Dr. Peter P Karpawich

Biography

Peter P. Karpawich, MSc, MD is the Director of the Cardiac Electrophysiology and Pacing Services at the Children’s Hospital of Michigan and Professor at the Wayne State University School of Medicine in Detroit. He has expertise in Pediatric/Congenital Heart electrophysiology and pacing with extensive research in cardiac rhythm managementarrhythmia mapping and ablation therapies, pacemaker lead design technologies, alternate site mapping for optimization of paced myocardial function and resynchronization pacing for heart failure. He performed initial studies on the feasibility of His bundle pacing to improve physiologic pacing and low-threshold as well as steroid-eluting pacing leads. Dr Karpawich has contributed to over 280 scientific publications, textbook chapters and textbooks and is on the Editorial Boards and Reviewer of several peer-review international journals. He is Fellow of the Heart Rhythm SocietyAmerican College of CardiologyAmerican Heart Association and American Academy of Pediatrics and recipient of awards for research and teaching.

 

Abstract

Statement of the Problem: Cardiac Resynchronization Pacing therapy (CRT) is an established therapy to remodel the failing ventricle in heart failure (HF) but with variable reported success rates. However, published Guidelines for patient (pt) selection excluded structural and CHD pts as well as limit success to QRS duration and ejection fraction (EF), both variables which have been questioned as to their validity and accuracy. In this regard better criteria are needed to both risk stratify CHD pts as well as to determine success. Purpose: To present updated information on the efficacy of pt pre-selection based on direct left ventricular (LV) contractility (dP/dt) as well as multiple ECHO parameters of success. Methods: Pts referred for CRT pacing for HF all had ECGs and underwent hemodynamic catheterization pressure studies which included direct contractility (dP/dt-max) pre-and post-acute pacing and 9 ECHO-derived parameters in addition to EF. These included left atrial (LA)/LV strain, endo-/myocardial and average peak/end-systolic strain (S), as well LV sphericity index. Selection for CRT was based on a ?15% acute improvement in dP/dt-max. Post CRT, pts were followed up to 18 years. Findings: 26/40 CHD pts with HF showed initial dP/dt improvement (597 ± 171 to 848 ±207mmHg-sec, p < 0.006)). Post CRT, all improved clinically. At 1 year post CRT, dP/dt either improved or remained stable (848±207 to 958±305mmHg-sec, p = 0.14). QRS and EF showed only a 7 and 21% change respectively (P=NS) while other ECHO parameters showed much more improvement: LAS -5.8±4 to -9.3±4.2 (60%) and endocardial S -6.4±2.9 to -9.2±5 (44%). However, no value reached significance. Conclusion: Contractility-guided CRT pt selection improves HF outcomes.  ECHO-derived strain values are more sensitive than QRS and EF to show improvement and offer better non-invasive  markers of paced ventricular response.

Dr. Gerald M. Lemole

Biography

Gerald M. Lemole, MD served as Chief of Cardiovascular Surgery at Christiana Care Health Services from 1986 through 2006. Subsequently, he served as the Medical Director for the Center of Integrative Health at The Preventive Medicine and Rehabilitation Institute. Dr. Lemole received his undergraduate degree from Villanova and doctor of medicine degree from Temple University School of Medicine. After a residency in general surgery at Temple University Hospital, he did his cardiac training at Baylor College of Medicine in Houston, Texas, from 1967 to 1969. While at Baylor, Dr. Lemole became certified by the American Board of Surgery and the American Board of Thoracic Surgery and began serving as instructor in surgery. In 1968, he was a member of the surgical team that performed the first successful heart transplant in the United States. Dr. Lemole returned to Philadelphia from Texas in 1969 to serve as an instructor in surgery at Temple. That same year, he performed the first coronary bypass in the tri-state area of Pennsylvania, New Jersey and Delaware. At age 32, he was named Chief of Cardiothoracic Surgery at Temple University. He was Chief of Surgery at Deborah Heart & Lung Center, Brown Mills, NJ from 1972 to 1984. In 1975, at age 38, he became a full professor at Temple, an achievement which also made him one of the youngest full professors of surgery in the United States. In 1982, while visiting Turkey, Dr. Lemole performed that nation's first coronary artery  bypass procedure. His major professional memberships include the Society of Thoracic Surgeons, the Society for Vascular Surgeons, and the American Association for Thoracic Surgery. He is also a member of many societies and associated committees related to his profession. Dr. Lemole has lectured extensively and written numerous articles for professional publications. He has also published three books and is currently working on a book for post-cancer treatments. He has been a visiting professor at the Universities of Dublin and Istanbul, the Military Medical College of Ankara, Allegheny General Hospital, Fengtai Heart Institute, Beijing, China, People's Hospital and 2nd Military Medical University, China, and Columbia Presbyterian University Hospital. He is listed in the publication Who's Who in the United States and the Marquis Who's Who Directory of Medical Specialists. He is a past recipient of the American Medical Association Physician's Recognition Award and numerous other awards.

