Day 2 :
Keynote Forum
Yoshiaki Omura
New York Medical College, USA
Keynote: Non-invasive quick diagnosis of cardiovascular diseases from eyebrows & upper lip, and new method of detecting various cancers from recorded ECGs
Time : 10:00-10:40
Biography:
Yoshiaki Omura has received his Oncological Residency training at Cancer Institute of Columbia University and Doctor of Science Degree through research on Pharmaco-Electro-Physiology of Single Cardiac Cells in-vivo and in-vitro from Columbia University. He researched EMF Resonance phenomenon between two identical molecules for non-invasive detection of molecules, at Graduate Experimental Physics Dept., Columbia University for which he received US patent, and that became the main part of bi-digital O-Ring Test that he developed. He published over 270 original research articles, many chapters, and nine books. He is currently Adjunct Prof. of Family and Community Medicine, New York Medical College; President and Prof. of Int’l College of Acupuncture and Electro-Therapeutics, NY, Editor in Chief, Acupuncture and Electro-Therapeutics Research, Int’l Journal of Integrative Medicine, (indexed by 17 major int’l Indexing Periodicals) formerly, he was also Adjunct Prof. or Visiting Prof. in Universities in USA, France, Italy, Ukraine, Japan, Korea, and China.
Abstract:
Using Electro-magnetic Field (EMF) Resonance phenomenon between 2 identical molecules of identical weight, we can non-invasively and rapidly detect many molecules that exist inside of the body. Using this method, which received US patent in 1993, we were able to map most of the organ’s representation areas on the surface of the face, lips, tongue, hands and feet. When there is any abnormality for a specific internal organ, we found there will always be invisible or visible abnormalities that can be detected on the corresponding organ representation areas. The part of the eyebrows nearest to the nose represents the CardioVascular (CV) system. When there is an abnormality of the CV system, the hair in the eyebrow closest to the nose becomes whiter. When the problem progresses the white hair begins to disappear. When the hair at the eyebrows does not exist, there is almost always an abnormal response in the area and also cardiac Troponin I is significantly increased. If the patient has Atrial Fibrillation (AF), often, in the CV representation area corresponding to SA node and atrium area, there is a significant EMF resonance with monoclonal antibody of Borrelia burgdorferi (B.B.) spirochaete and a corresponding significant increase of ANP in the infected part of the heart at corresponding part of ECGs, while Lyme disease is not included among 13 possible causes of AF. On the face, there is another clinically important CV representation area existing at the left upper lip near the center of the mouth. Often, even if there is a CV problem, left upper lip CV representation area does not show any visible abnormality. However, there is always invisible abnormality. When there is a significant abnormality in the eyebrows at the CV representation area, there is always an equal amount of increased Cardiac Troponin I at left upper lip. If B.B. infection exists in the heart, B.B. resonance response can be found in the left upper lip CV representation area. If optimal dose of effective medicine is evaluated then abnormal, negative responses temporarily change to maximum positive responses. These infections can be screened non-invasively within several minutes and effective and safe treatment based on the individually detected cause(s) can be given after we examine the presence or absence of viral and/or bacterial infections and selecting the most safe, effective treatment available. In addition, the author developed a new method of detecting cancers from rapidly changing part of QRS complex and slowly rising part of T-wave of recorded ECGs.
- Chair & Co- chair
Chair
Matheus Heluany
Hospital São José, Brazil
Co-Chair
Satoru Takeno
Kindai University, Japan
- Special session by Dr. Jay Risk on the topic entitled " Long Term Effects and the Congenital Gap"
- Chair
Chair
Tomasz Kameczura
University of Rzeszow, Poland
- Clinical Cardiology | Interventional Cardiology | Cancer and Heart | Cardiovascular Disease
Location:
Session Introduction
Joseph Kitzmiller
The Ohio State University Medical Center, USA
Title: Translational and clinical applications of pharmacogenomics in cardiovascular medicine
Time : 12:40-13:10
Biography:
Joseph Kitzmiller is an NIH Translational Scholar in Pharmacogenomics and Faculty Member at The Ohio State University (Colleges of Engineering and Medicine). His research focuses on investigating the interplay among genetics, nutrition and cardiovascular pharmacotherapies. With active funding from the American Heart Association and the National Institutes of Health, he leads basic, translational, and clinical research of the largest classes of cardiovascular medications, statins and beta-blockers. He is a Board-Certified Pharmacologist, a Clinical Consultant for Gnome Diagnostics, and a Clinical Investigator at Ohio Clinical Trials. At Gnome Diagnostics, he provides Medical Leadership for the clinical implementation of pharmacogenomics testing, and his work at Ohio Clinical Trials involves implementation of early phase drug development studies. At the Ohio State University, he is an Associate Director of the Center for Pharmacogenomics and Director of the Clinical Pharmacology and Pharmacogenomics Fellowship Training Program.
