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The OCC-JCS Joint Symposium has been changed to on-demand streaming.
(As of Mar. 7)
Time Table(PDF)
March 10 am   March 10 pm
March 11 am   March 11 pm
March 12 am   March 12 pm
 Mikamo Lecture (Sponsored by Japan Heart Foundation)
March 11 (Sat.) 10:30 11:15    Room 1 Fukuoka Sunpalace 2F Main Hall
Reappraising the Role of Inflammation in Heart Failure
Chair Masatsugu Hori
    Osaka International Cancer Institute, Osaka
Speaker  Douglas L. Mann
    Washington University School of Medicine, Saint Louis, USA
 Mashimo Memorial Lecture
March 11 (Sat.) 14:00 14:45    Room 1 Fukuoka Sunpalace 2F Main Hall
Chair Kinya Otsu
    National Cerebral and Cardiovascular Center
Speaker  Yusuke Nakamura
    National Institutes of Biomedical Innovation, Health and Nutrition
 Congress Chairpersons's Lecture
March 11 (Sat.) 13:15 13:55    Room 1 Fukuoka Sunpalace 2F Main Hall
Chair Hitonobu Tomoike
    Sakakibara Heart Institute /NTT Basic Research Lαboratories
Speaker  Hiroyuki Tsutsui
    Department of Cardiovascular Medicine, Kyushu University
 Special Lecture
March 12 (Sun.) 11:15 12:00    Room 5 Fukuoka International Convention Center 3F Main Hall
Chair Keiko Yamauchi-Takihara
    Health and Counseling Center, Osaka University
Speaker  Robert Campbell
    Specially Appointed Professor, Waseda University
 President's Lecture
March 10 (Fri.) 13:30 14:00    Room 1 Fukuoka Sunpalace 2F Main Hall
Chair Issei Komuro
    Department of Cardiovascular Medicine, The University of Tokyo Graduate School of Medicine
Speaker  Ken-ichi Hirata
    President of the [Japanese] Circulation Society/ Division of Cardiovascular Medicine, Kobe University Graduate School of Medicine
 Plenary Session
Plenary Session 1
Future perspective of comprehensive CLTI management

In the revised Japanese Circulation Society (JCS) guidelines 2022, the disease concept of limb-threatening condition is newly updated from “critical limb ischemia (CLI)” to “chronic limb-threatening ischemia (CLTI)”. The former term, which is defined as ischemic rest pain with an ankle pressure (AP) <40 mm Hg, or tissue necrosis with an AP <60 mmHg, fails to encompass the full spectrum of patients who are evaluated and treated for limb-threatening ischemia in everyday practice. In fact, limb prognosis is not defined solely by ischemic severity. To solve this issue, the latter term is newly proposed and stratified by amputation risk according to wound extent, degree of ischemia, and presence and severity of foot infection (Wound, Ischemia, and foot Infection [WIfI]). The feature of CLTI is a broader and more heterogeneous group of patients with varying degrees of ischemia and infection that may delay wound healing and increase amputation risk. There is general agreement that revascularization is the first-line therapy but a multidisciplinary approach using medical therapy, wound care, cell therapy, and adjuvant therapy is more needed to treat this difficult disease optimally. In this plenary session, we would like to invite all experts in each treatment field to give presentations and discuss in depth the current status, limitations, and prospects of each treatment from the viewpoint of improving the long-term prognosis of CLTI.

Plenary Session 2
Recent Discoveries in Vascular Calcification

An ectopic calcification of blood vessel, as seen in advanced atherosclerosis, diabetes, renal failure or ageing, is associated with risks of cardiovascular and cerebral adverse events and also limits acute and chronic results of cardiovascular intervention. Discovering the mechanisms of vascular calcification is a remaining challenge in cardiovascular science and medicine. In this session, we invite researchers in this area and discuss recent discoveries in vascular calcification and therapeutic approaches.

Plenary Session 3
Cooperation with Oncologists and the Role of Cardiologists in Cancer Care

In Japan, cancer has been the leading cause of death for about 40 years, followed by cardiovascular disease in second place and stroke in fourth. However, among the elderly, the number of deaths from cardiovascular disease (cardiovascular disease and stroke) and cancer are almost the same. In this hyper-aged society, the number of patients with both cancer and cardiovascular diseases is rapidly increasing, and the number of patients with complications of both diseases is also increasing. However, it is known that treatment with anticancer drugs and radiation can cause all kinds of cardiovascular diseases, including hypertension, arrhythmia, myocardial infarction, and heart failure. In particular, many anticancer drugs damage the heart, and heart failure is increasingly occurring during and after cancer treatment. It has also been known for a long time that thromboembolism is common among cancer patients. Some anticancer drugs can damage blood vessels, and it has been pointed out that many cancer patients die from thromboembolism during treatment. Therefore, collaboration between oncologists and cardiologists has become important to ensure that cancer patients receive adequate cancer treatment and that they do not die from cardiovascular diseases after treatment. Until now, cancer and cardiovascular diseases were considered to be the most distant diseases, but oncology and cardiology are attracting attention worldwide as an interdisciplinary field encompassing these two major diseases. In this plenary session, we will discuss how oncologists and cardiologists should collaborate, and the current status and challenges of onco-cardiology.

Plenary Session 4
Frontiers in diagnosis and Treatment of Hereditary Arrhythmias

Hereditary arrhythmias are known as J-wave syndrome (Brugada syndrome and early repolarization syndrome), QT prolongation syndrome, catecholamine-induced polymorphic ventricular tachycardia, QT shortening syndrome, and progressive cardiac conduction defects. These diseases are a part of the major cause of sudden death in young people, but early detection and intervention of the diseases lead to prevent sudden death. Although advances in basic research, including genetic analysis, and numerous clinical studies have led to a better understanding of the causes, pathophysiology, diagnosis, risk stratification, and individualized management and treatment, there are still many aspects of the disease that remain to be elucidated. In this session, we will hear from experts on the front lines of research on pathogenesis, diagnosis, and treatment, and discuss the direction we should take in the future.

