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TradeshowNews
XVth World Congress of Cardiology in Barcelona
Edition 02 – 10/2006
A Publication by Philips Medical Systems
GETTING PERSONAL AT ESC
Dear Reader
The World Congress of Cardiology 2006, held in Barcelona at the
start of September, was a joint effort of the European Society of
Cardiology and the World Heart Federation. It showed that, though
it is complex, cardiology is one of the most exciting medical sectors
in which to work.
We have always prided ourselves at Philips with applying expertise
and experience to provide solutions that help meet the challenges
cardiologists face. Dealing with dramatic increases in the numbers
of cardiac patients means finding new ways of working and new
ways of working together. In Barcelona we showed how Philips
Medical Systems is Cardiac Care Connected. This means uniquely
gathering, integrating and making information accessible across the
CCU, and interventional and non-invasive areas of the cardiology
department. It helps focus on the needs of patients, rather than
technologies, to improve and streamline procedures. It lets cardiologists act earlier, react faster, and make more traceable and more
specific treatment decisions, based on quantitative data.
In this supplement, we look at how Cardiac Care Connected was
presented – and received – at the congress.
A whole world of cardiology
Yours,
T
Margrit Lelieveld
Marketing & Sales Director / EMEA
2
his year’s European Society of
The theme of the combined congress, “car-
Europeans aged 65 and over – with the asso-
ly unavoidable spread of cardiovascular dis-
Cardiology Congress took place in
diovascular disease and ageing”, was support-
ciated increase in the number of cardiovas-
ease to developing countries. The global
an expanded form with the World Heart
ed by many of the 300 sessions.
cular conditions.
nature of the event was also reflected in the
Foundation’s XVth World Congress of
Michal Tendera, President of the ESC, high-
But if this was the focus of the show, the
almost 4,000 abstracts, which were selected
Cardiology. With over 32,000 participants
lighted this as one of the most important
highlight was the opportunity to exchange
from over 10,000 submissions, coming from
over the course of 4 days, this was the year’s
challenges facing cardiovascular medicine.
various and best practices from around the
94 countries from Europe, Africa, Asia and
largest event in cardiovascular medicine.
By 2050 there will be twice as many
world – particularly to prevent the seeming-
the Americas.
3
GETTING PERSONAL AT ESC
Thinking care through
Philips presence reflects
the change of focus
hilips presence at this year’s
ESC, showed it was
addressing not just the technologies,
but the logic of the whole care cycle,”
said Kevin Haydon, Executive Vice
President, Chief Executive Officer,
Global Sales and Service of Philips
Medical Systems. Bert van Meurs, Senior
Vice President for cardiovascular X-ray
agreed, “while other booths stressed the
excellence of individual products, this
year Philips highlighted the strength
of the portfolio to address whole workflows”. Dr. Maarten Barmentlo, Chief
Executive Officer of Philips Connected
Care added, “this extends even outside the
hospital, to home telehealth systems and
remote patient management.“
“P
Dr. Maarten Barmentlo, Chief Executive Officer of Philips Connected Care
Kevin Haydon, Chief Executive Officer, Global Sales and Service International
4
In the spirit of setting standards others
follow, Gert van Santen, Director of
Healthcare Communications, EMEA,
was pleased that this year Philips
“dared to address less comfortable,
business-oriented aspects of coping
with the dramatic increases in the
number of cardiac patients.” For Margrit
Lelieveld, Marketing and Sales Director, EMEA, the change was also obvious
in the infectious enthusiasm of the
staff, “not just to lead in cardiac technology, but to be the leading cardiac
company.”
Cardiac Care Connected at the
World Congress of Cardiology 2006
Cardiac Care Connected is about thinking in clinical workflows.
This was reflected by Philips booth in the Exhibition area, which was divided,
not into different product groups, but into clinical areas.
or the CCU, Cardiac Care Connected focuses on the
challenges facing cardiologists and the treatments
they deliver. This means, for example, aids to interpret the
data available from patient monitoring, or support for
upholding best practices for CPR (Cardiopulmonary Resuscitation). In the non-invasive lab, the stress was on bringing
data together in the office – including to reevaluate earlier
studies – to boost confidence in decisions. In the interventional lab, it was the breadth of the portfolio, for both cath
lab and electrophysiology, and the availability of images and
data from other sources that was important. Finally, the home
telehealth area looked at extending monitoring to patients
after they are discharged, to boost compliance with doctors’
guidelines about medications and lifestyle habits for better
managing chronic disease.
