Papers by Stavroula Psychari
European Heart Journal, 2017
Journal of Atrial Fibrillation, Apr 1, 2018
Background: Permanent pacemaker implantation is accompanied by minor myocardial damage, indicated... more Background: Permanent pacemaker implantation is accompanied by minor myocardial damage, indicated by elevated serum levels of cardiac biomarkers. Aim of this prospective study was to comparably investigate the lead fixation type effect on the extent of myocardial injury and inflammation following pacemaker implantation, and to assess the possible clinical implications. Methods: Cardiac troponin I (cTnI) and C-reactive protein (CRP) were measured at baseline, 6 and 24h after implantation in 101 patients, categorized into the active and passive lead fixation group. Patients were followed up for clinical adverse events or abnormal pacing parameters at 24h, 7 and 30 days post-procedure. Results: cTnI increased at 6h post-procedure (p<0.05) in 23.8% of patients, and returned to baseline after 24h. The passive group demonstrated significantly higher cTnI at 6h compared to the active group (p=0.006). CRP increased significantly at 6h, and maintained an upward trend after 24h (p<0.01) in both groups. The active group demonstrated significantly higher CRP at 6h compared to the passive group. We did not identify an association of positive biomarkers with adverse events. Conclusions: cTnI and CRP can increase early after permanent pacemaker implantation, indicating mechanical myocardial injury and inflammation. The extent of these biomarkers elevation depends on the lead fixation type, and is not related to worse short-term prognosis.
Heart, 2002
Objective: To test whether type II diabetes prevents the recruitment of collaterals and the norma... more Objective: To test whether type II diabetes prevents the recruitment of collaterals and the normal reduction of myocardial ischaemia on repeated balloon inflations during coronary angioplasty. Methods: Two groups of patients were studied. A collateral circulation group consisted of 56 patients, 18 diabetic and 38 non-diabetic. All underwent a minimum of three balloon inflations. A pressure guide wire was used for the measurement of coronary wedge pressure (mm Hg). The angioplasty protocol was repeated in another group of 57 patients (myocardial ischaemia group) using both surface and intracoronary ECGs to assess myocardial ischaemia. Results: In diabetic patients, mean (SD) coronary wedge pressure was 35 (12) mm Hg during the first balloon inflation, 39 (15) mm Hg during the second (p < 0.05 v first inflation), and 42 (17) mm Hg during the third (p < 0.05 v first inflation); in non-diabetic patients the respective values were 36 (16), 37 (16), and 37 (16) mm Hg (F = 4.73, p = 0.01). The ratio of coronary wedge pressure to mean arterial pressure in diabetic patients in the three balloon inflations was 0.33 (0.11), 0.36 (0.13), and 0.39 (0.15), respectively (p < 0.05 v the first inflation); and in non-diabetic patients it was 0.33 (0.15), 0.34 (0.15), and 0.35 (0.15) (F = 1.92, p = 0.15). In the diabetic group the response was independent of the type of treatment. No difference between diabetic and non-diabetic patients was observed in the normal reduction of myocardial ischaemia on repeated balloon inflations. Conclusions: Type II diabetes does not prevent the recruitment of collateral vessels and the normal reduction of myocardial ischaemia on repeated balloon inflations during coronary angioplasty in single vessel disease, regardless of the type of antidiabetic treatment.
