2024-03-28T19:30:42Z
http://www.rhythmos.gr/index.php/Rhythmos/oai
oai:ojs.rhythmos.gr:article/6
2013-07-14T09:35:00Z
Rhythmos:CRDN
driver
"060101 2006 eng "
1792-7927
1792-7919
dc
Ηλεκτροφυσιολογικά / Βηματοδοτικά Νέα
Manolis, Antonis S
Athens University School of Medicine &
First Department of Cardiology, Evagelismos General Hospital of Athens, Athens, Greece
Το Σεμινάριο των Ομάδων Εργασίας της ΕΚΕ θα γίνει στη Θεσσαλονίκη στις 16-18/2/06
Το ετήσιο Συνέδριο του ACC θα γίνει στην Ατλάντα στις 11-14/3/06
Το “Cardiology Update 2006”, Διεθνές Συνέδριο Καρδιολογίας του Γ.Ν. Αθηνών «Ο Ευαγγελισμός», θα γίνει στις 13-15 Απριλίου 2006, στην Αθήνα (Ξενοδοχείο Caravel) (http://users.otenet.gr/~asm/)
Το ετήσιο Συνέδριο της HRS θα γίνει στη Βοστώνη στις 17-20/5/06
Το Cardiostim 2006 θα γίνει στη Νίκαια στις 14-17/6/06
Το Συνέδριο της ESC θα γίνει στη Βαρκελώνη στις 2-6/9/06
Το Πανελλήνιο Καρδιολογικό Συνέδριο θα γίνει στην Αθήνα στις 2-4/11/06
Το Συνέδριο του AHA θα γίνει στο Chicago στις 12-15/11/06
Τριετής έκβαση του καρδιακού επανασυγχρονισμού: η Σουηδική εμπειρία & τα προβλήματα
Στο νοσ/μείο Karolinska σε 40 ασθενείς με ένδειξη για αμφικοιλιακή βηματοδότηση (1998-2000), η εμφύτευση ήταν επιτυχής στους 35 (88%). Ανταποκρίθηκαν οι 23 (66%) στους 6 μήνες. Επιβίωσαν στα 3 χρόνια 23 (66%) (5 αιφνίδιοι θάνατοι-14%). Η κλινική κατάσταση (κατά NYHA) και η 6λεπτη βάδιση βελτιώθηκαν σημαντικά στους 6 μήνες και συνέχισαν να βελτιώνονται βαθμιαία στα 3 χρόνια, ενώ η ποιότητα ζωής βελτιωθείσα στους 6 μήνες παρέμεινε βελτιωμένη στα 3 χρόνια. Σε 6 (17%) απο τους 35 ασθενείς χρειάστηκε επανεγχείρηση για μετακίνηση ηλεκτροδίου (ν=4) ή υψηλό ουδό (ν=2) ή πρώϊμη εξάντληση γεννήτριας (ν=2) (Stahlberg et al, PACE 2005, 28:1013)... (excerpt)
Athens University School of Medicine
2013-07-14 12:35:00
application/pdf
http://www.rhythmos.gr/index.php/Rhythmos/article/view/6
Rhythmos; Vol. 1 No. 1 (2006)
eng
Copyright (c) 2015 Rhythmos
oai:ojs.rhythmos.gr:article/11
2013-07-14T10:13:07Z
Rhythmos:CRDN
driver
"060401 2006 eng "
1792-7927
1792-7919
dc
Ηλεκτροφυσιολογικά / Βηματοδοτικά Νέα
Manolis, Antonis S
Athens University School of Medicine &
First Department of Cardiology, Evagelismos General Hospital of Athens, Athens, Greece
Το “Cardiology Update 2006”, Διεθνές Συνέδριο Καρδιολογίας του Γ.Ν. Αθηνών «Ο Ευαγγελισμός», θα γίνει στις 13 -15 Απριλίου 2006, στην Αθήνα (Ξενοδοχείο Caravel) (http://users.otenet.gr/~asm/)
Το ετήσιο Συνέδριο της Heart Rhythm Society θα γίνει στη Βοστώνη στις 17-20/5/06
Το Cardiostim 2006 θα γίνει στη Νίκαια στις 14-17/6/06
Το Συνέδριο της ESC θα γίνει στη Βαρκελώνη στις 2-6/9/06
Το Πανελλήνιο καρδιολογικό Συνέδριο θα γίνει στην Αθήνα στις 2-4/11/06
Το Συνέδριο του AHA θα γίνει στο Chicago στις 12-15/11/06
Αποτελεσματική η διαδερμική αφαίρεση μολυσμένων ηλεκτροδίων ακόμη και παρουσία μεγάλων (> 1 cm) εκβλαστήσεων
Σε 53 ασθενείς με μεγάλες (> 1cm) εκβλαστήσεις ηλεκτροδίων, η αφαίρεση έγινε με διαδερμική προσέγγιση σε 30 και χειρουργικά σε 23 ασθενείς. Η διαδερμική τεχνική ήταν επιτυχής στους 29 χωρίς περαιτέρω επιπλοκές, ενώ 1 υποβλήθηκε σε εγχείρηση λόγω ρήξης του ηλεκτροδίου. Αντίθετα η περι-εγχειρητική θνητότητα στη χειρουργική ομάδα ανήλθε στο 5.7% (3 ασθενείς) (Ruttmann et al, PACE 2006, 29:231)... (excerpt)
Athens University School of Medicine
2013-07-14 13:13:07
application/pdf
http://www.rhythmos.gr/index.php/Rhythmos/article/view/11
Rhythmos; Vol. 1 No. 2 (2006)
ell
Copyright (c) 2015 Rhythmos
oai:ojs.rhythmos.gr:article/15
2013-07-14T11:26:55Z
Rhythmos:CRDN
driver
"060701 2006 eng "
1792-7927
1792-7919
dc
Ηλεκτροφυσιολογικά / Βηματοδοτικά Νέα
Manolis, Antonis S
Athens University School of Medicine &
First Department of Cardiology, Evagelismos General Hospital of Athens, Athens, Greece
Το Συνέδριο της ESC θα γίνει στη Βαρκελώνη στις 2-6/9/06
Το Πανελλήνιο Kαρδιολογικό Συνέδριο θα γίνει στην Αθήνα στις 2-4/11/06
Το Συνέδριο του AHA θα γίνει στο Chicago στις 12-15/11/06
Το Συνέδριο του ACC θα γίνει στη Ν. Ορλεάνη στις 24-27/3/07
Το “Cardiology Update 2008”, Διεθνές Συνέδριο Καρδιολογίας του Γ.Ν. Αθηνών «Ο Ευαγγελισμός», θα γίνει στις 17-19 Απριλίου 2008, στην Αθήνα (Ξενοδοχείο Caravel) (http://users.otenet.gr/~asm/)
Το Ιχθυέλαιο Τελικά δεν Προστατεύει από τις Κοιλιακές Ταχυαρρυθμίες (Μελέτη SOFA)
Συνολικά 546 ασθενείς με εμφυτευμένο απινιδωτή τυχαιοποιήθηκαν σε λήψη 2 g ημερησίως ιχθυελαίου (ν=273) ή placebo (ν=273) για διάμεση περίοδο περίπου 1 έτους. Το πρωτοπαθές καταληκτικό σημείο (δόκιμη θεραπεία απινιδωτού για κοιλιακή αρρυθμία ή θάνατος) επήλθε στο 30% και 33% αντίστοιχα (p=0.33) (Brouwer et al, JAMA 2006;295:2613)... (excerpt)
Athens University School of Medicine
2013-07-14 14:26:55
application/pdf
http://www.rhythmos.gr/index.php/Rhythmos/article/view/15
Rhythmos; Vol. 1 No. 3 (2006)
ell
Copyright (c) 2015 Rhythmos
oai:ojs.rhythmos.gr:article/19
2013-07-14T11:55:28Z
Rhythmos:CRDN
driver
"061001 2006 eng "
1792-7927
1792-7919
dc
Ηλεκτροφυσιολογικά / Βηματοδοτικά Νέα
Manolis, Antonis S
Athens University School of Medicine &
First Department of Cardiology, Evagelismos General Hospital of Athens, Athens, Greece
Το Πανελλήνιο Kαρδιολογικό Συνέδριο θα γίνει στην Αθήνα (Hilton) στις 2-4/11/06
Το Συνέδριο του AHA θα γίνει στο Chicago στις 12-15/11/06
Το Συμπόσιο της Βοστώνης για την κολπική μαρμαρυγή (Boston AF Symposium) θα γίνει στις 11-13/1/07
Το Σεμινάριο των Ομάδων Εργασίας της ΕΚΕ θα γίνει στις 2/07
Το Συνέδριο του ACC θα γίνει στη Ν. Ορλεάνη στις 24-27/3/07
Το Συνέδριο της HRS θα γίνει στο Denver στις 9-12/5/2007
Το EuroPCR θα γίνει στη Βαρκελώνη στις 22-25/5/07
Το Europace 2007 θα γίνει στη Λισσαβώνα στις 24-27/6/07
Το “Cardiology Update 2008”, Διεθνές Συνέδριο Καρδιολογίας του Γ.Ν. Αθηνών «Ο Ευαγγελισμός», θα γίνει στις 17-19 Απριλίου 2008, στην Αθήνα (Ξενοδοχείο Caravel) (http://users.otenet.gr/~asm/)
Όχι Τόσο Αιφνίδια η Επέλευση του Αιφνιδίου Θανάτου
Μεταξύ 5831 κλήσεων για επείγουσα βοήθεια, 406 αφορούσαν ασθενείς με καρδιακή ανακοπή, εκ των οποίων 66% είχαν γνωστή καρδιοπάθεια. Σε 72%, η ανακοπή επήλθε στο σπίτι, και σε 67% επήλθε μπροστά σε μάρτυρα. Πληροφορίες για προηγηθέντα συμπτώματα ήταν διαθέσιμες στο 80% (ν=323) από τους 406 ασθενείς και στους 274 με την ανακοπή μπροστά σε μάρτυρα. Τα συμπτώματα ήσαν παρόμοια και στις 2 ομάδες. Τυπική στηθάγχη για 120 λεπτά (διάμεση τιμή) είχαν 25% από τους 274 με την ανακοπή μπροστά σε μάρτυρα και το 33% όσων είχαν συμπτώματα διάρκειας <1 ώρα. Οι συγγραφείς κατέληξαν στο συμπέρασμα ότι ο αιφνίδιος θάνατος επέρχεται συχνά στο σπίτι μπροστά σε συγγενείς και μετά από παρατεταμένη περίοδο τυπικών προειδοποιητικών συμπτωμάτων, ενισχύοντας την άποψη ότι πέρα από τους εξωτερικούς απινιδωτές, θα πρέπει να δοθεί βάρος σε προγράμματα εκπαίδευσης ασθενών υψηλού κινδύνου και των συγγενών τους (Mueller et al, Circulation 2006;114:1146)... (excerpt)
Athens University School of Medicine
2013-07-14 14:55:28
application/pdf
http://www.rhythmos.gr/index.php/Rhythmos/article/view/19
Rhythmos; Vol. 1 No. 4 (2006)
ell
Copyright (c) 2015 Rhythmos
oai:ojs.rhythmos.gr:article/23
2013-07-14T12:18:47Z
Rhythmos:CRDN
driver
"070101 2007 eng "
1792-7927
1792-7919
dc
Ηλεκτροφυσιολογικά / Βηματοδοτικά Νέα
Manolis, Antonis S
Athens University School of Medicine &
First Department of Cardiology, Evagelismos General Hospital of Athens, Athens, Greece
Το Σεμινάριο των Ομάδων Εργασίας της ΕΚΕ θα γίνει στη Θεσσαλονίκη στις 8-10/2/07
Το Συνέδριο του ACC θα γίνει στη Ν. Ορλεάνη στις 24-27/3/07
Το Συνέδριο της HRS θα γίνει στο Denver στις 9-12/5/2007
Το EuroPCR θα γίνει στη Βαρκελώνη στις 22-25/5/07
Το Europace 2007 θα γίνει στη Λισσαβώνα στις 24-27/6/07
Το “Cardiology Update 2008”, Διεθνές Συνέδριο Καρδιολογίας του Γ.Ν. Αθηνών «Ο Ευαγγελισμός», θα γίνει στις 17-19 Απριλίου 2008, στην Αθήνα (Ξενοδοχείο Caravel) (http://users.otenet.gr/~asm/)
Ο Εναλλασσόμενος του Τ (TWA) Προσδιορίζει Ασθενείς με Ισχαιμική Μυοκαρδιοπάθεια που Ωφελούνται από τον Απινιδωτή
Σε 392 (51%) από 768 ασθενείς με ισχαιμική μυοκαρδιοπάθεια (ΚΕ<35%) χωρίς ιστορικό κοιλιακών αρρυθμιών εμφυτεύθηκε απινιδωτής. Από αυτούς 514 (67%) είχαν μη-αρνητικό (θετικό ή απροσδιόριστο) εναλλασσόμενο του Τ (TWA). Σε πολυπαραγοντιακή ανάλυση, ο απινιδωτής μείωσε την ολική & αρρυθμική θνητότητα στους ασθενείς με μη-αρνητικό TWA αλλά όχι σε όσους είχαν αρνητικό TWA (hazard ratio-HR 0.85). Ο αριθμός που χρειάστηκε να λάβουν απινιδωτή (NNT) για 2 έτη για να σωθεί 1 ζωή ήταν 9 μεταξύ των μη-αρνητικών και 76 μεταξύ των αρνητικων TWA ασθενών (Chow et al, JACC 2007, 49:50).
Η Χρήση του Εναλλασσόμενου του Τ (TWA) για τη Διαστρωμάτωση Κινδύνου σε Ασθενείς Χαμηλού Κινδύνου (Μετεμφραγματίες με Καλό ΚΕ)
Σε 1041 μετεμφραγματίες ασθενείς με κλάσμα εξώθησης (ΚΕ) >40% διενεργήθηκε & αξιολογήθηκε η δοκιμασία του εναλλασσόμενου του Τ (T-wave alternans-TWA) 48+66 ημέρες μετά το έμφραγμα μεταξύ άλλων 10 μεταβλητών. Σε μέσο διάστημα 32 μηνών, 38 ασθενείς (3.7%) κατέληξαν από μη-καρδιακά αίτια. Από τους υπόλοιπους 1003, 18 (1.8%) είχαν αιφνίδιο θάνατο ή απειλητική κοιλιακή αρρυθμία. Η δοκιμασία TWA ήταν θετική σε 169 (17%), αρνητική σε 747 (74%) και μη-διαγνωστική σε 87 (9%). Θετική δοκιμασία TWA, μη-εμμένουσα κοιλιακή ταχυκαρδία, και θετικά όψιμα δυναμικά ήταν προγνωστικοί δείκτες αρρυθμικών συμβαμάτων, ενώ η διαδερμική επαναγγείωση μείωσε τον κίνδυνο. Σε πολυπαρογοντιακή ανάλυση, η δοκιμασία TWA ήταν ο σημαντικότερος προγνωστικός δείκτης (hazard ratio 19.7) με την υψηλότερη ευαισθησία και αρνητική προβλεπτική αξία (Ikeda et al, JACC 2006, 48:2268)... (excerpt)
Athens University School of Medicine
2013-07-14 15:18:47
application/pdf
http://www.rhythmos.gr/index.php/Rhythmos/article/view/23
Rhythmos; Vol. 2 No. 1 (2007)
ell
Copyright (c) 2015 Rhythmos
oai:ojs.rhythmos.gr:article/28
2013-07-14T13:04:16Z
Rhythmos:CRDN
driver
"070401 2007 eng "
1792-7927
1792-7919
dc
Ηλεκτροφυσιολογικά / Βηματοδοτικά Νέα
Manolis, Antonis S
Athens University School of Medicine &
First Department of Cardiology, Evagelismos General Hospital of Athens, Athens, Greece
Sakellariou, Dimitris
Pastromas, Sokratis
Το Συνέδριο της HRS θα γίνει στο Denver στις 9-12/5/2007
Το EuroPCR θα γίνει στη Βαρκελώνη στις 22-25/5/07
Το Europace 2007 θα γίνει στη Λισσαβώνα στις 24-27/6/07
Το Ετήσιο Συνέδριο της ESC θα γίνει στη Βιέννη στις 1-5/9/2007
Το Συνέδριο TCT θα γίνει στην Washington στις 20-25/10/2007
Το 28ο Πανελλήνιο Καρδιολογικό Συνέδριο θα γίνει στη Ρόδο (Rodos Palace) στις 25-27/10/2007
Το Συνέδριο του AHA θα γίνει στο Orlando στις 4-7/11/2007
Το 57ο Ετήσιο Συνέδριο του ACC θα γίνει στο Chicago στις 29/3-1/4/2008
Το “Cardiology Update 2008”, Διεθνές Συνέδριο Καρδιολογίας του Γ.Ν. Αθηνών «Ο Ευαγγελισμός», θα γίνει στις 17-19 Απριλίου 2008, στην Αθήνα (Ξενοδοχείο Caravel) (http://users.otenet.gr/~asm/)
Απογοήτευση και από τον Εναλλασσόμενο του Τ (TWA) στην Πρόβλεψη του Αιφνιδίου Θανάτου
Κατά την ανάλυση των δεδομένων που αφορούν τη προγνωστική αξία και χρήση του TWA σε 490 ασθενείς στη μελέτη SCD-HeFT, δεν υπήρξε διαφορά στα συμβάματα ή τη θνητότητα μεταξύ TWA- και TWA+ ασθενών με ή χωρίς απινιδωτή, γεγονός που υποδηλώνει ότι ο TWA δεν είναι χρήσιμος στη διαστρωμάτωση του κινδύνου. Επιπλέον, η ανάδειξη πολλών ασθενών (41%) με απροσδιόριστο αποτέλεσμα του TWA περιορίζει την αξία αυτού του δείκτη (Gold MR et al, AHA 2006, Abstr. No.: 2113)
Επιπλέον σε σειρά 566 ασθενών στη μελέτη ABCD με στεφανιαία νόσο, κλάσμα εξώθησης (ΚΕ) <40% (μέσο ΚΕ 28%, 70% σε κατηγορία ΙΙΙ-ΙV κατά NYHA, >80% σε βέλτιστη αγωγή) και ιστορικό ριπών κοιλιακής ταχυκαρδίας (ΚΤ), αλλά χωρίς εμμένουσα ΚΤ, που υποβλήθηκαν σε ηλεκτροφυσιολογικό έλεγχο (ΗΦΕ) και TWA, η θετική (~10%) και αρνητική (~96%) προβλεπτική αξία του TWA ήταν περίπου ίδια με του ΗΦΕ. Η χρήση και των δύο εξετάσεων (ΗΦΕ+TWA) είχε συνεργικό αποτέλεσμα (2.3% συμβάματα όταν TWA- & ΗΦΕ-, 5% όταν TWA+/ΗΦΕ-, 7.5% όταν TWA-/ΗΦΕ+, και 12.6% όταν TWA+/ΗΦΕ+) (ABCD Trial, AHA 2006)... (excerpt)
Athens University School of Medicine
2013-07-14 16:04:16
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http://www.rhythmos.gr/index.php/Rhythmos/article/view/28
Rhythmos; Vol. 2 No. 2 (2007)
ell
Copyright (c) 2015 Rhythmos
oai:ojs.rhythmos.gr:article/35
2013-07-14T14:05:48Z
Rhythmos:CRDN
driver
"070701 2007 eng "
1792-7927
1792-7919
dc
Ηλεκτροφυσιολογικά / Βηματοδοτικά Νέα
Manolis, Antonis S
Athens University School of Medicine &
First Department of Cardiology, Evagelismos General Hospital of Athens, Athens, Greece
Sakellariou, Dimitris
Koulouris, Spyridon
Το ετήσιο Συνέδριο της ESC θα γίνει στη Βιέννη στις 1-5/9/2007
Το Συνέδριο TCT θα γίνει στην Washington στις 20-25/10/2007
Το 28ο Πανελλήνιο Καρδιολογικό Συνέδριο θα γίνει στη Ρόδο (Rodos Palace) στις 25-27/10/2007
Το Συνέδριο του AHA θα γίνει στο Orlando στις 4-7/11/2007
Το 57ο ετήσιο Συνέδριο του ACC θα γίνει στο Chicago στις 29/3-1/4/2008
Το “Cardiology Update 2008”, Διεθνές Συνέδριο Καρδιολογίας του Γ.Ν. Αθηνών «Ο Ευαγγελισμός», θα γίνει στις 17-19 Απριλίου 2008, στην Αθήνα (Ξενοδοχείο Caravel) (www.evagelismos.dom.gr & www.cardiologyupdate.dom.gr )
Το συνέδριο της HRS θα γίνει στο San Francisco στις 14-17/5/2008
Το CardioStim 2008 θα γίνει στη Nice στις 18-21/6/2008
Επιπλοκές Απινιδωτικών Ηλεκτροδίων στη Δεκαετία
Σε 990 ασθενείς που έλαβαν απινιδωτή, 148 (15%) εμφάνισαν δυσλειτουργία απινιδωτικών ηλεκτροδίων σε διάστημα 31 μηνών (διάμεσος χρόνος παρακολούθησης). Η 5ετής & 8ετής αντοχή των ηλεκτροδίων ήταν 85% και 60% αντίστοιχα. Η αποτυχία τους αυξήθηκε προοδευτικά και στα 10 χρόνια έφτασε το 20% (p<0.001). Η δυσλειτουργία εμφανίστηκε τόσο στα παλαιά όσο και στα νεότερα μοντέλα. Οι ασθενείς με δυσλειτουργία ηλεκτροδίων ήταν γενικά νεότεροι σε ηλικία και συχνότερα γυναίκες. Η εμφύτευση πολλαπλών ηλεκτροδίων συσχετιζόταν με υψηλότερη τάση για δυσλειτουργία στα απινιδωτικά ηλεκτρόδια. Οι κυριότερες επιπλοκές ήταν ρήξη της μόνωσης (56%), ρήξη αγωγού (12%), απώλεια κοιλιακής σύλληψης (11%), παθολογική αντίσταση ηλεκτροδίου (10%) και απώλεια ανίχνευσης (10%) (Kleeman et al, Circulation 2007;115:2474)... (excerpt)
Athens University School of Medicine
2013-07-14 17:05:48
application/pdf
http://www.rhythmos.gr/index.php/Rhythmos/article/view/35
Rhythmos; Vol. 2 No. 3 (2007)
ell
Copyright (c) 2014 Rhythmos
oai:ojs.rhythmos.gr:article/41
2013-07-14T14:50:10Z
Rhythmos:CRDN
driver
"071001 2007 eng "
1792-7927
1792-7919
dc
Ηλεκτροφυσιολογικά / Βηματοδοτικά Νέα
Manolis, Antonis S
Athens University School of Medicine &
First Department of Cardiology, Evagelismos General Hospital of Athens, Athens, Greece
Sakellariou, Dimitris
Koulouris, Spyridon
Το Συνέδριο TCT θα γίνει στην Washington στις 20-25/10/2007
Το 28ο Πανελλήνιο Καρδιολογικό Συνέδριο θα γίνει στη Ρόδο (Rodos Palace) στις 25-27/10/2007
Το Συνέδριο του AHA θα γίνει στο Orlando στις 4-7/11/2007
Το 57ο ετήσιο Συνέδριο του ACC θα γίνει στο Chicago στις 29/3-1/4/2008
Το “Cardiology Update 2008”, Διεθνές Συνέδριο Καρδιολογίας του Γ.Ν. Αθηνών «Ο Ευαγγελισμός», θα γίνει στις 17-19 Απριλίου 2008, στην Αθήνα (Ξενοδοχείο Caravel) (www.evagelismos.dom.gr & www.cardiologyupdate.dom.gr )
Το συνέδριο της HRS θα γίνει στο San Francisco στις 14-17/5/2008
Το CardioStim 2008 θα γίνει στη Nice στις 18-21/6/2008
Η Saga των Ανακλήσεων δεν Έχει Τέλος: Πρόωρη Δυσλειτουργία των Απινιδωτικών Ηλεκτροδίων Sprint Fidelis
Η λειτουργία των απινιδωτικών ηλεκτροδίων Sprint Fidelis model 6949 συγκρίθηκε με εκείνη των ηλεκτροδίων Sprint Quattro Secure model 6947. Η διάρκεια ζωής 583 ηλεκτροδίων Sprint Fidelis 6949 που εμφυτεύθηκαν στο διάστημα 9/2004 έως 2/2007 ήταν σημαντικά βραχύτερη από εκείνη 285 ηλεκτροδίων τύπου Sprint Quattro Secure model 6947 που εμφυτεύθηκαν από 11/2001 έως 2/2007 (P = 0.005). Σε 6 ασθενείς δυσλειτούργησαν τα ηλεκτρόδια Sprint Fidelis 4–23 μήνες μετά την εμφύτευση. Οι 5 από τους 6 ασθενείς είχαν παλλαπλές αδόκιμες απινιδώσεις λόγω ρήξης του αγωγού των ηλεκτροδίων, ενώ ο 6ος ασθενής είχε αποτυχία του μηχανισμού ενεργητικής πρόσφυσης. Έρευνα στη βάση δεδομένων του FDA ανέδειξε αναφορές σε 679 ηλεκτρόδια Sprint Fidelis. Τα συχνότερα παράπονα ή παρατηρήσεις ήσαν αδόκιμες απινιδώσεις (33%), υψηλή αντίσταση (33%), και ρήξη (35%). Σε 125 ηλεκτρόδια που αναλύθηκαν από την κατασκευάστρια εταιρεία, 62 αφορούσαν ρήξη ηλεκτροδίου είτε του ανιχνευτικού είτε του απινιδωτικού (Hauser et al, Heart Rhythm 2007;4:892). (Σ.Σ.: τελικά τα ηλεκτρόδια Sprint Fidelis αποσύρθηκαν από την αγορά τον Οκτώβριο 2007)...(excerpt)
Athens University School of Medicine
2013-07-14 17:50:10
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http://www.rhythmos.gr/index.php/Rhythmos/article/view/41
Rhythmos; Vol. 2 No. 4 (2007)
ell
Copyright (c) 2014 Rhythmos
oai:ojs.rhythmos.gr:article/46
2013-07-14T15:31:10Z
Rhythmos:CRDN
driver
"080101 2008 eng "
1792-7927
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Ηλεκτροφυσιολογικά / Βηματοδοτικά Νέα
Manolis, Antonis S
Athens University School of Medicine &
First Department of Cardiology, Evagelismos General Hospital of Athens, Athens, Greece
Pastromas, Sokratis
Sakellariou, Dimitris
Το 57ο ετήσιο Συνέδριο του ACC θα γίνει στο Chicago στις 29/3-1/4/2008
Το “Cardiology Update 2008”, Διεθνές Συνέδριο Καρδιολογίας του Γ.Ν. Αθηνών «Ο Ευαγγελισμός», θα γίνει στις 17-19 Απριλίου 2008, στην Αθήνα (Ξενοδοχείο Caravel) (www.evagelismos.dom.gr & www.cardiologyupdate.dom.gr )
Το συνέδριο της HRS θα γίνει στο San Francisco στις 14-17/5/2008
Το CardioStim 2008 θα γίνει στη Nice στις 18-21/6/2008
Το Πανευρωπαϊκό Καρδιολογικό Συνέδριο (ESC) θα γίνει στο Μόναχο στις 30/8-3/9/08
Το Συνέδριο TCT θα γίνει στην Washington στις 12-17/10/2008
Το 29ο Πανελλήνιο Καρδιολογικό Συνέδριο θα γίνει στην Αθήνα (Hilton) στις 30/10-1/11/2008
Το Συνέδριο του AHA θα γίνει στη Νέα Ορλεάνη στις 8-12/11/2008
Το Συνέδριο EuroPace θα γίνει στο Βερολίνο στις 21-24/6/09
Συσχέτιση της Υποτροπής Κολπικής Μαρμαρυγής μετά από NSTEMI με τις Διαταραχές του Αριστερού Κόλπου
Μελετήθηκαν προοπτικά ασθενείς με NSTEMI που εμφάνισαν κολπική μαρμαρυγή προσφάτου ενάρξεως με καταληκτικά σημεία τα καρδιαγγειακά συμβάματα, τις κολπικές ταχυαρρυθμίες και το θάνατο. Από τους 101 ασθενείς που είχαν προσφάτου ενάρξεως κολπική μαρμαρυγή, οι 88 είχαν πρόσφατα υπερηχοκαρδιογραφήματα και οι 69 είχαν διάταση του αριστερού κόλπου (78%), ενώ το χρονικό διάστημα παρακολούθησης ήταν 24 μήνες (μέση τιμή 21,4%). Το μεγάλο εύρος του κύματος P (≥110 ms) και η μειωμένη κλασματική βράχυνση της αριστερής κοιλίας ήταν πιο εκσεσημασμένα σε αυτούς με διάταση του αριστερού κόλπου και υπήρχε ανεξάρτητη συσχέτιση με την κολπική μαρμαρυγή. Ο επιπολασμός των ως άνω διαταραχών επαναπόλωσης στους ασθενείς με κολπική διάταση ήταν 56%, ενώ σε αυτή την ομάδα των ασθενών παρατηρούνταν πιο συχνά κολπική μαρμαρυγή (43% vs 15%; p = 0.03) και καρδιακή ανεπάρκεια (63% vs 35%; p = 0.03) χωρίς όμως αύξηση στη θνησιμότητα. Ωστόσο, ο συνολικός επιπολασμός όψιμων καρδιαγγειακών συμβάντων ήταν υψηλότερος σε αυτή την υποομάδα (71% vs 45%; p = 0.02) σε σχέση με τις άμεσες καρδιαγγειακές επιπλοκές (20% vs 26%; p = 0.60). Έτσι, αποδείχτηκε υψηλότερο ποσοστό επεισοδίων υποτροπιάζουσας κολπικής μαρμαρυγής στους ασθενείς με NSTEMI με συνδυασμό ηλεκτροκαρδιογραφικών και υπερηχοκαρδιογραφικών διαταραχών του αριστερού κόλπου σε σχέση με όσους δεν εμφάνιζαν τέτοιες δια-ταραχές. (Ariyarajah V et al, Am J Cardiol 2008;101:30 –34)... (excerpt)
Athens University School of Medicine
2013-07-14 18:31:10
application/pdf
http://www.rhythmos.gr/index.php/Rhythmos/article/view/46
Rhythmos; Vol. 3 No. 1 (2008)
ell
Copyright (c) 2015 Rhythmos
oai:ojs.rhythmos.gr:article/50
2013-07-14T15:55:29Z
Rhythmos:CRDN
driver
"080401 2008 eng "
1792-7927
1792-7919
dc
Ηλεκτροφυσιολογικά / Βηματοδοτικά Νέα
Manolis, Antonis S
Athens University School of Medicine &
First Department of Cardiology, Evagelismos General Hospital of Athens, Athens, Greece
Sakellariou, Dimitris
Pastromas, Sokratis
Το “Cardiology Update 2008”, Διεθνές Συνέδριο Καρδιολογίας του Γ.Ν. Αθηνών «Ο Ευαγγελισμός», θα γίνει στις 17-19 Απριλίου 2008, στην Αθήνα (Ξενοδοχείο Caravel) (www.evagelismos.dom.gr & www.cardiologyupdate.dom.gr )
Το συνέδριο της HRS θα γίνει στο San Francisco στις 14-17/5/2008
Το CardioStim 2008 θα γίνει στη Nice στις 18-21/6/2008
Το Πανευρωπαϊκό Καρδιολογικό Συνέδριο (ESC) θα γίνει στο Μόναχο στις 30/8-3/9/08
Το Συνέδριο TCT θα γίνει στην Washington στις 12-17/10/2008
Το 29ο Πανελλήνιο Καρδιολογικό Συνέδριο θα γίνει στην Αθήνα (Hilton) στις 30/10-1/11/2008
Το Συνέδριο του AHA θα γίνει στη Νέα Ορλεάνη στις 8-12/11/2008
Το Συνέδριο EuroPace θα γίνει στο Βερολίνο στις 21-24/6/09
Συσχέτιση της Εμφάνισης Κολπικής Μαρμαρυγής με το Γενετικό και Ηλεκτροφυσιολογίκο Υπόβαθρο σε Ασθενείς με σύνδρομο Brugada.
Στη μελέτη αυτή που συμμετείχαν 73 ασθενείς με σύνδρομο Brugada, καταγράφηκαν η ύπαρξη μετάλλαξης στο γονίδιο SCN5A, η παρουσία δυσμενών κλινικών ευρημάτων (ιστορικό συγκοπής, ύπαρξη τεκμηριωμένης κοιλιακής μαρμαρυγής και οικογενειακό ιστορικό αιφνιδίου θανάτου) και συσχετίστηκαν με την εμφάνιση επεισοδίων κολπικής μαρμαρυγής. Επίσης μελετήθηκαν και συσχετίστηκαν με τα ανωτέρω και ηλεκτροφυσιολογικές παράμετροι. Στους 10 από τους 73 ασθενείς παρουσιάστηκαν επεισόδια κολπικής μαρμαρυγής και από την ανάλυση των δεδομένων προκύπτει ότι κολπική μαρμαρυγή εμφανίζεται συχνότερα σε ασθενείς με ιστορικό συγκοπής (60.0%vs. 22.2%, p < 0.03) και τεκμηριωμένης κοιλιακής μαρμαρυγής (40.0% vs. 14.3%,p < 0.05). Αντίθετα η εμφάνιση μετάλλαξης στο SCN5A αν και σχετίζεται με τις ηλεκτρο-φυσιολογικές παραμέτρους δε σχετίζεται με την εμφάνιση κολπικής μαρμαρυγής (Kusano et al, J Am Coll Cardiol, 2008; 51:1083)... (excerpt)
Athens University School of Medicine
2013-07-14 18:55:29
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http://www.rhythmos.gr/index.php/Rhythmos/article/view/50
Rhythmos; Vol. 3 No. 2 (2008)
ell
Copyright (c) 2014 Rhythmos
oai:ojs.rhythmos.gr:article/54
2013-07-14T16:20:55Z
Rhythmos:CRDN
driver
"080701 2008 eng "
1792-7927
1792-7919
dc
Ηλεκτροφυσιολογικά / Βηματοδοτικά Νέα
Manolis, Antonis S
Athens University School of Medicine &
First Department of Cardiology, Evagelismos General Hospital of Athens, Athens, Greece
Koulouris, Spyridon
Pastromas, Sokratis
Το Συνέδριο της ESC θα γίνει στο Μόναχο στις 30/8-5/9/2008.
