Abstracts - SA Heart Congress 2016

Index of abstracts: alphabetical listing of first authors

Pacing with restoration of respiratory sinus arrhythmia improved cardiac contractility and the left ventricular output: a translational study

Introduction: Respiratory sinus arrhythmia (RSA) is a prognostic value for patients with heart failure and is defined as a beat-to-beat variation of the timing between the heart beats. Patients with heart failure or patients with permanent cardiac pacing might benefit from restoration of RSA. The aim of this translational, proof-of-principle study was to evaluate the effect of pacing with or without restored RSAon parameters of LV cardiac contractility and the cardiac output

Blunt trauma associated with increased cardiovascular morbidity

Cardiovascular diseases and trauma are two major public health issues. Evidence from numerous clinical case reports suggests that trauma may lead to various cardiovascular disorders, such as acute myocardial infarction, cardiac valve disorders and arrhythmias. Various mechanisms of such associations have been suggested; however, no population based studies have been conducted. Population-based studies are important in that they reduce the potential for selection bias and confounding, both of which may limit the interpretation of case reports. In addition, population based studies which include control groups provide quantitative estimates of association. We hypothesize that trauma is significantly associated with increased risk for certain cardiovascular disorders. To examine this issue, we conducted a cross-sectional analysis of the association between certain types of trauma (i.e. blunt cardiac injury (BCI), blunt thoracic injury, blunt abdominal/ pelvic trauma) and certain cardiac disorders (cardiac valve insufficiency and acute myocardial infarction) based on a large database of all hospital discharges from 19 states during a one-year period. We also conducted a matched case-control study of the association between blunt cardiac and thoracic injury and cardiac arrhythmias. Both the exposure (trauma) and the disease (cardiovascular disorders) were identified based on ICD-9-CM codes. Various confounding factors have been identified through the database. Unadjusted, multivariate logistic and the conditional adjusted multivariable regression analyses were performed. Independent of potential confounding factors, discharge for BCI was associated with a 12-fold increased risk for tricuspid valve insufficiency, incompetence, regurgitation or stenosis and a 3.4-fold increased risk for aortic valve insufficiency, incompetence, regurgitation or stenosis. Independent of confounding factors and coronary arteriography status, direct trauma to the heart was associated with a 3-fold increased risk for acute myocardial infarction in persons 46 years or older. When the diagnosis of acute myocardial infarction was confirmed by coronary arteriography, BCI was associated with a 5-fold risk elevation among patients 46 years and older and a 44-fold elevation among patients 45 years and younger. Abdominal or pelvic trauma, irrespective of confounding factors and coronary arteriography status, was associated with a 70% increase in the risk of acute myocardial infarction among patients 45 years and younger and a 3-fold increase among patients 46 years and older. We also found that after adjusting for potential confounders, patients 45 years and younger diagnosed with BCI had 13-fold increase in the risk of cardiac arrhythmia.This research has public health significance because it represents one of very few attempts to look at the association between two major health issues - namely trauma and cardiovascular disorders at such a large population based level. With the findings that several types of traumatic injury (such as thoracic, cardiac, abdominal and pelvic) are associated with an increased risk of specific cardiovascular disorders - namely - cardiac valve insufficiency, acute myocardial infarction and cardiac arrhythmias, it appears that trauma may play an important and heretofore largely unrecognized role in a portion of the national burden of cardiovascular morbidity and mortality

Animals and Medicine

Animals and Medicine: The Contribution of Animal Experiments to the Control of Disease offers a detailed, scholarly historical review of the critical role animal experiments have played in advancing medical knowledge. Laboratory animals have been essential to this progress, and the knowledge gained has saved countless lives—both human and animal. Unfortunately, those opposed to using animals in research have often employed doctored evidence to suggest that the practice has impeded medical progress. This volume presents the articles Jack Botting wrote for the Research Defence Society News from 1991 to 1996, papers which provided scientists with the information needed to rebut such claims. Collected, they can now reach a wider readership interested in understanding the part of animal experiments in the history of medicine—from the discovery of key vaccines to the advancement of research on a range of diseases, among them hypertension, kidney failure and cancer. This book is essential reading for anyone curious about the role of animal experimentation in the history of science from the nineteenth century to the present