Abstract

Increasing interest has been directed towards the role of the lymphatics, Inflammation and the immune system in reverse cholesterol transport in cardiovascular disease.  Clearance of cholesterol in the arterial wall via the adjacent lymphatics vessels was first proposed almost 40 years ago and has been corroborated and strengthened by significant research in the recent past. A better understanding of  reverse cholesterol is continually developing. However, large questions remain regarding the relationship between the disease and specific associated characteristics that are found in either the absence or presence of pathology. For example, we know that arteriosclerosis is associated with oxidized cholesterol, homocysteine elevation, bacterial infections and dental caries. Endothelial integrity and intramural antioxidant micro nutritional status are also important. Lastly, seemingly unrelated activities like exercise, stress modification and dietary optimization significantly correlate with good vascular health. Cardiovascular Lymph egress and the lymphatic endothelial communication with the neuro- immune- endocrine systems, give a plausible explanation for the profound benefits of these seemingly disparate actions, which allows for a unifying concept in arteriosclerotic cardiovascular disease. It is also posited that lymphatic derangements may also be significant for other chronic degenerative diseases such as inflammatory bowel disease, and neurodegenerative diseases.

Dr. Robert Joel Goldberg

Biography

Dr. Robert Joel Goldberg is currently an Emeritus Professor at the University of Massachusetts Medical School, USA. He completed his Ph.D. Epidemiology from Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, the United States in 1978.

He has been actively involved in community-based studies of the natural history and primary and secondary prevention of coronary heart diseaseheart failure, and deep venous thrombosis for more than 2 decades. He and several clinical researchers established the Worcester Heart Attack Study in the early 1980s. Through the current period of federal funding support, they are examining more than 3 decade long trends (1975-2007) in the incidence rates, in-hospital and long-term survival, and therapeutic approaches used in the management of more than 14,000 greater Worcester residents hospitalized with acute myocardial infarction at all medical centers in the Worcester metropolitan area. Presently he serves as the Co-PI on a population-based surveillance project that is examining changing trends in the incidence, hospital and long-term case-fatality rates, and management practices of in and outpatients with venous thromboembolism among residents of the Worcester metropolitan area. They are also receiving funding support from the National Heart, Lung, and Blood Institute to develop community-wide hospital and outpatient surveillance for heart failure in greater Worcester residents. He also serves as the senior epidemiologist for the Global Registry of Acute Coronary Events (GRACE) Project which is a large multinational coronary disease registry examining differences in the management practices, hospital, and post-discharge outcomes of more than 50,000 patients hospitalized in 14 countries with an acute coronary syndrome.

In collaboration with several investigators from the UMMS, they have recently received funding support from the NIH to initiate two observational epidemiologic studies, one in the area of acute heart failure and the other in the setting of venous thrombosis in the elderly. In the heart failure (HF) project, they are studying the symptoms patients with acute HF report experiencing, their extent of delay in seeking medical care after the onset of these acute symptoms, and factors facilitating or serving as obstacles to, the seeking of medical care in a timely manner. 

Dr. Trudy Wassenaar

Biography

Trudy Wassenaar, director of Molecular Microbiology and Genomics Consultants (MMGC), has a wide expertise in microbiology, both in applied and in fundamental research. She has worked as a consultant for companies, and governmental agencies and collaborated with colleagues from academia for over 20 years. Her collaboration with David Ussery started 17 years ago. She published over 120 publications in international peer-reviewed journals and wrote a popular science book entitled ‘Bacteria, the Bad, the Benign and the Beautiful’ that was published in 2011. Together with David Ussery and Stephano Borini she co-authored a textbook entitled ‘Bioinformatics for Microbiologists’ which came out in 2009. Her publication H-index is currently 47.

