24^th Annual Cardiologists Conference June 11-13, 2018 Barcelona, Spain

Biography:

Luis Martinez Millan is PhD in Medicine and specialized in Pediatrics. Since 1992 is Full Professor in Human Anatomy and Embryology. His research is centered on development and plasticity of sensory systems, documenting the reorganization of sensory afferents after removal of visual inputs in young animals and enhancing the plastic possibilities after lesions in adult systems. In the last years he observed changes of gene expression in encephalic neurons under the influence of modified geomagnetic fields. And very recently he detected changes in blood vessels density and distribution in experimental animals submitted to modified geomagnetic fields. Presently he is Professor Emeritus adscribed to the Achucarro Center of Neurosciences in Lejona (Spain).

Abstract:

Changes of 100 degrees in the orientation of the horizontal vector of a geomagnetic field produced by three pairs of Helmholtz coils cause unanticipated alterations in the brain as well as the heart. In the rodent brain, it leads to significant cfos expression in cortical and subcortical brain structures. This expression requires neurotransmitter secretion and is mediated by the MAPKinases pathway. In the heart, autonomous and cholinergic cardiac innervations are responsible for a permanent electrical activity that makes the myocardium a receptor for magnetic fields actions. Mice submitted to the same aforementioned modified geomagnetic fields for one hour every 8 hours during a period of 10 days caused a cardiac hypertrophy. This was mainly due to a considerable increase of myocardic blood vessels distributed in both ventricles, as well as, in the intermediate and deep myocardic strata. Moreover, significant increase of cfos expression was detected in treated cases in comparison with controls. Vasculoepithelial growth factor participates in the higher density of vessels. Although these preliminary results have to be completed by studying time course, persistency and appearance after experimental myocardial infarction, it suggests the potential towards alternative clinical therapies and a translational value. The added benefit is that the magnetic apparatus is inexpensive and the envisaged application to human patients would be non-invasive.

Left pricture shows the left ventricle of a control animal and the right one shows the  left ventricle of a treated animal

Recent Publications:

Biography:

Major. Dr. Biji Soman graduated from Government Medical College, Trivandrum in 1996 served in the Indian Army as a Short Service Commission (SSC) officer for 5 years. Then he joined Sree Utharadom Thirunal (SUT) Hospital in Trivandrum, a reputed tertiary care cardiac centre as Registrar in Cardiology and Cardiac Catheterisation Lab. He went to United Kingdom in 2005 and trained at the prestigious Guy’s & St. Thomas’ NHS Trust Hospital, London in Cardiology. He did Post Graduate Diploma in Clinical Cardiology from Kerala Institute of Medical Sciences (KIMS), Trivandrum, passed out with Distinction and First Rank in Kerala state. He obtained Membership of Royal College of Physicians (MRCP UK) in 2013. He became substantive Consultant Cardiologist in 2014; was elected as a collegiate member of Royal College of Physicians and Surgeons of Glasgow MRCPS (Glas) in 2014.  He is presently affiliated with Sree Gokulam Medical College and Research Foundation Trivandrum as Consultant Cardiologist. He won awards for best paper presentations in National Conferences. He is the faculty in International and National conferences in Clinical Cardiology. He has several academic publications to his credit in both National and International peer reviewed Scientific Journals. His area of interest is cardiovascular diseases among women.

Abstract:

Objective: Diabetes mellitus is known to be a major risk factor for the development of coronary artery disease (CAD). The aim of this study was to assess and compare the extent and the severity of coronary artery disease (CAD) in diabetic and non diabetic women with acute coronary syndrome.
Methods: Angiographic findings of diabetic and non diabetic women, who presented with acute coronary syndrome were analysed and compared. Two interventional cardiologists, determined the presence and characteristics of atherosclerotic lesion, according to the American Heart Association classification.
Results: 283 women who presented with acute coronary syndrome were studied, of these 166 with mean age of 60.84 ± 9.49 years were diabetic and 117 with mean age of 58.70 ± 11.78 years were non diabetic. Unstable angina was significant among non diabetic women [99 vs. 84, p = 0.035, OR 1, (CI 0.349 – 0.965)], while ST elevation myocardial infarction (STEMI) was significantly higher among diabetic women [36 vs. 12, p = 0.012, OR 2.423 (CI 1.201 – 4.89)]. Diabetic women had higher incidence of triple vessel disease (TVD) [44 vs. 12, p < 0.001 OR 3.156, (CI 1.584 – 6.289)], while non diabetic women had higher incidence of angiographically normal epicardial coronary arteries [14 vs. 30, p <0.001 OR = 1, (CI 0.134 – 0.531)], segmental distribution showed proximal segment disease was the commonest, however, diabetic women had greater number of lesion per patient (2.47 vs. 1.31). Diabetics also had greater no. of left mainstem disease, though not statistically significant (10 vs. 3, p = 0.735). LAD was more commonly involved among non diabetic women (112 vs. 60, p = 0.007). Diabetics had greater type B2 [124 vs. 16, p < 0.001, OR = 3.692, (CI 2.113 – 6.449)] and type C [228 vs. 69, p = 0.027, OR = 1.514, (CI 1.047 – 2.190)] lesions, while non DM had greater percentage of type A [20 vs. 28, p < 0.001, OR= 1, (CI 0.126 – 0.423)] and B1 [48 vs. 44, p < 0.001, OR = 1 (CI 0.209 – 0.525)] lesions.
Conclusion: These findings confirm that the diabetic women have more severe and extensive coronary artery disease than the non diabetics, especially among south Indian women.

Biography:

Dr. AM Thirugnanam, MD., MSICP, Ph (USA).FSCAI. (USA) is currently the senior interventional cardiologist at Virinchi Hospitals in Hyderabad, India. He did under-graduation in 1996 from Ashwood Medical University (Texas); Masters(MD) in internal medicine in 1999 from Belford University (Texas) and PhD (1999-2002) in interventional cardiology Ashwood Medical University. He has presented more than 150 research papers in national and international conferences, especially in cellular and interventional level. He had held various positions in national and international conferences. He had conducted many national conferences in Cardiology. He has been teaching non-invasive and Invasive cardiology to undergraduate and postgraduate medical students for the past six years and writing articles in indexed journals and media. He has been conducting monthly CME for doctors regularly on advanced cardiology topics with clinical experience which have been helping them in their day to day practice. He conducted research on advanced interventional pharmacology like Bivalirudin, prasugrel, GP2b3a RB in PCI.

Abstract:

Background: This is follow up results of Use of new generation Everolimus and Sirolimus stents in chronic renal patients have been shown  to reduce myocardial infarction, target vessel revascularization (TVR) and major adverse cardiovascular events (MACE), without increasing in bleeding risk in CKD patients.

Objective: Our aim to compare the safety and efficacy outcome between new generation Everolimus stent and Sirolimus eluting stents in patients undergoing PCI with New EES and SES.

Methods: We retrospectively analyzed 150 patients who underwent PCI in our centers, between August 2014 and August 2017. Patients were divided in to two groups: new EES (n=105) and new SES (n=45). Primary end points were at 1-year, 2-year, 3-year, composite of all cause of death, MI, CVA, TVR, MACE and stent thrombosis were also evaluated.

Results: Femoral access in 30% and 70% radial access were used. Rate of dual antiplatelet used 1 year were 96% in EES and 90% in SES. The primary end points occurred in 7% of EES and in 25% of SES. There were significant differences found with respect to the rate of 3 years all-cause mortality (3% vs 18%), MI (1% vs 15%), CVA (0.5% vs 5%), ST (1.5% vs 15%), TVR ( 2% vs 18%), MACE (1% vs 14%) and 2 cases of major bleeding were observed in SES patients and not in EES.

Conclusion: New EES stents shown very positive and encouraging results in CKD patients than new SES stents. This 3 years study may further be extended to evaluate very late events.

Biography:

Višnja Nesek Adam is anesthesiologist, emergency medicine specialist and subspecialist in intensive care medicine. She is recognised for her expertise in emergency medicine. Dr. Nesek served as Assistant Professor at JJ Strossmayer School of Medicine  at the University of Osijek. Although she loves the clinical practice of anesthesia and emergency medicine, teaching students is her true passion and she was responsible for teaching medical students, residents and fellows about the anesthesia and emergency medicine. She is also Head of the University Department of anesthesiology, reanimatology and intensive care medicine and Center for emergency medicine.

Abstract:

Statement of the Problem: Elective cardioversion (EC) is a short procedure aim to return the heart to a normal rhythm following cardiac dysrhythmias. This procedure is extremely stimulating and painful and can be distressing for the patient; therefore anesthetists are often requested to provide anesthesia. The level of sedation required for cardioversion is either deep sedation or general anesthesia. Selection of the anesthetic agent is important, because a short duration of action, early recovery without complications and hemodynamic stability are required. This is particularly important in hemodynamically unstable patients. The purpose of this study was to compare propofol and midazolam – fentanyl combination for procedural sedation during EC.
Methodology & Theoretical Orientation: Patients older than 18 years, American Society of Anesthesiologists I-III grades undergoing elective cardioversion were randomly divided into one of two groups. Group P (n = 30) were received propofol 1 mg/kg intravenous (IV) bolus followed by 0.5 mg/kg. Group MF ( n = 30) were initially administered fentanyl (1.25 μg/kg IV), followed by a bolus of midazolam 3 mg IV and titrated to the sedation. Time to sedation and level of consciousness was assessed by subjective clinical signs of patients: incoherent speech, vertical nystagmus, glassy eyes, yawning and then muscular relaxation. During the procedures a change in heart rate, blood pressure, and respiratory pattern were also observed. We have recorded the time intervals needed for eyes opening (awakening time) and replay psycho-cognitive functions assessed by the patient’s ability to open his/her eyes upon command and to correctly pronounce the name.
Findings: Mean time to sedation was faster with propofol and patients in the propofol group had shorter mean times to wakening and full consciousness, but propofol was associated with a higher incidence of apnea.
Conclusion & Significance: The propofol provided satisfactory hemodynamic stability, along with shorter sedation and wakening. However, the advantage of shorter sedation and wakening times associated with propofol should be weighed against the possibility of adverse events, particularly respiratory depression.

Recent Publications:

1. Gerstein NS, Young A, Schulman PM, Stecker EC, Jessel PM (2016) Sedation in the Electrophysiology Laboratory: A Multidisciplinary Review. J Am Heart Assoc. 13;5(6). pii: e003629. doi: 10.1161/JAHA.116.003629.
2. Desai PM, Kane D, Sarkar MS (2015) Cardioversion: What to choose? Etomidate or propofol. Ann Card Anaesth 18:306-11. 2.
3. Chung MY,  Chea JS, Kim CJ, Lee BH (2001) Effect of Midazolam, Fentanyl and Propofol for Intravenous Anesthesia in Patients Undergoing the Cardioversion. Korean J Anesthesiol 41(3):284.
4. Tang RB, Dong JZ, Zhao WD, Liu XP, Kang JP, Long DY, Yu RH, Hu FL, Liu XH, Ma CS (2007).
5. Unconscious sedation/analgesia with propofol versus conscious sedation with fentanyl/midazolam for catheter ablation of atrial fibrillation: a prospective, randomized study. Chin Med J 120:2036–2038.  Zed PJ, Abu-Laban RB, Chan WW, Harrison DW (2007) Efficacy, safety and patient satisfaction of propofol for procedural sedation and analgesia in the emergency department: a prospective study. CJEM. 9(6):421-7.

Biography:

Dr. Fabiola Sozzi works as a staff cardiologist at the University Hospital Policlinico of Milan, Italy, with high-specialization nomination. She has high skills in multimodality imaging of heart disease using echocardiography integrated with cardiac magnetic resonance imaging, cardiac computed tomography and nuclear. She also works in the acute clinical setting treating acute cardiac syndromes. She gained a high expertise in echocardiography at the Thoraxcentre of Rotterdam (NL), where she defended the PhD thesis on stress cardiac imaging under the supervision of Professor J. Roelandt. She is Visiting Professor at the University of Milan where she leads several research projects and teaches at the Faculty of Medicine and School of Specialization of Cardiology. She is author of 70 papers published in indexed peer-reviewed international journals and reviewer of several medical international journals.

