22^nd World Cardiology Conference December 11-12, 2017 Rome, Italy

Biography:

Brojendra Agarwala has completed his MBBS from University of Kolkata, India and completed Pediatric Cardiology fellowship from New York University Medical Center New York, NY, USA. He is a Pediatric Cardiologist and Professor of Pediatrics at the University of Chicago. He has received Best Teacher Award by the pediatric residents and the medical students. He has published 68 papers in reputed journals. He is named as one of the top doctors and best pediatricians in Chicago magazine for many years.

Abstract:

Competitive athletes are those who participates in an organized team or individual sports that requires regular competition against others. Athletic activities substantially increase the sympathetic drive resulting in surge in catecholamine level that increases blood pressure, heart rate, myocardial contractility and oxygen demand. This can cause myocardial ischemia and arrhythmia that may lead to sudden death in athletes with known and unrecognized heart conditions during athletic activities. It is estimates that 1-2/100,000 SCD/year happens worldwide. According to the International Olympic Committee, SCD rate in athletes is ~ three times higher than in the normal population. There are many structural and acquired heart conditions that are not clinically manifested. Many physicians are involved in medical clearance of children for participations in school sports activities. Physicians have to recognize them to protect athletes from catastrophic events. In order to prevent sudden cardiac death physicians should be aware of cardiac conditions that may cause problem. Also physicians should be familiar with general guidelines for evaluation of an athlete and clearance for participation in athletic activities. Guidelines vary in different parts of the world. In this presentation I will discuss guidelines for European, Italian and in USA outlined by American heart Association. In this presentation the causes of congenital and acquired heart conditions and arrhythmias that can cause sudden cardiac death will be discussed with authors experience and literature review.

Biography:

Abstract:

Eosinophilic coronary periarteritis (EPCA) was recently reported by Kajihara and his co-workers as a new pathologic entity, and clinically showed a vasospastic angina and sudden cardiac death (SCD). The patients were relatively young (mainly 30 to 50 years old) and predominantly male. The characteristic clinical findings of this disease include a) vasospastic angina (Prinzmetal’s variant angina) appearing usually from evening to early in the morning, b) all patients experienced SCD early in the morning, and c) allergy or history of allergy was hard to identify in the patients with this disease. Histological findings include a) eosinophilic inframmatory infiltration limited to the adventitia and periadventitial soft tissue is recognized in the epicardial large coronary arteries, b) all 3 main coronary artery branches are affected, with the left anterior descending artery most frequently affected, c) medial smooth muscle cells of the affected coronary artery and both internal and external elastic laminae are well preserved, d) fibrinoid necrosis or granuloma as seen in polyarteritis nodosa (PN) or allergic granulomatous angiitis (AGA) are not found in or around the inflammatory areas, and e) no findings of any type of vasculitis in any other tissue or organs. Spontaneous coronary artery dissection (SCAD) is frequently accompanied by eosinophilic inflammatory infiltration limited to the adventitia and periadventitial soft tissue in the dissected portion of the epicaldial coronary arteries, i.e., same as the findings of EPCA, and the patients usually die suddenly. EPCA was recently reported in the patient with cocaine abuse. The diagnosis of ECPA is very difficult to make at the clinical examination stage and is made almost exclusively at autopsy. However, vasospastic angina appearing mainly from the evening to early in the morning (Prinzmetal’s variant angina) is the most important symptom of this disease.

Biography:

Jean Pierre Usdin MD., is a Former Internal of the Hospitals of Paris, Former Head of clinic, Assistant of the Hospitals of Paris, Former consultant in scientific committee of medical Journal CONSENSUS and previous Chief of the cardiologic department of American Hospital of Paris (2006-2012). He is currently renowned Cardiologist at American Hospital of Paris, Member of European Society of Cardiology, Member of French Society of Cardiology. Being a Journalist and Blogger in Medscape France (From 2010) he has blogs dedicated to general cardiology: reports discussions and notes about trials, cardiology congresses, live-comments on 2015 ESC congress in London.

Abstract:

In February 2004 the emblematic journal of American Heart Association « Circulation” did a special issue focused on cardiovascular disease in women. It was time to inform female population about the burden of stroke, myocardial infarction. Women were aware of cancer especially Breast but ignore the price they paid to cardiovascular disease: the worldwide leading cause of women’s death. Active associations like women in Red spread the information in USA. European Society Cardiology was not in rest with the campaign Women at Heart. So what, 15 years passed and cardiovascular disease are still the first cause of death in women, ahead all form of cancer. What happened? Why? This persevering situation in spite of many efforts done by Media, university, care of physicians, cardiologists? Among numerous reasons, two main seem to emerge: Number one: In doctors minds the concept of women cardiovascular disease still remain far from their awareness. Women’s cardiovascular disease specificity is now a part of our training but preconceived ideas have a long life. Number two: the warning of cardiovascular disease does not work. Justified women’ fears of breast cancer are at the tip of their preoccupation. Cardiovascular diseases does not afraid women (men too) and cancerous tumour done. We continue to see women smoking, being obese, pursuing a sedentary life, and not informing their daughter about the danger of this attitude. Women accept cancer screening but they rarely perform blood sugar and cholesterol test. We cardiologists, attending physician, medical society, government, media have to be vigilant, specifickly in women who suffered from preeclampsia, gestational diabetes, healed from a breast cancer and continuously repeat cardiovascular diseases kill more people than cancer.

