European Heart Journal (2015) 36, 2548–2554
doi:10.1093/eurheartj/ehv389
Leaders in cardiovascular research
Perfectly placed: Stefanie Dimmeler on the
importance of finding the right niche
Stefanie Dimmeler PhD FESC FAHA is Professor of Experimental
Medicine and the Director of the Institute of Cardiovascular
Regeneration at Goethe University in Frankfurt, Germany. She is
known for her work on endothelial biology and for on-going clinical
trials using human progenitor cells for cardiac repair
Tell me about yourself?
I was born in a small village close to Lake Constance in a very beautiful part of Germany. My father was a farmer and my mother was a
teacher and I had a wonderful childhood playing outdoors and
working on the farm in the school holidays. When I grew up the
village seemed very small and I wanted to go to
a bigger place such as Freiburg, but eventually I
was awarded a place at Konstanz University to
study biology.
How did your interest in
science and cardiology
develop?
fellowship in the surgical department at the University of Cologne.
Although my supervisors from biochemistry had warned me that
I would have a tough time working as a biologist in a medical department, I found spending 2 h a day with the doctors in the intensive
care unit really helped me. It was tough, but it was a good decision
in the end and helped me understand things in a truly translational
way which I would not have learned in the
normal postdoctoral PhD fellowship.
Which single person
influenced you the
most?
There have been different people who influenced and inspired me at different stages of
During my undergraduate studies I had to choose
my career starting with my PhD supervisor Albetween two projects for my diploma, one was
brecht Wendel, who was not only a scientist,
working with platelets and inflammatory cells in
but also a very charismatic and cultured perbiochemical pharmacology and the other was foson. When I first went to the University of
cused on marine biology. Both were interesting
Frankfurt from Cologne, cardiovascular scienand it was a major decision to choose the medictist Rudi Busse was a fantastic mentor and
Stefanie Dimmeler
ally orientated option over becoming a classical
helped me set up the research group. Andreas
biologist, but I wanted to focus on something that was medically
Zeiher taught me almost everything about cardiology and I have also
relevant. I ended up in cardiology purely by chance after I had
been influenced in many ways by friends, family, and colleagues.
been working with nitric oxide (NO) and started to apply it to vascular biology and endothelial cells. I now consider myself lucky to be
involved in cardiology because it is a fascinating area for a biologist
that involves many diseases and offers great potential.
Where and with whom did you do
your medical training?
My career path has been unusual in that I do not have an MD or
formal medical training. I learnt a lot from my first post-doctoral
What are your key areas of
research and how was your interest
in these areas aroused?
I started working with NO for my PhD thesis with a biochemistry
focus. After I was recruited to the molecular cardiology department
at Frankfurt, I changed focus to look at the role of NO as a potentially protective molecule in relation to endothelial cells. Eventually,
Published on behalf of the European Society of Cardiology. All rights reserved. & The Author 2015. For permissions please email: [email protected].
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we were able to demonstrate that the generation of NO prevents
the apoptosis of endothelial cells and we also showed how this molecule can be generated by an alternative pathway. At that time the
understanding was that only calcium could activate endothelial
NO. My first steps into cardiology were really interesting, particularly later when we looked at regeneration and repair of the heart
and were able to use new stem cell technology to try and understand how vessels are repaired and how bone marrow itself
contributes heart repair. We isolated so-called endothelial
precursor cells from the blood and showed that although they
were not true stem cells, they had a protective effect that could
help vessels repair themselves and grow. From this basic science
research we started a clinical trial using bone marrow cells which
is now at stage III, to test whether bone-marrow mononuclear
cells might improve clinical outcomes of patients with acute
myocardial infarction (MI).
In recent years, I have become more interested in epigenetic mechanisms, particularly in RNA molecules because when the human
genome was transcribed, the majority of the sequence was found to
have a so-called non-coding function. There are roughly 30 000 of
these non-coding RNAs in endothelial cells and we are now trying
to investigate their function. We are also keen to understand the
function of microRNAs, which we have shown to be involved in different aspects of cardiovascular biology such as cardiac ageing. We
are currently developing anti-microRNAs in the lab and hope to
move towards therapeutic approaches soon.
What do you do outside your
profession?
How has your research evolved?
