Day 1 :
Morning Star Hospital, India
Ramachandran Muthiah, Consultant Physician & Cardiologist, Zion hospital, Azhagiamandapam and Morning star hospital, Marthandam, Kanyakumari District, India. Completed M.D. in General Medicine in 1996, D.M. in cardiology in 2003 under Tamil Nadu Dr.MGR Medical University, Chennai, India. Worked as medical officer in Rural health services for 5 years and in teaching category as Assistant Professor at Madras medical college, Coimbatore medical college, Thoothukudi medical college and Professor at Dr.SMCSI Mission hospital & Medical college, Karakonam, Trovandrum and Azeezia Medical college, Kollam. Published many papers in Cardiosource, American College of Cardiology Foundation, Case Reports in Clinical Medicine (SCIRP) and Journal of Saudi Heart Association. Special research on Rheumatic fever and Endomyocardial fibrosis in tropical belts, Myxomas, Ineffective endocarditis, apical hypertrophic cardiomyopathy, Ebstein’s anomaly, Rheumatic Taussig-Bing Heart, Costello syndrome and Tetralogy of Fallot.
The rising incidence of CAD is a new phenomenon in developing countries. The increasing burden of coronary artery disease (CAD) in tropical and subtropical belts of the Equator since it remains blurred and carries a grim prognosis. The worldwide burden is set to reach 47 million disability by the year 2020 as projected by World Health Organization . Several Western studies have demonstrated a significant role of various nutrients like fat, saturated fat and cholesterol in the causation of CAD. In contrast, the traditional Indian diet is low in fat content and, therefore cannot be the sole cause for the high prevalence of CAD in Indians. Plaque buildup in endocardium and coronary arteries, causing ischemic injury and arrhythmic episodes, is a vanishing mystery in its pathogenesis and emphasizing alternative routes for understanding and treatment of this enigmatic disease. Recently, an increase in the incidence of CAD was reported from southern states of India and other etiologies, the infectious or inflammatory conditions such as Endomyocardial fibrosis may provide an insight in its analysis. Virchow, first proposed an association between infection and IHD (ischemic heart disease) > 100 years ago. Cardiotropic viruses were first implicated in the pathogenesis of CAD in 1968 when experimental Coxsackie B4 virus infection in mice was shown to produce acute coronary arteritis . Other investigators suggest a link between Coxsackie B virus and coronary artery disease, following a report of myocardial infarction, occurring in two normolipidemic male patients due to an unknown viral illness . Bacterial infection may lead to molecular sequelae that might have effects on the initiation and maintenance of atherosclerotic process. ]. The individuals having seropositive for C. pnemoniae and H.pylori, shown to possess elevated levels of fibrinogen, a risk factor for CAD. Antibiotic treatment should slow its progressin and early eradication of the organism is important to prevent future cardiovascular events. Recently, evidence of myocardial injury, as defined as an elevated troponin level, is common among patients hospitalized with COVID-19, caused by cardiac microvascular damage and systemic inflammatory response syndrome (cytokine storm) with increased risk of a poor prognosis. Among patients who are diagnosed with COVID-19, there is a broad range for prevalent CAD. rates between 4.2 and 25 percent have been reported, with most series from China. Patient with COVID-19 pneumonia with respiratory failure may not be an optimal candidate to reap the benefit of myocardial reperfusion .The important steps to prevent and decrease the risk of CAD is to reduce the chance of getting this disorder by epidemiological measures with an advice of blood thinning medications such as small daily dose aspirin, statins, nitrates and antibiotics in susceptible individuals
African Americans have the highest number of premature deaths and disabilities from hypertension disease (CDC, 2019). It is estimated that hypertension among black adults who reside in Dallas, Texas, is as high as 86 % (Dallas County.org, 2016). The quasi-experimental project was framed by Orem's self-care theory to encouraged patients to be as independent as possible. A self-selected sample of N=35 home bound African Americans in South Dallas, Texas between 40 and 80 years of age participated in an intervention. The practice improvement project involved personal coaching on healthy lifestyle behaviors and self-blood measure monitoring to increase self- efficacy in management of hypertension and to lower the systolic blood pressure measurements. A paired samples t-test estimated that the average systolic blood pressure decreased from 151.1to 118.8 (8.8). The 32.7mmHg decrease in SBP was significant (t=-18.06, p<.001) and suggests the intervention was successful in lowering systolic blood pressure readings between baseline and the 8-week follow-up. These findings carry significant clinical implications for the use of health coaching to support healthy behavioral change, self-monitoring of blood pressure, manage hypertension, and prevent other chronic co-morbidities such as cardiovascular disease (CVD), stroke, and chronic kidney disease (CKD). Future studies on non-pharmacological interventions for promoting lifestyle change in this highly vulnerable population are strongly recommended.
