future of cardiology

FUTURE OF CARDIOLOGY

MAGDALENA KOCIERZ-WOŹNOWSKA MD PhD

FIRST DEPARTMENT OF CARDIOLOGY MEDICAL UNIVERSITY OF SILESIA

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%    

%    

FUTURE OF CARDIOLOGY INVASIVE PREVENTIVE

ARTIFICIAL INTELLIGENCE

EMR

SENSORS TISSUE ENGINEERING NANOTECHNOLOGY

3D PRINTING

GENOMICS

TOTAL ARTIFICIAL HEART

WORLD: 4000 heart transplants / 10000 patients on the waiting list / year

•  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

Dwa mikrosilniki

TAH – FIRST PHASE OF CLINICAL TRIAL

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

PROCYRION-AORTIX

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%

TISSUE ENGINEERING, HOW TO BUILD A HEART ?

•  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

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

“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

3D TISSUE PRINTING

Micro CT of the aortic valve and 3D reconstruction

Hydrogel conduit 3D printing

Encapsulation of cells into the conduit

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)

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)

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

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

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

NON-INVASIVE ABLATION STEREOTACTIC WITH THE CYBERKNIFE

IMAGING

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

PORTABLE ECHO VSCAN

MOBIUS SP1

VISIQ

MOBIUS SP1

PREVENTION

CZUJNIKI

GAMIFIKACJA

EMR

AI

EMR

„WEARABLES” SENSORS

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

„PRO” SENSORS AliveCor

EMPA AUM CADence Perminova

Withings iBG Star

END OF THE STETHOSCOPE? Stethee

ViScope MD

Steth IO

IRHYTHM ZIO PATCH

VITAL CONNECT PATCH MD

•  EKG- 1 lead •  HR / HRV •  Respiratory rate •  Body temperature •  Movements •  Body posture/ collapses

IMPLANTABLE SENSORS

i-IronIC

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 HELPAROUND JERRY THE BEAR

GAMIFICATION

FEEDBACK  PLAY  

FRIENDS  

engagement

behavioral change, behavioral influence

competition with friends

motivation

points, budges, trophies

tasks to be performed

APPLE RESEARCH KIT

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.

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

THANK YOU.

E-mail: mkocierz2014@gmail.com