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Doundoulakis Ioannis Gavriilaki Maria Tsiachris Dimitris Arsenos Petros Antoniou Christos-Konstantinos Dimou Smaro Soulaidopoulos Stergios Farmakis Ioannis Akrivos Evangelos Stoiloudis Panagiotis Notas Konstantinos Kimiskidis Vasilios K. Giannakoulas George Paraskevaidis Stylianos Gatzoulis Konstantinos A. Tsioufis Konstantinos 《Cardiovascular drugs and therapy / sponsored by the International Society of Cardiovascular Pharmacotherapy》2022,36(5):951-958
Cardiovascular Drugs and Therapy - Atrial high-rate episodes (AHREs) recorded with cardiac implantable electronic devices (CIEDs) have been associated with the development of clinical atrial... 相似文献
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Filippos K. Triposkiadis Javed Butler Georgios Karayannis Randall C. Starling Gerasimos Filippatos Kathy Wolski John Parissis Charalabos Parisis Dimitrios Rovithis Konstantinos Koutrakis John Skoularigis Christos-Konstantinos Antoniou Christina Chrysohoou Christos Pitsavos Christodoulos Stefanadis John Nastas Themistoklis Tsaknakis Lilian Mantziari Georgios Giannakoulas Haralambos Karvounis Andreas P. Kalogeropoulos Gregory Giamouzis 《International journal of cardiology》2014
Aims
The role of low-dose dopamine infusion in patients with acute decompensated heart failure (ADHF) remains controversial. We aim to evaluate the efficacy and safety of high- versus low-dose furosemide with or without low-dose dopamine infusion in this patient population.Methods and results
161 ADHF patients (78 years; 46% female; ejection fraction 31%) were randomized to 8-hour continuous infusions of: a) high-dose furosemide (HDF, n = 50, 20 mg/h), b) low-dose furosemide and low-dose dopamine (LDFD, n = 56, 5 mg/h and 5 μg kg− 1 min− 1 respectively), or c) low-dose furosemide (LDF, n = 55, furosemide 5 mg/h). The main outcomes were 60-day and one-year all-cause mortality (ACM) and hospitalization for HF (HHF). Dyspnea relief (Borg index), worsening renal function (WRF, rise in serum creatinine (sCr) ≥ 0.3 mg/dL), and length of stay (LOS) were also assessed. The urinary output at 2, 4, 6, 8, and 24 h was not significantly different in the three groups. Neither the ACM at day 60 (4.0%, 7.1%, and 7.2%; P = 0.74) or at one year (38.1%, 33.9% and 32.7%, P = 0.84) nor the HHF at day 60 (22.0%, 21.4%, and 14.5%, P = 0.55) or one year (60.0%, 50.0%, and 47%, P = 0.40) differed between HDF, LDFD, and LDF groups, respectively. No differences in the Borg index or LOS were noted. WRF was higher in the HDF than in LDFD and LDF groups at day 1 (24% vs. 11% vs. 7%, P < 0.0001) but not at sCr peak (44% vs. 38% vs. 29%, P = 0.27). No significant differences in adverse events were noted.Conclusions
In ADHF patients, there were no significant differences in the in-hospital and post-discharge outcomes between high- vs. low-dose furosemide infusion; the addition of low-dose dopamine infusion was not associated with any beneficial effects. 相似文献3.
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Polychronis Dilaveris Christos-Konstantinos Antoniou Konstantinos A. Gatzoulis 《Trends in Cardiovascular Medicine》2017,27(8):542-555
Publication of the DANISH randomized trial led to considerable debate, given that it demonstrated no survival benefit stemming from current implantable cardioverter-defibrillator (ICD) allocation criteria in patients with non-ischemic dilated cardiomyopathy (NIDCM). Consequently, a thorough reconsideration of our approach to sudden cardiac death (SCD)-risk stratification appears to be in order. NIDCM encompasses a wide spectrum of disease entities, often with differing arrhythmogenicity; however, in its kernel, is still defined by the fundamentals of electrophysiology that dictate that abnormal tissue, exhibiting altered electrophysiological properties is necessary for arrhythmogenesis, but not enough, given that formation of functional circuits is required. In this review article, we will attempt a presentation of the current status in SCD-risk stratification in NIDCM and introduce the concept of multifactorial tiered approach, bringing together non-invasive indices of arrhythmic potential and programmed ventricular stimulation, as an alternative approach, in order to finally delineate a potential basis for the design and realization of trials necessary to achieve a paradigm shift and improvement in NIDCM SCD-risk stratification. 相似文献
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Stergios Soulaidopoulos MD Petros Arsenos MD PhD Ioannis Doundoulakis MD Dimitrios Tsiachris MD PhD Christos-Konstantinos Antoniou MD PhD Polychronis Dilaveris MD PhD Nikolaos Fragakis MD PhD Melani Sotiriadou MD Skevos Sideris MD PhD Athanasios Kordalis MD PhD Ageliki Laina MD Dimitrios Tousoulis MD PhD Konstantinos Tsioufis MD PhD Konstantinos A. Gatzoulis MD PhD 《Annals of noninvasive electrocardiology》2021,26(5):e12850
