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Panoulas VF, Nihoyannopoulos P, 2018, Pocket-Size Hand-Held Echocardiography, Echocardiography, Second Edition, Pages: 937-943
Pocket-size hand-held echocardiography (PHE) devices have recently emerged as a new category of miniaturized echo machines. They are relatively cheap, smartphone-size hand-held echo machines with limited technical capabilities. They aim to improve upon physician diagnostic skills rather than provide a tool for a comprehensive diagnostic echocardiographic examination. They are often used in both emergency and outpatient clinic settings, leading physicians to correct differential diagnoses and treatment pathways. With the exception of cardiologists who are certified for transthoracic echocardiography according to national legislation, specific training and certification is recommended by European and American guidelines for all other users, to avoid misuse and misinterpretation of the findings of PHE. The length and the duration of training, however, remains a matter of debate. In the current chapter we discuss the history, technical characteristics and use of PHE with examples taken from real-life scenarios.
Dawson D, Nihoyannopoulos P, 2018, Pulmonary Embolism, Echocardiography, Second Edition, Pages: 397-412, ISBN: 9783319716152
The right ventricle (RV) has a complex anatomy: it is the most anteriorly positioned cardiac chamber, directly behind the sternum and it marks the inferior border of the heart. It is anatomically subdivided into three components: the inflow tract (sinus), which includes the tricuspid valve (TV), the outflow tract (infundibulum or conus) which represents the smooth outflow region, separated from the inflow tract by crista supraventricularis and the highly trabeculated apical portion.
Kamperidis V, Nihoyannopoulos P, Bax JJ, et al., 2018, Assessing the Right Ventricle, Echocardiography, Second Edition, Pages: 373-395, ISBN: 9783319716152
The complex 3-dimensional (3D) anatomy of the right ventricle (RV) has challenged the assessment of the dimensions and function of this cardiac chamber for years. Using 2-dimensional (2D) echocardiography, multiple views from different angles are needed to comprehensively assess all the segments of the RV. Further advances in tissue Doppler and strain imaging have provided several functional parameters of the RV that are associated with prognosis in different clinical scenarios (from acute myocardial infarction to pulmonary arterial hypertension and congenital heart disease). However, the advent of 3D imaging techniques has unveiled the true shape of the RV and has permitted global and segmental analysis of the RV function. In this chapter, the anatomy of the RV and how to assess its dimensions and function using echocardiographic techniques will be reviewed.
Papadopoulos CH, Oikonomidis D, Lazaris E, et al., 2018, Echocardiography and cardiac arrhythmias., Hellenic J Cardiol, Vol: 59, Pages: 140-149
Cardiac arrhythmias refer to any abnormality or disturbance in the normal activation sequence of the myocardium and may be indicative of structural heart disease and the cause of significant cardiovascular complications and sudden cardiac death. The following review summarizes the current state-of-the-art knowledge on the role of echocardiography in the management of cardiac arrhythmias and focuses on atrial fibrillation and ventricular arrhythmias where echocardiography presents a particular diagnostic and prognostic interest. Moreover, a brief reference is made to the effect of cardiac arrhythmias and conduction abnormalities on echocardiographic examination.
