Publications by authors named "Gregory Giamouzis"

55 Publications

The management of atrial fibrillation in heart failure: an expert panel consensus.

Heart Fail Rev 2020 May 28. Epub 2020 May 28.

Heart Failure Unit, Department of Cardiology, Attikon University Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece.

Heart failure (HF) and atrial fibrillation (AF) often coexist, being closely interrelated as the one increases the prevalence and incidence and worsens the prognosis of the other. Their frequent coexistence raises several challenges, including under-diagnosis of HF with preserved ejection fraction in AF and of AF in HF, characterization and diagnosis of atrial cardiomyopathy, target and impact of rate control therapy on outcomes, optimal rhythm control strategy in the era of catheter ablation, HF-related thromboembolic risk and management of anticoagulation in patients with comorbidities, such as chronic kidney disease or transient renal function worsening, coronary artery disease or acute coronary syndromes, valvular or structural heart disease interventions and cancer. In the present document, derived by an expert panel meeting, we sought to focus on the above challenging issues, outlining the existing evidence and identifying gaps in knowledge that need to be addressed.
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http://dx.doi.org/10.1007/s10741-020-09978-0DOI Listing
May 2020

Practical Recommendations for the Diagnosis and Medical Management of Stable Angina: An Expert Panel Consensus.

J Cardiovasc Pharmacol 2019 10;74(4):308-314

Second Department of Cardiology, Attikon University Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece.

Stable angina affects a significant number of coronary artery disease patients, impairing their quality of life and worsening their prognosis. It manifests even despite a history of revascularization and is often poorly controlled with drug therapy. Comorbid conditions are frequently encountered in coronary artery disease patients, affecting their prognosis and rendering the diagnosis and management of angina more challenging. In this article, derived by an expert panel meeting, we attempt a practical approach to stable angina, focusing on symptomatic patients subjected to previous coronary revascularization or not suitable for revascularization and providing handy diagnostic and therapeutic algorithms and comorbidity-adjusted therapeutic approaches in accordance with existing evidence, current recommendations, and locally available therapeutic options.
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http://dx.doi.org/10.1097/FJC.0000000000000716DOI Listing
October 2019

Management of iron deficiency in chronic heart failure: Practical considerations for clinical use and future directions.

Eur J Intern Med 2019 Jul 17;65:17-25. Epub 2019 May 17.

Heart Failure Unit, Second Cardiology Department, University of Athens, Attikon Hospital, Athens, Greece.

Heart Failure (HF) is a global pandemic with rapidly increasing prevalence. In an attempt to maintain patients well being, the therapeutic interest has expanded to the vicious cycles that confer to HF mortality and morbidity and a number of comorbidities have been targeted. Iron deficiency represents a common comorbid condition that affects outcomes in HF. The treatment of iron deficiency is strongly supported by the cardiologic societies all over the world. Intravenous iron, primarily ferric carboxymaltose, has shown clinical benefit in this setting, irrespective of the anemia status. Practical recommendations though are lacking. In this document, we have tried to cover the practical gap and provide useful details for intravenous iron use.
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http://dx.doi.org/10.1016/j.ejim.2019.05.011DOI Listing
July 2019

Hospitalization affects the anticoagulation patterns of patients with atrial fibrillation.

J Thromb Thrombolysis 2019 Aug;48(2):225-232

First Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, St. Kiriakidi 1, 54636, Thessaloniki, Greece.

