EHRA 2023: the hottest science in heart rhythm disorder

Barcelona, Spain and online 16 to 18 April. Discover what’s new and on the horizon in the prevention and treatment of heart rhythm disorders at EHRA 2023, a scientific congress of the European Society of Cardiology (ESC). Featuring more than 120 scientific sessions with cutting-edge findings and lively debates on contemporary issues in heart rhythm management. Digital health takes centre stage in numerous sessions examining the use of digital twins, avatars , wearables and remote monitoring to improve care for patients with arrhythmias.1-3 Professor Andrea Sarkozy, EHRA Scientific Programme Co-Chairperson, said: “ Electrophysiologists were early adopters of digital innovations, for example in arrhythmia screening and follow-up. Wearable devices are an important evolution as they lead to more patient involvement and patient centred care. Remote monitoring became more widespread during the pandemic and will undoubtedly become standard practice in the near future. The field continues to advance, with exciting developments on the use of digital twins and avatars.” Also on the agenda: artificial intelligence (AI) for the detection and treatment of atrial fibrillation.4,5 Professor Serge Boveda, EHRA Scientific Programme Chairperson, said: “AI is an intense area of research that holds great promise for the diagnosis and management of arrhythmias. For example, computerised identification of standard and novel ablation target sites has the potential to significantly improve the success of this treatment.” Focus on sudden death: sessions dedicated to young patients, sportspeople, and new strategies for prevention.6-8 “Cardiogenetics is taking important steps towards avoiding sudden death in young people, for example by early identification of patients with genetic mutations or arrhythmias,” said Professor Sarkozy. “ AI is pushing the boundaries in the fight against sudden death by using electrocardiogram (ECG) findings to pinpoint those at risk. Screening athletes for potentially lethal mutations is controversial: hear up-to-date evidence for and against this prevention strategy.” Not to miss: gender disparities in device therapy.9 Professor Sarkozy said: “Women are still underrepresented in trials and as a consequence are treated based on the results of studies including mostly men. Sustainability report: multiple sessions exploring what this means for the medical specialty of heart rhythm disturbances including reuse of catheters, safety and economics.11-14 “In today’s world of environmental, economic and social crisis each part and layer of society should take responsibility, including the electrophysiology community,” said Professor Boveda. “We will explore what is possible from a regulatory perspective and hear from trailblazing European centres.”Innovation is central to the congress: don’t miss the simulation village for a first look at sophisticated tools and the EHRA innovation summit for a glimpse of how unmet needs might be addressed in the near future. This year’s congress theme celebrates the 20th anniversary of EHRA. Professor Boveda said: “Stay tuned for a special session in which we look at the past, present and future of heart rhythm disorders. 20 Prominent electrophysiologists will share their lifelong learning and pioneering experience that has improved the lives of many patients with arrhythmias.”

Ancora Heart Enrolls First Patient in European Multi-Center Study

Ancora Heart, Inc., a company developing a novel therapy to address heart failure, today announced the first patient was enrolled in the CorCinch EU study, a European multi-center clinical evaluation of the AccuCinch® Ventricular Repair System as a treatment for patients with reduced ejection fraction systolic heart failure (HFrEF).
The first patient was enrolled at Homolka Hospital in Prague, Czech Republic by Prof. Petr Neužil, M.D., CSc., FESC, head of the department of cardiology at Homolka Hospital and principal investigator of the study. The AccuCinch procedure was completed by co-investigator Vivek Reddy, M.D., director of cardiac arrhythmia services at The Mount Sinai Hospital in New York, along with Prof. Neužil.
This is the second recently initiated Ancora study evaluating the AccuCinch system focused specifically on heart failure and the enlarged left ventricle. The study will enroll up to 132 patients from heart centers across Europe.
The transcatheter AccuCinch therapy is designed to complement and enhance the existing care cardiologists provide to further manage symptoms and slow, or stop, the progression of heart failure. For some patients, AccuCinch may have the potential to reverse the enlargement of the left ventricle. For patients where heart failure has progressed beyond the ability for medications and pacemakers to manage symptoms, non-surgical percutaneous device therapy with AccuCinch may provide an effective treatment option. The AccuCinch system is designed to directly repair the left ventricle of the heart, thereby addressing the fundamental issue in the progression of systolic heart failure.

Heart doctors call for permission to provide therapy to stroke patients

Paris, France Heart doctors from the European Society of Cardiology (ESC) Council on Stroke are calling on national health authorities for permission to provide stroke patients with mechanical thrombectomy, a life-saving treatment for acute ischaemic stroke, in regions where there is a lack of trained specialists. Details of the proposal are presented today at EuroPCR 2018.1“We have evidence that after a short period of training on the procedure, interventional cardiologists treating acute ischaemic stroke achieve the same results as traditional interventional neuroradiologists,” said Professor Petr Widimsky, Chair of the ESC Council on Stroke.Acute ischaemic stroke is a severe form of the condition where a blood vessel to the brain becomes blocked. It accounts for up to four in five strokes, or over one million cases in Europe each year.Without treatment most patients die or are severely disabled and permanently bedridden. Even with clot-busting drugs, 75% of patients die or are severely disabled. With mechanical thrombectomy, a procedure to physically remove the clot and restore blood flow to the brain, about half of patients survive and function normally. If performed within two to three hours of symptom onset, the rate of survival with normal neurological function rises to more than 70% of patients.In Europe, mechanical thrombectomy is currently provided by interventional neuroradiologists, but there is a severe shortage of these specialists. Even countries with the most specialists, such as Germany, the Netherlands and the Czech Republic, only have sufficient numbers to treat around one-third of acute ischaemic stroke patients. In some other countries, less than 1% of acute ischaemic stroke patients can be treated.Professor Widimsky said: “There are interventional cardiology units in all countries in Europe and the Americas, and in most other continents. The equipment for mechanical thrombectomy is available; it’s the trained specialists to perform the procedure that are lacking. This situation could be solved by training cardiologists to perform mechanical thrombectomy.”The ESC Council on Stroke is proposing that interventional cardiologists receive three months of training on how to do mechanical thrombectomy, rather than the typical two years required for other physicians. “Many interventional cardiologists routinely perform stenting of the carotid arteries so three months of training is sufficient to learn intracranial mechanical thrombectomy,” said Professor Widimsky. “It is up to health authorities in each country to decide if they will allow this.”
The proposals are being put forward by the ESC Council on Stroke and the European Association of Percutaneous Cardiovascular Interventions, a branch of the ESC.

