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`flfif
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`1 5 7004
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`750 High|and Avenue
`Madison, WI 53705
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`EBLING LIBRARY
`UNIVERSITY OF WISCONSIN
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`28 August— 1 September 2004, Munich — Germany
`
`
`One of the main missions of the Congress of the European Society of Cardiology (ESC) is the presentation of innova—
`tive research. This year again, a large number of abstracts were submitted for review (see Figure 1). This high number of
`submissions underscores the strength of basic, epidemiological and clinical sciences in Europe and abroad, as well as the
`attractiveness of the European Congress as a whole. Out of 8557 submitted abstracts this year, 5.1% came from Japan, 3.9%
`from the USA and 2.4% from Brazil, amongst other non—European countries. The abstracts covered all aspects of cardio-
`vascular medicine, but the three main areas accounting for 10% or more of all abstracts were coronary artery disease, heart
`failure and myocardial function, arrhythmias and pacing. Since abstracts are now submitted as either “Bench” or “Bedside”,
`the contribution of Basic Science is clearly identified and amounts to 16.3% of all submissions, an encouraging 2.3% increase
`compared to Vienna 2003.
`
`
`
`Figure 1. Abstracts submitted to the annual ESC Congress
`
`
`ESC Congress 2004 — Munich, DE
`Abstract submission
`
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`09°
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`Annual congress
`
`This year we will again be holding four Award sessions, in which the best science from young investigators under the age
`of 36 will be competitively presented. These sessions will all take place on Sunday, 29 August 2004, from 12:40 to 13:55 and
`we are looking forward to a large audience. Attractive prizes for the winning abstracts in Basic, Population, Clinical Sciences
`and Thrombosis are given by the ESC at the Awards Ceremony.
`In line with the general theme of the Congress, “Diabetes & the Heart”, many abstract sessions will be devoted to basic and
`clinical aspects of this growing epidemic, not to mention the special EASD—ESC scholarship session, to be held on Tuesday,
`31 August 2004, from 1 1:00 to 12:30. These outstanding contributions (half of which are selected by each organization) will
`be presented at both ESC and EASD meetings.
`
`Abstract selection is based on expert and unbiased peer review, resulting in the final selection Of 2680 abstracts to be
`included in one of the 124 oral sessions or 1449 poster presentations. Expert colleagues from Europe and abroad grade the
`abstracts on-line, with the help of customized web—based tools. The abstracts are blinded for the author’s names, city and
`country of origin. The average grade given by these experts was used to select the best abstracts for further evaluation by
`members of the Congress Procramme Committee. We would like to extend our sincere thanks to all the members of the
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`Abstract Selection
`
`Congress Programme Committee and to the 543 abstract graders for their dedication and enthusiastic work in reviewing the
`
`It is important to note that selection of an abstract for oral or poster presentation does not reflect the grades this abstract
`received. Oral sessions are constructed by the Programme Committee to present related work covering one particular topic.
`Thus, the poster sessions feature some of the highest graded abstracts of the congress, in particular the Moderated Poster
`sessions. These posters will be presented and discussed in a specially designed and highlighted area of the poster hall. Using
`microphone support. scientists will have the opportunity to present and defend their findings in front of some of the most
`prestigious experts of our discipline.
`In addition, this year we will introduce an entirely new concept, namely the e-Poster sessions, whereby the 464 posters
`selected for the topics Basic Science & Cardiac Imaging will be available in electronic format for the entire duration of the
`congress through a specially dedicated computer system (e—Poster lounge of 40 computers located in the Poster hall close
`to the FOCUS rooms). This technology has a lot to offer to stimulate interaction and maximize exposure of the data. Not
`only can you discuss with the poster presenter during his allotted timeslot, but any participant in the Congress can drop in
`whenever convenient and Visualize any of the e—Posters, alone or in company. Facilities for presentation to small groups via
`projection on larger plasma screens can be made available. Computer facilities allow for the inclusion of video clips, movies
`or other animations in the material to be presented, and there are many other useful features to be discovered .
