5^th World Heart Congress April 15-16, 2019 Holiday Inn Amsterdam - Arena Towers, Amsterdam, Netherlands

Chair

William J Rowe

University of Toledo Medical Center, USA

Session Introduction

Dipesh Ludhwani

Rosalind Franklin University, USA

Title: Left Ventricular free wall rupture: A rare complication of acute myocardial Infarction

Biography:

Dipesh Ludhwani completed his medical school in India before working as a research assistant at Rutgers New Jersey Medical School. He started his Internal Medicine residency at Chicago Medical School, Northwestern Mchenry hospital in 2017. Currently a second-year resident, Dr. Ludhwani has been unanimously selected as the future third year chief resident for his residency program. He is interested in pursuing Cardiology fellowship and has published and presented numerous abstracts at regional and national conferences.

Abstract:

Introduction: Coronary artery disease (CAD) remains the leading cause of mortality worldwide. 40% of patients with CAD present as Acute Myocardial Infarction (AMI). More than half of AMI related deaths occur before reaching the hospital. Arrhythmia remains the most common cause of death in such patients. Left ventricular free wall rupture (LVFWR) is a rare complication of AMI occurring in approximately 2% of cases postcatheterization. Most acute cases present with symptoms of angina and sudden hemodynamic collapse. In one-third cases, organized thrombus and pericardium can seal the perforation causing subacute rupture.

Case Presentation: An 83-year-old male with a past medical history of coronary artery disease status post four vessel bypass graft ten years ago presented to ED with complaints of chest pain and shortness of breath from last one week. On presentation, the patient had normal vitals and lateral lead ST-T changes on electrocardiogram. Labs revealed troponin of 10.20ng/ml and elevated S. creatinine (1.55mg/dl). An overhead cardiac alert was called and the patient was transferred to the Cath lab for presumed AMI. Coronary angiogram showed patent bypass grafts and left ventricular anterior wall aneurysm. Post-angiogram patient had a transthoracic echocardiogram (TTE) which revealed left ventricle anterior free wall rupture which was later confirmed on CT angiogram of the chest. Cardiothoracic surgery was consulted however surgery was delayed to allow stabilization of friable necrotic tissue and to let clopidogrel wear off. During this period patient had regular follow-up TTE to monitor LVFWR. Rupture size was kept in check with a strict heart rate and blood pressure control. The patient finally underwent redo-sternotomy with patch closure of left ventricular rupture site. Postoperatively patient was hemodynamically supported with Intra-aortic balloon pump (IABP) temporarily. Further course remained uncomplicated and the patient was discharged to an acute care facility for supervised cardiac rehabilitation.

Discussion: LVFWR is a deadly complication of AMI occurring between 5-14 days after AMI. LWFWR should be suspected in patients with persistent chest pain especially after a recent coronary event. A normal angiogram with non-obstructive coronary arteries after recent AMI should not exclude this diagnosis as LVFWR has been reported in patients with Myocardial Infarction with Normal Coronary Arteries (MINCA). Management is dictated by the acuity of presentation. Medical therapy to hemodynamically stabilize the patient followed by emergent surgery remains the mainstay treatment option. Biocompatible glues and patches are increasingly preferred over infarctectomy and direct myocardial suturing to cover rupture site. Despite high peri-operative mortality rate rapid institution of treatment is associated with improved long-term survival.

Latt Koko Kyaw

Russian National Research Medical University, Russian Federation

Title: Comparison of two different surgical methods in acute ascending aortic dissection: Long-term results

Biography:

Latt Koko Kyaw has completed his residency cardiovascular surgery 3 years ago and now as a young researcher who is doing PhD in the Russian National Research Medical University, Moscow, Russia.

Abstract:

Background: Acute aortic dissection frequently involves ascending aorta and aortic root. Depending to aortic valve and root pathology, the proximal aorta can be replaced by two standard surgical methods: Aortic root reconstruction or supracoronary replacement of ascending aorta. We tried to compare these two surgical methods with surgical mortality and long term outcomes.

Methods: Between January 2007 and June 2017, 100 patients who had acute ascending aortic dissection underwent operations. Patients were divided into two groups according to the surgical procedure. Supracoronary replacement of aorta was applied in 68 patients (Group 1). The other 32 patients with severely dilated or destructed aortic root underwent root reconstruction procedure (Group 2).

