Japanese

Program (Titles omitted)

Program at-a-glance



Mikamo Lecture(Sponsored by Japan Heart Foundation)

English

March 27 (Sat.) 8:00-9:00

Chairperson: Ken-ichi Hirata Division of Cardiovascular Medicine, Kobe University Graduate School of Medicine

Speaker: Eric Olson UT Southwestern Medical Center, USA

Mashimo Memorial Lecture

Japanese

March 26 (Fri.) 14:00-15:00

Chairperson: Yoshihiko Saito Department of Cardiovascular Medicine, Nara Medical University

Speaker: Tasuku Honjo Kyoto University Institute for Advanced Study

WCC Special Lecture

Japanese

March 26 (Fri.) 15:05-16:05

Chairperson: Hisao Ogawa National Cerebral and Cardiovascular Center

Speaker: Shinya Yamanaka Center for iPS Cell Research and Application (CiRA)

Congress Chairperson's Lecture

Japanese

March 27 (Sat.) 13:50-14:30

Present and Future of Cardiovascular Medicine

Chairperson: Kazuwa Nakao Kyoto University Graduate School of Medicine Medical Innovation Center

Speaker: Yoshihiko Saito Department of Cardiovascular Medicine, Nara Medical University

Plenary Sessions

Japanese

01. New Evidence with Big Data in Cardiovascular Diseases

Chairperson: Yoshihiro Miyamoto National Cerebral and Cardiovascular Center
Hideo Yasunaga Department of Clinical Epidemiology and Health Economics, School of Public Health, University of Tokyo

Chairperson's Message

Big data has already been utilized in various fields of our society through artificial intelligence (AI) and business intelligence (BI) while an environment for utilizing big data has also been constructed in the medical field. In the medical field, big data are secondarily created from administrative claims data, the Diagnosis Procedure Combination (DPC) data, specific health check-up /specific health guidance, and several information in electronic medical records are expected making medical policies for improving quality of medical care and optimizing medical costs. And, it is expected to be used as a support tool in medical treatment, prevention of onset and aggravation of cardiovascular diseases. Also, some highly comprehensive registries could be used as big data. In addition to recognizing the current state of medical care and improving the quality of medical care, we could use them to plan clinical trials, recruit for clinical research on development of pharmaceuticals, and post-marketing surveillance if they are built as highly accurate database. In this plenary session, we will introduce evidence obtained by interpreting and practical models by using representative medical databases such as J-ROAD, which is a database of the Japanese Circulation Society, and JCVSD, which is a database for cardiac surgery. It would propose you a new-found database project for cardiovascular diseases.

Japanese

02. New Insights and Findings on Aortic Dissection

Chairperson: Hitoshi Ogino Tokyo Medical University Cardiovascular Surgery
Hideaki Yoshino Nomura Hospital/ Kyorin University, Cardiology

Chairperson's Message

Aortic dissection (AD), which occurs suddenly, is one of the most serious acute cardiovascular diseases with a high mortality rate. Particularly in acute AD, for patient lifesaving, smooth patient transportation and hospital admission, rapid diagnosis, and appropriate treatments are required. However, lots of issues remain unknown in the medical practices, including the onset mechanism of AD. As a solution, the international registry of acute aortic dissection (IRAD) has been organized mainly by the major aortic centers in Europe and the United States, and a lot of findings have been reported these two decades. Unfortunately, including the difference in the frequency of AD, there are many parts different from the actual situations in Japan, and the IRAD reports do not seem to be suitable for the current Japanese medical practices in AD. There are a number of reports from the Japanese registry of acute AD (JRAD) and the Tokyo's AD registry, but it is furthermore necessary to have nationwide and more detailed investigations approaching the actual situations of AD. On the other hand, in the medical cares for acute AD, the recently advanced imaging studies leading to the AD onset, including the blood flow analysis and vascular endoscopy findings, have been of lots of concerns. Additionally, as a new trend of AD therapies, endovascular treatments including thoracic endovascular aortic repair (TEVAR) and frozen elephant trunk procedure have been frequently applied. TEVAR has been also indicated increasingly for chronic staged type A AD after the proximal repair as well as chronic type B AD. In this session, we would discuss new findings on AD including the onset mechanism, its diagnostic imaging, acute and chronic stage treatments, to further improve its medical cares in Japan.

English

03. Frontiers in Diagnosis and Treatment of Specific Aortic Diseases

Chairperson: Mitsuaki Isobe Sakakibara Heart Institute
Eric Isselbacher Cardiology Division, Massachusetts General Hospital, USA

Chairperson's Message

Dissection and aneurysm formation comprise the bulk of aortic diseases physicians see in clinical practice. However, we all know that there are many other disorders of the aorta. Large vessel arteritis affects the aorta and is divided into the following categories, Takayasu arteritis and giant cell arteritis. Behcet’s disease and IgG4-related disease also involve the aorta. The latter has been studied in great detail in Japan and has gained worldwide attention in recent years. Although they are not common, cardiologists and cardiovascular surgeons nevertheless encounter these diseases in daily practice. One of the problems with diagnosis of these less common aortic diseases is a lack of specific biomarkers for them, forcing us to rely on nonspecific inflammatory markers and various imaging tests. Advanced imaging technology such as the recently developed FDG-PET appears to be useful for detecting inflammation of large vessels, and is gaining in popularity, but there is still much to be learned. With respect to treatment of these diseases, in addition to conventional immunosuppressants, there are new ones such as tocilizumab for large vessel arteritis which are showing promise. For vascular stenosis, dilation, and aortic regurgitation, treatment including optimal timing and indications for surgery or intravascular treatment are largely unknown. Marfan syndrome is a hereditary aortic disease, for which much new information is coming to light, including the existence of closely related diseases. In this way, aortic diseases are extremely fertile ground for research: research into mechanism, research into better diagnosis, research into optimal treatment. So we are really looking forward to the sessions ahead in which we will be sharing the latest knowledge, both in clinical and basic science, in the area of specific aortic diseases.

English

04. New Drugs for Chronic Heart Failure

Chairperson: Hiroyuki Tsutsui Kyushu University Cardiovascular Medicine
John McMurray BHF Cardiovascular Research, University of Glasgow, UK

Chairperson's Message

On the basis of the pathophysiological mechanism and the large-scale clinical trials, the pharmacological treatment for heart failure has been greatly advanced from diuretic and digitalis to the inhibition of neurohumoral factors. RAA inhibitors including ACE inhibitor, angiotensin receptor antagonist (ARB), mineralocorticoid receptor antagonist (MRA) and β blockers are recommended for HFrEF. On the other hand, diuretics and the treatment for the comorbidities are recommended for HFpEF.

The prognosis of patients with heart failure is still poor, and the development of a more effective therapeutic drug is greatly needed. If channel inhibitor, ivabradine, and angiotensin receptor-neprilysin inhibitor (ARNI), sacubitril/valsartan, are now approved for HFrEF and used in Japan. Furthermore, VICTORIA with soluble guanylate cyclase (sGC) stimulator, vericiguat, and DAPA-HF with SGLT-2 inhibitor, dapagliflozin, have reported the improvement of outcomes in patients with HFrEF. GALACTIC-HF with cardiac myosin activator, omecamtiv mecarbil, is under way.

Recently, various types of new drugs for heart failure have been developed. This plenary session aimed to present the latest findings of the research about the new therapeutic drugs for heart failure and further understand the present and future of heart failure treatment.

English

05. Genomic Medicine Approach to Cardiomyopathy

Chairperson: Tomomi Ide Kyushu University
Christine Seidman Cardiovascular Medicine and Genetics, Brigham and Women's Hospital and Harvard Medical School, USA

Chairperson's Message

Advances in gene analysis techniques have allowed the identification of the causative genes of inherited cardiomyopathy. Genome-associated cardiomyopathy includes not only direct functional associations with gene mutations or deletions but also susceptibility to onset changes due to differences in genetic background as well as prognosis and responsiveness to medical therapy. The complicated role of genome medicine in the pathology of cardiomyopathy is increasingly obvious; thus, more specific approaches may be proposed by detailed individual genomic diagnoses. Furthermore, clarifying the detailed genomic contribution of related proteins or mRNAs may allow the development of specific precision medicine. Genome editing technology, genome engineering, and efforts to repair the genome using various technologies are under development.

