Anastasia Anthi - Academia.edu (original) (raw)

Papers by Anastasia Anthi

Research paper thumbnail of Pulmonary Vascular Research Institute GoDeep: A meta‐registry merging deep phenotyping datafrom international PH reference centers

Pulmonary Circulation

The Pulmonary Vascular Research Institute GoDeep meta-registry is a collaboration of pulmonary hy... more The Pulmonary Vascular Research Institute GoDeep meta-registry is a collaboration of pulmonary hypertension (PH) reference centers across the globe. Merging worldwide PH data in a central meta-registry to allow advanced analysis of the heterogeneity of PH and its groups/subgroups on a worldwide geographical, ethnical, and etiological landscape (ClinTrial. gov NCT05329714). Retrospective and prospective PH patient data (diagnosis based on catheterization; individuals with exclusion of PH are included as a comparator group) are mapped to a common clinical parameter set of more than 350 items, anonymized and electronically exported to a central server. Use and access is decided by the GoDeep steering board, where each center has one vote. As of April 2022, GoDeep comprised 15,742 individuals with 1.9 million data points from eight PH centers. Geographic distribution comprises 3990 enrollees (25%) from America and 11,752 (75%) from Europe. Eightynine perecent were diagnosed with PH and 11% were classified as not PH and provided a comparator group. The retrospective observation period is an average of 3.5 years (standard error of the mean 0.04), with 1159 PH patients followed for over 10 years. Pulmonary arterial hypertension represents the largest PH group (42.6%), followed by Group 2 (21.7%), Group 3 (17.3%), Group 4 (15.2%), and Group 5 (3.3%). The age distribution spans several decades, with patients 60 years or older comprising 60%. The majority of patients met an intermediate risk profile upon diagnosis. Data entry from a further six centers is ongoing, and negotiations with >10 centers worldwide have commenced. Using electronic interface-based automated retrospective and prospective data transfer, GoDeep aims to provide in-depth epidemiological and etiological understanding of PH and its various groups/subgroups on a global scale, offering insights for improved management.

Research paper thumbnail of The wide spectrum of β-thalassaemia intermedia-induced pulmonary hypertension: two case reports on the possible role of specific pulmonary arterial hypertension therapy

Pulmonary Circulation, 2021

Pulmonary hypertension (PH) development remains a significant cardiovascular complication of haem... more Pulmonary hypertension (PH) development remains a significant cardiovascular complication of haemoglobinopathies, severely affecting the morbidity and mortality of such patients. According to the 5th World Symposium on PH, PH related with chronic haemolytic anaemias is classified in group 5, mainly due to the multifactorial pathophysiology of PH in this patient population. There are no clear guidelines regarding the management of PH in patients with haemoglobinopathies; the use of specific pulmonary arterial hypertension (PAH) therapy in patients with β-thalassaemia and PH is based on data derived from other forms of PH, expert opinion and small series or case reports. The existing knowledge on the use of specific-PAH therapy in β-thalassaemia patients with PH is limited, and in most cases the diagnosis of PH is based on echocardiographic findings only. We herein report two patients with β-thalassaemia intermedia (TI) and PH, who got same initial approach but different outcome, to h...

Research paper thumbnail of Epidemiology and Management of Chronic Thromboembolic Pulmonary Hypertension in Greece. Real-World Data from the Hellenic Pulmonary Hypertension Registry (HOPE)

Journal of Clinical Medicine

Chronic Thromboembolic Pulmonary Hypertension (CTEPH) is a rare disease with poor prognosis if le... more Chronic Thromboembolic Pulmonary Hypertension (CTEPH) is a rare disease with poor prognosis if left untreated, characterized by pulmonary vascular bed obstruction due to unresolving thromboembolic material. The Hellenic pulmonary hypertension registry (HOPE) was launched in Greece in early 2015 and enrolls patients from all pulmonary hypertension subgroups in Greece. In total, 98 patients with CTEPH were enrolled from January 2015 until November 2019. Of these patients, 55.1% represented incident population, 50% were classified in the World Health Organization functional class II and 49% had a history of acute pulmonary embolism. The median values of pulmonary vascular resistance (PVR) and cardiac index were 7.4 (4.8) WU and 2.4 (1.0) L/min/m2, respectively, the mean diffusing capacity for carbon monoxide was 74.8 ± 20.6%, the median 6-minute walk distance was 347 (220) meters and the median value of N Terminal-pro brain natriuretic peptide was 506.0 (1450.0) pg/mL. In total, 60.2% ...

