Rhythmos (E-Journal - First Department of Cardiology / Evagelismos General Hospital of Athens)
Not a member yet
289 research outputs found
Sort by
Vaping and Puffing: Know your Risks / Your Life is in Danger: E-Cigarette Lethality
No full textThe recent spate of lung illnesses and deaths in e-cigarette users has alarmed the regulatory authorities mainly in the US, where the death toll already counts >30 cases, but is also of great concern to global authorities and of course to the vaping community. The issues of e-cigarette toxicity are herein reviewed. Rhythmos 2019;14(4):67-70
New (2018) American (ACC/AHA) Cholesterol Guidelines: Main Messages
Get PDFKey points and main messages of the new (2018) American Guidelines on cholesterol management are herein provided with tabulation of the risk assessment tools, the classification of statins according to their therapeutic intensity and desired lipid levels in children. Rhythmos 2019;14(1):1-4
Carcinogenic Impurities in Generic Sartans: An Issue of Authorities’ Control or a Problem with Generics?
Get PDFThe recent flood tide of recalls of sartan generics due to carcinogenic impurities has brought to the forefront the issue of the safety and efficacy of generic drugs. Several of these issues are discussed in this editorial. Rhythmos 2019;14(2):23-26
Sugary Beverages Pose Significant Risks to Cardiovascular and Overall Health
Get PDFConsumption of added sugar is associated with weight gain and metabolic syndrome, but most importantly with cardiovascular disease (CVD) morbidity and mortality. Sugar-sweetened beverages (SSBs) in the form of soft drinks or sodas constitute a major source of added sugar with its attendant ill effects on health. Of particular concern is the rising consumption of soft drinks among young people. The World Health Organization (WHO) recommends the reduction of free sugars to <10% of total energy intake due to their potential implications in dental caries, weight gain and CVD consequences, however, adherence to this recommendation is generally very low. Non-caloric drinks in the form of artificially sweetened beverages (ASBs) (diet sodas) are popular as alternatives to SSBs. However, these sweeteners may also have various negative, albeit at a lesser degree, health outcomes, including weight gain, obesity, metabolic syndrome, type II diabetes, and CV events. Finally, substantially lower health risks are incurred from 100% fruit juice consumption compared with SSBs. All these issues are herein reviewed and measures are discussed to lessen the consequences of such an unhealthy dietary behavior. Rhythmos 2019;14(3):45-50
Cardiology News / Recent Literature Review / Second Quarter 2018
Get PDFESC Meeting: Munich, 25-29/8/2018TCT Meeting: San Diego, 21-25/9/2018Hellenic Cardiological Society Meeting, Athens, 18-20/10/2018AHA Meeting: Chicago, 10-12/11/2018EASEL Study: Sodium Glucose Cotransporter 2 Inhibitors (SGLT2i) Confer a Lower Rate of All-Cause Mortality, Hospitalization for Heart Failure (HF), and Major Adverse Cardiovascular Events (MACE)After propensity matching, 25 258 patients were followed for a median of 1.6 years. Compared with non-SGLT2i, initiation of SGLT2i was associated with a lower rate of all-cause mortality and hospitalization for HF (1.73 vs 3.01 events per 100 person-years; HR, 0.57) and MACE (2.31 vs 3.45 events per 100 person-years; HR, 0.67). SGLT2i initiation was also associated with an ≈2-fold higher risk of below-knee lower extremity amputation (0.17 vs 0.09 events per 100 person-years; HR, 1.99). Because of the disproportionate canagliflozin exposure in the database, the majority of amputations were observed on canagliflozin (Udell JA et al, Circulation 2018;137:1450-9).In Most Young Patients Who Experienced Sudden Cardiac Arrest (SCA), Sports was a Trigger in a Minority of Cases, while Standard Cardiovascular Risk Factors were Found in Over Half of themAmong 186 SCAs in the young (ages 5-34 years) (5% of all SCAs), overall prevalence of warning signs before SCA was low (29%), and 26 (14%) were associated with sports as a trigger. The