Scientific Program

Conference Series Ltd invites all the participants across the globe to attend 4th International Conference on Clinical & Experimental Cardiology Hilton San Antonio Airport, USA.

Day 3 :

  • Track 7: Interventional Cardiology
Speaker

Chair

Santhosh K. G. Koshy

University of Tennessee Health Sciences Center, USA

Speaker

Co-Chair

Pupalan Iyngkaran

Flinders University, Australia

Speaker
Biography:

Richard J. Frink is the Principal Investigator of the Heart Research Foundation of Sacramento. He received his training at the University of Iowa, the Mayo Clinic and the University of Alabama in Birmingham. He practiced invasive cardiology in Sacramento, California for 35 years and established a laboratory to study the post-mortem heart. He has published approximately 25 research papers and a book, Inflammatory Atherosclerosis: Characteristics of the Injurious Agent, detailing the pathologic findings in patients who died of acute coronary disease. The primary focus of his work has been the pathogenesis of atherosclerosis and the mechanism responsible for sudden cardiac death.

Abstract:

Background: The heart is believed to escape serious injury during cardiopulmonary resuscitation (CPR). However, no comprehensive study of the coronary arteries or the conduction system has been performed to see if these structures might be injured during CPR. Direct injury to the heart may contribute to the poor prognosis of patients successfully resuscitated from sudden cardiac death.
Materials and Methods: One hundred five human hearts, 83males and 22 females, were extensively studied at autopsy. Eighty three died of acute coronary disease and 22 of noncoronary causes. Eighty patients, 62 males, mean age 53 and 18 females, mean age 70 received CPR. Sixty patients died in the hospital.
Results: Evidence consistent with direct injury was found in 35 (44%) of patients who received CPR. These structural changes were characterized by fractures of the coronary arteries and or hemorrhage in the region of the HIS bundle. These injuries were not related to the site where CPR was performed, nor to the duration of CPR.
Conclusions: CPR is associated with evidence of direct blunt injury to the coronary arteries and/or the HIS bundle. These lesions may influence the outcome of resuscitation efforts as well as the ultimate prognosis.

Speaker
Biography:

Pupalan Iyngkaran is a Consultant Cardiologist with subspecialty training in Heart Failure and Cardiovascular Imaging. He is also Senior Lecturer in Cardiology at Flinders University. He started his cardiology training at the Queen Elizabeth Hospital, South Australia. He spent part of his training at the National Heart Centre, Singapore. He completed his cardiovascular training with additional subspecialty training in echocardiography at the Flinders Medical Centre, South Australia. Upon completing cardiology training he spent several years at the Department of Epidemiology and Preventive Medicine, Monash University, Melbourne. Under guidance of Professor Henry Krum he was involved in basic science work on uremic toxins in cardiacmyocytes and setting up several heart failure databases on novel renal injury biomarkers in acute heart failure admissions and chronic heart failure. During this time he completed courses on clinical trial design, good clinical practice and gained additional clinical skills in Cardiac MRI and CTCA. With his research interest in heart failure he took a clinical and research position at the Royal Darwin Hospital, Northern Territory. He spends his time equally between clinical work across urban and remote centers in the Northern Territory and heart failure research. He is currently involved with several ongoing studies exploring the quality of care and outcomes of acute heat failure admissions, chronic disease and comorbidities management and improving patient journey for Indigenous clients. He has received governmental and non-governmental competitive funding and has published in peer review journals on these topics. He was also a contributor to the Northern Territory Heart failure treatment manual.

Abstract:

Heart Failure is a leading cause of morbidity and mortality in the Northern Territory and developed world. In many cases the diagnosis and management is straight forward. In these cases HF guidelines are relevant and helpful. The Northern Territory has a unique multiethnic demography spread over large geographical distances. The multiethnic demography includes a sizeable Indigenous population. Sixty percent live in 2 major towns serviced by 2 major public hospitals Additional factors that can affect heart failure management are prevalent in remote areas and are not well addressed within randomized controlled trials. In particular associated co-morbidities such as DM, CRF, IHD, HT, RHD, staffing issues and geographical limitations are for regular specialist review. This talk is focused on building a case for widening the therapeutic paradigm for heart failure with comorbidities. The focus is on a brief overview of epidemiology of heart failure with comorbidities, the common overlapping physiological processes, the interpretation of the external validity of trial evidence, and finally exploring the available evidence for the important therapies within the guidelines. A need to consider a wider therapeutic paradigm may also have relevance for clients in other health systems.

Speaker
Biography:

Yochai Birnbaum has completed his MD at the age of 25 years from the Hebrew University in Jerusalem, Israel. He completed residency in Internal Medicine and fellowship in Cardiology at Sackler School of Medicine, Tel Aviv, Israel. He is a professor of Medicine at Baylor College of Medicine and the Director of Baylor Heart Clinic. He is a professor of Biochemistry and Molecular Biology at UTMB, Galveston, TX. He has published more than 265 papers in reputed journals and has been serving as an editorial board member of 6 journals.

Abstract:

Both clopidogrel (Clop) and Ticagrelor (Tic) are P2Y12 ADP receptor antagonists. In a phase III clinical trial (PLATO) Tic showed superior results over Clop in patients with acute coronary syndromes. Tic inhibits cell uptake of adenosine and thus, may augment adenosine effects. Adenosine protects the heart against ischemia-reperfusion injury. We compared the effects of Clop and Tic on myocardial infarct size (IS).
Methods: Rats received oral Tic (0, 75, 150 or 300 mg/kg/d) or Clop (30 or 90 mg/kg/d) for 7d and subjected to 30 min coronary artery ligation and 24h reperfusion. Area at risk (AR) was assessed by blue dye and IS by TTC. There were 8 animals per group. Body weight, left ventricular weight and the size of the AR were comparable among group. Tic, dose-dependently, reduced IS. In contrast, Clop had no effect. Platelet inhibition was comparable between the Tic 150mg/kg/d and the Clop 30mg/kg/d and between the Tic 300mg/kg/d and Clop 90mg/kg/d. The infarct size limiting effect of Tic was partially inhibited with aspirin 10 mg/kg/d and completely inhibited with 25 mg/kg/d, whereas at 5 mg/kg/d aspirin did not have an adverse effect. The protective effect was also abrogated with CGS, an adenosine receptor blocker. Tic, but not Clop protects against ischemia-reperfusion injury and reduces myocardial IS. The effect is related to the inhibition of adenosine uptake and is inhibited by high doses of aspirin. This additional “pleiotropic” effect of Tic may (partially) explain the superiority of Tic over Clop in the clinical setting.