Abstract:

Doppler echocardiography can characterize left ventricular diastolic function through a combination of measurements, which show evidence of slowed ventricular relaxation, increased left ventricular stiffness or abnormal left ventricular filling. Doppler echocardiography can also provide an estimate of left ventricular filling pressures, one component of diastolic function that reflects pulmonary capillary wedge pressure. These parameters have been shown to correlate with exercise capacity.
A normal diastolic function response to exercise is characterized by normal and similar resting and exercise E/e’ measurements. Elevated left ventricular filling pressure is a cardinal feature of heart failure with preserved ejection fraction (HFpEF). The ratio of transmitral E to mitral annular e′ velocities (E/e′) at Doppler echocardiography has been proposed as a non-invasive measure of left ventricular filling pressure and endorsed by professional guidelines as a surrogate parameter of invasive left ventricular filling pressure in the diagnostic work-up of HFpEF. The diagnosis of HFpEF is straightforward when patients are acutely decompensated. To make matters more complex, many patients with HFpEF display normal left ventricular filling pressures at rest, with abnormalities that develop during stresses like exercise.
Invasive hemodynamic exercise testing has emerged as the gold standard to diagnose or exclude HFpEF in patients with exertional dyspnea of unclear etiology, but cost, risk, and the requirement for specialized training and equipment may limit its broad application in practice and in clinical trials. Therefore, Doppler echocardiography plays a central role in the non-invasive evaluation and grading of diastolic dysfunction.
The American College of Cardiology Foundation/American Heart Association guidelines define HFpEF as clinical signs and symptoms of HF, preserved ejection fraction, and no other obvious explanation for symptoms. This scheme works well for patients with a high likelihood of disease on the basis of clinical indicators of congestion. To address the patients without overt congestion, more recent guideline statements from the European Society of Cardiology (ESC) and American Society of Echocardiography/European Association of Cardiovascular Imaging (ASE/EACVI) require objective evidence of high left ventricular filling pressures.

Recent Publications:

1. Hiroyuki O, Hiiroo I, Miyo T, et al. Impact of Doppler derived left ventricular diastolicperformance on exercise capacity in normal individuals. Am Heart J 2000;139(4):716–722.
2. Borlaug BA, Paulus WJ. Heart failure with preserved ejection fraction: pathophysiology, diagnosis, and treatment. Eur Heart J. 2011;32:670-679.
3. Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JG, Coats AJ, Falk V, González-Juanatey JR, Harjola VP, Jankowska EA, Jessup M, Linde C, Nihoyannopoulos P, Parissis JT, Pieske B, Riley JP, Rosano GM, Ruilope LM, Ruschitzka F, Rutten FH, van der Meer P; Authors/Task Force Members. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J. 2016;37:2129-2200.
4. Nagueh SF, Appleton CP, Gillebert TC, Marino PN, Oh JK, Smiseth OA, Waggoner AD, Flachskampf FA, Pellikka PA, Evangelisa A. Recommendations for the evaluation of left ventricular diastolic function by echocardiography. Eur J Echocardiogr. 2009; 10:165-193.

Biography:

Jochen Senges is the Director of the Institute of Herzinfarktforschung Ludwigshafen. He completed his Medical School at University of Heidelberg, Berlin and Frankfurt 1961-1966; Medical Diploma at University of Heidelberg in 1966; Board certification in Internal Medicine in 1974. He was a Senior Staff Physician in Department of Cardiology, University of Heidelberg. He completed his PhD in Medicine with a neurophysiologic dissertation at University of Heidelberg in 1967 and; was a Research Fellow at Stanford University, California, USA in 1969. His main research topic is Cardiac Arrhythmias. He was an Associate Professor of the Medical Faculty, University of Heidelberg in 1981.

Abstract:

Atrial fibrillation (AF) is the most common cardiac rhythm disorder and affects mainly older people. Poor diagnosis of AF: Large registries (Gloria-AF) have clearly shown that about two-third of patients in Western Europe with newly diagnostic non valvular AF are detected asymptomatic/minimally symptomatic. The rate of previous stroke in these patients is more than twice as high as in symptomatic patients, despite no difference in CHA2DS2-VASc-Score. This may be explained by a longer but subclinical and therefore undiagnosed AF history. Poor medical adherence: poor medication adherence is the second most important factor underlying strokes in patients with atrial fibrillation. Various major studies have demonstrated that less than half of AF-patients are treated with guideline antithrombotic medication. Mass media campaign: these results underline the importance for both: public programs to detect non-valvular AF in the older population but also public education programs that should focus on patients’ poor understanding of the importance for sustained antithrombotic medication adherence to prevent stroke. The ARENA study includes a longstanding mass media campaign over one year to improve diagnosis and medical adherence in atrial fibrillation. Actually over 10.000 AF-patients are documented and first results will be presented at this meeting.

Recent Publications
1. Puls Miriam, Lubos Edith, Boekstegers Peter, Bardeleben Ralph Stephan von, Ouarrak Taoufik, Butter Christian, et al., (2016) One-year outcomes and predictors of mortality after MitraClip therapy in contemporary clinical practice: results from the German transcatheter mitral valve interventions registry. Eur Heart J 37(8):703–712.
2. Schmidt Martin, Dorwarth Uwe, Andresen Dietrich, Brachmann Johannes, et al., (2016) German ablation registry: cryoballoon vs. radiofrequency ablation in paroxysmal atrial fibrillation-one-year outcome data. Heart Rhythm 13(4):836–844.
3. Zylla Maura M, Brachmann Johannes, Lewalter Thorsten, Hoffmann Ellen, Kuck Karl-Heinz et al., (2016) Sex-related outcome of atrial fibrillation ablation - insights from the German ablation registry. Heart Rhythm 13(9):1837–1844.
4. Brachmann Johannes, Lewalter Thorsten, Kuck Karl-Heinz, et al., (2017) Long-term symptom improvement and patient satisfaction following catheter ablation of supraventricular tachycardia: insights from the German ablation registry. Eur Heart J 38(17):1317–1326.

Biography:

Arash Gharehbaghi received the M.S of biomedical engineering, on screening valvular and septal defects using heart sound signal analysis, from Amir Kabir University, Tehran, Iran, in 2000. He had been the head of the two research projects on cardiac signal analysis, between 2004 to 2008, that led to the international and domestic patents. He received his second M.S, on detecting ejection click from heart sound signal, from the Mon University, Belgium, in 2010, and his PhD degree from the Linköping University, Sweden, on severity assessment of valvular aortic stenosis using phonocardiography, in 2014. He is currently a research leader at Mälardalen University with the rise of coronary artery detection using intelligent phonocardiography.

Abstract:

Recent progresses in artificial intelligence made development of efficient decision support systems feasible. Application of such the DSS is rather seen in primary healthcare centers where accuracy of cardiac diagnosis is substantially low because of the complexities of cardiac auscultation. Our longstanding studies on heart sound analysis resulted in the novel methods that can provide sufficient means to extract significant medical information from the sounds to help the physicians in decision making. These methods were incorporated into a stand-alone system composed of an electronic stethoscope in conjunction with a portable computer. The resulted system, which we called the Intelligent phonocardiography (IPCG), provides an easy-to-use and inexpensive approach for cardiac assessments. Both the accuracy and the sensitivity of the IPCG in screening children with congenital heart disease were estimated to be higher than 87.0%, when a patient population of more than 250 individuals was employed. In a separate study, performance of the IPCG was investigated for assessing severity of valvular aortic stenosis in elderly patients, and the reliability and accuracy of the approach were estimated to be more than 80%. It is worth noting that screening patients with aortic stenosis based on IPCG had already been studied, where an accuracy of higher than 85% was achieved. Potential of the IPCG for pediatric cardiac assessments was rather studied in disease identification and also in discrimination between different cardiac defects with the systolic murmurs. Screening of the children with isolated bicuspid aortic valve, ventricular septal defect, and discrimination between valuvar aortic and pulmonic stenosis are considered as the examples of such studies. Results show that the IPCG has a high potential to be used in primary healthcare centers as an efficient decision support system. This can drastically reduce unnecessary echocardiography which is by far a more expensive approach.

Recent Publications:

1. Gharehbaghi A, et al (2015) Assessment of aortic valve stenosis severity using intelligent phonocardiography. International Journal of Cardiology 198:58-60.
2. Gharehbaghi A, et al (2017) A Deep Machine Learning Method for Classifying Cyclic Time Series of Biological Signals Using Time-Growing Neural Network, under press.
3. Sepehri A, et al (2016) An intelligent phonocardiography for automated screening of pediatric heart diseases, Journal of Medical SYstems 40(1).
4. Gharehbaghi A, et al (2017), Intelligent phonocardiography for screening ventricular septal defect using time growing neural network, Informatics Empowers Healthcare Transformation 238:108.
5. Gharehbaghi A, et al (2015) An intelligent method for discrimination between aortic and pulmonary stenosis using phonocardiogram, World Congress on Medical Physics and Biomedical Engineering 1010-1013.
6. Gharehbaghi A, et al (2015) A novel method for screening children with isolated bicuspid aortic valve, Cardiovascular Engineering and Technology, 6(4):546-556.

Biography:

Maja Karaman Ilić, PhD is an Anesthesiologist and IC Medicine Specialist presently working in Clinical Hospital Sveti Duh, Zagreb, Croatia. She is the assistant of Faculty of Medicine, JJ Strossmayer University of Osijek, Croatia. Her expertise has been focused on validation of non-invasive monitoring in volume status estimation of patients in Intensive Care Unit.

Abstract:

Aim: To investigate whether lung ultrasound can be used to detect fluid overload in the intensive care unit early after surgery.
Methods: This prospective study involved 60 patients without known cardiac or pulmonary diseases admitted to the intensive care unit at our Hospital after elective abdominal or vascular surgery. The inferior vena cava collapsibility index (IVCcl), PaO2/FiO2 ratio, and appearance of B-lines were determined upon admission to the intensive care unit and at 6, 12, and 24 h later. Fluid overload was de ned as IVCcl ≤ 40% and the presence of B-lines ≤7 mm. Tissue oxygenation impairment was defined as a PaO2/FiO2 ratio < 200.
Results: Fluid overload was detected in 42 patients (70%). The combination of dense B-lines and IVCcl ≤40% predicted fluid overload around the same time as drop of PaO2/FiO2 ratio (p = 0.115). Appearance of dense B lines correlated strongly with PaO2/FiO2 ratio (p < 0.001), while IVCcl did not correlate with PaO2/FiO2ratio (p = 0.071).
Conclusion: Our preliminary results suggest that lung ultrasonography may be a promising non-invasive method for early detection of fluid overload in spontaneous breathing intensive care patients soon after surgery. Our findings should be verified in larger studies.

Biography:

Sergio Mejía Viana has completed his Cardiology training and Doctorate at the University Clinic of Navarre. He was an interventional Cardiologist, Angiologist and Phlebologist for 20 years. He is a Fellow of the European Society of Cardiology, has written more than 100 scientific publications including abstracts, articles and book chapters. He returned to clinical practice with high interest in prevention. Currently, he is a Consultant at the Medical Investigation Unit in St. Bernard´s Hospital in Gibraltar.

Abstract:

Atherosclerosis is not a single disease entity. In fact, the lesions of atherosclerosis represent a common response of the artery to numerous and potentially different forms of insult. Examination of atherosclerotic lesions reveal that each lesion contains the elements of an inflammatory response together with varying levels of fibro proliferative response. Many authors have written extensively about the holes in the cholesterol theory, and that mainstream medicine´s obsession with reducing cholesterol levels has always been misguided. There is increasing concern regarding the health effects of exposure to various heavy metals in the environment. This is particularly true for mercury, cadmium, lead, aluminum and arsenic. Lead exposure increased through the mid 1970´s, largely as a result of use of tetraethyl lead in gasoline. At the peak of lead production, the atmospheric release of lead reached 600.000 tons annually. The half-life of lead in the body is extremely long as it accumulates in the bone. The association between lead and cardiovascular disease has been recognized for years and there is consistent epidemiological evidence that lead is an established risk factor for hypertension, promotes oxidative stress and inflammation, the triggering event of atherosclerosis. Cadmium production increased during the 20^th century as a result of the production of nickel-cadmium batteries, metal coatings and plastic stabilizers. Food and smoking are the major sources of cadmium for the general population. Cadmium is stored in the kidneys, liver, lungs, pancreas and central nervous system, with a half-life of over 15 years. A recent systematic review concluded that the evidence supports the role of cadmium as a cardiovascular disease risk factor, especially for coronary disease. Understanding that atherosclerosis is an inflammatory disease and not “fat deposits blocking arteries” will improve preventative strategies. The  consequences of metal toxicity should now be published widely enough in order to avoid cardiovascular problems.

