Publications by authors named "Konstantinos Aznaouridis"

117 Publications

Arterial biomarkers in the evaluation, management and prognosis of aortic stenosis.

Atherosclerosis 2021 Sep 13;332:1-15. Epub 2021 Jul 13.

Hypertension and Cardiometabolic Unit, First Department of Cardiology, Hippokration Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece. Electronic address:

Degenerative aortic valve stenosis is the most common primary valve disease and a significant cause of cardiovascular morbidity and mortality. In an era when new techniques for the management of aortic stenosis are gaining ground, the understanding of this disease is more important than ever to optimize treatment. So far, the focus has been placed on the assessment of the valve itself. However, the role that the arterial system plays in the pathogenesis and natural history of the disease needs to be further elucidated. Arteriosclerosis, when it coexists with a stenotic valve, augments the load posed on the left ventricle contributing to greater impairment of cardiovascular function. Arterial stiffness, a well-established predictor for cardiovascular disease and all-cause mortality, could play a role in the prognosis and quality of life of this population. Several studies using a variety of indices to assess arterial stiffness have tried to address the potential utility of arterial function assessment in the case of aortic stenosis. Importantly, reliable data identify a prognostic role of arterial biomarkers in aortic stenosis and stress their possible use to optimize timing and method of treatment. This review aims at summarizing the existing knowledge on the interplay between the heart and the vessels in the presence of degenerative aortic stenosis, prior, upon and after interventional management. Further, it discusses the evidence supporting the potential clinical application of arterial biomarkers for the assessment of progression, severity, management and prognosis of aortic stenosis.
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http://dx.doi.org/10.1016/j.atherosclerosis.2021.07.006DOI Listing
September 2021

Angiography-based estimation of coronary physiology: A frame is worth a thousand words.

Trends Cardiovasc Med 2021 Jul 28. Epub 2021 Jul 28.

First Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Hippokration Hospital, Athens, Greece.

Cumulative evidence has shown that coronary revascularization should be guided by functional significance of coronary lesions. Fractional flow reserve (FFR) is the gold standard for assessment of hemodynamic significance of coronary stenosis and FFR-guided percutaneous coronary intervention has improved clinical outcomes in patients with coronary artery disease. However, limitations of FFR such as increased operational time and cost, requirement of pressure wire and adenosine and technical difficulties have led to significant underutilization of the method in clinical practice. In the last few years, several methods of FFR estimation based on coronary angiography images have emerged to overcome invasive FFR limitations. The common elements of the novel indices include a 3D anatomical reconstruction of coronary vessels by angiographic projections and various approaches to fluid dynamics computation. Angiography-derived FFR methods have shown high diagnostic accuracy compared to invasive FFR. Although there are promising results regarding their prognostic role, large randomized trials evaluating clinical outcomes are lacking. The aim of this review is to present currently available angiography-derived FFR indices and highlight their differences, advantages, disadvantages and potential clinical implications.
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http://dx.doi.org/10.1016/j.tcm.2021.07.004DOI Listing
July 2021

Comparison of Ticagrelor Versus Clopidogrel on Cerebrovascular Microembolic Events and Platelet Inhibition during Transcatheter Aortic Valve Implantation.

Am J Cardiol 2021 09 7;154:78-85. Epub 2021 Jul 7.

Department of Cardiology, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece; Department of Cardiology, National and Kapodistrian University of Athens, Sotiria Hospital, Athens, Greece.

The impact of the antiplatelet regimen and the extent of associated platelet inhibition on cerebrovascular microembolic events during transcatheter aortic valve implantation (TAVI) are unknown. Our aim was to evaluate the effects of ticagrelor versus clopidogrel and of platelet inhibition on the number of cerebrovascular microembolic events in patients undergoing TAVI. Patients scheduled for TAVI were randomized previous to the procedure to either aspirin and ticagrelor or to aspirin and clopidogrel. Platelet inhibition was expressed in P2Y12 reaction units (PRU) and percentage of inhibition. High intensity transient signals (HITS) were assessed with transcranial Doppler (TCD). Safety outcomes were recorded according to the VARC-2 definitions. Among 90 patients randomized, 6 had an inadequate TCD signal. The total number of procedural HITS was lower in the ticagrelor group (416.5 [324.8, 484.2]) (42 patients) than in the clopidogrel group (723.5 [471.5, 875.0]) (42 patients), p <0.001. After adjusting for the duration of the procedure, diabetes, extra-cardiac arteriopathy, BMI, hypertension, aortic valve calcium content, procedural ACT, and pre-implantation balloon valvuloplasty, patients on ticagrelor had on average 256.8 (95% CI: [-335.7, -176.5]) fewer total procedural HITS than patients on clopidogrel. Platelet inhibition was greater with ticagrelor 26 [10, 74.5] PRU than with clopidogrel 207.5 (120 to 236.2) PRU, p <0.001, and correlated significantly with procedural HITS (r = 0.5, p <0.05). In conclusion, ticagrelor resulted in fewer procedural HITS, compared with clopidogrel, in patients undergoing TAVI, while achieving greater platelet inhibition.
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http://dx.doi.org/10.1016/j.amjcard.2021.05.047DOI Listing
September 2021

A single-center, prospective, observational study on maternal smoking during pregnancy in Greece: The HELENA study.

