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Spanish Society of Cardiology Congress 2015

Syncope and near drownings may signal sudden death risk

EU Project on primary prevention

11th International Congress on Coronary Artery Disease

XXI. World Congress of Echocardiography and Cardiology

Pacemakers for identifying asymptomatic AF

Eli Lilly discontinues Evacetrapib development

New ESC Grants for Medical Research Innovation

EHJ at Spanish Congress

Acute Cardiovascular Care 2015 Vienna

“Ten Commandments” of 2015 ESC Infective Endocarditis Guidelines

“Ten Commandments” of 2015 ESC Acute Coronary Syndromes Guidelines

“Ten Commandments” of 2015 ESC Pericardial Diseases Guidelines

“Ten Commandments” of 2015 ESC Pulmonary Hypertension Guidelines

“Ten Commandments” of 2015 ESC Ventricular Arrhythmias and Prevention of SCD Guidelines 

A Day with the Legends, ESC Congress 2015

Lightning Talks at ESC London

The Russian National Congress of Cardiology 2015

FDA approves first ARNi for heart failure on 7 July 2015

Action to tackle non-communicable diseases globally

Testing endurance athletes

Cardiac devices and smartphones in cardiology

NOAC treatment during AF ablation

ESC Grants available

ESC toolkit for cardiovascular nurses

2015 Arrigo Recordati Prize for Prevention

Tribute to Guido Tarone MD

Heartfailurematters.org now in Portuguese and Arabic

Hand grip strength predicts MI and CVA


The EHJ at the Spanish Society of Cardiology Congress 2015

The EHJ was represented by Prof. Thomas F Lüscher at the Congress of the Spanish Society of Cardiology, 22-24 October, Bilbao, Spain, which attracted 3500 participants.

Prof. Lüscher participated in several sessions at the Congress.

1. Opening ceremony. A very relevant session where Prof. Lüscher played a central role in delivering the opening lecture “From Eisenhower’s Heart Attack to Modern Cardiology”.

2. Hot Topics in Cardiology II “The Environment and Cardiovascular Health”. In this session another lecture was delivered on “Aging and longevity genes in cardiovascular disease”.

3. A Joint session between Revista Española de Cardiología and the European Heart Journal. The session focused on the discussion of the best papers published in Revista along with papers published in the European Heart Journal by Spanish cardiologists. Thomas Lüscher chaired the session and provided the final remarks.

Professor Juan Sanchis Editor-in-Chief of Rev Esp Cardiol commented, “we at the Spanish Society of Cardiology are very pleased with the really active participation of the EHJ editor-in-chief at our Congress”.


Syncope and near drownings should not be ignored

Syncope and near drowning events may signal an increased risk of sudden death, reveals research presented at the South Africa  Heart Congress 2015 by Professor Paul Brink, professor of internal medicine at the University of Stellenbosch in Tygerberg, South Africa. Such events point to long QT syndrome (LQTS) that can be undetected or misdiagnosed as epilepsy or a panic attack.

The annual congress of the South African Heart Association was held in Rustenburg 25 - 28 October, 2015.

Numerous patients with LQTS in South Africa share the same causal KCNQ1 A341V mutation which can all be traced to a common founder couple of Dutch descent in the early 18th century. The current study was set up in the early 1990s to document the founder effect and later expanded to study modifiers of severity together with the group of Peter Schwartz in Italy.
Through cascade screening of relatives of 26 LQTS index cases, the researchers identified 203 living patients with the KCNQ1 A341V mutation. Nearly four in five (79%) of the mutation carriers had experienced blackouts. Only 26% of the patients had been diagnosed with LQTS initially and given appropriate treatment, while 40% were incorrectly diagnosed with epilepsy and 34% were given incorrect laymen’s or medical explanations such as drowning or sick sinus syndrome.

Some 23 patients died before the age of 20 years. Half “drowned” despite being able swimmers. A 13 year old girl died on a skating rink while being treated for epilepsy and a five year old boy “choked on water”.

“Our research shows that many patients with LQTS never see a doctor, or when they do, they are misdiagnosed,” said Professor Brink. “The most common misdiagnosis in living patients was epilepsy, while in those who died it was drowning.”

“The most feared consequence of LQTS is death during syncope,” continued Professor Brink. “But a lot of patients do not see a doctor after a first fainting spell, or even subsequent ones. They faint, lie on the ground for a minute or two, wake up and go on with normal life. They may even see alternative medicine practitioners for these seemingly innocuous events.”

Professor Brink concluded: “Sudden deaths can be prevented if people recognise unusual fainting events and take action. Fainting at the sight of blood is harmless but a blackout during activity is cause for further investigation. The same goes for drownings or near drownings. If someone suddenly stops swimming during a competition and floats lifeless this is obviously not a typical drowning.”


11th International Congress on Coronary Artery Disease

The 11th International Congress on Coronary Artery Disease takes place in Italy this year and its theme is “From Prevention to Intervention”.

The 4 day meeting has an extensive programme including topics from angiogenesis and cell therapy, through atheromatous plaque regression, diagnostic methods, interventional cardiology and cardiac surgery.

The 2015 Congress will provide a comprehensive update on all aspects of coronary disease – from prevention to intervention and from bench to bedside. It will also include focused discussions on the new challenges regarding structural heart disease and valve disease now addressed by interventionist and surgeon alike.

There is a large international faculty of speakers from as far afield as Australia to North America.

The venue is Palazzo dei Congress in Florence, Italy and the congress is accredited with 15 EBAC credits.

more information


XXI. World Congress of Echocardiography and Cardiology 

The XXI. World Congress of Echocardiography and Cardiology will take place 20-22 November, 2015, in Istanbul, Turkey. The organisers are arranging a high quality scientific program with contributions from world renowned physicians and scientists in the fields of Cardiology, Cardiovascular Surgery and Echocardiography.

The Congress will be held at the Istanbul Lutfi Kirdar Convention and Exhibition Centre (ICEC), located in the heart of congress valley in downtown Istanbul. It is within walking distance of many different category hotels and shopping sites.

Istanbul maintains a distinguished position among the world metropolitan areas, with its unique location between two continents, together with its cultural heritage spanning thousands of years. As one of the most energetic cities in the world, Istanbul continually grows as a center of attraction, representing a contrast in harmony and presenting a breath-taking choice of sights, smells and tastes that everyone must experience at least once in a lifetime. Thus, we believe getting together in such a charming atmosphere with our colleagues is an opportunity nobody should miss.

Hosting this congress in Istanbul -where Asia meets Europe- will not only help us enhance patient care but also build bridges between participants from various countries.

We look forward to welcoming physicians in Istanbul, during November, 2015.

Prof. M. Serdar Küçükoglu
XXI. World Congress of
Echocardiography and Cardiology

Prof. Navin Nanda
International President

XXI. World Congress of
Echocardiography and Cardiology


EU Project unveils obesity & smoking trends across Europe and shows how primary prevention is the key to a healthy future

Results of the EConDA (Economics of Chronic Diseases) EU-funded project were announced in Brussels on 22 September, at a conference bringing together EU policymakers, health professionals, health economists and health stakeholders from the EU arena.

The project, which lasted 2.5 years, showed how ‘upstream’ prevention interventions focusing on reducing people’s exposure to risk factors before a chronic disease has occurred is generally more cost-effective in terms of healthcare savings – including social care, welfare costs and losses in productivity - than treating an individual for a chronic condition.

Chronic diseases are the first cause of mortality in Europe, causing the death of 9 out of 10 citizens. They also represent a major economic burden with a total estimated cost to the EU economy of € 700 billion annually.

