Publications by authors named "John Skoularigis"

51 Publications

Delayed Acute Coronary Syndrome Caused by Multiple Bee Stings: A Rare Case of Kounis Syndrome.

Cureus 2021 Mar 26;13(3):e14120. Epub 2021 Mar 26.

Department of Cardiology, University Hospital of Larissa, Larissa, GRC.

A 51-year-old female patient was admitted to our hospital for medical evaluation and treatment of a syncopal episode following multiple bee stings. The syncopal episode was attributed to an allergic reaction and the patient was treated with intravenous hydration and anti-histamines. Twenty-four hours later, the patient manifested an acute coronary syndrome with chest discomfort, electrocardiographic disorders, and myocardial enzyme motility (including troponin). Coronary angiography was performed without revealing pathological findings and she was diagnosed with Kounis syndrome type I. The management of the patient included administration of single antiplatelet therapy combined with a calcium channel blocker (CCB). The patient follow-up was uncomplicated. In patients with Kounis syndrome type I undergoing a normal coronary angiography, in the absence of specific guidelines, single antiplatelet therapy and CCB may be a reasonable approach.
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http://dx.doi.org/10.7759/cureus.14120DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8075771PMC
March 2021

Diagnosis of coronary artery disease: potential complications of imaging techniques.

Acta Cardiol 2021 Apr 16:1-4. Epub 2021 Apr 16.

Department of Cardiology, General Hospital of Veroia, Veroia, Greece.

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http://dx.doi.org/10.1080/00015385.2021.1911467DOI Listing
April 2021

Relative contribution of risk factors/co-morbidities to heart failure pathogenesis: interaction with ejection fraction.

ESC Heart Fail 2020 Sep 19. Epub 2020 Sep 19.

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

Aims: The relative impact of each individual coexisting morbidity on the pathogenesis of heart failure (HF) is incompletely understood. This study aimed to evaluate the prevalence of individual cardiac and non-cardiac coexisting morbidities both in the overall HF population and in the subgroup of HF patients with a single coexisting morbidity, stratified by left ventricular ejection fraction (LVEF) categories, as a measure of the relative contribution of each co-morbidity to the pathogenesis of HF.

Methods And Results: This is a prospective, observational study, in which unselected ambulatory patients with chronic HF visiting the HF clinic of a tertiary university hospital from January 2016 to January 2019 were classified according to baseline LVEF into three groups: (i) LVEF < 40%, (ii) LVEF = 40-49%, and (iii) LVEF ≥ 50% and then evaluated for various coexisting morbidities. Overall, 1064 patients (age 73.4 ± 12.1 years, male gender 57.7%, LVEF 43.6 ± 13.9, N-terminal pro-brain natriuretic peptide 2187 ± 710 ng/L, and estimated glomerular filtration rate 67.2 ± 25 mL/min/1.73 m ) were recruited in this study. Of these, 361 (33.9%) had an LVEF < 40%, 247 (23.2%) an LVEF = 40-49%, and 456 (42.9%) an LVEF ≥ 50%. There were 90 (8.5%) HF patients with a single coexisting morbidity, 33 (36.7%) with LVEF ≥ 50%, 27 (30.0%) with LVEF = 40-49%, and 30 (33.3%) with LVEF < 40%. Among these patients, those with LVEF ≥ 50% suffered mostly from hypertension (85.7%), whereas the second most common coexisting morbidity was atrial fibrillation (AF) (9.5%). HF patients with LVEF = 40-49% usually suffered from hypertension (35.7%), AF (28.6%), or myocardial infarction (MI) (21.4%). Finally, HF patients with LVEF < 40% usually suffered from MI (30.8%), AF (30.8%), or hypertension (15.4%).

