Day 3 :
- Track 3: Heart Diseases & Track 7: Current Research in Cardiology
Chair
Yoshiaki Omura
New York Medical College, Heart Disease Research Foundation, USA
Co-Chair
Anthony Martin Gerdes
New York Institute of Technology-College of Osteopathic Medicine, USA
Session Introduction
Yoshiaki Omura
New York Medical College, USA
Title: New method of detecting various cancers & their biochemical information from rapidly changing part of QRS complex & slowly rising part of T-wave of ECGs was found: Its clinical application for non-invasive screening of cancers & evaluation of any cancer treatments
Biography:
Yoshiaki Omura received Oncological Residency Training at Cancer Institute of Columbia University & Doctor of Science Degree through research on Pharmaco-Electro-Physiology of Single Cardiac Cells in-vivo and in-vitro from Columbia University. He published over 265 original research articles, many chapters and 9 books. He is currently Adjunct Prof. of Family & Community Medicine, New York Medical College; Director of Medical Research, Heart Disease Research Foundation, New York; President and Prof. of International College of Acupuncture and Electro-Therapeutics, New York; Editor in Chief, Acupuncture & Electro-Therapeutics Research, International Journal of Integrative Medicine, which is indexed by 17 major international Indexing Periodicals. Currently he is also Executive Editor of Integrative Oncology. Formerly, he was also Adjunct Prof. or Visiting Prof. in Universities in USA, France, Italy, Ukraine, Japan and China.
Abstract:
Introduction: The author successfully detected biochemical changes, bacterial and viral infections, and identified the exact location of the infections of different part of the heart by ECGs. Similar results were found at different parts of the brain by ECGs during the last decade. Recently the author found that using ECGs, cancer information can be detected not only on different part of the heart but also in the rest of the body. Method: Various cancers existing in patients were detected from the rapidly changing part of QRS complex as well as the rising part of T-wave of every recorded 12 lead ECGs of the patient by detecting maximum Electro-magnetic Field (EMF) resonance phenomenon between 2 identical molecules with same amount using simple method which received a U.S. patent in 1993. From recorded ECGs, EMF resonance phenomenon between specific cancer microscope tissue slides and ECG were only detected from rapidly changing part of QRS complexes of ECGs and also from a part of slowly rising part of T-waves. Rapidly changing parts of QRS complexes of ECG contain invisible information of specific cancers that exist in the same person. This information is detected at relatively large dV/dt of QRS complex of ECGs. Large dV/dt of QRS complexes is due to the large numbers of ventricular muscle excitation which generate relatively large electrical current and voltage with rest of the ECG, which has very little dV/dt with exception of slowly rising part of T-waves of ECGs which correspond to "the Vulnerable Period of Ventricular Fibrillation" or "Commotio Cordis" in spite of relatively small dV/dt. Result: Using ECGs, the author was able to detect cancers of various organs including lung, esophagus, breast, stomach, colon, uterus, ovary, prostate gland, common bone marrow related malignancies such as Hodgkin’s Lymphoma, Non Hodgkin’s Lymphoma, Multiple Myeloma as well as Leukemia and even brain tumor such as anaplastic astrocytoma and glioblastoma. In addition the author was also able to find when the patient has more than one different cancer at different parts of the body. Also, most of drugs taken within 10 hours before taking ECG can be detected from rapidly changing part of QRS complex & rising part of T-waves. Among 50 ECGs of various cancer patients examined without knowing diagnosis, 2 patients with different diagnosis were found from ECGs and later diagnosis from ECG was found to be correct. Furthermore, in 3 cancer patients, additional cancers were also detected from ECGs. Discussion: Thus, by comparing the same lead of ECGs before and after any treatment, the therapeutic effect of specific cancers can be evaluated. In addition, if 12 lead ECGs is taken periodically, we can find approximately when cancer information starts appearing in the ECGs. Maximum information from cancer can be found in rapidly changing QRS complex where dV/dt is relatively large. This new concept and method can be applied any recorded ECGs for detection and screening of the cancer. Consequently, ECGs can provide not only information on the heart but also can detect any single cancer or multiple cancers, which exist in the same individual. ECGs cannot only be used to detect cancer but also can be used to reveal undetected cancers or misdiagnosed cancers as well as detection of medication patient is taking.
Anthony Martin Gerdes
New York Institute of Technology-College of Osteopathic Medicine, USA
Title: A new treatment for heart failure right under our nose for over 60 years?
Biography:
Anthony Martin Gerdes has done PhD in Anatomy (1978), from University of Texas Medical Branch at Galveston. He was the Professor/Chair of Anatomy, University of South Dakota. Also the founding Scientist for Sanford Research-University of South Dakota. His Current position is Professor/Chair Biomedical Sciences, NYIT College of Osteopathic Medicine, Old Westbury, NY, 2011-present. Publications: ~120 peer reviewed journal articles. 2013 Distinguished Alumnus, Graduate School of Biomedical Sciences, UTMB at Galveston Anthony Martin Gerdes developed a precise method to determine cardiac myocyte shape. He then provided a comprehensive understanding of how cardiac myocytes remodel during growth, maturation, aging, cardiac hypertrophy, and heart failure (HF) from many etiologies. After demonstrating that low thyroid hormone function alone can cause heart failure, he showed remarkable beneficial changes in myocyte shape and vascular remodeling, reduced fibrosis, and improved LF function after thyroid hormone treatment of various models of HF (including ischemia, diabetes, hypertension).
Abstract:
In 1950, a study showed that Thyroid Hormone (TH) treatment significantly reduced cardiovascular mortality and rates of myocardial infarction in three patient groups. Rather than extend these findings, subsequent poorly designed larger clinical studies using toxic doses of TH analogs convinced the medical community that TH treatment of heart diseases was too risky, primarily due to increased risk of inducing arrhythmias. Due to a steady stream of positive new information, however, this issue has not gone away. Over the years, we have learned many things about low thyroid function and heart diseases. In many studies, low TH function has been linked to increased mortality in patients with various heart diseases. Many short term clinical studies also show improvement in cardiac patients treated with THs. A key animal study clearly demonstrated that hypothyroidism alone can eventually cause heart failure with maladaptive myocyte remodeling and impaired coronary blood flow. Cumulatively, animal studies suggest that all types of heart disease lead to low cardiac tissue T3 levels. One has to ask the question, why is there so much opposition to a drug that improves systolic/diastolic function, improves coronary blood flow, inhibits myocardial fibrosis, reverses fetal gene expression, and reduces arrhythmias (yes, really)? There are good reasons to be apprehensive. But, is fear of over treatment unreasonable? Is there a safe, therapeutic window for TH treatment of heart diseases, including heart failure? Over the past few years, animal research in our lab has focused on answering the critical questions that have blocked progress to translation in this field. These results will be discussed.
Galya Naydenova Atanasova
University Hospital, Bulgaria
Title: Mean arterial pressure as a component of metabolic syndrome
Biography:
Galya Naydenova Atanasova completed her PhD training in Cardiology from Department of Cardiology, Pulmonology and Endocrinology at Medical University, Pleven, Bulgaria. She is PhD in Cardiology, Cardiologist, General Practitioner, and Assistant Professor at Pleven Medical University, Bulgaria. She has attended to many International Events and presented her research work. She did many researches on metabolic syndrome ,myocardial infarction, and genetic markers. Dr. Atanasova also serves on several national and international committees. She has served on the Editorial Board of International Journal of Clinical Cardiology, etc. She was nominated by the Foundation Photon for research contributions with Academic Excellence Award-2015 and Photon Innovations-2015 Award.
Abstract:
Objectives of this study were to evaluate opportunities of using of mean arterial pressure (MAP) as a component of the metabolic syndrome (MS) instead systolic and diastolic blood pressures (SBP and DBP) and to create a model, using logistic regression. A total of 104 persons without any apparent disease were selected. Among these people MS was found in 35, according to NCEP-ATP III definition. One way ANOVA test, multiple comparison tests of means and multiple logistic regression analyses were used. The MAP was obtained by the formula MAP=SBP/3+2DBP/3. The four groups used in ANOVA were men and women with and without MS. The ANOVA F-statistic is 17.71 with p-value less than 0.00001. Multiple logistic regressions were used to determine odds ratio (OR) of MS. The first model included the following components of MS - waist (WS), HDL cholesterol, blood glucose (GLU) and serum triglycerides (TG). The second model included WS and TG. MAP was used as the last variable in the both models. The p-values for overall models fit statistic was less than 0.00001. The values of regression coefficients and corresponding p-values were calculated. Thresholds for OR above which the decision about presence of MS should be made, were found. The results indicated strong relation between value of MAP and MS. The proposed model showed a reliable determination of MS, using only one biochemical marker.
Sergey Suchkov
I.M.Sechenov First Moscow State Medical University, Russia
Title: Post-infectious autoimmune syndrome (PIFAS) as an integrated and combinatorial biomarker to monitor autoimmune myocarditis and thus the chronification of post-infectious diseases of autoimmune origin
Biography:
Sergey Suchkov, MD, PhD, male, was born in 11.01.1957, researcher-immunologist, clinician, graduated from School of Medicine, A.V.Lunacharskii Astrakhan State Medical University, Russia, in 1980. Suchkov has been trained at the Institute for Medical Enzymology, The USSR Academy of Medical Sciences, National Center for Immunology (Russia), National Institutes of Health Bethesda, USA) and British Society for Immunology to cover 4 British university facili-ties. Dr Suchkov worked for the Central Laboratory at Lenin’s Mausoleum, then at the Institute for Medical Enzymology, The USSR Academy of Medical Sciences, for the Institute of Devel-opmental Biology, Russian Academy of Sciences (RAN), Helmholtz Institute of Eye Diseases, and for Moscow Regional Clinical Research Institute including a position of the Immunologist-in-Chief of the Health Services of the Moscow Region. Since 2005, he has been working as Pro-fessor of A.I.Evdokimov Moscow State Medical & Dental University and I.M.Sechenov First Moscow State Medical University. From 2007, Suchkov was the First Vice-President and Dean of the School of Preventive and Personalized Medicine of the University of World Politics and Law. In 1991-1995, Dr Suchkov was a Chief Scientific Secretary of the Editorial Board of the International Journal “Biomedical Science” (issued by the Russian Academy of Sciences and Royal Society of Medicine, UK). In 1995-2005, Suchkov was a Director of the Russian-American Program in Immunology of the Eye Diseases. Dr Suchkov is a member of the Advisory Board, EPMA (European Association of Predictive, Preventive and Personalized Medicine), Brussels, EU, member of the Editorial Boards, Open Journal of Autoimmunity, EPMA J., Personalized Medicine Universe, American J.Cardiovascular Res. Dr Suchkov has published more than 500 papers. He is known as an author of the Concept of postinfectious clinical and immunological syndrome, co-author of the concept of abzymes and their impact into the pathogenesis of aotuimmunity conditions, and as one of the pioneers in promoting the Concept of Predictive, Preventive and Personalized Medicine.
Abstract:
Development of PIFAS as a post-infectious autoimmune syndrome (PIFAS) to illustrate a new combinatorial and integrated biomarker of the immune-mediated (including latent) disorders is featured with a progression of chronic relapsing diseases of post-infectious origin. We have investigated the syndrome-like immunopathology as applicable to chronic inflammatory processes including chronic myocarditis. In view of the structural homology immune response caused by a microbial pathogen to balance between two categories of epitopes (self-epitopes and microbial epitopes) is being developed through both autoreactive T-cells and auto-Abs. The identification of such pathogen is restricted by some difficulties. Thus, for autoimmune myocarditis (AIM) to make a bridging link with the infection is established for two-thirds of all patients, and transformation of primary (infectious) phase into PIFAS is initiated by mimicking epitopes of, for instance, Coxsackievirus (CVB3) and/or Herpesviridae (CMV), herewith presence of cardiomyosine autoreactive CTLs (CM-auto reactive CTLs) and anti-CM auto-Abs, damaging myocardium to release sequestered autoAgs and to facilitate the induction and/or development of PIFAS is required. We can stress that a tandem of two mutually mimicking epitopes (microbial and self-epitopes) is implicated in the pathogenesis of PIFAS. The therapeutic strategy for such patients should be different. And the identification of the primary pathogen or microbial associate is no less im-portant part of the protocol being used, for what we applied immunodiagnostic screening com-bined with molecular diagnostics. There are no obvious clinical and laboratory criteria to get the syndrome validated. An application of transgenic models to suit the aims of clinical practice will give an opportunity to reveal the events gapped between induction and progressing of PIFAS and will allow to pre-select spe-cific targets to control induction and progression of PIFAS and thus chronification of the clinical illness to prevent the latter in time.
Scott Willoughby
Royal Adelaide Hospital, Australia
Title: Time course of prothrombotic response after radiofrequency catheter ablation for atrial fibrillation
Biography:
Scott Willoughby obtained his PhD in 1999 from the University of Adelaide. From June 1999 to June 2001 he was a Post-doctoral Fellow at the Whitaker Cardiovascular Institute, Boston University Medical Centre and Boston, Massachusetts under the mentorship of Prof Joseph Loscalzo (current Editor in- chief Circulation). Willoughby is the Head of the Thrombosis and Vascular Biology Laboratory at the Centre for Heart Rhythm Disorders, University of Adelaide and South Australian Health and Medical Research Institute, Adelaide, Australia. Dr Willoughby’s research focuses on understanding the integrative physiological mechanisms controlling inappropriate thrombus formation in conditions of increased cardiovascular risk. Dr Willoughby’s work has been published his work in leading journals such as Proceedings of the National Academy of Sciences of The United States of America, Arteriosclerosis Thrombosis and Vascular Biology, Journal of the American College of Cardiology, Heart Rhythm, Circulation Arrhythmia and Electrophysiology and European Heart Journal. He has published more than published 40 papers and serves on the editorial board of 3 journals. He has also received several awards during his career and has received more than $3 million in personal and collaborative research funding.
Abstract:
Introduction: Nonvalvular atrial fibrillation (AF) confers a five-fold increased risk of stroke. Whether catheter ablation (CA) subsequently decreases prothrombotic risk is unknown. Objective: The purpose of this study was to define the time course of inflammation, myocardial injury, and prothrombotic markers after radiofrequency ablation for AF and its relation to AF recurrence. In addition, we assessed the long-term effects of CA for AF on prothrombotic risk. Results and conclusions: Patients undergoing radiofrequency ablation for AF exhibit an inflammatory response within 3 days. The extent of inflammatory response predicts early AF recurrence but not late recurrence. Prothrombotic markers are elevated at 1 week after ablation and may contribute to increased risk of early thrombotic events after AF ablation. Catheter ablation and successful maintenance of SR leads to a decrease in platelet activation and improvement in endothelial function in patients with AF. These findings suggest that AF is an important determinant of the prothrombotic state and that this may be reduced by successful catheter ablation.
L. Ray Matthews
Morehouse School of Medicine, USA
Title: Daily, high dose vitamin D supplementation reduces the incidence of myocardial infarctions in surgical intensive care unit patients
Biography:
Matthews is a full-time faculty member of Morehouse School of Medicine, Department of Surgery in Atlanta, Georgia, where he serves as Associate Professor of Clinical Surgery. Matthews serves as Director of Surgical Critical Care. He received his medical degree from the University of Mississippi and completed his surgical residency training at Morehouse School of Medicine. He completed a two year surgical critical care fellowship at the Mayo Clinical College of Medicine in Rochester, Minnesota. He is a published author on landmark vitamin D-deficiency manuscripts.
