Global Summit on Heart Diseases and Therapeutics October 20-21, 2016 Chicago, Illinois, USA

Biography:

Cromwell received his MD degree from the Louisiana State University School of Medicine in New Orleans, LA and completed postgraduate work in Lipid Disorders at the Washington University School of Medicine Lipid Research Center in St. Louis, MO. He is Chief of the Lipoprotein and Metabolic Disorders Institute, Discipline Director for Cardiovascular Disease at Laboratory Corporation of America (LabCorp), and Adjunct Associate Professor at Wake Forest University School of Medicine, USA. He has published over 25 book chapters and papers in journals including Lancet, Journal of the American College of Cardiology, American Journal of Cardiology, and Journal of Clinical Lipidology.

Abstract:

Managing low-density lipoprotein (LDL) is an integral part of clinical practice. Recent guidelines have shifted from attaining discrete LDL goals (based on an individual’s cardiovascular disease risk), to use of specific therapies shown to reduce atherosclerotic cardiovascular disease (ASCVD) events in randomized controlled trials. Following institution of outcome proven therapy, on-treatment LDL levels are advocated to judge adherence, individual response, and aid consideration of adjustments to therapy. What remains controversial is whether LDL-guided adjustments in treatment can lead to further reduction in ASCVD events. Historically, the cholesterol content of LDL particles (LDL-C) has been used to express LDL quantity. However, due to variability in the cholesterol carried in LDL particles, frequent disagreement (discordance) occurs between LDL-C and particle number measures of LDL quantity, including apolipoprotein B-100 (apo B) or nuclear magnetic resonance (NMR) LDL particle number (LDL-P). Epidemiologic and clinical intervention trials consistently demonstrate that ASCVD risk tracks with LDL particle number (apo B or NMR LDL-P), rather than LDL-C, when these measures are discordant. Furthermore, managed care claims data demonstrate significant additional reduction of ASCVD events is noted among high-risk patients attaining low NMR LDL-P (mean 860 nmol/L) versus statin treated subjects with low LDL-C (mean 79 mg/dL). Accordingly, many expert society recommendations and guidelines now advocate use of LDL particle number (NMR LDL-P or apo B) to adjudicate individual response and aid adjustment in therapy to optimize individual therapy.

Biography:

Pautasso Enrique José graduated as a physician from the University of Buenos Aires, Argentina in 1974.In December 1982 he became a cardiologist. Pautasso Enrique José got this degree at the Salvador University in Buenos Aires, Argentina. From 1990 to 2001 he was chief of the Nuclear Cardiology service at the “Hospital Instituto de Cardiología National Medicine Academy, Argentina. In December 2000 he was named cardiology consultor by the Medicine School of the province of Buenos Aires. In 2005 he was president of the Argentine Cardiology Society in the northern suburbs of the city. Finally the University of Buenos Aires granted me medical doctor in the year 2009.He has carried out more than 100 scientific researches which were published in national and international magazines. In addition, he has been awarded various science prizes. The last one was in 2011 for the best work on cardiology; awarded by the National Medicine Academy. During the last 15 years he has worked on cardiovascular disease prevention by means of the Cold Pressor Test.

Abstract:

A lot of studies have been published that have demonstrated that the patients with a normal myocardial perfusion test with single positron emission tomography (SPECT)  belong to the group of low coronary risk , since the incidence of cardiovascular events is less than 10 % at ten years.Endothelial dysfunction is the first alteration known that intervenes in the development of coronary artery disease and it can be evaluated by a perfusion test with SPECT and the cold pressor test (CPT). In a population of low coronary risk we could identify those patients most likely to suffer from cardiovascular events with the cold presser test. For this reason more than 1000 consecutive patients that had a normal exercise perfusion test with SPECT were admitted in a nuclear medicine center. The cold pressor test was performed between the third and fifth day after the study SPECT. The cold pressor test was considered positive if a decreased uptake of the radionuclide was observed in the perfusion images obtained during the CPT, which were normal in the respective post-exercise images and negative if no changes were observed in the radiotracer uptake in any of the myocardial perfusion images obtained after the exercise test and the CPT .The average follow-up was 51 ±16 months having located  85.4% of the population. The events analyzed were: cardiac mortality, non-fatal myocardial infarction and coronary revascularization. In this population of patients without demonstrated ischemic heart disease, the prevalence of a positive cold pressor test was 37,5%.Trough out 119 month follow up we have observed event free survival of 95% and 83% in the group of a negative and positive cold presser test respectively.  In our 10 years of experience we have observed the great utility of the cold pressor test, in a low coronary risk population because with this test we could identify a subgroup of patients with a higher likelihood of suffering from cardiovascular events. On the other hand for patients with a normal SPECT but inadequate excercise test, we suggest to complete the study with the cold pressor test in order to identify patients with intermediate coronary risk. Trough the cold pressor test we have also detected the probability of future cardiovascular even in diabetes patients.

Biography:

Livia Valentin has completed her PhD from University of São Paulo School of Medicine-FMUSP and postdoctoral from Harvard Medical School; David Geffen School of Medicine at UCLA; Cleveland Clinic Lerner College of Medicine of Case Werstern University; University of Copenhagen; Utrecht University; Max Planck Institute and Karolinska Institute as a multicenter study. She is the Principal Investigator of the RCT Evaluation of POCD through the MentalPlus® digital game. She has published papers in anesthesia and neuropsychology journals and has been serving as an editorial board member of a indexed journal and reviewer of journal about anesthesiology and neuroscience.