Recent Publications:

1. Mejia Viana S (2015) From Framingham to Hunt 2: 60 Years Blaming the Wrong Culprit?. J Cardiol Curr Res 2015, 4(1): 00131.
2. Nigra A,Ruiz-Hernandez A, Redon J, Navas-Acien A (2016) Environmental Metals and Cardiovascular Disease in Adults: A Systematic Review Beyond Lead and Cadmium. Current environmental health report December 2016, Volume 3, Issue 4,  pp 416–433.
3. Solenkova NV, Newman JD, Berger JS, Thurston G, Hochman JS, Lamas GA. Metal pollutants and cardiovascular disease: mechanisms and consequences of exposure. Am Heart J. 2014;168:812–22.
4. Lamas GA, Navas-Acien A, Mark DB, Lee KL. Heavy metals, cardiovascular disease, and the unexpected benefits of edetate chelation therapy. J Am Coll Cardiol. 2016;67:2411–8.
5. Huang Y-CT, Ghio AJ. Vascular effects of ambient pollutant particles and metals. Curr Vasc Pharmacol United Arab Emirates. 2006;4:199–203.

Biography:

Sibel Catirli Enar completed her Graduation from Ä°stanbul University, Ä°stanbul Medical School in 1981.  She has completed her specialization in Anesthesiology and Critical Care at Ä°stanbul Medical School in 1985 and in Cardiology at Ä°stanbul University Ä°nstitute of Cardiology in 1992. She became an Associate Professor of Cardiology in 2000, Fellow of European Society of Cardiology in 2010, Fellow of American Society of Echocardiography in 2012, Fellow of International Society of Cardiac Ultrasound in 2012 and Fellow of American College of Cardiology in 2016. She is working at Turkiye Hospital and Memorial Hospital in Istanbul, Turkey since 2000. She worked as a Research Fellow at Cleveland Clinic of Foundation, USA from 1996-1998 and at University of Alabama at Birmingham-USA from 2006-2008 as well. She has several publications in national and international journals. She served as speaker and moderator in national and international congresses. Her area of interest is Echocardiography.

Abstract:

Background: Stenotic rheumatic aortic valve diseases carry a higher risk in pregnancy. Regurgitant lesions are usually better tolerated. Mechanical valve prosthesis carry the risk of valve thrombosis and bleeding complications.Tissue valve prosthesis avoid the use of anticoagulants and thus, the complications.However,they are associated with higher risk of degeneration. According to ROPAC (The registry on pregnancy and cardiac disease), symptomatic and severe aortic stenosis carry a risk of heart failure and is associated with high rates of hospitalization for cardiac reasons. We report three cases: aortic mechanical valve, aortic homograft valve and severe aortic regurgitation in pregnancy.
Cases: Case 1 is a 30 years old female. She had undergone AVR due to rheumatic valvular disease.Valve thrombus occured in the first trimester and was successfuly resolved with tpa. Delivery was done with Ceaserean section (SC). There was some increase in her mitral regurgitation after the delivery. Baby had low birth weight,but no other complications occured.
Case 2 is a 25 years old female who had aortic homograft valve replacement for her bicuspid aortic valve. First pregnacy was uneventful.In her second pregnancy, aortic regurgitation was present and delivery was done with SC.She was treated medically. Case 3 is a 30 years old female who had rheumatic moderate aortic regurgitattion.During pregnancy, aortic regurgitation increased, and delivery was done with CS. After the delivery, aortic regurgitation decreased. No complications occurred with the baby.
Conclusion: Careful management of aortic valve diseases during pregnancy reduces complications. Even patients with  mechanical prosthetic valves may be successfully treated. Mortality in pregnant women with aortic stenosis is very low. However,these patients carry a risk of heart failure which can be managed medically. Appropriate pre-conceptional patient evaluation and counseling is important in these patients.

Recent Publications:

1. van Hagen IM, Roos-Hessenlink JW, Donvito V et al.(2017). Incidence and predictors of obstetric and fetal complications in women with structural heart disease. Heart 2017.
2. Bons LR, Roos-Hesselink JW.(2016). Aortic disease and pregnancy. Curr Opin Cardiol.2016 Nov; 31(6):611-617.
3. Orwat S, Diller GP, van Hagen IM et al.(2016).Risk of pregnancy in moderate and severe aortic stenosis: From the multinational ROPAC registry. J Am Coll Cardiol 2016 Oct 18; 68(16):1727-37.
4. Sliwa K, Johnson MR, Zilla P, Roos-Hesselink JW.(2015).Management of valvular disease in pregnancy: A global perspective.(2015). Eur Heart J.2015 May 7; 36(18):1078-89.
5. Carboni S, Capucci R, Pivato E et al.(2013). Marfan’s syndrome and pregnancy: A good maternal and fetal outcome. J Prenat Med.2013Apr; 7(2):21-4.
6. De Santo LS, Romano G, della corte A et al.(2012).mechanical aortic valve replacement in young women planning on pregnancy:  Maternal and fetal outcomes under low oral anticoagulation, a pilot observational study on a comprehensive pre-operative counselling protocol. J Am Coll Cardiol 2012 Mar 20; 59(12):1110-5.

Biography:

Negar Omidi completed Masters (MD) in General medicine from Iran university of Medical Sciences, Tehran, Iran (1999-2007). She then specialized in cardiology from Shahid Beheshti University of Medical Sciences, Tehran, Iran (2009-2013). She worked in Tehran Heart Center and Ziaeian Hospital for quite a long time. She is currently the Assistant Professor in the Cardiology department of Tehran Heart Center, Tehran, Iran.

Abstract:

Introduction: Pregnancy can affect cardiac conduction system and make the pregnant women susceptible to arrhythmias, as increased susceptibility to atrial ones are common and ventricular arrhythmias are rare, but deadly.
Material and methods: Current study performed on 96 pregnant women, aged between 18 to 35 years, from 2015 to 2016. The sampling was simple convenient. Standard 12-lead surface electrocardiogram took at first trimester (2-nd month) and repeated on third trimester (8th month) and electrocardiographic indices calculated.
Results: The mean PR interval in T1 period was 133.36±20.9 ms and in T3 was 125.03±22.6ms (P =0.046).The mean QT in T1and T3 were 324.02±19.4ms 314.30±18.9ms respectively. (P <0.001).mean JT interval in T1 and T3 were 171.42±78.4ms and 166.48±75ms respectively (P=0.052). QRS duration in T1 and T3 were 98.02±9.1ms and 90.47±8.4 ms respectively (P=0.027). Mean of QTc (corrected QT interval) were 393.20±42.48 ms and 384.03± 23.2  in T1 and T3 respectively(P 0.023).
Discussion: According to our results mean parameters of electrocardiographic indices as PR, QT, RR, QRS and TP between two trimesters showed significant statistical differences. Mean of these indices reduced significantly, except JT and all of these indices were in normal range.

Recent Publications:

1. Mehdizadeh M.Pasbakhsh P .Negar Omidi ;  Nuropathological changes  in the  PDAPP transgenic mouse model of  transgenic mouse of Alzheimers disease ; ACTA  medica Iranica Journ;  2005;  Vol 43, No 3.
2. Pasbakhsh P. Negar Omidi. German DW ; Interaction of vesicular monoamine trasporter   and neuromelanin pigment among the midbrain dopaminergic neurons in man;  ACTA  medica Iranica Journal ;  2009 ;47(4).
3. Negar Omidi. Sharif Kashani M.Asad pour M . Khorghami MR.Ghorbani Y; The correlation of diastolic dysfuncion with TIMI frame count in patient s with chronic stable angina pectoris; Tehran University Medical Journal ; December 2012;  Vol. 70; No. 9; 555-563.
4. Tabib O.Khorghami, MR.Meraji .  Negar Omidi .Mir Mesdagh. Accuracy of Doppler- derived indexes in prediction of pulmonary  vascular  resistance in  children  with  pulmonary  hypertension  secondary to  congenital  heart  disease  with left to right shunt-Pediatric-Cardiology.Pediatric-Cardiology ; springer 2013;34.No. 7.
5. Jamali Moghadam SR. Negar Omidi. Bayrami .Jamali Moghadam S.  Ebola viral disease: a  review literature;  Asian Pacific Journal of Tropical Biomedicine ; April 2015; Volume 5, Issue 4 ; 260–267.

Biography:

Ali Al Bshabshe graduated from king Khalid university in Abha, Saudi Arabia in 2003, then he joined college of medicine and medical science, had Saudi board in internal medicine as well as Arab board and Jordanian board of internal medicine and the membership of the royal college of physician of the United Kingdom (MRCP UK). Fellowship training in adult critical care medicine at university of Ottawa Canada. Fellowship of the royal college of physician UK (FRCP). He is the associate professor of medicine at the department of medicine in college of medicine King Khalid University Abha, Saudi Arabia. adult critical care fellowship program director at southern region, Saudi Arabia. He was the former vice dean for clinical affairs, college of medicine King Khalid University Abha, Saudi Arabia.

Abstract:

Sepsis induced cardiomyopathy is an entity which most of the time overlooked by the practicing intensivist although it is not uncommon and good number critically ill septic patients might suffer from. There was a high incidence of severe sepsis attended in the ICU and high ICU and hospital mortality rates. Delayed diagnosis of sepsis and progression to multi organ failure which is associated with high mortality reported in the first 48 hours of ICU admission 1. Myocardial dysfunction is one of the main predictors of poor outcome in septic patients, with mortality rates next to 70%. 2. Severe sepsis and septic shock are the main cause of death in non-cardiac Intensive Care Units (ICU), with unacceptably high mortality rates 3. One of the proposed pathological mechanisms in sepsis induced cardiomyopathy is related to mitochondrial injury and dysfunction. 4. Oxidative stress leads to energetic (and thus functional) and structural failure of the cardiomyocyte. 5. Taken together, ROS derived from NOX1/NADPH oxidase play a pivotal role in endotoxin-induced cardiomyocyte apoptosis by increasing oxidation of Akt and subsequent de-phosphorylation by PP2A. Marked up-regulation of NOX1 may affect the risk of mortality under systemic inflammatory conditions. 6. In this proposed presentation, I will review the incidence of sepsis induced cardiomyopathy along with pathogenesis and recent literature related to the topic.

Recent Publications:

1. Blanco J, Muriel-Bombín A, Sagredo V, et al. Incidence, organ dysfunction and mortality in severe sepsis: a Spanish multicentre study. Critical Care. 2008; 12(6): R158. doi:10.1186/cc7157.
2. Romero-Bermejo FJ, Ruiz-Bailen M, Gil-Cebrian J, Huertos-Ranchal MJ. Sepsis-induced Cardiomyopathy. Current Cardiology Reviews. 2011;7(3):163-183. doi:10.2174/157340311798220494.
3. Annane D, Bellissant E, Cavaillon JM. Septic shock. Lancet. 2005; 365:63–78. 
4. Martin GS, Mannino DM, Eaton S, Moss M. The epidemiology of sepsis in the United States from 1979 through 2000. N Engl J Med. 2003; 348:1546–54.
5. Tsolaki V, Makris D, Mantzarlis K, Zakynthinos E. Sepsis-Induced Cardiomyopathy: Oxidative Implications in the Initiation and Resolution of the Damage. Oxidative Medicine and Cellular Longevity. 2017; 2017:7393525. doi:10.1155/2017/7393525.
6. Matsuno K., Iwata K., Matsumoto M., et al. NOX1/NADPH oxidase is involved in endotoxin-induced cardiomyocyte apoptosis. Free Radical Biology & Medicine. 2012;53(9):1718–1728. doi: 10.1016/j.freeradbiomed.2012.08.590.

Biography:

Professor Guo-Wei He, MD, PhD ((Monash), DSc (Monash) is Vice President and  Chief (Academic) and Senior Surgeon of Department of Cardiovascular Surgery, as well as Director, Center for Basic Medical Research, TEDA International Cardiovascular Hospital (from October, 2007-), Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China. Professor He currently also holds Clinical Professor of Surgery, Department of Surgery, Oregon Health and Science University, Portland, OR, U.S.A. and Chair Professor, Zhejiang University as well as Hangzhou Normal University, China. Previously, Professor He was Chair Professor of Cardiothoracic Surgery, Department of Surgery, University of Hong Kong & Honorary Consultant Cardiac Surgeon, The Grantham Hospital, Hospital Authority, Hong Kong and then Research Professor of Surgery & Director, Cardiovascular Surgical Research Laboratory, Department of Surgery, The Chinese University of Hong Kong, Hong Kong and Professor of Surgery at Nankai University.  He was also Director, Cardiovascular Research, Starr Academic Center, Providence Heart Institute, Portland OR, U.S.A. Professor He is (or was) a member of editorial board for more than 20 international journals including The Annals of Thoracic Surgery (U.S.A.), World Journal of Surgery (U.S.A.) , and The Heart Surgery Forum (U.S.A.).  He received a number of science award including First Prize, 2012 Tianjin (China) Natural Science Award.  He is awardee of a number of Research Grants from Research Grants Council, Hong Kong, Am. Heart Assoc., St. Vincent Medical Foundation, U.S.A. and more recently from National Science Foundation & The Ministry of Science & Technology, China. Professor He has contributed in a number of books.  In addition, as the sole editor, he has published a book entitled: Arterial Grafts for Coronary Artery Bypass Grafting Surgery (Springer-Verlarg); this book has been published in two editions now with an additional edition in Chinese. Professor He has had 321 publications indexed by SCI (Science Citation Index, U.S.A.) and 202 full papers including editorials indexed by “Pub Med” including multiple papers in “Circulation”.