F
5
CARDIAC CARE CONNECTED
What is
“Cardiac Care Connected”?
Operating Room
Monitoring / Imaging
Treatment
Diagnosis
Diagnostics
Imaging
Prevention
Rehabilitation
Management
C
6
Home
Treatment
Integrated solutions that help clinicians better address today’s major heart diseases
ardiology is a complex challenge that demands optimal
clinical and management skills. With a
dramatic increase in cardiac patients in
the years ahead, clinicians need new
ways to more accurately and cost-effectively treat the three main diseases:
ischemia, arrhythmia and heart failure.
Philips has long worked with leading
cardiologists to develop innovative
solutions dedicated to addressing these.
With Cardiac Care Connected, we
build on these applications by connecting them through all parts of the CCU,
and interventional and non-invasive
areas in the cardiology department, to
create the strongest support available
for the cardiac care cycle. Our goal: to
let cardiologists focus on the needs of
their patients.
Cardiac Care Connected harnesses the
strengths of the broadest cardiac portfolio on the market altogether. This
will let cardiac care professionals from
different hospital departments access
all patient information and images –
from current and existing studies, from
any cardiology imaging modality. In
Xcelera 2.1, for example, the complete
and detailed view of each patient’s cardiac condition is available in a single
workspace. It is also supported by a
suite of accurate measurement and
Intensive Care unit
Monitoring
Follow Up
Pre-Hospital / Ambulance
Monitoring
Home Healthcare
Personal Care
Home Healthcare
Remote Monitoring
Home Healthcare
Emergency Response Service
Hospital
In cardiology Philips is the only company present across the entire care cycle
analysis tools for 2D and 3D echo, cardiovascular X-ray, and
cardiac CT and MRI images. The results are treatment decisions that are better informed, more accurate and timelier.
In addition, Xcelera WebForum provides secure, direct access
to the information from within and outside the hospital. This
lets clinicians compare and contrast data from patients
assessed in different locations, or share information within
their clinical community.
From hospital to home
But Cardiac Care Connected does not stop at the doors of the
hospital. Remote patient management extends the cardiac
care cycle into the home. Motiva is a groundbreaking TVbased platform for chronic care management. It lets clinicians
educate and communicate with their patients at home, by
complementing remote monitoring with a personalized, yet
automated, programme of daily interaction and feedback.
This improves the patient’s knowledge and boosts their confidence in changing behaviours to better manage their chronic
condition.
Philips also has other new non-invasive, interventional, CCU
and home care products that make cardiac care connected
possible. These help clinicians make intelligent decisions
about a patient’s cardiac condition, by integrating and
analysing information from different sources, and include:
• Using 3D CT images for planning diagnosis in the cath
lab
• Simplifying ventricular functional analysis
• Helping the planning and assessing the impact of electrophysiology studies
• Including CT segmentation and CT/fluoroscopy overlays
to improve catheter location
• Streamlining workflows in the cath lab
• Guiding operations using intracardiac echo
7
DIALOGUE
Improving results
Several studies, most notably the TEN-HMS and WHARF
studies, have shown remote patient management can reduce
patient mortality rates. Integrated remote monitoring helps
identify worsening heart failure and the early symptoms of
co-morbidities.
Referring to his work on the TEN-HMS study, Prof. John
G.F. Cleland (University of Hull, Academic Department of
Cardiology, Foundation Chair in Cardiology, Hull UK) pointed
out the advantage of remote patient management over conventional care. “A nurse call line, or a system like Philips
Motiva, gives the patient immediate feedback on their condition
and reminds them of and reinforces the necessary changes in
their lifestyle,” he says. From his own experience, Prof.
Stephen Gottlieb (Division of Cardiology University of
Maryland School of Medicine, Baltimore, Maryland, USA)
also found that, regardless of how it was delivered, intensive
remote patient monitoring can reduce patient mortality.
Role of remote patient
management in guideline-based
heart failure care
An EBAC accredited education session brought together
experiences from Europe and North America.
nitial findings suggest remote management could be an
important way of helping cardiovascular patients keep
the advantages of their therapy, and improve both the quality
and length of their lives. With the increasing average age of
the population in Europe and North America, and the associated rise in cardiac disease and decrease in the number of caregivers available, it could also be a way of improving productivity to look after the increasing caseload.
