Anastasios Papadopoulos

Ablation of Superior Pulmonary Veins Compared to Ablation of All Four Pulmonary Veins

Introduction: Isolation of all pulmonary veins (PV) is advocated for treatment of paroxysmal atrial fibrillation (PAF). However, the superior PVs are responsible for most AF triggers, whereas the inferior PVs carry the higher risk for ablation‐induced ostial stenosis. The aim of this study was to compare a superior PV isolation approach with isolation of all PVs for treatment of PAF.

Prevalence and Potential Mechanisms of Sustained Ventricular Arrhythmias During Dobutamine Stress Echocardiography: A Literature Review

Sustained ventricular tachycardia during dobutamine stress echocardiography is a rare complication of dobutamine stress echocardiography. It may be related to reduced left ventricular function and prior myocardial infarction but cannot be used as a sensitive or specific sign for myocardial ischemia. The clinical significance of dobutamine stress echocardiography-induced sustained ventricular tachycardia is uncertain, and this condition probably does not represent an adverse prognostic sign.

LATE-BREAKING ABSTRACT: Maximum oxygen uptake (maxVO2) during a 6-minute step test (6-MST) in healthy people: Validation of a low cost exercise test

Introduction: Stepping has been one of the first proposed exercise tests but is not been adequately studied regarding cardiopulmonary parameters. Aims and objectives: Measuring cardiopulmonary and metabolic exercise indices in a 6-MST. Methods: Healthy volunteers were included in the study. Exercise protocol imposed ascending and descending a single step 23cm high with a rate of at least 20steps/minute and 3-minute recovery period. Blood pressure, ECG and expired gases were measured. Subjects were considered to have achieved maxVO2 when respiratory quotient (RQ)>1.1 or the 90% of individual9s estimated max heart rate. Results: Twenty two subjects (13 males/9 females) aged 38,64±6,22years old were included in the study. All of them achieved RQ>1.1 but only 7 out of 22 the estimated maxHR>90% (mean value 84,53%±8,54). They ascended and descended 158,27±21,76steps, producing 177,54±31,06Joules/step and a total mechanical work of 27.800±6960Joules with a power of 77,22±19,33Watts. PeakVO2 was measured 1.756,00±414,67mL/min or 21,75±2,97mL/Kg/min equivalent with 6,21±0,85METS. Expired VCO2 at peak exercise was measured 1.846,22 ±443,50mL/min. Anaerobic Threshold (AT) occurred at 57,29%±14,50 of the predicted peakVO2. We found that for every 1mL/min of peakVO2 uptake a mechanical work of 0,06±0,008Joules was produced. PeakVO2 was found to be statistically correlated with measured peakVCO2, AT, estimated maxHR, maxVE, maxVT, VD/VT and total mechanical work (p Conclusions: 6-MST seems to be a reliable submaximal exercise test which could be applied in everyday clinical practice, provided that it needs cheaper equipment compared to conventional exercise tests.