Katsi V, Kallistratos MS, Kontoangelos K, et al., 2017, Arterial hypertension and health-related quality of life, Frontiers in Psychiatry, Vol: 8
© 2017 Katsi, Kallistratos, Kontoangelos, Sakkas, Souliotis, Tsioufis, Nihoyannopoulos, Papadimitriou and Tousoulis. Purpose: To investigate the effect of awareness of arterial hypertension on quality of life in hypertensive patients in Greece. Materials and methods: This was a prospective observational study that included 189 aware hypertensive patients on treatment with antihypertensive therapy. Patients were ambulatory men or women =18 years old, with diagnosed essential hypertension. The administration and fulfillment of the questionnaires was given at the outpatient hypertensive clinic starting with the SF-36 and continuing with the BDI-I test. Results: The mean BDI score was 9.9 ± 6.9, and 58, 25, 8.9, and 7.3% were identified as without, with minimal, moderate, and 0.8% with severe depression, respectively. The mean score for physical component summary (PCS-36) was 48.9 ± 7.6, and the mean score for mental component summary (MCS-36) was 46.0 ± 10.6. The stage of hypertension was not an independent predictor for any of the SF-36 dimensions. Dippers had not different levels of health-related quality of life (HRQOL) as compared with non-dippers. LV hypertrophy was associated with lower scores on bodily pain (p < 0.05) and kidney failure was associated with lower scores on general health perception (p < 0.05). Female gender, increased age, and the presence of COPD were independently associated with lower physical and mental health scores (p < 0.05). Score on BDI independently correlated with all dimensions of SF-36, indicating that greater depression levels are associated with lower levels of HRQOL. Conclusion: The stage as well as awareness of arterial hypertension does not affect physical and mental health. The fact that arterial hypertension per se is not a symptomatic disease may explain these results at least in patients with uncomplicated hypertension.
Ringle A, Dornhorst A, Rehman MB, et al., 2017, Evolution of subclinical myocardial dysfunction detected by two-dimensional and three-dimensional speckle tracking in asymptomatic type 1 diabetic patients: a long-term follow-up study, Echo Research and Practice, Vol: 4, Pages: 73-81, ISSN: 2055-0464
Background We sought to assess the long-term evolution of left ventricular (LV) function using two-dimensional (2D) and three-dimensional (3D) speckle tracking echocardiography (STE) for the detection of preclinical diabetic cardiomyopathy, in asymptomatic type 1 diabetic patients, over a 6-year follow-up.Design and methods Sixty-six asymptomatic type 1 diabetic patients with no cardiovascular risk factors were compared to 26 matched healthy controls. Conventional, 2D and 3D-STE were performed at baseline. A subgroup of 14 patients underwent a 6-year follow-up evaluation.Results At baseline, diabetic patients had similar LV ejection fraction (60 vs 61%; P = NS), but impaired longitudinal function, as assessed by 2D-global longitudinal strain (GLS) (−18.9 ± 2 vs −20.5 ± 2; P = 0.0002) and 3D-GLS (−17.5 ± 2 vs −19 ± 2; P = 0.003). At follow-up, diabetic patients had worsened longitudinal function compared to baseline (2D-GLS: −18.4 ± 1 vs −19.2 ± 1; P = 0.03). Global circumferential (GCS) and radial (GRS) strains were unchanged at baseline and during follow-up. Metabolic status did not correlate with GLS, whereas GCS and GRS showed a good correlation, suggestive of a compensatory increase of circumferential and radial functions in advanced stages of the disease – long-term diabetes (GCS: −26 ± 3 vs −23.3 ± 3; P = 0.008) and in the presence of microvascular complications (GRS: 38.8 ± 9 vs 34.3 ± 8; P = 0.04).Conclusions Subclinical myocardial dysfunction can be detected by 2D and 3D-STE in type 1 diabetic patients, independently of any other cardiovascular risk factors. Diabetic cardiomyopathy progression was suggested by a mil
Diaz-Navarro R, Nihoyannopoulos P, 2017, Post-myocardial infarction left ventricular pseudoaneurysm diagnosed incidentally by echocardiography, Echo Research and Practice, Vol: 4, Pages: K37-K40, ISSN: 2055-0464
A 54-year-old male developed a left ventricular pseudoaneurysm (Ps) along the lateral wall of the left ventricle (LV), which was diagnosed incidentally by two-dimensional transthoracic echocardiography (2DTTE) 6 months after an acute myocardial infarction. Color flow imaging (CFI) showed blood flow from the LV into the aneurysmal cavity and invasive coronary angiography revealed sub-occlusion of the circumflex artery. A complementary study using cardiovascular magnetic resonance (CMR) confirmed a dilated left ventricle with depressed ejection fraction, thin dyskinetic anterolateral and inferolateral walls, a Ps adjacent to the lateral wall of the LV contained by the pericardium and blood passing in and out through a small defect in the LV mid-anterolateral wall. Late gadolinium-enhanced imaging demonstrated transmural myocardial infarction in the lateral wall and delayed enhancement of the pericardium, which formed the walls of the Ps. A conservative approach was adopted in this case, optimizing the patient’s heart failure medications, including cardioselective beta-blocker agents, angiotensin-converting enzyme inhibitors, spironolactone and chronic anticoagulation therapy because of a high risk of ischemic stroke in these patients. At the 13-month follow-up, the patient remained stable with New York Heart Association class II heart failure. In conclusion, 2DTTE and CFI seem to be suitable initial methods for diagnosing Ps of the LV, but CMR is an excellent complementary method for characterizing further this cardiac entity. Furthermore, the long-term outcome of patients with Ps of the LV who are treated medically appears to be relatively benign.
