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

Biography:

Syed Raza  graduated from Aligarh University in India  in 1993. After completeing his postgraduate degree in Medicine from the same university, he moved to the UK for higher specialist studies. He successfully completed MRCP and CCT and later also  awarded Fellow of the Royal College of Physicians of Edinburgh. He was awarded professor John Goodwin prize for outstanding performannce 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 has to his credit  numerous publications and he has presentated his work in  different parts of the world. He is peer review author for some well respected journals.

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 and 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:

Galya Naydenova Atanasova completed her Ph.D. training in Cardiology from Department of Cardiology, Pulmonology and Endocrinology at Pleven Medical University, Bulgaria. She is a Cardiologist, Assistant Professor at the Department of Internal Medicine, Medical University, Pleven. She is a General Practitioner in Pleven. She specialized in Cardiology from Pleven Medical University during 2015, and General Medicine from Pleven Medical University, Bulgaria during 1993. She has attended to many International Events and presented her research work. She did many researches on metabolic syndrome and myocardial infarction of heart.

Abstract:

In a number of epidemiological studies, elevated blood pressure (BP) has been identified as a risk factor for coronary artery disease, heart failure, cerebrovascular disease, etc.
The object of the study is to assess the degree of influence BP as a risk factor for myocardial infarction (MI) by logistic regression analysis.
During year 2012 study in 99 subjects with survived MI, inhabitants of Pleven region in Republic of Bulgaria was conducted.

The following biomarkers are tested (fasting): HDL-cholesterol, serum triglycerides (TG) and total cholesterol (TC). Data processing is a logistic regression analysis.

In our study developed two regression models. The first model includes SBP, level of triglycerides (Tg) and the level of total cholesterol (TC). An increase of 10% from the average value of the factor increase in OR for the occurrence of MI in men SBP is 2.05 times, and the level of TC was 1.28 times. times). The second model includes SBP, Tg levels and levels of HDL-cholesterol.  Increase by 10% the level of Tg in little increase in the chances of occurrence of MI in women (1.05 times) and can therefore be concluded that Tg is not a risk factor for subjects studied.The most important risk factor for MI in our study is the increase of SBP. It has a great influence on the attitude of the chances of heart attack in men than in women.

Biography:

Syed  Raza  graduated from Aligarh University in India  in 1993. After completeing his postgraduate degree in Medicine from the same university, he moved to the UK for higher specialist studies. He successfully completed MRCP and CCT and later also  awarded Fellow of the Royal College of Physicians of Edinburgh. He was awarded professor John Goodwin prize for outstanding performannce 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 has to his credit  numerous publications and he has presentated his work in  different parts of the world. He is peer review author for some well respected journals.

Abstract:

Introduction: Statin  is the most  controversial  molecule , at the same time  very commonly  used  as well as misused  amongst all cardiovascukar  drugs.

Method : We  studied  a large  cohort of patients  to see  if  statin was being prescribed  by specialist  and general physicians  simply based  on their  random  clinical decision or current standard guidelines were  being followed.

Analysis and Results: It was discovered  that  a vast majority of patients  were being prescribed Statin simply based  on the numerical  value  of total  cholesterol and LDL levels.  A  cardiovascular  risk  approach  was not applied  in these patients.  On the other  hand  patients  particularly  diabetic  who are  now considered  at higher  risk  for cardiovascular event  were  being missed out on statin. Appropriate  potency  and  adequate  dosing  of statin  therapy was not always adhered to.  Statin therapy  was  also  discontinued  in patients despite strong clinical indication  simply based on mild rise in liver or muscle enzymes.  Use of Ezetemibe as adjunct therapy was very limited.

Conclusion: Standard  guidelines  are not always being used  while prescribing Statin treatment. Physicians  still tend to initiate  and stop statin thyerapy only based  on their own random clinical judgement. This action does  leave  some  high risk patients  unprotected  and made deprived  of  important  and readily available  drug therapy.

