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Biomedical subjects

Stamatios Lerakis

Publications and source records attributed to Stamatios Lerakis.

At least 19 recordsLinked to original sources
PubMed2006

Application of contrast echocardiography in the evaluation of a right-sided vegetative lesion.

Transesophageal echocardiography has significantly improved the detection of vegetative lesions, including those associated with indwelling central venous lines. However, in certain cases, the increased mobility of these lesions as well as the presence of indwelling catheters obscure the precise delineation of their origin and the detection of attachment to adjacent structures. We report a case of right-sided endocarditis in which the use of contrast was instrumental to the comprehensive evaluation of the lesion and to subsequent patient management.

Cardiac Catheterization↗
PubMed2006

Intracoronary stent visualized on transesophageal echocardiogram in a case of coronary dissection complicated by aortic dissection.

We present a case of a patient presenting with a myocardial infarction with subsequent coronary intervention resulting in a coronary dissection complicated by an aortic dissection. The coronary dissection was treated with coronary stents. Transesophageal echocardiogram visualized the intracoronary stent within the intimal flap of the aortic dissection. The aortic dissection was successfully managed conservatively.

Aortic Dissection↗
PubMed2006

Staphylococcus aureus endocarditis: The Grady Memorial Hospital Experience.

BACKGROUND: Staphylococcus aureus is a common cause of endocarditis. Previous studies have shown that the mortality rate associated with S aureus endocarditis remains high, and methicillin resistance is becoming more prevalent. METHODS: Over the past 4 years, 283 patients with suspected endocarditis were referred to the cardiology department of Grady Memorial Hospital for echocardiography. Their clinical course and demographic information was entered into a database. Among these patients, 87 (30.6%) were confirmed to have endocarditis, with 41 (47.1%) of them culture positive for either methicillin-resistant (MRSA) or methicillin-sensitive S aureus (MSSA). Of these patients, 14 were MRSA culture positive, and 27 were MSSA culture positive. These two groups were compared with respect to demographic information and morbidity and mortality outcomes. RESULTS: The MRSA and MSSA groups were found to be similar upon analysis in all baseline characteristics. There was a non-statistical trend among the two groups in origin of infection, as the MRSA group tended toward nosocomial infection more often. Outcomes, including surgery, death, and complications were also found to be similar between the two groups. CONCLUSIONS: There does not seem to be difference in the outcome of MRSA versus MSSA endocarditis. Nosocomial infection may predispose patients to MRSA endocarditis, but a larger study with a greater sample size is necessary to evaluate these questions more accurately.

Community-Acquired Infections↗
PubMed2006

Predictive value of C-reactive protein and left ventricular diastolic filling pattern after a non-ST elevation myocardial infarction.

BACKGROUND: Recent studies have shown that the odds ratio for high-sensitivity C-reactive protein (CRP) in predicting a coronary events in healthy subjects is 1.4, a value substantially less than previously reported. It is unclear whether this extends to acute coronary syndrome patients or if CRP would predict long-term events in this population. We evaluated the predictive value of CRP in patients with non-ST segment elevation myocardial infarction (NSTEMI) as their first manifestation of coronary artery disease and compared it with that of left ventricle diastolic function. METHODS: Serum CRP concentration measurement and left ventricle diastolic function evaluation were performed in 51 consecutive patients with NSTEMI 48 hours, 3 months, and 6 months after infarction. Patients were followed for 1 year and events comprising the endpoints of death, new myocardial infarction, percutaneous coronary intervention, and coronary artery bypass grafting were reported. RESULTS: Thirty of 51 patients developed the endpoints. Mean CRP concentration in patients who developed any endpoint and those who did not was similar at 48 hours, 3 months, and 6 months. A strong correlation between the presence of impaired relaxation 6 months after the infarction and development of the combined endpoints was noted (P < 0.001). CONCLUSION: CRP has limited value in predicting future cardiovascular events in subjects with NSTEMI. Other biomarkers or a combination of other biomarkers may be needed to identify patients at high risk. Evaluation of diastolic left ventricular function not during the acute phase but 6 months later could predict adverse outcome in our series.