In addition, techniques for inducing differentiation from various stem cells into cardiac myocytes, including induced pluripotent stem (iPS) cells, have been developed as potential therapeutic strategies for severe heart failure. Moreover, myocardial regeneration has accelerated with technological progress.

This symposium aims to broadly discuss both basic and clinical issues and prospects in the era of genomic medicine, in terms of the associations with genetic pathogenesis, therapeutics and clinical applications.

English

06. Novel Aspects of Evaluating Multiple Organs in Heart Failure Management

Chairperson: Takayuki Inomata Department of Cardiovascular Medicine, Kitasato University Kitasato Institute Hospital
Rudolf Allert DeBoer Cardiology, University Medical Center Groningen, Netherlands

Chairperson's Message

Heart failure is defined as a condition in which some organs are impaired due to hypoperfusion or congestion caused by depressed cardiac function for any reasons. In other words, heart failure is not influenced only by the heart itself, but a condition that is determined by organs other than the heart. However, the insights of inter-organ communication in heart failure have not been fully applied in clinical practice partly because there have been few clinical indicators established to visualize the effects on each organ.

In this session, we would like to discuss the significance of clinical surrogate markers for each organ such as brain, liver, kidney, intestine and muscle in heart failure management, focusing on multimodality imaging assessment.

Japanese

07. Frontiers in Artificial Intelligence for Cardiovascular Imaging

Chairperson: Masataka Sata Department of Cardiovascular Medicine, Tokushima University Graduate School
Masahiro Jinzaki Department of Radiology, Keio University School of Medicine

Chairperson's Message

In the field of medical imaging, image reconstruction, triage for patients, and decision support by artificial intelligence (AI) have been developed. In the cardiovascular medicine, there are a wide range of diagnostic applications including CT, MRI, single photon emission CT, catheterization and echocardiography. It could be a powerful tool in some situations. On the other hand, there are many obstacles to utilize AI in routine clinical practices. We should consider personal information when gathering training data from patients. Overlearning from big data may lead to a low percentage of correct answers. Deep learning itself is a “black box” which makes it difficult to explain what is going on under the hood. There is a task regarding how to integrate AI to the workflow of the medical setting. The pharmaceuticals and medical devices law requires reapproval after relearning of AI.

In this symposium, we would like to discuss the frontiers in AI for cardiovascular imaging and the challenges for the future.

English

08. 

Strategic Treatment for Heart Valve Disease
Catheter Interventional Treatment vs Less Invasive Cardiac Surgery

Chairperson: Yoshiki Sawa Department of Cardiovascular Surgery, Osaka University
Joseph Woo Department of Cardiothoracic Surgery, Stanford University School of Medicine, USA

Chairperson's Message

Aorta stenosis (AS) keeps being increased in our country in association with social aging, and the number of aorta valve replacement for elder patients has also grown. However, there were an ineligible number of inoperable patients with AS because of comorbidity and/or high frailty. For these patients, transcatheter aorta valve replacement (TAVR) has been developed in Japan. Moreover, results of PARTNER-lll trial for low risk AS will change the paradigm of AS treatment. For mitral regurgitation with high operative risks, in particular with severe ventricular dysfunction, the therapeutic strategy has not been established. MitraClip has been approved as a noninvasive procedure for patients with severe mitral regurgitation and high operative risks, and Clinical trial for approval of TMVR and Neochord has been already started in Japan. On the other hand, less invasive surgical treatment such as MICS surgery, Robotics surgery and Sutureless valve for AS have been developed.

In this session, we would like to reconfirm points to be kept in mind to exert benefits through the transcatheter noninvasive therapy for Structure heart diseases and to discuss a plan for issues to be resolved.

English

09. Renal Denervation Up-to-date: Basic and Clinical Evidence

Chairperson: Kazuomi Kario Division of Cardiovascular Medicine, Jichi Medical University
Felix Mahfoud Innere Medizin III, Saarland University Medical Center, Germany

Chairperson's Message

Renal denervation, a novel innovative therapy that modify the circulation regulatory system to reduce the onset and severity of cardiovascular disease are drawing attention. Kidneys regulate fluid volume in the circulation, and its condition is directly related to the pathogenesis of hypertension and heart failure. The renal denervation partially blocks the renal sympathetic nervous system, which is an organ-related pathway between the brain and the kidney. Radiofrequency ablation, ultrasonic ablation, and chemical ablation with alcohol are the most common techniques. Denervation is performed through the lumen of the renal artery using a catheter. A recently published randomized controlled trial with a sham group (SPYRAL HTN-OFF MED/ ON MED study and RADIANCE-HTN study) clearly showed an blood pressure effect of renal denervation throughout 24 hours including nighttime and morning hours. This technique may help to manage poorly controlled hypertension and prevent arrhythmias and heart failure. Future investigation will focus on the antihypertensive mechanism of renal denervation, including the central nervous system, and its multifaceted effects on circulating blood volume and metabolisms, as well as on the inflammatory immune system. In addition, the identification of responders, evaluation of efficacy, innovations in denervation techniques, and interactions with drugs, including novel cardiovascular agents such as SGLT2 inhibitors or ARNI, need to be clarified. Translational research between basic and clinical research is important to resolve these issues. In this plenary session, we will discuss the basic and clinical aspects of renal denervation, which is about to be introduced into the clinical practice. We would like to summarize the latest evidence and plan for the near future.

English

10. Diabetes and Cardiorenal Syndrome

Chairperson: Toyoaki Murohara Nagoya University
John McMurray BHF Cardiovascular Research, University of Glasgow, UK

Chairperson's Message

The global prevalence of type 2 diabetes (T2DM) keeps rising and is estimated about 463 million in 2019. In Japan, the prevalence of T2DM is expected to increase from 7.4 million to approximately 8.9  million by 2030. T2DM is a chronic, progressive disease associated with a number of not only metabolic abnormalities but also macro- and microvascular comorbidities, which reduce patients’ quality of life (QoL) and cause cardiovascular death. Cardiovascular disease (CVD) is the leading cause of morbidity and mortality in patients with T2DM. The mechanisms of diabetes-associated cardiorenal injury may be multifactorial. One of the leading mechanisms is direct endothelial injury by high blood glucose level, that can cause atherosclerotic disease progression and microvascular disorders such as retinopathy, renal disease (DKD) and neuropathy. More recently, T2DM is considered to affect cardiomyocyte function. T2DM can cause mitochondrial injury, metabolic disturbance and energy production inside cardiomyocytes that cause heart failure. T2DM also causes interstitial fibrosis in both cardiac and renal tissues. DKD-mediated volume retention, anemia and sympathetic activation further worsen heart failure status. In this session, we would like to discuss in depth all the concern regarding T2DM and cardiorenal syndrome, and is open for many abstract submissions.

English

11. Revisiting School Cardiac Screening

Chairperson: Yoshihide Mitani Department of Pediatrics, Mie University Graduate School of Medicine
Jonathan Drezner Department of Family Medicine, University of Washington, USA

Chairperson's Message

School cardiac screening has been conducted for more than 60 years since its beginning in Japan. After the enforcement regulation in the School Health Law was revised, cardiac screening, including electrocardiogram (ECG), was started for all freshmen in elementary, middle and high school in 1995. After the subsequent development of guidelines, the 2016 Guidelines for School Cardiac Screening (Japanese Circulation Society and the Japanese Society of Pediatric Cardiology and Cardiac Surgery) has been released. The objectives of current school cardiac screening are early detection and management of pediatric heart disease and prevention of sudden cardiac death. The usefulness in detecting diseases such as long QT syndrome, myocardial diseases and pulmonary arterial hypertension has been reported. However, standardization and equalization of the interpretation of ECG is a critical issue in Japan. Although its effectiveness in preventing sudden cardiac death has been noted overseas, it has not been adopted as a health care system because human resources and cost-effectiveness have been considered as a challenge.

