PROGRAMME
Dear Colleagues, It is our great pleasure to welcome you to the 12th Congress of the Hungarian Society of Arterial Stiffness held in Budapest at the Hotel Holiday Beach Budapest, on 29-30 September 2017. The title of the congress and its main topic in this year the Vascular Calcifi cation and Arterial Stiffness. The vascular calcifi cation is one of the most extensively studied topic during the last decade and strong relationship was found between vascular mineralization and embryonic bone formation. The mineralization of the arteries increases arterial stiffness. Thus, the measurement of aortic stiffness, i.e. the proper measurement of aortic pulse wave velocity has a great potential to be one of the most effective diagnostic tool revealing vascular calcifi cation. Beyond the functional diagnostic method such as measuring arterial stiffness, the visual, image verifi cation of the arterial calcifi cation with carotid ultrasound plays also a fundamental role. However, conceptional changes are going on even in this topic, because it has been proved that not the intima-media thickness (IMT), but the plaques are stronger predictors of hard cardiovascular outcomes. It is our great pleasure to inform you that most distinguished key opinion leaders accepted our invitation; professor Linda L. Demer from University of California about vascular calcifi cation; professor Stefano Rimoldi from University of Bern about the possible link between heart rate and central blood pressure will present state of the art lectures. Obviously the most challenging question is whether can we treat the vascular calcifi cation? We organize a dedicated block trying to answer this question. Finally, we wish to highlight new approaches in the clinical implementation of the measurement of arterial stiffness and to organize our traditional case demonstration explaining what to do with our patients having abnormal stiffness parameters. We do really hope, everyone can fi nd interesting topics in the program and on behalf of the Hungarian Society of Arterial Stiffness we wish a very useful congress and a pleasant stay in Budapest. 2. Miklós Illyés MD PhD president Erzsébet Valéria Hidvégi MD PhD general secretary
CHAIRPERSON OF THE CONGRESS Miklós Illyés MD PhD SECRETARY OF THE CONGRESS Erzsébet Valéria Hidvégi MD PhD SCIENTIFIC COMMITTEE President: Prof. Attila Cziráki MD PhD Members: Miklós Illyés MD PhD Prof. Pál Soltész MD DSA ORGANIZING COMMITTEE Miklós Illyés MD PhD Erzsébet Valéria Hidvégi MD PhD Erika Bernáth PharmD SCIENTIFIC INFORMATION Miklós Illyés MD PhD E-mail: miklos.illyes@tensiomed.com 3.
TITLE OF THE CONGRESS: VASCULAR CALCIFICATION AND ARTERIAL STIFFNESS Offi cial languages: English (29th September) and Hungarian (30th September) PROGRAMME 29th September 2017 (Friday) 08.00 09.00 Registration 09.00 09.10 Opening Ceremony 09.15 17.15 Scientifi c Program (coffee breaks and lunch) 17.45 18.50 HSAS Business Meeting 19.30 23.00 Dinner 30th September 2017 (Saturday) 08.30 12.50 Scientifi c Program (coffee break) 13.00 Lunch (optional) SCIENTIFIC PROGRAMME 29th September 2017 (Friday) 09:00 09:10 OPENING CEREMONY 09:15 09:50 Arterial function basic knowledges for beginners Erzsébet Valéria HIDVÉGI, University of Pécs, Pécs, Hungary (30 + 5 minutes) 09:50 10:40 VASCULAR CALCIFICATION Chairs: Prof. Linda L. DEMER, Miklós ILLYÉS State of the Art lecture: Vascular Calcification Prof. Linda L. DEMER, University of California, Los Angeles, USA (35 + 15 minutes) 10:40 11:10 COFFEE BREAK 4. 