Abstract:

In the “Precision Medicine” era, integration of multiple ‘omics’ technologies will allow us to gain a more complete picture of the constituents and functions of diseases and provide far richer information for predictive modelling of phenotypes.
The multiple ‘omics’ technologies largely refer to high-throughput technologies that have revolutionized medical research. These technologies allow integrative studies at genomic, epigenomic, transcriptomic, proteomic, and metabolomic levels, etc.  In cardiovascular diseases, genomics, epigenomics, transcriptomics, proteomics, and metabolomics are particularly important in understanding the mechanisms of the disease.  Multi-omics offers the opportunity to understand the flow of information that underlies cardiovascular diseases better than the studies at a single omics level.
We have been using these multi-omics technologies in coronary artery disease, heart valvular diseases, and congenital heart diseases.  With the multi-omics studies, we now have deeper understanding of the complexity in mechanism(s) of these diseases.  This lecture will detail some of our studies as well as views on the prospects in this area.

Biography:

Athos Capuani is a Cardiothoracic Surgeon with a long working experience in acquired and congenital heart diseases. For the recent years he is very interested in fetal life. The main area of investigation is the embryology-morphology of CHD and the links with genetic and epigenetic disorders. He found an anatomical common denominator in the most complex malformations: The Trabecula Septomarginalis sequential malrotation. He thinks that many complex CHD could be addressed during pregnancy on the light of this model and the modern molecular biology what he refers as Molecular Cardiac Surgery.

Abstract:

Statement of the Problem: The classical congenital heart surgery in complex malformations still carries high risk and poor long term outcome despite the advances marked over the 20^th century.
Hypothesis: A very early diagnosis and non invasive treatment during pregnancy on the light of the modern molecular biology would strongly affect the medical and surgical history of Congenital Heart Diseases (CHD).
Methodology: We reconsidered the embryogenesis and the morphology of the most severe CHD.
Findings: We found a common anatomical denominator in all morphological settings: the Trabecula Septomarginalis sequential malrotation counterclockwise apex-base axis (TSM, Leonardo’s cord). The TSM is composed in the normal heart by an Anterior Limb AL committed to the Outlet Septum and by a Posterior Limb PL committed to the inner curvature. Fig.1. TSM (brown) and Outlet Septum (green) rotation in sequential phenotypes from normal to Transposition of Great arteries. Fig.2. TSM rotation seen from the apex: PL green, AL Yellow. The TSM rotating follows the development of the right ventricle and is always traceable in the classical V shape or variants.
Conclusions:

1. The TSM sequential malrotation is proposed as a model for new investigations and treatments during pregnancy.
2. Each malformed cardiac phenotype has a specific molecular profile which can be identified by the Next Generation Sequencing analysis (NGS) and edited by the CRISPR-cas9 technique what we refer as NGS Molecular Cardiac Surgery.

Recent Publications:

1. Capuani A (2017) New Perspectives in Cardiac Surgery: The Virtual Ventricle and the Molecular Cardiac Surgery. Proceedings of 7th World Congress of Pediatric Cardiology and Cardiac Surgery. Barcelona 2017,P2271:726-727. www.wcpccs2017.org.
2. Capuani A (2016) Targeting exome sequences in congenital heart diseases: are we there yet? Proceedings of the XXXI Congress of the International Academy of Pathology and 28th Congress of the European Society of Pathology. Cologne 2016, Virchows Archiv 2016; 469(Suppl1):S1-S346 E-PS-02-003,pp s242.
3. Capuani  A  (2015)  Potential  treatment  of  congenital  heart malformations during cardiac morphogenesis. Proceedings of the 27th European Congress of Pathology. Belgrade 2015, Virchows Archiv 2015;467(Suppl1):S1-S279 PS05-005,pp s97.
4. Capuani A (2014) The trabecula septomarginalis (Leonardo’s cord) in abnormal ventriculo-arterial connections. J Cardiothorac Surg 2014;9:71-81.

Biography:

Alexander Manché is the Chairman of the Cardiothoracic Surgery at Mater Dei Hospital, Malta. He qualified at Westminster Medical School, London in 1979 and spent 18 years in the UK and the US, including 2 years of research at the Rayne Institute. He returned to Malta in 1995 and set up the Cardiothoracic Unit, which offers a comprehensive adult service including surgery for ischaemic and valvular heart disease, thoracic vascular conditions, heart transplantation, vascular access as well as lung disease. His journal publications and presentations at scientific meetings number over two hundred.  He has a special interest in the epidemiology of aortic valve surgery.

Abstract:

The indications for Transcatheter Aortic Valve Implantation (TAVI) are evolving. The original indication, in patients with unacceptably high risk for surgery, was expanded to include high-risk patients also eligible for surgery. TAVI is now being offered to intermediate-risk patients without available long-term data. Surgery in these patients offers excellent results, both in the short and long term.
Surgical aortic valve replacement, with or without concomitant coronary revascularisation, can achieve a normal life expectancy in intermediate-risk patients aged 68 or older. We present a 20-year relative survival study, comparing patients’ outcomes with that of normal controls derived from the National Statistics database. The study also correlated long-term survival with patient-related, procedure-related and post-operative complication-related factors.
Surgical AVR for severe aortic stenosis in intermediate-risk patients yields excellent long-term survival. The decision to offer TAVI to these patients should factor in the known long-term results of surgery.

Recent Publications:

1. Long-term outcomes after surgical aortic valve replacement. A Manché. Cardiothoracic Department, Mater Dei Hospital, Malta. J Clin Exp Cardiolog 2017, 8:9(Suppl): 31. doi: 10.4172/2155-9880-C1-077.
2. TAVI : Trans-Apical and trans-Aortic approaches.  A Manché. Invited speaker in symposium on The TAVI Experience in Malta. Drugsales Ltd, in conjunction with Edwards Life Sciences. October 2011.
3. Initial TAVI experience in Malta. A Manché, A Cassar, A Fenech. Oral presentation,  8th Maltese Medical School conference, Malta, November 2012.
4. Early surgical intervention in aortic valve disease. A Manché. Oral presentation,  5th Annual meeting of the Maltese Cardiac Society, Malta, October 2014.
5. Should patients with asymptomatic severe aortic stenosis be referred for surgery? A Manché. Oral presentation,  International Congress of Cardiology, Malta, March 2015.
6. Is valve size more important than patient-prosthesis mismatch in long-term survival after aortic valve replacement?  A Manché, L Camilleri. Malta Medical Journal 2015; 27:Suppl. 95 Abstract P3.06.
7. Long-term survival after aortic valve replacement: A twenty-year relative survival study. A Manché, L Camilleri, D Gauci. Malta Medical Journal 2015; 27:Suppl. 64 Abstract OP6.18.
8. Does aortic valve replacement restore normal life expectancy? a twenty-year relative survival study.  A Manché, L Camilleri, D Gauci. International Cardiovascular Forum Journal 2016;6:3-10.
9. At what age does aortic valve replacement restore life expectancy? A Manché, L Camilleri. SCTS Conference News. The official newspaper of the SCTS Annual Meeting and Cardiothoracic Forum 2016. page 30.
10. The myths and challenges of patient-prosthesis mismatch. A Manché. Oral presentation 7th Annual meeting of the Maltese Cardiac Society, Malta, October 2016.
11. The impact of age in prosthesis-patient mismatch on long-term survival after aortic valve replacement: in-vitro versus in-vivo values.  A Manché, A Casha, L Camilleri. Journal of Advances in Medical and Pharmaceutical Sciences 2016;9:1-8   JAMPS.28381 ISSN: 2394-1111.

Biography:

Fabiola Sozzi works as a staff cardiologist at the University Hospital Policlinico of Milan, Italy, with high-specialization nomination. She has high skills in multimodality imaging of heart disease using echocardiography integrated with cardiac magnetic resonance imaging, cardiac computed tomography and nuclear. She also works in the acute clinical setting treating acute cardiac syndromes. She gained a high expertise in echocardiography at the Thoraxcentre of Rotterdam (NL), where she defended the PhD thesis on stress cardiac imaging under the supervision of Professor J. Roelandt. She is Visiting Professor at the University of Milan where she leads several research projects and teaches at the Faculty of Medicine and School of Specialization of Cardiology. She is author of 70 papers published in indexed peer-reviewed international journals and reviewer of several medical international journals.

Abstract:

Chronic dyspnea is associated with a variety of diseases and is also a major symptom of heart failure (HF). The differential diagnosis of dyspnea is a daily routine in every cardiology practice. Approximately one-half of patients with HF have a preserved ejection fraction (HFpEF). Diagnosis of HFpEF is challenging and relies largely on demonstration of elevated cardiac filling pressures represented by the pulmonary capillary wedge pressure.
Healthy individuals with normal relaxation are able to increase the rate of myocardial relaxation when there is a need for increased diastolic filling. Faster relaxation allows the achievement of a lower minimal left ventricular (LV) diastolic pressure at a shorter time interval than in the resting state. Hence, increased LV filling can occur even with a shortened diastolic filling time. When myocardial relaxation is reduced in the resting state, it cannot be increased as much as necessary to meet the demands of exertion or stress. In this situation with abnormal myocardial relaxation, a reduced diastolic filling period and a lack of atrial contraction compromise LV filling substantially, causing the increase in left atrial and LV diastolic pressures (hence, decreased diastolic reserve).
Collectively, there is growing evidence that the diastolic stress test can provide important diagnostic findings that can be helpful in the management of patients presenting with dyspnea of an unclear etiology. Many patients present with exertional dyspnea and exercise intolerance, but have normal LV filling pressures at rest. In these patients, it is important to evaluate filling pressure with exercise. Exercise can be performed using a supine bicycle or treadmill protocol. Alterantively dobutamine can be used, though its vasodilator as well as inotrope effect determine a very different hemodynamic response compared to that of exercise. We need to record mitral inflow by pulsed Doppler echocardiography at the level of the mitral tips, mitral annular velocities by spectral Doppler echocardiography, and tricuspid regurgitation jet by continuous-wave Doppler at baseline and after the termination of exercise. Diastolic function parameters can be obtained after the assessment of regional wall motion abnormalities, especially when an exercise echocardiogram is performed for the evaluation of dyspnea. In patients with diastolic heart failure, left atrial pressure is increased, leading to an increase in mitral E velocity, whereas annular e’ velocity remains reduced given the limited preload effect on e’. Moreover, an increase in the pulmonary artery systolic pressure can be detected by the increase in peak velocity of the tricuspid regurgitation jet. On the other hand, in the absence of cardiac disease, e’ increases to a similar extent to the increase in mitral E velocity, and the normal E/e’ ratio essentially is unchanged with exercise. The concept of the diastolic stress test were introduced more than 10 years ago by Ha et al. Subsequently, exercise E/e’ ratio was validated against invasive measurements. Importantly, exercise septal E/e’ ratio was an important determinant of exercise capacity, and its decline with age was noted in a large series of patients referred for exercise echocardiography. Furthermore, a recent study showed the incremental prognostic value of exercise E/e’ ratio over clinical variables and exercise wall motion score index.
In conclusion, diastolic stress test has an interesting role in patients with heart failure and preserved ejection fraction that present symptoms during activity, normal ejection fraction and inconclusive diastolic function at rest.

Recent Publications:

1. Nagueh SF, Appleton CP, Gillebert TC, Marino PN, Oh JK, Smiseth OA, Waggoner AD, Flachskampf FA, Pellikka PA, Evangelisa A. Recommendations for the evaluation of left ventricular diastolic function by echocardiography. Eur J Echocardiogr. 2009; 10:165-193.
2. Oh JK, Park SJ, Nagueh SF. Established and Novel Clinical Applications of Diastolic Function Assessment by Echocardiography. Circ Cardiovasc Imaging 2011;4:444-445.
3. Ratanasit N, Karaketklang K, Chirakarnjanakorn S, Krittayaphong R, Jakrapanichakul D. Left atrial volume as an independent predictor of exercise capacity in patients with isolated diastolic dysfunction presented with exertional dyspnea. Cardiovascular Ultrasound 2014,12:19-26.
4. Ha J, Oh J, Redfield M, Ujino K, Seward J, Tajik A. Triphasic mitral inflow velocity with middiastolic filling: clinical implications and associated echocardiographic findings. J Am Soc Echocardiogr. 2004;17: 428–431.

