20^th European Cardiology Conference October 16-18, 2017 Hotel Mercure Budapest Buda, Budapest, Hungary

Biography:

Adj Associate Professor Sophia Chew obtained her MBBS, MMED(Anaesthesia) from the National University of Singapore and is a Fellow of the Australian and New Zealand College of Anaesthestists.  She trained in cardiac anaesthesia at the Duke University Medical Centre in the United States of America.

She is the Director of Research at the Department of Anaesthesiology at the Singapore General Hospital and Deputy Vice Chair of the Academic Clinical Program.  A/P Chew has published more than 25 papers in reputed journals and won numerous awards for abstract presentations both locally and internationally.

Abstract:

Acute kidney injury (AKI) is common, occurring in about 1 in 3 patients after cardiac surgery.  It is associated with increased mortality, morbidity and healthcare costs.  It is a multifactorial disorder and there is currently limited renoprotective mechanisms, hence prevention and early recognition of AKI is the focus of extensive clinical and basic science research.

AKI risk models are useful for predicting acute renal failure requiring dialysis but are limited in  non dialysis requiring AKI due to non-standardized definitions of AKI used, differing intraoperative variable, small cohorts and lack of external validation. Furthermore, all these models have been based on the Western population which may not be valid in the Asia-Pacific region.

We developed and validated a risk model that utilized both preoperative and intraoperative variables to predict AKI after cardiac surgery in our local population.  Similar to other studies, increased age, hypertension, eGFR less than 60ml/min, prolonged bypass time and use of intra-aortic balloon pump were risk factors for AKI.  In addition, preoperative anemia, lowest haematocrit during bypass and intraoperative red blood cell transfusion are significant modifiable  risk factors in our model.  The risk score is easy to use, robust and allows for early detection of the patient at risk of AKI and institution of early management strategies.  Our AKI risk model is the first developed for an Asian population and has high clinical utility given the large population of Chinese and Indians globally . 

Biography:

Will be updated soon...

Abstract:

31-year-old woman with a diagnosis of mitral valve endocarditis and left sacroiilitis due to streptococcus viridians with intermediate CIM to Penicillin (0,25 ug/ml). In another institution she was treated with ampicillin for 3 weeks and then with oral amoxicillin. She is admitted to our Hospital with fever and petechiae on both lower extremities. Negative blood culture tests to common germs. Transaesophagial echocardiogram in anterior valve of mitral valve: 1.9 by 1.2 cm sessile image, lobulated, mobile, within left auricle, with slight mitral insufficiency. During her admission she shows embolic phenomena in inferior extremities, without compromising peripheral pulses. Assessed by vascular cardio- surgeon, a non-surgical conduct is decided. The patient completes 4 weeks of ampicillin 12g/day plus 240mg/day gentamicin with a favorable evolution. 10 days after being released she complains of pain on left calf. A complete body bone scintigraphy is performed with T99 marked with ciprofloxacin: hyper-uptake in left leg middle third in tibia topography and clear reduction sacroiliac hyper-uptake. Left leg RMI: in the deep sector of superior third there appears a structure with lobulated contours and well-defined margins of 89 mm height and a diameter of 44mm in the axial shaft with re-enforcement of paramagnetic contrast, with iso, hypo and hyper-uptaking areas. Inferior extremities arterial Ecodoppler: in tibio-peroneal trunk and anterior tibia artery source: a saccular, hypoechogenic and heterogeneous structure is found of 10cm-long lobulated contours. Turbulent arterial flow with a positive Doppler signal. Conclusion: a pseudoaneurysm compromising tibio-peroneal trunk with peroneal and tibial posterior arteries with hypoflow. Endoluminal repair of giant sterile mycotic pseudoaneurysm of tibio-peroneal trunk was performed, with satisfactory evolution and without complications.

Biography:

Tareq Aleinati MD FRCSC is a consultant cardiac surgeon who had his training done at McMaster University, Hamilton, Canada. He then did fellowships in the fields of complex mitral valve surgeries and heart failure surgical interventions with VAD and heart transplantation at University of Toronto, Toronto and McGill University, Montreal, Canada. He currently works at Chest Diseases Hospital in Kuwait, one of the leading specialized hospitals in Middle East. Areas of expertise include valvular and aortic reconstruction, heart failure surgery, total arterial coronary artery revascularization, atrial fibrillation surgery and minimally invasive cardiac surgery ( Aortic, Mitral and Tricuspid valves, CoxMaze ablation, ASD repair).

Abstract:

The full-length median sternotomy is the standard approach for single, double and triple valve operations. Right anterior mini-thoracotomy is a well-known minimal access approach for isolated aortic valve replacement or combined aortic and mitral valve surgeries. However, replacing or repairing three valves with concomitant CryoMaze through such an access is not well established. We hereby describe a case of 49 year-old male patient with rheumatic heart disease and a large left atrium associated with permanent atrial fibrillation. He underwent a successful aortic and mitral valve replacement with tricuspid valve repair and concomitant left atrial Maze using argon based Cryo-ablation through right anterior minithoracotomy. This was approached via the 3rd intercostal space with establishment of cardiopulmonary bypass through peripheral arterial and venous cannulation. Post-operative Echo showed good results and six months later the patient continues to be in normal sinus rhythm. The patient regained full functional capacity in four weeks post-operatively. Thus, we have shown that performing such a complex procedure through minimal access is feasible with successful outcomes.

Biography:

Leoné Malan aims to underpin a novel pathway pertaining brain-heart health. Considering this focus she designed the first well-controlled psychophysiological prospective cohort study in Sub Saharan Africa (SABPA), and as PI received an international award for design excellence (France, 2008). She conceptualized a Hypertension Research clinic on-campus and induced cardiovascular monitoring programs. Apart from being a council member of the European Society Cardiology on Hypertension, she holds various professional memberships. International peer-reviewed publications totals >135 publications and several grants support her research. She and her international expert and pharmaceutical stake holders’ network aims to develop a diagnostic tool to phenotype stress and related cardiomyopathy.

Abstract:

Sympatho-adrenal responses are activated as an innate defense coping (DefS) mechanism during emotional stress. Whether these sympatho-adrenal responses drive cardiac troponin T (cTnT) increases are unknown. Therefore, associations between cTnT and sympatho-adrenal responses were assessed. A prospective cohort, excluding atrial fibrillation, myocardial infarction and stroke cases, was followed for 3 years (N=342; 45.6±9.0 years). We obtained serum high-sensitive cTnT and outcome measures [Coping-Strategy-Indicator, depression/Patient-Health-Questionnarie-9, 24h BP, 24h heart-rate-variability (HRV) and 24h urinary catecholamines]. Blacks showed moderate depression (36% vs. 13%) and 24h hypertension (67% vs. 42%) prevalence compared to Whites. A receiver-operating-characteristics cTnT cut-point 4.2 ng/L predicted hypertension in Blacks [AUC 0.68 (95% CI 0.60-0.76); sensitivity/specificity 63/70%; P≤0.001], which was used as binary exposure measure in relation to outcome measures. In cross-sectional analyses, elevated cTnT was related to DefS [OR 1.34 (95% CI 0.98-1.83); P=0.06]; 24h BP [OR 1.03-1.04 (95% CI 1.01-1.08); P≤0.02] and depressed HRV [OR 2.19 (95% CI 1.09-4.41); P=0.03] in Blacks, but not in Whites. At 3 year follow-up, elevated cTnT was related to attenuated urine norepinephrine:creatinine ratio in Blacks [OR 1.46 (95% CI 1.01-2.10); P=0.04]. In Whites, a cut point of 5.6 ng/L cTnT (P≤0.001) predicted hypertension but was not associated with outcome measures. To conclude, central neural control systems exemplified a brain-heart stress pathway. Desensitization of sympatho-adrenal responses occurred with initial neural- (HRV) followed by neuroendocrine dysfunction (norepinephrine:creatinine) in relation to elevated cTnT. Chronic defensiveness may thus drive desensitization, reflecting ischemic heart disease risk in Blacks at a 4.2 ng/L cTnT cut-point.