A fat belly is bad for your heart

Ljubljana, Slovenia Belly fat, even in people who are not otherwise overweight, is bad for the heart, according to results from the Mayo Clinic presented today at EuroPrevent 2018, a European Society of Cardiology congress.“See your doctor if your waist is bigger than your hips,” said study author Dr Jose Medina-Inojosa, from the division of Preventive Cardiology at the Mayo Clinic, Rochester, Minnesota, and The International Clinical Research Centre of St. Anne’s University Hospital (FNUSA-ICRC), Brno, Czech Republic.Body mass index (BMI), which is weight relative to height in kg/m2, is used to categorise adults as underweight, normal weight, overweight or obese. However, BMI does not account for the amount and distribution of fat and muscle.Central obesity is a store of excess fat around the middle of the body and is a marker of abnormal fat distribution. This study tested the hypothesis that people with normal weight and central obesity would have more heart problems than people with normal weight and normal fat distribution.In 1997 to 2000 the study enrolled 1,692 residents of Olmsted County, Minnesota, aged 45 years or older. The sample was representative of the county population for age and sex. Participants underwent a clinical examination and measurements were taken of weight, height, waist circumference and hip circumference. Central obesity was defined as a ratio dividing the waist circumference by the hip circumference of 0.90 or above for men and 0.85 or above for women.
Patients were followed-up from 2000 to 2016 for the occurrence of major adverse cardiovascular events (MACE) using linked medical records from the Rochester Epidemiology Project. MACE was defined as heart attack, surgical or percutaneous coronary revascularisation to open blocked arteries, stroke, or death from cardiovascular causes.Participants with a normal BMI (18.5–24.9 kg/m2) and central obesity had an approximately two-fold higher long-term risk of MACE compared to participants without central obesity, regardless of their BMI. Dr Medina-Inojosa said: “People with a normal weight but a fat belly have more chance of heart problems than people without a fat belly, even if they are obese according to BMI. This body shape indicates a sedentary lifestyle, low muscle mass, and eating too many refined carbohydrates.” “The belly is usually the first place we deposit fat, so people classified as overweight BMI but without a fat belly probably have more muscle which is good for health,” he continued. “Muscle is like a metabolic storehouse and helps decrease lipid and sugar levels in the blood.”Participants with a normal BMI and central obesity also had a higher risk of MACE than overweight and obese participants with central obesity. Dr Medina-Inojosa said that overweight and obese people with central obesity might also have more muscle mass which could be protective.
He said: “If you have fat around your belly and it’s greater than the size of your hips, visit your doctor to assess your cardiovascular health and fat distribution. If you have central obesity the target will be waist loss rather than weight loss. Exercise more, decrease sedentary time by taking the stairs or getting off the train one stop early and walking, increase your muscle mass with strength and resistance training, and cut out refined carbohydrates.”Dr Medina-Inojosa said it was important for doctors not to assume that people with a normal BMI are not at risk of heart problems or that their fat distribution is normal. He said: “Our study provides evidence that doctors should also measure central obesity to get a better picture of whether a patient is at risk.”

Study finds the heart can terminate atrial fibrillation itself after local gene therapy

Barcelona, Spain The heart is capable of terminating arrhythmias itself after local gene therapy, potentially avoiding the need for patients to undergo painful electric shocks, according to a proof-of-concept study presented today at EHRA 2018, a European Society of Cardiology congress.Atrial fibrillation is the most common heart rhythm disorder (arrhythmia). Treatment aims to restore the heart’s normal rhythm and includes drugs, which are not effective in all patients, ablation, for which efficiency remains suboptimal in the long-term, and electric shocks, which are effective but painful and require hospitalisation. This leaves a large and growing group of patients without optimal treatment options.That is why study author Dr Emile Nyns, a physician and PhD candidate in the laboratory of Daniël Pijnappels at the Leiden University Medical Centre, Leiden, the Netherlands, took a completely different approach. He said: “As the heart itself is already electrically active, we tested whether and how it could generate the electrical current needed for arrhythmia termination.”
The researchers used a technique called optogenetics, which uses light to control functioning of cells that have been genetically modified to express light-sensitive ion channels.First they genetically modified the right atrium in eight adult rats using a process called gene painting, which involves a small thoracic incision and actually painting the atrium with vectors coding for these ion channels.The researchers waited four to six weeks for the light-sensitive ion channels to be expressed, then made a small incision in the thorax of each rat and induced atrial fibrillation. Next they shone a light on the atrium for one second. This terminated 94% of atrial fibrillation.
Dr Nyns said: “Shining light on the atrium opened the light-sensitive ion channels. This led to depolarisation of the atrium, which terminated atrial fibrillation and restored the heart’s normal rhythm. We only needed a single light pulse of one second to terminate nearly all arrhythmias.“The heart itself generated the electrical current needed to stop the arrhythmias,” he continued. “It is completely pain free, unlike electric shocks.” He said: “Our study provides proof-of-concept that the heart can be enabled to terminate atrial fibrillation by itself after optogenetic gene therapy.” In future Dr Nyns envisages that the technique could be used in atrial fibrillation patients together with an implantable light-emitting diode (LED) device. “The result would be continuous, ambulatory and pain free maintenance of the heart’s normal rhythm, something that cannot be achieved today,” he said. “The quality of life and prognosis of AF patients could be significantly increased, especially for patients with frequent episodes of drug refractory, symptomatic atrial fibrillation, despite ablation therapy.” The researchers did not observe adverse effects from the method, but Dr Nyns said: “Further research is certainly needed before this technique can be used in patients. However, the results are promising and we believe that the time has come to develop the next generation of therapy for cardiac arrhythmias, which do not rely on pills or electronics, but on biology instead.”

