Day 1 :
University Duisburg-Essen, Germany
Keynote: Improved cardiovascular risk prediction using signs of atherosclerosis-Lesson from the Heinz Nixdorf Recall study and Multi-ethnic study of atherosclerosis
Time : 09:00-09:30
Raimund Erbel studied medicine in cologne and Düsseldorf. His internship lead him to hospitals in Düsseldorf, Leverkusen, Koblenz, and Aachen. In Mainz he was signed consultant and received a Professorship in 1993, tenure-ship in 1998 and became a full professor and director of the department of cardiology in Essen 2003, where he worked until 2015. He was able to built up the 1st Heart Center located within a University Clinic in Germany providing an excellent partnership with the department of thoracic and cardiovascular surgery. The highlight was the opening of 1st hybrid room allowing heart catheterization and cardiovascular surgery without transportation of the patient in a specially designed room, so that cardiologists, anesthesiologists and cardiac surgeons found ideal working spaces. Early in 1993 he become aware of the new electron beam computed tomography which was installed in Bochum und Mülheim. The detection of coronary artery calcification as an early sign of atherosclerosis by this non invasive method was fascinating. He started to evaluate the possibilities of primary prevention. In 2000 he started the Heinz Nixdorf Recall study funded by the Heinz Nixdorf Foundation. This study is now in its 16th year of follow up and has already started a multi generation cohort. The study received national and international reputation and is currently involved in many multi-centre epidemiological projects looking not only to known cardiovascular risk factors but also to psychosocial factors as well as effects of pollution.
Despite the progress in the diagnosis and treatment of cardiovascular diseases the high frequency of sudden death is the biggest challenge today. Sudden and unexpected, acute myocardial infarctions occur even in “healthy” men due to plaque rupture or erosion based on subclinical coronary atherosclerosis. In relation to the total number of people, who die in the course of myocardial infarction, the number of out of hospital deaths reaches two thirds of all deaths. That means, only primary preventive strategies will be able to reduce this often tragic event, already know in the old Egypt documents. The best non-invasive method in order to detect signs of coronary atherosclerosis is computed tomography (CT), because this technique is able to visualize, localize and quantify coronary artery calcification (CAC). Calcium is, on the other hand, found intra- than extracellularly; an early sign of developing coronary atherosclerosis. In men at the age of 40 years, in women 10 years later, CAC appears and growths in the following years. CAC quantification is based on the Agatston algorithm. The detection and quantification of CAC helps to identify people at risk nowadays with low x-ray exposure of the patients´ chest. CAC increases during life on an exponential curvature, which allows the prediction of the progression. Due to the remodeling process– exhausted at a level of 40-50% of the vessel plaque area - , coronary atherosclerosis remains for decades subclinically until the plaque load exceeds a level which results in a significant luminal narrowing. In this stage the plaque load has usually reached 70–90 percent of the vessel cross-sectional area. However, not the luminal narrowing, but the plaque rupture or erosion is the main reason of the acute events leading to mural or occlusive thrombus formation and in many cases to formation of micro-embolization resulting in microinfartcs/infarctlets. Therefore, risk reduction based on know signs of coronary atherosclerosis already in the early phase, will help to start a new era of primary prevention.
Max-Planck-Institut fĂĽr biophysikalische Chemie, Germany
Keynote: Cardiovascular MRI in real time
Time : 09:30-10:00
Jens Frahm is the Director of Biomedizinische NMR Forschungs GmbH (non-profit) at the Max-Planck-Institute for Biophysical Chemistry in Göttingen, Germany.rnHis research is devoted to the methodological development of magnetic resonance imaging (MRI) and the advancement of MRI in science and medicine. Hisrnpublications include more than 430 articles, patents, and book chapters. For his ground-breaking workFrahm received the European Magnetic Resonance Award,rnthe Gold Medal of the International Society for Magnetic Resonance in Medicine, the Karl Heinz Beckurts-Award for Technology Transfer, the State Award of LowerrnSaxony, theResearch Award of the Sobek Foundation for Multiple Sclerosis and the Science Award of the Foundation for German Science.
This lecture presents recent advances towards real-time magnetic resonance imaging (MRI) which result in high-qualityrnimage series of dynamic processes with acquisition times of only 10 to 40 milliseconds. The acquisition technique employsrnradially encoded gradient-echo sequences with up to 30-fold data undersampling. Image reconstruction emerges as therniterative solution of a nonlinear inverse problem which is accomplished by a bypass computer with 8 graphical processingrnunits fully integrated into a commercial MRI system. Apart from a brief description of the acquisition and reconstructionrntechnique, the talk will focus onapplications to cardiac function, quantitative blood flow and myocardial T1 mapping. Thesernstudies may now be performed without the need for ECG synchronization and during free breathing. Taken together, real-timernMRI techniques offer the chance to develop comprehensive CMR protocols which are comfortable to the patient, provide newrndiagnostic opportunities (e.g., immediate physiological responses to stress or exercise), are insensitive to irregular motion (e.g.,rnpatients with arrhythmia), and may even be more cost-effective (i.e., much shorter) than current examinations. Future progressrnis foreseeable and will involve more extensive parametric mapping studies (e.g., T2* relaxation, perfusion and temperature)rnand a revitalization of “interventional” MRI procedures.
Universite Pierre et Marie Curie, France
Keynote: Value of echocardiography in cardiomyopathies, with special reference to right ventricular dysfunction
Time : 10:00-10:30
Guy H Fontaine MD PhD HDR has made 15 original contributions in the design and the use of the first cardiac pace makers in the early 60s. He has serendipitouslyrnidentified ARVD during antiarrhythmic surgery in the early 70s. He has developed the technique of Fulguration to replace surgery in the early 80s. He has been onernof the 216 individuals who have made a significant contribution to the study of cardiovascular disease since the 14th century and one of the 500 greatest geniusesrnof the 21st Century (USA Books), one of the 100 life time of achievement (UK Book). He has > 900 publications including 201 book chapters. He is a reviewer ofrn17 scientific journals both in basic and clinical science. He has given 11 master lectures of 90 minutes each in inland China in 2014. He is now developing newrntechniques for brain protection in OHCA, stroke and spinal cord injury by hypothermia.
