New research results and scientific exchange

The theme of this year’s DGK Congress was “New Spaces for Cardiovascular Health.” The goal was to exchange the latest scientific findings and thus increase the chances for patients. Topics were broad, ranging from new diagnostic and treatment pathways to virtual health offerings to risks and opportunities of current care offerings.

Can life be prolonged sustainably with the help of cardiovascular prevention? Whether it’s nicotine abuse, obesity, or lack of exercise, many things are currently classified as cardiovascular risk factors. Accordingly, a great deal of focus is placed on their prevention. However, there is not always evidence to support this. Cardiovascular disease is the leading cause of death in both men and women. Taking preventive action here is certainly a step in the right direction. Currently, in addition to nicotine abuse, obesity or lack of exercise, LDL cholesterol (LDL-C) and blood pressure are under particular scrutiny. However, to date, only the regulation of LDL-C and hypertension has been shown to extend lifespan. However, the situation is quite different for the other aspects. For example, it was possible to show the high importance attached to socio-economic status. Despite abstinence from nicotine and alcohol, exercise, and a balanced diet, an individual with low income and status has a higher cardiovascular mortality risk than an individual from a less compromised social class. Also, it seems to depend on the type of exercise whether it is good for our body or not. For example, recreational exercise has a cardiovascular protective effect, whereas physically demanding work is associated with an increased risk of cardiovascular disease.

Sport for heart failure

The reduction in performance associated with heart failure often leads patients to take it easy. However, exercise promotes quality of life and may improve outcome. In a clinical research study, the effect of two different exercise programs was analyzed in 180 diastolic heart failure (HFpEF) sufferers. One cohort practiced moderate exercise (e.g., walking) 5 times per week for 40 min, and the second group was initially exposed to high-intensity interval training (3 times per week for 40 min each) for 3 months, followed by 9 months of home training. It was found that the maximum oxygen uptake capacity increased significantly in both experimental groups. However, improvement in primary impaired diastolic function could only be demonstrated for the cohort that participated in interval training.

Innovative mitral valve replacement in view

Catheter-based mitral valve interventions – in a supporting role, edge-to-edge therapy – have become firmly established in the treatment of mitral regurgitation. Thanks to further technical developments, it is now also possible to treat complex vitiligo. Nevertheless, there are patients who are not candidates for interventional mitral valve reconstruction. The only solution in such cases is often catheter-based mitral valve replacement. So far, mainly transapical systems are available. However, these are much more invasive than purely transvascular systems. Now, the HighLife interventional transseptal-transvenous mitral valve replacement system has cleared the first hurdle to clinical use. The system consists of two components: a subannular ring implant and the actual valve prosthesis. In the first step of the procedure, a special catheter is inserted into the left ventricle via femoral arterial access through retrograde passage of the aortic valve. This is followed by the so-called guidewire-looping, in which the guidewire circles the tendon filaments of the mitral valve. The next step is to introduce the ring component of the system. This ring serves as an anchoring point for the valve prosthesis. The final step is the implantation of the prosthetic valve into this annular structure via a transfemoral-transseptal approach. Feasibility, safety, and performance of this valve procedure will be evaluated in an international prospective single-arm study in 65 patients. First results: Despite the presence of high-risk factors, implantation of the HighLife prosthesis was successful in 27 of currently 30 patients. The technical success rate was thus 90%. In addition, almost 90% of patients showed no insufficiency at all after 30 days (grade 0), and the remaining patients showed a reduction in severity to 1. This improvement persisted over three and six months.

Prognosis in acute coronary syndrome

Acute coronary syndrome can be triggered by different pathomechanisms. The underlying infarct mechanism apparently determines the further prognosis of infarct patients. This is the conclusion of a recent study. Most frequently, investigators identified plaque rupture as the cause of infarction (63%). This was followed by plaque erosion at a rate of 24%. Less common causes were late stent thrombosis (6%), dissection (4%), and calcified nodules (3%). Patients with plaque ruptures iwere twice as likely to have recurrent cardiovascular complications in the next two years than patients with plaque erosions.

Congress: 88th Annual Meeting of the German Society of Cardiology (DGK)