Abstract:

Postoperative cognitive dysfunction (POCD) is a contrary event observed between 20 to 83%, especially in elderly and after cardiac surgery. Prevention and rehabilitation on cases of POCD may improve the quality of life. The neuromodulator effect of the noninvasive cerebral stimulation has been used in the treatment of brain injuries, depression, and also in the cognitive rehabilitation. The hypothesis is that the use of the transcranial direct current stimulation (tDCS) technique can decrease the occurrence of POCD and cognitively rehabilitate patients submitted to cardiac surgeries. The objective of this study will be to evaluate the tDCS effect over the occurrence of POCD in patients on cardiac surgeries. After approval the institutional ethics committee, will be included in the study 138 adult submitted a cardiac surgery. After assigned the consent form patients will be randomly allocated in two groups. tDCS GROUP: Submitted to 2 daily sessions of cerebral stimulation, starting from the first day after surgery during 4 consecutive days, with each session having 20 minutes. Will be applied a direct current stimulus of 2 mA in the right anode and in the left cathode on the prefrontal right region. SHAM GROUP: The same equipment used in tDCS as simulated stimulus similar to the active one. Will also be summited to neuropsychological tests to evaluate memory, attention, and executive functions as well as data relative of surgery, cognitive evolution and quality of life in postoperative period. The neuropsychological test will be describes according groups and the moments of application, with mean and standard deviation (SD) and compared to results of normative tables with Z-score (±1,96). The data will be expressed in means, medians, confidence intervals (CI-95%) and SD and analyzed by Generalized Estimating Equation (GEE), to comparison of the results between the two groups. P<0,05 will be considered significant.

Biography:

Dr. Wang is a professor and the director of Department of Cardiology, Zhongnan Hospital of Wuhan University, China. He has completed his MD and PhD from Tongji Medical University, China and postdoctoral training from Germany Heart Center of Technical University of Munich, Germany and Emory University, USA. Dr. Wang has published 40 peer-reviewed papers in highly impacted journals and has been serving as an editorial board member of 3 prestigious medical journals. He has been awarded NIH R01 and R21 grants in USA and the General Project Award and the Key Project Award from the National Natural Science Foundation in China.

Abstract:

The excessive activation of calmodulin-dependent protein kinase II (CaMKII) plays a key role in heart failure (HF) development. As a result, CaMKII becomes a novel therapeutic target. Here, we studied alterations of systolic and diastolic function, β-adrenergic regulation and exercise tolerance in pressure overload HF mice after acute and 1 week chronic CaMKII inhibition. Pressure overload HF was induced by severe thoracic aortic banding (sTAB), while cardiac function was monitored by M-mode echocardiography. CaMKII inhibitor KN93 was given intraperitoneally to HF mice for one time (acute inhibition) and once a day for continuous 7 days (chronic inhibition), respectively. Acute and chronic CaMKII inhibition improved systolic function but the diastolic function was reduced, especially for the chronic inhibition, manifested by the increase in E/Em ratio and site of left atrium. We have tested the effects of CaMKII inhibition on adrenergic stimulation in HF mice by isoproterenol (ISO) injection or 10 min swimming before and after acute and chronic CaMKII inhibition, We found that chronic CaMKII inhibition significantly enhanced the positive inotropic effect of ISO or swimming with a recovery of β1-AR expression illustrated by Western blots. An interesting finding was that after acute CaMKII inhibition, the HF mice started sinking in water in several seconds of swimming. Chronic inhibition of CaMKII improved systolic function, adrenergic regulation and exercise tolerance in HF mice. The diastolic function is impaired, which is more prominent for acute CaMKII inhibition.

Biography:

Salwa Elgebaly graduated from the University of Alexandria Faculty of Pharmacy and holds a Master’s Degree from the University of Wisconsin Faculty of Medicine in Madison, Wisconsin; and a PhD from the University of North Carolina, Faculty of Pharmacy at Chapel Hill, North Carolina.  She is a former Associate Professor at the University of Connecticut School of Medicine and she is currently the Executive Director of Nour Heart Institute (subsidiary of Nour Heart, Inc.).  Dr. Elgebaly is the Inventor of 9 Patents Issued by the U.S. Patent Office.

Dr. Elgebaly identified and patented the potent inflammatory mediator, Nourin as a key ‘initial signal’ in early reperfusion injury. Her research targets the development of new therapy for patients with Ischemic Heart Diseases (IHD).  She is currently developing a new combined therapy of the anti-inflammatory Nourexin™ (Nourin specific competitive antagonist) and the anti-apoptotic Nourexal™ (ATP preservation during ischemia) to protect AMI patients from reperfusion injury. 

Abstract:

Myocardial tissue has an extreme sensitivity to ischemia and hypoperfusion. The current available options to address this problem are all directed at restoring tissue perfusion in the myocardium. However, the main mechanism of myocardial ischemia that leads to reduction in cardiac function and irreversible injury is through the exhaustion of the high-energy adenosine triphosphate (ATP). Depletion of ATP during ischemia is one of the major factors that accelerate the apoptotic process of healthy myocardial tissue, leading to tissue progression to necrosis and heart failure.

Our research has demonstrated that reduction of ATP during ischemia also resulted in the rapid release (within 5 minutes) of the potent inflammatory mediator Nourin by ischemic myocardial tissue and coronary arteries. The release of Nourin was associated with early cardiac inflammation characterized by large influx of neutrophils. Our studies also indicated that Nourin purified from human ischemic hearts, is an ‘early inflammatory signal’ which stimulates leukocyte chemotaxis, adhesion and activation to release high levels of chemokines, cytokines, adhesion molecules and digestive enzymes. Specifically, Nourin stimulates human monocytes to release high levels of tumor necrosis factor- α (TNF-α), which is a major contributor of myocardial apoptosis.