Tob Prev Cessat 2021 26;7:16. Epub 2021 Feb 26.

Department of Cardiology, Helena Venizelou General & Maternity Hospital, Athens, Greece.

Introduction: The unequivocal association between exposure to smoke and numerous complications of pregnancy, demonstrated in the last decades, has led to a significant decrease of smoking rates in pregnancy. The aim of the present study was to determine the prevalence of maternal smoking and to elucidate factors predisposing to it among pregnant women in Athens, Greece.

Methods: A population of 1700 pregnant women (mean age: 31.2±5.5 years) who visited consecutively the Cardiology Department of Helena Venizelou Maternity Hospital in Athens, Greece, between September 2016 and August 2017, was prospectively analyzed. Data regarding changes in the future mother's smoking habit as well as different sociodemographic factors potentially related to these changes were recorded.

Results: Of the 1700 participants, 704 (41.4%) were smokers, and of those 52.4% quit smoking after knowledge of their pregnancy status. The overall prevalence of smoking in pregnancy was 19.7%. Prevalence was higher in women who were aged <20 years (p=0.038), were multipara (p=0.032), had ≤12 years of education (p=0.044) and had a partner who was a smoker (p=0.047). Women aged ≤20 years were more likely to be persistent smokers at the beginning of pregnancy and demonstrated a higher prevalence of smoking during pregnancy (42.2% vs 19.7% in the overall study population).

Conclusions: Our data demonstrate that maternal smoking during pregnancy still remains a major public health issue in Greece with a prevalence higher than most other industrialized countries.
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http://dx.doi.org/10.18332/tpc/131824DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7908060PMC
February 2021

Transcatheter closure of paravalvular leak: Multicenter experience and follow-up.

Hellenic J Cardiol 2021 Feb 19. Epub 2021 Feb 19.

1(st) Department of Cardiology, University of Athens, 'Hippokration' Hospital, Athens, Greece; 3(rd) Department of Cardiology, University of Athens, 'Sotiria' Hospital, Athens, Greece.

Background: Paravalvular leak (PVL) is a common complication following valve replacement, which leads to heart failure and hemolysis. Transcatheter PVL closure has emerged as a reliable alternative with promising results. We quote the combined three-center experience of PVL patients treated percutaneously.

Methods: Consecutive patients treated percutaneously for PVL were retrospectively studied. Procedural characteristics, inhospital, and long-term clinical outcomes were assessed. Technical (successful deployment) and clinical (NYHA and/or hemolysis improvement) success were evaluated.

Results: In total, 39 patients treated for PVL in either the aortic (12 patients) or the mitral (27 patients) position were studied. Amplatzer Vascular Plug III was the most commonly used device among the 45 devices totally implanted. Postprocedurally, the rates of at least moderate PVL (87.5% preprocedurally vs 10.5% at discharge) and functional status (mean NYHA class 2.8 ± 0.7 on admission vs 1.5 ± 0.8 at follow-up) were statistically significantly improved. Total population technical success rate was 89.7%, being comparable between patients treated for mitral or aortic valve PVLs (92.6% vs 83.3%, respectively). Clinical success was achieved in 82.1% of patient cohort without statistical difference among those with isolated aortic or mitral PVL or among those with PVL closure an indication of heart failure or hemolysis. During a mean follow-up of 33.5 months, five patients died, including one periprocedural death.

Conclusions: This multicenter recorded experience confirms that percutaneous PVL closure can be performed with high technical and clinical success rates and limited complications that lead to significant PVL reduction and functional status improvement.
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http://dx.doi.org/10.1016/j.hjc.2021.02.002DOI Listing
February 2021

The Mediterranean Diet Benefit on Cardiovascular Hemodynamics and Erectile Function in Chronic Heart Failure Male Patients by Decoding Central and Peripheral Vessel Rheology.

Nutrients 2020 Dec 30;13(1). Epub 2020 Dec 30.

First Cardiology Clinic, Hippokration Hospital, School of Medicine, University of Athens, 11527 Athens, Greece.

Background: Mediterranean diet was evaluated on erectile performance and cardiovascular hemodynamics, in chronic heart failure patients.

Methods: 150 male stable heart failure patients were enrolled in the study (62 ± 10 years, New York Heart Association (NYHA) classes I-II, ejection fraction ≤40%). A detailed echocardiographic evaluation including estimation of the global longitudinal strain of the left ventricle and the systolic tissue doppler velocity of the tricuspid annulus was performed. Erectile dysfunction severity was assessed by the Sexual Health Inventory for Men-5 (SHIM-5) score. Adherence to the Mediterranean diet was evaluated by the MedDietScore.

