Ignatios Ikonomidis

Attikon University Hospital, Athínai, Attica, Greece

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Publications (178)785.94 Total impact

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    ABSTRACT: Aims: We investigated the association between left ventricular (LV) torsional deformation and vascular dysfunction, fibrosis, neurohumoral activation, and exercise capacity in patients with normal ejection fraction METHODS AND RESULTS: In 320 newly-diagnosed untreated hypertensive patients and 160 controls, we measured: pulse wave velocity (PWV); coronary flow reserve (CFR) by Doppler echocardiography; global longitudinal strain and strain rate, peak twisting, the percentage changes between peak twisting, and untwisting at mitral valve opening (%dpTw - UtwMVO ), at peak (%dpTw - UtwPEF ), and the end of early LV diastolic filling (%dpTw - UtwEDF ) by speckle tracking imaging; transforming growth factor (TGFb-1), metalloproteinase-9 (MMP-9), tissue inhibitor of matrix metalloptoteinase-1(TIMP-1), markers of collagen synthesis, and N-terminal pro-brain natriuretic peptide (NT-proBNP). Oxygen consumption (VO2 ), measured by means of cardiopulmonary exercise test, was assessed in a subset of 80 patients. The PWV, CFR, longitudinal strain and strain rate, %dpTw-UtwMVO , %dpTw-UtwPEF , and %dpTw-UtwEDF were impaired in hypertensive patients compared with controls. In multivariable analysis, CFR, PWV, LV mass, and systolic blood pressure were independent determinants of longitudinal strain, strain rate, and untwisting markers (P < 0.05). Increased TGFb-1 was related with increased collagen synthesis markers, TIMP-1 and MMP-9 and these biomarkers were associated with impaired longitudinal systolic strain rate, untwisting markers, CFR and PWV (P < 0.05). Delayed untwisting as assessed by reduced %dpTw - UtwEDF was related with increased NT-proBNP and reduced VO2 (P < 0.05). Conclusions: Impaired LV untwisting is associated with increased arterial stiffness and coronary microcirculatory dysfunction, and is linked to reduced exercise capacity and neurohumoral activation in hypertensive heart disease. A fibrotic process may be the common link between vascular dysfunction and abnormal myocardial deformation.
    European Journal of Heart Failure 10/2015; DOI:10.1002/ejhf.403 · 6.53 Impact Factor