Katsi V, Georgiopoulos G, Laina A, et al., 2017, Left ventricular ejection fraction as therapeutic target: is it the ideal marker?, Heart Fail Rev, Vol: 22, Pages: 641-655
Heart failure (HF) consists the fastest growing clinical cardiac disease. HF patients are categorized on the basis of underlying left ventricular ejection fraction (LVEF) into HF with preserved EF (HFpEF), reduced LVEF (HFrEF), and mid-range LVEF (HFmrEF). While LVEF is the most commonly used surrogate marker of left ventricular (LV) systolic function, the implementation of two-dimensional echocardiography in estimating this parameter imposes certain caveats on current HF classification. Most importantly, LVEF could fluctuate in repeated measurements or even recover after treatment, thus blunting the borders between proposed categories of HF and enabling upward classification of patients. Under this prism, we sought to summarize possible procedures to improve systolic function in patients with HFrEF either naturally or by the means of pharmacologic and non-pharmacologic treatment and devices. Therefore, we reviewed established pharmacotherapy, including beta-blockers, inhibitors of renin-angiotensin-aldosterone axis, statins, and digoxin as well as novel treatments like sacubitril-valsartan, ranolazine, and ivabradine. In addition, we assessed evidence in favor of cardiac resynchronization therapy and exercise training programs. Finally, innovative therapeutic strategies, including stem cells, xanthine oxidase inhibitors, antibiotic regimens, and omega-3 polyunsaturated fatty acids, were also taken into consideration. We concluded that LVEF is subject to changes in HF after intervention and besides the aforementioned HFrEF, HFpEF, and HFmrEF categories, a new entity of HF patients with recovered LVEF should be acknowledged. An improved global and refined LV function assessment by sophisticated imaging modalities and circulating biomarkers is expected to render HF classification more accurate and indicate patients with viable-yet dysfunctional-myocardium and favorable characteristics as the ideal candidates for LVEF recovery by individualized HF therapy.
