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Cardiovascular Medicine
1st edition, november 2012
www.heartsoc.co.uk
The future of
cardiovascular
medicine?
cardiac regeneration
medicine: synthetic
cardiac grafts
foreword
Cardiology remains one of the most exciting
and rapidly evolving specialties in the whole
of medicine and, as a result, always tends to
attract high quality trainees. This is
fortunate as cardiovascular disease accounts
for a large proportion of the patients seen
both in hospital and in primary care and
remains one of the biggest killers in modern
Western society.
It was as a 3rd year medical student that I first became attracted to Cardiology as a
specialty and I hope this national undergraduate cardiovascular conference will serve
as a catalyst for many of you to pursue a similar path. Cardiology has always been a
fascinating and rewarding specialty. The clinical and research developments in
cardiology have been massive and eclipsed most other specialties. There is no
indication that this rapid pace of development in cardiology is likely to slow down
over the duration of your own careers in medicine.
I must congratulate the organisers of the National Undergraduate Cardiovascular
Conference 2012 for putting together such an excellent programme spanning both
research and a spectrum of clinical specialties in modern cardiovascular care. It will
give you a valuable insight into why cardiovascular medicine remains one of the most
innovative, challenging and, above all, rewarding areas of modern medicine. I am
sure you will have a fantastic day.
President
the committee
Alexander Bush
Speakers &
Seminars
Speakers &
Seminars
Treasurer &
Sponsorships
Michael Stephanou
Research
Presentation
Research
Presentation
Publications &
Media
Hamed Hajiesmaeili
Stelios Iacovides
Ka Ho Oscar Chiu
Committee Support
Aman
Chungh
Stephanie
Kwok
Luke
Michael
Claire
McAleer
Avinash
Segaran
contents
Programme
Speakers Biographies
Abstracts:
The Panel
12
Oral Presentations
14
Poster Presentations
16
Delegate Information
24
programme
08:00 09:00
Registration
09:00 09:15
Welcome
09:15 10:00
10:00 10:45
Electrophysiology
-Dr. Arthur Yue
10:45 11:15
Coffee/Poster Presentations
11:15 12:00
12:00 12:45
12.45 13:45
Lunch/Poster Presentations
13:45 14:30
Oral Presentations
14:30 15:15
15:15 16:00
16:00 16:15
Coffee/Poster Presentations
16:15 17:00
Cardiothoracic Surgery
-Mr. Nicola Viola
17:00 17:30
17:30 18:00
youtube.com/medicaldefenceunion
@The_MDU
the speakers
Keynote Speaker: Professor Alexander Seifalian
Dr. Alex Seifalian is a Professor of Nanotechnology
and Regenerative Medicine at the Division of
Surgery & Interventional Science, University College
of London, UK. His breakthrough work in bypass
grafts for cardiovascular treatment saw the
Professor awarded the 2007 'Winner of The Overall
Cardiovascular Innovation Award' by the prestigious
Medical Futures Innovation Awards panel, while his
work on harnessing nanotechnology for implanted
devices has resulted in the development of 'NASA style' nanotechnology coatings for
bypass grafts used in heart and blood vessel surgery.
His research interests include development of nanomaterials, development of
cardiovascular implants, development of nanofluorescence particle including
quantum dots for localization and treatment of cancer, stem cells for development of
organs using tissue engineering, development of organs using biodegradation
nanomaterials and stem cells, including liver and intestine, hepatic microcirculation
and oxygenation using an optical technique, ischemia repercussion injury and
preconditioning. In fact, the team lead by Dr. Seifalian patented a nanocomposite
material that was used to create the first ever completely synthetic windpipe.
the speakers
Dr. Andrew Whittaker
Dr. Whittaker is currently a 4th year Cardiology Specialty Registrar
training in Interventional Cardiology. From January 2013 he will be
the Interventional Cardiology Fellow at Wessex Cardiothoracic
Centre. He qualified from University of Leicester Medical School in
2000 and completed his PRHO and SHO training in Leicester. After
gaining MRCP he undertook a 3-year period of research in
cardiovascular medicine for which he was awarded a Doctorate in
Medicine. His research project was titled The Role of Endothelial
Progenitor Cells in the Aetiology and Pathogenesis of Coronary
Artery Disease. He subsequently entered Specialist Registrar
training in Cardiology and is currently enjoying his training in the Wessex Deanery.
