Scientific Program

Conference Series LLC Ltd invites all the participants across the globe to attend 2nd International Conference on Non-invasive Cardiac Imaging, Nuclear Cardiology & Echocardiography Amsterdam, Netherlands.

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Day 2 :

Keynote Forum

Pieter A. Doevendans

University Medical Center Utrecht, The Netherlands

Keynote: Efficacy of renal denervation in the porcine Model

Time : 10:00-10:40

Nuclear Cardiology  2017 International Conference Keynote Speaker Pieter A. Doevendans photo
Biography:

Pieter Doevendans became a cardiologist in Maastricht. In 1993-1994 he had the opportunity to work with Ken Chien at UCSD San Diego where the work on stem cells started. The work was completed in Maastricht and provided the basis for a thesis on the promoter of the atrialMLC gene. Upon return in the Netherlands he worked with Christine Mummery and Hans Clevers (Hubrecht Laboratory). In the meantime he remained active as an interventional cardiologist initially in Maastricht, but from 2002 on in Utrecht. Here he was appointed full professor in Cardiology in 2004 and head of the department in 2005. He was funded by various national and international foundations.

Abstract:

Rationale: Recently, the efficacy of renal denervation (RDN) has been questioned. It is discussed whether RDN is able to adequately reach the renal nerves.

Objective: We aimed to investigate how effective RDN was by means of functional hemodynamic measurements and nerve damage on histology.

Methods and results: We performed hemodynamic measurements in both renal arteries of healthy pigs using a Doppler flow and pressure wire. Subsequently unilateral denervation was performed, followed by repeated bilateral hemodynamic measurements. Pigs were terminated directly after RDN or were followed for 3 weeks or 3 months after the procedure. After termination, both treated and control arteries were prepared for histology to evaluate vascular damage and nerve damage. Directly after RDN, resting renal blood flow tended to increase. In contrast, renal resistance reserve increased significantly during follow-up. Vascular histopathology showed that most nerves around the treated arteries were located outside the lesion areas, whereas only14% of the nerves per pig were observed within a lesion area. Subsequently, a correlation was noted between a more impaired adventitia and a reduction in renal resistance reserve (β: -0.33; P=0.05) at three weeks of follow-up

Conclusion: Only a small minority of renal nerves was targeted after RDN. Furthermore, more severe adventitial damage was related to a reduction in renal resistance in the treated arteries at follow-up. These hemodynamic and histological observations may indicate that RDN did not sufficiently target the renal nerves. Potentially, this may explain the significant spread in the response after RDN.

Figure 6: Title: Nerve damage outside the lesion area Legend: 3 weeks histology results showing a treated vessel with nerve damage outside the lesion area. A 20 x magnification (a-e) zooms in on the affected nerve that is indicated with an arrow in picture 1- 6. Serial sections were stained with HE, MST, α-SMA, S100, PGP9.5 and TH. The perineurial tissue and nerves located at the opposite site of the lesion were affected by an extensive inflammatory 21 response (1,a and 2,b), increased proliferation of myofibroblasts (3,c), a reduction in neural tissue (4,d;5,e) and loss of neurotransmitter production of the affected nerves. (adapted from publication in PlosOne 2015).

Keynote Forum

Attila Kardos

Milton Keynes University Hospital, UK

Keynote: What is new in the assessment of patients with chest pain ESC and the NICE recommendations

Time : 10:00-10:50

Nuclear Cardiology  2017 International Conference Keynote Speaker Attila Kardos photo
Biography:

Attila Kardos is a consultant cardiologist at Milton Keynes University Hospital NHS Foundation Trust and a Hon Senior Lecturer to the Division of Cardiovascular Medicine, Radcliffe Department of Medicine Oxford University. He is a clinical lead in multimodality Cardiovascular Imaging and a Director of Research and Development of the Trust. His research interest includes advanced imaging based recognition or cardiovascular pathologies utilizing Cardiac MRI , Cardiac CTA, and advanced echocardiography. His earlier research encompasses exercise physiology and the influence of the autonomic nervous system on exercise performance. Dr Kardos is Chief investigator on in the VECTRA CEB research project that investigates the utility of electrical biomarker in chest pain assessment. He has been and currently is a local principle investigator in several multi-centric trials e.g. EMPHESIS, PARADIGME, PARADIGME –Extent, IMPROVE-IT, RAPID –CTCA, EVAREST, EUROASPIRE-V, SUPPORT-HF2. He is also a member of several Editorial board of a variety of scientific journals.

Abstract:

The prevalence of chest pain presentation to the emergency department is in the range of 25-30%. Stable coronary artery disease has a relatively good long-term outcome with low MCAE rate.  The standardization of the diagnosis and management of chest pain patients had been proposed by the European Society of Cardiology and the UK National Institute of Health and Care Excellence (NICE) in 2013 and 2010 respectively. The evolution of diagnostic modalities in cardiology and the evidence from imaging based RCT the triple pillars of chest pain diagnostics (clinical symptoms and risk factors, pre-test probability assessment, and a variety of diagnostic tests for risk stratification) as has been simplified to symptomatic assessment and anatomical imaging of coronary arteries by Cardiac CT Angiography as a gate keeper modality in the update documents of the NICE guidelines in November 2016. Utilizing its high negative predictive accuracy CCTA can be used as a rule out test but equally can predict event depending on the extent and severity of coronary artery disease. Functional test like stress echocardiography, myocardial nuclear perfusion scintigraphy, CMR perfusion have a different role in detecting objective sign of ischaemia in patients with equivocal or moderate degree of coronary artery stenosis on CCTA and in patients with previous coronary artery disease who present with uncertain chest pain symptoms. Those patients only who had sever coronary stenosis on CCTA or present with typical chest pain with prior know CAD will be considered for invasive coronary angiography with view to risk stratify/deliver treatment. In this talk the currently operational guidelines will be reviewed and discussed.

References:

  1. Eur Heart J 2013;34:2949–3003 - doi:10.1093/eurheartj/eht296
  2. Chest pain of recent onset. Assessment and diagnosis. November 2016 NICE

Break: Networking and Refreshments Break: 10:50-11:05 @ Pre function
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