ESC Congress 2018

Day 1 Congress News Saturday 25 August 2018

PAGE 9 Digital health and PAGE 3 New CV imaging PAGE 10 The creation PAGE 10 Cardiologist the future Top picks technologies of TAVI burnout Hear from the Chair of ESC’s new Henning Rud Andersen A growing problem What is their place? Digital Health Committee tells his story discussed

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ESC Congress 2018 A unique opportunity to learn, experience and interact! Scientific Resources ‘Expert Advice’ sessions and a dedicated lecture With ESC Congress always striving to be hall, the ‘Library Room’, provides a particularly clinically relevant and up to date, new Clinical Select the presentation of interest and click on: “View full abstract” or suited stage for discussions. The addition of two Practice Guidelines will be unveiled on “Access slides & videos online” ‘Science Boxes’ to the array of lecture rooms syncope, cardiovascular disease in pregnancy, allows the presentation of substantially more myocardial revascularisation and arterial “ESC Congresses” in Prof. App Store® / Google Play Stephan abstracts in oral form. hypertension, with sessions to help attendees Achenbach understand the underlying science and Great excitement will surround the 14 ‘Late support implementation of recommendations. NEW! Session evaluation. Breaking Science Sessions’ and particularly the Your opinion matters Herzlich Willkommen in München! five not-to-be-missed ‘Hot Line Sessions’. Trials I am honoured that my home country is host Need help? ESC Congress 2018 features a rich presented in these sessions will receive world-wide to ESC Congress 2018. I urge you to embrace Find assistance at the info points located in and stimulating programme and attention as they provide potentially practice- all opportunities and make the most of these the Registration Area & Spotlight Village and this year’s spotlight, ‘Valvular Heart changing insight. This includes – among many unique and truly exciting days that bring on the SERVIER stand A200 Disease’, places a special emphasis others – the use of aspirin for primary prevention together the world of cardiology. Enjoy Munich! on the substantial growth in this area. (ARRIVE and ASCEND, the later in diabetes), oral ESC Congress 2018 module is “ESC Congress 2018 programme and anticoagulation in heart failure without atrial Inaugural Session supported by SERVIER in the form of an educational grant faculty are larger and more diverse fibrillation (COMMANDER HF), extended use of Today, 17:00 – 18:00; Munich – Main Auditorium than ever as we present, interpret and ticagrelor rather than dual antiplatelet therapy discuss the latest scientific findings after stenting (GLOBAL LEADERS), drug-coated and provide in-depth clinical teaching balloons for small-vessel interventions (BASKET- and education,” says Congress SMALL 2) and the impact of high-sensitivity What’s Your Diagnosis? BROUGHT TO YOU BY THE EUROPEAN ASSOCIATION Programme Committee Chairperson troponin testing on outcomes in suspected acute OF CARDIOVASCULAR IMAGING (EACVI) Professor Stephan Achenbach. coronary syndrome (High-STEACS). For the Echocardiography. Apical 4 chamber view in first time, randomised trials will address topics a 22-year old female with heart palpitations.

ESC Congress 2018 introduces several new such as drug treatment of transthyretin amyloid Thor Edvardsen, Oslo University Hospital, Oslo, Norway features for enhanced learning and interaction, cardiomyopathy (ATTR-ACT) and oral antibiotics including a new track called ‘Cardiology in 4 for endocarditis (POET). The functionality of the Days’, which covers the entire field of cardiology Mobile App has been improved and now allows with highly educational lectures given by leading attendees to direct questions to the panel even in experts. We have also expanded the successful these packed blockbuster sessions. Answer on page 3.

www.escardio.org/ESC2018 #ESCcongress ESC Congress News – Saturday 25 August

ESC Congress – Facts & Figures

NEW

www.escardio.org/ESC2018 2018 ESC Clinical Practice #ESCCongress Tweet the latest science Guidelines in the spotlight Shape the conversation

“All the ESC Guidelines’ updates in 2018 have been made more Prof. Stephan Windecker concise and much more visual with illustrations and extensive use of graphics and figures. ESC Congress 2018 sees the release of four new ESC Clinical Practice Guidelines on: They are very user friendly Arterial Hypertension; Syncope; Myocardial and easily accessible.” Revascularization; and Cardiovascular Diseases during Pregnancy, as well as a consensus document on the Fourth Universal An important asset is the link with ESC CardioMed, directly Definition of Myocardial Infarction (see table). connecting ESC Guidelines with corresponding textbook sections (e.g. the 2017 Valvular Heart Disease and 2017 Peripheral The updates to these documents have been developed Arterial Diseases Guidelines). This latest mix of guidelines by expert Task Forces under the governance of the ESC’s summarises all recent evidence, research and expertise relevant Committee for Practice Guidelines (CPG), chaired by to these cardiovascular conditions and provides a vital resource Professor Stephan Windecker (Bern University Hospital, Bern, for practising healthcare professionals. Don’t miss the overview Switzerland). “Each guideline takes around two years from session of all these ESC Guidelines tomorrow, Sunday at 08:30 – appointment of the Task Force Chairs, who are selected based 10:00; Munich – Main Auditorium. on their established scientific track record and their leadership 1. 2018 ESC/ESH Guidelines for the Management of Arterial abilities, and selection of the Task Force Members, to the launch Hypertension. Eur Heart J 2018. doi:10.1093/eurheartj/ehy339. of the final output at the annual ESC Congress,” explains Prof. 2. 2018 ESC Guidelines for the Diagnosis and Management of Syncope. Windecker. “Task Forces are composed of representatives Eur Heart J. 2018;39:1883–1948. doi: 10.1093/eurheartj/ehy037. from various ESC Associations, Working Groups and Councils 3. 2018 ESC/EACTS Guidelines on Myocardial Revascularization. and additional individuals chosen on the basis of their Eur Heart J. 2018. doi: 10.1093/eurheartj/ehy394. expertise. Together with the Review Coordinators, who 4. 2018 ESC Guidelines for the Management of Cardiovascular manage incorporation of two or three rounds of peer review Diseases during Pregnancy. Eur Heart J 2018. doi: 10.1093/ comments, and the large pool of peer reviewers, including also Eurheartj/ehy340. the 56 National Societies of ESC, there are over 100 experts 5. 2018 ESC/ACC/AHA/WHF. Fourth Universal Definition of Myocardial Infarction. Eur Heart J. 2018. doi: 10.1093/eurheartj/ehy462. contributing to the development of each document,” he says.

