V Votteas

Laiko Hospital, Athínai, Attica, Greece

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Publications (60)102.29 Total impact

  • Journal of Hypertension 05/2010; 28:e364–e365. · 4.22 Impact Factor
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    ABSTRACT: We evaluated the relationship between coronary artery stenosis status and established cardiovascular risk factors in a large population of 1228 patients who consecutively underwent coronary angiography. Smoking proved to be the most important predictive factor for angiographically significant coronary artery disease (CAD), followed by dyslipidemia, diabetes, family history, and hypertension in a descending order of significance. Obesity rates did not differ significantly between the CAD positive and negative groups, nor changed significantly as the number of affected vessels increased. Smoking, dyslipidemia, and diabetes were positively associated with atherosclerotic involvement of all 3 major coronary arteries, whereas hypertension related only to significant stenosis of left anterior descending and left circumflex artery. The only established risk factors that could reliably predict left main stem disease were diabetes and age. Furthermore, large-scale studies will delineate the implications of the existing interrelationship between clinical and angiographic features.
    Angiology 05/2010; 62(1):74-80. · 2.37 Impact Factor
  • Journal of Hypertension - J HYPERTENSION. 01/2010; 28.
  • Journal of Hypertension - J HYPERTENSION. 01/2010; 28.
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    ABSTRACT: Background: Valvular heart disease is prevalent in systemic lupus erythematosus (SLE) and is a common cause of morbidity and mortality. Valvular thickening and verrucous valvular vegetations (Libman–Sacks) are the most common lesions. The purpose of this prospective study was to analyze the incidence of Libman–Sacks vegetations in patients with SLE.Methods: Two hundred and seventeen consecutive patients (196 females, 21 males, aged 53 ± 11 years) with SLE were evaluated with M-mode, 2D, and Doppler echocardiography. Libman–Sacks vegetations were defined as distinct localized masses of varying size and shape on the surface of the valve leaflets and exhibiting no independent motion. In 76 (35%) patients with SLE there were antiphospholipid antibodies (APL) present.Results: Thirty-two (14.7%) patients with SLE had Libman–Sacks vegetations and in 21 (65.6%) of them there was a presence of antiphospholipid antibodies. In 22 patients the location of the masses was in the mitral, in 9 in the aortic, and in 1 in the tricuspid valve, whereas in 4 cases in BOTH valves. Valvular regurgitation was the predominant lesion in 18 mitral, 9 aortic, and 1 tricuspid, but only 2 cases had severe mitral regurgitation. Valvular stenosis was detected in 5 cases. Three patients had severe mitral stenosis and one of them died, while in the other two patients mitral stenosis was reversed with treatment of the underlying disease. The remaining two cases had severe aortic stenosis but one of them, also having severe mitral regurgitation, died suddenly.Conclusion: Our results show that Libman–Sacks vegetations are quite frequent in patients with SLE and are related to the presence of antiphospholipid antibodies. The most common lesion is valvular regurgitation and rarely valvular stenosis.
    Echocardiography 09/2009; 21(2):210 - 210. · 1.26 Impact Factor
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    ABSTRACT: The purpose of this study was to investigate the association of various methods for body fat assessment with indices of peripheral artery disease in the deep and superficial femoral arteries. The intima-media thickness (IMT), maximal IMT (max IMT), femoral wall thickness (FWT), maximal FWT (max FWT), cross-sectional intima media area (CIMA), and atherosclerotic burden score (ABS) were measured sonographically in 26 subjects. The minimum thickness of the abdominal subcutaneous fat layer (Smin) was measured sonographically close to the xyphoid process, and body fat percentage was calculated using various formulas. Smin correlated significantly with body fat percentage calculated with all formulas and was the sole parameter that was associated significantly with all the femoral artery atherosclerotic indices IMT: r = 0.74, p < 0.001; max IMT: r = 0.53, p < 0.05; FWT: r = 0.78, p < 0.001; max FWT: r = 0.57, p < 0.005; ABS: r = 0.52, p < 0.05; CIMA: r = 0.86, p < 0.001; Smin was the major independent predictor of femoral IMT on a multiple stepwise regression analysis (beta = 0.02; SE = 0.008, R(2) = 0.35, p < 0.05). Smin correlates better than indirect indices and formulas of body fat estimation with markers of extracoronary atherosclerosis. Sonographic measurement of Smin may serve in the future as a useful tool in everyday clinical practice.
