Advanced Heart Failure and Heart Transplant Fellow (ACGME-accredited) Health Science Center, University of Texas, Houston, United States  2007- 2008

I acquired advanced knowledge and clinical competences in:

• Dilated cardiomyopathy and its differential diagnosis

• Endomyocardial biopsy indications and procedural skills

• Mechanical support in patients presenting with Heart Failure, including intra-aortic balloon counter pulsation and ventricular assist device therapy

• Cardiac transplantation risks and benefits assessment

• Pre-transplantation evaluation protocols • Participation in the post-transplantation specialist care team • Treatment of acute and chronic allograft rejection.

Research Fellow in Cardio-Oncology M.D. Anderson Cancer Center, University of Texas, United States

In parallel with my Heart Failure & Transplant Fellowship , I worked for six months in researching Left Ventricular Systolic dysfunction and Heart Failure induced by cardiotoxic cancer therapies such as radiotherapy, conventional chemotherapy (anthracyclines) and newer anticancer treatments. My research focused on chemotherapy-induced cardiomyopathy.

Critical Care Fellow (Board-accredited) Intensive Care Unit

Metaxa Cancer Hospital, Greek NHS and ICU, Erasme Hospital, Brussels, Belgium 2005-2006

Subspecialty training in Critical Care Medicine split between ‘Metaxa’ Hospital (18 months) and ‘Erasme’ Hospital (six months). The training program comprised:

• Participation in every stage of critical care from initial admission through discharge • Gradually unsupervised coordination of care provision with increasing responsibility to manage critically ill patients

• Input in the management of major complications and terminal-stage care

• Practical skills including intubation, ventilation, arterial, central venous, and intracranial cannulation, tube or needle thoracostomy.

Qualifications & Certifications

Degree in Medicine – 1st class with merit – National Kapodistrian University of Athens

Board Certification in Cardiology – Greek NHS

Dissertation for the degree philosophiae doctor (PhD) "Target therapies-induced Cardiotoxicity " University of Texas 2003

Board Subspecialty Certificate in Critical Care Medicine – trained in Greece and Belgium 2006

Certified Hypertension Specialist by the American Hypertension Society 2010

MSc in the Methodology of Biomedical Research, Biostatistics and Clinical Bio-informatics – University of Larissa, Greece 2017

Certified in Adult  Echocardiography by the European Society of Cardiology 2014, 2019

Current position

Joint lead of the first autonomous Cardio-Oncology Unit, officially established in 2012. More than 1,500 patients are examined in the Unit every year with more than 4,000 echocardiograms performed. We focus on the diagnosis, prevention and treatment of the cardiovascular complications of cancer and anti-cancer treatment. Most cases relate to reduced Left Ventricle systolic function and the progressive development of Heart Failure as a result of the cardiotoxicity of anti-neoplastic treatment. We also manage cardiovascular events that occur in the context of anticancer therapeutic procedures, such as severe coronary syndromes, arrhythmias and thromboembolic disease. Additionally, our Cardio-Oncology Team registers, monitors and manages resistant hypertension caused by small molecule inhibitors of tyrosine kinase and VEGF inhibitors, these being the pillars of modern anticancer therapies. Of special interest is the diagnosis and management of myocarditis occurring during Checkpoint blockade in cancer immunotherapy. Other cardiac aspects of neoplastic disease (e.g. pericarditis, amyloidosis), as well as rarer entities such as primary and secondary heart tumors, are also registered, monitored and diagnosed.

Cardiovascular Pharmacotherapy Core member of the ESC Working Group on Cardiovascular Drugs with active participation in the design, patient recruitment and analysis of data in large, multicenter studies

Advisor to major pharmaceutical companies, currently working with IEO Milan, Erasme Brussels and Tenon Paris.

Research work

Heart Failure

• Acute Decompensated Heart Failure Study of the association between biomarkers – troponins, natriuretic peptides, inflammatory markers (TNFa) and carcino-embryonic antigens (C-125) – with the survival rate of patients with Heart Failure. Relevant publications/presentations: Critical Care 2007,11(Suppl 2):P248 Critical Care 2007,11(Suppl 2):P222 Ιnt Care Med 2007,33(Suppl 2):P0253 Critical Care 2008,12(Suppl 2):P242 Critical Care 2008,12(Suppl 2):P441 Critical Care 209,13(Suppl 1):P416 Critical Care 2009,13(Suppl 1):P456.

• Cardio-renal Syndrome Study of the impact of anemia and hyponatremia in the chronic Heart Failure process and the potentially beneficial role of anemia treatment in the natural history of HF.

• Myocardial Dysfunction due to sepsis Title: Positive effect of levosimendan in the hemodynamic and clinical profile of the septic patient. Relevant publication: Critical Care 2009,13 Suppl 1:P165.

