Scientific Program

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

Day 2 :

Keynote Forum

Fekry ElDeeb

Cardiologist, Zulekha Hospitals

Keynote: Challenging cases from the Catheterisation Laboratory

Time : 10:00 AM

Conference Series World Cardiology 2016 International Conference Keynote Speaker Fekry ElDeeb photo
Biography:

Fekry El Deeb is one of the first interventional Cardiologists in the Middle East. He started practicing Coronary Angioplasty at the Catharina Hospital, The Netherlands in 1986.He has worked in major hospitals such as the King Faisal Specialist Hospital and Research Center and the King Fahad National Guard hospital, Riyadh, Saudi Arabia as a Consultant and Director of the Cardiac Catheterization Laboratory.With interventional experience of more than 25 years, Dr. Fekry has performed over 15,000 different coronary, peripheral and valvular procedures

Abstract:

Atherosclerosis is a progressive disease which affect several vascular structures in the body. It is not uncommon to find patients with advanced atherosclerosis involving several vascular beds at the same time (coronary, carotid and other peripheral arteries). In this presentation, we reviewed the role of percutaneous vasculat intervention as an attractive model of therapy for such advanced cases The first case was for a 72 years old male patient with severe diffuse calcified three coronary vessels disease which was not operable. He had CCC class III-IV angina on mild effort and at rest. This was treated successfuly with Rotablator angioplasty and stenting.The second case was for a 65 years old patient with advanced severe atherosclerosis of both legs arteries as well to both renal arteries.The patient had intermittent claudication on walking for 50 meters. Percutaneous intervention to all lesions was done successfuly.The third case was for a 60 years old male patient with severe three coronay vessel disease and significant right carotid artery stenosis with aneurysm. The patient was elected for Coronary Artery Bypass Surgery. The Carotid artery stenosis and aneurysm was treated with Carotid angioplasy and stent using a filter device successfuly before cardiac surgery.Conclusion:Accumulative experience over years made it possible to treat several vascular atherosclerotic lesions all over the body using the technique of percutaneous vascular angioplasty and stenting. It is a very plausible and attractive method of treatment with relatively low risk and fast recovery.The cost of the procedures continue to decrease with the availability of supplies from several vendors and the increase number of cases.

Break: Networking & Refreshments Break 10:40-11:00 @ Foyer

Keynote Forum

Manotosh Panja

The BM Birla Heart Research Centre, India

Keynote: Current status of intervention in Aortoarteritis in India, The largest experience of the world

Time : 11:00 AM

Conference Series World Cardiology 2016 International Conference Keynote Speaker Manotosh Panja photo
Biography:

Manotosh Panja is the chief adviser in Medical Education and Senior Interventional Cardiology in B.M.Birla Heart Research Centre. He is the Director of Interventional Cardiology, Belle Vue Clinic. Formerly he was  Director professor & Head of Cardiology Division at S.S.K.M Hospital & Institute of Post Graduate Medicine Education & Research. He was the Dean of Indian College of Physician (2012-2013). He was also The President of Cardiology Society of India(1995-1996) and Association of Physician of India.(2003-2004). He is a Fellow of American College of Cardiology. He has Published 270 paper. He is also a recipient of Dr.B.C.RAY National Award by Medical Council of India , presented by President of India. He is the Examiner of DM (Cardiology) and D.N.B Cardiology. AIMS (Delhi) ,PGI(Chandigarh) and all other Universities of India for 20 years.

 

Abstract:

AIM

To demonstrate that Angioplasty with or without stenting is the only sort of treatment which can save the life of the patients in addition to medical therapy with the largest experience of the world.

METHODS AND RESULTS

Aortoretritis is a chronic inflamtory disease in aorta and its branches which is prevelent worldwide. Its a single center study conducted from the year 1978 to 2012 from  IPGME&R, Kolkata, West Bengal. India. We have reported the largest series of around 750 cases of non specific Aortorteritis. The male female ration was 1:6.4, and the pattern of involvement were like Type I 16%, type II 8%, type III 76%, type iv 36%, type V 10%. Angioplasty done in these cases showed involvement of aortic arch, thorasic and abdominal aorta, renal artery, carotid artery, pulmonary artery, coronary artery, aortic valve (regargitation). 274 angioplasty were done in these cases. Carotid angioplasty was attempted in 40 lesions in 36 patients with 705 success rate. 1 patient had major embolic event, 3 patient had TIA. Angiographic restenosis of carotid was seen in 7 cases (17.5%). Subclavian angioplasty was attempted in 64 lesions in 58 patients. Stenting was done in 14 cases, Aortic balloon angioplasty was done in 58 patients in 52 patients with stenting in 12 lesions. Success rate was 58% restenosis rate is following: thoracic aorta 25%, abdominal aorta 38%, 120 renal angioplasty with stenting in 96 lesions was done. Restenosis rate was 18%. Incidence of coronary artery involvement is 10% in our series. Ostial and Proximal Left main Stem as well as RCA involevement ware onserved. PTCA with cutting balloon followed by DES (LMCA and Proximal LAD 10 cases, RCA 5 cases) were done. Restenosis happened in 3 cases in 5 years.

CONCLUSIONS

Aortoarteritis carries substential morbidity and mortality. Medical therapy is not very effective. Angioplasty procedure symptometic improvement and prevent complications, failed angioplasty implicated high mortality.

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.

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.

Speaker
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

Sameh Salama

Cairo University, Egypt

Title: Cardiovascular safety of the glucose lowering therapies

Time : 12:00 PM

Speaker
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.

Atef Elbahry

Port Fouad Hospital –Port-Said, Egypt

Title: Resistant hypertension: what do we need to know?

Time : 12:20 PM

Speaker
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.

Break: Lunch Break 12:40-13:40 @ Market Place
  • Clinical Cardiology & Interventional Cardiology
Speaker

Chair

Fekry Eleeb

Zulekha Hospitals, UAE

Speaker
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%.

Speaker
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.

 

Speaker
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:

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.

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.

Speaker
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

 

 (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.

Speaker
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.

Sekib Sokolovic

University of Sarajevo, Bosnia and Herzegovina

Title: The correlation of Body Mass Index and Arterial Stiffness
Speaker
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, İnflammatory 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.  

Speaker
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.

 

Speaker
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.

  • Workshop
Speaker
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).

Break: Lunch Break 12:40-13:40 @ Market Place
  • Vascular Heart Disease | Cardiovascular Surgeries & Case Reports | Current Research & Clinical Trials in Cardiology

Chair

Arun Prasad

All India Institute of Medical Sciences, India

Session Introduction

Arun Prasad

All India Institute of Medical Sciences, India

Title: Mortality due to rheumatic heart disease in developing world

Time : 16:20 PM

Speaker
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.

Speaker
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.

 

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. 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