Abstract:
Often overlooked, are the roles that chronic inflammation/oxidative stress play in the pathogenesis of myocardial infarctions. We hypothesized that vitamin D (a secosteroid hormone with anti-inflammatory capabilities) would reduce the incidence, length of stay, and hospital costs in surgical intensive care unit patients. We performed a prospective study of 565 patients divided into two groups admitted to the surgical intensive care unit at Grady Memorial Hospital between August 2009 and August 2012. Group 1 was treated with vitamin D 50,000 international units weekly. Group 2 was treated with vitamin D 50,000 international units daily. Primary outcomes were incidence of myocardial infarctions, length of stay, and cost. There were not any statistical differences between the two groups in terms of demographics: age, gender, race, serum albumin, CD4 count, or baseline vitamin D levels. The number/incidence of myocardial infarctions in Group 1 was 22 (7.8%) and 11 (3.9%) in Group 2 (p value 0.047). The length of stay for the 22 patients in Group 1 who had a myocardial infarctions was 36.1 days and 8.2 days for the 11 patients in Group 2 (p value 0.007). The intensive care unit cost for the 22 patients in Group 1 who had a myocardial infarction was $138,991 and $31,549 for the 11 patients in Group 2 (p 0.0005). Our study demonstrates that vitamin D deficiency is associated with an increased incidence of myocardial infarctions, cost, and length of stay. Further studies are needed to fully assess the impact of vitamin D on cardiovascular health.
Veena Dhawan
Institute of Medical Education and Research (PGIMER), India
Title: Terminalia arjuna modulates IL-18-induced inflammation in human monocytic cell line and in patients with stable coronary artery disease
Biography:
Veena Dhawan has completed her Department of Experimental Medicine and Biotechnology, Research Block-B, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh-160012, INDIA. She is the senior faculty (Professor) in the Department of Experimental Medicine and Biotechnology. She has published more than 50 papers in national and International journals.
Abstract:
The bark extract of Terminalia arjuna is used traditionally, as a cardioprotective agent in Ayurvedic system of medicine. Coronary artery disease(CAD)attracts morbidity and mortality worldwide and inflammation plays a pivotal role in pathophysiology of CAD. Besides use of several drugs like statins, inflammation persists in these patients. The present study demonstrates the anti-inflammatory and cardioprotective effects of Terminalia arjuna in vitro in a human monocytic cell-line (THP-1 cells and its validation in stable patients of coronary artery disease. THP-1 cells were exposed to pro-inflammatory cytokine IL-18 and the effect ofan aqueous extract of Terminalia arjuna was evaluated in vitro on the expression of inflammatory molecules.The observations of the in vitro study were further validated in a randomized, placebo-controlled, double-blind clinical trial in 50 subjects with stable CAD who received either placebo or T. arjuna (500 mg twice a day; Himalaya) and were followed up to 6 months. Expression of inflammatory genes eg. CXCL3, COX-2, DUSP-1 and OSM was significantly reduced in vitro in a dose and time-dependent manner by Terminalia arjuna. TA utilized MAPKs and NF-ΚB pathways for its mode of action. These findings were validated in medicated stable-CAD patients who were given Terminalia arjuna. Our data advocates use of Terminalia arjuna as an adjuvant therapy that helps to prevent and ameliorate CAD via its anti-inflammatory and cardioprotective effects. Future studies are warranted in a larger population setup using Terminalia arjuna as an adjuvant therapy to assess its efficacy.
Emile Toby
Global Movement for Human Rights and Justice, West Africa
Title: Awareness and knowledge of sexually transmitted diseases (STDs) among school-going adolescents in Sierra Leone
Biography:
Emile Toby is a Sierra Leonean and graduate from Njala University who has been working with difference organization in the fight against HIV/ AIDS. He started his campaign in 2010 when he formed the Children and Youths in Development to sensitize young on HIV/AIDS. He has attended many national conferences on HIV has partnered with the national aids secretariat in Sierra Leone in organizing sensitization programs on STDS. Mr. Emile Toby started as an HIV peer educator before later became a coordinator so he has gained lots of experience in STDS education. He served as accountant for the International Education and Resource Network (IEARN).
Abstract:
Sexually transmitted diseases (STDs) are a major health problem affecting mostly young people, not only in developing, but also in developed countries. We conducted this systematic review to determine awareness and knowledge of school-going male and female adolescents in Sierra Leone of STDs and if possible, how they perceive their own risk of contracting an STD. Results of this review can help point out areas where STD risk communication for adolescents needs to be improved Over the period 1992-2014, a general increase of gonorrhea and syphilis infections was noted in Africa, both in the general population and among adolescents. From the mid-2000s however, increases in the diagnoses of sexually transmitted diseases, in particular syphilis and gonorrhea have been reported in several African countries, especially among teenagers 16-19 years old. The problem with most STDs is that they can occur symptom-free and can thus be passed on unaware during unprotected sexual intercourse. On an individual level, complications can include pelvic inflammatory diseases and possibly lead to ectopic pregnancies and infertility. The declining age of first sexual intercourse has been proffered as one possible explanation for the increase in numbers of STDs. According to data from different African countries, the average age of first sexual intercourse has decreased over the last three decades, with increasing proportions of adolescents reporting sexual activity before the age of 16 years.
Biography:
Hong Seok Lee, M.D. has completed his M.D. at Catholic University of Korea, and did internal medicine residency at Seoul St. Mary Hospital in Korea. Currently, Hong Seok Lee has been doing internal medicine at New York Medical College, Metropolitan Hospital.
Abstract:
Objectives: To determine how blood pressure, according to the JNC 8 guideline, affected heart failure outcomes in our population. Background: The JNC 8 hypertension guidelines were released in 2014 targeting higher blood pressure goals and in attempt to decrease the use antihypertensive medications. Metabolic syndrome was reported to increase cardiovascular complication and mortality in heart failure. Method: 732 patients enrolled in our heart failure program were analyzed retrospectively. And 344 patients who had been followed since Jan 1st ,2013 were included. We applied a blood pressure goal of less than 150/90 mmHg for patients 60 years of age or older who did not have diabetes or chronic kidney disease. Patients 18 to 59 years of age without major comorbidities, and those 60 years of age or older who had diabetes, chronic kidney disease, or both conditions, the new blood pressure goal is less than 140/90 mmHg. Based on ACC/AHA guidelines, heart failure is classified as a reduced ejection fraction(HFrEF, EF <40), preserved ejection fraction (HFpEF, EF>50) and heart failure with an improved ejection fraction(HFpEF(i),EF≥40).Metabolic syndrome was defined according to NCEP-ATP III. The data were analyzed using SAS Ver. 9.4. Results: 95.9% (330/344) patients were controlled based on the new guidelines. Mean systolic blood pressure was 128.9±18mmHg in HFrEF and 125.1±17 mmHg in HFpEF. Metabolic syndrome [Odds ratio (OR): 0.119,95% Confidence Interval(CI): 0.048-0.284] , ACE inhibitor [OR: 2.659,95% CI: 1.500-0.415] and lasix [OR: 1.904,95% ,CI: 1.068-3.394] were noted to significantly differentiate the controlled versus the uncontrolled BP group in reduced ejection fraction group of our cohort. And metabolic syndrome was associated with blood pressure control in preserved ejection fraction group [OR: 0.340, 95% CI: 0.140-0.827]. Conclusion: According to JNC 8, it appears our patients may be having their B.P. too tightly controlled. Also, this suggests that patients who enrolled in our heart failure program may need less intensive B.P. management. In addition, patients with metabolic syndrome might have association with blood pressure control, which means that metabolic derangement in HFrEF suggests paradoxical effect of metabolic syndrome on blood pressure control.
Alexander Berezin
State Medical University, Ukraine
Title: Circulating endothelial cell-derived micro-particles as a marker of clinical outcomes in chronic heart failure patients
Biography:
Alexander E. Berezin received the MD degree from State Medical University, Zaporozhye, Ukraine, in 1992. PhD degree in field of Heart Failure was earned in State Medical University, Zaporozhye, Ukraine in 1994. He is currently Professor of Medicine, Chief of Cardiology Unit of Internal Medicine Department at State Medical University, Zaporozhye, Ukraine. He became a Member (M) the Ukrainian Cardiology Association in 1997; M of the Ukrainian Heart Failure Association in 2000; M of Heart Failure Association of the ESC in 2004; M of European Acute Cardiovascular Care Association in 2010; M of W.G. on Atherosclerosis and Vascular Biology of the ESC in 2010; M of European Association of Percutaneous Cardiovascular Interventions in 2012; M of European Association for Cardiovascular Prevention and Rehabilitation in 2012, M of W.G. on Hypertension & the Heart of the ESC in 2012. From 2002 to 2012, he was Associate Professor at the Internal Medicine Department at State Medical University, Ukraine. His research interest includes the fundamental study of biological markers of cardiovascular diseases, the implementation of visualization procedures and percutaneous cardiovascular interventions, the development of cardiovascular prevention and rehabilitation, especially in the field affected heart failure and coronary artery disease, as well as regenerative medicine.
Abstract:
Background / aim: Chronic heart failure (CHF) remains a leading cause of cardiovascular morbidity and mortality. Although the endothelium is considered an important targeting for traditional risk factors and endothelial dysfunction remained independently associated with mortality from CHF, the innate molecular mechanisms affected forming of endothelial dysfunction is being became not fully clear. The study aim was to evaluate whether circulating micro particles with apoptotic or none-apoptotic phenotypes are useful for risk assessment of three-year cumulative fatal and non-fatal cardiovascular events in CHF patients. Methods: It was studied prospectively the incidence of fatal and non-fatal cardiovascular events, as well as the frequency of occurrence of death from any cause in a cohort of 388 patients with CHF during 3 years of observation. Circulating levels of NT-pro brain natriuretic peptide (NT-pro-BNP), high-sensitivity C-reactive protein (hs-CRP), endothelial apoptotic micro particles (EMPs) were measured at baseline. Results: Median follow-up was of 2.32 years (IQR=1.8-3.1). During follow-up, 110 cardiovascular events (including 43 fatal cases) were determined. Additionally, 74 subjects were hospitalized repetitively due to worsening CHF and also 16 subjects were readmitted in the hospital due to other cardiovascular reasons. In the univariate logistic regression analysis, the main factors independently related with cumulative end-points were creatinine, fasting glucose, HbA1c, total cholesterol, uric acid various types of EPMs, NT-pro-BNP, hs-CRP, NYHA class, decreased left ventricular ejection fraction (LVEF) less 45%, and type 2 diabetes mellitus. In multivariate model NYHA class, decreased LVEF (less 45%), NT-pro-BNP, hs-CRP, CD144+/CD31+/annexin V+ EMPs, and CD31+/annexin V+ EMPs remained statistically significant for cumulative end-point. Adding of CD144+/CD31+/annexin V+ EMCs and CD31+/annexin V+ EMCs to the standard ABC model may improve the relative IDI for cumulative end-point by 11.4% and 10.5% respectively. These data are very promising, and they are required new investigation with higher statistical power and increased sample size to be overcome the internal limitations of the study. Conclusion: Apoptotic phenotype of circulating micro particles may relate three-year combined clinical outcomes in CHF patients. Finally, identification of the pattern of circulating EMPs may help to determine patients at high risk and reclassify it for possible biomarker-guided therapy of CHF.
- Track 4: Cardiovascular Drugs & Track 6: Interventional Cardiology
Location: San Antonio
Session Introduction
Jose Antonio Franchini Ramires
University of São Paulo Medical School, Brazil
Title: Inflammation, coronary artery disease and liver: what is the relationship?
Biography:
Jose Antonio F. Ramires has completed his Ph.D. at the age of 31 years from University of São Paulo (USP) Medical School. He was the Director of the Heart Institute-INCOR of the University of São Paulo, from 1997 to 2012, where is Head Professor of Cardiology. He was President of the Council to evaluate all the University Professor at USP. He was President of the undergraduate Committee of USP Medical School. He has published more than 480 papers in reputed journals and has been serving as an editorial board member of repute. He was President of the Society of Cardiology of the State of São Paulo, Brazilian Heart Foundation, Brazilian Society of Cardiology, and vice-President of the Interamerican Cardiology Society.
Abstract:
The liver is recognized as a metabolically active organ, responsible for the synthesis of protein, cholesterol and large glycogen storage. Moreover, when stimulated by cytokines released by any inflammatory process, produces and releases proteins into the circulation in response to inflammation, eg fibrinogen, serum amyloid A, C-reactive protein and others. But, while these proteins show the intensity of the inflammatory process they also should serve as a protective response. However, increased fibrinogen may predispose to thrombosis and the pentameric CRP synthesized by the liver becomes monomeric as it is involved in the local inflammation, there becomes the aggressor. With this, we conclude that the liver integrity is important for defending the body, producing inflammation markers and eventually determining aggression. If this reasoning is correct in severe liver disease we would lose the protection, without production of inflammatory response proteins. However, when we compare the presence and characteristic of atherosclerotic plaques of coronary arteries, in four groups of patients: 1-coronary artery disease, 2-liver pre-transplantation, 3-patients with other diseases (non-cardiac or liver) and 4-post-accident or gun, evaluated by necropsy, it was observed that the plaques have different content and different inflammatory response. The most interesting was the finding of the plaque of the row of transplant patients, having the lower cholesterol content, many fibrosis and, practically, absence of intraplaque bacterial agents or hemorrhage. So the question is: several liver failure is a protector of atherosclerosis ?
Cianci Vincenzo
University of Swansea, UK
Title: Initial experience with MINI-OPCABG in hybrid coronary revascularization
Biography:
Vincenzo Cianci is senior registrar in cardio thoracic surgery at the University of Swansea in UK, previously was staff resident of cardiac surgery at the University of Sacred Heart in Campobasso (Italy). He obtained his medical degree at University of Naples (Italy), and he completed his post graduate training at University of Milan. Cianci began his surgical career as fellow at Humanitas Gavazzeni clinic in Bergamo, after he was staff resident at University of Pavia for five years. In 2011 he was senior registrar in cardiothoracic surgery at Queen Elizabeth Hospital at University of Birmingham (UK). In 2012 he was staff resident in cardiocentro Ticino Lugano (Switzerland). His past clinical practice has encompassed the full spectrum of adult cardiovascular and thoracic surgery including experience in heart and lung transplantation, left ventricular assist device. His current practice focuses on minimally invasive coronary Bypass graft , thoracoscopic epicardial atrial fibrillation . He collaborates actively with Prof. Benetti for the development of Hybrid coronary revascularization with a novel surgical technique.