Speaker
Biography:

Santhosh K. G. Koshy has completed his MBBS at the age of 22 years from University of Kerala in India and then completed Internal Medicine residency and Cardiology fellowship at the same University. He also completed internal Medicine residency and Cardiology fellowship in United States before his fellowship in Interventional Cardiology at University of Alabama at Birmingham. He was a faculty at Baylor College of Medicine before he moved to University of Tennessee, where he is currently the Chief of Medicine at Regional One Health System of University of Tennessee Health Sciences Center in Memphis. He is also the director of Cardiovascular Services and Interventional Cardiology at Regional Med Hospitals and also the director of interventional cardiology fellowship at University of Tennessee.

Abstract:

Resistant hypertension (RH) has been a nightmare for both specialists and primary care physicians. RH comprises up to 20-25% of patients who are enrolled in hypertension related trials. The risk of cardiovascular events is significantly increased in patients with resistant hypertension. The management of this condition also utilizes excessive health care resources. Several complex neural and humeral physiological processes coordinate the regulation of blood pressure. The autonomic nervous system plays a very important role especially through its sympathetic component. The peri-renal arterial sympathetic fibers and those at the region of carotid sinus are important in blood pressure modulation.
Modulation of blood pressure by modifying the input from the perirenal sympathetic fibers and also that from the carotid sinus has been promising in early studies. This includes Renal Denervation (RDN) and Baroreceptor Activation Therapies (BAT). However, long-term results and safety is not known well. The current status, feasibility, outcome and future directions of both RDN and BAT will be discussed. A detailed discussion of the preclinical and initial clinical trials of both these strategies will be discussed as well.

Speaker
Biography:

Hiromi Matsubara had completed his Ph.D. from Okayama University Medical School in 2000 and was promoted as Associate Professor of Cardiovascular Medicine at Okayama University Graduate School of Medicine and Dentistry. He then became the Director of Division of Cardiology at National Hospital Organization Okayama Medical Center and also serves as the Director of Department of Clinical Science since 2010. His investigative interests have focused on clinical and physiologic aspects of pulmonary hypertension. He has made National Hospital Organization Okayama Medical Center as one of the largest pulmonary hypertension center in Japan.

Abstract:

Progress in medical treatment for pulmonary arterial hypertension has improved the prognosis of the patients. However, patients with chronic thromboembolic pulmonary hypertension (CTEPH) have been left behind this progress. There has been no effective therapeutic option especially for the patients diagnosed as unsuitable for endarterectomy. Recently, we reported our initial experience of balloon pulmonary angioplasty (BPA) for the treatment of 68 patients with CTEPH. Although overall outcome of angioplasty was almost comparable to that of endarterectomy, there were remaining problems to be resolved such as the risk of post procedural pulmonary injury and the existence of learning curve in reducing the complication. We have been trying to elucidate the cause of post procedural pulmonary injury and found that most complications were caused by BPA related vascular injury (BRVI). Some of the BRVI seems to be related to balloon dilatation itself. Remaining BRVI seems to be caused by wire injury and it would be the reason of learning curve. After the refinement of our procedure, BRVI have been almost eliminated. In most recent 400 BPA procedures, we have never experienced severe BRVI. Now, we consider that the safety and the efficacy of BPA have been established. In this presentation, I'd like to talk about the current status of BPA based on our experience in more than 200 inoperable patients with CTEPH.

Víctor Moles

Unidad de Intervenciones Cardiovasculares, Argentina

Title: Ceramic coating prevents corrosion of cardiovascular stainless steel stents
Speaker
Biography:

Victor Moles is a Director at Bioimagen, Santa Fe, Argentina and also Director at Unidad de Intervenciones Cardiovasculares, Clínica de Nefrología, Urologia y Enfermedades Cardiovasculares, Argentina.

Abstract:

Ninety percent of coronary percutaneous interventions (PCI) consist in stenting to restore blood flow. Arterial re-obstruction due to restenosis and thrombosis represent a limitation of PCI. These physiological responses are mainly attributed to the release of corrosion products from the metallic stents direct to endothelial tissue and blood flow. This work presents the corrosion phenomena observed in commercially available stents and the relations with its metallurgical condition, composition of the physiological environment in which they are implanted and manufacturing processes. It also includes a comparison with ceramic coated stents. Commercially available stents made of 316L steel were used. EDX, AES, SEM and metallographic techniques were used for chemical analysis, surface composition, topography and determination of metallurgical states, respectively. Stents were immersed in PBS saline solution at 37°C for 8 weeks. Periodically, the stents were withdrawn from the physiological environment to monitor the progress of corrosion. After 2 weeks of incubation, stents showed a dendritic corrosion pattern. This is associated with chemical segregation of alloying elements in the metal matrix for the effect of temperature at which the stent are subjected during its laser manufacture. At 4 weeks, the surface showed a pattern of vermicular corrosion located at the curved sections of the stent. This is related to the presence of residual stresses in the curved sectors as a result of stent crimping process made after the laser draft. After 6 weeks, stents exhibited large pits due high chloride content on the physiological medium. In the ceramic coated stents corrosion was practically zero until 6 weeks of incubation. Ceramic coating after surface passivation could be a way to reduce endothelial proliferation and restenosis.

Speaker
Biography:

Mannix Auger-Messier is a pharmacologist (Ph.D. from the University of Sherbrooke, 2005) and a molecular cardiovascular biologist (postdoctoral fellowship in Jeffery D. Molkentin's lab, HHMI, Cincinnati). He is a Research Professor at the Faculty of Medicine and Health Sciences - University of Sherbrooke (Division of Cardiology) since 2011. His research program aims to delineate cell signaling mechanisms participating in heart physiology and disease. His laboratory exploits a wide range of approaches from molecular pharmacology to physiopathology studies of the heart in genetically modified mouse models. Ongoing studies in his laboratory focus on elucidating the mechanisms of action of p38-MAPK and DUSP proteins in the heart. The Auger-Messier laboratory is currently funded by the Natural Sciences and Engineering Research Council of Canada (NSERC; 2013-2018) and the Canadian Institutes of Health Research (CIHR; 2013-2017).

Abstract:

Hypertension, diabetes, and myocardial infarction are amongst the diverse pathological conditions known to aggravate heart dysfunction. As a compensatory response to stress, multiple signaling pathways like the mitogen-activated protein kinase (MAPK) cascades are activated in the heart. Because the p38 MAPK functions as a cardiac negative inotrope, we hypothesized that the phosphatases regulating its actions might also alter myocardial contractility. The role of the dual-specificity phosphatase (DUSP) proteins, some of which were previously shown to dephosphorylate p38 MAPK and inactivate it, still had to be characterized in the heart. We demonstrated that DUSP1 and DUSP4 are cardioprotective factors playing a critical role in the preservation of heart function. In fact, mice lacking both DUSP1 and DUSP4 (DUSP1/4-KO) displayed significantly reduced myocardial contractility, and developed spontaneously dilated cardiomyopathy with aging. Moreover, the chronic administration of a p38 MAPK pharmacologic inhibitor prevented the development of dilated cardiomyopathy in DUSP1/4-KO mice. Whether DUSP1 and DUSP4 are the only two primary regulators of p38 MAPK in the heart still has to be proven.

