Konstantina Aggeli

Effects of pravastatin on thoracic aortic atherosclerosis in patients with heterozygous familial hypercholesterolemia

Data regarding the effects of plasma lipid lowering on the evolution of thoracic aortic atherosclerosis (TAA) are scarce. In this study, we performed transesophageal echocardiography to characterize TAA in 16 newly diagnosed patients with heterozygous familial hypercholesterolemia and to follow its evolution after 2 years of statin treatment. TAA was graded as follows: grade I = normal intima; grade II = increased intimal echo density without thickening; grade IIIA = increased intimal echo density with single atheromatous plaque < or = 3 mm; grade IIIB = multiple plaques < or = 3mm; grade IV = > or = 1 plaque >3 mm; and grade V = mobile or ulcerated plaques. Baseline aortic intimal morphology was grade I in one patient, grade II in 4, grade IIIA in 6, grade IIIB in 3, and grade IV in 2 patients. Hypolipidemic treatment resulted in significant reductions in plasma total cholesterol and low-density lipoprotein (LDL) cholesterol. Follow-up aortic morphology was grade I in 5 patients, grade II in 2, grade IIIA in 3, grade IIIB in 3, and grade IV in 3 patients. TAA remained stable in 7 patients, progressed in 3, and regressed in 6 patients. TAA evolved in a uniform manner in the ascending aorta, aortic arch, and descending aorta. Patients with TAA regression were younger (39+/-14 vs 52+/-8 years, p=0.038) and had a greater decrease in plasma LDL cholesterol as a result of treatment (138+/-56 vs 73+/-55 mg/dl, p=0.036) than patients with TAA stability or progression. These observations support the hypothesis that hypolipidemic treatment may favorably affect the course of TAA in patients with heterozygous familial hypercholesterolemia.

Meta-Analysis of Studies Evaluating the Effect of Cilostazol on Major Outcomes After Carotid Stenting

Purpose: To evaluate the effect of cilostazol on major outcomes after carotid artery stenting (CAS). Methods: A systematic literature review was conducted conforming to established criteria in order to identify articles published prior to May 2015 evaluating major post-CAS outcomes in patients treated with cilostazol vs patients not treated with cilostazol. Major outcomes included in-stent restenosis (ISR) within the observation period, the revascularization rate, major/minor bleeding, and the myocardial infarction/stroke/death rate (MI/stroke/death) at 30 days and within the observation period. Data were pooled for all studies containing adequate data for each outcome investigated; effect estimates are presented as the odds ratios (ORs) and 95 confidence intervals (CI). Results: Overall, 7 studies pertaining to 1297 patients were eligible. Heterogeneity was low among studies so a fixed-effect analysis was conducted. Six studies (n=1233) were compared for the ISR endpoint, showing a significantly lower ISR rate with cilostazol treatment after a mean follow-up of 20 months (OR 0.158, 95% CI 0.072 to 0.349, p<0.001). Five studies (n=649) were compared regarding 30-day MI/stroke/death (OR 0.724, 95% CI 0.293 to 1.789, p=0.484) and 3 studies (n=1076) were analyzed regarding MI/stroke/death within the entire follow-up period (OR 0.768, 95% CI 0.477 to 1.236, p=0.276); no significant difference was found between the groups. Data on bleeding rates and revascularization rates post ISR were inadequate to conduct further analysis. Conclusion: Cilostazol seems to decrease total ISR rates in patients undergoing CAS without affecting MI/stroke/death events, both in the early and late settings.

Prevalence of interatrial block in patients with Friedreich's Ataxia

UNLABELLED Interatrial block is a predictor of atrial arrhythmias. Aim of the present study was to estimate the prevalence of interatrial block (IAB) in Friedreichs Ataxia (FA) compared to controls and correlate it with echocardiographic and genetic features. METHODS IAB, defined as an electrocardiographic (ECG) derived P-wave duration >120 ms, echocardiographic variables and genetic markers were evaluated in 23 FA patients with no manifestation of cardiac involvement and were compared to 23 sex- and age-matched controls. RESULTS IAB was significantly more frequent among FA patients compared to controls (11/23 vs 1/23, p<0.005 respectively). However, no correlations with echocardiographic parameters or Guanine-Adenine-Adenine (GAA) trinucleotide repeat lengths could be established. CONCLUSION Early recognition of IAB could allow the identification of asymptomatic FA patients who are prone to develop potentially life-threatening arrhythmias.

Preoperative Cardiac Assessment before Carotid Surgery: Should Perhaps Things Change?

