Report from the VIIth International Congress of the Polish Cardiac Society R. Dworakowski, A. Rynkiewicz On September 11-12 2003, the TriCity was the venue for the VIIth International Congress of the Polish Cardiac Society. The annual Congress of the Polish Cardiac Society (Polskie Towarzystwo Kardiologiczne – PTK) is the largest and most important cardiological event in Poland. This year’s Congress drew a record number of participants – about 3200 cardiologists, including 27 important foreign guests from, among others, France, Belgium, Italy, Germany, Sweden, Norway and Israel. Approximately 900 abstracts were submitted to the Congress, of this number 160 qualified for oral presentation and 432 for poster presentation. Original papers were presented during 29 abstract sessions. In addition, the scientific programme of the Congress included over 13 educational sessions, 14 sessions of the PTK Working Groups and 18 satellite symposia. It is simply not possible to prepare even the briefest description of such a vast scientific programme. Some appearances, however, aroused particular interest and lead to exceptionally lively scientific discussions. The Opening Ceremony of the VIIth International Congress of the PTK brought together a number of illustrious guests. Representatives of regional administration and a delegation of the President of the Republic of Poland were also present. During the ceremony, Professors Lars Ryden, Mirosława Narkiewicz and Jerzy Kuch were presented with very prestigious distinctions, titles of Honorary Members of the Polish Cardiac Society. A number of other scientific awards and grants were also presented, however it is impossible to mention them all in such a short report. The Polish Cardiac Society works in close cooperation with the German Cardiac Society and French Cardiological Society. Within the framework of this cooperation, joint Polish-German and Polish-French sessions were organised. In addition, for the first time in the history of Polish Cardiac Society Congresses, due to the efforts of the Organisation Committee, the Congress has received European Board for Accreditation in Cardiology (EBAC) accreditation; the Board has allocated 2 educational points (CME) for participation in the following sessions: Joint session of the German Cardiac Society and the Polish Cardiac Society; Joint session of the French Cardiological Society and the Polish Cardiac Society; Indicators for evaluation of atherosclerosis progression; Guidelines for resuscitation and intensive cardiological therapy 2003; Use of molecular biology methods in the treatment of coronary heart disease.
The subject of the French-Polish session, moderated by Professor M. Komajda and Professor A. Cieśliński, was circulatory insufficiency. In their presentations, the greatest authorities from Poland and France described epidemiological problems and progress in the treatment of circulatory insufficiency. The role of resynchronisation in the treatment of patients with circulatory insufficiency was also discussed. The importance of beta-blockers and aldosterone antagonists in reducing mortality was stressed on numerous occasions. Subjects no less topical, concerning the treatment of atrial fibrillation and acute coronary syndromes, were discussed during the German-Polish session, moderated by the Presidents of the National Cardiac Societies, Professor T. Meinertz and Professor A. Cieśliński. Treatment results of acute coronary syndromes were presented, among others, during this session, based on the Polish Register of Invasive Cardiac Procedures. The educational session of the European Society of Cardiology and the Polish Cardiac Society attracted much interest. During this session, Professor Y. Hasin discussed current guidelines for resuscitation and intensive therapy, published in 2003. One of the most current topics today, the prospects of gene therapy in the treatment of cardiovascular diseases, was raised during the session held on Saturday, entitled “Use of molecular biology methods in the treatment of coronary heart disease”. The large amount of interest generated by this session was undoubtedly due to its subject, but also to the lecturers, who not only presented their own achievements, but also directions of further research and therapeutic possibilities. Professor Siminiak’s lecture, which concerned the currently popular topic of stem cell transplantation in cardiology, generated particular interest. Controversies concerning adjunctive therapy in acute myocardial infarction generated a traditionally heated discussion. The achievements of the Centre in Cracow in facilitated therapy of acute myocardial infarction were presented during one of the abstract sessions. Despite encouraging results, facilitated therapy has not yet become standard practice and results obtained by respective centres need to be confirmed in large randomised clinical studies. A joint session of the PTK and the Polish Hypertension Society was held for the first time in the history of the PTK Congress, chaired by Professor J. Głuszek and Professor K. Kawecka-Jaszcz. The session, besides covering several basic data pertaining to the pathophysiology of hypertension, also dealt with the role and importance of hypotensive drugs. Also presented were the VIIth JNC Report, the newest European Society of Cardiology guidelines and the most current principles of hypertension management, published by the
