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A Kranidis

Publications and source records attributed to A Kranidis.

At least 19 recordsLinked to original sources
PubMed2001

Functional and prognostic significance of silent ischemia during dobutamine stress echocardiography in the elderly.

BACKGROUND: The functional and prognostic significance of silent ischemia relative to symptomatic ischemia during non-invasive testing remains controversial. DESIGN: The aim of this prospective study was to assess whether the presence of dobutamine-induced silent ischemia was associated with the amount of myocardial ischemic burden and to determine the prognostic significance of painless ischemia in elderly people with stable coronary artery disease. METHODS: A cohort of 289 patients > or =70 years of age with positive dobutamine stress echocardiography result and significant coronary artery disease proven by coronary arteriography, were followed up during a 35 +/- 13 month period for the development of cardiac events. RESULTS: The prevalence of silent ischemia during dobutamine infusion was 63%. Patients with painful ischemia were more likely to have lower peak heart rate (P < 0.01) and showed ST segment depression more frequently during the dobutamine stress test than did patients with painless ischemia (52 versus 31%, P < 0.05). There was no significant difference between the patients with and without angina according to wall motion score index at rest (1.35 +/- 0.29 versus 1.32 +/- 0.37) and at peak stress (1.61 +/- 0.35 versus 1.58 +/- 0.44), stress-rest wall motion index difference (0.27 +/- 0.09 versus 0.25 +/- 0.08), the presence of dyskinesia at peak stress (36 versus 31%), the number of segments with regional > or =2 point change from rest to peak stress (38 versus 29%) and the decrease of left ventricular end systolic volume at peak stress (89 versus 86%). During the follow-up period a total of 269 patients developed 153 (57%) cardiac events: 15 cardiac deaths, 19 non-fatal myocardial infarctions, 119 episodes of unstable angina. No significant difference in cardiac mortality and in total cardiac event rate was observed between patients with or without angina (6 versus 5% and 60 versus 55%, respectively). CONCLUSIONS: Our data demonstrate that the magnitude of myocardial dysfunction assessed by dobutamine stress echocardiography is comparable in elderly patients with or without anginal chest pain. The presence of painful ischemia is not accompanied by an increased risk for subsequent cardiac events in this cohort of patients.

Aged↗
PubMed2000

Mitral regurgitation protects from left atrial thrombogenesis in patients with mitral valve disease and atrial fibrillation.

The aim of this study was to test the hypothesis that mitral regurgitation (MR) has a protective effect on the development of left atrial thrombus (LAT) in patients with rheumatic heart disease and atrial fibrillation (AF). The study population consisted of 48 anticoagulated patients (mean age = 57.1 +/- 10 years). Predominant mitral stenosis (MS) was present in 14 patients, predominant MR in 14, and a mechanical valve in 20. All patients underwent detailed transesophageal echocardiography. Severity of MR was based on measurements of the MR jet by color flow mapping. Patients were divided into two groups: (a) those with MR > or = 3+ (n = 12, 25%), and (b) those without significant MR (n = 36, 75%). A LAT was found in six patients (12.5%), who also had spontaneous echo contrast (SEC), while another group of 30 patients (62.5%) had SEC only. LAT and/or SEC were present in 2/12 patients (16.6%) with significant MR versus 34/36 patients (94.4%) without significant MR (P < 0.001). In addition to the absence of significant MR, left atrial diameter (LAD) > 60 mm, and severity of MS were also related to the presence of thrombus and/or SEC. Significant MR had a protective effect against thromboembolism, although this effect was abolished if LAD > 60 mm was present. In conclusion, in patients with mitral valve disease and AF, significant MR protects against LAT formation and systemic embolization. This protective effect was lost when LAD was > 60 mm.

Atrial Fibrillation↗
PubMed1998

Fractionated carboplatin radiosensitization: a phase I dose-escalation study.