For early reperfusion injury, the first few minutes of reperfusion after ischemic infarct constitute a critical phase that leads to impaired microcirculations and the ‘no reflow’ phenomenon. Inflammation is central to microcirculation obstruction (MVO) in early reperfusion and also in late reperfusion injury. Since both inflammation and ATP depletion play a key role in MVO and infarct size, we tested the cardioprotective benefits of our patented Nourexal™ therapy in a number of animal models (dogs, rats and rabbits) of ischemia/reperfusion, including: acute myocardial infarction (AMI), global warm cardiac arrest, cardiopulmonary bypass for coronary revascularization and heart transplantation models (prolonged heart preservation and nonheartbeating donor hearts).

We have demonstrated that administrating Nourexal™ (Cyclocreatine Phosphate - CCrP) minutes before ischemia (a) preserved high levels of ATP in ischemic myocardium; (b) reduced myocardial cell injury, acidosis and edema; (c) reduced Nourin formation in the myocardium and its blood levels; (d) reduced post-ischemic cardiac inflammation and apoptosis; and (e) restored immediate strong cardiac contractibility during reperfusion without arrhythmia.

Clinical application is where myocardial ischemia is predictable and pretreatment of patients with Nourexal™ would improve the patients’ outcome and quality of life. These include patients undergoing cardiopulmonary bypass for coronary revascularization, heart transplantation and AMI patients undergoing angioplasty procedures / Percutaneous Coronary Intervention (PCI).

For AMI patients, administering Nourexal™ during myocardial infarction and reperfusion will likely (a) protect cardiomyocytes from energy depletion and early inflammation; (b) protect the adequacy of microcirculations; (c) increase the amount of salvaged myocardium; and (d) reduce the progression of the ischemic myocardium to necrosis during the critical first 4 to 6 hours of reperfusion. Furthermore, targeting the early inflammatory mediator Nourin will likely produce the right balance between reducing the early harmful effect of inflammation without affecting its beneficial healing and scar formation.

In summary, we believe that this novel Nourexal™ therapy will provide heart protection against ischemic and reperfusion injury and it will be particularly critical for AMI patients with long transport times to the hospital and for patients who cannot get timely pharmacologic or mechanical revascularization. This early protection will likely reduce the incidence of chronic heart failure and improve the patients’ outcome and quality of life.

Biography:

Justin Nabity has been a Financial & Career Development Advisor to physicians since 2005. He is from two families of physicians and financial planners with over 200 years of collective medical practice and financial experience. As a result, Physician Advisors solely caters to the needs of physicians. Justin has been a guest speaker to nearly 200 institutions and associations. He is a board member of the Entrepreneurs Organization (EO), a board candidate of the National Association of Insurance and Financial Advisors (NAIFA), listed on 2014 Best Financial Advisers for Medical Economics, 2013 Million Dollar Round Table’s Top of the Table, and a repeat invited speaker for American Association of Ophthalmologists (AAO) as well as the Mayo Fellowship Association (MFA). Justin has authored dozens of lectures on Contract Review, Financial Planning, Disability Insurance, Physician Job Search, Debt Management, Retirement Planning, and Wealth Planning, among others.

Abstract:

Only 28% of physicians are very confident about their financial decisions. Additionally, over half of physicians are concerned about having enough money to retire.Financial preparedness is not just about investing in the right funds; it’s about finding the right job and negotiating well. It’s about tackling debt aggressively, including student loans, while not neglecting retirement planning. For residents and fellows, it’s about creatively and purposefully putting a limited paycheck to work instead of waiting until FINALLY finishing training. It’s also about being prepared for job interviews and protecting a physician’s potential with the right coverage.According to the 2015 MGMA Compensation Report, the median annual earning potential of a cardiologist is *$476,376 and an interventionist is *$566,370. These earning potentials illustrate the compelling reason why when planning for retirement, proper diversification goes far beyond having an investment allocation spread out among various asset classes. A truly diversified investment strategy also takes into consideration the impact of taxes both today and when retirement is reached.

A diversified investment strategy provides physicians the ability to minimize tax liability in order to optimize the tax efficiency of their portfolio both today and in retirement years. Traditionally, individuals rely solely on their 401(k), IRAs or other tax-deferred vehicles for savings. However, this one-dimensional savings strategy provides little to no flexibility when an individual reaches retirement. Diversification involves spreading investments among tax-deferred, tax-favored and taxable accounts during a physician’s working years so they can plan to optimize their tax situation in retirement.Whether discussing contract negotiation, interviewing, debt management or retirement planning, the remedy to this concerning statistic is to universally “Plan for the End in the Beginning.”

Biography:

Abstract:

Biography:

Dalin Tang received his PhD from UW-Madison in 1988. He is Professor of Mathematics and Biomedical Engineering at WPI (since 1988). He was named John E. Sinclair Professor of Mathematics in 2003-2006. He received WPI Trustee’s research award, the highest honor for faculty research at WPI. He was elected Fellow of AHA in 2011, Fellow of ASME in 2016. His research interest is image-based modeling for ventricles and vulnerable plaques. He has received 29 grants including 3 NIH R01 grants and one NSF/NIGMS grant ($1.8M). He served on various NSF, NIH, and AHA panels. AE of PLOS One and BMEO.