Societies Guideline/ consensus document Task Force Chairs

Bryan Williams (UK); ESC/ESH Arterial Hypertension1 Giuseppe Mancia (Italy) What’s Your Diagnosis? Michele Brignole (Italy); ESC Syncope2 Solution Angel Moya (Spain) BROUGHT TO YOU BY THE EUROPEAN ASSOCIATION OF CARDIOVASCULAR IMAGING (EACVI) Franz Josef Neumann (Germany); ESC/EACTS Myocardial Revascularization3 The abnormal trabeculations (arrows) in the left ventricular apex Miguel Sousa Uva (Portugal) are typical for left ventricular non-compaction cardiomyopathy. Vera Regitz-Zagrosek (Germany); It can be associated with left ventricular dilation and/or Cardiovascular Diseases during hypertrophy, and systolic or diastolic dysfunction. ESC Jolien W Roos-Hesselink Pregnancy4 Thor Edvardsen, Oslo University Hospital, Oslo, Norway (Netherlands)

Kristian Thygesen (Denmark); Fourth Universal Definition of ESC/ACC/AHA/WHF Joseph Alpert (USA); Myocardial Infarction5 Harvey White (New Zealand)

The future of cardiovascular imaging

and the US-based PROMISE trial have shown us that with “18F-NaF PET-CT is an exciting CTCA we can see whether a patient actually has CHD, and also that CCTA-guided changes in management can improve technique, which could be used Prof. clinical outcomes,” he says. David Newby to identify vulnerable plaques, As for other important imaging techniques, Prof. Newby potentially informing the future thinks that positron emission tomography (PET) holds management of patients with Professor David Newby (University of Edinburgh, promise for the identification of patients at risk for myocardial Edinburgh, UK) will tomorrow give the ESC Rene infarction. “Atherosclerotic lesions at risk of rupture have stable and unstable coronary Laennec Lecture on Clinical Cardiology (Sunday, particular characteristics, including calcification, which is the artery disease.” 09:30 – 10:00; Moscow – Village 5). body’s response to a necrotic, inflammatory stimulus—similar to that seen in the lungs following tuberculosis infection. Identifying those that are most at risk for myocardial infarction Over the last ten years, Prof. Newby has focussed his When there is a lot of calcification over the plaque it is less is a key goal for the future of cardiovascular imaging. “We need research interests on advanced imaging of the heart. He was likely to rupture, but early microcalcification is not as stable,” to find out which patients require treatment the most and to Chief Investigator for the SCOT-HEART trial, which showed he explains. “We have shown that combined PET-CT using see where imaging technology can help.” that the addition of CT coronary angiography (CTCA) to 18F-NaF as a marker for calcification activity can identify 1. SCOT-HEART investigators. Lancet 2015;385:2383–2391. standard clinical care clarifies the diagnosis of angina due to ruptured and high-risk coronary plaque in patients with 2. Joshi NV, et al. Lancet 2014;383:705–713. coronary heart disease (CHD).1 “Results from SCOT-HEART myocardial infarction and stable angina.2”

#ESCcongress 3 ESC Congress News – Saturday 25 August

Innovation Abstract of the day: Does one size fit all for ECG-based through teamwork risk stratification in athletes? There is no doubt that regular detecting cardiovascular conditions that He continues, “The 1950s/60s was a pioneering exercise is beneficial to health are associated with an increased risk of phase in cardiac surgery; there was a large and has a positive impact on SCD (HRCC). The application of the three unmet need and masses of enthusiasm—key cardiovascular risk factors; criteria resulted in the detection of different Prof. Francesco ingredients for innovation. For example, the however, in rare cases, exercise conditions: for example, ESC and Seattle Maisano development of cardiopulmonary bypass can result in sudden cardiac criteria most commonly detected atrial was facilitated by the need in the community death (SCD). enlargement (22%) and left ventricular for breakthrough technology, which created hypertrophy (20%), while the International Professor Francesco Maisano great potential for innovations in cardiac The cause of SCD in young athletes (aged criteria most commonly detected ST- (Division of Cardiac Surgery, surgery.” What else is important? Prof. Maisano 35 years and younger) is mostly inherited segment depression (13%) and T-wave University Hospital of Zurich, doesn’t hesitate. “Teamwork,” he says. “Most cardiac conditions, which can be identified inversion (12%). Cardiovascular conditions Zurich, Switzerland), who today innovations are the result of years of work on screening because of complaints or by an were diagnosed in more than half (57%) gives the ESC Paul Hugenholtz involving many people. It’s the convergence of ECG.1,2 Recommendations advocate for ECG of the referred athletes, with 11% having Lecture for Innovation (Saturday, ideas from different backgrounds that is key.” screening of younger competitive athletes to HRCC. SCD occurred in three athletes. Of the 12:40 – 13:20; Digital Health Cardiology today is facing huge environmental prevent SCD,2 but these recommendations criteria tested, the ESC criteria were found Stage – Exhibition 3), is changes. Indeed, the world is changing at a fast have not been tested in older or ‘master’ to be the most sensitive (67%) and the keen to emphasise what pace and it’s only by joining forces and sharing athletes (aged over 35 years). International criteria were the most specific ‘innovation’ means. ideas that we can make progress thinks (47%). The proportion of false-positive and Prof. Maisano. “It’s important to listen to each Today, Doctor Nicole M. Panhuyzen- false-negative results with the International “Generally, I think the concept is overused. other, not just to talk.” Goedkoop (Amsterdam University criteria was 9.9% and 39.7%, compared with Really, it’s evolution—a natural process,” he Medical Centers and Radboud University 24.3% and 19.0% with the ESC criteria and explains. “When we talk about innovation, “The future holds great potential,” says Prof. Medical Center, Nijmegen, Netherlands) 16.2% and 30.4% with the Seattle criteria. it’s usually understood as being the action Maisano. “We’ve changed the way we treat will present the results of a study that Dr. Panhuyzen-Goedkoop will conclude that of a few, which is a misconception. We patients and, with Heart Teams, the way in which evaluated whether criteria-based ECG criteria based on ECG findings intended for need to understand the difference between we work; what’s next is that education needs to recommendations proposed for young use in young athletes are also appropriate innovators and inventors.” change too. We need to adapt the way we train athletes could also be used in master for master athletes over the age of 35. people—younger physicians should be supported athletes (Abstract 81104). The study “Innovation is due to not to copy their mentors, but to watch and used data from 494 master athletes 1. Wasfy MM, et al. Methodist Debakey learn, and to take advice, but not too much with abnormal screening results that Cardiovasc J 2016;12:76–80. participation of the direction. It’s important they can make decisions, triggered referral for cardiac evaluation. 2. Panhuyzen-Goedkoop NM, et al. Neth Heart whole community; work in a multidisciplinary team and interact Dr. Panhuyzen-Goedkoop’s group J 2018;26:127–132. well with each other.” And this is where ESC retrospectively analysed the ECG results for 3. Corrado D, et al. Eur Heart J 2005;26:516–524. everyone has the comes in, he explains. “Without ESC, without a these athletes according to ESC,3 Seattle4 4. Drezner JA, et al. Br J Sports Med 2013;47:122–124. community, there will be no innovation. It is a and International5 criteria to define which potential to be 5. Sharma S, et al. Eur Heart J 2018;39:1466–1480. cycle: innovation needs a community, and the criteria were the most appropriate for a part of it.” community needs innovation.”

