Biomedical subjects

Ilias Karabinos

Publications and source records attributed to Ilias Karabinos.

14 recordsLinked to original sources

PubMed2006

Acute changes in N-terminal pro-brain natriuretic peptide induced by dobutamine stress echocardiography.

AIMS: Aim of the study was to determine the effect of dobutamine stress echocardiography (DSE)-induced ischemia on circulating levels of N-terminal fragment of B-type natriuretic peptide (NT-pro-BNP). METHODS AND RESULTS: One hundred and twenty-eight patients underwent DSE for the evaluation of known or suspected coronary artery disease. NT-pro-BNP levels were measured before and 1h after completion of DSE. NT-pro-BNP levels were similar before and after DSE regardless of whether patients had (123+/-101.8 vs. 124.2+/-108.3, p=NS) or did not have inducible ischemia (96.5+/-70.5 vs. 100.5+/-71.1, p=NS). Patients with inducible myocardial ischemia had no different NT-pro-BNP levels compared to patients without inducible ischemia both before (123+/-101.8 vs. 96.5+/-70pg/ml, p=0.37) and after DSE (124.2+/-108.3 vs. 100.5+/-71.1pg/ml, p=0.55). Patients with severe inducible ischemia had significantly higher NT-pro-BNP levels compared to patients with mild or moderate inducible ischemia and patients without inducible ischemia, both before (208.5+/-125.5 vs. 96+/-78.9 vs. 96.5+/-70pg/ml, p=0.017 and p=0.025, respectively) and after DSE (212.5+/-138.1 vs. 94.8+/-81.1 vs. 100.5+/-71.1pg/ml, p=0.015 and p=0.023, respectively). NT-pro-BNP levels before DSE could be independently predicted by age (p<0.0001), presence of diabetes mellitus (p=0.002), and ejection fraction (p=0.005), but not DSE inducible ischemia. CONCLUSION: NT-pro-BNP is not affected by DSE-induced ischemia and cannot be used in clinical practice to improve diagnostic accuracy of DSE.

Acute Disease↗

PubMed2006

Handgrip-enhanced myocardial fractional flow reserve for assessment of coronary artery stenoses.

BACKGROUND: Fractional flow reserve (FFR) may yield false-negative results in up to 12% of lesions tested, and there is a zone of uncertainty at borderline values. METHODS: Forty-eight patients were investigated by means of dobutamine stress echocardiography (DSE), coronary angiography, and FFR assessment of 48 coronary lesions before, during, and immediately after handgrip exercise. RESULTS: Mean FFR values were lower during and immediately after handgrip exercise as compared with baseline (0.86 +/- 0.09 vs 0.87 +/- 0.08 vs 0.88 +/- 0.08, P < .05, respectively). The sensitivity of FFR < or = 0.75 for predicting myocardial ischemia on DSE was 17.6% before handgrip exercise, 52.9% during, and 35.5% immediately after exercise. The specificity of FFR < or = 0.75 before, during, and immediate after exercise was 100%, 93.5%, and 96.8%, respectively. In 10 patients, FFR values > 0.75 before handgrip became < or = 0.75 during or immediately after handgrip exercise (P = .01). All these patients had angina and/or DSE indicating ischemia in the territory of the vessel studied, and underwent coronary intervention. At 6 months follow-up, all patients were asymptomatic with negative DSE tests. CONCLUSIONS: The addition of handgrip exercise can significantly lower the FFR and potentially improve its ability to detect physiologically significant stenoses.

Angina Pectoris↗

PubMed2006

Spontaneous coronary artery dissection during a dobutamine stress echocardiography.

We report a case of a spontaneous dissection of the right coronary artery during a dobutamine stress echocardiography (DSE) study in a middle-aged male. Our patient experienced a severe retrosternal pain of abrupt onset during the DSE study, whereas EKG was evident of significant ST segment elevation in II, III, avF, and V5-V6 leads, followed by an accelerated idioventricular rhythm. Immediate coronary angiogram revealed a minor dissection of the distal part of the right coronary artery.

Aortic Dissection↗

PubMed2006

Sirolimus-versus paclitaxel-eluting stents: a comparison of two consecutive series in routine clinical practice.