- Heart Failure and Cardiomyopathies
Songshan Hospital, China
Objective To explore the early warning of acute aggravation in discharged patients with chroninc heart failure.
Methods Patients of chronic heart failure with reduced effection fraction (HFrEF) were selected from consecutive cases discharged from Songshan hospital in 2016 to 2020. A follow-up table of integrals (EWI, early warning Integral) according to the ralative factors of pathogenesis, inducement, EF, early sympotum, early sign and BNP level was designed to investigate retrospectivly the latest acute aggravation before hospitalization. Logistic regresion was used to define early warning factors and their judgement criterium.
Results Altogether 100 patients were selected from 105 consecutive discharged patients. Male/female was 46/54 with age 63.5±7.6 years and EF 41.3±5.2%. Annual hospitalization was 1.8±0.7 times. All patients complicated with organic heart disease and most of them were atrial fibrillation, hypertension, coronary heart disease and degenerative valvular disease (18%-56%). Regression showed that early acute aggravation was significantly related to pathogenesis 0.89, EF0.87, overwork 0.83, aggravated edema 0.72, shortness of breath 0.68, declined activity 0.56 (P<0.05～0.01). EWI was designed according to 2 major factors (organic heart disease and reduced EF 2 scores in each ) and at least 1/4 minor factors (overwork, aggravated edema, shortness of breath, declined activity 1 score in each). A score larger than 5/8 suggests strongly high risk of early acute aggravation of chronic HFrEF. Subsequent BNP tests were positive in the whole group of patients.
Conclusions Discharged patients with chronic HFrEF exist identifinable sigh of early warning. EWI could be used to find their early acute aggravation. Defined diagnosis could be made by subsequent BNP test.
University of Strathclyde, UK
Afrah Aladwani , he is a PhD candidate at the University of Strathclyde, UK. His areas of interests include clinical pharmace, cardio-oncology and geriatric oncology. He supposed to earn my degree this year.
Introduction: Trastuzumab is a HER-2 targeted humanized monoclonal antibody that significantly improves the therapeutic outcomes of metastatic and non-metastatic breast cancer. However, it is associated with an increased risk of cardiotoxicity that ranges from mild decline in the cardiac ejection fraction to permanent cardiomyopathy. Concerns have been raised in treating eligible older patients. This study compares trastuzumab outcomes between two age cohorts in the Kuwait Cancer Control Centre (KCCC).
Methods: In a prospective comparative population-based study, 93 HER-2 positive breast cancer patients undergoing different chemotherapy protocols + trastuzumab were included and divided into two cohorts based on their age (˂60 and ≥60 years old). The baseline left ventricular ejection fraction (LVEF) was assessed and monitored every three months during trastuzumab treatment. Event of cardiotoxicity was defined as ≥10% decline in the LVEF from the baseline. The lower accepted normal limit of the LVEF was 50%.
Results: The median baseline LVEF was 65% in both age cohorts (IQR 8% and 9% for older and younger patients respectively). Whereas, the median LVEF post-trastuzumab treatment was 51% and 55% in older and younger patients, respectively (IQR 8%; p-value = 0.22), although older patients had significantly lower exposure to anthracyclines compared to younger patients (60% and 84.1% respectively; p-value ˂0.001). 86.7% and 55.6% of older and younger patients, respectively, developed ≥10% decline in their LVEF from the baseline. Among those, only 29% of older and 27% of younger patients reached a LVEF value below 50% (p-value = 0.88). Statistically, age was the only factor that significantly correlated with trastuzumab-induced cardiotoxicity (OR 4; p-value ˂0.012), but it did not increase the requirement for permanent discontinuation of treatment. A baseline LVEF value below 60% contributed to developing a post-treatment value below normal ranges (<50%).