Echocardiography is nowadays the simplest and less expensive mode of cardiac imaging. However, its value on RV functionrnneeds to know some of the basics in the pathology of this chamber starting by normal RV. RV free wall is very thin (3 mm)rnas compared to the LV (10 mm). Also, in the normal heart there is practically no contribution of RV in hemodynamics andrnfinally a detailed histological feature shows the presence of an exceedingly large amount of fat (without fibrosis) which explainsrnirreversible RV failure in 12% of heart transplant patients. Therefore, it seems obvious that research efforts have to be directedrntowards a proper investigation of these parameters which can be reconsidered with recent advances in echocardiography suchrnas strain, speckle technique, 3D echocardiography, etc. Especially, because the mechanism and the trouble of development ofrnthis disease has been properly reproduced in the laboratory from iPSC lines. The other main concern properly identified inrnARVD is the possible deleterious effect of a superimposed inflammatory phenomenon of myocarditis which can be the resultrnof a particular susceptibility of this genetically modified myocardium by the same gene which has produced the trouble inrndevelopment. When myocarditis is involved, a wide spectrum of disorders will be produced leading to RV echocardiographicrnFractional Area Change FAC which looks a better parameter than Tricuspid Annulus Plane Systolic Excursion TAPSE (SagunerrnCirculation 2014) but also involvement of the left ventricle which is finally the cause of irreversible heart failure at the end-stagernof the disease. In that case, follow-up of patients should be performed by serial echocardiograms paying attention to the TAPSErnand FAC but also to the LVEF. Abrupt drop of LVEF associated with troponin release will be the marker of a superimposedrnmyocarditis which may have several patterns of evolution encompassing the fulminant form with irreversible hyper acute heartrnfailure which can be sometimes controlled by LV mechanical myocardial support to minor or even no cardiac deteriorationrnin the most frequent situation. In between, the decrease in LVEF can stop after complete healing of myocarditis of lead torncontinuous deterioration of cardiac function in case of an induced autoimmune phenomenon. It has been also suspected thatrnthe same concept of the deleterious effect of a superimposed myocarditis can be extended to other inherited cardiomyopathiesrnsuch as IDCM, HCM and even WPW syndrome.
- Track: 1Cardiologists, Track: 2 Pediatric Cardiology & Track: 3 Heart Diseases
San Camillo-Forlanini Hospital, Italy
Medical University of Wroclaw, Poland
The Childrenâ€™s Hospital of Michigan, USA
Title: Ten year performance of the 4.1 French, lumenless, catheter-delivered pacing lead among patients with and without congenital heart
Time : 11:00-11:20
Peter P Karpawich completed his Masters in Science degree from The University of Detroit and his Medical Degree from Hahnemann/Drexel University in Philadelphia, PA. He completed his Post-doctoral Residency in Pediatrics at The Children's Medical Center, University of Texas (Dallas) and Pediatric Cardiology Fellowship at Texas Children's Hospital, Baylor University (Houston). He the founder and Director of the Cardiac Electrophysiology Program at the Children's Hospital of Michigan and Professor of Pediatric Medicine, Wayne State University School of Medicine (Detroit). He has published over 250 scientific papers, textbook chapters and textbooks and is on the Editorial staff of several internationally-recognized medical journals.
Introduction: The lumenless, 4.1F diameter M3830 steroid pacing lead (Medtronic, Inc.) is a coaxial, solid core, non-styletdelivered design. Approved for use in 2005, the very long term performance is largely unknown, especially among congenital heart disease (CHD) pts and with implant at alternate (non appendage/apex) pacing sites (AP). This study presents 10 year post implant evaluation of this lead among CHD pts. Methods: From 2005-2015, 126 pts (age 2-50, mean 19y, 58% male) received 190 leads: atrial 105; ventricle 85. CHD pre-/postrepair structural anatomy (73%) included septal defects, tetralogy and transposition with 93% implant at AP (e.g. septal). Data included sensing, pacing thresholds and lead impedances (Imp). Results: Follow-up was from 1-120 months (mean 60) with >50% of pts followed > 5 y post implant. Comparative implant with latest follow-up showed excellent < 1v) pacing thresholds (volts at 0.4-0.5ms) graph): atrial (A) (0.70±0.3 vs. 0.63±0.3 vs. (P=NS)) and ventricular (V) (0.64±0.3 vs. 0.89±0.4 vs. (p<0.05)) and sensed P (mean 3.5±1.9 vs. 3.6±2mv (NS) and R waves (10.6±5 vs. 9.6±4.8mv (NS). Lead Imp were all in the normal range for lead design (A: 745±223 vs. 556±121 Ω: V 845±255 vs. 522±82 Ω (p < 0.05). Only 2 A leads dislodged (< 1 month) and one was repositioned and 2 other leads (1 A, 1 V) were extracted. Conclusions: The 4.1Fr, lumenless pacing lead shows ease of implant regardless of CHD or site, excellent very long term (10y) stability and performance indices with a very low rate of complications.
San Camillo-Forlanini Hospital, Italy
Title: Surgical approach to heart valve infective endocarditis complicated by abscess: A single center experience
Time : 11:20-11:40
Marco Picichè (MD, PhD) graduated with a degree in Medicine in Florence in 1995 and completed his Cardiac Surgery residency in Rome in 2000. He earned his research master in Surgical Science (Paris, 2007) and a university diploma in vascular surgery (Paris, 2007). In 2009 he opened the 44th Congress of the European Society for Surgical Research. He has written many publications and worked as a guest reviewer for many international leading journals. He is a Member of the Editorial Board of several English language Journals. He received a Doctor of Philosophy (PhD) in Paris. He is the Editor in Chief of the multi-author book "Dawn and Evolution of Cardiac procedures-Research Avenues in cardiac Surgery and Interventional cardiology". Currently he is a cardiac surgeon in Rome.
Introduction: Heart valve infectious endocarditis represents a fatal event if left untreated. The onset of an abscess has an impact on the surgical indication and strategy. We reviewed our experience with this serious complication. Material & Methods: Data of 74 patients have been retrospectively analyzed using the department's database. Operations were performed over an 8-year and 7-month period, from July 2007 to January 2016, by different operating surgeons. Patients presenting one or more abscesses were included in the study. Morbidity and mortality rate within 30 days were reviewed. Results: There were 8 males and 5 females. Age ranged from 33 to 77 years (mean 60±15). Various surgical procedures have been performed, such as aortic or/and mitral valve replacement, mitral or/and tricuspid valve repair and a freestyle prosthetic valve implant in pulmonary position. Moreover, in two patients surgery was extended to the ascending aorta, and in 1 case a coronary artery bypass graft was performed. A patch technique was adopted whenever necessary. Overall, 11 patients survived. Two patients died, one due to septic shock and the other due to pneumonia. Conclusion: The onset of abscesses represents a serious complication of heart valve infectious endocarditis that increases the complexity of operations. This, however, does not directly affect the 30-day mortality-rate, which appears to be influenced, in contrast, by the dissemination of infection.
