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:

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:

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.