Innovative Solutions to Cardiovascular Challenges …caribbeancardiac.org/wp-content/uploads/2015/11/CCS_2014...Conference 2015 17 CCS 2014 Honouree 18 Past Honourees 19 Profile on

CARIBBEAN CARDIAC SOCIETY

29th CARIBBEAN CARDIOLOGY CONFERENCE Atlantis Paradise Island Bahamas

July 23-26 2014

PROGRAMME

Innovative Solutions to Cardiovascular Challenges and the Caribbean

EDUCATE INFORM UPDATE

Table of Contents

Conference Information 2

Messages 6

Organizing Committee 11

Faculty 13

Schedule at a Glance 14

Social Programme 15

SponsorsExhibitors 16

Conference 2015 17

CCS 2014 Honouree 18

Past Honourees 19

Profile on The Bahamas 20

Past Presidents 22

Council Members 24

Schedule of Presentations 25

Official Opening Ceremony Programme 26

Abstracts 33

29th Caribbean Cardiology Conference

About the Conference

This educational activity is designed to inform educate and update the Caribbeanrsquos 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 23 2014 through Saturday July 26 2014 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 29th 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 heshe actually spent in the activity

Registration amp Secretariat Hours Tuesday July 22 2014 200pm - 500pm

Wednesday July 23 2014 700am - 500pm

Thursday July 24 2014 700am - 500pm

Friday July 25 2014 700am - 500pm

Saturday July 26 2014 700am - 500pm

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 amp Party

Adult US$140

Non-Members Child US$70

Allied Health US$400 US$110

Medical Students US$150 US$60

Industry Representatives US$700 US$180

Guests US$340

ldquoInnovative Solutions to Cardiovascular Challenges and The Caribbeanrdquo

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 ndash Thursday

Orange One Day ndash Friday

Purple One Day ndash 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 hotelConference 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 Atlantis 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

Child Policy

Children are not allowed in Meeting Rooms or Exhibit Halls Childrenrsquos tickets can be purchased for the Conference Dinner amp Party at the Secretariat located in the Atropos Room Atlantis

Lost and Found

If you have lost or found an item please contact the CCS Conference Secretariat in the Atropos Room Atlantis

No Smoking Policy The Caribbean Cardiac Society promotes a ldquoNo Smokingrdquo 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

Air Canada 1-242-377-8220

American Airlines 1-800-433-7300

Avis Car Rental 1-242-326-6380

Budget Rent A Car 1-242-377-7405

Hertz Rent A Car 1-242-377-8684

Meals at Atlantis During lunch breaks where there are no sponsored lunch sessions attendees are encouraged to grab a quick lunch at the following restaurants within close proximity of the Grand Ballroom and Conference Center Murrayrsquos Deli Virgilrsquos BBQ Olives Marina Pizzeria and Starbucks Coral Tower For other recommendations please ask any member of the Atlantis staff

Dear Colleagues

It is my pleasure to welcome you to the 29th Caribbean Cardiology

Conference being held this year at the Atlantis Paradise Island Bahamas under the theme ldquoInnovative Solutions to Cardiovascular Challenges and the Caribbeanrdquo As our previous attendees know and our first time attendees will soon learn the Annual Caribbean Cardiology meeting has grown to be the premier meeting of cardiovascular specialists in the region

As the Caribbean positions itself as a leader in the fight against the growing global epidemic of chronic non-communicable diseases it is more important than ever that our regionrsquos practitioners be updated on the most recent and emerging innovations in clinical surgical and interventional approaches to the prevention and management of cardiovascular diseases This yearrsquos programme will feature an outstanding cadre of speakers including Dr Elliott Antman President-Elect of the American Heart Association and Dr Joshua Hare Director of the Interdisciplinary Stem Cell Institute (ISCI) at the University Of Miami Miller School Of Medicine We look forward to hearing Dr Antman make the case for ldquoDisruptive Innovationrdquo and to have Dr Hare highlight the role Stem cells can play in the future of cardiovascular practice We are also very proud of the research from within the region that will be presented and the wide cross-section of territories represented in the progamme We are also pleased to welcome the next generation of Caribbean clinicians our Residents who will present their clinical cases in hopes of walking away with the Charles Denbow Young Clinician Award This award represents our Societyrsquos ongoing commitment to nurturing the clinical skills vital to the diagnosis and management of cardiovascular diseases in the region The CCS Council is proud of the excellent scientific programme crafted by our hard-working Conference Planning Committee we know you will find it both educational and informative and ultimately of benefit to your various patient populations when you return to your practices and professional spaces We are also sure you will find the social programme to be exciting as well with opportunities to sample the unique Bahamian culture and to build and renew strong collegial relations with your peers from across the region I wish you a productive conference and a pleasant stay in the Bahamas

Message from the President Caribbean Cardiac Society

Dr Ronald Henry MBBS CMTT MBBS GACP FESC FSCAI President Caribbean Cardiac Society

Message from the Conference Chairman

Dear Colleagues Guests and Visitors It gives me great pleasure and is indeed an honour to welcome you all back to the friendly shores of our archipelagic Commonwealth of The Bahamas for this 4th time and on the occasion of our 29th Annual Scientific Meeting of our Caribbean Cardiac Society To my Dutch Colleagues Welkom To my Spanish Colleagues Bienvenido To my French Colleagues Bienvenue And last but not least to my English Colleagues from the region beyond and The Commonwealth of The Bahamas I extend to you a very warm Bahamian Welcome Our theme this year ldquoInnovative Solutions to Cardiovascular Challenges AND

The Caribbeanrdquo deserves some clarification Many consider the word ldquoandrdquo to be an error because surely one meant ldquoInnovative Solutions to Cardiovascular Challenges IN The Caribbeanrdquo Alas they are not correct and there is no error We fully intend to explore ldquoInnovative Solutions to Cardiovascular Challenges AND The Caribbeanrdquo with a view to highlighting the potential opportunities for our Caribbean countries and colleagues in the cardiovascular space and others to be able to play an integral role in the research development education and commercialization of new technologies while providing an inviting forum with expectedly FDA rigour in a non-FDA jurisdiction This is particularly useful for disruptive technologies which will be the primary focus of our Annual Cardiology Lecture delivered by Prof Elliott Antman of Harvardrsquos Brigham and Womenrsquos Hospital Our Opening Night Lecture will be presented by Prof Joshua Hare Director of The Interdisciplinary Stem Cell Institute at the University of Miami Florida on the 4Rs of ldquoStem Cells Repair Replace Regenerate Rejuvenaterdquo This is most timely in light of The Bahamas having just passed its Stem Cell Act in 2013 recognizing what many consider to be the way and wave of the future of Medicine Dr Brian Bethea will be delivering our Annual Surgical Lecture on ldquoE-Valving Technologiesrdquo which holds promise to take valve replacement surgery to the next level In our own practice at The Bahamas Heart Centre and The Medical Pavilion Bahamas we have established several new entities in The Partners Stem Cell Centre The Partners Clinical Research Centre and The Institute for Advanced Medical Procedures in support of our Bahamian and Caribbean mission while utilizing our basic tenets of REST Research (LocalInternationalFirst-In-Man - FIM) Education Services (Clinical) and TransNational Medical Care We have already initiated a number of exciting FIM studies and a Medical Touristic Stem Cell Trial and will be anchoring our Regenerative Medicine Program with ISCI and Prof Hare Our very own Interventional Cardiologist Dr Bimal Francis successfully and innovatively performed the first known in the world percutaneous interventional repairpalliation of an ARCAPA Lesion (Anomalous Origin of The Right Coronary Artery from The Pulmonary Artery) in 2009 As President of the Caribbean Cardiac Society back in 2006-2008 I chose to champion our participation in international clinical trials like PANORAMA by Medtronic and the Clarify Trial by Servier Our crowning research achievement is now unfolding with our acceptance into Harvardrsquos TIMI Trial Group under the leadership of Prof Eugene Braunwald our Millennium Speaker in the Bahamas in 2000 and now led by Prof Marc Sabatine Prof Elliott Antman and our Honoree Dr Robert Giugliano Today as National and Caribbean Lead Investigator for the TIMI 61 CAMELLIA Trial I can say that Dreams can be made to come true And so I close with the famous words of Martin Luther King who said ldquoI HAVE A DREAMrdquo and another soon to be famous or infamous President who said ldquoYES WE CANrdquo Thank you and Enjoy the Conference Atlantis Nassau New Providence Island The Bahamas Each Other and Most of All Enjoy Yourselves

Dr Conville Brown MD MBBS FACC FESC Conference Chairman Caribbean Cardiac Society

Message from the Prime Minister Commonwealth of the Bahamas

It affords me much pleasure to be able to welcome the delegates and observers who have come to The Bahamas for the 29

th Annual Scientific

Meeting of the Caribbean Cardiac Society I extend a particularly warm welcome to the President of the Society Dr Ronald Henry and to the Conference Committee Chairman our very own Dr Conville Brown I am reliably informed that this is now your fourth meeting in The Bahamas and this gives me the assurance that your previous meetings in this venue must have been so successful that you have again returned to our shores

The Bahamas is very proud of its own efforts and its growing expertise in the field of Cardiology and can boast of having among its cadre of health professionals several well-known and highly respected members of the profession who have an international reputation in the field of Cardiology Cardiology is an ever growing and acute field of medicine made all the more relevant because of many factors which influence the pathology of so many of the people of the Caribbean Region and which has resulted in ever increasing incidences of cardiovascular diseases The theme of your gathering this year ldquoInnovative Solutions to Cardiovascular Challenges and The Caribbeanrdquo will no doubt discuss and share common experiences and come up with innovative solutions to meet one of medicinersquos growing areas of concern I think it is only through sharing of knowledge whether it is through the presentation of scholarly papers or through smaller discussions of firsthand experience that the entire Caribbean Cardiology Society will remain up to date on the latest trends and innovation It is my hope that as much of your sessions as possible will remain open to members of the public especially other members of the health profession who might be able to benefit from your discussions and exchanges One issue that I am sure will come to the fore is the high cost of health care with particular reference of cardiology and arising from this would be the issue of access by many of our people to this type of care I am looking forward to meeting with all of you and sharing in your opening session and to learn a bit more about this fascinating but vital branch of medicine which is so indispensable to the health and well-being of our people throughout the Caribbean Once again I wish your proceedings at this your 29

th Annual Scientific Meeting every

success and I welcome you to our beautiful country Perry G Christie Prime Minister

Message from the Governor-General Commonwealth of the Bahamas

Government House The Bahamas

It is a pleasure for me to welcome delegates to the Caribbean and International Cardiovascular Community Twenty-ninth Annual Scientific Meeting of the Caribbean Cardiac Society (CCS) here at the Atlantis Resort on Paradise Island The theme you have chosen ldquoInnovative Solutions to Cardiovascular Challenges and the Caribbeanrdquo suggests that this Meeting which perhaps serves as the most significant activity of the CCS represents the most ideal opportunity for cardiologists surgeons and physicians with an

interest in Cardiology to gather and discuss the latest advances in the field No doubt the theme of this yearrsquos Meeting will also resonate well with The Bahamasrsquo landmark establishment of the Stem Cell Act and regulations It is noted that the CCS recognizes industry as an important partner in continuing medical education on current and emerging medicines and technologies for the management of cardiovascular disease I am advised that the annual meeting has evolved from humble beginnings of a one-day distance mode meeting in 1986 to a four-day meeting with 200 ndash 250 professionals in attendance from over 18 Caribbean countries the United States of America Canada and the United Kingdom This bodes well for the exchange of best practices amongst some of the greatest minds in Cardiology including The Bahamasrsquo Dr Conville Brown Conference Committee Chairman and Past President of the Caribbean Cardiology Society I acknowledge the extensive work of the CCS in research community support to ensure that persons with cardiac disease were identified and receive treatment and being policy advisor to governments regarding medical legislations new systems procedures and policies ndash all with a view to ensuring that the best possible care is administered to patients Congratulations are offered to Dr Conville S Brown his hard-working and committed committee and all those persons who assisted in the staging of this event On behalf of the people of the Commonwealth of The Bahamas and on my own behalf I again wish to extend a warm welcome to all of you attending this all-important meeting as you seek to improve the quality of life for our peoples May this Caribbean Cardiac Society Meeting be a great success Dame Marguerite Pindling Governor-General

Message from the Minister of Health Commonwealth of the Bahamas

I wish to extend warmest greetings and congratulations to the President Executives and Members of the Caribbean Cardiac Society on the occasion of its 29

th Annual Scientific Meeting

scheduled to be held here in The Bahamas from the 23rd ndash 26th

July 2014 I also take this opportunity to officially welcome all of the Partners Scientists Experts and Participants of the cardiovascular community from our sister countries within the Caribbean and North America

I am advised that the Caribbean Cardiac Society was formally launched in 1988 as the primary forum for Cardiologists and Surgeons in the Caribbean region and throughout the world to share best practices ldquoin the true spirit of Caribbean co-operation and the advancement of the knowledge of diseases of the heart and circulation among medical and para-medical professions in the Caribbeanrdquo It is against this backdrop that the Annual Caribbean Cardiology Conference has become the premier cardiovascular meeting in the region and the 2014 meeting will be no different as you assemble under the theme ldquoInnovative Solutions to Cardiovascular Challenges and The Caribbeanrdquo The prepared agenda highlights the critical importance for the need for research and continuing medical education on current and emerging medicines and technologies for the management of cardiovascular disease in our country and by extension our global community I also view with keen interest the keynote lecture to be delivered by Professor Joshua Hare of the University of Miami United States of America ldquoStem Cells Repair Replace Regenerate Rejuvenate ldquo as The Bahamas has recently enacted the Stem Cell Act and Regulations 2013 On behalf of the Government and the Ministry of Health I extend heartfelt thanks and best wishes to the President Dr Ronald Henry the conference committee chairman and host and Past President Dr Conville S Brown as you deliberate and form new networking relationships in this scientific forum over the next three days and I look forward to working closely with your members to re-define the delivery of healthcare in our country The Honourable Dr M Perry Gomez MP Minister of Health

Organizing Committee

Dr Ronald Henry Trinidad amp Tobago

Dr Henry Steward Curaccedilao

Dr Conville Brown The Bahamas

Dr Victor Elliott

Jamaica Dr Marilyn Lawrence-Wright

Jamaica

Invited Faculty

Dr Elliott Antman MD FACC FAHA

Senior Physician at the Brigham and Womens Hospital and Associate Dean for Clinical and Translational Research at Harvard Medical School

Dr Joshua Hare MD FACC FAHA

Louis Lemberg Professor and Director of the Interdisciplinary Stem Cell Institute (ISCI) at the University of Miami Miller School of Medicine

Dr Gregory Giugliano Tufts University School of Medicine

Massachusetts USA

Dr Michael Black St Maryrsquos Medical Center

Florida USA

Dr Robert Giugliano Brigham amp Womenrsquos Hospital

Massachusetts USA

Prof Raul Garillo Universidad Catolica Argentina

Buenos Aires Argentina

Dr Ravikishore Amancharla Health City

Cayman Islands

Prof Alistair Hall Leeds Medical School

Yorkshire UK

Schedule at a Glance

Social Programme

Wednesday July 23 700PM - 1000PM The Official Opening will be held in the Grand Ballroom AB Atlantis

Welcome Reception to follow at the BLU Pool Deck

Attire Lounge suit

Thursday July 24 730PM - 1100PM

The Awards Banquet will be held in the Grand Ballroom EFG Atlantis Join the CCS

Membership in an elegant atmosphere as we honour our 2014 Honouree Dr Robert

Giugliano The Banquet will also see the presentation of the

2014 Charles Denbow Young Clinician Award

Attire Formal

Friday July 25 700PM - 100AM The CCS Conference Dinner and Party will be held at ldquoLe Chateau des Brunsrdquo

171 Eastern Road or East Bay Street and Wild Tamarind Drive

Return transportation will be provided from the Royal and Beach Tower lobbies

of the Atlantis and from the Comfort Suites

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 Atropos Room 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