BACKGROUND: We compared two consecutive series of patients treated with sirolimus-eluting stents (SES) or paclitaxel-eluting stents (PES). METHODS: Two hundred and ninety-five patients with 590 coronary lesions were treated with 274 SES and 379 PES. Patients with symptoms or positive dobutamine stress echocardiography were subjected to repeat coronary angiography. RESULTS: During a follow-up of 13.3 +/- 5.7 months, the incidence rate of major adverse cardiac events (MACE) was 4.1%, including, 1 death, 4 Q-wave myocardial infarctions, 2 late angiographic stent thromboses, 3 subacute stent thromboses, and 11 target vessel revascularizations (TVR), and was not significantly different between SES (n = 5) and PES (n = 7). Stent overlapping was found to be an independent predictor of both MACE (odds ratio = 0.078, P = 0.02) and TVR (odds ratio = 0.077, P = 0.02). Follow-up symptoms- or ischemia-driven angiography was performed in 45 patients. Only vessel size was a predictor of stent restenosis (P = 0.02), independent of stent type. Late loss was independently predicted by postdilatation of stent (beta =-0.24, P = 0.03), but not by type of stent (P = 0.14) or other parameters. Edge restenosis was seen in 8 patients subjected to lesion predilatation. The restenosis pattern after SES implantation was focal, but diffuse (n = 1) or proliferative (n = 1) restenosis, and in-stent aneurysm formation (n = 1) was also seen with PES. CONCLUSIONS: Despite a trend for a higher incidence of MACE with PES, no significant differences between the two stent types were detected. Diffuse restenosis was seen only with PES, and edge restenosis only in lesions with balloon predilatation before stent implantation. Stent overlapping was an independent predictor of both TVR and MACE.

Blood Vessel Prosthesis Implantation↗

PubMed2005

Comparison of the effects of ramipril versus telmisartan in reducing serum levels of high-sensitivity C-reactive protein and oxidized low-density lipoprotein cholesterol in patients with type 2 diabetes mellitus.

The effect of ramipril (an angiotensin [AT]-converting enzyme inhibitor), telmisartan (an AT-II type 1 receptor blocker), or their combination on inflammation and lipid peroxidation was assessed in 37 patients with type 2 diabetes who were free of coronary artery disease. All regimens were associated with a significant reduction of C-reactive protein and oxidized low-density lipoprotein cholesterol serum levels (p <0.001). These results further enlighten the mechanisms underlying the cardiovascular beneficial effect of renin-AT system inhibition.

Angiotensin II Type 1 Receptor Blockers↗

PubMed2005

Transcoronary transplantation of autologous mesenchymal stem cells and endothelial progenitors into infarcted human myocardium.

The aim of the study was to investigate whether a combination of mesenchymal stem cells (MSCs) capable of differentiating into cardiac myocytes and endothelial progenitors (EPCs) that mainly promote neoangiogenesis might be able to facilitate tissue repair in myocardial scars. Previous studies have shown that intracoronary transplantation of autologous bone marrow stem cells results in improvement of contractility in infracted areas of human myocardium. Eleven patients with an anteroseptal myocardial infarction (MI) underwent transcoronary transplantation of bone marrow-derived MSCs and EPCs to the infarcted area through the left anterior descending artery. Eleven age- and sex-matched patients served as controls. Wall motion score index was significantly lower at follow-up in the transplantation (P = 0.04) but not in the control group. On stress echocardiography, there was improvement of myocardial contractility in one or more previously nonviable myocardial segments in 5 out of 11 patients (all with recent infarctions) and in none of the controls (P = 0.01). Restoration of uptake of Tc(99m) sestamibi in one or more previously nonviable myocardial scars was seen in 6 out of 11 patients subjected to transplantation and in none of the controls (P = 0.02). Cell transplantation was an independent predictor of improvement of nonviable tissue. Intracoronary transplantation of MSCs and EPCs is feasible, safe, and may contribute to regional regeneration of myocardial tissue early or late following MI.

Adult↗

PubMed2005

Impaired systolic dysfunction of left ventricular longitudinal fibers: a sign of early hypertensive cardiomyopathy.