Biography:

Abstract:

Background: Longitudinal cardiac rotation (LR) is a movement of the apex during systole and diastole, with the heart appearing to rotate in a clockwise or counterclockwise direction. In this pilot study, we hypothesized that LR abnormalities are present in children with end-stage kidney disease (ESKD) undergoing hemodialysis (HD). We also assessed the effect of preload on LR.

Methods: Twelve patients with ESKD (58% male; aged 17.5 ± 4.4 years) were prospectively studied. Four-chamber views were acquired 1 hour before and after HD. Data were compared with 12 controls. Speckle tracking imaging was used for assessment of LR (°), longitudinal strain (%), and mechanical dyssynchrony (septum-lateral delay).

Results: LR abnormalities were seen in 50% of patients (end-systolic LR < -3.00° or > +3.00°). In 4 patients, LR changed in the opposite direction after HD. LR abnormalities were not seen in controls (LR between -2.00° and +2.00°). Controls showed the highest mean longitudinal strain (patients: - 19.75 ± 1.81% vs controls: - 22.60 ± 3.00%, P < 0.0001). Longitudinal strain decreased significantly after HD (preHD: - 19.75 ± 1.81% vs postHD: - 17.41 ± 1.68%, P < 0.0001). Mechanical dyssynchrony was more pronounced in patients (patients: 140.4 ± 90.0 msec vs controls: 106.4 ± 68.9 msec, P < 0.0001), and increased after HD (preHD: 93.1 ± 84.6 msec vs postHD: 140.4 ± 90.0 msec, P = 0.003).

Conclusions: Patients with ESKD have LR abnormalities, impaired longitudinal strain and more pronounced dyssynchrony. Preload reduction acutely changed the direction of LR in ~ 30% patients.

Biography:

Abstract:

Objectives: To study the detection rate of congenital fetal heart anomalies in first trimester scanning compared with second trimester scanning and to postnatal exam and neonatal echocardiography.

Methods: This is a prospective observational study performed at a tertiary Fetal Medicine Unit. Patients had a first trimester scan from 11–14 weeks which included screening for Down’s syndrome by measurement of the NT thickness, detection of Nasal bone, measurement of DV flow and tricuspid valve flow. Full anatomy exam was performed with special interest in the heart. Examination of the heart included; the four chamber view, intact inter-ventricular septum, correct outflow tract and the three vessel view in the mediastinum. Pulsed Doppler was done at level of tricuspid valve to exclude regurgitation. A similar examination of the heart was performed at 20–24 weeks with full anatomy survey for other congenital malformations. Comparison of the two fetal heart examinations was done compared to final neonatal examination and neonatal echocardiography when indicated.

Results: A total of 300 pregnant females were examined. The mean age of the patients were; 29.9±6.3. Mean BMI was 32.5. The mean GA at the first trimester was 12.9±0.9 and the mean

GA at the second trimester was 20.4±1.4. A total of 11 congenital heart anomalies were confirmed postnatal (3.7%).Seven were diagnosed and 4 were missed at the first trimester and one was falsely diagnosed as having an anomaly giving a detection rate of 63.6%, specificity 99.7%, PPV 87.5%, NPV 98.6% and agreement reached 98.3% (kappa 0.728) In the second trimester scan 9 cases were diagnosed, 2 cases were missed giving a detection rate of 81.8%, specificity 99%, PPV 75%, NPV 99.3% agreement 98.3% (kappa 0.774).

Conclusions: First trimester heart examination has a good detection rate for congenital heart anomalies and should be done as a routine during first trimester screening for Down’s syndrome.

Biography:

Kibwe Mwewa has completed his Masters degree in laboratory Medicine and Medical Science, department of physiology in 2015 at the University of KwaZulu Natal, South Africa. His is currently pursuing his PhD in the same field focusing on pulmonary hypertension.

Abstract:

Introduction: Hypertension is a major health problem throughout the world because of it high prevalence and its association with increased risk of cardiovascular disease. Oxidative stress, trace element status and exercise have been demonstrated to play a major role in the pathogenesis of hypertension. The objective of this study was therefore to investigate the effect of moderate treadmill activity on cardiovascular factors in the spontaneously hypertensive rat (SHR) model of hypertension.

