77 results on '"Raisakis K"'
Search Results
2. Inflammatory Biomarkers in Coronary Artery Ectasia: A Systematic Review and Meta-Analysis
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Vrachatis, D.A. Papathanasiou, K.A. Kazantzis, D. Sanz-Sánchez, J. Giotaki, S.G. Raisakis, K. Kaoukis, A. Kossyvakis, C. Deftereos, G. Reimers, B. Avramides, D. Siasos, G. Cleman, M. Giannopoulos, G. Lansky, A. Deftereos, S.
- Abstract
Isolated coronary artery ectasia (CAE) is a relatively rare clinical entity, the pathogenesis of which is poorly understood. More and more evidence is accumulating to suggest a critical inflammatory component. We aimed to elucidate any association between neutrophil to lymphocyte ratio and coronary artery ectasia. A systematic MEDLINE database, ClinicalTrials.gov, medRxiv, Scopus and Cochrane Library search was conducted: 50 studies were deemed relevant, reporting on difference in NLR levels between CAE patients and controls (primary endpoint) and/or on high-sensitive CRP, IL-6, TNF-a and RDW levels (secondary endpoint), and were included in our final analysis. (PROSPERO registration number: CRD42021224195). All inflammatory biomarkers under investigation were found higher in coronary artery ectasia patients as compared to healthy controls (NLR; SMD = 0.73; 95% CI: 0.27–1.20, hs-CRP; SMD = 0.96; 95% CI: 0.64–1.28, IL-6; SMD = 2.68; 95% CI: 0.95–4.41, TNF-a; SMD = 0.50; 95% CI: 0.24–0.75, RDW; SMD = 0.56; 95% CI: 0.26–0.87). The main limitations inherent in this analysis are small case-control studies of moderate quality and high statistical heterogeneity. Our findings underscore that inflammatory dysregulation is implicated in coronary artery ectasia and merits further investigation. © 2022 by the authors. Licensee MDPI, Basel, Switzerland.
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- 2022
3. Early arrhythmia recurrence after cryoballoon ablation in atrial fibrillation: A systematic review and meta-analysis
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Vrachatis DA, Papathanasiou KA, Kossyvakis C, Kazantzis D, Giotaki SG, Deftereos G, Sanz-Sánchez J, Raisakis K, Kaoukis A, Avramides D, Lambadiari V, Siasos G, Giannopoulos G, and Deftereos S
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early arrhythmia recurrence ,cryoablation ,blanking period ,atrial fibrillation ,late arrhythmia recurrence - Abstract
INTRODUCTION: Early arrhythmia recurrence within the 3-month blanking period is a common event that historically has been attributed to reversible phenomena. While its mechanistic links remain obscure, accumulating evidence support the argument of shortening the blanking period. We aimed to elucidate the association between early and late arrhythmia recurrence after atrial fibrillation cryoablation. METHODS: The MEDLINE database, ClinicalTrials. gov, medRxiv, and Cochrane Library were searched for studies evaluating early and late arrhythmia recurrence rates in patients undergoing cryoablation for atrial fibrillation. Data were pooled by meta-analysis using a random-effects model. The primary endpoint was late arrhythmia recurrence. RESULTS: Early arrhythmia recurrence was found predictive of decreased arrhythmia-free survival after evaluating 3975 patients with paroxysmal or persistent atrial fibrillation who underwent cryoablation (odds ratio [OR]: 5.31; 95% confidence interval [CI]: 3.75-7.51). This pattern remained unchanged after subanalyzing atrial fibrillation type (paroxysmal; OR: 7.16; 95% CI: 4.40-11.65 and persistent; OR: 7.63; 95% CI: 3.62-16.07) as well as cryoablation catheter generation (first generation; OR: 5.15, 95% CI: 2.39-11.11 and advanced generation; OR: 5.83, 95% CI: 3.68-9.23). Studies permitting antiarrhythmic drug utilization during the blanking period or examining early recurrence as a secondary outcome were found to be a significant source of statistical heterogeneity. CONCLUSION: Our findings suggest that early arrhythmia recurrence is predictive of late outcomes after cryoablation for atrial fibrillation. Identifying which patients deserve earlier reintervention is an open research avenue.
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- 2022
4. Ticagrelor versus clopidogrel in patients with STEMI treated with thrombolysis: The MIRTOS trial
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Hamilos, M. Kanakakis, J. Anastasiou, I. Karvounis, C. Vasilikos, V. Goudevenos, J. Michalis, L. Koutouzis, M. Tsiafoutis, I. Raisakis, K. Stakos, D. Hahalis, G. Vardas, P.
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cardiovascular diseases - Abstract
Aims: We aimed to demonstrate whether coronary microvascular function is improved after ticagrelor administration compared to clopidogrel administration in STEMI subjects undergoing thrombolysis. Methods and results: MIRTOS is a multicentre study of ticagrelor versus clopidogrel in STEMI subjects treated with fibrinolysis. We enrolled 335 patients
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- 2021
5. Atrial fibrillation risk in patients suffering from type I diabetes mellitus. A review of clinical and experimental evidence
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Vrachatis, D.A. Papathanasiou, K.A. Kossyvakis, C. Giotaki, S.G. Raisakis, K. Iliodromitis, K.E. Reimers, B. Stefanini, G.G. Cleman, M. Sianos, G. Lansky, A. Deftereos, S.G. Giannopoulos, G.
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Atrial fibrillation (AF) and diabetes mellitus (DM) are commonly encountered in clinical practice. Although, the long term macrovascular and microvascular sequela of DM are well validated, the association between the less prevalent type 1 DM (T1DM) and atrial arrhythmogenesis is poorly understood. In the present review we highlight the current experimental and clinical data addressing this complex interaction. Animal studies support that T1DM, characterized by insulin deficiency and glycemic variability, impairs phosphatidylinositol 3‑kinase (PI3K)/protein kinase B signaling pathway. This pathway holds a central role in atrial electrical and structural remodeling responsible for arrhythmia initiation and maintenance. The molecular ‘’footprint’’ of T1DM in atrial myocytes seems to involve a state of increased oxidative stress, impaired glucose transportation, ionic channel dysregulation and eventually fibrosis. On the contrary only a few clinical studies have examined the role of T1DM as an independent risk factor for AF development, and are discussed here. Further research is needed to solidify the real magnitude of this association and to investigate the clinical implications of PI3K molecular signaling pathway in atrial fibrillation management. © 2021 Elsevier B.V.
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- 2021
6. The Greek study in the effects of colchicine in COvid-19 complications prevention (GRECCO-19 study): Rationale and study design
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Deftereos, S.G. Siasos, G. Giannopoulos, G. Vrachatis, D.A. Angelidis, C. Giotaki, S.G. Gargalianos, P. Giamarellou, H. Gogos, C. Daikos, G. Lazanas, M. Lagiou, P. Saroglou, G. Sipsas, N. Tsiodras, S. Chatzigeorgiou, D. Moussas, N. Kotanidou, A. Koulouris, N. Oikonomou, E. Kaoukis, A. Kossyvakis, C. Raisakis, K. Fountoulaki, K. Comis, M. Tsiachris, D. Sarri, E. Theodorakis, A. Martinez-Dolz, L. Sanz-Sánchez, J. Reimers, B. Stefanini, G.G. Cleman, M. Filippou, D. Olympios, C.D. Pyrgakis, V.N. Goudevenos, J. Hahalis, G. Kolettis, T.M. Iliodromitis, E. Tousoulis, D. Stefanadis, C.
- Abstract
Objective: Colchicine has been utilized safely in a variety of cardiovascular clinical conditions. Among its potential mechanisms of action is the non-selective inhibition of NLRP3 inflammasome which is thought to be a major pathophysiologic component in the clinical course of patients with COVID-19. GRECCO-19 will be a prospective, randomized, open-labeled, controlled study to assess the effects of colchicine in COVID-19 complications prevention. Methods: Patients with laboratory confirmed SARS-CoV-2 infection (under RT PCR) and clinical picture that involves temperature >37.5 oC and at least two out of the: i. sustained coughing, ii. sustained throat pain, iii. Anosmia and/or ageusia, iv. fatigue/tiredness, v. PaO2
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- 2020
7. Short-term fluctuations of plasma NT-proBNP levels in patients with new-onset atrial fibrillation: a way to assess time of onset?
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Deftereos, S, Giannopoulos, G, Kossyvakis, C, Raisakis, K, Theodorakis, A, Kaoukis, A, Toli, K, Panagopoulou, V, Driva, M, Mantas, I, Pyrgakis, V, and Alpert, M A
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- 2010
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8. How should i treat a TAVI-eligible patient with a left ventricular thrombus and rapid clinical deterioration?
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Deftereos, S. Giannopoulos, G. Raisakis, K. Vrettou, A.-R. Kolokathis, F. Zacharoulis, A. Angouras, D. Alexopoulos, D. Lekakis, J.
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cardiovascular system - Abstract
BACKGROUND: An 89-year-old male with heart failure due to severe aortic stenosis and chronic renal failure was scheduled for transcatheter aortic valve implantation (TAVI). INVESTIGATION: The day before the procedure the patient underwent an echocardiogram (as per in-house pre-procedural protocol). A large mobile thrombus was discovered at the left ventricular apex, and the TAVI procedure was cancelled. DIAGNOSIS: Severe calcific aortic stenosis with a large mobile intracavitary thrombus. MANAGEMENT: As the patient presented four weeks later with worsening symptoms of acute heart failure and could not be weaned from intravenous furosemide, the Heart Team decided to proceed with TAVI, trying to minimise wire manipulations throughout the procedure. An Evolut R system was implanted with no complications. Three days after the procedure, the patient was off intravenous diuretics and able to walk around the ward. © Europa Digital & Publishing 2017. All rights reserved.
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- 2017
9. Colchicine and the heart: Pushing the envelope
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Deftereos, S. Giannopoulos, G. Papoutsidakis, N. Panagopoulou, V. Kossyvakis, C. Raisakis, K. Cleman, M.W. Stefanadis, C.
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Colchicine, a natural and ancient drug still used today, is traditionally considered the staple therapy for gout and a second-line treatment for pericarditis, as well as a basic part of familial Mediterranean fever and Behcet's disease management. It is commonly classified as an anti-inflammatory agent, although its mechanism of action does not involve the arachidonic acid pathway affected by non-steroid anti-inflammatory drugs and glucocorticoids. Colchicine inhibits microtubule polymerization by binding to tubulin, thus affecting any process that requires cytoskeletal changes, including cell mitosis and neutrophil motility. Recent studies suggest that colchicine may prove to be useful in a much wider spectrum of cardiovascular diseases than previously suspected, rekindling the interest in this old drug. In this review we briefly present the biochemical characteristics, mechanism of action and side-effects of colchicine, as well as examine what is currently known about the promising role of colchicine in cardiovascular medicine beyond pericardial disease. © 2013 by the American College of Cardiology Foundation.
