38^th World Cardiology Conference March 27-28, 2023 London, UK

Biography:

Neiva Maciel is a physician with experience clinical cardiology and cardiovascular imaging. She has built her career based on clinical care, cardiovascular study reporting, research and teaching at the “Hospital de Agudos Dr. Cosme Argerich”, where she is Staff of Nuclear Medicine department. She participates in the Argentine Society of Cardiology (SAC) as an active member of the Nuclear Cardiology Council; she has worked as scientific secretary for three years and elected director of the Nuclear Cardiology Council for 2023. She is part of the Scientific Committee of SAC Congress. She is Staff of “Hospital de Agudos Dr. Cosme Argerich”.

Abstract:

Problem statement: Cardiac amyloidosis is a disease caused by amyloid deposits at the cardiac level and may be multisystemic. There are more than 30 types of amyloid, 9 of which can affect the heart. There are three main types of cardiac amyloidosis: AL, ATTRwt, or ATTRh. Since cardiac compromise is what determines the prognosis, it is important to make a correct diagnosis and typing, since treatment and prognosis are different for each subtype. The diagnosis can be invasive or non-invasive. Multi-images play an important role, but not all of them make it possible to avoid endomyocardial biopsy. Two clinical cases are presented with different forms of presentation and diagnostic management.

Clinical cases: Patient 1: 87-year-old male, hypertensive and medicated, osteomuscular, compromise, neurosensory and orthostatism. Echocardiogram: SIV: 14 mm, PP: 19 mm and FEY 63%. Electrocardiogram: pseudo infarct pattern and low voltage. Bone scintigraphy: Perugini grade 3 cardiac uptake, Dosage of light chains in blood and urine by immunofixation and negative Kappa/Lambda ratio. Genetic study ruled out alteration of the TTR gene. New Echocardiogram: Longitudinal Strain of -10, SIV 16 mm, PP 11 mm and Fey 43%. It is interpreted as ATTRwt type amyloidosis and treatment is started. Patient 2: 76 years old, hypertensive, FAC, Fey: 48%, Electrocardiogram pseudoinfarction pattern, IVS 13 mm and Bone scintigraphy uptake Peruginni grade 1 and H/CL ratio 1.2 [Figure 1]. In this case, it must first be ensured that the uptake is from the myocardial walls and not the blood pool and prevent pitt falls. Tissue biopsy cardiac or extracardiac is required for correct diagnosis and treatment.

Conclusion: The diagnosis of cardiac amylodosis requires high clinical suspicion. Multi-imaging studies are required and the bone scintigraphy with phosphonates allows an early diagnosis and in the absence of blood dyscrasia allows avoiding the endomyocardial biopsy.

Biography:

Deepa Selvi Rani is from CSIR-Centre for Cellular and Molecular Biology, Hyderabad, India. She is interested in understanding the Genetic basis of Cardiovascular Diseases, Male infertility, Mitochondrial disorders and the Origin of Modern Humans. She has two master's degrees, MSc in Biochemistry and MSc in Biotechnology. Her PhD work was on "Molecular Studies in Cardiomyopathies and Noonan Syndrome." She identified several mutations in sarcomere protein genes causing cardiomyopathies and sudden cardiac arrest in Indian patients. To understand the disease specifically, she studied DNA sequence variations and their association in patients, their molecular mechanisms, which are relevant to pharmacogenomic studies and personalized medicine. She is an enthusiastic, dedicated, outstanding researcher and published more than 60 papers in peer-reviewed International Journals. She has a 23 h-index, 41 i10-index and a total of 1800 citations.

Abstract:

Background: Troponin I (TNNI3) is the inhibitory subunit of the thin filament regulatory complex Troponin, which confers calcium sensitivity to striated muscle actomyosin ATPase activity. Mutations (2-7%) in this gene were reported in Hypertrophic Cardio Myopathy (HCM) patients. However, the frequencies of mutations and associated clinical presentation have not been established in Indian cardiomyopathy patients, hence we have undertaken this study.

Methods: We have sequenced all the exons, including the exon-intron boundaries of TNNI3 gene in 101 HCM patients, along with 160 healthy controls, inhabited in the same geographical region of southern India.