Biography:

James I-Sheng Huang received his DDS degree at Chung Shan Medical University, with more than 30 years of experience in clinical dentistry, specializing in implantology. He was the former president of Taiwan Dental Association and contributed in dental health care by implementing a global budget in Taiwan National Health Insurance. In recent years, the occurrence of syncope in clinical cases marked his interest in the trigeminocardiac reflex (TCR), and subsequently received his PhD at Chung Shan Medical University researching the relationship and between TCR and dental reflexes.

Abstract:

Background/Purpose: Trigeminocardiac reflex (TCR) is a unique clinical incident of acute change in hemodynamic balance, which may lead to hypotension, bradycardia, and even clinical crisis. To date, no study evaluated the impact of non-surgical root canal treatment (NSRCT) of irreversible pulpitis teeth, cavitary filling, or implantation under either local infiltration or block anesthesia on hemodynamic changes. Methods: We enrolled 111 patients with 138 irreversible pulpitis teeth that were treated by two sessions of NSRCT. The first session involved mainly the removal of vital pulp tissue with the direct stimulation of the dental branches of the trigeminal nerve, and the second session included the root canal enlargement and debridement with minimal disturbance to the dental branches of the trigeminal nerve. Vital signs mainly the blood pressure were recorded during both NSRCT sessions. Results: The incidences of NSRCT patients with MABP decrease ≧ 10%, ≧ 15%, or ≧ 20% were all significantly higher in the first NSRCT session than in the second NSRCT session (all the P-values < 0.001). In the first NSRCT session, the incidence  of patients with MABP decrease ≧ 10% was significantly associated with tooth type. For both upper and lower teeth,the patients with premolars treated by NSRCR had significantly higher incidences of MABP decrease ≧ 10% than those with either anterior or molar teeth treated by NSRCR (all the P-values < 0.05).

Conclusion: We conclude that vital pulp extirpation may lead to a substantial drop in patient’s blood pressure possibly related to TCR.

Biography:

Dr. Anna Rekhviashvili MD, PhD is currently working as a cardiologistchief of the Outpatients and Diagnostics Department at Archangel St Michael Clinical Hospital and is leading Arterial Hypertension and Vascular Study Center, Tbilisi, Georgia. She completed her M.D. in Tbilisi State University, Georgia in 2002. She was Junior doctor and PhD student from 2003-2008 in the National Institute of Cardiology. She worked as a cardiologist at the Iv. Javakhishvili Tbilisi State University Hospital, Tbilisi, Georgia. She was Visiting Research Fellow at the Continuum Heart Institute, Beth Israel Medical Center, Albert Einstein College of Medicine New York, NY in 2010 and Visiting Professor at the AMC, Amsterdam, Netherlands in 2016. She is a member of many professional national and international societies in cardiology, hypertension and atherosclerosis. Research interests are diurnal variation of blood pressure, endothelial dysfunction, micro- and macrocirculation in hypertension. She has many publications in national and international journals.

Abstract:

Introduction: Left ventricular hypertrophy (LVH) is the most common target organ damage in arterial hypertension (AH). Hence, the association of LVH and circadian rhythm of blood pressure (BP) is still under debate. Nondipping circadian BP pattern increase risk of cardiovascular and cerebrovascular events, that may be due to the abnormalities in blood coagulation and activation of thrombogenesis

The purpose of this study is to proof hypothesis, that non-dipper hypertensive patients in comparison with dippers have an adverse blood coagulation and activated thrombogenesis, as well as more severe LVH.

Methods: 57 patients with AH and 17 controls with normal BP were included in the study. 24-hour ambulatory BP monitoring, cardiac ultrasound and examination of blood rheology, namely plasma and whole blood viscosity, fibrinogen concentration, platelet aggregation and adhesive activity was performed in all the patients according to the standard protocols. Written informed consent was obtained from all participants.

Results: Dipper pattern was revealed in 20 patients and nondipping in 37 hypertensive patients. Nondipper hypertensives in comparison with dippers had higher levels of fibrinogen concentration, plasma and whole blood viscosity, platelet aggregation, as well as adhesiveness (P<0.001). The prevalence of LVH was markedly higher among non-dipper patients with AH than among those without this disease or dipper pattern.

Conclusion: Results of our study confirm the hypothesis, that nondipper hypertensive patients in comparison with dipper hypertensive patients have statistically significant deterioration of blood rheology and have markedly higher prevalence of significant LVH. Hence, we can conclude that nondipper hypertensive patients are markedly prone to the cardiovascular complications due to the significant LVH and high risk of thrombogenesis.

Recommendations are made for the doctors involved in AH management to check blood rheology besides the LVH assessment and ABPM for proper evaluation of a patient’s potential risk and avoid possible CV complications. 

Biography:

Alexander Manché is the Chairman of the Cardiothoracic Surgery at Mater Dei Hospital, Malta. He qualified at Westminster Medical School, London in 1979 and spent 18 years in the UK and the US, including 2 years of research at the Rayne Institute. He returned to Malta in 1995 and set up the Cardiothoracic Unit, which offers a comprehensive adult service including surgery for ischaemic and valvular heart disease, thoracic vascular conditions, heart transplantation, vascular access as well as lung disease.

His journal publications and presentations at scientific meetings number over two hundred.  He has a special interest in the epidemiology of aortic valve surgery.

Abstract:

Transcatheter Aortic Valve Implantation (TAVI) is increasingly employed in the treatment of severe aortic stenosis. Initially the indication was in patients who were refused surgery on the grounds of an unacceptably high risk. Long-term results following TAVI are sparse and current data suggests that about a third of patients are alive at 6 years.  TAVI is now being offered to intermediate risk patients without available long-term data. Surgery in such patients offers excellent results, both in the short and long term.

We present our unit’s long-term outcomes after surgical aortic valve replacement (sAVR), with or without concomitant coronary revascularisation. We conclude, from a 20-year relative survival study, that patients aged 68 or older can achieve a normal life expectancy after sAVR. This study correlated long-term survival with patient-related, procedure-related and post-operative complication-related factors. In a second study we evaluated the effect of prosthesis-patient mismatch on long-term survival.

We believe that sAVR remains the gold standard of treatment for severe aortic stenosis.

The decision to offer patients TAVI should take into consideration the known long-term results of surgery.

Biography:

Tareq Aleinati MD FRCSC is a consultant cardiac surgeon who had his training done at McMaster University, Hamilton, Canada. He then did fellowships in the fields of complex mitral valve surgeries and heart failure surgical interventions with VAD and heart transplantation at University of Toronto, Toronto and McGill University, Montreal, Canada. He currently works at Chest Diseases Hospital in Kuwait, one of the leading specialized hospitals in Middle East. Areas of expertise include valvular and aortic reconstruction, heart failure surgery, total arterial coronary artery revascularization, atrial fibrillation surgery and minimally invasive cardiac surgery ( Aortic, Mitral and Tricuspid valves, CoxMaze ablation, ASD repair).

Abstract:

AF is the most frequently encountered tachyarrthymia in cardiac surgery patients. Maze IV and its LA lesion set are both associated with the highest success rate of treatment of AF. Recently we introduced minimally invasive cryoablation Maze in our institution. Our study objective is to evaluate feasibility, safety, and early results of concomitant AF treatment with argon based cryoablation in patients undergoing valvular procedures through right minithoracotomy.

Methods and results

Between October 2016 and January 2017, data were retrospectively collected of all patients who underwent cryoablation Maze combined with valve surgeries through right minithoracotomy approach. Argon based cryoablation devices were used in all cases. Seven patients were identified. Five of those underwent one-valve surgery, one had two-valve surgery with ASD closure, and one had three-valve surgery, all with cryoablation Maze. Four (58%) were females, average age was 56 years, 4(58%) had rheumatic valvular disease while 3(42%) had degenerative MR. LVEF 51±9.1% and left atrial size 69.4±20 mm. All patients had permanent AF. CPB and cross clamp times were 256±60 and 184±52 minutes respectively. There were no mortality, MACE or stroke. Five patients (71%) were in normal sinus rhythm at 8 month follow up.

Conclusion

Our initial experience using Argon based cryoablation for concomitant treatment of AF through right minithoracotomy seems to be feasible and safe. Our early success rate (71%) in treating AF through this approach is promising. We also demonstrated that such approach seems to be feasible and successful in complex multiple valve procedures associated with permanent AF and large atria. A bigger study group  and more than one year follow up results are needed to support our initial conclusion.