Carotid endarterectomy has been associated with perioperative symptomatic or asymptomatic myocardial ischemia and cardiac mortality although it has been classified as a procedure of intermediate cardiac risk. Recent data indicate that the Cardiac Risk Index score for preoperative assessment by the latest guidelines is not suitable for vascular surgery procedures in general and carotid procedures in particular. This review aims to present and analyze all these results, concluding that current recommendations for this specific procedure should perhaps be reevaluated.

Detection of right ventricular dysfunction by tissue Doppler imaging in asymptomatic patients with pulmonary sarcoidosis

To the Editors: Tissue Doppler imaging (TDI) is a relatively new ultrasound modality in echocardiography, which is used to detect left and right ventricular functional abnormalities early and accurately by recording systolic and diastolic velocities of the mitral and tricuspidal annulus, respectively. The value of this method has been corroborated on numerous studies describing right ventricular (RV) dysfunction in a variety of systemic diseases with pulmonary and/or cardiovascular involvement 1. Sarcoidosis is a multisystem granulomatous disease of unknown aetiology characterised by cardiorespiratory manifestations, among others. RV dysfunction is often apparent but not clinically recognised until pulmonary hypertension has been developed 2. The purpose of this study was to evaluate RV function in patients with sarcoidosis by the use of ultrasound, including the TDI modality, and correlate it with clinical, respiratory and cardiac parameters. We conducted an observational case–control study. Consecutive sarcoidosis patients were recruited from the outpatient Sarcoidosis Clinic of the General Hospital of Chest Diseases of Athens, Athens, Greece between October 2007 and June 2008. The primary criterion for enrolment was the presence of biopsy-proven pulmonary sarcoidosis without the presence of cardiac involvement, according to the modified criteria of the Japanese Ministry of Health and Welfare 3. The exclusion criterion was the presence of any associated disease that could influence systolic and/or diastolic properties of the heart. Subgroup analyses were performed with the patients divided in two groups based on the therapy administered: a subgroup with patients who did not receive any therapy and a subgroup with patients who received any kind of therapy (cortisone, etc .). Those who did not receive any medication were further classified into groups according to the disease stage at which the patients originally presented. All patients were compared to healthy volunteers. The two groups (patients and healthy controls) were age-, …

The significance of right-sided chest leads in exercise testing for the detection of right ventricular dysfunction post myocardial infarction of the inferior wall

BACKGROUND The incorporation of right-sided chest leads (V(3)R-V(5)R) into the standard exercise testing has been reported to improve its diagnostic accuracy. The purpose of this study was to evaluate the ability of exercise testing in detecting right ventricular (RV) dysfunction post myocardial infarction (MI) of the inferior wall, using additional V(3)R-V(5)R leads. METHODS We studied 133 patients (59 ± 5 years, 81 males) with a history of inferior MI due to right coronary artery obstruction (affirmed with coronary angiography). All patients underwent an echocardiographic assessment of RV function 4 weeks after discharge and an exercise treadmill test in order to detect possible RV dysfunction. Recordings during exercise were obtained with the standard 12 leads plus V(3)R-V(5)R. RESULTS From 133 patients, 97 (group A) presented with normal right ventricle according to the echocardiographic study while the rest 36 patients (group B) presented with RV dysfunction. Maximal exercise-induced ST-segment deviation (in mm) was similar in the standard 12 leads for the 2 groups (2.1 ± 0.4 vs 1.8 ± 0.3, p = NS) while in V(3)R-V(5)R it was greater in group B (0.7 ± 0.3 vs 1.4 ± 0.4, p<0.05). Sensitivity, positive prognostic value, negative prognostic value and accuracy of exercise testing in detecting RV dysfunction were all improved using V(3)R-V(5)R (78 vs 47%, 39 vs 29%, 87 vs 75%, 62 vs 55% respectively, p<0.05 for all) while specificity was not deteriorated (56 vs 58%, p = NS). CONCLUSIONS The addition of right-sided chest leads (V(3)R-V(5)R) improves the diagnostic ability of standard exercise testing in detecting and especially in excluding RV dysfunction post inferior MI.

Atheromatosis and endothelial response of the small peripheral arteries: a peritoneal dialysis versus hemodialysis patients mismatch

Methods 84 male ESRD patients, 46 on HD and the rest 38 on PD without apparent cardiovascular disease enrolled the study. The two groups did not differ statistically in age, (64,9 vs 64) prevalence of hypertension, diabetes mellitus, smoking and lipid profile. All underwent common carotid ultrasound intima –media thickness (cIMT) evaluation to uncover subclinical atheromatosis. Endothelial function was estimated by the SHIM-5 score (theoretical range 0-25) that grades erectile potency, a nitric oxide depended phenomenon based on vasodilator ability of the penile vasculature. Higher grading indicates a healthier endothelial vascular status.