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Papers by Panagiota Georgiadou

Research paper thumbnail of Skeletal Muscle Hypothesis in Heart Failure: Potential Triggers of Ergoreflex Stimulation

Research paper thumbnail of Malondialdehyde kinetics following coronary artery bypass grafting and its relation to osteopontin

European Surgery, 2014

Background Cardiac surgery is associated with inflammation and oxidative stress; malondialdehyde ... more Background Cardiac surgery is associated with inflammation and oxidative stress; malondialdehyde (MDA) is a marker of oxidative stress and osteopontin (OPN) is a proinflammatory cytokine. We studied MDA kinetics following coronary artery bypass grafting (CABG) and its relation to OPN. Methods We evaluated 50 consecutive patients (60 ± 10 year-old, 44 men and 6 women) with stable coronary artery disease and left ventricular ejection fraction of 50 ± 8 % undergoing elective CABG on pump. Peripheral plasma samples were drawn at baseline, 24 and 72 h postoperatively. OPN was evaluated at baseline and MDA and cardiac enzymes at all time points. Results MDA levels increased significantly at 72 h postoperative compared with preoperative and 24 h postoperative levels whereas there was no difference between the pre and first postoperative values (p = 0.67). MDA change was positively correlated with the change in troponin at baseline and at 72 h (r = 0.6, p = 0.022) as well as with preoperative OPN levels (r = 0.28, p = 0.047). There was a significant positive correlation between MDA at 72 h and age (r = 0.27, p = 0.039). In addition, MDA change differed significantly in relation to diabetes at baseline and at 72 h-2.99 (4.77) in diabetics versus 0.69 (3.82) in non-diabetics (p = 0.05). Conclusions MDA increases post on-pump CABG but only at 72 h and this increase correlates with preoperative OPN levels. In addition, MDA increase is related to age and diabetes as well as troponin increase following surgery.

Research paper thumbnail of Left ventricular pseudoaneurysm formation: Two cases and review of the literature

World journal of clinical cases, Jan 16, 2014

Left ventricular wall rupture (LVWR) comprises a complication of acute myocardial infarction (AMI... more Left ventricular wall rupture (LVWR) comprises a complication of acute myocardial infarction (AMI). Acute LVWR is a fatal condition, unless the formation of a pseudoaneurysm occurs. Several risk factors have been described, predisposing to LVWR. High index of suspicion and imaging techniques, namely echocardiography and computed tomography, are the cornerstones of timely diagnosis of the condition. As LVWR usually leads to death, emergency surgery is the treatment of choice, resulting in significant reduction in mortality and providing favorable short-term outcomes and adequate prognosis during late follow-up. Herein, we present two patients who were diagnosed with LVWR following AMI, and subsequent pseudoaneurysm formation. In parallel, we review the aforementioned condition.

Research paper thumbnail of Chronic Heart Failure and Serum Collagen

General Methods in Biomarker Research and their Applications, 2014

Research paper thumbnail of Chapter 3 Effect of Hormone Replacement Therapy on Inflammatory Biomarkers

Advances in Clinical Chemistry, 2009

Cardiovascular disease is the leading cause of death among women. Inflammation plays a central ro... more Cardiovascular disease is the leading cause of death among women. Inflammation plays a central role in the pathogenesis of many forms of vascular disease, including atherosclerosis. Women present with cardiovascular disease a decade after men and this has been attributed to the protective effect of female ovarian sex hormones. Hormone replacement therapy (HRT), including a variety of estrogen preparations with or without a progestin, has negative effects on most of these soluble inflammatory markers, including E-selectin, cell adhesion molecules, monocyte chemoattractant protein-1, and tumor necrosis factor-alpha, inconsistent effects on interleukin-6, and stimulatory effects on vasoprotective cytokine, such as the transforming growth factor-alpha. C-reactive protein, a circulating proinflammatory cytokine produced in both liver and atherosclerotic arteries, increases in response to oral conjugated estrogens but not to transdermal estrogen. Animal and observational studies have shown beneficial effects of hormone therapy in the perimenopausal period or before the development of significant atherosclerosis, whereas randomized trials in older women have not shown any benefit in either primary prevention or secondary prevention of cardiovascular events. Many important questions about the effects of ovarian hormones on vascular inflammation and the pathogenesis of vascular disease cannot be answered in human subjects. This review outlines the effects of HRT on inflammatory biomarkers, summarizes results from observational and randomized trials, and highlights unanswered questions of hormone therapy and cardiovascular risk.