Results: The SHIM-5 score was positively correlated with the MedDietScore ( = 0.006) and augmentation index ( = 0.031) and inversely correlated with age ( = 0.002). MedDietScore was negatively associated with intima-media-thickness ( < 0.001) and serum prolactin levels ( = 0.05). Multi-adjusted analysis revealed that the inverse relation of SHIM-5 and prolactin levels remained significant only among patients with low adherence to the Mediterranean diet ( = 0.012).

Conclusion: Consumption of Mediterranean diet benefits cardiovascular hemodynamics, while suppressing serum prolactin levels. Such physiology may enhance erectile ability independently of the of the left ventricle ejection fraction.
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http://dx.doi.org/10.3390/nu13010108DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7824543PMC
December 2020

Dual Antithrombotic Therapy in Atrial Fibrillation Patients undergoing Percutaneous Coronary Angioplasty: The Impact of Bleeding Risk Score on Outcome.

Thromb Haemost 2021 06 30;121(6):845-847. Epub 2020 Dec 30.

2nd Department of Cardiology, Attikon University Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece.

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http://dx.doi.org/10.1055/s-0040-1721777DOI Listing
June 2021

Transvenous extraction of permanent pacemaker and defibrillator leads: Reduced procedural complexity and higher procedural success rates in patients with infective versus noninfective indications.

J Cardiovasc Electrophysiol 2021 02 25;32(2):491-499. Epub 2020 Dec 25.

Department of Cardiology, Hippokration General Hospital, Athens, Greece.

Introduction: Transvenous lead extraction (TLE) is critical in the long-term management of patients with cardiac implanted electronic devices (CIEDs). The aim of the study is to evaluate the outcomes of TLE and to investigate the impact of infection.

Methods And Results: Data of patients undergoing extraction of permanent pacemaker and defibrillator leads during October 2014-September 2019 were prospectively analyzed. Overall, 242 consecutive patients (aged 71.0 ± 14.0 years, 31.4% female), underwent an equal number of TLE operations for the removal of 516 leads. Infection was the commonest indication (n = 201, 83.1%). Mean implant-to-extraction duration was 7.6 ± 5.4 years. Complete procedural success was recorded in 96.1%, and clinical procedural success was achieved in 97.1% of attempted lead extractions. Major complications occurred in two (0.8%) and minor complications in seven (2.9%) patients. Leads were removed exclusively by using locking stylets in 65.7% of the cases. In the subgroup of noninfective patients, advanced extraction tools were more frequently required compared to patients with CIED infections, to extract leads (success only with locking stylet: 55.8% vs. 67.8%, p = .032). In addition, patients without infection demonstrated lower complete procedural success rates (90.7% vs. 97.2%, p = .004), higher major complication rates (2.4% vs. 0.5%, p = .31) and longer procedural times (136 ± 13 vs. 111 ± 15 min, p = .001).

Conclusions: Our data demonstrate high procedural efficacy and safety and indicate that in patients with noninfective indications, the procedure is more demanding, thus supporting the hypothesis that leads infection dissolves and/or prohibits the formation of fibrotic adherences.
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http://dx.doi.org/10.1111/jce.14841DOI Listing
February 2021

Recurrence of Pericardial Effusion After Pericardiocentesis: Does Catheter-Induced Acute Pericardial Inflammation Play a Role?

Am J Med Sci 2021 05 12;361(5):676-678. Epub 2020 Oct 12.

1st Cardiology Clinic, National and Kapodistrian University of Athens, School of Medicine, Hippokration General Hospital, Athens, Greece.

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http://dx.doi.org/10.1016/j.amjms.2020.10.012DOI Listing
May 2021

The impact of transcatheter aortic valve implantation on arterial stiffness and wave reflections.

Int J Cardiol 2021 01 14;323:213-219. Epub 2020 Aug 14.

Peripheral Vessels Unit, First Department of Cardiology, Hippokration Hospital, National and Kapodistrian University of Athens, Athens Medical School, Greece. Electronic address:

Background: The study of arterial properties in patients with aortic valve stenosis who undergo transcatheter aortic valve implantation (TAVI) remains challenging and results so far seem equivocal. We sought to investigate the acute and long-term effect of TAVI on arterial stiffness and wave reflections.

Methods: We enrolled 90 patients (mean age 80.2 ± 8.1 years, 50% males) with severe symptomatic aortic stenosis undergoing TAVI. Arterial stiffness was assessed by carotid-femoral and brachial-ankle pulse wave velocity (cfPWV and baPWV). Augmentation index corrected for heart rate ([email protected]), central pressures and subendocardial viability ratio (SEVR) were assessed with arterial tonometry. Measurements were conducted at baseline, after TAVI and at 1 year.