11:10 12:55 VASCULAR CALCIFICATION AND ARTERIAL STIFFNESS Chairs: Prof. Stefano RIMOLDI, Prof. Attila CZIRÁKI
11:10 11:45 Vascular Calcification - Arterial Stiffness Miklós ILLYÉS, University of Pécs, Pécs, Hungary (30 + 5 minutes) 11:45 12:20 Heart Rate and Central Blood Pressure: Is There a Link? Prof. Stefano RIMOLDI, Dept. of Cardiology, University of Bern, Switzerland (30 + 5 minutes) 12:20 12:55 Arterial Stiffness Measurement at the GP s Office: Does It Make Sense? Franco MUGGLI, Dept. of Medicine, University of Lausanne, Lausanne, Switzerland (30 + 5 minutes) 13:00 14:30 LUNCH 14:30 15:35 CAN WE TREAT THE VASCULAR CALCIFICATION? Chairs: Adriana ALBU, Miklós ILLYÉS 14:30 15:10 Treatment of Vascular Calcification Adriana ALBU, Dept. of Medicine II., Iulin Hatieganu Universitiy of Medicine and Pharmacy, Cluj-Napoca, Romania (30 + 10 minutes) 15:10 15:35 H-Art and K2 Booster How to Reveal and to Treat Vascular Calcification? Miklós ILLYÉS, TensioMed Schweiz, Wettingen, Switzerland (sponsored lecture) (20 + 5 minutes) 15:35 16:00 COFFEE BREAK 16:00 17:15 NEW APPROACHES IN THE CLINICAL IMPLEMENTATION OF THE MEASUREMENT OF ARTERIAL STIFFNESS Chairs: Prof. Gábor NÉMETH, Zsolt SZABÓ 5.
16:00 16:25 Connection between Diastolic Dysfunction and Arterial (Dys)function. Is the Diastolic Dysfunction the Cardiac Manifestation of the Increased Arterial Stiffness? Prof. Attila CZIRÁKI, University of Pécs, Pécs, Hungary (20 + 5 minutes) 16:25 16:50 The Role of Arterial Stiffness Measurement in the Practice of Anaesthesiology and Intesive Therapy Nándor ÖVEGES, University of Szeged, Szeged, Hungary (20 + 5 minutes) 16:50 17:15 Better Health for Women Menopause and Arterial Stiffness Prof. Gábor NÉMETH, University of Szeged, Szeged, Hungary (20 + 5 minutes) 17:45 18:50 HSAS BUSINESS MEETING 19:30 23:00 DINNER 30th September 2017 (Saturday) 08:30 08:50 THE ARTERIOGRAPH HOW CAN WE USE IT? Practical Training Erzsébet Valéria HIDVÉGI, University of Pécs, Pécs, Hungary 09:00 10:00 LIVE PATIENT DEMONSTRATION - (antecedents, measurement by Arteriograph, carotid ultrasound, echocardiography, discussion) Prof. Attila CZIRÁKI, University of Pécs, Pécs, Hungary Miklós ILLYÉS, University of Pécs, Pécs, Hungary 10:00 11:00 DISCUSSION: CARDIOVASCULAR RISK STRATIFICATION WHAT CAN A GP DO? CASE REPORTS. Prof. Attila CZIRÁKI, University of Pécs, Pécs, Hungary Miklós ILLYÉS, University of Pécs, Pécs, Hungary 6.
11:00 11:30 COFFEE BREAK 11:30 12:20 POSTER SESSION (The offi cial language of the Poster Session is English. The Authors can present their papers in 5+2 minutes.) Chairs: Prof. Attila CZIRÁKI, Erzsébet Valéria HIDVÉGI, Miklós ILLYÉS 12:30 12:50 CLOSING CEREMONY 13:00 LUNCH (OPTIONAL) 7.
