7^th World Congress on Cardiology November 14-30, -0001 Orlando, USA

Biography:

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

Abstract:

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

Biography:

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

Abstract:

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

Biography:

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

Abstract:

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

Biography:

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

Abstract:

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

Biography:

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

Abstract:

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

Biography:

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

Abstract:

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

Biography:

Syed Raza  graduated from Aligarh University in India  in 1993. After completeing his postgraduate degree in Medicine from the same university, he moved to the UK for higher specialist studies. He successfully completed MRCP and CCT and later also  awarded Fellow of the Royal College of Physicians of Edinburgh. He was awarded professor John Goodwin prize for outstanding performannce in Diploma Cardiology exam  at Hammersmith Hospital, University of London in 2001. He is currently serving as  consultant in Cardiology and Head of the department of Medicine  at Awali Hospital, Bahrain. He has to his credit  numerous publications and he has presentated his work in  different parts of the world. He is peer review author for some well respected journals.

Abstract:

Introduction: It is neccessary to risk stratify patients  of cardiovascular  diseases  so as to guide and standerdise  management .

Method : We  made  use of QRisk 2 (UK)  to assess  10 year cardiovascular  risk of patients  who presented to the Cardiology clinic. Each patient’s relevant data were  entered  in the  QRisk2  assessment  tool  and  a 10 year risk was worked out. Based on the obtained figure, further management  strategy  was planned  for  that patient.

Analysis and Results: All low risk patients unless contraindicated underwent some kind of stress testing for evidence of reversible ischemia. Decision based of CV risk score to perform CT coronary angiography  when deemed apparopriate  were  utilised for moderate  risk  category.  Majority of high risk patients  were considered for catheter based coronary angiography. Similarly, based on CV risk scoring, Aspirin and Statin therapy were started in 34% and 28% patients respectively. Aspirin and Statin therapy if deemed inappropriate were stopped in 12% and 21% patients respectively.

Conclusion: Simple cardiovascular assessment  tools are readily available  online  that can be downloaded for personal use. Using cardiovascular risk assessment tool simplifies clinical decision making. It helps to  standerdise  treatment  and also guides us to avoid  harmful, inappropriate  and unneccessary  treatment. This  therefore is very suitable  for day to day parctice  and  works best in the interest of patient safety.  Appropriate  use  of  investigations and other resources are used in managing  patients further.

Biography:

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

Abstract:

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

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

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

Biography:

Syed  Raza  graduated from Aligarh University in India  in 1993. After completeing his postgraduate degree in Medicine from the same university, he moved to the UK for higher specialist studies. He successfully completed MRCP and CCT and later also  awarded Fellow of the Royal College of Physicians of Edinburgh. He was awarded professor John Goodwin prize for outstanding performannce in Diploma Cardiology exam  at Hammersmith Hospital, University of London in 2001. He is currently serving as  consultant in Cardiology and Head of the department of Medicine  at Awali Hospital, Bahrain. He has to his credit  numerous publications and he has presentated his work in  different parts of the world. He is peer review author for some well respected journals.

Abstract:

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

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

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

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

Biography:

Abstract:

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

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

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

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

Biography:

Abstract:

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

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

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

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

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

Biography:

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

Abstract:

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

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

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

Biography:

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

Abstract:

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

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

Biography:

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

Abstract:

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

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

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

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

Biography:

Abstract:

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

Biography:

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

Abstract:

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

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

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

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

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

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

Biography:

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

Abstract:

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

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

Biography:

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

Abstract:

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

Biography:

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

Abstract:

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

Biography:

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

Abstract:

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

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

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

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

Biography:

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

Abstract:

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

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

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

Biography:

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

Abstract:

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

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

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

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

Biography:

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

Abstract:

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

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

Biography:

