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L Anthopoulos

Publications and source records attributed to L Anthopoulos.

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↗
PubMed2001

Comparative haemodynamic responses to the first dose of short- and long-acting ACE inhibitors in patients with congestive heart failure.

BACKGROUND: Angiotensin Converting Enzyme inhibitors (ACEi's) confer significant mortality and morbidity benefits in all functional grades of chronic heart failure (CHF). However, physicians' concerns regarding the possible occurrence of first-dose hypotension appear to be a contributing factor to their under-utilisation in both hospital and primary care settings. We investigated whether long-acting and short-acting ACEi's differ in their haemodynamic responses to the first-dose in patients with CHF. METHOD: This was a multicentre, randomised, open, two-parallel-group study of captopril 6.25 mg and perindopril 2 mg. 240 patients with CHF, age 68.9 +/- 8.9 years, of whom 66% were male, NYHA II-IV, with average blood pressure baseline values of 132.2 +/- 16.2/78.5 +/- 10.5 mmHg for systolic and diastolic blood pressure, and left ventricular ejection fraction (LVEF) of 31.3 +/- 7.4% received either captopril (n = 124) or perindopril (n = 116). Blood pressure was continuously monitored during the 8 h following drug intake. Minimum levels and maximum decreases in systolic, diastolic and mean arterial pressures were measured, along with the incidence of hypotensive episodes defined as mean blood pressure (MBP) fall > 20 mmHg, whether symptomatic or not. Subgroups of patients distributed according to age, baseline blood pressure (BP) and LVEF were subsequently analysed. RESULTS: Overall, a statistically significant treatment effect in favour of perindopril was observed. First-dose hypotension was observed more frequently following captopril than perindopril administration, with lower MAP minimal levels (78.0 +/- 8.9 vs. 84.5 +/- 10.1 mmHg, p < 0.0001), greater maximum falls (17.6 +/- 8.3 vs. 12.8 +/- 7.3 mmHg, p < 0.0001) and more frequent hypotensive episodes (42% vs. 15%, p < 0.0001). The incidence of at least one symptomatic episode was also significantly higher with captopril (10 patients vs. one patient, p = 0.029). Subgroup analyses according to age (< or = 70 years or > 70 years) or LVEF (< or = 30% or > 30%) reflected the main result. CONCLUSION: Initiation of treatment with ACE inhibitors is associated with different haemodynamic and clinical tolerances in CHF patients, regardless of their risk for hypotension, with possible clinical implications.

Aged↗
PubMed2000

Outcome of patients with congestive heart failure treated with standard versus high doses of enalapril: a multicenter study. High Enalapril Dose Study Group.

OBJECTIVES: We sought to prospectively and randomly compare survival with clinical and hemodynamic variables in patients with congestive heart failure (CHF) treated with standard versus high doses of enalapril. BACKGROUND: Angiotensin-converting enzyme (ACE) inhibitors produce hemodynamic and symptomatic benefits in patients with CHF, but there is still controversy about the optimal dose in this clinical setting. METHODS: Two hundred and forty-eight patients with advanced CHF (age 56.3+/-12 years) were randomized to receive a maximal tolerated dose of enalapril, up to 20 mg/day in group 1 (mean dose achieved 17.9+/-4.3 mg/day, n = 122) and 60 mg/day in group 2 (mean dose achieved 42+/-19.3 mg/day, n = 126). RESULTS: At enrollment, patients in group 1 were in New York Heart Association (NYHA) functional class 2.6+/-0.7 and had a mean systolic blood pressure (SBP) of 117+/-18 mm Hg, a mean heart rate (HR) of 85+/-16 beats/min and a left ventricular ejection fraction (LVEF) of 20.0+/-9.8%. In group 2, patients were in NYHA class 2.6+/-0.7; their SBP was 118+/-17 mm Hg, HR 83+/-15 beats/min and LVEF 18.8+/-8.1%. There were no significant differences in these characteristics between the two groups of patients at enrollment. After 12 months of follow-up, 22 (18%) of 122 patients in group 1 and 23 (18%) of 126 patients in group 2 had died (p = 0.995, with 80% power of the study to detect a delta difference of 13%). The NYHA class was the same (1.9+/-0.7) in both groups; SBP was 111+/-16 and 111+/-17 mm Hg, HR 77+/-12 and 79+/-13 beats/min and LVEF 31+/-19% and 30+/-12% in groups 1 and 2, respectively. These differences were not statistically significant. The study had a power of 80% to detect (p = 0.05) the following changes: 13% in death rate, 0.25 units in NYHA class, 6 mm Hg in SBP, 5 beats/min in HR and 6% in LVEF. CONCLUSIONS: No significant differences were found in survival and clinical and hemodynamic variables between patients receiving standard and those receiving high doses of enalapril.

