8^th Global Cardiologists and Echocardiography Annual Meeting July 18-20, 2016 Berlin, Germany

Biography:

Robert Skalik, MD, PhD is a consultant in cardiology, exercise physiologist. He completed his PhD in echocardiography from Medical University of Wrocław. He covered internship in the Department of Cardiology at Free University of Amsterdam, the Netherlands. He is a lecturer in Post-graduate School of Cardiology, University of Perugia and an academic teacher and researcher in Department of Physiology, former consultant in cardiology in Department of Cardiac Surgery and Cardiology, Medical University of Wrocław, former Head of Department of Cardiac Rehabilitation, Wrocław, private practice in cardiology, Wrocław, research projects evaluator for EU. He has published 103 papers on cardiology and human physiology.

Abstract:

Physical capacity is a complex process and may be subject to significant modulation due to intensity of aerobic and anaerobic processes, efficacy of thermoregulation, psychomotor performance and psychological factors irrespective of normal functioning of the cardiovascular and musculoskeletal systems. Hence, the dynamics and magnitude of changes in core body temperature in response to acute physical exercise in cardiopulmonary exercise test (CPX) and their relationship to exercise capacity have not been elucidated yet. The role of the cortical centers in modulation of fatigue perception in physically active people is also controversial. The cerebral cortex is a significant determinant of psychomotor performance. The results of the study confirmed a significant relationship between core body temperature at maximal physical effort (Tc) in CPX and psychomotor performance in healthy amateur athletes. The psychomotor performance was also related to carbon dioxide output at maximal physical exercise, ventilatory equivalent for carbon dioxide at the anaerobic threshold. Thermo-metabolic (VO2AT divided by Tc) and neurothermo-metabolic (VO2AT divided by the sum of Tc and psychomotor performance score) index are strongly related to parameters of exercise capacity as measured at maximal physical effort during CPX (VE, VCO2). The Rate of Perceived Exertion (Borg scale) immediately after CPX, is not related to Tc, exercise capacity parameters and psychomotor skills. The magnitude of changes in core body temperature during CPX may affect the parameters of physical fitness through modulation of psychomotor skills. Psycho-motor performance influences ventilator parameters. Subjective perception of physical effort does not correlate with exercise capacity parameters in CPX.

Biography:

Shaimaa Moustafa is an Assistant Professor of Cardiology Department of Cardiology, Benha Faculty of Medicine, Benha University, Egypt.

Abstract:

Introduction: Myocardial deformation assessed by two dimensional speckle tracking echocardiography (2D-STE) allows accurate evaluation of regional and global left ventricular (LV) function and is sensitive to detect abnormalities induced by ischemia. Objective: To examine the value of speckle tracking echocardiography to detect the presence, extent and severity of coronary artery affection in patients with suspected stable angina pectoris. Methods: 200 candidates with suspected stable angina pectoris and normal resting conventional echocardiography were subjected to 2D-STE and coronary angiography. Global longitudinal peak systolic (GLPSS) and the most affected segment was calculated and were correlated to the results of coronary angiography for each patient. Results: There was a statistically significant difference in the mean of global longitudinal peak systolic strain between normal coronaries and different degrees of CAD (-20.11± 0.8 for normal, -18.34± 2.52 for single vessel, -16.14± 2.85 for two vessel, -14.81± 2.12 for three vessel, -13.01± 2.92 for left main disease). Global longitudinal peak systolic strain showed high sensitivity for the diagnosis of single vessel CAD (90%, specificity 95.1%, cutoff value: -18.44, AUC: 0.954); two vessels disease (90%, sensitivity 88.9%, cutoff value -17.35, AUC: 0.906) and for three vessels CAD (cutoff value -15.33, sensitivity 63% & specificity 72.2% AUC 0.681) GLPSS also showed statistical significance for localization of the affected vessel for LAD, LCX and RCA(P= 0.001) and significant correlation with syntax score (P= 0.001) . Conclusion: 2D-STE has good sensitivity and specificity to assess the presence, extent and severity of CAD.

Biography:

Vincenzo Cianci I is senior registrar in cardiothoracic surgery at the University of Swansea in UK, previously was staff resident of cardiac surgery at the University of Sacred Heart in Campobasso (Italy). He obtained his medical degree at University of Naples (Italy), and he completed his post graduate training at University of Milan. Dr Cianci began his surgical career as fellow at Humanitas Gavazzeni clinic in Bergamo, after he was staff resident at University of Pavia for five years. In 2011 he was senior registrar in cardiothoracic surgery at Queen Elizabeth Hospital at University of Birmingham (UK). In 2012 He was staff resident in cardiocentro Ticino Lugano (Switzerland). His past clinical practice has encompassed the full spectrum of adult cardiovascular and thoracic surgery including experience in heart and lung transplantation, left ventricular assist device. His current practice focuses on minimally invasive coronary By pass graft, thoracoscopic epicardial atrial fibrillation. He collaborates actively with Prof. Benetti for the development of Hybrid coronary revascularization with a novel surgical technique.

Abstract:

From 1990 to 2016 38 patients received Hybrid coronary treatment during the same Hospitalization in ours Institutions with different surgical off pump approaches, Sternotomy, MIDCAB and MINI OPCABG. 20 patients were stenting after a MINI OPCABG operation. The average age was 69±4.8, 4 patients had Left Main and a Right coronary lesion 10 patients had three vessels disease and 6 two vessel disease; the average SYNTAX score was 35.2 (range33-43). Eight patients received a circumflex and right coronary stenting six patients a right and six a circumflex coronary stenting. We described the technique and methodology for this approach. Technique: The patients are prepared as for standard coronary bypass operation through medium sternotomy. A skin incision is made from the xiphoid up to the level between the third and fourth intercostal space. The sternum is open and the left table is lifted to dissect the left mammary up to the third intercostal space, in general around 7 to 10 cm. isolated without the veins. It is important that the angle of the superior part where the mammary is attached to the sternum has to be below 20% to avoid any potential kinking. After the pericardium is cleaned to identify the area of the pulmonary artery, the pericardium is open to the apex and towards the right around 5 to 6 cm., initially in that moment in most of the cases the area of the LAD is seen and the potential area of the anastomosis is defined, mechanical stabilizer is always in position in this place with the opening part towards the head of the patient to avoid any problem of damaging the graft when you need to take it. The anastomosis is performed in a running way with 7 or 8 polypropylene depending on the size of the artery. We didn't use shunt, normally except if the artery has more than 2,5 mm in size. Results: No thirty day mortality was reported in our series. All patients completed hybrid procedure and there wasn’t any conversion to full sternotomy. Mean intubation time was 1.5±3.2 hrs and length of hospital stay was 3.2±1.2 days, two patients reiceved packed RBC (red bloodcells) transfusion, hospital MACCE was 0%. During PCI procedure angiographic evaluation LIMA grafting was routinly performed and LIMA patency rate was 100% at one year follow up. Patients freedom from MACCE was 100%. Conclusion: The introduction of DES with lower rates of restenosis and better clinical outcomes may make hybrid coronary revascularization a more sustainable and feasible option than previously reported. Nevertheless, this hybrid approach has not been widely adopted because practical and logistical concerns have been expressed. These concerns implicate the need for close cooperation between surgeon and interventional cardiologist, logistical issues regarding sequencing and timing of the procedures and the use of aggressive antiplatelet therapy for DES can be minimised. We believe that with MINI-OPCABG can solve these issues because this surgical technique reduces the surgical trauma without opening pleural space with less discomfort for the patient, moreover the partial dissection of LIMA reduces the risk of post operative bleeding The HCR procedure was associated with short hospital stays (including ICU stay and intubation time), low MACCE and 30-day mortality rate, low PRBC transfusion requirements. This study has limitations because it was based on the retrospective design, moreover patients for one stop hybrid coronary revascularization were also carefully selected and our good results should be interpreted with caution. However there is a small sample size and longterm follow-up and randomized multi center trial comparing one stop hybrid revascularization with MINI-OPCABG with conventional CABG will be needed. These favourable preliminary findings warrant further investigation.

Biography:

Shailesh Kumar Patil has done his MBBS and MD internal medicine from reputed institutions in India with academic excellence. Trained in cardiology for 3 years in one of the high volume centre in India, where highest number of pacemaker implantations are done in asia. Also well trained in thansthoracic and trasesophageal echocardiograph and performed around 5000 femoral and radial angiographies, 1000 angioplasties including complex corornary and peripheral angioplasties, pediatric device implantations and balloon mitral valvuloplasty. He has got 7 national and international publications to his name. He is presently consultant cardiologist at 250 bed tertiary hospital in Pune, India.

Abstract:

Rheumatic heart disease occurring at a young age including juvenile mitral stenosis results in morbidity as well as mortality in adolescents and young adults, and also becomes one of the major cause of loss of the most productive years of life in developing countries like India. Rarely rheumatic MS may occur in < 5 years age, wherein rapid hemodynamic progression and cardiac morbidity and mortality occur. Our patient was 4 years old child with severe mitral stenosis (documented since 2 year 6 months of age) presenting with repeated pulmonary edema and the typical echocardiographic findings strongly indicated a rheumatic origin of this condition. Considering the fulminating nature of disease, patient was planned for early intervention and was taken for balloon mitral valvotomy with 20 mm Tyshak balloon. Percutaneous transmitralcommisurotomy (PTMC) may therefore become the only lifesaving intervention in these cases unless contraindicated, although the procedure entails considerable technical issues in this age group like sizing of peripheral venous sheath, choice of balloon, estimation of optimum balloon size by the height criteria. A few case series of balloon mitral valvotomy in patients aged 7 to 12 years have also been reported, and the procedure has been safe and effective even in this young population. To the best of our knowledge,our patient was the youngest documented case of established rheumatic heart disease and also one of the youngest PTMC procedure performed.

Biography:

Nany Hassan Abu Al-Makarim El Gayar is an Assistant Professor of Internal Medicine, Geriatrics Department at Alexandria University, Egypt. He has done MS in Rheumatology and MD in Geriatrics. He has published 10 papers in reputed journals.

Abstract:

Metabolic syndrome (MetS) is a major public-health problem and clinical challenge worldwide. Several epidemiological studies have confirmed the increased risk of CVD in individuals with MetS. Osteocalcin (OCN) is a bone-derived, noncollagenous protein that recently recognized as hormone regulating energy metabolism. Importantly, osteocalcin expression has been described in calcifying vascular smooth muscle cells We aimed in the present study to analyze the correlation between serum levels of OCN and vascular calcification in elderly persons with metabolic syndrome. 74 elderly males, 65 years and older were included in the present study, divided into two groups; group I; 40 patients satisfied at least three criteria of the metabolic syndrome (MetS) according to NCEP-ATP III definition, and group II; 34 age-matched healthy males serving as a control group. BMI was calculated, blood samples were taken for lipid profile, and total OCN levels using ELISA kits. Carotid Doppler B mode ultrasonography was done for all participants. Patients with MetS exhibited significantly higher BMIs, waist circumference, fasting blood sugar, Triglycerides, blood pressure, total cholesterol, and lower HDL-ch, compared to the controls subjects. Patients with MetS had significantly lower levels of total Osteocalcin than control subjects. Also, patients with MetS had significantly higher IMT and higher number of carotid plaques than the control subjects. Total OCN was significantly negatively correlated with parameters of carotid atherosclerosis. It is also negatively correlated with dyslipidemic parameters. Its correlation with components of Mets did not reach a statistical significance. We concluded that serum osteocalcin levels were significantly associated with carotid atherosclerosis in patients with metabolic syndrome. This may reflect the role of osteocalcin as a circulating endocrine factor which regulates glucose metabolism and thereby cardiovascular risk in patients with metabolic syndrome. Prospective studies are needed to assess the time course and relevance of serum osteocalcin in the development of atherosclerosis in patients with metabolic syndrome.

Biography:

Graduate of Al-Azhar University in Cairo, Egypt and specialized in Cardiology since being a resident in the dept. of Cardiology. International training in the University of Pittsburgh medical center, USA ( preventive Cardiology).Later in the university of Britania occidentale in France ( Interventional Cardiology).Full professor of Cardiology and director of the cath lab, Al-Azhar uni. Member of the post graduate teaching and examining board.Supervised and evaluated more than 40 research projects for Master and Doctorate degrees in national universities in Egypt.Consultant of the National health organization in Egypt.Reviewer In the Egyptian Journal of hospital Medicine.

Abstract:

In this work 100 Egyptian patients of age range (53.89+8.11 years) with suspected CAD were included, they underwent full clinical evaluation, coronary calcium score in all calcified lesions along the major epicardial arteries and the whole-heart Agatston score measured using the multi-slice spiral computed tomography. Coronary angio was done to all patients for proper evaluation of degree of coronary stenosis. In the study group, one, two, three and four coronary lesions were found in 40%, 19%, 32% and 8% respectively, while the related median total calcium score was found to be 104, 78, 36 and 249 respectively. LM artery showed Agatston score of 11.73, 128.65 and 241.6 in normal, mild and significant stenosis respectively with P value of P<0.001. LAD artery showed Agatston score of 3.21, 35.3, 68.27 and 87.92 in normal, mild, significant and total occluding lesions respectively with P value of P<0.001. CX artery showed Agatston score of 33.42, 73.09, 11.54 and 12.14 in normal, mild, significant and total occluding lesions respectively with no significant correlation. RCA artery showed Agatston score of 5.58, 0, 4.16 and 101.7 in normal, mild, significant and total occluding lesions respectively with P-value of P<0.001. In this work – First to study an Egyptian population – the Calcium score estimated by non-invasive multi-slice CT in the studied group with low and intermediate calcium scores does not correlate closely with the degree of coronary artery stenosis estimated by coronary angiography and does not correlate with the known international figures and grades for Agatston score. A question about the pathophysiology of the plaque formation in Egyptians and possibly opening the door for specific preventive measures is to be considered.

Biography:

Andreas Petropoulos graduated from Aristotle University’s Medical School, Greece in 1989. Followed 30year career as a medical officer, senior Flight Surgeon in the Hellenic Air-Force. Specialized in Aviation-Hyperbaric Medicine, Pediatrics, Fetal, Pediatrics and Congenital Cardiology in USA, Europe. He holds MSc in Preventive Cardiology and a member of AEPC working groups in “Prevention” & “Heart Failure-Pulmonary Hypertension”. He worked and lectured in Athens and Brussels universities. Currently consults in Pediatrics, Fetal. Pediatrics & Congenital Cardiology in MerkeziKlinika and Associate Professor at the State University and Post Graduate, CME Center in Azerbaijan. His research focuses on prevention, CVD imaging techniques, fetal cardiology, heart failure.

Abstract:

Heart failure (HF) in childhood is a clinical and pathophysiological syndrome, resulting from: 1.Ventricular inotropic dysfunction, 2. Volume and/or Pressure overload, 3. Irregular heart rhythm 4.Long standing hyperdynamic circulations leading to a mismatch to the metabolic needs of the body. Presents as failure to thrive, respiratory distress, exercise intolerance and associated with circulatory, neurohormonal, molecular abnormalities. HF has numerous etiologies. It is a common clinical presentation as a consequence of cardiac or non-cardiac disorders, congenital or acquired. The aim of this paper is to present the current advances on treatment of HF in childhood. It focuses on the 2014 International Society of Heart and Lung Transplantation (ISHLT), guidelines. These improve the previous 2004 ISHLT guidelines and amalgamate scientific data from the 2013 ACCF/AHA for management of HF in adults. We will focus on the existing variety in treatment strategies.

Biography:

Youssef Fathy Mohamed Nosir had graduated from Faculty of Medicine, Al-Azhar University, Egypt in 1985. He completed his Cardiology training and obtained MSc in 1991 from Al-Azhar University. He spent a fellowship at Thorax center, Rotterdam, the Netherlands from 1994-99 and obtained his PhD at 1999 from Erasmus University, Rotterdam. He also obtained MD (Doctorate degree in Cardiology) in 2001 from Al-Azhar University. His current position is Consultant Cardiologist at King Fahd Armed Force Hospital, Jeddah, KSA and Professor of Cardiology at Al-Azhar University, Cairo, Egypt.

Abstract:

TAVI is a relatively new procedure for replacing the non operable severely stenotic AV in elderly patients. TEE monitoring the procedure is still questionable. At KFAFH, Jeddah, KSA, TEE was performed during TAVI procedure to re-measure the annulus size and to monitor all procedure steps. 47 patients underwent TAVI procedure at KFAFH between 20112 and 2015. The procedure was successful in all patients. TEE could detect 9 acute complications during the procedure that were managed immediately. 1- One acute fresh mobile thrombus was detected over the catheter in LV after balloon dilatation. The catheter was removed with the thrombus thread over it. 2- Acute severe MR in 4 patients TEE could detect the cause, one was due to acute ischemia and 3 were due to distal displacement of posterior MV leaflet by the LV catheter. MR was disappeared after dealing with the cause. 3- Pericardial effusion was detected immediately post procedure in 3 cases that necessitate tapping. 4- Acute severe hypotension immediately following valve deployment during rapid pacing was detected in one patient. TEE revealed acute severe LV systolic dysfunction with SWMA related to distal LAD segments and development of severe MR. Immediate coronary angiography revealed acute LM stenosis and primary stenting was performed with DES. After LM stenting LV systolic function improved and MR was disappeared. In conclusion TEE is recommended to monitor TAVI procedure for early detection of acute complication during the procedure that allows immediate and proper management of complication for favorable clinical outcomes.

Biography:

Krzysztof Piotrowski, a specialist in Obstetrics, Gynecology and Clinical genetics, completed his PhD with a dissertation on fetal echocardiography. Putting his knowledge into practice, he performs about 3,000 USG investigations of gravidas annually for prenatal diagnosis. He has published many scientific papers and chapters covering prenatal diagnosis. Having introduced the BACs-on-BEADs TM technology to Polish diagnostics, at present he is focused on applying molecular genetics prenatally. For the last nine years he was the Manager of Cytogenetic Unit for Pomeranian Medical University, Szczecin, Poland. Lately, he has founded a new independent genetic centre, DIAGEN – PREDIAG.

Abstract:

Congenital Heart Diseases are the most common malformations both as an isolated form and a part of genetic syndromes. Extraordinarily fast development of molecular genetics confirms that almost all CHD are genetically dependent in terms of micro aberrations in different regions of a chromosome or single gene mutations. On the other hand, CHD are an important component of diverse genetic diseases, including monogenic, metabolic and mitochondrial disorders, most often as secondary cardiomyopathies. The genes participating therein are located nearly on each chromosome, mainly on pathways, along with ligand genes and co-factors, transcription factors or individually. Many mechanism on heart development are based on the balance between apoptosis, proliferation and migration. Crucial genes controlling fetal development, including the creation of heart tube and the forming of left and right ventricular outflow are primary “homeobox” genes grouped in 4 clusters HOX1- 4 . Other genes condition the forming of different structures. Moreover, in numerous functional disorders, for example the arrhythmia or block, the reason is also genetic, namely the mutation of ion- channel gene placed in 6 chromosomes.Many genes of cardiogenesis were identified thanks to the investigation of other genetic disorders, for example PTPN11 gene in Noonan syndrome. The gene is also responsible for the development of pulmonary valves or TBX5 gene in Holt-Oram Syndrome. Heart development is also affected by the imprinting (about 30 genes) and the inactivation of the X chromosome in day 21 stage of embryo. We propose, e.g. a practical classification could refer to specific CHD characteristic of particular disorders, which might prove helpful in daily practice because in prenatal diagnosis CHD is often the sole syndrome confirmed by USG scan, which may depend on truly isolated nature or non-specific mild ultrasound co-markers.

Biography:

Klaus-Dieter Schlüter, born 09.07.1959, studied biology at the Westfälische-Wilhelms-University, Münster, Germany. He made his PhD at Gesellschaft für Biotechnologische Forschung, Braunschweig, Germany, and spent his Post-Doc education at Heinrich-Heine-University Düsseldorf, Germany. In 2002 he became professor for physiology at Justus-Liebig-University in Giessen, Germany. Research areas are biology of cardiomyocytes, hypertensive heart disease, and ischemia/reperfusion. He published over 100 original articles and several review articles, editorials and book chapters. Current activities include editing of a book entitled “Cardiomyocytes – Active players in cardiac disease”. He is member of the German Society of Cardiology and of the German Physiological Society.

Abstract:

Cardiomyocytes are terminally differentiated cells in a term that they lose their ability for cell division shortly after birth. However, cardiac remodeling requires intensive reconstruction of contractile units that is still possible in these cells. Cultivation of adult rat ventricular cardiomyocytes (ARVC), terminally differentiated cells, on culture dishes requires remodeling of cells in order to adapt cell shapes to the two-dimensional surface. It is known that ARVC are able to degrade their contractile units (sarcomeres) and reform new sarcomers alongside stress fibres. However, it is not known which molecules trigger this process and whether this process is comparable to remodeling processes in vivo. We recognized that swiprosin, a calcium-dependent protein that stabilizes actin filaments and thereby stabilizes stress fibres, is required for the reformation of sarcomeres in ARVC. When swiprosin activation is blocked by verapamil or when swiprosin is downregulated by administration of siRNA directed against swiprosin, ARVC were unable to rebuilt sarcomeres. Moreover, in vivo expression of swiprosin was induced in post-infarct hearts during a phase of intensive cardiac remodeling. Swiprosin expression strongly correlated with GRK2 expression that represses β-adrenoceptor coupling. In vitro, silencing of swiprosin reduced GRK2 expression and this improved β-adrenoceptor coupling. A role for increased diastolic calcium levels in cardiac calls has well been described in cardiac remodeling. However, these effects were linked to calcineurin-dependent transcription factor activation and could exlplain only part of the remodeling process. Here we describe another link between diastolic calcium levels and remodeling requiring activation (dimerization) of swiprosin in cardiomyocytes.

Biography:

Rohit M Sane, MBBS, is a pioneer of non-invasive cardiac care management. He is the Founder of Madhavbaug Cardiac Rehabilitation Center which includes 138 OPDs & 2 IPDs in Maharashtra, India.

Abstract:

Abnormal six-minute walk test (6MWT) findings which indicates decreased functional capacity is considered as predictor of increased cardiovascular risk and mortality. However, the importance of this variable as predictor of mortality in heart failure (HF) patients with low ejection fraction (EF) is not well established. Therefore, we aimed to determine the influence of 6MWT findings on prediction of cardiac-related mortality in patients with low EF. Analyses were based on 108 heart failure patients with low EF undergoing treatment at Madhavbaug Cardiac Rehabilitation Centre between January 2012 and January 2014. Estimated functional capacity measured through 6MWT findings (expressed as the distance walked in meters) to determine its prognostic importance during 3 years of follow-up. Of 128 patients, 50(39%) died during follow-up; all reported deaths were found to be as cardiac related. In survived patients group, the distance walked was greater than 409.72(±93) meter while in died patients group; it was less than 300.17(±124) meter. The 2D echo data suggested that in both the groups, the left ventricular mass was 290 g and ejection fraction was 28.7% and 26.62% in survived and died patients, respectively. On uni-variable analysis, estimated functional capacity measured through 6MWT findings was a strong predictor of death, with 50(39%) deaths occurring in patients achieving p<0.05. On multivariable analysis, the strongest independent predictors of cardiac related mortality were poor functional capacity. The distance walked by patients in 6MWT had strong relation to the number of reported deaths; functional capacity was a predictor of death. For reported cardiac mortality; functional capacity remained as independent predictor of mortality.

Biography:

Boris Schmitt completed his medical studies in Freiburg, Innsbruck and Berlin. In 2001 he started his career as a pediatrician at the DHZB in the department of congenital heart disease.On a journey through the Berlin hospitals (Charité departments and the Children’s Hospital Neukölln) he gained experience in different pediatric specialties including emergency medicine and neonatal and pediatric intensive care.He completed his doctoral thesis in 2005 and his medical specialization in pediatrics in 2007, returned to DHZB and became a member of the cardiovascular MRI team. Boris has been the team leader of KidCathLab since the very beginning in 2009. When the group came to life he shifted his focus from clinical work to research activities.His main interests and abilities are pediatric cardiology, catheterization and imaging. And most importantly, he has an open (h)ear(t) for new ideas. He is also a co-founder of a company for planning, implementation and marketing of telemedicine networks and he is certified in mountain and expedition medicine.

Abstract:

Beta-blockers contribute to treatment of heart failure. Their mechanism of action, however, is incompletely understood. Gradients in beta-blocker sensitivity of helically aligned cardiomyocytes compared with counteracting transversely intruding cardiomyocytes seem crucial. We hypothesize that selective blockade of transversely intruding cardiomyocytes by low-dose beta-blockade unloads ventricular performance. Cardiac magnetic resonance imaging (MRI) 3D tagging delivers parameters of myocardial performance. We studied 13 healthy volunteers by MRI 3D tagging during escalated intravenous administration of esmolol. The circumferential, longitudinal, and radial myocardial shortening was determined for each dose. The curves were analyzed for peak value, time-to-peak, upslope, and area-under-the-curve. At low doses, from 5 to 25 µg/kg/min, peak contraction increased while time-to-peak decreased yielding a steeper upslope. Combining the values revealed a left shift of the curves at low doses compared with baseline without esmolol. At doses of 50 to 150 µg/kg/min, a right shift with flattening occurred. In healthy volunteers we found more pronounced myocardial shortening at low compared with clinical dosage of beta-blockers. In patients with ventricular hypertrophy and higher prevalence of transversely intruding cardiomyocytes selective low-dose beta-blockade could be even more effective. MRI 3D tagging could help to determine optimal individual beta-blocker dosing avoiding undesirable side effects.

Biography:

Brojendra Agarwala has completed his MBBS from University of Kolkata, India and completed Pediatric cardiology fellowship from New York University Medical Center New York, NY, USA. He is a Pediatric Cardiologist and Professor of Pediatrics at the University of Chicago. He has received best teacher award by the pediatric residents and the medical students. He has published 68 papers in reputed journals. He is named as one of the Top Doctors and Best pediatricians in Chicago magazine for many years.

Abstract:

Competitive athletes are those who participates in an organized team or individual sports that requires regular competition against others. Athletic activities substantially increase the sympathetic drive resulting in surge in catecholamine level that increases blood pressure, heart rate, myocardial contractility and oxygen demand. This can cause myocardial ischemia and arrhythmia that may lead to sudden death in athletes with known and unrecognized heart conditions during athletic activities. It is estimated that 1-2/100,000 SCD/year happens worldwide. According to the International Olympic Committee, SCD rate in athletes is ~ three times higher than in the normal population. There are many structural and acquired heart conditions that are not clinically manifested. Many physicians are involved in medical clearance of children for participations in school sports activities. Physicians have to recognize them to protect athletes from catastrophic events. In order to prevent sudden cardiac death physicians should be aware of cardiac conditions that may cause problem. Also physicians should be familiar with general guidelines for evaluation of an athlete and clearance for participation in athletic activities. Guidelines vary in different parts of the world. In this presentation I will discuss guidelines for European, Italian and in USA outlined by American heart Association. In this presentation the causes of congenital and acquired heart conditions and arrhythmias that can cause sudden cardiac death will be discussed with authors experience and literature review.