Biography:

Biography: Dr. Gasparovic is an associate professor of surgery at the University Hospital Rebro Zagreb where he serves as the Director of the Adult cardiac surgical division. He has been trained in cardiac surgery at both the University Hospital Rebro Zagreb and the Brigham and Women’s Hospital, Harvard University. He is the author of over 80 peer-reviewed publications, and has also written six book chapters on cardiac surgery. 

Abstract:

INTRODUCTION: Infections are an important source of morbidity and mortality among heart transplantation (HTx) recipients. Understanding the origins and predisposing conditions are critical for improvement of outcomes. Patients requiring renal replacement therapy (RRT) after HTx are particularly susceptible to infections.

METHODS: All 167 consecutive patients undergoing heart transplantation in a single academic center from January 2008 to December 2016 were screened for analysis.  Patients with missing microbial data were excluded (N=9).  The remaining 158 patients were dichotomized according to the need for periprocedural RRT. Twenty-seven patients required RRT (17%). Patients requiring postoperative RRT had lower preoperative creatinine clearance (53±21 vs. 62±21 ml/min, P=0.044), greater body mass indices (27±3 vs. 25±5, P=0.014) and were more likely to be diabetic (41% vs. 20%, P=0.026). Propensity score adjustment was used in order to account for multiple covariates (recipient age and gender, organ ischemic time, body mass index, pulmonary vascular resistance, creatinine clearance, duration of cardiopulmonary bypass, diabetes, preoperative and postoperative mechanical circulatory assistance). 

RESULTS: The incidence of any positive microbial isolates among patients requiring RRT after Htx was significantly higher on unadjusted analysis (25/27 (93%) vs. 95/131 (73%), OR 4.77 [1.01-30.53], P=0.026). Patients requiring RRT had an increased susceptibility to positive microbial isolates from blood cultures (13/26 (50%) vs. 20/90 (22%), OR 3.50 [1.28-9.67], P=0.012). Propensity score adjusted analysis corroborated the significant difference for positive blood cultures (OR 3.97 [1.28-12.32], P=0.017), while the incidence of total microbial isolates was just below the level of statistical significance (OR 4.55 [0.90-23.05], P=0.067).

CONCLUSIONS: We have shown that patients requiring early RRT following HTx had an increased susceptibility to infections via various portals of entry, predominantly due to an increase in blood borne infections.  Understanding the underlying conditions leading to infection-related morbidity is paramount in infection control and prevention

Biography:

Will be updated soon...

Abstract:

Background- Cardiovascular disease is the number one cause for mortality in women. There has been a steady increase in mortality in women younger than 55. There is a lack of awareness and knowledge regarding signs and symptoms of cardiovascular disease in women. A unique sub-group of this population is pregnant women. Acute Myocardial infarction incidence is 0.2-1% in pregnant women. There has been a steady increase of pregnancy in older women and cardiovascular complications. In this group-Mother Mortality is 9% and fetal mortality is 6%.

Aim-  early identification and assessment of women and high risk pregnancy.

Method-case presentation of 37 year old woman with Ischemic heart disease and Status post coronary stent placement. Before discharge home from ICCU she consults with nursing staff about becoming pregnant. 

Results- women suffering from ischemic heart disease are able to become pregnant and undergo labor and vaginal delivery while under close surveillance. Epidural anesthesia should be preformed and the birthing mother should be attached to cardiac monitoring while in labor and delivery. Caesarian section should be performed only is cases when mother is hemodynamically unstable, or in cases that myocardial infarction occurred close to day of delivery.

Conclusion- Since the increase of pregnancy in older women and cardiovascular complications, it is imperative that intensive care nurses know how to instruct and guide these women regarding their obstetric future.

Biography:

Dr. Andris Skride is an interventional cardiologist and pulmonary hypertension expert at Pauls Stradins Clinical University Hospital in Riga, Latvia. He is the founder and current manager of Latvian pulmonary hypertension registry and head of Rare Disease Specialist Association of Latvia. Dr. Skride has been actively involved in education of health professionals in Latvia, aiming to increase the awareness of rare diseases in daily practice as many of those diseases are severely underdiagnosed in developing countries. He is also one of the main organizers of two local conferences on rare diseases and of the first Baltic Pulmonary Hypertension Conference which took place in Riga last spring.

Abstract:

Choriocarcinoma of the pulmonary artery is rare but curable. The condition is characterized by unspecific symptoms and radiological findings, which can mimic pneumonia and tuberculosis in early stages and pulmonary embolism and chronic thromboembolic pulmonary hypertension in later stages of disease, representing diagnostic challenges. It is important to identify unspecific respiratory symptoms in the presence of meno-metrorrhagia after pregnancy and/or childbirth, and to measure β-hCG levels.

Biography:

Tomohiro Asahi graduated from Tokyo Medical and Dental University in 1991 and started training in internal medicine and cardiology at University of the Ryukyus. He has completed his PhD program in 2001. He is currently a chief cardiologist at Naha City Hospital since 2007 and continues clinical research mainly on heart failure.

Abstract:

Background: The evaluation of the inferior vena cava (IVC) diameter and respiratory collapse is useful in the management of acute heart failure (HF) syndrome. However, its impact on the prognosis is unknown.

Methods: Seventy-four consecutive patients admitted for acute HF syndrome were analyzed and followed for 1 year. The measurement of IVC diameter after stabilization of respiratory distress were performed on admission. The IVC collapsibility index (IVC-CI) was calculated as (maximal IVC−minimal IVC)/maximal IVC. According to the initial IVC-CI, the patients were divided into the collapse group (IVC-CI≥0.5: n=34) and the non-collapse group (IVC-CI<0.5: n=40). During 1 year, the endpoints were mortality due to HF and the combined event of mortality and readmission for HF.

Results: Age, the proportion of male subjects, and left ventricular ejection fraction were comparable between the groups. Initial blood pressure (178±35 mmHg vs. 143±34 mmHg, p<0.01) and initial amount of oxygen administration (5.7±5.6 L/min vs. 2.9±4.2 L/min, p<0.05) were higher in collapse group than in non-collapse group. The Kaplan-Meier curves showed that survival free of the mortality and combined event during 1 year were higher in collapse group.

Conclusions: Although the degree of pulmonary congestion was severer in collapse group, prognosis of HF was better. This might indicate that the lower central venous pressure and the less fluid accumulation contribute the better prognosis of HF. 

Biography:

Will be updated soon...

Abstract:

Will be updated soon...

Biography:

Katharina is working as a Specialty Registrar in a Department of General Surgery at a teaching hospital of the Charité Berlin in Germany. She has an interest in the perioperative management of surgical patients and is collaborating on interdisciplinary research projects in cardiac and thoracic surgery as well as in intensive care medicine.

Abstract:

Background: Fast track recovery programmes are a major innovation in the care of general surgical patients, reducing perioperative complications, length of stay (LOS) and reducing costs. It is unclear how these relate to the post cardiac surgery population.

Methods: We analysed all databases for studies which evaluated fast track rocovery after cardiac surgery from 1999-2016. A total of 7 studies were identified; 4 studies (3 prospective, 1 retrospective) comparing a fast-track recovery vs. a control group; 3 studies (1 prospective, 2 retrospective) assessing the reasons for failure of fast track recovery programmes.

Results: A total of 792 patients were included comparing fast track recovery. In-hospital mortality was lower in one retrospective cohort study (0.5% vs. 3.3%, p<0.01).

The total length of stay was lower in two studies (p<0.01, 10 (8–12) vs. 11days (9 –14), p=0.02). One study showed lower pain scores on day 1-3 (p<0.01, p<0.05, p<0.01).

Enhanced recovery had lower mean costs í4182±í2284 ($6683±$3650) vs. 4553±í1355 ($7277±$2165), p<0.001).

Three studies with a total of 15,212 patients analysed the failure of enhanced recovery programmes. These described a success rate of 97%, 89% and 84% retrospectively. One study found a readmission to be associated with a prolonged ICU stay (105+/-180.0 vs. 19.2+/-2.4 hours of initial ICU stay) and worse outcomes. Independent risk factors for failure were age, female sex, prolonged surgery, and prolonged cross-clamp time and left ventricular dysfunction.

