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PROGRAMME REDUCING THE BURDEN OF CARDIOVASCULAR DISEASE IN THE CARIBBEAN : A CALL TO ACTION

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Page 1: REDUCING THE BURDEN OF CARDIOVASCULAR DISEASE IN …...first annual meeting to be held since the loss of our founding President Dr. Donald ... As the USA’s largest and most prestigious

PROGRAMME

“REDUCING THE BURDEN OF CARDIOVASCULAR DISEASE IN THE CARIBBEAN : A CALL TO ACTION”

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Table of Contents

Conference Information 2

Conference 2015 5

Messages 6

Organizing Committee 9

Faculty 10

Schedule at a Glance 12

Social Programme 13

Sponsors/Exhibitors 14

Past Honourees 16

Profile of Jamaica 17

Past Presidents 18

Council Members 20

Conference Schedule 21

Official Opening Ceremony Programme 22

Abstracts 31

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About the Conference

This educational activity is designed to inform, educate and update the Caribbean’s cardiac care professionals on emerging treatments, modalities, diagnostic techniques and equipment appropriate for the optimization of the diagnosis, treatment and management of the cardiovascular patient in the Caribbean. The approaches, treatments and diagnostic tools discussed will be assessed for their applicability and accessibility within the Caribbean.

Verification of job function and status as a student may be required (identification card, business card or letter from supervisor). One-Day Registration is available Wednesday July 15, 2015 through Saturday July 18, 2015. The registrant is entitled to admission to the exposition, educational events and the coffee break scheduled for the day registered only. Social event tickets can be purchased from the Secretariat at any time during the opening hours listed above.

Conference Information

Accreditation Statement The 30th Annual Caribbean Cardiology Conference will be planned and implemented in accordance with the essential policies of the Accreditation Committee of the Medical Council of Jamaica through the Caribbean Cardiac Society. Each participant should claim only those hours that he/she actually spent in the activity.

Registration & Secretariat Hours Tuesday July 14, 2015 2:00pm - 5:00pm

Wednesday July 15, 2015 7:00am - 5:00pm

Thursday July 16, 2015 7:00am - 5:00pm

Friday July 17, 2015 7:00am - 5:00pm

Saturday July 18, 2015 7:00am - 5:00pm

Registration Fee Full Registration

One-Day Registration

Function Tickets

Caribbean Cardiac Society Members Awards Banquet US$200

Physicians US$630 US$160

Allied Health US$380 US$100 Conference Dinner & Party

Adult US$140

Non-Members Child US$70

Physicians US$710 US$180

Allied Health US$400 US$110

Medical Students US$150 US$60

Industry Representatives US$700 US$180

Guests US$340

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Name Badges

Your name badge serves as your passport to all educational sessions and the exhibit area. You must wear your name badge at all times. Social function tickets will be included in the name tag holders and must be presented at each event. Participants will not be admitted to social functions without the appropriate ticket.

Blue Full Registration

Gray Guest Registration

Yellow Exhibit Registration

Green One Day – Thursday

Orange One Day – Friday

Purple One Day – Saturday

Black Temporary

Red Staff

As in any metropolitan area, we recommend for your safety that you do not wear your name badge in public (outside of the hotel/Conference function areas).

Refunds and Exchanges

Refunds will not be issued until after the Conference. Tickets for Conference social events are NOT refundable.

Dress Code

Business casual dress is encouraged for conference sessions. Meeting rooms at the Hyatt Ziva can get quite cold so attendees are reminded to take with them an extra layer, a light jacket or a sweater. The Annual Awards Banquet is a formal event while the Conference Party is casual.

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Child Policy Children are not allowed in Meeting Rooms or Exhibit Halls. Children’s tickets can be purchased for the Conference Dinner & Party at the Secretariat located in the Rose Hall Boardroom, Hyatt.

Lost and Found If you have lost or found an item, please contact the CCS Conference Secretariat in the Rose Hall Board-room, Hyatt.

No Smoking Policy The Caribbean Cardiac Society promotes a “No Smoking” policy. The use of tobacco products or any type of electronic nicotine delivery system is strictly prohibited in the Conference Centre, all hotel meeting rooms and venues hosting CCS events. Thank you for your compliance.

Helpful Phone Numbers

Meals at Hyatt Ziva During lunch breaks where there are no sponsored lunch sessions, attendees are encouraged to have lunch at the restaurants within close proximity of the Grand Ballroom.

Airlines Car Rental

Air Canada 1-800-677-2485 Avis Rent A Car 1-888-888-2847

American Airlines 1-800-744-0006 Budget Car Rental 876-759-1793

British Airways 1-800-247-9297 Hertz 876-924-8028

Caribbean Airlines 1-888-359-2475 Island Car Rental 1-888-991-4255

Cayman Airlines 876-633-7243 876-633-7244 876-633-7279

Delta Airlines 1-800-221-1212

Fly Jamaica 876-656-9832

Jetblue 1-800-963-3014

Virgin Atlantic 1-800-744-7477

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Dear Colleagues, It gives me great pleasure to welcome you to the 30th Caribbean Cardiology Conference being held this year in Montego Bay, Jamaica under the theme “Reducing the Burden of Cardiovascular Disease in the Caribbean: A Call to Action.” As a Society we are very proud of our 30 year legacy of providing the very best in cardiovascular education to the region’s cardiologists, cardiovascular surgeons and allied health professionals. We are particularly pleased to be hosting our 30th meeting in beautiful Jamaica where our Society had its beginnings.

The impact of cardiovascular disease is increasingly being felt by low and middle income countries, with more than 75% of deaths due to CVD occurring in these countries. It is particularly important then that the nations of the Caribbean take bold and innovative actions to stem the rising morbidity and mortality due to cardiovascular diseases. The Caribbean has already positioned itself as a leader in the fight against the growing global epidemic of chronic non-communicable diseases and this conference will serve as a call to continue to work together to improve the cardiovascular health of the Caribbean people through prevention as well as primary and secondary interventions. This year’s programme will feature outstanding faculty including Dr. Mary Walsh, Vie-President of the American College of Cardiology; Dr. Clyde Yancy, Past-President of the American Heart Association; and Prof. Magdi Yakoub, founder and chairman of the Chain of Hope UK. We look forward to having Dr. Walsh’s perspective on ethics in the management of cardiovascular disease and Dr. Yancy’s insight into how Heart Failure management can be optimized in the Caribbean. We are also very proud of the research from within the region that will be presented representing territories from the Bahamas to Guyana. In keeping with our commitment to nurturing the clinical skills vital to the diagnosis and management of cardiovascular diseases we are pleased once again to welcome our Residents who will present their clinical cases in hopes of walking away with the coveted Charles Denbow Young Clinician Award. We are also excited about the first CCS Interventional Roundtable which will offer our interventionists the opportunity to share and discuss interesting and challenging cases and elevate their collective knowledge and skills. The leadership of the CCS is proud of the comprehensive and varied scientific programme crafted by our diligent Conference Planning Committee; we know you will find it educational and informative; and that it will leave you ultimately challenged to answer the call to reduce the burden of cardiovascular disease on our families, communities, businesses and governments. Lastly, we also call on you to enjoy the social programme, build and renew collegial relationships and enjoy your time in Jamaica!

Message from the President Caribbean Cardiac Society

Dr. Henry Steward President Caribbean Cardiac Society

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Message from the Conference Chairpersons

Dear Colleagues; As we gather for the Caribbean Cardiac Society’s 30

th annual cardiovascular conference,

we can reflect with pride on the profound impact of a group of cardiologists who came together for the first meeting of what would become the Caribbean Cardiac Society. We can also be proud of how this conference has grown since that first staging, constantly improving on the number and quality of research papers presented and bringing the world’s premiere minds in cardiovascular medicine to the Caribbean to share with our colleagues. This conference has played a major role in fulfilling the Society’s objective to improve the health of the Caribbean people through the advancement of cardiovascular knowledge in the region. This year’s conference with its theme “Reducing the Burden of Cardiovascular Disease in the Caribbean: A Call to Action” promises to challenge us all to apply the latest in cardiovascular knowledge, medicine and technology with our ingenuity and dedication to meet and exceed established standards of care and prevention here in the Caribbean. This 30

th Caribbean Cardiology Conference is a significant milestone and it is appropriate

that is being held in the territory where the CCS came into being. This meeting is also the first annual meeting to be held since the loss of our founding President Dr. Donald Christian. This conference is the enduring legacy of his efforts to integrate the Caribbean’s cardiovascular community. For some of our speakers this will be their first visit with us and to them we offer a warm Caribbean welcome. In particular we would like to welcome Dr. Mary Walsh and Dr. Clyde Yancy, distinguished invited faculty who are joining us for the

first time. We are also pleased to welcome back our returning invited faculty Dr. Vladimír Džavík and Prof. Magdi Yacoub.

Dr. Džavík will moderate the first ever CCS Interventional Roundtable and we look forward to his insight as we discuss and share cases from our catheterization laboratories across the region. Prof. Yacoub will deliver our Annual Cardiac Surgery Lecture. Heart failure will

feature prominently in the programme as Dr. Yancy will address its optimal management in the Caribbean. Dr. Walsh will share with us on the ethics involved in managing cardiovascular patients. The programme will also run the gamut of cardiovascular medicine and science including prevention, imaging, intervention and surgery. It will also highlight ways that as practitioners we can work to improve the delivery of cardiovascular care in resource challenged environments. Welcome to Jamaica and welcome to the 30

th annual conference of the CCS where exciting developments in the world

of cardiovascular medicine await. Dr. Victor Elliott Dr. Marilyn Lawrence Wright Conference Co-Chair Conference Co-Chair

Dr. Victor Elliott

Dr. Marilyn Lawrence Wright

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Message from the President of the American College of Physicians

Dear Caribbean Internal Medicine Colleagues, I write to you as the 91st, and the third African American President of the American College of Physicians to endorse, encourage and humbly plead that the plans and efforts underway to formally and officially establish an official Caribbean Chapter of our esteemed organization be accelerated and enhanced. I encourage you to use the occasion of the 30th Caribbean Cardiology Conference as a forum to chart a way forward.

I am well aware of the superb quality of internal medicine physicians among the nations’ of the region. The excellence and preeminence manifested in your daily work caring for your patients in your respective beloved homelands is indeed worthy of such signal recognition. As the USA’s largest and most prestigious medical specialty organization representing internal medicine and subspecialties, it is only right and fitting that the Caribbean joins with other regions of the world in strengthening and formalizing a strong connection to the College. My dear colleagues, now is the time! As you work closely with the ACP’s International Division to undertake such efforts, please know that you have my best wishes for the ultimate success for this important undertaking. Sincerely, Wayne J. Riley, M.D. MPH, MBA, MACP

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Organizing Committee

Dr. Henry Steward Curaçao

Dr. Conville Brown The Bahamas

Dr. Victor Elliott

Jamaica

Dr. Marilyn Lawrence-Wright Jamaica

Dr. Richard Ishmael Barbados

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Invited Faculty

Mary Norine Walsh, MD, FACC is the Medical Director of the Heart Failure and Cardiac Transplantation Programs and Director of Nuclear Cardiology at St. Vincent Heart Center and Clinical Associate Professor of Medicine at Indiana University School of Medicine. She is program director of the St Vincent Advanced Heart Failure and Transplantation fellowship. She is past president of the Indiana affiliate of the American Heart Association, past board member of the American Society of Nuclear Cardiology and a current board member of WomenHeart - the National Coalition for Women with Heart Disease.

She has served as an associate editor of HeartWatch – a publication of the Massachusetts Medical Society and currently serves on the editorial board of the Journal of Cardiac Failure and as an editorial consultant for JACC Heart Failure and a reviewer for multiple scientific journals. She is an author of more than 80 articles and book chapters.

