Athanasios Aggelis

Relationship of Asymmetric Dimethylarginine With Penile Doppler Ultrasound Parameters in Men with Vasculogenic Erectile Dysfunction

BACKGROUND Asymmetric dimethylarginine (ADMA), a selective endogenous nitric oxide synthase inhibitor, is elevated in many conditions associated with erectile dysfunction (ED), such as hypertension, diabetes, hyperlipidemia, and renal failure; it is also increased in men with coronary artery disease and ED. The dynamic penile colour Doppler ultrasound is considered the gold standard for the evaluation of penile vascular damage. OBJECTIVE We investigated whether the extent of ultrasonographically documented penile vascular disease is associated with higher ADMA levels. DESIGN, SETTING, AND PARTICIPANTS One hundred four consecutive ED patients (mean age: 56 ± 9 yr) without manifest cardiovascular/atherosclerotic disease and 31 subjects with normal erectile function matched for age and traditional risk factors were studied. MEASUREMENTS We evaluated penile dynamic colour Doppler parameters of arterial insufficiency (peak systolic velocity) and veno-occlusive dysfunction (end diastolic velocity) and measured systemic inflammatory markers/mediators. RESULTS AND LIMITATIONS Compared to men without ED, ED patients had significantly higher ADMA levels (p<0.001). ADMA was significantly increased in patients with severe arterial insufficiency (PSV<25 cm/s) compared to subjects with borderline insufficiency and men with normal penile arterial function (p<0.001, by analysis of variance). Multivariable analysis adjusting for age, mean pressure, other risk factors, high-sensitivity C-reactive protein, testosterone, and treatment showed independent inverse association between ADMA level and peak systolic velocity (p<0.01). The combination of higher ADMA level with arterial insufficiency showed greater impact on 10-yr risk of a cardiovascular event compared to either parameter alone. CONCLUSIONS ADMA level is independently associated with ultrasonographically documented poor penile arterial inflow. This finding underlines the important role of ADMA as a marker of penile arterial damage and implies a contribution of this compound to the pathophysiology of generalised vascular disease associated with ED.

Prediction of Cardiovascular Events With Aortic Stiffness in Patients With Erectile Dysfunction

Erectile dysfunction confers an independent risk for cardiovascular events and total mortality. Aortic pulse wave velocity (PWV) is an important predictor of cardiovascular events and all-cause mortality. We investigated whether PWV predicts major adverse cardiovascular events (MACEs) in patients with erectile dysfunction beyond traditional risk factors. MACEs in relation to PWV were analyzed with proportional hazards models in 344 patients (mean age, 56 years) without established cardiovascular disease. During a mean follow-up of 4.7 years (range, 1–8.5 years), 24 of 344 participants (7.0%) experienced a MACE. Subjects in the highest PWV tertile (>8.8 m/s) had a 4-fold higher risk of MACEs compared with those in the lowest PWV tertile (<7.6 m/s; adjusted hazard ratio, 3.97; P=0.035). A PWV value of 7.81 m/s was associated with a negative predictive value (ability to rule out MACE) of 98.1%. Addition of PWV to standard risk factor model yielded correct patient reclassification to higher or lower risk category by 27.6% (P=0.0332) in the whole cohort. Our results show that higher aortic stiffness is associated with increased risk for a MACE in patients with erectile dysfunction without known cardiovascular disease. Aortic PWV improves risk prediction when added to standard risk factors and may represent a valuable biomarker of prediction of cardiovascular disease risk in these patients.

Beneficial Effect of Vardenafil on Aortic Stiffness and Wave Reflections

Although vardenafil is widely prescribed for erectile dysfunction (ED), its effect on arterial function is not defined. Aortic stiffness, aortic pressures, and wave reflections are predictors of cardiovascular risk. The investigators assessed the hypothesis that vardenafil acutely improves aortic stiffness, aortic pressures, and wave reflections in ED patients. Twelve ED patients (mean age 58 ± 9 years) received vardenafil 20 mg in a randomized, placebo‐controlled, double‐blind, 2‐way crossover design. Aortic stiffness was evaluated with carotid—femoral pulse wave velocity (PWV); wave reflections and aortic pressures were evaluated with augmentation index (AIx) and systolic, diastolic, and pulse pressure of the aortic pressure waveform, respectively. PWV, aortic pressures, and AIx were measured at baseline and for 3 hours after vardenafil intake or placebo. PWV decreased significantly (by 0.7 m/s, P = .001), denoting a decrease in aortic stiffness. AIx decreased significantly (by 7%, P = .008), denoting a decreased effect of wave reflections from the periphery. Aortic pressures decreased significantly (all P < .05). Statin use at baseline significantly interacted with the effects of treatment on both PWV and AIx (P = .003 and P < .001, respectively). This study shows, for the first time, that vardenafil has a favorable acute effect on aortic stiffness and wave reflection in ED patients.

