Day 1 :
Keynote Forum
S Jamal Mustafa
West Virginia University, USA
Keynote: Coronary flow regulation and it’s signaling by adenosine
Time : 09:00-10:00
Biography:
S Jamal Mustafa is a Professor of Pharmacology at West Virginia University School of Medicine and a Senior Advisor to the Pilot Core of the West Virginia Clinical Science and Translational Institute. He has served as an Assistant Dean for Research at the Health Sciences Center from 2005-15. He has received Dean’s
Award for Excellence in Research from School of Medicine in 2008 and became a Robert C Byrd Professor in 2010. In addition, he received Chancellor’s Award for Outstanding Achievement in Research and Scholarly Activities from Health Sciences Center in 2013. He had published over 200 manuscripts. For almost 40 years, he had been studying the role of adenosine receptors in coronary flow regulation and it is signaling in coronary smooth muscle and endothelial cells from various species including human. He and his teams past work has led to the approval of a selective A2A adenosine receptor agonist (Lexican®) for myocardial perfusion imaging. Currently he and his team are using adenosine receptor and beta-adrenergic receptor knockout mice to understand the relationship between these receptors in coronary flow regulation leading to treatment of coronary artery disease.
Abstract:
Adenosine acts through its receptors (A1, A2A, A2B and A3) via G-proteins and causes an increase in Coronary Flow (CF) mostly through A2A AR. However, the role of other ARs in the modulation of CF is not well understood. Using Knock Outs (KO), we investigated the role for each AR in the regulation of CF. Using the isolated heart from A3 KO mice; we reported an increase in A2A-mediated CF. Similarly, we found an increase in CF in A1 KO mice with A2A agonist (CGS- 21680; CGS). In addition, in A2A KO mice response to CGS was abolished, thus confirming the KO. On the other hand, A2A KO mice showed a decrease in CF to NECA (non-selective agonist). BAY60-6583 (A2B selective agonist; BAY) was without an effect on CF in A2B KO mice; however, it increased CF significantly in A2A KO. CGS also caused a significant increase in CF in A2B KO mice. In addition, exogenous adenosine-induced increase in CF in wild type, A2A KO and A2B KO mice were significantly reduced with catalase. BAY-induced increase in CF in WT was significantly inhibited with Glibenclamide. Overall, our data support stimulatory roles for A2A and A2B and inhibitory roles for A1 and A3 in the regulation of CF. These observations provide new evidence for the presence of all four ARs in CF regulation. We propose that, activation of A2A/B may release H2O2 which then activates KATP channels, leading to vasodilation. These studies may lead to the better understanding of the role of ARs in coronary disease and better therapeutic approaches.
Keynote Forum
Brajesh Mittal
Garhoud Private Hospital, UAE
Keynote: Stent blockage: Different shades of grey
Time : 10:00-11:00
Biography:
Currently Brajesh Mittal is working as Consultant Interventional Cardiologist and Head of Cardiology Department at Garhoud Private Hospital, Dubai. He is the Chairman of SCALE- “Stemi Care for All in Emirates” and CME Committee and Garhoud Hospital. His main area of interest is complex coronary and primary angioplasty. He has several publications and presentations at national and international level and is a regular participant as Faculty at large forums incl. European Society of Hypertension, Euro PCR, Arab Health, Emirates Cardiac Society, National Interventional Council India and Cardiology Society of India
Abstract:
Stent blockage has and estimated incidence of 1-5%. It is multifactorial nature and may have devastating consequences viz. AC myocardial infarction/sudden cardiac death, case fatality rate can be as high as 45%. It is prudent to identify those at high risk and should have a clear aim to minimize occurrence. There are several predictors of stent thrombosis and are related to 3 groups: patient, lesion and procedure. Among the most important ones are antiplatelet non-responsiveness, noncompliance or premature cessation. Long lesions/small vessels; stent under expansion. Strongest factors are: Discontinuation OR Dual Antiplatelet Therapy (DAPT), stent under sizing, intermediate lesion proximal to stent, concomitant malignancy, and acute coronary syndrome. Overall early ST >>late ST (>70%). Drug eluting stents also carry the risk of more frequent Very Late Stent Thrombosis (VLST). Underlying pathology depends upon the timing of stent occlusion; while acute and subacute stent occlusion is predominantly thrombotic, later occlusions are more of neo-atherosclerosis. A good mix is being underlying neo-atherosclerosis, thin cap fibroatheroma and thrombus on top. DAPT compliance and procedural optimization are the two most important areas of attention for all the interventional cardiologists to minimize and avoid this potentially devastating complication.
- Clinical Cardiology| Cardiac Surgery | Rehabilitation of Cardiovascular Diseases and Healthcare | Interventional cardiology | Cardiac Diseases
Location: Conference Hall 1
Chair
Yassmin Hanfi
King Fahad Armed Forces Hospital, Saudi Arabia
Session Introduction
Yassmin Hanfi
King Fahad Armed Forces Hospital, Saudi Arabia
Title: Double-chambered left ventricle and abnormal papillary muscle formation
Time : 11:30-12:05
Biography:
Yassmin Hanfi is a Consultant Cardiologist specialized in Advanced Cardiac Imaging (TTE, TEE, CCTA, CMR). Her cardiac training was in Paris with advanced international cardiac teams followed by subspecialty in London at the Royal Brompton Hospital. Her specialty of cardiac imaging is an everyday practice for cardiologist and health care practitioner.
Abstract:
Papillary muscles develop separately from mitral valve leaflet and chordae. Where papillary muscles origin from myocardial
ridge of the anterior wall and to the posterior wall of the left ventricle, chordae and mitral valve leaflets origin from a cushion tissue. The myocardial ridge gradually loosens from the ventricular wall and meanwhile the cushion tissue transforms into leaflet and chordae. Abnormality in the development of papillary muscle could be responsible of a rare form of double chamber LV. The double chamber LV can be mis-diagnosed as aneurysm or rupture LV. Identification of such form of double chamber LV would have an impact for the patient management care. Here is a case report of double chamber LV with variable presentation as previously published. Case report 17 years old male patient with a recent history of palpitation not related to exertion. Normal ECG findings. A trans-thoracic echocardiogram revealed mildly dilated left ventricle with abnormal trabeculated appearance and papillary muscle apparatus forming double chamber LV with mild obstruction. Cardiovascular Magnetic Resonance (CMR) cine images showed a well formed compacted myocardial layer with normal systolic thickening excluding the LV non-compaction pathology. Although confirmed an anomalous muscular bridge opposite to the normally formed Anterolateral (AL) papillary muscle causing partial division of the LV in two chambers without significant obstruction at rest (Panels A, B, D). Peak recorded velocity <1 m/s by velocity mapping at rest (Panel E). While the posteromedial papillary
muscle is abnormally hypoplastic and heavily fragmented (Panels G, H). The mitral valve found to be with mild bellowing of its anterior leaflet with no significant regurgitation. Late gadolinium enhancement phase at the abnormally hypoplastic posteromedian papillary muscle.