Conclusions: Hypertension is strongly associated with the development of HF with low, intermediate, or near-normal/normal LVEF whereas a history of MI or AF with HF with a low or an intermediate LVEF.
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http://dx.doi.org/10.1002/ehf2.12975DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7754965PMC
September 2020

Coexisting Morbidities in Heart Failure: No Robust Interaction with the Left Ventricular Ejection Fraction.

Curr Heart Fail Rep 2020 08;17(4):133-144

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

Purpose Of Review: Heart failure (HF) patients often present with multiple coexisting morbidities. In this review, we contend that coexisting morbidities are highly prevalent and clinically important regardless of the left ventricular ejection fraction (LVEF).

Recent Findings: Multimorbidity is prevalent in the ambulatory subjects of the community and increases with age. Differences in the prevalence of coexisting morbidities between HF with preserved LVEF (> 50%), mid-range LVEF (40-50%), and reduced LVEF (< 40%) are either not demonstrable or whenever present are small and unrelated to morbidity and mortality. The constellation of coexisting morbidities together with the disease modifiers (age, sex, genes, other) defines the HF phenotype and outcome. There is no robust evidence supporting an interaction in HF patients between the prevalence and clinical significance of coexisting morbidities and the LVEF.
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http://dx.doi.org/10.1007/s11897-020-00461-3DOI Listing
August 2020

Preoperative Antiplatelet Therapy and Bleeding Risk in Patients Undergoing Off-Pump Coronary Artery Bypass Grafting: A Fine Balance.

Angiology 2020 09 20;71(8):701-703. Epub 2020 May 20.

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

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http://dx.doi.org/10.1177/0003319720925973DOI Listing
September 2020

Recurrent Acute Coronary Syndromes in a Patient with Idiopathic Thrombocytopenic Purpura.

Case Rep Cardiol 2020 12;2020:6738348. Epub 2020 Mar 12.

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

A 53-year-old man was admitted to a peripheral hospital with the diagnosis of acute myocardial infarction without ST elevation. Due to the concomitant presence of first-diagnosed thrombocytopenia (platelet count 50.000/L), it was decided to be treated conservatively with clopidogrel. Five days later, he developed an acute myocardial infarction with ST elevation (STEMI) and was transferred to our department for primary percutaneous coronary intervention (PCI). Coronary angiography revealed three-vessel disease. The left anterior descending lesion was considered culprit, and PCI was successfully performed using a drug-eluting balloon. This approach was considered safer due to the risk of intolerance of prolonged dual antiplatelet therapy in case of stent implantation. Indeed, four days later, aspirin was discontinued, and the patient remained only on clopidogrel due to a platelet fall. Meanwhile, idiopathic thrombocytopenic purpura (ITP) was diagnosed by hematology consultation, and specific ITP treatment was initiated. Seven days following the procedure, the patient was transferred to the Hematology clinic, where a continuous rise of platelet count up to 115.000/L while on clopidogrel was observed, and he was discharged from the hospital asymptomatic. Unfortunately, twenty days later, the patient died of a lung infection. In ITP patients with STEMI, primary PCI with drug-eluting balloon angioplasty may be a reasonable approach.
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http://dx.doi.org/10.1155/2020/6738348DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7093901PMC
March 2020

Surgery for infective endocarditis: old problem-still unanswered questions?

Eur J Cardiothorac Surg 2020 05;57(5):1016

Cardiology Department, Larissa University Hospital, Larissa, Greece.

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http://dx.doi.org/10.1093/ejcts/ezz362DOI Listing
May 2020

Validation of the Larissa Heart Failure Risk Score for risk stratification in acute heart failure.

Int J Cardiol 2020 05 28;307:119-124. Epub 2019 Dec 28.

Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan.

Background: The LHFRS is a simple score derived from three factors (history of hypertension, history of coronary artery disease/myocardial infarction, and red blood cell distribution width) deployed for the risk stratification of AHF in Greek population. This study aimed to validate the Larissa Heart Failure Risk Score (LHFRS) in patients with acute heart failure (AHF) in a Japanese population.

