|Year : 2013 | Volume
| Issue : 4 | Page : 192-195
ABSTRACTS from the 11 th Gulf Heart Association Conference Bahrain, February 26 - 28, 2014
|Date of Web Publication||12-Feb-2014|
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
. ABSTRACTS from the 11 th Gulf Heart Association Conference Bahrain, February 26 - 28, 2014. Heart Views 2013;14:192-5
Vitamin D and CVD
Al Ain and Al Noor Hospital, UAE
Vitamin D deficiency has been implicated as an independent risk factor for incident CV events and all-cause mortality in several large prospective studies. A recent meta-analysis of prospective studies that assessed the relationship between vitamin D status and CVD risk from 1966 to 2012, revealed an inverse relationship between levels of 25-OH D and future risk of CVD endpoints, including coronary heart disease, stroke, and total CVD mortality. In contrast, the Women's Health Initiative observed after 7 years of follow-up that rates of incident CVD events did not differ between the treatment and placebo groups. This review will provide much needed evidence for determining the relationship between vitamin D and CVD.
Physical Activity Prescription in Health and Diseases: Basic Concepts and Practical Applications
Hazzaa M. Al-Hazzaa
King Saud University, Riyadh, Saudi Arabia
During the past few decades, GCC countries have witnessed enormous life style transformation. Consequently, physical inactivity and sedentary living along with the associated non- communicable disease (NCD) risks have dramatically increased. Estimated population attributable fractions (PAFs) for NCD risks associated with physical inactivity in most of the GCC countries are considered the highest among the WHO Eastern Mediterranean region and within the whole WHO regions. This is mainly due to the high prevalence of physical inactivity among the population of the GCC countries. This presentation reviews succinctly the scientific evidence supporting the role of physical activity in promoting health and preventing and managing non-communicable diseases. It also presents and discusses some relevant terminologies and concepts that are essential in understanding the science of physical activity prescription. Needless to say that physical activity prescription has moved a long way since the 1992 AHA recognition of physical inactivity as a primary risk factor for CHD and CVD to the recent Exercise is Medicine initiative led by the American College of Sports Medicine (ACSM), which is calling on all health care providers to assess and review every patient's physical activity program at every visit. It is well recognized that physical activity provides a wide spectrum of health benefits. Strong scientific evidence links physical activity with reduced CHD, stroke, high blood pressure, type 2 diabetes, premature death, weight gain, depression, breast and colon cancer and loss of cognitive function. Furthermore, there is a moderately strong evidence showing that physical activity aids in maintaining weight loss, improves sleep, reduces the risk of osteoporosis and can sustains functional ability among elderly. Although some health benefits appear to begin with as little as 60 minutes a week, research indicates that a total amount of 150 minutes per week of moderate-intensity aerobic activity consistently reduces the risk of many chronic diseases and other adverse health outcomes.
Role of Cardiovascular Magnetic Resonance in Heart Failure
National Heart and Lung Institute, Imperial College, London, UK
Evaluation and management of heart failure remains clinically challenging. Current care often includes multiple imaging studies and requires: Characterisation of myocardial and valvular structures and their function; differentiation of ischaemic versus non-ischaemic causes, including identification of potentially modifiable substrate; risk stratification for therapeutic management, such as revascularisation benefit.
Cardiovascular Magnetic Resonance (CMR) provides a unique non-invasive imaging tool which in a single scan setting can accurately assess ventricular volumes and function, flow quantification, myocardial viability, tissue characterization and myocardial perfusion imaging. Its excellent spatial resolution set it above other imaging techniques to analyze RV morphology and detect RV cardiomyopathies and for identification of regional ventricular hypertrophy or dilatation. Careful application of this technology provides an opportunity to improve diagnostic and prognostic efficiency and care in these patients. In this presentation, the diagnostic and prognostic value of CMR in assessing heart failure will be discussed in a wide range of ischaemic and non-ischaemic cardiomyopathies.
The Value of Imaging in the Heart Failure Patient
Fausto J Pinto
Lisbon University, Lisbon, Portugal
Left ventricular (LV) function is the most important prognostic indicator in patients with cardiac disease. Several methods have been developed over the years to assess both qualitatively and quantitatively different parameters of LV function. The role of cardiac imaging is thus essential in this setting. Echocardiography has been the most popular technique since it is non invasive and can provide complete information on cardiac structure as well as on its function. In addition it can help assessing the etiology of the underlying heart condition and improve the understanding of pathophysiology at the same time it can be repeated as many times as needed with no discomfort for the patient.
The use of M-Mode, 2D and Doppler flow assessment can provide an array of anatomical and functional information very useful in the assessment of patients with heart failure, including the measurement of internal diameters, areas, volumes/ejection fraction, cardiac output, LV mass, dP/dt. The introduction of Doppler flow assessment in clinical practice helped to improve our ability of studying and understanding LV filling. The mitral valve (MV) inflow, together with the pulmonary venous flow and the size of the left atrium provide important information with real clinical applications. The use of tissue Doppler added a new dimension to the understanding of systolic and diastolic function. The main advantage regards the direct measurement of myocardial function, by sampling directly the myocardium with fewer limitations than blood flow velocities analysis.
