Cardiology





Highlights of the European Congress
of Cardiology 2012



 

By Dr Mary Ellen Kitler, PhD, FCP

The European Society of Cardiology is a knowledge-based professional association, representing more than 75,000 cardiology professionals from Europe and the rest of the world. Its mission is to reduce the burden of cardiovascular disease in Europe.

The European Society of Cardiology held their 60th European Congress of Cardiology in Munich, Germany, 25 to 29 August 2012. This congress is the largest medical meeting in Europe. The Congress was attended by 27,500 delegates from 130 countries. The Society accepted 4,200 abstracts from the 9,600 submitted abstracts. The largest number of abstracts came from Japan. The programme highlighted the most relevant issues in the diagnosis, management and treatment of cardiovascular disease, which includes basic research, clinical research and population research. There were 426 sessions. Additionally, there were 70 industry-sponsored satellite sessions and 200 exhibiting companies.

European Heart for Children

During his tenure as President of the European Society of Cardiology in 2009, Professor Roberto Ferrari from Italy established the capacity building ESC humanitarian project called “European Heart for Children (EHC)”. The project is simple and straight forward with three stages:

1. Medical missions in a given country to demonstrate to the medical and political community that it is possible to treat children with congenital heart disease.

2. Providing training for physicians, technicians, and nurses to be trained outside their own country on how to treat congenital heart disease by offering scholarships.

3. Creating the necessary conditions for suitable healthcare development in countries in transition so that the country can build and equip a healthcare structure able to treat congenital heart disease.



EHC Global Forum

EHC has formed the EHC Global Forum by collaborating with three humanitarian organisations, i.e, Chaîne de l`espoir from France, Bambini Cardiopatici nel Mondo from Italy and Chain of Hope from the UK. From 2009 to 2010, the EHC Forum conducted missions in Syria, Morocco, and Egypt, examined 414 children, operated on and saved 38 children, and took 9 children to Italy for complex surgery. EHC is supported by sales of EHC merchandise, donations of money and equipment, donations of expertise by cardiologists and related healthcare professionals, and fundraising events. The theme that unites these four organisations is transparency towards their generous donors.

From Bench to Practice

The theme of this year’s congress was “From Bench to Practice”. Translating innovative science into daily clinical practice is a challenge shared by clinical scientists and clinical physicians. By choosing this theme, the ESC encouraged critical discussion of new techniques and their rapid adoption by clinical medicine. The exhibition hall had an emerging technologies section that showcased the newest developments from start-up companies at the forefront of research.

Galectin-3

BG Medicine, MA, USA presented their novel commercially-available quantitative blood assay for the biomarker, galectin-3, which is used for the evaluation and management of patients with heart failure. Galectin-3 is an independent marker for outcome in heart failure patients. Furthermore, the level of the biomarker is particularly useful to predict the outcome of heart failure patients with preserved left ventricular ejection fraction. Elevated galectin-3 levels are common in 30% to 50% of heart failure patients and these particular patients are at greater risk of adverse outcomes. The BGM assay is US FDA-cleared to be used in conjunction with clinical evaluation as an aid in assessing the prognosis of patients with chronic heart failure.

ABI

Huntleigh Diagnostics Products Division, Cardiff, UK has developed the dopplex ABIlity automatic ankle brachial index system. The portable system can be easily used in a primary care clinic, hospital or the patient’s home. The patient does not need to rest before the test can be performed. Leads are simultaneously placed on both arms and both legs. In three minutes, the ABI is automatically accurately calculated, interpreted and displayed with pulse volume waveforms on the LCD panel. Results can be printed on the integral printer.

Genotyping

Spartan Biosciences, Ottawa, Ontario, Canada presented their point-of-care genetic test for cytochrome P450 CYP2C19 *2. The test is simple to conduct since it requires only a buccal swab, which is inserted into the instrument. The test is automatic and requires only 60 minutes to identify the CYP2C19* carrier status. Use of patient-specific factors, such as CYP2C19 genotype, offers promise for developing a personalised medicine approach to antiplatelet treatment regimens. Spartan Biosciences presented data from a clinical trial in patients undergoing percutaneous coronary intervention (PCI) followed by antiplatelet therapy. For two arms of the clinical trial, physicians based their prescriptions on the rapid genotyping results from the Spartan Biosciences assay. Patients, which were CYP2C19 *2 carriers, were prescribed prasugrel. Patients, which were CYP2C19 *2 non-carriers, were prescribed clopidogrel. Patients in the third arm in the clinical trial were not tested for genotype and were prescribed clopidgrel. Results showed that rapid genotyping resulted in overall improved health outcomes for the patients tested.

