11th International Heart Conference
Scientific Program
Keynote Session:
Title: To understand, respect and let live our body: Health for all through wisdom – gaining the most op mal health while reversing the epidemic of cardio-vascular diseases
Biography:
Suresh Vatsyayann ( who likes to be called just “Suresh,”) with more than 51 years of experience in the ï¬ eld of medicine and surgery has been there and seen it all through his own microscope and his macro vision, the good, the bad and the ugly. His vast experience in trea ng pa ents suff ering from all kinds of illnesses has given him a near-complete insight of the human body and its nuances. He is a ï¬ rm believer that if every human being starts to understand their body and the problems associated with it they would become healthier with the least eff ort. In his prac ce, he spends suffi cient me with every pa ent that is necessary trying to explain all the details about their body, the disease and the best prac ce management of their per nent issues.
Abstract:
Background: Solar energy via plants to animals is consumed by human beings. We acquire and use this energy. Complex development via evolu on and muta on for the last few billion years have made our bodies to con nue our symbio c co-existence with its hos le and yet the lifegiving environment. Evidence indicates that a sustainable, op mal and holis c health and happiness can come only from synerge c rela onships. We the advocates of “health for all” would have to make the public well informed so that people adopt sound lifestyles u lising the capabili es of their bodies as the bodies were meant to be in the context of its total environment and our true posi on in it. Scien ï¬ cally (medically) speaking, we have an abundance of knowledge (of the parts) at this stage of our development; however, there are only a few people who have a ained a true wisdom of pu ng the ‘parts’ together and construc ng the ‘whole.’ The epidemic of cardiovascular diseases (CVD) is on a path of a never-ending journey toward the worst. For the communi es to take eff ec ve charge of the situa on, it becomes expedient for the public to understand the broad pathogenesis of these well-established health issues vis-àvis life and living. We, the medical professionals are well placed to enlighten the masses and reverse the epidemic of CVD. Methods: It involved sharing wisdom to bring
about lifestyle change through common sense, common person language, and through the prac ce of ‘a two-way honest communica on daily (one-to-one), weekly (group sessions) and periodically in the community for the last 16 years by the author. Use of informa on-sharing in rela on to body’s homoeostasis, self-correc ng, self-preserving and slow but sure con nuous acclima za on to the dynamic environment was made an integral part of all the sessions. Conclusion: Understanding life, living, energy transfer and the purpose of the living bodies puts people in a be er posi on to tackle their mul faceted problems of ill health, par cularly the CVD with and, or without the co-morbidi es of obesity, diabetes mellitus-II, etc. This happens when people are well informed and thus self-mo vated to use the obtained wisdom adop ng certain lifestyles in tune with nature. This will help physicians to lead a crusade of ‘health for all through wisdom’. Wisdom of knowing the nature of the body, body func ons and its internal and external rela onships, helps people to follow simple strategies to secure the most op mal health while reducing the physical, developmental, emo onal, psychological, ï¬ nancial and other resource constraints/burdens on the individuals, the families, the healthcare providers and the na ons.
Title: Analysis of myocardial bridge in males and females of North Indian popula on- an angiographic study
Biography:
Rajani Singh has completed MBBS and MS (Anatomy) from MLN Medical College University of Allahabad, India. She has the experience of 14 years teaching to medical graduates and post graduates in prime medical ins tute of India, currently she is addi onal professor of Anatomy in AIIMS Rishikesh Dehradun. She has published 65 quality publica ons in reputed na onal and interna onal journals. She represented KGMU and AIIMS at 9 Interna onal and 15 na onal conferences of Anatomy but also awarded memberships of 4 interna onally popular and 3 na onal anatomical socie es. Besides being editor of Archives of Anatomy and Physiology India, Scien ï¬ c pages Anatomy and Physiology, USA and Anatomy and Physiology open access, she is working as a member of editorial board of Clinical Anatomy, USA and member of Advisory board of OA Case Report London. She has wri en one chapter on Microanatomy of nerves to illiacus on invita on for ‘E-book of Human Anatomy at glance’ to be published by Aus n Publica on USA. She received best researchers and best paper awards.
