Kommentar zu den neuen Leitlinien (2011) der Europ?ischen Gesellschaft für Kardiologie zum Management von Herz-Kreislauf-Erkrankungen in der Schwangerschaft

The new European Society for Cardiology (ESC) guidelines give as first international guidelines grades of recommendations for the assessment of cardiovascular diseases during pregnancy (http://www.escardio.org). Background information on essential topics, such as congenital, valvular, coronary and hypertensive heart diseases, aortic diseases, cardiomyopathy, arrhythmia and thromboembolism are extensively described. The maternal risk, the risk for the offspring, management, delivery and possible interventions are systematically presented. The expert consensus is based on the interdisciplinary competence of the authors including representatives of medical societies of gynecology and cardiovascular surgery. The guidelines support the establishment of highly specialized centres in Germany for treatment of pregnant women with congenital or acquired heart diseases by an interdisciplinary team. On the basis of the complex and diverse problems associated with heart diseases during pregnancy and the increasing number of young women with congenital heart diseases reaching adulthood, these guidelines are of particular importance. The pocket version of the guidelines is also available in the German language (http://leitlinien.dgk.org).     

Kommentar zu den neuen Leitlinien (2010) der Europäischen Gesellschaft für Kardiologie (ESC) zum Management von Erwachsenen mit angeborenen Herzfehlern (EMAH)

The new Guidelines of the European Society of Cardiology for the Management of Grown-up Congenital Heart (GUCH) Disease, published in 2010, have been endorsed by the German Cardiac Society and the pocket version has been translated. The present comments outline the concept of the new document, specific German aspects are highlighted and the most important differences compared to the previous version published in 2003 and to the guidelines published by the German-speaking societies are summarized. Finally, the document is compared to the recent guidelines of the American Heart Association and the American College of Cardiology. The new ESC guidelines should be the new standard for Germany together with the German recommendations for the organization of care for GUCH and the accreditation in the subspecialty GUCH. Compared to previous documents the guidelines provide more comprehensive information with more precise recommendations that should help to improve the quality of care.     

Kommentar: Fokus Update der Leitlinien der Europäischen Gesellschaft für Kardiologie (ESC) zum Management des Vorhofflimmerns

The updated 2012 guidelines of the European Society of Cardiology for the management of atrial fibrillation focus on the novelties and new innovations since the last edition in 2010. The evaluation of patients with atrial fibrillation concerning the thromboembolic stroke risk by using the CHA₂DS₂-VASc score instead of the CHADS₂ score is discussed extensively. As almost all patients with atrial fibrillation benefit from anticoagulation the guidelines focus on the identification of low-risk patients who should not receive oral anticoagulants. Stroke prevention with acetylsalicylic acid is not recommended. The results and advantages of the new direct oral anticoagulants are extensively discussed and their use is recommended as a preferred option in contrast to the vitamin K antagonists. The implantation of a left atrial appendage closure device as prophylaxis for cardiac thromboembolism is mentioned for the first time and recommended as an alternative for patients with contraindications for anticoagulants and a high risk for bleeding. In addition to stroke prevention by anticoagulants the results using vernakalant and recommendations for pharmacological cardioversion are discussed as an alternative to electrical cardioversion. In the recommendations for pharmacological long-term antiarrhythmic therapy dronedarone is discussed and positioned as an alternative to class IC antiarrhythmics and amiodarone. Catheter ablation of atrial fibrillation targeting pulmonary vein electrical isolation is recommended for patients with paroxysmal atrial fibrillation and a low risk for procedure-related complications as first line therapy, given that the institutional conditions are met and the procedure is performed by an experienced electrophysiologist.     

Kommentar zu den neuen Leitlinien (2012) der Europäischen Gesellschaft für Kardiologie zur kardiovaskulären Prävention

The new European guidelines on cardiovascular disease (CV) prevention are supported by nine medical societies. They have been restructured, are shorter and more readable. Each subchapter starts with key messages and recommendations are labelled with an evidence level. The subchapter ends with the most important newest information and persisting gaps of evidence for further research. The most important change is the categorization of cardiovascular risk in four levels: low (<1%), medium (1%-<5%), high (5%-<10%) and very high risk (>10%). All patients with CV disease are in the very high risk group with, e.g. a low-density lipoprotein (LDL) cholesterol goal of <70 mg/dl (<1.8 mmol/l). Treatment adherence and behavioral changes can best be achieved by motivational interviews which require some time. The physician has the responsibility for clear recommendations in the discharge summary after hospitalization and for offering help and feedback in the implementation phase of behavioral change.     

