Biography

Dao Wen Wang, MD, PhD, is an academician of International Eurasian Academy of Sciences (IEAS), a Senior Specialist of Hubei Province. He is the Honorary Director of Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science & Technology, Director of Hubei Key Laboratory of Genetics and Molecular Mechanism of Cardiologic Disorders, and Director of Translational Medicine Center & Genetic Diagnosis Center. He is also Director of Hubei Provincial Quality Control Center of Fulminant Myocarditis, a Standing Committee member of Chinese College of Cardiovascular Physicians (CCCP), a committee member of Chinese Society of Internal Medicine, and chairman of Internal Medicine Section of Hubei Medical Association. Wang works on studying both clinical and basic issues in cardiology. He especially contributes to the diagnosis and treatment of fulminant myocarditis, heart failure, as well as genetic diagnosis and personalized medicine. Dr. Wang has published more than 280 papers (corresponding author), some in top journals in the field of Cardiology like Circulation, JACC, Eur Heart J, and Circulation Research. His H-index is 58.

Abstract

Background: Myocarditis is a lift-threatening inflammatory disease of the heart and is lack of effective treatment measures. Hydroxychloroquine (HCQ), a classic antimalarial drug, has been widely used in the treatment of rheumatic diseases. This study investigated whether HCQ can treat chronic autoimmune myocarditis.

Methods and Results: Murine autoimmune myocarditis was induced, and therapeutic effects of oral HCQ on acute and chronic myocarditis were evaluated using echocardiography, cardiac catheterization, and analysis of inflammatory scores in cardiac tissue. Results showed that HCQ treatment significantly improved cardiac function, inhibited ventricle enlargement and reduced cardiac inflammation. Single-cell transcriptomic analysis in the heart showed that HCQ treatment significantly reduced infiltration of macrophage, neutrophiles and T-cells, inhibited inflammatory pathway, especially the secretion of CXCL16 from macrophages, thereby reducing the chemotaxis of T cells, especially NKT cells and Th17 cells. Finally, both in vitro and in vivo experiments confirm the inhibitory effect of HCQ on CXCL16-CXCR6 axis between macrophages and T cells. Additionally, treatment with anti-CXCL16 antibody can also improve cardiac function and attenuate cardiac fibrosis in myocarditis.

Conclusions: HCQ treatments clinically cure mice with autoimmune myocarditis through inhibiting innate immune and infiltration of macrophages majorly via CXCL16-CXCR6 axis.

Biography

Waqas Dar is a consultant cardiologist at Rehmatul lil Alameen institute of Cardiology, Lahore, Pakistan and has 12 years of experience in field of cardiology. He was graduated from medical school in Pakistan in 2011. He has special interest in cardiac electrophysiology including invasive and non-invasive approaches. He has done a lot of research work which has been published in eminent journals. He has a positive attitude and uses tireless energy at his work place to educate his colleagues and junior doctors. 

Abstract

Atrioventricular (AV) block is an AV conduction disorder that can manifest in various settings, with varying symptomaticity and severity. Complications of acute ST-elevation myocardial infarction (STEMI) as AV blocks are often observed. The first degree of atrioventricular block is the most common and requires no treatment. The seconddegree block is sub-classified in Mobitz type I and Mobitz type II. This study aimed to determine the frequency of highdegree atrioventricular block in acute anterior wall myocardial infarction cases. The current cross-sectional analysis was conducted at the Department of Cardiology, Rehmat-ul-Lil-Alameen Institute of Cardiology, Lahore, from 19- 02-2021 to 18-08-2021. A total of 311 patients were enrolled in the study. Cases underwent an electrocardiogram, and high degree AV Block was labeled per operational definitions. The results were noted and recorded on the same proforma. The overall mean age of the patients was 55.6±8.4 years. Gender distribution of patients shows a higher frequency of 57.9% males compared to 42.1% females with a female-to-male ratio of 1:1.4. High degree of atrioventricular block was found among 5.8% of the total patients. Around 5.8% of AWMI patients presented with high-grade AV block in this study are in-concomitant with other studies. No association of risk factors (p-value >0.05) was presented regarding age, gender, DM, hypertension, dyslipidemia, family history of CAD, and smoking in this study.

