M Griffin

Cyprus University of Technology, Leymosun, Lemesos, Cyprus

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Publications (100)185.43 Total impact

  • [show abstract] [hide abstract]
    ABSTRACT: Aim: The aim of the study was to test the association between circulating levels of matrix prometalloproteinase1 (pro-MMP1) and its tissue inhibitors TIMP1 and TIMP2 with prevalent cardiovascular events. Methods: Prevalent cardiovascular events were documented in 500 participants of the Cyprus study (46% men) over the age of 40. Serum levels of pro-MMP1, TIMP1 and TIMP2 were measured with ELISA and the association between quartiles of serum levels and presence of cardiovascular disease (CVD) was tested using multivariable binary regression models. Results: Lower serum levels of pro-MMP1 and TIMP1 were strongly associated with presence of CVD at baseline even after adjustment for conventional risk factors (Pfor trend=0.006 and P=0.001, respectively) and inflammatory factors (Pfor trend=0.005 and P=0.002, respectively) with people in the highest quartile of pro-MMP1 having a reduced odds for cardiovascular disease by about 70% compared to the lowest quartile (ORadjusted=0.26; 95% CI=0.19 to 0.75; P=0.01), whereas people with TIMP1 levels >1000 ng/mL had a 75% reduced odds for CVD compared to the rest (ORadjusted=0.25; 95% CI=0.11 to 0.60; Pfor trend=0.002). TIMP2 levels were not associated with prevalent cardiovascular disease. Conclusion: A strong association between lower levels of circulating pro-MMP1 and TIMP1 and risk of prevalent cardiovascular disease in a general population cohort over 40 years is evident, independent from common cardiovascular and inflammatory risk factors. The role of MMP1 and its tissue inhibitors, should be tested further in prospective studies of cardiovascular disease.
    International angiology: a journal of the International Union of Angiology 12/2013; 32(6):599-604. · 1.46 Impact Factor
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    ABSTRACT: The aim of this document is to provide a clear and concise account of the evidence regarding efficacy or harm for various methods available to prevent and manage venous thromboembolism (VTE).
    International angiology: a journal of the International Union of Angiology 04/2013; 32(2):111-260. · 1.46 Impact Factor
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    ABSTRACT: Electrical stimulation of calf muscles has been shown to be effective in prevention of DVT. The aim was to determine: (a) dependence of venous blood velocity and ejected volume on the rates of stimulated calf contractions: (b) clinical factors affecting efficacy in healthy individuals. The maximum intensity stimulus tolerated was applied to calves of 24 volunteers. In popliteal veins, peak systolic velocities (PSV), ejected volume per individual stimulus (stroke volume SV) and ejected total volume flow per minute (TVF) of expelled blood were determined using ultrasound. Stimulation rates from 2 to 120 beats per minute (bpm) were applied. Mean baseline popliteal PSV was 10 cm/s. For stimulation rates between 2 and 8 bpm, the PSV was 10 times higher and reached 96-105 cm/s. Stroke volume (SV) per individual stimulus decreased in a similar fashion. With increasing rates of stimulation the TVF increased by a factor of 12 times (from 20 ml/min to 240 ml/min). Electrical stimulation is an effective method of activating the calf muscle pump. Enhancements of popliteal blood velocity and volume flow are key factors in the prevention of venous stasis and DVT. Further studies are justified to determine the stimulation rates in those with a compromised venous system.
    European journal of vascular and endovascular surgery: the official journal of the European Society for Vascular Surgery 12/2010; 40(6):766-71. · 2.92 Impact Factor
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    ABSTRACT: Herein, we present the European Society for Vascular Surgery Guidelines pertinent to the secondary prevention of cerebrovascular events in patients with carotid artery stenosis including lipid lowering therapy, antiplatelet therapy and other risk factor modification. These recommendations are based on current evidence from clinical trials. There is a need for aggressive prevention treatment in patients with carotid artery disease. We also discuss the diagnosis and grading of carotid artery stenosis.