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www.escardio.org/ESC2018 European Heart for Children: Paul Hugenholtz to be honoured with Addressing inequalities within the a named lecture ESC family and worldwide

At today’s Inaugural Session, the hugely Dr. Paul Hugenholtz important work of European Heart for Children (EHC) will be acknowledged. ESC is proud to announce that a new named lecture Worldwide and also in Europe, not all children born with will be presented annually at ESC Congress in recognition congenital malformation have equal access to appropriate care of the longstanding contribution of the prominent and, in some cases, the range of disparity is significant. Nine Dutch cardiologist, Doctor Paul Hugenholtz. years ago, Claudia Florio and her husband, Roberto Ferrari, President of the ESC at the time (2008–2010), realised that the After qualifying at Leiden University, Dr. Hugenholtz spent ESC’s mission to ‘reduce the burden of cardiovascular disease’ 20 years in the USA, before returning to the Netherlands to could not be achieved in some member countries. With the help establish what would become the Erasmus Medical Centre of Isabel Bardinet and François Heraud, the EHC was created in Rotterdam. Dr. Hugenholtz became involved in the ESC as an international humanitarian organisation under the same in the early 1970s and helped to orchestrate major changes umbrella as ESC, but as a separate independent entity. which have become key ESC features, such as establishment of centrally organised international annual congresses, When describing the progress made by the EHC in the past better communication of scientific investigations via the nine years, Professor Ferrari says “We have supported 26 European Heart Journal and the introduction of Working missions in various ESC member countries during which Groups to increase collaboration around important topics. 2,218 children were examined, diagnosed and treated, and 306 operations have been successfully performed.” EHC has Dr. Hugenholtz was President of the ESC from 1984 to 1988, also developed a training grant programme for healthcare a period characterised by growth and co-operation and the professionals in countries where further medical education is creation of the Fellowship of the ESC — a role to which he needed. To date, EHC has trained two cardiac surgeons, two himself was the first elected member. Over the years, Dr. cardiologists and six nurses. Exciting ongoing EHC-led projects Show your support Hugenholtz has continued to emphasise that cardiologists outside of Europe include the building of a training centre for Visit the EHC booth in the ESC Plaza and purchase tickets for the must consider the entire cardiovascular system as their young paediatric cardiologists in Nigeria and the construction Humanitarian Dinner on Monday 27 August at Zum Augustiner. responsibility and to address the atherosclerosis epidemic of a dedicated paediatric cardiac unit in Morocco. using preventive measures and considering nutrition.

ACTELION SATELLITE SYMPOSIUM Marius M. Hoeper (Co-Chair), Hannover, Germany SUNDAY, 26 AUGUST 2018, 13:00 – 14:00 Irene Lang (Co-Chair), Vienna, Austria ROOM ALGIERS – VILLAGE 3 Nazzareno Galiè, Bologna, Italy Achieve more in PAH – Translating insights into patient beneﬁ ts, Volume 1 Jean-Luc Vachiéry, Brussels, Belgium

ACTELION SATELLITE SYMPOSIUM Stephan Rosenkranz (Co-Chair), Cologne, Germany MONDAY, 27 AUGUST 2018, 13:00 – 14:00 Adam Torbicki (Co-Chair), Otwock, Poland ROOM BRUSSELS – VILLAGE 4 Fabrice Bauer, Rouen, France Achieve more in PAH – Translating insights into patient beneﬁ ts, Volume 2 Vallerie McLaughlin, Ann Arbor, USA

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#ESCcongress 5 ACCESS TO/FROM COACH PARKING SPOTLIGHT VILLAGE Ankara ESC Congress News – Saturday 25 August Belgrade

Practical Tutorials (PT) Cairo Agora 1 Damascus Minsk EXHIBITION 3 Arrhythmias and VILLAGE 6 POSTER AREA VILLAGE 3 Imaging San Marino Device Therapy Digital Tirana Health Yerevan Science Box Agora 2 (First oor) (First oor)

Meeting Rooms Zone E PT 1 - 2 VILLAGE 1 Zone B Zone A Bern Heart Failure Basic Science Stockholm Meeting VILLAGE 2 VILLAGE 5 VILLAGE 4 Rooms Zone D Bratislava Meeting Rooms Meeting Rooms THE HUB EXHIBITION 2 VILLAGE 2 Hypertension Copenhagen VILLAGE 3

Schumann Haendel Brahms Meeting Rooms Zone D Algiers Vienna VILLAGE 4

Meeting Brussels CENTRE Rooms Ljubljana Zone C (First oor) (First oor)