Abstract:
Myocardial bridging (MB) is congenital anatomic varia on in which a band of cardiac muscle covers a part of an epicardial coronary artery. The artery under the cover of myocardium is known as ‘tunnelled segment’. The clinical implica on of myocardial bridging is a debatable subject since early 1960s at the introduc on of coronary arteriography. Myocardial bridge is considered benign by many authors but recent literature describes it as associated with various clinical condi ons such as myocardial ischaemia, circulatory problems, angina, myocardial infarc on, sudden cardiac death, systolic compression and other cardiac insults that may require surgical interven on. It is also said that myocardial bridges has ‘protec ve eff ect’ from atherosclerosis within the coronary artery that is bridged when compared with uncovered vessels of the same heart. The present study is aimed to analyse the presence of myocardial bridges over coronary arteries and their branches by coronary angiography. 380 coronary angiographs consis ng of 292 male and 88 females were analysed retrospec vely for the presence of MB on the coronary arteries and their branches
in department of Anatomy and cardiology, AIIMS Rishikesh. 20 MBs was observed in 19 cases (2 females and 17males) out of 380 cases of angiographs (88 females and 292 males) cons tu ng 5.26 %. Single MB was observed in 18 cases and two MBs were observed in one case. In 18 cases, MB was observed only on LAD while in one case; both LAD and LCX were covered by MB. Length of MB ranged between 12mm to 30 mm with mean 21.5 ± 2.12. Percentage reduc on of diameter and area of coronary artery covered by MB ranged between 22.9- 78.69 and 40.48- 95.5 respec vely. In our case all the pa ents with MB were having coronary artery diseases except one. Thus isolated MB may be benign anomaly but it is deï¬ nitely a contribu ng factor in causing various coronary heart diseases. It is great challenge to cardiologist to detect symptoma c pa ents with MB and to plan be er therapeu c and surgical interven ons. An op mal use of new non-invasive diagnos c methods in combina on with invasive methods will enhance our understanding of this anomaly and help in reducing the mortality.
Oral Session 1:
- Current Trends in Cardiology, Cardiac Surgery, Cardio-Oncology, Cardiac Engineering, Biomimetic and Implants
Title: High risk off pump CABG anesthesiolgy & intensive care issues
Biography:
Dr Vikram Arora has completed his MD in 2010 a er that he worked for a year in For s Escorts hospital, okhla N. delhi as senior resident. He completed his fellowship in cardiac anaesthesia from For s hospital, Mohali. He was trained in both adult and paediatric cardiac cases. He was also trained in transoesophageal echocardiography during his fellowship period. He worked as A ending consultant in For s Hospital, Mohali. Than from 2014-2018 he joined Max super Speciality Hospital as Associate Consultant. He joined as Consultant Cardiac Anaesthesia from April 2018 in IVY hospital Mohali. Dr Vikram has experience of over 2500 cardiac cases.
Abstract:
Off -pump coronary artery bypass (OPCAB) surgery has shown to have some advantages compared to on-pump cardiac surgery, par cularly the reduc on in postopera ve complica ons including systemic infl amma on, myocardial injury and cerebral injury. The anaesthesiologist has to deal with diff erent issues including hemodynamic instability and myocardial ischemia during aorto-coronary bypass gra ing. The anaesthesiologist and surgeon should collaborate and plan the best periopera ve strategy to provide op mal care and ensure a rapid and complete recovery. Off pump CABG in poor LV func on is controversial. Preopera vely we stra fy pa ents according to euro score and manage accordingly. In poor LV & acute MI pateints were primarily induced with opioids anaesthe c agents and followed by slow extuba on guided by cardiac output and clinical
state of pa ent. Intra-aor c balloon pump(IABP) was inserted according to pa ent’s preopera ve clinical state, pulmonary artery pressure or depending on coronary lesion anatomy. IABP is usually removed post extuba on guided by Pulmonary artery pressure monitoring and echocardiographic func oning of heart. Intra-aor c balloon pump was gradually weaned from 1:1 to 1:2 & 1:3, followed by reduc on in support of intra-aor c balloon pump volume. Poor LV func on pa ents are elec vely ven lated in our ins tute for Post-opera ve day 1 and are extubated on post-opera ve day 2. Intra-aor c balloon pump was removed by day 4 and usually these pa ents get discharged by pod 7. We would like to outline some protocols followed in our ins tu on for off pump CABG in poor LV func on pa ents and acute myocardial infarcta on.
Title: Wellness and stress management
Biography:
Dr. Rachna K Singh is a mental health professional with a medical background focused on providing Individual, Group and Corporate Counseling with a strong focus on Hospital and Clinical care. Her speciali es include stress management, lifestyle management for heart diseases, and suppor ve care for chronically ill pa ents, work-life balance, parent-child bonding, cancer support care, ante/postnatal care, rela onship counseling, pre-marital & marital counseling, adolescent counseling, neurological, psychiatric & psychological illnesses like depression, anxiety, insomnia. She has been providing her exper se using psychotherapy and alternate systems of medicine like Homeopathy for over 15 years.