Methods and results: Sixteen SHR and 16 Wistar rats were randomly divided into an exercise (n=8) and a non-exercise (n=8). All the rats in the exercise group were subjected to a progressive treadmill exercise regimen for 8 weeks. Blood pressure, blood glucose and body weight was recorded weekly. At the end of the study, C-reactive protein (CRP), trace elements were measured in the blood and Total antioxidant capacity (TAC) was measured in the skeletal muscle. Hypertension developed in both SHR groups only. Elevated CRP level in both SHR and Wistar exercised groups suggest an inflammatory response associated with hypertension and exercise. There were no significant compensatory increases in TAC during exercise in the SHR. Decreased levels of Iron, Selenium and manganese were also observed in the exercise groups.

Conclusion: This study reports that the pathological changes associated with oxidative stress are exacerbated when coupled with exercise in this model of hypertension.

Biography:

Fatih Yalcin is currently working at the Johns Hopkins University as the Fulbright Faculty and his current studies are being supported by US Government Fulbright Scholarship, Washington, DC. His long-term experince is on chronic cardiac deformation and management of thrombus formation using Dabigatran treatment.

Abstract:

Prof. Yalcin has focused on pressure overload-induced heart remodeling in hypertension, his research interest is related to conventional and novel imaging methods including regional imaging and functional analysis of heart muscle tissue as summarized below.

He described regional heart geometry by real-time 3 dimensional imaging in patients with primary and secondary left ventricular hypertrophy (LVH) to hypertension (AJC 2000). Tissue Doppler advantageous for assessment of diastology in cardiac diseases (JHH, 2002). Stress-induced high pressure gradients in hypertensive patients with focal hypertrophy (IJC 2002). CV pub. nb. 39, 2004). Increased stress-induced tissue dynamics in hypertension detected by tissue Doppler imaging (JHH, 2006). Longitudinal and spherical mitral anulus motion reflecting contractile function detected by real-time 3 dimensional imaging in patients with primary and secondary LVH to hypertension (ECHOCARDIOGRAPHY, 2008). He also described the “Stressed heart morphology” which has been documented in clinical conditions with both acute stress cardiomyopathy and chronic stress due to pressure overload in hypertension (IJC, 2009).

Biography:

Lilian L. Sharovsky is a Psychologist, PhD at Heart Institute (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Researcher at Sujeito-Corpo (SuCor), a Psychosomatic Interdisciplinar Research and study Group of Psychology Institute da Universidade de São Paulo, Brazil. 

Abstract:

Different studies have clearly and convincingly demonstrated the important correlation between psychological factors and pathogenesis of coronary artery disease, particularly of depressive symptoms. Nevertheless, symptoms of anxiety are also considered fundamental to higher cardiovascular risk. Traditional risk factors such as hypertension, high blood glucose levels, obesity, increased waist circumference, dyslipidemia can be directly related to alcohol abuse, a hyper caloric diet, rich in carbohydrates, saturated fat and sedentary life in an attempt by the patient to control symptoms of anxiety. However, the latter tend to be under diagnosed in clinical practice contributing to a metabolic deterioration and the occurrence of vascular events. Therefore, it is essential to early identify persons with high psychological risk.

The aim of the study was to analyze the intensity of anxiety symptoms using the Hamilton Anxiety Scale (HARS) in 136 participants (69 women) without a coronary event history, cerebrovascular and / or psychiatric illness and had not suffered a significant stressor in the last 6 months (bereavement, job loss or violence) and presenting aggregation of cardiovascular risk factors under ambulatory treatment.                                                                                                

93 participants (68.4%) had serious or very serious symptoms of anxiety, 17 (12.5%) moderate symptoms, in women the mean score was 36.7 (very serious) and men was 26 (severe) (Mann Whitney p <0.0001).