Το Συνέδριο TCT θα γίνει στην Washington στις 12-17/10/2008.
Το 29ο Πανελλήνιο Καρδιολογικό Συνέδριο θα γίνει στην Αθήνα (Hilton) στις 30/10 – 1/11/2008.
Το Συνέδριο της AHA θα γίνει στη Νέα Ορλεάνη στις 8-12/11/2008.
Το Συνέδριο Boston AF Symposium θα γίνει στη Βοστώνη στις 15-17/1/2009.
Το Συνέδριο του ACC θα γίνει στο Orlando στις 29-31/3/2009.
Το Συνέδριο της HRS θα γίνει στη Βοστώνη στις 13-16/5/2009.
Το Europace θα γίνει στο Βερολίνο στις 21-24/6/2009.
Περιεπεμβατική Αντιθρομβωτική Αγωγή σε Ασθενείς που Λαμβάνουν Αντιπηκτικά για Χρόνια Κολπική Μαρμαρυγή
Στην προοπτική αυτή μελέτη συμμετείχαν 345 ασθενείς (μέση ηλικία 74±9 έτη, 33% γυναίκες) οι οποίοι λάμβαναν αντιπηκτικά για χρόνια κολπική μαρμαρυγή χωρίς να πάσχουν από βαλβιδοπάθεια και οι οποίοι επρόκειτο να υποβληθούν σε χειρουργική επέμβαση. Η βαρφαρίνη διακόπηκε 4-5 ημέρες προεγχειρητικά και επαναχορηγήθηκε κατά το δυνατόν συντομότερα μετεγχειρητικά. Η απόφαση να χορηγηθεί θεραπεία με ηπαρίνη στο διάστημα αυτό λαμβάνονταν εξατομικευμένα για κάθε ασθενή ανάλογα με τον κίνδυνο πρόκλησης αιμορραγίας ή εγκεφαλικού επεισοδίου. Οι 345 ασθενείς υπεβλήθησαν σε 386 επεμβάσεις από τις οποίες σε 44 δεν διεκόπη η βαρφαρίνη, ενώ σε 204 χορηγήθηκε ηπαρίνη. Οι ασθενείς που έλαβαν ηπαρίνη είχαν μεγάλη πιθανότητα θρομβοεμβολικού επεισοδίου λόγω ιστορικού (43% vs 24%, p<0,001) και υψηλότερο score (2.2 vs 1.9; p=0.06) του δείκτη CHADS2 (συμφορητική καρδιακή ανεπάρκεια, ηλικία, σακχαρώδης διαβήτης, αγγειακό εγκεφαλικό επεισόδιο). Η τρίμηνη αθροιστική επίπτωση θρομβοεμβολικού επεισοδίου ή αιμορραγίας στους ασθενείς που διεκόπη η αντιπηκτική αγωγή ήταν χαμηλή και δεν επηρεάστηκε σημαντικά από τη χορήγηση ηπαρίνης στο διάστημα της διακοπής του αντιπηκτικού (Wysokinsiki WE et al, Mayo Clin Proc 2008; 83:639)... (excerpt)
Athens University School of Medicine
2013-07-14 19:20:55
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http://www.rhythmos.gr/index.php/Rhythmos/article/view/54
Rhythmos; Vol. 3 No. 3 (2008)
ell
Copyright (c) 2015 Rhythmos
oai:ojs.rhythmos.gr:article/61
2013-07-14T17:20:38Z
Rhythmos:CRDN
driver
"081001 2008 eng "
1792-7927
1792-7919
dc
Ηλεκτροφυσιολογικά / Βηματοδοτικά Νέα
Manolis, Antonis S
Athens University School of Medicine &
First Department of Cardiology, Evagelismos General Hospital of Athens, Athens, Greece
Sakellariou, Dimitris
Pastromas, Sokratis
Το συνέδριο της AHA θα γίνει στη Νέα Ορλεάνη στις 8-12/11/2008.
Το συνέδριο Boston AF Symposium θα γίνει στη Βοστώνη στις 15-17/01/2009.
Το συνέδριο του ACC θα γίνει στο Orlando στις 29-31/03/2009.
Το συνέδριο της HRS θα γίνει στη Βοστώνη στις 13-16/05/2009.
Το Europace θα γίνει στο Βερολίνο στις 21-24/06/2009.
Καρδιακός Επανασυγχρονισμός (CRT) σε Ασθενείς με Κολπική Μαρμαρυγή.
Στη μεταανάλυση αυτή χρησιμοποιήθηκαν προοπτικές μελέτες και συγκρίθηκε ο καρδιακός επανασυγχρονισμός σε ασθενείς με κολπική μαρμαρυγή και φλεβοκομβικό ρυθμό. Ως καταληκτικά σημεία χρησιμοποιήθηκαν ο θάνατος, η λειτουργική κατηγορία κατά NYHA, το κλάσμα εξώθησης, το Minnesota score για την ποιότητα ζωής και η 6λεπτη βάδιση. Επιλέχτηκαν 5 μελέτες που περιλάμβαναν 1164 ασθενείς είτε με φλεβοκομβικό ρυθμό είτε με κολπική μαρμαρυγή που έλαβαν θεραπεία CRT και εμφάνισαν σημαντική βελτίωση. Η θνησιμότητα δεν διέφερε σημαντικά μετά ένα χρόνο (RRR: 1,57, 95% CI: 0,87-2,81). Η λειτουργική τάξη κατά NΥΗΑ βελτιώθηκε εξίσου και για τις 2 ομάδες (-0,90 και -0,84 για τους ασθενείς σε φλεβόκομβο- SR και κΜ αντίστοιχα). Οι ασθενείς με SR είχαν μεγαλύτερη βελτίωση στην 6λεπτη βάδιση και στο Minessota score συγκριτικά με τους αντίστοιχους με κΜ. Οι τελευταίοι, ωστόσο, βελτίωσαν συγκριτικά στατιστικά σημαντικά κατά μικρό όμως ποσοστό (0,39% CI:95% CI:0,22%-0,55%) το κλάσμα εξώθησης (Upadhyay GA et al, JACC 2008;52: 1239-46)... (excerpt)
Athens University School of Medicine
2013-07-14 20:20:38
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http://www.rhythmos.gr/index.php/Rhythmos/article/view/61
Rhythmos; Vol. 3 No. 4 (2008)
ell
Copyright (c) 2014 Rhythmos
oai:ojs.rhythmos.gr:article/62
2013-07-14T17:20:38Z
Rhythmos:CRDN
driver
"081001 2008 eng "
1792-7927
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Αρρυθμιολογικά Νέα από το Συνέδριο ESC 2008
Sakellariou, Dimitris
Athens University School of Medicine &
First Department of Cardiology, Evagelismos General Hospital of Athens, Athens, Greece
Στο πρόσφατο Συνέδριο της Ευρωπαικής Καρδιολογικής Εταιρείας που διεξήχθη στο Μόναχο ανακοινώθηκαν τα αποτελέσματα σημαντικών μελετών στον τομέα της Αρρυθμιολογίας.
Συγκεκριμένα ανακοινώθηκαν τα αποτελέσματα μιας υποανάλυσης της μελέτης ΑΤΗΕΝΑ, μιας μεγάλης τυχαιοποιημένης μελέτης που μελέτησε την επίδραση της δρονεδαρόνης, ενός νέου αντιαρρυθμικού φαρμάκου, σε ασθενείς με κολπική μαρμαρυγή. Στη μελέτη συμπεριλήφθηκαν 4628 ασθενείς με κολπική μαρμαρυγή οι οποίοι παρακολουθήθηκαν για 21 μήνες. Στο τέλος της παρακολούθησης παρατηρήθηκε μείωση των εγκεφαλικών κατά 34% (p:0.027) σε σχέση με τους ασθενείς που λάμβαναν εικονικό φάρμακο. Υπενθυμίζεται ότι τα αποτελέσματα της κυρίως μελέτης που είχαν ανακοινωθεί νωρίτερα είχαν δείξει μείωση κατά 24% (p<0.001) στη θνησιμότητα και στις νοσηλείες για καρδιαγγειακά συμβάματα, όπως επίσης και μείωση κατά 29% (p: =0.034) της καρδιαγγειαής θνησιμότητας και κατά 45% μείωση του αρρυθμιολογικού θανάτου. Έτσι η ασφάλεια και η αποτελεσματικότητα της δρονεδαρόνης φαίνεται να εδραιώνεται και δείχνει να αποτελεί ασφαλές υποκατάστατο της αμιωδαρόνης... (excerpt)
Athens University School of Medicine
2013-07-14 20:20:38
application/pdf
http://www.rhythmos.gr/index.php/Rhythmos/article/view/62
Rhythmos; Vol. 3 No. 4 (2008)
ell
Copyright (c) 2015 Rhythmos
oai:ojs.rhythmos.gr:article/63
2013-07-14T17:20:38Z
Rhythmos:CRDN
driver
"081001 2008 eng "
1792-7927
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Σχέση του Ευρέος QRS με Κοιλιακές Ταχυαρρυθμίες και Αιφνίδιο Θάνατο στη Μελέτη MADIT II
Skeberis, Vasilis
Athens University School of Medicine &
First Department of Cardiology, Evagelismos General Hospital of Athens, Athens, Greece
Υπάρχουν αντικρουόμενες απόψεις στη βιβλιογραφία για τη σχέση του ευρέος QRS, με αρρυθμικά συμβάντα, όπως αιφνίδιο θάνατο και κοιλιακή. ταχυκαρδία/μαρμαρυγή. Σε ασθενείς της μελέτης MADIT-II που έλαβαν είτε φαρμακευτική αγωγή είτε ICD, έγινε σύγκριση της επιμήκυνσης του QRS με τα αρρυθμικά συμβάματα.
Στην ομάδα των ασθενών με φαρμακευτική αγωγή, η διάρκεια του QRS ήταν ανεξάρτητος παράγοντας αιφνιδίου θανάτου (HR=2.12, CI 1,20-3,76, p=0.01). Στην ομάδα με ICD, η επιμήκυνση του QRS δεν ήταν ανεξάρτητος παράγοντας για τον αιφνίδιο θάνατο ή κοιλιακή ταχυκαρδία/ μαρμαρυγή (HR=0.77, CI 0,47-1,24, p=0.28)... (excerpt)
Athens University School of Medicine
2013-07-14 20:20:38
application/pdf
http://www.rhythmos.gr/index.php/Rhythmos/article/view/63
Rhythmos; Vol. 3 No. 4 (2008)
ell
Copyright (c) 2015 Rhythmos
oai:ojs.rhythmos.gr:article/67
2013-07-14T17:47:27Z
Rhythmos:CRDN
driver
"090101 2009 eng "
1792-7927
1792-7919
dc
Ηλεκτροφυσιολογικά / Βηματοδοτικά Νέα
Manolis, Antonis S
Athens University School of Medicine &
First Department of Cardiology, Evagelismos General Hospital of Athens, Athens, Greece
Sakellariou, Dimitris
Pastromas, Sokratis
Το συνέδριο Boston AF Symposium θα γίνει στη Βοστώνη στις 15-17/01/2009.
Τα Σεμινάρια των Ομάδων Εργασίας της ΕΚΕ θα γίνουν στη Θεσσαλονίκη στις 12-14/2/09
Το συνέδριο του ACC θα γίνει στο Orlando στις 29-31/03/2009.
Το συνέδριο της HRS θα γίνει στη Βοστώνη στις 13-16/05/2009.
Το Europace θα γίνει στο Βερολίνο στις 21-24/06/2009.
Το συνέδριο της ESC θα γίνει στη Βαρκελώνη στις 29/8-2/9/2009
Το συνέδριο του ΑΗΑ θα γίνει στο Orlando στις 14-18/11/2009
Ανάστροφη Αναδιαμόρφωση αλλά όχι Κλινική Βελτίωση με τον Επανασυγχρονισμό σε Ασθενείς με NYHA I ή II (μελέτη REVERSE)
Απο 610 ασθενείς με ήπια συμπτώματα καρδιακής ανεπάρκειας NYHA I ή II, QRS >120 ms & KE <40%, που έλαβαν αμφικοιλιακή βηματοδότηση, 419 τυχαιοποιήθηκαν σε ενεργή βηματοδότηση και 191 σε ανενεργή επί 12 μήνες. Το πρωτοπαθές καταληκτικό σημείο ήταν ίδιο και για τις δύο ομάδες (16% & 21% αντίστοιχα είχαν επιδείνωση συμπτωμάτων). Ωστόσο, οι δείκτες ανάστροφης αναδιαμόρφωσης (p < 0.0001), και ο χρόνος έως την πρώτη νοσηλεία (hazard ratio: 0.47, p = 0.03 ) ήταν ευνοϊκότεροι στην πρώτη ομάδα. Η θνητότητα ήταν περίπου ίδια (2.2% vs 1.6%). Οι επιπλοκές (16%) δεν διέφεραν στις 2 ομάδες (Linde et al, JACC 2008, 52:1834)... (excerpt)
Athens University School of Medicine
2013-07-14 20:47:27
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http://www.rhythmos.gr/index.php/Rhythmos/article/view/67
Rhythmos; Vol. 4 No. 1 (2009)
ell
Copyright (c) 2014 Rhythmos
oai:ojs.rhythmos.gr:article/70
2013-07-14T18:51:17Z
Rhythmos:CRDN
driver
"090401 2009 eng "
1792-7927
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Αρρυθμιολογικά Νέα απο το Συνέδριο ACC 2009
Sakellariou, Dimitris
Athens University School of Medicine &
First Department of Cardiology, Evagelismos General Hospital of Athens, Athens, Greece
Στο πρόσφατο συνέδριο του American College of Cardiology (ACC) που διενεργήθηκε από 28/3 ως 31/3/2009 ανακοινώθηκαν μεταξύ άλλων και τα αποτελέσματα των παρακάτω σημαντικών μελετών που σχετίζονται με την Ηλεκροφυσιολογία και την Αρρυθμιολογία.
Συγκεκριμένα στην μελέτη PROTECT AF στην οποία συμμετείχαν 707 ασθενείς με κολπική μαρμαρυγή μελετήθηκε η ασφάλεια και η αποτελεσματικότητα μιας συσκευής σύγκλεισης του ωτίου του αριστερού κόλπου (WATCHMAN) η οποία τοποθετείται διαδερμικά. Στους 463 ασθενείς τοποθετήθηκε η συσκευή αυτή και κατόπιν διακόπηκαν τα αντιπηκτικά ενώ στους υπόλοιπους 244 συνεχίστηκε η κλασσική φαρμακευτική αγωγή με αντιπηκτικά. Κατά τη διάρκεια του follow up η συχνότητα της εμφάνισης εγκεφαλικού (ισχαιμικού ή αιμορραγικού) και θανάτου από καρδιαγγειακά αίτια ήταν 3.4 ανά 100 ασθενείς-έτος στην ομάδα των ασθενών που έλαβε τη συσκευή έναντι 5.0 ανά 100 ασθενείς-έτος στην ομάδα των ασθενών που λάμβαναν αντιπηκτικά. Παρατηρήθηκε δηλαδή μια μείωση του κινδύνου κατά 32%. Όσον αφορά την ασφάλεια της συσκευής μετά την επιτυχή τοποθέτηση της συσκευής, η εμφάνιση επιπλοκών ήταν σημαντικά μικρότερη στους ασθενείς που έλαβαν την συσκευή (1.7 έναντι 4.2 ανά 100 ασθενείς-έτος , Σχετικός Κίνδυνος: 0,40). Έτσι, η συσκευή αυτή σύγκλεισης του ωτίου του αριστερού κόλπου φαίνεται να αποτελεί μια ασφαλή και αποτελεσματική επιλογή στους ασθενείς με κολπική μαρμαρυγή που δεν μπορούν ή δεν επιθυμούν να λάβουν αντιπηκτική αγωγή... (excerpt)
Athens University School of Medicine
2013-07-14 21:51:17
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http://www.rhythmos.gr/index.php/Rhythmos/article/view/70
Rhythmos; Vol. 4 No. 2 (2009)
ell
Copyright (c) 2015 Rhythmos
oai:ojs.rhythmos.gr:article/72
2013-07-14T18:51:17Z
Rhythmos:CRDN
driver
"090401 2009 eng "
1792-7927
1792-7919
dc
Ηλεκτροφυσιολογικά / Βηματοδοτικά Νέα
Manolis, Antonis S
Athens University School of Medicine &
First Department of Cardiology, Evagelismos General Hospital of Athens, Athens, Greece
Sakellariou, Dimitris
Pastromas, Sokratis
Το συνέδριο της HRS θα γίνει στη Βοστώνη στις 13-16/05/2009.
Το Europace θα γίνει στο Βερολίνο στις 21-24/06/2009.
Το συνέδριο της ESC θα γίνει στη Βαρκελώνη στις 29/8-2/9/2009
Το συνέδριο του ΑΗΑ θα γίνει στο Orlando στις 14-18/11/2009
Επίδραση της Εξωγενούς χορήγησης ω-3 Λιπαρών Οξέων σε Ασθενείς με Μόνιμο Απινιδωτή
Στη μεταανάλυση αυτή χρησιμοποιήθηκαν στοιχεία από 3 μελέτες που διερεύνησαν την επίδραση της χορήγησης ω-3 λιπαρών οξέων στην εμφάνιση κοιλιακής ταχυκαρδίας σε ασθενείς με εμφυτευμένο απινιδωτή. Σε σύνολο 1148 ασθενών δεν παρατηρήθηκε σημαντική διαφορά στη χρονική διάρκεια που εμφανίστηκε η πρώτη κοιλιακή ταχυκαρδία ή μαρμαρυγή για την οποία ενεργοποιήθηκε ο απινιδωτής (σχετικός κίνδυνος: 0.90, p=ns) με την προσθήκη των ω-3 στην συνήθη αγωγή (Brouwer et al , Eur Heart J 2009 30: 820-826).
Η Χορήγηση Στατίνης δεν Βοηθά στη Διατήρηση Φλεβοκομβικού Ρυθμού μετά από Καρδιοανάταξη σε Ασθενείς με Κολπική Μαρμαρυγή
Στη μελέτη αυτή συμμετείχαν 234 ασθενείς με εμμένουσα κολπική μαρμαρυγή οι οποίοι προγραμματισμένα θα υποβάλλονταν σε ηλεκτρική ανάταξη της κολπικής μαρμαρυγής. Στους 118 από αυτούς χορηγήθηκαν 80 mg ατορβαστατίνης 14 ημέρες πριν και 30 ημέρες μετά την ανάταξη και στους υπόλοιπους placebo. Το ποσοστό των ασθενών που ανατάχθηκαν επιτυχώς σε φλεβόκομβο ήταν παρόμοιο και στις δύο ομάδες (89% και 86% αντίστοιχα). Στο τέλος της μηνιαίας παρακολούθησης το 51% των ασθενών που έλαβαν στατίνη ήταν σε φλεβοκομβικό ρυθμό έναντι 42% (p=0.18) της ομάδας που έλαβε placebo (Almroth et al, Eur Heart J 2009 30: 827-833)... (excerpt)
Athens University School of Medicine
2013-07-14 21:51:17
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http://www.rhythmos.gr/index.php/Rhythmos/article/view/72
Rhythmos; Vol. 4 No. 2 (2009)
ell
Copyright (c) 2014 Rhythmos
oai:ojs.rhythmos.gr:article/73
2013-07-14T18:51:17Z
Rhythmos:CRDN
driver
"090401 2009 eng "
1792-7927
1792-7919
dc
Νέα απο τη Βιομηχανία
Manolis, Antonis S
Athens University School of Medicine &
First Department of Cardiology, Evagelismos General Hospital of Athens, Athens, Greece
Η πλέον πρόσφατη ενημέρωση (13/3/2009) για το μεγάλο πρόβλημα δυσλειτουργίας του απινιδωτικού ηλεκτροδίου Sprint Fidelis της Medtronic αφορά σε 268000 ηλεκτρόδια που εμφυτεύθηκαν παγκοσμίως. Η βάση δεδομένων MAUDE της επιτροπής FDA περιλαμβάνει 107 αναφορές/ισχυρισμούς για θανάτους που αποδόθηκαν σε αυτό το ηλεκτρόδιο, ενώ η ίδια εταιρία παραδέχεται τη ρήξη του ηλεκτροδίου ως πιθανή αιτία μόνον για 13 απο αυτούς, εκ των οποίων οι 4 αναφέρει ότι επήλθαν κατά την προσπάθεια εκφύτευσης του ηλεκτροδίου. Η εταιρία συμβουλεύει τη χρήση του συστήματος ειδοποίησης Lead Integrity Alert (LIA) σε όλους τους ασθενείς που φέρουν αυτό το ηλεκτρόδιο και στενή παρακολούθηση για να διαγνωσθεί τυχόν ρήξη του ηλεκτροδίου. Το σύστημα LIA αναμένεται να προειδοποιήσει ~3 ημέρες νωρίτερα για αδόκιμη θεραπεία το 76% των ασθενών με ηλεκτρόδιο Sprint Fidelis. Η εταιρία προτείνει 4 επιλογές: 1) να αφεθεί ανέπαφο το ηλεκτρόδιο που λειτουργεί καλά, 2) να τοποθετηθεί νέο απινιδωτικό ηλεκτρόδιο, χωρίς να αφαιρεθεί το παλαιό, 3) να τοποθετηθεί νέο βηματοδοτικό/ανιχνευτικό ηλεκτρόδιο χωρίς να αφαιρεθεί το υπάρχον, καθ’όσον το 90% των δυσλειτουργιών αφορά το βηματοδοτικό/ ανιχνευτικό κύκλωμα και όχι το απινιδωτικό, & 4) ασυνήθεις περιστάσεις μπορεί να επιβάλουν την αφαίρεση/εκφύτευση του δυσλειτουργούντος ηλεκτροδίου και εμφύτευση νέου απινιδωτικού ηλεκτροδίου, επέμβαση που πρέπει να γίνει απο λίαν έμπειρο στις εκφυτεύσεις καρδιολόγο (http://www.medtronic.com/product-advisories/physician/sprint -fidelis/PHYSLETTER-2009-03-13.htm).
Νέα σειρά βηματοδοτών (SureScan™ Pacing System: βηματοδότης EnRhythm MRI™ SureScan™ και ηλεκτρόδιο CapSureFix MRI™ SureScan) απο υλικά με σημαντικά μειωμένα τα σιδηρομαγνητικά στοιχεία και τεχνολογία (SureScan) που επιτρέπουν την ασφαλή υποβολή των ασθενών σε μαγνητική τομογραφία χωρίς ηλεκτρομαγνητική παρεμβολή, έθεσε σε κυκλοφορία η εταιρεία Medtronic... (excerpt)
Athens University School of Medicine
2013-07-14 21:51:17
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http://www.rhythmos.gr/index.php/Rhythmos/article/view/73
Rhythmos; Vol. 4 No. 2 (2009)
ell
Copyright (c) 2015 Rhythmos
oai:ojs.rhythmos.gr:article/77
2013-07-14T20:25:58Z
Rhythmos:CRDN
driver
"090701 2009 eng "
1792-7927
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Νέα από το Europace 2009
Anninos, Ector
Athens University School of Medicine &
First Department of Cardiology, Evagelismos General Hospital of Athens, Athens, Greece
Νέες Οδηγίες για την Οδήγηση σε ασθενείς που φέρουν ICD (Συναινετικό Κείμενο 12 Ειδικών)
Οι περιορισμοί στο θέμα της οδήγησης ποικίλλουν στις Ευρωπαϊκές χώρες. Οι οδηγίες περιλαμβάνουν τις ακόλουθες 2 ομάδες: ερασιτεχνική & επαγγελματική οδήγηση.
Ο κίνδυνος ενεργοποίησης της συσκευής και παροδικής αδυναμίας ελέγχου του οχήματος είναι μικρότερος σε όσους φέρουν ICD για πρωτογενή πρόληψη και κατά συνέπεια οι περιορισμοί είναι πιο ελαστικοί στην περίπτωση αυτή. Τόσο οι ασθενείς όσο και οι συγγενείς τους πρέπει να είναι κατάλληλα ενημερωμένοι και εκπαιδευμένοι. Επισημαίνεται ότι οι κίνδυνοι είναι απότοκοι κυρίως της υπάρχουσας καρδιολογικής πάθησης και όχι της παρουσίας του ICD καθεαυτού... (excerpt)
Athens University School of Medicine
2013-07-14 23:25:58
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http://www.rhythmos.gr/index.php/Rhythmos/article/view/77
Rhythmos; Vol. 4 No. 3 (2009)
ell
Copyright (c) 2015 Rhythmos
oai:ojs.rhythmos.gr:article/78
2013-07-14T20:25:58Z
Rhythmos:CRDN
driver
"090701 2009 eng "
1792-7927
1792-7919
dc
Ηλεκτροφυσιολογικά / Βηματοδοτικά Νέα
Manolis, Antonis S
Athens University School of Medicine &
First Department of Cardiology, Evagelismos General Hospital of Athens, Athens, Greece
Sakellariou, Dimitris
Pastromas, Sokratis
Το συνέδριο της ESC θα γίνει στη Βαρκελώνη στις 29/8 – 2/9/2009.
Το 30ο Πανελλήνιο Καρδιολογικό Συνέδριο θα γίνει στην Αθήνα (Hilton) από 29 – 31/10/2009.
Το συνέδριο της AHA θα γίνει στο Orlando στις 14 – 18/11/2009.
Μακροπρόθεσμα Αποτελέσματα σε ασθενείς με Παράταση του PR Διαστήματος ή 1ου Βαθμού Κολποκοιλιακό Αποκλεισμό
Σκοπός της μελέτης αυτής ήταν η διερεύνηση της κλινικής σημασίας της παράτασης του PR διαστήματος σε περιπατητικούς ασθενείς. Μελετήθηκαν προοπτικά 7575 άτομα από τον πληθυσμό της μελέτης Framingham (μέση ηλικία 47 έτη, 54% γυναίκες) που υπεβλήθησαν σε ΗΚΓ 12 απαγωγών. Ο πληθυσμός των ατόμων αυτών παρακολουθήθηκε προοπτικά κατά τη διάρκεια του 2007 από τη βασική καταγραφή από το 1968 – 1974. Χρησιμοποιήθηκαν πολυπαραγοντικά μοντέλα αναλογικού κινδύνου (Cox proportional hazards models) ώστε να ερμηνευτεί η πιθανή συσχέτιση της παράτασης του PR και αρρυθμικών συμβαμάτων ή θανάτου. Κατά τη διάρκεια της παρακολούθησης, 481 άτομα εμφάνισαν κολπική μαρμαρυγή (AF), 124 χρειάστηκαν εμφύτευση μόνιμου βηματοδότη και 1739 απεβίωσαν. Κατά την αρχική εξέταση (baseline) 124 είχαν διάστημα PR>200 msec. Για τα άτομα με διάστημα PR ≥200 msec συγκριτικά με εκείνους με PR≤200 msec, τα ποσοστά επίπτωσης για κάθε 10000 ανθρωπο-έτη ήταν 140 (95% CI, 95-208) vs 36 (95% CI, 32-39)για εμφάνιση AF, 59 (95% CI, 40-87) vs 6 (95% CI, 5-7) για εμφύτευση βηματοδότη, και 334 (95% CI, 260-428) vs 129 (95% CI, 123-135)για θνητότητα από κάθε αίτιο. Η αντίστοιχη αύξηση του απόλυτου κινδύνου ήταν 1.04% (AF), 0.53% (εμφύτευση βηματοδότη), και 2.05% (θάνατος από κάθε αίτιο) ανά έτος. Σε πολυπαραγοντικές αναλύσεις κάθε αύξηση του PR κατά 20 msec σχετίστηκε με διορθωμένο Hazard Ratio (HR) 1.11 (95% CI, 1.02-1.22; P=.02), για εμφάνιση AF,1.22 (95% CI, 1.14-1.30; P<.001) για εμφύτευση βηματοδότη, και 1.08 (95% CI, 1.02-1.13; P = .005)για θάνατο από κάθε αιτία. Τα άτομα με 1ου βαθμού κολποκοιλιακό αποκλεισμό είχαν διπλάσιο διορθωμένο κίνδυνο για ανάπτυξη AF (HR, 2.06; 95% CI, 1.36-3.12;P < .001), τριπλάσιο κίνδυνο εμφύτευσης βηματοδότη(HR, 2.89; 95% CI, 1.83-4.57; P < .001), και 1,4 διορθωμένο κίνδυνο για θάνατο από κάθε αιτία (HR, 1.44, 95% CI, 1.09-1.91;P =.01). Συμπερασματικά, η παράταση του PR interval συσχετίζεται με αυξημένο κίνδυνο πρόκλησης AF, εμφύτευσης βηματοδότη και θνητότητας από κάθε αίτιο (Cheng S et al, JAMA 2009;301:2571-2577)... (excerpt)
Athens University School of Medicine
2013-07-14 23:25:58
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http://www.rhythmos.gr/index.php/Rhythmos/article/view/78
Rhythmos; Vol. 4 No. 3 (2009)
ell
Copyright (c) 2015 Rhythmos
oai:ojs.rhythmos.gr:article/82
2013-07-14T21:10:05Z
Rhythmos:CRDN
driver
"091001 2009 eng "
1792-7927
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Αρρυθμιολογικά Νέα από το Πανευρωπαϊκό Καρδιολογικό Συνέδριο (ESC) 2009
Pastromas, Sokratis
Athens University School of Medicine &
First Department of Cardiology, Evagelismos General Hospital of Athens, Athens, Greece
Sakellariou, Dimitris
Στο πρόσφατο συνέδριο της Ευρωπαϊκής Καρδιολογικής Εταιρείας (ESC) που έλαβε χώρα στη Βαρκελώνη από τις 29 Αυγούστου έως τις 2 Σεπτεμβρίου 2009 ανακοινώθηκαν τα αποτελέσματα των παρακάτω κλινικών μελετών που έχουν σχέση με την Αρρυθμιολογία:
RELY
Στη διπλή τυφλή αυτή μελέτη συγκρίθηκε η αποτελεσματικότητα του dabigatran, που είναι αναστολέας της θρομβίνης, συγκριτικά με αυτή της βαρφαρίνης όσον αφορά την πρόληψη εμφάνισης αγγειακού εγκεφαλικού επεισοδίου (ΑΕΕ) σε ασθενείς με κολπική μαρμαρυγή. Συνολικά τυχαιοποιήθηκαν 18113 ασθενείς με κολπική μαρμαρυγή και κίνδυνο ΑΕΕ και έλαβαν τυφλά και τυχαιοποιημένα συγκεκριμένη δοσολογία dabigatran (110 ή 150 mg δυο φορές ημερησίως) ή βαρφαρίνη σε δόση ανάλογη επίτευξης θεραπευτικού στόχου. Η μέση διάρκεια παρακολούθησης ήταν 2 χρόνια και το κύριο καταληκτικό σημείο ήταν η εμφάνιση ΑΕΕ ή συστηματικής εμβολής. Στόχος ήταν να αναδειχθεί η μη κατωτερότητα του dabigatran (non inferiority trial) συγκριτικά με τη βαρφαρίνη. Έτσι, τα ποσοστά όσον αφορά το κύριο καταληκτικό σημείο ήταν 1,69% ανά έτος για τη βαρφαρίνη συγκριτικά με 1,53% για την ομάδα των ασθενών που λάμβανε 110 mg dabigatran (σχετικός κίνδυνος για το dabigatran 0,91; p<0.001 όσον αφορά μη κατωτερότητα) και 1.11% αντίστοιχα για την ομάδα των ασθενών που λάμβανε 150 mg dabigatran (σχετικός κίνδυνος για το dabigatran, 0,66; p<0.001 όσον αφορά ανωτερότητα). Τα ποσοστά μειζόνων αιμορραγιών ήταν 3,36% ανά έτος για την ομάδα της βαρφαρίνης, 2.71% για την ομάδα που λάμβανε 110 mg dabigatran (p=0.003) και 3.11% αντίστοιχα για την ομάδα που λάμβανε 150 mg dabigatran (p=0.31)... (excerpt)
Athens University School of Medicine
2013-07-15 00:10:05
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http://www.rhythmos.gr/index.php/Rhythmos/article/view/82
Rhythmos; Vol. 4 No. 4 (2009)
ell
Copyright (c) 2014 Rhythmos
oai:ojs.rhythmos.gr:article/83
2013-07-14T21:10:05Z
Rhythmos:CRDN
driver
"091001 2009 eng "
1792-7927
1792-7919
dc
Ηλεκτροφυσιολογικά / Βηματοδοτικά Νέα
Manolis, Antonis S
Athens University School of Medicine &
First Department of Cardiology, Evagelismos General Hospital of Athens, Athens, Greece
Pastromas, Sokratis
Anninos, Ector
Το 30ο Πανελλήνιο Καρδιολογικό Συνέδριο θα γίνει στην Αθήνα (Hilton) από 29 – 31/10/2009.
Το συνέδριο της AHA θα διεξαχθεί στο Orlando στις 14 – 18/11/2009.
