Occasionally life-threatening adverse interactions have occurred in humans after the simultaneous oral intake of a wide variety of cardiovascular drugs with fruit juices (grapefruit/pomegranate) or herbal products (St. Johns Wort). Multiple ingredients present in plant-derived remedies may inhibit or induce gut transporters (P-glycoprotein) or metabolizing enzymes (CYP450-isozymes), glucuronidation pathway, and thus change the rate and extent of absorption, metabolism, bioavailability, pharmacokinetics, and pharmacodynamics of cardiovascular drugs. The interactive effects may be additive, synergistic or antagonistic in nature, and may complicate the dosing regimen of long-term medications. Drug-herb/juice interactions may be significantly important for drugs with a narrow therapeutic range (warfarin, digoxin, antiarrhythmics), and for sensitive populations like elderly and frail patients, pregnant and nursing mothers or very sick individuals (AIDS and cancer patients), who may be exposed to polypharmacy. As self-prescribing popularity of herbal remedies, fruit juices and dietary supplements is growing, physicians should inquire before prescribing, whether their patients are consuming any interacting juice or herbal product and either instruct their patients to stop consuming such products or adjust drug dosage to compensate for drug-herbal/juice effects. Collaborative efforts are required from patients, physicians, and industry to minimize or possibly prevent any potential risks associated with the concomitant use of botanical remedies and interacting drugs. Post-marketing surveillance is also needed to determine potential drug-herb-juice interactions.
Harpal Buttar received Doctor of Veterinary Medicine degree from Hissar, India, and M.Sc. and Ph.D. degrees in Pharmacology from the University of Alberta, Edmonton, Canada. For over 41 years, Dr. Buttar worked as a Senior Research Scientist & Assessment Officer in the Therapeutic Products Directorate, Health Canada, and retired in January 2013. Since 1994 - to date, he has held cross-appointment of Adjunct Professorship in the Department of Pathology & Laboratory Medicine, Faculty of Medicine, University of Ottawa, Ontario, Canada. Dr. Buttar is the author and co-author of ten book chapters and 112 research and review papers published in peer-reviewed journals.
Various cancers, cardiovascular diseases and brain problems can be screened quickly by detection of visible and invisible abnormal findings appearing at organ representation areas. Using strong electromagnetic field resonance phenomenon between 2 identical molecules or tissues, known as O-Ring Test, for which US patent was given, we can identify any molecules non-invasively. Using this method, we were able to map accurate organ representation areas at different parts of the body surfaces. Abnormality always appears as visible or non-visible changes. In cancer positive areas, we found significant increases in OncogenC-fosAb2, Integrin α5 β1, & 8-OH-dG and significant decrease in Taurine&1α, 25 (OH)2D3 (T &1 D3). In various brain problems, Acetylcholine is markedly reduced to 1ng or less. In the abnormal areasrepresenting the heart, there is significant increase in Cardiac Troponin I and significant decrease in T & 1 D3. In memory and motor problems, there is a marked reduction in Acetylcholine, T & 1 D3. Inthe presence of malignancies, organ representation areas have visible and invisible changes. These invisible changes can be detected using simple method of O-Ring Test. In the case of eyebrow representation areas, both for heart diseases and cancers, atabnormal organ representation area, first color of hair becomes whiter, and then hair starts disappearing. When problem progresses, there will be no hair.For diagnosis of cancer of digestive system, particularly colon cancers, they are represented at the right corner of mouth to lower lip next to it. Often they do not show any visible changes, but O-Ring Test shows a high negative value of (-)6 or more when there is a possibility of malignancy. Cardiovascular systems are represented in the left upper lip, starting near the center. We recently discovered that various cancers can be screened and diagnosed through rapidly changing QRS Complex of ECGs. Mouth, Hand and Foot Writings of right & left sides of body (which take 10 mins to complete) were developed& improved during past 15 years to make permanent medical record & quick non-invasive diagnosis & evaluation of any therapeutic effect of various cancers including brain tumors & bone marrow related malignancies including early stage of Hodgkins Lymphoma, Non-Hodgkins Lymphoma, Multiple Myeloma & various leukemias.
Dr. Omura (M.D) Yokohama City University, with internship at Toyoko University Hospital, Tokyo and Sc.D. - in Pharmaco-Electrophysiology of Single Cardiac Cells, Columbia University, New York), far-reaching expertise is rooted in a strong academic background involving an unusual combination of fields including experimental physics (B.S. in Applied Physics, Waseda University, Tokyo--the founder of the SONY Corporation graduated from the same Engineering School--and three years in Graduate Experimental Physics, non-matriculated, Columbia University), medical electronics (Research Professor, Department of Electrical Engineering, Manhattan College, where he introduced the first course in Biomedical Electronics), and basic and clinical medicine (Research Fellow in Cardiovascular Surgery, and Residency at the Cancer Research Hospital, Columbia University) from both Western and Oriental perspectives (several teaching and research Professorship appointments at various universities in Japan and the U.S.).
In an elderly population, many patients are suffering from multiple and multilocular cardiovascular diseases. Age and multimorbidity are limits for conventional open heart surgery. New hybrid interventions are offering treatment options also for this growing group of patients: Patients with cerebrovascular disease and often status post stroke are frequently also suffering from degenerative aortic valve disease. In a specially developed hybrid procedure, a typical endarterectomy of the affected carotid artery, mostly under local anesthesia, is performed first and afterwards, via a vascular graft anastomosed to the patients common carotid artery, a catheterbased aortic valve replacement (TAVI) is added. All of our first 4 patients were discharged home without new neurologic pathologies. Many elderly patients are referred to us for a TAVI procedure but preoperative investigations reveal further significant cardiac pathologies as coronary artery disease with severe left main or diffuse triple vessel involvement, further valvular disease or even congenital defects. In a novel hybrid approach, we address the other pathologies in a typical way and finally insert a TAVI valve under direct vision via a small mini aortotomy. So the aortic valve replacement does add no more than 10 minutes to the cross clamp time and such, even complex operations may be performed in very old and multimorbid patients with a reasonable risk, as to be seen in more than 20 patients of our group. Conclusion: With new hybrid approaches, even complex cardiovascular pathologies in elderly and multimorbid patients can be treated with an acceptable risk and good results.
Rainer Moosdorf MD, PhD, has studied medicine and dentistry before he started his specialization in cardiovascular surgery at the University Hospital Giessen. After 2 clinical and research sabbaticals at the Heinemann Research Center and Carolinas Heart Center in Charlotte/NC he became a full professor for cardiovascular surgery at the University Hospital in Bonn and vice - director of the department in 1990. His research was already at that time focused on arrhythmia and endovascular surgery. 1994 he was appointed as full professor and chairman of the department for cardiovascular surgery at the University in Marburg. Besides his established research activities which were continuously funded by public grants, he recently also participated in a research group dealing with psychological influencing of outcome after open heart surgery. He is a FAHA and member of the critical care working group of the STS.
Myocarditis is an important cause of acute and chronic heart failure. We wanted to determine whether purified exosome product (PEP) can improve and/or prevent myocarditis using a preclinical mouse model of myocarditis. Because estrogen protects women from myocarditis and heart failure we also tested premenopausal PEP (pmPEP). To determine the appropriate dose of PEP/pmPEP, we administered PEP and pmPEP vs. PBS controls ip to male BALB/c mice at day -1, 0 and +1 after viral infection to induce myocarditis and harvested mice at day 10 post infection (pi) during the peak of acute myocarditis. We found that the dose and exposure route was successful. We found that pmPEP, but not PEP, significantly decreased acute myocarditis based on histology (ANOVA p=0.0009). and decreased total immune cells (CD45 p=0.008), macrophages, neutrophils and mast cells (CD11b p=0.04), macrophages (F4/80 p=0.009), and T cells (CD3 p=0.02, CD4 p=0.01) but no other immune cell populations in the heart. Markers for both M1 and M2 macrophages were also significantly decreased with pmPEP treatment, indicating a global decrease in inflammation. Importantly, CR1, the central inhibitor of the complement cascade, was significantly increased by pmPEP but not PEP (p=0.004). Next we treated male BALB/c mice with PEP, pmPEP or PBS ip on day 8, 9 and 10 pi (a clinically relevant timepoint) and harvested on day 11 pi during acute myocarditis. Here we found that both PEP and pmPEP significantly reduced acute myocarditis compared to controls (ANOVA PEP p=0.006, pmPEP p= 0.005). These findings suggest that PEP/pmPEP could be given to patients who come in with acute onset myocarditis to decrease the severity of disease and potentially prevent sudden death.
Dr. Fairweather obtained her PhD in Immunology and Microbiology from the University of Western Australia in 2000 examining how viral infections could cause autoimmune heart disease. She conducted her Postdoctoral Fellowship at Johns Hopkins University School of Medicine in Baltimore, Maryland with Dr. Noel Rose, MD, PhD, who is credited with coming up with the idea of autoimmune disease, where she developed a new translational model of inflammatory heart disease. She then joined the Johns Hopkins Bloomberg School of Public Health Department of Environmental Health Sciences in 2005 where she continued to examine how sex hormones, infections and chemicals could drive autoimmune and cardiovascular diseases. Recently she joined Mayo Clinic in Jacksonville, Florida as Director of Translational Research for the Department of Cardiovascular Diseases where her work focuses on translational bedside to bench projects. Her lab is involved in projects examining sex differences in biomarkers and new therapeutics for diseases like myocarditis, dilated cardiomyopathy, pulmonary hypertension and kidney stone disease, for example. She is also an Associate Professor in the Department of Immunology and Medicine at Mayo Clinic and maintains an Adjunct Faculty appointment at Johns Hopkins Bloomberg School of Public Health with a joint appointment in the School of Medicine Department of Pathology. She has 73 publications including 9 book chapters. Dr. Fairweather has received National Institutes of Health, American Heart Association, private and industry funding for her research.