Research paper thumbnail of Ischemia-Modified Albumin in Relation to Exercise Stress Testing

Journal of the American College of Cardiology, 2006

Research paper thumbnail of Sleep‐disordered breathing in a general heart failure population: relationships to neurohumoral activation and subjective symptoms

Journal of Sleep Research, 2006

SummaryThe aim of this study was to determine the prevalence of sleep‐related breathing disorders... more SummaryThe aim of this study was to determine the prevalence of sleep‐related breathing disorders (SDB) in a UK general heart failure (HF) population, and assess its impact on neurohumoral markers and symptoms of sleepiness and quality of life. Eighty‐four ambulatory patients (72 male, mean (SD) age 68.6 (10) yrs) attending UK HF clinics underwent an overnight recording of respiratory impedance, SaO2 and heart rate using a portable monitor (Nexan). Brain natriuretic peptide (BNP) and urinary catecholamines were measured. Subjective sleepiness and the impairment in quality of life were assessed (Epworth Sleepiness Scale (ESS), SF‐36 Health Performance Score). SDB was classified using the Apnoea/Hypopnoea Index (AHI). The prevalence of SDB (AHI > 15 events h−1) was 24%, increasing from 15% in mild‐to‐moderate HF to 39% in severe HF. Patients with SDB had significantly higher levels of BNP and noradrenaline than those without SDB (mean (SD) BNP: 187 (119) versus 73 (98) pg mL−1, P =...

Research paper thumbnail of Ischemia-modified albumin in acute aortic dissection

Journal of Clinical Laboratory Analysis, 2010

Research paper thumbnail of Exercise Capacity and Biochemical Profile during Exercise in Patients with Glycogen Storage Disease Type I

The Journal of Clinical Endocrinology & Metabolism, 2005

Research paper thumbnail of Significant changes in platelet count, volume and size in acute aortic dissection

International Journal of Cardiology, 2013

Mean platelet volume (MPV) and platelet size distribution width (PDW) are markers of platelet (PL... more Mean platelet volume (MPV) and platelet size distribution width (PDW) are markers of platelet (PLT) size and variability in PLT size as well as PLT activation [1–3]. Reduced PLT count and increased MPV values have been reported in unruptured abdominal aortic aneurysms [4,5]. Others, however, have noted lower PLT indices (MPV and PDW) in patients with aortic aneurysm compared to age-matched controls [6]. High-grade inflammation is associated with low MPV whereas low-grade inflammation is associated with high MPV; inflammation may play a role in pathogenesis of aneurysm formation and rupture [3]. We studied PLT indices in patients with acute aortic dissection (AAD), chronic aortic aneurysms and age and sex matched normal subjects. We studied, prospectively, 100 consecutive patients with AAD admitted to our hospital for emergency surgery (group I), 100 patients with chronic aneurysms of the ascending aorta scheduled for coronary angiography prior to elective surgical repair (group II) and 100 age and sex matched normal subjects who served as controls (group III). The diagnosis was confirmed for all patients with computed tomography. Dissection was classified according to the Stanford criteria. In patients with AAD, blood samples were obtained as soon as the patient came to hospital and for patients in group II the morning of the admission, prior to catheterization. All patients gave informed consent and the study protocol was approved by the Ethics Committee of our institution. The authors of this manuscript have certified that they comply with the PrinciplesofEthicalPublishingintheInternationalJournalofCardiology. PLT indices were evaluated with anautomatic counter, including PLT count, MPV, PDW and MPV/PLT ratio (Coulter LH780, Hematology Analyzer, Beckman, Miami, USA).Bloodsamples were collected in tubes with potassium ethylenediaminetetraacetate and were analyzed 1 h after venipuncture. We also measured D-dimers with Elisa (Vidas Ddimer, Biomerieux, France) and CRP with an immunoturbidimetric method (Cobas Integra, Roche, Mannheim, Germany). The groups were compared by means of chi-square or Fishers' exact test, Kruskal Wallis test or non-parametric one-way analysis of variance, Mann–Whitney test and Spearman rank correlation coefficient, as appropriate. Baseline characteristics for all three groups are presented in Table 1. In type A dissection, 8 patients died before surgery and the remaining were all but one operated; this patient declined surgery. There were 3 deaths in the operating room and 7 post-operative deaths. In type B dissection, 2 patients died on arrival to our unit; 2 patients were transferred elsewhere for vascular surgery and 1 was operated on site; the remaining 10 were managed conservativelyand did well. Ingroup II, there were 2 deaths. As expected, aortic cross clamping time and cardiopulmonary bypass time were significantly longer in group I than in group II (p b 0.001) whereas the duration of hospitalization was similar in the 2 groups (p = 0.192). Table 2 illustratestheresultsofstudiedbiochemicalvariablesamong groups. Within group I, PLT count was lower [186 (146,212) vs 222 (195,264)] and the MPV/PLT ratio was higher [0.047(0.036, 0.059) vs 0.037(0.033, 0.04)] in type A dissection compared to type B (p = 0.009 and p = 0.008, respectively). In addition, MPV as well as the MPV/PLT ratiowere significantlylowerinpatientswithmore extensivedissection with involvementof the abdominal aorta and the iliacarteries; in detail, when comparing thoracic vs thoracic–abdominal vs thoracic–abdominal–iliacdissection,MPVwas8.7(8.1,9.5),7.9(7.4,8.4)and8.1(7.1,8.7), respectively (p = 0.013) and MPV/PLT ratio was 0.05 (0.037, 0.062), 0.041 (0.036, 0.047) and 0.038 (0.034, 0.048), respectively (p = 0.042).