Scarce data are available on the effects of hospitalization on oral anticoagulation (OAC) patterns in patients with atrial fibrillation (AF). This study aimed to capture the evolving OAC patterns of patients with known non-valvular AF at high risk for stroke (CHADS-Vasc score ≥ 2 for males and ≥ 3 for females) during hospitalization. A total of 561 eligible patients who were admitted to the cardiology ward of a tertiary hospital were studied. Pre- and post-hospitalization OAC patterns [vitamin-K antagonist (VKA), non-vitamin K oral anticoagulants (NOAC), no OAC], changes between these patterns (initiation, switch, discontinuation, no change) and the respective patient profiles and discharge diagnoses were assessed. During hospitalization, OAC administration increased from 73.1 to 86.6% of patients (p for trend < 0.001). NOAC use increased significantly (42.2-56.1%, p for trend < 0.001), whereas VKA use remained stable (30.8-30.5%). Of patients, 17.3% initiated OAC, 7.1% switched between OACs, 3.7% discontinued OAC treatment, while the rest underwent no change in anticoagulation status. Bleeding risk, use of concomitant antiplatelet therapy and incidence of primary discharge diagnosis of AF or ST-elevation myocardial infarction differed significantly between groups of initiation, switch, discontinuation and no change in OAC therapy. In conclusion, in patients with known AF at high risk for stroke, hospitalization was associated with an increase in OAC uptake, driven mainly by NOAC initiation. Three out of 10 patients initiated, switched or discontinued OAC treatment during hospitalization and this was associated with discrete epidemiologic parameters.
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http://dx.doi.org/10.1007/s11239-019-01832-xDOI Listing
August 2019

Direct Oral Anticoagulants in Nonvalvular Atrial Fibrillation: Practical Considerations on the Choice of Agent and Dosing.

Cardiology 2018 5;140(2):126-132. Epub 2018 Jul 5.

Department of Cardiology, Heart Failure Unit, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece.

Direct or new oral anticoagulants (NOACs), including the direct thrombin inhibitor dabigatran and the direct factor Xa inhibitors rivaroxaban, apixaban, and edoxaban, have recently revolutionized the field of antithrombotic therapy for stroke and systemic embolism prevention in nonvalvular atrial fibrillation (NVAF). Randomized controlled trials have shown that these agents have at least comparable efficacy with vitamin K antagonists along with superior safety, at least in what concerns intracranial hemorrhage. As a result, NOACs are indicated as first-line anticoagulation therapy for NVAF patients with at least one risk factor for stroke or systemic embolism. The rapid introduction, however, of NOACs in a field dominated for decades by vitamin antagonists and the variety of agents and dosing schemes may create difficulties in decision making. In the present article, we attempt to determine a practical approach to the choice of agent and dose in different clinical scenarios by considering not only the results of seminal randomized trials and post hoc analyses but also data from real-world patient populations as well as the recently available possibility of rapid NOAC reversal.
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http://dx.doi.org/10.1159/000489922DOI Listing
June 2019

Editorial: Oxidative Stress in the Critically Ill Patients: Pathophysiology and Potential Interventions.

Oxid Med Cell Longev 2018;2018:2353128. Epub 2018 Mar 25.

CHU Lille, Critical Care Center and Lille University School of Medicine, Lille, France.

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http://dx.doi.org/10.1155/2018/2353128DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5889860PMC
December 2018

Impact of renin-angiotensin-aldosterone system polymorphisms on myocardial perfusion: Correlations with myocardial single photon emission computed tomography-derived parameters.

J Nucl Cardiol 2019 08 17;26(4):1298-1308. Epub 2018 Jan 17.

Department of Nuclear Medicine, University Hospital of Larissa, Mezourlo, 41110, Larissa, Greece.

Background: Renin-angiotensin-aldosterone system (RAAS) has an important role in atherosclerosis. We investigated the effects of six RAAS gene polymorphisms on myocardial perfusion.

Methods And Results: We examined 810 patients with known or suspected coronary artery disease (CAD) using stress-rest myocardial single-photon emission computed tomography. Summed stress score (SSS), summed rest score (SRS), summed difference score (SDS), transient ischemic dilation (TID), and lung/heart ratio (LHR) were recorded. The following gene polymorphisms were investigated: angiotensin-converting enzyme (ACE) insertion/deletion (I/D), angiotensinogen (AGT) M235T and T174M, angiotensin II type 1 receptor (AT1R) A1166C, renin (REN) C5312T, and angiotensin II type 2 receptor (AT2R) C3123A. The heterozygotes or homozygotes on ACE D allele were 7.54 times more likely to have abnormal SSS, while the AGT (T174M) heterozygotes were 5.19 times more likely to have abnormal SSS. The homozygotes of ACE D had significantly higher values on TID and LHR, while the AGT (T174M) heterozygotes had higher values on TID. The AT1R heterozygotes had greater odds for having SSS ≥ 3. The patients carried AT1R homozygosity of C allele had significantly higher values on TID, while heterozygotes of AT1R had significantly higher values on LHR.