A class of scaled Bessel sampling theorems

Sampling theorems for a class of scaled Bessel unitary transforms are presented. The derivations are based on the properties of the generalized Laguerre functions. This class of scaled Bessel unitary transforms includes the classical sine and cosine transforms, but also novel chirp sine and modified Hankel transforms. The results for the sine and cosine transform can also be utilized to yield a sampling theorem, different from Shannon's, for the Fourier transform

Special Topics in Cardiac Surgery

This book considers mainly the current perioperative care, as well as progresses in new cardiac surgery technologies. Perioperative strategies and new technologies in the field of cardiac surgery will continue to contribute to improvements in postoperative outcomes and enable the cardiac surgical society to optimize surgical procedures. This book should prove to be a useful reference for trainees, senior surgeons and nurses in cardiac surgery, as well as anesthesiologists, perfusionists, and all the related health care workers who are involved in taking care of patients with heart disease which require surgical therapy. I hope these internationally cumulative and diligent efforts will provide patients undergoing cardiac surgery with meticulous perioperative care methods

Special propedeutics of internal diseases

ВНУТРЕННИЕ БОЛЕЗНИКУРСЫ ЛЕКЦИЙПРОПЕДЕВТИКА ВНУТРЕННИХ БОЛЕЗНЕЙГИПЕРСЕНСИБИЛИЗАЦИЯЭНДОКРИННОЙ СИСТЕМЫ БОЛЕЗНИГЕМАТОЛОГИЧЕСКИЕ БОЛЕЗНИПОЧЕК БОЛЕЗНИУРОЛОГИЧЕСКИЕ БОЛЕЗНИПИЩЕВАРИТЕЛЬНОЙ СИСТЕМЫ БОЛЕЗНИДЫХАТЕЛЬНЫХ ПУТЕЙ БОЛЕЗНИКРОВООБРАЩЕНИЯ РАССТРОЙСТВАВ лекциях представлены сведения по основам клинической диагностики внутренних болезней

Pharmacological interventions for the hemodynamic management of deceased organ donors

