Nikolaos Alexopoulos - Academia.edu (original) (raw)

Papers by Nikolaos Alexopoulos

Research paper thumbnail of There is a Parallel Escalation Between Retinal Vascular Alterations and Arterial Stiffness in Essential Hypertension

Journal of Hypertension, Jun 1, 2011

Research paper thumbnail of Hypertension Later in Life

to 112+/4 mmHg (p<0.0001) while MSNA decreased to 28+/-5% of baseline values (p<0.0001) and... more to 112+/4 mmHg (p<0.0001) while MSNA decreased to 28+/-5% of baseline values (p<0.0001) and HR decreased from 71+/-3 to 61+/-3 bpm (p<0.0001). The largest increases in BP were accompanied by the most marked decreases in MSNA (r=-0.79, p=0.003) and HR (r=-0.49; p=0.01) during the first 5 seconds of the AVF occlusion. During AVF occlusion baseline CO of 6.9+/-0.3 decreased to 5.6+/-0.3 l/min (p<0.0001) while baroreflex sensitivity increased from 10+/-1 to 17+/-2 ms/mmHg (p<0.001). Conclusions: Arterial baroreceptor activation and increased arterial baroreflex sensitivity decrease heart rate during AVF occlusion. In addition our study is the first to demonstrate that arterial baroreflex activation decreases sympathetic nerve traffic during the Nicoladoni-Branham sign.

Research paper thumbnail of Coronary Aging in HIV‐Infected Patients

Clinical Infectious Diseases, Dec 1, 2009

Background. Human immunodeficiency virus (HIV)-infected patients often demonstrate accelerated ag... more Background. Human immunodeficiency virus (HIV)-infected patients often demonstrate accelerated aging processes. We investigated whether the vascular age of a cohort of stable HIV-infected patients receiving antiretroviral therapy (ART) was increased and sought out predictors of increased vascular age. Methods. In this cross-sectional study, 400 HIV-infected patients (mean age, 48 years) attending a cardiometabolic clinic underwent cardiac computed tomography imaging to identify coronary artery calcium (CAC). Vascular age was estimated on the basis of the extent of CAC by means of previously published equations. Results. Increased vascular age was observed in 162 patients (40.5%), with an average increase of 15 years (range, 1-43 years) over the chronological age. In univariable analyses, chronological age, male sex, systolic blood pressure, duration of ART, fasting glucose level, fasting serum triglyceride level, total cholesterol level, low-density and high-density lipoprotein cholesterol levels, hypertension, and the presence of the metabolic syndrome were associated with increased vascular age. In multivariable linear regression analyses, current CD4 + cell count was the only predictor of increased vascular age (;). b p 0.51 P p .005 Conclusions. Increased vascular age is frequent among HIV-infected patients and appears to be associated with CD4 + cell count. If these findings were to be confirmed in prospective trials, a positive response to ART with an increase in CD4 + cell count may become a marker of increased risk of atherosclerosis development.

Research paper thumbnail of Usefulness of Dobutamine Stress Echocardiography with Tissue Doppler Imaging for the Evaluation and Follow-Up of Patients with Repaired Tetralogy of Fallot

Journal of The American Society of Echocardiography, Oct 1, 2008

The longstanding pulmonary regurgitation in patients with repaired tetralogy of Fallot (RTOF) res... more The longstanding pulmonary regurgitation in patients with repaired tetralogy of Fallot (RTOF) results in right ventricular (RV) failure. The estimation of RV function and reserve in these patients is of great importance, especially for the determination of the proper timing of pulmonary valve replacement. Tissue Doppler imaging (TDI) of the tricuspid annulus has been proved a valuable tool in the evaluation of these patients. Dobutamine stress echocardiography (DSE) in low doses detects the contractility reserve of cardiac myocytes. The aim of our study was to estimate RV reserve in patients with RTOF with the use of DSE and TDI and to examine whether this is related to baseline TDI indices of the tricuspid annulus. We studied 21 patients with RTOF and 21 age- and gender-matched controls with TDI Doppler at the tricuspid annulus during DSE. TDI measurements were made at baseline and at infusion rates of 10 and 20 microg x kg x min. Patients with RTOF had lower values of TDI indices at baseline and during dobutamine infusion and smaller dobutamine-induced increase of Sa (DeltaSa) (3.8 +/- 1.2 vs. 10.8 +/- 3.6 cm/sec, 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;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;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;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 Aa (3.5 +/- 2.2 vs. 10.0 +/- 3.2 cm/sec, 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;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;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;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). A value of DeltaSa &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;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;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;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; or = 6 cm/sec clearly discriminated patients from controls and could be predicted by values of Sa &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;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;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;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; 11.5 cm/sec with sensitivity of 95% and specificity of 100%. In patients with RTOF, impaired RV contractile reserve can be documented with TDI of tricuspid annular motion during DSE and is predicted by TDI indices at rest. Its serial estimation may contribute to optimal timing of reoperation.