Results: Immediately after TAVI there was an increase in arterial stiffness (7.5 ± 1.5 m/s vs 8.4 ± 1.7 m/s, p = .001 for cfPWV and 1773 ± 459 vs 2383 ± 645 cm/s, p < .001 for baPWV) that was retained at 1 year (7.5 ± 1.5 m/s vs 8.7 ± 1.7 m/s, p < .001 and 1773 ± 459 cm/s vs 2286 ± 575, p < .001). Post-TAVI we also observed a decrease in [email protected] (32.2 ± 12.9% vs 27.9 ± 8.4%, p = .016) that was attenuated 1 year later (32.2 ± 12.9% vs 29.8 ± 9.1%, p = .38), and an increase in SEVR (131.2 ± 30.0% vs 148.4 ± 36.1%, p = .002), which remained improved at 1 year (131.2 ± 30.0% vs 146.0 ± 32.2%, p = .01).

Conclusions: After TAVI the arterial system exhibits an increase of stiffness in response to the acute relief of the obstruction, which is retained in the long term.
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http://dx.doi.org/10.1016/j.ijcard.2020.08.040DOI Listing
January 2021

No-reflow phenomenon and comparison to the normal-flow population postprimary percutaneous coronary intervention for ST elevation myocardial infarction: case-control study (NORM PPCI).

Open Heart 2020 07;7(2)

Department of Academic Cardiology, Hull York Medical School Centre for Cardiovascular and Metabolic Research, Cottingham, UK.

Introduction: No-reflow (NR) phenomenon is characterised by the failure of myocardial reperfusion despite the absence of mechanical coronary obstruction. NR negatively affects patient outcomes, emphasising the importance of prediction and management. The objective was to evaluate the incidence and independent predictors of NR in patients presenting with ST-elevation myocardial infarction (STEMI).

Methods: This was a single-centre prospective case-control study. Cases were subjects who suffered NR, and the control comparators were those who did not. Clinical outcomes were documented. Salient variables relating to the patients and their presentation, history and angiographical findings were compared using one-way analysis of variance or χ test. Multiple regression determined the independent predictors, and a risk score was established based on the β coefficient.

Results: Of 173 consecutive patients, 24 (13.9%) suffered from NR, with 46% occurring post stent implantation. Patients with NR had increased risk of in-hospital death (OR 7.0, 95% CI 1.3 to 36.7, p=0.022). From baseline variables available prior to percutaneous coronary intervention, the independent predictors of NR were increased lesion complexity, admission systolic hypertension, weight of <78 kg and history of hypertension. Continuous data were transformed into best-fit binary variables, and a risk score was defined. Significant difference was demonstrated between the risk score of patients with NR (4.1±1) compared with controls (2.6±1) (p<0.001), and the risk score was considered a good test (area under the curve=0.823). A score of ≥4 had 75% sensitivity and 76.5% specificity.

Conclusion: Patients with NR have a higher rate of mortality following STEMI. Predictors of NR include lesion complexity, systolic hypertension and low weight. Further validation of this risk model is required.
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http://dx.doi.org/10.1136/openhrt-2019-001215DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7380712PMC
July 2020

Eligibility for PCSK-9 inhibitors treatment in acute coronary syndrome, chronic coronary artery disease and outpatient dyslipidemic patients.

Atherosclerosis 2020 06 15;303:29-35. Epub 2020 May 15.

1st Department of Cardiology, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece.

Background And Aims: We aimed to investigate potential eligibility for proprotein convertase subtilisin-kexin type 9 (PCSK9) inhibitors in patients with coronary artery disease and dyslipidaemia according to patient characteristics and variable criteria.

Methods: We prospectively enrolled 2000 patients (acute coronary syndrome = 407, chronic coronary artery disease inpatients = 1087, outpatient Lipid's clinic = 506). To calculate PCSK-9 inhibitors real-world eligibility, a proprietary adjustable software was developed, which stores data and patient characteristics and can determine eligibility depending on different criteria. We tested four scenarios with different LDL thresholds according to ESC/EAS 2016 and 2019 Guidelines, 2017 American College of Cardiology Expert Consensus, and National criteria.

Results: The eligible percentage was 18.85%, 9.75%, 8.55% and 2.15%, in the total population for the four classifications, respectively, and it varied according to clinical status. The increase toward more recent guidelines was mostly attributed to the increasing number of coronary patients who become eligible as our criteria become stricter.

Conclusions: For the first time, a realistic estimation of PCSK-9 eligibility is provided via an adjustable predictive model in a population of 2000 patients with acute coronary syndrome, chronic coronary artery disease and dyslipidaemia. This can be a valuable tool for the incorporation of PCSK-9 inhibitors in health care systems.
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http://dx.doi.org/10.1016/j.atherosclerosis.2020.04.024DOI Listing
June 2020

Rotatripsy: A Hybrid "Drill and Disrupt" Approach for Treating Heavily Calcified Coronary Lesions.

