16^th World Cardiology Congress December 08-10, 2016 Dubai, UAE

Faida Kučukalic had started residency in 1980 at the University Clinical Centre Sarajevo (UCCS). She had finished her residency in 1983 in Belgrade, Serbia. She is specialized in the field of cardio anesthesiology in referent cardio surgery centers in Western Europe. She is the Chief of Cardio anesthesiology and Intensive Care Unit at the Heart Centre UCCS. She received a recognition for special contribution for the development of cardio surgery- cardio anesthesiology from the Directory Board UCCS. She received her PhD titled: „ NT pro BNP as a marker left ventricle dysfunction“in 2013. She attended various congresses and published 60 papers.

Introduction: Congestive heart failure caused dominantly by coronary artery disease activates number of compensatory mechanism where secretion of natriuretic peptide takes a very important place. N-terminal pro brain natriuretic peptides is a established biomarker of ventricular dysfunction for diagnosis, screening, prognosis, monitoring and optimatisation of pharmacological management. Aims: High plasma levels of NTproBNP before cardiac procedure are associated with higher prognostic importance. Subjects and methods: We included 60 patients (43 man and 17 woman), undergoing coronary revascularisation (CABG), or replacement of aortic (mitral) valvule. All patients had left ventricular dysfunction with reduced ejection fraction (EF<40%). Plasma level of NTproBNP has been taken preoperatively, and postoperative 5 days after surgery. Results: Our results have shown that concentration of NTproBNP were 1322,2 pg/ml preoperatively, and in postoperative period 6067,9 pg/ml for all participants. The subgroup with severe dysfunction of the left ventricule (EF<30%) had value of NTproBNP 1560,47 pg/ml preoperatively while the subgroup with intermediate left ventricular dysfunction (EF 31-40%) had a value of 1194,00 pg/ml. In postoperative period in subgroup of participants with EF<30% NTproBNP level was 7219,23 pg/ml, compared with subgroup with EF 31-40% where this parameter valued 5461,00 pg/ml. Conclusions: Concentration of NTproBNP was correlated with left ventricular dysfunction. All participants had postoperative NTproBNP increase (p<1%). NTproBNP has a strong prognostic value and it will help us to identify patients who will need more intensive management after hospital discharge. Repeated biomarker measurement will become the strongest independent prognostic marker for rehospitalisation, adverse cardiovascular events and mortality in short and long-term period. Using NTproBNP as a biomarker-guide therapy we will try to act on the main goal of heart failure treatment, which include: prognosis, morbidity and motrtality.

Mohammad Murtaza Zaman was born on the 10th of April 1985 in a small town called Wah in the Rawalpindi district of Pakistan. After completing his schooling in Wah he went to Army Medical College Rawalpindi for his MBBS.He completed his degree in 2009 and went to the United Kingdom for further training. Subsequently he went through the UK foundation training,core medical training and passed his MRCP exams. Currently he is doing his masters degree in Cardiology from Kings College London as well as a fellowship in cardiology at Lister Hospital. His goal is to train as an interventional cardiologist and go back to Pakistan.

Atrial fibrillation is the most common sustained cardiac arrhythmia and results in significant mortality and morbidity predominantly due to ischemic stroke and heart failure. The prevalence is rising due to an increasing elderly population. Improved management strategies for ischemic heart disease and heart failure has resulted in a longer life expectancy and therefore increases the likelihood of developing AF secondary to these cardiac conditions. The American College of Cardiology, European College Society of Cardiology and NICE recommend a beta-blocker or a rate limiting calcium-channel blocker as first line treatment for controlling heart rate in patients who are haemodynamically stable. In clinical practice there seems to be debate among clinicians as to the superiority of one agent over the other. Searches were conducted in November 2015 on Embase (1974 to 2015 November), Ovid Medline (1946 to November Week 2, 2015) and the Cochrane Database. Four main facets were searched; ‘atrial fibrillation’, ‘beta-blockers’, ‘calcium-channel blockers’ and ‘rate control’. In total one hundred and nine (n=109) papers were returned. The duplicates were removed leaving ninety three (n=93) papers. All titles were reviewed and seventy-four were removed as they were irrelevant with regards to the question. Nineteen (n= 19) abstracts were pursued out of which fourteen were discarded for not meeting the eligibility criteria. Statistical analysis was carried out using the Review Manager software. The results showed that calcium-channel blockers were more effective than beta-blockers in controlling the heart rate at 20 minutes with a trend towards significance.

