Georgios Giannoglou

Efficacy of Various “Classic” Echocardiographic and Laboratory Indices in Distinguishing the “Gray Zone” between Athlete's Heart and Hypertrophic Cardiomyopathy: A Pilot Study

Left ventricular hypertrophy (LVH) with intraventricular septum thickness (IVST) between 1.2 and 1.5 cm in athletes represents a “gray zone” between physiologic adaptation and mild hypertrophic cardiomyopathy (HCM). Various echo and laboratory parameters have been reported till now in the literature to discriminate the “gray zone” entities. Aim of this study was to assess the efficacy of these “classic” parameters in differentiating physiologic LVH in athletes from mild HCM in a highly selected population. Nine highly trained athletes with IVST (1.28 ± 0.07 cm), 9 patients with mild HCM (1.38 ± 0.11 cm), and 26 athletes without LVH (1.06 ± 0.09 cm; P < 0.0005) underwent echocardiographic study, cardiopulmonary treadmill exercise stress test, and brain natriuretic peptide (BNP) measurement before and after exercise. Among all parameters tested, 7 were found to significantly differ between “gray zone” groups. After bootstrapping analysis, it was found that athletes with left ventricular end‐diastolic diameter <4.74 cm, mitral deceleration time >200 ms, isovolumic relaxation time >94 ms, tricuspid E/A < 1.63, septum Em < 9.5 cm/sec, relative wall thickness >0.445, and a BNP value at rest >9.84 pg/mL had a greater possibility for having underlying cardiomyopathy. A 10‐point score based on these parameters showed accuracy (area under the curve = 0.958 [95%CI: 0.738–1.0; P = 0.00005, standard error = 0.0342]) for revealing HCM in a gray zone athletic population. Differentiation of adaptive LVH versus HCM in a gray zone population could be facilitated by recognition of certain features referring to LV dimensions, diastolic function, and BNP.

The dependence of patient dose on factors relating to the technique and complexity of Interventional Cardiology procedures

Dose-area product (DAP) measurements were conducted for 168 coronary angiography (CA) and 89 single vessel percutaneous transluminal coronary angioplasty (PTCA) to examine the factors influencing patient dose beyond the X-ray exposure parameters. It was found that for CA, the DAP increases with the number of catheters used and with the number of vessels with stenosis. DAP values for patients with a prior bypass surgery, were higher compared to those without such a medical record to surgery. In PTCA, the use of coronary stents did not enhance the patient radiation dose significantly. Noticeable differences were found in the percentage contribution of each projection to the total DAP between the three types of single vessel PTCA. Finally low variations in DAP were found among the cardiologists performing both procedures.

Practice patterns of cardiologists, general practitioners, and internists for managing supraventricular tachycardias in Greece

Objectives Supraventricular tachycardias (SVT) often lead to emergency room and primary care visits. Not only cardiologists, but also general practitioners (GPs) and internists are involved to an increasing extent in the acute and long-term management of SVT. We aimed to explore the differences between practice patterns of cardiologists and noncardiologists with regard to SVT management in Greece. Methods A cross-sectional questionnaire survey was conducted among 250 cardiologists and 250 GPs/internists from various areas across Greece. Results A response rate of 61.8% was obtained. Vagal maneuvers were the initial therapeutic approach for SVT termination; however, 22% of noncardiologists would rather start with an antiarrhythmic drug. Adenosine was the most popular drug for SVT termination, but the GPs/internists would use it less often than the cardiologists (67 vs. 86%, P<0.001). The GPs/internists would keep the patient for at least 24 h or more after SVT termination, while 48% of the cardiologists would discharge the patient within the first 3 h. Noncardiologists would more often suggest a 24-h Holter recording than the cardiologists (73 vs. 55%, P<0.005). With regard to the long-term management of SVT, the GPs/internists would prescribe antiarrhythmic drugs earlier than the cardiologists, and seem to be less familiar with the indications for the electrophysiological testing and ablation. Conclusion Significant differences in practice patterns exist in Greece with regard to SVT management between cardiologists and noncardiologists. The GPs/internists seem to rely more on antiarrhythmic drugs and tend to underestimate the role of ablation therapy for the long-term management of SVT.

