Georgia Vogiatzi - Academia.edu (original) (raw)
Papers by Georgia Vogiatzi
QJM : monthly journal of the Association of Physicians, 2011
Regular physical activity (PA) has shown substantial cardiac benefits. We sought to investigate w... more Regular physical activity (PA) has shown substantial cardiac benefits. We sought to investigate whether habitual PA is associated with changes of the electrical action potential duration, as it is represented by the QT duration on a rest ECG, in a population based sample of middle-aged and elderly individuals of Ikaria island.
Current Medicinal Chemistry
: Atherosclerotic cardiovascular diseases remain the leading cause of morbidity and mortality wor... more : Atherosclerotic cardiovascular diseases remain the leading cause of morbidity and mortality worldwide despite all efforts made towards their management. Other than targeting the traditional risk factors for their development, scientific interest has been shifted towards epigenetic regulation, with microRNAs (miRs) being at the forefront. MiR-126, in particular, has been extensively studied in the context of cardiovascular diseases. Downregulated expression of this miR has been associated with highly prevalent cardiovascular risk factors such as arterial hypertension and diabetes mellitus. At the same time, its diagnostic and prognostic capability concerning coronary artery disease is still under investigation, with up-to-date data pointing towards a dysregulated expression in a stable disease state and acute myocardial infarction. Moreover, a lower expression of miR-126 may indicate a higher disease complexity, as well as an increased risk for future major adverse cardiac and cerebrovascular events. Ultimately, overexpression of miR-126 may emerge as a novel therapeutic target in atherosclerotic cardiovascular diseases due to its potential in promoting therapeutic angiogenesis and anti-inflammatory effects. However, the existing challenges in miR therapeutics need to be resolved before translation to clinical practice.
Hellenic Journal of Cardiology, 2021
This is a PDF file of an article that has undergone enhancements after acceptance, such as the ad... more This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
European Heart Journal, 2017
Prevention-Epidemiology / Diabetes 927 (post AMI) in 2 cases. Nonischaemic LGE pattern was found ... more Prevention-Epidemiology / Diabetes 927 (post AMI) in 2 cases. Nonischaemic LGE pattern was found in 15 cases (37.5%): patchy subepi-midmyocardial LGE suggesting previous myocarditis in 8 athletes, and with aspecific pattern in 7 athletes. Athletes with nonischaemic LGE had normal laboratory parameters without wall motion abnormalities, in their cases systemic diseases were ruled out. One athlete was diagnosed with Fabry-disease (2.5%), one with coronary artery abnormality (anomalous origin of the left main coronary artery from the right sinus of Valsalva) (2.5%). Regarding the 10 aborted SCD cases, CMR findings were the following: ARVC (n=3), aspecific LGE pattern (n=2), and no structural myocardium abnormality (n=5). In the last group two athletes were diagnosed with long QT-syndrome, one with Wolff-Parkinson-Whitesyndrome and one with Brugada-syndrome. In our national CMR registry the most common structural alteration was nonischaemic fibrosis, the most common cardiomyopathy was HCM, and the leading cause of SCD in Hungarian competitive athletes was ARVC. The national registers are highly important for a better understanding the etiology and the geographical differences of SCD in athletes.
The American Journal of Cardiology, 2003
European Heart Journal, 2021
Introduction Cardiovascular complications of Coronavirus disease (COVID-19), resulting from the S... more Introduction Cardiovascular complications of Coronavirus disease (COVID-19), resulting from the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), have been documented. Endothelium-induced “cytokine storm” in critically ill COVID-19 patients is one of the leading causes of morbidity and mortality. Vascular endothelial damage caused by COVID-19 emphasizes the crucial role of endothelium in COVID-19 clinical impact. Purpose To examine the mid-term (1-month) impact of COVID-19 in endothelial function. Methods In this case control study, 20 consecutive patients who were hospitalized for COVID-19 either on Intensive Care Unit (ICU) or non-ICU were examined one month following hospital discharge. In the control group we recruited 12 consecutive subjects from the outpatient cardiology clinic. Demographic and clinical data were collected, and endothelial function was evaluated by brachial artery flow-mediated dilation (FMD). Results There was no difference in age between COVID-19...
Nutrients, 2021
The aim of this study was to evaluate several sociodemographic, lifestyle, and clinical character... more The aim of this study was to evaluate several sociodemographic, lifestyle, and clinical characteristics of the IKARIA study participants and to find healthy aging trajectories of multimorbidity of Ikarian islanders. During 2009, 1410 people (aged 30+) from Ikaria Island, Greece, were voluntarily enrolled in the IKARIA study. Multimorbidity was defined as the combination of at least two of the following chronic diseases: hypertension; hypercholesterolemia; diabetes; obesity; cancer; CVD; osteoporosis; thyroid, renal, and chronic obstructive pulmonary disease. A healthy aging index (HAI) ranging from 0 to 100 was constructed using 4 attributes, i.e., depression symptomatology, cognitive function, mobility, and socializing. The prevalence of multimorbidity was 51% among men and 65.5% among women, while the average number of comorbidities was 1.7 ± 1.4 for men and 2.2 ± 1.4 for women. The most prevalent chronic diseases among men with multimorbidity were hypertension, hypercholesterolem...
European Heart Journal, 2020
Introduction Both anthracyclines and trastuzumab are key regiments for the treatment of breast ca... more Introduction Both anthracyclines and trastuzumab are key regiments for the treatment of breast cancer, but their concurrent use is contraindicated because of their cardiotoxicity. Their effects on vascular function have been less well studied. Purpose We explored the effects of the anthracycline-based chemotherapy followed by trastuzumab-based treatment on endothelial function and arterial stiffness in patients with breast cancer. Methods 46 female patients (54.56±11.5 years old) with breast cancer scheduled for anthracycline-based chemotherapy followed by the combination of trastuzumab and taxane were enrolled. Trastuzumab was continued until the completion of one-year treatment. All participants underwent assessment of the brachial flow mediated dilatation (FMD), endothelial independent dilatation (EID), carotid-femoral pulse wave velocity (PWV) and augmentation index (AIx) at baseline (BL), at the end of anthracycline treatment (FU1), 3 months following initiation of trastuzumab ...
