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

Biography:

Jan J. Piek is cardiologist since 1989 and is specialized in the interventional cardiology at the Academic Medical Center (AMC) in Amsterdam. He finished his thesis in 1992. He was appointed as a professor of clinical cardiology in 1999. He was co-chairman of the Heart Center of the AMC since 2004 and is director since 2008. He has published more than 400 articles in peer reviewed journals.

Abstract:

Wide attention for the appropriateness of coronary stenting in stable ischemic heart disease has increased interest in coronary physiology to guide decision making. For many, coronary physiology equals the measurement of coronary pressure to calculate the fractional flow reserve (FFR). While accumulating evidence supports the contention that FFR-guided revascularization is superior to revascularization based on coronary angiography, it is frequently overlooked that FFR is a coronary pressure-derived estimate of coronary flow impairment. It is not the same as the direct measures of coronary flow from which it was derived, and which are critical determinants of myocardial ischemia. The presentation includes the basic principles of coronary pressure and flow measurements, why coronary flow is physiologically and clinically more important than coronary pressure as well as the limitations and clinical consequences of FFR-guided clinical decision making. Moreover, the scientific consequences of using FFR as a gold standard reference test are discussed including the potential of coronary flow to improve risk stratification and clinical decision making in patients with ischemic heart disease.
 

Biography:

Stavros G Drakos is an Associate Professor of Cardiology with Tenure, Co-Chief Heart Failure and Transplant Section, Medical Director of the Mechanical Circulatory Support (MCS) Program and Investigator at the Eccles Institute of Human Genetics, U of Utah. His clinical and translational research interests are focused on cardiac recovery associated with unloading and MCS in both the chronic HF setting and the acute setting (i.e. acute HF/cardiogenic shock). He has published original work generated both in the clinical arena and in the laboratory which led to the establishment of the Utah Cardiac Recovery Program (UCAR). His ongoing clinical and labbased research is focused on understanding the clinical, metabolic and molecular profile of the recovered human heart and utilize biological information and clinical characteristics derived from these studies to understand, predict and manipulate cardiac recovery applicable to all stages of HF. Dr. Drakos is co-chairing the NIH/NHLBI Working Group 'Advancing the Science of Myocardial Recovery with Mechanical Circulatory Support'.

Abstract:

Myocardial remodeling induced by pressure and volume overload drives the vicious cycle of progressive myocardial dysfunction in chronic heart failure (HF). Mechanical volume and pressure unloading induced by implantable cardiac assist devices allows a reversal of stress-related compensatory responses of the overloaded myocardium so that selected patients requiring long-term mechanical circulatory support for advanced HF can achieve clinically meaningful degrees of improvement in the structure and function of their native heart. Insights from clinical and translational studies on myocardial recovery with mechanical circulatory support may enhance the understanding of how the pathophysiologic mechanisms of HF progression might be reversed. The end points of ongoing and future translational and clinical studies are discussed to identify specific investigational strategies that may advance the field of myocardial recovery driven by hemodynamic unloading of the heart.

Biography:

Samer Ellahham has served as Chief Quality Officer for SKMC since 2009. In his role, Dr. Ellahham has led the development of a quality and safety program that has been highly successful and visible and has been recognized internationally by a number of awards.

As Chief Quality Officer and Global Healthcare Leader, he has a focus on ensuring that that implementation of this best practices leads to breakthrough improvements in clinical quality and patient safety.

He Ellahham is a recognized leader in quality, safety, and the use of robust performance improvement in improving healthcare delivery. He serves on a number of US and international committees and advisory bodies.

Samer Ellahham is Certified Professional in Healthcare Quality (CPHQ) by The National Association for Healthcare Quality (NAHQ). He is certified in Medical Quality (CMQ) by The American Board of Medical Quality (ABMQ). He is the recipient of the Quality Leadership Award from the World Quality Congress and Awards and the Business Leadership Excellence Award from World Leadership Congress in 2015. He is one the nominees for Safe Care magazine Person of the Year in the United States.

Abstract:

Heart failure is a major cause of morbidity and mortality. It is important to discriminate between HFrEF and HFpEF. An array of evidence-based medical and device therapies are available to improve outcomes and alleviate symptoms in HFrEF. Treatment for HFpEF remains under active study.

The presentation will outline the difference between heart failure with reduced ejection fraction (HFrEF) and heart failure with preserved ejection fraction (HFpEF). It will then state the difference between the pathophysiology, etiology, and clinical presentation of HFrEF and HFpEF. Finally the presentation will identify an individualized treatment plan for a patient with HFpEF utilizing current evidence. A team-based, collaborative approach is essential when patients have comorbid conditions and multiple healthcare providers.

Biography:

Baris Cankaya has completed his graduation from Ankara University Medical Faculty in 2000. He is working as Anesthesiology Specialist at Marmara University Training Hospital. He has attended several academic meetings nationally and internationally. His academic interests include microcirculation, fluid therapy, resuscitation, patient safety and perioperative analgesia. He has participated in various international workshops, congress/symposiums and certifications and to list a few: EPLS provider Berlin 2015; NLS provider Athens 2015; MECOR Level I October 2014; ECMO workshop 2015, Leicester; Airway workshop ICISA 2014, Tel Aviv; Innovations Workshop ICISA 2014, Tel Aviv; Gastro 2016, Birmingham: oral presentation: Sedation for pediatric patient with end stage hepatic disease outside operating room; International intensive care symposium Ä°stanbul 2015 and so on.

Abstract:

Cardiopulmonary resuscitation for the newborn needs to be more demonstrated with hospital staff not only pediatrics and obstetrics specialists but nurses and technicians as well. Success is only made with a team approach. Simulations and manikins play important role for training. Updated 2015 guidelines are available and a new one will replace five years later. Extracorporeal membrane oxygenation technique (ECMO) helps for survival. Examples of resuscitation errors include failure to accurately detect heart rate, clinically significant delays in the initiation of Positive Pressure Ventilation (PPV), initiation of Chest Compressions (CC). Physiologic changes during delivery plays an important role. Approximately 85% of babies born at term will initiate spontaneous respirations within 10-30 s of birth, and the rest will respond to drying, stimulation and PPV. But 2% will be intubated and 0.1% will require CPR. The components of an effective CPR are optimal assessment of heart rate, umbilical cord milking, temperature maintenance in the delivery room and the infant, sustained inflations, oxygen concentration for resuscitating premature newborns, CC ratio and neonatal resuscitation instructors. Bartlett published the initial experience of ECMO with 45 newborns. This trial showed a >50% survival in patients whose mortality estimated at the time of was 90%. The UK trial of neonatal ECMO is the only controlled randomized trial to determine its efficacy. Its compared outcome (mortality and disability) between similar children managed in good quality neonatal centers in a standard fashion against transfer to and treatment in an ECMO centre. According to the results ECMO was superior to conventional approach. ECMO requires some more parameters to monitorize such as blood flow (ml/kg/min), revolutions per minute (rpm), pressure in the circuit, anticoagulation. ECMO treatment is best for the newborns with meconium aspiration. In the near future, we will be discussing extracorporeal fetal support technique.

Biography:

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

Abstract:

Hypertension is a major health problem throughout the world because of it high prevalence and its association with increased risk of cardiovascular disease.  Oxidative stress, trace element status and exercise have been demonstrated to play a major role in the pathogenesis of hypertension. The objective of this study was therefore to investigate the effect of an eight-week exercise regimen on the antioxidant and associated trace element status in the spontaneously hypertensive rat (SHR) model of hypertension. Methods and results: Sixteen SHR and 16 Wistar rats were randomly divided into an exercise (n=8) and a non-exercise (n=8). All the rats in the exercise group were subjected to a progressive treadmill exercise regimen for 8 weeks. Blood pressure, blood glucose and body weight was recorded weekly. At the end of the study, C-reactive protein (CRP), trace elements were measured in the blood and Total Antioxidant Capacity (TAC) was measured in the skeletal muscle. Hypertension developed in both SHR groups only. Elevated CRP level in both SHR and Wistar exercised groups suggest an inflammatory response associated with hypertension and exercise. There were no significant compensatory increases in TAC during exercise in the SHR. Decreased levels of Iron, Selenium and manganese were also observed in the exercise groups.

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

Biography:

Baris Cankaya has completed his graduation from Ankara University Medical Faculty in 2000. He is working as Anesthesiology Specialist at Marmara University Training Hospital. He has attended several academic meetings nationally and internationally. His academic interests include microcirculation, fluid therapy, resuscitation, patient safety and perioperative analgesia. He has participated in various international workshops, congress/symposiums and certifications and to list a few: EPLS provider Berlin 2015; NLS provider Athens 2015; MECOR Level I October 2014; ECMO workshop 2015, Leicester; Airway workshop ICISA 2014, Tel Aviv; Innovations Workshop ICISA 2014, Tel Aviv; Gastro 2016, Birmingham: oral presentation: Sedation for pediatric patient with end stage hepatic disease outside operating room; International intensive care symposium Ä°stanbul 2015 and so on.

Abstract:

Women experience physiologic changes during pregnancy which make clinicians focus on both the pregnant and the newborn with a specialized topic. There are some reasons why cardiopulmonary resuscitation is more difficult to perform and leading to less effective management in the pregnant than in the non-pregnant. Some changes associated with pregnancy are cardiovascular changes (increased heart rate, increased stroke volume, increased cardiac output, decreased systemic vascular resistance, increased uterine blood flow), respiratory changes (increased respiratory rate, increased oxygen consumption, decreased functional residual capacity, decreased bronchial tonus, increased upper airway vascularity), increased renal blood flow, increased cortisol, aldosterone, ACTH and insulin levels, decreased albumin, increased sedation, shift of oxy-Hgb dissociation curve to right and increased plasma volume. At term, the vena cava is completely occluded in 90% of supine positioned pregnant patients and the stroke volume may be only 30% of that of a non-pregnant woman. During cardiac arrest, avoiding for the effects of the gravid uterus on venous return, a maternal pelvic tilt to the left of greater than 15 degrees is recommended. The tilt needs to be less than 30 degrees for effective closed chest compression. Delivery of the fetus during cardiac arrest will reduce the oxygen demands on the mother and also increase the venous return to the heart. The esophageal sphincter is more relaxed during pregnancy, so entrance of air into the stomach is increased. Passive regurgitation of stomach contents which are greater in volume and more acidic in pregnancy can damage the lungs. The need for cardiopulmonary resuscitation (CPR) is a rare event occurring in one out of 30,000 pregnancies. Cardiac disease remains the leading cause of death in pregnancy. Physiological changes that occur in pregnancy, including the overall increase in circulatory volume status, may contribute to improved survival in pregnant women having non-traumatic

Biography:

Sabrina Zeghichi-Hamri is an Associate Professor at Bejaia University (Algeria), did her PhD in Physiology, Physiopathology and Pharmacology from Grenoble University (France) and MSc. in Food Quality Management from the Mediterranean Agronomic Institute of Chania, Crete (Greece). She is a Researcher at the Department of Cardiology (Grenoble University Hospital). Her project was to study the effects of Omega-3 fatty acids on malignant ventricular arrhythmias in rats and in patients with implantable cardioverter defibrillator. Currently, she is working on phytochemicals and their antioxidant activities and their effects in prevention of chronic diseases; at the Laboratory of Biomathematics, Biochemistry, Biophysics and Scientometrics (Bejaia University).