University Children Hospital, Latvia
Title: Which type of stem cells and what method for implantation should be preferred in pediatric cardiology (6 years of experience)
Time : 11:40-12:00
Aris Lacis is a Cardiac Surgeon, Professor, MD, PhD graduated from Riga Medical Institute in 1961. He is a General and Thoracic Surgeon in P. Stradina University Hospital in Riga (1964–1969), Thoracic and Cardiac Surgeon in the Latvian Centre for Cardiovascular Surgery (1969–1994), since 1994 until 2012, he is the Head of Pediatric Cardiology and Cardiac Surgery Clinic in University Children’s Hospital, Riga and since 2012; he is a Consulting Professor of this Clinic. He serves as a Vice-President of Latvian Society for Cardiovascular Surgery, President of Latvian Association for Pediatric Cardiologists and is the author of 395 scientific publications, 3 monographs and 13 patents. He is an investigator for more than 10 clinical trials including cardio-surgical procedures performed under deep hypothermia, hybrid procedures etc.
Context: On a global level, stem cell research has been a major challenge during the last decade. There have been achieved positive results in experimental studies on animals and there have been identified several conditions in adult population where bone marrow derived progenitor stem cell transplantation (BMPSCT) may play a crucial role. Though, little is known about possible implementation of the BMPSCT in pediatrics, dilated cardio-myopathy and pulmonary arterial hypertension in particular. There are uncertainties around the destiny of stem cells after their injection into the blood stream. In particular, it regards migration and homing of implanted cells in the target tissues. As yet unclear is the possible role of sympathetic nervous system in the context of osteo-reflexotherapy. There is still no definitive answer to the question on which is the preferred type of stem cells to be use for transplantation in different settings. Objective: To determine the role of BMPSCT in management of critically ill pediatric patients followed by assessment of safety and efficacy of the procedure. Design, Settings, Participants: Two patients (9 and 15 years old) with trisomy 21 and severe pulmonary arterial hypertension due to uncorrected large ventricular septal defects were been admitted to our department to receive intrapulmonary BMPSCT procedure. Both patients underwent radionuclide scintigraphy before the procedure, followed by repeated scans 6, 12, 24 and 36 months after BMPSCT. Latest results show improvement of lungs vascularization. Seven patients (4 months – 17 years) with dilated idiopathic cardio-myopathy were admitted for intra-myocardial BMPSCT procedure. All patients underwent repeated clinical examination every two months, up to 6 years after cell transplantation. We observed improvement of left ventricular ejection fraction, decrease of left ventricular end diastolic dimension by echocardiography and cardio-thoracic index at chest X-ray exams, reduction of serum brain natriuretic peptide serum levels and decrease of the stage of heart failure from stage IV to stage I, by NYHA classification. No peri-procedural harmful side effects were observed. Conclusions: The results are promising and we suggest that BMPSCT might be used for the stabilization of the patient to get the time for further symptomatic treatment or serve as a bridge for heart or lung transplantation.
Brojendra Agarwala has completed his MBBS from University of Kolkata, India and completed Pediatric cardiology fellowship from New York university medical center New York, NY, USA. He is a Pediatric Cardiologist and Professor of Pediatrics at the University of Chicago. He has received best teacher award by the pediatric residents and the medical students. He has published 68 papers in reputed journals. He is named as one of the top doctors and best pediatricians in Chicago magazine for many years.
In 2015 Pediatric cardiology is a very well developed specialty. In the past cardiology as a specialty was limited to the Internists. For centuries pediatric cardiology was developed into a specialty where only trained pediatricians in cardiology took care of Fetuses with congenital heart disease (CHD), neonates and further followed them into adulthood. With excellent care, children with severe life threatening CHD are surviving into adulthood and leading productive lives serving the society as physicians, lawyers, MBAs and many other professions and non-professional activities. In 1938 when Robert Gross ligated a patent ductus, a new era of pediatric cardiology was born. Clinical acumen, understanding of physiology, anatomy, angiography and development of extracorporeal circulation allowed caring for children with CHD which was previously lethal. A few interested pediatricians taught themselves and finally the subspecialty was born. In 1961 pediatric cardiology became the first subspecialty board in the USA. In the past 60 year significant progress has been made in non-invasive imaging e.g. cardiac ultrasound, color-Doppler, MRI, CT scan. Utilization of these modalities has made invasive diagnostic cardiac catheterization almost unnecessary. Development of interventional cardiac catheterization has almost replaced cardiac surgery in multiple CHD. For the past 50 year pediatric cardiology was focused on diagnosis, patient care, education and clinical research. However, for the past 10 years basic research discoveries of the cause of the CHD have developed, which will hopefully prevent them from happening in the future. Pediatric cardiology is team work involving cardiologists, anatomists, physiologists, surgeons, intensivists, interventionists and the anesthesiologists – all play very important roles in caring for children with cardiac problem. In my presentation, I will discuss more in depth about the role of individual physicians and scientists that have helped to develop this wonderful subspecialty in pediatrics.
Albany Medical College, USA
Time : 12:20-12:40
Branko Furst, MD, FFARCSI is a graduate of University at Ljubljana Medical School, Slovenia and completed residency in Anesthesiology at Queen Alexandra Hospital in Portsmouth and at the Middlesex Hospitals in London, UK. His academic career then took him to El Paso, Texas where he joined the faculty at the department of Anesthesiology at Texas Tech University Medical School. His research interests include cardiovascular physiology and mechanisms of general anesthesia. He is the author of the book “The Heart and Circulation – an Integrative Model” (Springer, 2013) and has lectured on various aspects of the circulation nationally and internationally. Currently he is Associate Professor of Anesthesiology at Albany Medical College, Albany, NY and divides his time between clinical anesthesiology, research and resident education.