According to EConDA, obesity rates will be increasing across Europe and in all social groups, with better educated people projected to be less obese than those with lower education levels. This will have an important impact on health inequalities, with the less educated being subject to a greater burden of obesity-related chronic diseases such as type 2 diabetes.

Portugal represents an interesting exception to this trend, as the social gradient is predicted to reverse by 2050, with the more educated men and women projected to be more obese or overweight than those with lower education levels. A similar pattern in the future is predicted for obesity in the Netherlands.

More encouragingly, by 2050, smoking prevalence is forecast to decrease largely as a result of important policy measures such as tobacco taxation and bans on smoking in public places. Provided that these and other policies are maintained to prevent take up of smoking and help existing smokers to give up, this downward trend is set to continue.

A user-friendly tool has been developed for researchers and policy makers to test the impact of interventions which aim to reduce obesity and smoking on the future burden of chronic diseases. This tool can be downloaded here: http://econdaproject.eu/tools.php


Pacemakers identify atrial fibrillation to start anticoagulation early

Pacemakers identify AF and enable initiation of anticoagulation to prevent strokes, according to research presented in an abstract by Dr Nathan Denham, a cardiologist at Warrington Hospital, UK on 17 October at Acute Cardiovascular Care 2015.

Pacemakers can detect asymptomatic AF but are not routinely monitored for this purpose. The current study investigated whether pacemaker checks could be used to identify patients with asymptomatic AF who could then be given anticoagulation for stroke prevention.

The study retrospectively included 223 patients who received a pacemaker during a 5 year period and had not been diagnosed with AF prior to implantation. During follow up clinics a wand was placed over the pacemaker to collect information on battery life, and so on. The researchers examined the data on how many patents were currently experiencing AF, and how many people had episodes of AF but then converted to sinus rhythm.

In patients with AF, the investigators calculated their stroke risk using the CHA2DS2-VASc score to see how many should be receiving anticoagulation to prevent stroke. ESC guidelines recommend that patients with AF and a score of 2 or more should be given oral anticoagulation to prevent stroke.(1)

During the follow up period, 36 patients had at least one episode of AF detected, of whom 27 had AF identified during a routine pacemaker check (12% of the study population). All but one of the 27 patients needed anticoagulation to prevent stroke based on their CHA2DS2-VASc score.

Dr Denham said: “The proportion of pacemaker patients with undiagnosed AF was higher than expected. Nearly all of them should have been receiving anticoagulation to prevent stroke. Pacemaker checks are simple to perform and our study shows that it is worthwhile using them to identify patients at risk.”

The average time between pacemaker checks and AF diagnosis was 6 months. Just over one-third of patients waited 12 months between checks to discover they had AF. Dr Denham said: “Stable patients have pacemaker checks every 12 months but our results support more frequent monitoring to identify AF.”

Remote telemonitoring would allow pacemaker checks to be done more often without patients having to travel to hospital. “Telemonitoring would identify AF much earlier so that anticoagulation could be started,” said Dr Denham. “The fact that we found such a high proportion of patients with AF who should have been on anticoagulation suggests that telemonitoring is worth pursuing. Although we can’t conclude this from our study, the cost of telemonitoring may be offset by the savings from preventing strokes.”

He concluded: “One-third of people with AF don’t know they have it so we need to use all of the tools available to recognise it. Our study suggests that pacemaker checks are a good way to identify new cases of AF so that anticoagulation can be started to prevent strokes.”

Sources of funding: None.
Disclosures: None.

1. Camm AJ, et al. 2012 focused update of the ESC Guidelines for the management of atrial fibrillation. European Heart Journal. 2012;33:2719–2747.


Eli Lilly discontinues Evacetrapib development

Eli Lilly and the ACCELERATE study academic leadership announced on 12 October that they will discontinue the development of Evacetrapib for the treatment of high-risk atherosclerotic cardiovascular disease. They accepted the recommendation of the independent data monitoring committee, to terminate the Phase 3 trial of the investigational Evacetrapib due to insufficient efficacy. They will now conclude other studies in the programme.

The independent data monitoring committee based its recommendation on data from periodic reviews, which suggested there was a low probability that the study would achieve its primary endpoint based on results to date. The study will not be discontinued for safety findings. After further analysis results of the study will be presented in scientific forums in the future.

David Ricks Lilly senior vice president and president of Lilly Bio-Medicines stated “we will be working with investigators to appropriately conclude these trials.”


New ESC Grants for Medical Research Innovation

The ESC announced the launch of its new ESC Grants for Medical Research Innovation, at the opening of the ESC Congress 2015 in London. An ambitious programme sponsored exclusively by Böhringer Ingelheim, is aimed at stimulating worldwide research in cardiovascular medicine.

“This grant project is a reflection of the ESC’s commitment to encouraging new and innovative research aimed at improving patient outcomes in thromboembolic disease – a leading cause of mortality worldwide,” said Professor Francesco Cosentino, chair of the programme’s scientific committee. “It is estimated that one in four people die as a result of thromboembolic disease and more research into this disorder is urgently needed,” he said.

The programme, offers four grants, to a maximum of €400,000 each, which will be awarded to independent interventional and observational research projects in the areas of atrial fibrillation, stroke, deep vein thrombosis/pulmonary embolism, percutaneous coronary intervention, coronary artery disease and/or peripheral artery disease.

“We are excited about this initiative because it is a great opportunity to perform important studies aiming for a better understanding of novel therapeutic strategies in this setting,” said Prof. Cosentino. “We are now ready to receive applications from around the world for these prestigious grants - until the November 1st deadline - and look forward to announcing the four winners at European Heart House on December 1st following live presentations by all finalists.”

Eligible research should run no longer than 18 months and have publishable outcomes to be presented at ESC Congress 2017.

Applications may be made via this dedicated webpage: www.escardio.org/innovationgrants


The EHJ at Spanish Society of Cardiology Congress, Bilbao, 22-24 October

The European Heart Journal will be represented at the Congress of the Spanish Society of Cardiology in Bilbao 22-24 October in the following sessions:

1. Opening ceremony. A very relevant session where Thomas Lüscher, EHJ editor-in-chief    will play a central role delivering the opening lecture entitled “From Eisenhower’s Heart Attack to Modern Cardiology”.

2. Hot Topics in Cardiology II. “Environment and Cardiovascular Health”. In this session Thomas Lüscher will speak about “Aging and longevity genes in cardiovascular disease”.

3. A Joint session between Revista Española de Cardiología and the European Heart Journal. The session will focus on the discussion of the best papers published in Revista along with some papers published in the European Heart Journal by Spanish cardiologists. Thomas Lüscher will chair the session and provide the closing statements.


Acute Cardiovascular Care conference will highlight innovations and controversies

Acute Cardiovascular Care 201will be held 17 - 19 October 2015 in Vienna, Austria at the HOFBURG Vienna Congress Centre. It is the annual meeting of the Acute Cardiovascular Care Association (ACCA), a registered branch of the European Society of Cardiology (ESC).

Prof Kurt Huber, Chairperson of the Scientific Programme Committee stated “The main theme this year is innovations in acute cardiovascular care.  Novelties will be presented and discussed through the abstracts and symposia. E.g. in a session on innovations in acute heart failure, experts will present the latest data on new treatments such as vasodilator therapy, ventricular-arterial coupling, an interatrial decompression device, and mechanical support.”

Controversies in clinical practice that are heavily discussed among physicians will include:

  • pre-hospital treatment of patients with ACS,
  • the use of bivalirudin versus heparin during primary PCI,
  • thrombus aspiration in patients with STEMI,
  • the early management after, out of hospital cardiac arrest.