Senior R, Becher H, Monaghan M, et al., 2017, Clinical practice of contrast echocardiography: recommendation by the European Association of Cardiovascular Imaging (EACVI) 2017, EUROPEAN HEART JOURNAL-CARDIOVASCULAR IMAGING, Vol: 18, Pages: 1205-+, ISSN: 2047-2404
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Keramida K, Bingcang J, Wensel R, et al., 2017, The effect of anti-HER2 therapy in biventricular deformation mechanics, ESC annual meeting, Publisher: OXFORD UNIV PRESS, Pages: 1305-1305, ISSN: 0195-668X
Katsi V, Georgiopoulos G, Marketou M, et al., 2017, Atrial fibrillation in pregnancy: a growing challenge., Curr Med Res Opin, Vol: 33, Pages: 1497-1504
BACKGROUND: Atrial fibrillation (AF) constitutes a relatively infrequent pregnancy complication, which may be a therapeutic Gordian knot. Indeed, sparse data exist regarding the prevalence, prognosis, and management of AF during pregnancy. In general, AF occurs as a benign, self-limited arrhythmia, but occasionally may have severe hemodynamic consequences in pregnant patients suffering from heart failure, congenital heart disease, or other comorbidities. Extra-cardiac causes of AF should always be meticulously excluded. REVIEW: Treatment decisions are difficult, since medications may cross the placental barrier and potentially affect fetal growth and organogenesis, or even result in fetal bradyarrhythmias. Treatment goals are not differentiated in comparison to those regarding AF occurring in the general population. Still, while maternal treatment is prioritized, issues regarding fetal health must deliberately be considered. Consequently, hemodynamic instability is to be promptly treated with synchronized electrical cardioversion. In contrast, in stable patients, pharmacologic cardioversion, under appropriate antithrombotic regimen, should be attempted. Selection of appropriate antithrombotic therapy, including novel oral anticoagulants, imposes further difficulties on therapeutic decision-making. Further clinical trials are warranted in order to assess the pathophysiology and prognosis of AF in pregnancy and ameliorate the evidence-based therapeutic strategy in this specific group of the population.
Kadoglou NPE, Biddulph JP, Rafnsson SB, et al., 2017, The association of ferritin with cardiovascular and all-cause mortality in community-dwellers: The English longitudinal study of ageing, PLOS ONE, Vol: 12, ISSN: 1932-6203
Background:Ferritin constitutes a sensitive iron-storage index and multi-functional protein. Evidence on its association with mortality in general population is scarce and conflicting. We investigated the sex-specific associations of ferritin levels with all-cause and cardiovascular mortality in a population-based cohort.Methods:Data came from the English Longitudinal Study of Ageing and the national mortality registry. The sample comprised 5,471 participants aged ≥52 years. Blood concentration of ferritin was measured at baseline in 2004–05. Sex-specific Cox proportional hazards models were estimated with adjustment for age, major chronic diseases, marital status, educational attainment, total net household wealth, anemia, inflammatory markers, body mass index, smoking, and physical activity. Stratified analyses by chronic disease status were also performed.Results:We categorized ferritin in sex-specific quartiles. In men, we used, the following categorization: lowest (2-69ng/ml), second lowest (70-118ng/ml), second highest (reference category) (119-193ng/ml) and highest (194-598ng/ml) ferritin quartiles. In women, ferritin was categorized as follows: lowest (2-44ng/ml), second lowest (45-73ng/ml), second highest (reference category) (74-115ng/ml) and highest (116-341ng/ml) ferritin quartiles. 841 deaths of which 262 cardiovascular disease-related were recorded over a mean follow-up time of 7.7 years. Risk for all-cause mortality was found increased in men with hyperferritinemia (194-598ng/ml) and no history of major chronic diseases compared with the reference group [fully-adjusted HR: 1.49 (95%CI 1.03–2.16)]. Among women, those in the lowest ferritin quartile (2-44ng/ml) had increased risk for all-cause mortality [fully-adjusted HR: 1.59 (95%CI 1.18–2.13)] compared with the reference group after adjustment for all covariates. Regarding cardiovascular mortality, we observed a positive association with ferritin levels in men, which was blunted
Katsi V, Georgountzos G, Kallistratos MS, et al., 2017, The role of statins in prevention of preeclampsia: A promise for the future?, Frontiers in Pharmacology, Vol: 8
© 2017 Katsi, Georgountzos, Kallistratos, Zerdes, Makris, Manolis, Nihoyannopoulos and Tousoulis. Preeclampsia has been linked to high morbidity and mortality during pregnancy. However, no efficient pharmacological options for the prevention of this condition are currently available. Preeclampsia is thought to share several pathophysiologic mechanisms with cardiovascular disease, which has led to investigations for the potential role of statins (HMG CoA reductase inhibitors) in its prevention and early management. Pravastatin seems to have a safer pharmacokinetic profile compared to other statins, however, the existing preclinical evidence for its effectiveness in preeclampsia treatment has been mostly restricted to animal models. This review aims to summarize the current data and delineate the potential future role of statins in the prevention and management of preeclampsia.
