Athanasios Kranidis

Neutrophil Count on Admission Predicts Major In‐hospital Events in Patients with a Non‐ST‐Segment Elevation Acute Coronary Syndrome

Inflammation plays a key role in the pathogenesis of acute coronary syndromes (ACS). In this context we assessed neutrophil count as a predictor of major in‐hospital events in patients admitted for a non‐ST‐segment elevation (NSTE) ACS.

Clinical implications of the echocardiographic assessment of left ventricular long axis function.

The assessment of the left and right ventricular long axis function by Doppler echocardiography was started many years ago with the use of M-mode. Two-dimensional echocardiography was subsequently used to study the longitudinal function of the left ventricle. The studies of that era led to useful conclusions. However, tissue Doppler imaging, a relatively new echocardiographic technique, recently became the first choice for such an assessment. Moreover, the advances of tissue tracking and strain rate also have an important contribution. New studies were conducted and new data derived for left and right ventricular function in various cardiac diseases. Τhe aim of this review was to present the accumulated knowledge of the Doppler echocardiography study of the left ventricular long axis function and the relevant clinical implications.

Ivabradine: a Selective If Current Inhibitor in the Treatment of Stable Angina

The role of heart rate reduction in the management of myocardial ischemia and chronic stable angina is pivotal. However, broad use and appropriate dosing of commonly used rate-slowing drugs is limited by their poor tolerability. Ivabradine is a selective inhibitor of the If currents of the sinoatrial node cells. If currents activity determines the slope of the depolarization curve towards the threshold level controlling heart rate in patients with sinus rhythm. Ivabradine, a compound of the benzocyclobutane (S 16257), exhibits a unique specificity for the If current and has a more favorable profile of adverse reactions compared to other If inhibitors. Accordingly, ivabradine has been used in the treatment of stable angina, where it presented anti-anginal and anti-ischemic effects equivalent to the effects of atenolol and amlodipine. Clinical studies proved the efficacy of ivabradine in patients with stable angina, while clinical data are awaited to verify its probable value in the treatment of atrial tachyarrhythmias and tachycardia due to ventricular dysfunction. Thus, the clinical value of ivabradine, which has completed clinical development for stable angina, is expected to exceed its role in the treatment of myocardial ischemia. In this context, ivabradine, promising efficacious and safe pharmacological management of heart rate, is a huge step in cardiovascular therapeutics.

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.

Ranolazine: safe and effective in a patient with hypertensive cardiomyopathy and multiple episodes of electrical storm

Among implantable cardioverter‐defibrillator (ICD) recipients, there are patients with recurrent episodes of electrical storm (ES), retractable to the optimal antiarrhythmic drug therapy or invasive ablation procedures. A relatively novel anti‐ischemic drug with also antiarrhythmic properties, ranolazine, may effectively suppress ventricular arrhythmias in such patients for a long period of time.

Pericardial Fluid Drainage in the Thoracic Cavity During Pericardiocentesis

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.

Thrombosis of Left Coronary Artery During Primary Percutaneous Coronary Intervention

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.

Idiopathic Effusive-Constrictive Pericarditis

The Takotsubo syndrome or apical ballooning, also known as “broken heart syndrome” (BHS) among a variety of suggested names, was first described by Sato et al in the Japanese population approximately 20 years ago. Since then, it has been increasingly recognized in other countries and in 2006 it was classified as a type of stress cardiomyopathy among acquired cardiomyopathies. The prevalence of the BHS is estimated to be 1-2% of patients presenting with an acute coronary syndrome but higher rates have been reported lately, due to a wider recognition of the syndrome. One of the hallmarks of the BHS is a strict predilection for postmenopausal women (over 90% in most series), whereas men account for less than 10% of cases. It has also been reported that among BHS patients, 43% had a preceding acute medical condition and 27% had a severe emotional or physical stressor associated with a “fight or flight” hypersympathetic response... (excerpt)Patients with diabetes mellitus have more advanced coronary artery disease (CAD) eith greater plaque burden, longer lesions, smaller, more diffusely diseased vessels. On the other hand, approximately 25% undergoing percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) have diabetes. Regardless of the type of revascularization, diabetic patients have worse prognosis compared to patients without diabetes. With regards to PCI, diabetic patients have a higher restenosis rate and are at greater risk for myocardial infarction and stent thrombosis than patients without diabetes... (excerpt)

Acute myocardial infarction presumambly embolic, in a patient with a mechanical aortic valve: a rare cause of non atherosclerotic coronary arterial occlusion

Abstract We present a case of an acute myocardial infarction with ST segment elevation in a patient with a mechanical aortic valve prosthesis who had discontinued anticoagulant therapy. We performed a primary coronary intervention procedure, including thrombus aspiration as well as plain balloon angioplasty (low atmospheres), in order to restore coronary flow in left anterior descending artery as soon as possible. Review of the literature suggests that in such cases the diagnosis of the embolic origin of the acute coronary syndrome is assumed and can never been proved definitely. Thrombus aspiration must be included in the therapeutic strategy of these patients.

Left ventricular long-axis dysfunction in hypertensive patients.

It was with great interest that we read the article by Muller-Brunotte et al. [1]. The investigators studied, amongst other factors the diastolic function of the left ventricle at the left ventricular long axis using the tissue Doppler imaging technique and, calculating the circulating levels of the carboxyterminal propeptide of procollagen type I, they concluded that myocardial fibrosis and diastolic dysfunction are present in hypertension before left ventricular hypertrophy develops. Additionally, their findings with irbesartan suggest that angiotensin II inhibition may help in the control of myocardial fibrosis and diastolic function in hypertensive patients with left ventricular hypertrophy.