Abstract:

Background – Studies that evaluated the effects of omega-3 polyunsaturated fatty acids (n-3) on cardiovascular diseases have yielded conflicting results. We aimed at examining the association between plant/marine n-3 and malignant ventricular arrhythmias (MVA) among patients benefiting from the best preventive strategy including implantable cardioverter defibrillator (ICD).

Methods and Results – Consecutive patients in whom an ICD was implanted for primary or secondary prevention of MVA were eligible. All patients had blood fatty acid analysis. The method of Kaplan-Meier was used to estimate the survival curves in each quartile of the main plant (ALA) and marine (EPA and DHA) n-3.  Among the 238 enrolled patients, 100 had a relevant endpoint recorded by the ICD or died from a cardiac cause during a mean follow-up of 30±12 months. No significant difference in MVA was observed between quartiles of ALA (log-rank test p=0.88), EPA (log-rank test p=0.58) and DHA (log-rank test p=0.97). In a multivariate Cox proportional hazard model including age, sex, ischemic heart disease, diabetes, smoking, hypertension and high cholesterol as covariates, we found no association between MVA and n-3: hazard ratio was 1.12 (95% CI 0.62-2.02) for ALA and 1.44 (95% CI 0.81-2.58) for the sum of main marine n-3.

Conclusions – Plant and marine n-3 do not seem to either increase or decrease the risk of MVA in patients who are not n-3 deficient and benefit from the most effective preventive treatment. Further studies are required to test whether n-3 deficient patients would still benefit from n-3 supplements. Finally, these data raise major questions regarding interactions between dietary n-3 and certain medications.

Biography:

Daniela Lončar lives in Tuzla, Bosnia and Herzegovina. She is an internist at the Clinical Center Tuzla, Clinic for Internal diseases,ICU. She deals with the non-invasive cardiology with a particular focus of interest in echocardiography. She is senior assistant on the subject of Internal medicine at the Medical school of the University of Tuzla.

Abstract:

Cardiovascular diseases are a major cause of morbidity and mortality in patients at the end stage of renal disease. Left ventricular hypertrophy, coronary heart disease and heart failure are the most prevalent cardiovascular diseases in dialysis patients. The patients on chronic dialysis have a 10 to 20-fold higher risk of development of cardiovascular disease than the general population. The aim of this study was to define the frequency of risk factors (traditional and non-traditional) for cardiovascular diseases in dialysis
patients. 50 patients were included: 22 men (44%) and 28 women (56%). 35 patients (70%) treated by hemodialysis, while 15 patients (30%) were treated by continuous ambulatory peritoneal dialysis (CAPD).  The frequency of traditional factors was: hypertension (62%), hyperlipidemia (60%), diabetes (25%) and smoking (24%). Anemia was present in 86% patients. From non-traditional metabolic risk factors, 82% hyperhomocysteinemia was present in 82% of patients, microinflammation in 26%, hypoalbuminemia in 30% and secondary hyperparatireoidism in 36%. To present the study and repeat again that dialysis patients have high risk of development of cardiovascular disease and this population should be an ideal target group for primary prevention.

Biography:

Abstract:

Hypocalcemic cardiomyopathy in infants is characterized by heart failure in a previously normal infant with hypocalcemia without organic cardiac lesion. Vitamin D deficiency rickets is increasing in Middle East. In a six month study 136 cases of rickets were diagnosed in the main Children's Hospital in Almadinah but none of them showed evidence of cardiomyopathy except a case presented in this meeting. Concerned of missing this serious complication of rickets we searched pub med and present this review article.

61 cases of hypocalcemic cardiomyopathy were reported as case reports with two series of 16 and 15 cases from London and Delhi, respectively. The major features of these cases: the age ranged from one month to 15 months with a mean age of 5 months. All presented with heart failure and hypocalcemia. There was a minor feature of rickets in a few of the cases. All had high alkaline phosphatase. Echo cardiology evidence of cardiomyopathy was found in all. Most of them responded to calcium, vitamin D and cardio tonic and diuretics.

We concentrated on pathogenesis of this hypocalcemic cardiomyopathy and reviewed the literature. The evidence available supports that the most likely cause of cardiomyopathy is hypocalcemia. Hypo vitamin D also contributes but hyperparathyroidism might have a protective role as we did not detect any evidence of cardiomyopathy with hyperparathyroidism per sey and florid features of rickets.

We need to look out for cardiomyopathy among infants with hypocalcemia. For prevention maternal supplementation during pregnancy and lactation with up to 2000 units of vitamin D and 400 units for their infants.

Biography:

Ahmed Abd-Elwahab Algohary completed his PhD in Medicine & Surgery from Zagazig University, Egypt. He is now working at Dessole SettiSharm Resorts & Hotels as a Doctor who manages Guest Emergencies and Medical Cases. His clinical skills are Interpreting ECG and ABG, Interpreting echocardiography and coronary angiography, Peripheral IV lines insertion – endotracheal intubation and Central venous line insertion pericardiocentesis.

Abstract:

Introduction: Diabetic patients with normal left ventricular ejection fraction are frequently associated with diastolic dysfunction .Speckle tracking is more sensitive than LVEF in detection subclinical LV systolic dysfunction. However, it is not clear whether there is any difference in early LV systolic dysfunction between DM patients if they have controlled or uncontrolled blood glucose.

Aim: Detection of different patterns of global longitudinal strain in diabetic non ischemic patients either controlled or uncontrolled blood glucose level, using global longitudinal strain by speckle tracking.

Methods: fifty two diabetic patients had been referred from internal medicine clinic after they had been tested for HBA1c test and stratified into two groups

Group І: it include26 DM patients with controlled blood sugar.

Group ǁ: it include26 DM patients with uncontrolled blood sugar

The two groups had been subjected to the following diagnostic workup:

Full medical history, full clinical examination, laboratory assessment , twelve lead resting ECG ,Stress ECG, Echocardiography study, Traditional Tissue Doppler imaging ,Assessment of global longitudinal strain.

     Patients with IHD, Systolic dysfunction, CHD ,Valvular, Arrhythmia, HOCM ,Pericardial, major systemic disease had been excluded.

Result: there was significant statistical difference in GLS, Age , Diabetic Type ,Diabetic Duration,2HPP Blood sugar level, E/é ratio in controlled DM compared to uncontrolled DM (p<0.05),there was no significant difference in Gender ,FBS. EF, E/A in controlled DM compared to uncontrolled DM.

Conclusion: Poor blood glucose control, as indicated by HbA1c>6.5%, leads to reductions in LV global longitudinal systolic strain, which is associated with preclinical LV dysfunction.

Biography:

He is doing his PhD in Physiological Sciences from the Federal University of Espírito Santo (UFES). He is Master of Physiological Sciences, specialist in Teaching for graduation and Nursing in critical care with emphasis on cardiology and bachelor of Nursing at the Catholic University Salesian of Espirito Santo. He is a teacher at EMESCAM for graduate in nursing and teacher in MULTIVIX for graduate in nursing, pharmacy, dentistry and medicine. Currently a researcher in nursing care in cardiac arrest and first aid education in high schools.

Abstract:

Renovascular hypertension occurs by reduced renal perfusion pressure, which activates the renin-angiotensin-aldosterone system (RAAS). Several studies indicate that the increased angiotensin II and oxidative stress plays an important role in renovascular hypertension and progression of tissue damage. The purpose of this study was to test whether the administration of aliskiren (ALSK) and L-arginine (L-ARG) would restore ventricular hypertrophy and reduce oxidative stress in a rat renovascular hypertension model. Wistar rats underwent surgery for implantation of silver clip on the left renal artery to induce renovascular hypertension (2K1C). After 7 days was performed plethysmography of tail for indirect measurement of systolic blood pressure (SBP). The rats were divided in five groups: SHAM; 2K1C; 2K1C plus ALSK; 2K1C plus L-ARG; and 2K1C plus ALSK+ L-ARG. The treatment was performed for 21 days by gavage. At the end of treatment blood samples were taken and analyzed the dry weight of the left ventricle and the expression of  SOD, CAT and gp91phox in the cardiac tissue by Western blotting. In addition, that the advanced oxidation product (AOPP) levels and the estimate of reactive oxygen species by dihydroethidium fluorescence were analyzed. After 21 days of treatment, only the ALSK+L-ARG group was effective in normalizing the arterial pressure (108.8±2.8 mm Hg). The L-ARG and ALSK+L-ARG groups did not show hypertrophy of the left ventricle. All treatments were effective in increase the antioxidant pathway and reduce oxidative pathway. In conclusion, the treatment with ALSK or L-ARG reduced oxidative stress and and reverse left ventricular hypertrophy.

Biography:

Jenny-Lynn V. Juhuri has completed her College degree (Medical Technology) at the age of 19 years from University of Santo Tomas, Philippines, and her Medicine degree from University of Santo Tomas Faculty of Medicine and Surgery at the age of 25 years. She had her residency in Internal Medicine at Makati Medical Center and had her fellowship training in Adult Cardiology at the Philippine Heart Center. She was board certified (Adult Cardiologist) at the age of 32 and is presently taking up her subspecialty training in the Non-Invasive Department (Echocardiography) of Adult Cardiology at the Philippine Heart Center.    

Abstract:

Congenital coronary artery fistulas are rare cardiac defects. A fistula associated with other cardiac anomalies, like valvular heart disease, is an extremely rare condition. We report a young symptomatic patient who presented with a continuous murmur heard along second right intercostal space and a systolic murmur at the apex on clinical examination. Chest x-ray showed left ventricular prominence and transthoracic echocardiography with doppler studies showed right coronary fistula draining into the right atrium and moderate mitral regurgitation. She is being followed up with medical management at the outpatient department. We recommend coronary angiography with cardiac catheterization, and if patient will give her consent, surgical repair of the fistula with possible mitral valve surgery is recommended. We conclude that diagnosis of coronary artery fistula should be considered when patient presents with continuous murmur. A non-invasive test, like transthoracic echocardiography with Doppler studies, can demonstrate dilated coronary arteries and their receiving chambers or vessels.

