Singularity University Exponential Cardiology

Christian Assad-Kottner MD Twitter: @Christianassad

FutureMed 2011

The future of cardiology

to understand the future

one must understand the past

Risk Factors

hypertension Diabetes Age M>55 F>65 obesity

gfr < 60ML/MIN TOBACCO SEDENTARISM FAMHX

the core of cards

DIABETES

HYPERTENSION

OBESITY

DYSLIPIDEMIA

SMOKING

DEFINITION

DIABETES FASTING GLUCOSE > 100 2 HOUR GLUCOSE TOLERANCE TEST > 200 HGBA1C >6.5

HYPERTENSION

NORMAL <120 / <80 PREHYPERTENSIVE 121-139/80-89 HYPERTENSION 1 140-159/90/99 HYPERTENSION 2 >160/>100

DYSLIPIDEMIA

NO RISK FACTORS LDL <160 1-2 LDL <130 >2 LDL <100 PREFERABLY <70

SMOKING ATHEROSCLEROSIS, DECREASED NO

OBESITY

BMI: 18-25 NORMAL 25-30 OVERWEIGHT 30-39 OBESITY >40 MORBID OBESITY > ORLISTAT - GASTRIC BYPASS

POPULATION AFFECTED Cost

DIABETES 29 million. 8m dont know they have it

$245 billion

HYPERTENSION 67 million $47.5 billion

DYSLIPIDEMIA 71 million $35 billion

SMOKING 42.1 million $193 billion

OBESITY 78 million $210 billion

http://www.cdc.gov/heartdisease/!

CORONARY ARTERY

DISEASE

HEART FAILURE

PERIPHERAL ARTERIAL DISEASE

DIAGNOSTIC TESTS

EKG TTE/TEE CT/MRI/PET CORONARY ANGIOGRAPHY LABS

IMAGING STUDIES ECHO CT/MRI LABS

ABI ARTERIAL DUPLEX CT ANGIOGRAPHY

MEDICATIONS

Aspirin ACEi/ARB BBlockers Statins CCB C2PY12 Inhibitors

BBlockers Acei Statins Inotropic Agents Drips: Milrinone, Dobutamine, Dopamine

Good Luck Cilostazole

INTERVENTIONS

Revascularization Bypass Surgery Percutaneous Intervention

Inotropic Medications Heart Transplant

ATHERECTOMY BALLOON ANGIOPLASTY

DEVICES IABP IMPELLA ECHMO

IABP IMPELLA LVAD: HEART MATE

LASER WILDCAT SILVERHAWK OCELLOT JETSTREAM

the present

ATHEROSCLEROSIS

CORONARIES / PVD -  STENTS -  ANGIOPLASTY -  ATHERECTOMY -  THROMBECTOMY -  CABG ARRYTHMIAS -AICD -CRT -PACEMAKERS VALVULAR DISEASE -OPEN HEART -TAVR -MITRAL HEART FAILURE -  TRANSPLANT -  LVADS

STENTS/BALLOONS - BARE METAL STENTS - DRUG ELUTING STENTS - BIOABSORBABLE

SUPPORT DEVICES - IABP - IMPELLA

LEFT VENTRICULAR ASSIST DEVICES - HEART MATE II

ATHERECTOMY DEVICES -TurboElite Excimer Laser - DIAMONDBACK 360 ORBITAL - SILVERHAWK/TURBOHAWK - JETSTREAM

TRANSPLANTATION - PACEMAKERS/AICD/CRT

AORTIC VALVES - Direct Flow - Sadra Lotus - St. Jude Portico - Engager - Symetis Acurate - Jena Valve

MV replacement - CardiAQ - mitral clip - EndoValve - Valtech Cardiovalve - ValveXchange - Lutter Valve - Neovasc - Medtronic - Edwards

IABP - Impella Valve Replacement

Atherectomy Devices

Thoracic Endovascular Aortic Repair

MITRAL CLIP

evar

140,000

to

180,000

euros

Carmat estimates 100,000 could benefit from its artificial heart, a market worth more than 16 billion euros ($22 billion)

December 18, 2013 at Georges Pompidou European Hospital team in Paris (France) - a world first. Died in March 2 (75 days)

Carmat

imaging

By 2030, approximately 40% of the U.S. population is expected to have some form of CVD. !

http://www.cdc.gov/heartdisease/!

As a result, direct medical costs for CVD in the U.S. are expected to triple from $273 billion

currently to $818 billion in 2030.!

After 2030 we will be adding one year of life for every year that passess.

how to tackle cvd?

THE FUTURE OF CARDIOLOGY

COMES IN 2 FLAVORS

THIS IS ONE…

ai

Sensors

3D Printing

emr

Tissue

Engineering

genomics

invasive

prev

Nanotechnology

Tissue Engineering/3d printing

Tissue Engineering/3d printing

Using hydrogels, and combination of microCT imaging, custom algorithms, and 3D printing to generate cell-seeded valves!

http://www.bme.cornell.edu/!

Tissue Engineering/3d printing

Adenoviral Vector to insert T-box 18 gene related to development of SA NODE. Converts cardiomyocytes into pacemaker cells.

Biological

Pacemaker?

http://stm.sciencemag.org/content/6/245/245ra94!

Genetically modified pigs (GTKOhTg.hCD46.hTM) with modified targeted immunosuppression (anti CD40) achieved long term cardiac xenograft survival

preventive

POPULATION AFFECTED Cost

DIABETES 29 million. 8m dont know they have it

$245 billion

HYPERTENSION 67 million $47.5 billion

DYSLIPIDEMIA 71 million $35 billion

SMOKING 42.1 million $193 billion

OBESITY 78 million $210 billion

!

Predictive!

preventive!

personalized!

participatory!

!

!

4p!

http://www.nature.com/polopoly_fs/1.14702!/menu/main/topColumns/topLeftColumn/pdf/506144a.pdf!

!

march 2014 !

pilot study!

“the Hundred

Person Wellness

Project”!!

!

leroy Hood !

!

president of the !

I nst i tute for

Systems Biology!!National Medal of Science!!

ISB will sequence whole genome of each participant"Wear digital devices that will continuously record activity, sleep, vital signs"Every 3 months researchers will gather samples of participants"Blood- CBC,BMP plus 20 less-commonly monitored variables"Urine- Measure 5 biochemicals"Saliva- Measure 5 biochemicals "Stool- Major microbial species"

Implantable Wireless Biosensors!

i-IronIC puede detectar distintos metabolitos "

What does that

data mean?

SENSORS EMR

GAMIFICATION

80%!

20%!

Healthcare Provider + AI Team

50%!

50%!

20%!

80%!

Stage I

Empower

Stage II

Equal to MD

Stage III

replace

ai roll to assess Big Data, EMRs, Genetic Testing, Symptoms and environment for a/P

•  innovate do not renovate

•  not because we do things one way means that it is the “right way”

•  preventive focus is what can save healthcare

•  invasive focus is what will save our aging patients

•  there is a right project for your particular stage in life. do not limit yourself

points

Thank You E-mail: christianassad@gmail.com Twitter:@christianassad http://about.me/christianassad exponentialmed.com