29^th World Cardiology Conference November 19-20, 2018 Edinburgh, Scotland

Biography:

Konstantina Triantafillopoulou was born in Northern Greece in 1978. She graduated from Medical School of Democritus University of Thrace in 2004, and received many scholarships from State and Private Foundations. Fulfilled the specialty in Cardiothoracic Surgery in 2015 in AHEPA University Hospital Thessaloniki, Greece and started a PhD Research studying “The effect of Minimal Extracorporeal Circulation in coagulation during adult cardiac operations, with conventional and viscoelastic tests”. She shares a high interest in Perioperative Bleeding Management in Cardiac Surgery, attending many PBM seminars organized by Danube University of Krems, University of Zurich (Maastricht-Netherlands, Vienna and Hainburg-Austria) and Weill Cornel Medicine (Doha Qatar). She is the member of Hellenic Society of Thoracic and Cardiovascular Surgeons (HSTCS), ERC as an Instructor for Advanced Life Support, Medical Association of Thessaloniki, International Society on Thrombosis and Haemostasis. Since 2015 She is in private medical practice in Saint Luke’s Hospital, Blue Cross Hospital, Interbalkan Medical Center, Thessaloniki Greece in a variety of cardiac and thoracic cases.

Abstract:

Introduction: Perioperative bleeding is common among patients in cardiac surgery. Major bleeding, transfusion and anemia have been characterized as the deadly triad of cardiac surgery. Patient blood management (PBM) in cardiac surgery contributes to the maintenance of perioperative haemostasis and the minimization of bleeding, which reduce blood transfusion requirements. PBM in cardiac surgery comprises of an interaction not only between the cardiothoracic surgeon, the anesthesiologist and the clinical perfusionist, but furthermore the cardiologist and hematologist.

Theoretical Orientation: This multidisciplinary approach following evidence-based guidelines can be the only accepted way to prevent any adverse outcomes. The methodology to identify and amend all factors related to increased risk of bleeding, transfusion and reoperation includes preoperative assessment, intraoperative techniques and postoperative management by all affiliated specialties. Advanced age, preoperative anemia, antiplatelet therapy and platelet dysfunction, use of NOACs, congenital and acquired coagulopathies, non-elective cardiac surgery, complex procedures and redo cardiac surgery, additional to individual comorbidities are only few of the risk factors. Risk scores, advanced surgical techniques, minimal procedures and PBM algorithms need to be addressed for the patient’s benefit.

Conclusion: Perioperative bleeding management in cardiac surgery comprises a multidisciplinary and multifactorial approach and consists of a sequence of separate strategies and interventions. It is a constant interaction between the cardiac surgeon, anesthesiologist, perfusionist, cardiologist, hematologist and intensivists, in addition to evidence-based guidelines, recommendations, algorithms, multicentric trials and ongoing research.

Biography:

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

Abstract:

Purpose: The purpose of this study is to determine prevalence of diastolic dysfunction of the left ventricle in patients on chronic dialysis treatment and also determine prevalence of diastolic cardiac insufficiency in patients on chronic dialysis treatment.

Design & Methodology: A prospective study included 49 chronic dialysis patients (both hemodialysis and continuous ambulatory peritoneal dialysis). All patients had their medical history and electrocardiogram taken and underwent complete physical examination and echocardiography evaluation. Variables of diastolic dysfunction were determined by continuous (mitral inflow velocity) and pulse color Doppler patterns (pulmonary veins flow and motion of mitral annulus). Diagnostic criteria included symptoms of cardiac insufficiency (at rest or exertion), existence of diastolic dysfunction determined by echocardiography.