Biography:

Sejla Sehović is a cardiologist and Fellow of New Westminster College. She has
an outstanding record of ethical leadership and her professional experience and residencies
include: !
• 2013-2015: Associate Director, Medical Liaison Group for Europe, Medical Affairs
Chicago (ABBOTT)
• 2005-2013: Cardiologist, Heart Center, University of Sarajevo - Sarajevo, Bosnia and
Hercegovina
• 2007: Echocardiography Transoesophageal Echo Training and Advance Techniques, DHZ
Herzzentrum, BERLIN, Germany
 

Abstract:

Background:   Procedural riks of ERCP are well recognized but  significance of cardiac risks remains controversial.This study aimed to evaluate ERCP-related highly sensitive cardiac troponin I (hs TnI) release in even small amounts of myocardial injury and to analyze potential relationship between myocardial ischemia and the development of post-ERCP pancreatitis.

Methods: 120 patients (aged 18-93 years) scheduled  for ERCP were enrolled in this study.Cardiovascular risk factors were identified in 60% of patients.All patients were  assessed clinically and with electrocardiography for the presence of ischemic disease before the procedure. Hs TNI ( limit of detection 1,9ng/l) was measured at baseline(pre- ERCP) , during ERCP and 2h post-ERCP.During ERCP procedure patients were also monitored with Holter tape rekorder.Amylase and lipase were measured before and 24 hours after ERCP.

Results: Twelve patients (12 %)developed myocardial ischemia/injury during ERCP with new ECG changes and  without any clinical symptom. 50 % of change in Hs TnI second measurement  was documented  in   12 patients (  p<0.01) .Patients with myocardial ischemia during ERCP had a significantly higher values of amylase and lipase levels(60,3%vs 16.2%; p<0.01)

Conclusions:The relationship was found between hs TnI  small elevation  and new ECG and  rythm changes on Holter during ERCP. Post ERCP pancreatitis was associated with myocardial ischemia/injury during ERCP.

Biography:

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.

Abstract:

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.

Biography:

He is a Professor Doctor of Cardiology. He is working Department of Cardiology and Director of Clinical Electrophysiology at the University of Gaziantep in Turkey. Dr. Sucu's clinical interests of clinical an invasive electrophysiology including both device implantation and catheter ablation therapies. Dr. Sucu has published more than 70 national and international scientific manuscripts.

Abstract:

Backgrounds: Prolongation of the peak and the end of T wave (Tp-e) has been reported to be associated with ventricular arrhythmias. High dose pulse intravenous steroids (pulse therapy) are an accepted practice to treat severe manifestations of inflammatory, autoimmune and renal diseases. Sudden death, cardiac arrhythmias, circulatory collapse and cardiac arrest have been reported occasionally, usually following rapid administration of large doses of methylprednisolone.

Methods: We enrolled 50 consecutive various inflammatory and autoimmune diseases in patients with acute relapse to perform ECG 4 hours before, and 12 hours after infusion of 1000 mg intravenous (IV) methylprednisolone. Myocardial repolarization can be evaluated with QT interval (QT), corrected QT interval (QTc), QT dispersion, and transmural dispersion of repolarization. (Tp-e), which is the interval between the peak and the end of T wave on electrocardiogram (ECG), is accepted as an index of transmural dispersion of ventricular repolarization. JT dispersion (JTd), corrected JT (JTc), (Tp-e)/QT ratio, (Tp-e)/QTc ratio are also used as an electrocardiographic index of ventricular arrhythmogenesis. Our goal in these patients, we aimed to assess ventricular repolarization in patients with before and after high dose pulse intravenous steroids therapy in patients.

Results: The baseline characteristics of the patients before and after high dose pulse intravenous steroids therapy are presented in the table 1 and 2.

Conclusions: Our results show that after high dose pulse intravenous steroids therapy in patients is associated with prolonged Tp-e interval and increased Tp-e/QT and Tp-e/QTc ratio.

Table 1: Characteristics of the Study Population

Table 2: Electrocardiographic Measurements of the Patients

QTd: QT interval dispersion, QTI: QT interval index, QTc: Corrected QT interval, JTd: JT interval dispersion, JTc: Corrected JT, Values are presented as mean±SD.p<0.05.

Biography:

Abstract:

Background : Presence of right ventricular myocardial infarction (RVMI) imposes an increased risk of shock, arrhythmia and death in inferior wall myocardial infarction (IWMI) .There are only limited studies validating usefulness of various echocardiographic  parameters of RV function in assessing RV infarction and prediction of proximal RCA stenosis .

Objective : We  aimed  to assess  the validity of echocardiographic parameters assessing right ventricular (RV) function for  prediction of proximal right coronary artery (RCA)  stenosis in patients with first episode of acute inferior wall myocardial infarction  .

Methods :This is prospective study  included 128  patients with first episode of acute IWMI who present within 24 hour of onset of symptoms.  Patients with previous abnormal left ventricular function; left bundle branch block (LBBB); atrial fibrillation (AF); paced rhythm;  pulmonary hypertension > 40 mmHg ; pulmonary embolism and poor echo window were excluded . All patients were subjected to the following:  ECG, cardiac enzymes (CKMB) and troponin and transthoracic   echocardiography (TTE)  which was done  within 24 hours of symptom onset to assess right ventricular (RV) systolic function using different parameters : RV fractional area change (RV-FAC) , myocardial perfusion index of RV MPI – by Pulsed Wave Doppler & by Tissue Doppler Imaging  which was calculated as (MPI = IVRT + IVCT/ET). , tricuspid  annular plane systolic excursion (TAPSE) and  DTI-Derived Tricuspid  lateral annular systolic velocity ( S wave velocity)   . LV dimension (ESD, EDD ) and ejection fraction  . Coronary angiography performed as apart of primary PCI or within one month as an elective procedure.   Patients were divided into two groups, Group 1:  Patients  with  significant  proximal RCA stenosis ( included 42 patients), Group 2:  Patients without  significant proximal RCA stenosis,( included 86 patients).

Results :Patients with proximal RCA ( group 1 ) had significantly lower blood pressure (p = 0.001)  and heart rate ( p=0.0218) , higher level of troponin  p = 0.009, there were significant difference in TAPSE (12.5 ±2.6  vs  21.1 ± 3.3, p = 0.0001) , RVFAC  ( 23.8 ± 6  vs  41.6 ± 5.2 .p = 0.0001 ), MPI-PW  (0.5 ± 0.07 vs 0.28 ± 0.05 , p = 0.0001); MPI-TDI  (0.603 ±  0.06  vs 0.39 ± 0.04, p = 0.0001), lower S wave velocity (10.44 ± 2.61 cm/s vs. 12.11 ± 2.94 cm/s, p = 0.013)  . A cut-off value of  ≥0.557 for MPI had a sensitivity of 95.2 and specificity of 90.7% for the diagnosis proximal RCA. A cut-off value of  TAPSE ≤  16.5 had a sensitivity of 100% and specificity of 95.3% for the diagnosis proximal RCA and  A cut-off value of  RVFAC ≤ 34  had a sensitivity of 100% and specificity of 95.3% for the diagnosis proximal RCA.

Conclusion: RV function parameters  are useful for  prediction of proximal RCA stenosis in patients with acute inferior MI.

Biography:

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.

Abstract:

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.

Biography:

Pham Xuan anh has completed his PhD at the age of 35 years from Hanoi Medical University, Vietnam. He is the director of Hoan My Vinh Hospital. He has published 5 papers in reputed journals.

Abstract:

OBJECTIVES:

In order to study clinical outcomes of using thrombolytic agent (alteplase) as primary reperfusion in patients with acute ST-segment elevation myocardial infarction in Ha Tinh General Hospital.

METHODS:

Data on demographics, medications, in-hospital outcomes were collected from a prospective registry of acute ST-segment elevation myocardial infarction patients (age≤75) admitted from August, 2013 to February, 2016.

RESULTS:

During the 2.5-year period, 32 consecutive patients with acute ST-segment elevation myocardial infarction who received alteplase were enrolled. The mean age was 62.4 year and 84.3% were male. There were 12 patients (37.5%) which the time from symptom onset to hospital presentation ≤180 minutes and 20 others (62.5%) from >180 to 360 minutes. Median time door to needle was 50 minutes. ST-segment resolution was found in 93.7% of patients (10 of them (31.2%) had ST-segment renormalization). In the earlier hospital presentation patient group, the ST-segment renormalization was better than the other group. There was no bleeding complication in this study. In-hospital mortality was 3.1%. Revascularization was performed in 62.5% at Hanoi hospitals.

CONCLUSION:

Our data, alteplase in acute STEMI provided very good clinical reperfusion with no bleeding complication in 32 patients. Most of our patients needed secondary angioplasty intervention to fix their coronary artery disease.

Biography:

He is a consultant cardiologist at Prince Sultan Cardiac Center Al Hassa, KSA and fellow of American Society of Echocardiography. His main area of interest is 2D &3D Trans esophageal Echo. He is also an Active member of interventional team for structural heart diseases. He had shared for many procedures like TAVR, Wachman device for LAA occlusion, BMV and Mitral clip. Beside his work as a consultant cardiologist he is responsible for CME department for doctors in his center. He is the founder of cardiology arrhythmia club in eastern region. He is also the co-chairman of Cardiology club in Eastern region Al Hassa, KSA

Abstract:

Percutaneous watchman device closure of the left atrial appendage is an increasingly recognized procedure as a valid alternative to oral anticoagulation, especially in patients with contraindication to anticoagulant therapy or those at high risk of bleeding. Despite previous reports has shown non inferiority of device closure to warfarin in preventing vascular stroke in patients with non valvular atrial fibrillation, several complications such as hemo-pericardium, pericardial effusion and device thrombosis have been reported after left atrial appendage closure. Device embolization is another complication with an average reported rate of less than 4%. We have reported migrating watchman device in patient with previous trans catheter aortic valve implantation procedure which finally necessitate surgical intervention.
 

Biography:

He is a consultant cardiologist at Prince Sultan Cardiac Center Al Hassa, KSA and fellow of American Society of Echocardiography. His main area of interest is 2D &3D Trans esophageal Echo. He is also an Active member of interventional team for structural heart diseases. He had shared for many procedures like TAVR, Wachman device for LAA occlusion, BMV and Mitral clip. Beside his work as a consultant cardiologist he is responsible for CME department for doctors in his center. He is the founder of cardiology arrhythmia club in eastern region. He is also the co-chairman of Cardiology club in Eastern region Al Hassa, KSA

Abstract:

Percutaneous device closure of atrial septal defect (ASD) has emerged as an alternative to traditional surgical closure. Although reduced hospital stay, decreased morbidity and absence of a surgical incision are beneficial, other procedure- or device-related complications are coming into light.

