future of cardiology
TRANSCRIPT
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