Adolescent↗
PubMed1999

Combined dynamic cardiomyoplasty and transvenous implantable cardioverter defibrillator system.

A transvenous implantable cardioverter defibrillator (ICD) was implanted in a patient with drug refractory ventricular fibrillation who had undergone latissimus dorsi cardiomyoplasty. The skeletal muscle was stimulated by a pulse train generator (cardiostimulator) implanted at the time of cardiomyoplasty. With proper programming of the devices neither adverse ICD-cardiostimulator interactions nor device malfunction were observed. Thus, the combined implantation of a cardiostimulator and an ICD is a feasible and safe therapeutic option.

Adult↗
PubMed1999

Non-invasive evaluation of coronary reserve. Assessment of coronary reserve in patients with coronary artery disease by transesophageal-Doppler echocardiography.

We assessed coronary flow reserve using transesophageal Doppler echocardiography in patients with coronary artery disease. The study included 33 coronary artery disease patients who were undergoing coronary arteriography. The blood flow velocities of the left anterior descending artery before and after intravenous infusion (0.56 mg/min for 4 min) of dipyridamole were recorded using transesophageal Doppler echocardiography. Fourteen normal healthy individuals, matched for age, served as a control group. The index of coronary flow reserve, i.e. the ratio of dipyridamole to baseline maximum diastolic velocity, was calculated. Maximal coronary flow reserve in coronary artery disease patients was significantly lower than in the control group (1.4+/-0.2 vs. 2.8+/-0.3, P<0.001). The coronary artery disease patients were classified into three groups: Group A included 10 patients with <50% left anterior descending artery stenosis; Group B included seven patients with 50-69% left anterior descending artery stenosis; 16 patients with >70% left anterior descending artery stenosis constituted Group C. The maximum coronary flow reserve was significantly different for A vs. B and A vs. C. (A, 1.77+/-0.18; B, 1.51+/-0.1; C, 1.28+/-0.24). A strong and significant correlation was found between the maximum coronary flow reserve and the degree of proximal left anterior descending artery stenosis (r=0.78, P<0.001). Coronary artery disease patients without left anterior descending artery stenosis on the arteriogram exhibited lower maximum coronary flow reserve compared to the control subjects (1.78+/-0.19 vs. 2.8+/-0.3, P=0.000).

Analysis of Variance↗
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

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

Intrahospital transportation: monitoring and risks.

Patients' intrahospital transport is considered as part of the mediconursing care continuum, since patients frequently need diagnostic or therapeutic procedures not performed at the bedside (Waddell 1975, Rutherford & Fisher 1986). Severe complications, such as airway obstruction, artificial airway or intravenous line removal, arterial blood gas and blood pressure changes, and arrhythmias or cardiac arrest, have been described during this transportation, especially in critically ill patients (Taylor et al 1970). Risks can be diminished if the patients are appropriately selected and carefully monitored during transportation (Venkataraman & Orr 1992).

Adult↗
PubMed1996

Fifteen year surveillance of echinococcal heart disease from a referral hospital in Greece.