Abstract:

Accurate assessment of ventricular stress and strain is critical for cardiovascular investigations. From a mechanical point of view, zero-stress ventricular geometry information is required for correct stress/strain calculations. Sarcomere shortening in active contraction leads to change of ventricular zero-stress configurations during the cardiac cycle. A new model using different zero-load geometries (diastole and systole) was introduced to provide more accurate diastolic and systolic stress/strain calculations. Cardiac magnetic resonance (CMR) data were obtained from 16 patients with repaired tetralogy of Fallot (TOF) prior to pulmonary valve replacement (8 male; mean age 34.5 years). CMR-based patient-specific computational right and left ventricular (RV and LV) models using one zero-load geometry (old model) and two zero-load geometries (no-load diastole and systole geometries, new model) were constructed and RV mechanical stress and strain were obtained for analysis. Based on the average values from the 16 patients, peak-systolic stress from the new model was 28% higher than that from the old model. Peak-systolic strain from the new model was 40% higher than that from the old model. The new model also provided end-systole and end-diastole stress and strain values that were not available from the old model. The new 2-geometry model may be able to provide more accurate ventricular stress and strain calculations by using different zero-load geometries for the diastole and systole phases, respectively. The new model may be used in patient studies to further examine its impact on risk stratification and planning surgical interventions.

Biography:

Livia Valentin has completed her PhD from University of São Paulo School of Medicine- FMUSP and postdoctoral from Harvard Medical School; David Geffen School of Medicine at UCLA; Cleveland Clinic Lerner College of Medicine of Case Werstern University; University of Copenhagen; Utrecht University; Max Planck Institute and Karolinska Institute as a multicenter study. She is the Principal Investigator of the RCT Evaluation of POCD through the MentalPlus® digital game. She has published papers in anesthesia and neuropsychology journals and has been serving as an editorial board member of a indexed journal and reviewer of journal about anesthesiology and neuroscience.

Abstract:

POCD remains a common postoperative complication associated with higher morbidity and mortality, especially in elderly patients and cardiac surgery. Research on digital games may not relate directly to postoperative cognitive dysfunction, but it can illuminate the possibilities of games related cognitive improvement in people with cognitive dysfunction. MentalPlus^® is a digital game developed first to evaluate the cognitive dysfunction, in special POCD. This study investigated the association between the use of MentalPlus^® game series of sessions in cardiac surgery patients with cognitive dysfunction and their results after them. Based on these findings, the scientific community could have interest to develop a major project to evaluate the impact of its usefulness for POCD rehabilitation.

Biography:

To be updated soon.

Abstract:

It is too much easier and cheaper combat to obesity, than in the future to treat hypertension and its complications.Design and Method: We used an online system for patient education based on the video lessons, full of humor, pictures, and cartoons to convey the necessary information on good nutrition, necessary to do exercises and the need for exposure to the sun to our patients.Watching the short movies, the patients formed the habits of good nutrition during the first month already, which includes a diet with restriction of fat, digestible carbohydrates and daily consumption of low-fat dairy products, slow carbohydrates, protein and fiber. Were also presented recommendations for compliance with the physical activity, as well as vitamin D consumption. A patient was in touch with a doctor-endocrinologist, if he has any additional questions. We examined data from a survey of 500 patients registered in the online system and 100 patients control group who were given the same recommendations on the appointment. Persistent decrease in body weight by an average of 6.5 kg over six months was demonstrated in all patients of the main group, we also found it out that systolic and diastolic blood pressure levels decreased more than 9 mm Hg, the consumption of milk and dairy products increased by 2.6 times, compared with patients in the control group. The exposure to the sun was observed 15 to 30 minutes daily, compared with the control group 5-10 minutes. Regular physical activity were the main group of 260 minutes per week, in control group 80 minutes per week.

Biography:

Abstract:

Biography:

Dr M Asad is a junior doctor at The Royal Oldham Hospital, Manchester, United Kingdom. She is an MbCHB with French Medical Studies Diploma and Masters in Public Health and Global Health.

Abstract:

Dobutamine stress echo (DSE) is a consistently employed non-invasive exercise-independent stress modality used to localize and assess coronary artery disease and myocardial ischaemia. DSE is a highly sensitive method for detection and localization of coronary artery disease. It is an internationally used test for the evaluation of patients with known or suspected coronary artery disease. The safety profile of the test has been widely examined via large studies involving sizeable cohorts of patients.Coronary vasospasm leading to ST elevation is a rare but documented complication of the test. Dobutamine, as a pharmacologic agent, although noted to cause vasoconstriction, has not been associated with coronary spasm. However, there are rare reports describing ECG ST segment elevation during dobutamine infusion in the absence of significant coronary artery disease or previous myocardial infarction, suggesting that dobutamine induced coronary artery spasm may occur.Myocardial ischaemia induced by dobutamine is frequently associated with ST segment depression on ECG.  However, ST elevations during DSE have been documented in several isolated reports and are an important source of false positive results.This is an important case series detailing three cases where coronary artery spasm during DSE resulted in electrocardiogram changes and subsequent angioplasty. Localisation of coronary artery occlusion was varied between ECGs during DSE and angioplasty, and in one case normal coronary arteries were observed. This could be due to dobutamine induced coronary artery spasm phenomenon. This case series has some important practical implications for interventional cardiologists.

Biography:

To be updated soon.

