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Article ; Online: Large pericardial effusion in a woman in the second trimester of pregnancy: a case report.

Rammos, Aidonis / Papaioannou, Eftychia / Lazaros, George / Siminelakis, Stavros / Naka, Katerina K

European heart journal. Case reports

2024 Volume 8, Issue 3, Page(s) ytae080

Abstract: Background: Pericardial effusion is common in pregnancy, with causes similar to the general population. Usually, it is found in the third trimester and disappears spontaneously after labour; however, there is a risk of progression to tamponade. ... ...

Abstract	Background: Pericardial effusion is common in pregnancy, with causes similar to the general population. Usually, it is found in the third trimester and disappears spontaneously after labour; however, there is a risk of progression to tamponade. Management is based on expert opinion, since few studies have been published. Case summary: A woman with enlargement of a known, chronic, presumably idiopathic pericardial effusion, in the 17th gestation week, presented with mild dyspnoea, without specific echocardiographic signs of cardiac tamponade. She received double antithrombotic treatment with aspirin 100 mg, started before conception, and a prophylactic dose of tinzaparin 4500 IU, started at the beginning of the pregnancy due to obstetrical antiphospholipid syndrome. A multidisciplinary team consisting of the treating obstetrician-gynaecologist, haematologist, cardiothoracic surgeon, and cardiologist discussed the management, taking into account the large size of the effusion and the significant increase during pregnancy, the possibility of further increase during the third trimester, the antiplatelet and antithrombotic treatment, which increased the haemorrhagic risk, and the difficulty and risk to intervene later in pregnancy. A surgical pericardial window was proposed to the patient and family and was performed uneventfully. Discussion: This case demonstrates the importance of a multidisciplinary team approach and shared decision-making in the management of these complex cardio-obstetric patients in order to achieve optimal therapeutic results.
Language	English
Publishing date	2024-02-09
Publishing country	England
Document type	Case Reports
ISSN	2514-2119
ISSN (online)	2514-2119
DOI	10.1093/ehjcr/ytae080
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Article ; Online: Current and emerging perspectives on pathophysiology, diagnosis, and management of hypertrophic cardiomyopathy.

Gartzonikas, Ilias K / Naka, Katerina K / Anastasakis, Aris

Hellenic journal of cardiology : HJC = Hellenike kardiologike epitheorese

2022 Volume 70, Page(s) 65–74

Abstract: Hypertrophic cardiomyopathy (HCM) is the most common genetically inherited cardiomyopathy with an autosomal dominant inheritance pattern. A disease-causing gene is found between 34% and >60% of the times and the two most frequently mutated genes, which ... ...

Abstract	Hypertrophic cardiomyopathy (HCM) is the most common genetically inherited cardiomyopathy with an autosomal dominant inheritance pattern. A disease-causing gene is found between 34% and >60% of the times and the two most frequently mutated genes, which encode sarcomeric proteins, are MYBPC3 and MYH7. HCM is a diagnosis of exclusion since secondary causes of left ventricular hypertrophy should first be ruled out. These include hypertension, aortic stenosis, infiltrative disease, metabolic and endocrine disorders, mitochondrial cardiomyopathies, neuromuscular disorders, malformation syndromes and some chronic drug use. The disease is characterized by great heterogeneity of its clinical manifestations, however diastolic dysfunction and increased ventricular arrhythmogenesis are commonly seen. Current HCM therapies focus on symptom management and prevention of sudden cardiac death. Symptom management includes the use of pharmacological agents, elimination of medication promoting outflow track obstruction, control of comorbid conditions and invasive procedures, whereas in the prevention of sudden cardiac death, implantable cardiac defibrillators and antiarrhythmic drugs are used. A targeted therapy for LVOTO represented by allosteric cardiac myosin inhibitors has been developed. In terms of sport participation, a more liberal approach is recently recommended, after careful evaluation and common-shared decision. The application of the current therapies has lowered HCM mortality rates to <1.0%/year, however it appears to have shifted focus to heart failure and atrial fibrillation, as the predominant causes of disease-related morbidity and mortality and, therefore, unmet treatment need. With improved understanding of the genetic and molecular basis of HCM, the present decade will witness novel treatments for disease prevention and modification.
MeSH term(s)	Humans ; Cardiomyopathy, Hypertrophic/diagnosis ; Cardiomyopathy, Hypertrophic/genetics ; Cardiomyopathy, Hypertrophic/therapy ; Cardiomyopathies/complications ; Heart Failure/etiology ; Atrial Fibrillation/complications ; Death, Sudden, Cardiac/etiology ; Death, Sudden, Cardiac/prevention & control
Language	English
Publishing date	2022-11-17
Publishing country	Netherlands
Document type	Journal Article ; Review
ZDB-ID	2215027-4
ISSN	2241-5955 ; 1109-9666
ISSN (online)	2241-5955
ISSN	1109-9666
DOI	10.1016/j.hjc.2022.11.002
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Article: Editorial to "effectiveness of catheter ablation of atrial fibrillation according to heart failure etiology".