Abstract:
The concept of wellness or complete wellness refers to a completely well rounded human being. It is inclusive of a holis c concept comprising of our mind, body, and soul. However, our wellness can be compromised with the pa erns of our faulty lifestyle including stress, faulty diets, sedentary life, smoking and alcoholism. In addi on, the pressure to perform, factors related to urbaniza on, our busy schedules and peer pressure seemingly contributes more to our faulty lifestyle pa erns. Consequently, stress has become a normal part of life for most of us owing majorly to these faulty lifestyle habbits.
But, if le unmanaged, stress can lead to emo onal, psychological and even physical problems, including palpita on, high blood pressure, chest pains and even coronary artery disease. Hence it is essen al to iden fy the sources of stress (stressors), types of stress (Eustress and Distress), causal factors, and symptomatology and learn to deal with it eff ec vely before it impacts ones Heart & Health.
Title: Intellectual property rights and innova on in health care industry
Biography:
Isha Sharma is the Director of Trayambak Overseas Private Limited based at Noida. She is a registered patent agent whose experience includes 7 years with her clients across the globe. She has done her BTech and MTech in biotechnology at Amity University, India. She has also done 1 year PG diploma in IPR and is also qualiï¬ ed to prac se law in India. She prac ces as a registered patent agent. Isha also train students and corporates about the importance of IPR. She has conducted Intellectual Property Awareness workshop & lectures at IIT, Amity University, Geeta Law College, Panipat, IIPTA, Delhi and NITIE, Mumbai. She has also been invited as a speaker at business entrepreneur’s summit, 2018 Delhi & Speaker at Women entrepreneur’s summit, 2018, Jalandhar, India.
Abstract:
The ra onale of the intellectual property (IP) system in general, and the patent system, is to make investment in innova on a rac ve and to off er a mechanism which ensures that the knowledge contained in patent applica ons is accessible to society. In this way, it seeks to balance compe ng private and public interests. The cost and me required to develop new medicine or devices can run into the billions of dollars and take over a decade. To protect their enormous sunk costs, pharmaceu cal and biotech companies must be conï¬ dent that compe tors will not be able to launch copycat or generic versions of those medicines or devices before they have been able to recoup their costs and make a proï¬ t. Intellectual property rights – limited terms of patent protec on during which companies can market their products without compe on – have been ins tuted to encourage investment in R&D. Innova on and
the intellectual property (IP) o en underpinning it are crucial drivers of human progress. Innova on saves lives, facilitates human connec ons that have even sparked revolu ons and entertains and enchants people around the globe. IP rights and enforcement of those rights globally is vital to the con nued fl ow of future new inven ons as free markets depend on IP and the resul ng innova on. Innova on, helps to ï¬ nd treatment paths, improved or new medica on, be er equipment’s & devices and more to help pa ents lead longer and be er lives. Intellectual Property has enabled the research and development of today’s medicines and it will lead to the development cure and treatment of currently s ll unmet needs. Intellectual Property is at the heart of our health system as it sustains the ï¬ nancing model for research and development.
Title: Ischemic heart failure; myocardial viability evalua on before revasculariza on
Biography:
Awadhesh Pandey has completed Post-gradua on at Tata Memorial Hospital, Mumbai, India & DNB at pres gious Nizam’s Ins tute of medical sciences, India. Dr. Pandey has twice been awarded as a young scien st while was a faculty at the Nizam’s Ins tute of medical sciences, Hyderabad. He has 13 publica ons in interna onal and na onal journals with a review ar cle in Indian journal of nephrology. Dr. Pandey has more than 200 oral presenta ons to his credit in na onal & interna onal conferences.