Research paper thumbnail of Low-Dose Dobutamine Stress Echocardiography for the Early Detection of Pulmonary Arterial Hypertension in Selected Patients with Systemic Sclerosis Whose Resting Echocardiography Is Non-Diagnostic for Pulmonary Hypertension

Journal of Clinical Medicine

Background: Dobutamine stress echocardiography (DSE) has limited application in systemic sclerosi... more Background: Dobutamine stress echocardiography (DSE) has limited application in systemic sclerosis (SSc). We examined DSE usefulness in revealing pulmonary arterial hypertension (PAH) in selected SSc patients whose resting echocardiography for pulmonary hypertension (PH) was non-diagnostic. Methods: Forty SSc patients underwent right heart catheterization (RHC) and, simultaneously, low-dose DSE (incremental doses up to 20 μg/kg/min). Inclusion criteria were: preserved left and right ventricular (RV) function (tricuspid annulus plane systolic excursion [TAPSE] ≥ 16 mm and tissue Doppler imaging-derived systolic velocity of tricuspid annulus [RVS’] > 10 cm/s), normal pulmonary function tests, and baseline maximal tricuspid regurgitation (TR) velocity of 2.7–3.2 m/s. Results: Of 36 patients who completed DSE, resting RHC diagnosed PAH in 12 patients (33.3%). At 20 μg/kg/min, patients with PAH had higher TR velocity, higher pulmonary arterial pressure measured by RHC, and lower RV in...

Research paper thumbnail of Is pulmonary arterial hypertension associated with interferon-β therapy for multiple sclerosis reversible? A case study to explore the complexity

ERJ Open Research

Interferon (IFN)-β has been classified as a drug that is possibly associated with development of ... more Interferon (IFN)-β has been classified as a drug that is possibly associated with development of pulmonary arterial hypertension (PAH), a devastating disease that can lead to right heart failure and premature death [1]. Drug-and toxin-induced PAH is a well-known entity in the field of pulmonary hypertension (PH) since the epidemic of idiopathic PAH occurred in the central Europe, between 1967 and 1971, following the use of anorexigens. Τhe Sixth World Symposium on Pulmonary Hypertension, based on recent data, proposed a simplified characterisation of PAH associated with drugs and toxins into two subgroups (definite and possible) to help physicians to identify drugs requiring specific surveillance. According to this framework, and supported by case series and case reports, IFN-β is classified as a drug with possible association with PAH development [2]. In the literature, there are several cases of patients with multiple sclerosis (MS) on treatment with IFN-β who were diagnosed with PAH associated with the IFN-β exposure [3-9]. The need to identify and present related cases has been highlighted [4, 5]. We report a case of a patient with MS on treatment with IFN-β who subsequently developed PAH. The initial suspicion of PAH, the subsequent diagnosis and management, and the final outcome are presented in order to underline the reversibility of PAH following IFN-β discontinuation and specific PAH therapy administration, and the emerging need to early detect similar cases. A 32-year-old female was diagnosed with relapsing remitting MS on 2010 with an Expanded Disability Status Scale score of 1 and negative immunological indices. She had received therapy with IFN-β for 6 years when she presented to our PH clinic with a 4-month history of dyspnoea on exertion, fatigue, dizziness and episodes of presyncope. She thought her symptoms were MS-related. Her past medical history was otherwise unremarkable, with no known risk factors for PAH. Upon admission to the hospital, in New York Heart Association functional class (NYHA-FC) III, she was unable to complete the 6-min walking test (6MWT) due to a presyncopal episode during the fourth minute of the walk. A transthoracic echocardiography demonstrated right ventricular dilatation and systolic dysfunction, tricuspid regurgitant jet velocity of 4 m•s −1 , and left ventricular ejection fraction of 60%. Flattening of the intraventricular septum during both systole and diastole was also noted. High-resolution computed tomography and angiography of the lungs revealed dilatation of the right heart ventricle and an enlarged pulmonary arterial trunk (3.8 cm). There were no lung lesions nor signs of pulmonary embolism. A perfusion lung scan was unremarkable. Pulmonary function tests were normal with a mildly reduced diffusion capacity of 72% pred. Baseline blood work was normal, including thyroid function tests, @ERSpublications The possible causal relationship between interferon-β exposure and pulmonary arterial hypertension development requires close follow-up of patients on treatment with interferon-β http://bit.ly/2OPGSVP Cite this article as: Anthi A, Stagaki E, Rallidis L, et al. Is pulmonary arterial hypertension associated with interferon-β therapy for multiple sclerosis reversible? A case study to explore the complexity.

Research paper thumbnail of Cardiac Catheterization versus Echocardiography for Monitoring Pulmonary Pressure: A Prospective Study in Patients with Connective Tissue Disease-Associated Pulmonary Arterial Hypertension

Diagnostics

Standard echocardiography is important for pulmonary arterial hypertension (PAH) screening in pat... more Standard echocardiography is important for pulmonary arterial hypertension (PAH) screening in patients with connective tissue disease (CTD), but PAH diagnosis and monitoring require cardiac catheterization. Herein, using cardiac catheterization as reference, we tested the hypothesis that follow-up echocardiography is adequate for clinical decision-making in these patients. We prospectively studied 69 consecutive patients with CTD-associated PAH. Invasive baseline pulmonary artery systolic pressure (PASP) was 60.19 ± 16.33 mmHg (mean ± SD) and pulmonary vascular resistance (PVR) was 6.44 ± 2.95WU. All patients underwent hemodynamic and echocardiographic follow-up after 9.47 ± 7.29 months; 27 patients had a third follow-up after 17.2 ± 7.4 months from baseline. We examined whether clinically meaningful hemodynamic deterioration of follow-up catheterization-derived PASP (i.e., > 10% increase) could be predicted by simultaneous echocardiography. Echocardiography predicted hemodynamic...