Biography:

Takao Konishi is a Medicine Doctor (MD-Medicine), is a Clinical Fellow of Department of Cardiology, Hokkaido Cardiovascular Hospital, the Japanese Circulation Society certified Specialist, the Japanese Society of Internal Medicine certified Specialist, the Japanese Association of Cardiovascular Intervention and Therapeutics certified Physician, the Fellow of the Japanese Society of Ultrasonics in Medicine, AHA ACLS Instructor and AHA BLS Instructor. He also belongs to Department of Cancer Pathology, Hokkaido University School of Medicine. He is involved in a clinical research in the graduate school of medicine.

Abstract:

A 78-year-old man presented to our hospital complaining of shortness of breath on exertion, 1 week after the onset of chest pain. Coronary angiography determined a severely stenosed, long diffuse lesion of the proximal-mid (segment 6-7) left anterior descending (LAD) coronary artery. Using a left radial approach, a 6 Fr 6Fr TAIGA EBU 3.5 guiding catheter (Medtronic Inc.) was used to engage the left coronary artery (LCA). An XT-R guidewire with a support of Corsair, to which was exchanged from SION blue guidewire (Asahi Intecc) could cross through the LAD artery. Intravascular ultrasound (IVUS) imaging determined fully circumferential fibrocalcified plaque or thrombus from the segment 6 to 7. A 3.0 x 13 mm Lacrosse NSE ALPHA balloon was selected for predilatation of segment 6, but was not easily able to cross the highly calcified and stenosed lesion. Using so-called leopard-crawl technique, NSE balloon could successfully reach the lesion site, and subsequent dilatation of the lesion was performed at 12 atm from distal to proximal segment 6. The tip pressure of guiding catheter suddenly showed 0 mmHg in the monitor. Angiography revealed a large thrombus in the left main trunk and left circumflex artery. After aspiration thrombectomy, using Export Advance^TM Aspiration Catheter (Medtronic Inc.), several red thrombi were aspirated, resulting in disappearance of thrombus in angiography. The ACT was 293 sec. After stent implantation of Resolute Integrity 3.0/26mm for segment 6, the patient was free from symptoms with TIMI grade 3 flow. Histopathological examination showed that the thrombus was slightly organized, which suggested that the thrombus was probably formed not during the procedure, but several days before the admission. This case highlights that non-slip element balloon provides a useful scoring effect, but infrequently causes thrombus shift when extracting the balloon catheter because of its unique design.

Biography:

Juan Jose Martinez Rivas is a fourth year Geriatric Specialist Resident with special interest in geriatric stroke and cardiovascular diseases. He did his graduation from University Los Andes in Merida, Venezuela with specialist rotation underway in Granollers Spain. He is interested in medical innovation and research with 6 oral communications presented in the Geriatrics national conference of Spain during the residency.

Abstract:

Introduction: The interatrial block (IAB) is a delay in atrial conduction defined as a wide p-wave (wpw) on electrocardiogram (ECG) but has low specificity for supraventricular tachycardia (SVA) and ischemic stroke (IS) prediction. New criteria for IAB appeared as the biphasic morphology of p wave in the inferior leads, which has increased its predictive value. The objective of this study is to find relationship between new IAB’s criteria (NIAB) and IS of undetermined cause (ISUC).

Method: retrospective study of 188 cases admitted to hospital for ISUC (A group) without prior arrhythmias, compared to 180 controls admitted for other causes (B group). NIAB finding on the ECG (biphasic p≥120ms in II, III and AVF) was assessed in both groups. Data analysis was made to find IAB differences between groups in relation to age (<75; ≥75) and comorbidities.

Results: 368 patients (47% women; mean age 72,7+15,2; Barthel index 79,5+24,9) were included. wpw and NIAB findings were significantly more prevalent in A group (p≤0.000), with no other differences observed. Significant differences were found considering age: stronger association wpw-IS vs NIAB-IS in the youngest group (OR 24,1(12,4-46,7) vs 20,5(4,8-87,3) in contrast with a stronger association NIAB-IS vs wpw-IS in the oldest group (OR 33,8(4,3-264,7 vs 7,4(2,1-26,8).

Conclusions: wpw and NIAB were significantly related to ISUC. Relevant differences were found considering age, being more prevalent the presence of wpw in younger with IS of UC and NIAB in elder. Although more studies are needed, these outcomes could justify primary prophylaxis with anticoagulation before SVA appears.

Biography:

Josephine Achan is a young Researcher with special interest in cardiovascular disease. She is currently practising in Uganda Heart Institute as a Physician and second year adult cardiology fellow. She is involved in the local research in her country and currently part of the acute myocardial infarction in Uganda.

