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Cardiology on the cutting edge: updates from the European Society of Cardiology (ESC) Congress 2020
BMC Cardiovascular Disorders volume 20, Article number: 448 (2020)
The 2020 annual Congress of the European Society of Cardiology (ESC) was the first ever to be held virtually. Under the spotlight of ‘the cutting edge of cardiology’, exciting and ground-breaking cardiovascular (CV) science was presented both in basic and clinical research. This commentary summarizes essential updates from ESC 2020—The Digital Experience. Despite the challenges that coronavirus disease 2019 (COVID-19) has posed on the conduct of clinical trials, the ESC Congress launched the results of major studies bringing innovation to the field of general cardiology, cardiac surgery, heart failure, interventional cardiology, and atrial fibrillation. In addition to three new ESC guidelines updates, the first ESC Guidelines on Sports Cardiology and Exercise in Patients with Cardiovascular Disease were presented. As former ESC president, Professor Casadei undoubtedly pointed out the ESC Congress 2020 was a great success. During the ESC 2020 Congress, BMC Cardiovascular Disorders updated to seven journal sections including Arrhythmias and Electrophysiology, CV Surgery, Coronary Artery Disease, Epidemiology and Digital health, Hypertension and Vascular biology, Primary prevention and CV Risk, and Structural Diseases, Heart Failure, and Congenital Disorders. To conclude, an important take-home message for all CV health care professionals engaged in the COVID-19 pandemic is that we must foresee and be prepared to tackle the dramatic, long-term CV complications of COVID-19 patients.
In 2020, the coronavirus disease 2019 (COVID-19) pandemic dramatically changed the world and way of living. Nevertheless, the 2020 European Society of Cardiology (ESC) annual Congress remained immune, from a scientific point of view, becoming an event like no other, with the most exciting ground-breaking scientific presentations covering the full spectrum of cardiovascular (CV) medicine. The spotlight theme of this virtual ESC Congress was ‘the cutting edge of cardiology’ and it gathered a record-breaking audience of 116,000 delegates from 211 countries .
Although daily life has been significantly affected by the pandemic, ‘cardiovascular diseases are still the number one killer worldwide and that as a community we continue to make great strides to improve the lives of our patients’ . The relevance of such a statement is of utmost importance now more than ever, since we failed to foresee the direct and indirect CV consequences of COVID-19 in our patients . Indeed, the fear of COVID-19 strikingly reduced hospital admissions due to both acute coronary syndrome (ACS) and heart failure (HF) up to 50% [3,4,5,6]. This in turn, has dramatic consequences for long-term ACS complications and is already associated with increased mortality for both ischemic heart disease and decompensated HF [4, 6]. Therefore, it is important that we prepare for the consequences of the pandemic and thoroughly consider the treatment of CV diseases in the new dimension provided by COVID-19 along while keeping the pace with CV research .
Despite being virtual, the Congress attracted a great deal of excellent science, with expected impact on the clinical practice for both cardiologists and non-cardiologists. The ESC Congress shed light on the results of breakthrough studies bringing innovation to the field of cardiology in addition to four new guidelines presented, i.e. those for the management of (1) atrial fibrillation (AF) , (2) acute coronary syndromes in patients presenting without persistent ST-segment elevation , (3) adult congenital heart diseases , and (4) on sports cardiology and exercise in patients with CV disease .
In this commentary, we summarized the most important trials presented during the 2020 Virtual ESC Congress (Table 1) which we predict will improve our everyday clinical practice [12,13,14,15,16,17,18,19,20,21,22,23,24]. The EMPEROR-Reduced (EMPagliflozin outcomE tRial in Patients With chrOnic heaRt Failure With Reduced Ejection Fraction) trial  further strengthened the positive findings observed in the DAPA-HF (Study to Evaluate the Effect of Dapagliflozin on the Incidence of Worsening Heart Failure or Cardiovascular Death in Patients With Chronic Heart Failure) trial . In this study, the anti-diabetic drug empagliflozin on top of optimized medical therapy reduced the composite primary endpoint of CV death and hospitalization in patients with HF and reduced ejection fraction (HFrEF), with the great majority of them presenting with a left ventricle ejection fraction (LVEF) of ≤ 30%. In addition, empagliflozin showed positive effects on reducing the progression of kidney disease . A meta-analysis of EMPEROR-Reduced and DAPA-HF trials confirmed these findings .