Research paper thumbnail of D-dimer and BNP levels in acute aortic dissection

International Journal of Cardiology, 2007

Research paper thumbnail of High homocysteine and low folate concentrations in acute aortic dissection

International Journal of Cardiology, 2013

Biomarkers for monitoring progression and prognosis of thoracic aneurysm are of great interest. H... more Biomarkers for monitoring progression and prognosis of thoracic aneurysm are of great interest. Homocysteine (Hcy) induces elastolysis in arterial media and may directly affect fibrillin-1 or collagen whereas lipoprotein (Lp) (a) inhibits elastolysis by reducing activation of matrix metallopeptidase-9. We studied 31 consecutive patients with acute aortic dissection (AAD) admitted for emergency surgery (group I, 60 ± 13 years old, 25 men), 30 consecutive patients with chronic aneurysms of the ascending aorta (group II, 67 ± 12 years old, 24 men) and 20 healthy controls (group III, 58 ± 15 years old, 14 men). We evaluated Hcy, folate, B12, Lp(a) and methylenetetrahydrofolate reductase (MTHFR) C677T polymorphism at baseline. Hcy, folate and B12 differed significantly among the 3 studied groups (P=0.016, P=0.004 and P=0.001, respectively). The levels of Hcy and B12 were significantly higher in group I compared to both groups II and III (P=0.05 and P=0.002, P<0.001 and P=0.017, respectively) and without significant differences between groups II and III (P=0.083 and P=0.124). Folate was significantly lower in group I compared to both groups II and III (P=0.001 and P=0.006, respectively) and without marked difference between groups II and III (P=0.409). No significant difference was found in serum levels of Lp (a) (P=0.074) or among the frequency of MTHFR C677T genotypes. Patients with AAD present with higher Hcy and lower folate compared to both chronic aneurysms and controls.

Research paper thumbnail of Plasma levels of osteopontin before and 24 h after percutaneous coronary intervention

Expert Opinion on Therapeutic Targets, 2008

ABSTRACT

Research paper thumbnail of Osteopontin as a novel prognostic marker in stable ischaemic heart disease: a 3‐year follow‐up study

European Journal of Clinical Investigation, 2010

Eur J Clin Invest 2010; 40 (4): 288–293Objectives Osteopontin (OPN) is a glycoprotein, which may... more Eur J Clin Invest 2010; 40 (4): 288–293Objectives Osteopontin (OPN) is a glycoprotein, which may play a major role in the regulation of biological phenomena. Increased levels of OPN have been linked to the presence and to the severity of atherosclerosis. This study was undertaken to assess the prognostic significance of plasma OPN levels in patients with stable ischaemic heart disease (IHD).Methods In 101 patients with stable IHD and angiographically documented significant coronary artery stenosis, plasma OPN levels were measured at baseline (time of coronary arteriography). Patients were prospectively followed for a median time of 3 years (minimum 2·25, maximum 3·9 years). The primary study endpoint was the composite of cardiovascular death, non‐fatal myocardial infarction, need for revascularization and hospitalization for cardiovascular reasons.Results Baseline lnOPN levels were directly related to age (r = 0·27, P < 0·001) and inversely to left ventricular ejection fractio...

Research paper thumbnail of Ischaemia modified albumin in radiofrequency catheter ablation

EP Europace, 2007

Ischaemia modified albumin (IMA) is considered a marker of myocardial ischaemia, in contrast to t... more Ischaemia modified albumin (IMA) is considered a marker of myocardial ischaemia, in contrast to the biomarkers of myocardial injury [creatine kinase (CK), the MB isoenzyme of CK, and cardiac troponin I (Tn-I)] that are released when cardiac necrosis occurs. Ischaemia modified albumin has been reported to increase following percutaneous coronary intervention and in acute coronary syndromes. We sought to determine whether IMA increases following radiofrequency (RF) ablation. Methods and results We studied 40 consecutive patients who underwent RF catheter ablation; 20 were men and 20 women and their age was 47 + 16 (16-77) years. All patients underwent electrophysiological study and subsequent RF ablation. Peripheral venous samples were collected before the procedure (baseline), immediately after the procedure, 2 h post-procedure and the following day (20 h postprocedure) and assayed for CK, the MB isoenzyme of CK, cardiac Tn-I and IMA. Ischaemia-modified albumin plasma levels did not differ significantly at all four time points, baseline, and following ablation (P ¼ 0.5974), whereas CK, CK-MB, and Tn-I increased significantly at all time points compared with baseline (P ,0.0001). Post-ablation, all but three 3 CK measurements were in the normal range; 14 patients had CK-MB plasma levels above the upper limit of normal; all but one patient had Tn-I elevated. Conclusion The IMA plasma levels do not change significantly following RF ablation, unlike biomarkers of myocardial injury, implying that myocardial necrosis occurs without preceding ischaemia.

