Day 3 :
- 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.
- 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.