Plenary Session 5
Cardiac catheter-based interventions for stroke prevention

The AMPLATZER™ patent foramen ovale (PFO) Occluder and WATCHMAN™ left atrial appendage closure (LAAC) devices have been approved in Japan since 2019. The previous trials studied patients who had recent cryptogenic strokes and were found to have a PFO. Those study results showed that a PFO closure, with an antiplatelet regimen, is associated with a lower rate of recurrent strokes than taking antithrombotic medication alone. An LAAC with a WATCHMAN™ is a proven one-time procedure that reduces the risk of strokes in non-valvular atrial fibrillation (NVAF) patients and the risk of bleeding that comes with long term oral anticoagulant use. Furthermore, in a patient-level meta-analysis combining the 5-year outcomes, compared with warfarin, an LAAC provided equivalent rates of all-cause strokes, with a reduction in hemorrhagic strokes and disabling/fatal strokes. There were no significant differences in ischemic strokes, but an LAAC was associated with a significant reduction in both the cardiovascular and all-cause mortality. LAACs with the new-generation WATCHMAN FLX™, which provides a high rate of an effective closure with few early adverse events, and the number of patients with NVAF undergoing LAACs is increasing worldwide. However, there are still some concerns such as the optimal post procedure antithrombotic regimen and device related thrombi. We will hotly discuss who are the better candidates for PFO occlusions and LAACs based on the clinical data from Japanese patients, and we hope that this session will contribute to the formation of brain-heart teams for stroke prevention in the real-world clinical practice.

Plenary Session 6
Home monitoring, advanced heart failure, destination therapy, palliative care

In recent years, advance care planning and palliative care have become the new standard in heart failure care. The current theme in heart failure is how to reach the end of life while maintaining good quality of life (QOL). In this session, we aim to discuss home treatments for advanced heart failure from various angles. From the viewpoint of preventing rehospitalization, which greatly impacts the QOL in patients with heart failure, a combination of interventions utilizing a multidisciplinary team approach and the latest technology such as pulmonary arterial pressure monitoring with CardioMEMS is the highest quality care. However, its limitations have become apparent, and new modalities are in development. Destination therapy (DT) has become an option for patients diagnosed with stage D heart failure as a long-term home treatment. In scrutinizing the cost-effectiveness of patients who are repeatedly re-hospitalized and taking into consideration QOL, the target population of DT should be expanded in the near future. In addition, end-of-life care including withdrawal of treatment, has been partially discussed with the introduction of DT, but has not reached maturity in Japan. I would like to welcome Dr. JoAnn Lindenfeld, the principal investigator of the GUIDE-HF in the United States, and hope to have an active discussion with multi-professional colleagues within Japan and abroad.

Plenary Session 7
Diagnostic Imaging for Heart Failure

Heart failure is defined as “a clinical syndrome consisting of dyspnea, malaise, swelling and decreased exercise capacity due to the loss of compensation for cardiac pumping function due to structural and functional abnormalities of the heart.” Therefore, diagnostic imaging for the treatment of heart failure requires evaluation of heart structural and functional abnormalities, the presence of congestion and organ hypoperfusion, and impaired exercise tolerance. In addition, there is a wide range of objectives, from assessment of the severity to prognostic evaluation of the patient. Treatment modalities are also diversifying. In addition to conventional agents that inhibit the renin-angiotensin-aldosterone system and sympathetic nerve activity, new agents with various mechanisms of action have emerged, including agents that decrease pulse rate only, agents thought to stimulate the production of cGMP, and agents that inhibit SGLT2. Non-drug therapies have also been enhanced by targeting atrial fibrillation, mitral regurgitation, and pulmonary hypertension. Furthermore, Artificial intelligence has been incorporated to reveal phenomena that we could not understand. In this session, we would like to discuss how imaging tests can evaluate the pathophysiology of heart failure and its application to treatment based on the latest findings in response to this diversification of treatment modalities.

Plenary Session 8
Phenotypes of vascular aging and non-vascular aging: Their experimental and clinical findings

In experimental studies, several findings for the mechanisms of vascular aging have been reported, and treatments against vascular aging also have been demonstrated. On the other hand, in a clinical setting, as compared to chronological age, three phenotypes of vascular aging (i.e., early, age-appropriate, and opposite [i.e., healthy status]) may be existed. However, their naming, methods to assess them, and their definitions have not been established, and also the clinical implications of those assessments also have not been clear. Vascular aging is observed in all parts of arterial tree consisted with elastic artery, muscular artery and arterioles, and vascular aging leads structural (enlargement, wall hypertrophy, remodeling and/or vascular rarefaction) and functional (impaired vasodilatation and constriction) abnormalities. The severity of vascular damage in arterial tree are assessed by imaging and/or physiological/biochemical markers. For example, several epidemiological studies used carotid IMT as a marker of vascular aging. Furthermore, when arterial stiffness is applied as a marker of vascular aging, a recent study has demonstrated that those three phenotypes of vascular aging are associated with cardiovascular outcomes. Therefore, the prevention of vascular aging and continuation of healthy status in vasculature may be important for the prevention of poor cardiovascular outcomes. However, clinical findings for such prevention and continuation and experimental results to support such findings have been limited. In this session, based on experimental/clinical findings, following issues will be discussed; the methods to assess phenotypes of vascular aging, the mechanisms of such phenotypes (i.e., factors for vascular damage), the clinical implication of both assessments (i.e., organ damages and cardiovascular events), strategies to prevent vascular aging or continue healthy status in vasculature.

