Mitral Interventions Research Articles

The Average Pixel Intensity Method and Outcome of Mitral Regurgitation in Mitral Valve Prolapse

Mitral regurgitation (MR) is a frequent consequence of mitral valve prolapse (MVP). However, the echocardiographic grading of MR is challenging, and the recommended grading parameters have several limitations. The authors developed a novel echocardiographic parameter to grade MR, the average pixel intensity (API) method, on the basis of pixel intensity analysis of the continuous-wave Doppler signal. Transthoracic echocardiography was performed prospectively in consecutive patients with MVP (N=149). MR was quantitatively assessed using the API method, vena contracta width, effective regurgitant orifice area, and regurgitant volume. The primary clinical events were cardiovascular mortality, mitral valve surgery, percutaneous mitral intervention, and heart failure hospitalization. The API method was feasible in 90% of all patients with MVP, which was significantly higher than vena contracta width, effective regurgitant orifice area, and regurgitant volume. During a median follow-up period of 17months, 44 patients (32%) had major adverse cardiac events, and the majority of events occurred in the holosystolic MVP subgroup. The degree of MR severity by the API method was highly significant for the prediction of events. An API cutoff of 111 arbitrary units was defined as "severe" MR due to MVP, with overall superior sensitivity and specificity compared with cutoffs for established MR grading parameters. In patients who did not have major adverse cardiac events during the follow-up period (n=92), no significant changes in measures of MR severity were found on follow-up echocardiography. The API method is predictive of clinical events and outcomes in MR due to MVP. Therefore, the API method may be considered for grading the severity of MR due to MVP in clinical practice.

5941Improvement of cardiac output after transcatheter repair of severe tricuspid regurgitation impacts all-cause mortality

Abstract Background Severe tricuspid regurgitation (TR) impairs right-ventricular forward stroke volume and left-ventricular preload leading to a reduction of cardiac output (CO). Transcatheter tricuspid valve repair (TTVR) is a novel experimental treatment strategy for TR and an alternative to surgery in fragile patients. The clinical impact of improved CO after TTVR on the prognosis of chronic heart failure patients is currently unknown. Purpose This study has been designed to analyze the impact of TTVR on CO and the association to post-interventional hospitalization for congestive heart failure (CHF) and all-cause mortality. Methods Between February 2017 and October 2018 we prospectively enrolled 70 patients suffering from chronic heart failure (median age 78 years; 54% female; 90% NYHA III or IV; median NT-pro-BNP of 3,540 ng/ml) due to severe TR (all ≥ grade 3 of 4). All patients underwent TTVR with isolated intervention to the tricuspid valve (n=41) or combined mitral and tricuspid intervention due to concomitant mitral regurgitation (n=29). Invasive CO was measured shortly before TTVR under general anesthesia using transpulmonary thermodilution. For a more physiologic assessment, non-invasive CO was measured using the inert gas rebreathing technique (Innocor, Innovision, Glamsbjerg, Denmark). Non-invasive CO was assessed 2 weeks prior TTVR (baseline), at the day of discharge from the hospital (post-procedural) and after a median of 193 days (interquartile range, IQR 53 to 360 days; follow-up). Results Invasive CO significantly correlated to non-invasive assessment of CO at baseline (Pearsons correlation coefficient r=0.36, p<0.01). Baseline median non-invasive CO (3.3 l/min, IQR 2.4 to 4.2 l/min) improved with TTVR in the post-procedural analysis (4.0 l/min, IQR 2.8 to 5.1 l/min, p<0.001). At follow-up, median non-invasive CO improved by 0.5 l/min (IQR 0.0 to 1.6 l/min). CO changed ≤0.5 l/min in 37 patients (low ΔCO) and >0.5 l/min in 33 patients (high ΔCO). Hospitalization for CHF was significantly lower with high ΔCO (18%), when compared to low ΔCO (54%; p<0.01). Furthermore, all-cause mortality was significantly reduced in the high ΔCO-group (3%), when compared to the low ΔCO-group (43%; p<0.001). Significant differences in mortality were also observed in the subgroup of patients with isolated tricuspid intervention (10% vs. 45%, p=0.016). Conclusion Successful TTVR with maintenance of improved CO impacts patient prognosis and is associated to a reduced rate of hospitalization and all-cause mortality.