Carboplatin is one of the most common drugs used for radiochemotherapy of cancer. However, the best way to combine the drug with fractionated radiotherapy has not been established. In the present study the authors investigated which maximum tolerated daily bolus dose of carboplatin would allow safe radiopotentiation for 10 consecutive radiotherapy days, the scheme being repeated twice during the 6 weeks that a conventional radiotherapy scheme lasts. Seventy-two patients with lung or pelvis malignancies were included in a dose escalation study. Twenty-four patients comprised the first baseline cohort and were treated with radiotherapy alone. The daily dose of carboplatin was escalated starting from 38 mg/m2 daily (for 10 days) and increasing by 7 mg/m2 per day. Six patients were to be included in each cohort. All 12 patients treated at the 38 mg/m2 and 45 mg/m2 dose level completed two cycles of 10-day carboplatin treatment with no grade III-IV toxicity. Granulocyte colony-stimulating factor effectively averted the incidence of neutropenia and allowed the administration of the second carboplatin 10-day cycle in five of six patients at the 52 mg/m2 daily dose level. Platelet grade III-IV toxicity was observed in all 12 patients (six supported with granulocyte colony-stimulating factor and six with granulocyte colony-stimulating factor and recombinant human erythropoietin) treated at the 59 mg/m2 daily dose level and none of them received the second cycle of chemotherapy. Twelve patients were treated at the same dose level using amifostine 500 mg before carboplatin infusion. Two patients interrupted chemotherapy because of severe nausea and vomiting. Nine of 10 who accomplished the 10-day treatment had platelet levels more than 90,000/microl on day 28 and completed the second 10-day cycle without severe toxicity. Acute radiation toxicity did not increase in the carboplatin cohorts. In this study the authors established a high-dose fractionated carboplatin schedule that can be safely administered during radical radiotherapy.

Adult↗
PubMed1997

Coronary microcirculation evaluation with transesophageal echocardiography Doppler in type II diabetics.

Evaluation of coronary microvascular function can be obtained through coronary flow reserve measurements. The aim of this study was to evaluate the coronary microvascular function by using transesophageal-Doppler echocardiographic assessment of coronary flow reserve. The study included 32 normotensive patients with type II diabetes mellitus (group A) of short duration (6.1+/-3.8 years) aged 55.4+/-9.4 years and 14 healthy volunteers matched for age, gender and BMI (group B). No patients had clinical evidence of coronary artery disease and all of them produced a negative recent stress ECG test. Excluded from the study were patients with anemia, left ventricular hypertrophy, arrhythmia, congenital, or acquired structural heart disease. All subjects underwent transesophageal-Doppler echocardiography. Satisfactory coronary blood flow velocity recordings could be obtained from the initial segment of the left anterior descending coronary artery in healthy volunteers and in 27 patients at baseline and 2 min after dipyridamole infusion (0.56 mg/kg, for 4 min). In the remaining 5 patients no satisfactory recordings were available. The indexes of coronary flow reserve, i.e. the ratios of dipyridamole over basal maximum and mean diastolic velocities were calculated. Dipyridamole/rest maximal coronary reserve (Table 3) was 1.946+/-0.743, while this ratio for the mean diastolic velocity was 1.969+/-0.805 in group A. The respective values for group B, were 2.811+/-0.345 (P=0.000 vs. group A) and 2.914+/-0.303 (P=0.000 vs. group A). Thus, the increase in coronary flow reserve although present in both groups, it was more impressive in the normal group. Multiple regression logistic analysis of: age, sex, smoking, glucosylated hemoglobin, duration of diabetes and type of therapy, did not show any correlation of these parameters with the above ratios. This study shows that coronary flow reserve, as measured with transesophageal echocardiography-Doppler, is severely impaired in normotensive patients with type II diabetes, with relatively short duration of the disease.

Age Factors↗
PubMed1997

Aneurysm of the mitral-aortic intervalvular fibrosa as a rare cause of angina pectoris: angiographic demonstration.

