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

Biography:

Tomasz M Kameczura is an Interventional Cardiologist, Clinician, Inventor, Researcher and University Lecturer. He is also the Founder and CEO of NewTechMed LLC, New York.

Abstract:

Background: The reduction of heart damage and improvement of patient outcome are the main goals in the treatment of myocardial infarction. For both, shortening of time to reperfusion and use of appropriate pharmacological treatment is crucial. Two commonly recognized milestones in this area are the techniques of mechanical reperfusion and new generations of antiplatelet drugs. Restrain of myocardial metabolic activity seems to be possible third way, which may have an impact on myocardial damage especially during the critical ischemia. The use of direct heart hypothermia to reduce myocardial metabolic activity is a very promising tool for reducing left ventricle damage and improve patients prognosis.

Methods: The study is conducted using an animal model. We compared 20 domestic swines (Polish Landrace Pig), 10 in the study group (SG) and 10 in the control group (CG). The animals in both groups were randomly paired by age, sex and body mass. Animals in the CG were sequentially given analgesia, sedation and respiratory therapy. After that we got an arterial access (femoral artery), performed coronarography and by using balloon catheters (BC), we performed inflation in proximal part of  LAD (POBA) (target prox /mid LAD with a diameter of 2.5-4.0 mm behind DG1). After 45 minutes, the balloon was deflated and removed from the LAD. The animal was observed, monitored (if necessary, appropriate medication was given). After 48 hours since POBA, the MRI was performed with assessment of  EF of LV and quantitative assessment of microvascular obstruction (MO). Similarly, in SG the coronary angiography was performed with POBA LAD. After removal of BC from the LAD, a dry puncture of pericardium (pericardial catheter inserted to the pericardial sac) was performed, with subsequent 12 hrs procedure of direct hypothermia of heart (saline 30°C). 48 hours since POBA, there was MRI evaluation made in CG (MRI CG2) with estimation of  EF and MO.

Conclusion: Direct heart hypothermia (DHH) method by METcooler in acute experimental heart ischemia is a viable and safe method in an animal model. Dry pericardial puncture and lowering the temperature in the pericardial sac by applying a closed refrigerant circuit are relatively simple procedures that can be performed if necessary in a regular ER or cardiology department. Preliminary results demonstrate that the DHH may be considered in the future as an additional method to reduce cardiac damage in the course of myocardial infarction. In the future we plan to carry out further researches that will strengthen the position of the DHH as a strategic element of the proceedings in myocardial infarction, TAVI and BAV surgeries, as well as bridging therapy in advanced coronary artery disease before the heart transplant (HTX) and unstable ventricular arrhythmias.

Biography:

Galya Atanasova has completed her PhD training in Cardiology from Department of Cardiology, Pulmonology and Endocrinology at Pleven Medical University, Bulgaria. She is a General Practitioner and Cardiologist in Trainee at Pleven Medical University, Bulgaria. She specialized in General Medicine from Pleven Medical University, Bulgaria during 1993. She has attended many international events and presented her research work. She did many researches on metabolic syndrome and myocardial infarction of heart.

Abstract:

Objectives of this study is to evaluate influence of the metabolic syndrome (MS) and its components on pulse pressure (PP) and apolipoprotein B/apolipoprotein A1 (Apo B/Apo A1). A total of 107 persons without any apparent disease were selected. Among these subjects MS was found in 36. One way ANOVA test, multiple comparison test of means and multiple logistic regression analyses are used. The four groups used in ANOVA are men and women with and without MS. The ANOVA F-statisticis showed 3.683 with p-value 0.0145. The multiple comparison tests showed differences between subjects with and without MS. The first logistic regression includes gender, PP and Apo B/Apo A1. The results showed that the pulse pressure was the more significant factor that contributes to metabolic syndrome for women than for men. The results showed that PP and Apo B/Apo A1 ratio could be used as complex marker for MS, Fig.1. When the pulse pressure was wide and wriest was greater than 102/88 cm (men/women) the odds ratio was above 1. These two factors could be used to diagnose metabolic syndrome. The same conclusion could be made for wide pulse pressure and triglycerides level greater than 1.7 mmol/l. The results showed that PP and wriest or triglycerides level could be used as indicator of MS. In conclusion, wide pulse pressure with some of the considered clinical and biochemical markers could be used to diagnose MS. The results showed that for simultaneously increase of PP with 5 mm Hg and increase of Apo B/Apo A1 with 0.05045 it was expected about 1.5787 times increase in the odds ratio (OR) of MS. The results indicated relation between PP and increase of OR of MS. The increase of OR of MS with increase of PP and Apo B/Apo A1 is obtained. Increase of PP and Apo B/Apo A1 influences cardiometabolic risk.

Biography:

Ashish K Saxena is a Clinical Cardiologist, an alumnus of Christian Medical College, Ludhiana. He has special interest in heart failure, diabetes and thyroid disorder, and is passionate about learning, clinical research and improving the health and well-being of the society. With the aim to attain best knowledge and explore newer frontiers in the treatment of various disorders he drives a passion to teach and make awareness about quality of health and life. This approach is responsive for his easy accessibility and confidence attained by his fellow co-workers and patients associated with him.

Abstract:

Thyroid diseases, both hyperthyroid and hypothyroid have significant profound and clinically relevant findings on the heart that gives rise to various signs and symptoms of cardiovascular disease. There needs to be an understanding of the action of this hormone on the cardiovascular system and it is possible to explain the changes in the cardiac output, contractility, rhythm changes, blood pressure and vascular resistance. Echocardiography is an emerging scientific application that gives a better assay of the cardiovascular haemodynamics and its reversibility on subsequent follow up of patients. Pericardial effusion, heart failure, dyslipidaemia and the complex interrelationship between hypothyroidism and ischemic heart disease can be well established on echocardiography.  Primary pulmonary hypertension a progressive disease leading to right heart failure and premature death is often of unknown origin. Recently, a link to the thyroid disease has been identified and this disease can be kept among one of the differential diagnosis. Diastolic dysfunction and mitral valve prolapse, enlargement of left atrium and atrial fibrillation leading to congestive heart failure can be easily demonstrated by echocardiography. The clinical correlation of the thyroid hormone with the EKG and echocardiography helps to attain a better level of understanding the prognosis of the disease as well as a guide to the morbidity and mortality associated with the disease.

Biography:

Ayman Saleh is currently working as a Professor of Cardiology at Ain Shams University, Egypt.

Abstract:

Background: No reflow phenomenon is associated with major adverse cardiac events, prediction of no reflow using laboratory and noninvasive imaging techniques can help in early prevention and management of this phenomenon.

Objectives: To investigate the predictive value of serum sP-selectin and endothelial dysfunction assessed by using brachial artery flow mediated dilation (FMD)  in patients with STEMI undergoing primary PCI to address patients with high incidence of no reflow.

Methods: The prognostic performance, clinical and angiographic correlates of sP-selectin and FMD was assessed in 96 patients admitted in National Heart Institute and Ain Shams University Hospitals by STEMI and underwent primary PCI as a reperfusion strategy. Each patient was subjected to (history taking, clinical examination, laboratory investigations including withdrawal of serum samples for detection of sP-selectin levels, echocardiography, and assessment of endothelial dysfunction by measuring the FMD, assessment of the angiographic results using TIMI flow grade and myocardial blush grade. Follow up of the patients during hospital stay and after one month for the incidence of MACE.

Results: A significant correlation between patients with high serum sP-selectin and TIMI flow ≤ II was found (P=0.038) and between the serum levels of the sP-selectin and the MBG score (P=0.009), also a significant correlation between the FMD and the MBG score among the study cases (P=0.029) as well as a significant correlation between the FMD and the serum P-selectin level among study cases (P=0.016). There were no statistical significance between TIMI flow grade and brachial artery FMD (P=0.075). Also no significant correlation was found  between the patients' serum levels of sP-selectin, brachial artery FMD  and the incidence of MACE during the hospital stay or during one month of follow up after discharge (P=0.127 and P=0.693, respectively).

Conclusions: Serum sP-selectin level in patients with STEMI treated by primary PCI can predict the patients who will develop no reflow phenomenon after PCI, FMD could not predict the incidence of no reflow among those patients.

Biography:

Cornelia Zara is a Cardiologist at Theracardia, Romania. She has a keen interest in heart failure patients. Her specialties are in Cardiology, Cardiac Ultrasound and Vascular Ultrasound.