Abstract:

Since 1996, we have developed an innovative technique of ventriculoplasty, the “Twist Technique”(TT). The procedure performed has the purpose of preserving not only the volume and the shape of the LV but, above all, to restore the physiologic counterclockwise (CCW) twist of the cardiac apex through a rearrangement of its fibers, rebuilding the natural apical vortex of the LV. We present our experience in LV remodeling.From 1996 to 2015, 289 patients with post-infarction LV aneurysm underwent reconstructive procedures. Mean age was 56.4 ± 7.3 years. Average LV ejection fraction (EF) was 38.9% ± 11.6%. LV reconstruction was performed by using the TT in 265 patients (91.7%). Jatene technique is performed. Afterwards, the orifice closure is obtained performing the TT: a running 2-0 polypropylene suture orients cardiac fibers remodeling heart apex in a cone shape; stitches are outdistanced of 1 cm on the lateral side of the endocardial wall and of 1/2 cm on the endocardial septum. The distal and akinetic portion of the septum is folded and therefore excluded. In 257 patients (88.9%) concomitant myocardial revascularization was performed. Perioperative mortality was 2.4%. Mean follow-up was 8.45 ± 4.2 years. Actuarial survival rate at 13 years was 73 %. The physiological movement of the new apex, that unfolds in a natural CCW twist, considerably improved LV EF. Mean post-operatively EF was 46.1 ± 9.3 %.

Biography:

To be updated soon.

Abstract:

From September 2014 to February 2016, a total of 1611 diagnostic coronary angiograms at catheterization laboratory at Benha university hospital were prospectively examined to find out patients with CAE. Those patients were divided into 2 groups: Mixed CAE with obstructive CAD “group 1” and pure CAE “group 2”. Two control groups of age-adjusted subjects were selected consecutively in a 1:1 fashion; one with normal coronaries “group 3” (Pure CAE: normal coronaries) and the other with obstructive CAD only “group 4” (Mixed CAE: obstructive CAD). All recruited subjects underwent carotid intima-media thickness (IMT) and high sensitivity C-reactive protein (hs-CRP) level measurements.There were 61 patients with CAE out of 1611 coronary angiograms performed (3.78%). Of those, 35 subjects (57%) showed mixed CAE “group 1” and 26 (47%) showed pure CAE “group 2”. Age and gender-adjusted logistic regression analysis model revealed that significant independent predictors for CAE were: hypertension, smoking, absence of diabetes mellitus (DM) and hs-CRP level > 3 mg/L. Mean carotid IMT was significantly higher in group 2 than group 3 and in group 4 than group 1 (1±0.1 versus 0.4±0.2 mm and 1.4±0.4 versus 1±0.2 mm respectively, p < 0.001 for both). Mean hs-CRP level was significantly higher in group 1 than group 4 and in group 2 than group 3 (7±2 versus 3±0.8 mg/L and 6±2 versus 1±0.6 mg/L respectively, p < 0.001 for both)

Biography:

Mamta P Sumi (PhD student)  is  working on a research protocol entitled  “A genetic study to evaluate clinical implication of Thrombomodulin and associated proteins in Coronary Artery Disease” under the guidance of Dr.PC Ray in the Deptt of Biochemistry MAMC, New Delhi.

Abstract:

Coronary artery disease (CAD) is a leading cause of death in developed countries and is rapidly assuming epidemic proportions in developing countries as well. It has been shown that lower vitamin D levels appear to predict an increased risk of CAD mortality in patients with Type 2 Diabetes mellitus (T2DM). Coronary atherogenesis leading to CAD is an immunological phenomenon caused by foam cells i.e. transformed macrophages at the lesion site. Apart from the traditional role of vita D in calcium homoestasis lot of recent experimental evidences are available on role of vita D levels, VDR gene polymorphism, vitamin D binding protein gene polymorphism in immune reaction as immuno modulators and now-a- days are being considered as risk factors in generating coronary atherogenesis leading to CAD particularly in association with T2DM. Recent studies also provide that IL-4 exerts proinflammatory effects on vascular endothelium and may play a critical role in developing coronary atherosclerosis. So we set our aims for this study to investigate the association of vita D , VDR gene polymorphism and serum IL-4 levels in CAD with or without T2DM.The study involves two groups of patients suffering from CAD with T2DM (n=40) and CAD without T2DM (n=40) attended emergency or coronary care unit of Lok Nayak Hospital, New Delhi. A total of 6ml of blood sample was collected for estimation of serum vita D and IL-4 levels by chemiluminescence immuno assay method and VDR gene polymorphism (exon ll, rs 2228570) by PCR-RFLP using Fok1 restriction enzyme. Other relevant routine blood biochemistry tests were done by Beckman coulter fully automated analyzer using commercially available kits.Serum vita D levels were decreased in both groups of patients, more significantly decreased in the presence of T2DM in CAD patients. Serum IL-4 levels were significantly higher in CAD with T2DM group as compared to CAD without T2DM group. No association could be found between VDR gene polymorphism (Fok1) and risk of CAD in T2DM and non T2DM individuals. No significant correlation was found between vitamin D and IL-4 levels in the patients of both groups. No significant association was observed between low 25-hydroxy vitamin D levels with VDR genotypes (Fok1) in both groups of patients.The association between VDR Fok1 polymorphism, vitamin D and inflammatory markers needs to be further explored in diabetic CAD patients. A bigger study involving a much larger number of patients would help to generalize the results of this study.