P3372Prediction of outcome in functional mitral regurgitation using the average pixel intensity method

Abstract Background Functional mitral regurgitation (FMR) is a frequent finding in patients with systolic heart failure. However, the echocardiographic grading of MR is challenging and different severity cut-offs are recommended by international guidelines. We developed and validated a novel echocardiographic parameter to grade MR, the average pixel intensity (API) method, based on pixel intensity analysis of the continuous wave Doppler signal. Purpose In this study, we assessed the long-term predictive value of the API method on clinical endpoints in FMR. Methods Transthoracic echocardiography was performed in consecutive heart failure patients with reduced EF (HF-REF) (n=221). MR was assessed using the API method, vena contracta width (VCW), effective regurgitant orifice area (PISA-EROA) and regurgitant volume (PISA-RV). The primary clinical events were major adverse cardiac events (MACE: cardiovascular mortality, mitral valve surgery, percutaneous mitral intervention or heart failure hospitalization). Results The API method was feasible in 97% of all FMR patients, which was significantly higher than parameters such as VCW, PISA-EROA and PISA-RV. 84 patients (37%) had one or more clinical events during the follow-up period (cardiovascular mortality (20%), mitral valve surgery (5%), percutaneous mitral intervention (5%), heart failure hospitalization (16%) or heart transplantation (2%)). Based on ROC curves, an API cut-off of 121 au was defined as “severe” MVP-MR with an overall better sensitivity and specificity than current guideline-recommended parameters. On multivariate analysis, MR graded with API was independently predictive for clinical events, whereas PISA-based methods were not independent. In addition, pulmonary pressures and NYHA class were powerful independent predictors of clinical outcome in FMR on multivariate analysis. Conclusions The API method better predicts clinical events and outcome in FMR compared to established grading methods. Therefore, the API method may be considered for grading FMR severity in clinical practice.

LONG-TERM SURVIVAL IMPACT OF CONCOMITANT MITRAL VALVE INTERVENTION IN PATIENTS WITH SEVERE AORTIC STENOSIS AND FUNCTIONAL MITRAL REGURGITATION UNDERGOING AORTIC VALVE REPLACEMENT

Whether patients with severe aortic stenosis (AS) and significant (≥moderate) functional mitral regurgitation (FMR) should undergo isolated aortic valve replacement (AVR) or double aortic and mitral valve replacement (DVR) remains controversial. Accordingly, we sought to compare their perioperative and long-term outcomes following AVR or DVR. Among patients undergoing isolated AVR, we also sought to determine the impact of significant residual MR on long-term survival. Data prospectively collected from 736 consecutive patients with severe AS and FMR were retrospectively analyzed, and their echocardiograms reviewed by a single blinded cardiologist. Patients with organic or ischemic MR (previous or concomitant CABG/PCI), previous AVR or more-than-mild aortic regurgitation were excluded, resulting in 74 patients constituting our study population. Of these, 19 patients had a DVR, and 55 patients an isolated AVR. Among patients undergoing DVR, 14 (74%) underwent mitral valve replacement and 5 (26%) underwent mitral valve repair. Their pre-operative characteristics, post-operative complications and age-adjusted survival over time were compared. Patients from the isolated AVR group were older and had milder FMR (87% moderate and 13% severe MR vs 12% moderate and 88% severe MR in the DVR group, p < 0.0001). Patients undergoing DVR required more post-operative blood transfusions (84% vs 38%, p=0.0005) and had a longer hospital stay (9.9 vs 7.0 days, p=0.01), but there were no differences in perioperative mortality (5.3% vs 6.7%, p=0.83) or other complications compared with patients undergoing isolated AVR. After adjustment for age, there was no significant difference in survival over time between the two groups (p=0.26, see figure). However, patients in the isolated AVR group whose MR improved following surgery (60%) had significantly increased long-term survival compared with patients in the group with significant residual MR (40%) (p=0.03). In patients with severe AS and significant FMR, DVR is not associated with significant differences in perioperative mortality, perioperative complications and long-term age-adjusted survival. In patients undergoing isolated AVR, nearly a third remain with significant residual MR at long-term follow up, and persistence of significant residual MR after surgery is associated with significantly lower long-term survival. This suggests that in patients with significant FMR and severe AS, a concomitant mitral intervention should be strongly considered, or a staged approach contemplated in the absence of MR improvement after the initial surgery.

Is There Currently a Place for Combined Mitral and Aortic Transcatheter Interventions?