Early psychological diagnosis of anxiety symptoms can contribute to prevent cardiovascular events in patients with increased cardiovascular risk factors.

Biography:

Abstract:

Proper interpretation of intra-atrial structures using a single imaging modality often proves to be difficult. We report a 60 year old male with stable coronary artery disease who had a trans-thoracic echocardiography where a right atrial mass was discovered. He was referred to our centre for further cardiac imaging of the right atrium (RA). Cardiac magnetic resonance (Panel A) and computed tomography (Panel B) showed no well-defined mass (arrow heads) but rather a possible membrane crossing the RA. Two dimensional (Panel C) and three dimensional (Panel D) trans-esophageal echocardiography showed a fenestrated membrane (yellow arrow heads), spanning from the crista terminalis to the inferoposterior margin of the coronary sinus ostium, dividing the RA into two parts. The tricuspid valve leaflets (white arrow head) were elongated with apically displaced co-aptation point with moderate regurgitation and no elevation in pulmonary artery pressure.  These findings were consistent with Cor-triatriatum dexter. Cor triatratum dexter is an extremely rare congenital heart anomaly and represents the right counterpart of the relatively more commonly found Cor-triatratum sinister. It is caused by persistence of the right valve of the right horn of the sinus venosus. Clinical manifestations may range from severe cyanosis during neonatal period to completely asymptomatic condition with accidental discovery of the membrane.

Biography:

Emili Manna is junior research fellow of Sinha Institute of Medical Science and Technology from September 2014 and has been completed her M.Sc. from Vidyasagar University at the year 2014 from the department of Biochemistry. The area of her working is includes the occurrences of Cardiovascular disease in breast cancer patients and thereapy.

Abstract:

Background: The increased incidences of acute myocardial infarction (AMI) in breast cancer have been reported before. However the mechanism of AMI in breast cancer related to the status of platelet function remains obscure. The role of testosterone in the pathophysiology of AMI in breast cancer was investigated.

Methods: Fifty five female breast cancer patients between the ages of 25-60 participated in this study. None of the participants had diabetes mellitus, hypertension or any life threatening infection. These volunteers at presentation have not yet undergone any therapy for the condition. An equal number of age matched normal female volunteers also participated in the study. No normal female volunteers had ever received any contraceptive medications. The platelet rich plasma (PRP) was prepared from the peripheral blood and collected in sodium citrated. The syntheses of dermcidin isoform-2(DCN-2),an environmentally induced stress  protein and a potent platelet aggregating agent , and troponin I in neutrophils were assayed by enzyme linked immunosorbent assay after invitro translation of the corresponding m-RNAs.                                                                                                                                                                    

Results: Treatment of PRP from the breast cancer subjected with 2.0 µM ADP resulted in the 4 fold increase in the aggregation of the platelets compared to control (p <0.0001,n=55) and the incubation of breast cancer PRP with 80 µM acetyl salicylic acid (aspirin) for 30 min at 37â—‹C failed to inhibit ADP induced platelet aggregation. As the systemic increase of testosterone, an inhibitor of nitric oxide synthase has been reported to be associated with breast cancer, when the normal neutrophils’ suspension (106 cells/ml) in Tyrode buffer pH 7.4 was incubated with 20nM testosterone for 2 h at 37â—‹C the syntheses of both DCN-2 and troponin-I the signal molecules for AMI were found to be increased by 6 and 2 fold respectively.

In contrast, the addition of 30 µU/ml insulin to the neutrophil suspension that increased NO synthesis was found to neutralise the testosterone effects on the syntheses of the signal molecules for AMI.

Incubation of normal PRP with DCN-2 and troponin-I similar to the amount that was  present in the plasma of breast cancer patients for 2h at37â—‹C resulted in the failure of aspirin to inhibit the platelet aggregation.

It is concluded that the testosterone induced increased syntheses of DCN -2 and troponin -I in the circulation of the breast cancer patients could induce / enhance the occurrence of AMI.

