Hung Kuo, Wen-Hwa Wang, Wan-Jing Ho, Tsu-Shiu Hsu, Bülent Mutlu, Halil Atas, Gul Ongen, Zeynep Un, Gulfer Okumus, Ismail Hanta, Paul Corris, Andrew Peacock, Colin Church, Mark Toshner, Michael Newnham, Gastroenterology & Hepatology, Pulmonary Medicine, Pulmonary medicine, ACS - Pulmonary hypertension & thrombosis, and VU University medical center

Subjects
real-world, pulmonary embolism, pyrimidines, MedDRA, data analysis, Peripheral edema, Chronic thromboembolic pulmonary hypertension, randomized controlled trials as topic, Clinical practice, registry, time factors, law.invention, chronic thromboembolic pulmonary hypertension, 0302 clinical medicine, Randomized controlled trial, law, middle aged, Medicine, 030212 general & internal medicine, humans, Hipertensió pulmonar, pyrazoles, clinical practice, aged, female, riociguat, safety, chronic disease, hypertension, pulmonary, male, multicenter studies as topic, prospective studies, recurrence, treatment outcome, registries, medicine.symptom, Safety, medicine.drug, Pulmonary and Respiratory Medicine, medicine.medical_specialty, Registry, hypertension, pulmonary, Hypertension, Pulmonary, Riociguat, Pulmonary hypertension, 03 medical and health sciences, Internal medicine, Adverse effect, business.industry, medicine.disease, Pneumonia, 030228 respiratory system, Real-world, Pulmonary hemorrhage, business
Abstract

