World Heart Congress May 22- 24, 2017 Osaka, Japan

Duo Huang is a PhD student of the University of Hong Kong and have majored in Cardiology. This study is her PhD project approved by the Institutional Review Board (IRB) of the University of Hong Kong/ Hong Kong Hospital Authority West Cluster.

Background: Left ventricular diastolic dysfunction (LVDD) has a high prevalence in patients with peritoneal dialysis (PD) therapy, and left atrial (LA) deformation analysis has been suggested as an alternative approach for estimating left ventricular (LV) dysfunction. Purpose of this study: To investigate the independent predictors of residual renal function (RRF) in PD patients. Methodology: A total of 82 PD patients (mean age: 60 ± 13years; 61% men) were recruited and followed for 3 years. Assessed the LA myocardial function using LA strain (LAs, %) parameters (systolic [LAS-S], early diastolic [LAS-E], and late diastolic [LAS-A] during atrial contraction) by two-dimensional speckle tracking echocardiography (2D-STE) measured daily urine volume and total weekly urea and creatinine clearance (Kt/V and CrCl) by using 24 hours urine and dialysate. Patients were divided into non-LVDD and LVDD groups according to the recommendations of American Society of Echocardiography (ASE). Findings: The results showed that LAS-A in the non-LVDD group decreased faster than the LVDD group after 3 years of follow-up. What’s more, the LVDD group showed faster decline of RRF as evidenced by total Kt/V, renal Kt/V, total CrCl, renal CrCl and daily urine volume than non-LVDD group after 3 years of PD therapy. Meanwhile, there were close relationships between LAS-E and total Kt/V, renal Kt/V, total CrCl, renal CrCl and daily urine volume. In addition, multivariable regression analysis demonstrated that LAS-E was demonstrated as an independent predictor of changes of total CrCl and renal CrCl. Conclusion: With LVDD, PD patients are prone to having faster decline of LA strain and RRF than those with normal diastolic function. The LA deformation parameters may be used as echocardiographic findings to predict the changes of RRF in PD patients. Therefore, maintaining LA function to protect LV diastolic function can prevent decline of RRF in PD patients.

Eliverta Zera is working as a Cardiologist in regional hospital Durres AL. She has a long experience as a Cardiologist and has tried to give her contribution in improving the health and wellbeing. This abstract is a part of her PhD studies and has a huge research background in the field of Epidemiology. This study is the first to investigate the differences in the risk factors, rate of complications and in hospital mortality between white and black patients. Our results suggest that appropriate measures are needed to increase the awareness on risk factors for patients with cardiovascular disease.

Introduction: A little is known about the differences in clinical and angiographic features and the outcomes of patients with acute myocardial infarction by race. Aim: The purpose of this study was to determine the difference in the frequency of risk factors and in-hospital outcome among patients with AMI by race in Durres population, Albania. Methodology & Theoretical Orientation: In the study were enrolled 499 patients with acute myocardial infarction hospitalized in cardiology department in regional hospital Durres, Albania, from September 2012 to September 2015. Demographic, risk factors and clinical data were collected from hospital medical records. Differences in distribution of risk factors and inpatients outcomes by race were assessed by the chi-square test for categorical variables and by Student's t-test for continuous variables. A p-value <0.05 was considered significant. Findings: Of 499 patients, 49 participants (9.8%) belonged to the black race. Compared with white patients, the black patients with AMI were younger (62.5 vs. 65.8 years old p<0.05), had more frequently a positive family history (65.2 % vs. 40.3%, p<0.05), a higher percentage of history of smoking (77.6% vs. 52.6%, p<0.05) and a higher percentage of obesity (65.3% vs. 51.2% p<0.05). The black patients were less likely to undergo coronary angiography and coronary revascularization after the AMI episode. There was no difference in the in-hospital mortality and complications rate between two groups of race. Conclusion & Significance: The risk factors for an AMI event are more likely to be present among patients who belong to black race. The black patients received less frequently a coronary angiography after episode of AMI. However, no difference was found in the complications and in-hospital mortality rate between two groups.

