Anna Kaladaridou | National & Kapodistrian University of Athens (original) (raw)

Papers by Anna Kaladaridou

Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography, 2015

Right ventricular apical pacing may induce detrimental effects on left ventricular function and c... more Right ventricular apical pacing may induce detrimental effects on left ventricular function and coronary flow. In this study, the effects of pacing site and mode on cardiac mechanics and coronary blood flow were evaluated. This prospective study included 25 patients who received dual-chamber pacemakers with the ventricular lead placed in the right ventricular apex and presented in sinus rhythm (SR) at their regularly scheduled visits at the pacemaker clinic. Patients underwent complete transthoracic echocardiographic examinations while in SR, followed by noninvasive Doppler assessment of coronary flow in the left anterior descending coronary artery (LAD) and speckle-tracking echocardiography of short-axis planes in SR, atrial pacing (AAI-P), atrioventricular (dual-chamber) pacing (DDD-P), and ventricular pacing (VVI-P). Rotation of the base was significantly decreased with VVI-P compared with AAI-P. Left ventricular twist decreased significantly with DDD-P compared with AAI-P. Circu...

Cardiology research and practice, 2014

Aim. To assess the effect on left ventricular (LV) function of atrioventricular (AV) and ventricu... more Aim. To assess the effect on left ventricular (LV) function of atrioventricular (AV) and ventricular pacing at the LV apical or lateral wall and to compare the normal torsional and deformation pattern of the intact LV myocardium with those created by the aforementioned LV pacing modes and sites. Methods. Experiments were conducted in pigs (n = 21) with normal LV function to investigate the acute hemodynamic effects of epicardial AV and ventricular LV pacing at the LV apical or lateral wall. Torsional and deformation indices of LV function were assessed using speckle tracking echocardiography. Results. AV pacing at the apex revealed a significant reduction in the radial strain of the base (P < 0.03), without affecting significantly the ejection fraction and the LV torsion or twist. In contrast, AV pacing at the lateral wall produced, in addition to the reduction of the radial strain of the base (P < 0.01), significant reduction of the circumferential and the radial strain of th...

Hellenic journal of cardiology : HJC = Hellēnikē kardiologikē epitheōrēsē

The aim of this study was to determine whether left ventricular (LV) apical rotation assessed by ... more The aim of this study was to determine whether left ventricular (LV) apical rotation assessed by speckle tracking echocardiography (STE) can predict global LV systolic dysfunction after acute anterior myocardial infarction (AMI). STE analysis was applied to LV short-axis images at the basal and apical levels in 21 open-chest pigs, before and after left anterior descending coronary artery ligation. LV radial and circumferential strain and strain rate, apical and basal rotation, and LV torsion were recorded. LV apical rotation (3.68 ± 1.73° pre-AMI vs. 2.19 ± 1.64° post-AMI, p<0.009), peak systolic rotation rate, and radial and circumferential strain as well as strain rate decreased significantly 30 min postAMI. The LV global torsion decreased significantly. Strain and rotational changes of the LV apex were primarily correlated with ejection fraction (EF), but those of the LV base were not. EF had a significant correlation with the global LV twist (r=0.31, p<0.05). On multivaria...

In vivo (Athens, Greece)

The purpose of the present study was to examine the effect of SonoVue™ on right ventricular (RV) ... more The purpose of the present study was to examine the effect of SonoVue™ on right ventricular (RV) dimensions and contractility in patients with heart failure. Twenty-four patients were divided into two groups. Group A consisted of 15 patients with heart failure and group B (control) of nine patients without heart disease. SonoVue was administered at low (2 ml) and high (4 ml) doses in both groups separately, in a random order. RV dimensions, contractility, peak systolic pressure gradient from tricuspid regurgitation (TRPG) and the time to maximal RV end-diastolic dimension (EDD), as well as the time for RV-EDD to return to the baseline value (recovery), were calculated in every cardiac cycle starting before the administration of SonoVue (baseline) until the recovery of RV-EDD. Low-(group A, p<0.001 and group B, p<0.05) and high-dose (group A, p<0.0001 and group B, p<0.01) contrast infusion increased the RV-EDD compared to baseline values. TRPG increased significantly (p&l...

