Travel Bursary Report, Caroline Coats, ESC 2012

The Conference

The European Society of Cardiology is now the largest cardiovascular meeting in the world and certainly had a truly international feel about it.  As a young researcher, there was plenty on offer to educate, challenge and motivate me.  The spotlight of this year’s event was “From Bench to Practice” a focus which brings together basic science and everyday clinical medicine.

Several new clinical practice guidelines were launched notably in the management of heart failure, acute ST elevation myocardial infarction and atrial fibrillation.  Sessions where delegates could “meet the Task Force” behind the guidelines were focused and provocative and illustrated the volume of work that goes into writing these documents.  Important updates to the 2010 guidelines on atrial fibrillation included the role of new anticoagulants, left atrial occlusion devices and risk stratification for stroke prevention.  Vernakalant is now included for pharmacological cardioversion of recent onset atrial fibrillation and Dronedarone is to be used with caution in patients with heart failure.  The changes in just 2 years illustrate how rapidly this field is moving.

I was interested to attend several sessions on new heart failure treatments.  Initial results were presented from the PARAMOUNT study, a Phase 2 trial examining the efficacy and safety of LCZ696 (a new angiotensin receptor neprilysin inhibitor) in patients with heart failure with preserved ejection fraction.  By inhibiting the renin-angiotension-aldosterone system and potentiating natriuretic peptides this drug aims to restore neurohumoral balance.  Early results, published simultaneously in the Lancet, found that LCZ696 was well tolerated and reduced NT-proBNP to a greater extent than valsartan at 12 weeks.  PARADIGM-HF compares the same agent, LCZ696 against enalapril in patients with chronic heart failure and ejection fraction ≤35%.  Whether such a dual-acting agent will be useful to improve mortality remains to be determined.

Other highlights of the conference were the basic science sessions, which were generally presented in an accessible and relevant way to clinicians.  “Cardiovascular disease in a petri dish” showcased the progress in induced pluripotent stem cell technology.  Despite a number of limitations, I am sure this will provide an exciting way to study disease models and test new treatments, without the ethical challenges of embryonic stem cell research.

Poster presentation

I presented two posters at the meeting from projects I have conducted whilst working at The Heart Hospital.  The first examined natriuretic peptide measurement in Anderson Fabry disease: we found NT-proBNP concentrations were elevated in patients with early cardiac involvement, suggesting this could assist in decisions regarding the timing of enzyme replacement therapy (Coats et al, Am J Cardiol Oct 4, 2012).  The second was a large study of nearly 2000 patients, examining the clinical and prognostic role of exercise testing in patients with hypertrophic cardiomyopathy.  We found sub-maximal exercise parameters were potentially more useful than peak VO₂ and patients with enhanced ventilator responses have a substantially higher risk of death or transplantation.  The poster sessions constitute a major part of the scientific presentations at the ESC congress.  Although rather overwhelming in size, these sessions do provide an informal platform to present work, meet new contacts and stimulate ideas for further research.

Outside the Conference

Munich is a typical Bavarian city with beautiful architecture and an impressive amount of open space.  The meeting was an excellent opportunity to visit the city and catch up with old colleagues from Europe, New Zealand and the UK.  Although time was limited, we were able to dine in the Hofbräuhaus, enjoy traditional Weißwurst and walk in the impressive Englischer Garten.