Scientific Program

Conference Series Ltd invites all the participants across the globe to attend 6th International Conference on Clinical & Experimental Cardiology San Antonio, USA.

Day 2 :

OMICS International Cardiology 2015 International Conference Keynote Speaker Yoshiaki Omura photo
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.rn

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.rnrnrnrnMethod: 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.rnrnrnrnResult: 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.rnrnDiscussion: 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.rn

OMICS International Cardiology 2015 International Conference Keynote Speaker Yu-Fang Jin photo
Biography:

Abstract:

Vast research efforts have been devoted to providing clinical diagnostic markers of myocardial infarction (MI), leading to over one million abstracts associated with “MI” and “Cardiovascular Diseases” in PubMed. Accumulation of the research results imposed a challenge to integrate and interpret these results. To address this problem and better understand how the left ventricle (LV) remodels post-MI at both the molecular and cellular levels, we propose here an integrative framework that couples computational methods and experimental data. We selected an initial set of MI-related proteins from published human studies and constructed an MI-specific protein-protein-interaction network (MIPIN). Structural and functional analysis of the MIPIN showed that the post-MI LV exhibited increased representation of proteins involved in transcriptional activity, inflammatory response, and extracellular matrix (ECM) remodeling. Known plasma or serum expression changes of the MIPIN proteins in patients with MI were acquired by data mining of the PubMed and UniProt knowledgebase, and served as a training set to predict unlabeled MIPIN protein changes post-MI. The predictions were validated with published results in PubMed, suggesting prognosticative capability of the MIPIN. Further, we established the first knowledge map related to the post-MI response, providing a major step towards enhancing our understanding of molecular interactions specific to MI and linking the molecular interaction, cellular responses, and biological processes to quantify LV remodeling.

  • Track 8: Cardiac Surgery & Track 2: Cardiovascular Surgeries
Location: San Antonio
Speaker

Chair

Louis Samuels

Lankenau Medical Center, USA

Speaker

Co-Chair

Masoor Kamalesh

Indiana University, USA

Speaker
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.

Speaker
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.

Speaker
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.

Speaker
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.

Speaker
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.

Speaker
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.

Speaker
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.

  • 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
Speaker
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-3 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.