European Heart Journal, 2013

Aims: Inotrope treatment is often necessary in refractory to optimal management end stage heart f... more Aims: Inotrope treatment is often necessary in refractory to optimal management end stage heart failure, when signs of end-organ hypoperfusion appear. The effect of specific inotropes on patient outcome remains controversial. The aim of the study was to compare the effect of levosimendan versus dobutamine, alone or in combination with levosimendan, on the outcome of end-stage heart failure patients, requiring inotropic therapy. Methods and results: We studied 63 patients in NYHA class IV, refractory to optimal medical therapy, recently hospitalized for cardiac decompensation and stabilized by an intravenous inotrope. They were randomly assigned to intermittent infusions of either a) dobutamine, 10 mg/kg/min, versus b) levosimendan, 0.3 mg/kg/ min, versus c) dobutamine, 10 mg/kg/min + levosimendan 0.2 mg/kg/min, each administered weekly, for 6 h, over a 6-month period. All patients received amiodarone, 400 mg/day, to suppress the proarrhythmic effects of the inotropes. Baseline characteristics of the 3 groups were similar. At 6 months, survival free from death or urgent left ventricular device implantation was 80% in the levosimendan, 48% in the dobutamine (P =0.037 versus levosimendan), and 43% in the levosimendan+ dobutamine (P=0.009 versus levosimendan) group. At 3 months, NYHA class improved significantly in all 3 groups, whereas pulmonary capillary wedge pressure decreased (27 ± 4 to 19 ± 8 mmHg, P=0.008) and cardiac index increased (1.5± 0.3 to 2.1 ± 0.3 l/min/m 2 , P=0.002) significantly only in patients assigned to levosimendan. Conclusions: In patients with refractory end-stage heart failure, intermittent administration of levosimendan conferred survival and hemodynamic benefits in comparison to a regimen of intermittent infusions of dobutamine, alone or in combination with levosimendan.

Pacing and Clinical Electrophysiology, 2011

The aim of this study was to examine the effects on left ventricular (LV) function of LV apical o... more The aim of this study was to examine the effects on left ventricular (LV) function of LV apical or/and lateral wall pacing during an experimental acute myocardial infarction. In 12 anesthetized pigs, epicardial LV pacing at the apex or lateral wall, or at both sites simultaneously, was performed before and after left anterior descending (LAD) ligation. Data concerning LV function were obtained by two-dimensional echo during spontaneous sinus rhythm (SR) and during pacing before and 15, 45, 60, and 90 minutes after LAD ligation. Before ligation of the LAD, pacing at the lateral wall (48.04 ± 6.25%) or both sites (45.71 ± 6.31%) reduced the LV ejection fraction (EF) significantly (P &amp;amp;amp;amp;amp;lt; 0.01) in comparison to SR (55.44 ± 4.10%). However, during pacing at the apex (50.19 ± 6.50%), the reduction was not significant. After LAD ligation, the EF during lateral pacing (43.02 ± 7.71%) was significantly higher than during apical pacing (38.78 ± 8.26%, P &amp;amp;amp;amp;amp;lt; 0.04) but was not significantly different from that during dual-site pacing (41.65 ± 8.69%). Pacing within the ischemic LV apical zone after LAD ligation impairs left ventricular ejection fraction, as compared with pacing the nonischemic LV lateral wall, and should therefore be avoided in clinical settings where the LV pacing site may be chosen.