Conclusions: Among the polymorphisms investigated, ACE D allele had the strongest association with abnormal myocardial perfusion.
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http://dx.doi.org/10.1007/s12350-017-1181-8DOI Listing
August 2019

Left ventricular geometry as a major determinant of left ventricular ejection fraction: physiological considerations and clinical implications.

Eur J Heart Fail 2018 03 6;20(3):436-444. Epub 2017 Nov 6.

Department of Cardiology, Athens University Hospital Attikon, Athens, Greece.

The limited myocardial fibre thickening and shortening alone cannot explain the marked left ventricular (LV) volume reduction during LV ejection. This can only be achieved with LV helical (spiral) orientation of myocardial fibres, which is determined by the non-contractile LV myocardial components (intrasarcomeric and extrasarcomeric cytoskeleton, extracellular matrix). Preservation of LV ejection fraction (LVEF) in heart failure (HF) is due to the presence of normal ellipsoid LV configuration and spiral myocardial fibre orientation. Conversely, reduction of LVEF in HF results from spherical LV configuration associated with impaired myocardial fibre orientation. These mechanisms are supported by the fact that biomarkers of inflammation and fibrosis are strong predictors of LV reverse remodelling in HF with reduced LVEF (HFrEF) and therapeutic interventions in HFrEF that retard or inhibit extracellular matrix remodelling are effective, whereas those that increase myocardial contractility are ineffective. Thus, current classification of HF, based on LVEF, should be revised, and future therapy in HF should focus on interventions affecting the non-contractile LV myocardial components rather than on LV myocardial contractility.
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http://dx.doi.org/10.1002/ejhf.1055DOI Listing
March 2018

Left atrial volume index in patients with heart failure and severely impaired left ventricular systolic function: the role of established echocardiographic parameters, circulating cystatin C and galectin-3.

Ther Adv Cardiovasc Dis 2017 Nov 22;11(11):283-295. Epub 2017 Aug 22.

Biomedical Research Foundation, Academy of Athens, Athens, Greece.

Backround: Left atrial (LA) enlargement plays an important role in the development of heart failure (HF) and is a robust prognostic factor. Fibrotic processes have also been advocated to evoke HF through finite signalling proteins.

Methods: We examined the association of two such proteins, cystatin C (CysC) and galectin-3 (Gal-3), and other clinical, echocardiographic and biochemical parameters with LA volume index (LAVi) in patients with HF with severely impaired left ventricular ejection fraction (LVEF). Severe renal, liver, autoimmune disease and cancer were exclusion criteria.

Results: A total of 40 patients with HF (31 men, age 66.6 ± 1.7) with LVEF = 25.4 ± 0.9% were divided into two groups according to the mean LAVi (51.03 ± 2.9 ml/m) calculated by two-dimensional transthoracic echocardiography. Greater LAVi was positively associated with LV end-diastolic volume ( p = 0.017), LV end-systolic volume ( p = 0.025), mitral regurgitant volume (MRV) ( p = 0.001), right ventricular systolic pressure (RVSP) ( p < 0.001), restrictive diastolic filling pattern ( p = 0.003) and atrial fibrillation ( p = 0.005). Plasma CysC was positively correlated with LAVi ( R = 0.135, p = 0.019) and log-transformed plasma Gal-3 ( R = 0.109, p = 0.042) by simple linear regression analysis. Stepwise multiple linear regression analysis showed that only MRV ( t = 2.236, p = 0.032), CysC ( t = 2.467, p = 0.019) and RVSP ( t = 2.155, p = 0.038) were significant predictors of LAVi.

Conclusions: Apart from known determinants of LAVi, circulating CysC and Gal-3 were associated with greater LA dilatation in patients with HF with reduced LVEF. Interestingly, the correlation between these two fibrotic proteins was positive.
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http://dx.doi.org/10.1177/1753944717727498DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5933668PMC
November 2017

Red blood cell distribution width as a prognostic marker in patients with heart failure and diabetes mellitus.

