E Chatzistamatiou

Hippokration General Hospital, Athens, Athínai, Attica, Greece

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Publications (23)90.47 Total impact

  • M Orii · T Tanimoto · M Yokoyama · S Ota · T Kubo · K Hirata · A Tanaka · T Imanishi · T Akasaka · Mm Michelsen · [...] · R Olander · Jkm Sundholm · Th Ojala · S Andersson · T Sarkola · M Karolyi · I Kocsmar · R Raaijmakers · Ph Kitslaar · B Szilveszter
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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.
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    ABSTRACT: The clinical relevance of nocturnal hypertension (NH) in comparison with non-dipping status has not been clarified yet, as regards subclinical target organ damage. We aimed to elucidate whether NH or dipping status reflects better organ damage. The study population included 319 newly diagnosed hypertensive patients. Subclinical organ damage was evaluated to all participants. On the basis of nocturnal blood pressure (BP) levels the population was divided into two groups: NH and nocturnal normotension. Also, individuals were defined as dippers and non-dippers according to systolic BP fall. Patients with NH were characterized by increased arterial pulse wave velocity (PWV; 9.1±1.7 vs 8.4±1.5 m s(-1), P=0.0001) and carotid intima-media thickness (0.77±0.18 vs 0.69±0.15 mm, P=0.016) compared with normotensive subjects. Notably, they also exhibited higher values of left ventricular mass index (88.1±22.9 vs 82.8±16.6 g m(-)(2) P=0.043). On the contrary, non-dipping status was associated only with differences in PWV (9.26±0.2 vs 8.64±0.2 m s(-1), P=0.031, 8) and in creatinine clearance (95±3 vs 106±4, P=0.025) in the group of NH. The presence of NH is accompanied by subclinical atherosclerosis, as well as structural abnormalities of the left ventricle. Therefore, NH rather than non-dipping status could be preferably integrated with the risk of organ damage.Journal of Human Hypertension advance online publication, 5 March 2015; doi:10.1038/jhh.2015.5.
    Journal of Human Hypertension 03/2015; DOI:10.1038/jhh.2015.5 · 2.69 Impact Factor
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    ABSTRACT: Purpose: We have previously demonstrated that multi-line transmit (MLT) beam forming can provide high quality full field-of-view (90° sector) B-mode images at very high frame rates, i.e. up to 500 fps. The purpose of this study was to test the feasibility of this technique in imaging the mechanical intraventricular waves such as the one associated with activation of the left ventricle. Methods: A dedicated pulse sequence using MLT was implemented on the ULA-OP research scanner equipped with a 2.0 MHz phased array to obtain 90° sector images at a frame rate of 436 fps. The left ventricle of a healthy volunteer was imaged from the apical 4 chamber view and the RF data was acquired. Subsequently, the strain rate was extracted from the RF data using a normalized cross-correlation method. Results: As expected, during the early filling phase, myocardium lengthening (positive strain rate) was observed propagating from the base of the septum to the apex and back (Figure a). A similar wave was detected in the lateral wall, although a brief shortening (negative strain rate) was detected in the mid-wall which could be the result of reverberations (Figure b). During isovolumetric contraction, the septal wall shortened before the lateral wall (as expected) - moreover - there seemed to be an intra-wall base-apex shortening gradient (Figure c and d). Conclusions: Our preliminary results show that visualization of the cardiac mechanical activation could be feasible using MLT based high frame rate imaging. Further research is required to examine this in depth, which is the topic of on-going work.