Το συνέδριο του ACC θα διεξαχθεί στην Atlanta από 14 – 16/03/2010
Το συνέδριο Athens Cardiology Update 2010 θα διεξαχθεί στην Αθήνα (Crowne Plaza Hotel) από 25 – 27/03/2010
Το συνέδριο της HRS θα διεξαχθεί στο Denver στις 12 – 15/05/2010
Το συνέδριο Cardiostim θα διεξαχθεί στη Nice στις 16 – 19/06/2010
Επιπτώσεις του Τύπου της Κολπικής Μαρμαρυγής και των Επαναλαμβανόμενων Συνεδριών Κατάλυσης (Αblation) στη Μακροχρόνια Ελάττωση Υποτροπών: Αποτελέσματα Πολυκεντρικής Μελέτης
Στόχος της προοπτικής αυτής πολυκεντρικής μέλετης ήταν η σύγκριση των αποτελεσμάτων της θεραπείας με ablation σε ασθενείς με παροξυσμική κολπική μαρμαρυγή (PAF) και μη παροξυσμική (NPAF). Αποτιμήθηκε ο ρόλος και οι επιπτώσεις των επαναλαμβανόμενων επεμβάσεων ablation σε ασθενείς με συχνές υποτροπές της νόσου. Συνολικά 1404 ασθενείς υπεβλήθησαν σε ablation AF από 12 ηλεκτροφυσιολόγους σε 4 κέντρα αναφοράς χρησιμοποιώντας ενδοκαρδιακό υπερηχογράφημα (ICE). Από αυτούς οι 728 έπασχαν από PAF και οι 676 από NPAF. Μεταξύ των ασθενών με NPAF, 293 είχαν εμμένουσα AF και 383 μακροχρόνια εμμένουσα AF. Οι ασθενείς με NPAF είχαν υψηλότερη επίπτωση υπέρτασης και/ή οργανικής καρδιακής νόσου (64.8% vs 48.5%, P=0.003) και χαμηλότερο κλάσμα εξώθησης (53.3% ± 8.7% vs 55.7 ± 6.5%, P<0.001). Όλοι οι ασθενείς υπεβλήθησαν σε ηλεκτρική απομόνωση του άντρου και των τεσσάρων πνευμονικών φλεβών καθώς και της άνω κοίλης φλέβας. Ο μέσος χρόνος παρακολούθησης ήταν 57 ± 17 μήνες, οπότε και 565 από τους 728 ασθενείς με PAF και 454 από τους 676 με NPAF (77.6% vs 67.2%, P<0.001) ήταν ελεύθεροι υποτροπών AF μετά από μια μόνο επέμβαση ablation. Όσον αφορά τις υποτροπές, το 74.2% (121/163) των ασθενών με PAF και το 74.8% (166/222) αυτών με NPAF υπεβλήθησαν ξανά σε ablation μετά το οποίο το 92.4% των ασθενών με PAF και το 84.0% αυτών με NPAF παρέμειναν ελεύθεροι συμπτωμάτων AF (Bhargava M et al, Heart Rhythm 2009;6:1403-12)... (excerpt)
Athens University School of Medicine
2013-07-15 00:10:05
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http://www.rhythmos.gr/index.php/Rhythmos/article/view/83
Rhythmos; Vol. 4 No. 4 (2009)
ell
Copyright (c) 2015 Rhythmos
oai:ojs.rhythmos.gr:article/88
2013-07-15T21:14:47Z
Rhythmos:CRDN
driver
"100101 2010 eng "
1792-7927
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Ηλεκτροφυσιολογικά / Βηματοδοτικά Νέα
Manolis, Antonis S
Athens University School of Medicine &
First Department of Cardiology, Evagelismos General Hospital of Athens, Athens, Greece
Koulouris, Spyridon
Pastromas, Sokratis
Το σεμινάριο των Ομάδων Εργασίας της ΕΚΕ θα διεξαχθεί στις 18 – 20/02/2010 στη Θεσσαλονίκη
Το συνέδριο του ACC θα διεξαχθεί στην Atlanta στις 14 – 16/03/2010
Το συνέδριο Athens Cardiology Update 2010 θα διεξαχθεί στην Αθήνα (Crowne Plaza Hotel) στις 25 – 27/03/2010
Το συνέδριο της HRS θα διεξαχθεί στο Denver των ΗΠΑ στις 12 – 15/05/2010
Το συνέδριο Cardiostim θα διεξαχθεί στη Nice στις 16 – 19/06/2010
Μακροχρόνια Αποτελέσματα της Χρήσης ICDs σε ασθενείς με Υπερτροφική Αποφρακτική Μυοκαρδιοπάθεια
Μελετήθηκαν συνολικά 104 ασθενείς μέσης ηλικίας 35,6 ετών οι οποίοι παρακολουθήθηκαν κατά μέσο όρο 4,6 έτη. Σε αυτούς η εμφύτευση ICD έγινε για δευτερογενή (n=26) και πρωτογενή πρόληψη (n=78) αιφνιδίου καρδιακού θανάτου. Στη δεύτερη ομάδα σε 14 ασθενείς (53,8%) καταγράφηκε τουλάχιστον 1 δόκιμη εκφόρτιση του ICD (7,9% /έτος). Στην πρώτη ομάδα δόκιμες εκφορτίσεις καταγράφηκαν σε 13 ασθενείς (16,7%) και το αντίστοιχο ποσοστό θεραπευτικής παρέμβασης ήταν 4,0%/έτος. Η μη εμμένουσα κοιλιακή ταχυκαρδία ήταν ο μόνος προγνωστικός παράγοντας κινδύνου για τη δόκιμη εκφόρτιση του ICD στην ομάδα της πρωτογενούς πρόληψης (θετική προγνωστική αξία 22%, αρνητική προγνωστική αξία 96%). Δεν παρατηρήθηκε σημαντική διαφορά στην επίπτωση των δόκιμων εκφορτίσεων στην ομάδα της πρωτογενούς πρόληψης με 1,2 ή περισσότερους παράγοντες κινδύνου. Στις επιπλοκές που παρατηρήθηκαν περιλαμβάνονται: αδόκιμες εκφορτίσεις (33.7%), δυσλειτουργία ηλεκτροδίων (12.5%), και λοιμώξεις στο 4.8% των ασθενών, ενώ κατά τη διάρκεια της παρακολούθησης 4 ασθενείς απεβίωσαν (Syska P et al, JCE, 2010 [Epub ahead of print])
Επίπτωση και Περιεπεμβατικοί Προγνωστικοί δείκτες Αγγειακών Εγκεφαλικών σε ασθενείς που υποβάλλονται σε Ablation Κολπικής Μαρμαρυγής
Τα αγγειακά εγκεφαλικά επεισόδια (ΑΕΕ) αποτελούν μια σοβαρή επιπλοκή των επεμβάσεων κατάλυσης της κολπικής μαρμαρυγής (κΜ) χωρίς να έχουν αποσαφηνιστεί αφενός η επίπτωσή τους και αφετέρου οι κλινικοί προγνωστικοί δείκτες. Η μελέτη περιέλαβε 721 περιπτώσεις σε 579 διαδοχικούς ασθενείς (ηλικία 57±11 έτη, 23% γυναίκες και 345 εξ΄αυτών με επίμονη κΜ) που παραπέμφθηκαν για ablation κΜ. Ως περιεπεμβατικό ΑΕΕ ορίστηκε κάθε επεισόδιο από το κεντρικό νευρικό που συνέβη οποιαδήποτε στιγμή από την έναρξη της επέμβασης έως και 30 ημέρες μετά το ablation και αξιολογήθηκε νευρολογικά. Σε κάθε περίπτωση διενεργήθηκε CT και/ή MRI εγκεφάλου. Οι ασθενείς ήταν σε αντιπηκτική αγωγή με ουαρφαρίνη για τουλάχιστον 4 εβδομάδες προ και αμέσως μετά την επέμβαση με χορήγηση ενοξαπαρίνης ως θεραπεία γεφύρωσης. Επίσης, 24 ώρες πριν το ablation όλοι οι ασθενείς υποβλήθηκαν σε διοισοφάγειο ηχωκαρδιογράφημα. Έτσι, περιεπεμβατικά ΑΕΕ συνέβησαν σε 10 από τα 721 περιστατικά (1,4%) ενώ ο κίνδυνος δεν μεταβλήθηκε σημαντικά κατά τη διάρκεια της μελέτης. Από τα 10 αυτά περιστατικά (ηλικίας 62±11 έτη, 1 γυναίκα, 5 περιστατικά με επίμονη κΜ) τα 6 εκδήλωσαν νευρολογική συμπτωματολογία εντός 24 ωρών, 3 μετά από 24 – 48 ώρες ενώ 1 ασθενής 6 ημέρες μετά την επέμβαση. Όλα τα εγκεφαλικά επεισόδια ήταν ισχαιμικής αιτιολογίας. Τέσσερεις από 43 ασθενείς (9,3%) που εκδήλωσαν επεισόδιο είχαν προηγούμενο ιστορικό ΑΕΕ. Τα ΑΕΕ συνέβησαν στο 0,3%, 1,0% και 4,7% των ασθενών με CHADS2 score 0, 1 και ≥2 αντίστοιχα. Σε δυο ξεχωριστές πολυπαραγοντικές αναλύσεις, η ύπαρξη CHADS2 score ≥2 (OR 7,1, P=0,02) και ιστορικού ΑΕΕ (OR 9.5, P<0,01) παρέμειναν ανεξάρτητοι προγνωστικοί παράγοντες για την πρόκληση περιεπεμβατικού ΑΕΕ (Scherr D. et al, JCE 2009;20:1357-63)... (excerpt)
Athens University School of Medicine
2013-07-16 00:14:47
application/pdf
http://www.rhythmos.gr/index.php/Rhythmos/article/view/88
Rhythmos; Vol. 5 No. 1 (2010)
ell
Copyright (c) 2015 Rhythmos
oai:ojs.rhythmos.gr:article/92
2013-07-16T17:36:47Z
Rhythmos:CRDN
driver
"100401 2010 eng "
1792-7927
1792-7919
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Ηλεκτροφυσιολογικά / Βηματοδοτικά Νέα
Manolis, Antonis S
Athens University School of Medicine &
First Department of Cardiology, Evagelismos General Hospital of Athens, Athens, Greece
Koulouris, Spyridon
Pastromas, Sokratis
Το συνέδριο της HRS θα διεξαχθεί στο Denver των ΗΠΑ στις 12-15/05/2010
Το συνέδριο Cardiostim θα διεξαχθεί στη Nice στις 16-19/06/2010
Το Πανευρωπαϊκό Συνέδριο της ESC θα πραγματοποιηθεί στη Στοκχόλμη από 28/08/2010–01/09/2010
Το επεμβατικό συνέδριο TCT θα γίνει στην Washington στις 21-25/9/10
Το Πανελλήνιο Καρδιολογικό Συνέδριο της ΕΚΕ (HCS) θα γίνει στην Αθήνα στις 21-23/10/2010
Το συνέδριο της AHA θα γίνει στο Chicago στις 13-17/11/2010
Το συνέδριο του ACC θα γίνει στη New Orleans στις 3-5/4/2011
Το συνέδριο της HRS θα γίνει στο San Francisco στις 4-7/5/2011
Το συνέδριο του Europace θα γίνει στη Μαδρίτη στις 26-29/6/2011
Το συνέδριο της ESC θα γίνει στο Παρίσι στις 27-31/8/2011
Το συνέδριο του TCT θα γίνει στο San Francisco στις 7-11/11/2011
Το Πανελλήνιο Καρδιολογικό Συνέδριο της ΕΚΕ (HCS) 2011: εκκρεμεί η ανακοίνωση
Το συνέδριο του AHA θα γίνει στο Orlando στις 12-16/11/2011
Το συνέδριο του ACC 2012: εκκρεμεί η ανακοίνωση
Το συνέδριο Athens Cardiology Update 2012 θα διεξαχθεί στην Αθήνα στις 5 – 7/04/2012
Μετα-ανάλυση της Αποτελεσματικότητας της Κατάλυσης σε Ασθενείς με Κολπική Μαρμαρυγή στο Μέγεθος, τον Όγκο και τη Λειτουργικότητα του Αρ. Κόλπου
Οι επιπτώσεις της κατάλυσης με ραδιοσυχνότητα στο μέγεθος, τον όγκο και τη λειτουργικότητα του αριστερού κόλπου σε ασθενείς με κολπική μαρμαρυγή (κΜ) δεν είναι επαρκώς κατανοητές. Η συγκεκριμένη ανασκόπηση συμπεριέλαβε στοιχεία από πολλές βάσεις δεδομένων και τελικά 17 μελέτες με συνολικό αριθμό 869 ασθενών χρησιμοποιήθηκαν για την εξαγωγή συμπερασμάτων. Μετά την κατάλυση παρατηρείται σημαντική μείωση στη διάμετρο και όγκο του αριστερού κόλπου. Δεν τεκμηριώνεται αύξηση του κλάσματος εξωθήσεως του αριστερού κόλπου. Οι μειώσεις στις διαστάσεις και τον όγκο παρέμεναν σημαντικές μόνο σε όσους δεν εμφάνιζαν υποτροπή της αρρυθμίας, ενώ το κλάσμα εξώθησης ήταν σταθερό σε όσους παρέμεναν σε φλεβοκομβικό ρυθμό και μειωνόταν σε περιπτώσεις υποτροπών. (Jeevanantham V et al, Am J Cardiol 2010;105: 1317-26)
Ποσοστό Ασθενών που Χρήζουν Εμφύτευσης Απινιδωτή βάσει των Κατευθυντηρίων Οδηγιών και Επιπτώσεις στον Προϋπολογισμό των Συστημάτων Υγείας σε Ιταλία και ΗΠΑ. Στοιχεία από τη μελέτη ALPHA
Στοιχεία από 3513 ασθενείς της μελέτης ALPHA αξιολογήθηκαν με τη βοήθεια μοντέλου βασισμένου στις τρέχουσες κατευθυντήριες οδηγίες και σε επιδημιολογικά δεδομένα για να εκτιμηθεί ο αριθμός των ασθενών που χρήζουν θεραπείας με ICD και συγκρίθηκαν με την καταγεγραμμένη συχνότητα εμφύτευσης. Μέχρι και 54% των ασθενών με καρδιακή ανεπάρκεια είναι κατάλληλοι για εμφύτευση απινιδωτή. Εάν εφαρμοσθούν οι οδηγίες, οι εμφυτεύσεις θα αυξηθούν σημαντικά αγγίζοντας τις 27671 ανά εκατομμύριο κατοίκων στην Ιταλία και τις 4261 ανά εκατομμύριο κατοίκων στις ΗΠΑ. Μια ετήσια αύξηση των εμφυτεύσεων για προφυλακτικούς λόγους της τάξης του 20% στις ΗΠΑ και 68% στην Ιταλία θεωρείται αναγκαία για την αντιμετώπιση των περιστατικών σε ορίζοντα 5 ετίας (Pedretti RF et al, Europace, 2010 [Epub ahead of print])... (excerpt)
Athens University School of Medicine
2013-07-16 20:36:47
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http://www.rhythmos.gr/index.php/Rhythmos/article/view/92
Rhythmos; Vol. 5 No. 2 (2010)
ell
Copyright (c) 2015 Rhythmos
oai:ojs.rhythmos.gr:article/95
2013-07-16T18:03:23Z
Rhythmos:CRDN
driver
"100701 2010 eng "
1792-7927
1792-7919
dc
Ηλεκτροφυσιολογικά / Βηματοδοτικά Νέα
Manolis, Antonis S
Athens University School of Medicine &
First Department of Cardiology, Evagelismos General Hospital of Athens, Athens, Greece
Koulouris, Spyridon
Pastromas, Sokratis
Anninos, Ector
Το Πανευρωπαϊκό Συνέδριο της ESC θα πραγματοποιηθεί στη Στοκχόλμη από 28/08/2010–01/09/2010
Το επεμβατικό συνέδριο TCT θα γίνει στην Washington στις 21-25/9/10
Το Πανελλήνιο Καρδιολογικό Συνέδριο της ΕΚΕ (HCS) θα γίνει στην Αθήνα στις 21-23/10/2010
Το συνέδριο της AHA θα γίνει στο Chicago στις 13-17/11/2010
Το συνέδριο του ACC θα γίνει στη New Orleans στις 3-5/4/2011
Το συνέδριο της HRS θα γίνει στο San Francisco στις 4-7/5/2011
Το συνέδριο του Europace θα γίνει στη Μαδρίτη στις 26-29/6/2011
Το συνέδριο της ESC θα γίνει στο Παρίσι στις 27-31/8/2011
Το συνέδριο του TCT θα γίνει στο San Francisco στις 7-11/11/2011
Το Πανελλήνιο Καρδιολογικό Συνέδριο της ΕΚΕ (HCS) 2011: εκκρεμεί η ανακοίνωση
Το συνέδριο του AHA θα γίνει στο Orlando στις 12-16/11/2011
Το συνέδριο του ACC 2012: εκκρεμεί η ανακοίνωση
Το συνέδριο Athens Cardiology Update 2012 θα διεξαχθεί στην Αθήνα στις 5 – 7/04/2012
Η Διαφορική Επίδραση της Αμφικοιλιακής Βηματοδότησης και της Βηματοδότησης από τη Δεξιά Κοιλία στην Εφεδρεία Στεφανιαίας Ροής σε Ασθενείς με Ισχαιμική Καρδιοπάθεια
Η θεραπεία του κοιλιακού επανασυγχρονισμού έχει αποκτήσει σημαντική θέση στην αντιμετώπιση της καρδιακής ανεπάρκειας. Παράλληλα, φαίνεται ότι η αναβάθμιση των συμβατικών βηματοδοτικών συστημάτων σε αμφικοιλιακά προσφέρει ουσιώδες όφελος. Σκοπός της μελέτης ήταν να εξετάσει την επίδραση της αμφικοιλιακής βηματοδότησης σε σχέση με τη βηματοδότηση από τη δεξιά κοιλία στην εφεδρεία στεφανιαίας ροής σε ασθενείς με ισχαιμική καρδιοπάθεια. Είκοσι ασθενείς με καρδιακή ανεπάρκεια και αμφικοιλιακό σύστημα, 10 εκ των οποίων βελτιώθηκαν με τη θεραπεία και 10 που δεν ανταποκρίθηκαν, επελέγησαν τυχαία και μετρήθηκε αιματηρά, με ενδοστεφανιαία έγχυση αδενοσίνης η στεφανιαία εφεδρεία στον πρόσθιο κατιόντα υπό βηματοδότηση από τη δεξιά κοιλία (RV) και αμφικοιλιακά (BiV). Σε όλους υπήρχε σημαντική διαφορά στις μετρήσεις αναλόγως του είδους της βηματοδότησης (μέση διαφορά 0.15, διάστημα εμπιστοσύνης 95% 0.07–0.23, p=0.001). Σε εκείνους που ανταποκρίθηκαν στον επανασυγχρονισμό υπήρχε σημαντική διαφορά με την αμφικοιλιακή βηματοδότηση (μέση διαφορά στεφανιαίας εφεδρείας BiV - RV 0.26 ± 0.06 95% διάστημα εμπιστοσύνης 0.13–0.39, p=0.002), ενώ στους μη ανταποκριθέντες η διαφορά ήταν 0.04 ± 0.03 (p=0.168). Κατά συνέπεια, η αμφικοιλιακή βηματοδότηση σχετίζεται με μεγαλύτερη στεφανιαία εφεδρεία συνολικά σε σχέση με την απλή διπλοεστιακή βηματοδότηση. Η διαφορά αποδίδεται σχεδόν αποκλειστικά στην ευεργετική δράση του επανασυγχρονισμού σε όσους απαντούν ευνοϊκά στη θεραπεία (Deftereos S et al., JCE 2010 Jun 17. [Epub ahead of print])... (excerpt)
Athens University School of Medicine
2013-07-16 21:03:23
application/pdf
http://www.rhythmos.gr/index.php/Rhythmos/article/view/95
Rhythmos; Vol. 5 No. 3 (2010)
ell
Copyright (c) 2015 Rhythmos
oai:ojs.rhythmos.gr:article/96
2013-07-16T18:03:23Z
Rhythmos:CRDN
driver
"100701 2010 eng "
1792-7927
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dc
Νέα απο τη Βιομηχανία
Manolis, Antonis S
Athens University School of Medicine &
First Department of Cardiology, Evagelismos General Hospital of Athens, Athens, Greece
Νέο σύστημα αποκλεισμού του αριστερού ωτίου είναι διαθέσιμο απο την εταιρεία AGA Medical Corporation, το Amplatzer cardiac plug (ACP), σε ασθενείς με κολπική μαρμαρυγή, που δεν μπορούν να παίρνουν αντιπηκτική αγωγή. Η συσκευή μοιάζει με τις άλλες συσκευές σύγκλεισης ενδοκαρδιακών επικοινωνιών της ίδιας εταιρείας, έχει δηλαδή ένα άπω βύσμα (16-30 mm) και έναν εγγύς δίσκο (20-36 mm) με σύνδεση σε κοινό κεντρικό άξονα, που εισάγεται μέσω θηκαριού 9-13F, με τη χρήση δια-διαφραγματικής (transseptal) παρακέντησης και αποδεσμεύεται με παρόμοιο τρόπο με εκείνο των άλλων συσκευών. Μέχρι τώρα στο αρχείο ACP FIM Registry έχουν καταγραφεί 130 περιστατικά στα οποία η εμφύτευση απέτυχε στα 5 με σύνολο επιπλοκών 12% (4 tamponade, 2 εμβολισμοί συσκευής, 2 εγκεφαλικά, 1 διάτρηση πνευμονικής αρτηρίας, 3 περικαρδιακές συλλογές, & 2 παροδικές ανασπάσεις του ST). Απο την εμπερία απο κέντρο της Φρανκφούρτης σε 27 απο 30 ασθενείς σε διάστημα παρακολούθησης 9 μηνών δεν αναφέρθησαν όψιμα συμβάματα (εγκεφαλικά, εμβολισμοί συσκευής, θρόμβοι, υπολειπόμενη ροή στο ωτίο).
Μόλις δόθηκε CE Mark στα νέα (2ης γενιάς) μοντέλα βηματοδοτών της εταιρείας Medtronic, Ensura MRI™ SureScan™, ανθεκτικά στη μαγνητική τομογραφία,...(excerpt)
Athens University School of Medicine
2013-07-16 21:03:23
application/pdf
http://www.rhythmos.gr/index.php/Rhythmos/article/view/96
Rhythmos; Vol. 5 No. 3 (2010)
ell
Copyright (c) 2015 Rhythmos
oai:ojs.rhythmos.gr:article/100
2013-07-16T20:11:40Z
Rhythmos:CRDN
driver
"101001 2010 eng "
1792-7927
1792-7919
dc
Ηλεκτροφυσιολογικά / Βηματοδοτικά Νέα
Manolis, Antonis S
Athens University School of Medicine &
First Department of Cardiology, Evagelismos General Hospital of Athens, Athens, Greece
Koulouris, Spyridon
Anninos, Ector
Το Πανελλήνιο Καρδιολογικό Συνέδριο θα γίνει στην Αθήνα στις 21-23/10/2010
Το συνέδριο της AHA θα γίνει στο Chicago στις 13-17/11/2010
Το Σεμινάριο των Ομάδων Εργασίας της ΕΚΕ θα γίνει στο Λουτράκι στις 17-19/2/2011
Το συνέδριο του ACC θα γίνει στη New Orleans στις 3-5/4/2011
Το συνέδριο της HRS θα γίνει στο San Francisco στις 4-7/5/2011
Το συνέδριο επεμβατικής καρδιολογίας EuroPCR θα γίνει στο Παρίσι στις 17-20/5/2011
Το συνέδριο του Europace θα γίνει στη Μαδρίτη στις 26-29/6/2011
Το συνέδριο της ESC θα γίνει στο Παρίσι στις 27-31/8/2011
Το συνέδριο του TCT θα γίνει στο San Francisco στις 7-11/11/2011
Το συνέδριο του AHA θα γίνει στο Orlando στις 12-16/11/2011
Το συνέδριο Athens Cardiology Update 2012 θα διεξαχθεί στην Αθήνα στις 5 – 7/04/2012
Νέα από το Συνέδριο της Ευρωπαϊκής Καρδιολογικής Εταιρείας (Στοκχόλμη 28/8-1/9/2010)
Μελέτη SHIFT
Σε αυτή την πολυκεντρική, διπλή τυφλή τυχαιοποιημένη μελέτη 6505 ασθενείς με καρδιακή ανεπάρκεια NYHA II-IV, κλάσμα εξώθησης <35%, καρδιακή συχνότητα ηρεμίας>70 bpm με φλεβο-κομβικό ρυθμό, πλήρη αγωγή που περιελάμβανε και β-αναστολέα στο 90% και νοσηλεία για καρδιακή ανεπάρκεια το τελευταίο έτος τυχαιοποιήθηκαν σε ιβαμπραδίνη (5 mg x2 αρχική δόση με ρύθμιση μέχρι 7,5 mg x2 ώστε να επιτυγχάνεται ΚΣ 50-60/ min) ή placebo. Το πρωτογενές καταληκτικό σημείο ήταν ο συνδυασμός θανάτου ή νοσηλείας για καρδιακή ανεπάρκεια. Μετά μέση παρακολούθηση 23 μηνών οι ασθενείς στην ομάδα της ιβαμπραδίνης είχαν σημαντικά μικρότερη επίπτωση του καταληκτικού σημείου (24% ως 29% HR 0.82, p<0.0001), αλλά και των συνιστωσών του. Μικρότερη ήταν και η συχνότητα εμφάνισης παρενεργειών στην ομάδα του υπό δοκιμή φαρμάκου (3388 ως 3847 περιπτώσεις, p=0.025). Το όφελος της χορήγησης ιβαμπραδίνης ήταν μεγαλύτερο σε ασθενείς με υψηλότερη καρδιακή συχνότητα. Ο κίνδυνος ήταν 0.93 για ασθενείς με ΚΣ<77 /min & 0.75 για όσους ξεκίνησαν με ΚΣ >77/min (p=0.029).
Μελέτη DANPACE
Η πολυκεντρική αυτή τυχαιοποιημένη μελέτη συνέκρινε την κολπική με τη διπλοεστιακή βηματοδότηση σε 1415 ασθενείς με νόσο φλεβο-κόμβου, στενό QRS και φυσιολογική κ-Κ αγωγή που τυχαιοποιήθηκαν σε AAIR ή DDDR βηματοδότηση και παρακολουθήθηκαν για 10 έτη με πρωτογενές σημείο το θάνατο από οποιαδήποτε αιτία και δευτερογενή καταληκτικά σημεία την εμφάνιση παροξυσμικής ή χρόνιας κΜ, εγκεφαλικού, καρδιακής ανεπάρκειας ή την επανεπέμβαση... (excerpt)
Athens University School of Medicine
2013-07-16 23:11:40
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http://www.rhythmos.gr/index.php/Rhythmos/article/view/100
Rhythmos; Vol. 5 No. 4 (2010)
ell
Copyright (c) 2014 Rhythmos
oai:ojs.rhythmos.gr:article/107
2013-07-16T20:43:33Z
Rhythmos:CRDN
driver
"110101 2011 eng "
1792-7927
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NEWS FROM THE INDUSTRY: Safety Announcements
Anninos, Ector
First Department of Cardiology, Evagelismos General Hospital of Athens, Athens, Greece
Koulouris, Spyridon
Evagelismos Hospital, Athens
Medtronic informs that a software problem has been noticed in the following models: Consulta CRT-D, Secura DR/VR, Concerto II CRT-D, Virtuoso II DR/VR, Maximo II CRT-D, Maximo IIDR/VR. By April, 19 2010 Medtronic has received 5 confirmed reports from 144000 devices none of them associated with adverse effects of any kind. A particular sequence of the following 3 facts must take place within a few ms to cause this problem.
1. The high voltage capacitors obtain the programmed energy (termination of charge)
2. Battery voltage measurement is in progress and
3. The ventricular tachyarrhythmia is self-terminated and the subsequent therapy delivery is postponed.
In that case, all future high voltage therapies would have an elongated charge time or would fail to deliver due to charge circuit time-out. The alert systems of the devices will notify the patients to seek medical attention and this problem will be fixed with a new software installed. The possibility of this malfunction is estimated about 1/27000 devices per year and the possibility of a patient needing therapy before the device alert is activated is about 1/291000 per year... (excerpt)
Athens University School of Medicine
2013-07-16 23:43:33
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http://www.rhythmos.gr/index.php/Rhythmos/article/view/107
Rhythmos; Vol. 6 No. 1 (2011)
eng
Copyright (c) 2015 Rhythmos
oai:ojs.rhythmos.gr:article/111
2013-07-17T16:20:33Z
Rhythmos:CRDN
driver
"110401 2011 eng "
1792-7927
1792-7919
dc
Cardiology News /Recent Literature Review
Manolis, Antonis S
Athens University School of Medicine &
First Department of Cardiology, Evagelismos General Hospital of Athens, Athens, Greece
Anninos, Ector
Evagelismos Hospital, Athens
Koulouris, Spyridon
Evagelismos Hospital, Athens
The ACC Annual Congress is slated for April 3-5, 2011 in New Orleans
The HRS Annual Meeting is scheduled for May 4-7, 2011 in San Francisco
Euro-PCR will take place in Paris on May 17-20, 2011
The ESC Annual Congress is slated for 27-31/8/2011 in Paris
The TCT Annual Conference will be held in San Francisco 7-11/11/2011
The AHA Annual Scientific Sessions are scheduled for 12-16/11/2011 in Orlando
Athens Cardiology Update 2012 is slated for April 5-7, 2012
Local Atrial Inflammation Present in Paroxysmal AF
Atrial biopsies were obtained from 70 patients (age 60 ± 12 years, 49 males) undergoing radiofrequency catheter ablation for AF and 10 patients with Wolff-Parkinson-White syndrome, all undergoing trans-septal puncture. Biopsies were obtained by washing the dilator and needle used for trans-septal puncture with 20 mL sterile phosphate-buffered saline, and formalin fixed specimen were examined by immunohistochemistry for the presence of intracytoplasmic C-reactive protein. C-reactive protein was revealed in isolated atrial cardiomyocytes in 11 (73%) of 15 patients with paroxysmal AF as compared with 2 (25%) of 8 patients with persistent AF (P= 0.02). This technique for obrtaining biopsy specimen was safe and feasible. In this study, local atrial inflammation as assessed by C-reactive protein present in atrial myocytes, is more likely involved in paroxysmal rather than in persistent AF (Narducci ML et al, Europace. 2011 Mar 29. [Epub ahead of print])... (excerpt)
Athens University School of Medicine
2013-07-17 19:20:33
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http://www.rhythmos.gr/index.php/Rhythmos/article/view/111
Rhythmos; Vol. 6 No. 2 (2011)
eng
Copyright (c) 2015 Rhythmos
oai:ojs.rhythmos.gr:article/115
2013-07-17T17:27:14Z
Rhythmos:CRDN
driver
"110701 2011 eng "
1792-7927
1792-7919
dc
Cardiology News / Recent Literature Review
Metaxa, Sofia
Evagelismos Hospital, Athens
Koulouris, Spyridon
Evagelismos Hospital, Athens
Manolis, Antonis S
Athens University School of Medicine &
First Department of Cardiology, Evagelismos General Hospital of Athens, Athens, Greece
The ESC Annual Congress is slated for 27-31/8/2011 in Paris
The TCT Annual Conference will be held in San Francisco 7-11/11/2011
The AHA Annual Scientific Sessions are scheduled for 12-16/11/2011 in Orlando
The Athens Cardiology Update 2012 is slated for April 5-7, 2012
Reverse remodeling in cardiac resynchronization therapy reduces the risk of ventricular tachyarrhythmias in the MADIT-CRT trial
The risk for ventricular tachyarrhythmias (VTA) (including ventricular tachycardia, ventricular fibrillation and ventricular flutter) was assessed in patients receiving cardiac resynchronization defribrillator therapy (CRT-D) or cardioverter-defribillator therapy (ICD) according to echocardiographic findings during 1-year follow-up. It was found that high responders to CRT-D (defined as ≥ 25% reduction in left ventricular end-systolic volume) experience a significant 55% reduction in the risk of VTA compared with ICD only patients (p<0.001), whereas the risk of VTA was not significantly different between low responders and ICD-only patients (p=0.21). (Barsheshet A et al, J Am Coll Cardiol 2011; 57: 2416-2423)
High-dose atorvastatin does not prevent development of atrial fibrillation in patients with prior stroke or transient ischemic attack in the SPARCL trial
Statins are included as upstream therapy for prevention of new-onset of atrial fibrillation (AF) in the 2010 guidelines for the management of AF. The SPARCL trial tested the hypothesis that long-term treatment with high-dose atorvastatin (80 mg) reduces the occurrence of AF in 4731 patients with prior stroke or transient ischemic attack who were followed up for a median of 4.8 years (patients with prior paroxysmal AF were excluded from the trial). It was concluded that the time from randomization to first occurrence of new AF did not differ between atorvastatin (139 cases of new AF) and placebo (122 cases) group (hazard ratio 1.15, 95% CI 0.90-1.46, P=0.26). (Schwartz GG et al, Am Heart J 2011; 161: 993-999)... (excerpt)
Athens University School of Medicine
2013-07-17 20:27:14
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http://www.rhythmos.gr/index.php/Rhythmos/article/view/115
Rhythmos; Vol. 6 No. 3 (2011)
eng
Copyright (c) 2015 Rhythmos
oai:ojs.rhythmos.gr:article/119
2013-07-17T17:53:40Z
Rhythmos:CRDN
driver
"111001 2011 eng "
1792-7927
1792-7919
dc
Cardiology News / Recent Literature Review
Anninos, Hector
Evagelismos Hospital, Athens
Koulouris, Spyridon
Evagelismos Hospital, Athens
Manolis, Antonis S
Athens University School of Medicine &
First Department of Cardiology, Evagelismos General Hospital of Athens, Athens, Greece
The TCT Annual Conference will be held in San Francisco 7-11/11/2011
The AHA Annual Scientific Sessions are scheduled for 12-16/11/2011 in Orlando
The next ACC Annual Meeting is slated for 24-27/3/2012 in Chicago
The Athens Cardiology Update 2012 is slated for April 5-7, 2012
The HRS 33rd Annual Meeting will be held in Boston, 9-12/5/2012
The next ESC Annual Congress will be held in Munich, 25-29/8/2012
Incidence and Predictors of ICD Therapy in Patients With Arrhythmogenic Right Ventricular Dysplasia/ Cardiomyopathy (ARVC) Undergoing ICD Implantation for Primary Prevention
Eighty-four patients with definite or probable ARVC underwent ICD implantation for primary prevention. After a follow-up of 4.7 ± 3.4 years, appropriate ICD therapy was delivered in 40 patients (48%). Predictors of such an intervention were proband status (p < 0.001), inducibility at electrophysiologic study (p = 0.005), presence of nonsustained ventricular tachycardia (p < 0.001), and Holter premature ventricular complex count >1,000/24 h (p = 0.024). In multivariate analysis, inducibility at electrophysiologic study and nonsustained ventricular tachycardia remained significant predictors. The number of these risk factors correlates with the incidence of ICD activation with the 5-year survival free of appropriate ICD therapy for patients with 1, 2, 3, and 4 risk factors being 100%, 83%, 21%, and 15%, respectively (Bhonsale A et al, J Am Coll Cardiol 2011; 58:1485-1496).