Results: Hospital mortality was 19.1% in group 1 and 25% in group 2 (P=0.3936). Long term survival was 73.5% vs 71.8%, 67.7% vs 65.6, 60.3% vs 59.4%, 54.4% vs 53.1%, 48.5% vs 43.8% in 2, 4, 6, 8, 10 years after surgery respectively. Rate of redo surgery was 4 patients in group 1, 2.72 % (3 for distal spread of aortic dissection and 1 for prosthesis infection) and 1 patient in group 2, 0.32 % for distal spread of aortic dissection. There was

no redo operation for aortic valve or root problem. The type of surgical procedure was not found to be an independent predictor of hospital mortality, long term survival and redo operations.

Conclusions: Supracoronary replacement of aorta and aortic root reconstruction procedure are comparable standard operative methods for acute ascending aortic dissection with favorable long term results.

Ahmed Al-Smadi

University of Ulster, Jordan

Title: High levels of risk factors but poor secondary prevention for patients with coronary heart disease in public hospitals in Jordan

Biography:

Abstract:

Secondary prevention (SP) is a priority after coronary revascularization for effective long term cardiovascular care. Coronary Heart Disease (CHD) is a major health problem in Jordan, but little is known about the current provision of SP. We aimed to evaluate risk factors and explore the current provision of SP of CHD in public hospitals in Jordan. 

A quantitative repeated measures research design was used using a quota sample of 180 patients during hospitalization post coronary revascularization and six months later from three interventional hospitals following. 

Of the 180 patients at discharge, 77% were obese or overweight, 59% were smokers, 59% had low levels of physical activity, 51% had elevated LDL, 58% had uncontrolled blood glucose and 11% had uncontrolled blood pressure (BP). Of the 169 patients presenting at follow-up 75% were obese or overweight, 47% continued to smoke, 41% had low levels of physical activity, 64% had not controlled blood glucose and 25% had not controlled BP. There was no cardiac rehabilitation, or secondary prevention available post discharge. 

Despite an extremely high prevalence of risk factors in this population, the provision of SP is poor, which requires urgent improvement and the contribution of nurses’ to SP should be enhanced.

Emam M. Esmayel

Internal Medicine and Biochemistry, Egypt

Title: Low plasma level of sirtuin-1 as a novel biomarkers of cerebrovascular stroke and its clinical severity

Biography:

Abstract:

Background: Sirtuins are 7- members family of deacetylases that are involved in many metabolic and cellular processes in humans. Sirtuin-1 is well characterized for its anti-inflammatory and anti- oxidant properties. However, there is still controversy about its neuroprotective role. To our knowledge, this is the first study to assess plasma levels of sirtuin-1 in patients with stroke.

Objectives: This study is constructed with the objective of assessment whether plasma sirtuin-1 could discriminate between cases of stroke and controls and between ischemic and hemorrhagic stroke. Also, we aimed to assess the association between plasma sirtuin-1 level and clinical severity of stroke.

Methods: Plasma levels of sirtuin-1 were assessed in 14 patients with ischemic stroke and 13 patients with hemorrhagic stroke verified by CT brain imaging, as well as in 27 healthy control subjects matched for age, gender and body mass index by ELISA. Clinical severity of stroke was assessed by the modified National Institute of Health stroke scale ( mNIHSS) , where higher score denoted more severity.

Results: Plasma levels of sirtuin-1 were significantly lower in ischemic (1.49 ± 2.5 ng/ ml) and hemorrhagic( 1.48± 3.1ng /ml) groups , both compared to controls (4.35±5.4 ng/ml ,p= 0.02), with no significant difference between both stroke groups . Highly significant negative correlation was noticed between plasma sirtuin-1 levels and the score of mNIHSS(r=- 0.5, p=0.008) .

Conclusions: Low plasma sirtuin-1 might be a distinctive marker of cerebrovascular stroke and its clinical severity. However, it failed to discriminate between ischemic and hemorrhagic stroke. Further studies to assess its use in diagnosis, prevention and treatment of stroke are warranted.

Wondu Reta

Jimma Medical Center, Ethiopia

Title: Adherence of rheumatic heart disease patients to secondary prophylaxis and reasons for poor adherence at jimma medical center

Biography:

Wondu Reta is working as an assistant professor in the jimma medical center, Ethiopia. His research interest is on clinical cardiac surgeries.

Abstract:

Background: Rheumatic heart disease (RHD) is the major long-term sequel of acute rheumatic fever, which involves the cardiac valves leading to stenosis or regurgitation with resultant hemodynamic disturbance. The incidence of ARF and prevalence RHD in the sub-Saharan Africa including Ethiopia, are amongst the highest in the world. The main priority of longterm management of ARF or RHD is to ensure that patients are adherent to the secondary prophylaxis which is monthly benzathine penicillin injection to prevent  recurrent attacks of ARF.