Coronary ischemia

Premier Heart, NY, USA presented their multifunctional cardiogram (MCG). Premier Heart describes the MCG system as “a revolution in cardiac care, leveraging the principles of computational biology and systems analysis to assist physicians in the detection of coronary ischemia”. MCG can be used for quantitative early detection of coronary ischemia and evaluation of treatment effectiveness. MCG is a stress-free, radiation-free, and non-invasive method for point of care diagnosis. The test results from MCG are available in 15 minutes. The diagnostic reports are designed so that both clinicians and the general public can understand the reports. The report includes a disease severity score, which can be used to aid in diagnosis. The MCG system is able to detect coronary artery disease at early stages. Premier Heart presented data from a clinical trial in the emergency room in Verona, Italy. The investigators stated that the system had a low expense. Furthermore, the high sensitivity of the MCG method may allow delaying coronary angiography to allow more appropriate management of these patients.

Practice guidelines

The ESC produces practice guidelines on many clinical conditions. Their purpose is to improve the quality of clinical practice and patient care in Europe. The Committee for Clinical Practice Guidelines of the ESC presented five new guidelines during 2012 and gave them to each congress participant. The five 2012 practice guidelines were Guidelines for the Management of Atrial Fibrillation (AFib), Guidelines on the Management of Acute Myocardial Infarction in Patients Presenting with Persistent ST-Segment Elevation (AMI-STEMI), European Guidelines on CVD Prevention (CVD Prevention) by the Fifth Joint European Societies Task Force on Cardiovascular Disease Prevention in Clinical Practice, Guidelines for the Diagnosis and Treatment of Acute and Chronic Heart Failure (Heart Failure), and ESC/Facts Guidelines on the Management of Valvular Heart Disease (VHD).

Congress participants also received the consensus document, entitled The 3rd Universal Definition of Myocardial Infarction (3rd Universal MI). The ESC Guidelines are updated regularly whenever new information is available. Normally, the various task forces work for two or three years and cooperate with different groups to ensure that the guidelines contain the latest evidence-based recommendations. The guidelines set standards of clinical excellence. Their implementation normally has a major impact on the treatment of these various clinical problems.

Optimal antiplatelet therapy

Professor Willem Dewilde, Sint Antonius Nieuwegein, Netherlands presented the results of the randomized trial, entitled: What is the Optimal antiplatelet and anticoagulant therapy in patients with oral anticoagulation and coronary stenting (WOEST). Triple therapy, i.e., oral anticoagulants, aspirin and clopidogrel, is recommended according to the guidelines but is known to increase the risk of major bleeding. Major bleeding increases mortality. WOEST was the first randomized trial to address the optimal antiplatelet therapy in patients on oral anticoagulants undergoing coronary stenting. The primary endpoint was reached, showing that oral anticoagulants plus clopidogrel causes less bleeding than the triple antithrombotic therapy. The secondary endpoint was also met, i.e., with dual therapy, there is no excess of thrombotic or thromboembolitic events, such as stroke, stent thrombosis, target vessel revascularization, myocardial infarction or death. The dual therapy group had less all-cause mortality. Professor Dewilde proposed that the strategy of oral anticoagulants plus clopidogrel, but without aspirin, could be used in this group of high-risk patients on oral anticoagulants when undergoing percutaneous coronary stenting.

The MADONNA study

Dr Jolanta Siller-Matula, Vienna, Austria discussed the results of the randomized trial, entitled: The MADONNA study – Multiple electrode aggregometry in patients receiving dual antiplatelet therapy to guide treatment with novel platelet antagonists. Standard antiplatelet treatment in patients undergoing percutaneous coronary intervention (PCI) normally uses two antiplatelet medications, aspirin and clopidogrel. However, measurements of platelet aggregation in clopidogrel-treated patients shows that one patient in four is a nonresponder. The aim of the study was to determine if individualised treatment with platelet inhibitors according to the results of whole blood aggregometry improves clinical outcomes in patients undergoing PCI. The investigators used the whole blood aggregometry test to determine if a patient was a clopidogrelresponder or a clopidogrel-non-responder. The test gives an answer in 10 minutes.