Sudden cardiac death(SCD)-caused by ventricular fibrillation(VF) or standstill- occurs in about 350.000 persons every year in US alone(1000/day!) and in about 3 million worldwide and the majority of them occur in the low-risk group at relatively younger age, in their best years of life, usually witnessed -at home or office. Since survival drops by 10% for every minute delay-only few(5%)- survive: no ambulance in the world will be quick enough to save them or leave them without neurological damage that will put them in a nursing home, at a huge cost for family or society. Since SCD may occur in apparently healthy people, without any preceding symptoms-all people, especially above age 40 or at risk for myocardial infarction-are at risk. Therefore every home or office should have a defibrillator device, exactly like they have fire-extinguishers, but isn't our life more precious than our home? Of course the first group in urgent need for such a device is the high risk group for sudden death-those with reduced heart function and heart failure after heart attacks- part of them will get automatic implantable defibrillators(AICDs)-at a cost of approximately 20.000$ each, but those uninsured or not eligible due to co morbidities or older age or during the first month after acute MI or CABG and the big rest of the world (developing countries)-no economy there can afford AICD implantation to all who need it-and it will be recommended by physicians to have at least a low-cost automatic external defibrillator(AED)- at home. AICDs-need surgical implantation and may deliver inappropriate shock-thus are risky and related to grave psychological burden on the patients in whom they are implanted, with end-of-life dilemmas. They need constant follow-up in dedicated centers and surgical battery replacement. The existing AEDs, that are now distributed in public places such as in airports, airplanes and schools - although approved by FDA for home use several years ago, since they are safe,-are not a good solution for home-use, due to their high cost (about1000-2000$ each)for battery and capacitor not needed in TED- and their big maintenance problem-such a device that lies for years in the office or home and not in use-may not work in the instance you urgently need it due to battery or capacitor failure. They do not have pacing capabilities due to their limited energy source. Our TED device, modifies by computer the sinusoidal alternating electrical current from the mains to a biphasic defibrillatory wave, similar to that of a standard AED. Since it derives its energy from the mains, it will always be operational, as long as it will be plugged in via a running cord to the mains outlet and its cost-affordable to every household-about 300$ only-and even less if mass production(as expected) will be used..In addition since there is no need to charge the capacitor it may deliver immediately repeated shocks in case of failed shocks, at a higher energy and to externally pace the heart in case bradycardia or standstill caused SCD or it occurred after the electric shock. It may also use rapid pacing to stop ventricular tachycardia instead of shock-all these features cannot be delivered by existing AEDs. New pulse sensor technology-like Apple watch or Cardiacsense-will allow detection of SCD even if it occurs during sleep or the person lives alone and will alert nearby people to enter the room and use TED to save him. Our device, which uses a new, breakthrough technology-protected by patents , will drastically reduce the huge number of sudden cardiac deaths-as well as may be reimbursed by insurance companies or HMOs. In order to prove the safety and feasibility of TED -we performed 2 animal experiments: in the first-we used a pig model; defibrillation thresholds were compared to that of a standard defibrillator using a step-down protocol and found to be identical. The paper describing this new technology was published in Europace journal 2010 and received the Neufeld prize from the Israel Heart Society. The second experiment-done recently, used a rat model: six rats, underwent a mid LAD coronary surgical closure at 3 months age and 3 months later VF was induced and TED defibrillation was successfully achieved in all, repeatedly. External pacing was successfully achieved using TED in all ,at a heart rate above their sinus rate, for an unlimited time before and after defibrillation. We conclude that modified alternating shock delivered by our device-TED- is feasible and as effective as that of the standard biphasic direct current defibrillator-thus will apply for 510k approval. This low-cost new technology should be used to treat sudden cardiac arrest occurring at home/office and implemented in AEDs to solve a huge unmet need, for an unlimited market.
Prof. Teddy Weiss has completed his MD in 1974 from Hebrew University School of Medicine and cardiology at Hadassah hospital in 1976 and postdoctoral studies at Cedars-Sinai cardiology center in Los-Angeles in 1984 .Since than he is a fellow of the American College of Cardiology. He was the director of the coronary care unit at Hadassah for 30 years and is the co-chairman of the Jerusalem Cardiology Chapter for the last 25 years. He is now the director of the Cardiac Rehabilitation center at Hadassah hospital and has published more than 250 papers in reputed journals with a great impact on nuclear and interventional cardiology and early pre-hospital thrombolysis for acute myocardial infarction.
A new systems approach to diseased states and wellness result in a new branch in the healthcare services, namely, personalized medicine (PM). To achieve the implementation of PM concept into the daily practice including clinical cardiology, it is necessary to create a fundamentally new strategy based upon the subclinical recognition of bioindicators (biopredictors and biomarkers) of hidden abnormalities long before the disease clinically manifests itself. Each decision-maker values the impact of their decision to use PM on their own budget and well-being, which may not necessarily be optimal for society as a whole. It would be extremely useful to integrate data harvesting from different databanks for applications such as prediction and personalization of further treatment to thus provide more tailored measures for the patients and persons-at-risk resulting in improved outcomes whilst securing the healthy state and wellness, reduced adverse events, and more cost effective use of health care resources. One of the most advanced areas in cardiology is atherosclerosis, cardiovascular and coronary disorders as well as in yocarditis. A lack of medical guidelines has been identified by the majority of responders as the predominant barrier for adoption, indicating a need for the development of best practices and guidelines to support the implementation of PM into the daily practice of cardiologists! Implementation of PM requires a lot before the current model physician-patient could be gradually displaced by a new model medical advisor-healthy person-at-risk. This is the reason for developing global scientific, clinical, social, and educational projects in the area of PM to elicit the content of The new branch. (1) T.A. Bodrova, D.S. Kostyushev, E.N. Antonova, Sh. Slavin, D.A. Gnatenko, M.O. Bocharova, M. Legg, P. Pozzilli, S.V..Suchkov. Introduction into PPPM as a new paradigm of public health service: an integrative view EPMA Journal, 2012, 3, 16, P. 3-16 (2) Sergey Suchkov. Predictive, Preventive and Personalized Medicine (PPPM) as an integrative part of national healthcare services to move ahead In: Proceedings (Programme Book) of the ESBB Annual Meeting, Verona, Italy, October 8th-11th, 2013, P. 30-31, S-13 (3) I.A. Sadkovsky, O. Golubnitschaja, M.A. Mandrik, M.A. Studne-va1, H. Abe, H. Schroeder, E.N. Antono-va, F.Betsou, T.A. Bodrova, K. Payne, S.V. Suchkov. PPPM (Predictive, Preventive and Personalized Medicine) as a New Model of the National and International Healthcare Services and Thus a Promising Strategy to Prevent a Disease: From Basics to Practice. International Journal of Clinical Medicine, 2014, 5, 855-870 (4) Zemskov VM, Alekseev AA, Gnatenko DA, Kozlova MN, Shishkina NS, Zemskov AM, Zhegalova IV, Bleykhman DA, Bahov NI, Suchkov SV. Overexpression of Nitric Oxide Synthase Re-stores Circulating Angiogenic Cell Function in Patients With Coronary Artery Disease: Implications for Autologous Cell Therapy for Myocardial Infarction. The Journal of the American Heart Association, 2016, 5, 1-18 (5) Zemskov, A., Zemskov, V., Zemskova, V., Buch, T., Cherno-va, L. Bleykhman, D., Marshall, T., Abe, H., Zhegalova, I., Barach, P. and Suchkov, S. A STEPWISE SCREENING PROTOCOL TO SECURE THE MODULE-BASED TREATMENT FOR MANAGING IMMUNOPATHOLOGY. International Journal of Information Research and Review, 2017, Vol. 04, Issue, 01, pp. 3507-3510
Sergey Suchkov was born in the City of Astrakhan, Russia, in a dynasty of medical doctors, graduated from Astrakhan State Medical University and was awarded with MD. Then maintained his PhD and Doctors Degree. And later was working for Helmholtz Eye Research Institute and Moscow Regional Clinical Research Institute (MONIKI). Dr Suchkov was a Secretary-in-Chief of the Editorial Board, Biomedical Science, an international journal published jointly by the USSR Academy of Sciences and the Royal Society of Chemistry, UK. At present, Dr Sergey Suchkov is: (i) a Director, Center for Personalized Medicine, Sechenov University, (ii) Chair, Dept for Translational Medicine, Moscow Engineering Physical University (MAPhI), and (iii) Secretary General, United Cultural Convention (UCC), Cambridge, UK. A Member of the: New York Academy of Sciences, American Chemical Society (ACS), American Heart Association (AHA), AMEE, Dundee, UK; EPMA, Brussels, EU; PMC, Washington, DC, USA and ISPM, Tokyo, Japan.
IT networks of hospitals are promising targets for cyber in particular ransom attacks, because short term availability of medical data may be of vital importance and confidentiality of health data is a regulatory issue (HIPAA). Since hospitals are open systems for patients, employees and other stakeholders risks for intrusion are not controlled by a perimeter defense alone. Moreover, the introduction of wireless networks (WIFI/WLAN) and a pervasive digital transformation of communication, processes and documentation enhance vulnerability. Executives under-invest in cyber security and staffing is critical as budget resources are limited.
Thus, professional risk management is of vital importance. An appropriate information security managements System (ISMS) may be installed and maintained according to ISO 27001 or national regulatory frameworks. This presentation covers some selective critical issues and first line considerations for small and medium sized companies/hospitals.
First CEO and leading management must be convinced and involved. An ISMS may be established by a project but must be maintained as a persisting process. Sources of intrusion comprise employees, patients , processes and technical infrastructure. A balanced and effective ISMS must go beyond merely technical solutions and has to account for all these vulnerabilities. A comprehensive and continuously updated ISMS plan must be established and maintained. An efficient and fast deployment comprises a combination of the following:
1. Implement simple measures with general impact, if not already in place, e.g. firewall, antivirus, sandboxing, logical or/and physical separation of networks, frequent back-ups, white-listing...