Antiplatelet therapy in ACS patients is a hot topic and research will be revealed on the duration of dual antiplatelet therapy. Biomarkers are a rapidly evolving area and new rule-in and rule-out strategies in MI using high sensitive troponin assays and the new marker copeptin will be debated.

Treatment of pulmonary embolism and DVT with non-vitamin K antagonist oral anticoagulants (NOACs), will be included in the programme for the first time this year.

Other crucial topics have been added to the scientific programme such as antithrombotic therapy, atrial fibrillation, treatment of bleeding, interventional cardiology, pacemakers and ICDs, external heart pumps, and stroke systems of care.

A novel ESC position paper on the pre-hospital management of chest pain and dyspnoea will be distributed during the meeting. (1)  

First author Professor Farzin Beygui said: “The position paper is the first symptom based paper ever published on the subject covering the wide spectrum of acute cardiovascular conditions that may cause chest pain or dyspnoea.”

“Its aim is to provide guidance which may be applicable in all European countries despite the variety of emergency medical services (EMS), for pre-hospital management, based on evidence where available or expert opinion and consensus.”

The paper may provoke controversy over its recommendation for physician based EMS. Unlike most EMS worldwide, the majority of EMS in Europe are physician-based. Because a high level of pre-hospital care may require emergency physicians on scene, the paper recommends a physician-based EMS organisation with the availability of emergency physicians in the case of chest pain or acute dyspnoea of suspected cardiac origin.

“This point is based on expert consensus and not striking evidence,” said Professor Beygui. “The presence of a physician may improve pre-hospital diagnosis (ultrasound), allow higher rates of reperfusion therapy especially by pre-hospital fibrinolysis, provide higher levels of competence for treating life threatening conditions and more accurate identification of the destination for patient transfer.”

The three day event features over 45 sessions with lectures from global leaders and breaking results in the abstract-based programme. More than 1 000 cardiologists, emergency physicians, intensive care physicians, internists, surgeons, imaging specialists, interventionists, nurses, paramedics and students from nearly 80 countries are expected.

State-of-the-art advances in emergency cardiac care are set to be unveiled, making it an event not to be missed.

The scientific programme is available here


(1)Beygui FCastren MBrunetti NDRosell-Ortiz FChrist MZeymer UHuber KFolke FSvensson LBueno HVan't Hof ANikolaou NNibbe LCharpentier SSwahn ETubaro MGoldstein P. Pre-hospital management of patients with chest pain and/or dyspnoea of cardiac origin. A position paper of the Acute Cardiovascular Care Association (ACCA) of the ESC. Eur Heart J Acute Cardiovasc Care. 2015 Aug 27. http://acc.sagepub.com/content/early/2015/08/27/2048872615604119.full



Two sets of “Ten Commandments” are presented with some overlap for this very serious condition, Infective Endocarditis, which has a grave prognosis and mortality even in the 21st century.

“Ten Commandments” presented by ESC Task Force member Barbara JM Mulder MD

  1. Antibiotic prophylaxis should be restricted to highest-risk patients, but preventive measures should be maintained or extended, to all patients with cardiac disease.
  2. Echocardiography (TTE and TOE), positive blood cultures and clinical features remain the cornerstone for the diagnosis of IE and new imaging modalities (MRI, CT, PET/CT) may allow the diagnosis of embolic events and of cardiac involvement when TTE/TOE are negative or doubtful.
  3. Prognostic assessment at admission, using simple clinical, microbiological, and echocardiographic parameters, should be used to select the best initial approach; patients with persistently positive blood cultures after 48–72 h of starting antibiotics have a worse prognosis.
  4. Heart failure is the most frequent and among the most severe complication of IE and is an indication for early surgery in native and prosthetic valve endocarditis, even in patients with cardiogenic shock.
  5. Uncontrolled infection is most frequently related to peri-valvular extension or ‘difficult-to-treat’ organisms and is an indication for early surgery.
  6. The risk of embolism is highest during the first 2 weeks of antibiotic therapy and the decision to operate early to prevent embolism should depend on size and mobility of the vegetation, previous embolism, type of microorganism, and duration of antibiotic therapy.
  7. After a first neurological event, cardiac surgery, if indicated, is generally not contraindicated, except when extensive brain damage or intracranial haemorrhage is present.
  8. Recurrences are rare following IE, and may be associated with inadequate initial antibiotic therapy, resistant microorganisms, a persistent focus of infection, intravenous drug abuse, and chronic dialysis.
  9. Complicated and staphylococcal prosthetic valve endocarditis are associated with a worse prognosis and must be managed aggressively; patients with non-complicated, non-staphylococcal late prosthetic valve endocarditis can be managed conservatively with close follow-up.
  10. Cardiac device-related IE must be suspected in the presence of frequently misleading symptoms: prognosis is poor, probably because of its frequent occurrence in elderly patients with associated comorbidities and must be treated by prolonged antibiotic therapy and device removal.

Barbara JM Mulder MD

ESC Task Force member



“Ten Commandments” presented by ESC Task Force member, co-chair and chair.

  1. Creation of an “Endocarditis Team”. A multidisciplinary approach is mandatory, to include cardiologists, cardiac surgeons and specialists of infectious diseases.
  2. The creation of referral Endocarditis Centres is recommended due to the severity of the disease. Centres with experience in complex surgery are the best place to treat such patients.
  3. While echocardiography plays a key role in diagnostic algorithms, the need for a multimodality imaging approach for diagnosing endocarditis is highlighted. The new guidelines show the important diagnostic role of other imaging techniques, such as PET-CT that may be helpful in diagnosis and management decisions.
  4. The Early strategy in endocarditis is crucial:
    1. Early diagnosis,
    2. Early antibiotic therapy,
    3. Early surgery.
  5. Repeat TTE and /or TOE examination is recommended within 5–7 days in case of initially negative examination when clinical suspicion of IE remains high, or as soon as a new complication of IE is suspected (new murmur, embolism, persisting fever, heart failure, abscess, atrioventricular block).
  6. Prophylaxis is still controversial. Antibiotic prophylaxis should be considered for patients at highest risk for IE with a IIa recommendation. It should be considered in:

i) Patients with any prosthetic valve, including transcatheter valve, or those in whom any prosthetic material was used for cardiac valve repair.

ii) Patients with previous episode of IE.

iii) Patients with congenital heart disease:

a) Any type of cyanotic congenital heart disease or 

b) Any type of congenital heart disease repaired with a prosthetic material.

  1. New antibiotic strategies were proposed in staphylococcal endocarditis. A consensus was difficult to obtain in the subgroup of patients with the most severe form of IE. Ongoing studies on this topic will be useful.
  2. Urgent surgery in specialised Centres is recommended in cases with aortic or mitral native valve endocarditis (NVE) or prosthetic valve endocarditis (PVE) with severe regurgitation or obstruction causing symptoms of heart failure or echocardiographic signs of poor haemodynamic tolerance, must by treated by urgent surgery. It is also recommended in patients with locally uncontrolled infection (abscess, false aneurysm, fistula, enlarging vegetation) or in infections caused by fungi or multiresistant organisms. Patients with aortic or mitral NVE or PVE with persistent vegetations >10 mm after ≥1 embolic episode despite appropriate antibiotic therapy must also be treated by urgent surgery.
  3. Special mention is made related to endocarditis in patients with cardiac devices (CDRIE). Prolonged (i.e. before and after extraction) antibiotic therapy and complete hardware (device and leads) removal are recommended. Percutaneous extraction is recommended in most patients with CDRIE, even those with vegetations >10 mm. In these patients routine antibiotic prophylaxis is recommended before device implantation.
  4. Related to patients with neurological complications. After a silent embolism or transient ischaemic attack, cardiac surgery, if indicated, is recommended without delay.