Robert J Chilton

University of Texas Health Science Center San Antonio, USA

Title: Cardiovascular implications of incretins after SAVOR and EXAMINE in diabetes patients
Speaker
Biography:

Robert J Chilton, DO, is an Associate Professor of Medicine and Director of the Cardiac Catheterization Laboratory at the Audie Murphy VA/University of Texas Health Science Center at San Antonio. A fellow of the American College of Cardiology, American College of Physicians, American College of Osteopathic Internists, and American Heart Association, He also chairs the Electrophysiology Board Examination for the American Osteopathic Association. He received his Bachelor of Science degree from Philips University, Oklahoma, and his DO from the University of Osteopathic Medicine and Surgery, Iowa. He completed his internship at Wright-Patterson Air Force Base, Dayton, Ohio; his residency at the University of Oklahoma Health Science Center, Oklahoma City, Oklahoma; and a cardiology fellowship at the Wilford Hall United States Air Force Medical Center, Texas. He is board certified in internal medicine, cardiovascular disease, and electrophysiology. Over the past 20 years, He has authored numerous articles, book chapters, abstracts, and presentations on cardiology. He has lectured widely, garnering several awards including 1994 Outstanding Teacher from the University of Texas Health Science Center at San Antonio.

Abstract:

Recent publication of DPP-4 inhibitor trials, SAVOR have raised many questions related to cardiovascular concerns with heart failure hospitalization. The EXAMINE trial did find a significant increase in heart failure hospitalization. The macrovascular events were not reduced compared to the control arm with DPP 4 inhibitors. There were very low hypoglycemic events and no significant difference in pancreatitis between drug treatment group and controls.

Speaker
Biography:

Nian-Qing (Nan) Shi has completed her Ph.D. in Microbiology in 2000 from The University of Wisconsin-Madison. After she finished an industrial post-doctoral training in mitochondrial redox regulation with Tate and Lyle, she returned to academia to investigate the molecular composition and structure/function of a mitochondrial ATP-sensitive potassium (mitoKATP) channel in cardioprotection. Her team identified and cloned the cardiac mitoKATP channel, which had been pursuing by the field since 1991. In her recent studies, she started exploring the roles of HCN2 channels in congenital heart diseases. She serves as editorial members for 3 journals and reviewers for several major cardiac journals.

Abstract:

Estrogen has been shown to modulate female protection against ischemia-reperfusion (I-R) stress. Composed by a Kir6.2 pore and an SUR2 regulatory subunit, cardiac ATP-sensitive potassium channels (KATP) remain quiescent under normal physiological conditions but they are activated by stress stimuli. It remains unclear whether KATP is a regulatory target of estrogen in the female-specific stress signaling pathway. In this study, we employed knockout mice in which SUR2 is disrupted (SUR2KO) to characterize their I-R response using an in vivo occlusion model. Echocardiographic results indicated that SUR2KO females were pre-disposed to cardiac dysfunction at baseline. These mice were more susceptible to I-R stress by having bigger infarcts than WT controls. The observation was confirmed using ovariectomized mice implanted with 17β-estradiol (E2) or placebo pellets (0.1 g/g/day, 21-day release), where the estrogen-mediated protection was diminished in KO hearts post IR. Expression studies showed that SUR2 protein level, but not RNA level, was up-regulated in WT-IR mice relative to untreated controls, possibly via post-translational modifications. Our antibodies further detected differentially glycosylated SUR2 species after PNGase-F treatment, suggesting that SUR2 is modified by N-glycosylation. We subsequently showed that E2 could increase level of complex-glycosylated SUR2. Comparative proteomic profiling identified 41 differentially altered hits between KO-IR and WT-IR mice encompassing those related to estrogen biosynthesis and N-glycosylation. Our data suggest that KATP is likely a downstream regulatory target of estrogen and it is indispensable in female stress signaling. Increasing SUR2 expression by N-glycosylation mediated by estrogen may be effective to enhance KATP activity in I-R.

Speaker
Biography:

Guo-Zhen Chen has completed her Ph.D. at the age of 35 years from Shanghai Second Medical University and Postdoctoral studies from Fudan University School of Medicine. She is a Vice-chief Physician and Master Tutor of Pediatric Cardiology in China till now and Research Associate in University of Pittsburgh from Nov. 2011 to Aug. 2012. As the first author and corresponding author, she has published more than 41 papers in some American Medical Journals and main Chinese National Medical Journals.

Abstract:

Introduction: Up to now, there are still lack of reports about right ventricular (RV) functional assessment and influencing factor analysis during perioperative period and short term after surgery. With real-time three-dimensional echocardiography (RT3DE) as the main technique, the study aimed to assess perioperative RV systolic function of conotruncal defects in pediatric patients who were operated with RV outflow tract reconstruction.
Materials and Methods: In 40 patients, RV systolic functional parameters before and three days after the surgery were assessed by RT3DE, etc, including end diastolic volume (3D-RVEDV), end systolic volume (3D-RVESV) and ejection fraction (3D-RVEF), RV fractional area change in apical four chamber view (RV-4FAC) and apical two chamber view (RV-2FAC), as well as tricuspid annular plane systolic excursion (TAPSE). Changes of perioperative RV systolic function were clarified by comparing these preoperative and post-operative parameters using T test, and then their values were analyzed.
Results: Compared with the preoperative measurements, in three days after the surgery the post-operative measurements of RVEDV, RVEF, RV-2FAC and TAPSE were significantly reduced, whereas RV-4FAC and RVESV were not changed significantly. In addition, RV-4FAC and RV-2FAC didn't show any significant difference during the preoperative period, while RV-2FAC was reduced compared with RV-4FAC postoperatively.
Conclusions: 3D-RVEF, RV-2FAC, TAPSE are three sensitive parameters to reflect the perioperative RV systolic function. After the surgery, the whole and regional RV systolic function such as RV outflow tract movement is impaired. RV outflow tract dysfunction might be the more important factor for RV whole systolic functional impairment.

