Future of cardiology

2,590 views

Published on

A talk about the future of cardiology (also medicine in general) given on the 28th april 2014 in the Medical University of Silesia in Poland to doctors and students. It shows the trends of medicine and medical technology development with the biggest potential.

Published in: Health & Medicine

Future of cardiology

  1. 1. FUTURE OF CARDIOLOGY MAGDALENA KOCIERZ-WOŹNOWSKA MD PhD FIRST DEPARTMENT OF CARDIOLOGY MEDICAL UNIVERSITY OF SILESIA
  2. 2. WHERE ARE WE ? CVD in EU €196 billion CVD in US $380 billion CVD 4millon deaths 2015 2030 2045 CVD in EU €600 billion CVD in US $1000 billion 40% people with CVD 20% >40 years with HF Immortality ? CVD 21%       Stroke15%       Other 16%       Stomach cancer 1%     Other cancer 10%     Respiratory disease 5%     Injuries and poisoning 4%     All other 21%       Breast cancer 3%     Colo-rectal cancer 2%     Lung cancer 2%     %    
  3. 3. FUTURE OF CARDIOLOGY INVASIVE PREVENTIVE ARTIFICIAL INTELLIGENCE EMR SENSORSTISSUE ENGINEERINGNANOTECHNOLOGY 3D PRINTING GENOMICS
  4. 4. TOTAL ARTIFICIAL HEART WORLD: 4000 heart transplants / 10000 patients on the waiting list / year
  5. 5. •  140-180k Euro (HTX- EU 100k Euro, USA 600k $) •  External battery >12hours of work, <3kg •  900g (900 parts) TAH – FIRST PHASE OF CLINICAL TRIAL (4 PATIENTS) •  I patient died 74 days after operation (2013/2014) •  II patient implanted 08.2014 died 9 months after operation 01.05.2015 Working time (comparable to HTX)- 5 years
  6. 6. Dwa mikrosilniki TAH – FIRST PHASE OF CLINICAL TRIAL
  7. 7. TAH – FIRST PHASE OF CLINICAL TRIAL Programmer with teletransmission Exchangeable lithium-ionic batteries Electric power Artificial heart Data about the system function Driver of the artificial heart with telediagnostics through telephone line
  8. 8. PROCYRION-AORTIX
  9. 9. PROCYRION- AORTIX Smallest LVAD (left ventricle assist device) For patients NYHA III-IV Minimal risk of procedure, device dysfunction and thrombosis Localization in the descending aorta- below the carotid arteries (reduces stroke risk) Increase of the renal flow up to 30%
  10. 10. TISSUE ENGINEERING, HOW TO BUILD A HEART ?
  11. 11. •  Multicenter clinical trial- USA and Europe •  80 patients already implanted (in 60 as a dialysis access, in 20 as a femoral-popliteal by-pass) •  Grafts made of human acellular collagen matrix •  Sterile, non-immunogenic, easy to use, no cryopreservation needed BIOGRAFTS
  12. 12. 3D BIOPRINTING Stem cells taken from a biopsy of a patient are multiplied and used to form a bioink. Bioprinting of cell layers interspersed with layers of hydrogel, which functions as a temporary mould around the cells. The bioink made of cell aggregates is loaded into cartridges Growth and maturation of the bioprint, hydrogel removal. The bioprinted tissue is ready to be used in medical research or for transplantation. I stage II stage III stage IV stage
  13. 13. “The heart is one of the easiest organs to bioprint, we’ll do it in a decade…” Stuart K.Williams, Cardiovascular Innovation Institute 3D BIOPRINTING
  14. 14. 3D TISSUE PRINTING Micro CT of the aortic valve and 3D reconstruction Hydrogel conduit 3D printing Encapsulation of cells into the conduit
  15. 15. ENDOVASCULAR VALVE REGENERATION SYSTEM Mechanical burr cleaning with controllable deflecting tip Ultrasonic cleaning Microcurrent regeneration signal= recruiting stem cells with homing signal and differentiating them to valve tissue Full optical, ultrasound or echo viewing of valve repair field of view real time (Cellvizio)
