Publications by authors named "Manios Efstathios"

The prevalence of systolic hypertension phenotypes based on simultaneous 24-h brachial (br) and aortic (ao) ambulatory blood pressure monitoring (ABPM) remains unknown. We sought to describe their prevalence and associations with hypertension mediated organ damage (HMOD). Participants with 24-h br and ao ABPM, carotid ultrasound and echocardiography data were categorized into 4 systolic hypertension phenotypes: sustained systolic br and ao normotension (SSN), isolated br systolic hypertension (IbrSH), isolated ao systolic hypertension (IaoSH) and sustained br and ao systolic hypertension (SSH).

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  • The study aimed to assess the impact of the COVID-19 pandemic on hypertension awareness and treatment in Greece, analyzing data collected in 2019 and 2022 during the May Measurement Month (MMM) initiative.
  • Data from over 12,000 adults revealed consistent hypertension prevalence rates (around 41-43%) before and after the pandemic, but an increase in undiagnosed cases was observed, rising from 21.3% to 27.5%.
  • The findings suggest that while the overall prevalence of hypertension remained stable, there is a pressing need for improved national strategies to detect and manage hypertension effectively in Greece, especially post-pandemic.
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  • - The SUN4P project investigates stroke healthcare quality in Greece by analyzing patient data from nine hospitals for first-ever strokes between 2019-2021.
  • - Out of 892 patients studied, the majority had ischemic strokes, with only a small percentage receiving treatment in specialized acute stroke units; yet, a high percentage received follow-up medications upon discharge.
  • - This study marks the first comprehensive data collection on stroke care quality in Greece, aiming to enhance treatment standards and outcomes for stroke patients nationwide.
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  • The study assessed the one-year total cost of strokes in Greece, focusing on patients with first-ever acute strokes admitted to hospitals within 48 hours of symptom onset.
  • It found that the total annual cost of stroke care was EUR 343.1 million in 2021, averaging EUR 10,722 per patient, with an estimated cost-effectiveness of EUR 23,308 per Quality Adjusted Life Year (QALY).
  • Key costs included 53.3% direct healthcare expenses and significant productivity losses, totaling EUR 160.2 million from work absences, premature retirement, and caregiving, emphasizing the need for improved stroke care and effective interventions.
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  • * In Greece, early restriction measures resulted in a milder Covid-19 surge, allowing for a study comparing stroke admissions before and during the pandemic.
  • * The study found no significant differences in stroke severity or patient characteristics between the two periods, but there was a notable delay in the time from symptom onset to CT scan during the pandemic (p=0.03).
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  • The study aims to create consensus recommendations for the design and functionality of various blood pressure (BP) measuring devices used in clinical settings for managing hypertension.
  • A scientific meeting held by the European Society of Hypertension gathered input from international experts and device manufacturers to establish guidelines for five types of BP monitors, listing essential and optional features.
  • The recommendations are intended for both manufacturers, to guide the development of BP devices, and healthcare administrators, to assist in selecting the most suitable options for hypertension management.
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  • Blood pressure (BP) constantly changes due to environmental and behavioral factors, as well as the body's own regulation mechanisms, and increased BP variability (BPV) can indicate cardiovascular issues and heighten health risks.
  • While BPV was previously seen mostly in research contexts due to mixed evidence, experts are now focusing on its clinical significance and standardizing how it should be assessed.
  • A position paper from the European Society of Hypertension aims to clarify BPV measurement methods and clinical applications, providing practical guidelines for researchers and healthcare professionals to improve BPV management.
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  • The study aimed to determine if early cardiac rhythm control benefits patients with acute ischemic stroke and paroxysmal atrial fibrillation (PAF) compared to those with sustained atrial fibrillation (AF).
  • Researchers followed 297 patients who had their first stroke and confirmed PAF to analyze outcomes like mortality, stroke recurrence, and major adverse cardiovascular events (MACE) over a median period of 28 months.
  • The results indicated that patients with self-terminating PAF had significantly lower risks of death, stroke recurrence, and MACE compared to those with sustained AF, suggesting that early rhythm control may have benefits.
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  • The study investigates how aortic stiffness and pressure wave reflections relate to long-term outcomes in stroke patients, using data from the Athens Stroke Registry.
  • It analyzed 552 patients and found that high aortic stiffness is independently linked to increased mortality and cardiovascular events, but not necessarily to stroke recurrence or functional disability.
  • The combination of high aortic stiffness and low pressure wave reflections significantly raises the risk of adverse outcomes, highlighting their combined importance in post-stroke patient management.
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Unlabelled: The aim of this study was to calculate the average operational cost per sub-type of stroke patient and to investigate cost drivers (e.g. ALoS, NIHSS score, age) correlated to cost.

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Unlabelled: To assess stroke patient-reported experiences and hospital staff experiences, during hospital stay.

Methods: Stroke patient-reported experiences (n=387) were recorded using the translated and culturally adapted NHS-Stroke Questionnaire into Greek and staff experiences (n=236) were investigated using the Compassion Satisfaction and Burnout subscales of the ProQOL questionnaire.

Results: Staff's mean compassion satisfaction score was 39.

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Unlabelled: The aim of this study was to present the descriptive characteristics of the Stroke Units Necessity for Patients (SUN4P) registry.

Methods: The study population derived from the web-based SUN4P registry included 823 patients with first-ever acute stroke. Descriptive statistics were used to present patients' characteristics.

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Unlabelled: Background Stratification of cardiovascular risk in patients with ischemic stroke is important as it may inform management strategies. We aimed to develop a machine-learning-derived prognostic model for the prediction of cardiovascular risk in ischemic stroke patients.