Rupturgefahr abdomineller Aortenaneurysmen

Until today, there is no reliable criterion to predict the risk of rupture of abdominal aortic aneurysms (AAAs), which could help in the final clinical decision. The acceptance of the traditional diameter criterion has led to unnecessary surgical procedures with the subsequent high mortality and morbidity. On the other hand, small aneurysms are known that sometimes are subject to rupture, which could be avoided in the case of an early surgical decision. Thus, it becomes necessary to find new criteria, which can reliably predict the actual risk of rupture of AAAs in the clinical setting. This prediction will certainly be a useful clinical tool in the management of patients with AAAs. According to the biomechanical approach in predicting the risk of aneurysm rupture and to the fundamental principles in cardiovascular mechanics, rupture occurs when the AAA wall stresses exceed the failure strength of the wall. Therefore, it becomes obvious that the knowledge of the distribution of stress on a particular AAA wall would be a good indication of its susceptibility to rupture. A methodology to noninvasively determine the in vivo distribution of stresses on the AAA wall is therefore necessary.ZusammenfassungZum gegenwärtigen Zeitpunkt gibt es kein allgemein anerkanntes Verfahren zur Bestimmung der Rupturgefahr abdomineller Aortenaneurysmen. Die traditionelle Heranziehung des größten Durchmessers des Aneurysmas zur Stellung der Operationsindikation führt möglicherweise zu letztlich unnötigen Operationen mit hoher perioperativer Morbidität und Mortalität. Wohlbekannt ist andererseits die Rupturgefahr auch kleinerer Aneurysmen; hier könnte die rechtzeitige operative Behandlung lebensrettend sein. Somit besteht die dringende Notwendigkeit der Identifikation von Kriterien, welche die individuelle Ruptur gefahr verlässlich beschreiben. Unter Zugrundelegung biomechanischer Kriterien, insbesondere der Prinzipien der Herz-Kreislauf-Mechanik, kommt es zur Ruptur des Aneurysmas in dem Moment, wo der absolute Summenwert der Wandspannungen die Belastbarkeit der Wandstrukturen des Aneurysmas überschreitet. Die Berechnung und Kartographierung der unterschiedlichen Spannungen in den Wandstrukturen des Aortenaneurysmas könnten eine verbesserte Vorhersagbarkeit der Rupturgefahr erlauben. Eine Möglichkeit der unblutigen Berechnung der Verteilung der Wandspannungen innerhalb eines abdominellen Aortenaneurysmas in vivo wird beschrieben.AbstractUntil today, there is no reliable criterion to predict the risk of rupture of abdominal aortic aneurysms (AAAs), which could help in the final clinical decision. The acceptance of the traditional diameter criterion has led to unnecessary surgical procedures with the subsequent high mortality and morbidity. On the other hand, small aneurysms are known that sometimes are subject to rupture, which could be avoided in the case of an early surgical decision. Thus, it becomes necessary to find new criteria, which can reliably predict the actual risk of rupture of AAAs in the clinical setting. This prediction will certainly be a useful clinical tool in the management of patients with AAAs. According to the biomechanical approach in predicting the risk of aneurysm rupture and to the fundamental principles in cardiovascular mechanics, rupture occurs when the AAA wall stresses exceed the failure strength of the wall. Therefore, it becomes obvious that the knowledge of the distribution of stress on a particular AAA wall would be a good indication of its susceptibility to rupture. A methodology to noninvasively determine the in vivo distribution of stresses on the AAA wall is therefore necessary.