His sub-specialty interest is Interventional Cardiology (percutaneous coronary and
valvular interventions). Dr. Whittaker maintains an interest in clinical research with
special interest in coronary artery disease pathophysiology, endothelial dysfunction
and repair, cardiovascular genetics, and cellular reparative mechanisms in
cardiovascular disease.
the speakers
Dr. Aisling Carroll
Dr. Carroll is a consultant cardiologist
specialising in adult congenital heart disease at
Southampton General Hospital. She graduated
from National University of Ireland, Galway
and completed her sub-specialty Cardiology
Fellowships in adult congenital heart disease,
heart failure and cardiac transplantation at
Mayo Clinic, Minnesota, USA. She is a
prominent speaker having given many talks in
various cardiology and congenital heart disease
conferences.
10
1
OxfOrd HandbOOk Of
CardiOlOgy
Second edition
A brilliant and
comprehensive review
of cardiology. It is
easily the best quick
reference guide in
cardiology available.
- Cardiology News
Visit www.oup.com/uk/medicine
for more information and to order your copy
abstracts
The core around which this conference is based is the cardiovascular research being
conducted by undergraduates around the country. This year, four students will be presenting
their research during an oral plenary session. Up to 20 more students will be presenting their
work as a poster. This represents a fantastic opportunity for undergraduates involved in
cardiovascular research to present their work to a national audience of interested students,
and to our faculty of leading cardiovascular researchers.
The Panel
Dr. Simon Corbett
12
abstracts
Dr. Paul Roberts
Dr.
James
Rosengarten
James is currently the Research Fellow in Cardiac Rhythm Management, based at University
Hospital Southampton. Under the supervision of Prof. Morgan and Prof. Hanson at the
University of Southampton, he is utilising engineering techniques to discover novel
biomarkers of sudden cardiac death risk. He is a Wessex specialist registrar in cardiology,
specialising in electrophysiology and devices. He has a strong interest in education and
training, from examining students at the University of Southampton, through to representing
Wessex trainees at a national level.
13
abstracts
Oral Presentations
Is there a difference in self-reported quality of life between affected and unaffected paediatric cardiac
patients?
Name: Revati Kumar
University/ Trust/ Department: University College London, United Kingdom
Project Type: Clinical
Project Field: Paediatric Cardiology
Authors: Revati Kumar, Dr. Sara O'Curry, Ms. Holly Clisby, Dr Juan Pablo Kaski
Abstract
Background: A well-documented effect of suffering from a chronic condition is the impact on the patients healthrelated quality of life. However, for paediatric conditions, literature is currently divided. The relative rarity of the
conditions means that there is a scarcity of information. Aim: The purpose of this study was to evaluate whether
affected children self-reported a difference in quality of life when compared to unaffected children. Methods: 83
children between the ages of 8 and 18 presenting to the heart function, hypertrophic cardiomyopathy and inherited
arrhythmia clinics at Great Ormond Street Hospital formed the study population. The tools used to measure quality of
life were the PedsQL Generic Core Scales 4.0 and the PedsQL Cardiac Module 3.0, well-established and validated
questionnaires. In addition, a subgroup analysis within the affected cohort sought to investigate whether the severity
of the condition affected quality of life. Results: Results indicated that affected children experience a lower quality of
life than unaffected children in terms of their physical capabilities (p=0.035). No difference was demonstrated
between the cohorts in terms of psychosocial functioning (p=0.071). The subgroup analysis indicated no difference in
quality of life between the groups; further research with larger sample sizes may be necessitated in order to validate
these findings. Conclusions: The findings indicate that although affected children have significantly lower physical
abilities than unaffected children, they are currently receiving excellent psychological support to help them cope with
their illness, and this should be maintained.
Effect of remote ischaemic conditioning (RIC) on myocardial infarct size in STEMI patients
undergoing primary PCI
Name: Fiona Chan
University/ Trust/ Department: University College London, United Kingdom
Project Type: Clinical
Project Field: Cardiovascular Clinical Trial
Authors: Fiona Chan, Steven White, Derek M Yellon, Derek J Hausenloy
Abstract
Background: Despite optimal therapy, patients with a ST-elevation myocardial infarction (STEMI) still experience
significant morbidity and mortality. Remote ischaemic conditioning (RIC) may be a novel therapeutic strategy for
improving outcomes in STEMI patients. In RIC, cardioprotection is elicited by serially inflating and deflating a blood
pressure cuff on the upper arm to induce cycles of non-lethal ischaemia and reperfusion. In ERIC-STEMI, we
investigate whether RIC could reduce MI size in patients undergoing primary percutaneous coronary intervention
(PPCI). Methods: The ERIC-STEMI is an ongoing single-centre, single-blinded randomised controlled clinical trial
that investigates whether RIC reduces MI size and improves myocardial salvage in STEMI patients undergoing PPCI.