José Luis Zamorano MD

ESC Task Force member


Gilbert Habib MD

ESC Task Force Chairperson

Patrizio Lanzelloti MD

ESC Task Force co-Chairperson

“Ten Commandments” of 2015 ESC Guidelines for the Management of Acute Coronary Syndromes in patients presenting without Persistent ST-Segment Elevation (NSTE-ACS)

  1. "Similar to the 0 h and 3 h protocol”, a rapid rule-out and rule-in protocol for myocardial infarction (MI) at 0 h and 1 h is recommended if a high-sensitivity troponin test with a validated 0 h/1 h algorithm is available. 
  2. Echocardiography is recommended to evaluate regional and global left ventricular (LV) function and to rule in or rule out differential diagnoses.
  3. A P2Y12 inhibitor is recommended in addition to aspirin for 12 months, unless there are contraindications such as excessive risk of bleeds. 
  4. Ticagrelor is recommended for all patients at moderate to high risk of ischaemic events (e.g. elevated cardiac troponins), regardless of initial treatment strategy.
  5. Prasugrel is recommended in patients who are proceeding to percutaneous coronary intervention (PCI).
  6. Clopidogrel is recommended for patients who cannot receive ticagrelor or prasugrel or who require oral anticoagulation.
  7. Antithrombotic strategies for patients requiring oral anticoagulation should be personalized, and the different combinations of oral anticoagulants with single or dual antiplatelet therapy and their variable duration be tailored on the basis of the patient's bleeding risk and management strategy. 
  8. An immediate invasive strategy (<2 h) is recommended in patients with at least one of the following very-high-risk criteria:

Haemodynamic instability or cardiogenic shock,
Recurrent or ongoing chest pain,
Refractory to medical treatment,
Life-threatening arrhythmias or cardiac arrest,
Mechanical complications of MI,
Acute heart failure with refractory angina or ST deviation,
Recurrent dynamic ST- or T-wave changes, particularly with intermittent ST elevation.

  1. An early invasive strategy (<24 h) is recommended in patients with at least one of the following high-risk criteria:

Rise or fall in troponin compatible with MI,
Dynamic ST- or T-wave changes (symptomatic or silent),
Registry of Acute Coronary Events (GRACE) score >140.

  1. An invasive strategy (<72 h) is recommended in patients with at least one of the following intermediate risk criteria:

Diabetes mellitus renal insufficiency (eGFR <60 mL/min/1.73 m2),
LV ejection fraction <40% or congestive heart failure,
Early post-infarction angina,
Recent PCI,
Prior coronary artery bypass grafting (CABG),
Global GRACE risk score >109 and <140,
Or, in the presence of recurrent symptoms or ischaemia on non-invasive testing.

  1. In centres experienced with radial access, a radial approach is recommended for coronary angiography and PCI. It is recommended that centres treating ACS patients implement a transition from transfemoral to transradial access. 
  2. In patients with multivessel coronary artery disease, it is recommended to base the revascularisation strategy (e.g. ad hoc culprit-lesion PCI, multivessel PCI, CABG) on the clinical status and comorbidities as well as the disease severity (including distribution, angiographic lesion characteristics, SYNTAX score) according to the local Heart Team protocol.
  3. It is recommended to start high-intensity statin therapy as early as possible unless contraindicated, and maintain it long-term.

Marco Roffi MD FESC
ESC Task Force chair
Division of Cardiology, University Hospital
Geneva, Switzerland
corresponding author


Carlo Patrono MD
ESC Task Force co-chair
Istituto di Farmacologia
Università Cattolica del Sacro Cuore
Rome, Italy

The “Ten Commandments” of the ESC Guidelines 2015 for Diagnosis and Management of Pericardial Diseases

1.   Hospital admission is recommended for high risk patients with acute pericarditis, defined by a risk factor of either predictor of a specific cause (non-viral or non-idiopathic) or of increased risk of complications.

At least one risk factor among: high fever (>38ºC), subacute course, large pericardial effusion, cardiac tamponade, failure to respond to non-steroidal anti-inflammatory drug (NSAID) therapy; myopericarditis, immunosuppression, trauma or oral anticoagulant therapy.

2.   Colchicine is recommended as a first line therapy for acute pericarditis as an adjunct to aspirin/NSAID therapy.

3.   Pericardiocentesis, or surgical drainage, is indicated for cardiac tamponade, or for symptomatic moderate to large pericardial effusions which do not respond to medical therapy and for suspicion of bacterial or neoplastic aetiology.

4.   The mainstay of treatment for chronic permanent constriction is pericardiectomy.

5.   A general diagnostic work-up should be performed to identify causes that require targeted therapies.  A modern approach for the management of pericardial diseases should include the integration of biological markers, as well as different imaging modalities.

6.   Routine viral serology is not recommended in acute pericarditis, with the possible exception of HIV and HCV.  For the definite diagnosis of viral pericarditis, a comprehensive work-up of histological, cytological, immunohistological and molecular investigations in pericardial fluid should be considered.  In the absence of such argument the term “presumed viral pericarditis” should be used.

7.   In patients living in non-endemic areas, empiric anti-tuberculosis treatment is not recommended when systematic investigation fails to yield a diagnosis of tuberculous pericarditis. By contrast, in patients living in endemic areas empiric antituberculosis chemotherapy is recommended for exudative pericardial effusion, after excluding other causes.

8.   Effective pericardial drainage is recommended for purulent pericarditis as well as administration of intravenous antibiotics.

9.   Cytological analyses of pericardial fluid are recommended for the confirmation of malignant pericardial disease. Pericardial or epicardial biopsy should be considered for the confirmation of malignant pericardial disease.

10.   Aspirin is not recommended for therapy of acute pericarditis in children but NSAIDs at high doses are recommended as first line therapy.

For more information see: http://www.escardio.org/guidelines-surveys/esc-guidelines/Pages/essential-message-slideset.aspx

Philippe Charron MD PhD
ESC Task Force co-chair
First and corresponding author

Yehuda Adler MD MHA
ESC Task Force co-chair

The “Ten Commandments” of the 2015 ESC-ERS Guidelines on Pulmonary Hypertension

  1. Right heart catheterization is recommended to confirm the diagnosis of pulmonary arterial hypertension (PAH - Group 1) and to support treatment decisions
  2. Vasoreactivity testing performed during right heart catheterization is recommended in patients with idiopathic PAH, inherited PAH and PAH induced by drugs or toxin use, to detect patients who can be treated with high doses of a calcium channel blocker
  3. It is recommended to evaluate the severity of PAH patients with a panel of data derived from clinical assessment, exercise tests, biochemical markers, and echocardiographic and haemodynamic evaluation and to perform regular follow-up assessments every 3-6 months in stable patients.
  4. It is recommended to avoid pregnancy in patients with PAH
  5. It is recommended for referral centres to provide care by a multi-professional team (cardiology and respiratory medicine physicians, clinical nurse specialist, radiologists, psychological and social work support, with appropriate on-call expertise)
  6. Initial drug monotherapy or initial oral drug combination therapy is recommended in treatment naïve, low or intermediate risk patients with PAH
  7. Sequential drug combination therapy is recommended in PAH patients with inadequate treatment response to initial monotherapy or to initial oral drug combination therapy.
  8. Initial combination therapy including an intravenous prostacyclin analogue is recommended in high risk PAH patients
  9. The use of PAH approved therapies is not recommended in patients with pulmonary hypertension due to left heart disease or lung diseases
  10. Surgical pulmonary endarterectomy in deep hypothermia circulatory arrest is recommended for patients with chronic thrombo-embolic pulmonary hypertension [CTEPH] and it is recommended that the assessment of operability and decisions regarding other treatment strategies (drugs therapy or balloon pulmonary angioplasty) be made by a multidisciplinary team of experts