Research paper thumbnail of A Severe COVID-19 Case Complicated by Right Atrium Thrombus

American Journal of Case Reports

Research paper thumbnail of Pulmonary Hypertension in Thalassaemia

Research paper thumbnail of Effects of positive end-expiratory pressure (PEEP) in cardiac surgery patients

Respiratory Medicine, 1998

Research paper thumbnail of Pulmonary hypertension in β thalassaemia

The Lancet Respiratory Medicine, 2013

Pulmonary hypertension is one of the leading causes of morbidity and mortality in patients with h... more Pulmonary hypertension is one of the leading causes of morbidity and mortality in patients with haemolytic disorders and is a frequent finding in echocardiographic screening of patients with β thalassaemia. Substantial progress has been made in understanding of the multifactorial pathophysiology of pulmonary hypertension in β thalassaemia. Haemolysis, reduced nitric oxide bioavailability, iron overload, and hypercoagulopathy are among the main pathogenetic mechanisms. Various disease-directed therapeutic methods, such as transfusion, chelation, and splenectomy, have important roles in the development of pulmonary hypertension in β thalassaemia. Studies investigating the prevalence of pulmonary hypertension in β thalassaemia are mostly based on echocardiographic findings, and are thus limited by the scarcity of information derived from right heart catheterisation. Invasive pulmonary haemodynamic data are needed to clarify the true prevalence of pulmonary hypertension in β thalassaemia, to better understand the underlying pathophysiology and risk factors, and to define the optimum therapy for this devastating complication.

Research paper thumbnail of P-43 Cardiac arrest after open heart surgery and interventional procedures

Research paper thumbnail of Pulmonary Hypertension in Parenchymal Lung Disease

Pulmonary Medicine, 2012

Idiopathic pulmonary arterial hypertension (IPAH) has been extensively investigated, although it ... more Idiopathic pulmonary arterial hypertension (IPAH) has been extensively investigated, although it represents a less common form of the pulmonary hypertension (PH) family, as shown by international registries. Interestingly, in types of PH that are encountered in parenchymal lung diseases such as interstitial lung diseases (ILDs), chronic obstructive pulmonary disease (COPD), and many other diffuse parenchymal lung diseases, some of which are very common, the available data is limited. In this paper, we try to browse in the latest available data regarding the occurrence, pathogenesis, and treatment of PH in chronic parenchymal lung diseases.

Research paper thumbnail of O-42 First year survival after successful CPR in the immediate postoperative period following open heart surgery

Research paper thumbnail of O-32 Antimicrobial protection in cardiac surgery patients undergoing open chest CPR

Research paper thumbnail of Pulmonary Hypertension in a Patient with T-cell Large Granular Lymphocytic Leukemia

Research paper thumbnail of Prediction of prolonged ventilatory support in blunt thoracic trauma patients

Intensive Care Medicine, 2003

Objective: To identify predictors of prolonged (>7 days) mechanical ventilation (MV) in patients ... more Objective: To identify predictors of prolonged (>7 days) mechanical ventilation (MV) in patients with blunt thoracic trauma. Design: Prospective analysis of consecutive patients. Setting: Adult intensive care unit (ICU) in a teaching, tertiary-care hospital. Patients and participants: Sixty-nine patients (53 men, 16 women) with thoracic trauma having a median age of 35 (range 17-85) years and a median injury severity score (ISS) of 29 (range 14-41) were enrolled in the present study. Associated injuries included head-neck (77%), extremities (72%), external (67%), abdomen-pelvis (67%), and face (55%). Interventions: Patient surveillance and data collection. Measurements and results: Thirty-three (48%) of the 69 patients required prolonged ventilatory support, ranging in duration from 8 to 38 (median 18) days. Logistic regression analysis revealed that advancing age (odds ratio=1.04, p=0.04), severity of head injury (odds ratio=1.92, p=0.008), and bilateral thoracic injuries (odds ratio=12.80, p<0.0001) were significant and independent predictors of long-lasting MV. In contrast, gender, injuries affecting the other body regions (face, abdomen-pelvis, extremities, and external), laparotomy in patients with abdominal injury, or PaO 2 /FIO 2 on admission in the ICU, were unrelated to prolonged MV. Conclusions: In thoracic trauma patients admitted in the ICU, prolonged mechanical ventilation was primarily determined by presence of bilateral chest injuries, age, and degree of neurotrauma. This information may help in planning the long-term care of such patients.