Evan Hindoro works as an Internship Doctor in Belitung Timur General Hospital. After graduating as a Medical Doctor in 2016, he embarked to enrich his skills and knowledge in Cardiology by working as a Research Assistant at the National Cardiovascular Centre Harapan Kita (NCCHK), Indonesia. Beside his responsibility as a Medical Doctor, he filled up his days with basic research training and participating in workshops. His credibility in medical research has been proven in several publications, both local and international journals. In 2015 his papers, titled “Fractional Flow Reserves: Nurturing a functional perspective in angioplasty” and “Routine thrombus aspiration in primary percutaneous coronary intervention: Is it still necessary?” have been published in European Heart Journal Supplement. He is currently working on a coronary artery diseases registry in the Departement of Cardiology, Siloam Hospital Lippo Karawaci, Tangerang, Indonesia.

Introduction: Pulmonary atresia (PA) with ventricular septal defect (VSD) is the ultimate form of tetralogy of Fallot, which comprises of 0.07 per 1000 live birth. Case Description: A 3 years-old boy presented with recurrent dyspnea and fatigue since 6 months ago. He usually looks blue in the lips and fingers while crying; recurrent squat and failure to thrive also complained by his parent. He was born with spontaneous vaginal birth, weight of 3200 grams. He currently weighs 10.7 kg with stable vital signs. Resting oxygen saturation of 68-72% with clubbing finger was observed. Ejection systolic murmur grade II/6 at lower left sternal border and no continuous murmur was heard on auscultation. Blood and radiology workup indicated secondary polycythemia vera and increased bilateral perihilar markings. ECG showed RAD, P pulmonale and RVH with incomplete RBBB. Transthoracic echocardiography revealed bidirectional shunt of VSD, overriding aorta, absence flow from RV to PA with abundant of major aorto-pulmonary collateral arteries (MAPCAs). No left aortic arch CoA nor PDA was found. These findings suggested a PA-VSD with MAPCAs. He was given by propranolol 5 mg once daily and referred for Blalock-Taussig (BT) shunt procedures. Discussion: In this case, the pulmonary arterial supply was from multiple MAPCAs which further divide to supply all pulmonary segments on both sides. This might explain why our patient is unique as he did not develop cyanosis or breathlessness up to 3 years old due to MAPCAs supplying blood to lungs. The symptoms persisted might due to insufficient MAPCAs to preserve pulmonary blood flow (PBF). Thus, staged repair was planned for this patient, which comprises unifocalization of the MAPCAs followed by RV to PA continuity and closure of VSD. Conclusion: BT shunt is necessary for patient with PA-VSD, especially in our patient who showed insufficient MAPCAs to preserve PBF. We should evaluate the MAPCAs before proceeding to definitive repair.

Evan Hindoro works as an Internship Doctor in Belitung Timur General Hospital. After graduating as a Medical Doctor in 2016, he embarked to enrich his skills and knowledge in Cardiology by working as a Research Assistant at the National Cardiovascular Centre Harapan Kita (NCCHK), Indonesia. Beside his responsibility as a Medical Doctor, he filled up his days with basic research training and participating in workshops. His credibility in medical research has been proven in several publications, both local and international journals. In 2015 his papers, titled “Fractional Flow Reserves: Nurturing a functional perspective in angioplasty” and “Routine thrombus aspiration in primary percutaneous coronary intervention: Is it still necessary?” have been published in European Heart Journal Supplement. He is currently working on a coronary artery diseases registry in the Departement of Cardiology, Siloam Hospital Lippo Karawaci, Tangerang, Indonesia.