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    ABSTRACT: We sought to evaluate the potential enhanced fibrinolytic and antiplatelet activity of dabigatran etexilate (DE) due to decreased thrombin levels in patients with stroke or transient ischemic attack and non-valvular atrial fibrillation (NVAF). Consecutive patients with cerebrovascular diseases and NVAF that were treated with DE in a tertiary university hospital. Fibrinolysis and platelet function were assessed by thromboelastometry (ROTEM) and platelet function analyzer (PFA)-100, respectively, before and after treatment with DE. Conventional coagulation tests, endogenous thrombin potential (ETP) and hemoclot thrombin inhibitors (HTI), were also performed in order to detect any possible correlation between dabigatran plasma levels, its anticoagulant activity and the intensity of platelet dysfunction or fibrinolysis. A total of nineteen patients fulfilled our inclusion criteria (mean age 62.3±7.2years; 47% males; median CHADS2-score: 3; interquartile range: 2-4). DE treatment was associated with a significant reduction of the lysis index (LI60) at 60min (p=0.036), and prolongation of the PFA-100 CEPI closure time (p=0.024). After dabigatran treatment, abnormal PFA-100 results were obtained in two patients (11%, 95% CI: 2%-33%). DE levels (determined by HTI) were strongly inversely correlated (rho=-0.85; p<0.001) with the area under the curve (AUC) values in ETP assay. Νo association was found between HTI and PFA-100 CEPI CT (p=0.64), or LI60 measurements (p=0.60). Our findings indicate that DE might affect platelet function and fibrinolysis and highlight the potential role of ETP as an alternative option in DE monitoring. The intensity and clinical relevance of DE antiplatelet and fibrinolytic effects require further investigation. Copyright © 2015 Elsevier B.V. All rights reserved.
    Journal of the neurological sciences 07/2015; DOI:10.1016/j.jns.2015.07.031 · 2.47 Impact Factor
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    ABSTRACT: The purpose of the present study was to evaluate the prognostic value of left atrial (LA) mechanics and stiffness in a prospective cohort of 82 asymptomatic patients (31 men, mean age 73±10 years) with severe aortic stenosis (AS) and normal left ventricular ejection fraction. Methods: By the use of 2-dimensional speckle tracking echocardiography, LA reservoir, strain rate and stiffness, LV strain, rotations, and twist were evaluated. The predefined end points were the occurrence of symptoms,aortic valve replacement and death. Results: At study entry, all patients had reduced LA reservoir (19.6±5%) and LV global longitudinal strain (LVGLS) (-15.3±3%), enhanced Zva (7.3 ±0.7 mm Hg/ml/m2) and LA stiffness (0.9±0.1). During follow-up (17.2±15.3 months) 53 patients (64.6%) reached the predefined end-points. No difference was found between symptomatic and asymptomatic patients as regards LV ejection fraction, LA volumes and AS severity. On the contrary, patients with events had lower indexed stroke volume p=0.001), LVGLS (p<0.001), LA reservoir (p<0.001) and higher LV mass (p=0.007), Zva (p<0.001) and LA stiffness (p<0.001), than those asymptomatic. Patients with lower LA reservoir (≤ 19.3%, median value) and higher LA stiffness (≥ 0.89, median value) had significantly worse event-free survival (figure 1). When the global population was split according to the median of LVGLS and Zva (GLS ≥ -15.2% and Zva ≤ 6.26 mmHg/ml/m2), amoung patients with minor impairment of LVGLS and Zva, the subgroup with events had significantly lower LA reservoir (p=0.01 and p=0.02, respectively) and higher LA stiffness (p=0.02 and p=0.02, respectively) if compared to the asymptomatic; Conclusion: LA mechanics may be a relevant contributor to the prognostic stratification of patients with asymptomatic severe AS.
  • Ignatios Ikonomidis · George Makavos · John Lekakis ·
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    ABSTRACT: The current traditional risk scores are not sufficient to predict the full incidence of cardiovascular disease. In this brief review, we discuss the pathophysiological mechanisms through which arterial stiffness affects cardiac function and the additive value of markers of arterial stiffness, to detect the presence of coronary artery disease (CAD) and predict adverse outcome in these patients. Arterial stiffness causes early arrival of wave reflections in systole instead of diastole and, thus, increases systolic afterload and reduces diastolic coronary perfusion pressure. Abnormal collagen turnover, cytokines, and metalloproteinase activity are common biochemical links between vascular and myocardial stiffness. Pulse wave velocity, augmentation index, and central pressures measured by simple noninvasive methods are related to atheromatic plaque vulnerability, incidence, severity, and extent of CAD. Recent meta-analyses have shown the additive value of markers of arterial stiffness, and particularly of pulse wave velocity, to detect CAD, predict cardiovascular events, and reclassify patients to a higher cardiovascular risk. Studies assessing whether reduction of arterial stiffness is associated with improved prognosis are lacking. Markers of arterial stiffness are useful tools to identify early atherosclerosis and adverse clinical outcomes in young adults and individuals with a modest risk factor profile. Assessing arterial stiffness may facilitate cardiovascular risk stratification beyond traditional risk scores.
    Current opinion in cardiology 07/2015; 30(4):422-431. DOI:10.1097/HCO.0000000000000179 · 2.70 Impact Factor
