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Cardiovascular Research at the American College of Cardiology Scientific Sessions 2019: the meeting's highlights

The American College of Cardiology’s (ACC) Annual Scientific Session brings together leaders in the field of clinical cardiology from around the world to discuss the latest science and research related to cardiovascular disease. With almost 12 000 attendees and more than 250 reporters representing over 20 countries at ACC 19, abstracts and cases presented at this conference have significant global impact. ACC this year started off with the Simon Dack Keynote lecture by Dr Canessa on the topic Don’t Let a Tragedy Dictate Who You Are. Dr Canessa, a paediatric cardiologist in Montevideo, Uruguay discussed the importance of working together towards the same objective, always keeping in mind the bigger picture in cardiology. At age 19 years, he endured a plane crash in the Andes Mountains that killed 29 people and left him stranded in the middle of nowhere. Over 72 days he had to face the harshest of weather, resorted to cannibalism in order to feed himself and hiked for 10 days in the Andes in search of help for himself and the other survivors. However, he did not let tragedy dictate his life and delivered a clear message about the importance of hope, endurance, and the spirit of cooperation in pursuit of a successful and fulfilling life (https://www.acc. org/latest-in-cardiology/articles/2019/03/08/24/42/simon-dack-keynotedont-let-a-tragedy-dictate-who-you-are-acc-2019). Day 1 at ACC 19 included the anticipated Apple Heart study which highlighted the role of technological advancement in cardiology to potentially identify health problems. The Apple Watch and corresponding Heart Study application used photoplethysmography to intermittently measure blood flow activity and detect subtle changes in the form of a tachogram which in turn help in identifying irregular heartbeats. Detection of repeat tachograms of an irregular pulse triggered a notification via the application which then prompted the study participant to contact the study doctor in order to determine if the participant should wear an electrocardiogram (ECG) patch. The primary endpoints were atrial fibrillation (AFib) >30 s on ECG patch and simultaneous AFib on ECG patch and tachogram. A pulse notification was received by 0.52% of the study participants. Notification rates were most frequent (slightly >3.0%) in older participants over age 65 years and lowest (0.16%) in younger participants under age 40 years, respectively. AFib was identified in 34% of those who wore the ECG patch and received a pulse notification, thus potentially indicating a need for follow-up clinical evaluation in those patients (https://www.acc.org/latest-in-cardiology/ articles/2019/03/08/15/32/sat-9am-apple-heart-study-acc-2019). Depression is a common risk factor among patients hospitalized for heart failure. Day 1 at ACC ended with two depression trials, including the Hopeful Heart trial which showed that collaborative care (involving multiple sub-specialties) for heart failure and depression was superior at improving quality of life when compared with usual care among patients recently hospitalized for heart failure. Concurrent with quality of life improvement, enhancement in mood symptoms was also seen; however, no difference in readmissions and mortality within 12 months was found between the two groups (https://www.acc.org/latest-in-cardi ology/clinical-trials/2019/03/15/13/30/hopeful-heart). The second depression trial, the CODIACS-QOL trial, aimed to evaluate depression screening compared with no screening in recent acute coronary syndrome patients. Depression screening failed to improve qualityadjusted life-years or depression-free days in post-acute coronary syndrome patients with no prior history of depression (https://www.acc. org/latest-in-cardiology/clinical-trials/2019/03/15/13/42/codiacs-qol). The highlight of ACC 19 was Day 2, with the presentation of two of the most anticipated trials, PARTNER 3 and Evolut Low Risk, both of which received a standing ovation. These trials explored the utility of transcatheter aortic valve replacement (TAVR) in low surgical risk patients. While the PARTNER 3 trial using the SAPIEN 3 system (Edwards Lifesciences) showed that in low-risk patients, TAVR was superior to surgical aortic valve replacement (SAVR) at reducing death, stroke, or rehospitalization at 1 year; the Evolut Low Risk trial using the self-expanding valve (CoreValve/Evolut R/Evolut PRO; Medtronic) showed that TAVR was non-inferior to SAVR for mortality/disabling stroke at 24 months for treatment of severe symptomatic aortic stenosis in lowrisk patients. Both of these trials build on prior literature showing TAVR to be non-inferior or even superior to SAVR in high and intermediate surgical risk patients. However, long-term follow-up will be essential in order to understand the long-term durability of the valves including structural valve degeneration and the risk of subclinical leaflet thrombosis. ‘This is a historic moment, and of all of us here should remember it as such’, proclaimed Dr Braunwald, MD, Brigham and Women’s Hospital, Boston, MA, during the discussion panel immediately following presentation of the trials (https://www.medscape.com/ viewarticle/910515). Another interesting study highlighted was the MOMENTUM trial. Left ventricular assist systems are increasingly employed in patients with