Abstract:
Myocardial viability categorized into 5 categories such as normal myocardium, reversibly ischaemic myocardium, peri infarct ischaemic myocardium, stunned myocardium, hiberna ng myocardium. In this era of mul modality and mul parametric imaging heave with a spectrum of imaging modali es to choose from, nuclear imaging delivers best results as far as Viability imaging is concerned as Viability is a physiological phenomenon that can be imaged directly with a physiological imaging modality (SPECT AND PET). Anatomical modali es “claim” to assess viability but with limited results. Accurate pre-op assessment can deliver best results for pa ent standing on a
“T” junc on of medical vs. interven onal management, thus the dilemma resolved and the clinician conï¬ dently can go ahead with the right choice of therapy. If revascularisa on is contemplated and viable myocardium present the resultant beneï¬ t of improvement in quality of life can be conï¬ dently arrived at in a preopera ve scenario. Viable myocardium is located anatomically in the sub epicardial layers of the le ventricular wall, above the infarct in the sub endocardial layers in the distribu on of a steno c coronary artery. Thallium 201, 99m Tc SESTA MIBI, 18-F FDG are few radio tracers used to determine myocardial viability, the “gold standard” being 18 F FDG according to literature.
Title: Management of nutri onal needs in Heart failure-A ght rope walk
Biography:
Dt. Pallavi Jassal M.Sc. is a Foods & Nutri on Die cians completed her PGD Naturopathy & Yoga. she is a Chief Consultant at Diet, Nutri on & Natural Health. she is a Cer ï¬ ed Nutri onist by Canadian Society of Nutri on Management. and Formerly at Chris an Medical College, Ludhiana, Mediwell Heart Ins tute, Chandigarh
Abstract:
Lifestyle diseases are ailments that are primarily a ributed to the day to day habits of people. A sedentary life can cause a number of health issues that can lead to chronic non-communicable diseases that can have even life-threatening consequences. Examples of lifestyle diseases are cardiovascular diseases (like heart a acks and strokes), cancers, chronic respiratory diseases, diabetes, obesity, Alzheimer's disease, depression and other lifestyle associated diseases. Globally, the popula on has gained more than a decade of life expectancy since 1980, rising to 69.0 years in men and 74.8 years in women in 2015. Also, the rate of people dying from cardiovascular disease and cancers has also reduced, although at a slower pace. About 17.5 million people died from cardiovascular diseases in 2012, represen ng 31 percent of all global deaths. This number is expected to increase to more than 23 million by 2030. People are living for more years but with illness and disability. High blood pressure, smoking, high blood
sugar, high body mass index, and childhood undernutri on were the world's leading risk factors for premature death and ill health. Stronger interven ons are required for the preven on, control and treatment of cardiovascular diseases to reduce the burden and save lives. A strategy which aff ects the societal infl uences, regional cultural diversity and the changing lifestyles due to urbaniza on should be formed. Deï¬ nitely, the involvement of the medical community in preven on eff orts is important. Strict and prac cal methods to control the use of and exposure to tobacco, along with encouragement of healthy lifestyles, such as increased physical ac vity and decreased fat and carbohydrate consump on, should be an integral part of any program. A strategic approach should be designed so that all stages of the life cycle are targeted. Spreading awareness about harmful eff ects of tobacco products and content of salt in foods can help millions of people avoid unnecessary death and suff ering from cardiovascular disease.
Title: Lifestyle modiï¬ ca on in cardiovascular disease
Biography:
Dr. Sandeep Jassal MD (AM), BAMS, PGD is working at Preven ve and Promo ve Healthcare Apollo Hospitals.he has also doing his work at Family Physician and Wellness Consultant. He is Cer ï¬ ed Advanced Cardio-Vascular Life Support Provider by American Heart Associa on.