Adult↗
PubMed2006

Effect of lipid levels and lipid-lowering therapy on restenosis after coronary artery stenting.

BACKGROUND: Recent experimental and clinical data suggest that lowering serum lipid levels with statins may prevent or delay the process of restenosis. The purpose of this trial is to determine whether lipid levels relate to restenosis and/or whether statin therapy can prevent or delay the process of restenosis after intracoronary stenting. METHODS: One hundred thirty-six patients who underwent single coronary artery stenting from June 1995 to June 1997 in our institution were included in the study. All these patients were followed for at least 9 months (mean 392+/-148 days) for major adverse cardiac events (MACE). We defined as MACE the occurrence of death, myocardial infarction, or need for target lesion revascularization. From this cohort, 103 patients had at least one lipid parameter from the lipid profile evaluated within 2 months from the date of the procedure. Patients who had the stent because of an acute myocardial infarction were included in the study only if their lipid profile was evaluated before or at least 6 weeks after the event. Patients with triglyceride levels above 500 had both triglyceride and low-density lipoprotein cholesterol levels excluded from the statistical analysis. Patients were divided into two groups based on lipid levels: normal (Group I; n=31) and elevated (Group II; n=72). Patient outcomes were also analyzed by statin therapy use. RESULTS: There was no significant difference in MACE rates between the two groups when outcomes were analyzed by lipid levels (22.6% versus 20.8% P=0.8). Furthermore, outcomes were analyzed by use of statin therapy (Group III, n=53, on statin versus Group IV, n=50, on no statin). There was also no difference in MACE rates between the two groups (20.8% versus 22%; P=0.8). CONCLUSION: The process of restenosis has unique features that differentiate it from atherosclerosis. Although lipid-lowering therapy is crucial in delaying the process of atherosclerosis, its role in the prevention of restenosis is yet to be proven.

Aged↗
PubMed2006

The use of echocardiography for the evaluation of dyssynchrony.

Tissue Doppler imaging (TDI), is a new imaging tool that allows measurement of dyssynchrony. In several small studies, TDI predicted clinical response and reverse remodeling after cardiac resynchronization therapy (CRT). Moreover, it allowed detection of mechanical dyssynchrony in heart failure patients with narrow QRS. Using TDI, the selection criteria for CRT might be changed to include heart failure patients with narrow QRS. Furthermore, it will help predict responders to this therapy, hence decreasing the percentage of nonresponders and allowing a more cost-effective use of this new technology.

Arrhythmias, Cardiac↗
PubMed2005

Atorvastatin improves left ventricular systolic function and serum markers of inflammation in nonischemic heart failure.

OBJECTIVES: This study examined the effect of statin therapy on vascular markers of inflammation and echocardiographic findings in patients with nonischemic forms of cardiomyopathy. BACKGROUND: Despite advances in therapy, morbidity and mortality from heart failure (HF) remain high. We wished to determine whether treatment with atorvastatin affects left ventricular (LV) systolic function and markers of inflammation in patients with nonischemic HF. METHODS: A total of 108 patients with nonischemic HF and a left ventricular ejection fraction (LVEF) < or =35% were randomized to either atorvastatin 20 mg/day or placebo in a double-blinded fashion for a 12-month period. The LVEF and LV end-diastolic diameter (LVEDD) and left ventricular end-systolic diameter (LVESD) were determined by echocardiography. Serum markers of inflammation and oxidation were also measured. RESULTS: The LVEF increased from 0.33 +/- 0.05 to 0.37 +/- 0.04 (p = 0.01) in the atorvastatin group over the 12-month follow-up period, whereas those patients in the placebo group experienced a decline in ejection fraction during the same time period. In addition, LVEDD was reduced from 57.1 +/- 5.9 mm to 53.4 +/- 5.1 mm (p = 0.007) and LVESD was reduced from 42.4 +/- 3.8 mm to 39.1 +/- 3.8 mm (p = 0.02) in the cohort of patients treated with atorvastatin; these dimensions increased in the placebo group. There was an increase in erythrocyte superoxide dismutase (E-SOD) activity, and there were significant reductions in serum levels of high sensitivity C-reactive protein, interleukin-6 (IL-6), and tumor necrosis factor-alpha receptor II (TNF-alpha RII) in the atorvastatin group. CONCLUSIONS: The use of atorvastatin in patients with nonischemic HF improves LVEF and attenuates adverse LV remodeling. The effects on soluble levels of several inflammatory markers with atorvastatin suggest, in part, mechanisms by which statins might exert their beneficial effects in nonischemic HF.