Abstract:

Myocardial infarction is one of the leading causes of mortality worldwide with decreasing incidence in developed countries and increasing incidences in developing countries, Uganda inclusive. This increasing trend has been attributed to urbanization and changing life styles in developing countries. There is high burden of risk factors like hypertension and diabetes mellitus in our setting. The purpose of this study is to describe the clinical presentation and in-hospital outcome among patients admitted with myocardial infarction in Mulago hospital. This was a prospective cohort study that was conducted in Mulago Hospital complex and Uganda Heart Institute in 2013. 54 subjects were recruited during the eight months study period. Data on collected through standardized questionnaire and blood samples obtained. Participants were followed for minimum of two weeks and maximum of one month. A total of 54 patients were recruited, 29/54 (63%) had ST segment elevation myocardial infarction (STEMI) and 17/54(37%) had non-ST segment elevation myocardial infarction. Chest pain (66.7%) was the common presentation. Most patients in this study came to the hospital more than 72hours with median time of presentation to the hospital from onset of symptoms 93.5hours (SD 57.09, OR=1.002 95%CI 0.9-1.0). The mean age for the study participants was 58.7(SD=+/-10) with more males 38/54 (70.4%) than females 16/54 (29.6%). Common associated symptoms were breathlessness 39/54(54.7%), palpitations 21/54 (38.9%). Symptoms occurred at rest, with exercise and emotional stress. Only 7/59 (13%) of the participants had low systolic and 11/54(20.4%) low diastolic blood pressure. 18/54 (33.3%) had high systolic and 20/54(37%) diastolic pressure at admission. 19/54(35.2%) of participants had significant pulmonary rales at admission. 34/54(63%) had New York Heart Association class I and 40/54(74.1%) were in Killip class I. Risk factors include past medical history of hypertension 35/54 (OR=1.53, 95% CI=0.48-4.90), diabetes mellitus (OR=1.52, 95% CI=0.46-4.95), dyslipidaemia 7/54 (OR=1.73, 955CI=0.29-10.10), high LDL Cholesterol were higher risk for myocardial infarction. Low HDL (OR=1.9, 95% CI=0.55-6.58) confers higher risk for myocardial infarction compared to normal and high HDL cholesterol levels. Also similar patterns are seen in family history as positive for hypertension (59.3%) (OR=1.1, 955CI=0.35-3.88) and diabetes mellitus (37%). Over all 10/54(24.1%) developed shock, 10/54(18.5%) had pulmonary oedema and congestive heart failure, 6/54(11.1%) developed arrhythmia, 6/54(11.1%) died in the hospital, and 2/54(3.7%) had ventricular wall aneurysm formation. 1/54(1.9%) had stroke, re infarction and thrombus formation. Majority of patients admitted with myocardial infarction had STEMI and present with chest pain. Most patients are males. Hypertension, Diabetes Mellitus and dyslipidaemia were high risk factors. Almost half of the patients with STEMI developed pulmonary edema, shock, congestive heart failure and arrhythmia.

Biography:

Kamalika Roy Choudhury did her PhD from SINP, India on Cell Biology and Proteomics of Huntington’s disease. She is currently working on cardiovascular translational research; looking for proteomic alterations and post translational modifications during acute coronary syndrome.

Abstract:

Statement of the Problem: Atherosclerotic lesions in humans typically develop over years to decades; one of the longest incubation periods of disease onset in humans. Acute coronary syndrome (ACS) includes unstable angina and acute myocardial infarction. Atherosclerosis is the major source of mortality in the developed countries, claiming more lives than all types of cancer combined. WHO predicts atherosclerosis to become an epidemic in developing countries like India in coming years as it acquires western lifestyles. Only few reports are available on the plasma proteome profile of ACS. In this study, we used STEMI patients and age and sex matched control subjects.

Methodology & Theoretical Orientation: We used nano LC-MS orbitrap mass spectrometer and SWATH-MS to annotate proteins and identify differential expressions between control and ACS samples respectively. We used GeneCodis 3.0 and PANTHER for pathway enrichment analysis.

Findings: Using nano LC-MS orbitrap mass spectrometer we identified ~3000 proteins from control and STEMI patients respectively. We also performed SWATH-MS to identify differential expressions of proteins, if any. 65 proteins (27 downregulated, 38 upregulated) show differential expressions between control and STEMI patients. Some protein expression patterns were validated using western blotting and ELISA to look into the molecular detail. Here we intend to focus on the reverse cholesterol transport (RCT) pathway.

Conclusion & Significance: We found downregulation of ZAG, a novel adipokine in ACS patients from SWATH and validated using western and ELISA. Upregulation of a novel ATP binding cassette transporter, ABCA5, was observed in STEMI using orbitrap-MS. We show here that these might be responsible for the alteration in reverse cholesterol transport pathway during ACS which has a great impact on atherosclerotic pathway.

Biography:

Jay Risk is the National Spokesman for the Tetralogy of Fallot Foundation Inc. – a non-profit organization focused on growing the fields of adult congenital medicine, bridging the congenital gap, giving the condition a voice, providing a national institution for patients and families suffering from TOF and building a National TOF network for awareness. He is also a Comedian, Producer, Technical Director and has appeared on the soap opera ‘The Guiding Light’, the TLC Channel, ‘People Are Talking’ with Matt Lauer from ‘The Today Show’, Regis and Kathy Lee, ABC pilot ‘Florida’s Last Call’ performed at the IMPROV Comedy Clubs, recently worked with Renee Taylor from the sitcom ‘The Nanny’ and just filmed a commercial with Judy Gold from True TV and Rosie O’Donnell from the ‘Rosie ’Donnell Show’.