With regard to inflammation and CV disease, the LoDoCo2 (Low Dose Colchicine for secondary prevention of cardiovascular disease) trial showed that in patients with chronic coronary disease, low-dose colchicine (0.5 mg once daily) significantly reduced the risk of CV events compared with placebo . These results confirmed the previous observations from the open-label LoDoCo (Low Dose Colchicine) trial, that found a reduced risk of acute CV events among those patients with chronic coronary disease who received 0.5 mg of colchicine once daily than the placebo group . These beneficial effects were first observed in the COLCOT (Colchicine Cardiovascular Outcomes Trial), where patients with a recent acute myocardial infarction (within 30 days) who received colchicine 0.5 mg once daily experienced less frequently the composite endpoint of CV death, resuscitated cardiac arrest, myocardial infarction, stroke, or urgent hospitalization for angina leading to coronary revascularization compared with those who received placebo .
Interesting news came from the AF field, not only due to the publication of the updated guidelines , but also from the results of three major studies—the EAST-AFNET 4 (Early Treatment of Atrial Fibrillation for Stroke Prevention Trial), RATE-AF (Rate Control Therapy Evaluation in Permanent Atrial Fibrillation), and CASA-AF (Catheter Ablation Versus Thoracoscopic Surgical Ablation in Long Standing Persistent Atrial Fibrillation) . The EAST-AFNET 4 found that the early initiation of a rhythm control therapy was associated with a reduced risk of CV outcomes (death from CV causes, stroke, hospitalization for HF, or ACS) than usual care in those patients with early AF and other CV diseases across a 5-year follow-up period . The RATE-AF trial gave a new life to an old, sometimes neglected, drug like digoxin. Indeed, this study showed that digoxin was associated with symptom improvement and reduction in N-terminal-pro B-type natriuretic peptide compared with a β-blocker in patients with permanent AF . CASA-AF demonstrated that surgical ablation was not superior to catheter ablation in treating long-standing persistent AF, while catheter ablation allowed greater symptomatic relief, cost-effectiveness, and quality of life .
A relevant trial in these challenging times of COVID-19 was presented at the ESC Congress, the BRACE CORONA (Angiotensin Receptor Blockers and Angiotensin-converting Enzyme Inhibitors and Adverse Outcomes in Patients With COVID19) trial. This study tested the temporary suspension of renin–angiotensin–aldosterone system (RAAS) blockers for 30 days versus continuation of these drugs in those chronically taking RAAS blockers and hospitalized due to COVID-19 . The conclusion of the study was that among patients hospitalized with COVID-19 and receiving chronic a RAAS blocker, drug suspension was not beneficial and suspension versus continuation did not improve the days alive and out of the hospital .
Lastly, a game changing new molecule, mavacamten, a selective allosteric inhibitor of cardiac myosin ATPase, improved exercise capacity, left ventricular outflow tract obstruction, New York Heart Association (NYHA) functional class, and health status in patients with obstructive hypertrophic cardiomyopathy. The results of the EXPLORER-HCM trial might reshape, in the future, the landscape of hypertrophic cardiomyopathy, significantly reducing the number of patients with the obstructive form of the disease and, perhaps, ameliorating long-term outcomes and reducing the risk of sudden death in these patients .
During the 2020 Virtual ESC Congress, the Editorial Board of BMC Cardiovascular Disorders met. This virtual meeting was led by the Editor, Dr. Ciarán Martin Fitzpatrick, together with Sections Editors and most Associate Editors. The meeting provided the opportunity to discuss the positive changes at the Journal and the future steps to keep progressing. The improvement in the handling of manuscripts by Associate Editors greatly reduced turnaround times and attracted more submissions in the past months. As far as the metrics is concerned, BMC Cardiovascular Disorders steadily improved from previous years with an updated 2019 yearly downloads of 890,588 and impact factor of 2.078. The Journal has also updated its sections to comply with new relevant topics in CV medicine. The new sections are: Arrhythmias and Electrophysiology; CV Surgery; Coronary Artery Disease; Epidemiology and Digital Health; Hypertension and Vascular Biology; Primary Prevention and CV Risk, and Structural Diseases, Heart Failure, and Congenital Disorders. Presented during this meeting was Lesyuk et al.’s ‘Cost-of-illness studies in heart failure: a systematic review 2004–2016’ , which was the journal’s most cited article so far in 2020 with 37 citations.