Mohammed Takroni
King Faisal Specialist Hospital and Research Center, Saudi Arabia
Title: The effectiveness of a home-based cardiac rehabilitation program using individualized exercise (physiotools-R) compared to hospital-based cardiac rehabilitation programs and standard care on the exercise capacity, psychological well-being and quality of life of CHD patients post-CABG surgery
Time : 12:05-12:40
Biography:
Mohammed Abdullah Takroni a cardiac rehabilitation specialist graduated from king Saud University at 1992 with a bachelor degree in physical therapy, in Fellowship program in cardiopulmonary rehabilitation at Duke University and Medical (DUMC), North Carolina, USA, 1996. Master degree in physical therapy from King Saud University 2008, and also Master degree in sport medicine and rehabilitation, Manchester Metropolitan University (MMU), United Kingdom, 2009. PhD, in Cardiovascular and pulmonary Rehabilitation, Glasgow Caledonian University, Glasgow, UK, 2011. Member of the American Association of Cardiovascular and pulmonary Rehabilitation (AACVPR), member of the Irish Association of cardiopulmonary rehabilitation (IACR), member of the British Association for Cardiovascular Prevention and Rehabilitation (BACPR), member of Saudi Heart Association (SHA). Develop the Cardiac Rehabilitation programs at King Faisal specialist hospital and research center (KFSH&RC), Riyadh, Saudi Arabia. Innovated the Vascular, Pulmonary, and post open-heart surgery and heart transplantation protocols which
are applied now in most of the Cardiac centers in Riyadh and around the kingdom. Participate in several symposiums, local and international. Presented several lectures and study days inside an outside the kingdom as cardiac rehabilitation specialist, Currently, head section of cardiac rehab team king Faisal Heart Institute, king Faisal specialist hospital and research center, and the inpatient supervisor, physical therapy department.
Abstract:
Background: Saudi Arabia is facing significantly increased mortality rate from Cardio Vascular Diseases (CVDs). Studies
have reported that participation in Phase III cardiac rehabilitation (CR) program is associated with a reduction in morbidity and mortality for patients following CABG. Currently, there is no phase III provision of CR for coronary heart disease (CHD) patients in the KSA (King Saudi Arabia).
Aim: To evaluate the effectiveness of home CR program using individualized exercise (physiotools-R) compared to a phase III
hospital CR program and standard care with home instructions on the exercise capacity, psychological well-being, physiology,
body composition and quality of life of CHD patients after CABG surgery.
Method: A total of 73 eligible participants were recruited from the King Faisal Heart Institute (KFHI), in Riyadh. All the
participants had CHD and were 6-8 weeks post-CABG surgery. Participants were randomly assigned to one of three groups: A
hospital CR group (n=25), a home CR group (n=24) and a control group (n=24). Measurements were at baseline post 8 weeks of CR intervention and then again after 4 weeks of observation. Hospital CR program of group based aerobic circuit training and a similar structured individualized exercise program using physiotools-R were used as intervention groups for 8 weeks, three times a week for two hours per session, then four weeks of observation as follow up. The control group followed standard care which comprised home instructions about self-walking and post-operation precautions.
Result: The ISWT (incremental shuttle walking test) distance is clinically improved after in both intervention groups compared
to baseline p<0.001. However, after four weeks of observation follow up, the ISWT distance of the hospital group decreased, but unpredictably, it continued to improve in the home group p<0.001. No significant change was reported in the control group p>0.05. Similarly, all outcome measures: METs (measurement of exercise tolerance), HADS-A (hospital anxiety and depression scale-A), HADS-D (hospital anxiety and depression scale-D), PCS (population cohort study) and MCS (mechanical circulatory support) showed statistically significant improvement post-CR intervention p<0.001.
Conclusion: The findings confirm that home CR using an individualized exercise has similar or possibly even better, effects in comparison to hospital-based Phase III CR in improving the exercise capacity, psychology, quality of life and body composition of CHD patients post-CABG surgery. Therefore, applying a home CR program for patients in remote areas will reduce the rehospitalization rate and will contribute to improving the quality of life of those patients. Continuous improvement of the home group post follow up was the challenge.
Olivier Jegaden
Mediclinic Airport Road Hospital, UAE
Title: Minimally invasive cardiac surgery-Where do we stand?
Time : 12:40-13:15
Biography:
Olivier Jegaden is a Professor of Cardiac Surgery & the Head of the department at CHU of Lyon in France. He joined the Cleveland Clinic Abu Dhabi and is the Professor of Surgery in the Cleveland Clinic Lerner College of Medicine of Case Western Reserve University in Ohio, USA. he is currently working at Mediclinic Airport Road Hospital, UAE. He is an expert in total arterial revascularization for coronary disease, minimally invasive valve repair and transcatheter valve replacement.
Abstract:
Recognition of the significant advantages of minimizing surgical approach has resulted in a substantial increase in the
number of minimally invasive cardiac surgical procedures being performed. Synchronously, technological advances in
optics, instrumentation and perfusion technology have facilitated its adoption rate. This technology has been applied to many cardiac surgical procedures mitral valve repair, aortic valve replacement and coronary artery bypass grafting in 1 or 2-vessel disease patients. Meta-analyses and propensity matched comparisons have demonstrated the non-inferiority of minimally invasive cardiac surgery in low or intermediate risk patients. However, in advanced cardiac disease, these new surgical standards are not less invasive enough to reduce the cardiac risk of the procedure or the negative impact of the comorbidity factors, and it has opened the way of transcatheter techniques. The place of each option is presented and discussed.