J Invasive Cardiol 2020 Jun;32(6):E175

1st Department of Cardiology, Hippokration Hospital, 114 Vas. Sofias Avenue, 11527 Athens, Greece.

In balloon-uncrossable calcified lesions, rotational atherectomy (RA) is the first-line modality to enable operators to advance balloons and stents over the stenosis. If the lesion is undilatable after RA, a hybrid approach with additional intracoronary lithotripsy (rotatripsy) can be an effective approach that further modifies the calcified plaque and enables stent delivery.
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June 2020

Acute effect of heat-not-burn versus standard cigarette smoking on arterial stiffness and wave reflections in young smokers.

Eur J Prev Cardiol 2021 Sep;28(11):e9-e11

Hypertension and Cardiometabolic Syndrome Unit and Smoking Cessation Unit, 1st Cardiology Department, Athens Medical School, Hippokration Hospital, Greece.

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http://dx.doi.org/10.1177/2047487320918365DOI Listing
September 2021

Enterococcus faecium purulent pericarditis with transient constriction.

Hellenic J Cardiol 2021 Jan-Feb;62(1):92-94. Epub 2020 Apr 21.

First Cardiology Department, Hippokration General Hospital, National and Kapodistrian University of Athens, Greece.

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http://dx.doi.org/10.1016/j.hjc.2020.03.004DOI Listing
August 2021

Neoplastic cardiac tamponade in a pregnant woman.

Eur Heart J 2020 04;41(16):1610

1st Department of Cardiology, Hippokration Hospital, National and Kapodistrian University of Athens, 114 Vas. Sofias Avenue, 11527 Athens, Greece.

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http://dx.doi.org/10.1093/eurheartj/ehaa025DOI Listing
April 2020

Jailed in a Bony Prison: Post-tuberculotic Calcific Constrictive Pericarditis.

Am J Med Sci 2020 03 1;359(3):188-189. Epub 2019 Nov 1.

First Department of Cardiology, Hippokration Hospital, University of Athens Medical School, Athens, Greece.

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http://dx.doi.org/10.1016/j.amjms.2019.10.013DOI Listing
March 2020

Aortic wall stiffness as a side-effect of anti-cancer medication.

Expert Rev Cardiovasc Ther 2019 Nov 20;17(11):791-799. Epub 2019 Nov 20.

1st Department of Cardiology, Hippokration Hospital, Athens, Greece.

: Malignancies and cardiovascular disease are the two leading causes of mortality worldwide. There is a growing concern that anti-cancer drugs may lead to increased cardiovascular morbidity among cancer survivors. This may be the result of direct effects of the cancer treatment on heart function, or due to an indirect acceleration of atherosclerosis.: We searched two bibliographic databases [PubMed, Scopus] and one full-text database (Google Scholar) for publications on chemotherapy and arterial stiffness since 1970. Anthracyclines, alkylating agents and tyrosine kinase inhibitors seem to affect arterial elastic properties. These effects can be non-reversible and may appear after treatment termination. Monoclonal antibodies may induce either a temporary increase or no change on arterial stiffness of patients with malignancies. Anti-microtubule agents and antimetabolites have not been extensively studied so far.: This literature review suggests that certain anticancer medications may impair arterial stiffness, and that assessment of arterial elastic properties before and after initiation of anti-neoplasmatic therapy may be clinically useful in order to develop protective strategies against chemotherapy-induced vascular effects. Further research is warranted to confirm the effects of anti-cancer agents on arterial stiffness, as well as their potential clinical implications. Future research lies in finding new targeted biomarkers identifying arterial stiffness such as micro RNAs while imaging techniques could also be implemented in assessment of vascular toxicity.
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http://dx.doi.org/10.1080/14779072.2019.1691528DOI Listing
November 2019

Statins in Stroke.

Curr Med Chem 2019 ;26(33):6174-6185

1st Department of Cardiology, Athens Medical School, Hippokration Hospital, Athens, Greece.

Background: Stroke is a major cause of mortality and disability in modern societies. Statins are effective medications in decreasing cardiovascular events through lipid lowering and pleiotropic effects.

Objective: To summarize current evidence regarding the role of statins in the prevention and management of stroke.

Methods: A narrative review of current evidence regarding the effect of statins in stroke management. Electronic searches of MEDLINE, EMBASE and Cochrane Databases were performed.

Results: In primary prevention of stroke in patients with risk factors but no established cardiovascular disease, potent statins such as atorvastatin and rosuvastatin have shown some benefits, but the clinical relevance of this effect is questionable. In populations at higher risk of stroke, such as patients with established coronary heart disease, the majority of relevant studies have shown a beneficial effect of statins in preventing stroke. Similarly, in patients with a previous cerebrovascular event, there is a clear benefit of statins for the prevention of recurrent events. The use of statins is not associated with an increased risk of intracranial bleeding in primary prevention studies. There may be an increased incidence of non-fatal hemorrhagic stroke with high dose statins in patients with a previous cerebrovascular event. Patients who experience a stroke while on statins should not discontinue statins. In addition, statins are associated with better survival and improved functional outcome when administered during the acute phase of stroke in statin-naive patients. In contrast, statins do not confer any benefit in patients with acute ischemic stroke who receive thrombolysis.