2. Establish a security-monitoring-concept (e.g. rights an roles, audit-trail ...), 3. Define, communicate and update an emergency plan (e.g. alarms, reponsible staff, first aid...)
4. Triage of risks by identification of valuable assets (e.g. sensible data...)and weak spots in particularly critical environments (e.g. medical devices in the operation theater, catheterization laboratory or intensive care unit...), Top level criteria may be potential harm(e.g. death, permanent impairment, no significant hearm), access time as critical factor (e.g. availability demands high, medium or low) and probability of event (e.g. Pareto-principle),
5. Integrate risk management into tenders and new investments and projects concerning medical devices and IT from the beginning (e. g. according to IEC 80001). ISMS should be enforced by fostering risk culture by communication and instruction amongst employees. Preventive strategies should be installed.
The ISMS should be systematically extended to all critical environments and to all sensible data. An anonymous critical incident reporting system may help to identify and prevent looming dangers. Surveillance of network traffic may identify abnormalities and violations of rules. Modern cybersecurity intrusion detection systems use sophisticated methods of data mining and machine learning.
Dr. Wellnhofer has completed his MD in 1984 at Technical University in Munich and his PhD 2010 at Charite University Medicine Berlin on the field of modelling and simulation in cardiac imaging. He has done studies in informatics and statistics as well as health economy. He is clinical cardiologist, scientist and university teacher. His fields of work are cardiac imaging in particular of coronary atherosclerosis, biomedical informatics and statistics, regulatory issues regarding software as medical device and health technology assessment. He published more than 90 papers in reputed journals and holds several patents. His h-index is 24.Recently he has completed succesfully several MOOCS in data science and machine learning. After his retirement December 2017 he will be working as guest researcher at the Institute of Computer-assisted Medicine at the Charite - Medical University Berlin. Moreover he will continue to work with German Heart Center on a medical device project funded by the German Federal Ministery of Education and Research..
Wearable devices have gained a momentum in being utilized in the health care system. The in-take of smart devices have started in the commercial health and fitness arena. Activity trackers HR monitors with GPS systems have become part of our normal living to gain motivation and check activity that could lead to healthier life and preventing disease development. With the advent of new biosensor technologies wearable devices have been developed that can monitor vital signs including HR, body temperature, respiratory rate, blood pressure, pO2 and can derive ECG. In this keynote lecture the current place of wearable devices in primary prevention and in the healthcare system will be reviewed.
Professor Attila Kardos is a consultant cardiologist at Milton Keynes University Hospital and has a Honorary Chair in the University of Buckingham. He is also a Hon Senior Lecturer to the Division of Cardiovascular Medicine, Radcliffe Department of Medicine Oxford University. He is a clinical lead in multimodality Cardiovascular Imaging and a Vice Chair of Research and Development and is the lead of the Cardiovascular Research Unit in the Trust. His research interest includes advanced imaging based recognition or cardiovascular pathologies utilizing Cardiac MRI , Cardiac CTA, and advanced echocardiography. In addition, he is a principle investigator in a clinical trial incorporating wearable devices in the hospital setting. His earlier research encompasses exercise physiology and the influence of the autonomic nervous system on exercise performance. Prof. Kardos is a local PI in several commercial and non-commercial clinical trials. He is also a member of several Editorial boards of a variety of scientific journals.
The theory of large elastic deformation of the myocardium was applied to derive a mathematical expression for the non-linear end-systolic pressure-volume relation (ESPVR) in the heart ventricles. Relations between the ejection fraction (EF) and the parameters describing the ESPVR have been calculated. These relations can be applied to the study of the problem of heart failure with reduced or preserved EF (HFpEF). Applications to clinical data published in the literature show the consistency of the mathematical formalism used. The results presented in the figure show a possible application, a relation between the percentage occurrence of heart failure (HF) and EF has been extended to obtain a relation between percentage of heart failure and the ratio SW/TW (SW = stroke work, TW = total area under the ESPVR), as well as with the ratio (SWx -SW) /SW ( SWx = maximum stroke work corresponding to a given ESPVR). The quantity SWR = SWx - SW is the stroke work reserve. The figure shows an optimal value for SW /TW ≈ 0.4, and an optimal value for SWR/SW ≈ 0.5. The results presented in the figure correspond to five clinical groups of patients: normal *, aortic stenosis o, aortic valvular regurgitation +, mitral regurgitation ^, miscellaneous cardiomyopathies x Note that the normal group (*) appears near the minimum of both curves (corresponding to EF ≈ 0.67).
Rachad Mounir. Shoucri has a B.Sc. in Electrical Engineering from Alexandria University, Egypt, a M.Sc. in Optical Physics, and a Ph.D. in Theoretical Physics from Laval University, Quebec, Canada. After graduation in 1975, he worked for five years at the Hopital Saint-Sacrement and the Institut de Cardiologie de Quebec where he developed his current interest in mathematical physiology and in the application of mathematics in cardiology. Since 1981 he is with the Department of Mathematics and Computer Science at the Royal Military College of Canada, Kingston, Ontario, where he is now Professor Emeritus.
An association of endothelial NO synthase gene polymorphism with arterial stiffness has been widely investigated but that with timing structure of cardiac cycle and subendocardial viability ratio (SEVR) is unclear. Augmentation pressure (AP), augmentation index (AIx75), aorta-to-radial pulse pressure amplification (Ampl), time to reflection wave, relative systole duration and SEVR were assessed by pulse wave analysis in 65 apparently healthy residents of the middle Kola Peninsula (68 N) (32 women) aged 27-65 years. The insertion/deletion 4a/4b NO synthase gene polymorphisms were determined by PCR. Paired comparisons were conducted to test differences between II and ID genotypes (DD genotype was presented in two individuals only and was exluded from the analysys). For male subjects, heterozygote allele carriers (ID) had higher values of AP (p=0.004, Mann-Whitney test), AIx (p=0.029), and lower Ampl (p=0.007) than II carriers, i. e. had stiffer arteries. Women with ID haplotype had higher aortic systolic (p=0.046) and mean (p=0.080) blood pressures, left ventricular ejection duration (p=0.090) and lower SEVR (p=0.043) compared to II carriers. It is concluded that individuals carrying ID genotype of NOS3 polymorphism have stiff arteries and seem to be at high risk for cardiovascular diseases.
Vladimir N. Melnikov is a Senior Reseacher and Associate Professor at the Institute of Physiology and Basic Medicine in Novosibirsk, Russia. He has graduated from the Novosibirsk State University and completed his Ph.D. thesis on the circadian chronoendocrinology of adrenals. In 2009, he obtained his Dr. Sc. degree in Human Ecology. At different stages of his scientific carier he worked as clinical physiologist and lecturer (Novosibirsk State University, courses on Ecology and Physical Anthropology). He supervised three graduate students and three MD students. His list of publications includes 103 papers and four monographs.
Rationale: For the last decade, stem cell therapies have emerged as one of the most highly investigated treatments for cardiovascular disease. Most of preclinical and clinical research has been conducted to aim at the recovery or regeneration of ischemic myocardium in adult patients and less attention was paid to the patients of pediatric heart failure. Since 2011, we started intracoronary administration of cardiosphere-derived cells (CDCs) in patients with hypoplastic Left Heart Syndrome(HLHS) and single ventricles(SV). Objective: To investigate mid-term follow up result of CDC infusion to the patients with HLHS and SV. Methods and Results: We evaluated the effectiveness of CDCs using an integrated cohort study in 101patients with HLHS and SV, including 41 patients that received CDC infusion and 60 controls treated with staged palliation alone. Atrial tissue was obtained during bi directional Glenn(BDG) or Fontan operation to isolate CDCs. The cells were cultured to reach a cell number of 30,000 per kg of body weight and then infused into the coronary artery by cardiac catheterization 1 month after the surgical procedure. Phase I trial (TICAP trial) was to evaluate stem cell therapy in infants with HLHS (7 treated and 7 control patients). Phase II trial (PERSEUS) was to verify the efficacy of stem cell therapy to a total of 34 patients, randomly assigned to the treatment or control group in a 1:1 ratio. In Phase II, we expanded indication to the patients with SV. Ejection fraction is assessed by echocardiography, ventriculography, and cardiac MRI at 3 and 12 months after treatment and compared with that of the control group. Using cardiac magnetic resonance late gadolinium enhancement, we also assess myocardial fibrosis, which was not investigated in the phase I study. CDC infusion increased ventricular function (stage 2: +8.4% (+)(-) 10.0% vs +1.6% (+)(-) 6.4%, P=0.03; stage 3: +7.9% (+)(-) 7.5% vs -1.1% (+)(-) 5.5%, P<0.001) compared with controls. Survival did not differ between the 2 groups, whereas overall patients treated by CDCs had lower incidences of late failure (P=0.022), adverse events (P=0.013), and catheter intervention (P=0.005) compared with controls. Conclusions: Intracoronary administration of CDCs in patients with HLHS and SV showed favorable effects on ventricular function and was associated with reduced late complications after staged procedures.
Dr. Shunji Sano is a pediatric heart surgeon who treats children born with heart defects. Over the course of his career, Sano has performed more than 7,000 pediatric cardiac surgeries.
Sano is world renowned for surgical innovation. He pioneered a procedure to treat hypoplastic left heart syndrome that is now called the Sano procedure and used by many pediatric cardiac surgeons throughout the world. His research interests include heart stimulation, neonatal surgery and progenitor cell therapy - also called stem cell therapy.