PRO Beethoven STAGE Bach Preventive Cardiology & VILLAGE 5 MEMBERS’ Zone B Coronary Artery Disease, Acute Coronary LOUNGE Zone A EXHIBITION 1 VILLAGE 1 Cardiovascular Disease in Baku Syndromes, Acute Cardiac Care, Special Populations Moscow Valvular, Myocardial, Pericardial, Pulmonary, FESC ESC PLAZA Congenital Heart Disease, LOUNGE Meeting Rooms Zone C VILLAGE 6 Aortic Disease, Peripheral Vascular Disease, CPR Workshops Stroke, Interventional Cardiology and Kiev Meeting Rooms Cardiovascular Surgery Meeting Rooms Madrid Tunis

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SPOTLIGHT VILLAGE Haendel (First oor) ESC 2018 Schumann app i ESC HQ POSTER AREA (First oor) MAIN ENTRANCE Agora 1 - 2 TRAIN Science Box 1 - 2 EXHIBITION 3 Digital Health

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www.escardio.org/ESC2018 Sessions of the day

9:00 – 10:00 w 12:45 – 13:15 Joining clinical practices: cardiovascular disease and Agora 1 Patient and family journeys through cardiac illness Precision medicine in coronary patients: enhanced risk identification and treatment -Experts on the Spot type 2 diabetes -Satellite Symposium organised by Bach organised by MSD Stockholm Novo Nordisk A/S 9:00 – 10:30 Treating tricuspid regurgitation : what is new? ESC/ESH Guidelines on BP-lowering treatment: Beethoven -Experts on the Spot organised by Abbott solutions for a new challenge -Satellite Symposium The Influence of Quality Metrics in Interventional Copenhagen organised by Menarini Bach Cardiology and Heart Failure: Helpful or Hopeless? New concepts in vascular protection: exploring the role of antithrombotic therapy -Experts on the Spot Emerging evidence-based approaches to reduce Beethoven The changing face of congenital heart disease Brahms organised by Medscape residual atherosclerotic risk -Satellite Symposium Algiers organised by Novartis Brahms Expert Advice - Drug prescription in the elderly State of the art ICD therapy: Only shock to save a life Haendel -Experts on the Spot organised by Medtronic LDL-c: done deal, next epigenetics? -Satellite Haendel Out of hospital management of heart failure Brussels Symposium organised by PACE Ambulatory blood pressure monitoring (ABPM): Schumann Mini quiz - Sweden vs Cardiologist of Tomorrow Group a clinical tool for hypertension diagnosis, risk Hypertension-related cardiovascular risks in obesity. assessment and therapy evaluation -Experts on the New perspective and monitoring technology -Satellite Digital Health Schumann Spot organised by Medtronic Ljubljana Symposium organised by Omron Stage e-Health and m-health: hype or here to stay? Dabigatran use in diverse cardiology settings -Satellite Minsk Expert Advice - CTO Workshop Kiev Symposium organised by Boehringer Ingelheim 13:30 – 14:45 Co-morbidities in chronic heart failure – time for Yerevan Mitral valve disease: from surgery to intervention Science Box 2 Cardiovascular risk in athletes paradigm shifts in the management of hyperkalaemia Tirana Surgery for combined heart disease and iron deficiency -Satellite Symposium organised Madrid by Charité Stable coronary artery disease: review, update, and 13:30 – 15:00 Damascus State of the Art in 2018 Centre Stage Live in the Box: Percutaneous mitral valve repair Bern HDL cholesterol - A moving target 15:30 – 16:45 ESC ATLAS of Cardiology: statistics on cardiovascular Cardiac rehabilitation: underutilised after Bach disease and care Digital Health Stockholm myocardial infarction? Stage Best of Apps Facilitating optimal outcomes and care Ljubljana New insights into lipid biology and cardiovascular disease Beethoven in acute cardiology Optimized heart failure care throughout the patient Moscow journey -Satellite Symposium organised by SERVIER Madrid Stroke, atrial fibrillation and anticoagulation Brahms Valvular heart disease - The “Big Picture” Left ventricular hypertrophy: what to do Haendel in clinical practice? 15:30 – 17:00 11:00 – 12:30 Spotlights on optimisation of guideline-supported Schumann Mini quiz - Bulgaria vs Morocco Centre Stage Late Breaking Science in Interventional Cardiology 1 reperfusion strategies for STEMI -Satellite Symposium Agora 1 Innovative drug therapies Bern organised by Boehringer Ingelheim Squaring the circle: from congenital to acquired Reducing cardiovascular mortality in patients with Bach complex valvular and myocardial disease Agora 2 Treatment of atrial fibrillation type 2 diabetes: closing the gap between evidence Beethoven Optimising outcomes in valvular heart disease Digital Health and practice -Satellite Symposium organised by Stage Late Breaking Science in Telemedicine Boehringer Ingelheim & Eli Lilly and Company Brahms The PCI Summit Bratislava Diabetes Alliance Science Box 1 Improving outcomes in cardiac arrest Haendel My patient is asymptomatic but has... GARFIELD-AF: new light shed on atrial fibrillation and Meet the Experts - Chest pain and normal coronary its management -Satellite Symposium organised by Schumann Mini quiz - Czech Republic vs Greece Minsk arteries: a clinician's conundrum Vienna Thrombosis Research Institute Agora 1 Obesity and cardiovascular disease Difficult treatment decisions in patients with severe Translating real world evidence into your clinical Belgrade aortic valve stenosis practice for your multi-morbid patient -Satellite Agora 2 Hypertension -Risk profiling and treatment Double jeopardy - Pulmonary hypertension in high- Baku Symposium organised by Bayer AG Digital Health Everyone get ready! Digital Health will change Yerevan risk situations Stage healthcare on a patient and population level What you always wanted to know about aortic Cairo pathology and its treatment 17:00 – 18:00 Science Box 1 Cardiovascular rehabilitation revisited Surgical help for acute emergencies The Inaugural session will be immediately followed Science Box 2 Hot topics in valvular heart disease Tirana in cardiovascular medicine Munich by a networking event in ESC Plaza Minsk The benefits of keeping cardiac interventions simple Damascus Risk of sudden death in hypertrophic cardiomyopathy Valvular heart disease: review, update, and State of Belgrade the Art in 2018 Bern An Update on Prevention