Patients with suspected STEMI are recruited on arrival at the PPCI centre, then randomised to receive either RIC or
control. In the RIC protocol, a blood pressure cuff is inflated to 200mmHg for 5 min then deflated for 5 min, a cycle
repeated 4 times. Control patients have a deflated cuff for 40 minutes. Blood samples are taken for measurement of
serum Troponin-T at the time of PPCI and 6, 12, 24 and 48 hrs following PPCI. A 48hr area under the curve (AUC) was
calculated as a measure of MI size. Patients also have cardiac MRI at discharge and at 6 months to assess MI size,
myocardial salvage, cardiac remodelling and function. Results: As of August 2012, 180 patients have been recruited.
An interim analysis of the blood results for 114 patients (n=54 RIC; n=60 control) revealed that RIC resulted in 23%
reduction in 48hr AUC TroponinT (71,518 ng/L (7,616) with RIC versus 93,669 ng/L (7,969) with control;
p=0.047). Conclusions: In this interim analysis of 114 patients of the ERIC-STEMI study, it appears that STEMI
patients randomised to receive RIC prior to PPCI had a 23% smaller MI size when compared to control patients.
14
abstracts
The role of circulating endothelial precursor cells in the development of arteriovenous fistulae used
in haemodialysis
Name: Sonul Gajree
University/ Trust/ Department: University of Glasgow, United Kingdom
Project Type: Laboratory
Project Field: Renal Transplantation & Haemodialysis
Authors: Vesey A, Gajree S, Glen J, Aitken E, Clancy M
Abstract
Background: Circulating endothelial precursor cells (CEPC) are central to vasculogenesis. Maturation of an autologous
arteriovenous fistula (AVF) requires a large expansion of blood vessels and may depend on vasculogenesis. We aimed
to evaluate the role of CEPCs in AVF maturation. Methods: Patients with end-stage renal failure about to undergo
creation of an AVF were recruited. Whole blood was sampled immediately pre-op, 2 days post-op and 4 weeks post-op.
CEPC quantification was performed using a commercially available kit. Clinical and duplex ultrasound assessment was
undertaken immediately pre-op and 4 weeks post-op. CEPC titres were correlated with clinical and ultrasonographic
outcome data. Results: Interim data are summarised (n=15). There was a trend to lower baseline CEPC titres in
subjects compared to healthy controls. Smoking was significantly associated with lower baseline CEPC levels
(p<0.0005). Day 2 post-op levels of CEPC were significantly higher than pre-op levels (p=0.028). At the time of
writing, 5 patients had completed 4 week follow-up with 100% primary patency. Fistula diameter was positively
associated with immediate post-op rise in CEPC levels (p=0.015) but not with baseline CEPC levels. Conclusion:
Although these are early results, it has been demonstrated that a greater immediate post-op rise in CEPC count is
associated with a larger fistula diameter at 4 weeks. It is hoped that these results will be confirmed and translate to
clinical outcomes as more patients are recruited. A targeted pharmacological intervention designed to increase CPEC
levels (e.g. erythropoetin) and potentially improve AVF patency could then be tested.
What is the angiographic significance of reciprocal ST segment depression in ST elevation
myocardial infarction?
Name: Charles Johnson
University/ Trust/ Department: University of Sheffield, United Kingdom
Project Type: Clinical
Project Field: Acute STEMI
Authors: C Johnson, S Brown, S Turton, A Sultan, R Orme, C Jackson, D Tayler, A Morton, J Gunn
Abstract
Background: ST elevation myocardial infarction (STEMI) is frequently associated with reciprocal
electrocardiographic ST segment depression. For 30 years there has been debate about the significance and origin of
this finding. The advent of primary angioplasty for STEMI allows us to re-examine the question. Method: We analyzed
the ECGs and angiograms of patients presenting to the primary angioplasty service of our hospital with STEMI
between June and December 2009. STEMI was defined as characteristic chest pain with ST elevation (STE) 1mm in
2 limb leads or 2mm in 2 contiguous chest leads, and reciprocal change as 1mm ST depression in the inferior
leads for anterior STEMI, and in the anterior leads for inferior STEMI. We measured the aggregate magnitude of STE
in each territory. We determined the extent of angiographic disease, both culprit (ipsilateral) and bystander
(contralateral), in terms of the number of coronary arteries and segments affected, the SYNTAX scores, and vessel
dominance. Results: Of 188 patients, 70% were male, the mean age was 63.4 years, 95 had anterior and 93 inferior
STEMI. Reciprocal change was seen in 39% of anterior and 46% of inferior STEMIs. The magnitude of STE for inferior
STEMIs was 81% greater for cases with reciprocal change than for those without (p<0.001); and for anterior STEMIs it
was 27% greater (p=0.05). There was a correlation between ipsilateral maximum STE and contralateral maximum ST
depression for inferior, but not anterior, STEMI. There was no relationship between reciprocal change and
contralateral coronary artery disease (vessels, segments or SYNTAX score) for either anterior or inferior STEMIs.
