Development of next generation sequencing technology has enabled large-scale and comprehensive understanding of human genomes. As illustrated in identification of disease risk variants by genome-wide association studies (GWAS) and panel-based sequencing of cancer genomes, genomic medicine has become commoditized. Consumer-based genome services by companies and public deposits of biobank-driven genome data have promoted the society where “everyone knows everyone’s genome”. Elongation of human lifespan and implementation of precision medicine for disease risk prediction based on human genomes are warranted. In the field of cardiovascular diseases, development of high-resolution precision medicine models is necessary. Polygenic risk score (PRS), which aggregates genome-wide disease risk variant genotypes of individuals, can stratify subjects in the population through disease risk prediction. PRS is now considered as a promising approach of precision medicine in a variety of medical fields including cardiovascular medicine. On the other hands, pitfalls of PRS is also reported, such as bias due to population stratification. Further analytical improvements towards unbiased PRS estimation is warranted. In addition to GWAS, utilization of omics information can also contribute to construction of precision medicine models. Development of omics assay technologies, such as single cell sequencing, has enabled collection of tissue-specific and time course omics information. We need to focus more on how to develop omics-based precision medicine of cardiovascular diseases in the post GWAS era. We would like to discuss this challenging topic in this symposium.

In recent years, the utilization of ICT and AI technology has attracted extensive attention in medical fields in the world. It has been 15 years since revolutionary learning methods including Deep Learning were proposed. The AI development environment has been opened to general researchers. In fact, several AI algorithms, such as CNN, Gradient Boosting, and so on, are prevailing and can be easily implemented. In Cardiology, AI has been applied to deriving and utilizing unstructured data including ECG waveform data and images obtained from Echocardiography and Cardiac CT, and to predicting prognosis by clinical information. Furthermore, AI algorithms are going to be utilized for the personalized medicine based on biometric information such as genome/omics information and biological monitoring data. Now, we are seeing a paradigm shift in the importance of the clinical researches from clinical randomized trial to a huge volume of Real World Data utilized and processed by AI. In this symposium, we would like to introduce the latest trends in Japan and overseas regarding the AI applications in Cardiology, and to deepen our discussion on future prospects.

On the basis of the pathophysiological mechanism and the large-scale clinical trials, the pharmacological treatment for heart failure has been greatly advanced from diuretic and digitalis to the inhibition of neurohumoral factors. RAA inhibitors including ACE inhibitor, angiotensin receptor antagonist (ARB), mineralocorticoid receptor antagonist (MRA) and β blockers are recommended for HFrEF. On the other hand, diuretics and the treatment for the comorbidities are recommended for HFpEF.

The prognosis of patients with heart failure is still poor, and the development of a more effective therapeutic drug is greatly needed. If channel inhibitor, ivabradine, and angiotensin receptor-neprilysin inhibitor (ARNI), sacubitril/valsartan, are now approved for HFrEF and used in Japan. Furthermore, VICTORIA with soluble guanylate cyclase (sGC) stimulator, vericiguat, and DAPA-HF with SGLT-2 inhibitor, dapagliflozin, have reported the improvement of outcomes in patients with HFrEF. GALACTIC-HF with cardiac myosin activator, omecamtiv mecarbil, is under way.

Recently, various types of new drugs for heart failure have been developed. This plenary session aimed to present the latest findings of the research about the new therapeutic drugs for heart failure and further understand the present and future of heart failure treatment.