European Heart Journal, Aug 1, 2017
tality were significantly higher in patients with reduced EF than those without (all p<0.01). In-... more tality were significantly higher in patients with reduced EF than those without (all p<0.01). In-hospit and 1-year outcomes in Study 1 n (%) Reduced EF (n=613) Non-reduced EF (n=8534) P value In hospital mortality 38 (6.2) 68 (0.8) <0.001 Heart failure post PCI 40 (6.5) 125 (1.5) <0.001 Acute kidney injury 107 (20.9) 880 (12.0) <0.001 Bleeding complications 36 (5.9) 241 (2.8) <0.001 1 year mortality 21 (8.5) 71 (2.0) <0.001 Conclusions: STEMI and silent ischemia were both frequent indications for PCI in patients with LV dysfunction. LV dysfunction was at greater risk for in-hospital complication and 1-year prognosis after PCI.
Journal of the American College of Cardiology, 2020
Background: Sleep is an essential physiological process and disturbance of sleep duration may be ... more Background: Sleep is an essential physiological process and disturbance of sleep duration may be associated with atherosclerosis. Methods: The Corinthia study is a cross sectional epidemiological study based on 2043 inhabitants of Corinthia region in Greece. Ultrasonography was used to measure intima media thickness (IMT) and the mean IMT (mIMT) was considered a representative of carotid atherosclerosis burden. Thickness of IMT>1.5 mm or protrusion >50% compared to adjacent segments was defined as atherosclerotic plaque. Total sleeping time per day was recorded via surveys. Sleep duration was categorized as normal (NSD, 6-8h), long (LSD, >8h) and short (SSD, <6h). Results: Subjects with NSD had less prevalence of diabetes mellitus (p=0.001) but there was no difference in other cardiovascular risk factors. Interestingly, mIMT (SSD: 1.07±0.5 mm vs. NSD: 0.98±0.43 mm vs. LSD: 1.07±0.53 mm, p=0.001) and carotid atherosclerotic plaque (SSD: 30% vs. NSD: 23% vs. LSD: 29%, p=0.016) were decreased in NSD subjects (Figure). After adjustment for known confounders, regression analysis revealed that subjects with SSD and LSD have 54% and 39% increased odds respectively of carotid atheromatic plaque than those with NSD (Figure). Conclusion: A balanced sleeping duration of 6-8h daily can act as an additive cardioprotective factor in the modern western type societies. Short and long sleep duration may act as a cardiovascular risk factor.
European Cardiology Review, 2019
Diabetes is a complex metabolic disorder affecting the glucose status of the human body. Chronic ... more Diabetes is a complex metabolic disorder affecting the glucose status of the human body. Chronic hyperglycaemia related to diabetes is associated with end organ failure. The clinical relationship between diabetes and atherosclerotic cardiovascular disease is well established. This makes therapeutic approaches that simultaneously target diabetes and atherosclerotic disease an attractive area for research. The majority of people with diabetes fall into two broad pathogenetic categories, type 1 or type 2 diabetes. The role of obesity, adipose tissue, gut microbiota and pancreatic beta cell function in diabetes are under intensive scrutiny with several clinical trials to have been completed while more are in development. The emerging role of inflammation in both type 1 and type 2 diabetes (T1D and T1D) pathophysiology and associated metabolic disorders, has generated increasing interest in targeting inflammation to improve prevention and control of the disease. After an extensive review...
Atherosclerosis, 2019
Background and aims: Sedentary lifestyle, unlike leisure time physical activity (PA), is associat... more Background and aims: Sedentary lifestyle, unlike leisure time physical activity (PA), is associated with atherosclerosis progression. Regarding the interrelationship between television watching, as a sedentary behavior pattern, and cardiovascular disease burden, few data exist. Methods: In this cross-sectional epidemiological study based on 2,043 inhabitants of the Corinthia region, in Greece, ultrasonography was used to measure carotid intimamedia thickness (IMT) in both carotid arteries. The average (meanIMT) and maximum thickness (maxIMT) were determined as representative values of subclinical atherosclerosis. We evaluated PA using the self-reported International Physical Activity Questionnaire (IPAQ). Based on specific questions, the average hours per week spent on watching television (TV), videos or DVD were calculated for each participant. Results: According to TV viewing time, subjects were categorized into the low (≤7 hours/week), moderate (7˃ TV hours/week ≤21) and high (˃21 hours/week) TV viewing time groups. Prevalence of carotid atheromatic plaque was lower in the low TV viewing time group compared to the moderate and high TV viewing time groups (p=0.02). TV viewing time was associated with increased carotid IMT (p=0.03) and the prevalence of carotid atheromatic plaque (p=0.02), even after adjustment for age, body mass index, cardiovascular risk factors or history of cardiovascular disease. Subjects in the high TV viewing time group have 80% increase odds of carotid atheromatic plaque compared to patients categorized in the low TV viewing time group (p=0.01).