Introduction: Palpitations occasionally foreshadow serious underlying cardiac event for adults. In children, however, they typically arise from physiologic stimuli such as fever, exercise, anxiety or anemia rather than life-threatening causes (eg. arrhythmia) therefore, causing frequent misdiagnosis on its underlying cause. Case description: An 11 year-old girl was presented to ER with sudden palpitation since 5 minutes ago after woke up. There were no complaints of syncope, dizziness, chest pain and dyspnea. Prior history of normal vaginal birth, no delayed of crying and cyanotic was noted. No prior family history of premature CVD. Her mother admitted she had recurrent ER visit due to palpitation despite good compliance of verapamil 40 mg BID. On physical exam, she was hemodynamic stable without any sign of heart failure and unremarkable heart examination. ECG monitor showed an orthodromic AVRT, with rate of 166 bpm. Rhythm converted to sinus rhythm after amiodarone 150 mg IV bolus. Normal chest x-ray and echocardiography were done. EP study indicated postero-lateral-anterior and right postero-septal accessories pathways. An RF ablation was successfully done. Patient was discharged and given amiodarone 200 mg OD. During 6-months follow up, there were no palpitations nor dyspnea, patient clinically stable. Findings: Rapid assessment in ER should be done in children with palpation, including ECG monitor. AVRT occurred due to the presence of AV bypass tract which may happen at rest, it accounts for approximately 80% of all cases of PSVT. In clinical practice, clinician might prefer medical therapy over ablation, especially in children due to parental fear. However, successful rate with AVRT ablation is 93.3%, with 3.3% of recurrence rate. Ablation substantially improves quality of life and reduces costs over drugs therapy in AVRT patients. Conclusion: Ablation is an effective and safe method over drugs therapy in young children with AVRT.

I Kiluk is a very promising Young Doctor, who started training in Cardiology in 01.01.2013 and PhD studies in 01.10.2013. Currently, she works as Resident Physician in the Department of Cardiology, Medical University of Bialystok Clinical Hospital. Since 4th year of the studies at the Medical University of Bialystok, she has been particularly interested in Cardiology and exhibited considerable part in the activities of Student’s Scientific Group of Department of Cardiology. During this time, she has proven to be a hardworking and dedicated Student, Scientist and now Physician, who would benefit from participation in such world-renowned event. She is the author of several publications concerning acute pulmonary embolism.

Introduction: Pulmonary embolism (PE) is a major cause of mortality, morbidity, and hospitalization in Europe. In 30-40% cases of the PE, the cause (idiopathic or unprovoked PE) cannot be determined. Nowadays, metabolomics becomes important part of clinical studies. It can help to understand the disease process and propose diagnostic and prognostic biomarkers. Until, now, there was no study using untargeted metabolomics in population of acute PE patients. Purpose: The purpose of the study is to apply metabolomics to evaluate prognosis factors and identify novel diagnostic and prognostic markers for PE, what can also bring new insight into disease pathophysiology. Methods: Prospective analysis of plasma samples collected from 42 patients hospitalized in Cardiology Department (proven acute PE, treated with low molecular weight heparin (LMWH)) and 13 healthy controls treated with adequate dose of LMWH was performed. Samples were fingerprinted with LC-QTOF-MS. Differences between patients’ subgroups (all PE patients, control after drug (CAD), subgroups of idiopathic PE patients with and without deep vein thrombosis (DVT)) and controls were evaluated. Depending on data distribution t-test or Mann-Whitney test were used. Results: Performed metabolomics analysis resulted in detection of more than 200 significantly altered metabolites. Multivariate statistics confirmed clear separation between the examined groups. Venn diagrams allow selecting common and differentiating compounds for particular comparison (Figure1). Significant changes were observed in level of cholesterol derivatives, acylcarnitines, phospholipids, fatty acid (like arachidonic acid) and their amides. Conclusions: Metabolic fingerprinting could be helpful to improve diagnosis and to understand pathophysiological mechanisms related to acute PE. The metabolites significantly different in acute PE patients were associated with hypoxia, lipid-related energy imbalance, alterations in mitochondrial function and signal transduction pathways. Moreover, some of the detected compounds were linked with cardiovascular diseases before.