`.
`. Look for all
`necessary information about this exciting new approach to scientific exchange on the ESC website, www.cscardioorg.
`To all organizers, participants and accompanying persons, we extend a warm welcome. .We hope that you will enjoy the
`conference, both scientifically and socially.
`
`
`
`WILLIAM WIJNS
`-
`ESC Congress Programme Committee
`
`fire/MM
`
`JEAN-PIERRE BASSAND
`President
`European Society of Cardiology
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`Epidemiology anrl treatment ofpnlnionaijv arterial hypertension / The ECG aml electr'opliysiologir' markers ofarrliytlnnic events
`
`
`Inhaled treprostinil is a potent pulmonary vasodilatcr in
`severe pulmonary hypertension
`R. Voswinckel, MG. Kohstall, B. Enke, T. Gessler, F Reichenberger,
`H.A. Ghofrani, W. Seeger, H. Olschewski. Medical Clinic 2, Department
`0/ internal Medicine, Giessen, Germany
`
`
`
`220 Sildenafil in the treatment of primary pulmonary
`hypertension
`A. Dharmadhikari‘, M. Kulkarniz, V. Tzilos3, F. Airoldi4, I. SheibanS.
`’Nashik, lndia: 2'Flajebahadur Heart Foundation, Cardiology, Nashik,
`India; 3Hospital Hunry Dununt, lnterventional Cardiology, Athens,
`Greece; “Hospital San Ratfae/e, Interventional Cardiology, Milano, Italy;
`5 University Hospital, Tor/no, Interventionat Cardiology, Torino, Italy
`Backgroud: The role of sildenafil as a pulmonary vasodilatcr is being extensively
`evaluated in the treatment of pulmonary hypertension.
`Aim: This was a prospective study to assess the benefit of adding sildenafil in
`patients with high pulmonary artery pressures secondary to atrial septal defect
`(ASD), already receiving the conventional therapy.
`Methods: Thirty consecutive patients with moderate to severe primary pulmonary
`hypertension were included in this study. All the patients were diagnosed previ-
`ously and were receiving the conventional therapy with digoxin, diuretic and a
`calcium channel blocker. Sildenafil was added in the dose of 50 mg twice a day
`without changing the previous regimens. Changes in the New York Heart Asso-
`ciation (NYHA) symptom class, distance covered during the six minute walk test
`and modified Borg dyspnea score were evaluated monthly. Acceptance of the new
`drug was assessed every week in the first month and then at the monthly follow
`up. Echocardiography and Doppler study was undertaken at baseline and every
`month for a period of six months. The parameters studied were the pulmonary
`artery systolic pressure (PASP) by tricuspid regurgitation (TR) jet and pulmonary
`artery diastolic pressure (PADP) by pulmonary regurgitation (PR) jet.
`Results: Mean age of the subjects was 42.6i9.3 years. Twenty seven (90%)
`were females and 3 (10%) were males. Sildenafil was well tolerated and there
`was no dropout because of undesireable effects of the drug. Changes in the
`heart rate and systemic blood pressure were not significant enough to warrant
`withdrawl of the drug. Two patients died during the follow-up period. At the begin-
`ning of the therapy, 22 (73.3%) patients were in NYHA Class III or IV while at the
`end of six months, only 8 patients remained in either of these classes (p<0.05).
`
`By the 6 min walk test, functional capacity improved from 1816:1224 meters
`to 302.7i1503 meters p(<0.05). Modified Borg dyspnea score improved from
`
`5.6::12 to 3.3i1.1 (p<0.05). PASP by TR jet (mmHg) was down from 81 .3i14.7
`
`
`lo 51.4::11.7 (p<0.05). PADP by PR jet (mmHg) reduced from 56.2::11.7 to
`33.4i9.1 (p<0.05).
`Conclusion: Sildenafil is well tolerated, improves symptoms, and reduces the
`systolic and diastolic pulmonary artery pressures in patients with moderate to
`severe primary pulmonary arterial hypertension.
