Papers by Georgios Efthimiadis
Left Atrium in Hypertrophic Cardiomyopathy: Time for Reconsideration of Its Clinical Importance?
The American Journal of Cardiology, 2007
Journal of the American College of Cardiology, 2010
Balloon valvuloplasty as destination therapy in elderly with severe aortic stenosis: a cardiac catheterization study
Journal of Geriatric Cardiology, May 12, 2015
In the current era of transcatheter aortic valve replacement, there is renewed interest in balloo... more In the current era of transcatheter aortic valve replacement, there is renewed interest in balloon aortic valvuloplasty (BAV) and invasive hemodynamic evaluation of aortic stenosis (AS). The current report aimed to study the invasive hemodynamics of severe AS patients treated with BAV as destination therapy and to identify factors associated with better hemodynamic outcome and prognosis. From 2009 to 2012, 63 high risk elderly patients were treated with BAV as destination therapy for symptomatic severe AS and were all prospectively included in the study. Their hemodynamics were invasively evaluated during catheterization, pre- and post-BAV at the same session. All Post-BAV patients were regularly followed-up. The patients (82 ± 6 years, 52% male) had post-BAV aortic valve area index (AVAi) significantly increased and mean pressure gradient (MPG) significantly reduced. During the follow-up of 0.9 (maximum 3.3) years, those with post-BAV AVAi < 0.6 cm(2)/m(2) compared with the AVAi ≥ 0.6 cm(2)/m(2) group had significantly higher mortality (60% vs. 28%, log-rank P = 0.02), even after adjusting for age, gender, atrial fibrillation, chronic kidney disease, diabetes mellitus, coronary artery disease and EuroSCORE [HR: 5.58, 95% confidence interval (CI): 1.62-19.20, P = 0.006]. The only independent predictor of moderate AS post-BAV was the pre-BAV AVAi increase by 0.1cm(2)/m(2) (OR: 3.81, 95% CI: 1.33-10.89, P = 0.01). Pre-BAV AVAi ≥ 0.39 cm(2)/m(2) could predict with sensitivity 84% and specificity 70% the post-BAV hemodynamic outcome. BAV as destination therapy for severe AS offered immediate and significant hemodynamic improvement. The survival was significantly better when a moderate degree of AS was present.
Cardiovascular Ultrasound
Background: Hypertrophic cardiomyopathy (HCM) is an extremely heterogeneous disease. An under rec... more Background: Hypertrophic cardiomyopathy (HCM) is an extremely heterogeneous disease. An under recognized and very often missed subgroup within this broad spectrum concerns patients with left ventricular (LV) apical aneurysms in the absence of coronary artery disease.
The Strain, the Valve, and the LVOT Obstruction
Journal of the American College of Cardiology, 2015
Implantation of cardioverter defibrillator in post-myocardial infarction patients: when and how?
European heart journal, 2007
... Myerburg RJ,; Priori SG,; Quinones MA,; Roden DM,; Silka MJ,; Tracy C,; Blanc JJ,; Budaj A,; ... more ... Myerburg RJ,; Priori SG,; Quinones MA,; Roden DM,; Silka MJ,; Tracy C,; Blanc JJ,; Budaj A,; Dean V,; Deckers JW,; Despres C,; Dickstein K,; Lekakis J,; McGregor K,; Metra M,; Morais J,; Osterspey A,; Tamargo JL,; Zamorano JL,; Smith ...
Mechanical aberrations in hypetrophic cardiomyopathy: emerging concepts
Frontiers in Physiology, 2015
Hypertrophic cardiomyopathy is the most common monogenic disorder in cardiology. Despite importan... more Hypertrophic cardiomyopathy is the most common monogenic disorder in cardiology. Despite important advances in understanding disease pathogenesis, it is not clear how flaws in individual sarcomere components are responsible for the observed phenotype. The aim of this article is to provide a brief interpretative analysis of some currently proposed pathophysiological mechanisms of hypertrophic cardiomyopathy, with a special emphasis on alterations in the cardiac mechanical properties.
Balloon valvuloplasty as destination therapy in elderly with severe aortic stenosis: a cardiac catheterization study
Journal of geriatric cardiology : JGC, 2015
In the current era of transcatheter aortic valve replacement, there is renewed interest in balloo... more In the current era of transcatheter aortic valve replacement, there is renewed interest in balloon aortic valvuloplasty (BAV) and invasive hemodynamic evaluation of aortic stenosis (AS). The current report aimed to study the invasive hemodynamics of severe AS patients treated with BAV as destination therapy and to identify factors associated with better hemodynamic outcome and prognosis. From 2009 to 2012, 63 high risk elderly patients were treated with BAV as destination therapy for symptomatic severe AS and were all prospectively included in the study. Their hemodynamics were invasively evaluated during catheterization, pre- and post-BAV at the same session. All Post-BAV patients were regularly followed-up. The patients (82 ± 6 years, 52% male) had post-BAV aortic valve area index (AVAi) significantly increased and mean pressure gradient (MPG) significantly reduced. During the follow-up of 0.9 (maximum 3.3) years, those with post-BAV AVAi < 0.6 cm(2)/m(2) compared with the AVAi...