POSTER ABSTRACTS 1. HYPOXIA INDUCES RUNX2 AND SOX9-DEPENDENT OSTEOGENIC DIFFERENTIATION OF VASCULAR SMOOTH MUSCLE CELLS IN VITRO AND IN VIVO Jeney Viktória 1, Balogh Enikő 1, Tóth Andrea 1, Paragh György 1, 1 Department of Internal Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary Introduction: Hypoxia and calcifi cation are often present together in advanced atherosclerotic lesions. Objectives: We aimed to investigate whether hypoxia triggers osteogenic differentiation and extracellular matrix mineralization of vascular smooth muscle cells (VSCMs) in vitro and in vivo. Methods: We cultured VSMCs (human, aorta) under normoxic (21% O2) and hypoxic (1% O2) conditions. Mice (C57BL/6) were injected intraperitoneally with CoCl2 (30mg/kg body weight, twice in every other day), aortas were harvested for analysis 72 hours post-treatment. Quantitative RT-PCR was used to evaluate mrna levels of Runx2, Sox9, and osteocalcin. Protein expressions of Runx2 and Sox9 were assessed by western blotting. Osteocalcin levels were determined by ELISA. Matrix mineralization was visualized by Alizarin red staining. Extracellular matrix calcium content was measured by Calcium Assay Kit. The production of reactive oxygen species (ROS) was evaluated by DCFDA-Cellular ROS Detection Kit. Results: In VSMCs hypoxia increased mrna and protein levels of Runx2 (7.8-/3.6-fold), Sox9 (8.8-/4-fold) and osteocalcin (8-/22.6-fold) respectively. Treatment of mice with the hypoxia mimetic CoCl2 caused a 2.4-fold increase in Runx2 and a 4.9-fold increase in Sox9 mrna levels in the aorta. In VSMCs hypoxia potently accelerated matrix mineralization induced by elevated phosphate. Hypoxia increased ROS production in VSMC. Scavenging ROS by N-acetyl cysteine resulted decreased levels of Runx2, Sox9 and osteocalcin mrna and reduced mineralization under hypoxia. Conclusion: Our results highlight the critical role of hypoxia in osteogenic differentiation of VSMCs. Hypoxia-induced mineralization can contribute to intima calcifi cation, a characteristic feature of complicated lesions. 8.
2. NON-INVASIVE ASSESSMENT OF ARTERIAL FUNCTION IN OVERWEIGHT AND OBESE CHILDREN AND ADOLESCENTS Jakab Andrea Emese 1, Hidvégi Erzsébet Valéria 2, Illyés Miklós 2, Cziráki Attila 2, Bereczki Csaba 1 1 Department of Pediatrics, Albert Szent-Györgyi Health Center, University of Szeged, Szeged, Hungary 2 Heart Institute, Faculty of Medicine, University of Pécs, Pécs, Hungary Introduction: Overweight (OW) and obesity (O) are pandemic all over the World. Obesity may cause early atherosclerosis enhancing cardiovascular (CV) risk. Arterial function parameters (AFPs) predict the CV risk in adults. We may suppose the alteration of these parameters in OW and O children and adolescents, as well. Objectives: To determine the frequency of OW and O in a large population of children and adolescents; to fi nd differences in AFPs measured in patients and healthy subjects. Methods: 6,824 (3,673 boys) healthy children and adolescents aged 3-18 years were examined. OW, O and systolic/and-or diastolic hypertension were defi ned by the relevant guidelines. The AFPs (aortic pulse wave velocity [PWVao], aortic augmentation index [Aixao], aortic systolic blood pressure [SBPao]) were measured by a noninvasive, occlusive-oscillometric, invasively validated device. Four patient groups were created in both gender (OW, OW with increased systolic blood pressure [OW+ISBP], O, O+ISBP). Results were compared to those measured in sex and age matched control groups. Results: 518 (14.1%) OW and 274 (7.5 %) O boys, 397 (12.6%) OW and 174 (5.5%) O girls, totally 915 (13.4%) OW and 448 (6.6%) O children and adolescents were found. PWVao was increased in all patient groups, but signifi cant differences were found only in groups of OW+ISBP and O+ISBP in both genders (5.8 m/s vs. 6.2 m/s, 5.6 m/s vs. 6.2 m/s in boys; 5.7 m/s vs. 6.2 m/s, 5.7 m/s vs. 6.1 m/s in girls; p<0.001). No differences were found regarding Aixao. SBPao were increased in all patient s groups signifi cantly (OW boys: 101.8-104.3 mmhg, OW girls: 101.0-103.4 mmhg (p<0.001), OW+ISBP boys: 102.6-121.6 mmhg, OW+ISBP girls: 100.2-120.0 mmhg (p<0.0001), O boys: 100.6-103.2 mmhg, O girls: 99.3-102.4 mmhg (p<0.001), O+ISBP boys: 101.3-120.3 mmhg, O+ISBP girls: 101-119.6 mmhg (p<0.0001). Conclusion: Total prevalence of overweight and obesity was 20.0% in our population. PWVao was increased in all patient groups. SPBao was signifi cantly increased in all patient groups. SPBao may serve as a surrogate marker in the procedure of CV risk stratifi cation in OW and O children and adolescents. On the other hand, the increased SPBao indicates increased CV risk for these patients. 9.