Nazzareno Galiè MD
ESC Task Force chairperson

Marc Humbert MD PhD
ERS Task Force chairperson

“Ten Commandments” of the 2015 ESC Guidelines for the Management of Patients with Ventricular Arrhythmias and Prevention of Sudden Cardiac Death

  1. Investigate individuals with known or suspected ventricular arrhythmias completely, applying both non-invasive and invasive techniques: a good etiological diagnosis is the first step towards efficient management of patients and the prevention of sudden cardiac death.
  2. Perform a complete autopsy in victims of sudden unexplained death, especially when they are young: the identification of an inheritable disease as the cause of death may prevent other tragedies within their family.
  3. Consider the use of an implantable cardioverter defibrillator (ICD) in all survivors of an episode of ventricular fibrillation or ventricular tachycardia accompanied by haemodynamic instability that occurs without apparent reversible causes or outside of the acute phase of myocardial infarction. These patients have a high incidence of recurrent life-threatening arrhythmias.
  4. Ensure that patients with STEMI acute coronary syndromes and unstable angina are urgently sent to reperfusion, especially when recurrent ventricular tachycardia and ventricular fibrillation are present: reducing delays from first medical contact to reperfusion helps prevent sudden cardiac death.
  5. Evaluate left ventricular ejection fraction both before discharge and 6–12 weeks after myocardial infarction: post-MI patients may benefit from ICD implantation for the primary prevention of sudden cardiac death.
  6. Implement optimal therapy including pharmacological agents (ACE inhibitors, beta-blockers, and mineralocorticoid receptor antagonists) and, if appropriate, ICDs in patients with heart failure with severe systolic dysfunction (left ventricular ejection fraction ≤35%).
  7. Consider the addition of cardiac resynchronization therapy for patients with the previous characteristics, when they also have intraventricular conduction delays with left bundle branch block appearance and QRS duration of >120 ms.
  8. Updated diagnostic criteria for inherited arrhythmogenic syndromes, including Long QT Syndrome and Brugada Syndrome, have been proposed by the new guidelines. Please refer to them in your clinical practice.
  9. Consider catheter ablation in experienced centres as a valuable tool to treat patients presenting scar-related ventricular tachycardias, bundle branch re-entrant tachycardia or electrical storms.
  10. Discuss with your patients the issues related to the impact that ICDs may have on their quality of life, before the implant and during their disease progression. Consider the possibility of deactivating the ICD when their clinical conditions deteriorate. Always respect your patients’ autonomy.

Andrea Mazzanti MD
Molecular Cardiology
IRCCS Salvatore Maugeri Foundation



A Day with the Legends at ESC Congress 2015

Sunday 30 August in The Hub at Regents Park

08:30 to 09:10 - ESC Andreas Grüntzig Lecture on Interventional Cardiology

Interventional cardiology, where real life and science do not necessarily meet          

Bernard Meier (Bern, CH)

Chairman and Professor of Cardiology, Swiss Cardiovascular Center Bern, University Hospital, Bern, Switzerland.
Swiss native. Trained at the medical school of the University of Zurich, Switzerland, graduated 1975 (best of 180). Board certified in internal medicine 1980 and cardiology 1983. Cardiology training at Emory University, Atlanta, Georgia, USA, with Andreas Grüntzig

1983 - 1992 Head of invasive cardiology, University Hospital, Geneva, Switzerland.
1992 - Chairman and Professor of Cardiology, University Hospital, Bern, Switzerland.
2001 - Rotating Chairman, Swiss Cardiovascular Center, University Hospital, Bern, Switzerland.

Specialized in interventional cardiology. Involved in coronary angioplasty since the first case performed by Andreas Grüntzig on September 16, 1977 in Zurich, Switzerland. Author and co-author of numerous books, reviews, and original articles on cardiology, in particular interventional cardiology. Organizer and active participant of countless educational meetings on interventional cardiology. Fellow of the American College of Cardiology and of the European Society of Cardiology. Past president of the Swiss Society of Cardiology. Recipient of several awards.

09:20 to 10:00 - ESC William Harvey Lecture on Basic Science

Microcircular networks: the business end of the circulation

Axel Radlach Pries (Berlin, DE)

Axel Radlach Pries studied medicine at the University of Cologne and defended his doctoral thesis in 1980 with ‘summa cum laude’.

He worked as postdoctoral fellow in Cologne and Berlin University and 1997-1998 at the Institute of Anaesthesiology of the German Heart Center Berlin. 1998 he became full professor at the Department of Physiology, Free University Berlin and 2001 head of the Charité Institute for Physiology.

His scientific interests include microcirculation, tumour vasculature, blood rheology, vascular adaptation, angiogenesis, and the endothelial surface layer. He was general secretary of the ESM (European Society for Microcirculation) and is chair of the International Liaison Committee for Microcirculation.

In the ESC, he was chair of the Working Group for Coronary Pathophysiology and Microcirculation and the Council for Basic Cardiovascular Science (CBCS). Since 2015, he is Dean of the Charité University Medicine Berlin.


Meet the Legends

10:10 - 10:50 - Keith Fox (Edinburgh, UK)

He was a founding Fellow of the European Society of Cardiology and Chair of the Programme of the European Society of Cardiology 2012-2014.  In addition, he was President of the British Cardiovascular Society from 2009 to 2012.

His awards include the Silver Medal of the European Society of Cardiology in 2010 and again in 2014 and the Mackenzie medal of the British Cardiovascular Society (2013). Professor Fox’s major research interest lies in the mechanisms and manifestations of acute coronary arterial disease; his work extends from underlying biological mechanisms to in vitro and in vivo studies and clinical trials.

He is an International Associate Editor of the European Heart Journal and Deputy Editor of the Journal of the American College of Cardiology JACC (Europe).  His ongoing research interests include the mechanisms of inflammation and plaque rupture in acute coronary syndromes and antithrombotic therapies.


A Journey to Stockholm

11:00 - 12:30 - Ageing and cardiovascular disease: role of cellular senescence

Elisabeth Blackburn (San Francisco, US)

Professor Elizabeth H. Blackburn is a Nobel Laureate and Morris Herzstein Professor of Biology and Physiology, in the Department of Biochemistry and Biophysics at the University of California San Francisco (UCSF).

She is a leader in the area of telomere and telomerase research. Elizabeth Blackburn discovered the molecular nature of telomeres - the ends of eukaryotic chromosomes that serve as protective caps essential for preserving the genetic information - and co-discovered the ribonucleoprotein enzyme, telomerase. Professor Blackburn and her research team at UCSF are working with various cells including human cells, with the goal of understanding telomerase and telomere biology. They also collaborate in investigating the roles of telomere biology in human health and diseases, in clinical and other human studies.

Throughout her career, Professor Blackburn has won many prestigious awards. She was elected Fellow of the American Academy of Arts and Sciences (1991) and the Royal Society of London (1992). She was elected Foreign Associate of the National Academy of Sciences (1993) and Member of the Institute of Medicine (2000). She served on the President’s Council on Bioethics from 2002 to 2004, and has been awarded honorary degrees by 11 Universities. She received the Albert Lasker Medical Research Award for Basic Medical Research in 2006, and in 2007 was named one of TIME Magazine’s 100 Most Influential People. In 2008 she was the North American Laureate for L’Oreal-UNESCO For Women in Science.