Abstract:
Lifestyle diseases are the ailments that are primarily based on the day to day habits of people. Habits that detract people from indulging in physical ac vity and healthy ea ng push them towards a number of health issues that can lead to chronic disease or NCDs (non-communicable diseases) that can increase morbidity & mortality. With research & good an -microbial armament, we have gained on good control upon communicable diseases due to which the world popula on has gained more than a decade of life expectancy since 1980, rising to 69.0 years in men and 74.8 years in women in 2015. But, an es mated 17.5 million people died from cardiovascular diseases in 2012, represen ng 31 percent of all global deaths. This number is expected to increase to more than 23 million by 2030. The number of annual deaths has increased from roughly 48 million in 1990 to almost 56 million in 2015. 70% (40 million) of global deaths in 2015 were due to non-communicable diseases. People are spending more years living with illness and disability. High blood pressure, high blood sugar, high body mass index, high reï¬ ned carbohydrate, high saturated fats, tobacco & alcohol use, were the world's leading risk
factors for premature death and ill health in 2015. Innova ve approaches and eff ec ve and evidence based interven ons are required for the preven on, control and treatment of cardiovascular diseases to reduce the burden and save lives. There is need to develop broad and sustainable strategy for cardiovascular research and preven on. Such a strategy should recognize the unique societal infl uences, regional cultural diversity and the changing lifestyles as rates of urbaniza on con nue to increase drama cally. The involvement of the medical community in preven on eff orts is important. Strong methods to control the use of and exposure to tobacco, coupled with promo on of healthy lifestyles, such as increased physical ac vity and decreased fat and carbohydrate consump on, should be an integral part of any na onal program. A comprehensive strategy should be designed so that all stages of the life cycle are targeted. Reducing the consump on of wrong foods and op ng for the right food choices along with regular moderate physical ac vity can help millions of people avoid unnecessary deaths and suff ering from cardiovascular disease
Title: Role of coronary collaterals in Ischemic heart failure
Biography:
Nidhi Puri has done MBBS and MS(Anatomy) from IGMC Shimla, H.P. India.She has a meritorious academic record throughout. Her total teaching experience in anatomy is23 years . She has been professor since last 7 years and has been heading the department of anatomy since last 4years. She is an innova ve and enthusias c teacher and also has keen interest in research. She has 22 publica ons in various peer reviewed and reputed na onal and interna onal journals. She has also presented her work in various na onal as well as interna onal conferences. She has supervised various thesis projects of MD students and PhD scholars. She has also been awarded on interna onal women’s day in 201 for her contribu ons to the society.
Abstract:
Introduc on: Coronary collaterals are an alterna ve source of blood supply to myocardium jeopardized by ischemia. In comparison with other species, the human coronary collateral circula on is well developed in some pa ents. Method: This is a retrospec ve study done on 200 preopera ve angiograms in pa ents with coronary artery disease. Pa ents were classiï¬ ed according to age, gender and degree of obstruc on in major vessels. Collateral vessels were graded according to the Rentrop classiï¬ ca on. Pa ents with collaterals were further classiï¬ ed on the basis of intensity of collaterals into 3 groups: those with no collateraliza on (Grade 0), poor collateraliza on (Grade 1) and those with adequate collateraliza on (Grade 2 - 3). Result: Coronary collaterals were seen more o en in pa ents with more than 90% occlusion of coronary, age more than 70 years and history of previous myocardial infarc on. Pa ents with comorbidi es like diabetes and hypertension had poor collaterals. Pa ents with ï¬ rst acute MI had poorly developed collaterals with recent onset ischemic heart failure and worst outcome. Pa ents with chronic ischemic heart failure with ejec on frac on less than 25% had usually good collaterals and be er outcome a er revasculariza on in comparison to those who had no collaterals. Conclusion: Young pa ents with acute ischemic heart failure following ï¬ rst MI usually had poor collaterals and worst outcome, pa ents with chronic ischemic heart failure and less comorbidi es had good collaterals and tolerated revasculariza on procedures be er.
Keynote Session:
Title: Coronary fl ow regula on by adenosine it’s signaling
Biography:
S Jamal MustafaI is the Professor of Pharmacology at West Virginia University School of Medicine and a Senior Advisor to the Pilot Core of the West Virginia Clinical Science and Transla onal Ins tute. He served as an Assistant Dean for Research and the Health Sciences Center from 2005-15. He has received Dean’s Award for Excellence in Research from School of Medicine in 2008 and became a Robert C. Byrd Professor in 2010. In addi on, he received Chancellor’s Award for Outstanding Achievement in Research and Scholarly Ac vi es from HSC in 2013. He has published over 200 manuscripts. Prof. Jamal and the coworker’s past work have led to the approval of an A2A selec ve AR agonist (Lexican®) for myocardial perfusion imaging. Currently, they are using AR and β adrenergic receptor KOs to be er understand the rela onship between these receptors in coronary fl ow regula on.
Abstract:
Adenosine acts through its receptors (A1, A2A, A2B, and A3) via G-proteins and causes an increase in coronary fl ow (CF) mostly through A2A AR. However, the role of other ARs in the modula on of CF is not well understood. Using KOs, we inves gated the role for each AR in the regula on of CF. Using the isolated heart from A3 KO mice; we reported an increase in A2A-mediated CF. Similarly, we found an increase in CF in A1 KO mice with A2A agonist (CGS-21680). Also, in A2A KO mice, response to CGS was abolished. On the other hand, A2A KO mice showed a decrease in CF to NECA (non-selec ve agonist). BAY60-6583 (A2B selec ve agonist) was without an eff ect on CF in A2B KO mice; however, it increased CF signiï¬ cantly in A2A KO. CGS also
caused a signiï¬ cant increase in CF in A2B KO mice. Also, exogenous adenosine-induced increase in CF in WT, A2A KO, and A2B KO mice were signiï¬ cantly reduced with catalase. BAY-induced increase in CF in WT was signiï¬ cantly inhibited with glibenclamide. Overall, our data support s mulatory roles for A2A and A2B and inhibitory roles for A1 and A3 in the regula on of CF. These observa ons provide new evidence for the presence of all four ARs in CF regula on. We propose, that ac va on of A2A/B may release H2O2 which then ac vates KATP channels, leading to vasodila on. These studies may lead to be er understanding of the role of ARs in coronary disease and may lead to be er therapeu c approaches.
