Publications by authors named "Marieta P Theodorakopoulou"

12 Publications

  • Page 1 of 1

Pulmonary hypertension and cardiovascular mortality in end-stage kidney disease: still some way to go before conclusive evidence.

Int Urol Nephrol 2021 May 7. Epub 2021 May 7.

Department of Respiratory Medicine, G. Papanikolaou Hospital, Exohi, 57010, Thessaloniki, Greece.

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http://dx.doi.org/10.1007/s11255-021-02883-xDOI Listing
May 2021

Omega-3 Fatty Acid Supplementation for Endothelial Dysfunction in COPD: Another Fiasco? Or Maybe Not?

Chronic Obstr Pulm Dis 2021 Apr;8(2):185-187

Department of Respiratory Medicine, G. Papanikolaou Hospital, Thessaloniki, Greece.

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http://dx.doi.org/10.15326/jcopdf.2021.0206DOI Listing
April 2021

Dapagliflozin does not affect blood pressure variability in prediabetic prehypertensive subjects.

Blood Press Monit 2021 Jun;26(3):242-243

Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece.

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http://dx.doi.org/10.1097/MBP.0000000000000516DOI Listing
June 2021

Assessment of Exercise Intolerance in Patients with Pre-Dialysis CKD with Cardiopulmonary Function Testing: Translation to Everyday Practice.

Am J Nephrol 2021 Apr 21:1-15. Epub 2021 Apr 21.

Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece.

Background: Chronic kidney disease (CKD) is often characterized by increased prevalence of cardiovascular risk factors and increased incidence of cardiovascular events and death. Reduced cardiovascular reserve and exercise intolerance are common in patients with CKD and are associated with adverse outcomes.

Summary: The gold standard for identifying exercise limitation is cardiopulmonary exercise testing (CPET). CPET provides an integrative evaluation of cardiovascular, pulmonary, hematopoietic, neuropsychological, and metabolic function during maximal or submaximal exercise. It is useful in clinical setting for differentiation of the causes of exercise intolerance, risk stratification, and assessment of response to relevant treatments. A number of recent studies have used CPET in patients with pre-dialysis CKD, aiming to assess the cardiovascular reserve of these individuals, as well as the effect of interventions such as exercise training programs on their functional capacity. This review provides an in-depth description of CPET methodology and an overview of studies that utilized CPET technology to assess cardiovascular reserve in patients with pre-dialysis CKD. Key Messages: CPET can delineate multisystem changes and offer comprehensive phenotyping of factors determining overall cardiovascular risk. Potential clinical applications of CPET in CKD patients range from objective diagnosis of exercise intolerance to preoperative and long-term risk stratification and providing intermediate endpoints for clinical trials. Future studies should delineate the association of CPET indexes, with cardiovascular and respiratory alterations and hard outcomes in CKD patients, to enhance its diagnostic and prognostic utility in this population.
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http://dx.doi.org/10.1159/000515384DOI Listing
April 2021

Vascular endothelial damage in COPD: current functional assessment methods and future perspectives.

Expert Rev Respir Med 2021 May 4:1-13. Epub 2021 May 4.

Department of Respiratory Medicine, G. Papanikolaou Hospital, Thessaloniki, Greece.

: Cardiovascular disease is a major cause of death in chronic obstructive pulmonary disease (COPD), but the relationship between these two entities is not fully understood; smoking, inflammation, arterial stiffness and endothelial dysfunction are significant determinants. Endothelial dysfunction is not only associated with cardiovascular disease, but also with COPD severity.: Several functional methods have been developed to evaluate endothelial function in healthy and diseased individuals; from the invasive angiography of epicardial coronary arteries and Venous-Occlusion-Plethysmography, to more modern, noninvasive approaches such as Flow-Mediated-Dilatation, Peripheral-Arterial-Tonometry and Near-Infrared-Spectroscopy, all these methods have boosted clinical research in this field. In this context, this narrative review, which included articles published in PubMed and Scopus up to 25-November-2020, summarizes available functional methods for endothelial damage assessment in COPD and discusses existing evidence on their associations with comorbidities and outcomes in this population.: Accumulated evidence suggests that endothelial dysfunction occurs in early stages of CΟPD and worsens with pulmonary obstruction severity and during acute exacerbations. Novel methods evaluating endothelial function offer a detailed, real-time assessment of different parameters related to vascular function and should be increasingly used to shed more light on the role of endothelial damage on cardiovascular and COPD progression.
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http://dx.doi.org/10.1080/17476348.2021.1919089DOI Listing
May 2021

Accuracy of Peridialytic, Intradialytic, and Scheduled Interdialytic Recordings in Detecting Elevated Ambulatory Blood Pressure in Hemodialysis Patients.