Tamara Feygin is an Associate Professor of Clinical Radiology at University of Pennsylvania and Children's Hospital of Philadelphia. Her primary interests are fetal and neonatal imaging. She led the development and implementation of magnetic resonance “Fluoroscopy” in clinical practice for assessment of dynamic processes in fetuses. She is a dedicated Educator and Mentor of medical students, radiology residents and radiology and neuroradiology fellows. She has been invited to present her work nationally and internationally. She is a Member of the European Society of Neuroradiology, the Radiological Society of North America, the Society for Pediatric Radiology, and a Senior Member of the American Society of Neuroradiology.Tamara Feygin is an Associate Professor of Clinical Radiology at University of Pennsylvania and Children's Hospital of Philadelphia. Her primary interests are fetal and neonatal imaging. She led the development and implementation of magnetic resonance “Fluoroscopy” in clinical practice for assessment of dynamic processes in fetuses. She is a dedicated Educator and Mentor of medical students, radiology residents and radiology and neuroradiology fellows. She has been invited to present her work nationally and internationally. She is a Member of the European Society of Neuroradiology, the Radiological Society of North America, the Society for Pediatric Radiology, and a Senior Member of the American Society of Neuroradiology.

Abstract:

A variety of congenital heart diseases (CHD) may be diagnosed prenatally. Traditionally, the fetal heart was primarily assessed by fetal echography. However, fetal MRI has been proven as a helpful imaging tool in detection of cardio-vascular anomalies in utero. Numerous conditions, including transposition of great vessels, aorta coarctation, hypoplastic left heart syndrome, tetralogy of Fallout, cardiac aneurysm, pericardiac/cardiac tumors may be demonstrated on MR imaging. In addition, presence of other coexisting anomalies outside of the cardio-vascular system may be revealed. Some cardio-vascular anomalies may be more than an isolated problem and could be a part of an underlying systemic/genetic condition. Even in the absence of genetic abnormalities, infants with CHD are at increased risk of brain lesions (15-45%) or neurodevelopmental delay.  There is numerous data from autopsy reports, postnatal imaging and from more recent prenatal imaging research that congenital heart defects delay structural brain development in utero.  The demonstration of a full spectrum of fetal anomalies provides extremely valuable information to clinicians and parents-to be. Fetal MR may be a feasible addition for timely and precise diagnosis of cardiac disease and associated anomalies. Prenatal imaging therefore helps to predict pregnancy outcome, and prepares couples for the birth of a child with an abnormality.  The obtained information may also assist in thorough screening of fetal patients for eligibility for fetal treatment. It may help to prognosticate to some degree important issues of patient’s developmental outcome and quality of life.

Biography:

Hideko Kasahara completed her MD and PhD from Nagoya University and National Institute of Physiological Sciences in Japan, and postdoctoral studies from University of Michigan and Beth Israel Deaconess Medical Center/Harvard University. She is currently Associate Professor, University of Florida College of Medicine. She has published 48 papers, half of which are related to Nkx2-5 in reputed journals, and has been serving as an editorial board member of Laboratory Investigation.

Abstract:

Introduction: Heterozygous missense mutations in the homeodomain of human NKX2-5 lead to a high penetrance of diverse cardiac anomalies, including Tetralogy of Fallot, along with near complete penetrance of atrioventricular (AV) conduction defects, compared with mutations outside the homeodomain. We recently replicated a disease-causing missense mutation in the homeodomain in a knockin mouse model, Nkx2-5^+/R52G, which demonstrate a high incidence of cardiac malformations and AV conduction defects. Although these mutant mice were backcrossed over 8 generations and expected to have almost the same genetic codes, these mice demonstrate pleiotropic cardiac anomalies, suggesting the presence of non-genetic effects.

Hypothesis: Since maternal health conditions are critical for normal embryonic development, we hypothesize that cardiac defects in the mutant mothers affects embryonic cardiac development.

Methods: Heterozygous mutant and wild-type mice were mated in two different groups: (Group 1) female mutant Nkx2-5^+/R52G and male normal mice; (Group 2) female normal mice and male mutant Nkx2-5^+/R52G mice. The offspring were analyzed postnatal day 7 (P7) by which the mutant mice with severe cardiac anomalies are expected to die.

Results: The genotype of the offspring from Group 2 follows the Mendelian’s law (51% wild-type and 49% mutant, n=115). However the ratio of the genotype from Group 2 was 65% wild-type and 35% mutant (n=89), suggesting that half of the mutant mice died before postnatal day 7.

Conclusion: Our results indicate that when the mothers have heterozygous Nkx2-5 mutation, less number of mutant mice survive until P7, and lead to near 50% of loss of mutant offspring by P7. 