Naser Yamani is a graduate of Kakatiya Medical College, Warangal, India. He trained for his Internal medicine residency at Prestigious John H Stroger Hospital Of Cook County, Chicago, Illinois, USA. He is currently a faculty at the same hospital and also holds a post of Assistant Professor in Department of Internal Medicine at RUSH university in Chicago. Naser Yamani Provides superior care and professional work ethics that resulted in overall improvement of patient satisfaction quotient. Naser Yamani is very interested in field of Cardiology and is very uptodate in ever changing field of cardiology. He has presentations in various journals published in America. Currently Naser Yamani holds certifications in American Board Of Internal Medicine and American College of Physicians.

Introduction: Systemic Vascular Resistance (SVR) is a measurement of resistance and impediment of the systemic vascular bed to blood flow. SVR is a frequently used clinical index for left ventricular afterload. Elevated SVR is a major factor in inability to increase Stroke Volume (SV) of the left ventricle and increase the Left Ventricle End Diastolic Pressure (LVEDP). Sodium Nitroprusside is a pure after load reducing agent and has been used traditionally to decrease SVR, which leads to increase in stroke volume and increase in Cardiac Output (CO). Several studies in past have demonstrated effectiveness of Nitroprusside in treatment of acute or chronic heart failure of different etiologies. In our case, we used continuous Nicardipine infusion as an alternative agent in decreasing the Systemic Vascular Resistance, which is more cost effective, with more favorable side effect profile and provided the desired effects of decreasing the SVR. Case: 53 y/o F with PMH of systolic Heart failure, Paroxysmal Supraventricular Tachycardia s/p ablation 2010( unknown specifics), asthma/COPD on home 2L O2, HTN, HLD, DM2 who was admitted to our coronary intensive care unit as an outside hospital transfer for acute on chronic CHF exacerbation. Patient initially presented to community hospital with symptoms of heart failure and was admitted to telemetry unit for Heart failure exacerbation secondary to non-compliance. IV diuresis was initiated but patient had minimal urine output, and elevation of creatinine, and hypotension with SBPs 90's. Patient was transferred to CCU for IV diuresis and inotrope support. She was started on dobutamine with some improvement but was unable to be weaned of dobutamine drip hence she was transferred to our institution for evaluation for advanced care for evaluation of LVAD and Heart Transplant. On arrival to our institution her vital signs were BP 127/83, pulse 92, RR 18, sating 93% on 2 L of O2. On admission she was short of breath on walking few steps. She reports 3 pillow orthopnea, PND, and worsening LE edema over the last month. She denied chest pain, tightness, and palpitations. EKG showed ventricular rate of 105, Right axis deviation, Wandering pacemaker. Examination revealed No JVD elevation. Heart sounds were regular without murmur and rubs, Rest of examination was normal. CBC was normal except Hg of 11. Serum Creatinine of 1.69 mg/dl and GFR of 39. Day 2 of admission patient underwent Left and Right Heart catheterization and was found to have non occlusive coronary artery disease and dynamics showed Cardiac output (CO) 2.67, Cardiac Index (CI) 1.44, Peripheral vascular resistance (PVR) 149.9, systemic vascular resistance (SVR) 2128.38 DSc, SVR-26.61 wood units, SVI 3937 DSc. Swanz Ganz catheter was placed for monitoring of hemodynamics. Trans Thoracic Echocardiogram showed LVEF 25-30%, with severe diffuse hypo kinesis, G2DD, Right ventricular systolic function was moderately reduced, dilated left and right atrium, structurally normal Mitral valve with Moderate Mitral regurgitation. Normal Aortic valve without stenosis or regurgitation. Mild to moderate tricuspid regurgitation. Trivial Pulmonary regurgitation, PASP of 55 Mm Hg Discussion: Due to elevated Systemic Vascular Resistance (SVR) it was decided to use sodium nitroprusside which is a pure afterload reducing agent in effort to reduce her afterload in anticipation of decreasing systemic vascular resistance and in turn increasing Cardiac output. Due to unavailability of nitroprusside, it was decided to use Nicardipine infusion to achieve the target of reducing after load. Hemodynamics recording through Swanz ganz reading on Hospital day 3 on Nicardipine titration to maintain Mean Arterial Pressure (MAP) around 70 mm Hg showed reading of CO of 5.2 liters, CI of 2.8 liters, SVR of 1169 DSc. As MAP was maintained dobutamine drip was weaned off and patient was started on oral Hydralazine and Amlodipine. Day 4 of admission her CO was maintained and SVR was reduced hence Nicardipine drip was weaned off and stopped. Her creatinine improved with diuretics adjustment. After being weaned of the dobutamine and Nicardipine she maintained her MAP ~ 70 Mm HG. Her fluid status improved and she was discharged in stable condition. 2 weeks later, she was evaluated in Heart failure clinic, with improved exercise tolerance and marked improvement of her heart failure symptoms. Hence aggressive interventional procedure like LVAD was avoided at this time.