There is no single answer which fits everyone and it really depends
on an individual’s background. In general I would advise that it is very
important to find an environment that suits you. I was very lucky in
my career to find a niche with people who stimulated me and supported me. In this respect, people are like stem cells which also need
to find the right niche to survive. You also need a lot of luck and hard
work and as luck is not generally something you can influence, it is
important to work hard.
New discoveries coming from basic science have always fascinated
me and pushed me in new directions. Most people stick to one topic or theme, but I have always been interested in how new developments in the basic science arena can be applied to the
cardiovascular sector. For example, when regulatory microRNAs
were discovered, I wanted to see whether there was any relevance
to humans in general and to cardiovascular disease in particular.
My approach to research is not a purely technical approach, but
rather a combination of curiosity to find new things to apply in a
clinical setting to disease in general and cardiovascular disease in
particular.
I like all types of outdoor sports and activities possibly because I
spend so long sitting indoors and perhaps because of my outdoor
childhood. I enjoy skiing, triathlon, cycling, running, and swimming.
I also like cooking and reading and I have a small terrace where I
like to raise and take care of plants. Overall, I try to lead a happy,
balanced life.
Which book would you take
to a remote island?
I am currently reading a biography of Voltaire, named ‘Emilie and
Voltaire’, which is very interesting and revealing about his thoughts
in relation to science. I would not be able to take just one book.
I would have to take a whole library, but I think a very big book
with practical advice and tips on how to survive would be a good
choice in this situation.
What advice would you give
to a young researcher who is
just setting out?
Which piece of work are you most
proud of?
My research background reflects what I am proud of generally, but
initial studies identifying the novel regulatory pathway by which NO
synthase is regulated and how NO works to prevent endothelial cell
death was clearly a very important finding which inspired a lot of
other researchers. I also think the findings on endothelial precursor
cells have helped us better understand the way things work and if we
are lucky, may help us find new therapeutic approaches to disease.
We do not have enough evidence yet, but if that works out, it would
really be something to be proud of.
Key publications
1. Boon RA, Iekushi K, Lechner S, Seeger T, Fischer A, Heydt S, Kaluza D, Tréguer K,
Carmona G, Bonauer A, Horrevoets AJ, Didier N, Girmatsion Z, Biliczki P, Ehrlich JR,
Katus HA, Müller OJ, Potente M, Zeiher AM, Hermeking H, Dimmeler S.
MicroRNA-34a regulates cardiac ageing and function. Nature 2013;495:107 –110.
2. Bonauer A, Carmona G, Iwasaki M, Mione M, Koyanagi M, Fischer A, Burchfield J,
Fox H, Doebele C, Ohtani K, Chavakis E, Potente M, Tjwa M, Urbich C,
Zeiher AM, Dimmeler S. MicroRNA-92a controls angiogenesis and functional recovery of ischemic tissues in mice. Science 2009;324:1710 –1713.
3. Dimmeler S, Fisslthaler B, Fleming I, Hermann C, Busse R, Zeiher AM. Activation of
nitric oxide synthase in endothelial cells via Akt-dependent phosphorylation. Nature
1999;399:601–605.
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The European Society of Cardiology
in Rio 2015
The good relationship between the European Society of Cardiology
and the Brazilian Society of Cardiology is well known. Having a
Portuguese-speaking European Society of Cardiology President at
the moment can only enhance this relationship further
When one mentions Rio de Janeiro, images of sunshine, beaches,
cocktails, and dancing come to mind. However, this fantasy is incorrect. The ESC in Rio programme is a full-day programme which
was extremely well attended and equally well organized by the Rio
de Janeiro section of the Brazilian Society of Cardiology. Actually,
Brazil is more than a country, it is like a continent and as such, each
state has its own cardiology society which organizes annual meetings and then all convene during the annual meeting of the parent
society.
Sao Paolo and Rio de Janeiro are the largest states and so it is not at
all surprising that under the guidance of Olga Ferreira de Souza, President of the Rio de Janeiro Society of Cardiology, and Gláucia Maria
Moraes de Oliverira, President of the Rio de Janeiro Society of Cardiology Congress, as well as the Brazilian Organising Committee of:
† Jadelson P. Andrade, Past President of the Brazilian Society of
Cardiology (2012/13)
† Jorge Ilha Guimarães, Past President of the Brazilian Society of
Cardiology (2010/11)
† Marcus V. Bolı́var Malachias President Elect of the Brazilian Society of Cardiology (2016/17)
† Oscar P. Dutra, Member of the Brazilian Society of Cardiology
A unique programme had been arranged which attracted an audience of 500 on Saturday 18 April 2015, on a splendid sunny day
when Copacabana beach was at its peak of activity. I had a rare opportunity to confirm this at the conclusion of the meeting when I
was able to go for a brief walk before dinner.
