International conference on Cardiovascular Medicine August 01-02, 2016 Manchester, UK

Carolina Nunes França has completed her PhD from Federal University of Sao Paulo, Brazil and Post-doctoral studies from University of Bonn, Germany. She is Professor of University of Santo Amaro – UNISA (Health Science Post Graduation), Brazil. She has published more than 36 papers in reputed journals.

Introduction: Chronic kidney disease is characterized by loss, normally gradual and progressive, of the excretory capacity by kidneys and constitutes a serious public health problem and higher rate of cardiovascular events as acute myocardial infarct, stroke and mortality when compared to the general population. Endothelial micro-particles are shed by the membrane of different cell types after activation or apoptosis and are related to classic risk factors and cardiovascular disease. Objective: Evaluate if the progression of kidney disease is related to the increase in circulating endothelial micro-particles, in patients with established cardiovascular disease. Methods: Some variables related to kidney disease (urine and serum creatinine, albumine/creatinine relation, glomerular filtration rate) were correlated with endotelial micro-particle levels, in patients with cardiovascular disease (n=84), comparing the values obtained to micro-particles according to the stage of kidney failure. Results: There were no significant correlations between the parameters evaluated (correlation between endothelial micro-particles and serum creatinine [Spearman, rho = -0,208; p = 0,064]; correlation between endothelial micro-particles and glomerular filtration rate [Spearman, rho = 0.194, p = 0.085]), other correlations also not significant. Conclusion: There was no evidence concerning the increase of endothelial micro-particles related to the progression of kidney disease in patients with cardiovascular disease.

Max and Michael are both medical students in their fourth year, studying at the University of Birmingham. They are both interested in pursuing careers in cardiology and are keen to kick start their research portfolios. This will be their first medical academic conference

Background: PCI is recommended by NICE as an effective intervention in STEMI; however it is not entirely clear whether radial or femoral access is the optimal choice for this procedure. This literature review examines the evidence available and discusses which of the two approaches has the best impact on patient outcomes. Methods: The following review questions were drawn up to focus research: 1. Does radial access carry a reduced risk of vascular complications compared to femoral? 2. What is the difference in mortality between the two approaches? 3. What is the difference in quality of life between the two approaches? 4. Is there a significant reduction in reperfusion time using femoral access compared to radial? A literature search was conducted on the database MEDLINE. Due to the availability of good evidence on MEDLINE, other databases were not used in our literature search. Criteria included English language papers from 2010-2015. A total of 11 studies were included. Discussion: Overall, the studies examined revealed fewer vascular complications and a decreased mortality in patients undergoing PCI via radial access compared to femoral. There were no significant changes in quality of life between the two approaches. There were also no significant differences in reperfusion time. Conclusion: Although femoral has traditionally been the favoured approach for PCI, from the evidence base that across all age groups, it is evident that outcomes are improved using the radial approach. However, there is significant scope for research and innovation to improve techniques for radial access in the future.

Azar Hussain has completed his MBBS from Pakistan and completed his MRCS from Royal College of Surgeons of Edinburgh. He completed his MSc in Translational Research in cardiovascular medicine from university of Bristol. At present, he is pursuing his MD on ‘Effect of oxygen on small human pulmonary artery’ from Hull York Medical School. He is also pursuing a Diploma in Post-graduate research training and an MSc in healthcare improvement leadership. He published 5 papers in reputed journals and delivered talks on both national and international cardiothoracic forum.