Biography:

Moustafa M. Eldeib was Graduated from faculty of medicine .Alazhar university 2007 with grade excellent with honor, master degree of cardiovascular degree at 2011 (at age 28 yrs old)with grade very good, MD thesis was discussed last January.( at age 32 yr old)

Abstract:

Background: Conventional echocardiography at rest provides little information regarding the presence of CAD, Longitudinally orientated myocardial fibers are located subendocardially, the area most susceptible to ischaemia, that is why measurements of longitudinal motion and deformation may be the most sensitive markers of CAD using (2DSE) The aim of this study was to determine if 2DSE performed at rest can enhance the sensitivity of exercise test and if it can predict the presence of coronary artery disease in patients with stable angina pectoris. Methods: our study included (120) subjects suspected to be stable angina pectoris patients presented for evaluation of chest pain at Al-Hussein University Hospital – Al-Azhar University – Cairo – Egypt between December 2013 and December 2015, The patients were classified according to coronary angiography results in to two groups: Group (A): 40 patients with normal coronary angiography as a control subjects,Group (B): 80 patients with significant coronary artery disease. Results: There was statistically significant difference between the two groups as regard E wave, A wave, E/A ration, DT, Em and E/Em, there was statistically significant difference between the two groups as regard SLSS and GLS 17 and GLS 12, there was statistically significant difference between the two groups as regard SLSr and Sr17and Sr 12, there was statistically significant difference between the two groups as regard ST segment deviation during stress ECG, exercise capacity (METs) and Duke Score,;in this study we found that strain parameters at BA, BAS, MA, MIS, MAS, AI and AL segments were found to be significant predictor of LAD stenosis and BP and MP were found to be significant predictor of LCX stenosis and BI was found to be predictor of RCA stenosis, also we found that strain rate parameters at BA, MA, MAS, AI, AL and apex segments were found to be significant predictor of LAD stenosis, and BL, BP and ML were found to be significant predictor of LCX stenosis and BI and MI were found to be predictor of RCA stenosis, the diagnostic performance of the exercise test was significantly improved by GLS17 in terms of a significant increased AUC for the exercise test in combination with GLS17 Conclusion: In patients with suspected SAP, GLS assessed by 2DSE at rest is a predictor of significant CAD and significantly improves the diagnostic performance of exercise test, and capable of identifying which coronary artery is stenotic.

Biography:

Dr Stephenson’s research interests lie in the field of functional cardiac anatomy. Exploiting national and international collaborative relationships he uses multi-scale imaging techniques, including micro-CT and synchrotron-CT, to investigate the micro-anatomical structure and function of the working myocardium and cardiac conduction system in healthy and failing hearts. Dr Stephenson graduated with a first class honours degree in Anatomy and Human Biology from the University of Liverpool (UK) in 2009. Later that year he received the Cardiac Surgery Research Award from Alder Hey Children’s NHS Foundation Trust, funding his PhD and subsequent post-doctoral position. In 2016 Dr Stephenson was appointed Lecturer in Medical Sciences-Anatomy at the University of Central Lancashire, and currently holds honorary positions at the University of Liverpool, Liverpool John Moores University and Alder Hey Children’s Hospital. This year he was awarded an EU funded Marie Sklodowska-Curie Individual Fellowship, the project aims to investigate the potential diagnostic link between regional micro-structural and metabolic remodelling in heart disease.

Abstract:

The intricate micro-structure of the heart and its relationship with cardiac function has been debated for decades, without current consensus. Therefore scientists and clinicians strive to improve our understanding of cardiac anatomy in 3D, and provide 4D explanations of its role in contractile function in health and disease. Ex-vivo contrast enhanced micro-CT utilises the same principles as clinical CT, producing 3D tomographic images non-destructively. Micro-CT, however, permits spatial resolutions approaching the scale of individual cells (5-20 µm). Our iodine based contrast agent allows differentiation of multiple soft tissue types; fat, myocardium, conduction system, and extracellular matrix show decreasing X-ray absorption and thus grayscale values respectively. Using micro-CT to image human and rabbit hearts ex-vivo, we reveal the true structural heterogeneity of the heart in 3D and provide new insight into the structural basis for antagonistic forces generated within healthy and failing hearts. We show how the myocyte chains aggregate to form a heterogeneous interconnected network of lamellar units, bound internally by dense endomysium and externally by sparse perimysium. The units are seen to be complex and variable 3D structures, which exhibit sheet, cord, and branched elements. They maintain the helical myocyte arrangement, but can twist and intrude radially, occasionally forming orthogonal abutments with adjacent units. We have obtained 3D myocyte orientation at near cellular resolution. Using computer algorithms we extract the helical and intrusion angle of the myocytes on a voxel by voxel basis; the longitudinal chains they form are then tracked and visualised in 3D. Thus we reveal the heterogeneity of myocyte arrangement, showing the classic helical depictions to be over-simplified. Many myocytes have intruding angles greater than 20°, with an increased population observed in the sub-endocardium. This number is reduced in regions of dilatation in failing hearts, potentially hampering diastolic filling and reducing intrinsic stability thus perpetuating dilatation. This data gives new insight into the structural heterogeneity of the cardiac mesh, revealing the complex 3D morphology and interactions between the lamellar units and myocyte chains housed within them. We show how the intrusion of chains of myocytes offers a structural basis for intrinsic antagonism, and show how myocyte intrusion is reduced in regions of dilatation, providing new information on contractile dysfunction in the setting of intrinsic antagonism.

Biography:

Christoph Brune is a tenure track assistant professor for computational mathematics (NWO, NDNS+) in the Department of Applied Mathematics at the University of Twente. In the group Applied Analysis and Computational Science his mentor is Prof. Stephan van Gils (chair nonlinear analysis).In 2011-2012 he was a CAM Assistant Adjunct Professor in the Department of Mathematics at University of California Los Angeles (UCLA) working together with Prof. Andrea Bertozzi and Prof. Stanley Osher on projects in inverse problems, 4D imaging/image processing, optimal transport and machine learning. Christoph taught classes and supervised Bachelor, Master and PhD students.

Abstract:

Obtaining a quantitative micro-structure analysis of the myocardium is essential to its understanding as a structured continuum. To address the interplay of structure and intrinsic antagonistic function of the myocardium while comparing normal and diseased hearts there is a strong need for an automatic, robust and precise framework to measure in a rapid procedure the 3D arrangement of bundles of cardiomyocytes. In this work we focus on pneumographic micro-CT measurements of porcine hearts. The main contribution is an automatic framework for quantitative 3D structure analysis of the whole myocardium with the same impressive resolution like the measured data. Prior to and during micro-CT- imaging the myocardial interstitial space was slightly pneumatically distended for better discrimination of the heart muscle´s lamellar basic structure. Compressed air was perfused through the coronary arteries, resulting in an isolated distension of the perimysial inter-lamellar space, while the dense endomysial compartment was not reached by gas. CT-imaging was performed in a Scanco Medical micro-CT device. Via novel mathematical imaging techniques and efficient computer algorithms, adequate for very high-resolution data sets, we can obtain precise quantitative values of helical and intruding angles at each voxel of the myocardium. The mathematical framework is based on three main steps: (1) a preprocessing component, where fine fibre structures are enriched by nonlinear anisotropic noise filters and simultaneous contrast enhancement, (2) an orientation estimation component, which uses novel structure tensor methods to compute the local orientation at each voxel and (3) an advanced automatic segmentation method which extracts a 3D surface of the myocardium and simultaneously computes normal vectors, serving as precise reference directions for computing helical and intruding angles given by (2). With this imaging tool we can quantify global alignment of heterogeneously interconnected networks of lamellar units. Due to the full coverage of the cardiac mesh and simultaneous segmentation we can also analyse and compare angular distributions between different myocardial compartments. We measure a particularly high prevalence of intruding and extruding structures which deviate from the tangential alignment and which are inclined towards endocardium and epicardium with angles exceeding 40 degrees. Computed helical and intruding angles in the whole myocardium are pivotal data to explain form-stabilizing structures as well as those which drive ventricular wall motion. In the future this might allow further analysis of the relative prevalence of constrictive as compared to dilative forces. According to histological findings and underlined by data from direct measurements of contractile forces in normal and diseased hearts, the relationship of those two opposing forces is disturbed, resulting in a derailment of the intrinsic antagonism of the myocardium, particularly in cases of ventricular hypertrophy which in most cases is complicated by fibrosis.

Biography:

He is from the Cardiology Department KFAFH,Saudia Arabia and the Cardiology department, Alazhar University, Egypt

Abstract:

TAVI is a relatively new procedure for replacing the non operable severely stenotic AV in elderly patients. TEE monitoring the procedure is still questionable. At KFAFH, Jeddah, KSA, TEE was performed during TAVI procedure to re-measure the annulus size and to monitor all procedure steps. 47 patients underwent TAVI procedure at KFAFH between 20112 and 2015. The procedure was successful in all patients. TEE could detect 9 acute complications during the procedure that were managed immediately. 1- One acute fresh mobile thrombus was detected over the catheter in LV after balloon dilatation. The catheter was removed with the thrombus thread over it. 2- Acute severe MR in 4 patients TEE could detect the cause, one was due to acute ischemia and 3 were due to distal displacement of posterior MV leaflet by the LV catheter. MR was disappeared after dealing with the cause. 3- Pericardial effusion was detected immediately post procedure in 3 cases that necessitate tapping. 4- Acute severe hypotension immediately following valve deployment during rapid pacing was detected in one patient. TEE revealed acute severe LV systolic dysfunction with SWMA related to distal LAD segments and development of severe MR. Immediate coronary angiography revealed acute LM stenosis and primary stenting was performed with DES. After LM stenting LV systolic function improved and MR was disappeared. In conclusion TEE is recommended to monitor TAVI procedure for early detection of acute complication during the procedure that allow immediate and proper management of complication for favorable clinical outcomes.

Biography:

Graduate of Al-Azhar University in Cairo, Egypt and specialized in Cardiology since being a resident in the dept. of Cardiology. International training in the University of Pittsburgh medical center, USA ( preventive Cardiology).Later in the university of Britania occidentale in France ( Interventional Cardiology).Full professor of Cardiology and director of the cath lab, Al-Azhar uni. Member of the post graduate teaching and examining board. Supervised and evaluated more than 40 research projects for Master and Doctorate degrees in national universities in Egypt.Consultant of the National health organization in Egypt.Reviewer In the Egyptian Journal of hospital Medicine.

Abstract:

In this work 120 patients suspected of having stable angina pectoris were included, they were presented for evaluation of chest pain and to whom clinical evaluation, echocardiography, nuclear scanning and coronary angiography were done. They were classified into group (A) 40 control patients considered as control group with normal coronaries, and group (B) 80 patients with significant CAD. Results: The study showed that regarding the Echo. Parameters, there were statistically significant difference between the 2 groups regarding the A wave, E/A ration, DT, Em and E/EM. Also regarding SLSS and GLS 17 and GLS 12 as well as SLSr, GLSr 17 and GLSr 12. Significant difference was present regarding number of vessels affected as regard GLS 12, GLSr 12 and GLSr 17. In comparison with the results of MPI, there were positive correlation between the number of segments affected in MPI and GLS 12 and GLSr 12. A statistically significant correlation was also found between the 17 segments in MPI and SLSS and SLSr parameters. Conclusion: Myocardial strain by speckle tracking is superior to conventional echo. Parameters measurements of global and segmental LS using 2DSE an it is more sensitive tool in the identification of WMA at rest than visual analysis and that support its use to risk stratify atherosclerotic CAD. It is found that 2DSE is not inferior to the MPI in the non-invasive diagnosis of CAD.

Biography:

Morten Smerup is from the Dept. of Cardiothoracic Surgery,Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark. He has surgical experience of +50 general surgical cases, incl. appendectomies, herniotomies and gall-bladder surgery, +50 CABG cases, Thirteen aortic valve replacements and one tricuspid valvuloplasty, Fifteen ASD cases, three partial AVSD cases, four VSD cases, two pulmonary valve replacements (both re-dos), two BT-shunts, three coarctation repairs, two RVOTO, one pulmonary artery banding, one subaortic membrane and more than 50 standard pediatric cannulation procedures.

Abstract:

From an anatomical point of view the individual myocytes making up left ventricular walls are organized as an anisotropic three-dimensional mesh. This can be characterized in terms of the myocyte angulation relative to the overall geometry of the heart, i.e. helical angles, transmural angles and transverse angles, but also in terms of the organisation of the myocytes and the connective tissue of the heart into superstructures, the myocyte aggregates (also called myocardial sheets or –lamellae), which can be further characterised according to their relation to the overall geometry. From a functional point of view, the deformation of the cardiac walls has been extensively described using strain theory on local cuboids of myocardium, characterising the so-called principal and shear strains. However only lately there has been a satisfactory synthesis of the anatomical and the functional aspects of the myocardium. In this talk I will attempt to describe the fundamentals with an emphasis on the clinical impact for practicing cardiologists, based upon experimental data on the diastolic and systolic architecture in normal, hypertrophic and dilated porcine hearts. Furthermore, novel theories on potential mechanisms in heart development that govern the final arrangement of the myocardium is presented.

Biography:

Professor Gafarov Valery, in 1974 - MD (Novosibirsk medical university). 1980 - Phd, theme " Epidemiological studying Acute Myocardial Infarction in conditions of large industrial centre of Western Siberia". 1991 - MPH; 2003 - professor on a specialty "cardiology"; 2003 - present time – head of collaborative laboratory of epidemiology cardiovascular diseases and Laboratory of psychological, sociological aspects of therapeutic diseases of Research Institute of Internal and Preventive Medicine. The author of 758 scientific publications (articles and abstracts), from them 6 monographs.

Abstract:

Objective: To explore the job stress effect on risk of stroke and arterial hypertension (AH) in female population of 25-64y in Russia over 16 years of follow-up. Methods: Under the third screening of the WHO "MONICA-psychosocial" program random representative sample of women aged 25-64 years (n=870) were surveyed in Novosibirsk. Levels of job stress were estimated by questionnaire based on Karasek's job demands-control model. From 1995 to 2010 women were followed for the incidence of AH, stroke. Cox regression model was used for risk assessment (HR). Results: The prevalence of high job stress level in women aged 25-64 years was 31.6%. HR of stroke over 16 years of follow-up was 1.96-fold higher (95.0%CI:1.01-3.79, p<0.05) in women with job stress, HR of AH was 1.39-fold higher (95.0%CI:1.08-1.78, p=0.01) compared to those without stress. There were tendencies of increasing stroke and AH rates in married women experienced stress at work. Stroke developed in women with lower educational level and AH significantly higher developed in women with higher educational level (p for all <0.05) having job stress. AH and stroke rates was found higher for physical workers with job stress (χ2=5.47 df=1 p<0.05) and AH rates were tend to be higher in managers experienced stress at work. Conclusions: There is high prevalence of stress at work in female population aged 25-64y in Russia. Women with job stress have significantly higher risk of stroke and AH over 16-th years of follow-up, especially in married ones and in physical workers with job stress.

Biography:

Peter F Niederer is an Emeritus Professor at the Institute of Biomedical Engineering, ETH Zurich, Switzerland. He is also the President of the IT'IS Foundation

Abstract:

In order to demonstrate the hierarchically ordered connectivity of the left myocardium, gentle inflation by compressed air and subsequent CT-based analysis was performed on excised pig hearts. Perimysial spaces become thereby visible and allow to demarcate lamellar segments. In addition to the well-known global helical pattern of the spatial direction field, a quite inhomogeneous arrangement with respect to lamellar segment orientation manifests itself. In particular, up to 30% of the lamellar segments deviate significantly, namely by more than 10° ( up to 45 and more degrees) from a surface-parallel direction. Visual impression might in fact suggest some similarity with a bird’s nest. These findings along with force measurements made in the ventricular wall can be interpreted as follows. First, constrictive units with a primarily transmural orientation counteract to some extent systolic constriction and act in an antagonistic fashion. This feature may on the one hand be protective (excessive deformations are avoided), on the other, modulation of wall thickening according to local conditions is enabled. Second, architectural variations are expected to be such as to prohibit local stress concentrations and equalize overall loading conditions. Geometrically regular fiber architectures were examined in the form of mathematical models that showed, among other, that even slight disturbances of a regular pattern lead to a significant loss of cardiac performance. In contrast, in case of an architecture involving appreciable stochastic local aberrations, even large changes seem to have a minor effect on the ejection fraction thereby stabilizing ventricular function over a wide range of physiological conditions.

Biography:

Ahmed is a resident physician and a researcher in the Department of Thoracic Organ Transplantation at the University Hospital of Essen, Germany. He is a graduate of the faculty of Medicine-Alexandria University, 2006, Alexandria, Egypt. He did his Critical Care Medicine residency in Alexandria university hospital. In August 2008 he completed his Master Degree in critical care medicine. He then worked as a specialist in Critical care medicine for 6 years. His most recent study was published in the Transplant International Journal 2015.

Abstract:

Background: Ventricular assist devices (VADs) have been proven to be effective in improving survival and quality of life in patients with refractory heart failure. However, outcomes depend on a variety of preoperative parameters. Aim of the study: This study evaluates retrospectively the patients profiles; clinical outcome, postoperative complications and mortality in patients who underwent VAD implantation in our center taking into account preoperative Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) levels aiming at anticipation of postoperative complications and optimization of the preoperative strategies. Methods: Between August 2010 and March 2015, 104 patients underwent VAD implantation in our university hospital. INTERMACS profiles were as follow: level 1 in 27 patients, level 2 in 20 patients, level 3 in 27 patients, level 4 in 25 patients, level 5 in 4 patients and level 6 in 1 patients respectively. Patients were divided into 3 groups: Group-A included 27 patients at INTERMACS level 1. Group B included 47 patients at INTERMACS level 2/3 and group C included 30 patients at INTERMACS Level 4/5/6. Preoperative clinical, echocardiographic, and hemodynamic and laboratory data were compared between groups as well as the incidence and time of onset of postoperative complications and mortality. Results: Preoperatively, group A had a significantly lower cardiac index, lower mean arterial blood pressure, lower serum hemoglobin, higher serum blood urea nitrogen, higher serum procalcitonin and higher incidence of metabolic acidosis (p<0.05). Postoperatively, group A had a higher incidence of respiratory failure, Hemorrhage, multi-organ failure, right ventricular failure and tracheotomy (p<0.05). Total mortality was higher in group A than in group B (p = 0.017) and in group C (p=0.017) but not between groups B and C (p =0.81). Early mortality (at 30 days after VAD) was higher in group A than in group B (p=0.015) and group C (p=0.010). After 30 days mortality was not statistically different between groups. Sepsis (47.1%), right ventricular failure (37.5%) and respiratory failure (33.7%) were the most common post-operative complications after VAD implantation, whereas renal failure was the most common complication within 1 week after the operation (23.1%). Multi-organ failure was the most common cause of mortality (13.5 % n=10). Predictors of total mortality were preoperative high central venous pressure (HR, 1.077; 95% CI, 1.019–1.138, p=0.008), high systolic pulmonary artery pressure (HR, 1.056; 95% CI, 1.015–1.099 p=0.007), high serum blood urea nitrogen (HR, 1.031; 95% CI, 1.018–1.045; p=0.001), high serum procalcitonin (HR, 1.134; 95% CI, 1.040–1.237; p=0.04), metabolic acidosis (HR, 3.496; 95% CI, 1.708–7.157; p=0.001), low serum Hemoglobin (HR, 0.780; 95% CI, 0.667–0.913; p=0.02). Conclusion: INTERMACS scale correlates with outcomes after VAD implantation in our single center study. Anticipation of postoperative complications allows for preoperative strategies to minimize these complications. Optimization of preoperative volume status, preload, right heart function, correction of preoperative anemia and management of preoperative sepsis are recommended to lower the total mortality in such patients.

Biography:

Adriana Tamburello is going to compleate her studies at the age of 25 years from Palermo University School of Medicine with honors, and she is doing research activity in Policlinico Paolo Giaccone Chair of Cardiovascular Diseases, Department for Promoting of Health (PROSAMI), University of Palermo, Italy – Division of Cardiology, Regional Reference Centre for Diagnosis and Care of Heart Failure, Centre for the Early Diagnosis of Preclinical Atherosclerosis and for Secondary Prevention of Cardiovascular Diseases, Department of Emerging Pathologies, University Hospital “Paolo Giaccone”, Palermo, Italy.

Abstract:

Background: The Role of Nterminalpro Btype natriuretic peptide (NTproBNP) to stratify risk in patients with heart failure (HF) has been analyzed. NT-proBNP levels are increased in HF, and well correlate with ventricular wall stress and severity of HF. Repeated measurements of this marker through blood sampling, give accuracy of risk stratification. Purpose: To assess the prognostic value of NTproBNP levels and the risk of short-term death in patients with HF. Method: We studied 235 patients with an average age of 74,123 years, with clinical and echocardiographic signs of HF. 161 have HFrEF (EF≤ 45%) while 74 have HFpEF (EF > 45%). NTproBNP was evaluated at the hospitalization and at discharge and in 76 patients it was furthermore checked after 30 days from discharge.The median followup was 8months. We noticed the relationship between percentage NTproBNP increase from baseline to admission, and the percentage NTproBNP reduction from admission to discharge, that it is related with therapy during the hospitalization. Moreover we considered different parameters that may alter basic values NT-proBNP, such as chronic renal failure, physical activities and the use of certain drugs, overcoming these tresholds. Results: NT-proBNP values above 1100 pg/mL are prognostically meaningful in chronic HF, and a rising pattern is predictive of impending adverse outcome. Moreover, drugs used for chronic HF (such as, vasodilators, aldosterone blockers and β-blockers) tend to lower values of NT-proBNP.NTproBNP at discharge give an important prognostic index for mortality (HFrEF 28,9% deceased: CIndex 0,84 P< 0,0001; HFpEF 13,6% deceased: CIndex 0,76 P = 0,0004). In multivariate Cox analysis it is the stronger and independent prognostic factor (HFrEF all P≤ 0,02; HFpEF all P≤ 0,03). The percentage changes stratify the risk only for mortality ( χ2 13,68 P = 0,001) conversely, categorical risk stratification shows a prognostic role for all outcomes (all logrank P< 0,0001) and provides independent prognostic informations when threshold values are specific for HFrEF or HFpEF compared to titrations. Among these patients HF, the median NT-proBNP levels were higher in those patients dying by 45 days median of follow-up (9450 pg/mL) when compared with those surviving (2017 pg/mL, P<0.001 for difference). Conclusions: The determination of levels of NTproBNP in patients with heart failure is important for prediction of cardiovascular events: increased levels of this biomarker indicate the severity of myocardial dysfunction and severity of chronic heart failure. High levels of NT-proBNP are related with decreasing expectation of life and worse quality of daily living.

Biography:

Maria Nathania is an intercalating medical student from Universitas Indonesia, currently undertaking her Post-graduate (MRes, Master by Research) degree in Cardiovascular Sciences at Newcastle University (UK). In 2015, she presented her work on the International Student Congress of Medical Sciences held by the University Medical Center Groningen. She has profound interest in Cardiology and participated in a short research fellowship with Prof. Adriaan A. Voors, MD, PhD, looking at the effect of Aliskiren on urine albumin to creatinine ratio in patients with chronic heart failure and renal dysfunction.

Abstract:

Background: Cardiac dysfunction and diminished performance are major characteristics of heart failure. Diminished cardiac energy phosphate metabolism (i.e. PCr/ATP) has been suggested to cause cardiac dysfunction and chronic heart failure. The aim of this study was to define the relationship between cardiac high-energy phosphate metabolism and cardiac performance. Methods: Thirty-six healthy women (younger, ≤50 years, n=20; and older ≥60 years, n=15) underwent cardiac MRI with 31P spectroscopy to assess cardiac high-energy phosphate metabolism (i.e. PCr/ATP ratio), and performed cardiopulmonary exercise testing with non-invasive central hemodynamic assessment. Cardiac power output (CPO), as a measure of cardiac performance, was calculated as the product of cardiac output and mean arterial blood pressure. Results: PCr/ATP ratio was significantly lower in older compared to younger age women (1.92±0.48 vs. 2.29±0.55, p<0.05), as were peak exercise CPO (3.35±0.73 vs. 4.14±0.81 watts, p<0.01), diastolic function (i.e. E/A ratio, (1.33±0.54 vs. 3.07±1.84, p<0.01), and peak exercise oxygen consumption (1382.9±255.0 vs. 1940.3±434.4 ml/min, p<0.01). Further analysis revealed that PCr/ATP ratio shows significant positive relationship with E/A ratio (r=0.42, P<0.05), peak CPO (r=0.40, p<0.05), and peak oxygen consumption (r=0.50, p<0.01). Subgroup analysis based on age however showed that PCr/ATP ratio was significantly related to peak CPO in younger but not in older women (r=0.44, p=0.05 vs. r=0.14, p>0.05). Conclusions: High-energy phosphate metabolism and performance of the heart decline with age. Our findings demonstrate that cardiac high-energy phosphate metabolism plays an important role in overall cardiac function and performance in younger but not older age.

Biography:

Naresh Sen is a Consultant Cardiologist affiliated with Narayana Hrudayalaya Institute of Cardiac Science, India. He got his medical graduation from Rajasthan University, Jaipur and post-graduation in internal medicine from South America and post doctoral training in Cardiology from Cacos & Turks. He has also been elected for Fellowship award of various societies of Cardiology . He worked in Cardiology (Invasive & Non-Invasive) as Registrar or Consultant at renowned cardiac hospital ports of India like NH & Medanta last 5 years. He has special interest in coronary artery disease and heart failure prevention. He has published around 50 publications in Cardiology .For his hard work, he was awarded as best cardiology consultant in Rajasthan, 2013 by Director of AIIMS, New Delhi.

Abstract:

Background: CRT (Cardiac Re-synchronization Therapy) has been approved beneficially in heart failure patients with refractory optimized medical therapy based on many studies. The guidelines have shown CRT is indicated in NYHA class IIIIV, QRS>150 ms, LBBB (Left bundle branch block) to improve heart functions, ventricular re-modeling and clinical symptoms. Purpose: Comparison of stress induced mechanical dys-synchrony between rate dependent LBBB and RBBB (Right bundle branch block) and beneficial role of CRT to improve LV function and reduce mortality. Method: Patients presenting dyspnea on exertion NYHA class I-II to III-IV by stress test, normal QRS to rate dependent LBBB or RBBB by Stress test or Dubutamine Stress Echo were studied. CRT on cardiac function was assessed by Cath-study, Echo and MRI (Magnetic Resonance Imaging). Result: 12-months observational study done on stress induced rate dependent LBBB and RBBB with worsening dys-synchrony and poor LV function were treated with CRT. Results have shown improved LV function in rate dependent LBBB patients (31±6%) vs. RBBB patients (4.5±4%) with P value<0.04. and reduce mortality among rate dependent LBBB with CRT vs. without CRT ( 5% vs. 20%) and another side mortality difference between rate dependent RBBB with CRT and without CRT were not found significantly. Conclusion: Stress induced rate dependent LBBB with mechanical dys-synchrony leads to heart failure is benefited by CRT than Rate dependent RBBB.