QJM : monthly journal of the Association of Physicians, Jan 3, 2017
Aging is characterized by an insidious decline in cognitive function. Several genetic and lifesty... more Aging is characterized by an insidious decline in cognitive function. Several genetic and lifestyle factors have been implicated in the increased risk or early onset of dementia We sought to assess the role of tumor necrosis factor (TNF) and angiotensin-converting enzyme (ACE) polymorphisms on the development of impaired mental health in respect to indices ïf arterial aging in nonagenarian individuals. 178 consecutive subjects above 75 years that permanently inhabit in the island of Ikaria, Greece were recruited. Aortic distensibility (AoD) was calculated and genetic evaluation was performed on the ACE Ins/Del gene polymorphism (intron 16) and the G/A transition (position -308) of the TNF gene. Cognitive function was evaluated using the Mini-mental State Examination (MMSE). The DD genotype for ACE was independently associated (b=-0.44, p = 0.007) with AD while AoD remained an independent determinant of mental status (OR = 1.82, p = 0.036). Interestingly though, when a combined genet...
Current vascular pharmacology, Jan 26, 2017
Sildenafil, a phosphodiesterase type 5 (PDE5) inhibitor, has endothelium protective and angiogeni... more Sildenafil, a phosphodiesterase type 5 (PDE5) inhibitor, has endothelium protective and angiogenic effects. To test if sildenafil improves tissue perfusion and neovascularization and downregulates pro-inflammatory molecules following limb ischemia. 30 ApoE-/- male mice, bred with cholesterol rich diet for 4 weeks, were anesthetized and underwent unilateral hind-limb ischemia with ligation of the left femoral artery. Mice were randomized in 2 groups: sildenafil (1 mg/Kg for 7 days intraperitoneally, i.p.) or normal saline (0.4 ml for 7 days, i.p.). Bilateral hind-limb perfusion was estimated by laser Doppler imaging after surgery on days 0, 7 and 28. Sildenafil significantly reduced at day 28 compared with day 0 levels of soluble intracellular adhesion molecule-1(sICAM-1) [2.24(1.81-2.41) vs 1.29(0.87-1.45) ng/ml, p=0,01], soluble E-selectin (sE-Selectin) [5.52 (3.67-6.14) vs 1.71 (1.42-2.86) ng/ml, p=0.02] and tissue plasminogen activator inhibitor-1 (tΡΑΙ-1) [0.13(0.07-0.21) vs 0.0...
Hellenic Journal of Cardiology, 2016
Environmental factors constitute an important but underappreciated risk factor towards the develo... more Environmental factors constitute an important but underappreciated risk factor towards the development and progression of cardiovascular disease (CVD). Environmental exposure to variable pollutants is implicated in the derangement or propagation of adverse pathophysiological processes linked with atherosclerosis, including genetic, hemodynamic, metabolic, oxidative and inflammation parameters. However, no data exist on environmental pollution in rural or semi-rural areas. Therefore, the purpose of the "Corinthia" study is to examine the impact of environmental pollution in indices of cardiovascular morbidity and mortality in a cross-sectional and longitudinal design. The Corinthia study began in October 2015 and is planned to recruit 1,500 individuals from different regions of Corinthia country with different environmental exposures to pollutants and different patterns of soil/ground and/ or air pollution until December 2016. Baseline measurements will include lifestyle measurements, anthropometric characteristics and a comprehensive cardiovascular examination. The follow-up is planned to extend prospectively up to 10 years and this study is anticipated to provide valuable data on the distinct impact of soil and air pollution on early markers of
Journal of the American College of Cardiology, 2013
Background: Bone marrow derived progenitor cells have been suggested to promote postnatal neovasc... more Background: Bone marrow derived progenitor cells have been suggested to promote postnatal neovascularization. In this study we investigated whether direct intramuscular infusion of enriched hematopoietic cells, improved limb perfusion in a murine model of hind limb ischemia. methods: Wild type C57BL/6 male mice underwent unilateral hind-limb ischemia, were divided in three groups (n=12/group) and received a single intramuscular injection of 1x106 Lin-/sca+ cells, or granulocyte colony-stimulating factor (G-CSF) for 7 days or normal saline. Each group mice underwent Laser Doppler perfusion Imaging on days 1, 7 and 28 after surgery for the estimation of the bilateral hind-limb perfusion. At day 28 they were sacrificed and quantitative real time RT-PCR was performed to the muscle tissues from both limbs to analyze the differential gene expression of vascular endothelial growth factor (VEGF), Tie-2, Ang-1 and Ang-2. Muscle tissue sections were stained with rat anti-CD31antibody. Capillaries and arterioles in the ischemic areas were counted with confocal microscopy at day 28. results: Ischemic/non ischemic ratio was significantly increased in ischemic limbs of cell-and G-CSF-treated mice versus control mice at 7 days (p<0.05 vs control), which was maintained at 28 days (p<0.05 vs control) only in the cell-treated group. There was no significant increase of ischemic/nonischemic ratio in the cell-treated mice compared with G-CSF at day 7 or day 28 (p=NS). Capillary density was increased in the cell-treated group compared to G-CSF-treated group and control (p<0.05). No difference in the capillary density between the G-CSF-treated and the control group was observed. Compared to the G-CSF and control group, the expression of VEGF (p<0.05), Ang-2 (p<0.05) and sTie-2 (p<0.05) were significantly increased in the ischemic limbs of the Epo-treated group. In contrast, the Ang-1 expression didn't significantly differ between the three groups. conclusion: Direct intramuscular infusion of lin-/sca+ significantly improves blood flow and increases neoangiogenesis by upregulation of the Ang-2/Tie-2 pathway when compared with G-CSF and control treatment in ischemic limbs.
