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Transcatheter aortic valve replacement and stroke： a comprehensive review

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Journal of Geriatric Cardiology 2018年第1期15卷 95-104页

作者： Periklis A Davlouros Virginia C Mplani Ioanna Koniari grigorios tsigkas George Hahalis Department of Cardiology Patras University Hospital Rion Patras Greece

Transcatheter aortic valve implantation （TAVR） has emerged as an alternative, rapidly evolving treatment option for patients with se- vere aortic stenosis and high surgical risk. Stroke is a devastating complication being confined mainly in the periprocedural and 30-day pe- riod following TAVR, with a lower and relatively constant frequency thereafter. Early stroke is mainly due to debris embolization during the procedure, whereas later events are associated with patient specific factors. Despite the fact that the rate of clinical stroke has been constantly decreasing compared to initial TAVR experience, modern neuro-imaging with MRI suggests that new ischemic lesions post-TAVR are almost universal. The impact of the latter is largely unknown. However, they seem to correlate with a reduction in neurocognitive function. Because TAVR is set to expand its indication to lower surgical-risk patients, stroke prophylaxis during and after TAVR becomes of paramount importance. Based on clinical and pathophysiological evidence, three lines of research are actively employed towards this direction： improvement in valve and delivery system technology with an aim to reduce manipulations and contact with the calcified aortic arch and native valve, antithrombotic therapy, and embolic protection devices. Careful patient selection, design of the procedure, and tailored antithrombotic strategies respecting the bleeding risks of this fragile population constitute the main defense against stroke following TAVR.

关键词： Aortic stenosis Stroke Transcatheter aortic valve replacement

Beta-blocker treatment in heart failure patients with atrial fibrillation:challenges and perspectives

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Journal of Geriatric Cardiology 2021年第5期18卷 362-375页

作者： Emmanouil Chourdakis Ioanna Koniari Dimitrios Velissaris grigorios tsigkas Nikolaos G Kounis Neriman Osman Krankenhaus der Barmherzigen Brüder Trier Germany Manchester Heart Institute Manchester University Foundation TrustManchesterUnited Kingdom Department of Internal Medicine University Hospital of PatrasPatrasGreece Cardiology Department University Hospital of PatrasPatrasGreece

Heart failure(HF)and atrial fibrillation(AF)are common conditions that share similar clinical phenotype and frequently *** classification of HF in patients with preserved ejection fraction(>50%,HFpEF),midrange reduced EF(40%−49%,HFmrEF)and reduced EF(<40%,HFrEF)are crucial for optimising the therapeutic approach,as each subgroup responds *** constitute an important component of our pharmacological regimen for chronic *** administration is reccomended in patients with HF with reduced ejection fraction in stable sinus rhythm,due to improvement of symptoms,the better long termoutcome and *** beneficial role of betablocker use in patients with preserved EF still remain unclear,as no treatment showed a positive impact,regarding morbidity or mortality *** presence of AF in HF patients increases as the disease severity evolves and is associated with a higher rate of cardiovascular morbidity and *** more question is the use of betablocker in HF patients irrespective of EF and concomitant *** are many conflicting data and publications,regarding the beta blocker benefit in this ***,it is supported an attenuation of betablockers beneficial effect in HF patients with AF.A design of more randomised trials/studies with HF patients and concomitant AF may improve our clinical approach of betablockers use and identify the patients with HF,who mostly profit from an invasive approach.

关键词： treatment evolve mostly

Transcatheter versus surgical aortic valve replacement in severe, symptomatic aortic stenosis

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Journal of Geriatric Cardiology 2018年第1期15卷 76-85页

作者： tsigkas grigorios Despotopoulos Stefanos Makris Athanasios Koniari Ioanna Armylagos Stylianos Davlouros Periklis Hahalis George Department of Cardiology Medical School University of Patras Patras Greece

Aortic stenosis （AS） is the most common type of valvular heart disease in the elderly. Surgical aortic valve replacement （SAVR） has been the standard practice for treating severe, symptomatic AS, but recently new treatment options have emerged, Transcatheter aortic valve replacement （TAVR） is now an established treatment option in patients at high surgical risk. In this review, we focus on recent developments and compare the two treatment methods in specific populations in terms of efficacy and safety （e.g., in patients with history of prior thoracic surgery, type of anesthesia employed, access site used or need for permanent pacing）. The impact of comorbidities （pulmonary hypertension, arterial hypertension and obesity paradox）, the cost-effectiveness of TAVR vs. SAVR and advances in transcatheter valve technology as well as issues that merit further investigation are further discussed. Moreover, outcomes and complications of TAVR in patients of different risk category （extremely high, high, intermediate and low risk） are analyzed. We strongly believe that during the following years, TAVR may evolve as the treatment of choice in a broader group of patients with symptomatic AS and beyond those with intermediate and high-risk features.