BACKGROUND: Atrioventricular plane displacement (AVPD) study by M-mode echocardiography can supply useful clinical information about left ventricular (LV) long-axis function. HYPOTHESIS: We assessed the hypothesis that AVPD estimation could be used to detect early hypertensive cardiomyopathy. METHODS: The study population included 81 hypertensive patients with normal LV ejection fraction and fractional shortening, and 50 age- and gender-matched healthy controls. By utilizing M-mode and apical views, the following parameters were estimated: early mitral flow peak velocity (E) and deceleration time (DT), peak velocity of late mitral flow (A), A/E ratio, isovolumic relaxation time (IVRT), total AVPD, AVPD motion during atrial systole (At), systolic AVPD (total AVPD-At), and At/total AVPD ratio. RESULTS: Of 81 hypertensive patients, 16 (19.7%) had a normal (Group 1) and 65 (80.3%) an impaired LV relaxation filling pattern (Group 2). Mean total AVPD-At was significantly lower in Group 2 than in Group 1 (7.1 +/- 2 vs. 10.3 +/- 3 mm, p<0.001) and in Group 1 compared with healthy subjects (10.3 +/- 3 vs. 13.1 +/- 1 mm, p<0.001). Mean At and At/total AVPD were significantly higher in Group 2 than in Group 1 (46.9 +/- 8.6 vs. 37.7 +/- 8.7%, p<0.001), but not in Group 1 compared with healthy subjects (37.7 +/- 8.7 vs. 36 +/- 6%, p>0.05). CONCLUSIONS: Hypertensive patients without overt systolic dysfunction demonstrate LV long-axis systolic dysfunction, while long-axis diastolic dysfunction always coexists with abnormal diastolic filling patterns. This suggests that long-axis systolic dysfunction precedes diastolic dysfunction at the same axis in hypertensive patients.

Adult↗

PubMed2005

Latent arterial hypertension in apparently lone atrial fibrillation.

INTRODUCTION: Longitudinal studies on lone AF are rare and the incidence of hypertension in this population unknown. This study aimed at investigating the incidence of arterial hypertension in patients with apparently lone atrial fibrillation (AF). METHODS AND RESULTS: Out of 292 consecutive patients presented with permanent or paroxysmal AF, 32 patients were diagnosed as having lone AF according to strict criteria. Three patients were subjected to ablation of the ligament of Marshall, 14 patients to pulmonary vein isolation, and the remainder were treated with beta blockade. Patients were followed-up for a 1-3 year period. During follow-up, 14 patients were diagnosed as having arterial hypertension. Thirteen of them had recurrent AF despite ligament of Marshall ablation (1 patient), pulmonary vein isolation (4 patients) and beta blockade (8 patients). Cox regression analysis revealed that the only significant predictor of development of hypertension was complete or partial response to antiarrhythmic therapy (beta=3.82, S.E.=1.22, exp(b)=45.63, 95% C.I.=4.17-499.2, p=0.001), independent of age (beta=-0.01, p=0.74), sex (beta=-0.91, p=0.28), left ventricular ejection fraction (beta=0.06, p=0.52), left atrial size (beta=0.58, p=0.7) and kind of antiarrhythmic therapy (ablation or drug therapy) (beta=1.36, p=0.09). In patients with lone AF that did not respond at all to antiarrhythmic therapy, there was a 45.6 times higher risk of diagnosing hypertension during the next 3 years as compared to responders. CONCLUSION: Approximately 44% of patients with an initial diagnosis of lone AF may represent occult cases of arterial hypertension. In these patients hypertension may affect AF recurrence and treatment outcomes, regardless of the mode of antiarrhythmic therapy used.

Adult↗

PubMed2005

Microalbuminuria: a strong predictor of 3-year adverse prognosis in nondiabetic patients with acute myocardial infarction.

BACKGROUND: The aim of this study is to evaluate the significance of microalbuminuria (MA) as a 3-year prognostic index in nondiabetic patients with acute myocardial infarction (AMI). METHODS: One hundred seventy-five patients with AMI were followed prospectively for 3 years. The study end point was cardiac death or rehospitalization for an acute coronary event. RESULTS: Forty-two patients (24%) developed a new cardiac event during the follow-up. Microalbuminuria (P < .001), pulmonary edema during initial hospitalization (P < .001) and postinfarction angina (P = .0364), advanced age (P = .001), severe atherosclerosis (high Gensini score) (P = .036), ejection fraction <50% (P = .0013), history of bypass surgery (P = .0265), and early conservative management (P = .0214) were all associated with adverse prognosis. Cox proportional hazards regression analysis showed that MA was an independent predictor of 3-year adverse prognosis in all the models tested, with an adjusted relative risk for the development of a cardiac event ranging from 2.1 to 4.3. CONCLUSIONS: In nondiabetic patients with AMI, MA is a strong and independent predictor of an adverse cardiac event within the next 3 years.