Abstract

Conflicting evidence exists whether gender differences in the risk of cardiovascular diseases (CVD) can be attributed to the gut microbiome. The microbiome of CVD patients is generally less diverse compared to healthy controls, with more bacteria belonging to Gram-negative Bacteroidetes and Proteobacteria, and fewer Gram-positive Firmicutes. Confusingly, the microbiome of women with high estradiol levels also display these trends compared to low estradiol women, while estradiol levels are considered to be protective of CVD. There are various mechanistic explainations how a healthy microbiome might affect cardiovascular health. The major bacterial players here are species that produce TMAO from dietary TMA found in meat, eggs and fish, and organisms that produce short-chain fatty acids (SCFA) while degrading dietary fiber. TMAO, thought to increase the risk of CVD, can be produced by a wide variety of species belonging to Proteobacteria, Firmicutes and Actinobacteria that employ different genes for this. Therefore, it is difficult to assess gender-related effects of TMAO production by the microbiome, as there are too many species involved. The production of SCFA, especially butyrate, is considered beneficial for a healthy gut and reduces the risk of CVD. Bacteria producing SCFA are mainly Firmicutes, plus some Bacteroides and Actinobacteria members. Butyrate is thought to stimulate an intact gut barrier. When in short supply, for instance due to dysbiosis, a damaged epithelial barrier results in endotoxemia, which increases the risk for chronic kidney disease and CVD. Again, based on the ‘typical’ high-estrogen female microbiome, such women should have an increased CVD risk. Since only certain bacterial groups may be responsible for the mentioned activities, with variation at the species and even strain level, assessing the gut microbiome by 16S is often not sufficient. At present it remains difficult to determine relative species abundance relating to gender, and to explain observations with the differences in heart disease between genders. Unfortunately, underlying factors (dietary habits, obesity, age, genetics) seem to have a greater effect on the risk of CVD. 

Dr. AJEYA UKADGAONKAR

Biography

Dr. Ajeya N Ukadgaonkar is an Interventional Cardiologist having DNB (certified by National Board of Examination) in Cardiology. He has completed his MD in Internal Medicine and has worked as an Assistant Professor in Internal Medicine. He has 2 publications in international and 1 publication in a national journal to his name. He bears a special interest in the field of research.

Abstract

Coronary artery aneurysms are rarely seen with an overall incidence of 1.5 to 5% and post coronary intervention incidence is 0.2 to 1.7%. They are reported to be more common after a drug eluting stent (DES) rather than a bare metal stent (BMS). Post stent coronary artery aneurysm formation is a dreaded complication which can lead to sudden death. We report a case of a 53 years old diabetic and hypertensive male who underwent percutaneous transluminal coronary angioplasty (PTCA) to the left anterior descending artery (LAD) with everolimus eluting stent (EES). Two months later he presented with angina, heart failure and severe left ventricular dysfunction. His check coronary angiography revealed a giant (30 x 20 mm) type 2 coronary artery aneurysm arising from LAD with occluded stent distal to the aneurysm. He was posted for surgery, during which the aneurysm was found to be communicating directly to the left ventricular cavity. Surgical aneurysmectomy with coronary artery bypass graft to LAD was done. Post operatively, the patient recovered rapidly and was discharged. To the best of our knowledge, acquired (post PTCA) giant coronary artery aneurysm communicating to the left ventricular cavity has hardly been reported yet. Due to paucity of these types of cases we have a limited experience in diagnosis and management of these patients. This case report will serve as an informative tool for diagnosis and management of these rare presentations of the heterogeneous disease. Prompt identification and treatment is the key for management of this fatal complication.

Dr. William J. Rowe M.D. FBIS

Biography

William J. Rowe M.D. FBIS (Fellow British Interplanetary Society), FACN (Fellow American College of Nutrition, Retired Fellow Royal Society of Medicine), is a board certified specialist in Internal Medicine. He received his M.D. at the University of Cincinnati and was in private practice in Toledo, Ohio for 34 years. During that time he supervised over 5000 symptom-limited maximum hospital-based treadmill stress tests. He studied 3 world class extraordinary endurance athletes and published their exercise-related magnesium deficiencies. This triggered a 20-year pursuit of the cardiovascular complications of Space flight. All his publications are posted on his website  www.femsinspace.com ).