Relationships of osteoprotegerin with albuminuria and asymmetric dimethylarginine in essential hypertension: integrating vascular dysfunction

Objectives: To investigate the inter-relationships of osteoprotegerin (OPG) with albumin to creatinine ratio (ACR) and asymmetric dimethylargine (ADMA) in hypertensive patients. Methods: In 198 untreated non-diabetic hypertensive patients [130 males, mean age = 51.5 years, office blood pressure (BP) = 152/98 mmHg] ACR values and OPG and ADMA levels were determined. Results: Based on the median value of OPG distribution (5.03 pmol/l) patients with high (n = 101) compared with those with low OPG values (n = 97) had greater 24-h systolic BP (152 ± 5 versus 137 ± 7 mmHg, p < 0.0001), ACR [25.3 (5 – 190) versus 17.3 (5 – 92) mg/g, p = 0.003) and ADMA [0.62 (0.58 – 0.68) versus 0.57 (0.48 – 0.62) μmol/l, p = 0.001), independently of confounding factors. Multiple regression analyses revealed that ADMA (b = 0.388, p < 0.0001), 24-h systolic BP (b = 0.228, p = 0.01) and ACR (b = 0.470, p < 0.0001) were independent predictors of OPG (R2 = 0.398, p < 0.0001). Conclusions: In hypertensive patients, high OPG levels are accompanied by pronounced albuminuria and endothelial dysfunction, as reflected by raised ADMA levels. Furthermore, the independent associations of OPG with ACR and ADMA, suggests a link between OPG and the progression of diffuse hypertensive vascular damage.

Mediterranean Diet Mediates the Adverse Effect of Depressive Symptomatology on Short-Term Outcome in Elderly Survivors from an Acute Coronary Event

Aims. We evaluated the interaction effect between depressive symptoms and dietary habits on 30-day development of cardiovascular disease (CVD) (death or rehospitalization) in elderly, acute coronary syndrome (ACS) survivors. Methods. During 2006–2008, we recorded 277 nonfatal, consecutive ACS admissions (75 ± 6 years, 70% males, 70% had diagnosis of myocardial infarction) with complete 30-day follow-up. Assessment of recent depressive symptoms was based on the CES-D scale. Among sociodemographic, bioclinical, lifestyle characteristics, the MedDietScore that assesses the inherent characteristics of the Mediterranean diet was applied. Results. 22% of the ACS pts developed a CVD event during the first 30 days (14.8% rehospitalization and 9.4% death). Patients in the upper tertile of the CES-D scale (i.e., >18) had higher incidence of CVD events as compared with those in the lowest tertile (21% versus 8%, P = .01). Multiple logistic regression analysis revealed that 1-unit increase in CES-D was associated with 4% higher odds (95% CI 1.008–1.076, P = .01) of CVD events; however, when MedDietScore was entered in the model, CES-D lost its significance (P = .20). Conclusion. Short-term depressive symptoms are related to a worsen 30-day prognosis of ACS patients; however, this relationship was mediated by Mediterranean diet adherence.

HIGH INTENSITY, INTERVAL EXERCISE IMPROVES QUALITY OF LIFE, VENTRICULAR DIASTOLIC FUNCTION, ERGOMETRIC CAPACITY AND PSYCHOLOGICAL STATUS OF PATIENTS WITH CHRONIC HEART FAILURE: A PHASE III RANDOMIZED CLINICAL TRIAL

The aim of this work was to evaluate the effect of high intensity, interval exercise on the quality of life (QoL) and diastolic function among chronic heart failure (CHF) patients. a phase III clinical trial with100 consecutive CHF patients (NYHA class II-IV, ejection fraction<30%) randomly

PREDICTION OF CARDIOVASCULAR EVENTS AND ALL-CAUSE MORTALITY WITH ERECTILE DYSFUNCTION: A SYSTEMATIC REVIEW AND META-ANALYSIS OF COHORT STUDIES

Erectile dysfunction (ED) is the early clinical manifestation of a generalized vascular disease and carries an independent risk for cardiovascular (CV) events. We aimed to perform a meta-analysis of all longitudinal studies for determining the ability of ED to predict risk of CV events and all-cause

Mechanical Wenckebach Phenomenon in Thrombosed Tricuspid Valve Prosthesis

Graphical abstract

CARDIOVASCULAR EFFECTS OF HIGH-INTENSITY INTERVAL AEROBIC TRAINING COMBINED WITH STRENGTH EXERCISE IN PATIENTS WITH CHRONIC HEART FAILURE: A RANDOMIZED PHASE III CLINICAL TRIAL

Aim of this work was to evaluate the effect of high-intensity interval exercise (i.e., 30 sec at 100% of max workload, followed by 30 sec at rest, on 3days/week 45minutes working-out schedule for 12 weeks), on left ventricular function and aortic elastic properties among chronic heart failure (CHF)

MEDITERRANEAN DIET MEDIATES THE ADVERSE EFFECT OF DEPRESSIVE SYMPTOMATOLOGY ON SHORT-TERM OUTCOME IN ELDERLY SURVIVORS FROM AN ACUTE CORONARY EVENT.

Aims. We evaluated the interaction effect between depressive symptoms and dietary habits on 30-day development of cardiovascular disease (CVD) (death or rehospitalization) in elderly, acute coronary syndrome (ACS) survivors. Methods. During 2006–2008, we recorded 277 nonfatal, consecutive ACS admissions (75 ± 6 years, 70% males, 70% had diagnosis of myocardial infarction) with complete 30-day follow-up. Assessment of recent depressive symptoms was based on the CES-D scale. Among sociodemographic, bioclinical, lifestyle characteristics, the MedDietScore that assesses the inherent characteristics of the Mediterranean diet was applied. Results. 22% of the ACS pts developed a CVD event during the first 30 days (14.8% rehospitalization and 9.4% death). Patients in the upper tertile of the CES-D scale (i.e., >18) had higher incidence of CVD events as compared with those in the lowest tertile (21% versus 8%, P = .01). Multiple logistic regression analysis revealed that 1unit increase in CES-D was associated with 4% higher odds (95% CI 1.008–1.076, P = .01) of CVD events; however, when MedDietScore was entered in the model, CES-D lost its significance (P = .20). Conclusion. Short-term depressive symptoms are related to a worsen 30-day prognosis of ACS patients; however, this relationship was mediated by Mediterranean diet adherence.