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Antithrombotic therapy in TAVI

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Journal of Geriatric Cardiology 2018年第1期15卷 66-75页

作者： Manolis Vavuranakis Konstantinos Kalogeras Angelos Michail Kolokathis dimitrios Vrachatis Nikolaos Magkoutis Gerasimos Siasos Euaggelos Oikonomou Maria Kariori Theodoros Papaioannou Maria Lavda Carmen Moldovan Ourania Katsarou dimitrios tousoulis The First Department of Cardiology Hippokration Hospital Medical School National & Kapodistrian University of Athens Ilioupoli Greece

Transcatheter aortic valve implantation （TAVI） carries a significant thromboembolic and concomitant bleeding risk, not only during the procedure but also during the periprocedural period. Many issues concerning optimal antithrombotic therapy after TAVI are still under debate. In the present review, we aimed to identify all relevant studies evaluating antithrombotic therapeutic strategies in relation to clinical outcomes after the procedure. Four randomized control trials （RCT） were identified analyzing the post-TAVI antithrombotic strategy with all of them utilizing aspirin lifelong plus clopidogrel for 3-6 months. Seventeen registries have been identified, with a wide variance among them regarding baseline characteristics, while concerning antiplatelet therapy, clopidogrel duration was ranging from 3-12 months. Four non-randomized trials were identified, comparing single vs. dual antiplatelet therapy after TAVI, in respect of investigating thromboembolic outcome events over bleeding complications. Finally, limited data from a single RCT and a retrospective study exist with regards to anticoagulant treatment during the procedure and the optimal antithrombotic therapy when concomitant atrial fibrillation. In conclusion, due to the high risk and frailty of the treated population, antithrombotic therapy after TAVI should be carefully evaluated. Diminishing ischaemic and bleeding complications remains the main challenge in these patients with further studies to be needed in this field.

关键词： Antiplatelets Antithrombotic Bleeding Stroke Transcatheter aortic valve implantation

Arrhythmic risk stratification in ischemic,non-ischemic and hypertrophic cardiomyopathy:A two-step multifactorial,electrophysiology study inclusive approach

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World Journal of Cardiology 2022年第3期14卷 139-151页

作者： Petros Arsenos Konstantinos A Gatzoulis dimitrios Tsiachris Polychronis Dilaveris Skevos Sideris Ilias Sotiropoulos Stefanos Archontakis Christos-Konstantinos Antoniou Athanasios Kordalis Ioannis Skiadas Konstantinos Toutouzas Charalambos Vlachopoulos dimitrios tousoulis Konstantinos Tsioufis First Department of Cardiology National and Kapodistrian University of AthensHippokration HospitalAthens 11527AttikaGreece Athens Heart Center Athens Medical CenterAthens 15125AttikaGreece Department of Cardiology Hippokration HospitalAthens 11527AttikaGreece Fifth Department of Cardiology Hygeia HospitalMarousi 15123AttikaGreece

Annual arrhythmic sudden cardiac death ranges from 0.6%to 4%in ischemic cardiomyopathy(ICM),1%to 2%in non-ischemic cardiomyopathy(NICM),and 1%in hypertrophic cardiomyopathy(HCM).Towards a more effective arrhythmic risk stratification(ARS)we hereby present a two-step ARS with the usage of seven non-invasive risk factors:Late potentials presence(≥2/3 positive criteria),premature ventricular contractions(≥30/h),non-sustained ventricular tachycardia(≥1episode/24 h),abnormal heart rate turbulence(onset≥0%and slope≤2.5 ms)and reduced deceleration capacity(≤4.5 ms),abnormal T wave alternans(≥65μV),decreased heart rate variability(SDNN440 ms in males and>450 ms in females)which reflect the arrhythmogenic mechanisms for the selection of the intermediate arrhythmic risk patients in the first *** the second step,these intermediate-risk patients undergo a programmed ventricular stimulation(PVS)for the detection of inducible,truly high-risk ICM and NICM patients,who will benefit from an implantable cardioverter *** HCM patients,we also suggest the incorporation of the PVS either for the low HCM Risk-score patients or for the patients with one traditional risk factor in order to improve the inadequate sensitivity of the former and the low specificity of the latter.

关键词： Arrhythmic sudden cardiac death Risk stratification Non-invasive risk factors Electrophysiology study Two-step approach Arrhythmias in cardiomyopathy

Congenital heart“Challenges”in Down syndrome

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World Journal of Cardiology 2024年第5期16卷 217-220页

作者： Maria Drakopoulou Panayotis K Vlachakis Costas Tsioufis Dimitris tousoulis Department of First Cardiology Hippokration General HospitalAthens Medical SchoolNational and Kapodistrian University of AthensAthens 11527Greece

In this editorial,we comment on the article by Kong et al published in the recent issue of the World Journal of *** this interesting case,the authors present the challenges faced in managing a 13-year-old patient with Down syndrome(DS)and congenital heart disease(CHD)associated with pulmonary arterial *** this distinct population,the Authors underscore the need for early diagnosis and management as well as the need of a multidisciplinary approach for decision *** seems that the occurrence of CHD in patients with DS adds layers of complexity to their clinical *** editorial aims to provide a comprehensive overview of the intricate interplay between DS and congenital heart disorders,offering insights into the nuanced diagnostic and therapeutic considerations for physicians.