Dr. Vladimír Džavík is a graduate of the Faculty of Medicine at the University of Alberta, Class of 1983. After completing his Cardiology and Interventional Cardiology training at the Ottawa Heart Institute in 1991, he joined the faculty at the University of Alberta. In 2000 he moved to Toronto where he served as Director of the Cardiac Catheterization Laboratories and Interventional Cardiology at the Peter Munk Cardiac Centre, University Health Network in Toronto for 11 years.

He has had an active research career, having authored or co-authored more than 160 manuscripts in peer-reviewed journals and more than 140 abstracts in national

and international scientifi c meetings. His research interests range from percutaneous coronary intervention during and after acute myocardial infarction, study of optimal therapy for cardiogenic shock, outcomes in high-risk PCI. He was the Canadian Leader and Executive Committee member of the Occluded Artery Trial (OAT), an international collaboration studying the late open artery hypothesis, and serves as Principal Investigator of TOSCA-2, the OAT angiographic ancillary study, having received a National Institutes of Health (US) grant to conduct this study.

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Invited Faculty

Clyde W. Yancy, MD, MSc is Chief of Cardiology at Northwestern University, Feinberg School of Medicine, and Associate Director of the Bluhm Cardiovascular Institute at Northwestern Memorial Hospital. He holds the Magerstadt Endowed Professor of Medicine Chair and also holds an appointment as Professor of Medical Social Sciences. He is the newly appointed Northwestern University, Feinberg School of Medicine, Vice-Dean of Diversity & Inclusion. Formerly he was the Medical Director, Baylor Heart and Vascular Institute at Baylor University Medical Center in Dallas, Texas and Chief of Cardiothoracic Transplantation at Baylor University Medical Center, Dallas, TX.

He is the current chair of the ACC/AHA Heart Failure Guideline Writing Committee. He is a former President of the American Heart Association (2009-2010), past recipient of the National Physician of the Year (AHA) and recently received the Gold Heart Award for a career of service from the American Heart Association. He serves on the Health Equities Committee for the American Hospital Association.

Professor Sir Magdi Yacoub, FRS is Professor of Cardiothoracic Surgery at the NationalHeart and Lung Institute, Imperial College London and Founder and Director of Research at Harefield Heart Science Centre (Magdi Yacoub Institute) overseeing 60 scientists and students focused on tissue engineering, myocardial regeneration, stem cell biology, end stage heart failure and transplant immunology.

Professor Yacoub established the largest heart and lung transplantation programme in the world where more than 2,500 transplant operations have been performed. He has also developed novel operations for a number of complex congenital heart anomalies as well as leading research including tissue engineering heart valves, myocardial

regeneration, novel left ventricular assist devices and wireless sensors with collaborations within Imperial College, nationally and internationally.

Sir Magdi has an active interest in global healthcare delivery with focus on developing programmes in Egypt, The Gulf Region, Mozambique, Ethiopia and Jamaica. He is Founder and President of the Chain of Hope charity, treating children with correctable cardiac conditions from developing countries and establishing

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Schedule at a Glance

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Social Programme

Wednesday July 15, 7:00PM - 10:00PM The Official Opening will be held in the Ballroom Salon 1

Welcome Reception to follow on the Ballroom Terrace. Attire: Lounge suit

Thursday July 16, 7:30PM - 11:00PM

The Awards Banquet will be held in the Ballroom Salon 1. The Banquet will see the

presentation of the 2015 Charles Denbow Young Clinician Award. Attire: Formal

Friday July 17, 7:00PM - 1:00AM The CCS Conference Dinner and Party will be held at The Montego Bay Yacht Club

Return transportation will be provided from the Hyatt Ziva Attire: Casual

Banquet and Party tickets are included in your Full Registration, OR they can be purchased

in advance at the Conference Secretariat in the Rosehall Boardroom. Tickets will not be sold

at the door. Please remember to bring your tickets to be presented on entry to both functions.

Special Dietary Requirements

Individuals with special dietary requirements must request special meals (vegetarian/vegan/fruit) 24 hours in advance at the Conference Secretariat. We regret that requests for special meals not made in advance may not be honoured.

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Sponsors & Exhibitors

PLATINUM

SILVER AstraZeneca

Boston Scientific del Caribe, Inc. Jackson Memorial Hospital | University of Miami Hospital

Johns Hopkins Medicine St. Jude Medical Puerto Rico

EXHIBITOR Abbott International

American College of Physicians (ACP) BW (2011) Limited

Baptist Health South Florida Boehringer Ingelheim (Canada) Ltd.

Chain of Hope Jamaica Cleveland Clinic Florida

Fundación Cardiovascular de Colombia Health City Cayman Islands

Holy Cross Hospital MSD

Memorial Healthcare System Merck Serono Norav Medical

Reva Air Ambulance Roche Diagnostics Central America & Caribbean

Sanofi Servier Caribbean Ltd.

Skyservice Air Ambulance Sunbelt Medical International

The Heart Foundation of Jamaica

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Past Honourees

1991 2004 2012

Prof. Mario Garcia Palmieri Centre Hospitalier Universitaire de Fort-de-France

Dr. Mercedes Dullum

Sir Kenneth Stuart Dr. Albert Penco

Dr. H.A.L. McShire

2005 2013

1995 Prof. Trevor Austin Hassell Dr. Roy Tilluckdharry

Prof. Sir Magdi Yacoub The Sir Victor Sassoon (Bahamas)

Dr. Theo Poon King 2014

2006 Dr. Robert Giugliano

1999 Dr. Knox Hagley

Dr. S. Sivapragasm Mrs. Phyllis Francis

Dr. Winston Ince Cardiology Unit, University Hospital

Dr. Tarcisio Kroon

Dr. Keith McKenzie 2007

Dr. George Wattley Prof. Gerald Grell

Dr. Cyril Nelson Dr. Dominque Larifla

Dr. Phillipe Cohen-Tenoudji

2000

Dr. Cecil Bethel 2008

Prof. Charles Denbow

2001 Mrs. Cynthia Hassett

Dr. Donald Christian

Dr. Richard Haynes 2009

Dr. Ronald Henry

2002 Dr. Richard Ishmael

Dr. James Ling

Dr. Michael Wooming 2010

Dr. Edward Chung

2003 Mrs. Beverley Dinham-Spencer

Dr. Yves Donatien

Prof. Edwin Besterman 2011

Prof. Howard Spencer The Grenada Heart Foundation

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Jamaica, the third largest island of the Greater Antilles, is best described by its Arawak (Taino) name “Xaymaca” which translates to “land of wood and water”. The island is a lush tropical oasis, with miles of beaches, fertile valleys, far-reaching plains, rugged mountains, and hidden caves. There are also hundreds of indigenous species, including bats, birds, reptiles, insects, mammals, and a variety of flora. Under Spanish occupation, after Christopher Columbus’ discovery of Jamaica in 1492, the Tainos were driven to extinction, and African slaves were brought to work on the many plantations that had been established throughout the island. In 1655, British forces seized control from the Spaniards, and by 1670, the island was declared a British colony. Today, 53 years after independence, Jamaicans are proud of their cultural and religious heritage, expressed through their food, music, and language. Jamaica is world renowned for its tourism product: the white sand

beaches, the tranquil eastern parishes, the booming nightlife of its major cities, and for ambassadors such as Usain Bolt, the fastest man on Earth, and reggae icon, Bob Marley. Jamaica offers something for everyone! From the south to the north coasts, island roamers can hike through the mountain ranges of the island’s interior, and view the picturesque waterfalls and rivers that are replete throughout the terrain; from east to west, one can track the sun across the horizon, rising in the cool, tranquil parish of Portland in the east, and setting in its fiery-red fanfare on the horizon of Negril in the west. Spotlight on Montego Bay Montego Bay is the capital of the parish of St. James, and is the second largest city in Jamaica by area, and the fourth by population. When Christopher Columbus first visited, he named the bay Golfo de Buen Tiempo ("Fair Weather Gulf"). The name "Montego Bay" is believed to have originated from the Spanish word manteca ("lard"), allegedly because during the Spanish settlement period, it was the port where lard, leather, and beef were exported. The coast is dotted with numerous tourist resorts, many of which are newly constructed. Famous tourist destinations include the White Witch's Rose Hall and Tryall, both of which feature world-class golf courses. Quick facts on Jamaica Capital- Kingston Currency- Jamaican dollar Area - (total) 10,991 sq. km (4,244 sq. mi) Terrain - Mountainous interior, coastal plains. Population- 2,930,050 (July 2014 est.) Language- English

http://en.wikipedia.org/wiki/Montego_Bay

http://www.jamaicans.com/culture/poems/folk-song--by-empress-maxine-foster.shtml#ixzz3KkxA6PDz

Montego Bay here I come

Montego Bay Here I come

Montego Bay Here I come

Am coming home with my son. I hope I get Jamaican Bun, Ackee, Saltfish and Yellow Yam Lay back in a de rising sun Montego Bay here I come! -Maxine Foster

Profile of Jamaica

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Dr. Donald Christian Jamaica

1989 - 1992

Prof. Trevor Hassell Barbados

1992 - 1994

Dr. Roy Tilluckdharry Trinidad & Tobago

1994 - 1996

Prof. Howard Spencer Jamaica

1996 - 2000

Dr. Yves Donatien Martinique

2000 - 2002

Dr. Ivan Perot Trinidad & Tobago

2002 - 2004

Dr. Edward Chung Jamaica

2004 - 2006

Dr. Conville Brown The Bahamas 2006 - 2008

Dr. Martin Didier St. Lucia

2008-2010

Dr. Raymond Massay Barbados

2010 - 2012

Caribbean Cardiac Society Past Presidents

Dr. Ronald Henry Trinidad & Tobago

2012 - 2014

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Council of the Caribbean Cardiac Society

Dr. Henry Steward President Curacao

Dr. Richard Ishmael Vice President

Barbados

Dr. Marilyn Lawrence-Wright Treasurer Jamaica

Dr. Ronald Henry Immediate Past President

Trinidad & Tobago

Dr. Mercedes Dullum USA

Dr. Victor Elliott Jamaica

Dr. Caroline Lawrence St. Kitts and Nevis

Dr. Kendall Griffith US Virgin Islands

Dr. Roy Tilluckdharry Trinidad & Tobago

Dr. Jeanice Stanley-Jean St. Lucia

Dr. Jocelyn Inamo Martinique

Dr. Pravinde Ramoutar Secretary

Trinidad & Tobago

Dr. Martin Didier St. Lucia

Dr. Raymond Massay Barbados

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WEDNESDAY JULY 15 UPDATES IN CARDIOLOGY FOR THE GENERAL PHYSICIAN 9:00am – 12:00noon GRAND BALLROOM SALON 1

INTERVENTIONAL ROUNDTABLE 9:00am – 12:00noon MODERATOR: Vladimír Džavík ST. CATHERINE ROOM

Conference Schedule

9:00 – 9:10 Opening Remarks

9:10 – 9:50 Management of acute Myocardial Infarctions

9:50 – 10:30 Atrial Fibrillation

10:30 – 11:10 Pacemakers and Defibrillators

11:10 – 11:50 Heart Failure

11:50 – 12:00 Closing Remarks

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Official Opening Ceremony & Welcome Reception

30th Caribbean Cardiology Conference Official Opening Ceremony & Welcome Reception

Wednesday July 15, 7:00pm

Grand Ballroom Salon 1 Hyatt Ziva

Montego Bay, Jamaica

PROGRAMME

National Anthem of Jamaica Opening Remarks Dr. Victor Elliott Conference Co-Chairperson President’s Remarks Dr. Henry Steward President Caribbean Cardiac Society Roll Call Dr. Pravinde Ramoutar Secretary Caribbean Cardiac Society Keynote Lecture Dr. Mary Walsh Ethics in the Management of Cardiovascular Patients Vice-President