Journal of the American College of Cardiology, 2011
Background: Regular physical activity (PA) has substantial cardiac benefits. QT interval represen... more Background: Regular physical activity (PA) has substantial cardiac benefits. QT interval represents the duration of ventricular repolarization and its prolongation is associated with greater mortality risk. Aim of the study was to evaluate the impact of PA on QT duration in a sample of middle aged and elderly individuals of Ikaria island, a place worldwide recognized as having high rates of longevity and low cardiovascular mortality rates. Methods: We enrolled 1071 inhabitants of Ikaria Island (65±13 yrs, 47% males); Among several demographic and clinical characteristics PA was estimated with IPAQ (low, with expended calories < 4 Kcal/min, moderate with expended calories 4-7 Kcal/min and vigorous with expended calories >7 Kcal/min). QT duration was measured from a 12-lead surface digital recorded electrocardiogram and heart rate-corrected QT (QTc) was calculated using Bazett's formula. Results: Among participants, 85% reported at least moderate PA levels. Women in the "vigorous" and "moderate" PA level compared to those in the "low" PA level had significantly shorter QTc (408±2 msec vs. 419±2 msec, p=0.002, 411±1 msec vs. 419±2 msec, p=0.002, respectively). In contrast men in the "vigorous" and "moderate" PA level compared to those in the "low" PA level had no significantly shorter QTc (395±2 msec vs. 402±3 msec, p=0.29, 402±2msec vs. 402±3, p=0.99). Furthermore, linear regression analysis revealed that PA level was significantly associated with shorter QTc in women (b=-12.5, p=0.001) even after adjustment for age, BMI, adherence to the Mediterranean diet, smoking status and the presence of cardiovascular disease, hypertension, diabetes melitus and hypercholesterolemia, while no such association was evident in men. Moreover compared to women in the "low" PA level, women in the "moderate" and "vigorous" PA level had decreased odds of having QTc interval > 450 msec by 70% (OR: 0.29 [0.12, 0.72]) and 80% (OR: 0.18 [0.04, 0.85]) respectively. Conclusion: Increased PA is associated with shorter QTc interval only in middle aged and elderly women of Ikaria Island irrespectively of habituals or medical conditions, illustrating gender differences in the cardioprotective effect of habitual exercise.
Journal of the American College of Cardiology, 2011
Background: Erythropoietin (EPO) has been shown to enhance angiogenesis, but its precise mechanis... more Background: Erythropoietin (EPO) has been shown to enhance angiogenesis, but its precise mechanisms of enhancement during ischemia are not fully elucidated. The angiopoietin (Ang)/Tie system has been reported to be critically involved in disease progression through the activation of signaling pathways that control angiogenic remodeling and Ang-1 and Ang-2 activation. Methods: Wild type C57BL/6 male mice underwent unilateral hind-limb ischemia and were subsequently divided in two groups and received either EPO or normal saline intramuscularly (im). At day 28 they were sacrificed and quantitative real time RT-PCR was performed to the muscle tissues from both limbs to analyze the differential gene expression of vascular endothelial growth factor (VEGF), Tie-2, Ang-1 and Ang-2. Mice underwent Laser Doppler perfusion imaging after surgery on days 1, 7 and 28 for the estimation of the bilateral hind-limb perfusion. Muscle tissue sections were stained with rat anti-CD31 antibody. Capillaries and arterioles in the ischemic areas were counted with confocal microscopy at day 28. Results: Ischemic/non-ischemic ratio was significantly increased in ischemic limbs of EPO-treated mice versus control mice at 7 days (p<0.014 vs control for EPO), which was maintained at 28 days (p<0.05 vs control). Capillary density was increased in the EPO-treated group compared to control (1.92±0.95 vs 0.71±0.59 cap/cm2 p<0.05). The expression of Ang-2, Tie-2 and VEGF in the ischemic limbs of the Epo-treated group was significantly increased compared to the control group (p<0.05 vs control). In contrast, the Ang-1 expression didn't significantly differ between the two groups. Conclusion: Erythropoietin treatment improves perfusion in both limbs, promotes vasculogenesis and increases neoangiogenesis by upregulation of the Ang-2/Tie-2 pathway and down regulation of Ang-1. These finding suggests that erythropoietin may play a critical role in neoangiogenesis by interfering with the local expression of angiogenic factor.
Journal of the American College of Cardiology, 2011
Background: Sildenafil has vasodilating, endothelial protective and angiogenic effects. Therefore... more Background: Sildenafil has vasodilating, endothelial protective and angiogenic effects. Therefore, we examined whether sildenafil improves tissue perfusion, neovascularization and downregulates proinflammatory molecules' levels following limb ischemia in the atherosclerotic milieu. Methods: ApoE-/-mice, (diet for 6 weeks), underwent experimentally unilateral hind-limb ischemia. Mice were divided in three groups and received sildenafil or normal saline. Mice underwent laser Doppler perfusion imaging after surgery on days 0, 7 and 28. Blood flow was assessed by the ratio of the Laser Doppler signal density. Capillaries and arterioles (ischemic areas) were counted under confocal microscopy. sICAM-1, sE-Selectin and PAI-1 levels were evaluated at days 0, 28 with enzyme-linked immunosorbent assay (ELISA). Results: Sildenafil increased significantly perfusion in the ischemic limb compared to controls (Fig). Ischemia exerted no significant effects on sICAM (from 1.91±0.15 to 0.140±0.19 ng/ml, p=NS), sE-Selectin (from 4.23±0.877 to 2.69±1.00 ng/ml, p=NS) and PAI-1 levels (from 0.219±0.055 to 0.126±0.054 ng/ml, p=NS). Sildenafil significantly decreased sICAM-1 (from 2.1±0.15 to 1.2±0.12 ng/ml, p<0.01), s-selectin (from 5.34±0.4 to 2.45±0.51 ng/ml, p<0.01) and PAI-1 (from 0.13±0.02 to 0.07±0.012 ng/ml) levels. Conclusion: Sildenafil exerts significant beneficial effects on tissue perfusion and neovascularisation after limb ischemia and downregulates adhesion molecules.