Shyam K Ashok
Aster Ramesh Group of Hospitals, India
Title: CABG in diffuse coronary artery disease
Time : 14:15-14:50
Biography:
Shyam Krishnan Ashok has completed his MBBS and then MS in General Surgery, he did his MCH in CVTS from Seth GS Medical College, Mumbai, India. He later joined Narayana Hrudayalaya, Bangalore, India. He has worked as a Fellow in Adult Cardiothoracic Department in Royal Melbourne Hospital, Australia. His area of interest is coronary artery bypass, especially total arterial revascularization. He is currently working at Aster CMI Hospital as Consultant Cardiothoracic Surgeon.
Abstract:
Statement of the Problem: In India 2.78 million deaths are due to cardiovascular diseases of which 50% are due to CAD.
Peculiarities of CAD patterns in Indian patients-Younger age at presentation, high incidence of DVD and TVD, diffuse
involvement, distal disease and significant LV dysfunction at presentation. Diffuse CAD has the length of significant stenosis >20 mm, multiple significant stenosis (>70% narrowing) in the same artery separated by segment of apparently normal vessel and significant narrowing involving the whole length of coronary artery.
Method: We perform OP CAB and use LIMA and veins as conduits to perform the surgery. Once the conduits are harvested, we heparinize with IV Heparin 3 mg/Kg given to achieve an ACT>300. Using the octopus as stabilizer, we perform an endarterectomy of the LAD first and then use a vein patch to cover the defect. LIMA is then used to anastomose the LAD on the vein patch. Veins are used to bypass the LCX and RCA, as deemed appropriate. The proximal ends of the vein grafts are anastomosed to ascending aorta with side clamp and heart beating. Intra OP we start Lomodex infusion 20 ml/hr which is continued for 24 hours and the inotropes used are Adrenaline and Dobutamine as and when necessary. Post-operatively Aspirin 75 mg is given and Heparin infusion started after 6 hours to maintain ACT of around 150 for 24 hours. Patients are usually extubated after 4 hours provided they are hemodynamically stable. Anticoagulation by Acitrom is commenced orally from day 1 to maintain an INR of 2 for 3 months.
Result: Out of the 20 patients in last 18 months outcomes have been excellent with no in-hospital mortality or cerebrovascular
incidents.
Conclusion: Off pump CABG with coronary endarterectomy offers a good solution to the problem of diffuse coronary artery disease.
Elena Leonova
Federal Central Tuberculosis Research Institute, Russia
Title: Factors associated with right ventricular dysfunction among patients with pulmonary sarcoidosis
Time : 14:50-15:25
Biography:
Elena Leonova is a PhD researcher from the Department of Differential Diagnosis of Interstitial Lung Diseases and Extracorporeal Therapeutic Methods, Federal Central Tuberculosis Research Institute. She had her researches on cardiovascular problems among patients with interstitial lung diseases. Along with the research work and teaching activities, she is actively engaged in medical practice.
Abstract:
Background & Aim: Arterial Stiffness (AS) is one of the most potent prognostic factors of cardiovascular morbidity and
mortality. Obesity has many effects on cardiovascular structure, function and hemodynamics. Effects of AS and Body Mass
Index (BMI) on the Right Ventricle (RV) function among patients with Pulmonary Sarcoidosis (PS) are unknown. The aim is to investigate the RV systolic dysfunction by several echocardiographic parameters among patients with PS and determine how it is associated with AS and BMI.
Method: We identified 82 patients with biopsy-proven pulmonary sarcoidosis, who underwent echocardiography, spirometry, Diffusing Capacity of Carbon Monoxide (DLCO), plethysmography. Pulmonary High Resolution Computed Tomography (HRCT) was assessed by Kazerooni scale (ground-glass and fibrosis). Aortic Pulse Wave Velocity (PWV), BMI were evaluated. RV systolic function was assessed among all subjects using different methods (Tricuspid Annular Plane Systolic Excursion (TAPSE), RV myocardial Performance Index (MPI) and RV systolic excursion velocity by tissue Doppler (S’)).
Result: RV systolic dysfunction was found in 17% of subjects by TAPSE, 19.5% by RV MPI and S’. All parameters of RV systolic
function correlated with DLCO (p<0.01), total lung capacity (p<0.001), HRCT, PWV (p<0.01). In multivariate regression
analysis the factors associated with RV systolic dysfunction were the PWV (p=0.006), HRCT (p=0.001).
Conclusion: The systolic function of the RV is associated with lungs involving and arterial stiffness. BMI has not shown any
correlation with RV systolic dysfunction.
Nahid El Faquir
Erasmus University Medical Center, Netherlands
Title: The role of contact pressure in the development of conduction abnormalities after TAVI: A patient specific computer simulation analysis
Time : 15:25-16:00
Biography:
Nahid El Faquir is a Research Fellow in Interventional Cardiology at the Erasmus University Medical Center, Rotterdam, Netherlands. She has received her MD degree from the Erasmus University. Her main research interest is interventions in structural heart disease.
Abstract:
Statement of the Problem: Conduction abnormalities after Transcatheter Aortic Valve Implantation (TAVI) still occur while indications for TAVI expand to younger and lower risk patients. The role of contact pressure generated by the valve frame in the development of conduction abnormalities post TAVI remains unknown.
Method: A European multi-center study was conducted including 112 patients with severe aortic valve stenosis who had undergone a pre-procedural CT and was treated
by a self-expanding valve. A patient specific region of the aortic root containing the atrioventricular conduction pathway was selected on CT based on the inferior border of the membranous septum. Computer simulation analysis was performed in all cases to quantify contact pressure and contact pressure index (percentage of area subjected to pressure) in the region of interest.
Findings: 62 patients (55%) developed new conduction abnormalities. Maximum contact pressure and contact pressure index (median [IQR]) were significantly higher in patients with new conduction abnormalities (0.51 MPa [0.43-0.70] and (33% [22-44]) compared to patients without (0.29 MPa [0.06-0.50] and 12% [1-28]) (Fig. 1A). Multivariable analysis showed that maximum contact pressure and contact pressure index were independently associated with the occurrence of new conduction abnormalities (p=0.01). By ROC analysis a cut-off
value was determined for maximum contact pressure and contact pressure index consisting of respectively 0.39 MPa and 14% (Fig. 1B).