Biography:

Zaid Altheeb is currently a Cardiology fellow at New York Medical College. He graduated from Jordan University of Science and Technology (J.U.S.T) in 2009. He has a Medical degree in medicine and surgery. He is in the American board of internal medicine from New York Medical College at St. Joseph’s, Paterson-New Jersey USA. He is a Member in American college of physicians ACP and American College of Cardiology ACC. He has publications in the field of cardiovascular medicine.

Abstract:

Background: Inflammation plays an important role in left ventricular remodeling and myocytes hypertrophy and remodeling. Higher levels of inflammatory markers, like IL-6, TNF-a, and CRP, were found in patients with heart failure with preserved ejection fraction (HFpEF). Neutrophil to lymphocyte ratio (NLR) represents a widely available, non-specific marker of systemic inflammation. It was validated as a significant predictor of adverse outcomes in multiple cardiovascular diseases, such as acute coronary syndrome and valvular heart disease. In this study we aimed to explore the utility of NLR as a predictor of long-term mortality in patients with HFpEF. Methods: 376 patients admitted to our hospital between 2010 and 2012 for acute HFpEF exacerbations were evaluated for study inclusion. 296 patients met the study inclusion criteria. Depending on the initial NLR level, patients were divided into two groups; NLR >= 4.5 and NLR < 4. Three-year vital status was obtained via electronic medical records and Social Security Death Index. Survival analysis was used to evaluate the predictive value of NLR level between these two groups. Results: There was a higher all-cause 3-year mortality (6.8% vs 15.3%, Chi-squared 4.6, p 0.033) in patients with NLR >= 4.5 when compared to those with NLR =4.5 (84.7% vs 93.2%, Chi-squared 5.423, P 0.02, HR 2.3456, CI 1.19-4.64). Using univariate Cox proportional-hazards regression analysis, patients with NLR >=4.5 had 2.35 fold increase in 3-year mortality when compared to those with NLR < 4.5 (HR 2.35, CI 1.12-4.79, P 0.0244). In a multivariate cox regression analysis, with the adjustment for age, sex, race, history of coronary artery disease, stroke, hypertension, diabetes, end-stage renal disease and tobacco use, NLR remained a significant independent predictor of 3-year mortality and patients had a 2.53 fold increased risk of mortality (HR 2.53, CI 1.14-5.62, P 0.0229). Conclusions: NLR, using a cutoff value of 4.5, represents an independent predictor of long-term mortality in patients with HFpEF.

Biography:

To be updated...

Abstract:

Background: The lack of a correlation of myocardial infarction after coronary artery bypass surgery (type V MI) with electrocardiographic abnormalities is quite complex, creatingnumerous controversies, especially after the emergence of assays with high sensitivity troponin. Objective: To understand the release of myocardial necrosis biomarkers after on-pump coronary artery bypass grafting (CABG) in the absence of new delayed enhancement by gadolinium. Methods: In this prospective study, we evaluated patients with stable coronary artery disease, multivessel, left ventricular function was preserved, normal baseline cardiac biomarkers, and formal indication for elective on-pump CABG. Electrocardiograms and concentrations of high-sensitive cardiac troponin I (cTnI) and creatine kinase (CK)-MB were assessed before and after procedures. Cardiac magnetic resonance (CMR) and late gadolinium enhancement were performed before and after procedures. MI was defined as more than ten times the 99th percentile upper reference limit for cTnI and for (CK)- MB after coronary artery bypass grafting (CABG), and new late gadolinium enhancement for CMR. Result: Of the Sixty-nine patients referred for on-pump CABG, 54 patients showed no evidence of type V MI in the CMR. This group showed a male predominance with 39 (72.2%), mean age of 61.3 (± 8.3) years old and mean score of Syntax 28 (± 10). After surgery, of the 54 (100%) patients who had a cTnI peak above the 99th percentile, 52(96%) were 10 times higher than the 99th percentile. On the other hand, of the 54 (100%) patients that had a peak (CK)-MB above the 99 percentile limit, only 13 (24%) were greater than 10 times the 99th percentile. The mean peak of cTnI release was 3.15(0.12 to 50.0) ng/ml, 78.75x higher than the 99th percentile. Conclusion: In this study sample, different from that observed with (CK)-MB, troponin was excessively increased in the absence of late enhancement. Thus, (CK)-MB was more accurate than cTnI for diagnosing type V MI. These data suggest a higher troponin cutoff for the diagnosis of CABG related MI.

Biography:

Peter P Karpawich completed his Masters in Science degree from The University of Detroit and his Medical Degree from Hahnemann/Drexel University in Philadelphia, PA. He completed his Post-doctoral Residency in Pediatrics at The Children's Medical Center, University of Texas (Dallas) and Pediatric Cardiology Fellowship at Texas Children's Hospital, Baylor University (Houston). He the founder and Director of the Cardiac Electrophysiology Program at the Children's Hospital of Michigan and Professor of Pediatric Medicine, Wayne State University School of Medicine (Detroit). He has published over 250 scientific papers, textbook chapters and textbooks and is on the Editorial staff of several internationally-recognized medical journals.

Abstract:

Introduction: The lumenless, 4.1F diameter M3830 steroid pacing lead (Medtronic, Inc.) is a coaxial, solid core, non-styletdelivered design. Approved for use in 2005, the very long term performance is largely unknown, especially among congenital heart disease (CHD) pts and with implant at alternate (non appendage/apex) pacing sites (AP). This study presents 10 year post implant evaluation of this lead among CHD pts. Methods: From 2005-2015, 126 pts (age 2-50, mean 19y, 58% male) received 190 leads: atrial 105; ventricle 85. CHD pre-/postrepair structural anatomy (73%) included septal defects, tetralogy and transposition with 93% implant at AP (e.g. septal). Data included sensing, pacing thresholds and lead impedances (Imp). Results: Follow-up was from 1-120 months (mean 60) with >50% of pts followed > 5 y post implant. Comparative implant with latest follow-up showed excellent < 1v) pacing thresholds (volts at 0.4-0.5ms) graph): atrial (A) (0.70±0.3 vs. 0.63±0.3 vs. (P=NS)) and ventricular (V) (0.64±0.3 vs. 0.89±0.4 vs. (p<0.05)) and sensed P (mean 3.5±1.9 vs. 3.6±2mv (NS) and R waves (10.6±5 vs. 9.6±4.8mv (NS). Lead Imp were all in the normal range for lead design (A: 745±223 vs. 556±121 Ω: V 845±255 vs. 522±82 Ω (p < 0.05). Only 2 A leads dislodged (< 1 month) and one was repositioned and 2 other leads (1 A, 1 V) were extracted. Conclusions: The 4.1Fr, lumenless pacing lead shows ease of implant regardless of CHD or site, excellent very long term (10y) stability and performance indices with a very low rate of complications.

Biography:

Marco Picichè (MD, PhD) graduated with a degree in Medicine in Florence in 1995 and completed his Cardiac Surgery residency in Rome in 2000. He earned his research master in Surgical Science (Paris, 2007) and a university diploma in vascular surgery (Paris, 2007). In 2009 he opened the 44th Congress of the European Society for Surgical Research. He has written many publications and worked as a guest reviewer for many international leading journals. He is a Member of the Editorial Board of several English language Journals. He received a Doctor of Philosophy (PhD) in Paris. He is the Editor in Chief of the multi-author book "Dawn and Evolution of Cardiac procedures-Research Avenues in cardiac Surgery and Interventional cardiology". Currently he is a cardiac surgeon in Rome.

Abstract:

Introduction: Heart valve infectious endocarditis represents a fatal event if left untreated. The onset of an abscess has an impact on the surgical indication and strategy. We reviewed our experience with this serious complication. Material & Methods: Data of 74 patients have been retrospectively analyzed using the department's database. Operations were performed over an 8-year and 7-month period, from July 2007 to January 2016, by different operating surgeons. Patients presenting one or more abscesses were included in the study. Morbidity and mortality rate within 30 days were reviewed. Results: There were 8 males and 5 females. Age ranged from 33 to 77 years (mean 60±15). Various surgical procedures have been performed, such as aortic or/and mitral valve replacement, mitral or/and tricuspid valve repair and a freestyle prosthetic valve implant in pulmonary position. Moreover, in two patients surgery was extended to the asceneding aorta, and in 1 case a coronary artery bypass graft was performed. A patch technique was adopted whenever necessary. Overall, 11 patients survived. Two patients died, one due to septic shock and the other due to pneumonia. Conclusion: The onset of abscesses represents a serious complication of heart valve infectious endocarditis that increases the complexity of operations. This, however, does not directly affect the 30-day mortality-rate, which appears to be influenced, in contrast, by the dissemination of infection.

Biography:

Aris Lacis is a Cardiac Surgeon, Professor, MD, PhD graduated from Riga Medical Institute in 1961. He is a General and Thoracic Surgeon in P. Stradina University Hospital in Riga (1964–1969), Thoracic and Cardiac Surgeon in the Latvian Centre for Cardiovascular Surgery (1969–1994), since 1994 until 2012, he is the Head of Pediatric Cardiology and Cardiac Surgery Clinic in University Children’s Hospital, Riga and since 2012; he is a Consulting Professor of this Clinic. He serves as a Vice-President of Latvian Society for Cardiovascular Surgery, President of Latvian Association for Pediatric Cardiologists and is the author of 395 scientific publications, 3 monographs and 13 patents. He is an investigator for more than 10 clinical trials including cardio-surgical procedures performed under deep hypothermia, hybrid procedures etc.

Abstract:

Context: On a global level, stem cell research has been a major challenge during the last decade. There have been achieved positive results in experimental studies on animals and there have been identified several conditions in adult population where bone marrow derived progenitor stem cell transplantation (BMPSCT) may play a crucial role. Though, little is known about possible implementation of the BMPSCT in pediatrics, dilated cardio-myopathy and pulmonary arterial hypertension in particular. There are uncertainties around the destiny of stem cells after their injection into the blood stream. In particular, it regards migration and homing of implanted cells in the target tissues. As yet unclear is the possible role of sympathetic nervous system in the context of osteo-reflexotherapy. There is still no definitive answer to the question on which is the preferred type of stem cells to be use for transplantation in different settings. Objective: To determine the role of BMPSCT in management of critically ill pediatric patients followed by assessment of safety and efficacy of the procedure. Design, Settings, Participants: Two patients (9 and 15 years old) with trisomy 21 and severe pulmonary arterial hypertension due to uncorrected large ventricular septal defects were been admitted to our department to receive intrapulmonary BMPSCT procedure. Both patients underwent radionuclide scintigraphy before the procedure, followed by repeated scans 6, 12, 24 and 36 months after BMPSCT. Latest results show improvement of lungs vascularization. Seven patients (4 months – 17 years) with dilated idiopathic cardio-myopathy were admitted for intra-myocardial BMPSCT procedure. All patients underwent repeated clinical examination every two months, up to 6 years after cell transplantation. We observed improvement of left ventricular ejection fraction, decrease of left ventricular end diastolic dimension by echocardiography and cardio-thoracic index at chest X-ray exams, reduction of serum brain natriuretic peptide serum levels and decrease of the stage of heart failure from stage IV to stage I, by NYHA classification. No peri-procedural harmful side effects were observed. Conclusions: The results are promising and we suggest that BMPSCT might be used for the stabilization of the patient to get the time for further symptomatic treatment or serve as a bridge for heart or lung transplantation.

Biography:

Brojendra Agarwala has completed his MBBS from University of Kolkata, India and completed Pediatric cardiology fellowship from New York university medical center New York, NY, USA. He is a Pediatric Cardiologist and Professor of Pediatrics at the University of Chicago. He has received best teacher award by the pediatric residents and the medical students. He has published 68 papers in reputed journals. He is named as one of the top doctors and best pediatricians in Chicago magazine for many years.

Abstract:

In 2015 Pediatric cardiology is a very well developed specialty. In the past cardiology as a specialty was limited to the Internists. For centuries pediatric cardiology was developed into a specialty where only trained pediatricians in cardiology took care of Fetuses with congenital heart disease (CHD), neonates and further followed them into adulthood. With excellent care, children with severe life threatening CHD are surviving into adulthood and leading productive lives serving the society as physicians, lawyers, MBAs and many other professions and non-professional activities. In 1938 when Robert Gross ligated a patent ductus, a new era of pediatric cardiology was born. Clinical acumen, understanding of physiology, anatomy, angiography and development of extracorporeal circulation allowed caring for children with CHD which was previously lethal. A few interested pediatricians taught themselves and finally the subspecialty was born. In 1961 pediatric cardiology became the first subspecialty board in the USA. In the past 60 year significant progress has been made in non-invasive imaging e.g. cardiac ultrasound, color-Doppler, MRI, CT scan. Utilization of these modalities has made invasive diagnostic cardiac catheterization almost unnecessary. Development of interventional cardiac catheterization has almost replaced cardiac surgery in multiple CHD. For the past 50 year pediatric cardiology was focused on diagnosis, patient care, education and clinical research. However, for the past 10 years basic research discoveries of the cause of the CHD have developed, which will hopefully prevent them from happening in the future. Pediatric cardiology is team work involving cardiologists, anatomists, physiologists, surgeons, intensivists, interventionists and the anesthesiologists – all play very important roles in caring for children with cardiac problem. In my presentation, I will discuss more in depth about the role of individual physicians and scientists that have helped to develop this wonderful subspecialty in pediatrics.

Biography:

Branko Furst, MD, FFARCSI is a graduate of University at Ljubljana Medical School, Slovenia and completed residency in Anesthesiology at Queen Alexandra Hospital in Portsmouth and at the Middlesex Hospitals in London, UK. His academic career then took him to El Paso, Texas where he joined the faculty at the department of Anesthesiology at Texas Tech University Medical School. His research interests include cardiovascular physiology and mechanisms of general anesthesia. He is the author of the book “The Heart and Circulation – an Integrative Model” (Springer, 2013) and has lectured on various aspects of the circulation nationally and internationally. Currently he is Associate Professor of Anesthesiology at Albany Medical College, Albany, NY and divides his time between clinical anesthesiology, research and resident education.

Abstract:

The debate whether the heart is a pressure or a flow generating pump continues to be a subject of debate amongst clinicians and cardiovascular physiologists. It is based on the assumption that the heart, a hollow muscular organ equipped with valves, impels the blood through the systemic and pulmonary circuits. It will be argued that the long standing issue over the nature of the heart’s function can be resolved by adopting the phenomenon-based, evolutionary model of circulation. The model shows that the movement of blood is the primary phenomenon generated at the levels of the capillaries. It exists before the functional maturity of the heart and is intricately linked with metabolic demands of the tissues. The pressure in the vessels, therefore, is a derived phenomenon resulting from the rhythmic interruption of flow by the heart in combination with the dynamic response of the peripheral vasculature. The heart thus functions as an impedance-pump generating pressure, but not the flow of blood. The proposed model will be supported by examples from embryology, comparative anatomy and a number of clinical scenarios.

Biography:

Irena Levitan, PhD, is Professor of Medicine and Adjunct Professor of Pharmacology and Bioengineering at the University of Illinois at Chicago. Her current research focuses on cholesterol regulation of ion channels and cellular biomechanics. She published more than 70 papers and book chapters and is a recipient of Guyton Distinguished Lecturer award for quantitative and biophysical work on cholesterol modulation of ion channels and how this can affect integrated organ function from the Association of Chairs of Departments of Physiology. She also edited two books "Cholesterol Regulation of Ion Channels and Receptors" (Wiley,2012) ands “Vascular Ion Channels” (Springer,2016).

Abstract:

Plasma hypercholesterolemia is well known to be a major risk factor for the development of cardiovascular disease. Our studies focus on the impact of cholesterol on two types of inwardly-rectifying K+ channels expressed in cardiomyocytes: classical inward rectifiers Kir channels (Kir2) that play a major role in maintaining cardiac membrane potential and G-protein gated Kir (GIRK or Kir3) channels that play an important role in the regulation of atrial action potential. Paradoxically, our studies show that elevation of membrane cholesterol in vitro and in vivo has opposite effects on Kir2 and Kir3 channels in the same cells. Specifically, enriching cardiomyocytes with cholesterol in vitro suppresses the activity of Kir2 channels but enhances the activity of Kir3 channels. Furthermore, plasma dyslipidemia in vivo also have opposite effects on these channels in freshly-isolated cardiomyocytes. Both effects are mediated by a decrease or increase in the open probability of Kir2 and Kir3 respectively. Even more surprising, even though cholesterol has opposite effects on the function of Kir2 and Kir3, both effects are abrogated by a specific mutation indicating that they share some structural determinants. These studies are discussed in terms of the structural-mechanistic insights into cholesterol regulation of Kir channels and in terms of the physiological/pathological impact of these coupled effects on cardiac function.

Biography:

Asma Chadli is a Professor of Endocrinology and Diabetes at the Faculty of Medicine and Pharmacy, University Hassane II of Casablanca and Head of Unit of Endocrinology, Diabetes and Metabolic Diseases at Ibn Rushd University Hospital, Casablanca, Morroco. She is a specialist in diabetes and endocrinology. She was appointed as Assistant Professor of Endocrinology in Casablanca in 2001 and full-term Professor in 2005. Her main areas of research interest currently include the thyroid cancer and the type-2 diabetes mellitus. She has published her work in a number of international and national peer-reviewed journals. She has served many national and international committees and boards.

Abstract:

Introduction: The present study aims at determining the relationship between the plasma fibrinogen concentration and the severity of coronary heart disease in type 2 diabetic patients. Methods: Prospective analytical survey, based on a sample of 120 subjects divided in four groups: 30 diabetic coronary patients (G1), 30 coronary diabetic patients (G2), 30 non-coronary diabetic patients (G3), and 30 healthy subjects (G4). The correlation between fibrinogen and the quantitative cardiovascular risk factors (age, diabetes duration, hyperglycemia, obesity based on the body mass index (IMC>30Kg/m2), dyslipidemia manifested by low HDL cholesterol, and/or high LDL cholesterol and/or high TG; was done using Pearson’s correlation coefficient "r ". Results: The average age was 59.58±7.88 years and female gender was predominated by 52.5%. The plasma fibrinogen concentration corresponded to 3.46g/L±0.86 in G1; 3.73g/L±1.11 in G2; 3.06g/L±0.98 in G3 and 2.46g/L±0.51 in G4; significant difference with fibrinogen and the four groups (P=0.001), also with the clinical and para-clinical coronary disease severity. The correlation between fibrinogen and LDL was significant (p=0.035) in the T2D patient’s group (G3). In patients with type 2 Diabetes, the association of fibrinogen with diabetes duration was significant (p=0.036). The association of fibrinogen with both hypertension and smoking was significant in all groups; respectively (p=0.01) and (p=0.03). Conclusion: In the Moroccan population, the plasma fibrinogen concentration was positively and significantly correlated with the coronary heart disease severity.

Biography:

Natasa Chrysodonta is currently a foundation year 2 doctor in the United Kingdom. She has completed her medical degree at the University of Bristol and is currently undertaking an MSc in Genomic Medicine in Queen’s Marry University of London.

Abstract:

Alagille syndrome is an autosomal dominant disorder, also known as arteriohepatic dysplasia Alagille-Watson syndrome, or syndromic bile duct paucity. The syndrome expressivity is highly variable but when fully expressed patients have cardiac malformations, skeletal and ophthalmological abnormalities in conjunction with cholestasis and bile duct paucity. It has been identified that the multisystem involvement is due to defects in the Notch signaling pathway, with the main mutation identified in JAG1. Despite relative good prognosis, mortality by the age of 20 years reaches 70%. The major contributor to the previous is the complex congenital heart disease in addition to the hepatic pathology in these patients. This emphasizes the need for early and appropriate treatment in this population. This review examines the evidence surrounding the management of this syndrome, primarily from a cardiovascular perspective.

Biography:

Nany Hassan Abu Al-Makarim El Gayar is an Assistant Professor of Internal Medicine, Geriatrics Department at Alexandria University, Egypt. He has done MS in Rheumatology and MD in Geriatrics. He has published 10 papers in reputed journals.

Abstract:

Objective: The aim of this work is to evaluate the relationship between serum testosterone concentration and carotid atherosclerosis in elderly males. Methods: The current study included 40 subjects who were classified into two groups; the first group included 30 elderly healthy males as the cases group and the second group included 10 young males as the control group. Serum level of total testosterone was measured using immunoassay kits, sex hormone binding globulin (SHBG) was measured using immunoassay kits and free androgen index (FAI) was calculated. Results: Ultra-sonographic measurement of carotid intima-media thickness (IMT). Total testosterone level was significantly lower in the cases group than control group (t=5.354, p<0.001). SHBG was significantly higher in the cases group than the control group (t=4.796, p<0.001). Free androgen index (FAI) was significantly lower in cases group than control group (z=4.686, p<0.001). Intima-Media thickness (IMT) was significantly higher in the cases group than the control group (t=3.513, p=0.001). As regards the number of plaques 10 males from the cases group did not have any plaques, 13 males had one plaque and 7 males had two plaques however in the control group 9 males did not have any plaques and only one male, had one plaque, so cases group had significantly higher prevalence of plaques than the control group (z=3.007, p=0.003). A significant negative correlation between total testosterone and SHBG (R=-0.856, P<0.001), a significant positive correlation between total testosterone and FAI (R=0.957, P<0.001), and a significant negative correlation between testosterone and both IMT (R=-0.501, P=0.005) and number of plaques and (R=-0.358, P=0.52). SHBG was negatively correlated with FAI (R=-0.845, P<0.001) but it was positively correlated with both IMT (R=0.392, P=0353) and number of plaques (R=0.032, P=0.056). There were significant negative correlations between FAI and both IMT (R=-0.601, P<0.001) and number of plaques (R=-0.461, P=0.010). IMT was positively correlated with the number of plaques (R=0.760, P<0.001). Conclusion: These findings suggest that normal physiologic testosterone levels may help to protect men from the development of atherosclerosis. In elderly men, low plasma testosterone is associated with elevated carotid intima-media thickness. A negative correlation has been demonstrated between endogenous testosterone levels and IMT of the carotid arteries. These findings suggest that men with lower levels of endogenous testosterone may be at a higher risk of developing atherosclerosis.

Biography:

Lorenz Fischer has done his Medical studies in Bern; Federal Exam in 1981; and doctoral thesis in 1984. He is a Specialist in General Internal Medicine. Since 2002, he is also the Chair holder for Neural Therapy at the University of Bern. He was also Vice president of the International Medical Association of Neural Therapy and of the Swiss Medical Association of Neural Therapy. His main research field is the autonomic nervous system (pain and inflammation) as well as the influence of local anesthetics on it. The author of "Fischer L. Neuraltherapie – Neurophysiologie, Injektionstechnik und Therapievorschläge. 4th. edition, Stuttgart; MSV: 2014". Co-publisher of "Fischer L., Peuker E. (Eds.) Lehrbuch integrative Schmerztherapie. Stuttgart; Haug: 2011". He has several contributions to textbooks about pain.

Abstract:

The autonomic nervous system plays an important role in the regulation of blood pressure, heart rate, myocardial contractility and coronary perfusion. The balance of activity of its sympathetic and parasympathetic branches has a key part in this. An imbalance in the autonomic cardiac fibers can furtherlead, inter alia, to cardiac arrhythmias. In general, an imbalance of the sympathetic and parasympathetic branches of the autonomic nervous system can also cause and maintain pain and inflammation. The various pathomechanisms involved can be influenced by local anesthetics (LA), especially by a stellate ganglion block (SGB). Several authors have demonstrated that SGB using LA has a beneficial effect on cardiac arrhythmias. As we could demonstrate an effective and sustained reduction in sympathetically maintained inflammation and pain with SGBin acute CRPS, we suppose that sympathetically maintained inflammation of the heart, too, can be influenced by SGB. Against this background, extensive studies are needed, but since the safety of SGB has been a major concern, our goal was to learn more about it (Puente de la Vega Costa K, Gómez Perez MA, Roqueta C, Fischer L: Effects on hemodynamic variables and echocardiographic parameters after a stellate ganglion block in 15 healthy volunteers. We found that, since both sympathetic and parasympathetic fibers are involved in SGB, there is only a small variation in the parameters discussed, which shows the SGB to be safe for broader application than before.

Biography:

This lecture presents recent advances towards real-time magnetic resonance imaging (MRI) which result in high-quality image series of dynamic processes with acquisition times of only 10 to 40 milliseconds. The acquisition technique employs radially encoded gradient-echo sequences with up to 30-fold data undersampling. Image reconstruction emerges as the iterative solution of a nonlinear inverse problem which is accomplished by a bypass computer with 8 graphical processing units fully integrated into a commercial MRI system. Apart from a brief description of the acquisition and reconstruction technique, the talk will focus on applications to cardiac function, quantitative blood flow and myocardial T1 mapping. These studies may now be performed without the need for ECG synchronization and during free breathing. Taken together, real-time MRI techniques offer the chance to develop comprehensive CMR protocols which are comfortable to the patient, provide new diagnostic opportunities (e.g., immediate physiological responses to stress or exercise), are insensitive to irregular motion (e.g., patients with arrhythmia), and may even be more cost-effective (i.e., much shorter) than current examinations. Future progress is foreseeable and will involve more extensive parametric mapping studies (e.g., T2* relaxation, perfusion and temperature) and a revitalization of “interventional” MRI procedures.