Together with this exciting news, BMC Cardiovascular is pleased to offer its readers a wide range of submission initiatives, which are helpful in the progression of knowledge within the CV field. We must bear in mind that despite the world locking down momentarily, the continuous effort of healthcare professionals and researchers contributed to timely treatments and a better understanding of the COVID-19 disease and its direct and indirect impact on patients’ management, treatment, outcomes and, ultimately, our daily life.
Availability of data and materials
Angiotensin-converting enzyme inhibitor
Acute coronary syndrome.
Adjusted geometric mean ratio
Acute lung injury
Adjusted mean difference
Coronary artery disease
Coronavirus disease 2019
Chronic coronary disease
Coronary artery disease
Estimated glomerular filtration rate
Hospitalization for heart failure
Individualized medical therapy
Left ventricle ejection fraction
Major adverse cardiac event
New York Heart Association
- pVO2 :
Peak oxygen consumption
Red blood cell
Simplified Pulmonary Embolism Severity Index
Transcatheter aortic-valve implantation
Casadei B. Barbara Casadei opening at virtual ESC Annual Congress 2020. Eur Heart J. 2020;41(33):3122–3.
Driggin E, Madhavan MV, Bikdeli B, Chuich T, Laracy J, Biondi-Zoccai G, Brown TS, Der Nigoghossian C, Zidar DA, Haythe J, et al. Cardiovascular considerations for patients, health care workers, and health systems during the COVID-19 pandemic. J Am Coll Cardiol. 2020;75(18):2352–71.
De Filippo O, D’Ascenzo F, Angelini F, Bocchino PP, Conrotto F, Saglietto A, Secco GG, Campo G, Gallone G, Verardi R, et al. Reduced rate of hospital admissions for ACS during Covid-19 outbreak in Northern Italy. N Engl J Med. 2020;383(1):88–9.
De Rosa S, Spaccarotella C, Basso C, Calabro MP, Curcio A, Filardi PP, Mancone M, Mercuro G, Muscoli S, Nodari S, et al. Reduction of hospitalizations for myocardial infarction in Italy in the COVID-19 era. Eur Heart J. 2020;41(22):2083–8.
Garcia S, Albaghdadi MS, Meraj PM, Schmidt C, Garberich R, Jaffer FA, Dixon S, Rade JJ, Tannenbaum M, Chambers J, et al. Reduction in ST-segment elevation cardiac catheterization laboratory activations in the United States during COVID-19 pandemic. J Am Coll Cardiol. 2020;75(22):2871–2.
Cannata A, Bromage DI, Rind IA, Gregorio C, Bannister C, Albarjas M, Piper S, Shah AM, McDonagh TA. Temporal trends in decompensated heart failure and outcomes during COVID-19: a multisite report from heart failure referral centres in London. Eur J Heart Fail. 2020. https://doi.org/10.1002/ejhf.1986.
Dixon DL, Van Tassell BW, Vecchie A, Bonaventura A, Talasaz AH, Kakavand H, D’Ascenzo F, Perciaccante A, Castagno D, Ammirati E, et al. Cardiovascular considerations in treating patients with coronavirus disease 2019 (COVID-19). J Cardiovasc Pharmacol. 2020;75(5):359–67.
Hindricks G, Potpara T, Dagres N, Arbelo E, Bax JJ, Blomstrom-Lundqvist C, Boriani G, Castella M, Dan GA, Dilaveris PE, et al. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association of Cardio-Thoracic Surgery (EACTS). Eur Heart J. 2020. https://doi.org/10.1093/eurheartj/ehaa612/5899003.
Collet JP, Thiele H, Barbato E, Barthelemy O, Bauersachs J, Bhatt DL, Dendale P, Dorobantu M, Edvardsen T, Folliguet T, et al. 2020 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. Eur Heart J. 2020. https://doi.org/10.1093/eurheartj/ehaa612/5899003.