QJM : monthly journal of the Association of Physicians, 2011
Regular physical activity (PA) has shown substantial cardiac benefits. We sought to investigate w... more Regular physical activity (PA) has shown substantial cardiac benefits. We sought to investigate whether habitual PA is associated with changes of the electrical action potential duration, as it is represented by the QT duration on a rest ECG, in a population based sample of middle-aged and elderly individuals of Ikaria island.
Current Medicinal Chemistry
: Atherosclerotic cardiovascular diseases remain the leading cause of morbidity and mortality wor... more : Atherosclerotic cardiovascular diseases remain the leading cause of morbidity and mortality worldwide despite all efforts made towards their management. Other than targeting the traditional risk factors for their development, scientific interest has been shifted towards epigenetic regulation, with microRNAs (miRs) being at the forefront. MiR-126, in particular, has been extensively studied in the context of cardiovascular diseases. Downregulated expression of this miR has been associated with highly prevalent cardiovascular risk factors such as arterial hypertension and diabetes mellitus. At the same time, its diagnostic and prognostic capability concerning coronary artery disease is still under investigation, with up-to-date data pointing towards a dysregulated expression in a stable disease state and acute myocardial infarction. Moreover, a lower expression of miR-126 may indicate a higher disease complexity, as well as an increased risk for future major adverse cardiac and cerebrovascular events. Ultimately, overexpression of miR-126 may emerge as a novel therapeutic target in atherosclerotic cardiovascular diseases due to its potential in promoting therapeutic angiogenesis and anti-inflammatory effects. However, the existing challenges in miR therapeutics need to be resolved before translation to clinical practice.
Hellenic Journal of Cardiology, 2021
This is a PDF file of an article that has undergone enhancements after acceptance, such as the ad... more This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
European Heart Journal, 2017
Prevention-Epidemiology / Diabetes 927 (post AMI) in 2 cases. Nonischaemic LGE pattern was found ... more Prevention-Epidemiology / Diabetes 927 (post AMI) in 2 cases. Nonischaemic LGE pattern was found in 15 cases (37.5%): patchy subepi-midmyocardial LGE suggesting previous myocarditis in 8 athletes, and with aspecific pattern in 7 athletes. Athletes with nonischaemic LGE had normal laboratory parameters without wall motion abnormalities, in their cases systemic diseases were ruled out. One athlete was diagnosed with Fabry-disease (2.5%), one with coronary artery abnormality (anomalous origin of the left main coronary artery from the right sinus of Valsalva) (2.5%). Regarding the 10 aborted SCD cases, CMR findings were the following: ARVC (n=3), aspecific LGE pattern (n=2), and no structural myocardium abnormality (n=5). In the last group two athletes were diagnosed with long QT-syndrome, one with Wolff-Parkinson-Whitesyndrome and one with Brugada-syndrome. In our national CMR registry the most common structural alteration was nonischaemic fibrosis, the most common cardiomyopathy was HCM, and the leading cause of SCD in Hungarian competitive athletes was ARVC. The national registers are highly important for a better understanding the etiology and the geographical differences of SCD in athletes.
The American Journal of Cardiology, 2003
European Heart Journal, 2021
Introduction Cardiovascular complications of Coronavirus disease (COVID-19), resulting from the S... more Introduction Cardiovascular complications of Coronavirus disease (COVID-19), resulting from the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), have been documented. Endothelium-induced “cytokine storm” in critically ill COVID-19 patients is one of the leading causes of morbidity and mortality. Vascular endothelial damage caused by COVID-19 emphasizes the crucial role of endothelium in COVID-19 clinical impact. Purpose To examine the mid-term (1-month) impact of COVID-19 in endothelial function. Methods In this case control study, 20 consecutive patients who were hospitalized for COVID-19 either on Intensive Care Unit (ICU) or non-ICU were examined one month following hospital discharge. In the control group we recruited 12 consecutive subjects from the outpatient cardiology clinic. Demographic and clinical data were collected, and endothelial function was evaluated by brachial artery flow-mediated dilation (FMD). Results There was no difference in age between COVID-19...
Nutrients, 2021
The aim of this study was to evaluate several sociodemographic, lifestyle, and clinical character... more The aim of this study was to evaluate several sociodemographic, lifestyle, and clinical characteristics of the IKARIA study participants and to find healthy aging trajectories of multimorbidity of Ikarian islanders. During 2009, 1410 people (aged 30+) from Ikaria Island, Greece, were voluntarily enrolled in the IKARIA study. Multimorbidity was defined as the combination of at least two of the following chronic diseases: hypertension; hypercholesterolemia; diabetes; obesity; cancer; CVD; osteoporosis; thyroid, renal, and chronic obstructive pulmonary disease. A healthy aging index (HAI) ranging from 0 to 100 was constructed using 4 attributes, i.e., depression symptomatology, cognitive function, mobility, and socializing. The prevalence of multimorbidity was 51% among men and 65.5% among women, while the average number of comorbidities was 1.7 ± 1.4 for men and 2.2 ± 1.4 for women. The most prevalent chronic diseases among men with multimorbidity were hypertension, hypercholesterolem...
European Heart Journal, 2020
Introduction Both anthracyclines and trastuzumab are key regiments for the treatment of breast ca... more Introduction Both anthracyclines and trastuzumab are key regiments for the treatment of breast cancer, but their concurrent use is contraindicated because of their cardiotoxicity. Their effects on vascular function have been less well studied. Purpose We explored the effects of the anthracycline-based chemotherapy followed by trastuzumab-based treatment on endothelial function and arterial stiffness in patients with breast cancer. Methods 46 female patients (54.56±11.5 years old) with breast cancer scheduled for anthracycline-based chemotherapy followed by the combination of trastuzumab and taxane were enrolled. Trastuzumab was continued until the completion of one-year treatment. All participants underwent assessment of the brachial flow mediated dilatation (FMD), endothelial independent dilatation (EID), carotid-femoral pulse wave velocity (PWV) and augmentation index (AIx) at baseline (BL), at the end of anthracycline treatment (FU1), 3 months following initiation of trastuzumab ...