    European Heart Journal – Cardiovascular Imaging 12/2014; 15(suppl 2):ii25-ii51. DOI:10.1093/ehjci/jeu248 · 4.11 Impact Factor
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    ABSTRACT: Purpose: Although delayed-enhancement magnetic resonance imaging (DEMRI) is essential for diagnosis of cardiac sarcoidosis (CS), the test was not available when pacemaker was implamted. Recently, MR-conditional pacemaker has become avilable and we hypothesized that this device would be useful for diagnosis and management of CS. The aim of this study was to assess the diagnostic ability of MR-conditional pacemaker about CS in patients with advanced A-V nodal block (AAVB). Methods: Twenty-seven AAVB patients (14 men, 13 women; mean age, 69 ± 11 years) who were implanted MR-conditional pacemaker were studied. DEMRI was performed 6 weeks after implantation of permanent pacemaker. In patients with positive for DE, additional examinations like echocardiography, radioisotope imaging, biopsy, and coronary computed-tomography were performed due to confirm the diagnosis of CS and exclude coronary artery disease. Results: DE was observed in 12 patients (44 %). Out of 12 patients, 2 patients were excluded for having prior myocardial infarction. Seven of 10 (70 %) patients were diagnosed of CS by the consensus criteria. Compared with non-CS group, CS group had significantly lower age (61 ± 12 years vs. 72 ± 9 years p = 0.017). There was no significant difference about sex, angiotensin-converting enzyme, brain natriuretic peptide, and left ventricular ejection fraction between 2 groups. Six patients had started corticosteroid therapy and 5 patients (83%) recovered A-V nodal conduction. Conclusion: MR-conditional pacemaker was useful for diagnosis and management of patients with AAVB caused by CS.
    European Heart Journal – Cardiovascular Imaging 12/2014; 15 Suppl 2(suppl 2):ii168-ii195. DOI:10.1093/ehjci/jeu256 · 4.11 Impact Factor
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    ABSTRACT: Purpose: Renal resistive index (RI) reflects not only intrarenal, but also systemic hemodynamic conditions. Brain natriuretic peptide (BNP) is released by ventricular myocardium in response to high loading conditions. Aim of our study was to explore the relationship between BNP levels and RI in essential hypertensive (EH) patients. Methods: We studied 409 consecutive, newly diagnosed, never treated EH patients. All patients underwent renal Doppler ultrasound with RI measurement. The mean value of RI from both kidneys was used for this analysis. Measurement of brain natriuretic peptide (BNP) was performed by an immunoassay method. Based on BNP levels the study population was split into quartiles (A ≤5.2, B 5.2–11.9, C 11.9–24.5, D >24.5 pg/ml). Results: RI was significantly and positively correlated with BNP levels (r=0.393, p<0.001). Compared to lowest (A), patients in the highest quartile (D) were older, female, with lower diastolic blood pressure and heart rate (Table). Moreover, indices of left ventricular diastolic dysfunction and aortic stiffness were more prevalent in group D, while there was no difference with regard to indices of systolic function. Finally, according to multivariate regression analysis BNP (b=0.032, 95% CI: 0.0028–0.062, p=0.032) remained an independent predictor of RI, adjusting for age, gender, BMI, GFR and BP. View this table:Enlarge table
    European Heart Journal 09/2013; 34(suppl 1):2894-2894. DOI:10.1093/eurheartj/eht309.2894 · 14.72 Impact Factor
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    ABSTRACT: J Clin Hypertens (Greenwich). 2012;00:00-00. ©2012 Wiley Periodicals, Inc. Delayed blood pressure (BP) and heart rate (HR) decline at recovery post-exercise are independent predictors of incident coronary artery disease (CAD). Delayed BP recovery and exaggerated BP response to exercise are independent predictors of future arterial hypertension (AH). This study sought to examine whether the combination of two exercise parameters provides additional prognostic value than each variable alone. A total of 830 non-CAD patients (374 normotensive) were followed for new-onset CAD and/or AH for 5 years after diagnostic exercise testing (ET). At the end of follow-up, patients without overt CAD underwent a second ET. Stress imaging modalities and coronary angiography, where appropriate, ruled out CAD. New-onset CAD was detected in 110 participants (13.3%) whereas AH was detected in 41 former normotensives (11.0%). The adjusted (for confounders) relative risk (RR) of CAD in abnormal BP and HR recovery patients was 1.95 (95% confidence interval [CI], 1.28-2.98; P=.011) compared with delayed BP and normal HR recovery patients and 1.71 (95% CI, 1.08-2.75; P=.014) compared with normal BP and delayed HR recovery patients. The adjusted RR of AH in normotensives with abnormal BP recovery and response was 2.18 (95% CI, 1.03-4.72; P=.047) compared with delayed BP recovery and normal BP response patients and 2.48 (95% CI, 1.14-4.97; P=.038) compared with normal BP recovery and exaggerated BP response individuals. In conclusion, the combination of two independent exercise predictors is an even stronger CAD/AH predictor than its components.