Methods: We performed post-hoc analysis of 1670 consecutive patients enrolled in the REALITY-AHF. In all, 964 patients were finally enrolled. Exclusion criteria included patients with anemia, malignancies and sepsis. The primary outcome was defined as a composite of all-cause mortality and/or heart failure readmission, and the secondary outcome was defined as all-cause mortality.

Results: The median admission LHFRS value was 1 (interquartile range [IQR]: 0-2). During a median follow-up of 365 (IQR: 161-365) days, the primary and secondary outcomes were observed in 321 and 157 patients, respectively. LHFRS was an independent predictor of both the primary (adjusted hazard ratio per 1-point increase, 95% confidence interval: 1.17 [1.04-1.32], p = 0.011), and the secondary outcomes (1.31 [1.12-1.55], p = 0.001). Patients with higher LHFRS scores (≥2) exhibited significantly worse outcomes than those with lower scores (<2) both for the primary outcome (1.40 [1.07-1.83], p = 0.014) and the secondary outcome (1.60 [1.09-2.34], p = 0.015). Additionally, LHFRS revealed an excellent goodness of fit (observed versus predicted outcomes) for predicting both the primary and the secondary outcomes (p > 0.99 and p = 0.99, respectively).

Conclusion: The simple LHFRS was proved as a reliable predictor of outcomes in patients with AHF.
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http://dx.doi.org/10.1016/j.ijcard.2019.12.051DOI Listing
May 2020

Sudden Arrhythmic Death at the Higher End of the Heart Failure Spectrum.

Angiology 2020 May 26;71(5):389-396. Epub 2019 Dec 26.

Department of Cardiology, University General Hospital of Larissa, Larisa, Greece.

The risk of sudden cardiac death (SCD) is high in heart failure (HF) patients. Sudden arrhythmic death (SAD) is a frequent cause of exit in HF patients at the lower end of the HF spectrum, and implantable cardioverter-defibrillators have been recommended to prevent these life-threatening rhythm disturbances in select patients. However, less is known regarding the cause of SCD in patients at the upper end of the HF spectrum, despite the fact that the majority of out-of-hospital SCD victims have unknown or near-normal/normal left ventricular ejection fraction (LVEF). In this review, we report the epidemiology, summarize the mechanisms, discuss the diagnostic challenges, and propose a stepwise approach for the prevention of SAD in HF with near-normal/normal LVEF.
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http://dx.doi.org/10.1177/0003319719896475DOI Listing
May 2020

Acutely decompensated versus acute heart failure: two different entities.

Heart Fail Rev 2020 11;25(6):907-916

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

Heart failure (HF) has been classified in chronic HF (CHF) and acute HF (AHF). The latter has been subdivided in acutely decompensated chronic HF (ADCHF) defined as the deterioration of preexisting CHF and de novo AHF defined as the rapid development of new symptoms and signs of HF that requires urgent medical attention. However, ADCHF and de novo AHF have fundamental pathophysiological differences. Most importantly, the typical illness trajectory of HF, which is similar to that of other chronic organ diseases including lung, renal, and liver failure, features a gradual decline, with acute episodes usually related to disease evolution followed by partial recovery. Thus, ADCHF should be considered part of the natural history of CHF and renamed CHF exacerbation (CHFE) in accordance with the appropriate terminology used in chronic obstructive pulmonary disease. AHF, in turn, should include only acute de novo HF. The clinical implications of this paradigm shift will be in CHFE the change in focus from in-hospital to optimal ambulatory CHF management aiming at primary and secondary CHFE prevention, while in AHF, the institution of measures for in-hospital limitation of cardiac injury and prevention or retardation of symptomatic CHF development.
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http://dx.doi.org/10.1007/s10741-019-09894-yDOI Listing
November 2020

Left atrial systolic function in acute coronary syndromes.

Hellenic J Cardiol 2020 Jul - Aug;61(4):291-292. Epub 2019 Nov 20.