    Journal of Clinical Ultrasound 04/2009; 37(5):263-9. · 0.70 Impact Factor
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    ABSTRACT: A 54-year-old female patient with a congenital ventricular septal defect (VSD) was admitted to the authors' hospital for an investigation of mild fever of four months' duration. Her history revealed pulmonary valve endocarditis contracted 18 years previously. Echocardiography revealed an echogenic mobile mass on the pulmonic valve that caused mild regurgitation, while blood cultures were positive for Streptococcus viridans. The patient was administered ceftriaxone and gentamycin, and had an uneventful clinical course. She was advised to undergo surgical closure of the VSD in order to avoid any recurrence of endocarditis.
    The Journal of heart valve disease 04/2009; 18(2):167-9. · 1.07 Impact Factor
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    ABSTRACT: A 77-year-old male patient with a history of rheumatoid arthritis was admitted to our hospital for investigation of syncope and dyspnea on exertion class II according to NYHA class association. The electrocardiogram revealed complete heart block whereas the echocardiogram showed severe aortic valve stenosis with a peak gradient = 80 mmHg. A permanent pacemaker was implanted in addition to aortic valve replacement. The coexistence of complete heart block and severe aortic stenosis with rheumatoid arthritis are presented. Further studies are necessary to assess whether a true association of the above conditions exist.
    Cases Journal 03/2009; 2(1):126.
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    ABSTRACT: To measure aortic stiffness and global left ventricular (LV) function in patients with ankylosing spondylitis (AS) and no clinical evidence of heart disease. Fifty-seven consecutive patients with AS (54 males, three females, mean age 41.78+/-10.02 years) without clinical evidence of cardiac involvement and 78 healthy subjects (73 males, five females, mean age 39.92+/-9.11 years) underwent complete echocardiographic study. Aortic stiffness was determined non-invasively by aortic distensibility (AoD) and the global LV function was evaluated by the myocardial performance index (the Tei index). AoD in patients with AS [(2.21+/-0.24)x10(-6) cm(2) dyn(-1)] was decreased compared to controls [(2.58+/-0.19) )x10(-6) cm(2) dyn(-1), p<0.01], confirming that aortic stiffness is increased in AS. The LV Tei index was significantly increased in the patient group compared to the control group (0.392+/-0.031 vs. 0.370+/-0.034, p<0.01). The ejection fraction (EF) did not differ between the two groups (p>0.05). In multivariate linear regression analysis, AoD was significantly associated with the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and LV isovolumic relaxation time (IVRT) whereas the LV Tei index was associated with BASDAI and the LV mass index. Patients with AS and no clinical evidence of cardiac disease have increased stiffness of the aorta and decreased global myocardial performance and both of these abnormal measurements correlate with disease activity. The abnormal Tei index may reflect an early manifestation of cardiac dysfunction in these patients.
    Scandinavian journal of rheumatology 03/2009; 38(3):216-21. · 2.51 Impact Factor
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    ABSTRACT: Recent evidence suggests that masked hypertension (MH) is a predictor of cardiovascular disease and that hypoadiponectinemia and hyperesistinemia may contribute to chronic inflammatory process, insulin resistance, endothelial dysfunction, and accelerated atherogenesis. The aim of this study was to examine the adiponectin and resistin plasma levels in patients with MH and compare the findings with those of healthy normotensive persons matched for age, sex, body mass index, and other risk factors. Overall, 130 (60 men and 70 women) healthy persons (mean age, 45+/-12 years) who had clinic blood pressure values <140/90 mm Hg were studied. The study population underwent 24-hour ambulatory blood pressure monitoring (ABPM). According to the ABPM recordings, 24 individuals (8 men and 16 women) had MH (daytime systolic blood pressure >or=135 mm Hg or daytime diastolic blood pressure >or=85 mm Hg; group A) and the remaining 106 participants (52 men and 54 women) had normal ABPM findings (group B). Adiponectin and resistin plasma levels were determined in both groups by enzyme-linked immunosorbent assay. Significantly higher (P<.01) resistin levels (12+/-4 vs 6.8+/-3.6 ng/mL) were found in group A compared with group B, while the adiponectin plasma levels were significantly lower (P<.01) in group A compared with group B (6+/-2.3 vs 11+/-2.7 microg/mL). Findings suggest that patients with MH have lower adiponectin levels and higher resistin levels compared with normotensive individuals. This observation may have prognostic significance for future cardiovascular events in patients with MH.