The LDL-Receptor and its Molecular Properties: From Theory to Novel Biochemical and Pharmacological Approaches in Reducing LDL-cholesterol

Background The Low Density Lipoprotein (LDL) Receptor (LDL-R) is a transmembrane protein playing a crucial role in effective lipid homeostasis. Various therapeutic agents has been used in management of dyslipidemias, however the outcome of therapeutic target is debated. Objective The aim of this review is to summarize and fully understand the current concept regarding LDL-R and its molecular properties, metabolic pathway, factors affecting LDL-R activity and all available pharmacological interventions. Additionally, non-lipid related properties of LDL-R are also referred. Methods Literature from the PubMed database was extracted to identify papers between 1984 to 2017 regarding LDL-R and therapeutic agents on dyslipidemia management. Results We analyzed basic data regarding agents associated with LDL-R (Sterol Regulating Element-Binding Proteins - SREBPs, Protein ARH, IDOL, Thyroid Hormones, Haematologic Disorders, Protein convertase subtilisin kexintype 9 - PCSK-9, ApoC-III) as well as non-lipid related properties of LDL-R, while all relevant (common and novel) pharmacological interventions (statins, fibrates, cholesterol absorption inhibitors, bile acid sequestrants and PCSK-9) are also referred. Conclusion LDL-R and its molecular properties are involved in lipid homeostasis, so potentially sets the therapeutic goals in cardiovascular patients, which is usually debated. Further research is needed in order to fully understand its properties, as well as to find the potential pharmacological interventions that could be beneficial in cholesterol homeostasis and various morbidities in order to reach the most appropriate therapeutic goal.

Rupturgefahr abdomineller AortenaneurysmenRupture Risk of Abdominal Aortic Aneurysms. The Role of Computational Mechanics

Until today, there is no reliable criterion to predict the risk of rupture of abdominal aortic aneurysms (AAAs), which could help in the final clinical decision. The acceptance of the traditional diameter criterion has led to unnecessary surgical procedures with the subsequent high mortality and morbidity. On the other hand, small aneurysms are known that sometimes are subject to rupture, which could be avoided in the case of an early surgical decision. Thus, it becomes necessary to find new criteria, which can reliably predict the actual risk of rupture of AAAs in the clinical setting. This prediction will certainly be a useful clinical tool in the management of patients with AAAs. According to the biomechanical approach in predicting the risk of aneurysm rupture and to the fundamental principles in cardiovascular mechanics, rupture occurs when the AAA wall stresses exceed the failure strength of the wall. Therefore, it becomes obvious that the knowledge of the distribution of stress on a particular AAA wall would be a good indication of its susceptibility to rupture. A methodology to noninvasively determine the in vivo distribution of stresses on the AAA wall is therefore necessary.ZusammenfassungZum gegenwärtigen Zeitpunkt gibt es kein allgemein anerkanntes Verfahren zur Bestimmung der Rupturgefahr abdomineller Aortenaneurysmen. Die traditionelle Heranziehung des größten Durchmessers des Aneurysmas zur Stellung der Operationsindikation führt möglicherweise zu letztlich unnötigen Operationen mit hoher perioperativer Morbidität und Mortalität. Wohlbekannt ist andererseits die Rupturgefahr auch kleinerer Aneurysmen; hier könnte die rechtzeitige operative Behandlung lebensrettend sein. Somit besteht die dringende Notwendigkeit der Identifikation von Kriterien, welche die individuelle Ruptur gefahr verlässlich beschreiben. Unter Zugrundelegung biomechanischer Kriterien, insbesondere der Prinzipien der Herz-Kreislauf-Mechanik, kommt es zur Ruptur des Aneurysmas in dem Moment, wo der absolute Summenwert der Wandspannungen die Belastbarkeit der Wandstrukturen des Aneurysmas überschreitet. Die Berechnung und Kartographierung der unterschiedlichen Spannungen in den Wandstrukturen des Aortenaneurysmas könnten eine verbesserte Vorhersagbarkeit der Rupturgefahr erlauben. Eine Möglichkeit der unblutigen Berechnung der Verteilung der Wandspannungen innerhalb eines abdominellen Aortenaneurysmas in vivo wird beschrieben.AbstractUntil today, there is no reliable criterion to predict the risk of rupture of abdominal aortic aneurysms (AAAs), which could help in the final clinical decision. The acceptance of the traditional diameter criterion has led to unnecessary surgical procedures with the subsequent high mortality and morbidity. On the other hand, small aneurysms are known that sometimes are subject to rupture, which could be avoided in the case of an early surgical decision. Thus, it becomes necessary to find new criteria, which can reliably predict the actual risk of rupture of AAAs in the clinical setting. This prediction will certainly be a useful clinical tool in the management of patients with AAAs. According to the biomechanical approach in predicting the risk of aneurysm rupture and to the fundamental principles in cardiovascular mechanics, rupture occurs when the AAA wall stresses exceed the failure strength of the wall. Therefore, it becomes obvious that the knowledge of the distribution of stress on a particular AAA wall would be a good indication of its susceptibility to rupture. A methodology to noninvasively determine the in vivo distribution of stresses on the AAA wall is therefore necessary.