Polish Hypertension Society for the purposes of the PTK Conference. The American JNC VII guidelines recommend initiation of hypotensive therapy with a thiazide diuretic in every case of uncomplicated hypertension. The reasons for this change in recommendations are the results of the ALLHAT Study, in which a thiazide diuretic was equally effective as a calcium channel blocker and angiotensin-converting enzyme (ACE) inhibitor. During the session, arguments were presented for and against this thesis, regarding mechanisms of action of hypotensive thiazide diuretics, their imputed metabolic and electrolyte adverse effects, organ protection by this group of drugs and the results of other clinical trials that evaluated thiazides, comparing them to placebo or novel hypotensive drugs. Current indications for thiazide diuretic therapy in the treatment of hypertension were also discussed, based on the recommendations of the European and Polish Scientific Societies, which put diuretics on an equal footing with ACEI, calcium channel blockers, beta blockers and AII receptor antagonists. Attendance at other sessions dealing with the subject of hypertension was also high. Problems connected with the treatment of hypertension in women were presented in detail by one of the foreign guests, Professor R. Cifkova. Not only hypertension, but also the problem of distinct differences in cardiovascular disease in women in general aroused considerable interest among Congress participants, as evidenced by the capacity audience at the session devoted to this topic. Contiguity of common interests has always existed between the two branches of medicine, cardiology and diabetology. Frequently, patients with diabetes are also cardiological patients and vice versa. This view has resulted in many important sessions being devoted to cardiodiabetology issues. Issues associated with prevention, prophylaxis of diabetic complications and the strategy for maintenance of patients with acute coronary syndrome and coexisting diabetes were discussed. The benefits of intensive statin treatment in preventing cardiovascular episodes was emphasised on numerous occasions. The course of coronary heart disease itself is non-typical in diabetic patients. Many a time these patients are referred to a cardiologist late in the day and cardiosurgical and interventive treatment results are steadily deteriorating in this group of patients. High expectations are entertained in this group of patients for the use of drug-coated stents (using rapamycin, among others). During cardiodiabetology sessions, the benefits of using abciximab in diabetic patients subjected to vascular intervention procedures were emphasised time and again; at the same time, attention was focused on results indicating the superiority of cardiosurgical procedures in the treatment of chronic stable coronary heart disease in diabetic patients.
The latest recommendations regarding prevention and the use of percutaneous coronary intervention (PCI) in ischaemic disease were presented during the most recent Congress of the European Society of Cardiology, which was held in Vienna. Discussions on such important issues could not be overlooked during PCS deliberations. Current recommendations on prevention emphasise the necessity of prevention of all cardiovascular diseases, not only coronary heart disease, for reason of their common aetiology – vascular disease. The SCORE model, recommended by experts, enables risk assessment while taking into consideration the specific character of a particular European region, country or patient. Previous recommendations set the threshold score for high risk as a 20% risk of any cardiovascular event over the next 10 years, while current recommendations define this value as a 5% risk of developing a fatal cardiovascular event. A new element of these recommendations is the special focus on diabetic patients; a set of therapeutic goals was developed for these patients and patients with metabolic syndrome, as they constitute a high risk group. During a session held in Gdańsk, extensive excerpts were presented and discussed on the use of PCI in the treatment of acute coronary syndromes with persistent ST segment elevation and without persistent ST elevation. In treating acute myocardial infarction, the most important step is to transport the patient as quickly as possible to a specialist centre capable of performing mechanical revascularization of occluded or stenotic vessels. The benefits of initial invasive treatment were emphasised time and again. The need to improve the chances for interventional treatment in patients with acute MI was emphasised in the lobby. The role of invasive cardiologists in the treatment of stable coronary heart disease was also discussed during the Congress. The joint symposium of cardiologists and invasive cardiologists traditionally attracted much interest. The large amount of interest was undoubtedly the result of the increasingly common practice of treating patients with coronary heart disease, hitherto qualified for cardiosurgical procedures, by interventional cardiologists – particularly in the case of main left coronary artery disease, triple-vessel disease, coronary heart disease in patients with diabetes. The most highly renowned authorities in the fields of cardiology and cardiosurgery attempted to reach a compromise and present recommendations on the treatment of coronary heart disease. The experts’ discussion lead to the conclusion that it is important to select the best method of revascularisation to fit the anatomy of the coronary vessel – so-called hybrid treatment. It should be noted that results of cardiosurgical treatment of diabetic patients have improved considerably.