    Current Vascular Pharmacology 09/2010; 8(5):673-81. · 2.82 Impact Factor
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    ABSTRACT: Different ultrasonic arterial wall measurements have been used as predictors of future myocardial infarction or stroke. The aim of the present study was to determine the relationship of total plaque area (TPA) (the sum of the atherosclerotic plaque area measurements from both carotid and both common femoral arteries) with prevalence of cardiovascular disease in a population-based cross-sectional study and compare it with intima-media thickness (IMT). Seven hundred sixty-two individuals (47% male) over the age of 40 were screened for cardiovascular risk factors. Evidence of clinical cardiovascular disease was present in 113 (14.8%). Both carotid and both common femoral bifurcations were scanned with ultrasound. After adjustment for conventional risk factors the association of IMT with prevalence of clinical cardiovascular disease was low (P=0.84, OR of upper IMT quintile 1.36; 95% CI 0.56 to 3.26) and of TPA high (P<0.001, OR of upper TPA quintile 8.38; 95% CI 2.57 to 27.32). TPA greater than 42 mm2 (cut-point derived from ROC curve analysis) identified 266 (34.9%) of the population that contained 87/113 (76.9%) of the clinical events (sensitivity: 77%; specificity: 73%; positive predictive value: 33%; negative predictive value: 94%; positive likelihood ratio of 2.79). In contrast, IMT greater than 0.07 mm had a sensitivity, specificity, positive and negative predictive value and positive likelihood ratio of 68%, 60%, 23%, 91% and 1.69 respectively. Total plaque area appears to be more strongly associated with the prevalence of cardiovascular disease than IMT. This finding warrants further prospective studies.
    International angiology: a journal of the International Union of Angiology 06/2010; 29(3):216-25. · 1.46 Impact Factor
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    ABSTRACT: Severity of stenosis remains the main factor for assessing risk of stroke in patients with internal carotid artery (ICA) disease. This study was conducted to investigate the association of plaque echostructure and other established and emerging cardiovascular risk factors with symptomatic ICA disease. Cross-sectional study of consecutive patients with significant (>50%) ICA stenosis. Carotid plaque echostructure, smoking, hypertension, diabetes mellitus, serum lipoprotein (a), homocysteine, vitamin B12, folate, cholesterol to high-density lipoprotein ratio, triglycerides, C-reactive protein, and the Framingham risk score were assessed in 124 consecutive patients (70 asymptomatic; 54 symptomatic) with significant (>50%) ICA stenosis. The asymptomatic and symptomatic groups did not differ in terms of gender distribution (P=0.76) and severity of stenosis (P=0.62). Echolucent plaques (type 1 and 2) were more predominant in patients with symptomatic disease (P=0.004, OR=2.13, 95% CI=1.26-3.6). Patients with plaques type 1 were relatively younger than those with type 4 (P=0.02). None of the other factors assessed had any significant association with symptomatic disease and any type of carotid plaque. Besides the severity of carotid stenosis, the presence of an echolucent plaque appears as an important factor associated with symptomatic ICA disease. Also young patients are more likely to have an echolucent plaque suggesting an age-related association with plaque maturation.
    The Journal of cardiovascular surgery 04/2010; 51(2):245-51. · 1.51 Impact Factor
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    ABSTRACT: Our aim was to test the association of mean leukocyte telomere length (LTL) with ultrasonic measures of subclinical atherosclerosis such as intima-media thickness in the common carotid (IMTcc) and sum of plaque areas (SPA) and with serological markers. Carotid and femoral bifurcations were scanned in 762 general population volunteers (46% men) over 40. Four features were considered: (a) IMTcc, (b) sum plaque areas of carotid plaques (SPAcar), (c) sum plaque area of common femoral plaques (SPAfem) and (d) sum plaque area (SPA--sum of the plaque areas of the largest plaques present in each of both carotid and femoral bifurcations). Mean LTL was determined with a quantitative real-time PCR-based method. IMTcc was strongly associated with mean LTL both before and after correction for traditional risk factors (B=-0.002; 95% CI=-0.004 to -0.00; p=0.014). In sex-specific analysis, the association was stronger in men (p for sex interaction<0.001). SPAfem was associated with LTL in women before and after correction (B=-0.195; 95% CI=-0.38 to -0.01; p=0.037) (p for sex interaction<0.001). LTL was also associated with age and sex-adjusted levels of hsCRP (p=0.012), sCD40L (p=0.042), homocysteine (p=0.006), creatinine (p=0.02), ApoA1 (p=0.01), Lp(a) (p=0.04) and HOMA-IR (p=0.008). Our results support the telomere hypothesis and highlight potential differences in the biological mechanisms leading to intima-media thickening and/or plaque formation between vascular beds. They may provide insights into a novel treatment of antisenescence to prevent atherosclerosis.