American College of Cardiology Medical Director, Heart Failure and Cardiac Transplantation St. Vincent Hospital

Official Opening

Vote of Thanks Dr. Marilyn Lawrence-Wright Conference Co-Chairperson

Reception follows immediately after in the Grand Ballroom Foyer and Terrace

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THURSDAY JULY 16 SCIENTIFIC SESSION 1 8:00am –9:00am CHAIRPERSON: Dr. Marilyn Lawrence-Wright Ballroom Salon I

S C I E N T I F I C S E S S I O N 2 9:05am – 10:15am CHAIRPERSON: Dr. Victor Elliott Ballroom Salon I

8:00 – 8:10 Maria Figura Canada

Identification and Categorization of the Burden of Heart Disease in Adults and Children Referred for Echocardiography at Georgetown Public Hospital Corporation in Guyana

8:10 – 8:20 Kenechukwu Mezue Jamaica

Nocturnal Non-Dipping Blood Pressure Profile in Caribbean Normotensives is Associated with Cardiac Target Organ Damage

8:20 – 8:30 Discussion

8:30 – 8:40 Gul H. Dadlani USA

Late Complications of Living with Congenital Heart Disease

8:40 – 8:50 Irka Ebanks Cayman Islands

Does CHA2DS2-VASc score also predict risk of developing Atrial Fibrillation? A sub-analysis of the CAFE (Cayman Islands Atrial Fibrillation in the Elderly) Study

8:50 – 9:00 Discussion

9:05 – 9:35 Phillip Habib USA Tenet Healthcare

Ventricular Assist Devices

9:35 – 9:45 Discussion

9:45 – 9:55 Marcus St. John USA

Improving Quality in the Cath Lab: The MCVI Experience

9:55 – 10:10 Gregory Giugliano USA

Cardiovascular Clinical Trials 2014 Year in Review

10:10 – 10:15 Discussion

10:15 – 11:00 COFFEE BREAK

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ANNUAL CARDIOLOGY LECTURE 11:00am – 11:45am CHAIRPERSON: Dr. Henry Steward Ballroom Salon I

CHARLES DENBOW YOUNG CLINICIAN PRESENTATIONS 11:45am – 12:30pm Ballroom Salon I

LUNCH SESSION 12:30pm – 2:00am St. Andrew Room

SCIENTIFIC SESSION 3 2:00pm – 3:30pm CHAIRPERSON: Dr. Edward Chung Ballroom Salon I

11:00 – 11:45 Clyde Yancy USA

Paradigm Shifts in Heart Failure Management

11:45 – 12:00 Lamin Bangura An Unusual Presentation of Familial Dilated Cardiomyopathy

12:00 – 12:15 Sonya Hamil Severe Pulmonary Hypertension and Patent Foramen Ovale

12:15 – 12:30 Cornelius Ramcharan Look into the patients eyes, then you will see the diagnosis

Lunchtime Presentation

Edward Chung Jamaica Servier Caribbean

Optimizing Heart Failure Management in the Caribbean

2:00 – 2:25 Hilton Franqui Puerto Rico Boston Scientific del Caribe

Longevity of Pacemakers and Subcutaneous ICDs

2:25 – 2:30 Discussion

2:30 – 2:55 Gregory Giugliano USA Astra Zeneca

DAPT, how long should it be used? Updating the Current Knowledge

2:55 – 3:00 Discussion

3:00 – 3:25 Raul Garillo Argentina Medtronic

Refractory Chronic Heart Failure: You Choose your Next Step

3:25 – 3:30 Discussion

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SCIENTIFIC SESSION 4 3:30pm – 4:30pm CHAIRPERSON: Dr. Mahendra Carpen Ballroom Salon I

3:30 – 3:40 Irka Ebanks Cayman Islands

First year Experience in Interventional Cardiac Electrophysiology at Health City Cayman Islands

3:40 – 3:55 Raul Mitrani USA Jackson Memorial Hospital University of Miami Hospital

Catheter Ablation for Atrial Fibrillation: Current Outcomes and Results

3:55 – 4:25 Ravikishore Amancharla Screening for Atrial Fibrillation

4:25 – 4:30 Discussion

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FRIDAY JULY 17 SCIENTIFIC SESSION 5 8:00am – 9:00am CHAIRPERSONS: Dr. Kevin Coy, Dr. Tricia Cummings Ballroom Salon I

SCIENTIFIC SESSION 6 9:05am – 10:15am CHAIRPERSONS: Dr. Richard Ishmael, Dr. Claudine Lewis Ballroom Salon I

8:00 – 8:10 Howard Bush USA

Same Day Discharge Following TransRadial Percutaneous Coronary Intervention

8:10 – 8:20 Alva Smith USA

Valve in Valve Treatment for Paravalvular Aortic Regurgitation Post TAVI

8:20 – 8:30 Discussion

8:30 – 8:40 Hakop Hrachian Leadless Pacing Technologies

8:40 – 8:50 Rhea Sancassani USA Jackson Memorial Hospital

Practical Strategies to Reduce the Cardiovascular Risk of Atrial Fibrillation: Outcomes and Results

8:50 – 9:00 Discussion

9:05 – 9:20 Sheila Klassen Canada

The Implementation of a Dedicated Heart Failure Clinic in Guyana: Barriers To Implementation and Interim Analysis

9:20 – 9:30 Alexandra Bell Canada

Impact of a Public Paediatric Cardiology Program on Outcomes among Paediatric Patients with Congenital Heart Disease in Guyana

9:30 – 9:40 Kendall Smith USA

Good Documentation is Good Patient Care: The Value of Accurate Documentation

9:40 – 9:50 Discussion

9:50 – 10:05 Wendy Post USA Johns Hopkins Medicine

Cardiovascular Disease in Patients with HIV

10:05 – 10:15 Discussion

10:15 – 11:00 COFFEE BREAK

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ANNUAL CARDIAC SURGERY LECTURE 11:00am – 11:45am CHAIRPERSON: Dr. Mercedes Dullum Ballroom Salon I

SCIENTIFIC SESSION 7 11:45am – 12:30pm CHAIRPERSON: Dr. Ronald Henry Ballroom Salon I

11:00 – 11:45 Magdi Yacoub United Kingdom

Future of a Caribbean Hub in Jamaica for Cardiac Patients

11:45 – 11:55 Richard Perryman USA

The Argument for a Cardiac Institute Model in the Caribbean

11:55 – 12:10 Jeffrey Jacobs USA Johns Hopkins Medicine

The Growth of Paediatric Heart Surgery in Jamaica

12:10 – 12:20 Conville Brown The Bahamas

The Silver Jubilee Anniversary of “Partnered Care” in The Bahamas and The Caribbean!

12:20 – 12:30 Discussion

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LUNCH SESSION 12:30pm – 2:00pm St. Andrew Room

SCIENTIFIC SESSION 8 2:00pm – 3:30pm CHAIRPERSONS: Dr. Mark Hoo Sang, Dr. Lisa Hurlock-Clarke Ballroom Salon I

SCIENTIFIC SESSION 9 3:30pm – 4:30pm CHAIRPERSON: Dr. Pravinde Ramoutar Ballroom Salon I

Lunchtime Presentation

Ali Shahriari USA Tenet Healthcare

Mechanically Assisted Thrombolysis of Major Pulmonary and Venous Thromboembolism

2:00 – 2:30

Brian Bethea USA Tenet Healthcare

Transcatheter Therapies

2:30 – 2:40 Discussion

2:40 – 2:50 Dabor Resiere Martinique

Cardiac Involvement in Severe Cases of Chikungunya Admitted in The Intensive Care Unit

2:50 – 3:00 Discussion

3:00 – 3:20 Francesco Santoni USA

Radiofrequency Ablation in the Treatment of Cardiac Arrhythmias

3:20 – 3:30 Discussion

3:30 – 3:40 Dabor Resiere Martinique

ECMO in Severe Acute Chest Syndrome in Patients with Sickle Cell Disease

3:40 – 3:50 Ronald Henry Trinidad & Tobago

Stable CAD in the Caribbean: Observations from the CLARIFY Registry

3:50 – 4:00 Discussion

4:00 – 4:10 Noel Crooks Jamaica

Clinical Outcomes of a Hybrid Strategy of Bare Metal Stent Combined with Drug-Eluting Stent versus Drug-Eluting Stent Exclusive Implantation for Multivessel Percutaneous Coronary Intervention

4:10 – 4:20 Sripadh Upadhya Cayman Islands

Case Report: Management of Severe Infundibular Stenosis Post-Balloon Pulmonary Valvotomy for a Child with Severe Pulmonary Stenosis

4:20 – 4:30 Discussion

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SATURDAY JULY 18

SCIENTIFIC SESSION 10 8:00am – 9:00am CHAIRPERSON: Dr. Roger Irvine, Dr. Jeanice Stanley-Jean Ballroom Salon I

SCIENTIFIC SESSION 11 9:00am – 10:15am CHAIRPERSON: Dr. Martin Didier Ballroom Salon I

8:00 – 8:10 Edward Savage USA

Surgical Treatment of Hypertrophic Obstructive Cardiomyopathy

8:10 – 8:35 Raul Garillo Argentina Medtronic

Where is Cardiac Resynchronization Therapy going?

8:35 – 8:40 Discussion

8:40 – 8:55 Vladimír Džavík Canada

Advances in the Treatment of Patients with Acute Myocardial Infarction

8:55 – 9:00 Discussion

9:00 – 9:15 Kenneth Connell Barbados

Creating a Wave of Change in Hypertension Care – the GSHTP Barbados Pilot at Year 1

9:15 – 9:30 Pragna Patel USA

Worldwide Hypertension Control: Scaling Up the GSHTP Globally

9:30 – 9:40 Discussion

9:40 – 9:55 Kenneth Connell Barbados

Capsules, Cost and Clouds - New Platforms for the Management of Hypertension

9:55 – 10:15 Discussion

10:15 – 10:45 COFFEE BREAK

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SCIENTIFIC SESSION 12 10:45am – 12:00pm CHAIRPERSON: Dr. Camille Christian-Shelton, Dr. Roy Tilluckdharry Ballroom Salon I

LUNCH BREAK 12:00pm – 1:00pm (Attendees at Leisure for Lunch) SCIENTIFIC SESSION 13 1:00pm – 2:40pm CHAIRPERSON: Dr. Conville Brown Ballroom Salon I

10:45 – 10:55 David Lopez USA

Cardiovascular Magnetic Resonance Imaging for patients with Repaired Tetralogy of Fallot

10:55 – 11:15 Sarah Lalman Guyana

The Guyana Echocardiography Education Program: Achievements and Challenges after the first 2 years.

11:15 – 11:25 Discussion

11:25 – 11:35 Tricia Cummings Trinidad & Tobago

The use of three dimensional Transesophageal echocardiography for the assessment of valvular heart disease and congenital heart disease prior to surgical intervention, the Trinidadian experience.

11:35 – 11:45 Moshe Porat Israel

Quantification of Mitral Regurgitation using Magnetic Resonance Imaging

11:45 – 12:00 Discussion

1:00 – 1:10 Ramona Lappot-Guzman Dominican Republic

Percutaneous Balloon Mitral Valvuloplassty in a Dominican Population Compared to International Reports.

