ΕΠΙΣΤΗΜΟΝΙΚΑ ΚΙ … ΑΛΛΑ”από τον Ομ. Καθηγητή, Ιωάννη Γουδέβενο, 30.10.2024 – ΣΥΣΚΕΥΕΣ ΣΤΗΝ ΚΑΡΔΙΑΚΗ ΑΝΕΠΑΡΚΕΙΑ

Πλήθος κόσμου έδωσε το «παρών» στα εγκαίνια του κέντρου κλινικής ευεξίας της ιατρού Πόπης Καλαϊτζή, συζύγου του υπουργού Οικονομικών, Κωστή Χατζηδάκη.

Πόπη  Για να λέμε και του στραβού το δίκιο με τα μέτρα που μας παίρνει ο Κωστής  φροντίζει  και για τη   ψυχική μας ευεξία!ΤΕΛΕΤΕΣ ΕΝΑΡΞΗΣ ΕΠΙΣΤΗΜΟΝΙΚΩΝ ΣΥΝΕΔΡΙΩΝ!

 …παλαιότερα αλλά ακόμη στην επαρχία: Ο Δεσπότης, ο Νομάρχης, ο Δήμαρχος με την φιλαρμονική  και οι τοπικοί πολιτευτές: δως τους μικρόφωνο να μη τελειώνουν ποτέ ή  να τελειώνουν με το αλησμόνητο  … με αγωνία περιμένουμε τα συμπεράσματα του συνεδρίου!!!. O Tempora o Mores

Συνάδελφοι-Συναδέλφισσες

Μετα ανάλυση με ελληνικά χρώματα για τους παράγοντες κινδύνου σ ενήλικες  με συγγενείς καρδιοπάθειες. JACC Adv. 2024;3:101359 Andreas S. Papazoglou, Konstantinos G. Kyriakoulis, Konstantinos Barmpagiannos, Dimitrios V. Moysidis, Anastasios Kartas, Maria Chatzi, Amalia Baroutidou, Vasileios Kamperidis, Antonios Ziakas, Konstantinos Dimopoulos, George Giannakoulas

Πολύ παραγωγικός ο  Γ. Γιαννακούλας.   Να μη ξεχνάμε τον πρωτοπορο που αφιέρωσε στη κυριολεξία την καριέρα στις συγγενείς καρδιοπάθειες  Κώστα  Βασιλειάδη στου ΠΑΠΑΝΙΚΟΛΑΟΥ 

KAΡΔΙΑΚΗ ΑΝΕΠΆΡΚΕΙΑ

ΣΥΣΚΕΥΕΣ ΣΤΗΝ ΚΑΡΔΙΑΚΗ ΑΝΕΠΑΡΚΕΙΑ Consensus για τα οφέλη και τις προκλήσεις για  τη βασισμένη σε συσκευές θεραπεία της Καρδιακής Ανεπάρκειας .  Το θέμα είναι cardioelite(φοριέται πολύ τελευταία) αλλά να έχουμε μια ιδέα τι “παίζει” γύρω μας

Με ελεύθερη πρόσβαση Estep JD, et al. J Card Fail.2024; online

Γρηγόρη και αυτός από το Cleveland!

Conceptual framework of device therapy in the management of heart failure… Συσκευών συνέχεια. Η μελέτη  RELIEVE HF -δημιουργία μεσοκολπικού shunt με συσκευή Ventura σε ασθενείς με ΚΑ με κάθε ΚΕ – δεν μείωσε τα συμπτώματα ούτε βελτίωσε την επιβίωση στα 2 χρόνια παρακολούθησης. H μελέτη είχε ανακοινωθεί στο ACC 24 και δημοσιεύτηκε τώρα. Gr Stone  Circulation. 2024;onlineΠΕΡΑ ΑΠΟ Τις GUIDELINES. Mη φαρμακευτική αντιμετώπιση της ΚΑ. JACC2024  online

ΕΓΚΕΦΑΛΙΚΑ : πρωτογενής πρόληψη

GUIDELINES από το 2014 έχουμε καινούργιες από  AHA/ASA για τη πρωτογενή πρόληψη των ΑΕΕ Bushnell C, et al. Stroke. 2024 On line

“The most effective way to reduce the occurrence of a stroke and stroke-related death is to prevent the first stroke. Some populations have an elevated risk of stroke, whether it be due to genetics, lifestyle, biological factors and/or social determinants of health, and in some cases, people do not receive appropriate screening to identify their risk.” δήλωσε η  chairwoman-νευρολόγος- των οδηγιών. Cheryl D. Bushnell

TAKE-HOME MESSAGES

1. From birth to old age, every person should have access to and regular visits with a primary care health professional to identify and achieve opportunities to promote brain health.

