Day 1 :
2nd Medical School and Charles University Prague, Czech Republic
Time : 10:00-10:40
Dr. Josef Veselka, PhD attended medical school at Charles University, Prague, Czech Republic, and graduated in 1989. He is Professor of Medicine, Chief of Department of Cardiology, 2nd Medical School, Charles University and University Hospital Motol, Prague. His main expertise and interest is both in cardiomyopathies and interventional cardiology. He is one of the pioneers in the field of structural and coronary interventions. He has been published more than 300 scientific papers and edited 5 monographs and textbooks. He is a member of several editorial boards of medical journals
Hypertrophic cardiomyopathy (HCM) is characterized by the presence of increased thickness of the left ventricular wall that is not solely explained by abnormal loading conditions.Two-thirds of the patients with HCM have an obstruction in the left ventricle after provocation or even while at rest. Left ventricular outflow tract obstruction in HCM is associated with greater morbidity and mortality, and relief of obstruction is associated with improvement in symptoms and perhaps outcome. The first step in treating obstruction is the introduction of negatively inotropic medications. The two invasive therapeutic approaches for treating a left ventricular obstruction are alcohol septal ablation and surgical myectomy. The ﬁnal decision concerning the optimal invasive therapy for patients with obstructive HCM should be individualized to each patient depending on his/her wishes and expectations, way of life, age, heart morphology, and hemodynamics, as well as the experience of the treating center. There is a clear learning and safety curve associated with volume of procedures in all forms of septal reduction, this suggests that these procedures should only be performed in expert centres (centres of excellence)
University of Nebraska College of Medicine, Omaha, Nebraska
Time : 10:40-11:20
My research interests are preclinical translational studies aimed to improve baro and chemo reflexes control of autonomic, respiratory, renal and cardiac function, using a variety of approaches such as gene manipulation, novel pharmacological interventions, exercise/diet, and surgical interventions (e.g. cardiac, carotid body, renal denervations). In contemporary studies, we have focused on carotid body chemoreflex function in heart. Hyper-sensitization and tonic activation of the carotid body chemoreflex coupled with suppression of the baroreflex functionally exacerbates renal and cardiac dysfunction (cardio-renal syndrome) leading to increased morbidity and mortality in animal models of systolic heart failure. Our recent evidence suggests that these effects are tied to altered regulation of the major anti-oxidant transcription factors Nrf2 and KLF2. NIH and AHA grants have continuously funded these and other neuro-circulatory related studies under my direction over the past thirty-five years, including a Program Project Grant for the past 17 years
Enhanced arterial chemoreflex function is strongly related to cardiorespiratory disorders and disease progression in heart failure (HF). The mechanisms underlying chemoreflex sensitization during HF are not fully understood. We have utilized preclinical animal models of HF to describe an important role of both carotid body and central chemoreceptor function on autonomic and cardio-respiratory dysfunction in both HFrEF (cardiac pacing in rabbits and myocardial infarct in rats) and HFpEF (arterial-venous fistula in rats). Despite the etiology of HF, HFrEF and HFpEF animals exhibit similar cardio-respiratory abnormalities of periodic breathing, sympatho-vagal imbalance, and arrhythmias. In HFrEF animals, carotid body chemoreflex sensitivity is enhanced, but central chemoreflex sensitivity is minimally impacted. Whereas, in HFpEF animals, the opposite scenario it true. In HFrEF, carotid body ablation restores normal breathing patterns and autonomic balance, reduces arrhythmias and increases survival. The enhanced neural activity from the carotid body in HFrEF and its impact on sympathetic hyperactivity and breathing instability are related to a chronic reduction in cardiac output that down regulates a flow sensitive transcription factor KLF2 in the carotid body. In HFpEF, carotid body function is not markedly altered, consistent with normal blood flow and KLF2 expression in the carotid body, but central chemoreflex sensitivity to changes in PaCO2 is markedly enhanced and correlates with the sympathetic hyperactivity and breathing instability observed in that condition. These studies suggest that the differential influences of HFrEF and HFpEF on carotid body and central chemoreceptor function are related to differences in systemic hemodynamics and blood flow. Nevertheless, elevated chemoreflex activity, whether from the carotid body or central chemoreceptors, contributes a major role to the sympathetic hyperactivity and breathing instability seen in HF. Clinical evaluation of chemoreflex sensitivity in HF patients can provide important information about the etiology of autonomic/respiratory dysfunction and disease progression in these patients and may guide more targeted therapeutic strategies
- Heart Disease | Molecular cardiology | Cardiovascular Medicine | Heart failure | Arrhythmias