Plenary Session 9
Prediction of future cardiovascular events by imaging and physiology

Recent development of cardiovascular (CV) imaging and physiology may demonstrate pathophysiology of various CV diseases in detail in daily clinical practice. The assessment of the CV diseases using these advanced imaging and physiology allows us to decide the treatment strategies based on the pathophysiological findings of them and to optimize the interventional procedures under the guidance of their estimation in detail, and to predict future major adverse cardiovascular events (MACEs) based on the big data analyses or artificial intelligence. Furthermore, recent advancement of imaging-based physiological estimation has been demonstrated not only significant correlations between them and real physiological evaluation but also the decrease of MACEs and the improvement of prognosis by several randomized prospective studies. Thus, imaging-based physiology may develop much more in the future for reducing the medical cost and for making the procedures simple. In the present session, present status and future perspectives in the prediction of MACEs by imaging and physiology in detail.

Plenary Session 10
The Heart Team in Ischemic Heart Disease in the Post ISCHEMIA Trial Era

Following the ISCHEMIA trial (initial revascularization strategy for stable angina does not improve prognosis), the 2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization was published in the USA. This new guideline downgrades the indication for CABG for stable multivessel disease with good cardiac function by two levels from recommended class I to IIb, and immediately after its publication the European, US, Latin American and Japanese cardiac surgical societies announced that they would not support it. However, the impact of the ISCHEMIA trial results on the cardiology societies is significant, and the new guidelines may lead to a paradigm shift to 'start drug treatment for stable angina first and see how it goes, and if symptoms persist, consider catheterization and revascularization'. A key point of the ISCHEMIA trial design was that the choice of CABG/PCI should be decided by the heart team at each center, resulting in CABG being performed in only 26% of patients. Perhaps the real problem with the ISCHEMIA trial for cardiac surgeons was that the rate of CABG determined by the Heart Team did not demonstrate the effect of CABG in preventing myocardial infarction and all-cause mortality, and the Heart Team policy was found to affect treatment effectiveness. In this session, we would like to ask for an overview of the current status and future direction of the heart team after the ISCHEMIA trial from the respective perspectives (CABG specialist, PCI specialist and pharmacotherapy specialist).

Plenary Session 11
Personal Health Records for Patients with Heart Disease

Personal Health Records (PHRs) using smartphones have been attracting attention in recent years. In addition to the collection of data such as pulse rate and step counts using wearable devices, there is a growing array of applications that incorporate blood pressure and weight measurement results by connecting to these devices. In addition to collecting personal information, some medical institutions and regional medical network systems offer PHR services that link clinical data such as blood test results and prescriptions with personal life logs including vital data. With the evolution of smartphones, measurement devices, and applications, the Fast Healthcare Interoperability Resources (FHIR), a next-generation data exchange protocol, is being developed as an international foundation for data sharing, and major health cloud services are already supporting it. In Japan, an implementation guide for the Japanese version of FHIR has been published and is being prepared as a standard. As PHR utilization improves, there are high expectations for the benefits of using PHRs for the treatment of cardiovascular diseases, including heart failure, with the main focus on disease control in the daily lives of patients. At the same time, however, there are still some issues to be addressed, such as the utilization of accumulated data and the establishment of business models. In this plenary session, we would like to provide actual examples of PHR applications and the associated issues, and thereby deepen the discussion on future trends and prospects.

Plenary Session 12
Challenges in the care for an emerging adult population after Fontan procedure

Fontan procedure is performed in complex congenital heart disease with a functional single ventricle, in which the otherwise pumping ventricle (right heart) is bypassed to the pulmonary circulation (right heart bypass) to eliminate hypoxemia and reduce ventricular preload. More than 50 years have passed since the first report in 1971. Advances in the surgical approaches have improved the outcomes. Currently, the 30-year survival rate is approximately 85%, and it is estimated that there will be approximately 50,000-70,000 post-Fontan cases internationally as of 2018. The post-Fontan adult is an important issue in the adult cardiology clinic. The Fontan circulation is associated with chronic heart failure characterized by congestion due to elevated central venous pressure and the low output due to decreased preload and increased afterload of the systemic ventricle. Complications in the long-term postoperative period include impaired ventricular function, arrhythmias, protein-losing enteropathy, thrombosis, and hypoxemia due to systemic and pulmonary shunts. In adulthood, hyperkinetic heart failure due to decreased systemic vascular resistance, abnormal glycolipid metabolism, and Fontan-associated liver disease (FALD), including cirrhosis and hepatocellular carcinoma, are complicated. Several issues need to be addressed, including imaging evaluation for complications, medical therapy, Fontan conversion from early procedures to the recent total cavopulmonary connection using an extracardiac conduit, and pregnancy and childbirth in women after Fontan. In this session, we would discuss issues encountered in the real-world cardiology clinic for adults after Fontan surgery.

Plenary Session 13
New horizon in heart failure: clinical update on SGLT2 inhibitors and the basic mechanisms

SGLT2 inhibitors (SGLT2i) improve cardiovascular outcomes in patients with heart failure (HF) over a wide range of ejection fractions and have changed the landscape of HF treatment. SGLT2i are fundamental first-line therapy for HFrEF and have a class 2a recommendation in HFmrEF and HFpEF in the latest AHA HF guideline. Although mechanisms underlying their cardiovascular benefits remain unclear, several possible mechanisms have been proposed, including hemodynamic unloading, metabolic effects, and reduction in sympathetic nervous activity. In this session, we have a panel of experts to discuss the clinical evidence of SGLT2i and the basic mechanisms of cardiovascular benefits.