Aged↗

PubMed2005

Sustained ventricular tachycardia induced by dobutamine stress echocardiography: a prospective study.

AIMS: To investigate the prognostic significance and electrophysiological characteristics of dobutamine stress echo (DSE)-induced sustained monomorphic ventricular tachycardia (VT). METHODS: In our department, 3022 DSE studies were carried out on 2688 patients, aged 54.7 +/- 11.8 years, over a 3.5 year period. Patients with DSE-induced VT were studied by means of coronary angiography and electrophysiological testing, and were followed-up for 17.8 +/- 9.3 months. RESULTS: During DSE, nine patients (0.3%) developed sustained monomorphic VT. Four patients had coronary artery disease, one developed spontaneous right coronary artery (RCA) dissection during DSE, one patient had peripartum cardiomyopathy and the remainder had normal coronary arteries. Logistic regression analysis did not identify clinical parameters such as left ventricular ejection fraction, documentation of an ischaemic response or the presence of non-viable myocardial segments during DSE, that could predict the occurrence of DSE-induced VT. Monomorphic VT was inducible by electrophysiological testing in two patients with CAD and reduced LVEF. During follow-up, only these two patients developed VT. CONCLUSION: Sustained monomorphic VT is a rare complication of DSE, with no predictive value for the identification of patients with coronary artery disease and no prognostic significance in patients with normal coronary arteries. No predictors of its occurrence were identified.

Coronary Angiography↗

PubMed2004

Right and left inferior extensions of the atrioventricular node may represent the anatomic substrate of the slow pathway in humans.

OBJECTIVES: The purpose of this study was to investigate the electrophysiologic characteristics of the inferior extensions of the human atrioventricular (AV) node and their possible relationship to slow pathway conduction. BACKGROUND: The human heart contains right and left inferior extensions of the AV node that relate to right and left atrial inputs. METHODS: Fourteen patients admitted for catheter ablation of left-sided accessory pathways were studied. Atrial pacing was performed from multiple sites in both atria, and simultaneous His-bundle recordings from right and left sides of the septum were made. RESULTS: Significant differences of A-H and stimulus to His (St-H) intervals with pacing at various sites were found. St-H intervals were similar during constant pacing from the low right atrium or the left inferoparaseptal area (112 +/- 28 ms vs 112 +/- 26 ms, P = .8, for right His recordings and 114 +/- 23 ms vs 111 +/- 25 ms, P = .9, for left His recordings). At maximum decrement, there were significantly shorter St-H intervals during left inferoparaseptal pacing compared to low right atrial pacing (201 +/- 24 ms vs 218 +/- 44 ms, P = .02, for right His recordings, and 200 +/- 24 ms vs 219 +/- 41 ms, P = .009, for left His recordings). Differences on right His recordings between St-H intervals at maximum decrement and at constant pacing from the low right atrium were significantly higher than corresponding differences on left His recordings during pacing from the left inferoparaseptal area (P = .035). CONCLUSIONS: Our findings support the concept that the right and left inferior extensions of the human AV node may represent the anatomic substrate of the slow pathway as defined electrophysiologically.

Adult↗

PubMed2004

Ablation of superior pulmonary veins compared to ablation of all four pulmonary veins:.

INTRODUCTION: Isolation of all pulmonary veins (PV) is advocated for treatment of paroxysmal atrial fibrillation (PAF). However, the superior PVs are responsible for most AF triggers, whereas the inferior PVs carry the higher risk for ablation-induced ostial stenosis. The aim of this study was to compare a superior PV isolation approach with isolation of all PVs for treatment of PAF. METHODS AND RESULTS: Fifty-two patients with PAF were randomized to either left superior pulmonary vein (LSPV) isolation followed by additional isolation of the right superior pulmonary vein (RSPV) in case of AF recurrence (group A, n = 27) or isolation of all four PVs followed by a repeat procedure in case of recurrence (group B, n = 25). At 1-year follow-up, 11 patients (41%) in group A and 8 patients (32%) in group B had AF relapse (P = 0.55). No significant differences in AF relapse were detected between groups at 3 and 12 months (log rank = 0.36, P = 0.54) and by Cox proportional hazards model analysis (P = 0.62). Nonsignificant PV stenosis was detected in two patients from group B. Total radiofrequency energy delivery and fluoroscopy and procedure times were lower in group A: 8.9 +/- 1.4 minutes vs 25.6 +/- 3.7 minutes (P < 0.001), 22.2 +/- 6.8 minutes vs 62 +/- 10.3 minutes (P < 0.001), and 131.8 +/- 26.5 minutes vs 222.2 +/- 32.3 minutes (P < 0.001), respectively. CONCLUSION: A staged superior PVs isolation approach confers equal success rates but with reduced radiofrequency energy delivery and fluoroscopy and procedure times compared to isolation of all PVs at the initial ablation attempt.