Yerevan Marfan Syndrome - A lifelong disease Stockholm Advanced nursing roles within cardiology Hypertension: review, update, and State of the Cairo Surgical options in acute and chronic heart failure Bratislava Art in 2018 Our Diversity Tirana Cardiac phenotyping and outcome implications Copenhagen Refining risk assessment in hypertension Essentials in PAD: New evidence since the PAD guidelines Meet the Experts - My patient has chest pain: Damascus - Will they change our practice? is our Strength Algiers which imaging modality should I use? Bern Do cardiac patients need psychosocial therapy? Vienna State of the Art in nuclear cardiology The ESC is proud of its 56 member Stockholm Cardiovascular evaluation of athletes: hot topics Recent advances in the genetic architecture National Cardiac Societies Brussels of valve disease Bratislava Late Breaking Pharmacological Science Mitochondria as an emerging target in Expert Advice - Combined hypertension and heart Ljubljana cardiovascular disease Copenhagen failure: navigating troubled waters Meet the Experts - When to use Cardiac MRI in Baku Late Breaking Science in Imaging Algiers everyday practice Expert Advice - Management of acute heart failure Moscow in the emergency room Vienna Echocardiographic assessment of the right heart What's cooking? The most recent developments Novel therapeutic targets for myocardial ischemia- Kiev in atrial fibrillation management Brussels reperfusion injury Madrid Atrial fibrillation ablation Ljubljana New approaches to the treatment of atrial fibrillation Expert Advice - Diagnosis and treatment of heart failure Baku with preserved ejection fraction (HFpEF) 15:30 – 16:15 Strategies to optimize established heart Have you considered cardiac amyloidosis in your Moscow failure therapies Cairo patients? -Satellite Symposium organised by Pfizer Should we perform atrial fibrillation ablation in Kiev asymptomatic patients? 15:30 – 16:30 Madrid Bleeding risk and oral anticoagulation Why are we not achieving guideline-recommended RAASi doses in heart failure? Dr Gunther’s 12:30 – 13:10 dilemma -Satellite Symposium organised by Centre Stage AstraZeneca ESC TV Stage ESC Guidelines 2017 - One Year After Differential diagnosis of hypertrophic cardiomyopathy - Imaging, genetics & rare causes -Satellite Bach Symposium organised by Shire 12:40 – 13:20 PCSK9 inhibition: science, outcomes and guidance Digital Health Brahms -Satellite Symposium organised by PACE Visit your National Cardiac Stage ESC Paul Hugenholtz lecture for Innovation Society on the ESC Plaza Why use percutaneous ventricular assist devices? Agora 1 The Cardiovascular Health Team – How to manage frailty Belgrade -Satellite Symposium organised by Abiomed

Abstract-based Programme Scientific & Educational Programme Sessions organised by Industry

Further information is available on the ESC Congress App

#ESCcongress 7 ESC Congress News – Saturday 25 August

EURObservational Research Keep up to date with ESC CardioMed An exciting, new online encyclopaedic resource from the ESC in collaboration with Oxford University Press, ESC CardioMed Programme: Revealing the true picture will keep you abreast of the latest advances in research and clinical practice in over 63 cardiology disciplines. So far, over of European cardiac healthcare 1,000 leading research and clinical specialists from around the world have contributed to this remarkable publication.

from EORP can give us an idea not just of how medicine is In-depth peer-reviewed articles and an expert editorial being practised, but also, in some cases, why. For example, board—overseen by a prestigious panel of editors comprising guidelines may not be adhered to because of financial or Professor John Camm from St Georges Hospital, University of Prof. logistical constraints rather than a lack of understanding or London, UK, Professor Thomas Lüscher from Royal Brompton Alec Vahanian awareness.” The ESC is continually looking to strengthen and Harefield Hospital Trust and Imperial College London, and extend the reach of EORP. “We want to improve the UK, Professor Gerald Maurer from the Medical University of quality of the registry by including data from across the Vienna, Austria and Professor Patrick Serruys from Imperial Established in 2009, the aim of the ESC spectrum of healthcare facilities,” says Prof. Vahanian. College London, UK—ensure this digital textbook contains EURObservational Research Programme “In particular, we would really like to engage more with high-quality information, which is presented with multi-media (EORP) is to improve healthcare throughout the ESC National Cardiac Societies—as well as working features and extensive illustration. Uniquely, ESC CardioMed Europe and beyond. groups, associations and centres—and share in the wealth of also includes cross-referenced links to ESC Clinical Practice information they hold so that we can provide doctors and Guidelines—currently the only general cardiology textbook to “It does this,” explains EORP Chair, Professor Alec Vahanian patients with a more detailed picture of the status of cardiac do this! Another key attribute of ESC CardioMed is that it is a (Hôpital Bichat, Paris, France), “by building on the previous care within Europe.” dynamic, evolving knowledge base, with content updated several ESC Euro Heart Survey programme to provide a better times a year to a robust schedule. “We believe that cardiologists understanding of medical practice in Europe and to identify will find the new digital format and ongoing updates of ESC areas where improvement is needed.” The programme has Don’t miss! CardioMed an invaluable resource in this complex, fast-moving a wide range of registries. “In addition to those on common ESC/EORP late breaking registry results to be presented medical field.” said Prof. Camm. “What’s more, ESC professional diseases, intervention and prevention, EORP is host to a during the following sessions: members and fellows will benefit from free access to all sections number of unique registries on rare diseases, including the EORP-AF general long-term and Euro Heart Survey of ESC CardioMed!” world’s largest registry on pregnancy in cardiac patients— AF registries, and ELECTRa registry sub-analysis: Sunday 26 August, 16:45 – 17:45; Kiev – Village 6 ROPAC. The data generated by EORP are a valuable resource Why not take a look at this new, for all those involved in cardiac care,” he says. During his EORP VHD II registry: Monday 27 August, invaluable resource? time as Chair, Prof. Vahanian focused on the ESC Clinical 08:30 – 10:00; Centre Stage – The Hub Visit the ESC or Oxford University Press stands. Alternatively, Practice Guidelines, using the key points—the main drivers ROPAC: Tuesday 28 August, 14:30 – 15:45; Centre Stage – The Hub visit online www.escardio.org/Education/Textbooks/esc- of quality in practice—to assess just how well guidelines cardiomed for links to taster sections of ESC CardioMed are incorporated into care. “The information we derive

