Dr Yiannis Panayiotides | Dr Yiannis Panayiotides

The effect of Dapagliflozin in the 6-minute walk test of patients with Heart Failure with preserved EF

Heart failure with preserved ejection fraction is a clinical syndrome associated with a significant functional limitation.

No treatment has yet been found to improve exercise performance in these patients.

In a recent randomized study including 289 HFpEF patients, it was demonstrated that patients receiving dapagliflozin after a 12 week-period exhibited an improvement in 6MWT by 15 meters compared to placebo. The beneficial response to dapagliflozin was consistent across all pre-specified subgroups.

Dapagliflozin, and possibly other SGLT-2 agents, should be strongly considered in patients with HFpEF, in order to enhance their functional capacity and quality of life.

Reference:
Circulation: Heart Failure
Effect of Dapagliflozin on 6-Minute Walk Distance in Heart Failure With Preserved Ejection Fraction:
PRESERVED-HF
Circ Heart Fail 2023 Oct 23;[EPub Ahead of Print], GD Lewis, K Gosch, LP Cohen, ME Nassif, SL Windsor,
BA Borlaug, DW Kitzman, SJ Shah, T Khumri, G Umpierrez, S Lamba, K Sharma, SS Khan, MN Kosiborod,
AJ Sauer

Smoking cessation after percutaneous coronary intervention (PCI)

Smoking is one of the most harmful habits for our health. This appears to be even more pronounced after a coronary intervention (PCI).

In a population-based retrospective cohort study involving 74,471 patients who underwent PCI, smokers had a nearly 20% higher rate of recurrent major adverse cardiovascular and cerebrovascular events compared with nonsmokers during a median follow-up period of 4 years.

A rather optimistic finding of this study, for smokers, is that in case of successful cessation after PCI there is a substantial reduction of risk which approximates the corresponding risk of non-smokers.

These findings amplify the importance of smoking cessation, especially after a coronary intervention.

Reference:
European Heart Journal
Smoking and cardiovascular outcomes after percutaneous coronary intervention: a Korean study
Eur Heart J 2023 Sep 26; YJ Ki, K Han, HS Kim, JK Han

Daily step count: how much is enough?

Physical activity is well known to be beneficial for the cardiovascular system, and good health in general. A recent publication addresses the issue of daily step count and how it affects our health.

According to the authors if an individual walks more than 2517 steps per day, a substantial reduction of overall mortality is achieved which reaches 8%.

The benefit of physical movement is increased even more if the daily step count exceeds 8763 steps per day, with the overall mortality to be reduced by 60%. A person who walks 7126 steps per day reduces the risk of any cardiovascular event by 51%.

There is no medication or supplement that can reduce mortality and cardiovascular risk that much. With the use of smartphones and smartwatches it is now very easy to monitor our daily step count. By reaching the numbers, mentioned above, we can easily and effectively protect our health.

Reference:
Relationship of Daily Step Counts to All-Cause Mortality and Cardiovascular Events
Niels A. Stens, Esmée A. Bakker, Asier Mañas, Laurien M. Buffart, Francisco B. Ortega, Duck-chul Lee,
Paul D. Thompson, Dick H.J. Thijssen, and Thijs M.H. Eijsvogels
J Am Coll Cardiol. 2023 Oct, 82 (15) 1483–1494

https://www.jacc.org/doi/10.1016/j.jacc.2023.07.029

The use of coronary artery calcium (CAC) as predictor of cardiovascular events

Coronary artery calcium (CAC) can be quickly quantified on a computed tomography (CT) and enables screening for subclinical atherosclerosis.

In a recent study it is demonstrated that among 5678 asymptomatic adults, 52% had a calcium score above zero. Those with CAC above 100 are estimated to have a 10 year-risk for acute cardiovascular events of about 24%.

Individuals with an increased CAC should be addressed with aggressive management of all cardiovascular risk factors. Statins should be initiated, as they have been documented to stabilize atheromatous plaques and reduce the progression of the disease.

It is interesting that in the study, only 26% of those with an increased CAC (above 100) were on statins.

Lifestyle modification, including smoking cessation, daily physical activity and nutrition optimization are also fundamental in the management of subclinical atherosclerosis.

Reference:
Journal of the American College of Cardiology
Association of Coronary Artery Calcium Detected by Routine Ungated CT Imaging With Cardiovascular
Outcomes J Am Coll Cardiol 2023 Sep 19;82(12)1192-1202, AW Peng, R Dudum, SS Jain, DJ Maron, BN Patel, N Khandwala, D Eng, AS Chaudhari, AT Sandhu, F Rodriguez

Morning exercise appears to be beneficial for weight management

It is highly debated which is the ideal time of day for someone to engage in physical exercise. According to a recent publication, which investigated the data retrieved from 5285 individuals, exercise in the morning succeeds better management of weight as well as reduced waist circumference.

According to the researchers, the adjusted means for body mass index were 25.9 kg/m² in the morning group, 27.6 kg/m² in the midday group, and 27.2 kg/m² in the evening group. For waist circumference, the respective measurements for the three groups were 91.5, 95.8, and 95.0 cm, respectively.