Conclusion: Treatment with statins prevents ischemic stroke, especially in patients with high cardiovascular risk and established atherosclerotic disease. It seems that both lipid lowering and pleiotropic effects contribute to these effects.
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http://dx.doi.org/10.2174/0929867326666190620104539DOI Listing
December 2019

Effect of Ticagrelor Versus Clopidogrel on Aortic Stiffness in Patients With Coronary Artery Disease.

J Am Heart Assoc 2019 06 5;8(12):e012521. Epub 2019 Jun 5.

1 First Department of Cardiology Hippokration Hospital Athens Medical School Athens Greece.

Background We compared the acute and midterm effect of ticagrelor versus clopidogrel on aortic stiffness. Methods and Results We studied 117 patients in a randomized, assessor-blinded, parallel-group trial. The acute effect of ticagrelor was studied in 58 patients randomized (1:1) to receive a loading dose of clopidogrel (600 mg) or ticagrelor (180 mg). Carotid-femoral pulse wave velocity (cf PWV ) was measured before, 3, and 24 hours after the loading dose. The midterm effect (30-day treatment period) was studied in 59 subjects who underwent percutaneous coronary intervention and were randomized to either clopidogrel (75 mg, OD) or ticagrelor (90 mg BID). cf PWV was measured before and at 30 days of treatment. Circulating markers of inflammation and endothelial function were measured at all study points. Repeated-measures analysis showed a significant main effect for treatment ( P=0.03), with the ticagrelor showing a reduction in cf PWV after treatment. cf PWV at 24 hours was significantly lower in the ticagrelor group compared with the clopidogrel group ( P=0.017) (maximal response reduction by 0.42±0.26 m/s). At 30 days, cf PWV decreased in the ticagrelor group, whereas there was no change with clopidogrel (-0.43±0.57 versus 0.12±0.14 m/s, P=0.004). There were no significant changes in both the acute and midterm study period in the pro-inflammatory and endothelial function parameters. Conclusions URL : https://www.clinicaltrials.gov . Unique identifier: NCT02071212. Ticagrelor decreases cf PWV for 24 hours after the loading dose and at 1 month post-percutaneous coronary intervention compared with clopidogrel. Considering that aortic stiffness is an independent predictor of cardiovascular events, this finding may have clinical implications regarding the beneficial effect of ticagrelor. Clinical Trial Registration URL : http://www.clinicaltrials.gov . Unique identifier: NCT02071212.
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http://dx.doi.org/10.1161/JAHA.119.012521DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6645640PMC
June 2019

Association of cardio-ankle vascular index with blood pressure indices: mathematical and methodological perspectives.

J Hum Hypertens 2020 09 22;34(8):602-603. Epub 2019 Mar 22.

Biomedical Engineering Unit, First Department of Cardiology, Medical School, National and Kapodistrian University of Athens, Athens, Greece.

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http://dx.doi.org/10.1038/s41371-019-0195-xDOI Listing
September 2020

Successful Stent Delivery Through a Slaloming Coronary Path.

J Invasive Cardiol 2019 02;31(2):E43

1st Department of Cardiology, Hippokration Hospital, 114 Vas. Sofias Avenue, 11527 Athens, Greece.

A 66-year-old man with refractory angina was admitted for percutaneous coronary intervention (PCI) through a tortuous saphenous vein graft sequentially anastomosed with a diagonal and a first marginal branch. Our target was a critical stenosis at the retrograde limb of the first marginal proximal to saphenous vein graft anastomosis. Stent delivery to our target lesion mandated tracking through sequential angulations. In this case, we enhanced the support of the guide catheter and delivered a stent on the retrograde limb of the first marginal branch with very deep intubation of the guide catheter into the saphenous vein graft and use of a buddy wire, which is a cheaper and relatively safer maneuver than complex techniques such as the double guide-catheter extension technique. Proper selection of the type and size of the guide catheter and meticulous attention to the pressure waveform in order to avoid ischemia or dissection of the graft is mandatory during this technique.
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February 2019

A clinical score for prediction of elevated aortic stiffness: derivation and validation in 3943 hypertensive patients.

J Hypertens 2019 02;37(2):339-346

Hypertension and Cardiometabolic Syndrome Unit, 1 Department of Cardiology, Medical School, National & Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece.