Research paper thumbnail of Prognostic value of adenosine stress cardiovascular magnetic resonance in patients with low-risk chest pain

Journal of Cardiovascular Magnetic Resonance, Sep 21, 2009

Background: Approximately 5% of patients with an acute coronary syndrome are discharged from the ... more Background: Approximately 5% of patients with an acute coronary syndrome are discharged from the emergency room with an erroneous diagnosis of non-cardiac chest pain. Highly accurate non-invasive stress imaging is valuable for assessment of low-risk chest pain patients to prevent these errors. Adenosine stress cardiovascular magnetic resonance (AS-CMR) is an imaging modality with increasing application. The goal of this study was to evaluate the negative prognostic value of AS-CMR among low-risk acute chest pain patients. Methods: We studied 103 patients, mean 56.7 ± 12.3 years of age, with chest pain and no electrocardiographic evidence of ischemia and negative cardiac biomarkers of necrosis, who were admitted to the Cardiac Decision Unit of our institution. All patients underwent AS-CMR. A negative AS-CMR was defined as absence of all the following: regional wall motion abnormalities at rest; perfusion defects during stress (adenosine) and rest; and myocardial scar on late gadolinium enhancement images. The patients were followed for a mean of 277 (range 161-462) days. The primary end point was defined as the combination of cardiac death, nonfatal acute myocardial infarction, re-hospitalization for chest pain, obstructive coronary artery disease (>50% coronary stenosis on invasive angiography) and coronary revascularization. Results: In 14 patients (13.6%), AS-CMR was positive. The remaining 89 patients (86.4%), who had negative AS-CMR, were discharged. No patient with negative AS-CMR reached the primary endpoint during follow-up. The negative predictive value of AS-CMR was 100%. Conclusion: AS-CMR holds promise as a useful tool to rule out significant coronary artery disease in patients with low-risk chest pain. Patients with negative AS-CMR have an excellent short and mid-term prognosis.

Research paper thumbnail of P.042 Not Only Diabetes Mellitus, but Also Impaired Glucose Tolerance is Associated with Erectile Dysfunction in Hypertensive Patients

Research paper thumbnail of Ambulatory Blood Pressure Monitoring Affects Sleep Quality and Blood Pressure

Journal of Hypertension, Jun 1, 2011

Background: Home Blood Pressure (HBP) was shown to be useful for antihypertensive treatment adjus... more Background: Home Blood Pressure (HBP) was shown to be useful for antihypertensive treatment adjustment. Guidelines suggest a target HBP below 135/85mmHg, corresponding to a target office BP (OBP) below 140/90mmHg. There is a "grey zone" corresponding to OBP controlled patients but with a systolic HBP between 131-140mmHg, for which the decision to change treatment is not resolved. Objectives: Principal: To assess the proportion of OBP controlled patients with a systolic HBP in the "grey zone" of 131-140mmHg. Secondary: Compare the decision to change treatment based on OBP, HBPM or ambulatory blood pressure measurement (ABPM). Methods: In 3 general practices, hypertensive patients with controlled OBP (< 140/90 mmHg) were assessed simultaneously with HBP measurements (ESH guidelines) and 24h ambulatory BP Measurements (ABPM). The decision to change treatment was compared as to whether it was based on OBP, HBP or ABPM. Results: In 52 patients with controlled OBP (< 140/90mmHg) 12 were found to have systolic HBP within the "grey zone" (131-140mmHg). Based on HBP, 14/52 required a treatment escalation (systolic HBP ≥ 135mmHg). However, among these patients and comparatively to daytime ABPM, HBP was found retrospectively to overestimate SBP control in 5 and underestimate SBP in 3. The correlation between systolic ABP and HBP was 85% (p < 0.0001). Conclusions: Agreement between different BP measurements methods is not fully established. A significant number of patients controlled on OBP fall into a "grey zone' using HBP. Target HBP are not defined and all hypertension trials are based on target OBP. Large-scale randomized studies demonstrating the prognostic value of HBP specifically in treated patients are needed.