Materials and Methods: A cross-sectional study was conducted among sampled 241 RHD patients having at least one year follow-up at cardiac clinic of JMC who appointed every month to receive injections of antibiotic prophylaxis. The data was collected for 4 months (from June 1-September 30, 2018 GC) by asking their follow-up status of last one year retrospectively and assessing related variables by using face to face interview. After the data was collected using structured questionnaires, it was coded, entered into Epi data and exported to SPSS for further analysis. The adherence rate of RHD patients was determined by frequency of annual injections of prophylaxis.

Objective: The present study was aimed to assess the adherence rate of RHD patients to secondary prophylaxis and reasons for poor adherence. 

Results: A total of 241 patients with RHD were interviewed, among those 224 (93.0%) were received the secondary prophylaxis at least once within last one year, despite frequency differs while 17 (7.0%) of them didn’t initiate the prophylaxis yet. The adherence rate of the assessed RHD patients to secondary prophylaxis was 55.2% while the left 108 RHD patients (44.8%) were generalized as non-adhered to the prophylaxis [can be who either don’t start the prophylaxis 17 (7.0% ) or who missed the prophylaxis more than three times annually 86 (35.6%)]. The main reasons to miss their prophylaxis among the 108 RHD patients with poor adherence were lack of money 41 (38%), far distance from hospital 28 (26%), fear of medication side effects and painful injection 25 (23%), and lack of knowledge about the disease and prevention 14 (13%).

Conclusion: RHD patients attending cardiac clinic of JMC had low adherence rate (44.8%) to the secondary prophylaxis due to lack of money, far distance from the setup, painful injection especially among children and lack of awareness about the disease.

Chair

William J Rowe

University of Toledo Medical Center, USA

Session Introduction

Susandy Oetama

National Cardiovascular Center Harapan Kita, Indonesia

Title: Sensitivity and specificity of the novel peguero-lo presti left ventricular hypertrophy voltage criterion compared to other criteria: a systematic review

Biography:

Susandy Oetama has completed his medical degree at the age of 24 years from Lambung Mangkurat University. He is currently working as a research associate at the Department of Research and Development at the National Cardiovascular Center Harapan Kita in Jakarta Pusat, Indonesia.

Abstract:

Left ventricular hypertrophy (LVH) is a well-known risk factor and strong predictor for cardiovascular diseases such as heart failure, coronary artery diseases and stroke. Diagnosing LVH early is clinically important given its massive impact on cardiovascular complications. A good, reliable, and easier diagnosing criterion is needed. This systematic review aims to compare the sensitivities and specificities of several established electrocardiogram voltage criteria, namely the Cornell and Sokolow-Lyon against the newer, supposedly better Peguero-Lo Presti voltage criterion in all adult population. A systematic literature search of articles published between January 1st 2017 and February 28th 2019 according to the PRISMA guideline was conducted. Search engines such as Pubmed, Highwire, CrossRef and ScienceDirect were used. Five studies were included in this review (n = 11,603), all crosssectional, and were assessed using the QUADAS quality assessment tool. Two studies were conducted in hypertensive patients; one study in patients with aortic stenosis; one study was carried out regardless of the diagnosis; and one study was conducted on the general population. Four studies provided evidence that the Peguero-Lo Presti criterion was superior compared to other voltage criteria. Only one study done in Chinese population suggested differently, and the authors proposed a revised cutoff point for the Peguero- Lo Presti criterion to be used in Asian Population. Evidence suggests that the new Peguero-Lo Presti voltage criterion could be a superior alternative in diagnosing LVH in daily practice. However, it may be necessary to modify the cutoff point in order to be used in other population groups as several factors could affect their baseline ECG complexes.

Amin Majdalawieh

Faculty of Arts & Sciences, United Arab Emirates

Title: Regulation of macrophage cholesterol homeostasis, inflammation and atherosclerosis by adipocyte enhancerbinding protein-1 (aebp1)

Biography:

Amin Majdalawieh earned a PhD in Biochemistry and Molecular Biology from Dalhousie University, Halifax, Canada. He pursued a post-doctoral fellowship in the Department of Biochemistry & Molecular Biology at Dalhousie University, Halifax, Canada. He received several research awards. His main research interests include cardiovascular disease (atherosclerosis), macrophage cholesterol homeostasis, obesity, cancer, signal transduction, inflammation, natural products, medicinal chemistry, and nutritional immunology. He published his research work in several prestigious international journals.