The debate whether the heart is a pressure or a flow generating pump continues to be a subject of debate amongst clinicians and cardiovascular physiologists. It is based on the assumption that the heart, a hollow muscular organ equipped with valves, impels the blood through the systemic and pulmonary circuits. It will be argued that the long standing issue over the nature of the heart’s function can be resolved by adopting the phenomenon-based, evolutionary model of circulation. The model shows that the movement of blood is the primary phenomenon generated at the levels of the capillaries. It exists before the functional maturity of the heart and is intricately linked with metabolic demands of the tissues. The pressure in the vessels, therefore, is a derived phenomenon resulting from the rhythmic interruption of flow by the heart in combination with the dynamic response of the peripheral vasculature. The heart thus functions as an impedance-pump generating pressure, but not the flow of blood. The proposed model will be supported by examples from embryology, comparative anatomy and a number of clinical scenarios.
University of Illinois, USA
Time : 12:40-13:00
Irena Levitan, PhD, is Professor of Medicine and Adjunct Professor of Pharmacology and Bioengineering at the University of Illinois at Chicago. Her current research focuses on cholesterol regulation of ion channels and cellular biomechanics. She published more than 70 papers and book chapters and is a recipient of Guyton Distinguished Lecturer award for quantitative and biophysical work on cholesterol modulation of ion channels and how this can affect integrated organ function from the Association of Chairs of Departments of Physiology. She also edited two books “Cholesterol Regulation of Ion Channels and Receptors” ands “Vascular Ion Channels”
Plasma hypercholesterolemia is well known to be a major risk factor for the development of cardiovascular disease. Our studies focus on the impact of cholesterol on two types of inwardly-rectifying K+ channels expressed in cardiomyocytes: classical inward rectifiers Kir channels (Kir2) that play a major role in maintaining cardiac membrane potential and G-protein gated Kir (GIRK or Kir3) channels that play an important role in the regulation of atrial action potential. Paradoxically, our studies show that elevation of membrane cholesterol in vitro and in vivo has opposite effects on Kir2 and Kir3 channels in the same cells. Specifically, enriching cardiomyocytes with cholesterol in vitro suppresses the activity of Kir2 channels but enhances the activity of Kir3 channels. Furthermore, plasma dyslipidemia in vivo also have opposite effects on these channels in freshly-isolated cardiomyocytes. Both effects are mediated by a decrease or increase in the open probability of Kir2 and Kir3 respectively. Even more surprising, even though cholesterol has opposite effects on the function of Kir2 and Kir3, both effects are abrogated by a specific mutation indicating that they share some structural determinants. These studies are discussed in terms of the structural-mechanistic insights into cholesterol regulation of Kir channels and in terms of the physiological/ pathological impact of these coupled effects on cardiac function.
Casablanca-Hassan II University, Morocco
Title: Correlation between the plasma fibrinogen concentration and coronary heart disease severity in Moroccan patients with type 2 diabetes
Time : 13:00-13:20
Asma Chadli is a Professor of Endocrinology and Diabetes at the Faculty of Medicine and Pharmacy, University Hassane II of Casablanca and Head of Unit of Endocrinology, Diabetes and Metabolic Diseases at Ibn Rushd University Hospital, Casablanca, Morroco. She is a specialist in diabetes and endocrinology. She was appointed as Assistant Professor of Endocrinology in Casablanca in 2001 and full-term Professor in 2005. Her main areas of research interest currently include the thyroid cancer and the type-2 diabetes mellitus. She has published her work in a number of international and national peer-reviewed journals. She has served many national and international committees and boards.
Introduction: The present study aims at determining the relationship between the plasma fibrinogen concentration and the severity of coronary heart disease in type 2 diabetic patients. Methods: Prospective analytical survey, based on a sample of 120 subjects divided in four groups: 30 diabetic coronary patients (G1), 30 coronary diabetic patients (G2), 30 non-coronary diabetic patients (G3), and 30 healthy subjects (G4). The correlation between fibrinogen and the quantitative cardiovascular risk factors (age, diabetes duration, hyperglycemia, obesity based on the body mass index (IMC>30Kg/m2), dyslipidemia manifested by low HDL cholesterol, and/or high LDL cholesterol and/or high TG; was done using Pearson’s correlation coefficient "r ". Results: The average age was 59.58±7.88 years and female gender was predominated by 52.5%. The plasma fibrinogen concentration corresponded to 3.46g/L±0.86 in G1; 3.73g/L±1.11 in G2; 3.06g/L±0.98 in G3 and 2.46g/L±0.51 in G4; significant difference with fibrinogen and the four groups (P=0.001), also with the clinical and para-clinical coronary disease severity. The correlation between fibrinogen and LDL was significant (p=0.035) in the T2D patient’s group (G3). In patients with type 2 Diabetes, the association of fibrinogen with diabetes duration was significant (p=0.036). The association of fibrinogen with both hypertension and smoking was significant in all groups; respectively (p=0.01) and (p=0.03). Conclusion: In the Moroccan population, the plasma fibrinogen concentration was positively and significantly correlated with the coronary heart disease severity.
Natasa Chrysodonta is currently a foundation year 2 doctor in the United Kingdom. She has completed her medical degree at the University of Bristol and is currently undertaking an MSc in Genomic Medicine in Queen’s Marry University of London.
Alagille syndrome is an autosomal dominant disorder, also known as arteriohepatic dysplasia Alagille-Watson syndrome, or syndromic bile duct paucity. The syndrome expressivity is highly variable but when fully expressed patients have cardiac malformations, skeletal and ophthalmological abnormalities in conjunction with cholestasis and bile duct paucity. It has been identified that the multisystem involvement is due to defects in the Notch signaling pathway, with the main mutation identified in JAG1. Despite relative good prognosis, mortality by the age of 20 years reaches 70%. The major contributor to the previous is the complex congenital heart disease in addition to the hepatic pathology in these patients. This emphasizes the need for early and appropriate treatment in this population. This review examines the evidence surrounding the management of this syndrome, primarily from a cardiovascular perspective.
Alexandria University, Egypt
Title: Study of the relation between serum testosterone level and carotid atherosclerosis in elderly males
Time : 15:00-15:20
Nany Hassan Abu Al-Makarim El Gayar is an Assistant Professor of Internal Medicine, Geriatrics Department at Alexandria University, Egypt. He has done MS in Rheumatology and MD in Geriatrics. He has published 10 papers in reputed journals.