Research paper thumbnail of P4.02 Lipids and Apolipoproteins Are Associated with Pulse Wave Velocity in Never-Treated Hypertensives

Research paper thumbnail of 6.5 Hemoglobin A1C is Associated with Pulse Wave Velocity in Never-Treated Hypertensives: The Impact of the American Diabetes Association 2010 Position Statement Definitions

Research paper thumbnail of Vascular age as a marker of premature biological ageing in HIV-infected patients

Vascular age as a marker of premature biological ageing in HIV-infected patient

Research paper thumbnail of Antiretroviral Therapy and Lipodystrophy as Predictors of Sub-Clinical Atherosclerosis

Although anti-retroviral therapy (ART) has prolonged survival in human immunodeficiency virus (HI... more Although anti-retroviral therapy (ART) has prolonged survival in human immunodeficiency virus (HIV)-infected persons, an increase in cardiovascular disease (CVD) has been observed. A frequent complication of ART is the development of lipodystrophy (LD) that may be associated with CVD. We assessed the contribution of chronic HIV infection, ART use and LD to the presence and extent of sub-clinical atherosclerosis as evaluated by coronary artery calcium (CAC) imaging

Research paper thumbnail of Pp.10.04: Determinants of Aortic Stiffness in a Long-Living Population

Objective: Ikaria, the Greek island of the East Aegean, is among the five places in the world wit... more Objective: Ikaria, the Greek island of the East Aegean, is among the five places in the world with the highest rates of octagenarians. Aortic stiffness, assessed by aortic pulse wave velocity (PWV), is an independent prognostic factor of cardiovascular and all-cause mortality. However, data on the assessment of aortic stiffness in long-living populations are lacking. The aim of the present study was to evaluate aortic stiffness in the inhabitants of Ikaria island, across a broad spectrum of age. Design and method: We studied a sample of the Ikaria island's inhabitants (N = 153). We divided the population into 4 age groups, each per decade: 1. 40–49 years old (N = 30), 2. 50–59 years old (N = 40), 3. 60–69 years old (N = 35) and 4. over 70 years of age (N = 48). Aortic stiffness was assessed by the measurement of carotid-femoral PWV using the Complior device. Laboratory evaluation was performed in all participants. Results: Systolic blood pressure (SBP) showed a gradual increase proportional to the advanced age group (from 131.1 ± 11.5 to 136.5 ± 15.1 to 143.6 ± 16.4 to 152.4 ± 21.7 mmHg, p < 0.01). On the contrary, no difference was observed in the levels of diastolic BP among groups (from 81.7 ± 6.4 to 83.5 ± 10.1 to 80.8 ± 7.3 to 81.6 ± 11.1 mmHg, p = NS). Pulse wave velocity increased gradually across the 4 groups of age (from 7.96 ± 0.95 to 8.76 ± 1.25 to 9.89 ± 1.19 to 12.05 ± 2.62 m/s, respectively, p < 0.001). In linear regression analysis, PWV was independently related to age group (b = 0.62, p < 0.001), heart rate (b = 0.24, p < 0.001), mean BP (b = 0.20, p < 0.01), creatinine (b = 0.15, p = 0.02) and, inversely, to BMI (b = -0.13, p = 0.03) Conclusions: Age is a powerful determinant of aortic stiffness in the population of Ikaria island. Moreover, haemodynamic parameters, such as arterial pressure and heart rate, as well as kidney function are independently associated with aortic stiffness. Interestingly, obesity is inversely related to PWV, a finding suggesting a possible ‘obesity paradox’ effect. Future studies in other long-living populations need to confirm the present findings and shed light into the relationship of arterial stiffness with longevity.

Research paper thumbnail of Coronary Ageing in Hiv Infected Patients

The objectives of this study were to assess the coronaryage (CA) of a cohort of HIV infected pati... more The objectives of this study were to assess the coronaryage (CA) of a cohort of HIV infected patients based on the extent of coronary artery calcium (CAC) and to iden-tify the variables associated with it

Research paper thumbnail of Secondary prevention of sudden cardiac death in a 65year untreated ALCAPA patient

International Journal of Cardiology, Sep 1, 2014

Research paper thumbnail of Effect of Dark Chocolate on Arterial Function in Healthy Individuals