Biography:

Anil Om is an interventional cardiologist at McLeod Regional Medical Center in Florence, SC and Director of their cardiac cath lab.  He received his cardiology training from Virginia Commonwealth University in Richmond, VA and his interventional fellowship from Strong Memorial Hospital in Rochester, NY. He has published more than 25 articles in reputed journals.

Abstract:

Contrast-induced nephropathy (CIN) is one of the complications of contrast angiography.  Various measures have been tried to reduce CIN, but so far, pre-procedural good hydration and minimal contrast used in the procedure have been shown to be of real benefit.  This study reports performing percutaneous coronary intervention (PCI) with minimal contrast.

Twelve patients with base-line significant renal insufficiency, felt to be at higher risk of CIN, underwent thirteen separate PCI by a single-operator.  Their charts were retrospectively reviewed for amount of contrast used and follow-up creatinine. All patients had iso-ismolar contrast and underwent evaluation by intravascular ultrasound.

No patients had CIN (defined by increase in 20% of serum creatinine from base line) and there were no procedural complications.

PCI in patients with baseline significant renal abnormality can be safely undertaken with proper precautionary steps (beyond the scope of this abstract) during the procedure. 

Biography:

S Jamal Mustafa is the Professor of Physiology and Pharmacology at West Virginia University (WVU). He has received Dean’s Award for Excellence in Research from SOM in 2008 and became a Robert C. Byrd Professor in 2010 and received Chancellor’s Award for Outstanding Achievement in Research and Scholarly Activities from HSC, in 2013. He has published over 200 manuscripts. His past work has led to the approval of an A_2A selective AR agonist (Lexican®) for myocardial perfusion imaging. Currently, they are using AR and β adrenergic receptor KOs to better understand the relationship between these receptors in coronary flow regulation.

Abstract:

Adenosine increases coronary flow (CF) through the activation of A_2A and A_2B adenosine receptors (ARs). However, these mechanisms are not fully understood. We previously showed that adenosine-induced increase in CF is in part through NADPH oxidase (Nox), which is independent of A₁ or A₃ ARs. In this study, we hypothesize that adenosine-mediated increase in CF is through Nox activation and depends on A_2A but not on A_2B ARs. Functional studies were conducted using Langendorff mouse hearts. Hydrogen peroxide (H₂O₂) production was measured in isolated coronary arteries from WT, A_2A and A_2B AR KO mice using immunofluorescence. Adenosine-induced concentration-dependent increase in CF was attenuated by the specific Nox2 inhibitor gp91 ds-tat or reactive oxygen species (ROS) scavenger EUK134 in both WT and A_2B but not A_2A AR KO hearts. Similarly, the A_2A AR selective agonist CGS-21680-induced increase in CF was significantly blunted by Nox2 inhibition in both WT and A_2B AR KO, while the A_2B AR selective agonist BAY 60-6583-induced increase in CF was not affected by Nox2 inhibition in WT. In intact isolated coronary arteries, adenosine-induced (10 μM) increase in H₂O₂ formation in both WT and A_2B AR KO mice was attenuated by Nox2 inhibition, whereas adenosine failed to increase H₂O₂ production in A_2A AR KO mice. In conclusion, adenosine-induced increase in CF is partially mediated by Nox2-derived H₂O₂, which critically depends upon the presence of A_2A AR. These studies may lead to better understanding of the role of ARs in coronary disease and may lead to better therapeutic approaches.

Biography:

Abstract:

Introduction: The aim of the study was to evaluate the clinical outcome, 30 day- and longterm follow up in patients undergoing ECMO for refractory postcardiotomy cardiogenic shock.

Methods: We analyzed all patients undergoing ECMO-Therapie (n=1040; age = 55.8±20.8; 67.2% male) between 11/1997 and 12/2013 at our institution. Follow-up range was from 0 to 13.9 years and was complete in 100%.

