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Three gold medals were awarded at yesterday’s Inaugural Session.
The beneficiaries were Keith Fox, British Heart Foundation Duke of Edinburgh Professor of Cardiology at the University of Edinburgh, Richard L Popp, Emeritus Professor of Cardiovascular Medicine at Stanford School of Medicine, California, and Michel Haissaguerre, Professor of Cardiology at the Centre Hospitalier Universitaire of Bordeaux, France. ESC Congress News talked to all three about their careers and research interests.
KF: I was one of the founding Fellows of the ESC back in the 1990s and since then have been responsible for several studies in acute coronary syndromes and thrombosis, with key results incorporated into European guidelines. Some of our results from the GRACE study, for example, have provided strong evidence on risk assessment and its timing in acute coronary syndromes. At a more formal level I was a board member of the ESC from 2008 to 2010 and from 2012 to 2014, and also Chair of the Scientific & Clinical Programme Committee for the ESC. Last year there were more than 30,000 taking part and a record number of abstracts submitted. That’s plenty of work for the Programme Committee!
Acute coronary diseases and atherothrombosis - in fact, the whole pathway from plaque formation to clinical manifestations. So this has involved me in studies of disease mechanisms in ACS to the assessment of antiplatelet and anticoagulant therapies. Presently, we are looking at the influence of genes and inflammation on plaque rupture events.
Well it’s difficult to say. They seem to have happened in a series of chapters, starting with our first studies on tPA in St Louis. But I guess I must be most proud of those whose outcomes have been implemented into guidelines and everyday practice in ACS. So to that extent I’d note our studies from the GRACE registry programme, and the RITA, ROCKETAF and OASIS programmes. The RITA-3 trial in 2005, for example, compared a strategy of routine angiography and revascularisation in non-STE ACS patients with a nonintervention strategy of watchful management. There was uncertainty about this at the time, but our results over five years clearly showed the benefit of routine intervention. So now, for higher risk patients we adopt a routine strategy of early angiography and intervention. More recently we’ve updated the algorithms derived from the GRACE registry data into a simple web-based and app risk calculator. The original risk prediction model was based on outcomes from more than 100,000 ACS patients, and now the risk scores we calculated have been validated externally and prospectively.
Of course, I feel very honoured, but also a little embarrassed to be in such company. My contributions to cardiology and the ESC seem somewhat modest alongside those of other gold medallists, but it s a great honour and one that I feel very proud of and very grateful fox.
MH: Initially, I decided to study medicine because I was interested in psychology. But during my second year internship with Professor Jean Francois Warin in Bordeaux I became fascinated by the way 12-lead ECG traces could describe an invisible electrical mechanism operating within the heart.
Once simple arrhythmias became, in the words of Douglas Zipes, ‘an endangered species’, the last big hurdle to overcome was cardiac fibrillation. My research team’s contribution has been to demonstrate that these chaotic wavelets have discrete origins, with the igniting sparks located mostly in the pulmonary veins in the atria or Purkinje cells in the ventricles.
With Pierre Jais, Mélèze Hocini, Dipen Shah and others I began mapping the first premature beat that initiates fibrillation. We found the sources of AF were not in the atria, but fired from cells in the pulmonary veins located in the vascular wall. It took about four years to be sure of our results – 99% perspiration for 1% inspiration. Now over 300,000 patients have been treated by targeting the pulmonary veins.
The same mapping concept was performed for patients with repetitive VF, but proved challenging because of the rapid syncopal nature of VF and isolated runs of ventricular ectopies. We found Purkinje sources initiating VF in both normal hearts and nearly all types of cardiac disease, with confirmation by discrete successful ablation. Such findings could have large therapeutic implications.
In 2012 we established the LIRYC Electrophysiology and Heart Modelling Institute in Bordeaux to develop a multidisciplinary programme dedicated to cardiac electrical dysfunctions such as AF, ventricular tachyarrhythmias and electrical ventricular dyssynchrony leading to heart failure using high-resolution mapping, cardiac imaging, signal processing and computer modelling. The institute brings together over 150 practitioners with multiple specialties in electrophysiology - from ion channels to whole heart and patient care.
While we’ve made progress in understanding arrhythmia mechanisms, the identification of risk factors, genetic abnormalities and tissue biomarkers needs to be improved. We need to be able to recognise those individuals who are susceptible to VF and sudden death. Advances will hopefully help optimise screening and therapeutic protocols and reduce the burden of arrhythmic morbidity and mortality.
RLP: The cardiac physical exam was the most fascinating thing I could imagine - I had always wanted to understand how the heart worked both normally and under the influence of disease.
J. Michael Criley from Johns Hopkins got me involved in angiography and Harvey Feigenbaum from Indiana University was one of the first in the US to use ultrasound for cardiac imaging. I’d also like to acknowledge over 150 dedicated cardiology fellows who taught me an enormous amount and pushed me to answer their challenging questions.
I was privileged to be part of the development of virtually all aspects of ultrasound cardiac diagnosis. My work was developing non-invasive ways to measure left ventricular volume, stroke volume and ejection fraction - and establishing standards for examination and measurement methods in echocardiography. With Liv Hatle I helped develop Doppler methods to measure gradients across heart valves and methods to recognise diastolic ventricular dysfunction. But one of my greatest achievements has been my involvement in the careers of a large number of leading academic cardiologists including Fausto Pinto and Jos Roelandt.
The fact that non-invasive methods have replaced invasive cardiac catheterisation for assessing structural heart disease is a major advance for patients allowing serial monitoring of the natural course of valve disease and heart failure.
Use of personal hand-held inexpensive ultrasound imaging devices will have a big role to play in augmenting physical exams. I believe that hand-held ultrasound units, the size of a cell phone, will ultimately replace the stethoscope.
Providing ‘patient centered care’ with a team of healthcare providers should be your focus. Training to do everything the team can provide will not serve either you or the patient well.
I have been incredibly lucky to have a wonderful wife Janis, two sons and five grandchildren. While you can always get someone to cover your patients, no one else can cover your role as a spouse or parent.
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