Abstract:

Background & Aim: It is well known that the latest concern of medical community is to identify the predictor factors for heart failure decompensations, in order to avoid undesirable hospitalizations. Identification of predicting factors for HF decompensations remains elusive with current clinical (symptoms, congestion score), biochemical (natriuretic peptides) and imaging (left ventricular ejection fraction, LV filling pressures and pulmonary B-lines) parameters. B lines and LV ejection fraction added to NT pro BNP could predict HF patients outcome and re-hospitalization risk. Thus, the aim of this retrospective study was to point out predicting factors for HF decompensations.

Methods & Results: 138 HF outpatients were included with a median follow-up of 24 months. Management was guided by current HF guidelines. Every patient went through a complete clinical exam including 6 MWT, standard transthoracic echocardiography focused on filling pressures parameters and B lines identification by pulmonary ultrasound. Biochemistry included serum creatinine and NT-pro BNP. Mean age of the group population was 70 years and 62% were men. As it concerns the etiology of HF, valvular disease was the most common (46%), followed by ischemic heart disease (33%) or a mix between them (9%). 50% of the patients were in III and IV NYHA class. Thirteen patients (9%) died during follow-up period. The advanced age, low weight, short distance in 6 MWT and advanced NYHA class correlated with death. NYHA class severity correlated with LV EF, ESV, LVOT VTI, the number of B-lines and also with the levels of NT-pro BNP. The number of HF decompensations were linked to the presence of high blood pressure, abnormal creatinine level, low TAPSE and advanced NYHA class.

Conclusion: B lines, LVEF, ESV and NT-pro BNP added to NYHA class approach could reduce re-hospitalizations in HF outpatients. Also, a good control of the blood pressure and renal function could decrease the risk of HF decompensations.

Biography:

Gobinda Kanti Paul has completed his MD in Cardiology and Post-graduation degree from NICVD under BSMMU in January 2008. He has published more than 10 publications in various index journals. He has passion for non-intervention cardiology specially echocardiography and preventive cardiology. Currently, he is an Assistant Professor/Consultant Cardiology and Residential Physician (RP) in the Mymensingh Medical College and Hospital. He also has a special interest in rheumatic fever and rheumatic heart disease and its prevention.

Abstract:

A 7-year old boy was diagnosed with William’s syndrome clinically with the help of some investigations. This child having mal-occlusion of multiple teeth with dental carries, large forehead, small chin, puffiness around both eye, looks like “elfin facies” with low IQ. He has a systolic murmur (Grade-3/6) in the base of the heart. Echo, Doppler gradient found in the just supra-valvular area, 114mmHg (Supra-valvular Aortic stenosis) & MVP (Mitra valve prolapse). This child also has blockage of naso-lacrimal duct, causing watering of eye. William’s syndrome (WS) is a neuro-developmental, multi-system genetic disorder characterized by distinctive personality traits, facial dysmorphisom (“elfin face”) and congenital cardiac defects, of which supra-valvula aortic stenosis is the most common lesion found. It is characterized by congenital heart defects (CHD), Skeletal and renal anomalies, cognitive disorder, social personality disorder and dysmorphic facies. WS is a rare familial multi-system disorder occurring in 1 per 20,000 live births.

Biography:

Jun-Yang Liou has his expertise in molecular signaling in regulating cell proliferation and differentiation. His research interests focus on these areas: (1) Role of 14-3-3 proteins, focal adhesion kinase and their associated downstream targets in cancer cell survival, proliferation, migration as well as tumor progression and metastasis. (2) Molecular mechanisms and signal pathways of 14-3-3 and Rho-ROCK in regulating mouse embryonic stem cell differentiation and proliferation. He has identified that inhibition of ROCK signaling contribute to neural and cardiac differentiation of mouse embryonic stem and induced pluripotent stem cells.

Abstract:

Cardiac and hematopoietic stem cells (HSCs) derived from embryonic ES cells are unlimited cell source and are potentially used for cell transplantation of various heart and hematological diseases. Rho-ROCK signaling was implicated in regulating differentiation of various stem cells. Rho-associated kinase (ROCK) plays an important role in maintaining embryonic stem (ES) cell pluripotency. However, whether ROCK involves in modulating mesodermal differentiation including cardiac stem/progenitor cells and HSCs remains unclear. To determine whether ROCK is involved in ES cell differentiation into cardiac and hematopoietic lineage, we evaluated the effect of ROCK inhibitors, Y-27632 and fasudil on murine ES and induced pluripotent stem (iPS) cell differentiation. Cells were cultured in hematopoietic differentiation medium in the presence or absence of ROCK inhibitor and colony formation as well as markers of HSCs and ES cells was analyzed. ROCK inhibition resulted in a drastic change in colony morphology accompanied by loss of HSC and expression of cardiac progenitor cell markers. Fasudil-induced cardiac cells were infused into a murine myocardial infarction model. They preserved left ventricular function. These findings provide new insights into the signaling required for ES cell differentiation into cardiac lineage or HSC and suggest that ROCK inhibitors are useful in directing iPS cell differentiation into cardiac progenitor cells for cell therapy of cardiovascular diseases.

Biography:

Carola Y Förster has a convincing track record in Neurophysiology with a strong focus on the dysfunctions of the blood-brain barrier (BBB). A significant aspect of her research is related to regulation of gene expression at the BBB, specifically by non-coding RNA, particular microRNA, to offer pharmacological solutions to the observed BBB alterations. For this, CF systematically studies the mechanisms from gene regulation, through transcription, to protein degradation and cellular morphology, linking basic science with clinical aspects. After years of experience in research, evaluation, teaching and administration both in hospital and education institutions, CF developed different in vitro and in vivo models of cerebrovascular disease and established recently a division of computational model to further strengthen this area of research.

Abstract:

Statement of the Problem: Cardiovascular diseases are the main cause of death worldwide. Aging populations show higher incidences of myocardial infarction, heart failure and stroke. MicroRNAs (miRs), a group of non-coding RNAs involved in mRNA regulation, have been demonstrated to play a role in many cardiovascular disorders. Blood-brain barrier (BBB) integrity is one of the important elements of central nervous system (CNS) homeostasis. Studies on regulators of BBB-physiology in health and disease may lead to new therapeutic strategies in cardiovascular system.

Methodology & Theoretical: An overview of the newest literature considering the miRs and their role in cardiovascular system will be given. In vitro and in vivo models for studying these regulations will be presented with methodological details.  An example of experimental work on brain microvascular endothelial cells and an experimental stroke model will be presented.

Orientation Findings: MiR-132/212 has been identified to be increased in hypoxic brain micro-vascular endothelial cells from mouse and humans. Specific targets of these miRs have been identified and studied for their miR-132/212-mediated regulation in vitro. In addition, in vivo inhibition of miRs has been examined in experimental stroke model. Cerebral capillaries were isolated from the control and hypoxic group. The selected target genes were also regulated by miRs in vivo. Inhibition of miRs in experimental stroke led to a decreased apoptosis of hippocampal neurons, as shown by TUNEL staining. However, there was no effect on lesion size and functional outcome.   

Conclusion & Significance: Elucidating the role of miRs in cardiovascular system may open new avenues for therapies and drug delivery.

Biography:

Abstract:

Biography:

Beder Gustavo Farez has completed his Medical studies at Universidad Nacional de La Plata, and has done Post-doctoral studies at Fundación Favaloro in Argentina, Hospital Universitario San Carlos, Madrid, Spain. He is a Professor of Medical Clinic and Physiology at Universidad Católica de Cuyo.

Abstract:

Heart failure with preserved ejection fraction is the most common kind of presentation of this syndrome in the office and laboratory of echo; and it is not easy to define whether the symptoms come from diastolic dysfunction. The patients frequently have comorbidities such as lung disease, anemia, and so on, thus the challenge is to detect the real origin of the symptomatology. There are many techniques to study the diastolic function, some are old and some are new, and most of them can be useful. Unfortunately, not all echo laboratories have machines with emerging techniques, so the results should be very well thought of. The general practitioner’s interpretation is a very important issue, which affects the physician’s treatment decision, and cardiologists often do not keep this in mind. In the echo results there are a lot of numbers, formulas, and conclusions that sometimes are confusing and do not help GPs to guide the treatment. Reports have to include the hemodynamic state, fluids, cardiac index, pulmonary artery pressure, filling pressure, and other data that can improve the treatment of patients. The aim of this presentation is to help GPs take advantage of all the information supplied in echo reports, since echocardiograms are becoming one of the most important complementary studies to evaluate patients with systolic and/or diastolic heart failure.

Biography:

Bambang Budiono has his expertise in Interventional Cardiology for 15 years. He has a lot of clinical experience and involved in some international registration and trials. His interest and expertise in interventional cardiology is well known, which make him invited as faculty in a lot of regional and international meetings.