Abstract:

Atherogenesis is a long-term process involving inflammatory response and metabolic dysfunction. Adipocyte enhancer-binding protein-1 (AEBP1) impedes macrophage cholesterol efflux, promoting foam cell formation, via PPARβ1 and LXRβ down-regulation. The objective of this study is to assess the role of macrophage AEBP1 in atherogenesis and evaluate the effect of its over-expression and ablation on atherosclerotic lesion formation in mice. Atherogenesis and macrophage infiltration were assessed using AEBP1-/-/LDLR-/- double-knockout mice, en face analysis, bone marrow (BM) transplantation, and immunohistochemistry of aortic cryosections. mRNA and protein levels were assessed by real-time PCR and immunoblotting, respectively. AEBP1-transgenic mice (AEBP1TG) with macrophage-specific AEBP1 over-expression exhibit hyperlipidemia and develop atherosclerosis. Consistently, ablation of AEBP1 results in significant attenuation of atherosclerosis in the AEBP1-/-/LDLR-/- doubleknockout mice. BM transplantation experiments reveal that LDLR-/- mice reconstituted with AEBP1-/-/LDLR-/- BM cells (LDLR-/-/KO-BM chimera) display significant reduction of atherosclerosis lesions compared to control mice reconstituted with AEBP1+/+/LDLR-/- BM cells (LDLR-/-/WT-BM chimera). Furthermore, transplantation of AEBP1TG BM cells with normal ApoE gene into ApoE-/- mice (ApoE-/-/TG-BM chimera) leads to significant atherogenesis despite the restoration of ApoE expression. Macrophages from ApoE-/-/TG-BM chimeric mice express reduced levels of PPARβ1, LXRβ, ABCA1 and ABCG1 and increased levels of the inflammatory mediators IL-6 and TNFβ compared to macrophages of control chimeric mice (ApoE- /-/NT-BM) that received AEBP1-non-transgenic (AEBP1NT) BM cells. Our in vivo experimental data strongly suggest that macrophage AEBP1 plays critical regulatory roles in atherogenesis. We anticipate that AEBP1 may serve as a potential therapeutic target for the treatment of atherosclerosis.

Tolga Han Efe

University of Health Sciences, Turkey

Title: Pulmonary arterial hemodynamic assessment by a novel index in systemic lupus erythematosus patients: Pulmonary pulse transit time

Biography:

Tolga Han Efe has completed his medical school education at the age of 23 years from Ege University and became a cardiologist at the age of 29. He has published more than 40 papers in journals. He is now working at Diskapi Yildirim Beyazit Education and Research Hospital.

Abstract:

Objective: Systemic lupus erythematosus (SLE) is a chronic, inflammatory, and autoimmune connective tissue disease. One of the leading causes of mortality among SLE patients is pulmonary hypertension. The aim of this study was to evaluate the association between echocardiographic findings, including the pulmonary pulse transit time and pulmonary hypertension parameters, in SLE patients. 

Methods: Thirty SLE patients (aged 39.9±11 years, 28 females) and 34 ageand sex-matched healthy volunteers (aged 37.9±11.5 years, 31 females) as the control group were included. Detailed medical histories were recorded, 12- lead electrocardiography, blood tests, and echocardiography were performed in the groups. Specialized right ventricular indicators [i.e, Tricuspid Annular Plane Systolic Excursion (TAPSE), estimated pulmonary artery systolic pressure (ePASP), right ventricular dimensions, and myocardial performance index (MPI)] were measured. The pulmonary pulse transit time was defined

as the time interval between the R-wave peak in ECG and the corresponding peak late-systolic pulmonary vein flow velocity.

Results: The mean disease duration was 121.1±49.9 months. The mean age at diagnosis was 35.0±15.4 years. The mean RV MPI was higher (p=0.026), mean TAPSE measurements were shorter (p=0.021), and mean ePASP was higher (p=0.036) in the SLE group than in the control group. In addition, pPTT was significantly shorter in the SLE group (p=0.003). pPTT was inversely correlated with disease duration (p<0.001), MPI (p=0.037), and ePASP (p=0.02) and positively correlated with TAPSE (p<0.001).

Conclusion: SLE patients have higher pPTT values than controls. Further, pPTT shows an inverse correlation with disease duration, MPI, and ePASP and a positive correlation with TAPSE.