Jen-Hwey Chiu is a Professor of Institute of Clinical Medicine and Institute of Traditional Medicine, School of Medicine, National Yang-Ming University, Taiwan, ROC. The expert fields include studies of acupuncture mechanisms, protective mechanisms of acupmoxa against ischemia-reperfusion injury of the heart, cancer biology and recurrent mechanisms of triple negative breast cancer.

Aims: Our previous studies demonstrated that electroacupuncture (EA) increased myocardial GSK3 phosphorylation and attenuated ischemia/ reperfusion (I/R) injury in rat hearts. However, the role of various opioid receptors (OR) subtypes in preconditioned RES-induced myocardial protection remains unknown. We investigated the role of OR subtype signalling in EA-induced cardioprotection against I/R injury of the rat heart. Methods: Male Spraque-Dawley rats were used. EA was performed on median nerves area with/without pretreatment with various receptors antagonists such as opioid receptor (OR) subtype receptors (KOR, DOR, and MOR). The expressions of Akt, GSK3, and PKCε expression were analyzed by Western blotting. When EA was preconditioned before the I/R model, the rat's hemodynamic index, infarction size, mortality and serum CK-MB were evaluated. Results: Our results showed that Akt, GSK3 and PKCε expression levels were significantly increased in the EA group compared to the sham group, which were blocked by pretreatment with specific antagonists targeting KOR and DOR, but not MOR subtype. Using I/R model, the duration of arrhythmia and infarct size were both significantly attenuated in EA group. The mortality rates of the sham EA group, the EA group, EA group + KOR antagonist, EA group + DOR/MOR antagonists (KOR left), EA group + DOR antagonist, and EA group + KOR/MOR antagonists (DOR left) were 50%, 20%, 67%, 13%, 50% and 55%, respectively. Conclusion: The mechanism of EA-induced myocardial protection against I/R injury seems to involve multiple target pathways such as Akt, KOR and/or DOR signalling.

Lusiani has completed her graduation from University of Indonesia as Medical Doctor, with the specialties including Internal Medicine from the University of Indonesia. Presently, she is working at the Cardiology Division, Internal Medicine Departement of Cipto Mangunkusumo General Hospital and Internal Medicine Departement of Aminah Hospital.

Background: HCV induced cardiomyopathy occurs only in patients who possess a certain genetic susceptibility. We are presenting a rare case of cardiomyopathy in a known hepatitis C young adult patient as an extrahepatic manifestation of hepatitis C. Case Description: A 21-year-old hepatitis C man admitted to hospital with shortness of breath since 20 days, abdominal swelling and tenderness, nausea, and vomiting. He was diagnosed with idiopatic heart failure 2 year ago. Physical examination revealed cardiomegaly and ascites. Abdominal USG showed congestive liver and splenomegaly. Echocardiography showed segmental hypokinetics and LVEF of 23%. During hospitalization, he developed cardiac arrest. Planned ICD was postponed and further evaluation has been taken. Discussion: Cardiomyopathy in young adult is a rare disease with most etiology is genetic heart diseases. This case demonstrated cardiomyopathy in a young adult man with presumed etiology is Hepatitis C. The development of HCV-associated cardiomyopathy may take place in genetically susceptible individuals in whom viral mechanisms may act in concert to produce myocardial damage. Treatment for heart failure remains a major issue in this case. Device implant might help the prognosis and survival, but the lastest medical condition has lead to postpone of those above. This patient had recurrent electrolyte imbalance due to parathyroid disease. Currently, the patient is under further investigation. Conclusion: Although the etiology of cardiomyopathy in this case still unidentified, we assumed that hepatitis C can develop cardiomyopathy. Previous study suggest that interferon is a promising treatment for myocardial diseases caused by HCV. Investigation of etiology of recurrent electrolyte imbalance might help to improve the outcome.