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    ABSTRACT: Insulin resistance is linked to endothelial dysfunction. We investigated whether first-degree relatives of type-2 diabetes patients (FDR) present differences in vascular function at baseline and during postprandial hyperglycemia compared to dysglycaemic or normoglycaemic subjects. We studied 40 FDR with normal oral glucose test (OGTT), 40 subjects with abnormal OGTT (dysglycaemic) and 20 subjects with normal OGTT without parental history of diabetes (normoglycaemic) with similar clinical characteristics. Glucose, insulin, pulse wave velocity (PWV), central systolic blood pressure (cSBP) and augmentation index (AI) were measured at 0, 30, 60, 90 and 120min during OGTT. Coronary flow reserve (CFR) was assessed using Doppler echocardiography at 0 and 120min after OGTT. Insulin sensitivity was evaluated using Matsuda and insulin sensitivity index (ISI). FDR and dysglycaemics had higher fasting insulin, reduced ISI, Matsuda index as well as reduced CFR (2.54 ± 0.5 vs. 2.45 ± 0.3 vs. 2.74 ± 0.5), increased PWV, (8.9 ± 1.1 vs. 10.3 ± 2.4vs. 8.0 ± 1.5 m/sec), AI (23.8 ± 13.6 vs. 26.5 ± 14.4vs.17.7 ± 14%) and cSBP than normoglycaemics (p < 0.05 for all comparisons). During OGTT, AI was similarly reduced in both normoglycaemic and FDR (p < 0.05) at peak insulin levels (60 min) though FDR had 2-fold higher insulin than normoglycaemics. AI was increased in dysglycaemics after peak glucose levels, at 120 min (p < 0.05). CFR was reduced by 10% and 15% at 120min in FDR and dysglycaemic respectively, while remained unchanged in normoglycaemics (p < 0.05). The percent reduction of CFR was related with the percent increase of glucose levels, ISI and Matsuda index(p < 0.05). First-degree relatives and dysglycaemic patients have impaired arterial and coronary microcirculatory function. Insulin resistance determines acute vascular responses during postprandial hyperglycemia. CLINICALTRIALS. NCT02244736. Copyright © 2015. Published by Elsevier Ireland Ltd.
    Atherosclerosis 06/2015; 241(2):455-462. DOI:10.1016/j.atherosclerosis.2015.06.006 · 3.99 Impact Factor
  • Article: PP.13.05
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    ABSTRACT: Objective: Aortic stiffness is considered valuable index of subclinical damage in hypertensive patients offering to cardiovascular risk estimation. The integrity of endothelial glycocalyx plays a vital role in vascular permeability, inflammation and elasticity. We aimed to explore any changes in aortic stiffness as well as in endothelial glycocalyx in patients with well controlled essential hypertension under treatment. Design and method: We studied 48 patients with newly diagnosed and never treated essential hypertension (mean age 48 + 10 years, 31 males). We performed carotid-femoral artery pulse wave velocity (PWV) in order to evaluate aortic stiffness. Increased perfusion boundary region (PBR) of the sublingual arterial microvessels (ranged from 5-25 micrometers) using Sideview Darkfield imaging (Microscan, Glycocheck) was measured as a non-invasive accurate index of reduced endothelial glycocalyx thickness. All patients started antihypertensive treatment and they re-evaluated in a period 16 + 8 months later. Results: Regarding total population, 30 patients (63%, group A) were well controlled regarding their blood pressure (<140/90 mmHg), 11 patients (22%, group B) were uncontrolled while 7 patients (15%, group C) stopped medication. We found that in group A: a. 17 patients (57%) significantly reduced their PWV (p < 0.001) in a period of 14 + 8 months and their therapy was based in RAAS antagonists (72%), b. 15 patients (50%) improved their endothelial glycocalyx (PBR5-9) (p = 0.002) after 15 + 8 months based in RAAS antagonists (73%) and c. 11 patients (37%) both PWV (p < 0.001) and endothelial glycocalyx (PBR5-9) (p = 0.006) were improved after 14 + 9 months based in RAAS antagonists (73%). Conclusions: Cardiovascular risk reduction in hypertensives is based not only in blood pressure decrease but also in target organ damage improvement. This is the first study showing the parallel improvement of aortic stiffness and endothelial dysfunction in well controlled hypertensives after at least one year antihypertensive treatment based on RAAS antagonists. Further studies are needed to confirm our results and establish endothelial glycocalyx measurement as a valuable tool in cardiovascular risk estimation Copyright
    Journal of Hypertension 06/2015; 33:e239. DOI:10.1097/01.hjh.0000468077.05389.15 · 4.72 Impact Factor
  • Article: PP.32.29
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    ABSTRACT: Objective: Abnormal systolic blood pressure response at peak exercise during cardiopulmonary exercise test (hypertensive response) is considered as a cardiovascular risk factor. Aim of the study was to determine whether hypertensive response associates with impaired aerobic exercise capacity after maximal cardiopulmonary exercise test as well as with target organ damage indices in a cohort of recently diagnosed and well-controlled hypertensives. Design and method: 84 hypertensive patients (mean age 50 + 11 years, 56 males) with I-II essential hypertension underwent carotid-femoral pulse wave velocity (PWV), carotid intima-media thickness (cIMT), coronary flow reserve (CFR) and left ventricular mass index (LVMI) estimation at baseline. Antihypertensive treatment was added, blood pressure was nearly normalized in one month period and subsequently maximal, symptom-limited CPET was performed. Patients were divided in two groups regarding the presence of hypertensive response at peak exercise (>210 mmHg in males and > 190 mmHg in females). Group A had normal BP response (n = 64) at peak exercise while Group B had hypertensive response (n = 20). Results: At baseline evaluation no significant differences were found within groups regarding BMI, LDL levels, smoking habit, office and 24 h systolic BP, pulse pressure (PP), cIMT, LVMI and CFR. Patients with hypertensive response were older (p < 0.001), had increased baseline arterial stiffness expressed as PWV and 24 h PP (p < 0.05), increased systolic BP before and at peak exercise (p < 0.001) while exercise parameters (work load, mets, peak VO2, peak VO2/kg) were reduced (p < 0.001). Conclusions: Hypertensive response during maximal cardiopulmonary exercise testing in controlled hypertensives accompanies increased baseline aortic stiffness and impaired exercise parameters. Whether long-term antihypertensive treatment improves arterial stiffness and abolishes hypertensive response at peak exercise needs to be further investigated. Copyright
    Journal of Hypertension 06/2015; 33:e428. DOI:10.1097/01.hjh.0000468723.84103.76 · 4.72 Impact Factor
  • Article: PP.02.11