Results: Our study revealed a total of 16 mutations. Interestingly, we have observed Arginine to Glutamine (R to Q) mutation at 3 positions 98,141 and 162, exclusively in HCM patients with family history of sudden cardiac death. The novel R98Q was observed in a severe Hypertrophic Obstructive Cardio Myopathy patient (HOCM). The R141Q mutation was observed in two familial cases of severe Asymmetric Septal Hypertrophy (ASH++). The R162Q mutation was observed in a ASH++ patient with mean septal thickness of 29 mm and have also consists of allelic heterogeneity by means of having one more synonymous (E179E) mutation at g.4797:GàA: in the same exon 7, which replaces a very frequent codon (GAG: 85%) with a rare codon (GAA: 14%). Screening for R162Q mutation in all the available family members revealed its presence in 9 individuals, including 7 with allelic heterogeneity (R162Q and E179E) of which 4 were severely affected. We also found 2 novel SNPs, (g.2653; GàA and g.4003 CàT) exclusively in HCM and in silico analysis of these SNPs have predicted to cause defect in recognition/binding sites for proteins responsible for proper splicing.

Conclusion: Our study has provided valuable information regarding the prevalence of TNNI3 mutations in Indian HCM patients and its risk assessment; these will help in genetic counselling and to adopt appropriate treatment strategies.

Biography:

Volodymyr V. Isaienko is affiliated from Amosov National Institute of Cardiovascular Surgery, Ukraine

Abstract:

Introduction: Among heart tumors, myxomas make up about 80% of benign neoplasms. In cardio surgical practice, the frequency of diagnosis of Primary Heart Tumors (PHT), of which more than 80% are morphologically benign tumors, ranges from 0.09% to 1.9% of the total number of hospitalized patients.

The aim of the study: To determine the issue of optimal diagnostic tactics and surgical treatment with heart mix.

Material and methods: In the N.M. Amosov National Institute of Cardio-Vascular surgery of the Academy of Medical Sciences of Ukraine for the period from January 1, 1969 to January 1, 2023, 1015 patients were operated on for primary heart tumors. Cardiac Myxomas (CM) were found in 902 (88.9%) patients, of which 793 (87.9%) cases were myxomas of the Left Atrium (LA). Myxomas of the Right Atrium (RA) were determined in 81 (9.0%) observations, CM in the Left (LV) and Right (RV) Ventricles in 8 (0.9%) cases, respectively. Multicentric tumor growth with damage to two or three chambers of the heart was detected in 12 (1.3%) patients. The age of CM patients ranged from 3 to 79 years (on average 48.4 ± 3.4 years), of which 653 (72.4%) were aged 31 to 60 years. Non-myxoma benign tumors were observed in 41 (4%) cases. Malignant tumors were observed in 70 (6.9%) cases.

Results: 328 (36.3%) and 77 (8.5%) patients with CM were assigned to III and IV functional classes according to the NYHA classification, respectively, which often required urgent surgical treatment in these groups. Hospital mortality in recent years was 0% in the surgical treatment of CM, that is, 539 operations were performed without fatal consequences.

Conclusions: The issues of optimal tactics for patients with CM consist of urgent diagnosis and surgical intervention, which ensures the effectiveness of treatment of CM, which is confirmed by the data of long-term results. There were 684 (78.3%) patients in I functional class NYHA, in II functional class-129 (14.8%) patients, respectively; patient survival up to 20 years was 79.7%.

Biography:

Shizhao Zhang has his expertise in evaluation and passion in investigating precision medicine for elderly patients diagnosed with coronary artery disease. He has formulated individualized polypharmacy for elderly patients based on the effect of gene mutations, so as to prevent potential drug–drug–gene interactions and improve the clinical outcomes.

Abstract:

Objective: To analyze the related factors of bleeding events in ticagrelor-treated elderly patients with coronary artery disease.

Method: Patients aged ≥ 65 years diagnosed with coronary artery disease and treated with ticagrelor were enrolled. All patients were followed up to observe the occurrence of Bleeding Academic Research Consortium (BARC) ≥ 2 requiring clinical intervention within 1 year. Patients were divided into bleeding group (n=55) and bleeding-free group (n=328) according to the occurrence of BARC ≥ 2 bleeding events. Multivariate regression analysis was applied to analyze the related factors of bleeding events during ticagrelor treatment 

Results: A total of 383 patients with coronary artery disease were recruited in this study, with 39 cases (10.18%) diagnosed with stable coronary artery disease, 344 cases (89.82%) diagnosed with the acute coronary syndrome and 37 cases (9.66%) received PCI. The serum level of hemoglobin and ratio of used β-blockers and calcium ion channel blocking agents were significantly lower while the platelet count, incidence of type 2 diabetes and ratio of used proton pump inhibitors were significantly higher in bleeding group than in bleeding free group. Among the eligible patients, 55 (14.36%) had BARC ≥ 2 bleeding events [Figure 1] and 10 patients (2.61%) had BARC ≥ 3 bleeding events during a 1-year follow-up. Gastrointestinal bleeding was the most common bleeding event (47.27%, n=26). Multivariate regression analysis found that decreased hemoglobin content (OR:0.98, 95% CI:0.96-1.00, P=0.02), type 2 diabetes (OR:2.46, 95% CI:1.29-4.69, P=0.01), application of proton pump inhibitors (OR:4.53, 95% CI:1.62-12.72, P<0.01) and application of β-blockers (OR:0.42, 95% CI:0.20-0.89, P=0.02) were independently associated with BARC ≥ 2 bleeding events [Table 2].