Abstract:

Within congenital medicine, heart patients suffering from Congenital Heart Defects (Specifically referencing Tetraogy of Fallot patients in our presentation)…There is a universal medical system disconnect within medical care (either preventative, emergency or routine treatment) which operates with a large hole underlying systematic patient care which compromises patient safety. The effects of this gap range from small complications during treatment to the worst outcome being the death of a patient. The lack of continuing education for General Cardiologists, the miniscule number of properly trained and certified Adult Congenital Doctors, the undersized fields of Adult Congenital Medicine and the current practices of using a Pediatric Cardiologist teamed with a General Cardiologist to try and properly treat an Adult Congenital Heart Patient (Tetralogy of Fallot Specific) has shown to help but, the data contrary to the success of these combined efforts shows the need for a serious overhaul and restructuring of present and future medical practices. Medical mandates proposing continuing education and a greater awareness needed by doctors treating such CHD/TOF patients to avoid such preventable negative occurrences are needed, detrimental to the overall health and longevity of a CHD patient and the data that is recorded shows mild complications, to progressive complications during treatment or, ultimately the death of the patient. Jay Risk, a CHD/TOF patient is speaking about his own experiences, research through his foundation and his views are non-bias. According to the US National Library of Medicine 47% of patients are successful” when transferring from pediatric to adult congenital medicine. Thus, 53% of overall patients experience mild to serious complications, even death. 53% is more than half of the CHD patient population, warranting a new and serious focus and stronger efforts being concentrated in solutions?

Biography:

Raghav Lumb graduated from Kurukshetra University, Haryana, India and a post graduate Internal Medicine from Bharati Vidyapeeth University Medical College, Pune , India, presently an aspiring resident of DM Cardiology. Believes in sheer hard work and has passion learning best of cardiology prioritizing patient care. Has few publications in his name , looking forward for more research and work in cardiology in upcoming years.

Abstract:

Introduction: Left atrial compliance (LAC) is an important determinant of cardiac function, both in the normal and pathological state. The basic hemodynamic features of mitral stenosis (MS) are an elevation of left atrial (LA) pressure, resulting from antegrade flow across the mitral valve (MV). The severity of MS and extent of narrowing of MV orifice determine the degree of LA pressure.

Aim: To study the Left atrial compliance in patients with Rheumatic Mitral Stenosis, to analyse the predictors of LA pressure in rheumatic MS, to study effects of successful Balloon mitral Valvuloplasty (BMV) on left atrial compliance.

Methodology: 50 patients undergoing BMV by Inoue technique where included in this study. Doppler echocardiography was performed in all before BMV. Left atrial size, left ventricular end diastolic dimension, left ventricular end systolic dimension and left ventricular ejection fraction were calculated. Mitral valve area (MVA) was measured by 2-D echo planimetry and pressure half time method from continuous mitral flow velocity profile. Mean mitral valve gradient (MVG) was also measured by continuous wave Doppler echocardiography. During BMV procedure right heart catheterization was performed with balloon tipped catheter. Pulmonary capillary wedge pressure, systolic, diastolic and means pulmonary artery pressures were measured with fluid filled catheters. Trans-septal puncture was done from right femoral vein with Brocken brought needle and Mullins transeptal sheath. Left heart catheterization was performed through it. The left atrial ‘a’ and ‘v’ waves amplitude were measured at end-expiration Cardiac output was determined by Fick’s method. LAC was calculated by dividing the systolic rise in LA pressure by stroke volume.

Results: Though LAC was depressed in patients with rheumatic MS, and improved dramatically (from 2.5±0.51 to 7.11±1.71cm³/mm Hg) following successful BMV. Those with higher LA mean pressure had lower LAC. Those with higher PA pressure, higher TMG, Lower MVA and lower LAC had higher mean LA Presssure with strongest negative relationship noted with LAC. However in multivariate analysis only TMG and LAC were predictors of LA pressure.

Conclusion: LAC is important determinant of left atrial pressure in patients of rheumatic mitral stenosis and which correlates with symptomatology. Rheumatic MS has markedly depressed LAC.This depressed compliance improves immediately following successful balloon mitral valvuloplasty. This improvement in compliance occurs irrespective of left atrial mean pressure.

Biography:

Madhumanti Panja is a final year student in the course of DNB Cardiology (Degree course), from the National Board of Examination under the Government of India

Abstract:

AIM: Coronary stents in PCI were designed to reduce abrupt vessel closure and restenosis. Despite pharmacological and technical advances, complication like; late thrombosis and restenosis are of concern for coronary revascularization procedure. The objective is to analyze the long-term follow-up information especially the late complication over several years in consecutive procedures.

Method & Results:  A single center observational study was conducted from August 1996 to July 2004, in the department of Cardiology, IPGME&R, Kolkata, West Bengal, India. Till 2002 all had Bare Metal Stents (BMS) and then onwards majority (60%) underwent BMS and 40% were treated with Drug Eluting Stents (DES).  A total of (* cases with first stent implantation and turned up for regular follow –up were included in this study. Over 15 years patients were strictly observed clinically 1, 2, 3 months initially and there after every 3 month or any time in between when symptoms experienced.

Mean age of the population was 55 + or – 2 years and 85% were male. Before the procedure, 34% had unstable angina. 28% had prior event of myocardial infraction and rest had chronic stable angina. Clinical profile showed diabetes mellitus in 1/3^rd of the patients and 605 had hypertension. Majority (75%) revealed one vessel disease. Among 98 cases 80 had BMS and 18 had DES. During the follow-up (range 1 to 15 years), the incidence of major adverse cardiac event (MACE) in 12 cases with BMS and two with DES.  Ten patient with BMS and two patient with DES had instent restenosis and late stent thrombosis in one with BMS and 2 with DES. Whereas coronary aneurysm was noted only in one patient with DES.