American Journal of Hypertension, Jun 1, 2005

Background: Epidemiologic studies suggest that high flavonoid intake confers a benefit on cardiov... more Background: Epidemiologic studies suggest that high flavonoid intake confers a benefit on cardiovascular outcome. Endothelial function, arterial stiffness, and wave reflections are important determinants of cardiovascular performance and are predictors of cardiovascular risk. Methods: The effect of flavonoid-rich dark chocolate (100 g) on endothelial function, aortic stiffness, wave reflections, and oxidant status were studied for 3 h in 17 young healthy volunteers according to a randomized, single-blind, sham procedure-controlled, cross-over protocol. Flow-mediated dilation (FMD) of the brachial artery, aortic augmentation index (AIx), and carotid-femoral pulse wave velocity (PWV) were used as measures of endothelial function, wave reflections, and aortic stiffness, respectively. Plasma oxidant status was evaluated with measurement of plasma malondialdehyde (MDA) and total antioxidant capacity (TAC). Results: Chocolate led to a significant increase in resting and hyperemic brachial artery diameter throughout the study (maximum increase by 0.15 mm and 0.18 mm, respectively, P Ͻ .001 for both). The FMD increased significantly at 60 min (absolute increase 1.43%, P Ͻ .05). The AIx was significantly decreased with chocolate throughout the study (maximum absolute decrease 7.8%, P Ͻ .001), indicating a decrease in wave reflections, whereas PWV did not change to a significant extent. Plasma MDA and TAC did not change after chocolate, indicating no alterations in plasma oxidant status. Conclusions: Our study shows for the first time that consumption of dark chocolate acutely decreases wave reflections, that it does not affect aortic stiffness, and that it may exert a beneficial effect on endothelial function in healthy adults. Chocolate consumption may exert a protective effect on the cardiovascular system; further studies are warranted to assess any long-term effects.

Research paper thumbnail of Abstract 21015: Coronary Inflammation in Humans Drives Spatial Changes of Perivascular Adipose Tissue Composition Detectable by a Novel Computed Tomography-Based Technology

Circulation, 2017

Background: Non-invasive detection of vascular inflammation remains an unmet goal. We hypothesize... more Background: Non-invasive detection of vascular inflammation remains an unmet goal. We hypothesized that phenotypic changes in perivascular adipose tissue (PVAT) induced by vascular inflammation can be quantified using a new computed tomography angiography (CTA) methodology. Methods: In Arm 1, human PVAT adipocytes were cultured +/- inflammatory cytokines (n=7) or co-cultured with vascular tissue (+/-Angiotensin-II, n=6) to assess the effects of vascular inflammation on PVAT differentiation. In Arm 2, AT explants (epicardial, subcutaneous and thoracic AT) from 453 cardiac surgery patients were used in histology and gene expression studies to relate the ex vivo images with in vivo CT scan information (n=105) on the biology of the explants. In Arm 3, in 267 patients undergoing diagnostic CTA, PVAT attenuation (Fat Attenuation Index (FAI) defined as the average CT attenuation of AT), was analysed around the proximal right coronary artery. In Arm 4, PVAT FAI around unstable (culprit) and...

Research paper thumbnail of The prognostic role of late gadolinium enhancement on cardiac magnetic resonance in patients with nonischemic cardiomyopathy and reduced ejection fraction, implanted with cardioverter defibrillators for primary prevention. A systematic review and meta-analysis

Journal of Interventional Cardiac Electrophysiology, 2021

Background Previous studies suggest that late gadolinium enhancement (LGE) on cardiac magnetic re... more Background Previous studies suggest that late gadolinium enhancement (LGE) on cardiac magnetic resonance (CMR) is associated with arrhythmic events in patients with nonischemic cardiomyopathy (NICM), while others have questioned the role of left ventricular ejection fraction (LVEF) as a sole predictor of future events. Objectives To evaluate the role of LGE on CMR in identifying patients with NICM and reduced LVEF for whom a benefit from defibrillator implantation for primary prevention is not anticipated, thus they are mainly exposed to potential risks. Methods Major electronic databases were searched for studies reporting the incidence of appropriate device therapy (ADT), sudden cardiac death (SCD), and cardiac death based on the presence of LGE on CMR, among patients with NICM and reduced LVEF, implanted with a cardioverter defibrillator for primary prevention.

