4^th World Heart Congress April 29 - May 01, 2019 Kyoto, Japan

Wilawan Thirapatarapong has completed her Medical Bachelor’s degree from Chulalongkorn University and Rehabilitation Postdoctoral studies from Mahiol University School of Medicine. She is the Director of Cardiac Rehabilitation, Rehabilitation, Siriraj Hospital Mahidol University. She has published more than 20 papers in the reputed journals.

Background: Although the use of Incentive Spirometry (IS) with Deep Breathing Exercise (DBE) is widely used in clinical practice in patients who have undergone Coronary Artery Bypass Graft (CABG) surgery, the effect of this combination therapy has not been conclusively elucidated. The aim of this study was to investigate the effect of post-operative combined IS and DBE versus DBE alone on inspiratory muscle strength following CABG.

Method: The randomized clinical trial was conducted in patients scheduled to undergo CABG surgery at the Siriraj Hospital. The study group received IS and DBE and the control group received DBE only. Maximal Inspiratory Pressure (MIP) before surgery and at day 4 after surgery was assessed by respiratory pressure meter. Secondary outcomes, including post-operative pulmonary complication and duration of post-operative hospitalization, were obtained from medical records.

Result: 90 patients were included, with 47 and 43 patients assigned to the study and control groups, respectively. In both groups, there was a significant reduction in MIP from pre-operative baseline to post-operative day 4. However, the MIP in the IS group had a significantly smaller reduction in MIP than the reduction in the control group [33.0±23.2% vs. 47.2±20.1%, respectively; p=0.006, 95% CI (3.9-23.3)]. There was no difference between groups for the secondary outcomes.

Conclusion: Patients in the study group had significantly better recovery of inspiratory muscle strength on day 4 post-CABG than patients in the control group. There was no significant difference between groups for either post-operative pulmonary complications or length of hospital stay

Yochai Birnbaum has completed his Master’s degree from the Hebrew University,  Jerusalem, Israel. He is the John S. Dunn Chair and Professor of  Medicine at Baylor College of Medicine, Houston, Texas. He has published more than 320 papers in reputed journals and has been serving as an Editorial Board Member for many journals.

Jorge Polonia is a Professor of Medicine & Clinical Pharmacology, Faculty of Medicine of Porto University, Portugal in Hypertension Unit, H Pedro Hispano. Matosinhos, Portugal (Excellence Centre ESH) and Full Professor of Medicine ESSaude Universidade de Aveiro, Portugal, also a Coordenator of Unidade Farmacovigilancia, Portuguese Drug Agency. Past-President Portuguese Ass Hypertension, Portuguese Society Cardiology, European Specialist in Clinic Hypertension (ESH), Vogal of the Council of European Society of Hypertension (ESH)

Background: White Coat Hypertensive subjects (WCH) are usually classified on the basis of normal daytime ambulatory or home Blood Pressures (BP). Since night time BP is the most powerful predictor of risk, we evaluate the long term value of morning surge, pulse wave velocity and micro albuminuria in WCH with normal daytime and normal night time BP values in comparison with control Normotensives (NT).

Method: For a median of 90 months, we prospectively evaluated the evolution of morning BP systolic surge, pulse wave velocity and micro albuminuria in Normotensive subjects (NT, n=101, 60% female; ageing 50±11 years) (clinic BP<140/90, awake BP<135/85 and nighttime <120/70 mmHg) and in 254 untreated subjects (45±14 years, 62% female) with WCH (clinic BP>140/90, ABP<130/85 mmHg) with no other major cardiovascular risk factors and in 97 sustained hypertensive subjects (HT: age 54±7 years, 58% female) .

Result: Evaluation was done baseline and between 37-150 months during follow-up: 65±19 months in NT, 70±29 months in WCH and 60±17 in HT. Cardio Vascular (CV) event rates per 100 patients-years were 0.61 in WCH, 0.66 in NT and 2.2 in HT groups. Morning SBP surge was at baseline higher in WCT 25±10 vs. in NT 22±10 mmHg (p<0.05), and in HT 34±12 mmHg,

p<0.01 vs. NT and WCH). These values did not change much at the end of follow-up with exception of that in NT 26±12 mmHg no longer different from WCH i.e 26±13 mmHg. The percentage of non-dippers was 37.4% in NT, 36.5% in WCH and 38.3 in HT. Pulse Wave Velocity (PWV) as a measurement of aortic stiffness was greater (p<0.03) in HT, PWV 10.9±4.6 m/s than in WCH, PWV 9.6±2.4 m/s and NT PWV 9.6±2.3 m/s. At the end of follow-up PWV values went up slightly but the relation between groups were maintained: PWV in HT 11.4±4.9 m/s, in WCH, PWV 9.7±2.8 m/s and NT 9.7±2.7 m/s.

Conclusion: After 89 months of follow-up, both the morning surge and PWV in WCH with normal night time BP values were similar to that of NT subjects but clearly inferior to the HT. That may suggest WCH with normal night time BP has a relative benign prognosis and night time BP should be included in the WCHT definition and in its prognostic stratification

Kewal Krishan is the Director of Heart Transplant and Ventricular Assist Devices, Principal, Consultant, Cardiothoracic Surgeon at Max Super Speciality Hospital, New Delhi. He has done four years (2 years each) Advanced Clinical Fellowships at world’s top hospitals including Mayo Clinic, Rochester MN, USA and MountSinai Medical Center New York, USA where he gained expertise in advanced therapies like heart transplant, LVADs and ECMO

Ventricular assist devices are an established therapy for advanced heart failure. Continuous flow devices are representing an innovative design with potential for small size and greater reliability by simplification of pumping mechanism. A small percentage of patients who are too ill to wait for donor heart Left Ventricular Assist Device (LVAD) offers lifesaving therapy in them. We started our program in Feb 2015. So far, we have put 17 LVADs in 16 patients. Out of 17, five were Heart Mate II and four were Heart Ware and 8 were Heart Mate III. Twelve patients were male and four were females. Twelve patients had dilated cardiomyopathy and four had ischemic cardiomyopathy. Average ICU stay was 5 days and hospital stay was 18 days. One had thrombosis of device on post-operative day three which required exchange of the device. One of them died on postoperative day 12 because of ventricular arrhythmia and right ventricular failure. In one patient device was removed as bridge to recovery after 18 months. One patient was bridge to transplant. A LVAD provides effective hemodynamic support in patients with end stage heart failure with improved functional status and quality of life. LVAD is the only alternative that offers a ray of hope to thousands of patients whose hearts are too weak to survive and those waiting for a heart transplant. Improvements in device design, along with advances in surgical and medical management have allowed VAD patients to return home, to work, and to their communities, with excellent quality of life.