Heart failure is a complex disease that depends on correct
I
8
diagnoses and effective therapies. All too often, hard-won
progress is at risk when the patient moves between primary
and secondary care. Sometimes this is for reasons as simple as
a general practitioner modifying medication, without the
patient’s cardiologist knowing, to treat some other condition.
Remote patient management enables the entire care team to
effectively monitor the patient at home, to intervene earlier if
the patient decompensates and hopefully avoid unnecessary rehospitalizations.
Prof. Cleland also noted how keeping communication between
hospital and patients is important for their sense of security
after discharge. Prof. Guus van Montfort, Managing Director
Healthcare with Achmea, the largest health insurer in the
Netherlands (and member of the board of Eurotransplant
International Federation, Leiden) highlighted the satisfaction
patients get from managing their own condition, and Prof.
Gottlieb added that repeated contact solidified the doctor/
patient relationship, and made the patients more keen to
comply, to “please their doctor”. “Though these are important – and we are preparing a study to quantify the improved
quality of life,” says Prof. Gottlieb, “these are hard ideas to
factor into a business decision.”
Reducing costs
Like many others, Prof. Gottlieb’s team at the University of
Maryland initially looked to remote patient management as a
way of reducing hospitalizations, and of controlling costs.
However, he explains, probably because of the increase in
information available from remote monitoring, patients are
at times brought back to hospital for co-morbidities that
might otherwise have gone unnoticed. To some extent these
results correspond with the findings of the TEN-HMS study.
Yet the TEN-HMS study demonstrated a shorter lenght of
stay and a trend toward fewer hospital days, and thus an overall savings with telemonitoring in addition to improved survival rates.
Professor Dr. Guus van Montfort, Healthcare Director with Achmea
“The goal is to help patients
their own conditions.
This will help the healthcare
system cope with the increasing caseload.”
9
SYMPOSIA REPORT
Joint Nuclear Medicine, Magnetic Resonance, X-ray and Computed
Tomography Satellite Symposium
Recent Advances
in Cardiac Imaging
combination of MR imaging with
X-ray imaging (XMR) offers a new
approach in cardiovascular procedures.
Motiva gives the patient feedback on their condition, and reminds them of and reinforces the necessary changes in their lifestyle.
Prof. Cleland comments that “using electronic tools for remote
patient management can help use healthcare resources more
efficiently.” Staff account for up to 80% of the cost of delivering healthcare in the UK, so automating clinical intervention
and patient educationas much as possible is the first step in
improving staff efficiency and making best use of their
expertise. Prof. Dr. Eckart Fleck (Berlin, Germany) expanded
on this by demanding that remote patient management needs
to integrate into the overall workflow and into the patient
record, if it is to maximize the efficiency benefits.
Prof. van Montfort reported how using broadband-enabled
patient education and monitoring could increase staff efficiency, though the pilot study he is involved in is not due to
announce results until the first quarter of 2007. Achmea is
using a call centre (Medical Service Center), staffed by trained
nurses and medical professionals who provide first line
response, who use Philips Motiva to monitor the patient’s
condition and to deliver feedback and targeted education.
The Remote Patient Management area on the Philips’ booth.
10
“The eventual goal,” he says “is to support implementation of
effective disease management tools, help patients manage
their own conditions, and to foster prevention. This will help
the healthcare system cope with the increasing caseload.” He
suggested that part of this process means having to work
closely with technology partners. Achmea is working with
Philips, whose Motiva care management platform enables
call centre nurses to monitor patient vital sign parameters
and deliver training modules to patients at home.
A presentation by Dr. Thierry
Lefèvre from the Institute of
Jacques Cartier, Massy, France on
non-invasive MDCT cardiac imaging, demonstrated how CT imaging is a robust method for visualization of the entire coronary artery
tree in a single breath hold. The
lecture continued with a focus on
the integration of MDCT in the
cath lab offering a new approach
for interventional procedures. Not
only is less contrast media required
during PCI, but procedural time is
spared.
r. Andrew Kelion from Harefield Hospital,
Harefield, UK presented the positioning of nuclear
cardiology in the United Kingdom and shared his experience
and the importance of nuclear medicine at Harefield with the
audience.