Exclusion of the Left Atrial Appendage with a Novel Device: Early Results of a Multicenter Trial
Seventy patients with atrial fibrillation or a CHADS2 score greater than 2 undergoing elective cardiac surgery were eligible for concomitant AtriClip device (35, 40, 45, and 50 mm) insertion. Safety was assessed at 30 days, and efficacy of left atrial appendage exclusion was assessed at operation (by transesophageal echocardiography) and at 3-month follow-up (by computed tomography angiography or transesophageal echocardiography). Intraprocedural success reached 95.7% (67 of 70 patients). Although significant adverse events occurred in 34 of 70 patients (48.6%), none was related to the device and there was no perioperative mortality. At 3-month follow-up, 98.4% of the patients had successful left atrial appendage exclusion by computed tomography angiography or transesophageal echocardiography imaging (Ailawadi G et al, J Thorac Cardiovasc Surg 2011; 142:1002-1009)... (excerpt)
Athens University School of Medicine
2013-07-17 20:53:40
application/pdf
http://www.rhythmos.gr/index.php/Rhythmos/article/view/119
Rhythmos; Vol. 6 No. 4 (2011)
eng
Copyright (c) 2015 Rhythmos
oai:ojs.rhythmos.gr:article/122
2013-07-17T18:53:57Z
Rhythmos:CRDN
driver
"120101 2012 eng "
1792-7927
1792-7919
dc
Cardiology News /Recent Literature Review / Last Quarter 2011
Manolis, Antonis S
Athens University School of Medicine &
First Department of Cardiology, Evagelismos General Hospital of Athens, Athens, Greece
Anninos, Hector
Evagelismos Hospital, Athens
The ACC Meeting is slated for 24-27/3/2012 in Chicago
The Athens Cardiology Update 2012 is slated for April 5-7, 2012
The HRS 33rd Meeting will be held in Boston, 9-12/5/12
The ESC Congress will be held in Munich, 25-29/8/2012
ALLHAT Trial: Once Heart Failure Develops in High-Risk Hypertensive Patients, Mortality is High
At a mean follow-up of 8.9 years, of 1761 participants in the ALLHAT trial with incident heart failure (HF) in-trial, 1348 (77%) died. Mortality rates were similar across treatment comparisons, with adjusted 10-year all-cause mortality rates per 100 persons of 83 for chlorthalidone, 86 for amlodipine, and 87 for lisinopril. Mortality was similar for those with preserved (81%) and low ejection fraction (84%). Thus, once HF develops, risk of death is high and consistent across randomized treatment groups. Measures to prevent the development of HF, especially blood pressure control, must be a priority if mortality associated with the development of HF is to be addressed (Piller LB et al, Circulation 2011;124:1811-1818).
Isolated Low HDL-Cholesterol is Associated with Increased Coronary Risk
Data from 220 060 participants (87% Asian) in 37 studies from the Asia-Pacific region indicated low HDL-C (HDL <40 mg/dl in men and <50 mg/dl in women) among 33.1% of Asians vs 27.0% of non-Asians (P<0.001). The prevalence of low HDL-C in the absence of other lipid abnormalities (isolated low HDL-C) was higher in Asians compared with non-Asians: 22.4% vs 14.5%, respectively (P<0.001). After 6.8 years, there were 574 coronary heart disease and 739 stroke events. There was an inverse relationship between low HDL-C with coronary heart disease in all individuals (hazard ratio, 1.57). In Asians, isolated low levels of HDL-C were as strongly associated with coronary heart disease risk as low levels of HDL-C combined with other lipid abnormalities (hazard ratio, 1.67 vs 1.63, respectively). There was no association between low HDL-C and stroke risk (Huxley RR et al, Circulation2011;124:2056-2064)... (excerpt)
Athens University School of Medicine
2013-07-17 21:53:57
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http://www.rhythmos.gr/index.php/Rhythmos/article/view/122
Rhythmos; Vol. 7 No. 1 (2012)
eng
Copyright (c) 2015 Rhythmos
oai:ojs.rhythmos.gr:article/125
2017-01-10T18:13:00Z
Rhythmos:CRDN
driver
"120401 2012 eng "
1792-7927
1792-7919
dc
Cardiology News /Recent Literature Review / First Quarter 2012
Manolis, Antonis S
Athens University School of Medicine &
First Department of Cardiology, Evagelismos General Hospital of Athens, Athens, Greece
Anninos, Hector
Evagelismos Hospital, Athens
The Athens Cardiology Update 2012 is slated for April 5-7, 2012
The HRS 33rd Meeting will be held in Boston, 9-12/5/12
The ESC Congress will be held in Munich, 25-29/8/2012
TCT Meeting will take place in Miami, 22-26/10/12
HCS Meeting to be held in Athens, 1-3/11/12
AHA 2012 is scheduled for Los Angeles, 3-7/11/12
PARTNER Trial (Cohort B): TAVI Remains Cost-Effective for Patients with Severe Aortic Stenosis who are not Candidates for Surgery
The PARTNER trial randomized patients with symptomatic, severe aortic stenosis who were not candidates for surgery to transcatheter aortic valve implantation (TAVI) (n=179) or standard therapy (n=179). Mean costs for the initial TAVI procedure and hospitalization were $42,806 and $78,542, respectively. Follow-up costs through 12 months were lower with TAVI ($29,289 vs $53,621) because of reduced hospitalization rates, but cumulative 1-year costs remained higher ($106,076 vs $53,621). Projection was that over a patient’s lifetime, TAVI would increase discounted life expectancy by 1.6 years (1.3 quality-adjusted life-years-QALY) at an incremental cost of $79,837. The incremental cost-effectiveness ratio for TAVI was thus estimated at $50,200 per year of life gained or $61,889 per QALY gained. The authors concluded that TAVI increases life expectancy at an incremental cost per life-year gained well within accepted values for commonly used cardiovascular technologies. (Reynolds MR et al, Circulation 2012;125:1102-1109).
SCAAR Registry: Lower Risk of Stent Thrombosis & Restenosis with Unrestricted Use of ‘New-Generation’ Drug-Eluting Stents
A total of 94,384 consecutive stent implantations, including bare metal (BMS, n=64,631), older generation drug-eluting stents (o-DES, n=19,202), and new generation DES (n-DES, n = 10 551) were evaluated in Sweden. Older generation DES comprised Cypher and Cypher Select, Taxus Express and Taxus Liberte, and Endeavor Sprint, while n-DES included Endeavor Resolute, XienceV, Xience Prime, Promus, and Promus Element. A statistically significant lower risk of restenosis was shown for n-DES compared with BMS [adjusted hazard ratio (HR) 0.29] and o-DES (HR 0.62). A lower risk of definite ST was found in n-DES compared with BMS (HR 0.38) and o-DES (HR, 0.57). The risk of death was significantly lower in n-DES compared with o-DES (adjusted HR: 0.77) and BMS (adjusted HR: 0.55). The authors concluded that PCI with n-DES is associated with a 38% lower risk of clinical restenosis, a 43% lower risk of definite ST, and a 23% lower risk of death compared with o-DES (Sarno G et al, Eur Heart J 2012;33:606-613)... (excerpt)
Athens University School of Medicine
2013-07-17 22:10:18
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http://www.rhythmos.gr/index.php/Rhythmos/article/view/125
Rhythmos; Vol. 7 No. 2 (2012)
eng
Copyright (c) 2015 Rhythmos
oai:ojs.rhythmos.gr:article/128
2013-07-17T19:24:33Z
Rhythmos:CRDN
driver
"120701 2012 eng "
1792-7927
1792-7919
dc
Cardiology News /Recent Literature Review / Mid Quarter 2012
Manolis, Antonis S
Athens University School of Medicine &
First Department of Cardiology, Evagelismos General Hospital of Athens, Athens, Greece
Koulouris, Spyridon
Evagelismos Hospital, Athens
The ESC Congress will be held in Munich, 25-29/8/2012
TCT Meeting will take place in Miami, 22-26/10/12
HCS Meeting to be held in Athens, 1-3/11/12
AHA 2012 is scheduled for Los Angeles, 3-7/11/12
TWENTE Trial: the Resolute Zotarolimus Eluting Stents are Noninferior to Xience V Everolimus Eluting Stents in Treating “Real-World” Patients with Complex Lesions and “Off-label” Indications for DES
A total of 1,391 patients were randomly assigned to zotarolimus eluting stents (ZES) (n = 697) or everolimus eluting stents (EES) (n = 694). Acute coronary syndromes were present in 52% and “off-label” feature in 77% of patients. Of the lesions, 70% were type B2/C; the post-dilation rate was very high (82%). In ZES and EES, target vessel failure (TVF) occurred in 8.2% and 8.1%, respectively (absolute risk-difference 0.1%; p (noninferiority) = 0.001). The definite-or-probable stent thrombosis rates were relatively low and similar for ZES and EES (0.9% and 1.2%, respectively, p = NS). Definite stent thrombosis rates were also low (0.58% and 0%, respectively, p = NS). In EES, probable stent thrombosis beyond day 8 was observed only in patients not adhering to dual antiplatelet therapy. The authors concluded that resolute ZES were noninferior to Xience V EES in treating “real-world” patients with a vast majority of complex lesions and “off-label” indications for drug-eluting stents (DES), which were implanted with liberal use of post-dilation (von Birgelen C et al, J Am Coll Cardiol 2012;59:1350–1361).
The TARGET Study: Placement of the LV Lead to the Latest Sites of Contraction and Away from the Scar Confers the Best Response to CRT
Among 220 patients receiving cardiac resynchronization therapy (CRT), the left ventricular (LV) lead was positioned at the latest site of peak contraction (as determined by echocardiographic speckle-tracking 2-dimensional radial strain imaging) with an amplitude of >10% to signify freedom from scar (n=110, TARGET group), while in the control group (n=110) standard unguided CRT was performed. In the TARGET group, there was a greater proportion of responders at 6 months (70% vs 55%, p = 0.031) with an absolute difference in the primary endpoint (>15% reduction in LV end-systolic volume at 6 months) of 15%. Compared with controls, TARGET patients had a higher clinical response (83% vs 65%, p = 0.003) and lower rates of the combined endpoint (all-cause mortality and heart failure–related hospitalization) (p = 0.031). The authors concluded that compared with standard CRT treatment, the use of speckle-tracking echocardiography to the target LV lead placement yields significantly improved response and clinical status and lower rates of combined death and heart failure–related hospitalization (Khan FZ et al, J Am Coll Cardiol 2012;59:1509–1518)... (excerpt)
Athens University School of Medicine
2013-07-17 22:24:33
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http://www.rhythmos.gr/index.php/Rhythmos/article/view/128
Rhythmos; Vol. 7 No. 3 (2012)
eng
Copyright (c) 2015 Rhythmos
oai:ojs.rhythmos.gr:article/131
2013-09-22T16:02:34Z
Rhythmos:CRDN
driver
"121001 2012 eng "
1792-7927
1792-7919
dc
Cardiology News /Recent Literature Review Third Quarter 2012
Manolis, Antonis S
Athens University School of Medicine &
First Department of Cardiology, Evagelismos General Hospital of Athens, Athens, Greece
Metaxa, Sofia
Evagelismos Hospital, Athens
Anninos, Hector
Evagelismos Hospital, Athens
TCT Meeting will take place in Miami, 22-26/10/12
HCS Meeting to be held in Athens, 1-3/11/12
AHA 2012 is scheduled for Los Angeles, 3-7/11/12
EuroEcho will take place in Athens, 5-8/12/2012
HCS Working Group Seminars: Thessaloniki, 14-16/2/2013
ACC Meeting: San Francisco, 9-11/3/13
HRS Meeting: Denver, 8-11/5/13
EuroPCR: Paris, 21-24/5/13
EuroPace: Athens, 23-26/6/13
ESC Congress: Amsterdam, 31/8-4/9/13
Dennmark Cohort Study: In Patients with AF, Interruption of Warfarin Confers Increased Short-Term Risk of Death or Thrombo-Embolic Events
In total, 48,989 atrial fibrillation (AF) patients receiving warfarin were included in this retrospective cohort study. Of these, 35,396 patients had at least one episode of warfarin treatment interruption. In all, 8255 deaths or thromboembolic events occurred during treatment interruption showing an initial clustering of events during 0–90 days. The first 90-day interval of treatment interruption was associated with a markedly higher risk of death or thrombo-embolism (incidence rate ratio-IRR 2.5) vs the interval of 271–360 days. The authors concluded that in this patient population with AF, almost 3 out of 4 patients on warfarin treatment had one or more periods of treatment interruption. Interruption of warfarin therapy was associated with a significantly increased short-term risk of thrombo-embolism or death during the first 90 days of interruption (Raunso J et al, Eur Heart J 2012; 33: 1886–1892).
Left Ventricular Dyssynchrony May Determine Outcome Following CRT in Patients with RBBB and Help in the Selection of CRT Candidates
Echocardiography was performed in 561 cardiac resynchronization therapy (CRT) recipients (89 with RBBB & 472 with LBBB) before and 6 months after CRT. RBBB patients had a higher prevalence of male gender, ischemic heart disease, atrial fibrillation, and lower exercise capacity when compared with LBBB patients, despite smaller left ventricular (LV) volumes. In addition, the extent of both interventricular and LV dyssynchrony was less in RBBB patients. At 6 months, RBBB patients also showed limited LV reverse remodelling. LV dyssynchrony and mitral regurgitation were identified as independent predictors of all-cause mortality or heart failure hospitalization among RBBB patients. The authors concluded that RBBB patients referred for CRT exhibit interventricular and LV dyssynchrony, albeit less than their LBBB counterparts; preimplantation LV dyssynchrony may be an important determinant of death or heart failure hospitalization among CRT recipients with RBBB (Leong DP et al, Eur Heart J 2012; 33: 1934–1941)... (excerpt)
Athens University School of Medicine
2013-09-22 19:02:34
application/pdf
http://www.rhythmos.gr/index.php/Rhythmos/article/view/131
Rhythmos; Vol. 7 No. 4 (2012)
eng
Copyright (c) 2015 Rhythmos
oai:ojs.rhythmos.gr:article/134
2013-11-29T15:17:17Z
Rhythmos:CRDN
driver
"130101 2013 eng "
1792-7927
1792-7919
dc
Cardiology News /Recent Literature Review / Last Quarter 2012
Manolis, Antonis S
Athens University School of Medicine &
First Department of Cardiology, Evagelismos General Hospital of Athens, Athens, Greece
Anninos, Hector
Evagelismos Hospital, Athens
HCS Working Group Seminars will take place in Thessaloniki, 14-16/2/2013
ACC Meeting is slated for San Francisco, 9-11/3/13
HRS Meeting will take place in Denver, 8-11/5/13
EuroPCR to be held in Paris, 21-24/5/13
EuroPace will be held in Athens, 23-26/6/13
ESC Congress will be held in Amsterdam, 31/8-4/9/13
TCT Meeting: San Francisco, 28/10-1/11/13
AHA 2013: Dallas, 16-20/11/13
Metoprolol is not Effective in Long QT Syndromes Types 1 and 2 Compared to Propranolol and Nadolol
The effect of beta blockers was assessed in 382 LQT1/ LQT2 patients (56% female, 27% symptomatic, mean heart rate 76 bpm, mean QTc 472 ms) started on propranolol (n=134), metoprolol (n=147), and nadolol (n=101) at a median age of 14 years. The QTc shortening with propranolol was significantly greater than with other beta-blockers in all patients and in the subset with QTc >480 ms. None of the asymptomatic patients had arrhythmia events. Among symptomatic patients (n=101), 15 had syncope. The QTc shortening was significantly less pronounced among patients with syncope. There was a greater risk of syncope for symptomatic patients initiated on metoprolol compared to users of the other 2 beta-blockers combined, after adjustment for genotype (odds ratio: 3.95, p=0.025). Kaplan-Meier analysis showed a significantly lower event-free survival for symptomatic patients receiving metoprolol compared to propranolol/nadolol. The authors concluded that propranolol and nadolol are significantly more effective than metoprolol in preventing arrhythmic events in symptomatic patients. Also, propranolol was superior to both nadolol and metoprolol in terms of shortening the QTc, particularly in high-risk patients with markedly prolonged QTc. Patients with syncope had significantly less QTc shortening than the event-free patients (Chockalingam P et al, J Am Coll Cardiol 2012;60:2092–2099).
Still Limitations in Subcutaneous ICD
A total of 118 patients (75% males, mean age 50 years) received the entirely subcutaneous implantable cardioverter defibrillator (S-ICD) system. After 18 months of follow-up, 8 patients experienced 45 successful appropriate shocks (98% first shock conversion efficacy). No sudden deaths occurred. Inappropriate shocks occurred in 15 patients (13%), mainly due to T-wave oversensing, mostly solved by a software upgrade and changing the sensing vector of the S-ICD. Complications were noted in 16 patients (14%), more frequently in the first 15 implantations per center. The authors concluded that S-ICD is effective in terminating ventricular arrhythmias, but it has still limitations due to its subcutaneous position. Inappropriate therapy is an important issue in the S-ICD. However, both inappropriate shocks and device-related complications seemed to be related to a learning curve of both the device and the physician (Nordkamp et al, J Am Coll Cardiol 2012;60:1933–1939)... (excerpt)
Athens University School of Medicine
2013-11-29 17:17:17
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http://www.rhythmos.gr/index.php/Rhythmos/article/view/134
Rhythmos; Vol. 8 No. 1 (2013)
eng
Copyright (c) 2015 Rhythmos
oai:ojs.rhythmos.gr:article/137
2013-08-24T16:17:38Z
Rhythmos:CRDN
driver
"130101 2013 eng "
1792-7927
1792-7919
dc
Cardiology News /Recent Literature Review / First Quarter 2013
Manolis, Antonis S
Athens University School of Medicine &
First Department of Cardiology, Evagelismos General Hospital of Athens, Athens, Greece
Rouska, Effie
Evagelismos Hospital, Athens
Anninos, Hector
Evagelismos Hospital, Athens
HRS Meeting will take place in Denver, 8-11/5/13
EuroPCR to be held in Paris, 21-24/5/13
EuroPace will be held in Athens, 23-26/6/13
ESC Congress will be held in Amsterdam, 31/8-4/9/13
TCT Meeting: San Francisco, 28/10-1/11/13
AHA 2013: Dallas, 16-20/11/13
Pre-RELAX-AHF and RELAX-AHF Trials: Relaxin Reduces 6-month Mortality in Acute Heart Failure Patients
In the Pre-RELAX-AHF (Relaxin in Acute Heart Failure) phase II study and RELAX-AHF phase III study patients hospitalized for acute heart failure were randomized within 16 h to IV placebo or serelaxin. Serelaxin reduced 6-month mortality in both studies (combined studies: N = 1,395; hazard ratio: 0.62; p = 0.0076). In RELAX-AHF, serelaxin improved the markers of cardiac (high-sensitivity cardiac troponin T), renal (creatinine/cystatin-C), and hepatic (AST/ALT) damage and of decongestion (N-T pro–BNP), while changes in these markers at day 2 and worsening heart failure during admission were associated with 6-month mortality. The authors concluded that early administration of serelaxin was associated with a reduction of 6-month mortality, while fewer signs of organ damage and more rapid relief of congestion were noted during the first days after admission (Metra et al, J Am Coll Cardiol 2013;61:196–206)
Favorable 5-Year Outcome after TAVI
The 5-year outcome was evaluated in 88 patients undergoing successful TAVI with a balloon-expandable valve. Mean aortic valve gradient decreased from 46 + 18 mm Hg to 10 + 4.5 mm Hg after TAVI and maintained at 11.8 + 5.7 mm Hg at 5 years (p for post-TAVI trend = 0.06). Mean aortic valve area increased from 0.62 + 0.17 cm2 to 1.67 + 0.41 cm2 after TAVI and 1.40 + 0.25 cm2 at 5 years (p for post-TAVI trend <0.01). At 5 years, 3 patients (3.4%) had moderate prosthetic valve dysfunction. Survival rates at 1 to 5 years were 83%, 74%, 53%, 42%, and 35%, respectively. Median survival time after TAVI was 3.4 years, and the risk of death was significantly increased in patients with chronic obstructive pulmonary disease (hazard ratio [HR]: 2.17) and at least moderate paravalvular regurgitation (adjusted HR: 2.98). Thus, a favorable long-term outcome after TAVI was demonstrated. Signs of moderate prosthetic valve failure were observed in 3.4% of patients. No patients developed severe prosthetic regurgitation or stenosis. Comorbidities, mainly chronic lung disease and at least moderate paravalvular regurgitation, were associated with reduced long-term survival (Toggweiler et al, J Am Coll Cardiol 2013;61:413–419)... (excerpt)
Athens University School of Medicine
2013-07-22 00:00:23
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http://www.rhythmos.gr/index.php/Rhythmos/article/view/137
Rhythmos; Vol. 8 No. 2 (2013)
eng
Copyright (c) 2015 Rhythmos
oai:ojs.rhythmos.gr:article/141
2013-08-30T19:54:50Z
Rhythmos:CRDN
driver
"130830 2013 eng "
1792-7927
1792-7919
dc
Cardiology News /Recent Literature Review / Second Quarter 2013
Manolis, Antonis S
Athens University School of Medicine &
First Department of Cardiology, Evagelismos General Hospital of Athens, Athens, Greece
Rouska, Effie
Evagelismos Hospital, Athens
Anninos, Hector
Evagelismos Hospital, Athens
ESC Congress will be held in Amsterdam, 31/8-4/9/13
HCS Meeting: Athens, 10-12/10/2013
TCT Meeting: San Francisco, 28/10-1/11/13
AHA 2013: Dallas, 16-20/11/13
ACC 2014: Washington, DC, 29-31/3/2014
Athens Cardiology Update 2014: Athens (Crown Plaza Hotel), 10-12/4/2014
HRS Meeting: San Francisco, 7-10/5/2014
EuroPCR: Paris, 20-23/5/2014
CardioStim 2014: Nice, 18-21/6/2014
ARMYDA-9 CAROTID: Clopidogrel Load & Atorvastatin Reload Prevent Ischemic Cerebral Events After Protected Carotid Stenting
A total of 156 patients undergoing protected carotid stenting were randomized to a 600-mg (n=78) or 300-mg (n=78) clopidogrel load given 6 h before intervention and either an atorvastatin reload (n=76; 80 mg + 40 mg initiating 12 h before the procedure) or no statin reload (n=80). Occurrence of the primary outcome (30-day incidence of TIA/stroke or new ischemic lesions on cerebral MRI performed at 24-48 h) was lower in the 600-mg clopidogrel arm (18% vs. 35.9% in the 300-mg group; p = 0.019) and in the atorvastatin reload arm (18.4% vs 35.0% in the no statin reload group; p=0.031). High-dose clopidogrel also significantly reduced the TIA/ stroke rate at 30 days (0% vs 9%, p = 0.02), without an increase in bleeding risk. The authors concluded that in patients undergoing carotid stenting, a 600-mg clopido-grel load and a short-term reload with high-dose atorva-statin protects against early ischemic cerebral events (Patti G et al, J Am Coll Cardiol 2013;61:1379-1387)
MADIT CRT: Carvedilol Produces 30% Reduction in Hospitalizations for HF or Death When Compared With Metoprolol
The effects of metoprolol and carvedilol were compared in the MADIT-CR study. Hospitalization for HF or death occurred in 23% on carvedilol and 30% on metoprolol (hazard ratio-HR: 0.70, p=0.001), further attenuated in the subgroup of CRT-D patients (HR: 0.61, p = 0.001) and CRT-D patients with LBBB (HR: 0.51, p < 0.001). Ventricular arrhythmias occurred in 22% and in 26%, respectively, of the patients receiving carvedilol or metoprolol (HR: 0.80, p = 0.050). A dose-dependent relationship was found in carvedilol, but not in metoprolol. The authors concluded that in HF patients in NYHA class I/II & wide QRS, carvedilol was associated with a 30% reduction in hospitalizations for HF or death when compared with metoprolol. A novel beneficial and synergistic effect of carvedilol was seen in patients with CRT-D & LBBB. Finally, a dose-dependent effect was apparent in carvedilol, but not in metoprolol (Ruwald et al, J Am Coll Cardiol 2013;61:1518–1526)... (excerpt)
Athens University School of Medicine
2013-08-30 22:54:02
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http://www.rhythmos.gr/index.php/Rhythmos/article/view/141
Rhythmos; Vol. 8 No. 3 (2013)
eng
Copyright (c) 2015 Rhythmos
oai:ojs.rhythmos.gr:article/144
2013-10-20T11:54:40Z
Rhythmos:CRDN
driver
"131020 2013 eng "
1792-7927
1792-7919
dc
Cardiology News /Recent Literature Review / Third Quarter 2013
Manolis, Antonis S
Athens University School of Medicine &
First Department of Cardiology, Evagelismos General Hospital of Athens, Athens, Greece
Rouska, Effie
Evagelismos Hospital, Athens
Anninos, Hector
Evagelismos Hospital, Athens
HCS Meeting: Athens, 10-12/10/2013
TCT Meeting: San Francisco, 28/10-1/11/13
AHA 2013: Dallas, 16-20/11/13
ACC 2014: Washington, DC, 29-31/3/2014
Athens Cardiology Update 2014: Athens (Crown Plaza Hotel), 10-12/4/2014
HRS Meeting: San Francisco, 7-10/5/2014
EuroPCR: Paris, 20-23/5/2014
CardioStim 2014: Nice, 18-21/6/2014
Percutaneous Left Atrial Appendage Closure May be a Therapeutic Alternative in Patients with Atrial Fibrillation (AF) and Absolute Contraindications to Anticoagulation Therapy
Left atrial appendage closure (LAAC) with the AMPLATZER Cardiac Plug (ACP) was successfully performed in 51 of 52 (98%) patients (aged 74+8 years) with AF and absolute contraindications to anticoagulation therapy. Most patients received dual-antiplatelet therapy after the procedure for 1-3 months and single antiplatelet therapy thereafter. Main complications were device embolization (1.9%) and pericardial effusion (1.9%), with no cases of periprocedural stroke. At follow-up (20+5 months), death rate was 5.8%, stroke 1.9%, systemic embolism 0%, pericardial effusion 1.9%, and major bleeding 1.9%. The presence of mild peridevice leak was observed in 16.2% of patients at the 6-month follow-up as evaluated by transesophageal echo. There were no cases of device thrombosis. The authors concluded that in patients with nonvalvular AF at high risk of cardioembolic events and absolute contraindications to anticoagulation, LAAC using the ACP device followed by dual-/single-antiplatelet therapy was associated with a low rate of embolic and bleeding events and no device thrombosis at short and midterm follow-up (Urena M et al, J Am Coll Cardiol 2013;62:96–102).
Preliminary Favorable Experience With Percutaneous Left Atrial Appendage Suture Ligation Using the LARIAT Device in Patients With Atrial Fibrillation
Percutaneous ligation of the left atrial appendage (LAA) with the LARIAT device (a snare with a pre-tied suture guided epicardially over the LAA) was success-fully performed in 85 of 89 (96%) patients with complete closure achieved in 81 patients, while 4 had a <2-3-mm residual LAA leak. There were 3 complications (during pericardial access, n=2; & transseptal catheterization, n=1). Adverse events included severe pericarditis post-operatively (n=2), late pericardial effusion (n=1), sudden death (n=2), & late strokes (n=2). At 1 (81 of 85) & 3 months (77 of 81) post-ligation, 95% of the patients had complete LAA closure by transesophageal echo (TEE). Of the 65 patients undergoing 1-year TEE, there was 98% complete LAA closure, including patients with previous leaks. The authors concluded that LAA closure with the LARIAT device can be performed effectively with acceptably low complication rate (Bartus et al, J Am Coll Cardiol 2013;62:108–118)... (excerpt)
Athens University School of Medicine
2013-10-20 14:54:40
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http://www.rhythmos.gr/index.php/Rhythmos/article/view/144
Rhythmos; Vol. 8 No. 4 (2013)
eng
Copyright (c) 2015 Rhythmos
oai:ojs.rhythmos.gr:article/147
2014-02-24T00:13:30Z
Rhythmos:CRDN
driver
"140224 2014 eng "
1792-7927
1792-7919
dc
Cardiology News /Recent Literature Review / Fourth Quarter 2013
Manolis, Antonis S
Athens University School of Medicine &
First Department of Cardiology, Evagelismos General Hospital of Athens, Athens, Greece
Rouska, Effie
Evagelismos Hospital, Athens
Anninos, Hector
Evagelismos Hospital, Athens
ACC Congress 2014: Washington, DC, 29-31/3/2014
Athens Cardiology Update 2014: Athens (Crown Plaza Hotel), 10-12/4/2014
HRS Meeting: San Francisco, 7-10/5/2014
EuroPCR: Paris, 20-23/5/2014
CardioStim 2014: Nice, 18-21/6/2014
ESC Congress 2014 (Barcelona, 30/8-3/9/14)
Only One Fifth of the Sudden Cardiac Arrest Victims in the Community are Eligible for a Primary Prevention ICD Before the Event, but Among These, a Small Proportion (13%) are Actually Implanted
According to data from the Oregon Sudden Unexpected Death study, among 2093 victims of sudden cardiac arrest (SCA) over a decade, of 448 having information about left ventricular ejection fraction (LVEF), 92 (20.5%) were eligible for primary ICD implantation, 304 (67.9%) were ineligible because of LVEF>35%, & the remainder (52, 11.6%) had LVEF ≤35% but were ineligible on the basis of clinical criteria. Among eligible subjects, only 12 (13%) received a primary ICD. Compared with recipients, ICD nonrecipients were older (age at LVEF assessment, 67.1±13.6 vs 58.5±14.8 years, P=0.05), with 20% aged ≥80 years (vs 0% among recipients, P=NS). Additionally, a subgroup (26%) had either a clinical history of dementia or were undergoing chronic dialysis. The authors concluded that only one fifth of the SCA cases in the community were eligible for a primary prevention ICD before the event, but among these, a small proportion (13%) were actually implanted. Although older age and comorbidity may explain nondeployment in a subgroup of these cases, other determinants such as socioeconomic factors, health insurance, patient preference, and clinical practice patterns may play a role (Narayanan K, et al, Circulation 2013;128:1733-1738).
