14^th International Conference on Clinical & Experimental Cardiology November 14-16, 2016 Orlando, Florida, USA

Biography:

Athilingam has completed her PhD in 2008 from University of Rochester, New York. Athilingam is an accomplished nurse and acute care nurse practitioner with a focused practice and research in the evaluation and management of patients with heart failure and have been actively exploring the use of technology-based interventions that will be easy to use by older adults who live alone and may be cognitively challenged. She has published widely in this topic. She is recently elected as a Fellow of the Heart Failure Society of America and a Fellow of the American Association of Nurse Practitioners.

Abstract:

Mobile technology has become an indispensable component of the current hyper-connected world population. Therefore, we developed a user-friendly mobile application (HeartMApp), using the Information, Motivation, Behavioral skills model (IMB) as its theoretical foundation and patient engagement as the key mediator. Heart failure (HF) is a significant public health problem affecting 5.7 million Americans, predominantly older adults. Patients with HF are required to engage in complex self-management behaviors including daily weighing, assessing HF symptoms, adhering to complex medication regimens, consuming a low-salt diet, participating in physical activity, and responding to symptoms appropriately. Lack of resources, support, and motivation can lead to poor self-management, which contributes to the high rate (25%) 30-day HF readmissions nationwide. Unfortunately, currently available interventions to improve HF self-management have demonstrated no sustained benefits. HeartMapp is an easy to use non-pharmacological, non-invasive application developed with five main features: 1) assessment of daily weight, blood pressure, and HF symptoms; 2) exercise including physical activity (walking) and deep breathing; 3) real-time vital signs monitoring using the wearable Bluetooth device; 4) HF information that includes evidence-based, audio-enabled, interactive HF education; and 5) Stats include a graphic module displaying patient performance trends. HeartMapp uses Bluetooth sensors and wireless networks that consist of an Android application, tested on the Nexus 4 and Nexus 5 running the Android 4.4.0 platform.  For researchers and health care providers, HeartMapp provides an unobtrusive way to collect real-time ecological momentary assessment (EMA) data on individual performance from patients’ responses indicating their engagement in daily HF self-management.

Biography:

Jay Risk is a lifelong congenital heart patient and nationally televised speaker living with Tetralogy of Fallot. Justin founded the ‘Tetralogy of Fallot Foundation Inc.’ a non-profit organization, for purposes of helping others affected with this condition and bettering the condition’s current solutions to repair and care for the patient.  Justin has been the poster child for Deborah Heart and Lung Center, has been seen on Regis and Cathy Lee, “People are Talking” & “Nine Broadcast Plaza” with both Matt Lauer and Richard Bey - all speaking about living with congenital heart defects. Notable speeches for reference:  The Make A Wish Foundation, Deborah Heart and Lung Center, NJ Pediatric Cardiology Conference at the Sheraton Hotel Ball Room.

Abstract:

‘Long Term Effects and the Congenital Gap’ is a 3 part oral presentation (video aid if allowed) beginning with a documented case study of a congenital heart patient living with Tetralogy of Fallot. Focus of Part1’s case study outlines the direct effects of enduring multiple surgical repairs which include mental, physical and collateral affects ranging from short term to lifelong issues.  The purpose is to offer cardiologists a better understanding into the plight of a lifelong heart patient not previously reviewed or considered.  Part 2’s focus is to discuss the urgency and importance of solving the present challenge a congenital heart patient faces, while transitioning from a pediatric heart patient to an adult heart patient (due to age) as it relates to the world of present medicine. Specific issues are discussed such as: a lack of patient resources, the problem of an adult congenital patient being treated by a general cardiologist, and the void that exists in care when transitioning from pediatric cardiology to adult congenital cardiology.  Part3 gives reason to why we need to grow the field of “Adult Congenital Cardiology” and all related fields…Statistics, analysis and testimonials to be provided as part of the presentation.

Biography:

Yan has completed her PhD at Tokyo Medical and Dental University and postdoctoral studies from Beth Israel Deaconess Medical Center and Wayne State University School of Medicine. She is a principal scientist (Research Scientist IV) in Alexion Pharmaceuticals and has obtained 9 patents and published approximately 18 peer-reviewed scientific manuscripts.