Am J Kidney Dis 2021 Apr 12. Epub 2021 Apr 12.

Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Greece.

Rationale And Objective: Current recommendations suggest the use of ambulatory-BP-monitoring (ABPM) as the gold-standard for hypertension diagnosis and management in hemodialysis patients. This study assesses the accuracy of peridialytic, intradialytic, and scheduled interdialytic recordings in detecting abnormally elevated 44-h interdialytic BP.

Study Design: Diagnostic test study.

Settings And Participants: 242 Greek hemodialysis patients who successfully underwent ABPM.

Tests Compared: Ambulatory BP was used as reference to evaluate the accuracy of following BP metrics: pre- and post-dialysis, intradialytic, intradialytic plus pre/post-dialysis, and scheduled interdialytic BP at off-dialysis day at 8:00 am, 8:00 pm, and their average.

Outcome: 44-h ambulatory SBP/DBP ≥130/80 mmHg.

Results: 44-h SBP/DBP levels differed significantly from pre- and post-dialysis BP, but showed no or minor differences compared to the other BP metrics. Bland-Altman plots showed absence of systematic bias for all metrics, but large between-method difference and wider 95% limits of agreement for pre- and post-dialysis BP compared to intradialytic, intradialytic plus pre/post-dialysis and averaged scheduled interdialytic BP. The sensitivity/specificity and κ-statistic for diagnosing 44-h SBP≥130 mmHg were low for pre-dialysis (86.5%/38.6%, κ-statistic=0.27) and post-dialysis BP (63.1%/73.3%, κ-statistic=0.35), but better for intradialytic (77.3%/76.2%, κ-statistic=0.53), intradialytic plus pre/post-dialysis (76.6%/72.3%, κ-statistic=0.49), and scheduled interdialytic BP (87.9%/77.2%, κ-statistic=0.66). In ROC-analyses, the Areas-Under-the-Curve (AUC) of pre-dialysis (AUC 0.723) and post-dialysis SBP (AUC 0.746) were significantly lower than that of intradialytic (AUC 0.850), intradialytic plus pre/post-dialysis (AUC 0.850) and scheduled interdialytic SBP (AUC 0.917) (z-test, p<0.001 for all pairwise comparisons). Similar observations were made for DBP.

Limitations: Typical home BP data were not obtained and no assessment was obtained of reproducibility of examined metrics over time.

Conclusions: Intradialytic, intradialytic plus pre/post-dialysis, and scheduled interdialytic BP measurements were more accurate in detecting elevated 44-h BP than pre- and post-dialysis BP. Averaged intradialytic BP recordings or scheduled readings at the off-dialysis day appear to be promising approaches to the diagnosis of elevated BP in hemodialysis.
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http://dx.doi.org/10.1053/j.ajkd.2021.01.022DOI Listing
April 2021

Vascular endothelial injury assessed with functional techniques in systemic sclerosis patients with pulmonary arterial hypertension versus systemic sclerosis patients without pulmonary arterial hypertension: a systematic review and meta-analysis.

Rheumatol Int 2021 Jun 8;41(6):1045-1053. Epub 2021 Apr 8.

Department of Respiratory Medicine, G. Papanikolaou Hospital, Thessaloniki, Greece.