Objective: The aim of this work is to evaluate the relationship between serum testosterone concentration and carotid atherosclerosis in elderly males. Methods: The current study included 40 subjects who were classified into two groups; the first group included 30 elderly healthy males as the cases group and the second group included 10 young males as the control group. Serum level of total testosterone was measured using immunoassay kits, sex hormone binding globulin (SHBG) was measured using immunoassay kits and free androgen index (FAI) was calculated. Results: Ultra-sonographic measurement of carotid intima-media thickness (IMT). Total testosterone level was significantly lower in the cases group than control group (t=5.354, p<0.001). SHBG was significantly higher in the cases group than the control group (t=4.796, p<0.001). Free androgen index (FAI) was significantly lower in cases group than control group (z=4.686, p<0.001). Intima-Media thickness (IMT) was significantly higher in the cases group than the control group (t=3.513, p=0.001). As regards the number of plaques 10 males from the cases group did not have any plaques, 13 males had one plaque and 7 males had two plaques however in the control group 9 males did not have any plaques and only one male, had one plaque, so cases group had significantly higher prevalence of plaques than the control group (z=3.007, p=0.003). A significant negative correlation between total testosterone and SHBG (R=-0.856, P<0.001), a significant positive correlation between total testosterone and FAI (R=0.957, P<0.001), and a significant negative correlation between testosterone and both IMT (R=-0.501, P=0.005) and number of plaques and (R=-0.358, P=0.52). SHBG was negatively correlated with FAI (R=-0.845, P<0.001) but it was positively correlated with both IMT (R=0.392, P=0353) and number of plaques (R=0.032, P=0.056). There were significant negative correlations between FAI and both IMT (R=-0.601, P<0.001) and number of plaques (R=-0.461, P=0.010). IMT was positively correlated with the number of plaques (R=0.760, P<0.001). Conclusion: These findings suggest that normal physiologic testosterone levels may help to protect men from the development of atherosclerosis. In elderly men, low plasma testosterone is associated with elevated carotid intima-media thickness. A negative correlation has been demonstrated between endogenous testosterone levels and IMT of the carotid arteries. These findings suggest that men with lower levels of endogenous testosterone may be at a higher risk of developing atherosclerosis.
University of Bern, Switzerland
Time : 15:20-15:40
Lorenz Fischer has done his Medical studies in Bern; Federal Exam in 1981; and doctoral thesis in 1984. He is a Specialist in General Internal Medicine. Since 2002, he is also the Chair holder for Neural Therapy at the University of Bern. He was also Vice president of the International Medical Association of Neural Therapy and of the Swiss Medical Association of Neural Therapy. His main research field is the autonomic nervous system (pain and inflammation) as well as the influence of local anesthetics on it. The author of "Fischer L. Neuraltherapie – Neurophysiologie, Injektionstechnik und Therapievorschläge. 4th. edition, Stuttgart; MSV: 2014". Co-publisher of "Fischer L., Peuker E. (Eds.) Lehrbuch integrative Schmerztherapie. Stuttgart; Haug: 2011". He has several contributions to textbooks about pain.
The autonomic nervous system plays an important role in the regulation of blood pressure, heart rate, myocardial contractility and coronary perfusion. The balance of activity of its sympathetic and parasympathetic branches has a key part in this. An imbalance in the autonomic cardiac fibers can furtherlead, inter alia, to cardiac arrhythmias. In general, an imbalance of the sympathetic and parasympathetic branches of the autonomic nervous system can also cause and maintain pain and inflammation. The various pathomechanisms involved can be influenced by local anesthetics (LA), especially by a stellate ganglion block (SGB). Several authors have demonstrated that SGB using LA has a beneficial effect on cardiac arrhythmias. As we could demonstrate an effective and sustained reduction in sympathetically maintained inflammation and pain with SGBin acute CRPS, we suppose that sympathetically maintained inflammation of the heart, too, can be influenced by SGB. Against this background, extensive studies are needed, but since the safety of SGB has been a major concern, our goal was to learn more about it (Puente de la Vega Costa K, Gómez Perez MA, Roqueta C, Fischer L: Effects on hemodynamic variables and echocardiographic parameters after a stellate ganglion block in 15 healthy volunteers. We found that, since both sympathetic and parasympathetic fibers are involved in SGB, there is only a small variation in the parameters discussed, which shows the SGB to be safe for broader application than before.
- Special session
Location: Berlin, Germany
Medical University of Wroclaw, Poland
Robert Skalik is a consultant in cardiology and is an exercise physiologist. He completed his PhD in Echocardiography from Medical University of Wroclaw. Hecovered internship in Department of Cardiology, Free University of Amsterdam, the Netherlands. He is a Lecturer in Postgraduate School of Cardiology, University of Perugia and an academic teacher and researcher in Department of Physiology. He is former consultant in cardiology inDepartment of Cardiac Surgery and Cardiology, Medical University of Wroclaw and former Head of Department of Cardiac Rehabilitation, Wroclaw. He underwent private practice in cardiology, Wroclaw and is a research projects evaluator for EU. He has published 103 papers on cardiology and human physiology.
The aim of this presentation is to describe examples of health care use cases leveraging potential of digital technologies like remote patient monitoring devices, smart-phones’ applications, data gateways care delivery platforms and machine learning techniques to boost diagnosis and disease management as well as to improve quality of life and reduce healthcarerelated costs. It demonstrates how patients can receive better tailored diagnostics and treatment by monitoring of selected physiological parameters of patients such as blood pressure, heart rate, glucose, weight and others, transferring them to cloud
based platform for correlating with data drawn from other sources and unleashing the power of data mining algorithms. The report includes examples of innovations enabled by healthcare platform delivered by DIFMED LTD that offers tracking of patients’ health conditions. The smart-phone technology and remote monitoring devices were used to enable physicians to proactively act before the health conditions of patients significantly deteriorated or became critical. The presented user stories proved the potential of digital technologies to propel transformation towards a preventive, proactive and personalized
medicine. This kind of healthcare will soon target the needs and expectations of digital and network native patient’s generation. It will become more and more important in the society facing the constantly growing problem of civilization –related chronic diseases and lack of financial resources for the maintenance of more and more expensive healthcare systems.
Location: Berlin, Germany
CharitĂ©-UniversitĂ¤tsmedizin Berlin, Germany
Wolfgang Poller is the Head of Experimental Research Activities, Charité - Universitätsmedizin Berlin, CharitéCentrum cardiovascular and vascular medicine Department of Cardiology.