Plenary Session 14
Aortic Aneurysm and Aortic Dissection - From Bench to Bedside

The incidence of aortic dissection, as well as aortic aneurysm, has increased to more than 10 per 100,000 people per year in the recent registry, and the in-hospital mortality rate for these diseases remains extremely high. Despite remarkable advances in endovascular therapy based on the development of devices such as stent-grafts, there is still no treatment to control the progression of the disease. The aortic wall is a precise multilayered structure of diverse cell populations and extracellular matrices, which constantly regulates its structure and function to adapt to the changing biomechanical environment. Disruption of these regulatory mechanisms leads to abnormal signal transduction and transformation of smooth muscle, endothelium, and fibroblasts, destruction and remodeling of extracellular matrix including elastic fibers and collagen, and inflammation over a long period, ultimately leading to rapid outcomes such as rupture and dissociation. New findings have been reported, such as the association of disease with abnormalities in smooth muscle cell contractility due to changes in gene expression by epigenetic regulation and microRNAs, clonal expansion of smooth muscle cells, and proteoglycan metabolism. To understand how the diverse aortic components and extracellular matrices are spatiotemporally regulated in the presence of high levels of mechanical stress, and to elucidate the mechanisms of their disruption as a basis for the development of therapies to control disease progression, this session will focus on the latest research findings in aortic aneurysms and dissection.

Plenary Session 15
Molecular mechanisms underlying the development of HFpEF

Prevalence of Heart Failure with preserved Ejection Fraction (HFpEF) is increasing globally in association with the progression of aging societies. HFpEF is considered a specific entity, with different molecular adaptations and a different pathophysiological profile compared to HF with reduced EF (HFrEF). There is a lack of therapeutic options that show improvement in morbidity and mortality, although certain novel therapies have shown a decrease in heart failure hospitalizations. Understanding of molecular mechanisms underlying HFpEF will contribute to the development of novel therapeutic strategies. In this session, cutting edge on molecular mechanisms underlying HFpEF will be presented and discussed.

Plenary Session 16
New Evidence and Advanced Technology in Implantable Cardiac Electrical Device Therapy

Advances in cardiac electrical implantable devices (CIEDs) have, in part, exceeded our expectations. At the same time, however, it is extremely difficult to be skilled in the functions of these highly sophisticated devices. In addition, clinical evidence for the use of various devices is in abundance, and it is not easy to become familiar with them. Electrical therapy for the heart has moved beyond the classical indications for bradyarrhythmias to include the prevention of heart failure as well as improving the prognosis of patients with heart failure. In particular, the newly emerging stimulated conduction system pacing for cardiac synchronization has maximized the benefits of electrotherapy and has brought about a paradigm shift in the next generation. Pacing for tachycardia has also taken a new turn: ICDs now automatically measure the distance to the tachycardia circuit and terminate ventricular tachycardia at the optimal number of ATP. The utility of anti-tachycardia pacing for atrial arrhythmias has also been established. Remote monitoring enables early detection and transmission of both device and biometric information without the patient having to leave home, contributing to improved prognosis and reduced number of outpatient visits. In addition, CIEDs continue to develop in many other areas, such as leadless pacemakers with acquired atrioventricular synchronization and improved rate-response function. Researchers in Japan have not lagged behind, creating and disseminating a great deal of new evidence to the world. This program promises to be an excellent opportunity to provide our colleagues with the newest information on these topics. We look forward to seeing you there.

Plenary Session 17
Current status and future of regenerative medicine in cardiovascular disease

The basic research of regenerative medicine in the cardiovascular field in the world has made remarkable progress and has made a great contribution to the acceleration of clinical application. The differentiation-inducing system from ES / iPS cells to cardiomyocytes has been almost established, and selective differentiation into ventricular and atrioventricular muscles has become possible. In addition, techniques for maturing cardiomyocytes in vitro are gradually being developed, and are expected to be applied to drug discovery. Furthermore, disease model iPS cells have been created for various hereditary heart diseases, and have been used for elucidation of pathological conditions and analysis of drug discovery targets. In addition, research on large animal models with a view to clinical application 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 an eye on clinical application and research on the purification and purification method of cardiomyocytes have also produced great results. By introducing myocardial-specific genes into fibroblasts and the like, technological development has progressed regarding a direct reprogramming method for producing myocardial-like cells, and production efficiency has also improved. Clinical trials have already begun, and the results are expected. In this plenary session, we will focus on the development of basic technologies that will lead these myocardial regenerative medicine, and aim to see the future image of myocardial regenerative medicine in the near future.

Symposium 1
Wearable Devices for Blood Pressure in the Era of Society5.0

Hypertension is the most major risk factor for cardiovascular disease and the therapeutic target that could contribute most to preventing its onset. However, it is estimated that there are 43 million patients in Japan, and only 27% have achieved their antihypertensive target. It is no exaggeration to say that overcoming this situation is the proposition of the Society 5.0. Society 5.0 is a system that highly integrates cyberspace (virtual space) and physical space (real space) to achieve both economic development and the resolution of social issues, and is a new society following the hunting society (Society 1.0), the agricultural society (Society 2.0), the industrial society (Society 3.0) and the information society (Society 4.0). Healthcare is an important area in Society 5.0, and the focus of attention in hypertension, for which new measures are required, is blood pressure measurement using wearable devices. The development of non-contact as well as contact-type wearable devices is progressing, and the analysis of the big data of blood pressure linked to daily life using artificial intelligence is expected to lead to individually optimised treatment for hypertension, including the development of hypertension indexes and advance predictions, which were previously unthinkable. Furthermore, if hypertension treatment apps and personal health records are developed, it can be expected to 'create towns that do not suffer from hypertension'. In this symposium, we would like to discuss the vision, mission and value of hypertension treatment in the society 5.0 era, including wearable devices of blood pressure or hypertension treatment apps.

Symposium 2
Transformation of Field of Circulation by Artificial Intelligence

After three artificial intelligence (AI) booms, the fourth AI boom is approaching. With the advent of deep learning, AI is expected to advance in medicine/healthcare significantly. AI is currently being applied in automatic image interpretation, prognosis prediction, and treatment selection, etc; however, the potential of AI reaches beyond these applications. Owing to advances in medical care and its specialized areas, the knowledge required by doctors has increased significantly. Although obtaining deeper knowledge is possible, it should be difficult to keep holistic medical care. AI has the power to reintegrate this knowledge and help doctors in curing "disease" and healing "humans". However, AI should not be considered solely based on its current medical application as increased activity is expected in the context of digital transformation. As the control of information has shifted to patients through a strong connection smartphones, patients are being increasingly committed to decision ?making medical care. Thus, patients can be major users of medical AI. On the other hands, many issues remain in this context. First, the shift in social ethics cannot match the rate of AI development. Further, AI will be refined further by utilization and learning, but simultaneously, it needs to remain focused on the foundation of academia. Continued competitive advancement of AI, whose theory tends to be a black box, may result in inefficiency and unscientific outcomes. In this session, we would like to encourage discussions on the changes in the circulation field that AI is currently advancing as well as the changes to be aimed for.