Conclusion: Small retrospective and prospective studies demonstrate fast track recovery after cardiac surgery as an important management strategy in carefully pre-selected patient groups decreasing the intensive care LOS, total duration of intubation, potentially the LOS and is a cost effective strategy compared to conventional recovery. There is a lack of randomised trail data assessing which components of the fast tracking system contribute most to the outcomes.

Biography:

Will be updated soon...

Abstract:

Stress affect at least 90% of the world population, as a result of the current lifestyle. In the heart, catecholamines released during the stress response activate beta adrenergic receptors (?-AR), mainly beta

1 (?1-AR) and beta 2 (?2-AR) subtypes. Alterations in the proportion of ?-ARs subtypes, with a role played by  ?2-ARs-Gi protein-PI3K-Akt signaling pathways, have been described in several cardiovascular disorders, including heart failure, aging, and in animal models of behavioral stress. This has been the focus of our research group. More recently, it has been shown that sirtuins play a role in several organic processes through the activation of the PI3K-Akt signaling. 

Sirtuins are involved in the modulation of the cellular stress response, by activating several downstream molecules, such as those involved in the control of p53, Akt, HIF1-? and NF-?B. SIRT1 and SIRT3 are crucially related to the regulation of cardiomyocyte energy metabolism, production of reactive oxygen species. In the cardiac tissue, SIRT and ?2-ARs-Gi control signaling pathways of cell survival and death, with various roles in the regulation of energy production and oxidative stress, aging, autophagy, energy metabolism, oxidative stress and some diseases. Here, the role played by ?2-ARs and sirtuins during aging, heart fails and in the adaptation to stress is revised and a hypothesis is presented of an interplay between ?2-ARs and sirtuins in the heart.

Biography:

Will be updated soon...

Abstract:

A 74-year-old female with interstitial pneumonia and old myocardial infarction was admitted with stroke because of calcific emboli. Caseous calcification of the mitral annulus was detected using computed tomography (CT) and transthoracic echocardiography during the follow-up of the interstitial pneumonia and myocardial infarction, respectively. On recent examination, echocardiography showed caseous calcification of the mitral annulus. CT revealed an oval calcification with a homogeneous density in and a scattered calcification under the posterior mitral annulus, which was detected for the first time and could not be detected by echocardiography. Rupture of the caseous calcification was suspected. Surgical treatment was postponed because the interstitial pneumonia worsened. CT performed during treatment of pneumonia showed changes in the shape and density of caseous calcification; however, scattered calcification under the mitral annulus persisted. Operative findings were consistent with signs on CT, i.e., a white, soft, plaster-like content and a similar scattered material around the chordae of the posterior leaflet. The sequences of changes of caseous calcification of the mitral annulus obtained by CT suggest its importance as a follow-up tool and indicate the necessity and timing of surgery.

Biography:

Béla Nagy Jr. graduated as an MD at University of Debrecen in 2004 and completed his PhD from the same University in 2010. He worked as a postdoctoral fellow at Temple University School of Medicine in Philadelphia, PA for two years. Currently, he is an assistant professor at Department of Laboratory Medicine, University of Debrecen. He has published more than 30 peer-reviewed international papers, especially in platelet physiology in metabolic and cardiovascular diseases. He is the advisor of two full-time PhD students focusing on the analysis of platelet and plasma microRNAs in diabetes mellitus and septic conditions.

Abstract:

MiRNAs play a prominent role in the regulation of vasculature in coronary artery disease via controlling critical signaling pathways. Previous studies described that miR-223 suppressed ICAM-1 in endothelial cells (EC), while vascular inflammation via NF-κB was regulated by miR-181b. Non-coding small RNAs promoted vascular inflammation and remodeling after stent injury, as in-stent restenosis (ISR) was prevented by genetic ablation of miR-21 attenuating neointimal formation after stenting in pigs. Few data are available, which miRNAs are involved in EC activation after stent implantation. Our group recently published higher levels of soluble E-selectin and VCAM-1 after bare-metal (BMS) versus drug-eluting stenting (DES) in stable angina patients. One fifth of BMS subjects displayed ISR, while no DES individuals had complication. We compared plasma miRNAs in patients with or without ISR, and miRNA alterations were analyzed in cultured human coronary artery and umbilical vein endothelial cells challenged with recombinant TNF-α in the presence or absence of externally added everolimus. We found that there were 36 significantly decreased and 21 upregulated circulating miRNAs in BMS with ISR vs. those BMS without complication and all DES patients. Among in vitro conditions, TNF-α enhanced miR-146a, miR-155 and miR-185 expression in both EC cultures indicating cellular inflammatory response and dysfunction. Decreased miR-424, miR-223 and miR-181b were found with elevated E-selectin, ICAM-1 and VCAM-1 mRNA levels. In contrast, everolimus raised these miRNAs causing significantly depressed mRNAs and protein concentration of these adhesion proteins. In conclusion, everolimus suppressed EC activation in case of DES via modulating circulating and cellular miRNAs.

Biography:

Ravi Ghatnatti is a young cardiac surgeon from India and presently working as Assistant Professor in Cradiothoracic and Vascular Surgery department of KLE’s Dr Prabhakar Kore Hospital, Belgaum,India. He is expertise in coronary artery bypasses grafting and total arterial revascularization. He has International and National publications to his credit. His work on “Renal Dysfunction and Hemodilution- What is the threshold hematocrit acceptable on cardiopulmonary bypass?” was presented in 51^st Society of Thoracic Surgeons meeting 2015 held at San Diego, California USA.

Abstract:

Coronary endarterectomy assures complete revascularization of the myocardium in case of diffusely diseased vessels and prevents residual ischemia. Recently cardiac surgeons are performing increasing number of coronary endarterectomy and it has evolved as an important adjuvant procedure in coronary artery bypass grafting. There are controversies regarding the efficiency of coronary endarterectomy. Higher rates of mortality and morbidity are the frequent points of criticism. At present the available evidence supports coronary endarterectomy in off-pump coronary artery bypass surgery and along with valvular procedures. Graft patency is better with open technique. Post-operative anticoagulation regimen although not uniform, the overall outcome remains the same. Therefore it is important to focus on the current results to accept coronary endarterectomy as a routine procedure like coronary artery bypass surgery.

Biography:

Claudia Lenk studied technical physics but started early to use her physics background to study physiological mechanisms. Her focus lies on the study of mechanisms underlying observations like the synchronization between heartbeat and breathing or the generation and episodic occurrence of atrial fibrillation. Therefore, she combines computational modeling with experiments. She obtained her PhD at the Technische Universität Ilmenau, Germany, for her modeling studies and experiments on AF mechanisms. 

Abstract:

A major risk of stroke is atrial fibrillation (AF), the most common cardiac arrhythmia in clinical practice in the industrial countries [1]. Paroxysmal AF, characterized by the alternation of fibrillation episodes with normal sinus rhythm, complicates AF detection and thus stroke prevention.

A proposed mechanism for the intermittent occurrence is the interaction of excitation waves from two different sources, called pacemaker, located in separate regions [2]. The primary pacemaker represents the sinus node in the right atrium while the secondary one represents a self-excitatory source in the left atrium such as an ectopic focus or reentrant wave. The pacemaker’s waves can only get in contact through a small bridge resembling conducting pathways between the atria. Results from the CONFIRM trial [3] support the hypotheses of a perturbing source as generating mechanism of AF.

In this talk we present results from modeling studies based on two different electrophysiological models [4] and relate them to experimental results. The FitzHugh-Nagumo (FHN) model is a generic model with unphysiological action potential shape and restitution properties. More realistic is the model of Bueno-Orovio, Cherry and Fenton (BOCF-model), which we adapted to atrial electrophysiology.

Three different types of irregular patterns are observed in the FHN model whereas in the BOCF model only one type was present [4].  However, for a reduced excitability in the BOCF model corresponding to a reduced sodium channel conductance not only the three types of fibrillatory-like patterns are recovered but also another type is observed. This one is caused by a partial conduction block of the waves at the bridge as was described for experiments on rapid pacing of Bachmanns Bundle [5]. Furthermore, the strength of irregularity is increased compared to the other types.

Which type of fibrillatory-like pattern occurs is determined by the pacemakers frequencies. Thus, these studies propose an explanation for the episodic occurrence of paroxysmal AF which does not require any tissue heterogeneities. Changes in the frequency can trigger AF episodes, which might explain why AF episodes occur for some patients when they are resting and for others while they are active or stressed.  