Abstract:
Pharmacogenomics (PGx), a cornerstone of personalized medicine and optimal health care, has become common place in the practice of cardiovascular medicine. PGx testing can inform drug- and dose-selection strategies to improve efficacy and minimize the risk of adverse effects. The US FDA-approved drug labeling of warfarin recommends VKORC1 and CYP2C9 testing to determine initial doses of warfarin, and testing has resulted in significantly decreased rates of warfarin-associated adverse events. Clopidogrel drug labeling describes the use of CYP2C19 testing to identify patients less likely to respond to clopidogrel so that alternate therapies can be considered. PGx testing also has indication for improving the safety of statins, one of the most commonly prescribed classes of medication worldwide. The Clinical Pharmacogenetics Implementation Consortium (CPIC), a shared project between the US National Institutes of Health (NIH) Pharmacogenomics Knowledgebase (Pharm GKB) and the NIH Pharmacogenomics Research Network (PGRN), recommends SLCO1B1 testing to identify patients at higher risk of simvastatin-associated myopathy. Findings from our ongoing research suggest polymorphisms in CYP3A4 and CYP3A5, the primary metabolizing enzymes for several statins, may to play an important role in characterizing simvastatin myopathy risk. Clinical outcomes associated with beta-blockers, another prominent class of cardiovascular medications, may also be improved with PGx testing. Findings from our ongoing research suggest CYP2D6 testing may prove useful in establishing goals for maintenance dose of beta-blockers in patients with heart failure. This presentation offers a contemporary overview of PGx testing, briefly discussing implications and limitations of emerging validated tests relevant to various classes of cardiovascular pharmacotherapies (e.g., anticoagulants, beta-blockers, and statins). A review of the clinical and translational research used to establish current official guidelines for PGx applications in cardiovascular medicine, will be followed by an in-depth description of our ongoing research involving promising novel PGx applications for statin and beta-blocker pharmacotherapies.
Robert Dumaine
Université de Sherbrooke, Canada
Title: Emerging role of non-cardiac sodium channels in arrhythmias
Time : 14:10-14:40
Biography:
Robert Dumaine initiated and managed the Cardiac molecular genetic program at the Masonic Medical Research Laboratory (NY) from 1996-2004 and was Director of the Department of Physiology and Biophysics at the University of Sherbrooke from 2004-2009. He is now a Professor at the Department of Pharmacology and Physiology at the Univ. de Sherbrooke Qc. Canada. His expertise is on cardiac arrhythmias linked to potassium and sodium ion channel defects. His major contribution includes the discovery of arrhythmogenic mechanisms causing inherited and acquired forms of Long QT syndrome, Short QT syndrome and Brugada Syndrome. In collaboration with P. Schwartz laboratory, he has published the first study linking SIDS to cardiac sodium channel defects. He has pioneered research on the role of non-cardiac sodium channels in heart function and recently showed that overexpression of neuronal sodium channels in the heart could explain the QT prolongation and some of the arrhythmias observed in SUDEP and SIDS.
Abstract:
Satoru Takeno
Kindai University, Japan
Title: The attempts to diagnose and treat children with asymptomatic arrhythmias in Japan
Time : 14:40-15:10
Biography:
Satoru Takeno is graduated from Akita University in 2001. After completing the residency program in general pediatrics at the International Medical Center of Japan, he started his career as a pediatric cardiologist at Kyoto University Hospital. Since 2011, he has engaged in pediatric electrophysiological study and catheter ablation at Kindai University. His specialization is the developmental change of the atrioventricular node in children. He has dedicated his work to investigating the maturational changes of electrical conduction around the triangle of Koch, and the possible mechanisms of developing atrioventricular nodal reentrant tachycardia in children.
Abstract:
Even though arrhythmias in children are not uncommon, we less frequently encounter patients with rhythm disturbances in clinical settings. One of the main reasons for this is that children cannot express their symptoms well. This can lead to the delayed diagnosis that in turn causes progression to either heart failure or tachycardia-induced cardiomyopathy. Therefore, it is essential to strive to detect children with arrhythmia who seem to be asymptomatic, to diagnose, and to treat them properly, in order to improve their quality of life in the future. In Japan in 1994, the government revised the law and all first-grade students in elementary, junior high and senior high school nationwide have to receive electrocardiography on entrance. According to the past report in 2009, 616 (0.69%) out of 89,099 children who received school-based cardiovascular screening in Tokyo had any abnormal findings. Among them, premature ventricular contraction was the most frequent at 60%, followed by WPW syndrome at 19%, premature atrial contraction at 4.7%. However, those patients identified through school-based cardiovascular screenings include a large number of asymptomatic children, and there are many cases where it is difficult to manage them. In this presentation, I will outline the management and problems associated with asymptomatic children with arrhythmias extracted from school-based cardiovascular screenings held in Japan.
Ahmed A M Abbas
Blackpool Teaching Hospital, UK
Title: ICD Lead Migration Case Report : A lesson to learn
Time : 15:10-15:40
Biography:
Ahmed A M Abbas is a Cardiothoracic Registrar at Blackpool Teaching Hospital, UK. He has graduated from Babylon University in Iraq and progressed in surgical training in the UK.
Abstract:
During this cardiology era, the use of ICD is crucial in reducing the mortality of chronic heart failure with ejection fraction of less than 35% and post cardiac arrest. ICD is indicated for primary prevention of sudden cardiac death in patients with ischemic LV dysfunction of less than 40% EF, NYHA class II or III with optimal medical therapy, have a reasonable survival expectation and good functional status for a year. Although uncommon, ICD therapy comes with a risk of significant and even life-threatening complication of cardiac perforation which usually happens at the time of insertion. The incidence of ICD lead perforation reported between 0.34% and 5.2% according to one study. Literature review has revealed wide variety of presentation ranging from no symptoms to fatal tamponade. All cases in one study share common feature of altered lead parameters which highlights the importance of home monitoring to predict and prevent fatal complications. The right atrium and right ventricular apex are the most frequent sites of perforation. In theory, the lead movement with systole is the culprit. This made the thin and stiff leads more likely to perforate especially if mounted with helical screw. Not surprisingly, perforation through the right ventricular apex is frequently an asymptomatic event. Another explanation is related to lead mobility during patient arms movement (Twiddlers Syndrome) as in our case. What makes our case unusual is the fact that perforation symptoms started three years post ICD implantation and the massive anterior thoraco-abdominal haematoma that finally lead to the diagnosis. Previous loss of lead parameters was preceding the perforation on CT. Pacing Clinsymptoms; therefore, high index of suspicion is required for ICD lead migration in such cases.