    Journal of Clinical Hypertension 02/2009; 11(2):61-5. · 2.36 Impact Factor
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    I Moyssakis, N Lionakis, V Votteas
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    ABSTRACT: A 60-year-old woman with a history of rheumatoid arthritis was admitted to the hospital for investigation of dyspnea on exertion (New York Heart Association class II), polyarthralgias and mild fever. An echocardiogram revealed asymmetric hypertrophy of the interventricular septum with signs of subaortic obstruction.The coexistence of rheumatoid arthritis and hypertrophic cardiomyopathy could be connected with the human lymphocyte antigen DR4, which is common in both conditions. Further studies are necessary to assess whether a true association of the above diseases exists.
    Experimental and clinical cardiology 02/2009; 14(1):e21-2. · 1.10 Impact Factor
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    ABSTRACT: A 42 year old woman was admitted to our hospital for investigation of eosinophilia. There were no findings from the physical examination of the lungs and heart. The echocardiography showed a segmental hypokinesia of the interventricular septum and the apex causing left ventricular dysfunction with an ejection fraction 45% and mild pericardial effusion. Cardiac magnetic resonance was performed, for detection of lesions associated with the underline disease, using electrocardiogram-triggered T2-weighted and T1-weighted multislice spin-echo images (before and after an intravenous bolus of gadolinium).The analysis of T2-weighted images revealed increased signal on the mid part of interventricular septum, suggesting myocardial oedema. In the delayed-enhanced images, areas of late phase gadolinium enhancement (indicative of fibrosis) were identified in the mid part of interventricular septum. Methylprednisolone therapy was started. The patient had follow-up echocardiographic examination every month and on sixth month improvement of left ventricular dysfunction was shown with an ejection fraction 55%.In conclusion our case is a typical Churg Strauss Syndrome with characteristic myocardial involvement which improved after corticosteroid treatment. The cardiac magnetic resonance has significant role for early and accurate detection and differentiation of myocardial damage even in preserved cardiac wall motion and cavity size.
    Cases Journal 01/2009; 2:6564.
  • Diabetologie Und Stoffwechsel - DIABETOL STOFFWECHS. 01/2009; 4.
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    ABSTRACT: The aim of our study was to investigate whether collagen degradation is altered in participants with masked hypertension and whether this alteration could be related to disturbances in the matrix metalloproteinases plasma concentration and to compare the findings with those participants with normal blood pressure levels matched for age, sex, and body mass index. Twenty-four (11 men, 13 women) participants with masked hypertension [mean age 46 +/- 7 years and body mass index 25.9 +/- 2.1 kg/m(2) (group A)] and 106 healthy normotensives (49 men, 57 women) with normal blood pressure [mean age 44 +/- 6 years and body mass index 25.5 +/- 2.4 kg/m(2) (group B)]. The plasma levels of matrix metalloproteinase-9 were significantly higher, while the levels of tissue inhibitors of metalloproteinases-1 and -4 were significantly lower in group A compared with group B (matrix metalloproteinase-9: 569 +/- 135 vs. 282 +/- 117 ng/mL, TIMP-1: 169 +/- 42 vs. 230 +/- 37 ng/mL, P < .01, and TIMP-4: 2.1 +/- 1.3 vs. 4.2 +/- 1.98 ng/mL, P < .04, respectively). Patients with masked hypertension had significantly increased matrix metalloproteinase-9 plasma levels and significantly decreased plasma levels of tissue inhibitors of metalloproteinases-1 and -4 compared with participants with normal blood pressure. These findings need further investigation.
