Stavros Dimopoulos

• PhD, EDIC
• Chief Director Cardiac Surgery ICU at Onassis Cardiac Surgery Center

Cardiac surgery procedures are among the main treatments for people with cardiovascular disease, with physiotherapy playing a vital part. Respiratory complications are common and associated with prolonged Intensive Care Unit (ICU) and hospital stay, as well as increased mortality. Inspiratory muscle training has been found to be beneficial in impro...

Ischemic stroke (IS) is a severe complication and leading cause of mortality in patients under extracorporeal membrane oxygenation (ECMO). The aim of our narrative review is to summarize the existing evidence and provide a deep examination of the diagnosis and treatment of acute ischemic stroke patients undergoing ECMO support. The incidence rate o...

Introduction A young man was referred to our Center for refractory cardiogenic shock, accompanied with uncontrolled atrial flutter of unknown duration. The patient was supported with VenoArterial Extracorporeal Membrane Oxygenation (VA ECMO) and Intra-Aortic Balloon Pump (IABP) as a bridge to decision. Case Report His course was complicated by pul...

Coronary heart disease and aortic stenosis are prevalent cardiovascular diseases worldwide, leading to morbidity and mortality. Coronary artery bypass grafting (CABG) and surgical aortic valve replacement (SAVR) have therapeutic benefits, including improved postoperative quality of life (QoL) and enhanced patient functional capacity which are key i...

Background/Objectives: The aim of this study was to investigate the feasibility and safety of neuromuscular electrical stimulation (NMES) in patients on extracorporeal membrane oxygenation (ECMO) and thoroughly assess any potential adverse events. Methods: We conducted a prospective observational study assessing safety and feasibility, including 16...

BACKGROUND Transplant recipients commonly harbor multidrug-resistant organisms (MDROs), as a result of frequent hospital admissions and increased exposure to antimicrobials and invasive procedures. AIM To investigate the impact of patient demographic and clinical characteristics on MDRO acquisition, as well as the impact of MDRO acquisition on inte...

Introduction The lifetime prevalence of performance related musculoskeletal disorders in musicians is reported to reach a very high rate (93%) and many times affect the music performance, playing efficacy, the quality of their work or their career progression. It can also have a significant financial burden on the musicians as well as on the organi...

Introduction Patients with chronic heart failure (CHF) have been presented with microcirculation alterations and vascular endothelial dysfunction. Exercise training programs, including inspiratory muscle training (IMT) as an alternative/additional means of exercise, have been shown to improve the functional status of these patients. However, there...

In this editorial we comment on the detrimental consequences that post-intensive care syndrome (PICS) has in the quality of life of intensive care unit (ICU) survivors, highlighting the importance of early onset of multidisciplinary rehabilitation from within the ICU. Although, the syndrome was identified and well described early in 2012, more awar...

Background: Pulmonary hypertension (PH) is a serious progressive disorder of the modern world, characterized by endothelial dysfunction and impaired vasoreactivity. Patients with PH usually present exercise intolerance from the very early stages and reduced exercise capacity. Exercise training has been shown to have beneficial effects in patients...

In this editorial we comment on the article by Kuwahara et al , published in the recent issue of the World Journal of Cardiology . In this interesting paper, the authors showed a correlation between portal vein pulsatility ratio, examined by bedside ultrasonography, and prognosis of hospitalized patients with acute heart failure. Systemic congestio...

Rheumatoid arthritis (RA) is an autoimmune disease characterized by chronic inflammation. The purpose of this systematic review is to evaluate the effectiveness of exercise training on functional capacity and quality of life (QoL) in patients with RA. We performed a search in four databases, selecting clinical trials that included community or outp...

Background/Objectives: The aim of this study was to investigate feasibility and safety of neuromuscular electrical stimulation (NMES) in patients on extracorporeal membrane oxygenation (ECMO) and assess thoroughly any potential adverse events. Methods: We conducted a safety and feasibility study including 16 ICU patients on ECMO support who were ad...

Physical inactivity remains in high levels after cardiac surgery, reaching up to 50%. Patients present a significant loss of functional capacity, with prominent muscle weakness after cardiac surgery due to anesthesia, surgical incision, duration of cardiopulmonary bypass, and mechanical ventilation that affects their quality of life. These complica...