Background: Different models are used to explore the underlying cellular and molecular mechanism of lung disease especially pulmonary vascular disease but most of the experiments were performed on animal models with little evidence available from humans. Objective: The aim of this study is to provide a baseline optimal resting tension (ORT) value for performing experiments on human pulmonary artery rings and strips. Methods: After REC approval, tissue samples were collected from lung surgery patients. Total 20 PA rings of internal diameter 2-4 mm and 2 mm long were prepared and mounted under physiological conditions in organ bath system and myograph. After equilibration at 1g basal tension, 40mM KCl induced active tension (AT) recorded. Samples washed for 30 minutes and repeated twice at 1g to confirm reproducibility. Further experiments performed at 1.2g, 1.4g, 1.6g, 1.8g and 2g basal tension and KCl induced AT recorded. Results: In human pulmonary artery rings increasing the basal tension from 1.0 g to 1.6 g significantly augmented the 40mM KCl induced active tension. Increasing the active tension from 1.6 g to 2.0 g either decreased or plateaued the 40mM KCl induced response. Both organ bath and myograph shows similar result and confirmed that optimal RT for human pulmonary artery rings to be 1.61 g. The optimal resting tension in our experiment was 1.61 g for pulmonary artery ring. Conclusion: More studies are needed to validate this data and also to identify if the optimal resting tension is different in different size pulmonary arteries.

It is well established that physical exercise continues to be one of the most valuable forms of non-pharmacological therapy against diabetes mellitus; however, the precise mechanism remains unknown. The aim of this study was to investigate the cardio-protective effect of voluntary exercise in the Goto-Kakizaki type 2 diabetic rat hearts against ischemia reperfusion injury and to clarify its biochemical background, focusing on the nitric oxide synthase/hemeoxygenase system.

Amin Al-awar is a PhD student at University of Szeged. He is currently conducting research at the Biology Doctoral School/ Faculty of Sciences and Informatics, specifically in the department of Physiology, Anatomy and Neurosciences at Csaba Varga’s Endocrinology Lab, as he is the head of the department too. His PhD studies and research is under the supervision of Dr. Krisztina Kupai, who holds a PharmD and PhD degree and in her account around 30 papers published in international and reputed journals in the field of Diabetes and Cardiovascular diseases. He is also a member in the European Cardiovascular Society.

To be updated soon...

Purpose: To assess compliance with and awareness about oral anticoagulant therapy (OAT) among Saudi patients, and their willingness to use the point-of-care (POC) INR testing devices for self- monitoring. Methods: A cross-sectional study was conducted in the anticoagulation clinic at King Khalid University Hospital (KKUH) in Riyadh, Saudi Arabia over the period of six months.A face-to-face interview questionnaire was carried out for all patients fulfilling the inclusion criteria and analysed according to: demographics, adherence, knowledge, and INR control. Compliance and knowledge were assessed based on Morisky 8-item medication adherence scale and the oral anticoagulation knowledge test (OAK) respectively. Comparison between knowledge, adherence and INR range with demographics was conducted. Results: Most of the respondents were on warfarin (89.5%). Generally, Patients had poor knowledge and medium adherence (53.1%) with OAT predominantly among the elderly. (24%) of the Poor Knowledge group (PKG) were high adherent participants compared to (14.5%) of the Fine Knowledge Group (FKG). However, (53.2%) of FKG had a controlled INR where this percentage falls into (27%) in the PKG, with a significant difference between the two regarding their INR range (p=0.001). Majority of patients (74.7%) were eager to make use of the POC-INR devices. Conclusion: Patients had poor knowledge about OAT, but most of them were highly adherent compared to the FKG. However, significant difference was noted in INR control where the FKG had controlled INR more than the PKG. Our results show that the level of knowledge didn’t affect the degree of compliance, but educational programs would definitely help patients in having less complication, less visits to the clinics and improve their routine in general. The majority of Patients were accepting to the idea of using the POC-INR devices, which will help them in keeping the INR within the therapeutic range, and potentially reducing adverse clinical outcomes.

Bo-Jen Chen is a medical student in China Medical University, Taiwan.