Conclusion: Bare metal stent is effective and safe. All complication except restenosis were higher in DES.

Biography:

Ayshat Yandieva is a graduate student of the Department of Hospital Therapy â„–1 of Moscow State University of Medicine and Dentistry. Along with the research work and teaching activities, she is actively engaged in medical practice, heading the sleep laboratory of Eurasian Clinic in Moscow and developing the direction of sleep medicine in Russia.

Abstract:

Statement of the Problem:  The combination of metabolic syndrome (MetS) and obstructive sleep apnea (OSA) is characterized by a significant increase in cardiovascular risks. Some factors, such as systemic inflammation and arterial stiffening may mediate cardiovascular diseases in these patients. Arterial stiffness is widely accepted as early marker of atherosclerosis and cardiovascular outcomes. Systemic inflammation also plays an important role in the development of cardiovascular complications. The purpose of this study is to determine the effect of continuous positive airway pressure (CPAP) on arterial stiffness and plasma CRP levels in patients with MetS and OSA. Materials and methods: total of 74 patients with MetS and moderate-to-severe OSA were randomized to CPAP (n = 36) and non-CPAP (n = 38) treatment groups for 12 weeks to investigate the effects of CPAP-treatment on arterial stiffness and plasma CRP levels. Findings: Initially, there were no significant differences between the two groups for all the studied parameters. After 12 weeks of therapeutic CPAP, there was registered decrease in R/L-PWV (from 12,7±2,6 m/s to 11,1±3,4 m/s, p <0.05), CAVI (from 8,2±1,8 to 6,5 ±1,8, p <0.05), AIx (from 1,66±0,15 to 0,96±0,12, p<0,05), although change of ABI was not statistically significant. In non-CPAP patients, there was no reliable dynamic in parameters of arterial stiffness. Also, the CPAP-treatment patients presented lower circulating levels of CRP after 3 months of therapy: 6,17±0,52 mg/L vs. 8,32±0,44mg/L at the baseline (p<0,01). On the other hand, no significant differences were found in the control group of patients. Conclusions and significance: appropriate CPAP therapy in patients with MetS and OSA improves both vascular stiffness and chronic systemic inflammation, that leads to reducing general cardiovascular risks.

Biography:

Ghadeer Dawwas is a PhD student at the Department of Pharmaceutical Outcomes and Policy at the University of Florida. Her research is focusing on assessing the effectiveness and safety of medications using population based data with a special focus on cardiovascular diseases.

Abstract:

Background: Patients with diabetes and concomitant heart failure are at higher risk of readmission but few studies evaluated predictors of hospital readmission among this population.

Purpose: To identify predictors of hospital readmission among diabetic patients with heart failure using data from 130 United States Hospitals.

Methods: A retrospective cohort analysis using data from 130 United States hospitals was conducted. Patients who had a diagnosis of diabetes based on primary or secondary diagnosis codes (ICD-9-CM): 250.x0 or 250.x2) and heart failure (ICD-9- CM codes 402.×1, 404.×1, 404.×3, and 428.××) between 1998-2008 were identified. The multivariable logistic regression model was used to identify predictors of hospital readmission.

Results: A total of 18,603 patients were identified (81.6% were 60 years or older, 55% female, mean length of stay: 4.8 days, 75% Caucasian). Predictors of higher risk of hospital readmission were females compared to males (odds ratio (OR): 1.1, 95% CI [1.0, 1.13], total number of outpatients visits (OR: 1.1, 95% CI [1.1, 1.11]), total number of emergency room visits (OR:1.2, 95% CI [1.13, 1.27]), total number of inpatients visits (OR:1.34, 95% CI [1.30, 1.37]), and HBA1C measurement >8 (OR:1.25, 95% CI[ 1.1, 1.50]). The use of insulin, however, had protective effect (OR: 0.89, 95% CI [0.81, 0.98].

Conclusion: Among patients with diabetes and concomitant heart failure, females, a higher number of outpatients’ visits, emergency room visits, inpatients visits, and a higher HBA1C measurement were predictors of higher hospital readmission. Identifying patients at higher risk of hospital readmission can aid in targeting selected subgroups who might be at greater risk of future readmissions. Thus targeting intervention toward higher risk populations can reduce future healthcare utilization.

Biography:

Hauer was born in 1947 in Amsterdam. He obtained MD graduation in 1974 at Leiden University and in 1980 Board Certification in Cardiology at Amsterdam University (mentor prof. Durrer). His mentors in Clinical Electrophysiology were Prystowsky and Zipes at Indiana University. In 1987 Hauer obtained his PhD degree with a thesis on ventricular arrhythmias and catheter ablation. In the years 1996-2012 he was full professor in Clinical Electrophysiology at the University Medical Center in Utrecht, Netherlands.

Hauer is author or co-author of 190 publications in the field of cardiac arrhythmias in peer-reviewed international journals and member of the editorial board of Journal of Cardiovascular Electrophysiology.  He was mentor of 15 PhD students.

Since 2005 Hauer is project leader of the Netherlands Heart Institute project on Arrhythmogenic Cardiomyopathy with focus on diagnosis,  genotype-phenotype correlation, and long-term risk assessment. This project is in collaboration with Johns Hopkins University in Baltimore (Dr. Calkins).