Research paper thumbnail of Cytokine gene polymorphisms are associated with markers of disease severity and prognosis in patients with idiopathic dilated cardiomyopathy

Cytokine, 2011

... Stamatis Adamopoulos a , Fotis Kolokathis b , Angeliki Gkouziouta a , Panagiota Georgiadou a ... more ... Stamatis Adamopoulos a , Fotis Kolokathis b , Angeliki Gkouziouta a , Panagiota Georgiadou a , Corresponding Author Contact Information , E-mail The Corresponding Author , Antigoni Chaidaroglou c , George K. Karavolias a , Dimitrios Degiannis c , Vassilis Voudris a and ...

Research paper thumbnail of Ischemia modified albumin changes – review and clinical implications

cclm, 2011

Ischemia modified albumin (IMA), as measured using the albumin cobalt binding test, is currently ... more Ischemia modified albumin (IMA), as measured using the albumin cobalt binding test, is currently the most promising biomarker for early detection of ischemia before the onset of irreversible cardiac injury. This paper reviews the information available on IMA, including its pathophysiology, analysis, clinical applications and future perspectives. The data provided was identified by a search of MEDLINE using the terms IMA, biomarkers and ischemia. IMA may be useful to cover the complete diagnostic window of patients presenting with acute coronary syndromes (ACS) in the Emergency Department, along with the electrocardiogram and cardiac troponins. Preliminary data regarding the significance of IMA in the prognosis of either ACS or following revascularization need further study.

Research paper thumbnail of Heart-type fatty acid binding protein in elective cardioversion of atrial fibrillation

Clinical Biochemistry, 2011

Research paper thumbnail of Ischemia modified albumin in relation to pharmacologic stress testing in coronary artery disease

Clinica Chimica Acta, 2008

Ischemia modified albumin (IMA) is considered a biomarker of myocardial ischemia. We sought to in... more Ischemia modified albumin (IMA) is considered a biomarker of myocardial ischemia. We sought to investigate whether IMA plasma levels change during pharmacological stress test, in patients with stable coronary artery disease. We studied 37 patients undergoing non-invasive evaluation with a pharmacological stress test, either with radionuclide myocardial perfusion imaging with adenosine or stress echocardiography with dobutamine. Peripheral venous samples were collected before the stress test (baseline), at the end of adenosine infusion or at the peak dose of dobutamine and 60 min after the completion of the stress test for IMA measurement. IMA plasma levels significantly increased at peak vs. baseline (91.28+/-9.59 U/ml vs. 97.97+/-9.69 U/ml, 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;lt;0.0001) and subsequently, decreased significantly at 60 min compared to peak (97.97+/-9.69 U/ml vs. 94+/-15.22 U/ml, p=0.016), returning to values similar to those at baseline (p=0.134). Similarly, in patients with a negative stress test, IMA significantly increased at peak compared to baseline (91.08+/-10.03 U/ml vs. 99.58+/-8.43 U/ml, p=0.006) and returned to baseline at 60 min (99.58+/-8.43 U/ml vs. 91.83+/-7.93 U/ml, p=0.019), the 60 minute levels being similar to baseline values (p=0.212). Conversely, in patients with a positive stress test, IMA significantly increased at peak compared to baseline (91.38+/-10.13 U/ml vs. 97.17+/-10.34 U/ml, p=0.006) and although decreased at 1 h, this did not reach statistical significance compared either to the baseline or to the peak values (95.04+/-17.76 U/ml vs. 91.38+/-10.13 U/ml, p=0.315 and 95.04+/-17.76 U/ml vs. 97.17+/-10.34 U/ml, p=0.235, respectively). IMA plasma levels change significantly during pharmacologic stress testing, in patients with coronary artery disease, but with no difference between the positive and the negative tests.

Research paper thumbnail of Skeletal Muscle Reflex in Heart Failure Patients

Circulation, 2002

Background— An important role of the increased stimulation of skeletal muscle ergoreceptors (intr... more Background— An important role of the increased stimulation of skeletal muscle ergoreceptors (intramuscular afferents sensitive to products of muscle work) in the genesis of symptoms of exertion intolerance in chronic heart failure (CHF) has been proposed. With the use of selective infusions and dietary manipulation methods, we sought to identify the role of H + , K + , lactate, and peripheral hemodynamics on ergoreflex overactivation. Methods and Results— Ten stable CHF patients (aged 67.9±2.5 years, peak oxygen uptake 16.3±1.2 mL · kg −1 · min −1 ) and 10 age-matched and sex-matched healthy subjects were studied. The ergoreflex contribution to ventilation was assessed by post-handgrip regional circulatory occlusion (PH-RCO) and computed as the difference in ventilation between PH-RCO and a control run without PH-RCO. This test was performed on 6 separate occasions. On each occasion a different chemical was infused (insulin, sodium nitroprusside, sodium bicarbonate, dopamine, or sal...

