News | Published 25 May 2019 | doi:10.4414/cvm.2019.02026 Cite this as: Cardiovasc Med. 2019;22:w02026 Cardiology Update London 2018 For the second time, last December experts from the Unit- ed Kingdom, Europe and the United States (fig. 1) re- viewed the year in cardiology at the Royal Society of Med- icine in the heart of London. This novel course, supported by the European Society of Cardiology (ESC) and organ- ised by Zurich Heart House (www.zhh.ch), has grown im- pressively and welcomed over 350 participants from all over the world, including a group from Switzerland. The state-of-the-art lectures This postgraduate course started with three state-of-the-art lectures by Peter Libby from the Harvard Medical School in Boston, Patrick Serruys form Imperial College London (on the future role of computer tomography in the manage- ment of coronary artery disease) and Milton Packer from the Baylor University Medical Center in Dallas (on the fu- ture of heart failure). Peter Libby set the stage with a lecture on CHIP (clonal haematopoiesis of indeterminate potential), a newly recog- nised cardiovascular risk factor. We acquire over our life- time somatic mutations that are associated with haemato- logical disorders [1, 2](fig. 2). The majority of the variants occur in three genes: DNMT3A, TET2, and ASXL1. Al- though these mutations markedly increase the risk for haematological disorders, not all individuals develop such diseases. Interestingly, age-related clonal haematopoiesis due to such mutations also doubles the risk of coronary artery disease and stroke. White blood cells carrying such mutation are proinflammatory and develop more neu- trophil extracellular traps, and as a result the risk of atherothrombotic complications increases. Patrick W. Serruys then gave an impressive lecture on the potential of modern coronary computed tomography (CT) in the management of coronary patients even prior to car- diac procedures. Coronary CT provides, with ever decreas- ing radiation exposure, not only precise information on coronary artery structure, including the SYNTAX score (fig. 3), but also, through the CT-based measurement of fractional flow reserve (FFR), on the haemodynamic sig- nificance of plaques [3]. This allows proper and nonin- vasive planning of coronary and valvular procedures. The vision of Patrick Serruys is that eventually surgeons and in- terventional cardiologists will reach therapeutic decisions and precisely plan their procedures noninvasively using CT, hopefully with better results to the benefit of the pa- tients. The third state-of-the-art lecture, given by Milton Packer, was on the future of heart failure (fig. 4). He suggested that novel therapies will become available, such as drugs modulating autophagy, an intracellular process that disas- sembles unnecessary or dysfunctional components that oc- cur at a considerable rate in disease states such as heart failure. Notably, molecules modulating this process are al- ready available and might be developed for clinical use in Figure 1: The Cardiology Update London 2019 with some of the faculty members (from left to right: Bernard Gersh, John Deanfield, Thomas F. Lüscher, Peter Libby and Mark Pfeffer. Correspondence: Thomas F. Lüscher, FRCP, Präsident Forschungskom- mission, Schweizerische Herzstiftung, Dufourstrasse 30, CH-3000 Bern 14, car- dio[at]tomluescher.ch Cardiovascular Medicine · PDF of the online version · www.cardiovascmed.ch Published under the copyright license “Attribution – Non-Commercial – No Derivatives 4.0”. No commercial reuse without permission. See http://emh.ch/en/services/permissions.html. Page 1 of 3
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News | Published 25 May 2019 | doi:10.4414/cvm.2019.02026Cite this as: Cardiovasc Med. 2019;22:w02026
Cardiology Update London 2018
For the second time, last December experts from the Unit-ed Kingdom, Europe and the United States (fig. 1) re-viewed the year in cardiology at the Royal Society of Med-icine in the heart of London. This novel course, supportedby the European Society of Cardiology (ESC) and organ-ised by Zurich Heart House (www.zhh.ch), has grown im-pressively and welcomed over 350 participants from allover the world, including a group from Switzerland.
The state-of-the-art lectures
This postgraduate course started with three state-of-the-artlectures by Peter Libby from the Harvard Medical Schoolin Boston, Patrick Serruys form Imperial College London(on the future role of computer tomography in the manage-ment of coronary artery disease) and Milton Packer fromthe Baylor University Medical Center in Dallas (on the fu-ture of heart failure).
Peter Libby set the stage with a lecture on CHIP (clonalhaematopoiesis of indeterminate potential), a newly recog-nised cardiovascular risk factor. We acquire over our life-time somatic mutations that are associated with haemato-logical disorders [1, 2] (fig. 2). The majority of the variantsoccur in three genes: DNMT3A, TET2, and ASXL1. Al-though these mutations markedly increase the risk forhaematological disorders, not all individuals develop suchdiseases. Interestingly, age-related clonal haematopoiesisdue to such mutations also doubles the risk of coronaryartery disease and stroke. White blood cells carrying suchmutation are proinflammatory and develop more neu-trophil extracellular traps, and as a result the risk ofatherothrombotic complications increases.