Appropriate ICD Therapies over 10 Years are More Prevalent in Symptomatic Brugada Syndrome (19-48%) but Still Occur in Asymptomatic Patients (12%)
A total of 378 patients (310 men; aged 46±13 years) with a type 1 Brugada ECG pattern were implanted with an implantable cardioverter-defibrillator-ICD; 31 for aborted sudden cardiac arrest, 181 for syncope, and 166 asymptomatic. During a mean follow-up of 77±42 months for 363 patients, 7 patients (2%) died (1 as a result of an inappropriate shock), and 46 patients (12%) had appropriate device therapy (5±5 shocks per patient). Appropriate device therapy rates at 10 years were 48% for patients whose ICD indication was aborted sudden cardiac arrest, 19% for those with syncope, and 12% for the asymptomatic patients. At 10 years, rates of inappropriate shock and lead failure were 37% and 29%, respectively. Inappropriate shock occurred in 91 patients (24%) because of lead failure (n=38), supraventricular tachycardia (n=20), T-wave oversensing (n=14), or sinus tachycardia (n=12). Reduced inappropriate shocks were noted with introduction of remote monitoring, programming a high single ventricular fibrillation zone (>210–220 bpm), and a long detection time. The authors concluded that appropriate therapies are more prevalent in symptomatic Brugada syndrome but are not insignificant in asymptoma-tic patients (1%/y). Optimal ICD programming and remote monitoring dramatically reduce inappropriate shocks. However, lead failure remains a major problem in this population (Sacher F et al, Circulation 2013;128: 1739-1747)... (excerpt)
Athens University School of Medicine
2014-02-24 02:13:30
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http://www.rhythmos.gr/index.php/Rhythmos/article/view/147
Rhythmos; Vol. 9 No. 1 (2014)
eng
Copyright (c) 2014 Rhythmos
oai:ojs.rhythmos.gr:article/151
2014-08-14T14:04:32Z
Rhythmos:CRDN
driver
"140814 2014 eng "
1792-7927
1792-7919
dc
Cardiology News /Recent Literature Review / First Quarter 2014
Vlachos, Konstantinos
Second Department of Cardiology, Evagelismos General Hospital of Athens, Athens, Greece
Letsas, Kostas
Second Department of Cardiology, Evagelismos General Hospital of Athens, Athens, Greece
Manolis, Antonis S
Athens University School of Medicine &
First Department of Cardiology, Evagelismos General Hospital of Athens, Athens, Greece
Athens Cardiology Update 2014: Athens (Crown Plaza Hotel), 10-12/4/2014
HRS Meeting: San Francisco, 7-10/5/2014
EuroPCR: Paris, 20-23/5/2014
CardioStim: Nice, 18-21/6/2014
ESC Congress: Barcelona, 30/8-3/9/14
TCT: Washington, 12-17/9/14
HCS Annual Meeting: Athens, 23-25/10/2014
AHA: Chicago, 15-19/11/14
Cutting Inappropriate ICD Shocks: Long Arrhythmia-Detection Time Strategy Confirmed
Programming implantable cardioverter defibrillators (ICDs) to delay the time they take to treat ventricular arrhythmias cuts mortality by 23% and inappropriate shocks by more than one-half in a meta-analysis encompassing ~4900 patients. The included studies were prospective and multicenter and covered both primary and secondary prevention and patients with either ischemic or nonischemic cardiomyopathy. The risk of syncope did not rise significantly with longer detection times, despite traditional concerns that lots of patients would not tolerate prolonged arrhythmia exposure before their ICD is allowed to deliver therapy, either shocks or antitachycardia pacing (ATP). Instead, the extra time frequently gave devices a better chance to exclude non–life-threatening arrhythmias like atrial fibrillation and to let otherwise self-terminating ventricular arrhythmias play out on their own. Current nominal settings used by some ICD manufacturers are likely to be too aggressive, with arrhythmia detection times that in some cases may be as short as 1-3 s. These results highlight the importance of setting longer default ICD detection times. The analysis included 4896 patients from the MADIT-RIT, ADVANCE 3, and PROVIDE randomized trials and the RELEVANT nonrandomized study. Overall, 264 patients received appropriate shocks and 253 experienced inappropriate shocks at follow-up (12 - 17 months). The relative risk (RR) of death from any cause was 0.77 (p=0.02) in the prolonged-detection-time groups compared with controls; the risks of inappropriate shocks and appropriate and inappropriate ATP also fell significantly. Why there were fewer deaths with longer detection times is unclear but it may derive from less exposure to potential hazards of shocks and ATP; inappropriate shocks may up mortality, and ATP poses a small risk of inducing ventricular fibrillation; or it may be due to some other factor, e.g. avoidance of treatment for multiple ICD therapies (e.g., prescription of antiarrhythmic drugs) (Scott PA et al, Heart Rhythm 2014; DOI:10.1016/j.hrthm.2014.02.009. Epub 2014 Feb 12)... (excerpt)
Athens University School of Medicine
2014-08-14 17:04:32
application/pdf
http://www.rhythmos.gr/index.php/Rhythmos/article/view/151
Rhythmos; Vol. 9 No. 2 (2014)
eng
Copyright (c) 2015 Rhythmos
oai:ojs.rhythmos.gr:article/154
2014-08-14T14:49:33Z
Rhythmos:CRDN
driver
"140814 2014 eng "
1792-7927
1792-7919
dc
Cardiology News / Recent Literature Review / Second Quarter 2014
Manolis, Antonis S
Athens University School of Medicine &
First Department of Cardiology, Evagelismos General Hospital of Athens, Athens, Greece
Vlachos, Konstantinos
Evagelismos Hospital, Athens
Anninos, Hector
Evagelismos Hospital, Athens
ESC Congress: Barcelona, 30/8-3/9/14
TCT: Washington, 12-17/9/14
HCS Annual Meeting: Athens, 23-25/10/2014
AHA: Chicago, 15-19/11/14
20th Annual Boston AF Symposium: Orlando, 8-10/1/15
HCS Working Groups Seminar: Ioannina, 2/2015
ACC: San Diego, 14-16/3/15
HRS: Boston, 13-16/5/15
EuroPCR: Paris, 19-22/5/15
Europace: Milan, 21-24/6/15
ESC: London, 29/8-2/9/15
Short QT Syndrome is Highly Lethal
A total of 62 out of 73 short QT syndrome (SQTS) patients (84% male; mean age, 26 ± 15 years; corrected QT interval, 329 ± 22 ms) were followed for 60 ± 41 months. Cardiac arrest (CA) was the most frequent presenting symptom (40% of probands). There was an age dependency in the susceptibility to arrhythmias, with a peak in the occurrence of CA in the first year of life (4%) and a second peak (1.3%) between 20 and 40 years of age; the probability of a first occurrence of CA by 40 years of age was 41%. Despite the male predominance, female patients had a similar risk profile. Familial disease was present in 44% of kindreds, but the yield of genetic screening was low (14%). A history of CA was the only predictor of recurrences at follow-up (p< 0.0000001). Arrhythmias occurred mainly at rest. The authors concluded that SQTS is highly lethal with CA often as the first manifestation of the disease with a peak incidence in the first year of life; survivors of CA have a high CA recurrence rate; implantation of a defibrillator is strongly recommended (Mazzanti A et al, J Am Coll Cardiol 2014;63:1300-1308).
Inferior Vena Cava (IVC) Filters in Patients With Acute Symptomatic Venous Thromboembolism (VTE) and a Significant Bleeding Risk Lower Pulmonary Embolism Mortality but Increase Risk of Recurrence
In a prospective cohort study of patients with acute VTE identified from the RIETE (Computerized Registry of Patients With Venous Thromboembolism), the investigators assessed the association between IVC filter insertion due to significant bleeding risk and the 30-day outcomes [all-cause mortality, pulmonary embolism (PE)-related mortality, and VTE rates]. Of 40,142 patients who had acute symptomatic VTE, 371 received an IVC filter. A total of 344 patients treated with a filter were matched with 344 patients treated without a filter. There was a non-significant trend toward lower risk of all-cause death for filter insertion (6.6% vs 10.2%; p = 0.12). The risk adjusted PE-related mortality rate was lower for filter insertion than no insertion (1.7% vs 4.9%; p = 0.03). Risk-adjusted recurrent VTE rates were higher for filter insertion than for no insertion (6.1% vs 0.6%; p < 0.001). The authors concluded that in patients presenting with VTE and a significant bleeding risk, IVC filter insertion compared with anticoagulant therapy was associated with a lower risk of PE-related death and a higher risk of recurrent VTE (Muriel et al, J Am Coll Cardiol 2014;63:1675–1683). ... (excerpt)
Athens University School of Medicine
2014-08-14 17:41:20
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http://www.rhythmos.gr/index.php/Rhythmos/article/view/154
Rhythmos; Vol. 9 No. 3 (2014)
eng
Copyright (c) 2015 Rhythmos
oai:ojs.rhythmos.gr:article/158
2015-01-17T09:30:41Z
Rhythmos:CRDN
driver
"150117 2015 eng "
1792-7927
1792-7919
dc
Cardiology News /Recent Literature Review / Third Quarter 2014
Manolis, Antonis S
Athens University School of Medicine &
First Department of Cardiology, Evagelismos General Hospital of Athens, Athens, Greece
Anninos, Hector
Evagelismos Hospital, Athens
HCS Annual Meeting: Athens, 23-25/10/2014
AHA: Chicago, 15-19/11/14
20th Annual Boston AF Symposium: Orlando, 8-10/1/15
HCS Working Groups Seminar: Ioannina, 2/2015
ACC: San Diego, 14-16/3/15
HRS: Boston, 13-16/5/15
EuroPCR: Paris, 19-22/5/15
Europace: Milan, 21-24/6/15
ESC: London, 29/8-2/9/15
Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC): ICDs Save Lives & Antitachycardia Pacing (ATP) is Highly Successful Regardless of Heart Rate
Of 137 patients enrolled in a prospective North American ARVC registry, 108 received implantable cardioverter defibrillators (ICDs); 48 had 502 sustained episodes of ventricular arrhythmias (VAs) (489 monomorphic and 13 polymorphic). In the ICD patients, independent predictors of VAs in follow-up included spontaneous sustained VAs before ICD implantation and T-wave inversions inferiorly. The only independent predictor for life-threatening VAs, defined as sustained ventricular tachycardia (VT) ≥240 beats/min or ventricular fibrillation, was a younger age at enrollment. Anti-tachycardia pacing (ATP), independent of VT cycle length, was successful in terminating 92% of VT episodes. The authors concluded that in ARVC most VAs at follow-up are monomorphic. Risk factors for VAs were spontaneous VAs before enrollment and a younger age at ICD implantation. ATP is highly successful in terminating VT, and all ICDs should be programmed for ATP, even for rapid VT (Link M et al, J Am Coll Cardiol 2014;64:119-125).
PREVAIL: Left Atrial Appendage (LAA) Occlusion a Reasonable Alternative to Warfarin for Stroke Prevention in Non-Valvular Atrial Fibrillation?
In the PROTECT AF trial in patients with nonvalvular atrial fibrillation (NVAF), LAA occlusion with the Watchman device was noninferior to warfarin for stroke prevention, but procedural safety was questionable. The PREVAIL study further assessed efficacy and safety of this device in patients with NVAF who had a CHADS2 score ≥1-2. At 1½ years, the rate of first primary efficacy endpoint (composite of stroke, systemic embolism [SE], and cardiovascular/ unexplained death) was 0.064 in the device group (n=269) vs 0.063 in the control group (n=138) and did not achieve noninferiority criteria. The rate for the second primary efficacy endpoint (stroke or SE >7 days’ post-randomization) was 0.0253 vs 0.0200 (risk difference 0.0053), achieving noninferiority. Early safety events occurred in 2.2% of the device arm (lower than in PROTECT AF). All adverse effects were lower in PREVAIL trial than in PROTECT AF (4.2% vs 8.7%; p = 0.004). Pericardial effusions requiring surgery decreased from 1.6% to 0.4% (p= 0.027), and those requiring peri-cardiocentesis decreased from 2.9% to 1.5% (p=NS). The authors concluded that LAA occlusion was noninferior to warfarin for ischemic stroke prevention or SE >7 days’ post-procedure. Noninferiority was not achieved for overall efficacy but procedural safety improved (Holmes DR et al, J Am Coll Cardiol 2014;64:1-12)... (excerpt)
Athens University School of Medicine
2015-01-17 11:30:41
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http://www.rhythmos.gr/index.php/Rhythmos/article/view/158
Rhythmos; Vol. 9 No. 4 (2014)
eng
Copyright (c) 2015 Rhythmos
oai:ojs.rhythmos.gr:article/162
2015-02-04T10:34:17Z
Rhythmos:CRDN
driver
"150201 2015 eng "
1792-7927
1792-7919
dc
Cardiology News /Recent Literature Review / Last Quarter 2014
Manolis, Antonis S
Athens University School of Medicine &
First Department of Cardiology, Evagelismos General Hospital of Athens, Athens, Greece
Anninos, Hector
Evagelismos Hospital, Athens
20th Annual Boston AF Symposium: Orlando, 8-10/1/15
HCS Working Groups Seminar: Ioannina, 2/2015
ACC: San Diego, 14-16/3/15
HRS: Boston, 13-16/5/15
EuroPCR: Paris, 19-22/5/15
Europace: Milan, 21-24/6/15
ESC: London, 29/8-2/9/15
AFFORD study: n-3 Polyunsaturated Fatty Acids (Fish Oil) do not Reduce Atrial Fibrillation Recurrences
In a double-blind, randomized, placebo-controlled trial of fish oil (4 g/day, docosahexaenoic acid - DHA: eicosapentaenoic acid - EPA 1:2) vs safflower oil placebo in 337 patients with symptomatic paroxysmal or persistent AF followed for 9 ± 4 months, the primary endpoint (time to first symptomatic or asymptomatic AF recurrence lasting >30 s) occurred in 64% of patients in the fish oil arm and 63% of patients in the placebo arm (hazard ratio: 1.10; p= NS). hs-CRP and myeloperoxidase - MPO were normal at baseline and decreased to a similar degree at 6 months. The authors concluded that high-dose fish oil does not reduce AF recurrence in patients with a history of AF not receiving AA therapy, and does not reduce inflammation or oxidative stress markers in this population (Nigam A et al, J Am Coll Cardiol 2014;64:1441-1448).
N.B.: Another randomized study (VITAL - VITamin D and OmegA-3 TriaL) is currently examining the effect of 1 g/d of n-3 PUFAs on AF in a much larger population (N=25,875) without cardiac disease over 5 years.
RELAX-AHF: Serelaxin Reduces Mainly Cardiova-scular & Sudden Deaths, Rather than HF Deaths
The RELAX-AHF study showed that IV serelaxin (recombinant human relaxin-2) compared with placebo reduced mortality at 6 months among 1,161 patients with acute heart failure (HF). In this group there were 107 deaths (9.3%): 37 (35%) from HF, 25 (23%) from sudden death, 15 (14%) from other cardiovascular (CV) causes, 19 (18%) from non-CV causes, and 11 (10%) classified as unknown. The treatment effect of serelaxin was most pronounced on other CV deaths (hazard ratio - HR: 0.29; p= 0.005) and sudden death (HR: 0.46; p= 0.065), with no effect of serelaxin treatment on HF or non-CV deaths. The authors concluded that the effects of serelaxin on mortality were mainly due to reduced CV causes and sudden death, without apparent effect on HF deaths (Feleker GM et al, J Am Coll Cardiol 2014;64:1591-1598). N.B.: an ongoing large phase III outcome trial (NCT01870778) will further examine serelaxin’s effect on mortality.
ARISTOTLE: Anticoagulation Quality was Lower in Warfarin-Treated Patients who Received Amiodarone, and Amiodarone was Associated with Significantly Higher Risk of Thrombo-embolism, while Apixaban had a Benefit over Warfarin in Both Groups
In the ARISTOTLE trial, 2,051 (11.4%) patients received amiodarone. Time in the therapeutic range (TTR) in patients on warfarin and amiodarone was lower than patients not on amiodarone (56.5% vs 63%; p<0.0001). More patients on amiodarone had thromboembolism (stroke or systemic embolism) (1.58%/year vs 1.19%/year; hazard ratio -HR: 1.47; p= 0.0322). Mortality and major bleeding rates were higher, albeit not significantly different, in the amiodarone vs the non-amiodarone group. Apixaban, compared with warfarin, decreased systemic embolism, death, and major bleeding in both groups. The authors concluded that amiodarone was associated with significantly increased stroke and systemic embolism risk and a lower TTR when used with warfarin. Apixaban consistently reduced the rate of stroke and systemic embolism, death, and major bleeding compared with warfarin in both (amiodarone and non-amiodarone) groups (Flaker G et al, J Am Coll Cardiol 2014;64:1541-1550)... (excerpt)
Athens University School of Medicine
2015-02-01 23:52:15
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http://www.rhythmos.gr/index.php/Rhythmos/article/view/162
Rhythmos; Vol. 10 No. 1 (2015)
eng
Copyright (c) 2015 Rhythmos
oai:ojs.rhythmos.gr:article/166
2016-03-04T11:51:26Z
Rhythmos:CRDN
driver
"160304 2016 eng "
1792-7927
1792-7919
dc
Cardiology News / Recent Literature Review / First Quarter 2015
Manolis, Antonis S
Third Department of Cardiology, Athens University School of Medicine, Athens, Greece
Anninos, Hector
Evagelismos Hospital, Athens
HRS Meeting: Boston, 13-16/5/2015
EuroPCR: Paris, 19-22/5/2015
EHRA Europace-CardioStim: Milan, 21-24/6/2015
ESC Congress: London, 29/8-2/9/2015
TCT Meeting 2015: San Francisco, 11-15/10/2015
HCS Congress: Thessaloniki, 29-31/10/2015
AHA Scientific Sessions: Orlando, 7-11/11/2015
Low-Level Transcutaneous Electrical Vagus Nerve Stimulation (LLTS) Suppresses Atrial Fibrillation
Patients with paroxysmal atrial fibrillation (AF) were randomized to 1 hour of 20 Hz LLTS (n= 20) or sham control (n= 20) by attaching a flat metal clip onto the tragus in the right ear. AF was induced by burst atrial pacing at baseline and after 1 hour of LLTS or sham treatment. Blood samples from the coronary sinus and the femoral vein were collected at those time points and analyzed for inflammatory cytokines, including tumor necrosis factor alpha and C-reactive protein. Pacing-induced AF duration decreased significantly by 6.3 ± 1.9 min compared with baseline in the LLTS but not in the control group (p=0.002). AF cycle length increased significantly from baseline by 28.8 ± 6.5 ms in the LLTS but not in the control group (p= 0.0002). Femoral vein but not coronary sinus tumor necrosis factor (TNF)-alpha and C-reactive protein levels decreased significantly only in the LLTS group. The authors concluded that LLTS suppresses AF and decreases inflammatory cytokines in patients with paroxysmal AF, supporting a role of neuromodulation to treat AF (Stavrakis S et al, J Am Coll Cardiol 2015;65:867-875).
Among Patients with Early Repolarization Syndrome, Programmed Stimulation Does not Predict Future Arrhythmic Events
In a multicenter study, 81 patients, aged 36+13 years, with early repolarization (ER) syndrome and aborted sudden death due to ventricular fibrillation (VF) underwent an electrophysiology study (EPS). VF was inducible in only 18 of 81 (22%) patients. During follow-up of 7.0 ± 4.9 years, 6 of 18 (33%) patients with inducible VF, and 21 of 63 (33%) noninducible patients experienced VF recurrences (p= NS). VF storm occurred in 3 inducible and 4 noninducible patients. VF inducibility was not associated with maximum J-wave amplitude or J-wave distribution (inferior, odds ratio -OR: 0.96; lateral, OR: 1.57; inferior and lateral, OR: 0.83; all p = NS), which have previously been shown to predict outcome in patients with an ER pattern. The authors concluded that EPS did not enhance risk stratification in ER syndrome (Mahida S et al, J Am Coll Cardiol 2015;65:151-159)... (excerpt)
Athens University School of Medicine
2016-03-04 13:47:50
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http://www.rhythmos.gr/index.php/Rhythmos/article/view/166
Rhythmos; Vol. 10 No. 2 (2015)
eng
Copyright (c) 2016 Rhythmos
oai:ojs.rhythmos.gr:article/170
2016-03-04T12:24:06Z
Rhythmos:CRDN
driver
"160304 2016 eng "
1792-7927
1792-7919
dc
Cardiology News / Recent Literature Review / Second Quarter 2015
Manolis, Antonis S
Third Department of Cardiology, Athens University School of Medicine, Athens, Greece
Anninos, Hector
Evagelismos Hospital, Athens
ESC Congress: London, 29/8-2/9/2015
TCT Meeting 2015: San Francisco, 11-15/10/2015
HCS Congress: Thessaloniki, 29-31/10/2015
AHA Scientific Sessions: Orlando, 7-11/11/2015
DAPT Study: Continuation of Dual Antiplatelet Therapy After PCI in Patients With and Without Acute Myocardial Infarction (MI) Beyond 1 Year Reduced Ischemic Events, but Increased Bleeding Compared With Treatment With Aspirin Alone
Among 11,648 randomized patients (9,961 treated with DES, 1,687 with BMS), 30.7% presenting with MI, between 12 and 30 months, continued thienopyridine reduced stent thrombosis compared with placebo in patients with and without MI at presentation (MI group, 0.5% vs 1.9%, p< 0.001; no MI group, 0.4% vs. 1.1%, p< 0.001). The reduction in major adverse cardiovascular and cerebrovascular events (MACCE) for continued thienopyridine was greater for patients with MI (3.9% vs 6.8%; p< 0.001 for MI; 4.4% vs 5.3%; p= 0.08 for no MI). In both groups, continued thienopyridine reduced MI (2.2% vs 5.2%, p< 0.001 for MI; 2.1% vs 3.5%, p< 0.001 for no MI) but increased bleeding (1.9% vs 0.8%, p= 0.005 for MI; 2.6% vs 1.7%, p= 0.007 for no MI). The authors concluded that extended dual antiplatelet therapy reduced the risk of stent thrombosis and MI in patients with and without MI, but increased bleeding (Yeh RW et al, J Am Coll Cardiol 2015;65:2211-2221).
Metaanalysis: Dual Antiplatelet Therapy (DAPT) is Associated With Protection Against Stent Thrombosis but Increases Risk of Bleeding in Patients With Drug Eluting Stents (DES) / Benefit of Extended DAPT for Patients With First-Generation DES, but not for Second-Generation DES
Metaanalysis of 10 randomized controlled trials (N = 32,135) indicated that compared to longer duration DAPT (L-DAPT; mean exposure time 20.3 months for second-generation DES and 28 months for first-generation DES), shorter duration DAPT (S-DAPT; mean exposure time 7.8 months for second-generation DES and 10.9 months for first-generation DES) had an overall higher rate of stent thrombosis (odds ratio - OR: 1.71; p = 0.001). The effect of S-DAPT on stent thrombosis was attenuated with the use of second-generation DES (OR: 1.54) compared with first-generation DES (OR: 3.94; p for interaction = 0.008). S-DAPT had an overall significantly lower risk of bleeding (OR: 0.63; p < 0.001). Finally, a numerically lower all-cause mortality rate was observed with S-DAPT (OR: 0.87; p = 0.073). The authors conclu-ded that S-DAPT had overall lower rates of bleeding, yet higher rates of stent thrombosis compared with L-DAPT; the latter effect was significantly attenuated with the use of second-generation DES. All-cause mortality was higher (not statistically) with L-DAPT (Giustino G et al, J Am Coll Cardiol 2015;65: 1298-1310)... (excerpt)
Athens University School of Medicine
2016-03-04 14:24:06
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http://www.rhythmos.gr/index.php/Rhythmos/article/view/170
Rhythmos; Vol. 10 No. 3 (2015)
eng
Copyright (c) 2016 Rhythmos
oai:ojs.rhythmos.gr:article/174
2016-03-04T19:32:19Z
Rhythmos:CRDN
driver
"160304 2016 eng "
1792-7927
1792-7919
dc
Cardiology News / Recent Literature Review / Third Quarter 2015
Manolis, Antonis S
Third Department of Cardiology, Athens University School of Medicine, Athens, Greece
Anninos, Hector
Evagelismos Hospital, Athens
TCT Meeting 2015: San Francisco, 11-15/10/2015
HCS Congress: Thessaloniki, 29-31/10/2015
AHA Scientific Sessions: Orlando, 7-11/11/2015
Boston AF Symposium: Orlando, 14-16/1/2016
ACC 65th Annual Session: Chicago, 2-4/4/2016
HRS 37th Annual Meeting: San Francisco, 4-7/5/16
CardioStim/Europace: Nice, 8-11/6/2016
Euro PCR: Paris, 17-20/5/2016
ESC Meeting: Rome, 27-31/8/2016
Sustained Chronic Obesity Results in Chronic Stretch, Diffuse Interstitial Fibrosis, Conduction Abnormalities, and Increased Vulnerability to AF
In an animal study, 10 chronically obese sheep, compared with 10 age-matched controls, demonstrated greater total body fat, left atrial (LA) volume, LA pressure, and pulmonary artery pressures, reduced atrial conduction velocity with increased conduction heterogeneity, increased fractionated electrograms, decreased posterior LA voltage, and increased voltage heterogeneity (all p<0.001), with no change in the effective refractory period (ERP) or ERP heterogeneity. Obesity was associated with more episodes (p=0.02), prolongation (p=0.01), and greater cumulative duration (p=0.02) of atrial fibrillation (AF). Epicardial fat infiltrated the posterior LA in the obese group (p<0.001), consistent with reduced endocardial voltage in this region. Atrial fibrosis (p=0.03) and atrial transforming growth factor (TGF)-β1 protein (p= 0.002) were increased in the obese group. The authors concluded that obesity results in global biatrial endocardial remodeling, and increased propensity for AF (Mahajan R et al, J Am Coll Cardiol 2015;66:1-11).
An Increased Percentage of PVCs on 24-h Holter Monitor Confers a Decrease in LVEF, Increased Incident CHF, and Increased Mortality: PVCs might be an Important Cause of Occult or “Idiopathic” Cardiomyopathy and an Important Determinant of Incident CHF Among Those with Other Established CHF Risk Factors
Among 1,139 Cardiovascular Health Study (CHS) participants, with a normal LVEF and no history of CHF, randomly assigned to 24-h Holter monitoring, those in the upper quartile vs the lowest quartile of PVC frequency had a 3-fold greater odds of a 5-year decrease in LVEF (odds ratio - OR: 3.10; p= 0.005), a 48% increased risk of incident CHF (HR: 1.48; p= 0.02), and a 31% increased risk of death (HR: 1.31; p = 0.01) during a median follow-up of >13 years. The specificity for the 15-year risk of CHF exceeded 90% when PVCs included at least 0.7% of ventricular beats. The population-level risk for incident CHF attributed to PVCs was 8.1%. The authors concluded that in a population-based sample, a higher frequency of PVCs was associated with a decrease in LVEF, an increase in incident CHF, and increased mortality (Dukes JW et al, J Am Coll Cardiol 2015;66:101-109)... (excerpt)
Athens University School of Medicine
2016-03-04 21:32:19
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http://www.rhythmos.gr/index.php/Rhythmos/article/view/174
Rhythmos; Vol. 10 No. 4 (2015)
eng
Copyright (c) 2016 Rhythmos
oai:ojs.rhythmos.gr:article/178
2016-07-03T19:47:36Z
Rhythmos:CRDN
driver
"160304 2016 eng "
1792-7927
1792-7919
dc
Cardiology News / Recent Literature Review / Last Quarter 2015
Manolis, Antonis S
Third Department of Cardiology, Athens University School of Medicine, Athens, Greece
Anninos, Hector
Evagelismos Hospital, Athens
Boston AF Symposium: Orlando, 14-16/1/2016
ACC 65th Annual Session: Chicago, 2-4/4/2016
HRS 37th Annual Meeting: San Francisco, 4-7/5/16
CardioStim/Europace: Nice, 8-11/6/2016
Euro PCR: Paris, 17-20/5/2016
ESC Meeting: Rome, 27-31/8/2016
Targeting Ablation to the Distal Segment of the Main Renal Artery and Post-Bifurcation Branches May Optimize Renal Denervation (RDN)
Insufficient procedural efficacy has been proposed to explain nonresponse to renal denervation (RDN). The impact of different patterns of lesion placements on the efficacy and consistency of catheter-based radiofrequency (RF) RDN was examined in pigs. Increasing the number of RF lesions (4, 8, and 12) in the main renal artery was not sufficient, but targeted treatment of the renal artery branches or distal segment of the main renal artery resulted in markedly less variability of response and significantly greater reduction of both norepinephrine (NE) and axon density than conventional treatment of only the main renal artery. Combination treatment (main artery plus branches) produced the greatest change in renal NE and axon density with the least heterogeneity. The changes lasted through 28 days post-treatment (Mahfoud F et al, J Am Coll Cardiol 2015;66:1766-1775).
High Levels of Cardiorespiratory Fitness in Midlife Confer Lower Mortality, Use of Health Care Resources, and Health Care Costs Later in Life
Among 19,571 healthy individuals who underwent cardiorespiratory fitness assessment at a mean age of 49 years, over 126,388 person-years of follow-up, average annual health care costs were significantly lower for participants aged >65 years with high than low midlife fitness in both men and women. Average annual health care costs in later life were incrementally lower per MET achieved in midlife in men and women. The authors concluded that higher cardiorespiratory fitness in middle age is strongly associated with lower health care costs at an average of 22 years later in life, independent of cardiovascular risk factors (Bachmann JM et al, J Am Coll Cardiol 2015;66:1876-1885).
Moderate Physical Activity is Associated with a Reduced Risk of Atrial Fibrillation (AF) in Middle-Aged and Elderly Women
According to a Swedish study comprising 36,513 AF-free women (aged 49–83, median 60 years) during a median of 12 years, 2915 cases of AF were diagnosed. The risk of AF decreased with increasing levels of leisure-time exercise at study entry (relative risk - RR 0.85, for ≥4 h/week vs <1 h/week) and walking/bicycling (RR 0.81, for ≥40 min/day vs almost never) (Drca N et al, Heart 2015;101:1627-1630)... (excerpt)
Athens University School of Medicine
2016-03-04 22:00:13
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http://www.rhythmos.gr/index.php/Rhythmos/article/view/178
Rhythmos; Vol. 11 No. 1 (2016)
eng
Copyright (c) 2016 Rhythmos
oai:ojs.rhythmos.gr:article/182
2016-04-05T09:32:20Z
Rhythmos:CRDN
driver
"160405 2016 eng "
1792-7927
1792-7919
dc
Cardiology News / Recent Literature Review / First Quarter 2016
Manolis, Antonis S
Third Department of Cardiology, Athens University School of Medicine, Athens, Greece
Anninos, Hector
Evagelismos Hospital, Athens
ACC 65th Annual Session: Chicago, 2-4/4/2016
HRS 37th Annual Meeting: San Francisco, 4-7/5/16
CardioStim/Europace: Nice, 8-11/6/2016
Euro PCR: Paris, 17-20/5/2016
ESC Meeting: Rome, 27-31/8/2016
HCS Panhellenic Congress: Athens, 20-22/10/2016
TCT Conference: Washington, DC, 29/10-2/11/2016
AHA Scientific Sessions: New Orleans, 12-16/11/2016
Exercise-Based Cardiac Rehabilitation Reduces the Risk of Cardiovascular (CV) Mortality and Hospital Admission and Improves Quality of Life in Patients With Coronary Heart Disease
Meta-analyses of exercise-based cardiac rehabilitation (CR) studies (n=63) comprising 14,486 participants with median follow-up of 1 year indicated that CR led to a reduction in CV mortality (relative risk - RR: 0.74) and the risk of hospital admissions (RR: 0.82). There was no significant effect on mortality, MI, or revascularization. The majority of studies (14 of 20) showed higher levels of health-related quality of life following exercise-based CR compared with control subjects (Anderson L et al, J Am Coll Cardiol 2016;67:1-12).
Coronary CT Angiography (CCTA), Applied Early in Suspected Acute Coronary Syndrome (ACS), is Safe and Associated with Less Outpatient Testing and Lower Costs. However, in the Era of hs-Troponins, it does not Identify more Patients with Significant CAD Requiring Coronary Revascularization, nor does it Shorten Hospital Stay or Allow for More Immediate Discharge from the Emergency Department (ED)
Among 500 patients (age 54 ± 10 years, 47% women) with symptoms suggestive of an ACS at the ED, there was no difference in the primary endpoint (22 or 9% patients underwent coronary revascularization within 30 days in the CCTA group and 17 or 7% in the standard care group; p= NS). Discharge from the ED was not more frequent after CCTA (65% vs 59%, p= NS), and length of stay was similar (6.3 h in both groups; p= NS). The CCTA group had lower direct medical costs (€337 vs €511, p< 0.01) and less outpatient testing (10 or 4% vs 26 or 10%, p< 0.01). There was no difference in incidence of undetected ACS (Dedic A et al, J Am Coll Cardiol 2016; 67:16-26).
Cost-Effectiveness of Transcatheter Aortic Valve Implantation (TAVI) with a Self-Expanding Prosthesis vs Surgical Aortic Valve Replacement (AVR): TAVI in Patients at High Risk for Complications with AVR Provides Important Incremental Health Benefits at Reasonable Incremental Costs and is an Acceptable Value for the U.S. Health Care System
Relative to AVR, TAVI reduced initial length of stay an average of 4.4 days, decreased the need for rehabilitation services at discharge, and resulted in superior 1-month quality of life. Index admission and projected lifetime costs were higher with TAVI than with AVR (differences $11,260 and $17,849 per patient, respectively), whereas TAVI was projected to provide a lifetime gain of 0.32 quality-adjusted life-years (QALY; 0.41 LY) with 3% discounting. Lifetime incremental cost-effectiveness ratios were $55,090 per QALY gained and $43,114 per LY gained. N.B.: mean procedure costs: $37,920 for TAVI & $14,258 for AVR (Reynolds MR et al, J Am Coll Cardiol 2016;67:29-38)... (excerpt)
Athens University School of Medicine
2016-04-05 12:32:20
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http://www.rhythmos.gr/index.php/Rhythmos/article/view/182
Rhythmos; Vol. 11 No. 2 (2016)
eng
Copyright (c) 2016 Rhythmos
oai:ojs.rhythmos.gr:article/192
2016-07-18T06:16:54Z
Rhythmos:CRDN
driver
"160718 2016 eng "
1792-7927
1792-7919
dc
Cardiology News / Recent Literature Review / Second Quarter 2016
Manolis, Antonis S
Third Department of Cardiology, Athens University School of Medicine, Athens, Greece
Anninos, Hector
Evagelismos Hospital, Athens, Greece
ESC Meeting: Rome, 27-31/8/2016
HCS Panhellenic Congress: Athens, 20-22/10/2016
TCT Conference: Washington, DC, 29/10-2/11/2016
AHA Scientific Sessions: New Orleans, 12-16/11/2016
AF Symposium: Orlando, 12-14/1/2017
ACC.17: Washington, DC, 17-19/3/2017
HONEST Study: Morning Home Blood Pressure (BP) May be Superior to Clinic BP as a Predictor of Coronary Events and Stroke in Patients With Hypertension
In 21,591 hypertensive patients (mean age ~65 years), having 127 stroke and 121 CAD events over a mean follow-up of 2 years, the incidence of stroke events was significantly higher in patients with morning home systolic blood pressure (HSBP) ≥145 mmHg compared with <125 mmHg (hazard ratio -HR ~6.0), and in patients with clinic systolic blood pressure (CSBP) ≥150 mmHg compared with <130 mmHg (HR 5.82); morning HSBP predicted stroke events similarly to CSBP. Incidence of CAD events was significantly higher in patients with morning HSBP ≥145 mmHg compared with <125 mmHg (HR 6.24) and in patients with CSBP ≥160 mmHg compared with <130 mmHg (HR 3.51). Thus, compared with morning HSBP predicted CAD events more strongly than CSBP (Kario K et al, J Am Coll Cardiol 2016;67:1519-1527).