Cardiovasc Diabetol 2017 07 6;16(1):81. Epub 2017 Jul 6.

Department of Cardiology, University General Hospital of Larissa, P.O. Box 1425, 411 10, Larissa, Greece.

Background: Red blood cell distribution width (RDW) is an established prognostic marker in acute and chronic heart failure (HF). Recent studies have pointed out a link among RDW, diabetes mellitus (DM) and inflammation. We sought to investigate the prognostic value and longitudinal pattern of RDW in patients with concomitant HF and DM, which remains unknown.

Methods: A total of 218 patients (71 diabetics) who presented with acute HF had RDW measured at admission, discharge and 4, 8 and 12 months post-discharge. The study endpoint was all-cause mortality or rehospitalization for HF during 1-year follow-up.

Results: The study endpoint was met in 33 patients (46.5%) with DM and in 54 patients (36.7%) without DM. RDW at admission was associated with higher event rate both in HF patients with and without DM (adjusted HR: 1.349, p = 0.002, 95% CI 1.120-1.624 and adjusted HR: 1.142, p = 0.033, 95% CI 1.011-1.291 respectively). In addition, a significant interaction was found between diabetes and RDW longitudinal changes (β = -0.002; SE = 0.001; p = 0.042).

Conclusions: Despite the similar prognostic significance of RDW in diabetic and non-diabetic HF patients regarding the study endpoint, longitudinal changes were found to be significantly different between these two groups of HF patients. This might be due to the higher inflammatory burden that diabetic HF patients carry and may provide new insights to the pathophysiological mechanism of RDW increase in HF, which remains unknown.
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http://dx.doi.org/10.1186/s12933-017-0563-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5501451PMC
July 2017

Repetitive use of levosimendan in advanced heart failure: need for stronger evidence in a field in dire need of a useful therapy.

Int J Cardiol 2017 Sep 23;243:389-395. Epub 2017 May 23.

Dipartimento di Scienze Cardiologiche Medico-Chirurgiche, Ospedali Riuniti, Ancona, Italy.

Patients in the latest stages of heart failure are severely compromised, with poor quality of life and frequent hospitalizations. Heart transplantation and left ventricular assist device implantation are viable options only for a minority, and intermittent or continuous infusions of positive inotropes may be needed as a bridge therapy or as a symptomatic approach. In these settings, levosimendan has potential advantages over conventional inotropes (catecholamines and phosphodiesterase inhibitors), such as sustained effects after initial infusion, synergy with beta-blockers, and no increase in oxygen consumption. Levosimendan has been suggested as a treatment that reduces re-hospitalization and improves quality of life. However, previous clinical studies of intermittent infusions of levosimendan were not powered to show statistical significance on key outcome parameters. A panel of 45 expert clinicians from 12 European countries met in Rome on November 24-25, 2016 to review the literature and envision an appropriately designed clinical trial addressing these needs. In the earlier FIGHT trial (daily subcutaneous injection of liraglutide in heart failure patients with reduced ejection fraction) a composite Global Rank Score was used as primary end-point where death, re-hospitalization, and change in N-terminal-prohormone-brain natriuretic peptide level were considered in a hierarchical order. In the present study, we tested the same end-point post hoc in the PERSIST and LEVOREP trials on oral and repeated i.v. levosimendan, respectively, and demonstrated superiority of levosimendan treatment vs placebo. The use of the same composite end-point in a properly powered study on repetitive levosimendan in advanced heart failure is strongly advocated.
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http://dx.doi.org/10.1016/j.ijcard.2017.05.081DOI Listing
September 2017

Favorable Pulse Wave Augmentation Indices and Left Ventricular Diastolic Profile in β-Thalassemia Minor.

Angiology 2017 Nov 3;68(10):899-906. Epub 2017 Apr 3.