Abstract:

Vascular smooth muscle cell (VSMCs) proliferation-associated stenosis is a major hallmark in the pathogenesis of Generalized Arterial Calcification of Infancy (GACI), an ultra-rare disease associated with ENPP1 loss of function mutations in the majority of patients. ENPP1 is an ectonucleotide pyrophosphatase that hydrolyzes ATP and serves as a key regulator of bone mineralization, however, the role that ENPP1 plays in intimal proliferation is poorly understood. Knockout mice lacking ENPP1 do not recapitulate the phenotype of intimal thickening, a common pathological feature in most GACI patients.  Here, we examined the impact of ENPP1 on proliferation of primary rat VSMCs. Silencing ENPP1 using siRNA led to a significant increase in proliferation of VSMCs relative to that of cells transfected with negative control siRNA. This increased proliferation was inhibited by over expression of ENPP1 using an adenoviral vector encoding mouse ENPP1cDNA. Treatment of VSMCs with the ENPP1- reaction products AMP or Adenosine resulted in moderate inhibition of VSMC proliferation, while treatment with the ENPP1-Fc fusion protein inhibited VSMC proliferation significantly.  In contrast, neither addition of bisphosphonates, a current off-label treatment used for GACI, nor inorganic pyrophosphate (PPi) affected proliferation of VSMCs. In summary, using both loss of function and gain of function approaches, we demonstrated that ENPP1 negatively regulates VSMC proliferation, and that ENPP1-Fc protein replacement is effective in inhibiting proliferation associated with loss of ENPP1 in VSMCs. These findings suggest that ENPP1 enzyme replacement may serve as a potential therapeutic approach for treating myointimal proliferation in GACI disease.

Biography:

George Thomas did his graduation and post-graduation from the Bombay University, India. His is currently a Chief Cardiologist at Saraf Hospital, Kochi. He has several national and international publications including chapters in text books. He has been an invited speaker at national and international conferences. He is listed in “Marquis Who’s Who in Medicine and Healthcare”, “Who’s Who in Science and Engineering”, “Who’s Who in Asia” and “Who’s Who in the World”. He has done tremendous contributions in medicine: First in the world to point out the serious flaws in Tissue Doppler Echocardiography; developed a classification and nomenclature for coronary disease; developed a classification and a simplified study of Trans-mitral Doppler patterns, etc.

Abstract:

Tissue Doppler has been around for over 25 years. In spite of the large number of published papers in reputed journals, this has been an unsound modality. This is because of the flawed data collection. In tissue Doppler both the measurement and Doppler principles are compromised making it totally unacceptable. The play of colors and the fanciful waveforms have misguided us. Doppler is best suited for flow studies and applying it to tissue motion is illogical. Due to the basic faults in the application of measurement and Doppler principles all data obtained by tissue Doppler is scientifically incorrect. This makes all the published papers on the subject flawed. Making diagnostic decisions based on this faulty application of technology would be unacceptable to the scientific cardiologist. In this presentation I will be discussing the basic flaws in this technology based on the papers published by me.

Biography:

Maurizio Pesce, PhD, is a Biologist with expertise in cardiovascular tissues regenerative medicine and tissue engineering. His work has been specifically dedicated to the assessment of adult-derived stem cells in cardiac and vascular (re)generation. He currently holds a position as a Group Leader of the Tissue Engineering Unit at the Research division in Centro Cardiologico Monzino in Milano, Italy where he conducts research on pathological readout of cell mechanosensing and novel approaches in vascular, valve and myocardial tissue engineering. 

Abstract:

The generation of bioartificial tissues using patient-derived or allogenic (progenitor) cells, has become a clinically relevant opportunity for translation in various branches of medicine, e.g. dermatology, ophthalmology and diabetes care. Despite an always increasing number of patients with cardiovascular diseases, no feasible options exist to produce biomimetic engineered tissues that might be employed as definitive substitutes in cardiovascular medicine. In fact, while stem cells with cardiovascular competence have been identified and characterized, their employment has remained mainly confined to regenerative medicine, with insufficient translation into effective tissue engineering strategies. The devices presently available to replace diseased myocardium, occluded vessels and failing valves is limited to materials with tensile resistance (patches for ventricular reconstruction), autologous vessels (mammary/radial arteries and saphenous vein for aorto-coronary bypass grafts) and mechanical/bio-prosthetic valves; all of which have major limitations such as insufficient mechanical integration, post-engraftment patency reduction and calcification. Merging stem cell biology with recent bio-engineering techniques will be of great help in the production of new bio-synthetic cardiovascular implants. In fact, the design of complex biomaterial patterning in microscale or nanoscale dimensions and novel “High Throughput” screening systems may be exploited to perform synthetic modeling of the tissue self-renewing conditions and to a rapid identification of new biomaterials. 