Research paper thumbnail of Skeletal Muscle Hypothesis in Heart Failure: Potential Triggers of Ergoreflex Stimulation

Research paper thumbnail of Malondialdehyde kinetics following coronary artery bypass grafting and its relation to osteopontin

European Surgery, 2014

Background Cardiac surgery is associated with inflammation and oxidative stress; malondialdehyde ... more Background Cardiac surgery is associated with inflammation and oxidative stress; malondialdehyde (MDA) is a marker of oxidative stress and osteopontin (OPN) is a proinflammatory cytokine. We studied MDA kinetics following coronary artery bypass grafting (CABG) and its relation to OPN. Methods We evaluated 50 consecutive patients (60 ± 10 year-old, 44 men and 6 women) with stable coronary artery disease and left ventricular ejection fraction of 50 ± 8 % undergoing elective CABG on pump. Peripheral plasma samples were drawn at baseline, 24 and 72 h postoperatively. OPN was evaluated at baseline and MDA and cardiac enzymes at all time points. Results MDA levels increased significantly at 72 h postoperative compared with preoperative and 24 h postoperative levels whereas there was no difference between the pre and first postoperative values (p = 0.67). MDA change was positively correlated with the change in troponin at baseline and at 72 h (r = 0.6, p = 0.022) as well as with preoperative OPN levels (r = 0.28, p = 0.047). There was a significant positive correlation between MDA at 72 h and age (r = 0.27, p = 0.039). In addition, MDA change differed significantly in relation to diabetes at baseline and at 72 h-2.99 (4.77) in diabetics versus 0.69 (3.82) in non-diabetics (p = 0.05). Conclusions MDA increases post on-pump CABG but only at 72 h and this increase correlates with preoperative OPN levels. In addition, MDA increase is related to age and diabetes as well as troponin increase following surgery.

Research paper thumbnail of Left ventricular pseudoaneurysm formation: Two cases and review of the literature

World journal of clinical cases, Jan 16, 2014

Left ventricular wall rupture (LVWR) comprises a complication of acute myocardial infarction (AMI... more Left ventricular wall rupture (LVWR) comprises a complication of acute myocardial infarction (AMI). Acute LVWR is a fatal condition, unless the formation of a pseudoaneurysm occurs. Several risk factors have been described, predisposing to LVWR. High index of suspicion and imaging techniques, namely echocardiography and computed tomography, are the cornerstones of timely diagnosis of the condition. As LVWR usually leads to death, emergency surgery is the treatment of choice, resulting in significant reduction in mortality and providing favorable short-term outcomes and adequate prognosis during late follow-up. Herein, we present two patients who were diagnosed with LVWR following AMI, and subsequent pseudoaneurysm formation. In parallel, we review the aforementioned condition.

Research paper thumbnail of Chronic Heart Failure and Serum Collagen

General Methods in Biomarker Research and their Applications, 2014

Research paper thumbnail of Chapter 3 Effect of Hormone Replacement Therapy on Inflammatory Biomarkers

Advances in Clinical Chemistry, 2009

Cardiovascular disease is the leading cause of death among women. Inflammation plays a central ro... more Cardiovascular disease is the leading cause of death among women. Inflammation plays a central role in the pathogenesis of many forms of vascular disease, including atherosclerosis. Women present with cardiovascular disease a decade after men and this has been attributed to the protective effect of female ovarian sex hormones. Hormone replacement therapy (HRT), including a variety of estrogen preparations with or without a progestin, has negative effects on most of these soluble inflammatory markers, including E-selectin, cell adhesion molecules, monocyte chemoattractant protein-1, and tumor necrosis factor-alpha, inconsistent effects on interleukin-6, and stimulatory effects on vasoprotective cytokine, such as the transforming growth factor-alpha. C-reactive protein, a circulating proinflammatory cytokine produced in both liver and atherosclerotic arteries, increases in response to oral conjugated estrogens but not to transdermal estrogen. Animal and observational studies have shown beneficial effects of hormone therapy in the perimenopausal period or before the development of significant atherosclerosis, whereas randomized trials in older women have not shown any benefit in either primary prevention or secondary prevention of cardiovascular events. Many important questions about the effects of ovarian hormones on vascular inflammation and the pathogenesis of vascular disease cannot be answered in human subjects. This review outlines the effects of HRT on inflammatory biomarkers, summarizes results from observational and randomized trials, and highlights unanswered questions of hormone therapy and cardiovascular risk.