    Atherosclerosis 02/2010; 211(1):176-81. · 3.71 Impact Factor
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    Journal of Vascular Surgery - J VASC SURG. 01/2010; 51(3):790-790.
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    ABSTRACT: Background: The purpose of this study was to determine the cerebrovascular risk stratification potential of baseline degree of stenosis, clinical features, and ultrasonic plaque characteristics in patients with asymptomatic internal carotid artery (ICA) stenosis. Methods: This was a prospective, multicenter, cohort study of patients undergoing medical intervention for vascular disease. Hazard ratios for ICA stenosis, clinical features, and plaque texture features associated with ipsilateral cerebrovascular or retinal ischemic (CORI) events were calculated using proportional hazards models. Results: A total of 1121 patients with 50% to 99% asymptomatic ICA stenosis in relation to the bulb (European Carotid Surgery Trial [ECST] method) were followed-up for 6 to 96 months (mean, 48). A total of 130 ipsilateral CORI events occurred. Severity of stenosis, age, systolic blood pressure, increased serum creatinine, smoking history of more than 10 pack-years, history of contralateral transient ischemic attacks (TIAs) or stroke, low grayscale median (GSM), increased plaque area, plaque types 1, 2, and 3, and the presence of discrete white areas (DWAs) without acoustic shadowing were associated with increased risk. Receiver operating characteristic (ROC) curves were constructed for predicted risk versus observed CORI events as a measure of model validity. The areas under the ROC curves for a model of stenosis alone, a model of stenosis combined with clinical features and a model of stenosis combined with clinical, and plaque features were 0.59 (95% confidence interval [CI] 0.54-0.64), 0.66 (0.62-0.72), and 0.82 (0.78-0.86), respectively. In the last model, stenosis, history of contralateral TIAs or stroke, GSM, plaque area, and DWAs were independent predictors of ipsilateral CORI events. Combinations of these could stratify patients into different levels of risk for ipsilateral CORI and stroke, with predicted risk close to observed risk. Of the 923 patients with <70% stenosis, the predicted cumulative 5-year stroke rate was <5% in 495, 5% to 9.9% in 202, 10% to 19.9% in 142, and <20% in 84 patients. Conclusion: Cerebrovascular risk stratification is possible using a combination of clinical and ultrasonic plaque features. These findings need to be validated in additional prospective studies of patients receiving optimal medical intervention alone.
    Journal of Vascular Surgery 01/2010; 52(6):1486-1496. · 2.88 Impact Factor
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    ABSTRACT: Herein, we present the European Society for Vascular Surgery Guidelines pertinent to the secondary prevention of cerebrovascular events in patients with carotid artery stenosis including lipid lowering therapy, antiplatelet therapy and other risk factor modification. These recommendations are based on current evidence from clinical trials. There is a need for aggressive prevention treatment in patients with carotid artery disease. We also discuss the diagnosis and grading of carotid artery stenosis.
    Current Vascular Pharmacology 01/2010; 8(5):682-91. · 2.82 Impact Factor
  • Atherosclerosis Supplements - ATHEROSCLER SUPPL. 01/2010; 11(2):50-50.
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    ABSTRACT: The common carotid intima-media thickness (IMT) is considered as a marker of cardiovascular disease, while the value of the common femoral IMT is not well defined. The aim of the present study was to investigate the value of common femoral IMT alone or in combination with the common carotid IMT as a marker of cardiovascular disease in asymptomatic adults. Eighty-three individuals with no history of cardiovascular disease were subjected to IMT measurement of both common carotid and common femoral arteries with high-resolution ultrasonography. The Framingham Heart Study (FHS) risk score was calculated for each subject (according to gender) and was correlated with the carotid IMT, femoral IMT, and the combined IMT measured at both arterial sites. The carotid and femoral IMT separately and in combination were found to be correlated with the FHS risk score, calculated based on either the total cholesterol or low density lipoprotein plasma levels (carotid IMT: r = 0.28, p = 0.035, and r = 0.35, p = 0.007, respectively, femoral IMT: r = 0.38, p = 0.003, and r = 0.43, p = 0.001, respectively, carotid-femoral IMT: r = 0.37, p = 0.005, and r = 0.46, p = 0.0001, respectively). In addition, femoral IMT was found to be correlated with the carotid IMT (r = 0.41, p = 0.001). Common carotid and common femoral IMT showed similar correlation with the FHS risk score. Additionally, the combination of IMT from both arterial sites was found to have similar correlation with the FHS risk score to carotid IMT alone.