Conclusion: The magnitude of reciprocal ST segment depression in STEMI is related to the magnitude of STE in the
culprit territory, and is unrelated to the presence or extent of non-culprit disease. Reciprocal change probably reflects
the size of the index STEMI itself.
15
abstracts
Poster Presentations
Prevention of stroke following a transient ischaemic attack
Name: Zenab Sher
University/ Trust/ Department: Kings College London, United Kingdom
Project Type: Audit
Project Field: Vascular Medicine
Authors: Zenab A Sher
Abstract
Introduction: In the UK, stroke accounts for 11% of deaths. A Transient Ischaemic Attack (TIA) is a neurological emergency, caused by risk factors
for stroke. Its clinical presentation includes unilateral hemiplegia, hemiparesis, coordination problems and speech and visual disturbances,
depending on the location of the lesion. The patient usually recovers from these symptoms within a day, unlike a stroke which may lead to
permanent disablement. The risk of developing stroke after a TIA is greatest in the first 48 hours following onset of symptoms. Intervention and
treatment after a TIA can help reduce this from 10% to much lower in the highest risk patients. Based on the ABCD2 scoring system, a high risk
patient is someone with a score of >4. Aim: To see if NICE guidelines are met appropriately are all high risk patients seen by a specialist within 24
hours of symptom onset? Methods: Retrospective data analysis of consultation outcomes and delay to treatment for TIA patients at the stoke unit, in
April - July in 2010. Results: 37 patients were seen in the TIA clinic, 46% of which were diagnosed as TIA. The remaining 54% presented with
stroke-like symptoms which were other causes. 88% of the TIA patients were treated with Aspirin, whilst the remainder 12% were already on
warfarin. Of the TIA patients, 47% were classified as high risk of stroke as they had an ABCD2 score of 4 or more. From the high risk patients,
87.5% were seen in clinic within 24 hours of symptom onset. Conclusion: A considerably high number of patients were seen by a specialist within
the recommended time frame based on NICE Guidelines, however not all patients are referred within the 24 hours. Telephone triaging, referrer
education and raising public awareness of stroke symptoms can help improve this.
The use of atrial fibrillation cycle length as a predictor of ablation success
Name: Alexandra Hanlon
University/ Trust/ Department: King's College London, United Kingdom
Project Type: Article
Project Field: Atrial fibrillation ablation
Authors: Alexandra Hanlon
Abstract
The current policy to ablate only those patients with paroxysmal AF (duration <7 days) is too excluding, and the use of AF cycle length (AFCL) is
proposed as the method of patient selection. Longer AFCL is known to reflect reduced AF complexity, and the current study shows that a surface
ECG recorded intra-f wave duration of >142ms has a specificity of 92.9% and sensitivity of 69.7% in predicting successful termination of persistent
(>7 days) AF at ablation, with success being defined as maintenance of sinus rhythm without pharmacological antiarrhythmic treatment for more
than 12 months. Furthermore, an AFCL of >142ms in conjunction with an AF duration of <21 months has a 100% specificity in predicting
procedural termination of AF. Longer AF cycle length also correlates with better response to antiarrythmic therapy and DC cardioversion. Therefore,
it is proposed that surface ECG AFCL should be the method of patient selection for ablation, in order to include those patients with long AF
duration, but who may still undergo successful ablation.