Biography:

Rubina Barolia is working as an Assistant professor at Aga Khan University. Her current research focus is on prevention of cardiovascular diseases in people of low socioeconomic status. She has been working as interim Director for Masters Programme. She has worked extensively in curriculum development for Masters Programme in the Pakistan, Syria and East Africa. Dr. Barolia has also published her research work in national and international Journals. She has been awarded several awards in recognition of her scholarship, such as doctoral fellowship from International Development Research Centre, Ottawa, Canada and Betty Ford Medical Award, California USA. 

Abstract:

This qualitative research study was to understand the effects of various factors that inform Pakistani people of low SES in making decisions on food choices after diagnosis with CVD.

Research Questions: (a) What are the factors that inform Pakistani people of low SES in making decisions on food choices after diagnosis with CVD? (b) What are the factors that promote the consumption of healthy diets in people of low SES who have CVD? (c) What factors inhibit people of low SES who have CVD from consuming healthy diets? 24 participants were selected from two cardiac centers in Karachi, Pakistan. Seven major themes are (a) the meaning of food and healthy diet: a social dimension; (b) poverty and a healthy diet: not a matter of choice; simply to satisfy hunger; (c) Health promotion is a political issue: survival is difficult because of political unrest in Karachi (c) hope for recovery and family support: motivation for dietary change; (d) Family support and family relationships affect diet change (e) self-control and self-determination: choosing between taste and health; and (f) culture and family values promote or hinder dietary change. The participants’ data reveals that food choices do not simply mean the consumptions of healthy items; it means communication, socialisation, expressing culture, reflects family and religious values. The challenge lies in identifying and resolving the underlying structures and mechanisms that shape behaviour change.

Biography:

G.Belostotskaya graduated from Leningrad State University in 1970 and defended her thesis in 1984 on a specialty "Radiobiology". Now she is working in Sechenov Institute of Evolutionary Physiology and Biochemistry of the Russian academy of sciences as the Head of Cytoanalysis centre. In recent years, she has been studying the resident muscle stem cells and published more then 15 papers in Russian Journals and several articles in “Cell Cycle” (2014, 2015), Bioelectromagnetics (2014), Carbohydrate Polymers (2015). Being the head of investigations she released 7 specialists and 2 graduate students. The works have been supported by the 11 Russian grants.

Abstract:

Despite intensive research of cardiac stem cell (CSC) biology, there has been an open question whether CSCs or adult cardiomyocytes (CMs) are responsible for renewal of adult mammalian myocardium. In addition, it is not clear why CSCs are not able to regenerate cardiac tissue after myocardial infarction (MI). Using in vitro and ex vivo experiments on myocardial cells obtained from newborn and young adult rats, we described the phenomenon of intracellular development of CSCs inside CMs with formation of “cell-in-cell structures” (CICSs) [Belostotskaya et al., 2015]. Later, CSC-containing CICSs were also found in the myocardium of adult mammals, human including. Here we present the data on cardiomyogenic differentiation of CICS-embedded CSCs obtained in the in vivo rat model of permanent left coronary artery ligation as well as myocardial ischemia-reperfusion. Two weeks after transient ischemia, CSCs were found to be actively involved in myogenesis in the peri-infarct area and remote to the infarct area locations. Importantly, new CMs were produced not only by means of formation of CSC-derived colonies, but also by differentiation of transient amplifying cells (TACs) released from pre-existing CICSs. Permanent coronary ligation also caused formation of new and opening of pre-existing CICSs; however, this was not accompanied with increased myogenic differentiation of TACs. Therefore, despite the presence of small colonies in intact areas of the heart, MI is associated with severe inhibition of cardiomyogenesis in infarct and peri-infarct areas.