3. ARTERIAL STIFFNESS IN PATIENTS WITH RHEUMATOID ARTHRITIS IS ASSOCIATED WITH EPICARDIAL ADIPOSE TISSUE THICKNESS Petra Cristian Vasile 1, Albu Adriana 2, Bondor Cosmina 3, Rednic Simona 1 1 Department of Rheumatology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania, 2 2nd Department of Internal Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania, 3 Medical Informatics and Biostatistics Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania 10. Introduction: Rheumatoid arthritis (RA) is a chronic infl ammatory systemic disease associated with increased mortality rates, mainly due to cardiovascular disease. RA patients exhibit accelerated atherosclerosis and reduced vascular compliance, due to traditional and infl ammatory risk factors as well. Epicardial adipose tissue (EAT) and pericardial adipose tissue (PAT) represent metabolically active fat deposits, the measurement of which could aid the assessment of subclinical organ damage. These markers of visceral adiposity were shown to be associated with conventional anthropometric and clinical variables, such as body mass index, systolic blood pressure and also with carotid intima-media thickness. However, whether it may correlate with established parameters of arterial stiffness has been little explored yet. Objectives: The aim of the study is to evaluate the relationship between arterial stiffness, on one hand and classical cardiovascular risk factors and EAT, PAT thickness, on the other hand, in patients with RA. Methods: We consecutively enrolled 73 subjects (62 female, mean (+SD) age 58±12 years) who fulfi lled the 2010 American College of Rheumatology/European League Against Rheumatism classifi cation criteria for RA. Arterial stiffness was assessed by aortic pulse wave velocity (apwv) in each subject using an oscillometric method. The end-systolic and end-diastolic EAT and PAT thickness was assessed by means of transthoracic two-dimensional (2D) guided M-mode echocardiography, from the standard parasternal long-axis view on the free wall of the right ventricle, perpendicular to the aortic annulus. The results are part of an ongoing study, we are still actively recruiting patients with RA and for the control group. Results: End-diastolic EAT (r=0.24, p=0.038), end-systolic EAT (r=0.44, p<0.001) and PAT (r=0.31, p=0.01) were all associated with arterial stiffness as measured by apwv. As expected, PWV was positively
correlated with age (r=0.44, p<0.001) and disease duration (r=0.47, p<0.001). Moreover, after controlling for age, waist circumference, triglycerides, total-cholesterol, LDL-cholesterol, serum fasting glucose, body mass index, disease duration in a multivariate linear regression analysis, enter model, end-systolic EAT thickness remained signifi cantly correlated with apwv (b=7.79, p<0.001, 95% CI for b 3.87-11.71). Conclusion: To our knowledge, this is the fi rst study to demonstrate an independent relationship between markers of visceral adiposity and arterial stiffness in RA patients. Our results suggest that echocardiographic visceral adiposity assessment may be an accessible tool for the early detection of subclinical organ damage. Further prospective studies are needed to explore whether EAT is a causal factor and/or the result of increased arterial stiffness in the context of chronic infl ammation. 11.