Dissection and aneurysm formation comprise the bulk of aortic diseases physicians see in clinical practice. However, we all know that there are many other disorders of the aorta. Large vessel arteritis affects the aorta and is divided into the following categories, Takayasu arteritis and giant cell arteritis. Behcet’s disease and IgG4-related disease also involve the aorta. The latter has been studied in great detail in Japan and has gained worldwide attention in recent years. Although they are not common, cardiologists and cardiovascular surgeons nevertheless encounter these diseases in daily practice. One of the problems with diagnosis of these less common aortic diseases is a lack of specific biomarkers for them, forcing us to rely on nonspecific inflammatory markers and various imaging tests. Advanced imaging technology such as the recently developed FDG-PET appears to be useful for detecting inflammation of large vessels, and is gaining in popularity, but there is still much to be learned. With respect to treatment of these diseases, in addition to conventional immunosuppressants, there are new ones such as tocilizumab for large vessel arteritis which are showing promise. For vascular stenosis, dilation, and aortic regurgitation, treatment including optimal timing and indications for surgery or intravascular treatment are largely unknown. Marfan syndrome is a hereditary aortic disease, for which much new information is coming to light, including the existence of closely related diseases. In this way, aortic diseases are extremely fertile ground for research: research into mechanism, research into better diagnosis, research into optimal treatment. So we are really looking forward to the sessions ahead in which we will be sharing the latest knowledge, both in clinical and basic science, in the area of specific aortic diseases.

Advances in gene analysis techniques have allowed the identification of the causative genes of inherited cardiomyopathy. Genome-associated cardiomyopathy includes not only direct functional associations with gene mutations or deletions but also susceptibility to onset changes due to differences in genetic background as well as prognosis and responsiveness to medical therapy. The complicated role of genome medicine in the pathology of cardiomyopathy is increasingly obvious; thus, more specific approaches may be proposed by detailed individual genomic diagnoses. Furthermore, clarifying the detailed genomic contribution of related proteins or mRNAs may allow the development of specific precision medicine. Genome editing technology, genome engineering, and efforts to repair the genome using various technologies are under development.

In addition, techniques for inducing differentiation from various stem cells into cardiac myocytes, including induced pluripotent stem (iPS) cells, have been developed as potential therapeutic strategies for severe heart failure. Moreover, myocardial regeneration has accelerated with technological progress.

This symposium aims to broadly discuss both basic and clinical issues and prospects in the era of genomic medicine, in terms of the associations with genetic pathogenesis, therapeutics and clinical applications.

The incidence of cardiovascular and metabolic diseases, such as atherosclerosis, diabetes, and heart failure, increases with age. It has been suggested that an age-associated increase in chronic inflammation (inflammaging) contributes to the onset and progression of age-related diseases including cardiovascular and metabolic diseases. For example, a number of basic and clinical studies with statins have shown that age-associated hypercholesterolemia promotes vascular inflammation, thereby leading to the onset and progression of atherosclerosis. The CANTOS study demonstrated that direct suppression of the inflammatory response can lead to a reduction of residual cardiovascular risk. Age and/or obesity-induced visceral adipose tissue inflammation provokes systemic insulin resistance, which negatively regulates cardiovascular function. It has also been reported that inflammaging in the heart is involved in the onset and progression of heart failure. The mechanisms associated with inflammaging include: age-associated clonal hematopoiesis; dysbiosis; accumulation of senescent cells, and abnormal immune response, however the entirety of the mechanisms involved remain elusive. Moreover, the therapeutic strategy targeting inflammaging for cardiovascular and metabolic diseases has not yet been sufficiently developed. In the present session we will review the issues surrounding inflammaging in cardiovascular and metabolic diseases, and discuss a perspective of novel therapeutic strategies of immune modulation.

The global prevalence of type 2 diabetes (T2DM) keeps rising and is estimated about 463 million in 2019. In Japan, the prevalence of T2DM is expected to increase from 7.4 million to approximately 8.9  million by 2030. T2DM is a chronic, progressive disease associated with a number of not only metabolic abnormalities but also macro- and microvascular comorbidities, which reduce patients’ quality of life (QoL) and cause cardiovascular death. Cardiovascular disease (CVD) is the leading cause of morbidity and mortality in patients with T2DM. The mechanisms of diabetes-associated cardiorenal injury may be multifactorial. One of the leading mechanisms is direct endothelial injury by high blood glucose level, that can cause atherosclerotic disease progression and microvascular disorders such as retinopathy, renal disease (DKD) and neuropathy. More recently, T2DM is considered to affect cardiomyocyte function. T2DM can cause mitochondrial injury, metabolic disturbance and energy production inside cardiomyocytes that cause heart failure. T2DM also causes interstitial fibrosis in both cardiac and renal tissues. DKD-mediated volume retention, anemia and sympathetic activation further worsen heart failure status. In this session, we would like to discuss in depth all the concern regarding T2DM and cardiorenal syndrome, and is open for many abstract submissions.