Conclusions: Hemoglobin, diabetes and concomitant medications are associated with the bleeding events in ticagrelor-treated elderly patients with coronary artery disease.

Biography:

Background: The Gini coefficient is a statistical tool generally used by economists to quantify income inequality. To our best knowledge, this is the first study to apply the Gini coefficient to power spectral of Heart Rate Variability (HRV).

Objectives: 1) Use the Gini coefficient to measure the inequality in distribution of frequency bands of HRV during rest and under mental stress. 2) To evaluate the Gini coefficient as a psychophysiological indicator of mental stress in comparison to traditional HRV indices.

Methods: Thirteen healthy subjects (19 ± 1.5 years) participated. Their RR intervals were obtained by electrocardiogram during rest (five minutes) and during mental stress (arithmetic challenge; five minutes) and were used to derive estimates of power spectral densities of HRV. Spectral Gini Coefficient (SpG) was proposed to measure the inequality in the power distribution of the RR intervals in each of HRV bands. SpG from each band was compared with its respective traditional index of HRV during the conditions of rest and mental stress.

Results: There was a significant decrease in HF power as well as significant increases in heart rate, LF power, LF2 power and LF/HF during mental stress. There was also a significant increase in SpG (LF) and SpG (LF2) during mental stress. Coefficient of variation showed SpG has more homogeneity compared to the traditional index of HRV during mental stress. The Pearson Correlation showed poor correlation between traditional and spectral indices of HRV except for LF and SpG (LF2).

Conclusions: Gini coefficient of zero means that the power is distributed equally for all frequencies and Gini coefficient of 1 suggests that there is a single frequency with all the power within a specific spectral bandwidth. In other words, increase in Gini coefficient value suggests that there are fewer frequencies, with the most power within that frequency band compared to before. Spectral inequality of heart rate variability analyzed from the Gini coefficient is an independent and homogeneous psychophysiological indicator of mental stress.

Abstract:

Shreya Ghiya is a registered physical therapist, certified Kinesiotaping practitioner and researcher currently working in USA. She is highly motivated to address and manage orthopedic and cardiovascular pathologies using various physical therapy principles. Her research interests include Yogic breathing exercises, mediation techniques, cardiovascular physiology and heart rate variability and pain mechanisms.

Biography:

Liu Haiping has her expertise in evaluation and passion in investigating precision medicine for patients diagnosed with hypertension. Her open and contextual evaluation model is based on the effects of gene mutations on the efficacy and adverse reactions of antihypertensive drugs. She has formulated individualized antihypertensive drug regimen for patients, so as to improve the blood pressure compliance rate and reduce the risk of cardiovascular adverse events.

Abstract:

To investigate the efficacy of β-blocker therapy on the clinical outcomes of patients with essential hypertension combined with Coronary Artery Disease (CAD) in the real world. Patients who diagnosed with essential hypertension and CAD during hospitalization from December 2015 to February 2017 were recruited consecutively. All patients were followed up for 5 years and Major Adverse Cardiovascular Events (MACE, defined as s a composite of all-cause mortality, non-fatal stroke, non-fatal myocardial infarction or heart failure) and blood pressure [uncontrolled blood pressure: systolic blood pressure ≥ 140 mmHg and/or diastolic blood pressure ≥ 90 mmHg] were observed. A total of 615 patients were enrolled, including 418 males and 197 females, aged 37~92 (64.14 ± 10.32) years, of whom 441 patients (71.71%) were received β-blocker therapy throughout the 5 years follow up period. Compared to non-β-blocker treated patients, the β-blocker treated patients were younger, with higher rates of myocardial infarction history and medication of nitrates and statins, lower rates of chronic bronchitis and renal insufficiency. There were no significant differences in sex category, smoking history, diuretics, angiotensin converting enzyme inhibitors, angiotensin receptor antagonists and calcium channel blockers between β-blocker treated patients and untreated patients. Multivariate logistic regression analysis found that use of β-blocker can reduce the risk of 5-year MACE in patients with hypertension and CAD (9.75% vs. 20.11%, P=0.019). The blood pressure uncontrolled rate is significantly reduced in β-blocker treated patients (45.13% vs. 48.85%, P=0.044). Age subgroup analyses showed a significant reduction of the risk of MACE in patients ≥ 65 years with β-blocker therapy (11.43% vs. 28.72%, P=0.014), while the benefit of β-blockers on systolic blood pressure control was observed only in patients <65 years (29.70% vs. 33.75%, P=0.034). β-blockers could reduce the risk of MACE and blood pressure uncontrolled rate in patients with essential hypertension and CAD and the benefits are affected by age.

