Day 1 :
Keynote Forum
Kevin A. Courville
Prevail Heart Clinics, USA
Keynote: Utilizing Computer Assisted Medication Management to Improve Outpatient Treatment of Heart Failure and Reduce Heart Failure Hospitalizations
Time : 10:00-10:40
Biography:
Kevin A. Courville, is a Fellow of the Heart Failure Society of America, Fellow of the American College of Cardiology and Alpha Omega Alpha Honor Medical Society. He received his cardiology training at Ochsner Heart and Vascular Institute in New Orleans, Louisiana. He has been recognized as one of the top cardiologists in America for several years and dedicates his clinical, research and development efforts into the outpatient management of heart failure and chronic cardiovascular diseases.
Abstract:
Optimal outpatient management of patients with chronic heart failure requires implementation and execution of evidence-based therapies, careful monitoring of clinical status, adequate patient education, adherence to patient's self-directed goals and readily available access to knowledgeable healthcare providers and/or heart failure specialists. These initiatives have the burden of a significant time and resource requirement. The ratio of the exponential increase in the number of patients with heart failure versus specialty heart failure providers are forcing patients to receive care from providers who do not have a primary focus on the treatment of heart failure nor the time or resources to "keep up" with all aspects of care required of each patient. PULSARIO Remote Heart Management system integrates these objectives with provider education and computer assisted medication titration into a single unified solution which enables the non-heart failure specialists to treat heart failure patients to the level of specialty care. Prevail Heart Clinics (PHC) evaluated 394 consecutive patients from October 2014 thru May of 2016. Patients were enrolled into the Prevail solution using the Pulsario system and treated as per goals directed by the Pulsario system and the Prevail team. The result was an all-cause 30-day readmission rate of only 6.1% and a 71.4% reduction of HF hospitalizations during the first year of application of this technology into a rural clinic with predominant care provided by a physician assistant. Computer assisted medication management in the Pulsario system is feasible, cost effective, clinically effective and improves the lives of patients with heart failure.
Keynote Forum
Heinz-Peter Schultheiss
Institute of Cardiac and Diagnostic Therapy, Germany
Keynote: Differential Therapy of Myocarditis and Inflammatory Cardiomyopathy
Time : 10:40-11:30
Biography:
Heinz-Peter Schultheiss, Professor of Internal Medicine and Cardiology, is CEO of Institute for cardiac diagnostic and therapy (IKDT) Berlin, Germany since 2003. He was the chairman of the Working group “Inflammatory heart muscle diseases“ of the German Society of Cardiology, Chairman of the “Working Group on Myocardial and Pericardial Disease“ of the European Society of Cardiology, Member of the "Council on Cardiomyopathies“ of the International Society of Cardiology, Chairman of the Medical Society Berlin, Member of German Society for Internal Medicine, Member of European Society of Cardiology
Abstract:
Cardiomyocytes can be destroyed by direct virus damage, the antiviral immune response, or a truly autoimmune injury. Beside an optimal heart failure therapy, the mainstay of treatment for myocarditis and inflammatory cardiomyopathy (CMi) is the biopsy-proven specific immunomodulatory treatment regarding the underlying pathophysiological mechanisms. Chronic viral infections of the heart (mainly Parvovirus B19, Human-Herpes virus (HHV) 6, Coxsackie-adeno virus, Ebstein-Barr virus, Cytomegalie virus, and Hepatitis virus) are considered one antecedent event leading to progressive dysfunction of the myocardium, often with an impaired prognosis due to a virus- or immune-mediated myocardial injury.
The effectiveness of anti-viral-therapy has been proven in recent studies, showing that enterovirus/ adenovirus – positive patients benefit from anti-viral therapy with interferon beta-1b, whereas in patients suffering from parvovirus B19 infection no established therapy exists. However, the nucleoside analogues Telbivudine seems to be a promising drug in patients with proof of active viral replication. Follow-up studies revealed an association with HHV6 and the clinical course of myocarditis and CMi. HHV-6 is able to integrate its genomes into telomeres of human chromosomes. We recently demonstrated that antiviral therapy with Ganciclovir can diminish HHV-6 replication as well as cardiac symptoms of these patients. Myocardial inflammatory processes due to autoimmunity warrant immunosuppressive treatment in order to prevent immune-mediated myocardial injury. Immunosuppression (treatment with prednisone and azathioprine for 6 months) demands biopsy-based exclusion of virus since virus-positive patients do not improve or even deteriorate under anti-inflammatory treatment, while virus-negative patients with post-infectious, auto-immune inflammatory process respond well in clinical trials, and - after termination - long lasting LVEF improvement has been documented.