Conclusion: Patient-specific computer simulation showed that maximum contact pressure and contact pressure index was
associated with new conduction abnormalities after TAVI. Patient-specific computer simulation may have an added value in TAVI planning.
Essam Hamed Amin Ali
Total Quality Management Consultant, UAE
Title: Quality management in the heart catheterization laboratory
Time : 16:00-16:35
Biography:
Essam Hamed Amin Ali is a Professional with Quality Management and Hospital Management, planning and interpersonal skills. He has completed his Doctorate degree in Business Administration in Quality Management, USA; MS in Quality Management System from the University of Wollongong, Australia and Bachelor of Medicine from Cairo University, Cairo, Egypt in 1991. He is a Member of Medical Education Committee, Ministry of Health, Abu Dhabi, UAE. His areas of expertise includes total quality management; ISO standards, EFQM model, JCI standard, strategic planning, operations management, medical staff relations, quality assurance, change management, cross cultural management, continuous quality improvement, trainer and consultancy for joint commission international on accreditation of healthcare organizations.
Abstract:
The role of the cardiac catheterization laboratory has progressed from study of cardiac function and anatomy for purposes of diagnosis to evaluation of candidates for surgery and finally to providing catheter-based, non-surgical interventional treatment. Quality management within the catheterization laboratory includes the quality control, the heart catheterization technique and the policy. Quality management is critical in the heart catheterization laboratory. The purpose of the best practices statement is to ensure patient safety, cath lab efficiency, the referring physician and patient’s satisfaction. A continued quality improvement program is patient-orientated and requires good planning. One of the main emphases in the catheterization lab is the standardization which includes the patient preparation, the procedure itself and the management. The hospital should provide the necessary resources to implement best practices through adequate staffing, equipment and information technology, in order to assure the performance of these practices and encourage ongoing review. A continuous circle of treatment planes, performance and check is regarded as the Deming cycle and leads to continuous improvement of quality. Important are both the avoidance and detection of complications. It is recommended to follow the zero mistake hypothesis of Crosby, which means quality control by the lab supervisor, a quality consciousness, a quality measurement and quality improvement, as well as using a day to day quality improvement and to teach quality control. In order to provide the safest, highest quality patient care in the cath lab, it is essential to have a comprehensive quality control program in place. Quality Control (QC) verifies that equipment and products are meeting the recommended manufacturers’ standards and they are performing at the necessary level to provide safe and effective delivery of care. It also ensures that the necessary supplies are available to provide patient care. Regular QC and maintenance extends equipment life and allows its use to be at peak efficiency. In order to develop and
maintain a high-caliber QC program, there needs to be collaborative effort between: (1) Product vendors and manufacturers, (2) regulatory agencies such as the joint commission, point-of-care testing, (3) biomedical maintenance, (4) staff development, (5) the cardiac cath lab staff and (6) other vested parties. By utilizing all available resources, a comprehensive QC program can be designed, maintained and upgraded as necessary.
- Clinical Cardiology| Neonatal Cardiology | Cardiac Nursing | Hypertension | Heart failure | Echocardiography | Clinical Case Reports on Cardiology
Location: Conference Hall 1
Chair
Ahmed Mohammed Samman
Ministry of Health, Saudi Arabia
Session Introduction
Ahmed Mohammed Samman
Ministry of Health, Saudi Arabia
Title: The role of advanced cardiac imaging is diagnosis of complex adult’s congenital heart disease
Time : 11:30-12:05
Biography:
He worked in Arab Board Internal medicine in – (KFSH) King Faisal Specialist hospital –Riyadh-Saudi Arabia from 1996 to 2001 and he has Canadian Fellowship in Cardiology- (UBC) - university of British Columbia (2001-2004), Canadian Fellowship in Adult Congenital cardiology- (UOT) University Of Toronto (2004-2005), Canadian Fellowship in Adult Echocardiography – (UOT) University Of Toronto (2005-2006), Canadian Fellowship in Cardiac Magnetic Resonance - (UOC) University Of Calgary (2006-2007) and American College of Cardiology (ACC) - Cardiac CT angiography Training –(Riyadh May-2010). He is currently working as
supervisor of cardiac services in Jeddah, dedicated for the establishment of cardiac services pathways including Cardiac Imaging and ACHD.
Abstract:
Background: The recent improvements in non-invasive, cross-sectional cardiovascular imaging modalities (MR and CT) have
resulted in a change in our approach to the assessment and follow up of patients with Congenital Heart Disease (CHD).
Currently, clinical practice is to use echocardiography in all cases of CHD. However, echocardiography can be technically
difficult to perform, providing sub-optimal imaging. In these situations, we use cardiovascular MR to further define CHD
anatomy and physiology. This is particularly important prior to and following corrective surgical and interventional procedures.
Method: Sequential segmental analysis is illustrated using different cases from adults with CHD. Cardiovascular MR is critical to the non-invasive assessment of ventricular/valvular function and blood flow through haemodynamically significant lesions and shunts. We specifically use MDCT in the initial diagnostic assessment of great vessel anatomy in young patients, especially in circumstances where functional information is not required. Finally, the use of cardiac catheterization/angiography if haemo-dynamic information is required (pulmonary vascular resistance studies) or if there is a high degree of suspicion of coronary artery abnormalities.
Conclusion: This approach can improve non-invasive diagnosis and reveal detailed anatomy that is important for both clinical
decision-making and surgical planning of adults with CHD.
Samah Salah Alasrawi
AlJalila Children`s Hospital,UAE
Title: Cardiovascular hemodynamics assessment in children
Time : 12:05-12:40
Biography:
Samah Salah Alasrawi is a Pediatric Cardiologist at Al Jalila Children’s Specialty Hospital. She has completed her Bachelor’s degree and Master’s degree in Pediatric Cardiology from Damascus University, Syria. She has clinical and research interests in congenital heart diseases, pulmonary hypertension, cardiomyopathies and arrhythmias in children.
Abstract:
Objective: To know how we can assist the cardiac hemodynamics, what we measure: Intra cardiac pressures. What we calculate: Cardiac output, Qp (pulmonary blood flow), Qs (systemic blood flow), PVR (Pulmonary vascular resistance), SVR (systemic vascular resistance), Ejection Fraction, RVSP (Right ventricle systolic pressure), PAP (Pulmonary Artery Pressure). Obtaining accurate hemodynamics requires careful attention to detail, Calculation of cardiac output has many potential sources of error, limit assumptions as much as possible. Valuable information about disease states can be obtained with basic diagnostic catheterization and good Echo.