In recent years, deep learning has been applied in various fields of medical science and is expected to be applied in the field of school cardiac screening. In addition, after the enactment of the Basic Act on Prevention of Cardiovascular Diseases and Stroke in December 2019, school cardiac screening is expected to play an important role in preventing adult-onset cardiovascular diseases.

In light of the above circumstances, we would like to summarize what has been accomplished in school cardiac examinations in Japan as of 5 years after the establishment of the JCS/JSPCCS guideline, and discuss current issues, related to new approaches to ECG interpretation in school children, and efforts to prevent adult-onset cardiovascular diseases to explore the future direction of research, with reference to the status in United States.

English

12. Cardiovascular Precision Medicine Based on GWAS Findings

Chairperson: Masayuki Yoshida Department of Life Science and Bioethics, Graduate School of Medicine, Tokyo Medical and Dental University
Yukinori Okada Department of Statistical Genetics, Osaka University Graduate School of Medicine

Chairperson's Message

Development of next generation sequencing technology has enabled large-scale and comprehensive understanding of human genomes. As illustrated in identification of disease risk variants by genome-wide association studies (GWAS) and panel-based sequencing of cancer genomes, genomic medicine has become commoditized. Consumer-based genome services by companies and public deposits of biobank-driven genome data have promoted the society where “everyone knows everyone’s genome”. Elongation of human lifespan and implementation of precision medicine for disease risk prediction based on human genomes are warranted. In the field of cardiovascular diseases, development of high-resolution precision medicine models is necessary. Polygenic risk score (PRS), which aggregates genome-wide disease risk variant genotypes of individuals, can stratify subjects in the population through disease risk prediction. PRS is now considered as a promising approach of precision medicine in a variety of medical fields including cardiovascular medicine. On the other hands, pitfalls of PRS is also reported, such as bias due to population stratification. Further analytical improvements towards unbiased PRS estimation is warranted. In addition to GWAS, utilization of omics information can also contribute to construction of precision medicine models. Development of omics assay technologies, such as single cell sequencing, has enabled collection of tissue-specific and time course omics information. We need to focus more on how to develop omics-based precision medicine of cardiovascular diseases in the post GWAS era. We would like to discuss this challenging topic in this symposium.

English

13. Molecular Mechanisms of Cardiovascular Aging and Diseases Progression

Chairperson: Tohru Minamino Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine
Kenneth Walsh School of Medicine, University of Virginia, USA

Chairperson's Message

The incidence of cardiovascular and metabolic diseases, such as atherosclerosis, diabetes, and heart failure, increases with age. It has been suggested that an age-associated increase in chronic inflammation (inflammaging) contributes to the onset and progression of age-related diseases including cardiovascular and metabolic diseases. For example, a number of basic and clinical studies with statins have shown that age-associated hypercholesterolemia promotes vascular inflammation, thereby leading to the onset and progression of atherosclerosis. The CANTOS study demonstrated that direct suppression of the inflammatory response can lead to a reduction of residual cardiovascular risk. Age and/or obesity-induced visceral adipose tissue inflammation provokes systemic insulin resistance, which negatively regulates cardiovascular function. It has also been reported that inflammaging in the heart is involved in the onset and progression of heart failure. The mechanisms associated with inflammaging include: age-associated clonal hematopoiesis; dysbiosis; accumulation of senescent cells, and abnormal immune response, however the entirety of the mechanisms involved remain elusive. Moreover, the therapeutic strategy targeting inflammaging for cardiovascular and metabolic diseases has not yet been sufficiently developed. In the present session we will review the issues surrounding inflammaging in cardiovascular and metabolic diseases, and discuss a perspective of novel therapeutic strategies of immune modulation.

English

14. Recent Advance of Cardiovascular Regeneration Research

Chairperson: Keiichi Fukuda Department of Cardiology, Keio University
Charles Murry Institute for Stem Cell and Regenerative Medicine, University of Washington, USA

Chairperson's Message

Basic research on regenerative medicine in the cardiovascular field in Japan has made remarkable progress and has made a great contribution to its acceleration to clinical application. The differentiation induction system from ES and iPS cells to cardiomyocytes has been established, and selective differentiation into ventricular muscles and atrial muscles has become possible. In addition, a technique for maturing cardiomyocytes in vitro has been gradually developed, and is expected to be applied to drug discovery. Furthermore, disease model iPS cells have been produced for various hereditary heart diseases and have been used for elucidation of pathological conditions and analysis of drug targets. In addition, research on large animal models with a view to clinical applications of regenerative medicine and development of mini myocardial tissue using tissue engineering techniques are also being carried out. The development of mass production methods with a view to clinical application and research on purification methods for cardiomyocytes have also produced great results. By introducing combination of myocardium-specific genes into fibroblasts or other type of cells, technological development has progressed and the efficiency of production has also improved with respect to the direct reprogramming method for producing myocardial-like cells. In this plenary session, we will focus on the development of fundamental technologies that will drive these myocardial regenerative medicine, and aim to see the future image of myocardial regenerative medicine in the near future.

English

15. Up Date of Intensive Care for Cardiogenic Shock

Chairperson: Yoshio Tahara Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
Robert W. Neumar Department of Emergency Medicine, University of Michigan, USA

Chairperson's Message

Among patients admitted to intensive care units, especially, cardiogenic shock can cause difficulty in life-saving if its direction is mistaken. Situations that require quick decisions have been sporadically seen such as the evaluation of hemodynamics and the selection of treatment. The mortality rate of cardiogenic shock exceeded 70% in the 1970’s, but has improved to 30% to 40% since 2010. New cardiac assist devices have been developed during the last 10 years. However, the current incidence of, and mortality from, cardiogenic shock in Japan remain unclear. To improve the outcomes of cardiogenic shock in Japan, it is essential to understand the current situations such as the prehospital care system, intensive care after admission, and intensive care management. The aims of this session are to improve the mortality of cardiogenic shock on the basis of the following items: (1) prognostic factors for the incidence of cardiogenic shock in the community, (2) encouragement of treatment in cardiovascular hospitals and the start of early treatment, (3) cooperation between primary care physicians and cardiologists and between cardiologists and intensivists with cardiogenic shock, (4) understanding differences in pathological characteristics and outcomes according to diseases that may cause cardiogenic shock, such as acute myocardial infarction and acute myocarditis, and (5) the effectiveness and timing of the selection of percutaneous mechanical circulatory support devices such as intra-aortic balloon pumping (IABP), extracorporeal membrane oxygenation (ECMO), and Impella® systems and the prevention of complications (indications, induction, management, and withdrawal or limitations). In this session, we would like to introduce treatment outcomes and the latest approach in advanced hospitals in this field. We would be glad if this session could give all participants help in practicing the cardiovascular management of cardiogenic shock from tomorrow.

English

16. Utilizing AI for Cardiovascular Disease Practice

Chairperson: Kunihiro Nishimura Department of Preventive Medicinen, National Cerebral and Cardiovascular Center
Khung Keong Yeo Cardiology, National Heart Centre of Singapore, Singapore

Chairperson's Message

In recent years, the utilization of ICT and AI technology has attracted extensive attention in medical fields in the world. It has been 15 years since revolutionary learning methods including Deep Learning were proposed. The AI development environment has been opened to general researchers. In fact, several AI algorithms, such as CNN, Gradient Boosting, and so on, are prevailing and can be easily implemented. In Cardiology, AI has been applied to deriving and utilizing unstructured data including ECG waveform data and images obtained from Echocardiography and Cardiac CT, and to predicting prognosis by clinical information. Furthermore, AI algorithms are going to be utilized for the personalized medicine based on biometric information such as genome/omics information and biological monitoring data. Now, we are seeing a paradigm shift in the importance of the clinical researches from clinical randomized trial to a huge volume of Real World Data utilized and processed by AI. In this symposium, we would like to introduce the latest trends in Japan and overseas regarding the AI applications in Cardiology, and to deepen our discussion on future prospects.

