Day 1 :
Keynote Forum
Shabeer Nellikode
Universal Hospitals, UAE
Keynote: Neurology and cardiology: Point of contact
Time : 09:00 AM-10:00 AM
Biography:
Shabeer Nellikode is the Founder and Managing Director of UBC World and Universal Hospital, UAE. He is also a Consultant Neurologist and treating other disorders at Universal Hospitals and Clinics, UAE. He is also the Director of LifeLine Hospitals, Abu Dhabi and MD at Universal Business Corporation, Petro-global Technologies, Abu Dhabi. He has been awarded the 50 Most Talented Healthcare Leaders of the Middle East Award.
Abstract:
Strokes resulting from cardiac diseases and cardiac abnormalities associated with neuromuscular disorders are examples of the many points of contact between neurology and cardiology. Cardiac diseases can be complicated by stroke, cognitive impairment and brain infections. Cardiac conditions including Atrial Fibrillation (AF), cardiomyopathies, valvular heart disease, intertribal septal anomalies and cardiac interventions account for 20%-30% of all ischemic strokes. The mechanism of cardiogenic stroke is often embolic, but hypoperfusion may also occur, particularly in those with cerebral steno-occlusive disease. Cognitive decline can be associated with congestive heart failure and coronary artery bypass graft procedures, whereas meningitis and brain abscesses are possible complications of infective endocarditis. Cerebrovascular disease may also affect the heart. Stroke can cause large inverted T waves in anterior ECG leads and a variety of cardiac arrhythmias. Cardiomyopathies and conduction abnormalities are part of the spectrum of many neuromuscular disorders including mitochondrial disorders and muscular dystrophies. Cardiologists and neurologists share responsibility for caring for patients with or at risk for cardiogenic strokes and for screening and managing the heart disease associated with neuromuscular disorders
Keynote Forum
Walter Bini
Healthpoint Hospital, Abu Dhabi-UAE
Keynote: Artificial intelligence (AI): Is this really what we need?
Time : 10:00-11:00
Biography:
Walter Bini has completed his Diploma from Westminster School, USA and Postgraduate degree from Universidad de Zaragoza, Facultad de Medicina, Zaragoza, Spain. He was the Middle East Chairman of ISLASS. He was the Head of Neurosurgery, Sheikh Khalifa General Hospital, UAQ-UAE. He is currently a Consultant Neurosurgeon, Orthopedic Department, spine section of Lanzo Hospital COF, Lanzo d’Intelvi in Italy and also Visiting Consultant Neurosurgeon, Orthopedic Department of Healthpoint hospital in Abu Dhabi, UAE.
Abstract:
Throughout the world there is an ever increasing hype regarding AI, its potential and everyone is so convinced of its endless benefits. Experts seem to agree that by or soon after 2030, machine intelligence will supersede human intelligence and life as we know it will change. The learning process, memories as well as our emotions that make us who we are, including our common sense, decisions, intuitions, morality, free will and consciousness are part of our brain and heart axis as well as of our environment. Can or should this be replicated? Where are we heading and for what or with what intentions or consequences? Perhaps we need to take a step back and look at the beginning, at the book of Genesis. Michelangelo in his famous painting depicted God wrapped in a shape that represents the brain endowing Adam with life and also intelligence. There is a merger between brain and human intelligence, our human existence and the axis between brain-intelligence and the heart-emotions. The present ongoing and it seems unstoppable trend of a human-AI revolution has opened a Pandora’s Box with some possibilities but also difficulties, questions and potential problems. For example, imagine a certain decision we take intuitively (brain/heart ) but an artificial intelligence machine knows or prefers an alternative answer or decision and suppresses via a neural code certain brain regions and therefore changes our own decision, who is in control now? Who are we then? EEG and fMRI are our working tools for further ideas on merging human and artificial intelligence machines and this augmented human intelligence is full of both promises but also pitfalls and perhaps the key is in that we do not fall to the temptation of playing or assuming the role of God. Our journey into the profound corners of our brain, mind and connection with the heart remains a long and mysterious undertaking. We definitely should refrain from manipulating for we are risking our individuality and personal intrinsic nature.
- Heart Disease and Brain Health | Neurology | Cardiac Surgery |Clinical Cardiology | Heart & Brain Disorders
Session Introduction
Salah A. Mohamed
University of Luebeck, Germany
Title: Dilatation of the ascending aorta associated with bicuspid aortic valve
Biography:
Salah A Mohamed is an Associate Professor of Experimental Cardiac Surgery. He has published in many reputed scientific journals on the topics of aortic and aortic valve disease, genetics and biomarker discovery. His laboratory also focuses on understanding the causes of atrial fibrillation. He is an Editorial Board Member of many scientific and medical journals.