Becoming a FESC was the most honorable distinction I could receive. After all these years, belonging to such a renowned global scientific society still gives me a huge sense of pride and accomplishment

Prof. Stavros Konstantinides, FESC

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D8493-Pub-FESC-130x195_v6.indd 1 10/08/2018 16:56 www.escardio.org/ESC2018 Are you ready for how digital health is transforming healthcare for doctors and patients?

technologies and social media. Digital health that is changing,” says Prof. Cowie, “and members, 94% thought they needed to have a is simply the term used to capture all these the ESC, on behalf of cardiologists, wants to better understanding of it and 80% thought it different types of technology,” Prof. Cowie embrace this change. Only by being a part would radically change their practice.1 I would Prof. explains, providing an example to illustrate how of the conversation with those developing urge everyone at ESC Congress 2018 to come Martin Cowie digital technologies have improved patient and regulating new technologies can the ESC to the Digital Health area, visit the booths, sit management in cardiology. “Consider a patient influence their direction and impact on clinical in on some of the many scientific sessions with periodic palpitation, which is sufficiently practice. We understand that while many of and watch live demonstrations of cutting- The term ‘digital health’ will infrequent to be missed by standard seven- the innovations will have a positive effect, the edge solutions and technologies. This is an undoubtedly strike fear into the day continuous ECG monitoring. This patient impact of others may be less clear cut. In these ideal opportunity for doctors to get hands-on heart of some doctors. But it will now be able to use a device clipped onto circumstances, we want to be able to discuss experience of digital health and to see how it shouldn’t, says Professor Martin a smartphone to monitor their palpitation the evidence and to make sure that the new applies to their daily practice.” In addition to Cowie (Imperial College London, whenever it happens. What is more, the approach really is better than the old one.” the congress activities, ESC is remodelling and London, UK), Chair of ESC’s new information can be made available instantly modernising its website, making the different Digital Health Committee. to their physician,” he says, continuing, “these The ESC’s Digital Health Committee, which sections more linked up and providing greater types of technology enable care to be tailored to had its first meeting in April this year, is access to information on new technologies. “This is an exciting time for digital technology the individual and may liberate patients from the coordinating a range of activities and resources The society is also exploring the possibility of and we shouldn’t be scared of it,” he reassures. constraints of clinic visits. As for doctors, they to help doctors to access information on the holding a stand-alone digital meeting—creating “Most doctors are already using aspects of are able to access the information anywhere and technologies that are out there and understand cross-links between cardiologists and the digital health, such as electronic medical records at any time, at their convenience.” how they can improve patient management. different groups involved in digital technology— and e-prescribing. Technology is moving at “Trialled at last year’s congress, the new Digital and is looking into producing a new, more a rapid pace, providing doctors and patients Health area at ESC Congress 2018 is bigger and interactive journal. with an increasing number of options for “Digital health will better. The number of companies wanting to managing patient health more efficiently, more significantly alter how showcase devices in the area far exceeded our “Digital health is the future,” says Prof. Cowie, effectively and more conveniently. Advances expectations and it was a difficult task to select “there is no going back. ESC is determined have seen the introduction of a whole range of we practise medicine.” the 50 we thought would be of most interest to ensure that the society remains new technologies, including remote monitoring to our members,” says Prof. Cowie. “We know contemporary and faces up to the challenges devices, teleconsultations, mobile health “Up to now, healthcare has been relatively that cardiologists are keen to learn about digital of today and tomorrow rather than the apps or hand-held devices and also wearable slow to take digital technology on board but health; in a recent survey of over 2,200 ESC challenges of yesterday.”

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2018 Saturday 25th August Satellite Symposia

15.30 – 17.00 Translating Real World Evidence Baku – Village 5 into Your Clinical Practice for Your Multi-Morbid Patient

Co-Chairs: Christian Ruff and Manesh Patel

15.30 – 17.00 Garfield-AF: New Light Vienna – Village 3 Shed on Atrial Fibrillation and its Management

Co-Chairs: Ajay Kakkar and Jean-Pierre Bassand

To learn more about our programme at ESC Congress 2018, visit us at booth #B200

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#ESCcongress 9 ESC Congress News – Saturday 25 August

Congress theme: Heart valves Talking to TAVI creator, Henning Rud Andersen

Henning Rud Andersen

Imagine coming up with a spur-of- the-moment idea and going on to see it change the lives of millions of people worldwide. Welcome to Henning Rud Andersen with the first presentation of TAVI data as a poster at ESC Congress 1992 in Barcelona, along with the 1992 publication in European heart Journal1 the world of Henning Rud Andersen (Aarhus University Hospital, Aarhus, SDK: You initially had difficulty in would embolise at low loads, I found that in recommended for TAVI. He underwent Denmark), inventor of transcatheter attracting interest in TAVI. Why do you 80 kg pigs it could withstand 2 kg before it the procedure at my own hospital, with me aortic valve implantation (TAVI), who think this was? began to distort, proving that the implanted waiting anxiously outside the theatre. It was talks here to his long-time colleague HRA: Because it was a crazy idea and I valve remained stable without embolisation. very successful and seven years on, the ‘old and friend, Steen Dalby Kristensen. was an unknown researcher! I still have Viking’ is still going strong. the rejection letters from Journal of SDK: What kept you motivated during the SDK: Take us back to the beginning. the American College of Cardiology and periods of disinterest and rejection? SDK: What is the future for TAVI? What gave you the idea for TAVI and Circulation, stating that the research wasn’t HRA: I was young and enthusiastic and I HRA: The main challenge now is to get when did your interest in it start? a high enough priority. Industry weren’t was convinced it was a good idea. When you it into the developing world. There are HRA: I know exactly when it was, interested because their advice from experts have a good idea, you don’t give up. And, to millions of people in areas such as Africa February 1989. I was at a congress in Phoenix, was that TAVI wasn’t feasible. We have be honest, it was a lot of fun. and India with infection- or rheumatic Arizona, USA, listening to a presentation to remember that surgery was the go-to disease-associated aortic valve stenosis about coronary artery stent implantation in approach for many cardiac vascular diseases SDK: How long did it take to get TAVI who are dying in their teens or early dogs. It suddenly occurred to me that instead at the time and there was resistance to accepted for formal investigation? twenties. We need to find ways to simplify of using 3 mm stents, it should be possible emerging interventional measures. HRA: In 1992, I finally got my research the technology and to make it cheaper so to make them ten times as big, to put a valve published in a paper in European Heart that we can give these patients access to the inside them and to implant the device using SDK: How did you go about investigating Journal.1 But it was another 10 years before same life-saving opportunities that we in the the balloon technique. The funny thing is that TAVI without support? research groups in Europe took up the idea developed world enjoy. at the time I had no experience in the area—I HRA: I researched in the evenings after and were able to reproduce my findings. This was doing electrophysiology research—and I had finished work. I had access to the attracted industry support and led to the 1. Andersen HR, et al. Eur Heart J 1992;13:704–708. had gone to the presentation just because it laboratory but I used some of my own first-in-man implantation by Professor Alain sounded interesting. money and made all the valves myself, by Cribier (Université de Rouen, Rouen, France) hand. The research centred around two on 16 April, 2002. types of experiments: in vitro pressure Don’t miss! “It took only a split testing in a simulated circulatory system SDK: Tell us a bit about the use of the Valvular heart disease: review, update, and State of the Art in 2018 second to come up with and load testing of the implanted valve in device for your father Today, 11:00 – 12:30; the idea but 10 years pig aorta. The first in vivo implantation in a HRA: At the age of 86 years, my father pig was performed on 1 May, 1989. Despite was diagnosed with aortic stenosis and, Belgrade – Spotlight Village to develop it.” assurances by surgeons that the device being considered too frail for surgery, was