Symposia

English

1. Vulnerable Plaques and Vulnerable Patients: Up-to-date

Chairperson: Shiro Uemura Kawasaki Medical School Cardiovascular Medicine
Ik-Kyung Jang Cardiology, Massachusetts General Hospital, Harvard Medical School, USA

Chairperson's Message

The concept of “Vulnerable plaque” was proposed by Dr. Muller et al. in1989, and it is defined as atherosclerotic plaques that place patients at high risk for developing cardiovascular events such as acute coronary syndrome and sudden cardiac death following subsequent destabilization and thrombus formation. During the past 30 years, our understanding of “vulnerable plaque” became deeper due to the progress in basic researches on the mechanisms of coronary atherosclerosis as well as the accumulation of clinical findings. However, the beneficial impact of this concept on primary and secondary prevention of cardiovascular events appears to be still insufficient.

In this symposium, we will have an opportunity to get the latest knowledge from experts in this field. The symposium will cover the basic mechanisms, non-invasive diagnosis (positron emission CT: FDG-PET, MRI, coronary CT),invasive diagnostic imaging (intravascular ultrasound: IVUS, optical coherence tomography: OCT), near-infrared spectroscopy: NIRS), and blood biomarkers (such as high sensitivity-CRP) of vulnerable plaques. Based on the lectures, we will have discussion about remaining questions to be answered as well as what preventive/therapeutic interventions should be taken based on accurate diagnosis of vulnerable plaque.

English

2. Treatment Strategies for Severe AMI

Chairperson: Yuji Ikari Department of Cardiology, Tokai University
Navin Kapur Division of Cardiology, Department of Medicine, Tufts Medical Center, USA

Chairperson's Message

Primary PCI is the first-line treatment for ST-segment elevation acute myocardial infarction (STEMI). The mortality rate for STEMI is significantly lower with primary PCI. However, inadequate rates of primary PCI and high mortality rates in cases of cardiogenic shock remain unresolved issues. Inadequate rate of primary PCI is a complicated area including awareness by patients, transport issues, hospital access issues, and initial response issues for non-cardiologists. Cardiogenic shock, on the other hand, is an area where new treatments are awaited. With the increased use of AEDs, many cases of myocardial infarction

with left main disease, which previously resulted in death before transport to the hospital, are now seen in hospitals. Coronary artery bypass graft is selected for left main disease with stable angina due to lower recurrence rate, but in cases of cardiogenic shock of the left main lesion, the only viable option is to treat it with intervention. In addition, left main lesions contain rich plaque burden and are associated with distal emboli, and slow flow means that survival is unlikely.

The combination of Impella and ECMO has been shown to be a physiologically superior method, and it is hoped that the combination of Impella and ECMO will improve prognosis in this area. Treatment strategies for severe AMI are a major barrier to next-generation cardiology practice, and we would like to discuss these issues.

English

3. Importance of Heart Team in the Treatment of Coronary Artery Disease

Chairperson: Masato Nakamura Division of Cardiovascular Medicine, Toho University, Ohashi Medical Center
David Taggart Cardiovascular Surgery, University of Oxford, John Radcliffe Hospital, UK

Chairperson's Message

Although many evidences for coronary artery disease are accumulated year by year and many recommendations are written in the guidelines reflecting them, it is known that the cases to which the guidelines can be applied are limited. In addition to the problems of coexisting diseases such as valvular disease, low heart function, renal dysfunction, and systemic vascular disease due to an aging society, social and psycho-psychological vulnerabilities should be considered. Moreover, the hopes of patients and their families also play a large role. Therefore, there is a need for discussions by multiple experts that goes beyond mere discussion by interventionalist and cardiac surgeon. In addition, there are many PCI facilities in Japan that do not have cardiac surgery, and it is desired to form and practice a heart team in the area.

Therefore, we would like to make the Heart Team even more informative by soliciting presentations on innovations at different facilities and different modes of operation.

English

4. Front Lines of Optimal Management of Atherosclerosis Risks

Chairperson: Shizuya Yamashita Rinku General Medical Center
Paul Ridker Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, USA

Chairperson's Message

Japanese Circulation Society, in collaboration with the Japan Stroke Society, has set a “Five-Year Plan for Overcoming Cardiovascular Disease” to prevent stroke and cardiovascular diseases all over Japan. Cerebro- and cardiovascular diseases are caused by atherosclerosis of arteries and it is very important to control a variety of risk factors for atherosclerosis for their prevention. Especially, the importance of management of LDL-C has been established by a number of mega-trials of LDL-C lowering drugs such as statins, intestinal cholesterol transporter inhibitor, and PCSK9 inhibitors. However, even if serum LDL-C level is lowered to approximately 30 mg/dL, cardiovascular events are only partially prevented. Therefore, it may be crucial to appropriately control a variety of other risk factors. In this symposium, we will discuss, in addition to the current management of LDL-C, about the optimal strategies for treatment of dyslipidemia, diabetes/impaired glucose tolerance, hypertension, metabolic syndrome and other risk factors for atherosclerosis. Furthermore, we will also focus on the recent novel drug interventions for prevention of atherosclerotic cardiovascular diseases. Based upon these discussions, we will shed light into the directions for drug developments to attenuate atherogenesis and the progression of atherosclerosis.

English

5. Forefront of Revascularization and Pharmacokinetic Therapy for Peripheral Arterial Disease

Chairperson: Takanori Yasu Dokkyo Medical University Nikko Medical Center
Mary McDermott Internal Medicine, Northwestern University Feinberg School of Medicine, USA

Chairperson's Message

Peripheral artery disease (PAD) affects an estimated 200 million people worldwide. PADpatients are often associated with polyvascular disease, such as cerebrovascular or coronary artery disease and are high risk group of cardiovascular morbidity and mortality. We should determine the tailor-made best course of treatment for each patient with PAD. This symposium focuses on up-dated information of revascularization and pharmacokinetic therapy for PAD patients.

English

6. Novel Cardiovascular Approaches for Stroke Prevention by Multidisciplinary Brain-heart Team

Chairperson: Yoshihiro Morino Division of Cardiology, Department of Internal Medicine, Iwate Medical University
Mamoo Nakamura Cardiology, Cedars-Sinai Medical Center, USA

Chairperson's Message

Proportion of cardiogenic embolization is relatively high in overall stroke, in which clinical significance become more significant due to its tendency of larger ischemic areas. Patients complicated with underlying cardiac diseases that may cause intracardiac embolus must require adequate preventive therapy regardless with history of stroke. Because of such crossing demands between brain and heart, new cardiovascular approaches by multidisciplinary medical intervention, so called “brain-heart team”, gradually become popular. Especially, in cases with secondary prevention of stroke, treatment strategies depend on accurate diagnosis of “embolization” for initial cerebrovascular event by neurologists. Systemic anticoagulant therapy is considered as first line therapy for prevention, and novel anticoagulant agents have altered patients’ satisfaction as well as safety. However, there is an unneglectable proportion of patients for whom continuation of oral anticoagulation is problematic due to bleeding complications, which demands alternative approaches instead of medication. In these days, thanks to developments of catheter intervention and less invasive cardiac surgery, managements of relevant cardiac structures like left atrial appendages and patent forameno vale become available as such alternative treatment. In this symposium, we would like to discuss on novel cardiovascular approaches targeting such cardiac structures, taking cross talk by the multidisciplinary staff including cardiologists, cardiac surgeon, and neurologists, focusing on “brain-heart team” approaches. We welcome the abstracts of new researches especially regarding with theme of accurate diagnosis of cardiac embolization, therapeutic challenges with devices and surgery for relevant cardiac structures, and utilization of images for such treatment.

