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ESC Andreas Grüntzig Lecture on Interventional Cardiology: A ballad of applied coronary physiology. From 50% diameter stenosis to fractional flow reserve (FFR) and microvascular resistance reserve (MRR)

ESC Named Lecture

Bernard De Bruyne, presenter of this year’s Andreas Grüntzig Lecture, is Co-Director of the Cardiovascular Center Aalst (Aalst, Belgium) and Professor of Cardiology at the University of Lausanne (Lausanne, Switzerland). Among his ground-breaking achievements over the past 35 years, he is perhaps best known as one of the team that first described the now widely used diagnostic standard of fractional flow reserve (FFR).

As a young medic choosing to specialise, Prof. De Bruyne recognised immediately that the new field of interventional cardiology offered huge potential to revolutionise treatment. “It was obvious that there was a lot of scope to develop and improve beyond balloon angioplasty, which was the only real intervention at that time,” he said. Prof. De Bruyne thinks that the almost exponential evolution of the field over the past few decades is now beginning to slow down, due partly to the introduction of more stringent regulation. He reflects that had such a regulatory environment existed in the late 1970s, Andreas Grüntzig’s first balloon angioplasty would probably never have taken place.

When asked what he considers to be his greatest career achievements to date, Prof. De Bruyne is characteristically modest, preferring to leave that decision to his peers. However, he is proud of the centre at Aalst, commenting, “It is extremely gratifying to see that our centre has attracted over 150 clinical research fellows, many of whom have gone on to become key opinion leaders.” And he has high praise for the interventional cardiology community. “I have been lucky enough to work with a variety of really extraordinary people, both in Aalst and around the world,” he said.

Prof. De Bruyne’s Andreas Grüntzig Lecture gives an overview of the last 25 years in applied coronary physiology. Immensely honoured to have been chosen to present the lecture, he is particularly keen to highlight the importance of looking at the haemodynamics of the coronary circulation and exploring the microcirculation in patients with suspected coronary artery disease. Indeed, he thinks that the study of the microcirculation is one of the main challenges for the field. “It is clear that we need the further development of structural interventions and to bring mitral and tricuspid interventions to the level transcatheter aortic valve implantation has reached. But most investment and work should go into investigating the microcirculation,” he said. “There is currently a lot of enthusiasm regarding management strategies involving the microcirculation. However, the first thing we need desperately is an objective, physiologically sound, reproducible microcirculation metric; something that plays a similar role to that of FFR for the epicardial vessels. If we do not have good metrics, we cannot quantify effects; and if we cannot quantify, we cannot treat effectively.” He thinks that precision medicine should be applied to the study of the microcirculation and, according to Prof. De Bruyne, there is no better place to do applied precision medicine than in the catheterisation laboratory. “That is just another reason why interventional cardiology and the cath lab are the most exciting part of cardiology,” he said.

The content of this article reflects the personal opinion of the author/s and is not necessarily the official position of the European Society of Cardiology.