4. DOPPLER INDEX ÉS ARTÉRIÁS STIFFNESS ÉRTÉKEK ÖSSZEFÜGGÉSEI HÁZIORVOSI PRAXISUNK MAGAS RIZIKÓJÚ BETEGEINEK VIZSGÁLATA TÜKRÉBEN Himodi Anita 1, Polyák Zita 1, Visy László 1, Hegyi Ilona 1, Vasas István 1 1 Kardirex Egészségügyi Központ, Győr A Kardirex Egészségügyi Központ kezdetektől fogva mindig is nagy hangsúlyt fektetett a prevencióra. Korábban a pitvarfi brilláció korai felismerését célzó kampányban vettünk részt, 2016-ban a perifériás érszűkület, társbetegségek és artériás stiffness összefüggésének irányában vizsgáltuk háziorvosi praxisunkat. 956 fős felnőtt háziorvosi praxisunkban a dohányzó, hypertoniás, praediabeteses, diabeteses, hyperlipidaemiás illetve atherosclerosisban szenvedő, azaz a magas kardiovascularis rizikóval élő betegeink anyagcsere állapotát kontrolláltuk, kiegészítve arteriográfos vizsgálattal és doppler index méréssel. A vizsgálatban 106 fő, 48 férfi és 58 nő vett részt, 14 fő dohányzik. 31 fő diabeteses, emelkedett vércukor érték miatt jelenleg gyógyszeres kezelésben még nem részesült 8 fő, kezelt hyperlipidaemiás 51 fő, még nem kezelt, frissen kimutatott emelkedett koleszterin értékekkel 31 főt találtunk. Mindösszesen 76 esetben találtunk kóros PWV eredményt (9 m/s felett) a vizsgált betegcsoportban, 22 esetben pedig kóros (<0,9 vagy > 1,3) doppler indexet, ebből 17 esetben emelkedett volt a PWV értéke is. A 14 dohányzó páciensből 11 emelkedett PWV értéket mutatott, 2 kóros doppler indexet. Akiknél emelkedett doppler indexet találtunk, 2 fő dohányos, 19 fő hypertoniás, 10 fő diabeteses és 2 fő praediabeteses, hyperlipidaemiás (kezelt illetve még kezeletlen) 15 fő. Kardiális intervenciós kezelésen átesett 11 fő, 10 kóros PWV értéket mutatott, 8 pedig doppler index eltérést, az agyi eseményen átesett betegek szintén kóros stiffness és doppler értékeket mutattak. 12. Összességében elmondható, hogy a kóros doppler index 77 %-ban együtt járt a PWV emelkedésével a vizsgált beteganyagon, valamint a
hypertoniásoknál mintegy 70 %-ban kóros stiffness értékeket észleltünk. A PWV értéke a rizikótényezők (diabetes, dohányzás, hypertonia, hypercholesterinaemia, atherosclerosis) tükrében emelkedést mutatott. Vizsgálatunk is alátámasztotta, hogy rizikótényezőkkel élőknél mennyire fontos az érfali rugalmasság vizsgálata, illetve a betegek szív-érrendszeri állapotának után követése a háziorvosi praxisokban is. 13.
5. TÜDŐTRANSZPLANTÁLT BETEGEK ARTÉRIÁS STIFFNESS VIZSGÁLATÁNAK JELENTŐSÉGE Böcskei Renáta Marietta 1, Benczúr Béla 2, Süttő Zoltán 1, Eszes Noémi 1, Lang György 4, Rényi-Vámos Ferenc 3, Müller Veronika 1, Losonczy György 1, Bohács Anikó 1. 1 Semmelweis Egyetem, Pulmonológiai Klinika, Budapest 2 Tolna Megyei Balassa János Kórház, Szekszárd 3 Semmelwis Egyetem, Mellkas Sebészeti Klinika, Budapest 4 MUW Mellkas Sebészeti Klinika, Bécs A szolid szervtranszplantációt követő kombinált immunszupresszív kezelés, a tüdőtranszplantált betegeknél is nagy valószínűséggel hozzájárul a kardiovaszkuláris társbetegségek, a magas vérnyomás, hiperlipidémia, diabétesz és a vesebetegség kialakulásához. Hipertrigliceridémiát okozó hatásuk accelerált atherosclerosist okozhat. A korai poszt transzplantációs időszakban elsősorban infekcióval, míg a késői szakaszban a malignitással is számolhatunk. COPD miatt transzplantált betegeknél a korábbi dohányzás, a fokozott gyulladásos válasz is emeli ezen betegeknél a kardiovaszkuláris rizikót. Tüdőtranszplantált betegek hosszú távú után követése során a kardiovaszkuláris rizikó szűrésére, a kardiovaszkuláris