Microvascular dysfunction is one of the hallmarks of systemic sclerosis (SSc). The presence of pulmonary-arterial-hypertension (PAH) in SSc-patients is associated with poor prognosis. This is a systematic review and meta-analysis of studies assessing microvascular and endothelial injury with functional techniques in SSc-patients with PAH (SSc-PAH) compared to those without PAH (SSc-non-PAH) (PROSPERO: CRD42021236212). Literature search involved PubMed, the-Cochrane-Library, Web-of-Science, Scopus and manual search of article references. Studies assessing microvascular function by all available functional methods were considered eligible. Preclinical studies and studies using structural nailfold-videocapillaroscopy or biomarkers were excluded. Newcastle-Ottawa-Scale (NOS) was applied to evaluate the quality of retrieved studies. From a total of 602 retrieved articles, four studies (n = 159 participants) were included in meta-analysis; three studies were of high quality (NOS ≥ 7). In pooled analysis, a marginally significant impaired microvascular function was observed in SSc-PAH compared to SSc-non-PAH patients [SMD - 0.71, 95% CI (- 1.53, 0.12)], with significant between-study heterogeneity (I = 80%, p = 0.002). Among the studies examining endothelium-dependent and -independent vasodilation with LDF-iontophoresis, SSc-PAH subjects had significantly impaired endothelium-dependent-vasodilation [Ach-stimulated %change WMD - 216.79, 95% CI (- 337.87, - 95.71), I = 0%, p = 0.40], but no significant differences in endothelium-independent-vasodilation [SNP-stimulated %change WMD 90.84, 95% CI (- 82.52, 264.19), I = 44%, p = 0.18] compared with SSc-non-PAH subjects. In sensitivity analysis including only studies where SSc-PAH patients were diagnosed by right-heart-catheterization, a borderline difference between the two groups was noted [SMD - 1.09, 95% CI (- 2.30, 0.13), I = 82%, p = 0.004]. SSc-PAH patients showed marginally impaired microvascular function in the pooled analysis, as well as impaired endothelium-dependent-vasodilation in subgroup analysis compared with SSc-non-PAH patients. Vascular endothelial dysfunction could be involved in high cardiovascular risk of patients with SSc and PAH.
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http://dx.doi.org/10.1007/s00296-021-04850-2DOI Listing
June 2021

Endothelial Dysfunction during Acute Exacerbations of Chronic Obstructive Pulmonary Disease: A Systematic Review and Meta-Analysis.

COPD 2021 Apr 29;18(2):246-253. Epub 2021 Mar 29.

Department of Respiratory Medicine, G. Papanikolaou Hospital, Thessaloniki, Greece.

Chronic obstructive pulmonary disease (COPD) is characterized by high cardiovascular risk, which is further amplified during acute COPD exacerbations (AECOPD). Endothelial dysfunction has been previously suggested as one of the potential pathogenetic mechanisms. In order to study the effects of AECOPD on endothelial function assessed by available functional methods, we performed a literature search involving Pubmed and Scopus databases. Eligible studies were those that included adult patients with COPD and evaluated endothelial damage semi-invasive or noninvasive functional methods, during AECOPD and after recovery or in stable condition. Newcastle-Ottawa Scale was applied to evaluate the quality of retrieved studies. Endothelial function was significantly impaired during AECOPD compared to recovery/stable condition (SMD: -0.87, 95%CI [-1.19, -0.55]). Patients during AECOPD presented a significantly worse response in endothelium-dependent (flow-mediated dilatation WMD: -2.59, 95%CI [-3.75, -1.42]) and independent vasodilation (nitroglycerine-mediated dilatation WMD: -3.13, 95%CI [-5.18, -1.09]) compared to recovery. Sensitivity analyses confirmed the above results. In conclusion, endothelium-dependent and independent vasodilation is worse during AECOPD compared to the stable condition. Endothelial dysfunction could play a role in the high cardiovascular risk during AECOPD.
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http://dx.doi.org/10.1080/15412555.2021.1900094DOI Listing
April 2021

Εndothelial and microvascular function in CKD: Evaluation methods and associations with outcomes.

Eur J Clin Invest 2021 Mar 27:e13557. Epub 2021 Mar 27.

Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece.

Background: Cardiovascular disease is the major cause of morbidity and mortality in patients with chronic kidney disease (CKD). Endothelial dysfunction, the hallmark of atherosclerosis, is suggested to be involved pathogenetically in cardiovascular and renal disease progression in these patients.

Methods: This is a narrative review presenting the techniques and markers used for assessment of microvascular and endothelial function in patients with CKD and discussing findings of the relevant studies on the associations of endothelial dysfunction with co-morbid conditions and outcomes in this population.

Results: Venous Occlusion Plethysmography was the first method to evaluate microvascular function; subsequently, several relevant techniques have been developed and used in patients with CKD, including brachial Flow-Mediated Dilatation, and more recently, Near-Infrared Spectroscopy and Laser Speckle Contrast Analysis. Furthermore, several circulating biomarkers are commonly used in clinical research. Studies assessing endothelial function using the above techniques and biomarkers suggest that endothelial dysfunction occurs early in CKD and contributes to the target organ damage, cardiovascular events, death and progression towards end-stage kidney disease.

Conclusions: Older and newer functional methods and several biomarkers have assessed endothelial dysfunction in CKD; accumulated evidence supports an association of endothelial dysfunction with outcomes. Future research with new, non-invasive and easily applicable methods could further delineate the role of endothelial dysfunction on cardiovascular and renal disease progression in patients with CKD.
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http://dx.doi.org/10.1111/eci.13557DOI Listing
March 2021

Effects of intradialytic exercise on physical performance and cardiopulmonary fitness: promises that need to be confirmed.