Atorvastatin↗
PubMed2005

Evidence-based management of coronary artery disease in the elderly--current perspectives.

Cardiovascular disease accounts for significant morbidity and mortality in the elderly. The clinical trial data available to guide therapy in this growing population subset are relatively limited. This review will focus on treatment approaches and recommendations obtained from subgroup analyses of elderly patients from major clinical trials for the management of chronic stable angina, acute coronary syndromes (unstable angina and non-ST-segment elevation myocardial infarction), and coronary revascularization. Recent advances in the treatment of stable angina have shown that use of angiotensin-converting enzyme inhibitors and lipid-lowering therapy as adjunctive measures show benefit in the elderly by reducing the occurrence of death, nonfatal myocardial infarction, and unstable angina. However, if patients experience disabling or unstable anginal symptoms despite effective medical therapy, coronary revascularization must be considered. Several clinical trials have shown a significant reduction in major adverse cardiac events when using intravenous glycoprotein receptor antagonists periprocedurally during percutaneous revascularization approaches in elderly patients with unstable angina or non-ST-segment elevation myocardial infarction, especially when these measures are performed as soon as possible. However, the success of myocardial revascularization by a percutaneous or surgical approach is highly dependent on the patient's associated comorbidities, especially in patients over age 80 years.

Aged↗
PubMed2005

Coronary artery vasospasm during dobutamine stress echocardiography.

Compared with the frequent occurrence of S-T segment depression, the development of S-T segment elevation during dobutamine stress echocardiography is a relatively rare finding, especially in the setting of nonobstructive coronary artery disease. We present two patients who developed chest discomfort with S-T segment elevation during dobutamine stress testing. Both patients had unremarkable baseline echocardiograms and no history suggestive of coronary vasospasm. Subsequent coronary angiography revealed nonobstructive disease. It is speculated that the likely presence of endothelial dysfunction coupled with mild coronary atherosclerosis caused an imbalance between the coronary vasodilatory and vasoconstrictive forces. The inhibition of the vasodilatory effects of beta-adrenergic receptor stimulation and flow-mediated dilation of dobutamine was overcome by the vasoconstrictive effects of dobutamine-stimulated alpha-1 receptor activation; thus, contributing to the development of coronary vasospasm. This condition is important to recognize and appreciate as the initial treatment for this condition favors the use of nitrates over beta-blockade.

Adult↗
PubMed2005

Successfully treated mitral valve Proteus mirabilis endocarditis.

Infective endocarditis caused by Proteus mirabilis is rare and is fatal in most cases. A case of a 64-year-old man presenting with fever, dysuria, and murmur is reported. P mirabilis endocarditis was diagnosed based on clinical presentation, blood culture findings, and the presence of a large mitral valve vegetation seen on echocardiogram. The patient survived after long-term antibiotics and surgical replacement of the mitral valve. The clinical characteristics and complications from reported cases of P mirabilis endocarditis are reviewed.

Anti-Bacterial Agents↗
PubMed2005

Part I: use of echocardiography in the evaluation of patients with suspected cardioembolic stroke.

One-sixth of all ischemic strokes are a result of embolization from the heart. Echocardiography serves as the cornerstone in evaluating patients who may have had a cardioembolic stroke. This article is the first of a two-part review series focusing on the role of echocardiography in the diagnosis and treatment of cardioembolic stroke. Specifically, this section will focus on nonrheumatic atrial fibrillation as well as cardiovascular masses as potential embolic sources.