1:10 – 1:20 Madeline Santana Dominican Republic

Coronary Fistulae Correction: A Case Series

1:20 – 1:30 Discussion

1:30 – 1:40 Gordan Samoukovic Canada

Feasibility and Considerations for Transport of Patients with Ventricular Assist Devices

1:40 – 1:50 Binoy Chattuparambil Cayman Islands

Successful Implantation of Left Ventricular Assist Device: A First for the Caribbean

1:50 – 2:00 Discussion

2:00 – 2:20 Robert Giugliano USA

Key Lessons from the IMPROVE IT Trial

2:20 – 2:30 Discussion

2:30 – 2:40 CLOSING REMARKS

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Abstracts

THURSDAY JULY 16 T ITLE: IDENT IF IC ATIO N AND C AT EGORI Z AT ION OF T HE BURDEN OF HE ART D ISE ASE IN

AD ULT S AND CHI LDREN REFERR ED FOR ECHOC ARDI OGR APHY AT GEORGET OWN

PUBLIC HOSPIT AL C ORP OR AT ION IN GUY AN A

Author(s): Figura, M., Pirani, F., Dhani, A., Lalman, S., Kolman, L., Warnica, J.W., & Isaac, D.

Cardiovascular diseases are the leading cause of death in most South American and Caribbean countries. Reliable

information on prevalence/ classification of heart disease (HD), essential to national prevention and management

policies, is lacking in Guyana. In 2012, an Echocardiography Lab was established at Georgetown Public Hospital

(GPHC), to provide access to diagnosis of HD, and opportunities to evaluate demographics and etiologies.

Objectives:

1. Determine burden of HD among adults and children referred for echocardiography at GPHC.

2. Categorize etiology of HD.

Methods: Retrospective descriptive study of echocardiograms at GPHC Echo lab from July 2012 - January 2015, using

the Echo Lab electronic database. Studies reviewed by 2 independent echo readers for diagnosis; discrepancies

resolved by consensus.

Results: 1802 echocardiograms were performed on 1493 patients from July 2012 - January 2015: 34% paediatric, 35%

hospital inpatients. Only 36% were normal.

Adult primary diagnoses: left ventricular dysfunction (26%), valvular HD (15%), LVH (9%), congenital HD (6%), and

pulmonary hypertension (6%).

Children: congenital HD in 58% of all echos (91% of abnormal echos), with acquired valvular disease at 4% of all echos

(6% of abnormal echos).

Conclusions: In patients referred to GPHC echo lab, the burden of HD is high. The pattern of adult HD is consistent with

the rising prevalence of hypertension and diabetes, plus rheumatic and degenerative valve disease. Prevalence of

congenital HD in children is high, the vast majority untreated well past the recommended age for intervention. This data

can help inform new public health strategies in Guyana.

T ITLE: NOCT URN AL NON -DIPPING BLOOD PRESS URE PROFILE IN C ARIBBE AN

NORM OT ENSIVES IS ASS OCI AT ED WIT H C ARDI AC T ARGET ORG AN D AM AGE

Author(s): Mezue, K., Isiguzo, G., Madu, C., Nwuruku, G., Baugh, D., & Madu, E.

A non-dipping pattern of nocturnal blood pressure in hypertensive patients is an established key predictor of cardiac

target organ damage. We studied a group of patients with normal blood pressure to determine if the absence of

nocturnal dip in blood pressure is associated with objective evidence of cardiovascular target organ damage.

Our study population consisted of a cohort of 43 normotensive patients without documented coronary artery disease who

were seen at the Heart Institute of the Caribbean, Kingston, Jamaica, in 2013. Ambulatory blood pressure was measured

using the GE Tonoport V device to identify the blood pressure profiles (dipping vs non-dipping), and cardiac target organ

damage was estimated from 2D-echocardiography.

The mean age of the cohort was 52 ± 15 years. There were no statistically significant differences between the groups

with respect to age, gender, weight, height, body mass index, or outpatient BP. There was a statistically significant

difference in sleeping blood pressure between dippers and non-dippers, 112 ± 7/64 ± 2 mmHg vs 117 ± 3/69 ± 2 mmHg

(p-0.004).

The non-dipping blood pressure cohort showed more evidence of cardiovascular target damage compared to the dipping

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cohort with a significantly increased Relative Wall Thickness 0.35 ± 0.07cm vs. 0.42 ± 0.05cm (p-0001), Left Ventricular

Mass Index 95 ± 14 vs. 105 ± 14 g/m2 (p-0.018), and Left Atrial Volume Index 26 ± 3.5 vs. 30 ± 3.4 (p-0.001). Left

ventricular geometry among cohorts with non-dipping pattern also showed more likelihood of concentric remodelling,

concentric hypertrophy and eccentric hypertrophy.

T ITLE: L AT E COM PLIC AT IONS OF L IV IN G WIT H CONGENIT AL HEART D I SE ASE

Author(s): Dadlani, G.

Congenital heart disease is the #1 birth defect in the world. Congenital heart disease occurs in approximately 1/100 live

births and there are >1,000,000 infants born annually in the world. Over 50% of these infants will require surgical

intervention. Advances in surgical and interventional catheterizations, have decreased the death rate by almost 30% in

the last decade. Today, >90% of infants born with congenital heart disease in the USA will survive to adulthood.

Although survival has improved, this is a lifelong disease that may have many associated late morbidities. As these

infants age, the cardiovascular system may also prematurely age and predispose them late complications. Medical

providers caring for patients with congenital heart disease at any age need to be aware of: the wide spectrum of

congenital heart disease, the need for lifelong follow-up and how to recognize these complications. Table 1 lists these

late complications from congenital heart disease. Our hope is that increased awareness of the late complications of

congenital heart disease will lead to enhanced survival of adult congenital heart disease survivors throughout the world.

Late Complications of Living with Congenital Heart Disease

Heart Structure

- Valvular regurgitation

- Aortic root dilation

Heart Function

- Ventricular dysfunction (single/ right/ left ventricle)

- Development of a cardiomyopathy (dilated/ restrictive)

Electrical System

- Arrhythmias (supraventricular/ ventricular)

- Conduction disturbance (heart block)

Cardiovascular Disease

- Thrombo-embolic disease

- Hypertension

- Pulmonary hypertension

- Coronary artery disease

- Aneurysms

Endocarditis

Neurodevelopmental Delays

Pregnancy/ Contraception

T ITLE: DOES CH A 2 DS 2 -VASC SCORE AL SO PRE DICT R ISK OF DEVELOPIN G AT RI AL

F IBRILL AT ION? A SUB­ AN ALYSIS OF T HE C AF E (C AYM AN ISL AND S AT R I AL

F IBRILL AT ION IN T HE ELDERLY) ST UDY

Author(s): Ebanks, I.L., Gundad, P.S., Babu, N.S., Rankine, S., & Amancharla, R.K.G.

Background & Objectives: CHA2DS2-VASc score is a well-accepted risk stratification tool for stroke risk prediction in

patients with AF. As many of the components of this tool are also risk factors for developing AF, we hypothesized a

potential relationship between CHA2DS2-VASc score and development of AF during the on-going, prospective CAFE

Study being conducted at Health City Cayman Islands.

Method: Data from 574 persons enrolled in the CAFE Study was analysed on the following aspects:

1. Mean CHA2DS2-VASc scores of persons with and without AF

Risk of AF at a cut-off value of CHA2DS2-VASc score of 3

1 Results: There were 58 persons with AF out of the 574 persons enrolled (Mean age 74 ± 6.6 years) (234 males).

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1. CHA2DS2-VASc score was significantly higher in persons with AF as compared with those in sinus rhythm (3.64 ± 1.5

vs 3.18 ± 1.3, p = 0.016).

The following figure shows the relation between CHA2DS2-VASc score (cut off of 3) and risk of AF in percentage.

Clearly persons with CHA2DS2-VASc score ≥3 had a significantly HIGHER prevalence of AF suggesting a definite

relation with the CHA2DS2-VASc risk assessment tool.

Conclusion: Preliminary data from the CAFE Study have clearly shown that CHA2DS2-VASc score, in addition to

predicting stroke risk, can also predict risk for developing AF. This suggests that aggressive modification of some of the

individual risk factors embodied in the CHA2DS2-VASc tool may have therapeutic benefits in management of AF. Analysis

of a larger sample size will give a clearer picture.

T ITLE: IM PROVING QU ALIT Y IN T HE C AT H L AB : T HE M CVI EXPERIENC E

Author(s): St. John, M.

As a health system in a crowded marketplace, Baptist Health South Florida, and Miami Cardiac and Vascular Institute

(MCVI) in particular, has always prided itself on being a center of excellence. After achieving accreditation as a chest

pain center, it was a natural progression to go through the Accreditation for Cardiovascular Excellence (ACE) process for

the cardiac catheterization lab. This review confirmed that we were an excellent program, but had opportunities for

improvement. We had long participated in the NCDR program, but had not been translating that data into action plans for

improvement. At the top of the corrective action plan outlined by ACE was a suggestion to review and implement the

strategies in the Society for Cardiac Angiography and Intervention Quality Improvement Toolkit.

This led to the creation of the Continuous Quality Improvement (CQI) Program in Interventional Cardiology Services in

the summer of 2012, whose purpose was to “provide the structure and process for improving patient safety, clinical

outcomes and efficiencies in the cardiac catheterization lab”. We implemented quarterly meetings timed to follow the

NCDR reports, and refined forms to improve documentation of pre-procedure indication and post-procedure reporting.

We also implemented a random case review process and a CIN protocol.

The hard work has led to measurable successes in a relatively short time. There is a 100% participation in peer review.

Documentation has improved and comparison of our NCDR reports pre- and post-intervention show improvements in a

majority of AUC metrics, quality metrics and PCI performance measures.

T ITLE: C ARDIOV ASCUL AR CL IN IC AL T RI ALS 20 14 YE AR IN REVIEW

Author(s): Giugliano, G.

Each year important advances in cardiovascular medicine are presented at the various major scientific sessions held

throughout the world. However, the demands of clinical practice often make attendance at these meetings challenging.

Subsequent delays between the live presentation and publication in the literature leaves practitioners without a reliable

tool for integrating new knowledge into their practice.

We will present peer-reviewed highlights of the most important cardiovascular clinical trials presented within the past year

at major scientific sessions (ESC 2014, TCT 2014, AHA 2014, and ACC 2015) as covered by MD Conference Express.

These trials include new treatments for heart failure (PARADIGM HF and POPE2/COPP2), more breakthroughs in lipid

management with PCSK9 inhibition (ODYSSEY) and Ezetimibe (IMPROVE IT), novel applications for the NOACs (A-

VERT), finality to PFO closure (PRIMA), bioabsorbable stents (ABSORB II), duration of P2Y12 inhibition revisited

(DAPT), and more to come following the ACC this spring. These data cover a broad range of cardiovascular topics from

heart failure to cardiac interventions. Our goal is to bring the busy clinician up to speed with the latest developments in

clinical cardiovascular studies of the past year.

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T ITLE: REFR ACT ORY CHRONIC H EAR T F AILURE: YOU CHOOSE YOUR NEXT ST EP

( MED T R O N I C SPO NSO R ED L EC T U R E)

Author(s): Garillo, R.

Refractory chronic heart failure, usually has sudden death or irreversible pump failure as outcome. In some

circumstances, the defibrillator or cardiac resynchronization therapy could have a role. But nevertheless, there are two

drawbacks when it’s time to make a decision:

1. patient does not exactly match the guidelines,

2. guidelines rarely contemplated the general condition of the patient.

T ITLE: F IRST YEAR EX PERIENC E IN IN T ERVENT ION AL C ARDI AC ELECT ROPHYSIOLOGY

AT HE ALT H C ITY C AYM AN ISL AND S

Author(s): Ebanks, I.L., Polasani, S., Gundad, P.S., Kumar, D., Jacques, A., & Amancharla, R.K.G.

Background & Objectives: Access to Interventional Cardiac Electrophysiology (Catheter ablation & Device therapy) has

revolutionized the diagnosis and treatment of cardiac arrhythmias. We summarize the first year experience of these

services at the HCCI hospital.