Research paper thumbnail of Ischemia-Modified Albumin in Relation to Exercise Stress Testing

Journal of the American College of Cardiology, 2006

Research paper thumbnail of Sleep‐disordered breathing in a general heart failure population: relationships to neurohumoral activation and subjective symptoms

Journal of Sleep Research, 2006

SummaryThe aim of this study was to determine the prevalence of sleep‐related breathing disorders... more SummaryThe aim of this study was to determine the prevalence of sleep‐related breathing disorders (SDB) in a UK general heart failure (HF) population, and assess its impact on neurohumoral markers and symptoms of sleepiness and quality of life. Eighty‐four ambulatory patients (72 male, mean (SD) age 68.6 (10) yrs) attending UK HF clinics underwent an overnight recording of respiratory impedance, SaO2 and heart rate using a portable monitor (Nexan). Brain natriuretic peptide (BNP) and urinary catecholamines were measured. Subjective sleepiness and the impairment in quality of life were assessed (Epworth Sleepiness Scale (ESS), SF‐36 Health Performance Score). SDB was classified using the Apnoea/Hypopnoea Index (AHI). The prevalence of SDB (AHI > 15 events h−1) was 24%, increasing from 15% in mild‐to‐moderate HF to 39% in severe HF. Patients with SDB had significantly higher levels of BNP and noradrenaline than those without SDB (mean (SD) BNP: 187 (119) versus 73 (98) pg mL−1, P =...

Research paper thumbnail of Ischemia-modified albumin in acute aortic dissection

Journal of Clinical Laboratory Analysis, 2010

Research paper thumbnail of Exercise Capacity and Biochemical Profile during Exercise in Patients with Glycogen Storage Disease Type I

The Journal of Clinical Endocrinology & Metabolism, 2005

Research paper thumbnail of Significant changes in platelet count, volume and size in acute aortic dissection

International Journal of Cardiology, 2013

Mean platelet volume (MPV) and platelet size distribution width (PDW) are markers of platelet (PL... more Mean platelet volume (MPV) and platelet size distribution width (PDW) are markers of platelet (PLT) size and variability in PLT size as well as PLT activation [1–3]. Reduced PLT count and increased MPV values have been reported in unruptured abdominal aortic aneurysms [4,5]. Others, however, have noted lower PLT indices (MPV and PDW) in patients with aortic aneurysm compared to age-matched controls [6]. High-grade inflammation is associated with low MPV whereas low-grade inflammation is associated with high MPV; inflammation may play a role in pathogenesis of aneurysm formation and rupture [3]. We studied PLT indices in patients with acute aortic dissection (AAD), chronic aortic aneurysms and age and sex matched normal subjects. We studied, prospectively, 100 consecutive patients with AAD admitted to our hospital for emergency surgery (group I), 100 patients with chronic aneurysms of the ascending aorta scheduled for coronary angiography prior to elective surgical repair (group II) and 100 age and sex matched normal subjects who served as controls (group III). The diagnosis was confirmed for all patients with computed tomography. Dissection was classified according to the Stanford criteria. In patients with AAD, blood samples were obtained as soon as the patient came to hospital and for patients in group II the morning of the admission, prior to catheterization. All patients gave informed consent and the study protocol was approved by the Ethics Committee of our institution. The authors of this manuscript have certified that they comply with the PrinciplesofEthicalPublishingintheInternationalJournalofCardiology. PLT indices were evaluated with anautomatic counter, including PLT count, MPV, PDW and MPV/PLT ratio (Coulter LH780, Hematology Analyzer, Beckman, Miami, USA).Bloodsamples were collected in tubes with potassium ethylenediaminetetraacetate and were analyzed 1 h after venipuncture. We also measured D-dimers with Elisa (Vidas Ddimer, Biomerieux, France) and CRP with an immunoturbidimetric method (Cobas Integra, Roche, Mannheim, Germany). The groups were compared by means of chi-square or Fishers' exact test, Kruskal Wallis test or non-parametric one-way analysis of variance, Mann–Whitney test and Spearman rank correlation coefficient, as appropriate. Baseline characteristics for all three groups are presented in Table 1. In type A dissection, 8 patients died before surgery and the remaining were all but one operated; this patient declined surgery. There were 3 deaths in the operating room and 7 post-operative deaths. In type B dissection, 2 patients died on arrival to our unit; 2 patients were transferred elsewhere for vascular surgery and 1 was operated on site; the remaining 10 were managed conservativelyand did well. Ingroup II, there were 2 deaths. As expected, aortic cross clamping time and cardiopulmonary bypass time were significantly longer in group I than in group II (p b 0.001) whereas the duration of hospitalization was similar in the 2 groups (p = 0.192). Table 2 illustratestheresultsofstudiedbiochemicalvariablesamong groups. Within group I, PLT count was lower [186 (146,212) vs 222 (195,264)] and the MPV/PLT ratio was higher [0.047(0.036, 0.059) vs 0.037(0.033, 0.04)] in type A dissection compared to type B (p = 0.009 and p = 0.008, respectively). In addition, MPV as well as the MPV/PLT ratiowere significantlylowerinpatientswithmore extensivedissection with involvementof the abdominal aorta and the iliacarteries; in detail, when comparing thoracic vs thoracic–abdominal vs thoracic–abdominal–iliacdissection,MPVwas8.7(8.1,9.5),7.9(7.4,8.4)and8.1(7.1,8.7), respectively (p = 0.013) and MPV/PLT ratio was 0.05 (0.037, 0.062), 0.041 (0.036, 0.047) and 0.038 (0.034, 0.048), respectively (p = 0.042).