The goal was to evaluate published data on the incidence, diagnosis, and management of symptomatic combined mitral and aortic valvular disease. Furthermore, to identify the role of treatment using contemporary transcatheter techniques. Up to a quarter of symptomatic adult valvular disease is caused by multiple left-sided valvular lesions. The etiologic spectrum of this combined disease has shifted from rheumatic to degenerative. Both presentation and diagnosis of lesions are modified compared with isolated disease. Based upon narrative review, there are only limited observational experiences, insufficient to provide robust guidance. These data, however, indicate the feasibility of interventions such as transcatheter aortic valve replacement and edge-to-edge mitral valve repair to treat such disease and mitigate the risks of open surgery. Combined aortic and mitral valve disease is commonly encountered. There is a role for transcatheter interventions based on limited data; however, more research is needed.

Transcatheter mitral valve repair: review of current techniques

Mitral regurgitation is common and is associated with excess morbidity and mortality. Despite these poor outcomes, only a minority of affected patients undergo mitral surgery, for several reasons, which underlines the substantial unmet need for treatment for this disorder. Transcatheter mitral valve repair interventions have been developed to treat mitral regurgitation in an undertreated patient population. The aim of this status quo review is to provide an overview of currently available transcatheter mitral valve repair techniques, the different approaches and the clinical outcomes reported so far.

Transcatheter Mitral Valve Implantation with the Medtronic Intrepid™ Transcatheter Mitral Valve Replacement System.

Mitral regurgitation is the most prevalent yet undertreated valvulopathy despite its adverse prognosis. With the emergence of transcatheter mitral interventions, the potential for this huge unmet disease burden to be addressed may finally be realized. Medtronic Intrepid™ Transcatheter Mitral Valve Replacement System represents one of several novel solutions. Based on early data from the pilot study, its efficacy and clinical utility is currently being tested against the mainstay treatment of surgical mitral valve replacement in a randomized trial. While there remain significant challenges before transcatheter mitral intervention can become part of the routine treatment algorithm, the authors are optimistic that transcatheter mitral valve repair and intervention have the potential in revolutionizing the management of severe symptomatic mitral regurgitation.

Surgical management of left ventricular outflow tract obstruction in a specialized hypertrophic obstructive cardiomyopathy center

ObjectivesThis study evaluates operative approach and contemporary surgical outcomes in the management of left ventricular outflow tract obstruction by a single surgeon at a high-volume, specialized hypertrophic cardiomyopathy center. MethodsThis is a retrospective review of 1559 consecutive operations for left ventricular outflow tract obstruction from 2005 to 2015. Demographic profiles, echocardiogram-derived ventricular morphology and hemodynamics, operative data, and in-hospital outcomes were analyzed. ResultsOf the 1559 operations, 586 were isolated septal myectomies, 522 were myectomies with mitral valve or subvalvular apparatus intervention, 422 were myectomies with another concomitant procedure, and 29 were isolated mitral valve interventions without myectomy. Common mitral valve interventions included anterior leaflet shortening (16%), chordae tendineae resection (9.8%), papillary muscle resection (7.2%), and papillary muscle reorientation (7.5%). Ninety-two patients underwent mitral valve replacement, 42 for left ventricular outflow tract obstruction and 50 for intrinsic mitral valve pathology. Patients undergoing mitral interventions had thinner septums (18 ± 0.4 mm vs 22 ± 0.5 mm, P < .001) and less myocardium removed (6.2 ± 3.5 g vs 8.8 ± 3.8 g, P < .001) than patients without a mitral intervention. Prevalence of in-hospital permanent pacemaker insertion was 4.2% (n = 1334) for complete heart block and 1.1% (n = 464) for isolated septal myectomy with normal preoperative conduction. Overall, there were 2 postoperative ventricular septal defects (0.13%) and none for isolated myectomies. Operative mortality was 0.38%. ConclusionsSeptal myectomy can be performed safely with excellent outcomes when the procedure is performed by a highly experienced surgeon in a high-volume, specialized center. A mitral valve intervention is a useful adjunct in patients with moderate hypertrophy.

Percutaneous Techniques, Limitations and Challenges for the Failed Surgical Mitral Intervention.