Dennis Boateng
University of Hasselt, Belgium
Title: Atria fibrillation (AF) detection from photoplethymography (PPG) based on pattern analysis
Time : 15:40-16:10
Biography:
Dennis Boateng has completed his Masters in Clinical Trials from the University of Ghana and hopeful to Graduate in February 2018 in the Master of Biostatistics from the University of Hasselt Belgium. He has worked at the Kintampo Health Research Center as a Data Manager and had practical experience in implementing trials on diagnostic instruments for screening as well as internship from Fibricheck in Belgium that implements PPG technology. He has a few publications in the Application of a Biometric Identification Technique for Linking Community and Hospital Data in Rural Ghana and other local publications from the Kintampo Health Research Center.
Abstract:
Atrial fibrillation (AF) is an irregular condition related to heartbeat leading to several complications including strokes. AF requires extensive and regular diagnosis to confirm its severity, however traditional methods using Electrocardiogram (ECG) is expensive, invasive and time consuming. An innovative approach is the use of PPG implemented on smart phone technologies which has a wide coverage and accessibility for users. However, PPG signals obtained are not clouded by subjectivity yet they do not necessarily report a single definitive depiction of reality relating to autonomic regulations and requires extensive derivation of features to classify individuals correctly. Even though the signals obtained in ECG and PPG are different, their peaks are similar and can be used to derive features that relate to biological interpretation and decisions to classify individuals into a category of heart arrhythmia. Currently, statistical techniques and literature available to classify individuals are few based on the features obtained from the peaks. In many instances, time domain features do not provide direct interpretation of biological features related to heart arrhythmia and therefore more features required. Required methodology for classifying individuals is urgently needed for different arrhythmia and validation to decrease its prevalence. In our approach, the performance of the classifier based on learning and test set can be implemented using the derived features from peaks. The performance and biases of the classification can be further obtained in comparison to gold standard (ECG). Presently, both Poincare and Tachograms provide useful graphical depictions of Heart Rate Variability measurements which can be a platform to improve classification of individuals decreasing the estimated burden of heart related diseases globally.
P.Manokar
Sri Ramachandra University, India
Title: Magnetic Resonance Imaging in evaluation of Heart Failure: A prospective study of 500 consecutive patients
Time : 16:10-16:40
Biography:
P Manokar is a Professor of Cardiology at Sri Ramachandra University, Porur, Chennai, India. He qualified as the Youngest Cardiologist to complete formal training in Cardiology at the age of 29 years in India and then became the youngest to become Professor of Cardiology at the age of 38 years. I work in a JCI accredited University Hospital, the largest stand alone private health care facility in South East Asia with over 2000 beds. He trained at OSU under the able guidance of Dr WT Abraham. He head the Transplant Program and the AHS Training program in Sri Ramachandra University
Abstract:
Background: Conventional diagnostic algorithm in Heart Failure starts with 2DEchocardiography and ends with coronary angiogram in most patients. We decided to evaluate HF patients with MRI and correlate the findings with information available by other modalities
Methods: We evaluated 500 patients of heart failure from various institutions with Magnetic resonance imaging. All patients underwent MRI at a single centre and all images were evaluated by a single operator (RJ). Cine imaging using segmented, breath-held steady-state free precession (SSFP) or real time pulse sequences; morphologic imaging using turbo spin-echo (TSE)-based sequences; perfusion imaging; inversion-recovery delayed-enhancement imaging; phase-contrast flow imaging were done.
Findings: We evaluated 500 patients from 10 institutions referred by 13 cardiologists. 20 patients (4%) had constrictive pericarditis. 10 had cardiac tamponad due to localised pericardial collection of fluid. 30 patients (6%) isolated diastolic HF with restrictive physiology. The remaining 440 patients (88%) had systolic heart failure with LV dysfunction (EF<55%). The etiologydemonstrable by MRI were Ischemic 260 (52%) and non-ischemic 180(36%). The non-ischemic included HCM 60 (12%), ARVC/D 30(6%), myocarditis 30(6%), sarcoidosis 10(2%), EMF 10(2%), Non compaction 10(2%), amyloidosis 20(4%), indeterminate etiology 10(2%). The viability assessment with delayed hyperenhancement was useful in guiding revascularization in the ischemic subset.
Conclusion: MRI evaluation in HF is a comprehensive single stop imaging option for assessment of cardiac anatomy, physiology, pathology and hemodynamics thus could guide appropriate therapies.
Matheus Heluany
Hospital São José, Brazil
Title: Case Report: Case of coronary revascularization in a patient with Situs inversus totalis in a Brazilian hospital
Time : 17:00-17:30
Biography:
Matheus Heluany has his expertise in General Surgery, and is Residente of Cardiovascular Surgery at Hospital São José in Criciúma, a city in the South of Brazil. He is graduated in Medicine by UNESC (Universidade do Extremo Sul Catarinense) and have his General Surgery Residence at Hospital São José in Criciúma. He has experience in Emergency Medicine and has worked as Attending at the biggest Emergency room at the South of Santa Catarina.