Speaker
Biography:

Veronica Widgren graduated from the Lund University, Sweden and has attained her M.D. degree in august 2010. She is currently working as a resident physician at the medicine clinic in the Varnamo hospital, Sweden. Her specializations are Internal medicine and Cardiology. She is a Member of Swedish Society of Cardiology. The area of her research is atrial fibrillation and its predictors. She has published her first research article “Aortic stenosis and mitral regurgitation as predictors of atrial fibrillation during 11 years of follow-up” at BMC Cardiovascular Disorders in October 2012.

Abstract:

There is limited information about any association between the onset of atrial fibrillation and the presence of valvular disease. We retrospectively examined 940 patients in sinus rhythm, examined by echocardiography in 1996. During 11 years of follow-up, we assessed the incidence of atrial fibrillation and outcome defined as valvular surgery or death, in relation to baseline valvular function. In univariate analysis, the risk of developing AF was related to aortic stenosis and mitral regurgitation. Also the risk of valvular surgery or death was related to aortic stenosis and mitral regurgitation. In multivariate analyses, adjusting for sex, age, other valvular abnormalities, left ventricular ejection fraction and left atrial size – aortic stenosis was independently related to both endpoints, whereas mitral regurgitation was not independently related to either endpoint. In conclusion, aortic stenosis, but not mitral regurgitation, was independently predictive of development of atrial fibrillation and combined valvular surgery or death. In patients with combined aortic stenosis and mitral regurgitation, the grade of aortic stenosis, more than the grade of mitral regurgitation, determined the risk of atrial fibrillation and combination of valvular surgery or death. Further studies using contemporary echocardiographic quantification of aortic stenosis are warranted to confirm these retrospective data.

Speaker
Biography:

Mahek Shah did his Medical Graduation at Seth GS Medical College, India. And after he moved to US and he is currently doing his Internal Medicine resident at Einstein Medical Centre, Philadelphia. His main research area is Cardiology and he had done many projects in Cardiology during his training period.

Abstract:

Introduction: Total occlusion of the infrarenal aorta has an estimated prevalence of <0.1%. Bypass surgery and aortic endarterectomy are considered the standard treatment for aortoiliac occlusive disease (AIOD). Catheter based endovascular approach is an alternative in patients at unacceptably high risk for surgery and is associated with lesser morbidity and faster recovery.
Case: A 54 year old African American male with history of lumbar radiculopathy, polysubstance abuse and 20 years of smoking presented with severe left leg pain and an inability to walk for over 3 weeks. He also complained of substernal chest pain two days ago that was exertional. On exam, the left foot was cold and both his feet had only faint doppler signals without palpable pulses.
An electrocardiogram revealed ST segment elevations with T wave inversion in leads II, III and aVF. A 2D echocardiogram showed an ejection fraction of 20-25% with severe hypokinesis of the anterior, anteroseptal and apical walls. A CT scan of the chest and abdomen showed a chronic complete infra-renal aortic occlusion and major collateral blood supply to the bilateral common iliac arteries from the internal mammary arteries (IMA). He received a coronary angiogram demonstrating severe narrowing of the left anterior descending, second obtuse marginal and ramus intermedius arteries that were stented. Within 3 days, he developed an in-stent thrombosis of the ramus intermedius artery that was successfully restented.
The blood pressure in his lower extremity was unmeasurable. He acquired a severe infection of his left lower extremity that acutely worsened with a rapid decline in his mental functions. An emergent angiogram of the left lower extremity demonstrated an acute thrombosis of the superficial femoral artery. Using a wildcat catheter, endovascular revascularization of the occluded aorta was achieved and a self expanding stent was placed. Percutaneous angioplasty of the left common and external iliac arteries was also performed due to severe atherosclerosis. A balloon dilatation and revascularization of the mid superficial femoral artery re-established blood flow in the the left lower extremity. Post-procedure, the infection continued to worsen and he received a left above knee amputation that was followed by a prolonged recovery.
Discussion: Collateral blood supply via bilateral IMA to the lower extremities meant that using the left IMA for coronary revascularization would compromise blood supply to the lower extremity. Hence, the patient underwent percutaneous angioplasty of the stenosed coronary arteries. An endovascular approach was preferred for recanalizing the aorta even in the acute setting, keeping in mind the high risk for surgical mortality in this case. When applied to the appropriate anatomical problem, the results of iliac angioplasty/stent placement rival open surgical results but its application in proximal occlusive disease is controversial with lack of long-term follow-up data.

  • Track 8: Current Research in Cardiology
Speaker

Chair

Yoshiaki Omura

New York Medical College & Heart Disease Research Foundation, USA

Speaker

Co-Chair

Noemi Csaszar-Nagy

National Center for Spinal Disorders, Hungary

Session Introduction

Robert Mallet

University of North Texas Health Science Center, USA

Title: Hold that thought: Induction of erythropoietin to protect the ischemic brain
Speaker
Biography:

Robert Mallet, Ph.D., Regents Professor of Integrative Physiology at University of North Texas Health Science Center, Fort Worth, TX has devoted his research career to harnessing the complex intermediary metabolism of the heart and brain to foster recovery of these organs from ischemic insults. His research, funded by the National Institute of Neurological Disorders and Stroke, is deciphering the mechanisms by which pyruvate-enhanced cardiopulmonary resuscitation prevents irreversible damage to the brain and fosters neurobehavioral recovery from cardiac arrest. He earned his Ph.D. degree in 1986 from George Washington University and from 1986-1990 completed a Postdoctoral Fellowship at Uniformed Services University of the Health Sciences. In 2013, he was named a Distinguished Scientist of the Society for Experimental Biology and Medicine.

Abstract:

Ischemic brain injury inflicted by stroke and cardiac arrest ranks among the leading causes of death and long-term disability in the United States. The brain is exquisitely sensitive to interruptions in its blood supply, and suffers irreversible damage within 10-15 minutes of severe ischemia. The complexities of the injury cascades ignited by ischemia and reperfusion have thwarted development of effective neuroprotective interventions. Although recombinant tissue plasminogen activator and therapeutic hypothermia have been found efficacious for stroke and cardiac arrest, respectively, these treatments are constrained by narrow therapeutic windows, potentially detrimental side effects and the limited availability of hypothermia equipment. Mounting evidence demonstrates the cytokine hormone erythropoietin (EPO) to be a powerful neuroprotective agent and a potential adjuvant to established therapies. Moreover, the brain parenchyma can produce EPO internally, and EPO's membrane receptors and signaling components also are expressed in neurons and astrocytes. EPO activates signaling cascades that increase the brain's resistance to ischemia-reperfusion stress by stabilizing mitochondrial membranes, limiting formation of reactive oxygen and nitrogen intermediates, and suppressing pro-inflammatory cytokine production and neutrophil infiltration. Collectively, these mechanisms preserve functional brain tissue, thereby improving post-ischemic neurocognitive recovery. Research conducted in this laboratory has demonstrated that pyruvate, a blood brain barrier-permeable energy substrate and antioxidant, induces EPO synthesis in the brain by stabilizing transcription of the hypoxia-inducible EPO gene, raising the possibility of therapeutic induction of EPO to preserve brain threatened by severe ischemia.

