Collaborating for improvements in cardiac care

The Cardiology on the Green conference, held in the RCSI on 4-6 April 2019, was the inaugural joint meeting between the Irish Cardiac Society (ICS) and the Mayo Clinic, US, and marked 70 years since the establishment of the ICS.

The conference hosted a range of distinguished national and international speakers, all of whom are renowned experts in their fields.

The first session was chaired by Dr Barry Boilson of the Mayo Clinic and Prof Ken McDonald, Consultant Cardiologist at St Vincent’s University Hospital in Dublin.

Dr Jim Crowley, ICS President, opened the conference, referring to the “great opportunity” provided by the meeting to enhance professional contacts and exchange clinical expertise. Dr Boilson added that there had been “tremendous excitement” building in the Mayo Clinic at the prospect of the meeting, adding that it presented an important building-block for future collaboration between the two bodies.

The attendees first heard from Prof McDonald, who addressed issues in natriuretic peptides in cardiology and provided an overview of the STOP-HF trial. “Because of the onslaught of heart failure (HF), and because we continue to fail to produce an effective therapy for HF with preserved systolic function — although we may have something by the end of the year as a result of the PARAGON study — we realised that there is a need to start preventing HF,” he stated.

Prof McDonald, who was one of the people instrumental in setting-up the conference, pointed out that approximately one-fifth to one-sixth of the population are at risk of developing HF and he presented “very concerning” data to show that stage B HF is now more dominant at the age of 50 years than normal status. “There has been excellent work by numerous people… to show that natriuretic peptide, above all other cardiovascular (CV) risk indicators, sets out the risk for HF. However, interestingly, and relevant to the STOP-HF data, it also sets out the risk of cardiovascular disease in general, so it stands out as the risk indicator for CV disease above all other risk factors.”

Collaboration

The meeting next heard from Dr Valentina Cannone, Assistant Professor of Medicine at the Mayo Clinic, who collaborated with Prof McDonald on the STOP-HF trial and spoke on the topic: ‘Overview of Collaborative Work between St Vincent’s University Hospital and the Mayo Clinic’. Dr Cannone told the attendees: “In this trial, we approached BNP from a different perspective — as a cardiac hormone secreted by the heart as a compensatory response to volume overload.”

BNP induces natriuresis and has a vasodilatory effect, and can also inhibit the renin-angiotensin-aldosterone system, she explained, as well as inhibiting cardiac fibrosis and cardiac hypertrophy.

Dr Cannone, outlining the recent work in her laboratory, stated: “This study supports the concept that there might be a cardiovascular protective effect exerted by the genetic variant rs198389 and BNP circulating levels associated with this genetic variant. But importantly, our study also supports the idea that augmenting the BNP system may have a cardioprotective, therapeutic effect in the prevention of HF.”