Adult↗

PubMedDate not supplied

Comparison of enoxaparin and unfractionated heparin in coronary angioplasty.

INTRODUCTION: Recent studies have shown that enoxaparin may be equally as safe and effective as unfractionated heparin during a coronary angioplasty procedure. The aim of this study was to investigate whether enoxaparin can be used effectively and safely in place of unfractionated heparin in patients undergoing emergency or programmed coronary angioplasty, regardless of the use of platelet glycoprotein IIb/IIIa inhibitors. METHODS: We compared two series of consecutive patients, who received unfractionated heparin (n = 217) or enoxaparin (n = 116) during emergency or programmed angioplasty, regardless of age, weight, renal function and the coadministration of platelet glycoprotein IIb/IIIa inhibitors. In the patients who received enoxaparin the arterial sheaths were removed immediately after the procedure. RESULTS: There were no significant differences between the two groups as regards clinical characteristics or risk factors for coronary artery disease. During a 30-day follow up no major adverse cardiac events were observed (death, myocardial infarction, target vessel revascularisation). Multivariate logistic regression analysis showed no correlation between the anticoagulant used and the occurrence of major cardiac events in the two groups of patients (log odds ratio = -9.46, p = 0.89), after controlling for age, sex, administration of platelet glycoprotein IIb/IIIa inhibitors, number of coronary lesions, number of stents used, clinical picture and risk factors for coronary artery disease. As regards the development of haematoma in the groin, the only significant independent predictive factor for this was the coadministration of platelet glycoprotein IIb/IIIa inhibitors. CONCLUSIONS: The use of enoxaparin in coronary angioplasty is safe, effective and allows faster removal of sheaths and mobilisation of the patient.

Aged↗

PubMedDate not supplied

Study of atrial function using echocardiographic automatic boundary detection following external or internal cardioversion for idiopathic atrial fibrillation.

INTRODUCTION: The aim of this study was to evaluate the validity of an echocardiographic method of automatic boundary detection (ABD) in the assessment of the degree of atrial dysfunction in patients who had undergone external or internal cardioversion for idiopathic atrial fibrillation. METHODS: The study population included 31 patients (mean age 48 +/- 6.5 years) with idiopathic atrial fibrillation. The patients were randomised into two groups: Group 1 (14 patients, 8 +/- 3.13 joules), where internal cardioversion was applied, and Group 2 (17 patients, 200-360 joules), where external cardioversion was used for restoration of sinus rhythm. During the following 24 hours the ABD method was used in both groups to assess the following functional indices for both the left and the right atrium: a) total fractional change of atrial area (delta1), b) passive change of atrial area (delta2), c) change of atrial area due to atrial contraction (delta3) and d) index of % atrial expansion (delta4). RESULTS: All patients in both groups were successfully cardioverted (100%, p: NS). Post-cardioversion indices delta1-delta4 for both left and right atria did not differ between the 2 groups (p:NS). A negative correlation was found between left atrial function as assessed by ABD and the mean energy in joules delivered through the catheter in each patient for successful cardioversion (r = -0.55 to r = -0.67 and p = 0.04 to p = 0.01). However, no relevant correlations were found for the right atrium (p:NS). CONCLUSIONS: 1) The atrial dysfunction which follows the cardioversion of idiopathic atrial fibrillation (atrial stunning) is not related to the type of cardioversion (internal or external). 2) The higher the amount of energy delivered during internal cardioversion, the greater the degree of left atrial dysfunction observed.

Atrial Fibrillation↗