Materials & Method: This retrospective single-center study analyses clinical characteristics and in-hospital outcomes of

32 patients who underwent Radio-frequency ablation and Device implant procedures between 15 April 2014 and 20

February 2015.

Results: From 15 April 2014 to 20 February 2015, 16 RF ablations and 16 Device implants were performed at Health

City Cayman Islands. Ages of ablation patients ranged from 18 to 72 years (8 males). The indications for ablation were

AVNRT (n=6), accessory pathways (n=3), RVOT VT (n=2), Ischemic VT (n=1), Isthmus dependent atrial flutter (n=3),

Paroxysmal atrial fibrillation (n=1). 3D electro-anatomic mapping (Navix) was used in atrial flutter, atrial fibrillation and

ventricular tachycardias. The acute success rate was 100% for all procedures and early recurrence was seen in one

patient (Ischemic VT). The Device implants respectively were Pacemaker (5), ICD (7), CRTD (1) and Loop recorder (3).

Ages ranged from 39 to 82 (10 males). Two patients had small pneumothorax requiring drainage. Otherwise, there were

no major complications.

Conclusion: During first year of Electrophysiology experience at Health City Cayman Islands, the overall success rate

was high with no hospital mortality or major adverse cardiac events.

T ITLE: C AT HET ER AB L AT ION FOR AT RI AL F IBRILL AT ION : CURRENT OUT COM ES AND

RESULT S ( J A CK SON M EM ORI A L H O SPI T AL / U N I VERSI T Y O F MI AMI H O SPI T AL

SPO N SO R ED L EC TUR E)

Author(s): Mitrani, R.

Atrial fibrillation (AF) is a growing epidemic that has major economic and healthcare implications. Over the past decade,

a 23% increase in AF hospitalization was reported across the United States. As the population ages, it is estimated that

there exists a 1 in 4 lifetime risk of developing AF. Catheter ablation has become a commonly performed therapy for AF.

In patients with symptomatic AF, catheter ablation has reduced AF recurrence and improved quality of life as compared

with pharmacologic antiarrhythmic therapy. The current Guidelines recommend catheter ablation in patients with

symptomatic, paroxysmal AF who have not responded to or tolerated antiarrhythmic medications; furthermore, AF

ablation may be a reasonable treatment for other patients with symptomatic paroxysmal or persistent AF even as first-

line therapy.

Outcomes for successful catheter ablation for AF depends on the type of AF, duration of AF, left atrial size and/or

volume, and the presence of other comorbidities. In general patients with paroxysmal AF have the highest success rates

in the range of 75-80%, whereas patients with persistent AF may have success rates in the 50-60% range. Patients with

large left atrial size and/or volumes and those who have been in AF for the longer than 1-2 years have lower likelihood

of ablation success.

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Improvements in ablation technologies have helped to improve outcomes for catheter ablation in AF. In particular, the

newer generation cryoballoons and the newer pressure sensitive ablation catheters have enabled the delivery of more

durable ablation lesions. This in turn has reduced recurrence rates of AF.

In conclusion, catheter ablation for AF is a standard therapy for those patients with symptomatic AF, particularly in those

who have already failed at least one antiarrhythmic drug.

T ITLE: SCREENING FOR AT RI AL F IB RILL AT ION (ST . J UDE M EDIC A L SP O N SO R ED

L EC T U R E)

Author(s): Amancharla, R.K.

Atrial fibrillation is turning out to be the major behemoth among non-communicable diseases. The global prevalence data

show an ever-increasing trend and it is likely that by 2050 the estimated number of patients with AF is likely to touch 16

million. It is responsible for a significant amount of morbidity and also mortality. The most common complication of atrial

fibrillation is the risk of stroke. There is very clear data that anticoagulant therapy in the higher risk category persons with

atrial fibrillation definitely reduces the risk of stroke. Therefore the logical hypothesis is that screening for asymptomatic

atrial fibrillation in people at risk and treating them appropriately would reduce the incidence of this devastating

complication. The current lecture proposes to address the following issues pertaining to screening for AF

The prevalence of asymptomatic atrial fibrillation Prognostic importance of screen detected AF Methods of screening for atrial fibrillation Available data on sensitivity and specificity of screening methodology Opportunistic versus systematic screening Controversies of AF screening Possible guidance on screening

A brief overview of the ongoing CAFE (Cayman AF in the Elderly) survey will also be discussed.

FRIDAY JULY 17 T ITLE: SAM E D AY D ISC H ARGE FOLLOWING T R AN SR ADI AL PERCUT ANEOU S CORON ARY

INT ERVENT ION

Author(s): Bush, H.S., Lahoti, A., Fromkin, K.R., & Asher, C.

TransRadial (TR) access for percutaneous coronary intervention (PCI) is emerging as an attractive access route for

revascularization. Advantages of this approach have included: reduction in access site complications, possible mortality

reduction in certain patient subsets, earlier ambulation, and patient preference. Previous data has suggested a reduction

in hospital length of stay and subsequent reductions in procedural costs. We have previously reported on our experience

with same day discharge (SDD) in TR PCI patients. With our initial protocol, approximately 35% of all PCI patients were

discharged the day of procedure. The purpose of this report is to look at the patients that were not discharged the day of

the procedure (i.e. outpatient with extended recovery/ hospitalized the night of their PCI) and categorized them based on

the reason for not going home. With this analysis, we were able to devise strategies that would subsequently allow many

of these patients to also be safely discharged following their PCI. We then implemented these strategies and evaluated

their impact on SDD in TR PCI patients. We will report on how we have continued to grow this initiative. As part of a

continued effort to reduce costs and more effectively utilize resources, strategies such as SDD following PCI will be

important as we continue to meet the needs of our patients and move into the future of cardiovascular medicine. With

our experience in this well-defined subset of patients, we can begin to examine criteria that may be applied to more

diverse groups of PCI patients.

T ITLE: VAL VE IN VAL V E T REAT M ENT FOR PAR AV ALVUL AR AORT IC REGURGIT AT ION

POST T AVI

Author(s): Smith, A.D., Patel, N.K., & Paris, T.

Introduction: Paravalvular aortic regurgitation is a common complication of transvalvular aortic valve replacement

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compared to surgical aortic valve replacement. It is important to recognize, treat and prevent this complication which is

associated with increased mortality.

Case Presentation:

An 88 year old male with past medical history of severe aortic stenosis, non-obstructive coronary artery disease, COPD,

paroxysmal atrial fibrillation and hyperlipidemia presented with worsening dyspnea on doing routine daily activities

(NYHA Grade 3). His heart failure, secondary to aortic stenosis, was treated one year prior with balloon aortic

valvuloplasty as a bridge to transcutaneous aortic valve replacement. He was on Digoxin and Lisinopril for his heart

failure.

On examination, he had ejection systolic murmur radiating to carotids. Patient had normal complete blood count and

basal metabolic panel. His echocardiogram showed severe aortic stenosis with valve area of 0.59 cm2, mean gradient

of 38mmHg ejection fraction 55%, moderate mitral regurgitation and severe pulmonary hypertension.

Patient underwent #26 Sapien transfemoral transcutaneous aortic valve implantation (TAVI). The procedure was

complicated with moderate to severe paravalvular aortic regurgitation. A valve in valve procedure was done to achieve

hemodynamic stability. Post procedure, patient was extubated without incident and recovery was uneventful.

Discussion: Paravalvular regurgitation post transcutaneous aortic valve replacement is mainly caused by incomplete

apposition of prosthesis with aortic annulus due inadequate inflation of prosthesis, heavy calcified annulus, undersized

prosthesis, implantation of valve too low and an inadequate aortic balloon valvuloplasty prior to deployment of a self-

expanding valve. The initial sign is low aortic diastolic pressure, increasing left ventricular filling pressure leading to

myocardial ischemia, left ventricular dysfunction and shock. As per PARTNER trial, at least mild aortic regurgitation was

identified in 40% and moderate to severe aortic regurgitation in 10%. This is associated with an increased 2 years

mortality (hazard ratio 2:1). Paravalvular aortic regurgitation was identified early in this case and was corrected with the

insertion of another prosthetic valve during the surgery, hence, valve in valve.

References

Paravalvular leak after transcatheter aortic valve replacement: . : The New Achilles’ heel. J Am Coll Cardiol. March 19, 2013; 61(11):1125-1136. doi:10.1016/j.jacc.2012.08.1039; Epub 2013 Jan 30.

Two-year outcomes after transcatheter or surgical aortic-valve replacement. N Engl J Med 2012 May 3; 366(18):1686-95. doi: 10.1056/NEJMoa1200384; Epub 2012 Mar 26

T ITLE: LEADLESS PAC I NG T ECHNOLOGIES

Author(s): Hrachian, H.

Pacemakers have been used for more than 50 years, and over the years have become more sophisticated and reliable;

however, they are associated with potential complications such as repositioning, lead fractures, pneumothorax, acute

and chronic lead perforation, and pocket infections which may pose serious risks to patients.

Pacemaker and implantable cardioverter defibrillator (ICD) leads have faced several high profile recalls over the years

which have placed them under serious scrutiny.

Leadless pacemakers and ICDs are expected to bring a paradigm shift to the cardiac rhythm management (CRM)

market in the coming years.

They provide smaller profile, potential to reduce complications, and shorter recovery time.

Clinical trials are ongoing and results have been relatively promising.

T ITLE: PR ACT IC AL ST R AT EGIES T O REDUCE T HE C ARDI O V ASCUL AR RI SK O F AT RI AL

F IBRILL AT ION ( J A CK SON M EM ORI A L H O SPI T AL / U N I VER SI T Y O F MI AMI H O SPI T AL

SPO N SO R ED L EC TUR E)

Author(s): Sancassani, R.

This presentation will:

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Define the burden of atrial fibrillation (AF)

Discuss factors associated with the increasing burden of AF

Identify key areas of focus to help guide practitioners in reducing the burden and severity of AF for their patients.

T ITLE: T HE IM PLEM ENT AT ION OF A D EDIC AT ED HE ART FAI LURE CL IN I C IN GUY AN A:

P ILOT PROJECT AN D IN T ERIM AN ALYSI S

Author(s): Klassen, S., Fine, N., Lane, T., Zahir, S., & Isaac, D.

Background: Heart failure (HF) represents a significant proportion of the cardiovascular disease burden in developing

countries. Guyana is a small South American country with limited ability for organized, guideline-based chronic disease

care, leading to suboptimal HF management. We hypothesized that implementation of a HF Clinic managed by trained

nurses with local physician support is feasible and improves clinical outcomes in chronic HF.

Methods: This is a single-center, prospective study of adult patients referred to a dedicated HF Clinic in Guyana, using

clinical management protocols in accordance with Canadian Cardiovascular Society guidelines. HF etiology was

categorized. Study outcomes include:

Compliance with scheduled follow-up

All-cause mortality and hospitalizations

Baseline to follow-up change in New York Heart Association functional class (NYHA FC) and left ventricular ejection

fraction (LVEF)

Proportion of patients treated with guideline-based management.

Results: At the time of abstract submission, 40 patients had been evaluated and managed in the HF Clinic. Mean LVEF

was 32%. HF etiology included ischemic cardiomyopathy (21), hypertensive cardiomyopathy (8), dilated cardiomyopathy

(7), and valvular cardiomyopathy (4). Baseline NYHA FC was II in 22, III in 15, and IV in 3 patients. Four (4) patients

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were lost to follow-up, 2 died. Interim analysis of data from patients recruited from program inception November 2014 to

April 2015, will be presented.

Conclusion: A nurse-managed, dedicated HF Clinic in Guyana is feasible. Baseline data for HF patients managed by this

clinic is reported. Full clinical follow-up and outcomes data will be discussed.