Objective: The soluble guanylate cyclase stimulator riociguat is approved for the treatment of adult patients with pulmonary arterial hypertension (PAH) and inoperable or persistent/recurrent chronic thromboembolic pulmonary hypertension (CTEPH) following Phase 3 randomized trials. The EXPosurE Registry RiociguaT in patients with pulmonary hypertension (EXPERT) study was designed to monitor the long-term safety of riociguat in clinical practice. Methods: EXPERT was an international, multicenter, prospective, uncontrolled, non-interventional cohort study of patients treated with riociguat. Patients were followed for at least 1 year and up to 4 years from enrollment or until 30 days after stopping riociguat treatment. Primary safety outcomes were adverse events (AEs) and serious adverse events (SAEs) coded using Medical Dictionary for Regulatory Activities preferred terms and System Organ Classes version 21.0, collected during routine clinic visits and collated via case report forms. Results: In total, 956 patients with CTEPH were included in the analysis. The most common AEs in these patients were peripheral edema/edema (11.7%), dizziness (7.5%), right ventricular (RV)/cardiac failure (7.7%), and pneumonia (5.0%). The most common SAEs were RV/cardiac failure (7.4%), pneumonia (4.1%), dyspnea (3.6%), and syncope (2.5%). Exposure-adjusted rates of hemoptysis/pulmonary hemorrhage and hypotension were low and comparable to those in the long-term extension study of riociguat (Chronic Thromboembolic Pulmonary Hypertension Soluble Guanylate Cyclase–Stimulator Trial [CHEST-2]). Conclusion: Data from EXPERT show that in patients with CTEPH, the safety of riociguat in routine practice was consistent with the known safety profile of the drug, and no new safety concerns were identified. © 2020 The Authors Eli Lilly and Company; Pfizer; Bayer; GlaxoSmithKline; Merck; Actelion Pharmaceuticals; Meso Scale Diagnostics; United Therapeutics Corporation; Novartis Pharma; Merck Sharp and Dohme; GlaxoSmithKline Australia; Deutsche Forschungsgemeinschaft; Grupo Ferrer Internacional, S.A The EXPERT registry was funded by Bayer AG (Berlin, Germany) and Merck Sharp & Dohme Corp., a subsidiary of Merck & Co. Inc., Kenilworth, NJ, USA. The authors acknowledge the database administration by Torsten Tille, Dresden, and the project administration of Mrs Romy Hoppenz and Mrs Linda Kottke at GWT-TUD GmbH, Dresden. Medical writing services provided by Richard Murphy PhD of Adelphi Communications Ltd, Macclesfield, UK were funded by Bayer AG in accordance with Good Publication Practice (GPP3) guidelines. The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Prof Marius M. Hoeper reports personal fees from Bayer AG, during the conduct of the study; personal fees from Actelion, personal fees from Acceleron, personal fees from MSD, personal fees from Jansen, personal fees from Pfizer, outside the submitted work. Dr Hans Klose reports speaker and consultancy fees from Actelion, Bayer AG, GSK, Novartis, Pfizer, and United Therapeutics and research support from Actelion, Bayer AG, GSK, Pfizer, and MSD. Dr Michael Halank reports personal fees and non-financial support from Actelion, AstraZeneca, Bayer AG, Berlin-Chemie, GSK, OMT, MSD, and Novartis. Dr George Giannakoulas reports speaker and consultancy fees from Actelion, Bayer, ELPEN Pharmaceuticals, GSK, Pfizer, Lilly, and United Therapeutics, and research support from GSK, ELPEN Pharmaceuticals, and Galenica. Dr Henning Gall has received honoraria and/or other support from Actelion, AstraZeneca, Bayer, BMS, GSK, Janssen-Cilag, Lilly, MSD, Novartis, OMT, Pfizer, and United Therapeutics. Dr Pavel Jansa reports consultancy and speaker fees from MSD, AOP Orphan, and Actelion. Prof Ekkehard Grünig reports research grants and speaker honoraria/consultancy fees from Actelion and Bayer/MSD, research grants from GSK, United Therapeutics, Bellerophon, OMT GmbH, Pfizer, Reata, and Novartis, and speaker honoraria from Bial, Medscape, and OrPha Swiss GmbH. Prof David Pittrow reports personal fees from Actelion, Bayer AG, Aspen, Boehringer Ingelheim, Sanofi, Biogen, Shire, and MSD outside the submitted work. Silvia Ulrich reports research grants and personal fees from Actelion, Bayer, MSD, and Orpha Swiss. Tobias J. Lange has received personal fees from Actelion, MSD, Pfizer, and OMT orphan. Dr Iraklis Tsangaris reports speaker and consultancy fees from Actelion, Bayer AG, ELPEN, GSK, MSD, Pfizer, and United Therapeutics. Stephan Rosenkranz reports remunerations for lectures and/or consultancy from Abbott, Actelion, Arena, Bayer, Ferrer, GSK, MSD, Novartis, Pfizer, and United Therapeutics; and research support to his institution from Actelion, Bayer, Novartis, Pfizer, and United Therapeutics. Repke J. Snijder reports grants from Pfizer and Actelion Pharmaceuticals. Prof Iveta Šimková reports consultancy and speaker fees from MSD, AOP Orphan, and Actelion. Dr Marc Humbert reports grants and personal fees from Bayer and GSK, and personal fees from Actelion, Merck, and United Therapeutics. Marion Delcroix has received investigator, speaker, consultant, and steering committee member fees from Actelion, Bayer AG, Bellerophon, Eli Lilly, GlaxoSmithKline, MSD, Pfizer, and Reata, and research grants from Actelion. Joan A. Barberà reports receipt of honoraria for consultation or speaker fees from Actelion and Merck; and research support through his institution from Actelion, Merck, GlaxoSmithKline, and Ferrer. Joanna Pepke-Zaba reports research grants and speaker honoraria/consultancy fees from Actelion, Bayer/MSD, and GSK. Jean-Luc Vachiéry reports ongoing consultancies to Actelion, Sonnivie, Arena Pharma, Bial Portela, and Respira Therapeutics, past consultancies to AstraZeneca, BayerShering, CardioMEMS, GlaxoSmithKline, Pfizer, Merck, and United Therapeutics, and current membership of an advisory board or similar group for Actelion and GlaxoSmithKline. Jean-Luc Vachiéry's institution receives funding from Actelion Pharmaceuticals for performing clinical studies. Regina Steringer-Mascherbauer, Jens Klotsche, and Miguel-Angel Gomez Sanchez have no conflicts of interest relevant to the EXPERT study. Hossein-Ardeschir Ghofrani reports personal fees for advisory board work, and payment for lectures including service on speaker bureaus, from Actelion, Bayer, GSK, Novartis, and Pfizer; consultancy fees from Actelion, Bayer, Bellerophon Pulse Technologies, GSK, MSD, Novartis, and Pfizer; and grants from Deutsche Forschungsgemeinschaft (DFG). Pilar Escribano Subias reports personal fees from Actelion, Bayer AG, GlaxoSmithKline, and Merck Sharp & Dohme, and grants from Actelion, Bayer AG, GlaxoSmithKline, and Ferrer, outside the submitted work. Gérald Simonneau reports personal fees and non-financial support from Actelion, personal fees and non-financial support from Bayer, personal fees and non-financial support from MSD, outside the submitted work. Douglas S. Helmersen reports industry-sponsored research with Bayer AG, United Therapeutics, and Gilead Sciences, Inc., and advisory board/speaker fees from Bayer AG and Actelion. David Langleben reports honoraria, consultation fees, research support, and/or travel expenses from Actelion, Arena, Bayer AG, Northern Therapeutics, PhaseBio, Acceleron, Janssen, and United Therapeutics. Anco Boonstra reports consultancy fees from Pfizer BV and hospitality from Teva Nederland. Lisa M. Mielniczuk reports speaker fees and honoraria from Bayer AG, and speaker fees, consultancy fees, and travel fees from Actelion. Evgenia Williams and Christian Meier are employees of Bayer AG.