Biography:

Perry Fisher is an Internal Medicine resident at the Mount Sinai Beth Israel Medical Center in New York. Born and raised in Queens, New York, Fisher attended an accelerated B.S./ M.D. program at the Sophie Davis School of Biomedical Education. He completed his clinical medical school training at Albany Medical College. Along the way, Fisher performed clinical research, presented at multiple conferences and lectures, published works, and amassed several awards honoring his work. Fisher now practices inpatient medicine at Beth Israel Hospital, and maintains outpatient privileges at the Ryan NENA Community Health Center – serving the underserved population of New York City’s Lower East Side. He has a passion for the art of Cardiology, and aspires to specialize in Cardiovascular Medicine.

Abstract:

Angioimmunoblastic T-Cell Lymphoma (AITL) is an uncommon lymphoma with rare cardiac manifestations. We present a clinical example where non-contrast and contrast enhanced echocardiograms demonstrated remarkably different myocardial compositions, particularly in our patient identifying infiltrating lymphoma in the myocardium. Case: A 68-year-old African American man with past medical history of AITL presented with weakness and fatigue for 2 weeks. Transthoracic echocardiogram (TTE) without contrast was performed that showed a pericardial effusion and an echolucency of the left ventricle concerning for pseudoaneurysm. Repeat TTE was performed using IV contrast revealed the presence of multiple non-communicating hypodensities within the myocardium. Pericardial fluid analysis did not reveal evidence of lymphoma, however pleural fluid cytology exhibited abnormal cells consistent with T-cell lymphoma. Discussion: In our patient, contrast enhanced echocardiography identified infiltrating lymphoma in the myocardium that was not seen with standard 2D imaging. Echocardiographic contrast agents are excellent tools for the evaluation of the LV endocardium especially in the detection and classification of intracardiac masses, including thrombi and tumors. Most malignant tumors, secondary to neovascularization, have an abnormally concentrated and dilated vasculature and concordantly, will display increased contrast enhancement compared to the adjacent myocardium. Contrary to the norm, we found metastatic lesions in our patient with deceased pixel intensity. The use of contrast agents should be considered when evaluating patients with non-cardiac diseases that have the potential for infiltrating the myocardium, but the level of contrast enhancement may be variable with certain types of tumors.: Angioimmunoblastic T-Cell Lymphoma (AITL) is an uncommon lymphoma with rare cardiac manifestations. We present a clinical example where non-contrast and contrast enhanced echocardiograms demonstrated remarkably different myocardial compositions, particularly in our patient identifying infiltrating lymphoma in the myocardium.

Biography:

Khal is a life long learner, Canadaian consultant physician. He is an American Board of Internal Medicine  and the Royal College of Physicians and Surgeons of Canada certified. He is enrolled in a Master of Health Administration degree at (University of Regina, Canada), and is an Executive Master of Cardiovascular Outcoms and Economics offer holder from the London Shool of economics (LSE). He was the head of Medicine, and Cardiac Rehabilitation program at the Niagara Health System of Ontario,and worked as a consultant physician, and the head of the Cardiac Rehabilitation and Heart failure programs in the middle East.

Abstract:

The two components of disability-adjusted life years (DALYs), years of life lost (YLL) and years lived with disability (YLD), are underutilized in evaluating heart failure with reduced ejection fraction (HFrEF) and global burden of diseases (GBD),. We aimed to describe both direct (medical) and indirect (morbidity and mortality) cost of CHF in high-income non-OECD Middle Eastern countries in relation to YLL and YLD.We used the World Health Organization GBD methodology to calculate DALYs, YLL, and YLD in 174 prospectively enrolled patients in a single centre heart failure registry using 0.4 disability weight (DW) and 3% future age discounts. We reported the cost of hospitalization, re-hospitalization, and non-invasive and invasive procedures per 1,000 HFrEF patients in US dollars.Expressing results as per 1,000 HErEF capita revealed DALYs of 1480 +/− 1909 vs. 2177 +/− 2547 (460, 3894) in females and males, respectively.The costs per HFrEF capita in US dollars (USD) were $909.00 +/− 676.1 for a single day hospital stay, $7,999 per single hospitalization, $12311 +/− 13840 for annual hospitalizations, $20486 +/− 22068 for all cause hospitalizations, and $37355 +/− 49336 from the time of diagnosis until death or recovery.In this study, HFrEF imposed a substantial economic and disability burden on the non-OECD non-North American Middle Eastern countries; however, males represented a higher economic burden than females.

Biography:

Perry Fisher is an Internal Medicine resident at the Mount Sinai Beth Israel Medical Center in New York. Born and raised in Queens, New York, Fisher attended an accelerated B.S./ M.D. program at the Sophie Davis School of Biomedical Education. He completed his clinical medical school training at Albany Medical College. Along the way, Fisher performed clinical research, presented at multiple conferences and lectures, published works, and amassed several awards honoring his work. Fisher now practices inpatient medicine at Beth Israel Hospital, and maintains outpatient privileges at the Ryan NENA Community Health Center – serving the underserved population of New York City’s Lower East Side. He has a passion for the art of Cardiology, and aspires to specialize in Cardiovascular Medicine.

Abstract:

Takosubo cardiomyopathy (TC), also known as stress cardiomyopathy, is a syndrome characterized by cardiac dyskinesis with symptoms that mimic those of myocardial infarction, but present in the absence of obstructive coronary artery disease. While its pathogenesis is not completely understood, TC is believed to be triggered by acute illness and/or emotional stress. It is theorized that this syndrome’s inflammatory features extend to the pericardium; however little data exists regarding the incidence of pericardial effusion in the setting of TC.To illustrate an incident of TC with concurrent pericardial effusion – the association of which remains questionable.Bybee KA, Kara T, Prasad A, et al. Systematic review: transient left ventricular apical ballooning: a syndrome that mimics ST-segment elevation myocardial infarction. Ann Intern Med 2004; 141:858.Eitel I, Lücke C, Grothoff M et al (2010) Inflammation in takotsubo cardiomyopathy: insights from cardiovascular magnetic resonance imaging. Eur Radiol 20(2):422–431 16.