The lecture will discuss recent developments and clinical perspectives noncoding RNA research, with special emphasis on the translation of basic science insights and preclinical research into clinically valuable novel diagnostic tools and therapeutic strategies. Regarding diagnostic value, ncRNA biomarkers (both miRs and lncRNAs) will be critically weighedagainst current differential diagnostic and prognostic markers. Regarding therapy, ncRNA molecules can be targets as well as tools. The fundamental novelty of these therapies arises from the fact that they exploit tailormade molecular interactions between endogenous and synthetic ncRNAs. Preclinical animal studies showed high efficacy of anti-miR therapeutics, and of RNA interference (RNAi) strategies employing ncRNAs as tools for silencing of protein-coding genes. An increasing spectrum of endogenous ncRNAs is employed for the development of novel therapeutic ncRNA tools (tRNA and rRNA scaffolds, chimeric tRNA/miR structures). Clinical trials attempting translation of these strategies into clinical practice have met with variable
success so far. The most successful trials addressed precisely defined patient cohorts in whom one pathomechanism was the sole or dominant cause of disease development and progression. Accordingly, future clinical trials are likely to increasingly focus upon patients in whom the high costs and efforts of ncRNA therapeutics development are likely to result in significant
clinical success and patient benefit. We discuss selection criteria and suitable clinical outcome parameters, and paradigmatic ncRNA-based strategies at late preclinical stage or in clinical trials are reviewed with regard to clinical translational potential and possible impact upon clinical practice.
Dirk Lassner is in the Management and Laboratory direction (GLP/GCP, College of American Pathologists (CAP)), Acquisition, Marketing and Sales Management of diagnostic and CRO service (trials, gene chips),Biochemist/Molecular biologist (RT-PCR, QPCR, gene arrays, sequencing, SNP technology), Cell biologist (cell culture, flow cytometry, in-situ techniques (hybridization, PCR, antibodies)), International co-operations in research and molecular diagnostics in cardiology. He is
the Managing and Laboratory Director of InstitutKardialeDiagnostik und Therapie GmbH (IKDT), Berlin since 2003, Permanent collaboration and participation in several national and international R&D projects with Dept of Cardiology, Charite University Hospital Berlin since 2003, Managing Director of AugustusburgBioTech GmbH, 2001 to 2002. He has done his PhD (Dr. rer.nat.) at University Leipzig – magna cum laude in 1996.He has over 50 publications on cardiomyopathies and different patent applications.
The most common cause of death in Western European Countries are cardiovascular diseases. By estimation of the European Society
of Cardiology (ESC) 12 million patients in Europe are suffering from heart failure problems, 3 million patients are showing dilated cardiomyopathy (DCM). Cardiomyopathies arise mainly from inflammation and infections with bacteria or cardiotropic viruses.
Current state-of-the-art in EMB Diagnostics is a combination of histological staining for diagnosis of active myocarditis or storage diseases, immunohistochemical staining with specific antibodies and digital imaging analysis for quantitative evaluation of intramyocardial inflammation and the molecular biological detection of cardiotropic viruses. Viral infections of the myocardium are considered to be a main cause for the development of DCM. The qualitative detection of most relevant cardiotropic viruses (Adenovirus, Enterovirus, Epstein-Barr-Virus (EBV), Erythrovirus (B19V), Human Herpesvirus 6 (HHV6)) should be supported by sequencing, quantification of viral load and measurement of transcripts (mRNA) as marker of viral activity, especially for B19V and HHV6. Digital numeric quantifications of inflammatory infiltrates in myocardium has shown a close correlation with clinical course and mortality. Number of cytotoxic cells (Perforin) in initial EMB is predictive for worse progression of LV function in examined
patients. The increasing number of T memory cells (CD45RO) in EMB results in significantly increasing mortality in a 10-year follow-up. High number of inflammatory cells in virus-negative patients request the immediate immunosuppressive treatment to prevent myocardial injuries and failing heart. In virus-positive patients an antiviral therapy is indicated.
Due to focal pathology, diagnostics are failing if the EMB does not contain the area of interest. Therefore at least 8 EMBs should be taken. Biopsies from left or right ventricle are equally meaningful. The chance that the sampling error occurs are much likely if only very few biopsies will be analysed. However, first investigations indicate that the presence of individual gene expression patterns (mRNA) of myocardial tissue can be used for identification of specific disease situations without proof of histological or virological markers in the examined myocardial tissue. These disease specific profiles will be changed during effective treatment and thereby could be applied for therapy monitoring.
Personalized medicine comprises the genetic information together with the phenotypic and environmental factors to yield a tailored healthcare for each individual and removes the limitations of the "one-size-fits-all" therapy approach. Novel biomarkers and multiparametric approaches in expanded EMB diagnostics provide the opportunity to translate therapies from bench to bedside, to diagnose and predict disease, and to improve patient-tailored treatments based on the unique signatures of a patient's disease.
Institute of Cardiac and Diagnostic Therapy (IKDT) Berlin, Germany
Heinz-Peter Schultheiss is a Professor of Internal Medicine and Cardiology. He is the CEO of Institute for cardiac diagnostic and therapy (IKDT) Berlin. From 1997 -2000 he was the Chairman of the Medical Society Berlin. He is a Member of German Society for Internal Medicine and a Member of European Society of Cardiology.
Myocarditis and inflammatory cardiomyopathy (DCMi) are a challenging diagnosis due to the heterogeneity of clinical presentation which is highly variable and ranges broadly from subclinical symptoms to fulminant heart failure.Because the clinical course of myocarditis and DCMi is unpredictable and the non-invasive diagnostic tests – includingECG, echocardiography, MRI, and serological tests - are limited in their ability to make a clear cut diagnosis, all patients with clinically suspected myocarditis and DCMi have to undergo endomyocardial biopsy (EMB), before irreversible and thus untreatable damage to the myocardium has developed. Actually, the ESC working group on myocardial and pericardial diseases recommends in the statement position paper that in all patients fulfilling the diagnostic criteria for clinically suspected myocarditis selective coronary angiography and EMB should performed.Any rational and specific therapeutic regimen for DCMi must consider the underlying pathogenesis based on histological,immunohistological and virological evaluation of EMBs. The exact analysis and quantification of intramyocardial infiltrates as well as the characterization diagnosis of viral pathogens have been shown by multivariate regression analysis to be independent predictors of the clinical outcome. The phase of viremia, and the active replication, as well as the extend and quality of infiltration seems to proceed the phase of target organ injury and future progression of the disease. The mainstay of treatment for myocarditis and DCMi is an optimal heart failure medical regimen. Moreover, EMB is the
basis for personalized immunosuppressive or antiviral treatment.