Symposium 3
For future medical device

To realize extension of healthy life expectancy, there is a great need for research and development of medical devices, including advanced and highly accurate diagnosis, minimally invasive devices and treatment technologies that contribute to improving the quality of life, and novel devices that bring unprecedented new value. Moreover, research and development of devices related to Digital Therapeutics and SaMD (Software as Medical Device) for diagnostic assistance is becoming more active.
In this session, we would like to invite abstracts on research and development, and efforts to realize future medical devices, and discuss issues to accelerate the development of future medical devices and to expedite those clinical applications.

Symposium 4
Challenges for building a better medical service system

There is no doubt about improvements of life prognosis by emergent revascularization (i.e. primary percutaneous coronary intervention) as an initial treatment of acute myocardial infarction (AMI). However, actual in-hospital mortality has not been improved for the past several years, which requires additional measures for regional disparities of rates of emergent revascularization, out-of-hospital triage, and medical service systems during recovery as well as chronic periods in order to further reduce the mortality. Moreover, “The Basic Act on extension of healthy life expectancy for strokes and cardiac diseases (No. 105, Dec. 14th, Heisei 30)”, established in last year, requires discussion of actions on prevention, diagnosis, treatment, and rehabilitation for reduction of mortality of cardiovascular diseases with adequate temporal perspectives. Furthermore, it has been reported that Covid-19 pandemic significantly affects the mortality of patients with ischemic heart disease, which highlights the need of any effects of historical background such as a coronavirus crisis on AMI treatment. In this session, re-evaluating current status of AMI with real-world data, we would like to discuss on the issues of any potential challenges for reduction of mortality of AMI considering entire time courses including at prevention, acute, recovery, and chronic phases.

Symposium 5
Facing the challenge of multimorbidity and polypharmacy in the management of older patients

Current clinical practice mainly target single disease-specific care that does not embrace the complexities imposed by concurrent conditions、i.e., multimorbidity. The use of multiple medications often leads to inappropriate drug use, under-prescription, low adherence and side effects. This symposium will focus on challenges of polypharmacy in cardiovascular medicine and discuss research priorities to optimize care of complex older patients such as dementia.

Symposium 6
Insurance medical care issues and countermeasures in the cardiovascular field: "CCU addition" and "cost effectiveness"

The Insurance Medical 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. At present, with the slogan of introducing and strengthening medical technology that is useful to the public, cardiologists 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". According to this strategy, we have requested the MHLW to add points to the medical treatment fee for "specific medical treatment" and "explanation and consent" in the treatment of severe heart diseases. It has also promoted "medical cooperation" and "home medical care", establishes "remote medical care" to support regional medical care, and has demanded the establishment of new medical fees. Furthermore, we have requested new establishment of medical care fee that accompanies construction of medical care system aiming at promotion of “team medical care” and reduction of “medical doctor burden”. Under such circumstances, it is an indispensable issue to obtain addition of coronary care unit (CCU) as a medical treatment fee in cardiovascular medical treatment, and we should consider cost-effective, since cardiovascular treatment tends to require high medical expenses. In this symposium, we plan to discuss countermeasures focusing on “CCU addition” as medical fee and “cost-effectiveness” in insurance medical care in the cardiovascular field in the coming era of technical evaluation.

Symposium 7
Current status of tricuspid regurgitation and new treatment strategies

Tricuspid regurgitation (TR) has not received much attention for a long time, but recently it has become recognized that TR is a disease with a poor prognosis and requires more aggressive intervention. It is also said that TR is increasing as the number of elderly people increases. On the other hand, their current status and evidence are scarce, and the severity of TR, evaluation of right ventricular function, mechanism of TR, and actual condition of TR due to chronic atrial fibrillation are not fully clarified. With regard to invasive interventions, the balance between necessity and safety is not well understood, and it is often unclear when and how to do so. In the past, conservative treatment centered on diuretics according to symptoms was performed for a long period of time, and surgery was considered when medical treatment became difficult, but multiple organ failure such as liver failure has already progressed. In such cases, the results of tricuspid valve surgery have been poor. In the 2020 edition of the guidelines for valvular heart disease treatment, surgical treatment is recommended at an earlier timing than after "right heart failure that is difficult to treat medically". In addition, new repair procedures have been developed and the treatment strategy is being reviewed for the terminal stage of TR. In this session, we will have a hot discussion about the latest diagnosis and treatment strategy of TR, including the current state and diagnosis of TR, surgical treatment, and catheter treatment.

Symposium 8
Treatment of Atrial Fibrillation in the Elderly: Focusing on non-pharmacologic Therapy

Atrial fibrillation is a major cause of heart failure and cardiogenic cerebral embolism. In Japan, the number of patients with atrial fibrillation is increasing rapidly with the increase in the elderly population. Catheter ablation is widely performed to restore a sinus rhythm, and surgical procedures (Maze procedure, pulmonary vein isolation, etc.) are performed for the same purpose. Patients with persistent atrial fibrillation who are at high risk of cerebral embolism are treated with implantation of a left atrial appendage closure device or minimally invasive ligation/amputation of left atrial appendage. Patients with heart failure or bradycardia are sometimes treated with implanted devices such as biventricular pacing or pacemakers. The number of elderly patients with atrial fibrillation who receive the above non-pharmacologic therapies is increasing steadily. Unlike younger atrial fibrillation patients, elderly atrial fibrillation patients often have sarcopenia/frailty or comorbidities. There is no consensus as to which elderly patients should be treated with non-pharmacological therapy and to what extent, and which elderly patients should be considered off-label. In this symposium, we would like to discuss the current status, indications, and problems of non-pharmacological treatment in the elderly.