Research paper thumbnail of A case of aortic arch coarctation, bicuspid aortic valve and aortic sinus aneurysm in an adult with moderate hypertension

Hellenic Journal of Cardiology, 2017

Research paper thumbnail of The Tree of Sirtuins and the Garden of Cardiovascular Youth

Current Vascular Pharmacology, 2015

Research paper thumbnail of Cigar Smoking Has a Detrimental Effect on Arterial Stiffness

Journal of Hypertension, 2004

Research paper thumbnail of There is a Parallel Escalation Between Retinal Vascular Alterations and Arterial Stiffness in Essential Hypertension

Journal of Hypertension, Jun 1, 2011

Research paper thumbnail of Hypertension Later in Life

to 112+/4 mmHg (p<0.0001) while MSNA decreased to 28+/-5% of baseline values (p<0.0001) and... more to 112+/4 mmHg (p<0.0001) while MSNA decreased to 28+/-5% of baseline values (p<0.0001) and HR decreased from 71+/-3 to 61+/-3 bpm (p<0.0001). The largest increases in BP were accompanied by the most marked decreases in MSNA (r=-0.79, p=0.003) and HR (r=-0.49; p=0.01) during the first 5 seconds of the AVF occlusion. During AVF occlusion baseline CO of 6.9+/-0.3 decreased to 5.6+/-0.3 l/min (p<0.0001) while baroreflex sensitivity increased from 10+/-1 to 17+/-2 ms/mmHg (p<0.001). Conclusions: Arterial baroreceptor activation and increased arterial baroreflex sensitivity decrease heart rate during AVF occlusion. In addition our study is the first to demonstrate that arterial baroreflex activation decreases sympathetic nerve traffic during the Nicoladoni-Branham sign.

Research paper thumbnail of Coronary Aging in HIV‐Infected Patients

Clinical Infectious Diseases, Dec 1, 2009

Background. Human immunodeficiency virus (HIV)-infected patients often demonstrate accelerated ag... more Background. Human immunodeficiency virus (HIV)-infected patients often demonstrate accelerated aging processes. We investigated whether the vascular age of a cohort of stable HIV-infected patients receiving antiretroviral therapy (ART) was increased and sought out predictors of increased vascular age. Methods. In this cross-sectional study, 400 HIV-infected patients (mean age, 48 years) attending a cardiometabolic clinic underwent cardiac computed tomography imaging to identify coronary artery calcium (CAC). Vascular age was estimated on the basis of the extent of CAC by means of previously published equations. Results. Increased vascular age was observed in 162 patients (40.5%), with an average increase of 15 years (range, 1-43 years) over the chronological age. In univariable analyses, chronological age, male sex, systolic blood pressure, duration of ART, fasting glucose level, fasting serum triglyceride level, total cholesterol level, low-density and high-density lipoprotein cholesterol levels, hypertension, and the presence of the metabolic syndrome were associated with increased vascular age. In multivariable linear regression analyses, current CD4 + cell count was the only predictor of increased vascular age (;). b p 0.51 P p .005 Conclusions. Increased vascular age is frequent among HIV-infected patients and appears to be associated with CD4 + cell count. If these findings were to be confirmed in prospective trials, a positive response to ART with an increase in CD4 + cell count may become a marker of increased risk of atherosclerosis development.

Research paper thumbnail of Usefulness of Dobutamine Stress Echocardiography with Tissue Doppler Imaging for the Evaluation and Follow-Up of Patients with Repaired Tetralogy of Fallot

Journal of The American Society of Echocardiography, Oct 1, 2008

The longstanding pulmonary regurgitation in patients with repaired tetralogy of Fallot (RTOF) res... more The longstanding pulmonary regurgitation in patients with repaired tetralogy of Fallot (RTOF) results in right ventricular (RV) failure. The estimation of RV function and reserve in these patients is of great importance, especially for the determination of the proper timing of pulmonary valve replacement. Tissue Doppler imaging (TDI) of the tricuspid annulus has been proved a valuable tool in the evaluation of these patients. Dobutamine stress echocardiography (DSE) in low doses detects the contractility reserve of cardiac myocytes. The aim of our study was to estimate RV reserve in patients with RTOF with the use of DSE and TDI and to examine whether this is related to baseline TDI indices of the tricuspid annulus. We studied 21 patients with RTOF and 21 age- and gender-matched controls with TDI Doppler at the tricuspid annulus during DSE. TDI measurements were made at baseline and at infusion rates of 10 and 20 microg x kg x min. Patients with RTOF had lower values of TDI indices at baseline and during dobutamine infusion and smaller dobutamine-induced increase of Sa (DeltaSa) (3.8 +/- 1.2 vs. 10.8 +/- 3.6 cm/sec, 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;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;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;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 Aa (3.5 +/- 2.2 vs. 10.0 +/- 3.2 cm/sec, 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;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;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;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). A value of DeltaSa &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;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;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;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; or = 6 cm/sec clearly discriminated patients from controls and could be predicted by values of Sa &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;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;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;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; 11.5 cm/sec with sensitivity of 95% and specificity of 100%. In patients with RTOF, impaired RV contractile reserve can be documented with TDI of tricuspid annular motion during DSE and is predicted by TDI indices at rest. Its serial estimation may contribute to optimal timing of reoperation.