Biography:

Shreya Ghiya is a passionate physical therapist with interest in Yoga and breathing exercises and their effects on different physiological variables. Her research interests include effects of breathing exercises on heart rate variability at fixed breathing rate. She also proposes new applications of Gini index on heart rate variability as an independent and homogenous indicator of mental stress evaluation.

Abstract:

Objective: Anulom-Vilom breathing (alternate nasal breathing) is one of yogic breathing exercises which aim to cure various physical and psychological ailments. The aim of this study was to compare the immediate effects of Anulom-Vilom (AV) breathing and Paced Breathing at the same breathing rate (PB) on heart rate variability.

Intervention: Twenty healthy young adults (22.3 ± 2.9 yrs) performed Anulom-vilom breathing and paced breathing for 30 minutes in a random order. Blood pressure and continuous EKG were recorded before and during each breathing manipulations. The last 5 minutes of 30 minutes of ECG data were utilized to calculate heart rate variability.

Results: Heart rate and blood pressure were significantly lower during paced breathing compared to Anulom-Vilom breathing (P<0.05). Total power, low frequency power and low frequency/high frequency increased and high frequency decreased during both breathing manipulations compared to rest periods (P<0.05). There was a breathing x time interaction on lnLF/lnHF (F=6.72; p=0.018) 

Conclusion: We found that both AV and PB resulted in decreased parasympathetic and/or increased sympathetic control of the heart. Furthermore, AV may result in less of an increase in sympathetic and/or less of a reduction in parasympathetic control than PB. Future research should aim to determine the mechanisms responsible for these changes and potentially examine the time course of autonomic changes in response to chronic AV breathing practice.

Biography:

Robert Buckingham, MD, FACP, received his MD from University of Illinois, Chicago, residency at Northwestern University and has been a practicing internist for 43 years. In addition to internal medicine, he subspecializes in cardiometabolics. He also holds several medical director positions and has published five books regarding chronic inflammation and metabolism.

Abstract:

We postulate that in a healthy, precisely timed and counter balanced 2-step dance-step rhythm; interstitial space cells facilitate cardiomyocyte health and longevity. Cardiomyocytes are work horse cells that utilize Oxidative Phosphorylation (OXPHOS) for 95% of ATP production. With such a demanding role and low proliferative ability, the cardiomyocyte must rely on an external support system consisting of helper cells to preserve functionality. Such cells include the resident cardiac macrophage, progenitor cell and fibroblast. The cardiac macrophage, with its intimate relationship to the cardiomyocyte may be capable of activating silenced cardiomyocyte embryonic genes through growth factors to replace cardiomyocyte infrastructure. In coordination with the capillary cell 2-step dance-step rhythm, cardiomyocytes predominantly utilize OXPHOS while the capillary cell and helper cells use nitric oxide production and a modified TCA cycle. Coordinated with interstitial space sanitation and inflammatory mediators, the helper cells facilitate a cytokine excitatory signal to the capillary cell causing an increase in luminal permeability to plasma immune arsenal. Increased permeability requires immediate and abundant ATP provided by a simultaneous swing to OXPHOS. Similarly, helper cells respond to the capillary cell and also swing combustion to OXPHOS for the purpose of interstitial space sanitation, extracellular matrix repair and cardiomyocyte repair/proliferation. In contrast, the cardiomyocyte responds to the capillary cell by decreasing permeability to a hostile interstitial space and swings to nitric oxide production. Once interstitial space sanitation is achieved the capillary and helper cells swing back to nitric oxide production and decrease luminal permeability while the cardiomyocyte increases permeability to a sanitized interstitial space and resumes OXPHOS. As such, during the macrophage OXPHOS phase it becomes essential to cardiomyocyte repair. In a counterbalanced 2-step dance-step rhythm the macrophage accomplishes both cardiomyocyte repair and interstitial space phagocytosis during OXPHOS for the purpose of preserved end organ functionality.