A comprehensive approach to the reduction of device-related infection in a cardiology department
Name: Kirsty Bromage
University/ Trust/ Department: University of Bristol, United Kingdom
Project Type: Audit
Project Field: Implantable Cardiac Devices
Authors: Richard Bond, Daniel Augustine, Kirsty Bromage, Lara Howells, Richard Kilbey, Stuart Walker, Mark Dayer
Abstract
Introduction: Infection is a serious complication of cardiac device implantation (CDI). Few large-scale clinical audits have been carried out, meaning
estimations of risk may not reflect current practice. Aims: To quantify infection rates of CDI procedures carried out in a district general hospital
before and after the instigation of a comprehensive infection control policy. Methods: Retrospective analysis of outcomes for all CDIs from January
2007 to May 2012. Following a spike in infection rates, a series of changes were introduced during June 2011 and beyond in an effort to reduce
device-related infections. These comprised: Chloroprep instead of povidone-iodine/chlorhexidine, a pre-pacemaker shower, routine venograms
stopped, Vicryl Plus in place of Vicryl, any instruments with rust removed from use, Flucloxacillin for 48h, MSSA screening for high risk cases
(September 2011) and all cases (May 2012), theatre air filters and flows replaced/reviewed, Chlorhexidine nail brushes. Results: Prior to the review
of practice, 1948 CDIs were carried out, 35 of which resulted in device-related infections (1.8%). We identified two spikes in infection rates that were
significantly higher than our long-term infection rates: April-July 2010 (4.8%, Fishers exact test p=0.019) and February-June 2011 (3.8%, Fishers
exact test p=0.043). Since the comprehensive review of practice was implemented, there has only been 1 infection within 3 months of device
implantation out of the 318 cases performed between July 1st 2011 and 25th May 2012 (to allow for 3 months of follow-up): a rate of 0.3%. Although
this value is not significantly lower than our long-term rates (Fishers exact test, p=0.0511), it is significantly lower than the rate between February
and June 2011 (Fishers exact test, p=0.004). Conclusion: A thorough review of practice had the impact of reducing device-related infection.
Whether this will result in a durable and significant reduction in device-related infection remains to be seen.
16
abstracts
Coronary artery bypass grafting with Y-type saphenous vein: a case report highlighting the associated intra-operative benefits
Name: Iheukwumere Duru
University/ Trust/ Department: Manchester Medical School - University Hospital South Manchester, United Kingdom
Project Type: Case Report
Project Field: Coronary Artery Bypass Graft
Authors: I Duru, B Krishnamoorthy, WR Critchley, JE Fildes, N Yonan
Abstract
The long saphenous vein (LSV) is the predominant conduit utilised in coronary artery bypass graft (CABG) surgery, and can be retrieved via
endoscopic vein harvesting (EVH). Whilst EVH is associated with significantly greater recovery, wound healing and cosmetic appearance than the
traditional open vein harvesting technique, the long-term outcome has been questioned. Retrieval of the LSV has been associated with elevated risk
of bleeding in the tunnel during harvesting. This complication is even more distinct when a branch of the Y-type, anatomical variant of the LSV is
dissected and cauterised, due to the size of the vessel being cut. However, we demonstrate a case in which the Y-type variant of the LSV was instead
harvested and successfully utilised as a conduit. We therefore present the benefits associated with our approach. The postoperative results of this
case were compared to the outcome of 5 other patients, in whom the same anatomical variant of the LSV was dissected and cut by diathermy. Our
findings indicate that harvesting, rather than cauterising the Y-type vessel, resulted in fewer complications, including intraoperative bleeding. This
further reduced the operating time and did not necessitate the conversion to either open or bridging techniques in order to extract the vessel.
Renal function after mitral valve surgery performed with minimally invasive vs. conventional sternotomy approach
Name: Aleksandra Szczap
University/ Trust/ Department: University of Bristol, United Kingdom
Project Type: Audit
Project Field: Cardiac surgery
Authors: A Szczap, F Ciulli, G Asimakopoulos
Abstract
Background: Patients undergoing mitral valve surgery frequently sustain renal injury. Using plasma creatinine and the Cockroft-Gault formula to
estimate creatinine clearance (eCrCl), this study examines the hypothesis that minimally invasive mitral valve repair (MIMVR) is associated with
lesser degree of renal injury as compared with mitral valve repair (MVR) through sternotomy. Methods: This study evaluates data from all isolated
MVRs performed by two surgeons at our institution over a 3-year period. Data were collected using our prospective computerised database. In total,
there were 27 patients undergoing MIMVR and 170 patients undergoing MVR via sternotomy. Pre- and postoperative renal function at day 1, 4 and
7 was measured in the two groups. A secondary analysis with the populations divided into normal (eCrCl>50mL/min) and compromised preoperative renal function (eCrCl<50mL/min) was performed. Results: The two groups were similar with regards to age, gender, BMI, EuroSCORE,
angina and dyspnoea status, heart rhythm, left ventricular function, previous MIs, previous PCIs, diabetes, hypertension, smoking, pulmonary
disease, post-operative hospitalization, in-hospital death, post-operative heamofiltration and re-operation. (P>0.05). Renal function improved
significantly in both groups between pre-operatively and day 4 (P<0.05). There was no significant difference between groups at any time point in
terms of plasma creatinine levels pre- and post-operatively (values for MIMVR vs. MVR: 104.0 vs.105.5, 103.8 vs.104.0, 97.6 vs.100.0 and 103.4
vs100.0 umol/Lpre-operatively, on day 1, 4 and 7 respectively. P>0.05 for all) and creatinine clearance values (values for MIMVR vs. MVR: 62.7 vs.