The congress centre was superb, close to the faculty hotel which
meant that we did not have the usual traffic problems of the main
congress centre in Rio.
The scientific programme was straightforward, proving that
simple is better. It consisted of a series of 45 min lectures on ‘small’
topics, such as hypertension, atherosclerosis, acute coronary syndromes, imaging, heart failure, atrial fibrillation, intervention, and arrhythmias. Each presentation was introduced, chaired, and discussed
Roberto Ferrari
Rio 2015
Fausto Pinto Rio 2015
by a Brazilian key opinion leader which then stimulated a very interesting discussion. All of this was complimented by two satellite symposia, both on the new anticoagulants, allowing us to be up to date
on this issue.
The ESC was represented by Roberto Ferrari, Keith Fox, Michel
Komajda, Thomas Lüscher, Fausto Pinto, Panos Vardas, and Stephan
Windecker.
For those who still have visions of the fantasy of Rio, the ESC
President and most of the ESC delegation arrived early in the morning on the 18th and left the same afternoon at the closure of the
meeting. With the excuse of being part of the scientific committee,
I was able to arrive the day before and enjoy a wonderful congress
dinner with Panos Vardas and many Brazilian friends.
In conclusion, this was a fantastic initiative, in a fantastic city, with a
good scientific programme which allowed us to learn from each other.
I have now arranged for MyESC in Rio 2016 as testament to the
success of the meeting. Most of the credit is due to our ESC
President, to whom all of us are miu obligado.
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The Brazilian Society of Cardiology
A portrait of the largest cardiology society in Latin America
and affiliated member of the European Society of Cardiology
History
Founded on 14 August 1943, in the city of São Paulo by Dante Pazzanese MD, the Brazilian Society of Cardiology (BSC) currently has
13 000 members and is the largest Cardiology Society in Latin
America. Since 1943, several specialized departments and study
groups have been created in addition to BSC Congresses which
have been taking place for 61 years.
Brazilian Society of Cardiology has two headquarters, one in Rio
de Janeiro which houses the administrative/financial teams, the
Information Center, and the Events Center. It was home to the
Advisory Team for the XIII World Congress of Cardiology
(1998). The other one is located in São Paulo, which houses the
Publications Department and the Fund for Improving Cardiology
Research (BSC/FUNCOR).
Brazilian Society of Cardiology
mission
The BSC is a not-for-profit organization with the purpose of uniting
medical professionals specializing in Cardiology. Its objectives include the planning and performance of projects for the benefit of
its members and Brazilian Cardiology in general, facilitating the
exchange of technical and scientific information and furthering
continuing education.
In addition, the BSC has 25 State chapters, 2 regional chapters, 13
scientific departments, and 9 study groups, which gives it the status
of a nationwide scientific entity.
The Publications Department is responsible for publishing the
Arquivos Brasileiros de Cardiologia and the BSC Journal. The Arquivos
Brasileiros de Cardiologia has been continuously published for
50 years, is of a technical nature, and features major scientific articles
from the Brazilian and International Cardiology scenes. The BSC
Journal has a less academic approach, addressing subjects of general
interest to the Society at large.
The BSC/Funcor is responsible for fostering professional
improvement and scientific/technological research in the field of
Cardiology, as well as disseminating the epidemiological aspects of
cardiovascular diseases, increasing the public’s attention of inherent
risk factors and providing information about the possibilities of
prevention and treatment.
By facilitating the dissemination and participation in Cardiology
events, it enables members and non-members to sign up online
for the BSC Congress, as well as for the Congresses of State
Societies and Scientific Departments. Furthermore, it encourages
scientific research and investigation by publishing the monthly
journal Arquivos Brasileiros de Cardiologia, which includes the best
manuscripts of the year, in addition to guidelines, standards, and
theses databases.