Research paper thumbnail of Prognostic value of adenosine stress cardiovascular magnetic resonance in patients with low-risk chest pain

Journal of Cardiovascular Magnetic Resonance, Sep 21, 2009

Background: Approximately 5% of patients with an acute coronary syndrome are discharged from the ... more Background: Approximately 5% of patients with an acute coronary syndrome are discharged from the emergency room with an erroneous diagnosis of non-cardiac chest pain. Highly accurate non-invasive stress imaging is valuable for assessment of low-risk chest pain patients to prevent these errors. Adenosine stress cardiovascular magnetic resonance (AS-CMR) is an imaging modality with increasing application. The goal of this study was to evaluate the negative prognostic value of AS-CMR among low-risk acute chest pain patients. Methods: We studied 103 patients, mean 56.7 ± 12.3 years of age, with chest pain and no electrocardiographic evidence of ischemia and negative cardiac biomarkers of necrosis, who were admitted to the Cardiac Decision Unit of our institution. All patients underwent AS-CMR. A negative AS-CMR was defined as absence of all the following: regional wall motion abnormalities at rest; perfusion defects during stress (adenosine) and rest; and myocardial scar on late gadolinium enhancement images. The patients were followed for a mean of 277 (range 161-462) days. The primary end point was defined as the combination of cardiac death, nonfatal acute myocardial infarction, re-hospitalization for chest pain, obstructive coronary artery disease (>50% coronary stenosis on invasive angiography) and coronary revascularization. Results: In 14 patients (13.6%), AS-CMR was positive. The remaining 89 patients (86.4%), who had negative AS-CMR, were discharged. No patient with negative AS-CMR reached the primary endpoint during follow-up. The negative predictive value of AS-CMR was 100%. Conclusion: AS-CMR holds promise as a useful tool to rule out significant coronary artery disease in patients with low-risk chest pain. Patients with negative AS-CMR have an excellent short and mid-term prognosis.

Research paper thumbnail of P.042 Not Only Diabetes Mellitus, but Also Impaired Glucose Tolerance is Associated with Erectile Dysfunction in Hypertensive Patients

Research paper thumbnail of Ambulatory Blood Pressure Monitoring Affects Sleep Quality and Blood Pressure

Journal of Hypertension, Jun 1, 2011

Background: Home Blood Pressure (HBP) was shown to be useful for antihypertensive treatment adjus... more Background: Home Blood Pressure (HBP) was shown to be useful for antihypertensive treatment adjustment. Guidelines suggest a target HBP below 135/85mmHg, corresponding to a target office BP (OBP) below 140/90mmHg. There is a "grey zone" corresponding to OBP controlled patients but with a systolic HBP between 131-140mmHg, for which the decision to change treatment is not resolved. Objectives: Principal: To assess the proportion of OBP controlled patients with a systolic HBP in the "grey zone" of 131-140mmHg. Secondary: Compare the decision to change treatment based on OBP, HBPM or ambulatory blood pressure measurement (ABPM). Methods: In 3 general practices, hypertensive patients with controlled OBP (< 140/90 mmHg) were assessed simultaneously with HBP measurements (ESH guidelines) and 24h ambulatory BP Measurements (ABPM). The decision to change treatment was compared as to whether it was based on OBP, HBP or ABPM. Results: In 52 patients with controlled OBP (< 140/90mmHg) 12 were found to have systolic HBP within the "grey zone" (131-140mmHg). Based on HBP, 14/52 required a treatment escalation (systolic HBP ≥ 135mmHg). However, among these patients and comparatively to daytime ABPM, HBP was found retrospectively to overestimate SBP control in 5 and underestimate SBP in 3. The correlation between systolic ABP and HBP was 85% (p < 0.0001). Conclusions: Agreement between different BP measurements methods is not fully established. A significant number of patients controlled on OBP fall into a "grey zone' using HBP. Target HBP are not defined and all hypertension trials are based on target OBP. Large-scale randomized studies demonstrating the prognostic value of HBP specifically in treated patients are needed.

