Day 1 :
President, North American Scientific Committee on Cardiovascular Health, USA
Keynote: An Examination of Identifiable Risk Factors and Health Outcomes Associated with Cardiovascular Health in Children and Adults
Time : 09:30-10:20
Damien Byas, PhD, is an Epidemiologist and Professor of Public Health at American Public Health Association. He is an International Public Health Delegate and President of North American Scientific Committee on Cardiovascular Health.
Statement of the Problem: The World Health Organization (2017) recently reported that “worldwide, at least 2.8 million people die each year as a result of being overweight or obese, and an estimated 35.8 million (2.3%) of global Disability-adjusted life years (DALYs) are caused by both cardiovascular wellness and overweight or obesity. The purpose of this study was examine identifiable risk factors and disease outcomes which may be associated with cardiovascular health in children and adult populations.
Methodology & Theoretical Orientation: This study examined inpatient pediatric patients using the Kids´ Inpatient Database (KID), Healthcare Cost and Utilization Project (HCUP), and the Agency for Healthcare Research and Quality (AHRQ, 2014;2016). A large randomly drawn sample (N = 524,581) of boys (n = 244,553) and girls (n = 280,028) ages 5 to 12, was examined in this research study to test for the association between cardiovascular health and disease related outcomes. Additionally, a small adult sample of adults ages 19 to 55 (N = 143), enrolled in an undergraduate level city college program, were assessed to determine if there was a relationship between Cardiovascular Health and associated risk factors and other health. The Pearson Chi Square test was applied to measure for significant variable associations in this research study in addition to the application of the Cramer’s V analysis to examine for strength of variable associations. A multiple regression analysis was applied to determine if obesity prevalence and type 2 diabetes risk were significant predictors of cardiovascular health in adult groups. Findings: The research found that there were significant associations between cardiovascular health and health outcomes in children (p < .001) and that the factors of obesity and type 2 diabetes risk were significant predictors for cardiovascular health in adults (p < .05).
Conclusion & Significance: The outcome of this research study provides support for improved efforts to develop more effective strategies to promote positive healthy lifestyles in adults and children’s populations.
President- Latvian Association for Pediatric Cardiologists, Latvia
Keynote: Effectiveness of autologous bone marrow-derived mononuclear cells delivery in wide spectrum of pathologies
Time : 10:20-11:10
Aris Lacis, cardiac surgeon, professor, MD, PhD graduated Riga Medical Institute in 1961. General and thoracic surgeon in P. Stradina University Hospital in Riga (1964–1969). Thoracic and cardiac surgeon in the Latvian Centre for Cardiovascular Surgery (1969–1994). Since 1994 until 2012 – the head of Pediatric Cardiology and Cardiac Surgery Clinic in University Children’s Hospital, Riga; since 2012 – a consulting professor of this Clinic. Vicepresident of Latvian Society for Cardiovascular Surgery. President of Latvian Association for Pediatric Cardiologists. Author of 395 scientific publications, 3 monographs and 13 patents. Investigator in more than 10 clinical trials including cardiosurgical procedures performed under deep hypothermia, hybrid procedures etc. In May 2009 have been used transcutan intramyocardial delivery techniques for treatment (idiopathic dilated cardiomyopathia) the first 3 months aged patient in the world with autologous bone marrow derived progenitor cells. In November 2010 the first patient with end stage pulmonary hypertension received intrapulmonary implantation autologous stem cells.
The promising field of regenerative medicine is working to restore structure and function of damaged tissues and organs. The adult heart represents an attractive candidate for cell-based technologies. While there is a wealth of preclinical and clinical data showing the safety, feasibility and efficacy of stem cells in adults with acute myocardial infarction and heart failure, less is known about possible implementation of stem cell therapy in infants and children with heart failure due to dilated cardiomyopathy and pulmonary arterial hypertension. The challenges facing cardiac stem cell therapy are multiple. There are uncertainties around the destiny of stem cells after their injection into the blood stream. In particular, it regards migration and homing of implanted cells in the target tissues. As yet unclear is the possible role of sympathetic nervous system in the context of osteoreflexotherapy. There is still no definitive answer to the question on which is the preferred type of stem cells to be used for transplantation in different settings. Since 2008, when we first used autologous bone marrow-derived mononuclear cells (BM-MNCs) in patient with acute myocardial infarction, we have investigated the use of stem cells not only for myocardial regeneration in adults and pediatric patients, but also in adult patients with diabetes mellitus and osteoarthritis. The objective is to determine the role of BM-MNCs in management of wide spectrum of pathologies, including critically ill pediatric patients, adult patients with acute myocardial infarction and heart failure and adult patients with osteoarthritis. Two patients (9 and 15 years old) with trisomy 21 and severe pulmonary arterial hypertension due to uncorrected large ventricular septal defects received imtra-pulmonary BM-MNCs implantation. Radionuclide scintigraphy showed improvement of lungs vascularization during 36 months follow-up. Seven patients (4 months–17 years) with dilated idiopathic cardiomyopathy received intra-myocardial BM-MNCs injections. During follow-up (up to 7 years), we observed improvement of left ventricular ejection fraction (LVEF), decrease of left ventricular end diastolic dimension by echocardiography and cardio-thoracic index at chest X-ray exams, reduction of serum brain-natriuretic peptide serum levels and decrease of the stage of heart failure from stage IV to stage I, by NYHA classification. No peri-procedural harmful side effects were observed. We performed BM-MNCs intracoronary infusion in 101 adult patients with acute myocardial infarction with reduced LVEF and in 14 patients with chronic heart failure. Our results showed statistically significant improvement in LVEF at 12 months. We also infused BM-MNCs to the pancreas directly via branches of splenic artery or superior pancreaticoduodenal artery we have performed single intra-articular BM-MNCs injections in 70 patients with knee or hip joint osteoarthritis (stage II–III). No adverse effects after the BM-MNC injection were observed. Preliminary analysis showed decrease in pain and other symptoms and statistically significant improvement by clinical scoring system using different questionnaires. The results are promising and we suggest that BM-MNCs might be used for the stabilization of the adult and pediatric patients to improve symptoms and outcomes or serve as a bridge for heart or lung transplantation or delay joint replacement surgery. It also could be recommended in cases if other more traditional treatment options fail or are contraindicated.