Treatment for heart attack patients to be debated at Acute Cardiovascular Care 2018

Milan (Italy) The optimal treatment for heart attack patients will be debated at Acute Cardiovascular Care 2018. The annual congress of the Acute Cardiovascular Care Association (ACCA), a registered branch of the European Society of Cardiology (ESC), will be held 3 to 5 March at the MiCo Milano Congressi in Milan, Italy. Recommendations for treating heart attack patients, such as time windows for diagnosis and treatment, are outlined in the 2017 ESC guidelines for patients with ST-segment elevation myocardial infarction (STEMI).Two ‘Great Debate’ sessions will focus on controversies, including: whether to perform percutaneous coronary intervention (PCI) of non-infarct-related arteries immediately after primary PCI; the usefulness of risk scores in defining the optimal duration of dual antiplatelet therapy; and whether it is time to reconsider aspirin as a routine therapy for preventing a second heart attack.Professor Kurt Huber, Chairperson of the Scientific Programme, said: “Hot topics in acute coronary syndromes will be discussed by leaders in the field in several sessions. We will debate, for example, whether antithrombotic therapy should start in the ambulance or the emergency room.”Controversial treatments in acute heart failure, such as whether morphine should be given to all patients with acute pulmonary oedema, will also be debated. The 2016 ESC heart failure guidelines2 recommend switching to sacubitril/valsartan3 if patients do not improve on standard medications. But awareness of the relatively new treatment is low, especially outside specialist clinics, and its use will be examined.Acute Cardiovascular Care is the leading scientific event for all health professionals caring for acutely ill cardiac patients. It brings together more than 1,000 cardiologists, intensivists, anaesthesiologists, internists, cardiac surgeons, nurses, paramedics and other allied professionals from over 80 countries.One session is devoted to critically ill patients outside of hospital, who are initially seen by emergency doctors or paramedics. Subjects include what to consider when airlifting cardiac patients, when to terminate resuscitation, the cause and treatment of arrhythmias, and whether extracorporeal membrane oxygenation (ECMO) is an option for patients with cardiogenic shock outside the hospital.
ECMO is another hot topic that will be featured and members of the press can get the latest updates from research and practical experience. The use of extracorporeal cardiopulmonary resuscitation (ECPR) will also be covered extensively. “The use of ECPR is gaining more attention and we have invited the leaders in this area to present their data,” said Dr Sergio Leonardi, Co-Chairperson of the Scientific Programme.The congress theme ‘working together for acute cardiovascular patients’ highlights the fact that patients with acute cardiac conditions often have other issues – for example with their kidneys or lungs, or an infection – that contributed to the acute situation. Cooperation among many specialists is needed to ensure that patients receive optimal, timely care.The congress emphasises practical issues in caring for critically ill patients. Hands-on demonstrations and training will be given in the ACCA School, which covers ECMO, pacemakers, implantable cardioverter defibrillators, and renal replacement therapy. These are sessions not to miss for journalists wanting to see and hear the nuts and bolts of treating patients in this field.
Dr Leonardi said: “This is the congress for practical insights into the management of complex patients encountered in everyday clinical practice. Acute cardiac care is a field in which it can be challenging to gather scientific evidence and the congress brings together clinician thought leaders to guide us through some of the most challenging scenarios we face every day.”Professor Huber said: “The special thing about our meeting is that it’s very patient-oriented. We discuss the most recent science and recommendations and then talk about what to do with the patient in front of you. This is the most important acute cardiac care meeting of the year.”

Microcirculation and the heart

Roma venerdì 23 giugno, 09:30 Auditorium I Clinica Medica Policlinico Umberto I – Viale del Policlinico 155 Axel R. Pries, preside della Charité – Universitätsmedizin Berline, terrà la lezione “Microcirculation and the heart”. Il seminario si svolge nell’ambito delle attività scientifiche istituzionali organizzate dalla presidenza della Facoltà di Medicina e odontoiatria. L’incontro sarà introdotto dal rettore Eugenio Gaudio e sarà moderato da Francesco Fedele, Carlo Gaudio e Massimo Volpe.

Heart failure mortality is inversely related to wealth of country

Paris, France. Death in patients with heart failure is inversely related to the wealth of the country they live in, according to late breaking results from the INTERCHF study presented today at Heart Failure 2017 and the 4th World Congress on Acute Heart Failure.1 Death rates in India and Africa were three to four times higher than those documented in Western countries. “Heart failure is a common condition that causes morbidity and mortality worldwide,” said lead author Dr Hisham Dokainish, a principal investigator at the Population Health Research Institute (PHRI), McMaster University, Hamilton, Canada.“Most data on heart failure have come from Western countries but the majority of the world’s population lives elsewhere,” he continued. “This study was conducted to fill large gaps in knowledge about congestive heart failure in non-Western countries.”
The International Congestive Heart Failure (INTERCHF) study was an observational cohort study that enrolled 5 823 patients with heart failure in 16 countries grouped into six regions: Africa (Mozambique, Nigeria, South Africa, Sudan, Uganda), China, India, the Middle East (Egypt, Qatar, Saudi Arabia), Southeast Asia (Malaysia, the Philippines), and South America (Argentina, Chile, Colombia, and Ecuador).Data on each patient was collected at baseline, six months and one year and entered into the electronic data management system at PHRI. Baseline data included demographics (age, sex), cardiac and non-cardiac factors (previous heart attack or stroke, duration of congestive heart failure, diabetes mellitus, renal failure, chronic obstructive pulmonary disease), medications, socioeconomic factors (education level, literacy, employment, urban/rural setting), and heart failure aetiology.At six months and one year data was collected on the frequency and cause of any hospitalisations in the previous six months. Information was also recorded on death and cause of death. The investigators calculated death rates in each region and adjusted for 20 variables which included demographic, clinical, and socioeconomic factors, medications, and cause of heart failure.The overall all-cause mortality rate for the entire study population was 17%. It was highest in Africa (34%) and India (23%), intermediate in Southeast Asia (15%), and lowest in the Middle East (9%), South America (9%) and China (7%).Dr Dokainish said: “Mortality in patients with heart failure was inversely related to the wealth of the country. The poorer the country, the higher the mortality, and the richer the country, the lower the mortality.” “In Western countries the one-year mortality rate for patients with heart failure is 5–10%,” added Dr Dokainish. “We’re finding two to three times that death rate in African and Indian patients.” “We were very surprised by the much higher mortality rates,” he continued. “You could say maybe the patients in Africa or India were sicker, or didn’t take their medicines, or had poorer heart function, but we adjusted for all of those things and don’t really understand why their death rates were so much higher.”The researchers hypothesised that variables not measured in the study contributed to the high death rates, such as access to and quality of healthcare, and cardiac biomarkers. These variables will be measured in the next phase of the research programme, the Global Congestive Heart Failure (G-CHF) study, which aims to recruit 25 000 heart failure patients from all inhabited continents and income levels. Genetic analyses will also be conducted in a G-CHF substudy.
Dr Dokainish said: “INTERCHF has shown that there are large differences in the risk of heart failure patients dying at one year depending on where they live. We hope to discover why these differences exist through the G-CHF study. If that identifies barriers to receiving care that are due to the way a healthcare system is structured, access to healthcare, or quality of healthcare, then that would need to be addressed.” Authors: ESC Press Office.

