Day 1 :
Universite Pierre et Marie Curie & La Salpetriere Hospital, France
Time : 09:10-09:50
Guy Hugues Fontaine has made 16 original contributions in the design and the use of the first cardiac pacemakers in the early 60s. He has serendipitously identified Arrhythmogenic Right Ventricular Dysplasia (ARVD) during his contributions to antiarrhythmic surgery in the early 70s. He has developed the technique of Fulguration to replace surgery in the early 80s. He has been one of the 216 individuals who have made a significant contribution to the study of cardiovascular disease since the 14th century, one of the 500 greatest geniuses of the 21th century, one of the 100 life time of achievement. He has 900+ publications including 201 book chapters. He is a Reviewer of 21 scientific journals both in basic and clinical science. He has developed new techniques of hypothermia for neurologic brain protection in OHCA, stroke and spinal cord injury. He has recently invented a high-tech device which can be considered as the ultimate in palliative care.
An increasing number of genetic mutations can explain the mechanism of inherited cardiomyopathies which can lead to arrhythmias and risk of sudden death as well as irreversible heart failure in the end stage of the disease. Arrhythmogenic Right Ventricular Dysplasia (ARVD) has been identified by the presenter in 1977 as side work at the beginning of anti-arrhythmic surgery. Genetic background has been discovered mostly due to PKP2 desmosomal mutation with increased RV size, presence of large amount of fatty tissue mostly located on the right ventricle with apoptotic thinness of the free wall and segmental anomalies of contraction. Based on systematic analysis of histology of right ventricle in patients who died of a non-cardiac cause it was found that this disease is frequent in the general population (4%) but become clinically apparent in a small number of cases. Clinical presentation is mostly ventricular arrhythmias which can lead to unexpected sudden cardiac death especially in young people and during endurance sports. Some of these patients seen at a late stage of the disease can be misclassified as IDCM in whom heart transplantation is the only effective treatment. However, in some rare patients, the disease can stop completely its progression. An important marker of the disease is the presence of Epsilon wave on the ECG. Naxos disease, Uhl’s anomalies are rare but important forms. They have initiated the discovery of the first mutation and help in the understanding of arrhythmogenicity as well as advanced forms of treatment including drugs, ablation and implantation of implanted cardiac defibrillator. Brugada syndrome (BrS) has a unique ECG pattern of coved type of the T wave of the ECG observed only in lead V1. Structural changes are sometimes suggesting ARVD. However, BrS and ARVD are two different entities with some degree overlap both phenotypically and genotypically in a small number of cases. Both of them can be controlled by antiarrhythmic drugs, ablation of ventricular tachycardia and implanted cardiac defibrillator. Right Ventricular Outflow Tract Ventricular Tachycardia (ROVT VT) is generally benign but one personal case of SD with pathologic documentation demonstrated a localized infundibular anomaly suggesting localized ARVD. Hypertrophic Cardiomyopathy (HCM) is produced by a genetic mutation in the contractile molecules of the heart producing hypertrophy of myocardial fibers with disarray. It is also a major cause of SD during sports recognized as the most frequent. Idiopathic Dilated Cardiomyopathy (IDCM) is mostly due to multiple genetic mutations lamin and myosin affecting myocardial force of contraction. All of these cardiomyopathies can be affected by superimposed myocarditis which is frequently the determinant of prognosis.
American Hospital of Paris, France
Keynote: Listening, speaking, understanding, clearing up the patient’s speech are the major keys in patient’s well-being
Time : 09:50-10:30
Dr. Jean Pierre Usdin MD., is a Former Internal of the Hospitals of Paris, Former head of clinic, Assistant of the Hospitals of Paris, Former consultant in scientific committee of medical Journal CONSENSUS and previous Chief of the cardiologic department of American Hospital of Paris(2006-2012). He is currently renowned Cardiologist at American Hospital of Paris, Member of European Society of Cardiology, Member of French Society of Cardiology. Being a Journalist and Blogger in Medscape France(From 2010) he has blogs dedicated to general cardiology: reports discussions and notes about trials, cardiology congresses, live-comments on 2015 ESC congress in London.