Kashif Bin Naeem
Al Baraha Hospital, UAE
Title: Role of R-R interval variation study in the diagnosis of Cardiac Autonomic Neuropathy (CAN) in patients with Diabetes Mellitus (DM) in the Middle East population
Time : 12:40-13:15
Biography:
Kashif Bin Naeem is currently working as a Specialist (Non-invasive) Cardiologist at Al Baraha Hospital, Dubai, Ministry of Health and Prevention, UAE. He has completed his Residency in Internal Medicine from London in 2007 and was awarded MRCP, UK. He has recently been awarded CESR (CCT equivalent) Certification in Cardiology, UK. He also holds Diplomate Certification in Comprehensive Echocardiography, NBE, USA. He is an active researcher and has several publications as well as abstracts in international meetings. He is the current Member of Dubai Research and Ethics Committee.
Abstract:
Introduction & Aim: Cardiac Autonomic Neuropathy (CAN) is a serious and common complication of diabetes. Meta-analyses of published data demonstrate that reduced cardiovascular autonomic function as measured by Heart Rate Variability (HRV) is strongly (i.e. relative risk is doubled) associated with an increased risk of silent myocardial ischemia and mortality. Despite its relationship to an increased risk of cardiovascular mortality and its association with multiple symptoms and impairments, the significance of CAN has not been fully appreciated and not studied in the Middle East population. Hence, we conducted a study to measure the HRV by R-R interval variability in diabetic patients to determine the incidence of autonomic neuropathy.
Method: A prospective analysis of 37 patients fulfilling the criteria for diagnosis of diabetes mellitus with/without neuropathic/ autonomic symptoms was performed between Jan 2017 and Oct 2017. We followed a protocol where R-R interval variation and Sympathetic Skin Response (SSR) were studied in all patients. R-R interval variation was studied during (1) deep breathing (at rate of 6/min), (2) breath holding for 15 seconds and (3) standing. The coefficient of variation of RR interval during the procedure were studied for all the 3 above mentioned manoeuvers while the ratio of R-R interval maximum to R-R interval minimum was studied for procedures of deep breathing and breath holding only. Additionally, the ratio of the 30th:15th R-R interval was analyzed during standing only.
Result: Autonomic studies were performed in 37 diabetic patients. 70.2% (26/37) had abnormal study. HRV abnormality was found in 69.7% (23/33) of the patients. SSR abnormality was found in 35% of the patients (8/23). In diabetic patients without clinical features of sensory, motor or autonomic involvement, autonomic study abnormality was found in 80% (8/10). HRV abnormality was detected in 70% (7/10) and SSR abnormality in 12.5% (1/8). Among diabetic patients with features of autonomic neuropathy, 70% (7/10) had abnormal study. HRV abnormality was detected in 66.7% (6/9) and SSR abnormality in 33.3% (3/9). Among symptomatic (motor/ sensory) diabetic patients without autonomic symptoms, 72% (13/18) had abnormal study. HRV abnormality was found in 70.6% (12/17) and SSR study abnormality in 41.2% (07/17). Among patients with HRV abnormalities, the abnormalities were detected in 11.5% (3/26) on deep breathing, 46.2% (12/26) on Valsalva maneuver and 69.2% (18/26) on standing (30th:15th R-R interval).
Conclusion: Cardiac autonomic involvement in DM is common (70.2%) as detected by our study, even in patients without clinical evidence of sensory/motor neuropathy (80% detected in our study) or autonomic neuropathy (72%). However, patients with clinical autonomic manifestations are associated with more incidence of electrophysiological abnormality (70%). R-R interval variation study is more sensitive (70%) than the sympathetic skin response study (35%). Among the maneuvers for measurements for R-R interval variation, abnormalities are detected more in standing compared to deep breathing and Valsalva.
Mujeeb A M
Kerala Institute of Medical Sciences, India
Title: Renal failure: The worse scenario in heart failure
Time : 14:15-14:50
Biography:
Mujeeb A M has obtained his MD degree from Irkutsk State Medical University, Russia. He has worked as a Medical Officer for 4 years in various hospitals. He has completed his Post Graduate Diploma in Clinical Cardiology. He has worked as Clinical Cardiologist in Kerala, India. He is currently working as Clinical Cardiologist in National Cardiac Centre, IGMH Male, Maldives. He is also a PhD Fellow in Cardiology from Irkutsk State Medical University.
Abstract:
Introduction & Aim: Renal impairment is a common and independent risk factor for morbidity and mortality in patients with heart failure. In this study we have analyzed the outcome of patients with a combination of heart failure with renal failure. Here we have analyzed the co morbid factors, readmissions and mortality of patients with heart failure with normal and abnormal renal function.
Method: This prospective observational study was conducted in the Kerala Institute of Medical Sciences, over a period of 2 years from 1st June 2012. All patients who have admitted in the cardiac care unit with signs and symptoms of heart failure (NYHA class 3 or 4) irrespective of etiology were selected. These patients belonged to coronary artery disease, valvular heart diseases, cardiomyopathies, congenital heart diseases and cor pulmonale. From the 287 heart failure patients 124 patients had renal failure. Renal parameters were assessed by renal function tests and by calculating GFR. Cardiac functions were assessed clinically and echocardiographically.
Result: These 287 patients were sub-divided into two groups, 124 patients had a combination of Heart Failure and Renal Failure (HFRF) and 163 Heart Failure Patients with Normal Renal Function (HFNRF). Renal failure patients were elder than the other group. The mean age of patients with normal and abnormal renal function were 62(11) years and 66 (9) years respectively. Co-morbid factors were more with HFRF patients. Diabetes mellitus in HFRF patients were 76.6% (n=95) compared to 58.3% (n=95) in HFNRF patients (p- .001). Hypertension was found in 66.1 % (n=82) in HFRF patients and 51.5% (n=84) in the other group (p-0.013). Anemia was found in 64.5% (n=80) and 36.8% (n=60) of patients with HFRF and with HFNRF respectively (p<0.0001). We followed the patients for two years. Recurrent admissions and mortality were more in HFRF patients. There were 87.9% (n=108) of patients readmitted in the HFRF group, but only 44.1% (n=72) required readmission in HFNRF patients (p- .001). There were 53.2% (n=66) of patients were expired in HFRF patients compared to 25.7% (n=42) in HFNRF patients (p<0.000).