Abstract

Of 12 moon walkers, James Irwin on day after return from Apollo 15 mission, showed extraordinary bicycle ( B) stress test (ST) hypertension ( 275/125) after 3 minutes exercise; supervising > 5000  maximum treadmill  ST, author never witnessed ST- blood pressure approaching this level.  Symptom-limited maximum B stress test showed “cyanotic fingernails”; possibly venous blood trapped peripherally, supporting author’s “Apollo 15 Space Syndrome,” postulating that severe fingertip pain during space walks, triggered by plasma fluid, trapped distally;  mechanism could be related to endothelial dysfunction, providing “silent ischemia” warning.  Neil Armstrong returned to Earth with severe diastolic hypertension  ( 160/135), consistent with ischemic left ventricular dysfunction; 50 mm increase in comparison with resting  BP 110/85. With inhalation of lunar dust, brought into habitat on space suit, with high lunar iron (I) this dust inhalation, along with reduced (R) space flight- transferrin, R antioxidant, calcium  (Ca) blocker -  magnesium, conducive to severe oxidative stress, Ca overload  with potential endothelial injuries. Using moon walker studies as example, my recent editorials show that I dust, released from brakes, with over 90% of brakes made of I, is a major hypertension factor and may  also contribute to myocardial infarctions.

Dr. Alexander Gorodkov

Biography

A. Gorodkov graduated from the Moscow university (1979), had PhD(1986) and Dr Sci (2004) degrees working in the field of Cardiovascular physiology. These last 25 years he deals with the study of nature and structure of the swirling blood flow in the heart and main vessels

Abstract

The swirling movement of blood in the proximal arterial segment of the circulatory system meets a number of requirements, which are weakly consistent with the fluid flow principles accepted in traditional hydrodynamics. The velocity field of such a flow may be described in a cylindrical coordinate system by means of partial exact solution of Navier-Stoks and continuity equations admitting the potentiality of the longitudinal and radial velocity components. The medium viscosity is included only in the expression for the azimuthal velocity component, and the viscosity was manifested only in a narrow axial region of a swirling jet. The resulting swirling flow is quasi-potential, axisymmetric, and convergent. The flow structure implies the absence of rupture and stagnation zones. The real blood flow in the heart and aorta seems to be very close to this class of swirling flows under the normal physiological conditions that allows the identification of its basic properties. In previous works, it has been proved that the dynamic spatial geometry of the flow channel of the left heart and aorta corresponds to theoretically calculated streamlines of the swirling flow of corresponding dimension, described by the exact solution. This flow has an external border, and the interaction with the channel border and between moving fluid elements is supposed to be weak. The flow evolution is determined by the time-dependent functions, which are the frequency and rotating characteristics of the jet, as well as functions depending on the jet dimensions. Previous experimental studies revealed the close connection between changes in the characteristic functions and the dynamics of the cardiac cycle. In order to formalize these functions, the analytical solution for the velocity field of a swirling jet was substituted into the system of Navier-Stokes and continuity equations in a cylindrical coordinate system. The solution of resulted differential equations has allowed the establishment of a link between these functions and the spatial coordinates of the swirling jet. Therefore a new formal mathematical tool has been found which allows the definition of the conditions providing a renewable swirling blood flow to imply in the heart and the aorta. 

Mrs. Renata Nivoloni

Biography

Renata Balbino is a Registered Nurse specialized in Primary Care Education and coaching to Home Health Care professionals. As a Primary Care Nurse and CEO of Dedicare Cuidados Integrais I`m always looking for ways to prevent and care for health including cardiovascular diseases. I will present a case report on how to use children to help their families in preventing cardiovascular illness.