64.5, 65.9 vs. 65.9, 70.5 vs. 70.4 and 61.3 vs. 69.0 ml/min pre-operatively, on day 1, 4 and 7 respectively. P>0.05 for all). The above observation
weres also valid for patients with reduced renal function pre-operatively. Conclusion: Overall, MVR does not result in singificant renal dysfunction.
There is no difference in renal function between patients undergoing MIMVR and MVR through sternotomy.
Is it possible to transmit sounds through the arterial system as a means of measuring blood pressure?
Name: Aisha Ali
University/ Trust/ Department: University of Manchester, United Kingdom
Project Type: Clinical
Project Field: Cardiology
Authors: Aisha Ali, Ewan Glassey, Sabeera Hussain
Abstract
Background: We aim to study how vibrations propagate along the arterial system and whether a new non invasive auscultative method of measuring
blood pressure in patients with arrhythmias is achievable. Method: 59 participants were included in the study, 18 had a normal BMI, 5 were
underweight and 31 were considered moderately obese. Measurements with a Doppler ultrasound were made at the brachial and radial arteries. A
sensitive microphone was mounted within the acoustic pathway of a stethoscope. Artificial sounds were produced at the subclavian artery and
detected by the three probes. Recordings were made on the left arm at three positions and two time intervals (cuff deflated and inflated.) The
difference of the amplitude of sound waves during cuff deflation and inflation (VD1-VI1) and the difference of the frequency (FI1-FD1) was
calculated. Results: A significant attenuation of sound was caused by the restriction of blood flow through the brachial and radial artery. The
microphone (VD1-VI1) was on average 66.45mV (95% CI 23.9-52.9.) The (FI1-FD1) recorded by the microphone during the two time intervals was
5.03Hz (95% Cl 7.6- 2.45.) Indicating that frequency of sound waves rises with cuff pressure. Conclusion: The attenuation of artificial sounds during
cuff inflation demonstrates that sound waves conduct through the arterial blood supply. This often coincides in time with the Korotkoff sounds.
These observations suggest that the production of regular rhythmic vibrations may be used in addition to Korotkoff sounds as an audible criterion
for recognising systolic pressure in patients with AF.
17
abstracts
Systolic arterial blood pressure is underestimated by auscultation compared with Doppler return-to-flow
Name: Sabeera Hussain
University/ Trust/ Department: University of Manchester, Blood Pressure & Heart Research Centre, Stockport NHS Foundation Trust, United
Kingdom
Project Type: Clinical
Project Field: Blood Pressure and Heart Research
Authors: S. Hussain, PS Lewis
Abstract
Introduction: Systolic blood pressure (SBP) is a key indicator of cardiovascular risk. It is therefore important to measure blood pressure accurately
to aid diagnosis and research. Methods: We studied 24 females and 32 males aged between 18-85 years. With subjects in a sitting position with their
left arm supported horizontal at level of shoulder, an A and D Medical UA 767 PC semi-automated blood pressure monitor was used to inflate and
deflate an appropriately sized cuff placed on the upper arm. Three readings were taken at 1 minute intervals. SBP was assessed, during cuff
deflation, by simultaneous auscultation of first Korotkoff sound (K1) heard over brachial artery with the bell of a Littmann stethoscope and by the
point of return of arterial blood flow measured by flat-bed Doppler probes placed over the brachial and radial arteries. Results: SBP measurements
differed significantly between methods. The pressure at which arterial blood flow returned at the brachial Doppler was 5.58mmHg higher than K1
(95% CI 1.85 to 9.32, p value= 0.004). The point of return of radial Doppler flow was 2.44mmHg higher than K1 (95% CI 0.66 to 4.21, p value =
0.008). Conclusion: The traditional auscultatory method of blood pressure measurement underestimates systolic blood pressure compared with
Doppler return-to-flow whether measured at the brachial or radial arteries, leading to potential errors in assessing cardiovascular risk and
monitoring patients' health.