Hospital BP de São Paulo-Brazil
Title: New Surgical approach idea for patients with heart failure and mitral insufficiency. The technique of the two ventricles
Time : 11:35-12:05
Dr. Rafael Otto Schneidewind is a surgeon at the BP Hospital of São Paulo, with his training as a cardiovascular surgeon at Herzzentrum Wuppertal and at the Freiburg Universitäts klinikum in Germany, a specialist in Assist Devices and heart transplants
Statement of the Problem: Patients with cardiac insufficiency with mitral regurgitation number a poor prognosis in the short and medium term, being the therapy for this problem is the replacement or valve repair which takes a of the frame in the short and medium term. Theoretical Orientation: We have proposed the technique where we construct a Neo ventricle with flexible material inside the left ventricle (Conus) where the native ventricle is kept filling through a Left Atrium Appendage to Left Ventricular Bypass so that the Left Atrium and the Left Ventricle are double outlet. Findings: The first tests in the Flow Engineering and Hydrodynamics laboratory were very encouraging, we hope to start tests at Animal Lab next year. Conclusion : This technique waits to decrease the Wall Stress of the native ventricle and thus alleviates the La Place Strength in the wall of the ventricle, where theoretically we would improve cardiac remodeling
Virginiat Tech Carilion School of Medicine, USA
Time : 12:05-12:35
Ms. Phan has completed her MPH at Tufts University, and is currently a 4th year medical student at Virginia Tech School of Medicine. She has a special interest in the Congestive Heart Failure population, and done research and published on the outcomes of LVAD implantation
Heart failure (HF) affects 5 million people in the United States, with almost 80% of cases occurring in patients over the age of 65. Several studies have found that HF is associated with a 2-year mortality rate of approximately 45–50%. Although palliative care can compliment traditional medical management at any stage in HF its role becomes more prominent as patients transition to late stages of HF. There is need to develop and further examine models that integrate symptom guided palliative care interventions with established guideline directed therapies in the advancing HF population. For HF patients with a significantly high disease burden as outlined by the New York Heart Association (NYHA) Stage III/IV there are many under utilized interventions that the Palliative Care Department could use to improve symptom management. This retrospective study will examine whether patients who meet criteria for NYHA Stage III/IV are receiving appropriate services and pharmaceutical interventions for their degree of symptom burden (as measured through use of appropriate anxiolytics, antiemetics, or opioids). Palliative Care intervention will be measured through proxy of implemented DNR orders, and reduced symptom burden measured through reduced Emergency Department (ED) visits from exacerbation of HF symptoms. Hypothesizing earlier palliative care interventions will reduce symptom burden thereby improving quality of life and reducing hospital readmissions. Study group sample sizes will be 61 patients in Group 1 (palliative care intervention group) and 61 patients in Group 2 (control)
I-Shou University, Taiwan
Title: Combination exercise regimen and resveratrol intake can be considered for cardiac rejuvenation therapy in the aging process
Time : 12:35-13:05
Jia-Ping Wu has completed his PhD degree from China Medical University and postdoctoral studies from China Medical University and E-Da Hospital, I-Shou University, Kaohsiung, Taiwan. During his Ph.D study, he finished 10 publications since 2012-2015 and 10 projects including my thesis. After published all. he found some subjects that are very interested from this institute. He has been serving as an editorial board member of repute
The aging process is a time-dependent physiological program from birth to elderly. This process has many different molecular biology mechanisms to regulate different aging grade. Indeed, exercise regime or supplementary resveratrol intake can facilitate aging process reversed. However, their combination in the molecular biology interaction is our interesting in this study. We purchased natural aging mice and gene type senescence-accelerated SAMP8 mice. To examine different molecular biology interaction of survival and apoptosis signaling in natural and gene-type senescence-accelerated SAMP8 mice liver after exercise training, supplementary resveratrol intake, or their combination using western blotting. Histological pathophysiology of age-related liver disease was examined using hematoxylin-eosin and Masson's trichrome staining. Apoptosis cells were determined using TUNEL staining. Results showed SIRT-1/AMPK increased induced and Foxo1a/Foxo3a decreased was observed in natural aging after their combination. Upregulation of survival and downregulation of apoptosis was observed in western blotting analysis protein expression levels. In the genetic type of genetic senescence-accelerated mice SAMP8, genetic senescence-accelerated liver cross-section observed adipocytes and collagen. In 3-month-old and 6-month-old genetic type of genetic senescence-accelerated mice SAMP8, combination