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- 2013
10. The role of endothelin system in cardiovascular disease and the potential therapeutic perspectives of its inhibition
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Kaoukis, A. Deftereos, S. Raisakis, K. Giannopoulos, G. Bouras, G. Panagopoulou, V. Papoutsidakis, N. Cleman, M.W. Stefanadis, C.
- Abstract
Since its identification in 1988 and the recognition of its primary role as a potent vasoconstrictor, endothelin has been extensively studied and is now considered as a ubiquitous protein, involved in important aspects of human homeostasis as well as in several pathophysiological pathways, mostly associated with cardiovascular disease. From an evolutionary point of view, endothelin consists a primitive molecule with the rare characteristic of being exactly the same in all mammals, thus permitting scientists to perform experiments in animals and doing predictions for humans. The understanding of its contribution to the genesis, evolution and maintenance of disease through activation of special receptor subtypes has led to the development of both selective and unselective receptor antagonists. Despite the disappointing results of these antagonists in the field of heart failure, almost from the initial animal trials of bosentan, a dual endothelin receptor antagonist, in pulmonary arterial hypertension, it has been demonstrated that the drug leads at least to hemodynamic and clinical improvement of the patients, thus receiving official approval for the management of this rare but eventually lethal disease. Resistant hypertension is another area where endothelin receptor blockers might potentially play a role, while the pathophysiological role of endothelin in atherosclerotic coronary artery disease is well-established and the relative research goes on. The main goal of this review is to describe the endothelin system and mostly to enlighten its role in pathophysiologic pathways, as well to state the relative research in the various fields of cardiovascular disease and also highlight its prognostic significance wherever there exists one. © 2013 Bentham Science Publishers.
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- 2013
11. Differential effect of biventricular and right ventricular DDD pacing on coronary flow reserve in patients with ischemic cardiomyopathy
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Deftereos, S. Giannopoulos, G. Kossyvakis, C. Raisakis, K. Kaoukis, A. Driva, M. Panagopoulou, V. Ntzouvara, O. Theodorakis, A. Toutouzas, K. Pyrgakis, V. Stefanadis, C.
- Abstract
CRT and Coronary Flow Reserve. Background: Cardiac resynchronization therapy (CRT) has become a mainstay in heart failure management. There are also indications that upgrading of existing pacemakers to CRT systems may be of benefit. The aim of this study was to assess the effect of biventricular (BiV), compared with right ventricular (RV), pacing, on coronary flow reserve (CFR), in patients with ischemic cardiomyopathy. Methods and Results: From our database of heart failure patients implanted with BiV pacemakers, 20 patients (10 responders and 10 non-responders to CRT) were randomly selected. Left anterior descending artery coronary flow reserve was measured invasively, under BiV and RV pacing, using intracoronary adenosine to induce hyperemia. In all the 20 patients, there was a significant difference in the pairwise comparison between CFR recorded during BiV and RV pacing (mean difference 0.15, 95% confidence interval 0.07-0.23, P = 0.001). When comparing responders to non-responders, there was a significant difference as to the effect of BiV, compared with RV, pacing on CFR: mean difference (BiV minus RV CFR) was 0.26 ± 0.06 (95% confidence interval 0.13-0.39; P = 0.002), while in non-responders the difference was 0.04 ± 0.03 (95% confidence interval -0.02 to 0.10; P = 0.168). Conclusion: BiV pacing is overall associated to higher CFR, compared with RV DDD pacing. This difference is almost exclusively attributable to the beneficial effect of CRT on coronary flow reserve in CRT-responders. This effect may contribute to the beneficial action of resynchronization in the failing heart and can be viewed in the context of reports of the usefulness of upgrading RV pacemakers to CRT systems. © 2010 Wiley Periodicals, Inc.
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- 2010
12. Estimation of atrial fibrillation recency of onset and safety of cardioversion using NTproBNP levels in patients with unknown time of onset
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Deftereos, S., primary, Giannopoulos, G., additional, Kossyvakis, C., additional, Raisakis, K., additional, Kaoukis, A., additional, Aggeli, C., additional, Toli, K., additional, Theodorakis, A., additional, Panagopoulou, V., additional, Driva, M., additional, Mantas, I., additional, Pyrgakis, V., additional, Rentoukas, I., additional, and Stefanadis, C., additional
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- 2011
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13. Feasibility of peripheral venous access for temporary right ventricular pacing
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Deftereos, S., Giannopoulos, G., Raisakis, K., Kossyvakis, C., Panagopoulou, V., Kaoukis, A., Mavrogianni, A. -D, Doudoumis, K., Theodorakis, A., Bobotis, G., Pyrgakis, V., and Christodoulos Stefanadis
14. Intracardiac echocardiography imaging of periprosthetic valvular regurgitation.
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Deftereos S, Giannopoulos G, Raisakis K, Kaoukis A, and Kossyvakis C
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- 2010
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15. Relation of ventricular tachycardia/fibrillation to Beta-blocker dose maximization guided by pacing mode analysis in nonpacemaker-dependent patients with implantable cardioverter-defibrillator.
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Deftereos S, Giannopoulos G, Kossyvakis C, Kaoukis A, Raisakis K, Panagopoulou V, Ntzouvara O, Perpinia A, Rentoukas I, Pyrgakis V, Manolis AS, and Stefanadis C
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- 2011
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16. Left atrial appendage morphofunctional indices could be predictive of arrhythmia recurrence post-atrial fibrillation ablation: a meta-analysis.
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Papathanasiou KA, Vrachatis DA, Kazantzis D, Kossyvakis C, Giotaki SG, Deftereos G, Raisakis K, Kaoukis A, Avramides D, Lambadiari V, Siasos G, and Deftereos S
- Abstract
Background: Left atrium changes are implicated in atrial fibrillation (AF) substrate and are predictive of AF outcomes. Left atrial appendage (LAA) is an integral component of left atrial structure and could be affected by atrial cardiomyopathy. We aimed to elucidate the association between LAA indices and late arrhythmia recurrence after atrial fibrillation catheter ablation (AFCA)., Methods: The MEDLINE database, ClinicalTrials.gov, medRxiv and Cochrane Library were searched for studies evaluating LAA and late arrhythmia recurrence in patients undergoing AFCA. Data were pooled by meta-analysis using a random-effects model. The primary endpoint was pre-ablation difference in LAA anatomic or functional indices., Results: A total of 34 studies were found eligible and five LAA indices were analyzed. LAA ejection fraction and LAA emptying velocity were significantly lower in patients with AF recurrence post-ablation [SMD = - 0.66; 95% CI (- 1.01, - 0.32) and SMD = - 0.56; 95% CI (- 0.73, - 0.40) respectively] as compared to arrhythmia free controls. LAA volume and LAA orifice area were significantly higher in patients with AF recurrence post-ablation (SMD = 0.51; 95% CI 0.35-0.67, and SMD = 0.35; 95% CI 0.20-0.49, respectively) as compared to arrhythmia free controls. LAA morphology was not predictive of AF recurrence post-ablation (chicken wing morphology; OR 1.27; 95% CI 0.79-2.02). Moderate statistical heterogeneity and small case-control studies are the main limitations of our meta-analysis., Conclusions: Our findings suggest that LAA ejection fraction, LAA emptying velocity, LAA orifice area and LAA volume differ between patients suffering from arrhythmia recurrence post-ablation and arrhythmia free counterparts, while LAA morphology is not predictive of AF recurrence., (© 2023. The Author(s).)
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- 2023
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17. Advances in the Management of Heart Failure with Reduced Ejection Fraction; The Role of SGLT2is, ARNI, Myotropes, Vericiguat, and Anti-inflammatory Agents: A Mini-review
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Vrachatis DA, Papathanasiou KA, Giotaki SG, Raisakis K, Kaoukis A, Kossyvakis C, Theodorakis A, Pediotidis S, Avramides D, Siasos G, and Deftereos S
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Heart failure with reduced ejection fraction (HFrEF) has been associated with poor prognosis, reduced quality of life, and increased healthcare expenditure. Despite tremendous advances in HFrEF management, reduced survival and a high rate of hospitalization remain unsolved issues. Furthermore, HFrEF morbidity and economic burden are estimated to increase in the following years; hence, new therapies are constantly emerging. In the last few years, a series of landmark clinical trials have expanded our therapeutic armamentarium with a ground-breaking change in HFrEF-related outcomes. Sodium-glucose co-transporter 2 inhibitors (mainly dapagliflozin and empagliflozin) have already revolutionized the management of HFrEF patients via a significant reduction in cardiovascular mortality and heart failure hospitalizations. Furthermore, vericiguat and omecamtiv mecarbil have emerged as promising and novel disease-modifying therapies. The former restores the impaired cyclic guanosine monophosphate pathway, and the latter stimulates cardiac myosin without marked arrhythmogenesis. Both vericiguat and omecamtiv mecarbil have been shown to reduce heart failure admissions. Sacubitril/valsartan is an established and effective therapy in HFrEF patients and should be considered as a replacement for angiotensin-converting enzyme inhibitors (ACEi) or angiotensin II receptor blockers (ARBs). Lastly, inflammasome activity is implicated in HFrEF pathophysiology, and the role of anti-inflammatory agents in HFrEF trajectories is readily scrutinized, yet available therapies are ineffective. This mini-review summarizes the major and most recent studies in this field, thus covering the current advances in HFrEF therapeutics.
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- 2023
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18. Inflammatory Biomarkers in Coronary Artery Ectasia: A Systematic Review and Meta-Analysis.
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Vrachatis DA, Papathanasiou KA, Kazantzis D, Sanz-Sánchez J, Giotaki SG, Raisakis K, Kaoukis A, Kossyvakis C, Deftereos G, Reimers B, Avramides D, Siasos G, Cleman M, Giannopoulos G, Lansky A, and Deftereos S
- Abstract
Isolated coronary artery ectasia (CAE) is a relatively rare clinical entity, the pathogenesis of which is poorly understood. More and more evidence is accumulating to suggest a critical inflammatory component. We aimed to elucidate any association between neutrophil to lymphocyte ratio and coronary artery ectasia. A systematic MEDLINE database, ClinicalTrials.gov, medRxiv, Scopus and Cochrane Library search was conducted: 50 studies were deemed relevant, reporting on difference in NLR levels between CAE patients and controls (primary endpoint) and/or on high-sensitive CRP, IL-6, TNF-a and RDW levels (secondary endpoint), and were included in our final analysis. (PROSPERO registration number: CRD42021224195). All inflammatory biomarkers under investigation were found higher in coronary artery ectasia patients as compared to healthy controls (NLR; SMD = 0.73; 95% CI: 0.27-1.20, hs-CRP; SMD = 0.96; 95% CI: 0.64-1.28, IL-6; SMD = 2.68; 95% CI: 0.95-4.41, TNF-a; SMD = 0.50; 95% CI: 0.24-0.75, RDW; SMD = 0.56; 95% CI: 0.26-0.87). The main limitations inherent in this analysis are small case-control studies of moderate quality and high statistical heterogeneity. Our findings underscore that inflammatory dysregulation is implicated in coronary artery ectasia and merits further investigation.