Personalised workouts to prevent heart disease designed by new digital instrument

Sophia Antipolis. Personalised workouts to prevent heart disease can be designed by a new digital instrument, according to research published today in the European Journal of Preventive Cardiology.1 The EXPERT tool specifies the ideal exercise type, intensity, frequency, and duration needed to prevent a first or repeat cardiovascular event.
“Exercise reduces cardiovascular risk, improves body composition and physical fitness, and lowers mortality and morbidity,” said lead author Professor Dominique Hansen, associate professor in exercise physiology and rehabilitation of internal diseases at Hasselt University, Diepenbeek, Belgium. “But surveys have shown that many clinicians experience great difficulties in prescribing specific exercise programmes for patients with multiple cardiovascular diseases and risk factors.” The European Association of Preventive Cardiology Exercise Prescription in Everyday Practice and Rehabilitative Training (EXPERT) tool generates exercise prescriptions for patients with different combinations of cardiovascular risk factors or cardiovascular diseases. The tool was designed by cardiovascular rehabilitation specialists from 11 European countries, in close collaboration with computer scientists from Hasselt University. EXPERT can be installed on a laptop or personal computer (PC). During a consultation, the clinician inputs the patient’s characteristics and cardiovascular risk factors, cardiovascular diseases and other chronic conditions, medications, adverse events during exercise testing, and physical fitness (from a cardiopulmonary exercise test).The tool automatically designs a personalised exercise programme for the patient. It includes the ideal exercise type, intensity, frequency, and duration of each session. Safety precautions are also given for patients with certain conditions. The advice can be printed out and given to the patient to carry out at home, and reviewed by the clinician in a few months.Professor Hansen said: “EXPERT generates an exercise prescription and safety precautions since certain patients are not allowed to do certain exercises. For example a diabetic patient with retinopathy should not do high-intensity exercise.” “This tool is the first of its kind,” said Professor Hansen. “It integrates all the international recommendations on exercise to calculate the optimum training programme for an individual patient. It really is personalised medicine.” There are different exercise goals for each cardiovascular risk factor and cardiovascular disease. In a patient who has diabetes, is overweight and has hypertension the three goals are to reduce blood glucose, fat mass, and blood pressure. The tool takes all three goals into account.Professor Hansen said: “EXPERT provides the exercise prescription a patient needs to meet their particular exercise goals, which should ultimately help them to feel better and reduce their risks of morbidity and mortality. By prescribing an exercise programme that really works patients are more likely to be motivated to continue because they see that it is improving their health.” The next step is to test the impact of EXPERT on patient outcomes in a clinical trial. Professor Hansen said: “Our hypothesis is that clinicians using the tool will prescribe exercise interventions with much greater clinical benefits. That will lead to greater reductions in body weight, blood pressure, blood glucose, and lipids, and improvements in physical fitness, with a positive impact on morbidity and mortality.”

Exercise associated with improved heart attack survival

Sophia Antipolis, 12 April 2017: Exercise is associated with improved survival after a heart attack, according to research published today in the European Journal of Preventive Cardiology.1 The chances of survival increased as the amount of exercise rose.“We know that exercise protects people against having a heart attack,” said last author Professor Eva Prescott, professor of cardiovascular prevention and rehabilitation, University of Copenhagen, Denmark. “Animal studies suggest that myocardial infarctions are smaller and less likely to be fatal in animals that exercise. We wanted to see if exercise was linked with less serious myocardial infarctions in people.” The study included 14 223 participants of the Copenhagen City Heart Study who had never had a heart attack or stroke. Levels of physical activity were assessed at baseline in 1976–1978 and classified as sedentary, light, moderate, or high.2
Participants were followed through registries until 2013. A total of 1 664 participants had a myocardial infarction, of whom 425 died immediately.The investigators compared levels of physical activity between those who died immediately from their myocardial infarction and those who survived. They found that patients who exercised were less likely to die from their myocardial infarction.There was a dose-response relationship between exercise and death from myocardial infarction. Patients with light or moderate/high physical activity levels were 32% and 47% less likely to die from their myocardial infarction, respectively, than sedentary patients.Professor Prescott said: “Patients who were sedentary were more likely to die when they got a myocardial infarction and patients who did exercise were more likely to survive. There was also a dose-response relationship, so that the odds of dying if people got a myocardial infarction declined with the level of exercise they did, reaching an almost 50% reduction for those who were the most physically active.” “One possible explanation is that people who exercise may develop collateral blood vessels in the heart which ensure the heart continues to get enough blood after a blockage,” she continued. “Exercise may also increase levels of chemical substances that improve blood flow and reduce injury to the heart from a heart attack.”
Professor Prescott said: “This was an observational study so we cannot conclude that the associations are causal. The results need to be confirmed before we can make strong recommendations. But I think it’s safe to say that we already knew exercise was good for health and this might indicate that continuing to exercise even after developing atherosclerosis may reduce the seriousness of a heart attack if it does occur.”

