Day 1 :
Adjunct Professor of Family & Community Medicine, New York Medical College, USA
Keynote: Non-invasive quick diagnosis of cardiovascular diseases from visible and invisible changes on eyebrows & upper lip and their safe & effective treatment
Time : 10:25-11:10
Yoshiaki Omura received both Oncology Residency Training and a Doctor of Science Degree through research on Pharmaco-Electro Physiology of Single Cardiac Cells in vivo and in vitro from Columbia University. He has published over 250 articles and 7 books. He is Executive Editor of Integrative Oncology & Editorial Board Member of Journal of Clinical Trials in Cardiology, etc. Using his new diagnostic method, which received U.S. patent, he can non-invasively and rapidly measure many neurotransmitters, other chemicals, asbestos, viruses, and bacteria. He developed non-invasive quick diagnostic methods of malignancies, as well as a method of evaluating the effects of any treatment.
The method of Electro-magnetic Field (EMF) Resonance phenomenon between 2 identical molecules of identical weight was originally developed at Pupin Laboratory of Graduate Experimental Physics division of Columbia University. Using this method, we can non-invasively & rapidly detect any molecules that exist inside of the body including the brain. Using this method, which received US patent in 1993, we were able to map most of the organ’s representation areas on the surface of the Face, Tongue, Hands, & Feet. When there is any abnormality for a specific internal organ, we found there will always be invisible or visible abnormalities that can be detected on the organ representation areas of the abnormal organ. About 7 years ago, we were able to map the organ representation area of the eyebrows. In the eyebrows, every organ is represented. The part of the eyebrows nearest to the nose represents the cardiovascular (CV) system. When there is an abnormality of the CV system, the hair in the eyebrow closest to the nose becomes whiter. Then, when the problem progresses, the white hair begins to disappear. Therefore, just by seeing the eyebrows, we can detect visible abnormalities on the CV representation areas of the eyebrow. When the hair at the eyebrows does not exist, there is almost always an abnormal response in the area where the hair is missing, For example, in the area where there is no hair of CV system representation area, Cardiac Troponin I is significantly increased. If the patient has atrial fibrillation, in the CV representation area, particularly corresponding to SA node and atrium area, there is a significant EMF resonance with monoclonal antibody of Borrelia Burgdorferi (B.B.) spirochaete and a corresponding significant increase of ANP in the infected part of the heart at corresponding part of ECGs such as SA node area & P-wave. On the face, among several CV representation areas, there is another important CV representation area existing at the left upper lip near the center of the mouth.
Thomas Jefferson University School of Medicine, USA
Keynote: Beating heart pump-assisted direct coronary artery bypass (PAD-CAB): The best of both worlds
Time : 11:30-12:15
Louis Samuels graduated Medical School from Hahnemann University (Philadelphia, PA) in 1987 and completed his Cardiothoracic Surgical training in 1995. He joined the faculty of Drexel University as the Surgical Director of Cardiac Transplantation. In 2001, Dr. Samuels and his team implanted the world’s 5th totally implantable electric artificial heart (AbioCor™). In 2003, he joined the Main Line Health System as the Surgical Director of Heart Failure. In addition to cardiac transplantation and LVAD implantation, Dr. Samuels performs CABG and Valvular surgery. In 2012, Dr. Samuels became Professor of Surgery at Thomas Jefferson University School of Medicine. Dr. Samuels has authored over 100 peer reviewed manuscripts and serves as a reviewer for the Annals of Thoracic Surgery. In addition to participating in several clinical trials related to mechanical circulatory support, he continues to serve as a consultant and medical advisor to new technologies currently in trial.