In virus-positive DCMi Interferon-ß treatment is a well-tolerated and safe treatment option, leading to effective virus clearance in patients with coxsackie- and adenovirus-positive cardiomyopathy. Favourable clinical effects assess quality of life, NYHA functional class, patient global assessment and survival.
In case of biopsy-proven virus-negative inflammatory cardiomyopathy - based on an exact characterization and quantification of infiltrative cells - immunosuppressive therapy is an effective and safe option. Administered anti-inflammatory drugs are corticosteroids, azathioprine, and cyclosporine. Immunosuppressive treatment in virus-negative DCMi showed
effectiveness and beneficial effects even after a long-term follow-up period.
In summary, any rational and immunomodulatory therapeutic regime for DCMi must consider the underlying pathogenesis based on histological, immunohistological and virological evaluation of EMBs. Thisisbe the basis for a rational,causal, personalized and specific therapy.
CoruĂ±a University Hospital, Spain
Lorenzo Monserrat is the CEO, Health in Code, A Coruña, Spainfrom2012 – Present. He is also the Co-Founder and Scientific Director, Health in Code 2006 – 2011.He is doing his research in Galician Health Service, Spain. He is a Cardiology Consultant, A Coruña University Hospital, Spain. He has done his PhD from European Doctorate in Medicine, University of A Coruña, Spain and MD, in Medicine and Surgery, University of Santiago de Compostela, Spain.
The inherited cardiovascular diseases (cardiomyopathies, channelopathies and inherited vascular diseases) are a heterogeneous conjunct of primary diseases usually of genetic origin and familialpresentation, which are associated with sudden deathrisk. Theidentification of multiple genetic causes for these diseases has opened a new window for their early diagnosis, the
understanding of their natural history, and for the improvement in their risk stratification and management. However, in the last years, the clinical application of genetics has been limited by the cost and low yield of the available genotyping technologies. The irruption of Next Generation Sequencing, has completely changed this scenario. This group of disruptive technologies allow the evaluation in parallel of hundreds or even thousands of genes at an affordable cost. Now the challenge is not the
genotyping, but the interpretation of the complex results.
In our presentation we review the main aspects related to the application and impact of Next Generation Sequencing in the study of the inherited cardiovascular diseases, with a special focus in the clinical validation and the interpretation of the results.
The successful application of NGS in the clinical diagnosis and managment of inherited cardiovascular diseases requires the adequate integration of genotyping technology, bioinformatics and clinical interpretation supported by knowledge managment systems. We will present in this session:
• Results and validation of NGS technologies in inherited cardiovascular diseases associated with sudden death
• Our advanced and innovative multidisciplinary approach for the clinical interpretation of the results
• Examples of the usefulness of NGS in the evaluation of inherited cardiovascular diseases
- Track: 5 Echocardiography
Fabiola B Sozzi
University of Milan, Italy
University of Milan, Italy
Time : 16:50-17:10
Fabiola Sozzi works as a practicing cardiologist at the University Hospital Policlinico of Milan, IT. She worked in the Echolab of the Thoraxcentre, Rotterdam, NL where she defended her PhD thesis on cardiac imaging under the supervision of Professor Roelandt. She reached an high expertise in the non-invasive diagnosis of CAD using all the different available techniques: cardiac CT and MRI integrated with stressecho and nuclear. She also works in the acute clinical setting treating the acute cardiac disease. She is visiting professor at the University of Milan where she teaches and leads several research projects.
Stress cardiac magnetic resonance imaging (CMR) has been shown to have excellent diagnostic accuracy for detection of significant coronary artery disease (CAD). CMR provides valuable clinical data on the evaluation of structural, functional and valvular heart disease. As a result, stress CMR is increasingly being used to assess chest pain in patients with known or suspected CAD. CMR potentials derive from its high-spatial resolution, image contrast, lack of ionizing radiation and excellent depiction of wall motion. An essential characteristic of stress modalities is the negative prognostic value. The detection of myocardial ischemia with stress CMR is typically based on first-pass perfusion imaging, to search for inducible perfusion defects, or on wall motion abnormality imaging. An important goal of any stress modality is to identify those patients with low cardiac event rate. We reviewed 300 patients with suspected or known CAD, who undergone adenosine stress-CMR. End-points, during a long-term follow-up (5.5 years) were all causes of mortality and major adverse cardiac events. An excellent outcome for adverse cardiac events was found. The power of CMR relies also on the evaluation of viability with late gadolinium enhancement (LGE) methods. The LGE differentiate viable myocardium from scar on the basis of differences in cell membrane integrity for acute myocardial infarction. In chronic infarction, the scarred tissue enhances much more than normal myocardium due to increases in extracellular volume. Beyond infarct size or infarct detection, LGE is a strong predictor of mortality and adverse cardiac events. CMR can also image microvascular obstruction and intracardiac thrombus. CMR can determine infarct size, area at risk and thus estimate myocardial salvage after acute myocardial infarction.
Azerbaijan State Medical University, Azerbaijan
Title: Title: Echocardiography approach to childhood Pulmonary Hypertension. What is the best way for initial assessment?
Time : 17:10-17:30
Andreas Petropoulos graduated from Aristotle University’s Medical School, Greece in 1989. He has followed 30 years career as a medical officer, senior Flight Surgeon in the Hellenic Air-Force. He is specialized in Aviation-Hyperbaric Medicine, Pediatrics, Fetal, Pediatrics and Congenital Cardiology in USA, Europe. He holds MSc in Preventive Cardiology and a member of AEPC working groups in “Prevention” & “Heart Failure-Pulmonary Hypertension”. He worked and lectured in Athens and Brussels universities. Currently he consults in Pediatrics, Fetal. Pediatrics & Congenital Cardiology in Merkezi Klinika and is the Associate Professor at the State University and Post Graduate, CME Center in Azerbaijan. His research focuses on prevention, CVD imaging techniques, fetal cardiology and heart failure.