Heart Failure is a chronic and progressively deteriorating syndrome that has reached epidemic proportions worldwide. Improved outcomes have been achieved with novel drugs and devices. However, the number of patients refractory to conventional medical therapy is growing. These advanced heart failure patients suffer from severe symptoms and frequent...

BACKGROUND Lack of mobilization and prolonged stay in the intensive care unit (ICU) are major factors resulting in the development of ICU-acquired muscle weakness (ICUAW). ICUAW is a type of skeletal muscle dysfunction and a common complication of patients after cardiac surgery, and may be a risk factor for prolonged duration of mechanical ventilat...

Endothelial dysfunction and inflammation are common pathophysiological characteristics of chronic heart failure (CHF). Endothelial progenitor cells (EPCs) are recognized as useful markers of vascular damage and endothelial repair. The aim of this study was to investigate the effects of a cardiac rehabilitation program on EPCs and inflammatory profi...

Background: Patients admitted to intensive care unit (ICU) after cardiac surgery develop acute kidney injury (AKI) immediately post-operation. We hypothesized that AKI occurs mainly due to perioperative risk factors and may affect outcome. Aim: To assess peri-operative risk factors for AKI post cardiac surgery and its relationship with clinical...

Introduction Pulmonary hemorrhage is a life-threatening complication of VA-ECMO occasionally presenting with Harlequin syndrome. Case report We present a case of a VA-ECMO patient complicated with pulmonary hemorrhage, complete right lung atelectasis and differential hypoxia refractory to conventional treatment including optimal mechanical ventila...

Background: Type 2 diabetes mellitus (T2DM) is a chronic metabolic syndrome characterized by insulin resistance and hyperglycemia that may lead to endothelial dysfunction, reduced functional capacity and exercise intolerance. Regular aerobic exercise has been promoted as the most beneficial non-pharmacological treatment of cardiovascular diseases....

Background Aerobic exercise, either continuous or high intensity interval training (HIIT), induces important benefits in chronic heart failure (CHF) patients. Resistance training has been also shown to be beneficial in CHF. However, data regarding combined aerobic exercise and muscle strength training is still limited. The aim of this study was to...

Spontaneous coronary artery dissection (SCAD) is a rare non-atherosclerotic cause of acute coronary syndromes defined as non-iatrogenic, non-traumatic separation of the coronary artery wall. The most common profile is a middle-aged woman between 44 and 53 years with few cardiovascular risk factors. SCAD is frequently linked with predisposing factor...

Heart failure (HF) is a major public health issue worldwide with increased prevalence and a high number of hospitalizations. Patients with chronic HF and either reduced ejection fraction (HFrEF) or mildly reduced ejection fraction (HFmrEF) present vascular endothelial dysfunction and significantly decreased circulating levels of endothelial progeni...

Purpose: The purpose of this study was to investigate the effect of a cardiac rehabilitation program on the acute response on endothelial progenitor cells and circulating endothelial cells after maximal exercise in patients with chronic heart failure of different severity. Methods: Forty-four chronic heart failure patients were enrolled in a 36-...

Background/aim: Multiple reports from all over the world link COVID-19 with endothelial/coagulation disorders as well as a dysregulated immune response. This study tested the hypothesis that immunostimulation will be greater in COVID-19 patients than in patients with H1N1 infection or bacterial sepsis. Also, whether an increase in immune stimulati...

The aim of this qualitative systematic review is to summarize and analyze the different modalities of exercise training and its potential effects in patients on extracorporeal membrane oxygenation (ECMO) support. ECMO is an outbreaking, life-saving technology of the last decades which is being used as a gold standard treatment in patients with seve...

The purpose of this study was to compare the acute cardiorespiratory responses and time spent above different %VO2peak intensities between three “iso-work” protocols: (a) a high intensity interval training protocol (HIIT), (b) a higher intensity continuous protocol (CON70) and (c) a lower intensity continuous protocol (CON50) in patients with chron...

Heart transplantation remains the gold standard in the treatment of end-stage heart failure (HF). Heart transplantation patients present lower exercise capacity due to cardiovascular and musculoskeletal alterations leading thus to poor quality of life and reduction in the ability of daily self-service. Impaired vascular function and diastolic dysfu...

Background: Early mobilization of the Intensive Care Unit (ICU) patients improves muscle strength and functional capacity. It has been demonstrated that prevents Intensive Care Unit Acquired Weakness (ICUAW) and accelerates ICU discharge. However, data on mobilization early after cardiac surgery are inadequate. This study aimed to record early mobi...