Published
2021

17. In Silico analysis of stent deployment- effect of stent design

Author

I. Dimitrios Fotiadis, Lorenza Petrini, Giancarlo Pennati, Claire Conway, R. Elazer Edelman, Georgia S. Karanasiou, A. I. Sakellarios, S. Nikolaos Tachos, and K. Lampros Michalis

Subjects
medicine.medical_specialty, medicine.medical_treatment, Finite Element Analysis, 0206 medical engineering, CAD, 02 engineering and technology, 030204 cardiovascular system & hematology, Prosthesis Design, Electronic mail, Coronary artery disease, 03 medical and health sciences, Arterial segment, 0302 clinical medicine, Stent deployment, Internal medicine, Humans, Medicine, Computer Simulation, cardiovascular diseases, business.industry, Hemodynamics, Stent, Arteries, Patient specific, equipment and supplies, medicine.disease, 020601 biomedical engineering, surgical procedures, operative, Cardiology, Stents, business, Stent design
Abstract

Coronary artery disease (CAD) remains the leading cause of death in Europe and worldwide. One of the most common pathologic processes involved in CAD is atherosclerosis. Coronary stents are expandable scaffolds that are used to widen the occluded arteries and enable the blood flow restoration. To achieve an adequate delivery and placement of coronary stents different parameters play a significant role. Due to the strain that the stents are exposed to and the forces they should withstand, the stent design is dominant. This study focuses on investigating the effect of the stent design in two finite element models using two stents with difference in the strut thickness. The in silico deployment is performed in a reconstructed patient specific arterial segment. The results are analyzed in terms of stress in the stent and the arterial wall and demonstrate how stent expansion is extensively affected by the scaffold's design.

Published
2018

18. European Board for Accreditation in Cardiology (EBAC) 2015 CME/CPD Survey Summary

Author

Robert Schaefer, Reinhard Griebenow, Heinz Weber, Julie Simper, Lampros Michalis, and Co-Authors: Julie Simper (International CME/CPD Consulting), Robert Schaefer (CEO, EBAC), Reinhard Griebenow (Chairman, EBAC Advisory Committee), Lampros Michalis (Vice-President of Education, UEMS Cardiology Section), Heinz Weber (Chairman, ECSF)

Subjects
Response rate (survey), medicine.medical_specialty, lcsh:LC8-6691, lcsh:R5-920, CME/CPD, evaluation, lcsh:Special aspects of education, business.industry, conflict of interest, accreditation, provider, needs assessment, Survey, CME/CPD, provider, EBAC, accreditation, needs assessment, conflict of interest, evaluation, respondents, Internal medicine, Family medicine, Original Research Articles, Needs assessment, respondents, medicine, Cardiology, EBAC, business, lcsh:Medicine (General), Survey, Accreditation
Abstract

In the spring of 2015, the European Board for Accreditation in Cardiology (EBAC) collaborated with International CME/CPD Consulting to design and administer a survey to approximately 1,171 professionals active in the field of European CME/CPD, with a focus on cardiology. With a nearly 5% response rate, the results herewith are non-representative, but do express current behaviours and attitudes of those active in European accredited CME/CPD. Keywords: Survey, CME/CPD, provider, EBAC, accreditation, needs assessment, conflict of interest, evaluation, respondents (Published: 7 January 2016) Citation: Journal of European CME 2016, 5 : 29757 - http://dx.doi.org/10.3402/jecme.v5.29757

Published
2015

19. Role of Low Endothelial Shear Stress and Plaque Characteristics in the Prediction of Nonculprit Major Adverse Cardiac Events: The PROSPECT Study