Title: The associa on between Helicobacter Pylori (H. pylori) infec on and cardiovascular risk factors remains controversial.
Biography:
To be updated
Abstract:
Background: The associa on between Helicobacter Pylori (H. pylori) infec on and cardiovascular risk factors remains controversial. The high prevalence of H. pylori infec on among Afghan pa ents facilitates to inves gate this associa on. The aim of the present study was to determine the associa on between H. pylori infec on and cardiovascular risk factors among pa ents visi ng an outpa ent clinic in Andkhoy, Afghanistan. Materials and Methods: We performed a cross-sec onal study of 271 consecu ve pa ents in an outpa ent clinic in Andkhoy, Afghanistan from April 2017 to June 2017. The diagnosis of H. pylori infec on was achieved using the enzyme-linked immunosorbent assay (ELISA) test. The pa ents were divided into H. pylori posi ve (n=189) and H. pylori nega ve (n=82) groups. The associa on between H. pylori infec on and cardiovascular risk factors was analyzed.
Results: Of the total 271 study par cipants, 102 (37.6%) were males and 169 (62.4%) were females. The mean age of the pa ents who were H. pylori-posi ve and H. pylorinega ve was 51.0 ± 17.6 years and 51.6 ± 17.6 years, respec vely. In mul variate logis c regression analyses, H. pylori infec on was signiï¬ cantly associated with Diabetes mellitus (DM) (odds ra o [OR] 3.16, 95% conï¬ dence interval [CI] 1.31-7.62, P = 0.011), BMI (body mass index) levels (OR 1.17, 95% CI 108-1.26, P < 0.001). Conclusions: Our study indicated that H. pylori infec on was signiï¬ cantly associated with DM and BMI levels in an outpa ent clinic in Andkhoy, Afghanistan. More aggressive measures, including DM, obesity control, and H. pylori eradica on should be needed.
Title: Improving cardiac protein quality control as a novel therapeu c strategy
Biography:
Dr. Wang had studied/worked in biomedicine for 14 yrs in Wuhan, China. He was appointed Assistant Professor in 2001, promoted to Associate Professor in 2005, tenured in 2006, and became full Professor and Director of the MD/PhD program in 2006. Basic biomedical sciences: biochemistry and molecular biology, anatomy, histology and physiology, cell biology and transgenics. Dr. X-J Wang's research laboratory is primarily funded by NIH R01 grants and focuses on protein quality control and degrada on in cardiovascular physiology and pathophysiology, molecular mechanisms of the progression from primary heart diseases to conges ve heart failure, and molecular pathogenesis of misfolded proteins.
