Aris Anastasakis - Academia.edu (original) (raw)

Uploads

Papers by Aris Anastasakis

Research paper thumbnail of CURRENTOPINION Treatment of arrhythmogenic right ventricular

cardiomyopathy/dysplasia: an international task force consensus statement

Research paper thumbnail of Dilated cardiomyopathy in the era of precision medicine: latest concepts and developments

Heart Failure Reviews, 2021

Dilated cardiomyopathy (DCM) is an umbrella term entailing a wide variety of genetic and non-gene... more Dilated cardiomyopathy (DCM) is an umbrella term entailing a wide variety of genetic and non-genetic etiologies, leading to left ventricular systolic dysfunction and dilatation, not explained by abnormal loading conditions or coronary artery disease. The clinical presentation can vary from asymptomatic to heart failure symptoms or sudden cardiac death (SCD) even in previously asymptomatic individuals. In the last 2 decades, there has been striking progress in the understanding of the complex genetic basis of DCM, with the discovery of additional genes and genotype-phenotype correlation studies. Rigorous clinical work-up of DCM patients, meticulous family screening, and the implementation of advanced imaging techniques pave the way for a more efficient and earlier diagnosis as well as more precise indications for implantable cardioverter defibrillator implantation and prevention of SCD. In the era of precision medicine, genotype-directed therapies have started to emerge. In this review, we focus on updates of the genetic background of DCM, characteristic phenotypes caused by recently described pathogenic variants, specific indications for prevention of SCD in those individuals and genotype-directed treatments under development. Finally, the latest developments in distinguishing athletic heart syndrome from subclinical DCM are described.

Research paper thumbnail of Abstract 19338: Marathon Runners Have Increased Arterial Stiffness and Intima-Media Thickness: Implications for Cardiovascular Risk

Circulation, 2010

Objective: Marathon running represents an aerobic, vigorous and competitive exercise. Aortic stif... more Objective: Marathon running represents an aerobic, vigorous and competitive exercise. Aortic stiffness and wave reflections are independent predictors of cardiovascular risk. Increased Intima Media...

Research paper thumbnail of Clinical profile and genotype-phenotype assessment of arrhythmogenic right ventricular cardiomyopathy/dysplasia due to desmosomal mutations

European Heart Journal, 2011

Research paper thumbnail of Clinical profile of patients affected by dominant desmosomal arrhythmogenic right ventricular cardiomyopathy

Research paper thumbnail of Clinical Profile of Cardiac Involvement in Danon Disease

Circulation: Genomic and Precision Medicine, 2020

Background: The X-linked Danon disease manifests by severe cardiomyopathy, myopathy, and neuropsy... more Background: The X-linked Danon disease manifests by severe cardiomyopathy, myopathy, and neuropsychiatric problems. We designed this registry to generate a comprehensive picture of clinical presentations and outcome of patients with Danon disease in cardiomyopathy centers throughout Europe. Methods: Clinical and genetic data were collected in 16 cardiology centers from 8 European countries. Results: The cohort comprised 30 male and 27 female patients. The age at diagnosis was birth to 42 years in men and 2 to 65 in women. Cardiac involvement was observed in 96%. Extracardiac manifestations were prominent in men but not in women. Left ventricular (LV) hypertrophy was reported in 73% of male and 74% of female patients. LV systolic dysfunction was reported in 40% of men (who had LV ejection fraction, 34±11%) and 59% of women (LV ejection fraction, 28±13%). The risk of arrhythmia and heart failure was comparable among sexes. The age of first heart failure hospitalization was lower in me...

Research paper thumbnail of Atrial substrate characterization in patients with atrial fibrillation and hypertrophic cardiomyopathy: Evidence for an extensive fibrotic disease