Abstract:

Introduction: Arrhythmogenic Cardiomyopathies (ACM) are inherited cardiomyopathies histologically caracterized by fibro-fatty myocardial alteration, and clinically by ventricular arrhythmias starting at an early disease stage, usually later followed by identifiable structural and hemodynamic disorder. Arrhythmogenic Right Ventricular Dysplasia/Cardiomyopathy (ARVD/C) is in its typical form a subcategory of ACM with primarily RV involvement. However, ACM also includes predominant left ventricular disease. ACM is associated with pathogenic mutations encoding desmosomal and non-desmosomal proteins.

Aim: Analysis of genotype-phenotype correlation in a large transatlantic ACM patient cohort.

Results: In 577 well-phenotyped patients (230 probands, 347 relatives) pathogenic mutations were found in 5 desmosomal (JUP, PKP2, DSG2, DSC2, DSP) and 2 non-desmosomal genes (TMEM43, PLN). Mutations in PKP2 were found in 80% of individuals. 36 Patients presented with sudden cardiac death, particularly in 4/19 (21%) with DSP, versus only 29/463 (6%) with PKP2.Those presenting alive were followed during 6±7 years. Arrhythmic outcome in males was worse compared to females, and >1 mutation did worse compared to a single mutation. PLN and DSP were significantly more associated with left ventricular dysfunction than PKP2. Premature truncating, splice site, and missense mutations were associated with a similar arrhythmic and hemodynamic outcome.

Conclusion: Genotype-phenotype correlation shows clinically relevant differences. Because of frequent predominant left ventricular involvement in DSP and PLN, fulfilment of ARVD/C Task Force Criteria may be absent, although these subcategories have an unfavorable outcome.

Biography:

E Martin Kloosterman is Director of the Lynn Heart and Vascular Institute Boca Raton Regional Hospital / Florida Atlantic University. Florida, USA. At BRRH he performs an extensive variety of interventions related to cardiac devices implants and treatment of cardiac arrhythmias using the latest developments in the field including, transcatheter pacemaker, fluoroless ablations, cryoballoon and rotor mapping for the treatment of atrial fibrillation. He invented the remote-K-viewer, a system that enables physicians to communicate and guide reprograms cardiac devices remotely in real time. He leads the largest volume service of CareLink Express in the US, with a tailored service protocol.

Abstract:

Statement of the Problem: Following the moto: “if a robot in Mars can be Remote-Control from earth; we can likely Remote-Control a pacemaker in Boca Raton, Florida”; we have been pursuing this goal since 2010.

Methodology & Theoretical Orientation: The use of cardiac implantable electronic devices (CIEDs) has evolved exponentially over the past decade and with it the need of a prompt response to device interrogation. In 2002 home remote monitoring network was introduced. In 2012 device remote interrogation extended to Hospitals. In 2014 a new generation of wireless insertable cardiac monitors became clinically available with global connectivity and 2017 a system surfaced with direct Bluetooth connectivity of a diagnostic implanted cardiac monitor to the patient’s smart phone. The use of this technology requires a robust office monitoring system able to handle the vast incoming information and subsequently taking action accordingly if needed. The use of home remote monitoring became part of the standard of care and formal guideline established by a consensus document of the Heart Rhythm Society in 2015. In parallel to these advances we explore the real-time remote interaction and management of CIEDs. In 2010 real-time programmer screen visualization and “guided-reprogramming” using an attached laptop to a programmer and a remote iPad was tested in the Emergency Room. Since then we evolved to complete remote control of CIEDs not only with access to diagnostics but with the ability of performing programming changes as deemed necessary without a specialist at the device side.

Conclusion & Significance: There are different ways of interrogating remotely a CIED device and obtain alerts regarding arrhythmic and other sensors events. However, the ability of remote control in real-time the interrogation and reprograming of CIEDs as needed opens new possibilities for service models and device interactions that have yet to be defined and developed

Biography:

Amer H is currently an Associate Consultant at King Abdulaziz Hospital for National Guards, Saudi Arabia, he has the following qualifications, participated with researches in many national and international conferences. He is a diplomate American Board Member of Nuclear Cardiology (Cbnc) dec 2015, he has fellowship of Asian Nuclear Medicine Board FANMB/ OSAKA-JAPAN NOV 2014, fellowship of European Board of Nuclear Medicine FEBNM, Milan/Italy Oct 2012.

Abstract:

Introduction: The ECG effects of diabetes are well known, however the influence of diabetes on the ECG findings during adenosine infusion compared to non-diabetics was not thoroughly investigated.

Methods: We performed a retrospective analysis of 213 patients identifying all the reported Gated myocardial perfusion SPECT with adenosine stress tests between January 2012 to January 2017 for all patients who presented with diabetes mellitus as a sole risk factor based on the hospital records and patient interview. The data were collected from the nuclear medicine database.

Results: Overall, 109 (51.17%) were females with mean age 55.51 ± 10.91 years. 103 (48.36%) were diabetic, 26 (12.21%) obese, and 32 (15.02%) were smokers. Only 3 (1.41%) has baseline ECG change, while 35 (16.43%) demonstrated arrhythmic ECG changes following adenosine infusion 17 (48.57) of them within diabetic group and18 (51.43%) within non-diabetic group, with no significant difference in both univariate and multivariate analysis.

Conclusion: The study showed that adenosine infusion result in moderate number of arrhythmic changes, with no significant association between diabetes mellitus and the ECG changes during adenosine infusion. Female showed a predominance of such changes (67%) compared to male patient with no significance P: value.