1 Department of Cardiology, Larissa University Hospital, Larissa, Greece.

β-Thalassemia minor (β-Τm) is associated with rheological and biochemical alterations that can affect cardiovascular function. We aimed to evaluate the elastic arterial properties and the pulse wave augmentation indices in a population of patients with β-Τm. Seventy-five individuals with β-Τm (age 55.5 [42.75-65.25], women 48%) and 127 controls (age 57 years [48-63], women 55.1%) underwent comprehensive echocardiographic evaluation and applanation tonometry of the radial and femoral artery. Pulse wave analysis revealed that augmentation pressure, augmentation index (AIx), and heart rate-corrected AIx were significantly lower (median [interquartile range]: 8.75 [4.625-13] vs 11 [6.5-14.5], P = .017; 26.5 [17.5-33.375] vs 30.5 [20.75-37.5], P = .014; and 22.25 [15.125-29.5] vs 27 [20.5-33], P = .008, respectively) in the β-Τm group compared to controls. The left atrial active emptying volume was significantly lower and the isovolumic relaxation time was shorter in the β-Τm group compared to the control group (10.2 [7.4-14.4] vs 12.0 [8.6-15.8], P = .040 and 78 [70-90] vs 90 [70-104], P = .034, respectively). β-Thalassemia minor is associated with favorable pulse wave augmentation indices and left ventricular diastolic function profile in asymptomatic individuals with cardiovascular risk factors.
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http://dx.doi.org/10.1177/0003319717701658DOI Listing
November 2017

Glycaemic control in heart failure: a PARADIGM shift for patients with concomitant diabetes?

Lancet Diabetes Endocrinol 2017 05 18;5(5):314-315. Epub 2017 Mar 18.

Cardiology Division, Stony Brook University, New York, NY 11794, USA. Electronic address:

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http://dx.doi.org/10.1016/S2213-8587(17)30089-XDOI Listing
May 2017

Association between copayment, medication adherence and outcomes in the management of patients with diabetes and heart failure.

Health Policy 2017 Apr 28;121(4):363-377. Epub 2017 Feb 28.

Department of Health Services Organization, National School of Public Health, Athens, Greece.

Objective: To determine the association between copayment, medication adherence and outcomes in patients with Heart failure (HF) and Diabetes Mellitus (DM).

Methods: PubMed, Scopus and Cochrane databases were searched using combinations of four sets of key words for: drug cost sharing; resource use, health and economic outcomes; medication adherence; and chronic disease.

Results: Thirty eight studies were included in the review. Concerning the direct effect of copayment changes on outcomes, the scarcity and diversity of data, does not allow us to reach a clear conclusion, although there is some evidence indicating that higher copayments may result in poorer health and economic outcomes. Seven and one studies evaluating the relationship between copayment and medication adherence in DM and HF population, respectively, demonstrated an inverse statistically significant association. All studies (29) examining the relationship between medication adherence and outcomes, revealed that increased adherence is associated with health benefits in both DM and HF patients. Finally, the majority of studies in both populations, showed that medication adherence was related to lower resource utilization which in turn may lead to lower total healthcare cost.

Conclusion: The results of our systematic review imply that lower copayments may result in higher medication adherence, which in turn may lead to better health outcomes and lower total healthcare expenses. Future studies are recommended to reinforce these findings.
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http://dx.doi.org/10.1016/j.healthpol.2017.02.008DOI Listing
April 2017

SPECT and PET in ischemic heart failure.

Heart Fail Rev 2017 03;22(2):243-261

Department of Nuclear Medicine, Larissa University Hospital, Larissa, Greece.

Heart failure is a common clinical syndrome associated with significant morbidity and mortality worldwide. Ischemic heart disease is the leading cause of heart failure, at least in the industrialized countries. Proper diagnosis of the syndrome and management of patients with heart failure require anatomical and functional information obtained through various imaging modalities. Nuclear cardiology techniques play a main role in the evaluation of heart failure. Myocardial single photon emission computed tomography (SPECT) with thallium-201 or technetium-99 m labelled tracers offer valuable data regarding ventricular function, myocardial perfusion, viability, and intraventricular synchronism. Moreover, positron emission tomography (PET) permits accurate evaluation of myocardial perfusion, metabolism, and viability, providing high-quality images and the ability of quantitative analysis. As these imaging techniques assess different parameters of cardiac structure and function, variations of sensitivity and specificity have been reported among them. In addition, the role of SPECT and PET guided therapy remains controversial. In this comprehensive review, we address these controversies and report the advances in patient's investigation with SPECT and PET in ischemic heart failure. Furthermore, we present the innovations in technology that are expected to strengthen the role of nuclear cardiology modalities in the investigation of heart failure.
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http://dx.doi.org/10.1007/s10741-017-9594-7DOI Listing
March 2017

Global left atrial failure in heart failure.