The advent of percutaneous therapies has significantly altered therapeutic options for patients with valvular heart disease. Building on the success of transcatheter aortic valve replacement, both expanded indications and purpose-built devices are now being used to address percutaneous approaches for mitral valve pathology. While surgical mitral valve repair remains the gold standard for addressing significant mitral valve pathology, there has been a progressive increase in the utilization of bioprosthetic valves despite their limited lifespan. The risks of reoperation to address mitral valve repair failure or bioprosthetic valve dysfunction is not insignificant. In light of the aging population and the potential for significant associated comorbidities, less invasive alternative techniques hold particular appeal. Utilization of commercially available transcatheter aortic valve replacement valves for failed surgical valves has been shown to have better short-term mortality than would be predicted for open reoperation. As a result, the US Food and Drug Administration approved the utilization of transcatheter mitral valve-in-valve replacement for the failed bioprosthetic valve in high surgical risk patients. Despite the favorable outcomes, transcatheter mitral valve-in-valve is not without procedural challenges and potential complications including malpositioning, embolization, paravalvular leak, and outflow tract obstruction. Awareness of these challenges, mitigation strategies, and therapeutic options is imperative to optimizing outcomes in this high-risk patient population.

Fluoroscopic Overlay of Landmarks from Pre-procedural CT Images after 2D3D Image Fusion to Optimize Trans-septal Access During Percutaneous Mitral Interventions

ABSTRACT Background: Recent evolution of transcatheter mitral devices and interventions has mandated the need for further optimizing trans-septal access technique with respect to its precise location and distance from the mitral valve annulus. Methods: Based on the individual procedural context, “ideal” trans-septal access site was planned in multi-slice CT images. In addition, relevant landmarks such as mitral annulus, para-valvular leak site, left atrial appendage (LAA) ostium were electronically marked. CT-fluoroscopy image fusion was performed using a commercially available software after acquiring two fluoroscopic images at-least 30° apart. Manual refinement of image fusion was performed by aligning structures such as a prosthetic valve or mitral annular calcification, when necessary. Results: Between June and October 2016, a total of five procedures (n = 3 Mitral paravalvular leak, n = 2 Mitraclip®) were performed in four patients using trans-esophageal echocardiography (TEE) and CT image fusion guidance. Fluoroscopic overlay of landmarks including the optimal trans-septal puncture site from pre-procedural CT images was feasible in all five procedures. Median time for CT-fluoroscopy image fusion was 4:08 minutes. Median time for left atrial access was 7:00 minutes. Median (range) fluoroscopy time and total procedural dose-area-product were 29.9 minutes (15.1–77.5) and 16,638 microGy-m2 (9464–18,990) respectively. Conclusion: In addition to real-time TEE imaging, pre-procedural CT planning, image fusion and overlay of relevant landmarks enhances 2D fluoroscopy and provided additional 3D image guidance. Seamless integration of such multi-modality image information can help further optimize steps such as trans-septal access for complex mitral interventions.

TCT-799 The importance of emerging transcatheter mitral valve technologies in cost-effectiveness and post-procedure outcomes

Mitral intervention has historically been open surgical and has been limited to a small subset of patients who could tolerate surgery and where there was perceived clinical benefit. With the emergence of transcatheter mitral interventions, we sought to compare the types of patients undergoing

Impact of Concomitant Mitral Valve Surgery With LVAD Placement: Systematic Review and Meta-Analysis.

The aim of this systematic review and meta-analysis was to evaluate the outcomes of concomitant mitral valve surgery for significant preexisting mitral regurgitation (MR) in patients undergoing continuous-flow left ventricular assist device (CF-LVAD) implantation. Electronic search was performed to identify all studies in the English literature examining concurrent mitral valve surgery in patients with CF-LVAD implantation. Identified articles were systematically assessed for inclusion and exclusion criteria. Of 2319 studies identified, 8 studies were included. Among 445 patients with moderate to severe or severe MR, 113 (25.4%) patients received concurrent mitral valvular intervention during CF-LVAD implantation. There were no significant differences in cardiopulmonary bypass time (MR Surgery 154 min vs. no MR Surgery 119 min, P = 0.64) or hospital length of stay (MR Surgery 21 days vs. no MR Surgery 18 days, P = 0.93). On follow-up, there were no significant differences in freedom from greater than moderate MR (MR Surgery 100% vs. no MR Surgery 74%, P = 0.12) or left ventricular end-diastolic diameter (MR Surgery: 60 mm vs. no MR Surgery 65 mm, P = 0.51). Survival was comparable at 6-months (MR Surgery 77% vs. no MR Surgery 81%, P = 0.75), 1-year (MR Surgery 72% vs. no MR Surgery 80%, P = 0.36), and 2-years of follow-up (MR Surgery 65% vs. no MR Surgery 70%, P = 0.56). The results of our systematic review and meta-analysis of 8 studies consisting of 445 patients demonstrates that the addition of mitral valve intervention to CF-LVAD implantation appears to be safe with comparable survival to those undergoing CF-LVAD implantation alone. Large prospective randomized clinical trials are needed to elucidate whether concomitant mitral valve intervention during CF-LVAD implantation in patients with severe MR is necessary.