Heart failure is defined as a condition in which some organs are impaired due to hypoperfusion or congestion caused by depressed cardiac function for any reasons. In other words, heart failure is not influenced only by the heart itself, but a condition that is determined by organs other than the heart. However, the insights of inter-organ communication in heart failure have not been fully applied in clinical practice partly because there have been few clinical indicators established to visualize the effects on each organ.

In this session, we would like to discuss the significance of clinical surrogate markers for each organ such as brain, liver, kidney, intestine and muscle in heart failure management, focusing on multimodality imaging assessment.

Renal denervation, a novel innovative therapy that modify the circulation regulatory system to reduce the onset and severity of cardiovascular disease are drawing attention. Kidneys regulate fluid volume in the circulation, and its condition is directly related to the pathogenesis of hypertension and heart failure. The renal denervation partially blocks the renal sympathetic nervous system, which is an organ-related pathway between the brain and the kidney. Radiofrequency ablation, ultrasonic ablation, and chemical ablation with alcohol are the most common techniques. Denervation is performed through the lumen of the renal artery using a catheter. A recently published randomized controlled trial with a sham group (SPYRAL HTN-OFF MED/ ON MED study and RADIANCE-HTN study) clearly showed an blood pressure effect of renal denervation throughout 24 hours including nighttime and morning hours. This technique may help to manage poorly controlled hypertension and prevent arrhythmias and heart failure. Future investigation will focus on the antihypertensive mechanism of renal denervation, including the central nervous system, and its multifaceted effects on circulating blood volume and metabolisms, as well as on the inflammatory immune system. In addition, the identification of responders, evaluation of efficacy, innovations in denervation techniques, and interactions with drugs, including novel cardiovascular agents such as SGLT2 inhibitors or ARNI, need to be clarified. Translational research between basic and clinical research is important to resolve these issues. In this plenary session, we will discuss the basic and clinical aspects of renal denervation, which is about to be introduced into the clinical practice. We would like to summarize the latest evidence and plan for the near future.

Aorta stenosis (AS) keeps being increased in our country in association with social aging, and the number of aorta valve replacement for elder patients has also grown. However, there were an ineligible number of inoperable patients with AS because of comorbidity and/or high frailty. For these patients, transcatheter aorta valve replacement (TAVR) has been developed in Japan. Moreover, results of PARTNER-lll trial for low risk AS will change the paradigm of AS treatment. For mitral regurgitation with high operative risks, in particular with severe ventricular dysfunction, the therapeutic strategy has not been established. MitraClip has been approved as a noninvasive procedure for patients with severe mitral regurgitation and high operative risks, and Clinical trial for approval of TMVR and Neochord has been already started in Japan. On the other hand, less invasive surgical treatment such as MICS surgery, Robotics surgery and Sutureless valve for AS have been developed.

In this session, we would like to reconfirm points to be kept in mind to exert benefits through the transcatheter noninvasive therapy for Structure heart diseases and to discuss a plan for issues to be resolved.