关键词： Down syndrome Congenital heart disease Atrioventricular septal defect Pulmonary hypertension Right heart catheterization

Role of genetic testing in cardiomyopathies:Αprimer for cardiologists

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World Journal of Cardiology 2022年第1期14卷 29-39页

作者： Georgia Vogiatzi George Lazaros Evangelos Oikonomou Emilia Lazarou Emmanouil Vavuranakis Dimitris tousoulis The Third Department of Cardiology Sotiria HospitalAthens 11527Greece The First Department of Cardiology Hippokration HospitalAthens 11526Greece The First Department of Cardiology Hippokration HospitalMedical School of National and Kapodistrian University of AthensAthens 11527Greece

Recent advances in cardiovascular genetics have transformed genetic testing into a valuable part of management of families with inherited *** novel mutations have been identified,understanding when to consider genetic testing has emerged as an important consideration in the management of these *** genetic testing has a paramount importance in the risk stratification of family members,in the prognosis of probands at higher risk of a serious phenotype expression,and finally in the identification of new mutations,all of which are discussed in this *** indications for each type of cardiomyopathy are described,along with the limitations of genetic ***,the importance of public sharing of variants in large data sets is *** ultimate aim of this review is to present key messages about the genetic testing process in order to minimize potential harms and provide suggestions to specialized clinicians who act as a part of a multidisciplinary team in order to offer the best care to families with inherited cardiomyopathies.

关键词： Cardiomyopathy Genetic counselling Genetic testing Variant Hereditary

Diabetes mellitus and atrial fibrillation-from pathophysiology to treatment

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World Journal of Diabetes 2023年第5期14卷 512-527页

作者： Marianna Leopoulou Panagiotis Theofilis Athanasios Kordalis Nikolaos Papageorgiou Marios Sagris Evangelos Oikonomou Dimitris tousoulis 1^(st)Cardiology Clinic ‘Hippokration’General HospitalNational and Kapodistrian University of AthensSchool of MedicineAthens 11527Greece 3^(rd)Cardiology Clinic ‘Sotiria’Chest Diseases HospitalNational and Kapodistrian University of AthensSchool of MedicineAthens 11527Greece

Type 2 diabetes mellitus(T2DM)is a leading risk factor for cardiovascular complications around the globe and one of the most common medical *** fibrillation(AF)is the most common supraventricular arrhythmia,with a rapidly increasing prevalence.T2DM has been closely associated with the risk of AF development,identified as an independent risk *** cardiovascular complications,both AF and T2DM have been linked with high *** underlying pathophysiology has not been fully determined yet;however,it is multifactorial,including structural,electrical,and autonomic *** therapies include pharmaceutical agents in sodium-glucose cotransporter-2 inhibitors,as well as antiarrhythmic strategies,such as cardioversion and *** interest,glucose-lowering therapies may affect the prevalence of *** review presents the current evidence regarding the connection between the two entities,the pathophysiological pathways that link them,and the therapeutic options that exist.

关键词： Atrial fibrillation Diabetes mellitus Pathophysiology Treatment

Overview of coronary artery variants, aberrations and anomalies

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World Journal of Cardiology 2018年第10期10卷 127-140页

作者： Stylianos Kastellanos Konstantinos Aznaouridis Charalambos Vlachopoulos Eleftherios Tsiamis Evangelos Oikonomou Dimitris tousoulis Cardiology Department Castle Hill HospitalHull and East Yorkshire NHS Trust Peripheral Vessels Unit and EKKAN (Unit for the athletes and for hereditary cardiovascular diseases) 1st Department of CardiologyHippokration HospitalMedical School of National and Kapodistrian University of Athens

Coronary artery anomalies and variants are relatively uncommon congenital disorders of the coronary artery anatomy and constitute the second most common cause of sudden cardiac death in young competitive athletes. The rapid advancement of imaging techniques, including computed tomography, magnetic resonance imaging, intravascular ultrasound and optical coherence tomography, have provided us with a wealth of new information on the subject. Anomalous origin of a coronary artery from the contralateral sinus is the anomaly most frequently associated with sudden cardiac death, in particular if the anomalous coronary artery has a course between the aorta and the pulmonary artery. However, other coronary anomalies, like anomalous origin of the left coronary artery from the pulmonary artery, atresia of the left main stem and coronary fistulae, have also been implicated in cases of sudden cardiac death. Patients are usually asymptomatic, and in most of the cases, coronary anomalies are discovered incidentally during coronary angiography or on autopsy following sudden cardiac death. However, in some cases, symptoms like angina, syncope, heart failure and myocardial infarction may occur. The aims of this article are to present a brief overview of the diverse coronary variants and anomalies, focusing especially on anatomical features, clinical manifestations, risk of sudden cardiac death and pathophysiologic mechanism of symptoms, as well as to provide valuable information regarding diagnostic workup, follow-up, therapeutic choices and timing of surgical treatment.

