Session 07 : Rheumatic Heart Disease

Session 7: Rheumatic Heart Disease
Chairpersons: Subir Maulik and Shantanu Sengupta

3:10-3:30 G. Karthikeyan 
Newer perspectives in Rheumatic Heart Disease
3:30-3:50 Arun Bandyopadhyay 
Proteomics of Rheumatic Heart Disease
3:50-4:10 Santhosh Satheesh 

Rheumatic heart disease: Current understanding of disease burden, pathogenesis and prevention

posted Jan 26, 2017, 1:46 AM by sourav ghosh

G. Karthikeyan
All India Institute of Medical Science, New Delhi, India

This talk will present new data on disease burden from the Global Burden of Disease Study and provide an update on recent data from clinical and echocardiographic studies. The talk will also summarize recent insights and ongoing work on the genetics and pathogenesis of RHD. Finally, an update on the current status of preventive strategies will also be presented.

Plasma proteomics in Rheumatic Heart Disease and Coronary Artery Disease

posted Jan 26, 2017, 1:45 AM by sourav ghosh

Arun Bandyopadhyay
1 Cell Biology and Physiology Division, CSIR-Indian Institute of Chemical Biology, Kolkata, India, 2 Institute of post graduate Medical Education & Research , SSKM Hospital, Kolkata, India, 3 Apollo Gleneagles Hospital, Kolkata, India

The traditional approach to study cardiovascular disease (CVD) and develop new biomarkers was to look at one or a few candidate molecules. But, the advent of new proteomic techniques in CVD research allows analysing the expression of a plethora of proteins at one go. Proteomics and bioinformatics are powerful tools to identify protein based biomarkers involved in a disease state. The current advancement in proteomic technologies helps studying global protein expression changes associated with human disease processes. One of the advantages of these proteomic studies is that new biomarkers (diagnostic and/or prognostic) can be discovered which will help provide a better framework for treatment of cardiovascular diseases. Thus, the detection, identification and characterization of variations in the proteome occurring during the course of heart disease will provide both (i) insight into the underlying molecular mechanisms and (ii) potential cardiac specific biomarkers for regular, systematic observation and assessment of cardiac status.
The aim of this study was to provide a list of potential blood based protein markers for RHD and CAD. We utilized on-line label-free MS/MS using blood plasma as the source material. On-line LC-ESI-MS is the method of choice because the initial LC separation step decreases the amount of analytes that can be simultaneously ionized. Thus, the possibility of ion suppression is reduced rendering the method quantitative in nature. Such label-free quantitative LC-MS approaches can compare innumerable samples. Therefore, they are ideal for biomarker discovery because experimental workflows normally compare a large number of specimens to validate the results from a statistical point of view. Consequently, the label-free quantitative LC-MS methods employed in this thesis helped analyse the full potential of clinical plasma samples as a source of disease biomarkers in RHD and CAD respectively. Some of which might play important roles in the pathophysiology of RHD and CAD and improve the existing diagnostic strategies. Taken together, it may be said that the results of the proteome analysis may be useful to understand the pathophysiological changes associated with RHD and CAD. Some of the altered protein(s) unique to these diseases might qualify as potential CVD biomarker(s). Those biomarkers may be utilized for the development of diagnostics which in turn, would help therapeutic intervention timely and might save human lives [This work is supported by CSIR grant no. MLP123 to AB.

Balloon Aortic Valvuloplasty in Rheumatic Aortic Valve Disease

posted Jan 26, 2017, 1:42 AM by sourav ghosh

Santhosh Satheesh
Jawaharlal Institute of Postgraduate Medical Education and Research, Pondichery, India

Rheumatic Heart Disease causes significant morbidity and mortality. Though the Mitral Valve is most commonly involved, Aortic Valve is affected in over 50% of patients. Balloon Valvuloplasty is the treatment of choice in Mitral Stenosis of Rheumatic Etiology but scant data was available in the literature about the efficacy of Balloon Aortic Valvuloplasty in rheumatic heart JIPMER we evaluated 92 patients who underwent Balloon Valvuloplasty. The procedure was successful in 85% of patients and majority of them did not nned an open heart surgery over the 5 year follow up period, with significant improvement in cardiac haemodynamics with relief of symptoms. BAV is a effective treatment strategy in Rheumatic Valvular Aortic Stenosis.

Emerging therapies in pulmonary hypertension

posted Jan 26, 2017, 1:41 AM by sourav ghosh

S. Ramakrishnan
Professor of Cardiology,All India Institute of Medical Sciences, New Delhi,India

Idiopathic pulmonary hypertension (IPAH) is a rare disease associated with high morbidity and mortality. The pathogenesis is not fully understood. Diagnostic evaluation focuses on ruling out other aetiologies of pulmonary hypertension and prognosticating the disease. Congenital heart disease and left sided heart disease associated pulmonary hypertension are more common in India. Therapies for idiopathic pulmonary hypertension have evolved over the past decade. Phosphodiesterase 5 inhibitors (sildenafil, tadalafil), endothelin antagonists (Bosentan and ambrisentan) and prostanoids are the class of drugs shown to be useful in pulmonary hypertension. An initial combination of ambrisentan and tadalafil may be beneficial in selected patients with IPAH. Riociguat and macitentan are the newer agents approved for use in PAH following landmark clinical trials confirming their efficacy. After prostanoids, initial combination therapy, riociguat and macitentan have shown improvement in hard clinical end points. Balloon atrial septostomy, Pott’s shunt, stem cell therapy, and radiofrequency ablation are the other therapies that could benefit an IPAH patient with refractory symptoms. Despite these advances, the outcomes of various forms of pulmonary hypertension remains poor especially in India, where some forms of therapy are not available and patients often are diagnosed at an advanced stage of disease.

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