After earning his medical and doctoral degrees at Okayama University Medical School in Japan, Sano completed residencies in general surgery at Okayama University Hospital and Hiroshima City Hospital. He completed fellowships in cardiovascular surgery, cardiothoracic surgery and pediatric cadriothoracic surgery at Hyogo Kenritsu Amagasaki Hospital, Okayama University Medical School, Green Lane Hospital in New Zealand and the Royal Children's Hospital in Australia.
Sano became a youngest consultant cardiac surgeon in pediatrics at Royal Children's Hospital at age 37. At age 41, he became a youngest professor and chairman at Okayama University Medical School and served in those posts for 24 years. Sano is now a professor of surgery at UCSF.
Objective: The issue whether radial artery (RA) as third arterial conduit in addition to bilateral internal thoracic artery (BITA) is associated with better survival than saphenous vein (SV) remains undetermined. A retrospective propensity score matching analysis was conducted to study the impact of BITA+RA on long-term survival compared to BITA+SV. Methods: Study population included a selected low-risk group of 206 patients undergoing BITA grafting with RA as third arterial conduit (BITA+RA) and 469 subjects undergoing BITA grafting with additional SV graft (BITA+SV). RA was considered only for target stenosis of at least 80%. We finally obtained 190 propensity score-matched pairs for comparison.
Dr. Francesco Formica obtained his medical degree in 1992 at University of Catania (Italy) and his postgraduate diploma of Cardiac Surgeon in 1998 at the same University. Since 2002 he is appointed as Assistant Professor of Cardiac Surgery at University of Milano-Bicocca (Italy) and Consultant Cardiac Surgeon at San Gerardo Hospital in Monza (Italy). His interests regard all aspect of acquired cardiac disease in the adult population with particular attention to the total arterial myocardial revascularization, mitral valve surgery, aortic valve surgery and the surgery of the congestive heart failure. Since 2012 dr. Formica is coordinator of the mechanical circulatory support program in cardiac surgery (LVAD program) at San Gerardo Hospital. He has published more than 50 articles in international and reputed Journals and serving as reviewer of many of them.
Pulmonary arterial hypertension (PAH) is a fatal disease characterized by vascular remodeling leading to high pulmonary arterial pressure (PAP) and right ventricular (RV) heart failure. Gene therapy is a promising approach to treat PAH. The most used monocrotaline (MCT) rat model of PAH does not mimic the pathophysiology of the PAH in humans. A refined rat model however, the pneumonectomy plus MCT (PNT-MCT), displays all of the features of PAH and most importantly plexiform lesions whereby therapeutics aim to reverse. In this study, we investigated whether intratracheal delivery of sarcoplasmic reticulum calcium ATPase (SERCA2a) gene reverse the severity of PAH in the PNT- MCT model. Left pneumonectomy was performed in rats. One week later, the animals received the MCT injection. At 3 weeks, the severity of PAH disease was confirmed. Thereafter, PNT-MCT rats received either intratracheal delivery of gene construct with adeno-associated virus/SERCA2a (AAV1/SERCA2a) or saline. Hemodynamic parameters were determined by magnetic resonance imaging (MRI) and RV catheterization. RV hypertrophy, heart and lung fibrosis were assessed. Molecular biology assays for gene expression and immunostaining were used to quantify SERCA2a and disease markers. Four weeks after gene delivery, RV function was improved in AAV1.SERCA2a treated-animals with an increase of stroke volume and ejection fraction compared to saline group (275 (+)(-) 22 l vs. 192 (+)(-) 22 l and 56 (+)(-) 3 l vs. 44 (+)(-) 3 l, p<0.05), while RV end systolic volume was decreased (199 (+)(-) 16 l vs. 283 (+)(-) 24 l, p<0.05). Hemodynamic parameters including mean pulmonary pressure were improved in AAV1.SERCA2a group (26 (+)(-) 3 mmHg vs. 61 (+)(-) 6 mmHg and 21 (+)(-) 3 mmHg vs. 41 (+)(-) 3 mmHg respectively, p<0.01) compared to control. RV hypertrophy was reduced in AAV1.SERCA2a treated animals (0.37g (+)(-) 0.03 vs. 0.63g (+)(-) 0.02, p<0.0001). All serotypes of collagen demonstrated decreased expression after AAV1/SERCA2a administration. Histologically, the animals after gene therapy showed a significant regression of plexiform lesions from grade 4 to grade 1-2. In conclusion, intratracheal administration of AAV1/SERCA2a gene can reverse the severe PAH phenotype and may be considered as a potential treatment.
2001-2005: Graduate Research Fellow, University PARIS XI. Faculty of Pharmacy, Chatenay-
Malabry and Pitie-Salpetriere Hospital INSERM/UPMC UMRS 956, Paris, France
2005-2006 Postdoctoral Training. INSERM/UPMC UMRS 956, Pitie-salpetriere Hospital, Paris,
France, (Mentor: Dr Anne-Marie Lompre).
2006-2007: Research Fellow in Medicine, Cardiovascular Research Center, Massachusetts General Hospital and Harvard Medical School, Boston (Mentor: Dr Roger J. Hajjar). 2007- 2009 Research Fellow, Cardiovascular Research Center, Icahn School of Medicine at Mount Sinai, New York (Mentor: Dr Roger J. Hajjar).
2009-2016: Instructor Cardiology, Cardiovascular Research Center, Icahn School of Medicine at Mount Sinai, New York.
2017: Assistant Professor, Cardiology, Cardiovascular Research Center, Icahn School of Medicine at Mount Sinai, New York.
Obesity is a growing public health problem, afflicting 600 million people worldwide in 2014 (WHO fact sheet #311), predisposing to diabetes, heart disease, and cancer, and inflicting healthcare costs over 100 billion dollars in the U.S. alone. Obesity is characterized by a tremendous increase in adipose tissue that is in large part due to massive volumetric expansion of the constituent adipocytes. There is a longstanding concept that metabolic disease in obesity is associated more with adipocyte size than numbers. In support of this concept, recent studies have highlighted a connection between adipocyte size and membrane tension with adipocyte signaling and adipogenesis - suggesting adipocyte-autonomous mechanisms of lipid homeostasis. Here, we demonstrate that a Lucine Rich Repeat Containing Protein 8a, LRRC8a, is required for a volume/mechano-sensitive current in adipocytes, endothelial cells and human atrial cardiomyocytes. We find that LRRC8a is induced and activated in hypertrophic adipocytes in the setting of obesity and is required for adipocyte hypertrophy and glucose uptake. In vivo, both shRNA-mediated LRRC8a knock-down and adipose-targeted LRRCC8a deletion reduce adipocyte size and fat mass in obese mice. These studies identify the volume-sensitive molecule LRRC8a as a cell-autonomous sensor of adipocyte size that regulates adipocyte growth, insulin sensitivity and glucose tolerance in the setting of obesity. As LRRC8a is broadly expressed, and PI3K-AKT pathway ubiquitous, and fundamentally intertwined with numerous signaling pathways we anticipate that LRRC8a signaling will be physiologically and pathophysiologically important in a multitude of different tissues and disease states.
Dr. Yanhui Zhang has completed her Ph.D from the University of Hong Kong and postdoctoral studies from University of Connecticut Health Center and University of Iowa. During her research career, she has been awarded many prizes and AHA postdoctoral fellowship. She has published papers in high-ranked journals such as Nature Cell Biology, Nature Communications, Cardiovascular Research and Basic Research in Cardiology. Dr. Zhang is an associate professor in Xiamen University. Her current research interest is mechanosignaling in cardiovascular diseases.
Background : The goal of this study was to compare survival between trans-catheter mitral valve (MV) repair using Mitral Clip system) , Mitral valve repair -surgery, and conservative treatment in high-surgical-risk patients symptomatic with severe mitral valve regurgitation (MR). Mitral valve repair (MV‐repair) is the gold standard treatment for MV disease Up to 50% of patients with symptomatic severe MR are denied for surgery due to high perioperative risk. Trans-catheter MV repair might be an alternative. Furthermore, surgical correction for functional MR is controversial with suboptimal outcomes and significant perioperative mortality. The percutaneous Mitral Clip implantation can be seen as a viable option in high surgical risk patients Methods and Results: Extracting the data base on methodology, using a quality criteria, and standard form, and outcome measures. explored for patients who underwent Mitral Valve Repair Surgery & Mitral Clip between 2011 and 2017. Survival data . Total of 327 patients with MV disease, 171 were aged ≥70 years. Patients with repeat cardiac Thirty‐day mortality was 6.3 % (MV‐repair) versus 8.2% (mitral valve replacement. patients in the Mitral Clip group were significantly older , had significantly lower LVEF and significantly higher EuroSCORE The number of patients with post-procedure residual MR severity >2 was significantly higher in the MitraClip group compared to the surgical group (20.4% vs. 0.6%). Conclusions: It can be achieved excellent outcomes after MV Repair surgery in elderly patients. Long‐term survival is superior after MV‐repair and the re‐operation rate is low. MV‐repair should be the preferred surgical approach in elderly patients. Despite a higher risk profile in the Mitral Clip patients compared to surgical intervention, the clinical outcomes were similar although surgery was more effective in reducing MR in the early post procedure period. We conclude the value of the Mitral Clip as a treatment option for severe, symptomatic MR in comparison to conventional valvular surgery.
Dr. Hatem Al-Masri is a cardiac critical care intensivist and consultant of cardiac surgery. Dr. Al-Masri completed his medical degree (M.D.-Doktorate) at Charles University - Faculty of Medicine, holds a degree in biochemistry from the University of Waterloo - Canada, completed his residency training in Germany (Leading Facharzt) and holds training fellowships in Cardiac Surgery from IJN KL Malaysia, Switzerland, and Canada. Dr. Al-Masri is the author of an award-wining medical research paper titled Hemodynamic Support Requires Integrated Approach Comparing LVAD vs. IABP in Patients Experiencing Left Venticular Failure (Best Paper of Young Cardiac Surgeon) at the 8th International Congress of Update in Cardiology and Cardiovascular Surgery (UCCVS 2012) awarded by European Society for Cardiovascular Surgery, World Society of Arrhythmias (WSA ) and the Society of Cardiology and the International Academic of Vascular and Endovascular Surgery (ISCP). Dr. Al-Masri is a member of the Medical German Association, Malaysian Medical Association and the Saudi Medical Council.