Symposium 9
The future standard therapy for HFpEF patients

Heart failure with preserved ejection fraction (HFpEF) is characterized by a high incidence of non-cardiac comorbidities such as hypertension, diabetes mellitus and atrial fibrillation. As frailty was common and was associated with aging in HFpEF patients, the proportional contribution of non-cardiac events to death or hospitalization is higher in HFpEF than in heart failure with reduced ejection fraction (HFrEF). Since the recent trial showed that SGLT2 inhibitors significantly reduced composite of HF hospitalization and cardiovascular (CV) death in HFpEF patients, they have emerged as an effective therapy for HFpEF. On the other hands, nutritional intervention and exercise training have essential roles in the management of HFpEF to improve patient outcomes and quality of their lives. Meanwhile, as HFpEF is a heterogeneous syndrome, phenotype-based therapeutic strategies can provide new insight into the future standardization of HFpEF treatment. In this session, we would like to invite you to discuss the future standard therapy for HFpEF patients from multiple points of view.

Symposium 10
Progress in Diagnosis and Treatment of CTEPH

Pulmonary endarterectomy (PEA), balloon pulmonary angioplasty (BPA), and pulmonary vasodilators have been approved and established for the treatment of chronic thromboembolic pulmonary hypertension (CTEPH). The relatively high operative mortality rate and postoperative residual pulmonary hypertension remain to be addressed. The efficacy of BPA and pulmonary vasodilators for the treatment of postoperative pulmonary hypertension has been recently established and is expected to improve long-term survival. However, the data on the bridging therapy such as pretreatments of pulmonary vasodilators or BPA in operable high-risk patients are lacking. Although BPA has shown to almost normalize pulmonary artery pressure and the improve long-term prognosis in inoperable cases, some of those patients have shown shortness of breath and decreased cardiac output. In addition, some cases have not been treated with early therapeutic intervention due to delays in VQ scans and other modalities. In this session, we will discuss imaging modalities for early diagnosis and the latest treatment strategies, and explore the future direction of CTEPH treatment.

Symposium 11
Utilization of newly developed technologies of non-invasive diagnostic cardiac imaging in early diagnosis of drug-treatable cardiomyopathies

In recent years, therapeutic agents for Fabry disease and amyloidosis have been used clinically. These therapeutic agents are known to be more effective when the agents are used at the initial stages where myocardial fibrosis does not progress. Also, in cardiac sarcoidosis steroid treatment is more effective if it can be treated with steroid before myocardial fibrosis does not progress. However, they are often diagnosed first at advanced stages such as Stages C or D of heart failure. Even if senile amyloidosis was diagnosed first at age of 90 it may be difficult to start a therapeutic drug. Delay of treatment due to lack of early diagnosis may contribute to the increase in patients with heart failure, and early diagnosis and early intervention of the treatable cardiomyopathies could be more important. However, early diagnosis of these cardiomyopathies is not easy in the real world. Myocardial biopsy is promising but invasive and might be hesitated in the patients with the early stage of heart failure. There could be produced a sampling error due to a small sample of myocardial tissue. Echocardiography, cardiac MRI, and nuclear cardiology imaging which are minimally invasive, could be effective for early diagnosis of treatable cardiomyopathies. Of course, medical history, medical examination, electrocardiogram, and chest X-ray photograph are basically used for diagnosis, but it could be effective to utilize the newly developed diagnostic cardiac imaging technologies in addition to the series of information. In this symposium, we would like to introduce these diagnostic cardiac imaging technologies and discuss the utilization. We are looking forward to seeing you.

Symposium 12
Diagnosis and Treatment of Arrhythmias Associated with Cardiomyopathy

Cardiomyopathy is defined as “myaocardial diseases with cardiac dysfunction”, and the JCS/JHFS 2018 Guideline on the Diagnosis and Treatment of Cardiomyopathies classify it into four categories: hypertrophic cardiomyopathy (HCM), dilated cardiomyopathy (DCM), restrictive cardiomyopathy (RCM), and arrhythmogenic right ventricular cardiomyopathy (ARVC). All cardiomyopathies can cause ventricular tachyarrhythmias (ventricular tachycardia (VT)/ventricular fibrillation (VF), leading to sudden cardiac death (SCD). Personalized treatment is important to prevent SCD. For example, laminopathy caused by lamin A/C gene mutation has a poor prognosis, and early ICD or CRT-D thrapy is recommended. SCD due to VT/VF is common in cardiac sarcoidosis, and Class I ICD is indicated in the guidelines. On the other side, SCD in cardiac amyloidosis is often caused by pulseless electrical activity (PEA) and is not currently indicated for Class I ICD. However, early diagnosis and appropriate medical therapy with tafamidis or patisiran may expand the indications for ICD in the future. Associations of supraventricular tachyarrhythmias are also a serious clinical problem. Atrial fibrillation (AF) associated with HCM patients frequently provokes heart failure (HF) and thromboembolism. CASTLE-AF study suggested that catheter ablation for AF may reduce a composite end point of all-cause mortality and hospitalization for worsening HF more than medical therapy in patients with AF complicated by HFrEF (the most common etiology of DCM). ARVC has recently been reported to be associated with tachyarrhythmia in the concept of arrhythmogenic cardiomyopathy (ACM) and also in Fabry's disease as other secondary cardiomyopathies. In this symposium, we would like to discuss how to diagnose and treat (pharmacologically/non-pharmacologically) the supraventricular/ventricular arrhythmias based on the latest diagnostic and therapeutic advances in each myocardial disease.