Keynote Forum
Waldo Emerson Pinheiro Daniel
Federal University of RN, Brazil
Keynote: MICS CABG OFF PUMP – Why this choice? How I do!
Time : 11:50-12:30
Biography:
Waldo Emerson Pinheiro Daniel has completed the graduation of Medicine in the Federal University of Rio Grande do Norte (UFRN) on August 18, 1992; at the age of 25 years old. Concluded Medical Residence in General Surgery in 12/31/1994 by Federal University of Rio Grande do Norte, Onofre Lopes Hospital, being awarded the title of specialist. In 01/02/1995 started the Medical Residency in Cardivascular Surgery at São Joaquim Hospital of the Real and Benemérita Portuguese Society of Beneficence of São Paulo, Dr. José Pedro da Silva service, where remained until 12/12/1998, when concluded and being awarded the title of specialist. He is Associated Member of Brasilian Society of Cardiovascular Surgery. When he came back to Natal/RN has assembled a team, dedicating the Adult Cardiac Surgery, But mainly MICS and Aortic Surgery and he has been working in several private Hospital and the University Hospital of which he is the Head of the Cardiovascular Surgery Service at the moment.
Abstract:
The present study was performed with 132 patients with Coronary Artery disease, randomly selected, excluding only those with a greatly increase Cardiac area and/ or patient with ejection fraction below 40%, as well as patients with severe pneumopahies and significant depression of ventilatory function. All patients underwent complete revascularization of the myocardium without the use of extracorporeal circulation, nor at least as ventricular assistance and the access was performed through left anterolateral thoracotomy. The left Internal Mamary artery was harvested in its entirety and by direct vision in used in situ; the Safenous Graft, when used, its proximal anastomosis is performed first and in the ascending portion of the Aorta Artery. In the first and a few days after surgery, it was observed there was a significant decreases in thoracic drainage volume(competed to conventional surgery), past the first postoperative day, the analgesia is decreased and usually the patients leaves the CTI. These patients invariably present as oligossymptomatic or even asymptomatic, more confident, being discharged about the 4th day of hospitalization. After discharge, in consultation, the patients reported us, the early return to their normal life and their satisfaction with it, consequently whit the procedure. After six months, the same patients underwent coronary Angiotomography(That show us a hundred per cent of Mamary Artery graft and eight nine per cent of the safenous graft pattency), to control graft patency and also the clinical evaluation, that in this series, precisely in this is month evaluation, no patient presented any complaints or symptoms.
- Cardiac Surgery | Cardiovascular Disease and Nutrition |Myocardial Infarction | Coronary Heart Diseases | Cardiac Stroke | Heart Failure | Case Reports on Cardiology
Location: Olimpica 1, Holiday Inn Rome Aurelia
Chair
Heinz-Peter Schultheiss
Institute of Cardiac and Diagnostic Therapy, Germany
Session Introduction
Chiara Mozzini
University of Verona, Italy
Title: Endoplasmic Reticulum Stress, Inflammation, Oxidative Stress And Neutrophil Extracellular Traps In Cardiovascular Diseases
Time : 12:30-13:10
Biography:
Chiara Mozzini is an Adjunct Professor in the section of Internal Medicine at University of Verona, Italy. Graduated from University of Brescia and Certified in 2012 with Specialist in Internal Medicine from University of Verona ,Italy. Board. With PhD certification in Clinical and experimental Medical Sciences, 2016. Research Fields: Atherosclerosis;- Cardiovascular Diseases; Coronary Artery Disease;- Diabetes;- Oxidative Stress;- Endoplasmic Reticulum Stress;- Ultrasound (Cardiac-Abdominal- Vascular).