Among patients admitted to intensive care units, especially, cardiogenic shock can cause difficulty in life-saving if its direction is mistaken. Situations that require quick decisions have been sporadically seen such as the evaluation of hemodynamics and the selection of treatment. The mortality rate of cardiogenic shock exceeded 70% in the 1970’s, but has improved to 30% to 40% since 2010. New cardiac assist devices have been developed during the last 10 years. However, the current incidence of, and mortality from, cardiogenic shock in Japan remain unclear. To improve the outcomes of cardiogenic shock in Japan, it is essential to understand the current situations such as the prehospital care system, intensive care after admission, and intensive care management. The aims of this session are to improve the mortality of cardiogenic shock on the basis of the following items: (1) prognostic factors for the incidence of cardiogenic shock in the community, (2) encouragement of treatment in cardiovascular hospitals and the start of early treatment, (3) cooperation between primary care physicians and cardiologists and between cardiologists and intensivists with cardiogenic shock, (4) understanding differences in pathological characteristics and outcomes according to diseases that may cause cardiogenic shock, such as acute myocardial infarction and acute myocarditis, and (5) the effectiveness and timing of the selection of percutaneous mechanical circulatory support devices such as intra-aortic balloon pumping (IABP), extracorporeal membrane oxygenation (ECMO), and Impella® systems and the prevention of complications (indications, induction, management, and withdrawal or limitations). In this session, we would like to introduce treatment outcomes and the latest approach in advanced hospitals in this field. We would be glad if this session could give all participants help in practicing the cardiovascular management of cardiogenic shock from tomorrow.

School cardiac screening has been conducted for more than 60 years since its beginning in Japan. After the enforcement regulation in the School Health Law was revised, cardiac screening, including electrocardiogram (ECG), was started for all freshmen in elementary, middle and high school in 1995. After the subsequent development of guidelines, the 2016 Guidelines for School Cardiac Screening (Japanese Circulation Society and the Japanese Society of Pediatric Cardiology and Cardiac Surgery) has been released. The objectives of current school cardiac screening are early detection and management of pediatric heart disease and prevention of sudden cardiac death. The usefulness in detecting diseases such as long QT syndrome, myocardial diseases and pulmonary arterial hypertension has been reported. However, standardization and equalization of the interpretation of ECG is a critical issue in Japan. Although its effectiveness in preventing sudden cardiac death has been noted overseas, it has not been adopted as a health care system because human resources and cost-effectiveness have been considered as a challenge.

In recent years, deep learning has been applied in various fields of medical science and is expected to be applied in the field of school cardiac screening. In addition, after the enactment of the Basic Act on Prevention of Cardiovascular Diseases and Stroke in December 2019, school cardiac screening is expected to play an important role in preventing adult-onset cardiovascular diseases.

In light of the above circumstances, we would like to summarize what has been accomplished in school cardiac examinations in Japan as of 5 years after the establishment of the JCS/JSPCCS guideline, and discuss current issues, related to new approaches to ECG interpretation in school children, and efforts to prevent adult-onset cardiovascular diseases to explore the future direction of research, with reference to the status in United States.

Basic research on regenerative medicine in the cardiovascular field in Japan has made remarkable progress and has made a great contribution to its acceleration to clinical application. The differentiation induction system from ES and iPS cells to cardiomyocytes has been established, and selective differentiation into ventricular muscles and atrial muscles has become possible. In addition, a technique for maturing cardiomyocytes in vitro has been gradually developed, and is expected to be applied to drug discovery. Furthermore, disease model iPS cells have been produced for various hereditary heart diseases and have been used for elucidation of pathological conditions and analysis of drug targets. In addition, research on large animal models with a view to clinical applications 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 a view to clinical application and research on purification methods for cardiomyocytes have also produced great results. By introducing combination of myocardium-specific genes into fibroblasts or other type of cells, technological development has progressed and the efficiency of production has also improved with respect to the direct reprogramming method for producing myocardial-like cells. In this plenary session, we will focus on the development of fundamental technologies that will drive these myocardial regenerative medicine, and aim to see the future image of myocardial regenerative medicine in the near future.

Destination therapy for continuous-flow ventricular assist device (cf-VAD) will be approved for health insurance coverage soon. There are many issues to be discussed and solved, such as reasonable criteria for cf-VAD implantation in patients with advanced age and/or comorbidities, desirable home management and patient education, acceptable family and social support systems matching recent demands, and so on. It should be also deeply discussed what are desirable measures at the end of life during DT treatment whose goal is improvement of quality of life in order to take root in Japanese society.