Results: In the study, a total of 49 patients were observed: 23 men (46.93%) and 26 women (53.06%). The average age of the patients was 48.17±10.56 years and the average duration of dialysis treatment was 43.6±18.5 months. Diastolic dysfunction was verified by echocardiography in 10 (20.4%) patients that is in 7 (70%) women and 3 (30%) men, of the average age 58.8±8.53 years and the average duration of dialysis 42.8±17.9 months. All patients with diastolic dysfunction of the left ventricle had preserved systolic function of the left ventricle (normal ejection fraction). Diastolic cardiac insufficiency was diagnosed in 3 (6.12%) patients, that is in 2 women and 1 man. The average age of patients with diastolic cardiac insufficiency was 54±7.59 years and the average duration of dialysis treatment was 41.7±7.5 months.

Conclusion: There is a high prevalence of diastolic dysfunction of the left ventricle in chronic dialysis patients.

Biography:

Mohamed Haykal is the Researcher in Cardìology at Ministry Of Scientific Researches, Egypt. He is also the Member of advisory board, international society of cardiomyopathy, Japan

Abstract:

Background: One of the most rapid and easy techniques for assessing left ventricular (LV) systolic function is transthoracic echocardiography, but its main disadvantage is being a subjective method and needs high experience to get an accurate assessment of the global LV systolic function especially in patients with regional wall motion abnormalities. One of the new modalities of echocardiography is 2D speckle tracking which permits offline calculation of myocardial velocities and deformation so it gives more accurate and operator independent evaluation of the LV global systolic function.

Aim: The aim of work is to validate solid numbers of LV global strain value by 2D speckle tracking that correlates left ventricular ejection fraction (LVEF) by Simpson’s method for more accurate assessment of global LV systolic function especially in patients with regional wall motion abnormality.

Patients & Methods: The study involved 120 individuals; 20 with normal LV systolic function and 100 patients with LV systolic dysfunction and regional wall motion abnormality. All the cases had their LV systolic function assessed first Simpson’s method by transthoracic echocardiography then speckle tracking for all of them had been done and correlation between results of EF by Simpson’s method and LV global strain was done and statistical analysis was done.

Results: Our study had shown that: Global strain more negative than or equal to -16 is equal to EF more than or equal to 55% by transthoracic echo (normal LV systolic function). Global strain more negative than or equal to -13% and less negative than -16 is equal to EF more than or equal to 45% and less than 54% (mild LV systolic dysfunction). Global strain more negative than or equal to -9.8% and less negative than -13% is equal to EF more than or equal to 30% and less than 45% (moderate LV systolic dysfunction). Global strain less negative than -9.8% is equal to EF below 30% (severe LV systolic dysfunction).

Conclusion: Speckle tracking provides an easy, accurate bed side modality for assessment of LV systolic function through calculation of LV global strain which is an operator independent technique.

Biography:

Nahid Azad is currently working as Professor of Medicine, Dept of Internal & Geriatric Medicine, University of Ottawa, Canada

Abstract:

Heart failure (HF) is the leading cause of hospital admissions among older patients and is a growing public health concern contributing to both premature death and disability and to increased health care costs. HF diagnoses and treatment of older people is based on clinical studies of younger men. However, symptoms are age and gender dependent; therefore, treatment protocols need to be updated. Although HF and geriatric syndromes are not directly linked (causality), many older patients suffer from both and require an integrated treatment plan including PCP (planar cell polarity), geriatrician, cardiologist, and multidisciplinary team. Frailty is a key geriatrics indicator. When not diagnosed and managed correctly in conjunction with HF, frailty leads to many unnecessary ER visits and hospitalizations. Consequently, there is a growing field geriatric cardiology. Clinical guidelines for management of HF need updating; clinical research trials need to include a gender-balanced older population; and cardiologists need curriculum updates that include increased collaboration with geriatricians. Creativity is required to develop new approaches that can improve treatment outcomes and reduce treatment costs – and many opportunities exist.