Abstract:
Targeted removal of damaged/misfolded proteins in the cell is primarily performed by the ubiqui nproteasome system (UPS). When escaped from UPSmediated degrada on, misfolded proteins tend to form aberrant aggregates which are no longer accessible by the proteasome and are generally believed to be removed by macroautophagy. Remarkable accumula on of myocardial ubiqui nated proteins and autophagosomes are observed in human heart failure of nearly all causes, indica ve of UPS and autophagic dysfunc on in the development of cardiac failure. The crea on of stable cell lines, adenoviruses, and stable transgenic mice expressing a surrogate UPS substrate, such as green fl uorescence protein (GFP) modiï¬ ed by fusion with degron CL1 (known as GFPu or GFPdgn), has made it possible and convenient to monitor dynamic changes in UPS performance in situ or in vivo, and thereby enabled my lab to demonstrate for the ï¬ rst me in intact animals that increases in misfolded proteins and resultant aberrant protein aggrega on impair UPS func on and cause proteasome func onal insuffi ciency (PFI). Similarly, we and collaborators detected cardiac UPS func onal insuffi ciency in acute ischemia/reperfusion (I/R), chronic pressure overload, and diabe c cardiomyopathy. Using both gain- and loss-of-func on approaches, we were able to demonstrate that PFI is a major factor underlying UPS malfunc on and plays an important pathogenic role in heart disease with
increased proteotoxic stress such as proteinopathy, I/R injury and diabe c cardiomyopathy in mice. Furthermore, we have discovered that cGMP-dependent kinase (PKG) posi vely regulates the proteasome in cardiomyocytes, PKG ac va on by either gene c or pharmacological means, such as phosphodiesterase 5 (PDE5) inhibi on, promotes proteasome-dependent degrada on of a surrogate and a bona ï¬ de misfolded protein in cardiomyocytes, and PDE5 inhibi on by sildenaï¬ l reduces misfolded protein abundance and aggrega on and slows down disease progression in a well-established mouse model of cardiac proteinopathy. We have also collected strong evidence that the protec on of PDE5 inhibi on against I/R injury depends largely on improving proteasome func on. Muscarinic receptor ac va on can enhance cardiac proteasomal func on in a PKG dependent manner. These ï¬ ndings demonstrate the feasibility to use pharmacological method to enhance UPSmediated degrada on of misfolded proteins and thereby to treat heart disease with elevated misfolded proteins. A good body of evidence has also demonstrated that increasing autophagy is beneï¬ cial to the treatment of most heart diseases. Hence, improving cardiac protein quality control through UPS enhancement and increasing autophagic fl ux has emerged as a promising novel therapeu c strategy warranted for transla onal studies.
Oral Session 1:
- Brain-Heart disorders and Neurocardiology|Pediatric & Fetal Cardiology|Clinical Cardiology: Pharmacology and Toxicology|Diagnostics, Cardiac Imaging and Nuclear Cardiology Diabetes & Obesity|Case Reports in Cardiology
Title: Surgical aor c valve replacement remains the 'gold standard' in comparison to transcatheter aor c valve implanta on (TAVI)
Biography:
Hatem Al-Masri is a cardiac cri cal care Intensivist and Consultant of cardiac surgery. Dr. Al-Masri completed his medical degree (M.D.-Doktorate) at Charles University Faculty of Medicine, holds a degree in biochemistry from the University of Waterloo, Canada, completed his residency training in Germany (Leading Facharzt) and holds training fellowships in Cardiac Surgery from IJN KL Malaysia, Switzerland, and Canada. Dr. Al-Masri is the author of an award-wining medical research paper tled “Hemodynamic Support Requires Integrated Approach Comparing LVAD vs. IABP in Pa ents Experiencing Le Ven cular Failure” (Best Paper of Young Cardiac Surgeon) at the 8th Interna onal Congress of Update in Cardiology and Cardiovascular Surgery (UCCVS 2012) awarded by European Society for Cardiovascular Surgery, World Society of Arrhythmias (WSA ) and the Society of Cardiology and the Interna onal Academic of Vascular and Endovascular Surgery (ISCP). Dr. Al-Masri is a member of the Medical German Associa on, Malaysian Medical Associa on and the Saudi Medical Council, in addi on to, Saudi Medical council.
Abstract:
Background: Surgical AVR is the treatment of choice for pa ents with symptoma c severe degenera ve aor c stenosis, as it off ers both symptoma c relief and the poten al for improved long-term survival. An increasing number of elderly pa ents with mul ple comorbidi es are referred for transcatheter aor c valve implanta on (TAVI), partly due to the perceived high risks of surgery. These include in par cular pa ents who have had previous cardiac surgery. The study aim was to compare the outcomes of pa ents with aor c valve disease. Methods: All pa ents aged > 76 years that underwent a procedure for severe aor c stenosis with or without coronary revasculariza on at the authors' ins tu on were included in the study; thus, 308 pa ents underwent previous cardiac surgery was allocated to TAVI TAVI and 192 underwent previous surgery and subsequently had redo surgery AVR. Pa ents in the TAVI group were older (mean age 87). Treatment modali es were chosen for individual pa ents according to their EuroSCORE and had a higher
logis c EuroSCORE. Results: A total of 500 pa ents was discussed ,of these pa ents, 192 underwent TAVI, 308 of whom had undergone previous cardiac surgery Twenty one pa ents (10%) died during the procedure in the TAVI group, and 32 (13%) died in the AVR group . Predictors for mortality were: age, female gender and surgical valve replacement .Gradients across the implanted valves at one to three months postopera vely were lower in the TAVI group . Conclusion: Surgical aor c valve replacement remains the 'gold standard' treatment for aor c valve disease.Improved risk stra ï¬ ca on in pa ents with aor c valve disease and re-do cardiac surgery is required .AVR and TAVI will likely be off ered to diff erent groups of pa ents Transcatheter aor c valve implanta on is the treatment of choice for symptoma c aor c stenosis in the unacceptably high-risk or inoperable pa ents, and is a reasonable op on for highrisk pa ents in general.