Biography:

Helena Domínguez, MD, PhD, is Consultant Cardiologist at the Hospital of Bispebjerg-Frederiksberg since 2014, and Associate Professor in the Institute of Biomedicine of the Health Faculty, University of Copenhagen. Her research covers translational science in two main areas: i) vascular function, with special focus on insulin resistance, and ii) use of eHealth technologies to improve patient management, with special focus on frail elderly, heart failure and atrial fibrillation. Teaching responsibilities: Lung and Heart Physiology, and Electrocardiography and Echocardiography exercises for medicine students. Postgraduate courses target PhD students within the area of vascular insulin resistance and methods to study vascular function.

Abstract:

Stroke from thombi formed in the left atrium appendage (LAA) is the most feared complication of atrial fibrillation (AF), and is preventable with anti-coagulant medicines. AF with onset the days after heart surgery is considered a phenomenon rather than a definite diagnosis, and anti-coagulation in not systematically recommended in current guidelines. We hypothesize that; closure of the LAA during surgery may protect the brain regardless of known AF.
Between 2010 and 2015 we included 205 patients, of whom 185 were randomized 185 to closure of the LAA with double suture, or control, and followed the patients for up to six year (mean 3,7 years). Investigations included brain MRI before the operation, at discharge after the operation and, at least six months after surgery, and findings of new silent brain infarctions (SBI) in clinical settings. 141 patients followed the protocol, of whom 14 (18%) reached primary events (stroke, TIA or silent infarctions) occurred in the control group vs. 4 (6%) in the LAACS group (hazard ratio 0.3; 95% CI: 0.1 – 1.0, p=0.05). In the total cohort, 163 (86.2%) had no history of AF, of whom 80 (49.1%) developed new-onset AF. Later AF occurred in 35 of those (43.8% recurrence) and, in six additional patients. The moderate number of patients in the LAACS trial does not allow to draw definite conclusions. Hence, we seek to further investigate our hypothesis in a larger trial (N 2000) with homogenous closure of the LAA with clips, and end-point of stroke/TIA.

Biography:

Camelia Nicolae, PhD is currently the Assistant Professor at Internal Medicine and Cardiology Department, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania. She has been working in the Coronary and Intensive Care Unit since graduation. In clinical activity, she was interested in diagnosis and treatment of acute coronary syndrome, acute cardiac failure and pulmonary thromboembolism. She had a special preoccupation about ventricular remodelling post-acute myocardial infarction, which was reflected in her doctoral thesis. After the publication of the latest cardiology guidelines about stable coronary ischemic disease, she developed a constant interest in the high incidence and prevalence of this pathology “in real life”. Dr. Nicolae is constantly searching diagnostic solutions for early identification of coronary ischemic disease in different subgroups of general population with high cardiovascular risk, that don’t have a detailed approach accordingly to current protocols. In her career, she sustained and published over 70 scientific papers and original studies and in the last three years public conferences were mainly focused on stable coronary ischemic disease.

Abstract:

Statement of the problem: The aim of the conference is to emphasize the difference between incidence, prevalence and mortality of stable coronary ischemic disease in “real life” and the data from the guidelines. In the light of current protocols, we diagnose and stratify the risk of stable coronary ischemic disease depending on gender, age and the presence of chest pain. This approach ignores a significant number of asymptomatic subjects who present one or more cardiovascular risk factors. Among this, diabetes mellitus and chronic kidney disease represents clinical equivalents of coronary ischemic disease as the guidelines specifies.
Theoretical orientation: According to a lot of clinical studies performed in UK and USA, the majority percent of sudden death is caused by ischemic heart disease. So, what are the reasons to exclude from diagnose and risk stratification the most vulnerable candidates?  Messrs Bayes de Luna and Roberto Elosua proved in a remarkable study published in 2012, that the greatest numbers of sudden deaths, 300.000/ year are encountered in general population. The second most frequent sudden deaths, 250.000/year, are registered in the subgroup with risk factors in general population. In another study performed in USA and published in 2008, 80% of sudden deaths were caused by coronary ischemic disease. According to the most recent statistic data, the mortality decreases in ischemic heart disease, but its incidence is increasing.
Conclusion: Current guidelines mention that the avoidance of excessive costs for elaborated investigation represented a constant concern, but in “real life” coronary ischemic disease remains under- diagnosed and under- treated. Recommendations: every clinical physician must decide upon the most proper methods to diagnose coronary ischemic disease depending on the clinical data of the patient.

Recent Publications:

1. Kee-Joon Choi,MD, Jae-Kwan Song, MD, You-Ho Kim, MD, Seong-Wook Park, MD, Seung-Jung Park, MD, Jung-Min Ahn, MD, Ki Hong Lee,MD, Sang-Yong Yoo, MD, Young-Rak Cho, MD, Jon Suh, MD, Eun-Seok Shin,MD, Jae-Hwan Lee, MD, Dong Il Shin, MD, Sung-Hwan Kim, MD, Sang Hong Baek,MD, Ki Bae Seung, MD, Chang WookNam,MD, Eun-SunJin,MD, Se-WhanLee,MD, Jun HyokOh,MD, JaeHyunJang, HyungWookPark,MD, Nam Sik Yoon,MD, Jeong Gwan Cho,MD, Cheol Hyun Lee, MD, Duk-Woo Park, MD, Soo-Jin Kang, MD, Seung-Whan Lee, MD, Jun Kim, MD, Young-Hak Kim, MD, Ki-Byung Nam, MD, CheolWhan Lee, MD, ( 2016), Prognosis of Variant Angina Manifesting as Aborted Sudden Cardiac Death, J Am Coll Cardiol;68:137–45.
2. Wilkins E, Wilson L, Wickramasinghe K, Bhatnagar P, Leal J, Luengo-Fernandez R, Burns R, Rayner M, Townsend N (2017), European Cardiovascular Disease Statistics, European Heart Network.
3. Antonio Bayes de Luna, Roberto Elosua, (2012), Sudden Death, Rev Esp Cardiol; 65:1039-1052.
4. Jaskanwal D. Sara, MBChB; Mackram F. Eleid, MD; Rajiv Gulati, MD, PhD;and David R. Holmes Jr, MD, (2014), Sudden Cardiac Death From the Perspective ofCoronary Artery Disease,Mayo Clin Proc, 89(12):1685-1698.
5. Sumeet S. Chugh, Kyndaron Reinier, Jonathan Jui, (2008), Epidemiology of sudden cardiac death: clinical and research implication, Prog Cardiovasc Dis, 51(3): 213-228.

Biography:

Sergio Mejía Viana has completed his Cardiology training and Doctorate at the University Clinic of Navarre. He was an interventional Cardiologist, Angiologist and Phlebologist for 20 years. He is a Fellow of the European Society of Cardiology, has written more than 100 scientific publications including abstracts, articles and book chapters. He returned to clinical practice with high interest in prevention. Currently, he is a Consultant at the Medical Investigation Unit in St. Bernard´s Hospital in Gibraltar.

Abstract:

Stress is defined as a process in which environmental demands strain an organism’s adaptive capacity resulting in both psychological demands as well as biological changes that could place at risk for illness. Emotional stress is a major contributing factor to the six leading causes of death in the United States: cancer, coronary heart disease, accidental injuries, respiratory disorders, cirrhosis of the liver and suicide. According to statistics from Meridian Stress Management Consultancy in the U.K, almost 180,000 people in the U.K die each year from some form of stress-related illness. But our bodies are not only under emotional stress. Due to poor nutritional habits and environmental pollution we are constantly under the effect of a wide variety of chemical stressors which is defined as hazardous substances which, when released into an environment, damage the living organisms or ecosystems or reduces their ability to cope with environmental and biological changes (too many cups of coffee, too much alcohol, too much junk food, too many medications, inhaling substances at the factory or office, pollution on the road, smokers in your environment, etc.). We have also physical stress that is caused by, for example: pushing your body to the limits, working out at the gym, driving long distances continually, sitting in front of a computer for extended periods without breaks, gardening for long periods, any kind of labor intensive job, etc. There are additional definitions for mental, emotional and even spiritual stress. This workshop has the aim of providing the attendees with easy to learn tools to understand stress physiology, diagnosis and treatment using biologically effective methods like heart rate variability  biofeedback that increase coherence between the parasympathetic and sympathetic nervous systems. Inputs on chemicals stressors like nutritional recommendations and knowledge on heavy metals will be discussed.

Recent Pubications:

1. J. Pumpria, K. Howorka, D. Groves , M. Chester, J. Nolan, Functional Assessment of Heart Rate Variability: Physiological Basis and Practical Applications, International Journal of Cardiology 84 (2002).
2. M. Biagini, C. Cammarota, M. Prisco, F. Di Liberato, V. Fiori, P. Greziosi, P. Perelli, R. Romano, M. Lanza, Autonomic Nervous System Function Assessed By Analysis of Heart Rate Variability At Rest and During Exercise In Hypertensive and Normotensive Subjects, American Journal of Hypertension, Volume 17, Issue 5, Supplement 1, May 2004..
3. Heart Rate Variability Biofeedback, Self-Regulation, and Severe Brain Injury Sonya Kim, Ph.D., CRC, Joseph F. Rath, Ph.D., Rollin McCraty, Ph.D., Vance Zemon, Ph.D., Marie M. Cavallo, Ph.D., and Frederick W. Foley, Ph.D. Biofeedback Association for Applied Psychophysiology & Biofeedback Spring 2015, Volume 43, Issue 1, pp. 6–14..
4. Azar B. Probing links between stress and cancer. APA Monitor Online. 1999;30:1–4..
5. Greenberg JS. Comprehensive stress management. 7th ed. New York: McGraw-Hill; 2002.
6. Klaudia Jomovaa, Marian Valkob. Advances in metal-induced oxidative stress and human disease. Toxicology 283 (2011) 65–87.

Biography:

Telmo Pereira is a Senior Lecturer and Researcher at the Polytechnic Institute of Coimbra, Coimbra Health School, and is the Head of the Clinical Physiology Department. In the last five year, he has developed research in the areas of Cardiovascular Prevention and Neurosciences, and has also collaborated in the development of new non-invasive technology options for the assessment of vascular function.

Abstract:

In recent years, great emphasis has been placed on the role of arterial stiffness (AS) and central blood pressure (cBP) as measures of the cumulative effect of cardiovascular risk factors over the process of physiologic ageing. These parameters, currently labeled as arterial “tissue biomarkers”, were shown to be independent predictors for the development of cardiovascular (CV) diseases, and could thus increase the discriminative capacity when coupled to classic CV risk scores. Consequently, the assessment of AS and cBP are recommended as additional tests for the clinical evaluation of hypertensive patients (based on history, physical examination and findings from routine laboratory tests), for estimating the global cardiovascular risk in the overall population, and for describing the vascular ageing continuum.
Currently, the most widely employed methods for evaluating pulse waveforms are those based on applanation tonometry and transfer functions, although oscillometric blood pressure devices using specific algorithms for pulse wave analyses (PWA) have been proposed. At present, oscillometry is an affordable and reliable technique, and may allow a comfortable, accurate, repeated and prolonged estimation of arterial stiffness and central hemodynamics in daily life conditions, making it particular suitable for community-based follow-up intervention programmes, and for addressing the major questions underlined by the early vascular ageing (EVA) concept, namely: the validation of tissue biomarkers as surrogate end points for CV risk reduction; the determination of the predictive value of various of these arterial tissue biomarkers, and the discriminative improvement over conventional cardiovascular risk factors; the identification of effective and multidisciplinary actions to  counteract the pathophysiological processes reflected in the EVA syndrome, particularly  the aggressive decrease of atherosclerosis modifiers (ADAM). Hence, we designed a project to be implemented in a community setting based on the inter-play between Pharmacy Services, a Technology Company and a Research center, and the preliminary results will be presented.

