Day 1 :
Keynote Forum
Gary L. Murray
Research Heart and Vascular Institute, USA
Keynote: The potential role of a unique, simple, quick, accurate, inexpensive, routine evaluation of Autonomic Nervous System(ANS) sympathetic(s) and parasympathetic(p) activity in cardiovascular diseases(CVD)
Time : 10:00-10:45
Biography:
Gary L Murray received a Phi Beta Kappa Bachelor’s degree from Rhodes College, Memphis, TN, USA, receiving the Belk Bible Award for the most outstanding Bible student. After graduating from the Tulane University School of Medicine, New Orleans, LA, USA, his Postdoctoral training was at the University of Tennessee Center of Health Care Sciences, Memphis, TN, USA. He became Co-Director of the Cardiac Catheterization as well as Nuclear Cardiology laboratories at Baptist Hospital, Memphis, TN, USA. He then became Chief of Medicine, Nellis AFB, North Las Vegas, NV, USA. Since, he has been in private practice in Memphis, yet he has managed to publish several articles and co-created the Shad-Murray first pass RNA exercise test for coronary disease that was employed at many centers in the USA and Europe. He participated in clinical trials of the first elective coronary stent, as well as the first coronary atherectomy and laser devices. His ANS studies have been cited in the new textbook on clinical autonomic disorders by Colombo. He has spoken in several countries worldwide. He currently is Director of Research at the Heart and Vascular Institute, Germantown, TN, USA.
Abstract:
Evaluation of the important role the ANS plays in the development, progression, treatment, and prognosis of CVD has not been routine in clinical practice. However, new studies using a unique, easily applied technology have demonstrated the importance of ANS measures in the management of patients with risk factors for CVD, hypertension, orthostatic hypotension, congestive heart failure, and coronary disease. This new, unique technique and results of many studies will be discussed in detail. It is suggested that ANS measurement should be routinely used in CVD clinics, improving outcomes and lowering costs.
Keynote Forum
Matt Reed
University of Edinburgh, Scotland
Keynote: The use of patient led technology to investigate palpitations
Time : 11:15-12:00
Biography:
Matt graduated from Cambridge University in 1997. He joined the South East Scotland Emergency Medicine Training Programme in 2002 and has been a Consultant in Emergency Medicine in Edinburgh since 2007. Matt is also an Honorary Reader with the Acute Care group of the University of Edinburgh. After completing his Doctorate of Medicine thesis in 2009 on the risk stratification of syncope in the ED, Matt has continued research work in this area focusing on the use of biomarkers and ambulatory monitoring in syncope. He has published over 80 peer reviewed papers as well as numerous conference presentations and has personally been awarded over £950,000 in research contracts/grants in his career. Matt is Deputy Director and Founder member of EMERGE, a member of the RCEM Research and Publication Committee, a member of the European Society of Cardiology Syncope Task Force, a module co-lead on the Queen Mary University of London MSc Emergency & Resuscitation medicine, chair of the Royal Infirmary of Edinburgh Hospital Transfusion Committee and immediate past chair of the Scottish Transfusion and Support in Trauma Group.
Research Interests: Syncope/transient loss of consciousness, Emergency Department organ donation, Cardiac arrest
Abstract:
Matt will discuss how the current landscape of digital biomarker technology and mobile health is changing how we will deliver healthcare. He will talk about his own research in this area including the IPED multicentre study which has now finished recruiting and is investigating whether patient led mobile health technology can improve the detection of the underlying cause of symptomatic palpitations in patients who present acutely to the Emergency Department
Keynote Forum
Kosmas I. Tsakiridis
St Luke’s Hospital, Greece
Keynote: BIMA Sceletonization. Tips, tricks and advantages
Time : 12:00-12:45
Biography:
Kosmas Tsakiridis was born in northern Greece in 1967. He graduated from Medical School of Democritus University of Thrace in 1996, received a scholarship from the State Scholarship Foundation for two years, started his specialty training in Cardiac and Thoracic surgery (1998) and in 2006 he received the title from University of Cardiac and Thoracic Dept in University Hospital of Alexandroupolis, Thrace, Greece. He also completed his Doctorate study (Grade A) with the title “Effect of Lornoxicam in lung inflammatory response syndrome after operations for cardiac surgery with cardiopulmonary bypass” on the April of 2006. Since then he has been working on the private sector. From 2010 to 2016 he was the Head of the Cardio-Thoracic Department of St. Lukes Hospital, Thessalonkiki, Greece where he conducted modern techniques in a variety of cardiac and thoracic cases (off pump, valve repair etc) and also thoracoscopic techniques (VATS) for lung diseases. Since 2017, he also operates in the private Hospital “Kyanous Stavros”, in Thessaloniki, Greece. Since 2018 he has been admitted to the European Board of Thoracic Surgery (FEBTS). He is also the Member of Hellenic Society of Thoracic and Cardiovascular Surgeons (HSTCS) and from 2014 General Secretary of the Committee, Euro Asian Bridge Society (EAB) and from 2015 Treasurer of the Committee, European Society of Thoracic Surgeons (ESTS), European Association of Cardiac and Thoracic Surgeons (EACTS), Gold Member in European Respiratory Society (ERS), Member in International Association for the Study of Lung Cancer (IASLC) and in Cardiothoracic Surgery Network - CTS Net (http://www.ctsnet.org/home/ktsakiridis). Member in World Society of Cardiac and Thoracic Surgeons (WSCTS) During his training he was Clinical Fellow at the Papworth Hospital, Cambridge, UK and participated in many medical workshops in Europe.