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- 2022
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19. Immunologic Dysregulation and Hypercoagulability as a Pathophysiologic Background in COVID-19 Infection and the Immunomodulating Role of Colchicine.
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Vrachatis DA, Papathanasiou KA, Giotaki SG, Raisakis K, Kossyvakis C, Kaoukis A, Kolokathis F, Deftereos G, Iliodromitis KE, Avramides D, Bogossian H, Siasos G, Giannopoulos G, Reimers B, Lansky A, Tardif JC, and Deftereos S
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In 2020, SARS-COV-2 put health systems under unprecedented resource and manpower pressure leading to significant number of deaths. Expectedly, researchers sought to shed light on the pathophysiologic background of this novel disease (COVID-19) as well as to facilitate the design of effective therapeutic modalities. Indeed, early enough the pivotal role of inflammatory and thrombotic pathways in SARS-COV-2 infection has been illustrated. The purpose of this article is to briefly present the epidemiologic and clinical features of COVID-19, analyze the pathophysiologic importance of immunologic dysregulation and hypercoagulability in developing disease complications and finally to present an up-to-date systematic review of colchicine's immunomodulating capacity in view of hindering coronavirus complications.
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- 2021
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20. Impact of colchicine on mortality in patients with COVID-19: A meta-analysis.
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Vrachatis DA, Giannopoulos GV, Giotaki SG, Raisakis K, Kossyvakis C, Iliodromitis KE, Reimers B, Tousoulis D, Cleman M, Stefanadis C, Lansky A, and Deftereos SG
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- Humans, SARS-CoV-2, Treatment Outcome, COVID-19, Colchicine therapeutic use
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- 2021
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21. Molecular Insights in Atrial Fibrillation Pathogenesis and Therapeutics: A Narrative Review.
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Papathanasiou KA, Giotaki SG, Vrachatis DA, Siasos G, Lambadiari V, Iliodromitis KE, Kossyvakis C, Kaoukis A, Raisakis K, Deftereos G, Papaioannou TG, Giannopoulos G, Avramides D, and Deftereos SG
- Abstract
The prevalence of atrial fibrillation (AF) is bound to increase globally in the following years, affecting the quality of life of millions of people, increasing mortality and morbidity, and beleaguering health care systems. Increasingly effective therapeutic options against AF are the constantly evolving electroanatomic substrate mapping systems of the left atrium (LA) and ablation catheter technologies. Yet, a prerequisite for better long-term success rates is the understanding of AF pathogenesis and maintenance. LA electrical and anatomical remodeling remains in the epicenter of current research for novel diagnostic and treatment modalities. On a molecular level, electrical remodeling lies on impaired calcium handling, enhanced inwardly rectifying potassium currents, and gap junction perturbations. In addition, a wide array of profibrotic stimuli activates fibroblast to an increased extracellular matrix turnover via various intermediaries. Concomitant dysregulation of the autonomic nervous system and the humoral function of increased epicardial adipose tissue (EAT) are established mediators in the pathophysiology of AF. Local atrial lymphomononuclear cells infiltrate and increased inflammasome activity accelerate and perpetuate arrhythmia substrate. Finally, impaired intracellular protein metabolism, excessive oxidative stress, and mitochondrial dysfunction deplete atrial cardiomyocyte ATP and promote arrhythmogenesis. These overlapping cellular and molecular alterations hinder us from distinguishing the cause from the effect in AF pathogenesis. Yet, a plethora of therapeutic modalities target these molecular perturbations and hold promise in combating the AF burden. Namely, atrial selective ion channel inhibitors, AF gene therapy, anti-fibrotic agents, AF drug repurposing, immunomodulators, and indirect cardiac neuromodulation are discussed here.
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- 2021
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22. Could Sodium/Glucose Co-Transporter-2 Inhibitors Have Antiarrhythmic Potential in Atrial Fibrillation? Literature Review and Future Considerations.
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Vrachatis DA, Papathanasiou KA, Iliodromitis KE, Giotaki SG, Kossyvakis C, Raisakis K, Kaoukis A, Lambadiari V, Avramides D, Reimers B, Stefanini GG, Cleman M, Giannopoulos G, Lansky A, and Deftereos SG
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- Atrial Fibrillation complications, Atrial Fibrillation physiopathology, Atrial Remodeling physiology, Diabetes Mellitus, Type 2 complications, Diabetes Mellitus, Type 2 drug therapy, Energy Metabolism, Hemodynamics, Humans, Inflammation metabolism, Mitochondria metabolism, Sympatholytics therapeutic use, Uric Acid metabolism, Anti-Arrhythmia Agents therapeutic use, Atrial Fibrillation drug therapy, Sodium-Glucose Transporter 2 Inhibitors therapeutic use
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The global burden of atrial fibrillation (AF) is constantly increasing, necessitating novel and effective therapeutic options. Sodium glucose co-transporter 2 (SGLT2) inhibitors have been introduced in clinical practice as glucose-lowering medications. However, they have recently gained prominence for their potential to exert substantial cardiorenal protection and are being evaluated in large clinical trials including patients with type 2 diabetes and normoglycemic adults. In this review we present up-to-date available evidence in a pathophysiology-directed manner from cell to bedside. Preclinical and clinical data regarding a conceivable antiarrhythmic effect of SGLT2 inhibitors are beginning to accumulate. Herein we comprehensively present data that explore the potential pathophysiological link between SGLT2 inhibitors and AF. With regard to clinical data, no randomized controlled trials evaluating SGLT2 inhibitors effects on AF as a pre-specified endpoint are available. However, data from randomized controlled trial post-hoc analysis as well as observational studies point to a possible beneficial effect of SGLT2 inhibitors on AF. Meta-analyses addressing this question report inconsistent results and the real magnitude of AF prevention by SGLT2 inhibition remains unclear. Still, while (i) pathophysiologic mechanisms involved in AF might be favorably affected by SGLT2 inhibitors and (ii) emerging, yet inconsistent, clinical data imply that SGLT2 inhibitor-mediated cardiorenal protection could also exert antiarrhythmic effects, the argument of whether these novel drugs will reduce AF burden is unsettled and mandates appropriately designed and adequately sized randomized controlled studies., (© 2021. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)
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- 2021
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23. A stand-alone structured educational programme after myocardial infarction: a randomised study.
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Giannopoulos G, Karageorgiou S, Vrachatis D, Anagnostopoulos I, Kousta MS, Lakka E, Giotaki S, Raisakis K, Sianos G, Toutouzas K, Cleman M, and Deftereos S
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Background: Acute myocardial infarction (MI) is a major clinical manifestation of coronary artery disease. Post-MI morbidity and mortality can be reduced by lifestyle changes and aggressive risk factor modification. These changes can be applied more effectively if the patient is actively involved in the process. The hypothesis of this study was that an educational programme in post-MI patients could lead to reduced incidence of cardiovascular events., Methods: Post-MI patients were prospectively randomised into two groups. Patients in the intervention arm were scheduled to attend an 8-week-long educational programme on top of usual treatment, while controls received optimal treatment. The primary endpoint was the composite of all-cause death, MI, cerebrovascular event and unscheduled hospitalisation for cardiovascular causes. Endpoint adjudication was blinded., Results: 329 patients (238 men) were included, with a mean follow-up time of 17±4 months. In the primary analysis, mean primary end point-free survival time was 597 days (95% CI 571 to 624) in controls, compared with 663 days (95% CI 638 to 687) in the intervention group (p<0.001). The HR in the univariate Cox regression analysis was 0.48 (95% CI 0.32 to 0.73; p=0.001). The raw rates of the primary endpoint were 20.8% (6 deaths, 13 MIs, 2 strokes and 14 hospitalisations) vs 36.6% (8 deaths, 22 MIs, 7 strokes and 22 hospitalisations), respectively (OR 0.46, 95% CI 0.28 to 0.74; p=0.002)., Conclusion: These results suggest that a relatively short adult education programme offered to post-MI patients has beneficial effects, resulting in reduced risk of cardiovascular events., Trial Registration Number: NCT04007887., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. No commercial re-use. See rights and permissions. Published by BMJ.)
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- 2021
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24. Atrial fibrillation risk in patients suffering from type I diabetes mellitus. A review of clinical and experimental evidence.
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Vrachatis DA, Papathanasiou KA, Kossyvakis C, Giotaki SG, Raisakis K, Iliodromitis KE, Reimers B, Stefanini GG, Cleman M, Sianos G, Lansky A, Deftereos SG, and Giannopoulos G
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- Aged, Diabetes Mellitus, Type 1 pathology, Female, Humans, Male, Middle Aged, Atrial Fibrillation etiology, Diabetes Mellitus, Type 1 complications
- Abstract
Atrial fibrillation (AF) and diabetes mellitus (DM) are commonly encountered in clinical practice. Although, the long term macrovascular and microvascular sequela of DM are well validated, the association between the less prevalent type 1 DM (T1DM) and atrial arrhythmogenesis is poorly understood. In the present review we highlight the current experimental and clinical data addressing this complex interaction. Animal studies support that T1DM, characterized by insulin deficiency and glycemic variability, impairs phosphatidylinositol 3‑kinase (PI3K)/protein kinase B signaling pathway. This pathway holds a central role in atrial electrical and structural remodeling responsible for arrhythmia initiation and maintenance. The molecular ''footprint'' of T1DM in atrial myocytes seems to involve a state of increased oxidative stress, impaired glucose transportation, ionic channel dysregulation and eventually fibrosis. On the contrary only a few clinical studies have examined the role of T1DM as an independent risk factor for AF development, and are discussed here. Further research is needed to solidify the real magnitude of this association and to investigate the clinical implications of PI3K molecular signaling pathway in atrial fibrillation management., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2021 Elsevier B.V. All rights reserved.)
- Published
- 2021
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25. Ticagrelor versus clopidogrel in patients with STEMI treated with thrombolysis: the MIRTOS trial.