Syncope represents a relatively uncommon symptom of supraventricular tachycardia (SVT). It is likely that an impaired autonomic vasomotor response to the hemodynamic stress of tachycardia is the determinant of hemodynamic changes leading to cerebral hypoperfusion and syncope. In this regard, tilt-table test may detect abnormalities in the autonomic nervous function and predict the occurrence of syncope during SVT. Electrophysiology studies may reproduce the SVT, distinguish it from other life-threatening ventricular tachyarrhythmias, and exclude other causes of syncope. Not infrequently mixed syncope mechanisms are revealed during the above diagnostic workup raising doubts about the operating mechanism in the clinical setting. In such cases of uncertainty, an implantable loop recorder, providing long-term cardiac monitoring, may play a pivotal role in the establishment of the diagnosis, confirming the association of an arrhythmic event with the symptom. Herein, we present four such cases with recurrent unexplained syncope finally attributed to paroxysmal SVT guiding them to a potentially radical treatment through radiofrequency catheter ablation. 相似文献
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Petros Arsenos Konstantinos A Gatzoulis Dimitrios Tsiachris Polychronis Dilaveris Skevos Sideris Ilias Sotiropoulos Stefanos Archontakis Christos-Konstantinos Antoniou Athanasios Kordalis Ioannis Skiadas Konstantinos Toutouzas Charalambos Vlachopoulos Dimitrios Tousoulis Konstantinos Tsioufis 《World journal of cardiology》2022,14(3):139-151
Annual arrhythmic sudden cardiac death ranges from 0.6% to 4% in ischemic cardiomyopathy (ICM), 1% to 2% in non-ischemic cardiomyopathy (NICM), and 1% in hypertrophic cardiomyopathy (HCM). Towards a more effective arrhythmic risk stratification (ARS) we hereby present a two-step ARS with the usage of seven non-invasive risk factors: Late potentials presence (≥ 2/3 positive criteria), premature ventricular contractions (≥ 30/h), non-sustained ventricular tachycardia (≥ 1episode/24 h), abnormal heart rate turbulence (onset ≥ 0% and slope ≤ 2.5 ms) and reduced deceleration capacity (≤ 4.5 ms), abnormal T wave alternans (≥ 65μV), decreased heart rate variability (SDNN < 70ms), and prolonged QTc interval (> 440 ms in males and > 450 ms in females) which reflect the arrhythmogenic mechanisms for the selection of the intermediate arrhythmic risk patients in the first step. In the second step, these intermediate-risk patients undergo a programmed ventricular stimulation (PVS) for the detection of inducible, truly high-risk ICM and NICM patients, who will benefit from an implantable cardioverter defibrillator. For HCM patients, we also suggest the incorporation of the PVS either for the low HCM Risk-score patients or for the patients with one traditional risk factor in order to improve the inadequate sensitivity of the former and the low specificity of the latter. 相似文献
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Konstantinos Triantafyllou MD Nikolaos Fragakis MD PhD Konstantinos A. Gatzoulis MD PhD Antonios Antoniadis MD PhD Georgios Giannopoulos MD PhD Petros Arsenos MD PhD Dimitrios Tsiachris MD PhD Christos-Konstantinos Antoniou MD PhD Konstantinos Trachanas MD PhD Konstantinos Tsimos MD PhD Vassilios Vassilikos MD PhD 《Annals of noninvasive electrocardiology》2023,28(6):e13087
Background
Risk stratification for sudden cardiac death in post-myocardial infarction (post-MI) patients remains a challenging task. Several electrocardiographic noninvasive risk factors (NIRFs) have been associated with adverse outcomes and were used to refine risk assessment. This study aimed to evaluate the performance of NIRFs extracted from 45-min short resting Holter ECG recordings (SHR), in predicting ventricular tachycardia inducibility with programmed ventricular stimulation (PVS) in post-MI patients with preserved left ventricular ejection fraction (LVEF).Methods
We studied 99 post-MI ischemia-free patients (mean age: 60.5 ± 9.5 years, 86.9% men) with LVEF ≥40%, at least 40 days after revascularization. All the patients underwent PVS and a high-resolution SHR. The following parameters were evaluated: mean heart rate, ventricular arrhythmias (premature ventricular complexes, couplets, tachycardias), QTc duration, heart rate variability (HRV), deceleration capacity, heart rate turbulence, late potentials, and T-wave alternans.Results
PVS was positive in 24 patients (24.2%). HRV, assessed by the standard deviation of normal-to-normal R–R intervals (SDNN), was significantly decreased in the positive PVS group (42 ms vs. 51 ms, p = .039). SDNN values <50 ms were also associated with PVS inducibility (OR 3.081, p = .032 in univariate analysis, and 4.588, p = .013 in multivariate analysis). No significant differences were identified for the other NIRFs. The presence of diabetes, history of ST-elevation MI (STEMI) and LVEF <50% were also important predictors of positive PVS.Conclusions
HRV assessed from SHR, combined with other noninvasive clinical and echocardiographic variables (diabetes, STEMI history, LVEF), can provide an initial, practical, and rapid screening tool for arrhythmic risk assessment in post-MI patients with preserved LVEF. 相似文献
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