Although many evidences for coronary artery disease are accumulated year by year and many recommendations are written in the guidelines reflecting them, it is known that the cases to which the guidelines can be applied are limited. In addition to the problems of coexisting diseases such as valvular disease, low heart function, renal dysfunction, and systemic vascular disease due to an aging society, social and psycho-psychological vulnerabilities should be considered. Moreover, the hopes of patients and their families also play a large role. Therefore, there is a need for discussions by multiple experts that goes beyond mere discussion by interventionalist and cardiac surgeon. In addition, there are many PCI facilities in Japan that do not have cardiac surgery, and it is desired to form and practice a heart team in the area.

Therefore, we would like to make the Heart Team even more informative by soliciting presentations on innovations at different facilities and different modes of operation.

Since the first causative gene in congenital long QT syndrome (LQTS) was discovered in1996, genetic studies have identified a significant link between mutations in genes encoding for cardiac ion channels or other membrane components and several inherited arrhythmias. The responsible genes mainly KCNQ1 (LQT1), KCNH2 (LQT2) and SCN5A (LQT3) have been identified in 75% of congenital LQTS patients, and genotype-phenotype correlation has been well investigated, enabling genotype-specific management and pharmacological therapy, so-called precision medicine. Moreover, mutation site- or mutation type-specific risk stratification has been introduced in congenital LQTS. Genetic diagnosis rate is less (20-30%) in patients with Brugada syndrome (BrS). Recently, BrS is believed to be multifactorial genetic disorder, and only SCN5A gene is considered to be a pathogenic gene. Other inherited arrhythmias include catecholaminergic polymorphic ventricular tachycardia(CPVT), arrhythmogenic right ventricular cardiomyopathy (ARVC), short QT syndrome, and early repolarization syndrome. Mutations in ryanodine receptor gene (RYR2) are identified in more than 50% of patients with CPVT, and mutations in genes encoding for cytoskeletal and desmosomal proteins have been reported in ARVC patients, in whom genotype-phenotype correlation and risk stratification in relation to causative genes have been evaluated. In this symposium, expert physicians and researchers are welcome to present their own clinical and experimental data and to provide a comprehensive discussion for current perspective on precision medicine of inherited arrhythmias.

Myocardial diseases are diverse, including primary cardiomyopathy such as hypertrophic cardiomyopathy and dilated cardiomyopathy, and secondary cardiomyopathy such as amyloidosis and sarcoidosis. Morphological abnormalities detected are not always helpful to diagnose cardiomyopathies. However, early diagnosis is required for determining treatments and predicting its prognosis. Various imaging modalities such as echocardiography, CT, MRI and nuclear imaging are used for noninvasive diagnosis, but recently, thanks to technological progresses and deeper understanding of pathological conditions, new analysis methods and parameters are being produced. However, in clinical practice, it may be difficult to determine which modality should be used at which timing for which disease to diagnose, and which modality should be optimal for prognostic prediction. Without true understandings, the modality can be useless.

In this session, we would like to discuss the latest topics of diagnostic imaging modalities and discuss the future use of various modalities that contribute to early diagnosis through their application to various myocardial diseases.

Although the importance of the atria is often underestimated in the shadow of the ventricles, atrial abnormalities contribute to a variety of pathophysiologies. Organic and/or functional changes of the atrial muscle and interstitium and electrical abnormalities have interaction with one another, induce the impairment of reservoir function, conduit function, or booster pump function of the atria, and result in hemodynamic deterioration. There have been scattered studies showing that atrial dysfunction is related to heart failure severity. Atrial fibrillation is both a result of, and a cause or exacerbator of, such atrial changes. The results of a study showing a difference in the effect of beta-blockers in HFrEF with and without atrial fibrillation have received much attention. Recent epidemiological studies found that more than a half of HFpEF patients have atrial fibrillation, suggesting that atrial function plays a major role in the pathogenesis of HFpEF. Furthermore, atrial functional mitral or tricuspid regurgitation caused by the enlarged atria without ventricular dilatation or dysfunction is getting a lot of attention as one of causes of heart failure.