Baumgartner H, De Backer J, Babu-Narayan SV, Budts W, Chessa M, Diller GP, Lung B, Kluin J, Lang IM, Meijboom F, et al. 2020 ESC Guidelines for the management of adult congenital heart disease. Eur Heart J. 2020. https://doi.org/10.1093/eurheartj/ehaa554.
Pelliccia A, Sharma S, Gati S, Back M, Borjesson M, Caselli S, Collet JP, Corrado D, Drezner JA, Halle M, et al. 2020 ESC Guidelines on sports cardiology and exercise in patients with cardiovascular disease. Eur Heart J. 2020. https://doi.org/10.1093/eurheartj/ehaa605.
Rate Control Therapy Evaluation in Permanent Atrial Fibrillation—RATE-AF. Presented by Dr. Dipak Kotecha at the European Society of Cardiology Virtual Congress, August 29, 2020. https://www.acc.org/latest-in-cardiology/clinical-trials/2020/08/28/15/59/rate-af. Last accessed 23 Sept 2020.
First randomised trial backs safety of common heart drugs in COVID-19 patients BRACE CORONA trial presented in a Hot Line Session today at ESC Congress 2020. Presented by Dr. Renato D. Lopes at the European Society of Cardiology Virtual Congress, September 1, 2020. https://www.escardio.org/The-ESC/Press-Office/Press-releases/LOPES. Last accessed 21 Sept 2020.
PARALLAX meets one primary endpoint in heart failure with preserved ejection fraction. PARALLAX trial presented in a Hot Line Session today at ESC Congress 2020. Presented by Dr. Burkert Pieske at the European Society of Cardiology Virtual Congress, August 30th, 2020. https://www.escardio.org/The-ESC/Press-Office/Press-releases/PIESKE. Last accessed 23 Sept 2020.
Trial clarifies which patients with acute pulmonary embolism can be managed at home. HOME-PE trial presented in a Hot Line Session today at ESC Congress 2020. Presented by Dr. Pierre-Marie Roy at the European Society of Cardiology Virtual Congress, August 31st, 2020. https://www.escardio.org/The-ESC/Press-Office/Press-releases/Trial-clarifies-which-patients-with-acute-pulmonary-embolism-can-be-managed-at-home. Last accessed 23 Sept 2020.
Randomized Trial of Transfusion Strategies in Patients With Myocardial Infarction and Anemia—REALITY. Presented by Dr. Philippe Gabriel Steg at the European Society of Cardiology Virtual Congress, September 1, 2020. https://esc2020.escardio.org/detail/video/ref:S31204?_ga=2.117322051.413019163.1600901788-834326117.1596400834. Last accessed 23 Sept 2020.
Bouabdallaoui N, Tardif JC, Waters DD, Pinto FJ, Maggioni AP, Diaz R, Berry C, Koenig W, Lopez-Sendon J, Gamra H, et al. Time-to-treatment initiation of colchicine and cardiovascular outcomes after myocardial infarction in the Colchicine Cardiovascular Outcomes Trial (COLCOT). Eur Heart J. 2020. https://doi.org/10.1093/eurheartj/ehaa659.
Brouwer J, Nijenhuis VJ, Delewi R, Hermanides RS, Holvoet W, Dubois CLF, Frambach P, De Bruyne B, van Houwelingen GK, Van Der Heyden JAS, et al. Aspirin with or without clopidogrel after transcatheter aortic-valve implantation. N Engl J Med. 2020. https://doi.org/10.1056/nejmoa1915152.
Budoff MJ, Bhatt DL, Kinninger A, Lakshmanan S, Muhlestein JB, Le VT, May HT, Shaikh K, Shekar C, Roy SK, et al. Effect of icosapent ethyl on progression of coronary atherosclerosis in patients with elevated triglycerides on statin therapy: final results of the EVAPORATE trial. Eur Heart J. 2020. https://doi.org/10.1093/eurheartj/ehaa652.
Kirchhof P, Camm AJ, Goette A, Brandes A, Eckardt L, Elvan A, Fetsch T, van Gelder IC, Haase D, Haegeli LM, et al. Early rhythm-control therapy in patients with atrial fibrillation. N Engl J Med. 2020. https://doi.org/10.1056/NEJMoa2019422.