Keramida K, Bingcang J, Wensel R, et al., 2017, Assessment of trastuzumab effect on both ventricles by 2D speckle tracking analysis, European Heart failure meeting, Publisher: WILEY, Pages: 261-261, ISSN: 1388-9842
Bechman K, Gopalan D, Nihoyannopoulos P, et al., 2017, A cohort study reveals myocarditis to be a rare and life-threatening presentation of large vessel vasculitis, Seminars in Arthritis and Rheumatism, Vol: 47, Pages: 241-246, ISSN: 1532-866X
BackgroundThe predominant forms of adult large vessel vasculitis (LVV) are giant cell arteritis (GCA) and Takayasu arteritis (TA). Cardiac involvement in LVV is a cause of morbidity and mortality, particularly in TA. Cardiac failure is most commonly secondary to uncontrolled arterial hypertension or myocardial ischaemia. Pulmonary hypertension and aortic valve incompetence following ascending aortic dilatation represent other serious cardiovascular complications. However, cardiac failure as a consequence of myocarditis is rarely reported, principally in single case reports or in autopsy studies.MethodsThe Imperial College LVV database was, retrospectively, reviewed to identify patients with cardiac involvement at presentation. Patients with evidence for myocarditis were identified. The cardiac presentation, imaging studies and subsequent medical and surgical management were reviewed in detail.ResultsThe cohort included 139 patients with TA and 24 with GCA. Sixteen presented with cardiac failure without a history of ischaemic coronary heart disease, 14 (10%) with TA and 2 (8.3%) with GCA. Cardiovascular disease identified at presentation included aortic regurgitation (n = 11), myocarditis (n = 4) and hypertensive cardiomyopathy secondary to renal artery stenosis (n = 1). Those patients with evidence of myocarditis at presentation (2.8%) underwent transthoracic echocardiography and cardiac magnetic resonance imaging (CMR). These non-invasive techniques were sufficient for diagnosis of clinically significant myocarditis. Furthermore, they were subsequently used to monitor response to treatment, with serial improvement in left ventricular ejection fraction (LVEF) observed in all 4 patients (p < 0.05). Prednisolone plus cyclophosphamide (CyC) therapy was associated with significant improvement in heart failure symptoms and LVEF in 3 cases. In one case where CyC was contraindicated, tocilizumab treatment led to marked improvement in cardiac symptoms.ConclusionClinicall
Colclough A, Nihoyannopoulos P, 2017, Pocket-sized point-of-care cardiac ultrasound devices Role in the emergency department, HERZ, Vol: 42, Pages: 255-261, ISSN: 0340-9937
Sulemane S, Panoulas VF, Nihoyannopoulos P, 2017, Echocardiographic assessment in patients with chronic kidney disease: Current update, ECHOCARDIOGRAPHY-A JOURNAL OF CARDIOVASCULAR ULTRASOUND AND ALLIED TECHNIQUES, Vol: 34, Pages: 594-602, ISSN: 0742-2822
Rehman MB, Howard LS, Christiaens LP, et al., 2017, Resting right ventricular function is associated with exercise performance in PAH, but not in CTEPH., Eur Heart J Cardiovasc Imaging
Aims: To assess whether resting right ventricular (RV) function assessed by Global RV longitudinal strain (RVLS) and RV fractional area change (FAC) is associated with exercise performance in pulmonary arterial hypertension (PAH) and in chronic thromboembolic pulmonary hypertension (CTEPH). Methods and results: We prospectively recruited 46 consecutive patients with PAH and 42 patients with CTEPH who were referred for cardio-pulmonary exercise testing (CPET) and transthoracic echocardiography. Resting RV systolic function was assessed with RVLS and FAC. CPET parameters analyzed were percentage of predicted maximal oxygen consumption (VO2max) and the slope of ventilation against carbon dioxide production (VE/VCO2). Spearman correlation was performed between echocardiographic measurements and CPET measurements. In PAH, spearman correlation found an association between RVLS and VE/VCO2 (coefficient = 0.556, P < 0.001) and percentage predicted VO2max (coefficient = -0.393, P = 0.007), while FAC was associated with VE/VCO2 (coefficient = -0.481, P = 0.001) and percentage of predicted VO2max (coefficient = 0.356, P = 0.015). Conversely, in CTEPH, resting RV function was neither associated with percentage of predicted VO2max nor with VE/VCO2, whether assessed by RVLS or FAC. Conclusion: In PAH, resting RV function as assessed by FAC or RVLS is associated with exercise performance and could therefore make a significant contribution to non-invasive assessment in PAH patients. This association is not found in CTEPH, suggesting a disconnection between resting RV function and exercise performance, with implications for the use of exercise measurements as a prognostic marker and clinical/research endpoint in CTEPH.