Every effort is made to ensure that meals served at all official CCS events are healthy and low in fats and cholesterol Individuals with special dietary requirements must request special meals (vegetarianfruit) 24 hours in advance at the Conference Secretariat We regret that requests for special meals not made in advance may not be honoured

Sponsors amp Exhibitors

PLATINUM

SILVER

Boehringer Ingelheim Canada Ltd Caribbean Division Fundacion Cardiovascular de Colombia

Jackson Memorial Hospital Johns Hopkins Medicine

Servier Caribbean Limited St Jude Medical

EXHIBITOR

Baptist Health South Florida Bayer Healthcare Pharmaceuthicals

Biomedical International Corp Boston Scientific Broward Health

BW (2011) Limited Cleveland Clinic

Lifeforce International MSD

Merck Serono Nueterra Global Alliance Pfizer Pharmaceutical

Reva Inc Roche Diagnostics Central America amp Caribbean

Sanofi

Medtronic Tenet Healthcare

Dr Giugliano MD is a Senior Investigator with the TIMI Study Group Staff Physician in the Cardiovascular Division at Brigham and Womenrsquos Hospital and Associate Professor of Medicine at Harvard Medical School He graduated Summa Cum Laude Phi Beta Kappa (Mathematics) from Dartmouth College (1985) receiving a medical degree at Harvard Medical School (1989) Dr Giugliano completed residency and chief residency at Cedars-Sinai Medical Center (UCLA affiliate1989-93) and cardiology fellowship at Massachusetts General Hospital (1993-6) In 1996 Dr Giugliano joined the Brigham and Womenrsquos Hospital as a Medicine Research Fellow in the Thrombolysis in Myocardial Infarction (TIMI) Study Group directed by Eugene Braunwald and completed a Science Masters (Epidemiology) at the Harvard School of Public Health In 1997 he joined the Cardiovascular Division faculty of the Brigham and Womenrsquos Hospital and has served as the principal investigator for 9 multicenter clinical trials at TIMI His areas of research interests include novel antithrombotic fibrinolytic agents and lipid-lowering therapies and patient outcomes following Acute Coronary Syndromes (ACS) He has authored more than 200 articles and chapters and delivered hundreds of lectures Dr Giugliano is the Principal Investigator for the ENGAGE-AF TIMI 48 trial of the factor Xa inhibitor edoxaban in patients with fibrillation He is also a member of the Operations Committees and Lead TIMI Investigator for the IMPROVE-IT trial evaluating ezetimibe in 18000 patients post ACS the FOURIER trial studying evolocumab a PCSK9 inhibitor in hyperlipidemic patients with prior cardiovascular disease and the EARLY ACS trial of eptifibatide in ACS Dr Giugliano serves on numerous Data Safety Monitoring Boards clinical endpoint committees and HolterECG Core Laboratories He actively participates in the clinical activities of the Cardiovascular Division attending in the Levine Cardiac Intensive Care Unit telemetry unit and consult services and sees patients in a busy growing outpatient practice

Robert P Giugliano MD Senior Investigator TIMI Study Group Staff Physician in the Cardiovascular Division Brigham and Womenrsquos Hospital Boston MA and Associate Professor of Medicine at Harvard Medical School

CCS 2014 Honouree

Past Honourees

1991 2005

Prof Mario Garcia Palmieri Prof Trevor Austin Hassell

Sir Kenneth Stuart The Sir Victor Sassoon (Bahamas) Heart Foundation

Dr HAL McShire

1995 Dr Knox Hagley

Prof Sir Magdi Yacoub Mrs Phyllis Francis

Dr Theo Poon King Cardiology Unit University Hospital of the West Indies

1999 2007

Dr S Sivapragasm Prof Gerald Grell

Dr Winston Ince Dr Dominque Larifla

Dr Tarcisio Kroon Dr Phillipe Cohen-Tenoudji

Dr Keith McKenzie

Dr George Wattley 2008

Dr Cyril Nelson Prof Charles Denbow

Mrs Cynthia Hassett

Dr Cecil Bethel 2009

Dr Ronald Henry

2001 Dr Richard Ishmael

Dr Donald Christian

Dr Richard Haynes 2010

Dr Edward Chung

2002 Mrs Beverley Dinham-Spencer

Dr James Ling

Dr Michael Wooming 2011

The Grenada Heart Foundation

Dr Yves Donatien 2012

Prof Edwin Besterman Dr Mercedes Dullum

Prof Howard Spencer Dr Albert Penco

2004 2013

Centre Hospitalier Universitaire de Fort-de-France Dr Roy Tilluckdharry

Profile on The Bahamas

The Commonwealth of The Bahamas is a 750 mile long chain of

approximately 700 islands and 2500 small limestone-formed islets

or cays This Atlantic Ocean archipelago stretches from the

northwestern island of Bimini through 100000 square miles of water

to the most southeastern island Inagua The islands gained

independence from the United Kingdom on July 10 1973 Before

that The Bahamas originally home to the Lucayan Indians experienced Spanish French and

American occupation

The closest island to the United States of America is Bimini which is known as the gateway to The

Bahamas Inagua has the largest bird population including one of the worldrsquos largest colonies of

flamingos The largest island Andros Island is 2300 square miles and boasts an extensive creek

system About 30 of the islands of The Bahamas including Eleuthera Cat Island Long Island

Crooked Island and Exuma are inhabited The highest point is Mount Alvernia on Cat Island with an

altitude of 63 metres (207 ft) Nassau capital city of The Bahamas lies on the island of New

Providence

The nationrsquos most populated areas are Nassau and Freeport (on Grand Bahama) New Providence

Island Grand Bahama and Paradise Island all form the City Islands the metropolitan hubs of the

archipelago The other inhabited cays are collectively called the Family Islands or the Out Islands

The islands of The Bahamas offer something for everyone The variety of landscapes and attractions

offer everything from exquisite dining shopping and exciting night life and gambling in the

metropolitan areas to the tranquillity and mellow atmosphere of the culturally rich areas of the Family

Islands These islands are surrounded by reef systems replete with wondrous marine life and

seascapes It is these reefs that make The Bahamas renowned as a premier ecotourism centre and

dive site Transport on and between the islands is offered by taxis rental cars buses and ferries The

Fast Ferry service is offered between designated main islands However local ferries serve as water

taxis shuttling locals and tourists between neighbouring cays of a main island

The venue of the 2014 Caribbean Cardiac Society Conference the Atlantis Paradise Island boasts

various marine life exhibits shopping areas and activities for adults children and teenagers Wildlife

exhibits can be found in the Beach Coral and Royal Towers where one can view turtles sharks

stingrays and other amazing sea life There is also the Dolphin Cay and Aquaventure located in the

Power Tower This Tower houses The Abyss a 55-foot body slide which ends in a cave with two large

freshwater aquaria surrounding the slide

Quick facts on The Commonwealth of the Bahamas

Capital Nassau

Currency Bahamian Dollar

Area- total 13878 km2 (5358 sq mi)

Terrain Low and flat with ridges that usually rise no more than 15 to 20 m (49 to 66 ft)

Population 371960 (World Bank 2012 estimate)

Language English

The estimated cost of a taxi between the Nassau airport on New Providence Island and The Atlantis Hotel on

Paradise Island is approximately US$2700 for 2 people The exchange rate between the Bahamian and US

dollar is 11 and the US dollar is widely accepted across the islands Look for the BahamaHost decal in the

cab window and you will ldquoexperience knowledgeable professional Bahamian hospitalityrdquo as a passenger in

that cab There are no shuttle buses running between Nassau and Paradise Island however there is a

wealth of information in the airport lobby detailing how to get around in The Bahamas

Dr Donald Christian Jamaica

1989 - 1992

Prof Trevor Hassell Barbados

1992 - 1994

Dr Roy Tilluckdharry Trinidad amp Tobago

1994 - 1996

Prof Howard Spencer Jamaica

1996 - 2000

Dr Yves Donatien Martinique

2000 - 2002

Dr Ivan Perot Trinidad amp 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

Council of the Caribbean Cardiac Society

Dr Henry Steward Vice President

Curaccedilao

Dr Ronald Henry President

Trinidad amp Tobago

Dr Marilyn Lawrence-Wright Treasurer Jamaica

Dr Raymond Massay Immediate Past President

Barbados

Dr Mercedes Dullum USA

Dr Victor Elliott Jamaica

Dr Caroline Lawrence St Kitts and Nevis

Dr Kendall Griffith US Virgin Islands

Dr Jeanice Stanley-Jean St Lucia

Dr Jocelyn Inamo Martinique

Dr Pravinde Ramoutar Secretary

Trinidad amp Tobago

Wednesday July 23

Updates and Guidelines for General Physicians and Internists 900am ndash 100pm Grand Ballroom E

900 OPENING REMARKS Conville Brown The Bahamas

Update on Hypertension Highlights of JNC VIII

Kenneth Connell Barbados

940 Update on Lipids and Cardiovascular Disease

Robert Giugliano USA

1010 Diabetes Mellitus The Cardiac Equivalent

Jeff Massay Barbados

1040 COFFEE BREAK

1125 Update on the Metabolic Syndromes and Obesity

Martin Didier St Lucia

1155 The Final Common Pathway Updates and Guidelines for Acute Coronary Syndrome

Gregory Giugliano USA

1225 PANEL DISCUSSION

1255 CLOSING REMARKS

Official Opening Ceremony amp Welcome Reception

Wednesday July 23 700pm Grand Ballroom AB

Atlantis Paradise Island The Bahamas

PROGRAMME

National Anthem of The Bahamas Angelique Sabrina White Opening Remarks Dr Conville Brown Conference Chairman Presidentrsquos Remarks Dr Ronald Henry President Caribbean Cardiac Society

Roll Call Dr Pravinde Ramoutar Secretary Caribbean Cardiac Society Welcome Hon Dr M Perry Gomez Minister of Health The Commonwealth of The Bahamas Welcome The Rt Hon Perry Gladstone Christie Prime Minister The Commonwealth of The Bahamas

Keynote Lecture Prof Joshua Hare

Louis Lemberg Professor

Director The Interdisciplinary Stem

Cell Institute University of Miami

Vote of Thanks Dr Henry Steward Vice President Caribbean Cardiac Society

Reception follows immediately after at the BLU Pool Deck Atlantis

SCIENTIFIC SESSION Chairpersons Ronald Henry

800am ndash 1015am Winston Forbes Grand Ballroom AB 800 ndash 810 Left Ventricular Hypertrophy Correlation between Electrocardiography and

Echocardiography in Jamaican Adults

Kurlene Cenac St Lucia

810 ndash 820 Cardiovascular Risk Factors among Patients Presenting to the Heart Foundation of Jamaica for an Electrocardiogram Ayoki Levy Jamaica

820 ndash 830 DISCUSSION

830 ndash 850 Cardiovascular Clinical Trials Year in Review

850 ndash 905 The Evaluation of Coronary Artery Disease in Women Pamela Ouyang USA Johns Hopkins Sponsored Lecture

Thursday July 24

915 ndash 925 Wolff-Parkinson White and Ebstein Anomaly in a Paediatric Patient A Case Report Anny Duarte Jimenez Dominican Republic

925 ndash 935 Idiopathic Ventricular Tachycardia Induced Cardiomyopathy in a Paediatric Patient A Case Report Antonio Villegas Savinon Dominican Republic

935 ndash 1005 Adults with Congenital Heart Disease Repeat Offenders Michael Black USA Tenet Healthcare Sponsored Lecture

10 05 ndash 1015 DISCUSSION

1015 ndash 1100 COFFEE BREAK

ANNUAL CARDIOLOGY LECTURE Chairperson Conville Brown

1100AM ndash 1145AM 1100 ndash 1145 Clinical Research and the Development of Medical Therapeutics The Case for Disruptive

Innovation Elliott Antman USA

CHARLES DENBOW YOUNG CLINICIAN PRESENTATIONS

1145AM ndash 1230PM 1145 ndash 1200 Rhythm and Blues

Georgette Meade Jamaica

1200 ndash 1215 An Unusual Case of Severe Non Pitting Edema Ramona Lappot USA

1215 ndash 1230 Viral Syndrome A Nearly Lethal Presentation Julio Valentin-Nieves Puerto Rico

LUNCH SESSION

Grand Ballroom C 1230 ndash 200 Valve Sparing Root Replacement in Patients with Ascending Aortic Aneurysms

Ali Shahiari USA Tenet Healthcare Sponsored Lecture

SCIENTIFIC SESSION II Chairpersons Edward Chung

200pm ndash 400pm Tricia Cummings Grand Ballroom AB 200 ndash 210 Cryptogenic stroke and atrial Fibrillation Saga Is it Really Cryptogenic

Hakop Hrachian USA

210 ndash 230 Once Daily Edoxaban Prevents Stroke Reduces Bleeding and Saves Lives in Patients with Atrial Fibrillation Robert Giugliano USA

230 ndash 300 A Stroke Neurologistrsquos Perspective on the Devastating Effects of Stroke from Afib and how the New Oral Anticoagulants Can Help Ted Wein Canada Boehringer Ingelheim Sponsored Lecture

315 ndash 345 AF Ablation ndash State of the Art Ravikishore Amancharla Cayman Islands St Jude Medical Sponsored Lecture

Biennial General Meeting

400pm ndash 500pm

SCIENTIFIC SESSION III Chairpersons Mercedes Dullum

800am ndash 1015pm Duane Sands Grand Ballroom AB 800 ndash 810 Assessment of Valve Regurgitation using 3D vs 2D Magnetic Resonance Imaging

Moshe Porat Israel

810 ndash 820 Skeletonizaion of Mammary Artery Impact on Sternal Infections Giovanni Teodori Trinidad and Tobago

820 - 830 Aortic Valve Repair Techniques and Outcomes Edward Savage USA

ANNUAL CARDIAC SURGERY LECTURE

840 ndash 910 ldquoe-Valving Technologies Brian Bethea USA Tenet Healthcare Sponsored Lecture

920 ndash 930 Transatlantic Transfer of Patients on Veno-arterial Extracorporeal Membrane Oxygenation (VA-ECMO) as Airbridge to Heart Transplantation Dabor Resiere Martinique

930 ndash 940 Should Cardiac Surgery be Indicated and Performed on Patients Older than 80 Years Alvaro Diego Pentildea Columbia

950 ndash 1000 Surgical Treatment of Adult Ventricular Septal Defects A Four Year Experience at CHC- Trinidad Giovanni Teodori Trinidad and Tobago

1000 ndash 1010 107 Entries to the West Indies Cardiac Surgery Registry from a Single Centre in Trinidad amp Tobago Randolph Rawlins Trinidad and Tobago

Friday July 25

SCIENTIFIC SESSION IV Chairpersons Victor Elliott 1100am ndash 100pm Raymond Massay Grand Ballroom AB 1100 ndash 1130 Corevalve ndash New Evidence in High Risk Patients

Juan Gaspar USA Medtronic Sponsored Lecture

1140 ndash 1150 A Case of Valve In Valve Post Trans Procedural Core Valve Migration Antonio Villegas Savinon Dominican Republic

1150 ndash 1200 Periprocedural Complications and Short Term Mortality of PCI Patients at Caribbean Heart Institute from January 2011 - June 2013 A Preliminary Study Joel Joseph Guyana

1200 ndash 1210 CCS PCI Registry Update Ronald Henry Trinidad and Tobago

1220 ndash 1230 PCI in Octogenarian Patients at Fundacion Cardiovascular de Colombia Jose Saaibi Colombia Fundacion Cardiovascular de Colombia Sponsored Lecture

1230 ndash 1240 PCI Without On-Site Surgical Backup The SRMC Experience Roy Flood US Virgin Islands

1240 ndash 1250 A Novel Interventional Approach to ARCAPA (Anomalous Right Coronary Artery from the Pulmonary Artery) Bimal Francis The Bahamas

LUNCH BREAK (Attendees at leisure for lunch) 100pm ndash 200pm

SCIENTIFIC SESSION V Chairpersons Martin Didier

200PM ndash 400PM Richard Ishmael Grand Ballroom AB 200 ndash 230

Whatrsquos new in the Therapeutic Approach for the Management of Hypertensive Patients with CAD Alistair Hall United Kingdom Servier Sponsored Lecture