Nidorf SM, Fiolet ATL, Mosterd A, Eikelboom JW, Schut A, Opstal TSJ, The SHK, Xu XF, Ireland MA, Lenderink T, et al. Colchicine in patients with chronic coronary disease. N Engl J Med. 2020. https://doi.org/10.1056/NEJMoa2021372.
Olivotto I, Oreziak A, Barriales-Villa R, Abraham TP, Masri A, Garcia-Pavia P, Saberi S, Lakdawala NK, Wheeler MT, Owens A, et al. Mavacamten for treatment of symptomatic obstructive hypertrophic cardiomyopathy (EXPLORER-HCM): a randomised, double-blind, placebo-controlled, phase 3 trial. Lancet. 2020;396(10253):759–69.
Packer M, Anker SD, Butler J, Filippatos G, Pocock SJ, Carson P, Januzzi J, Verma S, Tsutsui H, Brueckmann M, et al. Cardiovascular and renal outcomes with empagliflozin in heart failure. N Engl J Med. 2020. https://doi.org/10.1056/NEJMoa2022190.
Tong DC, Quinn S, Nasis A, Hiew C, Roberts-Thomson P, Adams H, Sriamareswaran R, Htun NM, Wilson W, Stub D, et al. Colchicine in patients with acute coronary syndrome: the Australian COPS randomized clinical trial. Circulation. 2020. https://doi.org/10.1161/CIRCULATIONAHA.120.050771.
McMurray JJV, Solomon SD, Inzucchi SE, Kober L, Kosiborod MN, Martinez FA, Ponikowski P, Sabatine MS, Anand IS, Belohlavek J, et al. Dapagliflozin in patients with heart failure and reduced ejection fraction. N Engl J Med. 2019;381(21):1995–2008.
Zannad F, Ferreira JP, Pocock SJ, Anker SD, Butler J, Filippatos G, Brueckmann M, Ofstad AP, Pfarr E, Jamal W, et al. SGLT2 inhibitors in patients with heart failure with reduced ejection fraction: a meta-analysis of the EMPEROR-Reduced and DAPA-HF trials. Lancet. 2020. https://doi.org/10.1016/S0140-6736(20)31824-9.
Nidorf SM, Eikelboom JW, Budgeon CA, Thompson PL. Low-dose colchicine for secondary prevention of cardiovascular disease. J Am Coll Cardiol. 2013;61(4):404–10.
Tardif JC, Kouz S, Waters DD, Bertrand OF, Diaz R, Maggioni AP, Pinto FJ, Ibrahim R, Gamra H, Kiwan GS, et al. Efficacy and safety of low-dose colchicine after myocardial infarction. N Engl J Med. 2019;381(26):2497–505.
Haldar S, Khan HB, Boyalla V, Kralj-Hans I, Jones S, Lord J, Onyimadu O, Satishkumar A, Bahrami T, De Souza A, et al. Catheter ablation vs. thoracoscopic surgical ablation in long-standing persistent atrial fibrillation: CASA-AF randomized controlled trial. Eur Heart J. 2020. https://doi.org/10.1093/eurheartj/ehaa658 (Epub ahead of print).
Lesyuk W, Kriza C, Kolominsky-Rabas P. Cost-of-illness studies in heart failure: a systematic review 2004–2016. BMC Cardiovasc Disord. 2018;18(1):74.
The authors would like to thank the originals of ESC 2020—The Digital Experience—and all those who participated.
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Dr. Bonaventura and Dr. Vecchié received a travel grant from Kiniksa Pharmaceuticals Ltd. to attend the 2019 AHA Scientific Sessions. The other authors report no conflict of interests.
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Gallego-Colon, E., Bonaventura, A., Vecchié, A. et al. Cardiology on the cutting edge: updates from the European Society of Cardiology (ESC) Congress 2020. BMC Cardiovasc Disord 20, 448 (2020). https://doi.org/10.1186/s12872-020-01734-4
- ESC Congress
- ESC guidelines
- Heart failure
- Myocardial infarction
- Pulmonary embolism
- Atrial fibrillation