Hippokration Hospital

Thessaloníki, Greece

Hippokration Hospital

Thessaloníki, Greece
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Antonopoulos A.S.,Hippokration Hospital | Antonopoulos A.S.,University of Oxford | Tousoulis D.,Hippokration Hospital
Cardiovascular Research | Year: 2017

Clinical observations suggest a complex relationship between human obesity and cardiovascular disease. Whilst abdominal (visceral) adiposity leads to deleterious metabolic disturbances, subcutaneous fat accumulation has a benign effect on cardiometabolic risk. Notably, an accumulating body of evidence paradoxically links increased body mass index with a better prognosis in patients with established cardiovascular disease, a finding that has been termed the 'obesity paradox'. Whilst this is now acknowledged to be an epidemiological finding, a metabolically healthy obese group associated with low cardiovascular risk has also been identified. The current concept of adipose tissue (AT) biology suggests that AT expansion is feasible without accompanying adipocyte dysfunction. A metabolically healthy obese phenotype can be promoted by exercise, but is also linked with intrinsic AT molecular characteristics such as efficient fat storage and lipid droplet formation, high adipogenesis capacity, low extracellular matrix fibrosis, angiogenesis potential, adipocyte browning and low macrophages infiltration/activation. Such features are associated with a secretomic profile of human AT which is protective for the cardiovascular system. In the present review, we summarize the existing knowledge on the molecular mechanisms underlying the 'obesity paradox' and whether fatness can be healthy too. © The Author 2017.

Drakopoulou M.,Hippokration Hospital
Current pharmaceutical design | Year: 2011

Although enormous progress has been made in the prevention and treatment of cardiovascular disease, it still remains the leading cause of death worldwide. During the last decades, advances in the understanding of the pathophysiology of vulnerable plaque progression, coupled with novel diagnostic and therapeutic approaches, created a new opportunity for progress against cardiovascular disease. It has been demonstrated that inflammation, implicated in all stages of atherosclerosis, is an integral part of vulnerable plaque development and progression, leading eventually to plaque instability. Thus, new diagnostic modalities have been proposed for the detection of local plaque inflammation. Moreover, treatments such as stenting, photodynamic therapy, and novel pharmaceutical agents are under consideration as methods to stabilize the vulnerable plaques by inhibiting inflammation. This review provides an overview of the inflammatory process leading to atherosclerotic cardiovascular disease and the potential clinical strategies that may substantially decrease the incidence of events. We will mention the major impact of local and systemic inflammation on plaque advancing and destabilization, the imaging techniques for early detection of vulnerable plaques and the potential therapeutic strategies.

Aznaouridis K.,Hippokration Hospital | Vlachopoulos C.,Hippokration Hospital | Protogerou A.,Laiko Hospital | Stefanadis C.,Hippokration Hospital
Stroke | Year: 2012

BACKGROUND AND PURPOSE-: Blood pressure variables derived by ambulatory monitoring are important prognostic markers in hypertensive patients. Recent studies showed that ambulatory systolic-diastolic pressure regression index (ASDPRI), also known as ambulatory arterial stiffness index, may correlate with cardiovascular (CV) outcomes. METHODS-: We explored the predictive value of ASDPRI for future CV events, stroke, and all-cause mortality by meta-analyses of 7 longitudinal studies that had evaluated ASDPRI and had followed 20 505 subjects for a mean follow-up of 7.8 years. RESULTS-: The pooled relative risk of total CV events (including CV mortality), stroke, and all-cause mortality was 1.51 (95% CI, 1.18-1.93; P=0.001; 5 studies), 2.01 (95% CI, 1.60-2.52; P<0.001; 4 studies), and 1.25 (95% CI, 1.10-1.41; P=0.001; 4 studies), respectively, for high ASDPRI versus low ASDPRI subjects. An increase of ASDPRI by 1 standard deviation was associated with an age-adjusted, sex-adjusted, and risk factor-adjusted relative risk increase of total CV events and stroke by 15% and 30%, respectively. ASDPRI predicted stroke better than total CV events, predicted stroke better in normotensive subjects than in hypertensive patients, and also predicted total CV events better in females than in males. There was not significant publication bias. CONCLUSIONS-: ASDPRI is an ambulatory blood pressure-derived biomarker that strongly predicts future CV events, stroke, and all-cause mortality. These findings suggest that this index may be useful for risk stratification purposes. © 2012 American Heart Association, Inc.