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Hamilos M, Kanakakis J, Anastasiou I, Karvounis C, Vasilikos V, Goudevenos J, Michalis L, Koutouzis M, Tsiafoutis I, Raisakis K, Stakos D, Hahalis G, and Vardas P
- Subjects
- Aged, Clopidogrel adverse effects, Fibrinolysis, Humans, Platelet Aggregation Inhibitors therapeutic use, Thrombolytic Therapy, Ticagrelor therapeutic use, Treatment Outcome, Percutaneous Coronary Intervention, ST Elevation Myocardial Infarction drug therapy
- Abstract
Aims: We aimed to demonstrate whether coronary microvascular function is improved after ticagrelor administration compared to clopidogrel administration in STEMI subjects undergoing thrombolysis., Methods and Results: MIRTOS is a multicentre study of ticagrelor versus clopidogrel in STEMI subjects treated with fibrinolysis. We enrolled 335 patients <75 years old with STEMI eligible for thrombolysis, of whom 167 were randomised to receive clopidogrel and 168 to receive ticagrelor together with thrombolysis. Primary outcome was the difference in post-PCI corrected TIMI frame count (CTFC). All clinical events were recorded in a three-month follow-up period. From the 335 patients who were randomised, 259 underwent PCI (129 clopidogrel and 130 ticagrelor) and 154 angiographies were analysable for the study primary endpoint. No significant difference was found between the clopidogrel (n=85) and ticagrelor (n=69) groups for CTFC (24.33±17.35 vs 28.33±17.59, p=0.10). No significant differences were observed in MACE and major bleeding events between randomisation groups (OR 2.0, 95% CI: 0.18-22.2, p=0.99)., Conclusions: Thrombolysis with ticagrelor in patients <75 years old was not able to demonstrate superiority compared to clopidogrel in terms of microvascular injury, while there was no difference between the two groups in MACE and major bleeding events., Trial Registration: ClinicalTrials.gov Identifier: NCT02429271. EudraCT Number 2014-004082-25.
- Published
- 2021
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26. "TAVI: Valve in valve. A new field for structuralists? Literature review".
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Vrachatis DA, Vavuranakis M, Tsoukala S, Giotaki S, Papaioannou TG, Siasos G, Deftereos G, Giannopoulos G, Raisakis K, Tousoulis D, Deftereos S, and Vavuranakis M
- Subjects
- Aortic Valve diagnostic imaging, Aortic Valve surgery, Humans, Prosthesis Design, Treatment Outcome, Aortic Valve Stenosis surgery, Bioprosthesis, Heart Valve Prosthesis, Heart Valve Prosthesis Implantation adverse effects, Transcatheter Aortic Valve Replacement adverse effects
- Abstract
Transcatheter aortic valve implantation (TAVI) led to the foundation of the subspecialty of structural heart interventions and created an emerging area of clinical and technical issues. Soon after TAVI introduction into clinical practice, boundaries were expanded with utilization of valve-in-valve (V-i-V) techniques. V-i-V comprised a diverse subset of patients including TAVI within TAVI, TAVI within a degenerated surgically implanted bioprosthesis, or even TAVI-in-TAVI-in-surgical bioprosthesis. In the present review, we summarize the available literature and present initial experience on the field in Greece., (Copyright © 2019 Hellenic Society of Cardiology. Published by Elsevier B.V. All rights reserved.)
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- 2020
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27. The Greek study in the effects of colchicine in COvid-19 complications prevention (GRECCO-19 study): Rationale and study design.
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Deftereos SG, Siasos G, Giannopoulos G, Vrachatis DA, Angelidis C, Giotaki SG, Gargalianos P, Giamarellou H, Gogos C, Daikos G, Lazanas M, Lagiou P, Saroglou G, Sipsas N, Tsiodras S, Chatzigeorgiou D, Moussas N, Kotanidou A, Koulouris N, Oikonomou E, Kaoukis A, Kossyvakis C, Raisakis K, Fountoulaki K, Comis M, Tsiachris D, Sarri E, Theodorakis A, Martinez-Dolz L, Sanz-Sánchez J, Reimers B, Stefanini GG, Cleman M, Filippou D, Olympios CD, Pyrgakis VN, Goudevenos J, Hahalis G, Kolettis TM, Iliodromitis E, Tousoulis D, and Stefanadis C
- Subjects
- Antirheumatic Agents administration & dosage, Antirheumatic Agents adverse effects, Betacoronavirus isolation & purification, COVID-19, COVID-19 Testing, Clinical Laboratory Techniques methods, Humans, Randomized Controlled Trials as Topic, SARS-CoV-2, Symptom Assessment methods, Troponin analysis, Colchicine administration & dosage, Colchicine adverse effects, Coronavirus Infections complications, Coronavirus Infections diagnosis, Coronavirus Infections physiopathology, Heart Diseases blood, Heart Diseases etiology, Heart Diseases prevention & control, Pandemics, Pneumonia, Viral complications, Pneumonia, Viral diagnosis, Pneumonia, Viral physiopathology
- Abstract
Objective: Colchicine has been utilized safely in a variety of cardiovascular clinical conditions. Among its potential mechanisms of action is the non-selective inhibition of NLRP3 inflammasome which is thought to be a major pathophysiologic component in the clinical course of patients with COVID-19. GRECCO-19 will be a prospective, randomized, open-labeled, controlled study to assess the effects of colchicine in COVID-19 complications prevention., Methods: Patients with laboratory confirmed SARS-CoV-2 infection (under RT PCR) and clinical picture that involves temperature >37.5 oC and at least two out of the: i. sustained coughing, ii. sustained throat pain, iii. Anosmia and/or ageusia, iv. fatigue/tiredness, v. PaO2<95 mmHg will be included. Patients will be randomised (1:1) in colchicine or control group., Results: Trial results will be disseminated through peer-reviewed publications and conference presentations., Conclusion: GRECCO-19 trial aims to identify whether colchicine may positively intervene in the clinical course of COVID-19. (ClinicalTrials.gov Identifier: NCT04326790)., Competing Interests: Conflict of interest No conflict of interest exists., (Copyright © 2020 Hellenic Society of Cardiology. Published by Elsevier B.V. All rights reserved.)
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- 2020
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28. How should I treat a TAVI-eligible patient with a left ventricular thrombus and rapid clinical deterioration?
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Deftereos S, Giannopoulos G, Raisakis K, Vrettou AR, Kolokathis F, Zacharoulis A, Angouras D, Alexopoulos D, Lekakis J, Eggebrecht H, Lämmer J, Papadopoulos N, and Collet JP
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- Aged, 80 and over, Aortic Valve Stenosis diagnostic imaging, Humans, Male, Thrombosis diagnostic imaging, Transcatheter Aortic Valve Replacement methods, Treatment Outcome, Aortic Valve Stenosis surgery, Clinical Deterioration, Thrombosis surgery
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- 2017
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29. Calcium Ions in Inherited Cardiomyopathies.
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Deftereos S, Papoutsidakis N, Giannopoulos G, Angelidis C, Raisakis K, Bouras G, Davlouros P, Panagopoulou V, Goudevenos J, Cleman MW, and Lekakis J
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- Animals, Apoptosis, Arrhythmogenic Right Ventricular Dysplasia genetics, Arrhythmogenic Right Ventricular Dysplasia metabolism, Arrhythmogenic Right Ventricular Dysplasia pathology, Calcium-Binding Proteins genetics, Calcium-Binding Proteins metabolism, Cardiomyopathies genetics, Cardiomyopathies pathology, Cations, Divalent, Heart Defects, Congenital genetics, Heart Defects, Congenital metabolism, Heart Defects, Congenital pathology, Humans, Tropomyosin genetics, Tropomyosin metabolism, Troponin genetics, Troponin metabolism, Calcium metabolism, Cardiomyopathies metabolism
- Abstract
Inherited cardiomyopathies are a known cause of heart failure, although the pathways and mechanisms leading from mutation to the heart failure phenotype have not been elucidated. There is strong evidence that this transition is mediated, at least in part, by abnormal intracellular Ca(2+) handling, a key ion in ventricular excitation, contraction and relaxation. Studies in human myocytes, animal models and in vitro reconstituted contractile protein complexes have shown consistent correlations between Ca(2+) sensitivity and cardiomyopathy phenotype, irrespective of the causal mutation. In this review we present the available data about the connection between mutations linked to familial hypertrophic (HCM), dilated (DCM) and restrictive (RCM) cardiomyopathy, right ventricular arrhythmogenic cardiomyopathy/dysplasia (ARVC/D) as well as left ventricular non-compaction and the increase or decrease in Ca(2+) sensitivity, together with the results of attempts to reverse the manifestation of heart failure by manipulating Ca(2+) homeostasis.
- Published
- 2016
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30. A predictive score of radial artery spasm in patients undergoing transradial percutaneous coronary intervention.
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Giannopoulos G, Raisakis K, Synetos A, Davlouros P, Hahalis G, Alexopoulos D, Tousoulis D, Lekakis J, Stefanadis C, Cleman MW, and Deftereos S
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- Aged, Angioplasty, Balloon, Coronary adverse effects, Cohort Studies, Coronary Angiography methods, Coronary Stenosis diagnostic imaging, Female, Follow-Up Studies, Humans, Logistic Models, Male, Middle Aged, Percutaneous Coronary Intervention adverse effects, Percutaneous Coronary Intervention methods, Predictive Value of Tests, Prospective Studies, ROC Curve, Reproducibility of Results, Risk Assessment, Severity of Illness Index, Spasm physiopathology, Statistics, Nonparametric, Treatment Outcome, Angioplasty, Balloon, Coronary methods, Coronary Stenosis therapy, Radial Artery physiopathology, Vascular Resistance
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Objective: Radial artery spasm may hinder completion of transradial angiography or PCI, leading to access site crossover, prolonged procedure times and complications. The aim of this study was to derive a radial artery spasm risk score in patients undergoing elective percutaneous coronary intervention (PCI), prospectively validate it, and apply it in a real-life clinical setting., Methods: The study population consisted of 3 cohorts of patients undergoing elective PCI with transradial access: the derivation cohort (N=1006), the validation cohort (N=576) and the intervention cohort (N=140), consisting of patients with high risk score, in whom intensified spasm-preventive measures were applied., Results: Multivariable analysis in the derivation cohort showed that 5 weighted factors could be used to construct a risk score for spasm: body-mass index, height, current smoking, hypertension and peripheral artery disease (c-statistic 0.945, with an optimal cut-off of 4). In the validation cohort, the cut-off of 4 predicted spasm with a sensitivity of 84.5% and a specificity of 74.7%. In the intervention cohort, which included only patients with a spasm-risk score of ≥4, the rate of spasm was drastically reduced (odds ratio 0.32, 95% confidence interval 0.17-0.61), compared to the corresponding high spasm risk subgroup of patients of the validation cohort., Conclusion: A spasm risk score can be used to predict radial artery spasm during elective transradial PCI. Using this score, a high spasm risk patient subgroup can be identified, where intensive spasm-preventive measures can lead to a significant reduction in the frequency of spasm., (Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.)
- Published
- 2015
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31. A comparison of low versus standard heparin dose for prevention of forearm artery occlusion after 5 French coronary angiography.