Increased right atrial volume index predicts low duke activity status index in patients with chronic heart failure
Hellenic journal of cardiology: HJC = Hellēnikē kardiologikē epitheōrēsē
The aim of the present study was to examine the value of the right atrial volume index (RAVI) as ... more The aim of the present study was to examine the value of the right atrial volume index (RAVI) as predictor of functional capacity in patients with heart failure. A total of 51 patients with stable chronic heart failure of ischaemic or non-ischaemic aetiology were prospectively enrolled. The systolic function of the right ventricle was quantified using the tricuspid annular plane systolic excursion (TAPSE). Right atrial volume was measured in the apical 4-chamber view and was indexed to body surface area. The functional capacity was assessed by the Duke Activity Status Index (DASI). Patients with a low functional capacity (DASI<10) had lower TAPSE (1.4 ± 0.3 cm versus 2.0 ± 0.4 cm, p<0.001), higher RAVI (42 ± 15 ml/m(2) versus 22 ± 9 ml/m(2), p<0.001), higher estimated right ventricular systolic pressure (61 ± 13 mmHg versus 40 ± 16 mmHg, p<0.001), larger right ventricular end-diastolic diameter (4.7 ± 0.8 cm versus 3.6 ± 0.7 cm, p<0.001) and lower left ventricular eje...
European Journal of Heart Failure Supplements, 2008
Swiss medical weekly, Jan 31, 2008
Hellenic journal of cardiology : HJC = Hellēnikē kardiologikē epitheōrēsē
There are limited reports in the literature concerning right ventricular (RV) performance in pati... more There are limited reports in the literature concerning right ventricular (RV) performance in patients with non end-stage idiopathic pulmonary fibrosis (IPF) who exhibit mild to moderate pulmonary hypertension (PH). We evaluated RV functional impairment in such a cohort using both conventional echocardiography and tissue Doppler imaging (TDI) and in addition we assessed the association of specific TDI indices with survival. Twenty-two clinically stable patients with non-end stage IPF and mild to moderate PH were assessed. Twenty-two healthy individuals served as controls. We evaluated RV systolic and diastolic function and further estimated peak pulmonary artery systolic pressure (PASP). In addition, by combining TDI and Doppler echocardiography, we calculated the ratio of trans-tricuspid E-wave velocity to early diastolic tricuspid annulus velocity (RV E/Em). Patients were followed for a median period of 22 months and the incidence of death was recorded. Both echocardiographic modal...
Perspectives on sudden death prevention in hypertrophic cardiomyopathy
Cardiology in review
Sudden death (SD) is the most dramatic event in hypertrophic cardiomyopathy (HCM), often represen... more Sudden death (SD) is the most dramatic event in hypertrophic cardiomyopathy (HCM), often representing the first clinical manifestation of the disease, and the first concern of the clinicians who take care of such patients. HCM is now recognized as the primary cause of SD in young persons (<35 years of age), including trained athletes. Current data in unselected HCM patient populations report an approximate 0.7% per year incidence of SD, with the total cardiovascular mortality being around 1.4% annually. This review, incorporating contemporary research findings, addresses the major aspects of SD and its prevention in HCM. The traditional risk factors and other controversial risk factors for SD or the arbitrators for that event are thoroughly analyzed and the need for the development of a unique and accurate factor for SD risk stratification is discussed. Rather than enumerating clinical studies and guidelines, challenging problems concerning all aspects of SD in HCM, are criticall...
Hypertrophic cardiomyopathy in 2013: Current speculations and future perspectives
World journal of cardiology, Jan 26, 2014
Hypertrophic cardiomyopathy (HCM), the most variable cardiac disease in terms of phenotypic prese... more Hypertrophic cardiomyopathy (HCM), the most variable cardiac disease in terms of phenotypic presentation and clinical outcome, represents the most common inherited cardiomyopathic process with an autosomal dominant trait of inheritance. To date, more than 1400 mutations of myofilament proteins associated with the disease have been identified, most of them "private" ones. This striking allelic and locus heterogeneity of the disease certainly complicates the establishment of phenotype-genotype correlations. Additionally, topics pertaining to patients' everyday lives, such as sudden cardiac death (SCD) risk stratification and prevention, along with disease prognosis, are grossly related to the genetic variation of HCM. This review incorporates contemporary research findings and addresses major aspects of HCM, including preclinical diagnosis, genetic analysis, left ventricular outflow tract obstruction and SCD. More specifically, the spectrum of genetic analysis, the selec...