Abstract:
Ji-Eun Park
Korea Institute of Oriental Medicine, South Korea
Title: Factors associated with Hypertension control by sex: A Systematic Review
Time : 17:30-18:00
Biography:
Ji-Eun Park has completed his PhD from Seoul National University. She is the Senior Researcher in Korean Institute of Oriental Medicine. She has published more than 30 papers in reputed journals of public health and alternative medicine field.
Abstract:
Introduction: Hypertension is a major risk factor for cardiovascular disease, and for hypertensive patients to avoid complications and increase their quality of life its control is important. Factors affecting hypertension control might be not limited to the individual. In this study, we review existing studies of factors related to hypertension control and evaluate these on four levels: individual, work/family, community, and social. As the impact of factors may also differ between males and females, the effects of various factors on hypertension control were analyzed according to sex.
Methods: Four databases (Pubmed, Web of Science, DBpia, and Korean studies information service system) were searched. All studies investigating the factors related to hypertension control were included.
Results: Thirty studies met the inclusion criteria, and the factors associated with hypertension control varied across the four levels from individual to social. Whether the effect of these factors on HT control was positive or negative was controversial. In the only six studies including sex-specific analysis, health status, smoking, cardiovascular disease, and duration of hypertension was significant only in men. Factors significant only for women included marital status, exercise, alcohol, waist circumference, and health insurance.
Conclusions: Factors associated with hypertension control were distributed not only on an individual level but also on macroscopic levels such as community and social. To improve hypertension control, such factors should be considered across all levels. Moreover, factors associated with hypertension control may differ between men and women. Further studies are necessary to develop gender-specific, multidimensional interventions for hypertension control.
Nurul Islam
Calcutta National Medical College, India
Title: Minimal radiation exposure transcatheter patent ductus arteriosus closure using only venous access- A novel technique
Time : 18:00- 18:30
Biography:
Nurul Islam has completed graduation at 25 years of age in medical science from Calcutta National Medical College, India and had post-graduation in Pediatrics from Vivekanada Institute of Medical Sciences under The West Bengal University of Health Sciences in 2010, He has completed his fellowship in Pediatric Cardiology under Diplomate National Board (DNB) from Indraprastha Apollo Hospitals, Delhi and had training in Advanced Pediatric Cardiac Intervention in Evelina Children Hospital, Guys and St Thomas Trust in UK. Now working as consultant interventional pediatric cardiologist in The Mission hospital and as visiting consultant pediatric cardiologist in esteemed institute, Ramakrishna Mission Seva Pratisthan, Kolkata, West Bengal, India.
Abstract:
Objective: The transcatheter closure of patent ductus arteriosus (PDA), as well as other pediatric cardiac interventions has raised the concerns regarding radiation exposure, particularly relevant when treating children with almost normal life expectancy. The purpose of this study is to show how to perform the transcatheter closure of PDA in children while giving less ionized radiation exposure and to prove that the amount of radiation can be reduced by using pressure trace during catheter manipulation. This is Prospective analysis of feasibility, safety and advantages of doing PDA device closure using only venous access under minimal radiation technique.
Background: Taking an arterial access for transcatheter device closure has been a standard practice but has some inherent complications. The use of radiation or fluoroscopy is necessary but it has some ill effects on tissues, especially in children because of their greater sensitivity compared to adults and also for health care providers inside catheterization laboratory for continuous exposure.
Method: As per our departmental policy, we decided to go for PDA device closure only through venous access in the beginning March 2016 till date. We decided to reduce the radiation time during the procedure by different techniques; most important was entry from IVC to RA, RA to RV and RV to pulmonary artery (ductal end) under pressure tracing guidance and occasionally crossed the ductus under echocardiographic guidance. Echocardiography was used for patient selection and assessment for pre procedure sizing of device and procedural outcome without using aortic angiogram.
Result: 137 out of 176 patients underwent PDA device closure from March 2016 to April 2017, over thirteen months with only venous access and under minimal radiation technique, weighing 3.8- 42 kg with half of them < 10 kg . Fluoroscopic time ranged from 0.04 to 2.12 minutes. Twelve patients had difficulty in entering right ventricle from right atrium and required fluoroscopic guidance. Immediate closure was achieved in 126 patients. Three Syndromic babies had mild flow acceleration across left pulmonary artery and two patients had small intradevice shunt at 12 months of follow up.
Conclusion: PDA device closure can be comfortably done without an arterial access irrespective age and weight of the patients. Apart from pre procedure echocardiographic device selection, pressure trace guidance catheter manipulation can reduce radiation time and effective radiation to patients as well as health care providers compared to conventional technique.
- Heart Failure | Diabetic Cardiovascular Disease | Cardiac Surgery | Current Research in Cardiology
Location:
Session Introduction
Tomasz Kameczura
Rzeszów Uniwersity, Poland
Title: Rating of the limitation of damage to the left ventricle through the use of hypothermia of heart after reperfusion in STEMI - animal model
Time : 11:00- 11:30
Biography:
Dr Tomasz M Kameczura is interventional cardiologist, consultant of cardiology. Living and working in Poland, EU. Experienced in PCI of LM. He is also university lecturer and inventor. Currently working on optimization and safety procedures of heart hypothermia.