Author

Peter H, Stone, Akiko, Maehara, Ahmet Umit, Coskun, Charles C, Maynard, Marina, Zaromytidou, Gerasimos, Siasos, Ioannis, Andreou, Dimitris, Fotiadis, Kostas, Stefanou, Michail, Papafaklis, Lampros, Michalis, Alexandra J, Lansky, Gary S, Mintz, Patrick W, Serruys, Charles L, Feldman, and Gregg W, Stone

Subjects
Time Factors, Pilot Projects, Coronary Artery Disease, Coronary Angiography, Coronary Vessels, Risk Assessment, Plaque, Atherosclerotic, United States, Europe, Percutaneous Coronary Intervention, Treatment Outcome, Predictive Value of Tests, Risk Factors, Coronary Circulation, Disease Progression, Humans, Endothelium, Vascular, Prospective Studies, Stress, Mechanical, Ultrasonography, Interventional
Abstract

This study sought to determine whether low endothelial shear stress (ESS) adds independent prognostication for future major adverse cardiac events (MACE) in coronary lesions in patients with high-risk acute coronary syndrome (ACS) from the United States and Europe.Low ESS is a proinflammatory, proatherogenic stimulus associated with coronary plaque development, progression, and destabilization in human-like animal models and in humans. Previous natural history studies including baseline ESS characterization investigated low-risk patients.In the PROSPECT (Providing Regional Observations to Study Predictors of Events in the Coronary Tree) study, 697 patients with ACS underwent 3-vessel intracoronary imaging. Independent predictors of MACE attributable to untreated nonculprit (nc) coronary lesions during 3.4-year follow-up were large plaque burden (PB), small minimum lumen area (MLA), and thin-cap fibroatheroma (TCFA) morphology. In this analysis, baseline ESS of nc lesions leading to new MACE (nc-MACE lesions) and randomly selected control nc lesions without MACE (nc-non-MACE lesions) were calculated. A propensity score for ESS was constructed for each lesion, and the relationship between ESS and subsequent nc-MACE was examined.A total of 145 lesions were analyzed in 97 patients: 23 nc-MACE lesions (13 TCFAs, 10 thick-cap fibroatheromas [ThCFAs]), and 122 nc-non-MACE lesions (63 TCFAs, 59 ThCFAs). Low local ESS (1.3 Pa) was strongly associated with subsequent nc-MACE compared with physiological/high ESS (≥1.3 Pa) (23 of 101 [22.8%]) versus (0 of 44 [0%]). In propensity-adjusted Cox regression, low ESS was strongly associated with MACE (hazard ratio: 4.34; 95% confidence interval: 1.89 to 10.00; p 0.001). Categorizing plaques by anatomic risk (high risk: ≥2 high-risk characteristics PB ≥70%, MLA ≤4 mmLocal low ESS provides incremental risk stratification of untreated coronary lesions in high-risk patients, beyond measures of PB, MLA, and morphology.

Published
2016

20. Abstract 16948: Local Low Endothelial Shear Stress (ESS) Provides Incremental Prediction of Non-culprit MACE in Addition to Plaque Burden, Minimal Lumen Area, and Plaque Morphology: The PROSPECT Study

Author

Peter H Stone, Akiko Maehara, Ahmet U Coskun, Charles C Maynard, Ioannis Andreou, Gerasimos Siasos, Marina Zaromitidou, Dimitris Fotiadis, Kostas Stefanou, Michail Papafaklis, Lampros Michalis, Alexandra J Lansky, Gary S Mintz, Patrick W Serruys, Charles L Feldman, and Gregg W Stone

Subjects
Physiology (medical), cardiovascular diseases, Cardiology and Cardiovascular Medicine
Abstract