Abstract:
To summarize the understanding of the interrelated roles of endoplasmic reticulum (ER) stress, oxidative stress and inflammation in cardiovascular diseases. Insults interfering with ER function lead to the accumulation of unfolded and misfolded proteins in the ER. An excess of proteins folding in the ER is known as ER stress. This condition initiates the unfolded protein response (UPR). When the UPR fails to control the level of unfolded and misfolded proteins, ER-initiated apoptotic signalling is induced. Moreover, the role of the protective nuclear erythroid-related factor 2 (Nrf2)/antioxidant-related element (ARE) and the activation of the pro-inflammatory nuclear factor-kappa B (NF-kB) are analysed. Current literature data are presented, focusing on three topics of related pathologies: atherosclerotic plaque, coronary artery disease and diabetes. Moreover, current evidence suggests the likelihood of a link between venous thromboembolism (VTE) and atherosclerosis, although they have been traditionally considered as different pathological identities. The contribution of neutrophils to human atherogenesis has been underestimated, if compared to their contribution established in VTE. This is due to the major importance attributed to macrophages in the plaque destabilization. Nevertheless, recently, the role of neutrophils in atherogenesis deserves increasing attention. In particular, neutrophil extracellular traps (NETs) are net-like chromatin fibres which are released from dying neutrophils. The death of neutrophils with NETs formation is called NETosis. During activation, neutrophils produce Reactive Oxygen Species (ROS), through the activation of nicotinamide adenine dinucleotide phosphate (NADPH) oxidase. The main function of NETs is trapping and killing pathogens. However, NETs formation has been observed in various chronic inflammatory diseases, autoimmune diseases, vasculitis, lung diseases, cancer and VTE. Recent studies suggest that NETs formation could contribute also to atherosclerosis progression. New data report the presence of NETs in the luminal portion of human atherosclerotic vessels and coronary specimens obtained from patients after acute myocardial infarction. Programmed death mechanisms in atherosclerosis such as apoptosis, efferocytosis and also NETosis, share common features and triggers. If defective, they can lead the cells to a switch from programmed death to necrosis, resulting in the release of pro-atherogenic factors, accumulation of cell debris and progression of the disease. This talk aims to analyse the emerging role of neutrophils focusing on NETosis and oxidative stress burden in orchestrating common mechanisms in atherosclerosis and thrombosis.
Takeo Tedoriya
Ageo Central General Hospital, Japan
Title: Virtual Reality Image Analysis in Aortic Valve Leaflet Reconstruction
Time : 14:10- 14:40
Biography:
Takeo Tedoriya has completed his PhD at the age of 28 years from Kanazawa University and trained cardiac surgery at German Heart Institute Berlin to get German board of cardiac surgery, thereafter moved to St.Vincent Hospital Sydney as a temporary consultant for heart-lung transplantation unit, after working at Kanazawa University Medical Center. He had been the professor and director of Showa University for 10 years, followed by the director of Ageo Central General Hospital, Cardiovascular Center. He has published more than 45 papers in reputed journals and has been serving as a reviewer for several journals.
Abstract:
Aortic valve reconstruction with three same-sized autologous pericardial leaflets has been performed for patients with narrow aortic roots or contraindication for valve-prostheses. Since this procedure requires precise information of the aortic root including configuration of Valsalva sinus, we assessed physiologic-anatomical condition of the aortic root by Virtual Reality (VR) Image in order to accomplish this technique with a reproducible fashion. VR Imaging; Enrolled patients underwent enhanced ECG-triggered cardiac CT. Axial images using a 264-row CT with slice thickness of 0.625mm were obtained during mid-to-end diastole. Subtracted volume rendering data of the aortic root were converted to stereolithography (STL) file in Visalius3D, a novel 3D workstation. Preoperatively the aortic root was assessed in order to decide neo-commissure and offsetting of deviated nadir in cases of unbalanced aortic root, like type 0 bicuspid valve. Basic surgical technique was; 1) same-sized three pieces of leaflets from autologous pericardium were tailored to original templates referred by STJ diameter, 2) the new commissures and nadirs were confirmed based on VR image (in case the non-coronary nadir deviated toward the left ventricle, a crescent form Valsalva plication were required), 3) three leaflets were sutured on the cusp-sutureline, 4) commissure coaptation stitches were placed between each leaflet to prevent from minor leakage and coronary orifices obstruction. Postoperative echocardiography revealed nicely opening of new-leaflet with no AR. VR image analysis had notably provides valuable information for understanding of precise anatomy of the aortic root.