Conclusion: Breast cancer patients aged 60 years and above in Kuwait were at 4-fold higher risk of developing ≥10% decline in their LVEF from the baseline than younger patients during trastuzumab treatment. Surprisingly, previous exposure to anthracyclines and multiple comorbidities were not associated with a significant increased risk of cardiotoxicity.
National Institute Of Cardiovascular Diseases ,Pakistan
Dr. Zara Shirazi is a final year resident of Cardiac Surgery. She is completing her cardiac surgery training from National Institute of Cardiovascular Diseases (NICVD) which is one of the best Cardiac Centres in Pakistan, Karachi, Pakistan .Her training will end in January 2021.She has completed her two years of General Surgery training from K.M.Ruth Pfau Civil Hospital Karachi in the year of 2018 at the age of 26 years. She has done graduation and has taken her MBBS degree in the year 2015 from Dow University Of Health Sciences ( DUHS) . She has published papers and case reports in reputed journals. She has always taken interest in researches. Her practise focuses on cardiac surgery and works in conjunction with researchers at the national level. Dr Zara hopes her work will continue to bring new innovations in the field of cardiac surgery and encouraging people to have more self-confidence to pursue the things they love and believe.
Isolated mitral valve replacement is a routinely performed procedure at our institute due to higher prevalence of rheumatic heart disease in every age category. Hardly any researches are available that dictate the predictors of surgical mortality in isolated mitral valve procedure. The aim of this study was to identify the most prevailing pre-operative factors in patients who had mortality after isolated mitral valve surgery.
A retrospective observational study of two years was performed from January 2018 to December 2019 at the Adult Cardiac Surgery Department of a tertiary care cardiac center in Karachi, Pakistan. Patients of either gender of age ranging from 16 to 65 years who had mortality within 30 days after isolated mitral valve surgery were included in the study. Variables assessed from records were anemia, New York Heart Association (NYHA) functional classification, prolonged symptoms, poor nutritional status, degree of left ventricular (LV) dysfunction, valve pathology, pulmonary artery hypertension, and cardiac arrhythmias.
We report our isolated mitral valve mortality rate of 5.5% (38/697) in the two-year duration. The most commonly encountered pre-operative factors were severe mitral regurgitation and pulmonary artery hypertension, which were observed in 32 (84.2%) and 23 (60.5%) patients, respectively. Other factors that were common to these patients were higher NYHA functional class (class III in 23 [60.5%] and class IV in 9 [23.7%]), prolonged duration of symptoms (20 [52.6%]), and right ventricular dysfunction (moderate in 21 [55.3%] and severe in 7 [18.4%]).
The outcome of our study suggests that severe mitral regurgitation, pulmonary artery hypertension, high NYHA functional class, LV dysfunction, and prolonged symptoms were the common predisposing factor in patients with peri-operative mortality after isolated MVR
Kozani General Hospital, Greece
Purpose: Diabetes is a strong risk factor for cardiovascular disease. Prediabetes (Glu: 110-126mg / dl) is five times more likely to progress to Diabetes Mellitus (DM). According to the guidelines of the World Health Organization, the diagnosis of diabetes requires a glycosylated hemoglobin (HbA1c) value greater than 6.4%. This study was designed to investigate the relationship between HbA1c and coronary artery disease (CAD), as well as the relationship between HbA1c and the ultrasound markers of patients under study.
Material-Method: 69 participants (35% women, 65% men), aged 25 to 79 years without diagnosis of MD based on fasting glucose measurements (Glu: <110mg / dl), who did not receive anti-diabetic medication, were recorded. The participants were divided into 2 groups. The first group (n = 29) with HbA1c value from 5.5% to 6.4% while the second group (n = 40) with HbA1c value ≤5.5%.
Results: In the 1st group, CAD was found at 49.6%, while in the second group the corresponding percentage of CAD was found at 28.5% with a statistically significant correlation. No statistically significant difference was observed in the ultrasound indices of the two study groups [mean Simpson ejection fraction (EF) 55.3% vs 50.43%, mean left ventricular diastolic diameter (LVEDD) 49.62 mm vs 48.15mm, mean left atrium diameter (LAd) 38.2mm vs 39.6mm].
Conclusions: In conclusion, the group with HbA1c values of 5.5% -6.4% showed CAD at a rate of 21% higher compared to the group with HbA1c ≤5,5%. The ultrasound indices studied did not show statistically significant differences between the two groups, which means that they do not help to predict coronary heart disease in the groups with the specific HbA1c levels.