Abstract:
We describe our initial experience in one stop hybrid coronary revascularization using MINI-OPCABG with PCI DES-stenting on the other non-LAD vessel. The large variability in hybrid coronary revascularization techniques makes it difficult to draw firm conclusions from the currently available evidences, but the hybrid strategy using MINI-OPCABG appears to be a promising and cost-effective alternative for CABG in the treatment of multi-vessel coronary artery disease. In this paper we want to point out the methodology and our initial experience. Materials And Methods: Five patients were treated with hybrid revascularization, the average age was 69 ±6.2, one patient had left main and right coronary lesion, four patient three vessels disease and one patient double vessels disease. The average Euroscore II was 7.40% (range 0.33-19.34), the average Sintax score was 34.8 (range33-41) Three patients received Circumflex and right coronary stenting, other two patients only right coronary stenting. We start with surgery (MINI-OPCABG), and in a range of 6 hours patient was undergone to PCI with DES in single stage. Surgical technique: As was described ï›1ï a skin incision is made from the xiphoid up to the level between the third or fourth intercostal space. The sternum is opened and the left table is lifted to dissect the left mammary artery (LIMA). The LIMA was dissected up to the third intercostals space with scheletonized technique The angle of the superior part where the LIMA is attached to the sternum needs to be below 20 % to avoid any potential kinkink. LIMA distance was measured with the pericardium closed if it achieves the diaphragmatic reflection of the pericardium means that LIMA length is correct. The retractor is changed and two stitches around 2 cm deep in the left border of the pericardium was placed with a distance of a 5 to 7 cm with better exposure Lad area , we decided to perform anastomosis with stabilizer always with the opening part towards the head of the patient to avoid any problem of damaging the graft when you need to take it Results: No in hospital mortality was reported. All patients completed hybrid procedure and there wasn’t any conversion to full sternotomy. Mean intubation time was 1, 5 ±3.2 hrs and length of hospital stay was 3.2±1.2 days , one patient received PRBC transfusion , hospital MACCE was 0%. During PCI procedure angiographic evaluation LIMA grafting was routinary performed and LIMA patency rate was 100%. At one year follow up patients freedom from MACCE was 100%. Discussion: In 1997 we performed for the first time in the world an ambulatory coronary surgery using xiphoid approach. ï›2ï We modified this technique opening a small distal part of stenum and we call MINI-OPCABG to this technique. The potential advantage of the MINI OPCABG versus MIDCABG operation is : 1) MINI OPCABG operation is easy to convert to full sternotomy, 2) patients were less painful 3) potential faster recovery 4) reduction of hospital cost The introduction of DES with lower rates of restenosis and better clinical outcomes may make hybrid coronary revascularization a more sustainable and feasible option than previously reported. ï›3ï Nevertheless, this hybrid approach has not been widely adopted because practical and logistical concerns have been expressed. These concerns implicate the need for close cooperation between surgeon and interventional cardiologist, logistical issues regarding sequencing and timing of the procedures and the use of aggressive antiplatelet therapy for DES. We believe that with MINIOPCABG can solve this issues because this surgical technique reduces the surgical trauma without opening pleural space with less discomfort for the patient , moreover the partial dissection of LIMA reduces the risk of post operative bleeding giving the possibility of starting in a range of only 6 hours the PCI procedure. The HCR procedure was associated with short hospital stays (including ICU stay and intubation time), low MACCE and 30-day mortality rate, low PRBC transfusion requirements. ï›4ï This study has limitations because it was based on the retrospective design, moreover patients for one stop hybrid coronary revascularization were also carefully selected and our good results should be interpreted with caution. However there is a small sample size and long term follow-up and randomized multi-center trial comparing one stop hybrid revascularization with MINI-OPCABG with conventional CABG should be needed.
Jean C. Bopassa
University of Texas Health Science Center at San Antonio, USA
Title: Acute post-ischemic GPER1 activation protects the myocardium against ischemia/reperfusion injury by reducing mitochondrial protein ubiquitination, histone acetylation and calpain10 levels and inhibition of the mPTP opening
Biography:
Jean C. Bopassa has completed his PhD at the age of 31 years from Claude Bernard University, Lyon1, France and postdoctoral studies from Harvard University and Unviversity of California at Los Angeles. Currently, he is Assistant professor in the Department of Physiology, in the school of medicine at UTHSCSA. He has published more than 17 papers in reputed journals and has been serving as an editorial board member of several reputed journal.
Abstract:
We recently found that acute pre-ischemic estrogen-induced cardioprotection against ischemia/reperfusion injury was mainly mediated via G protein-coupled estrogen receptor1 (GPER1) activation but not through classical estrogen receptors: alpha (ERï¡) and beta (ERï¢). We investigated whether acute post-ischemic estrogen (PI-E2) treatment can also induce cardioprotective effect via GPER1 activation in the intact animal subjected to ischemia/ reperfusion injury. Male and ovariectomized female were subjected to 35 min of the left anterior descending (LAD) artery occlusion, followed by 180 min reperfusion. An E2 bolus (50 mg/kg) or PBS (same volume) was applied via the femoral vein 5 min before reperfusion and a GPER1 antagonist, G15, was given 10 min before E2. Myocardial infarct size was assessed by TTC staining method. Mitochondrial Ca2+ retention capacity (CRC) required to induce mitochondrial permeability transition pore (mPTP) opening was assessed after 10 min reperfusion. Expression of ubiquitinated; acetylated; calpains1 and 10 proteins were measured by Western Blot in mitochondrial fractions. We found that PI-E2 treatment reduced myocardial infarct size and increased mitochondrial CRC. PI-E2 treatment reduced mitochondrial protein acetylation, ubiquitination and also calpain10 levels in mitochondrial fractions as compared to control, respectively. Interestingly, all these of E2 effects were abolished by addition of G15. Acute PI-E2 treatment induces cardioprotection against ischemia/reperfusion injury via GPER1. PI-E2 effects through GPER1 involve the reduction mitochondrial proteins acetylation, ubiquitination, and calpain10 levels and is associated with the inhibition of the mPTP opening.
Jorge C. Trainini
Hospital Presidente Perón, Argentina
Title: Ventricular torsion and cardiac suction effect: The electrophysiological analysis of the cardiac band muscle
Biography:
Jorge C. Trainini is Surgeon, Chief of Cardiac Surgery Hospital "Presidente Peron" of Avellaneda, Province of Buenos Aires, Argentina. His writings were published trials of blood circulation (Medical Aventis, 2003) and The Crucified thought (Master Eos, 2004), along with some notes appeared in newspapers and magazines. It also has some unpublished works , as Rasinari and desolate geographies. In Lumen Sundown he published his Utopia (2008) test, and his work Pedro Cossio, the Nobel was not (2007), product of his research into the life and work of the eminent Argentine cardiologist, of which he was a disciple.
Abstract:
The Torrent Guasp concept postulates that the ventricles are formed by a continuous muscle band that begins at the level of the pulmonary valve and extends to the aortic root, limiting in this way the two ventricular chambers. This specific anatomical arrangement would support the interpretation of two fundamental aspects of left ventricular dynamics: 1) the torsion mechanism and 2) the physiology of rapid diastolic filling by the suction effect. To investigate the electrophysiological basis of this mechanism, the left ventricular activation sequence was studied by 3D electroanatomical mapping (EAM) in five patients, during radiofrequency ablation of arrhythmias associated to probable abnormal epicardial pathways. As the descending band segment is endocardial and the ascending band segment is epicardial, two approaches were used to perform the mapping.
Conclusions: 1) 3D endo-epicardial mapping shows electrical activation of the apical loop concurrent with synchronic contraction of the ascending and descending band segments; 2) The simultaneous and opposing activation of the ascending band segment to the starting point of its radial activation from the descending band segment, at the point where both band segments cross, is consistent with the clockwise and anticlockwise ventricular torsion of apical and basal areas; 3) Late activation of the ascending band segment, compatible with persistent contraction of the ascending band segment during early isovolumic diastole (basis of the suction mechanism) is produced without need to postulate electrical activation beyond the QRS. The novel activation sequence of the Torrent Guasp band found in this study would explain the previous process triggering the ventricular torsion and suction mechanism. Moreover, this work demonstrates that activation of the ascending band segment completes the QRS. This finding explains the persistent contraction of this muscle segment during early diastole, rejecting the traditional concept of passive relaxation.
Abdulaziz Joury
George Washington University, USA
Title: Severe fibrosing mediastinitis with atypical presentation: effective control with novel therapeutic approach
Biography:
Abdulaziz Joury has completed his medical degree in 2014 obtained from King Saud University, Riyadh, Saudi Arabia. He got his scholarship in internal medicine and cardiology sciences from Ministry of Health, Saudi Arabia. Currently he is working as a research fellow and clinical observer in the George Washington University, Washington, DC. He has been awarded as the best moderated presenter in the European Society of Cardiology Congress that held in Barcelona, Spain in 2014. Joury is interested in cardiology and cardiac sciences and interested to be one of the leaders in future of cardiology.
Abstract:
Fibrosing mediastinitis (FM), also known as sclerosing mediastinitis, is an uncommon but serious disease involving the mediastinal structures. A high index of suspicion is essential to establishing the diagnosis of FM and starting the appropriate therapy for patients. Here, we report a case of a young female who presented with chest symptoms and subsequently underwent different laboratory and radiologic investigations and an excisional biopsy. The findings of these investigations were consistent with the diagnosis of idiopathic FM. Her disease was associated with complete occlusion of three pulmonary veins and the left main pulmonary artery. The patient was treated with initial high-dose steroids followed by maintenance steroid and methotrexate therapy with very good long-term disease control. Clinical response, high-sensitivity C-reactive protein (Hs-CRP) and erythrocyte sedimentation rate (ESR) were used to monitor disease activity and response to therapy.
Khaled Sherif
Texas Tech University Health Sciences Center, USA
Title: Iatrogenic norepinephrine-induced Takotsubo cardiomyopathy
Biography:
Khaled Sherif has completed his M.B.B.Ch at the age of 26 years from University of Tripoli/ Libya and has completed his residency training at Libya in 2008 before he came to USA and finish another residency training in Internal Medicine at Texas Tech University, Lubbock- TX and Geriatric/ Palliative Medicine at University of Oklahoma. He is going to be director of Internal Medicine / Palliative Medicine clinic at Covenant Medical center, Lubbock/TX. He has published more than 15 papers and abstracts in reputed journals and has been chosen as an editorial board reviewer of repute.
Abstract:
Introduction: Stress-induced cardiomyopathy is a syndrome of transient cardiac dysfunction with no clear pathophysiology. It is thought to be secondary to catecholamine surge. The mechanism by which catecholamine can induce transient cardiac dysfunction is unknown. Case: We report a 76 year-old woman who was admitted to the hospital with diverticulitis. Two units of packed RBC with furosemide were ordered. After the patient received blood, norepinephrine 4mg IV was given instead of furosemide due to a nursing error. Soon after that, the patient started complaining of chest pain with dyspnea. Electrocardiogram showed new ST segment and T wave changes in the precordial leads. The cardiac biomarkers were elevated. TTE showed ejection fraction of 25-29%. A coronary angiogram was performed and showed evidence of apical ballooning with no evidence of any coronary artery blockages. The diagnosis of Takotsubo cardiomyopathy was made. The patient was treated with beta-blockers, ACE inhibitors, and aldosterone antagonist for heart failure. Clinically, she improved over time and repeated TTE 6 months later showed EF 50-55%. Discussion: The prevalence of TCM in the general population is estimated to be between 1.7% and 2.2% in patients who present with suspected acute coronary syndrome. It is possible that high doses of catecholamines are directly toxic to myocardial cells. This is supported by histological findings from animal studies and autopsy that document myofibril degeneration, contraction band necrosis, and leukocyte infiltration. In our case, the patient accidentally received a high dose of norepinephrine, which stimulates alpha and beta-1 adrenergic receptors, produces both positive ionotropic and vasodepressor effects. TCM is not a very rare disease but we want to raise awareness of the possible harmful effects of catecholamine on the cardiocytes. To the best of our knowledge, this is first case report about Stress-induced cardiomyopathy secondary to iatrogenic norepinephrine injection.
Biography:
Usama A. Omar has completed his FEBIC at the age of 35 years from National Heart Institute, FEBC at age of 31 y and MSc from Cairo School of Medicine. He is the director of Cath Lab at International Medical Center IMC, a largest militery hospital in Egypt . He has published two papers in reputed journals.
Abstract:
One of the important properity of Gadolinium has a higher atomic number (Z = 64) and a higher k edge (50 keV) than iodine (Z = 53; k edge, 33 keV). These properties allow gadolinium and iodine to absorb x rays in the diagnostic energy spectrum. the higher k edge of gadolinium allows the use of imaging at a higher kilovolt peak level (in the range of 96 kVp) without the loss of contrast, as compared with a lower kilovolt peak level used for imaging with iodinated media (in the range of 73 kVp). So, radiographic images of similar volumes of gadolinium exhibit one-eighth to one-fourth strength iodine preparation ,However, gadolinium chelates are limited as an angiographic contrast media because of the relatively low concentration of gadolinium chelate molecules in the preparations available in the United States. Gadolinium, occupying central position in the lanthanide series has 7 unpaired electrons and gives excellent signal in MRI. Adding gold chelates can give rise to nanosystems detectable both by X-Ray CT and MRI. They encapsulate gold nanoparticles with a multilayered organic shell composed of gadolinium chelates bound to each other with disulfi de bonds .This nanoparticle complex could be served both as X-ray and MRI contrasting agent due to presence of radiopaque gold and superparamagnetic gadolinium ions Beam hardening results in increased image contrast for a given concentration of gadolinium relative to that of iodine and accounts for some of the differences noted between theoretical models and calculations and in vivo observations of image contrast.which give us an idea about viable tissue with enhaced gadolinuim ,this gives a great evidence based medicin of sucessfule reperfusion and tissue viability by post procedure MRI.
Mohamed Ayan
Creighton University Medical Center, USA
Title: Treatment of bare metal stent in-stent restenosis with balloon angioplasty alone versus stenting: meta-analysis of randomized controlled trial
Biography:
Mohamed Ayan has completed his medical school at Tripoli University. He did his internal Medicine residency at Tripoli University Affiliated hospitals and Master of Public Health at Benedictine University, Lisle IL. He is currently a third year internal medicine resident at Creighton University Medical Centre, and is very interested in Cardiology and research, applied for cardiology fellowship this year. He is also a member in Committee on Scientific Research (CoSR) Resident and Fellow section American Medical Association. He has more than 20 peer reviewed journal/abstract published. Furthermore, he is serving as per reviewer for SGIM and ACP annual meeting.
Abstract:
Background: In-stent restenosis of bare metal stent (BMS) is one of the major drawback of primary coronary intervention (PCI). Currently there is no ideal treatment for BMS restenosis. We aimed to perform meta-analysis for randomized controlled trials assessing the long-term safety and efficacy of stenting versus balloon angioplasty for patient with BMS in-stent restenosis.
Method: We conducted a comprehensive search for randomized controlled trials (RCT) using special search criteria. Five prospective randomized controlled trials were identified. Relative Risk (RR) and 95% confidence intervals (CI) computed using the Mantel-Haenszel method. Random-effect model was used in analysis of all the variables.
Result: A total of 5 RCT were included in the meta-analysis, a total of 1486 patients were enrolled. At one year follow up compared to balloon angioplasty using stenting in treatment of BMS in-stent restenosis reduced the rate of target vessel revascularization (RR -2.1; 95% CI, -2.6 to -1.6, P = 0.000). However, there were no significant differences in the rate of mortality (RR -2.1; 95% CI, -2.6 to -1.6, P = 0.000) and myocardial infarction (RR -2.1; 95% CI, -2.6 to -1.6, P = 0.000).
Conclusions: In patients with BMS in-stent restenosis, the outcome of using stenting was superior to balloon angioplasty alone in reducing the rate of target vessel revascularization, however; there were no statistically significant difference in the rate of mortality and myocardial infarction.
Anjali Om
McLeod Regional Medical Center, USA
Title: Hypomagnesaemia post-percutaneous coronary interventions
Biography:
Anjali Om is a sophomore at Virginia Commonwealth University in the Guaranteed Admissions BS/MD program.