Rainer G. H. Moosdorf
University Hospital Marburg, Germany
Title: Less invasive intraoperative Laser-VT-Ablation
Time : 14:40- 15:10
Biography:
He started his career as a resident at the University Hospital in Giessen in 1978. In 1990 he became a full professor for cardiovascular surgery at the University in Bonn and vice chairman of the respective department. In 1989 and 1990 he spent two semesters at the Carolinas Heart Institute in Charlotte/NC as a research and clinical fellow. Since 1994,He is working at the University Hospital in Marburg as a full professor for cardiovascular surgery and director of the department. Between 2001 and 2011 he also held the position of the vice medical director and since 2006 the medical director of the University Hospital in Marburg. The main specialties within cardiovascular surgery are laser- and arrhythmia surgery, endovascular procedures including TAVI´s and endovascular reconstructions of the aortic arch and reconstructive surgery of the coronaries. As the chairman of the board of "Medical Network Hessen" he is an official representative of the State of Hessen in the field of clinical medicine and medical education.
Abstract:
While ventricular fibrillation is often induced by acute ischemia or the immediate sequelae of it, ventricular tachycardia are mostly due to a pathological substrate such as even small scars or inflammatory infiltrates. As a consequence, sole revascularization does influence ischemia induced arrhythmias while most VTs remain unchanged. In case of necessary cardiac surgery, especially for myocardial revascularization, an intraoperative mapping and laser-ablation of the identified foci is recommended. If larger scars or even aneurysms are present, an endocardial and epicardial ablation is performed and has demonstrated its high efficacy with a successrate of more than 90%. In case of only small scars or infiltrates, we refrain from opening the ventricle and only perform an epicardial mapping and deep ablation, which is even curative in more than half oft he cases without further need of an ICD implantation, as demonstrated in a study with > 30 patients. As the whole procedure is performed on the beating heart, it does not add to ischemic time and does not increase the risk significantly.Laser-VT-ablation is an effective, less invasive, curative therapy for patients with an indication for open heart surgery, especially coronary revascularization, and with documented VTs.
Tamara Feygin
University of Pennsylvania, USA
Title: Prenatal MR imaging of congenital heart diseases and associated abnormalities
Time : 15:10- 15:40
Biography:
Tamara Feygin is an Associate Professor of Clinical Radiology at the University of Pennsylvania, Perelman School of Medicine, and a pediatric neuroradiologist at The Children’s Hospital of Philadelphia. Her primary interests are fetal and neonatal imaging. Dr. Feygin led the development and implementation of magnetic resonance “fluoroscopy” in clinical practice for assessment of dynamic processes in fetuses. Dr. Feygin is a dedicated educator and mentor of medical students, radiology residents, and radiology and neuroradiology fellows. Dr. Feygin is a co-author of books, chapters and scientific peer-reviewed papers. She has been invited to present her work nationally and internationally. She is a member of the European Society of Neuroradiology, the Radiological Society of North America, the Society for Pediatric Radiology, and a senior member of the American Society of Neuroradiology.