Abstract

According to the World Health Organization (WHO) cardiovascular diseases (CVD) continue to be the major cause of death around the world, in an analysis concerning the evolution of CVD, the entity points out that in the last two decades high income countries have observed a reduction in prevalence of CVD, while a rapid and astonishing increase in these diseases occurs in low and middle income countries.1The Brazilian Society of Cardiology emphasizes the pandemic scenario of cardiovascular morbidity and mortality as greatest health challenge of the country, “a dramatic scenario and far from minimally acceptable control.”The socioeconomic burden related to early  mortality, the aftermath and damages to society shows the need of intensify CVD prevention among these countries, manly when considering the cost-benefit of preventive actions to curative actions. The scarcity of resources in the poorest countries, secondary social damages to morbidity and mortality of people in working age1,3,4 The Brazilian Ministry of Health recommends “health promotion with emphasis on school”, current Brazilian studies ratify the  effectiveness of the method for reducing the risk of cardiovascular disease in parents from public6,7 and private8 school children, following  line of studies with positive results observed in developed countries like England9 and German10The WHO and other  important researches corroborate the need to  engage  the entire family,  considering the genetics  and lifestyle issues that affect  the family’s cardiovascular health. 9,13Doctoral Thesis held at the University of São Paulo reinforce the lack of studies about the subject in public school in developing countries, such as Brazil, and with lower income families.6 The dissertation highlighted the need to expand the work in the area, particularly when it is considered that “large investments and improvement in the diagnostic and treatment area of CVD were not followed by the development of strategies to reinforce prevention, the main way to combat the problem.”6  The USP group of study developed a  program to prevent  CVD in public schools, the actions occurred weekly, during a year, in the classroom hours with children between 6 and 10 years of age, with play activities, theaters, games and practices with focus on promoting physical activities and adoption health lifestyle habits. The children were guided to apply these concepts of health   in their daily life of family togetherness.6-8At the end of the study, the analysis of cardiovascular risk factors showed significant improvement among parents of the intervention group compared to the control group, especially among parents with high or intermediate risk of cardiovascular illnesses.6-7The study in public schools6-7, used the same method of previous research group study carried out in private8 schools that also observed significant decrease of cardiovascular risk from parents. The Brazilian experiences highlight that this education program could transform the child in a multiplier agent of CVD prevention practices next to parents and other family members, provide condition for the child to develop and live a healthy lifestyle.6-8The study highlight the very   low cost of the program, as only a health professional , working two days a week is able to develop the project in a school with more than five hundred students.The cost-effectiveness of the method should be spotlighted, considering that the financing costs of the program depends on public health system, which in Brazil, as in many other countries is a sector with dearth of funding and lack investments in the preventive area. Latest development in information and communication technology (TICs), especially the reduction in the price of these services and the electronic devices, could greatly contribute to the use of internet and mobile telephony in this preventive strategy. The program will be extended to other cities, the USP research group intends  plan to test the use of TICs and other adaptations to the method in order to further reduce  the investment needed to implement the educational actions. The challenge to minimize program cost, will allow increase the number of assisted people in the health cardiovascular education project in the schools, this will be the goal of the researchers for the next years.  

Dr. Dao Wen Wang

Biography

Dr. Dao Wen Wang obtained his Ph.D. in Cardiology from Tongji Medical University (1992) and did the post-doctoral study with Dr. Capdevila at Vanderbilt University. He is the Chief of Department of Internal Medicine and Division of Cardiology Tongji Hospital, Tongji Medical CollegeHuazhong University of Science & Technology, and Director of Translational Medicine Center & Genetic Diagnosis Center and Institute of Hypertension. He is also Chairman of ISHR Chinese Section Translational Medicine Council and Chairman of Internal Medicine Section of Medical Association of Hubei Province. Dr. Wang works on studying both clinical and basic issues in cardiology and promoting evidence-based medicine and standardized treatment protocols in clinical practice. 

Dr. Kristina Sambol

Biography

Kristina sambol, MD, specialist in Family Medicine, received her medical degree and MMed fromThe University of Zagreb School of Medicine (UZSM/ZSM). For the last 7 years she has been a family physician in Health Center Varazdin County.  She has authored many academic and research works throughout her career, and has  participated in few clinical trials. She is a member  of the Croatian Association of Family Medicine. Her clinical interests include  chronic disease, type 2 diabetes mellitus in a primary care setting. Outside of work, Dr. Kristina enjoys spending time with family and friends traveling, cooking, and staying active.  