Research paper thumbnail of Effects of Peep in postoperative cardiac surgery patients

Intensive Care Medicine, 1996

Respiratory complications, particularly atelectasis, are commonly seen in open heart surgery pati... more Respiratory complications, particularly atelectasis, are commonly seen in open heart surgery patients (pts). Routine use of PEEP (5 to 10 cm H20 ) has been advocated in these pts, but its utility is largely unknown. On the other hand, the use of PEEP is sometimes avoided in cardiac surgery pts because of circulatory depression. In this study, we assessed the effect of low levels of PEEP on postoperative gas exchange and hemodynamic indices in a group of cardiac surgery pts.

Research paper thumbnail of Functional status and quality of life in long-term survivors of cardiac arrest after cardiac surgery

Critical Care Medicine, 2001

To assess long-term survival, functional status, and quality of life in patients who experienced ... more To assess long-term survival, functional status, and quality of life in patients who experienced cardiac arrest after cardiac surgery. Prospective, observational study. An 18-bed, adult cardiac surgery intensive care unit in a tertiary teaching center. Twenty-nine cardiac surgery patients who suffered an unexpected cardiac arrest in the immediate postoperative period. The New York Heart Association classification and a questionnaire based on the Nottingham Health Profile were used to evaluate functional status and quality of life 4 yrs after hospital discharge. Of the 29 patients who experienced cardiac arrest during the first 24 hrs after cardiac surgery, 27 patients (93%) were successfully resuscitated and 23 patients (79%) survived to hospital discharge. Evaluation 4 yrs postdischarge showed that, of the 29 patients, 16 patients (55%) were still alive (long-term survivors). Functional status assessment of long-term survivors revealed that 12 patients (75%) were grouped in New York Heart Association class I, 3 patients (19%) in class II, and 1 patient (6%) in class III. None of them had a neurologic deficit. They all were living independently at home, without need of any nursing care. No patient reported any abnormal emotional reactions, and six patients (38%) had mild sleep disturbances, such as early awaking. Regarding activities of daily living, 20% returned to work, 94% were able to look after their home, 96% had a social life, 63% were sexually active, 81% were involved in their hobbies, and 75% had gone on holidays. Cardiac surgery patients who experience an unexpected cardiac arrest in the immediate postoperative period have a 55% chance of being alive 4 yrs postdischarge. The majority of these long-term survivors has a good outcome with respect to functional status and quality of life.

Research paper thumbnail of High prevalence of decreased cortisol reserve in brain-dead potential organ donors

Critical Care Medicine, 2003

To investigate the adrenocortical function in brain-dead patients, potential organ donors. Prospe... more To investigate the adrenocortical function in brain-dead patients, potential organ donors. Prospective study. Intensive care units in two teaching hospitals. A total of 37 patients (28 men, nine women) with severe brain injury, having a mean age of 42 +/- 18 yrs, were included in the study. Group A consisted of 20 brain-injured patients who did not deteriorate to brain death. Group B included 17 brain-injured patients who were brain dead; of these, ten patients developed brain death during ICU stay and seven patients were admitted to the ICU after clinical brain death. In all patients (group A and group B), a morning blood sample was obtained at admission to the ICU to determine baseline plasma cortisol. Subsequently, 1 microg of corticotropin (adrenocorticotropic hormone, Synacthen) was administered intravenously, and a blood sample was taken 30 mins after the injection. In group B patients who became brain dead while being treated in the ICU (n = 10), the same procedure was repeated the morning after the confirmation of brain death. Patients having a cortisol level of at least 18 microg/dL after the administration of adrenocorticotropic hormone were defined as responders. After the occurrence of brain death, group B patients had significantly lower values for baseline (8.5 +/- 6.2 vs. 17.0 +/- 6.6 microg/dL, p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;.001) and stimulated (16.9 +/- 6.3 vs. 23.9 +/- 5.7 microg/dL, p =.001) plasma cortisol compared with group A patients. Thirteen group B patients (76%) and two group A patients (10%) were nonresponders to adrenocorticotropic hormone (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;.001). In group B patients, baseline and stimulated cortisol concentrations were significantly related (r =.71, p =.001), whereas there was no correlation between baseline cortisol and the increment in cortisol (r = -.37, p =.15). Mean hormonal data of the ten brain-dead patients studied at admission in the ICU and after the occurrence of brain death were the following: baseline plasma cortisol (23.5 +/- 11.4 vs. 6.8 +/- 4.2 microg/dL, p =.003) and stimulated serum cortisol (28.8 +/- 9.9 vs. 16.3 +/- 4.3 microg/dL, p =.008). Adrenal cortisol secretion after dynamic stimulation is deficient in a substantial proportion of brain-dead potential organ donors.

Research paper thumbnail of Functional status and quality of life (QoL) in long-term survivors of cardiac arrest after cardiac surgery

Critical Care, 2000

The incidence of PMI among patients undergoing noncardiac surgery is low and its mortality is neg... more The incidence of PMI among patients undergoing noncardiac surgery is low and its mortality is negligible. Physicians should become more selective in the use of monitored beds and in the ordering of a work up to rule out PMI.