Patrick W. Serruys then gave an impressive lecture on thepotential of modern coronary computed tomography (CT)in the management of coronary patients even prior to car-diac procedures. Coronary CT provides, with ever decreas-ing radiation exposure, not only precise information oncoronary artery structure, including the SYNTAX score(fig. 3), but also, through the CT-based measurement offractional flow reserve (FFR), on the haemodynamic sig-nificance of plaques [3]. This allows proper and nonin-vasive planning of coronary and valvular procedures. Thevision of Patrick Serruys is that eventually surgeons and in-terventional cardiologists will reach therapeutic decisionsand precisely plan their procedures noninvasively usingCT, hopefully with better results to the benefit of the pa-tients.
The third state-of-the-art lecture, given by Milton Packer,was on the future of heart failure (fig. 4). He suggested
that novel therapies will become available, such as drugsmodulating autophagy, an intracellular process that disas-sembles unnecessary or dysfunctional components that oc-cur at a considerable rate in disease states such as heartfailure. Notably, molecules modulating this process are al-ready available and might be developed for clinical use in
Figure 1: The Cardiology Update London 2019 with some of thefaculty members (from left to right: Bernard Gersh, John Deanfield,Thomas F. Lüscher, Peter Libby and Mark Pfeffer.
Correspondence:Thomas F. Lüscher, FRCP,Präsident Forschungskom-mission, SchweizerischeHerzstiftung, Dufourstrasse30, CH-3000 Bern 14, car-dio[at]tomluescher.ch
Cardiovascular Medicine · PDF of the online version · www.cardiovascmed.ch
Published under the copyright license “Attribution – Non-Commercial – No Derivatives 4.0”.No commercial reuse without permission. See http://emh.ch/en/services/permissions.html.
Page 1 of 3
the near future. He also predicted an increasing use of de-vices in this patient population. Finally, as the number ofheart failure patients increases, there will be a shortage notonly of heart failure specialists, but also of general cardi-ologists to manage these patients. As even general prac-titioners do not have the time and resources to provideguideline-based management of patients with heart failure,paraprofessionals and possibly even robots might take partin the care of these patients.
The course then continued with seven sessions in which allrelevant aspects of cardiovascular medicine, including pre-vention, chronic and acute coronary syndromes, arrhyth-mias, valvular heart disease, heart failure and cardiomy-opathies, where covered by experts in the respective field.
Breakthroughs in cardiovascular prevention
Ulf Landmesser, formerly form Zurich and now Chairmanof Cardiology at the Charité in Berlin (fig. 5), Gabriel Steg
Figure 2: Peter Libby giving his lecture on clonal haematopoiesisand cardiovascular disease.
Figure 3: Patrick W. Serruys lecturing on the noninvasive function-al SYNTAX score, based on coronary CT in a patients with coro-nary artery disease and a score of 19 points (from reference [3]).
from Paris and Neil Poulter from London discussed cur-rent prevention guidelines and the use of novel drugs suchas antibodies directed against proprotein convertase sub-tilisin/kexin type 9 (PCSK9) [4], sodium-glucose co-trans-porter-2 (SGLT2) inhibitors and glucagon-like peptide-1(GLP-1) agonists. Imaging to diagnose coronary artery dis-ease and prior to structural interventions was reviewed intwo excellent lectures by Jereon Bax, a past President ofthe ESC from Leyden (fig. 6).
Arrhythmias and valvular heart disease
The session on arrhythmias included lectures on atrial fib-rillation by John A. Camm from London, on geneticallymediated sudden death by Josip Brugada, the discoverer ofBrugada syndrome, and on syncope by the chairman of the2018 ESC Guidelines Michele Brignole.
Valvular heart disease remains centre–stage, with transar-terial valve implantation or TAVI now evolving into a stan-dard procedure in high and intermediate risk patients withaortic stenosis, as outlined by Bernard Prendergast fromLondon. He also pointed out that, with the broadening in-dication for TAVI procedures, there will be an increasingneed for operators and centres to cope with this clinical de-mand, which will be challenging for the healthcare systemsof many countries. Georg Nickenig from Bonn dissectedCOAPT [5] and the somewhat smaller Mitra-FR trial [6],which revealed divergent results. Importantly, patients inCOAPT had more severe heart failure and mitral regurgi-tation, larger ventricles, and a higher event rate, suggestingthat this patient population may be more suitable for theprocedure, as pointed out in a recent viewpoint article inthe European Heart Journal [7].