Journal of Electrocardiology, 2021

INTRODUCTION Data regarding the left atrial (LA) electroanatomical substrate in patients with hyp... more INTRODUCTION Data regarding the left atrial (LA) electroanatomical substrate in patients with hypertrophic cardiomyopathy (HCM) and atrial fibrillation (AF) are missing. In this electroanatomical mapping (EAM) study, we evaluated the extent of LA fibrosis and its impact on catheter ablation outcomes in patients with HCM and AF. MATERIALS AND METHODS High-density LA EAM was performed during AF in 28 consecutive patients with obstructive HCM and AF (42.9% displayed paroxysmal AF and 57.1% persistent AF). Propensity score (PS) matching analysis was performed to reduce the impact of potential confounding factors. PS were derived to match patients at a 1:1 ratio. Patients were matched according to age, sex and LA diameter. After PS, 28 non-HCM patients with AF were selected, and served as controls. Two different cut-off values of bipolar signal amplitude were investigated for fibrosis characterization (≤0.25 mV and ≤ 0.4 mV). HCM patients underwent pulmonary vein antral isolation (PVAI) and roof line, while non-HCM patients PVAI only. RESULTS After the 3-month blanking period, 10 HCM patients (35.7%) displayed atrial arrhythmia recurrence. HCM patients with arrhythmia recurrence showed significantly greater low voltage areas defined as either bipolar voltage ≤0.25 mV (22.5 ± 10% vs. 5.5 ± 6.4%, p = 0.001) or ≤ 0.4 mV (32 ± 13.9% vs. 5.9 ± 5.1%, p < 0.001). The presence of low voltage areas ≤0.4 mV greater than 14.1% of the total LA area also predicted arrhythmia recurrence with excellent sensitivity (100%) and specificity (100%). Univariate analysis revealed that the extent of LA fibrosis was the only predictor of AF recurrence. After PS matching with non-HCM patients, patients with HCM exhibited wider fibrotic regions ≤0.25 mV compared to non-HCM patients (p = 0.016). CONCLUSIONS High-density EAM reveals extensive LA fibrotic disease in patients with HCM, an event with certain implications in catheter ablation outcomes.

Research paper thumbnail of Arrhythmic risk stratification in non-ischemic dilated cardiomyopathy: Where do we stand after Danish?

Trends in Cardiovascular Medicine, 2017

Publication of the DANISH randomized trial led to considerable debate, given that it demonstrated... more Publication of the DANISH randomized trial led to considerable debate, given that it demonstrated no survival benefit stemming from current implantable cardioverterdefibrillator (ICD) allocation criteria in patients with nonischemic dilated cardiomyopathy (NIDCM). Consequently, a thorough reconsideration of our approach to sudden cardiac death (SCD) risk stratification appears to be in order. NIDCM encompasses a wide spectrum of disease entities, often with differing arrhythmogenicity; however, in its kernel, is still defined by the fundamentals of electrophysiology that dictate that abnormal tissue, exhibiting altered electrophysiological properties is necessary for arrhythmogenesis, but not enough, given that formation of functional circuits is required. In this review article we will attempt a presentation of the current status in SCD risk stratification in NIDCM and introduce the concept of multifactorial tiered approach, bringing together noninvasive indices of arrhythmic potential and programmed ventricular stimulation, as an alternative approach, in order to finally delineate a potential basis for the design and realization of trials necessary to achieve a paradigm shift and improvement in NIDCM SCD risk stratification.

Research paper thumbnail of Cardiomyopathy ''Petrified'' Right Ventricle in Long-Standing Naxos Arrhythmogenic Right Ventricular

Research paper thumbnail of The Human Genome: Implications for Medicine and Society

Research paper thumbnail of Sudden death in the young in Greece: the unknown cause cases and the hidden cardiac diseases

Research paper thumbnail of Genetics of Heritable Thoracic Aortic Disease

Cardiogenetics

Genetic testing plays an increasing diagnostic and prognostic role in the management of patients ... more Genetic testing plays an increasing diagnostic and prognostic role in the management of patients with heritable thoracic aortic disease (HTAD). The identification of a specific variant can establish or confirm the diagnosis of syndromic HTAD, dictate extensive evaluation of the arterial tree in HTAD with known distal vasculature involvement and justify closer follow-up and earlier surgical intervention in HTAD with high risk of dissection of minimal or normal aortic size. Evolving phenotype–genotype correlations lead us towards more precise and individualized management and treatment of patients with HTAD. In this review, we present the latest evidence regarding the role of genetics in patients with HTAD.

Research paper thumbnail of Diagnosis of arrhythmogenic cardiomyopathy: The Padua criteria

International Journal of Cardiology

Research paper thumbnail of Arrhythmogenic Right Ventricular Cardiomyopathy: The Challenge of Genetic Interpretation in Clinically Suspected Cases

Research paper thumbnail of Arrhythmic risk stratification in hypertrophic cardiomyopathy: are we missing something?