Research paper thumbnail of Pulmonary Vascular Research Institute GoDeep: A meta‐registry merging deep phenotyping datafrom international PH reference centers

Pulmonary Circulation

The Pulmonary Vascular Research Institute GoDeep meta-registry is a collaboration of pulmonary hy... more The Pulmonary Vascular Research Institute GoDeep meta-registry is a collaboration of pulmonary hypertension (PH) reference centers across the globe. Merging worldwide PH data in a central meta-registry to allow advanced analysis of the heterogeneity of PH and its groups/subgroups on a worldwide geographical, ethnical, and etiological landscape (ClinTrial. gov NCT05329714). Retrospective and prospective PH patient data (diagnosis based on catheterization; individuals with exclusion of PH are included as a comparator group) are mapped to a common clinical parameter set of more than 350 items, anonymized and electronically exported to a central server. Use and access is decided by the GoDeep steering board, where each center has one vote. As of April 2022, GoDeep comprised 15,742 individuals with 1.9 million data points from eight PH centers. Geographic distribution comprises 3990 enrollees (25%) from America and 11,752 (75%) from Europe. Eightynine perecent were diagnosed with PH and 11% were classified as not PH and provided a comparator group. The retrospective observation period is an average of 3.5 years (standard error of the mean 0.04), with 1159 PH patients followed for over 10 years. Pulmonary arterial hypertension represents the largest PH group (42.6%), followed by Group 2 (21.7%), Group 3 (17.3%), Group 4 (15.2%), and Group 5 (3.3%). The age distribution spans several decades, with patients 60 years or older comprising 60%. The majority of patients met an intermediate risk profile upon diagnosis. Data entry from a further six centers is ongoing, and negotiations with >10 centers worldwide have commenced. Using electronic interface-based automated retrospective and prospective data transfer, GoDeep aims to provide in-depth epidemiological and etiological understanding of PH and its various groups/subgroups on a global scale, offering insights for improved management.

Research paper thumbnail of The wide spectrum of β-thalassaemia intermedia-induced pulmonary hypertension: two case reports on the possible role of specific pulmonary arterial hypertension therapy

Pulmonary Circulation, 2021

Pulmonary hypertension (PH) development remains a significant cardiovascular complication of haem... more Pulmonary hypertension (PH) development remains a significant cardiovascular complication of haemoglobinopathies, severely affecting the morbidity and mortality of such patients. According to the 5th World Symposium on PH, PH related with chronic haemolytic anaemias is classified in group 5, mainly due to the multifactorial pathophysiology of PH in this patient population. There are no clear guidelines regarding the management of PH in patients with haemoglobinopathies; the use of specific pulmonary arterial hypertension (PAH) therapy in patients with β-thalassaemia and PH is based on data derived from other forms of PH, expert opinion and small series or case reports. The existing knowledge on the use of specific-PAH therapy in β-thalassaemia patients with PH is limited, and in most cases the diagnosis of PH is based on echocardiographic findings only. We herein report two patients with β-thalassaemia intermedia (TI) and PH, who got same initial approach but different outcome, to h...

Research paper thumbnail of Epidemiology and Management of Chronic Thromboembolic Pulmonary Hypertension in Greece. Real-World Data from the Hellenic Pulmonary Hypertension Registry (HOPE)

Journal of Clinical Medicine

Chronic Thromboembolic Pulmonary Hypertension (CTEPH) is a rare disease with poor prognosis if le... more Chronic Thromboembolic Pulmonary Hypertension (CTEPH) is a rare disease with poor prognosis if left untreated, characterized by pulmonary vascular bed obstruction due to unresolving thromboembolic material. The Hellenic pulmonary hypertension registry (HOPE) was launched in Greece in early 2015 and enrolls patients from all pulmonary hypertension subgroups in Greece. In total, 98 patients with CTEPH were enrolled from January 2015 until November 2019. Of these patients, 55.1% represented incident population, 50% were classified in the World Health Organization functional class II and 49% had a history of acute pulmonary embolism. The median values of pulmonary vascular resistance (PVR) and cardiac index were 7.4 (4.8) WU and 2.4 (1.0) L/min/m2, respectively, the mean diffusing capacity for carbon monoxide was 74.8 ± 20.6%, the median 6-minute walk distance was 347 (220) meters and the median value of N Terminal-pro brain natriuretic peptide was 506.0 (1450.0) pg/mL. In total, 60.2% ...