Title: Expandable polyurethane stent valve for transcatheter implanta on in children suff ering from heart valve disease; results of physical, hydrodynamic and experimental tests
Biography:
Miguel Angel Maluf has graduated from Universidade Nacional de Córdoba, Argen na and become a medical doctor in 1973. Dr. Maluf did specaliza on in Cardiovascular Surgery at Ins tuto do Coracao (INCOR) – São Paulo, Brazil. His Surgical Fellowship training was ï¬ nished by defending the Master’s, Doctoral and Postdoctoral thesis, in the Cardiovascular Division at Universidade Federal de São Paulo, Brazil. His research includes development of several models of biological cardiac prosthe c to remodeling of the right ventricle outlet tract, in congen al heart disease. Dr. Maluf has more than 25 interna onal plus 40 na onal publica ons, as well as 80 interna onal and 250 na onal presenta ons and more then 11 book chapters related to his research areas. Currently he works as Associate Professor of the Cardiovascular Division at São Paulo Federal University
Abstract:
Introduc on: Transcatheter valves manufactured using biological ssue, as the essen al structural component, can be induced to: mechanical degrada on a er crimping and early calciï¬ ca on in pediatric pa ents. Objec ves: Manufacture and successful tests of one expandable polyurethane stent valve, may reduce the repeated opera ons of valve replacement, during the growing children. Material / Methods: I)Physical tes ng: Prostheses were submi ed to universal tes ng in machine EMIC and a computer with Tesc so ware, able to generate graphs of force versus deforma on (stretching). II)Hydrodynamic tes ng: Prostheses with diameters from 12 to 22 mm, were submi ed to pulsa le physiological fl ow and stress condi ons. III)Experimental implants in sheep: Ten sheep was submi ed to prosthesis implant, by trans catheter technique in pulmonary posi on. In Group A: Four sheep w/ <20 kg, the stent was expanded up to 18mm and in Group B: Six sheep w/ > 20 kg, expanded up to 22mm. Results: Physical and Hydrodynamic tes ng of Polyurethane strip removal of stent valve, before and a er undergoing to 30 minutes crimping, showed preserva on of proper es of resistance and elas city elonga on. In vitro durability was proven for >15 years. Eight sheep, were submited to 3D echo study, performed in the 6th month of f.-up, showed: there was no signiï¬ cant transvalvular gradients and trivial regurgita on in 3 cases. Histologic, radiologic and electron microscopic study of the ï¬ rst prosthesis shows: integrity of structure and free of calciï¬ ca on. Seven survival sheep are well, a er 24th months of follow-up. Conclusion: Expandable polyurethane stent valve, with special design for implant and expansion in growing children, has experimental sa sfactory hemodynamic performance and durability in vitro and in vivo tests. Calciï¬ ca on and structural changes were not observed. In the next step, clinical studies are be planned.
Title: Is wide complex tachycardia s ll diagnos c challenge at EP LAB?
Biography:
To be updated
Abstract:
Introduction: The diff eren al diagnosis of wide complex tachycardia (WCT) is wide and complex. Accurate iden ï¬ ca on of the tachycardia mechanism is essen al for successful abla on. We study the role, accuracy and usefulness of speciï¬ c pacing maneuver that can simple and immediately Clarify the tachycardia mechanism in the electrophysiology laboratory.
Methods: 28 pa ents (33.1+11.9 years) with documented WCT underwent conven onal EPS. During the tachycardia, atrial overdrive pacing was performed. The following responses were observed: (1) a change of the QRS morphology during atrial pacing and (2) the ï¬ rst return electrogram of the tachycardia, whether occurring in the atrium (AVA response) or in the ventricle (AVVA response). The postpacing interval will be measured from the ï¬ rst paced atrial electrogram to the ï¬ rst arrived atrial electrogram at the pacing site. Conclusion: The response to atrial overdrive pacing during WCT with 1:1 AV rela onship can rapidly diagnose or rule out VT as a mechanism of tachycardia and diagnose wide complex tachycardia mechanism.