2. Screening for and addressing adverse social determinants of health are important in the approach to prevention of incident stroke. The new calls for more screening of risk factors such as high BP, high cholesterol and high blood glucose.  In addition, primary prevention of stroke would improve with more efforts to publicize the benefits of lifestyle changes such as better diet, increased physical activity, smoking cessation and better sleep.

This updated guideline includes an orientation to social determinants of health, acknowledging its impact on access to care and treatment of stroke risk factors.

3. The Mediterranean diet is a dietary pattern that has been shown to reduce the risk of stroke, especially when supplemented with nuts and olive oil. However, low-fat diets have had little impact on reducing the risk. This guideline recommends that adults with no prior CVD and those with high or intermediate risk adhere to the Mediterranean diet.

4. Physical activity is essential for cardiovascular health and stroke risk reduction. This guideline includes a summary of high-quality data showing that prolonged sedentary behavior during waking hours is associated with an increased risk of stroke. Therefore, we provide a new recommendation for screening for sedentary behavior and counseling patients to avoid being sedentary, as well as a call for new studies of interventions to disrupt sedentary behavior.

5.  GLP-1 receptor agonist use is effective (class IA recommendation) for stroke prevention in patients with diabetes, high CV risk or established CVD and HbA1c 7% or more. On the basis of these robust data, we provide a new recommendation for the use of these drugs in patients with diabetes and high CV risk or established CVD.

6. Blood pressure management is critical for stroke prevention. RCTs have demonstrated that treatment with 1 antihypertensive medication is effective for reaching the BP goal in only ≈30% of participants and that the majority of participants achieved the goal with 2 or 3 medications. Therefore, ≥2 antihypertensive medications are recommended  in most patients who require pharmacological treatment of hypertension.

7. Antiplatelet therapy is recommended for patients with antiphospholipid syndrome or systemic lupus erythematosus without a history of stroke or unprovoked VTE to prevent stroke. Patients with antiphospholipid syndrome who have had a prior unprovoked venous thrombosis likely benefit from VKA (INR 2–3)over DOACs.

8. Prevention of pregnancy-related stroke can be achieved primarily through management of hypertension. Treatment of verified  of systolic BP≥160 mm Hg or diastolic  ≥110 mm Hg during pregnancy and within 6 weeks postpartum is recommended to reduce the risk of fatal maternal intracerebral hemorrhage. In addition, adverse pregnancy outcomes are common and are associated with chronic hypertension and an elevated stroke risk later in life. if a woman had a history of preeclampsia (toxemia) during her pregnancy, then she should be screened for other CV and stroke risk factors immediately after delivery, specifically high blood pressure, because of the evidence that preeclampsia increases the risk of hypertension by fourfold and the risk of stroke by twofold in the 10 years after delivery. Therefore, screening for these pregnancy outcomes is recommended to evaluate for and manage vascular risk factors, and a screening tool is included to assist with screening in clini-cal practice.

9. Endometriosis, premature ovarian failure (<40 years of age), and early-onset menopause(< 45 years of age) are all associated with an increased risk for stroke. Therefore, screening for all 3 of these conditions is a reasonable step in the evaluation and management of vascular risk factors in these individuals to reduce stroke risk.

10. Understanding transgender health is essential to truly inclusive clinical practice. Transgender women taking estrogens for gender affirmation have been identified as having an increased risk of stroke. Therefore, evaluation and modification of risk factors could be beneficial for stroke risk reduction in this populatiοn.

11. Routine screening for carotid artery stenosis is not recommended to reduce the risk of stroke.  In patients with asymptomatic carotid artery stenosis  >70%, shared decision-making between the patient and the health care team to decide between the 2 courses of treatment(carotid revascularization or medical management) is recommended to determine the best method of reducing stroke risk.2a B-NR3. Medical treatment with statin can be beneficial to reduce the risk of stroke. 2b B-R4. In patients with asymptomatic carotid artery stenosis >70% and low periopera-tive risk, the use of carotid revascularization, inaddition to intensive medical therapy, may bereasonable to reduce the risk of stroke IIb

12. The guideline highlights the need for risk assessment in primary stroke prevention and includes the use of risk prediction tools to estimate risk for ASCVD so that patients receive timely prevention and treatment strategies. The Association has developed the PREVENT risk calculator as a screening tool that can help inform preventive treatment decisions. The PREVENT calculator can estimate 10-year and 30-year stroke and heart disease risk in individuals starting at age 30 — a decade earlier than the Pooled Cohort Equations calculator.

13. Implementing the recommendations in this guideline would make it possible to significantly reduce the risk of people having a first stroke. Most strategies will also help reduce the risk of dementia, another serious health condition related to vascular issues in the brain

ΚΑΡΔΙΟΓΚΟΛΟΓΙΑ

Anthracycline Cardiotoxicity in Adult Cancer Patients: State-of-the-Art Review. JACC CardioOncol  2024;6:655-677.