Chaque année, plusieurs milliers de patients aux prises avec une maladie chronique terminale s’ajoutent à la liste d’attente pour une transplantation d’organe, espérant ainsi prolonger leur espérance de vie. Le plus souvent, le don d’organes survient suite au décès neurologique d’un donneur, une condition qui n’est pas sans conséquence sur la qualité des organes. Les traitements pharmacologiques visant à rétablir l’homéostasie et à protéger les organes à transplanter ont été majoritairement étudiés dans des études observationnelles, au début des années 80. Depuis, très peu d’essais randomisés ont évalué l’impact d’interventions chez des donneurs sur des issues cliniques chez des receveurs. Conséquemment, le bénéfice net des traitements pharmacologiques utilisés de routine chez les donneurs d’organes après décès neurologique demeure inconnu et la rationnelle physiopathologique supportant leur utilisation est questionnable. Cette thèse a pour visée de recenser les évidences supportant les traitements pharmacologiques employés pour la stabilité hémodynamique des donneurs d’organes après décès neurologique et de décrire le niveau d’évidence supportant leur usage. Nous visons également à identifier des cibles de recherche potentielles basées sur de nouvelles observations pathophysiologiques. Pour atteindre ces objectifs, nous avons dressé un large portrait de la prise en charge actuelle des donneurs après décès neurologique, ceci menant ensuite à l’exploration des perceptions des médecins intensivistes canadiens en regard de ces interventions. Nous avons également exploré la présentation clinique cardiaque des donneurs et nous avons identifié des barrières à la recherche clinique dans le domaine. Notre thèse a mené à 4 articles scientifiques. D’abord, nous avons démontré à l’aide d’une revue systématique des lignes directrices internationales sur la prise en charge des donneurs après décès neurologique que les recommandations actuelles sont incohérentes et que leur faible qualité méthodologique reflète la lenteur de l’émergence de la recherche dans le domaine. Ensuite, nous avons effectué un sondage national auprès de médecins des soins intensifs ayant de l’expérience dans la prise en charge des donneurs. Nous avons ainsi démontré que les perceptions de pratiques sont très variables au pays et avons attribué ces divergences d’opinions au manque de données probantes, et à la possible inexpérience relative des médecins face aux rares cas de don d’organes sur une unité de soins intensifs. Notre troisième article a démontré que la dysfonction ventriculaire droite est fréquente après un décès neurologique, bien que la littérature actuelle ne mette l’emphase que sur la dysfonction ventriculaire gauche et ses conséquences. Nous émettons l’hypothèse que la description actuelle des conséquences hémodynamique du décès neurologique est incomplète et qu’une meilleure compréhension des mécanismes sous-jacents à la dysfonction ventriculaire droite permettrait d’identifier de nouvelles cibles thérapeutiques. Finalement, en s’appuyant sur nos observations, nous questionnons l’efficacité et la pertinence d’interventions pharmacologiques administrées de routine chez les donneurs telles que l’hormonothérapie de remplacement. Nous avons donc effectué un essai randomisé pilote visant à évaluer la faisabilité d’une étude multicentrique déterminante comparant la levothyroxine au placebo chez des donneurs potentiels. Cette étude pilote a démontré qu’une étude d’envergure était nécessaire afin d’évaluer le bénéfice de l’intervention et a permis d’identifier des barrières à la recherche spécifiques au domaine. Nous proposons que des activités de transfert de connaissances sur le niveau d’évidence supportant les interventions pharmacologiques actuelles soient implantées en préparation d’un essai randomisé contrôlé multicentrique. Cette thèse a permis de mettre en lumière la validité questionnable du traitement pharmacologique pour la prise en charge de l’instabilité hémodynamique des donneurs d’organes tel qu’il est utilisé présentement. Nous avons fait ressortir que le traitement actuel est historiquement basé sur des données de faible évidence. Nous suggérons que l’avenir de la recherche interventionnelle chez les donneurs d’organes repose sur la capacité des cliniciens et des chercheurs à reconnaitre les zones d’incertitude dans les connaissances actuelle et à accepter des changements dans leur pratique.Every year, thousands of chronically ill patients are added to the transplant list, in the hope of an organ transplant that could save their life. Most frequently, organ donation occurs following neurological death of a donor, a clinical pathological condition that can jeopardize the quality and stability of organs. The body of literature on the hemodynamic consequences of neurological death and their treatment exist since the early 80’s. Since then, very few randomized trials have been performed on the neurologically deceased donor population. As a consequence, the benefit of routine pharmacological therapies for the hemodynamic management of neurologically deceased donors on recipients’ outcomes is still uncertain, and the pathological theory underlying their use remains questionable. Consequently, this thesis aims at describing the actual body of evidence supporting the pharmacological treatment for the hemodynamic management of neurologically deceased donors and the theoretical rationale for their use. We also aimed at adding to the actual knowledge of brain death physiological hemodynamic consequences. To achieve this goal, we drew a broad portrait of the actual management of hemodynamic instability in organ donors, leading to the exploration of perceptions on these interventions. We then explored physiological consequences of neurological death at the heart level and evaluated the feasibility of conducting a multicentre trial on a pharmacological intervention in donors. Our thesis let to four research articles. First, we demonstrated through a systematic review of international guidelines for the management of neurologically deceased donors that the existing recommendations are inconsistent and that their poor methodological quality reflects the slow emergence of clinical research in the field. Then, in a national survey of intensive care physicians with experience in organ donor clinical management, we identified varying perceptions of practices in the country. We attributed this difference in opinions to the paucity of research in the field and to the possible relative inexperience of some physicians when managing deceased donors, a relatively rare condition in the intensive care unit. Our third article suggested that right ventricular dysfunction is frequent after neurological death, although existing literature focus mainly on the occurrence and consequences of left ventricular dysfunction. We postulate that the actual description of hemodynamic consequences of neurological death is incomplete and that a better understanding of the mechanisms underlying right ventricular dysfunction would permit to identify new therapeutic targets. Finally, based on our previous conclusions, we questioned the relevance and efficacy of levothyroxine routine administration in donors and designed a pilot randomized controlled trial to evaluate the feasibility of a multicenter definitive trial. This pilot trial permitted to identify important barriers to interventional research including neurologically deceased donors. We propose that knowledge translation activities on the actual level of evidence supporting routine interventions be implemented in the preparation of a future randomized trial. This thesis permits to question the validity of the actual pharmacological management of neurologically deceased donors highlighting the paucity of high-evidence literature in the field and the penetrance of historical interventions and concepts. We suggest that the future of research in the field lies on the ability to recognize areas of uncertainties and the acceptance of practice change