exercise training and resveratrol intake facilitate PI3K-AKT-ERK1-Bcl2 increased and Bad-Cytochrome c decreased. Combination exercise training and resveratrol intake in the 6-month-old genetic type of genetic senescence-accelerated mice SAMP8 has significant increases in p-PI3K/PI3K ratio (p<0.01), ERK1 (P<0.05), Bcl2 (p<0.0001) and Cytochrome c (p<0.05) compared with 3-month-old SAMP8 mice liver. Exercise training anti-aging function only observed in nature aging but did not find in genetic senescence-accelerated mice SAMP8. Resveratrol intake complementary has good function in natural aging and gene-type SAMP8 mice. Fortunately, their combination has excellently good interaction function in PI3K-AKT-ERK1-Bcl2 increased and Bad-Cytochrome c decreased. We suggest resveratrol intake can help exercise training therapy age-related cardiac disease
Gandhi Medical College, India
Time : 13:20-13:50
Prof. Dr.Karan Peepre, has completed his MBBS,MD,DNM at the age of 32 years from The University of jabalpur, University of Mumbai and Devi Ahilya University,Indore,India. He has been trained in Spect-CT,PET-CT, Nuclear Medicine,Nuclear Cardiology from AIIMS,New Delhi, World number One Emory University, School of Medicine, Atlanta,USA and Nuclear Medicine Centre,BARC,TMC,Mumbai. At present he is Professor and Head of Department of Nuclear medicine and Superintendent of Sultania lady Hospital,Gandhi Medical College,Bhopal,India.he has presented many research papers & delivered lectures in national and international conferences and chaired sceintific sessions, He has published more than 15 papers in reputed journals.3-Gold medals are in his credit
In 2015-16 about 40 million people were globally affected by heart failure. In developed countries, around 2% of adults have heart failure and in those over the age of 65, this increases to 6–10%. In the year after diagnosis the risk of death is about 35% after which it decreases to below 10% each year.Heart failure is a common, costly, and potentially fatal condition. Lifestyle changes, such as exercising, reducing salt in your diet, managing stress and losing weight-can improve quality of life. Heart attack happens when the flow of oxygen-rich blood to a section of heart muscle suddenly becomes blocked and the heart can’t get oxygen. If blood flow isn’t restored quickly, the section of heart muscle begins to die,resulting in to severe weakness and heart failure.Heart attacks most often occur as a result of corornary heart disease (CHD), also called coronary artery disease.When plaque builds up in the arteries, called atheroslerosis. The buildup of plaque occurs over many years.Eventually, an area of plaque can rupture (break open) inside of an artery. If the clot becomes large enough, it can mostly or completely block blood flow through a coronary artery. If the blockage isn't treated quickly, the portion of heart muscle fed by the artery begins to die. Heart failure (HF),signs and symptoms commonly include sweling in legs, shortness of breath, excessive tiredness.Common casues are coronary artery disease(CAD) including a previous myocardial infarction (heart attack), fibrillation,alcohol use in excess. Treatments can improve health of patient’s and help live longer
Centro Cardiologico Monzino, in Milan
Time : 13:50-14:20
Samér Kassem is a cardiac surgeon who works at Centro Cardiologico Monzino, in Milan.
He was born in Siria, where he had spent the first years of his life, between the cities of Latakia and Damascus. His working experience began with General Surgery. During that period he performed a lot of procedures, showing great competence. He then attended the Cardiac Surgery Program and took part to both adult and pediatric surgery. Once he migrated to Italy, he associated with the best trained surgeons at the most specialized centres of the North of the Country. In this way, he improved and refined his skills in both surgical practice and scientific research. Since 2004 he stably operates at Centro Cardiologico Monzino, where he found the excellence in Cardiac Surgery and, most of all, the opportunity to develop new personal surgical techniques in different fields. In fact, doctor Kassem has large and deep experience and knowledge and also a vivid interest in mitral and aortic valve surgery, aortic arch surgery, surgery of the ascending aorta and surgery of left ventricular aneurysms and, finally, coronary surgery. He has recently approached hypertrophic cardiomiopathy and its surgical management.
Kassem is also a talented oil painter. After studying art in Damascus, he has had the possibility to blend two different cultures, the Syrian and Italian one, once he moved to Italy. He had recently performed his last exhibition in an historical place along the Adda river, near Milan, where the “genius” Leonardo DaVinci left important traces of his amazing and all-life-long lasting work
Introduction The Systolic Anterior Motion (SAM) of mitral valve (MV) associated with the asymmetric hypertrophy of left ventricular septum are the two components responsible for left ventricular outflow obstruction (LVOTO) in Hypertrophic Obstructive Cardiomyopathy (HOCM). The transaortic left ventricular septal myomectomy has been proposed as the gold standard surgical procedure for symptomatic patients with severe HOCM since the late 1960s.