    Journal of Clinical Hypertension 03/2013; 15(3):162-70. DOI:10.1111/jch.12035 · 2.96 Impact Factor
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    ABSTRACT: Arterial hypertension is an established risk factor for acute coronary syndromes, and physical exertion may trigger the onset of such an event. The mechanisms involved include the rupture of a small, inflamed, coronary plaque and the activation of thrombogenic factors. Blood pressure (BP)–lowering treatment has been associated with beneficial effects on subclinical inflammation and thrombosis at rest and during exercise. This prospective study sought to compare the effect of different antihypertensive drugs on the inflammatory and thrombotic response during exercise. A total of 60 never-treated hypertensive patients were randomized to an angiotensin receptor blocker (ARB)- or non-dihydropyridine calcium channel blocker (CCB)-based regimen. Patients with inflammatory or coronary artery disease were excluded. Six months after pharmaceutical BP normalization, the patients underwent a maximal treadmill exercise testing. High-sensitivity C-reactive protein (hsCRP), serum amyloid A (SAA), white blood cells (WBC), tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), total fibrinogen (TF) and von Willebrand factor (vWF) levels, as well as plasminogen activator inhibitor-1 (PAI-1) activity were measured in blood samples taken while the patients were at rest and during peak exercise. All of these biomarkers increased with exercise, except PAI-1, which decreased (P<0.05 for the difference between resting and peak exercise for all biomarkers). The ARB group had less marked (P<0.05) exercise-induced changes than the CCB group in hsCRP (5.8% vs. 7.7%), SAA (4.2% vs. 7.2%), WBC (46.8% vs. 52.6%), TNF-α (16.3% vs. 24.3%), TF (9.5% vs. 16.9%) and PAI-1 (−9.5% vs. −12.3%) but a similar (P=NS) change in IL-6 (39.4% vs. 38.6%) and vWF (29.2% vs. 28.6%). In conclusion, ARBs are most likely more effective than CCBs at suppressing the exercise-induced acute phase response. Potential protection against exercise-related coronary events remains to be elucidated.
    Hypertension Research 09/2012; 35(12). DOI:10.1038/hr.2012.134 · 2.94 Impact Factor
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    ABSTRACT: Purpose: Atherosclerotic plaques progress in a highly individual manner. Plaque eccentricity has been associated with a rupture-prone phenotype and adverse coronary events in humans. Endothelial shear stress (ESS) critically determines plaque growth and low ESS leads to high-risk lesions. However, the factors responsible for rapid disease progression with increasing plaque eccentricity have not been studied. We investigated in vivo the effect of local hemodynamic and plaque characteristics on progressive luminal narrowing with increasing plaque eccentricity in humans. Methods: Three-dimensional coronary artery reconstruction using angiographic and intravascular ultrasound data was performed in 374 patients at baseline (BL) and 6-10 months later (FU) to assess plaque natural history as part of the PREDICTION Trial. A total of 874 coronary arteries were divided into consecutive 3-mm segments. We identified 408 BL discrete luminal narrowings with a throat in the middle surrounded by gradual narrowing proximal and distal to the throat. Local BL ESS was assessed by computational fluid dynamics. The eccentricity index (EI) at BL and FU was computed as the ratio of max to min plaque thickness at the throat. Mixed-effects logistic regression was used to investigate the effect of BL variables on the combined endpoint of substantial worsening of luminal narrowing (decrease in lumen area >1.8 mm2 or >20%) with an increase in plaque EI. Results: Lumen worsening with an increase in plaque EI was evident in 73 luminal narrowings (18%). Independent predictors of worsening lumen narrowing with plaque EI increase were low BL ESS (<1 Pa) distal to the throat (odds ratio [OR] =2.2 [95% CI: 1.3-3.7]; p=0.003) and large BL plaque burden (>51%) at the throat (OR=1.7 [95% CI: 1.0-2.8]; p=0.051). The incidence of worsening lumen narrowing with increasing plaque eccentricity was 30% in the presence of both predictors versus 15% in luminal narrowings without this combination of characteristics (OR=2.4 [95% CI: 1.4-4.3]; p=0.002). Conclusions: Low local ESS independently predicts areas with rapidly progressive luminal narrowing and increasing plaque eccentricity. Coronary regions manifesting an abrupt anatomic change, i.e., at highest risk to cause an adverse event, can be identified early by assessment of ESS and plaque burden.