Cardiac Magnetic Resonance (CMR) has assumed an increasing role in the assessment of patients with heart failure, either for quantification of LV dimensions and volumes or for more precise anatomic and functional evaluation, helping differentiating ischemic from non-ischemic cardiomyopathies. The study with late gadolinium enhancement to assess myocardial infarction extension and myocardial viability also plays a significant role.
Nuclear methods, such as radionuclide angiography, SPECT and PET are also used in specific settings, such as in coronary artery disease patients.
More recently, molecular imaging has grown in its ability to assess different biological processes which may play a role in heart failure.
In conclusion, cardiac imaging plays a pivotal role in the assessment and understanding of the heart failure patient.
Sudden Cardiac Death in the Athlete: Expecting the Unexpected
Sheikh Khalifa Medical City, UAE
Sudden death in young athletes is an unexpected and often tragic event that can be the result of cardiac or non-cardiac causes. The presentation will provide an overview of the epidemiology of sudden cardiac death in athletes, and discuss the more common underlying conditions. These include hypertrophic cardiomyopathy, congenital coronary anomalies, channelopathies, and arrhythmogenic right ventricular dysplasia. Other rare causes include commotio cordis. Professional recommendations for sports participation among patients with pre-existing conditions pre-disposing them to sudden death will be discussed. The role of the automatic external defibrillator in preventing sudden death on sports fields will be examined.
ECHO in TAVI
Mayo Clinic, USA
Transesophageal echocardiography (TEE) is critical to the success of transcatheter aortic valve implantation (TAVI). Preprocedural imaging objectives include: Confirming tricuspid aortic valve morphology; assessing landing zone site for suitability of valve deployment/potential complications taking into consideration valve/device characteristics. This includes checking for sub valvular calcification, and ruling out left ventricular outflow tract (LVOT) obstruction and significant basal septal hypertrophy; ruling out severe aortic or organic mitral regurgitation (severe organic mitral regurgitation is a particular problem for Core Valves because length of the ventricular component can interfere with mitral valve function; check for presence of asymmetric valvular calcification; assessment of left and right ventricular function; ruling out intracardiac thrombus; checking for presence of pericardial effusion; scanning of the thoracic aorta for bulky atheromatous plaques including mobile plaques.
Accurate aortic annulus measurement is critical for the success of TAVI because: Size of annulus will determine the size of the prosthesis that should be used; oversized prosthesis may cause significant central prosthesis regurgitation due to suboptimal stent expansion with impaired cusp mobility, aortic root hematoma or rupture, or coronary ostial obstruction; undersized prosthesis may result in significant periprosthetic regurgitation due to inadequate apposition of the stented valve with the surrounding annulus, device migration, or patient-prosthesis mismatch.
The periprocedural role of echocardiography (usually TEE) includes: Aiding in balloon positioning for aortic valvuloplasty; assessing the severity of aortic regurgitation following valvuloplasty; confirming the correct position of the prosthesis; checking prosthesis function immediately after implantation including presence of prosthesis regurgitation; checking for perivalvular regurgitation and assessing its severity. Risk factors associated with periprosthetic regurgitation include: Large aortic annulus; undersized prosthesis; asymmetric cusp calcification; LVOT calcification; prominent septal bulge; Low valve deployment.
If the balloon expandable Edwards-Sapien valve is deployed too low it can potentially embolize into the ventricle, but more commonly might leave native leaflets uncovered creating leaflet overhang which in turn interferes with prosthesis valve closure resulting in significant central AR or periprosthetic AR through the uncovered part of the prosthesis. Other potential complications from a low deployment include impingement and injury to the AML.
On the other hand, if the Edwards-Sapien valve is deployed too high within the aorta, it can potentially embolize into the aorta resulting in coronary artery obstruction or significant valvular or paravalvular regurgitation.
Other post TAVI complications for which echocardiography is a very useful too include: Cardiac perforation (pericardial effusion or tamponade); rupture of aortic root or annulus; traumatic ventricular septal defect/septal hematoma; avulsion of ascending aorta intima; new or worsening tricuspid regurgitation secondary to right heart instrumentation; new thrombus formation.
Cardiovascular Imaging: What does the Future Hold?
William A. Zoghbi
Houston, Texas, USA
The past few decades have witnessed significant improvements in cardiovascular imaging, particularly echocardiography, cardiac CT and cardiac MRI. In echocardiography, improvement of technology was seen with incorporation of 3D real time imaging, as well as speckle tracking for the improved evaluation of ventricle volumes, global and regional function. These technologies have further improved our evaluation of diastolic function. In the area of coronary disease, the aim to detect total risk, and not only manifestation of ischemia on stress testing, with the incorporation of coronary Ca scoring, LV hypertrophy and atrial enlargement. From a diagnostic point of view, few remaining problems for both echocardiography and nuclear techniques include difficulties in the inferior wall, in patients with ventricular hypertrophy, three vessel disease or bundle branch block. In these patients, application of CT coronary angiography and coronary calcium scoring improves overall risk assessment and diagnostic accuracy. In valvular heart disease, the focus in the future is to improve our quantitation of mitral regurgitation and determination of stress and strain on the leaflets with newer computer technology. Imaging has also moved recently into the catheterization laboratory with development of "interventional imaging", guiding the structural heart disease specialist in various interventions, be it in TAVR implantation or left atrial appendage occluders. With increased miniaturization of echocardiography, one can foresee improved diagnostics at the bedside, incorporating various digital technologies and synchronizing acquisitions with electronic health record for storage and review.