A 1-h Combination Algorithm Allows Fast Rule-Out/ Rule-In of Major Adverse Cardiac Events (MACE): In Patients with Chest Pain Presenting to Emergency Department (ED), Combining hs-cTnT Levels on Arrival and 1 h Later With the Patient History and ECG More Effectively Identified MACE Within 30 Days Than Screening Based on hs-cTnT Alone
In a prospective observational study enrolling 1,038 patients presenting to the emergency department (ED) with chest pain, an extended algorithm comprising hs-cTnT results at 1 h combined with history and ECG, identified 60% of all patients for rule-out and had a higher sensitivity than the troponin algorithm alone (97.5% vs 87.6%; p< 0.001). The negative predictive value was 99.5% and the likelihood ratio was 0.04 with the extended algorithm vs 97.8% and 0.17, respectively, with the troponin algorithm. The extended algorithm ruled-in 14% of patients with a higher sensitivity (75.2% vs 56.2%; p< 0.001) but a slightly lower specificity (94.0% vs 96.4%; p< 0.001) than the troponin algorithm. The rule-in arms of both algorithms had a likelihood ratio >10 (Mokhtari A et al, J Am Coll Cardiol 2016;67:1531-1540)... (excerpt)
Athens University School of Medicine
2016-07-18 09:16:54
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http://www.rhythmos.gr/index.php/Rhythmos/article/view/192
Rhythmos; Vol. 11 No. 3 (2016)
eng
Copyright (c) 2016 Rhythmos
oai:ojs.rhythmos.gr:article/235
2016-11-01T13:18:56Z
Rhythmos:CRDN
driver
"161101 2016 eng "
1792-7927
1792-7919
dc
Cardiology News / Recent Literature Review / Third Quarter 2016
Manolis, Antonis S
Third Department of Cardiology, Athens University School of Medicine, Athens, Greece
Anninos, Hector
Athens University School of Medicine, Athens, Greece
HCS Panhellenic Congress: Athens, 20-22/10/2016
TCT Conference: Washington, DC, 29/10-2/11/2016
AHA Scientific Sessions: New Orleans, 12-16/11/2016
AF Symposium: Orlando, 12-14/1/2017
ACC.17: Washington, DC, 17-19/3/2017
HRS Scientific sessions: Chicago, 10-13/5/2017
EHRA Europace-Cardiostim: Vienna, 18-21/6/2017
ESC Congress: Barcelona, 26-30/8/2017
POST 2 Study: Patients with Vasovagal Syncope Improved Modestly with Fludrocortisone 0.2 mg daily with Insignificant 31% Reduction in the Hazard of Fainting in the Intent-to-Treat Analysis
Among 210 patients (71% female, median age 30 years) with recurrent vasovagal syncope randomized to fludrocortisone or placebo at highest tolerated doses from 0.05 mg to 0.2 mg daily, there was a marginally nonsignificant reduction in syncope in the fludrocortisone group (hazard ratio - HR: 0.69; p = 0.069). In a multivariable model, fludrocortisone significantly reduced the likelihood of syncope (HR: 0.63; p = 0.024). When the analysis was restricted to outcomes after 2 weeks of dose stabilization, there was a significant benefit due to fludrocortisone (HR: 0.51; p = 0.019) (Sheldon R et al, J Am Coll Cardiol 2016;68:1-9).
Patients With Variant Angina Presenting With Aborted Sudden Arrhythmic Death (SCD) Face a Worse Prognosis Than Those Without SCD, While Therapy With Vasodilator Drugs is not Sufficiently Protective/ Additional ICD Implantation Might be Necessary as a Secondary Prevention Treatment
Among 188 patients with variant angina with atherosclerosis (ASCD) and 1,844 patients with variant angina without ASCD (predictors of ASCD: age, hypertension, hyperlipidemia, family history of sudden cardiac death, multivessel spasm, and left anterior descending artery spasm), over a median of 7.5 years, the incidence of cardiac death was higher in ASCD patients (24.1 vs 2.7 per 1,000 patient-years; hazard ratio - HR: 7.26; p< 0.001). Death from any cause also occurred more frequently in ASCD patients (27.5 vs 9.6 per 1,000 patient-years; HR: 3; p< 0.001). The incidence rate of recurrent ventricular tachyarrhythmia in ASCD patients was 32.4 per 1,000 patient-years, and the composite of cardiac death and ventricular tachyarrhythmia was 44.9 per 1,000 patient-years. A total of 24 ASCD patients received ICDs (Ahn JM et al, J Am Coll Cardiol 2016; 68:137-145)... (excerpt)
Athens University School of Medicine
2016-11-01 15:18:56
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http://www.rhythmos.gr/index.php/Rhythmos/article/view/235
Rhythmos; Vol. 11 No. 4 (2016)
eng
Copyright (c) 2016 Rhythmos
oai:ojs.rhythmos.gr:article/275
2017-01-10T09:45:44Z
Rhythmos:CRDN
driver
"170110 2017 eng "
1792-7927
1792-7919
dc
Cardiology News / Recent Literature Review / Last Quarter 2016
Manolis, Antonis S
Third Department of Cardiology, Athens University School of Medicine, Athens, Greece
Anninos, Hector
Athens University Medical School, Athens
AF Symposium: Orlando, 12-14/1/2017
ACC.17: Washington, DC, 17-19/3/2017
HRS Scientific sessions: Chicago, 10-13/5/2017
EHRA Europace-Cardiostim: Vienna, 18-21/6/2017
ESC Congress: Barcelona, 26-30/8/2017
TOHP Study: Direct Linear Relationship of an Accurate Measure of Usual Sodium Intake to Total Mortality Over a Period of 23-26 Years, With Higher Risk at High Sodium Intake and no Evidence of a U or J Shape
Based on multiple 24-h urine samples collected from pre-hypertensive adults 30 to 54 years of age, among 744 phase I and 2,382 phase II participants randomized to sodium reduction or control, 251 deaths occurred, representing a nonsignificant 15% lower risk in the active intervention (hazard ratio -HR: 0.85; p=NS). Among 2,974 participants not assigned to an active sodium intervention, 272 deaths occurred with a direct linear association between average sodium intake and mortality, with an HR of 0.75, 0.95, and 1.00 (references) and 1.07 (p trend= 0.30) for <2.3, 2.3 to <3.6, 3.6 to <4.8, and ≥4.8 g/24 h, respectively; and with an HR of 1.12 per 1 g/24 h (p = 0.05). There was no evidence of a J-shaped or nonlinear relationship. The HR per unit increase in sodium/ potassium ratio was 1.13 (p = 0.04) (Cook NR et al, J Am Coll Cardiol 2016;68:1609-1617).
FRANCE-2 (FRench Aortic National CoreValve and Edwards) Registry: In High-Risk Patients With Aortic Stenosis Undergoing TAVI, Later Mortality is Due Mainly to Noncardiac Causes / Beyond the First Month After the Procedure, Prosthetic Valve Function Remains Stable, the Incidence of Clinical Events is Low, and Functional Improvement is Usually Sustained
Among 4,201 patients undergoing TAVI, approaches were transfemoral 73%, transapical 18%, subclavian 6%, and transaortic or transcarotid 3% and median follow-up 3.8 years. The 3-year all-cause mortality was 42% and cardiovascular mortality 17.5%. Predictors of 3-year all-cause mortality were male gender (p< 0.001), low body mass index, (p< 0.001), AF (p< 0.001), dialysis (p< 0.001), NYHA class III or IV (p< 0.001), higher logistic EuroSCORE (p<0.001), transapical or subclavian approach (p< 0.001 for both vs transfemoral approach), need for permanent pacemaker implantation (p= 0.02), and post-implant periprosthetic aortic regurgitation grade ≥2 of 4 (p< 0.001). Severe events occurred mainly during the first month and subsequently in <2% of patients/year. Mean gradient, valve area, and residual aortic regurgitation were stable during follow-up (Gilard M et al, J Am Coll Cardiol 2016; 68:1637-1647)... (excerpt)
Athens University School of Medicine
2017-01-10 10:49:50
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Rhythmos; Vol. 12 No. 1 (2017)
eng
Copyright (c) 2017 Rhythmos
oai:ojs.rhythmos.gr:article/325
2017-04-21T18:43:46Z
Rhythmos:CRDN
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"170421 2017 eng "
1792-7927
1792-7919
dc
Cardiology News / Recent Literature Review / First Quarter 2017
Manolis, Antonis S
Third Department of Cardiology, Athens University School of Medicine, Athens, Greece
Anninos, Hector
Athens Univ School of Medicine, Athens, Greece
HRS Scientific sessions: Chicago, 10-13/5/2017
EHRA Europace-Cardiostim: Vienna, 18-21/6/2017
ESC Congress: Barcelona, 26-30/8/2017
TCT Congress: Denver, Colorado, 29/10-2/11/2017
AHA Meeting: Anaheim, Ca, 11-15/11/2017
Anterior T-Wave Inversion (ATWI), Present in 2.3% of Young Whites, More Common in Women and in Athletes, 77% Confined to Leads V1 - V2, Could be a Normal Variant in Asymptomatic Individuals Without a Family History of Cardiomyopathy or Premature SCD / In Contrast, ATWI Extending Beyond V2, Present in only 1% of Females and 0.2% in Men, May Justify Further Evaluation, Particularly when Preceded by J-Point or ST-Segment Depression
Among 14,646 individuals 16 to 35 years of age, including 4,720 females (32%) and 2,958 athletes (20%), ATWI was detected in 338 individuals (2.3%) and was more common in women than in men (4.3% vs. 1.4%, respectively; p< 0.0001) and more common among athletes than in nonathletes (3.5% vs 2%, respectively; p<0.0001). T-wave inversion was predominantly confined to leads V1 to V2 (77%). Only 1.2% of women and 0.2% of men exhibited ATWI beyond V2. No one with ATWI fulfilled diagnostic criteria for ARVC after further evaluation. Over 23.1±12.2 months none of the individuals with ATWI experienced an adverse event (Malhotra A et al, J Am Coll Cardiol 2017;69:1-9).
Alcohol Abuse Increases the Risk of AF, MI, and Heart Failure to an Extent Similar to that of Other Strong Risk Factors, and Affects Healthier Individuals Disproportionately / Protective Effects of Alcohol Against MI are Outweighed at Heavy Levels of Consumption by its Adverse Effects
Among 14,727,591 patients, 268,084 (1.8%) had alcohol abuse, which was associated with an increased risk of incident atrial fibrillation (AF) (hazard ratio -HR: 2.14; p<0.0001), myocardial infarction (MI) (HR: 1.45; p< 0.0001), and heart failure (HF) (HR: 2.34; p<0.0001). Individuals without conventional risk factors for cardiovascular disease exhibited a disproportionately enhanced risk of each outcome. The population-attributable risk of alcohol abuse on each outcome was of similar magnitude to other well-recognized modifiable risk factors (Whitman IR et al, J Am Coll Cardiol 2017;69:13-24).
LEADERS FREE Trial: in Patients at High Risk of Bleeding Undergoing PCI Followed by 1 Month of Dual Antiplatelet Therapy (DAPT), Polymer-Free Drug-Coated Stents (DCS) are both Safer and More Effective Than Bare Metal Stents (BMS) at 2 Years
Among 2,466 high bleeding risk patients randomized to a drug-coated stent (DCS) or a BMS followed by 1-month DAPT, at 2 years, the primary safety endpoint (cardiac death, MI, or stent thrombosis) had occurred in 147 DCS (12.6%) and 180 BMS patients (15.3%) (hazard ratio-HR: 0.80; p = 0.039). Clinically driven target lesion revascularization occurred in 77 DCS (6.8%) and 136 BMS patients (12%) (HR: 0.54; p< 0.0001). Major bleeding occurred in 8.9% of DCS and 9.2% of BMS patients (p= 0.95), and a coronary thrombotic event (MI and/or stent thrombosis) occurred in 8.2% of DCS and 10.6% of BMS patients (p= 0.045). One-year mortality was 27.1% for a major bleed and 26.3% for a thrombotic event. At 2 years, multivariate correlates of major bleeding were age >75 years, anemia, increased creatinine, and long-term anticoagulation. Correlates of the primary safety endpoint were age, anemia, heart failure, multivessel disease, number of stents, and use of a BMS (Garot P et al, J Am Coll Cardiol 2017;69:162-171)... (excerpt)
Rhythmos 2017;12(2):33-37.
Athens University School of Medicine
2017-04-21 21:43:46
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http://www.rhythmos.gr/index.php/Rhythmos/article/view/325
Rhythmos; Vol. 12 No. 2 (2017)
eng
Copyright (c) 2017 Rhythmos
oai:ojs.rhythmos.gr:article/389
2017-08-01T20:22:38Z
Rhythmos:CRDN
driver
"170801 2017 eng "
1792-7927
1792-7919
dc
Cardiology News / Recent Literature Review / Second Quarter 2017
Manolis, Antonis S
Third Department of Cardiology, Athens University School of Medicine, Athens, Greece
Anninos, Hector
Third Department of Cardiology, Athens University School of Medicine, Athens, Greece
ESC Congress: Barcelona, 26-30/8/2017
HCS 2017, 28th Panhellenic Cardiology Congress: Athens, 19-21/10/2017
TCT Congress: Denver, Colorado, 29/10-2/11/2017
AHA Meeting: Anaheim, Ca, 11-15/11/2017
ACC.18 Congress: Orlando, FL, 10-12/3/2018
Rhythmos 2017;12(3):53-57
In CRT-Eligible Heart Failure Patients with no History of Ventricular Arrhythmias, Addition of ICD Conveys Survival Benefit in Patients with Ischemic Cardiomyopathy (CM) but not in Those with Nonischemic CM
According to an observational, multicenter, European cohort study of 5,307 consecutive patients with dilated or ischemic CM, no history of sustained ventricular arrhythmias, who underwent CRT implantation with (n=4,037) or without (n=1,270) a defibrillator, over 41.4 ± 29.0 months, patients with ischemic (not dilated) CM had better survival when receiving CRT-D compared with those who received CRT-P (hazard ratio-HR: 0.76; p=0.005). Compared with recipients of ICD, the excess mortality in patients who did not receive ICDs was related to sudden cardiac death in 8% among those with ischemic CM but in only 0.4% of those with dilated CM (Barra S et al, J Am Coll Cardiol 2017; 69:1669-1678).
SELECT-LV Study: In a Population of Failed Conventional CRT Patients, Cardiac Resynchroniza-tion With Endocardial LV Stimulation via a Novel Leadless Pacing Electrode was Technically Feasible and Efficacious
Among 35 patients indicated for CRT who had “failed” conventional CRT, implantation of an LV endocardial leadless pacing electrode and a subcutaneous pulse generator was successful in 97.1% (n=34). The most common indications for endocardial LV pacing were difficult CS anatomy (n=12), failure to respond to conventional CRT (n=10), and a high CS pacing threshold or phrenic nerve stimulation (n=5). The primary performance endpoint, biventricular pacing on the 12-lead ECG at 1 month, was achieved in 33 of 34 patients. A total of 28 patients (84.8%) had improvement in the clinical composite score at 6 months, and 21 (66%) demonstrated a positive echocardiographic CRT response (≥5% absolute increase in LV ejection fraction). There were no pericardial effusions, but serious procedure/device-related events occurred in 3 patients (8.6%) within 24 h, and 8 patients (22.9%) between 24 h and 1 month (Reddy VY et al, J Am Coll Cardiol 2017;69:2119-29).
Improvements in both Survival and Heart Failure Hospitalizations with CRT-D were Greatest in Patients with a QRSD ≥180 ms with or without LBBB
Analysis of 24,960 patients receiving CRT-D and matched to patients with ICD indicated that among those with LBBB, patients with a QRSD ≥180 ms had a greater survival benefit with CRT-D vs standard ICD (hazard ration -HR for death: 0.65) compared with those having a QRSD 120 to 149 ms (HR: 0.85) and 150 to 179 ms (HR: 0.87). CRT-D vs ICD was associated with an improvement in survival in those with non-LBBB and a QRSD≥180 ms (HR for death: 0.78), but not in those with non-LBBB and a QRSD 150 to 179 ms (HR for death: 1.06) (Sundaram V et al, J Am Coll Cardiol 2017;69: 2026–36)... (excerpt)
Athens University School of Medicine
2017-08-01 23:20:32
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http://www.rhythmos.gr/index.php/Rhythmos/article/view/389
Rhythmos; Vol. 12 No. 3 (2017)
eng
Copyright (c) 2017 Rhythmos
oai:ojs.rhythmos.gr:article/393
2017-12-28T19:34:23Z
Rhythmos:CRDN
driver
"171228 2017 eng "
1792-7927
1792-7919
dc
Cardiology News / Recent Literature Review / Third Quarter 2017
Manolis, Antonis S
Third Department of Cardiology, Athens University School of Medicine, Athens, Greece
Anninos, Hector
Athens University School of Medicine, Athens
HCS 2017, 28th Panhellenic Cardiology Congress: Athens, 19-21/10/2017
TCT Congress: Denver, Colorado, 29/10-2/11/2017
AHA Meeting: Anaheim, Ca, 11-15/11/2017
ACC.18 Congress: Orlando, FL, 10-12/3/2018
HRS Meeting: Boston, 9-12/5/2018
ESC Meeting: Munich, 25-29/8/2018
Long QT syndrome (LQTS): Although Outcomes Have Improved, 1 in 4 Patients with Prior Symptoms Experience at Least 1 Subsequent, Albeit Nonlethal, Cardiac Event Demanding Further Optimization of Treatment Strategies
Among 606 patients with LQTS (LQT1 in 47%, LQT2 in 34%, and LQT3 in 9%), a potentially lethal cardiac channelopathy with a 1-5% annual risk of LQTS-triggered syncope, aborted cardiac arrest, or sudden cardiac death, there were 166 (27%) patients who were symptomatic prior to their first Mayo Clinic evaluation at a median age of 12 years at first symptom. Treatment strategies included no active therapy in 47 (8%) patients, beta-blockers alone in 350 (58%) patients, ICDs alone in 25 (4%) patients, left cardiac sympathetic denervation alone in 18 (3%) patients, and combination therapy in 166 (27%) patients. Over a median follow-up of 6.7 years, 556 (92%) patients did not experience a cardiac event. Only 8 of 440 (2%) previously asymptomatic patients experienced a single event. In contrast, 42 of 166 (25%) previously symptomatic patients experienced >1 events. Among the 30 patients with >2 events, 2 patients died and 3 LQT3 patients underwent cardiac transplantation (Rohatgi RK et al, J Am Coll Cardiol 2017;70:453–62).
TRAC-AF Study: Temperature-Controlled Irrigated Ablation Produces Rapid, Efficient, and Durable PV Isolation
A novel irrigated RF catheter (DiamondTemp -DT) designed with a diamond-embedded tip (for rapid cooling) and thermocouples to monitor tissue temperature, was first used in 6 pigs for atrial ablation in a temperature control mode (60°C/50 W) until there was ∼80% EGM amplitude reduction; lesion histology revealed transmurality in 51 of 55 lesions (92.7%). In a clinical feasibility study, the study group of 35 patients having PV isolation with the DT catheter, compared with a control group of 35 patients undergoing PV isolation with a standard force-sensing catheter, had shorter mean RF application duration (26.3 ± 5.2 min vs. 89.2 ± 27.2 min; p < 0.001), shorter mean fluoroscopic time (11.2 ± 8.5 min vs. 19.5 ± 6.8 min; p < 0.001), and lower acute dormant PV reconduction (0 of 35 vs. 5 of 35; p = 0.024). At 3 months, among 23 patients undergoing remapping, 39 of 46 PV pairs (84.8%) remained durably isolated in 17 of these patients (73.9%) (Iwasawa J et al, J Am Coll Cardiol 2017;70:542-553)... (excerpt)
Athens University School of Medicine
2017-12-28 21:34:23
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http://www.rhythmos.gr/index.php/Rhythmos/article/view/393
Rhythmos; Vol. 12 No. 4 (2017)
eng
Copyright (c) 2017 Rhythmos
oai:ojs.rhythmos.gr:article/397
2018-01-14T15:28:19Z
Rhythmos:CRDN
driver
"180114 2018 eng "
1792-7927
1792-7919
dc
Cardiology News / Recent Literature Review / Last Quarter 2017
Manolis, Antonis S
Third Department of Cardiology, Athens University School of Medicine, Athens, Greece
Anninos, Hector
Athens University School of Medicine, Athens
AF Symposium 2018: Orlando, FL, 11-13/1/208
ACC.18 Congress: Orlando, FL, 10-12/3/2018
EHRA Meeting: Barcelona, 18-20/3/2018
HRS Meeting: Boston, 9-12/5/2018
EuroPCR Meeting: Paris, 22-25/5/2018
ESC Meeting: Munich, 25-29/8/2018
SPAIN Study: Dual-Chamber Pacing With Closed Loop Stimulation (DDD-CLS) Reduced Syncope Burden and Time to First Recurrence by 7-Fold, and Prolonged Time to First Syncope Recurrence in Patients Age≥40 Years With Tilt-Induced Cardio-inhibitory Vasovagal Syncope
DDD-CLS pacing is a rate-responsive mode that uses intracardiac impedance as a surrogate of cardiac contractility to adapt heart rate to patient needs. Among 46 patients, aged 56.30 ± 10.63 years, with tilt-induced cardioinhiboitory vasovagal syncope, the proportion of patients with ≥50% reduction in the number of syncopal episodes was 72% with DDD-CLS compared with 28% with sham DDI mode (p=0.017). A total of 4 patients (8.7%) had events during DDD-CLS and 21 (45.7%) during sham DDI (hazard ratio: 6.7). Kaplan-Meier curve was significantly different between groups in time to first syncope: 29.2 months vs 9.3 months (p< 0.016); odds ratio: 0.11 (p< 0.0001) (Baron-Esquivias G et al, J Am Coll Cardiol 2017;70: 1720–28).
PESA Study: Skipping Breakfast is Associated With an Increased Odds of Prevalent Noncoronary and Generalized Atherosclerosis Independently of the Presence of Conventional CV Risk Factors
Three patterns of breakfast consumption were studied: high-energy breakfast, when contributing to >20% of total daily energy intake (27% of the population); low-energy breakfast, when contributing between 5% and 20% of total daily energy intake (70% of the population); and skipping breakfast, when consuming <5% of total daily energy (3% of the population). Independent of the presence of traditional and dietary CV risk factors, and compared with high-energy breakfast, habitual skipping breakfast was associated with a higher prevalence of noncoronary (odds ratio-OR: 1.55) and generalized (OR: 2.57) atherosclerosis (Uzhova I et al, J Am Coll Cardiol 2017;70: 1833-42).
"Real life" Longevity of Implantable Cardioverter-Defibrillator Devices (ICDs) Much Shorter than Manufacturers’ Projected Longevity
Manufacturers of implantable cardioverter-defibrillators (ICDs) promise a 5- to 9-year projected longevity; however, real-life data indicate otherwise. Over 20 years, among 685 ICD patients (601 men; age, 63.1 ± 13.3 years) with coronary (n = 396) or valvular (n = 15) disease, cardiomyopathy (n = 220), or electrical disease (n = 54) (mean ejection fraction 35%) and devices implanted for secondary (n = 562) or primary (n = 123) prevention (292 single-, 269 dual-chamber and 124 CRT devices implanted in the abdomen in 17 or chest in 668), ICD pulse generator replacements were performed in 238 patients. These were 209 men and 29 women, aged 63.7 ± 13.9 years, with ejection fraction of 37.7% ± 14.0%, who had an ICD for secondary (n = 210) or primary (n = 28) prevention. The mean ICD longevity was 58.3 ± 18.7 months. In 20 (8.4%) patients, devices exhibited premature battery depletion within 36 months. Most (94%) patients had none, minor, or modest use of ICD therapy. Longevity was longest for single-chamber devices and shortest for CRT devices. Latest-generation devices replaced over the second decade lasted longer compared with devices replaced during the first decade. When analyzed by manufacturer, Medtronic devices appeared to have longer longevity by 13 to 18 months. The authors concluded that ICDs continue to have limited longevity of 4.9 ± 1.6 years, and 8% demonstrate premature battery depletion by 3 years. CRT devices have the shortest longevity (mean, 3.8 years) by 13 to 17 months, compared with other ICD devices (Manolis AS et al, Clin Cardiol 2017;40:759-764)... (excerpt)
Athens University School of Medicine
2018-01-14 17:22:42
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http://www.rhythmos.gr/index.php/Rhythmos/article/view/397
Rhythmos; Vol. 13 No. 1 (2018)
eng
Copyright (c) 2018 Rhythmos
oai:ojs.rhythmos.gr:article/419
2018-04-07T10:21:11Z
Rhythmos:CRDN
driver
"180407 2018 eng "
1792-7927
1792-7919
dc
Cardiology News / Recent Literature Review / First Quarter 2018
Manolis, Antonis S
Third Department of Cardiology, Athens University School of Medicine, Athens, Greece
Anninos, Hector
Athens University School of Medicine, Athens, Greece
Manolis AS, Anninos H. Cardiology News / Recent Literature Review / First Quarter 2018. Rhythmos 2018;13(2):38-43.
HRS Meeting: Boston, 9-12/5/2018
EuroPCR Meeting: Paris, 22-25/5/2018
ESC Meeting: Munich, 25-29/8/2018
ICD in Children & Adolescents with Brugada Syndrome: ~1 in 4 Patients Receive Appropriate Life-Saving Interventions Over a Period of 7 Years, Although Inappropriate Shocks and Other Adverse Events Occur Relatively Frequently
Among 35 consecutive patients (aged 13.9±6.2 years). over a mean of 88 months, sustained ventricular arrhythmias were treated by the ICD in 9 patients (26%), including shocks in 8 (23%) and antitachycardia pacing in 1 patient (3%). Three patients (9%) died in an electrical storm. Seven patients (20%) experienced inappropriate shocks, and 5 (14%) had device-related complications. Aborted sudden cardiac death and spontaneous type I ECG were identified as independent predictors of appropriate shock occurrence (Gonzalez Corcia MC et al, J Am Coll Cardiol 2018;71: 148–57).
Cardiomyopathy (CM) Patients With LVEF≤35% and LBBB Demonstrate Significantly Less LV Functional Recovery With Medical Therapy Than Do Those With a Narrow QRS / Thus, They Would Benefit From Earlier Implantation of a CRT Device
Among 659 patients with CM, 111 having LBBB (17%), 59 wide QRS duration ≥120 ms but not LBBB (9%), and 489 narrow QRS duration (74%), adjusted mean increase in LVEF over 3-6 months in the 3 groups was 2.03%, 5.28%, and 8%, respectively (p<0.0001), with no different results for interim revascularization and myocardial infarction. The combined endpoint of heart failure hospitalization or mortality was highest for patients with LBBB (Sze et al, J Am Coll Cardiol 2017;71: 306-17).
1-Year Follow-Up of PRAGUE-18 Study: Among Patients With MI Undergoing Primary PCI, Antiplatelet Therapy With Prasugrel or Ticagrelor is Associated With Similar Outcomes / Economically Motivated, Early Post-Discharge Switch To Clopidogrel was not Associated With Increased Risk of Ischemic Events
Among 1,230 patients with acute myocardial infarction (MI) treated with primary PCI and randomized to prasugrel or ticagrelor, the endpoint (cardiovascular death, MI, or stroke at 1 year) occurred in 6.6% of prasugrel patients and in 5.7% of ticagrelor patients (hazard ratio: 1.167; p = 0.503). No significant differences were found in: CV death (3.3% vs 3%), MI (3% vs. 2.5%), stroke (1.1% vs 0.7%), all-cause death (4.7% vs. 4.2%), definite stent thrombosis (1.1% vs. 1.5%), all bleeding (10.9% vs. 11.1%), and TIMI major bleeding (0.9% vs. 0.7%). The percentage of patients who switched to clopidogrel for economic reasons was 34.1% (n=216) for prasugrel and 44.4% (n=265) for ticagrelor (p=0.003). Patients who were economically motivated to switch to clopidogrel had (compared with patients who continued the study medications) a lower risk of major CV events; however, they also had lower ischemic risk (Motovska Z et al, J Am Coll Cardiol 2018;71:371-81)... (excerpt)
Athens University School of Medicine
2018-04-07 13:21:11
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http://www.rhythmos.gr/index.php/Rhythmos/article/view/419
Rhythmos; Vol. 13 No. 2 (2018)
eng
Copyright (c) 2018 Rhythmos
oai:ojs.rhythmos.gr:article/431
2018-06-30T11:38:21Z
Rhythmos:CRDN
driver
"180630 2018 eng "
1792-7927
1792-7919
dc
Cardiology News / Recent Literature Review / Second Quarter 2018
Manolis, Antonis S
Third Department of Cardiology, Athens University School of Medicine, Athens, Greece
Anninos, Hector
Third Department of Cardiology, Athens University School of Medicine, Athens, Greece
ESC Meeting: Munich, 25-29/8/2018
TCT Meeting: San Diego, 21-25/9/2018
Hellenic Cardiological Society Meeting, Athens, 18-20/10/2018
AHA Meeting: Chicago, 10-12/11/2018
EASEL Study: Sodium Glucose Cotransporter 2 Inhibitors (SGLT2i) Confer a Lower Rate of All-Cause Mortality, Hospitalization for Heart Failure (HF), and Major Adverse Cardiovascular Events (MACE)
After propensity matching, 25 258 patients were followed for a median of 1.6 years. Compared with non-SGLT2i, initiation of SGLT2i was associated with a lower rate of all-cause mortality and hospitalization for HF (1.73 vs 3.01 events per 100 person-years; HR, 0.57) and MACE (2.31 vs 3.45 events per 100 person-years; HR, 0.67). SGLT2i initiation was also associated with an ≈2-fold higher risk of below-knee lower extremity amputation (0.17 vs 0.09 events per 100 person-years; HR, 1.99). Because of the disproportionate canagliflozin exposure in the database, the majority of amputations were observed on canagliflozin (Udell JA et al, Circulation 2018;137:1450-9).
In Most Young Patients Who Experienced Sudden Cardiac Arrest (SCA), Sports was a Trigger in a Minority of Cases, while Standard Cardiovascular Risk Factors were Found in Over Half of them
Among 186 SCAs in the young (ages 5-34 years) (5% of all SCAs), overall prevalence of warning signs before SCA was low (29%), and 26 (14%) were associated with sports as a trigger. The remainder (n=160) occurred in other settings categorized as non-sports. Sports-related SCAs accounted for 39% of SCAs in patients aged ≤18, 13% of SCAs in patients aged 19 to 25, and 7% of SCAs in patients aged 25 to 34. Sports-related SCA cases were more likely to present with shockable rhythms, and survival from cardiac arrest was 2.5-fold higher in sports-related vs non-sports SCA (28% vs 11%; P=0.05). Overall, the most common SCA-related conditions were sudden arrhythmic death syndrome (31%), coronary artery disease (22%), and hypertrophic cardiomyopathy (14%). There was an unexpectedly high overall prevalence of established cardiovascular risk factors (obesity, diabetes mellitus, hypertension, hyperlipidemia, smoking) with ≥1 risk factors in 58% of SCA cases (Jayaraman R et al, Circulation 2018;137:1561-1570).
Although Second Arterial Conduit Use May be Low and Declining, Arterial Grafts Are Associated with Lower Mortality and Fewer Cardiovascular Events / A Right Internal Mammary Artery (IMA) Graft Offered No Benefit Over that of a Radial Artery, But did Increase Risk of Sternal Wound Infection / Thus, the Radial Artery May be the Preferred Second Conduit
The study included patients who received second arterial (right IMA or radial artery, n=5866) or a venous conduit (n=53 566). Propensity score matching yielded 5813 matched sets. Subgroup analysis compared outcomes between propensity score–matched recipients of a right IMA (n=1576) or a radial artery (n=4290). Use of second arterial conduit use decreased from 10.7% in 2006 to 9.1% in 2011 (P<0.0001). However, receipt of a second arterial conduit was associated with lower mortality (13.1% vs 10.6% at 7 years; hazard ratio-HR, 0.79), and lower risks of MI (HR, 0.78) and repeat revascularization (HR, 0.82). In comparison with radial artery grafts, right IMA grafts were associated with similar mortality rates (10.3% vs 10.7% at 7 years; HR, 1.10) and individual risks of cardiovascular events, but the risk of sternal wound infection was increased (risk difference, 1.07%) (Goldstone AB et al, Circulation 2018;137:1698-1707)... (excerpt)
Athens University School of Medicine
2018-06-30 14:38:21
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http://www.rhythmos.gr/index.php/Rhythmos/article/view/431
Rhythmos; Vol. 13 No. 3 (2018)
eng
Copyright (c) 2018 Rhythmos
oai:ojs.rhythmos.gr:article/439
2018-10-31T20:41:26Z
Rhythmos:CRDN
driver
"181031 2018 eng "
1792-7927
1792-7919
dc
Cardiology News / Recent Literature Review / Third Quarter 2018
Manolis, Antonis S
Third Department of Cardiology, Athens University School of Medicine, Athens, Greece
Anninos, Hector
Athens University School of Medicine, Athens, Greece
Rhythmos 2018;13(4):81-88.
HCS 39th Meeting: Athens, 18-20/10/2018
AHA Meeting: Chicago, IL, USA, 10-12/11/2018
ACC.19 Meeting: New Orleans, LA, USA, 16-18/3/2019
EHRA Congress: Lisbon, 17-19/3/2019
HRS Meeting: San Francisco, CA, USA, 8-11/5/2019
EuroPCR: Paris, 21-24/5/2019
ESC Meeting: Paris, 31/8-4/9/2019
NOACs are All Associated With a Significant Standardized Absolute Risk Reduction of MI Compared With VKA
Among 31,739 patients with atrial fibrillation (AF) (median age, 74 years; 47% females), the standardized 1-year risk of MI for VKA was 1.6%, 1.2% for apixaban, 1.2% for dabigatran, and 1.1% for rivaroxaban. No significant risk differences were observed in the standardized 1-year risks of MI among the NOACs: dabigatran vs apixaban (0.04%), rivaroxaban versus apixaban (0.1%), and rivaroxaban versus dabigatran (−0.1%). The risk differences for NOACs vs VKA were all significant: −0.4% for apixaban, −0.4% for dabigatran, and −0.5% for rivaroxaban (Lee CJ-Y et al, J Am Coll Cardiol 2018;72: 17–26).