Hypertrophic cardiomyopathy with late enhancement of the non-hypertrophied left ventricular segments
Hellenic journal of cardiology : HJC = Hellēnikē kardiologikē epitheōrēsē
A 56-year-old asymptomatic man was referred for further evaluation because he displayed a rapid T... more A 56-year-old asymptomatic man was referred for further evaluation because he displayed a rapid T-wave change on the ECG, from positive T waves to giant negative T waves in the anterolateral precordial leads, within 2 years. Transthoracic echocardiography revealed mild left ventricular apical hypertrophy without obstruction. Cardiac magnetic resonance imaging showed apical hypertrophic cardiomyopathy with focal hyperenhancement of the non-hypertrophic basal lateral segment of the left ventricle and absence of hyperenhancement of the hypertrophied apical segments.
Hypertrophic cardiomyopathy with systolic anterior motion of the posterior mitral leaflet
Anadolu kardiyoloji dergisi : AKD = the Anatolian journal of cardiology, 2007
Doppler echocardiographic evaluation of right ventricular diastolic function in patients with mitral regurgitation
The Journal of heart valve disease, 2004
The effect of left ventricular (LV) pressure overload on right ventricular (RV) diastolic functio... more The effect of left ventricular (LV) pressure overload on right ventricular (RV) diastolic function has been extensively studied. In contrast, no data are available concerning the influence of LV volume overload on RV diastolic function. Accordingly, RV diastolic function was studied in patients with mitral regurgitation (MR) using Doppler echocardiography. RV diastolic indices were calculated, using pulsed Doppler echocardiography, in 30 patients (mean age 56.87 +/- 8.58 years) with severe MR, and in 30 healthy control subjects (mean age 56.67 +/- 8.52 years). Compared with controls, MR patients had a significantly lower RV E/A ratio (0.85 +/- 0.12 versus 1.21 +/- 0.16, p <0.001), a significantly prolonged RV isovolumic relaxation time (70 +/- 20 versus 30 +/- 10 ms, p <0.001), a significantly prolonged deceleration time of the transtricuspid E wave (210 +/- 20 versus 140 +/- 10 ms, p <0.001), and a significantly greater right atrial filling fraction (38.58 +/- 4.59 versus ...
Preparticipation cardiovascular screening in competitive athletes: the case in a Greek population
Scandinavian Journal of Medicine & Science in Sports, 2009
Feasibility and Significance of Preclinical Diagnosis in Hypertrophic Cardiomyopathy
Cardiology in review, Jan 26, 2014
Preclinical diagnosis in hypertrophic cardiomyopathy (HCM) refers to the detection of functional ... more Preclinical diagnosis in hypertrophic cardiomyopathy (HCM) refers to the detection of functional or histopathological abnormalities in subjects who carry any HCM-causing gene mutation, before or even without the development of left ventricular hypertrophy [genotype(+) /phenotype(-) subjects]. The concept that HCM pathology, may exist in the absence of left ventricular hypertrophy is quite old but the ability to recognize the presence of early myocardial changes is quite new. Lessons from animal models have shown that in experimental human HCM, myocardial cell mechanical dysfunction precedes histopathological changes, such as myocyte disarray, fibrosis and hypertrophy. Several clinical reports have demonstrated that the majority of HCM genotype(+) /phenotype (-) subjects display myocardial functional or histopathological changes, such as reduced Tissue Doppler Imaging-derived systolic and diastolic velocities, abnormal ECG, cardiac magnetic resonance (CMR)-visualized myocardial crypt...
Embolization after percutaneous coronary intervention in acute coronary syndrome
Herz, 2014
The aim of this study was to assess the occurrence of distal embolization and to quantify the amo... more The aim of this study was to assess the occurrence of distal embolization and to quantify the amount of embolic material captured during stent implantation in native coronary arteries, as compared with saphenous vein grafts (SVG) in patients at different time periods after an acute coronary syndrome. In all, 104 patients presenting with unstable or stable angina underwent percutaneous coronary intervention (PCI) in 107 vessels and stent implantation in 112 lesions, 53 % of which were in SVG. Device deployment and retrieval was successful in 111 lesions. Embolic material was detected in 74 % of the protection devices. Early PCI, during a 2-week period after the last ischemic episode, was associated with larger embolic load, especially in the right coronary artery. The length of the lesion was the only preprocedural independent variable that was found to be a significant predictor for the presence of emboli (p = 0.002). The stent diameter and the maximum dilatation pressure were the two procedural variables found to be significant predictors for the presence of emboli (p = 0.025 and p = 0.008, respectively). The irregularity of the lesion and the number of stents deployed were found to have a predictive correlation to the total area of the embolic particles (p = 0.04 and p = 0.005, respectively). Distal embolization of atherosclerotic debris is a frequent phenomenon after PCI not only in SVG but also in native vessels. The amount of embolic material seems to be related to the atherosclerotic burden of the vessel and to the early timing of the procedure as related to acute coronary syndrome.
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Papers by Georgios Efthimiadis