230 ndash245 Oxygen Requirements as a Screening Tool for the Detection of Late Pulmonary Hypertension in extremely Low Birth Weight Neonates Gul Dadlani USA Johns Hopkins Sponsored Lecture

245 ndash 255 Sudden Cardiac Death Risk Factor Identification in Hypertensive Patients Pierre-Henri Gacon France

310 ndash 325 CARPHA Hypertension Guidelines Update Kenneth Connell Barbados

325 ndash 340 Global Standardised Hypertension Treatment Project Pragna Patel USA

340 ndash 400 PANEL DISCUSSION

SCIENTIFIC SESSION VI Chairpersons Pravinde Ramoutar

800AM ndash 1015AM Caroline Lawrence Grand Ballroom AB 800 ndash 810 Postural Orthostatic Tachycardia Syndrome Case Series From Barbados

Michelle Ince Barbados

810 ndash 845 CRT in Mild Functional Classes From Rescue to Prevention Raul Garillo Argentina Medtronic Sponsored Lecture

855 ndash 905 The Global Registry of Acute Coronary Events (GRACE) Risk Score as a Predictor of One Year Mortality in a Multi-Ethnic Trinidadian Population with Acute Coronary Syndrome Michael Chin Trinidad and Tobago

905 ndash 935 Practical Application of 3D Echocardiography in Daily Clinical Practice Rhea Sancassani USA Jackson Memorial Sponsored Lecture

945 ndash 955 Sudden Death in Athletes Alix Dufresne USA

955 ndash 1005 Beliefs and Practices related to Cardiovascular Disease in St Lucia Whats the Message Martin Didier St Lucia

Saturday July 26

SCIENTIFIC SESSION VII Chairpersons Roy Tilluckdharry

1100am ndash 100pm Camille Christian-Shelton Grand Ballroom AB 1100 ndash 1110 The Role of exercise as a Form of Treatment and Prevention of Cardiovascular Disease

Brett Cook Jamaica

1110 ndash 1120 Cardiac Diagnosis is Predictive of Co-morbid Anxiety Disorders in an Outpatient Cardiology Clinic Setting Jeffrey Simmons USA

1130 ndash 1140 Renal Denervation in the Afro-Caribbean Population Arthur Liqui-Lung Curaccedilao

1140 ndash 1150 Antiplatelet Therapy in the Management of ACS in 2014 Marcus St John USA

1200 ndash 1210 Epidemiology and Management of out-of-hospital Cardiac Arrests in Martinique Assessment and Perspectives Dabor Resiere Martinique

1210 ndash 1220 Initial Local Experience with Unprotected Left Main Stenting Antonio Villegas Savinon Dominican Republic

1220 ndash 1230 Application of Low-Level Laser Therapy to Reduce Subcutaneous Adipose Volume Ryan Maloney USA

1230 - 1250 Update on Recent Cardiovascular Innovations in the Management of Structural Heart Disease Alan Heldman USA

IASC SESSION Chairpersons Marilyn Lawrence-Wright 200pm ndash 330pm Conville Brown Grand Ballroom AB 200 ndash 220 Chemo-Induced Cardiomyopathy

Diego Delgado Canada

220 ndash 230 Device Therapy in Chagas Disease Clinical Characteristics and Follow Up Raul Garillo Argentina

240 ndash 250 Safety and Efficacy of Cardiovascular and Peripheral Vascular Implantation of Vescell in Congestive Heart FailureRefractory Angina Patients and in patients with Critical Limb Ischemia Zurina Salas The Bahamas

250 ndash 300 Thirty- Day Mortality and Clinical Audit of Acute ST Segment Elevation Myocardial Infarction at San Fernando General Hospital Coronary Care Unit Pravinde Ramoutar Trinidad and Tobago

320 ndash 330 CLOSING REMARKS

Abstracts

THURSDAY JULY 24 Title Left Ventricular Hypertrophy Correlation between Electrocardiography and Echocardiography in Jamaican Adults Author(s) Cenac K Hurlock L Lawrence-Wright M Ferguson T Elliott V Lee M Left ventricular hypertrophy (LVH) is an independent marker of increased cardiovascular risk It is often present in hypertension and reflects the severity of hypertensive heart disease The electrocardiographic findings associated with LVH have been defined by well established criteria applied in common clinical practice Echocardiography however does not always correlate with the electrocardiogram (ECG) and may with significant frequency detect LVH in patients with reportedly ldquonormalrdquo ECGs or vice versa This study evaluates the level of agreement between ECG and echocardiogram (ECHO) detected LVH in a Jamaican population and seeks to determine which of the commonly used ECG criteria for LVH is most specific and sensitive to our population It also evaluates the clinical relevance of ECG and ECHO detected LVH Methods Data were collected from a total of 161 patients who had ECGs and ECHOs done at the Heat Foundation of Jamaica and at a private Cardiology centre between July and October 2013 Other relevant clinical data were collected as well Results ECG had low specificity and slightly higher sensitivity for detecting LVH in the study population The most sensitive ECG criterion for the detection of LVH was Framingham (88) while the most specific was Romhilt Estes (59) Sokolow Lyon Romhilt Estes and Cornell had sensitivities of 71 78 and 81 respectively Framingham was found to be 53 specific while Sokolow Lyon and Cornell were 55 and 54 specific respectively The Romhilt Estes criterion had the highest positive predictive value NYHA Class was not found to be a significant predictor of LVH via ECG or ECHO Conclusions This study suggests that it is reasonable to continue the use of the Sokolow Lyon criteria in everyday clinical practice as a screening tool for LVH in our setting The most accurate criterion appeared to be the Romhilt Estes and it should be applied in specialized settings as feasible The study provides valuable insight into the characteristics of our patient population and can be used to gather further research into this area Title Cardiovascular Risk Factors among Patients Presenting to the Heart Foundation of Jamaica for an Electrocardiogram Author(s) Levy A Lawrence-Wright M Nordmoe E Introduction The electrocardiogram is a simple tool used to screen for cardiovascular disease This study investigated the prevalence of cardiovascular risk factors among adults presenting to the Heart Foundation of Jamaica for an electrocardiogram Methods Records of all patients presenting for electrocardiogram during June 2013 were reviewed Data analysis was done using SPSS 19 Results There were 157 patients Mean age was 59plusmn14 years 61 were female 497 had hypertension 191 had diabetes mellitus 402 were overweight or obese 637 had a family history of cardiovascular disease lt 1 had a smoking history Mean blood pressure (BP) was 131plusmn2083plusmn13 mmHg mean body mass index 272plusmn54 kgm

2 mean

total cholesterol 51plusmn09 mmolL 382 of patients had an abnormal electrocardiogram In logistic regression analyses diastolic BP was the strongest predictor of an abnormal electrocardiogram (β = 2438 p = 003) Systolic BP (β = 1197 p = 003) was also significant There was a trend towards a higher prevalence of abnormal electrocardiogram among patients with diabetes mellitus (β = 0093 p = 082) and with overweight (β = 0167 p = 066) Conclusion Cardiovascular risk factors are prevalent among patients presenting to the Heart Foundation of Jamaica for an electrocardiogram Despite this 618 of patients screened had a normal electrocardiogram Diastolic BP was the strongest predictor of an abnormal electrocardiogram Title Cardiovascular Clinical Trials Year in Review Author(s) Giugliano G Johnson B Goodwin Schunemann J Giugliano R 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 MD Conference Express fills this gap by applying the rigorous standard of peer-review to the creation of our medical conference highlights reports We will present peer-reviewed highlights of the most important cardiovascular clinical trials presented within the past year at major scientific sessions (ESC 2013 TCT 2013 AHA 2013 and ACC 2014) as covered by MD Conference Express These trials include new evaluations of novel anticoagulants (Dabigatran use with mechanical heart valves [RE-ALIGN] Edoxaban for venous thromboembolism treatment [Hokusai-VTE] anticoagulation in atrial fibrillation [ENGAGE AF-TIMI 48]) the introduction of new technologies (chelation [TACT] renal denervation [SYMPLICITY HTN 3] a new transcutaneous aortic valve [COREVALVE Extreme Risk]) further insights into antiplatelet therapies (duration [OPTIMIZE] and interruption [PARIS] of dual antiplatelet therapy upstream prasugrel [ACCOAST] IV P2Y12 inhibition [CHAMPION PHOENIX]) modern evaluations of old practices (renal artery stenting [CORAL] treatment for HFpEF [TOPCAT]) and expansion of indications (cardiac resynchronization therapy [ECHO-CRT]) The controversial update of the ACCAHA guidelines for hyperlipidemia will also be discussed These data cover a broad range of cardiovascular topics Our goal is to bring the busy clinician up to speed with the latest developments in clinical cardiovascular studies of the past year Title The Evaluation of Coronary Artery Disease in Women (Johns Hopkins sponsored lecture) Author(s) Ouyang P In the Caribbean Community countries the five leading causes of death for men are heart disease cancers injuries and violence stroke and diabetes For women heart disease is also the leading cause of death followed by cancers diabetes stroke and hypertension It is estimated that deaths due to chronic non-communicable diseases will increase by 17 in Latin America and the Caribbean over the next 10 years Coronary disease (CHD) risk remains frequently underestimated in women Although the risk factors are similar the prevalence of these factors and their impact on CV risk can differ in men and women We have shown that among individuals age lt60 yrs without clinical CHD followed for 7-15 yrs diabetes increases risk for incident CHD by 36-fold in women but does not increase risk in men Reproductive history can provide information on future CHD risk in women The presentation of coronary syndromes differs between the sexes Women presenting with acute coronary syndromes have a lower prevalence of significant coronary disease on catheterization but angina continues to carry a high risk in women A number of risk assessment tools have been developed and published Some of these have not been validated in certain populations including African Americans and Hispanics These tools and the use of other imaging modalities in the assessment of cardiovascular risk in women will be discussed Title Wolff-Parkinson White and Ebstein Anomaly in a Pediatric Patient A Case Report Author(s) Duarte Jimenez A Vidal F Toribio Y Perez R The association of Ebstein anomaly and Wolff-Parkinson White Syndrome is not an uncommon situation It decreases life quality of patients and it also favors the occurrence of sudden death This is a case report of a 7 year old male patient with cyanosis palpitations and multiple syncope episodes with an echocardiogram showing Ebstein anomaly and an electrocardiogram registering 300bpm It was decided to take to the Electrophysiology lab where an electrophysiological study showed the presence of multiple accessory pathways after several applications the radio frequency ablation achieved the blockage of the 3 anomalous pathways The early and late follow up consult showed great results with no recurrence Title Idiopathic Ventricular Tachycardia Induced Cardiomyopathy in a Pediatric Patient A Case Report Author(s) Villegas Savinon A Tarafa J Vidal F Toribio Y Perez R The perpetuation of an arrhythmia may cause myocardial dysfunction which is one of the few reversible causes of heart failure this arrhythmia induced cardiomyopathy is known as tachycardiomyopathy Interrupting the mechanism producing this arrhythmia may cause a gradual recovery of cardiac function This is a case report of a 13 year old male patient with dyspnea on moderate exertion and atypical precordial pain with an echocardiogram showing mild systolic dysfunction (ef 45) and over 38 thousand right ventricular ectopic beats on several 24 hour Holter After being diagnosed with tachycardiomyopathy induced by right ventricular ectopy complexes originated in the right ventricle inflow

tract The patient was taken to the EP lab to perform the location and radiofrequency ablation of the right ventricular arrhythmic focus The first month follow up consult revealed important improvement in the ventricular function and disappearance of the idiopathic ventricular arrhythmia This is the first case documented and reported of a reversible tachycardiomyopathy in a pediatric patient caused by right ventricular ectopic complexes from the inflow tract Title Adults with Congenital Heart Disease Repeat Offenders (Tenet Healthcare sponsored lecture) Author(s) Black M This presentation will help illustrate the marked differences between acquired versus congenital heart disease in the adult population using both case studies and illustrations Patients with ACHD have had multiple previous procedures including catheterizations peripheral venous and arterial access and multiple exposure to anticoagulants ACHD

patients require the utmost in pre-operative planning in order to prevent both expected and unforeseen complications By reviewing the pertinent anatomy and physiology I hope to elucidate potential hazards in all three phases of patient care (pre- intra- and post-operative) ANNUAL CARDIOLOGY LECTURE Title Clinical Research and the Development of Medical Therapeutics The Case for Disruptive Innovation Author(s) Antman E LUNCH SESSION Title Valve Sparing Root Replacement in Patients with Ascending Aortic Aneurysms (Tenet Healthcare sponsored lecture) Author(s) Shahriari A Introduction Valve-sparing root replacement at our institution is routinely performed for treatment of annuloaortic ectasia and ascending aortic aneurysms where the aortic valve is competent or is insufficient (AI) but repairable Our results with this procedure are reviewed in this presentation Methods This is a retrospective observational study of 67 patients undergoing valve-sparing root replacement between December 2007 and March 2011 performed by one surgeon Chart analysis was performed and data were collected Endpoints were early and intermediate-term valve-related complications redo procedures stroke and mortality All patients are followed in the aortic disease clinic and follow-up was 100 complete Results In 40 (597) of these cases partial or total arch replacement using deep hypothermic circulatory arrest was performed In 57 patients (85) the Vascutek Gelweave Valsalva graft (Terumo- Ann Arbor MI) was used In 21 patients (313) the graft chosen was 1-3 mm larger than the measured size of the annulus (Group A) In 40 patients (Group B) the chosen graft was simply oversized by 5mm based on the size of the annulus No patient left the operating room with more than 1+ AI One patient (15) expired within 30 days One patient (15) had a stroke on postoperative day 6 One patient (15) underwent a redo aortic root replacement secondary to bacterial endocarditis There were no take instances of atrioventricular block or return to the operating room for bleeding The mean follow-up is 25+- 3 months Conclusion Valve-sparing root replacement does produce excellent outcomes in experienced centers In our experience this technique produces excellent cusp coaptation surfaces and helps avoid causing cusp prolapse while positioning the commisures Because of its many benefits for the patients serious consideration should be given to this procedure in cases with ascending root aneurysms Title Cryptogenic Stroke and Atrial Fibrillation Saga Is it Really Cryptogenic Author(s) Hrachian H Up to 30 of ischemic strokes have no identifiable cause despite extensive and costly evaluation and are known as cryptogenic stroke (CS) Up to 90 of Atrial fibrillation (AF) episodes can be asymptomatic and can be intermittent therefore could go undetected by routine evaluation after CS AF increases stroke risk by fivefold and this risk is generally equal for paroxysmal and persistent AF Detecting AF after CS is crucial since changing antiplatelet therapy to full anticoagulation may prevent future episodes of CS Optimal strategy for identifying intermittent AF after CS is unclear We discuss the close relationship between undetected AF with CS and latest technologies that can dramatically enhance detection of AF after CS Title Once Daily Edoxaban Prevents Stroke Reduces Bleeding and Saves Lives in Patients with Atrial Fibrillation Author(s) Giugliano R Background Edoxaban is a once-daily direct oral factor Xa inhibitor with proven antithrombotic effects Methods ENGAGE AF-TIMI 48 was a randomized double-blind trial comparing two once-daily edoxaban dose-regimens with warfarin in 21105 patients with moderate-high risk atrial fibrillation (median follow-up 28 years) The primary efficacy outcome was stroke or systemic embolism Each edoxaban regimen was tested for noninferiority versus warfarin while on-treatment The principal safety endpoint was major bleeding Results The annualized rates of the primary outcome on-treatment were 150 with warfarin (median time-in-therapeutic range 684) compared with 118 with high-dose edoxaban (HR 079 975 CI 063-099 Plt0001 for

noninferiority) and 161 with low-dose edoxaban (HR 107 975 CI 087-131 P=0005 for noninferiority) In the intention-to-treat analysis there was a trend favoring high-dose edoxaban (HR 087 975 CI 073-104 P=0081) and an unfavorable trend with low-dose edoxaban versus warfarin (HR 113 975 CI 096-134 P=0098) The major bleeding annualized rates were 343 with warfarin 275 with high-dose edoxaban (HR 080 Plt0001) and 161 with low-dose edoxaban (HR 047 95 CI Plt0001) Corresponding annualized rates of cardiovascular mortality were 317 274 (HR 086 P=0013) and 271 (HR 085 P=0008) and key secondary endpoint (stroke systemic embolism cardiovascular death) were 443 385 (HR 087 P=0005) and 423 (HR 095 P=032) Net clinical outcomes combining ischemic events bleeding and death were superior with edoxaban No excess in stroke bleeding or death were seen in the 30-day transition to open-label antiocagulation after the end of the trial Conclusions Both once-daily edoxaban dose-regimens were noninferior to warfarin for prevention of stroke or systemic embolism while significantly reducing bleeding and cardiovascular death Title A Stroke Neurologistrsquos Perspective on the Devastating Effects of Stroke from Afib and how the new Oral Anticoagulants can Help (Boehringer Ingelheim sponsored lecture) Author(s) Wein T Title AF Ablation ndash State of the Art (St Jude Medical sponsored lecture) Author(s) Amancharla R Atrial Fibrillation is the clinically most relevant arrhythmia responsible for significant social and economic impact at the global level At the individual level it is a major factor in morbidity QOL and mortality It is now clearly established that maintenance of sinus rhythm in these patients is the best option Although various forms of drug therapy have been tried an attempt at permanent cure by ablation strategy seems to be the most cost-effective option The current lecture will discuss the currently available ablation strategies The focus will be on patho-physiologic basis for these strategies indications for respective strategies the controversies and finally the complications An emphasis will be made on the newer developments in this rapidly evolving field