    European Heart Journal 08/2012; 33(suppl 1):355. DOI:10.1093/eurheartj/ehs282 · 14.72 Impact Factor
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    ABSTRACT: We investigated the correlation between systolic and diastolic nocturnal blood pressure (BP) values and office BP values, as well as parameters of 24-hour ambulatory BP monitoring, in patients with hypertension. In addition, we compared nocturnal hypertensives with nocturnal normotensives regarding their demographic, clinical, and laboratory characteristics, as well as other data from 24-hour BP monitoring. The study included 182 consecutive patients who had newly diagnosed, never treated, uncomplicated arterial hypertension. Blood samples were obtained from all patients for the determination of glycaemic and lipidaemic profiles. All underwent a complete echocardiographic examination, including tissue Doppler imaging, measurement of carotid intima-media thickness, measurement of carotid-femoral pulse wave velocity, and determination of the augmentation index of reflected waves (Aix@75), as well as 24-hour ambulatory BP monitoring. The population was divided into nocturnal normotensives (NN, n=77) and nocturnal hypertensives (NH, n=105, nocturnal BP >120/70 mmHg). Although the NH did not differ from the NN as regards the classical cardiovascular risk factors, they showed an excessive inotropic response to exercise (61.9% vs. 22.7%, p=0.028), higher levels of serum uric acid (5.5 ± 1.56 mg/dl vs. 4.7 ± 1.36 mg/dl, p=0.003), as well as greater arterial stiffness, as expressed by a higher carotid-femoral pulse wave velocity (8.6 ± 1.6 m/s vs. 7.9 ± 1.4 m/s, p=0.009), and a greater carotid intima-media thickness (0.74 ± 0.17 mm vs. 0.68 ± 0.15 mm, p=0.007). In addition, although the two groups did not differ significantly as regards office BP values and did not show strong correlations between nocturnal and office BP, both nocturnal diastolic and, especially, systolic BP showed strong correlations with levels of serum uric acid and with subclinical lesions in the heart, central aorta, peripheral vessels, and renal vasculature. Nocturnal BP is poorly correlated with office BP values. However, the presence of nocturnal hypertension is associated with morphological and functional disturbances of the cardiovascular net. 24-hour ambulatory BP monitoring is an essential tool for revealing this subgroup of hypertensive patients who are at increased cardiovascular risk.
    Hellenic journal of cardiology: HJC = Hellēnikē kardiologikē epitheōrēsē 07/2012; 53(4):263-72. · 0.79 Impact Factor
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    Hellenic journal of cardiology: HJC = Hellēnikē kardiologikē epitheōrēsē 11/2011; 52(6):516-24. · 0.79 Impact Factor
  • Journal of Hypertension 06/2011; 29:e358. DOI:10.1097/00004872-201106001-01045 · 4.22 Impact Factor
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    ABSTRACT: Exercise improves the clinical outcome of patients with coronary artery disease (CAD); however, the ideal exercise duration for each patient remains unclear. To investigate the effects of exercise duration on arterial elastic properties and antioxidant/pro-oxidant mechanisms in patients with CAD. DESIGN, SETTING, PATIENTS, INTERVENTIONS: Sixty male patients with CAD were randomised into two groups, and underwent exercise for 30 min or 60 min in a crossover design with 2 weeks' wash-out period. In all participants aortic and radial blood pressures (BP) and arterial elastic properties (augmentation index (AIx)/pulse wave velocity (PWV)) were determined at baseline and 24 h after exercise. Plasma malonyldialdehyde (MDA) and superoxide dismutase (SOD)1 and SOD2 levels were also measured. Exercise had no effect on aortic and radial BP (p=NS for all). Walking for 30 min improved AIx (from 33.79 ± 0.91% to 31.73 ± 0.86%, p<0.001) and PWV (from 9.26 ± 0.95 m/s to 9.06 ± 0.21 m/s, p<0.001), while exercise for 60 min had adverse effects on vascular stiffness (for AIx: from 33.37 ± 0.93% to 33.73 ± 1.05%, p=NS and for PWV: from 9.25 ± 0.19 m/s to 9.37 ± 0.21 m/s, p < 0.05 mainly in older patients). Exercise for 60 min was associated with a significant 20% increase in MDA levels (p<0.05). Exercise had no effects on SOD1 levels, however it significantly increased SOD2 levels after 30 min (from 2.26 ± 0.22 ng/mL to 2.36 ± 0.18 ng/mL, p < 0.05) but not after 60 min (p=NS). Conclusion Shorter exercise duration was associated with favourable antioxidant and vascular effects, while longer exercise blunted these beneficial effects and was accompanied by adverse effects on vascular function, mainly in older coronary patients. Further studies are required to explore the hypothesis that a more individualised approach to the selection of the appropriate exercise programme should be considered for patients with CAD.