`
`
`
`therapy of PAH (US and
`Background: Treprostinil has been approved for
`Canada) as continuous subcutaneous infusion. However, local pain at the infu-
`sion site is a major drawback. Inhaled therapy with another stable prostacyclin
`analogue (iloprost) has been approved for PPH (EMEA). In this study we investi-
`gated the acute hemodynamic response to inhaled treprostinil.
`Methods: Open-label, single blind placebo-controlled clinical study. After place-
`ment of a Swan-Ganz catheter and a femoral artery line, patients inhaled solvent
`solution (placebo) (n=8) or treprostinil for 6 min (OptiNeb ultrasound nebulizer,
`Nebu-tec, Germany) in concentrations of 16, 32, 48, and 64 jig/ml (n26, 6, 6, and
`3 patients). Measurement was performed before and after 0, 15, 30, 60, 90, 120,
`150 and 180 min. The mean area between the placebo and the treprostinil curves
`(ABC186) was calculated (baseline:100%).
`Results: We investigated idiopathic PAH (n:10), collagen vascular disease (n=5),
`chronic thromboembolic disease (n=9), and pulmonary fibrosis (n=5), f/m = 19/10,
`
`age 56 i 3 years, PAP, PAWP, and CVP 51.3 :: 2.2, 9.2 i 0.8, and 6.6 i 0.6
`
`
`mmHg, CO 4.4 i 0.3 l/min, SvO2 62.3 :: 1.2%, PVR 885 :: 72 dyn s cm‘5.
`At 16jtg/ml there were no significant adverse events. Headache, cough or bron-
`choconstriction were observed in 2, 1, and 2 patients at 32, 48, and 64 jig/ml.
`These were mild and transient in all patients but one (64 jtg/ml) who complained
`of major headache for 1 hour. Placebo inhalation was followed by slowly increas-
`ing PVR. Compared to this, the maximum lreprostinil effect was reached after
`about 50 min and half—maximal effects at about 110 min. The ABC186 for PVR
`
`
`was —24.7 i 4.4, -28.7 :: 4.9, and —29.0 i 4.7%; PAP —14.4 :: 3.3, -13.5 i 5.2,
`
`-13.1 i 2.6%; SAP —5.1 i 3.0, -6.0 i 3.1, -3.8 :: 2.1% at 16, 32 and 48 jtg/ml.
`Conclusion: Treprostinil inhalation results in a significant long-lasting pulmonary
`vasodilatation. With the applied technology, at a concentration of 16ug/ml, near
`maximal pulmonary vasodilatation is achieved without adverse effects. At higher
`doses, local and systemic side effects may occur, whereas pulmonary selectivity
`
`This study was supported by Lung Rx.
`
`The endothelin-receptor antagonist bosentan for the
`treatment of pulmonary arterial hypertension associated
`with congenital heart defects
`0. Sitbon‘, M. Beghettiz, J. Petita, L. lserin", M. Humbert‘, V. Gressins,
`G, Simonneau‘. ’Hopital Antoine Bee/ere, Clamart, France; 2HUG,
`Pediatric Cardiology Unit, Geneva, Switzerland; 30MC Marie-Lannelongue,
`Le PIessis-Ftobinson, France; 4Hopital Necker, Paris, France; 5Actelion
`Pharmaceuticals France, Paris, France
`
`Background: Treatment with the oral dual endothelin-receptor antagonist bosen-
`tan has been shown to be an effective alternative option to intravenous
`epoprostenol in functional class (FC) lll idiopathic pulmonary arterial hyperten-
`sion (PAH) patients.
`In patients with PAH associated with congenital heart de-
`fects (CHD), an improvement of exercise capacity and hemodynamics has been
`demonstrated with epoprostenol in one uncontrolled study (Rosenzweig et al. Cir-
`culation 1999; 99: 1858-65).
`The aim of this retrospective study was to evaluate the efficacy and safety of
`bosentan in F0 lll-lV CHD«PAH patients.
