3^rd World Heart Congress April 19-20, 2018 Amsterdam, Netherlands

Biography:

Ovidio A Garcia-Villarreal is a Cardiac Surgeon dedicated to the private practice, retired from the Social Medicine. He is the Past President of the Mexican Society of Cardiac Surgery, and the current President of the Mexican College of Cardiovascular and Thoracic Surgery. He has been working on the mitral, aortic and tricuspid reconstruction for more than 25 years. He has been pioneering in the field of Cardiac Arrhythmia Surgery, especially in Atrial Fibrillation Surgery (Cox-maze procedure) as well as in aortic valve sparing operations in Mexico. He has implemented national surgical models for valvular heart reconstruction and maze procedure. He has been also dedicated to clinical research, with more than 50 international publications in PubMed and Editor-in-Chief of the journal Cirugia Cardiaca en Mexico, and reviewer of more than 15 international journals. He is active member of the Mexican Society of Cardiac Surgery, Society of Thoracic Surgeons, European Association of Cardiothoracic Surgery, amongst others.

Abstract:

Background: Pulmonary vein (PV) isolation has been the cornerstone in the treatment of atrial fibrillation (AF). Many doubts exist about permanent total disconnection of the PV after catheter-based techniques. Surgical division of the PV is the most convincing technique to avoid any further reconnection. We believe this way is the clearest one to investigate how effective PV isolation alone is in the treatment for atrial fibrillation.

Material & Methods: From 1998 to 2010, we operated on 120 adult patients having rheumatic mitral valve disease and concomitant AF. All of them had long-standing persistent AF (> 1 year of duration). PV isolation was performed surgically by means of cut-and-sew in all these cases of mitral valve surgery. All patients were analyzed at three months, six months, one year, and once yearly after operation. Registers were recorded arising from Holter and echocardiographic study during the follow-up to seven years.

Results: Follow up completed at 93% for seven years. There was only one operative death (0.8%), and seven more along the follow-up. The end point was free from any AF, flutter or atrial tachyarrhythmia. Any type of tachyarrhythmia was present at 39%, 47%, 63%, 68%, and 70% at 3 months, one year, three years, five years, and seven years. The odds ratio for AF recurrence at seven years was 2.33 (95% CI, 1.46-3.71; p < 0.001). Left atrial size > 6.5 cm in diameter was directly related to AF recurrence at seven years after surgery (odds ratio= 8.25 [95% CI, 2.84-24.25; p < 0.001).

Conclusions: By dividing PV surgically, there is no doubt about definitive and complete PV disconnection. Surgical isolation of the PV is not enough to eliminate long-standing persistent AF. More complex procedures such as maze procedure should be considered to treat surgically the AF, especially long-standing persistent AF.

Biography:

Jun-Yang Liou has his expertise in molecular signaling in regulating cell proliferation and differentiation. His research interests focus on these areas: (1) Gene Regulation and Siganl Transduction in Regulating Cancer Cell Survival, Proliferation, Migration and Invasion. He has identified several regulators involved in Tumor Progression and Metastasis. (2) Molecular Mechanisms and Signal Pathways in Regulating Mouse Embryonic Stem Cell Differentiation and Proliferation. He has identified that inhibition of ROCK signaling contributes to neural, hematopoietic and cardiac differentiation of mouse embryonic stem and induced pluripotent stem cells.

Abstract:

Cardiac and hematopoietic stem/progenitor cells derived from Embryonic stem cells are unlimited cell source and are potentially used for cell transplantation of various heart and hematological diseases. Rho and Rho-associated kinase (ROCK) signaling was implicated in regulating differentiation of various stem cells and ROCK plays an important role in maintaining embryonic stem (ES) cell pluripotency. We have previously reported that suppression of ROCK signaling induced embryonic stem cells different into neural lineages. In this study, we examined whether ROCK signaling is involved in modulating mesodermal differentiation including cardiac stem/progenitor cells and hematopoietic stem cells (HSCs). To determine whether ROCK is involved in ES cell differentiation into cardiac and hematopoietic lineage, we evaluated the effect of ROCK inhibitors, Y-27632 and fasudil on mouse ES and induced pluripotent stem (iPS) cell differentiation. Cells were cultured in hematopoietic differentiation medium in the presence or absence of ROCK inhibitor and colony formation as well as markers of HSCs and ES cells were analyzed. ROCK inhibition resulted in a drastic change in colony morphology accompanied by loss of HSC and increase of cardiac progenitor cell markers. Fasudil-induced cardiac cells were infused into a mouse acute myocardial infarction model. They preserved left ventricular function. These findings provide new insights into the signaling required for ES cell differentiation into cardiac lineage or HSC and suggest that ROCK inhibitors are useful in directing iPS cell differentiation into cardiac progenitor cells for cell therapy of cardiovascular diseases.