Speaker
Biography:

Yoshiaki Omura received Oncology Residency Training and a Doctor of Science Degree through research on Pharmaco-Electro Physiology of Single Cardiac Cells in vivo and in vitro from Columbia University. He published over 250 articles and 7 books. He is currently Adjunct Professor, New York Medical College; Director of Medical Research, Heart Disease Research Foundation; Executive Editor, Integrative Oncology etc. Using his new diagnostic, U.S.-patented method, he can non-invasively and rapidly measure many neurotransmitters, chemicals, asbestos, viruses and bacteria. He developed a non-invasive, quick diagnostic method of malignancies, as well as a method of evaluating the effects of any treatment

Abstract:

Presently accepted methods of analysis and interpretations of ECGs are based on visual inspection of wave forms and magnitudes of voltages. In the past several years, we evaluated the possibility of detecting biochemical information in recorded ECGs. With our new non-invasive diagnostic method using Electromagnetic Field Resonance Phenomenon between 2 identical molecules, which received a US patent, we can detect invisible biochemical information not only from the surface of the chest wall above the heart, but also from recorded ECGs. With this approach, even when no visual abnormalities exist in recorded ECGs, we can often detect invisible abnormalities, which include biochemical substances, drugs, neurotransmitters, Cardiac Troponin I, calcium, bacteria, virus & fungi, as well as any malignancy which exists near the heart. In addition, if any non-visible abnormalities exist in any part of the heart, not only its corresponding biochemical abnormalities, but we can also identify the exact location of the abnormal cardiac tissue. When there are abnormalities in the small, important cardiac tissues, such as the SA node or AV node, the potential from these areas are too small to record. Without using expensive high gain amplifiers & signal averaging circuits, we can detect abnormalities that exist at the SA node or AV node and detect potential causes of abnormalities, such as Borrelia Burgdorferi in the SA node of some of the atrial fibrillation patients after receiving Acupuncture treatments of joint pain. Thus, we can identify what abnormalities exist at which parts of the heart, as invisible medical information

Speaker
Biography:

Csaszar Noemi Ph.D., ECP, is the Head of the Education Board of the Hungarian Association of Hypnosis (H.A.H), clinical psychologist, supervisor hypnotherapist, psychotherapist, Head of Psychotherapy Department and Psychosomatic Out-Patient Department at the National Center for Spinal Disorders in Budapest. She is the author of the special issue chapter: Csaszar N., Ganju A., Mirnics Zs., Varga P.P.: Psychosocial Issues In The Cancer Patient. Spine, 15:34 (22 Suppl):26-30, 2009. And the book chapter: Csaszar N.: Hypnotherapy treatment of chronic Pain. In: Vertes, G. (ed.): Hypnosis-Hypnotherapy. Budapest, Medicina Konyvkiado Rt., 2006, 31–62.

Abstract:

Several types of psychotherapies have been developed for patients suffering from chronic pain. In general it is problematic for all therapies to determine whether they are effective or not. The criteria for effectiveness could be the reduction of medication needed, the return of the patient to work, satisfaction evaluated positively by the patient, etc.
The organization called Initiative of Methods, Measurement and Pain Assessment in Clinical Trials (IMMPACT) suggested to develop an integrated method and a unified evaluation system for the results of different methods used for clinical pain assessment. This unified evaluation system includes the interference regarding pain, the severity of pain, emotional reactions and other evaluations regarding the treatment as a basic variable. In general we can say that psychological treatment is not for patients for whom effective and fast medical treatment is available without considerable side effects. Although patients can participate in a program of psychological treatment regardless to weather an organic pathology that needs medical intervention is present or not. The psychological approach can be used not only for the treatment of 'psychogenetic' pain but also in case when the patient loses partly his/her capacity to cope with the chronic disease that have strictly organic cause.
In our presentation we are going to show that in case of chronic pain there are effective psychological treatment methods that have been properly proven to be effective(in compliance with the 2013/14 EBM criteria). We are also going to talk about psycho-education, supportive therapy, behavior therapy, cognitive behavior therapy (CBT), acceptance and commitment therapy, dynamic oriented therapies, biofeedback and relaxation therapy, hypnotherapy, guided imagery, art therapy and family therapy.
With the above mentioned methods we can effectively treat a wide range of diseases related to pain and achieve moderate and considerable improvement. At the end we are going to unfold open issues such as: The limits of indication of psychological treatments, which are the most effective components of the treatment and what kind of effect do the different treatments have on pain.

Speaker
Biography:

Karen Hensen has completed her Ph.D. at the age of 28 years from Leuven University, Belgium and Postdoctoral studies from University of Massachusetts Medical School, Worcester, USA. She is the PI of the laboratory of Experimental Hematology at the Jessa Hospital, one of the largest private hospitals in Belgium. She has published more than 25 papers in reputed journals. The primary focus of her work is the development of a cardiac stem cell therapy for patients with heart failure.

Abstract:

The current therapy for myocardial infarction (MI) is not sufficient since mortality after MI remains very high. Stem cell transplantation seems to be a promising future therapy to repair the heart, by replacing the lost cardiomyocytes. Previous clinical studies using bone marrow stem cells (BMSC) reported only minor improvement of cardiac function. Indeed, follow-up research demonstrated only a limited cardiomyogenic differentiation potential of BMSC. However, BMSC transplantation can be beneficial because these cells can promote cardiomyocyte survival through paracrine effects. Meanwhile, scientific focus shifted from BMSC towards cardiac stem cells (CSCs). These cells are probably better suited for cardiac repair, since they are most likely “pre-programmed” to become cardiomyocytes. Recently, our research group reported the existence of a new intrinsic cardiac stem cell (CSC) population, the cardiac atrial appendage stem cells (CASCs). These CASCs do possess in vitro a greater myocardial differentiation potential compared to the previously described c-kit+ CSCs or the cardiosphere-derived stem cells. In an in-vivo follow-up study of autologous CASCs transplantation in a Gottingen minipig MI model, we showed that CASCs are able to preserve cardiac function, while control animals developed progressive ventricular dilatation.
In conclusion, the identification of this new stem cell population opens interesting perspectives for cell therapies in patients with ischemic heart disease or heart failure. Currently, further research is performed to assess if CASCs can contribute to cardiac angiogenesis via both endothelial differentiation and paracrine mechanisms. Furthermore, we also investigate in detail whether the endogenous repair mechanism of the heart can be stimulated by identifying the signalling pathways involved in self-renewal, proliferation and differentiation of CASCs.