    VASA.: Zeitschrift für Gefässkrankheiten. Journal for vascular diseases 06/2009; 38(2):147-54. · 1.01 Impact Factor
  • Journal of Vascular Surgery 01/2009; 49(4-49):902-909. · 2.88 Impact Factor
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    ABSTRACT: In moderate to high-risk general surgical patients, the cost effectiveness of mechanical prophylaxis for venous thromboembolism (VTE) is uncertain. Therefore, we determined the costs and savings of intermittent pneumatic compression (IPC) plus graduated compression stockings (GCS). Postoperative VTE events in the absence of prophylaxis, efficacy of prophylaxis and costs of prophylaxis have been obtained from the English literature and Medicare 2004 reimbursement schedule. In 1000 moderate to high risk general surgical patients, in the absence of prophylaxis, the cost of investigating and treating 72 patients with clinical suspicion of DVT and 32 with PE is calculated to be $263,779. This corresponds to a cost of $263 per surgical patient. The cost of IPC combined with TED stockings in 1000 similar patients would be $66 760, and the cost of diagnosis and treatment of the reduced numbers (69% reduction) of clinical VTE is $ 83,574 making a total of $150 344. This means a saving of $133,435 ($263,779 - $150,344) per 1000 patients. This corresponds to a saving of $113 per surgical patient. Sensitivity analysis demonstrates that despite variation in costs or efficacy for IPC plus GCS, marked savings persist. Prophylaxis with IPC not only prevents VTE but also saves money.
    International angiology: a journal of the International Union of Angiology 01/2009; 27(6):500-6. · 1.46 Impact Factor
  • Atherosclerosis 01/2009; 207(1). · 3.71 Impact Factor
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    ABSTRACT: Objectives: This study tested the hypothesis that silerit embolic infarcts on computed tomography (CT) brain scans can predict ipsilateral neurologic hemispheric events and stroke in patients with asymptomatic internal carotid artery stenosis. Methods: In a prospective multicenter natural history study, 821 patients with asymptomatic carotid stenosis graded with duplex scanning who had CT brain scans were monitored every 6 months for a maximum of 8 years. Duplex scans were reported centrally, and stenosis was expressed as a percentage in relation to the normal distal internal carotid criteria used by the North American Symptomatic Carotid Endarterectomy Trialists. CT brain scans were reported centrally by a neuroradiologist. In 146 patients (17.8%), 8 large cortical, 15 small cortical, 72 discrete subcortical, and 51 basal ganglia ipsilateral infarcts were present; these were considered likely to be embolic and were classified as such. Other infarct types, lacunes (n = 15), watershed (n = 9), and the presence of diffuse white matter changes (n = 95) were not considered to be embolic. Results: During a mean follow-up of 44.6 months (range, 6 months-8 years), 102 ipsilateral hemispheric neurologic events (amaurosis fugax in 16, 38 transient ischemic attacks [TIAs], and 47 strokes) occurred, 138 patients died, and 24 were lost to follow-up. In 462 patients with 60% to 99% stenosis, the cumulative event-free rate at 8 years was 0.81 (2.4% annual event rate) when embolic infarcts were absent and 0.63 (4.6% annual event rate) when present (log-rank P = .032). In 359 patients with <60% stenosis, embolic infarcts were not associated with increased risk (log-rank P = .65). In patients with 60% to 99% stenosis, the cumulative stroke-free rate was 0.92 (1.0% annual stroke rate) when embolic infarcts were absent and 0.71 (3.6% annual stroke rate) when present (log-rank P = .002). In the subgroup of 216 with moderate 60% to 79% stenosis, the cumulative TIA or stroke-free rate in the absence and presence of embolic infarcts was 0.90 (1.3% annual rate) and 0.65 (4.4% annual rate), respectively (log-rank P = .005). Conclusion: The presence of silent embolic infarcts can identify a high-risk group for ipsilateral hemispheric neurologic events and stroke and may prove useful in the management of patients with moderate asymptomatic carotid stenosis.
    Journal of Vascular Surgery 01/2009; 49(4):902-909. · 2.88 Impact Factor
  • Atherosclerosis Supplements - ATHEROSCLER SUPPL. 01/2009; 10(2).