Ten cases of hydatid heart disease were treated over a 15-year period (1980-1995). Cysts were located in the left ventricular wall (four patients), right ventricular wall (one patient), interventricular septum (one patient), interatrial septum (one patient), right atrium (one patient), pericardial cavity (one patient) and in multiple loci (one patient). Apart from two asymptomatic cases, clinical manifestations included chest pain (four patients), anaphylactic shock (one patient), constrictive pericarditis (one patient), congestive heart failure (one patient) and arterial embolism (one patient). Computed tomography was found useful in the detection of hydatid cysts and also in the determination of their morphology. Magnetic resonance was performed in three patients, with satisfactory imaging. Three out of the 10 patients died: rupture of pulmonary echinococcal cyst (one patient), massive pulmonary hydatid embolism (one patient) and rupture of an undiagnosed hydatid cyst of the right atrium during cannulation for cardiopulmonary bypass (one patient). One other patient experienced recurrent systemic embolism and became hemiplegic. Six patients were successfully treated. In five patients, the cysts were excised by open heart surgery, while in one by pericardiectomy. In addition, antiparasitic drugs were successfully used in two patients with long-term satisfactory results. In conclusion, cardiac echinococcosis is associated with an increased risk of potentially lethal complications. Newer techniques of cardiac imaging have helped locate the cysts while surgical removal may offer cure. Some patients responded to specific long-term drug treatment.

Adult↗
PubMed1995

Significance of echocardiographic atrioventricular plane displacement for the evaluation of left ventricular filling and end-diastolic pressure in patients with coronary artery disease.

The aim of this study is to assess the left ventricular filling and estimate the end-diastolic pressure of the left ventricle in patients with coronary artery disease (CAD) by echocardiographic measurement of the atrioventricular plane displacement (AVPD). In 101 patients (mean age 59 +/- 12 years) with CAD, a complete transthoracic echocardiographic study was performed, just prior to cardiac catheterization. The AVPD was recorded by M-mode echocardiography, from apical four and two chamber views. The recordings were obtained at four sites, corresponding to the septal, lateral, anterior and inferior walls of the left ventricle. The mean AVPD resulting from atrial systole (At), the mean total (T) diastolic AVPD, the ratio At/T(%) and the ratio of mitral annulus excursion during early and late diastole [(T-At)/At] were calculated. Firty-two age-matched healthy subjects served as control group. Both At and At/T were significantly greater in patients with CAD than in the controls (6.06 +/- 0.94 vs 5.53 +/- 0.55 mm, p < 0.01 and 43.4 +/- 5.9% vs 33.49 +/- 4.45%, p < 0.001 respectively). The ratio [(T-At)/At] correlated with the E/A ratio of transmitral flow, both in healthy subjects (r = 0.850, p < 0.001) and in patients with CAD (r = 0.722, p < 0.001). Correlation also existed both in patients with segmental wall motion abnormality (SWMA) (r = 0.691, p < 0.001) and in patients with SWMA (r = 0.818, p < 0.001). In patients with CAD, At/T further correlated with the left ventricular end-diastolic pressure (r = 0.517, p < 0.001). In patients with SWMA and in patients without, a correlation was also found (r = 0.516, p < 0.001 and r = 0.566, p < 0.001 respectively).(ABSTRACT TRUNCATED AT 250 WORDS)

Cardiac Catheterization↗
PubMed1995

Evaluation of left ventricular filling by echocardiographic atrioventricular plane displacement in patients with coronary artery disease.

Mean atrioventricular (AV) plane displacement which resulted from left atrial systole and its ratio to the total diastolic displacement, were determined by echocardiography in 101 patients with coronary artery disease. Ratio of motion of the AV plane caused by left atrial systole to the total diastolic displacement was correlated with late-to-early mitral flow peak velocity index (r = 0.7). Selecting a value of this ratio of the AV plane displacement > or = 44% to define Doppler characteristics indicating impaired left ventricular relaxation, resulted in a high sensitivity, specificity and predictive value. Its value was also validated in another prospectively examined group of coronary artery disease patients. In conclusion echocardiographic assessment of AV plane displacement can be used for the estimation of left ventricular filling in patients with coronary artery disease and particularly in detecting impaired left ventricular relaxation.