Abstract:

In the last 5 years, social media has come to dominate the international landscape. Medicine, while slow to adopt the use of social media, has become more a part of what physicians and patients use every day. More patients come to see their doctor already prepared with lots of information on their disease that has been obtained from the internet and social media sites such as disease specific facebook pages, twitter chats and Blogs. More physicians are becoming social media savvy. In a recent survey, nearly 90% of graduating medical students in the US uses social media in their daily work. In the session, we describe what social media is, how it can impact both doctors and patients and how it can impact outcomes. In addition, we discuss how social media is being used for conducting clinical trials and what regulatory agencies in both the US (FDA) and Europe are saying about the ways in which doctors and industry are using these outlets. TALK ONE TED TALK “Using Social Media to Transform Cardiovascular Care” (15 Minutes) Speaker: Kevin R. Campbell University of North Carolina, USA Content: TED talks tell a story. I will provide an overview of social media- what it is, who is using it and what its potential impact in medicine may be in the future. Specifically, This talk will illustrate real world examples of how social media can impact Cardiac Care on a global level. The discussion will be an excellent overview of the session as it will provide specific points on how SoMe can impact physicians, patients, innovation and ultimately the future of healthcare delivery TALK TWO “The Role of Social Media and INNOVATION in cardiovascular medicine: Connecting Minds and Producing Results “ (15 MINS) Dr David Albert, ALive Cor Chief Medical Officer Content: Dr Albert will provide an overview of how the use of social media promotes medical entrepreneurship and helps to facilitate innovation. Dr Albert will provide specific examples of how the use of social media has promoted the development of new cardiovascular technologies and how social media platforms can also help facilitate clinical trials like never before. TALK THREE “Social Media and Industry—Impacting Patients and Outcomes” (15MINS) Dr. Paul Tunnah, President of Pharmaphorum, London, UK Content: Dr Tunnah is an expert at the use of social media in industry—particularly in the medical device and pharmaceutical space. His talk will focus on how social media—when used properly and responsibly by industry—can help connect patients with providers, hospital systems and also educate them about new treatment options. Dr Tunnah will also discuss the latest in FDA and European regulatory statements concerning the use of social media by both industry and physicians. Ultimately, social media use by industry can be incredibly useful and can improve efficiency and outcomes for all stakeholders. TALK FOUR “Social Media and the Patient: Making Impacts that Improve Outcomes” 15MINS Speaker: Alexandra Fulford, Worldwide Social media consultant (NOTE: I met Alexandra in Frankfurt, Germany last year when I led an international “Think Tank” on social media. Her insights into the patient experience with social media are amazing. She is holds an MBA and consults for businesses worldwide on social media and medicine

Biography:

Galya Naydenova Atanasova completed her PhD training in Cardiology from Department of Cardiology, Pulmonology and Endocrinology at Pleven Medical University, Bulgaria. She is a Cardiologist, Assistant Professor at the Department of Internal Medicine, Medical University, Pleven. She is a General Practitioner in Pleven. She specialized in Cardiology from Pleven Medical University during 2015, and General Medicine from Pleven Medical University, Bulgaria during 1993. She has attended to many International Events and presented her research work. She did many researches on metabolic syndrome and myocardial infarction of heart.

Abstract:

Objectives of this study were to evaluate opportunities of using of mean arterial pressure (MAP) as a component of the metabolic syndrome (MS) instead systolic and diastolic blood pressures (SBP and DBP) and to create a model, using logistic regression. A total of 104 persons without any apparent disease were selected. Among these people MS was found in 35, according to NCEP-ATP III definition. One way ANOVA test, multiple comparison tests of means and multiple logistic regression analyses were used. The MAP was obtained by the formula MAP=SBP/3+2DBP/3. The four groups used in ANOVA were men and women with and without MS. The ANOVA F-statistic is 17.71 with p-value less than 0.00001. The box plot of ANOVA was shown on Figure 1. The multiple comparison tests showed statistically significant differences between groups of people with and without MS and negligible differences between men and women. Multiple logistic regressions were used to determine odds ratio (OR) of MS. The first model included the following components of MS - waist (WS), HDL cholesterol, blood glucose (GLU) and serum triglycerides (TG). The second model included WS and TG. MAP was used as the last variable in the both models. All dependent variables, except MAP, were dichotomous. Each dichotomous variable received value 1 if the criterion for corresponding component in definition was met. The p-values for overall models fit statistic was less than 0.00001. The results indicated strong relation between value of MAP and MS. The proposed model showed a reliable determination of MS, using only one biochemical marker. Reducing the number of used biochemical marker could improve the cost efficiency in the diagnostication of MS. MAP showed itself as a promising indicator, which after some broader studies could replace SBP and DBP in the MS definition.

Biography:

Govindan Vijayaraghavan is a cardiologist from India, credited with establishing the first 2D Echocardiography laboratory in India. He is the vice-chairman & Founder Director of the Kerala Institute of Medical Sciences and the President of the Society for Continuing Medical Education and Research, Trivandrum, Kerala. He was honoured by Government of India in 2009 for his services in the field of medical sciences by awarding him Padmashri

Abstract:

Background: Sepsis patients with myocardial injury has very high mortality(30-60%).Only a few studies incorporating electrocardiography, high sensitive troponin T(hsTnT), N-terminal pro-BNP(pro-BNP) and echocardiography has been conducted in these patients . Methods and Results: Out of 204 patients with sepsis enrolled, 111 patients satisfied the inclusion criteria and 103 completed the study. Myocardial injury was defined by elevation of hsTnT > 25 pg/ml. Initial hsTnT, pro-BNP and 2D echocardiography were repeated if sepsis progresses. Primary and secondary end point were in hospital mortality and left ventricular dysfunction(LVD).Simple sepsis was diagnosed in 45%; 19% had septic shock and 36% developed severe sepsis. male predominance(63%) with majority being diabetic (66%) and above 50 years of age (54%).Sinus tachycardia was present in 65% and T inversion in inferior leads in 32%.Systolic dysfunction(SD) was present in 42%, diastolic dysfunction(DD) in 21% and 21% had both SD and DD.HsTnT was elevated in 84% of the patients. Both hsTnT and pro-BNP were significantly correlated with LVD (p<0.001).Pro-BNP showed marked variation in different grades of LVD than hsTnT (table1).Both levels were lesser in DD than SD.Grade III DD was always associated with severe SD .Pro-BNP had significant correlation with pro-calcitonin level (p<0.001) and APACHE II score (p<0.001); HsTnT correlated only with APACHE II score (p<0.001). CRP level did not have correlation with cardiac markers. In hospital mortality was 8%.Pro BNP has better correlation with the survival (table2). ROC curve showed that a pro-BNP level >8530 pg/ml signified with mortality (sensitivity-100% and specificity-80%) and HsTnT level >178pg/ml correlated with mortality with 88% sensitivity and 71% specificity. Creatinine was elevated in 55% during the sepsis and had linear correlation with hsTnT level (p<0.01). Conclusion: Pro-BNP is a powerful tool for prognostication in sepsis with myocardial dysfunction and a value>8530 pg/ml signified decreased survival with 100% sensitivity.The significant elevation of pro-BNP with minimal elevation of hsTnT indicated that the pathophysiology is mainly myocardial stretch and not myocardial necrosis in sepsis; with full recovery in survivors. Table 1: distribution of pro-BNP and HsTnT in LVD (*21% had combined LVD) ECHOCARDIOGRAPHY % Mean pro-BNP(pg/ml) Range Mean HsTnT(pg/ml) Range Normal 16 2433 700-4100 76 <25-160 Mild LV SD 11 5481 3200-9200 210 80-360 Moderate LV SD 13 9608 5400-16100 254 150-480 Severe LV SD 18 16844 7200-25000 268 148-450 Grade I DD 8 3132 1024-5250 117 60-220 Grade II DD 13 6596 3500-9000 125 26-240 Table 2: cardiac markers in survivors/non survivors survivors Non-survivors p Pro-BNP(pg/ml)(mean) 6400 21805 <0.0001 hsTnT(pg/ml)(mean) 158 256 <0.047

Biography:

Hisham Ben Lamin, graduated from Tripoli Medical School, Libya in 1986, had his training in Libya, Australia and Jamaica. Post graduated in perioperative and critical care Cardiology from Melbourne University Australia 2009. He is interested in Women's heart diseases, Cardio-Oncology and acute Cardiology. He is a member of ESC including membership of ACCA and EACPR. He is living now in Spain.

Abstract:

Management of Cardiovascular Diseases in both sexes is equal, and we as Cardiologists usually meet with our patients of both sexes with CHD late in life, where at this level of interference the damage has already took place and we can only try to manipulate this damage. Women on the other side are at risk of developing CVD across most of their lives due to hormonal level variations, starting in early puberty, passing by adulthood curving around pregnancies and reaching menopause and post menopause era. Here I would like to put emphasis on pregnant women without CVD and developing high risk pregnancies in the form of preeclampsia, GDM, PPCM, and giving birth to low weight babies. At this level these women will start a subclinical progressive atherosclerosis that will be clinical within 1-10 years post-partum, exposing these women to CV events endangering their lives. These changes can be avoided in millions of women if we act early preventing future damage. If we add to this group those who are already having an existing heart diseases-acquired or congenital- and those who had Cancer therapy and developed Cardiotoxicity, the damage is more and may be fatal. The message here is early preventing these women from crossing to the damaging zone.

Biography:

Mohammed Saied Mohammed Bakeer was born, 18th June, 1979 at Al-Khanka city, Al-Kalyobia governorate, Egypt. He finished his secondary school education, 1998, from Shebiein Al kanater Azhari secondary school with score of 98%. He was graduated from Al-Azhar faculty of medicine, Cairo, Egypt, 2004 with excellent and honor degree. Has completed his residency program at internal medicine department, AL-Hussein university hospital, Cairo, Egypt 2006-2009. Obtained a master degree of internal medicine, from Al-Azhar University, 2009 with excellent degree. Worked as assistant lecturer of internal medicine&clinical hematology, Al-Azhar university hospital, 2010-2014. Obtained his MD degree in internal medicine &clinical hematology from Al-Azhar University, 2014. Has been working as lecturer of internal medicine &clinical hematology from 2014 till the moment.Mohammed is interested at hematoimmunology, hematooncology and hemostasis. Mohammed is now working on scientific project, with his colleagues at Al Azhar University exploring the effects of viral latency on different hematological parameters. Mohammed also is interested at the novel concepts of hemostasis and its relations to inflammation and autoinflamatory disorders.Mohammed is a member of Egyptian society of hematology, society of hematooncology (SOHO) and many others.

Abstract:

The initial “waterfall” or “cascade” model for coagulation was proposed in 1964 by MacFarlane, Davie and Ratnoff. Obscure in this model, is the role of the contact (intrinsic) pathway. As the known stimulus for it has been largely non physiological, such as glass and kaolin. Also people with deficiency of factor XII show no significant bleeding tendencies. While the connection between coagulation, inflammation and thrombosis is well known observation, however its exact mechanism was not clear. In recent years there has been a growing body of literature supporting the role of negatively charged,poly anionic linear polymers such as polyphosphate (poly-P) and extracellular nucleic acids (RNA and DNA) in thrombosis and inflammation. Poly-P is a highly anionic, linear polymer of orthophosphate, which is stored as metachromatic granules in many cells. The recent discovery that the dense granules of the platelets are actually a storage of (Poly- P), and the observation that (Poly- P) can strongly stimulate contact pathway has opened a way for a new understanding of coagulation system. Activation of the contact system by long-chain (poly-p) can also be strongly pro-inflammatory, in a manner dependent on factor XII activation and release of bradykinin from high molecular weight kininogen. It was also noted that platelet (poly-p) causes an approximately 3000-fold increase in the rate of back-activation of factor XI by thrombin, enhances the rate of factor V activation to Va by factor XIa. While (poly-p) is released mainly from platelets, extracellular DNA and RNA are released mainly from neutrophils; neutrophil extracellular traps (NETs).Both (poly-p) and (NETs) almost have the same function. Targeting (poly-P) for therapeutic benefit: Genetically knocking down (poly-P) levels in platelets in mice protects against experimentally induced thrombosis. The approach of targeting (poly-P) is either by enzymatic degradation or by neutralizing it by poly cationic inhibitors, the latter approach is proved to be more clinically applicable. Poly cationic inhibitors, such as spermin and many others have been proved to be highly effective antithrombotic agents in mouse model of arterial thrombosis, with much lower bleeding risk compared to heparin. Not only being a potentially attractive as antithrombotic agents, but this approach might also prove to be useful as a way of cutting the link between thrombosis and inflammation. Conclusions. Poly-P and other anionic polymers such as extracellular nucleic acids make up one of newest classes of molecules that function at the nexus of coagulation, inflammation and innate immunity. Our understanding to its physiological role in hemostasis will open the door to the possibility of novel, potentially safer antithrombotic agents.

Biography:

Mahmoud Mohamed Elsibaei is the Professor of Parasitology, Internal Medicine & hepatology at Ain Shams University, Egypt since 1995 and also the Chief of parasitology, Department faculty of medicine, Ain Shams University. He is the Ex Top manager (Director) and Principal Investigator for quality assurance &accreditation unit, faculty of medicine, Ain Shams University. He is the Member of quality committee for Ain Shams University hospitals and also the Consultant for TQM, EMS, CE and accreditation certificates. He also holds the position of Internal auditor and peer reviewer .

Abstract:

Many parasitic diseases can involve the myocardium , pericardium or both leading to miscellaneous syndromes that involve the myocardium are trypanosomes, toxoplasmosis, cysticercosis, trichinellosis. That involve the pericardium are Entamoeba, Echinococcus. Other miscellaneous syndromes are involved also pathology, pathophysiology & clinical manifestation of the heart involvement will be explained in details in this presentation.

Biography:

Weiqian Chen has completed her PhD at the age of 29 years from Nanjing University and postdoctoral studies in Developmental and Stem Cell Biology Program in University of Toronto as a post doctorate. Dr. Chen joined the Institute for Cardiovascular Science at Soochow University in 2013 as an associate professor, where she directed her research interests to heart and blood disorders. She has published more than 7 papers in reputed journals.

Abstract:

Cardiac cell apoptosis provoked by excessive sodium nitroprusside (SNP) toxicity, a potent vasodilator, limited its clinical application. Effective means for protection against SNP-induced cardiotoxicity would be highly needed. This study investigated the effects of Follistatin-like 1 (FSTL1) on the injury induced by SNP in rat cardiomyoblast H9c2 cells. SNP challenge significantly increased cardiac cell death, which was attenuated by FSTL1 pretreatment. Additionally, knockdown of endogenous FSTL1 enhanced SNP-induced cell apoptosis. Furthermore, FSTL1 pretreatment partially inhibited SNP-induced NO generation. LY294002 and BMP4 completely abolished cytoprotective role of FSTL1 against SNP challenge, indicating activation of Akt/GSK-3β and inhibition of BMP/Smad1/5/9 signaling is involved in this cellular process. Lastly, FSTL1-mediated cytoprotection is independent of Smad2/3 signaling, as SB525334 failed to remove its protective role. Taken together, these results indicated that FSTL1 protected the SNP-induced injury in cardiac H9c2 cells through, at least in part, the activation of Akt/GSK-3β and inhibition of Smad1/5/9 signaling.

Biography:

Bernhard Mumm has completed his Master of Science in Engineering, Computer Science and Cybernetics at the Technical University Munich / Germany in 1983. Since 1990 he is working at TOMTEC Imaging Systems, located in Munich Germany and holds the position as president. He has done 3D Echocardiography research & developments in cooperation with many university hospitals worldwide. He participated in many publications, book chapters, patents and talks at international scientific conferences on this topic.

Abstract:

Introduction: Diabetic heart disease or a chemotherapy treatment of a patient in cardio-oncology can have a profound impact on cardiac systolic and or diastolic function and structure. Especially diabetic patients are at a higher risk for developing heart disease than non-diabetic individual. These patients can also have numerous causes of heart related issues and disease. Detecting and monitoring of non-visual changes in cardiac dimensions and function has become very important. Methods: Echocardiography techniques are used for an evaluation of cardiac function and detection of early diabetic myocardial disease. Standard Echo measurements are here LV diameters, wall thicknesses, LV mass, fractional shortening, LV volumes and ejection, measured in 2D or better in 3D. Stress Echocardiography can be another diagnostic tool to evaluate cardiac function. Newer analysis tools feature automatic contour detection in 2D or 3D and myocardial tracking for a fast, accurate and highly reproducible global and regional functional analysis of LV myocardial strain. Conclusion: Automated imaging software that can assist in the management of patients with diabetic heart disease or in chemotherapy is becoming widely accepted over traditional imaging methods. Subclinical markers including the longitudinal strain provide an excellent means of monitoring non visual and regional abnormalities in LV systolic function. Automated software provides a high level of reproducibility which is crucial for the proper management of these patients.

Biography:

A D John completed BA from Harvard University and MD from New York Medical College. He has done his Internal Medical Residency from Metro West Medical Center; Framingham, MA and Anesthesia and Critical Care Residency from Johns Hopkins Hospital; Baltimore, MD. He has done Cardiac Anesthesia subspecialty in Johns Hopkins Hospital; Baltimore, MD and Cardiac Anesthesiology Fellowship from Massachusetts General Hospital; Boston, MA. He is an instructor at Harvard Medical School; Boston, MA and also at Johns Hopkins School; Baltimore, MD. He is an Assistant Professor of Anesthesiology and Critical Care Medicine at Johns Hopkins University School of Medicine; Baltimore, MD. He served as a Coeditor with Sancho Rodrigues-Villar for Protocols in Critical Care (in Press) and as an Editor for Anesthesia: Essential Clinical Updates for Provider (in Press).

Abstract:

The Post Anesthesia Care Unit (PACU) is a key element in ensuring a successful operative experience. Recovery from surgery is dependent on a transition from intensive focus of the operating room to a safe care in the hospital ward or home after surgery. The key area of transition is the Post-anesthesia Care Unit. It is the PACU that the patient ‘awakens’ from anesthesia. Respiratory function has to be maintained and stable vital signs have to be assured. In addition, pain issues as well as postoperative nausea have to be addressed. In an effort to facilitate throughput, each type of surgery is establishing protocols to aid in rapid recovery, minimize pain, increase ambulation and decrease hospital stay. What are the keys to ensuring patient safety in the PACU? What are the special issues for the cardiac patient undergoing non-cardiac surgery?

Biography:

Issam Mikati graduated from the American University of Beirut Medical School. He did Cardiology fellowship at Baylor College of Medicine. He complaeted imaging fellowship at the same institution. He is the associate director of the Echocardiography lab at Northwestern Memorial hospital in Chicago Illinois. He has published numerous papers in reputed journals and has served as a reviewer of premier journals.

Abstract:

Cardiomyopathy confers a poor prognosis. Early recognition and intervention is key to improve outcome. Classic methods of assessment of LV systolic dysfunction such Left Ventricular Ejection Fraction (LVEF) suffer from wide variance that limits their utility in detection of minor changes in systolic function on serial testing. In addition, the changes in LVEF appear late after significant myocardial damage has occured. This has been shown to affect prognosis of patients. Strain has been shown to be an accurate sensitive marker of LV function with leass varaiance than traditional methods of LV systolic function. It has been shown to drop early in the natural history of many systemic diease that affect the heart such as diabetic cardiomyopathy. Strain shows great promise in management of cardiomyopathies because its efficacy in early detection and potentially effects of treatment.

Biography:

Alfredo E Rodriguez graduated from Córdoba National Medical University, Argentina and completed his PhD from the Cordoba Catholic School of Medicine. He is Director of Centro de Estudios en Cardiología Intervencionista, a premier Research Organization and Head of the Cardiology Department of Sanatorio Otamendi, Buenos Aires, Argentina. He has published more than 250 papers in major peer review journals and also was Editor of four cardiology books the last one published in September 2015 by Springer. He is Editor-In-Chief of the Journal “Revista Argentina de Cardioangiología Intervencionista” and has been serving as an Editorial Board Member of worldwide repute Journals such as Euro-Intervention, JACC Cardiovascular Interventions, World Journal of Cardiology, Drug Designing Journal (2014), Journal of Developing Drugs (2014). He is also frequent reviewer from major cardiology and interventional cardiology Journals.

Abstract:

Takotsubo cardiomyopathy (TCM) was characterized by transient left ventricular dysfunction usually involving antero apical and infero apical regions of the myocardium with ST segment changes or T-wave inversion and minimal release of cardiac enzymes in the absence of significant coronary artery disease (CAD). TCM was in general associated with good prognosis, although a minority of patients develops severe hemodynamic complications, including cardiogenic shock, life threatening arrhythmias and cardiac rupture (CR). Isolated left ventricular impairment is the most common variant of this entity, but right ventricular involvement is also recognized and was associated with poor prognosis. Until January 2015, 14 cases of CR have been reported; included right or left ventricular wall rupture or ventricular septal perforation (VSP) VSP was reported in 4 cases 2 of them who survived were treated with open heart surgery. We are reporting the case of a female patient with acute T waves changes in antero-lateral leads in basal ECG, minor enzymes elevation; anterior and apical hipokinesia of the left ventricle and hipokinesia of the right ventricle observed at admission with trans-thoracic echocardiography (TE) and without significant CAD in the coronary angiogram, four days later she develop cardiogenic shock with left and right severe heart failure and in a new TE a VSP was observed and was located at 10mm of the left ventricular apex. The VSP was repaired successfully percutaneously using an Amplatzer device. Patient had a rapid improvement of her ventricular function and had hospital discharge three days later. TCM can be associated with severe complications including cardiac rupture and VSP. At our knowledge, this is the first reported case in the literature using a percutaneous endovascular technique to repair it.

Biography:

Flavia Ventriglia graduated and specialized in Pediatrics and Cardiology at the “Sapienza” University of Rome. He has done his PhD in Congenital Heart Disease at the University of Padua. He works as a Researcher Aggregate Professor of Pediatric Cardiology at the “Sapienza” University of Rome, first level manager at the UOC of Pediatric Cardiology at the Policlinico Umberto I in Rome and is responsible for the ECHOLAb of Fetal Echocardiography. He has published numerous scientific international papers in the field of pediatric cardiology and fetal cardiology.

Abstract:

Early fetal echocardiography (EFEC) is a fetal cardiac ultrasound analysis performed between the 12th and 16th week of pregnancy (compared with the usual 18-22 weeks). In the last 10 years, the introduction of “aneuploidy sonographic markers” in screening for cardiac defects has led to a shift from late second to end of the first trimester or beginning of the second trimester of pregnancy for specialist fetal echocardiography. In this prospective study, early obstetric screening was performed between January 2014 and October 2015, using “aneuploidy sonographic markers” following SIEOG Guidelines 2014. These parameters were then collected and strategically combined in an evaluation score to select the group of pregnancies for performing EFEC, in accordance with the American Society of Echocardiography guidelines for fetal Echocardiography. All second-level examinations were performed trans-abdominally using a 3D convex volumetric probe with frequency range of 4-8 MHz (Accuvix–Samsung). The outcome data included trans-abdominal fetal echocardiography from 18 weeks to term and after birth. Overall, 99 pregnant women in the first trimester underwent EFEC (95 singleton and 4 twin pregnancies). Specifically, 30 fetuses were evaluated for extra-cardiac anomalies evidenced by obstetric screening (30%), 25 for family history of congenital heart diseases (25%), 8 for family history of genetic-linked diseases (8%), 4 for heart diseases suspected by obstetric screening (4%) and 19 by normal screening (19%). EFEC detected 11 cases of CHD (10.7%); when EFEC CHD assessments were compared to those performed later in pregnancy (18 weeks GA-term), a high degree of diagnosis correspondence was evidenced. The higher sensitivity value of EFEC vs. late-FE, in comparison with the post-natal value, coupled with the high EFEC specificity shown vs. both the end points, enabled us to consider it as a really reliable diagnostic technology, at least in experienced hands. The introduction of a key combination of the more sensitive obstetric and cardiologic variables should facilitate the formulation of a possible flow-chart as a guide for CHD at-risk pregnancies.

Biography:

Marco Piciche MD, PhD graduated with a degree in Medicine in Florence in 1995 and completed his cardiac surgery residency in Rome in 2000. He earned his research master in Surgical Science (Paris, 2007) and a university diploma in vascular surgery (Paris, 2007). In 2009 he opened the 44th Congress of the European Society for Surgical Research. He has written many publications and worked as a guest reviewer for many international leading journals. He is a Member of the Editorial Board of several English language Journals. He received a Doctor of philosophy (PhD) in Paris. He is the Editor-in-Chief of the multi-author book "Dawn and Evolution of Cardiac procedures-Research Avenues in cardiac Surgery and Interventional cardiology”. Currently he is a cardiac surgeon in Rome.

Abstract:

Prior to the advent of cardiopulmonary bypass, myocardial revascularization strategies fell into three categories: Extracardiac procedures, cardiac operations on non-coronary artery structures and direct coronary artery surgery. After the invention of the heart-lung machine by John Gibbon in the fifties, coronary artery by-pass grafting spread all over the world. Since the nineties, the methods of surgical revascularization fell into two main categories, namely on-pump and offpump procedures. Progresses in techniques not with-standing, there are still a significant number of patients who may not benefit from conventional techniques of myocardial revascularization due to diffuse coronary artery disease. Since a certain level of morbidity and mortality is associated with direct surgical or endovascular coronary procedures, the search is on for less invasive and less costly alternatives that ensure myocardial blood supply. Researchers are on the lookout for new revascularization methods also because of the many patients suffering from diffuse coronary artery disease that may not benefit from conventional techniques. Some alternative myocardial revascularization methods attempted in recent years bear a resemblance to techniques tried andabandoned in the first half of the last century. Earlier attempts to achieve myocardial revascularization may constitute a fertile pool of ideas. In the era of coronary stenting, research still needs todraw some old ideas to elaborate derivative strategies that employ the tools of modern technology. It is important for clinicians and researchers to know the historical steps which paved the way to current practice.

Biography:

Robert Skalik, MD, PhD is a consultant in cardiology, exercise physiologist. He completed his PhD in echocardiography from Medical University of Wrocław. He covered internship in the Department of Cardiology at Free University of Amsterdam, the Netherlands. He is a lecturer in Post-graduate School of Cardiology, University of Perugia and an academic teacher and researcher in Department of Physiology, former consultant in cardiology in Department of Cardiac Surgery and Cardiology, Medical University of Wrocław, former Head of Department of Cardiac Rehabilitation, Wrocław, private practice in cardiology, Wrocław, research projects evaluator for EU. He has published 103 papers on cardiology and human physiology.

Abstract:

Professional and amateur athletic training can cause tremendous overload of the cardiovascular system and thus become a trigger for fatal cardiac events in athletes with previously undetected underlying heart diseases. Subsequently, every athlete should undergo a specialized diagnostic and qualification screening process before a training program is prescribed or continued. However, it is still unresolved issue which of the diagnostic tools should be routinely applied in order to increase the safety of extreme physical training and reduce the risk of sudden cardiac death. Pre-participation athlete evaluation including resting electrocardiography (EKG), physical examination and familial history of cardiovascular diseases is important, but does not always guarantee high diagnostic accuracy. The permanently growing interest in the sport activities raises serious and justified concerns about health and safety of extreme physical training and sport-related risk of sudden cardiac death (SCD). In recent years there are more and more press reports on cases of sudden cardiac death in young athletes during sport events. EKG is recommended by national and international medical associations as a basic tool to screen athletes. EKG is one of the oldest and simplest diagnostic instruments to diagnose cardiac diseases, but the main drawback of resting EKG is its interpretational ambiguity and controversial accuracy for the diagnosis of cardiovascular diseases. Hence, the complex and reliable evaluation of cardiovascular health status in athletes or athlete candidates should always include more sophisticated diagnostic techniques including echocardiography, exercise testing and cardiac magnetic resonance or in some selected cases cardiac computed tomography.

Biography:

Császár Noémi Ph. D., ECP, is the Head of the Education Board of the Hungarian Association of Hypnosis (H.A.H), clinical psychologist, supervisor hypnotherapist, psychotherapist, Head of Psychotherapy Department and Psychosomatic Out-Patient Department at the National Center for Spinal Disorders in Budapest. She is the author of the special issue chapter: Császár N., Ganju A., Mirnics Zs., Varga P.P.: Psychosocial Issues In The Cancer Patient. Spine, 15:34 (22 Suppl):26−30, 2009. And the book chapter: Császár N.: Hypnotherapy treatment of chronic Pain. In: Vértes, G. (ed.): Hypnosis─Hypnotherapy. Budapest, Medicina Könyvkiadó Rt., 2006, 31–62.