Abstract:

Statement of the Problem: The aim of using thrombus aspiration in STEMI is preventing distal embolization. Routine use of thrombus aspiration for STEMI has been down grade in recent guidelines from class IIA to Class IIB, and even class III, due to lack of benefit regarding cardiovascular endpoints, and evidence of harm as suggested by the increased risk of stroke. However, in total study there are only 64% with TIMI 0 flow in initial angiography, and 8% without evidence of thrombus. Therefore, in STEMI patients with heavy thrombus burden, or with TIMI-0 flow, the usefulness of thrombus aspiration needs to be evaluated.

Methodology: A prospective non randomized study was conducted with 36 STEMI patients with TIMI 0 flow in initial angiography.  Adult patients (≥18 years of age) with STEMI were eligible for inclusion in this study if they were referred for primary PCI within 12 h of symptom onset. Patients who had undergone previous coronary artery bypass surgery or had received fibrinolytic therapy were not eligible. All participants provided written informed consent. 6 Fr. Compatible thrombus aspirations were used in all of patients.

Result: Final angiography after stenting, demonstrated 34 patients (94.4%) with TIMI 3 flow and 32 (88.89%) patients with TIMI Myocardial Blush Score 3. 2 (5.56%) patients with TIMI 2 flow and TIMI myocardial blush Score 2. 2 Patients (5.56%) with TIMI-1 flow and Myocardial blush score 1. 6-month clinical evaluation, showed no evidence of stroke or repeat revascularization, but 2 patients (5.56%) showed recurrent hospitalization due to heart failure.

Conclusion: In STEMI with TIMI-0 flow, it is unable to recognize the amount of thrombus distal to the occluded vessel. Thrombus aspiration should be used in STEMI patients when the heavy thrombus burden is suspected, to reduce the risk of distal embolization that leads to micro-vascular obstruction. This preliminary study demonstrated potential benefit of thrombus aspiration in STEMI patients with TIMI-0 flow. Further study needs to confirm this preliminary result.

Biography:

Kavya Pingali has completed her MBBS at Siddhartha Medical College, Vijayawada. Subsequently, she obtained her MD in General Medicine at Guntur Medical College and DM Cardiology at Osmania Medical College, Hyderabad. She is currently a Senior Resident at Government Hospital, Guntur. She has an apt adroitness in performing coronary interventions. She had done multifarious coronary interventions independently, with a high success rate and a negligible number of complications. Moreover, she has a finesse to perform device closures for ASD and VSD and to implant the prosthetic heart valves.

Abstract:

Background: Implantation of prosthetic cardiac valves to treat hemodynamically significant valvular diseases has become common; however it is associated with complications. Thus this study was intended to evaluate the indications for implantation of prosthetic valve and complications after its implantation and prognosis after treatment of one of its complication, i.e., stuck valve.

Methods: This was a single-centered study wherein 50 patients who came to the emergency department with stuck valve were assessed. The 2D echocardiography was performed in all patients. Thrombolysis was done and the gradients were reassessed; further, response to treatment and development of complications before and after treatment were observed.

Results: Of total patients, 60% were females; mean age group was 30-40 yrs. Of these 80% presented with shortness of breath, 20% with palpitations, tachycardia was seen in 80% patients, blood pressure was <100/70 mmHg in 80% patients, hemoglobin was <8 gm% in 60% patients, serum bilirubin elevated in 45% patients, most of them were asymptomatic for 6 years and there was lack of compliance in 90% of patients. Drug used was Acitrom (acenocoumarol) 2 mg in 90% patients and drug interaction with digoxin is seen in 4% and INR was less than 1.5 in 25% of patients. Cardiomegaly was observed in 60% and 2D echocardiography showed global hypokinesia in 60% patients. Most common indication for valve replacement was mitral stenosis (60%) followed by mitral regurgitation (20%), aortic regurgitation and aortic stenosis (10%), combined mitral and tricuspid regurgitation (10%). Commonest valve was St. Jude (90%). Pannus was observed in 10% patients and thrombus was observed in 50% patients. Most patients had gradients 45/20 mmHg across mitral valve. In about 90% patients gradients decreased after thrombolysis (12/5 mmHg). The complications after valve placement were hemiparesis (4%), death before thrombolysis (5%) and death after thrombolysis (4%).

Conclusion: In light of these results, it can be concluded that prosthetic valves are seldom associated with some complications. Further, thrombolysis can be effective in patients with prosthetic valve thrombosis.

Biography:

Donglu Shi has received his PhD in Materials Science and Engineering in 1986 from the University Massachusetts at Amherst. He was a PI and Staff Scientist in the Materials Science Division of Argonne National Laboratory between 1988 and 1995. In 1995, he joined the faculty in the Department of Materials Science and Engineering at University of Cincinnati. He is currently the Chair of the Materials Science and Engineering Program at University of Cincinnati. He has so far published 265 refereed SCI journal publications including Physical Review Letters and Nature. He has edited 10 books on superconductivity, functional thin films, nanomaterials, biomaterials, tissue engineering, and nano biomedicine. He is the Editor-in-Chief of Nano LIFE, and Associate Editor of Materials Science & Engineering: C, and J. of Nanomaterials. He has won the Graduate Fellow Award, Excellent Researcher Award, SIGMA XI Research Recognition Award, and Neil Wandmecher Teaching Award.

Abstract:

In this presentation, we report the design of a new nanostructure that ideally satisfies the important biomedical requirements in medical diagnosis and treatment. Quantum dots (QDs) were conjugated on magnetic nano spheres (MNS) of polystyrene-Fe₃O₄ composites. Surface-associated QDs on these MNS exhibited intense visible emissions using fluorescent spectroscopy and successfully facilitated in vivo soft tissue imaging in mice. Furthermore, application of an alternating electromagnetic field effectively induced heating of the MNS into temperature ranges suitable for therapeutic hyperthermia. The magnetic nano spheres were incorporated with PLGA for drug delivery through an emulsion technique. The drug loading efficiency of PLGA-coated MNS were investigated. MNS were also functionalized with antibodies to target a lesion. Experimental results on MNS surface structure development, in vivo imaging, cell targeting, and hyperthermia will be presented. Future requirements, aims, and trends in the development of multi-functional nano particles, including graphene, particularly with intelligent functionalities for fundamental studies, are also given in this presentation.

Biography:

Attila Czompa, Pharm D, PhD, is responsible for the preparation of isolated working hearts originated from different types of rodents, and studying molecular signaling mechanisms associated with myocardial ischemia/reperfusion-induced injury. His studies also involve the measurement of ventricular function and myocardial infarct size by determining necrosis apoptosis and autophagy, western blot analysis and immunohistochemistry techniques.

Abstract:

Aims: According to the latest WHO mortality rates, ischemic heart diseases within the cardiovascular diseases are the main cause of death among non-communicable diseases. In the following investigation, we have aimed to test the properties of a nitric oxide (NO) donating acetylsalicylic (ASA) derivative, which is newly synthesized, stable, and water soluble compound at the University of Debrecen, Hungary. Based on our hypothesis this molecule could combine the positive effects of the anticoagulant ASA and the vasodilator effect of NO, therefore, it could be a more powerful medication against ischemic heart diseases.

Materials & Methods: In the first part of our experiments, we have aimed to test in vitro the possible cytotoxic effect of our ASA derivative on the MTT cell viability. H9c2 rat embryonic cardio myoblast cells were cultured in 10^-4–10^{-7 M containing medium. Next, we have measured the vasoactive effects on female Sprague Dawley rats ex vivo according to the Langendorff method in the presence or absence of the NO donating molecule.}

Results: Our newly synthesized NO donating ASA derivative did not affect the cell viability at the tested concentrations. Furthermore, we have noticed a dose-dependent vasodilatation was caused by our NO liberating compound.

Discussion: Based on the beneficial observations through our experimental arrangement, the new molecule synthesized at our University is a powerful vasodilator with no significant toxic effects. It may contribute to new therapeutic approaches against ischemic heart diseases and possibly related syndromes, but the molecular mechanisms need to be clarified.

Biography:

Michiaki Nagai has completed his graduation from the Jichi Medical University School of Medicine and has been engaged in the Cardiovascular Medicine. Using volumetric analysis in MR SPGR imaging, he has been investigating the fields for target hypertensive organ damages including the relationships among hypertension, blood pressure variability, brain atrophy, cognitive impairment and central autonomic nervous system including the insular cortex. He was engaged in the Interventional Cardiology at Hiroshima City Asa Hospital as the Vice Director. He won the Japanese Society of Hypertension Award in the International Society of Hypertension 2006, the Young Investigator’s Award in the 8^th Japanese Neurocardiology Workshop 2007 and Young Scientist Award in the second annual scientific forum of clinical hypertension of the Japanese Society of Hypertension 2013.