Although the term, atrial cardiomyopathy, is advocated, structural and functional abnormalities of the atria in heart failure have not been well studied to date. In this session, we want to discuss the pathogenesis, clinical assessment methods and therapeutic interventions of the structural and functional abnormalities of the atria in heart failure based on the latest findings.

With dramatic technological advances in biomedical engineering, cardiac implantable electronic devices (CIEDs) have undergone a rapid development: Pacemakers for bradycardia, anti-tachycardia-pacing and cardioversion/defibrillation (ICD) for lethal tachyarrhythmias, and cardiac resynchronization therapy (CRT) for advanced congestive heart failure are widely used around the world today. Implantable devices such as ICDs and CRTs are cornerstones of the modern treatment in heart failure patients, reducing the re-admission rate and mortality in this population. Wearable cardioverter-defibrillators, leadless-pacemakers, subcutaneous ICDs, and miniaturized implantable loop recorders have already been available in Japan for some years. His bundle pacing and left bundle pacing have also emerged as a new strategy for a physiological ventricular activation and might be effective in patients with advanced heart failure.

Remote monitoring (RM) has become a new standard of care in the follow-up of patients with CIEDs, and it might be quite useful in patients with advanced heart failure and concomitant atrial fibrillation. Furthermore, a remote hemodynamic monitoring device has recently been developed and is now often used in daily clinical care in both Europe and the United States.

Thus, CIEDs are not just electrical stimulation devices, but have already become reliable heart monitoring and therapeutic equipment, and further future developments and dissemination are expected. In this symposium, we would like to discuss the current status and near future of CIEDs for the diagnosis and treatment of cardiovascular disease.

Japanese Circulation Society, in collaboration with the Japan Stroke Society, has set a “Five-Year Plan for Overcoming Cardiovascular Disease” to prevent stroke and cardiovascular diseases all over Japan. Cerebro- and cardiovascular diseases are caused by atherosclerosis of arteries and it is very important to control a variety of risk factors for atherosclerosis for their prevention. Especially, the importance of management of LDL-C has been established by a number of mega-trials of LDL-C lowering drugs such as statins, intestinal cholesterol transporter inhibitor, and PCSK9 inhibitors. However, even if serum LDL-C level is lowered to approximately 30 mg/dL, cardiovascular events are only partially prevented. Therefore, it may be crucial to appropriately control a variety of other risk factors. In this symposium, we will discuss, in addition to the current management of LDL-C, about the optimal strategies for treatment of dyslipidemia, diabetes/impaired glucose tolerance, hypertension, metabolic syndrome and other risk factors for atherosclerosis. Furthermore, we will also focus on the recent novel drug interventions for prevention of atherosclerotic cardiovascular diseases. Based upon these discussions, we will shed light into the directions for drug developments to attenuate atherogenesis and the progression of atherosclerosis.

The number of heart failure patients is ~ 1.2 million in Japan and has been increasing although the total population has been decreasing. The treatments for heart failure including drugs and devices have been progressed very much, but its prognosis is still as poor as that of stomach cancer. The reason of the poor prognosis of heart failure might be lack of the treatments based on mechanisms of its development. Heart failure is a final stage of many cardiovascular diseases such as myocardial infarction, valvular diseases and hypertension. Many patients show cardiac hypertrophy before developing heart failure. Hearts are induced to form hypertrophy by hemodynamic overload to maintain its pump function, however, long-term hemodynamic overload induces the transition from cardiac hypertrophy to heart failure as a failure of the adaptation. Therefore, it is important to elucidate the molecular mechanisms of the transition. In this symposium, the cutting edge of molecular mechanisms of heart failure will be presented and discussed by a variety of aspects.