`
`Study population consisted in 24 patients (22 females, mean age 35 :: 15 years
`(8—68]) with CHD-PAH: atrial septal defect (ASD: 13), ventricular septal defect
`(VSD: 4), partial abnormal pulmonary venous return (3, associated with ASD in
`2 and repaired common atrium in 1), patent ductus arteriosus (PDA: 2), VSD as-
`sociated with PDA (1), aortopulmonary window (1). Four patients had undergone
`previous cardiac surgery.
`Patients had deteriorated despite conventional therapy (including oral anticoagu-
`lants, oxygen, diuretics) and were treated with chronic oral bosentan.
`Results: Before starting bosentan, 22 patients were in F0 Ill and 2 in F0 IV, with
`
`a resting 02 saturation (SaO2) of 89 :: 9%. Mean 6-min walk distance (6MWD)
`
`was 288 i 94 m and mean Borg index 3.0 :: 1.9. At last evaluation performed
`after 10 i 9 months of bosentan treatment,
`1 patient was in F0 I, 8 were is
`FC ll, 13 remained in PC I“ and 2 in F0 IV. The mean 6MWD improved by 49
`m (349 i 85 m, p = 0.008) with no change in Borg index (3.0 i 1.8) and resting
`SaO2 (89 i 6%). There were no differences between pre and poericuspid shunt
`subgroups in terms of baseline characteristics and response to bosentan therapy.
`After 13 :: 9 months of follow-up, all patients are alive on bosentan, but 3 (1 ASD.
`1 VSD, 1 aortopulmonary window) required combination therapy with intraVenous
`epoprostenol after 5, 7 and 9 months on bosentan.
`Conclusion: Chronic oral bosentan treatment improves exercise capacity in pa-
`tients with PAH associated with CHD who deteriorated despite conventional ther-
`
`REVISITING THE ELECTROCARDIOGRAM AND
`ELECTROPHYSIOLOGIC MARKERS OF ARRHYTHMIC
`EVENTS
`
`Prevalence of brugada-type ecg in an apparently healthy
`european population
`G. Forleo‘, F. Di Liberatoz, L. De Lucaz, G. Maglianoz, V. Morgiaz,
`F. Clementiz, MM. Gallagherz, F. Romeoz. ’University of Home,
`Department of Cardiology, Ftoma,
`ltaly,‘ 2 University 0/ Tor Vergata,
`Department of Cardiology, Home, ltaly
`Background: The Brugada Syndrome ECG is characterized by ST—segment ele—
`vation in right precordial leads and elevated risk of lethal arrhythmias in absence
`of identifiable structural heart disease. Few data are available on the Brugada
`type ECG, especially in Europeans. No epidemiological study has applied the di-
`agnostic criteria recently proposed by the Study Group of the Molecular Basis of
`Arrhythmias of the ESC.
`Methods: We analysed the ECG and clinical data of apparently healthy Euro—
`pean adults undergoing routine medical examinations for occupational reasons.
`At each examination subjects undenivent a medical interview, physical examina-
`tion, blood pressure measurement and 12-lead ECG. Enrolment was confined to
`persons without a history of heart disease at the time of first attendance in whom
`at least one 12—lead ECG of good quality was recorded. The ECG records of all
`7483 subjects (89.6% male, age 29,5i10,8 years at first attendance) were re-
`viewed by three cardiologists. We reviewed 1,97i2,1 ECGs for each subject. We
`considered a patient having a Brugada ECG pattern if 2 or more of the cardiolo-
`-gists judged that at least one of that persons ECGs fulfilled the criteria of the ESC
`Study Group.
`Results: The Brugada pattern was present in 26 patients (0.35%), all male (ta-
`ble).
`In 17 cases (654%),
`information was available about the progress of the
`subject subsequent to the ECG on which the Brugada pattern was first recorded.
`No sudden death or cardiac arrhythmia was recorded among these patients in a
`
`follow-up of 5.2::4.6 years (total follow-up 87.8 patient-years).
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