ATLAS ACS 2-TIMI 51 Trial: In Patients With ACS, Addition of Rivaroxaban, 2.5 mg bid, to Dual Antiplatelet Therapy With Aspirin and Clopidogrel Was Associated With a Net Reduction in Fatal or Irreversible Events Compared to Dual Antiplatelet Therapy Alone
Rivaroxaban, 2.5 mg bid, in ACS patients treated with aspirin and clopidogrel/ticlopidine was associated with 115 fewer fatal or irreversible ischemic events (663 for placebo vs 548 for therapy) and 10 additional fatal or irreversible seriously harmful events (33 vs 23 for placebo) per 10,000 patient-years of exposure. Thus, there would be 105 fatal or irreversible events prevented per 10,000 patient-years of exposure to rivaroxaban compared with placebo, with 11 (10 of 115) fatal or irreversible ischemic events prevented for each fatal or irreversible seriously harmful event caused. If only nonbleeding cardiovascular death is included as a fatal or irreversible event, then 95 events would be prevented per 10,000 patient-years of exposure in the group taking 2.5 mg bid (Gibson CM et al, J Am Coll Cardiol 2018;72: 129-36)
XANTUS Program: In a Pooled Analysis of Several practice-Based Registries, AF Patients on Rivaroxaban Had Generally Low Rates of Stroke, Bleeding, and Treatment Discontinuation and Results Were Broadly Consistent Across Different Regions of the World
Among 11,121 AF patients receiving rivaroxaban (mean age 70.5±10.5 years; female 42.9%) with comorbidities including heart failure (21.2%), hypertension (76.2%), and diabetes (22.3%), event rates were: events/100 patient-years: major bleeding 1.7 (lowest: Latin America 0.7; highest: Western Europe, Canada, and Israel 2.3); all-cause death 1.9 (lowest: Eastern Europe 1.5; highest: Latin America, Middle East, and Africa 2.7); and stroke or systemic embolism 1.0 (lowest: Latin America 0; highest: East Asia 1.8). One-year treatment persistence was 77.4% (lowest: East Asia 66.4%; highest: Eastern Europe 84.4%) (Kirchhof P et al, J Am Coll Cardiol 2018;72:141-53)... (excerpt)
Athens University School of Medicine
2018-10-31 22:20:20
application/pdf
http://www.rhythmos.gr/index.php/Rhythmos/article/view/439
Rhythmos; Vol. 13 No. 4 (2018)
eng
Copyright (c) 2018 Rhythmos
oai:ojs.rhythmos.gr:article/450
2019-01-08T14:15:36Z
Rhythmos:CRDN
driver
"190108 2019 eng "
1792-7927
1792-7919
dc
Cardiology News / Recent Literature Review / Last Quarter 2018
Manolis, Antonis S
Third Department of Cardiology, Athens University School of Medicine, Athens, Greece http://orcid.org/0000-0002-0336-4745
Anninos, Hector
Athens University School of Medicine, Athens
Rhythmos 2019;14(1):13-21.
ACC.19 Meeting: New Orleans, LA, USA, 16-18/3/2019
EHRA Congress: Lisbon, 17-19/3/2019
HRS Meeting: San Francisco, CA, USA, 8-11/5/2019
EuroPCR: Paris, 21-24/5/2019
ESC Meeting: Paris, 31/8-4/9/2019
TOTAL Trial: Although High Thrombus Burden Was an Important Predictor of Outcome in STEMI, Routine Thrombus Aspiration Did Not Improve Outcomes at 1 Year and Was Associated With an Increased Rate of Stroke
Among 10,732 patients with STEMI randomized to routine manual thrombectomy versus PCI alone, the primary outcome of cardiovascular (CV) death, MI, cardiogenic shock, or heart failure at 1 year was similar with thrombus aspiration in patients with high (8.1% vs. 8.3% thrombus aspiration; hazard ratio - HR: 0.97) or low thrombus burden (% vs. 5% thrombus aspiration; HR: 1.22; interaction p=0.41). However, among patients with high thrombus burden, stroke at 1 month was more frequent with thrombus aspiration (31 / 0.7% thrombus aspiration vs 16 / 0.4% PCI alone, HR: 1.90). In the high thrombus burden group, thrombus aspiration did not improve 1-month (HR: 0.78; p=0.06) and 1-year CV mortality (HR: 0.88; p=0.25). Irrespective of treatment assignment, high thrombus burden was an independent predictor of death (HR: 1.78) (Jolly SS et al, J Am Coll Cardiol 2018;72: 1589–96).
Meta-Analysis: Catheter Ablation of Atrial Fibrillation (AF) in Patients with Heart Failure (HF) was Superior to Conventional Drug Therapy in Improving All-Cause Mortality, HF Hospitalizations, LVEF, 6-Minute Walk Test Distance, VO2max, and Quality of Life, With an Increase, Albeit Non-Significant, in Adverse Events
Meta-analysis of 6 RCTs involving 775 patients indicated that compared with drug therapy, AF ablation reduced all-cause mortality (9% vs 17.6%; risk ratio -RR, 0.52) and HF hospitalizations (16.4% vs 27.6%; RR, 0.60). Ablation improved left ventricular ejection fraction (LVEF) (mean difference, 6.95%), 6-minute walk test distance (mean difference, 20.93 m), peak oxygen consumption (Vo2max) (mean difference, 3.17 mL/kg per minute), and quality of life (mean difference in Minnesota Living with Heart Failure Questionnaire score, −9.02 points). Serious adverse events were more common in the ablation groups (7.2% vs 3.8%; RR, 1.68) (Turagam MK et al, Ann Int Med 2018, Dec 25).
The Mitral Annulus Disjunction (MAD) Arrhythmic Syndrome
Mitral annulus disjunction (MAD) is an abnormal atrial displacement of the mitral valve leaflet hinge point. MAD has been associated with mitral valve prolapse (MVP) and sudden cardiac death. Among 116 patients with MAD (age 49 ± 15 years; 60% female), palpitations were the most common symptom (71%), while severe arrhythmic events occurred in 14 (12%) patients. Patients with severe arrhythmic events were younger (age 37 ± 13 years vs 51 ± 14 years; p=0.001), had lower ejection fraction (51 ± 5% vs 57 ± 7%; p=0.002) and had more frequently papillary muscle fibrosis (4 or 36% vs 6 or 9%; p=0.03). MVP was evident in 90 (78%) patients and was not associated with ventricular arrhythmia (Dejgaard LA et al, J Am Coll Cardiol 2018;72:1600-9)... (excerpt)
Athens University School of Medicine
2019-01-08 16:15:35
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http://www.rhythmos.gr/index.php/Rhythmos/article/view/450
Rhythmos; Vol. 14 No. 1 (2019)
eng
Copyright (c) 2019 Rhythmos
oai:ojs.rhythmos.gr:article/458
2019-04-26T20:05:21Z
Rhythmos:CRDN
driver
"190426 2019 eng "
1792-7927
1792-7919
dc
Cardiology News / Recent Literature Review / First Quarter 2019
Manolis, Antonis S
Third Department of Cardiology, Athens University School of Medicine, Athens, Greece
Anninos, Hector
Athens University School of Medicine, Athens
HRS Meeting: San Francisco, CA, USA, 8-11/5/2019
EuroPCR: Paris, 21-24/5/2019
ESC Meeting: Paris, 31/8-4/9/2019
TCT Meeting: San Francisco, 25-28/9/2019
HCS 40th Congress: Ioannina, 17-19/10/2019
AHA Meeting: Philadelphia, PA, USA, 16-18/11/2019
ACC Meeting: Chicago, IL, USA, 28-30/3/2020
EHRA Meeting: Vienna, 29-31/3/2020
SWEDEHEART Registry: Troponinemia is not Innocent and Demands Careful Workup
Among 48,872 patients, a cardiac troponin (cTn) level >99th percentile was found in 9,800 (20.1%) patients. The prevalence of cardiovascular (CV) risk factors as well as CV and nonCV comorbidities increased across higher cTn strata. In total, 7,529 (15.4%) patients had a major adverse event (MAE), defined as the composite of all-cause mortality, MI, readmission for heart failure, or stroke over a median of 4.9 years). MAE risk was associated with higher cTn strata (hazard ratio–HR for highest assay-specific cTn tertile: 2.59; HR 3.57 in patients without CV comorbidities, renal dysfunction, LV dysfunction, or significant coronary stenosis) (Eggers KM et al, J Am Coll Cardiol 2019;73: 1–9).
French SCAD Study: the rs9349379 Allele of the PHACTR1/EDN1 Genetic Locus Lying on Chromosome 6q24 is the First Generic Risk Locus for Spontaneous Coronary Artery Dissection
The previously reported risk allele for fibromuscular dysplasia (FMD) (rs9349379-A) was associated with a higher risk of SCAD in all studies. In a meta-analysis of 1,055 SCAD patients and 7,190 controls, the odds ratio (OR) was 1.67 per copy of rs9349379-A. In a subset of 491 SCAD patients, the OR estimate was higher for the association with SCAD in patients without FMD (OR: 1.89) than in SCAD cases with FMD (OR: 1.60). There was no effect of genotype on age at first event, pregnancy associated SCAD, or recurrence (Adlam D et al, J Am Coll Cardiol 2019;73:58-66).
COMPASS-CABG Study: Compared With Aspirin or Rivaroxaban Alone, the Combination of Rivaroxaban and Aspirin Did Not Prevent Early Failure of CABGs but Reduced MACE, Consistent With Outcomes in the Overall COMPASS Trial
Among 1,448 COMPASS trial patients randomized 4-14 days after CABG surgery to receive the combination of rivaroxaban plus aspirin, rivaroxaban alone, or aspirin alone, the combination of rivaroxaban and aspirin and the regimen of rivaroxaban alone did not reduce the graft failure rates compared with aspirin alone (combination vs. aspirin: 9.1% vs 8% failed grafts; odds ratio - OR: 1.13; p=0.45; rivaroxaban alone vs aspirin: 7.8% vs 8% failed grafts; OR: 0.95; p=0.75). Compared with aspirin, the combination was associated with fewer MACE (2.4% vs. 3.5%; hazard ratio-HR: 0.69; p=0.34), whereas rivaroxaban alone was not (3.3% vs 3.5%; HR: 0.99; p=0.98). There was no fatal bleeding or tamponade within 30 days of randomization (Lamy A et al, J Am Coll Cardiol 2019;73:121-30)... (excerpt)
Athens University School of Medicine
2019-04-26 23:05:21
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http://www.rhythmos.gr/index.php/Rhythmos/article/view/458
Rhythmos; Vol. 14 No. 2 (2019)
eng
Copyright (c) 2019 Rhythmos
oai:ojs.rhythmos.gr:article/468
2019-07-20T19:32:01Z
Rhythmos:CRDN
driver
"190720 2019 eng "
1792-7927
1792-7919
dc
Cardiology News / Recent Literature Review / Second Quarter 2019
Manolis, Antonis S
Third Department of Cardiology, Athens University School of Medicine, Athens, Greece
Anninos, Hector
Athens University School of Medicine, Athens
ESC Meeting: Paris, 31/8-4/9/2019
TCT Meeting: San Francisco, 25-28/9/2019
HCS 40th Congress: Ioannina, 17-19/10/2019
AHA Meeting: Philadelphia, PA, USA, 16-18/11/2019
ACC Meeting: Chicago, IL, USA, 28-30/3/2020
EHRA Meeting: Vienna, 29-31/3/2020
Rhythmos 2019;14(3):58-65.
AUGUSTUS Trial: In Patients With Atrial Fibrillation (AF) and a Recent Acute Coronary Syndrome (ACS) or PCI Treated With a P2Y12 Inhibitor, an Antithrombotic Regimen Including Apixaban, Without Aspirin, Resulted in Less Bleeding and Fewer Hospitalizations Without Significant Differences in the Incidence of Ischemic Events Than Regimens that Included a Vitamin K Antagonist (VKA), Aspirin, or Both
Among 4614 AF patients with ACS or PCI, major or clinically relevant nonmajor bleeding was noted in 10.5% of the patients receiving apixaban, as compared with 14.7% of those receiving a VKA (hazard ratio-HR, 0.69; P<0.001 for both noninferiority and superiority), and in 16.1% of the patients receiving aspirin, as compared with 9.0% of those receiving placebo (HR, 1.89; P<0.001). Patients in the apixaban group had a lower incidence of death or hospitalization than those in the VKA group (23.5% vs. 27.4%; HR, 0.83; P=0.002) and a similar incidence of ischemic events. Patients in the aspirin group had an incidence of death or hospitalization and of ischemic events that was similar to that in the placebo group (Lopes RD et al, N Engl J Med 2019; 380:1509-24).
COAPT Trial: Among Patients Successfully Resuscitated After Out-Of-Hospital Cardiac Arrest with no Signs of STEMI, a Strategy of Immediate Angiography Was Not Found to be Better Than a Strategy of Delayed Angiography With Respect to Overall Survival at 90 Days
At 90 days, 176 of 273 patients (64.5%) in the immediate angiography group and 178 of 265 patients (67.2%) in the delayed (delayed until after neurologic recovery) angiography group were alive (odds ratio, 0.89; P=NS). The median time to target temperature was 5.4 h in the immediate angiography group and 4.7 h in the delayed angiography group. No significant differences between the groups were found in the remaining secondary end points (Lemkers JS et al, N Engl J Med 2019; 380:1397-1407).
ANNEXA-4: In Patients With Acute Major Bleeding Associated With Use of a Factor Xa Inhibitor, Treatment With Andexanet Markedly Reduced Anti–Factor Xa Activity, and 82% of Patients Had Excellent or Good Hemostatic Efficacy at 12 Hours
Among 352 patients (mean age 77 years, most with CV disease) who had acute major bleeding (64% intracranial and 26% gastrointestinal) within 18 h after a factor Xa inhibitor and received a bolus of andexanet, followed by a 2-hour infusion, in patients who had received apixaban, the median anti–factor Xa activity decreased from 149.7 ng/ml at baseline to 11.1 ng/ml after the andexanet bolus (92% reduction); in patients who had received rivaroxaban, the median value decreased from 211.8 ng/ml to 14.2 ng/ml (92% reduction). Excellent or good hemostasis occurred in 204 of 249 patients (82%) who could be evaluated. Within 30 days, death occurred in 49 patients (14%) and a thrombotic event in 34 (10%). Reduction in anti–factor Xa activity was not predictive of hemostatic efficacy overall but was modestly predictive in patients with intracranial hemorrhage (Connolly SJ et al, N Engl J Med2019; 380:1326-35)... (excerpt). Rhythmos 2019;14(3):58-65.
Athens University School of Medicine
2019-07-20 22:32:01
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http://www.rhythmos.gr/index.php/Rhythmos/article/view/468
Rhythmos; Vol. 14 No. 3 (2019)
eng
Copyright (c) 2019 Rhythmos
oai:ojs.rhythmos.gr:article/471
2019-10-10T14:29:48Z
Rhythmos:CRDN
driver
"191009 2019 eng "
1792-7927
1792-7919
dc
Cardiology News / Recent Literature Review / Third Quarter 2019
Manolis, Antonis S
Third Department of Cardiology, Athens University School of Medicine, Athens, Greece
Anninos, Hector
Rhythmos 2019;14(4):80-86.
HCS 40th Cardiology Congress: Ioannina, 17-19/10/2019
AHA Meeting: Philadelphia, PA, USA, 16-18/11/2019
HCS Working Groups: Thessaloniki, 20-22/2/2020
ACC Meeting: Chicago, IL, USA, 28-30/3/2020
EHRA Meeting: Vienna, 29-31/3/2020
HRS Meeting: San Diego, 6-9/5/2020
EuroPCR: Paris, 19-22/5/2020
ESC Meeting: Amsterdam, 29/8-2/9/2020
Carpal Tunnel Syndrome (CTS) is Associated With Amyloidosis, Heart Failure (HF), and Adverse Cardiovascular (CV) Outcomes
Among 56,032 patients from the Danish registries who underwent surgical treatment for CTS, compared with a sex- and age-matched cohort, CTS was associated with a future diagnosis of amyloidosis (hazard ratio-HR: 12.12), and a higher incidence of HF, (HR 1.54). Risk of other adverse outcomes was also associated with CTS (p<0.0001 for AF, AV block, and pacemaker implantation) (Fosbel EL et al, J Am Coll Cardiol 2019; 74:15-23).
MI Risk Stratification with Single Measurement of High-Sensitivity Cardiac Troponin: an optimized threshold of <5 ng/l safely identified almost one-half of all patients as low risk at presentation, with hs-cTnI >120 ng/l identifying high-risk patients
Among 2,212 patients admitted for chest pain, acute MI occurred in 12%. Two assays of high-sensitivity cTnI had excellent sensitivities (98.6-99.6%) and negative predictive values (NPVs) (range 99.5-99.8%) for acute MI or death at 30 days across both assays. An optimized threshold of <5 ng/l identified almost one-half of all patients as low risk, with sensitivities of 98.6% and NPVs of 99.6% for acute MI or death at 30 days across both assays. For high-risk patients, hs-cTnI ≥120 ng/l resulted in positive predictive values for acute MI of ≥70% (Sandoval Y et al, J Am Coll Cardiol 2019; 74:271-82).
AG10, a Selective Transthyretin (TTR) Stabilizer, Appears a Safe and Effective Treatment for Patients With Amyloid TTR Cardiomyopathy (ATTR-CM)
Patients (n=49) with ATTR-CM (NYHA class II-III) were randomized 1:1:1 to AG10 400 mg, AG10 800 mg, or placebo bid for 28 days. AG10 is a selective, oral TTR stabilizer under development for ATTR-CM that mimics a protective TTR mutation. AG10 treatment was well-tolerated, achieved target plasma concentrations and achieved near-complete stabilization of TTR. TTR stabilization was more complete and less variable at the higher dose. Average serum TTR increased by 36 ± 21% and 51 ± 38% at 400 and 800 mg, respectively (both p<0.0001 vs placebo). Baseline serum TTR in treated subjects was below normal in 80% of mutant and 33% of wild-type subjects. AG10 treatment restored serum TTR to the normal range in all patients (Judge DP et al, J Am Coll Cardiol 2019; 74:285-95).
IMPULSE/PEFCAT: Pulsed Field Ablation (PFA) is a New Promising Mode Allowing Ultra-Rapid PV Isolation
During PFA, subsecond electric fields creating microscopic pores in cell membranes (electroporation) are particularly applicable to cardiomyocytes which have among the lowest thresholds to these fields, potentially permitting preferential myocardial ablation. Safety and effectiveness of catheter-PFA was assessed in 2 first-in-human trials in 81 patients with paroxysmal atrial fibrillation (AF). All PVs were acutely isolated by monophasic (n=15) or biphasic (n=66) PFA with ≤3 min elapsed delivery/patient, skin-to-skin procedure time of 92.2 ± 27.4 min, and fluoroscopy time of 13.1 ± 7.6 min. With successive waveform refinement, durability at 3 months improved from 18% to 100% of patients with all PVs isolated. There was only 1 procedure-related pericardial tamponade, with no additional adverse events over the 120-day median follow-up. The 12-month Kaplan-Meier estimate of freedom from arrhythmia was 87.4 ± 5.6% (Reddy VY et al, J Am Coll Cardiol 2019;74: 315-26)... (excerpt)
Athens University School of Medicine
2019-10-09 20:07:27
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http://www.rhythmos.gr/index.php/Rhythmos/article/view/471
Rhythmos; Vol. 14 No. 4 (2019)
eng
Copyright (c) 2019 Rhythmos
oai:ojs.rhythmos.gr:article/476
2020-01-30T16:41:16Z
Rhythmos:CRDN
driver
"200128 2020 eng "
1792-7927
1792-7919
dc
Cardiology News / Recent Literature Review / Last Quarter 2019
Manolis, Antonis S
Third Department of Cardiology, Athens University School of Medicine, Athens, Greece
Anninos, Hector
Athens University School of Medicine
HCS Working Groups: Thessaloniki, 20-22/2/2020
ACC Meeting: Chicago, IL, USA, 28-30/3/2020
EHRA Meeting: Vienna, 29-31/3/2020
HRS Meeting: San Diego, 6-9/5/2020
EuroPCR: Paris, 19-22/5/2020
ESC Meeting: Amsterdam, 29/8-2/9/2020
Childhood Secondhand Smoke Exposure Predicts Increased Risk for Adulthood Atrial Fibrillation (AF) After Adjustment for AF Risk Factors
A study analyzed Framingham Offspring cohort participants with parents in the Original cohort with known smoking status during the offspring’s childhood, evaluated every 2-8 years and being under routine surveillance for incident AF. Of 2,816 Offspring cohort participants with at least 1 parent in the Original cohort, 82% were exposed to parental smoking. For every pack/day increase in parental smoking, there was an 18% increase in offspring AF incidence (adjusted hazard ratio - HR: 1.18; p=0.04). Additionally, parental smoking was a risk factor for offspring smoking (adjusted odds ratio - OR: 1.34; p<0.001). Offspring smoking mediated 17% of the relationship between parental smoking and offspring AF (Groh CA et al, J Am Coll Cardiol 2019; 74:1658-64).
When Left Untreated, Severe Aortic Stenosis (AS) is Associated With Poor Long-Term Survival / But Also Moderate AS Confers Poor Survival Rates
Among 16,129 (6.7%), 3,315 (1.4%), and 6,383 (2.6%) patients had mild, moderate, and severe AS, respectively, on an adjusted basis (vs. no AS; 5-year mortality 19%), patients with mild to severe AS had an increasing risk of long-term mortality (adjusted hazard ratio: 1.44-2.09; p<0.001 for all comparisons). The 5-year mortality was 56% and 67%, respectively, in those with moderate AS (mean gradient 20.0-39.0 mmHg/peak velocity 3.0-3.9 m/s) and severe AS (≥40 mmHg, ≥4 m/s, or AV area<1 cm2 in low-flow, low-gradient severe AS). A markedly increased risk of death from all causes (5-year mortality >50%) and CV disease was evident from a mean AV gradient >20 mmHg (moderate AS) after adjusting for age, sex, LV systolic or diastolic dysfunction, and aortic regurgitation (Strange G et al, J Am Coll Cardiol 2019; 74:1851-63).
Premature (Age≤45 Years) Acute or Stable Obstructive Coronary Artery Disease (CAD) is an Aggressive Disease Despite the Currently Recommended Prevention Measures, With High Rates of Recurrent Events and Mortality
Among 880 patients with premature CAD, aged 40.1 ± 5.7 years, mainly men, smokers, with a family history of CAD or hypercholesterolemia, at baseline presentation, 91% underwent coronary revascularization, predominantly for acute MI (79%). Over 20 years, one-third (n = 264) of patients presented with a total of 399 ischemic events, and 36% had at least a second recurrent event. MI was the most frequent first recurrent event (n=131 of 264), mostly related to new coronary lesions (17% vs 8%; p=0.01; hazard ratio - HR: 1.45 for new vs initial culprit lesion). All-cause death (n=55; 6.3%) occurred at 8.4 years (median time). Ethnic origin (sub-Saharan African vs. Caucasian, adjusted HR - adjHR: 1.95; p=0.02), inflammatory disease (adjHR: 1.58; p=0.03), and persistent smoking (adjHR: 2.32; p<0.01) were the strongest correlates of a first recurrent event. When considering all recurrent events, the same factors and Asian ethnicity predicted poor outcome, but persistent smoking had the greatest impact on prognosis (Collet J-P et al, J Am Coll Cardiol 2019; 74:1868-78)... (excerpt)
Athens University School of Medicine
2020-01-30 00:00:00
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http://www.rhythmos.gr/index.php/Rhythmos/article/view/476
Rhythmos; Vol. 15 No. 1 (2020)
eng
Copyright (c) 2020 Rhythmos
oai:ojs.rhythmos.gr:article/480
2020-04-07T06:39:23Z
Rhythmos:CRDN
driver
"200407 2020 eng "
1792-7927
1792-7919
dc
Cardiology News / Recent Literature Review / First Quarter 2020
Manolis, Antonis S
Third Department of Cardiology, Athens University School of Medicine, Athens, Greece
Anninos, Hector
Athens University School of Medicine
Rhythmos 2020;15(2):35-41.
Virtual HRS Meeting: (San Diego) 6-9/5/2020
Virtual EuroPCR: (Paris) 19-22/5/2020
?ESC Meeting: Amsterdam, 29/8-2/9/2020
?TCT: Miami Beach, FL, USA, 23-27/9/20
?HCS/Panhellenic (41st) Congress of Cardiology: Athens, 22-24/10/20
Persistent Proarrhythmic Neural Remodeling (Characterized by Extracardiac Sympathetic Hyperinnervation and Sympathetic Neural Hyper-activity) Despite Recovery from Premature Ventricular Contraction-Induced Cardiomyopathy (PVC-CM)
In 12 canines, with pacing-applied PVC-CM, after 12 weeks of PVCs, LVEF and dP/dT decreased significantly. Resting sympathetic nerve activity (SNA) and vagal nerve activity (VNA), exercise SNA, SNA response to evoked PVCs, heart rate (HR) at rest, and exercise increased, whereas HR variability (HRV) decreased. There was increased spontaneous atrial and ventricular arrhythmias in PVC-CM. Increased SNA preceded both atrial and ventricular arrhythmia onset. Clonidine suppressed SNA and abolished all arrhythmias. After stopping PVC for 4 weeks, LVEF, dP/dT, and resting VNA recovered to baseline levels. However, SNA, resting HR, HRV, and atrial and ventricular proarrhythmia persisted. Sympathetic hyperinnervation was found in stellate ganglia but not ventricles of PVC-CM and recovered animals versus sham controls. The authors concluded that neural remodeling in PVC-CM is characterized by extracardiac sympathetic hyperinnervation and sympathetic neural hyperactivity that persists despite normalization of LVEF, constituting an important trigger and substrate for atrial and ventricular proarrhythmia (Tan AY et al, J Am Coll Cardiol 2020; 75:1-13).
PARAGON-HF: The Benefits of Sacubitril/Valsartan in HFpEF are Present When Initiated in the High-Risk Window Within 180 Days of a Recent Hospitalization
Among 4,796 randomized patients in PARAGON-HF, over a median follow-up of 35 months, risk of total HF hospitalizations and cardiovascular death was inversely and nonlinearly associated with timing from prior HF hospitalization (p<0.001). Compared with valsartan, absolute risk reductions with sacubitril/valsartan were more prominent in patients enrolled early after hospitalization: 6.4% (≤1 month), 4.6% (1-3 months), and 3.4% (3-6 months), whereas no risk reduction was observed in patients screened >6 months or who were never hospitalized (trend in absolute risk reduction: pinteraction=0.050) (Vaduganathan M et al, J Am Coll Cardiol 2020; 75:245-54).
Oral Anticoagulation (OAC) for Patients With Atrial Fibrillation (AF) on Long-Term Dialysis: Not Associated With a Reduced Risk of Thromboembolism / Warfarin, Dabigatran, and Rivaroxaban Were Associated With Higher Bleeding Risk Compared With Apixaban and no Anticoagulant
Of 16 observational studies (N=71,877) regarding patients on long-term dialysis who had AF, only 2 studies investigated direct OACs. Outcomes for dabigatran and rivaroxaban were limited to major bleeding events. Compared with no anticoagulants, apixaban and warfarin were not associated with a significant decrease in stroke and/or systemic thromboembolism (apixaban 5 mg, hazard ratio -HR: 0.59; apixaban 2.5 mg, HR: 1.00; warfarin, HR: 0.91). Apixaban 5 mg was associated with a significantly lower risk of mortality (vs. warfarin, HR: 0.65; vs. apixaban 2.5 mg, HR: 0.62; vs. no anticoagulant, HR: 0.61). Warfarin was associated with a significantly higher risk of major bleeding than apixaban 5 mg/2.5 mg and no anticoagulant (vs. apixaban 5 mg, HR: 1.41; vs. apixaban 2.5 mg, HR: 1.40; vs. no anticoagulant, HR: 1.31). Dabigatran and rivaroxaban were also associated with significantly higher risk of major bleeding than apixaban and no anticoagulant (Kuno T et al, J Am Coll Cardiol 2019; 75:273-85)... (excerpt)
Athens University School of Medicine
2020-04-07 09:39:23
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http://www.rhythmos.gr/index.php/Rhythmos/article/view/480
Rhythmos; Vol. 15 No. 2 (2020)
eng
Copyright (c) 2020 Rhythmos
oai:ojs.rhythmos.gr:article/486
2020-07-15T12:51:58Z
Rhythmos:CRDN
driver
"200715 2020 eng "
1792-7927
1792-7919
dc
Cardiology News / Recent Literature Review / Second Quarter 2020
Manolis, Antonis S
Third Department of Cardiology, Athens University School of Medicine, Athens, Greece
Anninos, Hector
Athens University School of Medicine
Cardiology News / Recent Literature Review / Second Quarter 2020
Rhythmos 2020;15(3):55-63.
ESC Meeting/Digital Experience: 29/8-1/9/2020
TCT/ Virtual Event: 14-18/10/2020
HCS/Panhellenic (41st) Congress of Cardiology: Athens, 22-24/10/2020
AHA Meeting 2020: cancelled
ACC Meeting: Atlanta, 20-22/3/2021
EHRA Meeting: Barcelona, 28-30/3/2021
Women Have a Higher Risk of MACE and Ischemia-Driven Target Lesion Revascularization (ID-TLR) Compared With Men at 5 Years Post-PCI
Among 32,877 patients, 9,141 (27.8%) were women who were older and had higher body mass index, more frequent hypertension and diabetes, and less frequent history of surgical or percutaneous revascularization compared with men. Lesions in women had smaller reference vessel diameter and shorter lesion length. At 5 years, women had a higher rate of MACE (18.9% vs 17.7%; p=0.003), all-cause death (10.4% vs 8.7%; p=0.0008), cardiac death (4.9% vs 4.0%; p=0.003) and ID-TLR (10.9% vs 10.2%; p=0.02) compared with men. By multivariable analysis, female sex was an independent predictor of MACE (hazard ratio [HR:]: 1.14; p=0.04) and ID-TLR (HR: 1.23; p=0.009) but not all-cause death (HR: 0.91; p=0.30) or cardiac death (HR: 0.97; p=0.85) (Kosmidou I et al, J Am Coll Cardiol 2020; 75:1631-40).
PARAGON-HF: Baseline and Mean Achieved Systolic Blood Pressure (SBP) of 120-129 mmHg Identified the Lowest Risk Patients With Heart Failure With Preserved Ejection Fraction Treated With Sacubitril/ Valsartan
Among 4,795 trial participants (age 73 ± 8 years, 52% women), multivariable analysis indicated that baseline and mean achieved SBP of 120-129 mmHg demonstrated the lowest risk for all outcomes. Sacubitril/valsartan reduced SBP by 5.2 mmHg compared with valsartan at 4 weeks, which was not modified by baseline SBP. However, sacubitril/valsartan reduced SBP more in women (6.3 mmHg) than men (4 mmHg) (interaction p=0.005). Change in SBP was directly associated with change in NT-proBNP (p<0.001) but not symptom score (p=0.40) (Selvaraj S et al, J Am Coll Cardiol 2020; 75:1644-56)... (excerpt)
Athens University School of Medicine
2020-07-15 08:50:13
application/pdf
http://www.rhythmos.gr/index.php/Rhythmos/article/view/486
Rhythmos; Vol. 15 No. 3 (2020)
eng
Copyright (c) 2020 Rhythmos
oai:ojs.rhythmos.gr:article/496
2020-10-02T11:13:36Z
Rhythmos:CRDN
driver
"201002 2020 eng "
1792-7927
1792-7919
dc
Cardiology News / Recent Literature Review / Third Quarter 2020
Manolis, Antonis S
Third Department of Cardiology, Athens University School of Medicine, Athens, Greece
Anninos, Hector
Athens University School of Medicine
Rhythmos 2020;15(4):80-87.
TCT/ Virtual Event: 14-18/10/2020
HCS/Panhellenic (41st) Congress of Cardiology: Athens, 22-24/10/2020
AHA Meeting 2020: cancelled
ACC Meeting: Atlanta, 20-22/3/2021
EHRA Meeting: Barcelona, 28-30/3/2021
COMPASS Trial: Rivaroxaban 2.5 mg bid Plus ASA vs ASA Alone Resulted in Fewer Events (Stroke and Cardiovascular Mortality), Particularly in High-Risk Subgroups and Those With Multiple Risk Characteristics With Less Frequent Severe Bleedings and Less Clinical Impact
Rivaroxaban 2.5 mg bid plus aspirin 100 mg reduced the risk of cardiovascular (CV) events as compared with ASA monotherapy in the COMPASS trial but increased the risk of major bleedings. The current prespecified analysis was performed to assess the net clinical benefit (NCB) of adding rivaroxaban 2.5 mg bid to ASA monotherapy in patients with chronic vascular disease in the COMPASS study cohort with a specific focus on high-risk subgroups. A lower number of NCB adverse outcomes was observed with rivaroxaban 2.5 mg bid plus ASA vs ASA alone (hazard ratio, 0.80, P=0.0005), which became increasingly favorable with longer treatment duration. In selected high-risk subgroups, a larger absolute risk reduction for experiencing a NCB event was observed (Steffel J et al, Circulation 2020; 142:40-48).