We report a rare complication of early embolization of the septal

Occlude device into the left atrium associated with deficient aortic rim necessitating surgical intervention.

Biography:

He is a consultant cardiologist at Prince Sultan Cardiac Center Al Hassa, KSA and fellow of American Society of Echocardiography. His main area of interest is 2D &3D Trans esophageal Echo. He is also an Active member of interventional team for structural heart diseases. He had shared for many procedures like TAVR, Wachman device for LAA occlusion, BMV and Mitral clip. Beside his work as a consultant cardiologist he is responsible for CME department for doctors in his center. He is the founder of cardiology arrhythmia club in eastern region. He is also the co-chairman of Cardiology club in Eastern region Al Hassa, KSA

Abstract:

Balloon mitral valvuloplasty (BMV) was one of the first catheter-based therapies for structural heart disease. Nowadays it becomes the treatment of choice for selected patients with rheumatic mitral stenosis. Because BMV results in commissural splitting, a limitation of mitral valve scoring system is the lack of information on commissural calcifications.

With recent advances of three dimensional echocardiography specially trans esophageal, it became the method of choice in evaluation of mitral stenosis ,for better evaluation of the commissures, proper selection of patient for BMV and accurate calculation of mitral valve area.

There is a more trend to use 3DTEE during BMV. In our center we had found it very beneficial in guiding internationalist in every step, evaluation of the results and immediate detection of complications that could happen during procedure.

In the near future, we expect that 3D TEE will be integral and essential tool in cat lab during BMV.

Biography:

Sabrina Zeghichi-Hamri is an Associate Professor at Bejaia University (Algeria), did her PhD in Physiology, Physiopathology and Pharmacology from Grenoble University (France) and MSc. in Food Quality Management from the Mediterranean Agronomic Institute of Chania, Crete (Greece). She is a Researcher at the Department of Cardiology (Grenoble University Hospital). Her project was to study the effects of Omega-3 fatty acids on malignant ventricular arrhythmias in rats and in patients with implantable cardioverter defibrillator. Currently, she is working on phytochemicals and their antioxidant activities and their effects in prevention of chronic diseases; at the Laboratory of Biomathematics, Biochemistry, Biophysics and Scientometrics (Bejaia University).

Abstract:

Background – Studies that evaluated the effects of omega-3 polyunsaturated fatty acids (n-3) on cardiovascular diseases have yielded conflicting results. We aimed at examining the association between plant/marine n-3 and malignant ventricular arrhythmias (MVA) among patients benefiting from the best preventive strategy including implantable cardioverter defibrillator (ICD).

Methods and Results – Consecutive patients in whom an ICD was implanted for primary or secondary prevention of MVA were eligible. All patients had blood fatty acid analysis. The method of Kaplan-Meier was used to estimate the survival curves in each quartile of the main plant (ALA) and marine (EPA and DHA) n-3.  Among the 238 enrolled patients, 100 had a relevant endpoint recorded by the ICD or died from a cardiac cause during a mean follow-up of 30±12 months. No significant difference in MVA was observed between quartiles of ALA (log-rank test p=0.88), EPA (log-rank test p=0.58) and DHA (log-rank test p=0.97). In a multivariate Cox proportional hazard model including age, sex, ischemic heart disease, diabetes, smoking, hypertension and high cholesterol as covariates, we found no association between MVA and n-3: hazard ratio was 1.12 (95% CI 0.62-2.02) for ALA and 1.44 (95% CI 0.81-2.58) for the sum of main marine n-3.

Conclusions – Plant and marine n-3 do not seem to either increase or decrease the risk of MVA in patients who are not n-3 deficient and benefit from the most effective preventive treatment. Further studies are required to test whether n-3 deficient patients would still benefit from n-3 supplements. Finally, these data raise major questions regarding interactions between dietary n-3 and certain medications.

Biography:

Abstract:

Background: Patients with acute pulmonary embolism (PE) have a high risk of death. N-Terminal pro-Brain Natriuretic Peptide (NT-pro BNP) has emerged as a biomarker for risk assessment in acute PE.

Objective: We aimed to detect in hospital prognostic value NT- pro BNP in patients with acute PE.

Methods: Sixty four patients  with  acute  PE .All patients  were subjected to ECG,  laboratory tests ( D-Dimer, troponin I,NT-pro BNP), Doppler  ultrasound for the venous system of lower limbs, echocardiography and 64 multislices CT pulmonary angiography.

Results: Patients were divided into two groups: group I (22) patients with normal NT-Pro BNP (<300 pg/ml), and group II (42) patients with elevated NT-Pro BNP. Group II had higher incidence of heart failure (28.6% vs. 4.6% P=0.025), impaired kidney function (creatinine 1.7 ±0.6 vs 1.1 ± 0.2 ,P=0.018) and cardiogenic shock (26.2% vs. 0% P=0.014) but lower incidence of chest pain (21.4% vs 45.5% P=0.04) and lower LV ejection fraction (51.3% ± 16.9% vs. 67.3% ± 12.8% P=0.043) compared to group I. Group II had higher treatment with thrombolytic therapy (35.7% vs. 9.1%, P= 0.021) and positive inotropic  (35.71% vs 4.55%, P=0.006) ,higher need for mechanical ventilation (26.2% vs. 4.55%, P=0.04) ,longer hospital stay (19.5 ±10.3 vs 5.3±4.5, p= 0.001) and higher mortality (19.05% vs. 0.0% P=0.042) than group I.

Conclusion: Elevated NT-pro BNP levels in patients with PE are associated with worse short term prognosis in terms higher of morbidity and mortality and it could be used as a valuable prognostic parameter and good indicator for the need of more aggressive therapy.

Biography:

Abstract:

Hypocalcemic cardiomyopathy in infants is characterized by heart failure in a previously normal infant with hypocalcemia without organic cardiac lesion. Vitamin D deficiency rickets is increasing in Middle East. In a six month study 136 cases of rickets were diagnosed in the main Children's Hospital in Almadinah but none of them showed evidence of cardiomyopathy except a case presented in this meeting. Concerned of missing this serious complication of rickets we searched pub med and present this review article.

61 cases of hypocalcemic cardiomyopathy were reported as case reports with two series of 16 and 15 cases from London and Delhi, respectively. The major features of these cases: the age ranged from one month to 15 months with a mean age of 5 months. All presented with heart failure and hypocalcemia. There was a minor feature of rickets in a few of the cases. All had high alkaline phosphatase. Echo cardiology evidence of cardiomyopathy was found in all. Most of them responded to calcium, vitamin D and cardio tonic and diuretics.

We concentrated on pathogenesis of this hypocalcemic cardiomyopathy and reviewed the literature. The evidence available supports that the most likely cause of cardiomyopathy is hypocalcemia. Hypo vitamin D also contributes but hyperparathyroidism might have a protective role as we did not detect any evidence of cardiomyopathy with hyperparathyroidism per sey and florid features of rickets.

We need to look out for cardiomyopathy among infants with hypocalcemia. For prevention maternal supplementation during pregnancy and lactation with up to 2000 units of vitamin D and 400 units for their infants.

Biography:

Ashraf Reda is the president of the Egyptian Association of Vascular biology and Atherosclerosis ( EAVA) and past treasurer of Egyptian society of Cardiology. He is the director and PI  of the Egyptian Cardio risk project and the principle investigator of many  national and international research project. He was graduated 1979 from Ain shams University. He had his master degree in cardiology 1984 and MD degree 1991 and he is a fellow of the European society of cardiology. Prof Ashraf Reda is the founder of the Egyptian working group of Lipidology and chairman of the Egyptian Board of Accreditation in cardiology.

Abstract:

Dyslipidaemia is a major health problem worldwide is is one of the major cardiovascular risk factors. LDL.C lowering is proved to be the main drive for reduction of CV events in high risk patients. However, whether this benefited is derived mainly from the lipid lowering itself (lipid hypothesis) or from statin therapy and its pleotropic effects (Statin hypothesis) is a debatable issue.  Recently the IMPROVE-IT it trial has given more supportive evidence for the lipid hypothesis and the “lower is the better “concept using a combination therapy.  The current guidelines recommend moderate or high intensity statin therapy as the principle lipid lowering strategy after CV risk assessment.  One of her most important and promising lipid lowering therapy is PSCK9 inhibitor, which are monoclonal antibodies targeting PCSK and increase recycling and availability of LDL receptors with significant LDL-C reduction.  This promising new lipid lowering therapy could be used in familial hypercholesterolemia cholesterolemia, patients with statin intolerance or statin resistance and those who couldn’t archive the LDL-C goals of therapy

Biography:

Dr. Sameh Salama is currently a Professor of Cardiology at Cairo University. He had his Doctorate degree n Cardiovasculr medicine at year 2000 from Cairo University, after finishing his training on Coronary interventions and intravascular imaging in the states in the period from 1997 to 1999.. He is a fellow of the Society of Coronary Angiography and Interventions (SCAI). He is a member of the Egyptian and European Societies of Cardiology as well as the Egyptian Hypertension Society. He is also a member of the excutive board of the Egyptian Association of Vascular Biology & Atherosclerosis. His main interest is in Coronary interventions and intravascular imaging, having numerous pupblications in this field in reputed journals. He is currently serving as an editorial board member in 3 international journals. He participated, as a prinicipal investigator, in many international Cardiovascular trials.  

Abstract:

Cardiovascular disease(CVD) and diabetes are among the leading global and regional causes of death; between 1990 and 2016 CVD deaths increased by 25%.In a recent comparative assessment of the global burden of metabolic risk factors for CVD, 60% of worldwide CVD deaths in year 2010 was attributable to four modifiable cardiometabolic risk factors: high BP, blood glucose, BMI, and serum cholesterol.Heart failure is twice as common in diabetic men and five times as common in diabetic women compared to non-diabetics and mortality rates are about twice that of non-diabetic population.The clinical spectrum of cardiovascular diseases in diabetes involves coronary artery disease, heart failure, serious arrythmias and sudden cardiac death,peripheral vascular disease,cerebrovascular disease and stroke.Higher glucose levels predicts higer CV risk, each 1% increase in HBA1c leads to 15% increase in the risk of heart failure.It is conclusively established that the microvascular complications of diabetes (retinopathy, nephropathy, and neuropathy) are directly related to the severity and duration of hyperglycaemia, as reflected by the HbA1c.However, macrovascular complications are the primary cause of mortality, with myocardial infarction and stroke accounting for 80% of all deaths in diabetic patients.Therefore, when selecting medications to normalize glucose levels in diabetic patients, it is important that the agent should not aggravate, and ideally even improve, cardiovascular risk factors (CVRFs) and reduce cardiovascular morbidity and mortality.In this presentation, we will review the effect of oral glucose-lowering drugs (metformin, sulfonylureas, meglitinides, thiazolidinediones, DPP4 inhibitors, SGLT2 inhibitors, and α-glucosidase inhibitors) on established CVRFs and long-term studies of cardiovascular outcomes.