Kommentar zu den Leitlinien der Europäischen Gesellschaft für Kardiologie (ESC) zur Diagnostik und Behandlung der akuten und chronischen Herzinsuffizienz

It is a goal of this commentary to address 1) most important aspects of the new guidelines, 2) to discuss controversial recommendations and 3) to focus on relevant aspects which are only addressed in the long version of the guidelines, but not in the pocket guidelines. Important new topics are the administration of mineralocorticoid receptor antagonists (aldosterone antagonists) and the indication for cardiac resynchronization therapy (CRT) already in patients with mild heart failure symptoms, the application of the sinus node inhibitor ivabradine, the substitution of iron to improve symptoms in heart failure and recommendation of a structured training program in patients with heart failure. In addition, revascularization strategies in heart failure will be discussed as well as interventional approaches for aortic stenosis and mitral regurgitation and finally early implantation of cardiac assist devices in patients with terminal heart failure.     

Kommentar zu den Leitlinien der Europ?ischen Gesellschaft für Kardiologie (ESC) zur Diagnostik und Therapie des akuten Koronarsyndroms ohne persistierende ST-Streckenhebung

Non-ST-elevation acute coronary syndromes (NSTE-ACS) comprise a wide spectrum of disease severities and mortality risks. Next to establishing the diagnosis, clinical management therefore also requires risk stratification in order to adequately select the intensity and urgency of further work-up and treatment. In September 2011 updated recommendations for the management of patients with NSTE-ACS were published by the European Society of Cardiology. Major innovations included the use of highly sensitive troponin assays, including the resulting possibility of establishing a fast-track protocol, the routine recommendation of echocardiography in all patients and the introduction of coronary computed tomography (CT) angiography as a possibility to rule out coronary disease in selected individuals. The importance of risk stratification is emphasized throughout the document and routine use of the GRACE risk score as well as the CRUSADE bleeding risk score is encouraged. The recommendations reflect the availability of new antithrombotic agents and new timelines for invasive work-up are introduced. This comment in German summarizes the ESC guidelines and highlights relevant amendments as compared to the previous version.     

Kommentar zu den 2015-Leitlinien der Europäischen Gesellschaft für Kardiologie zur Infektiösen Endokarditis

The 2015 European Society of Cardiology (ESC) endocarditis guidelines give advice on how to diagnose and treat endocarditis. Recommendations were changed due to improved imaging modalities (CT, nuclear imaging) that are now integrated in the modified Duke criteria. Therapeutic decision-making is improved by interdisciplinary endocarditis teams. Therapeutically, the first randomized study suggests early operation in patients with increased embolic risk; furthermore, antimicrobial strategies could be optimized.     

Kommentar zu der Leitlinie zur Diagnostik und Therapie von Synkopen der Europ?ischen Gesellschaft f��r Kardiologie 2009

The guideline emphasizes active risk stratification and the diagnostic strategy of prolonged ECG monitoring using an implantable loop recorder. The initial evaluation aims at establishing a prima-vista diagnosis or at least a diagnostic hypothesis and risk stratification according to ECG criteria and clinical hints. Carotid sinus massage as a diagnostic procedure remains controversial. Electrophysiological study for evaluation of suspected rhythmogenic syncope is of decreasing relevance. The loop recorder enables documentation of the rhythm during a subsequent syncope. Neurological work-up is not routinely recommended. A standardized evaluation minimizes the rate of unexplained syncopes. Therapeutic decisions include ICD or pacemaker, as indicated in cases of rhythmogenic syncope or carotid sinus syncope, and mostly general measures in cases of other reflex syncopes.     

Kommentar zu den Leitlinien der Europäischen Gesellschaft für Kardiologie (ESC) zur Therapie des akuten Herzinfarkts bei Patienten mit ST-Streckenhebung (STEMI)

In August 2012 amended guidelines of the European Society of Cardiology on the acute therapy patients with persisting ST segment elevation myocardial infarction (STEMI) were published to replace the guidelines from the year 2008. The major changes affect patients with atypical electrocardiogram (ECG) alterations with signs and symptoms of persistent ischemia who need rapid treatment. The treatment of patients with cardiac arrest has for the first time been given a chapter on its own with emphasis on the necessity for immediate invasive diagnostics. The chapter on logistics emphasizes the necessity for regional myocardial infarction networks in cooperation with general physicians, emergency services and hospitals with and without interventional possibilities for rapid reperfusion therapy. Primary percutaneous coronary intervention (PCI) remains the preferred reperfusion therapy and should be carried out within the first 90 min following first medical contact and by short symptom duration even within 60 min. For antithrombotic therapy the new platelet aggregation inhibitors prasugrel and ticagrelor as well as bivalirudin for acute anticoagulation are emphasized. Detailed information is given on secondary prevention with an emphasis on physical activity and lifestyle modifications.     