Biography:

Giuseppe Maiolino is employed as a cardiology consultant at the Azienda Ospedaliera di Padova. He received his MD and PhD degree at the University Of Padova School Of Medicine. He completed his cardiovascular disease fellowship at the University of Padova and his Internal Medicine residency at the Maimonides Medical Center, Albert Einstein College of Medicine. His research activity is focused on secondary hypertension, mainly primary aldosteronism and renovascular hypertension, and genetic/biohumoral markers of coronary artery disease

Abstract:

Statement of the Problem: Since blood pressure treatment results are disappointing, the Lancet Commission on Arterial Hypertension recently listed the search for secondary hypertension, among the key actions to prevent this major risk factor (1).  Methodology & Theoretical Orientation: Compelling data indicate that primary aldosteronism (PA) is the most frequent endocrine cause of secondary hypertension with prevalence across different studies, ranging between 1% to 30% in referral centers (2).  Based on these results the Endocrine Society guidelines advocates screening of stage II and III hypertensives and/or patients with PA high prevalence features (3).  Findings: A recently published study investigating a large cohort recruited in a primary care setting reported a PA prevalence of 5.9%, of which 46% was the surgically curable form of PA, i.e. aldosterone-producing adenoma (APA), and found most PA patients among those with stage I hypertension (45%) (4).  Hence, investigation of secondary hypertension has been advocated also in stage I hypertensive subjects (5), since PA increases the risk of target organ damage and a specific therapy, either surgical or medical, if timely undertaken, guarantees better outcomes.  However, the complexity of the PA diagnostic algorithm, which includes the systematic use of confirmatory tests, induces under screening that might be offset through a simpler approach, exploiting automated direct renin/plasma aldosterone assays and avoiding confirmatory tests in more florid PA cases (6).  Conclusion & Significance: PA is a highly prevalent cause of secondary hypertension in unselected adult hypertensive patients and most PA subjects are found among stage I hypertensives.  Excluding these patients from screening would cause overlooking of a high rate of PA and/or APA.  Since PA increases the risk of target organ damage and a specific therapy guarantees better outcomes, screening all hypertensive patients should be recommended.

Biography:

Ashok Tahilyani has done his MBBS from India and his basic specialist training (BST) in Internal medicine followed by his advance specialist training in Cardiology from Singapore. He has also done his MRCP (UK) exam at the same time during his BST training. He has presented many papers in various international cardiology conferences.

Abstract:

Introduction: Acute pulmonary oedema (APO) is associated with significant morbidity and mortality. Many published series of patients with APO are small and historical and offer only descriptive data on selected patients following acute myocardial infarction (AMI).

Objective: To provide a description of clinical factors and outcomes in an unselected consecutive series of patients with APO.

Methods: Case records were reviewed for all patients admitted to our institution with a primary diagnosis of APO in 2015. National databases were interrogated for readmission and mortality.

Results: 921 patients (mean age 70.99 and 70.90 years for male and female respectively with SD of 11.92 years for former and 11.95 years for latter, n=526 (63%) male, n 335 (36.3%) females) were identified. 165 patients (17%) had ejection fraction (EF>40%). Established ischemic heart disease (IHD), hypertension and diabetes were present in 61%, 83% and 55% respectively. Precipitating factors for APO included fluid indiscretion (21%) atrial fibrillation (8%), IHD (7%), infection (5%) and hypertension (4.8%). We followed these patients for 14 months +/- 8 months. The total mortality was 194 patients (21.06%) during the study period. Predictors for mortality were low EF (<35%) with high pulmonary artery systolic pressure (> 40mmHg) in the setting of AMI, sepsis and out of hospital collapse.

Conclusion: The outlook of APO in the present era remains substantial but may have improved from historical series.

Biography:

Apabrita Ayan Das is working on Cardiovascular Biology. He had pursued his MSc from Banaras Hindu University. Currently, he is pursuing his PhD under Dr. Arun Bandyopadhyay in CSIR-Indian Institute of Chemical Biology, India. His research is mainly focused on identifying novel prognostic and diagnostic marker for acute coronary syndrome and elucidates their role in coronary heart disease.
 

Abstract:

Statement of the Problem: Soluble TREM like transcript 1(sTLT1) is reported to be associated with major processes related to atherosclerosis and Acute Coronary Syndrome. Hence, our study aimed to determine the association of sTLT1 with Coronary Heart Disease and its ability to predict the risk in the aforementioned disease.

Methodology: 117 subjects with or without Acute Coronary Syndrome were enrolled and plasma levels of soluble TREM like Transcript 1, NT-proBNP, oxidized LDL and other cholesterols were estimated. Subclinical cases were identified by lipid profiling, electrocardiogram and echocardiography. Regression analysis and ROC analysis were performed to determine the predictive value of this protein.

Findings: sTLT1 level was significantly (p<0.05) higher in ACS subjects and asymptomatic than that of control subjects. The level of sTLT1 was not only associated with common risk factors of ACS in both patient and asymptomatic groups but also correlated with disease severity and it was also significantly associated (1338±375 pg/ml) with intima-media thickness in asymptomatic individuals (>1mm). Cut-off values of sTLT1 were found to be 875 pg/ml and 2500 pg/ml in asymptomatic and ACS subjects respectively, as revealed by Receiver operating characteristic (ROC) curve analysis. Multiple linear and logistic regression analysis revealed that sTLT1 level would independently predict ACS as it is significantly associated (Linear Regression: P<0.0001, r=0.674) (Logistic Regression: P=0.045, OR=1.02, 95% CI=1 to 1.04) with disease risk.