COVID-19: The Prevalence of DVT is High, Associated With Adverse Outcomes in Hospitalized Patients With COVID-19 / Prophylaxis for DVT May be Protective in Patients With a Padua Protection Score ≥4 After Admission
Of the 143 patients hospitalized with COVID-19 (age 63±14 years, 51.7% men), 66 patients developed lower extremity DVT (46.1%). Compared with patients who did not have DVT, patients with DVT were older and had a lower oxygenation index, a higher rate of cardiac injury, and worse prognosis, including an increased rate of deaths (34.8% vs 9 11.7%; P=0.001) and a decreased proportion of patients discharged (48.5% vs 77.9%; P<0.001). In the subgroup of patients with a Padua prediction score ≥4 and whose ultrasound scans were performed >72 h after admission, DVT was present in 34% patients in the subgroup receiving thromboprophylaxis vs 66% patients in the nonprophylaxis group (P=0.010) (Zhang L et al, Circulation 2020; 142:114–128).
Meta-Analysis: Prasugrel and Ticagrelor Reduced Ischemic Events and Increased Bleeding Compared With Clopidogrel in Patients with ACS / A Significant Mortality Reduction Was Observed With Ticagrelor Only /There was no Efficacy and Safety Difference Between Prasugrel and Ticagrelor
According to a network meta-analysis of 12 RCTs including 52 816 patients with acute coronary syndrome (ACS), in comparison with clopidogrel, ticagrelor significantly reduced cardiovascular mortality (hazard ratio-HR, 0.82) and all-cause mortality (HR, 0.83), with no significant mortality reduction with prasugrel (HR, 0.90 and HR, 0.92, respectively). In comparison with each other, there were no significant differences in mortality. In comparison with clopidogrel, prasugrel reduced myocardial infarction (HR, 0.81), whereas ticagrelor showed no risk reduction (HR, 0.97). Differences between prasugrel and ticagrelor were not significant. Stent thrombosis risk was significantly reduced by both ticagrelor and prasugrel versus clopidogrel (28%–50% range of reduction). In comparison with clopidogrel, both prasugrel (HR, 1.26) and ticagrelor (HR, 1.27) significantly increased major bleeding. There were no significant differences between prasugrel and ticagrelor for all outcomes explored (Navarese EP et al, Circulation. 2020;142:150–160)... (excerpt)
Athens University School of Medicine
2020-10-02 14:13:36
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http://www.rhythmos.gr/index.php/Rhythmos/article/view/496
Rhythmos; Vol. 15 No. 4 (2020)
eng
Copyright (c) 2020 Rhythmos
oai:ojs.rhythmos.gr:article/500
2022-05-01T08:19:46Z
Rhythmos:CRDN
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Cardiology News / Recent Literature Review / Last Quarter 2020
Manolis, Antonis S
First Department of Cardiology, Athens University School of Medicine, Athens, Greece
Anninos, Hector
Athens University School of Medicine
Rhythmos 2021;16(1): 14-21.
26th Annual International AF Virtual Symposium, 29-31/1/2021
EHRA online Congress, 23-25/4/2021
ACC Meeting: Atlanta, 15-17/5/2021
EuroPCR online, 18-20/5/201
ESC Digital Congress 27-30/8/2021
TCT Meeting, San Francisco, 22-26/10/2021
Active Myocardial Inflammation is a Powerful Predictor of Recurrent Ventricular Tachycardia (VT) Following Catheter Ablation: VT Ablation Should be Avoided During Active Myocarditis (AM), But is Often of Benefit for Recurrent VT After the Acute Phase of Myocarditis
Among 125 consecutive patients (age 51±14 years, 91% men, LVEF 52%±9%) with myocarditis diagnosed by endomyocardial biopsy (59%) and/or cardiac magnetic resonance (90%), undergoing VT ablation, with all patients showing low-voltage areas (LVA) at electro-anatomical map (97% epicardial or endoepicardial), VT recurrences were documented in 25 patients (20%) by 12 months, and in 43 (34%) by last follow-up (median 63 months). At multivariable analysis, active myocarditis (AM) stage was the only predictor of VT recurrences by 12 months (hazard ratio: 9.5; p < 0.001), whereas both AM stage and wide border zone were associated with arrhythmia recurrences anytime during follow-up. No VT episodes were found after redo ablation was performed in 23 patients with previous (non-active) myocarditis (Peretto G et al, J Am Coll Cardiol 2020;76:1644–1656).
Left Ventricular (LV) Non-Compaction (LVNC): Vigorous Recreational Physical Activity (VPA) May be a Possible Determinant of LV Hypertrabeculation in Asymptomatic Individuals
In PESA (Progression of Early Subclinical Atherosclerosis) study participants (n = 4,184 subjects free of cardiovascular disease), LVNC phenotype prevalence according to the Petersen criterion was significantly higher among participants in the highest VPA quintile (Q5 = 30.5%) than in participants with no VPA (14.2%). The Jacquier and Grothoff criteria were also more frequently fulfilled in participants in the highest VPA quintile (Jacquier Q5 = 27.4% vs no VPA = 12.8% and Grothoff Q5 = 15.8% vs no VPA = 7.1%). The prevalence of the systolic Stacey LVNC criterion was low (3.6%) and did not differ significantly between no VPA and Q5 (de la Chica JA et al, J Am Coll Cardiol 2020;76: 1723–1733).
Interleukin-1β (IL-1β) Measured on Admission is Associated with Risk of Premature Death in Patients with Myocardial Infarction
IL-1β concentration measured at admission in 1,398 patients with ST-segment elevation MI (STEMI) was associated with all-cause mortality at 90 days (adjusted hazard ratio - adjHR: 1.47 per 1 SD increase; p < 0.002). The relation was nonlinear, and the highest tertile of IL-1β was associated with higher mortality rates at 90 days (adjHR: 2.78; p = 0.0002) and at 1 year (adjHR: 1.93; p = 0.005), regardless of the hs-CRP concentration. Significant relationships were equally observed when considering cardiovascular mortality and MACEs at 90 days (adjHR: 2.42; p = 0.002, and adjHR: 2.29; p = 0.004, respectively) and at 1 year (adjHR: 2.32; p = 0.002, and adjHR: 2.35; p = 0.001, respectively) (Silvain J et al, J Am Coll Cardiol 2020;76:1763–1773)... (excerpt)
Athens University School of Medicine
2021-02-10 08:33:34
application/pdf
http://www.rhythmos.gr/index.php/Rhythmos/article/view/500
Rhythmos; Vol. 16 No. 1 (2021)
eng
Copyright (c) 2021 Rhythmos
oai:ojs.rhythmos.gr:article/504
2021-04-15T11:13:37Z
Rhythmos:CRDN
driver
"210415 2021 eng "
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Cardiology News / Recent Literature Review / First Quarter 2021
Manolis, Antonis S
First Department of Cardiology, Athens University School of Medicine, Athens, Greece
Anninos, Hector
Athens University School of Medicine
EHRA online Congress, 23-25/4/2021
ACC Meeting: Atlanta, 15-17/5/2021
EuroPCR online, 18-20/5/201
ESC Digital Congress 27-30/8/2021
TCT Meeting, San Francisco, 22-26/10/2021
EARLY-AF: Cryoballoon Ablation Lowers Rate of Atrial Fibrillation (AF) Recurrence Among Patients Receiving Initial Treatment for Symptomatic, Paroxysmal AF, Compared With Antiarrhythmic Drug (AAD) Therapy, as Assessed by Continuous Cardiac Rhythm Monitoring
Among 303 patients with symptomatic, paroxysmal, untreated AF randomized to catheter ablation with a cryothermy balloon or antiarrhythmic drug (AAD) therapy for initial rhythm control, at 1 year, 66 of 154 patients (42.9%) assigned to ablation had AF recurrence vs 101 of 149 patients (67.8%) assigned to AAD (hazard ratio-HR, 0.48; P<0.001). Symptomatic AF recurred in 11% vs 26.2% (HR, 0.39). The median percentage of time in AF was 0% with ablation and 0.13% with AAD. Serious adverse events occurred in 5 (3.2%) vs 6 patients (4%) (Andrade JG et al, N Engl J Med 2021; 384:305-315).
STOP AF First: Cryoballoon Ablation as Initial Therapy was Superior to Drug Therapy for Prevention of Recurrence in Patients With Paroxysmal Atrial Fibrillation (AF) with Uncommon Serious Procedure-Related Adverse Events
According to a multicenter trial which randomized 203 patients 18-80 years of age with paroxysmal AF to antiarrhythmic drugs (class I or III agents) (n=99) or pulmonary vein isolation with a cryoballoon (n=104), with initial success of the ablation procedure achieved in 97%, the Kaplan–Meier estimate of treatment success at 1 year was 74.6% in the ablation group and 45% in the drug-therapy group (P<0.001 by log-rank test). Two primary safety end-point events occurred in the ablation group (Kaplan–Meier estimate of the percentage of patients with an event within 12 months, 1.9%) (Wazni OM et al, N Engl J Med 2021; 384:316-324).
GALACTIC-HF: Among Patients with Heart Failure and a Reduced Ejection, Those on Omecamtic Mecarbil Had a Lower Incidence of a Composite of a HF Event or Death from Cardiovascular Causes on Placebo
Among 8256 patients (in- and out-patients) with symptomatic chronic HF and an ejection fraction of <35% assigned to omecamtiv mecarbil (25-50 mg bid) or placebo, in addition to standard HF therapy, over a median of 21.8 months, a primary-outcome event (composite of a first HF event, i.e. hospitalization or urgent visit for HF, or death from CV causes) occurred in 1523 of 4120 patients (37%) in the omecamtiv mecarbil group and in 1607 of 4112 patients (39.1%) in the placebo group (hazard ratio-HR, 0.92; P=0.03). A total of 808 patients (19.6%) and 798 patients (19.4%), respectively, died from CV causes (HR, 1.01). There was no significant difference between groups in the change from baseline on quality-of-life score. At week 24, the change from baseline for the median N-terminal pro–B-type natriuretic peptide level was 10% lower in the omecamtiv mecarbil group than in the placebo group; the median cardiac troponin I level was 4 ng/L higher. The frequency of cardiac ischemic and ventricular arrhythmia events was similar (Teerlink JR et al, N Engl J Med 2021; 384:105-116)... (excerpt)
Athens University School of Medicine
2021-04-15 13:55:41
application/pdf
http://www.rhythmos.gr/index.php/Rhythmos/article/view/504
Rhythmos; Vol. 16 No. 2 (2021)
eng
Copyright (c) 2021 Rhythmos
oai:ojs.rhythmos.gr:article/508
2021-10-30T14:50:13Z
Rhythmos:CRDN
driver
"211030 2021 eng "
1792-7927
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Cardiology News / Recent Literature Review / Second Quarter 2021
Manolis, Antonis S
First Department of Cardiology, Athens University School of Medicine, Athens, Greece
Anninos, Hector
Athens University School of Medicine
ESC Digital Congress 27-30/8/2021
TCT Meeting, San Francisco, 22-26/10/2021
42nd Panhellenic Congress of Cardiology, Athens, 21-23/10/21
AHA Scientific Sessions 2021, Boston, MA, USA, 13-15/10/21
ACC.22, Washington, DC, USA, 2-4/4/22
EuroPCR, Paris, France, 17-20/5/22
Systemic Lupus Erythematosus (SLE) Patients Have a Higher Associated Risk of Heart Failure (HF) and Other Cardiovascular (CV) Outcomes Compared with Matched Control Subjects
Among 3,411 SLE patients (median age: 44.6 years; 86% women) who were matched with 13,644 controls, over a median of 8.5 years, absolute 10-year risks of outcomes were: HF, 3.71% vs 1.94%; atrial fibrillation, 4.35% vs 2.82%; ischemic stroke, 3.75% vs 1.92%; MI, 2.17% vs 1.49%; venous thromboembolism, 6.03% vs 1.68%; and the composite of ICD implantation/ventricular arrhythmias/cardiac arrest, 0.89% vs 0.30% (SLE patients, vs control subjects). SLE with subsequent HF was associated with higher mortality compared with HF without SLE (adjusted hazard ratio: 1.50) (Yafasova A et al, J Am Coll Cardiol 2021;77:1717-27).
Worse Long-Term Outcomes of Patients with Late Presentation of ST-Segment Elevation Myocardial Infarction (STEMI)
Of 13,707 patients (2011-2015), 5,826 consecutive patients diagnosed with STEMI within 48 h of symptom onset were categorized as late (12-48 h; n = 624) or early (<12 h; n = 5,202) presenters. Late presenters had worse clinical outcomes (180-day mortality: 10.7% vs. 6.8%; 3-year mortality: 16.2% vs. 10.6%; both log-rank p < 0.001), whereas presentation at ≥12 h of symptom onset was not independently associated with increased mortality after STEMI. The use of invasive interventional procedures decreased from the first (<12 h) to the second (12-24 h) 12-h interval of symptom-to-door time (“no primary PCI strategy” increased from 4.9% to 12.4%, and “no PCI” from 2.3% to 6.6%; both p < 0.001). Mortality rates increased from the first to the second 12-h interval of symptom-to-door time (from 6.8% to 11.2% for 180-day mortality; from 10.6% to 17.3% for 3-year mortality; all p < 0.05) (Cho KH et al, J Am Coll Cardiol 2021;77:1859-70).
High Dietary Sodium (HS) Intake Increases Plasma Volume, Lowers Standing Plasma Norepinephrine, and Decreases Δ Heart Rate in Patients With Postural Tachycardia Syndrome (POTS)
Among 14 POTS patients and 13 healthy control subjects (HC), age 23-49 years, enrolled in a crossover study with 6 days of low (LS) (10 mEq/d) or high sodium (HS) (300 mEq/d) diet, in POTS, the HS diet reduced upright heart rate and Δ heart rate compared with the LS diet. Total blood volume and plasma volume (PV) increased, and standing norepinephrine decreased with the HS compared with the LS diet. However, upright heart rate, Δ heart rate, and upright norepinephrine remained higher in POTS than in controls on the HS diet, despite no difference in the measured PV (Garland EM et al, J Am Coll Cardiol 2021; 77:2174-84)... (excerpt)
Athens University School of Medicine
2021-07-03 10:55:32
application/pdf
http://www.rhythmos.gr/index.php/Rhythmos/article/view/508
Rhythmos; Vol. 16 No. 3 (2021)
eng
Copyright (c) 2021 Rhythmos
oai:ojs.rhythmos.gr:article/512
2021-10-30T15:36:19Z
Rhythmos:CRDN
driver
"211030 2021 eng "
1792-7927
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Cardiology News / Recent Literature Review / Third Quarter 2021
Manolis, Antonis S
First Department of Cardiology, Athens University School of Medicine, Athens, Greece
Anninos, Hector
Alexandra University Hospital
TCT Meeting, San Francisco, 22-26/10/2021
42nd Panhellenic Congress of Cardiology, Athens, 21-23/10/21
AHA Sessions 2021, Boston, MA, USA, 13-15/10/21
ACC.22, Washington, DC, USA, 2-4/4/22
EuroPCR, Paris, France, 17-20/5/22
Subanalysis of SYNTAXES: In Patients With 3-Vessel and/or Left Main Disease Having PCI or CABG, Those on Optimal Medical Therapy (OMT) at 5 Years Had a Survival Benefit at 10 Years
Among 1472 patients, patients on OMT at 5 years had a significantly lower mortality at 10 years compared with those on ≤2 types of medications (13.1% vs 19.9%; adjusted HR: 0.470; P=0.002) but had a mortality similar to those on 3 types of medications. Patients having CABG with antiplatelet drug and statin at 5 years had lower 10-year mortality than those without (Kawashima H et al, J Am Coll Cardiol 2021;78:27-38).
GALACTIC-HF: In Heart Failure (HF) Patients with Reduced Ejection Fraction (EF), Omecamtiv Mecardil Conferred Greater Benefit as Baseline EF Decreased
The risk of the primary composite endpoint (PCE) of time-to-first HF event or CV death in the placebo group was ~1.8-fold greater in the lowest EF (≤22%) vs the highest EF (≥33%) quartile. Amongst the pre-specified subgroups, EF was the strongest modifier of the treatment effect of omecamtiv mecarbil on the PCE (P=0.004). Patients receiving omecamtiv mecarbil had a progressively greater relative and absolute treatment effect as baseline EF decreased, with a 17% relative risk reduction for the PCE in patients with baseline EF≤22% (n=2,246; HR 0.83) vs patients with EF ≥33% (n=1,750; HR 0.99; P=0.013). The absolute reduction in the PCE increased with decreasing EF (EF≤22%; risk reduction, 7.4 events per 100 patient-years; number needed to treat for 3 years = 11.8), compared with no reduction in the highest EF quartile (Teerlink JR et al, J Am Coll Cardiol 2021;78:97-108).
Repurposing Metoprolol for COVID-19-Associated ARDS Appears a Safe and Inexpensive Strategy that Can Alleviate the Burden of the COVID-19 Pandemic
Among 20 COVID-19 patients with ARDS on invasive mechanical ventilation randomized to metoprolol (n=12, 15 mg daily for 3 days) or control (n=8, no treatment), patients randomized to metoprolol had significantly fewer neutrophils in bronchoalveolar lavage (BAL) on day 4 (P=0.016). Metoprolol also reduced neutrophil extracellular traps content and other markers of lung inflammation. Oxygenation (PaO2:FiO2) significantly improved after 3 days of metoprolol treatment (P=0.003), whereas it remained unchanged in control subjects. Metoprolol-treated patients spent fewer days on invasive mechanical ventilation than those in the control group (15.5±7.6 vs 21.9±12.6 days; P=0.17) (Clemente-Moragon A et al, J Am Coll Cardiol 2021;78:1001-11)... (excerpt)
Athens University School of Medicine
2021-10-30 18:36:18
application/pdf
http://www.rhythmos.gr/index.php/Rhythmos/article/view/512
Rhythmos; Vol. 16 No. 4 (2021)
eng
Copyright (c) 2021 Rhythmos
oai:ojs.rhythmos.gr:article/516
2022-01-10T16:05:27Z
Rhythmos:CRDN
driver
"220110 2022 eng "
1792-7927
1792-7919
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Cardiology News / Recent Literature Review / Last Quarter 2021
Manolis, Antonis S
First Department of Cardiology, Athens University School of Medicine, Athens, Greece
Anninos, Hector
Alexandra University Hospital, Athens
Recent Cardiology Literature Review (Rhythmos 2022;17(1):107-114. )
Cardiology Meetings:
27th Annual International AF Symposium, 13-15/1/22, New York, NY, USA
ACC.22, Washington, DC, USA, 2-4/4/22
EHRA 22, Copenhagen, Denmark, 3-5/4/22
HRS 22, San Francisco, CA, USA, 29/4-1/5/22
EuroPCR, Paris, France, 17-20/5/22
ESC Meeting, Barcelona, Spain, 26-29/8/2022
TCT 22, Boston, MA, USA, 16-20/9/22
Brugada Syndrome (BrS) is Associated With Increased Collagen Content Throughout Both Ventricles, With Maximal Collagen Proportions Observed Within BrS RVOT Epicardium
Evaluation of 28 whole hearts from consecutive sudden cardiac death cases attributed to BrS (75% men; median age of death 25 years, death occurred in sleep or at rest in 86%) and 29 hearts from a comparator group comprised of noncardiac deaths (control subjects), showed that the highest proportion of collagen was observed in the epicardial right ventricular outflow tract (RVOT) of the BrS group (23.7%). Ventricular myocardium from BrS decedents demonstrated a higher proportion of collagen compared with controls (ratio 1.45; P<0.001), with no significant interactions with respect to sampling location or tissue layer. There was insufficient evidence to support differences in collagen proportion in SCN5A-positive cases (n=5) vs control subjects (ratio 1.23; P=0.27) (Miles C et al, J Am Coll Cardiol 2021;78:1511–21).
XIENCE Short DAPT Program: Among High Bleeding Risk (HBR) Patients Undergoing PCI, 1-Month DAPT, Compared With 3-Month DAPT, Was Associated With Similar Ischemic Outcomes and Lower Bleeding Risk
Patients who received 1-month DAPT (XIENCE 28 USA and 28 Global; n=1392) were compared with those on 3-month DAPT (XIENCE 90; n= 1972) using propensity score stratification. The primary endpoint of all-cause mortality or myocardial infarction was similar between the 2 groups (7.3% vs 7.5%; P=0.41). The key secondary endpoint of BARC (Bleeding Academic Research Consortium) type 2-5 bleeding was lower with 1-month DAPT compared with 3-month DAPT (7.6% vs 10%; P=0.012). Major BARC type 3-5 bleeding did not differ at 12 months (3.6% vs 4.7%; P=0.082), but was lower with 1-month DAPT at 90 days (1.0% vs 2.1%; P=0.015) (Valgimigli M et al, J Am Coll Cardiol 2021;78:2060–2072).
A Booster (Third Dose) at Least 5 Months After a Second Dose of BNT162b2 Vaccine (Pfizer–BioNTech) Conferred 90% Lower Mortality Due to Covid-19 vs Those Who Did Not Receive a Booster
Among 843,208 participants 758,118 (90%) received the booster during the 54-day study period. Death due to Covid-19 occurred in 65 participants in the booster group (0.16 per 100,000 persons per day) and in 137 participants in the nonbooster group (2.98 per 100,000 persons per day). The adjusted hazard ratio–HR for death due to Covid-19 in the booster group, as compared with the nonbooster group, was 0.10 (P<0.001) (Arbel R et al, N Engl J Med 2021; 385:2413-2420)... (excerpt)
Athens University School of Medicine
2022-01-10 18:05:27
application/pdf
http://www.rhythmos.gr/index.php/Rhythmos/article/view/516
Rhythmos; Vol. 17 No. 1 (2022)
eng
Copyright (c) 2022 Rhythmos
oai:ojs.rhythmos.gr:article/520
2022-04-04T09:01:39Z
Rhythmos:CRDN
driver
"220404 2022 eng "
1792-7927
1792-7919
dc
Cardiology News / Recent Literature Review / First Quarter 2022
Manolis, Antonis S
First Department of Cardiology, Athens University School of Medicine, Athens, Greece
Anninos, Hector
Athens University School of Medicine
ACC.22, Washington, DC, USA, 2-4/4/22
EHRA 22, Copenhagen, Denmark, 3-5/4/22
HRS 22, San Francisco, CA, USA, 29/4-1/5/22
EuroPCR, Paris, France, 17-20/5/22
ESC Meeting, Barcelona, Spain, 26-29/8/2022
TCT 22, Boston, MA, USA, 16-20/9/22
PRAGUE-17: Left Atrial Appendage Closure (LAAC) Remains Noninferior to DOACs for Preventing Major CV, Neurological, or Bleeding Events / Nonprocedural Bleeding Was Significantly Reduced With LAAC
A total of 402 patients with AF (201 per group, age 73.3±7.0 years, 65.7% male, CHA2DS2-VASc 4.7±1.5, HASBLED 3.1±0.9) were randomized to percutaneous LAAC (Watchman or Amulet) with DOACs (95% apixaban). After a median of 3.5 years, LAAC was noninferior to DOACs for the primary endpoint (composite of cardioembolic events-i.e., stroke, TIA, or systemic embolism-, CV death, clinically relevant bleeding, or procedure-/device-related complications (LAAC group only)), by modified intention-to-treat (sub-distribution HR [sHR]: 0.81; P = 0.27; P for noninferiority = 0.006). For the components of the composite endpoint the corresponding sHRs were 0.68 (P= 0.19) for CV death, 1.14 (P=0.72) for all-stroke/TIA, 0.75 (P=0.28) for clinically relevant bleeding, and 0.55 (P=0.039) for nonprocedural clinically relevant bleeding. The primary endpoint outcomes were similar in the per-protocol (sHR: 0.80; P=0.25) and on-treatment (sHR: 0.82; P=0.30) analyses (Osmancik P et al, J Am Coll Cardiol 2022;79:1-14).
Higher Olive Oil Intake Conferred Lower Risk of Total and Cause-Specific Mortality / Replacing Margarine, Butter, Mayonnaise, and Dairy Fat with Olive Oil Lowered Mortality
Among 60,582 women (Nurses’ Health Study, 1990-2018) and 31,801 men (Health Professionals Follow-up Study, 1990-2018) who were free of cardiovascular (CV) disease or cancer, over 28 years, 36,856 deaths occurred. The multivariable-adjusted pooled HR for all-cause mortality among persons who had the highest consumption of olive oil (>0.5 tablespoon/day or >7 g/d) was 0.81 compared with those who never or rarely consumed olive oil. Higher olive oil intake conferred a 19% lower risk of CV mortality (HR: 0.81), 17% lower risk of cancer mortality (HR: 0.83), 29% lower risk of neurodegenerative disease mortality (HR: 0.71), and 18% lower risk of respiratory disease mortality (HR: 0.82). In substitution analyses, replacing 10 g/d of margarine, butter, mayonnaise, and dairy fat with the equivalent amount of olive oil conferred 8%-34% lower risk of total and cause-specific mortality. No significant associations were observed when olive oil was compared with other vegetable oils combined (Guasch-Ferré M et al, J Am Coll Cardiol 2022;79:101–112)... (excerpt)
Athens University School of Medicine
2022-04-04 12:01:39
application/pdf
http://www.rhythmos.gr/index.php/Rhythmos/article/view/520
Rhythmos; Vol. 17 No. 2 (2022)
eng
Copyright (c) 2022 Rhythmos
oai:ojs.rhythmos.gr:article/525
2022-07-15T05:09:54Z
Rhythmos:CRDN
driver
"220715 2022 eng "
1792-7927
1792-7919
dc
Cardiology News / Recent Literature Review / Second Quarter 2022
Manolis, Antonis S
First Department of Cardiology, Athens University School of Medicine, Athens, Greece
Hector Anninos, Hector
Athens University Scool of Medicine
ESC Meeting, Barcelona, Spain, 26-29/8/2022
TCT 22, Boston, MA, USA, 16-20/9/22
HCS, 43rd International Congress of Cardiology, Athens, 20-22/10/22
NY Cardiovascular Symposium 2022, New York, NY, USA, 9-11/12/22
AF Symposium, Boston, MA, USA, 2-4/2/2023
ACC Annual Meeting, New Orleans, LA, USA, 4-6/3/23
EHRA Annual Meeting, Barcelona, Spain, 16-18/4/23
Euro PCR 2023, Paris, 16-19/5/2023
HRS Annual Meeting, New Orleans, LA, USA, 19-21/5/23
Registry Study: In Patients With Multivessel Disease After Revascularization by PCI or CABG, Mildly Decreased Renal Function Did not Increase the Risk of the Primary Composite Outcome (Death, MI, or Stroke) and Mortality / Comparative Outcomes After PCI and CABG Were Similar in the Borderline-Risk Group
Among 10,354 eligible patients in a registry who underwent coronary revascularization, classified into 3 groups (stage I, n = 3,735, normal renal function; stage II, n = 5,122, mild dysfunction; and stage III, n = 1,497, moderate dysfunction), after propensity matching, the risk for primary composite outcome was not different between the stage I and the stage II group (HR: 1.12). However, the risk of the primary outcome was higher in the stage III group than in the stage I group (HR: 1.50). The relative effect of PCI vs CABG for the primary outcome was similar in the matched cohort of each renal function group of stages I, II, and III (Kim TO et al, J Am Coll Cardiol 2022;79:1270-84).
2-Cohort Studies: Long-Term Cumulative BP Was Associated With Subsequent Cognitive Decline, Dementia Risk, and All-Cause Mortality in Cognitively Healthy Adults Aged ≥50 Years / Efforts are Needed to Control Long-Term Systolic BP and Pulse Pressure and Maintain Adequate Diastolic BP
Data from the HRS (Health and Retirement Study, n=9,294, 45% men, median age 65 y) and ELSA (English Longitudinal Study of Ageing, n=7,566, 40% men, median age 62 y) indicated that over a median follow-up of 8 years each, elevated cumulative systolic BP and pulse pressure were independently associated with accelerated cognitive decline (P< 0.001 for both), elevated dementia risk (P< 0.001 for both), and all-cause mortality (P< 0.001 for both), while a significant inverse association was observed for diastolic BP. Strong dose-response relationships were identified, with similar results for the 2 cohorts. (Li C et al, J Am Coll Cardiol 2022;79:1321–35).
The BIOSIGNAL Study: MR-proANP is a Valid Biomarker to Determine Risk of Newly Diagnosed Atrial Fibrillation (NDAF) and MACE in Patients With Acute Ischemic Stroke (AIS) and Can Be Used as a Decision Tool to Identify Patients for Prolonged Cardiac Monitoring
Among 1,759 patients Log10MR-proANP levels were associated with cardioembolic (CE) stroke (OR: 7.96; risk ratio: 3.12), as well as NDAF (OR: 35.3; risk ratio: 11.47), and MACE (subdistributional HR: 2.02) during follow-up. The model to predict NDAF including only age and MR-proANP levels had a good discriminatory capacity with an area under the curve of 0.81, was well calibrated, and yielded higher net-benefit compared with validated scores to predict NDAF (AS5F score, CHA2DS2-VASc score) (Schweizer J et al, J Am Coll Cardiol 2022;79: 1369–81)... (excerpt)
Athens University School of Medicine
2022-07-15 08:09:54
application/pdf
http://www.rhythmos.gr/index.php/Rhythmos/article/view/525
Rhythmos; Vol. 17 No. 3 (2022)
eng
Copyright (c) 2022 Rhythmos
oai:ojs.rhythmos.gr:article/530
2022-10-15T16:49:25Z
Rhythmos:CRDN
driver
"221015 2022 eng "
1792-7927
1792-7919
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Cardiology News / Recent Literature Review / Third Quarter 2022
Manolis, Antonis S
First Department of Cardiology, Athens University School of Medicine, Athens, Greece
Anninos, Hector
Athens University School of Medicine
HCS, 43rd International Congress of Cardiology, Athens, 20-22/10/22
NY Cardiovascular Symposium 2022, New York, NY, USA, 9-11/12/22
AF Symposium, Boston, MA, USA, 2-4/2/2023
ACC Annual Meeting, New Orleans, LA, USA, 4-6/3/23
EHRA Annual Meeting, Barcelona, Spain, 16-18/4/23
Euro PCR 2023, Paris, 16-19/5/2023
HRS Annual Meeting, New Orleans, LA, USA, 19-21/5/23
EMPEROR-Preserved: Empagliflozin Reduced Cardiovascular Disease (CVD) and Heart Failure (HF) Hospitalizations (HFH) and Improved Symptoms Across a Wide Age Range / High age was not Associated with Decreased Efficacy or Intolerability
The relationship of age and empagliflozin effects was evaluated in the EMPEROR-Preserved trial. Patients (N=5,988) were grouped according to their baseline age (<65 years, n = 1,199; 65-74 years, n = 2,214; 75-79 years, n = 1,276; ≥80 years, n = 1,299). The incidence of primary outcomes (CVD or HFH) (P trend = 0.02) and CVD (P trend = 0.003) increased with age. Empagliflozin reduced primary outcomes (P trend = 0.33), first HFH (P trend = 0.22), and first and recurrent HFH (P trend = 0.11) across all age groups with an effect being similar at ≥75 years or >80 years. Empagliflozin improved Kansas City Cardiomyopathy Questionnaire–Clinical Summary Score at week 52 and attenuated the decline of estimated glomerular filtration rate without age interaction. There were no clinically relevant differences in adverse events between empagliflozin and placebo across the age groups. Thus, empagliflozin reduced primary outcomes and first and recurrent HFH and improved symptoms across a broad age spectrum. High age did not reduce efficacy or meaningful intolerability (Bohm M et al, J Am Coll Cardiol 2022;80:1-18).
ARIC Study: Adult Cancer Survivors Have Higher Risk of CVD, Especially HF, Independent of Traditional CV Risk Factors
A prospective community-based study including 12,414 ARIC (Atherosclerosis Risk In Communities) study participants (mean age 54 years, 55% female, 25% Black), of whom 3,250 (25%) had incident cancer over a median 13.6 years, indicated that age-adjusted incidence rates of CVD (per 1,000 person-years) were 23.1 (95% CI: 24.7-29.1) for cancer survivors and 12.0 (95% CI: 11.5-12.4) for subjects without cancer. After adjustment for CV risk factors, cancer survivors had significantly higher risks of CVD (HR: 1.37), HF (HR: 1.52), and stroke (HR: 1.22), but not CAD (HR: 1.11). Breast, lung, colorectal, and hematologic/lymphatic cancers, but not prostate cancer, were significantly associated with CVD risk (Florido R et al, J Am Coll Cardiol 2022;80:22–32).
VALOR-HCM Study: In Obstructive Hypertrophic Cardiomyopathy (OHCM) Patients With Intractable Symptoms, Mavacamten Reduced the Fraction of Patients Meeting Guideline Criteria for Septal Reduction Therapy (SRT) After 16 Weeks
Patients (N=112; age 60 ± 12 years, 51% men, 93% NYHA class III/IV) with left ventricular (LV) outflow tract (LVOT) gradient ≥50 mm Hg at rest/provocation who met guideline criteria for SRT were randomized, double blind, to mavacamten, 5 mg daily, or placebo, titrated up to 15 mg based on LVOT gradient and LV ejection fraction. After 16 weeks, 43 of 56 placebo patients (76.8%) and 10 of 56 mavacamten patients (17.9%) met guideline criteria or underwent SRT, difference (58.9%; P < 0.001). Hierarchical testing of secondary outcomes showed significant differences (P < 0.001) favoring mavacamten, mean differences in post-exercise peak LVOT gradient −37.2 mm Hg; ≥1 NYHA class improvement 41.1%; improvement in patient-reported outcome 9.4 points; and NT-proBNP and cardiac troponin I between-groups geometric mean ratio 0.33 and 0.53 (Desai MY et al, J Am Coll Cardiol 2022;80:95–108)... (excerpt)
Athens University School of Medicine
2022-10-15 19:49:25
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http://www.rhythmos.gr/index.php/Rhythmos/article/view/530
Rhythmos; Vol. 17 No. 4 (2022)
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