Abstract:

There are increasing number of patients needing medical care for medication resistant, chronic cardiac failure. Heart transplantation is a multidisciplinary area, where cooperation of well-organized professional team is required in every stage of the procedure. Patient suitability is a crucial point in transplantation; adequate patient selection is therefore a key stage regarding long-term success. Evaluation of suitability for heart transplantation must be carried out in the following domains: 1. Severity of heart disease and prognosis for conservative treatment 2. Overall health of other organs and organ systems. Is general condition of the patient sufficient enough to tolerate surgical stress and the side effects of prolonged immunosuppressive treatment? Is there any comorbidity influencing chance of survival or endangering the new heart? 3. Psychosocial suitability The aim of this presentation is to summarize the most important psychological and psychiatric diagnostic aspects of patient evaluation. Certain diseases of the central nervous system, mental disorders, psychiatric conditions, substance abuse and noncompliance are all to be considered in the screening process. Complex psychodiagnostics provides a tool for clinicians to identify potential risk factors so that adequate therapy can be started or optimized accordingly. Absolute contraindications include: - Acute psychosis where – regardless of treatment - sufficient compliance cannot be achieved. - Suicidal ideation, urges, motivation, or attempted suicide in patients’ history – which implies insufficient coping. - Acute bereavement, severe depression with or without psychotic symptoms and untreated recurrent depression. Acute bereavement and depression are important risk factors of morbidity and mortality, hostility and PTSD symptoms in the postoperative period, serving as a predictor of poor compliance. - Mental and behavioral disorders caused by psychoactive substance abuse, such as nicotine, alcohol or drugs. Relative contraindications that may lead to insufficient compliance include dissocial and unstable affective personality disorders, organic and symptomatic mental disorders (mental retardation and dementia), schizophrenia, schizotypal and paranoid disorders and bipolar affective disorders. Some other conditions must be considered as risk factors that can contribute to developing postoperative complications and prolonged hospitalization. These include adjustment disorders triggered by severe stress, neurotic, stress related and somatoform disorders, mild- and moderate levels of depression and dysthymia. Scientific background and clinical practice of risk assessment guided by national guidelines will be reviewed in the presentation.

Biography:

A D John completed BA from Harvard University and MD from New York Medical College. He has done his Internal Medical Residency from Metro West Medical Center; Framingham, MA and Anesthesia and Critical Care Residency from Johns Hopkins Hospital; Baltimore, MD. He has done Cardiac Anesthesia subspecialty in Johns Hopkins Hospital; Baltimore, MD and Cardiac Anesthesiology Fellowship from Massachusetts General Hospital; Boston, MA. He is an instructor at Harvard Medical School; Boston, MA and also at Johns Hopkins School; Baltimore, MD. He is an Assistant Professor of Anesthesiology and Critical Care Medicine at Johns Hopkins University School of Medicine; Baltimore, MD. He served as a Coeditor with Sancho Rodrigues-Villar for Protocols in Critical Care (in Press) and as an Editor for Anesthesia: Essential Clinical Updates for Provider (in Press)

Abstract:

The Post Anesthesia Care Unit (PACU) is a key element in ensuring a successful operative experience. Recovery from surgery is dependent on a transition from intensive focus of the operating room to a safe care in the hospital ward or home after surgery. The key area of transition is the Post Anesthesia Care Unit. It is the PACU that the patient ‘awakens’ from anesthesia. Respiratory function has to be maintained and stable vital signs have to be assured. In addition, pain issues as well as postoperative nausea have to be addressed. In an effort to facilitate throughput, each type of surgery is establishing protocols to aid in rapid recovery, minimize pain, increase ambulation, and decrease hospital stay. What are the keys to ensuring patient safety in the PACU? What are the special issues for the cardiac patient undergoing non-cardiac surgery?

Biography:

Robert Skalik, MD, PhD, consultant in cardiology, exercise physiologist. He completed his PhD in echocardiography from Medical University of Wrocław. He covered internship in Department of Cardiology, Free University of Amsterdam, the Netherlands, lecturer in Postgraduate School of Cardiology, University of Perugia, academic teacher and researcher in Department of Physiology, former consultant in cardiology in Department of Cardiac Surgery and Cardiology, Medical University of Wrocław, former Head of Department of Cardiac Rehabilitation, Wrocław , private practice in cardiology, Wrocław, research projects evaluator for EU. He has published 103 papers on cardiology and human physiology.

Abstract:

Professional and amateur athletic training can cause tremendous overload of the cardiovascular system and thus become a trigger for fatal cardiac events in athletes with previously undetected underlying heart diseases. Subsequently, every athlete should undergo a specialized diagnostic and qualification screening process before a training program is prescribed or continued. However, it is still unresolved issue which of the diagnostic tools should be routinely applied in order to increase the safety of extreme physical training and reduce the risk of sudden cardiac death. Pre-participation athlete evaluation including resting electrocardiography (EKG), physical examination and familial history of cardiovascular diseases is important, but does not always guarantee high diagnostic accuracy. The permanently growing interest in the sport activities raises serious and justified concerns about health and safety of extreme physical training and sport-related risk of sudden cardiac death (SCD). In recent years there are more and more press reports on cases of sudden cardiac death in young athletes during sport events. EKG is recommended by national and international medical associations as a basic tool to screen athletes. EKG is one of the oldest and simplest diagnostic instruments to diagnose cardiac diseases, but the main drawback of resting EKG is its interpretational ambiguity and controversial accuracy for the diagnosis of cardiovascular diseases. Hence, the complex and reliable evaluation of cardiovascular health status in athletes or athlete candidates should always include more sophisticated diagnostic techniques including echocardiography, exercise testing, and cardiac magnetic resonance or in some selected cases cardiac computed tomography.

Biography:

Marco Picichè (MD, Ph.D.) graduated with a degree in medicine in Florence in 1995 and completed his cardiac surgery residency in Rome in 2000. He earned his research master in Surgical Science (Paris, 2007), and a university diploma in vascular surgery (Paris, 2007). In 2009 he opened the 44th Congress of the European Society for Surgical Research. He has written many publications and worked as a guest reviewer for many international leading journals. He is a member of the Editorial Board of several English language Journals. He received a doctor of philosophy (Ph.D.) in Paris. He is the Editor in Chief of the multi-author book "Dawn and Evolution of Cardiac procedures-Research Avenues in cardiac Surgery and Interventiontional cardiology" (Springer Verlag 2012). Currently he is a cardiac surgeon in Rome.

Abstract:

Prior to the advent of cardiopulmonary bypass, myocardial revascularization strategies fell into three categories: extracardiac procedures, cardiac operations on noncoronary artery structures, and direct coronary artery surgery. After the invention of the heart-lung machine by John Gibbon in the fifties, coronary artery bypass grafting spread all over the world. Since the nineties, the methods of surgical revascularization fell into two main categories, namely on-pump and off-pump procedures. Progresses in techniques not withstanding, there are still a significant number of patients who may not benefit from conventional techniques of myocardial revascularization due to diffuse coronary artery disease. Since a certain level of morbidity and mortality is associated with direct surgical or endovascular coronary procedures, the search is on for less invasive and less costly alternatives that ensure myocardial blood supply. Researchers are on the lookout for new revascularization methods also because of the many patients suffering from diffuse coronary artery disease who may not benefit from conventional techniques. Some alternative myocardial revascularization methods attempted in recent years bear a resemblance to techniques tried and abandoned in the first half of the last century. Earlier attempts to achieve myocardial revascularization may constitute a fertile pool of ideas. In the era of coronary stenting, research still needs to draw some old ideas to elaborate derivative strategies that employ the tools of modern technology. It is important for clinicians and researchers to know the historical steps which paved the way to current practice.

Biography:

Dr. Hatem Al-Masri is a cardiac critical care intensivist and consultant of cardiac surgery. Dr. Al-Masri completed his medical degree (M.D.-Doktorate) at Charles University – Faculty of Medicine, holds a degree in biochemistry from the University of Waterloo - Canada, completed his residency training in Germany (Leading Facharzt) and holds training fellowships in Cardiac Surgery from IJN KL Malaysia, Switzerland, and Canada. Dr. Al-Masri is the author of an award-wining medical research paper titled “Hemodynamic Support Requires Integrated Approach Comparing pl.VAD vs. IABP in Patients Experiencing Left Venticular Failure” (Best Paper of Young Cardiac Surgeon) at the 8th International Congress of Update in Cardiology and Cardiovascular Surgery (UCCVS 2012) awarded by European Society for Cardiovascular Surgery, World Society of Arrhythmias (WSA ) and the Society of Cardiology and the International Academic of Vascular and Endovascular Surgery (ISCP). Dr. Al-Masri is a member of the Medical German Association, Malaysian Medical Association and the Saudi Medical Council.

Abstract:

BACKGROUND: An increase in the numbers of patients with diffuse coronary artery disease who are referred to cardiac surgeons had necessitated the need of developing new techniques to establish the revascularization of specially young patients or elderly with high risks to undergo future re-do surgeries. Long-segmental reconstruction of the diffusely diseased left anterior descending (LAD) coronary artery with the left internal thoracic artery (LITA) and or venous patch has been shown to be beneficial for patients with diffuse coronary artery disease. In this retrospective study, we analysed the long-term outcomes obtained with this technique. METHODS: Between Jan 2003 and October 2007, 1500 coronary artery bypass grafting (CABG) operations were performed by our team. Of these cases, a number of patients were found to have diffusely diseased coronary arteries (mainly LAD) underwent a r long-segmental reconstruction procedure with a LIMA graft or saphenous venous patch with or without endarteriectomies. CONCLUSIONS: Patients with diffuse coronary artery disease present a major challenge for cardiovascular surgeons. The long-term results of long-segmental coronary artery reconstruction are very encouraging, and this approach may be used safely in this subgroup of patients. Coronary artery reconstructions with exclusion of plaques or associated with endarterectomy when plaques are too calcified or stiff produce good stable results in the long run. Coronary endarterectomy should be reserved for arteries that are truly inoperable by other procedures including exclusion of plaques out of the lumen of a new reconstructed coronary vessel using coronary artery reconstruction technique.

Biography:

Alfredo E. Rodriguez graduated from Córdoba National Medical University, Argentina at the age of 22, and has completed his PhD at 30 from the Cordoba Catholic Shool of Medicine. He is Director of Centro de Estudios en Cardiología Intervencionista, a premier Research Organization and Head of the Cardiology Department of Sanatorio Otamendi, Buenos Aires, Argentina. He has published more than 250 papers in major peer review journals and also was Editor of four cardiology books the last one published in September 2015 by Springer. He is editor-in-chief in the Journal “Revista Argentina de Cardioangiología Intervencionista” and has been serving as an editorial board member of worldwide repute Journals such as EuroIntervention, JACC Cardiovascular Interventions, World Journal of Cardiology journal, Drug Designing Journal (2014); Journal of Developing Drugs (2014). He is also frequent reviewer from major cardiology and interventional cardiology Journals

Abstract:

Takotsubo cardiomyopathy (TCM) was characterized by transient left ventricular dysfunction usually involving antero apical and infero apical regions of the myocardium with ST segment changes or T-wave inversion and minimal release of cardiac enzymes in the absence of significant coronary artery disease (CAD). TCM was in general associated with good prognosis, although a minority of patients develops severe hemodynamic complications, including cardiogenic shock, life-threatening arrhythmias and cardiac rupture (CR).Isolated left ventricular impairment is the most common variant of this entity, but right ventricular involvement is also recognized and was associated with poor prognosis. Until January 2015, 14 cases of CR have been reported; included right or left ventricular wall rupture or ventricular septal perforation (VSP) VSP was reported in 4 cases 2 of them who survived were treated with open heart surgery. We are reporting the case of a female patient with acute T waves changes in anterolateral leads in basal ECG, minor enzymes elevation; anterior and apical hipokinesia of the left ventricle and hipokinesia of the right ventricle observed at admission with transthoracic echocardiography (TE) and without significant CAD in the coronary angiogram, four days later she develop cardiogenic shock with left and right severe heart failure and in a new TE a VSP was observed and was located at 10mm of the left ventricular apex. The VSP was repaired successfully percutaneously using an Amplatzer device. Patient had a rapid improvement of her ventricular function and had hospital discharge three days later. TCM can be associated with severe complications including cardiac rupture and VSP. At our knowledge, this is the first reported case in the literature using a percutaneous endovascular technique to repair it.

Biography:

Mohamed AHMED-NASR is the Emeritus Professor of cardiac surgery and Ex Head of Surgery of The Egyptian Heart Institute Head of the department 1999-2005 and 2009 – until July 31st 2011 that performs around 3000 open heart procedures per year in addition to another 1000 cases in the different private Cairo clinics. He does perform by himself around 250 cases per year. He is still of the old generation that performs both adult and pediatric cardiac surgery. He is the Consultant of Cardio-Thoracic Surgery Misr International & Dar El Shefa Hospitals. He is the Minister of Health of the shadow cabinet of Al Wafd Party.

Abstract:

Aim of the work: Emergency valve prostheses obstructions are becoming increasingly common. Analysis of causes and results are shown Patients and Methods: Between January 2004 and December 2013, 885 cases of cardiac valve prostheses obstruction were done. 617 (69,7%) MVR; 147 (16,6%)AVR; 121 (13,6%) DVR. Out of the 617 MVR 9 (1,4%) were due to endocarditis ,608 cases were due to valve thrombosis out of them 316 (52%) were pregnant women. In Aortic postion 7 cases (4,7%) were due to endocarditis and 140 case due to thrombosis out of them 22 cases were pregnant women. DVR 110 were due to valve thrombosis and 11 (9%) due to endocarditis in aortic position. Total mortality 118/885 (13,3%)(13,3%)(13,3%) 338 cases were pregnant women out of them 310 cases (92%) continues preganacy. 16 cases had immediate caesarian section in the immediate post-operative with 6 infant mortalities. Conclusion: Endocarditis represents 1,4% in Aortic position; 9% in DVR; and 4,7% in mitral position. Pregnancy represents a major factor in valve prostheses thrombosis due to anticoagulation program shifting from oral anticoagulation to Heparine.

Biography:

Ahmed is a resident physician and a researcher in the department of Thoracic Organ Transplantation at the University Hospital of Essen, Germany. He is a graduate of the faculty of Medicine-Alexandria University, 2006, Alexandria, Egypt. He did his Critical Care Medicine residency in Alexandria university hospital. In August 2008 he completed his Master Degree in critical care medicine. He then worked as a specialist in Critical care medicine for 6 years. His most recent study was published in the Transplant International Journal 2015.

Abstract:

Background: Ventricular assist devices (VADs) have been proven to be effective in improving survival and quality of life in patients with refractory heart failure. However, outcomes depend on a variety of preoperative parameters. Aim of the study: This study evaluates retrospectively the patients’ profiles; clinical outcome, postoperative complications and mortality in patients who underwent VAD implantation in our center taking into account preoperative Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) levels aiming at anticipation of postoperative complications and optimization of the preoperative strategies. Methods: Between August 2010 and March 2015, 104 patients underwent VAD implantation in our university hospital. INTERMACS profiles were as follow: level 1 in 27 patients, level 2 in 20 patients, level 3 in 27 patients, level 4 in 25 patients, level 5 in 4 patients and level 6 in 1 patients respectively. Patients were divided into 3 groups: Group A included 27 patients at INTERMACS level 1. Group B included 47 patients at INTERMACS level 2/3 and group C included 30 patients at INTERMACS Level 4/5/6. Preoperative clinical, echocardiographic, and hemodynamic and laboratory data were compared between groups as well as the incidence and time of onset of postoperative complications and mortality. Results: Preoperatively, group A had a significantly lower cardiac index, lower mean arterial blood pressure, lower serum hemoglobin, higher serum blood urea nitrogen, higher serum procalcitonin and higher incidence of metabolic acidosis (p < 0.05). Postoperatively, group A had a higher incidence of respiratory failure, Hemorrhage, multiorgan failure, right ventricular failure and tracheostomy (p < 0.05). Total mortality was higher in group A than in group B (p = 0.017) and in group C (p=0.017) but not between groups B and C (p =0.81). Early mortality (at 30 days after VAD) was higher in group A than in group B (p=0.015) and group C (p=0.010). After 30 days mortality was not statistically different between groups. Sepsis (47.1%), right ventricular failure (37.5%) and respiratory failure (33.7%) were the most common post-operative complications after VAD implantation, whereas renal failure was the most common complication within 1 week after the operation (23.1%). Multiorgan failure was the most common cause of mortality (13.5 % n=10). Predictors of total mortality were preoperative high central venous pressure (HR, 1.077; 95% CI, 1.019–1.138, p=0.008), high systolic pulmonary artery pressure (HR, 1.056; 95% CI, 1.015–1.099 p=0.007), high serum blood urea nitrogen (HR, 1.031; 95% CI, 1.018–1.045; p=0.001), high serum procalcitonin (HR, 1.134; 95% CI, 1.040–1.237; p=0.04), metabolic acidosis (HR, 3.496; 95% CI, 1.708–7.157; p=0.001), low serum Hemoglobin (HR, 0.780; 95% CI, 0.667–0.913; p=0.02). Conclusion: INTERMACS scale correlates with outcomes after VAD implantation in our single center study. Anticipation of postoperative complications allows for preoperative strategies to minimize these complications. Optimization of preoperative volume status, preload, right heart function, correction of preoperative anemia and management of preoperative sepsis are recommended to lower the total mortality in such patients.

Biography:

Fabiola B Sozzi works as a practicing cardiologist at the University Hospital Policlinico of Milan, IT. She worked in the Echolab of the Thoraxcentre, Rotterdam, NL where she defended her PhD thesis on cardiac imaging under the supervision of Professor Roelandt. She reached a high expertise in the non-invasive diagnosis of CAD using all the different available techniques: cardiac CT and MRI integrated with stressecho and nuclear. She also works in the acute clinical setting treating the acute cardiac disease. She is visiting professor at the University of Milan where she teaches and leads several research projects.

Abstract:

Stress echocardiography is a noninvasive cardiovascular diagnostic test that provides functional and hemodynamic information in the assessment of a number of cardiac diseases. Performing stress echocardiography with a pharmacologic agent such as dobutamine allows for simulation of increased heart rate and increased myocardial physiologic demands in patients who may be unable to exercise due to musculoskeletal or pulmonary comorbidities. Dobutamine stress echocardiography (DSE), like exercise echocardiography, has found its primary application in ischemic heart disease, with roles in identification of obstructive epicardial coronary artery disease, detection of viable myocardium, and assessment of the efficacy of anti-ischemic medical therapy in patients with known coronary artery disease. DSE features prominently in the evaluation and management of valvular heart disease by helping to assess the effects of mitral and aortic stenoses, as well as a specific use in differentiating true severe valvular aortic stenosis from pseudostenosis that may occur in the setting of left ventricular systolic dysfunction. DSE is generally well tolerated, and its side effects and contraindications generally relate to consequences of excess inotropic and/or chronotropic stimulation of the heart.

Biography:

Guy H Fontaine MD PhD HDR has made 15 original contributions in the design and the use of the first cardiac pace makers in the early 60s. He has serendipitously identified ARVD during antiarrhythmic surgery in the early 70s. He has developed the technique of Fulguration to replace surgery in the early 80s. He has been one of the 216 individuals who have made a significant contribution to the study of cardiovascular disease since the 14th century and one of the 500 greatest geniuses of the 21st Century (USA Books), one of the 100 life time of achievement (UK Book). He has > 900 publications including 201 book chapters. He is a reviewer of 17 scientific journals both in basic and clinical science. He has given 11 master lectures of 90 minutes each in inland China in 2014. He is now developing new techniques for brain protection in OHCA, stroke and spinal cord injury by hypothermia.

Abstract:

Epsilon wave was the name given to the second of double epicardial potentials recorded in patients with resistant ventricular tachycardia treated by antiarrhythmic surgery (Fontaine AHA abstract 1976). The timing of the first normal potential fell inside the QRS complex of the surface tracing; the second abnormal potential occurred after the end of the QRS complex. Other approaches were used to detect this delayed electrical activity which showed a spectrum of morphologies including fragmented potentials after the end of QRS complexes on the surface ECG, also called “Epsilon waves”. This anomaly was also recorded from an endocardial catheter, as well as on the standard ECG; more precisely on a bipolar precordial lead for Holter recording. It was also extracted by the summation averaging technique in patients who did not have Epsilon waves on the standard ECG despite the presence of epicardial Epsilon waves (Fontaine Kulbertus book 1977). Their behavior in sinus rhythm during stimulation and during VT has been described. Particular techniques have been studied to improve their detection on the surface ECG by increasing the sensitivity of the ECG recording, as well as filtering of the signal from an optimal bipolar precordial lead position (Fontaine Parmley book 1991). Detailed descriptions of these potentials suggest a post-excitation phenomenon due to an intramyocardial conduction defect well understood by the pathology of ARVD. This was consistent with a reentrant phenomenon. Finally, standardization of this approach led to the “Fontaine Lead System” (FLS) according to Dr. Willis Hurst who published in Circulation 1998 his discussion about “The naming of the waves in the ECG, with a brief account of their genesis”. The quantitative aspects on a new series of 43 patients were reported (Fontaine Ann Cardiol Angeiol 1993). We now present for the first time recording of Epsilon waves that are present before as well as after spontaneous episodes of ventricular tachycardia with an insertable loop recorder (Medtronic “Reveal”) in a patient with ARVD discovered after multiple episodes of acute myocarditis (Fontaine Europace in press). The brand new Schiller ECG High Definition machine will be able to detect more precisely fragmented potentials in the Epsilon wave and even inside the QRS complex in cardiomyopathies in general as well as in CAD. Conflict of interest: GF is a consultant for ECG machines, Defibrillators, new Chest compressor, Hypothermia for brain protection in OHCA and Stroke for the Schiller Company, Baar, Switzerland.

Biography:

Robert Skalik is a consultant in cardiology and is an exercise physiologist. He completed his PhD in Echocardiography from Medical University of Wroclaw. He covered internship in Department of Cardiology, Free University of Amsterdam, the Netherlands. He is a Lecturer in Postgraduate School of Cardiology, University of Perugia and an academic teacher and researcher in Department of Physiology. He is former consultant in cardiology in Department of Cardiac Surgery and Cardiology, Medical University of Wroclaw and former Head of Department of Cardiac Rehabilitation, Wroclaw. He underwent private practice in cardiology, Wroclaw and is a research projects evaluator for EU. He has published 103 papers on cardiology and human physiology.

Abstract:

The aim of this presentation is to describe examples of health care use cases leveraging potential of digital technologies like remote patient monitoring devices, smart-phones’ applications, data gateways care delivery platforms and machine learning techniques to boost diagnosis and disease management as well as to improve quality of life and reduce healthcare-related costs. It demonstrates how patients can receive better tailored diagnostics and treatment by monitoring of selected physiological parameters of patients such as blood pressure, heart rate, glucose, weight and others, transferring them to cloud based platform for correlating with data drawn from other sources and unleashing the power of data mining algorithms. The report includes examples of innovations enabled by healthcare platform delivered by DIFMED LTD that offers tracking of patients’ health conditions. The smart-phone technology and remote monitoring devices were used to enable physicians to proactively act before the health conditions of patients significantly deteriorated or became critical. The presented user stories proved the potential of digital technologies to propel transformation towards a preventive, proactive and personalized medicine. This kind of healthcare will soon target the needs and expectations of digital and network native patients’ generation. It will become more and more important in the society facing the constantly growing problem of civilization –related chronic diseases and lack of financial resources for the maintenance of more and more expensive healthcare systems.

Biography:

Peter P Karpawich completed his Masters in Science degree from The University of Detroit and his Medical Degree from Hahnemann/Drexel University in Philadelphia, PA. He completed his Post-doctoral Residency in Pediatrics at The Children's Medical Center, University of Texas (Dallas) and Pediatric Cardiology Fellowship at Texas Children's Hospital, Baylor University (Houston). He the Founder and Director of the Cardiac Electrophysiology Program at the Children's Hospital of Michigan and Professor of Pediatric Medicine, Wayne State University School of Medicine (Detroit). He has published over 250 scientific papers, textbook chapters and textbooks and is on the Editorial staff of several internationally-recognized medical journals.

Abstract:

Objectives: Patients (pts) with repaired congenital heart disease (CHD) can later develop heart failure (HF), leading to heart transplant (HT). Although cardiac resynchronization pacing therapy (CRT) has been applied to pts with normal anatomy, there is little information on CRT and CHD. This study evaluated acute hemodynamic contractility (dP/dt), not guidelines, among CHD pts to determine if it can predict chronic CRT efficacy. Methods: Forty patients with CHD and HF (NYHA II-IV) underwent cardiac catheterization (cath) with dP/dt-max both before and after acute CRT pacing. If acute paced-dP/dt-max improved ≥ 15% from baseline with CRT pacing, patients were given the option of CRT. Clinical follow-up after CRT testing was from 2-144 months (mean 35). Results: Preexisting pacemakers were present in 70% of pts. CHD was variable with 16/40 (40%) pts having either a single or systemic “right” ventricle morphology. Of the 40 pts, 26 (mean age 22y) met criteria for CRT benefit while 14 (mean age 29y) did not. There were no differences in age, QRS duration, left ventricular (LV) ejection fraction, LV end diastolic diameter, V contractility (dP/dt-max), nor PM between CRT groups. Among the CRT recipients, 21 pts (81%) improved in NYHA class and were removed from HT consideration. All underwent a repeat cath 6-14 months later showing continued improved contractility. Conclusion: Since published CRT guidelines do not apply to CHD pts, a better way to select which CHD pts may benefit from CRT is needed. Pre-CRT testing by direct paced-contractility response improves patient selection and responder rates.

Biography:

Al-Masri H Hatem is a cardiac critical care intensivist and consultant of cardiac surgery. He completed his medical degree (MD-Doktorate) at Charles University – Faculty of Medicine and holds a degree in Biochemistry from the University of Waterloo – Canada. He completed his residency training in Germany (Leading Facharzt) and holds training fellowships in Cardiac Surgery from IJN KL Malaysia, Switzerland and Canada. He is the author of an award-wining medical research paper titled “Hemodynamic Support Requires Integrated Approach Comparing pl.VAD vs. IABP in Patients Experiencing Left Venticular Failure” (Best Paper of Young Cardiac Surgeon) at the 8th International Congress of Update in Cardiology and Cardiovascular Surgery (UCCVS 2012) awarded by European Society for Cardiovascular Surgery, World Society of Arrhythmias (WSA) and the Society of Cardiology and the International Academic of Vascular and Endovascular Surgery (ISCP). He is a member of the Medical German Association, Malaysian Medical Association and the Saudi Medical Council.