Air Pollution, especially fine particles (PM 2.5) has been an important issue in Taiwan recently, especially in the three biggest cities, Taipei, Taichung and Kaohsiung. This study focused on the association between air pollutants concentrations (data from Taiwan Environmental Protection Administration (EPA)) and cardiovascular mortality (data from Taiwan Death Registry (TDR) provided by the Department of Health (DOH)). Concentration of fine particle is Kaohsiung>Taichung>Taipei (Daily average in 2006-2009: 46.84, 35.59, 30.11; Taiwan 34.61). Taichung, with moderate weather, appears to have most notable long-term effect of fine particle on cardiovascular disease death, which is especially evident in the cold season (Relative risk of Taichung: 1.06 in warm season, 1.34 in cold season; Taiwan: 0.98 in warm season, 1.02 in cold season). The long-term effect of fine particle on hypertensive disease and cerebrovascular disease is notably obvious in cold season in Taichung (Relative risk: hypertensive disease 1.47, cerebrovascular disease 1.36 in cold seasons; hypertensive disease 0.95, cerebrovascular disease 1.03 in warm seasons). On the other hand, short-term effects of fine particle on hypertensive disease are most evident (Odds Ratio: 1.89 in cold season). The long-term effect of fine particle on cardiovascular disease death is very obvious in the city Taichung. Seasonal effects in the cold season seem to worsen the situation. We also take the difference in composition of the fine particles in the three cities into consideration. Future work will include co-effects between weather and composition in different cities on the issue of fine particle effects on cardiovascular disease.

Alzahrani completed MSc in integrated physiology in health and diseases at Nottingham University in 2013. Then, she stared PhD in 2014 in the physiology (Beat to beat Cardiovascular monitoring using Finometer/concentration in cardiovascular response to autonomic stress testes) at Nottingham University. Alzahrani interested in developing a method to evaluate the autonomic disorders such as Diabetic Neuropathy.

Study Objective: The aim of this study was to develop a method of assessing cardiovascular function (heart rate (HR), cardiac output (CO), blood pressure (BP)) in response to deep breathing, standing maneuver and handgrip exercise, using a Finometer. Subjects: Twenty subjects (10 males and 10 females) were healthy, young mean age 24.4 years males and 26.7 years females, non-obese mean ± SD of BMI was 23.4±7.4, 22.8±4.5 males and females respectively. Methods: Beat to beat heat rate and blood pressure variability were monitored during deep breathing test, posture change to standing position and handgrip exercise using a Finometer. This involves a finger cuff pressure which placed in the middle left finger and arm cuff pressure on the upper left arm. Then, automatic calibration was made followed by recording of baseline measurements for 3 minutes and then physiological maneuvers were performed starting with deep breathing (2 minutes), standing (2 minutes) and handgrip exercise at 20%, 40% of MVC (2min) and 60% of MVC (1 minute). This event separated by time for recovery (15min) as well as (3min) baseline measurements before each physiological maneuver. Results: A significant increased and decreased in cardiovascular parameter during inspiration and expiration in both gender respectively (p<0.05). Orthostatic maneuver caused a significant reduction in systolic blood pressure and cardiac output whereas HR (p<0.05) and DBP (P>0.05) increased in both genders. Cardiovascular parameters showed a significant increased during handgrip exercise at 40% and 60% of MVC but not during 20% of MVC. Discussion: Cardiovascular changes during inspiration and expiration caused a stimulation or inhibition of pulmonary stretch receptors respectively; this was companied with changes of abdominal and intra-thoracic pressures. This was confirmed in the study, a significant reduction (P≤0.05) of the parameters during inspiration and increased (P≤0.05) during expiration which completely driven by parasympathetic nervous system. Posture maneuver causes blood pooling to the lower part of the body lead to decrease of cardiac output and venous return which stimulated the sympathetic and inhibited parasympathetic nervous system which in turn causes an increases of heart rate to maintain a reduction of blood pressure. A significant increase of cardiovascular parameters (P≤0.05) during handgrip exercise at 40% and 60% of MVC and this was due to stimulation of sympathetic discharge and inhibition of vagal tone as well as peripheral reflexes which originated from exercising muscle. Gender differences in responses to autonomic stress tests might be related to several factors such as body size, muscle mass and sex hormone. Overall, a variability of cardiovascular parameters during physiological maneuvers reflected the integrity and effectiveness of neuro-cardiovascular control. This will apply on the patients suffering from diabetic neuropathy and therefore developed a method to evaluate the autonomic nervous disorders.