Objective We have previously described one technique to prevent SAM post MV repair, the so-called “paradoxical artificial cords to prevent SAM after MV repair”. The aim of this article is to demonstrate the efficacy of this technique also to treat SAM in HOCM patients, in case of concomitant moderate septal myectomy.
Methods The subjects of the study are 5 patients with both SAM and LVOTO. All of them have been surgically treated, performing moderate transaortic septal myomectomy and correction of SAM by paradoxical artificial cords and ring annuloplasty.
Results The postoperative course of all patients was regular. No one of them developed the usual complications of this surgery (Ventricular Septal Defect [VSD] or Pacemaker [PM] implantation). Transthoracic Echocardiography TTE has demonstrated good result of the early postoperative interventricular gradient. The MV function was preserved and free of SAM.
Conclusion The paradoxical artificial cords technique could be considered as a valid treatment for SAM in patients with HOCM and LVOTO, if associated with moderate septal myectomy. The combination of these two surgical procedures is particularly important to avoid complications, especially VSD, in patients with a relatively thin interventricular septum, even in presence of hypertrophy
Norwegian University of Science and Technology, Trondheim, Norway
Time : 14:20-14:50
Imre Janszky has an MD and a PhD degree from Semmelweis Medical University, Budapest, Hungary and from Karolinska Institutet, Stockholm, Sweden, respectively. He is currently working at the Department of Public Health and General Practice/Medical Faculty/ Norwegian University of Science and Technology as professor in epidemiology. His main focus of research is on risk and prognostic factors for cardiovascular diseases
We analyzed the association between light-to-moderate alcohol intake and the risk of heart failure (HF).
METHODS AND RESULTS:
We studied 60,665 individuals free of HF who provided information on alcohol consumption in a population-based cohort study conducted in 1995-97 in Norway. Sociodemographic factors, cardiovascular risk factors and common chronic disorders were assessed by questionnaires and/or by a clinical examination. The cohort was followed for a first HF event for an average of 11.2 ± 3.0 years. Mean alcohol consumption was 2.95 ± 4.5 g/day; 1588 HF cases occurred during follow-up. The quantity of alcohol consumption was inversely associated with incident HF in this low-drinking population. The risk was lowest for consumption over three but less than six drinks/week; the multivariate hazard ratio when comparing this category to non-drinkers was 0.67 (95% CI: 0.50-0.92). Among problem drinkers based on CAGE questionnaires, total consumption showed no favorable association with HF, even when overall consumption was otherwise moderate. Excluding former drinkers and controlling for common chronic diseases had minimal effect on these associations. Frequent alcohol consumption, i.e. more than five times/month, was associated with the lowest HF risk; the adjusted hazard ratio comparing this group to alcohol intake less than once/month was 0.83 (95% CI: 0.68-1.03). We found no evidence for a differential effect according to beverage type, nor that the competing risks of death from other causes modified the association.
Frequent light-to-moderate alcohol consumption without problem drinking was associated with a lower HF risk in this population characterized by a low average alcohol intake
Inverclyde Royal Hospital, Greenock
Time : 14:50-15:20
Stefan Hindmarsh is a resident doctor working for the NHS in UK. Graduated from Aberdeen University medical school in 2016. President of the Medical Society as well as playing Secretary of the University Golf Team.
During the final year of training, spent time in a New Jersey ER/Trauma Centre where I got experience in pericardiocentesis as well as acute management of cardiac presentations.
While working as a Cardiology resident, he became adept at ECGs interpretation and Echocardiography. His interest is management of acute heart failure, identification and validation of novel factors predicting and/or affecting heart failure adverse outcomes
In this retrospective study, 96 patients admitted with Heart failure(HF) from the most deprived and least deprived tertile of Scottish Index of Multiple Deprivation (SIMD) (1 – 3 – most deprived and 7 - 9 – least deprived).
Between the two groups, no statistical difference exists between age, gender, haemoglobin or creatinine level; nor was there any difference in past medical history or cigarette use. Patients from the lower tertile has higher incidence of alcohol excess (16% vs 3%, p = 0.043) while higher incidence of AF for the higher tertile (55% vs 33%, p = 0.004). Prescription of diuretics, Beta-Blocker, ACE-I or ARB were not statistically different. Patients from higher tertile is more likely to receive aldosterone antagonist (37% vs 17%, p = 0.031) and combined Beta-blocker and ACE-i/ARB treatment (42% vs 21%, p = 0.025).