Eur J Heart Fail 2016 11;18(11):1307-1320

Ohio State University, Columbus, Ohio, USA.

The left atrium plays an important role in the maintenance of cardiovascular and neurohumoral homeostasis in heart failure. However, with progressive left ventricular dysfunction, left atrial (LA) dilation and mechanical failure develop, which frequently culminate in atrial fibrillation. Moreover, LA mechanical failure is accompanied by LA endocrine failure [deficient atrial natriuretic peptide (ANP) processing-synthesis/development of ANP resistance) and LA regulatory failure (dominance of sympathetic nervous system excitatory mechanisms, excessive vasopressin release) contributing to neurohumoral overactivity, vasoconstriction, and volume overload (global LA failure). The purpose of the present review is to describe the characteristics and emphasize the clinical significance of global LA failure in patients with heart failure.
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http://dx.doi.org/10.1002/ejhf.645DOI Listing
November 2016

Reframing the association and significance of co-morbidities in heart failure.

Eur J Heart Fail 2016 07 30;18(7):744-58. Epub 2016 Jun 30.

Department of Cardiology, Athens University Hospital Attikon, Athens, Greece.

Several co-existing diseases and/or conditions (co-morbidities) are present in patients with heart failure (HF), with diverse clinical relevance. Multiple mechanisms may underlie the co-existence of HF and co-morbidities, including direct causation, associated risk factors, heterogeneity, and independence. The complex inter-relationship of co-morbidities and their impact on the cardiovascular system contribute to the features of HF, both with reduced (HFrEF) and preserved ejection fraction (HFpEF). The purpose of this work is to provide an overview of the contribution of major cardiac and non-cardiac co-morbidities to HF development and outcomes, in the context of both HFpEF and HFrEF. Accordingly, epidemiological evidence linking co-morbidities to HF and the effect of prevalent and incident co-morbidities on HF outcome will be reviewed.
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http://dx.doi.org/10.1002/ejhf.600DOI Listing
July 2016

Renal biomarkers and outcomes in outpatients with heart failure: The Atlanta cardiomyopathy consortium.

Int J Cardiol 2016 Sep 13;218:136-143. Epub 2016 May 13.

Emory Clinical Cardiovascular Research Institute, Emory University, Atlanta, GA, United States.

Background/objectives: Cystatin-C and beta-2-microglobulin may be superior to serum creatinine, blood urea nitrogen (BUN), or estimated glomerular filtration rate (eGFR) in patients hospitalized with heart failure (HF). We compared these renal markers in ambulatory HF patients.

Methods: We prospectively evaluated the association of baseline renal markers and eGFR (by 4 different formulas) with (1) the composite of death or HF-related hospitalization and (2) rates of hospitalizations and emergency department (ED) visits in 166 outpatients with HF (57.3±11.6years; 57.2% white, 38.6% black, median left ventricular ejection fraction 27.5% [17.5, 40.0]).

Results: After a median of 3.9years, 63 (38.0%) patients met the composite endpoint. There were 458 hospitalizations (177 [38.6%] for HF) and 209 ED visits (51 [24.4%] for HF). Cystatin-based eGFR most consistently predicted (1) the composite endpoint (highest-to-lowest tertile adjusted hazard ratio [HR] 4.92 [95% CI 2.07-11.7; P<0.001]); and (2) hospitalization rates, including HF hospitalizations (highest-to-lowest tertile, adjusted relative rate 5.24 [95% CI 1.61-17.01; P=0.006]). Serum creatinine alone was a strong predictor of the composite endpoint (highest-to-lowest tertile, adjusted HR 3.20 [95% CI, 1.51-6.78; P=0.002]). Only the highest tertile of BUN was associated with rates of ED visits.