Steeds RP, Garbi M, Cardim N, et al., 2017, EACVI appropriateness criteria for the use of transthoracic echocardiography in adults: a report of literature and current practice review., Eur Heart J Cardiovasc Imaging
The European Association for Cardiovascular Imaging (EACVI) has outlined the rationale for setting appropriate use criteria (AUC) in cardiovascular (CV) imaging. Transthoracic echocardiography (TTE) is the most common imaging modality in CV disease and is a central tool in diagnosis, follow-up, management planning and intervention. The purpose of AUC is to inform referrers, both to avoid under-use, which may result in incomplete or incorrect diagnosis and treatment, and also over-use, which may delay correct diagnosis, lead to 'treatment cascade', and wastes resources. The first step in defining AUC for TTE in the adult has been for a panel of experts in echocardiography to review the evidence, guidelines, recommendations, and position papers from the European Society of Cardiology, EACVI and other specialist societies, and current state-of-the-art clinical practice. The attached document summarizes this work, which will be used to under-pin the development of AUC.
Sulemane S, Panoulas VF, Bratsas A, et al., 2017, Subclinical markers of cardiovascular disease predict adverse outcomes in chronic kidney disease patients with normal left ventricular ejection fraction, INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING, Vol: 33, Pages: 687-698, ISSN: 1569-5794
Emerging cardiovascular biomarkers, such as speckle tracking echocardiography (STE) and aortic pulse wave velocity (aPWV), have recently demonstrated the presence of subclinical left ventricular dysfunction and arterial stiffening in patients with chronic kidney disease (CKD) and no previous cardiovascular history. However, limited information exists on the prognostic impact of these biomarkers. We aimed to investigate whether STE and aPWV predict major adverse cardiac events (MACE) in this patient population. In this cohort study we prospectively analysed 106 CKD patients with no overt cardiovascular disease (CVD) and normal left ventricular ejection fraction. Cardiac deformation was measured using STE while aPWV was measured using arterial tonometry. The primary end-point was the composite of all-cause mortality, acute coronary syndrome, stable angina requiring revascularization (either using percutaneous coronary intervention or coronary artery bypass surgery), hospitalization for heart failure and stroke. Over a median follow up period of 49 months (interquartile range 11–63 months), 26 patients (24.5%) reached the primary endpoint. In a multivariable Cox hazards model, global longitudinal strain (GLS) (HR 1.12, 95% CI 1.02–1.29, p = 0.041) and aPWV (HR 1.31, 95% CI 1.05–1.41, p = 0.021) were significant, independent predictors of MACE. GLS and aPWV independently predict MACE in CKD patients with normal EF and no clinically overt CVD.