Research paper thumbnail of Low-Dose Dobutamine Stress Echocardiography for the Early Detection of Pulmonary Arterial Hypertension in Selected Patients with Systemic Sclerosis Whose Resting Echocardiography Is Non-Diagnostic for Pulmonary Hypertension

Journal of Clinical Medicine

Background: Dobutamine stress echocardiography (DSE) has limited application in systemic sclerosi... more Background: Dobutamine stress echocardiography (DSE) has limited application in systemic sclerosis (SSc). We examined DSE usefulness in revealing pulmonary arterial hypertension (PAH) in selected SSc patients whose resting echocardiography for pulmonary hypertension (PH) was non-diagnostic. Methods: Forty SSc patients underwent right heart catheterization (RHC) and, simultaneously, low-dose DSE (incremental doses up to 20 μg/kg/min). Inclusion criteria were: preserved left and right ventricular (RV) function (tricuspid annulus plane systolic excursion [TAPSE] ≥ 16 mm and tissue Doppler imaging-derived systolic velocity of tricuspid annulus [RVS’] > 10 cm/s), normal pulmonary function tests, and baseline maximal tricuspid regurgitation (TR) velocity of 2.7–3.2 m/s. Results: Of 36 patients who completed DSE, resting RHC diagnosed PAH in 12 patients (33.3%). At 20 μg/kg/min, patients with PAH had higher TR velocity, higher pulmonary arterial pressure measured by RHC, and lower RV in...

Research paper thumbnail of Is pulmonary arterial hypertension associated with interferon-β therapy for multiple sclerosis reversible? A case study to explore the complexity

ERJ Open Research

Interferon (IFN)-β has been classified as a drug that is possibly associated with development of ... more Interferon (IFN)-β has been classified as a drug that is possibly associated with development of pulmonary arterial hypertension (PAH), a devastating disease that can lead to right heart failure and premature death [1]. Drug-and toxin-induced PAH is a well-known entity in the field of pulmonary hypertension (PH) since the epidemic of idiopathic PAH occurred in the central Europe, between 1967 and 1971, following the use of anorexigens. Τhe Sixth World Symposium on Pulmonary Hypertension, based on recent data, proposed a simplified characterisation of PAH associated with drugs and toxins into two subgroups (definite and possible) to help physicians to identify drugs requiring specific surveillance. According to this framework, and supported by case series and case reports, IFN-β is classified as a drug with possible association with PAH development [2]. In the literature, there are several cases of patients with multiple sclerosis (MS) on treatment with IFN-β who were diagnosed with PAH associated with the IFN-β exposure [3-9]. The need to identify and present related cases has been highlighted [4, 5]. We report a case of a patient with MS on treatment with IFN-β who subsequently developed PAH. The initial suspicion of PAH, the subsequent diagnosis and management, and the final outcome are presented in order to underline the reversibility of PAH following IFN-β discontinuation and specific PAH therapy administration, and the emerging need to early detect similar cases. A 32-year-old female was diagnosed with relapsing remitting MS on 2010 with an Expanded Disability Status Scale score of 1 and negative immunological indices. She had received therapy with IFN-β for 6 years when she presented to our PH clinic with a 4-month history of dyspnoea on exertion, fatigue, dizziness and episodes of presyncope. She thought her symptoms were MS-related. Her past medical history was otherwise unremarkable, with no known risk factors for PAH. Upon admission to the hospital, in New York Heart Association functional class (NYHA-FC) III, she was unable to complete the 6-min walking test (6MWT) due to a presyncopal episode during the fourth minute of the walk. A transthoracic echocardiography demonstrated right ventricular dilatation and systolic dysfunction, tricuspid regurgitant jet velocity of 4 m•s −1 , and left ventricular ejection fraction of 60%. Flattening of the intraventricular septum during both systole and diastole was also noted. High-resolution computed tomography and angiography of the lungs revealed dilatation of the right heart ventricle and an enlarged pulmonary arterial trunk (3.8 cm). There were no lung lesions nor signs of pulmonary embolism. A perfusion lung scan was unremarkable. Pulmonary function tests were normal with a mildly reduced diffusion capacity of 72% pred. Baseline blood work was normal, including thyroid function tests, @ERSpublications The possible causal relationship between interferon-β exposure and pulmonary arterial hypertension development requires close follow-up of patients on treatment with interferon-β http://bit.ly/2OPGSVP Cite this article as: Anthi A, Stagaki E, Rallidis L, et al. Is pulmonary arterial hypertension associated with interferon-β therapy for multiple sclerosis reversible? A case study to explore the complexity.

Research paper thumbnail of Cardiac Catheterization versus Echocardiography for Monitoring Pulmonary Pressure: A Prospective Study in Patients with Connective Tissue Disease-Associated Pulmonary Arterial Hypertension

Diagnostics

Standard echocardiography is important for pulmonary arterial hypertension (PAH) screening in pat... more Standard echocardiography is important for pulmonary arterial hypertension (PAH) screening in patients with connective tissue disease (CTD), but PAH diagnosis and monitoring require cardiac catheterization. Herein, using cardiac catheterization as reference, we tested the hypothesis that follow-up echocardiography is adequate for clinical decision-making in these patients. We prospectively studied 69 consecutive patients with CTD-associated PAH. Invasive baseline pulmonary artery systolic pressure (PASP) was 60.19 ± 16.33 mmHg (mean ± SD) and pulmonary vascular resistance (PVR) was 6.44 ± 2.95WU. All patients underwent hemodynamic and echocardiographic follow-up after 9.47 ± 7.29 months; 27 patients had a third follow-up after 17.2 ± 7.4 months from baseline. We examined whether clinically meaningful hemodynamic deterioration of follow-up catheterization-derived PASP (i.e., > 10% increase) could be predicted by simultaneous echocardiography. Echocardiography predicted hemodynamic...