remainder (n=160) occurred in other settings categorized as non-sports. Sports-related SCAs accounted for 39% of SCAs in patients aged ≤18, 13% of SCAs in patients aged 19 to 25, and 7% of SCAs in patients aged 25 to 34. Sports-related SCA cases were more likely to present with shockable rhythms, and survival from cardiac arrest was 2.5-fold higher in sports-related vs non-sports SCA (28% vs 11%; P=0.05). Overall, the most common SCA-related conditions were sudden arrhythmic death syndrome (31%), coronary artery disease (22%), and hypertrophic cardiomyopathy (14%). There was an unexpectedly high overall prevalence of established cardiovascular risk factors (obesity, diabetes mellitus, hypertension, hyperlipidemia, smoking) with ≥1 risk factors in 58% of SCA cases (Jayaraman R et al, Circulation 2018;137:1561-1570).Although Second Arterial Conduit Use May be Low and Declining, Arterial Grafts Are Associated with Lower Mortality and Fewer Cardiovascular Events / A Right Internal Mammary Artery (IMA) Graft Offered No Benefit Over that of a Radial Artery, But did Increase Risk of Sternal Wound Infection / Thus, the Radial Artery May be the Preferred Second ConduitThe study included patients who received second arterial (right IMA or radial artery, n=5866) or a venous conduit (n=53 566). Propensity score matching yielded 5813 matched sets. Subgroup analysis compared outcomes between propensity score–matched recipients of a right IMA (n=1576) or a radial artery (n=4290). Use of second arterial conduit use decreased from 10.7% in 2006 to 9.1% in 2011 (P<0.0001). However, receipt of a second arterial conduit was associated with lower mortality (13.1% vs 10.6% at 7 years; hazard ratio-HR, 0.79), and lower risks of MI (HR, 0.78) and repeat revascularization (HR, 0.82). In comparison with radial artery grafts, right IMA grafts were associated with similar mortality rates (10.3% vs 10.7% at 7 years; HR, 1.10) and individual risks of cardiovascular events, but the risk of sternal wound infection was increased (risk difference, 1.07%) (Goldstone AB et al, Circulation 2018;137:1698-1707)... (excerpt)
New (2018) European (ESC/ESH) Hypertension Guidelines: What is New/ What is Different?
Get PDFThe changes introduced with the new (2018) compared with the previous (2013) European Hypertension Guidelines are herein highlighted together with some notable differences from current (2017) American Guidelines. Rhythmos 2018;13(4):71-74
Bioresorbable Scaffolds (BRS): A Ten-Year Saga Turned Sour
Get PDFThe first generation bioresorbable scaffolds (BRS) did not deliver their promise for reduced risk of late stent thrombosis and neoatherosclerosis forming inside the stent and restoration of endothelial vasomotion. To our chagrin, the incidence of early, late and very late scaffold thrombosis was higher than conventional metallic stents leading to increased rates of adverse cardiovascular events and outcomes. Unfortunately, it took a decade to fully appreciate these major drawbacks. The manufacturer of the first, apparently hastily approved BRS in both Europe and the USA discontinued its production in September 2017. Nevertheless, hope remains and newer generation BRS are already in the pipeline expecting that improved technology and implantation strategies may overcome these severe limitations and finally recredit and reinstate the BRS concept. Rhythmos 2018;13(2): 26-29
Cardiology News / Recent Literature Review / First Quarter 2018
Get PDFManolis AS, Anninos H. Cardiology News / Recent Literature Review / First Quarter 2018. Rhythmos 2018;13(2):38-43. HRS Meeting: Boston, 9-12/5/2018EuroPCR Meeting: Paris, 22-25/5/2018ESC Meeting: Munich, 25-29/8/2018ICD in Children & Adolescents with Brugada Syndrome: ~1 in 4 Patients Receive Appropriate Life-Saving Interventions Over a Period of 7 Years, Although Inappropriate Shocks and Other Adverse Events Occur Relatively Frequently Among 35 consecutive patients (aged 13.9±6.2 years). over a mean of 88 months, sustained ventricular arrhythmias were treated by the ICD in 9 patients (26%), including shocks in 