Mitral Intervention with LVAD: Preparing for Recovery.

Left ventricular assist device (LVAD) insertion is an increasingly common treatment of advanced heart failure. Insertion guidelines suggest regurgitant lesions of the mitral valve should not be addressed. However, recent evidence suggests that mitral regurgitation may not necessarily improve with LVAD insertion, and such patients may have worse outcomes. Thus, practice variability is high given the discrepancy between traditional thinking and new evidence that unrepaired mitral regurgitation may increase perioperative mortality. Additionally, the challenges of LVADs can make transesophageal echocardiography evaluation and assessment of mitral valve pathology difficult.

Development and Validation of a Teaching Module for Echocardiographic Scoring of Rheumatic Mitral Stenosis.

The Wilkins score and commissural calcification scores predict outcomes after percutaneous balloon mitral valvuloplasty. However, many cardiologists are inadequately trained in their application-both in the United States where the incidence of rheumatic heart disease has fallen and in rheumatic heart disease endemic countries where training infrastructure is weak. This study sought to develop a computer-based educational module teaching 2 scoring systems for rheumatic mitral stenosis and to validate the module among cardiology fellows in the United States and Uganda. We developed a module organized into 3 sets of 10 echocardiograms each. The module was completed by 13 cardiology fellows from 2 academic centers in the United States and 1 in Uganda. Subject answers were compared with a score assigned by 2 experts in echocardiography. The primary outcome was change in subjects' accuracy from set 1 to set 3, measured by mean absolute deviation from expert scores. Secondary outcomes included change in interoperator variability and individual subject bias from set 1 to set 3. The mean absolute deviations from expert scores in sets 1 and 3 were 2.09 and 1.82 for the Wilkins score (possible score range 0 to 16) and 1.13 and 0.94 for the commissural calcification score (possible score range 0 to 4). The change from set 1 to set 3 was statistically significant only for 1 of the Wilkins component scores (leaflet calcification, p < 0.001.) No change was seen in the interoperator variability. Individual subject bias in assigning the total Wilkins score was reduced from set 1 to set 3. Use of this module has the potential to enhance the training of cardiologists in the echocardiographic assessment of mitral stenosis. Modified versions of this module or similar ones should be tested in targeted populations of cardiology trainees with the most exposure to mitral stenosis interventions.

Mitral Valve Interventions in Structural Heart Disease.

Analyze the current state of the art and the future perspectives of mitral interventions in clinical setting. A systematic and critical review of the new mitral percutaneous therapies and imaging technologies is the basis to adopt the right treatment for each patient according to specific valve dysfunction and clinical presentation, waiting for definitive guidelines. While surgical mitral repair will remain the gold standard for low-risk healthy patients with degenerative mitral regurgitation (DMR), transcatheter mitral valve repair is becoming first line therapy in high risk patients with functional mitral regurgitation (FMR). The introduction of transcatheter mitral valve replacement will expand indications for advanced DMR and FMR in inoperable patients. The introduction of transcatheter mitral interventions is changing the mitral therapy scenario. Mitral interventionalists might evolve into hybrid professional figures able to offer a tailored approach for each patient, including surgical and percutaneous approaches, depending on the anatomo-functional status of the valve, to clinical conditions, and to the timing of the intervention.

Echocardiographic-fluoroscopic fusion imaging for transcatheter mitral valve repair guidance.

The echocardiographic-fluoroscopic fusion imaging is a new imaging system which has recently become available, with the proposal to facilitate catheters and device navigation during catheter-based structural heart disease interventions. Several reports have described the early developments and the first clinical experiences, but literature focusing on the practical applications of fusion imaging technology to mitral valve transcatheter interventions, and on its potential advantages and current limitations, is still limited. In this review, we, therefore, describe the role of this novel imaging system during Mitraclip, Cardioband, and paravalvular leak closure interventions. The technical principles and the fluoroscopic anatomy of the interatrial septum and mitral valve are also described.