Atrial Fibrillation↗
PubMed2004

Staphylococcus aureus bacteremia and endocarditis: the Grady Memorial Hospital experience with methicillin-sensitive S aureus and methicillin-resistant S aureus bacteremia.

BACKGROUND: Staphylococcus aureus has become the leading cause of endocarditis in most published series, and nosocomial acquisition is becoming more frequent. Previous studies involved community acquired methicillin-sensitive S aureus (MSSA), but recently, methicillin-resistant S aureus(MRSA) infection has increased. This may reflect the growing presence of this microorganism in clinical practice. Few data exist comparing the relative rates of endocarditis with MSSA and MRSA bacteremia. The purpose of this study was to compare these rates in a bacteremic population referred for diagnostic echocardiography. METHODS: Since July 1999, the demographic and clinical information of 104 consecutive patients with at least 2 blood cultures with positive results for S aureus who were referred for echocardiography to be evaluated for endocarditis at Grady Memorial Hospital (Atlanta, Ga) have been entered into a database. This database has further been restricted to patients who have undergone either a transesophageal echocardiogram or a transthoracic echocardiogram. RESULTS: Of the 104 patients with S aureus bacteremia, 53 had an infection of MSSA and 51 had an infection of MRSA. There were 33 patients (31.7%) with echocardiographically confirmed endocarditis, 23 patients (43.4%) in the MSSA group versus 10 patients (19.6%) in the MRSA group (P <.009). Community-acquired MSSA bacteremia was the cause of most of the community-acquired S aureus endocarditis (20 patients [87%] vs 3 patients [30%], P =.004), and the nosocomial-acquired MRSA bacteremia was the cause of most of the nosocomial-acquired S aureus endocarditis (3 patients [13%] vs 7 patients [70%], P =.0001). CONCLUSION: Our study confirms that S aureus bacteremia is associated with high rates of endocarditis. MSSA bacteremia is associated with higher rates of endocarditis than MRSA. Community MSSA is the cause of most of the community endocarditis, whereas nosocomial MRSA is the cause of most of the MRSA endocarditis. Patients with S aureus bacteremia should be aggressively evaluated for endocarditis.

Adult↗
PubMed2004

Contrast for vascular imaging.

This article discusses the use of standard contrast agents that, when coupled with high-resolution carotid ultrasound, offers the dramatic potential to improve measurement of intimal medial thickness, better defining luminal endothelial surface, improving the determination of plaque ulceration, and offering the dramatic capabilities to visualize directly neovasculature growth of the vasa vasorum. The technique may identify vulnerable plaques and may also show their alterations with therapeutic pharmacologic interventions. In the coronary circulation, use of contrast significantly enhances the ability to image the epicardial coronary arteries to obtain data on coronary flow reserve for the diagnosis of coronary artery disease.

Arteriosclerosis↗
PubMed2004

Timing of aortic valve surgery in chronic aortic stenosis and regurgitation.

The correct timing of aortic valve replacement in chronic aortic stenosis or regurgitation is a very important and sometimes difficult task for physicians caring for patients with aortic valve disease. In this review, we will present the current available literature regarding the appropriate management of these patients.

Aortic Valve↗
PubMed2004

Anomalous origin of the coronary arteries from the pulmonary trunk in two separate patients with a review of the clinical implications and current treatment recommendations.

Anomalous origin of a coronary artery from the pulmonary artery (PA) is an unusual abnormality. These anomalies are often hemodynamically significant and can lead to myocardial ischemia, myocardial infarction, and sudden cardiac death. Anomalous origin of the left coronary artery (LCA) from the pulmonary trunk is known as Bland-White-Garland syndrome and causes death in 80% to 85% of affected children in the first year of life. Treatment of the LCA arising from the PA is typically surgical, with ligation and reimplantation of the LCA to the aorta. In contrast, origination of the right coronary artery from the PA is usually a benign anomaly, although clinically significant sequelae can develop. Controversy exists regarding the need to intervene in the cases of patients with this usually incidentally discovered anomaly. We review the clinical presentation and treatment of patients with each anomaly and the current recommendations regarding the clinical course and management of such patients.

Aged↗