Biography:

Ibrahim has been trained in Egypt & UK. He became a national leader in heart failure, starting a specialized Heart Failure Clinic in Egypt, and founded the first Heart Failure Unit. The unit registry includes more than 700 patients. Ibrahim introduced the discipline of HF specialized nurse and shared in the establishment of the first heart failure patient support group. Currently he is the lead of heart failure services in North Cumbria. Dr Ibrahim has a special interest in right ventricular failure, peripartum cardiomyopathy, and HF with preserved EF. Ibrahim is the Principal Investigator of site of several international trials and Registries including; TIMI 51, QUALIFY, ESC HF-long term, REPORT-HF, and Peripartum CM.

Abstract:

As brain storming, the presentation starts with a case presentation of a 37 year old former drug abuser lady with RVF. The possible etiologies and the diagnostic work-up will be discussed. Cardiologists have become “LV centric” though circulation is a closed system and the RV plays an integral part in it. A complex interventricular dependence between both ventricles is present. The RV fails when there is pressure or volume overload or myocardial disease such as RV infarction or cardiomyopathy. However, the commonest cause of RV failure is pulmonary hypertension. Epidemiologically, the most frequent pathology for pulmonary hypertension development is LV failure. Diagnosis of RV failure is a clinical exercise. An algorithm will be presented. ECG and markers such as lactate and BNP are helpful. Echo is very important in the diagnosis to exclude extrinsic causes and to quantify, in particular, PASP, IVC diameter and collapsibility index and TAPSE. CT and cardiac MRI have become increasingly useful tools in elucidating the underlying pathology. A brief management pathway of RVF will be discussed.

Biography:

Marco Bertini has his expertise in Clinical Pharmacology. He is a Medical Doctor with a PhD in Clinical Pharmacology and Paediatrics. He was teaching Clinical Pharmacology in Pisa University, Italy and is actually involved in R&D in a Pharmaceutical Company (Laboratori Baldacci SpA). He has published more than 100 articles on different medical topics and was invited as “Speaker” in different international congresses. He is an Editorial Board Member of different international journals and is actively involved in Translational Medicine.

Abstract:

Statement of the Problem: Iron deficiency (ID) either with or without anemia (IDA), is an important comorbidity in heart failure (HF) patients and is associated with a worse prognosis. ID is present in approximately 50% of patients with HF with reduced left ventricular ejection fraction (HFrEF) and is an independent predictor of reduced functional capacity and mortality. Inexpensive and readily available oral iron supplementation, also at high dosage, has been demostrated to be uneffective in improving exercise capacity over 16 weeks ( ). Oral iron replacement treatment with the new compound Feralgine™ (a new patented co-processed oral iron preparation between ferrous bisglicinate chelate and sodium alginate) has recently demostrated to be more available than the gold-standard ferrous sulphate. The purpose of this observational study was to preliminarily understand the effectiveness of Feralgine™ supplementation in improving ID, IDA and HF symptoms during a 12 weeks treatment course.

Orientation:   A preliminary  study was been conducted on 41 HF patients (29 men and 12 women aged between 73 and 87 years old) affected by chronic heart failure (CHF) (38 patients are class III NYHA and 3 patients are IV Class NYHA) plus ID or IDA: 25 patients (60%) with HFrEF <40% and 16 (40%) with HFrEF between 40% and 50%. Every patient has been supplemented for 12 weeks with 30 mg of elemental iron belonging to Feralgine™ maintaining the previous HF drug’s treatment

Findings: At the end of oral iron supplementation (12 weeks) an increase was observed in Hb and ferritin, and surprisingly, 36 of the 41 patients (88%) had reduced their NYHA class from III to II.

Conclusion & Significance: To our knowledge this is the first time that an oral iron supplementation with low elemental iron (30 mg/daily) has shown to be effective in improve HF symptomatologies in ID/IDA-HF associated patients

Biography:

Gupta P received his BE (Distinction) Degree in Electronics Engineering from Sardar Vallabhbhai National Institute of Technology, Surat (India), in 1994. He did his Master’s degree in VLSI from Malaviya National Institute of Technology, Jaipur (India) in 2008. He started his professional career with the position of Lecturer (Electronics) in Department of Technical Education (DTE), Rajasthan in 1995. Presently, he is Lecturer (Selection Grade- stage-4) in DTE, Rajasthan. He has also worked as Technical Advisor for the Government of Rajasthan from December 2014 to February 2016. His field of interest is Biomedical Signal Processing, specifically abdominal ECG signal processing, intra cellular neuronal recordings and algorithms. Apart from his engineering interests, he is greatly interested in policy issues in higher and technical education. He has a professional membership of IEEE.