Detachment of the Amplatzer Device after Interventional Closure of a Mitral Prosthesis Paravalvular Leak

Background: Paraprosthetic leak is a complication of mitral and aortic valve implantation interventions, that can be treated either through a surgical procedure (repair or replacement of the prosthesis) or by means of a less-invasive percutaneous transcatheter approach. Nevertheless, this percutaneous intervention carries complications on its own, one of them being displacement of the occluder device.&#x0D; Results: This is the case of a 66-year-old patient, with a clinical history of two mitral valve replacement procedures, who presented with dyspnea, fatigue, and peripheral edema. Echocardiographic findings described severe mitral regurgitation due to the presence of a paravalvular leak. Considering the high perioperative mortality, renal and respiratory impairment, and the fact that this reoperation would have been the third cardiac surgery for the patient, percutaneous transcatheter closure of the leak was recommended. Four days after the successful procedure, a checkup echocardiogram revealed the migration of the occluder device to the left atrial cavity. Even though the operative risk was high and the prognosis poor, the only available treatment option was the surgical management that achieved the removal of the device and replacement of the diseased prosthesis.&#x0D; Conclusion: Albeit less invasive, lower risks, and better outcomes, the percutaneous intervention for leak closure has some clinically relevant complications that must be addressed promptly. One of these complications – detachment of the occluder device – even if quite rare, is a significant event that requires immediate surgical or interventional approach. A careful postoperative checkup is therefore essential to detect any complication and to address it directly.

Role of MDCT Imaging in Planning Mitral Valve Intervention.

Recent advancements in transcatheter valvular interventions have resulted in a growing demand for advanced cardiac imaging to help guide these procedures. Both echocardiography and multi-detector computed tomography have played essential roles in the maturation of transcatheter aortic valve replacement and are now building on these experiences and helping inform the nascent field of transcatheter mitral interventions. Advanced imaging is essential to aid in the diagnosis and determination of the mechanism of mitral regurgitation. In addition, they are integral to annular sizing, determination of the suitability of patient anatomy for specific devices and increasingly important in the determination of the risk of left ventricular outflow tract obstruction and providing appropriate patient-specific fluoroscopic angulation in advance of the procedure.

Educational needs and application of guidelines in the management of patients with mitral regurgitation. A European mixed-methods study.

To assess the knowledge and application of European Society of Cardiology (ESC) Guidelines in the management of mitral regurgitation (MR). A mixed-methods educational needs assessment was performed. Following a qualitative phase (interviews), an online survey was undertaken using three case scenarios (asymptomatic severe primary MR, symptomatic severe primary MR in the elderly, and severe secondary MR) in 115 primary care physicians (PCPs), and 439 cardiologists or cardiac surgeons from seven European countries. Systematic cardiac auscultation was performed by only 54% of clinicians in asymptomatic patients. Cardiologists appropriately interpreted echocardiographic assessment of mechanism and quantification of primary MR (≥75%), but only 44% recognized secondary MR as severe. In asymptomatic severe primary MR with an indication for surgery, 27% of PCPs did not refer the patient to a cardiologist and medical therapy was overused by 19% of cardiologists. In the elderly patient with severe symptomatic primary MR, 72% of cardiologists considered mitral intervention (transcatheter edge-to-edge valve repair in 72%). In severe symptomatic secondary MR, optimization of medical therapy was advised by only 51% of PCPs and 33% of cardiologists, and surgery considered in 30% of cases (transcatheter edge-to-edge repair in 64%). Systematic auscultation is underused by PCPs for the early detection of MR. Medical therapy is overused in primary MR and underused in secondary MR. Indications for interventions are appropriate in most patients with primary MR, but are unexpectedly frequent for secondary MR. These gaps identify important targets for future educational programs.

Cardiovascular research convergence 2018

The Cardiovascular Research Convergence 2018 was held at International Centre for Genetic Engineering and Biotechnology and All India Institute of Medical Sciences on October 13 and 14, 2018. The program highlights were interactive sessions between clinical and basic scientists and case-based learning on cases of Eisenmenger syndrome, familial heart failure, and young patients with myocardial infarction. Some of the best research presentations included papers on vitamin deficiency in rats, cytochrome b5 reductase 3 as target to counter hypertension, high throughput screening for molecules for antihypertensive compounds in plants, Dhadkan: A smartphone app for heart failure (HF) patients, genetic variants in association with coronary artery disease in India, biomarkers after mitral interventions, the Indian experience with angiotensin receptor neprilysin inhibitor, and the AIIMS yoga program Kardiac Rehabilitation Yoga Trial in patients with HF. A program for training nurses in HF management was also conducted.