• Acute Decompensated Heart Failure II (DAD-HF II) study Randomized, placebo-controlled, multicenter study of the efficacy and safety of high dose vs. low dose furosemide with or without dopamine infusion on the outcome of hospitalized patients with acute HF. (ClinicalTrials.gov: NCT00937092). Role: Principal investigator.

• PARAGON-HF study Title: Efficacy and safety of LCZ696 compared to Valsartan, on morbidity and mortality in Heart Failure patients with preserved Ejection Fraction. (ClinicalTrials.gov: NCT01920711). Role: Principal investigator.

Cardio-Oncology

• Cardio toxicity of anticancer treatment Study of the cardiovascular side-effects of chemotherapy and modern targeted cancer therapies, with a focus on the use of conventional and advanced echocardiography to achieve an early diagnosis of subtle Myocardial Dysfunction induced by anticancer treatment. Relevant publications: Eur Heart J 2008;29: P2981 Arch Hell Med 2008;25(Suppl1):A223 Eur Heart J 2011;32:459.

Ongoing prospective study in collaboration with the University of Athens Medical School entitled “Systolic inotropic reserve as a tool for risk stratification of cardio toxicity in breast cancer patients.” Study No. 189015687/20-12-2018.

• Side-effects of oncological drugs  Development of protocols for the management of cardiac side-effects of oncological drugs.

Role: Advisor to major pharmaceutical companies, currently working with IEO Milan, Erasme Brussels and Tenon Paris.

• Cardio-oncology guidelines Development of research protocols in Cardio-oncology and setting up the first Greek registry of Cardio-oncology patients. Role: Advisor to the Therapeutic Department of the University of Athens and author of Greek Cardio-oncology guidelines since 2018.

• Cardio-oncology registry Participant in EORP: Cardiac Oncology Toxicity Registry (ESC-COT EACVI-HFA), an ongoing project under the joint stewardship of the ΕSC and the HFA.

Hypertension

• Masked hypertension

Systematic study of masked hypertension in association with several phenotypes of blood pressure in patients with stage C hypertension, their healthy descendants, and passive smokers. Results: The clinical importance of these phenotypes and their association with high levels of leptin and resistin have also been demonstrated. Relevant publications and international presentations: Am JHypertens 2009 Aug;22(8):853-9 Circulation 2008;118:S_802 JACC 2009;53:A206.1021-76 Eur Heart J 2009;30:376.

• Hypertension and Sleep Apnea Syndrome

Deeper and further study in the association of sleep disorders and arterial hypertension. Relevant publications: Ιnt J Hypertens 2011 Jan 10;2011:947246 J Hypertens 2009;27(4)S206;17.65

• Hypertension and Assisted Reproductive Technology (ART)

Comparative evaluation of special treatments for sub fertility in pregnancies associated with hypertensive complications. Relevant publications: J Hum Hypertens. 2013 Mar;27(3):148-57 J Clin Hypertens (Greenwich). 2017 Feb;19(2):173-183.

• Medication algorithms for the management of arterial hypertension

Study of the safety and efficacy of antihypertensive treatments and, in particular, the feasible combinations of antihypertensive medication, the benefits and limitations of using double and triple combinations of antihypertensive medications, and outcome standardization to blood pressure reduction. Relevant publications: JHypertens 2019 Aug;37(8):1587-1589 JHypertens 2018 Jan;36(1):31-33.

Dyslipidemia

• Links between the treatment of dyslipidemia and risk reduction Analysis of the emergence of the primary outcome  through the evaluation of benefits resulting from different levels in lowering LDL-C in correspondence with a reduction in outcomes. Relevant publications: Clin Cardiol. 2015 Dec;38(12):763-9. Epub 2015 Circulation 2018 Jun12;137(24):2656-2657.

Continuing Medical Education

Postgraduate Course in Heart Failure University of Zurich, Switzerland, 2016-2017

Syllabus: Drug treatments, arrhythmias and device therapy, multidisciplinary procedures, acute and advanced HF, mechanical circulatory support and transplantation. Sponsored by the European Heart Academy of the ESC, and the Heart Failure Association.

Training in 3-D Cardiac Echo Echo Lab, University Hospital of Padua, Italy 2016

Cardiac CT imaging  Centro Cardiologico Monzino, Milan, Italy 2015

Advanced Echo Course Stress echo, Trans-esophageal, Strain imaging. Duration: six months. General Hospital of Nikea,  Athens,Greece  2011

Emergency Pre-hospital Medicine Duration: 400 hrs. Exam-based certification. National Emergency Assistance Center, Athens, Greece  2008