Recent Publications:

1. Picone DS, Schultz MG, Otahal P, Aakhus S, Al-Jumaily AM, Black JA, Bos WJ,Chambers JB, Chen CH, Cheng HM, Cremer A, Davies JE, Dwyer N, Gould BA, Hughes AD, Lacy PS, Laugesen E, Liang F, Melamed R, Muecke S, Ohte N, Okada S, Omboni S, Ott C, Peng X, Pereira T, Pucci G, Rajani R, Roberts-Thomson P, Rossen NB, Sueta  D, Sinha MD, Schmieder RE, Smulyan H, Srikanth VK, Stewart R, Stouffer GA, Takazawa K, Wang J, Westerhof BE, Weber F, Weber T, Williams B, Yamada H, Yamamoto E, Sharman JE. Accuracy of Cuff-Measured Blood Pressure: Systematic Reviews and Meta-Analyses. J Am Coll Cardiol. 2017 Aug 1;70(5):572 586.
2. Teixeira R, Monteiro R, Baptista R, Pereira T, Ribeiro MA, Gonçalves A, Cardim N, Gonçalves L. Aortic arch mechanics measured with two dimensional speckle tracking echocardiography. J Hypertens. 2017 Jul;35(7):1402-1410.
3. Omboni S, Posokhov IN, Parati G, Avolio A, Rogoza AN, Kotovskaya YV, Mulè G, Muiesan ML, Orlova IA, Grigoricheva EA, Cardona Muñoz E, Zelveian PH, Pereira T,  Peixoto Maldonado JM. Vascular Health Assessment of The Hypertensive Patients (VASOTENS) Registry: Study Protocol of an International, Web-Based Telemonitoring Registry for Ambulatory Blood Pressure and Arterial Stiffness. JMIR Res Protoc. 2016 Jun 29;5(2):e137. doi: 10.2196/resprot.5619.
4. Pereira T, Pereira TS, Santos H, Correia C, Cardoso J. Arterial pulse pressure waveform monitoring by novel optical probe. Int J Cardiol. 2015 Jan 20;179:95-6.
5. Pereira T, Santos I, Oliveira T, Vaz P, Pereira T, Santos H, Pereira H, Correia C, Cardoso J. Pulse pressure waveform estimation using distension profiling with contactless optical probe. Med Eng Phys. 2014 Nov;36(11):1515-20.
6. Pereira T, Maldonado J, Coutinho R, Cardoso E, Laranjeiro M, Andrade I, Conde J. Invasive validation of the Complior Analyse in the assessment of central artery pressure curves: a methodological study. Blood Press Monit. 2014 Oct;19(5):280-7.
7. Ben-Shlomo Y, Spears M, Boustred C, May M, Anderson SG, Benjamin EJ, Boutouyrie P, Cameron J, Chen CH, Cruickshank JK, Hwang SJ, Lakatta EG, Laurent S, Maldonado J, Mitchell GF, Najjar SS, Newman AB, Ohishi M, Pannier B, Pereira T, Vasan RS, Shokawa T, Sutton-Tyrell K, Verbeke F, Wang KL, Webb DJ, Willum Hansen T, Zoungas S, McEniery CM, Cockcroft JR, Wilkinson IB. Aortic pulse wave velocity improves cardiovascular event prediction: an individual participant meta-analysis of prospective observational data from 17,635 subjects. J Am Coll Cardiol. 2014 Feb 25;63(7):636-46. doi: 10.1016/j.jacc.2013.09.063.

Biography:

Bader Almustafa, MBBS, DPHC(RCGP), ABFM, SBFM, ECHS. After his graduate from medical school in 1989, he has done his postgraduate training in clinical pathology, family medicine, chronic care and hypertension in multiple institutions in KSA, UK, USA and Italy. Currently, he is a senior consultant Family physician and Clinical Hypertension Specialist in Qatif Primary Health Care, KSA. He has taking multiple leading responsibilities in multiple institutions. Currently, he is the General Secretary of the Saudi Hypertension Management Society, and the Middle East Representative of the World Hypertension League. Dr. Bader has developed and adapted multiple clinical and professional guidelines, and being engaged in multiple national and international scientific committees. Dr. Almustafa has carried out hundreds of training, quality improvement and research works in the management of hypertension and cardio-metabolic risk. He is having multiple published articles and books in the field of primary care and preventive cardiology, in particular. He has led and contributed in multiple international, regional and local work related to this field. He has been honored many times, for his work, regionally and internationally.

Abstract:

Since the mid-nineties, many professional bodies have issued their guidelines for the management of high blood pressure. In the current era, however, the modern telecommunication has made the dissemination of these guidelines easy and fast. It resulted, however, in creating confusion, where recommendations are conflicting or variable. This review presents the history of hypertension guidelines, worldwide, their agreements and variations, the queries addressed and those which are not.
The hypertension guidelines started as a disease-oriented targeting to control blood pressure, widened to have a more logic by approaching absolute cardiovascular risk, rather. Recently, multiple bodies have issued cardiovascular prevention guidelines combating multiple cardiovascular risk factors. This made the job of any practitioner difficult to follow which mandated a way to simplify the path from detection to control, in real practice. The cardiometabolic risk guideline is a novel approach to fill in this need.
In conclusion, though the disparities are many, all join the same concept. Disparities, however, may leave a lot of confusion among practitioners that need to be considered by guidelines developers. Translational guidelines, however, may abridge it.

Biography:

Ram Sharony (born 1959), is the director of Minimally Invasive Cardiac Surgery at Rabin Medical Center, Israel. He is a graduate of Ben Gurion University. Ram finished the residency program in Cardiothoracic surgery (year 2000). As an attending surgeon he was recruited by Tel Aviv medical center and shortly thereafter he was sent to a fellowship at New York University (NYU), USA. In his first year he performed a basic research and focused on expression of Serin protease inhibitors and MAP kinases pathway in vein grafts remodeling and published his basic science research in leading scientific journals. In the second year of fellowship he focused on clinical activity of minimally invasive valve surgery. He published his clinical research on the topic of mitral valve repair, outcomes of AVR among patients with reduced LV function, and his manuscripts on the survival benefit of Off Pump CABG in patients with atheromatous aorta contribute to the popularity of this operation in this subset population. In addition, his papers regarding the advantages of minimally invasive AVR over median sternotomy has been cited by many authors and contributed to the development of less invasive approach. Since 2008, Dr. Sharony serves as the director of minimally invasive unit at Rabin Medical Center, Israel, where he performs various types of mitral valve operations (replacement or repair) and aortic valve surgeries via less invasive approach for patients from different places in Israel and international medical tourism. As part of his clinical activity he leads the collaboration with the invasive cardiologists (TAVI team) and performs surgical procedures with catheter valve technologies. In addition to transapical approach for TAVI, various type of mitral valve in valve operation has been performed at Rabin medical center including direct Sapien valve deployment in severe mitral annular calcification (MAC).   He is the director of medical student’s program and the residency program. In addition to his contribution as chapter author in textbooks (including the chapter of acquired heart diseases in Schwartz's Principles of Surgery), Dr. Sharony has published on the topic of the myocardial protection (ischemic and pharmacologic preconditioning) and was involved in the research and development of heart assist device for the failing heart.  His recent scientific activity is on the topics of valvular heart disease, mainly tricuspid valve and transcatheter valve procedures. Ram is a proctor of Perceval sutureless valve (Livanova, Italy) and have gained a large experience with rapid deployed valve in many international medical centers. He has been invited as a speaker and panel discussant in various scientific meetings.

Abstract:

Objective: The transcatheter approach for a failed bio-prosthetic valve is an emerging alternative to redo-valve surgery in patients at high surgical risk. We aim to analyze the mid-term outcomes of patients undergoing valve-in-valve implantation in the mitral position.
Methods: A dual center clinical experience in treating consecutive patients with symptomatic structural bio-prosthetic mitral valve deterioration using the valve-in-valve technique via the trans-apical approach. Outcomes were rigorously assessed and reported based on VARC 2 criteria definitions.
Results: The valve-in-valve procedure in the mitral position was performed in 30 patients, mean age 76±12 years, mean STS score 10.7±6.0. Balloon-expandable Sapien devices were used in all patients. The composite endpoint of device success was achieved in 29/29 (100%) of patients.  The operative mortality was 3.5% (sepsis). Follow up (up to 6 years, mean 29 months) demonstrated survival rates of 90% and 83.3% during first and second year, respectively and remain constant afterward. Only one patient had cardiovascular related mortality (endocarditis) during this period. Most of surviving patients (96%) are in NYHA-FC I/II. No valve migration was observed. The mitral regurgitation degree among patients with predominant mitral regurgitation dropped immediately after the operation and remains constant during follow-up period (from 3.9±0.3 to 0.2±0.6 and 0.3±0.5, respectively. Post procedural mean mitral transvalvular gradient was 6.4±3.0 mmHg and remain constant during follow-up (6.3±1.6 mmHg, ns). Only one patient had mild para-valvular  (PVL) leak. All other patients had  no PVL.  The pre-operative pulmonary artery pressure decreased from 67.2±18.4 to 43.8±11.2 at follow-up (p>0.01).
Conclusions: Intermediate-term clinical outcomes of transcatheter valve-in-valve implantation for the treatment of mitral prosthetic valve deterioration in high risk patient are encouraging.  Despite significant clinical improvement, a residual elevated gradient across the valve, unrelated to the original deteriorated valve size were observed. This novel approach allows good survival rate and satisfactory quality of life during mid-term follow-up period.

Biography:

Gulzhan Myrzakhmetova is a cardiologist, candidate of Medical Science. She graduated from Almaty State Medical Institute in General Medicine. She has extensive work experience at regional cardiology hospitals. She has published more than 20 research articles. Her research interest includes heart transplantation, MSC and HF.

Abstract:

Introduction: The gold standard of diagnosis of rejection after HTX is endomyocardial biopsy. However, non-invasive methods for the early diagnosis of rejection reactions are currently being studied. With the improvement of the possibilities of ultrasound diagnosis of heart function, it becomes possible to study longitudinal deformation of the myocardium, as an early marker of violations of the contractile function of the heart.
Objective: To determine the possibilities of ultrasound TDI and strain heart rate as early markers of graft rejection.
Method: Patients n=32 after HTX were divided into two groups according to the results of EMB. The first group (1R, 2R) n=23 patients (20 men, the average age was 41±1.2 y); the second group (3R) n=9 patients (seven men, the average age 44±2.6 y). The duration of EMB after transplantation was 4-60 months. Survey methods: TDI and strain (Epic Q7 Philips). EMB signs of rejection of the humoral type (immunofluorescence study) and cellular (perivascular and interstitial infiltrate with or without necrosis and fibrosis).
Results: In case of TDI, there was no reliable difference between the two groups: mean Smed: 7.81±1.7 cm/s vs. 7.97±2.1 cm/s and mean Slat: 8.78±2.18 cm/s against 8.4±1.45 cm/s (as p=NS). However, the mean longitudinal strain of the left ventricle (strain) in the first group (-16.5±0.9) was significantly higher in comparison with the second group (-12.2±1.2), (p<0.05). Sensitivity and specificity for longitudinal deformation were 68% and 46%, respectively. In all patients (n=5, 1gp-1, 2g-4) with vasculopathy detected with CAG, the mean longitudinal deformation of the LV is decreased (strain-13.3).
Conclusion: Strain can be considered as a non-invasive marker of chronic transplant rejection and vasculopathy after cardiac transplantation.

Biography:

Jacob Jamesraj is a senior cardiac surgeon with a special interest in teaching and teaching aids. He has designed training kits for training surgeons in coronary surgery including beating heart surgery, valve replacements and repairs and minimally invasive surgery. He conducts wet lab workshops and conferences. He is well published. He is an avid poet and painter.

Abstract:

Simulators have gained an important role in cardiac surgical training. Beating heart surgery is demanding in terms of technical skills. The role of simulators hence cannot be overemphasised.  Simulating Cardiac motion credibly as to provide an apt practice atmosphere has been a challenge. Over the years we have designed many simulators and here we trace the steps that led to the most credible simulation of cardiac motion.
The initial simulators were motionless emphasizing only the varied positions. Tilting platforms came up next but were a poor design and the movements had no similarity to that of the heart. The next phase saw the inflatable balloon which was placed in the left ventricle and inflated and deflated using motorized bellows. This was the reverse of the actual cardiac motion and hence the design was changed. We used a motorized arm to move that of the stabilizer using a double ring linkage. This provided a more credible systole and diastole. Varying the positions and using a rheostat we could vary the heart rate and range of motion. This model offers more meaningful practice to the aspiring beating heart surgeon.

Biography:

Savvy Nandal is a Cardiology Registrar at the Northern Hospital in Melbourne, Australia. Her interests include management especially novel therapies of heart failure. Her working experience includes clinical, teaching as well as leadership roles at the teaching hospital.