Results: Patient mean body mass index was 26.6±5.4 kg/m², diabetes in 23.6%, pulmonary hypertension in 15.6%, active smoking in 25.1%, chronic obstructive pulmonary disease in 5.8%, peripheral arterial disease in 21.3%, preoperative intravenous inotropic in 9.2%, preoperative dialysis was in 4.6% and ejection fraction of 43.9±18%. Isolated CABG procedure was performed in 21% and isolated valve procedure in 12.2%. 30 day survival rate was 53±1.6%, 5 year survival rate was 19.8±1.5% and 16.4±1.9% after 10 years. Patient who were discharged from hospital had a 5 year survival rate of 60.6%±3.6% and 10 year survival rate of 50.3±5.3%. Additional surgery procedure increased mortality rate significant. Multivariate regression analysis revealed older age (p=0.01; OR 1.01 per year), preoperative beta blocker (p=0.005; OR 1.6) and active smoking (p=0.002; OR 1.7) as independent risk factors for mortality. Cox analysis revealed following predictors for long term mortality: preoperative calcium antagonist (p=0.01; OR 5.9), active smoking (p=0.013; OR 1.8), active endocarditis (p=0.013; OR 1.5), CABG operation (p=0.004; OR 1.3), aortic valve replacement operation (p=0.008; OR 1.3), mitral valve replacement (p=0.005; OR 1.4), replacement of the ascendens aorta (p=0.002; OR 1.5), postoperative cardiac arrhythmia (p=0.005; OR 5.6), symptomatic postoperative transitory psychotic syndrome (p< 0.001; OR 2.4), gastrointestinal complication (p=0.031; OR 8.9).

Conclusions: ECMO support is an acceptable option for patients with postcardiotomy cardiogenic shock who otherwise would die and is justified by good long-term outcome of hospital survivors. By high morbidity and mortality and also high resource management ECMO support must be definite by individual risk profile.

Biography:

Sweeney obtained his BSc and PhD in Pharmacology at University of Glasgow, UK. He then moved to the Hospital for Sick Children in Toronto as postdoctoral fellow. Sweeney is now Professor in the Department of Biology at York University. He has also served as Chief Scientific Officer and Diabetes Group Leader at Institut Pasteur Korea, a world-leading translational research institute. His research is funded by Canadian Institutes of Health Research, Canadian Diabetes Association and Heart & Stroke Foundation of Canada. Studies have resulted in publications in leading journals including Diabetes, Nature Reviews Cardiology, Proc Natl Acad Sci USA, Journal of Clinical Endocrinology & Metabolism, Endocrinology and Cell Metabolism. These studies focus mainly on diabetes and cardiovascular disease, in particular the mechanisms linking obesity with diabetes and heart failure.

Abstract:

The mechanisms of obesity- and diabetes-induced heart disease are multifaceted and remain to be clearly defined. There is currently great research and clinical interest in the effects of adipokines on the myocardium. This lecture will discuss the potential significance of adipokines in the pathogenesis of heart failure via their ability to regulate cardiac remodeling events including metabolism, hypertrophy, fibrosis, and cell death. As an example of a 'good' adipokine, the focus will first be on adiponectin which is known to confer numerous cardioprotective effects. Subsequently, lipocalin-2 is an example of an adipokine which mediates pro-inflammatory and pro-apoptotic effects. It is important when studying actions of adipokines to integrate cellular and mechanistic analyses and translate these to physiologically relevant in vivo models and clinical studies. However, assimilating studies on numerous cardiac remodeling events which ultimately dictate cardiac dysfunction into a unifying conclusion is challenging. Nevertheless, there is undoubted potential for the use of adipokines as robust biomarkers and appropriate therapeutic targets in heart failure.

Biography:

Abstract:

Objective: Evaluate the real-time tension adjusting to right ventricular pacing lead guided by transthoretic echocardiography during implantation procedure to the influence of long-term tricuspid insufficiency (TI).

Methods: Consecutive patients with following criteria were screened into the study:

1) Chronic three degree atriventricular conduction block. 2) Dual chamber pacemaker was intended to implant. 3) Without tricuspid insufficiency before procedure. 4) Right Passive fixarion ventricular lead from Medtronic Company could be used. Enrolled patients were randomized into TAF group (tension adjusting by fluorospy) and TAE group (tension adjusting by fluorospy plus echocardiography). All passive leads were fixed at right ventricular apex. After satisfied parameter measurement, Trans tricuspid lead tension was adjusted by fluorospy only in TAF group and by fluorospy plus echocardiography. In TAE group, lead tension was adjusten by fluorosoy at first. Then echocardiography was conducted to exam possible tricuspid insufficiency or valvular deformation until adjusting satisfaction. All patients were following up more than 12 months by regular echocardiography.