Graeme Wertheimer

University of Notre Dame, Australia

Title: Exploring the quality of anticoagulant prescribing in patients with atrial fibrillation at the St John of God Hawkesbury District Health Centre, New South Wales, Australia

Biography:

Graeme completed his Bachelor of Pharmacy at the age of 22 from the University of Tasmania. He graduated as the Valedictorian of the Health Faculty. Graeme was diagnosed with a brain tumour in which he had succcessfully surgically removed. This motivated him to pursue a medical career and he is currently a final year medical student at the University of Notre Dame, Sydney. Graeme has completed a first class honours project and this manuscript will make up part of his MD in which he will be graduating from later in 2018.

Abstract:

Background: Limited data are available on the clinical management of atrial fibrillation (AF) and its outcomes from an Australian perspective. Objective: To describe the appropriateness of antithrombotic prescribing for patients who presented with a diagnosis of AF to the Hawkesbury St John of God Hospital, NSW Australia. Methods: This retrospective observational study reviewed patients admitted to St John of God Hawkesbury Hospital (SJOGH) with AF between June 2016 and June 2017. We calculated stroke risk using the CHA2DS2-VASc score based on medical records and reviewed the appropriateness of oral anticoagulant (OAC) prescribing compared to the 2016 European Society of Cardiology (ESC) guidelines. Patients were excluded if they had only one episode of AF that reverted either spontaneously or upon cardioversion without any documented recurrences. Results: A total of 200 patients (<18 years) were included, with 180 (90%) deemed eligible for anticoagulation. Of these 72.8% (n=131) were prescribed an OAC. A total of 40.0% of patients at low risk of stroke and 68.4% at intermediate risk were prescribed an OAC, respectively. Apixaban was the direct oral anticoagulant of choice with 36.6% of patients prescribed an OAC receiving apixaban. Warfarin was prescribed for 25.1% of the patients prescribed an OAC.

Conclusions: The underutilisation of anticoagulant medication in high risk groups and over utilisation in low risk groups remains an ongoing issue in contemporary AF management and highlights the need to improve AF related stroke prevention in our jurisdiction.

Session Introduction

Oleksii Vynogradov

Heartin Inc, United States

Title: Using smart ECG t-shirt with AI based arrhythmia detection

Biography:

I'm a serial entrepreneur and investor with twenty-five years’ experience. I have created nine companies and have done couple exits so far. My professional background is business and team development, software/hardware engineering, sales, and finance.

For last eight years I have been focusing on healthcare area with a company called HeartIn. My company is creating a unique smart Garment with built-in sensors that brings wellness solutions and cardio-diagnostic to the mass market. The product has user-friendly comfortable design.

Abstract:

Our team used smart ECG t-shirt with real customers while workout to understand mass market screening case. We have 1789 records from 96 users. Quantity of records:

• Up to 10 seconds length - 97

• 10-60 seconds length - 187

• 60-300 seconds length - 167

• more than 300 seconds length – 224

Customers has no real arrhythmia detection. Algorithm has false positive detection:

• Up to 10 seconds length: None

• 10-60 seconds length - 2 Sinus bradycardia

• 60-300 seconds length 37 Sinus tachycardia and 13 Sinus bradycardias

• more than 300 seconds length 1975 Ventricular tachycardia 1356

Sinus tachycardia 496 Supraventricular ectopy or tachycardia 85 Sinus bradycardia 37 Ventricular trigeminy 15 Asystole 4 Ventricular bigeminy.

Chair

Sumit Verma

Soochow university, USA

Session Introduction

Eric Edward Vinck

El Bosque University, Colombia

Title: Video-assisted thoracoscopic cardiac denervation of refractory ventricular arrhythmias and electrical storms: A single-center series

Biography:

Eric Edward Vinck has completed his Medical School Training in 2015, is currently a third year General Surgery Resident at El Bosque University in Bogota. He has been part of the General Thoracic Surgery Research Division of Fundacion Cardioinfantil since 2014, has published nine papers both nationally and internationally.

Abstract:

Background: The combined treatment of beta-blockers with ablation and implanted cardioverter defibrillation therapy continues to be the mainstay treatment for ventricular arrhythmias (VAs). Despite treatment, some patients remain refractory. Recent studies have shown success rates using video-assisted thoracoscopic (VATS) cardiac denervation as an effective therapeutic option for these patients.

Case Series Presentation:During a period of three years, from 2015 through 2017, 20 patients (N=20) failed traditional medical and interventional treatment for the management of ventricular arrhythmias and electrical storms. After remaining refractory, the patients were referred to our thoracic surgery department for a VATS based treatment. The patients all had ventricular arrhythmias and electrical storms secondary to different cardiomyopathies. The patients were refractory to combined medical (betablockers), implanted cardioverter defibrillation (ICD) and ablation therapy.