Reccuring Strokes due to an Arterio-Venous Fistula in the Pulmonary Circulation

Percutaneous transluminal coronary angioplasty (PTCA) was introduced in the late 1970s as an alternative to coronary artery bypass graft surgery for coronary revascularization; since then, it has been accepted as a safe, reliable, and effective treatment for coronary artery disease, and its use has spread worldwide.Hyperlipidemia is a major cause of cardiovascular disease despite the availability of first-line cholesterol lowering agents such as statins. Although statin therapy is very efficient to reduce cholesterol, nearly 10-20% of individuals on statins, experience side effects, such myopathy, which hinder the drugs ability to achieve target low-density lipoprotein (LDL) cholesterol (LDL-C) levels. Statin-intolerant patients require more effective therapies for lowering LDL-C. As proprotein convertase subtilisin kexin type 9 (PCSK9) promotes the degradation of the LDL receptor (LDLR) and prevents it from recycling to the membrane, a new therapeutic approach to lowering LDL-C acts by blocking LDL-receptor degradation by serum PCSK9. Humanized monoclonal antibodies which target PCSK9 and its interaction with the LDL receptor (REGN727/SAR23653, AMG145, and RN316), as well as agents that inhibit PCSK9 synthesis, such as ALN-PCS, are now in clinical trials. The latter is a small interfering RNA (siRNA) that directs sequence-specific messenger RNA for PCSK9 leading to reduced hepatocyte-specific synthesis of PCSK9. Ongoing phase III trials’ results are awaited with great interest in order to define these agents’ long-term safety, tolerability and efficacy for reducing cardiovascular events.Sequential surgical thoracoscopic and electrophysiological (EP) ablation is gaining popularity as a novel approach for the treatment of patients with stand-alone, persistent and long standing persistent atrial fibrillation (AF).The measurement of fractional flow reserve (FFR) has been proven useful in evaluating whether or not to perform percutaneous coronary intervention (PCI), especially in the case of “intermediate” stenosis. Nowadays, the indication of its usefulness has been expanded. While coronary angiography remains the cornerstone for assessment of epicardial coronary artery lesions in the catheterization laboratory, FFR-guided coronary treatment has established its usefulness especially after FAME 1 & 2 trials.Atrial Fibrillation (AF) is associated with increased morbidity and mortality and a more severe impairment in quality of life compared with patients with congestive heart failure or myocardial infarction. Left atrial myocardial extensions, known as “myocardial sleeves”, are present in almost all pulmonary veins (PVs), and have been recognized as the main source of triggers that initiate and perpetuate AF.

Renin-dependent hypertension due to renal angiodysplasia.

hypertension in a 32-year-old male presented with a long standing, rather neglected, moderate hypertension. Clinical examination revealed no abnormal findings, apart from increased blood pressure which was measured 160/105 mm Hg. ECG was evident of hypertrophy of the left ventricle (left axis deviation, Sokolow index = 45 mm), Transthoracic echocardiography demonstrated mild concentric hypertrophy of the left ventricle (Interventricular Septum = 12.5 mm, Posterior Wall = 12 mm), mild dilatation of the aortic root (39.5 mm) and prolonged relaxation. Renal function was clinically within normal limits as assessed with creatinine plasma levels (0.9 mg/dl). Glomerular filtration rate (GFR) was estimated from the endogenous Clearance of Creatinine which included measurement of excretion of creatinine in 24 h urine collection, and was found to be 187 ml/min. Moreover microalbuminuria was not identified in 24 h urine collection (microalbumin = 10 mg/l, normal range < 30 mg/l). Peripheral plasma renin and aldosterone levels were measured in the supine position before getting up in the morning and were found to be significantly increased: aldosterone = 28 ng/ml (normal range supine = 1–16 ng/ml) and renin = 175 pg/ml (normal range supine = 2.4–29 pg/ml). Plasma levels of renin and aldosterone were also measured followingly, after standing for 30 min and administration of 40 mg of furosemide, and were found to get further increased: aldosterone = 65 ng/ml (normal range standing = 4–31 ng/ml) and renin = 499 pg/ml (normal range standing = 3.3–41 pg/ml): both kidneys were of normal size (ultrasound examination) and renal arteries had a normal Doppler flow pattern, as well as resistive indices (peak end diastolic velocity/peak systolic velocity, normal range < 0.75) which were found to be 0.55 for branches of the right renal artery, and 0.49 for branches of the left renal artery. Magnetic Resonance Angiography of the renal arteries was proposed which demonstrated a vascular tumour’ over the right renal artery, however with no clarified anatomy. An arteriogram was then performed and revealed a normal right renal artery supplying only the lower half of the kidney, whereas the upper half remained devoid of contrast during infusion (Fig. 1a, white arrow), and an additional aberrant artery, quite elongated ending in an angiodysplasia (Fig. 1b, medium-sized white arrow) with a poor supplying result to the upper half of the right kidney (Fig. 1b, small-sized white arrow). Moreover the right internal spermatic artery originated from this aberrant artery (Fig. 1b, large-sized white arrow), instead of the abdominal aorta. A Tc-DTPA flow study was then performed and demonstrated overall perfusion to the left kidney to be 66% compared with 34% for the right kidney, while Ilias Karabinos Georgios Papageorgiou Anastasios Papadopoulos Renin-dependent hypertension due to renal angiodysplasia CLINICAL CORRESPONDENCE Clin Res Cardiol 97:782–783 (2008) DOI 10.1007/s00392-008-0667-4