Objective: Aortic stiffness assessed by carotid-femoral pulse wave velocity (PWV) is an important predictor to gauge the overall risk of hypertensive patients; nonetheless, it is underutilized in everyday practice. We propose a simple scoring system based on clinical variables that can identify patients with a priority for measurement of PWV, that is, those with elevated PWV (≥10 m/s) and, consequently, at higher risk for events.

Methods: Patient data from three outpatient clinics (n = 3943) were used to form a derivation, internal and external validation cohort. For derivation, independent predictors of high PWV from a binary logistic regression model were split in subcategories and implemented in a simple clinical prediction scoring system with the acronym SAGE (office systolic blood pressure, age, glycemia and eGFR categories).

Results: Its performance was validated at the internal and external validation cohorts with c-statistics being 0.83 (95% CI 0.81-0.86) and 0.77 (95% CI 0.73-0.80), respectively. A cut-off of eight points to identify patients with high PWV in the internal/external validation cohorts yielded a positive-predictive value, negative-predictive value, sensitivity and specificity of 52/36%, 88/81%, 56/70% and 88/65%, respectively.

Conclusion: The SAGE score that takes into account easily measured clinical variables (office SBP, age, fasting glucose and eGFR categories) can be used to accurately predict elevated levels of PWV and prioritize its measurement in specific hypertensive patients. Its use will result in greater acknowledgement of the role of aortic stiffness and aid physicians in implementing it in clinical practice.
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http://dx.doi.org/10.1097/HJH.0000000000001904DOI Listing
February 2019

Multicenter Randomized Evaluation of High Versus Standard Heparin Dose on Incident Radial Arterial Occlusion After Transradial Coronary Angiography: The SPIRIT OF ARTEMIS Study.

JACC Cardiovasc Interv 2018 11 1;11(22):2241-2250. Epub 2018 Nov 1.

Patras University Hospital Rio, Patras, Greece.

Objectives: The aim of this study was to test the hypothesis that more intensive over standard anticoagulation administered during coronary angiography would significantly reduce rates of radial artery occlusion (RAO).

Background: RAO, although silent, remains a frequent and therefore worrisome complication following transradial coronary angiography. Anticoagulation is effective in reducing RAO, but the optimal heparin dose remains ill defined.

Methods: In this multicenter, randomized superiority trial, a high dose (100 IU/kg body weight administered in divided doses) and a standard dose (50 IU/kg body weight) of heparin during 5- or 6-F coronary angiography were compared. A total of 3,102 patients were randomized, of whom 1,836 patients not proceeding to percutaneous coronary intervention and without need for arterial access crossover entered the trial. Post-catheterization hemostasis did not follow a rigid protocol.

Results: A total of 102 early RAOs were found on ultrasonography (incidence 5.6%). In the high-dose heparin group, the rate of RAO was significantly lower compared with the standard-dose heparin group (27 [3.0%] vs. 75 [8.1%]; odds ratio: 0.35; 95% confidence interval: 0.22 to 0.55; p < 0.001), without compromising safety. The time to achieve hemostasis was similar between groups. To avoid 1 RAO, the number of patients needed to treat in the high-dose heparin group was approximately 20. These results were corroborated by our integrated database, showing an 80% reduction of forearm artery occlusions in high versus low heparin dose patients and our updated meta-analysis of randomized controlled trials demonstrating significant benefit of higher over lower anticoagulation intensity.

Conclusions: High compared with standard heparin dose significantly reduced the rate of RAO in patients undergoing coronary angiography. High-intensity anticoagulation should be considered in transradial diagnostic procedures. (High [100IU/Kg] Versus Standard [50IU/Kg] Heparin Dose for Prevention of Forearm Artery Occlusion; NCT02570243).
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http://dx.doi.org/10.1016/j.jcin.2018.08.009DOI Listing
November 2018

Overview of coronary artery variants, aberrations and anomalies.

World J Cardiol 2018 Oct;10(10):127-140

Peripheral Vessels Unit and EKKAN (Unit for the athletes and for hereditary cardiovascular diseases), 1 Department of Cardiology, Hippokration Hospital, Medical School of National and Kapodistrian University of Athens, Athens 11527, Greece.

Coronary artery anomalies and variants are relatively uncommon congenital disorders of the coronary artery anatomy and constitute the second most common cause of sudden cardiac death in young competitive athletes. The rapid advancement of imaging techniques, including computed tomography, magnetic resonance imaging, intravascular ultrasound and optical coherence tomography, have provided us with a wealth of new information on the subject. Anomalous origin of a coronary artery from the contralateral sinus is the anomaly most frequently associated with sudden cardiac death, in particular if the anomalous coronary artery has a course between the aorta and the pulmonary artery. However, other coronary anomalies, like anomalous origin of the left coronary artery from the pulmonary artery, atresia of the left main stem and coronary fistulae, have also been implicated in cases of sudden cardiac death. Patients are usually asymptomatic, and in most of the cases, coronary anomalies are discovered incidentally during coronary angiography or on autopsy following sudden cardiac death. However, in some cases, symptoms like angina, syncope, heart failure and myocardial infarction may occur. The aims of this article are to present a brief overview of the diverse coronary variants and anomalies, focusing especially on anatomical features, clinical manifestations, risk of sudden cardiac death and pathophysiologic mechanism of symptoms, as well as to provide valuable information regarding diagnostic workup, follow-up, therapeutic choices and timing of surgical treatment.
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http://dx.doi.org/10.4330/wjc.v10.i10.127DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6205847PMC
October 2018

Spiral Pseudodissection of a Tortuous Internal Mammary Artery Graft.