Pulmonary Hypertension (PH) in childhood is a condition of multiple etiologies with underestimated prevalence. Despite to the newer existing treatment options PH remains a progressive life limited condition. Although its gold standard diagnostic method is hemodynamic study by cardiac catheterization, the initial assessment as well as frequent follow-up is based on transthoracic echocardiography (TTE). The aim of this abstract is to focus on the best approach by using TTE in screening for, diagnosing and following up patients with a variety of etiologies, suffering from PH. We will focus on the resent (2016) proposed recommendations of the European Pediatric Pulmonary Vascular Disease Network, endorsed by ISHLT and DGPK on the use of Echocardiography to address holistically children suffering from PH. More, to highlight the most important and handy in everyday, clinical work, Echocardiography index to assess pulmonary artery pressures and biventricular systolic and diastolic function, that can improve our diagnostically and therapeutically approach towards childhood PH.
Marmara University Hospital, Turkey
Time : 17:30-17:50
Baris Cankaya has completed his graduation from Ankara University Medical Faculty in 2000. He is working as Anesthesiology Specialist at Marmara University Training Hospital. He has attended several academic meetings nationally and internationally. His academic interests include microcirculation, fluid therapy, resuscitation, patient safety and perioperative analgesia. He has participated in various international workshops, congress/symposiums and certifications and to list a few: EPLS provider Berlin 2015; NLS provider Athens 2015; MECOR Level I October 2014; ECMO workshop 2015, Leicester; Airway workshop ICISA 2014, Tel Aviv; Innovations Workshop ICISA 2014, Tel Aviv; Gastro 2016, Birmingham: oral presentation: Sedation for pediatric patient with end stage hepatic disease outside operating room; International intensive care symposium Ä°stanbul 2015 and so on.
Transesophageal echocardiography has a wide use in perioperative period. Heart chambers, valves, vessels, fluid management are all in view of TEE. But, limitations are appearing with experience progressing. A novel limitation is invisibility of the aortic arch. Undiagnosed atherosclerosis originating from ascending aorta is a major problem causing neurologic complications during cardiac surgery. Visualizing thoracic aorta is also important for transaortic heart valve implantation. TEE's lacking sensitivity for atherosclerosis in distal aortic arch is corrected with a view TEE. This technic is based on overcoming the air in trachea. Usage of A view TEE before sternotomy gives an advantage against epiaortic ultrasound. TEE allows continious monitoring and does not interfere with surgical site. This allows a complete visualization of distal aortic arch, thoracic aorta and origins of the cerebral arteries. Epiaortic ultrasound has the advantage of a high frequency probe on it for further analyzing the atherom plaque. Isala safety check and Katz classification helped for perioperative management, and mortality has reduced significantly. Preoxygenation and experience are important because of the time limitation. This procedure will help surgical team to review treatment plan. Adjustments of cannulation, distal arch cannulation, and intermittent ventricular fibrillating method and off pump surgery are the changes according to visualization. Further experience with a view TEE will help more for neurologic outcome in near future.
Tanta University, Egypt
Time : 17:50- 18:10
Osama A Tolba El Razaky had completed MD Pediatrics from Tanta University. He has obtained Post-doctoral studies in cardiac deformation. He is a Head of Egyptian Pediatric Cardiology Association and a member of Egyptian Universities promotion committee (Professor of Pediatrics). He is currently a Professor of Pediatric (Cardiology Unit) in Tanta University. He has published 20 papers in international journals and has been serving as a Reviewer for Acta Pediatric. He was a supervisor of 100 MS and 25 MD theses in Pediatrics. He is working as echographer in Pediatrics since 25 years. His main interest is TDI, STI and 3D Strain.
Background: The development of Diabetic cardiomyopathy (DCM) is multi-factorial and several pathophysiologic mechanisms have been proposed to explain structural and functional changes associated with DCM. α-lipoic acid (ALA) a powerful antioxidant may has a protective role in diabetic cardiac dysfunction. Aim of the work: This study aimed to assess the potential role of oxidative stress, inflammatory cytokines, apoptosis and fibrosis in diabetic cardiac insult. It also investigated the possible protective role of α-lipoic acid on diabetic left ventricular (LV) dysfunction in type 1 diabetic children and adolescents. Subjects & Methods: 30 patients were randomized to receive insulin treatment (n=15) or insulin plus α-lipoic acid 300 mg twice daily (n=15). Age and sex matched healthy control children and adolescents (n=15) were also included. Patients were evaluated with conventional 2-dimensional echocardiographic examination (2D), pulsed tissue Doppler (PTD), and 2-dimensional longitudinal strain echocardiography (2DS) before and after therapy.3D strain (longitudinal, circumferential, area and radial strain) were estimated. Plasma level of glutathione, malondialdhyde (MDA), nitric oxide, tumor necrosis factor-α (TNF-α), Fas Ligand (Fas-L), matrix metalloproteinase-2 (MMP-2) and troponin-I were determined before and after treatment. Results: Diabetic patients had significant lower level of glutathione and significant higher levels of malondialdhyde (MDA), nitric oxide, tumor necrosis factor-α (TNF-α), Fas Ligand (Fas-L), matrix metalloproteinase-2 (MMP-2) and troponin-I than control subjects. Increased expression of transforming growth factor-β (TGF-β) mRNA in peripheral blood mononuclear cells was also observed in diabetic patients. 2D global longitudinal strain and 3D longitudinal, circumferential and area strain were significantly decreased in diabetic children. α-lipoic acid significantly increased glutathione level and significantly decreased MDA, nitric oxide, TNF-α, Fas L, MMP-2, troponin I levels and TGF-β gene expression levels. Moreover, α-lipoic acid significantly increased mitral e/a ratio, ventricular global peak systolic strain in diabetic patients. There were significant negative correlation between Global peak systolic strain (G) and glutathione and significant positive correlations between G and MDA, NO, TNF-α and Fas-L. In addition, a significant positive correlation between e/a ratio and glutathione (r=0.515) and significant negative correlations between e/a and MDA, NO, TNF-α and Fas-L were also observed. Conclusion: These data suggest that oxidative stress, inflammatory cytokines such as TNF-α, apoptosis and fibrosis play a role in the development of diabetic cardiac dysfunction and that α-lipoic acid may have a beneficial role in the management of type 1 diabetic patients as a cardioprotective therapy and prevention of development of diabetic cardiomyopathy.