Abstract:
Nearly a million patients undergo percutaneous coronary interventions (PCI) in the United States every year. These patients are at high risk for arrhythmia, which can be precipitated by electrolyte imbalances, such as hypokalemia or hypomagnesemia. The effect of PCI or contrast used on these electrolytes post-procedure has not been well studied. We retrospectively analyzed the charts of 426 consecutive patients who had serum magnesium levels checked within two days pre-PCI and within two days post-PCI from January 2010-July 2015. Normal serum magnesium level in our lab was 1.4-2.0 (mEq/L). Of the 426 patients, 139 (33%) had a decrease of 0.4 mEq/L or more. Ninety (21%) patients had post-PCI serum magnesium levels ≤ 1.4 mEq/L. Despite PCI, the risk of arrhythmia in these patients remains high, especially in the immediate post-procedure period. If untreated, hypomagnesaemia post-PCI could precipitate arrhythmia in such high-risk patients. If confirmed in a larger series of patients, this new observation could necessitate a post-PCI check of electrolytes in all patients to minimize the risk of arrhythmia. The pathophysiology of hypomagnesaemia post-PCI would need further elucidation.
Francis Carl Catalan
Cardinal Santos Medical Center, Philippines
Title: A 44 year old male presenting as st elevation myocardial infarction in kawasaki disease: Case report
Biography:
Francis Carl L. Catalan MD presently an Adult Interventional fellow at Cardinal Santos Medical Center. He had his premedical major in Bachelor of Science in Physical Therapy. Following a completion of his Internal Medicine residency at the East Avenue Medical Center and Adult Cardiology training in Philippine Heart Center. To further augment his acquired clinical expertise and skills, he worked and acquainted himself in various hospital settings for 3 years. His competence as a doctor is not only existent in a clinical setting. But holistically, he exhibited competency in research and scientific presentations. He was duly recognized by various renowned research committees in Hong Kong, and Dubai. He is interested in interventional and experimental cardiology. He is also very excited to be part of this conference where he can learn from future innovations and practices.
Abstract:
Introduction: Kawasaki disease is a form of vasculitis that is self-limiting and usually occurs in children.. Its incidence is high in Japan and in Korea. Several causes have been inflicted as a trigger to Kawasaki but some studies mentioned toxins such as fungal toxin or bacterial superantigen. In children, it is easy to diagnose by using the clinical criteria such as persistent fever of more than 5 days, lymphadenopathy, strawberry tongue, rash and conjunctivitis. However, this criteria has not been widely accepted in adults. In Kawasaki disease, 25% of them may present with coronary artery aneurysm. It is defined as dilatation of more than1.5 times of the patient’s largest coronary. Case: This is a case of a 44-year old male, hypertensive, smoker, physician who came in due to sudden onset of chest pain. The pain was described to be chest heaviness, continuous, not relieve by rest, VAS 7/10. His family had no history of premature coronary artery disease. He had recurrent rhinitis and conjunctivitis during his childhood. On examination, he was stable with the following vital signs: blood pressure of 120/70, heart rate of 70 beats per minute, a respiratory rate of 18 cycles per minute, temperature of 36.8 C. He weighs 90 kg with a BMI of 21. His electrocardiogram revealed an ST segment elevation over the inferior leads (leads II, III and aVF). Initial troponin showed normal result but there was a 20% increment on the repeat troponin determination.Two dimensional echocardiography showed preserved ejection fraction of 75% with adequate wall motion and contractility With the presentation of classic angina and electrocardiogram result, he was brought to the catheterization laboratory for an emergency double set up. Emergency coronary angiography was done and revealed an ectatic right coronary artery with a large aneurysm over the distal segment and thrombus within its lumen. Aspiration thrombectomy was done hoping that the lumen would be free from thrombus but none was aspirated. Intracoronary Tirofiban was also administered. There was regression of the ST elevation. The patient was admitted for 5 days and was maintained on dual antiplatelet and anticoagulation. Currently, he is asymptomatic, on going rehabilitation with stable vital signs. Conclusion: Although atherosclerosis is the most common cause of Acute Coronary Syndrome, we should be mindful to the feasibility of unwonted causes of angina like dissection, inflammatory or autoimmune diseases. As a cardiologist, we should be wary with high index of suspicion of these rare entities as a cause of angina.
Tatyana Korolenko
Institute of Biochemistry SB RAMS, Russia
Title: Serum Cystatin C in patients with coronary stents and risk of restenosis
Biography:
Korolenko Tatyana is Post Doc from Institute of Physiology and Fundamental Medicine SB RAMS, Russia. Korolenko Tatyana has a research experience of Immunomodulators,Cell Biochem ,Novosibirsk,proteases, lysosomes. Korolenko Tatyana has 144 publications.
Abstract:
Objectives: To investigate whether patients with atherosclerosis after coronary stenting display altered serum cystatin C as a possible biomarker of acute ischemia.
Background: The incidence of coronary restenosis after stent placement is high, especially in the 1-year follow-up. Inflammation plays an important role in the pathogenesis of in-stent restenosis, causing neointimal proliferation through the stent meshes. Subsequent in-stent restenosis may affect the long-term safety and efficacy of angioplasty and stenting. Cystatin C was recently suggested as a candidate biomarker in cardiovascular pathology.
Methods: 34 male patients (61.8 ± 7.3 years) treated by anticoagulant therapy were enrolled in a study from the Outpatient Clinic N 1 of Novosibirsk (6 mos - 1 year after coronary stenting). The control group consisted of 25 healthy persons (50-65 years old). Serum CRP-hs, D-dimer (Architect C-8000, USA) and Cystatinc C by ELISA kit for humans (BioVendor, Czechia) were measured in all groups.
Results: In healthy persons, aged 50-65, an elevation of serum cystatin C (1.11± 0.23 mg/L, p< 0.01) was shown vs. healthy persons, aged 20-40 years. In patients with coronary stents, there was a significant increase in serum CRP-hs (p < 0.001), D-dimer (p < 0.001) and cystatin C (2.05 ± 0.21 mg/L, p < 0.001) vs the control (aged 50-65). Positive correlation was shown between cystatin C and d-Dimer in stenting patients (r = 0.45; p < 0.05).
Conclusions: Serum cystatin C is elevated in patients with coronary stenting, as well as CRP-hs, indicating on inflammation, increased risk of in-stent restenosis and ischemia.
Tatyana Korolenko
Institute of Physiology and Fundamental Medicine SB RAMS, Russia
Title: Serum cystatin C, an index of renal dysfunction, as a marker in ischemic heart disease
Biography:
Korolenko Tatyana is Post Doc from Institute of Physiology and Fundamental Medicine SB RAMS, Russia. Korolenko Tatyana has a research experience of Immunomodulators,Cell Biochem ,Novosibirsk,proteases, lysosomes. Korolenko Tatyana has 144 publications.
Abstract:
Objectives: To investigate whether patients with ischemic heart disease display altered serum cystatin C related to impaired renal function and/or as a possible biomarker of acute ischemia. Background: Cystatin C, a well known index of renal dysfunction, more efficient than creatinine, was recently suggested as a candidate biomarker in cardiovascular pathology. However, the precise role of cystatin C in cardiovascular diseases in acute myocardial infarction (MI) is not studied enough. The aim: to evaluate serum cystatin C in patients with ischemic heart disease in dynamics of myocardial infarction development. Methods: Forty-two male patients (62 ± 5.0 years) were enrolled in a study from Scientific Center of Experimental and Clinical Medicine of Novosibirsk. The control group consisted of 80 healthy persons of the appropriate age. Serum hs-CRP, D-dimer, cystatin C, creatinin, urea, lipid profile, LDH, CPK, CPK-MB were measured with help of Architect 8000 (Abbott, USA) and Access-2 (Beackman Coulter, USA), pro-BNP by ELISA method. Results: In healthy persons, aged 50-60, an elevation of serum cystatin C was shown vs. healthy persons, aged 20-40 years. In patients with ischemic heart disease, there was a significant (p < 0.001) increase in serum CPK-MD, CRP-hs D-dimer and elevated (p < 0.01) CPK, cystatin C vs the control. Positive correlation was shown between serum pro-BNP concentration and cystatin C (r = 0.57, p< 0.05) and correlation between pro-BNP and urea (r = 0.49, p< 0.05) indicating on cardio-renal syndrome development. Conclusions: Serum pro-BNP, cystatin C is elevated more significantly as compared with patients with myocardial infarction, as well as CRP-hs and D-dimer levels, indicating that these indexes can be used as predictors of increased risk of acute ischemia.
- Track 9: Cardiac Imaging
Session Introduction
Ersel Onrat
Afyon Kocatepe University, Turkey
Title: Late period dual chamber pace maker lead thrombus in a patient shortly after the onset of atrial fibrillation
Biography:
Ersel Onrat, MD, male, he was born in Turkey 1970, married and has one child. He graduated from School of Medicine, Hacettepe University in 1993 and attended the Osmangazi University, School of Medicine, Cardiology Department and graduated as a cardiologist in 1998. In 1999 he founded Cardiology Department in School of Medicine in Afyon Kocatepe University. He is a Professor since 2012 and also the chief of the Cardiology Department, chief of the Coronary Catheterization Labratory in School of Medicine in Afyon Kocatepe University, a lecturer in the same faculty as well.. Dr. Professor Ersel is interested in interventional cardiology and has some projects about atrial fibrillation, idiopathic dilated cardiomyopathy and cardiac rehabilitation. He has 44 scientific cardiology article in international cardiology journal.
Abstract:
Seventy four years old, caucassian female patient brought in to emergency department for an acute onset and deteriorating dyspnea. A DDD-R pacemaker was implanted seven years ago because of complete AV block. Previous routine follow-up exams and pacemaker technical values were within normal limits in all 7 years. But she was in atrial fibrillation in last follow up which was one month ago before detecting thrombus in pacemaker lead. Transtorasic echocardiography revealed a 1.5 x3.0 cm trombus in the right atrium attached to the lead (Figure 1). Patient was admitted to cardiovasular surgery intensive care unit with a plan for surgery because of large thrombus. Electrode-associated right atrial (RA) thrombus appears to be relatively common in acute period after pacemaker implantation and It’s usually asymptomatic. Patient’s previous follow-ups were within normal limits in 7 years. Probably an electrode-associated RA thrombi in this case has been happened after atrial fibrillation started and she has been taking no anticoagulan medicine. The important point which makes this case novel is there wasn’t thrombus formation before the patient was in AF in 7 years . According to best of our knowledge, there is no preivous case presented as atrial fibrillation associated pace maker lead thrombus in late period after lead implantation. It’s important to initiate anticoagulation as soon as the AF is detected, in patients with pacemakers. It is important that thrombus can occur in right chambers of heart beacuse of pacemaker electrodes.
Onder Akci
Afyon Kocatepe University, Turkey
Title: Possible coronary artery dissection due to electrical shock resulted in myocardial infarction
Biography:
Onder Akci has completed his PhD and he is Medical Faculty in Department of Cardiology at Kocatepe University, Afyonkarahisar, Turkey
Abstract:
Electric shock induced myocardial infarction is a rare condition. Electric shocks can lead to a wide vairety of clinical conditions from skin burns to fatal arrhythmic complications. Coronary angiogram of those patients are usually normal. Coronary thrombosis after electric shock has been accused of this consequence. The right coronary artery is the most affected artery. It’s believed to be due to the location of the right coronary artery, which is in close proximity to the chest wall. This case is about a 49 years old female patient presented with myocardial infaction right after an electric shock. The coronary angiogram revealed right coronary artery dissection. According to best of our knowledge, this is first case in the literature. The complete revascularization was achieved by implantation of a bare metal stent in the dissection site.
Ersel Onrat
Afyon Kocatepe University, Turkey
Title: The evaluation of pulmonary artery distensibility by echocardiography in patients with rheumatoid arthrtitis with having no pulmonary hypertension
Biography:
Ersel Onrat, MD, male, he was born in Turkey 1970, married and has one child. He graduated from School of Medicine, Hacettepe University in 1993 and attended the Osmangazi University, School of Medicine, Cardiology Department and graduated as a cardiologist in 1998. In 1999 he founded Cardiology Department in School of Medicine in Afyon Kocatepe University. He is a Professor since 2012 and also the chief of the Cardiology Department, chief of the Coronary Catheterization Labratory in School of Medicine in Afyon Kocatepe University, a lecturer in the same faculty as well.. Dr. Professor Ersel is interested in interventional cardiology and has some projects about atrial fibrillation, idiopathic dilated cardiomyopathy and cardiac rehabilitation. He has 44 scientific cardiology article in international cardiology journal.
Abstract:
Introduction: Rheumatoid arthritis is a systemic inflammatory disease that has pulmonary system involvement. Fibrosis of the lungs and interstitial lung disease are associated with RA in some patients, and early diagnosis is a cornerstone in treatment. Pulmonary artery distensibility has been investigated using MRI and echocardiography. It has been found well correlated with the severity of pulmonary hypertension.The aim of this study was to investigate whether echocardiographic measurement of the right pulmonary artery distensibility (percentage change in diameter of the right pulmonary artery in systole and diastole) may be of value in assessing the presence of pulmonary disease before it is symptomatic or it can be diagnosed by conventional methods. Materials and Methods: Forty-three patients (6 male, mean age: 55.3±12.3, mean disease duration:12.9±9.7 years) with RA and age and sex matched 18 healthy subjects ( 4 male, mean age: 42.6±15.7 ) recruited for the study. The body mass index values were similar in both groups. The RA group was clear of lung involvement proved with symptoms and chest x-rays. Mean pulmonary arterial blood pressure is normal in both groups (patient and control). In addition to conventional echocardiographic evaluation all subjects are evaluated for right pulmonary artery distensibility index (RPAD Index), which is calculated as the difference in diameter of the right pulmonary artery in systole and diastole. All echocardiographic measurements were done by two cardiologists and Both inter- and intraobserver variabilities were < 5% for all echocardiographic variables. Findings: Mean RPAD was 0.17 ±0.05 mm in patient group and 0.21±0.06 mm in control group. RPAD was higher in patient group but there wasn’t a statictically significant difference for RPAD between patient and control group Results: According to our results, RPAD is worsened in patients with RA, but it’s not significant. Low RPAD may be an early sign of lung involvement in RA and it should be verified with follow-ups for longer duration closely.
Onder Akci
Afyon Kocatepe University, Turkey
Title: Does pulse wave velocity predıct left internal mammarıan artery flow?
Biography:
Onder Akci has completed his PhD and he is Medical Faculty in Department of Cardiology at Kocatepe University, Afyonkarahisar, Turkey
Abstract:
Introduction: Atherosclerosis is a chronic, inflammatory and focal disease of the middle and large arteries. Coronary arteries, popliteal arteries and internal mammarian arteries (IMA) are middle sized arteries and they are prone to early atherosclerosis. Conventional risk factors of atherosclerosis (hypertension, diabetes mellitus, hyperlipidemia, advanced age, smoking, male sex) are a sign of extension of atherosclerosis and their existence correlated well with pulse wave velocity (PWV). Increased PWV is also an independent risk factor for cardiovascular mortality and morbidity. IMA is the most widely preffered artery for anastomosis in coronary artery bypass grafting (CABG). Because IMA is also an artery that is prone to atherosclerosis, the size and the blood flow through IMA has always been an interest for surgeants preoperatively. We investigated the relationship between PWV and IMA size ve blood flow in patients who are candidates for CABG. Material and Method: We recruited 21 patients (16 male, mean age 64,3) planned for CABG operation. Aortic PWV values are evaluated by echocardiography (GE, vivid E9, Solingen, Germany). IMA size and flow parameters are evaluated intraoperatively by cardiovasular surgeants. Findings: According to the early resuts of this prospective study, mean aortic PWV value was 9,32±1,69 m/sec, mean IMA diameter was 1,53±0,05 cm and mean IMA flow was 29,2±1,2 cc/min. Results:We found a statistically significant correlation between the IMA flow and IMA diameter (p < 0,05). But there wasn’t a significant correlation between the IMA flow or diameter and PWV (p > 0.05). According to our study, aortic pulse wave velocity can not predict IMA flow or IMA diameter.