Biography

Nurun Nahar Fatema has passed MBBS in 1985 & FCPS in Pediatrics in 1995. She was trained in Prince Sultan Cardiac Center in Riyadh, KSA in  Pediatric Cardiology from 1996 to 1998 .Later trained in Australia, UK, USA, India etc. Awarded with FRCP and FACC in 2009 and FSCAI in 2011.Working as Chief Pediatric Cardiologist of CMH Dhaka since 1998 and HOD pediatrics since 2014.  She is Head and prof of paediatrics of Armed Forces Medical College since 2014. Fatema is the pioneer Pediatric Cardiologist of Bangladesh. She performed more than 9000 pediatric cardiac interventions and innovated many new techniques in cardiac interventions.  Her NNF protocol for PPHN and cyanotic spell is widely used and saving life of hundreds of newborns and children. She has about 100 publications in different national and international medical journals. She has participated in more than hundred national and international seminar and presented scientific papers. She received highest national and peace time military award from her country for contribution to medical science.

Abstract

Introduction:

VSDs constituted 20% to of congenital heart defects. Incidence of VSD is about 1.35 to 3.5/1,000 live births. With the advent of echocardiography, the recognition of VSDs has increased to 5 to 50/1,000 live births .Spontaneous closure of small defects occurs before the age of three in approximately 45% patients depending on types. Patient with significant hemodynamic effects or small defects with complications needs closure. Surgical closure is an established procedure yields excellent result so far. Percutaneous device closure of VSD was first reported in 1988 (Lock et al.) and we started device closure of VSD in 2004 in CMH Dhaka as first ever in Bangladesh. Percutaneous closure is a recent technology which offer less aggressive, minimally invasive and more comfortable alternative of VSD closure in acceptable varieties. Usually Perimembranous VSD and Muscular Ventricular Septal Defect is suitable for device closure but Sub aortic VSD’s are immediately below the aortic valve and have propensity to develop aortic valve prolapse and aortic regurgitation. Doubly committed sub-arterial VSDs are mostly associated with aortic valve prolapse, and these types are difficult to do Device closure and usually referred to the cardiac surgeon for surgical closure.

Conclusion:

Device closure of Sub aortic & Doubly committed VSD is a complicated procedure than other VSD’s. Vicinity of two valve apparatus, moderator band, chordatendinae and papillary muscle needs careful consideration. Encroachment of Aortic valve or tricuspid valve within device may lead to serious hemodynamic derangement . Our study proved percutaneous closure of subaortic and doubly commited VSD in selected cases are safe effective, feasible technique under TEE/TTE guide, without general anesthesia and without need for stay in ICU. However large scale study is still required for strong recommendation.

Biography

Huihui Li is a post-doc at the University of Huazhong University of Science and Technology, Wuhan, China. She worked as a visiting scholar at Chinese Academy of Medical Sciences and Peking Union Medical College in 2021 and received her Ph. D degree from Huazhong University of Science and Technology in 2024.Li’s research focuses on fulminant.

Abstract

Fulminant myocarditis (FM) is a life-threatening, inflammatory disease. We explored the cellular dynamics and immunological networks during FM progression, the mechanisms underlying acute onset, and novel therapeutic targets. Four-to six-week-old male A/J mice were treated with coxsackievirus B3 (CVB3) to induce FM. During disease progression, dynamic changes in cardiac function, as measured by echocardiography, revealed a sudden decline in cardiac systolic function onday 4. Single-cell RNA sequencing was used to profile CD45+ cells and cardiomyocytes (CMs) extracted from mouse hearts on days 0, 4, and 7 post-infection. Transcriptomic signature revealed that healthy CMs differentiated into pro-angiogenic and pro-inflammatory CMs on day 4. Neutrophils, the most expanded immune cells on day 4, exhibited a developmental trajectory only after migrating to the heart. Neutrophils acquire higher pro-inflammatory, chemotactic, and cytokine-releasing abilities during the differentiation process. Well-developed neutrophils continuously attract peripheral neutrophils, resulting in the acute accumulation of neutrophils and subsequent monocytes in the heart. Moreover, cardiac-infiltrating neutrophils, but not viruses, induced phenotypic changes in CMs, which directly led to cardiac functional collapse. Blocking the self-recruiting loop of neutrophils by neutralising CXCR2 or CXCL2 and CXCL3 substantially reduced the mortality rate and prevented cardiac phenotypic changes and cytokine release in FM mice. This study provides a comprehensive single-cell atlas of immune cells and CMs in FM, and reveals that neutrophils exhibit a distinct developmental trajectory after infiltrating the heart. Well-developed cardiac neutrophils trigger the overactivation of the innate immune response and mediate phenotypic changes in FM. Our study suggests potential strategies for treating FM that target self-recruited neutrophils by blocking the CXCL2/CXCL3-CXCR2 axis.