Non-Alcoholic Fatty Liver Disease (NAFLD) is one of the major health problems which characterized by excessive fat accumulation in the liver. Worldwide, NAFLD has a reported prevalence of 6 to 35 percent in general population. The prevalence of NAFLD has increased as more patients develop a sedentary lifestyle, metabolic syndrome, and obesity. Aim and Objectives: To study cardiovascular disease risk factors among NAFLD patients aiming to reduce morbidity and mortality. Methodology: This was a cross sectional comparative study. Cardiovascular risk factors questionnaire including personal data, BMI, lipid profile, blood pressure was used to obtain the data from 150 patients with ultrasound diagnosed NAFLD and 150 patients with no evidence of NAFLD at Umm Al Qura University medical center, Makkah, Kingdom of Saudi Arabia. Results: 54.7% out of 150 NAFLD patients were males, 91.3% were obese, 50.7% were diabetics,28% hypertensive, 53.7% has high cholesterol level, 52.7 has high triglycerides and 64.6% has high LDL level. It was shown significant high prevalence of most of CVD risk factors among NAFD patients in comparison to age matched group of patients without NAFLD.CONCLUSION: NAFLD patients have a high risk of cardiovascular diseases more than non NAFLD.

MD Saqif Shahriar has done his graduation in 2006 from Sir Salimullah Medical College. He has completed his postgraduate fellowship & completed his MD in cardiology with a good result & become the younger Cardiologist in Bangladesh in 2014. He has a good experience in clinical & Interventional cardiology. He is involved in cardiovascular research work & has some publications. He is now working as a Registrar Cardiologist in National institute of Cardiovascular diseases, Bangladesh.

Aims: Speckle-tracking imaging is a novel method for assessing left ventricular function and ischemic changes. The aim of this study was to predict the presence of coronary artery disease by longitudinal 2D strain analysis using speckle tracking echocardiography in patients with stable or unstable angina with no regional wall motion abnormality at rest. Methods: This cross-sectional study included a total of 66 patients (mean age, 51.92 ± 8.9 years) with suspected coronary artery disease, without regional wall motion abnormality on resting echocardiography who underwent coronary angiography. Longitudinal 2D strain analysis by speckle tracking echocardiography was performed in all patients before coronary angiography. Global and segmental peak systolic longitudinal strain were recorded & computed by offline dedicated software semi-automatically on bull’s-eye report. The patients were divided into two groups according to the coronary angiographic findings; group- I: significant coronary artery disease on coronary angiogram (n=35), group-II: normal coronaries on coronary angiogram (n=31). All the baseline characteristics and outcomes were then compared between the two groups. Results: Peak systolic longitudinal strain values of all left ventricular segments were obtained successfully in 66 patients. Peak systolic longitudinal strain (both global and segmental) was significantly decreased in patients with significant coronary artery disease on coronary angiogram group. Receiver operating characteristic curve analysis demonstrated that global peak systolic longitudinal strain could effectively detect patients with coronary artery disease (area under receiver operating characteristic curve=0.877, 95% CI=0.749–0.960). According to receiver operating characteristic curve analysis, -18.77% appeared to be a good cutoff value for predicting those with significant coronary artery disease (specificity 77.4% and sensitivity 82.9%). Conclusion: The present study showed that resting peak systolic longitudinal strain (global & segmental) is significantly reduced and highly sensitive to detect significant coronary artery disease in patients with stable & unstable angina, even when resting wall motion and LV ejection fraction were normal. It is also observed that 2DSTE seems capable in identifying high risk patients with left main & triple vessel disease.