Introduction Acute exercise and exercise training may confer epigenetic modifications in healthy subjects. Epigenetic effects after exercise have been showed in patients with cardiovascular disease. The aim of this systematic review was to summarize the evidence from available clinical trials that study epigenetic adaptations after exercise in pati...

Background: Vascular endothelial dysfunction is an underlying pathophysiological feature of chronic heart failure (CHF). Patients with CHF are characterized by impaired vasodilation and inflammation of the vascular endothelium. They also have low levels of endothelial progenitor cells (EPCs). EPCs are bone marrow derived cells involved in endothel...

Background Chronic heart failure (CHF) remains a leading cause of morbidity and mortality and it is characterized by vascular endothelial dysfunction. During the last decades, endothelial progenitor cells (EPCs) are being used as an index of the endothelium restoration potential, therefore reflecting the vascular endothelial function. Exercise trai...

Introduction Primary graft dysfunction (PGD) is the main cause of early mortality after heart transplantation. Despite affecting approximately 7–8% of all recipients, the etiology and optimal treatment of this condition remains unknown. Extracorporeal membrane oxygenation (ECMO) is a key treatment modality, however optimal timing of initiation has...

We read with great interest the recently published study by Wright and colleagues, 1 in which the authors have investigated the prognostic value of thromboelastography (TEG) measurements of coagulation in patients with COVID-19 admitted to the ICU. Despite the retrospective nature of the study and the low sample size, the authors have interestingly...

Background: Patients undergoing cardiac surgery particularly those with comorbidities and frailty, experience frequently higher rates of post-operative morbidity, mortality and prolonged hospital length of stay. Muscle mass wasting seems to play important role in prolonged mechanical ventilation (MV) and consequently in intensive care unit (ICU) a...

Introduction Antineutrophil cytoplasmic autoantibody–associated vasculitis is an immune-mediated necrotizing vasculitis, affecting small- and medium-sized vessels. Case report A 22-year-old female patient with free medical history presented with life-threatening pulmonary hemorrhage due to antineutrophil cytoplasmic autoantibody–associated vasculi...

Introduction Vascular endothelial dysfunction is an underlying pathophysiological feature of chronic heart failure (CHF). Exercise has been shown to stimulate the mobilization of endothelial progenitor cells (EPC) in healthy populations. EPC contribute to the regeneration of the inflammatory endothelium and promote neovascularization. Purpose The...

Background: Patients with heart failure (HF) suffer from ventilatory abnormalities that are related to poor prognosis.Aim: The aim of the study was to investigate the respiratory drive in HF patients early after left ventricular assist device (LVAD) implantation. Methods: We enrolled eight HF patients after LVAD (HeartMate II) implantation and 8 pa...

Objectives: To investigate the safety of percutaneous dilatational tracheostomy in severe respiratory failure patients during veno-venous extracorporeal membrane oxygenation support. Design: A single-center, retrospective, observational cohort study. Setting: Tertiary referral severe respiratory failure center, university teaching hospital. P...

Objective The thrombomodulin/protein C and VWF/ADAMTS‐13 pathways are disturbed in sepsis, and have been implicated in the coagulation disorders that characterize the septic syndrome. We aimed to assess the variation of these endothelial parameters during sepsis and their putative association with outcome, in critically ill, septic patients. Metho...

Heart failure is often accompanied by severe malnutrition, which in combination with chronic inflammation, neuro-hormonal activation and reduced physical activity, is involved in the vicious cycle of heart failure, with progressive deterioration to cardiac cachexia. To date no specific treatment has been found for the cardiac cachexia syndrome. Alt...

Objective: The importance of abnormalities observed in the microcirculation of patients with arterial hypertension (AH) is being increasingly recognized. The authors aimed to evaluate skeletal muscle microcirculation in untreated, newly diagnosed hypertensive patients with Near Infrared Spectroscopy (NIRS), a non-invasive method that evaluates mic...

Background Exercise oscillatory ventilation in chronic heart failure has been suggested as a factor related to adverse cardiac events, aggravated prognosis and higher mortality. Exercise training is well known to affect exercise capacity and mechanisms of pathophysiology beneficially in chronic heart failure. Little is known, however, about the exe...