Biography

Biography

Abstract

Objectives:

In this study we determine the modifiable factors related to bleeding and transfusion in post-cardiac surgery patients who underwent open heart surgery.

Methods:

This is a retrospective study that includes two hundred patients who had undergone open heart surgery (OHS) at Northwest General Hospital and Research Center from December 2018 to July 2021. Platelet count and hemoglobin level were measured in the pre-operative period.

Results:

This study included both male and female patients. Postoperative platelets were counted as follow: 50-100 x109 L in 3.0% cases, 101-150 x109 L seen in 27.5% cases, and >150 x 109 L in 69.5% cases which required transfusion. We have also reported the increased requirement of transfusion of blood and blood products in patients with pre-operative hemoglobin (Hb) < 10 g/dl.

Discussion:

Bleeding Academic Research Consortium (BARC reported that 5 or more units of packed red blood cells (PRBCs) transfusions in 48 Hours and greater than 2 liters of chest tube output in 24 Hours are said to be significant in cardiac surgery patients.5 Patients that bleed actively can be taken to these summits rarely and early steps for optimization are usually necessary including the use of blood products, blood, medical optimization and reoperation. This is only possible with proper preoperative assessment of the patient.6 Correction of acidosis and hypothermia are the entity leading to decrease bleeding. The small bleeders can be tamponade by keeping the PEEP of around 10cm. These parameters can be achieved in order to assess the cause and status of profuse bleeding such as complete blood count, Thromboelastography, Prothrombin time, Activated thromboplastin time and fibrinogen levels.6,11 To improve the coagulation, Platelets transfusion, Fresh Frozen Plasma, and occasionally Desmopressin are the important parameters. Additional Protamine can be used to treat the Heparin rebounding phenomenon. Coagulopathy can be treated with a novel agent such as Recombinant factor VII. Aminocaproic acid and Tranexamic acid have frequent use too.19 The Commonly used and avoiding Preoperative associated factors leading to postoperative bleeding are Clopidogrel which should be stopped five days before the surgery, Ticagrelor which should be stopped three days before the operation, Heparin for acute coronary syndromes, low molecular weight heparin and patients on Warfarin or novel oral anticoagulants as these factors are not analyzed in our study. Common causes of excessive bleeding are extra cardiac bleeders, LIMA bed, and surgical bleeders from either distal or proximal anastomosis sites. That is why; it is quite complicated to ensure proper hemostasis.11

Biography

Igor Tomas is interventional cardiologyst in Institute for cardiovascular disease of Vojvodina, Serbia.Medical university Novi Sad, specialisation of internal medicine, cardiology, ultrasound. Tomas is member of europian society of cardilogy.Several articles in international papers. Interventinonal cardiologys with over 300 pci per year, TAVI 50 per year, IVUS, and rotablation!Transcatheter reparation on tricupid valve , first in human 3 implantaion.

Abstract

Calcification in coronary arteries very common in population of our patients.It is a major limiting facto in pecutaneous coronary intervention.Heavy calcified lesions increase procedural risc and incicence number of complication, and adverse cardiovascular events.Intravascular imaging ( IVUS , OCT) help us to undestand type of coronary lesion, amount of calcium, position of calcified plaque.(1)Calcium scoore is important value whichlead us which calcium tretment techinque to use (2,3).Rotablation and shockwave are most useful devices and imaging can determine which to use . We comment both modality's relative advantages and disadvantages and the data supporting their use. We will presentfour casess with imaging guided complex PCI in calcified coronary disease.

1.Angsubhakorn N, Kang N, Fearon C, Techorueangwiwat C, Swamy P, Brilakis ES, Bharadwaj AS. Contemporary Management of Severely Calcified Coronary Lesions. J Pers Med. 2022 Oct 3;12(10):1638. doi: 10.3390/jpm12101638. PMID: 36294777; PMCID: PMC9605395.