EP Europace, 2017
We occasionally encounter the 'is atrial fibrillation the cause or result of LV-dysfunction?' que... more We occasionally encounter the 'is atrial fibrillation the cause or result of LV-dysfunction?' question. Patients with pre-existing LV-dysfunction are likely to have AF. Conversely, even in subjects without LV-dysfunction, AF can induce a specific pathological condition in which AF persists and thereafter causes LV-dysfunction, leading to heart failure. This pathological condition is called as AF-induced cardiomyopathy (AIC). AIC could be reversed by maintaining sinus rhythm. However, whether the reversal would be partial or complete depends on the interval from AF onset. Consequently, understanding whether AF is cause or result is essential in determining the treatment strategy for AF patients with LV-dysfunction. Cardiac MRI has helped in identifying and characterizing the presence and the location of myocardial damage in diagnostic workup of patients with LV dysfunction of unknown cause. Hence, we investigated whether cardiac MRI allowed the differentiation of AIC from LV dysfunction pre-existing before AF initiation (Non-AIC). AIC is defined as a LV-dysfunction that has no specific findings from myocardial biopsy and might be improved by 50% or more in LV ejection fraction on the cardiac echocardiography by maintaining sinus rhythm. Non-AIC is a LV dysfunction pre-existing before AF initiation. Echocardiography was performed for both conditions before the MRI study. Cardiac MRI evaluated the late gadolinium enhancement (LGE) as the following: the number of LGE; segmental site of the LGE in the heart wall; the distribution pattern. Cardiac MRI study was performed on 355 cases in our hospital from March 2011, to December 2016. AIC corresponded in 16 cases, and Non-AIC, in15 cases. LV ejection fraction on the echocardiography was not significantly different between AIC and Non-AIC before the MRI study. In AIC, the LV ejection fraction significantly improved from 35.2610.3% to 58.966.1% (p<0.01) 6 months after sinus rhythm maintenance. In the MRI study, AIC had less the number of LGE (median, 1: 0, 2/16 (12.5%); 1, 11/16 (68.6%); 2, 3/16 (18.8%) than Non-AIC did (median, 2: 0, 2/15 (13.3%); 1, 1/15 (6.7%); 2, 6/15 (40%); 3, 4/15 (26.7%); 4, 1/15 (6.7%); 5, 1/15 (6.7%))(p<0.01).
EP Europace, 2017
We aimed to investigate the levels of circulating adiponectin and of the inflammatory markers hig... more We aimed to investigate the levels of circulating adiponectin and of the inflammatory markers high sensitivity C-reactive protein and interleukin-6 in AF and controls, and their possible relations to EAT thickness. Methods: We studied prospectively 103 patients with AF, divided into 2 subgroups, of paroxysmal and permanent AF and 81 controls, in sinus rhythm. EAT and left atrial size were assessed by echocardiography. Quantitative immunoassay techniques with use of specific monoclonal antibody for serum adiponectin were used for evaluation of adiponectin and inflammatory biomarkers. Biochemical and echocardiographic characteristics of the study patients are presented in Table 1. Results: Levels of circulating adiponectin, high sensitivity C-reactive protein and interleukin-6 were significantly increased in AF groups compared to controls (p<0.01). Adiponectin was inversely related to EAT size (R¼0.2, p¼0.003). All inflammatory markers were positively related to left atrial volume (R¼0.5, p<0.0001 for interleukin, R¼0.2, p¼0.02 for high sensitivity-C reactive protein, and R¼0.2, p¼0.003 for adiponectin respectively). Conclusion: Increased adiponectin levels in AF may reflect disconnection of the hormone from its receptors, or alternatively a reactive increase to the arrhythmia process. The inverse relation of elevated adiponectin to EAT and the direct association of inflammatory markers to left atrial size suggest a role of epicardial fat and inflammation in the remodeling process.
Nonalcoholic fatty liver disease (NAFLD) is closely related to insulin resistance and the metabol... more Nonalcoholic fatty liver disease (NAFLD) is closely related to insulin resistance and the metabolic syndrome and might be an important cardiovascular (CV) risk factor. Epicardial adipose tissue (EAT) has been implicated in the pathogenesis of obesity-related CV disease. In an NAFLD population, we investigated EAT thickness and its possible relations to NAFLD and cardiac structure and function. This was an observational study of 57 patients with NAFLD and 48 age-matched controls. Patients with NAFLD had significantly higher body mass index (P <.0001), waist circumference (P <.0001), and high-sensitivity C-reactive protein (P .005), whereas high-density lipoprotein cholesterol (P .01) and adiponectin (P .005) levels were significantly lower. The EAT was not thicker in NAFLD but was positively related to indices of impaired glucose tolerance and inflammation, with diabetes being an independent predictor of EAT thickness (b * 0.29, P .04). No relations were found between EAT and c...