Conclusion & Significance: Circulating sTLT1 represents a promising candidate for risk prediction in asymptomatic as well as ACS subjects which may reduce mortality rate by leading better prognosis.

Biography:

Subhanu Roy Chowdhury is an Assistant Professor in Physiology and Chief Faculty for UGC-sponsored course on Clinical Trial Managemnt. He is actively involved in UG/PG teaching for the last nine years and aiding professional development of students.

Abstract:

Different regulatory guidelines have endorsed on the achievement of optimum quality of chest compression (CC) in cardiac arrest patients. The optimum quality of CC is acknowledged as 50mm and 100/minute respectively. However, different studies have reflected that professional nurses fail to achieve the optimum quality of CC in cardiac arrest patients. Such limitations impose poor prognosis across concerned stakeholders. Earlier studies have highlighted that a lack of awareness and inappropriate compression techniques were the major causes that led to non-compliance with the guidelines for optimum CC. However, it was speculated that physical and physiological limitations across professional nurses may contribute towards such non-compliance. Hence, the present study explored the physical and physiological parameters in professional nurses and allied healthcare professionals that limit the quality of CC in cardiac arrest patients. The study was conducted as a prospective and randomized fashion involving 23 cardiac care unit (CCN) and 12 Intensive Care Unit (ICU) nurses. The physical and physiological parameters that were estimated include handgrip strength, reaction time, aerobic power/anerobic power ratio, body mass index, and body fat percentage. Logistic regression analysis was conducted with handgrip strength on different physical and physiological parameters. The regression analysis reflected that grip strength was negatively and significantly correlated with reaction time (p<0.05), BMI (p<0.001), body fat % (p <0.001) and aerobic/anerobic power ratio. It was concluded that greater anerobic power and higher lean body mass in professional nurses significantly influences the quality of CC in cardiac arrest patients.

Biography:

E Martin Kloosterman is Director of the Lynn Heart and Vascular Institute Boca Raton Regional Hospital / Florida Atlantic University. Florida, USA. At BRRH he performs an extensive variety of interventions related to cardiac devices implants and treatment of cardiac arrhythmias using the latest developments in the field including, transcatheter pacemaker, fluoroless ablations, cryoballoon and rotor mapping for the treatment of atrial fibrillation. He invented the remote-K-viewer, a system that enables physicians to communicate and guide reprograms cardiac devices remotely in real time. He leads the largest volume service of CareLink Express in the US, with a tailored service protocol.

Abstract:

Statement of the Problem: MRI scans in patients with cardiac MRI conditional devices (pacemakers and ICDs) are exponentially growing. All devices require pre-scan interrogation and accordingly reprograming to an MRI safe mode. Today there is no medical or industry guideline about how to program an MRI safe mode. The performance of this task is for the most part done by a field company representative whom should follow a “Cardiology Order” form. This workflow, across the US, is difficult to follow in its conceived fashion having significant limitations and compliance issues. Additionally, when the decision on safe mode is not done upon the scan performance, depending on the time interval the patient’s condition may have changed.

Methodology & Theoretical Orientation: In order to simplify the decision-making process and streamline the service model a proprietary algorithm was conceived to provide an answer in real time to the most appropriate MRI safe mode programming upon performing the scan. The algorithm was used in 11 MRI centers and applied to a total of 246 cardiac devices, from 4 different companies 232 Pacemakers (223 DDD/9 VVI); 14 ICDs (10 DDD/4 VVI). Sinus rhythm was the most common presenting underlying rhythm 93% and AF 7%. Most common presenting modes were: DDD 116, AAI-DDD 84, VVI 12, rate response was on in 50%. The most common MRI safe mode programmed were DOO 36%, followed by AOO 31%.

In no instance, a patient’s device interrogation wouldn’t fit the algorithm. There were no complications.

Conclusion & Significance: The clinical validation of the MRI safe mode selection using the MK-ALGORITHM© provides a standardize solution, that streamlines patient care, meant to be a resource for orders not only by the specialists but by other physicians involved in the patient care such as radiologists onsite at the MRI center performing the scan.

Biography:

Habib Dakik is Professor of Medicine and Chief of the Division of Cardiology at the American University of Beirut Medical Center.  He received his MD degree from AUB in 1990 and pursued training after that in Internal Medicine and Cardiology at Baylor College of Medicine, Houston, Texas. He is a fellow of the American College of cardiology. His main research interests have been in the risk stratification of patients with acute coronary syndromes and the role of advanced cardiac imaging techniques in the evaluation of patients with coronary artery disease.

Abstract:

Beta Blockers have been utilized routinely in patients with ischemic heart disease for several decades. Multiple large randomized clinical trials have examined their efficacy in several patient populations: Stable angina, myocardial infarction, congestive heart failure, post PCI, and post CABG. Their efficacy has been shown to be modulated by several factors including reperfusion status post MI, extent of myocardial ischemia, and degree of left ventricular dysfunction. In this workshop we will examine the pivotal trials that examined the efficacy of beta blockers in the MI and CABG population of patients and we will review the current ACC/AHA and ESC guidelines for their utilization in these patient subgroups.