Proportion of cardiogenic embolization is relatively high in overall stroke, in which clinical significance become more significant due to its tendency of larger ischemic areas. Patients complicated with underlying cardiac diseases that may cause intracardiac embolus must require adequate preventive therapy regardless with history of stroke. Because of such crossing demands between brain and heart, new cardiovascular approaches by multidisciplinary medical intervention, so called “brain-heart team”, gradually become popular. Especially, in cases with secondary prevention of stroke, treatment strategies depend on accurate diagnosis of “embolization” for initial cerebrovascular event by neurologists. Systemic anticoagulant therapy is considered as first line therapy for prevention, and novel anticoagulant agents have altered patients’ satisfaction as well as safety. However, there is an unneglectable proportion of patients for whom continuation of oral anticoagulation is problematic due to bleeding complications, which demands alternative approaches instead of medication. In these days, thanks to developments of catheter intervention and less invasive cardiac surgery, managements of relevant cardiac structures like left atrial appendages and patent forameno vale become available as such alternative treatment. In this symposium, we would like to discuss on novel cardiovascular approaches targeting such cardiac structures, taking cross talk by the multidisciplinary staff including cardiologists, cardiac surgeon, and neurologists, focusing on “brain-heart team” approaches. We welcome the abstracts of new researches especially regarding with theme of accurate diagnosis of cardiac embolization, therapeutic challenges with devices and surgery for relevant cardiac structures, and utilization of images for such treatment.

English

7. What Have the Advances in Cardiac Implantable Electronic Devices (CIEDs) Changed?: Current Status and the Near Future.

Chairperson: Hiroshi Tada Department of Cardiovascular Medicine, University of Fukui
Paul Friedman Department of Cardiovascular Medicine, Mayo Clinic, USA

Chairperson's Message

With dramatic technological advances in biomedical engineering, cardiac implantable electronic devices (CIEDs) have undergone a rapid development: Pacemakers for bradycardia, anti-tachycardia-pacing and cardioversion/defibrillation (ICD) for lethal tachyarrhythmias, and cardiac resynchronization therapy (CRT) for advanced congestive heart failure are widely used around the world today. Implantable devices such as ICDs and CRTs are cornerstones of the modern treatment in heart failure patients, reducing the re-admission rate and mortality in this population. Wearable cardioverter-defibrillators, leadless-pacemakers, subcutaneous ICDs, and miniaturized implantable loop recorders have already been available in Japan for some years. His bundle pacing and left bundle pacing have also emerged as a new strategy for a physiological ventricular activation and might be effective in patients with advanced heart failure.

Remote monitoring (RM) has become a new standard of care in the follow-up of patients with CIEDs, and it might be quite useful in patients with advanced heart failure and concomitant atrial fibrillation. Furthermore, a remote hemodynamic monitoring device has recently been developed and is now often used in daily clinical care in both Europe and the United States.

Thus, CIEDs are not just electrical stimulation devices, but have already become reliable heart monitoring and therapeutic equipment, and further future developments and dissemination are expected. In this symposium, we would like to discuss the current status and near future of CIEDs for the diagnosis and treatment of cardiovascular disease.

English

8. Recent Advancement of Non-pharmacological Therapies for Atrial Fibrillation

Chairperson: Teiichi Yamane The Jikei University School of Medicine
Laurent Macle Medicine, Cardiology, Electrophysiology, Montreal Heart Institute, Université de Montréal, Canada

Chairperson's Message

Among various fields in the Cardiology, there have been remarkable recent advances in approaches/therapies for the management of atrial fibrillation. Atrial fibrillation, which had become curable by surgical procedure in the end of 20th century, has become curable by catheter-based approaches. In addition to the traditional radiofrequency-energy, cryothermy coagulation and laser-energy using the balloon technology have become the choices for catheter ablation. As for the targets of the substrate of atrial fibrillation, multiple approaches including the linear ablations, CFAE ablations, drivers/rotors, and the GP ablations have been focused along with the progression of 3D technologies.

There have been remarkable progressions in the surgical treatment of AF as well. In addition to the traditional full Maze-procedure, less invasive procedures like endoscopical PVI/Maze procedure and left atrial appendectomy have become common procedures. One of the recent topics is the advancement of catheter-base left atrial appendage closure, which is another choice for patients with contra-indication of anticoagulative agents.

In this symposium, we would like to discuss both the utility and limitation of recent progression in the nonpharmacological approaches for atrial fibrillation.

English

9. Current Perspective on Precision Medicine of Inherited Arrhythmias

Chairperson: Wataru Shimizu Department of Cardiovascular Medicine, Graduate School of Medicine, Nippon Medical School
Arthur Wilde Heart Centre, Department of Cardiology, Amsterdam UMC, location AMC, Netherlands

Chairperson's Message

Since the first causative gene in congenital long QT syndrome (LQTS) was discovered in1996, genetic studies have identified a significant link between mutations in genes encoding for cardiac ion channels or other membrane components and several inherited arrhythmias. The responsible genes mainly KCNQ1 (LQT1), KCNH2 (LQT2) and SCN5A (LQT3) have been identified in 75% of congenital LQTS patients, and genotype-phenotype correlation has been well investigated, enabling genotype-specific management and pharmacological therapy, so-called precision medicine. Moreover, mutation site- or mutation type-specific risk stratification has been introduced in congenital LQTS. Genetic diagnosis rate is less (20-30%) in patients with Brugada syndrome (BrS). Recently, BrS is believed to be multifactorial genetic disorder, and only SCN5A gene is considered to be a pathogenic gene. Other inherited arrhythmias include catecholaminergic polymorphic ventricular tachycardia(CPVT), arrhythmogenic right ventricular cardiomyopathy (ARVC), short QT syndrome, and early repolarization syndrome. Mutations in ryanodine receptor gene (RYR2) are identified in more than 50% of patients with CPVT, and mutations in genes encoding for cytoskeletal and desmosomal proteins have been reported in ARVC patients, in whom genotype-phenotype correlation and risk stratification in relation to causative genes have been evaluated. In this symposium, expert physicians and researchers are welcome to present their own clinical and experimental data and to provide a comprehensive discussion for current perspective on precision medicine of inherited arrhythmias.

English

10. Molecular Mechanisms of Heart Failure

Chairperson: Issei Komuro The University of Tokyo Graduate School of Medicine
Eric N. Olson Molecular Biology, UT Southwestern Medical Center, USA

Chairperson's Message

The number of heart failure patients is ~ 1.2 million in Japan and has been increasing although the total population has been decreasing. The treatments for heart failure including drugs and devices have been progressed very much, but its prognosis is still as poor as that of stomach cancer. The reason of the poor prognosis of heart failure might be lack of the treatments based on mechanisms of its development. Heart failure is a final stage of many cardiovascular diseases such as myocardial infarction, valvular diseases and hypertension. Many patients show cardiac hypertrophy before developing heart failure. Hearts are induced to form hypertrophy by hemodynamic overload to maintain its pump function, however, long-term hemodynamic overload induces the transition from cardiac hypertrophy to heart failure as a failure of the adaptation. Therefore, it is important to elucidate the molecular mechanisms of the transition. In this symposium, the cutting edge of molecular mechanisms of heart failure will be presented and discussed by a variety of aspects.

English

11. Current Status and Future Concern of Non-pharmacological Therapy to Heart Failure among Super Aging Society

Chairperson: Koichiro Kinugawa The Second Department of Internal Medicine, University of Toyama
JoAnn Lindenfeld Cardiology, Vanderbilt University, USA

Chairperson's Message

The rapidly advancing super-aged society has brought about a pandemic of heart failure, and the etiologies and phenotypes have changed dramatically from 10 years ago. Although recent advances have been made in the pharmacological treatment of heart failure, development of the non-pharmacological treatment is also substantial. Accordingly, the guidelines are required to be up-dated almost every year, but unfortunately the guidelines neither mention about specific treatment or special care for the elderly, or treatments that are not suitable for the elderly. In this session, I would like to deepen the discussion on the following six themes regarding non-pharmacological treatment of heart failure. Of course, other important themes of elderly people that I could not describe here are welcome (nutrition, frail, rehabilitation in combination with device treatment, etc.).