Abstract:

Heart failure is a major cause of morbilidty and mortality worldwide. PARADIGM-HF study demonstrated Valsartan/ sacubitril (Entresto) decrease HF hospitalisation, cardiovascular mortality and all-cause mortality in patients with HF with reduced ejection fraction (HFrEF). Since addition of Entresto to Australian Pharmaceutical Benefit Scheme in June 2017, there has been considerable uptake of this drug. The aim of this study was to assess efficacy, tolerability and complications of Entresto with real-word evidence. We identified patients who were commenced on Entresto from 1/6/2017 to 30/11/2017 at a tertiary centre in Victoria, Australia via pharmacy dispensing database. 33 patients were commenced on Entresto with median age of 65; median EF was 31% with 57% secondary to ischaemic cardiomyopathy. 27 out of 33 patients were followed up via phone/ clinic/ patient records with three deaths in the time period. There was strong correlation in improvement in quality of life scores (EQ5D), pre vs post: 50 vs 65, (p value <0.05), New York Heart Association (NYHA) class (p value <0.05) and average BP reduction from 119 (101,137) to 110 (95,125) since commencement of Entresto. Commencement dose of Entresto was 24/26 mg in 60% patients and was up titrated in 37%. Only 14% were able to able to achieve recommenced maximal dose (97/103 mg). The commonest side effect was symptomatic hypotension, which led to dose reductions or complete cessation. Our study provides evidence that Entresto results in symptom improvement in addition to BP reduction in patients with HRrEF as well as common side effects of this drug. Further research is required to demonstrate whether these outcomes are sustained in the longer-term as well raise awareness of this novel therapy in the primary care setting.

Recent Publications
1. McMurray J J V, et al (2014) "Angiotensin-neprilysin inhibition versus enalapril in heart failure". The New Englan Journal of Medicine 371(11):993-1004.

Biography:

Konstantin V Pavlov has experience of being Laboratory Assistant, Engineer, Research Engineer, Junior Research Fellow, Regulatory Reviewer, Data Collector, Simultaneous Translator, Research Fellow and Senior Research Fellow at Frumkin Institute of Electrochemistry, Moscow Institute of Physics and Technology, Moscow Institute of Open Education, FMBI Institute of Physical-Chemical Medicine (in-house); Rosatom, Rosenergoatom, US NIHCD, US DOE, UK DTI, WANO, Ministries of Interior, Trade and Industry, Atomic Energy etc. His areas of research with hands-on experience and proven academic record include “Mathematical methods in physics, wet chemistry, electrophysiology, probabilistic risk assessment, metrology, fluorescent microscopy, and two-phase fluid dynamics in systems with non-stationary boundary conditions (flexible pipelines vulnerable to pipe whip, peristaltic systems etc.)”. The general approach assumed for this presentation is simplifying the complex interrelated systems by segmentation or statistical binning, and then discarding the outliers using alternative criteria.

Abstract:

Statement of the Problem: Cardiovascular system connects every organ of living organism through complex network of arteries, veins and capillaries. Tissues with no capillarization (cartilage, bone, and dentine) can exchange with blood through diffusion, and the substances capable of penetrating blood-brain barrier can travel with body fluids to any tissue (on different time scales). This makes pharmaceutic and surgical treatment of cardiovascular diseases closely interdependent with the state and activity of virtually every organ or tissue of organism. Same issues, for similar reasons, complicate diagnostics in cardiology.
Methodology & Theoretical Orientation: Statistical methods and digital simulations applied to non-linear dynamic systems have strong limitations. A hard and costly solution is binning data pools together for similar classes of objects, subsequently using Ishikawa diagrams to discriminate between the essential and non-consequential factors. Use of first physical principles (mechanics, hydrodynamics, thermodynamics, electrodynamics) in analyzing causes of the disease (blood biochemistry, blood flow obstruction, malnutrition, low oxygen or high CO in ambient air, oxidative stress etc.), as well as instruments and methods suitable for diagnostics (number of electrocardiogram leads; electrode and patient preparation, ambient conditions) appears to be another viable solution.
Findings: Theoretical analysis suggests that correlations between blood flow dynamics, elasticity of blood vessels/cell membranes, temperature, and functions of cell signaling receptors (insulin, barocepters, thermosensors etc) can be used to optimize treatment and diagnostics of patients. Experimental evidence supports this hypothesis.
Conclusion & Significance: Prophylactics, diagnostics, invasive surgery, anti-inflammatory treatment, pain medication, nutritional and psychologic support have to be coordinated to achieve the desirable result. Simultaneous use of several alternative methods aimed to protect patient and regulate his functions can be worse than complete absence of medical assistance. Multiple feedbacks, e.g. on physical (hydrodynamics, see above) and subconscious (proper nutrition prevents anxiety, thus ruling out false cardiologic symptoms) levels must be (and are) used by clinicists, as illustrated by examples in the presentation.

Recent Publications
1. S A Akimov, V V Aleksandrova, T R Galimzyanov, Pavel Bashkirov and Oleg V Batishchev (2017). Interaction of amphipathic peptides mediated by elastic membrane deformations. Biochemistry (Moscow) Supplement Series A,
Membrane and Cell Biology 11(3):206-216.
2. Rudenko M, Voronova O, Zernov V Kolmakov S, Makedonsky D, Mamberger K, Rudenko S, Volkov A. Volossatykh O, Khlestunov S and Prikhozhan Y (2009). Theoretical Principles of Heart Cycle Phase Analysis. Fouqué Literaturverlag. Frankfurt a/M. München - London - New York. – 336 Ñ€. ISBN 978-3-937909-57-8
3. T Lang (2006). How to report Statistics in Medicine M.Secic. American College of physicians. Philadelphia. - - 480 p.
4. Eduard V Bocharov, George V Sharonov, Olga V Bocharova and Konstantin Pavlov (2017). Conformational transitions and interactions underlying the function of membrane embedded receptor protein kinases. Biochimica et Biophysica Acta 1859(9 Pt A)
5. Galya Staneva, Denis S Osipenko, Timur R Galimzyanov, Konstantin V Pavlov and Sergey A Akimov (2016). Metabolic Precursor of Cholesterol Causes Formation of Chained Aggregates of Liquid-Ordered Domains. Langmuir, 2016, 32 (6), pp 1591–1600 DOI: 10.1021/acs.langmuir.5b03990

Biography:

Jacob Jamesraj is a senior cardiac surgeon with a special interest in teaching and teaching aids. He has designed training kits for training surgeons in coronary surgery including beating heart surgery, valve replacements and repairs and minimally invasive surgery. He conducts wet lab workshops and conferences. He is well published. He is an avid poet and painter.

Abstract:

Evaluating one’s own distal anastamosis is indispensable not only for the trainee but also the mature coronary surgeon. It provides insight into its betterment at all stages of one’s surgical career. We devised a scoring system that would enable introspection after a practice anastamosis in a wet lab on a bovine heart with an omental vessel for a conduit. The scoring system has three parts with three components in each; performance, organisation, kinetics, coordination finished anastomosis assessed from the outside; shape, lips, leaks, internal view, regularity of structures, tissue protrusion and lumen distortion. This is a reverse scoring system with 100 allotted points from which points are subtracted for imperfections. A systematic analysis of the anastamosis provides insight for improvement.

Biography:

Valéria Paula Sassoli Fazan completed her Graduation from School of Medicine of Ribeirão Preto, University of São Paulo, in 1991 and attended the Neurosurgery Residency Program at the same university. She obtained her MS in Morphology in 1995 and PhD in Neurology in 1999, at the School of Medicine of Ribeirão Preto. Currently, she is an Associate Professor in Department of Surgery and Anatomy and Manager of Microscopy and Morphometry Laboratory at Experimental Surgery Center in the School of Medicine of Ribeirão Preto, University of São Paulo. She is proficient with a wide-range of light and electron microscopy techniques including specimen preparation and handling, vacuum evaporation and autoradiography. She is an expert in Neurosciences, particularly in the fields of “Peripheral nerves and experimental models of neuropathies, digital image processing and analysis, stereology and morphometry.

Abstract:

Statement of the Problem: Hypertension has a negative impact on both central and peripheral nervous system (PNS) morphology and function. For the central nervous system, brain atrophy, loss of nerve cells in cerebrocortical areas, and glial reaction were well documented. The PNS involvement in hypertension is under investigation in our laboratory for several years and the presence of a so called “hypertensive neuropathy” is documented with endoneurial vascular lesions, axonal atrophy and loss of small myelinated fibers. Hypertension is about twice more prevalent in diabetics as in non-diabetics. Despite this common clinical association, the contribution of each isolated entity in the development of neuropathy is still not well understood. We aimed to investigate the presence of peripheral neuropathy in spontaneously hypertensive rats (SHR) and SHR with chronically induced diabetes, using a morphological and morphometric study of the sural nerves.
Methodology: Female SHR, eight weeks old, received a single intravenous injection of streptozotocin (STZ) to induce diabetes. Normotensive Wistar-Kyoto (WKY) and non-diabetic SHR received vehicle. Twelve weeks after the injection, sural nerves were dissected and prepared for light microscopy and myelinated fibers morphometric study.
Findings: Hypertensive rats showed characteristics of small fiber neuropathy and a severe reduction of the number and density or Schwann cells. The association between diabetes and hypertension caused an increase on the average size of the myelinated fibers, pointing to a small fiber loss, associated to axonal atrophy.
Conclusion & Significance: Association of hypertension and diabetes caused more pronounced changes than in the single disease models. The peripheral nerve disorder observed was a complex neuropathy, involving and including both, large and small fibers. Hypertension caused, indeed, an exacerbation of the alterations already observed in experimental models of diabetic neuropathy. Thus, hypertension associated with diabetes affect the structure of the PNS and that association of the two diseases results in an increased risk of nerve damage.

Recent Publications
1. da Silva G A, Mendes V A, Genari A B, Castania J A, Salgado H C and Fazan V P (2016) Recurrent laryngeal nerve alterations in developing spontaneously hypertensive rats. Laryngoscope 126(1):E40-7.
2. Sanada L S, Tavares M R, Sato K L, Ferreira R da S, Neubern M C, Castania J A, Salgado H C and Fazan V P S (2015) Association of chronic diabetes and hypertension in sural nerve morphometry: an experimental study. Diabetol Metab Syndr 7:9.
3. Oliveira F S, Nessler R A, Castania J A, Salgado H C and Fazan V P S (2013) Ultra structural and morphometric alterations in the aortic depressor nerve of rats due to long term experimental diabetes: effects of insulin treatment. Brain Res 1491:197-203.
4. Sanada L S, da Rocha Kalil A L, Tavares M R, Neubern M C, Salgado H C and Fazan V P S (2012) Sural nerve involvement in experimental hypertension: morphology and morphometry in male and female normotensive Wistar-Kyoto (WKY) and spontaneously hypertensive rats (SHR). BMC Neurosci 13:24.
5. Rodrigues A R, Ferreira R S, Salgado H C and Fazan V P S (2011) Morphometric analysis of the phrenic nerve in male and female Wistar-Kyoto (WKY) and spontaneously hypertensive rats (SHR). Braz J Med Biol Res 44(6):583-591.

Biography:

Syed Raza completed his Graduation from Aligarh University in India in 1993. After completing his Post-graduation in Medicine from the same university, he moved to UK for higher specialist studies. He successfully completed MRCP and CCT and later, he was awarded Fellow of the Royal College of Physicians of Edinburgh. He was awarded Professor John Goodwin prize for outstanding performance in Diploma Cardiology exam at Hammersmith Hospital, University of London in 2001. He is currently serving as Consultant in Cardiology and Head of the Department of Medicine at Awali Hospital, Bahrain. He is the Educational Coordinator and Chairman of Resuscitation Committee of the Hospital. He is the Regional Coordinator and Examiner for MRCP exam for the Royal College of Physicians of Edinburgh. He is an external examiner for Arabian Gulf Medical University. He is also the immediate Past Chairman of Medical Advisory Committee.

Abstract:

Introduction: It is neccessary to risk stratify patients of cardiovascular diseases so as to guide and standerdise management. Method: We made use of QRisk 2 (UK) to assess 10 year cardiovascular risk of patients who presented to the cardiology clinic. Each patient’s relevant data were entered in the QRisk2 assessment tool and a 10 year risk was worked out. Based on the obtained figure, further management strategy was planned for that patient.
Analysis & Results: All low risk patients unless contraindicated underwent some kind of stress testing for evidence of reversible ischemia. Decision based of CV risk score to perform CT coronary angiography when deemed apparopriate were utilised for moderate risk category. Majority of high risk patients were considered for catheter based coronary angiography. Similarly, based on CV risk scoring, Aspirin and Statin therapy were started in 34% and 28% patients respectively. Aspirin and Statin therapy if deemed inappropriate were stopped in 12% and 21% patients respectively.
Conclusion: Simple cardiovascular assessment tools are readily available online that can be downloaded for personal use. Using cardiovascular risk assessment tool simplifies clinical decision making. It helps to standerdise treatment and also guides us to avoid harmful, inappropriate and unneccessary treatment. This therefore is very suitable for day to day parctice and works best in the interest of patient safety. Appropriate use of investigations and other resources are used in managing patients further.