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    ABSTRACT: Objective: Red cell distribution width (RDW), a parameter of complete blood count in routine clinical practice, is a measure of erythrocytes size variability in the peripheral circulation. Increased RDW is independently associated with morbidity and mortality in cardiovascular diseases and is elevated in hypertensive patients compared with normotensives. We aimed to study the relationship of RDW with blood pressure parameters as well as arterial stiffness indices in recently diagnosed and never treated middle-aged patients with mild to moderate essential hypertension. Design and method: We studied 107 non-diabetic, recently diagnosed and never-treated patients with essential hypertension (mean age 49+11 years, 73 males). We performed 24 h ambulatory blood pressure measurement (ABPM) as well as carotid-femoral artery pulse wave velocity (PWV). Aortic stiffness was evaluated by PWV, office pulse pressure (PP) and 24 h PP. Results: We found that RDW was related with systolic BP (r = 0.17, p < 0.05) and office PP (r = 0.24, p = 0.01). In a linear regression analysis were age, weight, smoking, mean blood pressure and office PP were inserted as independent variables, we found an independent relationship between RDW and office PP (Beta = 0.25, p = 0.01). Similarly, in another model in which office PP was replaced by systolic BP (due to collinearity between systolic BP and office PP), we found an independent relationship between RDW and systolic BP (Beta = 0.57, p = 0.01) as well as mean BP (Beta = -0.44, p < 0.05). Conclusions: The present study provides substantial evidence that increased RDW independently relates with increased systolic blood pressure and impaired arterial stiffness in patients with essential hypertension. Further studies exploring the presence of this relationship even after antihypertensive treatment are needed. Copyright
    Journal of Hypertension 06/2015; 33:e142-e143. DOI:10.1097/01.hjh.0000467751.49444.9c · 4.72 Impact Factor
  • Article: PP.13.04
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    ABSTRACT: Objective: Target organ damage evaluation in patients with arterial hypertension is necessary in order to estimate cardiovascular risk (CVR) and plan treatment. The integrity of endothelial glycocalyx (EG) plays a vital role in vascular permeability, inflammation and elasticity and finally to cardiovascular disease. Sideview Darkfield imaging allows for non-invasive automated estimation of EG dimensions based on the erythrocyte column distribution.We aimed to estimate reference values of EG in untreated patients with untreated essential hypertension. Design and method: We studied 90 patients with newly diagnosed and never treated essential hypertension (mean age 48 + 10 years, 62 males). Increased perfusion boundary region (PBR) of the sublingual arterial microvessels (ranged from 5-25 micrometers) using Sideview Darkfield imaging (Microscan, Glycocheck) was measured as a non-invasive accurate index of reduced EG thickness. Results: Regarding total population, mean office BP was 149 + 17/93 + 11 mmHg, mean ABPM 138 + 11/86 + 9 mmHg, mean PBR 5-25 was 2.0 + 0.3, mean PBR 5-9 was 1.1 + 0.2, mean PBR 10-19 was 2.2 + 0.3, mean PBR 20-25 was 2.5 + 0.4. In male patients with mean office BP 139 + 11/92 + 10 mmHg and mean ABPM 139 + 11/89 + 8 mmHg, we found that mean PBR 5-25 was 2.0 + 0.3, mean PBR 5-9 was 1.1 + 0.2, mean PBR 10-19 was 2.2 + 0.3 and mean PBR 20-25 was 2.5 + 0.4. In female patients with mean office BP 157 + 18/95 + 13 mmHg and mean ABPM 136 + 9/81 + 9 mmHg, we found that mean PBR 5-25 was 2.1 + 0.3, mean PBR 5-9 was 1.2 + 0.1, mean PBR 10-19 was 2.2 + 0.4 and mean PBR 20-25 was 2.7 + 0.5. No correlation was found between PBR and age or BMI while a trend for systolic BP (office and 24 h) was revealed (p = 0.09). Conclusions: Cardiovascular risk reduction in hypertensives is based not only in blood pressure decrease but also in target organ damage improvement. EG might work as a future valuable tool in CVR estimation, so reference values for normotensives and several groups of hypertensives are needed. Further studies are needed to confirm our results in a larger population and establish EG measurement within target organ damage indices evaluation. Copyright
    Journal of Hypertension 06/2015; 33:e239. DOI:10.1097/01.hjh.0000468076.97764.ff · 4.72 Impact Factor
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    ABSTRACT: Endovascular abdominal aortic aneurysm repair (EVAR) and thoracic aortic aneurysm repair (TEVAR) have been widely incorporated into clinical practice. However, changes in arterial stiffness and post-implantation syndrome after aortic endografting remain important issues under investigation. The aneurysm sac wall motion after successful EVAR and TEVAR reflects complex interactions between all the components of the excluded aneurysm, including true compliance of the aneurysm wall itself, intra-aneurysm sac pressure, remodeling of the thrombus, and mechanical characteristics of the endograft. Experimental and clinical studies have shown that aortic endografting results in increased arterial stiffness in animal models. It can be assumed that the alterations of aortic mechanical properties can have a direct impact on heart output. The long-term impact of these mechanical changes on cardiovascular outcomes and the potential effects of different endografts on hemodynamics are important issues under investigation. Post-implantation syndrome (PIS) is a systemic inflammatory response frequently observed after endovascular treatment of aortic pathologies. The main features of PIS include fever, leukocytosis, elevated C-reactive protein levels, and coagulation disturbances. Endograft design appears to influence this inflammatory response following aortic endografting; woven polyester endografts have been shown to be associated with greater inflammatory response compared to polytetrafluoroethylene (PTFE) stent grafts. The purpose of this paper is to review the literature to elucidate arterial stiffness alterations and inflammatory response after EVAR and TEVAR and the impact of endograft design on aortic stiffness and the post-inflammatory response.