Kommentare zu den Leitlinien der Europäischen Gesellschaft für Kardiologie (ESC) zur Diagnostik und Therapie von Patienten mit ST-Streckenhebungsinfarkt (STEMI)

Very early reperfusion of the occluded infarct artery is the mainstay in the treatment of an acute myocardial infarction with persistent ST-segment elevation (STEMI). Pre-hospital (ambulance) clinical and ECG diagnosis is critical for reducing the time delays between onset of symptoms and start of reperfusion. This can best be achieved by establishing a network of non-PCI-capable and PCI-capable (24 h/7 days) hospitals connected by an efficient ambulance service. Primary PCI with stenting, when performed by an experienced team within the recommended time, is the best reperfusion treatment to save lives. Primary PCI should be performed within 120 min after ECG diagnosis (first medical contact) in all patients and within 90 min in patients presenting within 2 h and with a large infarct. In the absence of contraindications, all patients should receive aspirin, a thienopyridine and one of the following anticoagulants as soon as possible: bivalirudin or heparin, if primary PCI is planned; enoxaparin or heparin, if a fibrin-specific lytic agent is given. Routine i.v. administration of a beta-blocker is not indicated. Even after successful fibrinolysis, transfer to a PCI-capable hospital for coronary angiography, ideally between 3 and 24 h after start of fibrinolytic therapy, is indicated. Recent studies have shown that (if no contraindications exist), in patients with STEMI, clopidogrel may be replaced by prasugrel.     

Kommentar zur Leitlinie (2011) der Europ?ischen Gesellschaft für Kardiologie zur Diagnose und Therapie der peripheren arteriellen Erkrankungen

The recently published European Society for Cardiology (ESC) guideline on the diagnosis and treatment of peripheral artery disease (PAD) is a great step forward for an improved and standardized handling of patients with peripheral artery disease which will enforce the standard of quality of care. Diseases of the aorta are not covered. The guideline is addressed to everybody involved in the treatment of patients with PAD and try to give support for the daily clinical routine and practice. The purpose of the guideline is concerned with the recognition, diagnosis, prevention and treatment. Methodological and diagnostic details can be found in the internet version of the European Heart Journal. All vascular territories from the carotid to the limb arteries are described. The medical and interventional as well as surgical treatment are presented in relation to evidence-based medicine class and level based on listed references. The tables and decision trees are most helpful as are discussions of multiside PAD and commonly occurring disease manifestation in various territories.     

Leitlinien der Deutschen Gesellschaft für Kardiologie—Herz- und Kreislaufforschung

Ohne Zusammenfassung

---

Mitteilungen der Deutschen Gesellschaft für P?diatrische Kardiologie

Mitteilungen

Mitteilungen der Deutschen Gesellschaft für P?diatrische Kardiologie     

Geschichte der Kommission für Klinische Kardiologie der Deutschen Gesellschaft für Kardiologie – Herz- und Kreislaufforschung

The German Cardiac Society was founded in 1927 by Bruno Kisch and Arthur Weber. At that time the Society was dominated by members working in more theoretical areas of heart and circulation research (e.g. physiology, pathology and pharmacology). In 1971 the Commission for Clinical Cardiology was initiated by members of the Society working in clinical fields in order to prevent the founding of a new clinical society. It was the time when new technical methods in clinical cardiology were being introduced and more institutions with heart catheterization laboratories were founded. In 1983 the first clinical practice guidelines were published, just before the American College of Cardiology/American Heart Association (ACC/AHA) guidelines. Today the cIinical practice guidelines are evaluated in cooperation with the European Society of Cardiology. Since 1996 all guidelines have been published on the internet site of the German Cardiac Society. In 1982 the first of now 25 (2010) reports on the structure and number of the catheter laboratories and the number of procedures in Germany (Heart Report) were published.     

VII. Kongreß der Europäischen Gesellschaft für Hämatologie

Ohne Zusammenfassung