T ITLE: AN INVEST IG AT ION INTO B AR RIERS T O T HE IMPLEM ENT AT ION OF A H E ART

F AILURE CL IN IC IN GU Y AN A

Author(s): Klassen, S., Fine, N., Lane, T., Cort, R., Singh, U.D., Bafadel, A., & Isaac, D.

Background: Heart failure (HF) represents a significant disease burden in Guyana. A nurse-managed public-hospital HF

clinic was implemented in November 2014. On follow-up, many patients were noted to have suboptimal clinical

outcomes. The purpose of this study was to investigate barriers to provision of effective HF care in this setting.

Methods: A nurse-administered questionnaire focusing on barriers to compliance and clinic follow-up was administered to

HF clinic patients. Separate questionnaires were administered to clinic nurses and hospital physicians to assess their

perception of barriers to patient compliance, clinic follow-up, and referral practices.

Results: Questionnaire data was available for 19 of 40 HF clinic patients.

Patient barriers included:

Perception that a private, advertised clinic would provide better care (90%)

Cost of travel to clinic (58%) and distance from home (47%)

Discomfort talking about medical issues during telephone follow-up (33%)

Perception that they are receiving unnecessary medications (26%)

However, 89% of patients indicated better understanding about their disease and treatments since enrolled in HF clinic.

Nurse-identified patient barriers included:

Denial of cardiac diagnosis

Belief that medications unnecessary when asymptomatic, excess sodium intake not harmful, and medication side-

effects indicate toxicity

Nurses also identified barriers to their own practice, including lack of resources.

Physician questionnaires identified barriers to referral to HF clinic.

Conclusions: This study identifies patient, nursing, and physician barriers to effective HF management, many of which

are related to misconceptions. Only by addressing these barriers, will we be able to provide more effective HF

management.

T ITLE: IM PACT OF A P UBLIC P AEDI AT RIC C ARDIOLOGY PROGR AM ON OUT COM ES

AM ONG P AEDI AT RI C P AT IENT S WIT H CONGENIT AL H E ART D ISEASE IN G UY AN A –

IN IT I AL ASSESSM ENT

Author(s): Bell, A., Zahir, S., & Isaac, D.

Guyana lacks medical expertise in Congenital Heart Disease (CHD). Children with CHD suffer frequent illness, abnormal

development, and early death. A small proportion previously went abroad for surgery through charitable foundations.

With no triage system, funds were allocated to patients with better access, not urgent need.

In January 2014, the Guyana Paediatric Cardiology Steering Committee (GPCSC), a collaboration between Guyana

Ministry of Health, Georgetown Public Hospital, and the University of Calgary-supported Guyana Echocardiography

Education Program, was established to provide education and expert oversight for local paediatricians, CHD screening,

electronic database, and review/ triage of children requiring CHD surgery based on urgency.

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Objective: As an initial step to evaluate the impact of the GPCSC on outcomes in children with CHD, we investigated the

status/ outcomes of children sent for CHD surgery prior to GPCSC.

Methods: Data obtained from charitable foundations supporting Guyanese children with CHD, 2006 - 2013, and contact

with patient families. Analysis was descriptive.

Results: Minimal documentation of any expert follow-up; very few children had post-operative echocardiography before

identified by GPCSC.

Table 1

Conclusions: These children represent those undergoing CHD surgery through access to charitable foundations; thus a

small proportion of all Guyanese children with CHD. Age at surgery is much beyond standard recommendations. Post-

operative management is sub-standard, with suboptimal outcomes even in these “privileged” few. This lays the

groundwork for future assessment of the impact of GPCSC on children with CHD in Guyana.

T ITLE: C ARDI AC IN VOLVEM ENT IN SEVERE C ASES OF CHI KUNGUNY A ADM ITTED IN T HE

INT ENSIVE C ARE U NIT

Author(s): Resiere, D., Valentino, R., Perreau, C., Cabié, A., Inamo, J., Didier, M., Mégarbane, B., & Mehdaoui, H.

Background: Chikungunya is an arboviral disease transmitted by the bite of infected Aedes mosquitoes and caused by

chikungunya virus (ChickV), an alphavirus from the Togaviridae family. Among 78,000 chikungunya cases diagnosed in

Martinique from December 2013 to December 2014, 276 (0.3%) were hospitalized. Atypical manifestations accounted for

49% of the cases, mostly in children aged less than 5 years with seizures or in males aged more than 65 years with

exacerbation of underlying conditions, leading to renal, cardiac or neurologic disorders. The objectives were to describe

severe forms of chikungunya, clinical features and outcome of the patients admitted in the only Intensive Care Unit (ICU)

of Martinique (a French overseas territory in the WI), during the endemic period.

Methods: Prospective study of all ChickV-infected patients admitted in our ICU from 1/2/2014 to 18/12/2014, and

presenting at least an organ failure using the SOFA score. During this period, all the patients admitted to the ICU were

systematically tested for dengue and ChickV. Cases included in this study were defined by the presence of clinical signs

(acute fever and arthralgia) with biological confirmation using RT-PCR and/ or positive serology for IgM.

Results: During the study period, thirty ChickV-infected patients (0.05%) were hospitalized in the ICU. The median age

was 62 years [15-85] and male/female gender ratio 1.5. There were two children aged 6 and 15 years. The most

frequent underlying comorbidities included hypertension (52%), diabetes (32%), obesity (24%), chronic alcoholism

(20%), chronic cardiac disease (16%) and chronic renal failure (16%). Sixteen patients (53%) presented symptoms in

relation to the viral infection including encephalopathy (N=5), vasoplegic shock (N=4), septic shock (N=4 including 3

cases of pneumonia), acute poliradiculonevritis (N=3), acute renal failure (N=2), cardiac complications in 5 (myocarditis

(N=3, hemodynamic disorders=2), and ARDS (N=1). Median IGS2 score was 47 [12-94]. Two patients (8%) presented

one organ failure while the 92% others multiple organ failure. Coagulopathy was found in 60% of the patients, while liver

failure in 24% of the patients. Seventy-two per cent of the patients required mechanical ventilation. Refractory ARDS

Children known to have surgery pre-GPCSC 82

Age at surgery (average/median) 6.9/7 years

Known deceased 5 (17% of known status patients)

Contacted/ seen by GPCSC 24 (29%)

Seen by GPCSC, need additional surgery 6 (25% of follow-ups)

No follow-up yet, known alive 4 (5%)

Status unknown 49 (60%)

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required veno-venous ECMO in 1 patient. The SOFA score at 48 hours following admission (N=25) was 10 [2-18].

Median duration of ICU stay was 11.5 days. The mortality rate in ICU was 36.7%.

Conclusion: We report a series of severe Chick-V patients requiring ICU admission with an elevated mortality rate. Multi-

organ failure is a frequent complication requiring appropriated management to allow survival.

References:

Obeyesekere I, Hermon Y. Arbovirus heart disease: Myocarditis and cardiomyopathy following dengue and chikungunya

fever. A follow up study. Am Heart J 1973 ; 85 : 186-94.

T ITLE: C ARDIOV ASCUL AR DI SE ASE IN P AT IENT S WIT H H IV ( JOHNS HOPKINS MEDIC IN E

SPONSORED L ECTURE )

Author(s): Post, W.S.

Background: HIV is highly prevalent in the Caribbean. Patients with HIV are living longer since the advent of highly

effective antiretroviral therapy (HAART), and may be at increased risk for CVD.

Method: We performed coronary artery calcium scans in over 1000 HIV-infected (HIV+) and uninfected (HIV-) men and

coronary CT angiography in eligible men (n=764) between age 40-70 years in the Multicenter AIDS Cohort Study

(MACS). Coronary plaque presence, size and degree of stenosis were graded in each coronary segment. Visceral and

subcutaneous adipose tissue areas were assessed from non-contrast CT scans. A biomarker panel was measured, and

traditional CVD risk factors and HIV specific factors were assessed at exams every 6 months. Multivariable regression

models were performed to determine 1) differences in coronary plaque and stenosis between HIV+ and HIV- men and 2)

predictors of plaque.

Results: HIV+ men had a higher prevalence of coronary plaque than HIV- men, especially non-calcified plaque.

Coronary artery stenosis >50% was associated with lower nadir CD4+ T-cell count and greater number of years on

HAART. HIV+ men also had more epicardial and abdominal visceral fat and less subcutaneous thigh fat, and higher

levels of inflammatory biomarkers, even when viral load was suppressed. These factors were all associated with

coronary atherosclerosis, even after controlling for CVD risk factors. Chronic Hepatitis C infection was also

independently associated with atherosclerosis.

Conclusion: HIV+ men are at increased risk for subclinical CVD. Coronary atherosclerosis is associated with advanced

HIV disease, lipodystrophy, immune activation/ inflammation and Hepatitis C co-infection.

T ITLE: T HE ARGUM ENT FOR A C ARDI AC INST IT UT E M ODEL IN T HE C ARIBBE AN

Author(s): Perryman, R.A.

The established Departmental Model in medicine has been physician-centric, with traditional roles in credentialing, peer

review, and rarely has a budge, outside of Academic Centers. Departments do not have the ability to contract, and

quality of care is rarely a focus beyond conventional peer review.

The Institute Model, above all, is patient-centric and disease-focused, eg. cardiac disease or cancer. Multiple disciplines

are brought together to deliver quality focused care and may utilize a combination of employed, contracted and private

physicians and support staff. Institutes do have dedicated budgets and cost centers have an organizational structure to

support the product line and the ability to measure and monitor clinical performance and outcomes. Uniquely, Institutes

can contract with payers and providers of health care and are, therefore, an ideal model for the development of public-

private partnerships. As the burgeoning cost of healthcare continues to rise, governments, including those in the

Caribbean, are looking to form public-private partnerships to help to continue to provide high quality care at affordable

prices.

The Institute Model requires a governance body that is flexible, innovative, multi-disciplinary and focused on the primary

goal of providing quality care to the patient at a cost that results in value, and therefore, must be measurable and

reportable. I believe an Institute Model is ideally placed to fulfil these elements and is well-suited to the Caribbean

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medical environment.

T ITLE: T HE GROWTH OF PAEDI AT RIC HE ART SU RGERY IN J AM AIC A ( J O H N S H O PKI N S

MED I C I N E SPO N SO R ED L EC T U R E)

Author(s): Jacobs, J.P.

Background: A multi-national collaboration of stakeholders from across the globe, along with local Jamaican health care

professionals, has facilitated massive growth of paediatric heart surgery in Jamaica over the past decade. The purpose

of this presentation is to review the patterns of practice and results of one of the many surgical teams involved with this

remarkable growth.

Method: Several surgical teams have collaborated with the local Jamaican team to increase the volume and scope of

paediatric cardiac surgery in Jamaica. Important contributions have been made by a team headed by British surgeons in

collaboration with Chain of Hope and Gift of Life. Additional contributions have been made by a team headed by

surgeons and physicians from Johns Hopkins All Children’s Heart Institute, also in collaboration with Chain of Hope and

Gift of Life, as well as Rotary, the Larry King Cardiac Foundation, Edwards Life Sciences, Medtronic, St. Jude,

Caribbean Heart Menders, and many others. We reviewed all surgical cases performed by the team headed by surgeons

and physicians from Johns Hopkins All Children’s Heart Institute in collaboration with the local team from Bustamante

Children’s Hospital.

Results: In ten years (from 2006-2015), 102 index cardiac operations were performed. The case mix of these operations,

as classified by The Society of Thoracic Surgeons - European Association for Cardio-Thoracic Surgery Congenital Heart

Surgery Mortality Categories (STAT Mortality Categories), has become more complex every year. The collaboration

between the visiting surgical team and the local team has expanded beyond the domain of patient care to include

education, research, and advocacy.