Abstract:
The ascending aorta and the semilunar valves share common embryo logical origins, in which the contributions of various cell populations (e.g. cardiac neural crest cells) are involved. If during valvulogenesis, the original semilunar valve fails to separate and remains fused at the valve commissures, it results in the development of a Bicuspid Aortic Valve (BAV). BAV is the most common type of congenital cardiac malformations with an estimated incidence of 1-2% in the general population. This anomaly leads to an increased risk for severe cardiovascular events, which are not only due to valvular dysfunction itself but are further caused by concomitant dilatation of any or all of the segments of the proximal aorta occurring in roughly 40-60% of BAV patients, thus representing a significant risk factor for catastrophic clinical events involving high mortality and morbidity. With respect to operative criteria that are always seriously and controversially debated, surgical treatments are primarily decided in case of most serious causality. From the molecular biological respects, disturbed remodeling of the extracellular matrix in the aortic wall and an increased incidence of vascular smooth muscle cell loss play an essential role in the pathogenesis of thoracic aortic aneurysms associated with BAV. Here we report the extrinsic factors involved in hemodynamic alterations associated with increased wall shear stress due to modified flow profile and discuss the intrinsic factors of congenital aortic fragility, which is responsible for medial degeneration in the vessel wall. We discuss the genetic basis and basic pathology underlying BAV and ascending thoracic aortic aneurysms and compare these with known mechanisms underlying other aortic pathologies.
Recent Publications
1. Mohamed S A (2017) Genetic basis and hemodynamic aortopathy of the ascending aorta and dissection. Cardiac surgery. Avid Science: 2-39.
2. Mohamed S A (2017) Heart, aorta and aortic valve development and cardio-vascular malformations. Human Genetics & Embryology; 7: 139.
Khin Bo
Northern Lincolnshire and Goole NHS Foundation Trust, UK
Title: Multiple sclerosis, corpus callosum & bedside test
Biography:
Khin Bo is a Lecturer in Hull and York Medical School teaching CNS and Musculoskeletal Blocks. He has presented many poster and oral presentations in international neurorehabilitation conferences. He is currently working on developing hypertonic hand monitoring scale.
Abstract:
Demyelination affects highly myelinated structures like Corpus Callosum (CC). CC is unique in function that it connects right and left hemisphere. It synchronises bimanual or bipedal activities. Affecting CC can disturb synchrony between the two hemispheres will affect bimanual and bipedal tasks. The aim is to see if speed of clapping (bimanual activity) can reflect the involvement of CC in multiple sclerosis. Consecutive 70 multiple sclerosis patients from outpatient clinics and home visits were tests for bimanual hand function (clapping) exclusion criteria are upper limb power<3/5 MRC scale, pain, visual impairment, intentional tremors, stroke or cognitive impairment. Study period started from 01 Sep 2016. Comparison of speed between rapid supination/pronation of left and right hand separately and then clapping of both hands (supination/pronation of each hands alternatively). Patients had to do as fast as they could. Noticeable slowing of clapping comparing to single hand supination/pronation was taken as a sign slowing down of conduction through CC. 31 patients were excluded, 34 patients showed no noticeable difference, 2 patients were difficult to make conclusions and 3 patients showed definite slowing down in clapping. Positive patients will have difficulties in doing bimanual activities like using two sticks for mobility, typing using keyboard, pushing wheel chair bimanually, etc. It is possible to detect CC involvement by doing above bedside test and can be used in rehabilitation setting. Sample size is not large enough and larger studies need to follow to validate the finding.
Samer Ellahham
Cleveland Clinic Abu Dhabi, UAE
Title: Heart failure and dementia: Cardiogenic dementia
Biography:
Samer Ellahham has served as the Chief Quality Officer for SKMC. He has worked as a Chief Quality Officer and Global Healthcare Leader, focusing on ensuring that that implementation of the best practices lead to breakthrough improvements in clinical quality and patient safety. He is a Certified Professional in Healthcare Quality (CPHQ) by The National Association for Healthcare Quality (NAHQ). He is certified in Medical Quality (CMQ) by The American Board of Medical Quality (ABMQ). He is the recipient of the Quality Leadership Award from the World Quality Congress and Awards and the Business Leadership Excellence Award from World Leadership Congress.
Abstract:
Dementia and heart failure both represent growing social, healthcare and economic problems. The most common form of dementia is Alzheimer’s disease and the major risk factor for its development is increasing age. Other known risk factors includes family history, hypertension and hypotension, high cholesterol levels, low levels of physical activity and of education, obesity, genetics and recently heart failure. Decreased cerebral blood flow and neurohormonal activation due to heart failure may contribute to the dysfunction of the neurovascular unit and cause an energy crisis in neurons. The impaired clearance of amyloid beta and hyperphosphorylation of tau protein results in the formation of amyloid beta plaques and neurofibrillary tangles. An interdisciplinary approach towards elderly patients is needed. A better understanding of such newly understood relationships may result in a benefit for elderly patients from appropriate evidence-based treatment. Neuro-cardiology field helps integrates medical knowledge of interactions between chronic degenerative and cardiovascular diseases and applies this knowledge in clinical practice.