Varounis C, Katsi V, Nihoyannopoulos P, et al., 2017, Cardiovascular Hypertensive Crisis: Recent Evidence and Review of the Literature, Frontiers in Cardiovascular Medicine, Vol: 3
Despite the high prevalence of hypertension (HTN), only a small proportion of the hypertensive patients will ultimately develop hypertensive crisis. In fact, some patients with hypertensive crisis do not report a history of HTN or previous use of antihypertensive medication. The majority of the patients with hypertensive crisis often report non-specific symptoms, whereas heart-related symptoms (dyspnea, chest pain, arrhythmias, and syncope) are less common. Hypertensive crises can be divided into hypertensive emergencies or hypertensive urgencies according to the presence or absence of acute target organ damage, respectively. This differentiation is an extremely useful classification in clinical practice since a different management is needed, which in turn has a significant effect on the morbidity and mortality of these patients. Therefore, it is very crucial for the physician in the emergency department to identify the hypertensive emergencies and to manage them through blood pressure lowering medications in order to avoid further target organ damage or deterioration. The aim of this narrative review is to summarize the recent evidence in an effort to improve the awareness, recognition, risk stratification, and treatment of hypertensive crisis in patients referred to the emergency department.
Toutouzas K, Klettas D, Anousakis-Vlachochristou N, et al., 2017, The -174 G>C Interleukin-6 Gene Polymorphism is Associated with Angiographic Progression of Coronary Artery Disease over a 4-Year Period., Hellenic J Cardiol, Vol: 58, Pages: 80-86
BACKGROUND: Inflammation is a key process underlying the clinical course of coronary artery disease (CAD). C-reactive protein (CRP) and interleukin-6 (IL-6) contribute to its pathophysiology and act as biomarkers. We sought to examine whether known single nucleotide polymorphisms (SNPs) impact CAD progression, reflecting increased inflammation. METHODS: We retrospectively evaluated coronary angiographies of patients with established CAD who were re-investigated for stable/unstable angina after a time interval of >12 months. We defined progression of CAD as the emergence of a new plaque or a ≥20 % increase of a formerly non-significant lesion. We genotyped patients for the 1846 C>T CRP and -174 G>C IL-6 SNPs. The probability of CAD progression among the Mendelian randomization groups was evaluated using the Kaplan-Meier method. Data were analyzed using a Cox model that included relevant clinical factors. RESULTS: A total of 157 patients were included. The serum levels of CRP and IL-6 differed significantly between genotypes. The genotype frequencies of IL-6 were consistent with Hardy-Weinberg equilibrium, whereas those for CRP were excluded from our conclusions. At 48 months, 83 patients (52.9 %) with the IL-6 C allele versus 74 (47.1 %) with the G allele exhibited CAD progression. Patients with the IL-6 C allele had a 52.8 % probability for progression versus 13.3 % for those with the G allele (p=0.005). The results were confirmed by multivariate analysis; dyslipidemia, family history, and IL-6 SNP emerged as significant factors. CONCLUSION: Patients with established CAD who carried the -174 C allele of the IL-6 gene demonstrated an increased risk for the progression of coronary plaques over a four-year period. Further studies will be needed to validate these findings.