Abstract:

Transient left ventricular dysfunction in patients under emotional stress, also known as takotsubo cardiomyopathy, has been recognized as a distinct clinical entity. Recent studies have supported a notion that the cardiovascular system is regulated by cortical modulation. A network consisting of the insular cortex (Ic), anterior cingulate gyrus, and amygdala plays a crucial role in the regulation of central autonomic nervous system in relation to emotional stress such as anxiety, fear and sadness. Because, Ic is located in the region of the middle cerebral arteries, its structure tends to be exposed to a higher risk of cerebrovascular disease. And Ic damage has been associated with myocardial injury, increased brain natriuretic peptide and incidence of takotsubo cardiomyopathy. Because, Ic damage has been associated with increased sympathetic nervous system activity, Ic damage is suggested to have a pivotal role in the pathophysiology of takotsubo cardiomyopathy. We focus on the role of Ic as a mediator for the cardiovascular system in relation to emotional stress, and summarizes current knowledge on the relationships between Ic and takotsubo cardiomyopathy.

Biography:

Ima A Kusuma is a General Cardiologist at “JIH” Hospital Yogyakarta. She has passion in research and statistics. Her last research was effect of different fluids on endothelial glycocalyx in post CABG patients.

Abstract:

Introduction: Cerebral venous sinus thrombosis (CVST) is a rare neurovascular disorder with variable clinical presentation. CVST usually affect young individuals and three times more often in women than men. Mainstay therapy for CVST is giving heparin then continued by oral anticoagulant. However, achievement and maintenance of optimal INR is often difficult. One topic that will most likely be examined in the near future is the role of new oral anticoagulants (NOACs) in the treatment of CVST.

Case Report: A 37 years old woman with history of headache for two months admitted to the hospital with mild right sided weakness. She had dyslipidemia and history of taking oral contraceptives several years ago. On physical exam her vital signs were stable and within normal limits. Cerebral CT scan examination showed normal result, then MRI (MRA-MRV) was performed. MRV showed defect at left sinus tranversus. Patient was given new oral anticoagulant, rivaroxaban. It started at dosages of 15 mg twice daily. On the fifth day follow up, the right sided weakness was revealed. Rivaroxaban then continued for 21 days, followed by rivaroxaban 20 mg once daily. On the third months follow up, there were no complications in this patient.

Discussion: In patients with VTE and atrial fibrillation, NOACs are associated with an approximate 50% relative risk reduction in ICHs compared to warfarin. In neurological patients achievement and maintenance of optimal INR is often difficult. Various modifiable factors including diet, choice of drugs and their dosage are important predictors of stability hence should be carefully adjusted. The Rocket trial documented that rivaroxaban, a novel oral anticoagulant, has a lower rate of most concerning bleeds: fatal bleeding and intra cranial haematoma compared to warfarin, which makes it particularly attractive for the treatment of CVST. In this case, the use of rivaroxaban gave excellent result with no complication.

Conclusion: This case suggests a potential role of novel factor Xa inhibitor in the treatment of CVST.

Biography:

Kavya Pingali has completed her MBBS at Siddhartha Medical College, Vijayawada. Subsequently, she obtained her MD in General Medicine at Guntur Medical College and DM Cardiology at Osmania Medical College, Hyderabad. She is currently a Senior Resident at Government Hospital, Guntur. She has an apt adroitness in performing coronary interventions. She had done multifarious coronary interventions independently, with a high success rate and a negligible number of complications. Moreover, she has a finesse to perform device closures for ASD and VSD and to implant the prosthetic heart valves.

Abstract:

Aim: We aimed to study the clinical profile, risk factors, angiographic distribution and in-hospital outcomes of patients with complete heart block.

Methods: This was a prospective study which included 100 patients who came to the emergency department with complete heart block. Routine blood investigations including serum electrolytes were done. Coronary angiogram was done and lesions were assessed. Temporary pace maker was implanted followed by permanent pacemakers in required patients, and in-hospital complications were noted down.

Results: Commonest age group was >60 years (75%). The patients were predominately males. Most common presentation was chest pain (60%), followed by shortness of breath (30%) and giddiness (20%); 43% patients were on known hypertensives. Blood pressure at the time of admission was 100/70 mmHg, mean heart rate was around 40 bpm, tachypnoea was observed in 5% patients. Auscultation creps were found in 5% patients, creatinine levels were elevated in 5%, hypokalemia in 15%, echo showed regional wall motion abnormality in 30%. Severe and mild LV dysfunction 15% and 12% patients and good LV function in 3%. Degenerative complete heart block seen in 34% patients, diphtheric myocarditis 15%, hypokalemic 15%, dilated cardiomyopathy 2%. Of total, 53 patients had AV block, 14 had bifascicular block, 23 had LBBB, 6 had RBBB, 3 had mobitz I, and 1 had mobitz II. Inferior wall myocardial infarction (MI) was pervasively present in patients. On coronary angiogram, lesions were found in right coronary artery (RCA) (41%), left anterior descending artery (LAD) (23%), left circumflex artery (LCX) (23%), LCX and LAD (8%) and triple vessel disease (8%). Temporary pacemakers were implanted in 6 patients and permanent pacemakers in 43 patients. In-hospital outcomes constituted of complication like cardiogenic shock (10%) and death (26%). The patients who died either had 80-90% stenosis in RCA, triple vessel disease, ostio-proximal LAD occlusion, or diphtheric myocarditis.

Conclusion: Complete heart block was majorly associated with advanced age and inferior wall MI, virtually caused by dominant RCA occlusion. The in-hospital mortality was significantly higher in the patients with CHB.

Biography:

Evan Hindoro is currently an Internship Doctor at Belitung Timur General Hospital. After he graduated as Medical Doctor in 2016, he embarked to enrich his skills and knowledge in Cardiology by working as Research Assistant at National Cardiovascular Centre Harapan Kita (NCCHK), Indonesia. Beside his responsibility as Medical Doctor, he filled up his days with basic research training and workshop. His credibility in medical research has been proved in several publications in local and international journals. In 2015, his paper “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 coronary artery diseases registry in Department of Cardiology, Siloam Hospital Lippo Karawaci, Tangerang, Indonesia.

Abstract:

Statement of the Problem: Lipid has been identified as one of the pathogenic factors of atherosclerotic lesion in the last decade, especially coronary artery. Recent lipid guideline recommends the achievement of optimal lipid profile in very high risk patients. The purpose of this study is to support the proposition that serum lipid levels correlate with the severity of coronary artery lesions observed by coronary angiography.

 Methodology & Theoretical Orientation: 180 patients who had undergone coronary angiography were included in this study. Blood samples were taken to undergo lipid profile assessment, including total cholesterol (TC), high-density lipoprotein cholesterol (HDL), low-density lipoprotein cholesterol (LDL) and triglyceride (TG). New emerging lipid workups comprising atherogenic index (AI) and TG/HDL ratio were also calculated to predict the severity of coronary artery disease. Significant stenosis was defined as a reduction of at least 50% in the coronary artery. Angiographic findings were classified into multi-vessel disease, multi-lesion and extensive lesion. The correlation between lipid profiles and coronary angiography characterizations were analyzed by two ways ANOVA (SPSS 14.0).

Findings: There was significant correlation between lipid parameter level and angiographic findings respectively (multi-vessel disease, multi-lesion and extension lesion) (0.05, 0.001 and 0.001). Both atherogenic index and TG/HDL ratio have significant correlation to severity of coronary artery lesion.

Conclusions & Significance: Dyslipidemia is a significant risk factor in coronary artery disease. Nearly all routine parameters of lipid variables were associated with extent of coronary artery lesion. Atherogenic index and TG/HDL ratio are correlated to coronary angiography findings. As the sample size was small in our study, further large-scale population studies are required on this subject to draw solid conclusions.

Biography:

Dr. Ellahham has served as Chief Quality Officer for SKMC since 2009. In his role, Dr. Ellahham has led the development of a quality and safety program that has been highly successful and visible and has been recognized internationally by a number of awards.

As Chief Quality Officer and Global Leader, Dr. Ellahham has a focus on ensuring that that implementation of this best practices leads to breakthrough improvements in clinical quality and patient safety.