Biography:

Will be updated soon...

Abstract:

Statement of the problem:

In India 2.78 million death are due to Cardiovascular diseases of which 50 % are due to CAD.

Peculiarities of CAD patterns in Indian patients- Younger age at presentation, high incidence of DVD and TVD, diffuse involvement, distal disease and significant LV dysfunction at presentation

Diffuse CAD: Length of significant stenosis > 20 mm, multiple significant stenosis (> 70% narrowing) in the same artery separated by segment of apparently normal vessel and significant narrowing involving the whole length of coronary artery.

Methodology: We in our institute, perform OP CAB and use LIMA and veins as conduits to perform the surgery.

Once the conduits are harvested, we heparinize with I.V. Heparin 3 mg/Kg given to achieve an ACT >300.Using the octopus as stabilizer, we perform an endartrectomy of the LAD first and then use a vein patch to cover the defect. LIMA is then used to anastomose the LAD on the vein patch. Veins are used to bypass the LCX and RCA, as deemed appropriate. The proximal ends of the vein grafts are anastomosed to Ascending Aorta with side clamp and heart beating. Intra op we start Lomodex infusion 20ml/hr which is continued for 24 hours and the inotropes used are Adrenaline and Dobutamine as and when necessary. Postoperatively aspirin 75mg is given and Heparin infusion started after 6hours to maintain ACT of around 150 for 24 hours. Patients are usually extubated after 4 hours provided they are hemodynamically stable. Anticoagulation by Acitrom is commenced orally from day 1 to maintain an INR of 2 for 3 months.

Result: Out of the 20 patients in last 18months outcomes have been excellent with no in-hospital mortality or cerebrovascular incidents.

Conclusion: Off pump CABG with coronary end-arterectomy offers a good solution to the problem of diffuse coronary artery disease.

Biography:

D. Protogeros is a cardiac surgeon specialized in full arterial coronary revascularization on a beating heart and stem cell transplantation for ischemic heart failure. He is also an active participant and organizer of international collaborative projects.

Protogeros operated on over 5,000 adult heart patients between 1998 to present covering the entire range of cardio incidents including but not limited to coronary artery disease, heart valves, aneurysms, etc

Moreover, Protogeros has established a protocol for the heart team specialized on coronary artery bypass and implantation of mononuclear autologous pluripotent cells in patients suffering from ischemic heart failure.

Protogeros was trained by Prof. A. M. Calafiore and at present is Deputy Director of the 2^nd Cardiac Surgery Clinic, “HENRY DUNANT Hospital Center”, Athens, Greece

Abstract:

Due to the increase of average life expectancy and the higher incidence rate of cardiovascular disease with advancing age, more elderly patients are in need of cardiac surgery nowadays. Advances in pre- and post-operative care have made it possible that an increasing number of elderly patients can be operated safely and with a satisfactory outcome. Currently, coronary artery bypass surgery, aortic and mitral valve surgery, and major surgery of the aorta are performed in elderly patients. The data available show that most cardiac surgical procedures can be performed in elderly patients with a satisfactory outcome. Nevertheless, the risk for these patients is acceptable, only in the absence of comorbidities. In particular, renal dysfunction, cerebrovascular disease, and poor clinical state are associated with a worse outcome in elderly patients. Careful patient selection, flawless surgery, meticulous hemostasis, perfect anesthesia, and adequate myocardial protection are basic requirements for the success of cardiac surgery in elderly patients. The care of elderly cardiac surgical patients can be improved only through the strict collaboration of geriatricians, anesthesiologists, cardiologists, and cardiac surgeons, in order to obtain a tailored treatment for each individual patient.

We describe a combined cardiac surgery procedure , aortic valve replacement and double coronary bypass, on a 91-year old lady with hypertension, diabetes mellitus, renal insufficiency and cerebrovascular disease known as the oldest patient worldwide who has undergone this type of procedure.

Biography:

Rajani Singh has completed her MS (Anatomy) at the age of 33 years from MLN medical College University of Allahabad. She worked as Additional Professor Anatomy in Premier medical Institute of India wef july 2012 till date. She alsoworked as Lecturer for 4 years, Assistant Professor for 4 years and Associate Professor for one year in highly reputed King George Medical College Lucknow UP India  She has published more than 60 papers in reputed journals. She is member of AAA, AACA, AS, HAPS, ASI, ASI Upand SOCA. She has been on the editorial board of OA case Reports London, Clinical Anatomy USA, Archives of Anatomy and Physiology, Scientific pages Anatomy and Physiology, USA and  Anatomy and Physiology open access, USA.

Abstract:

Rate of fatal coronary artery diseases is increasing by leaps and bounds in modern times. The anatomy of coronary artery has recently been reemphasized in association with the use of coronary arteriography. The variant  vascular anatomy in general and coronary arterial anatomy in particular plays very crucial role in the arterial disease process, their diagnosis and treatment. Therefore, thorough understanding of variant and normal anatomy of coronary artery is imperative. The major coronary artery diseases are hardening and narrowing of these arteries due to atherosclerosis and arteriosclerosis. The advances made in coronary arterial bypass surgeries and modern methods of myocardial revascularization also make sound and detailed knowledge of the variant anatomy of coronary artery indispensable. Therefore, description of 3 cases of aberrant configuration of right/left, accessory and new arteries along with touching mechanism of atherosclerosis has been brought in this work. The right coronary artery in one case had high anomalous origin about 3 cm above the root of ascending aorta and accessory coronary artery arises at the level of right coronary artery irrigating left ventricle. Also right coronary artery had extended course up to left border of heart in second case. In third case, a new artery arises from anterior interventricular artery entering into the infundibulum and supplied septal papillary muscle. The variations in configuration of these arteries coupled with arising of new and accessory arteries not only alter irrigation pattern but also complicate imagery interpretation and surgical manipulations. Hope these results will aid the future cardiac health.

Biography:

Will to be updated soon...

Abstract:

Biography:

Major. Dr. Biji Soman graduated from Government Medical College, Trivandrum in 1996. Served in the Indian Army as a Short Service Commission (SSC) officer for 5 years and retired in 2002 in the rank of Major. Joined Sree Utharadom Thirunal (SUT) Hospital in Trivandrum, a reputed tertiary care cardiac centre as Registrar in Cardiology and Cardiac Catheterisation Lab. Went to United Kingdom in 2005 and trained at the prestigious Guy’s & St. Thomas’ NHS Trust Hospital, London in Cardiology. Did two years Post Graduate Diploma in Clinical Cardiology from Kerala Institute of Medical Sciences (KIMS), Trivandrum, passed out with Distinction and First Rank in Kerala state.

Obtained, Membership of Royal College of Physicians (MRCP UK) in 2013. Became substantive Consultant Cardiologist in 2014. Was elected as a collegiate member of Royal College of Physicians and Surgeons of Glasgow MRCPS (Glas) in 2014. Joined Meditrina Hospitals, Kottarakara as Consultant Cardiologist in March 2016.

Won awards for best paper presentations in National Conferences. Faculty in International and National conferences in Clinical Cardiology. Has several academic publications to his credit in both National and International peer reviewed Scientific Journals.

Abstract:

Background: Coronary Artery Disease (CAD) is increasingly becoming the disease of the young. Not much is known regarding the incidence, degree and pattern of CAD in pre-menopausal Indian women. Our aim was to study the prevalence and pattern of CAD among pre-menopausal women undergoing CAG.

Methods: Data of 100 women who underwent CAG for suspected CAD over 2 years were retrospectively analyzed. They were classified into pre-menopausal group (age ≤ 50 years) and post-menopausal group (age ≥ 60 years). Risk factor profile and coronary angiographic profile of these patients were studied and compared.

Results: The mean age of pre-menopausal women was 45.8 ± 4.2 years and 67.4 ± 6.4 years was the mean age of the post-menopausal women. Hypertension was the commonest risk factor in both the groups, with significantly higher incidence of hypertension in the post-menopausal group (24 vs. 41, p = 0.0029). Greater number of pre-menopausal women CAD with none of the risk factors, (15 vs. 04, p = 0.0004). There was a greater prevalence of obstructive CAD (31 vs. 15, p < 0.0013) among post-menopausal women, especially triple vessel disease (TVD) (3 vs. 15, p = 0.0018). Left anterior descending (LAD) artery is the most commonly affected vessel. Proximal segment was the most frequently affected segment of the coronary artery.