Ventricular repolarization (VR) markers on 12-leads electrocardiogram have been found to be useful for predicting malignant cardiac arrhythmias in several clinical conditions. The corrected QT interval (QTc), QT interval dispersion (QTd), Tpeak-Tend (Tp-e), Tpeak-Tend dispersion (Tp-ed) and Tp-e/QT have been studied and implemented in clinical practice for this purpose. In this conference, it will be discussed how these markers have demonstrated to be effective to predict malignant arrhythmias in medical conditions such as long and short QT syndromes, Brugada syndrome, early repolarization syndrome, acute myocardial ischemia, heart failure, hypertension, diabetes mellitus, obesity and highly trained athletes. Also, the main pathophysiological mechanisms that explain the arrhythmogenic predisposition in these diseases and the basis for VR markers are debated.
Yaniel Castro-Torres is a medical doctor who graduated at the age of 25 years from Universidad de Ciencias Medicas from Villa Clara, Cuba in 2014. He graduated with a gold degree and the best academic file from his University. Currently, he is taking a residency in Cardiology at Hospital Universitario Celestino Hernandez Robau from Villa Clara, Cuba. He has participated in more than 10 international congresses and published 23 papers in reputed medical journals. He has been awared twice with the Best Oral Presentation Prize at international meetings and Student and Young Researchers Award from CITMA, Cuba.
According to the Heart and Stroke Foundation South Africa (HSFSA), cardiovascular diseases are one of the largest burdens to treat in South Africa. Heart disease and strokes are South Africa biggest killers after HIV/AIDS. Every hour in South Africa five people have a heart attack and 10 people have strokes. More South Africans die of Coronary Vascular disease than all the cancers combined. The significant therapeutic impact of echocardiography has been accentuated over the last few years, especially in South Africa. Therefor the demand for echocardiography has increased drastically. Echocardiography has been shown to have a positive impact on the management of critical patients and influences the clinical management of these patients. When echocardiography screening is implemented at an early stage then appropriate care can be given immediately and waiting times for referrals to tertiary care settings or specialists can be reduced. Echocardiography gives important anatomical and functional information about the heart. A study done at the University of Cape Town showed that 84% of patient management was impacted by echocardiography and 56% of the echocardiograms that confirmed the referring doctor's diagnosis still had a significant impact on the patients clinical management. The significant change in clinical management occurring as a result of echocardiography raises the question if this should not become a routine scan for most patients admitted with a history of cardiovascular disease. A large majority of tertiary centres in South Africa do not have access to echocardiography services. The lack of echocardiography training appears to be one of the main limitations of the rollout of this service to tertiary centres in South Africa. The demand to access this service and the need for training in echocardiography has been highlighted in previous studies. The significant impact that echocardiography may have on the management of patients in the general wards or ICU suggest that appropriate training in echocardiography should be incorporated into the curriculum of the MMed degree in all recognised specialities of Medicine in South Africa. These programmes should be structured to meet the Health Professions Council of South Africa requirements for specialisation in this field.
Arne Husselmann is vastly experience in Clinical Technology, she relocated to Cape Town following graduating with a Bachelor degree in Clinical Technology, specializing in Cardiology at the University of Technology located in the Free State,South Africa. She gained a great deal of exposure to diverse pathologies in equally adult and pediatric Cardiology. Following her graduation, she worked as Senior Cardiac Technologist in the Cardiology department at Tygerberg Hospital in Cape Town.She also worked at Christiaan Barnard Hospital as a Cardiac Technologist in Cape Town alongside some of South Africa's best Cardiologists where she then recognized her vision of commencing her own practice. She is presently established at Louis Leipoldt Medi-clinic that serves as the basis for the Mobile Echocardiogram Clinic that indicated excessive growth over the past two years. Her current work scope includes servicing Blaauwberg, Milnerton and Cape Town Med clinics. Her ability to manage a mobile clinic has vastly improved the report turnover time in the industry, she is ambitious to extend her services Nationally by the end of 2018 that will give the medical field an improvement with more sufficient service times and patient turnarounds.
Introduction: Coronary artery disease (CAD) is characterized by building up of atherosclerotic plaques in the coronary arteries. Recently, monocyte-to-high density lipoprotein ratio (MHR) has been proposed as a novel prognostic indicator of CAD. Myocardial perfusion imaging is a useful non-invasive imaging test to evaluate the suspected or known CAD and to predict the prognosis as well. In addition to the MPI, several MPI findings such as transient ischemic dilatation (TID) of the left ventricle (LV) can supply valuable information to the physicians without any extra cost or radiation risk to the patient. TID be used as a predictor of severe coronary artery disease (CAD) or future cardiac events. Aim: To the best of our knowledge, relationship between MHR and MPI findings such as TID in patients with suspected CAD has not stated clearly and this is the first study to evaluate the relationship between MHR and MPI parameters. In the light of relation between MHR and CAD, the goal of our study is to investigate the correlation between MHR and MPI findings. Methods: A total of 134 patients were included in our study. Patients were divided into groups according to the MPS findings and coronary angiography (CAG) results. They were evaluated due to possible cardiac events by gated single-photon emission computed tomography (GSPECT) MPI and coronary angiography (CA). Evaluations include the assessment of myocardial perfusion, wall motion and wall thickening and the measurement of LVEDV, LVESV, LVEF, SSS, SDS, SRS and TID parameters. We examined on these data to determine the value of TID. Their hematologic and biochemical data were obtained. The monocyte-to-high density lipoprotein ratio was calculated, and the relationship between the groups and the MHR was statistically analysed. Results: The MHR was statistically higher in the patients with ischemia detected with MPS, than in patients who had normal MPS values (2.63 (+)(-) 1.71 and 2.04 (+)(-) 1.05, respectively). Therefore, the MHR was similar between patients who were both CAG positive and had ischemic MPS according to MPS findings. In addition, the MHR was similar for patients who had both normal MPS and CAG negative. MHR was detected as an independent predictor for coronary artery disease on logistic regression analysis (p = 0.005, OR = 1.29, 95% CI: 1.082 - 1.539). Conclusion: The MHR is an independent predictor for coronary artery disease. a high TID value was found to be well-correlated with the high of MHR in patient with CAD. This novel index is a beneficial identifier to interpret the results of MPS in terms of increasing diagnostic accuracy. This may provide valuable information to select the high-risk patients.
I am Murat SADIC, Medical Doctor and I was working as Ass. Professor in Nuclear Medicine in University of Health Science, Ankara Training and Research Hospital, Department of Nuclear Medicine in Ankara/Turkey. I graduated from Gaziantep University, School of Medicine in 2011 and received my MD. I got specialty degree from Department of Nuclear Medicine, Ankara Training and Research Hospital, in Ankara, Turkey. I have studied with Prof. Dr. Abass Alavi in University of Pennsylvania, Department of Radiology, Quantitative Medical Imaging Lab as a research fellow based on PET quantification and published some important abstracts at the different important congress.
I have been honored and selected in my country as The Young Scientific Research Award of the Year, 2014, 2015 and 2016. I have studied in The Scientific and Technological Research Council of Turkey (TUBITAK) as Primer Investigator and Project Mentor. I also have some project awards, funding and honours. Some of my works have been recognized by other professional organizations, including awards by the TUBITAK, ASNC (American Society of Nuclear Cardiology- International Abstract winner.), Radiological Society of North America (RSNA- Trainee Research Prize), Turkish Society of Ophthalmology (The Young Scientist Research Award). Some of my abstract are presented a lot of times in international congress and have been awarded as 1st poster prize or international abstract winner.
My research has been focused on Nuclear Cardiology, Radioactive iodine therapy, radioprotective agents and Quantitative Nuclear Medicine fields. I have experience in all Scintigraphic methods (especially myocardial perfusion scintigraphy, bone, kidney, lung, gastrointestinal, spleen, liver, thyroid, salivary, C14 UBT, thyroid uptake, etc.), radionucleid theraphy (I-131 theraphy for hyperthyroidism, Y-90 theraphy for radiosynovectomy), experimental animal (rat) study and scan. I am a talented and dedicated medical professional.
Besides my practical experience, I have published over 50 scholarly articles, 33 abstracts so far. Most of them were indexed in Thomson Reuters's Web of Science (SCI, SCI-Expanded). I am the first author or co-author in most of these articles. Some of these articles and abstracts were published by the journals such as Nuclear Medicine Communication, Journal of Nuclear Cardiology, Journal of Nuclear Medicine, European Journal of Nuclear Medicine and Molecular Imaging, Andrology, Veterinary Research, etc. I am invited as a special speaker a lot of time and some of my studies were also accepted and presented at the American Society Nuclear Cardiology, Society of Nuclear Medicine (SNMMI) and Radiological Society of North America (RSNA), European Association of Nuclear Medicine (EANM)'s Annual Meetings/Congress. I was invited as one of the top 50 Future Cancer Research Leaders by IARC (International Agency for Research on Cancer) and WHO (World Health Organization) and also invited as one of the top 20 researcher all over the world by International Atomic Energy Agency to international scientific conference in 2015 and 2016.
In addition, I have been active in supervising and teaching activities of Nuclear Medicine Assistant/Resident education for post-graduate level in our department since 2012. He has been a Nuclear Medicine Lecturer since 2012 in our department. I also have served or has been serving on editorial boards of international journal and have been reviewing research manuscripts for high impact journals.
