Day 1 :
Scripps Clinic, USA
Time : 10:40-11:20
Richard A Schatz is best known for his role in developing the Palmaz-Schatz stent, the first balloon expandable stent used worldwide. His work started a revolution in interventional cardiology that continues today. Since 1998 he has participated in many gene and stem cell trials as a Principal Investigator. He continues to practice at Scripps Clinic in La Jolla, CA and lecture worldwide.
Despite over 25 years of intense research and development at great expense there has yet to be an approved gene or stem cell for cardiac applications. The earliest work began with using VEGF injected as a plasmid DNA directly into the myocardium by thoracotomy, then intra myocardially using a trans-aortic delivery mapping catheter for refractory angina. Others used VEGF/FGF genes or proteins injected intra coronary or intravenously. Despite encouraging phase I and II results, phase III trials were either abandoned or negative. This approach was soon replaced with using stem cells, first autologous then allogenic, for not only refractory angina but for refractory CHF and post MI remodeling. Again, despite encouraging phase I and II results no phase III trial has yet proven positive. This talk will discuss in detail these trials and why there has yet to be a positive trial. There is still controversy regarding the type of cells to use, the method of delivery, the dose and the proper patient subset to treat. Study design is important in order to standardize trials to make it easier to recruit and to win regulatory approval. Endpoints must be carefully chosen to assure a realistic outcome not just for FDA approval but for acceptance by the cardiology community. One of the more interesting lessons learned from these trials is the profound placebo effect that appears in all trial designs and outcomes. Trial design must account for this and power the studies appropriately. Currently there is only one FDA approved trial underway in the USA for refractory CHF and the results are pending. Stem cell therapy for refractory CHF, refractory angina and post MI remodeling represents a great opportunity yet has been unfulfilled thus far. Hopefully with lessons learned from past experience, improved products, delivery and study designs we will see a clinically useful indication for this difficult subset of patients without other options.
UniversitÃ© de Sherbrooke, Canada
Time : 10:00-10:40
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 full 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 published the first study linking SIDS to cardiac sodium channel defects. He 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.
- Chair & Co- chair
Hospital São José, Brazil
Kindai University, Japan
- Special session by Dr. Jay Risk on the topic entitled " Long Term Effects and the Congenital Gap"
- Clinical Cardiology | Interventional Cardiology | Cancer and Heart | Cardiovascular Disease
The Ohio State University Medical Center, USA
Time : 12:40-13:10
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.
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.
UniversitÃ© de Sherbrooke, Canada
Time : 14:10-14:40
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.
Kindai University, Japan
Time : 14:40-15:10
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.
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.
Blackpool Teaching Hospital, UK
Time : 15:10-15:40
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.
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.
University of Hasselt, Belgium
Time : 15:40-16:10
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.
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.
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
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
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.
Hospital SÃ£o JosÃ©, Brazil
Title: Case Report: Case of coronary revascularization in a patient with Situs inversus totalis in a Brazilian hospital
Time : 17:00-17:30
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.
Korea Institute of Oriental Medicine, South Korea
Time : 17:30-18:00
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.
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.
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
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.
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.