Conclusion: Heart failure itself is a morbid condition with bad prognosis and the mortality is very high. This condition became worse when these patients develop renal failure. In our study we found that the co morbidities, recurrent admission and mortality were more in renal failure patients. Heart failure with renal failure is a bad combination; these patients should be
monitored.
Yagoub Musa
Alshaab Teaching Hospital, Sudan
Title: Frequency and cause of acute decompensation and hospital re-admission in patients with chronic heart failure (ADHF- Sudan)
Time : 09:00-09:35
Biography:
Yagoub Musa is the Fellow of the Royal College of Physicians of London and Fellow of the Heart Failure Association of the ESC. He is a Consultant Cardiologist trained in Interventional Cardiology at the NHCS, Singapore. He has completed CAS in Heart Failure at Zurich University, Switzerland. He is the Founder Head of the only Heart Failure Unit in Sudan and Chairman of Sudan working group on heart failure.
Abstract:
Background & Aim: Heart Failure (HF) re-admission identifies patients at high risk for adverse events. This study aimed to establish the frequency and factors associated with decompensation and readmission of patients with chronic HF at one of biggest cardiac centers in Sudan.
Method: In this prospective, observational, cross-sectional study, subjects≥18 years who re-admitted as Acute Decompensation (ADHF) at Alshaab Hospital (Khartoum-Sudan) in period from February-May 2016 were included; patients with first acute heart failure admission (Acute De-novo HF) and those who refused to participate were excluded. Descriptive statistics were used to determine the baseline characteristics of the study population and to compare them with those from other studies and registries.
Result: 220 consecutive patients are included, mean age of 63.7±14.5 years, 125 (56.8%) males. 141 (64.1%) are originally from rural areas, 151 (68.6%) are illiterates and only 4.0 (1.8%) are formally employed. 195 (88.64%) have HFrEF (EF<40%, 13 (5.91%) HFmrEF (EF 40-49%) and only 12 (5.45%) HFpEF (EF≥50%) Dilated Cardiomyopathy (DCM) was the commonest cause of heart failure in these studied patients, ischemia is the second, hypertension is the third (63.6%, 21.7%, 8.2%, respectively) while valvular heart disease is the fourth (6.5%). 51 (23.2%) re-admitted within the first 30 days, 59 (26.8%) within one to three months while half within a period of three to six months following the last discharge. During the last six months, 4.0 (1.8%) of patients re-admitted once, 38 (17.3%) twice, 66 (30%) thrice and 112 (50.9%) re-admitted ≥4 times. The cause of acute decompensation identified in 196 (89.1%) with non-adherence as the first cause of decompensation and re-admission, worsening renal function is the second, acute coronary syndrome is the third and tachyarrhythmias is the fourth (31.8% ,14.1%, 11.4% and 10.0% respectively).
Conclusion: In this study, acute decompensation and re-admission is very frequent but mostly preventable.
Yassmin Hanfi
King Fahad Armed Forces Hospital, Saudi Arabia
Title: Workshop in cardiac imaging What to except from transthoracic echocardiography TTE
Time : 14:50-16:20
Biography:
Yassmin Hanfi is a Consultant Cardiologist specialized in Advanced Cardiac Imaging (TTE, TEE, CCTA, CMR). Her cardiac training was in Paris with advanced international cardiac teams followed by subspecialty in London at the Royal Brompton Hospital. Her specialty of cardiac imaging is an everyday practice for cardiologist and health care practitioner.
Abstract:
What to except from transthoracic echocardiography TTE
For non-specialized cardiologist, cardiac fellow, GP, Technician on how to answer the clinical question using TTE. Explanation of each method used in TTE for LV EF assessment (Fractional shortening, fractional area changes, ejection fraction and stroke volume), regional wall motion assessment, ischemic complication, ischemic rupture of LV septum and LV free wall, ischemic MR, LV apical thrombus and pericardial effusion.
RV assessment by TTE
The right ventricle plays an important role in the morbidity and mortality of patients presenting with signs and symptoms of cardiopulmonary disease. However, the systematic assessment of right heart function is not uniformly carried out. This is due partly to the enormous attention given to the evaluation of the left heart and a lack of familiarity with ultrasound techniques that can be used. Parameters will be explained such as fractional area change [FAC], S’, tricuspid annular plane systolic excursion [TAPSE]; RV index of myocardial performance [RIMP] new updated and normal values, systolic pulmonary artery (PA) pressure (SPAP).
CMR in RV assessment and beyond
CMR is the gold standard for right ventricular assessment, has a superior acoustic window over other modalities and free of ionizing radiation.
- Clinical Case Reports on Cardiology| Cardiovascular Medicine | Cardiometabolic Health- Diabetes, Obesity, & Metabolism | Cardiovascular Engineering | Stem Cell Research and Regeneration on Cardiology | Healthcare
Location: Conference Hall 1
Chair
Minkyung Kim
Sheikh Khalifa Specialty Hospital, UAE
Session Introduction
Warkaa Alshamkhani
Belhoul Speciality Hospital, UAE
Title: Optical coherence characteristics of suspected hypersensitivity reaction following Ultimaster drug-eluting stent implantation
Time : 09:00-09:30
Biography:
Abstract:
The number of bioresorbable polymer coating stents that are commercially available is increasing. They present some potential benefits by eliminating the need for long-term polymer exposure as well as other appealing characteristics that facilitate and enhance endothelial coverage. Since its launch, several trails investigated the safety and efficacy of the bioresorbable stents. In 2014, the Century II trial compared the Ultimaster with Xience Everolimus-eluting stent with the circumferentially-coated durable polymer (Abbot Vascular). This trial concluded that the ultimaster is non-inferior to Xience Everolimus DES in its primary endpoint which was target vessel failure TVF. In another word, it showed excellent performance at a low rate of risk events. However, less is known regarding the effect of these new devices. The type of ISR and how it’s different regarding time course, morphology and more importantly in the clinical events. A 59-year-old female presented to the cardiology clinic with a history of recent angina. Her risk factors included dyslipidemia, type-II diabetes mellitus and previous PCI to both the Right Coronary Artery (RCA) with Terumo Ultimaster 2.5×38 mm Stent and the Circumflex artery (CX) using Abbot Xience Pro 2.25×23 m for non-ST elevation myocardial infarction in 2017. Stress echocardiogram proved reversible ischaemia in LAD and RCA regions and repeat catheterisation revealed an image angiographically compatible with significant In-Stent Restenosis (ISR) at mid-RCA stent; the CX showed moderate lesion just proximal to the previous stent which was widely patent and a severe proximal LAD disease. Surgical MDT was in favour of PCI as RCA anatomy distal to the stent is not graftable. For the RCA ISR treatment, we opted to perform Optical Coherence Tomography (OCT) for better characterisation of the lesion; this showed appropriate deployment of the stent, some areas with micro vessels and per-strut low-intensity signals suggestive of endothelial dysfunction, intimal hyperplasia with interestingly focal areas of inflammation suggestive of polymer hypersensitivity. The ISR was treated with DES pre-dilated for optimisation. The global literature and data on Ultimaster ISR and management (a paclitaxel-coated balloon or a drug-eluting stent) are scarce and to the very best of our knowledge, this case is one of the first descriptions of Ultimaster in-stent restenosis (or failure) secondary to possibly polymer allergic reaction. The use of intracoronary OCT imaging as an advanced imaging tool provided us with a unique opportunity to understand and manage complex and infrequent conditions like this one.