Proportion of cardiogenic embolization is relatively high in overall stroke, in which clinical significance become more significant due to its tendency of larger ischemic areas. Patients complicated with underlying cardiac diseases that may cause intracardiac embolus must require adequate preventive therapy regardless with history of stroke. Because of such crossing demands between brain and heart, new cardiovascular approaches by multidisciplinary medical intervention, so called “brain-heart team”, gradually become popular. Especially, in cases with secondary prevention of stroke, treatment strategies depend on accurate diagnosis of “embolization” for initial cerebrovascular event by neurologists. Systemic anticoagulant therapy is considered as first line therapy for prevention, and novel anticoagulant agents have altered patients’ satisfaction as well as safety. However, there is an unneglectable proportion of patients for whom continuation of oral anticoagulation is problematic due to bleeding complications, which demands alternative approaches instead of medication. In these days, thanks to developments of catheter intervention and less invasive cardiac surgery, managements of relevant cardiac structures like left atrial appendages and patent forameno vale become available as such alternative treatment. In this symposium, we would like to discuss on novel cardiovascular approaches targeting such cardiac structures, taking cross talk by the multidisciplinary staff including cardiologists, cardiac surgeon, and neurologists, focusing on “brain-heart team” approaches. We welcome the abstracts of new researches especially regarding with theme of accurate diagnosis of cardiac embolization, therapeutic challenges with devices and surgery for relevant cardiac structures, and utilization of images for such treatment.

Primary PCI is the first-line treatment for ST-segment elevation acute myocardial infarction (STEMI). The mortality rate for STEMI is significantly lower with primary PCI. However, inadequate rates of primary PCI and high mortality rates in cases of cardiogenic shock remain unresolved issues. Inadequate rate of primary PCI is a complicated area including awareness by patients, transport issues, hospital access issues, and initial response issues for non-cardiologists. Cardiogenic shock, on the other hand, is an area where new treatments are awaited. With the increased use of AEDs, many cases of myocardial infarction with left main disease, which previously resulted in death before transport to the hospital, are now seen in hospitals. Coronary artery bypass graft is selected for left main disease with stable angina due to lower recurrence rate, but in cases of cardiogenic shock of the left main lesion, the only viable option is to treat it with intervention. In addition, left main lesions contain rich plaque burden and are associated with distal emboli, and slow flow means that survival is unlikely.

The combination of Impella and ECMO has been shown to be a physiologically superior method, and it is hoped that the combination of Impella and ECMO will improve prognosis in this area. Treatment strategies for severe AMI are a major barrier to next-generation cardiology practice, and we would like to discuss these issues.

Understanding of pulmonary hypertension has expanded dramatically in Japan, based on the guidelines of the 6th World Symposium on Pulmonary Hypertension. The use of various evidence-bearing pulmonary vasodilators and early detection and therapeutic interventions have significantly improved the prognosis of the patients with pulmonary arterial hypertension (PAH). However, since the etiology of pulmonary hypertension is diverse and various factors are involved in the development and progression of the disease, the treatment outcome of PAH specific medication is still not always sufficient.

It is necessary to proceed with personalized medicine on the basis of the pathogenesis of PAH to achieve maximum treatment efficacy. In this symposium, we would like to deepen our understanding of the underlying mechanism for the development of pulmonary hypertension, and comprehensively discuss future therapeutic targets based on the results of translational research.