Abstract:
A variety of congenital heart diseases (CHD) may be diagnosed prenatally. Traditionally, the fetal heart was primarily assessed by fetal echography. However, fetal MRI has been proven as a helpful imaging tool in detection of cardio-vascular anomalies in utero. Numerous conditions, including aorta coarctation, hypoplastic left heart syndrome, tetralogy of Fallout, cardiac aneurysms, pericardial/cardiac tumors may be successfully detected on MR imaging. In addition, presence of other coexisting anomalies outside of the cardio-vascular system may be revealed. Some cardio-vascular anomalies may be more than an isolated problem and could be a part of an underlying systemic/genetic condition. Even in the absence of genetic abnormalities, infants with CHD are at increased risk of brain lesions (15-45%) or neurodevelopmental delay. The demonstration of a full spectrum of fetal anomalies provides extremely valuable information to clinicians and parents-to be. Fetal MR may be a feasible addition for timely and precise diagnosis of cardiac disease and associated anomalies. Prenatal imaging therefore helps to predict pregnancy outcome, and prepares couples for the birth of a child with an abnormality. The obtained information may also assist in thorough screening of fetal patients for eligibility for fetal treatment. It may help to prognosticate to some degree important issues of patient’s developmental outcome and quality of life.
Jochen Senges
University of Heidelberg, Germany
Title: Mass media Campaign to improve poor diagnosis and poor medical adherence in atrial fibrillation
Time : 15:40-16:10
Biography:
Jochen Senges is the Director of the Institute of Herzinfarktforschung Ludwigshafen. He completed his Medical School at University of Heidelberg, Berlin and Frankfurt 1961-1966; Medical Diploma at University of Heidelberg in 1966; Board certification in Internal Medicine in 1974. He was a Senior Staff Physician in Department of Cardiology, University of Heidelberg. He completed his PhD in Medicine with a neurophysiologic dissertation at University of Heidelberg in 1967 and; was a Research Fellow at Stanford University, California, USA in 1969. His main research topic is Cardiac Arrhythmias. He was an Associate Professor of the Medical Faculty, University of Heidelberg in 1981.
Abstract:
Atrial fibrillation (AF) is the most common cardiac rhythm disorder and affects mainly older people. Poor diagnosis of AF: Large registries (Gloria-AF) have clearly shown that about 2thirds of patients in Western Europe with newly diagnosis nonvalvular AF are detected asymptomatic/minimally symptomatic. The rate of previous stroke in these patients is more than twice as high as in symptomatic patients, despite no difference in CHA2DS2-VASc-Score. This may be explained by a longer but subclinical and therefore undiagnosed AF history. Poor medical adherence: poor medication adherence is the second most important factor underlying strokes in patients with atrial fibrillation. Various major studies have demonstrated that less than half of AF-patients are treated with guideline antithrombotic medication. Mass media campaign: these results underline the importance for both: public programs to detect non-valvular AF in the older population but also public education programs that should focus on patients poor understanding of the importance for sustained antithrombotic medication adherence to prevent stroke. The ARENA study includes a longstanding mass media campaign over one year to improve diagnosis and medical adherence in atrial fibrillation. Actually over 10.000 AF-patients are documented and first results will be presented at this meeting.
Ingrid E. Dumitriu
St. George’s University of London, UK
Title: Deregulations in CD4+ T lymphocytes subsets promote inflammation in atrial fibrillation
Time : 16:10-16:30
Biography:
Ingrid Dumitriu is a Reader (Associate Professor) in Cardiovascular Immunology at St. George’s, University of London, London UK. She leads the Cardiovascular Immunology research group and has an MD degree and a PhD in Immunology. Her research focuses on the role of inflammation and immune cells in atherosclerosis and other cardiovascular diseases. Dr Dumitriu is a nucleus member of the European Society of Cardiology (ESC) Working Group on Atherosclerosis and Vascular Biology. She is also a member of the ESC, European Atherosclerosis Society, British Society for Immunology, and ESC Working Group on Peripheral Circulation.