Cardio renal arrhythmia study in haemodialysis patients using implantable loop recorders
Name: Sidharth Mohan
University/ Trust/ Department: University of Southampton, United Kingdom
Project Type: Clinical
Project Field: Cardiology
Authors: Paul R Roberts, Sidharth Mohan
Abstract
Background: End Stage Renal Disease (ESRD) occurs as the final stage of chronic kidney disease (CKD). It is at this stage that the kidneys cannot
function for themselves and an intervention is needed. This is most often in the form of dialysis. The increasing incidence of contributing factors
such as diabetes and hypertension has lead to an increase in the prevalence of ESRD. Existing research shows that these patients on dialysis have
been shown to have extremely high sudden cardiac death (SCD) rates. It is thought that arrhythmias may be the cause of SCD in this population.
Aims: This is an ongoing study that is being conducted to investigate the link between SCD and arrhythmias in patients with ESRD on dialysis, using
implantable loop recorders. Methods: The observational study is being conducted on patients who suffer from ESRD and also one or more of the
following; Poor left ventricular function as defined by an ejection fraction of less than 35% on echocardiography; Renal failure secondary to
diabetes; Significant left ventricular hypertrophy. All patients that are part of the study must have an implantable loop recorder fitted (ILR-Reveal
device). The ILR once implanted is set up to transmit information using the CareLink remote system. Transmitted information is displayed as an
ECG rhythm strip on the CareLink website. Results: The study is still in its recruitment phase and so far 5 patients have been recruited for the study.
The results so far have shown signs of atrial fibrillation for 20% of the participants. Conclusion: This study shows that it is possible to record the
cardiac activity on a regular continuous basis for ESRD patients who are on dialysis. This is vital for gaining an insight into the role of arrhythmia
and cardiac disease in mortality caused by dialysis.
The influence of a baseline heart rate on the final outcome in patients with acute myocardial infarction with ST-segment
elevation (STEMI)
Name: Srdjan Milanov
University/ Trust/ Department: Faculty of Medical Sciences, University of Kragujevac, Serbia
Project Type: Clinical
Project Field: Cardiology
Authors: Srdjan Milanov, Dusica Ognjanovic, Goran Davidovic, Violeta Iric-Cupic
Abstract
Background: Acute myocardial infarction is a clinical form of the coronary heart disease characterized by permanent damage or loss of cardiac
tissue. Heart rate is the most important determinant of myocardial oxygen demand and cardiac workload. Many prospective studies have shown
association between baseline heart rate levels less than 80 beats per minute(bpm) and better outcome in patients with STEMI. Purpose was to
investigate the influence of baseline heart rate levels on the final outcome in patients with STEMI. Methods: This largely prospective and partly
retrospective, population-type study, included 167 patients with STEMI treated in Coronary Unit,C linical center Kragujevac form January to June
2011. Baseline heart rate was defined according to the first ECG on the admission. All data are stored in a specially designed database, and
statistically analyzed in the SPSS for Windows with the methods of descriptive and analytical statistics. Results: In the observed group of 167
patients, 13(7,8%) patients died and 154(92,2%) patients survived. Of a total number of patients, 106(63,5%) had baseline heart rate levels less than
80 bpm (2-test;p=0,000). Among the survivors, 98(58,7%) patients had baseline heart rate levels less than 80 bpm and 56(33,5%) greater than 80
bpm; and in the group of patients with a fatal outcome 8(48%) patients had baseline heart rate levels less than 80 bpm and 5(3%) greater than 80
bpm. Mean baseline heart rate among the survivors was 79.2721.59 (36-177) beats per minute. There was no statisticaly significant difference
between males and females. Conclusions: In the observed group of patients with STEMI baseline heart rate less than 80 bpm was associated with a
better outcome but a lot of patients who survived had heart rate greater than 80 bpm which indicates that heart rate had an important but not the
major role in a surviving of these patients.