Aged↗
PubMed1995

Pain assessment in acute myocardial infarction patients.

UNLABELLED: The purpose of this study was to investigate the pain intensity and duration, and to assess the pain control intervention, in patients with acute myocardial infarction (AMI). METHODS: Ninety-seven patients (18 diabetics and 79 non-diabetics) admitted to the hospital with chest pain were included in this study. Pain was measured on the numerical rating scale (NRS) 0-10, where 0 means no pain and 10 unbearable pain. All patients were followed for 12 hours, after the last chest pain episode. The data were statistically evaluated with the Student's t-test and chi square (chi 2). RESULTS: The pain in AMI patients with diabetes mellitus was lower in intensity (P < 0.002) and shorter in duration (P < 0.000) respectively, compared with the non-diabetic AMI patients. The intensity of pain in patients with an anterior infarction tended to be higher (P < 0.03) than in those with an inferior infarction. Finally, the systolic blood pressure fell significantly (P < 0.000) 90 min after admission. No other significant differences were found.

Angina Pectoris↗
PubMed1995

Left systolic atrioventricular plane displacement in the assessment of myocardial viability in patients with previous myocardial infarction.

UNLABELLED: In order to detect myocardial viability in coronary artery disease patients (CAD) with a previous myocardial infarction and dysfunction of the left ventricle (LV), the reliability of the left atrioventricular plane displacement (LAVPD) during low dose dobutamine stress echocardiography (DSE), was validated. The study population consisted of 70 CAD patients and 35 age and sex matched healthy subjects. From the apical four and two chamber views the LAVPD was recorded and measured by M-mode echocardiography, at four sites corresponding to the septal, lateral, anterior and inferior walls of the LV, prior and during the DSE (5-10 micrograms/kg/min). All patients underwent exercise SPECT Thallium-201 with four-hour redistribution and rest-reinjection, in order to determine tissue viability. Intraobserver and interobserver variability for the LAVPD was insignificant (5.8% and 7.2%, respectively). Healthy subjects exhibited a significant and equally distributed maximal increase of the LAVPD, at all sites during dobutamine infusion (DI) (p < 0.001). Patients also, showed a significant maximal increase of the LAVPD during DI, at all asynergic sites in which viable tissue was found (p < 0.001). However, in the asynergic sites without viable tissue the LAVPD did not significantly change (p < 0.05). Selecting a LAVPD increase of > 2 mm to detect viable myocardium at any asynergic site of LV, resulted in a sensitivity of 91% and specificity of 89%. When DSE was used for the detection of viable myocardium, sensitivity and specificity were found to be 80% and 87% respectively. The proportion of agreement between the two above mentioned methods was 82%. When the two methods were in agreement, the positive and negative predictive values were 94% and 97%, respectively. The validity of the above mentioned increase of the LAVPD was also prospectively examined in a similar group of 35 CAD patients exhibiting myocardial dysfunction as a result of a previous myocardial infarction (sensitivity 85% and specificity 90%, respectively). CONCLUSIONS: 1) The assessment of left LAVPD during DI is a new quantitative, accurate method with a low intraobserver and interobserver variability, in detecting viable myocardium. 2) Combination of this method and DSE proved good diagnostic markers of myocardial viability.

Dobutamine↗
PubMed1994

Apical hypertrophic cardiomyopathy with unusual features in a Greek woman.

We present a Mediterranean female patient with abnormal electrocardiographic findings and a history of shortness of breath during excessive effort (NYHA I) in whom apical hypertrophic cardiomyopathy with unusual features was detected by echocardiography and magnetic resonance imaging. There was a single fused apical hypertrophic papillary muscle and akinesia of the left ventricular apical segment. Abnormal left ventricular filling was also detected by Doppler echocardiography.

Adult↗