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.

1. FUTURE OF CARDIOLOGY
MAGDALENA KOCIERZ-WOŹNOWSKA MD PhD
FIRST DEPARTMENT OF CARDIOLOGY
MEDICAL UNIVERSITY OF SILESIA

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. FUTURE OF CARDIOLOGY
INVASIVE PREVENTIVE
ARTIFICIAL INTELLIGENCE
EMR
SENSORSTISSUE ENGINEERINGNANOTECHNOLOGY
3D PRINTING
GENOMICS

4. TOTAL ARTIFICIAL HEART
WORLD: 4000 heart transplants / 10000 patients on the waiting list / year

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. Dwa mikrosilniki
TAH – FIRST PHASE OF CLINICAL TRIAL

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. PROCYRION-AORTIX

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. TISSUE ENGINEERING,
HOW TO BUILD A HEART ?

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. 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. “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. 3D TISSUE PRINTING
Micro CT of the
aortic valve and
3D reconstruction
Hydrogel conduit
3D printing
Encapsulation
of cells into
the conduit

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. 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. 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. 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. 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. NON-INVASIVE ABLATION
STEREOTACTIC WITH THE CYBERKNIFE

21. IMAGING

22. NON-INVASIVE FFR
• 2011 EuroPCR innovation
• 11.2014 FDA approval
• DISCOVER-FLOW, DeFACTO, NXT
• FFRCT vs.CT-79 vs. 34% specificity

23. PORTABLE ECHO
VSCAN
MOBIUS
SP1
VISIQ
MOBIUS
SP1

24. PREVENTION
CZUJNIKI
GAMIFIKACJA
EMR
AI
EMR

25. „WEARABLES” SENSORS
One day of “wearables” use provides more
data than a doctor reads in a year.

26. „PRO” SENSORS
AliveCor
EMPAAUM CADencePerminova
WithingsiBG Star

27. END OF THE STETHOSCOPE?
Stethee
ViScope MD
Steth IO

28. IRHYTHM ZIO PATCH

29. VITAL CONNECT PATCH MD
• EKG- 1 lead
• HR / HRV
• Respiratory rate
• Body temperature
• Movements
• Body posture/ collapses

30. IMPLANTABLE SENSORS
i-IronIC

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. GAMIFICATION
FEEDBACK
PLAY
FRIENDS
engagement
behavioral change,
behavioral influence
competition with friends
motivation
points, budges, trophies
tasks to be performed

33. APPLE RESEARCH KIT

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. 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. THANK YOU.
E-mail: mkocierz2014@gmail.com