Professor Dr. Reza Razavi of Guy’s and St. Thomas’ Hospital,
London, UK clearly outlined and demonstrated to his listeners that there is a definite need for better anatomical visualization during interventional procedures and cardiac magnetic
resonance addresses this need for clinical diagnosis and treatment. Not only is MR a modality that provides excellent
anatomical and functional information, but a radiation free
imaging modality, especially important for children. The
D
11
SYMPOSIA REPORT
PRODUCT NEWS
Ongoing live 3D echocardiography
improvements for
wider clinical acceptance
The Xcelera cardiovascular information solution
How live 3D echocardiography is delivering on its early promises,
and making itself increasingly indispensable.
hree of the four speakers at this satellite symposium
outlined the speed with which the 3D data set was
acquired by Philips ultrasound machines – in just 4 beat
cycles – as important. For paediatrician Dr. John Simpson
(London, UK) having a complete 3D data set meant being
able to scroll through the various planes to get exactly the
relevant slices, with the confidence that he had missed nothing important.
Dr. Harald Kühl (Aachen, Germany) elaborated on the usefulness of Tomographic images from ultrasound that correlate
well with MR images for diagnostic quality. He also discussed the various possibilities of parametric imaging – such
as those from the QLAB software, on the echo machine or offline – to make mechanical asynchrony easier to recognize and
communicate.
he latest version of Xcelera, premiered at the ESC, is a single solution to meet clinical information needs for
different cardiovascular subspecialities.
This is the essence of Cardiac Care
Connected.
T
T
Xcelera provides a consistent, patient-centric workspace for information management across the cardiovascular care cycle.
A comprehensive overview of a patient’s
condition will help cardiac professionals to
more efficiently diagnose a patient’s condition and make more informed decisions
about the method of treatment.
Dr. Roxy Senior, Northwich Park Hospital, London
Dr. Leopoldo Perez de Isla, of Hospital Clinico San Carlos in
Madrid, Spain, presented how such parametric images are
practical in reproducibly quantifying left ventricular function
for assessing the success of Cardiac Resynchronisation
Therapy (CRT), and possibly in identifying patients who will
respond to CRT.
Dr. Roxy Senior, Northwich Park Hospital, London, UK,
showed how Philips new S5-1 single crystal transducer provides better images at lower power, so making better use of
contrast agents. Apart from assessing the perfusion of the
myocardium, this simplifies both perfusion and wall motion
studies.
12
Personal service
throughout the hospital
A focal point for cardiac imaging
The Xcelera workspace provides access to
X-ray, cardiac and vascular ultrasound, CT,
MR and nuclear medicine examinations, as
well as ECG and EP mapping and recordings. It utilizes the same, advanced, quantification tools as used on the modality
consoles, enabling more confident interpretations and the ability to consistently
re-quantify previous results outside the
examination room. And because both the
Xcelera workspace and the clinical applications feature
Philips’ consistent user interface, learning curves are short
and users experience a more enjoyable work environment.
Philips’ life cycle continuity program means a future safe
investment. We allow you to leverage previous investments
and enable access to the latest clinical and IT technologies.
For example, you can migrate earlier generations of Xcelera,
such as EnConcert and Inturis, to Xcelera.
Philips is a clinical partner committed to market-leading cardiovascular imaging equipment and information management. And Xcelera is Philips’ leading edge solution to ensure
the cardiac care cycle is well connected.
13
PRODUCT NEWS
X-RAY
Miniaturized transducer for Live 3D
Echo
EPNavigator
Philips presented as works-in-progress EPNavigator, a new
software application in the field of Electrophysiology.
EPNavigator enables users to segment previously acquired
3D CT datasets into 3 dimensional volumes of the heart and
overlay and register these 3D segmented data sets with live
fluoro X-ray images. The position and movement of the
catheters can be shown with respect to the 3D volume images
in order to support catheter/device navigation during specific
procedures.
The new X7-2 xMATRIX transducer, designed for pediatric
Live 3D imaging, is another significant milestone in Live 3D
Echo. It combines PureWave crystal technology with the
exclusive 3D xMATRIX transducer design. The perfect
arrangement of atoms in the PureWave piezocrystals over
conventional piezoceramics, makes them ideal for miniaturizing 3D xMATRIX transducers.
The x7-2 has 2500 active elements for fully sampled, high
resolution 3D volumes, yet its footprint is optimised for paediatric, neonate and epicardial imaging. To complement its
size, it uses a lightweight, ultra-flexible cable.
The result is best in market 3D image quality and color sensitivity, as well as PW Doppler.
QLAB plug-in for quantitative
functional information
The 3DQ Advanced plug-in eliminates geometric assumptions and reduces the problem of apical foreshortening, for
more accurate LV volumes and ejection fraction assessment.