Innocent Chima Nwaogu
University of Nigeria, Nigeria
Title: Morphology and histomorphometry of the aorta and its branches in grass-cutter (Thyronomys swinderianus)
Biography:
I. C. Nwaogu obtained his DVM from Kishinev Agricultural institute, USSR, MSc and PhD from the University of Nigeria, Nsukka (UNN). He is a Fellow of College of Veterinary Surgeons, Nigeria and currently the Head, Department of Veterinary Anatomy, UNN. He has published several scientific articles in reputable peer-review local and international journals and serves as member Editorial board, Nigerian Veterinary Journal.
Abstract:
The morphology and histomorphometry of the aorta and its branches in Grasscutter were studied using gross and light microscopic methods. The grasscutters were obtained from Demaco Farms in Akor-Nike in Enugu State, Nigeria and brought to the Department of Veterinary Anatomy, University of Nigeria , Nsukka for anatomic studies. They were humanely sacrificed, carefully dissected and patterns of arteries that originated from their aortic arch and descending aorta were examined. Segments of the aorta and its major branches were fixed in Bouin’s fluid and routinely processed for histology. The brachiocephalic trunk and left subclavian artery originated separately from the aortic arch. The brachiocephalic trunk gave off right subclavian and continued as a common trunk for the right and left common carotid arteries. Bronchoesophageal and dorsal intercostal arteries originated from the thoracic aorta. The abdominal aorta gave off the celiac, cranial and caudal mesenteric, renal, lumbar arteries and terminated into paired external and internal iliac and median sacral arteries. Microscopically, the aorta and its branches were elastic type of arteries though celiac and external iliac had characteristic features of both elastic and muscular arteries. The mean wall thickness and and luminal diameter were 580.38±2.07, 3442.78±68.05; 376.64±4.06, 3026.18±82.89 and 334.74±8.17, 2663.38±55.85μm for aortic arch, thoracic and abdominal aortae, respectively. The mean wall thickness and luminal diameter were 388.94±2.00, 2236.72±55.15; 236.16±30.00, 1598.68±95.22; 294.36±7.78, 1507.90±239.95 and 235.78±22.74, 1391.54±251.61μm for brachiocephalic trunk, left subclavian, celiac and external iliac arteries, respectively.
- Track 1: Clinical cardiology & Track 5: Pediatric heart diseases
Location: San Antonio
Session Introduction
Khaled Elmaghraby
Minia University, Egypt
Title: Elevated levels of neopterin are associated with coronary complex plaques in patients with acute coronary syndrome
Biography:
Khaled Sayed Mahmoud El Maghraby has completed his M.D. at the age of 34 years from AL Minia University. He is the associate professor of cardiology. He has published more than 26 papers in reputed journals.
Abstract:
Background: Neopterin, an immune modulator, produced by activated macrophages. Neopterin and many other proteins implicated in disruption, and plaque progression.
Aim: To investigate the association between plasma neopterin levels and the complexity of coronary angiographic lesions
Patients and methods: During a 12-month period, Forty five patients(Pts) had acute coronary syndrome without ST segment elevation and 15 age matched healthy subjects serve as control group were included in our study. None of the included subjects had ongoing systemic or cardiac inflammatory processes. All underwent a detailed clinical evaluation, routine laboratory investigations, troponin I, electrocardiogram and echocardiography. Quantitative assay of neopterin was measured using enzyme linked immunosorbent assay (ELISA) technique. Angiographic extent and severity of coronary artery disease were assessed and scored according to a Syntax score.
Results: There was a significant difference in neopterin level in pts with high syntax score (14.66±2.81 nmol/L) and those with Intermediate syntax score (11.12±1.5 nmol/L) when compared with low syntax score Pts (8.91±1.59 nmol/L) P value 0.001. Also this significance was noted when high syntax score Pts were compared with intermediate score (P value 0.03)
Conclusion: Serum neopterin concentration is associated with the presence of angiographically demonstrated complex lesions in patients with acute coronary syndrome. Our results suggest that neopterin level may be useful for risk stratification in patients with coronary artery disease
Biography:
Rohit Sane, Pioneer of Ayurvedic non- invasive cardiology in India with those 200+ Ayurvedic physicians team treated more than 20,000 CHD patients.
Abstract:
Introduction: National Commission on Macroeconomics predicted that by year 2015, India will have nearly 61 million coronary heart disease (CHD) cases which would to lead to 3.4 million of deaths. Many novel pharmacotherapeutics and non-pharmacotherapeutics options are currently ceasing the worsening of cardiac conditions, however, these options especially pharmacotherapeutics bring in lifetime dependency in patients. Affordability and side effects of the treatment remains the major concern for mass patient population. In such scenarios, Sampurna Hriday Shudhikaran (SHS), a novel Ayurvedic non-interventional therapy, of six days can be believed to give in genuinely promising and convincing outcomes. Therefore, present study was aimed to assess the effectiveness of SHS retrospectively in chronic heart failure (CHF) patients after three years.
Materials and Methods: SHS consisting of four major procedures - Snehan, Swedan, Hridhara, Basti procedure were carried out in the same order two times a day on patients for six consecutive days. Highly efficacious naturally medicated oils and other formulations were topically used in this treatment. In this retrospective cohort study, 690 patients who were admitted in Madhavbaug centres across Maharashtra during the year 2010-2011, were contacted by phone, out of which 542 patients were willingly to participate in this survey and were consented verbally. Primary data was collected using a tailored questionnaire over phone and analysed for mortality, survival and re-hospitalization rates. Secondary data analysis was done for outcomes like 6 Minute’s Walk Test (6MWT) in meters and Metabolic Equivalents (METs) done before and after the patients were treated with SHS therapy.
Results: SHS showed remarkable improvement in study population where 72.32% patients improved from NYHA Class II and III to NYHA Class I, 12.96% still possessed NYHA Class II, III and IV symptoms and 14.76% were dead. The re-hospitalization rate was 9.39% which covered elderly age group 50-59 years. The mean improvement after six days of SHS therapy was found to be 65 meters in 6MWT and 1.6 METs value.
Conclusions: This treatment has proven to improve functional capacity & quality of life in CHF patients to a significant extent. Positive cardiovascular health outcomes even after three years indicates long lasting cardioprotective effects of SHS.
Khaled Elmaghraby
Minia University, Egypt
Title: How accurate can electrocardiogram predict left ventricular diastolic dysfunction?
Biography:
Khaled Sayed Mahmoud El Maghraby has completed his M.D. at the age of 34 years from AL Minia University. He is the associate professor of cardiology. He has published more than 26 papers in reputed journals.
Abstract:
Background: Heart failure continues to be a major challenge to healthcare; several resting and exercise electrocardiographic parameters have been investigated to predict the left ventricular diastolic dysfunction (LVDD).
Objectives: We aimed to study different parameters in resting and exercise stress test to evaluate whether they can predict left ventricular diastolic dysfunction (LVDD).
Methods: One hundred and forty patients, classiï¬ed into 2 groups according to LVDD, were assessed by measurement of normal and corrected QT interval, T wave peak to T wave End and P wave dispersion in resting ECG. Exercise stress test looking for hump sign (upward deflection of the ST-segment) was done. The relationships between these ECG parameters and LVDD were investigated.
Results: We found signiï¬cant occurrence of hump sign in patients with LVDD, and there was a signiï¬cant difference between both groups regarding QTc and P wave dispersion. P wave dispersion was signiï¬cantly higher in patients with LVDD. Sensitivity and speciï¬city of the ST hump sign in prediction of LVDD were 86% and 78% respectively. We also concluded that P wave dispersion at cutoff value about 0.045 ms had the highest sensitivity (sensitivity 98%, speciï¬city 64%) while QTc at cutoff value 0.395 ms had the highest speciï¬city (sensitivity 81%, speciï¬city 79%).
Conclusion: P wave dispersion and hump sign were the most sensitive ECG signs for the prediction of LVDD.
Amira Esmat El Tantawy
Cairo University, Egypt
Title: Change in risk factors influencing cardiac functions in pediatric renal transplanted patients
Biography:
Amira Esmat El Tantawy has completed her PhD in Pediatrics from Kasr Alainy School of Medicine Cairo University, she is a Professor of Pediatrics and Pediatric Cardiology Consultant in Cairo University. She is the Director of Pediatric Cardiology training in the Department of Pediatrics, Abo El riesh Children’s specialized Hospital. She is one of Coordinators of Quality Assurance Cairo University. She is a Board Member founder of Ministry of health Pediatric Cardiology Fellowship. She won Cairo University Award of the best PhD thesis in 2012. She has more than 20 publications of which 6 are recognized internationally.
Abstract:
Cardiovascular disease accounts for the majority of deaths in children with chronic kidney disease (CKD) and post renal transplantation. The main objective of this work was to study the prevalence of the different cardiovascular risk factors presented either before or after renal transplantation measuring the LV function using conventional 2D , M mode echocardiography (left ventricular mass index (LVMI), pulsed Doppler (E/A ratio) and tissue Doppler imaging ( E’, A’, E’/A’ , and E/E’). This Cross-sectional, observational study included 30 children with renal transplantation and 10 normal children as control. Patients age of ranged from 5-14 years. Significant improvement in risk factors: Anaemia, Hypercholesterloaemia and hypertension HTN (p value 0.002, 0.005, and < 0.001 respectively) after renal transplantation was observed. Among transplanted patients, Prevalence of left ventricular hypertrophy was 93.3%. Patients have significant increase in left ventricular mass index (LVMI) than controls ( p<0.001), significant higher E/A ratio (p 0.014), and Significant lower A’ (p <0.001), Presence of HTN pre and post renal transplantation was the only risk factor significantly affecting the diastolic cardiac function with significant E/E’ (p 0.001 and p<0.001).
Sahar Shaker Sheta
Cairo University Children's Hospital, Egypt
Title: Real time three dimensional echocardiography in valvular pulmonary stenosis among pediatric age group
Biography:
Sahar Sheta has graduated M.B.B.Ch from the Faculty of Medicine ,Cairo, EGYPT 1989 and was signed up excellent. M.Sc in Pediatrics1994 . M.D in Pediatrics and Pediatric Cardiology 1998. Professor of Pediatrics and Pediatric Cardiology in the Department of Pediatrics since 2009 .Head and Director of Non Invasive Echocardiography Lab., Cairo University Children’s Hospital 2014. She has published more than 15 papers in reputed journals both nationally and internationally.She has been an invited speaker and chairperson in several international Pediatric cardiology conferences in USA, Europe and Middle East .
Abstract:
Background: Two Dimensional transthoracic echocardiography ( 2D –TTE) has been standard diagnostic imaging in patients with pulmonary valve stenosis ( PVS) .Recent advances has been the development of real time three dimensional transthoracic echocardiography (RT 3D-TTE) matrix-array transducers. Right ventricular outflow tract and pulmonary valve was not studied before by RT 3-D TTE among children. Objective: To determine the feasibility of RT 3D-TTE in the evaluation of PVS and measurement of pulmonary valve annulus (PVA), assess its reliability, reproducibility when compared with the standard 2D-TTE and invasive transcatheter angiography measurement. Methods: Prospective clinical study included 30 pediatric patients with mean age 2.76 years diagnosed with pulmonary valve stenosis were assessed by 2D-TTE, 3D-TTE and transcatheter angiography. Results: Transcatheter angiography sizing of (PVA) diameter had higher Pearson's correlation coefficient with RT 3-D TTE measurements (r = 0.909 & 0.812 respectively) than for 2-D TTE (r = 0.752). Measurements of PVA by the three techniques were compared with the reference standard by means of a Bland–Altman plot. Smallest mean absolute difference was obtained between (PVA) measurement trans catheter angiography (0.01(-0.07) cm) and RT 3D TTE diameter (0.01(-0.09) cm) rather than 2D TTE (0.11 (-0.06)cm). Interobserver reproducibility was calculated by means of intraclass correlation coefficient (ICC) of 2D-TEE was 0.983 (CI 95% 0.969 - 0.991; P < 0.001). Similarly, the value obtained with 3D-TTE was 0.981 (CI 95% 0.965–0.990; P < 0.001). Conclusion: RT 3D-TTE assessment of PVA is a feasible, reliable and reproducible imaging among children with PVS.
- Video Presentations
Session Introduction
Manuela Stoicescu
University of Oradea, Romania
Title: The chest pain with normal EKG
Biography:
Manuela Stoicescu is Consultant Internal Medicine Physician, PhD, Assistant Professor of University of Oradea, Faculty of Medicine and Pharmacy, English Section, Medical Disciplines Department, Romania and worked in the Internal Medicine Department. She published two books for students: Clinical cases for students of the Faculty of Medicine in English and Rumanian language, one monograph:” High blood pressure in the young an ignored problem?!”, a book on Amazon at an International Editor in Germany Lambert Academic Publishing –“Side Effects of Antiviral Hepatitis Treatment”, recent (march2015) a book with OMICS eBooks Group USA – “Tumour Markers in Hypertensive Young Patients”, many articles in prestigious ISSN Journals in USA, she’s Editorial Board Member in 2 ISSN Journals in USA and she was invited as speaker at 30 International Conferences all most of them in USA, Canada, China, Japan, Thailand, Spain, Dubai.
Abstract:
Objectives: The main objectives of this clinical case presentation is to attract attention about the situation from our medical practice when we can have a patient with typical constrictive chest pain like in ischemic heart disease but with normal EKG in crisis. Confers this normal EKG us safe that the patient is not in dangerous situation?
Material And Methods: I present the clinical case of a women patient 46 years old, in early menopause because of stressful situation in she’s family, who came at consultation with sudden constrictive chest pain, high intensity, irradiation in to the left shoulder, anxiety and sweating. Mention, very important, that the EKG was normal without ischemic – lesions changes in crisis of chest pain, but the pain disappeared immediately in 2 min after one drug 0,5mg of Nitroglycerine under the tongue. Because the patient was in menopause (so lost the estrogen protection for atherosclerosis and heart attack) in this stressing condition at home I have decided to be hospitalized for more safe indifferent that the pain stopped at the moment and the EKG was normal without any changes. After hospitalization however the EKG was normal the patient start the correct protocol for ischemic heart disease: beta-blocker, nitrate, aspirin, statine drugs and NTG under the tongue if she need. The blood tests were in normal range and cardiac enzymes as well. Only the level of cholesterol=250mg/dl was increase.
In the second day, in the morning, the patient present severe chest pain, constrictive, sweating, anxiety and was necessary perfusion with nitroglycerin to stopped the pain in 10min, but unusual the EKG in crisis was again normal and the level of cardiac enzymes were the same in normal range. In the third day in the morning the patient presented again constrictive chest pain, anxiety, sweating and was necessary again administration the perfusion of nitroglycerin to stopped the pain in approximate 15 minutes, because wasn’t stopped after NTG drug 0,5 mg under the tongue, but the EKG repeated in crisis was again normal and the level of cardiac enzymes remained normal as well. An echocardiography of the heart was performed to exclude the dissection of the aorta but was normal and the therapy was completed with Fraxiparine 0,4UI sc twice per day at 12 hours. In the third day because of repeated crisis of chest pain the patient was referred to the Surgery Cardiovascular Department and a heart coronarography was performed and surprising three coronary arteries were narrowing with 75%. So a severe left main or three-vessel disease stenosis of coronaries arteries was discover and the patient performed three stents implantation with good evolution.
Results and Discussions: How was possible that the EKG to be normal three days consecutively in context of these severe repetitive constrictive chest pain? when perfusion with nitroglycerin was necessary to be administrated repeated to stoped the pain and the level of specific cardiac enzymes were normal as well and excluded a heart attack.