Speaker
Biography:

Anna Bogdanova studied chemistry at the Lenindrad State University in USSR followed by Ph.D. studies in experimental biophysics at the Humboldt University in Berlin (Germany) and post-doctoral studies in general physiology at the Universities of Turku (Finland) and the University of Zurich. She is an independent group leader and a Senior Lecturer (Privatdozent) at the Veterinary Department of the University of Zurich and a member of the Zurich Center for Integrative Human Physiology. She is a member of American Physiological Society, and an author of more than 40 papers in reputed journals.

Abstract:

Effects of the NMDA receptor antagonists memantine, ketamine, eliprodil and others on alteration of heart rate, rhythicity and conductive system have been reported to follow the action of these drugs on the central nervous system. The mechanisms of action of these drugs in the heart has never been studied in detail. We have monitored autonomous heart responses to the agonists and antagonists of the NMDA receptors in rat heart. Subunit composition of the receptors was characterized in four chambers rat and human myocardium using RT-PCR and immunoblotting. The number of active receptors in various regions of the heart was assessed by means of autoradiography. Pharmacological profile of myocardial NMDARs was investigated in rat and human heart using [3H]-MK-801 and [3H]-ifenprdil replacement approach. Finally, we have addressed the possible role of NMDA receptors in pathology. Local changes in expression and activity of the receptors associated with ageing, hypertrophic remodeling and volume/pressure overload was studied in rats and in myocardial samples from patients undergoing mitral valve replacement surgery. The anti-arrhythmic action of selected NMDA receptor antagonists was explored in rat and human heart. The obtained data reveal an important role cardiac NMDA receptors play in control of heart rate and rhythmicity. Alterations in expression and activity of the receptors in diseased heart make these receptors into the attractive pharmacological target.

Iraida G. Sharina

University of Texas Medical School at Houston, USA

Title: Alternative RNA splicing and regulation of nitric oxide signaling
Speaker
Biography:

Iraida G. Sharina has completed her Ph.D. in Molecular Biology from Russian Academy of Science. She had her postdoctoral training at UT-Health Science Center in Houston as part of the research team of Dr. Ferid Murad, a Nobel Prize winner and major leader in NO field of research. She is an Assistant Professor in Department of Internal Medicine, Division of Cardiology of UT-MS. She published more than 22 research papers in high impact journals. Her current research is focusing on understanding of the genetic basis of NO/cGMP signaling.

Abstract:

Alternative splicing expands transcriptome diversity and allows cells to meet the requirements of an ever-changing extracellular environment. It has been more than 30 years since nitric oxide (NO), a gaseous free radical, was recognized as a critical physiologic signaling molecule. Since then the list of known NO-directed functions has grown substantially and includes regulation of smooth muscle function in vascular and gastrointestinal systems, inhibition of platelet aggregation and adhesion, neurotransmission and neuromodulation, regulation of cellular respiration and cytotoxicity, mitochondrial biogenesis and immune defense. However, the importance of alternative splicing in regulation of enzymatic components of NO signaling pathway started to emerge only recently. Our understanding of the mechanisms governing this process still remains very limited and awaits systematic investigation. Multiple evidences accumulated from different laboratories suggest that splicing of enzymes in the NO/cGMP pathway, including nitric oxide synthases, heterodimeric soluble guanylyl cyclase and cGMP-dependent protein kinase, is very complex and strongly affects NO signaling in response to various environmental clues. New data from our laboratory demonstrate that the expression of individual splice forms of nitric oxide receptor soluble Guanylyl Cyclase varies in human healthy and diseased aortic tissue. Our research suggests a possible contribution of splicing to the impaired sGC function in vascular disorders and uncovers a potential diagnostic tool or biomarker and a target for new therapeutics. Future studies will certainly bring new exciting insights into the role that alternative splicing plays in NO/cGMP biology.

Speaker
Biography:

Jian-Xing Xu is currently working in National Laboratory of Biomacromolecule. Center for Molecular Biology, Institute of Biophysics, Chinese Academy of Sciences, China. He has 4 research papers in top journals

Abstract:

It was proved in our lab that the ATP production in mitochondria by the way of electron transfer of respiratory chain is always combined with the generation of O2-. and H2O2 through the electron leak pathways. There are four electron leak pathways in the mitochondrial respiratory chain. Two of the cytochrome c mediated pathways play as a protective role by the way of down regulating the level of O2-. and H2O2 in mitochondria. The third pathway is O2-. + H+→HOO●. It is a way in somehow related to maintain body temperature because the reaction of HOO● with the double allyl hydrogen atom of the unsaturated fatty acid is a heat producing reaction. How the third pathway related with obesity is unknown. The fourth pathway is O2-. + NO→ONOO-. The ONOO-could pass through the membrane when it combines with H+. Therefore the fourth pathway could make O2-. and NO transportation long-distance pass through membranes. The physiological roles of the four electron leak pathways are not well known yet but the level of electron leakage is always higher when animal in pathological condition or diseases and aging. The H2O2 as a product of electron leakage of respiratory chain may be more pathological significance as it has longer life-span to spread across membranes and it can be changed to more dangerous HO● when in the presence of iron. 1. Evidence for the pathological significance of electron leakage of respiratory chain: A week inhibitor (3-nitro-N-methyl amine) of complex I and II could decrease the electron leak of respiratory chain and also decrease the damage of ischemia reperfusion. This result proved that the explosive generation of ROS by the electron leakage of respiratory chain plays a key role in the damage of ischemia reperfusion. A strong radical scavenger (Salvianic acid A) decreases the generation of ROS in mitochondria and also protect the MPP+-induced damage in SH-SY5Y cells. This result indicates the pathological role of electron leakage of respiratory chain in disease. 2. The mitochondrial ROS play an important role in health and longevity: The ROS generated in the electron leak pathways of respiratory chain can be a dangerous factor causing oxidative damager and aging, but more important is that the ROS in mitochondria play as the signals to stimulate anti-oxidative function and the ability of damage repairing. The later is the theoretical base of human health and longevity. Pay attention to the physiological role of different pathways of respiratory chain is a new field of bioenergetics. 3. The physiological role of O2-. and NO in mitochondria: The fourth pathway of O2-. + NO→ONOO-indicates that the balance between O2-. and NO in mitochondria has an important role in controlling the rate of ATP production in different physiological conditions. It is well known that the NO can be bind to the oxygen reactive center of complex IV to reduce ATP production of mitochondria. Whereas the O2-. can release the bond NO to increase the ATP production of mitochondria. The ratio of O2-. and NO in mitochondria is an important factor to regulate ATP production of mitochondria. 4. The role of O2-. in the functional migration of cytochrome c: The functional role of cytochrome c is depending on its location in the mitochondria. It is producing ATP in the respiratory chain. It is a scavenger to dispose of O2-. and H2O2 in the space of mitochondrial membranes. It is a factor to stimulate cell apoptosis in cytosol out of mitochondria. A functional migration of cytochrome c during the life span of cell is performed following aging. The O2-. generated in the electron leakage of respiratory chain plays a key role in driving cytochrome c migrating. 5. Clinical use of coenzyme Q in cardiology diseases: A side effect of oral coenzyme Q is lead to stomach uncomfortable. To overcome this side effect a combined use of coenzyme Q with antioxidant was suggested based on the electron leakage of mitochondrial respiratory chain. A mixture of coenzyme Q with vitamin E and selenium is good for health and longevity according to the leaked electrons can fall in different locations of mitochondria.