Annisa Ratya has completed her graduation from University of Indonesia as Medical Doctor, with the specialties including Internal Medicine from the University of Indonesia. Presently, she is working at the Cardiology Division, Internal Medicine Departement of Cipto Mangunkusumo General Hospital and Internal Medicine Departement of Aminah Hospital.

Background: Cardiomyopathy is a rare cardiac complication of SLE and potentially dangerous complication. We are presenting a case of cardiomyopathy in SLE patient as a cardiac complication of SLE. Case Description: A 27-year-old grade IV lupus nephritis woman came to our outpatient clinic for cardiovascular evaluation. She is a non-compliance dialysis patient and had no symptom. She had history of myocarditis 4 year ago. Physical examination revealed hypertension, pale conjunctiva and cardiomegaly. Laboratory results showed Hb of 6.0 mg/dL, ureum of 122 mg/dL, creatinine of 3.9 mg/dL, eGFR of 15.1 ml/min/1.73 m2, C3 of 60.6 mg/dL, C4 of 16 mg/dL, and anti dsNA of 2550.2 IU/mL. Newer echocardiography showed segmental hypokinetics, eccentric LVH and LVEF of 34%. She had methylprednison 2x16 mg, valsartan 1x160 mg, and mycophenolate mofetil 2x1000 mg. Discussion: Ineffective clearance of apoptotic bodies later induce endothelial dysfunction is the main reason of atherosclerosis induced ishemia cardiomyopathy as theoritical etiology in this case. This case demonstrated a SLE patient who has cardiovascular complication since 4 years and now progressed to cardiomyopathy. Risk factors of cardiomyopathy in this patient are untreated myocarditis, non-compliance, and Chronic Kidney Disease (CKD). Promoting effects of SLE and CKD lead to a high cardiovascular risk in lupus nephritis. Coronary angiography should remain a cornerstone of the evaluation in this patient. Conclusion: Myocardial involvement in lupus is one of the major causes of morbidity and mortality with SLE. Echocardiography remain the best imaging tool to investigate cardiovascular event, followed by other imaging modalities to help diagnoses. Prompt recognition and knowledge of cardiomyopathy might help the prognosis and survival of SLE patient.

Prafithrie Avialita Shanti is a former Resident at Department of Cardiology and Vascular Medicine, Faculty of Medicine, University of Indonesia. She has participated in ESC Congress as Cardiologist in 2015 and 2016. Her latest research was published in September 2014 in official Journal of the Indonesian Heart Association. She is also a member of several organizations such as Indonesian Heart Assosiation, Indonesian Doctor Society and Indonesian Society Interventional Cardiology.

Aortic dissection is a rare disease with fatal outcomes. Incidence of aortic dissection has recorded 5-30 cases per 1 million people per year in United States. Clinical symptoms usually mimicrize Acute Coronary Syndrome (ACS). The role of MSCT to describe incomplete triple rule out in acute chest pain clearly informs about the anatomy of coronary artery, aortic structure and anatomy of pulmonary artery. The main goal is to prevent misdiagnose and appropriate management and treatment of the underlying disease. We reported a case of Aortic dissection DeBakey type IIIb Stanford B. Male, 63 years old with chief complain of acute chest pain. At that time he was diagnosed as ACS. Detection of aortic dissection found incidentally when patient performed MSCT of coronary artery with incomplete triple rule out halpern, and then continues with MRI of aortic structure without contrast to find the entry tear side. Patients had appropriate management and treatment as aortic dissection; anti hypertension to control blood pressure and performed non-surgical intervention Thoracic Endovascular Aortic Repair (TEVAR).