Department of Cardiology, University General Hospital of Larissa, Larissa, Greece. Electronic address:

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http://dx.doi.org/10.1016/j.hjc.2019.10.005DOI Listing
November 2019

Comments on "Treatment of Pericardial Effusion Through Subxiphoid Tube Pericardiostomy and Computerized Tomography - Or Echocardiography - Guided Percutaneous Catheter Drainage Methods".

Braz J Cardiovasc Surg 2019 12 1;34(5):642. Epub 2019 Dec 1.

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

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http://dx.doi.org/10.21470/1678-9741-2019-0331DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6852451PMC
December 2019

Adult congenital heart disease with pulmonary arterial hypertension: mechanisms and management.

Heart Fail Rev 2020 09;25(5):773-794

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

Adult congenital heart disease (ACHD) encompasses a range of structural cardiac abnormalities present before birth attributable to abnormal foetal cardiac development. The pulmonary circulation of patients with ACHD and intracardiac or extracardiac defects is often exposed to increased blood flow and occasionally to systemic pressures. Depending on the location and magnitude of the defect as well as the time of surgical correction, the patient with ACHD is at risk of developing pulmonary arterial hypertension (PAH), which dramatically increases morbidity and mortality. It is encouraging that therapies applied in idiopathic PAH and significantly improve outcome are also effective in ACHD-related PAH (ACHD-PAH). This review summarizes the challenges encountered in the diagnosis and management of ACHD-PAH.
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http://dx.doi.org/10.1007/s10741-019-09847-5DOI Listing
September 2020

Relationship of CHADS-VASc score to left atrial volume and arterial stiffness in patients with atrial fibrillation.

Hellenic J Cardiol 2020 Jan - Feb;61(1):54-56. Epub 2019 Jul 24.

Department of Cardiology, University General Hospital of Larissa, Larissa, Greece. Electronic address:

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http://dx.doi.org/10.1016/j.hjc.2019.07.002DOI Listing
April 2021

In-hospital red blood cell distribution width change in patients with heart failure.

Eur J Heart Fail 2019 12 4;21(12):1659-1661. Epub 2019 Jul 4.

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

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http://dx.doi.org/10.1002/ejhf.1546DOI Listing
December 2019

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

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

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

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

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

Evaluating the role of perceived stress on the likelihood of having a non - fatal acute coronary syndrome: a case-control study.

Open Cardiovasc Med J 2014 25;8:68-75. Epub 2014 Jul 25.

Department of Nutrition and Dietetics, Harokopio University, Athens, Greece.

Objectives: The aim of the current study was to evaluate the independent role of perceived stress, measured by the PSS-14, on the likelihood of having acute coronary syndrome (ACS).

Conclusion: This is a case-control study with individual matching by age and sex. During 2010-2012, 250 consecutive patients (60±11 years, 78% men) with a first ACS and 250 population-based, control subjects (60±8.6 years, 77.6% men), were enrolled. Perceived stress levels were evaluated with the PSS-14 scale, depression status was assessed with the Zung Depression Rating Scale, anxiety status with the STAI scale and adherence to the Mediterranean diet was assessed by the MedDietScore.

Conclusion: Higher perceived stress was associated with increased likelihood of having an ACS, after adjusting for various factors (OR=1.15, %CI 1.11, 1.18). STAI and ZUNG scale were positively associated with the likelihood of having an ACS (OR: 1.27 %CI 1.20-1.34, p<0.001 and OR: 1.49 %CI 1.36-1.63, p<0.001 respectively). Stratified analysis by sex showed a greater impact of perceived stress in men, compared with women (Wald test value 45.65 vs 18.56, respectively). When stratifying by depression levels, the effect of perceived stress on ACS was not significant among depressed individuals. When stratifying by level of anxiety, higher odds of having an ACS was found in the low anxiety group (OR: 1.129, %CI 1.047-1.218).