In 2009, Professor Blackburn was awarded the Nobel Prize in Physiology or Medicine.


Meet the Legends

14:00 - 14:40 - Richard Popp (Palo Alto, US)

Dr. Richard Popp is Emeritus Professor of Medicine at Stanford University. Dr. Popp is a clinical cardiologist and teacher who focused his research on the development of all forms of ultrasound in cardiology with more than 300 scientific publications.  He has trained over 150 cardiologists through his clinical laboratory program.

Dr. Popp was Senior Associate Dean for Academic Affairs at Stanford from 1995-2000. He continues to teach in the Stanford Biodesign Innovation Program where he heads the Ethics and Policy group. He has been Chair, the Conflict of Interest Committee at the Medical School since 2000. 

Dr. Popp was President of the American College of Cardiology, the American Society of Echocardiography and the Association of University Cardiologists. He is the previous Chairman of the American Board of Internal Medicine’s Cardiovascular Diseases Sub-specialty Board. He is a Master of the American College of Cardiology and a Fellow of the American Heart Association, the American Society of Echocardiography, and the European Society of Cardiology. He has been given Honorary Fellowship in the Cardiology Society of several countries.

14:50 -15:30 Michel Haissaguerre (Pessac, FR)

16:30 - 17:10 - ESC Rene Laennec Lecture on Clinical Cardiology

The interaction of acute blood pressure change, pericardial restraint and acute outflow tract stretch - A new paradigm underlying sudden cardiac death
George Sutherland (London, UK)



17:20 -18:00 - ESC Geoffrey Rose Lecture on Population Sciences

Optimising cardiovascular health: old and new challenges

Kay-Tee Khaw (Cambridge, UK)

Kay Tee Khaw is Professor of Clinical Gerontology, University of Cambridge.   
She trained in medicine at Girton College, University of Cambridge and St. Mary's Hospital, University of London (now Imperial College). She worked under Geoffrey Rose in clinical medicine at St. Mary’s Hospital and subsequently in epidemiology at the London School of Hygiene and Tropical Medicine, with later clinical and academic posts in the University of London and University of California San Diego.  

Her research interests are the maintenance of health in later life and the causes and prevention of chronic diseases including cardiovascular disease, cancer and osteoporosis with a focus on nutrition, physical activity, and hormones. The research is based on longitudinal population studies and clinical trials.  

She is a principal investigator in the European Prospective Investigation in Cancer in Norfolk, part of a ten country half million participant research collaboration over two decades.  She is a Fellow of the Academy of Medical Sciences, UK and has a National Institutes of Health Research Senior Investigator award.


Continuing Excellence at the Heart of Cardiology – ESC publishing in 2015

The 2015 European Society of Cardiology Congress in London is in many ways the true highlight of the year for publishing in cardiology. Oxford University Press is delighted to be working with ESC again on what appears to be a bigger conference than ever before. Alongside the flagship European Heart Journal (now officially #2 in the world of cardiovascular medicine), we are showcasing some exciting new publications that are part of the ever-growing international ESC portfolio.

There are two new journals (EHJ-Cardiovascular Pharmacotherapy and EHJ-Quality of Care & Clinical Outcomes), as well as 4 major new ESC textbooks in, Intensive and Acute Cardiovascular CareCardiovascular ImagingPreventive Cardiology; and a beautiful, accessible case-based learning book with MCQs: The EHRA Book of Pacemaker, ICD, and CRT Troubleshooting. All are new for 2015 and available alongside the well-established ESC Textbook of Cardiovascular Medicine (Second Edition), The EAE Textbook of Echocardiography and the journal family, including Cardiovascular ResearchEuropean Heart Journal SupplementsEP-Europace and EHJ-Cardiovascular Imaging.

To give participants a taste of what’s new this year, don’t miss our series of Lightning Talks at the Oxford University Press stand (#B801) during lunch and coffee breaks. Every day during the Congress, ESC editors, authors, and advisors – all experts in their field – will give short talks about their work and experience.

Lightning Talks:

  • Professor Thomas Lüscher kicks-off the Lightning Talks at 16:00 on Saturday.



  • On Sunday Professor Jolanda van der Velden will speak, followed by Professor Marco Tubaro on STEMI systems of care and therapeutic strategies.

On Monday our line-up includes:

  • Professor Haran Burri who will present cases and brain teasers from his new book on device trouble shooting,



  • Professor Stefan Agewall who will introduce the new journal EHJ-Cardiovascular Pharmacotherapy,



  • Professor Pascal Vranckx and Professor Adam Timmis, who will share his experiences as a journal editor on low-level research misconduct. And for insights into the world of publishing in clinical medicine,


  • Ms. Rachel Fenwick from OUP will showcase our digital publishing platform Oxford Medicine Online, and



  • Mr Andy Sandland reveals all about Open Access Publishing during the breaks on Tuesday.



So don’t miss out – drop by the Oxford University Press stand to hear the speakers and discover everything that is on offer this year in cardiology, from definitive new textbooks with exclusive discounts, to free copies of all the ESC journals published by Oxford University Press.


The Russian National Congress of Cardiology 2015

The 2015 Congress will be held in Moscow, capital of the Russian Federation 22-25 September reports Prof Evgeny Shlyakhto

The Russian National Congress of Cardiology is a key annual event of the Russian Society of Cardiology, which gives an opportunity to discuss crucial issues of cardiovascular research and clinical practice on the multidisciplinary and international basis.

Today, the Russian Society of Cardiology is an all-Russian organization with more than 5,500 members and representations in about 60 regions of Russia. At the moment, 30 sections and 3 working groups are included in the Russian Society of Cardiology.

The Russian Society of Cardiology (RSC) is developing interdisciplinary approaches and aims to cooperate with other medical specialties. Among its members, there are internists, cardiovascular specialists, endocrinologists and other specialists interested in cardiovascular diseases.

The Russian National Congress of Cardiology has been held annually since 2000. Since 2012, one of the priorities for the RSC became its integration into the world cardiovascular community. Since that time there has been growing international participation, including leaders from the top world professional associations such as European Society of Cardiology and American College of Cardiology, which has become a new feature of the national event. This ensures an important contribution to its success as well as, to its scientific and educational value.

Today, the Russian National Congress of Cardiology is the key annual event of the most influential professional medical association in the country. The Congress scientific programme discusses the most significant modern achievements in prevention, diagnostics and treatment of cardiovascular diseases. The main topics include:

  • most demanding issues of emergency and elective cardiovascular care;
  • key problems in development and introduction of modern medical technologies into the primary and secondary prevention, diagnostics and treatment;
  • development of basic research: introducing the concept of translational medicine into cardiology;
  • improvement of pharmacotherapy following the latest evidence-based medical achievements;
  • modern imaging techniques in cardiology;
  • development of modern diagnostic methods (including prenatal methods) and technologies for the treatment of congenital cardiovascular defects and cardiology issues in perinatology and paediatrics;
  • development and introduction of new surgical interventions and hybrid technologies, problems of heart transplantation and innovations in the  treatment of cardiac arrhythmias;
  • co-morbidities in cardiology, geriatric aspects in cardiovascular diagnostics and treatment;
  • rehabilitation issues of cardiovascular patients and sports cardiology;
  • development of continuous medical education (CME) system in cardiology;
  • organization of nursery for cardiovascular patients.

The scientific programme traditionally consists of keynote lectures, plenary sessions, scientific symposia, workshops, poster sessions, a Young Cardiologist Award session, as well as training sessions with the possibility of receiving CME credits.