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Hahalis G, Xathopoulou I, Tsigkas G, Almpanis G, Christodoulou I, Grapsas N, Davlouros P, Koniari I, Deftereos S, Raisakis K, Christopoulou G, Giannopoulos G, Kounis N, Pyrgakis V, and Alexopoulos D
- Subjects
- Aged, Arterial Occlusive Diseases etiology, Catheters, Coronary Angiography adverse effects, Female, Forearm blood supply, Humans, Male, Middle Aged, Prospective Studies, Single-Blind Method, Anticoagulants administration & dosage, Arterial Occlusive Diseases prevention & control, Coronary Angiography instrumentation, Heparin administration & dosage, Radial Artery
- Abstract
Background: Radial artery occlusion (RAO) remains the Achilles' heel of transradial coronary procedures. Standard over lower systemic anticoagulation levels are believed to reduce RAO rates but this is ill-supported by scientific evidence. We compared whether standard in comparison with less intensive anticoagulation was superior in preventing vessel closure., Methods and Results: The two arms of this analysis included 731 pooled patients with the same inclusion and exclusion criteria. We assessed forearm arterial access site occlusion rate by unfractionated heparin (UFH) dose in an individual participant data meta-analysis of this randomized study and of consecutive eligible patients from our previous trial. We randomized 308 consecutive patients undergoing transradial coronary angiography with 5 French (5 Fr) catheters without need to crossover to receive 2500 or 5000 UFH units. The primary end-point was the ultrasonographically determined vessel occlusion rate. Incident RAOs in the randomized arm were 15.9% vs. 14%, in the low and standard UFH dose, respectively (p=0.7). Corresponding figures for forearm arterial occlusion rates in the pooled population were 13.0% vs. 9.9% (relative risk: 1.3, 95% confidence interval - CI: 0.88-1.98; p=0.2). Procedural and fluoroscopy duration was less than 15 and 3 min, respectively. The mean UFH dose difference was 3.52 (95% CI: -0.45 to 7.49) units per kilo body weight between occluded (n=84) and patent forearm arteries (n=647); (p=0.053)., Conclusions: Incident forearm arterial occlusions were high despite using 5 Fr catheters for a short-lasting procedure. Systemic anticoagulation with standard over lower UFH dose did not reduce the frequency of RAOs after coronary angiography., (Copyright © 2015. Published by Elsevier Ireland Ltd.)
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- 2015
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32. Central sympathetic inhibition to reduce postablation atrial fibrillation recurrences in hypertensive patients: a randomized, controlled study.
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Giannopoulos G, Kossyvakis C, Efremidis M, Katsivas A, Panagopoulou V, Doudoumis K, Raisakis K, Letsas K, Rentoukas I, Pyrgakis V, Manolis AS, Tousoulis D, Stefanadis C, and Deftereos S
- Subjects
- Aged, Atrial Fibrillation complications, Double-Blind Method, Female, Follow-Up Studies, Humans, Hypertension complications, Male, Middle Aged, Postoperative Complications drug therapy, Proportional Hazards Models, Prospective Studies, Recurrence, Treatment Outcome, Antihypertensive Agents administration & dosage, Atrial Fibrillation surgery, Catheter Ablation, Hypertension drug therapy, Imidazoles administration & dosage, Sympathetic Nervous System drug effects
- Abstract
Background: The autonomic system is an important determinant of atrial arrhythmogenesis. Current evidence indicates that a combined sympathovagal drive is most commonly responsible for eliciting atrial fibrillation (AF) episodes. The purpose of this study was to test whether moxonidine, a centrally acting sympathoinhibitory agent, can lead to a reduction in postablation AF recurrence., Methods and Results: This was a prospective, double-blinded, randomized study of 291 hypertensive patients with symptomatic paroxysmal AF who were scheduled to undergo pulmonary vein isolation. Patients were randomly assigned to receive either moxonidine (0.2-0.4 mg daily) or placebo, along with standard antihypertensive treatment. No significant differences in blood pressure levels were observed between the 2 groups. In the primary outcome analysis, mean recurrence-free survival was 467 days (95% CI, 445-489 days) in the moxonidine group as compared with 409 days (95% CI, 381-437 days) in control subjects (log rank test, P=0.006). The calculated 12-month recurrence rate estimates were 36.9% in the control group and 20.0% in the moxonidine group (P=0.007). Moxonidine treatment was associated with lower recurrence risk after adjustment for age, body mass index, number of AF episodes in the previous year, and left atrial diameter (adjusted hazard ratio, 0.35 [95% CI, 0.22-0.55]; P<0.001)., Conclusions: Treatment with moxonidine is associated with less AF recurrences after ablation treatment for drug-refractory AF in patients with hypertension. The observed effect does not appear to depend on the antihypertensive action of this agent., Clinical Trial Registration Url: http://www.clinicaltrials.gov. Unique identifier: NCT01791699., (© 2014 American Heart Association, Inc.)
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- 2014
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33. Intracardiac echocardiography begs to differ.
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Deftereos S, Kossyvakis C, Giannopoulos G, Raisakis K, Panagopoulou V, Doudoumis K, and Pyrgakis V
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- Humans, Male, Middle Aged, Cardiac Catheterization, Echocardiography methods, Heart Ventricles diagnostic imaging, Tachycardia, Ventricular diagnostic imaging, Ultrasonography, Interventional methods
- Published
- 2014
34. Association of virtual histology characteristics of the culprit plaque with post-fibrinolysis flow restoration in ST-elevation myocardial infarction.
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Giannopoulos G, Pappas L, Synetos A, Hahalis G, Raisakis K, Papadimitriou C, Kossyvakis C, Alexopoulos D, Tousoulis D, Stefanadis C, Cleman MW, and Deftereos S
- Subjects
- Aged, Coronary Angiography methods, Cross-Sectional Studies, Female, Humans, Male, Middle Aged, Myocardial Infarction epidemiology, Plaque, Atherosclerotic epidemiology, Blood Flow Velocity physiology, Myocardial Infarction diagnostic imaging, Myocardial Infarction therapy, Plaque, Atherosclerotic diagnostic imaging, Plaque, Atherosclerotic therapy, Thrombolytic Therapy trends
- Abstract
Objectives: We sought to test the hypothesis that virtual histology characteristics of the culprit lesion in patients with ST-elevation myocardial infarction are associated with blood flow restoration after thrombolysis., Methods: Consecutive patients referred for coronary angiography after successful thrombolysis were included in this correlational cross-sectional study. Evaluation with intravascular ultrasound (IVUS) and virtual histology of the culprit arterial segment was performed in all cases., Results: Forty-eight patients (60.5 ± 10.7 years) were included. TIMI flow grade 3 was found in 24 (50%). Diabetes was strongly associated with lower TIMI flow 3 rate (26.7% vs 60.6%; p = 0.029) and there was a significant difference in the time to thrombolysis (2.0 ± 0.8 hours in those with TIMI flow 3 vs 3.0 ± 0.7 hours in TIMI flow grades 1-2; p < 0.001). Patients with TIMI flow grades 3 and 1-2 had similar absolute total plaque volume (152.8 ± 59.3mm(3) vs 147.5 ± 92.3mm(3); p = 0.817) and absolute necrotic core (NC) volume (31.2 ± 13.9 mm(3) vs 33.6 ± 23.2mm(3); p = 0.671). However, there were significant differences in the relative NC content, both in proportion to the whole plaque volume (26.3% vs 29.9%; p = 0.016) and as an area fraction at the largest NC site (31.5% vs 40.3%; p < 0.001)., Conclusion: The NC content of atherosclerotic plaques is meaningful for flow restoration after the occurrence of a coronary event. This finding highlights the importance of plaque composition, as studied with virtual histology, not only for the sequence of processes leading to an acute plaque-related event, but also for thrombus formation and lysis, following the occurrence of such an event., (Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.)
- Published
- 2014
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35. Association of asymmetric dimethylarginine levels with treadmill-stress-test-derived prognosticators.
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Deftereos S, Bouras G, Tsounis D, Papadimitriou C, Hatzis G, Raisakis K, Panagopoulou V, Kaoukis A, Ioannidis A, Deftereos G, Kossyvakis C, Manolis AS, Alexopoulos D, Stefanadis C, Cleman MW, and Giannopoulos G
- Subjects
- Aged, Arginine blood, Coronary Artery Disease blood, Coronary Artery Disease physiopathology, Female, Humans, Male, Middle Aged, Prognosis, Risk Factors, Arginine analogs & derivatives, Biomarkers blood, Exercise Test methods
- Abstract
Background: Asymmetric dimethylarginine (ADMA) is an endogenous inhibitor of nitric oxide production. The purpose of this study was to assess the correlation between ADMA and treadmill stress test outcome parameters with known prognostic value, in patients with intermediate risk for coronary artery disease (CAD)., Methods: Study participants were referred for treadmill exercise stress test (EST) due to symptoms of suspected CAD. Participants with prior history of CAD, cerebrovascular events, peripheral artery disease, systemic inflammatory disease or use of anti-inflammatory agents were excluded. ADMA levels were measured before EST., Results: The study prospectively enrolled 209 individuals (165 males, aged 58.1±10.9). A significant negative correlation was detected between ADMA and maximal exercise time (r=-0.556, p<0.001), metabolic equivalents (METs) (r=-0.555, p<0.001) and Duke treadmill score (DTS) (r=-0.347, p<0.001). Subjects who exercised to ≥10 METs (n=114) had lower ADMA levels than those who achieved <7 METs (n=30) (0.58±0.06 vs 0.87±0.08μmol/L, p<0.001), and those with DTS<5 (n=63) had higher ADMA (0.75±0.19 vs 0.64±0.15μmol/L, p<0.001) compared to those with DTS ≥5 (n=146). In multivariable analysis, ADMA remained an independent predictor of DTS (R(2)=0.210; beta=-10.5; 95% confidence interval -14.9 to -6.2; adjusted p<0.001) and METs (R(2)=0.500; beta -8.5; 95% confidence interval -9.7 to -6.0; adjusted p<0.001) after adjustment for age, BMI, gender, diabetes, smoking status, dyslipidemia, hypertension and family history of premature CAD., Conclusion: ADMA is correlated to EST parameters with proven prognostic value. This implies that ADMA itself might be a useful prognosticator in patients with suspected CAD., (Copyright © 2014 The Canadian Society of Clinical Chemists. Published by Elsevier Inc. All rights reserved.)
- Published
- 2014
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36. Colchicine for prevention of atrial fibrillation recurrence after pulmonary vein isolation: mid-term efficacy and effect on quality of life.