Research paper thumbnail of A Severe COVID-19 Case Complicated by Right Atrium Thrombus

American Journal of Case Reports

Research paper thumbnail of Pulmonary Hypertension in Thalassaemia

Research paper thumbnail of Effects of positive end-expiratory pressure (PEEP) in cardiac surgery patients

Respiratory Medicine, 1998

Research paper thumbnail of Pulmonary hypertension in β thalassaemia

The Lancet Respiratory Medicine, 2013

Pulmonary hypertension is one of the leading causes of morbidity and mortality in patients with h... more Pulmonary hypertension is one of the leading causes of morbidity and mortality in patients with haemolytic disorders and is a frequent finding in echocardiographic screening of patients with β thalassaemia. Substantial progress has been made in understanding of the multifactorial pathophysiology of pulmonary hypertension in β thalassaemia. Haemolysis, reduced nitric oxide bioavailability, iron overload, and hypercoagulopathy are among the main pathogenetic mechanisms. Various disease-directed therapeutic methods, such as transfusion, chelation, and splenectomy, have important roles in the development of pulmonary hypertension in β thalassaemia. Studies investigating the prevalence of pulmonary hypertension in β thalassaemia are mostly based on echocardiographic findings, and are thus limited by the scarcity of information derived from right heart catheterisation. Invasive pulmonary haemodynamic data are needed to clarify the true prevalence of pulmonary hypertension in β thalassaemia, to better understand the underlying pathophysiology and risk factors, and to define the optimum therapy for this devastating complication.

Research paper thumbnail of P-43 Cardiac arrest after open heart surgery and interventional procedures

Research paper thumbnail of Pulmonary Hypertension in Parenchymal Lung Disease

Pulmonary Medicine, 2012

Idiopathic pulmonary arterial hypertension (IPAH) has been extensively investigated, although it ... more Idiopathic pulmonary arterial hypertension (IPAH) has been extensively investigated, although it represents a less common form of the pulmonary hypertension (PH) family, as shown by international registries. Interestingly, in types of PH that are encountered in parenchymal lung diseases such as interstitial lung diseases (ILDs), chronic obstructive pulmonary disease (COPD), and many other diffuse parenchymal lung diseases, some of which are very common, the available data is limited. In this paper, we try to browse in the latest available data regarding the occurrence, pathogenesis, and treatment of PH in chronic parenchymal lung diseases.

Research paper thumbnail of O-42 First year survival after successful CPR in the immediate postoperative period following open heart surgery

Research paper thumbnail of O-32 Antimicrobial protection in cardiac surgery patients undergoing open chest CPR

Research paper thumbnail of Pulmonary Hypertension in a Patient with T-cell Large Granular Lymphocytic Leukemia

Research paper thumbnail of Prediction of prolonged ventilatory support in blunt thoracic trauma patients

Intensive Care Medicine, 2003

Objective: To identify predictors of prolonged (>7 days) mechanical ventilation (MV) in patients ... more Objective: To identify predictors of prolonged (>7 days) mechanical ventilation (MV) in patients with blunt thoracic trauma. Design: Prospective analysis of consecutive patients. Setting: Adult intensive care unit (ICU) in a teaching, tertiary-care hospital. Patients and participants: Sixty-nine patients (53 men, 16 women) with thoracic trauma having a median age of 35 (range 17-85) years and a median injury severity score (ISS) of 29 (range 14-41) were enrolled in the present study. Associated injuries included head-neck (77%), extremities (72%), external (67%), abdomen-pelvis (67%), and face (55%). Interventions: Patient surveillance and data collection. Measurements and results: Thirty-three (48%) of the 69 patients required prolonged ventilatory support, ranging in duration from 8 to 38 (median 18) days. Logistic regression analysis revealed that advancing age (odds ratio=1.04, p=0.04), severity of head injury (odds ratio=1.92, p=0.008), and bilateral thoracic injuries (odds ratio=12.80, p<0.0001) were significant and independent predictors of long-lasting MV. In contrast, gender, injuries affecting the other body regions (face, abdomen-pelvis, extremities, and external), laparotomy in patients with abdominal injury, or PaO 2 /FIO 2 on admission in the ICU, were unrelated to prolonged MV. Conclusions: In thoracic trauma patients admitted in the ICU, prolonged mechanical ventilation was primarily determined by presence of bilateral chest injuries, age, and degree of neurotrauma. This information may help in planning the long-term care of such patients.

