The European Society of Cardiology Congress 2024 showcased the very latest in cardiovascular medicine and science with presentations and discussions about recent findings and new guidelines, as well as in-depth clinical teaching and education. Here, Dr Stefania Angela Di Fusco and Professor Furio Colivicchi from San Filippo Neri Hospital in Rome, Italy, share their take on the key themes and highlights from the congress.
The 2024 edition of the European Society of Cardiology (ESC) Congress was held in London from 30 August to 2 September, bringing together 31,800 participants and 5,400 faculty and presenters to share the progress of knowledge in the cardiovascular field.
A true milestone of the Congress was the significant inclusion of women, who made up 50% of the faculty.
The ESC Congress 2024 spotlight was ‘Personalising Cardiovascular Care’, with the main aim of promoting tailored patient care and moving away from the one-size-fits-all approach to treatment.
Research highlights
Over the four days, a host of late-breaking science sessions were held.
In light of HELIOS-B trial results, as Professor Esther Gonzalez Lopez commented, for patients with amyloidosis the future is brighter. Indeed, vutrisiran – a new drug for the treatment of amyloidosis – has been found to be effective in reducing mortality, cardiovascular events and markers of disease progression.
FINE-HEART study findings were also presented at the ESC Congress. The study is a prespecified pooled analysis of phase III clinical trials that tested finerenone, a mineralocorticoid receptor antagonist, in patients with a broad spectrum of cardio-kidney-metabolic conditions. The analysis included data of around 19,000 high risk patients and, as lead author Professor Muthiah Vaduganathan explained, the results support a disease-modifying potential role of finerenone in these patients.
The RESHAPE-HF2 trial provided new data on transcatheter edge-to-edge repair of mitral regurgitation (M-TEER). As illustrated by Professor Stefan Anker, the study has shown a significant reduction (-36%) in hospitalisation for heart failure and cardiovascular death with M-TEER versus a placebo.
Professor Helene Eltchaninoff presented the first clinical trial including a women-only population to compare transcatheter aortic valve implantation (TAVI) with surgical replacement. The RHEIA trial showed both the non-inferiority and superiority of TAVI in women.
Preliminary data of the BRING-UP Prevention study were commented on by Professor Furio Colivicchi – it’s principal investigator. This observational clinical study, including an Italian population of patients with known atherosclerotic cardiovascular disease, showed that, although high intensity statins are prescribed in a very high rate of patients, and often in association with ezetimibe, the percentage of patients with LDL-cholesterol at goal was low.
A further study presented during the ESC Congress was the EARTH-STEMI meta-analysis that, as highlighted by Professor Gianluca Campo, confirms the clinical benefits of complete revascularisation in older patients with ST segment elevation myocardial infarction, at least in the first four years.
2024 ESC Guidelines
This year the ESC is celebrating 30 years of producing guidelines and four new guidelines were presented over the course of the Congress. These documents, based on the most up-to-date evidence, are invaluable reference tools in the clinical practice of the cardiology community around the world.
The first new guideline presented focused on the management of elevated blood pressure and hypertension. This updates the 2018 ESC and European Society of Hypertension guidelines on the management of arterial hypertension. As the title of the document alludes to, the first revision is its focus on the cardiovascular risk related to high blood pressure as a continuous hazard.
A further major change is the overcoming of a step-based approach to obtain a reduction in blood pressure levels. Now, a systolic blood pressure treatment target of 120-129 mmHg is recommended, even for older patients who are not moderate to severely frail. A third option has also been added for the care of hypertension: the renal denervation. This treatment may be considered for patients with uncontrolled hypertension as a complementary option, in addition to lifestyle changes and pharmacological management.
The new ESC guidelines on the management of chronic coronary syndromes were presented on the second day of the Congress. Of particular note was that a new definition of the term chronic coronary syndrome has been formulated based on new pathophysiological understanding. The use of the Risk Factor-weighted Clinical Likelihood model is now recommended to estimate the probability of the presence of an obstructive coronary artery disease (CAD) before the implementation of instrumental diagnostic tests.
A coronary CT scan is recommended when there is a low-to-moderate (>5-50%) pre-test likelihood of CAD. These guidelines include a focus on angina and ischemia with non-obstructive coronary arteries (ANOCA, INOCA) and suggest that if patients remain symptomatic despite medical therapy, they should undergo invasive coronary functional testing to establish the most appropriate treatment.
A further new recommendation regards the use of simplified drug regimens and of digital health tools to improve treatment adherence.
The third ESC guideline presented in London was dedicated to the management of atrial fibrillation (AF). The novelties of these guidelines include the recommendation of a new score to assess the thromboembolic risk – the CHA2DS2-VA – which no longer includes gender. In hypertrophic cardiomyopathy and amyloidosis, anticoagulant treatment is recommended regardless of the CHA2DS2-VA. With regards to the antiarrhythmic treatment, transcatheter ablation is now recommended in patients with arrhythmia recurrence despite antiarrhythmic drugs and, in the case of tachycardia-induced cardiomyopathy, to reverse ventricular dysfunction.
The fourth set of new guidelines merges ESC’s recommendations for the management of peripheral artery diseases and aortic diseases for the first time. The guidelines emphasise the relevance of preventive measures including lifestyle modifications. Furthermore, they include bempedoic acid as recommended treatment in statin-intolerant patients who are at high cardiovascular risk and do not achieve LDL-C goal on ezetimibe. As regards aortic root and ascending aorta dilatation, annual monitoring with transthoracic echocardiography, and every three to five years with cardiac magnetic resonance or computed tomography, are recommended.
In addition to the new guidelines, during the congress the ESC Clinical Consensus Statement on Obesity and Cardiovascular Disease was presented and simultaneously published in the European Heart Journal. The first ESC Consensus Statement on this topic, it aims to raise public awareness of obesity as a main cardiovascular risk factor and to provide guidance for the clinical management of this condition.
Overall, the ESC Congress has been confirmed to be an excellent opportunity to dive in the cutting-edge research in cardiology.