Grey hair linked with increased heart disease risk in men

Malaga, Spain. Grey hair has been linked with an increased risk of heart disease in men, in research presented today at EuroPrevent 2017.Ageing is an unavoidable coronary risk factor and is associated with dermatological signs that could signal increased risk,” said Dr Irini Samuel, a cardiologist at Cairo University, Egypt. “More research is needed on cutaneous signs of risk that would enable us to intervene earlier in the cardiovascular disease process.”Atherosclerosis and hair greying share similar mechanisms such as impaired DNA repair, oxidative stress, inflammation, hormonal changes and senescence of functional cells. This study assessed the prevalence of grey hair in patients with coronary artery disease and whether it was an independent risk marker of disease.This was a prospective, observational study which included 545 adult men who underwent multi-slice computed tomography (CT) coronary angiography for suspected coronary artery disease. Patients were divided into subgroups according to the presence or absence of coronary artery disease, and the amount of grey/white hair.The amount of grey hair was graded using the hair whitening score: 1 = pure black hair, 2 = black more than white, 3 = black equals white, 4 = white more than black, and 5 = pure white. Each patients’ grade was determined by two independent observers.
Data was collected on traditional cardiovascular risk factors including hypertension, diabetes, smoking, dyslipidaemia, and family history of coronary artery disease.
The researchers found that a high hair whitening score (grade 3 or more) was associated with increased risk of coronary artery disease independent of chronological age and established cardiovascular risk factors. Patients with coronary artery disease had a statistically significant higher hair whitening score and higher coronary artery calcification than those without coronary artery disease.In multivariate regression analysis, age, hair whitening score, hypertension and dyslipidaemia were independent predictors of the presence of atherosclerotic coronary artery disease. Only age was an independent predictor of hair whitening.“Atherosclerosis and hair greying occur through similar biological pathways and the incidence of both increases with age,” said Dr Samuel. “Our findings suggest that, irrespective of chronological age, hair greying indicates biological age and could be a warning sign of increased cardiovascular risk.” Dr Samuel said asymptomatic patients at high risk of coronary artery disease should have regular check-ups to avoid early cardiac events by initiating preventive therapy.
“Further research is needed, in coordination with dermatologists, to learn more about the causative genetic and possible avoidable environmental factors that determine hair whitening,” she added. “A larger study including men and women is required to confirm the association between hair greying and cardiovascular disease in patients without other known cardiovascular risk factors.”She concluded: “If our findings are confirmed, standardisation of the scoring system for evaluation of hair greying could be used as a predictor for coronary artery disease.”

Esce “Random Activities of a Heart”

Venerdì 10 marzo esce in digital download su iTunes“Random Activities of a Heart” (etichetta Wormfood Records), l’album d’esordio della band londinese Retrospective for Love (fondata nel 2013 da Davide Shorty). Un album, a cui hanno collaborato Laïoung (talento nascente della scena trap italiana), Phat Kat (noto rapper di Detroit), Alba Plano, Otty, DUSTY, Nebbïa, Big Joe e Yazmyn Hendrix, che unisce melodie contagiose, armonie e groove influenzati da hip hop, soul e jazz, ed elettronica: “Siamo una richiesta d’aiuto arrivata attraverso il suono di un vinile, il bisogno d’amore e condivisione nell’accezione più pura. – racconta Davide Shorty. – La nostra musica ci rende un’unità, fa vibrare il corpo e ci dà modo di rilassare il viso stropicciato dalla quotidianità. Dovreste provarla, ne abbiamo in abbondanza per tutti. La consigliamo particolarmente a quei cuori che saltellano poco prima di rompersi, in modo da rendere i saltelli una danza riparatoria.” (foto: Randon)

Peripartum cardiomyopathy occurs globally and is not a disease of the poor

Sophia Antipolis. Peripartum cardiomyopathy (PPCM) occurs globally and is not a disease of the poor, according to research published today in the European Journal of Heart Failure. Cases were reported from many countries for the first time.“People have always thought PPCM was much more common and severe in Africans and that it was a disease of poverty but our study clearly shows that it’s not,” said lead author Professor Karen Sliwa, director of the Hatter Institute for Cardiovascular Research in Africa, Cape Town, South Africa. The study was conducted by the Heart Failure Association (HFA) of the European Society of Cardiology (ESC) Study Group on PPCM under the EURObservational Research Programme (EORP).PPCM is a structural heart muscle disease that occurs in women either at the end of pregnancy or up to five months after giving birth. Patients were previously healthy and then present with shortness of breath and heart failure.In about one-third of women with PPCM the heart muscle spontaneously recovers, but about 10% die from the disease and over half have a weakened heart muscle for the rest of their lives. The baby is sometimes born smaller and earlier, and in rare cases it dies.Research has shown that women with PPCM produce an abnormal breastfeeding hormone that leads to programmed cell death (apoptosis) and damage to the heart muscle.There is very little known about PPCM and until recently it was assumed that it occurred predominantly in African women. This registry study was conducted to find out whether PPCM occurs in other continents. Specifically, the researchers set out to discover how the disease presents, is diagnosed, and treated in different countries.The paper published today reports the baseline results of 411 patients from 43 countries representing all continents. Data collected included demographic characteristics, co-morbidities, treatments, type of hospital, and specialisation of the treating physician.The researchers found cases of PPCM in all 43 countries studied. All women with PPCM presented at the same age, and with the same symptoms and heart size, despite different ethnic backgrounds and huge disparities in socioeconomic factors and access to healthcare.“Our data shows that PPCM is truly a global disease, and irrespective of where you live, what healthcare system you have, what nutrition you have, and what education you have, you can get this disease,” said Professor Sliwa.“The disease presented quite uniformly despite occurring globally in different ethnic groups and in very different healthcare systems,” she continued. “This tells us that PPCM is to some extent a biological disease and women might have a genetic predisposition, which is probably a cellular and cardiac signalling abnormality. This is not a disease with marked differences between ethnic groups.”“We were surprised to see that there is a large percentage of women from the UK, for instance, and from Germany, countries which had not reported many cases so far,” added Professor Sliwa.
One month after diagnosis, 80% of the women with PPCM still had heart failure. About 7% of the women had blood clots – either a stroke, clot to the lung, or clot to the legs. “Despite good access to healthcare and good medical therapy, PPCM remains a very serious disease because many women remain in heart failure or develop blood clots,” said Professor Sliwa.“PPCM occurs in all health systems and is probably underdiagnosed in many parts of the world,” she continued. “More awareness needs to be created for this disease so that women can be given timely and appropriate treatment.”The registry aims to recruit 1,000 women with PPCM and will see if there are any differences in six month outcomes between ethnic groups.