All 20 patients agreed to surgery and were taken to cardiac denervation using a bilateral VATS approach by two thoracic surgeons at a single Cardiothoracic Center. During the month prior to bilateral VATS denervation a combined total of 29 (N=29) ICD shocks were registered in addition to six (N=6) cases of electrical storms averaging three (N=3) shocks per day. Mean shocks per patient was 2.3. During the first three months following VATS, the patients had a 90% (N=18/20) total resolution of ICD registered shocks, a 100% (N=6/6) resolution of electrical storms, and a 92% (N=11/12) resolution of shocks in patients having previous ablation therapy. No complications were documented following surgery except for one case of pneumothorax as a result of the procedure, and there were no peri-operative mortalities.

Conclusions: Bilateral thoracoscopic cardiac denervation can be a safe and seemingly effective therapeutic option for patients presenting with lifethreatening refractory ventricular arrhythmias and electrical storms in a variety of cardiomyopathies including Chagas disease.

 

Abdalazeem Ibrahem

National Health Research Institutes, United Kingdom

Title: Refractory VF cardiac arrest due to multiple pulmonary embolism

Biography:

Abdalazeem Ibrahem has done his Graduation from Kassala University, Sudan in 2009. He also did his Co-medical training in UK 2015, MRCP UK Diploma 2015. Currently he is working as Cardiology Registrar in University Hospital of North Durham, UK.

Abstract:

Introduction: Pulmonary embolism (PE) can be associated with arrhythmias. Ventricular fibrillation is reported to be associated with PE, but rare with high mortality and poor outcomes. We report a case of 67-year-old gentleman who presented with syncopal episode. On day three of admission, he was found to be in ventricular fibrillation, ALS algorithm was followed. When reversible conditions were explored, thromboembolism was falsely ruled out because of ECHO results on admission. Bed side ECHO performed to rule out cardiac tamponade, which showed multiple large echogenic mobile mass consistent with PE.

Conclusion: ALS (advanced life support) algorithm remains vital in exploring reversible conditions during cardiac arrest. Never be reassured by the previous normal results. Simple bed side ECHO gives a lot of information in emergency situation.

Case description: 7-year-old gentleman presented to emergency department  with syncopal episode. He doesn’t have any significant past medical history. He has significant alcohol intake and lives alone. On admission he was hemodynamically stable, no significant abnormality on systemic examination.

Initial investigations: CRP 120mg/L, WCC 12.2 x 109, HB 113 mg/dl, Urea and electrolytes normal, serial Troponin I 1560, 1189.

ECG: Atrial fibrillation with LBBB.

CXR: Right mid zone consolidation/mass (further imaging advised).

Bed side ECHO: Dilated cardiomyopathy, EF 20-25%.

Initial diagnosis: Community acquired pneumonia, newly diagnosed arrhythmia (AF) and Dilated cardiomyopathy.

Discussion: Pulmonary embolism common condition resulting in cardiac arrest in many patients. Thrombolysis performed at appropriate time results in improvement of overall mortality rate. Literature shows pulmonary embolism is mostly associated with pulseless electrical activity, right ventricular strain pattern but it can be associated with any kind of arrhythmias, some common than the other. In our case the embolic event is associated with ventricular fibrillation, which is rare but reported. Always have a high suspicion of pulmonary embolism in any arrhythmia, vague symptoms resulting in haemodynamic compromise situation. A bed side ECHO showed evidence of PE, which was thrombolysis appropriately. This massively improved the clinical outcome. This case again reemphasis about the ALS algorithm, exploring reversible conditions to improve the overall mortality. It’s safe to have high suspicion of thromboembolic event in any patient with cardiac arrest (even when the investigations show normal results). Re-think all the reversible conditions and rule out individually in the current situation rather than relying on the investigations on admission. Bedside simple ECHO can give lot of information in establishing a cause of cardiac arrest, when performed by qualified individual without interrupting CPR, if in progress.

Rhea Verma

Heart Rhythm Center, USA

Title: Relationship of transeptal puncture (TSP) site to the non-coronary cusp of aortic valve

Biography:

Abstract:

Background: Methods for performing TSP have evolved over time. Intracardiac echo (ICE) is standard in most practices for TSP during atrial fibrillation (AF) ablation. However, this has added significant cost to the procedure. We studied the feasibility of using aortic root angiography, specifically the relationship of TSP site to non-coronary cusp (NCC) of aortic valve to help facilitate needle localization prior to TSP.