Biography:

To be updated soon.

Abstract:

Genetic susceptibility is an important risk factor for aortic wall degeneration and its leads to thoracic aortic aneurysm and dissection (TAAD). In many patients with TAD, the aorta progressively dilates and ultimately ruptures. The purpose of this study was to determine the single nucleotide polymorphism in 6 genes associated with thoracic aortic aneurysm and dissection patients in Indian population-A case-control study.Genomic DNA was isolated from blood and aortic wall tissue of 66 patients with degenerative TAAD, and 67 control individuals. Six SNPs– rs819146, rs8003379, rs2853523, rs326118, rs3788205, and rs10757278 – were genotyped using TaqMan SNP Genotyping Assays (Applied Biosystems, Foster City, Calif). The data was analysed using STATA11.0 Statistical software. Associations between polymorphisms and disease in tissue, blood and within gender were estimated with odds ratios and their 95% confidence intervals.The T allele frequency for the SNP on 21q22.3, 5’ near gene as rs3788205 (- 2174 C/T) was higher in male patients than in male controls (P-.049). Moreover, with adjustment for traditional cardiovascular risk factors (sex, age, hypertension dyslipidemia diabetes and smoking), the rs3788205 {odd ratio (OD) 0.41, 95% confidence interval (CL) 0.14 to 1.09} polymorphism was found to be an independent susceptibility factor for TAAD in males.

Biography:

To be updated soon.

Abstract:

Platelet activation occurs in peripheral blood of patients with rheumatic mitral stenosis (MS) and atrial fibrillation (AF) and could be related to abnormal thrombogenesis. The CD40/CD40 ligand (CD40L) which reflects platelet activation, mediate a central role in thrombotic diseases. However, the role of CD40/CD40L system in rheumatic MS with or without AF remains unclear. Expressions of CD40 on monocytes and CD40L on platelets were determined by whole blood flow cytometry and serum levels of soluble CD40L were measured by enzyme-linked immunosorbent assay in group 1 (19 patients with MS) and group 2 (20 patients with MS and AF) compared to group 3 (10 controls). Patients with groups 1 and 2 had a significant increase in expression of CD40 on monocytes (P1 and P2 = 0.000) and serum levels of sCD40L (P1 = 0.014 and P2 = 0.033, respectively), but nonsignificant increase in expression of CD40L on platelets (P1 = 0.109 and P2 = 0.060, respectively) as compared to controls. There were no significant difference in all the parameters in group 1 compared to group 2. Correlation analysis demonstrated that there was a significant direct relationship between the severity of MS and serum levels of sCD40L (r = -0.469, p = 0.043). In conclusion, rheumatic MS patients with or without AF had upregulation of the CD40/CD40L system as well as elevated sCD40L levels. The levels of sCD40L had a significantly direct relationship with the severity of MS and it was the stenotic mitral valve, not AF, that had a significant impact on platelet activation

Biography:

To be updated soon.

Abstract:

Current treatments for myocardial infarction (MI) involves the reduction of two modifiable affecting the area of damage to the heart and patient outcome: ie. the time - from the first signs of MI to opening occluded artery (the shorter the damage less) and the use of appropriate pharmacological treatment. Modification of metabolic activity seems be possible third modifiable which may have an impact on damage to the left ventricular (LV) in the course of MI, especially during the critical ischemia. The use of periodic hypothermia during acute cardiac ischemia in order to reduce the level of metabolic activity of the heart tissue can significantly reduce the area of LV damage and improve the patients prognosis. Aim: Evaluation of MI- caused LV damage was performed by MRI (1.5T MR (GE)) with DE function (DE, delayed enhancement) and MVO (MVO, microvascular obstruction) in STEMI by applying direct heart hypothermia. Methods: The study was conducted in animal model. For this purpose, there were 20 animals (pigs) randomized to the study - 10 animals to study group (SG) and 10 to control group (CG). At the baseline, there were no significant differences in the age of the animals, sex, and anthropometric parameters. Animals in the CG were sequentially given analgesia, sedation and respiratory therapy. Then the MRI was performed with assessment of LV function and assessment of microvascular obstruction (MVO, microvascular obstruction) with a quantitative estimation of MVO. Then the coronary angiography was performed with extended (60 minutes) POBA LAD (target prox / mid LAD with a diameter of 2.5-3.0 mm behind DG1). 48 hours since POBA, there was MRI evaluation made in CG (MRI CG2). In SG MRI and POBA LAD were performed. Subsequently dry puncture of pericardium (pericardial catheter inserted to pericardial sac) with 12 – hrs procedure of direct hypothermia of heart was performed (saline cooled to 30 ° C). 48 hours since POBA LAD the MRI was performed for estimation of LV systolic function and MVO (MRI SG2). Comparison of baseline EF and MVO in CG1 and SG1 showed no significant differences (all p> 0.05). MVO was significantly reduced at SG2, and EF was significantly greater in SG2 comparison to the CG2. Similarly, for the EF and MVO significant difference was observed between the SG2 and CG2 (p <0.001).