Abstract:
The use of direct hypothermia of heart by METcooler used in the treatment of heart attack (STEMI) significantly reduces infarct size (microvascular obstruction (MVO)) and reduces the impairment of left ventricular systolic function (EF).
Background: Current treatments for myocardial infarction (MI) involves the reduction of two modifiable affecting the area of damage to the heart and patient outcome: ie. the time - from the first signs of MI to opening occluded artery (the shorter the damage less) and the use of appropriate pharmacological treatment. Modification of metabolic activity seems to be possible third modifiable which may have an impact on damage to the left ventricular (LV) in the course of heart attack, especially during the critical ischemia. The use of direct hypothermia of heart during acute cardiac ischemia in order to reduce the level of metabolic activity of the heart tissue can significantly reduce the area of LV damage and improve the patients prognosis.
Methods: The study was conducted on animal model. For this purpose we randomized 20 animals (domestic swine) to the study - 10 to the study group (SG) and 10 to the control group (CG). At the baseline, we found there is no significant difference in the age of the animals, sex, and anthropometric parameters. Animals in the CG were sequentially given analgesia, sedation and respiratory therapy. After that we get an arterial access (femoral artery), performed coronarography and by using balloon catheters perform inflation in proximal part of LAD (POBA) (target prox / mid LAD with a diameter of 2.5-3.0 mm behind DG1). After 60 minutes the balloon was deflated and removed from the LAD. The animal was observed, monitored (if necessary appropriate medication were given). Past 48-hours since POBA the MRI was performed with assessment of LV function and assessment of microvascular obstruction (MVO, microvascular obstruction) with a quantitative estimation of MVO. Similarly in SG the coronary angiography was performed with extended (60 minutes) POBA LAD. After removal of balloon catheter from the LAD, a dry puncture of pericardium (pericardial catheter inserted to pericardial sac) was performed, with subsequent, a 12 hrs procedure of direct hypothermia of heart (saline cooled to 30 ° C). 48 hours since POBA, there was MRI evaluation made in CG (MRI CG2) with estimation of LV function and MVO.
Results: Comparison of baseline EF and MVO in CG1 and SG1 showed no significant differences (all p> 0.05). MVO was significantly reduced at SG2, and EF was significantly greater in SG2 comparison to the CG2. Similarly, for the EF and MVO significant difference was observed between the SG2 and CG2 (p <0.001).
Conclusion: The use of direct hypothermia of heart by METcooler in STEMI significantly reduced the extent of damage of left ventricle.
Gobinda Kanti Paul
Mymensingh Medical College & Hospital, Bangladesh
Title: Long-Term survival in an Un-operated single ventricle
Time : 11:30-12:00
Biography:
Gobida Kanti Paul has completed his MD Cardiology, from NICVD under BSMMU, January 2008. He has more than 10 publications in different index journal one of the journals is in our medical college, named MMJ. One of his articles was published in International Journal of Clinical Medicine Research of AASCIT. He is also a Life Member of Indian Academy of Echocardiography. He has passion for nonintervention cardiology specially echocardiography and preventive cardiology. Currently, he is an Assistant Professor/Consultant Cardiology and Residential Physician in the Mymensingh Medical College and Hospital. He has special interest in rheumatic fever and rheumatic heart disease.
Abstract:
Single ventricle (SV) is a rare and complex congenital heart disease. Neonates with single ventricle have a high mortality. Survival into adulthood is rare without surgical intervention. A case of single ventricle with double inlet and double outlet with severe valvular pulmonary stenosis (peak pressure gradient around 80 mmHg) and mitral regurgitation (Grade-11) is being reported here. A 36 years old man smoker, non-diabetic, normotensive married, grocery shopper was admitted for shortness of breath (SOB) and recurrent palpitation with central cyanosis and clubbing, in the CCU, Mymensingh Medical College on 23rd October 2011. On examination SOB, NYHA class 1V, apex beat, in the left 6th intercostal space (ICS), 10 cm from the mid sternal line. There is an Ejection systolic murmur in the pulmonary area (Grade-3/6) and also Pansystolic murmur in the apex (Grade-2/6). He gave no history of weakness of any part of the body. The patient was treated for heart failure and atrial fibrillation. It is very much un-usual, he is now 42 years with very slowly progression his symptoms, mainly SOB, cyanosis and clubbing. Yet now he maintains his daily sedentary activities with taking help to some extent. He was advised for frequent and long-term follow up but he can’t maintain due to very slowly progression of his conditions and also disagree to undergone any cardiac surgical procedure. Exceptionally our case lives into adulthood likely due to balanced hemodynamic condition having pulmonary stenosis.
Paul S. Ramphal
University of the West Indies – Nassau Campus, Bahamas
Title: Development and Implementation of high-fidelity cardiac surgical simulation as a training tool for the next generation of cardiac surgeons: Description of a new paradigmextracts by HerboChip: a platform for drug screening on a chip
Time : 12:00-12:30
Biography:
Paul S Ramphal is a Professor of Surgery at the University of the West Indies, formerly in Jamaica and now at the Bahamas Campus, and Adjunct Assistant Professor of Surgery at the University of North Carolina at Chapel Hill, N C. His research interests have most lately been concerned with alternative methods of imparting basic and advanced surgical skills to young surgeons, especially in developing countries.