Aims: We investigated the role of high-sensitivity C-reactive protein (hsCRP), interleukin 6 (IL-... more Aims: We investigated the role of high-sensitivity C-reactive protein (hsCRP), interleukin 6 (IL-6), and N-terminal pro-brain natriuretic peptide (NTpro-BNP), in atrial fibrillation (AF) recurrence rate. Methods: A total of 80 patients with first AF episode were studied prospectively. Echocardiography (ECG), Holter ECG, and measurements of hsCRP, IL-6, and NTpro-BNP were performed immediately post conversion and at 1 month. Results: Recurrence was positively related to left atrial volume (P <.001), with no difference in NTpro-BNP, hsCRP, and IL-6. Decreased NTpro-BNP was observed in all at 1 month (P <.001, F 63.4) and was positively related to left atrial volume (P <.01). In the lone AF subgroup, NTpro-BNP was lower and dropped significantly at 1 month (interaction F 6.53, P <.01). Conclusions: Atrial volume was related to AF recurrence, whereas hsCRP, IL-6, and NTpro-BNP were not reliable for AF relapse. Relation of NTpro-BNP to left atrial volume could indicate a role...
Hellenic Journal of Cardiology, 2019
The American Journal of Cardiology, 1998
European Heart Journal, 2003
A 61year old man on chronic aspirin treatment with unstable angina was admitted to our hospital t... more A 61year old man on chronic aspirin treatment with unstable angina was admitted to our hospital to undergo programmed percutaneous coronary artery angioplasty. A balloon angioplasty (with a 3.5 mm diameter balloon) to a type B lesion in the proximal LAD was performed, and a stent (4.0 x 16mm stent) was implanted because of a dissection producing acute vessel occlusion. During the procedure 5000 IU of heparin was administered as a bolus. However, after the stent placement, haziness and a slow flow distally to the lesion was observed, TIMI scale 1 to 2, suggestive of coronary thrombus, and a bolus of 0.25 mg/kg body weight of the glycoprotein IIb/IIIa antagonist abciximab was given followed by infusion of 10 Ìg/min. Unfortunately, a short time later the chest pain recurred with concomitant ST elevation in all precordial leads. An anteriorlateral myocardial infarction evolved, and at that time thrombolytic treatment with a total of 10 U of reteplase was administered intravenously. Rete...
Hellenic journal of cardiology : HJC = Hellenike kardiologike epitheorese, 2005
We describe the case of a 57-year-old man with a mechanical aortic valve who had discontinued ora... more We describe the case of a 57-year-old man with a mechanical aortic valve who had discontinued oral anticoagulants for a long period and presented with symptoms of severe congestive heart failure, including pulmonary oedema and hypotension. Clinical and echocardiographic examination revealed a large thrombus obstructing the prosthetic valve. Since his critical clinical condition was not improved by heparin treatment we decided to administer intravenous fibrinolysis with 100 mg rtPA. Fibrinolytic treatment was entirely successful, with complete thrombus dissolution and restoration of clinical status. Thrombosis of mechanical prosthetic valves is a particularly serious complication with a high mortality rate. Early diagnosis and treatment are of paramount importance for these patients. Although surgical intervention is the suggested treatment in many series, fibrinolytic therapy offers a good alternative with a high success rate, especially in the critically ill patient where surgery c...
INTRODUCTION Inflammation has a major role in atherosclerosis and the acute phase C-reactive prot... more INTRODUCTION Inflammation has a major role in atherosclerosis and the acute phase C-reactive protein (CRP) is elevated after acute myocardial infarction. Inflammation is also implicated in autonomic nervous system control. Heart rate variability (HRV) has been used as a marker of abnormal autonomic activity after myocardial infarction. Our purpose was to investigate the relation between CRP levels and autonomic tone in patients after acute ST-segment elevation myocardial infarction. METHODS We studied prospectively 98 patients. CRP and the cardiac enzymes CK, CK-MB, and troponin-I were measured for a total of 72 hours and 24-hour Holter ECG recordings for HRV analysis were acquired before hospital discharge. RESULTS The natural logarithm of CRP levels was inversely correlated with the following logarithmic transformed indices of HRV in the time and in the frequency domain: SDNN, standard deviation of all normal R-R intervals, (r = -0.40, p < 0.001); SDANN index, standard deviatio...