Conclusion: The most important conclusion of this clinical case presentation is that a normal EKG (without ischemic - lesions changes) in a typical crisis of constrictive chest pain, don’t give us safe that the patient don’t have nothing and is better to start the standard protocol of therapy for ischemic heart disease, if the characteristics of chest pain are so typical clinic for angina pectoris, to protect our patient and to be in safe. A normal EKG in typical crisis of chest pain doesn’t exclude the diagnosis of ischemic heart disease. In our actual standard protocol in these situations the effort test should be perform but could be iatrogenic and dangerous. Except this clinical case report, in my medical practice, I have saw many clinical cases in the similar situations, for this reason I start the standard protocol of therapy for ischemic heart disease at these categories of patients with normal EKG to prevent sudden death. The typical chest pain with normal EKG in crisis could hide a very severe and risky ischemic heart disease with many severe stenosis of the coronaries arteries and don’t give us safe that the patient is not in danger.
Xiaolu Li
Shandong University, China
Title: Lung-specific RNA interference of coupling factor 6, a novel peptide, attenuates pulmonary arterial hypertension in rats
Biography:
Xiaolu Li is the researcher of the Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education and Chinese Ministry of Health, Shandong University Qilu Hospital, Jinan, Shandong, China, Department of Emergency, Qianfoshan Hospital, Jinan, Shandong, China
Abstract:
Background: Pulmonary arterial hypertension (PAH) is a progressive and life-threatening disease associated with high morbidity and mortality rates. However, the exact regulatory mechanism of PAH is unknown. Although mitochondrial coupling factor 6 (CF6) is known to function as a repressor, its role in PAH has not been explored. Objective: We investigated the involvement of endogenous CF6 in the development of PAH. Methods and Results: PAH was induced with monocrotaline (MCT), as demonstrated by significant increases in pulmonary artery pressure and vessel wall thickness (p<0.01). CF6 upregulation was confirmed by quantitative RT-PCR and ELISA. Immunohistochemistry analysis revealed a large amount of CF6 localized to all three layers of the vascular wall and the surrounding tissues in the PAH rats; however, it was barely detectable in endothelial cells (ECs). A total of 2×1010 gp of adeno-associated virus (AAV) was used for transduction of CF6 short hairpin RNA (shRNA) or a control vector, which was intratracheally transfected into the rats before or after MCT injection. The CF6 shRNA effectively reduced the CF6 mRNA and protein levels in the PAH rats and also reversing the 6-keto-PGF1a levels in circulation and in lung tissue (p<0.05). Finally, we found that CF6 shRNA reduced inflammatory infiltration, reversed endothelial dysfunction and vascular remodeling and ameliorated the severity of pulmonary hypertension and right ventricular dysfunction (p<0.05) at 4 weeks when it was used as both a pretreatment and rescue intervention. Conclusions: CF6 contributes to the pathogenesis of PAH, and it may function in association with prostacyclin. The blockage of CF6 could reverse the progression of PAH; thus, it might be applied as a novel therapeutic approach.
Naresh Sen
Narayana Hrudayalaya Institute Of Medical Science, India
Title: The rate dependent bundle branch block and mechanical dyssynchrony leads heart failure and beneficial effect of Cardiac Resynchronization Therapy
Biography:
Naresh Sen is a Consultant Cardiologist affiliated with Narayana Hrudayalaya Institute of Cardiac Science, India. He got his medical graduation from Rajasthan University, Jaipur and post-graduation in internal medicine from South America and post doctoral training in Cardiology from Cacos & Turks. He has also been elected for Fellowship award of various societies of Cardiology . He worked in Cardiology (Invasive & Non-Invasive) as Registrar or Consultant at renowned cardiac hospital ports of India like NH & Medanta last 5 years. He has special interest in coronary artery disease and heart failure prevention. He has published around 50 publications in Cardiology .For his hard work, he was awarded as best cardiology consultant in Rajasthan, 2013 by Director of AIIMS, New Delhi.
Abstract:
Background- CRT (Cardiac Resynchronization Therapy) has been approved beneficially in heart failure patients with refractory optimized medical therapy on based of many studies. The guidelines have shown CRT is indicated in NYHA class III-IV, QRS >150 ms, LBBB (Left bundle branch block) to improve heart functions, ventricular remodeling and clinical symptoms. Purpose-comparison of stress induced mechanical dyssynchrony between rate dependent LBBB and RBBB (Right bundle branch block) and beneficial role of CRT to improve LV function and reduce mortality. Method-Patients presenting dyspnea on exertion NYHA class I-II to III-IV by stress test , normal QRS to rate dependent LBBB or RBBB by Stress test or Dubutamine Stress Echo were studied. CRT on cardiac function was assessed by Cath study, Echo and MRI (Magnetic Resonance Imaging). Result- 46 Patients, male/female ratio (1.87), 12 months observational study done on stress induced rate dependent LBBB and RBBB with worsening dyssynchrony and poor LV function were treated with CRT. Results have shown improved LV function in rate dependent LBBB patients (31+/-6 %) v/s RBBB patients (4.5+/-4%) with P value <0.04. and reduce mortality among rate dependent LBBB with CRT v/s without CRT ( 5% v/s 20 %) and another side mortality difference between rate dependent RBBB with CRT and without CRT were not found significantly. Conclusion- Stress induced rate dependent LBBB with mechanical dyssynchrony leads to heart failure is benefited by CRT than Rate dependent RBBB.
Narjes benameur
University of Tunis El Manar, Tunisia
Title: Assessment of cardiac contraction using Hilbert Transform
Biography:
Narjes Benameur is a doctorate student in Biophysics major Medical imaging at the High Institute of Medical Technologies of Tunis-Tunisia. She is a member of Biophysics and Medical Technologies laboratory at the same institute. She contributed too many conferences in the area of Medical Image Analysis and cardiology with oral presentations. She is interested in her research in cardiac imaging and new methods for the quantification of cardiac contraction.
Abstract:
The Magnetic Resonance Imaging is the most used technique for the quantification of Cardiac movement thanks to the tagged MRI sequence considered as the reference technique for the quantitative assessment of the heart's contraction. Nevertheless, this technique suffers from some limitations such as the fading of the tags before the cardiac cycle and its acquisition protocol which causes a loss of some of the quality characteristics of MRI image in particular its contrast. The objective of this work is to propose a method to calculate, from the cine-MRI sequence, a parametric image showing the quantification of cardiac motion. The proposed method allows quantifying all the contraction amplitudes during a cardiac cycle into one image calculated from the analytical signals extracted from each pixel of the cine-MRI images. The originality of the proposed method is to calculate and quantify the instantaneous amplitudes of contraction through the mathematical tool "The Hilbert transform" which is well suited for cardiac signals characterized by their non-stationary aspect. We tested this method on a population consisting of healthy and pathological cases carriers of myocarditis and infarction. Comparing the results to those obtained with other methods, the proposed method shows a better performance for regional localization of cardiac contraction.
Akarsh Venkat
Manipal University, India
Title: A new stent retriever for cure of acute ischemic stroke
Biography:
Akarsh Venkat is currently in his fourth year of B.Tech in Biomedical Engineering from Manipal University. He is the Editor-in-Chief of the journal Archeus at the age of 20, which is released by the Biomedical Engineering Society of India. He finished a course on Cardiology with grade A in his second year of undergraduate study and has most recently completed a training at Sree Chitra Tirunal Institute of Medical Sciences and Technology, where India’s first artificial heart valve was designed.
Abstract:
Intra arterial and intravenous thrombus formation or blood clots cause blockage in the blood flow which leads to a stroke. The occurrence of a thrombus lodged in a coronary artery can result in a swift myocardial infarction. Stent retrievers are devices employed to mechanically remove the clot and restore blood flow. A large percentage of mortality rates is traced back to inefficiency of the device in extracting thrombus out of the vessel, assuming the subject has been operated on in time. Experiments reveal aspiration of thrombus at the site of blockage to be more effective in clot retrievers and must be incorporated on stent retrievers that allows complete viewing of a procedure. This enhances ease of accessibility of larger vessels like coronary arteries and veins, and reduces the rate of symptomatic intra cranial haemorrhage when vessel damage is avoided, and embolization, major contributors to the mortality rate. There is a proven decrease in clot fragmentation rates with the utilization of a device having a marginally increased length than the pioneer stentrievers. Time remains a chief concern considering treatment subsequent to eight hours of stroke onset is near futile and a model with the guide wire and microcatheter integrated into one entity is theoretically efficacious, as ongoing research suggests. However, evidence of its feasibility to be incorporated into smaller vessels is unavailable and practical trials are necessary. Additional research that will be conducted on design and compatibility could make an ideal device a reality.
- Track 8: Cardiac Surgery & Track 2: Cardiovascular Surgeries
Location: San Antonio
Chair
Louis Samuels
Lankenau Medical Center, USA
Co-Chair
Masoor Kamalesh
Indiana University, USA
Session Introduction
Louis Samuels
Lankenau Medical Center, USA
Title: The Impellaâ„¢ left ventricular assist device (LVAD) combined with veno-venous extra-corporeal membrane oxygenation (ECMO): An alternative to veno-arterial ECMO
Biography:
Louis Samuels graduated Medical School from Hahnemann University (Philadelphia, PA) in 1987 and completed his Cardiothoracic Surgical training in 1995. He joined the faculty of Drexel University as the Surgical Director of Cardiac Transplantation. In 2001, Dr. Samuels and his team implanted the world’s 5th totally implantable electric artificial heart (AbioCor™). In 2003, he joined the Main Line Health System as the Surgical Director of Heart Failure. In addition to cardiac transplantation and LVAD implantation, Dr. Samuels performs CABG and Valvular surgery. In 2012, Dr. Samuels became Professor of Surgery at Thomas Jefferson University School of Medicine. Dr. Samuels has authored over 100 peer reviewed manuscripts and serves as a reviewer for the Annals of Thoracic Surgery. In addition to participating in several clinical trials related to mechanical circulatory support, he continues to serve as a consultant and medical advisor to new technologies currently in trial.
Abstract:
Background: Acute cardio-pulmonary failure refractory to maximal medical therapy has been traditionally managed with veno-arterial (VA) extra-corporeal membrane oxygenation (ECMO). Although the advantage of this technology includes rapid deployment and complete circulatory rescue, the disadvantages include its inability to unload the left ventricle, retrograde systemic flow (when utilized in the bi-femoral configuration), potential for peripheral arterial complications, and the inability to uncouple cardiac and respiratory support. The purpose of this report is to describe a hybrid configuration utilizing the micro-axial flow impella™ LVAD with veno-venous (VV) ECMO as an alternative to veno-arterial (VA) ECMO. Methods: Two adult patients with refractory cardiopulmonary failure were managed with combined Impella™LVAD--VV ECMO: Patient 1: A 37 year old man with chronic non-ischemic cardiomyopathy (EF 20%) presented with acute decompensated heart failure requiring intubation (with aspiration) and vasopressor resuscitation. An impella™ 5.0 LVAD was inserted via the right trans-axillary artery using a 10mm graft. Three days later he developed polymicrobial pneumonia requiring VV ECMO using a two cannula system—right femoral vein inflow (25 Fr) and right internal jugular vein outflow (19 Fr). Flows for the two systems averaged 4.5 L/min. (Figure 1). Patient 2: A 47 year old man with dyslipidemia and tobacco abuse presented to the emergency room with an ST segment elevation MI. Cardiac catheterization showed severe three-vessel CAD and an LVEF of 15%. Intubation, Vasopressor and IABP support did not restore circulatory stability. An Impella CP™ LVAD was percutaneously inserted via the right femoral artery. Heavy sputum secretions—cultures were positive for Serratia marcescans-- contributed to ventilator-dependent respiratory failure requiring VV ECMO. This was accomplished with percutaneous insertion of the Avalon Elite™ trans-jugular double lumen cannula. Device flows averaged 4 L/min (Figure 2). Systemic anticoagulation was achieved with a heparin infusion with aPTT ranging between 45-55 seconds. Outcome measures included death, end-organ complications, bleeding, infection, and length of stay (LOS). Results: Patient 1: There were no technical complications inserting the hybrid system. The LVAD was removed after two weeks of support by withdrawing it from the graft and over sewing it with an endo-stapler flush with the axillary artery. The VV ECMO cannulae were removed seven days later at the bedside using manual pressure and two pursestring sutures. The patient was discharged to a rehabilitation facility on hospital day 44. There were no end-organ failures, no bleeding complications or infectious complications related to the devices. Patient 2: There were no technical complications inserting the hybrid system. The LVAD was removed after 9 days of support by removing it from its percutaneous insertion site and applying manual pressure (i.e. similar to IABP removal). The ECMO cannula was removed at the bedside two weeks later, securing the percutaneous insertion site with a pursestring suture. Acute Kidney Injury (AKI) developed while on mechanical circulatory support requiring temporary renal replacement therapy (RRT). Kidney function recovered during the hospitalization. The patient was discharged to a rehabilitation facility on hospital day 49 with all end-organ systems intact. Conclusions: The combination of the Impella™ LVAD with VV ECMO as a hybrid configuration is technically feasible and clinically efficacious for acute cardio-pulmonary failure refractory to maximal medical therapy. This unique configuration has distinct advantages over traditional VA ECMO: 1) direct LV unloading; 2) antegrade system blood flow; and 3) the ability to uncouple mechanical cardiac from pulmonary support during differential organ system recovery.
Masoor Kamalesh
Indiana University, USA
Title: Coronary revascularization in diabetes- bypass surgery or stenting?
Biography:
Masoor Kamalesh trained at Beth Israel Deaconess Hospital, Harvard Medical School for cardiology and is currently Chief of cardiology at VA medical center Indianapolis, Indiana University. His research interest is in Diabetes and Heart Disease. He has over 100 abstracts, reviews and original publications and has been funded by the Department of Veterans Affairs for his research.
Abstract:
Coronary bypass surgery and percutaneous coronary stenting are both viable techniques to revascularize diabetic subjects with coronary artery disease. However the relative advantages of these two procedures was not know till recent prospective trials were reported. In the Bypass versus Angioplasty Revascularization Investigation -2 Diabetes (BARI-2D) trial patients with diabetes and multi-vessel coronary disease were assigned to percutaneous coronary intervention (PCI)or coronary bypass graft (CABG) surgery at the discretion of the cardiologist. These groups were then randomized to either medical therapy or intervention. The study had a 2X2 factorial design where patients were also randomized to insulin provision or sensitization. At the end of the study the lowest event rate was found in the group that got prompt CABG and insulin sensitization. In the FREEDOM trial 1900 patients with diabetes and multi-vessel coronary disease were randomized to PCI or CABG. At 30 months median follow up, there were fewer primary events (death, myocardial infarction and stroke) in the CABG arm. All-cause mortality was lower in the CABG arm. In the VA-CARDS trial 198 patients with diabetes and severe coronary disease were randomized to PCI or CABG. At 2 years follow up CABG group had lower mortality although the primary combined endpoint of death and infarction was not different. These studies show that for diabetics with multi-vessel disease the best option is prompt CABG with optimal medical therapy.
Biography:
Athanasios Smyrlis MD obtained his MD degree, summa cum laude, from the University of Ioannina Medical School in Greece. He completed his Internal Medicine training at the Albert Einstein Medical Center in Philadelphia and his Cardiology training at the Western Connecticut Health Network, a Yale School of Medicine affiliate. He is the recipient of over twenty scholarships and awards for academic excellence. He has several publications in reputed journals and serves as a regular reviewer for multiple cardiology journals including the International Journal of Cardiology.