Research paper thumbnail of Proposed algorithm for return to sports in competitive athletes who have suffered COVID-19

Hellenic Journal of Cardiology

Research paper thumbnail of Definition and treatment of arrhythmogenic cardiomyopathy: an updated expert panel report

European Journal of Heart Failure

Research paper thumbnail of The mitral valve in hypertrophic cardiomyopathy: a three-dimensional transesophageal study

Hellenic Journal of Cardiology

Research paper thumbnail of Programmed ventricular stimulation predicts arrhythmic events and survival in hypertrophic cardiomyopathy

International journal of cardiology, Mar 1, 2018

Sudden cardiac death (SCD) risk stratification in hypertrophic cardiomyopathy (HCM) in the contex... more Sudden cardiac death (SCD) risk stratification in hypertrophic cardiomyopathy (HCM) in the context of primary prevention remains suboptimal. The purpose of this study was to examine the additional contribution of programmed ventricular stimulation (PVS) on established risk assessment. Two-hundred-and-three consecutive patients with diagnosed HCM and ≥1 noninvasive risk factors were prospectively enrolled over 19years. Patients were risk stratified, submitted to PVS and received an implantable cardioverter-defibrillator (ICD) according to then-current American Heart Association (AHA) guidelines and inducibility. Participants were prospectively followed-up for primary endpoint occurrence (appropriate ICD therapy or SCD). Contemporary (2015) AHA and European Society of Cardiology (ESC) guidelines were retrospectively assessed. During a median follow-up period of 60months the primary endpoint occurred in 20 patients, 19 of whom were inducible and received an ICD. Overall, 79 patients (3...

Research paper thumbnail of Primary" dilated hearts

International journal of cardiology, Apr 15, 2018

Dilated cardiomyopathy is part of the spectrum of heart failure which is a syndrome with certain ... more Dilated cardiomyopathy is part of the spectrum of heart failure which is a syndrome with certain morphological and functional characteristics. Although significant progress in the management of those patients has been achieved, seems that risk stratification and future treatments will be related to the specific pathological substrate.

Research paper thumbnail of CURRENTOPINION Treatment of arrhythmogenic right ventricular

cardiomyopathy/dysplasia: an international task force consensus statement

Research paper thumbnail of Dilated cardiomyopathy in the era of precision medicine: latest concepts and developments

Heart Failure Reviews, 2021

Dilated cardiomyopathy (DCM) is an umbrella term entailing a wide variety of genetic and non-gene... more Dilated cardiomyopathy (DCM) is an umbrella term entailing a wide variety of genetic and non-genetic etiologies, leading to left ventricular systolic dysfunction and dilatation, not explained by abnormal loading conditions or coronary artery disease. The clinical presentation can vary from asymptomatic to heart failure symptoms or sudden cardiac death (SCD) even in previously asymptomatic individuals. In the last 2 decades, there has been striking progress in the understanding of the complex genetic basis of DCM, with the discovery of additional genes and genotype-phenotype correlation studies. Rigorous clinical work-up of DCM patients, meticulous family screening, and the implementation of advanced imaging techniques pave the way for a more efficient and earlier diagnosis as well as more precise indications for implantable cardioverter defibrillator implantation and prevention of SCD. In the era of precision medicine, genotype-directed therapies have started to emerge. In this review, we focus on updates of the genetic background of DCM, characteristic phenotypes caused by recently described pathogenic variants, specific indications for prevention of SCD in those individuals and genotype-directed treatments under development. Finally, the latest developments in distinguishing athletic heart syndrome from subclinical DCM are described.

Research paper thumbnail of Abstract 19338: Marathon Runners Have Increased Arterial Stiffness and Intima-Media Thickness: Implications for Cardiovascular Risk

Circulation, 2010

Objective: Marathon running represents an aerobic, vigorous and competitive exercise. Aortic stif... more Objective: Marathon running represents an aerobic, vigorous and competitive exercise. Aortic stiffness and wave reflections are independent predictors of cardiovascular risk. Increased Intima Media...