Biography:

Manuela Stoicescu, Consultant Internal Medicine Doctor (PhD in Internal Medicine), Assistant Professor of University of Oradea, Faculty of Medicine and Pharmacy, Medical Disciplines Department, Romania, Internal Medicine Department. She is Member of Romanian Society of Internal Medicine, Member of Romanian Society of Cardiology, Chemistry, Biochemistry and Member of Balcanic Society of Medicine. She was invited as a speaker at more than 30 International Conferences, she is editorial board member in two ISSN prestigious Journal in U.S.A, she published  more than 20 articles in prestigious ISSN Journals in U.S.A. she published five books: two books for students in English and Romanian language: ”Clinical cases for students of the Faculty of Medicine”, one book in English language on Amazon at International Editor –LAP Lambert Publishing Academic House in Germany- “Side Effects of Antiviral Hepatitis Treatment”, one monograph in Romanian language ”High blood pressure in the young a ignored problem!”, two chapter books – Cardiovascular disease: Causes, Risks, Management CVD1- Causes of Cardiovascular Disease 1.5,1.6, U.S.A on Amazon. and recent a book “ Sudden Cardiac Death in the Young” in English language on Amazon  at International Editor–LAP LAMBERT Academic Publishing, OmniScriptum, Germany 2015 and she is Committing Organizing Member at  the  International Conferences.

Abstract:

The main objective of this clinical case presentation was to found the real cause of dangerous arrhythmias (frequents premature ventricular bates polymorphic, polytope and repeated passes of none sustained ventricular tachycardia) at a young patient. I present the clinical case of a young woman patient 21 years old, who came at the consultation for irregular palpitations after increase physical effort–mountain climbing-her favorite sport activity. At the objective examination were found irregular heart bates HR=98bates/min, without murmur heart or added sounds, BP=150/90mmHg, normal vesicular breath sound on the lung. The EKG showed: sinus rhythm, HR=98bates/minutes, many premature ventricular bates looks polymorphic, polytope and a short pass of a non sustained ventricular tachycardia (less than 30 seconds). The patient was monitored and followed antiarrhythmic therapy with xilin iv bolus 1mg/kg body and after that double dose of xilin 1% i.v. in perfusion during the first 24 hours with disappears of the dangerous arrhythmias and after that remain on beta-blocker therapy- Carvedilol 6, 25 mg daily. In the first instance these dangerous arrhythmias were put in context of increase physical effort. The usual laboratory tests and the specific cardiac enzymes: Troponin I and CPKMB were in normal range and was excluded a heart attack. The levels of TSH, Free T3, FreeT4 were normal and the thyroid ultrasound - normal, excluding a possible thyroidal disease(hyperthyroidism-Basedow Graves disease or toxic thyroid adenoma and cardiothyreosis The level of electrolytes (potassium, magnesium, calcium, sodium, chloride) were normal so a dyselectrolytemia was excluded like a cause of these dangerous arrhythmias. A Holter monitor(24h) was performed and put in evidence, unexpected, two short passes of non sustained ventricular tachycardia (less than 30 seconds) and a few premature ventricular bates polymorphic and need iv. antiarrhythmic therapy again with good evolution of the patient and remain on Carvedilol 6,25mg (2X1tb/daily) with good control of these. Transthoracic echocardiography put in evidence unexpected a solid mass inside of the left ventricular cavity. This unexpected formation put problem of differential diagnosis regarding the etiology: a thrombus? a vegetation formation but this must to be present on a valve in endocarditis not in this area, a cyst? a tumor formation? Transesophageal echocardiography (TEE) showed the same solid mass inside of the left ventricular cavity. The patient was referred to the Cardiovascular Surgery Department. The formation was removed from the left ventricular cavity and the result of the histhopathological examination confirmed safe the diagnosis of ventricular myxoma. The atrial myxoma is common in medical literature, but rare. Ventricular myxoma is very uncommon, rare and sometimes can develop so dangerous arrhythmias like repeated passes of ventricular tachycardia and also premature ventricular bates polymorphic and polytypic and can put in danger patent’s life because of risk of degeneration in ventricular fibrillation and cardiac arrest. Conclusion: sometimes, rare, un unknown ventricular myxoma could be the real cause of dangerous arrhythmias in the young and must to be removed.