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Deftereos S, Giannopoulos G, Efremidis M, Kossyvakis C, Katsivas A, Panagopoulou V, Papadimitriou C, Karageorgiou S, Doudoumis K, Raisakis K, Kaoukis A, Alexopoulos D, Manolis AS, Stefanadis C, and Cleman MW
- Subjects
- Atrial Fibrillation surgery, Colchicine administration & dosage, Female, Humans, Male, Middle Aged, Outcome Assessment, Health Care, Postoperative Care, Recurrence, Risk Reduction Behavior, Atrial Fibrillation prevention & control, Colchicine therapeutic use, Pulmonary Veins surgery, Quality of Life
- Abstract
Background: Our group previously showed that colchicine treatment is associated with decreased early recurrence rate after ablation for atrial fibrillation (AF)., Objective: The purpose of this study was to test the mid-term efficacy of colchicine in reducing AF recurrences after a single procedure of pulmonary vein isolation in patients with paroxysmal AF. Assessment of quality-of-life (QOL) changes was a secondary objective., Methods: Patients with paroxysmal AF who were scheduled for ablation were randomized to a 3-month course of colchicine 0.5 mg twice daily or placebo and were followed for a median of 15 months (with a 3-month blanking period). QOL was assessed with a general-purpose health-related QOL tool (26-item World Health Organization QOL questionnaire) at baseline and after 3 and 12 months., Results: Two hundred twenty-three randomized patients underwent ablation, and 206 patients were available for analysis (144 male, age 62.2 ± 5.8 years). AF recurrence rate in the colchicine group was 31.1% (32/103) vs 49.5% (51/103) in the control group (P = .010), translated in a relative risk reduction of 37% (odds ratio 0.46, 95% confidence interval 0.26-0.81). The number needed to treat was 6 (95% confidence interval 3.2-19.8). Physical domain QOL scores at 12 months were 63.6 ± 13.8 in the colchicine group and 52.5 ± 18.1 in controls, whereas psychological domain scores were 56.1 ± 13.7 vs 44.7 ± 17.3, respectively (P <.001, for both)., Conclusion: Colchicine treatment after pulmonary vein isolation for paroxysmal AF is associated with lower AF recurrence rates after a single procedure. This reduction is accompanied by corresponding improvements in physical and psychological health-related QOL scores., (Copyright © 2014 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.)
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- 2014
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37. Anti-inflammatory treatment with colchicine in stable chronic heart failure: a prospective, randomized study.
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Deftereos S, Giannopoulos G, Panagopoulou V, Bouras G, Raisakis K, Kossyvakis C, Karageorgiou S, Papadimitriou C, Vastaki M, Kaoukis A, Angelidis C, Pagoni S, Pyrgakis V, Alexopoulos D, Manolis AS, Stefanadis C, and Cleman MW
- Subjects
- Aged, Anti-Inflammatory Agents adverse effects, Biomarkers metabolism, C-Reactive Protein metabolism, Chronic Disease, Colchicine adverse effects, Double-Blind Method, Drug Administration Schedule, Exercise Tolerance drug effects, Female, Heart Failure blood, Heart Failure physiopathology, Humans, Interleukin-6 metabolism, Kaplan-Meier Estimate, Length of Stay, Male, Prospective Studies, Treatment Outcome, Anti-Inflammatory Agents administration & dosage, Colchicine administration & dosage, Heart Failure drug therapy
- Abstract
Objectives: The purpose of this study was to test the efficacy of a 6-month course of anti-inflammatory treatment with colchicine in improving functional status of patients with stable chronic heart failure (CHF)., Background: CHF has been shown to be associated with inflammatory activation. Inflammation has been designated as a therapeutic target in CHF., Methods: Patients with stable CHF were randomly assigned to colchicine (0.5 mg twice daily) or placebo for 6 months. The primary endpoint was the proportion of patients achieving at least one-grade improvement in New York Heart Association class., Results: Two hundred sixty-seven patients were available for final evaluation of the primary endpoint: its rate was 11% in the control group and 14% in the colchicine group (odds ratio: 1.40; 95% confidence interval: 0.67 to 2.93; p = 0.365). The rate of the composite of death or hospital stay for heart failure was 9.4% in the control group, compared with 10.1% in the colchicine group (p = 0.839). The changes in treadmill exercise time with treatment were insignificant and similar in the 2 groups (p = 0.938). C-reactive protein and interleukin-6 were both significantly reduced in the colchicine group (-5.1 mg/l and -4.8 pg/ml, respectively; p < 0.001 for both, compared with the control group)., Conclusions: According to this prospective, randomized study, anti-inflammatory treatment with colchicine in patients with stable CHF, although effective in reducing inflammation biomarker levels, did not affect in any significant way patient functional status (in terms of New York Heart Association class and objective treadmill exercise tolerance) or the likelihood of death or hospital stay for heart failure., (Copyright © 2014 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)
- Published
- 2014
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38. Innate immune inflammatory response in the acutely ischemic myocardium.
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Deftereos S, Angelidis C, Bouras G, Raisakis K, Gerckens U, Cleman MW, and Giannopoulos G
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- Acute Disease, Humans, Immunity, Innate immunology, Inflammation immunology, Myocardial Ischemia immunology
- Abstract
The "holy grail" of modern interventional cardiology is the salvage of viable myocardial tissue in the distribution of an acutely occluded coronary artery. Thrombolysis and percutaneous coronary interventions, provided they can be delivered on time, can interrupt the occlusion and save tissue. At the same time restoring the patency of the coronary vessels and providing the ischemic myocardium with blood can cause additional tissue damage. A key element of ischemic and reperfusion injury and major determinant of the evolution of damage in the injured myocardium is the inflammatory response. The innate immune system initiates and directs this response which is a prerequisite for subsequent healing. The complement cascade is set in motion following the release of subcellular membrane constituents. Endogenous 'danger' signals known as danger-associated molecular patterns (DAMPs) released from ischemic and dying cells alert the innate immune system and activate several signal transduction pathways through interactions with the highly conserved Toll like receptors (TLRs). Reactive oxygen species (ROS) generation directly induces pro-inflammatory cascades and triggers formation of the inflammasome. The challenge lies into designing strategies that specifically block the inflammatory cascades responsible for tissue damage without affecting those concerned with tissue healing.
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- 2014
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39. Colchicine and the heart: pushing the envelope.
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Deftereos S, Giannopoulos G, Papoutsidakis N, Panagopoulou V, Kossyvakis C, Raisakis K, Cleman MW, and Stefanadis C
- Subjects
- Angioplasty, Animals, Atrial Fibrillation drug therapy, Colchicine pharmacology, Coronary Artery Disease drug therapy, Humans, Pericarditis drug therapy, Tubulin Modulators pharmacology, Colchicine therapeutic use, Heart Diseases drug therapy, Tubulin Modulators therapeutic use
- Abstract
Colchicine, a natural and ancient drug still used today, is traditionally considered the staple therapy for gout and a second-line treatment for pericarditis, as well as a basic part of familial Mediterranean fever and Behcet's disease management. It is commonly classified as an anti-inflammatory agent, although its mechanism of action does not involve the arachidonic acid pathway affected by non-steroid anti-inflammatory drugs and glucocorticoids. Colchicine inhibits microtubule polymerization by binding to tubulin, thus affecting any process that requires cytoskeletal changes, including cell mitosis and neutrophil motility. Recent studies suggest that colchicine may prove to be useful in a much wider spectrum of cardiovascular diseases than previously suspected, rekindling the interest in this old drug. In this review we briefly present the biochemical characteristics, mechanism of action and side-effects of colchicine, as well as examine what is currently known about the promising role of colchicine in cardiovascular medicine beyond pericardial disease., (Copyright © 2013 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)
- Published
- 2013
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40. Effectiveness of moxonidine to reduce atrial fibrillation burden in hypertensive patients.
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Deftereos S, Giannopoulos G, Kossyvakis C, Efremidis M, Panagopoulou V, Raisakis K, Kaoukis A, Karageorgiou S, Bouras G, Katsivas A, Pyrgakis V, and Stefanadis C
- Subjects
- Adrenergic beta-Antagonists therapeutic use, Aged, Amiodarone therapeutic use, Angiotensin Receptor Antagonists therapeutic use, Angiotensin-Converting Enzyme Inhibitors therapeutic use, Atrial Fibrillation complications, Calcium Channel Blockers therapeutic use, Cross-Over Studies, Double-Blind Method, Drug Therapy, Combination, Female, Humans, Hypertension complications, Male, Middle Aged, Propafenone therapeutic use, Sotalol therapeutic use, Sympatholytics therapeutic use, Treatment Outcome, Anti-Arrhythmia Agents therapeutic use, Antihypertensive Agents therapeutic use, Atrial Fibrillation drug therapy, Hypertension drug therapy, Imidazoles therapeutic use
- Abstract
There is substantial evidence that the autonomic system plays an important part in the pathogenesis of atrial fibrillation (AF). It appears that, although some patients have a preponderantly sympathetic or vagal overactivation leading to AF, a combined sympathovagal drive is most commonly responsible for AF triggering. The purpose of this hypothesis-generating study was to test whether moxonidine, a centrally acting sympathoinhibitory agent, on top of optimal antihypertensive treatment, can lead to a decrease in AF burden in hypertensive patients with paroxysmal AF. This was a prospective, double-blind, 1-group, crossover study. Hypertensive patients with paroxysmal AF sequentially received treatment with placebo and moxonidine for two 6-week periods, respectively. The change in AF burden (measured as minutes of AF per day in three 48-hour Holter recordings) between the 2 treatment periods was the primary outcome measure. Fifty-six patients (median age 63.5 years, 35 men) were included. During moxonidine treatment, AF burden was reduced from 28.0 min/day (interquartile range [IQR] 15.0 to 57.8) to 16.5 min/day (IQR 4.0 to 36.3; p <0.01). European Heart Rhythm Association symptom severity class decreased from a median of 2.0 (IQR 1.0 to 2.0) to 1.0 (IQR 1.0 to 2.0; p = 0.01). Systolic blood pressure levels were similar in the 2 treatment periods, whereas diastolic blood pressure was lower (p <0.01) during moxonidine treatment. The most frequent complaint was dry mouth (28.6%). No serious adverse events were recorded. In conclusion, treatment with moxonidine, a centrally acting sympathoinhibitory agent, results in reduction of AF burden and alleviation of AF-related symptoms in hypertensive patients with paroxysmal AF., (Copyright © 2013 Elsevier Inc. All rights reserved.)
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- 2013
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41. Association of post-cardioversion transcardiac concentration gradient of soluble tumor necrosis factor-related apoptosis-inducing ligand (sTRAIL) and inflammatory biomarkers to atrial fibrillation recurrence.