Research paper thumbnail of Clinical profile and genotype-phenotype assessment of arrhythmogenic right ventricular cardiomyopathy/dysplasia due to desmosomal mutations

European Heart Journal, 2011

Research paper thumbnail of Clinical profile of patients affected by dominant desmosomal arrhythmogenic right ventricular cardiomyopathy

Research paper thumbnail of Clinical Profile of Cardiac Involvement in Danon Disease

Circulation: Genomic and Precision Medicine, 2020

Background: The X-linked Danon disease manifests by severe cardiomyopathy, myopathy, and neuropsy... more Background: The X-linked Danon disease manifests by severe cardiomyopathy, myopathy, and neuropsychiatric problems. We designed this registry to generate a comprehensive picture of clinical presentations and outcome of patients with Danon disease in cardiomyopathy centers throughout Europe. Methods: Clinical and genetic data were collected in 16 cardiology centers from 8 European countries. Results: The cohort comprised 30 male and 27 female patients. The age at diagnosis was birth to 42 years in men and 2 to 65 in women. Cardiac involvement was observed in 96%. Extracardiac manifestations were prominent in men but not in women. Left ventricular (LV) hypertrophy was reported in 73% of male and 74% of female patients. LV systolic dysfunction was reported in 40% of men (who had LV ejection fraction, 34±11%) and 59% of women (LV ejection fraction, 28±13%). The risk of arrhythmia and heart failure was comparable among sexes. The age of first heart failure hospitalization was lower in me...

Research paper thumbnail of Atrial substrate characterization in patients with atrial fibrillation and hypertrophic cardiomyopathy: Evidence for an extensive fibrotic disease

Journal of Electrocardiology, 2021

INTRODUCTION Data regarding the left atrial (LA) electroanatomical substrate in patients with hyp... more INTRODUCTION Data regarding the left atrial (LA) electroanatomical substrate in patients with hypertrophic cardiomyopathy (HCM) and atrial fibrillation (AF) are missing. In this electroanatomical mapping (EAM) study, we evaluated the extent of LA fibrosis and its impact on catheter ablation outcomes in patients with HCM and AF. MATERIALS AND METHODS High-density LA EAM was performed during AF in 28 consecutive patients with obstructive HCM and AF (42.9% displayed paroxysmal AF and 57.1% persistent AF). Propensity score (PS) matching analysis was performed to reduce the impact of potential confounding factors. PS were derived to match patients at a 1:1 ratio. Patients were matched according to age, sex and LA diameter. After PS, 28 non-HCM patients with AF were selected, and served as controls. Two different cut-off values of bipolar signal amplitude were investigated for fibrosis characterization (≤0.25 mV and ≤ 0.4 mV). HCM patients underwent pulmonary vein antral isolation (PVAI) and roof line, while non-HCM patients PVAI only. RESULTS After the 3-month blanking period, 10 HCM patients (35.7%) displayed atrial arrhythmia recurrence. HCM patients with arrhythmia recurrence showed significantly greater low voltage areas defined as either bipolar voltage ≤0.25 mV (22.5 ± 10% vs. 5.5 ± 6.4%, p = 0.001) or ≤ 0.4 mV (32 ± 13.9% vs. 5.9 ± 5.1%, p < 0.001). The presence of low voltage areas ≤0.4 mV greater than 14.1% of the total LA area also predicted arrhythmia recurrence with excellent sensitivity (100%) and specificity (100%). Univariate analysis revealed that the extent of LA fibrosis was the only predictor of AF recurrence. After PS matching with non-HCM patients, patients with HCM exhibited wider fibrotic regions ≤0.25 mV compared to non-HCM patients (p = 0.016). CONCLUSIONS High-density EAM reveals extensive LA fibrotic disease in patients with HCM, an event with certain implications in catheter ablation outcomes.

Research paper thumbnail of Arrhythmic risk stratification in non-ischemic dilated cardiomyopathy: Where do we stand after Danish?