2. Bajaj R, Garcia-Garcia HM, Courtney BK, Ramasamy A, Tufaro V, Erdogan E, Khan AH, Alves N, Rathod KS, Onuma Y, Serruys PW, Mathur A, Baumbach A, Bourantas CV. Multi-modality intravascular imaging for guiding coronary intervention and assessing coronary atheroma: the Novasight Hybrid IVUS-OCT system. Minerva Cardiol Angiol. 2021 Dec;69(6):655-670. doi: 10.23736/S2724-5683.21.05532-0. Epub 2021 Mar 11. PMID: 33703857.

3. Sharma SK, Vengrenyuk Y, Kini AS. IVUS, OCT, and Coronary Artery Calcification: Is There a Bone of Contention? JACC Cardiovasc Imaging. 2017 Aug;10(8):880-882. doi: 10.1016/j.jcmg.2017.06.008. PMID: 28797409.

Biography

Li Liang is a Chief Physician and a Master's supervisor at Xuzhou Medical University. Liang currently serves as the Deputy Director of the Cardiology Department, the Director ofthe Coronary Care Unit (CCU), the Director of the Heart Failure Center, and the Director of the Cardiovascular Metabolism Center. He is an editorial board member of Frontiers inCardiovascular Medicine and a reviewer for the European Heart Journal. Liang specializes in the interventional treatment of coronary artery disease, bedside and intracardiacultrasound, and the diagnosis and treatment of heart failure and critical cardiac conditions. He has long been engaged in basic and clinical research on coronary artery functionand microcirculation assessment, and was the first in the world to propose the concept of using multiple quantitative indicators in MCE (Myocardial Contrast Echocardiography)for the combined evaluation of coronary blood flow.

Abstract

Background: The LDL-C is the primary lipid therapy target for coronary artery disease (CAD) after PCI. However, progression of coronary atherosclerosis occurs even LDL-C controlled well. This study aims to elucidate the relationship between RLP-C and the progression of non-target lesions (NTLs) in patients with well-controlled lipid levels after PCI, as well as to explore the clinical characteristics of patients with high RLP-C concentrations.

Methods: This retrospective study included 769 CAD patients who underwent percutaneous coronary intervention (PCI) between May 1,2016, and May 31,2019, and followed up coronary angiography (CAG) within 6 to 24 months thereafter. LDL-C levels were used to assess lipid control. Patients were categorized into progression and non-progression groups based on the assessment of NTLs progression via quantitative coronary angiography (QCA). Multivariate Cox regression analysis identified RLP-C as an independent risk factor for NTLs progression. Using the ROC curve, an optimal cutoff value for RLP-C was determined, and patients were stratified into two groups. Propensity score matching balanced confounding factors between groups, and Log-rank tests compared Kaplan–Meier curves for overall follow-up to assess NTLs progression.

Results: The control of LDL-C remains inadequate in CAD patients after PCI. Multivariate Cox analysis showed that RLP-C was an independent lipid risk factor for NTLs progression when LDL-C controlled well. The ROC curve for RLP-C demonstrated an AUC of 0.721 (SE 0.044, 95% CI=0.635–0.807, P<0.001), with an optimal cutoff of 0.555 mmol/L for predicting NTLs progression. Following propensity score matching, Kaplan–Meier curves illustrated a significantly higher cumulative rate of NTLs progression in patients with RLP-C levels ?0.555 mmol/L (log-rank P<0.001; HR 4.175, 95% CI=3.045–5.723, P<0.001) compared to those with RLP-C levels <0.555 mmol/L. Elevated RLP-C levels were associated with high Triglyceride (TG) concentrations, diabetes mellitus (DM), and increased risk of revascularization.

Conclusion: The RLP-C could be a significant residual risk factor for cardiovascular disease progression after PCI. Lowering RLP-C below 0.555 mmol/L may assist in mitigating the progression of NTLs.

