Day 3 :
- Track 7: Cardiac Nursing Track 8: Heart Failure Track 9: Diabetes and the Heart
Location: Berlin, Germany
Chair
Andreas C Petropoulos
Azerbaijan State Medical University, Azerbaijan
Session Introduction
Robert Skalik
Wrocław Medical University, Poland
Title: Neglected mechanisms of cardiopulmonary capacity in health and heart failure- Why brain and heat stress really matter?
Time : 10:20-10:40
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.
Shaimaa Moustafa
Benha University, Egypt
Title: The correlation between speckle tracking echocardiography and coronary artery disease in patients with suspected stable angina pectoris
Time : 14:40-15:00
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.
Vincenzo Cianci
University of Swansea, UK
Title: MINI-OPCABG an alternative to hybrid coronary revascularization
Time : 14:20-14:40
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.
Shailesh Kumar Patil
Fabiani & Budhrani Heart Institute, India
Title: Balloon mitral valvotomy in youngest rheumatic mitral stenosis patient
Time : 14:00-14:20
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.
Nany Hassan Abu Al-Makarim El Gayar
Alexandria University, Egypt
Title: Serum total osteocalcin level as a vascular marker in elderly patients with metabolic syndrome
Time : 13:40-14:00
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.
Andreas C Petropoulos
Azerbaijan Medical University, Azerbaijan
Title: Treatment of heart failure in childhood strategies presented in the 2014 guidelines by ISHLT
Time : 12:15-12:35
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.
Youssef Fathy Mohamed Nosir
King Fahad Armed Forces Hospital, Saudi Arabia
Title: TEE monitoring TAVI can predict in procedure complications that allow early management for favorable outcome, KFAFH experience
Time : 11:55-12:15
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.
Krzysztof Piotrowski
Pomeranian Medical University, Poland
Title: The genetic aspect of human heart development in aspect of prenatal diagnosis
Time : 11:35-11:55
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.
Klaus-Dieter Schlüter
Justus-Liebig University Giessen, Germany
Title: Swiprosin – How cardiomyocytes can reorganize their sarcomeres and couple remodeling to β -adrenoceptor desensitization
Time : 11:15-11:35
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.
Rohit M Sane
Madhavbaug Cardiac Rehabilitation Centre, India
Title: Functional capacity is an independent predictor of mortality in heart failure patients with low ejection fraction
Time : 10:40-11:00
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.
Boris Schmitt
Deutsches Herzzentrum Berlin Germany
Title: MRI-3D-tagging insight into beta-blocker pharmaco-dynamics on the left ventricle supports theory of inner antagonism
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.
Brojendra Agarwala
University of Chicago Medicine Comer Children’s Hospital, USA
Title: Sudden unexpected death in young athlete
Time : 10:00-10:20
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.
Robert Stephenson
University of Central Lancashire, UK
Title: The structural heterogeneity of the cardiac mesh revealed by high-resolution micro-CT
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.
Christoph Brune
University of Twente, Netherlands
Title: The Automatic Framework for Quantitative 3D Myocardial Structure Analysis
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.
Youssef Fathy Mohamed Nosir
Cardiology Department KFAFH, Saudia Arabia
Title: TEE monitoring TAVI can detect procedure complications that allow early management for favorable clinical outcome, KFAFH experience
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.
Ehab E. El-Hefny
Al-Azhar University, Cairo, Egypt.
Title: Role of 2-Dimensional Speckle tracking echocardiography in diagnosis of coronary artery disease in stable angina pectoris patients
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.
Morten Smerup
Copenhagen University Hospital Denmark
Title: Structure-function relationship in myocardial substructures
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.
Valery Gafarov
Collaborative laboratory of cardiovascular diseases epidemiology, Russia
Title: Stress at work and 16-th years risk of hypertension and stroke in female population 25-64 years in Russia: MONICA-psychosocial epidemiological study
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.
Peter F Niederer
Institute of Biomedical Engineering, Switzerland
Title: The Architecture of the Mammalian Left Ventricle: Similarity with a Bird's Nest ?
Time : 10:10 - 10:20
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.
- Young Researchers Forum
Location: Berlin, Germany
Chair
Andreas C Petropoulos
Azerbaijan State Medical University, Azerbaijan
Session Introduction
Ahmed A
University Hospital of Essen, Germany
Title: Survival analysis and postoperative complications after ventricular assist device implantation, prognostic value of INTERMACS scale
Time : 15:00-15:15
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.
Adriana Tamburello
University Hospital “Paolo Giacconeâ€, Italy
Title: The role of NT proBNP in predicting prognosis and cardiovascular events in patients with heart failure
Time : 15:15-15:30
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.
Maria Nathania
Newcastle University, UK
Title: The role of cardiac high energy phosphate metabolism in cardiac function and performance: The impact of age
Time : 15:30-15:45
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.
Naresh Sen
Narayana Hrudayalaya Institute of Medical Science, India
Title: Cardiac resynchronisation therapy
Time : 15:45-16:00
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.
Zaid Altheeb
New York Medical College, USA
Title: Value of neutrophil to lymphocyte ratio as a predictor of mortality in patients with heart failure with preserved ejection fraction
Time : 16:00-16:15
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.