Research paper thumbnail of D-dimer and BNP levels in acute aortic dissection

International Journal of Cardiology, 2007

Research paper thumbnail of High homocysteine and low folate concentrations in acute aortic dissection

International Journal of Cardiology, 2013

Biomarkers for monitoring progression and prognosis of thoracic aneurysm are of great interest. H... more Biomarkers for monitoring progression and prognosis of thoracic aneurysm are of great interest. Homocysteine (Hcy) induces elastolysis in arterial media and may directly affect fibrillin-1 or collagen whereas lipoprotein (Lp) (a) inhibits elastolysis by reducing activation of matrix metallopeptidase-9. We studied 31 consecutive patients with acute aortic dissection (AAD) admitted for emergency surgery (group I, 60 ± 13 years old, 25 men), 30 consecutive patients with chronic aneurysms of the ascending aorta (group II, 67 ± 12 years old, 24 men) and 20 healthy controls (group III, 58 ± 15 years old, 14 men). We evaluated Hcy, folate, B12, Lp(a) and methylenetetrahydrofolate reductase (MTHFR) C677T polymorphism at baseline. Hcy, folate and B12 differed significantly among the 3 studied groups (P=0.016, P=0.004 and P=0.001, respectively). The levels of Hcy and B12 were significantly higher in group I compared to both groups II and III (P=0.05 and P=0.002, P&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001 and P=0.017, respectively) and without significant differences between groups II and III (P=0.083 and P=0.124). Folate was significantly lower in group I compared to both groups II and III (P=0.001 and P=0.006, respectively) and without marked difference between groups II and III (P=0.409). No significant difference was found in serum levels of Lp (a) (P=0.074) or among the frequency of MTHFR C677T genotypes. Patients with AAD present with higher Hcy and lower folate compared to both chronic aneurysms and controls.

Research paper thumbnail of Plasma levels of osteopontin before and 24 h after percutaneous coronary intervention

Expert Opinion on Therapeutic Targets, 2008

ABSTRACT

Research paper thumbnail of Osteopontin as a novel prognostic marker in stable ischaemic heart disease: a 3‐year follow‐up study

European Journal of Clinical Investigation, 2010

Eur J Clin Invest 2010; 40 (4): 288–293Objectives Osteopontin (OPN) is a glycoprotein, which may... more Eur J Clin Invest 2010; 40 (4): 288–293Objectives Osteopontin (OPN) is a glycoprotein, which may play a major role in the regulation of biological phenomena. Increased levels of OPN have been linked to the presence and to the severity of atherosclerosis. This study was undertaken to assess the prognostic significance of plasma OPN levels in patients with stable ischaemic heart disease (IHD).Methods In 101 patients with stable IHD and angiographically documented significant coronary artery stenosis, plasma OPN levels were measured at baseline (time of coronary arteriography). Patients were prospectively followed for a median time of 3 years (minimum 2·25, maximum 3·9 years). The primary study endpoint was the composite of cardiovascular death, non‐fatal myocardial infarction, need for revascularization and hospitalization for cardiovascular reasons.Results Baseline lnOPN levels were directly related to age (r = 0·27, P < 0·001) and inversely to left ventricular ejection fractio...

Research paper thumbnail of Ischaemia modified albumin in radiofrequency catheter ablation

EP Europace, 2007

Ischaemia modified albumin (IMA) is considered a marker of myocardial ischaemia, in contrast to t... more Ischaemia modified albumin (IMA) is considered a marker of myocardial ischaemia, in contrast to the biomarkers of myocardial injury [creatine kinase (CK), the MB isoenzyme of CK, and cardiac troponin I (Tn-I)] that are released when cardiac necrosis occurs. Ischaemia modified albumin has been reported to increase following percutaneous coronary intervention and in acute coronary syndromes. We sought to determine whether IMA increases following radiofrequency (RF) ablation. Methods and results We studied 40 consecutive patients who underwent RF catheter ablation; 20 were men and 20 women and their age was 47 + 16 (16-77) years. All patients underwent electrophysiological study and subsequent RF ablation. Peripheral venous samples were collected before the procedure (baseline), immediately after the procedure, 2 h post-procedure and the following day (20 h postprocedure) and assayed for CK, the MB isoenzyme of CK, cardiac Tn-I and IMA. Ischaemia-modified albumin plasma levels did not differ significantly at all four time points, baseline, and following ablation (P ¼ 0.5974), whereas CK, CK-MB, and Tn-I increased significantly at all time points compared with baseline (P ,0.0001). Post-ablation, all but three 3 CK measurements were in the normal range; 14 patients had CK-MB plasma levels above the upper limit of normal; all but one patient had Tn-I elevated. Conclusion The IMA plasma levels do not change significantly following RF ablation, unlike biomarkers of myocardial injury, implying that myocardial necrosis occurs without preceding ischaemia.