8 (23%) and antitachycardia pacing in 1 patient (3%). Three patients (9%) died in an electrical storm. Seven patients (20%) experienced inappropriate shocks, and 5 (14%) had device-related complications. Aborted sudden cardiac death and spontaneous type I ECG were identified as independent predictors of appropriate shock occurrence (Gonzalez Corcia MC et al, J Am Coll Cardiol 2018;71: 148–57).Cardiomyopathy (CM) Patients With LVEF≤35% and LBBB Demonstrate Significantly Less LV Functional Recovery With Medical Therapy Than Do Those With a Narrow QRS / Thus, They Would Benefit From Earlier Implantation of a CRT DeviceAmong 659 patients with CM, 111 having LBBB (17%), 59 wide QRS duration ≥120 ms but not LBBB (9%), and 489 narrow QRS duration (74%), adjusted mean increase in LVEF over 3-6 months in the 3 groups was 2.03%, 5.28%, and 8%, respectively (p<0.0001), with no different results for interim revascularization and myocardial infarction. The combined endpoint of heart failure hospitalization or mortality was highest for patients with LBBB (Sze et al, J Am Coll Cardiol 2017;71: 306-17).1-Year Follow-Up of PRAGUE-18 Study: Among Patients With MI Undergoing Primary PCI, Antiplatelet Therapy With Prasugrel or Ticagrelor is Associated With Similar Outcomes / Economically Motivated, Early Post-Discharge Switch To Clopidogrel was not Associated With Increased Risk of Ischemic Events Among 1,230 patients with acute myocardial infarction (MI) treated with primary PCI and randomized to prasugrel or ticagrelor, the endpoint (cardiovascular death, MI, or stroke at 1 year) occurred in 6.6% of prasugrel patients and in 5.7% of ticagrelor patients (hazard ratio: 1.167; p = 0.503). No significant differences were found in: CV death (3.3% vs 3%), MI (3% vs. 2.5%), stroke (1.1% vs 0.7%), all-cause death (4.7% vs. 4.2%), definite stent thrombosis (1.1% vs. 1.5%), all bleeding (10.9% vs. 11.1%), and TIMI major bleeding (0.9% vs. 0.7%). The percentage of patients who switched to clopidogrel for economic reasons was 34.1% (n=216) for prasugrel and 44.4% (n=265) for ticagrelor (p=0.003). Patients who were economically motivated to switch to clopidogrel had (compared with patients who continued the study medications) a lower risk of major CV events; however, they also had lower ischemic risk (Motovska Z et al, J Am Coll Cardiol 2018;71:371-81)... (excerpt
Insights into the Clinical Spectrum of Catecholaminergic Polymorphic Ventricular Tachycardia
Get PDFCatecholaminergic polymorphic ventricular tachycardia (CPVT) is induced by stress or exertion especially in young individuals with normal baseline ECG and without any structural heart disease. The most common type of ventricular tachycardia (VT) in these patients is bidirectional VT but could also be polymorphic VT or ventricular fibrillation. These two main types of CPVT are caused by mutations on the ryanodine (RyR2) or calsequestrin (CASQ2) receptor, with an autosomal dominant and recessive inheritance pattern respectively. The prognosis is dismal without treatment and the main therapeutic approach consists of administration of beta blocker, flecainide, calcium channel blockers or ICD implantation. Genetic testing is important for all family members of CPVT probands in order to identify asymptomatic carriers. Rhythmos 2018;13(1):6-8.
Ventricular Pace Suppression Function: Prophylaxing from Iatrogenic Dyssynchrony
Get PDFA patient with an implanted dual-chamber pacemaker (DDDR) for sick sinus syndrome had a pulse generator exchange due to battery depletion. Apropos with the procedure, it was noted that the patient had continuous ventricular pacing via a pacing lead located at the right ventricular apex. In order to avoid possible deleterious effects of the iatrogenic dyssynchrony conferred by this kind of pacing, the algorithm of ventricular pace suppression function was activated in the new device that practically led to functional AAI pacing, deemed a more physiologic mode of pacing that could prevent the potential harmful effects of right ventricular apical pacing. Rhythmos 2018;13(3):59-61