Abstract:

Assessment of fetal heart rate (FHR) and fetal heart rate variability (fHRV) reveals important information about fetal well-being, specifically in high risk pregnancies. Abdominal electrocardiogram (abdECG) recording is a non-invasive method to capture fetal electrocardiograms. In this paper, we propose a methodology to extract FHR (fetal RR time series) from the abdECG recordings using the recently introduced multivariate empirical mode decomposition (MEMD) technique. MEMD breaks a signal into a finite set of intrinsic mode functions (IMFs). First, elimination of the noisier abdECG channels, based on comparison of similar indexed IMFs that were obtained through the MEMD technique, is conducted. Thereafter, denoising of the remaining abdECG channels is performed by eliminating certain similar indexed IMFs. The unwanted mother QRS complexes are removed from these noise-free abdECG channels, and the candidate fetal R-peaks are detected through a wavelet based approach. The proposed methodology is validated using an open source real-life clinical database. The proposed technique resulted in a high value (0.983) of cross correlation between the detected and true FHR signals.

Biography:

Abid Amin was born on 25th June 1956 at Murdakarez Chaman Pakistan. He pursued his Primary and secondary school education at Islamia public school, Quetta and achieved his Intermediate certification from Govt Science College, Quetta. He received his Medical education (MBBS) from Bolan medical college Quetta 1981 and did his Post graduation diploma cardiology (dip card) 1986 NICVD Karachi and Post graduate doctor in medicine (MD-CARD) 1996 NICVD Karachi. He is the Fellow American College of cardiology (FACC) 2012 and fellow of European society of cardiology (FESC) 2013. MRCP (royal college of physician Glasgow UK ) 2013. He is the Former professor of cardiology and head of dept. of cardiology Bolan medical college Quetta. He also served as Former President Pakistan cardiac society, Vice president Pakistan hypertension league and Chairman heart failure council Pakistan cardiac society. He presented numerous papers at national and international conferences (ACC,ESC,ACC middle East, PHL,PCS). Presently he sis working as consultant cardiologist and chief executive Al- Qadeer hospital, Quetta Pakistan

Abstract:

CVD (cardiovascular disease) is a major health problem worldwide. It is common in older age group >55 years of age. In the current era the disease involves younger age population (45years and less) particularly in south Asian countries e.g. India, Pakistan and Bangladesh as compared to developed countries. The common risk factors for CADs are smoking, naswar (sublingual tobacco use), hypertension, diabetes mellitus, family history, sedentary lifestyle, obesity, hypercholesterolemia and hyperlipidemia (high triglyceride and low HDL). Less common risk factors are psychological stress, hyperhomosystinemia, physical inactivity, excessive food consumption (carbs and fats) and reuse of deep frying oil. Metabolic syndrome, prediabetes and diabetes are pretty common in young population of Southeast Asia. The presentation includes studies from Pakistan, Bangladesh and India on younger population, who were studied by coronary angiography, and related risk factors were evaluated by clinical and biochemical methods.