Speaker
Biography:

M. Rizwan Sohail is an Assistant Professor of Medicine at Mayo Clinic College of Medicine. He has a joint appointment in the Divisions of Infectious Diseases and Cardiovascular Diseases. He has published over 50 papers in peer-reviewed medical journals. His ongoing research work is primarily funded by the American Heart Association.

Abstract:

Infection is a serious complication of Cardiovascular Implantable Electronic Device (CIED) therapy that necessitates removal of entire device and prolonged systemic antimicrobial therapy. Despite improvement in implantation techniques, rising volume of device implantation and widespread use of perioperative antibiotic prophylaxis, rate of CIED infection is rising. Cardiac device infections are associated with significant morbidity, mortality and financial cost. Majority of these device infections are caused by staphylococci. These organisms create a biofilm on device surface that leads to unique diagnostic and management challenges. Blood cultures should be obtained in all patients with suspected CIED infection and transesophageal echocardiography (TEE) should be pursued in those with evidence of bloodstream infection to look for any evidence of CIED-associated endocarditis. For patients with confirmed CIED infection, complete device removal should be arranged as soon as possible. CIED leads can be extracted in majority of patients with percutaneous approach. However, for patients with other indications for cardiac surgery, such as cardiac abscess or valve dehiscence, or presence of large (>3cm) CIED lead vegetation, cardiac surgery should be consulted for lead removal. Duration of antimicrobial therapy depends on clinical presentation of CIED infection, ranging from 2 weeks for simple pocket infection to up to 6 weeks for CIED associated endocarditis. Among patients with CIED pocket infection or uncomplicated bloodstream infection, a new device can be implanted once blood cultures are negative for at least 72 hours. However, for patients with CIED associated endocarditis, a delay of 2 weeks between removal of infected device and implantation of replacement device is recommended.

Speaker
Biography:

Harsha Kumar H. N. completed his MBBS in 2001 from Government Medical College, Karnataka State and Pursued MD (Community Medicine) from Manipal University, India. He is currently Associate Professor, Department of Community Medicine at Kasturba Medical College. He has about 32 research publications in reputed journals. He is a resource person for training in Research Methodology and Biostatistics. He has authored and obtained Indian Council of Medical Research (ICMR) Projects. He teaches preventive medicine, conducts outreach health clinics in rural areas and is in charge of research in Non-Communicable diseases. He is in-charge of implementing public health programs in Mangalore City.

Abstract:

Background: Basic Life Support is an important part of emergency medical care. This study is done among medical undergraduate students to know their knowledge and perceptions about BLS, as they are going to face such situations in future as doctors.
Materials & methods: A questionnaire-based study is conducted among 377 medical undergraduate students. The questionnaire included following parts: 1. Basic Characteristics of study participants, 2. Knowledge about BLS/CPR, 3. Perceptions about BLS/CPR. The Components of knowledge and perception based questions were scored. The data was analyzed using SPSS version 12. Results are expressed as proportions in appropriate tables and graphs. Student’s Independent ‘t’ test was used to compare means between students who had undergone previous training if any and those who had no such training.
Results: Out of 377 students, majority (84.6%) had heard of BLS/CPR. Some of them (30.6%) could give the correct order of performing CPR as per AHA guidelines 2010. Few (18.9%) had undergone prior training in BLS, whereas only 17.7% had been in a situation which needed BLS/CPR. Nearly half (50.2%) were not confident of performing BLS/CPR. Comparison of the students revealed that students who had training had higher mean scores for ‘response to a situation needing BLS/CPR’ and ‘signs of successful resuscitation’, though there was little difference in their knowledge of ‘indications for BLS/CPR’. Overall perception was not favorable.
Conclusions: The knowledge was inadequate. Training improved their knowledge but not the perception. They were neither comfortable nor confident to handle a situation which needed BLS/CPR.

Speaker
Biography:

Tamer Mohamed has completed his Ph.D. at the age of 30 years from University of Manchester, UK and held various Postdoctoral training at the University of Manchester, University of Glasgow, and University of Gottingen. He is currently conducting a collaborative research program between the University of Manchester and the J. David Gladstone Research Institute (UCSF) to identify novel therapies for heart failure. He has published more than 15 papers in reputed journals in the past 10 years and has been awarded several awards including the prestigious Young Investigator Award at the European Society of Cardiology Congress in 2010.

Abstract:

Identification of novel regulators of cardiac hypertrophy is key in understanding the mechanisms of heart failure. The plasma membrane calcium ATPase 4 (PMCA4) is a ubiquitously expressed Ca2+ pump that is involved in regulating calcium signaling in the heart. Here we investigated a novel role of PMCA4 in controlling myocardial hypertrophy.
We subjected mice with a global knockout of PMCA4 (PMCA4-/-) to transverse aortic constriction (TAC) for 5 weeks. PMCA4-/- mice exhibited a significantly reduced hypertrophic response compared with wild type (WT) mice. This was accompanied by less fibrosis and a lower expression of hypertrophic marker BNP. However, cardiomyocyte specific knockout of PMCA4 did not show any protective effect following TAC prompting us to hypothesize that the protective effect might be due to PMCA4 ablation in fibroblasts. Microarray analysis revealed a ~100 folds upregulation of secreted frizzled-related protein 2 (sFRP2) in PMCA4-/- fibroblasts. sFRP2 is a potent inhibitor of the Wnt/β-catenin pathway. To unravel the clinical relevance of our findings we developed a specific pharmacological inhibitor of PMCA4, which had not previously been available. Using a modified colorimetric ATPase assay we screened a library of medically optimized drug-like molecules and identified Aurintricarboxylic acid (ATA) which has an IC50 of 150 nM for PMCA4. Injection of ATA in mice (5 mg/kg body weight/day ip) treated the pre-established TAC-induced hypertrophy.
Overall, our results demonstrated that specific inhibition of PMCA4 prevents and reverses pressure-overload hypertrophy making the plasma membrane calcium pump a potential target for the treatment of cardiac hypertrophy.