Manolis A.,Asclepeion General Hospital | Doumas M.,Aristotle University of Thessaloniki | Doumas M.,Hippokration Hospital
Current Hypertension Reports | Year: 2012

Sexual dysfunction is frequently encountered in hypertensive patients. Available data indicates that sexual dysfunction is more frequent in treated than in untreated patients, generating the hypothesis that antihypertensive therapy might be associated with sexual dysfunction. Several lines of evidence suggest that differences between antihypertensive drugs exist regarding their effects on sexual function. Older antihypertensive drugs (diuretics, beta blockers) exert detrimental effects on erectile function whereas newer drugs (nebivolol, angiotensin receptor blockers) have neutral or even beneficial effects. Phosphodiesterase (PDE)-5 inhibitors are effective in hypertensive patients and can be safely administered even when multidrug regimes are used. Precautions need to be taken with alpha blockers or patients with uncontrolled high-risk hypertension, while co-administration with nitrates is contraindicated. © Springer Science+Business Media, LLC 2012.

Dotis J.,Hippokration Hospital | Roilides E.,Aristotle University of Thessaloniki
Mycoses | Year: 2011

Chronic granulomatous disease (CGD) is a rare inherited disorder characterised by inability of phagocytes to kill catalase-positive organisms including certain fungi. Aspergillus species are the most frequent fungal pathogens. This study is a systematic review of the reported cases of osteomyelitis due to Aspergillus species in CGD patients. Retrospective analysis of 46 osteomyelitis cases caused by Aspergillus species in 43 CGD patients (three females) published in the English literature (PubMed) was performed. Twenty-three cases were due to Aspergillus fumigatus (50%), 20 to Aspergillus nidulans (43.5%), one to Aspergillus flavus and two to unspecified Aspergillus species. The median age was 8years (range 1.5-21). Osteomyelitis due to A. nidulans was associated with pulmonary infection and involved 'small bones' more frequently than A. fumigatus osteomyelitis (P=0.001). Amphotericin B was used in 91.3% and surgical debridement in 67.4% of all cases. The overall mortality of osteomyelitis due to Aspergillus species in CGD patients was 37%; 55% for A. nidulans compared to 13% for A. fumigatus (P=0.008). Aspergillus fumigatus causes osteomyelitis in CGD patients almost as frequently as A. nidulans and much more frequently than A. flavus. Osteomyelitis due to A. nidulans is associated with higher mortality than A. fumigatus. © 2011 Blackwell Verlag GmbH.

Tziomalos K.,Aristotle University of Thessaloniki | Perifanis V.,Hippokration Hospital
World Journal of Gastroenterology | Year: 2010

Accurate evaluation of iron overload is necessary to establish the diagnosis of hemochromatosis and guide chelation treatment in transfusion-dependent anemia. The liver is the primary site for iron storage in patients with hemochromatosis or transfusion-dependent anemia, therefore, liver iron concentration (LIC) accurately reflects total body iron stores. In the past 20 years, magnetic resonance imaging (MRI) has emerged as a promising method for measuring LIC in a variety of diseases. We review the potential role of MRI in LIC determination in the most important disorders that are characterized by iron overload, that is, thalassemia major, other hemoglobinopathies, acquired anemia, and hemochromatosis. Most studies have been performed in thalassemia major and MRI is currently a widely accepted method for guiding chelation treatment in these patients. However, the lack of correlation between liver and cardiac iron stores suggests that both organs should be evaluated with MRI, since cardiac disease is the leading cause of death in this population. It is also unclear which MRI method is the most accurate since there are no large studies that have directly compared the different available techniques. The role of MRI in the era of genetic diagnosis of hemochromatosis is also debated, whereas data on the accuracy of the method in other hematological and liver diseases are rather limited. However, MRI is a fast, non-invasive and relatively accurate diagnostic tool for assessing LIC, and its use is expected to increase as the role of iron in the pathogenesis of liver disease becomes clearer. © 2010 Baishideng.