Conclusions: In outpatients with HF, cystatin-based eGFR provides consistent prognostication across outcomes, except ED visits. Serum creatinine is an adequate prognosticator of death or HF hospitalization.
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http://dx.doi.org/10.1016/j.ijcard.2016.05.041DOI Listing
September 2016

Growing Evidence Linking Microvascular Dysfunction With Heart Failure With Preserved Ejection Fraction.

J Am Heart Assoc 2016 02 23;5(2). Epub 2016 Feb 23.

Cardiology Division, Stony Brook University, Stony Brook, NY.

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http://dx.doi.org/10.1161/JAHA.116.003259DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4802456PMC
February 2016

Interactions between Diabetes and the Heart.

J Diabetes Res 2016 24;2016:8032517. Epub 2016 Jan 24.

Cardiology Department, Larissa University Hospital, 41110 Larissa, Greece.

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http://dx.doi.org/10.1155/2016/8032517DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4745821PMC
December 2016

The medical and socioeconomic burden of heart failure: A comparative delineation with cancer.

Int J Cardiol 2016 Jan 20;203:279-81. Epub 2015 Oct 20.

Department of Cardiology, Athens University Hospital Attikon, Athens, Greece.

Cardiovascular disease and cancer represent the two leading causes of death in the Western World. Still, cardiovascular disease causes more deaths and more hospitalizations than cancer. Although mortality rates of both conditions are generally declining, this is not true for heart failure (HF). The prevalence of HF is increasing, although its incidence has been stabilized, mainly because of the population aging. The survival of patients with HF is overall worse than those with cancer. In addition, HF failure is the most common reason for hospitalization in the elderly, while hospitalization for HF is followed by adverse prognosis and represents the main contributor to the huge financial expenditure caused by the syndrome. The outcome of HF patients and thus its medical and socioeconomic burden may be improved by the more efficient in-hospital management of patients, the enhancement of adherence to guideline-recommended therapies, the identification and treatment of comorbid conditions and the introduction of more effective medical therapies.
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http://dx.doi.org/10.1016/j.ijcard.2015.10.172DOI Listing
January 2016

NGAL and ST2 levels in ambulatory patients with chronic heart failure. Clinical and echocardiographic correlates.

Scand Cardiovasc J 2015 Aug 11;49(4):213-9. Epub 2015 May 11.

1st Department of Cardiology, AHEPA University Hospital , Thessaloniki , Greece.

Aim: Neutrophil gelatinase-associated lipocalin (NGAL) and ST2 receptor, a member of the interleukin-1 receptor family, are novel biomarkers with a potential role in the diagnosis and risk stratification of patients with chronic heart failure (CHF). There is however scarce data on their relation with clinical characteristics and cardiac function in patients with CHF.

Methods: Consecutive ambulatory patients with CHF were studied. All patients underwent clinical and echocardiographic assessment, and blood samples were collected for the estimation of ST2 and NGAL serum levels during the same assessment.

Results: A total of 76 patients (79% male, mean age: 63 ± 14 years), with CHF and left ventricular ejection fraction of 28 ± 7% were included. Median NGAL was 0.16 (0.09-0.275) mg/L and median ST2 was 0.0125 (0.0071-0.0176) mg/L. No association between NGAL and ST2 was observed. Multivariate analysis revealed tissue Doppler-derived right ventricular systolic velocity as an independent predictor of ST2, and the duration of HF and serum creatinine levels as independent predictors of NGAL.

Conclusions: NGAL levels depend on the renal function and the duration of HF, while ST2 levels are affected by the right but not the left ventricular function and show no association with clinical indices of HF.
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http://dx.doi.org/10.3109/14017431.2015.1043141DOI Listing
August 2015

Surgical management of infective endocarditis: early and long-term mortality analysis. single-center experience and brief literature review.

Hellenic J Cardiol 2014 Nov-Dec;55(6):462-74

Department of Cardiovascular Surgery, Heart Center, Klinikum München Bogenhausen GmbH, Munich, Germany.

Introduction: In this study we evaluated factors that affect the early and long-term postoperative outcomes of patients with infective endocarditis.