Abstract:
The precise role of inflammation in the development and perpetuation of atrial fibrillation (AF) is yet to be fully uncovered. T and B lymphocytes, the main cellular effectors of adaptive immunity, have pivotal roles in orchestrating inflammation. Different subsets of lymphocytes either promote or prevent inflammation. We are investigating a unique subset of lymphocytes, the CD4+CD28null T cells that expand in patients with chronic inflammation. These cells secrete high levels of pro-inflammatory cytokines tumour necrosis factor-α (TNF-α) and interferon-g (IFN-g). The response of CD4+CD28null T cells is normally maintained under control by regulatory T cells (Treg), a specialised subset of T lymphocytes with suppressive function that maintain immune homeostasis and prevent pathogenic immune responses. The role of CD4+CD28null and Treg cells has not been investigated in AF. We found that CD4+CD28null T lymphocytes were significantly increased in the circulation of AF patients compared to controls (p<0.0001). In addition, AF patients had a marked reduction (p=0.0001) in Treg cells. The ratio of CD4+CD28null T lymphocytes to Tregs was significantly increased. In contrast, no alterations were identified in circulating B cell subsets. Levels of hsCRP, TNF-α and IFN-g did not correlate with CD4+CD28null T cell and Treg frequency. Instead, we demonstrate that the expansion of CD4+CD28null T cells is caused by defects in apoptosis pathways and increased activation and proliferation in response to homeostatic cytokines. These novel results suggest an imbalance in the mechanisms that maintain homeostasis in the immune response, which may promote inflammation in patients with AF.
- Special Session
Location: Olimpica 1, Holiday Inn Rome Aurelia
Session Introduction
Chiara Mozzini
University of Verona, Italy
Title: Endoplasmic Reticulum Stress, Inflammation, Oxidative Stress And Neutrophil Extracellular Traps In Cardiovascular Diseases
Biography:
Chiara Mozzini is an Adjunct Professor in the section of Internal Medicine at University of Verona, Italy. Graduated from University of Brescia and Certified in 2012 with Specialist in Internal Medicine from University of Verona ,Italy. Board. With PhD certification in Clinical and experimental Medical Sciences, 2016. Research Fields: Atherosclerosis;- Cardiovascular Diseases; Coronary Artery Disease;- Diabetes;- Oxidative Stress;- Endoplasmic Reticulum Stress;- Ultrasound (Cardiac-Abdominal- Vascular).
Abstract:
To summarize the understanding of the interrelated roles of endoplasmic reticulum (ER) stress, oxidative stress and inflammation in cardiovascular diseases. Insults interfering with ER function lead to the accumulation of unfolded and misfolded proteins in the ER. An excess of proteins folding in the ER is known as ER stress. This condition initiates the unfolded protein response (UPR). When the UPR fails to control the level of unfolded and misfolded proteins, ER-initiated apoptotic signalling is induced. Moreover, the role of the protective nuclear erythroid-related factor 2 (Nrf2)/antioxidant-related element (ARE) and the activation of the pro-inflammatory nuclear factor-kappa B (NF-kB) are analysed. Current literature data are presented, focusing on three topics of related pathologies: atherosclerotic plaque, coronary artery disease and diabetes. Moreover, current evidence suggests the likelihood of a link between venous thromboembolism (VTE) and atherosclerosis, although they have been traditionally considered as different pathological identities. The contribution of neutrophils to human atherogenesis has been underestimated, if compared to their contribution established in VTE. This is due to the major importance attributed to macrophages in the plaque destabilization. Nevertheless, recently, the role of neutrophils in atherogenesis deserves increasing attention. In particular, neutrophil extracellular traps (NETs) are net-like chromatin fibres which are released from dying neutrophils. The death of neutrophils with NETs formation is called NETosis. During activation, neutrophils produce Reactive Oxygen Species (ROS), through the activation of nicotinamide adenine dinucleotide phosphate (NADPH) oxidase. The main function of NETs is trapping and killing pathogens. However, NETs formation has been observed in various chronic inflammatory diseases, autoimmune diseases, vasculitis, lung diseases, cancer and VTE. Recent studies suggest that NETs formation could contribute also to atherosclerosis progression. New data report the presence of NETs in the luminal portion of human atherosclerotic vessels and coronary specimens obtained from patients after acute myocardial infarction. Programmed death mechanisms in atherosclerosis such as apoptosis, efferocytosis and also NETosis, share common features and triggers. If defective, they can lead the cells to a switch from programmed death to necrosis, resulting in the release of pro-atherogenic factors, accumulation of cell debris and progression of the disease. This talk aims to analyse the emerging role of neutrophils focusing on NETosis and oxidative stress burden in orchestrating common mechanisms in atherosclerosis and thrombosis.