Nuclear imaging has already incorporated newer crystals for improved sensitivity and decreased time of acquisition. Cardiac MRI is currently the only technology that can imaging scar, with expanded possibilities for the future. Positron emission tomography with new agents promise better quantitation of myocardial blood flow as well as depiction of areas and inflammation in patients with acute coronary syndromes.
Many opportunities and challenges await us in the expanding world of multimodality cardiovascular imaging. These include detection of early disease and definition of the cardiovascular phenotype. While we have to maintain innovation in individual imaging modalities, novel technologies would need ultimately to demonstrate impact on patient care and outcome. As professionals, we need to avoid layering of multiple tests in individual patients, be it from a safety or a cost point of view. Ultimately, the quest is to identify best and cost-effective approaches to disease detection and management, in a multimodality imaging world.
Cardiac MRI and CT Scan for the Diagnosis of Children with Congenital Heart Disease
Fahad Al Habshan
King Saud Bin Abdulaziz University for Health Sciences, Saudi Arabia
The diagnosis of congenital heart disease in children is a challenging issue. Most of the time the diagnosis can be reached based on careful clinical assessment and the use of echocardiography. Occasionally, further details are required necessitating the use of other modality of cardiac imaging such as angiography.
The development in both Magnetic Resonance Imaging (MRI) and Computerized Tomography (CT) in the field of cardiac imaging has led to the utilization of both techniques in the evaluation of children with congenital heart disease. The importance of both techniques is appreciated in the assessment of children with complex cardiovascular malformations, children with poor echo windows and as a better surrogate for the invasive diagnostic cardiac catheterization.
Cardiac CT angiography has improved significantly after the introduction of the spiral volume acquisition technique, the ability of multiplanner and Three-dimensional (3D) reconstruction of the images and the new development of the multidetector CT scanners. The imaging became fast with few seconds scanning time requiring no anesthesia or deep sedation, and it yields high resolution images. It is very valuable in the assessment of the congenital vascular anomalies including the aortic arch, pulmonary arteries and pulmonary veins. It has particularly great value in the assessment of associated airway and lung problems related to the congenital vascular anomalies such as vascular rings with airway compression, tracheo-bronchomalacia, lung hypoplasia., etc. The disadvantage of cardiac CT is the radiation exposure and the use of ionized contrast agents that have considerable documented side effects. Nowadays, due to the new development in the CT hardware and software, CT angiography can be performed in children using very small dose of radiation (sub-milliseivert).
Cardiac MRI has also improved significantly due to the recent advances in the cardiac sequences that are developed specifically for cardiac evaluation. The technique has moved from plain imaging into a more informative multiplanner imaging modality with a great capability of offering noninvasive functional and hemodynamic assessment for the ventricular volume, ventricular muscle mass, ejection faction, cardiac output and cardiac index in addition to the information of myocardial perfusion and delayed enhancement to detect ischemia, scarring and fibrosis. It also provides information about the flow velocity and volume that can help in the evaluation of shunt lesions, stenotic or regurgitant valves and vessels and the evaluation of differential lung perfusion. The MR angiography is a very powerful tool in the assessment of vascular anatomy, its 3D and multiplanner reconstruction yields wonderful images that provide detailed anatomic assessment. The contrast agent used in MR angiography is relatively safe with few known side effects. Cardiac MRI procedures are relatively long and tiresome necessitating the use of deep sedation or general anesthesia for the small children undergoing this procedure.
Both cardiac MRI and CT should be considered complementary and adjunctive tools in the diagnosis of congenital cardiovascular malformation rather than a first line investigation. Special training and skills are required for the performance of cardiac MRI and CT in addition to the knowledge and experience required in the field of congenital heart diseases.
Late Breaking Trials in Interventional Cardiology
Al-Thawra Cardiac Center, Yemen
The field of interventional cardiology has been characterized by innovation and technological progress in recent years. Clinicians, in partnership with specialists in molecular biology, biomedical engineering, biophysics and imaging technology, have raised the profile of interventional cardiology to the extent that it is now one of the most vibrant and dynamic subspecialties in mainstream medical practice. There is an increasing need to focus not only on the effectiveness of treatment, but on safety issues; for example drug-eluting stent thrombosis. Exciting trials in the field of interventional cardiology were published and presented in the cardiology conferences this year which open a new era in intervention. These trials and major scientific work published in the field of interventional cardiology will be highlighted during the presentation and provide a broad overview for general cardiologists, as well as a framework for more detailed study for those interested in interventional cardiology.