Biography:

Atef Elbahry had his MB.BcH in 1977 , MSc in 1983, MRCP in 1995, &  his PhD in clinical cardiovascular pharmacotherapy in 1999. A fellow of the American College of Angiology , a member of the American Hypertension Society. He is a principal investigator in the Global Anti‐coagulation Registry in the FIELD (GARFIELD).  He is also a principal invesigator in Heart Failure Long Term Registry. A consultant cardiologist and  head of CCU – Port Fouad Hospital – Port-Said, Egypt.

Abstract:

Resistant hypertension is a condition with difficult clinical management & high cardiovascular risk. Treatment or true resistant hypertension is a diagnosis of exclusion requiring a systemic approach to evaluation & management . The first step in the diagnosis of true resistant hypertension is the exclusion of causes of pseudo-resistance hypertension. Most epidemiological studies evaluating the prognosis of true resistance hypertension have limitations such as lack of uniformity in definitions & informations on drugs used , inclusion cases of pseudo-resistant hypertension as well as insufficient follow up time & exclusion of young people. New defintion is needed & definition should have global standards. Successful treatment requires identification and reversal of lifestyle factors contributing to treatment resistance . Recomendations for pharmacological treatment of true resistant hypertension remain largely empiric due to the lack of systemic assessments of 3 or 4 drugs combinations. Expanding our understanding of the causes of true resistant hypertenstion  & therapy potentially allowing for more effective prevention &/or treatment will be essential to improve the long term clinical management of this disorder.

Biography:

Abstract:

Background: Infections in young children may affect the vasculature and initiate early atherosclerosis. Whether infections experienced in childhood play a part in adult clinical cardiovascular disease remains unclear. We investigated the association between infections in early life and the occurrence of premature coronary heart disease.

Methods: We conducted a population-based case-control study of 153 patients with a first acute coronary syndrome before the age of 56 years and 153 age- and sex-matched controls. Any history of severe infections in childhood and
adolescence was obtained, together with clinical and laboratory measurements and other cardiovascular risk factors.We developed an infection score for the overall burden of early life infections. Conditional logistic regression was used to assess the associations.

Results: Infections experienced in early life increased the risk of acquiring acute coronary syndrome at a young age with an odds ratio (OR) of 2.67 (95% confidence interval (CI) 1.47–4.83, p¼0.001). After adjustments for traditional risk factors, lifestyle, dietary patterns, socio-economic status and parental history of cardiovascular events, these associations remained significant and changed only slightly. There was an indication for an interaction between infections in early life and current cardiovascular risk Framingham Risk Score (FRS); p-interaction¼0.052). Within participants with a low FRS (<10%), the OR of early life infection for acute coronary syndrome was 1.49 (95% CI 0.72–3.08, p¼0.283); within participants with an intermediate FRS (10–20%), the OR was 4.35 (95% CI 1.60–11.84, p¼0.004); and within participants with a high FRS (>20%), the OR 10.00 (95% CI 1.21–82.51, p¼0.032).

Conclusion: Infections in early life may partly explain premature coronary heart disease in adulthood and may potentiate traditional cardiovascular risk factor effects.

Biography:

Evanka Chopra has expertise in molecular/Cell Biology and Computational Biology techniques. She has qualified national level examination viz., CSIR/UGC-JRF and GATE. Evanka is an enthusiastic and hard bench worker with innovative and inquisitive mind and has an outstanding reasoning power reflected by her own alterations and designing in the protocols to get task done with optimum outputs.

Abstract:

Statement of the Problem: The risk of cardiovascular disease (CVD), asthma, non-alcoholic fatty liver disease (NAFLD) as well as common cancers is increased in subjects with metabolic syndrome (MetS). Interleukin-4 (IL-4), a marker of Th2 immune response, is often upregulated in these contexts and may potentiate aberrant arginine metabolism. Altered arginine/nitric oxide metabolism and mitochondrial dysfunction represent putative common molecular pathways that may connect these diseases, possibly via oxidative-stress driven induction of the cellular hypoxic response. The importance of this pathway is not well studied in MetS associated vascular dysfunction.

The purpose of this study is to investigate how altered arginine/methyl arginine balance, oxo-nitrative stress, hypoxic response, and mitochondrial dysfunction may cause vascular dysfunction in metabolic syndrome.

Methodology & Theoretical Orientation: MetS mice (C57BL/6) were fed chow-diet (CN), high-fat-diet (HFA), or high-fructose-diet (HFR) for 6 months. HFR and HFA diets induce MetS. Arginine/methyl arginine balance and oxo-nitrative stress were determined in aortic tissue by measuring the levels of ADMA, iNOS and 3-nitrotyrosine. Estimation of hypoxic response done by checking levels of HIF1α and resultant mitochondrial dysfunction by measuring levels of cytochrome c, TFAM, mitochondrial membrane potential and Mitochondrial Complex I and IV activity.

Conclusion & Significance: IL-4 and ADMA were increased in HFA and HFR mice with MetS, compared to normal controls (CN). Vascular endothelial cells of both these groups also showed an increase in oxo-nitrative stress. IL-4 and ADMA led to potent induction of the cellular hypoxic response (HIF1α), despite normoxic conditions. The hypoxic response was associated with increased levels of the hypoxamir-210 that targets mitochondria, reduced mitochondrial membrane potential, Complex I and Complex IV activities, decreased TFAM and PGC1α levels, and leak of cytochrome-c to cytosol.

In conclusion, IL-4 and ADMA are increased in MetS, leading to mitochondrial dysfunction through oxo-nitrative stress and hypoxic response. This has broad applicability to multiple diseases influenced by the hypoxic response, including cancer.

Biography:

Sejla Sehović is a cardiologist and Fellow of New Westminster College. She has an outstanding record of ethical leadership.She was an Associate Director, Medical Liaison Group for Europe, Medical Affairs
Chicago (ABBOTT) and Cardiologist at Heart Center, University of Sarajevo - Sarajevo, Bosnia and Hercegovina
 

Abstract:

Background:   Procedural riks of ERCP are well recognized but  significance of cardiac risks remains controversial.This study aimed to evaluate ERCP-related highly sensitive cardiac troponin I (hs TnI) release in even small amounts of myocardial injury and to analyze potential relationship between myocardial ischemia and the development of post-ERCP pancreatitis.

Methods: 120 patients (aged 18-93 years) scheduled  for ERCP were enrolled in this study. Cardiovascular risk factors were identified in 60% of patients.All patients were  assessed clinically and with electrocardiography for the presence of ischemic disease before the procedure. Hs TNI ( limit of detection 1,9ng/l) was measured at baseline(pre- ERCP), during ERCP and 2h post-ERCP. During ERCP procedure patients were also monitored with Holter tape rekorder. Amylase and lipase were measured before and 24 hours after ERCP.

Results: Twelve patients (12 %)developed myocardial ischemia/injury during ERCP with new ECG changes and  without any clinical symptom. 50 % of change in Hs TnI second measurement  was documented  in   12 patients (  p<0.01) .Patients with myocardial ischemia during ERCP had a significantly higher values of amylase and lipase levels(60,3%vs 16.2%; p<0.01)

Conclusions: The relationship was found between hs TnI small elevation  and new ECG and  rythm changes on Holter during ERCP. Post ERCP pancreatitis was associated with myocardial ischemia/injury during ERCP.

Biography:

Nabil Naser was graduated from Medical Faculty of the University of Sarajevo at the age of 26. At thje age of 40 has completed PhD - doctoral thesis entitled "The role and importance of dobutamine stress echocardiography in the detection and evaluation of coronary artery disease in comparison with coronary angiography ".Nabil Naser is a member of the Association of Cardiologists BiH, member of the European Society of Cardiology since 2003 and gained the title of European Cardiologist - EBSCO. Nabil Naser is a Fellow of the European Society of Cardiology. F.E.S.C. since 2004.

He is Assoc. Profesor at the Medical School of the University of Sarajevo and responsible teacher  for elective course "Emergencies in Cardiology". As an author and co-author he published over 50 scientific papers. He is a journal reviewer for Medical Archives and Bosnian Journal of Basic Medical siences (BJBJS).

Abstract:

Introduction: Due to the large number of patients with acute MI, the incidence of ischemic MR is also high. Ischemic mitral regurgitation is a complex multifactorial disease that involves left ventricular geometry, the mitral annulus, and the valvular/subvalvular apparatus. Ischemic mitral regurgitation is an important consequence of LV remodeling after myocardial infarction. Echocardiographic diagnosis and assessment of ischemic mitral regurgitation are critical to gauge its adverse effects on prognosis and to attempt to tailor rational treatment strategy.
Reaserch Objectives: The objective of this study is to determine the role of echocardiography in detecting and assessment of mitral regurgitation mechanism, severity, impact on treatment strategy and long term outcome in patients with myocardial infarction during the follow up period of 5 years. Patients and methods: The study covered 138 adult patients. All patients were subjected to echocardiography evaluation after acute myocardial infarction during the period of follow up for 5 years. We evaluated mechanisms and severity of mitral regurgitation which includes the regurgitant volume (RV), effective regurgitant orifice area (EROA), the regurgitant fraction (RF), Jet/LA area, also we measured the of vena contracta width (VC width cm) for assessment of IMR severity, papillary muscles anatomy and displacement, LV systolic function ± dilation, LV regional wall motion abnormality WMA, LV WMI, Left ventricle LV remodeling, impact on treatment strategy and long term mortality. Results: We analyzed and follow up 138 patients with previous (>16 days) Q-wave myocardial infarction by ECG who underwent TTE and TEE echocardiography for detection and assessment of ischemic mitral regurgitation (IMR) with baseline age (62 ± 9), ejection fraction (EF 41±12%), the regurgitant volume (RV) were 42±21 mL/beat, and effective regurgitant orifice area (EROA) 20±16 mm², the regurgitant fraction (RF) were 48±10%, Jet/LA area 47±12%.

Biography:

Himanshu Yadav has completed his graduation from S.N. medical college, Agra, India. He has done His Masters in medicine from King George medical university, Lucknow, India. He was awarded with 2 gold medals in MD by the President of India for being the best resident in MD and securing highest marks. He has completed his DM cardiology from King George medical university in year 2016. Currently he is working as consultant in Asian Heart Institute, Mumbai, India

Abstract:

Introduction: Complete heart block (CHB) is a complication of acute STEMI with high mortality. There is lack of information on the patient characteristics and management strategies that can predict the outcome in such patients.