Biography:

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

Abstract:

Introduction: Cardiovascular diseases are the greatest cause of morbidity and mortality in patients with chronic renal insufficiency. Patients treated with dialysis have a 10-20 times higher risk of developing cardiovascular disease than the general population. Patients with chronic kidney disease, apart from the usual, traditional risk factors for cardiovascular disease (age, diabetes, cigarette smoking, hypertension, positive family history), have additional risk factors, characteristic of the uremic syndrome, which are divided into the hemodynamic (anemia, retention of Na and H2O, AV fistula) and metabolic (hypoalbuminemia, hyperhomocysteinemia, oxidative stress, microinflammation, secondary hyperparathyroidism). The risk for cardiovascular disease may differ in patients on continuous ambulatory peritoneal dialysis and hemodialysis patients; especially in patients who remain on peritoneal dialysis for more than two years and which eventually lose their residual renal function. A part of cardiovascular damage in patients treated with dialysis is caused by the application of residual renal therapy. Therefore the question, whether hemodialysis or peritoneal dialysis is more harmful to dialysis patient, is very important.

Objectives: To identify the most frequent traditional and nontraditional risk factors for cardiovascular disease in patients on chronic dialysis (hemodialysis and continuous ambulatory peritoneal dialysis). To examine whether there is a difference in the frequency of risk factors for cardiovascular disease in patients on hemodialysis and continuous ambulatory peritoneal dialysis.

Design & Methodology: We conducted the prospective study that included 50 patients who were treated with chronic dialysis (hemodialysis and continuous ambulatory peritoneal dialysis). Subjects were divided into two groups; the test group: patients who were treated with continuous ambulatory peritoneal dialysis and the control group: patients who were treated with chronic hemodialysis. All the patients were taken anamnestic data, biochemical blood analysis, serum homocysteine ​​levels and underwent complete physical examination. The obtained data were submitted to statistical analysis using Student's t test and Chi square test. The statistical hypotheses were tested at α = 0.05, i.e. the difference between the groups was considered significant if p <0.05.

Results: The test group consisted of 15 subjects who were treated with continuous ambulatory peritoneal dialysis; the control group consisted of 35 subjects who were treated with chronic hemodialysis. The average age in the test group was 47.33 ± 13.86 years, the mean duration of continuous ambulatory peritoneal dialysis was 42.6 ± 3.72 months. The average age in the control group was 54.74 ± 16.08 years; the mean duration of hemodialysis duration was 79.05± 6.49 months. In the test group there was 5 (33.3%) men and 10 (66.7%) women; in the control group there was 17 (48.57%) men and 18 (51.43%) women.
Table 1 shows the prevalence of traditional risk factors for cardiovascular diseases by groups, there was no statistically significant difference between the test and control group.

Table 1. The prevalence of traditional risk factors for cardiovascular diseases by groups

Among the groups, there was no statistically significant difference between the test and control group in the incidence of anemia as non-traditional risk hemodynamic factor for cardiovascular disease. An anemia was diagnosed in 12 (80%) patients of the test group and in 31 (88.6%) patients of the control group (p - 0722). Table 2 presents the nontraditional metabolic risk factors for cardiovascular diseases by groups. There was a significant difference in central tendency for homocysteine ​​(p <0.002). Homocysteine ​​values ​​were higher in the control group compared to the test group.

Table 2: The nontraditional metabolic risk factors for cardiovascular diseases by groups

Secondary hyperparathyroidism was verified in 17 (48.57%) patients treated with hemodialysis, and in 6 (40%) patients treated with continuous ambulatory peritoneal dialysis. There was no statistically significant difference in parathyroid hormone values ​​between the groups (p 0.986).
Conclusion: In our study we did not find statistically significant differences in the prevalence of traditional and nontraditional risk factors for cardiovascular disease among patients treated with continuous ambulatory peritoneal dialysis and hemodialysis, except for the frequency of hyperhomocysteinemia, which was significantly more prevalent among patients on hemodialysis compared to patients treated with continuous ambulatory peritoneal dialysis.
The most common traditional risk factors for cardiovascular disease in patients of both groups were hypertension and hyperlipidemia.
Anemia was present in 12 (80%) patients from the test group and 31 (88.6%) patients from the control group. The most common nontraditional metabolic risk factor for the occurrence of cardiovascular disease in patients of both groups was hyperhomocysteinemia.