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    ABSTRACT: It has been demonstrated that an increased apolipoprotein B (ApoB)/apolipoprotein A-I (ApoA1) ratio is associated with atherogenic low density lipoprotein (LDL) particles and the development of clinical cardiovascular disease. The aim of this study was to test the hypothesis that ApoB/ApoA1 ratio is associated with early subclinical atherosclerosis as demonstrated by ultrasonic measurements. Both common carotid and common femoral bifurcations have been scanned with high-resolution ultrasound in 767 volunteers over the age of 40. The latter consisted of 95% of the population of two randomly selected areas. IMTcc, IMTmax (including plaques), total plaque thickness (TPT) (the sum of the thickest plaques present at each bifurcation in cm) and black plaque burden (BPB) (TPT means plaque type) using the Widder classification with type 1 being the most hyperechoic and calcified and type 5 the most hypoechoic plaque were recorded. A medical history was taken with emphasis on risk factors present and a fasting lipid profile including ApoB and ApoA1 was determined. In the total population (N.=767) the mean (+/-SD) ApoB/ApoA1 ratio was 0.85 (+/-0.22). In linear regression analysis, the Apob/ApoA1 ratio was significantly associated with all the ultrasonic measurements of early atherosclerosis (intima media thickness, IMTcc, IMTmax, TPT and BPB). These findings remained significant after correcting for age, gender, smoking, hypertension and diabetes (P<0.001 for all). The results indicate that a high ApoB/ApoA1 ratio is associated not only with early atherosclerosis but also with hypoechoic (BPB) and by inference unstable plaques.
    International angiology: a journal of the International Union of Angiology 02/2008; 27(1):74-80. · 1.46 Impact Factor
  • M Griffin, A Nicolaides, E Kyriacou
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    ABSTRACT: Image normalization using ''Adobe Photoshop'' a commercially available software package designed for photography has provided the means of making reproducible measurements of grey scale in ultrasonic images of carotid bifurcation plaques. A dedicated software package ''Plaque Texture Analysis'' has been developed by the authors that is simple to use, provides facilities for measurement of other texture features in addition to grey scale median (GSM) and allows the operator to save the normalised images, plaques and GSM measurements in a database for subsequent analysis. The aim of the study was to determine (a) the intraobserver variability of GSM when the same plaque images were analysed using both Adobe Photoshop and the dedicated software and (b) the interobserver variability when the same plaque images were analysed using the dedicated software by different observers. A sample of 33 images of carotid bifurcation plaques (16 symptomatic and 17 asymptomatic) producing greater than 50% stenosis of the internal carotid artery were analysed by two observers. The intraclass correlation coefficient and correlation coefficient (r) for GSM were 0.992 (95% CI 0.984 to 0.996) and 0.992 respectively for the first observer (MG); they were 0.986 (95% CI 0.972 to 0.993) and 0.987 respectively for the second observer (AN). The interobserver intraclass correlation coefficient and correlation coefficient (r) were 0.932 (95% CI 0.863 to 0.967) and 0.933 respectively. These findings and the automatic saving of the normalised images and measurements in a database for subsequent statistical analysis make the ''Plaque Texture Analysis'' software a powerful research tool.
    International angiology: a journal of the International Union of Angiology 01/2008; 26(4):372-7. · 1.46 Impact Factor

Publication Stats

1k Citations
91 Downloads
185.43 Total Impact Points

Institutions

  • 2013
    • Cyprus University of Technology
      Leymosun, Lemesos, Cyprus
  • 2009–2010
    • General University Hospital of Larissa
      Lárissa, Thessaly, Greece
  • 2000–2009
    • Imperial College London
      • Faculty of Medicine
      Londinium, England, United Kingdom
    • Soroka Medical Center
      • Department of Vascular Surgery
      Be'er Sheva`, Southern District, Israel
    • WWF United Kingdom
      Londinium, England, United Kingdom
  • 2008
    • University of Cyprus
      Lefkoşa, Lefkosia, Cyprus
  • 1996–2002
    • Università degli Studi G. d'Annunzio Chieti e Pescara
      • Division of Oral Surgery
      Chieta, Abruzzo, Italy
  • 2001
    • Ealing Hospital NHS Trust
      Londinium, England, United Kingdom