Abstract

Introduction: Arterial hypertension is a leading public health problem and a risk factor for the development of cardiovascular and cerebrovascular diseases. Most patients suffering from hypertension are monitored by family medicine physicians that have the requisite knowledge and skills needed to diagnose and treat this disease. This is greatly facilitated by 24-hour ambulatory blood pressure monitoring (ABPM), which has more diagnostic value for arterial hypertension than clinical measurement of blood pressure (BP) values and is also used for monitoring disease management and deciding on the therapy of choice. This article assesses the utility of 24-hour ABPM in family medicine clinics for establishing the diagnosis of arterial hypertension and monitoring patients with a previously established diagnosis. Patients and Methods: We included 52 patients in a cross-sectional study over a period of 4 months. BP values measured using 24-hour ABPM were compared with values initially measured at the clinic on the examination date. The difference in the percentage of uncontrolled hypertension diagnosed by clinical BP measurement in comparison with 24- hour ABPM was tested by applying the ?2 test. The association between BP values measured at the clinic and those measured by ABPM was tested using Spearman’s rank correlation coefficient. Results: The study comprised 18 men and 34 women. The average age of the participants was 56.06 years. Average 24-hour systolic pressure was 156.13 mmHg, and average diastolic pressure was 89.81 mmHg. The average values of systolic and diastolic pressure measured in the clinic were 141.98 mmHg and 84.52 mmHg, respectively. Uncontrolled systolic pressure demonstrated by ABPM was found in 47/52 patients, while 36/52 patients had uncontrolled diastolic pressure. In clinical measurements, uncontrolled systolic and diastolic BP values were registered in 29/52 and 9/52 patients, respectively. Conclusion: The measurement results demonstrate a positive correlation between BP values measured at the clinic and those measured using 24-hour ABPM. The application of ABPM contributes to correctly establishing the diagnosis of arterial hypertension and improved BP management. 

Dr. Sabrina Zeghichi-Hamri

Biography

Sabrina ZEGHICHI-HAMRI, Associate professor at Bejaia University (Algeria), Ph.D in Physiology, Physiopathology and Pharmacology from Grenoble University (France) and Master of Sciences in Food Quality Management from the Mediterranean Agronomic Institute of Chania, Crete (Greece).

Researcher at the department of cardiology (Grenoble University Hospital). My project was to study the effects of Omega-3 fatty acids on malignant ventricular arrhythmias and prevention of coronary heart diseases.

Currently, working on phytochemicals and their effects on the prevention of chronic diseases; at the Laboratory of Biomathematics, Biochemistry, Biophysics and Scientometrics (Bejaia University- Algeria).

Dr. Tatjana Cikac MD

Biography

Primarius Tatjana Cikac, MD, specialist in Family Medicine, is graduate of The University of Zagreb School of Medicine (UZSM/ZSM). Tatjana has been practicing since 1989,  in Varazdin, Croatia,  in prive GP office. Tatjana is also a mentor for family medicine resident. She has authored many academic and research works throughout her career, and has lead and participated in numerous clinical trials.  She has practiced broad spectrum family medicine which has included care of infants and children, adolescents and many diagnostic procedures.  Dr. Cikac is an active member of the regional leadership board of the Croatian Association of Family Medicine

Abstract

Introduction: Arterial hypertension is a leading public health problem and a risk factor for the development of cardiovascular and cerebrovascular diseases. Most patients suffering from hypertension are monitored by family medicine physicians that have the requisite knowledge and skills needed to diagnose and treat this disease. This is greatly facilitated by 24-hour ambulatory blood pressure monitoring (ABPM), which has more diagnostic value for arterial hypertension than clinical measurement of blood pressure (BP) values and is also used for monitoring disease management and deciding on the therapy of choice. This article assesses the utility of 24-hour ABPM in family medicine clinics for establishing the diagnosis of arterial hypertension and monitoring patients with a previously established diagnosis. Patients and Methods: We included 52 patients in a cross-sectional study over a period of 4 months. BP values measured using 24-hour ABPM were compared with values initially measured at the clinic on the examination date. The difference in the percentage of uncontrolled hypertension diagnosed by clinical BP measurement in comparison with 24- hour ABPM was tested by applying the ?2 test. The association between BP values measured at the clinic and those measured by ABPM was tested using Spearman’s rank correlation coefficient. Results: The study comprised 18 men and 34 women. The average age of the participants was 56.06 years. Average 24-hour systolic pressure was 156.13 mmHg, and average diastolic pressure was 89.81 mmHg. The average values of systolic and diastolic pressure measured in the clinic were 141.98 mmHg and 84.52 mmHg, respectively. Uncontrolled systolic pressure demonstrated by ABPM was found in 47/52 patients, while 36/52 patients had uncontrolled diastolic pressure. In clinical measurements, uncontrolled systolic and diastolic BP values were registered in 29/52 and 9/52 patients, respectively. Conclusion: The measurement results demonstrate a positive correlation between BP values measured at the clinic and those measured using 24-hour ABPM. The application of ABPM contributes to correctly establishing the diagnosis of arterial hypertension and improved BP management. 