Professor Fred Siguier (1909-1972) a major physician in the 50’ use to start a patient’s exam saying “Tell me exactly, precisely, in which circumstances your health problem started” Professor Siguier suffered of progressive blindness. So he asked to his assistants to make a full examination and to report their findings to their master’s sagacity. People with rare, but not only, diseases came from everywhere, seeking for Siguier’s perceptiveness to make clinical diagnosis he was a legend, the father of Internal Medicine. Of course it is an old story and so clinical exam… Things are not the same actually, medical history and searching for a splenomegaly, describing cardiac murmur are obsolete. X-rays, Ultrasounds are doing this job. The question is where is the relationship between physician and his (her) patient? The answer is in the computer sir! No need for making a full history, it is in the patient’s file, no need to point out a specific symptom, it is in the Medical report. Time is money: ask for all the laboratory tests and most imaging at the same time “in a parallel way” we will discuss after of the results…and the discovery of “abnormalities” we were not searching! However, what needs the patient from his doctor is: physician’s attention. The patient likes the palpation of his (her) abdomen, the listening of his (her) lungs, feeling doctor‘s hands on his (her) body searching for an abnormality “it hurts here doctor!”
Considering efficiency/cost ratio clinical exam is without any doubt the leader, leaving far away RMI, specific and expensive lab tests.
“Ecoutez le malade, il vous donne, vous offre généreusement le diagnostic.” (Listen to the patient, he gives you, he generously offers to you the diagnosis” Used to say Fred Siguier .
Gulf Medical University, UAE
Time : 10:50-11:30
Galal E Nagib El-kilany is an Assistant Clinical Professor and Consultant of Cardiology at Gulf Medical University (GMU), UAE. He is a Distinguished Fellow at International Society of Cardiovascular Ultrasound (ISCU), USA; President of ISCU; Fellow of European Society of Cardiology, France; Associate Editor of Journal of Molecular and Translational Research and Editor of World Heart Journal.
Background: The prevalence of obesity and diabetes has reached epidemic proportions, and in terms of the extent of its negative impact on the health has been compared to those of tobacco and hypercholesterolemia. One of the first medical consequences of obesity and diabetes mellitus to be recognized was cardiovascular disease (CVD). Obesity and diabetes are independent predictors of coronary heart disease, heart failure and stroke.
Aim: The aim of the study was to evaluate whether tissue Doppler imaging (TDI) and global longitudinal strain (GLS) detects a pre-clinical impairment of diastolic and systolic functions in obese subjects with type 2 diabetes with short duration of disease and normal cardiac function with conventional echocardiography (CE), and whether echocardiographic parameters are related to metabolic abnormalities.
Patients & Methods: We studied 240 obese (body mass index (BMI>30 kgm2), uncomplicated type 2 diabetic subjects with short duration of disease and 93 control subjects. All participants underwent CE, GLS and TDI echocardiography. With TDI, early mitral annular septal velocity (Ea), pre systolic conventional mitral flow atrial Doppler velocity (Aa), their ratio (Ea/Aa) and systolic velocity (Sa) were measured at the lateral corner of mitral annulus. Glycosylated haemoglobin, fasting plasma glucose and insulin were determined and homeostasis model assessment (HOMA-IR), as an index of insulin resistance, was calculated.
Results: Cardiac function with CE was similar in the two groups. Using TDI, diabetic obese subjects showed a lower Ea velocity (15.5+/-3.9 vs. 19.4+/-3.5 cm/s, P<0.0001), an increased Aa velocity (15.5+/-2.4 vs. 14.1+/-2.4 cm/s, P<0.05) and a reduced Ea/Aa ratio (1.00+/-0.2 vs. 1.39+/-0.3, P<0.0001), compared with control subjects. Interestingly, diabetic women had increased left ventricular (LV) wall thickness (18.8 vs. 16.1 mm, p<0.001). Trans thoracic echocardiography, myocardial Doppler-derived systolic (sm) and early diastolic velocity (em) and strain imaging (GLS) were obtained in obese diabetic subjects and 93 referents (BMI <25 kg/m2). BMI correlated with left ventricular (LV) mass and wall thickness (P<0.001). Severely obese subjects (BMI >35) had reduced LV systolic and diastolic function compared with referents, evidenced by lower average longitudinal peak systolic strain, sm, and reduced em, whereas LV ejection fraction remained normal. Differences in regional and global strain (-14.5%+/-1.4) were identified between the severely obese diabetic (BMI>35) and the referent patients (-17.6%+/-2.1), P<0.001.
Conclusion: An early stage of cardiac dysfunction and dilated cardiomyopathy can be evidenced by TDI and myocardial strain imaging in type 2 diabetic obese subjects even in the presence of a normal cardiac function with CE. This abnormality is associated with cardiac hypertrophy in one third of our studied patients.