Biography:

Onur Kaypakli is currently working as an Assistant Professor of Cardiology in the Department of Cardiology at Mustafa Kemal University, Faculty of Medicine - Hatay, Turkey.

Abstract:

Aim: Atrial fibrillation (AF) episodes can be silent, symptomatic or emerged with its complications in the pacemaker implanted patients. The aim of this study was to investigate the relation between P wave duration index (PWDI) and silent AF occurence in paitnets with cardiac resynchronization therapy (CRT).

Methods: The study population consisted of 181 CRT device implanted patients. The AF episodes that lasts at least 30 seconds with no symptoms were accepted as silent AF. PWDI is calculated by dividing the P wave duration by the PR interval.

Results: Patients were separated into two groups as “with silent AF” and “without silent AF”. Without silent AF group had 121 patients (mean age 62.9±8.7 years, 62% male). With silent AF group had 60 patients (mean age 67.9±9.7 years, 60% male). Paitents with silent AF had a significantly higher mean age (p=0.001). PR duration was significantly higher in paitents without silent AF (p=0.001). First degree IAB and PWDI values were significantly higher in patients with silent AF (p values were 0.001 and <0.001 respectively). Age (OR: 1.073, %95 CI:1.028-1.119,p=0.001) and PWDI (OR:1.053, %95 CI:1.028-1.078, p<0.001) were detected as independent predictors for silent AF in multivariate logistic regression analysis. In the ROC analysis, the cut off value of PWDI was determined as 0.67 to detect silent AF episodes with 81.7% sensitivity and 50.4% specificity (AUC:0.701, p<0.001).

Conclusion: PWDI and age significantly associated with silent AF in patients with CRT. PWDI can be considered to be a useful and easily applicable parameter to predict patients who will develop sient AF.

Biography:

Sahasrabuddhe A has been working as Assistant Professor at the Department of Physiology since 2007. She has keen interest in Research with many national and international publications to her credit. Her area of interest in research is obesity, diabetes cardio-metabolic disorders and endocrinology. Her work ‘Cardiac diastolic dysfunction and regional body fat distribution in insulin resistant peripubertal obese males’ received award in 22^nd Annual Congress of American Association of Clinical Endocrinologists held at Phoenix, Arizona from 1^st – 5^th May 2013. Her project ‘Cord blood levels of insulin and glucose in full term pregnancies’ won 2^nd prize in Academy of Medical Sciences (Jan 2008). She is on editorial board of reputed journals and on reviewer board of many journals national and international including BMJ-Case Reports.

Abstract:

Background: CAD is a leading cause of mortality and morbidity world-wide. Epicardial adipose tissue is unique visceral fat depot due to its anatomical and functional contiguity with myocardium and coronaries. Though under physiological conditions, it exhibits metabolic, biochemical and thermogenic cardioprotective properties; in pathological conditions it can exert vasocrine and paracrine actions through its pro-inflammatory cytokines on myocardium and coronaries. Though role of inflammation in development of CAD is well documented, the special role played by epicardial adipose tissue is poorly understood and less studied. Plasma inflammatory biomarkers may not adequately reflect this local tissue inflammation.

Aims: To find out the pathologic functioning of epicardial fat in patients with CAD and the difference in gene expression of epicardial fat in CAD and non-CAD patients.

Materials & Methods: After obtaining Ethics Committee clearance 27 patients undergoing CABG, and 16 Controls (non- CAD patients undergoing valvular heart surgeries) were recruited in the project. Epicardial adipose tissue sample was obtained and gene expression of following molecules was studied by TaqMan real-time reverse transcription–polymerase chain reaction (mRNA): UCP-1, MCP-1, Adiponectin, ADORA, VCAM and TNF-alpha. Fasting blood sugar, insulin, lipid profile, hsCRP, Homocysteine, Vitamin D, vitamin B12, TNF-alpha and Leptin levels were also measured.

Results: TNF-alpha, MCP-1, VCAM-1 were found to be up-regulated while the expression of UCP-1, ADORA and adiponectin were down-regulated in cases as compared with controls. After applying multivariate analysis for gene expression, up-regulation of MCP-1 was found to be statistically significant (p= 0.01). Vitamin D levels were low across the groups and there was no difference in the levels of vitamin D, vitamin B12, hsCRP, Homocysteine and TNF-alpha. Leptin levels were significantly high in cases (p=0.018).