Research paper thumbnail of P4.02 Lipids and Apolipoproteins Are Associated with Pulse Wave Velocity in Never-Treated Hypertensives

Research paper thumbnail of 6.5 Hemoglobin A1C is Associated with Pulse Wave Velocity in Never-Treated Hypertensives: The Impact of the American Diabetes Association 2010 Position Statement Definitions

Research paper thumbnail of Vascular age as a marker of premature biological ageing in HIV-infected patients

Vascular age as a marker of premature biological ageing in HIV-infected patient

Research paper thumbnail of Antiretroviral Therapy and Lipodystrophy as Predictors of Sub-Clinical Atherosclerosis

Although anti-retroviral therapy (ART) has prolonged survival in human immunodeficiency virus (HI... more Although anti-retroviral therapy (ART) has prolonged survival in human immunodeficiency virus (HIV)-infected persons, an increase in cardiovascular disease (CVD) has been observed. A frequent complication of ART is the development of lipodystrophy (LD) that may be associated with CVD. We assessed the contribution of chronic HIV infection, ART use and LD to the presence and extent of sub-clinical atherosclerosis as evaluated by coronary artery calcium (CAC) imaging

Research paper thumbnail of Pp.10.04: Determinants of Aortic Stiffness in a Long-Living Population

Objective: Ikaria, the Greek island of the East Aegean, is among the five places in the world wit... more Objective: Ikaria, the Greek island of the East Aegean, is among the five places in the world with the highest rates of octagenarians. Aortic stiffness, assessed by aortic pulse wave velocity (PWV), is an independent prognostic factor of cardiovascular and all-cause mortality. However, data on the assessment of aortic stiffness in long-living populations are lacking. The aim of the present study was to evaluate aortic stiffness in the inhabitants of Ikaria island, across a broad spectrum of age. Design and method: We studied a sample of the Ikaria island's inhabitants (N = 153). We divided the population into 4 age groups, each per decade: 1. 40–49 years old (N = 30), 2. 50–59 years old (N = 40), 3. 60–69 years old (N = 35) and 4. over 70 years of age (N = 48). Aortic stiffness was assessed by the measurement of carotid-femoral PWV using the Complior device. Laboratory evaluation was performed in all participants. Results: Systolic blood pressure (SBP) showed a gradual increase proportional to the advanced age group (from 131.1 ± 11.5 to 136.5 ± 15.1 to 143.6 ± 16.4 to 152.4 ± 21.7 mmHg, p < 0.01). On the contrary, no difference was observed in the levels of diastolic BP among groups (from 81.7 ± 6.4 to 83.5 ± 10.1 to 80.8 ± 7.3 to 81.6 ± 11.1 mmHg, p = NS). Pulse wave velocity increased gradually across the 4 groups of age (from 7.96 ± 0.95 to 8.76 ± 1.25 to 9.89 ± 1.19 to 12.05 ± 2.62 m/s, respectively, p < 0.001). In linear regression analysis, PWV was independently related to age group (b = 0.62, p < 0.001), heart rate (b = 0.24, p < 0.001), mean BP (b = 0.20, p < 0.01), creatinine (b = 0.15, p = 0.02) and, inversely, to BMI (b = -0.13, p = 0.03) Conclusions: Age is a powerful determinant of aortic stiffness in the population of Ikaria island. Moreover, haemodynamic parameters, such as arterial pressure and heart rate, as well as kidney function are independently associated with aortic stiffness. Interestingly, obesity is inversely related to PWV, a finding suggesting a possible ‘obesity paradox’ effect. Future studies in other long-living populations need to confirm the present findings and shed light into the relationship of arterial stiffness with longevity.

Research paper thumbnail of Coronary Ageing in Hiv Infected Patients

The objectives of this study were to assess the coronaryage (CA) of a cohort of HIV infected pati... more The objectives of this study were to assess the coronaryage (CA) of a cohort of HIV infected patients based on the extent of coronary artery calcium (CAC) and to iden-tify the variables associated with it

Research paper thumbnail of Secondary prevention of sudden cardiac death in a 65year untreated ALCAPA patient

International Journal of Cardiology, Sep 1, 2014

Research paper thumbnail of Effect of Dark Chocolate on Arterial Function in Healthy Individuals