Conclusion: Perceived stress appears as an independent ACS risk factor, although no causal relationship can be extracted due to the nature of the study. Early recognition and treatment of perceived stress may lead to ACS risk reduction.
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http://dx.doi.org/10.2174/1874192401408010068DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4141169PMC
August 2014

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

Efficacy and safety of high dose versus low dose furosemide with or without dopamine infusion: the Dopamine in Acute Decompensated Heart Failure II (DAD-HF II) trial.

Int J Cardiol 2014 Mar 10;172(1):115-21. Epub 2014 Jan 10.

Department of Cardiology, Larissa University Hospital, Medical School, University of Thessaly, Larissa, Greece. Electronic address:

Aims: The role of low-dose dopamine infusion in patients with acute decompensated heart failure (ADHF) remains controversial. We aim to evaluate the efficacy and safety of high- versus low-dose furosemide with or without low-dose dopamine infusion in this patient population.

Methods And Results: 161 ADHF patients (78 years; 46% female; ejection fraction 31%) were randomized to 8-hour continuous infusions of: a) high-dose furosemide (HDF, n=50, 20mg/h), b) low-dose furosemide and low-dose dopamine (LDFD, n=56, 5mg/h and 5 μg kg(-1)min(-1) respectively), or c) low-dose furosemide (LDF, n=55, furosemide 5mg/h). The main outcomes were 60-day and one-year all-cause mortality (ACM) and hospitalization for HF (HHF). Dyspnea relief (Borg index), worsening renal function (WRF, rise in serum creatinine (sCr) ≥ 0.3mg/dL), and length of stay (LOS) were also assessed. The urinary output at 2, 4, 6, 8, and 24h was not significantly different in the three groups. Neither the ACM at day 60 (4.0%, 7.1%, and 7.2%; P=0.74) or at one year (38.1%, 33.9% and 32.7%, P=0.84) nor the HHF at day 60 (22.0%, 21.4%, and 14.5%, P=0.55) or one year (60.0%, 50.0%, and 47%, P=0.40) differed between HDF, LDFD, and LDF groups, respectively. No differences in the Borg index or LOS were noted. WRF was higher in the HDF than in LDFD and LDF groups at day 1 (24% vs. 11% vs. 7%, P<0.0001) but not at sCr peak (44% vs. 38% vs. 29%, P=0.27). No significant differences in adverse events were noted.

Conclusions: In ADHF patients, there were no significant differences in the in-hospital and post-discharge outcomes between high- vs. low-dose furosemide infusion; the addition of low-dose dopamine infusion was not associated with any beneficial effects.
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http://dx.doi.org/10.1016/j.ijcard.2013.12.276DOI Listing
March 2014

The emerging role of Galectin-3 and ST2 in heart failure: practical considerations and pitfalls using novel biomarkers.

Curr Heart Fail Rep 2013 Dec;10(4):441-9

Department of Cardiology, University Hospital of Larissa, School of Medicine, University of Thessaly, P.O. Box 1425, 411 10, Larissa, Greece.

Heart failure (HF) is a leading cause of morbidity and mortality worldwide and, despite recent advances in therapy HF hospitalization rates remains unacceptably high. Prompt identification and optimal management of HF can affect long-term outcome. A valuable tool with diagnostic, prognostic, and treatment-guiding properties in this respect will be very useful, as exemplified by natriuretic peptides. However, natriuretic peptide levels show biological variation and are dependent on age, renal function, and body mass index. Recent advances in the field of molecular biology and HF pathophysiology have led to the discovery of other novel biomarkers that may have advantages. Among others, Galectin-3 (GAL3) and sST2 are 2 promising biomarkers that have been recently developed and can be used alone or in combination with natriuretic peptides in clinical practice. In the current paper, we review the existing data regarding GAL3 and sST2 in HF.
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http://dx.doi.org/10.1007/s11897-013-0169-1DOI Listing
December 2013