Dr. Ellahham is the recipient of the Quality Leadership Award from the Global Awards for excellence in Quality and Leadership and the Business Leadership Excellence Award from the World Leadership Congress. He was nominated in 2015 for SafeCare magazine Person of the Year. 

Abstract:

Nearly half of all patients with heart failure have a normal ejection fraction (EF). The prevalence of this syndrome, termed heart failure with preserved ejection fraction (HFpEF), continues to increase likely because of the increasing prevalence of common risk factors, including older age, female gender, hypertension, renal dysfunction, metabolic syndrome and obesity. In contrast to heart failure with reduced ejection fraction (HFrEF), no treatment has been proven in pivotal clinical trials to be effective for HFpEF, largely because of the pathophysiological heterogeneity that exists within the broad spectrum of HFpEF. This syndrome was historically considered to be caused exclusively by left ventricular diastolic dysfunction, but research has identified several other contributory factors, including limitations in left ventricular systolic reserve, systemic and pulmonary vascular function, nitric oxide bioavailability, chronotropic reserve, right heart function, autonomic tone, left atrial function, and peripheral impairments. Multiple individual mechanisms frequently coexist within the same patient to cause symptomatic heart failure, but between patients with HFpEF the extent to which each component is operative can differ widely, confounding treatment approaches.

Clinical trials have not yet identified effective treatments for HFpEF. Incomplete understanding of the pathophysiology of HFpEF, the likelihood that there is substantial pathophysiologic heterogeneity among affected patients, and the interplay of various risk factors have all been barriers in the development of effective treatments. Ongoing research initiatives given the rapidly increasing number of patients with this form of heart failure are critically important.

Biography:

Fontaine Guy Hugues has made 15 original contributions at the inception of cardiac pacemakers in the mid-60s. He has identified ARVD by serendipity in the late 70s, published 900 scientific papers including 201 book chapters. He is got place in 3 books: 216 Profiles in Cardiology since the 14^th century (Hurst 2003), 500 greatest Geniuses of the 21^st century (ABI) 2005 USA, the 100 Life time of Achievement (IBC) 2005 Cambridge UK. He is Reviewer of 17 journals both in clinical and basic Science. He has given 11 master lectures in China (2014). He is also working on brain and heart protection in cardiac arrest and stroke by therapeutic hypothermia.

Abstract:

Therapeutic hypothermia produced by evaporation of Per Fluoro Carbon in the fossa nasalis in a flow of oxygen reported in a prospective multicentre study has demonstrated a tendency to improve outcome in out of hospital cardiac arrest . When I saw the experiments on pigs at the Weil Institute of Cardiac Care Medicine (WICCM), I was immediately convinced that another approach of cooling could be abrupt decompression of gas. After multiple experiments, I demonstrated that it was possible to obtain on the same model a drop of brain temperature similar to the work previously reported at the WICCM. This work was presented in a Poster at the EHRA meeting Milano 2015. However, the simultaneous work on infrared images on severed pig heads suggested that it was possible to cool the brain by the decompression of gas inside the mouth instead of the nose which looks to be an even less invasive and faster method on the field. It was during these experiments that my wife watching TV beside me experienced on June 2011 an episode of cardiac arrest that I was able to diagnose immediately. I started Cardio Pulmonary Resuscitation followed by defibrillation performed by an old but still working defibrillator that I kept in the basement of my house when the original study of the method of “Fulguration” was completed. Before arrival of Fire Brigade I used a 900 ml bottle of compressed CO2 gas also available in the basement of my house and delivered the cooling gas at that time in the fossa nasalis. Despite a period of 6 min of no-flow she was able to recover after 5 days of coma with absolutely no neurologic deficit. This fortuitous resuscitation used for the first time for brain cooling by decompressed gas will be used for the first pilot study supported by the Schiller Company (Switzerland). It will start soon in the city of Lugano which is already famous for its highest success rate of resuscitation (50%). The second major interest of this new technique seems to be its application in stroke also suggested by multiple animal models experiments.

Biography:

Tassaniya Kraisornsawat has her expertise in “development in improving the health and wellbeing”. She has built this after years of experience in research and teaching both in hospital and education institutions. Now, she is the Head Nurse of Pediatric Cardiac Intensive Care Unit of Sunpasitthiprasong Hospital, Thailand. She published works particularly on heart diseases.

Abstract:

Vaso-vagal reflex is a significant and common complication in pediatric patients with cardiac catheterization. Vaso-vagal reflex includes several symptoms, such as tachycardia, pressure, lightheadedness, nausea, or cyanosis, are severe threats to cause death. To understand the vaso-vagal reflex among pediatric patients with cardiac catheterization, we conducted integrative literature to review content about nursing with the reflex. We reviewed, analyzed, and synthesized published research and grey literature between 2006 and 2016. Results were found that there were 9 papers related to vaso-vagal reflex among pediatric patients with cardiac catheterization. Overall, content about vaso-vagal reflex in pediatric patients with cardiac catheterization included three aspects. First, it was assessment of disorders and complications. Because pediatric patients with cardiac catheterization experienced changes in emotional and behavioral signs, nurses should concern and focus on these changes. Second, it was nursing to prevent irregularities and complications. Nurses need to care of the pediatric patients to reduce the pain, reducing anxiety and reducing fear. Lastly, it focuses on nursing after disorders and complications. Nurses care for the patients to get drugs or fluids to cause nausea and vomiting. Moreover, they nurse the patients with Trendelenburg position to prevent vaso-vagal reflex. Although there was little paper about the vaso-vagal reflex among pediatric patients with cardiac catheterization, it was the fundamental information to study and develop nursing practice guidelines based on the evidence vaso-vagal reflex in pediatric patients with cardiac catheterization for the future research.

Biography:

Irham Khairi has completed his graduation in Doctor of Medicine at Hasanuddin University, Makassar, Indonesia. Now, he is on duty in a primary care service at a local hospital. He is interested in conducting a study on the cardiovascular scope considering the incidence of cardiovascular disease, especially coronary heart disease, as it still holds quite high incidences in Indonesia, in addition to lifestyle of local people who have not been healthy.

Abstract:

Background: A large amount of literature has discussed the utility of lipid levels as risk factors in the prediction of cardiovascular events in the future. Many lipid and non-lipid biomarkers have been proposed as an indicator of risk factors for cardiovascular diseases. Lipid biomarkers assessed were total cholesterol, high-density lipoprotein (HDL), low-density lipoprotein (LDL) and triglycerides. However, in all studies the major atherogenic lipoprotein LDL is identified by the National Cholesterol Education Project (NCEP) as the primary target of cholesterol-lowering therapy. Dyslipidemia is a disorder of lipoprotein metabolism and included as a risk factor for coronary heart disease (CHD). Dyslipidemia may be manifested through the increase of total cholesterol, LDL cholesterol, triglyceride concentration and lower concentration of HDL cholesterol in the blood. To determine whether clinically lipids are the risk factors for CHD events, a study was conducted at RS Pendidikan Universitas Hasanuddin, Makassar, Indonesia.

Objective: This study aims to determine the frequency distribution of blood lipid levels as a risk factor in the incidence of coronary heart disease (CHD) at the RS Pendidikan Universitas Hasanuddin, Makassar, Indonesia period October 1, 2014 and November 1, 2014.

Methods: This study is a descriptive study design (cross-sectional) that aims to recognize definite lipid levels in the blood as a risk factor for CHD events. Data was taken from the primary data, where researchers visited and conducted interviews of CHD patients and from secondary data recorded on the CHD patient’s medical record, obtained from RS Pendidikan Universitas Hasanuddin, Makassar, Indonesia during the period from October 1, 2014 to November 1, 2014.

Results: The results of this study show the incidence of CHD, patients who were treated in RS Pendidikan Universitas Hasanuddin, Makassar, Indonesia, was most commonly found in men, as many as 17 people (56.7%). CHD patients were obtained highest in the age group 60-69, as many as 12 people (40.0%). CHD patients who have dyslipidemia are as many as 20 people (66.7%). In patients with dyslipidemia, we found the highest levels of lipid as increased triglycerides (TG) in as many as 6 people (20.0%), followed by increased LDL-only in as many as 5 people (16.7%). Patients with coronary heart disease who have comorbidities in which most have hypertension, in as many as 12 people (40%).

Biography:

M Parvaiz Farshori is currently working as a Professor at Department of Physiology, College of Medicine University of Hail, Saudi Arabia.