Biography:

Leandro Augusto Franco Nascimento has completed his medical school at the age of 24 years from the Faculty of Medicine of Petropolis and post-graduation studies in cardiology from Real and Meritorious Charitable Portuguese Association of São Paulo - São Joaquim Hospital

Abstract:

The present study reports the case of a female patient, black, 32, born in the city of  Mogi das Cruzes / SP, referred for examination of coronary angiography in hemodynamics service in Real e Benemérita Associação Portuguesa de Beneficência São Paulo - São Joaquim Hospital due to symptoms of exercise intolerance and palpitations with exercise test showing criteria for myocardial ischemia. During the hemodynamic examination she was diagnosed with Bland-White-Garland Syndrome, a rare congenital defect, estimating its incidence at 1:300,000 live births. We decided to admit her to perform complementary tests and therapeutic decision. After detailed study of the case, we accompany the patient in clinical and drug treatment for 5 months when she presented partial improvement of symptoms, but with myocardial scintigraphy showing drug induced ischemia, moderate/large extension, which led us to indicate the surgical treatment. After 3 months, patient is asymptomatic with myocardial scintigraphy showing lesser extension of ischemia. Her heart shows no signs of permanent ischemic damage, such dilatation or akinetic areas.

Biography:

Raphael Chiarini has completed his medical school at the age of 24 years from Universidade Mogi das Cruzes and post-graduation studies in cardiology from Real e Benemérita Associação Portuguesa de Beneficência de São Paulo – Hospital São Joaquim.

Abstract:

The present study reports the case of a female patient, black, 32, born in the city of  Mogi das Cruzes / SP, referred for examination of coronary angiography in hemodynamics service in Real e Benemérita Associação Portuguesa de Beneficência São Paulo - São Joaquim Hospital due to symptoms of exercise intolerance and palpitations with exercise test showing criteria for myocardial ischemia. During the hemodynamic examination she was diagnosed with Bland-White-Garland Syndrome, a rare congenital defect, estimating its incidence at 1:300,000 live births. We decided to admit her to perform complementary tests and therapeutic decision. After detailed study of the case, we accompany the patient in clinical and drug treatment for 5 months when she presented partial improvement of symptoms, but with myocardial scintigraphy showing drug induced ischemia, moderate/large extension, which led us to indicate the surgical treatment. After 3 months, patient is asymptomatic with myocardial scintigraphy showing lesser extension of ischemia. Her heart shows no signs of permanent ischemic damage, such dilatation or akinetic areas.

Biography:

We be updated soon.

Abstract:

The present study reports the case of a female patient, black, 32, born in the city of  Mogi das Cruzes / SP, referred for examination of coronary angiography in hemodynamics service in Real e Benemérita Associação Portuguesa de Beneficência São Paulo - São Joaquim Hospital due to symptoms of exercise intolerance and palpitations with exercise test showing criteria for myocardial ischemia. During the hemodynamic examination she was diagnosed with Bland-White-Garland Syndrome, a rare congenital defect, estimating its incidence at 1:300,000 live births. We decided to admit her to perform complementary tests and therapeutic decision. After detailed study of the case, we accompany the patient in clinical and drug treatment for 5 months when she presented partial improvement of symptoms, but with myocardial scintigraphy showing drug induced ischemia, moderate/large extension, which led us to indicate the surgical treatment. After 3 months, patient is asymptomatic with myocardial scintigraphy showing lesser extension of ischemia. Her heart shows no signs of permanent ischemic damage, such dilatation or akinetic areas.

Biography:

Will be updated soon.

Abstract:

The present study reports the case of a female patient, black, 32, born in the city of  Mogi das Cruzes / SP, referred for examination of coronary angiography in hemodynamics service in Real e Benemérita Associação Portuguesa de Beneficência São Paulo - São Joaquim Hospital due to symptoms of exercise intolerance and palpitations with exercise test showing criteria for myocardial ischemia. During the hemodynamic examination she was diagnosed with Bland-White-Garland Syndrome, a rare congenital defect, estimating its incidence at 1:300,000 live births. We decided to admit her to perform complementary tests and therapeutic decision. After detailed study of the case, we accompany the patient in clinical and drug treatment for 5 months when she presented partial improvement of symptoms, but with myocardial scintigraphy showing drug induced ischemia, moderate/large extension, which led us to indicate the surgical treatment. After 3 months, patient is asymptomatic with myocardial scintigraphy showing lesser extension of ischemia. Her heart shows no signs of permanent ischemic damage, such dilatation or akinetic areas.

Biography:

Mebratu Alebachew Gebrie has completed his MSc, MSc, at the age of 25 and 29 years from Addis Ababa University Medical and Natural Science Faculties, respectively. He is currently a PhD doctoral student at University of Verona, Italy. He has published 2 papers in journals and 4 in abstracts.

Abstract:

King et al., first time described Percutaneous Trans-catheter Closure in 1976. After that, with time after Paediatric population, catheter interventions for atrial septal defect (ASD) have been adapted for adult population. The most useful clinical benefits of this procedure are the significant improvement of symptoms and routine life activities without major cardiac surgery.This study aimed to assess a single institutional experience of the ASD closure and Patent Foramen Ovale Repair early and late outcome after Percutaneous Transcatheter Closure.A retrospective observational cohort study designed for percutaneous PFO/ASD closure patients at a single centre. We enrolled study group from February 2000 to June 2015. We collected data from patient`s electronic folders. In entire population, N=126 (80%) and N=25 (20%) of the patients underwent PFO and ASD closure, respectively.