1. How we indicate implantable cardioverter-defibrillator to elderly people? Is there any cost-effectiveness?
2. Does atrial fibrillation ablation have a crucial role in the treatment of heart failure for the elderly?
3. How old or how young should TAVR patients be?
4. Is catheter-based mitral/tricuspid plasty a gospel for the elderly?
5. To what extent can implantable ventricular assist device be applied to the elderly in the era of destination therapy?
6. How can we establish a system that enables withdrawal from invasive treatment in the end of life?

English

12. Structural and Functional Abnormalities of the Atria in Heart Failure ~from Diagnosis to Therapy~

Chairperson: Kazuhiro Yamamoto Department of Cardiovascular Medicine, and Endocrinology and Metabolism, Faculty of Medicine, Tottori University
Barry Borlaug Department of Cardiovascular Medicine, Mayo Clinic, USA

Chairperson's Message

Although the importance of the atria is often underestimated in the shadow of the ventricles, atrial abnormalities contribute to a variety of pathophysiologies. Organic and/or functional changes of the atrial muscle and interstitium and electrical abnormalities have interaction with one another, induce the impairment of reservoir function, conduit function, or booster pump function of the atria, and result in hemodynamic deterioration. There have been scattered studies showing that atrial dysfunction is related to heart failure severity. Atrial fibrillation is both a result of, and a cause or exacerbator of, such atrial changes. The results of a study showing a difference in the effect of beta-blockers in HFrEF with and without atrial fibrillation have received much attention. Recent epidemiological studies found that more than a half of HFpEF patients have atrial fibrillation, suggesting that atrial function plays a major role in the pathogenesis of HFpEF. Furthermore, atrial functional mitral or tricuspid regurgitation caused by the enlarged atria without ventricular dilatation or dysfunction is getting a lot of attention as one of causes of heart failure.

Although the term, atrial cardiomyopathy, is advocated, structural and functional abnormalities of the atria in heart failure have not been well studied to date. In this session, we want to discuss the pathogenesis, clinical assessment methods and therapeutic interventions of the structural and functional abnormalities of the atria in heart failure based on the latest findings.

English

13. Early Diagnosis of Cardiomyopathies Using Multimodality Imaging

Chairperson: Satoshi Nakatani Saiseikai Senri Hospital
Raymond Kwong Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, USA

Chairperson's Message

Myocardial diseases are diverse, including primary cardiomyopathy such as hypertrophic cardiomyopathy and dilated cardiomyopathy, and secondary cardiomyopathy such as amyloidosis and sarcoidosis. Morphological abnormalities detected are not always helpful to diagnose cardiomyopathies. However, early diagnosis is required for determining treatments and predicting its prognosis. Various imaging modalities such as echocardiography, CT, MRI and nuclear imaging are used for noninvasive diagnosis, but recently, thanks to technological progresses and deeper understanding of pathological conditions, new analysis methods and parameters are being produced. However, in clinical practice, it may be difficult to determine which modality should be used at which timing for which disease to diagnose, and which modality should be optimal for prognostic prediction. Without true understandings, the modality can be useless. In this session, we would like to discuss the latest topics of diagnostic imaging modalities and discuss the future use of various modalities that contribute to early diagnosis through their application to various myocardial diseases.

Japanese

14. How to Treat Atrial Functional Mitral Regurgitation?

Chairperson: Toshihiko Shibata Department of Cardiovascular Surgery, Osaka City University
Chisato Izumi Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center

Chairperson's Message

Functional MR was classified into 2 categories; one is functional MR associated with low ejection fraction resulting in valve tethering, and the other is functional MR associated with left atrial enlargement resulting in annular dilatation, that is often called “atrial functional MR”. Atrial functional MR often coexists with tricuspid regurgitation, that is “dual valve disease”. These two categories of functional MR have different mechanisms, treatment, and prognosis. However, in the ESC and ACC/AHA guidelines, these two categories are not stated separately, and their recommendations in functional MR are mainly for patients with low ejection fraction and valve tethering.

In the JCS guidelines published in 2020, these 2 categories are clearly defined and stated separately. However, we could not show the treatment recommendation flowchart because we have limited evidences about atrial functional MR. There are treatment options such as medications, cardioversion and catheter ablation as well as surgical and transcatheter intervention to the mitral valves, but treatment strategy has not been established yet.

In this session, we want to discuss the treatment strategy to atrial functional MR based on the data in a real world of clinical practice.

English

15. Present and Perspective of Continuous-flow Ventricular Assist Device in the Coming Time of Destination Therapy

Chairperson: Minoru Ono Department of Cardiovascular Surgery, Graduate School of Medicine, The University of Tokyo
Nir Uriel Cardiology, Columbia University/New York Presbyterian Hospital/Weill Cornell, USA

Chairperson's Message

Destination therapy for continuous-flow ventricular assist device (cf-VAD) will be approved for health insurance coverage soon. There are many issues to be discussed and solved, such as reasonable criteria for cf-VAD implantation in patients with advanced age and/or comorbidities, desirable home management and patient education, acceptable family and social support systems matching recent demands, and so on. It should be also deeply discussed what are desirable measures at the end of life during DT treatment whose goal is improvement of quality of life in order to take root in Japanese society.

Japanese

16. Cutting Edge of ICT Based Risk Management in Cardiovascular Medicine

Chairperson: Yusuke Ohya Department of Cardiovascular Medicine, Nephrology & Neurology, University of the Ryukyus
Yuichi Tamura Department of Cardiology, International University of Health and Welfare

Chairperson's Message

In the cardiovascular field, implantable devices such as pacemakers and ICDs have been used as monitoring system. This is where ICT are used to manage the risk of heart failure and arrhythmias. With the recent advances in artificial intelligence and the development of 5G system and other ICT tools, much more advanced risk management models are expected to be developed. For example, Tele-catheter labo, Tele-ICU/CCU and remote monitoring as telemedicine models, AI-enabled electrocardiograms, echocardiograms, and cardiac CTs using deep learning were frequently reported. In addition, the use of software are reported to change behavior in lifestyle management and smoking cessation, which are risk factors for cardiovascular disease. These findings are directly related to disease management in the context of COVID-19 controls and Smart City concept, and have the potential to fundamentally change the way of care for patients with a shortage of physicians, home care and/or infection control.

In this symposium, we will expect many attractive presentations to be submitted under a wide range of advanced cases of risk management using ICT. Both basic research to actual clinical applications are acceptable to develop present perspective in this field.

Japanese

17. Transforming Diversity for Changing Practice; Needs for Task Share

Chairperson: Yoshihiro Fukumoto Kurume University
Yasuko Bando Nagoya University

Chairperson's Message

Diversity is transforming from the gender equity action to enhancing human resources development and work-life balance. One of the emerging projects for the current diversity action is to establish new style of working for cardiologists by 2024, in which the doctors would be officially forced to reduce overwork. The government promotes a new system to achieve the task sharing of doctors with co-medical workers, namely, fostering nurse practitioner (NP). To effectively train professional NP as soon as possible, the package-type learning courses have been developed. Recently, the Japanese Circulation Society (JCS) and the Japanese Association of Cardiovascular Nursing (JACN) have declared the needs for the ” Cardiology package” to train NP, which was submitted to the Ministry of Health, Labour and Welfare.

The aim of this symposium is to share the essential updates and role models for the coming big challenges in working style for cardiologists at every stage to achieve the successful transforming in changing practice.

Japanese Designated Speakers Only

18. Diversity of Cardiologist – Mutual Interaction between Medicine and Economy

Chairperson: Yayoi Tsukada Testuou Department of ER and General Medicine, Nippon Medical School Musashi-Kosugi Hospital
Tatsunori Taniguchi Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine/ Remohab Inc.