Conclusion: Pre-menopausal women had a higher percentage of angiographically normal epicardial coronaries and non obstructive CAD, and even those who had obstructive CAD; the prevalence of multi vessel disease was much less when compared with the post-menopausal women. The risk factor profile and pattern of coronary disease in pre-menopausal women is different from the conventional picture.

Keywords: Coronary angiography, Coronary artery disease, Pre-menopausal Women, Non-obstructive coronary artery disease.

Biography:

Will to be updated soon...

Abstract:

Background: The best treatment for coronary artery disease (CAD) in patients with multivessel disease is still subject of debate. The hybrid coronary revascularization (HCR) is a procedure that combines both the advantages of conventional coronary artery bypass surgery (CABG), with the revascularization of the left anterior descending artery (LAD) using the left internal mammary artery (LIMA) graft, without the use of cardiopulmonary bypass (CPB), with minimally invasive benefits of percutaneous treatment of remaining affect arteries.

Objective: To assess, in a pilot study, feasibility and safety of HCR I patients with multivessel CAD and to compare early results (within 30 days) of this approach to conventional surgery.

Methods: Prospective clinical study, aiming to include 60 patients, randomized in a 2:1 ratio for hybrid treatment (HCR group, n=40) or conventional CABG (CABG group, n=20). Patients must have three-vessel disease, with an intermediate or high Syntax Score (>22), in which, after exclusion of LAD lesion, the remaining Syntax Score become low (>22). The primary endpoint of the study is the feasibility of HCR in the absence of major adverse events (a compound of overall mortality, acute myocardial infarction (MI), stroke or unplanned revascularization).

Results: Between August 2014 and April 2017, 46 patients were included in the study (HCR=32 and CABG =14). The primary endpoint was observed in 3 patients (8%), all belonging to HCR group (12%), however, without statistical significance (p=0.54). There was no statistical difference between the groups (HCR vs. CABG, respectively) in terms of mortality (3.2% vs 0%), unplanned revascularization (7% vs 0%), MI (7% vs 0%), or any of the secondary outcomes evaluated. Patients who presented with any of the complications (12 patients 26%) had a tendency (not statistical significant) to be older (62 vs 59 years; p=NS), and to present with higher risk scores (EuroSCORE 1.40 vs 0.70; p=0,19) than patients without complications.

Conclusions: HCR is a feasible and safe technique when compared to conventional surgery, with similar complications rates. However, the study is underpowered due to the low number of patients included.

Biography:

Krishna Prasad Irniraya is a Consultant Cardiothoracic Surgeon at Bombay Hospital Institute of Medical Sciences, Mumbai, India. He has completed his undergraduation in Medicine at the University of Calicut and his Surgical training at St. Martha’s Hospital, Bangalore. His cardiothoracic training is from Bombay Hospital Institute of Medical Sciences, attached to the University of Mumbai, India.

Abstract:

For total arterial grafting in CABG, the usual conduits used are the bilateral Internal Mammary Arteries i.e., LIMA & RIMA. Usually LIMA is used as a pedicle graft and the free RIMA on it to make the LIMA – RIMA ‘Y’ composite grafting. The LIMA stem is used to graft the LAD & Diagonal branches; whereas the RIMA stem is used to graft the OMs, PLB & PDA branches.

But in certain situations where the Pedicle LIMA cannot be used for e.g. in case of left Subclavian Artery stenosis, total arterial grafting can still be accomplished by certain modifications.

Instead of pedicle LIMA, RIMA pedicle to be used and the free LIMA onto it making the RIMA – LIMA ‘Y’ composite grafting. Here the RIMA stem is used to graft the LAD and the LIMA stem is used to graft the Diagonal, OMs, PLB & PDA branches. So complete arterial grafting can still be achieved.

Not only total arterial grafting can be achieved, we can avoid handling of the aorta for the proximal anastomosis when vein or radial artery conduits are used. There are certain situations where we need to use RIMA – LIMA ‘Y’ Grafting instead of LIMA – RIMA ‘Y’. So the indications, advantages & technical issues will be discussed.

Biography:

Will to be updated soon...

Abstract:

Biography:

Will be updated soon...

Abstract:

Background: Fibroblast growth factor-23 (FGF23) produced by osteocytes regulates calcium and phosphate homeostasis which are cornerstones for bone integrity. Recently, FGF23 was also found to be directly related with both severity and prognosis of heart failure. However, the mechanism of FGF23 regulation in heart failure, particularly in patients with preserved renal function is poorly understood.

Objective: The association of systemic inflammation (surrogated by CRP) and FGF23 regulation in patients with chronic heart failure and preserved renal function. Furthermore, we analyzed the prognostic ability of FGF23 and CRP in this population.

Methods: 221 stable non-ischemic heart failure patients (age ≥ 18) with reduced ejection fraction and an estimated glomerular filtration rate of more than 60 ml/min/1.73m² were analyzed. Fasting ct-FGF23, high sensitive CRP and a comprehensive panel of further biomarkers, as well as invasive hemodynamic measures from right heart catheterization, were used for univariate and multivariate regression analysis.

Results: In bivariate correlation analysis ct-FGF23 was correlated with CO (r= -0.42); NTproBNP (r=0.39); eGRF (r=-0.38) and CRP (r=0.37); for all of those p < 0.001. Multivariate linear regression analysis revealed CRP and CO as independently associated with ct-FGF23 (total model fit; r²=0.49; p <0.001). In time to event analysis both ct-FGF23 and CRP independently predicted transplant-free survival.

Conclusion: Our data indicates an association of systemic inflammation and FGF23 elevation in heart failure. Both, FGF23 and systemic inflammation independently predict transplant-free survival in non-ischemic heart failure patients with preserved kidney functions.

Biography:

Rezvanieh Salehi was born in Tabriz, Iran in 1957. She was graduated from Tabriz Medical university in 1984. Then she could pass her internal medical course in 1989. She began to work in Tabriz Medical university as an assistant professor in 1989. She was an echocardiography fellowship in Milan, Italy, in 2000, passed the EACRI exam in 2013, and national board of echocardiography in 2016. Now, she is working as a professor of cardiology and an echo-cardiologist in Tabriz Medical University, Cardiovascular surgery ward (Shahid Madani Heart Hospital).

Abstract:

Secondary mitral regurgitation (MR) occurs in setting of normal mitral apparatus (leaf lets, papillary muscles and chordas). Left ventricular (LV) enlargement in dilated and ischemic cardiomyopathies lead to stretch of mitral valve (MV) annulus and displacement of the papillary muscles which in turn causes secondary MR. The phenomenon is also known as functional MR (FMR) and has been associated with poor outcome. Correction of ensuing MR with surgical or with newly developed trans-catheter approaches however, does not reverse the underlying LV pathology hence might not improve prognosis. The revisions made in the recently published American Heart Association (AHA)/ American college of Cardiology (ACC) guidelines on valvular heart disease (VHD) which changed the definition of secondary versus primary MR by reducing effective regurgitant orifice area (ROA) from 0.4 to 0.2 cm² and regurgitant volume (RV) from 60 to 30 ml creates considerable controversies. Redefining severe MR based on EOA or RV may cause significant clinical challenges. According to the guidelines, diagnosis of severe MR requires careful assessment of a constellation of clinical findings, in conjunction with echocardiographic and sometimes other imaging modalities. In case of FMR, ROA is crescentic rather than circular and measurements of PISA with 2D transthoracic echocardiography underestimates the true ROA. In revised new VHD guidelines there is no class I indication for secondary MR intervention but considering already damaged LV and underestimation of MR severity early intervention seems to be reasonable. Mitral annuloplasty, mitral clip, Alfieri stitch and mitral cardio-band are various treatment methods that are currently being used.

Biography:

Abstract:

Endomyocardial biopsy is a standard diagnostic tool for detection of graft rejection. However, it is known, that endomyocardial invasive biopsy (EMB) is not safe and can entail serious complications.

Objective: assess clinical and labor data with TD-indexes on revealing the heart rejection after transplantation.