Dr. Kamila Kocanda

Biography

She graduated with honors from the Faculty of Law and Administration of the University of Warsaw and was a student of American law course run by lecturers from the Levin College of Law, University in Florida. She was a scholarship holder of the Socrates - Erasmus program at Erasmus University in Rotterdam, the Netherlands. In 2016, she defended her doctoral dissertation in the field of medical law. Kamila Kocanda is a lecturer of subjects in the field of medical law and a member of the Bioethical Committee of the Jan Kochanowski University in Kielce. She is the CEO of legal department in one of the biggest hospitals in Poland, dealing with medical law issues, defending physicians in court disputes regarding their legal liability. She provides legal services to entities performing medical activities. She owns, among others, ILEC (International Legal English Certificate by Cambridge) and BEC (Business English Certificate - level higher).

Abstract

Statement of the Problem: when prescribing a drug for its approved use, there is accepted drug labeling for healthcare providers on how to use the drug safely and effectively. Off label drug use (hereinafter called as: OLDU) is widely accepted and very common medical practice. However, physicians may be sued and bear legal liability in the event of an adverse event related to a medication prescribed for an off-label use. The issues involved in the problem concern multiple questions of legal significance and importance. What is the relation between current medical knowledge and medical indications of a drug in label indications based on clinical trial? What are the potential insurance company decisions regarding physician liability for serious adverse events in case of OLDU? Is it possible to receive reimbursement for OLDU from the public payer within the common health insurance? Should a physician obtain a separate informed consent of a patient for OLDU in the event it is nearly a standard of care in a specific field of medicine? The purpose of this study is to discuss the potential risk of the absence of suitable legal regulations concerning OLDU in the above-mentioned areas. Methodology & Theoretical Orientation: the analysis regarding current Polish legal regulations as an example of the lack of proper legislation have been led in order to assess the risk of legislator omission of acting. Findings: the research lead to the conclusion that insufficient legal regulations may transfer the burden of legal consequences to a physician while OLDU should be not only a medical but also a legal issue. Conclusion & Significance: a legislator intervention appears to be inevitably necessary in order to create legal framework in order to legitimate OLDU as legally and formally justified in order to convert OLDU from medical practice into in force law.

Prof Xingqun Liang

Biography

Key Laboratory of Arrhythmia, Ministry of Education, East Hospital, Tongji University School of Medicine, Shanghai, China

Dr. Eduard Margetic

Biography

Dr. Eduard Margetic is an Associate Professor in the School of Medicine, University of Zagreb, Department of Cardiology, University Hospital Centre Zagreb, Croatia. He is an interventional cardiologist with over 25 years of experience in the field. His main interests are: interventional treatment of HOCM, LMCA percutaneous intervention, acute coronary syndrome, peri-interventional myocardial injury, epidemiology and prevention of CHD. He has performed studies and conducted clinical trials in those areas. He is a President of Working Group on Invasive and Interventional Cardiology of Croatian Cardiac Society.

Abstract

Objectives: Familial hypercholesterolemia (FH) is an important cause of premature atherosclerosis and therefore the development of early onset coronary heart disease (CHD). We assessed the prevalence of FH patients among the patients with acute coronary syndrome (ACS) and the therapeutic approach to this specific population of patients.

Methods: In this pilot study 208 participants were enrolled who were ? 60 years of age and underwent cardiac catheterization during last year (2017.) and were hospitalised at Department of Cardiology, University Hospital Centre Zagreb. Using the diagnostic criteria for the FH  (MedPed algorithm) patients having HeFH (possible, probable or definite) were identified.