European Heart Journal, Aug 1, 2017
tality were significantly higher in patients with reduced EF than those without (all p<0.01). In-... more tality were significantly higher in patients with reduced EF than those without (all p<0.01). In-hospit and 1-year outcomes in Study 1 n (%) Reduced EF (n=613) Non-reduced EF (n=8534) P value In hospital mortality 38 (6.2) 68 (0.8) <0.001 Heart failure post PCI 40 (6.5) 125 (1.5) <0.001 Acute kidney injury 107 (20.9) 880 (12.0) <0.001 Bleeding complications 36 (5.9) 241 (2.8) <0.001 1 year mortality 21 (8.5) 71 (2.0) <0.001 Conclusions: STEMI and silent ischemia were both frequent indications for PCI in patients with LV dysfunction. LV dysfunction was at greater risk for in-hospital complication and 1-year prognosis after PCI.
Journal of the American College of Cardiology, 2020
Background: Sleep is an essential physiological process and disturbance of sleep duration may be ... more Background: Sleep is an essential physiological process and disturbance of sleep duration may be associated with atherosclerosis. Methods: The Corinthia study is a cross sectional epidemiological study based on 2043 inhabitants of Corinthia region in Greece. Ultrasonography was used to measure intima media thickness (IMT) and the mean IMT (mIMT) was considered a representative of carotid atherosclerosis burden. Thickness of IMT>1.5 mm or protrusion >50% compared to adjacent segments was defined as atherosclerotic plaque. Total sleeping time per day was recorded via surveys. Sleep duration was categorized as normal (NSD, 6-8h), long (LSD, >8h) and short (SSD, <6h). Results: Subjects with NSD had less prevalence of diabetes mellitus (p=0.001) but there was no difference in other cardiovascular risk factors. Interestingly, mIMT (SSD: 1.07±0.5 mm vs. NSD: 0.98±0.43 mm vs. LSD: 1.07±0.53 mm, p=0.001) and carotid atherosclerotic plaque (SSD: 30% vs. NSD: 23% vs. LSD: 29%, p=0.016) were decreased in NSD subjects (Figure). After adjustment for known confounders, regression analysis revealed that subjects with SSD and LSD have 54% and 39% increased odds respectively of carotid atheromatic plaque than those with NSD (Figure). Conclusion: A balanced sleeping duration of 6-8h daily can act as an additive cardioprotective factor in the modern western type societies. Short and long sleep duration may act as a cardiovascular risk factor.
European Cardiology Review, 2019
Diabetes is a complex metabolic disorder affecting the glucose status of the human body. Chronic ... more Diabetes is a complex metabolic disorder affecting the glucose status of the human body. Chronic hyperglycaemia related to diabetes is associated with end organ failure. The clinical relationship between diabetes and atherosclerotic cardiovascular disease is well established. This makes therapeutic approaches that simultaneously target diabetes and atherosclerotic disease an attractive area for research. The majority of people with diabetes fall into two broad pathogenetic categories, type 1 or type 2 diabetes. The role of obesity, adipose tissue, gut microbiota and pancreatic beta cell function in diabetes are under intensive scrutiny with several clinical trials to have been completed while more are in development. The emerging role of inflammation in both type 1 and type 2 diabetes (T1D and T1D) pathophysiology and associated metabolic disorders, has generated increasing interest in targeting inflammation to improve prevention and control of the disease. After an extensive review...
Atherosclerosis, 2019
Background and aims: Sedentary lifestyle, unlike leisure time physical activity (PA), is associat... more Background and aims: Sedentary lifestyle, unlike leisure time physical activity (PA), is associated with atherosclerosis progression. Regarding the interrelationship between television watching, as a sedentary behavior pattern, and cardiovascular disease burden, few data exist. Methods: In this cross-sectional epidemiological study based on 2,043 inhabitants of the Corinthia region, in Greece, ultrasonography was used to measure carotid intimamedia thickness (IMT) in both carotid arteries. The average (meanIMT) and maximum thickness (maxIMT) were determined as representative values of subclinical atherosclerosis. We evaluated PA using the self-reported International Physical Activity Questionnaire (IPAQ). Based on specific questions, the average hours per week spent on watching television (TV), videos or DVD were calculated for each participant. Results: According to TV viewing time, subjects were categorized into the low (≤7 hours/week), moderate (7˃ TV hours/week ≤21) and high (˃21 hours/week) TV viewing time groups. Prevalence of carotid atheromatic plaque was lower in the low TV viewing time group compared to the moderate and high TV viewing time groups (p=0.02). TV viewing time was associated with increased carotid IMT (p=0.03) and the prevalence of carotid atheromatic plaque (p=0.02), even after adjustment for age, body mass index, cardiovascular risk factors or history of cardiovascular disease. Subjects in the high TV viewing time group have 80% increase odds of carotid atheromatic plaque compared to patients categorized in the low TV viewing time group (p=0.01).