Bazoukis, George / Naka, Katerina K

Journal of arrhythmia

2019 Volume 36, Issue 1, Page(s) 93–94

Language	English
Publishing date	2019-12-27
Publishing country	Japan
Document type	Editorial
ZDB-ID	2696593-8
ISSN	1883-2148 ; 1880-4276
ISSN (online)	1883-2148
ISSN	1880-4276
DOI	10.1002/joa3.12295
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Article ; Online: In-Hospital versus Out-of-Hospital Pulmonary Embolism: Clinical Characteristics, Biochemical Markers and Echocardiographic Indices.

Ballas, Christos / Lakkas, Lampros / Kardakari, Olga / Papaioannou, Eftychia / Siaravas, Konstantinos C / Naka, Katerina K / Michalis, Lampros K / Katsouras, Christos S

Journal of cardiovascular development and disease

2024 Volume 11, Issue 4

Abstract: Background: A significant proportion of pulmonary embolisms (PEs) occurs in patients during hospitalisation for another reason. However, limited data regarding differences between out-of-hospital PE (OHPE) and in-hospital PE (IHPE) is available. We ... ...

Abstract	Background: A significant proportion of pulmonary embolisms (PEs) occurs in patients during hospitalisation for another reason. However, limited data regarding differences between out-of-hospital PE (OHPE) and in-hospital PE (IHPE) is available. We aimed to compare these groups regarding their clinical characteristics, biochemical markers, and echocardiographic indices. Methods: This was a prospective, single-arm, single-centre study. Adult consecutive patients with non-COVID-related PE from September 2019 to March 2022 were included and followed up for 12 months. Results: The study included 180 (84 women) patients, with 89 (49.4%) suffering from IHPE. IHPE patients were older, they more often had cancer, were diagnosed earlier after the onset of symptoms, they had less frequent pain and higher values of high sensitivity troponin I and brain natriuretic peptide levels compared to OHPE patients. Echocardiographic right ventricular (RV) dysfunction was detected in similar proportions in the 2 groups. IHPE had increased in-hospital mortality (14.6% vs. 3.3%, Conclusions: In this prospective cohort study, IHPE differed from OHPE patients regarding age, comorbidities, symptoms, and levels of biomarkers associated with RV dysfunction. IHPE patients had higher in-hospital mortality compared to OHPE patients and a similar risk of death after discharge.
Language	English
Publishing date	2024-03-28
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2777082-5
ISSN	2308-3425 ; 2308-3425
ISSN (online)	2308-3425
ISSN	2308-3425
DOI	10.3390/jcdd11040103
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Article ; Online: Venous Thromboembolism in Patients with Heart Failure.

Bechlioulis, Aris / Lakkas, Lampros / Rammos, Aidonis / Katsouras, Christos / Michalis, Lampros / Naka, Katerina

Current pharmaceutical design

2022 Volume 28, Issue 7, Page(s) 512–520

Abstract: Heart failure (HF) and venous thromboembolism (VTE) are common clinical entities, closely interrelated, sharing multiple pathophysiological mechanisms. Their co-incidence is associated with further worsening of the prognosis of one another. Despite their ...

Abstract	Heart failure (HF) and venous thromboembolism (VTE) are common clinical entities, closely interrelated, sharing multiple pathophysiological mechanisms. Their co-incidence is associated with further worsening of the prognosis of one another. Despite their frequent co-existence, important clinical questions still remain unanswered. The risk of VTE especially in chronic HF patients appears to vary widely in clinical studies, while the VTE-associated risk in HF patients is still not well determined and cannot be accurately predicted. Although scientific guidelines recommend venous thromboprophylaxis in patients hospitalized with an acute HF syndrome, venous thromboprophylaxis has not been studied adequately in prospective trials in ambulatory HF patients. In the present review, we aimed to summarize the current knowledge on the epidemiology of VTE and HF, the risk prediction for VTE occurrence in HF patients, the impact on patient outcome, and the need for anticoagulation in certain HF subgroups to improve prognosis, while we sought to identify gaps in knowledge that need to be addressed in the future.
MeSH term(s)	Anticoagulants/therapeutic use ; Heart Failure/chemically induced ; Heart Failure/complications ; Heart Failure/drug therapy ; Humans ; Prospective Studies ; Risk Factors ; Venous Thromboembolism/drug therapy ; Venous Thromboembolism/etiology
Chemical Substances	Anticoagulants
Language	English
Publishing date	2022-08-27
Publishing country	United Arab Emirates
Document type	Journal Article ; Review
ZDB-ID	1304236-1
ISSN	1873-4286 ; 1381-6128
ISSN (online)	1873-4286
ISSN	1381-6128
DOI	10.2174/1381612827666210830102419
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Article ; Online: Hyponatremia in patients with heart failure beyond the neurohormonal activation associated with reduced cardiac output: A holistic approach.

