Steve Parker, CEO of Quantum Imaging, looks back at this year’s highlights from the annual European Society of Cardiology Congress
The hot and crowded summer streets of Rome have been swelled this week as 30,000 attendees gathered for the world’s largest annual cardiology event, The European Society of Cardiology Congress. As always, a huge amount of material was presented at the event covering all aspects of research and clinical cardiology.
From our perspective, I picked up on several trends and heard interesting presentations that will influence how Acute Coronary Syndromes (heart attack and serious unstable angina) are diagnosed and the potential positive impact that those trends may have on the acute use of Magnetocardiography.
As more and more sensitive troponin assays (hscTn) are used, the debate continues about exactly how they should be deployed – and in the US there is debate over whether they should be used in clinical practice at all. One session at the Congress explored the use of hscTn and confirmed that there is little debate over what should happen to patients who present at emergency departments with “classic chest pain” and grossly elevated levels of high sensitive troponin. The majority of patients, however, will have a “slightly elevated” level of troponin which may, or may not, be diagnostic and will require further testing and serial blood tests. This moves from what was a “black and white” decision about raised troponins to one where troponin is only one factor in a much broader evaluation of the patient, including comorbidities, age etc.
In the United States, which represents an estimated third of the world’s potential market, the use of hscTn is yet to have been approved by the FDA because their concerns over it are yet to be adequately addressed. This debate stems back to 2012 when a document was issued raising concerns about how patients in the “grey zone” should be treated and how the false positives associated with higher-sensitivity troponin testing should be readily and safely identified. To date, there has still not been an answer that has satisfied the FDA to the extent where it has approved the use of high sensitive troponin assays.
Another interesting presentation was the findings of a group at the University of Leeds lead by the Professor of Cardiovascular Health Sciences, Dr Chris Gale. Dr Gale’s findings were extensively reported in the UK media with headlines such as the BBC’s “Third ‘given wrong initial heart attack diagnosis’” and The Times’ “Doctors miss signs of heart attack in women”. Data from 600,000 patients over 9 years was reviewed and it was found that 35% of women who were initially told that they were suffering from something other than what ultimately turned out to be a heart attack.
In response, a spokeswoman for NHS England commented: “We are working hard to continually improve tests for accurately diagnosing heart attacks in both men and women so that treatment can begin without delay…” This once again underpins the clear, and urgent, need for accurate and deployable testing for chest pain patients in acute areas of the hospital.
In summary, the high sensitivity discussion continues, but with each round there is a growing call for deployable technology that can sit alongside high-sensitive troponin tests to better manage patients who test positively and negatively to ensure that they end up on the correct diagnostic pathway, without adding significant institutional costs further down the line. Today, much of this is starting to be picked up by expensive imaging elsewhere in the hospital and in many cases during expensive and invasive cath lab procedures. All this essentially amounts to a growing evidence bank which indicates that deploying hscTn in the emergency room increases costs for already stretched healthcare budgets.