Conclusion: 10 lives per year times 20 years = 200 lives!! Partnership, Teamwork, and Sustainability = Thousands of

Lives!

T ITLE: T HE S ILVER JUBILEE ANNIVER S ARY OF “ PART NERED C AR E ” IN T HE B AH AM AS

AN D T HE C ARIBBE AN !

Author(s): Brown, C.S., Sin Quee-Brown, C., Francis, B., Coleman, H., Roberts, R., King-Dorsett, C., Sebastian, M.,

Roberts, A.

“Partnered Care” seeks to facilitate access to advanced, high tech cardiovascular and medical care that meets the

WHO dictates of being Available, Acceptable, Appropriate, Affordable, and therefore Accessible for All, independent of

their ability to pay. We now celebrate our 25th Anniversary and Silver Jubilee of practicing our Partnered Care Model in

The Bahamas and beyond.

Partnered Care was initially developed to facilitate making Hi-Tech Cardiovascular Medicine, that is Appropriate and

Acceptable via Standards of Care, More Available while Increasing Access to ALL, Irrespective of Their Ability

to Pay, by making it more Affordable. Partnered Care does so via its Tri-Partite Partnership and Its Bahamas Heart

Centre Discounted Service System between The Private Sector, The Government Sector and The User Sector or

General Public, whom we are most privileged to serve.

Our model has now been advanced to a Quadripartite Partnered Care Model with the addition of The Industry Sector.

We now present our 25 year experience in practicing Partnered Care in keeping with our Caribbean Cardiac Society’s

30th Caribbean Cardiology Conference Theme of “Reducing the Burden of Cardiovascular Disease in the

Caribbean: A Call To Action”.

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T ITLE: M ECH ANIC AL LY ASSIST ED THROM BOLYSI S OF M AJOR PULM ONAR Y AN D

VENOUS T HROM BOEM BOLI SM ( T EN ET H EAL T H C AR E SP O NSO R ED L EC T U R E)

Author(s): Shahriari, A.

Until recently, the standard of care for treating patients with pulmonary and venous thromboembolism (PE/VTE) was

anticoagulation with or without thrombolysis. In the last 5 years, new technology has been developed that very effectively

removes the thrombus burden by using a combination of mechanical removal and thrombolysis. The mechanical

component is either an ultrasound disruption of the thrombus, or mechanical suction of the thrombus and its removal.

This new technology not only performs a more complete thrombus removal, it also reduces the need of thrombolysis and

its associated complications.

In this presentation, we give an update on the safety and efficacy of this technology and discuss the utility and outcome

of mechanically assisted thrombectomy at our institution.

T ITLE: EXT R ACORPOREAL M EM BR ANE OXYGEN AT ION – A S AF E T HER APEUT IC O PT ION

IN SEVERE AC UT E CHEST SYNDROM E IN P AT IENT S WIT H S ICKLE CELL D ISE AS E

Author(s): Vally, S., Mora, P., Valentino, R., Fabre, J., Sanchez, B., Chabartier, C., Inamo, J., Mégarbane, B., Roques,

F., Mehdaoui, H., & Resiere, D.

Background: Acute chest syndrome is the main cause of death among young adults with sickle cell disease, hence the

potential benefit of extracorporeal membrane oxygenation (ECMO) in clinical worsening resulting in acute respiratory

distress syndrome (ARDS). This study describes our single centre experience, especially regarding patients outcome.

Method: Retrospective review of sickle cell disease patients referred for acute thoracic syndrome in the Intensive Care

Unit (ICU) from 2007 to 2014.

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Results: During the study period, 28 sickle cell disease patients (22 SS-genotyped and 6 SC-genotyped) were referred

for acute thoracic syndrome in the ICU. Median age was 30 years [6 - 42]. Male gender ratio was 10/28. There were two

children, aged 6 and 11 years. Sixteen patients (12 SS, 4 SC) required orotracheal mechanical ventilation. Refractory

ARDS requiring ECMO occurred among 8 patients (4 SS, 4 SC). These patients were aged 32 years [18 – 38]. Acute

thoracic syndrome was mostly due to lung infectious disease (4/8 patients). In most cases, ECMO was initiated less

than 2 days after admission in the ICU, and mean duration of assistance was 8±5 days. Mean duration of mechanical

ventilation was 18±13 days. ECMO was associated with a longer hospitalization in the Intensive Care Unit (21±24 vs

16±21, p=0.02). Complications related to vascular access occurred in two patients (thrombosis of the jugular vein, and

severe bleeding). The survival on ICU discharge was 88% in the overall group; 80% in those requiring mechanical

ventilation, and 83% in those treated with ECMO.

Conclusion: ECMO appears to be safe and useful to treat severe thoracic syndrome in sickle cell disease patients.

Prospective studies are needed to delineate its use in this indication, especially in patients with SC-genotype.

References:

Pelidis MA, Kato GJ, Resar LM, Dover GJ, Nichols DG, Walker LK, Casella JF. Successful treatment of life-threatening

acute chest syndrome of sickle cell disease with venovenous extracorporeal membrane oxygenation. J Pediatr Hematol

Oncol. 1997; 19(5):459-61.

T ITLE: GOOD DOCUM ENT AT ION IS GOOD PAT IENT C ARE: T HE VALUE OF ACCUR AT E

DOCUM ENT AT ION

Author(s): Dullum, M.K.C., & Smith, R.K.

Caring for your patient is the essence of being a doctor. However administering to your patients and providing physical

care is not enough for the practice of medicine in current times. We must also accurately document to reflect the care

we are providing to patients. The most important reason for accurate complete documentation of patient care is so we

can constantly evaluate and improve the care we provide to our patients. Proper documentation ensures accurate

measures of quality and efficiency, captures levels of acuity, risk of mortality and severity, and allows for clinical

research. It also elucidates admission conditions, and hospital acquired conditions. The healthcare environment is

rapidly changing. Gone are the days where medicine was practiced between the doctor and the patient. The doctor-

patient relationship now has a vast collection of voyeurs. The hospital chart has changed from a communication tool for

healthcare providers of the care we are providing, to an expansive record full of data and information. With all the

information available in the record, outside people have the ability to make conclusions about the care you are providing

for your patient based on what is documented in the chart. Physicians who document poorly are more likely to face

challenges such as poor quality designation, payment denials, malpractice and possibly fraud enforcement. The only

way clinical people outside the medical staff adjudicate performance is through billing data. The healthcare providers

code billing data from the chart documentation, so it is critical to have the documentation accurate and complete. The

use of data in value based purchasing and panel or ACO participation is another important reason to document

appropriately for survival of one’s practice. ICD 10 will allow for more clinically appropriate and specific documentation.

T ITLE: CL IN IC AL OUT C OM ES OF A HYBRID ST R AT EGY OF B ARE M ETAL ST ENT

COM BINED WIT H DRUG -ELUT ING ST ENT VERSUS DRUG -ELUT ING ST ENT E XCLUSIVE

IM PL ANT AT ION FOR M UL T I - VESSEL PER CUT ANEOU S CORON ARY INT ERVENT ION

Author(s): Crooks, N., Ivanov, J., Mackie, K., Chan, W., Sibbald, M., McGeoch, R., Hatton, R., Kotowycz, M.,

Overgaard, C.B., & Džavík, V.

Objective: This study aimed to examine the clinical outcomes of a hybrid strategy of percutaneous intervention (PCI) –

bare metal stent (BMS) combined with drug-eluting stent (DES) – versus exclusive DES implantation for patients

undergoing multi-vessel PCI.

Methods and results: A retrospective analysis of 1300 patients with multi-vessel coronary artery disease (MVD) who

received multi-vessel PCI between April 2007 and March 2011, was performed. (514 Hybrid, 786 exclusive DES).

Patients with multi-vessel PCI as well as demographic, angiographic and clinical information were obtained from

University Health Network (UHN) PCI registry database. All information of in-hospital outcomes, and four-year follow up

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was obtained from the discharge abstract database of the Canadian Institute for Health Information.

Patients fulfilling criteria for Multi-vessel coronary artery disease had coronary artery disease (CAD) involving two or

more major coronary arteries of at least 70% severity, and those fulfilling criteria for multi-vessel PCI had more than one

coronary stent implanted during the index procedure. Patients with significant left main disease were excluded. The

incidence of major adverse cardiac events (MACE = death or target vessel revascularization), were assessed during

follow up. At 4-year follow up there was a reduction in MACE rates (DES 30.3 ± 2.0% vs Hybrid 23.0 ± 2.4%, p value

0.01) and TVR in the Hybrid group (DES 20.9 ± 1.7% vs Hybrid 15.6 ± 1.9%, p value 0.069). Using the Logistic

regression module, factors favouring a DES exclusive approach included LV dysfunction, Diabetes Mellitus, bifurcation

lesions, less than TIMI 3 flow at the start of the procedure and prior PCI. Similarly, factors favouring the Hybrid approach

were SVG PCI and Type C lesions. Subgroup analysis revealed renal impairment (CrCl< 60) and LV ejection fraction

<20% were predictors of reduced survival in both Hybrid and DES exclusive groups.

Conclusion: Patients who undergo Hybrid PCI have a lower incidence of MACE and TVR at 4-year follow up. For

patients undergoing multi-vessel PCI who have favorable lesions and clinical features, a hybrid stent approach should be

considered a viable option for any contemporary PCI practice.

T ITLE: C ASE REPORT: M AN AGEM ENT OF SEVER E INFU NDIBUL AR ST ENOS IS POST -

B ALLOON PULM ON ARY VALVOT OM Y FOR A CHILD W IT H SEVERE PULM ON ARY ST ENOSIS

Author(s): Upadhya, S.

Balloon pulmonary valvotomy is the treatment of choice for valvar pulmonary stenosis. In older children with severe

pulmonary stenosis, infundibular component could be underestimated and could well manifest with severe infundibular

stenosis post balloon pulmonary valvotomy.

4-year-old severely symptomatic child presented with exertional dyspnoea class III and chest pain. After clinical and

echocardiographic examination, final diagnosis of severe valvular pulmonary stenosis and supra systemic right

ventricular pressures in right heart failure was made. High-risk balloon pulmonary valvotomy was done. Post valvotomy,

on table pulmonary artery to right ventricle pullback showed 40mmHg gradient across the infundibulum and no

significant gradient across the valve. Child had transient desaturation and hypotension immediately after the procedure

likely because of the severe infundibular spasm and was managed appropriately. Echocardiogram showed severe

infundibular stenosis with peak gradient of 110mmHg. The management option of whether to do any surgical intervention

for the severe infundibular obstruction was discussed. We decided to follow up as the infundibular obstruction could

regress and also infundibular spasm may be contributing partially for the obstruction. The child was put on beta-blockers

orally and follow-up done closely. Echocardiogram after 6 weeks showed remarkable improvement in the infundibular

obstruction (peak gradient reduced from 110mmHg to 38mmHg). The infundibular component of the pulmonary stenosis

got revealed once valvar obstruction was relieved.

Residual infundibular obstruction post valvotomy usually regress over time, even if it is severe. Beta-blockers should be

started if there is significant infundibular obstruction.

SATURDAY JULY 18 T ITLE: SURGIC AL TRE AT M ENT OF HYPERT ROPHIC OBST RUCT IVE C ARDIOM YOP AT HY

Author(s): Savage, E.

Since the initial operative experience of 10 patients presented by Morrow in 1964, septal myectomy has become the

standard of care to treat acquired muscular obstruction of the left ventricular outflow tract. This talk will review the

indications for intervention, development of the procedure, review outcomes and compare outcomes with other

therapeutic approaches.

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T ITLE: C ARDIOV ASCUL AR M AGN ET IC RESON ANCE IM AGING FOR PAT IEN T S WIT H

REP AIR ED T ET R ALOGY O F F ALLOT

Author(s): Lopez, D.