Christopoulou, Eliza / Liamis, George / Naka, Katerina / Touloupis, Panagiotis / Gkartzonikas, Ilias / Florentin, Matilda

Cardiology

2022

Abstract: Background: Heart failure (HF)is considered an epidemic disease with considerable morbidity, mortality and immense healthcare costs. Electrolyte abnormalities are often encountered in patients with HF posing a diagnostic and therapeutic challenge for ... ...

Abstract	Background: Heart failure (HF)is considered an epidemic disease with considerable morbidity, mortality and immense healthcare costs. Electrolyte abnormalities are often encountered in patients with HF posing a diagnostic and therapeutic challenge for clinicians. Hyponatremia affects up to one third of HF patients and represents an unfavorable prognostic factor. Summary: Low sodium levels in HF are mainly attributed to the neurohormonal activation secondary to decreased effective circulating volume. However, patients with HF often have several co-morbidities which may cause or exacerbate the pre-existing hyponatremia. Factors that provoke HF, such as alcohol overconsumption, may also be involved in hyponatremia development. Furthermore, drugs which are frequently prescribed to HF patients, especially diuretics, are potential culprits of hyponatremia and should always be addressed, since their withdrawal may reverse hyponatremia. Despite the great prevalence and the deleterious effects hyponatremia in these patients, it is often overlooked and consequently undertreated. In this review we present the mechanisms involved in the development of hyponatremia focusing on those besides neurohormonal activation. We also discuss the proper management of this electrolyte disorder which is frequently complex in patients with HF. Key messages: Hyponatremia in patients with HF is not only the result of neurohormonal activation; several co-morbidities and frequently used drugs should also be addressed. Hence, a holistic approach is required both for the diagnosis and optimal treatment.
Language	English
Publishing date	2022-09-21
Publishing country	Switzerland
Document type	Journal Article ; Review
ZDB-ID	80092-2
ISSN	1421-9751 ; 0008-6312
ISSN (online)	1421-9751
ISSN	0008-6312
DOI	10.1159/000526912
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Article ; Online: The effect of SGLT2 inhibitors, GLP1 agonists, and their sequential combination on cardiometabolic parameters: A randomized, prospective, intervention study.

Bechlioulis, Aris / Markozannes, Georgios / Chionidi, Ifigeneia / Liberopoulos, Evangelos / Naka, Katerina K / Ntzani, Evangelia E / Liatis, Stavros / Rizzo, Manfredi / Rizos, Evangelos C

Journal of diabetes and its complications

2023 Volume 37, Issue 4, Page(s) 108436

Abstract: Background: Pulse wave velocity (PWV) and augmentation index (AIx) are indices used to assess arterial stiffness. We aim to compare the effect of empagliflozin, liraglutide and their sequential combination on arterial stiffness indices in patients with ... ...

