Day 2 :
Keynote Forum
William J Rowe
University of Toledo Medical Center, USA
Keynote: Neil armstrong syndrome and thermoregulation
Biography:
William J Rowe is a board-certified Specialist in Internal Medicine. He completed his MD at University of Cincinnati and was in private practice in Toledo, Ohio for 34 years. He was a former Assistant Clinical Professor of Medicine at University of Ohio, School of Medicine. Out of four space syndromes, he has published two: The Apollo 15 Space Syndrome and Neil Armstrong Syndrome.
Abstract:
Neil Armstrong syndrome and thermoregulation Neil Armstrong syndrome triggered by very common earth related magnesium (Mg) deficits, invariably with spaces flight (SF); invariable dehydration with exercise-induced sweating with Mg loss and through kidneys; leaks of plasma through oxidative stress-induced defective capillaries; loss of thirst mechanism; in turn, angiotensin, catecholamine (C) elevations to twice earth levels when supine; vicious cycles with Mg ion deficits; can trigger C cardiomyopathy i.e. acute temporary heart failure. Normal earth CO2 levels about 0.03% with SF, levels can be 0.5-7% as on Mir; this, postulated to trigger calcium (Ca) overload with in turn coronary vasospasm, injuries to mitochondria along with impairment in telomere function; its synthesis is dependent upon Mg and in turn, decreased cardiac function. Since Mg required for thermoregulation was intensified by SF-exercise for at least 2 hours exercise/day; invariable SF mal-absorption with Mg levels reduced to p<0.0001 even though serum Mg lacks sensitivity. Neil Armstrong informed Houston twice at 4 minutes interval, of shortness of breath with heartrate up to 160 (tachycardia conducive to oxidative stress) with marked reduction to 60, half hour before pacific-splash down over three days later; severe thirst, quenched with in turn, reduced postulated high C. Mg is powerful antioxidant and Ca blocker. Severe dyspnea, thirst, tachycardia; the latter, corrected by water replenishment during three days back to Earth; one of only four- SF syndromes was observed; applicable to Earth in post-menopausal women, particularly if taking Ca supplements which reduces Mg absorption; marathoners at finish line; in tropics with water shortages; may be corrected quickly with I.V fluids or subcutaneous Mg.
- Hypertension | Cardiac Pharmacology | Heart Devices | Cardiology - Future Medicine | Heart Regeneration | Cardiologists | Nuclear Cardiology
Location: Rembrandt 1
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.
- Poster Presentations
Location: Foyer
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.
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.