Cardiovascular magnetic resonance (CMR) imaging has emerged as an important tool in the surveillance and

management of patients with repaired Tetralogy of Fallot (TOF). Despite major advances in surgical techniques, repair is

not curative, and most survivors have residual anatomic and hemodynamic abnormalities that can impact quality of life

and survival in adulthood. Thus, careful lifelong surveillance is paramount to the care of those with repaired TOF.

The objective of this talk is to discuss the utility of CMR in this patient population. Review the advantages and limitations

of CMR compared to other imaging modalities. Describe what information clinicians can learn from a CMR examination

and how the results might influence patient management.

T ITLE: T HE GUY AN A EC HOC ARDIOGR AP HY EDUC AT ION PROGR AM : ACHI EVEM ENT S AND

CH ALLENGES AFT ER T HE F IRST 2 YEARS

Author(s): Lalman, S., Pirani, F., Figura, M., Fung, P., Zahir, S., & Isaac, D.

Background: Cardiovascular morbidity and mortality is high in low and middle-income countries. Management of cardiac

disease requires accurate, timely diagnosis. The Guyana Echocardiography Education Program (GEEP) was developed

in 2012, in response to lack of access to quality cardiac diagnostics within the public system. GEEP provided an echolab

at Georgetown Pubic Hospital (GPHC) and combined distance / onsite education for local physicians to perform and

interpret echocardiograms to American Society of Echocardiography standards.

Objective: Evaluate the impact of GEEP over the first 2 years:

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Number of echocardiograms performed: inpatients, outpatients, adults, children

Number of physicians trained, and their ongoing involvement

Challenges and successes in implementation; applicability to other similar medical systems.

Methods: Observational data collected from GPHC EchoLab electronic database. Interviews from program participants

provided data on challenges and successes.

Results: 1318 echocardiograms performed over the initial 2 years: 406 - 1st year, 912 - 2nd year; 69% adults, 31%

pediatric. Majority were outpatient, however inpatient echocardiograms increased consistently over 2 years. <30% of all

pediatric and adult echos were normal.

7 physicians completed GEEP, 4 continue providing echo services at GPHC. Challenges to ongoing participation

included lack of perceived recognition of expertise, or ability to advance professionally.

Conclusions: GEEP has made major contributions to provision of high standard cardiac diagnostics within the public

system in Guyana, and has potential applicability in other similar medical systems. Ongoing challenges include

identifying participants able to amalgamate echocardiography into their professional careers and maintain their skills

and standards in echocardiography.

T ITLE: T HE USE O F T H REE D IM ENSION AL T R AN SESOPH AGEAL ECHOC ARDIO GR APHY

FOR T HE ASSESSM ENT OF VAL VUL AR HE ART D ISE ASE AND CONGENIT AL HEART

D ISE ASE PRIOR T O SUR GIC AL INT ERVENT ION, THE T RIN IDAD I AN EXPERI ENCE

Author(s): Cummings, T., Chin, M., & Ramlal, R.

The importance of accurate assessment of structural abnormalities of the heart using 2D and 3D transthoracic and

transesophageal echocardiography is vital to the cardiac surgeon in ensuring successful correction of abnormalities.

The use of 3D transesophageal echocardiography is widely used in developed countries; however, the use in the

Caribbean is limited by the lack of sufficient training of enough sonographers and cardiologists. We present our

experience in Trinidad and Tobago in these complex cases where we compare the 3D transesophageal images and

gross pathological surgical images demonstrating the accuracy of our studies.

T ITLE: QU ANT IF IC AT IO N OF M IT R AL R EGURGIT AT ION USING M AGNET IC RESON ANCE

IM AGING

Author(s): Porat, M., Gorodisky, L., Agmon, Y., Abadi, S., & Lessick, J.

Purpose: Valve Regurgitation, and in particular Mitral Regurgitation (MR), is usually assessed by echo-Doppler,

however, it is based on simplistic assumptions, including hemispheric geometry. Cardiac magnetic resonance (CMR)

enables detailed 3D evaluation of flow vectors making it theoretically suitable for MR quantification without any

assumptions. We aimed to test the feasibility of calculating MR regurgitant volume (RVol) by the PISA (Proximal

Isovelocity Surface Area) approach, using CMR 3D vs. 2D (in-plane) velocity vectors, compared to Doppler.

Methods: In a prospectively designed study, 27 patients with various grades of MR underwent CMR and echo-Doppler

on the same day. By CMR, multiple slices were obtained parallel to the mitral valve by 2D and 3D phase-contrast

imaging. The area of proximal flow convergence was identified and, after correcting for aliasing, the perimeter was

automatically measured using dedicated software for each temporal phase. The 2D and 3D-RVol were calculated as

the sum of PISA perimeters throughout systole, multiplied by slice width.

Results: For mild, moderate and severe MR, 2D-RVol was 11±6ml, 21±18ml and 54±25ml and 3D-RVol was 27±11ml,

34±22ml and 93±33ml, compared to Doppler-RVol 27±8ml, 41±16ml and 109±49ml. CMR 2D and 3D-RVol correlated

well with Doppler-RVol (r=0.76 and r=0.8). 3D-RVol was on average 8ml less than Doppler-RVol, and 2D-RVol was on

average 32ml less than Doppler-RVol.

Conclusion: Our proposed method assesses MR severity quantitatively. In contrast to gold standard methods, this

method is not based on assumptions of 3D symmetry, nor does it need to assume that there is no other valvular

regurgitation.

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T ITLE: PERCUT AN EOUS B ALLOON M IT R AL V AL VU LOPL AST Y IN A D OM INIC AN

POPUL AT ION COM PAR ED T O INT ERN AT ION AL REPORT S.

Author(s): Lappot Guzmón, R., & Ureña, P.

Purpose: Mitral stenosis is the most feared complication of rheumatic fever. Although its prevalence has diminished to

0.1% in developed countries, it remains an important cause of morbid-mortality in third world countries, representing in

the Dominican Republic 2% of annuals hospitalizations. Percutaneous balloon mitral valvuloplasty has demonstrated to

be an effective palliative method for treating mitral stenosis in a subset of patients. We analyze the experience of

percutaneous balloon mitral valvuloplasty in patients with mitral stenosis in a Dominican population and compare it to

international experience.

Methods: This is a retrospective descriptive study where we review 47 patients who underwent percutaneous balloon

mitral valvuloplasty from December 2008 to May 2013, focusing on demographic characteristics, pre and post

valvuloplasty valvular area and gradient, and procedure effectiveness (complications).

Results: 80.9% of patients were females; the average age was between 40-50years old. Pre-valvuloplasty area was

0.9+0.3 cm2, post procedure area was 1.9 + 0.6 cm

2. The reduction of the mean gradient was an average of 8.76mmHg.

The success rate was 96%, with 2 episodes of cardiac tamponade, one in the cath lab and it was resolved, and the other

in the observation room after the procedure that resulted in the death of the patient, representing a 2% mortality.

Conclusions: This review of the experience of percutaneous balloon mitral valvuloplasty is comparable with international

registries. And it showed to be an effective and safe therapeutic method.

T ITLE: CORON ARY F IST UL AE CORR ECTION. C ASE SERIES

Author(s): Santana M., Ramirez, J., Tarafa, J., Ureña, P., & Valdez, I.

A coronary fistula is an abnormal communication between a coronary artery and a cardiac cavity, vena cava or

pulmonary vein. Signs and symptoms of presentation depend on their caliber. Most are small and asymptomatic. If the

fistula has a big caliber, usually three times a normal coronary, it may present with a coronary steal phenomenon,

decreasing myocardium flow.

The major diagnostic tool is coronary angiography, which provides size and origin allowing taking the most convenient

course of action.

We present a case series of three patients with coronary steal phenomenon.

A 61 y/o male with history of high blood pressure, presents dyspnea and chest pain. On physical exam, BP: 140/90

mmHg, rest within normal limits. Workup for MI was negative. In spite of medical therapy symptoms remain. Patient

underwent coronary angiography, showing multiple coronary fistulae, arising from the Anterior Descending Artery.

A 59 y/o female, without morbidities presents with oppressive chest pain of moderate intensity. Non STEMI was

confirming with electrocardiogram and cardiac enzymes. The angiography showed no evidence of obstruction and a

fistula emerging from the Circumflex Artery to the Pulmonary Artery, with the phenomenon of coronary steal.

A 55 y/o male, asymptomatic, visits the doctor for routine exam. Computed Angiotomography shows evidence of

coronary disease. An elective coronary angiography showed a significant lesion in the Circumflex artery and also a high

output coronary fistula arising from the Anterior Descending Artery.

All patients underwent percutaneous coil correction with no further complications.

T ITLE: FEASIB IL ITY AND CONSID ER AT IONS FOR T R ANSPORT OF PAT IENT S WIT H

VENT RICUL AR ASSI ST D EVICES

Author(s): Samoukovic, G., Petrie, H., & Smith, M.C.

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Introduction: Acute heart failure and decompensation of chronic congestive heart failure tend to be challenging in terms

of clinical therapy even at best centres around the world. The mortality of such conditions reaches 80%. Since the

publication of REMATCH and HeartMate II trial, ventricular assist devices (VADs) have become the mainstay of therapy

for INTERMACS class 1-4 patients. Additionally, short term VADs and ECMO have become the therapy of choice for

acute heart failure of any aetiology. Transoceanic transport of patients with uni- or biventricular assist devices is

challenging in terms of both hemodynamic changes with altitude and technical aspects.

Methods: We present the hemodynamic data of a patient with a biventricular assist device transferred from U.K. to USA

at high altitude. We use these to demonstrate important clinical aspects of transfer of such patients. We focus on

hemodynamics and their impact on the VAD parameters; we therefore outline necessary adjustments. Additionally, we

focus on technical aspects of the transport- loading and off-loading, positioning and personnel.

Results: We present the case of a successful transatlantic transfer of a patient with a Levitronix Centrimag BiVAD. The

decreased preload secondary to lower-extremity blood pooling max managed by positioning and fluid boluses. The

optimal strategy is discussed. The availability of necessary personnel, including a cardiac surgeon/ intensivist and a

perfusionist is essential.

Conclusion: Trans-oceanic transport of patients with VADs is feasible and safe. Multidisciplinary approach with careful

planning and optimal hemodynamic management are essential.

T ITLE: SUCCESSFUL IM PL ANT AT ION OF LEFT VENT RICULAR ASSI ST DEVICE - A F IRST

FOR T HE C ARIBB E AN

Author(s): Chattuparambil, B., Modi, S., Amancharla, R.K., & Krishnan, D.

Left Ventricular Assist Devices (LVAD) have become a state-of-the-art therapy for advanced heart failure, both as a

destination therapy for patients for whom cardiac transplantation is not an option, or as a bridge to transplantation. We,

at the Health City Cayman Islands, have established a comprehensive heart failure clinic and in a span of ten months

have implanted two LVADs in patients with advanced chronic heart failure.

In this presentation, we share the experience of our LVAD program which is the first of its kind in the Caribbean.

Both the patients were relatively young males diagnosed to have chronic advanced cardiac failure for more than 8 years.

One patient was preoperatively diagnosed to have a prothrombotic disorder. Both of them had NYHA class III to IV

symptoms requiring frequent hospitalizations and were on continuous dobutamine infusion for a few months before

coming to our facility. As the chance for them to get a cardiac transplant elsewhere was very remote, and we do not

have a transplant program, we decided to go ahead with LVAD implantation after informed consent. Both the patients

underwent the procedure successfully with Heartmate II device, and are presently leading a near normal life.

The presentation explains in detail how to set up a LVAD program, the procedure, post-operative management and life

after LVAD implantation.

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