betegségekre vulnerábilis egyének kiemelését szükségesnek tartjuk. Első lépésként 49 egészséges és 51 tüdőtranszplantált beteg artériás stiffness összehasonlító vizsgálatát végeztük el, valamint a betegeink után követését megkezdtük. Tüdőtranszplantált betegcsoportban emelkedettebb aorta pulzushullám terjedési sebességet és augmentácios indexet találtunk. Szignifi káns különbség az aorta pulzushullám visszaverődés idejében (RT) volt mérhető. Az alacsony különbség hátterében a bevezetett statin terápia, a betegek fi atal életkora, valamint a transzplantációra került betegek, jó kardiovaszkuláris állapota állhat, hiszen ezen betegek szívkatéteres előszűrése operáció előtt szükséges. Hosszú távú kardiovaszkuláris után követésüket azonban fontosnak tartjuk, mind a gyakori infekciók, mind az immunszupresszív terápia együttes szisztémás hatása miatt. 14.
GENERAL INFORMATION THE CONFERENCE WEBSITE: http://www.en.stand-art.hu/mast2017 REGISTRATION FEES Registration fees After 30th June 2017 Physicians PhD students Nurses Representatives of pharmaceutical companies Accompanying persons 80,- EUR 45,- EUR 45,- EUR 80,- EUR 35,- EUR The registration fees include the badge, conference folder with congress documents, entry to all sessions, sponsor show, Friday lunch, coffee breaks and the amount of the current VAT. Meal content: 21,- EUR/day, shown on the invoice as a separate item. Dinner can be ordered separately on the application form (25,- EUR/ person). HOTEL INFORMATION Information about the hotel can be found on the congress website: www.en.stand-art.hu/mast2017. P.C.O. ORGANIZER - SECRETARY AND CONGRESS OFFICE STAND - ART Event Management H 6723 Szeged, Tisza Palace B/2., Felső Tisza-part 31-34. Phone: +36/62-999 950; Fax : +36/62-661 331 E-mail: info@stand-art.hu Webpage: www.en.stand-art.hu REGISTRATION AND ACCOMMODATION Stand-Art Event Management Anita Garhuth project manager Tel.: +36/62-999 950; Fax: +36/62-661 331; Mobil: +36/30-619 7348 E-mail: anita@stand-art.hu 15.
FINANCE AND BILLING Stand-Art Event Management Laura Jakab fi nancial assistant Tel.: +36/62-999 950; Fax: +36/62-661 331; Mobil: +36/30-619 7348 E-mail: laura@stand-art.hu REGISTRATION OFFICE OPEN 29th September 2017: 08.00 18.00 h 30th September 2017: 08-00 13.00 h REGISTRATION OFFICE PHONE NR.: +36/30-619 7348 ACCREDITATION Participants attending the conference are eligible to receive 16 credit points (Oftex code: SZTE-ÁOK/2017.II/00041). NAME BADGES: Participants are requested to wear their name badges at all time. ACCESS AND TRANSPORTATION: Venue is located about 20 km from Liszt Ferenc Airport and 2 km from the South Railway Station. Főtaxi (http://www.fotaxi.hu) is the recommended personal taxi company of the meeting. You can order a taxi by dialing +36/1-2222 222. Airport transfer fare is about 25. ELECTRICITY Electricity in Budapest is the European standard 220 Volt with the two round prongs and generally recessed sockets. PARKING: Parking is free at the conference venue for registered participants. OTHER IMPORTANT NOTES The prices on the registration page include VAT, but do NOT include any other charges payable for mediated services (meals). Congressional participation fees do not include any insurance, and the organizers will not be held responsible for personal or material damages occurring during the event. 16. EMERGENCY TELEPHONE NUMBERS Ambulance: 104 Police: 107 Fire Department: 105 General help: 112
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