Biography:

Ponrathi Athilingam has completed her PhD in 2008 from University of Rochester, New York. She is an accomplished Nurse and Acute Care Nurse Practitioner with a focused practice and research in the evaluation and management of patients with heart failure and has been actively exploring the use of technology-based interventions that will be easy to use by older adults who live alone and may be cognitively challenged. She has published widely in this topic. She is recently elected as a Fellow of the Heart Failure Society of America and a Fellow of the American Association of Nurse Practitioners. 

Abstract:

Patients with heart failure (HF) have four times the increased risk of cognitive impairment; yet receive no routine cognitive screening. Moreover, cognitive training in HF is in its infancy. The potential mechanism of cognitive intervention is believed to be engagement in cognitively stimulating activities based on the principle of neural plasticity. In a pilot study, we examined the feasibility and potential efficacy of “Brain Fitness”, a computerized auditory cognitive intervention (ACT) in improving cognitive and functional outcome and calculate effect sizes for a larger study. A total of 17 participants were randomized to either ACT (n=9) or wait-listed control (n=8). Individuals continued ACT at home for 16 weeks or until 40 hours of training was completed. The wait-listed control group received standard optimized medical therapy during the first 16 weeks and after follow-up was given ACT. Data were collected at baseline and at 16-weeks or at completion of 40 sessions of ACT. The results indicated improvement in auditory speed of processing and speech processing that transferred to enhance memory and everyday cognitive performance with moderate effect sizes. The result also reflected potential to improve HF self-care behavior with a small effect size and improvement in HF related quality of life with a moderate effect size. In addition, participants in the ACT group showed a trend for improvement in ejection fraction, which has not been tested previously in any studies. The potential benefit of ACT on these HF specific outcomes warrants further exploration in a larger sample. 

Biography:

Mangi M has completed his MBBS from Liaquat University of Medical and Health Sciences, Pakistan and Research Training from Mayo Clinic College of Medicine Jacksonville, FL. He is the Internal Medicine Resident at Orange Park Medical Center, Orange Park, FL. He has published 4 papers in reputed journals and has been serving as an Editorial Board Member of International Journal of Internal Medicine. 

Abstract:

Introduction: Non-alcoholic fatty liver disease (NAFLD) is a leading cause of liver disease in developed countries. Recently, NAFLD association with cardiovascular atherosclerosis was described. The aim of this study was to find whether an association exists between QT prolongation on EKG and NAFLD.

Methods: This is a case control retrospective study of 700 patients (109 patients with QT prolongation, and 591 without QT prolongation) admitted to Orange Park Medical Center, Orange Park from 2009 to 2015. Patients with history of alcohol use, congenital heart disease, infiltrative malignancy and myocarditis were excluded from the study. NAFLD was diagnosed by detection of hepatic steatosis on ultrasound or CT scan. Electrocardiograms were done on all 700 patients and were interpreted by a cardiologist. Univariate logistic regression was used to assess potential risk factors of QT prolongation, and multivariate logistic regression with backward elimination method was performed to determine if NAFLD was independent risk factor for QT prolongation.

Results: Multivariate logistic regression with backward elimination method identified 7 independent risk factors for QT prolongation, these included NAFLD (OR 4.33; 95% CI 2.40-7.80, p<0.0001), St change (OR 3.16; 95% CI 1.92-5.20, p<0.0001), other arrhythmia (OR 2.33; 95% CI 1.25-4.34, p=0.0081), PAC/PVC (OR 3.68; 95% CI 2.18-6.19, p<0.0001), TCA (OR 4.37; 95% CI 1.57-12.12, p=0.0047), smoking (OR 1.78; 95% CI 1.10-2.90, p=0.0198), and male (OR 0.40; 95% CI 0.24-0.68, p=0.0006).

Conclusion: This study suggests that NAFLD is an important independent risk factor for QT prolongation. We recommend a prospective randomized trial to identify the causation and mechanism of QT prolongation in NAFLD. Physicians should be cautious prescribing medications that are known to prolong QT interval in patients with NAFLD.

Biography:

Hiba Rehman has completed her MBBS from Hamdard University, Pakistan. She has published 4 papers in reputed journals and has been serving as a reviewer of various journals of Internal Medicine

Abstract:

Objectives: To systematically review the available guidelines on cardiovascular testing and their impact on health care system.
Introduction & Aim: According to an estimate, about 20%-30% of all health care spending is attributed to waste in health care. The providers contribute to a significant proportion of wasted health care dollars. This waste may be in the form of unnecessary radiological or laboratory investigation or new expensive medication or over- zealous investigative approach out of fear of legal action or law suits. With the growing health care cost in USA, national economy is under more strain. For this reason Choosing Wisely campaign came into action. The aim of Choosing Wisely campaign is to encourage discussions between providers and consumers regarding the care which a patient is going to get and to reach out and educate patients and their health care providers before going through the procedures on the basis of evidence, harm vs. benefit, duplicative or redundant test or procedure that patient already received and its necessity.