Abstract:
Ahmed Abdelgawad
National Heart Institute, Egypt
Title: Tricuspid valve repair with dacron band versus devaga or segmental annuloplasty: hospital outcome and short term results
Time : 12:30-13:00
Biography:
Ahmed Abdelgawad has completed his MD from Alazhar University, Cairo, Egypt. He also has MRCS, Msc General Surgery. He is a Member of STS, RCS England and ESCTS. He is a Member of the examination comitte of the Egyptian Board of Cardiothoracic Surgery. He has published 8 papers in reputed journals. He has worked as a Consultant Cardiac Surgeon at National Heart Institute of Egypt and currently work as an Associate Consultant Cardiac Surgeon at Madinah Cardiac Center of Saudia Arabia.
Abstract:
Background: The purpose of this study was to compare the hospital outcome and short term results of tricuspid valve (TV) repair with three repair techniques for functional tricuspid regurgitation (TR), namely, flexible Dacron band, DeVaga and segmental annuloplasty.
Methods: 60 patients underwent TV repair at National Heart Institute from January 2013 to November 2014, of which 20 had De Vega procedure (DV), 20 had a segmental annuloplasty (SA) procedure and 20 had a Dacron band (DB) procedure. Concomitant procedures done for rheumatic left sided valve pathology consisted of mitral valve replacement in 70% of patients, and double valve replacement in 30% of patients. Clinical and echocardiographic follow-up data were obtained. Follow-up was 100% complete and was concluded after one year.
Results: All demographic criteria and preoperative characteristics of the three studied groups were comparable except for right ventricular (RVEDD) size in cm that was significantly bigger in Dacron band group as compared to the other two groups (3.18±0.43 cm compared to 3.00±0.33 cm (DV) and to 2.88±0.35 cm (SA), p value of (0.045)). Similarly, all operative and postoperative criteria were comparable among the study groups. Noticeably, (RVEDD) size in cm remodeled better in (DB) group as compared to the other two groups, (2.54±0.26 cm compared to 2.83±0.311cm (DV) and to 2.72±0.29 cm (SA), p value of (0.009). the majority of patients in each group did not have tricuspid regurgitation (TR) or mild degree (+1) of (TR) on discharge. After one year of follow up, most of the patient had either no regurgitation or grade (+1 TR). 2 patients (10%) in DV group and one patient (5%) in SA group had (+3 TR), P value by Chi-square test was 0.399, 0.451, 0.840 for DB, DV, SA groups respectively. There was no statistical significance in the incidence of hospital mortality, only one patient died in DB and one in DV group (5%) and no death happened after hospital mortality for the three groups after one year.
Conclusions: The three techniques are options to repair the tricuspid valve, however, placement of an annuloplasty dacron band in patients undergoing tricuspid valve repair is associated with better RV reverse remodeling. Higher number of patients is needed to appreciate the effect on survival and rate of reintervention.
- Young Research Forum
Session Introduction
Ahmed Abdel Maksoud
Weston General Hospital, UK
Title: A comparison of the haemodynamic performance of five different prosthetic aortic valves implanted at a single cardiothoracic centre in the UK
Biography:
Ahmed Abdel Maksoud has completed his Medical degree at Warwick Medical School in 2013. He has completed his BSc in Biochemistry and Masters in Biological Sciences of Research at University of Manchester. After completing Medical school, he has worked at several hospitals in the UK, initially in the West Midlands. It is during this time, he investigated the outcome of aortic valve replacements by analysing echocardiograms results postoperatively at a single centre. He is currently working in Orthopaedics at Weston General hospital in Devon, UK
Abstract:
Available postoperative echocardiogram parameters within 2.5 years of operation date were compared between valves (N=350: Trifecta 42, Stjude 163, CE 92, Mosaic 32 and Hancock 21 ). Multivariate analysis which took into account patient age and valve size showed a significant difference between valves in postoperative peak/mean gradient (PG/MG), aortic valve area (AVA) and Indexed effective orifice area (IEOA) (N=350). The most significant difference was Trifecta versus each of Mosaic (P=0.000 (PG), 0.001 (AVA), 0.001 (IEOA)), St Jude epic (P=0.000 (PG), 0.000 (AVA), 0.000 (IEOA)), CE (P=0.026 (PG), 0.001 (AVA), 0.001 (IEOA)) and Hancock (P=0.008 (PG), 0.130 (AVA), 0.158 (IEOA)). Mosaic had a higher PG compared to all the other valves (P=0.000). For the most common valve size used (23 mm, n=121), the valves ranked in the following order of increasing pressure gradients: Trifecta (PG=17±3.39, MG=8±2.26, IEOA=1.03 ±0.1, AVA=1.97±0.19, n=12), Hancock (PG=19±4.57, MG=11 ±3.27, IEOA=0.79±0.1, AVA=1.47±0.16, n=9), CE (PG=24±3.52, MG=12±1.06, IEOA=0.82±0.07, AVA=1.59±0.12, n=31), Epic (PG=31±3.06, MG=16±1.79, IEOA=0.7±0.06, AVA=1.29±0.09, n=59) and Mosaic (PG=40±9.92, MG=20±3.1, IEOA=0.7±0.19, AVA=1.18±0.2, n=10). This comparison of a unique combination of valves shows that the new Trifecta valve has consistently low peak gradients
Puneet Kaur Randhawa
Punjabi University, India
Title: Investigating the involvement of glycogen synthase kinase-3β and gap junction signaling in TRPV1 and remote hind preconditioning-induced cardio-protection
Biography:
Abstract
Introduction: Remote ischemic preconditioning (RIPC) is the phenomenon that harnesses the body’s endogenous protective mechanisms against prolonged ischemia-reperfusion-induced injury.