Results: Total 76 patients (63.8+－11.5 yrs, male 43) were enrolled. Thirty seven cases were randomized into TAF group (64.3+-9.6 yrs, male 21) and 39 cases into TAE group (62.9+-10.7 yrs, male 22). All procedures were successful without complications. In TAE group, mild to moderate TI were detected and rectified after primary floroscopy tension adjusting in 12 patients (30.8%). In TAF group, mild to moderate TI was detected within 24 hours after procedure in 9 patients (24.3%) and it was kept to the end of follow up. During the follow up of 17.5+－4.8 months, TI in TAE group was significantly less than that in TAF group (0.5% vs 24.3%, P<0.01).

Conclusions Echocardiography guided right ventricular pacing lead tension adjusting significantly decreases acute and long-term mild to moderate tricuspid insufficiency.

Biography:

Jin Hur is an associate professor of Radiology at Yonsei University College of Medicine. He has completed his PhD in 2010 in Yonsei University College of Medicine.  He is now a visiting faculty in the department of radiology of Stanford University School of Medicine. He has published more than 50 papers in reputed journals.

Abstract:

It is clinically important to differentiate cardiac tumors from cardiac thrombi because of the difference in therapeutic approaches for these two pathologies. The purpose of this study was to assess the diagnostic value of a volume based quantification using dual-energy cardiac computed tomography (CCT) for differentiating between cardiac tumors and thrombi and to compare quantitative CCT values with late gadolinium enhancement cardiac magnetic resonance (LGE-CMR) parameters. We prospectively enrolled 31 patients who had a cardiac mass on echocardiography or computed tomography (CT). All patients underwent dual-energy CCT (GE HD750) and 20 patients underwent LGE-CMR imaging. For quantitative analysis, the following parameters of the cardiac masses were measured: CT attenuation values in Hounsfield units (HU), iodine concentration (IC, mg/ml), and signal intensity (SI) ratio. A mixed effects model was used to evaluate the significance of differences in mean CT attenuation values, mean iodine concentration, and SI ratios between the cardiac tumor and thrombus groups. Diagnostic performance of each parameter was evaluated by a receiver operating characteristics (ROC) curve. There were a total of 17 cardiac tumors and 15 cardiac thrombi. The mean iodine concentration (mg/ml) was significantly higher in cardiac tumors than cardiac thrombi (3.405 ± 2.624 for cardiac tumors; 2.056 ± 2.793 for cardiac thrombi, p = 0.001). The diagnostic performance of the IC and SI ratio for differentiating cardiac tumors from thrombi was not significantly different (AUC; 0.822 vs. 0.945, p = 0.084). Dual-energy CCT using volume-based iodine measurements can be used to differentiate between cardiac tumors and thrombi.

Biography:

Mark Houston received his MD from Vanderbilt Medical School and Internal Medicine Training at UCSF.  He is an Associate Clinical Professor of Medicine at Vanderbilt University School of Medicine, Clinical Instructor in the Department of Physical Therapy and Health Care Sciences  at  George Washington University (GWU), Director of the Hypertension Institute and Vascular Biology and Medical Director of the Division of Human Nutrition at Saint Thomas Hospital in Nashville, TN .

Dr Houston was selected as one of the Top Physicians in Hypertension in the US in 2008-2014 by the Consumer Research Council, and by USA Today as one of the Most Influential Doctors in the US in both Hypertension and Hyperlipidemia twice in 2009- 2010.  He was selected as The Patient’s Choice Award in 2010 -2012 by Consumer Reports USA.

He is triple boarded certified by the American Board of Internal Medicine (ABIM), the American Society of Hypertension (ASH) (FASH) and the American Board of Anti-Aging and Regenerative Medicine (ABAARM, FAARM).  He holds two Masters of Science degrees in HUMAN NUTRITION from the University of Bridgeport, CT and another in METABOLIC and NUTRITIONAL MEDICINE (University of South Florida School of Medicine-Tampa).  