Innovations to prevent heart disease take centre stage at EuroPrevent congress

Sophia Antipolis. Innovations to prevent heart disease will take centre stage at EuroPrevent 2017 in Malaga, Spain.EuroPrevent is the annual congress of the European Association of Preventive Cardiology (EAPC), a registered branch of the European Society of Cardiology (ESC). EuroPrevent 2017 takes place 6 to 8 April at the Palacio de Ferias y Congresos de Malaga (FYCMA). This year’s theme is “innovations in preventive cardiology”. The congress will explore novel ideas and technologies that could have an impact on society and what that impact could mean. “It’s the right time to talk about innovation in preventive cardiology because we are moving beyond classical treatments and approaches on a number of fronts,” said Professor Jean-Paul Schmid, programme committee chair.
Could the Nordic diet be the new Mediterranean diet? Experts will discuss how it provides cardiovascular protection that is also eco-friendly. Sessions on nutrition will also explore diet and the microbiome as the next frontier in cardiovascular prevention, examine whether patients with metabolic syndrome should eat low carbohydrate or low cholesterol diets, and ask “Do superfoods exist and do we need them?”.“Nutrition used to be our main weapon to lower cholesterol but it took a back seat when statins came on the scene,” said Professor Schmid. “EuroPrevent will look at new therapeutic uses of food and nutrients and also the potential dangers of genetically modified food.”
A breakthrough in the management of high cholesterol could see some patients using monoclonal antibodies called PCSK9-inhibitors. Journalists will find out which patients should add these to their statin regime and how effective the newer drugs are. Novel oral antidiabetic drugs are another important discovery that will be presented.Professor Schmid said: “Monoclonal antibodies are used in oncology and rheumatology, and now intensive lipid lowering with this new class of drugs is a hot topic. This potent medication may help patients unable to reach cholesterol targets on statins alone and better protect patients with familial hypercholesterolaemia who have genetically high cholesterol. Leaders in the field will talk about the safety of very low lipid levels.”
A session on social inequalities will examine cardiovascular disease incidence and survival in migrants, and explain the association between cardiovascular risk factors and borough socioeconomic level. “Cardiovascular disease in migrants is an increasingly important topic and we need strategies for prevention,” said Professor Schmid. “Members of the press will hear about the scale of the problem, how these populations are unique, and how we might screen and then help them.”
The latest science on the health effects of e-cigarettes and waterpipe will be presented, along with the impact of TV and movies on tobacco use and cessation in the young. “After the harms of secondhand smoke were confirmed and actions taken to prevent it we thought we knew everything about tobacco,” said Professor Schmid. “But e-cigarettes have reactivated the discussion about smoking, smoking cessation, and smoking behaviour. We will delve into the latest facts about the hazards of e-cigarettes and waterpipe.”
Experts will present the most up-to-date evidence on physical activity monitoring in patients with cardiovascular disease and investigate whether mobile apps help prevent cardiovascular disease in people of all ages. Journalists will hear lively, balanced debates on whether too much exercise can be detrimental to cardiovascular health, and whether exercise restriction is necessary for athletes with cardiac disease.Dr Michael Joner, previous winner of an ESC Grant for Medical Research Innovation will give the EuroPrevent 2017 Keynote Lecture. The Spanish Society of Cardiology will hold cardiopulmonary resuscitation workshops for the general public at Malaga Town Hall on all three days of the congress.Professor Schmid said: “As the leading international congress in preventive cardiology, EuroPrevent covers epidemiology and population science, cardiac rehabilitation and exercise, and sports cardiology. We are expecting more than 1000 cardiologists, allied health professionals, general practitioners, researchers and policy makers to attend. Journalists should register now for this top notch event.”

FedEx, Direct Relief, International Medical Corps & Heart to Heart International Team Up to Deliver Supplies and Aid to Haiti

More than 30 tons of critical aid is on the ground and in the hands of relief workers in Haiti. FedEx Corp. (NYSE: FDX) delivered the emergency supplies on board two charter flights this week in an effort to provide assistance to the people and communities affected by Hurricane Matthew.FedEx supported these disaster relief efforts through its humanitarian organization relationships with Direct Relief, International Medical Corps and Heart to Heart International. These organizations have medical staff and disaster relief supplies pre-positioned in the region.“The devastating reality is people in Haiti are relying on the delivery of humanitarian aid for life’s most basic necessities,” said Jenny Robertson, director of Global Citizenship and Reputation Management at FedEx. “The FedEx network and our people who power it are equipped to deliver these critical supplies where they’re needed most.”FedEx has worked with Direct Relief for more than a decade to deliver medical resources during times of disaster. The organization’s aid filled a charter flight that took off from the Memphis World Hub and arrived in Port-au-Prince Wednesday, October 12. Supplies included medication, medical equipment, hygiene kits and tents that can be used as pop-up health facilities.“Hurricane Matthew dealt a doubly cruel blow to Haiti, causing tragic loss of life and vastly increased risks and harm while at the same time damaging the health facilities and infrastructure critical to responding,” said Thomas Tighe, president and CEO, Direct Relief. “That’s why an aggressive, targeted response is so important and why FedEx’s leadership to take care of the transportation barrier is such a critically important step.”A second charter flight landed in Haiti October 13, filled with 35,000 pounds of relief supplies from International Medical Corps and Heart to Heart International. Together with these two organizations, FedEx delivered 11,000 hygiene kits, medicines and medical supplies.“Heart to Heart International (HHI) is proud of our long-standing relationship with FedEx. The humanitarian aid on today’s charter flight includes more than 11,000 personal hygiene kits that will be distributed to the people in Haiti where HHI is providing medical care. These hygiene kits play an important role in preventing the spread of disease, such as cholera,” said Jim Mitchum, CEO of Heart to Heart International.With many health facilities damaged, inaccessible, or non-functional as a result of Hurricane Matthew, the urgently needed aid will reach the most affected areas of Haiti, including Grand’Anse and Sud.“FedEx’s swift action in the wake of Hurricane Matthew makes it possible for our teams to save lives and alleviate suffering in some of the hardest hit communities in Haiti,” said Nancy Aossey, president and CEO of International Medical Corps. “FedEx knows that speed saves lives, and that every hour counts. They are making it possible for our teams to deliver urgently needed supplies and bring lifesaving medical care to those in need, helping stop the spread of cholera—a disease that has the potential to be far deadlier than the storm itself.”The relief effort is part of the company’s FedEx Cares initiative, through which FedEx will invest $200 million in more than 200 global communities by 2020 to create opportunities and deliver positive change around the world. (photos: aid haiti)