    Heart (British Cardiac Society) 02/2011; 97(10):832-7. DOI:10.1136/hrt.2010.209080 · 6.02 Impact Factor
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    ABSTRACT: Aim: Leptin is a peptide hormone that is primarily synthesized and secreted by adipose tissue whose principal action is the control of appetite and energy balance. Plasma Leptin concentration (PLC) is increased in obesity and correlate strongly with percentage body fat in both genders. Aim of the present study was to evaluate how abdominal fat compartments affects PLC in overweight essential hypertensive's.
    Journal of Hypertension 06/2010; 28. DOI:10.1097/01.hjh.0000379132.20252.73 · 4.22 Impact Factor
  • Journal of Hypertension 06/2010; 28. DOI:10.1097/01.hjh.0000379771.53377.23 · 4.22 Impact Factor
  • Journal of Hypertension 06/2010; 28. DOI:10.1097/01.hjh.0000379088.85910.fa · 4.22 Impact Factor
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    ABSTRACT: Background: In symptomatic patients and in patients with increased cardiovascular risk, peripheral arterial disease (PAD) is reliably detected with ankle-brachial index (ABI) values < 0.9. However, the clinical significance of low normal ABI (1-1.09) in essential hypertensive (EH) patients remains unknown.
    Journal of Hypertension 06/2010; 28. DOI:10.1097/01.hjh.0000379782.93281.3a · 4.22 Impact Factor
  • Journal of Hypertension 06/2010; 28. DOI:10.1097/01.hjh.0000379639.87023.7a · 4.22 Impact Factor
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    ABSTRACT: We investigated whether the type of left ventricular (LV) geometry is associated with left atrial (LA) size as determined either by LA diameter or by volume, indexed for body surface area, in essential hypertensives. A total of 339 consecutive, untreated, hypertensives (aged 51.8 years, 234 males) underwent 24-h ambulatory blood pressure (BP) monitoring and estimation of LA diameter and volume, as well as LV structure and function by echocardiography. LV hypertrophy was present in 130 (38.3%) patients whereas normal geometry (LV-NG), concentric remodeling (LV-CR), concentric hypertrophy (LV-CH) and eccentric hypertrophy (LV-EH) represented 34.5, 27.1, 25.7 and 12.7%, respectively. Patients with either LV-CH or LV-EH had increased LA diameter index compared with those with either LV-NG (by 1.1 mm m(-2), P<0.01 and 1.4 mm m(-2), P=0.003, respectively) or LV-CR (by 1.3 mm m(-2), P=0.003 and 1.6 mm m(-2), P=0.001, respectively). Similarly, patients with either LV-CH or LV-EH had significantly increased LA volume index compared with those with either LV-NG (by 3.2 ml m(-2), P<0.001 and 3.4 ml m(-2), P<0.005, respectively) or LV-CR (by 4.5 and 4.7 ml m(-2), respectively, P<0.001 for both). Multiple linear regression analysis showed that the independent predictors of both LA volume and diameter index were LV mass index, 24-h pulse pressure and E/Em.LA size assessed either by its diameter or by volume is closely related only to LV mass index and not to any specific LV geometric pattern in the early stages of essential hypertension.
    Journal of human hypertension 03/2009; 23(10):674-9. DOI:10.1038/jhh.2009.13 · 2.69 Impact Factor