The Society also serves as an interface between cardiologists and
patients.
Brazilian Society of Cardiology
portal
Brazilian Society of Cardiology and its portal aims to meet the needs
of Brazilian cardiology and further the exchange of technical and scientific knowledge among Brazilian and international cardiologists.
One of its main concerns is continuing education. It offers refresher
courses, specialization scholarships, online lectures, virtual conferences, and the Virtual Congress.
In the Scientific portal, BSC members have a restricted area
where they can create or update their homepages, check the address and phone number of colleagues throughout Brazil, use the
webmail and the Personal Appointment Book.
The Prevention portal is designed for the layman and gives tips on
quality of life. It presents information on smoking, coronary risk,
body mass index, stress, healthy recipes, heart bulletin, prevention
campaigns, and educational games.
BSC Directors 2014–15
President—Angelo Amato V. De Paola
Vice-president—Sergio Tavares Montenegro
President-elect—Marcus Vinı́cius Bolı́var Malachias
Editor-in-Chief Arquivos Brasileiros de Cardiologia – Luiz Felipe P Moreira
Andros Tofield
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The Acute Cardiovascular Care Association:
defining and developing a new specialty
The mission of the Acute Cardiovascular Care Association (ACCA)
is to improve the quality of care and outcomes in patients with acute
cardiovascular disease. The requirement for cardiologists trained in
the more acute aspects of cardiology is evident from recent publications discussing the current crisis in staffing and expertise in cardiac
intensive care. Instrumental to addressing this was the establishment
of a new subspecialty in cardiology [Intensive and Acute Cardiovascular Care (IACC)], and the creation of a new cardiovascular specialist, the intensive care cardiologist. In order to support these
emerging specialists in acute cardiovascular care, the ACCA is developing a comprehensive education programme in IACC that aims to
be relevant to all ESC member countries.
To achieve this, ACCA is working to integrate the whole range of
education opportunities already available through the European Society of Cardiology (ESC), as well as developing new ways to deliver
and support training in this specialty. Initiatives include defining a
curriculum in IACC, providing online resources for knowledge, skills
and professional development in the specialty and all supported by
the ESC Textbook of Intensive and Acute Cardiovascular Care,
recently updated and expanded (second edition now available).
The main features of this textbook are
that it is authoritative (written by key opinion leaders in the field), comprehensive
(11 sections and 78 chapters covering all aspects of IACC, including the cardiovascular
implications of many non-cardiovascular
diseases), innovative (addressing patient
safety and clinical governance, the heart
team, ultrasound-guided vascular access in
intensive/acute cardiac care, implanted cardiac support devices, donor organ management, and palliative care in the Intensive Cardiac
Care Units), and intended to be used in parallel with the ACCA elearning platform: ESCeL.
Moreover, the online edition of the textbook, which is available
independently from the print edition and will be included in the
ACCA membership, will be updated on a yearly basis by the authors
of the different chapters.
Although the educational programme of the ACCA is primarily
devoted to cardiologists training in acute cardiovascular care, the
Association recognizes that assessment and management of critically ill cardiac patients requires a team approach. This has led to the
Association opening its membership and educational programmes
to all those involved in IACC, reflecting the multidisciplinary and
multi-professional approach that is the whole patient pathway in
acute cardiovascular care.
Discover now the new edition of the IACC Textbook: www.
escardio.org/ACCA-Textbook and access one free chapter online:
‘The Heart Team’.
Marco Tubaro
Editor-in-chief
Susanna Price, Pascal Vranckx, Christiaan Vrints
Co-editors
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Book Review
The European Society of Cardiology textbook
of intensive and acute cardiovascular care
Editors: Marco Tubaro, Pascal Vranckx,
Co-Editors: Susanna Price, Christiaan Vrints
ISBN: 978-0-19-968703-9
Publisher: Oxford University Press
Second edition: 26 February 2015
Hardback 774 pages
The ESC Textbook of Intensive and Acute Cardiovascular Care covers
the entire spectrum of conditions, procedures, and organizational
aspects encountered in the management of acutely ill patients with
underlying cardiovascular disease.
The recently published second edition includes several new
chapters; nonetheless, the volume is even more concise than before
with a total of 761 pages. Every chapter written by renowned experts in the respective fields provides a summary followed by
text illustrated by instructive figures and tables and a personal perspective. Furthermore, several chapters are complemented by additional online material (i.e. an additional chapter on thoracic
ultrasound).
