Day 1 :
University Duisburg-Essen, Germany
Keynote: Improved cardiovascular risk prediction using signs of atherosclerosis - Lessons from the Heinz Nixdorf Recall study and Multi-ethnic study of atherosclerosis
Time : 09:00-09:30
Raimund Erbel studied medicine in cologne and Düsseldorf. His internship lead him to hospitals in Düsseldorf, Leverkusen, Koblenz, and Aachen. In Mainz hernwas signed consultant and received a Professorship in 1993, tenure-ship in 1998 and became a full professor and director of the department of cardiology in Essenrn 2003, where he worked until 2015. He was able to built up the 1st Heart Center located within a University Clinic in Germany providing an excellent partnership withrnthe department of thoracic and cardiovascular surgery. The highlight was the opening of 1st hybrid room allowing heart catheterization and cardiovascular surgeryrn without transportation of the patient in a specially designed room, so that cardiologists, anesthesiologists and cardiac surgeons found ideal working spaces. Early inrn1993 he become aware of the new electron beam computed tomography which was installed in Bochum und Mülheim. The detection of coronary artery calcifications an early sign of atherosclerosis by this non invasive method was fascinating. He started to evaluate the possibilities of primary prevention. In 2.000 he startedrnthe Heinz Nixdorf Recall study funded by the Heinz Nixdorf Foundation. This study is now in its 16th year of follow up and has already started a multi generation cohort. The study received national and international reputation and is currently involved in many multi-centre epidemiological projects looking not only to known cardiovascular risk factors but also to psychosocial factors as well as effects of pollution.
Despite the progress in the diagnosis and treatment of cardiovascular diseases the high frequency of sudden death is thernbiggest challenge today. Sudden and unexpected, acute myocardial infarctions occur even in “healthy” men due to plaquernrupture or erosion based on subclinical coronary atherosclerosis. In relation to the total number of people, who die in therncourse of myocardial infarction, the number of out of hospital deaths reaches two thirds of all deaths. That means, only primaryrnpreventive strategies will be able to reduce this often tragic event, already know in the old Egypt documents. The best noninvasivernmethod in order to detect signs of coronary atherosclerosis is computed tomography (CT), because this technique isrnable to visualize, localize and quantify coronary artery calcification (CAC). Calcium is, on the other hand, found intra- than extracellularly; an early sign of developing coronary atherosclerosis. In men at the age of 40 years, in women 10 years later,rnCAC appears and growths in the following years. CAC quantification is based on the Agatston algorithm. The detection and quantification of CAC helps to identify people at risk nowadays with low x-ray exposure of the patients´ chest. CAC increases during life on an exponential curvature, which allows the prediction of the progression. Due to the remodeling process–rnexhausted at a level of 40-50% of the vessel plaque area - , coronary atherosclerosis remains for decades subclinically until thernplaque load exceeds a level which results in a significant luminal narrowing. In this stage the plaque load has usually reached 70–90 percent of the vessel cross-sectional area. However, not the luminal narrowing, but the plaque rupture or erosion is thernmain reason of the acute events leading to mural or occlusive thrombus formation and in many cases to formation of microembolizationrn resulting in microinfartcs/infarctlets. Therefore, risk reduction based on know signs of coronary atherosclerosis already in the early phase, will help to start a new era of primary prevention.
Biomedizinische NMR Forschungs GmbH Max-Planck-Institut für Biophysikalische Chemie, Germany
Keynote: Cardiovascular MRI in real time
Time : 09:30-10:00
Jens Frahm is Director of Biomedizinische NMR Forschungs GmbH (non-profit) at the Max-Planck-Institute for biophysical Chemistry in Göttingen, Germany. His research is devoted to the methodological development of magnetic resonance imaging (MRI) and the advancement of MRI in science and medicine. His publications include more than 430 articles, patents, and book chapters. For his ground-breaking work Frahm received the European Magnetic Resonance Award, the Gold Medal of the International Society for Magnetic Resonance in Medicine, the Karl Heinz Beckurts-Award for Technology Transfer, the State Award of Lower Saxony, the Research Award of the Sobek Foundation for Multiple Sclerosis and the Science Award of the Foundation for German Science.