It was with great interest we read the article by Gandhi et al. [(1)][1] concerning the role of insulin-like growth factor-binding protein 7 (IGFBP7) as a biomarker of functional capacity in heart failure (HF) with preserved ejection fraction. Patients with inframedian peak oxygen consumption (Vo2p

With great interest we read the recent article by Panagiotou et al . [1] in which the authors investigated the correlation between tissue oxygen measurements ( S tO2) at rest and during constant-workload exercise with the analogous measurements of mixed venous oxygen saturation at the level of pulmonary artery ( S vO2) and inferior vena cava in pat...

Background: Ventilator-associated pneumonia (VAP), one of the most common hospital-acquired infections, has a high mortality rate. Objectives: To evaluate the incidence of VAP in a multidisciplinary intensive care unit and to examine the effects of the implementation of ventilator bundles and staff education on its incidence. Methods: A 24-mon...

Introduction: Polyarteritis Nodosa (PAN) is a systemic vasculitis affecting small and medium size arteries resulting in microaneurysms formation. Bilateral renal aneurysm rupture is a rare and life threatening complication. Although uncommon, PAN has been associated with chronic myelomonocytic leukaemia (CMML). Presentation of case: We report a...

Background: It remains controversial which type of exercise elicits optimum adaptations on skeletal myopathy of heart failure (HF). Aim was to evaluate the effect of high-intensity interval training (HIIT), with or without the addition of strength training, on skeletal muscle of HF patients. Methods and results: Thirteen male HF patients (age: 5...

Background/Introduction: Oscillatory ventilation (OV) in chronic heart failure (CHF) is described by the amplitude and the length of cyclic fluctuations in breathing. The clinical significance of the pattern of this phenomenon during exercise and during recovery has not been investigated yet. Purpose: To investigate the relationship between OV cha...

Background: Endothelial progenitor cells (EPCs) have been suggested to constitute a restoration index of the disturbed endothelium in ICU patients. Neuromuscular electric stimulation (NMES) is increasingly employed in ICU to prevent comorbidities such as ICU-acquired weakness, which is related to endothelial dysfunction. The role of NMES to mobiliz...

Purpose: Exercise training programs improve microcirculatory alternations in patients with chronic heart failure (CHF). However less is known about the acute effect of maximum exercise on the skeletal muscle microcirculation. We aimed to assess the effect of acute exercise on peripheral microcirculation of patients with CHF, as assessed by near-in...

Background: Endothelial progenitor cells (EPCs) have been suggested to constitute a restoration index of the disturbed endothelium in ICU patients. Neuromuscular electric stimulation (NMES) is increasingly employed in ICU to prevent comorbidities such as ICU-acquired weakness, which is related to endothelial dysfunction. The role of NMES to mobiliz...

Introduction. The pathophysiology of chronic heart failure (CHF) involves peripheral myopathy in which pro-inflammatory cytokines play an important role. Nevertheless, inflammation has also benefcial effects on skeletal muscle remodeling, by activating angiogenic and hypertrophic pathways in muscle tissue. Moreover, it remains a matter of discussion...

Introduction. The pathophysiology of chronic heart failure (CHF) involves multiple functional, histological and molecular alterations in skeletal muscle [1]. Capillary density is a peripheral limiting factor of exercise capacity and is signifcantly decreased in skeletal muscle of CHF patients. Although it is well known that exercise induces skeleta...

The goal of this study was to explore the relation between oxygen kinetics during constant work load submaximal cardiopulmonary exercise test (CPET) and disease severity in adult subjects with cystic fibrosis. Fourteen adult subjects with cystic fibrosis (CF; 8 males, 22 ± 4 y old) and a mean Schwachman score of 73 ± 11 and 10 healthy individuals (...

Aim: To evaluate Quality of life (QoL) in chronic heart failure (CHF) in relation to Neuroticism personality trait and CHF severity. Methods: Thirty six consecutive, outpatients with Chronic Heart Failure (6 females and 30 males, mean age: 54 ± 12 years), with a left ventricular ejection fraction ≤ 45% at optimal medical treatment at the time of...

Abstract PURPOSE: Exercise training induces several beneficial effects in patients with chronic heart failure (CHF). This study investigated the effects of high-intensity aerobic interval training (AIT) compared with combined AIT and strength training (COM) on early ventilatory and metabolic recovery pattern after symptom-limited cardiopulmonary e...

Purpose: Periodic breathing in chronic heart failure (CHF) patients is associated with reduced exercise capacity and quality of life, increased mortality and increased incidence of sudden cardiac death. Exercise rehabilitation programs improve exercise capacity and quality of life in CHF patients. So far, there is little data on the effect of exerc...