Abstract:

Introduction: According to WHO 2014 world health ranking survey Saudi Arabia ranks 27^th in coronary heart disease (CHD) related deaths. According to the same survey CHD was also the leading cause of deaths in Saudi Arabia followed by stroke, influenza, diabetes, and the kidney disease (WHO, 2014 survey). Several studies have suggested relationship between inheritance of blood group antigens and certain diseases such as diabetes, cardio vascular disease and cancers. Although many studies have suggested an association between the blood groups and the cardiovascular diseases however results have been inconsistent. For example one study suggests an association between the O blood groups and the increased risks of coronary heart disease, while others show blood group A to be associated with an increased risk CHD.

Aim: Since there are different studies with different conclusions about the association between CAD and the inheritance of AB and Rh (D) antigens, and since it is the leading cause of death in Saudi Arabia, we decided to perform a small study on 120 CHD patients who have had an acute myocardial infarction (MCI) in the recent past and were admitted to King Khaled Hospital (KKH) in Hail region of Saudi Arabia.

Materials & Methods: This study included 329 control and 111 male myocardial infarction patients enrolled at (KKH) Cardiology Department in Hail region of Saudi Arabia. On these patients’ ABO data was collected along with some other risk factors such as diabetes, smoking habits, age, gender, obesity and the family history of CAD. Data was statistically analysed using Z- test for two population proportions.

Results: Out of 329 control male population (age range 12-86, mean age 32.7 years), 3.35% were A^- and 20.7% were A⁺, 3.95% were B^- and 14.28% were B⁺, 2.43% were AB^- and 8.2% were AB⁺, 8.5% were O^- and 38.3% were O⁺. In comparison, when we analysed the blood group distribution among patients with myocardial infarction (age range 16-90, mean age 49.4 years), we found: Out of 111 male patients 0.9% were A^- and 30.6% were A⁺, 1.8% were B^- and 18.01% were B⁺, 0.9% were AB^- and 6.3% were AB⁺, 0.9% were O^- and 40.5.3% were O⁺.

Conclusions: As compared to control group A⁺ male patient show statistically high incidences of MCI and O^- show significantly low incidences of MCI.

Biography:

Ramon Hernandez Molina is a Clinical Cardiologist with over 25 years of experience in Cardiovascular Risk Assessment including prevention of cardiovascular events, as well as the cardiological follow-up of people who practice sports. For more than 5 years, he is the Reference Cardiologist for the continuous evaluation of the players of the first soccer team of Atletico Madrid. Developing activity through an intensive electrocardiographic and echocardiographic clinical evaluation in each and every one of the players, he believes that it is very important to individualize the cardiological prevention needs of the elite player to minimize their possible cardiovascular events.

Abstract:

Among the events of greater participation and worldwide repercussion is the practice of professional football. This is a sport of great importance in most of the countries of the five continents, with football-related sporting events being one of the most followed events by the world population. Unfortunately, the occurrence of adverse events related to the practice of this sport of cardiovascular origin constitutes a very important obstacle both for the normal development of this activity at a competitive level and in the development of the sports activity of elite players. The age range of high competition players in football is between 16 and 35 years. Normally these players undergo pre-entry examinations at different soccer clubs but the development of their physical activity in relation to cardiovascular events, among them sudden death, has shown that this initial evaluation is insufficient for the correct follow-up and prevention of cardiovascular events in the extreme physical activity that this type of athletes develop. The development of norms of cardiological performance in these players will allow a very significant decrease in the appearance of negative cardiovascular events as well as the prevention of any alterations that may affect their normal physical activity. There is no doubt that this type of cardiological action on the football player will contribute to the best development of football matches of the training and any activity of this type of elite athletes.

Biography:

Nicholas Chua is an Interventional Cardiology Fellow and Medical Lecturer at University of Technology MARA, Malaysia. His expertise is on Clinical Medicine, Undergraduate Teaching and Interventional Cardiology. His ongoing researches are on young acute coronary syndrome, statin therapy and dysfunctional HDL cholesterol.

Abstract:

Background: Magnesium Bioresorbable Scaffold (BRS) was launched last year. The advantage of using BRS include, reduced long-term complications such as stent fracture, late stent thrombosis and in-stent restenosis with return of normal vasomotor function and late lumen gain with plaque regression. However, procedural safety and long-term outcome data is scarce.

Objective: The objective of the study is to identify safety and outcome of patients undergoing Percutaneous Coronary Intervention (PCI) with magnesium BRS.

Materials & Methods: This was a prospective, observational single center study conducted in UiTM Sungai Buloh from 1^st November 2016 to 14^th February 2017.

Results: 7 patients who were enrolled had mean age of 46 (±9). All were male. Ethnicity breakdown showed 5 Malays, 1 Chinese and 1 Indian. Cardiovascular risk assessment revealed 85.7% diabetes mellitus, 42.9% smokers, 28.6% hypertension and 28.6% dyslipidemia. Target vessels treated were 6 left anterior descending (LAD) and 1 right coronary artery (RCA). Out of the 7 patients, 28.6% were type A lesions, 42.8% were type B1 and 28.5% were type C. Among those, 4 involved LAD-D1 bifurcations and 2 were Chronic Total Occlusions (CTO). The lesions were prepared with semi-compliant balloons in 5 cases and non-compliant balloons in 2 cases. The balloon-to-stent ratio were 1:1 (n=1), 0.92:1 (n=1), 0.85:1 (n=4) and 0.83:1 (n=1). The magnesium BRS diameters used were 3.5 mm (n=4) and 3.0 mm (n=3) with length of 15 mm (n=1), 20 mm (n=4) and 25 mm (n=2). Post-dilatation in one patient was carried out with non-compliant balloon of equal diameter to the stent, while the rest had upsizing with +0.5 mm larger balloons. Procedural outcome was 100% successful. At one-month follow-up, there were no symptoms, MACE or TLR.

Conclusions: We demonstrated safety and good short-term outcome in the use of magnesium BRS in our cohort. However, larger cohort and long-term outcome monitoring would better delineate the safety and efficacy of this BRS.

Biography:

Ioan A Gutiu has expertise in the study of atherosclerosis risk factors in cardiovascular disease especially in inflammation contribution, pathogenic interventions of non-traditional risk factors such as dental state, magnesium, uric acid, etc., all with possible therapeutical consequences. All his scientific and medical activities are linked to educational work in “Carol Davila” University of Medicine from Bucuresti –Romania.

Abstract:

Statement of the Problem: In atherosclerosis, hypomagnesaemia (HMg) may increase oxidation of LDL, activation of macrophages and platelets aggregation, freeing of cytokines, etc. Hyperuricemia (HUA) may increase risk of cardiovascular disease by metabolic interventions: could promote oxidative stress, endothelial dysfunction and low level inflammatory syndrome. Effects of association between HUA and HMg on atherosclerosis in cardiovascular disease (CVD) are still unclear now. We hypothesize that association of HMg and HUA may be found in more severe forms of atherosclerosis and may influence and aggravate atherosclerosis consequences (cardiovascular disease-CVD).

Methodology: In a cross sectional study of 405 cardiovascular patients (old myocardial infarction, angina pectoris, stroke), mean age 52.5 years, men 127 (31%), we analyzed presence of main atherosclerosis risk factors (dyslipidemia, arterial hypertension, serum glucose, smoking, obesity, etc.) and some usual markers of inflammation (fibrinogen, CPR, serum leukocytes, dental state: missing tooth and carries as markers of chronic gum inflammation).

Findings: We compared the patients group with HMg (first tertile) and high uric acid level (last tertile) with the rest of patients. Some atherosclerosis risk factors differ significantly in these groups: triglycerides (228.5+/-175.8 versus 144.5+/-108.5 mg%, P<0.001); HDL-cholesterol (45.3+/-12.5 versus 50.3+/-11.8 mg%, P<0.013), serum glucose (128.9+/-52.7 versus 95.7+/-25.7 mg%, P<0.001), systolic arterial pressure: (160.5+/-22.1 versus 152.9+/-26 mmHg, P<0.04); concerning inflammation: fibrinogen (410.8+/-120.8 versus 376.5+/-110.4mg%, P<0.034), missing tooth (18.4+/-8.4 versus 15.6+/-8.4, P<0.034).

Conclusion & Significance: Association of HMg and HUA may delimit a group of CAD patients with more severe atherosclerosis and inflammation. These deleterious effects of association of HMg and HUA imply an early detection and suppose therapeutically consequences.