Minkyung Kim
Sheikh Khalifa Specialty Hospital, UAE
Title: A case of paraganglioma presented with reverse Takotsubo syndrome
Time : 09:30-10:00
Biography:
Minkyung Kim completed her MPH from Korea University and completed her PhD course from Seoul National University, College Of Medicine. She worked as a Clinical Professor at Seoul National University Hospital from 2011 till 2014. She is a Consultant Cardiology at Sheikh Khalifa Specialty Hospital, RAK, UAE.
Abstract:
There is a sub-type of Takotsubo, a reverse Takotsubo, or Squid syndrome. We report a case of a 19-year-old man who presented with chest pain to emergency department and had hypertensive crisis. He had no medical history, recently relocated to United Arab Emirates and had trouble to get visa. He had struggle with his sponsor person for two days and has developed persistent chest pain and dizziness. In the emergency department, his initial blood pressure was 240/110 mm/Hg and it was fluctuating down to 100/70 mm/Hg. His troponin was positive and ECG showed no specific finding. Coronary angiography was done via right radial artery on 21st of Feb 2018, showed normal coronary. We did evaluation for secondary hypertension. From abdominal CT scan, we found retroperitoneal mass (suspicious of paraganglioma). TTE showed depressed EF with basal to mid akinesia and hyperactive apical part, which was compatible with reverse Takotsubo. With medical treatment, he was recovered well, his EF improved upto 51% and RWMA disappreared. 24 hours urine collection was done. Dopamin was 538 ug/24hr (normal range is~510 ug/24hr), epinephrine was 88 ug/24hr (0~20 ug/24hr), norepinephrine was 3431 ug/24hr (0~135 ug/24hr), metanephrine was 141 pg/mL (0~62 pg/mL), normetanephrine 3303 pg/mL (0~145 pg/mL), aldosterone was 9.9 ng/dL (0.0~30.0 ng/dL). Patient discharged with medication and went back to his home contury for further evaluation and surgery. The mechanism of Takotsubo syndrome or stress induced cardiomyopathy is not known. The surge of catecholamine in the stress condition was suggested as one of possible cause of Takotsubo syndrome.
Rabia Shabir Ahmad
Government College University, Pakistan
Title: Effectiveness of green tea in prevention of obesity and related metabolic disorders
Time : 10:30-11:00
Biography:
Rabia Shabir Ahmad has completed her PhD in Food Technology from National Institute of Food Science and Technology. She has also been awarded “Letter of Appreciation” for short duration completion of PhD. Her areas of interest are functional foods, human nutrition and food science. She is currently Administrating various HEC funded research project as principal investigator. She has published papers in well reputed international and national journals. She has participated in different conferences, trainings and workshops. She is also certified instructor from United States Department of Agriculture (USDA).
Abstract:
Phytochemicals have been a part of human society from old times to prevent from various maladies because most of drugs were prepared from the plants. During the last few years, scientific investigations have proposed several modules like diet based regimen to prevent life threatening disorders including obesity, hypercholesterolemia and related health problems including cardiovascular diseases. Obesity is a worldwide lifestyle-related disorder increasing at an alarming rate. Among contributory factors, dietary habits are considered one of reasons for its expansion. Among various prevention strategies, a promising tool is the use of functional/nutraceuticals foods that not only improve consumer health and wellness but also reduce disease risk with minimal cost. For the reason, functional ingredients are getting attention to improve lipid metabolism and control obesity and allied disorders. In this context, green tea is an important tool to improve thermogenesis and fat oxidation. Diabetes and obesity are the common metabolic syndromes related with expansion of coronary diseases. Green tea has significant role in body weight reduction that is due to its capability to activate β-oxidation of fatty acids. Moreover, Peroxisome Proliferators Activated Receptors (PPARs) transcriptionally regulate the expression of many lipid-metabolizing enzymes, including acyl-CoA oxidase and medium chain acyl-CoA dehydrogenase. Nuclear Factor-kB (NF-kB) is reported to inhibit PPARα mediated activation of PPAR response element-driven promoter through physical interaction of PPARα with NF-kB p65. Green tea inhibits the activation of NF-kB thereby regulate the transcription of PPAR-related genes by reducing the NF-kB activation that might lead to upregulation of the lipid metabolizing enzymes thus controlling lipid level and risk of coronary diseases.
Mansoor Mohsenabadi
Tehran University of Medical Science, Iran
Title: Designing and evaluating the efficacy of mobile cardiac dysrhythmia simulator application on critical care nurses’ knowledge and satisfaction
Time : 11:00-11:30
Biography:
Mansoor Mohsenabadi has completed his Bachelor of Science degree of Nursing from Tehran Welfare and Rehabilitation University. He has completed his Master of Science degree in Critical Care Nursing from Iran University of Medical Sciences and Masters in Medical e-Learning from Tehran University of Medical Sciences (Virtual School). He is the Critical Care Nurse of The Lavasani Heart Center.