关键词： Aortic stenosis Aortic valve replacement Stent valve Transcatheter aortic valve replacement

Incidence, pathophysiology, predictive factors and prognostic implications of new onset atrial fibrillation following transcatheter aortic valve implantation

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Journal of Geriatric Cardiology 2018年第1期15卷 50-54页

作者： Ioanna Konlari grigorios tsigkas Nikolaos Kounisx Dimitrios Velissaris Emmanouil Chourdakis Periklis Davlouros George Hahalis Department of Cardiology University Hospital of Patras Rion Patras Greece Department of Internal Medicine University Hospital of Patras Rion Patras Greece Krankenhaus der Barmherzigen Bruder Trier Germany

1 Introduction Atrial fibrillation （AF） constitutes the most frequent cardiac arrhythmia with an increasing prevalence and incidence in the general population, demonstrating a significant impact on cardiovascular morbidity and mortality. AF has been correlated with an increased risk of stroke, systemic embolism and long term morbidity compared to individuals with sinus rhythm. The highest prevalence of AF is reported in elderly as well as in patients with severe aortic stenosis, ranging between 16% and 40% in the latter. In the general population, AF scales the death risk up to 1.5 and 1.9 fold in men and women, respectively,

关键词： Atrial fibrillation Mortality Prognosis Transcatheter aoric valve implantation

Biomarkers in the clinical management of patients with atrial fibrillation and heart failure

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Journal of Geriatric Cardiology 2021年第11期18卷 908-951页

作者： Ioanna Koniari Eleni Artopoulou Dimitrios Velissaris Mark Ainslie Virginia Mplani Georgia Karavasili Nicholas Kounis grigorios tsigkas Manchester Heart Institute Manchester University Foundation TrustManchesterUnited Kingdom Department of Internal Medicine University Hospital of PatrasPatrasGreece Division of Cardiovascular Sciences University of Manchester Department of Cardiology University Hospital of PatrasPatrasGreece

Atrial fibrillation(AF)and heart failure(HF)are two cardiovascular diseases with an increasing prevalence *** conditions share common pathophysiologiesand frequently *** fact,the occurrence of either condition can‘cause’the development of the other,creating a new patient group that demands different management strategies to that if they occur in *** of the temproral association of the two conditions,their presence is linked with adverse cardi-ovascular outcomes,increased rate of hospitalizations,and increased economic burden on healthcare *** use of low-cost,easily accessible and applicable biomarkers may hasten the correct diagnosis and the effective treatment of AF and *** AF and HF effect multiple physiological pathways and thus a great number of biomarkers can be measured that potentially give the clinician important diagnostic and prognostic *** will then guide patient centred therapeutic *** current biomarkers that offer potential for guiding therapy,focus on the physiological pathways of miRNA,myocardial stretch and injury,oxidative stress,inflammation,fibrosis,coagulation and renal *** of these has different utility in current clinincal practice.

关键词： fibrillation diagnosis centre

Effect of atrial fibrillation on cognitive function in heart failure patients

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Journal of Geriatric Cardiology 2021年第7期18卷 585-590页

作者： Nikolaos Ktenopoulos Ioanna Koniari Virginia Mplani Eleni Artopoulou grigorios tsigkas Andreas Gerakaris Nicholas Kounis Dimitrios Velissaris Department of Internal Medicine University Hospital of PatrasPatrasGreece Department of Cardiology University Hospital of South ManchesterNHS Foundation TrustManchesterUnited Kingdom Department of Cardiology University Hospital of PatrasPatrasGreece

As the population ages,conditions like heart failure(HF),atrial fibrillation(AF)and cognitive impairment(CI)demonstrate higher *** is a very common clinical syndrome affecting many people *** is estimated that in the developed countries approximately 1%-2%of the adult population suffers from HF,whereas in adults>70 years old the incidence rises to≥10%.