FRIDAY JULY 25

Title Assessment of Valve Regurgitation using 3D vs 2D Magnetic Resonance Imaging 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 20 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 15plusmn11ml 29plusmn21ml and 51plusmn28ml and 3D-RVol was 25plusmn11ml 50plusmn30ml and 85plusmn37ml compared to Doppler-RVol 25plusmn8ml 43plusmn16ml and 116plusmn52ml CMR 2D and 3D-RVol correlated well with Doppler-RVol (r=077 and r=079) 3D-RVol was on average 11ml less than Doppler-RVol and 2D-RVol was on average 33ml less than Doppler-RVol Conclusion This feasibility study suggests that CMR-based 3D-PISA is superior to 2D-PISA and may be able to assess MR severity quantitatively without any geometric assumptions Title Skeletonization of Mammary Artery Impact on Sternal Infections Author(s) Teodori G Rahaman NC Rampersad A Bellino I Teodori J Angelini GD Aim Mediastinitis is a dreaded complication of cardiac surgery and is associated with a high mortality Skeletonising the internal mammary artery (IMA) during coronary surgery bypass grafting (CABG) preserves the collateral circulation and decreases sternal hypoperfusion The incidence of mediastinitis is therefore expected to be reduced especially in high risk patients with diabetes and impaired left ventricular function We reviewed our five year experience using skeletonised internal mammary artery at Caribbean Heart Care and our incidence of mediastinitis

Method A retrospective observational analysis was performed on all patients undergoing CABG with IMA from 2009 to 2013 Patient demographics such as diabetes and impaired left ventricular function were considered and in hospital mortality and mediastinitis Results 1505 patients underwent CABG during the study period Of these 321 (n=483) were female 612 (n=921) diabetic and 66 (n=99) had EF lt35 A skeletonised IMA was harvested in all patients but 44 (n=69) were not used 1480 IMAs were utilised with 44 patients receiving bilateral IMA grafts Forty IMAs were used as sequential grafts In hospital mortality was 112 (n=17) Four patients developed mediastinitis (026) after discharge and were readmitted for sternal debridement One of these patients had bilateral IMA harvest Conclusion In our study the routine use of skeletonised IMA in CABG was associated with a low incidence of mediastinitis despite the high incidence of diabetes in our patient population Title Aortic Valve Repair Techniques and Outcomes Author(s) Savage E The value of mitral valve repair is well established Initial attempts to repair the aortic valve did not compare favorably with replacement However a number of new techniques have been developed and shown to be durable repairing regurgitant bicuspid and tricuspid aortic valves This talk will provide a brief history of aortic valve repair review current techniques recent outcomes and discuss the merits of repair versus replacement Title ldquoe-Valving Technologies (Tenet Healthcare sponsored lecture) Author(s) Bethea B ANNUAL CARDIAC SURGERY LECTURE The field of structural heart disease is evolving rapidly Cardiac surgeons and cardiologists work side by side to deliver the optimal therapeutic option to their patients We will review the current options and approaches available to treat valvular heart disease Specifically we will discuss key decision points in the preoperative evaluation of a patient including evaluating the candidacy for traditional open interventions versus transcatheter therapies Further we will review the imaging necessary and their interpretation to help guide physicians in the treatment of their patients The current available technologies will be discussed in regards to device specific advantages and disadvantages The success and associated complications associated with the devices will be briefly reviewed based on the Valve Academic Research Consortium (VARC) 2 criteria A critical review of the key papers currently in the literature will also be provided At the conclusion the audience should have a firm understanding of the current technologies and the associated data Finally we will take a sneak peek into the future of transcatheter therapies to provide a framework to stay current in this rapidly evolving field Title Transatlantic Transfer of Patients on Veno-arterial Extracorporeal Membrane Oxygenation (VA-ECMO) as airbridge to Heart Transplantation Author(s) Resiere D Lebreton G Sanchez B Hennequin JL Valentino R Lucron H Pecout F Villain-Coquet L Isetta C Leacuteonard C Clerel M Meacutegarbane B Mehdaoui H Roques F Introduction Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is not only indicated in cases of refractory cardiogenic shock in the expectation of cardiac function recovery but also as a bridge to transplantation or for a long-term mechanical circulatory support In the French Departments of America (DFA) VA-ECMO is available in emergency cases but neither the heart transplantation nor long-term circulatory assistance is Prior to 2011 transfer of VA-ECMO patients on a commercial flight was not possible or at least not allowed After ground and inflight testing an agreement was reached with the airline in 2011 to proceed with the safe transfer of VA-ECMO patients The objective of this study was to demonstrate the feasibility of transatlantic transfers of ECLS-treated patients Methods Prospective observational study including all patients treated by VA-ECMO (pump Jostra

reg with femoral

cannulation) admitted to the general intensive care unit or cardiothoracic surgical department of the university hospital of Martinique and then transferred to metropolitan France by plane Results Ten patients (6 males 4 females 40 years (63plusmn8) have been transferred on VA-ECMO from 092011 to 022014 (Table) VA-ECMO indications included refractory cardiogenic failure refractory cardiac arrest post-myocardial infarction and dilated cardiomyopathy (DCM) Six patients were supported in Pointe-a-Pitre (Guadeloupe) two in Cayenne (French Guyana) one in Fort-de-France (Martinique) and one in Saint-Barthelemy The patients were placed on VA-ECMO then transferred to the ICU in Fort de France For those who did not improve transfer was decided to Paris on a commercial flight for inclusion on the emergency transplantation list Patient transfers took place in excellent conditions and without any incident

Conclusion Transatlantic transfer of VA-ECMO-treated patients on a commercial flight is beneficial to patients with terminal heart failure living in the DFA It allows patients to get the same opportunity of benefiting from heart transplantation procedure as in France VA-ECMO is effective as air-bridge to heart transplantation References Chenaitia H Massa H Toesca R Michelet P Auffray JP Gariboldi V Mobile cardio-respiratory support in prehospital emergency medicine Eur J Emerg Med 2011 18(2)99-101 Table

AMI acute myocardial infarction DCM dilated cardiomyopathy IABP intraaortic balloon pump

Pt Age

Etiology Site Referral Outcome

1 41y DCM Cayenne D3 post VA-ECMO Impellareg on day 6

Emergency list for transplantation

Death in septic shock on day 23

2 54y DCM Point-agrave-Pitre D4 post VA-ECMO Heartwarereg

Alive after 3 years

3 63y DCMAMI St Bartheacuteleacutemy D2 post VA-ECMO Impellareg on day 4

ECLS weaning on day 4

Death 20 days after Impellareg weaning

4 20y DCM Point-agrave-Pitre D2 post VA-ECMO IABP on day 3

Heparin-induced thromcytobopenia

Thrombosis of VA-ECMO circuit Death

5 46y Massive AMI

Point-agrave-Pitre D5 post VA-ECMO IABP on day 6

Heart transplantation on day 10

10 days on Heartwarereg

7 49y DCM Point-agrave-Pitre D3 post VA-ECMO Impellareg on day 6

8 8y Cardiogenic shock

Point-agrave-Pitre D4 post VA-ECMO Heartwarereg

9 61y DCMAMI Cayenne D2 post VA-ECMO Impellareg on day 4

VA-ECMO weaning on day 4

Died 15 days after Impellareg weaning

57y DCM Martinique D3 post VA-ECMO IABP on day 3

Emergency list for transplantation Alive

Title Should Cardiac Surgery be Indicated and Performed on Patients Older than 80 Years Author(s) Maldonado JD Diaz F Peaeliga D Rodriguez C Hurtado N Taboada L Introduction The operative mortality in patients older than 80 years has prompted a new way of approaching and performing cardiac surgery in this group of age The introduction of TAVR and the wide availability of cardiac intervention have moved the balance towards these treatments rather than surgery Objective Describe the results in patients older than 80 years that underwent cardiac surgery in our center and compare the surgical outcomes with those obtained in patients younger than 80 years Methods Patients were collected prospectively from July 2007 to January 2014 Patients were divided into CABG Aortic Valve Mitral Valve and combined procedures (CABG + Valve) In each subgroup outcomes were compared according to age Results 1355 patients have had one of these procedures 142 were older than 80 In general patients older than 80 years have more comorbidities and greater Euroscore Intraoperative variables were similar in both groups The 30 days mortality was 117 in patients older than 80 years ICU LOS total LOS complications and 30 years mortality were greater in this group however the first three were only significant in the CABG group and 30 days mortality in the combined surgery subgroup We found no differences in the POP use of blood products and 30 days readmission Conclusion Although the older group had a tendency to be sicker (higher Euroscore cardiac failure and co-morbidities) the mortality was reasonably low We think patients should not be accepted or denied for Cardiac Surgery only because of their age Title Surgical Treatment of Adult Ventricular Septal Defects A Four Year Experience at CHC- Trinidad Author(s) Teodori G Rahaman NC Rampersad A Bellino I Teodori J Roopchand R Aleong G Angelini GD We report our four year experience of surgical treatment of adult Ventricular Septal Defect (VSD) Nine patients were submitted to VSD surgical repair from January 2010 to February 2014 Five patients had congenital perimembranous VSD one suffered with residual VSD post surgical correction of post acute Myocardial Infarct done in 2006 and three patients had post acute Myocardial infarct VSD The clinical status depended on the etiology of the VSD going from total

hemodynamic stability in congenital VSD to critical conditions requiring Intra Aortic balloon pump in post acute MI patients Surgical repair of different types of VSD involved several techniques using single patch double patch with use of GRF glue or U pledgetted stitches according to the anatomy of VSD and the quality of surrounding tissues The surgical approach was also different depending on the type of VSD such as trans-myocardial trans-aortic and trans-tricuspidal exposure Concomitant surgery included CABG in post-infarct VSD Aortic valve replacement Tricuspid valve replacement and closure of ASD type Ostium Secundum No surgical perioperative complication was recorded all patients were discharged home No residual VSD was detected in the transthoracic echo at discharge During the follow up period one patient died six months after surgery for non-cardiac reasons Eight patients are alive with a follow up ranging from zero to four years All patients are in NYHA class I ndash II Despite the limited number of cases and the variety of type of VSD our experience showed good results in the surgical treatment of VSD Title 107 Entries to the West Indies Cardiac Surgery Registry from a Single Centre in Trinidad amp Tobago Author(s) Rawlins R Henry R Esimaje O Casula R Introduction The West Indies Cardiac Surgery Registry is an online database established in 2012 Ongoing voluntary data entry of open heart surgery operations performed by regional partners is being encouraged The Advanced Cardiovascular Institute of Surgical Therapies (ACIST) a single centre in Trinidad amp Tobago has entered 107 completed cardiac surgical operations for the period August 2012 to December 2013 Summary A summary of ACIST data revealed the following Coronary artery bypass grafting (CABG) was the commonest cardiac surgery (96) performed with 50 of patients undergoing a triple heart bypass operation 76 of surgeries were performed electively and 96 of CABG patients received a LIMA graft 87 of the patients were males ages range from 34 to 84 yrs and BMI 18 to 36 Cardiac disease risk factors hypertension was present in 60 of patients diabetes in 50 and 45 of patient were smokers 20 of patients had a family history of premature coronary events and 46 had coexisting cardiac arteriopathy 75 of patients were South Asian descent and 55 of surgeries were Government funded No blood products were used in 92 of all patients Conclusion The usefulness of data entry to the WICSR has been recognized and continued voluntary entry is encouraged to build a robust database which can provide evidence based responses to critical regional questions Title Corevalve ndash New evidence in High Risk Patients (Medtronic sponsored lecture) Author(s) Gaspar J Title A case of Valve in Valve Post Trans Procedural Core Valve Migration Author(s) Villegas Savinon A Lappot R Perez E Valdez I Urena P Background Transcatheter aortic valve replacement (TAVR) has become a viable alternative to traditional surgery for patients with severe aortic valve stenosis and high surgical risk Valve migration is a reported complication of TAVR We present a patient whose valve migrated after placement and our teamrsquos management Methods Results and Conclusion An 85 year old male with severe aortic stenosis mitral regurgitation and pulmonary hypertension chronic kidney disease cardiac cachexia and a NYHA Functional Class IV with a EuroScore II of 186 Post standard preparation and valvuloplasty the valve delivery system was passed via femoral access and positioned in the native aortic valve under real-time fluoroscopy and TEE guidance A 26mm CoreValve was deployed immediately post deployment the valve migrated into the aortic arch obstructing the right brachiocephalic trunk A 20mm Nucleus balloon was inflated displacing the dislodged valve into the ascending aorta A second 26mm CoreValve was successfully deployed through the first valve without incident Immediately post deployment there wasnrsquot evidence of aortic insufficiency and the mean aortic gradient was 5mmHg During the ICU recovery the patient presented a complete AV block requiring the implantation of a permanent pacemaker Before the discharge the transthoracic echocardiogram (TTE) revealed absence of paravalvular leaks and a normal functioning prosthetic valve The patient underwent Cardiac Rehabilitation program Follow up at six months reveals an unaltered TTE with NYHA FC I with an

improved global health We report this technique of Valve through Valve as technically feasible with favourable short and medium term outcome Title Periprocedural Complications and Short term Mortality of PCI Patients at Caribbean Heart Institute from January 2011 - June 2013 A Preliminary Study Author(s) Joseph J Alleyne D Lewis L Sukhoo-Pertab M Hermanstein M Gobin R Carpen M Primary Objective To assess outcomes of Percutaneous Coronary Interventions (PCI) done at Caribbean Heart Institute (CHI) at index hospitalisation 30 days and 6 months Secondary Objectives To assess indications and the length of time between diagnosis and intervention Method Electronic and paper records were reviewed Outcomes assessed at index hospitalization included acute renal failure arrhythmia myocardial infarction access site haematoma and bleeding Mortality was assessed at index hospitalisation 30 days and 6 months verified by death certificates at the National Death Registry Data was entered into IBM SPSS trial version 21 Means and frequencies were compared across groups using chi squared and t tests with 95 confidence intervals Results 966 of 58 PCIs were performed successfully The mean age at intervention was 565 (+- 75) years Male to female ratio was 31 ST elevation myocardial infarction (224) stable angina (172) unstable angina (155) non-ST elevation myocardial infarction (69) and unspecified angina (52) were indications for PCI Most PCIs (614) were done within one day of presenting to CHI 862 were discharged within two days of intervention Mortality was 0 18 and 21 at index hospitalization 30 days and 6 months respectively Cases were complicated by arrhythmia 172 MI 52 access site haematoma 34 acute renal failure 17 and blood transfusion 17 There were no statistically significant association of complications with any patient procedural variables all p-values gt005 Conclusion The PCIs done at CHI during the assessed period were safe and produced acceptable success and outcomes notwithstanding low volume of patients in a relatively new program Title CCS PCI Registry Update Author(s) Henry R Title PCI in Octogenarian Patients at Fundacion Cardiovascular de Colombia (Fundacion Cardiovascular de Columbia sponsored lecture) Author(s) Saaibi J The Fundacion Cardiovascular de Colombia (FCV) is the referral center for cardiovascular diseases on the east Colombian region In the last years there has been a regional tendency towards increase in the number of percutaneous coronary interventions in patients older than 80 years The population segment of old aged people has been presenting rising growth rates associated to improvement in the quality of the health services and increased life expectancy therefore resulting in increased prevalence of chronic diseases The heart disease is the first cause of death in such population with a load of the disease greater in the highest age range The old age patients that require hospital stay due to acute coronary syndrome present a higher morbidity and mortality even after adjusting the social and demographic variables Despite this fact there is scarce information regarding the risks and benefits of the clinical guidelines usage in the treatment of octogenarian patients and few studies evaluate the outcome of those patients undergoing cardiac catheterization and a potential percutaneous coronary intervention In our case series of octogenarian patients it is to be noted a relatively increased proportion of women compared to percutaneous intervention reports in patients less than 70 years The risk factor incidence is similar to a usual cath lab population in Colombia In these consecutive and contemporaneous series of octogenarian patients with coronary artery disease it is highlighted the number of percutaneous interventions in programmed or elective patients which suggests that along with the increase of life expectancy in this age group it is affected the quality of life secondary to symptoms caused by coronary artery disease These interventions were performed with a 100 rate of success The mortality in the series is high but corresponds to those patients that onset presented with severe hemodynamic compromise and it is similar to the data published in younger patients with similar clinical characteristics Despite the fact that the cardiac operative risk evaluation (EUROSCORE) of the population was of 20 the elective patients had a low mortality rate of 87 (EUROSCORE of 15) which suggests that the percutaneous intervention is feasible and secure in this age group The mortality rate in patients older than 80 years is higher when it comes to an acute coronary syndrome with ST elevation and hemodynamic compromise The comorbidities of more predictive power for fatal outcomes are renal disease and the presence of diabetes