Cardiologist burnout, a growing problem

Tunis – Library Room – Village 6). Perhaps (24%) and a lack of control/autonomy (21%). a lot of hoops that we need to jump through; one of the most striking findings is that “The independence of physicians is becoming the whole process could be simplified.” the greatest incidence of burnout—50% ever more restricted,” confirms Dr. DeMaria. Dr. Anthony of physicians—was reported for those in “Mounting rules and regulations—coming The US-based survey showed that 13% of DeMaria the 45–54 years old age group. “These are from government, payers and hospital cardiologists experienced depression as well relatively young physicians,” points out Dr. organisations—are frustrating. The transition to as burnout.1 Among those who reported DeMaria. “One might have expected burnout electronic health records is a classic example of depression, one-third stated that they were more There is no question that burnout to be more prevalent in older physicians who the need for increased documentation, which is easily exasperated by patients (33%) or less is a major problem among all have become more frustrated with increased certainly a problem in the US, and I have reason engaged with them (32%) as a result of their physicians across all specialties, bureaucracy, but this is not the case.” to believe that it’s the same in Europe,” he says. depression. “Interactions with colleagues and from family practice to internal medical staff are also affected,” highlights Dr. medicine and surgery. “Doctors are reporting that So, what can be done to support cardiologists DeMaria. “Even in the earliest stages of burnout, suffering burnout? Dr. DeMaria thinks that it begins to have an effect on how cardiologists Indeed, the results of a US-based survey of they are spending more looking at the causes of their frustrations deal with their day-to-day practice.” 15,000 physicians across 29 specialties show and more time dealing with is vital. “Assuming that the challenges and that 42% reported evidence of burnout.1 computers and documents, sources of stress are not financial, which The prevalence and nature of burn out “When the results were split by specialty, presumably is readily fixed with more money, has attracted the attention of the medical cardiology was somewhere in the middle with and less time interacting then the main issue is workload,” he says. profession and healthcare enterprise in 43% of physicians affected, whereas the with their patients and “Cardiologists are frequently called on to general, which is a positive step forward. As most affected were critical care specialists practising medicine.” handle after-hours emergencies and the Dr. DeMaria emphasises, “The ESC recognises and neurologists (both 48%) and the least takes are long and often impact lifestyle. the importance of burnout for cardiologists affected plastic surgeons (23%),” explains As for contributing factors, more than half of What would help enormously is a reduction and for their membership. They are giving Doctor Anthony DeMaria (University physicians (56%) who reported burnout cited in the call for documentation, especially as the topic a lot of attention and rightly so.” of California, San Diego, Division of excess bureaucracy.1. Other causes are long it is often not particularly important.” Giving Cardiovascular Medicine, La Jolla, California, working hours (39%), lack of respect from cardiologists greater autonomy is also key, he 1. Medscape National Physician Burnout and Depression Report 2018. www.medscape. thinks, “As things stand now, if we want to use USA), who will co-chair a special session on colleagues (26%), increasing computerisation com/slideshow/2018-lifestyle-burnout- this issue tomorrow (Sunday, 15:50 – 16:40; of practice (24%), insufficient compensation a specific drug or procedure, there are often depression-6009235, accessed 12 July 2018.

www.escardio.org/ESC2018 ESC Atlas of Cardiology – what can we learn?