Abstract	Background: Pulse wave velocity (PWV) and augmentation index (AIx) are indices used to assess arterial stiffness. We aim to compare the effect of empagliflozin, liraglutide and their sequential combination on arterial stiffness indices in patients with type 2 diabetes (T2D). Methods: This was a randomized single blind study evaluating the effect of empagliflozin vs liraglutide in adult patients with T2D. Patients were randomized to liraglutide titrated gradually to 1.8 mg or empagliflozin 25 mg in 1:1 ratio. Three months later empagliflozin was added to the liraglutide group, and liraglutide was added to the empagliflozin group. Patients were assessed with non-invasive tests for arterial stiffness (i.e., carotid-femoral PWV and AIx of aortic pressure) at baseline, 3-month and 9-month visits (final visit was extended for 3 months from the initial design due to Covid 19 pandemic). The primary outcome was the between-group difference of PWV change (ΔPWV) and ΔAIx at 3 months. Secondary outcomes included the between-group difference of ΔPWV and ΔAIx at 9 months, as well as the ΔPWV and ΔAIx between baseline and 9-month visit when total study population was assessed. Results: A total of 62 patients with T2D (30 started liraglutide; 32 empagliflozin, mean age 63 years, 25 % with established cardiovascular disease) participated in the study. We failed to show any significant between-group differences of ΔPWV and ΔΑΙx at 3 and 9 months, as well as between-group difference of ΔPWV and ΔAIx for the total study population between baseline and 9-month visit. In contrast, systemic vascular resistance and lipoprotein(a) levels improved, showing better results with liraglutide than empagliflozin. Favorable effects were also observed on body weight, body mass index, body and visceral fat, blood pressure, HbA1c, and uric acid levels. Conclusion: No evidence of a favorable change in arterial stiffness indices was seen with empagliflozin or liraglutide or their combination in this study. Well-designed powerful studies are needed to address any potential effects on arterial stiffness in selected populations.
MeSH term(s)	Humans ; Middle Aged ; Cardiovascular Diseases/epidemiology ; Cardiovascular Diseases/prevention & control ; Cardiovascular Diseases/complications ; COVID-19/complications ; Diabetes Mellitus, Type 2/complications ; Diabetes Mellitus, Type 2/drug therapy ; Liraglutide/adverse effects ; Prospective Studies ; Pulse Wave Analysis ; Single-Blind Method ; Sodium-Glucose Transporter 2 Inhibitors/therapeutic use ; Sodium-Glucose Transporter 2 Inhibitors/pharmacology ; Vascular Stiffness
Chemical Substances	empagliflozin (HDC1R2M35U) ; Liraglutide (839I73S42A) ; Sodium-Glucose Transporter 2 Inhibitors ; SLC5A2 protein, human
Language	English
Publishing date	2023-02-23
Publishing country	United States
Document type	Randomized Controlled Trial ; Journal Article
ZDB-ID	1105840-7
ISSN	1873-460X ; 1056-8727
ISSN (online)	1873-460X
ISSN	1056-8727
DOI	10.1016/j.jdiacomp.2023.108436
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Article: Endothelial dysfunction and heart failure: A review of the existing bibliography with emphasis on flow mediated dilation.

Giannitsi, Sofia / Bougiakli, Maria / Bechlioulis, Aris / Naka, Katerina

JRSM cardiovascular disease

2019 Volume 8, Page(s) 2048004019843047

Abstract: Heart failure affects 1-2% of the population worldwide, and it is characterized by episodes of decompensation often requiring hospitalization. Although targeted treatment has reduced the prevalence of rehospitalizations to 30-50%, mortality rates remain ... ...

Abstract	Heart failure affects 1-2% of the population worldwide, and it is characterized by episodes of decompensation often requiring hospitalization. Although targeted treatment has reduced the prevalence of rehospitalizations to 30-50%, mortality rates remain high. A complex blend of structural and functional alterations accounts for the genesis and progression of heart failure, but the exact underlying pathophysiology remains poorly understood. The aim of this review is to summarize endothelial dysfunction and its role in the pathogenesis and progression of heart failure. Moreover, it sums up all the appropriate methods of assessing endothelial dysfunction emphasizing on flow-mediated dilation and introduces endothelium as a potential target for new therapeutic development and research in the wide spectrum of the syndrome called heart failure.
Language	English
Publishing date	2019-04-11
Publishing country	England
Document type	Bibliography ; Journal Article ; Review
ISSN	2048-0040
ISSN	2048-0040
DOI	10.1177/2048004019843047
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Article: Virtual Hemodynamic Assessment of Coronary Lesions: The Advent of Functional Angiography and Coronary Imaging.

Nikopoulos, Sotirios / Papafaklis, Michail I / Tsompou, Panagiota / Sakellarios, Antonis / Siogkas, Panagiotis / Sioros, Spyros / Fotiadis, Dimitrios I / Katsouras, Christos S / Naka, Katerina K / Nikas, Dimitrios / Michalis, Lampros

Journal of clinical medicine

2024 Volume 13, Issue 8

Abstract: The fractional flow reserve (FFR) is well recognized as a gold standard measure for the estimation of functional coronary stenosis. Technological progressions in image processing have empowered the reconstruction of three-dimensional models of the ... ...

