Scientific Program

Conference Series Ltd invites all the participants across the globe to attend 16th World Cardiology Congress Dubai, UAE.

Day 1 :

Keynote Forum

Guy Hugues Fontaine

Pitié-Salpêtrière Hospital, France

Keynote: First histologic demonstration of Atrial Dysplasia in two ARVD patients

Time : 10:00 AM

Conference Series World Cardiology 2016 International Conference Keynote Speaker Guy Hugues Fontaine photo
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:

Since the reproduction of the disease-in-the-dish by the group of San Diego (Kim Nature 2013), the original term of ARVD is now back in Force (Fontaine Editorial AJC 2014). ARVD has been discovered by its disorder in ventricular abnormal activation leading to premature reactivation of myocardium called an extrasystole producing a basic bump in the chest. In a most severe form several consecutive bumps are observed poorly tolerated by women when they are frequent. In the worst situation this abnormal fast cardiac activity may result in sudden unexpected death. The disease is the result of a genetic anomaly mostly affecting the RV in which the myocardium is occupied bat fat and fibrosis. In addition, presence of lymphocytes is the marker of poor prognosis. In anecdotal cases it was observed that patients later confirmed as typical ARVD had atrial arrhythmias as the first presentation of the disease suggesting that the disease can start by the atrium before the ventricle and that atrium was also involved. This concept has been recently confirmed and published. However, I am the first to study the histology of the atrium in two patients with known ARVD who died suddenly in whom I performed myself the extraction of the heart immediately after death and in whom samples were taken from both ventricles and atria giving perfect gross pathology before immersion in formalin.

Special histologic staining was performed to clearly identify fibrosis. In the first patient only severe interstitial fibrosis was observed all over right and left ventricle. In the second patient a less severe interstitial fibrosis was observed but was associated to replacement fibrosis with some lymphocytes suggesting superimposed myocarditis.

The systematic study of the right ventricle of 82 individuals who died of non-cardiac cause in a general hospital showed that 3.7% had the histologic pattern of RVD and not ARVD since those individuals had non arrhythmias. Therefore, these cases represent the quiescent form of ARVD. It is therefore possible to consider that the same situation exists in the general population as far as atrial dysplasia is concerned. This situation may lead to atrial fibrillation spontaneously because of the anatomic creation of an anatomic substrate or it could a more stable form which become arrhythmogenic in case of superimposed myocarditis (Bonny CRP 2001).

Break: Networking & Refreshments Break 11:00-11:20 @ Foyer

Keynote Forum

Rainer Moosdorf

University Hospital of Giessen and Marburg, Germany

Keynote: Minimally invasive procedures in heart surgery from VT ablation to special accesses in TAVIs

Time : 11:20 AM

Conference Series World Cardiology 2016 International Conference Keynote Speaker Rainer Moosdorf photo
Biography:

Rainer Moosdorf is working in the field of Cardiovascular Surgery since more than 35 years. He started his career as a Resident at University Hospital in Giessen in 1978. In 1990, he became a full Professor for Cardiovascular Surgery at University in Bonn and Vice Chairman of the respective department. In 1989 and 1990, he was a Researcher and Clinical Fellow at Carolinas Heart Institute in Charlotte/NC. Since 1994, he has been working at University Hospital in Marburg as a full Professor for Cardiovascular Surgery and Director of the Department. Between 2001 and 2011, he was Vice Medical Director and since 2006, Medical Director at University Hospital in Marburg. His main specialties within cardiovascular surgery are “Laser and arrhythmia surgery, endovascular procedures including TAVI´s and endovascular reconstructions of the aortic arch, reconstructive surgery of the coronaries and some types of the French correction”. As Chairman of the board of Medical Network Hessen, he is an official representative of the State of Hessen in the field of Clinical Medicine and Medical Education.

Abstract:

Minimally invasive interventions have gained much interest in many surgical disciplines and also in cardiovascular surgery. Many of them are not truly minimal but less invasive as compared to interventional cardiology with its small puncture sites; even small thoracotomies are bigger and accordingly not minimally invasive. However, even less invasive procedures reduce the surgical burden for the sick heart and the increasingly sicker and elder patients. This shall be demonstrated by two different examples from opposite ends of the line. Ventricular Tachycardia (VT) is life threatening arrhythmias arising from scar areas, mainly following myocardial infarctions. The established therapy today is the implantation of ICDs to prevent sudden cardiac death. However, this is a palliative approach and many, especially younger patients are limited in their daily and professional life by syncope and potential shocks. A significant number of these patients have to undergo open heart surgery because of diffuse coronary artery disease or the sequel of a myocardial infarction like ventricular aneurysms. A simple mapping guided laser assisted ablation of the VT foci during such surgery may terminate the VTs, making an ICD implantation unnecessary, or at least reduce the arrhythmic burden in such a way that frequent VTs or even VT storms do not occur and ICD shocks become a rare event. With the introduction of the laser technique, these interventions are no longer consist of large resection but of small ablation spots, which may even be limited to the epicardial surface of the heart in suitable cases. Less invasive techniques have in these cases widened the spectrum of curative options in contrast to the palliative ICD. On the other end of the line, catheter based implantation techniques for the aortic (TAVI) and in near future also for the mitral valve has opened the doors for a large number of elderly and multi-morbid patients, who are formerly excluded from open heart surgery because of an incalculable risk. Many of them again show up with significant cardiovascular comorbidities which necessitate alternative procedures and approaches. Up to ¼ of elderly patients with a heart disease also suffer from symptomatic carotid artery disease. They may offer a combined approach of carotid endarterectomy even under local anesthesia followed by a transcarotid TAVI via the same access and special techniques may avoid a negative impairment of carotid perfusion during valve implantation. Even if open heart procedures are indicated in these elderly patients, additional to an aortic valve replacement, a transaortic direct TAVI may reduce cross clamp and operating time significantly and accordingly reduce the risk and provide a realistic therapeutic option. Some of these special techniques have been further developed at our department during recent years and shall be demonstrated with their results.

  • Cardiovascular Diseases | Heart Failure | Cardiopulmonary Resuscitation
Speaker

Chair

Rainer Moosdorf

University Hospital Marburg, Germany

Speaker

Co-Chair

Jan Piek

Academic Medical Center, The Netherlands

Session Introduction

Jan Piek

Academic Medical Center, Amsterdam, The Netherlands

Title: Fundamentals in coronary physiology: coronary pressure and flow for clinical decision making

Time : 12:20 PM

Speaker
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.
 

Speaker
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.

Speaker
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.

Break: Lunch Break 13:20-14:20 @ Market Place
Speaker
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 İstanbul 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.

Speaker
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 İstanbul 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

Speaker
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.

Break: Networking & Refreshments Break 15:40-16:00 @ Foyer

Daniela Lončar

JZU UKC Tuzla, Bosnia and Herzegovina

Title: Can we say renal failure is cardiovascular risk factor?
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.

Abdelwahab TH Elidrissy

University of Science and Technology Khartoum, Sudan

Title: Hypocalcemic Rachitic Cardiomyopathy in Infants
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.

Speaker
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.

Speaker
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.

Speaker
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.

Faida Kučukalic

University of Sarajevo, Bosnia and Hercegovina

Title: The significance of natriuretic peptide in heart failure
Speaker
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.

Speaker
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

 

 (n=50)

Sex(Female/Male)

36/14

Age(years)

36±13

BMI(kg/m2)

25,77±3,57

 

 

Table 2: Electrocardiographic Measurements of the Patients

 

Before(n=50)

After(-)(n=50)

P(value)

RR(msn)

713,20±159,82

840,60±191,30

0,001

Heart Rate(beat/min)

87,16±17,45

73,86±17,45

0,001

PR(msn)

143,90±21,51

132,90±15,58

0.004

QRS(msn)

88,74±13,61

88,86±12,07

0,963

P wave dispersion (msn)

16,20±6,96

16,60±8,71

0,800

T wave (msn)

170±29,13

181,20±23,26

0,03

(Tp-e) (msn)

74,60±13,12

83,80±13,68

0,001

QT(msn)

361,0±29,91

388,20±42,84

0,001

QTd(msn)

18,80±10,62

17,60±7,70

0,520

QTI(%)

114,59±12,48

108,06±18,84

0,04

QTc(msn)

401,60±19,79

413,72±26,38

0,01

JT(msn)

273,0±28,73

299,60±45,66

0,001

JTd(msn)

20,20±9,36

22,80±9,26

0,166

JTc(msn)

325,98±27,74

329,38±30,78

0,563

JTI(%)

118,18±17,54

110,56±13,92

0,01

(Tp-e)/QT(msn)

0,20±0,03

0,21±0,03

0,112

(Tp-e)/QTc(msn)

0,18±0,03

0,20±0,03

0,009

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.

Speaker
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.

Speaker
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.

Speaker
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.
 

Speaker
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.

Speaker
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.

Speaker
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.

  • Workshop

Session Introduction

Omar Kamel Hallak

American Hospital Dubai, UAE

Title: New oral anticoagulants for stroke prevention in atrial fibrillation
Speaker
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

  • Young Researchers Forum
Speaker

Chair

Manotosh Panja

B.M. Birla Heart Research Centre, India

Session Introduction

Andriany Qanitha

University of Amsterdam, The Netherlands

Title: Infections in early life and premature acute coronary syndrome: A case-control study

Time : 17:00 PM

Speaker
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.

Evanka Chopra

Institute of Genomics and Integrative Biology (IGIB), India

Title: Cardiovascular disease in metabolic syndrome associated with metabolic induction of a hypoxic response

Time : 17:20 PM

Speaker
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.

Speaker
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.

Speaker
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.

Speaker
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.