  • International Journal of Cardiology 03/2015; 182. DOI:10.1016/j.ijcard.2014.12.135 · 4.04 Impact Factor

  • Journal of the American College of Cardiology 03/2015; 65(10):A2083. DOI:10.1016/S0735-1097(15)62083-6 · 16.50 Impact Factor

  • Journal of the American College of Cardiology 03/2015; 65(10):A1210. DOI:10.1016/S0735-1097(15)61210-4 · 16.50 Impact Factor
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    ABSTRACT: High-density lipoprotein cholesterol (HDL-C), a negative risk factor, is positively associated with a decreased risk of coronary heart disease. We investigated the association between high HDL-C levels and target organ damage (TOD) in never treated women with hypertension. We measured HDL-C levels in 117 women followed by estimation of TODs, that is, pulse wave velocity, microalbuminuria, left ventricular mass index, coronary flow reserve, and carotid intima-media thickness (cIMT). Women were divided into 2 groups (HDLH and HDLL), regarding HDL-C quartiles (upper quartile vs the first 3 lower quartiles). In HDLH group : HDL ≥70 mg/dL), cIMT was nonindependently, negatively related to HDL-C (ρ = -.42, P < .05). Using receiver -operating characteristic curve (ROC) analysis in the HDLH group, we concluded that the cutoff value of HDL ≥76.5 mg/dL moderately predicted the absence of carotid atherosclerosis (area under the curve: 0.77, P = .02; confidence interval: 0.57-0.97; sensitivity 73% and specificity 67%). Increased HDL-C may predict the absence of carotid atherosclerosis in middle-age women with untreated essential hypertension and consequently contribute to total cardiovascular risk estimation and treatment planning. © The Author(s) 2015.
    Angiology 02/2015; 66(10). DOI:10.1177/0003319715572679 · 2.97 Impact Factor
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    Katerina K Naka · Ignatios Ikonomidis ·