Rupturgefahr abdomineller Aortenaneurysmen@@@Rupture Risk of Abdominal Aortic Aneurysms. The Role of Computational Mechanics: Die Bedeutung computergestützter Mechanik

Until today, there is no reliable criterion to predict the risk of rupture of abdominal aortic aneurysms (AAAs), which could help in the final clinical decision. The acceptance of the traditional diameter criterion has led to unnecessary surgical procedures with the subsequent high mortality and morbidity. On the other hand, small aneurysms are known that sometimes are subject to rupture, which could be avoided in the case of an early surgical decision. Thus, it becomes necessary to find new criteria, which can reliably predict the actual risk of rupture of AAAs in the clinical setting. This prediction will certainly be a useful clinical tool in the management of patients with AAAs. According to the biomechanical approach in predicting the risk of aneurysm rupture and to the fundamental principles in cardiovascular mechanics, rupture occurs when the AAA wall stresses exceed the failure strength of the wall. Therefore, it becomes obvious that the knowledge of the distribution of stress on a particular AAA wall would be a good indication of its susceptibility to rupture. A methodology to noninvasively determine the in vivo distribution of stresses on the AAA wall is therefore necessary.ZusammenfassungZum gegenwärtigen Zeitpunkt gibt es kein allgemein anerkanntes Verfahren zur Bestimmung der Rupturgefahr abdomineller Aortenaneurysmen. Die traditionelle Heranziehung des größten Durchmessers des Aneurysmas zur Stellung der Operationsindikation führt möglicherweise zu letztlich unnötigen Operationen mit hoher perioperativer Morbidität und Mortalität. Wohlbekannt ist andererseits die Rupturgefahr auch kleinerer Aneurysmen; hier könnte die rechtzeitige operative Behandlung lebensrettend sein. Somit besteht die dringende Notwendigkeit der Identifikation von Kriterien, welche die individuelle Ruptur gefahr verlässlich beschreiben. Unter Zugrundelegung biomechanischer Kriterien, insbesondere der Prinzipien der Herz-Kreislauf-Mechanik, kommt es zur Ruptur des Aneurysmas in dem Moment, wo der absolute Summenwert der Wandspannungen die Belastbarkeit der Wandstrukturen des Aneurysmas überschreitet. Die Berechnung und Kartographierung der unterschiedlichen Spannungen in den Wandstrukturen des Aortenaneurysmas könnten eine verbesserte Vorhersagbarkeit der Rupturgefahr erlauben. Eine Möglichkeit der unblutigen Berechnung der Verteilung der Wandspannungen innerhalb eines abdominellen Aortenaneurysmas in vivo wird beschrieben.AbstractUntil today, there is no reliable criterion to predict the risk of rupture of abdominal aortic aneurysms (AAAs), which could help in the final clinical decision. The acceptance of the traditional diameter criterion has led to unnecessary surgical procedures with the subsequent high mortality and morbidity. On the other hand, small aneurysms are known that sometimes are subject to rupture, which could be avoided in the case of an early surgical decision. Thus, it becomes necessary to find new criteria, which can reliably predict the actual risk of rupture of AAAs in the clinical setting. This prediction will certainly be a useful clinical tool in the management of patients with AAAs. According to the biomechanical approach in predicting the risk of aneurysm rupture and to the fundamental principles in cardiovascular mechanics, rupture occurs when the AAA wall stresses exceed the failure strength of the wall. Therefore, it becomes obvious that the knowledge of the distribution of stress on a particular AAA wall would be a good indication of its susceptibility to rupture. A methodology to noninvasively determine the in vivo distribution of stresses on the AAA wall is therefore necessary.