Introduction: Low ESS, a pro-inflammatory stimulus, is an important predictor of coronary plaque development/progression. Whether low ESS adds incremental predictive value for future major adverse cardiac events (MACE) in untreated coronary lesions in high-risk patients with an acute coronary syndrome (ACS) is unknown. Methods: In the PROSPECT study, 697 patients with ACS underwent 3-vessel intracoronary imaging. Independent predictors of non-culprit (nc) lesion MACE from untreated coronary lesions in 3 year followup (f/u) were large plaque burden (PB), small minimum lumen area (MLA), and thin cap fibroatheroma (TCFA) morphology. In the present analysis, all nc-lesions leading to a new MACE in f/u (nc-MACE lesions, n=50) and ~4-fold randomly selected control nc-lesions without f/u MACE (nc-non-MACE lesions) were analyzed. Baseline ESS for each lesion was calculated using computational fluid dynamics. A propensity score for low ESS was determined accounting for PB, MLA, TCFA, artery and location in the artery. Local ESS (lowest ESS in 90 o arc around the artery) was then examined for incremental association with MACE. Results: Imaging was sufficient for analysis in 32 nc-MACE lesions. Two nc-MACE lesions were excluded due to unreliable lesion morphology. Non-fibroatheromas were too few for analysis and excluded. Final dataset included 145 lesions: 13 nc-MACE TCFA, 10 nc-MACE thick cap fibroatheroma (ThCFA), and 122 non-nc-MACE lesions (63 TCFA, 59 ThCFA). Cumulative frequency distribution shows lesions responsible for future nc-MACE frequently exhibited low ESS (Figure). In a propensity-adjusted multivariable model, low ESS was strongly associated with nc-MACE in f/u (odds ratio 0.16 [95% CI 0.06-0.40], p Conclusions: After accounting for large PB, small MLA, TCFA, and lesion location, low local ESS adds significant and substantial incremental predictive value to identify high-risk untreated lesions likely to cause MACE during 3 year followup.

Published
2015

21. ASSOCIATION OF CORONARY EPICARDIAL ENDOTHELIAL DYSFUNCTION WITH LOW ENDOTHELIAL SHEAR STRESS IN PATIENTS WITH MILD CORONARY ATHEROSCLEROSIS WHO PRESENTED WITH CHEST PAIN

Author

Marina Zaromytidou, Peter Stone, Michelle Lucier, Dimitris Fotiadis, Lilach Lerman, Charles L. Feldman, Shi-Wei Yang, Jaskanwal D Sara, Gerasimos Siasos, Lampros Michalis, Kyoung H. Park, Ahmet U. Coskun, Michail I. Papafaklis, Amir Lerman, and Kostas Stefanou

Subjects
medicine.medical_specialty, business.industry, medicine.disease, Chest pain, Internal medicine, medicine, Shear stress, Cardiology, In patient, Endothelial dysfunction, medicine.symptom, Cardiology and Cardiovascular Medicine, business, Coronary atherosclerosis
Published
2017

22. Effects of smoking on heart rate at rest and during exercise, and on heart rate recovery, in young adults

Author

George, Papathanasiou, Dimitris, Georgakopoulos, Effie, Papageorgiou, Efthimia, Zerva, Lampros, Michalis, Vasiliki, Kalfakakou, and Angelos, Evangelou

Subjects
Adult, Male, Young Adult, Heart Rate, Smoking, Exercise Test, Humans, Female, Exercise
Abstract

There is an established link between smoking, abnormal heart rate (HR) values, and impaired cardiovascular health in middle-aged or older populations. The purpose of this study was to examine the effects of smoking on resting HR and on HR responses during and after exercise in young adults.A sample of 298 young adults (159 men), aged 20-29 years old, were selected from a large population of health-science students based on health status, body mass index, physical activity, and smoking habit. All subjects underwent a maximal Bruce treadmill test and their HR was recorded during, at peak, and after termination of exercise.Smokers had significantly higher resting HR values than non-smokers. Both female and male smokers showed a significantly slower HR increase during exercise. Female smokers failed to reach their age-predicted maximum HR by 6.0 bpm and males by 3.6 bpm. The actual maximum HR achieved (HRmax) was significantly lower for both female smokers (191.0 bpm vs.198.0 bpm) and male smokers (193.2 bpm vs.199.3 bpm), compared to non-smokers. Heart rate reserve was also significantly lower in female (114.6 bpm vs. 128.1 bpm) and male smokers (120.4 bpm vs. 133.0 bpm). During recovery, the HR decline was significantly attenuated, but only in female smokers. Females had a higher resting HR and showed a higher HR response during sub-maximal exercise compared to males.Smoking was found to affect young smokers' HR, increasing HR at rest, slowing HR increase during exercise and impairing their ability to reach the age-predicted HRmax. In addition, smoking was associated with an attenuated HR decline during recovery, but only in females.