- Special Session
Location: Abu Dhabi
Session Introduction
Milovanovic Branislav
University Hospital Center Bezanijska Kosa, Serbia
Title: The significance of artificial neural networks and biosignal processing in understanding of pathogenesis of syncope
Biography:
Branislav Milovanic Professor of Internal medicine and Cardiology,Medical faculty,University in Belgrade,Serbia. He has his expertise in cardiology, internal medicine and evaluation of autonomic nervous system.
Abstract:
Introduction & Aim: The predictive power of used statistical models is limited, so the alternative modes have been arisen, like Artificial Neural Networks (ANN). Artificial neural networks are an excellent candidate for a classifier with multiple input parameters. The aim of the study is use of ANN structure for modeling complex causal relationship between the selected predictive variables obtained on the basis of standard cardiologic examination and diagnosis of syncope.
Method: Data were obtained using short ECG analysis (Shiller AT-10), non-invasive beat-to-beat heart rate variability and baroreflex sensitivity (Task Force monitor) and 24 hour ambulatory ECG monitoring with long term HRV analysis. ECG parameters were obtained from the signals of all 12 ECG channels over the past 5 minutes using commercial software (Schiller AT-10, Austria). Total number of predictive variables is 53, from the categories of ECG time domain and spectral domain variables and parameters. The state of a sample of 496 adult patients was characterized by predefined set of 53 variables, diagnosed in accordance with the following distribution control (negative) group comprising 131 individuals while positive group includes 365 patients who experienced syncope. The available set of patients was divided into two groups training group of 284 patients, of which 50 in the control group, and test group of 262 patients, of which 131 represent complete control group.
Results: The results of this procedure are shown in Figures (1, 2), which present the relationship of the most important predictor variables and the state of patient groups. The onset of syncope is in direct correlation with higher value of LF ms, heart rate, QTc, lower value of QT interval, pNN50%, SDNN, higher positive value of P axis.
Conclusion: In this particular case the ANN structure enabled us a highly reliable discrimination of patients with syncope and patients without risk, based on standard cardiologic examination procedure.
References
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2. Williams E S, Thomas K L, Broderick S, Shaw L K, Velazquez E J, Al-Khatib S M and Daubert J P (2012) Race and gender variation in the QT interval and its association with mortality in patients with coronary artery disease: results from the Duke Databank for Cardiovascular Disease (DDCD). American heart journal; 164(3): 434-441.
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Tatjana Gligorijevic
University of Belgrade, Serbia
Title: Follow up and risk assessment using artificial neural networks in patients with myocardial infarction
Biography:
Tatjana Gligorijevic is a PhD student and Resident of Internal Medicine, working at the cardiology department, Neurocardiological Laboratory, Belgrade. She has her expertise in research of heart rate variability in different patient groups. Her research field of interest is risk stratification, classification and clustering algorithm using data mining.
Abstract:
Artificial Neural Networks (ANN) is learning models that mimic the principles of morphological and functional organization of biological neurons, which has the capacity to promote and facilitate current statistical methods. The aim of this paper is to identify individuals with high risk of all causes of mortality after acute myocardial infarction using ANN, and to assess their survival rates. A total of 1,705 consecutive patients who underwent 24-hour ECG monitoring, short ECG analysis, non-invasive beat-to-beat heart rate variability and baroreflex sensitivity were followed for 3 years; of these, 286 patients died. Depressed baroreflex sensitivity BRS (≤5.33 ms/mmHg) was independently related to increased risk of mortality. The proposed neural network classifier showed good performance for survival prediction. Neural network architecture with 25 neurons in the first hidden layer and 30 neurons in the second hidden layer showed the best classification performance 88% accuracy, 81% sensitivity, 93% specificity and 0.85 F-measure. The error threshold value of 0.03 showed the nest results. These findings support the theory that patients with high sympathetic activity have an increased risk of mortality independent of other risk factors. The artificial intelligence infrastructure can reliably identify individuals with higher risk.
Figure-1: Kaplan-Meier survival curves for cardiac death in patients with reduced BRS at or below 5.33 ms/mmHg in early phase after acute myocardial infarction.
References
1. Bigi R, Gregori D, Cortigiani L, Desideri A, Chiarotto F A and Toffolo G M (2005) Artificial neural networks and robust Bayesian classifiers for risk stratification following uncomplicated myocardial infarction. International Journal of Cardiology; 101(3): 481-487.
2. Choi W S, Cho Y, Kim N Y, Kang J K, Kim K H, Park, S H and Jun J E (2010) Prognostic value of standard electrocardiographic parameters for predicting major adverse cardiac events after acute myocardial infarction. Circulation; 122: 21.
3. Exner D V (2009) Noninvasive risk stratification after myocardial infarction: rationale, current evidence and the need for definitive trials. Canadian Journal of Cardiology; 25, 21A: 27A.
4. Lin J F, Hsu S Y, Wu S, Teng M S, Chou H H, Cheng S T and Ko Y L (2015) QT interval independently predicts mortality and heart failure in patients with ST-elevation myocardial Infarction. International Journal of Medical Sciences; 12(12): 968.
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