Title PCI without On-Site Surgical Backup The SRMC Experience Author(s) Flood RD Chamberlain K Comissiong SM Hackstaff G Turner JR Burd L Rucker D PCI without surgical backup is an accepted strategy for AMI However elective PCI without on-site surgery is less well accepted We describe our experience with primary and elective PCI at SRMC which serves the islands of St Thomas and St John as well as a large tourist population There is no on-site cardiac surgery and there are geographic financial and cultural barriers to expedient transfer to tertiary centers Methods 1149 invasive cardiac procedures have been performed at SRMC from January 2006 to June 2013 This includes 792 diagnostic procedures and 347 coronary interventions Primary PCI was performed based on the standard diagnostic criteria Candidates for elective PCI had angina abnormal non-invasive testing and favourable coronary anatomy Multivessel disease and left main lesions were considered for CABG as were high-risk lesions such as heavily calcified lesions and chronic total occlusions All patients received arterial closure devices unless contraindicated Clinical and angiographic success was achieved in 3 Emergency transfer for surgery did not occur Procedural complications such as abrupt closure perforations dissections and bleeding complications occurred in 11 patients Conclusions PCI can be safely performed in remote locations without on-site surgery with appropriate training case selection and experience Future refinements at SRMC include expansion of radial PCI program to promote decreased bleeding and expedited hospital discharge Title A Novel Interventional Approach to ARCAPA (Anomalous Right Coronary Artery from the Pulmonary Artery) Author(s) Francis B Brown CS Non-Surgical Palliation by Coil Embolization of Anomalous Origin of the Right Coronary Artery from the Pulmonary Artery (ARCAPA) in an Adult Anomalous origin of Right Coronary Artery from the Pulmonary Artery (ARCAPA) is a rare congenital coronary artery anomaly In contrast to anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) most patients with ARCAPA remain asymptomatic and are usually incidentally discovered in adulthood We report a 57-year old obese lady who presented with chest pain shortness of breath and palpitations whose coronary angiography revealed an ARCAPA Surgical repair of the anomalous artery is the standard treatment however she was a poor surgical risk and palliation of symptoms was successfully obtained by coil embolization of the ARCAPA Search of literature suggest that our case may be the first reported interventional approach to palliation of ARCAPA We wish to acknowledge our BICC Staff in Celeste Antoine and Mathew Title Whatrsquos new in the Therapeutic Approach for the Management of Hypertensive Patients with CAD (Servier sponsored lecture) Author(s) Hall A During 2013 new guidelines were issued in Europe and the USA These agreed on many of the key issues ndash but differed in some respects The JNC8 claimed to be a ldquoscientific advisoryrdquo document that applied stringent review techniques in its methods The American and International Society of Hypertension Guidance sought to be very practical but was criticized as being less scientifically stringent European guidelines appear to have managed to steer a course that maintained consensus and was both practical and scientifically robust Using these as a template for discussion it is relevant to note a number of the key recommendations Firstly that each of five drug classes may each be considered for use as mono-therapy The evidence cited in support of this statement in fact provides the most robust evidence for ACEinhibitors (ACEi) calcium channel blockers (CCB) and non-thiazide diuretics (NTD) Secondly the use of fixed combination therapy is supported ndash with emphasis on evidence based practice ACECCB combination therapies have been shown to prevent death from all causes ndash as also has ACEiNTD adjunctive therapy A primary role for ACEiCCB and ACEiNTD combinations in the management of Afro-Caribbean patients is entirely logical though has not been specifically assessed Key trials have been conducted across many ethnic groups ndash but the total number of Afro-Caribbean patients has been limited ACEiCCB and ACEiNTD combinations differ greatly from ARBCCB and ARBNTD combinations ndash for which no large trial data exists for patients of any ethnic origin Consequently such a decision would require two very large departures from the data Finally it should be noted that triple combinations such as ACEiCCBNTD have a role to play in future care This approach is most in-line with the evidence base and also the theoretical modelling that underpins the ldquopolypill conceptrdquo This predicts that use of three agents at half dose is both more effective and better tolerated that any one agent at full dose

Title Oxygen Requirements as a Screening Tool for the Detection of Late Pulmonary Hypertension in Extremely Low Birth Weight Neonates (All Children rsquos Hospital Sponsored lecture) Author(s) Aswani R Hayman L Nichols G Isshiki G Luciano AA Amankwah E Leshko J Dadlani G Background Pulmonary Hypertension (PH) in Extremely Low Birth Weight (ELBW) neonates causes significant morbidity and mortality Echocardiography is commonly used to screen for PH in ELBW and may miss gt60 of cases No standardized screening protocol exists for detection of late PH Objective Assess the utility of oxygen supplementation as a predictor of late PH in ELBW neonates Design Methods Retrospective review of 230 ELBW neonates (BW lt1000g) from 12008 ndash 122011 was performed at All Childrenrsquos Hospital Clinical data and oxygen supplementation at 30 days of life were recorded Logistic regression was used to estimate odds ratio (OR) and 95 confidence intervals (CI) for the association between oxygen supplementation and the diagnosis of PH Results Incidence of late PH=83 (19230) Neonates with PH had a lower birth weight and small for gestational age Neonates without PH had shorter days of ventilation length of stay chronic lung disease ligation of patent ductus arteriosus and mortality (Table 1) Unadjusted logistic regression analysis revealed that neonates requiring oxygen supplemental ge30 had an increased risk of developing PH (OR=377 95 CI=142-1000 p=001) After adjusting for birth weight the elevated risk attenuated and was of borderline statistical significance (OR=247 95 CI=089-684 p value=008) Receiver operating characteristic curve analysis showed an area under the curve of 069 (95 CI=058-079 p=00006) for oxygen supplementation in predicting late PH Conclusion Oxygen supplementation ge30 at day of life 30 may be a good screening tool for detecting late PH in ELBW neonates

Title Sudden Cardiac Death risk Factor Identification in Hypertensive Patients Author(s) Gacon PH Pillon F Subtil F Gueyffier F Introduction Sudden cardiac death is defined as an unexplained death within 24 hours after onset of symptoms or earlier It is a traumatic event for the patientrsquos family Ways of acting are limited and prevention is of primary importance For long its prevention has been confounded with coronary artery disease prevention However recent studies suggest that sudden cardiac death might be a distinct condition whose occurrence cannot be diminished by using blood pressure lowering medication Further research for risk factors for sudden cardiac death is necessary to identify situations in which a preventive strategy would be particularly relevant Methods The patients (16058) included were enrolled in five randomize controlled clinical studies available through the INDANA research program (COOPE MRFIT EWPHE STOP SYSTEUR studies) These studies assessed the benefits of antihypertensive treatments against placebo or absence of treatment in hypertensive patients The endpoint was the occurrence of sudden cardiac death Various covariates were taken into account including age sex smoking history of atrial fibrillation of heart failure of myocardial infarction and of stroke systolic blood pressure diastolic blood pressure body mass index blood glucose cholesterol creatinine level potassium level heart rate Baseline factors were related to risk of sudden cardiac death by logistic regression adjusting for trial and treatment group The model builds on 23 of the patients was converted to a risk score validated on the remaining third of patients Results In a multivariate analysis we found that the risk for sudden death multiplied 195 (95 CI 187 203) every 10 years of age (p=0001) by 416 (95 CI 145 1189) in men compared to women (p=0007) by 191 (95 CI 121 300) in smokers compared to non-smokers (p=0005) The rise of 1cmHg in systolic blood pressure multiplied by 114 (95 CI 113 116) the risk for sudden cardiac death (p= 003) and of 1mmolL cholesterol by 136 (95 CI 111 167) (p=0002) Conclusion This study shows that in hypertensive patients the covariates including age sex smoking systolic blood pressure high cholesterol which are risk factors for coronary events are risk factors for sudden cardiac death

Title CARPHA Hypertension Guidelines Update Author(s) Connell K Title Global Standardised Hypertension Treatment Project Author(s) Patel P

SATURDAY JULY 26

Title Postural Orthostatic Tachycardia Syndrome Case Series From Barbados Author(s) Ince M Massay R Postural Orthostatic Tachycardia Syndrome (POTS) is one of the clinical entities that makes up the disorder Orthostatic Intolerance (OI) This condition is not widely recognised however it is very well described the global incidence is estimated at 170100000 but there is no supporting regional data POTS has a wide range of symptoms (palpitations nausea lightheadedness tremulousness) which are often attributed to anxiety disorder The condition is more prevalent in women and has a negative impact on their quality of life Tilt table testing is the gold standard for diagnosis Quality of life can be improved with the available non-pharmocological and pharmocological treatment Herein we present a case series of this condition seen at a single centre cardiology practice and Queen Elizabeth Hospital in Barbados Title CRT in Mild Functional Classes From Rescue to Prevention (Medtronic sponsored lecture) Author(s) Garillo R Title The Global Registry of Acute Coronary Events (GRACE) Risk Score as a Predictor of One Year Mortality in a Multi-Ethnic Trinidadian Population with Acute Coronary Syndrome Author(s) Chin M Cummings T Thomas C Seemungal T There is limited data on the one year survival of acute coronary syndrome (ACS) in the Caribbean Current guidelines recommend early identification of high risk ACS patients since adequate risk stratification and appropriate management reduces one year mortality The GRACE risk score was previously shown to have good discrimination for in-hospital mortality in a Trinidadian population It however was not previously tested for one year mortality in a Caribbean population The aim of this study was to determine whether the GRACE risk score discriminated ACS survivors from non-survivors after one year and to identify predictors of morbidity and mortality This study is a one year follow-up on a cohort of ACS patients (n=372 mean age 63 years and males 57) admitted between November 2011 and April 2012 to the Eric Williams Medical Sciences Complex in Trinidad and Tobago for whom the GRACE risk score was tested for in-hospital mortality Baseline characteristics include 58 diabetes mellitus 69 hypertension 31 hyperlipidemia and 43 smoking history There were 25 STEMI 56 NSTEMI and 19 USAP patients There were 347 high risk 333 intermediate risk and 32 low risk patients The in-hospital mortality was 83 These patients were followed-up after one year via telephone interview and review of medical charts to determine morbidity and mortality The mortality after one year for 313 patients was 20 The remainder of findings will be presented at the scientific meeting in July 2014 Title Practical Application of 3D Echocardiography in Daily Clinical Practice (Jackson Memorial Hospital sponsored lecture) Author(s) Sancassani R Title Sudden Death in Athletes Author(s) Dufresne A Significant numbers of children and young adults participate in athletic competitions each year In the US the incidence of sudden cardiac death (SCD) averages 051 per 100000 athletes and that number seems to have remained stable

As people age the incidence of SCD tends to increase due to the prevalence of Coronary Disease In the USA the highest number of events occurred during basketball games followed by football In athletes with SCD most patients have underlying structural heart diseases with Hypertrophic Cardiomyopathy being the most common cause in the US It is important to identify what EKG findings are considered normal for an athlete so that young adults are not unnecessarily excluded from sport activities There are some controversies about the optimal method to screen athletes from physical examination to more extensive procedures including stress testing Lately some reports have indicated an increased incidence of SCD in athletes with sickle cell trait Title Beliefs and Practices Related to Cardiovascular Disease in St Lucia Whats the Message Author(s) Serieux E OrsquoBrien Cherry C Didier M Cardiovascular disease accounts for 33 of all deaths in St Lucia It is the leading cause of death globally and 80 of those deaths occur in low and middle- income countries The risk factors for CVD are largely behavioral so it is important to understand the drivers of these behaviors in order to develop effective prevention and intervention strategies Two qualitative studies conducted in July and December 2013 examined the beliefs and practices related to CVD risk factors in St Lucia In July 25 individual interviews were conducted with St Lucians aged 25 ndash 55 years old and in December four focus group sessions were held with 15 other St Lucians in the same age range Participants discussed their health status knowledge of CVD and CVD risk factors diet exercise and sleep habits alcohol consumption smoking and beliefs about body size They also revealed what they believed to be their personal risk and protective factors regarding CVD as well as the barriers they encounter in trying to improve their health Risk reduction for CVD relies on behavior modification which in turn is dependent on the use of effective intervention strategies The Health Belief Model the most frequently used theory in health promotion states that six constructs are responsible for behavior change The findings of these two studies will be presented and contextualized within the Health Belief Model in order to demonstrate in detail the type of prevention and intervention strategy that is necessary to address CVD in St Lucia

Title The Role of Exercise as a Form of Treatment and Prevention of Cardiovascular Disease Author(s) Cook B Exercise Is Medicine This presentation will focus on the role of exercise as a form of treatment and prevention of cardiovascular disease Participants will learn about various physiological adaptations which occur as the result of regular exercise and their effects on preventing and treating cardiovascular disease Much of this presentation will focus on exercise as a role in the prevention of cardiovascular disease This presentation will teach people how to develop an appropriate exercise prescription for improving cardiovascular fitness and overall health The presentation will also provide information on such things as appropriate exercise intensity exercise progression and duration and safety protocols when monitoring cardiovascular exercise In addition this presentation will provide a general overview on graded exercise testing to include VO2 max testing and various sub-maximal cardiovascular tests Title Cardiac Diagnosis is Predictive of Co-morbid Anxiety Disorder in an Outpatient Cardiology Clinic Setting Author(s) Simmons J Martel J Gasso J Anxiety disorders are the most common mental health disorders in the primary care setting and generally drive increased utilization of healthcare resources The Patient Health Questionnaire (PHQ) is a well validated screening tool used for detection of the most common mental health disorders encountered by primary care providers (depression anxiety disorders alcohol abuse eating disorders) We undertook PHQ screening of all clinic patients and then reviewed the available PHQ responses in patients with palpitations (n=16 M=4 m=48yrs) and coronary artery disease (CAD) (n=37 M=26 m=68yrs) regarding anxiety disorders Patients with BOTH palpitations AND coronary artery disease were excluded Panic disorder responses were considered categorically ldquopositiverdquo if any of the questions were answered affirmatively Generalized anxiety was considered ldquopositiverdquo after converting the questionnaire section to a Likert scale and a total of 5 ldquopointsrdquo or more was present Sixty-nine percent (1116) of patients with palpitations scored ldquopositiverdquo for panic disorder or generalized anxiety disorder versus only 27 (1037) of CAD patients (X2 p=0004359) Imp- Anxiety disorder is very common in patients with palpitations in the outpatient cardiology clinic and 25 times more common than in patients with CAD Screening for anxiety disorders in the cardiology clinic setting could lead to more specific treatment of symptoms and impact healthcare resource overutilization particularly in patients presenting with palpitations Title Renal Denervation in the Afro-Caribbean Population Author(s) Liqui-Lung A Purpose As hypertension is the key factor in cardiovascular mortality and morbidity in the Afro-Caribbean population we conducted a pilot study in this specific population to see if the novel treatment for resistant hypertension by renal nerve ablation would also be beneficial for this specific cohort with resistant hypertension