Aim: We hypothesize that reversal of block is a critical step in the outcome and prognosis of these patients. Thus persistent block could be another indication of revascularization irrespective of time delay in addition to cardiogenic shock, heart failure and ischemia.

Methods: It is a prospective single centre study conducted in a department of cardiology, India, from January to December 2015. All admitted patients of acute STEMI were evaluated. Of those, patients having CHB were enrolled. With limited resources, financial constraints and time of presentation (window period), patients were self-divided in to five groups: Primary PCI; thrombolysis with streptokinase (STK+<12 hours); pharmacoinvasive (PCI as early as possible following thrombolysis, STK+/PCI+); delayed PCI (24-36 hours, STK-/PCI+) and; non-re-vascularized (STK-/PCI-). Outcome during the hospital stay in different groups was compared with respect to time of reversal of block and mortality.

Results: Total 3954 STEMI patients evaluated. 146 (3.69%) had CHB. 109/146 (74.7%) were of inferior wall MI and 37 (25.3%) anterior wall MI. 37/146 (25.3%) expired. Mean time of reversal of block in different groups as depicted in the picture. Factors associated with early reversal were: Early presentation to hospital (<6 hours)(p-.01),Revascularization in any form(p-.0001), Primary PCI(p-.03), Narrow QRS, Normal renal functions (creatinine<1.5)(p-.0001) and Inferior wall MI. On multivariate analysis, Risk score predicting high mortality was-Age (mean 63.22±11.45years,p-.02), delayed presentation >12 hours(p-.001),presentation with heart failure or cardiogenic shock( p-.001), Wide QRS (p-.006), Low Ejection fraction(<40%)(p-.001)and No revascularization (p-.001).Out of 37 expired patients, block did not revert in 30 of them till death.

Conclusion: In patients whom block does not revert, prognosis is very poor. Revascularization in any form, preferably early PCI cause early reversal of block and thus alters prognosis.Even those who are out of window period, CHB should be an indication of revascularisaion/thrombolysis if not otherwise indicated.Other factors predicting mortality and delayed reversal of block were determined.

Biography:

Abdelaziz Gomaa is a Consultant Interventional Cardiologist at Dallah Hospital Riyadh, KSA and a Lecturer of Cardiology at Zagazig University, Egypt. He is pursuing certified level II training in Cardiac CT (Harefield-London Cardiac CT course) in addition to interventional cardiology practice. His work in Clinical Cardiology gave him good overview of different cardiology emergencies and urgencies.

Abstract:

Aim: We aimed to detect in hospital prognostic value NT- pro BNP in patients with acute PE.

Methods: 64 patients with acute PE were studied. All patients were subjected to ECG, laboratory tests (D-dimer, troponin I, NT-pro BNP), Doppler ultrasound for the venous system of lower limbs, transthoracic echocardiography and 64 multi-slices CT pulmonary angiography.

Results: Patients were divided into two groups: group I (22) patients with normal NT-pro BNP (<300 pg/ml), and group II (42) patients with elevated NT-pro BNP. Group II had higher incidence of heart failure (28.6% vs. 4.6% P=0.025), impaired kidney function (creatinine 1.7±0.6 vs. 1.1±0.2, P=0.018) and cardiogenic shock (26.2% vs. 0% P=0.014) but lower incidence of chest pain (21.4% vs. 45.5% P=0.04) and lower LV ejection fraction (51.3%±16.9% vs. 67.3%±12.8% P=0.043) compared to group I. Group II had higher treatment with thrombolytic therapy (35.7% vs. 9.1%, P= 0.021) and positive inotropic (35.71% vs. 4.55%, P=0.006), higher need for mechanical ventilation (26.2% vs. 4.55%, P=0.04), longer hospital stay (19.5±10.3 vs. 5.3±4.5, p=0.001) and higher mortality (19.05% vs. 0.0% P=0.042) than group I.

Conclusion: Elevated NT-pro BNP levels in patients with PE are associated with worse short term prognosis in terms of higher morbidity and mortality and it could be used as a valuable prognostic parameter and good indicator for the need of more aggressive therapy.

Biography:

Orhan Zengin is a fellow in the Rheumatology Fellowship Program at the Gaziantep University, School of Medicine Department of Rheumatology. He was born in Adıyaman, Turkey, in 1983. He completed his internship and graduated from Medical School of Firat University. Then, he worked as a physician and researcher at the Gaziantep University, School of Medicine Department of Internal Medicine.

 His research is focused in four main areas:

1) Relationship between periodontal destruction and autoimmune diseases.
2) Systemic sclerosis, clinical features, treatment outcome and mortality factors.
3) Simple inflammatory markers in systemic auto inflammatory diseases.
4) Epidemiology of familial Mediterranean fever in Turkey.

Abstract:

Backgrounds: Prolongation of the peak and the end of T wave (Tp-e) has been reported to be associated with ventricular arrhythmias. High dose pulse intravenous steroids (pulse therapy) are an accepted practice to treat severe manifestations of inflammatory, autoimmune and renal diseases. Sudden death, cardiac arrhythmias, circulatory collapse and cardiac arrest have been reported occasionally, usually following rapid administration of large doses of methylprednisolone.

Methods: We enrolled 50 consecutive various inflammatory and autoimmune diseases in patients with acute relapse to perform ECG 4 hours before, and 12 hours after infusion of 1000 mg intravenous (IV) methylprednisolone. Myocardial repolarization can be evaluated with QT interval (QT), corrected QT interval (QTc), QT dispersion, and transmural dispersion of repolarization. (Tp-e), which is the interval between the peak and the end of T wave on electrocardiogram (ECG), is accepted as an index of transmural dispersion of ventricular repolarization. JT dispersion (JTd), corrected JT (JTc), (Tp-e)/QT ratio, (Tp-e)/QTc ratio are also used as an electrocardiographic index of ventricular arrhythmogenesis. Our goal in these patients, we aimed to assess ventricular repolarization in patients with before and after high dose pulse intravenous steroids therapy in patients.

Results: The baseline characteristics of the patients before and after high dose pulse intravenous steroids therapy are presented in the table 1 and 2.

Conclusions: Our results show that after high dose pulse intravenous steroids therapy in patients is associated with prolonged Tp-e interval and increased Tp-e/QT and Tp-e/QTc ratio.

Table 1: Characteristics of the Study Population

Table 2: Electrocardiographic Measurements of the Patients

QTd: QT interval dispersion, QTI: QT interval index, QTc: Corrected QT interval, JTd: JT interval dispersion, JTc: Corrected JT, Values are presented as mean±SD.p<0.05.

Biography:

Recruited in 1997 as assistant teacher quality in cardiovascular surgery, having made an improvement in cardiovascular surgery training in 2000 at the Strasbourg hospital France (Professor head service: Pr Eisenmann) exercising as a standalone operating surgeon since 2001 to date; Head of Unit since 2002 . Cardiac surgeon at lecturer grade (maitre de conférences) since February 2012 after having defended my doctoral thesis in Medical Sciences at the University of Constantine (Theme: moderate aortic insufficiency during mitral valve surgery); Since my return from Strasbourg, I started with the head of department to improve the care of patients, it was limited to that date to valve surgery, initiating surgery (Coronary, and congenital thoracic aorta).

Abstract:

Background:

The prosthetic heart valve thrombosis (PVT) is a life threatening complication of mechanical valve prosthesis. It can be attributed more frequently to inadequate anticoagulant therapy;

In the aortic and mitral position reported incidence varies widely from 0.5% to 6% per patient-year, and is highest in the mitral position and up to 20% in tricuspid valve prosthesis.

Medical therapy (Thrombolysis) has emerged as an alternative therapy in high-risk surgical patients, considering that surgical prosthetic valve replacement is related to significant operative morbidity and mortality rates.

The purpose of this study is to present a single-center experience of 205 consecutive patients hospitalized between 2000 and 2016.

Methods: From 2000 to 2016, 205 consecutive patients were hospitalized in our center for mechanical prosthetic valve thrombosis (PVT). The diagnosis of PVT was mainly assessed by echocardiography and/or fluoroscopy. There were 41 men and 164 women (28 pregnant). Aged 07–75 years. Prosthetic valve location was mitral in 186 patients, tricuspid in 05, aortic in 8 and mir-tricuspide in one case.

Predisposing causes of MVT were: poor compliance with warfarin, pregnancy or unknown.

PVT occurred from 1 day to 38 years after surgery. Delay from first symptoms to hospitalization ranged from 1 to 4 months.

The diagnosis was an incidental finding during an echocardiografic: on the basis of a subacute increase in the transvalvular gradient seen due to thrombotic obstruction on transthoracic echocardiography and was confirmed by transesophageal echocardiography;

First clinical symptoms were: systemic emboli, progressive exertional dyspnea (NYHA II to III–IV), muffled opening or closing sounds of the prosthetic valve; left heart failure, stroke, and cardiogenic shock.  

Transthoracic echocardiography is the diagnostic tool often used to evaluate a patient with valve prosthesis, when there is suspicion of PVT, and also is useful in the follow-up of patients during thrombolysis. Fluoroscopy was complementary.

Anticoagulation regimen was inadequate, recently stopped or incorrectly conducted.

Results:

There were two groups; the first group (A) (139 patients) have been operated (CPB), It is emergency surgery in 103 patients; prosthetic replacement was done (128) or declotting and excision of panus (11 patients). In this group we deplore 19 (13.6%).

66 patients underwent medical treatment (heparin, oral anticoagulants and aspirin) on clinical, sonographic and under strict supervision in a hospital and some external purposes for a period of 07 days at 6 months. For the non-operated group, all patients have unlocked their fin; 04 deaths (6.06%) (hemorrhagic stroke, LV dysfunction and dysfunction VD).
 

Conclusion:

PVT remains a serious complication of mechanical heart valve prosthetic with high morbidity and mortality despite aggressive treatment by thrombolysis and/or surgery. Surgery treatment should be the preferred therapeutic modality for most patients with PVT.

Thrombolysis, followed by heparin, warfarin, and aspirin, is advised or high-risk surgical candidates without hemodynamic instability under strict echocardiographic survey. Because of the high risk of thromboembolism during thrombolysis for left sided PVT.

For certain category of patients, medical therapy (thrombolysis anticoagulation + + aspirin) may be offered in high-risk surgical patients; this with the consent of patients on medical and surgical rigorous monitoring and evaluating the operational risk compared to the risk of progression under medical treatment.

Biography:

Sekib Sokolovic is the Department Head of the Clinic for Heart and Rheumatic diseases, Sarajevo and Professor in University of Sarajevo. He is also the Deputy Head of Cardiology Clinic. His main areas of interest are Arterial Hypertension, Pulmonary Hypertension, Atherosclerosis, Ä°nflammatory markers, Echocardiography, Rheumatic diseases and Heart

Abstract:

Introduction: The correlation between the arterial stiffness and Body Mass Index (BMI) evaluated in our study. Measurement of the arterial stiffness is recommended in new ESC/ESH guidelines for the management of arterial hypertension.