Purpose: Left ventricular assist device (LVAD) implantation modifies the vicious cycle of chronic heart failure (CHF) and therefore improves functional capacity, quality of life and survival. The aim of this study was to examine respiratory drive and respiratory muscle strength after LVAD implantation. Methods: 7 patients with end stage CHF (6 male...

In Reply: We thank Dr Champion for his particular interest in our study and his thorough comments. However, we would like to share our concerns related to his comments. In our point of view, we should use the microvascular oxygen extraction rate with caution, as it is not yet a valid accurate

Background: Patients with chronic heart failure (CHF) are characterized by exercise intolerance and venti-latory abnormalities that are related to poor prognosis. We hypothesized that CHF patients have increased respiratory drive and abnormal breathing pattern during exercise in relation to disease severity. Materials and methods: The study populat...

Background: Patients with heart failure (HF) are characterized by several skeletal muscle abnormalities that are closely related to their exercise intolerance. Aim of this study was to investigate the effects of three different interval exercise training programs on skeletal muscle fiber-type distribution and aerobic capacity of HF patients. Method...

Intensive care unit-acquired weakness (ICUAW) is a common complication, associated with significant morbidity. Neuromuscular electrical stimulation (NMES) has shown promise for prevention. NMES acutely affects skeletal muscle microcirculation; such effects could mediate the favorable outcomes. However, optimal current characteristics have not been...

Patients with chronic heart failure (CHF) are characterized by exercise intolerance and ventilatory abnormalities that are related to poor prognosis. We hypothesized that CHF patients have increased respiratory drive and abnormal breathing pattern during exercise in relation to disease severity. The study population consisted of 219 stable CHF pati...

Chronic heart failure (CHF) is a complex clinical syndrome leading to exercise intolerance due to muscular fatigue and dyspnea. Hemodynamics fail to explain the reduced exercise capacity, while a significant skeletal muscular pathology seems to constitute the main underlying mechanism for exercise intolerance in CHF patients. There have been propos...

Background: Red blood cell (RBC) transfusion is the treatment basis in beta-thalassemia major. Aim: With the present study we aimed to investigate the effect of RBC transfusions on tissue oxygenation, in beta-thalassemics. Microcirculatory indices obtained by Near Infrared Spectroscopy (NIRS) were utilized. Methods: The relative oxyhemoglobin conce...

Purpose: Heart failure (HF) is associated with exercise intolerance and significant skeletal muscle abnormalities. Insulin-like growth factor 1 (IGF-1) is a significant regulator of skeletal muscle mass that promotes muscle hypertrophy. IGF-1 expression is reduced in skeletal muscle of HF patients. Three different IGF-1 isoforms are expressed in hu...

Cardiovascular adverse events in patients with myasthenia gravis (MG) are rare, but the early recognition of such events is crucial. We describe a case of a non-coronary myocardial infarction (MI) during the initial treatment period with pyridostigmine bromide in a female patient with MG. Clinicians should be cautious about the appearance of potent...

Background: Pulmonary microcirculation abnormalities are the main determinants of pulmonary arterial hypertension (PAH) pathophysiology. We hypothesized that PAH patients have peripheral tissue microcirculation alterations that might benefit from hyperoxic breathing. We evaluated peripheral muscle microcirculation with near-infrared spectroscopy,...

BACKGROUND: Skeletal muscle wasting is associated with altered catabolic/anabolic balance and poor prognosis in patients with chronic heart failure (CHF). This study evaluated catabolic and anabolic abnormalities in relation to disease severity in CHF patients. METHODS: Forty-two stable CHF patients (34 men; aged 56±12 years, body mass index, 27±5...

Patients with chronic heart failure (CHF) usually experience poor quality of life (QoL). Psychosocial interventions tend to affect QoL in CHF. The aim of this study was to explore: 1) the effectiveness of psychosocial interventions on patients' QoL; 2) the magnitude of this effect; and 3) factors that appear to moderate the reported effect on QoL....

We report a unique case of an adverse interaction between the oxazolidinone antibiotic linezolid, the tricyclic antidepressant amitriptyline and the opioid analgesic fentanyl in a 68-year-old woman with advanced ischemic peripheral arterial disease and sepsis, under empirical antibiotic treatment. We also summarize the current relevant literature a...