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Deftereos S, Giannopoulos G, Kossyvakis C, Raisakis K, Angelidis C, Efremidis M, Panagopoulou V, Kaoukis A, Theodorakis A, Toli K, Zavitsanakis P, Mantas I, Pyrgakis V, Stefanadis C, and Cleman MW
- Subjects
- Aged, Apoptosis, Atrial Fibrillation pathology, Biomarkers blood, Female, Humans, Male, Middle Aged, Recurrence, Solubility, Atrial Fibrillation blood, Atrial Fibrillation therapy, Electric Countershock, Inflammation blood, TNF-Related Apoptosis-Inducing Ligand blood
- Abstract
Objectives: Soluble tumor necrosis factor-related apoptosis-inducing ligand (sTRAIL) has been shown to have both pro- and anti-apoptotic activities and is associated to better prognosis in heart failure. The aim of this study was to determine the transcardiac concentration gradient of sTRAIL and inflammatory biomarkers after AF cardioversion and assess their relation to AF recurrence., Design and Methods: We measured transcardiac gradients (coronary sinus concentration minus aortic root concentration) of sTRAIL, C-reactive protein (hsCRP) and interleukin-6 (IL-6) in patients with non-valvular AF after electrical cardioversion. Six-month AF recurrence was the study endpoint., Results: There were no differences in sTRAIL and hsCRP concentrations in peripheral venous blood between patients with and without AF recurrence (p=0.066 and 0.149, respectively), while IL-6 was higher in patients with recurrence (p=0.032). Only sTRAIL showed a significant transcardiac gradient [3 pg/mL (IQR 1-4 pg/mL); p=0.01]. sTRAIL gradient was 4 pg/mL (IQR 3-5 pg/mL) in patients without recurrence versus -1 pg/mL (IQR -2-1 pg/mL) in those with recurrence (p<0.001). IL-6 (p=0.281) and hsCRP (p=0.979) aortic concentrations were not significantly different from coronary sinus concentrations. In multivariate analysis, sTRAIL transcardiac gradient (beta -0.81, p=0.004) remained a negative predictor of AF recurrence., Conclusion: This study demonstrates the existence of a significant transcardiac sTRAIL concentration gradient in patients with non-valvular AF, inversely associated to AF recurrence. These results suggest production of sTRAIL by the heart and a protective role against substrate-altering processes in AF-prone atria. This could have implications for TRAIL-targeting therapies currently under development., (Copyright © 2013 The Canadian Society of Clinical Chemists. Published by Elsevier Inc. All rights reserved.)
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- 2013
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42. Transulnar compared with transradial artery approach as a default strategy for coronary procedures: a randomized trial. The Transulnar or Transradial Instead of Coronary Transfemoral Angiographies Study (the AURA of ARTEMIS Study).
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Hahalis G, Tsigkas G, Xanthopoulou I, Deftereos S, Ziakas A, Raisakis K, Pappas C, Sourgounis A, Grapsas N, Davlouros P, Galati A, Plakomyti TE, Mylona P, Styliadis I, Pyrgakis V, and Alexopoulos D
- Subjects
- Aged, Cardiac Catheterization adverse effects, Coronary Angiography adverse effects, Early Termination of Clinical Trials, Feasibility Studies, Female, Greece, Humans, Logistic Models, Male, Middle Aged, Multivariate Analysis, Odds Ratio, Percutaneous Coronary Intervention adverse effects, Prospective Studies, Time Factors, Cardiac Catheterization methods, Coronary Angiography methods, Percutaneous Coronary Intervention methods, Radial Artery, Ulnar Artery
- Abstract
Background: The ulnar artery is rarely selected for coronary angiography or percutaneous coronary intervention despite the expanding use of the transradial approach. We aimed to establish noninferiority of a default transulnar relative to transradial approach in terms of feasibility and safety., Methods and Results: This was a prospective, randomized, multicenter, parallel-group study involving 902 patients at 5 sites eligible to undergo diagnostic coronary angiography and percutaneous coronary intervention. Patients were randomized in a 1:1 ratio to either transradial approach (reference intervention) or transulnar approach (experimental intervention) regardless of the Allen test results. The primary end point was a composite of cross-over to another arterial access, major adverse cardiovascular events, and major vascular events of the arm at 60 days. The study was prematurely terminated after the first interim analysis because of inferiority of the transulnar approach. Although the difference in the primary end point became inconclusive after adjustment for operator clustering (24.30%; 99.99% confidence interval [CI], -7.98% to 56.58%; P=0.03 at α=0.0001), need for cross-over in the transulnar group remained inferior to transradial access site with a difference of 26.34% (95% CI, 11.96%-40.69%; P=0.004)., Conclusions: As a result of higher cross-over rates, a first-line transulnar strategy was proven inferior to the transradial approach for coronary procedures. At present, the transulnar route should not be regarded as an acceptable alternative to the transradial access site.
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- 2013
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43. Renoprotective effect of remote ischemic post-conditioning by intermittent balloon inflations in patients undergoing percutaneous coronary intervention.
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Deftereos S, Giannopoulos G, Tzalamouras V, Raisakis K, Kossyvakis C, Kaoukis A, Panagopoulou V, Karageorgiou S, Avramides D, Toutouzas K, Hahalis G, Pyrgakis V, Manolis AS, Alexopoulos D, Stefanadis C, and Cleman MW
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- Acute Kidney Injury etiology, Aged, Female, Glomerular Filtration Rate, Humans, Male, Middle Aged, Percutaneous Coronary Intervention statistics & numerical data, Prospective Studies, Acute Kidney Injury prevention & control, Ischemic Postconditioning, Myocardial Infarction surgery, Percutaneous Coronary Intervention adverse effects
- Abstract
Objectives: The aim of the present study was to assess the efficacy of remote ischemic post-conditioning (RIPC) by repeated intermittent balloon inflations in preventing acute kidney injury (AKI) in patients with a non-ST-segment elevation myocardial infarction undergoing percutaneous coronary intervention (PCI)., Background: AKI complicating PCI is associated with increased morbidity and mortality. Remote ischemic preconditioning, using cycles of upper limb ischemia-reperfusion as a conditioning stimulus, has been recently shown to prevent AKI in patients undergoing elective coronary angiography., Methods: Eligible patients were randomized to receive RIPC by cycles of inflation and deflation of the stent balloon during PCI or a sham procedure (control patients). The primary endpoint was AKI, defined as an increase of ≥ 0.5 mg/dl or ≥ 25% in serum creatinine within 96 h from PCI. The 30-day rate of death or re-hospitalization for any cause was one of the secondary endpoints., Results: A total of 225 patients were included (median age, 68 years; 36% female). The AKI rate in the RIPC group was 12.4% versus 29.5% in the control group (p = 0.002; odds ratio: 0.34; 95% confidence interval: 0.16 to 0.71). The number needed to treat to avoid 1 case of AKI was 6 (95% confidence interval: 3.6 to 15.2). The 30-day rate of death or re-hospitalization for any cause was 22.3% in the control group versus 12.4% in RIPC patients (p = 0.05)., Conclusions: RIPC by serial balloon inflations and deflations during PCI was found to confer protection against AKI in patients with a non-ST-segment elevation myocardial infarction undergoing PCI. The reduction in the rate of AKI translated into a clear trend (of borderline significance) toward better 30-day clinical outcome., (Copyright © 2013 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)
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- 2013
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44. Alcohol septal ablation as a bail-out procedure for suicide left ventricle after transcatheter aortic valve implantation.
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Gerckens U, Pizzulli L, and Raisakis K
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- Aged, 80 and over, Cardiac Catheterization methods, Female, Humans, Salvage Therapy methods, Treatment Outcome, Aortic Stenosis, Subvalvular therapy, Aortic Valve, Cardiomyopathy, Hypertrophic therapy, Catheter Ablation methods, Ethanol therapeutic use, Heart Valve Prosthesis Implantation, Heart Ventricles surgery
- Abstract
With the advent of transcatheter aortic valve implantation (TAVI), many AS patients, formerly considered inoperable, can receive effective treatment. The relief of the left ventricular pressure overload could lead, in some cases, to the occurrence of dynamic intracavity pressure gradients (DIG) with deleterious clinical impact. This phenomenon resembles the physiology seen in hypertrophic obstructive cardiomyopathy. We report a case in which alcohol septal ablation was used as a bail-out therapy for the acutely developed intracavity obstruction after TAVI. Potential dynamic intracavity gradients should always be excluded in the acutely deteriorated patient postoperatively. Alcohol septal ablation can be considered as a salvage therapeutic tool when other therapies are ineffective to treat subvalvular obstruction.
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- 2013
45. Colchicine treatment for the prevention of bare-metal stent restenosis in diabetic patients.
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Deftereos S, Giannopoulos G, Raisakis K, Kossyvakis C, Kaoukis A, Panagopoulou V, Driva M, Hahalis G, Pyrgakis V, Alexopoulos D, Manolis AS, Stefanadis C, and Cleman MW
- Subjects
- Adult, Aged, Aged, 80 and over, Colchicine adverse effects, Coronary Angiography, Coronary Restenosis diagnostic imaging, Coronary Restenosis prevention & control, Coronary Vessels drug effects, Coronary Vessels surgery, Double-Blind Method, Female, Humans, Male, Middle Aged, Prospective Studies, Treatment Outcome, Colchicine therapeutic use, Coronary Restenosis drug therapy, Coronary Vessels pathology, Diabetes Mellitus, Type 2 complications, Neointima drug therapy, Percutaneous Coronary Intervention adverse effects, Stents adverse effects
- Abstract
Objectives: This study sought to test the hypothesis that colchicine treatment after percutaneous coronary intervention (PCI) can lead to a decrease in in-stent restenosis (ISR)., Background: ISR rates are particularly high in certain patient subsets, including diabetic patients, especially when a bare-metal stent (BMS) is used. Pharmacological interventions to decrease ISR could be of clinical relevance., Methods: Diabetic patients with contraindication to a drug-eluting stent, undergoing PCI with a BMS, were randomized to receive colchicine 0.5 mg twice daily or placebo for 6 months. Restenosis and neointima formation were studied with angiography and intravascular ultrasound 6 months after the index PCI., Results: A total of 196 patients (63.6 ± 7.0 years of age, 128 male) were available for analysis. The angiographic ISR rate was 16% in the colchicine group and 33% in the control group (p = 0.007; odds ratio: 0.38, 95% confidence interval: 0.18 to 0.79). The number needed to treat to avoid 1 case of angiographic ISR was 6 (95% confidence interval: 3.4 to 18.7). The results were similar for IVUS-defined ISR (odds ratio: 0.42; 95% confidence interval: 0.22 to 0.81; number needed to treat = 5). Lumen area loss was 1.6 mm(2) (interquartile range: 1.0 to 2.9 mm(2)) in colchicine-treated patients and 2.9 mm(2) (interquartile range: 1.4 to 4.8 mm(2)) in the control group (p = 0.002). Treatment-related adverse events were largely limited to gastrointestinal symptoms., Conclusions: Colchicine is associated with less neointimal hyperplasia and a decreased ISR rate when administered to diabetic patients after PCI with a BMS. This observation may prove useful in patients undergoing PCI in whom implantation of a drug-eluting stent is contraindicated or undesirable., (Copyright © 2013 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)
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- 2013
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46. Pre-procedural flow-mediated dilation associated to arterial spasm during transulnar coronary angiography and interventions.