Abstract:

This study was a randomized, double-blind, placebo-controlled and single-center trial of 40 patients, consisting of a screening visit, a 2-week run-in, and a 4-month treatment period with a combination nutritional supplement (LC). Advanced lipid testing and advanced cardiovascular inflammatory markers were measured.  LC® significantly reduced total cholesterol, LDL-C, VLDL-C, ox LDL, ApoB, TG, LDL-P, heart rate and diastolic blood pressure and increased HDL-P and increased LDL size compared to placebo at one month and four months.   In addition, LC® significantly reduced hs-CRP, TNF alpha, IL-6 within the treatment group from baseline. There were no adverse effects in the treatment group. LC® did not lower Co enzyme Q 10 levels or adversely affect any other lab parameters that were measured. These changes would be expected to reduce cardiovascular risk.  LC® is an effective and safe alternative to statins and other lipid- lowering drugs in the treatment of dyslipidemia.

Biography:

Khaled Sherif has completed his medical school at the age of 25 years from University of Tripoli/ Libya and Internal Medicine Residency from Texas Tech University Health Science Center, Lubbock TX. He is then has completed 2 fellowship training in Geriatric Medicine and Palliative Medicine before he starts working as internist in Covenant Medical Center, Lubbock TX. He is also a clinical faculty at Texas Tech University Department of Internal Medicine. He has published many papers in reputed journals and has been serving as an editorial board member of repute.

Abstract:

Gastropericardial fistula is an acquired disorder that is associated with a high mortality rate. It is a rare complication of laparoscopic surgery for reflux disease and thoracic procedures. A 74-year-old lady with history of gastroesophageal reflux disease (GERD) and surgically repaired hiatal hernia presented with history of chronic dyspnea and cough. Physical examination was normal apart of a pericardial rub. Laboratory data showed leukocytosis and the chest X-ray showed a large left-sided soft mass. As result of the mass on chest x ray, chest and abdominal CT scan was done and showed large pericardial effusion with hiatal hernia and gastro-pericardial connection. Gastropericardial fistula is an uncommon complication but it has very high mortality rate. Among causes that result in this condition, hiatal hernia and esophagogastric surgery have been the most frequently reported. The occurrence of post-operative gastropericardial fistula is induced by the perihiatal scarring. In addition, recurrence of hiatal hernia or migration of the surgical wrap may also favor occurrence of fistulae. For gastropericardial fistula, contrast media-enhanced traditional examinations are the cornerstone of diagnosis. Abdominal CT may reveal the fistula. Surgical correction is the most effective form of treatment.

Biography:

Abstract:

Statement of the Problem: Extensive clinical observations over the past decade have inextricably linked diabetes (DM) to cardiovascular disease (CVD) to an extent that an estimated 70% of all diabetics die from CVD complications. Despite significant clinical advances in CVD treatment, morbidity and mortality due to DM-associated CVD remains an important clinical challenge. Evidence suggests that AT2R, encoded by Agtr2 gene, improves cardiac repair after myocardial infarction. AT2R is an angiotensin II receptor and a member of the anti-inflammatory branch of renin-angiotensin system (RAS). Clinically, loss of AT2R expression in men due to the intronic G1675A or A1818T polymorphism is associated with increased arterial stiffness, and impaired kidney function. We hypothesized that an AT2R agonist that can elevate cardiovascular AT2R expression and activation in conditions of DM will protect patients from DM-associated CVD progression. There are no such drugs currently in standard of care. We reported recently that NP-6A4, an AT2R agonist developed by Novopyxis Inc., could increase the survival and viability of nutrient-stressed mouse and human cardiovascular cells better than beta-blockers and AT1 receptor blocker losartan. This study was performed to determine whether the protective effects of NP-6A4 are translational to a cardiac-impaired animal model (male Zucker Obese, ZO-M rat) a translational model for human CVD and type 2 diabetes (T2DM). We treated 11-week-old ZO-M rats exhibiting CVD with NP-6A4 (1.8mg/kg/day by subcutaneous delivery) for 2 weeks. This treatment improved several cardiac parameters including circumferential strain of endocardium (p≤0.05), myocardial performance index (MPI) (p≤0.005), and E/E’ ratio (p≤0.002). NP-6A4 also reduced cardiomyocyte hypertrophy and fibrosis in ZO-M rats, and increased capillary density and AT2R expression in the heart (p≤0.05). Therefore, we conclude that NP-6A4 is an effective drug that can increase cardiovascular protective AT2R expression and mitigate DM-associated CVD.