Speaker
Biography:

Manuela Stoicescu was an Assistant Researcher of University of Cluj Napoca. She completed her Ph.D. in Internal medicine and now she is a Consultant Internal Medicine Physician, Assistant Professor at University of Oradea, Romania. She also works at Emergency Hospital Internal Medicine Department. She has published two books, one monograph and papers in reputed journals. The topic of the monograph is: "High blood pressure in the young- an ignored problem?!" and the topic of the books is: Clinical cases for students of the faculty of medicine in English and Romanian language. She was invited as a speaker at many national and International Conferences. She is a Member of Romanian Society of Internal Medicine, Cardiology, Medical Chemistry, Biochemistry and Balkan Society of Medicine. And she is an Editorial Board Member for Journal of Developing drugs-OMICS GROUP.

Abstract:

Objectives: The main reason for the presentation of this clinical case was to attract attention to the dangerous possible risks of coarctation of the aorta in pregnancy because it was not diagnosed early in the patient and not presented for consultation as the patient was asymptomatic before pregnancy.
Material and Methods: I present the clinical case of a young woman patient aged 26, who was six months pregnant and came for a consultation because she felt a headache, dizziness, and noises in the both ears. The value of the blood pressure was very increased BP=230/130mmHg. At the objective examination there was no detection of focal neurological signs. Heart sounds where rhythmic, rate heart=82 beats/min without extra sounds but with a proto mezzo systolic murmur heard in the aortic area grade III, without irradiation and the same a proto systolic murmur heard in the mitral area, grade II, without irradiation. Because the patient was pregnant these two murmurs heart with this characteristic was very difficult to interpret because in the context of pregnancy it is possible to exist innocent murmurs if heard does not necessarily suggest an organic lesion of the heart or a valve disease. The EKG shows sinus rhythm, rate heart=82 beats/min, unexpected left axis deviation and also left ventricular hypertrophy. The echocardiography showed left ventricular hypertrophy and an unknown coarctation of the aorta was discovered. The rest of the laboratory tests were within the normal range.
Results and discussions: The undiagnosed congenital heart disease in very early postpartum is very dangerous in pregnancy first because they are more difficult to diagnose in this condition because in pregnancy there exists an innocent heart murmur in this context and a congenital heart disease which develops an organic murmur heart it is possible to confuse them. Of course innocent heart murmurs have a few specials characteristics such as: low grades, no irradiation, appears at many foci and disappeared with the cause which produces it, but the differential diagnosis with an organic murmur heart remains difficult in pregnancy except the heart murmur with a very increase degree V or VI. The second risk is the complications which are possible to appear in the pregnancy with the mother and the baby in context of an unknown congenital heart disease. The high blood pressure was secondary in the context of coarctation of the aorta aggravated in pregnancy and was also possible to be interpreted only in context of pregnancy. I want to mention that the patient was asymptomatic before pregnancy and was not presented at the consultation for this reason.

Speaker
Biography:

Daniel Peter Stoll is a Psychologist, clinical Psychologist Candidate, Ph.D. student and also the Deputy Head of the Psychotherapy Department of the National Centre for Spinal Disorders Hungary. His special interest is in bio-psycho-social evaluation of surgery candidates, also screening process engineering. The field of his doctoral study is the psychodynamic approach of chronic pain. Besides scientific work he is involved in daily patient care and experienced in clinical hypnotherapy and psychotherapy.

Abstract:

Psychosocial factors play undoubtedly important role in the development of cardiovascular diseases and also can highly affect the outcome of cardiac treatment efficacy or the success of rehabilitation.
These factors are shown as having two mayor roles in patient evaluation:
1. Risk factors are important in prognosis
2. Indicators of need for further specific psychological interventions.
According to the literature depression, severe anxiety and other psychosocial characteristics behave as risk factor, such as low socio-economic status, chronic family or work related stress, social isolation or lack of support, negative emotions, affective dysregulation and also negative personality patterns or hostility. Identifying and examining these factors have great potential in multidisciplinary patient care, by highlighting adverse outcome possibilities, and providing clinical solutions since many of the risk factors are treatable psychological conditions.
This presentation shows the important role psychologists can play in biopsychosocial assessment of patients who are candidates for medical treatments or cardiac surgery. The main aspects and benefits of cardiovascular patient evaluation and specific aimed interventions will be introduced, according to systematic review of the literature and clinical experiences.

Speaker
Biography:

Affan Irfan is currently a third year internal medicine resident at University of Illinois - Urbana Champaign, Illinois, USA. He graduated from Aga Khan University Medical College, Pakistan in 2008 and then worked as Postdoctoral Research Fellow in Department of Medicine and Cardiology at University Hospital Basel, Switzerland. He will pursue cardiovascular fellowship after his internal medicine graduation in June 2014.

Abstract:

A 63 year old male presented with acute right side weakness and dysarthria consistent with cerebrovascular accident. Prior history was significant for heart failure and hypertension. EKG showed atrial flutter with left bundle branch block. He received thrombolytic therapy which resolved his symptoms completely. TEE showed severe concentric hypertrophy with moderate to severely reduced LV function, EF of 35%. Right ventricular function was severely hypokinetic. Echo also showed moderate biatrial enlargement, thickened inter-atrial septum, and left atrial appendage thrombus. Thrombus was also noted below the tricuspid and mitral valves. The posterior mitral leaflet was immobile and there was trace mitral, tricuspid and moderate aortic regurgitation. Patient was started on anticoagulation, beta blockers, ACEI, aldosterone antagonist and diuretic. Cardiac catheterization did not show any significant obstructive coronary artery disease suggesting non-ischemic cardiomyopathy. Patient subsequently underwent a biventricular-ICD placement. Serial TEEs showed persistent left atrial thrombus despite therapeutic anticoagulation for 3 months. Based on echocardiographic findings there was concern for cardiac amyloidosis. However, serum and urine protein electrophoresis as well as abdominal fat pad biopsy were negative for amyloidosis. Due to strong clinical suspicion, myocardial biopsy was done which was consistent with cardiac amyloidosis suggesting isolated cardiac involvement. Patient was referred to tertiary care center for further treatment. This case illustrates the importance of pursuing a cardiac biopsy in cases with strong clinical suspicion even if hematological work up and fat pad biopsy are negative.