Chairperson's Message

While the significance of diversity is enhancing, the "Gender Equality Committee" was renamed to the "Diversity Promotion Committee" in 2018. To advance in cardiology with maximizing each person's ability as a professional, we should address not only gender diversity but also generation, lifestyle, culture/nationality, work history, research field. Diversity is the inclusion of unlike elements or quality. Both diversity and inclusiveness are a critical element for innovation. Diversity & inclusion in an organization means not only a diverse group of members but also respect and acceptance of each other to make a creative environment where they can be active together. The first step is to acknowledge and respect each other appropriately.

From the perspective of the sustainability of medicine, the topic of this session, "economy," has an indispensable relationship with medicine. As the medical costs in Japan are growing enormously year by year, an economically efficient and effective approach is essential to establish within the limited social resources. Recently, the trend shift from treatment to prevention and cure to care has accelerated in medicine, and the momentum for the promotion of preventive medicine has increased. At the same time, the entrepreneurship of physicians aiming to solve social problems caused by disease and health issues has become active.

In this session, the cardiologist venturing into the field of economics will present about their career paths and what they are currently challenging. We would like to discuss broadly how "cardiology" confronts "economy" interacting with each other and evolve in the future.

English

19. Novel Therapeutic Strategy of Pulmonary Hypertension –from Bench to Bed-

Chairperson: Keiko Yamauchi-Takihara Health and Counseling Center, Osaka University
Marc Humbert Department of Respiratory and Intensive Care Medicine, University Paris-Saclay, France

Chairperson's Message

Understanding of pulmonary hypertension has expanded dramatically in Japan, based on the guidelines of the 6th World Symposium on Pulmonary Hypertension. The use of various evidence-bearing pulmonary vasodilators and early detection and therapeutic interventions have significantly improved the prognosis of the patients with pulmonary arterial hypertension (PAH). However, since the etiology of pulmonary hypertension is diverse and various factors are involved in the development and progression of the disease, the treatment outcome of PAH specific medication is still not always sufficient.

It is necessary to proceed with personalized medicine on the basis of the pathogenesis of PAH to achieve maximum treatment efficacy. In this symposium, we would like to deepen our understanding of the underlying mechanism for the development of pulmonary hypertension, and comprehensively discuss future therapeutic targets based on the results of translational research.

Japanese Designated Speakers Only

20. The Latest Topics in Intensive Care That You Need to Know to Work in the CCU

Chairperson: Shunji Kasaoka Kumamoto University
Tomonori Itoh Iwate Medical University

Chairperson's Message

Welcome to the symposium session of intensive care. We are planning a session that will allow cardiologists to cover a wide range of new knowledge about intensive care in this session. The CCU is the cornerstone of cardiovascular emergency care, first established in the United States in 1962. The CCU have almost 60 years of history. During this time, there have been going to dramatic advances in the treatment of acute myocardial infarction with a mortality rate of less than 5%. However, the in-hospital mortality rate has not been established zero, and the problem of out-of-hospital cardiac arrest remains unresolved. Nowadays, emergency cardiovascular care is greatly affected by environmental factors such as disasters and pandemics and many things are going to the paradigm shift.

In this session, to look ahead to further advances in cardiovascular emergencies in the 21st century, we ask to discuss the latest topics in intensive care at the present time in a state-of-the-art. Moreover, we would encourage to provide new knowledge to each participant and patient after the session.

Japanese

21. Current Status and Effort of Rural Medical Care with Uneven Distribution of Doctors

Chairperson: Ryozo Nagai Jichi Medical University
Akihiko Nogami Department of Cardiology, Faculty of Medicine, University of Tsukuba

Chairperson's Message

Prefectures that have “areas lacking a doctor” or “areas that are equivalent to area lacking a doctor” in remote health care are 43 prefectures excluding Tokyo, Kanagawa, Osaka, and Chiba prefectures. Since 2008, the number of medical students has increased significantly and the number of doctors has been increasing year by year. However, the increase is biased to some medical disciplines, and the uneven distribution of doctors in regional areas and uneven distribution of medical disciplines has not yet been resolved. It has also been pointed out that there is a large difference in working hours between disciplines.

"Urgent measures to secure doctors" have been compiled to eliminate such uneven distribution of doctors in regions. The following are listed as the main points -- 1) construction of a national-level urgent temporary doctor dispatch system for areas where doctors are scarce, 2) improvement of working environment to eliminate overwork of hospital doctors, 3) improvement of working environment for female doctors, 4) reviewing the capacity of training hospitals to correct the number of trainees in cities, 5) establishing a support system for medical risks, 6) promoting the training of doctors who work in areas lacking doctors or medical disciplines with shortage of doctors.

In addition, according to the future estimation by 18 basic areas in the new specialist system, the medical disciplines that needed the most increases were internal medicine, followed by surgery. In the future, in order to secure sufficient cardiovascular medical care in all areas including remote areas, a wide range of ideas are required for cardiovascular specialist education in areas where doctors are unevenly distributed, doctor task shifts and task sharing, and career advancement especially for female doctors.

In this symposium, we will discuss the current status and effort by each medical school and medical institution.

Japanese

22.Team Medical Care for Heart Failure Including Community: Acute Care Hospitals and Community Network

Chairperson: Minako Yamaoka-Tojo Kitasato University School of Allied Health Sciences
Chikako Miura Japan Association for Development of Community Medicine

Chairperson's Message

In December 2018, “the Basic Act on Measures for Stroke, Heart Disease, and Other Cardiovascular Diseases to Extend Healthy Lifespan” was enacted. Five activity strategies are listed as a five-year plan, including "improving medical systems not only in the acute phase but also in the convalescent/chronic phase" and "training not only specialists but also medical staff to practice team medical care". In particular, for heart failure as a final result of all cardiovascular diseases, at any stage from 0th to 3rd of the cardiovascular disease prevention, and at any stage from acute to convalescent, chronic, and maintenance, it is important to have a multi-professional team medical care and to smoothly collaborate in all areas such as medical clinics, elderly facilities, and acute care hospitals. However, the number of beds is insufficient to shift from acute care hospitals to the chronic/convalescent care hospitals in the real world, and there are many cases where the acute phase immediately shifts to home. To prevent worsening and re-admitted to the hospital in patients with heart failure, a cooperation between the acute care hospitals and the community facilities is indispensable.

In this session, we will introduce the precise systems of regional cooperation and specific examples of their activities from facilities that are engaged in discharge to home support so that heart failure patients can smoothly transition from acute care hospitals to their homes. We would like to clarify the problems and issues in acute phase hospitals and regional collaboration and discuss the solutions.

Japanese

23. Robotics and Virtual Reality for Cardiovascular Medicine

Chairperson: Masanori Nakamura Nagoya Institute of Technology
Yasushi Sakata Osaka University

Chairperson's Message

The year 2020 is occupied by Novel Coronavirus Diseases (COVID-19). The humankind faces the danger of extinction due to this virus attack before the revolt of an artificial intelligence (AI). We strongly hope that AI will prove its worth in the rapid development of vaccines and silver bullets for COVID-19. In addition, we expect to clinically use many technologies, namely robotics and virtual reality. However, little is known about how these technologies will be used and what the developers are thinking of. We find few abstracts about technological developments in the meeting of the Japanese Circulation Society . Efficient technological developments require researches addressing unmet clinical needs. The Japanese Circulation Society is cooperating the Japan Society of Mechanical Engineers, aiming at mutual understanding between clinical practice and engineering. In this collaborative session, we would like to invite the researchers who are involved in the development of engineering technology and devices mainly for cardiovascular medicine. Compared with other countries such as the United States, the human resources and infrastructure involved in medical technology in Japan are insufficient. However, we hope that this session will help to gap the difference and lead to improvements in health care.

