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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

Catheter ablation for atrial fibrillation in heart failure:untying the Gordian knot

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Journal of Geriatric Cardiology 2021年第4期18卷 297-306页

作者： Saad Javed ioanna koniari David Fox Chris Skene Gregory YH Lip Dhiraj Gupta Liverpool Centre for Cardiovascular Science University of LiverpoolLiverpool Heart and Chest HospitalLiverpoolUK Division of Cardiovascular Sciences University of ManchesterManchesterUK Cardiology Department University Hospital of ManchesterManchesterUK

Atrial fibrillation(AF) and heart failure(HF) are complex clinical entities that occur concomitantly in a significant population of patients, and their prevalence is rising in epidemic proportions. Traditionally, both rate and rhythm control strategies have been regarded as equivalent in the management of dysrhythmia in this AF-HF cohort with escalation of treatment largely guided by symptoms. Both disorders are involved in an elaborate pathophysiological interplay with shared cardiovascular risk factors that contribute to the development and sustenance of both AF and HF. Recent studies and continued development of evidence to support catheter ablation for AF has brought into question the traditional belief in equivalence between rate and rhythm control. Indeed, recent trials, in particular the CASTLE-AF(Catheter Ablation versus Standard Conventional Therapy in Patients with Left Ventricular Dysfunction and Atrial Fibrillation) study, suggest that catheter ablation for AF improves survival and rates of hospitalisation in patients with concomitant HF and AF, threatening a paradigm shift in the management of this patient cohort. The evident mortality benefit from clinical trials suggests that catheter ablation for AF should be considered as a therapeutic intervention in all suitable patients with the AF-HF syndrome as these patients may derive the greatest benefit from restoration of sinus rhythm. Further research is needed to refine the evidence base, especially to determine which subgroup of HF patients benefit most from catheter ablation and what is the optimal timing.

关键词： Catheter ablation for atrial fibrillation in heart failure:untying the Gordian knot

Endocarditis after transcatheter aortic valve implantation： a current assessment

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Journal of Geriatric Cardiology 2018年第1期15卷 61-65页

作者： Emmanouil Chourdakis ioanna koniari George Hahalis Nicholas G Kounis Karl Eugen Hauptmann Krankenhaus der Barmherzigen Briider Trier Germany Patras University Hospital: Rio Patras Greece

1 Introduction Transcatheter aortic valve implantation （TAVI） constitutes an established treatment in inoperable or high perioperative risk patients with severe aortic stenosis, demonstrating similar mortality rates （at 30 days and 1 year） with surgical aortic valve replacement （SAVR）. Various complications have been reported during TAVI, weeks or months post procedure. The most frequent causes of transcatheter heart valve （THV） failure are paravalvular regurgitation, infective endocarditis （IE）, thrombosis and late valve Migration.

关键词： Infective endocarditis Prosthetic valve endocarditis Transcatheter aortic valve implantation

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 Valve-in-Valve implantation after late migration of balloon expandable Sapien- XT prosthesis in a severe pure aortic regurgitation case

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Journal of Geriatric Cardiology 2017年第12期14卷 763-765页

作者： Emmanouil Chourdakis ioanna koniari George Hahalis Nicholas Kounis Karl Eugen Hauptmann Krankenhaus der Barmherzigen Briider Trier Germany Department of InterventionalElectriphysiology Royal Brompton Hospital London United Kingdom Cardiology Department Patras University Hospital Rio Patras Greece

A 76-year old female, was admitted in our cardiac surgery clinic to perform surgical aortic valve replacement due to a severe aortic regurgitation with symptoms of congestive heart failure. Her past medical history in... 详细信息

关键词： Native aortic regurgitation Prosthetic valve migration Valve in Valve

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

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

Kounis syndrome:a clinical entity penetrating from pediatrics to geriatrics

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Journal of Geriatric Cardiology 2020年第5期17卷 294-299页

作者： Mattia Giovannini ioanna koniari Francesca Mori Silvia Ricci Luciano De Simone Silvia Favilli Sandra Trapani Giuseppe Indolfi Nicholas George Kounis Elio Novembre Allergy Unit Department of Pediatrics Meyer Children’s University Hospital Electrophysiology and Device Department University Hospital of South Manchester NHS Foundation Trust Department of Health Sciences University of Florence Meyer Children’s Hospital Pediatric Cardiology Unit Meyer Children’s University Hospital Department of Neurofarba University of Florence Meyer Children’s Hospital Department of Cardiology Patras University School of Medicine

1 Introduction Kounis syndrome constitutes a coronary hypersensitivity disorder defined by the association of an anaphylactoid,anaphylactic,allergic or hypersensitivity reaction with an acute coronary syndrome,in a physiopathological context involving various interrelated and interacting inflammatory cells,such as mast-cells,eosinophils and platelets.[1,2]Similar entities to Kounis syndrome might involve cerebral and mesenteric arteries.

关键词： Age Classification Coronary artery disease Kounis syndrome Myocardial infarction