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Deftereos S, Giannopoulos G, Tousoulis D, Raisakis K, Kossyvakis C, Kaoukis A, Panagopoulou V, Tzalamouras V, Hahalis G, Pyrgakis V, Cleman MW, and Stefanadis C
- Subjects
- Aged, Angioplasty, Balloon, Coronary methods, Cardiac Catheterization methods, Coronary Angiography methods, Coronary Circulation physiology, Coronary Vasospasm etiology, Coronary Vasospasm physiopathology, Female, Humans, Male, Middle Aged, Predictive Value of Tests, Ulnar Artery physiology, Vasodilation physiology, Angioplasty, Balloon, Coronary adverse effects, Cardiac Catheterization adverse effects, Coronary Angiography adverse effects, Coronary Artery Disease therapy, Coronary Vasospasm diagnosis
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- 2013
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47. Moderate procedural sedation and opioid analgesia during transradial coronary interventions to prevent spasm: a prospective randomized study.
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Deftereos S, Giannopoulos G, Raisakis K, Hahalis G, Kaoukis A, Kossyvakis C, Avramides D, Pappas L, Panagopoulou V, Pyrgakis V, Alexopoulos D, Stefanadis C, and Cleman MW
- Subjects
- Aged, Arterial Occlusive Diseases diagnostic imaging, Arterial Occlusive Diseases epidemiology, Chi-Square Distribution, Coronary Angiography, Female, Greece epidemiology, Humans, Incidence, Length of Stay, Logistic Models, Male, Middle Aged, Odds Ratio, Pain epidemiology, Pain prevention & control, Patient Readmission, Percutaneous Coronary Intervention mortality, Predictive Value of Tests, Prospective Studies, Radial Artery diagnostic imaging, Risk Factors, Time Factors, Treatment Outcome, Analgesics, Opioid administration & dosage, Arterial Occlusive Diseases prevention & control, Conscious Sedation, Fentanyl administration & dosage, Hypnotics and Sedatives administration & dosage, Midazolam administration & dosage, Percutaneous Coronary Intervention adverse effects, Radial Artery drug effects
- Abstract
Objectives: The aim of this study was to test the hypothesis that moderate procedural sedation can reduce the incidence of radial artery spasm., Background: Transradial access for left heart catheterization and percutaneous coronary intervention is increasingly used for emergent and elective procedures, in lieu of the femoral approach. However, increased rates of access site crossover have been reported, with radial artery spasm being a major contributor to this effect., Methods: Patients undergoing elective transradial percutaneous coronary intervention were prospectively randomized to receive fentanyl and midazolam during the procedure or no treatment (control subjects). The primary endpoint was angiographically confirmed radial artery spasm. Patient discomfort was quantified with a visual analogue scale., Results: Two thousand thirteen patients (age 64.5 ± 8.4 years) were randomized. Spasm occurred in 2.6% of the treatment group versus 8.3% of control subjects (p < 0.001; odds ratio [OR]: 0.29). The number needed to treat to avoid 1 case of spasm was 18 (95% confidence interval [CI]: 12.9 to 26.6). The access site crossover rate was 34% lower in the treatment group: 9.9% versus 15.0% (OR: 0.62; 95% CI: 0.48 to 0.82). Patient discomfort visual analogue scale score was 18.8 ± 12.5 in the treatment group versus 27.4 ± 17.4 in control subjects (p < 0.001). No significant differences were observed in the 30-day rate of death or repeat hospital stay for any cause: 4.6% versus 4.5% (OR: 1.02; 95% CI: 0.67 to 1.56)., Conclusions: Routine administration of relatively low doses of an opioid/benzodiazepine combination during transradial interventional procedures is associated with a substantial reduction in the rate of spasm, the need for access site crossover, and the procedure-related level of patient discomfort., (Copyright © 2013 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)
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- 2013
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48. NTproBNP: an important biomarker in cardiac diseases.
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Panagopoulou V, Deftereos S, Kossyvakis C, Raisakis K, Giannopoulos G, Bouras G, Pyrgakis V, and Cleman MW
- Subjects
- Amino Acid Sequence, Atrial Fibrillation, Coronary Artery Disease metabolism, Coronary Artery Disease mortality, Female, Heart Diseases physiopathology, Heart Failure blood, Heart Failure diagnosis, Humans, Hypertension metabolism, Male, Molecular Sequence Data, Natriuretic Peptide, Brain chemistry, Natriuretic Peptide, Brain metabolism, Obesity metabolism, Peptide Fragments chemistry, Peptide Fragments metabolism, Predictive Value of Tests, Prognosis, Sensitivity and Specificity, Ventricular Dysfunction, Right metabolism, Biomarkers blood, Heart Diseases metabolism, Natriuretic Peptide, Brain blood, Peptide Fragments blood
- Abstract
Natriuretic neuropeptides (ANP, BNP, CNP) are produced primarily in the cardiac atria under normal conditions. The main stimulus for ANP and BNP peptide synthesis and secretion is cardiac wall stress. Cardiac ventricular myocytes constitute the major source of BNP-related peptides. Ventricular NT-proBNP production is upregulated in cardiac failure and locally in the area surrounding a myocardial infarct. NT-proBNP is cleared passively by organs with high rate of blood flow (muscle, liver, kidney). It has a longer half life than BNP and higher plasma concentration. BNP and NTproBNP tend to be higher in women and lower in obese individuals. They are also higher in elderly, in left ventricular tachycardia, right ventricular overload, myocardial ischemia, hypoxaemia, renal dysfunction, liver cirrhosis, sepsis and infection. NT-proBNP is useful both in the diagnosis and prognosis of heart failure and is considered to be a gold standard biomarker in heart failure similar to BNP. A cut-off point 300 pg/ml has 99% sensitivity, 60%specificity and NPV 98%for exclusion of acute heart failure. NT proBNP has also a strong prognostic value of death in acute and chronic heart failure and also predicts short and long term mortality in patient with suspected or confirmed unstable CVD. Natriuretic peptides are also prognostic markers for the RV (Right Ventricular) Dysfunction. Their release is due to myocardial stretch from right ventricular pressure overload.Finally, there are data supporting that NT-proBNP might be useful to put a time frame on atrial fibrillation of unknown onset.
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- 2013
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49. The role of endothelin system in cardiovascular disease and the potential therapeutic perspectives of its inhibition.
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Kaoukis A, Deftereos S, Raisakis K, Giannopoulos G, Bouras G, Panagopoulou V, Papoutsidakis N, Cleman MW, and Stefanadis C
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- Animals, Atherosclerosis metabolism, Atherosclerosis physiopathology, Atrial Fibrillation metabolism, Atrial Fibrillation physiopathology, Bosentan, Cardiovascular Diseases physiopathology, Coronary Artery Disease metabolism, Coronary Artery Disease physiopathology, Endothelin-1 blood, Endothelin-1 physiology, Endothelins blood, Humans, Hypertension, Pulmonary drug therapy, Phenylpropionates pharmacology, Predictive Value of Tests, Pyridazines pharmacology, Receptors, Endothelin metabolism, Sulfonamides pharmacology, Sulfonamides therapeutic use, Cardiovascular Diseases drug therapy, Cardiovascular Diseases metabolism, Endothelin Receptor Antagonists, Endothelins physiology
- Abstract
Since its identification in 1988 and the recognition of its primary role as a potent vasoconstrictor, endothelin has been extensively studied and is now considered as a ubiquitous protein, involved in important aspects of human homeostasis as well as in several pathophysiological pathways, mostly associated with cardiovascular disease. From an evolutionary point of view, endothelin consists a primitive molecule with the rare characteristic of being exactly the same in all mammals, thus permitting scientists to perform experiments in animals and doing predictions for humans. The understanding of its contribution to the genesis, evolution and maintenance of disease through activation of special receptor subtypes has led to the development of both selective and unselective receptor antagonists. Despite the disappointing results of these antagonists in the field of heart failure, almost from the initial animal trials of bosentan, a dual endothelin receptor antagonist, in pulmonary arterial hypertension, it has been demonstrated that the drug leads at least to hemodynamic and clinical improvement of the patients, thus receiving official approval for the management of this rare but eventually lethal disease. Resistant hypertension is another area where endothelin receptor blockers might potentially play a role, while the pathophysiological role of endothelin in atherosclerotic coronary artery disease is well-established and the relative research goes on. The main goal of this review is to describe the endothelin system and mostly to enlighten its role in pathophysiologic pathways, as well to state the relative research in the various fields of cardiovascular disease and also highlight its prognostic significance wherever there exists one.
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- 2013
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50. High sensitivity troponin in cardiovascular disease. Is there more than a marker of myocardial death?
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Tsounis D, Deftereos S, Bouras G, Giannopoulos G, Anatoliotakis N, Raisakis K, Kossyvakis C, and Cleman MW
- Subjects
- Acute Coronary Syndrome diagnosis, Acute Coronary Syndrome metabolism, Coronary Artery Disease diagnosis, Coronary Artery Disease metabolism, Coronary Disease diagnosis, Coronary Disease metabolism, Heart Failure metabolism, Humans, Myocardial Infarction diagnosis, Myocardial Infarction metabolism, Predictive Value of Tests, Prognosis, Pulmonary Embolism diagnosis, Pulmonary Embolism metabolism, Sensitivity and Specificity, Troponin physiology, Troponin C blood, Troponin T blood, Biomarkers blood, Cardiovascular Diseases diagnosis, Cardiovascular Diseases metabolism, Troponin blood
- Abstract
Cardiovascular disease is the leading cause of death worldwide and coronary artery disease is its most prevalent manifestation, associated with high mortality and morbidity. In clinical practice cardiac troponins (cTn) are the cornerstone of the diagnosis, risk stratification and thus selection of the optimal treatment strategy in patients with acute coronary syndrome. According to the third update of the universal definition of myocardial infarction (MI) cTn is the preferred cardiac biomarker of myocardial necrosis in the setting of acute myocardial ischemia. Over the last years newer high sensitivity cardiac troponin (hs-cTn) assays have been developed that are more sensitive than conventional assays, have low limit of detection, low imprecision and low reference limits, but due to variability, the deployment of a standardization and harmonization method is required before their wide use in clinical practice. Recent studies have shown that their utilization seems to improve the diagnostic accuracy detecting MI in patients presenting with chest pain. However, the improved sensitivity comes along with a decreased specificity, though serial cTn measurements and the detection of early changes could improve the specificity and the overall diagnostic performance. Moreover, apart from their use in the diagnosis and risk stratification of MI and acute coronary syndromes, hs-cTn assays seem to have a key role in risk stratification and short and long-term prognosis in a variety of cardiovascular modalities such as stable coronary disease, heart failure and acute pulmonary embolism. In addition, studies have suggested that cTns may be used as a biomarker in the primary prevention of cardiovascular disease leading to the identification of high-risk populations or individuals with silent heart disease.
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- 2013
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