Key points

1. Anthracyclines remain a cornerstone treatment for many solid and hematologic malignancies despite their cardiotoxic effects. They are essential for treating lymphomas, acute leukemias, and soft tissue sarcomas.
2. Cancer therapy-related cardiac dysfunction (CTRCD) is defined by decreases in LVEF) >10% to <50% and/or global longitudinal strain (GLS) >15% relative decrease from baseline. RV dysfunction may also occur with anthracycline therapy, though less studied than LV effects.
3. Anthracycline-induced cardiotoxicity can manifest acutely (<1% of cases), early-onset (within first year, 98% of cases), or late-onset (>1 year after treatment). The risk of cardiotoxicity is dose-dependent, with higher cumulative doses associated with greater risk. The threshold between low and high heart failure risk is defined at 250-300 mg/m² for doxorubicin.
4. Mechanisms of anthracycline cardiotoxicity include oxidative stress, alterations in cell death pathways (apoptosis, pyroptosis, ferroptosis), and epigenetic changes. Genetic factors may influence individual susceptibility to anthracycline cardiotoxicity. Nearly 80 genes with single nucleotide polymorphisms have been linked to anthracycline-induced cardiotoxicity.
5. Key patient-related risk factors include age ( >65 years), pre-existing CV disease, and hypertension, which can increase the likelihood of cardiotoxicity by up to 1.5-2 times compared to lower-risk groups. High-risk patients undergoing anthracycline treatment should receive imaging and biomarker evaluations every 3-6 months during treatment and annually for ≥5 years post-treatment.
6. Echo is the first-line imaging modality for evaluating anthracycline-treated patients. GLS <16% or a relative modification >15% from baseline are considered risk markers.
7. The efficacy of primary prevention strategies with neurohormonal antagonists remains controversial, especially in low-risk patients. Recent trials (CECCY, PRADA, CardiacCARE) showed no significant cardioprotective effects in low- to moderate-risk patients. The optimal cardioprotective strategy for patients undergoing anthracycline therapy is yet to be  clearly defined

• CTRCD can be reversible if detected early and treated appropriately.  Dexrazoxane is the only FDA-approved drug for preventing anthracycline-related cardiotoxicity. It is recommended for patients who have received a cumulative doxorubicin dose of 300 mg/m². Liposomal doxorubicin formulations may reduce cardiac accumulation and subsequent toxicity, allowing for higher cumulative doses.
• Early detection and prompt initiation of ΗF therapy can lead to EF recovery in up to 82% of cases when started within 2 months post-chemotherapy. Management of anthracycline-induced CTRCD should follow current HF treatment guidelines.
• The ESC guidelines on cardio-oncology recommend treating CTRCD according to the current guidelines for nononcologic HF
• The care of patients with cancer is complex. Long-term CV surveillance is recommended for cancer survivors treated with anthracyclines, with follow-up tailored based on initial risk assessment. Dedicated survivorship clinics may improve long-term cardiovascular outcomes for cancer survivors, though resource constraints must be considered.
•  The medical community has the ability to prevent stroke with medications that are very effective, such as those for lowering blood pressure and cholesterol, and managing diabetes. The challenge for preventing a first stroke is to identify the patients who are at risk and making sure those patients have access to care. This could be primary care or specialist care depending on the patient’s medical history. There is much room for improvement, however. 60% of strokes are preventable by identifying risk factors and managing them. There is a renewed cause for alarm because stroke has risen from the 5th leading cause of death to the 4rth leading cause. Therefore, focusing on screening and identifying patients at risk, applying guideline-recommended therapies for prevention, and counseling on lifestyle are more important than ever if we want to reduce the burden of strokes.

ΠΡΑΧΤΙΚΟΣ(πλήρης) ΑΛΓΟΡΙΘΜΟΣ ΓΙΑ ΤΗΝ ΑΛΛΕΡΓΙΑ ΣΤΗΝ ΑΣΠΙΡΙΝΗ

ΠΕΡΙΣΤΑΤΙΚΟ ΕΒΔΟΜΑΔΑΣ HCM σαν παρενέργεια τοξικότητας από υδροξυχλωροκίνη σε γυναίκα 46 ετών με ρευματοειδή αρθρίτιδα.   Lancet 2024; 404:1560

Α. Echo shows severe concentric hypertrophy of the LVr walls with inhomogeneous myocardial texture (asterisks). (B) endomyocardial biopsy shows vacuolisation of the cardiac myocytes (arrows), a typical finding of hydroxychloroquine cardiac toxicity.

Oλοι στη Χερσόνησο Βρεεεεε!