Intelligent phonocardiography (IPCG), as a screening tool for cardiac disease, has been recently reported in a number of the studies. It is indeed a computerized phonocardiography supported by the intelligent methods for processing and classifying heart sound signals. Inexpensiveness and non-invasiveness of IPCG attributes desirable features with this approach which can make the IPCG as an important decision support system in the clinical setting, especially when considering the fact that the screening accuracy is considerably low in the primary healthcare centers. Our longstanding studies on heart sound signal processing brought up the term intelligent phonocardiography within the context of biomedical engineering and extended application of the IPCG not only to screening cardiac disease, but also towards becoming a diagnostic tool for cardiac assessments. Screening aortic stenosis and grading severity of the underlying stenosis, screening children with congenital heart disease and children with bicuspid aortic valve, detecting ventricular septal defect and discrimination between pathological and physiological murmurs are considered as a few examples of IPCG capabilities. In all the applications, both the accuracy and the sensitivity of the approach were estimated to be well higher than 80%, showing a very good performance comparing to a general practitioner. It is even higher than the performance of typical cardiologists who rely on the conventional auscultation that is still considered as the first screening method. IPCG can be easily implemented in web and mobile technologies for the telemedicine purpose.
Dr. Arash Gharehbaghi, is a researcher in Biomedical Engineering domain at Malardalen University, Sweden. He received his MSc in biomedical engineering from Amir Kabir University, Iran, his second MSc in Telemedia, from Mons University, Belgium, and his Ph.D degree in biomedical engineering from Linkoping University, Sweden. He received the first prize of the young investigator from International Federation of Biomedical Engineering (IFBME), in the Nordic Baltic conference, 2014. His research is focused on innovative devices for heart disease assessments, specifically development of machine learning methods for processing heart sound signals toward the disease diagnosis. His longstanding studies on heart sound signal processing, within the last two decades, led to several international and domestic patents, financed by different incorporations, toward creation innovative diagnostic tools for heart disease assessments.
The importance of adenosine and ATP in regulating many biological functions has long been recognized, especially for their effects on the cardiovascular homeostasis which may be used for management of hypertension and cardiovascular diseases. In response to ischemia, ATP is broken down to release adenosine. The activity of adenosine is very short lived because it is rapidly taken up by myocardial and endothelial cells, erythrocytes (RBC), and also rapidly metabolized to oxypurine metabolites and other adenine nucleotides. Extracellular and intracellular ATP is broken down rapidly to ADP and AMP and finally to adenosine by 5-nucleotidase. These metabolic events are known to occur in the myocardium as well as in RBC. We investigate in this study the feasibility of exploiting ATP metabolism in the RBC as systemic biomarker for post exercise hypotension and cardiovascular protection. An experimental exercise rat model was used to probe the relationship between post exercise hypotension and ATP metabolism in the RBC. The cardiovascular protective effect of exercise preconditioning was further investigated in an acute myocardial infarction model using mortality and ATP metabolism in the RBC as endpoints. We have shown post-exercise hypotension correlated significantly with RBC concentrations of ATP, and that exercise pre-conditioning reduced cardiovascular mortality and breakdown of ATP in the RBC. The post exercise effect was greater in hypertensive than in normotensive rats. The presentation will also discuss the opportunities, challenges and obstacles of exploiting ATP metabolism as targets for drug development. Suppored in part by CIHR, NSHRF and DPEF.
Pollen Yeung completed his Ph.D from University of Saskatchewan (Saskatoon, SK, Canada) and is currently Professor of Pharmacy and Medicine (Cardiology) at Dalhousie University in Halifax, NS, Canada. He has published more than 90 peer reviewed articles in reputed journals and is currently Editor-in-Chief of Cardiovascular Pharmacology Open Access, and an editorial board member for Recent Review of Clinical Trials, Medical Sciences Monitor, Metabolites, Natural Products Chemistry and Research Open Access, Cardiovascular and Hematological Disorder Drug Targets, and Current Drug Safety.
Author: Paloma Manea Introduction: Heart failure with preserved ejection fraction(HFp EF) is a common syndrome. Because left ventricular (LV) ejection fraction (EF) is normal , it was assumed that HFpEF results from altered diastolic properties. Hypothesis: Combined echocardiography (ECHO) and rest gated myocardial perfusion SPECT(GSPECT) studies may play a synergistic role in LV diastolic function evaluation. Methods: We quantified LV diastolic function in 32 HFpEF patients (25 females, median age 62 yrs., body mass index of 30(+)(-)4kg/m2, EF >53%, systolic blood pressure 139(+)(-)18mmHg). Based on 2D ECHO/Doppler studies, peak early filling(VE) and late diastolic filling velocities(VA), the E/A ratio, deceleration time of early filling velocity (DT) were examined as predictors of diastolic dysfunction. Rest GSPECT (661(+)(-)242 MBq of 99mTc-Tetrofosmin) derived peak filling rate (PFR), time to peak filling(TTPF) and phase analysis including phase standard deviation(PSD) and phase histogram bandwith (PHB) were assessed at the level of septal and lateral wall using QGS Cedars Sinai Medical Center Cardiac Suite.Results: LVEF was normal by both methods. After age standardization , a decreased E/A ratio was found in 80% and increased DT in 19% of patients.QGS derived PFR and TTPF were abnormal in 22,respectively 47% of cases.E/A ratio positively correlated with PFR( r=0.54, P<0.001). In all patients with abnormal E/A ratio there was a significant difference (p<0.001) between septal PHB(26.82(+)(-)22.66 degrees) and SD(7.36(+)(-)7.84) versus lateral PHB(53.65(+)(-)55.70degrees) and SD(15.99(+)(-)17.35).Conclusions: Grade 1 diastolic dysfunction demonstrated by both methods is associated with significant septal -to-lateral dyssynchrony in patients with normal systolic function. Combined ECHO and rest GSPECT proven synergic in HFpEF evaluation.
Paloma Manea MD, Ph D is a Specialist in Cardiology and Senior in Internal Medicine, Competence in Echocardiography, Lecturer at Grigore T.Popa University of Medicine and Pharmacy, Iași, Romania.
She was admitted to Emil Racovița High School in 1980, at 1st position, with 10 mark (written test at Mathematics and Romanian Language). In 1984 , she occupied, through competition, 1st position (from 4,500 candidates), with 9.96 mark at Grigore T. Popa University of Medicine and Pharmacy, Faculty of Medicine (written tests at Biology, Chemistry and Physics).
She published and communicated ( in Romania, Spain, Italy, Turkey, United States of America, China) 106 scientific medical works and 5 medical books. The main research areas are related to myocardial ischemia, heart failure, angiotensin-renin-aldosterone system, correlations between dentistry and medical diseases, geriatric pathology, Marfan syndrome.
The presence of Fragmented QRS (fQRS) on a routine 12-lead electrocardiogram represents distortion of signal conduction and altered ventricular depolarization due to myocardial scar/ischemia or myocardial fibrosis in patients with myocardial infarction (MI). Fragmentation originates from injured tissue around an infarct scar where ventricular activation is delayed and asynchronous resulting in the RSR' pattern of the QRS complex. During the last decades, coronary heart disease, especially acute myocardial infarction(AMI) has been a major cause of death and disability problem worldwide. Most attention has been directed at the study of diagnosis and treatment of AMI. Fragmented QRS was independently related to major adverse cardiac events (MACE) and all-cause mortality in previous studies. This study focus on the short-term prognostic value of fQRS complex for patient with STEMI undergoing primary percutaneous coronary intervention(p-PCI).
From 1983 to 1988 studied in clinical branch of Tianjin medical university and recived my Bachlor degress. In 1992 I study in cardiovascular department of Tianjin medical university and recived my Master degress. finally, in 1997 I finished my Doctor degress.
From 1988 to present , I still working in cardiovascular department of the second hospital of Tianjin medical university as assistant doctor, chief doctor and now I am a director and professor of cardiovascular department. my major research field is interventional cardiology. now, I have finished coronary angiography over 3000 cases and over 250 cases of PCI by myself every year.
Life-threatening cardiac tachyarrhythmias are clinical symptoms of chaotic excitation waves, whose complex patterns are primarily based on interactions of tissue characteristics with the electrical signal conduction. However, research focused on clinically applicable defibrillation is often limited by a lack of detailed understanding of these interactions. State-of-the-art high-energy shocks are under suspect to induce severe side-effects, such as electroporation, which indicate a substantial medical need for potential energy reduction in defibrillation. Multisite-pacing strategies for low-energetic defibrillation (e.g. LEAP) aim at controlling rotating excitation waves by selectively recruit anatomical obstacles or heterogeneities in electrical conduction (e.g. vessels, fatty tissue, infarction scars). So far, our in vitro as well as in vivo results demonstrate control of contraction dynamics during cardiac activity, suggesting that this experimental approach will enable the development, validation, and optimization of cardiac arrhythmia controlling methods. Here, the design and the results of our pre-clinically research are discussed, also with regard to recent cardiac optogenetic developments.
Claudia Richter studied biology at the University of Rostock, with focus on physiology and forensic sciences. She received her Ph.D. in 2011 and since 2017 she is group leader of the Photogenics Group within the MPRG Biomedical Physics at the Max Planck Institute for Dynamics and Self-Organization in Gottingen, Germany. Her research interests include cardiac dynamics, biophysical and molecular research, biomaterials and optogenetic approaches.