Background: Helicobacter pylori (H. pylori) colonize and infect gastric mucosa which might lead to chest discomfort. It is assumed that the products of H. pylori (cytokines, cytotoxic) denudate and erode the coronary artery plaque; therefore, it is suspected that H. pylori infection might be associated with inflammatory response of acute myocardial infarction (AMI), although the assumption is still controversial. Aim: Aim of this study is to identify the impact of H. pylori toward the severity and type of AMI; and the number of risk factor for chronic heart disease (CHD) in AMI patients. Method: Our study was a prospective cohort study that was conducted among patients with AMI at the hospitals in Manado city and its surrounding areas between 2015-2016. Data collection was carried out by filling in questionnaires, serology testing to identify antigen of H. pylori and conducting echocardiography in patients with AMI. Data was analyzed using SPSS program version 23.0. Results: There was no significant impact of H. pylori infection toward the severity of AMI (p=0.713) and the number of CHD risk factors (p=0.087); however, the type of AMI and H. pylori infection showed a significant association (p=0.017). STEMI patients tended to have H. pylori infection. Conclusion: No significant impact of H. pylori infection toward the severity of AMI and the number of CHD risk factors was found; however, there was a significant association between type of AMI (STEMI) and H. pylori infection.

Starry Homenta Rampengan has completed his PhD and Post-doctoral studies from University of Indonesia. He is Director of Jade Cardiovascular Clinic in North Sulawesi, Indonesia and Consultant Cardiologist, Interventionist at Siloam Hospital Manado and Kandou Hospital Manado, North Sulawesi, Indonesia. He has published more than 20 papers in journals.

Nattapong Thaiyanurak graduated his MD from College of Medicine, Rangsit University, Bangkok. He completed his residency in internal medicine and cardiology fellowship training from Siriraj Hospital, Mahidol Universtiy, Bangkok. He is currently the cardiologist at the Lampang Hospital and devotes his time in teaching medical students of Lampang Hospital Medical Education Center, Chiang Mai University.

Introduction: Type 3 aortic arch is a major predictor of neurological adverse events during carotid artery stenting. The aim of study was to determine the prevalence of different aortic arch types and predictors for aortic arch type 3 in Thai patients. Methods: Data were analyzed on 250 retrospectively enrolled patients who underwent thoracic aorta computed tomography angiogram (CTA) between February 2013 and July 2015. Patient data including age, height, body weight, and underlying diseases were reviewed. Two independent investigators comprehensively evaluated CTA studies to identify aortic arch type and variants, including variable carotid artery branch points according to preset definitions. Results: Type 2 arch (n=144,57.6%) was the most common morphologic variant in followed by type 3 (n=77,30.8%) and type 1 arch (n=29,11.6%). An anomalous aortic arch was found in 20 patients (8%). The most frequent anomaly was the bovine arch branching pattern, where there is a common origin of the innominate and left common carotid arteries (n=17,7%). Compared to simple arch (normal type 1 and 2), factors like older age (70.5years±13.6vs.61.8years ±16.6,p<0.001), lower body weight (56.9kg±15.2vs.62.9kg±14.5,p=0.002), lower body-mass index(BMI)(21.7±4.5vs.23.7±4.8,p=0.001), lower body surface area(BSA)(1.59m2±0.23vs.1.67m2±0.22,p=0.005) and lower glomerular filtration rate(ml/min /1.73m2)(67.5±26.5vs.75.2±26.6,p=0.028) were associated with more complex arch (type 3 and variants). Multiple logistic regression analysis demonstrated that age ≥ 65 years (OR=2.98,95%CI 1.65-5.38,p<0.001) and BMI ≤ 21kg/m2 (OR=2.40,95%CI 1.38-4.19,p=0.002) were predictor variables for complex arch. Conclusions: Type 2 arch was the most common variant. We found that age ≥ 65 years and BMI ≤ 21 kg/m2 were strong predictors of complex arch