Methods In this pilot study which was conducted at two different centrersquos The Taams Kliniek in Curacao and the Isala ziekenhuis in Zwolle the Netherlands we selected the patients by ethnicity and by the exclusion criteria of the ESC statement for renal ablation with the exception that we used 24 hour ambulatory blood-pressure monitoring instead of office blood pressure measurements All patients had the use of three or more antihypertensive drugs in adequate dosage and combinations including use of a diuretic and spironolactone All patients attempted to modify blood pressure with lifestyle changes Secondary hypertension has been excluded Patients had preserved renal function (glomerular filtration rate gt45 mLmin1732) absence of polar or accessory arteries no renal artery stenosis and no prior renal revascularization Six patients five female and one male were eligible for the procedure We used the St Jude EnligHTN RF catheter for the renal ablations Results All patients were successfully treated with an on average of 8 ablations per renal artery Prior to and post ablation renal sympatic stimulation was performed In 3 of the six patients we had acute responses leading to lowering of the medication We conducted 24 hour ambulatory blood-pressure monitoring at weeks 2 6 12 and 36 Conclusion Renal denervation seems to be a safe interventional treatment for resistant hypertension in the Afro Caribbean population giving an almost immediate response with hypotension and orthostasis in the first 2 weeks of treatment in 50 of the treated patients This form of intervention looks promising as it might reduce the medication intake and lower the admittance rate due to the complications of hypertension Title Antiplatelet Therapy in the Management of ACS in 2014 Author(s) St John M A 44 year old man with diabetes tobacco use hypertension and dyslipidemia presented to the emergency department with acute inferior STEMI He vomited bright red blood after receiving aspirin and heparin but before any additional antiplatelet agent He was loaded with ticagrelor and underwent emergent cardiac catheterization Angiography revealed an occluded right coronary artery He underwent thrombectomy angioplasty and stenting with a bare metal stent There was excellent angiographic result with restoration of TIMI 3 flow Bivalrudin had been administered 30 minutes post procedure the patient had recurrent chest pain and reelevation of the inferior ST segments Angiography confirmed acute stent thrombosis Integrilin and bivalrudin wre administered Thrombectomy and balloon dilation were performed in the previously placed stent Intravascular ultrasound demonstrated excellent stent apposition and no edge dissection The patient was reloaded with ticagrelor Acute stent thrombosis is a rare but dreaded complication of percutaneous coronary intervention Causes include stent factors patient factors lesion characteristics and procedural factors (1) In our patient the causes include highly reactive platelets in the setting of acute MI deployment of the stent in a necrotic core and lack of adequate absorption of the antiplatelet agents Platelet inhibition with newer oral agents though rapid is not instantaneous with recent data showing lack of inhibition of platelets at 2 hours in up to 46 of treated patients (2) The patient did well and was discharged on dual antiplatelet therapy and proton pump inhibitors He had no recurrent bleeding

(1) JACC 2010561357-65 (2) Circ Cardiovasc Interv 2012 DOI101161CIRCINTERVENTIONS112972323

Title Epidemiology and Management of out-of-hospital Cardiac Arrests in Martinique Assessment and Perspectives Author(s) Lafitte M Resiere D Hollecker E Villain-Coquet L Chabartier C Kaidomar S Ferge JL Perreau C Caffiot E Schloesser M Isetta C Meacutegarbane B Valentino R Mehdaoui H Background Sudden cardiac arrest is a common and important public health problem with poor survival Outcomes are improved by healthcare provider practices as recommended by the 2010 European Resuscitation Council Guidelines for Cardiopulmonary Resuscitation In France the National registry ReacuteAC was set up in 2010 because of the lack of national and international out-of-hospital cardiac arrest registry Methods A retrospective observational and monocentric study was performed from December 2012 to July 2013 including all out-of hospital cardiac arrests requiring the intervention of our emergency pre-hospital medical service (SAMU 972) The objectives were to describe the circumstances management of each link in the laquo chain of survival raquo and the different delays of care Univariate analysis was performed to identify factors associated with mortality on hospital admission Data from Samu 972 were compared to other French emergency medical centers Results One hundred and seventeen patients with cardiac arrest were included Sixty percent were men with a median age of 70 years Sixty-eight percent of out-of hospital cardiac arrests occurred at home and were witnessed in sixty-eight percent of cases as compared with other French centers Cardiopulmonary resuscitation (CPR) was initiated by bystanders in 30 Absence of CPR and early defibrillation were associated with asystole (89 of the cases) when

advanced cardiac life support was initiated by firefighters andor by emergency medical service Delay of departure of the emergency medical service vehicle and arrival at the scene were much longer in comparison to other centers Absence of CPR and delay for firefighters to reach the patients were associated with mortality on hospital admission (p=003 and p=004 respectively) The rate of return of spontaneous circulation was 13 with a 9-survival rate on hospital admission and 17-rate on day 30 The overall survival rate was lower than the other French centers Conclusion Epidemiology of out-of ndashhospital cardiac arrests in Martinique is similar to those from metropolis France however survival rate appears to be lower Several proposals could be suggested to improve outcome including 1)- increasing population training to basic cardiac life support 2)- enhancing public-access to early defibrillation 3)- reducing delays of pre-hospital medical services interventions and 4)- standardizing advanced cardiac life support However the definitive benefit of such interventions should be further investigated Reference Girotra S Nallamothu BK Spertus JA Li Y Krumholz HM Chan PS Trends in survival after in-hospital cardiac arrest N Engl J Med 2012 Nov 15 367(20)1912-20 Title Initial Local Experience with Unprotected Left Main Stenting Author(s) Villegas Savinon A Lappot R Perez E Valdez I Urena P Background purpose and methods Around 7 of patients that undergo cardiac angiography have left main coronary disease (LMCA) For this group of patients coronary stenting remained until recently contraindicated Recent data has shown LMCA stenting as a viable alternative in a selected group of patients We sought to determine clinical and demographic characteristics and the in-hospital outcomes after stenting of unprotected LMCA in our center We examined 49 patients from 2009 ndash 2013 Results and conclusions Mean age 703 plusmn 111 mean body mass index 269 plusmn 39 69 male patients Cardiovascular risk factors hypertension (86) diabetes mellitus (37) and hypercholesterolemia (27) Vascular access used radial (673) ad femoral (265) Type of Stents used Zotarolimus eluting stents (469) Everolimus eluting stents (429) Sirolimus eluting stents (61) and bare metal stents (41) Coexisting coronary artery disease 3 or more coronary artery lesions (3VD) in 552 (2VD) in 224 and isolated left main in 224 All patients had successful stent implantation there were two patients with coronary dissection and abrupt vessel closure which were successfully resolved percutaneously There were two patients intervened acutely with cardiogenic shock one patient presented acute kidney failure requiring dialysis and eventually dying There was one episode of major bleeding related to the femoral access requiring blood transfusion Intravascular ultrasound guidance was utilized routinely except in the emergency interventions Stenting of unprotected left main was associated with high procedural success and low in-hospital complication rate Further follow up is needed to evaluate long term outcomes Title Application of Low-Level Laser Therapy to Reduce Subcutaneous Adipose Volume Author(s) Maloney R Introduction Low-level laser therapy (LLLT) temporarily disrupts the membrane of subcutaneous adipocytes which in turn modulates cell permeability resulting in the release of intra-cellular lipids Laser-released lipids proceed through lipolytic pathways where they are metabolized Liberation and metabolism of targeted lipids yields a contouring effect Laser therapy has been used in interventional cardiology to reduce excess subcutaneous adiposity this outcome motivates patients and reduces the deleterious hypertrophic state of cells Herein we discuss the use of LLLT in treating obese subjects

Methods Thirty-five subjects presenting with a BMI between 30 and 40 kgm^2 were enrolled in a randomized sham-controlled study Test subjects underwent 12 laser treatments which were administered every two or three days Each treatment targeted abdominal subcutaneous tissue with the anterior and posterior region receiving 20 minutes of therapy Subjects were evaluated at baseline and weeks 2 4 and 6 Results Test subjects at week 6 demonstrated a circumference reduction of 437 inches (1109 cm) from their abdomen compared with 094 inches (287 cm) reported for control subjects Comparing the circumference change between each evaluation point demonstrated a significant reduction for test group subjects compared with no significant change for control subjects Conclusion These data demonstrate the efficacy of LLLT to reduce excess subcutaneous adiposity without producing an adverse event

IASC SESSION Title Chemo-Induced Cardiomyopathy Author(s) Delgado D Title Device Therapy in Chagas Disease Clinical Characteristics and Follow Up Author(s) Garillo R Malan A Pires M Barroso H Eloy R Batista De Sa L Brito M Pastore L Muratore C Introduction Chagasrsquo disease results in arrhythmias and is highly prevalent in Brazil and Latin America It has recently been detected in the US and European countries According to the Brazilian Pacemakers Register Chagasrsquo has been responsible for around 25 of all permanent pacing indications OBSERVE is a Brazilian study of profiles and epidemiological data in patients using Medtronic implantable devices including pacemakers (IPG) cardiac defibrillators (ICD) and heart re-synchronizers with (CRT-D) and without defibrillator (CRT-P) The aim of this report is to compare the baseline profile of Chagasrsquo and non Chagasrsquo patients Methods This ongoing real-world observational multicenter prospective study enrolled 2183 patients between December 2010 and December 2012 in 13 Brazilian centers Patients were over 18 years old and received a first implant or device replacement Patients enrolled in a concurrent clinical study were excluded Baseline data was collected at implant using an electronic data capture system Results There were 1626 IPGs 339 ICDs and 218 CRT-PDs implanted The patientsrsquo mean age was 673 plusmn 115 years and 525 were men Of all implants 555 (254) had Chagasrsquo disease (418 IPG 105 CDI and 32 CRT-PD) IPG Chagasic patients were younger had higher LVEF more often used amiodarone more often had a sinus bradycardia device indication and were less likely to present AF ICD Chagasic patients less frequently had a primary prevention indication for SCD more often used amiodarone and had more conduction disturbances CRT Chagasic patients had more RBBB more sinus bradycardia more frequent use of amiodarone and a history of more monomorphic VT (MVT) Conclusions This large real-world Brazilian registry shows several differences between Chagasic and non Chagasic patients implanted with a cardiac device Specifically at implant Chagasic patients had less AF and more RBBB amiodarone use MVT and sinus bradycardia Title Safety and Efficacy of Cardiovascular and Peripheral Vascular Implantation of Vescell in Congestive Heart FailureRefractory Angina Patients and in Patients with Critical Limb Ischemia Author(s) Salas Z Francis B Margolis J Sullebarger J Vijay R Brown CS A Phase I Open Label Non-Randomized Single-Center Study to Assess the Safety and Efficacy of Cardiovascular and Peripheral Vascular Implantation of Vescell

TM by a CatheterInjection Delivery System in Congestive Heart Failure

Refractory Angina Patients and a Needle Syringe Injection System in Critical Limb Ischemia or Severe Claudication ndash A Preliminary Report As of June 2014 Background Despite major advances in prophylaxis medical therapy and revascularization procedures for CAD and PAD a substantial proportion of patients suffer from CHF in the aftermath of myocardial infarction andor hypertensive heart disease and major amputations in extensive PAD due to poor distal artery run-off Vescell

TM is a blood-derived ex

-vivo generated autologous cellular product enriched in Angiogenic Cell Precursors developed with the intention of treating patients suffering from severe CHFrefractory angina andor PAD Objective To assess the safety and efficacy of VesCell

TM on myocardial function in CHFrefractory angina patients and

the improvement of intermittent claudication rest pain and healing of ulcerprevention of gangrene in critical limb ischemiasevere claudication patients Methods VesCell

TM was injected into the coronary arteries using a commercially available catheter delivery system in

the dose range of 20 to 100 million progenitor cells for CHFangina patients For the severe claudication patient VesCell

TM was injected into the gastrocnemius muscle and left SFA using a needle and syringe system Monitoring was

done 24 hours 1 month 3 months and 6 months post treatment Results Three patients with CHFangina and 1 patient with severe claudication were enrolled since 2012 The CHFangina patients were males with mean age of 54 years One patient had 2 MI and CABG in 1989 with blocked grafts in FC III-IV and the other patient had MI and PCI of LAD in 2011 in FC III Both patients improved to FC II with 138 improvement in EF from baseline (40 and 30) at 6 months post therapy The 82 year old PAD patient had gradual resolution of rest pains and the 6-Minute Walk Test improved from 251 feet at baseline to 700 feet 6 months post therapy

Conclusion VesCellTM

implantation appears to be safe and shows promise in efficacy in severe CHFrefractory angina and severe claudication Final results and conclusion are pending upon the completion of the study Title Thirty-Day Mortality and Clinical Audit of Acute ST Segment Elevation Myocardial Infarctions at San Fernando General Hospital Coronary Care Unit Author(s) Ramoutar P Singh R Chong R Lalla S Doddi B Objective To perform a clinical audit on the population of acute ST elevation myocardial infarctions admitted to the first public coronary care unit at a large tertiary hospital in San Fernando between January 2013 to December 2013 and obtain the 30 day mortality for ST elevation Myocardial infarctions Methods This retrospective study utilized the medical records and coronary care unit database to determine the incidence mortality and access to coronary angiography and revascularization for the study period Electrocardiogram criteria for STEMI onset of chest pain to needle time echocardiography findings cardiac biomarkers cardiovascular risk profiles were investigated using records to obtain mortality and outcome data and time taken for diagnostic and interventional procedures via the existing equitable access referral program via the Ministry Results During the study period 171 patients were admitted to the coronary care unit with confirmed ST elevation myocardial infarctions Of these 171 patients 54 (n=92) received thrombolytic therapy with an average time of 55 hours from onset of chest pain to time to fibrinolysis 59 patients received diagnostic coronary angiography and 17 of these patients went on for further intervention The estimated 30 day mortality was 117 (n=20) Conclusion PAHO and WHO have identified cardiovascular disease with myocardial infarction as the leading cause of death in Trinidad and Tobago Primary angioplasty remains the international gold standard in curbing mortality from ST elevation myocardial infarction worldwide This study highlights the mortality and outcome in providing thrombolytic therapy as the first line modality of treatment while underscoring the urgent need for a primary angioplasty program at a tertiary institution

Title Update on Recent Cardiovascular Innovations in the Management of Structural Heart Disease Author(s) Heldman A