Do you know how many heart Data from the 2017 edition of Atlas were data analysis, states: “Atlas makes clear that disparities among our member countries transplants or percutaneous recently published focussing on comparing economic resources are not the only driver and to promote effective implementation of coronary interventions your high-income and middle-income ESC member for delivery of equitable cardiovascular guidelines, ultimately looking to reduce the country is performing compared countries—important inequalities in disease healthcare, some middle-income ESC member healthcare gaps, to improve the accessibility of to other countries? burden, outcomes and service provision were countries report rates for interventional novel therapies to patients and much beyond identifed.1 The prevalence of risk factors, such procedures and device implantations that to reduce the burden of CVD across Europe,” How about the impact of smoking and as hypertension and smoking, was lower in match or exceed rates in wealthier high- concludes Professor Vardas. obesity on cardiovascular disease (CVD) or high- versus middle-income countries and income member countries.” which country has the most cardiologists these inequalities were thought likely to have 1. Atlas Writing Group. Eur Heart J 2018;39:508–579. per capita? The ESC Atlas of Cardiology contributed to the higher CVD mortality Declines in CVD mortality have seen cancer (Atlas)—a unique compendium that in middle-income countries. Considerable becoming a more common cause of death in a documents CVD statistics across the ESC inequalities in treatment facilities were also number of high-income member countries, but member countries—has the answers. observed and countries where declines in in middle-income countries declines in CVD coronary mortality were most pronounced mortality have been less consistent and CVD Get an exclusive Atlas were generally those with the best facilities for remains the leading cause of death. providing the most advanced contemporary demo at the ESC stand care. “Little wonder that middle-income Clearly, Atlas provides valuable insights into the countries generally have a higher prevalence inequalities surrounding CVD and its treatment Atlas maps, analyses and compares data, of CVD and mortality compared with high- across ESC member countries and the findings including major risk factors, for CVD prevalence income countries,” says Professor Vardas. will be relevant to many other countries around and mortality in each member country of the world allowing international benchmarking the ESC. It also features novel data on health Interestingly, the data showed that of cardiovascular risk factors, disease infrastructure and cardiovascular services unequal health outcomes were not always prevalence, healthcare delivery and outcomes. to highlight gaps and disparities in service an inevitable consequence of limited economic With a greater understanding of current provision and cardiovascular outcomes across resource. For example, in some middle- European CVD statistics and the enhanced Don’t miss! systems. “No other data compilation of this kind income countries, e.g. Bulgaria and Turkey, ability to predict future trends, Atlas will help is available for CVD and is the result of a huge reported rates of cardiac catheterisation and identify targets for reducing the burden of CVD ESC ATLAS of Cardiology: statistics on cardiovascular disease and care collaborative effort with ESC National Cardiac coronary stenting compared favourably with and delivering equitable healthcare across Societies,” says Professor Panos Vardas, Chief the best high-income countries. Professor Europe. “Now that we’ve got Atlas off the Today, 13:30 – 15:00; Bach – The Hub Strategy Officer of the European Heart Agency. Adam Timmis, first author of the 2017 Atlas ground, it is a unique opportunity to highlight

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#ESCcongress 11 ESC Congress News – Saturday 25 August

Franz Groedel: The German who co-founded the American College of Cardiology

Following Hitler’s rise to power, Prof. Groedel, considered Jewish because of his mother’s religious background, was Prof. forced to flee Germany and arrived in New York City in 1933. Franz Groedel Philip Reichert, an American radiologist trained at Cornell University and the Rockefeller Institute, built Prof. Groedel a device to map the electrocardiogram from multiple sites on Professor Franz Groedel was a pioneer the chest wall, enabling him to continue his research on the of cardiac radiology, electrocardiography pathways of cardiac impulse conduction.2 Out and about in Munich and scientific hydrotherapy, and co-founder of the American College of Cardiology (ACC). Prof. Groedel became President of the Rudolf Virchow Medical Bavarian hospitality is one big hearty reason why visitors Society in 1943 and then the New York Cardiological Society flock to Munich from all over the world. After a busy day After receiving his medical degree from the University of Leipzig in 1949.1 Envisioning an organisation with a wider national at the congress, relax in the leafy shade of one of Munich’s in 1904, Franz Groedel started his career helping to expand the scope dedicated to the continuing education of physicians many Biergartens (beer gardens) that date back over 200 diagnostic use of X-rays in Friedrich von Müller’s clinic in Munich.1 and scientists, he founded the ACC in 1949 along with his years or seek out the cosy atmosphere of a traditional In 1906, Prof. Groedel joined his father, also a physician, working assistant Max Miller and Reichert. Joined in 1950 by Kisch tavern or Wirtshaus. Savour famous cuisine, such as in his hometown of Bad Neuheim at a spa specialising in the and others from the New York Cardiological Society, who Weißwürste (white veal sausage), Schweinshaxe and Knödel treatment of cardiac patients. During the next few years, Prof. became the founding trustees of the ACC,2 Prof. Groedel was (roasted pork knuckle with dumplings), Leberkäse (a loaf- Groedel carried out much of his important early work on the use appointed the ACC’s first President and Reichert its Secretary. formed sausage) or Obatzda (cheese spread) with Brezl of X-rays to evaluate heart function and size, inventing the first Tragically, in October 1951 during preparations for the first (pretzel), washed down with world-renowned Bavarian beer. machine for taking serial X-rays in 1909.1 Later, as Professor of scientific meeting of the ACC, he sustained a fatal skull Munich’s beer heritage is almost as old as the city itself— Radiology at the University of Frankfurt, Prof. Groedel actively fracture. Kisch succeeded him as President and the meeting locals have been brewing ‘liquid bread’ here for 3,000 years. supported Bruno Kisch and Arthur Weber who founded the that Prof. Groedel had been preparing for, but sadly did not German Cardiac Society in 1927.2 live to see, was hailed a major success.2 It’s easy to enjoy the traditional foods and drink of Munich, thanks to the ‘walkable’ nature of the city. Major sights On succeeding his father as head of a private rehabilitation clinic, Had he been alive today, and attractions are within walking distance and can be Prof. Groedel formed a close friendship with William Kerckhoff, Prof.Groedel would certainly easily reached from the congress centre and hotels by the an American millionaire who brought his family to the spa at Bad be very proud of his legacy. extensive public transportation system of underground Nauheim. In 1929, with a generous donation from Kerckhoff’s widow, (U-Bahn) and suburban trains (S-Bahn), trams and buses. So Prof. Groedel set up a cardiology research and treatment centre, while in Munich, we do hope you get chance to sample its 1. Fye WB. Clin Cardiol 2000;23:133–134. the William G. Kerckhoff-Heart Research Institute, which eventually 2. Lüderitz B, et al. J Am Coll Cardiol 2013;61:802–807. famous foods and Bavarian beer—prost! became the model for similar heart centres around the world.1,2

ae Saturday, August 25, 2018 15:30 - 16:45 Satellite Symposium Optimized heart failure care throughout the patient journey

Chairpersons: Speakers: Don’t forget the Satellite Symposium M. Cowie M. Böhm (Germany) Experts on the Spot (UK) Chairperson: A. Maggioni (Italy) J. Howlett (Canada) Speakers: A. Coats (UK), J. Gonzalez Juanaler (Spain) P. Seferovic B. Pinto (India) New opportunities for treating heart (Serbia) C. Yancy (USA) failure through fixed-dose combinations M. Yilmaz (Turkey) 10:15-10:45 Sunday, August 26, 2018 Bach – The Hub

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