The 2014 Congress held in Kazan became the most significant event for the professional community: 170 scientific sessions and symposia, among them 12 plenary sessions, 11 educational seminars, 3 master classes, 3 discussion clubs and 3 round tables. In all about 4,500 delegates from 191 Russian cities and 29 foreign countries participated.

In 2015, the Russian National Congress of Cardiology will be held in Moscow, the capital of the Russian Federation, which hosts numerous of the most important events every year and well known for its traditional hospitality. The Congress guests will have an opportunity to get in touch with thousand years of Russian history and see the outstanding sights of one of the most beautiful cities in the world.

Evgeny Shlyakhto MD FESC

President of the Russian Society of Cardiology



Adolfo J de Bold’s 1981 pioneering discovery results in first ARNi drug approval for heart failure

The first drug in the class ARNi, a combination of an Angiotensin Receptor Blocker (valsartan) and a Neprilysin inhibitor (sacubitril) was approved by the U.S. Federal Drug Administration on 7 July 2015, after it had been demonstrated to reduce rehospitalisation rates and prolong life in patients with heart failure and reduced ejection fraction.

Adolfo J. de Bold discovered atrial natriuretic protein (ANP) in 1981 which he originally called atrial natriuretic factor whilst at Queen’s University, Kingston, Ontario, Canada. He found that an extract from the atrial muscle of rat hearts caused a rapid and profound increase in sodium and chloride excretion. This led to the PARADIGM-HF (Prospective comparison of ARNi with ACEi to Determine Impact on Global Mortality and Morbidity in Heart Failure) trial which was closed early based on the strength of interim results.

Dr Eugene Braunwald, TIMI Study Group, Boston, USA, has stated, “the unambiguous superiority of clinical outcomes in patients with HFrEF by the first ARNi over enalapril in the PARADIGM HF trial represents a significant achievement with important clinical implications. Adolfo J. de Bold’s discovery places him among the most important cardiovascular scientists of the last 100 years”.



Policy statement from AHA, ESC, EACPR and ACPM

Experts call for ‘all hands on deck’ to tackle global burden of non-communicable disease. A policy statement from the American Heart Association, the European Society of Cardiology, the European Association for Cardiovascular Prevention and Rehabilitation and the American College of Preventive Medicine on the action needed to tackle non-communicable diseases (NCDs) on a global basis, has just been published, simultaneously in EHJ and Mayo Clinic Proceedings [1].

The authors propose that organisations at every level of society, from the family unit, to companies, to industry, to government and non-governmental organisations worldwide should collaborate to create, implement and sustain healthy lifestyle initiatives that will reverse the current upward trajectory of NCDs.

They say that identifying the enormous burden caused by NCDs is not enough and it is time to pursue strategies both within and outside traditional healthcare systems that will succeed in promoting healthier lifestyles in order to prevent or delay health conditions that cause the deaths of over 36 million people worldwide each year at a cost of at least US $6.3 trillion – that is projected to rise to $13 trillion by 2030.

Professor Ross Arena, of the University of Illinois at Chicago (USA), who was chair of the policy statement authors stated “The challenge is how to initiate global change, not towards continuing documentation of the scale of the problem, but towards true action that will result in positive and measurable improvements in people’s lifestyles.”

The experts call for a paradigm shift in the prevention and treatment of NCDs. “The importance of promoting and leading a healthy lifestyle must take a significantly more prominent role, from the individual/family to global population level, capitalising on all forms of preventive strategies. They propose that the treatment of NCDs should move outside of the traditional, often reactionary, healthcare model. Prevention is the key and preventive strategies at earlier stages in the community are best, for instance at the very beginning of life.

The paper identifies a number of barriers or challenges to implementing healthy lifestyles, and it suggests possible solutions. The authors conclude that they hope their paper will motivate organisations at all levels of society to: “1) Embrace their defined roles with respect to HL [healthy lifestyles] promotion and take action that will result in meaningful and positive change; 2) officially designate one or more healthy lifestyle ambassadors that have the organisational support needed to develop and implement HL initiatives; and 3) commit to ongoing communication amongst stakeholders that will result in collaborative HL initiatives.”

[1] “Healthy lifestyle interventions to combat non-communicable disease: a novel non-hierarchical connectivity model for key stakeholders. A policy statement from the AHA, ESC, EACPR and ACPM”, by Ross Arena et al.
Published simultaneously in:
Mayo Clinic Proceedings, doi: 10.1016/j.mayocp.2015.05.001
European Heart Journal. doi:10.1093/eurheartj/ehv207


Endurance athletes should have cardiac testing while exercising rather than at rest

New evidence published in the European Heart Journal [1] 3 June, has shown that important signs of right ventricular dysfunction which are potentially fatal can only be detected during exercise.

In this new study, Prof André La Gerche and his colleagues in Australia and Belgium have found that problems in the way the right ventricle works become apparent only during exercise and cannot be detected when an athlete is resting. La Gerche said: “You do not test a racing car while it is sitting in the garage. Similarly, you can’t assess an athlete’s heart until you assess it under the stress of exercise.”

The researchers tested cardiac performance in 17 athletes with right ventricular arrhythmias, 8 of whom had an ICD in place, 10 healthy endurance athletes and 7 non-athletes, using  invasive procedures such as cardiac MRI with intravascular catheters, and non-invasive methods e.g. echocardiography. They found that cardiac function at rest was similar in all three groups, as was left ventricular function during exercise. However, measurements during exercise showed changes in right ventricular function in the athletes who were known to have arrhythmias compared to the other two groups.
La Gerche said: “These results should stimulate cardiologists who manage athletes to pay greater attention to the right side of the heart. The tests that we describe are ready for clinical use now and are not too challenging. It is simply a case of ‘you will not find unless you look’.”

In an accompanying editorial [2], Prof Sanjay Sharma, of St George’s University of London (UK), who is medical director of the London Marathon and chair of the European Society of Cardiology’s sports cardiology nucleus, and Dr Abbas Zaidi, a research fellow at St George’s University of London, and a marathon runner, describe the study as “novel and important in several regards”. They write: “Importantly, assessment of the right ventricle should form an integral component of risk assessment in athletes presenting with potentially lethal rhythm disturbances. Until only recently considered to be a Pandora’s Box of spurious and detrimental public messages, the right ventricle and its potential for adverse remodelling is increasingly acknowledged to represent the true Achilles’ heel of the endurance athlete.”
[1] “Exercise-induced right ventricular dysfunction is associated with ventricular arrhythmias in endurance athletes”, by André La Gerche et al. European Heart Journal. doi:10.1093/eurheartj/ehv202
[2] “Arrhythmogenic right ventricular remodelling in endurance athletes: Pandora’s Box or Achilles’ heel?” by Abbas Zaidi and Sanjay Sharma. European Heart Journal. doi:10.1093/eurheartj/ehv199

Uninterrupted NOAC therapy during AF ablation is safe

Uninterrupted treatment with novel oral anticoagulants (NOACs) during catheter ablation of atrial fibrillation (AF) is safe, according to research presented at EHRA EUROPACE – CARDIOSTIM 2015 by Dr Carsten Wunderlich.

The observational study included 549 consecutive patients with drug refractory AF who were scheduled for catheter ablation with pulmonary vein isolation at the Heart Centre Dresden. A total of 233 patients were taking a vitamin K antagonist and 316 patients were taking a NOAC. Patients continued to take their prescribed anticoagulation medication without missing any doses. After the procedure echocardiography was performed to exclude pericardial effusion and patients were followed up for six months.