Materials and methods: Since August 2011 there were 48 heart transplantations performed (10 are women in the age of 41±13.8 years from the donors of 42.5±13.5 years old. The 1^st group - 33 patients (68,7%), which had undergone EMB and in 2^nd group - 15 (31,2%) patients had not undergone EMB.  All patients from both groups was performed of laboratory indicators (included CRP)and echocardiography (2D echo in a resting state, tissue Doppler (TDI) in a resting state (PW-systolic parameters S velocity, myocardial strain) daily still the discharge and then in I, III, VI month.

Results: There were no significant differences evidenced in both groups (I/II groups) on basic results of leukocytes, lymphocytes and CRP analysis.

One patient from the 2^nd group after 19 month after TX had nonspecific clinical symptoms (palpitationand general fatigue), high level CRP (1.94 mg/l) and abnormal tissue Doppler (S' laterals 3.8 cm/c. S'medialis 3.9 cm/c. S'RV  3 cm/c.). And concentration of tacrolimus was low (6.7 ng/ml). We estimated this condition as graft rejection. After 10 days of timely administration of pulse therapy with solumedrol (1g per day i/v)and increased concentration of tacrolimus(13.8 ng/ml) improvement of clinical status, CRP decreased (0.1 mg/l) and tissue Doppler had better (S'lateralis 8 cm/c. S'medialis 7 cm/c. S'RV 7 cm/c). Patient was discharged after recovery.

Conclusion: Thus, we confirm that clinic, CRP and tissue Doppler (PW-systolic parametres S velocity) when patient has low concentration of tacrolimus can be used as non-invasive diagnostic tool of allograft rejection of patients after heart transplantation.

Biography:

Abstract:

Introduction: Vitamin D (VD) deficiency may be an important neglected factor in the pathogenesis of cardiovascular disease and its risk factors.

Aim: Investigate the relation between VD level and both exercise parameters and left ventricular systolic and diastolic functions.

Methods: Fasting blood samples were collected from 70 patients with chest pain, and serum levels of vitamin D, glucose, and lipids were measured. They were divided into 2 groups according to VD level. All patients were scheduled for exercise treadmill test and echocardiography.

Results: 30 patients had normal serum VD. They had lower incidence of diabetes, lower levels of total cholesterol and S.LDL. Also, they had longer exercise time (0.37±0.05 vs. 0.31±0.06, P 0.002) with higher metabolic equivalents (METs) (9.52±1.33 vs. 8.49±1.45, P 0.003) and minimal ST-segment depression (0.61±0.11 mm vs. 2.41±1.08 mm, P <0.001). No difference between both groups regarding ejection fraction (P> 0.05) but there was a significant decrease in the E/A ratio of the mitral valve in patients with low VD (1.26±0.27 vs.1.01±0.31, P 0.001). Patients with normal exercise test were 35 patients (50%). They had higher VD level (57.60±9.29 nmol/l vs 34.44±8.11, P <0.001). There was a significant negative correlation between VD and total cholesterol, S.LDL, and the degree of ST-segment depression in exercise ECG. A significant positive correlation was found between VD and both METS and E/A ratio of the mitral valve. Using logistic regression analysis, VD, METs, and diabetes were predictors for both CAD and cardiac dysfunction. Serum VD less than ≤47 nmol/l can predict coronary artery disease (CAD) and cardiac dysfunction with high accuracy (94.4% and 71.4% respectively).

Conclusion: A strong correlation exists between vitamin D and some of CAD risk factors and reduced vitamin D could have a role in exercise parameters abnormalities developed during stress test and diastolic dysfunction seen in patients presented with chest pain.

Biography:

Adiba Tarannum has completed her MBBS from Dhaka University and now pursuing her career in clinical nutrition. She also has a great interest in the public health context of clinical nutrition.  She has attended few conferences regarding this. She is trying to establish a field of clinical nutrition in Bangladesh which is becoming major issues in developing countries. She is doing several researches regarding nutritional issues of cardiovascular disease and obesity.

Abstract:

Cardiovascular diseases are the most common causes of premature morbidity and mortality worldwide. Cardiovascular disease burden is increasing in developing country like Bangladesh which is creating adverse effect to whole health system. A cross-sectional, descriptive study among the higher secondary students of Bangladesh was performed using convenience sampling to assess the student’s knowledge and perception of cardiovascular risk factors and prevention. Students had a good knowledgeable about cardiovascular risk factors but did not perceive themselves at risk for cardiovascular disease. More than 60% students have one or more risk behavior related to cardiovascular diseases. The knowledge about cardiovascular diseases risk factors and prevention among the participants is high, but it has little role on practicing health life.

Biography:

Yubi Lin has completed his PhD at the age of 30 years from Jinan University and postdoctoral studies from Guangdong Cardiovascular Institute, Medical School of South China University of Technology. He is the chief expert of Guangdong Province Family Doctor Association Telemedicine and the expert committee member of CMIA Remote Heart Monitoring Professional Committee of China. He has published more than 27 papers in reputed journals and has been serving as an editorial board member of repute.

Abstract:

Backgrounds: This study was designed to identify the pathogenic mutation in a Chinese family with arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC/D) using the whole genome sequencing (WGS).

Methods and results: Probands II: 1 and II: 2 underwent routine examinations for diagnosis. Genomic DNA was extracted from the peripheral blood of family members and analyzed using WGS. The potentially pathogenic mutations that occurred in genes DSG2, PKP4, PRKAG2, FOXD4, CTTN and DMD, which were identified by SIFT or Polyphen-2 software as “Damaging”, were validated using Sanger sequencing. Probands II:1 and II:2 shared an extremely rare homozygous mutation in the DSG2 (p.F531C) gene, which was also demonstrated using intersection analysis of WGS data from the probands II:1 and II:2. Electron microscopy and histological staining of myocardial biopsies showed widened and destroyed intercalated discs; interrupted, atrophic and disarranged myocardial fibers; and hyperplastic interstitial fibers, collagen fibers and adipocytes were infiltrated and invaded.

Conclusions: A homozygous mutation of DSG2 p.F531C was identified as the pathogenic mutation in patients with ARVC/D involving both ventricles, as the result of widened and impaired intercalated discs; interrupted myocardial fibers; and abnormally hyperplastic interstitial fibers, collagen fibers and adipocytes. 

Biography:

S M Tajdit Rahman is a resident thoracic surgeon of national institute of Bangladesh. He has completed his MBBS from Sir Salimullah Medical College, Bangladesh and has a fascination for research in cardiac and thoracic diseases. He is doing some researches under renowned professor and has a great achievement in extracurricular activities since his childhood. He is the convener of first ever biomedical conference for students in Bangladesh. He has attended more than 15 conferences both home and abroad.

Abstract:

Congenital cardiac disease is not uncommon in daily medical practice. Many studies have been carried out worldwide, showing incidence variation in different parts of the world as 5-10/1000 live birth. In Bangladesh, a mere study was done in this respect. This retrospective study was conducted from the records preserved in hospital register, compiled by the author from pediatric cardiology and cardiac surgery department over a period of 4 years extends from 2010-2013 in National Institute of Cardio Vascular Diseases Hospital. 6520 cases of live births weighing more than 1500gm and age over 28th weeks of gestational period were recorded by clinical examination and echocardiography with color Doppler. This study showed that 196 babies out of 6520 live births had CHD as 30/1000 live births. Study also expressed that higher incidence of CHD in preterm baby than full term baby. Amongst the congenital Heart lesions, Atrial Septal Defect, Ventricular Septal Defect, Patent Ductus Arteriosus, Tetralogy of Fallot`s, TGA were commonest having 20.41%, 13.78%, 10.71%, 8.67% and 4.59% respectively. 15.81% of the patients had other associated somatic anomalies among which down syndrome was the commonest (7.14%). CHD of various patterns deserves crucial challenge among the newborns for management in Bangladesh. Various factors like high maternal age, drugs intake, antenatal infection, family history, gestational DM, down’s syndrome, mother having SLE are related to these diseases. Moreover, appropriate research can be accomplished taking large relevant sample gathering from different tertiary medical college hospitals to reveal actual scenario to prevent and treat the diseases.

Biography:

Yubi Lin has completed his PhD at the age of 30 years from Jinan University and postdoctoral studies from Guangdong Cardiovascular Institute, Medical School of South China University of Technology. He is the chief expert of Guangdong Province Family Doctor Association Telemedicine and the expert committee member of CMIA Remote Heart Monitoring Professional Committee of China. He has published more than 27 papers in reputed journals and has been serving as an editorial board member of repute.