Patients were randomly assigned to a “guided group” and a “non-guided group”. The non-guided group received the standard therapy of aspirin and clopidogrel. In the guided group, clopidogrel nonresponders received personalised antiplatelet therapy, consisting of upward titration of clopidogrel or after the registration of prasugrel, prasugrel. Results showed that patients in the non-guided group were at a 7.9% higher risk to develop stent thrombosis compared to patients in the guided group.

Furthermore, no patient in the guided group had acute coronary syndrome but 2.5% of the patients in the non-guided group had ACS. Dr Siller-Matula recommended that all clinics introduce whole blood aggregometry testing for all patients scheduled for PCI. Based on the results of the test, PCI patients should receive personalised therapy. He estimated that providing individualised therapy for PCI patients would save medication costs of approximately €410 (US$XXX) per patient each year. Since individualised antiplatelet therapy is cost-effective, Dr Siller-Matula said health authorities and medical insurance companies should introduce this personalised therapy.

The Aldo-DHF trial

Professor Burkert Mathias Pieske, Graz, Austria, reported on the randomised multicenter international (Germany and Austria) 12 month clinical trial, entitled Aldosterone receptor blockade in diastolic heart failure (The Aldo-DHF trial). The trial compared spironolactone to placebo. More than half of heart failure patients in Europe have diastolic heart failure (DHF), which is also known as heart failure with preserved ejection fraction. In the elderly, particularly elderly women, DHF is the major type of heart failure. DHF patients have a poor quality of life and have a high rate of hospitalisation and mortality. In spite of the importance of DHF, to date, no therapy has shown therapeutic benefit. Spironolactone significantly improved diastolic function but did not change exercise capacity. Additionally, spironolactone induced cardiac remodelling, reduced left ventricular hypertrophy, which is known to be a detrimental consequence of diabetes and hypertension, and reduced both systolic and diastolic blood pressure. In this trial, spironolactone was safe without relevant adverse events. Professor Pieske emphasised that clinicians should consider prescribing spironolactone for patients with DHF in order to improve cardiac function and reduce blood pressure.

Psoriasis increases risk of diabetes

Dr Ole Ahlehoff, Copenhagen, Denmark presented results from the study, entitled Psoriasis is associated with increased risk of incident diabetes mellitus: a Danish nationwide cohort study. Approximately 125 million people in the world have psoriasis, which is a common chronic inflammatory disease. The study evaluated more than 4 million people, including approximately 50,000 psoriasis patients, who were followed for 13 years. The risk of new onset diabetes mellitus was increased in all patients with psoriasis compared to people without psoriasis. The risk was highest in patients with severe psoriasis. Dr. Ahlehoff stressed that more must be done to increase awareness in physicians that psoriasis patients have a high risk for diabetes mellitus and should be screened regularly for diabetes mellitus.

Stroke in women

Anders Mikkelsen, Copenhagen, Denmark presented the study entitled: Female sex as a risk factor for stroke in atrial fibrillation – a nationwide cohort study. The aim of this population study was to investigate the association between female gender and stroke/thromboembolism (TE). The study included 87,202 non-valvular atrial fibrillation patients, of whom 44,744 (51.3%) were female and had a follow-up of 12 years. The results showed that female gender did not increase the risk of stroke in female patients less than 75 years old. However, for female patients older than 75 years, female gender was associated with 20% increased risk of stroke after one year follow-up. Mikkelsen noted that a female patient older than 75 should receive anticoagulation therapy since the age of more than 75 is an independent risk factor for stroke/thromboembolism (TE).

- The next European Congress of Cardiology will be held in Amsterdam, Netherlands from 31 August to 4 September 2013. Further information can be found at
www.escardio.org

 

 Date of upload: 22nd Jan 2013

 

                                  
                                               Copyright © 2013 MiddleEastHealthMag.com. All Rights Reserved.