This lecture presents recent advances towards real-time magnetic resonance imaging (MRI) which result in high-quality image series of dynamic processes with acquisition times of only 10 to 40 milliseconds. The acquisition technique employs radially encoded gradient-echo sequences with up to 30-fold data undersampling. Image reconstruction emerges as the iterative solution of a nonlinear inverse problem which is accomplished by a bypass computer with 8 graphical processing units fully integrated into a commercial MRI system. Apart from a brief description of the acquisition and reconstruction technique, the talk will focus on applications to cardiac function, quantitative blood flow and myocardial T1 mapping. These studies may now be performed without the need for ECG synchronization and during free breathing. Taken together, real-time MRI techniques offer the chance to develop comprehensive CMR protocols which are comfortable to the patient, provide new diagnostic opportunities (e.g., immediate physiological responses to stress or exercise), are insensitive to irregular motion (e.g., patients with arrhythmia), and may even be more cost-effective (i.e., much shorter) than current examinations. Future progress is foreseeable and will involve more extensive parametric mapping studies (e.g., T2* relaxation, perfusion and temperature) and a revitalization of “interventional” MRI procedures.
Universite Pierre et Marie Curie, France
Keynote: Value of echocardiography in cardiomyopathies, with special reference to right ventricular dysfunction
Time : 10:00-10:30
Guy H Fontaine MD PhD HDR has made 15 original contributions in the design and the use of the first cardiac pace makers in the early 60s. He has serendipitouslyrnidentified ARVD during antiarrhythmic surgery in the early 70s. He has developed the technique of Fulguration to replace surgery in the early 80s. He has been onernof the 216 individuals who have made a significant contribution to the study of cardiovascular disease since the 14th century and one of the 500 greatest geniusesrnof the 21st Century (USA Books), one of the 100 life time of achievement (UK Book). He has > 900 publications including 201 book chapters. He is a reviewer ofrn17 scientific journals both in basic and clinical science. He has given 11 master lectures of 90 minutes each in inland China in 2014. He is now developing newrntechniques for brain protection in OHCA, stroke and spinal cord injury by hypothermia.
Echocardiography is nowadays the simplest and less expensive mode of cardiac imaging. However, its value on RV functionrnneeds to know some of the basics in the pathology of this chamber starting by normal RV. RV free wall is very thin (3 mm)rnas compared to the LV (10 mm). Also, in the normal heart there is practically no contribution of RV in hemodynamics andrnfinally a detailed histological feature shows the presence of an exceedingly large amount of fat (without fibrosis) which explains irreversible RV failure in 12% of heart transplant patients. Therefore, it seems obvious that research efforts have to be directedrntowards a proper investigation of these parameters which can be reconsidered with recent advances in echocardiography suchrnas strain, speckle technique, 3D echocardiography, etc. Especially, because the mechanism and the trouble of development of this disease has been properly reproduced in the laboratory from iPSC lines. The other main concern properly identified inrnARVD is the possible deleterious effect of a superimposed inflammatory phenomenon of myocarditis which can be the resultrnof a particular susceptibility of this genetically modified myocardium by the same gene which has produced the trouble inrndevelopment. When myocarditis is involved, a wide spectrum of disorders will be produced leading to RV echocardiographicrnFractional Area Change FAC which looks a better parameter than Tricuspid Annulus Plane Systolic Excursion TAPSE (SagunerrnCirculation 2014) but also involvement of the left ventricle which is finally the cause of irreversible heart failure at the end-stagernof the disease. In that case, follow-up of patients should be performed by serial echocardiograms paying attention to the TAPSErnand FAC but also to the LVEF. Abrupt drop of LVEF associated with troponin release will be the marker of a superimposedrnmyocarditis which may have several patterns of evolution encompassing the fulminant form with irreversible hyper acute heart failure which can be sometimes controlled by LV mechanical myocardial support to minor or even no cardiac deteriorationrnin the most frequent situation. In between, the decrease in LVEF can stop after complete healing of myocarditis of lead torncontinuous deterioration of cardiac function in case of an induced autoimmune phenomenon. It has been also suspected thatrnthe same concept of the deleterious effect of a superimposed myocarditis can be extended to other inherited cardiomyopathies such as IDCM, HCM and even WPW syndrome.