Reference:
The diurnal pattern of moderate-to-vigorous physical activity and obesity: a cross-sectional analysis: https://doi.org/10.1002/oby.23851

The European Association of Cardiovascular Imaging herewith confirms

Ioannis Panayiotides

has been awarded certification in EACVI Adult Transthoracic Echocardiography

from July 2019

Valid until July

2024

dr_ioannis_panayiotides_european_certification

Dr-Panayiotides-Yiannis-transcatheter-aortic-valve-implantation-TAVI.jpg

Severe aortic stenosis is a quite common clinical condition, particularly among individuals older than 70 years. It is usually accompanied by symptoms such as chest pain, easy fatigue, dyspnea and fainting attacks. However due to the timing of clinical presentation, symptoms are often attributed to other co-morbidities or simply the age of patient.

Physical examination is sometimes misleading in guiding diagnostic thinking, since the most expected physical findings are not always present. Diagnosis is easily made with echocardiography, a simple, convenient and non-invasive diagnostic procedure. With the use of ultrasound the physician is able to accurately determine the severity of aortic valve stenosis and also evaluate the function of other valves and the contractility of the heart. This echocardiographic evaluation is of paramount importance for the final decision regarding any therapeutic intervention.

Several medications have been used in order to regress or even delay the worsening of this condition, but none was found to be successful. The only way to manage this form of valvulopathy is surgical replacement of the pathologic valve. Each patient needs to be evaluated thoroughly in order to assess the surgical risk and the expected benefit from such intervention.

In general, a patient should be referred for surgery when the severity of aortic valve stenosis is documented (aortic valve area < 1cm2) and also when symptoms are present. For patients who are considered to be at high risk for a traditional surgical operation there is now the option of a transcutaneous procedure (TAVI).

After a successful replacement of the aortic valve the patient will be able to resume back to the normal daily activities without any restrictions, and most importantly without symptoms.

Dr-Panayiotides-Yiannis-catheter-ablation-of-atrial-fibrillation-1.jpg

Catheter ablation of atrial fibrillation is an invasive therapeutic option for individuals with AF. It was first introduced in the late 1980s and has now emerged as a quite common procedure in many hospitals. Accumulated clinical experience as well as data from several prospective randomized trials confirm that catheter ablation of AF is superior to antiarrhythmic drug therapy in controlling AF.

AF ablation is suggested to be particularly beneficial for patients with the paroxysmal form of AF without other severe comorbidities. Catheter ablation is indicated for treatment of patients with symptomatic AF in whom one or more attempts with antiarrhythmic drug (class I or III) therapy have failed.

In the recent guidelines for management of AF, catheter ablation is reasonable to be implemented as a first-line therapy in selected patients; however it is more practical in clinical practice to initiate a non-invasive pharmaceutical intervention first.

This procedure has made a remarkable progress in the last years mostly due to novel technological improvements and packed clinical experience and skills. Finally it should be noted that catheter ablation is very rarely associated with potentially life-threatening complications, such as an atriooesophageal fistula, stroke, and cardiac tamponade.

It is well established that diabetes substantially increases the incidence of cardiovascular events. The management of glucose control has significantly improved with the introduction of novel pharmaceutical agents and the mode of administrating insulin. However, apart from glucose control, it is imperative to effectively manage the risk of cardiovascular disease.

A recently published study evaluated the effect of statins in the progression of atheromatosis. Patients were studied with the use of intravascular ultrasound, a relatively new invasive diagnostic procedure, which identifies the components of coronary arterial wall.

The use of statins was clearly documented to be associated not only with stabilization of atheromatic plaque, but also with regression. This effect was noted in all patients, but it was more pronounced in diabetics. This finding reinforces the principal of initiating statins early in the course of diabetes, in order to minimize the risk of cardiovascular events.

References:

High-intensity statin therapy alters the natural history of diabetic coronary atherosclerosis

Stegman B, et al.

Diabetes Care, 09/12/2014 Clinical Article

People often start a diet in order to lose weight, reduce their cholesterol levels and maintain good health. Diets that are low in fat consumption are in general perceived as the most beneficial for optimal weight control and reduction of cardiovascular risk. However, a very recently published article comes to abolish this theory.

According to this study, 148 individuals without previous history of diabetes or cardiovascular disease were randomized into either low-carbohydrate or low-fat diet.

After one year of observation, a significant weight reduction was identified in the low-carbohydrate diet group (mean reduction 3.5 Kg). Also, the same group demonstrated a significant reduction of CRP, which is known to be a marker of inflammation that is positively correlated with the risk of cardiovascular events. Arterial pressure, glucose and cholesterol levels were similar in both groups.

Diets with low consumption of carbohydrates were initially introduced in the 70s (Atkins diet). However many people argued about the beneficial effect of this particular form of diet. In fact, it was suggested to increase the cardiovascular risk despite reduction of body weight.

Carbohydrates are the main source of energy and constitute a significant proportion of our daily meals (bread, cereals, potatoes, rise, pasta and fruits). Complex carbohydrates (whole grain bread and starchy vegetables) are those that require specific process and sugar is slowly digested and absorbed. Simple carbohydrates (table sugar, soft drinks, candy and white bread) are established to have a low nutritional value and cause an accumulation of fat in the body.

As a conclusion, a diet with a low consumption of carbohydrates is established to produce a significant reduction in body weight without the previous deleterious effects that were previously suggested. However, more research and a longer follow-up are required in order to safely apply such a notion in our everyday life.

Source:

Annals of Internal Medicine

Effects of Low-Carbohydrate and Low-Fat Diets: A Randomized Trial

Bazzano LA

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