CCS 2014 Programme Cover

CCS 2014 Programme

Table of Contents

Conference Information 2

Messages 6

Organizing Committee 11

Faculty 13

Schedule at a Glance 14

Social Programme 15

SponsorsExhibitors 16

Conference 2015 17

CCS 2014 Honouree 18

Past Honourees 19

Profile on The Bahamas 20

Past Presidents 22

Council Members 24

Schedule of Presentations 25

Official Opening Ceremony Programme 26

Abstracts 33

Function Tickets

Adult US$140

Guests US$340

Name Badges

Black Temporary

Red Staff

Child Policy

Lost and Found

Air Canada 1-242-377-8220

Dear Colleagues

Dr Victor Elliott

Jamaica

Invited Faculty

Massachusetts USA

Florida USA

Massachusetts USA

Cayman Islands

Yorkshire UK

Social Programme

Attire Lounge suit

Attire Formal

Attire Casual

PLATINUM

SILVER

EXHIBITOR

Sanofi

CCS 2014 Honouree

Past Honourees

1991 2005

Dr HAL McShire

1995 Dr Knox Hagley

1999 2007

Dr Keith McKenzie

Mrs Cynthia Hassett

Dr Ronald Henry

Dr Donald Christian

Dr Edward Chung

Dr James Ling

2004 2013

American occupation

Providence

Capital Nassau

Language English

1989 - 1992

1992 - 1994

1994 - 1996

1996 - 2000

2000 - 2002

2002 - 2004

2004 - 2006

2008-2010

Curaccedilao

Trinidad amp Tobago

Barbados

Trinidad amp Tobago

Wednesday July 23

1040 COFFEE BREAK

PROGRAMME

Thursday July 24

LUNCH SESSION

Hakop Hrachian USA

400pm ndash 500pm

Moshe Porat Israel

Friday July 25

Saturday July 26

Brett Cook Jamaica

Abstracts

2 mean

FRIDAY JULY 25

reg with femoral

Pt Age

Alive after 3 years

5 46y Massive AMI

SATURDAY JULY 26

CCS 2014 Programme

Function Tickets

Adult US$140

Guests US$340

Name Badges

Black Temporary

Red Staff

Child Policy

Lost and Found

Air Canada 1-242-377-8220

Dear Colleagues

Dr Victor Elliott

Jamaica

Invited Faculty

Massachusetts USA

Florida USA

Massachusetts USA

Cayman Islands

Yorkshire UK

Social Programme

Attire Lounge suit

Attire Formal

Attire Casual

PLATINUM

SILVER

EXHIBITOR

Sanofi

CCS 2014 Honouree

Past Honourees

1991 2005

Dr HAL McShire

1995 Dr Knox Hagley

1999 2007

Dr Keith McKenzie

Mrs Cynthia Hassett

Dr Ronald Henry

Dr Donald Christian

Dr Edward Chung

Dr James Ling

2004 2013

American occupation

Providence

Capital Nassau

Language English

1989 - 1992

1992 - 1994

1994 - 1996

1996 - 2000

2000 - 2002

2002 - 2004

2004 - 2006

2008-2010

Curaccedilao

Trinidad amp Tobago

Barbados

Trinidad amp Tobago

Wednesday July 23

1040 COFFEE BREAK

PROGRAMME

Thursday July 24

LUNCH SESSION

Hakop Hrachian USA

400pm ndash 500pm

Moshe Porat Israel

Friday July 25

Saturday July 26

Brett Cook Jamaica

Abstracts

2 mean

FRIDAY JULY 25

reg with femoral

Pt Age

Alive after 3 years

5 46y Massive AMI

SATURDAY JULY 26

CCS 2014 Programme

Name Badges

Black Temporary

Red Staff

Child Policy

Lost and Found

Air Canada 1-242-377-8220

Dear Colleagues

Dr Victor Elliott

Jamaica

Invited Faculty

Massachusetts USA

Florida USA

Massachusetts USA

Cayman Islands

Yorkshire UK

Social Programme

Attire Lounge suit

Attire Formal

Attire Casual

PLATINUM

SILVER

EXHIBITOR

Sanofi

CCS 2014 Honouree

Past Honourees

1991 2005

Dr HAL McShire

1995 Dr Knox Hagley

1999 2007

Dr Keith McKenzie

Mrs Cynthia Hassett

Dr Ronald Henry

Dr Donald Christian

Dr Edward Chung

Dr James Ling

2004 2013

American occupation

Providence

Capital Nassau

Language English

1989 - 1992

1992 - 1994

1994 - 1996

1996 - 2000

2000 - 2002

2002 - 2004

2004 - 2006

2008-2010

Curaccedilao

Trinidad amp Tobago

Barbados

Trinidad amp Tobago

Wednesday July 23

1040 COFFEE BREAK

PROGRAMME

Thursday July 24

LUNCH SESSION

Hakop Hrachian USA

400pm ndash 500pm

Moshe Porat Israel

Friday July 25

Saturday July 26

Brett Cook Jamaica

Abstracts

2 mean

FRIDAY JULY 25

reg with femoral

Pt Age

Alive after 3 years

5 46y Massive AMI

SATURDAY JULY 26

CCS 2014 Programme

Child Policy

Lost and Found

Air Canada 1-242-377-8220

Dear Colleagues

Dr Victor Elliott

Jamaica

Invited Faculty

Massachusetts USA

Florida USA

Massachusetts USA

Cayman Islands

Yorkshire UK

Social Programme

Attire Lounge suit

Attire Formal

Attire Casual

PLATINUM

SILVER

EXHIBITOR

Sanofi

CCS 2014 Honouree

Past Honourees

1991 2005

Dr HAL McShire

1995 Dr Knox Hagley

1999 2007

Dr Keith McKenzie

Mrs Cynthia Hassett

Dr Ronald Henry

Dr Donald Christian

Dr Edward Chung

Dr James Ling

2004 2013

American occupation

Providence

Capital Nassau

Language English

1989 - 1992

1992 - 1994

1994 - 1996

1996 - 2000

2000 - 2002

2002 - 2004

2004 - 2006

2008-2010

Curaccedilao

Trinidad amp Tobago

Barbados

Trinidad amp Tobago

Wednesday July 23

1040 COFFEE BREAK

PROGRAMME

Thursday July 24

LUNCH SESSION

Hakop Hrachian USA

400pm ndash 500pm

Moshe Porat Israel

Friday July 25

Saturday July 26

Brett Cook Jamaica

Abstracts

2 mean

FRIDAY JULY 25

reg with femoral

Pt Age

Alive after 3 years

5 46y Massive AMI

SATURDAY JULY 26

CCS 2014 Programme

Dear Colleagues

Dr Victor Elliott

Jamaica

Invited Faculty

Massachusetts USA

Florida USA

Massachusetts USA

Cayman Islands

Yorkshire UK

Social Programme

Attire Lounge suit

Attire Formal

Attire Casual

PLATINUM

SILVER

EXHIBITOR

Sanofi

CCS 2014 Honouree

Past Honourees

1991 2005

Dr HAL McShire

1995 Dr Knox Hagley

1999 2007

Dr Keith McKenzie

Mrs Cynthia Hassett

Dr Ronald Henry

Dr Donald Christian

Dr Edward Chung

Dr James Ling

2004 2013

American occupation

Providence

Capital Nassau

Language English

1989 - 1992

1992 - 1994

1994 - 1996

1996 - 2000

2000 - 2002

2002 - 2004

2004 - 2006

2008-2010

Curaccedilao

Trinidad amp Tobago

Barbados

Trinidad amp Tobago

Wednesday July 23

1040 COFFEE BREAK

PROGRAMME

Thursday July 24

LUNCH SESSION

Hakop Hrachian USA

400pm ndash 500pm

Moshe Porat Israel

Friday July 25

Saturday July 26

Brett Cook Jamaica

Abstracts

2 mean

FRIDAY JULY 25

reg with femoral

Pt Age

Alive after 3 years

5 46y Massive AMI

SATURDAY JULY 26

CCS 2014 Programme

Dear Colleagues

Dr Victor Elliott

Jamaica

Invited Faculty

Massachusetts USA

Florida USA

Massachusetts USA

Cayman Islands

Yorkshire UK

Social Programme

Attire Lounge suit

Attire Formal

Attire Casual

PLATINUM

SILVER

EXHIBITOR

Sanofi

CCS 2014 Honouree

Past Honourees

1991 2005

Dr HAL McShire

1995 Dr Knox Hagley

1999 2007

Dr Keith McKenzie

Mrs Cynthia Hassett

Dr Ronald Henry

Dr Donald Christian

Dr Edward Chung

Dr James Ling

2004 2013

American occupation

Providence

Capital Nassau

Language English

1989 - 1992

1992 - 1994

1994 - 1996

1996 - 2000

2000 - 2002

2002 - 2004

2004 - 2006

2008-2010

Curaccedilao

Trinidad amp Tobago

Barbados

Trinidad amp Tobago

Wednesday July 23

1040 COFFEE BREAK

PROGRAMME

Thursday July 24

LUNCH SESSION

Hakop Hrachian USA

400pm ndash 500pm

Moshe Porat Israel

Friday July 25

Saturday July 26

Brett Cook Jamaica

Abstracts

2 mean

FRIDAY JULY 25

reg with femoral

Pt Age

Alive after 3 years

5 46y Massive AMI

SATURDAY JULY 26

CCS 2014 Programme

Dr Victor Elliott

Jamaica

Invited Faculty

Massachusetts USA

Florida USA

Massachusetts USA

Cayman Islands

Yorkshire UK

Social Programme

Attire Lounge suit

Attire Formal

Attire Casual

PLATINUM

SILVER

EXHIBITOR

Sanofi

CCS 2014 Honouree

Past Honourees

1991 2005

Dr HAL McShire

1995 Dr Knox Hagley

1999 2007

Dr Keith McKenzie

Mrs Cynthia Hassett

Dr Ronald Henry

Dr Donald Christian

Dr Edward Chung

Dr James Ling

2004 2013

American occupation

Providence

Capital Nassau

Language English

1989 - 1992

1992 - 1994

1994 - 1996

1996 - 2000

2000 - 2002

2002 - 2004

2004 - 2006

2008-2010

Curaccedilao

Trinidad amp Tobago

Barbados

Trinidad amp Tobago

Wednesday July 23

1040 COFFEE BREAK

PROGRAMME

Thursday July 24

LUNCH SESSION

Hakop Hrachian USA

400pm ndash 500pm

Moshe Porat Israel

Friday July 25

Saturday July 26

Brett Cook Jamaica

Abstracts

2 mean

FRIDAY JULY 25

reg with femoral

Pt Age

Alive after 3 years

5 46y Massive AMI

SATURDAY JULY 26

CCS 2014 Programme

Dr Victor Elliott

Jamaica

Invited Faculty

Massachusetts USA

Florida USA

Massachusetts USA

Cayman Islands

Yorkshire UK

Social Programme

Attire Lounge suit

Attire Formal

Attire Casual

PLATINUM

SILVER

EXHIBITOR

Sanofi

CCS 2014 Honouree

Past Honourees

1991 2005

Dr HAL McShire

1995 Dr Knox Hagley

1999 2007

Dr Keith McKenzie

Mrs Cynthia Hassett

Dr Ronald Henry

Dr Donald Christian

Dr Edward Chung

Dr James Ling

2004 2013

American occupation

Providence

Capital Nassau

Language English

1989 - 1992

1992 - 1994

1994 - 1996

1996 - 2000

2000 - 2002

2002 - 2004

2004 - 2006

2008-2010

Curaccedilao

Trinidad amp Tobago

Barbados

Trinidad amp Tobago

Wednesday July 23

1040 COFFEE BREAK

PROGRAMME

Thursday July 24

LUNCH SESSION

Hakop Hrachian USA

400pm ndash 500pm

Moshe Porat Israel

Friday July 25

Saturday July 26

Brett Cook Jamaica

Abstracts

2 mean

FRIDAY JULY 25

reg with femoral

Pt Age

Alive after 3 years

5 46y Massive AMI

SATURDAY JULY 26

CCS 2014 Programme

Dr Victor Elliott

Jamaica

Invited Faculty

Massachusetts USA

Florida USA

Massachusetts USA

Cayman Islands

Yorkshire UK

Social Programme

Attire Lounge suit

Attire Formal

Attire Casual

PLATINUM

SILVER

EXHIBITOR

Sanofi

CCS 2014 Honouree

Past Honourees

1991 2005

Dr HAL McShire

1995 Dr Knox Hagley

1999 2007

Dr Keith McKenzie

Mrs Cynthia Hassett

Dr Ronald Henry

Dr Donald Christian

Dr Edward Chung

Dr James Ling

2004 2013

American occupation

Providence

Capital Nassau

Language English

1989 - 1992

1992 - 1994

1994 - 1996

1996 - 2000

2000 - 2002

2002 - 2004

2004 - 2006

2008-2010

Curaccedilao

Trinidad amp Tobago

Barbados

Trinidad amp Tobago

Wednesday July 23

1040 COFFEE BREAK

PROGRAMME

Thursday July 24

LUNCH SESSION

Hakop Hrachian USA

400pm ndash 500pm

Moshe Porat Israel

Friday July 25

Saturday July 26

Brett Cook Jamaica

Abstracts

2 mean

FRIDAY JULY 25

reg with femoral

Pt Age

Alive after 3 years

5 46y Massive AMI

SATURDAY JULY 26

CCS 2014 Programme

Dr Victor Elliott

Jamaica

Invited Faculty

Massachusetts USA

Florida USA

Massachusetts USA

Cayman Islands

Yorkshire UK

Social Programme

Attire Lounge suit

Attire Formal

Attire Casual

PLATINUM

SILVER

EXHIBITOR

Sanofi

CCS 2014 Honouree

Past Honourees

1991 2005

Dr HAL McShire

1995 Dr Knox Hagley

1999 2007

Dr Keith McKenzie

Mrs Cynthia Hassett

Dr Ronald Henry

Dr Donald Christian

Dr Edward Chung

Dr James Ling

2004 2013

American occupation

Providence

Capital Nassau

Language English

1989 - 1992

1992 - 1994

1994 - 1996

1996 - 2000

2000 - 2002

2002 - 2004

2004 - 2006

2008-2010

Curaccedilao

Trinidad amp Tobago

Barbados

Trinidad amp Tobago

Wednesday July 23

1040 COFFEE BREAK

PROGRAMME

Thursday July 24

LUNCH SESSION

Hakop Hrachian USA

400pm ndash 500pm

Moshe Porat Israel

Friday July 25

Saturday July 26

Brett Cook Jamaica

Abstracts

2 mean

FRIDAY JULY 25

reg with femoral

Pt Age

Alive after 3 years

5 46y Massive AMI

SATURDAY JULY 26

CCS 2014 Programme

Dr Victor Elliott

Jamaica

Invited Faculty

Massachusetts USA

Florida USA

Massachusetts USA

Cayman Islands

Yorkshire UK

Social Programme

Attire Lounge suit

Attire Formal

Attire Casual

PLATINUM

SILVER

EXHIBITOR

Sanofi

CCS 2014 Honouree

Past Honourees

1991 2005

Dr HAL McShire

1995 Dr Knox Hagley

1999 2007

Dr Keith McKenzie

Mrs Cynthia Hassett

Dr Ronald Henry

Dr Donald Christian

Dr Edward Chung

Dr James Ling

2004 2013

American occupation

Providence

Capital Nassau

Language English

1989 - 1992

1992 - 1994

1994 - 1996

1996 - 2000

2000 - 2002

2002 - 2004

2004 - 2006

2008-2010

Curaccedilao

Trinidad amp Tobago

Barbados

Trinidad amp Tobago

Wednesday July 23

1040 COFFEE BREAK

PROGRAMME

Thursday July 24

LUNCH SESSION

Hakop Hrachian USA

400pm ndash 500pm

Moshe Porat Israel

Friday July 25

Saturday July 26

Brett Cook Jamaica

Abstracts

2 mean

FRIDAY JULY 25

reg with femoral

Pt Age

Alive after 3 years

5 46y Massive AMI

SATURDAY JULY 26

CCS 2014 Programme

Invited Faculty

Massachusetts USA

Florida USA

Massachusetts USA

Cayman Islands

Yorkshire UK

Social Programme

Attire Lounge suit

Attire Formal

Attire Casual

PLATINUM