Published
2013

23. LOCALIZATION OF CULPRIT ENDOTHELIAL SHEAR STRESS PATTERNS ALONG THE COURSE OF UNTREATED CORONARY LESIONS RESPONSIBLE FOR FUTURE MACE: THE PROSPECT STUDY

Author

Gregg W. Stone, Gerasimos Siasos, Alexandra J. Lansky, Charles C. Maynard, Dimitris Fotiadis, Akiko Maehara, Kostas Stefanou, Gary S. Mintz, Lampros Michalis, Ioannis Andreou, Ahmet U. Coskun, Charles L. Feldman, Marina Zaromytidou, Peter Stone, Patrick W. Serruys, and Michail I. Papafaklis

Subjects
medicine.medical_specialty, business.industry, 030204 cardiovascular system & hematology, Independent predictor, Culprit, Surgery, Lesion, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, Shear stress, Cardiology, Medicine, 030212 general & internal medicine, medicine.symptom, Cardiology and Cardiovascular Medicine, business, Mace
Abstract

Low endothelial shear stress (ESS) is pro-inflammatory, and was an independent predictor of MACE in the PROSPECT study. The site of low ESS along the lesion course is unknown and may have important implications for evaluation of high-risk lesions. Baseline untreated non-culprit (nc) lesions in

Published
2016

24. Coronary Atherosclerosis

Author

Eugene P. McFadden, Patrick W. Serruys, Lampros Michalis, Chourmouzios A. Arampatzis, and Renu Virmani

Subjects
Coronary artery disease, medicine.medical_specialty, Current management, business.industry, Internal medicine, Cardiology, Medicine, business, medicine.disease, Coronary atherosclerosis
Published
2012

25. Correction of Anemia with Erythropoietin in Chronic Kidney Disease (stage 3 or 4): Effects on Cardiac Performance.

Author

Konstantinos Pappas, Chariklia Gouva, Konstantinos Katopodis, Petros Nikolopoulos, Panagiotis Korantzopoulos, Lampros Michalis, and John Goudevenos

Abstract

Abstract Background  It is not clear whether the correction of anemia with erythropoietin (rhuEpo) in patients with chronic kidney disease (CKD) has any benefit on cardiac function and geometry. Most studies are based on indices of systolic function and left ventricular mass (LVM) and the results are conflicting. Patients and methods  We sought to investigate the effect of rhuEpo on LV systolic and diastolic performance using conventional and novel echocardiographic indices. Thirty one patients with CKD (stage 3 or 4) were included. Fifteen patients (group I) treated with rhuEpo targeting at Hb ≥13.0 g/dL, while the remaining (group II) were not treated. Clinical and laboratory parameters were recorded at baseline and 1 year later. Ejection fraction (EF) and LVM were carefully determined. Diastolic function was assessed by mitral inflow indices (E and A wave velocities, Edt deceleration time and E/A) and novel indices of mitral annulus motion using Tissue Doppler Imaging (Em, Am, and E/Em). An index of global cardiac function (Tei) was also calculated. Results  At baseline, the 2 groups had comparable clinical and laboratory characteristics. After 1 year, a significant improvement in Hb levels (13.6 ± 1.2 vs 10.3 ± 1.2 g/dL, p p 2, p p p  0.01) and E/Em (9.7 ± 2.4 vs 14.8 ± 5.2, p  Conclusions  Correction of anemia with rhuEpo in patients with CKD seems to improve cardiac performance and geometry. [ABSTRACT FROM AUTHOR]

Published
2008
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26. In Silico analysis of stent deployment- effect of stent design.

Author

Georgia Karanasiou S, Nikolaos Tachos S, Sakellarios A, Conway C, Pennati G, Petrini L, Lampros Michalis K, Elazer Edelman R, and Dimitrios Fotiadis I

Subjects
Finite Element Analysis, Hemodynamics, Humans, Arteries, Computer Simulation, Prosthesis Design, Stents
Abstract

Coronary artery disease (CAD) remains the leading cause of death in Europe and worldwide. One of the most common pathologic processes involved in CAD is atherosclerosis. Coronary stents are expandable scaffolds that are used to widen the occluded arteries and enable the blood flow restoration. To achieve an adequate delivery and placement of coronary stents different parameters play a significant role. Due to the strain that the stents are exposed to and the forces they should withstand, the stent design is dominant. This study focuses on investigating the effect of the stent design in two finite element models using two stents with difference in the strut thickness. The in silico deployment is performed in a reconstructed patient specific arterial segment. The results are analyzed in terms of stress in the stent and the arterial wall and demonstrate how stent expansion is extensively affected by the scaffold's design.

Published
2018
Full Text
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