J Invasive Cardiol 2018 May;30(5):E37-E38

1st Department of Cardiology, Hippokration Hospital, 114 Vas Sofias Avenue, 11527 Athens, Greece.

Images and videos help describe a high-risk coronary intervention of an elongated and extremely tortuous LIMA graft to the LAD. LIMA had a complete 360° loop at the mid segment, followed by severe tortuosity and a subtotal occlusion at the anastomosis.
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May 2018

Cardiogoniometry Compared to Fractional Flow Reserve at Identifying Physiologically Significant Coronary Stenosis: The CARDIOFLOW Study.

Cardiovasc Eng Technol 2018 09 12;9(3):439-446. Epub 2018 Apr 12.

Department of Academic Cardiology, University of Hull, Castle Hill Hospital, Daisy Building, Castle Road, Cottingham, HU16 5JQ, UK.

Cardiogoniometry (CGM) is method of 3-dimensional electrocardiographic assessment which has been shown to identify patients with angiographically defined, stable coronary artery disease (CAD). However, angiographic evidence of CAD, does not always correlate to physiologically significant disease. The aim of our study was to assess the ability of CGM to detect physiologically significant coronary stenosis defined by fractional flow reserve (FFR). In a tertiary cardiology centre, elective patients with single vessel CAD were enrolled into a prospective double blinded observational study. A baseline CGM recording was performed at rest. A second CGM recording was performed during the FFR procedure, at the time of adenosine induced maximal hyperaemia. A significant CGM result was defined as an automatically calculated ischaemia score < 0 and a significant FFR ratio was defined as < 0.80. Measures of diagnostic performance (including sensitivity and specificity) were calculated for CGM at rest and during maximal hyperaemia. Forty-five patients were included (aged 61.1 ± 11.0; 60.0% male), of which eighteen (40%) were found to have significant CAD when assessed by FFR. At rest, CGM yielded a sensitivity of 33.3% and specificity of 63.0%. At maximal hyperaemia the sensitivity and specificity of CGM was 71.4 and 50.0% respectively. The diagnostic performance of CGM to detect physiologically significant stable CAD is poor at rest. Although, the diagnostic performance of CGM improves substantially during maximal hyperaemia, it does not reach sufficient levels of accuracy to be used routinely in clinical practice.
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http://dx.doi.org/10.1007/s13239-018-0354-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6096643PMC
September 2018

Effects of Intensive Blood Pressure Control in Patients with Evident Cardiovascular Disease: An Investigation Using the SPRINT Study Data.

Curr Vasc Pharmacol 2019 ;17(3):298-306

Hypertension and Cardiometabolic Unit, First Department of Cardiology, Hippokration Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece.

Background: Recent data advocate adoption of a more intensive treatment strategy for management of blood pressure (BP).

Objective: We investigated whether the overall effects of the Systolic Blood Pressure Intervention Trial (SPRINT) are applicable to cardiovascular disease (CVD) patients.

Methods: In a post hoc analysis we analyzed data from SPRINT that randomly assigned 9361 individuals to a systolic BP (SBP) target of <120 mmHg (intensive treatment) or <140 mmHg (standard treatment). 1562 patients had clinically evident CVD (age=70.3±9.3 years, 24% females) at study entry and were followed for 3.1 years. Further, we assessed the effect of low (<150 mmHg) baseline SBP on outcome.

Results: In CVD patients, there was no benefit from the intensive treatment regarding all endpoints, except for a marginally significant benefit on all-cause mortality (hazard ratio [HR]: 0.67; 95% confidence interval [CI], 0.45 to 1.00; p=0.0509). Further, while there was no increase in serious adverse events (SAE) in the intensive group, there was increased risk for study-related SAE, acute renal failure and electrolyte abnormalities. In patients with low baseline SBP there was a beneficial effect on allcause mortality (HR: 0.56; 95% CI: 0.33 to 0.96; p=0.033), but with greater stroke incidence (HR: 2.94; 95% CI: 1.04 to 8.29; p=0.042).

Conclusion: We confirm the beneficial effect of the intensive strategy in SPRINT study on all-cause mortality and the harmful effect on specific adverse outcomes in patients with CVD. However, in patients with low baseline SBP stroke may increase.
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http://dx.doi.org/10.2174/1570161116666180305160116DOI Listing
May 2020
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