Ana-Catarina Pinho-Gomes has completed two MSc degrees in Medicine and Cardiovascular Pathophysiology from the University of Porto, Portugal. She is currently a Cardiothoracic Surgery trainee in Manchester. She has already won over 25 academic prizes and published eight papers in reputed journals. She is a Member of the leading committees of the Association of Surgeons in Training and the Cardiothoracic Trainees Research Collaborative. Besides translational and clinical research in Cardiovascular Medicine, she is keen on teaching and pursuing a MSc degree in Medical Education at the University of Liverpool.

We report the first case of infective endocarditis caused by Paenibacillus provencensis, a very rare gram-positive spore-forming rod. A mitral valve vegetation was incidentally discovered by intra-operative transoesophageal echocardiography in a 70-year old lady undergoing aortic valve replacement. Empirical antibiotic treatment for infective endocarditis with gentamicin and teicoplanin was started. The precise identification of the causative agent relied on genotypic characterisation with 16S rDNA gene sequencing. Microbiologic culture was subsequently performed to obtain the antimicrobial susceptibility profile and adjusted the antibiotic regimen accordingly. The patient was treated with a four weeks course of vancomycin and meropenem, followed by a further two weeks of daptomycin due to the identification of vancomycin-resistant enterococci in a rectal swab. After a long in-hospital stay, the patient eventually recovered clinically and biochemically and transthoracic echocardiogram demonstrated a well-functioning mitral valve without residual lesions from the endocarditis. This is, to the best of our knowledge, the first report showing that Paenibacillus provencensis can be a pathogen in humans and that a member of the genus Paenibacillus may be involved in native valve endocarditis. This case also emphasises the importance of 16S rDNA gene sequencing by real-time polymerase chain reaction, as a rapid and accurate method to identify microorganisms, like Paenibacillus, which can be missed by conventional microbiology investigations.

Ghasem Yadegarfar has completed his PhD at the age of 43 years from Manchester University and postdoctoral studies from Manchester University Age & Cognitive Research Centre. He is a senior lecture in Epidemiology & Biostatistics. He has published more than 40 papers in reputed journals and has been serving as a reviewer of EJC and an editorial board member of Kerman University of Medical Sciences.

Objective: The role of job stress as a risk factor for chronic disease has been in debate. Several investigators argue in support of a causal connection while others remain controversial. The job stress in Iran and its relationship with cardiovascular diseases has not been focused on many scientific studies. This study was conducted to investigate health aspects of stressful work on cardiovascular disease risk factors. Method: This prospective cohort study was carried out on 227 male employees from 2010 to 2012. The Farsi version of Siegrist's ERI questionnaire was employed to measure job stress. Medical examination including height, weight, blood pressure and lipid profile were collected at pre-employment, baseline and 3 times in a 6-months interval. A two-level linear regression model was applied to CVD risk factors as outcome to evaluate the effect of job stress. Result: Median age was 30, mean scores of effort, reward, and over commitment were 10.7(SD=3.6), 41.4(SD=9.2), 14.1(SD=2.6) at baseline. Adjusted results for shift work, smoking, pre-employment height, weight, glucose, triglyceride, cholesterol, SBP and DBP showed age as a significant predictor of longitudinal change in BMI, SBP, DBP, LDL, total cholesterol; reward only predictor of BMI(β=-.01, p=0.012, 95% CI: -0.02, .002); effort predictors of LDL(β=-3.7, p=0.026, 95% CI: -6.9, -.44) and HDL(β=0.3, p=0.004, 95% CI:0.10, 0.51), and over commitment a predictor of HDL(β=-0.45, p=0.003, 95% CI:-0.75,-0.15). Conclusion: Components of job stress targeted some of CVD risk factors, reward only predictor BMI, effort predictors of LDL and HDL, over commitment a predictor of HDL, and age is a longitudinal predictor.