Symposium 13
Big Data Utilization in Cardiovascular Medicine ~present and future

Overcoming heart disease is an important issue worldwide, and especially in these aging society, the importance of multi-faceted, multilayered personalized medicine for prevention and disease intervention is recognized. It is hoped that the realization of medical care utilizing a wide variety of big data, including many large-scale clinical trials, epidemiological studies, registry research, clinical data, genetic databases, wearable devices, imaging technologies, and social networks, will open the way for unprecedented new perspectives in modern medical care, including heart disease, and lead to personalized medicine that has never been realized before. On the other hand, the realization of medical care using big data requires solving ethical and methodological issues. The purpose of this symposium is to deepen discussions on the current status, vision, and future prospects of medical care using big data.

Symposium 14
Skeletal muscle abnormalities and cardiac rehabilitation in heart failure

Exercise capacity is reduced in patients with heart failure and is closely associated with poor prognosis. Skeletal muscle function plays an important role along with cardiac function and lung function as factors that determine exercise tolerance. The results of past clinical studies have revealed that patients with heart failure exhibit various skeletal muscle abnormalities. In recent years, the number of elderly patients with heart failure is increasing, and the number of cases with sarcopenia and frail is increasing, and skeletal muscle abnormalities are attracting more and more attention. On the other hand, the mechanism of skeletal muscle abnormalities in such heart failure remains unclear, and there is no treatment method targeting skeletal muscle other than exercise therapy. Until now, skeletal muscle has been regarded as a locomotor organ, but recent research has come to consider it as an endocrine organ that secretes various hormones (myokines). In this symposium, we would like to discuss the latest research on elucidation of the mechanism of skeletal muscle abnormalities in heart failure and treatment methods including exercise therapy targeting them from a wide range of perspectives regardless of clinical or basic.

Symposium 15
Biology of Cell Death in Heart Failure

Various phenomena are involved in the pathogenesis of heart failure. Among them, the involvement of cell death and its forms have long been debated. Cell death had been classified into Type I apoptosis, Type II autophagic cell death, and Type III necrosis, and when the molecular mechanism of apoptosis was at its peak. Based on functional aspects, apoptosis has been classified into accidental cell death (ACD) and regulated cell death (RCD), and a variety of RCDs have been identified. In addition to pyroptosis and ferroptosis, a part of necrosis, which has been considered as unregulated cell death, was included in RCDs as necroptosis. As the role of cell death in various diseases has been demonstrated in this context, its involvement in cardiovascular disease and heart failure has been reported. In this symposium, we would like to deepen the discussion on the latest findings on the relationship between various RCDs and heart failure that have been revealed in recent years. Translated with www.DeepL.com/Translator (free version)

Symposium 16
Advances in mitophagy research: Toward maintaining mitochondrial function and overcoming cardiovascular disease

Mitochondria are organelles which regulate not only energy production but also highly organized functions such as detection, processing, and transmission of intracellular signals. Mitochondria extremely exhibit morphological dynamics such as fission and fusion according to the intracellular environment, and maintain high-level of functions. Mitophagy is one form of mitochondrial dynamics and selectively removes damaged mitochondria via autophagy machinery. Recent intensive research has demonstrated the interaction between impaired mitophagy and cardiovascular diseases. Furthermore, leading-edge analysis shed the light on the detailed mechanism of mitophagy and its involvement in the pathogenesis of broad range of diseases. We can imagine the day when modulating mitophagy can be applied for the prevention and treatment of age-related systemic diseases including heart failure, neurological diseases, and cancer. We hope that this symposium will provide a chance for presentations and discussions aimed at elucidating and overcoming the pathophysiology of cardiovascular disease through the latest progress of mitophagy research.

Symposium 17
What is an ideal destination therapy in Japan?

Destination therapy (DT) was approved for health insurance coverage in May 2021 and was expected to rapidly expand as in United States by opening up a chance for a patient aged over 65 years with advanced heart failure to receive an implantation of continuous-flow ventricular assist device. Although there may be some unfavorable conditions such as a reduced chance to screen an appropriate patient in the COVID-19 pandemic era and a limited number of implanting centers (7), the number of cf-VAD implantation is much lower than expected. In the J-MACS statistical report in March 2022, an average age of the DT patients was 53.4 years, which was higher than that of BTT patients (43.6 years), but cf-VAD was implanted mainly in patients of a younger age and not in those over 70 years. J-MACS profile 2 or 3 was the majority as the pre-implant severity condition, that was similar to the BTT patients. Then, what is an ideal destination therapy in Japan? How will we go for an ideal DT? Any proposals, positive opinions or constructive perspectives are welcomed from non-DT centers as well as active DT centers.

Symposium 18
Obesity, ectopic fat and cardiovascular disease: pathophysiology and treatment strategies from the cardiometabolic linkage

Overweight and obese individuals are more likely to be associated with cardiovascular risks such as dyslipidemia, glucose intolerance, and hypertension. Among these, visceral obesity is associated with a higher risk of cardiovascular disease than subcutaneous obesity, and is prone to cause cardiovascular disease. Recently, ectopic fat, the accumulation of fat in organs other than adipose tissue, has been featured as a mechanism/pathology for the development of cardiovascular disease associated with obesity. Ectopic fat found around cardiovascular systems is referred to as "cardiac and perivascular fat. Quantitative and qualitative changes in "cardiac and perivascular fat" are associated with the onset, severity, and response to treatment of various cardiovascular diseases, namely atherosclerotic cardiovascular disease, heart failure, and atrial fibrillation. In this symposium, we would like to invite opinion leaders who have provided noteworthy findings on obesity, ectopic fat, and cardiovascular disease to learn and discuss about the cross-talk between "cardiac fat and perivascular fat" and the cardiometabolic linkage.