SILVER

EXHIBITOR

Sanofi

CCS 2014 Honouree

Past Honourees

1991 2005

Dr HAL McShire

1995 Dr Knox Hagley

1999 2007

Dr Keith McKenzie

Mrs Cynthia Hassett

Dr Ronald Henry

Dr Donald Christian

Dr Edward Chung

Dr James Ling

2004 2013

American occupation

Providence

Capital Nassau

Language English

1989 - 1992

1992 - 1994

1994 - 1996

1996 - 2000

2000 - 2002

2002 - 2004

2004 - 2006

2008-2010

Curaccedilao

Trinidad amp Tobago

Barbados

Trinidad amp Tobago

Wednesday July 23

1040 COFFEE BREAK

PROGRAMME

Thursday July 24

LUNCH SESSION

Hakop Hrachian USA

400pm ndash 500pm

Moshe Porat Israel

Friday July 25

Saturday July 26

Brett Cook Jamaica

Abstracts

2 mean

FRIDAY JULY 25

reg with femoral

Pt Age

Alive after 3 years

5 46y Massive AMI

SATURDAY JULY 26

CCS 2014 Programme

Invited Faculty

Massachusetts USA

Florida USA

Massachusetts USA

Cayman Islands

Yorkshire UK

Social Programme

Attire Lounge suit

Attire Formal

Attire Casual

PLATINUM

SILVER

EXHIBITOR

Sanofi

CCS 2014 Honouree

Past Honourees

1991 2005

Dr HAL McShire

1995 Dr Knox Hagley

1999 2007

Dr Keith McKenzie

Mrs Cynthia Hassett

Dr Ronald Henry

Dr Donald Christian

Dr Edward Chung

Dr James Ling

2004 2013

American occupation

Providence

Capital Nassau

Language English

1989 - 1992

1992 - 1994

1994 - 1996

1996 - 2000

2000 - 2002

2002 - 2004

2004 - 2006

2008-2010

Curaccedilao

Trinidad amp Tobago

Barbados

Trinidad amp Tobago

Wednesday July 23

1040 COFFEE BREAK

PROGRAMME

Thursday July 24

LUNCH SESSION

Hakop Hrachian USA

400pm ndash 500pm

Moshe Porat Israel

Friday July 25

Saturday July 26

Brett Cook Jamaica

Abstracts

2 mean

FRIDAY JULY 25

reg with femoral

Pt Age

Alive after 3 years

5 46y Massive AMI

SATURDAY JULY 26

CCS 2014 Programme

Social Programme

Attire Lounge suit

Attire Formal

Attire Casual

PLATINUM

SILVER

EXHIBITOR

Sanofi

CCS 2014 Honouree

Past Honourees

1991 2005

Dr HAL McShire

1995 Dr Knox Hagley

1999 2007

Dr Keith McKenzie

Mrs Cynthia Hassett

Dr Ronald Henry

Dr Donald Christian

Dr Edward Chung

Dr James Ling

2004 2013

American occupation

Providence

Capital Nassau

Language English

1989 - 1992

1992 - 1994

1994 - 1996

1996 - 2000

2000 - 2002

2002 - 2004

2004 - 2006

2008-2010

Curaccedilao

Trinidad amp Tobago

Barbados

Trinidad amp Tobago

Wednesday July 23

1040 COFFEE BREAK

PROGRAMME

Thursday July 24

LUNCH SESSION

Hakop Hrachian USA

400pm ndash 500pm

Moshe Porat Israel

Friday July 25

Saturday July 26

Brett Cook Jamaica

Abstracts

2 mean

FRIDAY JULY 25

reg with femoral

Pt Age

Alive after 3 years

5 46y Massive AMI

SATURDAY JULY 26

CCS 2014 Programme

Social Programme

Attire Lounge suit

Attire Formal

Attire Casual

PLATINUM

SILVER

EXHIBITOR

Sanofi

CCS 2014 Honouree

Past Honourees

1991 2005

Dr HAL McShire

1995 Dr Knox Hagley

1999 2007

Dr Keith McKenzie

Mrs Cynthia Hassett

Dr Ronald Henry

Dr Donald Christian

Dr Edward Chung

Dr James Ling

2004 2013

American occupation

Providence

Capital Nassau

Language English

1989 - 1992

1992 - 1994

1994 - 1996

1996 - 2000

2000 - 2002

2002 - 2004

2004 - 2006

2008-2010

Curaccedilao

Trinidad amp Tobago

Barbados

Trinidad amp Tobago

Wednesday July 23

1040 COFFEE BREAK

PROGRAMME

Thursday July 24

LUNCH SESSION

Hakop Hrachian USA

400pm ndash 500pm

Moshe Porat Israel

Friday July 25

Saturday July 26

Brett Cook Jamaica

Abstracts

2 mean

FRIDAY JULY 25

reg with femoral

Pt Age

Alive after 3 years

5 46y Massive AMI

SATURDAY JULY 26

CCS 2014 Programme

PLATINUM

SILVER

EXHIBITOR

Sanofi

CCS 2014 Honouree

Past Honourees

1991 2005

Dr HAL McShire

1995 Dr Knox Hagley

1999 2007

Dr Keith McKenzie

Mrs Cynthia Hassett

Dr Ronald Henry

Dr Donald Christian

Dr Edward Chung

Dr James Ling

2004 2013

American occupation

Providence

Capital Nassau

Language English

1989 - 1992

1992 - 1994

1994 - 1996

1996 - 2000

2000 - 2002

2002 - 2004

2004 - 2006

2008-2010

Curaccedilao

Trinidad amp Tobago

Barbados

Trinidad amp Tobago

Wednesday July 23

1040 COFFEE BREAK

PROGRAMME

Thursday July 24

LUNCH SESSION

Hakop Hrachian USA

400pm ndash 500pm

Moshe Porat Israel

Friday July 25

Saturday July 26

Brett Cook Jamaica

Abstracts

2 mean

FRIDAY JULY 25

reg with femoral

Pt Age

Alive after 3 years

5 46y Massive AMI

SATURDAY JULY 26

CCS 2014 Programme

CCS 2014 Honouree

Past Honourees

1991 2005

Dr HAL McShire

1995 Dr Knox Hagley

1999 2007

Dr Keith McKenzie

Mrs Cynthia Hassett

Dr Ronald Henry

Dr Donald Christian

Dr Edward Chung

Dr James Ling

2004 2013

American occupation

Providence

Capital Nassau

Language English

1989 - 1992

1992 - 1994

1994 - 1996

1996 - 2000

2000 - 2002

2002 - 2004

2004 - 2006

2008-2010

Curaccedilao

Trinidad amp Tobago

Barbados

Trinidad amp Tobago

Wednesday July 23

1040 COFFEE BREAK

PROGRAMME

Thursday July 24

LUNCH SESSION

Hakop Hrachian USA

400pm ndash 500pm

Moshe Porat Israel

Friday July 25

Saturday July 26

Brett Cook Jamaica

Abstracts

2 mean

FRIDAY JULY 25

reg with femoral

Pt Age

Alive after 3 years

5 46y Massive AMI

SATURDAY JULY 26

CCS 2014 Programme

CCS 2014 Honouree

Past Honourees

1991 2005

Dr HAL McShire

1995 Dr Knox Hagley

1999 2007

Dr Keith McKenzie

Mrs Cynthia Hassett

Dr Ronald Henry

Dr Donald Christian

Dr Edward Chung

Dr James Ling

2004 2013

American occupation

Providence

Capital Nassau

Language English

1989 - 1992

1992 - 1994

1994 - 1996

1996 - 2000

2000 - 2002

2002 - 2004

2004 - 2006

2008-2010

Curaccedilao

Trinidad amp Tobago

Barbados

Trinidad amp Tobago

Wednesday July 23

1040 COFFEE BREAK

PROGRAMME

Thursday July 24

LUNCH SESSION

Hakop Hrachian USA

400pm ndash 500pm

Moshe Porat Israel

Friday July 25

Saturday July 26

Brett Cook Jamaica

Abstracts

2 mean

FRIDAY JULY 25

reg with femoral

Pt Age

Alive after 3 years

5 46y Massive AMI

SATURDAY JULY 26

CCS 2014 Programme

Past Honourees

1991 2005

Dr HAL McShire

1995 Dr Knox Hagley

1999 2007

Dr Keith McKenzie

Mrs Cynthia Hassett

Dr Ronald Henry

Dr Donald Christian

Dr Edward Chung

Dr James Ling

2004 2013

American occupation

Providence

Capital Nassau

Language English

1989 - 1992

1992 - 1994

1994 - 1996

1996 - 2000

2000 - 2002

2002 - 2004

2004 - 2006

2008-2010

Curaccedilao

Trinidad amp Tobago

Barbados

Trinidad amp Tobago

Wednesday July 23

1040 COFFEE BREAK

PROGRAMME

Thursday July 24

LUNCH SESSION

Hakop Hrachian USA

400pm ndash 500pm

Moshe Porat Israel

Friday July 25

Saturday July 26

Brett Cook Jamaica

Abstracts

2 mean

FRIDAY JULY 25

reg with femoral

Pt Age

Alive after 3 years

5 46y Massive AMI

SATURDAY JULY 26

CCS 2014 Programme

American occupation

Providence

Capital Nassau

Language English

1989 - 1992

1992 - 1994

1994 - 1996

1996 - 2000

2000 - 2002

2002 - 2004

2004 - 2006

2008-2010

Curaccedilao

Trinidad amp Tobago

Barbados

Trinidad amp Tobago

Wednesday July 23

1040 COFFEE BREAK

PROGRAMME

Thursday July 24

LUNCH SESSION

Hakop Hrachian USA

400pm ndash 500pm

Moshe Porat Israel

Friday July 25

Saturday July 26

Brett Cook Jamaica

Abstracts

2 mean

FRIDAY JULY 25

reg with femoral

Pt Age

Alive after 3 years

5 46y Massive AMI

SATURDAY JULY 26

CCS 2014 Programme

Capital Nassau

Language English

1989 - 1992

1992 - 1994

1994 - 1996

1996 - 2000

2000 - 2002

2002 - 2004

2004 - 2006

2008-2010

Curaccedilao

Trinidad amp Tobago

Barbados

Trinidad amp Tobago

Wednesday July 23

1040 COFFEE BREAK

PROGRAMME

Thursday July 24

LUNCH SESSION

Hakop Hrachian USA

400pm ndash 500pm

Moshe Porat Israel

Friday July 25

Saturday July 26

Brett Cook Jamaica

Abstracts

2 mean

FRIDAY JULY 25

reg with femoral

Pt Age

Alive after 3 years

5 46y Massive AMI

SATURDAY JULY 26

CCS 2014 Programme

1989 - 1992

1992 - 1994

1994 - 1996

1996 - 2000

2000 - 2002

2002 - 2004

2004 - 2006

2008-2010

Curaccedilao

Trinidad amp Tobago

Barbados

Trinidad amp Tobago

Wednesday July 23

1040 COFFEE BREAK

PROGRAMME

Thursday July 24

LUNCH SESSION

Hakop Hrachian USA

400pm ndash 500pm

Moshe Porat Israel

Friday July 25

Saturday July 26

Brett Cook Jamaica

Abstracts

2 mean

FRIDAY JULY 25

reg with femoral

Pt Age

Alive after 3 years

5 46y Massive AMI

SATURDAY JULY 26

CCS 2014 Programme

Curaccedilao

Trinidad amp Tobago

Barbados

Trinidad amp Tobago

Wednesday July 23

1040 COFFEE BREAK

PROGRAMME

Thursday July 24

LUNCH SESSION

Hakop Hrachian USA

400pm ndash 500pm

Moshe Porat Israel

Friday July 25

Saturday July 26

Brett Cook Jamaica

Abstracts

2 mean

FRIDAY JULY 25

reg with femoral

Pt Age

Alive after 3 years

5 46y Massive AMI

SATURDAY JULY 26

CCS 2014 Programme

Curaccedilao

Trinidad amp Tobago

Barbados

Trinidad amp Tobago

Wednesday July 23

1040 COFFEE BREAK

PROGRAMME

Thursday July 24

LUNCH SESSION

Hakop Hrachian USA

400pm ndash 500pm

Moshe Porat Israel

Friday July 25

Saturday July 26

Brett Cook Jamaica

Abstracts

2 mean

FRIDAY JULY 25

reg with femoral

Pt Age

Alive after 3 years

5 46y Massive AMI

SATURDAY JULY 26

CCS 2014 Programme

Wednesday July 23

1040 COFFEE BREAK

PROGRAMME

Thursday July 24

LUNCH SESSION

Hakop Hrachian USA

400pm ndash 500pm

Moshe Porat Israel

Friday July 25

Saturday July 26

Brett Cook Jamaica

Abstracts

2 mean

FRIDAY JULY 25

reg with femoral

Pt Age

Alive after 3 years

5 46y Massive AMI

SATURDAY JULY 26

CCS 2014 Programme

PROGRAMME

Thursday July 24

LUNCH SESSION

Hakop Hrachian USA

400pm ndash 500pm

Moshe Porat Israel

Friday July 25

Saturday July 26

Brett Cook Jamaica

Abstracts

2 mean

FRIDAY JULY 25

reg with femoral

Pt Age

Alive after 3 years

5 46y Massive AMI

SATURDAY JULY 26

CCS 2014 Programme

Thursday July 24

LUNCH SESSION

Hakop Hrachian USA

400pm ndash 500pm

Moshe Porat Israel

Friday July 25

Saturday July 26

Brett Cook Jamaica

Abstracts

2 mean

FRIDAY JULY 25

reg with femoral

Pt Age

Alive after 3 years

5 46y Massive AMI

SATURDAY JULY 26

CCS 2014 Programme

LUNCH SESSION

Hakop Hrachian USA

400pm ndash 500pm

Moshe Porat Israel

Friday July 25

Saturday July 26

Brett Cook Jamaica

Abstracts

2 mean

FRIDAY JULY 25

reg with femoral

Pt Age

Alive after 3 years

5 46y Massive AMI

SATURDAY JULY 26

CCS 2014 Programme

Moshe Porat Israel

Friday July 25

Saturday July 26

Brett Cook Jamaica

Abstracts

2 mean

FRIDAY JULY 25

reg with femoral

Pt Age

Alive after 3 years

5 46y Massive AMI

SATURDAY JULY 26

CCS 2014 Programme

Saturday July 26

Brett Cook Jamaica

Abstracts

2 mean

FRIDAY JULY 25

reg with femoral

Pt Age

Alive after 3 years

5 46y Massive AMI

SATURDAY JULY 26

CCS 2014 Programme

Saturday July 26

Brett Cook Jamaica

Abstracts

2 mean

FRIDAY JULY 25

reg with femoral

Pt Age

Alive after 3 years

5 46y Massive AMI

SATURDAY JULY 26

CCS 2014 Programme

Brett Cook Jamaica

Abstracts

2 mean

FRIDAY JULY 25

reg with femoral

Pt Age

Alive after 3 years

5 46y Massive AMI

SATURDAY JULY 26

CCS 2014 Programme

Abstracts

2 mean

FRIDAY JULY 25

reg with femoral

Pt Age

Alive after 3 years

5 46y Massive AMI

SATURDAY JULY 26

CCS 2014 Programme

FRIDAY JULY 25

reg with femoral

Pt Age

Alive after 3 years

5 46y Massive AMI

SATURDAY JULY 26

CCS 2014 Programme

FRIDAY JULY 25

reg with femoral

Pt Age

Alive after 3 years

5 46y Massive AMI

SATURDAY JULY 26

CCS 2014 Programme

FRIDAY JULY 25

reg with femoral

Pt Age

Alive after 3 years

5 46y Massive AMI

SATURDAY JULY 26

CCS 2014 Programme

FRIDAY JULY 25

reg with femoral

Pt Age

Alive after 3 years

5 46y Massive AMI

SATURDAY JULY 26

CCS 2014 Programme

reg with femoral

Pt Age

Alive after 3 years

5 46y Massive AMI

SATURDAY JULY 26

CCS 2014 Programme

Pt Age

Alive after 3 years

5 46y Massive AMI

SATURDAY JULY 26

CCS 2014 Programme

SATURDAY JULY 26

CCS 2014 Programme

SATURDAY JULY 26

CCS 2014 Programme

SATURDAY JULY 26

CCS 2014 Programme

SATURDAY JULY 26

CCS 2014 Programme

SATURDAY JULY 26

CCS 2014 Programme

SATURDAY JULY 26

CCS 2014 Programme

SATURDAY JULY 26

CCS 2014 Programme

Documents

Innovative Solutions to Cardiovascular Challenges …caribbeancardiac.org/wp-content/uploads/2015/11/CCS_2014...Conference 2015 17 CCS 2014 Honouree 18 Past Honourees 19 Profile on