18
abstracts
19
abstracts
20
Abstract
Background: Endothelial microparticles (EMPs) are formed as a result of endothelial damage, which is the precursor to the majority of
cardiovascular disease (CVD), and can be initiated, by a variety of factors including inflammatory mediators and cardiovascular risk factors such as
smoking and hypercholesterolaemia. EMPs have been shown to have detrimental pro-inflammatory and coagulative effects that promote CVD;
however, recent evidence suggests they also exert cytoprotective and anti-coagulant effects, via activated protein C (aPC). Aims: To optimise
thrombin generation and aPC generation assays. To use a variety of factors to stimulate human umbilical vein endothelial cells (HUVECs) to
produce EMPs. To compare aPC and thrombin generation on EMPs produced by different stimulation factors. Methods: HUVECs were grown to
confluence in vitro and then stimulated for 24 hours with either TNF- (4ng/ml), IL-6 (80ng/ml), Thrombin (1 U/ml), serum starved medium,
Glucose (5mM) or Glucose (25mM). Preliminary experiments were also carried out using microvascular endothelial cells. EMPs were then isolated
and washed via a centrifugation process. Thrombin and aPC generation assays were then performed on each of the EMP populations. EMP counts
and protein assays were also carried out as preliminary experiments. Results: Results show that EMPs can generate both aPC and thrombin. The
stimulus for EMP release did not produce a statistically significant difference in this ability, however TNF- appeared to reduce EMP aPC
production. This is supported by previous research on endothelial cells. EMP counts and protein assays provide interesting preliminary results.
Further research with EMP counts and expression of membrane proteins may help clarify these results and increase our understanding of EMP
function. Conclusions: The ability of EMPs to activate PC and thrombin, suggests they may play an important role in the development of CVD, but
may also as previously reported have beneficial cytoprotective effects.
abstracts
21
abstracts
Cardiac CT angiography is it ready as a screening tool for coronary artery disease?
Name: Joanna Melgies
University/ Trust/ Department: University of Bristol
Project Type: Critical Discussion
Project Field: Coronary Artery Disease
Authors: Joanna Melgies
Abstract
Coronary Artery Disease (CAD) is the most common heart disease in the UK, affecting approximately 2.6 million people, nearly 25% of whom do not
experience symptoms. Currently, there are no screening programs for CAD. Cardiac CT Angiography (CCTA) has been suggested as a non-invasive
and reliable method of atherosclerotic plaque assessment with a potential to use in screening programs. For this programme to be successful, CCTA
should be able to clearly identify pre-clinical disease in an appropriate patient group with cardiovascular risk factors by determining the plaque
activity and thus its vulnerability. Once these criteria are achieved, a significant, cost-effective reduction in cardiovascular mortality and morbidity
needs to be proven. The project reveals current understanding of atherosclerotic plaque formation, explains the technological features of CCTA and
critiques this method in light of three of the WHO criteria for devising a screening programme its ability to detect early stages of the disease, the
benefit versus risk balance and cost-effectiveness. Overall, it appears there is currently insufficient evidence to support use of CCTA in a screening
programme for coronary heart disease, however, with continued technology advancement this view will evolve.
The cost-effectiveness of cardiac MRI in the diagnosis and management of heart failure
Name: Edward Middleton
University/ Trust/ Department: Imperial College London, United Kingdom
Project Type: Clinical
Project Field: Health Economics Heart Failure
Authors: E Middleton, S Prasad
Abstract
Introduction: Heart failure is a condition with a high morbidity and mortality, affecting around 0.9% of the UK population. Its prevalence is rising due to an aging population and increased survival of acute coronary syndromes - and high costs are associated management. As a syndrome, heart
failure management requires identification of the aetiology and a treatment plan tailored to that case. Under guideline practice, this entails an
echocardiogram followed by subsequent follow-up tests. Through Gadolinium-based techniques and tissue characterisation, cardiac MRI can
provide detailed, accurate images of the failing heart. This study aimed to assess the cost-effectiveness of CMR in the diagnosis and management of
heart failure. Methods: This was done using a population of 25 patients with heart failure from the Royal Brompton Hospital, who had histories
presented to a panel of expert cardiologists. They were asked to create a management plan, based on information presented, which was entered into
a web program designed specifically for this study. Using NHS tariffs, the management plan costs were calculated and compared. Results: We found
that patients diagnosed using CMR-based protocols had management plans costing 301 more than standard protocols, on average. We found that
patients diagnosed with CMR had overall savings in the diagnosis phase, but increased costs in the treatment phase. These increased costs were as a
result of a greater number of patients being referred for revascularisation therapy: 25% vs 16% of cases. We also found that CMR increased the
proportion of these therapies that were PCI rather than CABG, from 14% to 47%. Conclusion: In conclusion, although the initial outlay may be more
costly, CMR may be more cost-effective in the diagnosis of heart failure than current guideline protocols. Increased costs were seen in the
management of patients, but this is due to a higher treatment rate among CMR-diagnosed patients.
22
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24
delegate information
Transportation
Train
Southampton Central train station is well served by trains from most
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23
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