Katsi V, Georgiopoulos G, Vogiatzi G, et al., 2017, Effects of Oral and Non-Insulin Injectable Antidiabetic Treatment in Hypertension: A Systematic Review., Curr Pharm Des, Vol: 23, Pages: 3743-3750
BACKGROUND: Diabetes mellitus type 2 (T2DM) often co-exists with hypertension, and this aggregation of co-morbidities amplifies the risk for future cardiovascular events. Therefore, it appears crucial to understand the essence of choosing oral and non-insulin injectable anti-diabetic drugs (ADs) with a favorable hemodynamic impact that could partially attenuate the increased baseline cardiovascular risk. OBJECTIVE: We sought to evaluate the effect of ADs on blood pressure (BP) indices and to assess the potential role of certain ADs towards hypertension treatment. METHOD: We performed a systematic review of the literature searching MEDLINE via Pubmed for all human studies implementing ADs, either individually or in combinations. RESULTS: Metformin was found to reduce BP in small cohorts but failed to confirm its beneficial effect in a metaanalysis of 41 studies. Thiazolidinediones are associated with BP lowering but are contraindicated in patients with heart failure. Sulfonylureas, on the other hand, may increase BP, while a-glucosidase inhibitors, DPP-4 inhibitors, and SGLT2 inhibitors activate favorable pathophysiologic mechanisms serving as potential BP lowering agents. Relevant BP reduction was established for GLP-1 Ras in most clinical trials. CONCLUSION: The favorable hemodynamic impact of certain classes of ADs might provide synergistic or incremental therapeutic benefits in high-risk patients suffering from both T2DM and hypertension. Additional randomized trials designed under the hypothesis of the emerging beneficial hemodynamic effect of ADs are expected to provide more robust evidence and to guide the optimization of combined treatment strategies in this challenging group of patients.
Ponikowski ADGDTP, Voors AA, Anker SD, et al., 2016, 2016 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure, Revista Espanola de Cardiologia, Vol: 69, Pages: 1167.-1167., ISSN: 0300-8932
Ponikowski P, Voors AA, Anker SD, et al., 2016, 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure, European Heart Journal, Vol: 37, Pages: 2129-2200, ISSN: 1522-9645
Panoulas VF, Ruparelia N, Franks R, et al., 2016, The Impact of Gender on Outcomes Following Transcatheter Aortic Valve Implantation: True Effect or Bias?, J Heart Valve Dis, Vol: 25, Pages: 552-556, ISSN: 0966-8519
Transcatheter aortic valve implantation (TAVI) is currently the treatment of choice for patients with severe aortic stenosis (AS) who are unsuitable for surgical aortic valve replacement (SAVR), and is an acceptable alternative for those at high and intermediate surgical risk. In published TAVI registries and meta-analyses, whilst women are significantly older they present with fewer comorbidities compared to men (including coronary artery disease, peripheral vascular disease, diabetes and chronic obstructive pulmonary disease). In response to chronic pressure overload from AS, women have been shown to develop greater levels of left ventricular hypertrophy than men, as well as having a greater preservation of LV ejection fraction (LVEF) and less fibrosis. Following aortic valve replacement, women have been shown to have a faster regression of myocardial hypertrophy, with a significant improvement in LVEF. Following TAVI, female gender seems to be associated with a significantly lower one-year mortality. In the current viewpoint, it is discussed whether these findings reflect a true differential treatment response to TAVI among women, or simply the higher comorbidity burden among males undergoing TAVI.
Zamorano JL, Lancellotti P, Rodriguez Muñoz D, et al., 2016, 2016 ESC Position Paper on cancer treatments and cardiovascular toxicity developed under the auspices of the ESC Committee for Practice Guidelines: The Task Force for cancer treatments and cardiovascular toxicity of the European Society of Cardiology (ESC), European Journal of Heart Failure, Vol: 19, Pages: 9-42, ISSN: 1879-0844
Zamorano JL, Lancellotti P, Rodriguez Muñoz D, et al., 2016, 2016 ESC Position Paper on cancer treatments and cardiovascular toxicity developed under the auspices of the ESC Committee for Practice Guidelines: The Task Force for cancer treatments and cardiovascular toxicity of the European Society of Cardiology (ESC), European Heart Journal, Vol: 37, Pages: 2768-2801, ISSN: 1522-9645
Panoulas V, Thyregod HG, Nihoyannopoulos P, et al., 2016, Increased survival of females with severe aortic stenosis after transcatheter aortic valve implantation compared to surgical aortic valve replacement; a meta-analysis of randomised controlled studies, Congress of the European-Society-of-Cardiology (ESC), Publisher: OXFORD UNIV PRESS, Pages: 72-72, ISSN: 0195-668X
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