Venkat Tirlapur qualified from Seth G S Medical College, Bombay in 1971. He came to Britain in 1976 and spent his junior years as a Doctor in Internal Medicine and Cardiology. His work on cardiac rehabilitation in post-myocardial infarction patients was published in The Lancet in 1979. He moved to the University of Wales as a Research Fellow for 3 years in Internal Medicine and 2 in Cardiology. His PhD research on nocturnal hypoxia and electrocardiographic changes in cor pulmonale patients was published in the NEJM in 1982. From 1986-1996 he worked as an International Investigator for multi-centre and multinational cardiovascular research studies. He has published papers in prestigious medical journals including The Lancet, Thorax, British Journal of Pharmacology, American Medical Journal, and The New England Journal of Medicine. He presently works as a Consultant in Acute Internal Medicine.

Introduction: Atrial fibrillation (AF) is the most common cardiac arrhythmia. Many studies demonstrate an increasing prevalence with persistent or permanent forms affecting 10-15% of population aged over 75 years. Management of AF is a source of debate among the American College of Cardiology, American Heart Association, European Society of Cardiology and National Institute of Health Care and Excellence (NICE). Acute Medical Units (AMU) is the first point of assessment. In view of increasing prevalence of AF and its impact on cost, we decided to complete this prospective audit. Methods: 815 patients attended AMU between 28.6.2015 to 27.7.15. Weight, blood pressure, heart rate, systemic examination, chest X-ray, ECG, CRP and Thyroid function were recorded. AF was confirmed by ECG. The number of days in hospital and total cost was calculated (NHS reference costs 2012 – 2013, November 2013). Results: Of the 815 patients, 126 suffered from AF, of which 64 males and 62 females. The average age was 76.4, ranging 30-96 years. The average prevalence was 15.45%. Data was categorized by age, <65, 66-75, 76-85 and >85, of which, the prevalence was 6.56, 18.06, 21.03 and 23.40 respectively. The average cost per day per bed was £273.00. Average hospital stay was 2.5, 4.45, 6.53, 8.61 days and average cost was £682.50, £1218.25, £1783.60 and £2349.45, respectively. 5.5% had paroxysmal AF. Conclusions: Our results show the prevalence and cost of AF is higher in over 75 years. The cost and hospital stay progressively increased with age. Thus care provision structures in the UK will be challenged by requirement to treat more patients with AF in future. It imposes a substantial economic as well as health-care burden to the NHS (National Health Service). This is likely to be true of other countries.

Zhen Zhe is a PhD student with major in Cardiology. Her major research interest is cardiac imaging especially for patients with diabetes.

Introduction: The associations between periodontitis and Type 2 diabetes mellitus (T2DM) and cardiovascular disease (CVD) have been well established recently. However, the association between periodontitis and subclinical cardiac dysfunction is not clear. In this study, our goal was to investigate the relationship between periodontitis and asymptomatic cardiac dysfunction by 1) basic dental test and 2) detailed cardiac assessment using echocardiography. Methods: 85 T2DM patients without cardiovascular diseases histories were enrolled. Dental test and transthoracic echocardiography were performed for the patient. Echocardiographic images were analyzed in detail with the following parameters i) Left ventricular function evaluated by Simpson’s method derived ejection fraction (LVEF) and speckle tracking derived global longitudinal strain (GLS), ii) diastolic function was assessed by tissue Doppler derived E’ and E/E’ ration. Dental measurement parameter including1) tooth loss number (TL) and probing depth (PD). Result: The mean age of the recruited participant are 59.9±9.1, 48.2% of them are male. Even though LVEF didn’t have significant relationship with dental parameters, TL and PD sill had significant correlation with GLS (r=0.32, p<0.01 and r=0.36, p<0.01, respectively). As to diastolic function, E’ and E/E’ also significantly associated with TL (r=-0.31, p<0.01 and r=0.32, p<0.01, respectively) and PD (r=-0.27, p=0.1 and r=0.31, p<0.01, respectively). Furthermore, multivariate analysis demonstrated TL and PD were the independent predictors of impaired GLS and E’. Conclusion: This study detected an independent relationship between the severity of periodontitis and cardiac systolic and diastolic dysfunction. These associations highlight the significance of further cardiac assessment and timely treatment for diabetic patients with periodontitis in the absence of relevant cardiac symptoms.