M. Drakopoulou

The Role of Inflammation in Atrial Fibrillation: A Myth or a Fact?

Atrial fibrillation (AF) is the most common sustained rhythm disturbance resulting in substantial morbidity and mortality as well as increased medical costs in general population. The possible association between AF and inflammation is suggested by several studies that are based on the identification of inflammatory serum biomarkers that are elevated in patients with AF. In this population, the successfulness of maintenance of sinus rhythm after cardioversion and the risk of cardioembolic stroke are related to the inflammatory burden. Furthermore, the positive effect of the antiinflammatory agents on the prevention and modulation of AF further supports this hypothesis.

Prognostic clinical and angiographic characteristics for the development of a new significant lesion in remote segments after successful percutaneous coronary intervention

BACKGROUND The majority of cardiovascular events in patients undergoing PCI arise from the progression of NCL during the long-term follow-up period. The purpose of the study was to investigate the clinical and angiographic factors related to the progression of non-culprit lesions (NCL) of patients undergoing percutaneous coronary interventions (PCI). METHODS One hundred and seventeen patients that underwent two coronary angiograms with a time interval greater than 3 months were enrolled. All patients underwent PCI as a treatment for the culprit lesion. In the second coronary angiography we investigated whether they had a new culprit lesion clearly differentiated from the one of the first angiogram. The demographic characteristics, the clinical syndrome responsible for the first PCI and the procedural characteristics were recorded. Quantitative coronary angiography was performed at the culprit lesion of the second angiography and in the same lesion in the first angiography. RESULTS Multivariate analysis showed that the independent variables for the development of a significant lesion at the follow-up requiring intervention were: the presence of complex lesion (53.78% vs 36.22%, p<0.001, OR=39.42), acute myocardial infarction (AMI) at the initial diagnosis (36.3% vs 32.4%, p<0.001, OR=3.9), and smoking (46.15% vs 53.84%, p=0.03, OR=0.29). CONCLUSIONS Patients with AMI and complex morphology of NCL have increased risk for a new intervention after successful PCI. Smoking at the time of the follow up, was associated with fewer coronary interventions.

Percutaneous Coronary Intervention in Chronic Stable Angina

Although the therapeutic advantage of percutaneous coronary intervention in acute coronary syndromes have been proved in numerous studies, its position in the treatment of stable angina remains a controversial issue. The results of the recent studies did not lead into definite answers for the proper treatment of chronic coronary artery disease. The identification of the patients that will benefit from the interventional approach is necessary and is probably based on the proper screening for myocardial ischemia with noninvasive diagnostic techniques. In this review article, we mention the most recent studies for the treatment of chronic stable angina with respect to clinical outcome and economical consequences.

Chapter 2.5 – Acute Coronary Syndromes

Among other clinical presentations of coronary artery disease, acute coronary syndromes (ACS) are particularly worrisome as they are prevalent but at the same time portend a worse prognosis. ACS represents a life-threatening manifestation of atherosclerosis. Pathological, imaging, and biological observations have demonstrated that atherosclerotic plaque rupture or erosion, with differing degrees of superimposed thrombosis form the basic pathophysiological mechanisms in most conditions of ACS. During the last decades, rapid progress has been made in understanding its pathophysiology. New studies have provided new elements for the identification of a vulnerable plaque and/or patient. Ultimately, plaque destabilization seems to be a biomechanical phenomenon that depends on a complex interplay between structural features, biological processes and applied exogenous forces and stresses. This chapter is focused on the pathophysiological and biological processes related to the stepwise progression of atherosclerotic plaques and plaque destabilization leading eventually to ACS. Current methods that can potentially be used to identify high-risk plaques and aid in the management of ACS are also discussed.

THE EFFECT OF MIXED AORTIC VALVE DISEASE IN CLINICAL OUTCOMES AFTER TRANSCATHETER AORTIC VALVE REPLACEMENT

Background: The significance of aortic regurgitation in patients with severe aortic stenosis is well known. The aim of this study was to investigate the impact of mixed aortic valve disease (MAVD) in patients undergoing transcatheter aortic valve replacement (TAVR) with a self-expanding valve.

Comparison of prognostic risk scores after successful primary percutaneous coronary intervention.

BACKGROUND The aim of this study was to compare the predictive ability of clinical risk scores (ACEF, EuroSCORE and EuroSCORE II) to angiographic (SYNTAX score) and combined risk scores (Global Risk Score and Clinical SXscore) towards cardiovascular death and/or major adverse cardiac events (MACE) in patients with ST-segment elevation acute myocardial infarction (STEMI) managed with primary percutaneous coronary intervention (pPCI). METHODS A total of 685 patients successfully treated with pPCI were evaluated and the risk scores were calculated. The primary endpoint was the 2-year incidence of fatal cardiac events. Secondary end points were target lesion failure (TLF), repeat revascularization (RR) and MACE. RESULTS Patients distributed in the highest tertile of EuroSCORE II presented increased rates of CV death (CVD), all-cause mortality and MACE (p<0.001 for all). EuroSCORE II was associated with increased C-statistics (0.873, 95% CIs: 0.784-0.962 and 0.825, 95% CIs: 0.752-0.898 respectively) for predicting CVD and MACE over competing risk scores (p<0.05). EuroSCORE II conferred incremental discrimination (Harrells C, p<0.05 for all, apart from CSS for predicting CVD) and reclassification value (Net Reclassification Index, p<0.05 for all, apart from CSS for reclassifying MACE) over alternative risk scores for studys main endpoints. EuroSCORE II independently predicted CVD (HR=1.06, 95% CIs: 1.03-1.09, p<0.001) and MACE (HR=1.07, 95% CIs: 1.04-1.10, p<0.001). CONCLUSION EuroSCORE II has the best predictive ability of CVD and/or MACE after successful pPCI for the treatment of STEMI.

TRANSCATHETER AORTIC VALVE IMPLANTATION IN PATIENTS WITH CONCOMITANT MITRAL OR TRICUSPID REGURGITATION

It remains a question whether patients with severe aortic stenosis and concomitant atrioventricular valve regurgitation exhibit clinical benefits of transcatheter aortic valve implantation (TAVI). We sought to investigate the prognostic impact of concomitant significant pre-procedural mitral