Aneurysms of the mitral-aortic interventricular fibrosa (MAIF) are exceptionally rare complications, commonly following aortic valve endocarditis. This report describes the angiographic findings of such an aneurysm, in a patient who developed an uncommon symptomatology of unstable angina pectoris, caused by the aneurysm's expansion against the coronary arteries. Surgical treatment is also discussed.

Aged↗
PubMed1997

Stress echocardiography using adenosine combined with nitroglycerin-dobutamine in the detection of viable myocardium in patients with previous myocardial infarction.

The aim of this study was to assess the value of adenosine (A) and the combination of nitroglycerin (N) with dobutamine (D) stress echocardiography (SE) in the identification of viable myocardium. The clinical and electrocardiographic (ECG) effects of both tests were also evaluated. Fifty-two coronary artery disease patients, aged 56.4 +/- 8 years, with left ventricular dysfunction due to a previous myocardial infarction (mean ejection fraction: 49 +/- 8%) were included in the study. Cardiac catheterization was performed in all patients before A (140 micrograms/kg/minute for five minutes) and the combination of N with D (5-10 micrograms/kg/minute) stress echocardiography. On the echocardiogram, the left ventricle was divided into 16 segments and wall motion was graded semiquantitatively from 1 (normal) to 4 (dyskinesia). The echocardiographic index was also estimated. A segment was considered viable during A infusion when resting asynergy showed deterioration of one grade or more. In contrast, segmental viability was considered to be present during the combination of N with D infusion when resting asynergy showed improvement of one grade or more. A thallium 201 single photon emission computed tomography (SPECT) with reinjection was performed as reference standard for the identification of viable myocardium. Stress echocardiography during infusion of A was associated with short-duration angina attacks in 3 (5.8%) patients and transient complete atrioventricular (AV) block in 1 (1.9%), whereas during the combination of N with D infusion, 6 (11.5%) patients experienced ventricular bigeminy lasting for a short period. ST segment elevation greater than 1 mm was recorded in those leads having a Q wave, in 19 (36.5%) patients. In 10 of these 19 (52.6%), viable myocardium was present in SPECT, as it was in 33 patients (63.5%) having no ST segment elevation (P = NS). Of a total of 832 segments that were graded during A-SE, 276 exhibited resting asynergy and the remaining 556 had normal motion and thickening at rest. The echocardiographic index during A infusion increased from 1.52 +/- 0.22 to 1.71 +/- 0.24 (P < 0.001), whereas during D and N infusion it decreased from 1.53 +/- 0.31 to 1.30 +/- 0.42 (P < 0.001). With SPECT considered as the gold standard for the identification of viable myocardium, sensitivity, specificity, and positive and negative predictive values of A-SE in detecting viable myocardium were 54%, 86%, 65% and 80%, respectively. The respective values for the combination of nitroglycerin with D-SE were 91%, 89%, 78%, and 96%, respectively. Stress echocardiography during A, and the combination of N with D, constitute safe methods in the identification of viable myocardium. The detection of ST segment elevation in the ECG leads with a Q wave during the combined infusion of nitroglycerin and dobutamine is not related to the presence of viable myocardial tissue. The A-SE provide moderate diagnostic accuracy, while the combination of N with D during SE is much superior in detecting viable myocardium.

Adenosine↗
PubMed1996

Angioplasty of a left anterior descending artery originating from the right sinus of Valsalva (discussion in decision making).

In this case report, we describe a successful percutaneous transluminal coronary angioplasty of an abnormally originating left anterior descending artery from the right sinus of Valsalva. We discuss about the decision making in this rare and challenging case, since there is more than one opinion as to which is the appropriate treatment in this group of patients.

Angioplasty, Balloon, Coronary↗
PubMed1996

Single coronary artery from the right sinus of Valsalva, associated with absence of left anterior descending and an ostium-secundum-type atrial septal defect: a rare combination. A case report.

A case of single coronary artery from the sinus of Valsalva, with an anomalous origin of the left circumflex coronary artery from the just proximal portion of the right coronary artery, absence of the left anterior descending, and an ostium-secundum-type atrial septal defect is presented. This combination seems to be very rare.

Adult↗