  16. 16. XENOTRANSPLANTATIONS •  Similar anatomy of a human and porcine heart •  The hearts of genetically modified piglets were transplanted into baboons (GTKOhCD46hTM) •  Modified immunosuppression (antyCD40/ antyCD154) •  Longest survival 236 days •  Immunosuppression with antyCD40 was better than antyCD154 (bleedings)
  17. 17. ELECTROTHERAPY MEDTRONIC MICRA   Delivered via a catheter through the femoral vein and positioned in the right ventricle Does not require a surgical „pocket”- less possible complications Attached to the wall of the ventricle, can be repositioned if needed Estimated battery life up to 10 years
  18. 18. BIOLOGICAL PACEMAKERS Adenovirus Tbox 18 gene transduction (a gene coding a transcription factor responsible for the sinus node development) Conversion of cardiomyocytes into pacemaker cells Potassium channel Ik1 inhibition in the cardiomyocytes of a guinea pig Conversion of cardiomyocytes into pacemaker cells Gene-based biological pacemaker Cell-based biological pacemaker or
  19. 19. PACEMAKERS POWERED BY HEARTBEAT •  piezoelectrical effect- high-efficiency mechanical-to-electrical energy conversion •  piezoelectric material- lead citronate titanate nanoribbons •  generates 0,2 µW/cm2 energy •  the material was affixed to heart, lungs and diaphragm •  organ movement was not disturbed •  the material generated enough voltage by opened and also by closed chest Gaz Piezoelektryk
  20. 20. NON-INVASIVE ABLATION STEREOTACTIC WITH THE CYBERKNIFE
  21. 21. IMAGING
  22. 22. NON-INVASIVE FFR •  2011 EuroPCR innovation •  11.2014 FDA approval •  DISCOVER-FLOW, DeFACTO, NXT •  FFRCT vs.CT-79 vs. 34% specificity
  23. 23. PORTABLE ECHO VSCAN MOBIUS SP1 VISIQ MOBIUS SP1
  24. 24. PREVENTION CZUJNIKI GAMIFIKACJA EMR AI EMR
  25. 25. „WEARABLES” SENSORS One day of “wearables” use provides more data than a doctor reads in a year.
  26. 26. „PRO” SENSORS AliveCor EMPAAUM CADencePerminova WithingsiBG Star
  27. 27. END OF THE STETHOSCOPE? Stethee ViScope MD Steth IO
  28. 28. IRHYTHM ZIO PATCH
  29. 29. VITAL CONNECT PATCH MD •  EKG- 1 lead •  HR / HRV •  Respiratory rate •  Body temperature •  Movements •  Body posture/ collapses
  30. 30. IMPLANTABLE SENSORS i-IronIC
  31. 31. FIGHTING DIABETES •  Diabetes is the second expensive disease in the world (after CAD) •  Treatment costs- 5%-10% outlays on health care •  Up to 2025 the diabetes treatment costs will exceed in Europe 10% of the entire health budget GLUCODAY HELPAROUNDJERRY THE BEAR
  32. 32. GAMIFICATION FEEDBACK   PLAY   FRIENDS   engagement behavioral change, behavioral influence competition with friends motivation points, budges, trophies tasks to be performed
  33. 33. APPLE RESEARCH KIT
  34. 34. ARTIFICIAL INTELLIGENCE 20%   50%   80%   I etap II etap III etap EMPOWER EQUAL TO MD REPLACE 2020 2030 2045 By 2020 doctors will face The amount of medical data that a human could process The volume of medical data doubles every 5 years.
  35. 35. ZOYS AVATAR PROJECT AVATAR D AVATAR C AVATAR B AVATAR A 2040- 2045 2030- 2035 2020- 2025 2015- 2020 A hologram-like Avatar An Avatar with an artificial brain in which a human personality is transferred at the end of one’s life An Avatar in which a human brain is transplanted at the end of one’s life A robotic copy of a human body remotely controlled via BCI
  36. 36. THANK YOU. E-mail: mkocierz2014@gmail.com

×