Recent advancements in cancer therapy dramatically improved the long-term outcome of cancer patients, leading to an increase in the number of cancer survivors, but cardiovascular adverse events owing to cancer therapy have greater impact on the prognosis and quality of life in cancer patients and survivors. Under such circumstances, it is increasingly of importance to manage the cardiovascular complications, which are related to both cancer itself and adverse effects of cancer therapies. In addition to anthracyclines, whose cardiotoxic effects have been recognized for decades, molecularly targeted anticancer drugs have entered a list, for which cardiovascular complications are concerned. Anticancer drugs often target molecules essential to cardiovascular homeostasis, but off-target effects can also induce toxic phenotype. Currently, the molecular mechanisms underlying the pathogenesis of cardiovascular toxicity by individual drugs remain to be precisely defined. In addition, epidemiological and clinical aspects of cardiovascular complications by cancer chemotherapy have not been sufficiently accumulated, due to a wide variety of chemotherapy regimens and patient characteristics involving cancer types, stages, and cardiovascular comorbidities. Under such circumstances, interdisciplinary collaboration between oncology and cardiology specialists is the prerequisite for the best management of cardiovascular risks and complications to avoid interruption of optimal cancer treatment. In this symposium, we will discuss the current status and future directions of cardio-oncology/onco-cardiology, based on cutting-edge basic, clinical, and epidemiological research on cardiovascular complications in relation to cancer chemotherapy.

Peripheral artery disease (PAD) affects an estimated 200 million people worldwide. PADpatients are often associated with polyvascular disease, such as cerebrovascular or coronary artery disease and are high risk group of cardiovascular morbidity and mortality. We should determine the tailor-made best course of treatment for each patient with PAD. This symposium focuses on up-dated information of revascularization and pharmacokinetic therapy for PAD patients.

The rapidly advancing super-aged society has brought about a pandemic of heart failure, and the etiologies and phenotypes have changed dramatically from 10 years ago. Although recent advances have been made in the pharmacological treatment of heart failure, development of the non-pharmacological treatment is also substantial. Accordingly, the guidelines are required to be up-dated almost every year, but unfortunately the guidelines neither mention about specific treatment or special care for the elderly, or treatments that are not suitable for the elderly. In this session, I would like to deepen the discussion on the following six themes regarding non-pharmacological treatment of heart failure. Of course, other important themes of elderly people that I could not describe here are welcome (nutrition, frail, rehabilitation in combination with device treatment, etc.).

Among various fields in the Cardiology, there have been remarkable recent advances in approaches/therapies for the management of atrial fibrillation. Atrial fibrillation, which had become curable by surgical procedure in the end of 20th century, has become curable by catheter-based approaches. In addition to the traditional radiofrequency-energy, cryothermy coagulation and laser-energy using the balloon technology have become the choices for catheter ablation. As for the targets of the substrate of atrial fibrillation, multiple approaches including the linear ablations, CFAE ablations, drivers/rotors, and the GP ablations have been focused along with the progression of 3D technologies.

There have been remarkable progressions in the surgical treatment of AF as well. In addition to the traditional full Maze-procedure, less invasive procedures like endoscopical PVI/Maze procedure and left atrial appendectomy have become common procedures. One of the recent topics is the advancement of catheter-base left atrial appendage closure, which is another choice for patients with contra-indication of anticoagulative agents.

In this symposium, we would like to discuss both the utility and limitation of recent progression in the nonpharmacological approaches for atrial fibrillation.

The concept of “Vulnerable plaque” was proposed by Dr. Muller et al. in1989, and it is defined as atherosclerotic plaques that place patients at high risk for developing cardiovascular events such as acute coronary syndrome and sudden cardiac death following subsequent destabilization and thrombus formation. During the past 30 years, our understanding of “vulnerable plaque” became deeper due to the progress in basic researches on the mechanisms of coronary atherosclerosis as well as the accumulation of clinical findings. However, the beneficial impact of this concept on primary and secondary prevention of cardiovascular events appears to be still insufficient.

In this symposium, we will have an opportunity to get the latest knowledge from experts in this field. The symposium will cover the basic mechanisms, non-invasive diagnosis (positron emission CT: FDG-PET, MRI, coronary CT),invasive diagnostic imaging (intravascular ultrasound: IVUS, optical coherence tomography: OCT), near-infrared spectroscopy: NIRS), and blood biomarkers (such as high sensitivity-CRP) of vulnerable plaques. Based on the lectures, we will have discussion about remaining questions to be answered as well as what preventive/therapeutic interventions should be taken based on accurate diagnosis of vulnerable plaque.