Abstract:
Introduction: Acute myocardial infarction (AMI) may occur incidentally or as a complication of an acute non cardiac pathology in patients admitted with a non-cardiac diagnosis, but its incidence, clinical presentation, risk factors and prognostic importance are not well defined. The limited available data in the literature suggest this constitutes an important subgroup of patients with AMI with non-typical clinical presentations, challenging management due to co-morbidities and high in-hospital mortality. Current clinical guidelines provide limited insight into the specific needs of this high-risk population. More extensive studies on this subset of AMI patients are required to improve opportunities in their clinical management. Methods: We conducted a retrospective analysis of medical and surgical patients admitted to Danbury Hospital from 2007 to 2012 with a non-cardiac diagnosis. Patients who developed in-hospital acute coronary syndrome were identified. Clinical characteristics, admission and discharge diagnosis, timing and type of myocardial infarction, therapeutic approach as well as limitations to standard AMI treatment were documented. In hospital and long term mortality were recorded. We conducted univariate and multivariate analysis of clinical parameters and identified predictors of mortality. Results: Among 38,324 patients admitted with a non-cardiac diagnosis 208 (0.005%) patients experienced AMI during the index admission. The mean age of the cohort was 75.9 ± 11.8 years, 101 were male (49%). 141 (68%) had a medical and 73 (32%) a surgical admission diagnosis. 42 patients (20.3%) had STEMI and 166 (80.2%) NSTEMI. In-hospital mortality was 27% (n=56) one year mortality was 37% (n=77). In multiple logistic regression analysis, sepsis (HR 2.33, CI 1.21-4.52, p=0.012), acute renal failure (HR 2.42, CI 1.30-4.52, p=0.006), acute CHF not present on admission (HR 2.10, CI 1.10-3.98, p=0.024), STEMI (HR 4.40, CI 2.15-9.00, p=0.001), contraindications to cardiac catheterization or PCI (HR 2.31, CI 1.23-4.32, p=0.009) ventricular arrhythmias (HR 2.90, CI 1.31-6.45, p=0.009) and hypotension defined as SBP<90 (HR 6.50, CI 3.26-13, p=0.001) were associated with increased mortality in hospital and 1 year mortality. Conclusions: Acute myocardial infarction in patients hospitalized for non-cardiac reasons is an uncommon clinical occurrence with high mortality in hospital and 1-year mortality. Possible delays in diagnosis and limited treatment options as a result of concomitant acute pathology may account for the poor outcomes. There is limited data in the literature on this subset of patients with Acute MI. More extensive studies are required in order to delineate their optimal clinical management and improve outcomes.
Sahar shaker sheta
Cairo University Children\'s Hospital, Egypt
Title: Longitudinal cardiac rotation abnormalities in children and young adults with end-stage renal failure undergoing hemodialysis: A pilot study
Biography:
Sahar Sheta has graduated M.B.B.Ch from the Faculty of Medicine, Cairo, Egypt 1989 and was signed up excellent. M.Sc in Pediatrics 1994. M.D in Pediatrics and Pediatric Cardiology 1998. Professor of Pediatrics and Pediatric Cardiology in the Department of Pediatrics since 2009. Head and Director of Non Invasive Echocardiography Lab., Cairo University Children’s Hospital 2014. She has published more than 15 papers in reputed journals both nationally and internationally. She has been an invited speaker and chairperson in several international Pediatric cardiology conferences in USA, Europe and Middle East.
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 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 post HD: - 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:
Athanasios Smyrlis MD obtained his MD degree, summa cum laude, from the University of Ioannina Medical School in Greece. He completed his Internal Medicine training at the Albert Einstein Medical Center in Philadelphia and his Cardiology training at the Western Connecticut Health Network, a Yale School of Medicine affiliate. He is the recipient of over twenty scholarships and awards for academic excellence. He has several publications in reputed journals and serves as a regular reviewer for multiple cardiology journals including the International Journal of Cardiology.
Abstract:
Introduction: As the US population continues to experience an increase in life expectancy, cardiac surgeons are confronted with the task of performing surgery in the most advanced age group. In the present era, the option of surgery is often weighed against less invasive procedures such as Percutaneous Coronary Intervention (PCI) and Transcatheter Aortic Valve Replacement (TAVR).The aim of this study is to demonstrate the feasibility of cardiac surgery in nonagenarians and assess its suitability in the modern era. Method: We performed retrospective data analysis of 14 consecutive patients over the age of 90 who underwent cardiac surgery in Danbury Hospital between January 2005 and October 2014. Demographic profiles, pre-surgical, intraoperative and post-surgical data were assessed using institutional database. Late survival was assessed using the social security index and outpatient electronic medical records. Results: All fourteen patients in the study group were Caucasian, comprised of nine males and five females. The mean age of the study group was 91.9+ years. In addition, eight out of the fourteen subjects (57.1%) were designated NYHA (New York Heart Association) class 3 or greater. Dyslipidemia and hypertension, the most prevalent comorbidities, were present in 85% (12/14) of those patients studied. The following were also observed among the study group: five patients underwent coronary artery bypass graft surgery (CABG), five had aortic valve replacement (AVR), three had both CBAG and AVR, and one had mitral valve replacement (MVR). Of those individuals, one was urgent and one was redo. Major complications occurred in 35.7% (5/14) of the population and the average post-operative length of stay was 13.6 days. There was no perioperative mortality. Three patients (21.4%) were re-admitted within 30 days primarily due to pulmonary edema. The survival rates at 30 days, 60 days, 1 year and 3.4 years were 100%, 92%, 78%, and 50% respectively. Five out of the fourteen patients (35.7%) were discharged directly to their home with the remaining 64.3% going to a rehabilitation facility. Conclusion: Although the study is limited by the small number of subjects, it demonstrates that in select patients, cardiac surgery can be performed in nonagenarians with marginally higher complication rates and good overall survival. Further studies and long term follow-up will be required to demonstrate if cardiac surgery in this age group remains an appropriate option over novel percutaneous approaches.
Biography:
Adel Bakr completed Master Degree of Cardiology, from Ain Shams University, Cairo, Egypt in May 2012. After four months, he started attending for PhD of Cardiovascular Diseases, Cairo University, Cairo, Egypt. Through 13 years, he has worked in more than eight different hospitals in cardiovascular department in ascending ranks and positions till being an associate consultant in Saudi German Hospital, Riyadh, Saudi Arabia.
Abstract:
Purpose: The present study aimed to investigate the clinical profile, in-hospital and 3-months outcome of ACS patients with insignificant coronary stenosis on a coronary angiography. Methods: This prospective observational study included 200 consecutive patients admitted with ACS. Group I (100 patients) included patients with insignificant CAD (all lesions <50% stenosis). Group II (100 patients) included patients with one or more lesions ˃70% stenosis. Patients with previous CABG were excluded. Results: Patients with insignificant CAD were significantly younger (61 vs. 67 years, p<0.001), more likely to be females (41% vs. 23%, p=0.006), less likely to smoke (p=0.006), less likely to have diabetes mellitus (p<0.001), and less likely to have history of CAD (p=0.042) or prior PCI (p=0.037). At presentation these patients were also less likely to have typical anginal pain (61% vs 91%, p<0.001), less likely to have heart failure (9% vs 30%, p<0.001), less likely to have ischemic ST-segment changes (10% vs 46%, p<0.001), had lower elevations in peak troponin I (p<0.001) and CK-MB levels (p<0.001), with lower LDL-C (p=0.006), and higher HDL-C levels (p=0.020). They were less likely to be treated with thienopyridines (p<0.001), statins (p<0.001), b-blockers (p=0.002), ACEI/ARBS (p=0.007), and higher rates of calcium channel blocker therapy (p<0.001), this trend continued at discharge. They had lower prevalence of major adverse clinical events at follow up (readmission for ACS (p=0.009), revascularization (p=0.035), recurrent chest pain (p=0.009), cardiogenic shock (p=0.029). Conclusion: Patients with ACS and insignificant CAD have different clinical profile and outcome compared to those with significant disease.
Hamza Najam Salam
Aga Khan University, Pakistan
Title: Comparison of awareness of risk factors for coronary artery disease in medical and non-medical students of Karachi
Biography:
Hamza Najam Salam is a graduate of the Aga Khan University Karachi, Pakistan. He gained research experiene as an observer from The Hospital of the University of Pennsylvania, Smell and Taste Center. He is applying for an Internal Medicine residency in the U.S this year.
Abstract:
Aim: To compare awareness of CAD and its risk factors between medical and non-medical college students and to determine the prevalence of modifiable risk factors for CAD in both groups of students. Methods: A sample of 311 medical and 320 non-medical students was taken from 4 universities (2 medical and 2 non-medicals) of Karachi, Pakistan. A self-administered questionnaire was used to collect the data regarding awareness and practices of smoking, obesity, physical activity and hypertension. Using SPSS version 22 descriptive analysis was done to calculate the overall prevalence of the sample. Chi squared test and Independent t-test were used to compare categorical and continuous variables, respectively. P-value ≤ 0.05 was considered as significant. Results: Out of the 311 medical students interviewed, 121(38.9%) were male and 190(61.1%) were female. 267(85.9%) medical students turned out to be overall aware as opposed to 200(62.5%) non-medical students. 98(30.6%) non-medical students were modifying lifestyles against CAD as opposed to only 89(28.6%) medical students. Amongst medical students chi squared test of significance showed an insignificant association between awareness and modifying lifestyle (p value >0.05). Amongst non-medical students we found a statistically significant relationship between awareness and modifying lifestyle (p value <0.05). Conclusion: The results of our study showed that medical students had higher awareness than non-medical students in terms of the risk factors leading up to the development of CAD. In contrast to medical students, non-medical students who were aware of the risk factors of CAD were significantly more likely to modify their lifestyles and to avoid practices leading up to the development of CAD.
Dinesh C. Sharma
K.M. Govt. Girls P. G. College, India
Title: Bio-musicology (music therapy) in the treatment of cardiovascular disorders
Biography:
Dinesh C. Sharma fields of Specialization are Biochemistry and Molecular biology and field of Innovative Expertise is Bio-mucicology (Musci Therapy). He has been teaching and research in Government Colleges of U.P. since 2000. He was honored with FIAES and Shiksha Rattan Purshkra. He establishes Indian Association of Music Therapy with a motto to “Establish music as a tool of therapy to treat various disorders scientifically and establish music to use as drug in future”. More than 110 of his research paper, articles have been published in journals, magazines, souvenir, proceedings and newspapers of national and international repute. His book “Toxicology of Synthetic pyrethroid” was published by international publisher. He has participated in 15 training courses and organized 8 national seminar, conferences on bio-musicology and eEducation. Under his supervision 2 candidates awarded M.Phil and more than 600 students completed their projects. His lectures and interviews are telecast on various television channels time to time. He is also assigned additional work as Nodal Officer (Directorate)-RUSA, Member PAB-RUSA, Advisor-UPSAAC, SLQAC, Website by government.
Abstract:
The purpose of this study was to examine that why we feel cool and calm when we listen specific music. How the music therapies affect us? Is pleasant sound have the power to effect physiology of livings? This study setup a relation between sound and hemato-biochemistry, that can be used to control cardiovascular disorders through neuro-endocrine stimulation up to a limit, but still need more work to be done to say with surety that specific music target specific bio-molecules, which effect the physiology and ultimately behaviour of humans. The fast pace of changing our life styles makes adjustment to it difficult. The blood, the blood vessels and the heart together form the cardiovascular system. These blood vessels are of a certain calibre, however they may constrict for a long period of time, thus causing the blood to flow through them under increased tension giving rise to an entity called 'Hypertension' - one of the major manifestations of mental stress and CVD’s. Music therapy is based on the associative and cognitive powers of the mind. Sound creates certain vibrations which are picked up and amplified by the human ear. These waves are then picked up by the sensory nerve going into the middle of the brain and redistributed throughout the neuron network to other parts of the brain to distinguish the pitch, tone, and frequency of that sound. During my study I used the sounds of acoustical environment which is the combination of natural sounds (wind, water, wildlife, vegetation) and cultural and historic sounds (battle re-enactments, tribal ceremonies). In this study conducted over human volunteers, I observed that the music have their impact over the hypertension and CVD’s by altering the levels of biochemical and haematological parameters such as significant decrease of serum total cholesterol, non-significant decrease of triglycerides, non-significant decrease of VLDL and LDL, significant increase of HDL in most cases, significant increase of adrenalin by sound A and B in human, significant decrease of cortisol in most cases. The decreases of LDL, VLDL, TG, Cortisol and increase of HDL and adrenalin are indicative of good health and the sounds which are responsible for such changes will be used to cure the patient of CVD, hypertension. On the basis of my finding, I can conclude that music therapy is helpful to control and treatment of hypertension, arteriosclerosis and other CVD’s and make us stress free healthy life.
Peter Edoba
Central Hospital, Nigeria
Title: Evaluation of congenital heart disease in Nigerian children with pneumonia
Biography:
Peter Edoba, is the founder and Chief Medical Director of Rapha Specialist Hospital in Nigeria and also a Senior Medical Officer with Central Hospital, Benin City, Edo State, Nigeria; Associate Fellow of the National Postgraduate Medical College of Nigeria; Bachelor of Medicine and Bachelor of Surgery (M.B, B.S), University of Benin; Masters (Degree) of Health Planning and Management (MHPM), University of Benin; Associate member of the Nigeria Institute of Management (AMNIM). Named an icon by daily champion Newspaper on account of what was termed the undeniable and inspiring contributions of Peter Edoba to the Nigerian Medical Association at State, National and International Levels.
Abstract:
Background: Pneumonia is a common cause of childhood morbidity and mortality globally. Some congenital heart disease (CHD) may predispose their sufferer to bronchopneumonia. Objective: To evaluate the contribution of CHD to pneumonia in children seen in a tertiary hospital in the Niger Delta region of Nigeria. Methods: Over a year, consecutive diagnosed radiologically with pneumonia were evaluated echardiographically for CHD. Certain characteristics in children with pneumonia and CHD were compared to those without CHD. Results: There were 121 children with pneumonia of which 61(50.40%) were males and their mean age was 10.2 + 10.93 months. The prevalence of CHD was 14(11.57%), the commonest CHD was ventricular septal defect (VSD) in 7(50.00%). Most of the CHD with septal defect had moderate to large defects. Children with CHD were 3 and 256 times more likely to have heart failure and murmur respectively compared to those without CHD, p=0.084 and <0.0001. Children with CHD stayed longer in the hospital 11.50 + 7.03 days than those without CHD 7.38 + 5.34 days, p=0.012. Conclusion: The children with CHD were more likely to have heart failure and murmur compared to those without CHD. Prevalence of CHD in children with pneumonia in this study is high, evaluation of children with pneumonia for CHD is therefore recommended.
Romeo Edosomwan
Central Hospital, Nigeria
Title: Chronic heart failure in children with congenital heart diseases in south-south, Nigeria
Biography:
Romeo Oziegbe Edosomwan, is a Senior Medical Officer with central Hospital, Benin City and the Edo State Hospitals Management Board, Benin City, Edo State, Nigeria. He is graduate of the University of Benin with Bachelor of Medicine, Bachelor of Surgery (M.B.B.S), Fellow, West African College of Surgeons (FWACS), Fellow of the Association for study of internal fixation (F.A.O. ASIF). He is also a member of Nigerian medical Association (NMA) and a co-founding trustee of Africa Network for Medical Practitioners(ANMP) with the Headquarter in Abuja, Nigeria
Abstract:
Background: Most of the previous reports on childhood congenital heart diseases (CHD) in Nigeria antedated the era of echocardiography. The objective of this study is to determine the economic burden to families of managing chronic heart failure in children with congenital heart disease.