Coronary Artery Bypass Grafting (CABG) is the most common cardiac surgery operation in adults. The clinical history of this procedure can be dated back to the 1960s when various surgeons began to consider coronary revascularization with a graft. At that time, the heart-lung machine was still a device with considerable challenges separate from the technical aspects of the operation itself. As such, the first bypass procedures were done Off-Pump on the beating heart, typically to the RCA only. With improvements in technology, coronary bypass grafting expanded to multi-vessel procedures utilizing cardio-pulmonary bypass, aortic cross-clamping, and cardioplegic arrest. This traditional technique afforded a near-perfect environment in which hemodynamic stability could be maintained while grafting the coronaries in a motionless field. The traditional CABG was, and remains, the standard by which all other techniques of coronary revascularization is measured. And the results, by the way, are excellent.
In the past two decades, alternatives to the traditional CABG have been proposed and tested by numerous surgeons—an attempt to minimize or eliminate the sequellae associated with the body’s exposure to the heart-lung machine. One area of investigation was considered and implemented: OFF-PUMP CABG (OP-CAB). The idea behind the OP-CAB was to determine if the CABG operation can be conducted on the beating heart without the support of the heart-lung machine. Special industry-sponsored devices (i.e. stabilizers) were developed to help accomplish this goal. Many manuscripts were published describing the techniques and outcomes of the OP-CAB procedure—some supporting its use and others showing no advantage over the traditional CABG. Often absent from these manuscripts are the “intangibles”—the stress on the surgeon and anesthesiologist while trying to perform the procedure; the difficulty in training residents and fellows to do the procedure; the “near misses” when events during the procedure (e.g. arrhythmia, hypotension, ST segment changes) force an emergency conversion to a traditional CABG; and the suggestion that some territories were left ungrafted for “technical reasons”.
In an effort to determine if a “hybrid” approach could afford the benefits of a beating heart technique utilizing the heat-lung machine, but without aortic cross-clamping and cardioplegic arrest, the pump-assisted CABG (PAD-CAB) was examined.
The purpose of this talk is to describe my experience with the PAD-CAB procedure from 2005 through 2016. During this time frame, more than 300 PAD-CAB cases were performed, representing 37% of the overall number of CABG cases (No. 834). Since 2013, the PAD-CAB approach represented 84% of the CABG cases; and since 2015, the PAD-CAB technique was utilized in 96% of the cases. Overall, the hospital and 30-d mortality for all PAD-CAB procedures was 0.65%, with only 1 death (0.35%) in the last 288 procedures. The majority of cases were men (76%), the average age was 67 years (range: 38 – 91 years), and the average number of grafts was 3.2 (range 1 – 5). Thirty-nine cases (12.7%) were emergent.
In summary, the PAD-CAB procedure is safe and effective and should be considered as an alternative to the traditional CABG.
- Heart Disease | Ischemic Heart Disease | Clinical Trials in Cardiology
Lipoprotein & Metabolic Disorders Institute, USA
Lipoprotein & Metabolic Disorders Institute, USA
Title: Use of particle number versus cholesterol measures to optimize management of LDL-related ASCVD risk
Time : 12:15-12:45 PM
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.
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.
Hospital Institute of Cardiology National Medicine Academy, Argentina
Title: Is it possible to predict future cardiovascular events in patients without coronary artery disease demonstrated?
Time : 12:45-13:15
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.
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.
University of São Paulo, Brazil
Title: Effects of the transcranial direct current stimulation on prevention of postoperative cognitive dysfunction after cardiac surgery
Time : 14:00-14:30
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.
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.
Wuhan University, China
Time : 14:30-15:00
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.
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.
Nour Heart Institute,USA
Time : 17:20-17:50
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.
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.
University of São Paulo, Brazil
Title: Neuropsychological assessment through MentalPlus digital game. The importance of this evaluation in heart disease and cardiac preoperative and postoperative for a good prognosis and possible cognitive rehabilitation
Time : 15:00-16:00
- Special Session
Bar Ilan University, Israel
Title: Personalized medicine in cardiovascular medicine using advanced stem cells technologies and linear array vascular ultra sound
Time : 16:20-17:20