Aim & Objective: The present study aims to explore the involvement of glycogen synthase kinase-3β and gap junction signaling in TRPV1 and remote hind preconditioning-induced cardioprotection.
Materials & Methods: In the present study, four consecutive cycles (5 minutes of ischemia-reperfusion) of remote hind limb preconditioning stimulus were delivered using a blood pressure cuff fastened at the inguinal level of the rat. The isolated rat hearts were mounted on the Langendorff’s apparatus and were exposed to 30 minutes of global ischemia-120 minutes of reperfusion. Sustained ischemia-reperfusion led to cardiac injury that was assessed in terms of infarct size, LDH release, CK release, LVDP, +dp/dtmax, -dp/dtmin, heart rate and coronary flow rate. The pharmacological agents employed in the present study included capsaicin (10 mg kg-1) as TRPV1 channel activator, AR-A014418 (1 and 3 mg kg-1) as glycogen synthase kinase-3β inhibitor and carbenoxolone disodium (50 and 100 mg kg-1) as gap junction blocker.
Results & Conclusion: Remote hind limb, capsaicin and AR-A014418 preconditioning led to significant reduction in the infarct size, LDH release, CK release and improved LVDP, +dp/dtmax, -dp/dtmin, heart rate and coronary flow rate. However, remote hind limb, capsaicin and AR-A014418 preconditioning-induced cardioprotective effects were remarkably reduced in the presence of carbenoxolone (100 mg kg-1). This indicates that remote preconditioning stimulus probably activates TRPV1 channels that may inhibit glycogen synthase kinase-3β activity which subsequently enhances gap junction coupling to produce cardioprotective effects.
Abstract:
Puneet Kaur Randhawa is a PhD scholar in the Department of Pharmaceutical Sciences and Drug Research, Punjabi University, Patiala (India). Her key area of research is exploring the molecular mechanisms involved in inducing remote ischemic preconditioning-induced cardioprotection. She has published six research articles and 15 review articles in reputed journals.
Mizanur Rahman
Karolinska Institute, Sweden
Title: Heat shock protein 60 induced atherosclerotic plaque inflammation inhibition by annexin A5
Biography:
Background: Atherosclerosis is characterized by presence of activated immune cells including dendritic cells (DCs) and T cells; dead cells and oxidized low-density lipoprotein (OxLDL). Role of heat shock protein 60 (HSP60) has been implicated in atherosclerosis. Annexin A5 (ANXA5) has atheroprotective properties.
Methods & Results: Human DCs differentiated from peripheral blood monocytes of atherosclerotic patients, were treated with human HSP60 or HSP90. Autologous T cells from atherosclerotic plaques were co-cultured with these pre-treated DCs. DCs and T cell activation was determined by FACScan, gene-activation and cytokine production. HSP60-induced T cell activation was MHC class II-dependent. T cells exposed to HSP60-treated DCs produced pro-inflammatory Th1 type cytokines. DC-T cells from patients who were not treated with lipid lowering drugs secreted more pro-inflammatory cytokine in compare to DC-T cells from lipid lowering drug treated patients secreted more pro-inflammatory cytokine in response to HSP60. HSP90 promoted DCs maturation but did not induce T cell activation. ANXA5 inhibited pro-inflammatory effect of HSP60. Further, ANXA5 inhibited oxLDL-induced HSP-activation of DCs and HSP-production from DCs of healthy donors.
Conclusions: HSP60 induces DCs-activation and induce MHC-II dependent pro-inflammatory T cell activation in atherosclerotic plaques. HSP60 could thus be an important T cell antigen in plaques, and mediate oxLDLs inflammatory effect, promoting plaque rupture and clinical manifestations of CVD. Anti-inflammatory effect of ANXA5 suggests a potential therapeutic role in cardiovascular disease
Abstract:
Howard Lan
Loma Linda University Medical Center, USA
Title: Clinical factors impacting access site in patients presenting with ST elevation myocardial infarction
Biography:
Howard Lan is a Senior Cardiology Fellow at Loma Linda University Medical Center and will continue his training in interventional cardiology at UCSF Fresno in 2018. He is passionate in the field of STEMI research with goals to identify factors that result in improved outcome in this patient population. He hopes to translate his research work into clinical practice in the future to better help patients who present with STEMI. He is also involved in Heart Failure Research and has found an association between cognitive impairment and higher mortality rate. By identifying heart failure patients who are at higher risks for poor outcome, the goal is to intervene early to improve quality of life and to improve overall survival.
Abstract:
Background: Despite, numerous publications showing improved outcomes in transradial (TR) access over transfemoral (TF) access in ST elevation myocardial infarction (STEMI) percutaneous coronary intervention (PCI), clinical factors including age, body mass index (BMI), hemodynamics, bradyarrhythmias may impact management decisions in cath lab thus are important to take into consideration during initial evaluation as access site choice for each STEMI patient should be individualized for best overall outcome.
Objective: The objective of this study was to identify clinical factors that influence TR vs TF access site choice in STEMI patients undergoing angiography and PCI.
Methods: This is a single-center retrospective study of consecutive STEMI patients undergoing angiography and PCI between 2008-2012. 321 patients were enrolled. 294 patients underwent PCI via TF approach and 27 patients underwent PCI via TR approach.