Biography:

He has worked as associate professor in the Department of Psychiatry and a senior research scientist in the Central Scientific Laboratory at the Grodno State Medical University (Belarus). He has published more than 700 papers in English and Russian language peer-reviewed journals and 30 monographs focusing on the epidemiology of alcohol/drug-related problems in transitional society. He is a founding member of the International Society of Addiction Medicine (ISAM), presiding member of the International Academy of Sobriety (IAS), national representative for Belarus of World Suicidology Net and is an active member of National Association of Psychiatrists. He currently serves as an Editorial Board member for the European Journal of Medicine, Substance Use and Misuse, Journal of Psychiatry, Acta Psychopathologica, Journal of Addiction Medicine and Therapeutic Science, Journal of Addiction and Therapy, Journal of Sociolomics, Periodic Review of Drinking & Culture, Suicidology, Journal of Cardiology & Diagnostics Research. He is also the Editor-in-Chief of Sobriology.

Abstract:

Background: The mortality rate from cardiovascular disease in Russia is one of the highest in the world. It was repeatedly emphasized that alcohol provides the most plausible explanation for both the high rate and the dramatic fluctuation in Russian cardiovascular mortality rate during the last decades, while other traditional risk factors identified in epidemiologic studies had little predictive value. Objectives: The aim of the present study was to estimate the premature cardiovascular mortality attributable to alcohol abuse in Russia on the basis of aggregate-level data of mortality and alcohol consumption. Methods: Age-standardized sex-specific male and female cardiovascular mortality data for the period 1980-2005 and data on overall alcohol consumption were analyzed by means ARIMA time series analysis. Results: The results of the analysis suggest that 36.1% of all male cardiovascular deaths and 25,8% female cardiovascular deaths in Russia could be attributed to alcohol. The estimated alcohol-attributable fraction for men ranged from 22,7% (75+ age group) to 60,8% (30-44 age group) and for women from 17,3% (75+ age group) and 62,4% (30-44 age group). Conclusions: The outcomes of this study provide support for the hypothesis that alcohol is a major contributor to the high cardiovascular mortality rate in Russian Federation. Therefore prevention of alcohol-attributable harm should be a major public health priority in Russia. Given the distribution of alcohol-related cardiovascular deaths, interventions should be focused on the young and middle-aged men and women.

Biography:

Abstract:

Objective: Evaluate the relationship between ablation dot number at pulmonary vein atrium (PVA) and long-term efficacy of paroxysmal atrial fibrillation (PAF).

Methods: Patients with PAF history more than 6 months were selected to isolate pulmonary veins (PV) at PVA. 3D mapping system (Carto-C3) and cool flow catheter (SmarTouch) were used to make the shell of atrium-PVA and ablation circle around PVA. Superior and inferior PVAs were ablated by single ablation circle. Maximal perpendicular diameters of the circle were measured. The ablation dot on the circle was counted and divided by the sum of two maximal circle diameters. Ablation dot number was defined as addition of left and right PVA ablation dot number. PVA isolation was defined as complete disappear of PV potential. PAF long-term efficacy was evaluated by regular clinical check and Hotter monitoring at 6 and 12 months after procedure.

Results: 160 patients with PAF (65.7+-8.6 yrs, male 110) and with PAF history of 15.7+-9.3 months were enrolled into the study. All PVs in each patient were isolated successfully by single procedure. Ablation dot number per circle and per patient was 32.6+-7.3 and 61.7+-9.1 respectively. During the follow up of 16.5+-3.3 months, 131 patients (81.9ï¼…) were free of PAF. PAF was recurrence in 29 patients (18.1ï¼…) in 4.2+-2.7 months after procedure. Ablation dot number was significantly different between patients with and without PAF recurrence (56.3+-5.7 vs. 63.8+-7.1, P<0.01).

Conclusions: Ablation dot number around PVA is positively related to the long-term efficacy of PAF. Dot creation per patient more than 63 significantly decreases PAF recurrence.

Biography:

Adeola Animasahun is a competent & seasoned Healthcare Professional, her greatest successes have been achieved in the areas of Electrocardiography, Echocardiography, and Diagnostic & interventional Pediatric Cardiology. She has more than 10 years of experience in all facets of Leading a Medical Unit, Operations Management, Training & Development, Consultative Services and overseeing Administration for demanding, high stress and fast paced Healthcare facilities. She promotes academic research initiatives and accurately employ research outcomes into relevant academic activities. She is a versatile contributor with experience in all core Pediatric Interventional Cardiology functions, problem-solving skills, and the ability to make difficult decisions.