Conclusion: Epicardial adipose tissue gene expression is significantly pathogenic in CAD patients with upregulation of inflammatory markers and downregulation of anti-inflammatory ones. Plasma levels of inflammatory markers may not be predictive of CAD risk.

Biography:

Xiao-Hua Wang has completed her PhD majored in Immunology from Soochow University. She has been the Director of Medical Nursing over 10 years. She has published more than 30 papers in impact journals and has been serving as a reviewer of some journals.

Abstract:

Background: Depression and anxiety often co-occur in coronary artery disease (CAD) patients undergoing percutaneous coronary intervention (PCI). However, previous studies have reported the separate impact of depression or anxiety on PCI patients.

Methods: A multicenter, prospective, longitudinal study was undertaken with a consecutive sample of 309 primary CAD patients undergoing PCI between June 2015 and May 2016 at 4 hospitals in China. The Hospital Anxiety and Depression Scale (HADS) were completed at baseline to assess anxiety and depression symptoms. Major adverse cardiovascular events (MACEs) were recorded for 12 months through outpatient clinic and monthly telephone follow-up, and medical records and death certificate review.

Results: Among the 309 patients (mean age 62.6±11.2 years, range 31-96), 80 (25.9%) had depression, and 100 (32.4%) had anxiety. The mean follow-up duration was 346 days (range 24 to 365). MACEs occurred in 26 (8.4%) patients, including 1 case of death, 10 cases of nonfatal new MIs, 4 cases of repeated coronary revascularization, 6 cases of in-stent restenosis, 2 cases of heart failure, and 3 cases of severe arrhythmia. The incidence rates of MACEs were significantly higher in patients with depression or anxiety than in those without. The Log Rank test showed that depression and anxiety (c²=9.53, P=0.002 and c²=6.10, P=0.014,) were associated with a higher rate of MACEs. Depression and anxiety were the predictors of higher MACE incidence (HR=3.15, 95% CI: 1.46-6.79, P=0.003; HR=2.55, 95% CI: 1.18-5.52, P=0.017, respectively). After adjustments for baseline characteristics, depression and anxiety remained the independent predictors of MACEs (HR=2.70, 95% CI: 1.22-5.95, P=0.014; HR=2.56, 95% CI: 1.18-5.54, P=0.017, respectively). A separate multivariate Cox regression test for possible interactions did not show an interaction between depression and anxiety. Cumulative event-free survival rates did not differ among depressed and anxious patients and depressed but non-anxious patients (Log Rank P=0.623) or among anxious but non-depressed patients and non-anxious, non-depressed patients (Log Rank P=0.082). The groups including patients with symptoms of depression showed an increased risk for MACEs, whereas there were no significant differences in the risk for MACEs between patients with only symptoms of anxiety and patients without these psychological symptoms.

Conclusions: Depression is associated with an increased risk of 170% for MACEs 12 month’s post-PCI, independent of anxiety. Although anxiety is associated with MACEs, it has no additional predictive value when co-occurring with depression.

Biography:

Liutsiia Feiskhanova is an Associate Professor of department of hospital therapy of Kazan State Medical University, Russia. She has published more than 25 articles in reputed journals. Her interests: cardiology, arrhythmology, rheumatology.

Abstract:

The risk of cardiovascular pathology in rheumatoid arthritis (RA) is 1.5-2 times higher than in the population. This increased risk is based on systemic chronic inflammation, which is the hallmark of rheumatoid arthritis. Framingham scale and SCORE are insufficiently reliable for assessment of cardiovascular risk in patients with RA, because they have the value of the presence of rheumatoid factor and long-lasting increase of ESR. Cardiovascular risk is correlated with the presence of rheumatoid factor, antibodies to cyclic citrullinated peptide, activity and duration of the disease. Dyslipidemia develops earlier than in the population. Proinflammatory cytokines are involved in atherosclerosis and myocardial fibrosis. Sudden cardiac death occurs in 2 times more often in people with RA, than in the population. The greatest contribution to the development of sudden cardiac death is made by ventricular arrhythmias. Patients with RA have a tendency to develop myocarditis and fibrosis, which leads to diastolic dysfunction. According to our data, the diastolic dysfunction correlates with the degree of activity of the disease (p<0.05). Pericardial damage is a common occurrence in rheumatic diseases. In our study the pericardial effusion is found in about 30% of cases according to echocardiography, but specialists often find it difficult and see this picture as an increase of myocardial mass, which in the calculation of parameters indicates the presence of eccentric hypertrophy. Given the fact that RA is the most common rheumatic disease, it needs the special attention to cardiovascular pathology that increases the risk of fatal consequences in patients with RA.