English

24. Cancer Chemotherapy and Cardiovascular Complications

Chairperson: Hiroshi Akazawa Department of Cardiovascular Medicine, The University of Tokyo
Alexander Lyon Cardio-Oncology Service and National Heart and Lung Institute, UK

Chairperson's Message

Recent advancements in cancer therapy dramatically improved the long-term outcome of cancer patients, leading to an increase in the number of cancer survivors, but cardiovascular adverse events owing to cancer therapy have greater impact on the prognosis and quality of life in cancer patients and survivors. Under such circumstances, it is increasingly of importance to manage the cardiovascular complications, which are related to both cancer itself and adverse effects of cancer therapies. In addition to anthracyclines, whose cardiotoxic effects have been recognized for decades, molecularly targeted anticancer drugs have entered a list, for which cardiovascular complications are concerned. Anticancer drugs often target molecules essential to cardiovascular homeostasis, but off-target effects can also induce toxic phenotype. Currently, the molecular mechanisms underlying the pathogenesis of cardiovascular toxicity by individual drugs remain to be precisely defined. In addition, epidemiological and clinical aspects of cardiovascular complications by cancer chemotherapy have not been sufficiently accumulated, due to a wide variety of chemotherapy regimens and patient characteristics involving cancer types, stages, and cardiovascular comorbidities. Under such circumstances, interdisciplinary collaboration between oncology and cardiology specialists is the prerequisite for the best management of cardiovascular risks and complications to avoid interruption of optimal cancer treatment. In this symposium, we will discuss the current status and future directions of cardio-oncology/onco-cardiology, based on cutting-edge basic, clinical, and epidemiological research on cardiovascular complications in relation to cancer chemotherapy.

Japanese

25. Challenges and Countermeasures in Cardiovascular Health Care: Toward the Era of Technical Evaluation

Chairperson: Takanori Ikeda Department of Cardiovascular Medicine, Toho University
Kazuo Matsumoto Higashimatsuyama Medical Association Hospital

Chairperson's Message

The Health Insurance Measures Committee of the Japanese Society of Cardiovascular Medicine compiles the technical proposals desired by many related societies through the Social Insurance Union of Societies Related to Internal Medicine or Surgery, as a responsibility of the main academic societies of the cardiovascular system that should contribute to medical progress. Request forms regarding medical fee revision are submitted to the Ministry of Health, Labor and Welfare (MHLW) every two years. When the medical fee was revised in 2020, a relatively large number of requests regarding unlisted and already-listed medical technologies in the cardiovascular field were accepted.

In the revision of medical fees in 2022, with the slogan of introducing and strengthening medical technology that is useful to the public, doctors take charge of their own medical technology based on the evaluation of so-called "things" such as pharmaceuticals, devices, and catheters. We are aiming to shift to an evaluation that emphasizes "technology". We request the MHLW to add points to the medical treatment fee for "specific medical treatment" and "explanation and consent" in the treatment of severe heart failure, serious arrhythmias, and so on. It also promotes "medical cooperation" and "home medical care", establishes "remote medical care" to support regional medical care, and demands the establishment of new medical fees. Establish a medical care system aiming at promotion of “team medical care” and reduction of “medical doctor burden”, and request new establishment of medical care fee that accompanies it.

In this symposium, we plan to discuss challenges and countermeasures in insurance medical care in the cardiovascular field in the coming era of technical evaluation.

Joint Symposia

English

ACC-JCS Joint Symposium

1. Frontiers in the treatment of mitral regurgitation

Chairperson: Kazuhiro Yamamoto  Division of Cardiology Medicine, Endocrinology and Metabolism, Department of Molecular Medicine and Therapeutics, Faculty of medicine, Tottori University

Chairperson's Message

The number of patients with mitral regurgitation has increased with aging of the society. Because surgical risk is elevated in elder patients, in particular, with severe left ventricular dysfunction, a less invasive approach to mitral regurgitation has been developed. Transcatheter edge-to-edge repair (Mitraclip®) has been clinically applied across the world, and as it becomes more widespread, the range of patient indications is expanding from their original indications as well. In patients with secondary mitral regurgitation, this repair approach seems to be the preferred one. In parallel with the spread of this method, several new and less invasive approaches have been proposed. This session will focus on the less invasive treatment of mitral regurgitation and the latest findings in the treatment.

English

AHA-JCS Joint Symposium

2. Covid-19 and cardiovascular disease: complications such as stroke

Chairperson: Koichi Node  Department of Cardiovascular Medicine, Saga University

Chairperson's Message

It has been reported that COVID-19 infection is more likely to become severe in patients with cardiovascular disease and diabetes. Cardiovascular complications include inflammation, heart failure, arrhythmia, pulmonary infarction, cerebral infarction, and serious pathological conditions due to thrombosis. At this symposium, we plan to discuss the management, treatment, and prevention of cardiovascular complications caused by COVID-19 infection.

English

ESC-JCS Joint Symposium

3. Recent advances in coronary imaging and intervention

Chairperson: Toshiro Shinke  Division of Cardiovascular Medicine, Showa University school of Medicine

Chairperson's Message

Recent advancement in coronary imaging techniques and technologies has provided us a more precise understanding of the pathophysiology of coronary artery disease, especially the progression of atherosclerotic changes leading to acute and chronic coronary syndromes. It also has moved beyond research frameworks to improve clinical decision-making strategies and optimize individualized coronary intervention. In this symposium, cutting-edge imaging technology in each invasive and non-invasive field will be discussed in order to achieve contemporary optimal management of patients with coronary artery disease.

English

KSC-JCS Joint Symposium

4. The new trend of regeneration therapy in cardiology

Chairperson: Keiichi Fukuda  Department of Cardiology, Keio University School of Medicine

Chairperson's Message

Clinical application of regenerative medicine in the cardiovascular field had been investigated using cardiac stem cells, skeletal myoblasts, mesenchymal stem cells, and ES and iPS cells. There is wide variation between therapeutic cell sources and methods of transplantation. Some studies examine direct transplantation of regenerated cardiomyocytes, and others expect that humoral factors improve cardiac function. In this joint session, we will discuss the future direction of regenerative medicine in order to achieve our final goals. We ask the speakers to clarify how they apply basic research in their clinics, what kind of heart disease is targeted, how long the transplanted cells can survive, how to prevent the tumor formation, and what is the mechanism of improvement of cardiac function.

English

CSC-JCS Joint Symposium

5. The recent advance in coronary intervention

Chairperson: Yuji Ikari  Department of Cardiology, Tokai University School of Medicine

Chairperson's Message

Percutaneous coronary intervention (PCI) is one of the major coronary revascularization procedures, along with bypass surgery. In 2015, a MATRIX study showed radial access for acute coronary syndrome reduces mortality rate. Radial access is technically difficult but its benefit is clear, and while slender PCI is an even more difficult technique, its less invasive aspect is attractive. We can detect plaque morphology using OCT imaging, and IVUS-guided PCI improves short-term and long-term outcomes. Chronic total occlusion is a challenging field in PCI, but several new techniques and devices have improved its success rate. In this session, we would like to discuss these recent advances in PCI and more.

English

APSC-JCS Joint Symposium

6. Management of stable coronary artery disease after ISCHEMIA trial

Chairperson: Hiroyuki Okura  Department of Cardiology, Gifu University Graduate School of Medicine

Chairperson's Message

Whether or not percutaneous coronary intervention (PCI) is beneficial in treating stable coronary artery disease has been debated. Currently, the indication of PCI is determined based on the presence or absence of ischemia, and FFR is widely used to assess coronary physiology rather than angiography-based anatomical assessment alone. The ISCHEMIA study found that PCI does not provide any notable clinical benefit over optimal medical therapy in stable coronary artery disease, even in the presence of coronary ischemia. This symposium will discuss the impact of the ISCHEMIA trial on treatment strategies for stable coronary artery disease. We will also discuss the potential benefit of PCI in the post-ISCHEMIA trial era.

Secretariat of the 85th Annual Scientific Meeting of the Japanese Circulation Society
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