Abstract	The fractional flow reserve (FFR) is well recognized as a gold standard measure for the estimation of functional coronary stenosis. Technological progressions in image processing have empowered the reconstruction of three-dimensional models of the coronary arteries via both non-invasive and invasive imaging modalities. The application of computational fluid dynamics (CFD) techniques to coronary 3D anatomical models allows the virtual evaluation of the hemodynamic significance of a coronary lesion with high diagnostic accuracy. Methods: Search of the bibliographic database for articles published from 2011 to 2023 using the following search terms: invasive FFR and non-invasive FFR. Pooled analysis of the sensitivity and specificity, with the corresponding confidence intervals from 32% to 94%. In addition, the summary processing times were determined. Results: In total, 24 studies published between 2011 and 2023 were included, with a total of 13,591 patients and 3345 vessels. The diagnostic accuracy of the invasive and non-invasive techniques at the per-patient level was 89% (95% CI, 85-92%) and 76% (95% CI, 61-80%), respectively, while on the per-vessel basis, it was 92% (95% CI, 82-88%) and 81% (95% CI, 75-87%), respectively. Conclusion: These opportunities providing hemodynamic information based on anatomy have given rise to a new era of functional angiography and coronary imaging. However, further validations are needed to overcome several scientific and computational challenges before these methods are applied in everyday clinical practice.
Language	English
Publishing date	2024-04-12
Publishing country	Switzerland
Document type	Journal Article ; Review
ZDB-ID	2662592-1
ISSN	2077-0383
ISSN	2077-0383
DOI	10.3390/jcm13082243
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Article ; Online: Real-world implementation of guidelines for heart failure management: A systematic review and meta-analysis.

Tsigkas, Grigorios / Apostolos, Anastasios / Aznaouridis, Konstantinos / Despotopoulos, Stefanos / Chrysohoou, Christina / Naka, Katerina K / Davlouros, Periklis

Hellenic journal of cardiology : HJC = Hellenike kardiologike epitheorese

2022 Volume 66, Page(s) 72–79

Abstract: The real-world implementation of heart failure (HF) guidelines remains unclear. Our present systematic review and meta-analysis aimed to examine the rate of HF patients receiving guideline-directed treatment to identify the proportion of under-treatment ... ...

Abstract	The real-world implementation of heart failure (HF) guidelines remains unclear. Our present systematic review and meta-analysis aimed to examine the rate of HF patients receiving guideline-directed treatment to identify the proportion of under-treatment patients and those who are treated with optimal doses, to evaluate the correlation of under-treatment patients' characteristics with the prescribed therapy, and finally, to evaluate the combined effect of the above on incidental mortality and rehospitalization. We conducted a systematic review of the literature indexed in Medline. We screened 1224 papers and excluded 1166 as they did not meet the inclusion criteria. Of the remaining 58 papers, which were evaluated by studying the full text, 11 papers that referred to 45866 patients were finally studied in this work. Angiotensin-Converting-Enzyme Inhibitor (ACEI) and Angiotensin II-Receptor Blocker (ARB) use was estimated to be 80.9% (95% CI: 73.9%, 86.4%), β-blockers' use was 78% (95% CI: 70.4%, 84.1%), Mineralocorticoid Receptor Antagonists' use was 47.4% (95% Cl 41.6%, 53.4%), and cardiac resynchronization therapy's use was 5.8% (95% Cl 3.4%, 9.6%). Meta-regression analysis showed that prescription of more than the half of target dose of ACEI/ARBs was found to be associated with reduced all-cause mortality (Z = -3.61, P = 0.0003), while the relationship with β-blockers was borderline (Z = -1.56, P = 0.11). A satisfactory adherence to the prescription of guideline-recommended treatment in patients with HF was observed. However, the under titration of the life-saving HF drugs need to be improved as only ultimate adherence to guideline-directed treatments may lead to the reduction of HF burden.
MeSH term(s)	Adrenergic beta-Antagonists/therapeutic use ; Angiotensin Receptor Antagonists/therapeutic use ; Angiotensin-Converting Enzyme Inhibitors/therapeutic use ; Heart Failure/drug therapy ; Humans ; Mineralocorticoid Receptor Antagonists/therapeutic use ; Stroke Volume
Chemical Substances	Adrenergic beta-Antagonists ; Angiotensin Receptor Antagonists ; Angiotensin-Converting Enzyme Inhibitors ; Mineralocorticoid Receptor Antagonists
Language	English
Publishing date	2022-05-01
Publishing country	Netherlands
Document type	Journal Article ; Meta-Analysis ; Review ; Systematic Review
ZDB-ID	2215027-4
ISSN	2241-5955 ; 1109-9666
ISSN (online)	2241-5955
ISSN	1109-9666
DOI	10.1016/j.hjc.2022.04.006
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