Trends in Cardiovascular Medicine, 2017

Publication of the DANISH randomized trial led to considerable debate, given that it demonstrated... more Publication of the DANISH randomized trial led to considerable debate, given that it demonstrated no survival benefit stemming from current implantable cardioverterdefibrillator (ICD) allocation criteria in patients with nonischemic dilated cardiomyopathy (NIDCM). Consequently, a thorough reconsideration of our approach to sudden cardiac death (SCD) risk stratification appears to be in order. NIDCM encompasses a wide spectrum of disease entities, often with differing arrhythmogenicity; however, in its kernel, is still defined by the fundamentals of electrophysiology that dictate that abnormal tissue, exhibiting altered electrophysiological properties is necessary for arrhythmogenesis, but not enough, given that formation of functional circuits is required. In this review article we will attempt a presentation of the current status in SCD risk stratification in NIDCM and introduce the concept of multifactorial tiered approach, bringing together noninvasive indices of arrhythmic potential and programmed ventricular stimulation, as an alternative approach, in order to finally delineate a potential basis for the design and realization of trials necessary to achieve a paradigm shift and improvement in NIDCM SCD risk stratification.

Research paper thumbnail of Cardiomyopathy ''Petrified'' Right Ventricle in Long-Standing Naxos Arrhythmogenic Right Ventricular

Research paper thumbnail of The Human Genome: Implications for Medicine and Society

Research paper thumbnail of Sudden death in the young in Greece: the unknown cause cases and the hidden cardiac diseases

Research paper thumbnail of Genetics of Heritable Thoracic Aortic Disease

Cardiogenetics

Genetic testing plays an increasing diagnostic and prognostic role in the management of patients ... more Genetic testing plays an increasing diagnostic and prognostic role in the management of patients with heritable thoracic aortic disease (HTAD). The identification of a specific variant can establish or confirm the diagnosis of syndromic HTAD, dictate extensive evaluation of the arterial tree in HTAD with known distal vasculature involvement and justify closer follow-up and earlier surgical intervention in HTAD with high risk of dissection of minimal or normal aortic size. Evolving phenotype–genotype correlations lead us towards more precise and individualized management and treatment of patients with HTAD. In this review, we present the latest evidence regarding the role of genetics in patients with HTAD.

Research paper thumbnail of Diagnosis of arrhythmogenic cardiomyopathy: The Padua criteria

International Journal of Cardiology

Research paper thumbnail of Arrhythmogenic Right Ventricular Cardiomyopathy: The Challenge of Genetic Interpretation in Clinically Suspected Cases

Research paper thumbnail of Arrhythmic risk stratification in hypertrophic cardiomyopathy: are we missing something?

Research paper thumbnail of Proposed algorithm for return to sports in competitive athletes who have suffered COVID-19

Hellenic Journal of Cardiology

Research paper thumbnail of Definition and treatment of arrhythmogenic cardiomyopathy: an updated expert panel report

European Journal of Heart Failure

Research paper thumbnail of The mitral valve in hypertrophic cardiomyopathy: a three-dimensional transesophageal study

Hellenic Journal of Cardiology

Research paper thumbnail of Programmed ventricular stimulation predicts arrhythmic events and survival in hypertrophic cardiomyopathy

International journal of cardiology, Mar 1, 2018

Sudden cardiac death (SCD) risk stratification in hypertrophic cardiomyopathy (HCM) in the contex... more Sudden cardiac death (SCD) risk stratification in hypertrophic cardiomyopathy (HCM) in the context of primary prevention remains suboptimal. The purpose of this study was to examine the additional contribution of programmed ventricular stimulation (PVS) on established risk assessment. Two-hundred-and-three consecutive patients with diagnosed HCM and ≥1 noninvasive risk factors were prospectively enrolled over 19years. Patients were risk stratified, submitted to PVS and received an implantable cardioverter-defibrillator (ICD) according to then-current American Heart Association (AHA) guidelines and inducibility. Participants were prospectively followed-up for primary endpoint occurrence (appropriate ICD therapy or SCD). Contemporary (2015) AHA and European Society of Cardiology (ESC) guidelines were retrospectively assessed. During a median follow-up period of 60months the primary endpoint occurred in 20 patients, 19 of whom were inducible and received an ICD. Overall, 79 patients (3...

Research paper thumbnail of Primary" dilated hearts

International journal of cardiology, Apr 15, 2018

Dilated cardiomyopathy is part of the spectrum of heart failure which is a syndrome with certain ... more Dilated cardiomyopathy is part of the spectrum of heart failure which is a syndrome with certain morphological and functional characteristics. Although significant progress in the management of those patients has been achieved, seems that risk stratification and future treatments will be related to the specific pathological substrate.