Abstract:
Background & Aim: Awareness of the immediate interpretation and principles of the interpretation of cardiac dysrhythmias is one of the most important clinical skills of medical and nursing staff in dealing with cardiac patients. With the increasing use of training based on modern techniques in medical education, the present study aims in designing and evaluating the efficacy of mobile cardiac dysrhythmia simulator application on critical care nurses’ knowledge and satisfaction.
Method: This quasi-experimental study was performed in 2017 on a group of critical care nurses (40 people). In this process beforeafter study, samples were selected conveniently and data were collected before the intervention by questionnaires (Demographic and knowledge measurement). Then the intervention was performed in this group with mobile cardiac dysrhythmia simulator application. Before intervention, mobile cardiac dysrhythmia simulator application was designed by researcher on the principles of educational design and Mobile Application Development Lifecycle Model (MADLC). After intervention, the participants’ knowledge again was evaluated in principles of the interpretation of cardiac dysrhythmias. Also satisfaction of critical care nurses in using application was completed. To analyze the data, descriptive and inferential statistics were used in SPSS (version 19).
Result: The results had shown the average rating of the participants in application group before intervention was 17/68±4/565 and after intervention was 21/33±2/693 that were statistically significant (P-value<0.001). Statistical analysis showed that after the intervention, the mean scores of knowledge of the participants were significantly higher than before intervention. Also, the average satisfaction level of the participants in the use of cardiac dysrhythmia simulator application in the study was about 85.72% which is acceptable and high.
Conclusion: Design and compilation of mobile cardiac dysrhythmia simulator application on the interpretation of cardiac dysrhythmias were performed based on the principles of educational design. The results of this study showed that knowledge of critical care nurses in the interpretation of cardiac dysrhythmias has an improvement. Also, the satisfaction level of the participants in the use of cardiac dysrhythmia simulator application in the study was acceptable and high.
Demeke Mekonnen
Jimma University medical center, Ethiopia
Title: Cardiac function in severe acute malnutrition
Time : 11:30-12:00
Biography:
Demeke Mekonnen is currently working as Consultant Pediatric cardiologist at Wolfson Medical Center and Assistant Professor of Pediatrics and child health at Jimma University medical center, Ethiopia. He has completed his Pediatric Cardiology fellowship Program at Wolfson Medical Center in 2017. He has pursued his PGDP medicine at Cardiff University.
Abstract:
Introduction & Aim: Malnutrition is one of the leading problems in developing countries with basic stance for majority of common childhood problems. The clinical forms that are prominent and are associated with mortality are the severe forms of acute malnutrition (edematous or non-edematous). Malnutrition affects every organ system. One of the most important organs involved-cardiac muscle was studied in this paper. The aim of this study was to compare the degree of cardiac muscle involvement among severely malnourished
children in contrast with age and sex matched anthropometrically normal controls. It is used as a baseline data for further detailed study in addition to its impact in the management of children with severe acute malnutrition by detailing cardiac function.
Method: The study was a cross-sectional comparative case control study among thirty children with severe acute malnutrition and age-sex matched fifteen control groups in JUSH pediatrics department from January to July 2013. Convenient selection of cases and controls with clearing of exclusion criteria was used after written consent was taken to select the legible 30 children who were not having any of the exclusion criteria seated. 15 children were selected as controls with anthropometric measures between ±2SD. Each child had undergone basic clinical examination (general examination, cardiorespiratory, integumentary and anthropometric measurement and interpretation) and echocardiographic assessment of LV mass, dimensions and systolic functions. Blood sample was taken for baseline investigation on hemoglobin/hematocrit. Results were expressed as means±standard error of means and considered statistically significant if p<0.05. Student t-test was used for comparison of means and standards using web-based software “GraphPad calcs”. SPSS®, EpiData, WHO Anthro were used in accordance.
Result: The mean ages for the cases were 2.4±1.7 years and for the control group was 3.3±1.8 years with males took 53.3% comparably in both groups. It was found that left ventricular posterior free wall thickness and LV mass were reduced significantly in the group with SAM (P=0.0001) whereas LVMi and systolic functions (ejection, fraction and fractional shortening) were not found to be statistically significant. The lowest mean value for EF and FS was on the edematous SAM children.
Conclusion: This study has revealed that there was cardiac atrophy without significant systolic functional impairment. It is recommended that we need to have a more detailed study with biochemical markers being integrated and severely malnourished children being followed prospectively for the changes with due treatment.
Sindew Mahmud Ahmed
Deber Berhan University, Ethiopia
Title: A cross sectional study to observe adherence to antihypertensive treatment and associated factors among hypertensive patient on follow up in Debre Birhan Referral Hospital, North Shoa, Ethiopia, 2017
Time : 12:00-13:00
Biography:
Sindew Mahmud Ahmed has completed his MSc from Addis Ababa University. He is currently a Lecturer of Nursing in Deber Berhan University. He has published 2 papers in reputed journals.
Abstract:
Background: Hypertension is defined as Systolic Blood Pressure ≥140 mmHg and/or Diastolic Blood Pressure ≥90 mmHg. It is aglobal public health challenge worldwide that contributes to the burden of hypertensive heart disease, stroke, renal failure, prematuremorbidity and mortality. Adherence to pharmacological treatment is a key to guaranteeing successful therapy outcomes.
Objectives: The general objective is to assess the prevalence of adherence to antihypertensive treatment and associated factors among hypertensive patient.
Methods: Cross-sectional study design was conducted in 271 study participants selected by using systematic random sampling method. The structured interviewer-administered questionnaire was used. Data was cleared using EPI info version 3.5.4 and was analyzed by using SPSS version 21 software. A multivariate analysis was performed to determine the independent effects of the explanatory variables. A p-value less than 0.05 were taken as significant for all analysis.
Results & Conclusion: From 270 study participants 63% of the respondents’ adherent to their antihypertensive treatment while the other 37% of the study participants were non-adherent. The multivariate logistic regression showed that those who have comorbid illness like heart disease were 95.4% less likely to adhere to their antihypertensive treatment. Patient who have forgetfulness of their drugs were 98.6% less likely to be adherent. Those patient who perceive HTN as somehow less severe disease were 98.2% less likely to be adherent to their antihypertensive treatment. This study identified variable like presence of comorbidity like heart disease, forgetfulness and perceived disease severity were strongest factors affecting medication adherence among patient on follow up at Debre Berhan Referral Hospital.