Research paper thumbnail of Effects of Peep in postoperative cardiac surgery patients

Intensive Care Medicine, 1996

Respiratory complications, particularly atelectasis, are commonly seen in open heart surgery pati... more Respiratory complications, particularly atelectasis, are commonly seen in open heart surgery patients (pts). Routine use of PEEP (5 to 10 cm H20 ) has been advocated in these pts, but its utility is largely unknown. On the other hand, the use of PEEP is sometimes avoided in cardiac surgery pts because of circulatory depression. In this study, we assessed the effect of low levels of PEEP on postoperative gas exchange and hemodynamic indices in a group of cardiac surgery pts.

Research paper thumbnail of Functional status and quality of life in long-term survivors of cardiac arrest after cardiac surgery

Critical Care Medicine, 2001

To assess long-term survival, functional status, and quality of life in patients who experienced ... more To assess long-term survival, functional status, and quality of life in patients who experienced cardiac arrest after cardiac surgery. Prospective, observational study. An 18-bed, adult cardiac surgery intensive care unit in a tertiary teaching center. Twenty-nine cardiac surgery patients who suffered an unexpected cardiac arrest in the immediate postoperative period. The New York Heart Association classification and a questionnaire based on the Nottingham Health Profile were used to evaluate functional status and quality of life 4 yrs after hospital discharge. Of the 29 patients who experienced cardiac arrest during the first 24 hrs after cardiac surgery, 27 patients (93%) were successfully resuscitated and 23 patients (79%) survived to hospital discharge. Evaluation 4 yrs postdischarge showed that, of the 29 patients, 16 patients (55%) were still alive (long-term survivors). Functional status assessment of long-term survivors revealed that 12 patients (75%) were grouped in New York Heart Association class I, 3 patients (19%) in class II, and 1 patient (6%) in class III. None of them had a neurologic deficit. They all were living independently at home, without need of any nursing care. No patient reported any abnormal emotional reactions, and six patients (38%) had mild sleep disturbances, such as early awaking. Regarding activities of daily living, 20% returned to work, 94% were able to look after their home, 96% had a social life, 63% were sexually active, 81% were involved in their hobbies, and 75% had gone on holidays. Cardiac surgery patients who experience an unexpected cardiac arrest in the immediate postoperative period have a 55% chance of being alive 4 yrs postdischarge. The majority of these long-term survivors has a good outcome with respect to functional status and quality of life.

Research paper thumbnail of High prevalence of decreased cortisol reserve in brain-dead potential organ donors

Critical Care Medicine, 2003

To investigate the adrenocortical function in brain-dead patients, potential organ donors. Prospe... more To investigate the adrenocortical function in brain-dead patients, potential organ donors. Prospective study. Intensive care units in two teaching hospitals. A total of 37 patients (28 men, nine women) with severe brain injury, having a mean age of 42 +/- 18 yrs, were included in the study. Group A consisted of 20 brain-injured patients who did not deteriorate to brain death. Group B included 17 brain-injured patients who were brain dead; of these, ten patients developed brain death during ICU stay and seven patients were admitted to the ICU after clinical brain death. In all patients (group A and group B), a morning blood sample was obtained at admission to the ICU to determine baseline plasma cortisol. Subsequently, 1 microg of corticotropin (adrenocorticotropic hormone, Synacthen) was administered intravenously, and a blood sample was taken 30 mins after the injection. In group B patients who became brain dead while being treated in the ICU (n = 10), the same procedure was repeated the morning after the confirmation of brain death. Patients having a cortisol level of at least 18 microg/dL after the administration of adrenocorticotropic hormone were defined as responders. After the occurrence of brain death, group B patients had significantly lower values for baseline (8.5 +/- 6.2 vs. 17.0 +/- 6.6 microg/dL, p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;.001) and stimulated (16.9 +/- 6.3 vs. 23.9 +/- 5.7 microg/dL, p =.001) plasma cortisol compared with group A patients. Thirteen group B patients (76%) and two group A patients (10%) were nonresponders to adrenocorticotropic hormone (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;.001). In group B patients, baseline and stimulated cortisol concentrations were significantly related (r =.71, p =.001), whereas there was no correlation between baseline cortisol and the increment in cortisol (r = -.37, p =.15). Mean hormonal data of the ten brain-dead patients studied at admission in the ICU and after the occurrence of brain death were the following: baseline plasma cortisol (23.5 +/- 11.4 vs. 6.8 +/- 4.2 microg/dL, p =.003) and stimulated serum cortisol (28.8 +/- 9.9 vs. 16.3 +/- 4.3 microg/dL, p =.008). Adrenal cortisol secretion after dynamic stimulation is deficient in a substantial proportion of brain-dead potential organ donors.

Research paper thumbnail of Functional status and quality of life (QoL) in long-term survivors of cardiac arrest after cardiac surgery

Critical Care, 2000

The incidence of PMI among patients undergoing noncardiac surgery is low and its mortality is neg... more The incidence of PMI among patients undergoing noncardiac surgery is low and its mortality is negligible. Physicians should become more selective in the use of monitored beds and in the ordering of a work up to rule out PMI.