Material and Method: In order to evaluate arterial stiffness, the measurement of aortic pulse wave velocity, (APWV) and Augmentation Index (AI) was performed using Agedio Arteriography. The estimation of cardiovascular risk factors was performed in all 112 subjects and two groups were formed: Hypertensive patients and Normotensives. BMI has been calculated in each subject. The open outpatient controlled prospective study has been designed.

Results: Preliminary results showed the significant increase in PWV with average values of 10,1 m/sec in hypertensive patients compared to 7,7 m/sec in normotensive ones. The Augmentation index was borderline at 32,75%, ranging from 24-56% vs 27,25%. Average blood pressure was 172/109,5mmHg, compared to 128/82    mmHG and heart rate was 70b/min in average vs. 89,5b/m. The BMI showed relationship between arterial stiffness in hypertensive versus normotensives.

Conclusion: The arterial stiffness has been proved significant in hypertensive patients and high BMI is important cardiovascular risk factor.  

Biography:

Nadeeja Himanthi Gamalath Seneviratne has done her MBBS from University of Colombo (UOC) Sri Lanka in 1998, and MD in Medicine from PGIM, UOC in 2013. She has done her post-doctoral training in Cardiology at NHSL Colombo, and presented her papers at local and international forums.

Abstract:

CABG is one of the treatment options for the patients with multi vessel coronary artery disease. This study was aimed to describe survival up to occurrence of cardiac events and factors associated with them among the CABG patients attending to cardiology clinics at NHSL.

Retrospective analytical study was carried out among the patients who had undergone CABG during 2004 to 2009. Cardiac event was defined as occurrence of any condition namely; unstable angina (UA), ST elevated myocardial infarction (STEMI), non ST elevated myocardial infarction (NSTEMI) and heart failure (HF) following the 12 months of CABG.

The sample (n=421) consists 74.6% males and mean age was 63.16years (SD = 7.86).  Among them UA (13.3%), STEMI (0.5%), NSTEMI (3.1%) and heart failure (8.6%) were detected. Kaplan-Mayer analysis revealed the probability of survival at 5 years was 0.796 (CI 0.781-0.871) and 10 year was 0.581 (CI 0.516- 0.688). According to the Cox Regression models males had 0.53 (95% CI 0.323 – 0.863) higher risk compared to females.  Cardiac diagnosis led to CABG was significantly associated with cardiac events. STEMI had age and sex standardized hazard ratio of 1.845(CI=0.926 -3.699) while for NSTEMI it was 1.214 (CI= 0.593- 2.484).

Though the survival of CABG patients was satisfactory, females and patients with STEMI and NSTEMI prior to CABG have higher likelihood of developing cardiac events. CABG could be recommended as a good treatment option and need of close follow up of high risk patients is emphasized.

Biography:

Recruited in 1997 as assistant teacher quality in cardiovascular surgery, having made an improvement in cardiovascular surgery training in 2000 at the Strasbourg hospital France (Professor head service: Pr Eisenmann) exercising as a standalone operating surgeon since 2001 to date; Head of Unit since 2002 . Cardiac surgeon at lecturer grade (maitre de conférences) since February 2012 after having defended my doctoral thesis in Medical Sciences at the University of Constantine (Theme: moderate aortic insufficiency during mitral valve surgery); Since my return from Strasbourg, I started with the head of department to improve the care of patients, it was limited to that date to valve surgery, initiating surgery (Coronary, and congenital thoracic aorta).

Abstract:

Objectives:
Aortic dissection is a life-threatening emergency, its incidence is not well known: 1% of sudden deaths; Currently, medical imaging diagnostics allows more accurate and more early. We report postoperative results of 62 patients operated in our center.
 

Patients and methods:
Between January 2000 and December 2015; 62 patients undergoing open heart aortic dissection interesting for the ascending aorta(62/ 5760 cardiopulmonary bypass : 1.07%); These 27 women and 35 men with an average age of 52 years (16-79 years), hypertension was observed in 38 patients.
The evolution of the symptoms varies from less than 24 hours to 4 months. NYHA I to IV; Sinus rhythm in 60/62 patients, the cardiothoracic index ranges from 0.5 to 0.78, the diagnosis was made by chest CT and echocardiography (FE varies from 25.7 to 78%, aortic insufficiency in 43 patients grade I to IV? aortic stenosis in 02 patients).
 

Results:
Forty eight patients operated in emergency; Surgery under CPB: deep hypothermia; 12; Moderate Hypothermia: 28; Normothermia: 22; circulatory arrest in deep hypothermia: 07; Femoral cannulation: 58; axillary cannulation: 04.
Practiced gesture
BENTALL Operation: 03;
Replacement of ascending aorta: 49;
Prosthetic Aortic valve replacement +  ascending and  Transverse aorta prosthetic replacement: 03;
Prosthetic Aortic valve replacement + Replacement ascending aorta and the right sinus + right coronary reimplantation: 01;
ascending aorta prosthetic replacement + Prosthetic Aortic valve replacement: 06;
Aortic clamping of 22-200 minutes; Inotropic +: 26/62 patients; Ventilation average from 6 hours to 9 days, ICU stay in 0-26 days, Average length of hospitalization of 0-39 days, ICU Complications 12/62, hospital complications 7/62; Hospital mortality: 11 deaths out of 62 operated (17.7%)
Conclusion :
 The aortic dissection is a very serious disease, the management involves multidisciplinary expertise, Early diagnosis, treatment will be medical and surgical emergency.
 Recent advances in medical imaging, surgery largely contribute to a better management of these patients.
 However, treatment is palliative because it leaves in place a more or less long aorta dissected segment.
 The risk of secondary ecstatic development of this pathological aorta mandates annual monitoring and clinical imaging.
 This monitoring allows early diagnosis of secondary complications.

Biography:

Guy Fontaine has made 15 original contributions at the inception of cardiac pacemakers in the mid-60s. He has identified ARVD by serendipity in the late 70s, published 900 scientific papers including 201 book chapters. He is in the 3 books: 216 Profiles in Cardiology since the 14th century (Hurst 2003), “500 greatest Geniuses of the 21th century” (ABI) 2005 USA, the “100 Life time of Achievement” (IBC) 2005 Cambridge UK. Reviewer of 17 journals both in clinical and basic Science. He has given 11 master lectures in China (2014). He is also working on brain and heart protection in cardiac arrest and stroke by therapeutic hypothermia.

Abstract:

During a discussion in an International meeting held in Marrakech between Walter Somerville (Editor in Chief of the British Heart Journal) and Jean Francois Goodwin (father of cardiomyopathies) it was suggested that some form of “disarray” which is the classical marker of Hypertrophic Cardiomyopathy (HCM) can be observed in the normal heart especially on the diaphragmatic aspect of the right ventricle close to the septum. As in the disease that I recently identified called Arrhythmogenic Right Ventricular Dysplasia (ARVD) presence of adipocytes (instead of disarray) was one of the features of this disease, it was logical to check if presence of fat was observable in the right ventricle of a normal individual. This lead to the examination of the right ventricle of 82 individuals from 15-75 years old who died of a non-cardiac cause in a general hospital of Paris. Surprisingly compact normal myocardium was observed in only 30% of the cases. 60% showed various grades of strands of adipocytes mixed with normal cardiomyocytes. This included 3.7% who had the histologic pattern of RVD and not ARVD since those individuals had non arrhythmias. Therefore, these cases represent the quiescent form of ARVD. 

Some typical ARVD patients enter the disease by atrial arrhythmias such as atrial extrasystole, flutter and atrial fibrillation (Saguner Circulation 2014). It was therefore suspected that the disease which affect the right ventricle is also affecting the atrium. Histology is the gold standard to diagnose ARVD. It was therefore possible to analyse the histologic structure of the atrium and subsequently to consider if the same situation exists in the general population as far as atrial dysplasia is concerned. In my clinical experience I had two ARVD patients who died of a non-cardiac cause in the hospital anf had immediate extraction of the heart in excellent technical condition. Therefore, it was possible to have samples of tissue from the four cavities confirming in the atrium the histologic structure found in the right ventricle of ARVD patients. The main consequence of this new discovery is to identify the possible mechanism of atrial fibrillation. Finally atrial dysplasia may lead to atrial fibrillation spontaneously because of the creation of an anatomic substrate or it could be a more stable form which become arrhythmogenic only in case of superimposed myocarditis (Bonny CRP 2001).

Biography:

Omar Hallak is currently Chief of Interventional Cardiology Department at   American Hospital Dubai, President (gulf Chapter) of international Society of Endovascular Specialists, Chairman of 4TS international conference, and   previous Board Member of Emirate Cardiac Society. Dr. Hallak received his post graduate training and research in United States at University of Illinois, Chicago, North Western University and Louisiana University in New Orleans. He is Board Certified in Interventional Cardiology, Cardiovascular Disease, Vascular Medicine, Endovascular Medicine, Nuclear Cardiology and Internal Medicine.
He was the Head of Cardiology Department at Saint Francis Hospital in USA, and assistant Professor at LSU New Orleans and University of West Virginia. He has performed thousands of procedures including Cardiac and Peripheral Vascular Intervention in addition to Pacemaker and ICD/ CRT Implantation.  He participated in many national and international research studies with many publications.  He involved extensively in local, regional and international cardiology conferences as a Speaker and as a Chairman.

Abstract:

Atrial Fibrillation is one of the most common arrhythmia in adults and  it is one of the major cause of Stroke. The stroke due to Atrial Fibrillation (AF) usually more sever comparing with other etiologies .

Warferin has been the gold stander medication to prevent stroke in AF patients With success rate about 65%. However, warfarin has many drawbacks:  it has unpredictable response, narrow therapeutic window , slow  onset/offset action, many interactions with food and medication, need continues monitoring .with about 50% only in the therapeutic range.

New Oral anticoagulants (NOAC) which became approved few years ago, have faster onset/offset action, no need for monitoring, less interaction with food and medication . several randomize studies confirm that NOAC is as effective as Warfarin or even more effective in some case, and it is safer and more convenient to use . however it is much more expensive .

The clinical application and practical aspect of their usage will be discuss further during the presentation

Biography:

Arun Prasad is an Assistant Professor in Department of Pediatrics at All India Institute of Medical Sciences, Patna. He is carrying nine years of experience in “Dealing with the patients with cardiac problems and doing echocardiography”. He has special concern for the patients of rheumatic heart disease and is trying to develop RHD Control Center in his institute. He believes that in the areas with higher prevalence of RHD, multipronged approach with active surveillance of acute rheumatic fever/rheumatic heart disease cases, community education regarding this disease, primary prevention and secondary prevention with patient registry system will definitely reduce the burden of this disease which becomes crippling in its severe form.