Abstract:

Objective: This study aimed to identify the pathogenic mutation in a Chinese family with unexplained sudden death (USD) or occasional syncope.

Materials and Methods: Whole exome sequencing and gene chip sequencing were respectively conducted for two related patients. The genetic data was screened using the 1000 genomes project and SNP database (PubMed), and the identified mutations were assessed for predicted pathogenicity using the SIFT and Polyphen-2 algorithms. 

Results: We identified a heterozygous mutation in the RYR2 gene at c.490C>T (p.P164S), highly conserved across all species, in three members of this family, while another heterozygous de novo mutation in SCN5A at c.5576G>A p.R1859H was detected in one family member. Both variants were verified by Sanger sequencing. Importantly, RYR2 p.P164S is associated with the risk of sudden cardiac death, such as in catecholaminergic polymorphic ventricular tachycardia.

Conclusions: A pathogenic mutation in RYR2 (p.P164S) is the likely cause of USD in a Chinese family associated with malignant ventricular arrhythmias. Whole exome and chip gene sequencing can be useful for discovering the genetic causes of USD. 

Biography:

Abstract:

Introduction: Work within cardiac catheter lab is rapidly advancing with increasingly complex procedures on patients with multiple co-morbidities. This results in a steep learning curve for team members and an increase need for vigilance, situation awareness and effective teamwork. The rapid development of simulation technology provides a safe and realistic environment in which to develop important non-technical skills as part of a multidisciplinary team.

Methods:  A multidisciplinary team of catheter laboratory staff from the University Hospital of South Manchester developed a two-day simulation course using a multimodal format including lectures, high fidelity simulations and small group workshops. The course focuses on a structured approach to the recognition, assessment and management of the critical ill patient, effective use of pre-procedure checklists and team role allocation. Candidates develop their non-technical skills through experiential learning simulating clinical scenarios. Six high fidelity simulations are based in the laboratory and recovery room followed by debriefing. Scenarios include ventricular fibrillation, anaphylaxis, tamponade and major haemorrhage. Workshops and lectures are designed to teach and develop practical skills and knowledge used in the initial management of a deteriorating or critical ill patient including basic airway skills, post resuscitation care and safe sedation.

Results: Feedback on lectures has revealed that 100% of candidates agreed or strongly agreed that lectures were easy to understand, relevant and useful for future clinical practice. 100% of candidates believed that the knowledge and skills gained would be useful to their future clinical practice, that it helped consolidate their learning and that the facilitation of their debriefing was effective.

Discussion: This multidisciplinary course has been designed to develop an effective team approach to critical situations in the cardiac catheter laboratory. Course development includes investigating the link between attendance on the course and change in practice and improved patient care. 

Biography:

Abstract:

This paper will discuss comparisons from complaint free or pre-cardiac disposition risk factor period until post and chronic heart failure stage.

Method- Scope review of past 5 years using key search words:  gender, cardiac/heart, symptom expression, risk factors, & complications. . Evidence-based guidelines for the prevention of CVD in adult women are presented.

There is an abundance of published works describing significant differences in cardiac disease comparing genders. The range of differences span expression of symptoms, timing of first complaint, reaction of health care teams to women cardiac patients and differences in post cardiac episode rehabilitation to name a few.

 Men have higher incidence of heart failure, but the overall prevalence rate is similar in both sexes, since women survive longer after the onset of heart failure. Women tend to be older when diagnosed with heart failure and more often have diastolic dysfunction than men. Women experience lower overall quality of life than men. The known gender differences in patients with heart failure need to be highlighted in guidelines as well as implemented in standard care. Women were more likely (64%) to be depressed than men (44%). Depressed female patients scored significantly worse than non-depressed patients on all components of QOL.  However, they did not differ in ejection fraction or treatment, except that

depressed patients were significantly less likely to be receiving beta-blockers. In advanced age, the increase in the rate of hypertension is steeper in women than in men, leading to a prevalence of hypertension of 69% in men and 72% in women at age 65 to 75 years.

Increased knowledge of gender-specific risks for Cardiac Disease has led to national campaigns to educate women. Future gender-related clinical and research activities should focus on the identification of sex- and gender-specific criteria for risk management in female cardiac patients.

Biography:

Abstract:

The aim of this presentatin is to increase ICU nurses' awareness and knowledge regarding differences in gender and  response to stress. According to 2011 survey by American Psychological Association more women reported a great deal of stress in their lives, compared with 20% of men. In terms of stress perception, women tend to report stress related to financial and economic issues, whereas men more often cite stress around work-related issues.  Women actually have greater functional connective density in their brains, as measured by functional MRI studies. Not just that, but the way Female brains are connected looks different from how male brains are connected. Women tend to have more interhemispheric connectomes, which actually allow for more connectivity between analytical and intuitive processes, whereas men tend to have more intrahemispheric connections—on the same side of the brain—which facilitates more connectivity between kinesthetic tasks and motor skills. More women feel that stress strongly affects their health. In terms of dealing with stress, women are more motivated than men to act on their stress. Does that lead to more action on behalf of women? The answer is no. Both men and women have a fairly high thought/action gap in stress management. To manage stress, it has been shown that women tend to engage in such activities as reading and spending time with family. Men engage more in physical activities, playing sports, and working out. Many studies have found that women are more predisposed to mental stress-induced myocardial ischemia compared with men. Moreover, women are more likely to have a lingering effect of negative emotions, which worsens outcomes as well.

the stress management program] is a great step forward. It's a huge opportunity for us to intervene at the right time to prevent this as much as possible.

Biography:

Abstract:

Increase ICU nurses' awareness regarding the topic of gender differences in cardiac rehabilitation post cardiac infarction. Published study show that women participate significantly less than men in cardiac rehabilitation programs. The factors contributing to their lack of involvement in cardiac rehabilitation programs is their older age, less robust physical baseline status, and physicians tendency to send fewer women to rehabilitation programs. Many papers found that women find exercise tiring and painful, dislike public or mixed-gender exercise, and perceive unmet emotional needs in Cardiac rehabilitation. The growing acknowledgement of gender-specific cardiovascular health needs highlights the need for effective risk reduction interventions for women. Investigators have called for strategies addressing underserved rehabilitation populations, such as women, who are least likely to avail themselves of these services. Gender-specific programs, tailored to individual readiness to change may be more effective than traditional programs in meeting women's unique needs. Future studies need to address many research questions. First, to what extent is attendance in women influenced by a motivationally enhanced, gender-tailored rehabilitation programs compared to that of women attending traditional programs, and second, what are the useful baseline sociodemographic and clinical predictors of attendance of the exercise and education components of cardiac rehabilitation? Nurses need to initiate and emphasize the importance of cardiac rehabilitation participation. Gender specific instructions to female and male patients differently based on evidence presented.

Biography:

Abstract:

The following information based on the latest available evidence can be used to provide guidance to use of Hormone replacement therapy and alternatives. Premenopausal women have a lower risk and incidence of hypertension and cardiovascular disease (CVD) compared to age-matched men and this sex advantage for women gradually disappears after menopause, suggesting that sexual hormones play a cardio protective role in women. However, randomized prospective primary or secondary prevention trials failed to confirm that hormone replacement therapy (HRT) affords cardio protection. This review highlights the factors that may contribute to this divergent outcome and could reveal why young or premenopausal women are protected from CVD and yet postmenopausal women do not benefit from HRT. Observational studies also show that postmenopausal women who receive hormone replacement therapy (HRT) have a lower rate of CVD and cardiac death than those not receiving HRT. However, two randomized prospective primary or secondary prevention trials, the Women’s Health Initiative (WHI) and the Heart and Estrogen/Progestin Replacement Study (HERS I and II)], showed that HRT may actually increase the risk and events of CVD in postmenopausal women. The reasons for this paradoxical characterization of HRT as both beneficial and detrimental remain unclear. Overall, the use of HRT has become one of the most controversial topics related to women’s health, making it all the more urgent to clarify whether estrogens (and/or HRT) prevent or promote CVD, as well as the mechanism(s) involved.  HRT has become one of the most controversial topics related to women’s health. Future studies are necessary if we are to understand the divergent published findings regarding HRT and develop new therapeutic strategies to improve the quality of life for women.