Biography:

Jerzy Dyczynski MD is a Cardiologist, a Medical Doctor and a Scientist who has over 40 years of Medical Experience. Initially, he worked as a Medical Physician. He graduated in Traditional Chinese Medicine during the early 1990’s in Beijing, China. He received his Doctorate in Cardiology in 2002 and graduated in Medical MBA (2008) from the German University in Management of Outpatient and Integrative Medical Care. Since 1991, he has practiced Holistic Cardiology, Internal Medicine, Holistic Medicine and Acupuncture in the hospital settings and performed cardiovascular research in Europe, before immigrating to Perth in 2007. He has been working at the Edith Cowan University in Perth on heart/brain medicine. He has been engaged in numerous medical research projects and published 60 scientific works in cardiology, cardiac diagnostics and acupuncture. Since 2014, he is running his medical practice in Perth.

Abstract:

This scientific study takes more than 2000 years of the exercise of a breathing technique practice to a new level of a significant medical intervention. The study included consecutive 163 patients, 53 males, 100 females from 39 to 93 years; average age was 73. A small portable device creates a dynamic window into the essential cardiovascular functions. It is an evidence based tool to assess also the autonomic nerve system, dynamism of the breathing and the hormonal activity. It displays the unique combination of the specific multi-channel ECG and 3 frequencies (high, low and very low) HRV analysis delivering a color coded mapping cardio portrait image in two minutes. It transforms the big cardiovascular HRV data into intelligent diagnostic information, which can be used for monitoring the respiratory muscle training intervention outcome. Two records were performed by all patients in sitting position with natural breathing activity as a baseline and in about 20 minutes later after introduction of the new diaphragmatic breathing technique and 10 minutes of the respiratory muscle training. The Cardio Stress Index (CSI) ranging from 0 to 100% was calculated as a computerized algorithm including: analysis of ECG-intervals, pulse rate, Fourié Transformation, heart’s cohesion and HRV as a baseline and after. The values of the CSI below 20% were considered as the normal level of the cardiovascular stress. The majority of 78.6% patients showed an increased CSI, 41.45% in average, which was statistically significant reduced to 22.79% after respiratory muscle training intervention (p<0.001). The positive, statistically significant impact of the respiratory muscle training intervention on the heart and the cardiovascular stress level measured as the short term HRV can be an ultimate 21^st century low-cost intelligent diagnostic analysis and a successful therapeutic intervention for the stress reduction.

Biography:

Mary Shibuya is an experienced native English medical editor/writer of 32 years living in Japan with a background in chemistry and allergy research at Mayo Clinic (Rochester, MN). For 23 years she was the language editor of the journal Internal Medicine, published by the Japanese Society of Internal Medicine. In addition to editing and preparing research articles for publication in international journals, she attended various medical/scientific congresses as Press (interviews, transcription, summarizing). She also enjoys lecturing on scientific medical writing in English to graduate schools and pharmaceutical companies. She strives to encourage ESL doctors/researchers to publish in English.

Abstract:

In a world of changing linguistic forms and non-standardized scientific terminology, English manuscript preparation for submission to an international medical journal can be challenging for both native and non-native speakers. It is imperative to develop a composition style which is clear and concise, while including sufficient background for orientation and also research details to impress the reviewers. This seminar highlights the important specific aspects of writing a quality scientific manuscript for journal submission, from appearance and organization to rules on repetition. Revision, which follows the manuscript writing, is critical to distinguish the first draft errors which are obvious to a review board, but less well recognized by authors. These first draft errors can be categorized into the following: 1) Layout/style errors, such as, margins, spacing, font, headings, paragraphs, numbering, abstract structuring and incomplete title page, 2) Grammar errors including, proper nouns, verb tenses, topic sentences, transitioning, paragraph body, spelling and abbreviations, and 3) Numerical errors, such as, citations, totals, p values, references, symbols and mismatched data. Following revision, the all-important Cover Letter must be composed. The necessary points to include as a means to “sell” the manuscript to the journal editor-in-chief are discussed. This seminar is designed to not only inform, but also encourage first time and seasoned writers to achieve a submission-ready manuscript for journal publication.

Biography:

Zara Berg is a PhD candidate in the Biomedical-Clinical Research Department at the University of Hawaii at Monoa. Currently, she is a Professor of Anatomy and Physiology at Kapioloni Community College. She was Chairwomen of Fort Peck Tribes IRB and on-site coordinator for community-based participatory research at Fort Peck Community College before further her education. Her interest includes environmental cardiology and gene-environment interaction. She has an MS in Interdisciplinary Toxicology from Texas A&M University and BS in Biology from Montana Tech of the University of Montana.

Abstract:

Occupational exposure to pesticides in the Honolulu Heart Program is significantly associated with total mortality. This study examines occupational exposure to pesticides on the job in relation to incident cardiovascular diseases. In the first 10 years, there was a positive correlation between age-adjusted CVD incidence and pesticide exposure. This relationship remained significant after adjustment for risk factors (p=0.05). There was no association for coronary heart disease or stroke and pesticide exposure when examined separately, possibly due to a smaller number of outcomes. Based on the OSHA exposure scale statistical, analyses were performed using a cohort of 7, 994 Japanese-American men from the Honolulu Heart Program. The biochemical mechanisms leading to CVD associated with risk factor will be discussed. These results are significant because the association between occupational exposure to pesticides and cardiovascular diseases have not been examined in this cohort. These findings are important in the prevention of cardiovascular diseases related to occupational exposures.

Biography:

Richultz C Montevirgen, MD, is a graduate of San Beda College of Medicine. He is currently taking his Internal Medicine Training at World Citi Medical Center. In future, he wants to pursue career in Interventional Cardiology

Abstract:

Acute limb ischemia of the upper extremity is the non-traumatic acute occlusion of arterial supply to a limb or organ presented with a constellation of symptoms specific to the tissue suddenly deprived of arterial perfusion. Irrespective of the arterial segment involved, this syndrome represents a vascular emergency. In every day clinical practice, acute arterial occlusion is synonymous with acute limb ischemia. Rapid recognition and treatment are required to prevent limb loss and life-threatening morbidity. Management of the syndrome has evolved, but the diagnostic skills required to recognize this clinical entity remain unchanged. We are presented with a case of a 65 year old, male, Filipino, who came in due to sudden right hand pain. The patient was presented initially with right hand pain that eventually developed numbness accompanied by pulselessness and cyanosis. The patient was then referred to a TCVS specialist for co-management, portable Doppler confirmed the absence of pulses in the radial and ulnar regions of the right hand. Anticoagulation using heparin bolus followed by heparin drip was initiated; the patient was then scheduled for emergency embolectomy. Intraoperative findings confirmed the presence of obstructing emboli in both radial and ulnar arteries of the right hand, freeing the obstruction resulted in immediate reperfusion of the affected limb. Post operatively, prothrombin and partial thromboplastin time was monitored. Warfarin 5 mg/tab was overlapped with the heparin drip while continuously monitoring the coagulation parameters for anticoagulant adjustments. This case highlights the importance of early recognition and emergent treatment of acute limb ischemia, which includes the paramount importance of proper history taking and physical examination, high index of suspicion, and non-invasive diagnostic tests that could give a quick but reliable impression to guide in the proper care of these kinds of patients are recommended. Prompt initiation of anticoagulation is the first line of treatment while embolectomy provides cure.

Biography:

Fadiea Al-Aieshy is a certified Pharmacist working at Karolinska University Hospital and a PhD-student in Medical Science at Karolinska Institute in Stockholm, Sweden. The main aim of her research is to evaluate biomarkers for the new oral anticoagulants dabigatran, apixaban and rivaroxaban, to increase safety and efficacy in individual patients.

Abstract:

Background: The direct factor Xa (FXa) inhibitors apixaban and rivaroxaban are used for stroke prevention in patients with atrial fibrillation (AF). The FXa-inhibitors do not require routine laboratory monitoring in the same extensive way as warfarin, but as exposure, i.e. plasma concentration, correlate to efficacy and safety and it was important to establish both the methods to monitor when needed and typical exposure intervals.

Aims: The aim of this study is to show the typical exposure range of apixaban and rivaroxaban in real-life patients with AF, and further to evaluate different laboratory methods for these measurements.

Methods: We have included a total of 141 AF patients treated with either apixaban 2.5 mg/5 mg (n=10/60) twice daily or rivaroxaban 15 mg/20 mg (n=10/61) once daily. Trough plasma concentrations were measured by liquid chromatography-tandem mass-spectrometry (LC-MS/MS) and Anti-FXa assays were calibrated with apixaban/rivaroxaban (STA® Liquid Anti-FXa (Diagnostica Stago, Asnieres, France)).