Innovation at the heart of the Energy Union

Innovation is at the heart of the Energy Union project. A year after the publication of the European Commission framework strategy for the Energy Union, the Jacques Delors Institute organised a conference in Brussels on February 25 2016, on the first year of the Energy Union.How can innovation speed-up the european energy transition, make it more profitable for european businesses and workers? This synthesis by Thomas Pellerin-Carlin, Research Fellow at the Jacques Delors Institute, explores the way through which innovation can speed-up the energy transition:
– A paradigm shift from ‘technological products’ towards ‘innovative services’
– New ways to create value lead to new ways to innovate
– Innovation is at the heart of the competitiveness of european businesses
– Consumers are key players of innovation and of the energy transition
– The public sector has a major role to play to boost innovation (photo: innovation)

Medication to prevent heart attacks linked with reduced heart attack severity

19 Sept 2016: Medications prescribed to prevent heart attacks such as statins and aspirin are also associated with reduced heart attack severity, according to research published in PLOS ONE.1 The observational study in nearly 15 000 patients provides further evidence of the benefit of taking these medications.The findings will be presented at the 27th Great Wall International Congress of Cardiology (GW-ICC), held 13 to 16 October 2016 in Beijing, China. Experts from the European Society of Cardiology (ESC) will present a special programme.2“Cardioprotective medications such as aspirin, statins, and beta-blockers are prescribed to patients who have high risk of a heart attack because they reduce the chance of a first or repeat event,” said first author Dr Min Li, a researcher in the Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Centre, Beijing, China.But she added: “Until now it was not known whether these drugs provided any benefit to patients who develop a heart attack despite taking the medication.”This study assessed the relationship between prior use of four preventive medications (antiplatelet agents such as aspirin, angiotensin converting enzyme inhibitors /angiotensin receptor blockers, statins, and beta-blockers) and in-hospital outcomes in patients with acute coronary syndromes (ACS). ACS such as myocardial infarction or unstable angina occur when the arteries carrying blood and oxygen to the heart become blocked.The study included 14 790 patients hospitalised for ACS in 75 hospitals in China who participated in the Clinical Pathways for Acute Coronary Syndromes—Phase 2 (CPACS-2) Study.3 Among the patients, 7501 had a history of cardiovascular disease (CVD) and were included in the study with a repeat ACS event, while the remainder had no history of CVD and entered the study with a first ACS event.The researchers assessed the association between prior medication use and in-hospital outcomes including severity of disease (type of ACS, systolic blood pressure 100 beats/minute), arrhythmias, and major adverse cardiovascular events (MACEs, including all deaths, non-fatal myocardial infarction or re-infarction, and non-fatal stroke). The researchers also did a major sub-group analysis based on whether or not patients had prior established CVD to reveal whether the effect of prior medication on clinical outcomes differed between first and repeat events. Prior use of each medication was significantly associated with less severity of disease, less arrhythmia, and reduced risk of MACEs during hospitalisation, after adjusting for multiple confounding factors. Many of the associations became non-significant after further adjusting for disease severity at presentation. The findings were similar in those with or without a history of CVD.
Dr Li said: “Each of the four preventive medications was associated with a reduction in poor clinical outcomes. The fact that many associations were not significant after we adjusted for disease severity suggests that these drugs may reduce the seriousness of ACS events, which lessens the clinical impact.” Compared to those taking none of the medications, patients taking 1, 2, 3 and 4 medications had a 23%, 33%, 52% and 41% reduced risk of MACEs. The same trend was observed for severity of disease and occurrence of arrhythmias. Similar findings were observed in patients with and without a history of CVD. Dr Li said: “Our findings suggest that the benefits of these medications may extend beyond preventing ACS. They may also reduce the severity of disease, and in-hospital adverse outcomes, in those who develop an ACS despite taking the drugs. The additional benefits of the four preventive medications were observed in patients with and without a CVD history, reducing the severity of repeat and first events.”She concluded: “We provide further evidence of the preventive benefit of these medications, and urge patients to continue taking them long-term when advised to do so by their doctor. Patients who still develop ACS while using the drugs should not lose confidence but continue to use them because they do help.” Professor Michel Komajda, a past president of the ESC and course director of the ESC programme in China, said: “We know that many heart attack patients stop taking their preventive medications. We need to do more to encourage adherence, and to help patients adopt healthy lifestyle behaviours.”

Novel heart valve replacement offers hope for thousands with rheumatic heart disease