Abstract:

Transposition of the great arteries is the most common cyanotic congenital heart lesion in the newborn. . Palliative and definitive interventions to manage children with transposition of the great arteries is currently not available in Nigeria and there are limited reports on it in Africa and sub-Saharan Africa. A prospective and cross sectional study involving consecutive patients diagnosed with transposition of the great arteries using clinical evaluation and echocardiography at the Pediatric Department of Lagos State University Teaching Hospital, Lagos Nigeria as part of a large study between January 2007 and December 2015. There were 51 cases of TGA within the study period with a male to female ratio of 2:1 and a prevalence of 1.55 per 10,000 among population of children who presented to center during the study.  Its proportion amongst children with congenital heart disease was 4.9% , while it  was 15.4% among those with cyanotic congenital heart disease. The mean age +   SD of the subjects was 10.3±21.8. Up to 70% of the patients were less than 6 months of age at initial presentation. The most common mode of presentation in our subjects was cyanosis. The most common associated intracardiac anomaly was ventricular septal defect which occurred in 56% of the patients.

Transposition of the great arteries is as common in Nigeria as in the other parts of the world. The most common mode of presentation was cyanosis. There is an urgent need to establish Pediatric Cardiac centers in Nigeria if these children are to be salvaged.

Biography:

Hari Babu completed his DM( Interventional cardiology) in 2014 as state topper of Rajiv Gandhi university. He did his post-graduation in Internal Medicine from M. S. Ramaiah Medical college. He also did his under graduation from Dr. B R Ambedkar Medical College. He was awarded second best scientific paper in Asia pacific Indialive International conference in Delhi 2014. Three scientific papers are under research, that will be published shortly.

Abstract:

Aim:-Tetralogy of fallot(TOF) is a most common cyanotic congenital heart disease encountered in clinical practice. Right ventricular function is an important determinant of post operative outcomes in these patients. Cardiac Magnetic Resonance Imaging is a gold standard in evaluating right ventricular function. However this technique is expensive, has limited availability, and requires significant expertise to acquire and interpret. Hence we would like to use 2D-Echo which is easily available.  Most of the parameters used in 2D-Echo in evaluating right ventricular function are load dependent except for isovolumic acceleration (IVA) and myocardial performance index(MPI). Hence in view of lack of data on Isovolumic acceleration on pre-operative evaluation in Congenital Heart Disease, we used this parameter in evaluating the post-operative outcomes in (TOF). Isovolumic acceleration is a ratio of peak velocity during isovolumic contraction and time to peak.

Methods:-Sixty three consecutive TOF patients planned for intracardiac repair referred for pre-operative Echocardiographic evaluation were studied. Their mean age was 9+/-3 years. All patients were in sinus rhythm with stable hemodynamic condition during Echocardiographic examination. Doppler tissue imaging technique was used to determine IVA. Recordings were made at a sweep speed of 50 to 100mm/s. Values are presented as means of 3 consecutive beats. The sample volume of 6mm. From the basal right ventricular free wall IVA was measured. These patients were followed up with IVA for 2 weeks and at 1 month.  We correlated preoperative IVA to length of ICU stay and 30 day mortality using chi-square test. A P value of <0.005 was considered significant.

Results:-Sixty three TOF patients were divided into four groups based on IVA values. Group 1 consisted of 19 patients who had IVA > 2.2m/s² were used as controls. Group 2 consisted 12 patients who had IVA between 1.5 and 2.2m/s². Group 3 consisted of 17 patients who had IVA between 1 and 1.5m/s². Group 4 consisted of 15 patients who had IVA <1m/s². Each group was further subdivided based on length of ICU stay and mortality. Group 1 and group 2 had no mortality nor the postoperative ICU stay was more than a week. In group 3, twelve had ICU stay for more than a week and three died in hospital. Group 4, thirteen patients had ICU stay for more than 1 week and 11 died in hospital.

Conclusion:-Our studied showed there is a significant association of pre-operative IVA to post operative outcomes in TOF patients and those patients whose IVA values < 1m/s² had high 30 day mortality with significant P values < 0.0001. Hence IVA can be used as a prognostic marker in TOF patients who are planned for intra-cardiac repair.