Abstract:

Statement of the Problem: Rheumatic heart disease (RHD) is the most common acquired heart disease in children in many parts of the world, especially in developing countries. At least 15.6 million people are estimated to be currently affected by RHD, with a significant number of them requiring repeated hospitalization and often unaffordable heart surgery in the next 5 to 20 years. The disease is crippling in its severe form and causes premature deaths. These morbidity and mortality may be controlled by primary and secondary prevention. Researchers have estimated the burden of rheumatic heart disease in Bihar, a major state in Northern India by finding one year mortality due to rheumatic heart disease in the largest tertiary cardiac care institute of the region.

Methodology & Theoretical Orientation: A retrospective audit of records was done at Indira Gandhi Institute of Cardiology, one of the largest tertiary cardiac centers of Bihar, to find out mortality due to RHD during year 2013.

Results: The mortality due to rheumatic heart disease in this cardiac centre during 2013 was 120 with more deaths in women (n=67, 56%) than men (n=53, 44%). Median age at death was 35 years. Minimum age at death was eight years and maximum age was 73 years. The highest number of deaths was noted in the 31-40 years age group, (19 women and 18 men). Out of a total 120 deaths, four had stuck valves (three had MVR and one had DVR).

Conclusion & Significance: Rheumatic heart disease is a significant health problem in developing world. The disease can be prevented and controlled by primary and secondary prevention. Nodal centers for RHD prevention should be established in the areas with higher prevalence of the disease to ensure patient registry, primary prevention and secondary prevention.

Biography:

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.

Abstract:

Background: The 6-minute walk test (6MWT) is a simple and inexpensive test that can be used to assess functional capacity and prognosis in patients with Chronic Heart Failure (CHF). Several studies have reported that there is significant correlation between the distance in 6MWT and cardiovascular events in patients with CHF.

Aim: Aim of this study is to determine the correlation between distance in 6MWT and Ejection Fraction (EF) to Cardiovascular Events (CE) in our CHF patients.

Methods: The study used prospective cohort study with observational-analytic. The sample are taken from patients with CHF. Dr. R. D. Kandou Hospital with purposive sampling technique and patient’s distance is measured by the 6MWT and the EF by using 2D echocardiography and analyzed using Chi-Square test.

Results: The result showed that from 16 patients with 6-MWT<300 m, where 25% had CE, rehospitalization and unstable angina (UA). Patients with 6-MWT>300 m, we found 42.8% experienced CE. The result of Chi-Square test showed there was no significant correlation between 6MWT and CE_, (p=0.252). In addition, CHF patients with EF<30%, 71.5% had CE (rehospitalization and UA), CHF patients with EF≥30% only 21.7% experienced CE. The result of Chi-Square test showed there was significant correlation between EF and CE (p=0.012).

Conclusions: There was no significant correlation between distance in 6MWT to cardiovascular events and there was significant correlation between EF and CE.

Biography:

Omar Hallak is currently Chief of Interventional Cardiology Department at  American Hospital Dubai, President (gulf Chapter) of international Society of Endovascular Specialists, Chairman of 4TS international conference, and   previous Board Member of Emirate Cardiac Society. He received his post graduate training and research in United States at University of Illinois, Chicago, North Western University and Louisiana University in New Orleans. He is Board Certified in Interventional Cardiology, Cardiovascular Disease, Vascular Medicine, Endovascular Medicine, Nuclear Cardiology and Internal Medicine.

He was the Head of Cardiology Department at Saint Francis Hospital in USA, and assistant Professor at LSU New Orleans and University of West Virginia. He has performed thousands of procedures including Cardiac and Peripheral Vascular Intervention in addition to Pacemaker and ICD/ CRT Implantation.  He participated in many national and international research studies with many publications.  He involved extensively in local, regional and international cardiology conferences as a Speaker and as a Chairman.

Abstract:

Atrial Fibrillation is one of the most common arrhythmia in adults and  it is one of the major cause of Stroke. The stroke due to Atrial Fibrillation (AF) usually more sever comparing with other etiologies .

Warferin has been the gold stander medication to prevent stroke in AF patients With success rate about 65%. However, warfarin has many drawbacks:  it has unpredictable response, narrow therapeutic window , slow  onset/offset action, many interactions with food and medication, need continues monitoring .with about 50% only in the therapeutic range.

New Oral anticoagulants (NOAC) which became approved few years ago, have faster onset/offset action, no need for monitoring, less interaction with food and medication . several randomize studies confirm that NOAC is as effective as Warfarin or even more effective in some case, and it is safer and more convenient to use . however it is much more expensive .

The clinical application and practical aspect of their usage will be discuss further during the presentation

Biography:

Abstract:

Background: Infections in young children may affect the vasculature and initiate early atherosclerosis. Whether infections experienced in childhood play a part in adult clinical cardiovascular disease remains unclear. We investigated the association between infections in early life and the occurrence of premature coronary heart disease.
Methods: We conducted a population-based case-control study of 153 patients with a first acute coronary syndrome before the age of 56 years and 153 age- and sex-matched controls. Any history of severe infections in childhood and
adolescence was obtained, together with clinical and laboratory measurements and other cardiovascular risk factors.We developed an infection score for the overall burden of early life infections. Conditional logistic regression was used to assess the associations.
Results: Infections experienced in early life increased the risk of acquiring acute coronary syndrome at a young age with an odds ratio (OR) of 2.67 (95% confidence interval (CI) 1.47–4.83, p¼0.001). After adjustments for traditional risk factors, lifestyle, dietary patterns, socio-economic status and parental history of cardiovascular events, these associations remained significant and changed only slightly. There was an indication for an interaction between infections in early life and current cardiovascular risk (Framingham Risk Score (FRS); p-interaction¼0.052). Within participants with a low FRS (<10%), the OR of early life infection for acute coronary syndrome was 1.49 (95% CI 0.72–3.08, p¼0.283); within
participants with an intermediate FRS (10–20%), the OR was 4.35 (95% CI 1.60–11.84, p¼0.004); and within participants with a high FRS (>20%), the OR 10.00 (95% CI 1.21–82.51, p¼0.032).
Conclusion: Infections in early life may partly explain premature coronary heart disease in adulthood and may potentiate traditional cardiovascular risk factor effects.

Biography:

Evanka Chopra has expertise in molecular/Cell Biology and Computational Biology techniques. She has qualified national level examination viz., CSIR/UGC-JRF and GATE. Evanka is an enthusiastic and hard bench worker with innovative and inquisitive mind and has an outstanding reasoning power reflected by her own alterations and designing in the protocols to get task done with optimum outputs. She can express herself fairly well in group discussion and can communicate scientific ideas and views, as evident from her several poster/oral presentations in conferences, journal club and lab presentations. She has published her doctoral research work in the Journal of IJC and Oncogene. She has enough zeal to turn into a bright researcher.

Abstract:

Statement of the Problem: The risk of cardiovascular disease (CVD), asthma, non-alcoholic fatty liver disease (NAFLD) as well as common cancers is increased in subjects with metabolic syndrome (MetS). Interleukin-4 (IL-4), a marker of Th2 immune response, is often upregulated in these contexts and may potentiate aberrant arginine metabolism. Altered arginine/nitric oxide metabolism and mitochondrial dysfunction represent putative common molecular pathways that may connect these diseases, possibly via oxidative-stress driven induction of the cellular hypoxic response. The importance of this pathway is not well studied in MetS associated vascular dysfunction.
The purpose of this study is to investigate how altered arginine/methyl arginine balance, oxo-nitrative stress, hypoxic response, and mitochondrial dysfunction may cause vascular dysfunction in metabolic syndrome.

dysfunction in metabolic syndrome.

Methodology & Theoretical Orientation: MetS mice (C57BL/6) were fed chow-diet (CN), high-fat-diet (HFA), or high-fructose-diet (HFR) for 6 months. HFR and HFA diets induce MetS. Arginine/methyl arginine balance and oxo-nitrative stress were determined in aortic tissue by measuring the levels of ADMA, iNOS and 3-nitrotyrosine. Estimation of hypoxic response done by checking levels of HIF1α and resultant mitochondrial dysfunction by measuring levels of cytochrome c, TFAM, mitochondrial membrane potential and Mitochondrial Complex I and IV activity.

Conclusion & Significance: IL-4 and ADMA were increased in HFA and HFR mice with MetS, compared to normal controls (CN). Vascular endothelial cells of both these groups also showed an increase in oxo-nitrative stress. IL-4 and ADMA led to potent induction of the cellular hypoxic response (HIF1α), despite normoxic conditions. The hypoxic response was associated with increased levels of the hypoxamir-210 that targets mitochondria, reduced mitochondrial membrane potential, Complex I and Complex IV activities, decreased TFAM and PGC1α levels, and leak of cytochrome-c to cytosol.

In conclusion, IL-4 and ADMA are increased in MetS, leading to mitochondrial dysfunction through oxo-nitrative stress and hypoxic response. This has broad applicability to multiple diseases influenced by the hypoxic response, including cancer.

Biography:

Swati Kundu has completed her PhD at the age of 27 years under the supervision of Prof. Luqman A. Khan from Jamia Millia Islamia University. She have published 5 full research papers in reputed journals and 5 abstracts published. She have attended 1 International and 4 National conferences as a presenter.

Abstract:

OBJECTIVE—Monoterpenic phenols have been reported for relaxant activity in smooth muscles. However, there are no reports concerning their relaxant activity on metal-exposed smooth muscle. The present study investigates effect of carvacrol and thymol on unexposed and As(III)-exposed isolated rat aortic rings and gives insight into their possible mechanism of action.

METHODS— Phenylephrine (PE)-induced isometric contractions of isolated aortic rings exposed to As(III), carvacrol and thymol in presence and absence of various inhibitors were measured in organ bath system (ADI, Australia).

RESULTS— Carvacrol and thymol cause significant relaxation of PE-contracted aortic rings. Co-incubation of aorticl rings with carvacrol/thymol and apocynin or verapamil indicates that relaxation caused by carvacrol and thymol is routed through quenching of reactive oxygen species (ROS) in addition to their previously reported effects on Ca2+ movements. Incubation with As(III) (25 µM) alone induced significant hypercontraction of rings. Co-incubation of rings with arsenic and carvacrol/thymol lead to complete containment of As(III) caused hypercontraction.

CONCLUSIONS-- Carvacrol and thymol induce relaxation of isolated rat aorta and ameliorate As(III)-induced hypercontraction primarily through ROS quenching.

Biography:

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.

Abstract:

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.

Biography:

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.

Abstract:

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.