No patients in either group experienced a stroke or systemic embolism. There was one pericardial effusion in the vitamin K antagonist group and two in the NOAC group. Three NOAC patients had an arteriovenous fistula compared to one on vitamin K antagonists. Pseudoaneurysms were experienced by seven patients on vitamin K antagonists and two on NOACs, while three NOAC patients had groin hematoma compared to four on vitamin K antagonists.

‘Our study suggests that NOACs can be continued during catheter ablation of AF without an increased risk of periprocedural bleeding or thromboembolism,’ said Wunderlich. ‘Importantly, pericardial effusions in the NOAC group did not require specialised treatment.’

He added: ‘The results of our observational study suggest that continuous NOACs are as good as continuous vitamin K antagonists during ablation of atrial fibrillation. Our study was conducted in a high volume centre with heart surgery on site and experienced physicians doing about 1,200 ablations a year. In clinical practice we do not stop NOACs before an ablation and this is a good approach for experienced centres but I would not recommend it for all hospitals. This is a single centre experience and a randomised trial is needed before firm conclusions can be drawn.’


ESC Grants available summer 2015

1. Young basic scientist wanting to get connections abroad?

The Council on Basic Cardiovascular Science encourages young scientists within Europe to establish research links by visiting institutions abroad. Apply for the ESC First Contact Initiative Grant by 15 July 2015

2. EACVI Training & Research Grants

The EACVI offers research & training grants to help young candidates in obtaining experience in a high standard academic centre in an ESC member country, other than their own
Don't miss the opportunity to get specialised training or research in a non-invasive cardiovascular imaging technique!

Application deadline: 30 September 2015


New ESC toolkit for cardiovascular nurses and allied professionals

The ESC Council on Cardiovascular Nursing and Allied Professions (CCNAP) launched its online toolkit during its Annual Congress EuroHeartCare 2015 weekend in Dubrovnik, on 14-15 June. Composed of videos, webcasts, presentations and educational tools, this toolkit aims to help Nurses in implementation of ESC Guidelines. This new initiative is an educational and motivational aid to nurses and allied professionals working in clinical practice.

The toolkit is part of the CCNAP Guidelines Implementation Programme which also includes a survey to evaluate knowledge of Nurses and Allied Professionals in Guidelines Implementation.


Salim Yusuf and John McMurray share renowned Prize

John McMurray and Salim Yusuf

Salim Yusuf MD and John J V McMurray MD shared the 2015 Recordarti Prize of €100,000.00 at an award ceremony during the European Society of Hypertension Annual Meeting 13 June 2015, in Milan, Italy.

The eighth edition of the Arrigo Recordati International Prize for Scientific Research recognized a clinical or basic science investigator who had achieved distinction in the study of secondary prevention and risk reduction strategies for patients with cardiovascular diseases.

In his acceptance speech Salim Yusuf spoke of his early career at Oxford, UK, which brought about the groundbreaking knowledge, that simple aspirin and beta blockers had a profound effect on reducing the mortality of acute myocardial infarction.

The Arrigo Recordati International Prize for Scientific Research was established in 2000 and is a legacy in memory of the Italian pharmaceutical entrepreneur Arrigo Recordati. It is awarded every two years to a scientist who has demonstrated dedication to the advancement of scientific knowledge in cardiology. 


Guido Tarone MD tribute

Guido Tarone

Guido Tarone, the current chair of the WG Myocardial Function, passed away on May 17 2015 at age 63. A bicycle accident took him away too soon from his beloved family, his students and his colleagues.

Guido was an integral member of the small European community of true basic scientists that entered the field of translational science in cardiology. He was associated with EU networks and together with his group in Turin, Italy, was one of the key partners to enthusiastically promote interactions and cooperation between the European groups.

Guido contributed substantially to ESC and HFA activities. He initiated and contributed to position papers, summer schools, workshops. He was as Chair of the WG on Myocardial Function appointed to the office at the ESC meeting in 2014. Guido organized the 2015 annual meeting of the WG on myocardial function together with HFA and the WG on Cell biology in Varenna, Italy, early in May. It was a great meeting, with a new format giving a lot of room to young scientists. It is a great tragedy that now we have to announce his unexpected demise which was an incredible shock.

His inspiring attitude towards science assures that his thoughts will be pursued. During his career he inspired, formed and influenced countless researchers. His personality left a strong imprint as well: Guido was not only a talented scientist, he was also a person with exquisite gentle manners and great humanity. He will be remembered for his warmth and for his kind, open mood. He showed how science requires inspiration and excitement but also independence of thought.

With his scientific work he pioneered our understanding how the heart sensitizes mechanical strain. His work focused on how interaction of cardiac muscle cells with the extracellular matrix could become novel therapeutic targets.
We will never forget Guido, he lives on in our hearts.

Johann Bauersachs, FESC, FHFA, Past Chair WG Myocardial Function
Stephane Heymans, Vice Chair WG Myocardial Function


Heartfailurematters.org now in Portuguese and Arabic

Heartfailurematters.org is a website created by the Heart Failure Association of the ESC and designed to provide easily understood and practical information about living with heart failure for patients, their families and carers. The site was developed by heart failure specialists, nurses and primary care physicians with input from patients and caregivers from across Europe. It is presented in 6 sections:

  • Understanding Heart Failure,
  • What can your doctor do?
  • What can you do?
  • Living with Heart Failure,
  • For caregivers,
  • Warning Signs

And also provides useful downloadable tools.  Tailored information is delivered not only in the text, but also by real-life videos of patients discussing the common issues faced by these patients. In addition, the site includes a number of original and captivating animations of the heart showing how the heart works, what goes wrong in heart failure and how treatments can improve symptoms and quality of life.

The site, based on a platform at the IT dept. at the European Heart House, receives over 140 000 visits per month. It is accessed from all over the world, due to the fact that the entire site is translated into 9 languages: English, Spanish, German, French, Dutch, Greek, Russian, Portuguese/Brazilian and Arabic. The site is also currently being translated into Swedish.
An animated guide helps visitors navigate through the site in all languages. Feedback from patients and healthcare professionals on the comprehensive but patient-friendly information is extremely positive and the site is regularly updated and reviewed by an active core group with representatives from each language.

Emphasis is placed on helping patients understand their condition and on providing practical advice for living with heart failure. The value of the site as an educational tool is currently being evaluated by a large randomised trial in the Netherlands. This attractive, web-based tool is an indispensable information resource as part of a treatment programme.

It is also employed by cardiologists, nurses and primary care physicians to provide information and educate patients living with heart failure.

Visit Heartfailurematters.org

Hand grip strength predicts MI and stroke

Weak hand grip strength is linked with shorter survival and a greater risk of myocardial infarction or stroke, according to the PURE study.

Reduced muscular strength, which can be measured by grip strength, has been consistently linked with early death, disability, and illness. But until now, information on the prognostic value of grip strength was limited, and mainly obtained from select high income countries.

The Prospective Urban-Rural Epidemiology (PURE) study included nearly 140,000 adults and was conducted in 17 countries of varying incomes and sociocultural settings. Grip strength was assessed using a handgrip dynamometer and subjects were followed for a median of four years.

The researchers found that every 5kg decline in grip strength was associated with a 16% increased risk of death from any cause, a 17% greater risk of cardiovascular death, a 17% higher risk of non-cardiovascular mortality, a 7% increased risk of heart attack and a 9% higher risk of stroke.

The associations persisted even after adjusting for age, education level, employment status, physical activity level, and tobacco and alcohol use.

Grip strength was a stronger predictor of all cause and cardiovascular mortality than systolic blood pressure.

Read the paper in The Lancet