Abstract:

Background: An increase in the numbers of patients with diffuse coronary artery disease who are referred to cardiac surgeons had necessitated the need of developing new techniques to establish the revascularization of especially young patients or elderly with high risks to undergo future redo surgeries. Long-segmental reconstruction of the diffusely diseased left anterior descending (LAD) coronary artery with the left internal thoracic artery (LITA) and or venous patch has been shown to be beneficial for patients with diffuse coronary artery disease. In this retrospective study, we analyzed the long-term outcomes obtained with this technique. Methods: Between Jan 2003 and October 2007, 1500 coronary artery bypass grafting (CABG) operations were performed by our team. Of these cases, a number of patients were found to have diffusely diseased coronary arteries (mainly LAD) underwent a long-segmental reconstruction procedure with a LIMA graft or saphenous venous patch with or without endarteriectomies. Results & Conclusion: Patients with diffuse coronary artery disease present a major challenge for cardiovascular surgeons. The long-term results of long-segmental coronary artery reconstruction are very encouraging and this approach may be used safely in this subgroup of patients. Coronary artery reconstructions with exclusion of plaques or associated with endarterectomy when plaques are too calcified or stiff produce good stable results in the long run. Coronary endarterectomy should be reserved for arteries that are truly inoperable by other procedures including exclusion of plaques out of the lumen of a new reconstructed coronary vessel using coronary artery reconstruction technique.

Biography:

Alfredo E Rodriguez graduated from Córdoba National Medical University, Argentina and completed his PhD from the Cordoba Catholic School of Medicine. He is Director of Centro de Estudios en Cardiología Intervencionista, a premier Research Organization and Head of the Cardiology Department of Sanatorio Otamendi, Buenos Aires, Argentina. He has published more than 250 papers in major peer review journals and also was Editor of four cardiology books the last one published in September 2015 by Springer. He is Editor-In-Chief of the Journal “Revista Argentina de Cardioangiología Intervencionista” and has been serving as an Editorial Board Member of worldwide repute Journals such as Euro-Intervention, JACC Cardiovascular Interventions, World Journal of Cardiology, Drug Designing Journal (2014), Journal of Developing Drugs (2014). He is also frequent reviewer from major cardiology and interventional cardiology Journals.

Abstract:

Recently, an angiographic score was introduced in clinical practice to stratified different levels of risk after PCI. The SYNTAX score (SS) classified patients in three different risk levels. Patients allocated with low SS could be equally treated with either PCI or CABG, whereas those with intermediate or high SS were better off with CABG. However, using original SS each coronary lesion with a diameter stenosis ≥50% in vessels ≥1.5 mm was scored. In contrast, in ERACI IV study, which included patients with multiple vessel disease and unprotected left main stenosis treated with 2nd generation DES, we used a revascularization strategy during PCI where operators were advised to only treat lesions ≥ than 70% in a ≥ 2.0mm reference vessel; therefore, no intermediate lesions should be treated and severe stenosis in vessels ≤ 2.0 mm was discouraged as well. If we recalculated SS using the above-mentioned operators' advices all intermediate lesions were not scored and severe stenosis in vessels < 2.0 mm were excluded for the analysis; after this new scoring, the original SS dropped from 27.7 to 22. More over after this new scoring in ERACI IV, low SS rose to 54.8%, intermediate dropped to 27.9% and only 17.2% of ERACI’s patients scored a high SS. At 24.5 months of follow up, MACCE rate was only 6.7%, composite of death/MI and stroke was 3.6% and unplanned new revascularization 4%. In conclusion, if we performed a SS scoring only severe stenosis in vessels with a reference diameter ≥ 2.0 mm would allow a more rational assessment of coronary anatomy which was associated with low events rate at 2 years of follow up.

Biography:

Ehab E El-Hefny is a Graduate of Al-Azhar University in Cairo, Egypt and specialized in Cardiology since being a resident in the Department of Cardiology. He did his international training in the University of Pittsburgh Medical Center, USA (Preventive Cardiology) and later in the University of Britania Occidentale in France (Interventional Cardiology). He is the Full Professor of Cardiology and Director of the Cath lab, Al-Azhar University Member of the post graduate teaching and examining board. He supervised and evaluated more than 40 research projects for Master and Doctorate degrees in national universities in Egypt. He is the consultant of the National health organization in Egypt and also Reviewer in the Egyptian Journal of Hospital Medicine.

Abstract:

In this work 120 patients suspected of having stable angina pectoris were included, they were presented for evaluation of chest pain and to whom clinical evaluation, echocardiography, nuclear scanning and coronary angiography were done. They were classified into group (A) 40 control patients considered as control group with normal coronaries, and group (B) 80 patients with significant CAD. The study showed that regarding the echo parameters, there were statistically significant differences between the 2 groups regarding the A wave, E/A ration, DT, Em and E/EM also regarding SLSS and GLS 17 and GLS 12 as well as SLSr, GLSr 17 and GLSr 12. Significant difference was present regarding number of vessels affected as regard GLS 12, GLSr 12 and GLSr 17. In comparison with the results of MPI, there were positive correlation between the number of segments affected in MPI and GLS 12 and GLSr 12. A statistically significant correlation was also found between the 17 segments in MPI, SLSS and SLSr parameters. Myocardial strain by speckle tracking is superior to conventional echo. Parameter measurements of global and segmental LS using 2DSE and it is more sensitive tool in the identification of WMA at rest than visual analysis and that support its use to risk stratifies atherosclerotic CAD. It is found that 2DSE is not inferior to the MPI in the non-invasive diagnosis of CAD.

Biography:

Krasimira Hristova is a consultant cardiologist and expert in echocardiography at National Cardiology Hospital and a consultant in cardiology at University Women Hospital "Nadejda". She has defended a Doctorate on the application of new echocardiographic methods for assessing myocardial deformation in patients after acute myocardial infarction. She has specialized in prestigious universities in Austria and Belgium. She received Master's degree in the field of Advance Medical Imaging in Cardiology at the Catholic University in Leuven, Belgium. She is an author of many scientific articles and is a prize winner for a young investigator award of the International Society of Hypertension in 2006, as well as a number of awards at national and international organizations. She was a secretary and currently the President of the working group on echocardiography in Bulgarian Society of Cardiology, Member of the Board of the European Association of Echocardiography and the Scientific Committee of the American Society of Echocardiography. She is the Visiting Professor in Creighton University- Omaha, Nebraska, USA. Sinse December 2013, she is a member of the Board of Directors of the World Hypertension League.

Abstract:

Noninvasive assessment of RV function nowadays, is mainly priority on 3-Dimensional echocardiography. 3D Echocardiography overcomes the difficulties in estimating RV volumes and function in different diseases. RV is systemic pumping chamber, facing increasing after load in CHD, cardiomyopathies, pulmonary hypertension. Difficult anatomy on the RV with heavy trabecularization make determination of blood-endocardial border difficult, missing of axis of symmetry complicate the task of geometry remodeling. Despite all these difficulties assessing RV volumes and function is crucial in the clinical management in patients with CHD. The Recommendations suppose assessing on RV function- volumes and EF to perform with 3D echocardiography. The results from different studies showed very high correlation on the results from MRI data assessing. The method is very simple, fast and with high accuracy to perform RV volumes and EF.

Biography:

Aldo Maggioni received his medical degree from the University of Milan, School of Medicine, where he also completed a fellowship in internal medicine. He performed a residency in cardiology at the University of Padua before becoming a clinical cardiologist in the Division of Cardiology at General Hospital “G. Fornaroli” in Magenta, Milan, then at General Hospital Fatebenefratelli ed Oftalmico, also in Milan. Aldo Maggioni is Member of the Steering Committee of the GISSI studies and Director of the Research Center of the Italian Association of Hospital Cardiologists in Florence. Since 2010 Dr Maggioni is the Scientific Coordinator of the EURObservational Research program of the European Society of Cardiology. Aldo Maggioni served as a member of the Steering Committee, Event Evaluation Committee, Data and Safety Monitoring Board of more than 50 clinical studies in areas including myocardial infarction, secondary prevention, diabetes, stroke, and acute and heart failure. Dr. Maggioni is author of about 500 peer reviewed papers and has been included in the list of the highly cited researchers over the last 11 years (2002-2013) by Thomson Reuters.

Abstract:

Aims: Patients with heart failure (HF) randomized in controlled trials are generally selected and do not fully represent the “real world”. The purpose of this presentation is to better describe the characteristics of HF analyzing administrative data of a population of nearly 2,500,000 subjects. Methods: Data came from the ARNO Observatory including in-habitants of 5 Local Health Units of the Italian National Health Service (INHS). Patients were selected when discharged for HF (January 1, 2008 - December 31, 2012). Clinical characteristics, pharmacological treatments, rate and reasons for re-hospitalization and direct costs for the INHS occurring during 1 year follow-up (FU) were described. Results: Of the 2,456,739 subjects included in the database, 54,059 (2.2%) were hospitalized for HF: 41,413 were discharged alive and prescribed on HF treatments. Mean age was 78±11 years, females accounted for 51.4%. Just 26.6% were managed in a cardiology setting. The more frequent co-morbidities were diabetes (30.7%), COPD (30.5%) and depression (21%). ACE-inhibitors/Angiotensin Receptor Blockers, Beta-Blockers and Mineralocorticoid antagonists were prescribed in 65.8, 49.7 and 42.1% of patients. During 1-year FU at least one re-hospitalization occurred in 56.6% of patients, 49% of them were due to non-cardiovascular causes. INHS’s direct cost per patient per year was 11,867€ of which 76% related to hospitalizations. Conclusions: Real world evidence provides a description of patients’ characteristics and treatment patterns that are very different from those reported by randomized clinical trials. Costs for the INHS are mainly driven by hospitalizations which are often due to non-cardiovascular reasons.

Biography:

Robert Skalik, MD, PhD, consultant in cardiology, exercise physiologist. He completed his PhD in echocardiography from Medical University of Wrocław. He covered internship in Department of Cardiology, Free University of Amsterdam, the Netherlands, lecturer in Postgraduate School of Cardiology, University of Perugia, academic teacher and researcher in Department of Physiology, former consultant in cardiology in Department of Cardiac Surgery and Cardiology, Medical University of Wrocław, former Head of Department of Cardiac Rehabilitation, Wrocław , private practice in cardiology, Wrocław, research projects evaluator for EU. He has published 103 papers on cardiology and human physiology.

Abstract:

Physical capacity is a complex process and may be subject to significant modulation due to intensity of aerobic and anaerobic processes, efficacy of thermoregulation, psychomotor performance and psychological factors irrespective of normal functioning of the cardiovascular and musculoskeletal systems. Hence, the dynamics and magnitude of changes in core body temperature in response to acute physical exercise in cardiopulmonary exercise test (CPX) and their relationship to exercise capacity have not been elucidated yet. The role of the cortical centers in modulation of fatigue perception in physically active people is also controversial. The cerebral cortex is a significant determinant of psychomotor performance. The results of the study confirmed a significant relationship between core body temperature at maximal physical effort (Tc ) in CPX and psychomotor performance in healthy amateur athletes. The psychomotor performance was also related to carbon dioxide output at maximal physical exercise, ventilatory equivalent for carbon dioxide at the anaerobic threshold. Thermometabolic (VO2AT divided by Tc) and neurothermometabolic (VO2AT divided by the sum of Tc and psychomotor performance score) index are strongly related to parameters of exercise capacity as measured at maximal physical effort during CPX (VE, VCO2). The Rate of Perceived Exertion (Borg scale) immediately after CPX is not related to Tc, exercise capacity parameters and psychomotor skills. The magnitude of changes in core body temperature during CPX may affect the parameters of physical fitness through modulation of psychomotor skills. Psychomotor performance influences ventilatory parameters. Subjective perception of physical effort does not correlate with exercise capacity parameters in CPX.

Biography:

Zaid Altheeb is currently a Cardiology fellow at New York Medical College. He graduated from Jordan University of Science and Technology (J.U.S.T) in 2009. He has a medical degree in medicine and surgery. He is in the American board of internal medicine from New York Medical College at St. Joseph’s, Paterson-New Jersey USA. Member in American college of physicians ACP. Member in American College of Cardiology ACC. Publications in the field of cardiovascular medicine

Abstract:

Background Inflammation plays an important role in left ventricular remodeling and myocytes hypertrophy and remodeling. Higher levels of inflammatory markers, like IL-6, TNF-a, and CRP, were found in patients with heart failure with preserved ejection fraction (HFpEF). Neutrophil to lymphocyte ratio (NLR) represents a widely available, nonspecific marker of systemic inflammation. It was validated as a significant predictor of adverse outcomes in multiple cardiovascular diseases, such as acute coronary syndrome and valvular heart disease. In this study we aimed to explore the utility of NLR as a predictor of long-term mortality in patients with HFpEF. Methods 376 patients admitted to our hospital between 2010 and 2012 for acute HFpEF exacerbations were evaluated for study inclusion. 296 patients met the study inclusion criteria. Depending on the initial NLR level, patients were divided into two groups; NLR >= 4.5 and NLR < 4. Three-year vital status was obtained via electronic medical records and Social Security Death Index. Survival analysis was used to evaluate the predictive value of NLR level between these two groups. Results There was a higher all-cause 3-year mortality (6.8% vs 15.3%, Chi-squared 4.6, p 0.033) in patients with NLR >= 4.5 when compared to those with NLR =4.5 (84.7% vs 93.2%, Chi-squared 5.423, P 0.02, HR 2.3456, CI 1.19-4.64). Using univariate Cox proportional-hazards regression analysis, patients with NLR >=4.5 had 2.35 fold increase in 3-year mortality when compared to those with NLR < 4.5 (HR 2.35, CI 1.12-4.79, P 0.0244). In a multivariate cox regression analysis, with the adjustment for age, sex, race, history of coronary artery disease, stroke, hypertension, diabetes, end-stage renal disease and tobacco use, NLR remained a significant independent predictor of 3-year mortality and patients had a 2.53 fold increased risk of mortality (HR 2.53, CI 1.14-5.62, P 0.0229). Conclusions NLR, using a cutoff value of 4.5, represents an independent predictor of long-term mortality in patients with HFpEF.

Biography:

Govindan Vijayaraghavan is a cardiologist from India, credited with establishing the first 2D Echocardiography laboratory in India. He is the vice-chairman & Founder Director of the Kerala Institute of Medical Sciences and the President of the Society for Continuing Medical Education and Research, Trivandrum, Kerala. He was honoured by Government of India in 2009 for his services in the field of medical sciences by awarding him Padmashri

Abstract:

Background: Sepsis patients with myocardial injury has very high mortality(30-60%).Only a few studies incorporating electrocardiography, high sensitive troponin T(hsTnT), N-terminal pro-BNP(pro-BNP) and echocardiography has been conducted in these patients . Methods and Results: Out of 204 patients with sepsis enrolled, 111 patients satisfied the inclusion criteria and 103 completed the study. Myocardial injury was defined by elevation of hsTnT > 25 pg/ml. Initial hsTnT, pro-BNP and 2D echocardiography were repeated if sepsis progresses. Primary and secondary end point were in hospital mortality and left ventricular dysfunction(LVD).Simple sepsis was diagnosed in 45%; 19% had septic shock and 36% developed severe sepsis. male predominance(63%) with majority being diabetic (66%) and above 50 years of age (54%).Sinus tachycardia was present in 65% and T inversion in inferior leads in 32%.Systolic dysfunction(SD) was present in 42%, diastolic dysfunction (DD) in 21% and 21% had both SD and DD. HsTnT was elevated in 84% of the patients. Both HsTnT and pro-BNP were significantly correlated with LVD (p<0.001).Though pro BNP and HsTnT vary in different levels of LVD (table1), variation was more marked with pro-BNP. Both levels were lesser in DD than SD. Grade III DD was always associated with severe SD .Pro-BNP had significant correlation with pro-calcitonin level (p<0.001) and APACHE II score (p<0.001); HsTnT had significant correlation only with APACHE II score (p<0.001). CRP level did not have correlation with cardiac markers. In hospital mortality was 8%.In survivors hsTnT was 158pg/ml and pro-BNP was 6400 pg/ml.In non-survivors hsTnT was 256 pg/ml (p<0.047) and pro-BNP was 21805pg/ml(p<0.001).Pro BNP has better correlation with the survival. ROC curve showed that a pro-BNP level >8530 pg/ml signified with mortality (sensitivity-100% and specificity-80%) and HsTnT level >178pg/ml correlated with mortality with 88% sensitivity and 71% specificity. Base line creatinine was normal in all patients; 55% had elevated creatinine during the sepsis and had linear correlation with hsTnT level (p<0.01). Conclusion: Pro-BNP is a powerful tool for prognostication in sepsis with myocardial dysfunction and a value>8530 pg/ml signified decreased survival with 100% sensitivity. The significant elevation of pro-BNP with minimal elevation of hsTnT indicated that the pathophysiology is mainly myocardial stretch and not myocardial necrosis in sepsis; with full recovery in survivors. Table 1: distribution of pro-BNP and HsTnT in LVD (*21% had combined LVD) ECHOCARDIOGRAPHY % Mean pro-BNP(pg/ml) Mean HsTnT(pg/ml) Normal 16 2433 (700-4100) 76 (<25-160) Mild LV SD 11 5481 (3200-9200) 210 (80-360) Moderate LV SD 13 9608 (5400-16100) 254 (150-480) Severe LV SD 18 16844 (7200-25000) 268 (148-450) Grade I DD 8 3132 (1024-5250) 117 (60-220) Grade II DD 13 6596 (3500-9000) 125 (26-240)

Biography:

Rohit M Sane, MBBS, is a pioneer of non-invasive cardiac care management. Dr. Rohit Sane is the Founder of Madhavbaug Cardiac Rehabilitation Center which includes 138 OPDs & 2 IPDs in Maharashtra, India. For more details log on to www.madhavbaug.org

Abstract:

Abnormal six-minute walk test (6MWT) findings which indicates decreased functional capacity is considered as predictor of increased cardiovascular risk and mortality. However, the importance of this variable as predictor of mortality in heart failure (HF) patients with low ejection fraction (EF) is not well established. Therefore, we aimed to determine the influence of 6MWT findings on prediction of cardiac-related mortality in patients with low EF. Analyses were based on 108 heart failure patients with low EF undergoing treatment at Madhavbaug Cardiac Rehabilitation Centre between January 2012 and January 2014. Estimated functional capacity measured through 6MWT findings (expressed as the distance walked in meters) to determine its prognostic importance during 3 years of follow-up. Of 128 patients, 50 (39%) died during follow-up; all reported deaths were found to be as cardiac related. In survived patients group, the distance walked was greater than 409.72(±93) meter while in died patients group, it was less than 300.17(±124) meter. The 2D echo data suggested that in both the groups, the left ventricular mass was 290 g and ejection fraction was 28.7 % and 26.62 % in survived and died patients, respectively. On univariable analysis, estimated functional capacity measured through 6MWT findings was a strong predictor of death, with 50 (39%) deaths occurring in patients achieving p< 0.05. On multivariable analysis, the strongest independent predictors of cardiac related mortality were poor functional capacity. The distance walked by patients in 6MWT had strong relation to the number of reported deaths, functional capacity was a predictor of death. For reported cardiac mortality, functional capacity remained as independent predictor of mortality.

Biography:

Makoto Suzuki is a cardiologist Cardiovascular Medicine, Sakakibara Heart Institute, Tokyo, Japan. His main research interests are myocardial infarction, coronary inflammation, myocardial mal-reperfusion, cardiology.

Abstract:

We retrospectively investigated our hypothesis that pre-percutaneous coronary intervention (PCI) procedural therapeutic hypothermia may have clinical advantages in patients with a profound cardiogenic shock complicating anterior ST-segment elevation myocardial infarction (STEMI). Methods: Of 483 consecutive patients treated with PCI for a first anterior STEMI including 31 patients with aborted sudden cardiac arrest between 2009 and 2013, a total of 37 consecutive patients with an anterior STEMI complicated with profound cardiogenic shock defined as the presence of hyperlactic acidemia (serum levels of lactate N4 mmol/L) with mechanical circulatory support were identified. An impaired myocardial tissue-level reperfusion (angiographic myocardial blush grade 0 or 1) and in-hospital mortality were evaluated in accordance with the presence or absence of pre-PCI procedural therapeutic hypothermia. Results: Thirteen patients were treated with pre-PCI procedural therapeutic hypothermia and 24 were not inducted with therapeutic hypothermia. Five patients with and 18 without pre-PCI procedural therapeutic hypothermia impaired myocardial tissue-level reperfusion (38% vs. 75%, p = 0.037). A total of 26 patients with in-hospital death (overall in-hospital mortality 70%) were composed of 6 with and 20 without therapeutic hypothermia (in-hospital mortality 46% vs. 83%, p = 0.028). A multivariate analysis demonstrated a significant association of pre-PCI procedural therapeutic hypothermia (p=0.021)with in-hospital survival benefit. Adverse events associated with therapeutic hypothermia were not found in 12 patients who completed this treatment. Conclusions: The present study may imply a crucial possibility of clinical benefits of pre-PCI procedural therapeutic hypothermia in patients with a cardiogenic shock complicating anterior STEMI

Biography:

Wolfgang Poller is the Head of Experimental Research Activities, Charité - Universitätsmedizin Berlin, CharitéCentrum cardiovascular and vascular medicine, Department of Cardiology

Abstract:

The lecture will discuss recent developments and clinical perspectives noncoding RNA research, with special emphasis on the translation of basic science insights and preclinical research into clinically valuable novel diagnostic tools and therapeutic strategies. Regarding diagnostic value, ncRNA biomarkers (both miRs and lncRNAs) will be critically weighed against current differential diagnostic and prognostic markers. Regarding therapy, ncRNA molecules can be targets as well as tools. The fundamental novelty of these therapies arises from the fact that they exploit tailormade molecular interactions between endogenous and synthetic ncRNAs. Preclinical animal studies showed high efficacy of anti-miR therapeutics, and of RNA interference (RNAi) strategies employing ncRNAs as tools for silencing of protein-coding genes. An increasing spectrum of endogenous ncRNAs is employed for the development of novel therapeutic ncRNA tools (tRNA and rRNA scaffolds, chimeric tRNA/miR structures). Clinical trials attempting translation of these strategies into clinical practice have met with variable success so far. The most successful trials addressed precisely defined patient cohorts in whom one pathomechanism was the sole or dominant cause of disease development and progression. Accordingly, future clinical trials are likely to increasingly focus upon patients in whom the high costs and efforts of ncRNA therapeutics development are likely to result in significant clinical success and patient benefit. We discuss selection criteria and suitable clinical outcome parameters, and paradigmatic ncRNA-based strategies at late preclinical stage or in clinical trials are reviewed with regard to clinical translational potential and possible impact upon clinical practice.

Biography:

Dirk Lassner is in the Management and Laboratory direction (GLP/GCP, College of American Pathologists (CAP)), Acquisition, Marketing and Sales Management of diagnostic and CRO service (trials, gene chips), Biochemist/Molecular biologist (RT-PCR, QPCR, gene arrays, sequencing, SNP technology), Cell biologist (cell culture, flow cytometry, in-situ techniques (hybridization, PCR, antibodies)), International co-operations in research and molecular diagnostics in cardiology. He is the Managing and Laboratory Director of InstitutKardialeDiagnostik und Therapie GmbH (IKDT), Berlin since 2003, Permanent collaboration and participation in several national and international R&D projects with Dept of Cardiology, Charite University Hospital Berlin since 2003, Managing Director of Augustusburg BioTech GmbH, 2001 to 2002. He has done his PhD (Dr. rer.nat.) at University Leipzig – magna cum laude in 1996.He has over 50 publications on cardiomyopathies and different patent applications.

Abstract:

The most common cause of death in Western European Countries are cardiovascular diseases. By estimation of the European Society of Cardiology (ESC) 12 million patients in Europe are suffering from heart failure problems, 3 million patients are showing dilated cardiomyopathy (DCM). Cardiomyopathies arise mainly from inflammation and infections with bacteria or cardiotropic viruses. Current state-of-the-art in EMB Diagnostics is a combination of histological staining for diagnosis of active myocarditis or storage diseases, immunohistochemical staining with specific antibodies and digital imaging analysis for quantitative evaluation of intramyocardial inflammation and the molecular biological detection of cardiotropic viruses. Viral infections of the myocardium are considered to be a main cause for the development of DCM. The qualitative detection of most relevant cardiotropic viruses (Adenovirus, Enterovirus, Epstein-Barr-Virus (EBV), Erythrovirus (B19V), Human Herpesvirus 6 (HHV6)) should be supported by sequencing, quantification of viral load and measurement of transcripts (mRNA) as marker of viral activity, especially for B19V and HHV6. Digital numeric quantifications of inflammatory infiltrates in myocardium has shown a close correlation with clinical course and mortality. Number of cytotoxic cells (Perforin) in initial EMB is predictive for worse progression of LV function in examined patients. The increasing number of T memory cells (CD45RO) in EMB results in significantly increasing mortality in a 10-year follow-up. High number of inflammatory cells in virus-negative patients request the immediate immunosuppressive treatment to prevent myocardial injuries and failing heart. In virus-positive patients an antiviral therapy is indicated. Due to focal pathology, diagnostics are failing if the EMB does not contain the area of interest. Therefore at least 8 EMBs should be taken. Biopsies from left or right ventricle are equally meaningful. The chance that the sampling error occurs are much likely if only very few biopsies will be analysed. However, first investigations indicate that the presence of individual gene expression patterns (mRNA) of myocardial tissue can be used for identification of specific disease situations without proof of histological or virological markers in the examined myocardial tissue. These disease specific profiles will be changed during effective treatment and thereby could be applied for therapy monitoring. Personalized medicine comprises the genetic information together with the phenotypic and environmental factors to yield a tailored healthcare for each individual and removes the limitations of the "one-size-fits-all" therapy approach. Novel biomarkers and multiparametric approaches in expanded EMB diagnostics provide the opportunity to translate therapies from bench to bedside, to diagnose and predict disease, and to improve patient-tailored treatments based on the unique signatures of a patient's disease.

Biography:

Heinz-Peter Schultheiss is a Professor of Internal Medicine and Cardiology. He is the CEO of Institute for cardiac diagnostic and therapy (IKDT) Berlin. From 1997 -2000 he was the Chairman of the Medical Society Berlin. He is a Member of German Society for Internal Medicine and a Member of European Society of Cardiology.

Abstract:

Myocarditis and inflammatory cardiomyopathy (DCMi) are a challenging diagnosis due to the heterogeneity of clinical presentation which is highly variable and ranges broadly from subclinical symptoms to fulminant heart failure. Because the clinical course of myocarditis and DCMi is unpredictable and the non-invasive diagnostic tests – including ECG, echocardiography, MRI, and serological tests - are limited in their ability to make a clear cut diagnosis, all patients with clinically suspected myocarditis and DCMi have to undergo endomyocardial biopsy (EMB), before irreversible and thus untreatable damage to the myocardium has developed. Actually, the ESC working group on myocardial and pericardial diseases recommend in the statement position paper that in all patients fulfilling the diagnostic criteria for clinically suspected myocarditis selective coronary angiography and EMB should performed.