Results: In logistic regression model, patient weight (HR 1.012–1.042, p<0.001) and body mass index (BMI) (HR 1.059-1.173, p<0.001) were the only significant factors favoring TR over TF approach in STEMI PCI. Other initial presenting factors such as age, gender, heart rate, and hypotension did not influence access site choice.
Conclusions: Current study suggests that STEMI patients with higher BMI, who are at increased risk for bleeding complications, are more likely to undergo PCI via TR over TF approach. Interestingly, the obesity paradox suggests that higher BMI is cardioprotective in acute coronary syndrome. The association among access site, BMI and mortality rate in STEMI PCI should be further investigated to delineate factors which result in better outcomes in STEMI patients.
Table.1: Baseline characteristics of ST elevation myocardial infarction patients who underwent percutaneous coronary intervention via transfemoral and transradial access. Hazard ratio and p-value were generated by logistic regression model demonstrating a statistical significant trend towards transradial approach in patients with higher weight and body mass index.
- Video Presentation
Session Introduction
Vladimir Ermoshkin
Russian New University, Russia
Title: New mechanism of acute kidney injury pathological role of arteriovenous anastomoses
Biography:
Vladimir Ermoshkin has graduated in Physics Department of Lomonosov Moscow State University in 1978. He had worked in RosNOU, physicist. Starting in 2011, He have published about 20 articles on cardiology in prominent magazines (Russian and English), and some time He had speech at international medical conferences
Abstract:
The problem of acute kidney injury (AKI) is very complicated. The main causes of AKI are physical interactions. It leads to blood stagnation. The main factor contributing to stagnation of blood, are functioning arteriovenous anastomoses (AVA). At the first stage, with an increase in blood pressure, arterial deformities can occur: increased arterial crimp in kidney, collateral growth, and increase in arterial stiffness, and growth of plaques. In addition, AVA's can open when a significant increase in blood pressure. Wherein BP falls, but the venous pressure increases. The balance of arterial and venous blood volume is disturbed. If there are valves absent or there are valves damaged by pressure, in the venous pressure can be transferred from one organ to another. For example, if there are AVA’s between the superior mesenteric artery and portal vein, it can lead increase venous pressure in the renal veins. An increase in venous pressure can lead to a decrease in the pressure gradient between arterioles and venules in the kidneys. This leads to stagnation, retardation and perfusion stasis in the kidneys, and a decrease in the release of urine. I believe that official medicine needs to focus its efforts on a thorough study of the AVA's work under various conditions for their growth and functioning. It is necessary to develop a new system of measures to prevent AKI, venous stasis, CVD.Ðе
Manuela Stoicescu
University of Oradea, Romania
Title: The risk of antidepressants drugs in patients with prolonged congenital QT syndrome
Time : 16:20-16:40
Biography:
Manuela Stoicescu is Consultant Internal Medicine Physician (PhD in Internal Medicine), Assistant Professor of University of Oradea, Faculty of Medicine and Pharmacy, Medical Disciplines Department, Romania. She was invited as a speaker at more than 30 International Conferences is USA, China, Japan, Canada, Thailand, Dubai, Spain, Germany, is Committing Organizing Member at many International Conferences, is editorial board member in two ISSN prestigious Journal in U.S.A, published more than 20 articles in prestigious ISSN Journals in U.S.A. She published five books: two books for students, two books on Amazon at International Editor–LAP Lambert Publishing Academic House in Germany- “Sudden Cardiac Death in the Young” and “Side Effects of Antiviral Hepatitis Treatment”, one monograph:“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. , a book in USA -‘Tumor Markers in Hypertensive Young Patients”
Abstract:
Objectives: The main important objective of this presentation is to attract attention that the therapy with antidepressant drugs is not inoffensive. In the last period there was an abuse of therapy with antidepressant drugs with or without serious justification. Many young women used these pills after diagnosis of depression. This abuse must to be stopped because of dangerous sides effects.
Material & Methods: Present the situation of a woman patient 40 years old, non-smoker, without coffee or alcohol consume, with a good life style, which started the therapy with tricyclic antidepressant drug–amitriptyline,10 mg orally 3 times daily with four month ago, after her husband deeds in a car accident and she was diagnosis with depression. After that, she came at the consultation for a crisis of palpitations. The EKG showed torsades de pointes and needs antiarrhythmic i.v. therapy to revue in sinus rhythm. When the patient become in sinus rhythm appear evident on EKG the QT interval very long so a prolonged QT interval. This could be a side effect after amitriptyline administration, or the patient can have had an unknown prolonged congenital QT interval and the antidepressant drug prolong more than that the QT interval and this degenerate and develop torsades de pointes, very risky because can induce ventricular fibrillation and sudden death. Of course the therapy was stopped.
Results & Discussions: The antidepressant drug - amitriptyline is contraindicating at the patients with congenital prolog QT syndrome. It is dangerous to start this therapy without one minimum EKG before, to exclude this congenital prolog QT syndrome unknown, because is asymptomatic. Also, at the categories of patients with normal EKG previously, can develop side effects prolog QT syndrome after amitriptyline, but if the congenital prolong QT syndrome is present, the risk for torsades de points are higher.
Conclusions: The administration of antidepressant drugs without an EKG before started this therapy, is dangerous because these categories of drugs especial amitriptyline develop side effects prolong QT syndrome and if a patient had an unknown congenital QT long syndrome this side effects prolong more QT interval and can degenerate in torsades de pointes, ventricular fibrillation, cardiac arrest and sudden death. The patients must to be attention about this dangerous risk.
- Poster Presentation