6-months follow-up demonstrates composite endpoint of heart failure readmission and mortality was statistically higher among patients of lower socioeconomic tertile (p = 0.042). Stepwise multiple regression analysis also confirmed socioeconomic deprivation as an independent predictor for more adverse clinical outcome for heart failure (p = 0.003, R2 = 22%).
Summary: Despite the establishment of universal healthcare, patients from the lower socioeconomic group are less likely to received prognostically beneficial medication and are more likely to be experience readmission for heart failure or death
King Faisal Specialist hospital and research center – Riyadh
Time : 15:35-16:05
Aljuhara Tha’ar AlMarzoog has completed bachelor degree in nursing in 2012 from King Saud University in Saudi Arabia and currently finalizing Master degree in Medical – Surgical nursing from the same university . Also She is cardiac nurse and works with heart failure team at King Faisal Heart center in King Faisal Specialist hospital and research center – Riyadh
The prevalence and incidence of heart failure ( HF ) have been increasing dramatically in Saudi Arabia due to of presence of multiple factors such as coronary artery disease , diabetes , hypertension , and valvular disorders . HF syndrome is very complex in its nature and can cause multiple psychological changes such as depression , therefore patients find it difficult to cope with this psychological change either due to social or spiritual factors . This study aims to find correlation between counseling and its effect on depression level among HF patient , and to address gap in knowledge regarding depression level on this group in Saudi Arabia
Matin Parker, India
Title: Study the relationship between left atrial (LA) volume and LV diastolic dysfunction and LV hypertrophy. Correlate LA volume with cardiovascular risk factors
Time : 16:05-16:35
In approximately 30-50% of the individuals who develop congestive cardiac failure the systolic function as assessed by left ventricular (LV) ejection fraction is either normal or relatively normal.
Study the relationship between left atrial (LA) volume and LV diastolic dysfunction and LV hypertrophy. Correlate LA volume with cardiovascular risk factors.
A total of 60 patients was included in the study. These patients underwent a screening echocardiography to diagnose left ventricular hypertrophy and diastolic dysfunction.
There is a significant correlation between left ventricular hypertrophy and diastolic dysfunction. 79% patients with evidence of diastolic dysfunction by tissue Doppler had a higher left atrial volume.
Increased left ventricular mass is associated with increasing severity of diastolic dysfunction. Increased left ventricular mass is also associated with increased left atrial volume indexed to body surface area. Left atrial volume correlates with the duration of diabetes mellitus. Increasing severity of left ventricular diastolic dysfunction correlates significantly with left atrial volume indexed to body surface area. At milder degrees of diastolic dysfunction, left atrial enlargement may not be the best predictor of severity. But with increasing severity of diastolic dysfunction in left ventricular hypertrophy, left atrial volume indexed to body surface area may be a sensitive and easy marker for assessment of severity and thus the long term prognosis in terms of atrial fibrillation, stroke and mortality
Hunan Normal University, Changsha, China
Time : 16:35-17:05
Xiushan Wu completed his PhD from Stockholm University in 1986-1990, postdoctoral studies from Michegan University and etc in 1990-1994 and Scientist in Karolinska Institute in 1994-2000. He is the Director and Professor of The Center for Heart Development, Hunan Normal University. His research focuses on understanding the mechanisms by which embryonic heart is developed using Drosophila, zebrafish and mice as models. He has published more than 350 papers including over 110 SCI papers
The heart is the first organ that forms and functions during embryonic development and is one of the organs most closely related to human health. In the early 1990s, the author was the first to demonstrate that canonical Wnt signaling controls the embryonic heart development using fruit fly model, and thus the signaling was introduced into the cardiac development field. Our finding was further proved by other studies with vertebrate models such as Xenopus, zebrafish and mice. Nowadays, Wnt signaling has become one of the most important signaling pathways in the cardiac development field. However, it was found that studies with different animal models and even in the same animal model can lead to opposed findings. For example, the author demonstrated that canonical Wnt signaling promotes cardiac development in Drosophila, while the others showed that it inhibits the heart development in vertebrate. The two contradictory conclusions about the role of canonical Wnt signaling in the regulation of heart development were not solved until 2007. However, in the same year, it emerged as a new paradox that canonical Wnt signaling activates or inhibits cellular aging[4-5]. Here our studies on the unresolved question of canonical Wnt signaling regulation in cardiac aging, and on the novel co-factors of the canonical Wnt signaling for cardiac development will be discussed based on our recent findings