关键词： atrial fibrillation clinical

The role of echocardiography and CT angiography in transcatheter aortic valve implantation patients

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Journal of Geriatric Cardiology 2018年第1期15卷 86-94页

作者： Emmanouil Chourdakis Ioanna Koniari Nicholas G Kourlis Dimitrios Velissaris Nikolaos Koutsogiannis grigorios tsigkas Karl Eugen Hauptmann Bruno Sontag George Hahalis Krankenhaus der Barmherzigen Briider Trier Germany Department of Cardiology University Hospital of Patras Rion Patras Greece Department of Internal Medicine University Hospital of Patras Rion Patras Greece

The transcatheter aortic valve implantation （TAVI） consist an altemative treatment in patients with severe aortic stenosis. Multimodality imaging using transthoracic echocardiography （TTE） or transesophageal echocardiography （TOE） and multislice CT （MSCT） constitute cornerstone techniques for the pre-operative management, peri-procedural guidance, follow up and recognition of possible transcatheter valve related complications. CT angiography is much more accurate regarding the total definition of aortic annulus diameter and circumferential area. Two-dimensional （2D） echocardiography, underestimates the aortic valve annulus diameter compared to 3D imaging techniques （MSCT, MRI and 3D TOE）. Three-dimensional TOE imaging provides measurements of the aortic valve annulus similar to those delivered by MSCT. The pre-procedural MSCT constitutes the gold standard modality minimizing the presence of paravalvular aortic regurgitation, one of the most frequent complications. TOE/TTE and MSCT performance could predict the possibility of pacemaker implantation post-procedural. The presence of a new transient or persisting MR can be assessed well by TOE. Both TTE and TOE, consist initially the basic examination for post TAVI evaluation. In case of transcatheter heart valve failure, the MSCT could be used as additional imaging technique.

关键词： Multi-slice computer tomography Transcatheter aortic valve implantation Transthoracic echocardiography

Anticoagulation for atrial fibrillation in heart failure patients:balancing between Scylla and Charybdis

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Journal of Geriatric Cardiology 2021年第5期18卷 352-361页

作者： grigorios tsigkas Anastasiοs Apostolos Stefanos Despotopoulos Georgios Vasilagkos Angeliki Papageorgiou Eleftherios Kallergis Georgios Leventopoulos Virginia Mplani Ioanna Koniari Dimitrios Velissaris John Parissis Department of Cardiology University Hospital of PatrasPatrasGreece Department of Cardiology University Hospital of HeraklionHeraklionGreece Department of Cardiology University Hospital of South ManchesterNHS Foundation TrustManchesterUnited Kingdom Department of Internal Medicine University Hospital of PatrasPatrasGreece Second Department of Cardiology National and Kapodistrian University of AthensAttikon University HospitalAthensGreece

The management of heart failure(HF)and atrial fibrillation(AF)in realworld practice remains a debating issue,while the number of HF patients with AF increase *** it is unclear if rhythm or rate control therapy is more beneficial and under which circumstances,anticoagulation therapy is the cornerstone of the AFHF patients’*** antagonists were the goldstandard during the past,but currently their usage is limited in specific *** K oral anticoagulants(NOACs)have gained ground during the last ten years and considered as goldstandard of a wide spectrum of HF *** current manuscript aims to review the current literature regarding the indications and the optimal choice and usage of NOACs in HF patients with AF.

关键词： patients fibrillation vitamin

Acute Myocardial Infarction Induced by Anaphylaxis in China： The Kounis Syndrome

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Chinese Medical Journal 2018年第19期131卷 2392-2393页

作者： Nicholas G Kounis Ioanna Koniari Emmanouil Chourdakis George D Soufras grigorios tsigkas Periklis Davlouros George Hahalis Department of Cardiology Patras University General Hospital Rion Patras Achaia 26504 Greece Department of Electrophysiology Queen Elizabeth Hospital Birmingham B15 2TH UK Department of Cardiology Krankenhaus der Barmherzigen Bruder Trier Nordallee 154292 Trier Germany Department of Cardiology "Saint Andrews" State General Hospital Patras 26226 Greece

In the very interesting report published in Chinese Medical Journal concerning a 65-year-old hypertensive and hyperlipidemic male patient, with stent implantation 5 years previously, the patient developed anaphylactic shock accompanied by chest discomfort, palpitation, itchiness, nausea, vomiting, dyspnea, wheezing, abdominal pain, sweating, pale complexion, dizziness, and syncope following bread and milk consumption. The clinical symptomatology was associated with electrocardiographic and laboratory evidence of acute inferolateral myocardial infarction, and the patient recovered with epinephrine, antiallergic, and myocardial infarction protocol therapy including ticagrelor and Clexane. Coronary arteriography demonstrated lesions in the left trunk and the three coronary branches, but the stented areas were unobstructed. The allergen test revealed a Grade 2 （2.11 kUA/L） for wheat and Grade 0 for milk.

关键词： SECONDARY HYPERSENSITIVITY INGESTION STENT