Biography:

Manuela Stoicescu is the Consultant in Internal Medicine, PhD, and Assistant Professor at University of Oradea, Faculty of Medicine and Pharmacy, Medical Disciplines Department, Romania.

Abstract:

Objective: The objective of this study is to find the real cause of a young patient with third degree AV block.
Materials & Methods: This study presents the situation of a young patient 27 years old, which presented syncope. The HR was 30bates/min, very severe bradycardia. The EKG showed severe bradycardia 30 bates/minute in context of third degree AV block. So, the patient presented Adams Stokes syncope. The patient was referred to the Cardiovascular Surgery Department and a permanent pace maker was implanted and the patient’s life was saved. The most important question is which was the cause of the third degree AV block with Adams Stokes syncope at young age? Because the patient’s present weakness, asthenia a biopsy of deltoid muscle was performed and shows increased variation in muscle fiber diameter in context of muscular dystrophy of Duchene.
Results & Discussion: This disease is a rare genetic neurological disease. The cause of the third degree AV block at this young patient was in context of this rare genetic neurologic disease - muscular dystrophy of Duchene, confirmed safe by histopathology examination after muscular biopsy.
Conclusion: In conclusion, at young patient with third degree AV block, we must take into account also this rare but possible cause - muscular dystrophy of Duchene.

Biography:

Bhavik Khatri is a 3rd year Cardiovascular Disease fellow at UCSF in Fresno, California. His interests are primarily in the use of non-invasive imaging in diagnoses and management of cardiac patients.

Abstract:

Background & Aim: Tachyarrhythmia induced cardiomyopathy (TIC) is typically diagnosed in a retrospective fashion from the resolution of left ventricular (LV) dysfunction upon recovery from the tachyarrhythmia. At present, our knowledge of echocardiographic diagnostic criteria for TIC is limited.
Methods: From retrospective chart review, we identified 206 consecutive patients presenting with first known episode o atrial fibrillation with rapid ventricular rate and echocardiographic evidence of moderate to severe left ventricular systolic dysfunction (LV EF<40%). A total of 21 were confirmed to have TIC based on the evidence of recovery of LV function with successful rate/rhythm management of the tachyarrhythmia. Workup including coronary angiogram was negative for any other underlying etiology. Clinical and electrocardiographic data were compared among TIC, ICM and NICM groups. We compared TIC group with 41 ischemic (ICM) and 37 non-ischemic cardiomyopathy (NICM) subjects; etiology of NICM was tachyarrhythmia such as drug induced.
Results: For the comparison of groups, analysis of variance (ANOVA) and Kruskal-Wallis test were used for continuous variables and Chi-square analysis for dichotomous variables. Obesity was more prevalent (61.9%) in TIC group. Characteristically, LV geometry (mass and size) was normal in TIC with no regional segmental wall motion or thickening abnormality. Specificity and sensitivity of normal LV morphology (size and mass) with no regional WMA in subjects with reduced EF (<40%) was 84% and 58% respectively for TIC. Compared to TIC and ICM, LV was dilated with eccentric hypertrophy in NICM. Regional segmental abnormality was diagnostic echocardiographic marker of ICM.
Conclusion: In newly diagnosed TIC, LV morphologic features including LV mass, size, myocardial segmental thickness and
wall motion were noted to be normal compared to ischemic and non-ischemic dilated cardiomyopathy.

Biography:

Weiju Zhou is a PhD student in Epidemiology and Global Health Research under the supervision of Prof Ruoling Chen (DoS) at University of Wolverhampton, UK. His research interests are socioeconomic status (SES) and cardiovascular diseases. He examines the data of the Anhui cohort study and the four-province health survey on older population in China, to address important research questions in health inequality. He has co-authored two papers published in peer-reviewed journals.

Abstract:

Background: Older people suffer from more heart diseases (HD) and depression, both of which increase all-cause mortality. It is little known on the impact of HD with depression on survival in older people living in rural areas, where the risks of HD and depression are different from their urban counterparts.
Methods: We examined the Anhui cohort study in China, which consisted of 1600 participants aged >=60 years who live in rural areas life-long. We conducted baseline health survey in 2003 using a standard method of interview, documenting any type of HD and diagnosing any depression (cases and subcases) from the GMS-AGECAT for each participant. In 2004, 2007 and 2011 we successfully re-interviewed surviving cohort members and monitored vital status of the cohort until 2012.
Results: Of 1600 participants, 1429 (89.3%) were followed up, of which 385 deaths were documented. There were significant differences in death rate among participants of having HD and depression (42.3%, 11/26), having HD without depression (35.4%, 23/65), having depression without HD (35.1%, 149/424) and having neither HD nor depression (22.1%, 202/914). After adjustment for age, sex, body mass index, educational level, smoking, alcohol drinking, living with somebody, hypertension, diabetes and stroke at baseline, hazard ratio of all-cause mortality was 2.01 (1.07-3.77) in those having HD and depression, 1.53 (0.99-2.37) in HD only and 1.67 (1.34-2.08) in depression only, compared to those without HD and depression.
Conclusions: Older people living in rural areas with HD and depression had an additional increase in all-cause mortality. Psychological interventions should be taken for those with HD living in rural areas to improve surviving outcome.

Biography:

Yasir Ghareeb Alrashdan is a 5th year Medical student at Hail University, Saudi Arabia. He is the Co-author in this research with his supervisor Dr. M Parvaiz Farshori who has done a lot of important research in medical field.

Abstract:

Introduction: According to the WHO world health ranking survey Saudi Arabia ranked 27th in coronary heart disease (CHD) related deaths. CHD was also the leading cause of deaths in Saudi Arabia (WHO, 2014 survey). One of the major reasons for CHD is tobacco use (WHO bulletin 2016) and the rapidly rising cases of obesity in Saudi Arabia due to consumption of unhealthy diet, lack of exercise or any other physical activity. In the recent past inheritance of ABO blood groups has been linked to various diseases such as diabetes many types of cancers and cardiovascular diseases, although several studies have been published showing the association between the inheritance of blood groups (ABO and Rh antigens) and cardiovascular diseases.
Aim: Since the results of previous studies have been inconsistent regarding the association between the CAD and the inheritance of AB and the Rh (D) blood group antigens, and since according to WHO, CAD is the leading cause of death in Saudi Arabia (WHO 2014 survey), we decided to perform a smaller study on 111 male CHD patients who were admitted in the recent past to the king Khaled hospital (KKH) in the Hail region of Saudi Arabia with an acute myocardial infarction (MI).
Materials & Methods: In the current study we randomly chose 329 male control subjects and 111 myocardial infarction male patients who were enrolled at (KKH) Cardiology Department in Hail region of Saudi Arabia. Other risk factors like diabetes, smoking, age, gender, obesity, family history of CAD. The data was analyzed by Z-test.
Results: Out of 329 randomly selected male control subjects 82% were found to be Rh+ and 18% were Rh- , 3.35 were A-, 20.7% were A+, 3.95 were B- and 14.28% were B+, 2.43% were AB- and 8.2% were AB+, 8.5% were O- and 38.3% were O+. among the MI patients Rh- 4.5% and Rh+ 95.5%, A- were 0.9% and A+ were 30.6%, B- were 1.8% and B+ were 18.01% , AB- were 0.9% and AB+ were 6.3%, O- were 0.9% and O+ were 40.5%.
Conclusions: A+ male patients show statistically high incidences of MI and O- show significantly low incidence of MI.

Recent Publications
1. Al-Dossary S S, Sarkis P E, Hassan A, Ezz E l Regal M and Fouda A E (2010) Obesity in Saudi children: a dangerous reality. East Mediterr Health J 16: 1003-1008.
2. Farshori M P Q, Al-Wakid I H, AL Ibrahim I K, ALShammari A F, Alduejieman M, et al. (2016) Distribution of ABO and Rhesus (Rh) blood group antigens in male type 2 diabetes mellitus patients in Hail region of Saudi Arabia: High incidences of diabetes mellitus in males with B+ blood type. Integr Obesity Diabetes 2: 1-6.
3. Fagherazzi G, Gusto G, Clavel-Chapelon F, Balkau B and Bonnet F (2015) ABO and Rhesus blood groups and risk of type 2 diabetes: evidence from the large E3N cohort study. Diabetologia 58: 519-522.

Biography:

Sami Salahia is a co-founder at MRSA Group and Genome Medical Research Association in the UAE. He is a 5th year medical student at Ain Shams University in Egypt with an interest in medical research and has a number of publications in peer reviewed journals. Being a Team Leader, he gives training to undergraduate
medical students in Egypt and UAE especially for secondary research.

Abstract:

Introduction: Hypertrophic Cardiomyopathy is an inherited disease caused by mutations that occur in B-myosin heavy chain that affects heart muscle proteins. It’s the most common cause of sudden cardiac arrest in Young Athletics. Angiotensin II receptor blockers (ARBs) such as Losartan is a medication that attenuate the myocardial hypertrophy and fibrosis.
Purpose: To systematically review and conduct a meta-analysis of randomized controlled trials investigating the impact of Losartan as Angiotensin receptor blocker on Hypertrophic Cardiomyopathy.
Methods: We searched PubMed, Medline, Scopus, Web of Science and ScienceDirect to detect randomized controlled trials that evaluate the impact of Losartan and ARBs on patients with Hypertrophic Cardiomyopathy.
Results: From a total of 694 entries identified, six RCTs were appropriate for inclusion into the final analysis. The metaanalysis indicated a significant lowering of Systolic blood pressure (mm Hg) compared to Placebo (MD= -7.16, 95% CI [-12.95, -1.36], p=0.02). While the pooled estimate showed no significant difference between Losartan and Placebo regarding Left atrial volume(MD= -5.71, 95% CI [-13.55, 2.14], p=0.15), Left ventricle outflow peak gradient(MD= 1.30, 95% CI [-4.69, 7.29], p=0.67), Left ventricular wall thickness(MD= -1.42, 95% CI [-6.32, 3.48], p=0.57), Left ventricle diastolic diameter (MD= 0.00, 95% CI [-7.10, 7.10], p=1.00), Diastolic blood pressure (MD= -1.00, 95% CI [-9.10, 7.10], p=0.81), NT-proBNP (MD= 7.00, 95% CI [2.04, 11.96], p=0.006). Regarding Tissue Doppler Ea (cm/s), Tissue Doppler Ea/Aa and E/E’ (lateral) The pooled estimate of studies did not differ significantly between the ARB and control group (MD= 2.03, 95% CI [-0.35, 4.42], p=0.09),(MD= 2.00, 95% CI [-0.30, 0.70], p=0.43), and E/E (MD= -2.60, 95% CI [-6.20, 0.99], p=0.16), respectively.
Conclusion: This meta-analysis showed a significant difference of lowering Systolic blood pressure (mm Hg) compared to Placebo while Losartan had no effect on improving the myocardial performance in patients with Hypertrophic Cardiomyopathy.

Recent Publications
1. Salahia S I, Safi O, El-sabbagh A E A, Ellotf H M, Fouda M A, Salahia S I, Ahmed M, et al (2017). PROSPERO International prospective register of systematic reviews Efficacy of tranexamic acid as compared to aprotinin undergoing cardiac surgery with cardiopulmonary bypass systematic review and meta-analysis.
2. Salahia S I, Saad A M, Hilali M F, Alkhaledi A N, Khalaf A R, and Khaled. (2017). A Long-term, T H PROSPERO International prospective register of systematic reviews Long-term versus short-term zoledronic acid for metastatic
breast cancer: a systematic review and meta-analysis.
3. Salahia S, Safi O, Saadeddin A, Mahmoud H, Al-husseini M, Sinokrot M, Al-husseini M et al (2017). PROSPERO International prospective register of systematic reviews Systematic review and meta-analysis of systemic infammatory response syndrome after pediatric congenital heart surgery.
4. Salahia S, Salahia H, Saad A, Haidar L, Rifai N, Ahmed I and Mohamed Y. (2017). PROSPERO International prospective register of systematic reviews Long-term efficacy of antibiotic prophylaxis for preventing recurrent uncomplicated urinary tract infections: a systematic review and meta-analysis.
5. Salahia S, Safi O, Hakmi A A, Mahmoud H, Salahia S, Safi O, Efficacy, A et al (2017). PROSPERO International prospective register of systematic reviews Efficacy and safety of the angiotensin II receptor blocker losartan for hypertrophic cardiomyopathy: Systematic Review and Meta-Analysis.