Methods: One hundred and eleven (111) consecutive patients undergoing AF ablation were enrolled. Aortic root angiography was performed by placing an angled pigtail catheter in the NCC. Images were taken in the RAO 45° and LAO 30°. The Brockenbrough needle was introduced in the SL1 sheath and retracted until it fell in the fossa ovalis (FO). Relationship of TSP site to NCC was recorded. ICE was required for various reasons in some patients (IVP dye allergy, severe vascular disease, severe atrial enlargement, and other anatomical variants). The degree of tenting of FO was also recorded in relationship to aortic margins in LAO 30°.

Results: There is a strong relationship between the TSP site and margins of the NCC in 97/107 (90.1%) patients, TSP were completed successfully by positioning the needle posterior to but within the inferior and superior margins of NCC in RAO. In a few patients, the needle was above (2/107-1.8%) or below NCC (8/107-7.4%). Variable degrees of tenting were visualized (mild 16/107, mod 53/107, severe 38/107). ICE was required in 11/111 (10%) of patients where this method was unsuccessful. Angiographic data was available in 107 patients. No cases of extra cardiac puncture were recorded i.e. no tamponade or dye extravasation.

Conclusions: TSP can be completed safely in the majority of patients using aortic root angiography and relationship to NCC as guidance. This can allow significant cost savings by using ICE in AF ablation only in selected cases.

Chih-Ying Changchien

Republic of China Air Force, Taiwan

Title: Indoxyl sulfate(IS) suppressed myocardial connexin43(Cx43) translation and phosphorylation via JNK activation

Biography:

Chin- Ying Changchien has completed her PhD degree in National Taiwan University in 2009 and promoted as professor in department of biology and anatomy, National Defense Medical Center in 2018. Her reaech focuses encompass uremic myopathy on skeletal muscle and myocardium; molecular therapy investigation on glioma and bladder cancer. She has been principle investigator of ministery of science and technology (MOST) since 2010 and  published more than 25 papers in reputed journals.

Abstract:

Heart rhythm disturbances has been widely recognized as major trigger of cardiovascular (CV) mortality in chronic kidney disease (CKD) patients. Connexin43 (Cx43)-composed gap junctions are essential in cardiomyocytes synchronization and may involve in pathological response to uremic toxins. In primary culture of rat neonatal cardiomyocytes, we demonstrated that indoxyl sulfate (IS) treatment decreased spontaneous contractions without viability impairment. Meanwhile, there was disruption of gap junction intercellular communication (GJIC) between cardiomyocytes since 30 minutes of IS stimulation. This phenomenon implicated close association between ISinduced bradycardia and gap junction alterations. Effect of IS caused time- and dose- dependent Cx43 redistribution. The patterns of Cx43 immunostaining returned to baseline when IS stimulation diminished. Furthermore, showterm IS exposure downregulated Cx43 total protein, phosphorylated form and mRNA level. The above changes as well as GIJC and Cx43 suppression were reversed by pretreatment with JNK inhibitor (SP600125). Elevated JNK1 and JNK2 phosphorylation were further identified post IS exposure 15 minutes. The inhibition of p-JNK could attenuate IS-mediated downward trends in Cx43 transcription and translation. Our findings disclose that IS might remodel myocardial gap junction and Cx43 expression through JNK regulation. 

Sahil Verma

Heart Rhythm Center, USA

Title: In a preliminary simulation data, stent with thinnest strut beta crystalline titanium gold alloy (β-ti-au) outperforms typical implants

Biography:

Abstract:

Background: Large volume of data support the overall safety of coronary stents for cardiovascular disease. Yet, one cannot lose sight of their shortcomings such as restenosis; hence stents continue to evolve in lattices, materials, and drugs. Studies outlining the successful use of titanium gold alloy stents to counter these issues are lacking.

Methods: In this analysis we obtained available historical manufacturing records on routinely used stents to compare to two revolutionary titaniumgold alloy stents. By using a 3D CAD finite element analysis space, each stent type was tested for flexibility, rigidity and radial forces. Except for lengths and diameter, each type was held to their own strut geometry and thickness. Our analysis focused on using Von Mises Stress and resulting deformation or expansion. Our assessments were performed by using discrete changes and Pearson’s chi-squared statistics to obtain significance of our findings. Three lengths: 15mm, 27.5mm and 40mm were tested for each type. Comparisons were obtained from the mean percentage length or diameter (3.5mm) changes.