Ioakeimidis N.,Hippokration Hospital | Kostis J.B.,Cardiovascular Institute
Journal of Cardiovascular Pharmacology and Therapeutics | Year: 2014

Phosphodiesterase (PDE) enzymes are widely distributed throughout the body, having numerous effects and functions. The PDE type 5 (PDE5) inhibitors are widely used to treat erectile dysfunction (ED). Recent, intense preclinical and clinical research with PDE5 inhibitors has shed light on new mechanisms and has revealed a number of pleiotropic effects on the cardiovascular (CV) system. To date, PDE5 inhibition has been shown to be effective for the treatment of idiopathic pulmonary arterial hypertension, and both sildenafil and tadalafil are approved for this indication. However, current or future PDE5 inhibitors have the potential of becoming clinically useful in a variety of CV conditions such as heart failure, coronary artery disease, and hypertension. The present review discusses recent findings regarding pharmacologic treatment of ED and its interaction with the CV system and highlights current and future clinical applications beyond ED.

Vlachopoulos C.,Hippokration Hospital | Aznaouridis K.,Hippokration Hospital | O'Rourke M.F.,Victor Chang Cardiac Research Institute | Safar M.E.,Diagnosis and Therapeutic Center | And 2 more authors.
European Heart Journal | Year: 2010

Aims To calculate robust quantitative estimates on the predictive value of central pressures and derived central haemodynamic indices for cardiovascular (CV) outcomes and all-cause mortality by meta-analysis of longitudinal studies. Methods and resultsWe meta-analysed 11 longitudinal studies that had employed measures of central haemodynamics and had followed 5648 subjects for a mean follow-up of 45 months. The age-and risk-factor-adjusted pooled relative risk (RR) of total CV events was 1.088 (95 CI 1.040-1.139) for a 10 mmHg increase of central systolic pressure, 1.137 (95 CI 1.063-1.215) for a 10 mmHg increase of central pulse pressure (PP), and 1.318 (95 CI 1.093-1.588) for a 10 absolute increase of central augmentation index (AIx). Furthermore, we found that a 10 increase of central AIx was associated with a RR of 1.384 (95 CI 1.192-1.606) for all-cause mortality. When compared with brachial PP, central PP was associated with marginally but not significantly higher RR of clinical events (P = 0.057). Conclusion Central haemodynamic indexes are independent predictors of future CV events and all-cause mortality. Augmentation index predicts clinical events independently of peripheral pressures, while central PP has a marginally but not significantly (P = 0.057) better predictive ability when compared with peripheral PP. Published on behalf of the European Society of Cardiology. © 2010 The Author.

Vlachopoulos C.,Hippokration Hospital | Aznaouridis K.,Hippokration Hospital | Terentes-Printzios D.,Hippokration Hospital | Ioakeimidis N.,Hippokration Hospital | Stefanadis C.,Hippokration Hospital
Hypertension | Year: 2012

Brachial-Ankle elasticity index (baEI; also known as brachial-Ankle pulse wave velocity) has been proposed as a surrogate end point for cardiovascular disease. We performed a meta-Analysis of longitudinal cohort studies for determining the ability of baEI to predict risk of cardiovascular events and all-cause mortality and dissecting factors influencing this predictive ability. Multiple online databases, reference lists from retrieved articles, and abstracts from international cardiovascular conventions were searched until April 2012. Longitudinal cohort studies that reported associations of baEI with clinical risk were included. Of the 18 studies included (8169 participants; mean follow-up, 3.6 years), 15 reported results on total cardiovascular events (5544 individuals), 7 on cardiovascular mortality (2274 individuals), and 9 on all-cause mortality (5097 individuals). The pooled relative risks for total cardiovascular events, cardiovascular mortality, and all-cause mortality were 2.95 (95% CI, 1.63-5.33), 5.36 (95% CI, 2.17-13.27), and 2.45 (95% CI, 1.56-3.86), respectively, for subjects with high versus low baEI (all P<0.001). An increase in baEI by 1 m/s corresponded with an increase of 12%, 13%, and 6% in total cardiovascular events, cardiovascular mortality, and all-cause mortality, respectively. We conclude that baEI is associated with increased risk of total cardiovascular events and all-cause mortality. Issues such as expansion of data to non-Asian populations, validation of path length estimation, determination of reference values, and prospective comparison with carotid-femoral pulse wave velocity remain to be resolved. © 2012 American Heart Association, Inc.

Toutouzas K.,Hippokration Hospital
The Journal of invasive cardiology | Year: 2012

We report the case of a patient presenting with unstable angina, in whom information obtained by coronary angiography was inconclusive for the existence of a culprit lesion in the ostium of the right coronary artery. The use of optical coherence tomography was required for proper lesion assessment.

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