Symposium 19
Roles of mechanical circulatory devices in cardiac intensive care

Intra-aortic balloon pumping (IABP) has been used for acute heart failure including cardiogenic shock since 1980, and extracorporeal ventricular assist devices (VAD) for severe heart failure have been advanced dramatically since 1990. Furthermore, since 2017, percutaneous mechanical circulatory support (IMPELLA) has become available in Japan, enabling new circulation assistance for cardiogenic shock. So-called ECPELLA, which is used in combination with V-A ECMO, has also been performed, and the importance of an approach under consideration of cardiac loading has been recognized again from the viewpoint of hemodynamics. At present, new devices for implantable VAD have become available, and implantation of VAD as a destination therapy for the patients who are not eligible for transplantation has started. On the other hand, with the new development of pharmacological therapies for heart failure,

Symposium 20
Outcomes of Transcatheter Aortic Valve Implantation for Hemodialysis patients in Japan

Various phenomena are involved in the pathogenesis of heart failure. Among them, the involvement of cell death and its forms have long been debated. Cell death had been classified into Type I apoptosis, Type II autophagic cell death, and Type III necrosis, and when the molecular mechanism of apoptosis was at its peak. Based on functional aspects, apoptosis has been classified into accidental cell death (ACD) and regulated cell death (RCD), and a variety of RCDs have been identified. In addition to pyroptosis and ferroptosis, a part of necrosis, which has been considered as unregulated cell death, was included in RCDs as necroptosis. As the role of cell death in various diseases has been demonstrated in this context, its involvement in cardiovascular disease and heart failure has been reported. In this symposium, we would like to deepen the discussion on the latest findings on the relationship between various RCDs and heart failure that have been revealed in recent years. Translated with www.DeepL.com/Translator (free version)

Symposium 21
What is the ideal management of CCS patients in diagnosis and treatment?

The importance of optimal medical therapy for CCS patients has been emphasized these days. Depending on the results of ISCHEMIA trial, we hear many people discuss that initial invasive strategy is not necessary and indication of PCI/CABG should be limited. These discussions are only for CCS patients but are not for ACS patients. However, CCS is the interval until the patients suffer ACS in the future and nobody knows when the patients suffer ACS. “JCS 2022 Guideline Focused Update on Diagnosis and Treatment in Patients With Stable Coronary Artery Disease” indicates that it is challenging to detect near ACS timely and change the treatment strategy from conservative to invasive. Indeed, ISCHEMIA trial demonstrated that the incidence of spontaneous acute MI is significantly lower in the initial invasive group than in the initial conservative group, suggesting the failure of timely conversion of the strategy from conservative to invasive. Once the patients suffer acute MI, the incidence of death, especially out-of-hospital death, is very high. Furthermore, MI is a cause of heart failure in those who survived. Therefore, the prevention of MI is one of important goals in CCS management. From these viewpoints, we would like to discuss the ideal management strategy of CCS patients in this session.

Symposium 22
Evaluation of right ventricular function using multi-modality imaging

In predicting the prognosis of cardiac disease, evaluating the function of the right and left ventricles is important. For the management of right ventricular failure, the pathophysiology of cardiac disease needs to be understood, and the pulmonary circulation and right ventricular function need to be evaluated. Reproducibility of tests is required to observe the changes in severity over time. To date, the treatment of tricuspid valve regurgitation has not been considered important and it has been referred to as the “forgotten valve”. In Japan, invasive and non-invasive therapy, including percutaneous catheter treatment for the tricuspid valve, has been performed. A comprehensive evaluation including right ventricular contraction and dilatation, tricuspid valve function, and pulmonary hypertension is required to determine treatment indications. The speckle tracking method and three-dimensional cardiac echo evaluation are useful, but the complicated three-dimensional structure of the right ventricle makes evaluation difficult. However, cardiac magnetic resonance imaging has high reproducibility in measuring the volume of the right ventricle and ejection fraction. Therefore, multi-modality evaluation including computed tomography, radioisotope imaging and magnetic resonance imaging is necessary in the future. At this symposium, we would like to reaffirm the current status of right ventricular evaluation by multi-modality imaging, and discuss what should be performed in the future.

Symposium 23
Managements and medical treatments in cardiac problems in pregnancy

Managements and treatments of cardiac problems in pregnancy are challenging for cardiologists, because this is a novel subspecialty and domestic educational programs remain unestablished. Therefore, lectures and discussions in this conference are very informative and useful. We will have a very interactive symposium with adult cardiologists, pediatric cardiologists, and obstetricians.

Symposium 24
How to save patients from aortic emergency?
: Latest knowledge and multidisciplinary medical care system

Suddenly occurred "Aortic Emergency" consisting of acute aortic dissection and rupture of aortic aneurysm is such a vexing disease category with extremely high mortality rates as to be discussed in the 5-year plan for overcoming Stroke and Cardiovascular Disease under the Basic Act on Cardiovascular Disease Control. The establishment of a medical care system for lifesaving is proposed, and the system including the administration is being created in various places of this country. With rapid diagnosis, appropriate treatment, introduction of new treatment methods and new devices, technical progress, and accumulation of experience, the mortality rate has been halved in the last 20 years, and the entire treatment results have recently been improved significantly. However, there are quite a few cases of death before the hospital or collapsing immediately after admission due to bleeding, shock and cardiac arrest associated with cardiac tamponade, malperfusion of the brain and coronary arteries, and so on. There is still room for improvement in the hyper-acute phase response such as patient transport before containment and initial response after arrival of the ambulance crew. Therefore, for solving the issue of "how to save the patient's life from such troublesome aortic emergency, the multidisciplinary and seamless flow of medical care by highly specialized "Aorta Team" is important to provide appropriate treatment without delay through prompt and accurate transportation and diagnosis. In addition, emergency medical care including transportation of patients is an issue to be examined from the viewpoint of the government, and a multidisciplinary approach by the government, the medical associations, and the collaboration of each society of cardiology, cardiovascular surgery, critical care, intensive care, anesthesiology, and radiology is important. In the symposium, we would discuss the multidisciplinary medical care system to save patients from aortic emergency and its establishment.

Congress Secretariat
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©The 87th Annual Scientific Meeting of the Japanese Circulation Society