Mohammad Alkhatatbeh has a PhD in Experimental Pharmacology and he is currently working as an assistant professor at Clinical Pharmacy Department in Jordan University of Science and Technology, Irbid, Jordan. He is interested in studying soluble CD36 as a possible biomarker of insulin resistance, Type 2 Diabetes and its association with cardiovascular risk factors

Cluster of differentiation 36 (CD36) is involved in the development of atherosclerosis by enhancing macrophage endocytosis of oxidized low-density lipoproteins and foam cell formation. Soluble CD36 (sCD36) was found to be elevated in type 2 diabetic patients and possibly acted as a marker of insulin resistance and atherosclerosis. In young subjects, sCD36 was associated with cardiovascular risk factors including obesity and hypertriglyceridemia. The present study was conducted to further investigate the association between plasma sCD36 and cardiovascular risk factors among middle-aged patients with metabolic syndrome (MetS) and healthy controls. sCD36 concentrations were determined by enzyme-linked immunosorbent assays (ELISA) for 41 patients with MetS and 36 healthy controls. Data for other variables were obtained from patient medical records. sCD36 concentrations were relatively low compared to the majority of other studies and were not significantly different between the MetS group and controls (P=0.17). sCD36 was also not correlated with age, body mass index, glucose, lipid profile, serum electrolytes and blood counts. sCD36 was not significantly different between subjects with obesity, hyperglycemia, dyslipidemia, hypertension or cardiovascular disease, and those without these abnormalities (P>0.05). The inconsistency between results reported in the present study and other studies may be unique to the study population or be a result of the lack of a reliable standardized method for determining absolute sCD36 concentrations. However, further investigations are required to assess CD36 tissue expression in the study population and to assess the accuracy of various commercially available sCD36 ELISA kits. Thus, the availability of a standardized simple sCD36 ELISA that could be performed in any basic laboratory would be more favorable to the specialized flow cytometry methods that detect CD36+ microparticles if it was to be used as a biomarker.

Marianne Gwechenberger is specialized in cardiology, electrophysiology and heart failure.

Background: Patients with diabetes have an increased risk for developing cardiovascular disease. Serum Galectin-3 (Gal-3) is a novel biomarker and has been associated with diabetes and heart failure. However, data on the predictive value of Gal-3 on outcome are limited. We evaluated the prognostic role of Gal-3 for cardiovascular events in diabetic patients. Methods: Nine hundred one consecutive patients with type 2 diabetes were followed for cardiac events. The primary endpoint was defined as a composite endpoint of unplanned cardiac hospitalization and all-cause mortality. The secondary endpoints were defined as a) unplanned hospitalization and b) all-cause mortality. Gal-3 was tested to predict end points in the context of known other predictors, especially N-terminal pro-B-type natriuretic peptide (NT-proBNP). Results: The mean age of the patients was 59.3±13.8 years (55.1% male), duration of diabetes was 12.5±12.1 years and the mean glycated hemoglobin (HbA1c) was 7.5 ±1.5%. The median Gal-3 and NT-proBNP serum levels were 25.7±19.0 ng/ ml and 272.3±445.2 pg/ml respectively. After a mean follow up of 56.5 (IQR 60-61) months 23.2% of patients reached the primary endpoint. Kaplan-Meier analysis revealed a worse outcome in patients with elevated Gal-3. Elevated Gal-3 levels were predictive for the primary endpoint (p<0.0001). However, it was not predictive for outcome after adjustment for age, gender, NT-proBNP, body mass index (BMI) and glomerular filtration rate (GFR). The same observation was made for secondary endpoints. In contrast NT- proBNP was a significant predictor of all endpoints. Conclusions: Serum Gal-3 is associated with cardiovascular outcome in diabetic patients. However when compared with established risk predictors like NT-proBNP, its value is limited.