    Angiology 01/2009; 60(6):757-62. · 2.37 Impact Factor
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    ABSTRACT: Systemic sarcoidosis (Sar) is a granulomatous disorder involving multiple organs. Widespread vascular involvement and microangiopathy are common in patients with Sar. In addition, subclinical cardiac involvement is increasingly recognized in patients with Sar. However, data on the effect of Sar on the elastic properties of the arteries and myocardial performance are limited. In this study we looked for differences in aortic distensibility (AoD) which is an index of aortic elasticity, and myocardial performance of the ventricles, between patients with Sar and healthy subjects. In addition, we examined potential associations between AoD and clinical, respiratory and echocardiographic findings in patients with Sar. A total of 83 consecutive patients (26 male/57 female, mean age 51.1 +/- 13.3 years) with Sar, without cardiac symptoms, were included. All patients underwent echocardiographic and respiratory evaluation including lung function tests. Additionally, 83 age- and sex-matched healthy subjects served as controls. AoD was determined non-invasively by ultrasonography. AoD was lower in the Sar compared to the control group (2.29 +/- 0.26 vs. 2.45 +/- 0.20 .10(-) (6) cm2 x dyn(-1), P < 0.01), while left ventricular mass (LVM) was higher in the Sar group (221.3 +/- 50.2 vs. 195.6 +/- 31.3 g, P = 0.007). Furthermore, myocardial performance of both ventricles was impaired in the Sar group. Multivariate linear regression analysis in the total sample population demonstrated a significant and independent inverse relationship between AoD and the presence of Sar (P < 0.001). The same analysis in the Sar patients showed that AoD was associated significantly and independently with the stage of Sar, age, systolic blood pressure, LVM and myocardial performance of both ventricles. No significant relationship was found between AoD and disease duration, pulmonary artery pressure or lung function tests. Presence and severity of Sar are associated with reduced aortic distensibility, irrespective of the disease duration, pulmonary artery pressure and lung function. In addition, patients with Sar have increased LVM and impaired myocardial performance.
    European Journal of Clinical Investigation 03/2008; 38(2):82-9. · 3.37 Impact Factor
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    ABSTRACT: Accumulating epidemiological studies have shown that healthy offspring of hypertensive patients exhibit some metabolic disturbances such as hyperinsulinemia, insulin resistance, lipid disorders, elevated plasma leptin levels and reduced insulin receptor number, features that may be predictors of future cardiovascular events. The aim of this study was to determine insulin, adiponectin and resistin plasma levels in young healthy offspring of patients with essential hypertension, and to compare the findings to those of young healthy offspring of healthy normotensives matched for age, sex and body mass index (BMI). Forty-six (24 male/22 female) healthy offspring of patients with essential hypertension-positive family history (FH+), mean age 18+/-3 years and BMI 22.4+/-1.4 kg/m2 (group A) and 50 (28 male/22 female) healthy offspring of healthy normotensives-negative family history (FH-) mean age 18+/-3.2 years and BMI 22.6+/-1.7 kg/m2 (group B) were studied. The two groups were matched for age, sex and BMI. Systolic and diastolic blood pressure (SBP and DBP) measurements, resting heart rate (HR), plasma insulin (RIA method), adiponectin and resistin plasma levels (ELISA) were determined in the whole study population. Mean SBP, DBP and resting HR were significantly higher in group A compared with group B (121+/-13 vs 110+/-10 mmHg, 78+/-6 vs 73+/-8 mmHg, 76+/-4 vs 72+/-6 beats/min, p<0.01, p<0.05 and p<0.01 respectively). Insulin and resistin plasma levels were significantly higher, while adiponectin levels were significantly lower. In group A compared with group B (21+/-7 vs 15+/-6 pIU/ml, 10+/-5 vs 6+/-3 ng/ml, 20+/-5 vs 29+/-8 microg/ml, p<0.01, p<0.01, p<0.01, respectively). Our findings suggest that increased SBP, DBP and resting HR as well as increased insulin and resistin plasma levels and decreased adiponectin plasma levels pre-exist in young healthy offspring with positive family history for essential hypertension. Further studies are needed to determine the clinical significance of these observations in attempt to classify these young healthy individuals for future cardiovascular risk.