Biography:

Vijaya pamidimukkala, has completed her DM in Neurology from PGIMER, Chandigarh. She has been a gold medalist at PGIMER, Chandigarh in MD (General Medicine). Her special interest is Stroke Management and main expertise in the Field of Comprehensive Stroke Therapy. Currently, she is running an active stroke program treating about 125 stroke cases per month. She achieved gold medals for 2 consecutive years for World Stroke Day activities from the World Stroke Organization. She started Stroke Volunteer Network Program involving the students and general public as stroke volunteers. She has published papers in international journals and has presented 17 paper presentations at various international conferences. In addition, she has presented 34 scientific paper presentations in national conferences, IMA meetings, CME and as invited guest speaker for scientific forums. She has been a member of 5 reputed organisations.

Abstract:

Extracranial vertebral artey stenosis is common in patients with posterior circulation ischaemic stroke. In our high volume stroke centre, we analysed the data of symtomatic extracranial vertebral artery stenosis treated with angioplasty from 2003 to 2013. Total 284 patients underwent vertebral angioplasty and were followed up and analysed. Inclusion criteria were: recent ipsilateral posterior circulation stroke, recurrent posterior circulation tias with documented critical vertebral artery stenosis at the origin. Patients with associated critical carotid stenosis and intracranial vertebral stenosis were excluded. Mean age of patients was 58±8 years and 72% were males. Of total, 56% were diabetic, 48% were hypertensive, 58% had coronary artey disease, 38% were smokers. All procedures were performed using standard percutaneous angioplasty protocol. Transfemoral route was approched in 94% procedures. Dual antiplatelets (aspirin 150 mg OD and clopidogrel 75 mg BD) and statins were given. Fifty-six patients received bare metal stents (BMS) and remaining received drug-eluting stents (DES). Mean follow-up of 2.5 years (1-6 years), was performed with clinical and doppler studies. Procedural success was 99.5%. Two patients had femoral hematoma. No major periprocedural complication like stroke or myocardial infarction (MI) or death were observed. Restenosis occurred in 4 patients (3 in BMS group; 1 in DES group). One patient had basilar stroke after 6 months and 2 patients had MI, of which 1 patient died. In conclusion, angioplasty with stenting of extracranial vertebral artery is safe procedure with very high success rate and good clinical outcome. However, further randomised trials should be held on treatment of extracranial vertebral stenosis

Biography:

Abstract:

Biography:

Maedeh Arabian has completed his PhD from School of Medicine, Iran University of Medical Sciences. She is the faculty member of Rajaie Cardiovascular Medical and Research Center and Head of the Cellular and Molecular Lab. She has published more than 10 papers in reputed journals and has been serving as an Editorial Board Member of Research in Cardiovascular Medicine Journal. She is intrested in “Role of Inflammation in Cardiovascular Diseases”.

Abstract:

The main causes of aortic valve stenosis (AS) are extracellular matrix remodeling and inflammation. However, the molecular mechanisms contributing to these inflammatory processes are not well established. Finding the novel biomarkers and targeted therapy of inflammation are considered as an attractive strategy in AS and atherosclerosis. The purpose of our study was to evaluate the level of resistin and modulatory role of sirtuin-1 (SIRT1) in patients with AS before and after the cardiac surgery and also evaluate the effects of resveratrol on the expressions of resistin and SIRT1. Twenty patients with AS which underwent an aortic valve replacement surgery were enrolled. Blood samples were collected before and 72 hr after the operation. Isolated peripheral mononuclear cells (PBMC) from the blood samples were cultured and treated with resveratrol (50 µM) and eventually analyzed for the levels of resistin and SIRT-1 activity and compared to the healthy subjects as a control. Resistin expression was higher in patients with AS compared to control (p<0.05) and its level augmented 72 hr post operation in patients group (p<0.05). SIRT1 activity was negatively associated with resistin mRNA levels and its activity was lower in patients group compared to control group. Cardiac surgery caused to more decrease in SIRT1 activity. Treatment with resveratrol, significantly diminished resistin mRNA level (p<0.05), whereas increased the SIRT1 activity (p<0.01) in patients group. Our findings revealed that in patients with AS resistin levels were increased whereas activity of SIRT1 reduced and cardiac surgery could augment these alterations. The results also suggest that, resveratrol could improve the inflammatory state by increasing SIRT1 activity and reduction in resistin. These findings suggest that resveratrol could modify inflammation through the regulation of SIRT1 activity and resistin level and could be a novel approach to decrease inflammation either in patients with AS or post operation conditions.