The first chapters of the book describe organizational aspects of
emergency medical systems, chest pain units, and intensive cardiac
care units as currently found across European countries and how
they impact on the outcome of patients suffering from acute manifestations of cardiovascular disease. Moreover, the role of databases and registries for measuring implementation and success
of novel procedures, technologies, and drugs in real-life are highlighted with key figures provided for several major registries from
a number of European countries.
A series of ensuing chapters cover a wide range of aspects regarding the monitoring of acutely ill patients with respect to the
cardiovascular system and beyond, providing classifications and
biomarkers to help the clinician in early diagnosis and risk stratification of patients.
Procedural aspects are covered in chapters on temporary pacemakers, pericardiocentesis, chest tubes, ultrasound-guided vascular access, renal replacement therapy, and ventilation which
provide useful instructions on how to handle these devices and
in which patients to use them with reference to the current literature (i.e. the use of non-invasive ventilation). Furthermore, practical aspects are addressed in several separate chapters, i.e.
when to perform transfusion for anaemia in patients with acute
coronary syndromes or how to manage sepsis or hyperglycaemia.
Chapters on acute heart failure provide a comprehensive overview
on how to treat these patients explaining device therapy and heart
transplantation and currently available drugs with key figures summarised from major trials including ongoing trials on novel drugs.
Chapters on acute coronary syndromes and cardiogenic shock
provide in-depth insight into current diagnostic and therapeutic
strategies including the use of culprit-lesion-only PCI vs. multivessel PCI, thrombus aspiration in STEMI and mechanical circulatory
support devices while referring the reader to the current literature for the latest study results in these rapidly evolving fields.
Chapters on arrhythmias include algorithms that allow us to distinguish the separate entities manifesting with wide or narrow
QRS complex tachycardia, respectively, serving as a useful reference on how to diagnose and treat these rhythm disturbances
commonly found in patients in acute cardiac care.
A series of chapters on other acute cardiovascular conditions
such as acute valvular disease, pulmonary hypertension, congenital
heart disease in adults, and pulmonary embolism provide valuable
information on the management of these patients and on the latest
developments in these areas (i.e. thrombolytic therapy in
intermediate-risk pulmonary embolism).
This book is a ‘must-have’ for beginners and established experts’
alike, serving as a reference for all care-givers in intensive and acute
cardiovascular care.
Furthermore, this book provides details of the curriculum to
obtain certification in Acute Cardiac Care as defined by the newly
formed Acute Cardiac Care Association (ACCA) of the European
Society of Cardiology.
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Venous thromboembolism patients and
mental health
One in five young venous thromboembolism patients require
psychotropic drugs within 5 years
One in five young people who experience a venous thromboembolism (VTE) will require psychotropic medication within 5
years, according to research presented at EuroHeartCare 2015.
Young VTE patients were twice as likely to experience mental
health problems requiring psychotropic medication as their
healthy peers.
This study is the first to investigate the mental health prognosis
of young VTE patients. Data from four nationwide registries was
used: the Danish Civil Registration System, the Danish National
Patient Register, the Danish National Prescription Registry, and
the Danish Medical Birth Registry.
The researchers identified 4132 patients aged 13–33 who had a
first VTE between 1997 and 2010. A control group of 19 292
people without VTE was randomly selected and matched to the
patients by sex and birth year.
All participants in the study were followed up in the prescription
registry for their first purchase of psychotropic drugs including antidepressants, anti-anxiety medications, sedatives, and antipsychotics.
Purchase of psychotropic drugs was used as a proxy measure for
mental health status and compared between the two groups.
Regression analysis was used to exclude other causes of psychotropic drug purchase such as postpartum depression.
The researchers found that psychotropic drug purchase was
substantially higher among the young VTE patients compared
with the control group. Among VTE patients the risk of purchasing
psychotropic drugs following their diagnosis was 7.1% after 1 year
and 22.1% after 5 years. Their excess risk relative to the controls
was 4.7% after 1 year and 10.8% after 5 years.
Jennifer Taylor MPhil
CardioPulse contact: Andros Tofield, Managing Editor. Email: [email protected]