Any rational and specific therapeutic regimen for DCMi must consider the underlying pathogenesis based on histological, immunohistological and virological evaluation of EMBs. The exact analysis and quantification of intramyocardial infiltrates as well as the characterization diagnosis of viral pathogens have been shown by multivariate regression analysis to be independent predictors of the clinical outcome. The phase of viremia, and the active replication, as well as the extend and quality of infiltration seems to proceed the phase of target organ injury and future progression of the disease.

The mainstay of treatment for myocarditis and DCMi is an optimal heart failure medical regimen. Moreover, EMB is the basis for personalized immunosuppressive or antiviral treatment.

In virus-positive DCMi Interferon-ß treatment is a well-tolerated and safe treatment option, leading to effective virus clearance in patients with coxsackie- and adenovirus-positive cardiomyopathy. Favourable clinical effects assess quality of life, NYHA functional class, patient global assessment and survival.

In case of biopsy-proven virus-negative inflammatory cardiomyopathy - based on an exact characterization and quantification of infiltrative cells - immunosuppressive therapy is an effective and safe option. Administered anti-inflammatory drugs are corticosteroids, azathioprine, and cyclosporine. Immunosuppressive treatment in virus-negative DCMi showed effectiveness and beneficial effects even after a long-term follow-up period.

In summary, any rational and immunomodulatory therapeutic regime for DCMi must consider the underlying pathogenesis based on histological, immunohistological and virological evaluation of EMBs. This is be the basis for a rational, causal, personalized and specific therapy.

Biography:

Lorenzo Monserrat is the CEO, Health in Code, A Coruña, Spainfrom2012 – Present. He is also the Co-Founder and Scientific Director, Health in Code 2006 – 2011. He is doing his research in Galician Health Service, Spain. He is a Cardiology Consultant, A Coruña University Hospital, Spain. He has done his PhD from European Doctorate in Medicine, University of A Coruña, Spain and MD, in Medicine and Surgery, University of Santiago de Compostela, Spain.

Abstract:

The inherited cardiovascular diseases (cardiomyopathies, channelopathies and inherited vascular diseases) are a heterogeneous conjunct of primary diseases usually of genetic origin and familial presentation, which are associated with sudden death risk . The identification of multiple genetic causes for these diseases has opened a new window for their early diagnosis, the understanding of their natural history, and for the improvement in their risk stratification and management. However, in the last years, the clinical application of genetics has been limited by the cost and low yield of the available genotyping technologies. The irruption of Next Generation Sequencing, has completely changed this scenario. This group of disruptive  technologies allow the evaluation in parallel of hundreds or even thousands of genes at an affordable cost. Now the challenge is not the genotyping, but the interpretation of the complex results.                                                                        

In our  presentation we review the main aspects related to the application and impact of Next Generation Sequencing in the study of the inherited cardiovascular diseases, with a special focus in the clinical validation and the interpretation of the results.

The successful application of NGS in the clinical diagnosis and managment of inherited cardiovascular diseases requires the adequate integration of genotyping technology, bioinformatics and clinical interpretation supported by knowledge managment systems. We will present in this session:

-       Results and validation of NGS technologies in inherited cardiovascular diseases associated with sudden death

-       Our advanced and innovative multidisciplinary approach for the clinical interpretation of the results

-       Examples of the usefulness of NGS in the evaluation of inherited cardiovascular diseases

Biography:

Fabiola Sozzi works as a practicing cardiologist at the University Hospital Policlinico of Milan, IT. She worked in the Echolab of the Thoraxcentre, Rotterdam, NL where she defended her PhD thesis on cardiac imaging under the supervision of Professor Roelandt. She reached an high expertise in the non-invasive diagnosis of CAD using all the different available techniques: cardiac CT and MRI integrated with stressecho and nuclear. She also works in the acute clinical setting treating the acute cardiac disease. She is visiting professor at the University of Milan where she teaches and leads several research projects.

Abstract:

Stress cardiac magnetic resonance imaging (CMR) has been shown to have excellent diagnostic accuracy for detection of significant coronary artery disease (CAD). CMR provides valuable clinical data on the evaluation of structural, functional and valvular heart disease. As a result, stress CMR is increasingly being used to assess chest pain in patients with known or suspected CAD. CMR potentials derive from its high-spatial resolution, image contrast, lack of ionizing radiation and excellent depiction of wall motion. An essential characteristic of stress modalities is the negative prognostic value. The detection of myocardial ischemia with stress CMR is typically based on first-pass perfusion imaging, to search for inducible perfusion defects, or on wall motion abnormality imaging. An important goal of any stress modality is to identify those patients with low cardiac event rate. We reviewed 300 patients with suspected or known CAD, who undergone adenosine stress-CMR. End-points, during a long-term follow-up (5.5 years) were all causes of mortality and major adverse cardiac events. An excellent outcome for adverse cardiac events was found. The power of CMR relies also on the evaluation of viability with late gadolinium enhancement (LGE) methods. The LGE differentiate viable myocardium from scar on the basis of differences in cell membrane integrity for acute myocardial infarction. In chronic infarction, the scarred tissue enhances much more than normal myocardium due to increases in extracellular volume. Beyond infarct size or infarct detection, LGE is a strong predictor of mortality and adverse cardiac events. CMR can also image microvascular obstruction and intracardiac thrombus. CMR can determine infarct size, area at risk and thus estimate myocardial salvage after acute myocardial infarction.

Biography:

Andreas Petropoulos graduated from Aristotle University’s Medical School, Greece in 1989. He has followed 30 years career as a medical officer, senior Flight Surgeon in the Hellenic Air-Force. He is specialized in Aviation-Hyperbaric Medicine, Pediatrics, Fetal, Pediatrics and Congenital Cardiology in USA, Europe. He holds MSc in Preventive Cardiology and a member of AEPC working groups in “Prevention” & “Heart Failure-Pulmonary Hypertension”. He worked and lectured in Athens and Brussels universities. Currently he consults in Pediatrics, Fetal. Pediatrics & Congenital Cardiology in Merkezi Klinika and is the Associate Professor at the State University and Post Graduate, CME Center in Azerbaijan. His research focuses on prevention, CVD imaging techniques, fetal cardiology and heart failure.

Abstract:

Pulmonary Hypertension (PH) in childhood is a condition of multiple etiologies with underestimated prevalence. Despite to the newer existing treatment options PH remains a progressive life limited condition. Although its gold standard diagnostic method is hemodynamic study by cardiac catheterization, the initial assessment as well as frequent follow-up is based on transthoracic echocardiography (TTE). The aim of this abstract is to focus on the best approach by using TTE in screening for, diagnosing and following up patients with a variety of etiologies, suffering from PH. We will focus on the resent (2016) proposed recommendations of the European Pediatric Pulmonary Vascular Disease Network, endorsed by ISHLT and DGPK on the use of Echocardiography to address holistically children suffering from PH. More, to highlight the most important and handy in everyday, clinical work, Echocardiography index to assess pulmonary artery pressures and biventricular systolic and diastolic function, that can improve our diagnostically and therapeutically approach towards childhood PH

Biography:

Baris Cankaya has completed his graduation from Ankara University Medical Faculty in 2000. He is working as Anesthesiology Specialist at Marmara University Training Hospital. He has attended several academic meetings nationally and internationally. His academic interests include microcirculation, fluid therapy, resuscitation, patient safety and perioperative analgesia. He has participated in various international workshops, congress/symposiums and certifications and to list a few: EPLS provider Berlin 2015; NLS provider Athens 2015; MECOR Level I October 2014; ECMO workshop 2015, Leicester; Airway workshop ICISA 2014, Tel Aviv; Innovations Workshop ICISA 2014, Tel Aviv; Gastro 2016, Birmingham: oral presentation: Sedation for pediatric patient with end stage hepatic disease outside operating room; International intensive care symposium Ä°stanbul 2015 and so on.

Abstract:

Transesophageal echocardiography has a wide use in perioperative period. Heart chambers, valves, vessels, fluid management are all in view of TEE. But, limitations are appearing with experience progressing. A novel limitation is invisibility of the aortic arch. Undiagnosed atherosclerosis originating from ascending aorta is a major problem causing neurologic complications during cardiac surgery. Visualizing thoracic aorta is also important for transaortic heart valve implantation. TEE's lacking sensitivity for atherosclerosis in distal aortic arch is corrected with a view TEE. This technic is based on overcoming the air in trachea. Usage of A view TEE before sternotomy gives an advantage against epiaortic ultrasound. TEE allows continious monitoring and does not interfere with surgical site. This allows a complete visualization of distal aortic arch, thoracic aorta and origins of the cerebral arteries. Epiaortic ultrasound has the advantage of a high frequency probe on it for further analyzing the atherom plaque. Isala safety check and Katz classification helped for perioperative management, and mortality has reduced significantly. Preoxygenation and experience are important because of the time limitation. This procedure will help surgical team to review treatment plan. Adjustments of cannulation, distal arch cannulation, and intermittent ventricular fibrillating method and off pump surgery are the changes according to visualization. Further experience with a view TEE will help more for neurologic outcome in near future.

Biography:

Osama A Tolba El Razaky had completed MD Pediatrics from Tanta University. He has obtained Post-doctoral studies in cardiac deformation. He is a Head of Egyptian Pediatric Cardiology Association and a member of Egyptian Universities promotion committee (Professor of Pediatrics). He is currently a Professor of Pediatric (Cardiology Unit) in Tanta University. He has published 20 papers in international journals and has been serving as a Reviewer for Acta Pediatric. He was a supervisor of 100 MS and 25 MD theses in Pediatrics. He is working as echographer in Pediatrics since 25 years. His main interest is TDI, STI and 3D Strain.

Abstract:

Background: The development of Diabetic cardiomyopathy (DCM) is multi-factorial and several pathophysiologic mechanisms have been proposed to explain structural and functional changes associated with DCM. α-lipoic acid (ALA) a powerful antioxidant may has a protective role in diabetic cardiac dysfunction. Aim of the work: This study aimed to assess the potential role of oxidative stress, inflammatory cytokines, apoptosis and fibrosis in diabetic cardiac insult. It also investigated the possible protective role of α-lipoic acid on diabetic left ventricular (LV) dysfunction in type 1 diabetic children and adolescents. Subjects & Methods: 30 patients were randomized to receive insulin treatment (n=15) or insulin plus α-lipoic acid 300 mg twice daily (n=15). Age and sex matched healthy control children and adolescents (n=15) were also included. Patients were evaluated with conventional 2-dimensional echocardiographic examination (2D), pulsed tissue Doppler (PTD), and 2-dimensional longitudinal strain echocardiography (2DS) before and after therapy.3D strain (longitudinal, circumferential, area and radial strain) were estimated. Plasma level of glutathione, malondialdhyde (MDA), nitric oxide, tumor necrosis factor-α (TNF-α), Fas Ligand (Fas-L), matrix metalloproteinase-2 (MMP-2) and troponin-I were determined before and after treatment. Results: Diabetic patients had significant lower level of glutathione and significant higher levels of malondialdhyde (MDA), nitric oxide, tumor necrosis factor-α (TNF-α), Fas Ligand (Fas-L), matrix metalloproteinase-2 (MMP-2) and troponin-I than control subjects. Increased expression of transforming growth factor-β (TGF-β) mRNA in peripheral blood mononuclear cells was also observed in diabetic patients. 2D global longitudinal strain and 3D longitudinal, circumferential and area strain were significantly decreased in diabetic children. α-lipoic acid significantly increased glutathione level and significantly decreased MDA, nitric oxide, TNF-α, Fas L, MMP-2, troponin I levels and TGF-β gene expression levels. Moreover, α-lipoic acid significantly increased mitral e/a ratio, ventricular global peak systolic strain in diabetic patients. There were significant negative correlation between Global peak systolic strain (G) and glutathione and significant positive correlations between G and MDA, NO, TNF-α and Fas-L. In addition, a significant positive correlation between e/a ratio and glutathione (r=0.515) and significant negative correlations between e/a and MDA, NO, TNF-α and Fas-L were also observed. Conclusion: These data suggest that oxidative stress, inflammatory cytokines such as TNF-α, apoptosis and fibrosis play a role in the development of diabetic cardiac dysfunction and that α-lipoic acid may have a beneficial role in the management of type 1 diabetic patients as a cardioprotective therapy and prevention of development of diabetic cardiomyopathy.

Biography:

Aris Lacis, Cardiac surgeon, Professor, MD, PhD graduated Riga Medical Institute in 1961. He worked as General and thoracic surgeon in P. Stradina University Hospital in Riga (1964–1969), Thoracic and cardiac surgeon in the Latvian Centre for Cardiovascular Surgery (1969-1994). From 1994 until 2012, he is the head of Pediatric Cardiology and Cardiac Surgery Clinic in University Children’s Hospital, Riga; since 2012 – he is the consulting Professor of this Clinic. He is also the Vice-President of Latvian Society for Cardiovascular Surgery and President of Latvian Association for Pediatric Cardiologists. He is the author of 395 scientific publications, 3 monographs and 13 patents. He is the Investigator in more than 10 clinical trials including cardiosurgical procedures performed under deep hypothermia, hybrid procedures etc. In May 2009 he have been used transcutan intramyocardial delivery techniques for treatment (idiopathic dilated cardiomyopathia) the first 3 months aged patient in the world with autologous bone marrow derived progenitor cells. In November 2010 the first patient with end stage pulmonary hypertension received intrapulmonary implantation autologous stem cells.

Abstract:

Context: On a global level, stem cell research has been a major challenge during the last decade. There have been achieved positive results in experimental studies on animals and there have been identified several conditions in adult population where bone marrow derived progenitor stem cell transplantation (BMPSCT) may play a crucial role. Though, little is known about possible implementation of the BMPSCT in paediatrics, dilated cardiomyopathy and pulmonary arterial hypertension in particular. There are uncertainties around the destiny of stem cells after their injection into the blood stream. In particular, it regards migration and homing of implanted cells in the target tissues. As yet unclear is the possible role of sympathetic nervous system in the context of osteoreflexotherapy. There is still no definitive answer to the question on which is the preferred type of stem cells to be use for transplantation in different settings. Objective: To determine the role of BMPSCT in management of critically ill paediatric patients followed by assessment of safety and efficacy of the procedure. Design, settings, participants: Two patients (9 and 15 years old) with trisomy 21 and severe pulmonary arterial hypertension due to uncorrected large ventricular septal defects were been admitted to our department to receive imtrapulmonary BMPSCT procedure. Both patients underwent radionuclide scintigraphy before the procedure, followed by repeated scans 6, 12, 24 and 36 months after BMPSCT. Latest results show improvement of lungs vascularization. Seven patients (4 months – 17 years) with dilated idiopathic cardiomyopathy were admitted for intramyocardial BMPSCT procedure. All patients underwent repeated clinical examination every two months, up to 6 years after cell transplantation. We observed improvement of left ventricular ejection fraction, decrease of left ventricular end diastolic dimension by echocardiography and cardio-thoracic index at chest X-ray exams, reduction of serum brain natriuretic peptide serum levels and decrease of the stage of heart failure from stage IV to stage I, by NYHA classification. No periprocedural harmful side effects were observed. Conclusions: The results are promising and we suggest that BMPSCT might be used for the stabilization of the patient to get the time for further symptomatic treatment or serve as a bridge for heart or lung transplantation.

Biography:

Dr. Brojendra Agarwala has completed his MBBS at the age of 23 years from University of Kolkata, India and completed Pediatric cardiology fellowship from New York university medical center New York, NY, USA. He is a pediatric cardiologist and professor of Pediatrics at the University of Chicago. He has received best teacher award by the pediatric residents and the medical students. He has published 68 papers in reputed journals. He is named as one of the Top Doctors and Best pediatricians in Chicago magazine for many years.

Abstract:

In 2015 Pediatric cardiology is a very well developed specialty. In the past cardiology as a specialty was limited to the Internists. For centuries pediatric cardiology was developed into a specialty where only trained pediatricians in cardiology took care of Fetuses with congenital heart disease (CHD), neonates and further followed them into adulthood. With excellent care, children with severe life threatening CHD are surviving into adulthood and leading productive lives serving the society as physicians, lawyers, MBAs and many other professions and non-professional activities. In 1938 when Robert Gross ligated a patent ductus, a new era of pediatric cardiology was born. Clinical acumen, understanding of physiology, anatomy, angiography and development of extracorporeal circulation allowed caring for children with CHD which was previously lethal. A few interested pediatricians taught themselves and finally the subspecialty was born. In 1961 pediatric cardiology became the first subspecialty board in the USA. I the past 60 year significant progress has been made in non-invasive imaging e.g. cardiac ultrasound, color-Doppler, MRI, CT scan. Utilization of these modalities has made invasive diagnostic cardiac catheterization almost unnecessary. Development of interventional cardiac catheterization has almost replaced cardiac surgery in multiple CHD. For the past 50 year pediatric cardiology was focused on diagnosis, patient care, education and clinical research. However, for the past 10 years basic research discoveries of the cause of the CHD have developed, which will hopefully prevent them from happening in the future. Pediatric cardiology is team work involving cardiologists, anatomists, physiologists, surgeons, intensivists, interventionists and the anesthesiologists – all play very important roles in caring for children with cardiac problem. In my presentation, I will discuss more in depth about the role of individual physicians and scientists that have helped to develop this wonderful subspecialty in pediatrics.

Biography:

Branko Furst, MD, FFARCSI is a graduate of University at Ljubljana Medical School, Slovenia and completed residency in anesthesiology at Queen Alexandra Hospital in Portsmouth and at the Middlesex Hospitals in London, UK. His academic career then took him to El Paso, Texas where he joined the faculty at the department of Anesthesiology at Texas Tech University Medical School. His research interests include cardiovascular physiology and mechanisms of general anesthesia. He is the author of the book “The Heart and Circulation – an Integrative Model” (Springer, 2013) and has lectured on various aspects of the circulation nationally and internationally. Currently he is Associate Professor of Anesthesiology at Albany Medical College, Albany, NY and divides his time between clinical anesthesiology, research, and resident education.

Abstract:

The debate whether the heart is a pressure or a flow generating pump continues to be a subject of debate amongst clinicians and cardiovascular physiologists. It is based on the assumption that the heart, a hollow muscular organ equipped with valves, impels the blood through the systemic and pulmonary circuits. It will be argued that the longstanding issue over the nature of the heart’s function can be resolved by adopting the phenomenon-based, evolutionary model of circulation. The model shows that the movement of blood is the primary phenomenon generated at the levels of the capillaries. It exists before the functional maturity of the heart and is intricately linked with metabolic demands of the tissues. The pressure in the vessels, therefore, is a derived phenomenon resulting from the rhythmic interruption of flow by the heart in combination with the dynamic response of the peripheral vasculature. The heart thus functions as an impedance-pump generating pressure, but not the flow of blood. The proposed model will be supported by examples from comparative anatomy and congenital heart defects, including atrial and ventricular septal defects, Eisenmenger syndrome, hypoplastic left heart syndrome and its palliation – the Fontan circulation.

Biography:

Paul Peter Lunkenheimer is a Professor of Cardiac Surgery at University Hospital Münster, Germany.He completed many projects like Harmonic partial left ventriculectomy using a Saugglockentechnik: Simplified Terminal technology, protecting the coronary arteries, preoperative diagnostic, structural and functional responses to the radius reduction.

Abstract:

Throughout the 20th century,it has generally been accepted that the cardiomyocytes making up the ventricular mass contract exclusively in centripetal direction. The validity of the law of Laplace depends on that prerequisite, as does the diagnostic reliability of hemodynamic measures such like intracavitary pressures, cardiac output, and the velocity of aortic blood flow. The background to this notion was the postulate of Otto Frank that all cardiomyocytes are aggegated together in strictly tangential fashion relative to the epicardial surface plane. There is now increasing structural and functional evidence, however, that the cardiomyocytes are capable simultaneously of producing constrictive and dilating forces. Myocardial Structure: Using macroscopic peeling, histology , diffusion tensor magnetic resonance imaging, and pneumatic distension followed by computed tomography, we have identified a wide range of angular deviations of the aggregated cardiomyocytes from the strictly tangential arrangement, with the measured angles ranging between 0 and 45 degrees relative to the epicardial surface plane, with some exceeding 45 degrees during systole and in the setting of hypertrophy. Contractile function: Measurements of developed forces throughout the left ventricular walls by means of needle force probes have confirmed tthe presence of two types of signal in human, as well as in animal, hearts. Auxotonic forces are generated in the two-fifths of the myocardial aggregates that deviate from the tangential alignment, are functioning partially to counteract systolic mural thickening. The anticipated unloading forces are generated by the remaining aggregates, which are aligned tangentially to produce cavity constriction and mural thickening. Intrinsic antagonism: The two forces simultaneously act in opposite direction, thus providing an antagonistic system to facilitate rapid ventricular dilation during early diastole, to stabilise ventricular shape, and to optimise the timing of the sequence of local mural inward motion. The intrinsic antagonism, nonetheless, is prone to dysfunction, especially in the settings of hypertrophy and fibrosis. This is because, with progressive mural thickening, there is a dramatic increase in the deviation of the aggregates from their predominant tangential alignment. Asymmetrical sensitivity to inotropic stimulation: We have also shown that the aggregates that generate auxotonic forces are significantly more sensitive to positive and negative inotropic stimulation than those generating the unloading forces. The intrinsic antagonism, therefore, is susceptibel to appropriate selective therapy. This is paricularly the case in the setting of hypertrophy, since during cardiac surgey we have shown the antagonistic forces to be critically augmented.

Biography:

Alfredo E. Rodriguez graduated from Córdoba National Medical University, Argentina at the age of 22, and has completed his PhD at 30 from the Cordoba Catholic Shool of Medicine. He is Director of Centro de Estudios en Cardiología Intervencionista, a premier Research Organization and Head of the Cardiology Department of Sanatorio Otamendi, Buenos Aires, Argentina. He has published more than 250 papers in major peer review journals and also was Editor of four cardiology books the last one published in September 2015 by Springer. He is editor-in-chief in the Journal “Revista Argentina de Cardioangiología Intervencionista” and has been serving as an editorial board member of worldwide repute Journals such as EuroIntervention, JACC Cardiovascular Interventions, World Journal of Cardiology journal, Drug Designing Journal (2014); Journal of Developing Drugs (2014). He is also frequent reviewer from major cardiology and interventional cardiology Journals

Abstract:

Recently, an angiographic score was introduced in clinical practice to stratified different levels of risk after PCI. The SYNTAX score (SS) classified patients in three different risk levels. Patients allocated with low SS could be equally treated with either PCI or CABG, whereas those with intermediate or high SS were better off with CABG. However, using original SS each coronary lesion with a diameter stenosis ≥50% in vessels ≥1.5 mm was scored. In contrast, in ERACI IV study, which included patients with multiple vessel disease and unprotected left main stenosis treated with 2nd generation DES, we used a revascularization strategy during PCI where operators were advised to only treat lesions ≥ than 70% in a ≥ 2.0 mmreference vessel; therefore, no intermediate lesions should be treated, and severe stenosis in vessels ≤2.0 mm was discouraged as well. If we recalculated SS using the above-mentioned operators' advices all intermediate lesions were not scored, and severe stenosis in vessels < 2.0 mm were excluded for the analysis; after this new scoring, the original SS dropped from 27.7 to 22. More over after this new scoring in ERACI IV, low SS rose to 54.8%, intermediate dropped to 27.9% and only 17.2% of ERACI’s patients scored a high SS. At 24.5 months of follow up, MACCE rate was only 6.7%, composite of death/MI and stroke was 3.6% and unplanned new revascularization 4%. In conclusion, if we performed a SS scoring only severe stenosis in vessels with a reference diameter ≥2.0 mm would allow a more rational assessment of coronary anatomy which was associated with low events rate at 2 years of follow up.

Biography:

Kleber B. A. Martins has completed his PhD at the age of 56 years from São Paulo University (USP) / Institute Dante Pazzanese of Cardiology. He is an Interventional and Clinic Cardiologist at Sao Lucas and Primavera Hospitals; two privates service organization in Brazil. He is the main author of the Randomized Trial of Creatine-kinase Leak After Rosuvastatin in Elective Percutaneous Coronary Intervention that has been published in the reputed Journal of Interventional Cardiology and has been serving as a reviewer board member.

Abstract:

Objectives: To determine the impact of percutaneous coronary intervention (PCI) performed at the same time of the peak concentration of rosuvastatin to reduce periprocedural myocardial infarction (PMI). Background: Prior studies suggest that a high dose of statin before PCI reduce periprocedural myocardial infarction. However, there is no information regarding the elective PCI performed at the time of the peak of statin concentration to reduce PMI. Methods: From 2011 to 2013, at a single center in Brazil we enrolled 544 patients who underwent elective PCI and after exclusions for baseline biases in clinical and angiographic characteristics, yielding 528 patients, we prospectively randomly assigned them to either a high loading dose of Rosuvastatin before PCI (n=264) or standard treatment (n = 264). After exclusions for biases in procedural characteristics a total of 487 patients underwent to end points analysis. The primary outcome was the incidence of MB fraction of creatine kinase (CK-MB) greater than three times the upper limit of normal. Results: The primary end point occurred in 7.6% in the rosuvastatin and 4.8% in the control group (p = 0.200). There was a higher incidence in elevation of CK-MB than normal baseline in the rosuvastatin (67.1% vs 59.2%, p = 0.701). There was no difference in major adverse event (0% in the rosuvastatin group versus 0.8% in control). Conclusions: The CLEAR-PCI suggest that elective PCI performed at the time of peak concentration of rosuvastatin in patients with stable coronary disease on long-term statin therapy showed no benefit.

Biography:

Naresh Sen is a Consultant Cardiologist affiliated with Narayana Hrudayalaya Institute of Cardiac Science, India. He got his medical graduation from Rajasthan University, Jaipur and post-graduation in internal medicine from South America and post doctoral training in Cardiology from USA. He has also been elected for Fellowship award of European Society of Cardiology (FESC) and American College of Cardiology (FACC). He worked in Cardiology (Invasive & Non-Invasive) as Registrar or Consultant at renowned cardiac hospital ports of India like NH & Medanta last 5 years. He has special interest in coronary artery disease and heart failure prevention. He has published around 20 publications in Cardiology .For his hard work, he was awarded as best cardiology consultant in Rajasthan, 2013 by Director of AIIMS, New Delhi.

Abstract:

Background: CRT ( Cardiac Resynchronisation Therapy) has been approved benificially in heart failure patients with refratory optimised medical therapy on based of many studies. The guidelines have shown CRT is indicated in NYHA class III-IV , QRS >150 ms, LBBB (Left bundle branch block) to improve heart functions, ventricular remodelling and clinical symptoms. Purpose-comparison of stress induced mechanical dyssynchrony between rate dependent LBBB and RBBB( Right bundle branch block) and beneficial role of CRT to improve LV function and reduce mortality. Method: Patients presenting dyspnea on exertion NYHA class I-II to III-IV by stress test , normal QRS to rate dependent LBBB or RBBB by Stress test or Dubutamine Stress Echo were studied. CRT on cardiac function were assessed by Cath study , Echo and MRI ( Magnetic Resonance Imaging). Result:12 months observational study done on stress induced rate dependent LBBB and RBBB with worsening dyssynchrony and poor LV function were treated with CRT. Results have shown improved LV function in rate dependent LBBB patients (31+/-6 %) v/s RBBB patients (4.5+/-4%) with P value <0.04. and reduce mortality among rate dependent LBBB with CRT v/s without CRT ( 5% v/s 20 %) and another side mortality difference between rate dependent RBBB with CRT and without CRT were not found significantly. Conclusion: Stress induced rate dependent LBBB with mechanical dyssynchrony leads to heart failure is benifited by CRT than Rate dependent RBBB.