Methods: We retrospectively reviewed 94 patients (68 male, 26 female, mean age 58.3 ± 13.1 years, range 20-85 years) with proven infective native (n=85) or prosthetic valve (n=9) endocarditis who underwent heart valve surgery between September 1997 and December 2007. Fifty-four patients (57.4%) underwent aortic, 28 (29.8%) mitral, 3 (3.2%) tricuspid, 8 (8.5%) double, and one patient (1%) triple valve surgery. In 75.5% of the procedures we implanted mechanical valves, in 13.8% biological prostheses, and 10.7% were reconstructive or other procedures. Midterm follow up was 100% complete with a cumulative duration of 545 patient-years (maximum 12 years).

Results: Overall hospital mortality (30 days) was 8.5% (n=8). Causes of early mortality were low cardiac output syndrome in 2 cases, sepsis with multiple organ failure in 5 cases, and intracerebral bleeding in one patient. Development of postoperative low cardiac output syndrome (p=0.01) was identified as an independent predictor of early mortality. Overall late mortality was 25.6% (n=22) with a cumulative rate of 4.03% per patient-year. Causes of late death were predominantly of extracardiac origin. Kaplan-Meier survival analysis revealed a cumulative survival rate at 12 years of 57.2%. Cox regression analysis identified diabetes mellitus (p=0.016) and postoperative low cardiac output syndrome (p=0.03) as independent late mortality factors.

Conclusions: Heart valve surgery in patients with infective endocarditis is associated with increased but acceptable early and long-term mortality. The mid-term prognosis is similar to that of patients undergoing elective valve replacement surgery.
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July 2015

Incident atrial fibrillation in systemic sclerosis: the predictive role of B-type natriuretic peptide.

Hellenic J Cardiol 2014 Jul-Aug;55(4):313-21

First Cardiac Department, University of Athens, Athens, University of Athens, Athens, Greece.

Introduction: Atrial fibrillation (AF) is common in patients with systemic sclerosis (SSc) and is associated with significant morbidity, mortality, and healthcare expenditures. The aim of this study was to prospectively determine the incidence and the independent predictors of AF in this patient population.

Methods: Forty-nine patients (age 50.15 ± 9.25 years, 87.8% female) and 21 healthy controls, all in sinus rhythm, were studied. Evaluation included blood sampling, B-type natriuretic peptide (BNP) measurement, comprehensive electrocardiography and echocardiography at baseline, and 24h ambulatory Holter monitoring at baseline and every 6 months.

Results: During a mean follow-up of 72 ± 24 months, 18 SSc patients (36.7%) developed AF (SSc-AF group) while 31 remained in sinus rhythm (SSc-SR group); all subjects in the control group (Cl group) remained in SR. Baseline differences between SSc-AF, SSc-SR, and Cl groups included: a) left ventricular (LV) mass: 84.5 ± 26 vs. 71.8 ± 18.6 vs. 60.5 ± 32.6 g/m(2), respectively (p=0.017); b) mitral tissue Doppler imaging E velocity: 14.5 ± 2.8 vs. 17.5 ± 3.4 vs. 20.5 ± 4.4 cm/s (p<0.001); c) left atrial (LA) volume: 18.8 ± 7.8 vs. 13.5 ± 5.1 vs. 9.7 ± 5.4 cm(3)/m(2) (p<0.001); d) LA active emptying volume: 7.6 ± 2.7 vs. 4.7 ± 3.2 vs. 3.3 ± 2.2 cm(3)/m(2) (p<0.001); and e) logBNP: 1.78 ± 0.47 vs. 1.31 ± 0.54 vs. 0.66 ± 0.38 pg/mL (p<0.001). In Cox proportional hazard analysis, BNP was the only independent predictor of incident AF.

Conclusion: Incident AF was high in SSc, especially in the presence of LV diastolic dysfunction with LA mechanical overload and elevated BNP levels. BNP was the only independent predictor of incident AF; therefore, it should be considered for risk stratification in this population.
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April 2015

Heart failure 2013.

Cardiol Res Pract 2013 30;2013:342316. Epub 2013 Dec 30.

Cardiology Department, Larissa University Hospital, P.O. Box 1425, 41110 Larissa, Greece.

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http://dx.doi.org/10.1155/2013/342316DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3893788PMC
February 2014