Biography

Souna is a dedicated cardiologist with a passion for cardiovascular health. Graduating with honors in both general medicine and cardiology from Yerevan State Medical University, Dr. Souna has honed their expertise through years of hands-on experience. For the past five years, she has been an invaluable asset to Nork Marash Medical Center, Yerevan, Armenia, where she has made a significant impact on patient care and medical research.Souna is a proud member of several prestigious professional organizations, including the European Society of Cardiology (ESC), the European Association of Cardiovascular Imaging (EACVi), the American College of Cardiology (ACC), and the Armenian Cardiac Association (ACVC). Her commitment to advancing the field of cardiology is evident in their active participation in the NSTE-ACS registry of ESC, where she contributed valuable insights to the understanding and treatment of non-ST-elevation acute coronary syndromes, she was enrolled as a co investigator in the study for evaluation of the TTR for INR control after mechanical valve prosthesis in Nork Marash Medical Center in the past year. Currently, Dr. Souna is involved in the STEMI registry of Armenia, aiming to improve the outcomes of patients with ST-elevation myocardial infarction through comprehensive data collection and analysis, and also involved in arrythmology fellowship program at Nork Marash Medical Center.

Abstract

Background

Resistance to high doses of different vitamin K antagonists is a very rare phenomenon, especially when the patient does not have the most common single nucleotide polymorphism mutations for warfarin resistance, which makes it challenging to reconsider the diagnosis of warfarin resistance or coagulopathy, and whether the patient will be thromboembolic episode-free after bioprosthesis replacement.

Case summary

A 42-year-old woman was diagnosed with severe mitral valve regurgitation, moderate aortic valve regurgitation, left ventricular global systolic dysfunction, no signs of pulmonary hypertension and dilated ascending aorta.She underwent mechanical mitral and aortic valve and ascending aorta prosthesisreplacement about one and a half years ago.

On PostOperative Day (POD) 3, warfarin (Coumadin®) 3 mg therapy was started with an International Normalized Ratio(INR) of 1.36 (therapeutic range, 2.00-3.00) and nadroparincalcium (Fraxiparine®) 0.6 mg once daily.She had a very long hospital stay for 79 days due to non-therapeutic INR readings.During her hospitalization, the warfarin dose was increased to 12 mg. However, the INR increased only until POD 11 with its subsequent decrease despite the high dose of warfarin.

An attempt to try several other anticoagulants (phenindione), (acenocumarol), with an increase in their doses aggressively,however, failed to correct the INR. Therefore, an switch back to warfarin was performed and the dose increased up to45 mg/day, during this time the INR was very labile with each increase and maintaining the new high dose of warfarin the INR decreased. Warfarin genetic tests were conducted, which did not detect any mutation for CYtochrome P450 enzymes (CYP2C9:430C>T; CYP2C9:A>C; CYP4F2:C>T) or Vitamin K epOxide ReductaseComplex (VKORC1:-1639 G>A) receptor, neither forcoagulation factor V nor factor II. It was decided to restart with a very low dose of warfarin 3 mg with the assumption that she might be inresponsive to high doses of warfarin and unfortunately had the same effect.

Finally, the patient was switched back to warfarin starting with 30 mg/day and increased aggressively up to 72 mg until the INR became 2.74. On the same day, she was discharged with an advice to continue the intake of warfarin 75 mg/day.

Warfarin dose was further increased up to 85 mg/day post-discharge, but the INR stayed at non-therapeutic levels. Enoxaparin sodium 0.6 mg twice daily started to prevent mechanical valve thrombosis. After multiple consultations with cardiac surgical and hematology teams, it was decided to prescribe the oral anticoagulant phenprocoumon(Marcoumar®) and an anti-Xa and anti-IIa taking into consideration that both prosthetic valves were normallyfunctioning with enoxaparin.

Conclusion

Despite the satisfying idea of changing the mechanical to bioprosthetic valves in similar cases, it is reasonable to maximize the chance of preserving till today both normally functioning mechanical valves with different types of oral anticoagulants in order to postpone multiple future bioprosthesis replacements in such young patients.

Biography

Anand Ahuja is a senior interventional cardiologist, holds 19 years of experience in invasive and non-invasive cardiology including thousands of coronary interventions, coronary imaging and CHIP cases. He serves on the editorial board, Journal of Cardiac Interventions. He is associate faculty, National Hypertension Working Group (a joint venture of European Society of Hypertension and Indian Society of Hypertension). He is regularly on the abstract grading panel, European Society of Cardiology Congress. He’s been an investigator in several international randomized clinical trials. He is a faculty at several national and international cardiology conferences.