Results: β-Ti-Au alloy in our hexagonal mesh was significantly more expansive (78.29 percent gain in diameter under 7 atm than Orsiro Hybrid (the baseline) p < 0.001. The best performance in vertical crush testing was obtained from our second original structure, titanium – gold alloy stent 1 (0.8 percent vs control). Nobori was the most longitudinally flexible in that testing category but was closely matched by beta titanium – gold alloy (1.97 percent vs 2.19 percent) with promus PREMIER’s performance serving as the zero-reference point. In radial strength testing, our opened and closed titanium-gold structures first and second designs respectively came second and third to Orsiro (10.03 percent >9.09 percent >7.80 percent). Maximum changes in displacements 0.19 and 0.25. Both values were significant. (95% CI 0.11-0.27, 0.17-2.33).

Conclusion: Routine use of Titanium in coronary stents has been hindered by its low density, elastic modulus and strength; contrary these results suggest that by mixing titanium with gold and on the right structure the alloy can be constructed with a thin strut for percutaneous coronary intervention.

Jacob Jamesraj

Madras Medical Mission Hospital, India

Title: Diastolic dysfunction as cardiac feature of rheumatoid arthritis

Biography:

Jacob Jamesraj is a cardiothoracic and vascular surgeon at the Madras Medical Mission Hospital in Chennai, India. His interests are off pump coronary surgery, valve repairs, homograft banking, minimally invasive surgery and teaching. He has designed many training kits which are useful in registrar training in coronary and valve surgeries. Minimal access surgery and Videoscopic techniques can be practiced on the simulator. He conducts a Cardiac Morphology course every year which is popular with students from all over India and the neighboring countries. He has designed database software.

Abstract:

Valve repairs skills in cardiac surgical practice are an important part of a surgeon’s armamentarium. A graded wet lab training program goes a long way in safely equipping a surgeon. We have designed a simulator (training device) to enable this. A five-step graded wet lab training program is proposed.

Step 1- Understanding Anatomical perspectives

Anatomy of the valves and its structural components are taught by dissection.

Step 2 - Implanting a ring

The bovine heart is mounted on the work table of the simulator. Surgical orientation and exposure of the valves, identification of the annulus and suture placement and implantation of the ring to achieve the ring annuloplasty are taught.

Step 3 - Complex repairs

Chordal shortening and lengthening techniques, chordal transfers and placement of artificial chordate are taught.

Step 4 - Minimally Invasive Surgery

The Minimal access attachment is placed, and MICS surgical techniques are taught.

Step 5 - Videoscope surgery

Adding a webcam connected to a laptop transforms the device into a videoscopic MICS technique learning arena. Thus, a registrar in training is equipped to be a safe valve repair surgeon with minimal access and videoscope skills.

Lidija Jevdijic

General Hospital Aurora, Serbia

Title: Significance of BMI ratio in pregnant women in the development of preeclampsia and the way of terminating pregnancy and birth weight

Biography:

Lidija Jevdjic graduated from the Faculty of Medicine of the University of Belgrade, Serbia, 1996. Specialist is internal medicine with sub specialization in cardiology. From 1997 to 2017 she was employed at the Clinic for Gynecology and Obstetrics Cassone 2018, she is the Head of the polyclinic department at the General Hospital "Aurora"Belgrade She is the author of many papers published in the country and abroad, as well as a lecturer at many national and international congresses. She is the author of the chapter "Cardiovascular Disease in Pregnancy" in the textbook "Anesthesia in Obstetrics. Dr. Jevdjić is the co-founder of the Center for Women's Heart in Serbia. Mother of three children.

Abstract:

Obesity is a global health problem that is increasing in prevalence. Thus, many pregnant patients are seen with high body mass index (BMI). Obesity during pregnancy is considered a high-risk state because it is associated with many complications. The test is to show not only the importance of the relationship of BMI among pregnant women in developing preeclampsia but also expressed the importance of BMI with severe preeclampsia in the third trimester, the way of terminating the pregnancy and birth weight. Among 2100 pregnant women who got cardinal l examination in the period Jun 2013 to June 2014, were 37 of them diagnosed with a severe form of preeclampsia. All of them had blood pressure over 160/110 mmHg and Sy Helpful the evaluation of gestational weight gain on pregnancy outcomes and newborn weight in different BMI, we categorized the pregnant women into three groups based on their BMI: Normal: BMI of 20-24.9 kg/m, Over weight: BMI of 25-30 kg/m and Obese: BMI > 30 kg/m. This research demonstrates that an increased maternal BMI with preeclampsia increases the incidence of induction of labor, caesarean section, pre term labor and low birth weight. Prevention is the best way to prevent this problem. As pregnancy is the worst time to lose weight, women with a high BMI should be encouraged to lose weight prior to conceiving. During the second half of pregnancy, one needs to closely watch for signs and symptoms of pre-eclampsia.