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

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.