Figure 4: Milton Packer during his lecture on “Heart failure 10years from now.”
Figure 5: Ulf Landmesser (right) lecturing about breakthroughs incardiovascular prevention (see reference [4]) and the currentguidelines to the audience at the Royal Society of Medicine (left).
News Cardiovasc Med. 2019;22:w02026
Cardiovascular Medicine · PDF of the online version · www.cardiovascmed.ch
Published under the copyright license “Attribution – Non-Commercial – No Derivatives 4.0”.No commercial reuse without permission. See http://emh.ch/en/services/permissions.html.
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Figure 6: Jereon Bax from Leyden, past President of the Euro-pean Society of Cardiology during his lecture on imaging of coro-nary artery disease, chaired by Ulf Landmesser from Berlin and K.Mohan from India.
The Paul Wood Lecture 2019
The Paul Hamilton Wood Lecture commemorates thegreatest British cardiologist of his time, who performedhis first cardiac catheterisation in the United Kingdom in1947. His major contribution was to refine the bedside di-agnosis of heart disease, correlating clinical findings withthe chest X-ray, the electrocardiogram and the haemody-namic data obtained by cardiac catheterisation.
This year, a splendid Paul Hamilton Wood Lecture wasgiven by Mark Pfeffer from the Harvard Medical Schooland Brigham and Women’s Hospital in Boston. He re-viewed the development of evidence-based managementof hypertension, remodelling and heart failure in recentdecades (fig. 7).
This is a modified version of an article published in the Eu-ropean Heart Journal [8].
Figure 7: Mark Pfeffer from Harvard Medical School in Boston pre-senter of the Paul Hamilton Wood Lecture 2018 with Thomas F.Lüscher and Kim Fox, both of Imperial College and the RoyalBrompton and Harefield Hospitals London, United Kingdom.
References1 Jaiswal S, Fontanillas P, Flannick J, Manning A, Grauman PV, Mar BG,
et al. Age-related clonal hematopoiesis associated with adverse out-comes. N Engl J Med. 2014;371(26):2488–98. doi: http://dx.doi.org/10.1056/NEJMoa1408617. PubMed.
2 Libby P, Ebert BL. CHIP (Clonal Hematopoiesis of Indeterminate Po-tential). Circulation. 2018;138(7):666–8. doi: http://dx.doi.org/10.1161/CIRCULATIONAHA.118.034392. PubMed.
3 Collet C, Onuma Y, Andreini D, Sonck J, Pompilio G, Mushtaq S, et al.Coronary computed tomography angiography for heart team decision-making in multivessel coronary artery disease. Eur Heart J.2018;39(41):3689–98. doi: http://dx.doi.org/10.1093/eurheartj/ehy581.PubMed.
4 Landmesser U, Chapman MJ, Stock JK, Amarenco P, Belch JJF, BorénJ, et al.; European Society of Cardiology/European Atherosclerosis So-ciety Task Force. New prospects for PCSK9 inhibition? Eur Heart J.2018;39(27):2600–1. doi: http://dx.doi.org/10.1093/eurheartj/ehy147.PubMed.
5 Lindenfeld J, Abraham WT, Kar S, Lim DS, Mishell JM, et al.; COAPTInvestigators. Transcatheter Mitral-Valve Repair in Patients with HeartFailure. N Engl J Med. 2018;379(24):2307–18. doi: http://dx.doi.org/10.1056/NEJMoa1806640. PubMed.
6 Obadia JF, Messika-Zeitoun D, Leurent G, Iung B, Bonnet G, Piriou N,et al.; MITRA-FR Investigators. Percutaneous Repair or Medical Treat-ment for Secondary Mitral Regurgitation. N Engl J Med.2018;379(24):2297–306. doi: http://dx.doi.org/10.1056/NEJ-Moa1805374. PubMed.
7 Prendergast BD, Baumgartner H, Delgado V, Gérard O, Haude M, Him-melmann A, et al. Transcatheter heart valve interventions: where arewe? Where are we going? Eur Heart J. 2019;40(5):422–40. doi:http://dx.doi.org/10.1093/eurheartj/ehy668. PubMed.
8 Tofield A. Cardiology Update 18 London. Eur Heart J.2019;40(8):640–3. doi: http://dx.doi.org/10.1093/eurheartj/ehz030.PubMed.
News Cardiovasc Med. 2019;22:w02026
Cardiovascular Medicine · PDF of the online version · www.cardiovascmed.ch
Published under the copyright license “Attribution – Non-Commercial – No Derivatives 4.0”.No commercial reuse without permission. See http://emh.ch/en/services/permissions.html.
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