Abstract

Methods:

192 patients presenting with STEMI for primary angioplasty during a 6-month period, were analysed with respect to their age, sex, geographical location (rural or urban), reference through a family doctor or not, diagnosis, presence of single or multi vessel CAD, time of presentation (day or night), procedure performed by a junior or senior cardiologist. The door to balloon time (DBT) was further split up as door to coronary angiography time, angiography to consent for primary PCI time and consent to balloon inflation time.

Observations:

Mean DBT was 99.27 minutes, the highest being 288 minutes and lowest 20 minutes. Mean door to angiography time 46.4 was minutes, mean angiography to consent time 29.2 minutes and mean consent to balloon inflation time 23.6 minutes.

Interpretation And Analysis:

The DBT was significantly higher for females, for rural patients, for primary PCI done during night time versus day (due to performing cath lab team on duty not being on duty on campus). It was also higher for patients presenting directly, versus those referred by family doctors. It was higher for those with multi vessel than single vessel CAD. Age or gender bias, education and awareness levels, acceptance of procedure and financial status were determinants of differential door to balloon times. The DBT was similar with respect to age of the patient, type of infarct (anterior or inferior), whether a junior or senior cardiologist performed the primary PCI procedure. This was because only trained and experienced cardiologists capable of performing primary PCI in STEMI were assigned the responsibility.

Conclusion:

DBT, an important determinant of primary PCI outcomes – in real world scenarios, is affected by multiple parameters beyond science. Due consideration of these factors and appropriate awareness and corrective measures will go a long way improving this vital cathlab quality indicator and help translate scientific triumphs into actual patient benefits. Abstract should give clear indication of the objectives, scope, results, methods used, and conclusion of your work. One figure and one table can be included in your results and discussions.

Biography

Dr. Chowdhury is a highly skilled Cardiovascular and Thoracic Surgeon with extensive experience in both government and private institutions. He graduated MBBS with Honors in Medicine from SUST in 2011 and obtained a Master of Surgery (MS) in Cardiovascular and Thoracic Surgery (CTVS) from Bangabandhu Sheikh Mujib Medical University in Dhaka in 2020.Throughout his career, he has attended over 1500 general surgeries and more than 2000 cardiac, vascular, and thoracic surgeries. He is known for his meticulous approach to treating every part of the patient's body during procedures, ensuring excellent results .He is a respected researcher with published articles in national and international journals. He frequently participates in scientific conferences, presenting his research findings. He is a member of prestigious surgical societies, both locally and internationally.

Abstract

Background:

Despite advancements in surgical techniques, myocardial protection strategies, and postoperative care, coronary artery bypass grafting (CABG) in patients with reduced left ventricular ejection fraction (LVEF) poses significant challenges, leading to increased postoperative morbidity and mortality. This study aims to evaluate the early outcomes of patients with LVEF <35% undergoing on-pump CABG, focusing on the use of intra-aortic balloon pump (IABP) support and its impact on postoperative LVEF improvement.

Methods:

Fifty-five patients with impaired LVEF who underwent isolated on-pump CABG at the Department of Cardiothoracic and Vascular Surgery in Evercare Hospital Dhaka, Bangladesh, between January 2020 and December 2023 were included. Fifteen cases received per-operative IABP support immediately after revascularization, meeting specific inclusion and exclusion criteria. Various preoperative, intraoperative, and postoperative variables were collected, analyzed, and compared.

Results:

The mean age of patients was 57.81 ± 7.57 years, with 72% being male and 18% female. Antegrade cardioplegia was administered to all patients. The mean LVEF increased from 33 ± 1.38% preoperatively to 40.2 ± 3% six months postoperatively. However, postoperative complications included low cardiac output syndrome in 45% of patients, pulmonary complications in 15%, neurological complications in 2%, sternal wound infection in one case, atrial fibrillation in 10%, and acute kidney injury in five cases. In-hospital mortality occurred in two cases.

Conclusion:

The results suggest that IABP support immediately following CABG in patients with reduced preoperative LVEF leads to improved postoperative LVEF and New York Heart Association (NYHA) functional class. This study sheds light on the potential benefits of IABP in enhancing early outcomes for this challenging patient population.