Materials And Methods: Two prospective stroke registries with consecutive acute ischemic stroke patients were used as training/validation and test datasets.

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The present paper provides an update of previous recommendations on Home Blood Pressure Monitoring from the European Society of Hypertension (ESH) Working Group on Blood Pressure Monitoring and Cardiovascular Variability sequentially published in years 2000, 2008 and 2010. This update has taken into account new evidence in this field, including a recent statement by the American Heart association, as well as technological developments, which have occurred over the past 20 years. The present document has been developed by the same ESH Working Group with inputs from an international team of experts, and has been endorsed by the ESH.

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  • * The study involved 5727 adult volunteers, revealing that while 78.7% of those with hypertension were diagnosed, only 48.3% had their condition under control, with women and older individuals showing higher rates of awareness and treatment.
  • * The findings suggest a correlation between hypertension and higher body mass index (BMI), as well as related health issues like diabetes and heart disease, indicating the necessity for widespread screening programs and improved training for healthcare professionals.
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  • The study investigates the impact of statin treatment on patients with embolic stroke of undetermined source (ESUS), focusing on stroke recurrence, major cardiovascular events (MACE), and mortality.
  • Among 264 ESUS patients followed for 4 years, those discharged on statins experienced significantly lower rates of stroke recurrence (3.58 vs. 7.23 per 100 patient-years), MACE (4.98 vs. 9.89 per 100 patient-years), and death (3.93 vs. 8.21 per 100 patient-years).
  • The results suggest that statin use at discharge is an effective independent predictor for reducing the risk of stroke recurrence, MACE, and death in ESUS
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  • This study evaluated how reliable opportunistic screening programs are in gauging hypertension rates and control in Greece's adult population.
  • Data were analyzed from two surveys: EMENO (2013-2016) used random sampling, while MMM (2019) relied on voluntary screening in urban areas.
  • Findings showed similar hypertension prevalence rates between the two methods, but opportunistic screening underestimated undiagnosed cases and overestimated treatment success, highlighting the need for more comprehensive national studies.
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Chemotherapy regimens for breast cancer treatment can promote vascular dysfunction and lead to high cardiovascular risk. To investigate the cardiovascular burden and vascular inflammation in metastatic breast cancer patients receiving CDK 4/6 inhibitors or everolimus in addition to standard hormonal treatment. 22 consecutive female patients with metastatic breast cancer were enrolled.

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COVID-19 infection is a new disease mainly affecting the respiratory system but is also accompanied by many extra-pulmonary manifestations. A case of a 47-year old male with unique myocardial fibrosis after COVID-19 infection involving the left ventricular wall, intraventricular septum and almost complete damage of interatrial septum, in combination with asymptomatic severe sinus arrest episodes related to mild obstructive sleep apnea syndrome is described here.

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Carfilzomib (CFZ) improves survival in relapsed/refractory multiple myeloma but is associated with cardiovascular adverse events (CVAEs). We prospectively investigated the effect of CFZ on endothelial function and associations with CVAEs. Forty-eight patients treated with Kd (CFZ 20/56 mg/m and dexamethasone) underwent serial endothelial function evaluation, using brachial artery flow-mediated dilatation (FMD) and 26S proteasome activity (PrA) measurement in PBMCs; patients were followed until disease progression or cycle 6 for a median of 10 months.

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COVID-19 pandemic caused a major crisis, affecting and straining health care systems, including some very advanced ones. The pandemic may have also indirectly affected access to health care for patients with other conditions, not related to COVID-19, even in countries not overwhelmed by an outbreak.We analyzed and compared visits to the emergency room (ER) department during the same calendar period of 2019 and 2020 (from March 1 to March 31 of each year) in our hospital, a medium size, tertiary center, located in the center of Athens, which is not a referral center for COVID-19.

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: The guidelines on hypertension recently published by the European Societies of Hypertension and Cardiology, have acknowledged cognitive function (and its decline) as a hypertension-mediated organ damage. In fact, brain damage can be the only hypertension-mediated organ damage in more than 30% of hypertensive patients, evolving undetected for several years if not appropriately screened; as long as undetected it cannot provide either corrective measures, nor adequate risk stratification of the hypertensive patient.The medical community dealing with older hypertensive patients should have a simple and pragmatic approach to early identify and precisely treat these patients.

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Background: Carotid atherosclerosis and likely pathogenic patent foramen ovale (PFO) are two potential embolic sources in patients with embolic stroke of undetermined source (ESUS). The relationship between these two mechanisms among ESUS patients remains unclear.

Aim: To investigate the relation between carotid atherosclerosis and likely pathogenic PFO in patients with ESUS.

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Article Synopsis
  • Atrial cardiopathy and likely pathogenic patent foramen ovale (PFO) are potential causes of embolic strokes of unknown origin, but their relationship in patients remains unclear.
  • In a study involving 367 patients with embolic stroke of undetermined source (ESUS), it was found that only a small percentage had both conditions, with many having one or the other, but not both.
  • The data suggests that the presence of atrial cardiopathy is inversely related to the presence of likely pathogenic PFO, meaning if one is present, the likelihood of the other decreases.
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Increased blood pressure (BP) variability is associated with the development of target organ damage. However, the optimal type and index of BP variability (BPV) regarding their prognostic significance is unclear. The aim of our study was to compare the association of ambulatory and home BPV with the left ventricular mass index (LVMI) in patients with chronic kidney disease (CKD).

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