QJM : monthly journal of the Association of Physicians, Jan 3, 2017
Aging is characterized by an insidious decline in cognitive function. Several genetic and lifesty... more Aging is characterized by an insidious decline in cognitive function. Several genetic and lifestyle factors have been implicated in the increased risk or early onset of dementia We sought to assess the role of tumor necrosis factor (TNF) and angiotensin-converting enzyme (ACE) polymorphisms on the development of impaired mental health in respect to indices ïf arterial aging in nonagenarian individuals. 178 consecutive subjects above 75 years that permanently inhabit in the island of Ikaria, Greece were recruited. Aortic distensibility (AoD) was calculated and genetic evaluation was performed on the ACE Ins/Del gene polymorphism (intron 16) and the G/A transition (position -308) of the TNF gene. Cognitive function was evaluated using the Mini-mental State Examination (MMSE). The DD genotype for ACE was independently associated (b=-0.44, p = 0.007) with AD while AoD remained an independent determinant of mental status (OR = 1.82, p = 0.036). Interestingly though, when a combined genet...
Current vascular pharmacology, Jan 26, 2017
Sildenafil, a phosphodiesterase type 5 (PDE5) inhibitor, has endothelium protective and angiogeni... more Sildenafil, a phosphodiesterase type 5 (PDE5) inhibitor, has endothelium protective and angiogenic effects. To test if sildenafil improves tissue perfusion and neovascularization and downregulates pro-inflammatory molecules following limb ischemia. 30 ApoE-/- male mice, bred with cholesterol rich diet for 4 weeks, were anesthetized and underwent unilateral hind-limb ischemia with ligation of the left femoral artery. Mice were randomized in 2 groups: sildenafil (1 mg/Kg for 7 days intraperitoneally, i.p.) or normal saline (0.4 ml for 7 days, i.p.). Bilateral hind-limb perfusion was estimated by laser Doppler imaging after surgery on days 0, 7 and 28. Sildenafil significantly reduced at day 28 compared with day 0 levels of soluble intracellular adhesion molecule-1(sICAM-1) [2.24(1.81-2.41) vs 1.29(0.87-1.45) ng/ml, p=0,01], soluble E-selectin (sE-Selectin) [5.52 (3.67-6.14) vs 1.71 (1.42-2.86) ng/ml, p=0.02] and tissue plasminogen activator inhibitor-1 (tΡΑΙ-1) [0.13(0.07-0.21) vs 0.0...
Hellenic Journal of Cardiology, 2016
Environmental factors constitute an important but underappreciated risk factor towards the develo... more Environmental factors constitute an important but underappreciated risk factor towards the development and progression of cardiovascular disease (CVD). Environmental exposure to variable pollutants is implicated in the derangement or propagation of adverse pathophysiological processes linked with atherosclerosis, including genetic, hemodynamic, metabolic, oxidative and inflammation parameters. However, no data exist on environmental pollution in rural or semi-rural areas. Therefore, the purpose of the "Corinthia" study is to examine the impact of environmental pollution in indices of cardiovascular morbidity and mortality in a cross-sectional and longitudinal design. The Corinthia study began in October 2015 and is planned to recruit 1,500 individuals from different regions of Corinthia country with different environmental exposures to pollutants and different patterns of soil/ground and/ or air pollution until December 2016. Baseline measurements will include lifestyle measurements, anthropometric characteristics and a comprehensive cardiovascular examination. The follow-up is planned to extend prospectively up to 10 years and this study is anticipated to provide valuable data on the distinct impact of soil and air pollution on early markers of
Journal of the American College of Cardiology, 2013
Background: Bone marrow derived progenitor cells have been suggested to promote postnatal neovasc... more Background: Bone marrow derived progenitor cells have been suggested to promote postnatal neovascularization. In this study we investigated whether direct intramuscular infusion of enriched hematopoietic cells, improved limb perfusion in a murine model of hind limb ischemia. methods: Wild type C57BL/6 male mice underwent unilateral hind-limb ischemia, were divided in three groups (n=12/group) and received a single intramuscular injection of 1x106 Lin-/sca+ cells, or granulocyte colony-stimulating factor (G-CSF) for 7 days or normal saline. Each group mice underwent Laser Doppler perfusion Imaging on days 1, 7 and 28 after surgery for the estimation of the bilateral hind-limb perfusion. At day 28 they were sacrificed and quantitative real time RT-PCR was performed to the muscle tissues from both limbs to analyze the differential gene expression of vascular endothelial growth factor (VEGF), Tie-2, Ang-1 and Ang-2. Muscle tissue sections were stained with rat anti-CD31antibody. Capillaries and arterioles in the ischemic areas were counted with confocal microscopy at day 28. results: Ischemic/non ischemic ratio was significantly increased in ischemic limbs of cell-and G-CSF-treated mice versus control mice at 7 days (p<0.05 vs control), which was maintained at 28 days (p<0.05 vs control) only in the cell-treated group. There was no significant increase of ischemic/nonischemic ratio in the cell-treated mice compared with G-CSF at day 7 or day 28 (p=NS). Capillary density was increased in the cell-treated group compared to G-CSF-treated group and control (p<0.05). No difference in the capillary density between the G-CSF-treated and the control group was observed. Compared to the G-CSF and control group, the expression of VEGF (p<0.05), Ang-2 (p<0.05) and sTie-2 (p<0.05) were significantly increased in the ischemic limbs of the Epo-treated group. In contrast, the Ang-1 expression didn't significantly differ between the three groups. conclusion: Direct intramuscular infusion of lin-/sca+ significantly improves blood flow and increases neoangiogenesis by upregulation of the Ang-2/Tie-2 pathway when compared with G-CSF and control treatment in ischemic limbs.