Background: Despite strictly following the guideline-driven pharmacological therapies and careful transitional care, the rates of preventable hospital readmission of heart failure patients and associated costs remain unacceptably high. Accordiing to several data available from variour hospitals, nearly 25% of patients are still symptomatic at time of discharge. Objective: Purpose: The aim of this study is to identify different factors affecting the re-admissions of HF patients to the hospital due to congestive heart failure. Methods: A retrospective electronic chart review was completed on 100 patients with HF who were admitted into our medical center between 2010 and 2012. Patients were included if aged ≥ 18 years with one of the ICD - HF codes as the principal discharge diagnosis within the study period. The data collected included age, sex, prior diagnosis of HF, date of diagnosis, hospitalization for HF within 30 days of the index HF admission, comorbid conditions like Diabetes Mellitus, Hypertension, Hyperlipidemia, Vitals measurement like systolic blood pressure (BP), heart rate (HR), respiratory rate (RR), weight, along with serum sodium and potassium, blood urea , serum creatinine, hematocrit, and glucose levels. For this study, comorbid conditions gathered were diabetes mellitus, coronary artery disease, prior percutaneous coronary intervention, associated Valvular heart diseases(VHD), stroke/TIA, chronic obstructive pulmonary disease (COPD) or Bronchial Asthma. Various classes of medications were reviewed at the time of admission to determine whether the patient was prescribed an ACE-I/ARB, blocker, diuretic, nitrates, aldosterone antagonist, digoxin etc. Descriptive statistics and univariate analyses using the chi-square test or Fishers exact test for categorical variables and the Mann-Whitney test for continuous data was used to compare patients readmitted within 30 days vs. those who were not readmitted within 30 days. Significant factors associated with readmission in the univariate analysis (p<0.10) were included for a multivariate logistic regression model. A receiver operating characteristic (ROC) curve was constructed to look at the final models ability to predict the outcome. A numerical measure of the accuracy of the model was obtained from the area under the curve (AUC), where an area of 1.0 signifies near perfect accuracy. The analysis of LOS was accomplished by applying standard methods of survival analysis, i.e., computing the Kaplan-Meier product limit curves, where the data were stratified by readmission within 30 days (Yes vs No). The groups were compared using the log-rank test. The median rates for each group were obtained from the Kaplan-Meier/Product-Limit Estimates and their corresponding 95% confidence intervals were computed, using Greenwoods formula to calculate the standard error. Unless otherwise specified, a result was considered statistically significant at the p<0.05 level of significance. Results: A total of 100 patients records were reviewed, and 78 patients were only included in the study. Some Patients were excluded from the study if they treated and transferred from an outside hospital. 16 out of patients were readmitted within 30 days of the index hospitalization, whereas 103 patients were readmitted after 30 days or not at all. With respect to secondary endpoints, there were 29 patients readmitted within 90 days of the index hospitalization, whereas 49 patients were readmitted after 90 days or not. On readmission, the majority of patients readmitted within 30 days were not on a target dose of an ACE-I/ARB (75%), and none were on a target dose of a B-blocker, compared to theire baseline LV Ejection Fraction, LV EF, Herat Rate and Blood Pressures. Nearly 25 % of the patients were not stricly adherent to the medications as advised by physician. On re admisssion, 78 % of the patients had either high Heart rate (HR) more than 80/minute at the time of dischage, and majority, nearly 68 % had a higher Blood Pressure (SBP) of more than 140 mm HG at the time of discharge. Conclusions: Based on the observations form the present study, multiple recommendations can be made to further improve the quality of care and reduce HF readmissions in clinical practice. Starting from the proper clical assessment along with the checking the vital parameters like Heart Rate (HR) and Blood Presssure (SBP), Respiratory Rate (RR) at the time of discharge along with the proper management of the risk factors like Diabetes and any coexisting conditions will definitely help to reduce the number of hospitalizations. Another important conclusion drawn form our study was those who were not on either absent or inadequate dose of Diuretic and/or ACE-I/ARB and/or B-blocker, had higher incidences of heart faiklures and readmission rates also were high in them.
Janardhana Rao Babburi is a specialist cardiologist currently working at Aster Medical center and Aster Hospital, Dubai, UAE. He did his MBBS in 2004, from Siddhartha Government medical college, NTR University of health sciences, Andhra Pradesh, India and MD (Internal Medicine) in 2008 from Kasturba medical College, Manipal University, Karnataka, India. He also worked as Assistant Professor in Internal medicine atvNRI medical college, Andhra pradesh and PSIMS and Research Foundation College, Andhra Pradesh, India. Then he pursued DM cardiology specialization in 2012 from Sri Ramachandra University, Sri Ramachandra Medical College and Research Institute, Chennai, India. In addition to treating the patients, he ia also active in writing Scientific papers and has publications in both national and international journals like Indian heart Journal, IHJ and Catheterizations and Cardiovascular Interventions, CCI. He is also involved in research work and he is one of the principle investigator for RIVER study for Rivaroxaban. He also presented few papers in national and international conferences.
ASD Plus syndromes are a terminology coined by us to describe clinical scenarios, which affect the hemodynamics of an uncomplicated ostium secundum atrial septal defect. It is not an etiopathogenic classification along the lines of Parkinson Plus Syndromes. It is an attempt to create a functional classification (category/group) to guide treatment priorities these clinical scenarios.
Atrial Septal Defect was the first intracardiac condition amenable to surgical correction and forms a milestone in the annals of cardiac surgery. At that point and later for half a century, the discussions revolved around the hemodynamic impact of an uncomplicated atrial septal defect. The onus was to avoid a surgical scar for a hitherto small defect whose natural history may never necessitate closure. The emphasis in imaging diagnosis was to look for associated anomalies like a partial anomalous pulmonary venous drainage or a silent left SVC drainage to left atrium. The type of defect, the shape of defect or its relation to nearby structures like aorta were never a concern to the clinical cardiologist or the surgeon. The scare (apprehension) always revolved around an unexpected primum component with its associations.
Rashkind and his followers turned the whole pyramid upside down. With the advent of device closure, the onus shifted to anatomical characteristics of the defect more than the physiological features. Echo concepts like adequacy of rims, relation to aorta and an obsessed search for pulmonary venous drainage patterns. Infact TEE became an obligatory component of ASD assessment in most institutions. The ease of device closure promoted the lowering the threshold of intervention and opened up a plethora of cases for device intervention. Cases which were surgical turn downs due to physician's reluctance, patient's fears and relatives concerns suddenly overwhelmed the new growing brigade of new pediatric interventional cardiologists. Till the reality check of device erosion impounded the device march, more than 10000 devices had been implanted worldwide with about 10 variants of the device platforms. Present emphasis has been like a "Back to the Basics" exercise. Meticulous attention to detail the anatomical features from rim dimensions to rim stability, septal orientation and malalignment angle have become the norm. Newer guidelines have been more stringent on assessment of device erosion risk, choice of device, patient education and followup imaging protocols. Device deployment needed to justify not just feasibility and safety but also long term stability, durability and freedom from reoperation.
ASD Plus Syndromes Interventions.
ASD Plus syndromes Interventions can be divided into two categories
1) 1) Double Intervention (ASD device closure + intervention for the second condition)
2) Single Intervention (ASD device closure with certain caveats)
1) Pulmonary stenosis 2) Mitral Stenosis 3) Congenital Complete Heart Block 4) Coronary Artery disease
1) ASD with Severe pulmonary Hypertension (borderline Eisenmenger physiology 2) ASD with LV Dysfunction (Systolic and Diastolic) 3) ASD with PAPVC, (Significant vs Non significant)
The challenge in these scenarios is both the timing of the interventions and the choice of approach and hardware with respect to the double clinical challenges.
P Manokar is a Professor of Cardiology at Sri Ramachandra University, Porur, Chennai, India. He qualified as the Youngest Cardiologist to complete formal training in Cardiology at the age of 29 years in India and then became the youngest to become Professor of Cardiology at the age of 38 years. I work in a JCI accredited University Hospital, the largest stand alone private health care facility in South East Asia with over 2000 beds. He trained at OSU under the able guidance of Dr WT Abraham. He head the Transplant Program and the AHS Training program in Sri Ramachandra University.
Background: Little is published about right ventricular diastolic performance in patients with isolated critical pulmonary valve stenosis after balloon pulmonary valvuloplasty.
Methods: A total of 44 patients age (mean(+)(-)SD 10(+)(-)7.7 year )with isolated critical pulmonary valve stenosis who had undergone balloon valvuloplasty with hemodynamic recording.. A subset of population (n=33patients) whom were able to return to our institute for follow up-und went further imaging by echocardiography after 6 month, their right ventricular function were compared with 33 control subjects of same age and sex. Twenty one out of33patients underwent cardiac magnetic resonance imaging with late gadolinium enhancement to assess the presence of right ventricular fibrosis.
Results: The right ventricular systolic pressure (p<0.0001) and right ventricular out flow tract gradient (p<0.0001) decreased acutely (p<0.0001) after balloon valvuloplasty. After 6months echocardiography demonstrated persistent reduction of righr ventricular outflow tract gradient .M-mode Left ventricular end diastolic dimension (P<0.001), end systolic dimension increased (P<0.001) and right ventricular end diastolic dimension decreased (P<0.001).Also all patients had persistent restrictive RV physiology. Compared with control subjects patients with persistent restrictive RV had significantly reduced tricuspid annular Ea and higher E/Ea than the control subject (p 0.001), these finding were consistent with restrictive right ventricular physiology with persisted elevation of right ventricular filling pressure. Furthermore, right ventricular systolic dysfunction was also suggested by reduced tricuspid annular systolic velocity (P<0.001). Late gadolinium enhancement was demonstrated in13out of 21patients with persistent right ventricular restrictive physiology, which involve predominantly anterior RV out flow tract, anterior wall and inferior wall. The right ventricularlate gadolinium enhancement score correlated positively with age (r=0.7, P<0.001).
Conclusion: The right ventricular diastolic dysfunction characteristic of restrictive right ventricular physiology after relief of chronic increase of pressure over load of critical pulmonary valve stenosis suggests that factor other than increase in after load involved in this physiology. Fibrosis is the most likely factor responsible for persistence of restrictive physiology as documented by late gadolinium enhancement.
M.B.C.H., Ain Shams University, 1971.
Diploma of Internal Medicine, Ains Shams University, 1975.