Methodology: We performed a literature search from 2009-2015, using PubMed, Medline, CENTRAL, EMBASE, Scopus, ISI, Regulatory Documents, Web of Science and manufacturers’ web clinical trial registries with multiple search terms. We reviewed guidelines from American Society of Nuclear Cardiology, American Society of Echocardiography, Society for Cardiovascular Magnetic Resonance, Heart Rhythm Society, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Computed Tomography and American College of Physicians.

Conclusion: All guidelines have same recommendation of not performing testing or procedures which are unnecessary. Not following these guidelines, not only affects the economy of the USA but also causes unnecessary mental and physical harm to the patient in various ways, and is not best use of limited resources which can be put to a better use somewhere else.

Biography:

Christian Mora Sicouret is a Physician from the Universidad Católica Santiago de Guayaquil, Ecuador.  His interest and devotion for research flourished while attending an Observership Program at Médica Sur Hospital, México DF during his last year of Medical School. He is currently working at Teodoro Maldonado Carbo Hospital, Guayaquil, Ecuador where he is working on the correlation of Hypertension and Cardiovascular disease in Hyperuricemic patients along with Ricardo Agualongo Núñez who works at Hospital Abel Gilbert Pontón, Guayaquil, Ecuador.

Abstract:

Statement of the problem: It has been suggested that hyperuricemia is an independent risk factor for the development of hypertension and other cardiovascular disease development. Though their mechanisms are not entirely clear, recent studies suggest that high uric acid levels precede hypertension through endothelial dysfunction, activation of the renin-angiotensin system, endothelial nitric oxide production inhibition and oxidative stress induction, resulting in vasoconstriction of preglomerular arterioles and the consequent increase in blood pressure. Low-grade chronic inflammation has also been presented as another mechanism, when monosodium urate crystals active cell surface receptors by triggering proinflammatory cytokines synthesis. The purpose of this study is to highlight hyperuricemia association with hypertension and cardiovascular disease in correlation with several variables.

Methodology & Theoretical Orientation: 154 patients were chosen from a population of 600 for a retrospective, cross-sectional study carried at Teodoro Maldonado Carbo Hospital, Guayaquil, Ecuador, tending to correlate uric acid levels, time of hypertension, hyperuricemia and cardiovascular disease diagnosis, and to compare these results with literature available in medical databases. 

Findings: An inverse correlation was found among uric acid levels and age (Rho= -0,309, P=0,000), showing the largest group affected is the one compromised by ages between 41-65 years old (M=9 related 10±7.34), most of which have hyperuricemia prior (5-10 years) to hypertension. Although ischemic heart disease was the most common pathology associated with hyperuricemia, the correlation with cardiovascular disease was not actually significant.

Conclusions: It has become evident that the appearance of hyperuricemia precedes hypertension in most patients, showing a correlation with uric acid levels where the most affected group is the one compromised by ages between 41-65 years old with a uric acid mean of 9.10 mg/dL. No significant link with cardiovascular diseases was shown.

Biography:

Ricardo Agualongo Núñez works at Hospital Abel Gilbert Pontón, Guayaquil, Ecuador.

Abstract:

Statement of the problem: It has been suggested that hyperuricemia is an independent risk factor for the development of hypertension and other cardiovascular disease development. Though their mechanisms are not entirely clear, recent studies suggest that high uric acid levels precede hypertension through endothelial dysfunction, activation of the renin-angiotensin system, endothelial nitric oxide production inhibition and oxidative stress induction, resulting in vasoconstriction of preglomerular arterioles and the consequent increase in blood pressure. Low-grade chronic inflammation has also been presented as another mechanism, when monosodium urate crystals active cell surface receptors by triggering proinflammatory cytokines synthesis. The purpose of this study is to highlight hyperuricemia association with hypertension and cardiovascular disease in correlation with several variables.

Methodology & Theoretical Orientation: 154 patients were chosen from a population of 600 for a retrospective, cross-sectional study carried at Teodoro Maldonado Carbo Hospital, Guayaquil, Ecuador, tending to correlate uric acid levels, time of hypertension, hyperuricemia and cardiovascular disease diagnosis, and to compare these results with literature available in medical databases.