Echocardiography, 2014

Aims: During pregnancy, important hemodynamic changes occur, consistent with an increase in prelo... more Aims: During pregnancy, important hemodynamic changes occur, consistent with an increase in preload and decrease in afterload and systemic vascular resistance. The aim of the present study was to investigate the changes in left ventricular (LV) strain and rotational properties during the 3 trimesters of normal pregnancy and to examine the factors that drive these changes. Methods and Results: Twenty-seven pregnant women (29.7 AE 6.9 years) and 11 age-matched nonpregnant controls (29.9 AE 5.4 years) were evaluated. Conventional echocardiography and two-dimensional speckle tracking imaging were performed at 8-12 (1st trimester), 21-28 (2nd trimester), and 33-36 (3rd trimester) weeks of pregnancy. LV rotation, twist, untwisting rate, and circumferential strain were measured using the parasternal short-axis views at basal and apical levels. Global longitudinal strain was calculated from the LV apical views. Peak LV twist and peak untwisting rate increased significantly in the 3rd trimester of normal pregnancy (13.48 AE 2.90°, 13.12 AE 3.30°, 16.83 AE 3.61°, P < 0.001; and À111.52 AE 23.54°/sec, À107.40 AE 26.58°/sec, À144.30 AE 45.14°/sec, P < 0.001; in the 1st, 2nd, and 3rd trimester, respectively). Global longitudinal and circumferential strain of the apex decreased significantly from the 2nd trimester. An independent association was found between the change in LV twist and the change in LV end-systolic volume between the 1st and 3rd trimester. Peak untwisting rate at the 3rd trimester correlated significantly with peak twist and LV end-diastolic volume. Conclusions: During normal pregnancy, LV twist and peak untwisting rate increase in the 3rd trimester and correlate with end-systolic and end-diastolic volume, respectively. Circumferential strain of the apex and global longitudinal strain decrease from the 2nd trimester. (Echocardiography 2014;31:155-163)

Artificial Organs, 2011

Acute myocardial infarction (AMI) causes left ventricular (LV) remodeling, which forms the substr... more Acute myocardial infarction (AMI) causes left ventricular (LV) remodeling, which forms the substrate for its early and late complications. The purpose of this study was to compare the acute effect of dobutamine or intraaortic balloon pumping (IABP), alone or in combination, on LV function in the early phase of an experimental AMI. In 18 pigs, AMI was induced by ligation of the left anterior descending artery (LAD). IABP or dobutamine infusion at a rate of 5 mg/kg/min, or a combination of the two, was applied immediately after ligation of the LAD. Echocardiographic measurements of the long and short LV axes were obtained before (baseline) and post LAD ligation and

Resuscitation, 2011

Objective: The early appearance of ventricular fibrillation (VF) following acute myocardial infar... more Objective: The early appearance of ventricular fibrillation (VF) following acute myocardial infarction (MI) is associated with adrenergic effects and electrical interactions although some early "mechanical" changes may also occur. The aim of the present experimental study was to examine whether early changes in the functional geometry of left ventricular (LV) contraction may be associated with ventricular arrhythmias occurring during the first 120 min of MI. Methods: In 11 swine left anterior descending (LAD) coronary artery ligation was performed. Aortic flow, LV end-diastolic pressure (LVEDP), LV long and short axis lengths were measured and their fractional shortening (FS) was calculated before and during the initial 120 min period of MI. Results: LV long axis FS and aortic flow decreased (p < 0.001) whereas LVEDP increased (p < 0.01) in all 11 animals within 30 min following LAD ligation. LV long and short axis lengths and LV short axis FS did not change significantly. VF occurred in 5 of the 11 animals within this 30 min period. LV short axis FS decreased (p < 0.05) in all 5 animals prior to VF and increased (p < 0.05) in all 6 animals without VF. In 3 of the 6 animals that had no VF during the initial 30 min VF occurred later. Similarly, LV short axis FS decreased prior to VF in all those 3 animals. LV short axis FS did not decrease in any of the remaining 3 swine without VF during the same period of time. Conclusion: Early changes in the functional geometry of LV contraction, in the form of a reduction of LV short axis FS, are associated with a greater incidence of VF in experimental acute MI.