    Blood Pressure 02/2008; 17(1):50-4. · 1.39 Impact Factor
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    ABSTRACT: Recent evidence demonstrate that masked hypertension (MH) is a significant predictor of cardiovascular disease, while, elevated levels of circulating antibodies against endothelial cell surface antigens (antiendothelial cell antibodies - AECA) seem to play an important role at the early stages of atherosclerosis process and of borderline hypertension as well. Aim of this study was to investigate the presence of AECA in patients (pts) with MH and to compare the AECA title among pts with MH and healthy normotensives (HN), matched for age, sex and body mass index. One hundred-thirty (60 M, 70 F) healthy subjects mean age 45+/-12 yrs who had clinic blood pressure <140/90 mm Hg were studied. The whole study population underwent 24 hour ambulatory blood pressure monitoring (ABPM). According to the ABPM recordings, 24 individuals (8 M, 16 F) had MH (daytime systolic blood pressure >/=135 mm Hg or daytime diastolic blood pressure >/=85 mm Hg - group A) and the remainder 106 subjects (52 M, 54 F) had normal ABPM recordings, group B. IgG and IgM AECA levels were determined by ELISA method. AECA levels were expressed as mean value+/-SD. None of the study population had a history of connective tissue disease or any metabolic disorder. Significantly increased titles of AECA class IgG were found in 8/24 pts of group A (30%) vs. 5/106 (4.6%) of group B (p<0,001). Significantly increased titles of AECA class IgM were also found in 6/24 pts of group A (25%) vs. 3/80 (3.8%) of group B (p<0,001). Our results suggest that patients with MH have significantly higher AECA levels of both classes (IgG, IgM) compared to healthy normotensives. These findings may indicate a possible explanation of the increased cardiovascular risk in MH. The possibility that high AECA levels may be a driving mechanism for the development of MH needs further investigation.
    International journal of cardiology 02/2008; 130(3):405-8. · 6.18 Impact Factor
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    ABSTRACT: A 55-year-old man with a history of uncontrolled hypertension was admitted because of an episode of severely elevated blood pressure. An electrocardiogram revealed complete atrioventricular block while imaging showed a dissecting aneurysm of the descending thoracic and abdominal aorta, type B according to the Stanford classification. Laboratory tests revealed significant increases in serum C-reactive protein. Coronary arteriography was performed and was negative for coronary artery disease. A VDD pacemaker was placed, and a combination of 4 antihypertensive agents was used as treatment. Type B aortic dissection may present with a wide range of manifestations. The authors suggest that measurement of C-reactive protein may be used in hypertensive patients to help reflect vascular injury and its degree, progression, and prognosis. Disorders of intraventricular conductivity are rarely seen in both types of dissection of the aorta (type A, B). Atrioventricular conductivity disorders that result in complete atrioventricular block have been reported only in patients with type A dissection (before the bifurcation of the subclavian artery). In this particular case, however, the authors diagnosed an atrioventricular conductivity disorder causing atrioventricular block in a patient with type B dissection. Consequently, the authors speculate that myocardial fibrosis, as a result of long-standing hypertension, could be the main pathogenetic mechanism leading to the development of such phenomena, resulting from a potential expanding of the fibrotic process to the atrioventricular conduction system.
    Journal of Clinical Hypertension 02/2008; 10(1):69-72. · 2.36 Impact Factor
  • D. P. Papadopoulos, Votteas V
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    ABSTRACT: A 70-year-old woman with recurred episodes of angina pectoris was admitted to our hospital for evaluation. After coronary angiography, a coronary-subclavian steal syndrome was reveled. A PICA in subclavian artery was performed to treat this patient.
    Scholarly Research Exchange. 01/2008;
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    ABSTRACT: Alpha-linolenic acid (ALA) is the natural precursor of the cardioprotective long-chain n-3 fatty acids. Available data indicate a possible beneficial effect of ALA on cardiovascular disease (CVD), but the response of various CVD risk factors to increased ALA intake is not well characterized. The purpose of the present study was to examine the effect of increased ALA intake on blood pressure in man. DESIGN, SETTING, SUBJECTS AND INTERVENTIONS: We used a prospective, two-group, parallel-arm design to examine the effect of a 12-week dietary supplementation with flaxseed oil, rich in ALA (8 g/day), on blood pressure in middle-aged dyslipidaemic men (n=59). The diet of the control group was supplemented with safflower oil, containing the equivalent n-6 fatty acid (11 g/day linoleic acid (LA); n=28). Arterial blood pressure was measured at the beginning and at the end of the dietary intervention period. Supplementation with ALA resulted in significantly lower systolic and diastolic blood pressure levels compared with LA (P=0.016 and P=0.011, respectively, from analysis of variance (ANOVA) for repeated measures). We observed a hypotensive effect of ALA, which may constitute another mechanism accounting in part for the apparent cardioprotective effect of this n-3 fatty acid.
    European Journal of Clinical Nutrition 11/2007; 61(10):1201-6. · 2.76 Impact Factor