Research paper thumbnail of Cytokine gene polymorphisms are associated with markers of disease severity and prognosis in patients with idiopathic dilated cardiomyopathy

Cytokine, 2011

... Stamatis Adamopoulos a , Fotis Kolokathis b , Angeliki Gkouziouta a , Panagiota Georgiadou a ... more ... Stamatis Adamopoulos a , Fotis Kolokathis b , Angeliki Gkouziouta a , Panagiota Georgiadou a , Corresponding Author Contact Information , E-mail The Corresponding Author , Antigoni Chaidaroglou c , George K. Karavolias a , Dimitrios Degiannis c , Vassilis Voudris a and ...

Research paper thumbnail of Ischemia modified albumin changes – review and clinical implications

cclm, 2011

Ischemia modified albumin (IMA), as measured using the albumin cobalt binding test, is currently ... more Ischemia modified albumin (IMA), as measured using the albumin cobalt binding test, is currently the most promising biomarker for early detection of ischemia before the onset of irreversible cardiac injury. This paper reviews the information available on IMA, including its pathophysiology, analysis, clinical applications and future perspectives. The data provided was identified by a search of MEDLINE using the terms IMA, biomarkers and ischemia. IMA may be useful to cover the complete diagnostic window of patients presenting with acute coronary syndromes (ACS) in the Emergency Department, along with the electrocardiogram and cardiac troponins. Preliminary data regarding the significance of IMA in the prognosis of either ACS or following revascularization need further study.

Research paper thumbnail of Heart-type fatty acid binding protein in elective cardioversion of atrial fibrillation

Clinical Biochemistry, 2011

Research paper thumbnail of Ischemia modified albumin in relation to pharmacologic stress testing in coronary artery disease

Clinica Chimica Acta, 2008

Ischemia modified albumin (IMA) is considered a biomarker of myocardial ischemia. We sought to in... more Ischemia modified albumin (IMA) is considered a biomarker of myocardial ischemia. We sought to investigate whether IMA plasma levels change during pharmacological stress test, in patients with stable coronary artery disease. We studied 37 patients undergoing non-invasive evaluation with a pharmacological stress test, either with radionuclide myocardial perfusion imaging with adenosine or stress echocardiography with dobutamine. Peripheral venous samples were collected before the stress test (baseline), at the end of adenosine infusion or at the peak dose of dobutamine and 60 min after the completion of the stress test for IMA measurement. IMA plasma levels significantly increased at peak vs. baseline (91.28+/-9.59 U/ml vs. 97.97+/-9.69 U/ml, 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;lt;0.0001) and subsequently, decreased significantly at 60 min compared to peak (97.97+/-9.69 U/ml vs. 94+/-15.22 U/ml, p=0.016), returning to values similar to those at baseline (p=0.134). Similarly, in patients with a negative stress test, IMA significantly increased at peak compared to baseline (91.08+/-10.03 U/ml vs. 99.58+/-8.43 U/ml, p=0.006) and returned to baseline at 60 min (99.58+/-8.43 U/ml vs. 91.83+/-7.93 U/ml, p=0.019), the 60 minute levels being similar to baseline values (p=0.212). Conversely, in patients with a positive stress test, IMA significantly increased at peak compared to baseline (91.38+/-10.13 U/ml vs. 97.17+/-10.34 U/ml, p=0.006) and although decreased at 1 h, this did not reach statistical significance compared either to the baseline or to the peak values (95.04+/-17.76 U/ml vs. 91.38+/-10.13 U/ml, p=0.315 and 95.04+/-17.76 U/ml vs. 97.17+/-10.34 U/ml, p=0.235, respectively). IMA plasma levels change significantly during pharmacologic stress testing, in patients with coronary artery disease, but with no difference between the positive and the negative tests.

Research paper thumbnail of Skeletal Muscle Reflex in Heart Failure Patients

Circulation, 2002

Background— An important role of the increased stimulation of skeletal muscle ergoreceptors (intr... more Background— An important role of the increased stimulation of skeletal muscle ergoreceptors (intramuscular afferents sensitive to products of muscle work) in the genesis of symptoms of exertion intolerance in chronic heart failure (CHF) has been proposed. With the use of selective infusions and dietary manipulation methods, we sought to identify the role of H + , K + , lactate, and peripheral hemodynamics on ergoreflex overactivation. Methods and Results— Ten stable CHF patients (aged 67.9±2.5 years, peak oxygen uptake 16.3±1.2 mL · kg −1 · min −1 ) and 10 age-matched and sex-matched healthy subjects were studied. The ergoreflex contribution to ventilation was assessed by post-handgrip regional circulatory occlusion (PH-RCO) and computed as the difference in ventilation between PH-RCO and a control run without PH-RCO. This test was performed on 6 separate occasions. On each occasion a different chemical was infused (insulin, sodium nitroprusside, sodium bicarbonate, dopamine, or sal...