His activities involve: paper submission to international PubMed journals (http://www.ncbi.nlm.nih.gov/pubmed/?term=tsakiridis+k.) which are now 101 papers, participation in many European conventions, conferences and medical symposia organization as well as guest speaking in various meetings and congresses. Editor in scientific PubMed Journals (Journal of Thoracic Disease – JTD, Clinics in Oncology) and Reviewer in PubMed Journals (Onco Targets and Therapy, Therapeutics and Clinical Risk Management, Archives of Organ Transplantation) Within the context of the 5th and 7th meeting of the Thoracic Surgery Working Teams (Hellenic Society of Thoracic and Cardiovascular Surgeons) He has been awarded twice the 1st place in the cardiothoracic surgery knowledge contest.
Abstract:
Introduction: The use of skeletonized bilateral mammary arteries (BIMA) in myocardial revascularization in off pump cardiac surgery has been established the last decades. Nevertheless, there is still a lot discussion and serious controversies about the broad aspect of this operation. Up to date there is no study that has examined the feasibility and the effect of the systematic use of skeletonized BIMA.
Methods: A short review of the literature helped us compare our result over the last ten years. This is a single center, retrospective observational study with 500 patients undergoing coronary artery bypass grafting. The vast majority of the operations were off the pump. BIMA was harvested skeletonized either with electrocautery or ultracision harmonic scalpel.
Results: There is an interesting rise in the percentages of BIMA through the years, reaching 80% of the patients in the last three years. The operations are almost exclusively off the pump. The graft flow was also measured with no significant differences between the arterial grafts. There were no major adverse cardiac events or complications, neither serious wound infections.
Conclusions: The systematic use of BIMA is safe and can be the gold standard for patients. The real discussion over this topic should include the coronary artery site selected for revascularization with the right mammary artery, regarding the length and the quality of the arterial graft. Furthermore, the surgical experience is an independent factor as well.
- Session: Clinical Cardiology | Cardiovascular Diseases |Cardiovascular Surgeries| Cardiology Case Reports | Cardiovascular Risk Management
Location: Meeting Hall: Gifford
Chair
Gary L. Murray
Research Heart and Vascular Institute, USA
Co-Chair
Kosmas I. Tsakiridis
St Luke’s Hospital, Greece
Session Introduction
Konstantina Triantafillopoulou
St. Luke’s Hospital, Thessaloniki, Greece
Title: Perioperative Bleeding Management in Cardiac Surgery, the multidisciplinary approach
Time : 12:45-13:15
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.
Daniela Loncar
University Clinical Center Tuzla, Bosnia and Herzegovina
Title: Diastolic dysfunction of the left ventricle in dialysis patients
Biography:
Daniela LonÄar 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.
Mohammad Haykal
Ministry of Scientific Research, Egypt
Title: Grading of LV systolic function by speckle tracking
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.
Nahid Azad
University of Ottawa, Canada
Title: Workshop:Opportunities for care optimization and hospitalization reduction for older persons with heart failure
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.
Bassem Ibrahim
North Cumbria University Hospitals, UK
Title: Workshop: Right Ventricular Failure (RVF)
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.