Cape Town, South Africa. A novel heart valve replacement method is revealed today that offers hope for the thousands of patients with rheumatic heart disease who need the procedure each year. The research is being presented at the SA Heart Congress 2016.
The annual congress of the South African Heart Association is held in Cape Town from 8 to 11 September 2016 and is jointly organised with the annual congress of the World Society of Cardiothoracic Surgeons. Experts from the European Society of Cardiology (ESC) will present a special programme. “Over the past decade heart valve surgery has been revolutionised by transcatheter aortic valve implantation (TAVI),” said lead author Dr Jacques Scherman, a cardiac surgeon in the Chris Barnard Division of Cardiothoracic Surgery, University of Cape Town, South Africa. “Heart valves are replaced or repaired via a catheter, obviating the need for open heart surgery or a heart-lung machine.”He continued: “TAVI is only indicated in patients with calcific degenerative aortic valve disease, which is the most prevalent aortic valve pathology in developed countries. In developing countries, rheumatic heart disease still accounts for the majority of patients in need of a heart valve intervention.”Rheumatic heart disease is caused by rheumatic fever, which results from a streptococcal infection. Patients develop fibrosis of the heart valves, leading to valvular heart disease, heart failure and death. In Africa alone there are around 15 million patients living with rheumatic heart disease of whom 100 000 per year might need a heart valve intervention at some stage of their life. The vast majority of these patients have no access to cardiac surgery or sophisticated cardiac imaging.Dr Scherman said: “Inspired by the success of TAVI for calcific aortic valve disease, we developed a simplified TAVI device for transcatheter aortic valve replacement in patients with rheumatic heart disease.”Currently available balloon expandable TAVI devices require the use of sophisticated cardiovascular imaging to correctly position the new valve. They also use a temporary pacemaker which allows the heart to beat so quickly that it stops blood circulating to the rest of the body (called rapid ventricular pacing).Dr Scherman said: “Rapid ventricular pacing can only be tolerated for a short period and therefore limits the time available to do the implantation.”The team in South Africa developed a novel TAVI device which is “non-occlusive”, meaning that there is no need to stop blood circulating to the body with rapid ventricular pacing. The device is also “self-locating” and does not require sophisticated cardiac imaging for positioning.The proof of concept study presented today tested the device in a sheep model. The investigators found that the device was easy to use and positioned the valve correctly, and the procedure could be performed without rapid ventricular pacing.Dr Scherman said: “We showed that this new non-occlusive, self-locating TAVI delivery system made it easy to perform transcatheter aortic valve replacement. Using tactile feedback the device is stabilised in the correct position within the aortic root during the implantation. It also has a temporary backflow valve to prevent blood leaking backwards into the ventricle during the implantation of the new valve. All these factors together allowed for a slow, controlled implantation compared to the currently available balloon expandable devices.”
He added: “This simplified approach to transcatheter aortic valve replacement could be done in hospitals without cardiac surgery at a fraction of the cost of conventional TAVI. It has the potential to save the lives of the large numbers of rheumatic heart disease patients in need of valve replacement.”Professor Karen Sliwa, president of the South African Heart Association, said: “I am truly excited that we have not only an internationally strong group working on epidemiology and prevention of rheumatic heart disease at the University of Cape Town, but also a dedicated and successful surgical group, led by Prof. Peter Zilla at the Chris Barnard Department. Although prevention is the final goal, millions will need surgery as life-saving measure for decades to come. Knowing from my own Pan-African collaborations how inadequate the provision of cardiac surgery is on the African continent this fascinating solution promises surgical help for all these young patients with rheumatic heart disease on a continent that has a fair density of general hospitals but hardly offers any open heart surgery.”Professor Fausto Pinto, ESC president and course director of the ESC programme in South Africa, said: “The development of innovative therapeutic strategies is extremely important to allow a larger number of patients to be treated.”

Avoidable heart attacks in Europe, a massive tragedy

Sophia-Antipolis. “So many people in Europe dying of heart disease, prematurely and unnecessarily, is a tragedy,” said Prof. Fausto Pinto, President of the European Society of Cardiology.New mortality data released this week show that during 2013, 184,000 fatal heart attacks in Europe and 94,000 fatal strokes could be considered premature and could have been avoided in light of current medical knowledge. Together, they accounted for almost half (48%) of all preventable deaths in people under the age of seventy five.The results, provided by Eurostat, the national statistical office of the European Union, is the most recent evidence yet that too many people are not getting the timely and effective health care they need.“We know how to save lives,” said Prof. Pinto. “Part of the problem is lack of proper investment in cardiovascular health care and management of that funding. This limits medical professionals’ access to new devices and procedures, which in the long term, give people more full and active lives and ultimately are less costly in the future.The ESC President said that insufficient funds for training and education are another major issue. “Too many hospitals and clinics lack the number of medical staff required to provide great cardiac care,” he added. “The recent mortality data should serve as a wakeup call for governments and hospitals.“Cardiovascular disease needs to be made number one priority by policy makers for both prevention and treatment, so that many lives can be saved.”

One-third of heart failure patients do not return to work

One-third of patients hospitalised with heart failure for the first time have not returned to work one year later, reveals a study in nearly 12 000 patients presented today at Heart Failure 2016 and the 3rd World Congress on Acute Heart Failure by Dr Rasmus Roerth, a physician at Copenhagen University Hospital in Copenhagen, Denmark.1. “Employment is crucial for self esteem and quality of life, as well as being of financial importance, in patients with all kinds of chronic illness,” said Dr Roerth.He continued: “Inability to maintain a full time job is an indirect consequence of heart failure beyond the usual clinical parameters of hospitalisation and death. Most information on heart failure is derived from studies in older patients since they are the majority. This has led to a knowledge gap regarding the impact of living with heart failure among younger patients, who perhaps have the most to lose from the condition.”The study included 11 880 heart failure patients of working age (18 to 60 years) who were employed prior to being hospitalised for heart failure. Information on age, length of hospital stay, gender, education level, income, comorbidities and working status was obtained from Danish nationwide registries.2 All Danish residents are included in the registries and have a unique personal identification number making it possible to link information on an individual level.The researchers found that one year after being hospitalised for heart failure for the first time, 68% of patients had returned to work, 25% had not, and 7% had died.Dr Roerth said: “Among patients who are alive one year after their first heart failure hospitalisation, 37% did not return to work, which is a substantial proportion. It confirms that heart failure significantly reduces a patient’s capacity to maintain a normal life and live independently.” Younger patients (18 to 30 years) were over three times more likely to return to work than older patients (51 to 60 years). “This is perhaps not that surprising because younger patients have fewer comorbidities and may have a greater determination to stay employed,” said Dr Roerth. Patients with a higher level of education were twice as likely to return to work as those with basic schooling. Dr Roerth said: “This could be because higher education is associated with less physically demanding jobs. In addition, it may be more possible for highly educated patients to arrange a flexible work life.”Men were 24% more likely to return to work than women. “We do not think that this is primarily explained by men having a better recovery than women,” said Dr Roerth. “It could be that men are more often forced to return to work, for economical and other reasons. Having a work identify may be more important to men.” Conversely, patients were less likely to return to work if they had stayed in hospital for more than 7 days, or had a history of stroke, chronic kidney disease, chronic obstructive pulmonary disease, diabetes or cancer. Dr Roerth said: “It’s important to highlight that our findings are associations and not necessarily causal connections. The associations might help to identify which patients are at the greatest risk of becoming unemployed after being in hospital with heart failure for the first time.” He continued: “More research is needed to better understand why this loss of employment occurs among those who were working before they went into hospital. It could be that physicians are afraid to advise returning to work because they have unfounded concerns about the risks. Some patients may have been wrongly told they were at high risk of death but could safely return to the workforce.” Dr Roerth concluded: “Removal from the labour market and dependence on public benefits has great economic consequences which go beyond the already significant financial burden that these patients place on the healthcare system. More knowledge on what stops patients going back to work will put us in a better position to find ways of preventing it, for example with more intensive rehabilitation, psychological support, or education.”