    European Heart Journal 02/2015; DOI:10.1093/eurheartj/ehv005 · 15.20 Impact Factor
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    ABSTRACT: Heart failure (HF) is the first reason for hospital admission in the elderly and represents a major financial burden, the greatest part of which results from hospitalization costs. We sought to analyze current HF hospitalization-related expenditure and identify predictors of cost in a public tertiary hospital in Europe. We performed a retrospective chart review of 197 consecutive patients, aged 56±16years, 80% male, with left ventricular ejection fraction (LVEF) of 30±10%, hospitalized for HF in a major university hospital in Athens, Greece. The survey involved the number of hospitalization days, laboratory investigations and medical therapies. Patients who were hospitalized in CCU/ICU or underwent interventional procedures or device implantations were excluded from analysis. Costs were estimated based on the Greek healthcare system perspective in 2013. Patients were hospitalized for a median of 7days with a total direct cost of €3198±3260/patient. The largest part of the expenses (79%) was attributed to hospitalization (ward), while laboratory investigations and medical treatment accounted for 17% and 4%, respectively. In multivariate analysis, pre-admission New York Heart Association NYHA class (p=0.001), serum creatinine (p=0.003) and NT-proBNP (p=0.004) were significant independent predictors of hospitalization cost. Direct cost of HF hospitalization is high particularly in patients with more severe symptoms, profound neurohormonal activation and renal dysfunction. Strategies to lower hospitalization rates are warranted in the current setting of financial constraints faced by many European countries. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.
    International Journal of Cardiology 02/2015; 180:46-9. DOI:10.1016/j.ijcard.2014.11.123 · 4.04 Impact Factor

  • Journal of Cardiovascular Medicine 01/2015; DOI:10.2459/JCM.0000000000000244 · 1.51 Impact Factor

Publication Stats

3k Citations
785.94 Total Impact Points


  • 2006-2015
    • Attikon University Hospital
      • • Department of Cardiology
      • • Department of Internal Medicine IV
      Athínai, Attica, Greece
  • 2012-2014
    • National and Kapodistrian University of Athens
      • Department of Medicine
      Athínai, Attica, Greece
  • 2007-2014
    • Harokopion University of Athens
      Athínai, Attica, Greece
  • 2010
    • University Hospital of Heraklion
      • Department of Gastroenterology
      Irákleio, Attica, Greece
  • 2003-2010
    • Alexandra Regional General Hospital
      Athínai, Attica, Greece
  • 2009
    • Evangelismos Hospital
      • Intensive Care Unit
      Athínai, Attica, Greece
  • 2004-2005
    • Imperial College London
      Londinium, England, United Kingdom
  • 2002
    • Πανεπιστημιακό Γενικό Νοσοκομείο Πατρών
      Pátra, West Greece, Greece
  • 2000
    • Onassis Cardiac Surgery Center
      • Department of Cardiology
      Kallithéa, Attiki, Greece
  • 1999
    • National Heart, Lung, and Blood Institute
      베서스다, Maryland, United States
  • 1998
    • The Heart Lung Center
      Londinium, England, United Kingdom
  • 1997
    • The Royal Orthopaedic Hospital NHS Foundation Trust
      Birmingham, England, United Kingdom