Results: Typical (10^th-90^th percentiles) exposure intervals were 43-118 ng/ml for apixaban and 13-63 ng/ml for rivaroxaban. The median trough apixaban plasma concentration measured by LC-MS/MS was 75 ng/ml (range 15-186 ng/ml). Patients who were treated with apixaban 5 mg twice daily had significantly higher drug levels than patients treated with the 2.5 mg dose. The median trough rivaroxaban plasma concentration measured by LC-MS/MS was 34 ng/ml (range 5-84 ng/ml). No significant difference in rivaroxaban concentration was seen between the 15 mg and 20 mg doses. Anti-FXa assays correlated strongly with LC-MS/MS for both apixaban and rivaroxaban (p<0.001).

Conclusions: Apixaban and rivaroxaban plasma concentrations varied substantially in AF patients. We here describe the range of exposures as well as typical exposure intervals for both drugs. We suggest that these typical exposure intervals may be used for dose guidance.

Biography:

Hidenobu Matsuzaki is a student of Gunma university department of medicine. He has an inquisitive research mind and also an enthusiastic passion for clinical medicine.

Abstract:

Statement of the Problem: Selenium is one of the elements necessary for producing enzymes and proteins. Selenium facilitates antioxidant action. Therefore, the lack of the selenium leads to the risk of cardiovascular diseases, such as heart disease¹⁾. Also, it is reported that the status of selenium is related to the cancer²⁾.

The significance of research: We want to determinate how the selenium status in the blood influences the prevalence of cardio vascular disease in Lampung, Indonesia. Such findings can lead to the key to identifying the method by which we can effectively reduce the risk of cardiovascular disease.

Materials and method: The location for this research is Lampung, Indonesia. There are some islands in Indonesia, and those areas have different prevalence. First, we use the data of selenium status in the blood in Jakarta, and also there are reports that the relation between selenium status and the concentration of selenium in the soil. Therefore, we use data of soil concentration in Jakarta and Lampung, expect the status of selenium in the blood in Lampung. Next, we make the figure of Mortality rate-selenium status, using the data of CDV mortality rate in Lampung.

Using these result, comparison of selenium status between other countries and thereby offer insight into possible means of disease risk factors.

Results:

The status of selenium in the blood in Lampung is enough but the mortality is high compare with other countries. It shows there is other reason of CVD.  As for the accuracy of those data, we don’t obtain all data we needed. Therefore we can increase accuracy collecting other data.

 Also, there are many risk factors associated with CVD. We can research other risk, and identify the cause of CVD in Lampung.

Biography:

Sheryll D Santos is a graduate of Doctor of Medicine at the University of the East Ramon Magsaysay Medical Center, Philippines. She had her Adult Cardiology Fellowship at St. Luke’s Medical Center- Global City, Metro Manila, Philippines. She is currently undergoing Clinical Research Fellowship in Echocardiography in the same institution.

Abstract:

Transcatheter Aortic Valve Replacement (TAVR) is a well-established therapeutic option for patients with inoperable severe, symptomatic aortic stenosis (AS). The self-expanding and balloon expandable systems have dominated, and large clinical trials have established their safety and efficacy. Despite good clinical outcomes, these valves exhibit technical limitation mainly paravalvular leak (PVL) and valve malposition associated with poor prognosis. Second generation valves have been developed and among them is the Lotus valve which is repositionable and fully retrievable and is designed to minimize PVL. The objective was to evaluate the safety and performance of the lotus valve system in symptomatic severe AS patients and to compare outcomes with those of corevalve treated patients at 30 days based on VARC-2 criteria. A total of 89 patients with symptomatic severe AS (77.3±8.08 years of age, 56% males with mean STS score of 10.4±11) underwent TAVR from February, 2012 to November, 2016. Seventeen patients underwent lotus TAVR and outcomes were compared with corevalve treated patients. Procedural device success showed no significant difference between the two cohorts. Successful single valve deployment and significantly less contrast loading (p<0.000) were seen with the lotus group. No significant difference in the early safety and clinical efficacy parameters at 30 days was seen in both groups. Echocardiography showed a significant decrease in the mean aortic gradient and increase in the aortic valve area for both groups. The lotus group has less degree of PVL (p<0.004) and lower pulmonary arterial systolic pressure (PASP) (p<0.011) as compared to the corevalve cohorts. In this matched comparison of patients with severe AS who underwent TAVR, no significant difference with regards to mortality, safety and clinical efficacy at 30 days between the two groups was seen. Significantly less PVL, greater improvement in the PASP and less contrast loading were seen in the lotus cohort. The clinical significance of these differences needs to be tested in a larger clinical trial with longer follow-up period.

Biography:

Fontini Christi C Cuenca is a graduate (Doctor of Medicine) at St. Louis University, Baguio City Philippines. She had her Adult Cardiology Fellowship at St. Luke’s Medical Center- Global City, Metro Manila, Philippines. She is currently undergoing Clinical Research fellowship in Echocardiography in the same institution.

Abstract:

Background: The safety and efficacy of transcatheter aortic valve replacement (TAVR) in symptomatic high risk tricuspid aortic valve (TAV) stenosis has been established. TAVR in bicuspid aortic valve (BAV) stenosis is currently considered as an off label application. Several studies with small sample size showed safety and efficacy of TAVR on BAV stenosis. There are currently no reports on Filipinos with BAV treated with TAVR.

Aim: The aim of this study is to assess the safety and efficacy of transcatheter aortic valve replacement among adult Filipinos with symptomatic severe stenotic bicuspid aortic valve.

Methods: Consecutive patients from February 2012 to November 2016 with severe symptomatic aortic stenosis who underwent TAVR in Saint Luke’s Medical Center-Global City were included in our study. Results were compared between patients who had TAVR on TAV stenosis versus TAVR on BAV stenosis.

Results: 89 patients were included in the study (n=89). 10 (11%) of these patients were identified as having BAV by multislice computed tomography and transthoracic echocardiography. No significant differences were noted in the aortic valve annulus size and aortic valve area (p=0.14) pre-operatively. BAV group received a relatively smaller bioprosthetic valve size (p=0.03). No significant difference was found between the BAV and TAV group procedural success. One patient in each group needed emergency open heart conversion (p=0.23). Post procedural echocardiographic assessment showed a higher mean pressure gradient (p=0.01) and increased PVL in the BAV group (1.01). There were no significant difference in the 30-day and 1-year cardiac mortality and all-cause mortality between the two groups (p=1.0).

Conclusions: TAVR in our limited experience represents a feasible and effective alternative treatment in patients with severe BAV stenosis. Procedural and 1-year outcomes are comparable to those patients with TAV stenosis. More research with larger population and long term follow up is needed to validate results.

Biography:

Patrick John Cruz has completed his graduation in Medicine in Philippines. He underwent Internal Medicine Residency in Manila, Philippines. He is a Fellow of the Philippine College of Physician. He is also affiliated and currently a Resident Physician in the Department of Cardiology at Khoo Teck Puat Hospital, Singapore.

Abstract:

Background: In great majority of the cases, acute myocardial infarction (AMI) is due to atherosclerosis, resulting in critical coronary occlusion usually with plaque rupture. However, non-obstructive coronary artery may be found during angiography in minority of patients presenting with AMI.

Objective: To give an overview of the clinical characteristics and possible etiologies of AMI patients with non-occlusive coronary artery in Singapore.

Method: This is a single center, retrospective, descriptive study of all patients who presented clinically with AMI (STEMI and NSTEMI) from January 2014 to January 2016 who had non-occlusive coronary arteries on coronary angiogram. Clinical profiles of these patients were retrieved from hospital records.

Results: Of the 1,404 patients admitted for NSTEMI and STEMI, 46 patients were included, giving a prevalence of 3.28%. Of these, 23 were male and 23 were female. Most are of the Chinese descent (41%) were followed by Malays (28%) and Indians (20%). Average BMI was 25.6±5.5. None had renal failure, 46% have hyperlipidemia, 39% with hypertension, and 20% with diabetes mellitus. Only 10% have a history of IHD and/or angioplasty, 17% had family history of CAD and 19% had reduced ejection fraction. Of those with non-occlusive coronary arteries, 37% have normal coronaries while 63% have minor CAD. Being a smoker, hyperlipidemic, hypertensive, diabetic and having past history of IHD didn’t point to a predilection towards having a non-occlusive CAD. Minor CAD patients are significantly older and all those with history of ethanol use belong to normal coronary group. Cardiomyopathies were attributed in 20% of patients, 15% to coronary spasm, 10% to muscular bridging and 2% to myocarditis/myopericarditis, while in majority (52%), the cause is unknown.

Conclusion: Non-occlusive CAD in coronary angiogram, though infrequent, can be observed in patients who present with AMI. Hypertension, hyperlipidemia, diabetes mellitus were not significantly associated with non-occlusive CAD in AMI.