Biography:

Paul Peter Lunkenheimer is a Professor of Cardiac Surgery at University Hospital Münster, Germany. He completed many projects like Harmonic partial left ventriculectomy using a Saugglockentechnik: Simplified Terminal technology, protecting the coronary arteries, preoperative diagnostic, structural and functional responses to the radius reduction.

Abstract:

Introduction: Throughout the 20th century, it has generally been accepted that the cardiomyocytes making up the ventricular mass contract exclusively in centripetal direction. The validity of the law of Laplace depends on that prerequisite, as does the diagnostic reliability of hemodynamic measures such like intra-cavitary pressures, cardiac output and the velocity of aortic blood flow. The background to this notion was the postulate of Otto Frank that all cardiomyocytes are aggregated together in strictly tangential fashion relative to the epicardial surface plane. There is now increasing structural and functional evidence, however, that the cardiomyocytes are capable simultaneously of producing constrictive and dilating forces. Myocardial structure: Using macroscopic peeling, histology, diffusion tensor magnetic resonance imaging, and pneumatic distension followed by computed tomography, we have identified a wide range of angular deviations of the aggregated cardiomyocytes from the strictly tangential arrangement, with the measured angles ranging between 0 and 45 degrees relative to the epicardial surface plane, with some exceeding 45 degrees during systole and in the setting of hypertrophy. Contractile function: Measurements of developed forces throughout the left ventricular walls by means of needle force probes have confirmed the presence of two types of signal in human, as well as in animal, hearts. Auxotonic forces are generated in the two-fifths of the myocardial aggregates that deviate from the tangential alignment, are functioning partially to counteract systolic mural thickening. The anticipated unloading forces are generated by the remaining aggregates, which are aligned tangentially to produce cavity constriction and mural thickening. Intrinsic antagonism: The two forces simultaneously act in opposite direction, thus providing an antagonistic system to facilitate rapid ventricular dilation during early diastole, to stabilize ventricular shape and to optimize the timing of the sequence of local mural inward motion. The intrinsic antagonism, nonetheless, is prone to dysfunction, especially in the settings of hypertrophy and fibrosis. This is because, with progressive mural thickening, there is a dramatic increase in the deviation of the aggregates from their predominant tangential alignment. Asymmetrical sensitivity to inotropic stimulation: We have also shown that the aggregates that generate auxotonic forces are significantly more sensitive to positive and negative inotropic stimulation than those generating the unloading forces. The intrinsic antagonism, therefore, is susceptible to appropriate selective therapy. This is particularly the case in the setting of hypertrophy, since during cardiac surgery we have shown the antagonistic forces to be critically augmented.

Biography:

Peter F Niederer is an Emeritus Professor at the Institute of Biomedical Engineering, ETH Zurich, Switzerland. He is also the President of the IT'IS Foundation.

Abstract:

In order to demonstrate the hierarchically ordered connectivity of the left myocardium, gentle inflation by compressed air and subsequent CT-based analysis was performed on excised pig hearts. Perimysial spaces become thereby visible and allow demarcating lamellar segments. In addition to the well-known global helical pattern of the spatial direction field, a quite inhomogeneous arrangement with respect to lamellar segment orientation manifests itself. In particular, up to 30% of the lamellar segments deviate significantly, by more than 10° (up to 45 and more degrees) from a surface-parallel direction. Visual impression might in fact suggest some similarity with a bird’s nest. These findings along with force measurements made in the ventricular wall can be interpreted as follows. First, constrictive units with a primarily transmural orientation counteract to some extent systolic constriction and act in an antagonistic fashion. This feature may on the one hand be protective (excessive deformations are avoided), on the other, modulation of wall thickening according to local conditions is enabled. Second, architectural variations are expected to be such as to prohibit local stress concentrations and equalize overall loading conditions. Geometrically regular fiber architectures were examined in the form of mathematical models that showed, among other, that even slight disturbances of a regular pattern lead to a significant loss of cardiac performance. In contrast, in case of architecture involving appreciable stochastic local aberrations, even large changes seem to have a minor effect on the ejection fraction thereby stabilizing ventricular function over a wide range of physiological conditions.

Biography:

Morten Smerup is from the Department of Cardiothoracic Surgery, Copenhagen University Hospital, Denmark. He has surgical experience of +50 general surgical cases, incl. appendectomies, herniotomies and gall-bladder surgery, +50 CABG cases, Thirteen aortic valve replacements and one tricuspid valvuloplasty, fifteen ASD cases, three partial AVSD cases, four VSD cases, two pulmonary valve replacements (both re-dos), two BT-shunts, three coarctation repairs, two RVOTO, one pulmonary artery banding, one subaortic membrane and more than 50 standard pediatric cannulation procedures.

Abstract:

From an anatomical point of view the individual myocytes making up left ventricular walls are organized as an anisotropic three-dimensional mesh. This can be characterized in terms of the myocyte angulation relative to the overall geometry of the heart, i.e. helical angles, transmural angles and transverse angles, but also in terms of the organization of the myocytes and the connective tissue of the heart into superstructures, the myocyte aggregates (also called myocardial sheets or –lamellae), which can be further characterized according to their relation to the overall geometry. From a functional point of view, the deformation of the cardiac walls has been extensively described using strain theory on local cuboids of myocardium, characterizing the so-called principal and shear strains. However only lately there has been a satisfactory synthesis of the anatomical and the functional aspects of the myocardium. In this talk I will attempt to describe the fundamentals with an emphasis on the clinical impact for practicing cardiologists, based upon experimental data on the diastolic and systolic architecture in normal, hypertrophic and dilated porcine hearts. Furthermore, novel theories on potential mechanisms in heart development that govern the final arrangement of the myocardium are presented.

Biography:

Boris Schmitt completed his medical studies in Freiburg, Innsbruck and Berlin. In 2001 he started his career as a Pediatrician at the DHZB in the department of congenital heart disease. He completed his Doctoral thesis in 2005 and his medical specialization in Pediatrics in 2007. He returned to DHZB and became a member of the cardiovascular MRI team. He has been the team leader of KidCathLab since the very beginning in 2009. When the group came to life he shifted his focus from clinical work to research activities. His main interests and abilities are pediatric cardiology, catheterization and imaging. And most importantly, he has an open (h) ear (t) for new ideas. He is also a co-founder of a company for planning, implementation and marketing of telemedicine networks and he is certified in mountain and expedition medicine.

Abstract:

Beta-blockers contribute to treatment of heart failure. Their mechanism of action, however, is incompletely understood. Gradients in beta-blocker sensitivity of helically aligned cardiomyocytes compared with counteracting transversely intruding cardiomyocytes seem crucial. We hypothesize that selective blockade of transversely intruding cardiomyocytes by low-dose beta-blockade unloads ventricular performance. Cardiac magnetic resonance imaging (MRI) 3D tagging delivers parameters of myocardial performance. We studied 13 healthy volunteers by MRI 3D tagging during escalated intravenous administration of esmolol. The circumferential, longitudinal and radial myocardial shortening was determined for each dose. The curves were analyzed for peak value, time-to-peak, upslope and area-under-the-curve. At low doses, from 5 to 25μg/kg/ min, peak contraction increased while time-to-peak decreased yielding a steeper upslope. Combining the values revealed a left shift of the curves at low doses compared with baseline without esmolol. At doses of 50 to 150μg/kg/min, a right shift with flattening occurred. In healthy volunteers we found more pronounced myocardial shortening at low compared with clinical dosage of beta-blockers. In patients with ventricular hypertrophy and higher prevalence of transversely intruding cardiomyocytes selective low-dose beta-blockade could be even more effective. MRI 3D tagging could help to determine optimal individual beta-blocker dosing avoiding undesirable side effects.

Biography:

Christoph Brune is a tenure track Assistant Professor for computational mathematics (NWO, NDNS+) in the Department of Applied Mathematics at the University of Twente. In 2011-2012, he was a CAM Assistant Adjunct Professor in the Department of Mathematics at University of California Los Angeles (UCLA) working together with Prof. Andrea Bertozzi and Prof. Stanley Osher on projects in inverse problems, 4D imaging/image processing, optimal transport and machine learning. He taught classes and supervised Bachelor, Master and PhD students.

Abstract:

Obtaining a quantitative micro-structure analysis of the myocardium is essential to its understanding as a structured continuum. To address the interplay of structure and intrinsic antagonistic function of the myocardium while comparing normal and diseased hearts there is a strong need for an automatic, robust and precise framework to measure in a rapid procedure the 3D arrangement of bundles of cardiomyocytes. In this work we focus on pneumographic micro-CT measurements of porcine hearts. The main contribution is an automatic framework for quantitative 3D structure analysis of the whole myocardium with the same impressive resolution like the measured data. Prior to and during micro-CT- imaging the myocardial interstitial space was slightly pneumatically distended for better discrimination of the heart muscle´s lamellar basic structure. Compressed air was perfused through the coronary arteries, resulting in an isolated distension of the perimysial inter-lamellar space, while the dense endomysial compartment was not reached by gas. CT-imaging was performed in a Scanco Medical micro-CT device. Via novel mathematical imaging techniques and efficient computer algorithms, adequate for very high-resolution data sets, we can obtain precise quantitative values of helical and intruding angles at each voxel of the myocardium. The mathematical framework is based on three main steps: (1) a preprocessing component, where fine fibre structures are enriched by nonlinear anisotropic noise filters and simultaneous contrast enhancement, (2) an orientation estimation component, which uses novel structure tensor methods to compute the local orientation at each voxel and (3) an advanced automatic segmentation method which extracts a 3D surface of the myocardium and simultaneously computes normal vectors, serving as precise reference directions for computing helical and intruding angles given by (2). With this imaging tool we can quantify global alignment of heterogeneously interconnected networks of lamellar units. Due to the full coverage of the cardiac mesh and simultaneous segmentation we can also analyze and compare angular distributions between different myocardial compartments. We measure a particularly high prevalence of intruding and extruding structures which deviate from the tangential alignment and which are inclined towards endocardium and epicardium with angles exceeding 40 degrees. Computed helical and intruding angles in the whole myocardium are pivotal data to explain form-stabilizing structures as well as those which drive ventricular wall motion. In the future this might allow further analysis of the relative prevalence of constrictive as compared to dilative forces. According to histological findings and underlined by data from direct measurements of contractile forces in normal and diseased hearts, the relationship of those two opposing forces is disturbed, resulting in a derailment of the intrinsic antagonism of the myocardium, particularly in cases of ventricular hypertrophy which in most cases is complicated by fibrosis.

Biography:

Robert Stephenson is Lecturer in Medical Sciences-Anatomy, School of Dentistry; University of Central Lancashire, United Kingdom.

Abstract:

The intricate micro-structure of the heart and its relationship with cardiac function has been debated for decades, without current consensus. Therefore scientists and clinicians strive to improve our understanding of cardiac anatomy in 3D and provide 4D explanations of its role in contractile function in health and disease. Ex-vivo contrast enhanced micro-CT utilizes the same principles as clinical CT, producing 3D tomographic images non-destructively. Micro-CT, however, permits spatial resolutions approaching the scale of individual cells (5-20 μm). Our iodine based contrast agent allows differentiation of multiple soft tissue types; fat, myocardium, conduction system and extracellular matrix show decreasing X-ray absorption and thus grayscale values respectively. Using micro-CT to image human and rabbit hearts ex-vivo, we reveal the true structural heterogeneity of the heart in 3D and provide new insight into the structural basis for antagonistic forces generated within healthy and failing hearts. We show how the myocyte chains aggregate to form a heterogeneous interconnected network of lamellar units, bound internally by dense endomysium and externally by sparse perimysium. The units are seen to be complex and variable 3D structures, which exhibit sheet, cord and branched elements. They maintain the helical myocyte arrangement, but can twist and intrude radially, occasionally forming orthogonal abutments with adjacent units. We have obtained 3D myocyte orientation at near cellular resolution. Using computer algorithms we extract the helical and intrusion angle of the myocytes on a voxel by voxel basis; the longitudinal chains they form are then tracked and visualized in 3D. Thus we reveal the heterogeneity of myocyte arrangement, showing the classic helical depictions to be over-simplified. Many myocytes have intruding angles greater than 20°, with an increased population observed in the sub-endocardium. This number is reduced in regions of dilatation in failing hearts, potentially hampering diastolic filling and reducing intrinsic stability thus perpetuating dilatation. This data gives new insight into the structural heterogeneity of the cardiac mesh, revealing the complex 3D morphology and interactions between the lamellar units and myocyte chains housed within them. We show how the intrusion of chains of myocytes offers a structural basis for intrinsic antagonism, and show how myocyte intrusion is reduced in regions of dilatation, providing new information on contractile dysfunction in the setting of intrinsic antagonism.

Biography:

Svetlana Reilly is a Research fellow at University of Oxford. Dr. Svetlana Reilly is a postdoc with Prof. Barbara Casadei in Cardiovascular Medicine, won the Young Research Worker Prize at the 2013 British Cardiovascular Society annual meeting. Dr. Svetlana Reilly has done completed her education from Medical academy, Russia.

Abstract:

Objectives - Atrial fibrillation (AF) is a growing public health burden and its treatment remains a challenge. AF leads to electrical remodelling of the atria, which, in turn, promotes AF maintenance and resistance to treatment. Although remodelling has long been a therapeutic target in AF, its causes remain poorly understood. Methods and findings – Using atrial samples from 259 patients (51 with permanent AF) and 36 goats (24 with AF), we show that atrial-specific upregulation of microRNA-31 (miR31) in goat and human AF causes dystrophin [DYS] translational repression and accelerates mRNA degradation of neuronal nitric oxide synthase [nNOS] leading to a profound reduction in atrial DYS and nitric oxide availability. Prediction algorithms and reporter assays established DYS and nNOS as miR31 targets. In actinomycin D-treated myocytes from patients in sinus rhythm, miR31 accelerated nNOS (but not DYS) mRNA decay. Physical interaction between miR31 and DYS or nNOS within the RNA induced silencing complex [RISC] in atrial myocytes from patients with AF [hAFm] was confirmed by immunoprecipitation of Argonaut 2. MiR31 overexpression and/or disruption of nNOS signaling (with nNOS-siRNA or secondary to nNOS gene deletion) recapitulates hallmark features of AF-induced remodelling (shortening of action potential duration [APD] and loss of APD rate-dependency) and significantly increases AF inducibility in mice in vivo. By contrast, silencing miR-31 in hAFm restores dystrophin and nNOS and normalizes atrial electrical properties. Masking miR31 binding site on the DYS increases both DYS and nNOS protein (but not mRNA), in keeping with a stabilising effect of DYS on nNOS protein. Indeed, K48-linked polyubiquitination and proteasomal degradation of nNOS were increased in hAFm. Interpretation - Atrial-specific upregulation of miR-31 in human AF is a key mechanism causing atrial dystrophin and nNOS depletion, which, in turn, contributes to the atrial phenotype begetting this arrhythmia.

Biography:

Robert Skalik, MD, PhD, consultant in cardiology, exercise physiologist. He completed his PhD in echocardiography from Medical University of Wrocław. He covered internship in Department of Cardiology, Free University of Amsterdam, the Netherlands, lecturer in Postgraduate School of Cardiology, University of Perugia, academic teacher and researcher in Department of Physiology, former consultant in cardiology in Department of Cardiac Surgery and Cardiology, Medical University of Wrocław, former Head of Department of Cardiac Rehabilitation, Wrocław , private practice in cardiology, Wrocław, research projects evaluator for EU. He has published 103 papers on cardiology and human physiology.

Abstract:

A 66-year-old woman was admitted to the emergency department after syncopal episode preceded by a crushing chest pain and bradycardia. On admission the patient presented with slight confusion and chest pain , varicose veins of the left lower extremity without swelling or signs of acute inflammatory process. The blood tests results showed thrombocytopenia, significantly elevated D-dimers level, lowered fibrinogen level and negative troponin test. Electrocardiography revealed signs of acute myocardial ischemia. On echocardiography, the lowered ejection fraction of the left ventricle (40%) with regional left ventricular contractility abnormalities, a small volume of pericardial fluid with a mobile fibrin strands, lack of signs of acute pulmonary embolism, normal sized ascending aorta without dissection were found. A chest computed tomography revealed fluid in the pericardial sac highly suggestive of the clotted blood, dissection of normal sized ascending aorta , a non-dissected aneurysm of the aortic arch and a saccular dilatation of the non-dissected proximal segment of the thoracic aorta. The acute aortic dissection is a life - threatening condition demanding immediate diagnosis. The clinical manifestation of this vascular pathology is sometimes a challenge and dependent on the section of the affected aorta. The conventional imaging instrumentation such as transthoracic echocardiography does not always guarantee high diagnostic accuracy of the disease. The transesophageal echocardiography is not always accessible in the emergency departments. D-dimers level and other hemostatic parameters can be a useful screening tool to identify patients with an unusual course of acute aortic dissection.

Biography:

Ersel Onrat, MD, male, he was born in Turkey 1970, married and has one child. He graduated from School of Medicine, Hacettepe University in 1993 and attended the Osmangazi University, School of Medicine, Cardiology Department and graduated as a cardiologist in 1998. In 1999 he founded Cardiology Department in School of Medicine in Afyon Kocatepe University. He is a Professor since 2012 and also the Chief of the Cardiology Department, Chief of the Coronary Catheterization Labratory in School of Medicine in Afyon Kocatepe University, a lecturer in the same faculty as well. Dr. Professor Ersel is interested in interventional cardiology and has some projects about atrial fibrillation, idiopathic dilated cardiomyopathy and cardiac rehabilitation. He has 44 scientific cardiology article in international cardiology journal.

Abstract:

Atrial fibrillation (AF) is the most common dysrhythmia and its incidence rises with aging. The cost of AF treatment per person ascends and it will ascends in the future, because of extending life span. AF impairs quality of life and increases mortality due to complications like thromboembolic events and heart failure. New treatments for AF are being developed every 5-10 years and also much more money is spent for these treatments. For all that an innovative method isn’t invented in AF treatment. The current treatment methods are not suitable for all patients. The new oral anticoagulants cannot be used instead of all warfarin indication, atrial appendix closure devices cannot be used for all patients and left atrial ablations cannot be performed in all patients. In fact, if we know the pathophysiology of AF, AF treatment is able to achieve greater success. Figure 1: Kourliouros et al. Am. Heart J 2009; 157: 243-252. There are 3 different parts in AF pathophysiology. These are structural remodeling, electrical remodeling and inflammation. Each of them associated with the others. One of these factors triggers AF, then the others penetrate the AF pathophysiology. Structural Remodelling: Atrial dilatation is the initiation factor in patients with mitral valve disease and AF. Atrial dilatation firstly occurs, then interstitial fibrosis and subsequent heterogeneity of conduction are formed. Structural changes like fibrosis, cellular hypertrophy and degeneration have been shown in patients with operated mitral valve and AF. Also these structural remodeling happened in experimental model AF (induced by atrial pacing). In experimental model and valvular disease with AF, there are some increased biomarker like collagen types, matrix metalloproteinase types, tumour growth factor beta-1 (TGFBeta-1), fibrillin, YKL 40, periostin, fibronectin, etc.,. There are two ways in atrial fibrosis, Angiotensin II and TGFBeta-1. It was shown that, pharmacologic treatment with some drugs have been decreased atrial fibrosis and altered atrial remodeling. These drugs are pioglitazone, candesartan, enalapril, spironolactone diacylglycerol kinase zeta, tetramethylpyrazine, pirfenidone or tranilast effect especially Angiotensin II and TGFBeat-1 pathways. Tranilast, pirfenidone, tetramethylpyrazine and diacylglycerol kinase zeta affects TGF Beta-1 pathway. Candesartan, enalapril and spironolactone fixes Angiotensin II pathway. It seems that these drugs can be new theraphy to reduce atrial fibrosis and to prevent atrial fibrillation formation by antifibrotic drugs and renin angiotensin system blockers. Atrial fibrosis is not only pathology in the formation of AF, but also the amount of atrial fibrosis detects the success of AF ablation. In the future, AF treatment with these drugs can be investigated. Imflammation: The inflammatory biomarkers level was higher in the patients with AF indicates that inflammation is also an important risk factor for AF. Especially after cardiac surgery, AF occurs in some patients due to imflammation. Corticosteroids, nonsteroid antiimflammatory drugs and colchicine prevent atrial fibrillation formation in postoperative period after cardiac surgery. These findings support postoperative AF is associated with imflammation. In population based cohort study, it was shown that high CRP levels were independently associated with future AF development in 6.5 years. Also CRP levels can predict successful cardioversion rate in patients with AF. The other imflamatuar biomarkers are C3, C4 and interleukin-6 which are asoociated with AF. All of these imflamatuar factors are associated with the amount of epicardial adipose tissue which is not only risk factor for AF but also as a prognostic factor for the determining the success of AF ablation. Up to now some cytokines secreted from adipose tissue were high level in patients with AF. These cytokines are Activin A, Resistin, Adiponectin and YKL 40. Conclusion: In the future, it seems that AF treatment model may be associated with the pathophysiological part (antifibrotic drugs, adipokines derivatives or blockers) of AF.

Biography:

Nany Hassan Abo-elmakarem El Gayar, Assistant professor of Internal Medicine, Geriatrics Department at Alexandria University, Egypt. Had done MS in Rheumatology and MD in Geriatrics. Has published 10 papers in reputed journals.

Abstract:

Metabolic syndrome (MetS) is a major public-health problem and clinical challenge worldwide. Several epidemiological studies have confirmed the increased risk of CVD in individuals with MetS. Osteocalcin (OCN) is a bone-derived, non-collagenous protein that recently recognized as hormone regulating energy metabolism. Importantly, osteocalcin expression has been described in calcifying vascular smooth muscle cells We aimed in the present study to analyze the correlation between serum levels of OCN and vascular calcification in elderly persons with metabolic syndrome.74 elderly males, 65 years and older were included in the present study, divided into two groups; group I; 40 patients satisfied at least three criteria of the metabolic syndrome (MetS) according to NCEP-ATP III definition , and group II; 34 age-matched healthy males serving as a control group. BMI was calculated, blood samples were taken for lipid profile, and total OCN levels using ELISA kits. Carotid Doppler B mode ultrasonography was done for all participants. Patients with MetS exhibited significantly higher BMIs, waist circumference, fasting blood sugar, Triglycerides, blood pressure, total cholesterol, and lower HDL-ch, compared to the controls subjects. Patients with MetS had significantly lower levels of total Osteocalcin than control subjects. Also, patients with MetS had significantly higher IMT and higher number of carotid plaques than the control subjects. Total OCN was significantly negatively correlated with parameters of carotid atherosclerosis. It is also negatively correlated with dyslipidemic parameters. Its correlation with components of Mets did not reach a statistical significance. We concluded that serum osteocalcin levels were significantly associated with carotid atherosclerosis in patients with metabolic syndrome. This may reflect the role of osteocalcin as a circulating endocrine factor which regulates glucose metabolism and thereby cardiovascular risk in patients with metabolic syndrome. Prospective studies are needed to assess the time course and relevance of serum osteocalcin in the development of atherosclerosis in patients with metabolic syndrome.

Biography:

Manjusha Hira is a Senior Registrar in Paediatric at Watford General Hospital UK.She has published more than 6 papers in reputed journals and Emmanuel Quist Therson is a Neonatal Consultant with Special Interest in Cardiology and the Associate Medical Director at Watford General Hospital, UK.

Abstract:

Sengers syndrome is a rare disorder that causes congenital cataract, hypertrophic cardiomyopathy (HOCM), skeletal myopathy and lactic acidosis. HOCM is usually fatal in infancy. It is an autosomal recessive mitochondrial depletion disorder resulting from the mutation of acylglycerolkinase (AGK) gene. This nuclear gene is responsible for the maintenance of mitochondrial DNA(mDNA). We report a 4 month old boy who had severe lactic acidosis at birth and progressive congenital cataract. Cataract and failure to thrive were missed on his primary examination until he presented with complete loss of vision at 3 months and subsequent heart failure secondary to severe HOCM at 4 months of age. His genetic testing revealed homozygous novel putative splicing mutation of AGK gene, c.1047-2A>G . This substitution has not been previously reported.There are about 40 case reports of Sengers syndrome to our knowledge. The severe form due to homozygous mutation, has early onset cataract, lactic acidosis and progressive HOCM leading to death in infancy. The milder form with heterozygous mutation, has a better prognosis and develops cardiomyopathy at later stages, with survival into their fourth decade. The mildest form reported had only cataracts. Uncertainty about the red eye reflex in non-Caucasian infants is common in primary examinations.Unexplained and persistent lactic acidosis at birth should not be discounted and should be followed up after discharge. Sengers syndrome should be considered as a differential diagnosis in babies who present with congenital cataracts especially if associated with lactic acidosis and later HOCM. Our patient is currently awaiting a cardiac transplant.

Biography:

Ahmed Abd-Elwahab Algohary completed his PhD in Medicine & Surgery from Zagazig University, Egypt. He is now working at Dessole SettiSharm Resorts & Hotels as a Doctor who manages Guest Emergencies and Medical Cases.

Abstract:

Introduction: Diabetic patients with normal left ventricular ejection fraction are frequently associated with diastolic dysfunction .Speckle tracking is more sensitive than LVEF in detection subclinical LV systolic dysfunction. Aim: Detection of different patterns of global longitudinal strain in diabetic patients using global longitudinal strain by speckle tracking. Methods: fifty two diabetic patients had been referred from internal medicine clinic after they had been tested for HBA1c test and stratified into two groups Group І: it include26 DM patients with controlled blood sugar. Group II: it include26 DM patients with uncontrolled blood sugar The two groups had been subjected to the following diagnostic workup: Full medical history, full clinical examination, laboratory assessment , twelve lead resting ECG ,Stress ECG, Echocardiography study, Traditional Tissue Doppler imaging ,Assessment of global longitudinal strain. Patients with IHD, Systolic dysfunction, CHD, Valvular, Arrhythmia, HOCM, Pericardial, major systemic disease had been excluded. Result: there was significant statistical difference in GLS, Age , Diabetic Type ,Diabetic Duration,2HPP Blood sugar level, E/é ratio in controlled DM compared to uncontrolled DM (p<0.05),there was no significant difference in Gender ,FBS. EF, E/A in controlled DM compared to uncontrolled DM. Conclusion: Diabetic duration was strongly correlated with reduction of global Longitudinal strain. Poor blood glucose control, as indicated by HbA1c>6.5%, leads to reductions in LV global longitudinal systolic strain, which is associated with preclinical LV dysfunction.