American Journal of Hypertension, Jun 1, 2005

Background: Epidemiologic studies suggest that high flavonoid intake confers a benefit on cardiov... more Background: Epidemiologic studies suggest that high flavonoid intake confers a benefit on cardiovascular outcome. Endothelial function, arterial stiffness, and wave reflections are important determinants of cardiovascular performance and are predictors of cardiovascular risk. Methods: The effect of flavonoid-rich dark chocolate (100 g) on endothelial function, aortic stiffness, wave reflections, and oxidant status were studied for 3 h in 17 young healthy volunteers according to a randomized, single-blind, sham procedure-controlled, cross-over protocol. Flow-mediated dilation (FMD) of the brachial artery, aortic augmentation index (AIx), and carotid-femoral pulse wave velocity (PWV) were used as measures of endothelial function, wave reflections, and aortic stiffness, respectively. Plasma oxidant status was evaluated with measurement of plasma malondialdehyde (MDA) and total antioxidant capacity (TAC). Results: Chocolate led to a significant increase in resting and hyperemic brachial artery diameter throughout the study (maximum increase by 0.15 mm and 0.18 mm, respectively, P Ͻ .001 for both). The FMD increased significantly at 60 min (absolute increase 1.43%, P Ͻ .05). The AIx was significantly decreased with chocolate throughout the study (maximum absolute decrease 7.8%, P Ͻ .001), indicating a decrease in wave reflections, whereas PWV did not change to a significant extent. Plasma MDA and TAC did not change after chocolate, indicating no alterations in plasma oxidant status. Conclusions: Our study shows for the first time that consumption of dark chocolate acutely decreases wave reflections, that it does not affect aortic stiffness, and that it may exert a beneficial effect on endothelial function in healthy adults. Chocolate consumption may exert a protective effect on the cardiovascular system; further studies are warranted to assess any long-term effects.

Research paper thumbnail of Abstract 21015: Coronary Inflammation in Humans Drives Spatial Changes of Perivascular Adipose Tissue Composition Detectable by a Novel Computed Tomography-Based Technology

Circulation, 2017

Background: Non-invasive detection of vascular inflammation remains an unmet goal. We hypothesize... more Background: Non-invasive detection of vascular inflammation remains an unmet goal. We hypothesized that phenotypic changes in perivascular adipose tissue (PVAT) induced by vascular inflammation can be quantified using a new computed tomography angiography (CTA) methodology. Methods: In Arm 1, human PVAT adipocytes were cultured +/- inflammatory cytokines (n=7) or co-cultured with vascular tissue (+/-Angiotensin-II, n=6) to assess the effects of vascular inflammation on PVAT differentiation. In Arm 2, AT explants (epicardial, subcutaneous and thoracic AT) from 453 cardiac surgery patients were used in histology and gene expression studies to relate the ex vivo images with in vivo CT scan information (n=105) on the biology of the explants. In Arm 3, in 267 patients undergoing diagnostic CTA, PVAT attenuation (Fat Attenuation Index (FAI) defined as the average CT attenuation of AT), was analysed around the proximal right coronary artery. In Arm 4, PVAT FAI around unstable (culprit) and...

Research paper thumbnail of The prognostic role of late gadolinium enhancement on cardiac magnetic resonance in patients with nonischemic cardiomyopathy and reduced ejection fraction, implanted with cardioverter defibrillators for primary prevention. A systematic review and meta-analysis

Journal of Interventional Cardiac Electrophysiology, 2021

Background Previous studies suggest that late gadolinium enhancement (LGE) on cardiac magnetic re... more Background Previous studies suggest that late gadolinium enhancement (LGE) on cardiac magnetic resonance (CMR) is associated with arrhythmic events in patients with nonischemic cardiomyopathy (NICM), while others have questioned the role of left ventricular ejection fraction (LVEF) as a sole predictor of future events. Objectives To evaluate the role of LGE on CMR in identifying patients with NICM and reduced LVEF for whom a benefit from defibrillator implantation for primary prevention is not anticipated, thus they are mainly exposed to potential risks. Methods Major electronic databases were searched for studies reporting the incidence of appropriate device therapy (ADT), sudden cardiac death (SCD), and cardiac death based on the presence of LGE on CMR, among patients with NICM and reduced LVEF, implanted with a cardioverter defibrillator for primary prevention.

Research paper thumbnail of A case of aortic arch coarctation, bicuspid aortic valve and aortic sinus aneurysm in an adult with moderate hypertension

Hellenic Journal of Cardiology, 2017

Research paper thumbnail of The Tree of Sirtuins and the Garden of Cardiovascular Youth

Current Vascular Pharmacology, 2015

Research paper thumbnail of Cigar Smoking Has a Detrimental Effect on Arterial Stiffness

Journal of Hypertension, 2004