Hellenic journal of cardiology : HJC = Hellenike kardiologike epitheorese, 2011
Optical coherence tomography (OCT) is an optical analogue of intravascular ultrasound that has re... more Optical coherence tomography (OCT) is an optical analogue of intravascular ultrasound that has recently been proposed as a high-resolution imaging method for plaque characterization. Histology-controlled studies have shown that OCT can evaluate the characteristics of culprit lesions, such as fibrous cap thickness, fibrous cap macrophage density, lipid core and intracoronary thrombus. We describe a case where OCT was used to evaluate the culprit lesion morphology in a patient with acute myocardial infarction. The patient was treated with stent implantation. OCT was also used to confirm good stent apposition.
SAGE Open Medicine
Objectives: Atrial fibrillation has been associated with obesity in epidemiological studies. Epic... more Objectives: Atrial fibrillation has been associated with obesity in epidemiological studies. Epicardial adipose tissue is an ectopic fat depot in the proximity of atria, with endocrine and inflammatory properties that is implicated in the pathophysiology of atrial fibrillation. Inflammation also has a role in atrial arrhythmogenesis. The aim of this study was to investigate the potential relations of epicardial adipose tissue to left atrial size and to adiponectin and the pro-inflammatory mediators, high-sensitivity C-reactive protein, and interleukin-6 in paroxysmal and permanent atrial fibrillation. Methods: This was a cross-sectional study of 103 atrial fibrillation patients, divided into two subgroups of paroxysmal and permanent atrial fibrillation, and 81 controls, in sinus rhythm. Echocardiography was used for estimation of epicardial adipose tissue and left atrial size and high-sensitivity C-reactive protein, interleukin-6 and adiponectin were measured in all subjects. Result...
Hellenic Journal of Cardiology Hjc Hellēnikē Kardiologikē Epitheōrēsē, 2011
Optical coherence tomography (OCT) is an optical analogue of intravascular ultrasound that has re... more Optical coherence tomography (OCT) is an optical analogue of intravascular ultrasound that has recently been proposed as a high-resolution imaging method for plaque characterization. Histology-controlled studies have shown that OCT can evaluate the characteristics of culprit lesions, such as fibrous cap thickness, fibrous cap macrophage density, lipid core and intracoronary thrombus. We describe a case where OCT was used to evaluate the culprit lesion morphology in a patient with acute myocardial infarction. The patient was treated with stent implantation. OCT was also used to confirm good stent apposition.
Chest Journal, Apr 1, 2002
Controversy exists regarding inhibition of ischemic preconditioning in hyperlipidemic animals. In... more Controversy exists regarding inhibition of ischemic preconditioning in hyperlipidemic animals. In this study, we tested the hypothesis that hyperlipidemia inhibits the normal reduction of myocardial ischemia on repeated balloon inflations (BIs) during angioplasty. We studied 33 patients undergoing coronary angioplasty. All underwent a minimum of three BIs. Patients were grouped according to the following plasma cholesterol levels: 13 patients had total cholesterol levels &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 200 mg/dL (the normal cholesterol group); and 20 patients had total cholesterol levels &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; or = 200 mg/dL (the elevated cholesterol group). Surface ST-segment elevations were recorded at the end of each BI. In the normal cholesterol group, the mean (+/- SD) ST-segment elevation decreased from 0.21 +/- 0.15 mV during the first BI to 0.11 +/- 0.11 mV during the third BI (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05). In the elevated cholesterol group, the respective decrease was from 0.18 +/- 0.16 to 0.14 +/- 0.15 mV (p = not significant) [between-group comparisons: F = 3.97; p = 0.02]. The decrease in ST-segment elevation was correlated with the total cholesterol levels (r = -0.48; p = 0.005), the low-density lipoprotein (LDL) cholesterol levels (r = -0.50; p = 0.003), and the high-density lipoprotein/LDL levels (r = 0.44; p = 0.01). Hyperlipidemia prevents the normal reduction of myocardial ischemia on repeated BIs during angioplasty. This leads to the clinical implication that reduction of cholesterol plasma levels, apart from its other known benefits, could also have a beneficial effect on cardioprotection.
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Papers by Stavroula Psychari