Diploma of Cardiology, Ain Shams University, 1979.
MD Cardiology, Al Azhar University, 1985.
Internship: Ain Shams University Hospitals, 1971-1972.
Resident of Internal Medicine: General Hospital in Ministry of Health, Ain Shams University Hospitals, 1972-1976.
Training Program in Cardiology: Ain Shams University Hospitals, 1976.
Resident Cardiologist: National Heart Institute, 1976-1978.
Cardiology fellow: National Heart Institute, 1980-1985.
Assistant Professor of Cardiology, National Heart Institute.
IAssistant Consultant/Associate Professor of Pediatric and Head of Department of Pediatric Cardiology, National Heart Institute, 1993.
Consultant cardiology, Head of Pediatric Cardiology, 1998-2007.
Senior consultant cardiologist at National Heart Institute, 2007-till now.
Member of Egyptian Society of Cardiology.
Member of Egyptian Society of Pediatric Cardiology.
Mitochondria are indispensible, dynamic subcellular organelles for cellular homeostasis. Energy demand, mitochondrial genome integrity and copy number relies on their counter balanced and equipoised fusion-fission phenomenon, arbitrated by GTP-dependent fusion proteins (MFN1/2, OPA1) and fission factors (Drp1, Fis1). Increased mitochondrial fission have been reported as cause or effect of apoptosis and silencing of Drp-1 or Fis-1 has protective effects during certain neurological and cardiovascular disorders. We hypothesised that silencing Drp-1 could be protective during chronic alcohol induced cardiomyopathy. However, interestingly, siRNA mediated silencing of Drp-1 did not prove to be cardioprotective by promoting mitochondrial localization of Bak and inducing intrinsic apoptosis by release of SMAC/DIABLO. On further analysing the cause of this failure, we found deregulated PI3K/Akt signalling with over-expression of PTEN, a potent inhibitor of AKT activation. Taken together, these data reveal that inhibition of mitochondrial fragmentation cannot be a potent drug target chronic/binge alcohol abusers. However, targeting the PI3K/Akt signalling cause pave the way novel treatment strategies for habitual alcoholics.
Dr. Subbiah Ramasamy was an Assistant Professor at the Department of Molecular Biology, School of Biological Sciences, Madurai Kamaraj University Madurai, Tamil Nadu, India. He was also a Visiting Research Fellow at Temple University, USA.
Left internal mammary artery (LIMA) and Long Saphenous vein grafts (SVG) are the most commonly used conduits for coronary artery bypass graft (CABG) surgery. Success of CABG depends on the patency of the grafts. However graft failure has posed challenges for successful surgical revascularization. Myocardial damage following CABG surgery is due to two different causes classified as graft or non-graft related 1) Non-graft-related ischaemia is related to inappropriate myocardial protection, excessive surgical manipulations, and air or plaque embolization 2) Graft-related injury is associated with: early graft thrombosis, anastomotic stenosis, bypass kinks, overstretching or tension, significant spasm or incomplete revascularization. Despite the benefits of CABG surgery, 15% to 25% of patients develop graft closure within one year following the procedure. The patency rate of grafts predicts both the short- and long-term benefit from CABG surgery. Discrimination between graft-related ischaemic events from other reasons must be made rapidly. Early reintervention has been proposed to allow myocardial rescue to preserve ventricular function after CABG surgery since MI is associated with congestive heart failure and significant adverse outcomes Saphenous vein bypass grafts may undergo a variety of morphologic changes that lead to graft occlusion. Graft occlusion can be divided in 2 types- 1) Early graft occlusion- is usually caused by technical factors or compromised anatomic runoff and is almost always thrombotic 2) Late graft occlusion- is usually a result of structural changes within the graft itself and is not usually associated with occlusive thrombosis. Progressive fibrous or fibromuscular intimal proliferation and, less frequently, atheromatous plaque formation are the most common pathologic changes found in grafts that become occluded late after coronary artery bypass surgery. Management of coronary artery bypass graft failure- Many patients with recurrent stable angina following CABG can be treated medically. Evaluation for ischemia is as in other patients with stable angina without prior CABG. Redo CABG or PCI should be decided by the Heart Team. Redo CABG or PCI should only be considered if the graft or coronary artery is of good size, severely narrowed and supplies a large territory of myocardium. Redo CABG is preferred in patients with more diseased or occluded grafts, reduced systolic function, total occlusions of native coronary arteries or in the absence of a patent arterial graft.
Progressive and dedicated medical professional, operated on more than 500 cases of adults and pediatrics cardiac patients having valvular diseases, CAD, congenital heart diseases, thoracic and vascular cases. Currently he is working cardiac surgeon at highly reputed and international fame King fahad Medical city, Riyadh, Kingdom of Saudi Arabia since 26 May 2015. Previously he had worked as Pediatrics Cardiac Surgeon at Fortis Escort Heart Institute, New Delhi of 350 beds capacity and done ASD, VSD, Glenn shunts, BT shunts, TAPVC, PAPVC, TOF and assisted in AV canal defects, TGA, CCTGA, Ebstein anomaly, ALCAPA, Fontans procedure, Rastellis procedure etc. He is intended to excel in the field of cardiac surgery, and clinical research work, enhance skills, learn and grow to contribute in services. He has contributed well under the guidance of senior surgeons and managed both outdoor and indoor patients, taken care of all ward patients preoperative and post-operative, ICU patient, done graft harvesting for coronary artery bypass surgeries, as saphenous vein graft and radial artery graft, sternotomy and assisted in all cardio thoracic surgeries as MIDCAB, HEART PORT, valve repair and replacement, CABG, Bentall's procedure, Aortic aneurysmal surgeries, Dissection of aorta repair, paricardiectomy , atrial septal defect, ventricular septal defect, TAVI, ECMO supports etc. Well versed for managing mass casualties. He had acquired necessary training at Neurosurgery unit, CTVS unit, Burn and plastic surgery unit, Pediatric Surgery, trauma center unit, urosurgery, gastrosurgery, ICU and emergency unit, laparoscopic surgery also performed all basic operations like Cholecystectomy, Hernioplasty, Appendicectomy, Mastectomy, Prostectomy etc. and has done around 200 exploratory laparotomies and performed various emergency operations like Splenectomy, Nephrectomy etc.
Stroke is a global health problem and is a leading cause of disability. It is one of the leading causes of mortality and morbidity worldwide. Participants: 110 proved stroke adult survivors and 110 controls (without stroke history) and whom were admitted to these hospitals were included. Findings: Out of 110 patients, 61.8% were females and 38.2% males. Mean age of cases was 65.80 years compared to 65.46 for controls. Most of them were living in Gaza city. The ischemic type found in 81.8% patients. The most medical risk factors associated with stroke were diabetes mellitus and hypertension; which represent 61.9% diabetes mellitus among cases compared to 38.1% among controls (P-value <0.001) and represent 61.4% of hypertension among cases compared to 38.6% among controls (P-value <0.001). For cardiac disorders, 60.3% of cases compared to 39.7% of controls have cardiac disorders (P-value <0.021). For lifestyle factors, obesity represent 56.9% among cases compared to 43.1% among controls (P-value <0.010), smoking represent 63.6% among cases compared to 236.4% among controls (P-value <0.001). For activity level, sedentary level represent 78.2% among cases compared to 21.8% among controls, (P-value <0.001) and stress represent 83.8% among cases compared to 16.2% among controls, (P-value <0.001). Interpretation: From the many studied risk factors that may affect the occurrence of stroke, Hypertension, diabetes and heart problems showed to be the biggest risk factors for stroke in Gaza strip, which fortunately can be controlled with appropriate medication and lifestyle changes.
I am holding a master degree in public health, epidemiology track. Through my master studying I have studied the stroke and its effects on stroked individual. Heart problems as risk factors causing stroke also were studied extensively . I am currently studying PhD in public health and targeting different public health problems like heart problems, environmental problems, child and sanitation diseases relationships.
Cardiac rehabilitation (CR) decrease cardiovascular mortality. Previous studies state that CR improved cardiovascular status through affecting of exercise on autonomic system. Heart Rate Recovery (HRR) is a strong indicator of all-cause and cardiovascular mortality. We have evaluated the effect of CR on HRR in men and women and elderly persons. Methods: We studied 64 cardiac patients that refered to Isfahan cardiovascular research center in a prospective study. The patients did an exercise test in Noughton protocol before and after CR. CR program included 24 sessions (3 sessions/week) aerobic exercise supervised by CR team. HRR and resting heart rate and exercise capacity was recorded before and after CR and analyzed is SPSS at level of P<0.05 by pair t-test and chi-square test. Results: HRR and exercise capacity (EC) improved significantly after CR (HRR: from 93 to 116.96 palse/minute, P=0.00; EC: from 9.31 to 11.18 palse/minute, P=0.00). Changing in HRR, resting heart rate and EC were not different in women and men as well as patients with age ≥60 and <60 year old significantly. Although these variables increased more in women than men and in patients with age ≥60 than patients with age <60 year old. Discussion: CR improves HRR and EC in cardiac patients specially in women and elderly patients so it is more beneficial for these groups, also we can use HRR as an indicator to evaluate outcomes of CR. Key words: heart rate recovery- exercise test-cardiac rehabilitation
Working as a physiotherapist in different places; interesting to research activities and teaching for different groups of people such as BSc and MSc students, patients and employers, being hopeful to continue my education in higher level and improve my skills as a physiotherapist and researcher.
> BSc (Physiotherapy), 1995-1999, Ahvaz University of Medical Sciences.
> MSc(Physiotherapy), 2010-2013, Isfahan University of Medical Sciences.
> Ph.D candidate in Physiotherapy at Tarbiat Modares university.
> Book: Evidence Based Practice Physical therapy (scientific editor for translation from English to persian).
> Book: Cardiac rehabilitation(2016)(Isfahan university of medical sciences publication).