The Congress in Vienna was recalled in the form of a session presenting the results of the EUROPA Study for the first time in Poland. This was one of the more important studies to be published in recent months. The study demonstrated that the use of perindopril in low risk patients with coronary heart disease reduces cardiovascular mortality in this group. Out of many interesting sessions, the sessions devoted to cardiac rehabilitation deserve a special mention. In his abstract session, Professor H. Saner, a European celebrity in the field of cardiac rehabilitation, presented current trends and concepts on cardiac rehabilitation of patients following myocardial infarction. It was emphasised that this is one of the important aspects of secondary prevention. The Congress also included a discussion on valid standards and new prospects for atrial fibrillation treatment. Virtually all the facts, problems and dilemmas arising in connection with this topic were presented and discussed during a session moderated by Professor Trusz-Gluza, Dr. A. Wnuk-Wojnar and Professor W. Kargul. Since the publication of ESC and AHA standards in 2001, studies have emerged (AFFIRM, RACE, STAF, HOT CAFE) that will change the strategy of atrial fibrillation management. All these studies showed that a treatment strategy consisting of rhythm control is not in the least inferior to rate control therapy, particularly in the elderly and patients with few symptoms. An analysis of the efficacy of antiarrhythmic drugs in maintaining sinus rhythm following cardioversion indicates that amiodarone possesses the highest efficacy. Recent years have seen intensive development of methods of nonpharmacological treatment of atrial fibrillation, among which the highest hopes are placed on percutaneous pulmonary vein ablation. Randomised clinical trials have been undertaken, their results will decide whether these methods will have widespread application. Detailed results of interventive treatment of atrial fibrillation from the I Klinika Kardiologii Górnośląskiego Ośrodka Kardiologii (First Clinic of Cardiology of the Upper Silesian Centre of Cardiology) for the last 2-year period were presented during the Congress, and these results are very encouraging. Without doubt, an important event was the session dedicated to Mieczysław Mirowski, an outstanding Pole, the co-originator of the cardioverter-defibrillator. In addition to an historical account of the development of this branch of cardiology, current ICD treatment in Poland was presented against a background of Europe and the world. A discussion took place on the indications for implantation of the newest models of these devices, since criteria for these procedures have expanded considerably. Better and better devices are being implanted in patients with a lower and lower risk of death. The role of ICDs in primary prevention of sudden cardiac death was discussed.
The artistic programme contributed to the value of the TriCity Cardiology Congress. At the Opening Ceremony, participants had the opportunity to listen to a concert performed by the Hanseatic Chamber Orchestra under the direction of Janusz Przybylski. The pier in Sopot was the venue for the last evening of the Congress, highlighted by a performance by Kayah. Kayah dedicated her stunning and perfectly rendered concert to all cardiologists, including those, who treat “broken hearts”. The VIIth Congress of the Polish Cardiac Society will no doubt remain in our memories for a very long time, not only as a significant scientific event, but also as a social event.