Method: This longitudinal study was conducted over a year. The families of children with congenital heart disease who were being managed for chronic heart failure in the clinic were recruited for the study. With the aid of a structured questionnaire, data were collected on a monthly basis for three consecutive months, on the family’s monthly income, cost of anti-failure medicines, transportation and the number of man-hours spent on clinic visitation. The percentage of the mean monthly income spent on medicines, transportation and the total cost of care were also computed.
Results: Thirty two families were recruited for the study. The children were 16(50%) each of males and females with a mean age of 2.2 + 1.7 years. The mean monthly income was $314.93 + 271.36 while the mean cost of total care was $17.61 + 10.58. The mean percentage of income spent on total care was 16.3 + 26.2% with a range of 0.7 – 122%. Families from low socioeconomic class spent significantly higher percentage of income on medicines and total care compared to those in middle or high socioeconomic classes. P=0.0095 and 0.041 respectively. Only three (0.09%) patients had surgery for their condition.
Conclusion: The mean percentage of income spent on care was significant and amounted to catastrophic health expenditure for a third of the families. Government input in strengthening the existing cardiac centres, establish new ones and subsidizing the cost of surgery to meet the needs for open heart surgery for children with CHDs is recommended.
Stanley Oshiorenuya
Rapha Special Hospitals, Nigeria
Title: Congenital heart disease at the central hospital and edo State hospitals management board
Biography:
Stanley Oshiorenuya, is a consultant cardiologist with Rapha Special Hospitals, a private Hospital in Benin City, Edo State and Port Harcourt, River State and also a Senior Medical officer with Central Hospital, Benin City, Edo State, Nigeria. He is a graduate of the University of Benin with Bachelor of Medicine, Bachelor of Surgery (M.B., B.S), Fellow, West African College of Surgeons (FWACS), Fellow of the Association for Study of Internal fixation (F.A.O. ASIF. He is also a member of Nigerian Medical Association (NMA) and a co-founding Trustee of Africa Network for Medical Practitioners (ANMP) with the Headquarter in Abuja, Nigeria.
Abstract:
Background: The objective of this study is to determine the reports on childhood congenital heart disease (CHD) in Nigeria. The advent of widespread use of echocardiography enables a more accurate and complete identification of CHD in children. Using echocardiography to determine the prevalence and pattern of CHD in the Central Hospital and Edo State Hospitals Management Board, Edo State, at this time, would be informative. Method: Patients presenting with CHD to the pediatric health facilities of Central Hospital between May 2005- May 2015 were prospectively enrolled in the study. They were evaluated with chest radiographs, electrocardiograms and echocardiograms. Result: Forty seven of the 10,539(4.6/1000) children who presented to the hospital during the period under review had CHD. There was no significant gender difference. The mean age at presentation was 2.6 + 3.5 years. Most of the patients were aged one year of age and below. Isolated ventricular septal defect (VSD) in 27 (55.1 percent) was the most frequent defect, followed by tetralogy of Fallot in 14 (28.6 percent); the other anomalies were atrial septal defect (ASD) and VSD in four (8.1 percent), patent ductus arteriosus and VSD in two (4.1 percent), and isolated ASD in two others. There were more patients from the low and middle socioeconomic classes than those from the high socioeconomic class (fisher’s exact test, P=0.66). Conclusion: The health seeking behaviours of the communities, which entails visiting trado-medical practitioners and churches rather than the hospital, may have accounted for the low prevalence of CHD found. The use of echocardiograms in the nurseries and routine screening of patients from CHD is advocated to allow for early detection and intervention Health education and public enlightenment would also improve the health seeking attitude in the study locale.
Joseph Ikhilea
Central Hospital, Nigeria
Title: Incidence and patterns of cardiovascular disease in south western Nigeria
Biography:
Joseph Ikhilea, is currently a senior Medical Officer with God’s Care Specialist Hospital in Benin City and also a medical officer in Central Hospital, Benin City, Edo State, Nigeria. He is a graduate of the University of Benin with Bachelor of Medicine, Bachelor of Surgery (M.B., B.S), Fellow, West African College of Surgeons (FWACS), Fellow of the Associate for Study of internal fixation (F.A.O., ASIF), He is also a member of Nigerian Medical Association (NMA) and a member Board of Trustee of Africa Network for Medical Practitioners with the Headquarter in Abuja, Nigeria. He is happily married and blessed with two children.
Abstract:
Background: Cardiovascular disease (CVD) has been major problem in the developed and developing countries and its burden in these countries is overwhelming. There is a dearth of literature and data on the prevalence and patterns of CVD in developing countries, especially Nigeria. Objectives: This study was carried out to determine the most common cardiovascular disorder, the mostly affected age sex groups and annual increase/decrease between 2009 and 2014 in South-Western Nigeria. Methods: Our study reviewed the pattern and incidence of CVD in South-Western Nigeria. Case notes of patients in University of Lagos Teaching Hospital and Obafemi Awolowo Teaching Hospital were reviewed between 2009 and 2014. These two teaching hospitals provide tertiary health care service to five out of Six states that form South-West Nigeria with a population of 29,720,322 Nigerians. Results: A total number of 4103 case notes of CVDs were reviewed out of which 2159(52.69%) were males while 1944(47.40%) were females. A steady rise in the incidence of CVD between 2009-2014 was observed. Hypertension (39.1%) was the most prevalent CVDs while congenital heart disease (1.1%) had the lowest. Conclusion: It was concluded that hypertension was the most prevalent CVD while congenital heart disease was the lowest. A steady increase in the incidence of CVD was observed during the period under review.
Yoshiaki Omura
New York Medical College, USA
Title: New method of detecting various cancers & their biochemical information from rapidly changing part of QRS complex & slowly rising part of t-wave of ECGs was found: its clinical application for non-invasive screening of cancers & evaluation of any cancer treatments
Biography:
Yoshiaki Omura received Oncological Residency Training at Cancer Institute of Columbia University & Doctor of Science Degree through research on Pharmaco-Electro-Physiology of Single Cardiac Cells in-vivo and in-vitro from Columbia University. He published over 265 original research articles, many chapters and 9 books. He is currently Adjunct Prof. of Family & Community Medicine, New York Medical College; Director of Medical Research, Heart Disease Research Foundation, New York; President and Prof. of International College of Acupuncture and Electro-Therapeutics, New York; Editor in Chief, Acupuncture & Electro-Therapeutics Research, International Journal of Integrative Medicine, which is indexed by 17 major international Indexing Periodicals. Currently he is also Executive Editor of Integrative Oncology. Formerly, he was also Adjunct Prof. or Visiting Prof. in Universities in USA, France, Italy, Ukraine, Japan and China.
Abstract:
Introduction: The author successfully detected biochemical changes, bacterial and viral infections, and identified the exact location of the infections of different part of the heart by ECGs. Similar results were found at different parts of the brain by ECGs during the last decade. Recently the author found that using ECGs, cancer information can be detected not only on different part of the heart but also in the rest of the body. Method: Various cancers existing in patients were detected from the rapidly changing part of QRS complex as well as the rising part of T-wave of every recorded 12 lead ECGs of the patient by detecting maximum Electro-magnetic Field (EMF) Resonance Phenomenon between 2 identical molecules with same amount using simple method which received a U.S. patent in 1993. From recorded ECGs, EMF Resonance Phenomenon between specific cancer microscope tissue slides and ECG were only detected from rapidly changing part of QRS complexes of ECGs and also from a part of slowly rising part of T-waves. Rapidly changing parts of QRS complexes of ECG contain invisible information of specific cancers that exist in the same person. This information is detected at relatively large dV/dt of QRS complex of ECGs. Large dV/dt of QRS complexes is due to the large numbers of ventricular muscle excitation which generate relatively large electrical current and voltage with rest of the ECG, which has very little dV/dt with exception of slowly rising part of T-waves of ECGs which correspond to "the Vulnerable Period of Ventricular Fibrillation" or "Commotio Cordis" in spite of relatively small dV/dt. Result: Using ECGs, the author was able to detect cancers of various organs including lung, esophagus, breast, stomach, colon, uterus, ovary, prostate gland, common bone marrow related malignancies such as Hodgkin’s Lymphoma, Non Hodgkin’s Lymphoma, Multiple Myeloma as well as Leukemia and even brain tumor such as anaplastic astrocytoma and glioblastoma. In addition the author was also able to find when the patient has more than one different cancer at different parts of the body. Also, most of drugs taken within 10 hours before taking ECG can be detected from rapidly changing part of QRS complex & rising part of T-waves. Among 50 ECGs of various cancer patients examined without knowing diagnosis, 2 patients with different diagnosis were found from ECGs and later diagnosis from ECG was found to be correct. Furthermore, in 3 cancer patients, additional cancers were also detected from ECGs. Discussion: Thus, by comparing the same lead of ECGs before and after any treatment, the therapeutic effect of specific cancers can be evaluated. In addition, if 12 lead ECGs is taken periodically, we can find approximately when cancer information starts appearing in the ECGs. Maximum information from cancer can be found in rapidly changing QRS complex where dV/dt is relatively large. This new concept and method can be applied any recorded ECGs for detection and screening of the cancer. Consequently, ECGs can provide not only information on the heart but also can detect any single cancer or multiple cancers, which exist in the same individual. ECGs cannot only be used to detect cancer but also can be used to reveal undetected cancers or misdiagnosed cancers as well as detection of medication patient is taking.
Bayram G. Hodjakuliyev
Turkmen State Medical University, Turkmenistan
Title: Long-term results of mitral valve replacement
Biography:
Bayram G. Hodjakuliyev has done his PhD from Turkmen State Medical University, Turkmenistan. Bayram G. Hodjakuliyev specializes in Long-term results of mitral valve replacement, LV myocardium.
Abstract:
Objectives: Study of myocardial remodeling of left ventricle (LV), depending on the duration of the postoperative period in patients after mitral valve replacement (MVR). Methods: The observation involved 105 patients after MVR aged 23 to 57 with circulatory failure (CF) of NYHA Class II and III. 63 of them were women, 42 were men. Depending on the duration of the postoperative period, the patients were divided into 3 groups 1st group included 32 (30,5%) patients with early postoperative period of 1-2 years, 2nd group included 38 (36,2%) patients with postoperative period of 6-10 years, and 3rd group included 35 (33,3%) patients with that of over 10 years. Results: In patients of Group 1, LV indicators remained within normal limits. In group 3, compared with group 1, the following were increased: end-diastolic dimension (EDD) - 10,6%; end-diastolic volume (EDV) - 24 %; end-systolic dimension (ESD) - 14,7%; end-systolic volume (ESV) - 32,3%, left atrium (LA) - 16,1%, ejection fraction (EF) was reduced by 11,8%, integral systolic remodeling index (ISRI) - 17,6%. In group 2, compared with group 1, the following were increased: sphericity index in systole (SIs) - 8,2%; sphericity index in diastole (SId) - 6,2%, myocardial stress in systole (MSs) - 4,7%, myocardial stress in diastole (MSd) - 1,8%, indexed myocardial mass (IMM) - 11,5%, and in the patients of group 3, SIs - 13,1%, SId - 6,2%, MSs - 23,4%, MSd - 7,4%, IMM - 24,6%. Despite the absence of LV dilatation in patients of group 1, a slight improvement was observed in the indicators of remodeling: SIs - 0,61±0,1cm, SId - 0,80±0,1cm, MSs – 126,9±20,8 g/cm2, MSd – 71,6±9,8g/cm2, IMM – 128,2±15,7g/m2 and LA - 4,7±0,3cm, reduction of ISRI - 77,3±10,2. For the patients of group 1 and group 2, eccentric LV non-dilated hypertrophy was typical, where for the patients of group 3, it was eccentric LV dilated hypertrophy. Conclusions: Thus, in the remote period (over 10 years) in patients after MVR, dilatation of the heart chambers is largely developed as associated hemodynamic load on the LV myocardium.
Bayram G. Hodjakuliyev
Turkmen State Medical University, Turkmenistan
Title: Risk factors of decompensation of heart failure in patients undergoing mitral valve replacement
Biography:
Bayram G. Hodjakuliyev has done his PhD from Turkmen State Medical University, Turkmenistan. Bayram G. Hodjakuliyev specializes in Long-term results of mitral valve replacement, LV myocardium.
Abstract:
Purpose of study: To examine the impact of risk factors on the remodeling process and systolic function of the left ventricle (LV) in patients after mitral valve replacement (MVR)
Information and methods: 125 patients of 28-63 years were examined after MVR. 76 of them were women, 49 were men. The patients were divided into 4 groups. Group 1 comprised 31 patients with ischemic heart disease (IHD), where Group 2 included 29 patients without IHD. Group 3 comprised 33 patients with high blood pressure (av. blood pressure -150.8 ± 4.1), Group comprised 32 patients with normal blood pressure (av. -114.0 ± 3.3). Comparative analysis was performed between the patients of Groups 1, 2, 3 and 4.
Results: In Group 1, there had been an increase in the size of LV in: end diastolic volume (EDV) - 19.5%, end systolic volume (ESV) - 13.4%, myocardial stress in systole (MSs) - 23.3% and in diastole (MSd) - 21.5%, indexed myocardial mass (IMM)-17.4%, lowering of ejection fraction (EF) up to 6.5%, in comparison with Group 2. In Group 3, there had been an increase in LV in: ESV - 24.9%, EDV - 19.5%, MSd - 30.2%, MSs - 31.3 %, IMM - 19.8%, lowering of EF in 12%, as opposed to Group 4.
Therefore, in patients undergoing mitral valve replacement, the presence of ischemic heart disease and hypertension contribute to the increase of hemodynamic load on myocardium, influencing the remodeling processes and systolic function of LV.
- Workshop
Session Introduction
Jean C. Bopassa
University of Texas Health Science Center at San Antonio, USA
Title: Novel Mechanisms in cardio protection against ischemia/reperfusion injury
Biography:
Jean C. Bopassa has completed his PhD at the age of 31 years from Claude Bernard University, Lyon1, France and postdoctoral studies from Harvard University and University of California at Los Angeles. Currently, he is an Assistant professor in the Department of Physiology, in the school of medicine at UTHSCSA. He has published more than 17 papers in reputed journals and has been serving as an editorial board member of several reputed journal.
Abstract:
Our research interests focus on elucidating the role of mitochondria in the cardio-protective effect of hormones against ischemia/reperfusion (I/R) injury and heart failure. The kind of injury that occurs in several clinical conditions such as: heart transplant, stroke, cardiac bypass, and coronary stenting after acute myocardial injury. Our research goal is to determine the molecular mechanisms involved in cardioprotection induced by both acute and chronic administration of sex hormones (estrogen, in particularly). Using both pharmacological and genetic approaches, we are interested in understanding the role of mitochondrial signaling (mitochondrial permeability transition pore (mPTP) opening, and the electron transfer chain) in estrogen-induced cardioprotective effects against ischemic myocardial injury and heart failure. Using both ex vivo and in vivo models, we have shown that acute pre-ischemic estrogen (E2) administration protects the myocardium from I/R injury mainly via activation of G-protein Coupled Estrogen Receptor 1 (GPER1), a non-steroidal receptor, in ovariectomized-female and male mouse heart. Interestingly, we established that acute pre-ischemic activation of GPER1 protects the myocardium against I/R injury by inhibiting mPTP opening via the MEK/ERK/GSK-3ï¢ pathway. Moreover, we found that acute post-ischemic GPER1 activation by E2 also induces cardioprotective effects against I/R injury by reducing mitochondrial protein ubiquitination, acetylation and calpain10 levels and inhibition of the mPTP opening.