Journal of the American College of Cardiology, 2011
Background: Regular physical activity (PA) has substantial cardiac benefits. QT interval represen... more Background: Regular physical activity (PA) has substantial cardiac benefits. QT interval represents the duration of ventricular repolarization and its prolongation is associated with greater mortality risk. Aim of the study was to evaluate the impact of PA on QT duration in a sample of middle aged and elderly individuals of Ikaria island, a place worldwide recognized as having high rates of longevity and low cardiovascular mortality rates. Methods: We enrolled 1071 inhabitants of Ikaria Island (65±13 yrs, 47% males); Among several demographic and clinical characteristics PA was estimated with IPAQ (low, with expended calories < 4 Kcal/min, moderate with expended calories 4-7 Kcal/min and vigorous with expended calories >7 Kcal/min). QT duration was measured from a 12-lead surface digital recorded electrocardiogram and heart rate-corrected QT (QTc) was calculated using Bazett's formula. Results: Among participants, 85% reported at least moderate PA levels. Women in the "vigorous" and "moderate" PA level compared to those in the "low" PA level had significantly shorter QTc (408±2 msec vs. 419±2 msec, p=0.002, 411±1 msec vs. 419±2 msec, p=0.002, respectively). In contrast men in the "vigorous" and "moderate" PA level compared to those in the "low" PA level had no significantly shorter QTc (395±2 msec vs. 402±3 msec, p=0.29, 402±2msec vs. 402±3, p=0.99). Furthermore, linear regression analysis revealed that PA level was significantly associated with shorter QTc in women (b=-12.5, p=0.001) even after adjustment for age, BMI, adherence to the Mediterranean diet, smoking status and the presence of cardiovascular disease, hypertension, diabetes melitus and hypercholesterolemia, while no such association was evident in men. Moreover compared to women in the "low" PA level, women in the "moderate" and "vigorous" PA level had decreased odds of having QTc interval > 450 msec by 70% (OR: 0.29 [0.12, 0.72]) and 80% (OR: 0.18 [0.04, 0.85]) respectively. Conclusion: Increased PA is associated with shorter QTc interval only in middle aged and elderly women of Ikaria Island irrespectively of habituals or medical conditions, illustrating gender differences in the cardioprotective effect of habitual exercise.
Journal of the American College of Cardiology, 2011
Background: Erythropoietin (EPO) has been shown to enhance angiogenesis, but its precise mechanis... more Background: Erythropoietin (EPO) has been shown to enhance angiogenesis, but its precise mechanisms of enhancement during ischemia are not fully elucidated. The angiopoietin (Ang)/Tie system has been reported to be critically involved in disease progression through the activation of signaling pathways that control angiogenic remodeling and Ang-1 and Ang-2 activation. Methods: Wild type C57BL/6 male mice underwent unilateral hind-limb ischemia and were subsequently divided in two groups and received either EPO or normal saline intramuscularly (im). At day 28 they were sacrificed and quantitative real time RT-PCR was performed to the muscle tissues from both limbs to analyze the differential gene expression of vascular endothelial growth factor (VEGF), Tie-2, Ang-1 and Ang-2. Mice underwent Laser Doppler perfusion imaging after surgery on days 1, 7 and 28 for the estimation of the bilateral hind-limb perfusion. Muscle tissue sections were stained with rat anti-CD31 antibody. Capillaries and arterioles in the ischemic areas were counted with confocal microscopy at day 28. Results: Ischemic/non-ischemic ratio was significantly increased in ischemic limbs of EPO-treated mice versus control mice at 7 days (p<0.014 vs control for EPO), which was maintained at 28 days (p<0.05 vs control). Capillary density was increased in the EPO-treated group compared to control (1.92±0.95 vs 0.71±0.59 cap/cm2 p<0.05). The expression of Ang-2, Tie-2 and VEGF in the ischemic limbs of the Epo-treated group was significantly increased compared to the control group (p<0.05 vs control). In contrast, the Ang-1 expression didn't significantly differ between the two groups. Conclusion: Erythropoietin treatment improves perfusion in both limbs, promotes vasculogenesis and increases neoangiogenesis by upregulation of the Ang-2/Tie-2 pathway and down regulation of Ang-1. These finding suggests that erythropoietin may play a critical role in neoangiogenesis by interfering with the local expression of angiogenic factor.
Journal of the American College of Cardiology, 2011
Background: Sildenafil has vasodilating, endothelial protective and angiogenic effects. Therefore... more Background: Sildenafil has vasodilating, endothelial protective and angiogenic effects. Therefore, we examined whether sildenafil improves tissue perfusion, neovascularization and downregulates proinflammatory molecules' levels following limb ischemia in the atherosclerotic milieu. Methods: ApoE-/-mice, (diet for 6 weeks), underwent experimentally unilateral hind-limb ischemia. Mice were divided in three groups and received sildenafil or normal saline. Mice underwent laser Doppler perfusion imaging after surgery on days 0, 7 and 28. Blood flow was assessed by the ratio of the Laser Doppler signal density. Capillaries and arterioles (ischemic areas) were counted under confocal microscopy. sICAM-1, sE-Selectin and PAI-1 levels were evaluated at days 0, 28 with enzyme-linked immunosorbent assay (ELISA). Results: Sildenafil increased significantly perfusion in the ischemic limb compared to controls (Fig). Ischemia exerted no significant effects on sICAM (from 1.91±0.15 to 0.140±0.19 ng/ml, p=NS), sE-Selectin (from 4.23±0.877 to 2.69±1.00 ng/ml, p=NS) and PAI-1 levels (from 0.219±0.055 to 0.126±0.054 ng/ml, p=NS). Sildenafil significantly decreased sICAM-1 (from 2.1±0.15 to 1.2±0.12 ng/ml, p<0.01), s-selectin (from 5.34±0.4 to 2.45±0.51 ng/ml, p<0.01) and PAI-1 (from 0.13±0.02 to 0.07±0.012 ng/ml) levels. Conclusion: Sildenafil exerts significant beneficial effects on tissue perfusion and neovascularisation after limb ischemia and downregulates adhesion molecules.