Int Urol Nephrol 2021 Jan 1. Epub 2021 Jan 1.

Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece.

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http://dx.doi.org/10.1007/s11255-020-02764-9DOI Listing
January 2021

Assessment of Endothelial and Microvascular Function in CKD: Older and Newer Techniques, Associated Risk Factors, and Relations with Outcomes.

Am J Nephrol 2020 11;51(12):931-949. Epub 2020 Dec 11.

Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece,

Background: Endothelium is the inner cellular lining of the vessels that modulates multiple biological processes including vasomotor tone, permeability, inflammatory responses, hemostasis, and angiogenesis. Endothelial dysfunction, the basis of atherosclerosis, is characterized by an imbalance between endothelium-derived relaxing factors and endothelium-derived contracting factors.

Summary: Starting from the semi-invasive venous occlusion plethysmography, several functional techniques have been developed to evaluate microvascular function and subsequently used in patients with CKD. Flow-mediated dilatation of the forearm is considered to be the "gold standard," while in the last years, novel, noninvasive methods such as laser speckle contrast imaging and near-infrared spectroscopy are scarcely used. Moreover, several circulating biomarkers of endothelial function have been used in studies in CKD patients. This review summarizes available functional methods and biochemical markers for the assessment of endothelial and microvascular function in CKD and discusses existing evidence on their associations with comorbid conditions and outcomes in this population. Key Messages: Accumulated evidence suggests that endothelial dysfunction occurs early in CKD and is associated with target organ damage, progression of renal injury, cardiovascular events, and mortality. Novel methods evaluating microvascular function can offer a detailed, real-time assessment of underlying phenomena and should be increasingly used to shed more light on the role of endothelial dysfunction on cardiovascular and renal disease progression in CKD.
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http://dx.doi.org/10.1159/000512263DOI Listing
December 2020

Dapagliflozin Does Not Affect Short-Term Blood Pressure Variability in Patients With Type 2 Diabetes Mellitus.

Am J Hypertens 2021 04;34(4):404-413

Department of Nephrology, Aristotle University of Thessaloniki, Hippokration Hospital, Thessaloniki, Greece.

Background: Increased blood pressure variability (BPV) is associated with increased cardiovascular and all-cause mortality in patients with type-2 diabetes mellitus (T2DM). Sodium-glucose co-transporter 2 (SGLT-2) inhibitors decrease the incidence of cardiovascular events, renal events, and death in this population. This study aimed to evaluate the effect of dapagliflozin on short-term BPV in patients with T2DM.

Methods: This is a secondary analysis of a double-blind, randomized, placebo-controlled trial in 85 patients with T2DM. Subjects were randomized to dapagliflozin 10 mg/day or placebo for 12 weeks. All participants underwent 24-hour ambulatory blood pressure (BP) monitoring with Mobil-O-Graph-NG device at baseline and study-end. SD, weighted SD (wSD), coefficient of variation, average real variability (ARV), and variation independent of mean were calculated for the 24-hour, daytime and nighttime periods.

Results: Dapagliflozin reduced 24-hour brachial BP compared with placebo. From baseline to study-end 24-hour brachial BPV indexes did not change with dapagliflozin (SBP-ARV: 11.51 ± 3.45 vs. 11.05 ± 3.35; P = 0.326, SBP-wSD: 13.59 ± 3.60 vs. 13.48 ± 3.33; P = 0.811) or placebo (SBP-ARV: 11.47 ± 3.63 vs. 11.05 ± 3.00; P = 0.388, SBP-wSD: 13.85 ± 4.38 vs. 13.97 ± 3.87; P = 0.308). Similarly, no significant changes in BPV indexes for daytime and nighttime were observed in any group. At study-end, no between-group differences were observed for any BPV index. Deltas (Δ) of all indexes during follow-up were minimal and not different between groups (SBP-wSD: dapagliflozin: -0.11 ± 3.05 vs. placebo: 0.12 ± 4.20; P = 0.227).

Conclusions: This study is the first to evaluate the effects of an SGLT-2 inhibitor on short-term BPV in T2DM, showing no effect of dapagliflozin on all BPV indexes studied.

Clinical Trials Registration: Trial Number NCT02887677.
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http://dx.doi.org/10.1093/ajh/hpaa207DOI Listing
April 2021