3D synchronicity indices help identify patients who will best
benefit from CRT.
3DQ Advanced also offers new parametric displays for better
quantitative assessment of dyssynchrony (timing display) and
ischemia (excursion display).
The timing display allows assessment of both early and
delayed contraction, by showing the distribution of Time to
Minimum Systolic Volume (TMSV). Areas with normal contraction times are shown in green, areas representing early
contraction are coded in progressively lighter shades of blue,
and areas which are late are coded in red – orange – yellow.
The excursion map uses color coding to present excursion
amplitudes.
14
Imprint 02 – October / 2006
TradeshowNews
XVth World Congress of Cardiology in Barcelona
Published by
Philips Medical Systems
Hewlett-Packard-Straße 2
71034 Böblingen, Germany
Editor
Christian Ragil
Executive Editor
Sandra Pfeiffer
Associate Editors
Maria Buscemi, Irene Kachmarsky,
Sandra Pfeiffer, Monika Wang-Kerschdorfer
Coordination
Stefan Geiger, K.(PUNKT) GmbH
Design & Artwork
K.(PUNKT) Agentur für Kommunikation GmbH
Printing
Druckerei Mack GmbH
Siemensstraße 15
71101 Schönaich
Feedback
Philips Medical Systems,
Fax +49 7031 463 1552
Liability
The editor assumes no liability for the correctness
of the publication, examination by the editorial
staff notwithstanding. Reproductions in any form,
in whole or in part, are only permitted with the
written approval of the editor.
15
Advertisement
“They gave me back
my life.”
Fusing SPECT and CT images to diagnose infection
with pinpoint accuracy.
Dr. Stephen Scharf (left) and Ronnie Sitton (above)
hen renowned Orthopedic
Surgeon Lon S.Weiner, M.D.,
Section Chief, Orthopedic
Trauma, Lenox Hill Hospital (Manhattan, New
York, USA), agreed to see Madlyn Sitton’s son,
he had no idea just how grave the situation
was. Until he saw the leg. Hit by a car in the
summer of 2004, 15-year-old Ronnie Sitton
was lucky to be alive. Rushed to a nearby
hospital, surgical fixation to repair shattered
femurs in both legs left him immobile for three
months and on crutches for six.While his right
leg healed, his left leg started to swell.
W
“By the time I saw him, nearly a year and a half
post surgery, I knew we had just a matter of
time to reverse a potentially tragic outcome,”
says Dr.Weiner.“Ronnie had no knee mobility.
His left leg was twice as big as the other; it was
so swollen and angry that we thought he might
have a vascular situation.When his Doppler
came back clear, I suspected we were dealing
with an occult infection.That’s when I sent
him to Dr. Scharf.”
Stephen C. Scharf, M.D., Chief of Nuclear
Medicine, Lenox Hill Hospital performed a
gallium study using the new Philips Precedence
SPECT/CT system and immediately discovered
an abnormality in the leg.“With SPECT alone,
we would have been able to confirm a soft
tissue infection. However, by fusing SPECT
images with CT images we were able to
pinpoint the exact location of the infection. In
this case, the SPECT/CT scan showed infection
in the screws with soft tissue infection in the
lateral part of the thigh,” recalls Dr. Scharf.
“We used the power of the scan to help
us save this boy’s leg. Not only did the scan
confirm one of our suspicions, but it also
guided us and allowed us to intervene with
tremendous accuracy.We removed the plates
and screws, cleaned out the infection, and most
For more information on this story and Philips Medical, go to www.philips.com/patientstories
importantly, stayed away from the knee,” says
Dr.Weiner.“We eliminated the ‘maybes’ by
fusing the two images, by connecting the what
with the where,” adds Dr. Scharf.
Mrs. Sitton shudders to think of the ‘what ifs?’
and credits Dr.Weiner, Dr. Scharf and Philips for
saving her son’s life.“Ronnie had had numerous
scans and no one was able to determine what
was going on with his leg. I knew something
was wrong and I knew I had to find an answer.
I sorted through 200 names until I found Dr.
Weiner.The fact that he knew Dr. Scharf and
that Dr. Scharf had the technology to diagnose
the problem … it’s a miracle.”
As for Ronnie, he’s not only walking, but is also
back on his skateboard.“Folks kept telling me
how lucky I was to have survived the accident
with just two broken legs. But the lucky part
was having my mom with me — she never left
my side and never let me give up.”