Results: Seventeen out of 208 patients (8,17%) had clinical diagnosis of FH. In this group two patients (11,76%) had definite HeFH, nine patients (52,94%) had probable HeFH and six (35,29%) patients had possible HeFH. Patients with FH were treated as follows: before hospitalization 70,59% were taking statins and 29,41% were without statin therapy. On discharge 94,12% were on statin therapy and one 5,88% without! Mean LDL cholesterol value in FH patients before/without statin therapy was 6,7 mmol/l while mean LDL cholesterol value in ACS patients, FH excluded from group, was 3,1 mmol/l. Only  25% of prehospital statin-treated patients were on high-intensity statin therapy. The percentage of patients treated by high-intensity statin was increased to 37,5% posthospital. None of the prehospital statin-treated FH patients had achieved target LDL cholesterol levels ?1,8 mmol/L.

Conclusions: The results of our pilot study showed that FH is underrecognised and therefore underdiagnosed in patients with early onset ACS. One out of twelve patients who develop ACS is FH patient. Despite using statins none of patients with FH was appropriately treated. It contributes to the great risk for the development of new cardiovascular event in patients with FH.  

Dr. Robert Joel Goldberg

Biography

Dr. Robert Joel Goldberg is currently an Emeritus Professor at the University of Massachusetts Medical School, USA. He completed his Ph.D. Epidemiology from Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, the United States in 1978.

He has been actively involved in community-based studies of the natural history and primary and secondary prevention of coronary heart diseaseheart failure, and deep venous thrombosis for more than 2 decades. He and several clinical researchers established the Worcester Heart Attack Study in the early 1980s. Through the current period of federal funding support, they are examining more than 3 decade long trends (1975-2007) in the incidence rates, in-hospital and long-term survival, and therapeutic approaches used in the management of more than 14,000 greater Worcester residents hospitalized with acute myocardial infarction at all medical centers in the Worcester metropolitan area. Presently he serves as the Co-PI on a population-based surveillance project that is examining changing trends in the incidence, hospital and long-term case-fatality rates, and management practices of in and outpatients with venous thromboembolism among residents of the Worcester metropolitan area. They are also receiving funding support from the National Heart, Lung, and Blood Institute to develop community-wide hospital and outpatient surveillance for heart failure in greater Worcester residents. He also serves as the senior epidemiologist for the Global Registry of Acute Coronary Events (GRACE) Project which is a large multinational coronary disease registry examining differences in the management practices, hospital, and post-discharge outcomes of more than 50,000 patients hospitalized in 14 countries with an acute coronary syndrome.

In collaboration with several investigators from the UMMS, they have recently received funding support from the NIH to initiate two observational epidemiologic studies, one in the area of acute heart failure and the other in the setting of venous thrombosis in the elderly. In the heart failure (HF) project, they are studying the symptoms patients with acute HF report experiencing, their extent of delay in seeking medical care after the onset of these acute symptoms, and factors facilitating or serving as obstacles to, the seeking of medical care in a timely manner. 

Dr. FEDERICO LEGA

Biography

Federico Lega is Affiliate Professor of Government, Health and Not for Profit at SDA Bocconi School of Management. He is Associate Professor, Department of Institutional Analysis and Public Management at Bocconi University. He is Full Professor of Health Management at the University of MilanAt SDA Bocconi, since 2015 he is Director International Master in Healthcare Management Economics and Policy (MIHMEP) and, from 2007 to 2015, he was leader of executive training in Healthcare sector. He drives two "academy" dedicated to managerial development of clinical professionals (MSM Lab for neurologists and Lab for Medical Laboratory) and, furthermore, he conducts specific programs dedicated to general and medical directors of health companies. Over the last 20 years, he has been involved in projects all over Italy and abroad. He conducted numerous workshops and consulting projects with many pharma and medical devices companies, hospitals, several local health authorities, Italian Regions and health boards. Recently, he is deepening the topics of competitiveness and strategic positioning of private health care companies. He is the author of numerous books and articles on the subject. His works have been published in British Journal of Management, Journal of Healthcare Management, Health Policy and International journal of clinical practice. He is a member of the Scientific Committee of the magazine Organizzazione Sanitaria; he is representative for Clinical Leadership and Associate Editor for the magazine BMC Health Service Research and Editor in Chief of the magazine Healt Service Management. He is also Chair of scientific committee of the European Healthcare Management Association. Since 2005, he is Adjunct Professor Department of Health Services AdministrationUniversity of Alabama (USA) and Research fellow at York University Management School (UK). He was Visiting Professor in many international Universities including Hamburg University and Care Center (2013) and Zurich University (2012).Federico earned a Degree in Economics and Business Administration and a Ph.D. in Business Administration and Management both from Bocconi University.