关键词： Ectopic coronary arteries Coronary artery anomalies Coronary fistulae Coronary artery variants Myocardial bridging Coronary artery anatomy Sudden cardiac death

“Heart failure in COVID-19 patients: Critical care experience”: A letter to the editor

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World Journal of Virology 2022年第4期11卷 216-220页

作者： Vasiliki Tsigkou Gerasimos Siasos Evangelos Oikonomou Evanthia Bletsa Manolis Vavuranakis Dimitris tousoulis Department of Cardiology ‘Sotiria’General HospitalNational and Kapodistrian University of AthensSchool of MedicineAthens 11527Greece Division of Cardiovascular Brigham and Women’s HospitalHarvard Medical SchoolBostonMA 02115United States Department of Cardiology ‘Hippokration’General HospitalNational and Kapodistrian University of AthensSchool of MedicineAthens 11527Greece

Coronavirus disease 2019(COVID-19)is associated with poor cardiovascular outcomes in patients with heart failure(HF)of all categories of ejection fraction(EF),but mainly in patients with HF with reduced ***,cardiac transplant patients exhibit worse cardiovascular prognosis,high mortality,and more admissions to the intensive care *** general,COVID-19 seems to deteriorate the clinical status of HF and favors the development of acute respiratory distress syndrome and multiorgan failure,especially in the presence of cardiovascular comorbidities such as diabetes mellitus,kidney dysfunction,and older ***-19 may induce new-onset HF with complex mechanisms that involve myocardial ***,myocardial injury comprises a large category of detrimental effects for the myocardium,such as myocardial infarction type 1 or type 2,Takotsubo cardiomyopathy,microvascular dysfunction and myocarditis,which are not easily distinguished by *** pathophysiologic mechanisms mainly involve direct myocardial damage by severe acute respiratory syndrome coronavirus 2,cytokine storm,hypercoagulation,inflammation,and endothelial *** proper management of patients with COVID-19 involves careful patient evaluation and ongoing monitoring for complications such as HF.

关键词： Heart failure COVID-19 Prognosis Intensive care unit New onset heart failure Ejection fraction

维生素C提高冠状动脉粥样硬化症病人一氧化氮的利用度

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国际内科学杂志 2000年第7期27卷 309-310页

作者： tousoulis D,张春平,王桂荣

维生素C对稳定型心绞痛患者冠状动脉内L-精氨酸依赖性冠状动脉舒张作用的影响

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世界核心医学期刊文摘(心脏病学分册) 2006年第2期 56-57页

作者： tousoulis D. Xenakis C. Tentolouris C. 刘文秀 Athens University Medical School S Karagiorga 69 16675 Athens Greece Dr.

Objective: To assess the effects of intravenous vitamin C administration on the vasomotor responses to intracoronary L-arginine infusion in epicardial coronary arteries. Methods: 28 patients with coronary artery disease and stable angina were enrolled in the study. Eight patients received intracoronary infusions of 150 μ mol/min L-arginine before and after intravenous infusion of vitamin C, 10 patients received intracoronary infusions of 150 μ mol/min L-arginine before and after intravenous infusion of normal saline, and 10 patients received intracoronary normal saline before and after intravenous infusion of vitamin C. The diameter of proximal and distal coronary artery segments was measured by quantitative angiography. Results: Infusion of L-arginine caused significant dilatation of both proximal(4.87(0.96)% , p< 0.01 v normal saline) and distal(6.33(1.38)% , p< 0.01 v normal saline) coronary segments. Co-infusion of vitamin C and L-arginine dilated proximal coronary segments by 8.68(1.40)% (p< 0.01 v normal saline, p< 0.01 v L-arginine) and distal segments by 13.07(2.15)% (p< 0.01 v normal saline, p< 0.01 v L-arginine). Intravenous infusion of vitamin C caused a borderline increase in proximal and distal coronary segment diameters(1.93(0.76)% and 2.09(1.28)% , respectively, not significant). Conclusions: L-Arginine dependent coronary segment vasodilatation was augmented by the antioxidant vitamin C in patients with coronary artery disease. Thus, vitamin C may have beneficial effects on nitric oxide bioavailability induced by L-arginine.

关键词：冠状动脉内精氨酸稳定型心绞痛舒张作用维生素患者