Stephan Achenbach is professor of medicine at the University of Erlangen, Erlangen, Germany and president of the European Society of Cardiology (ESC). A specialist in cardiac imaging, he talks to Cardiovascular News about how imaging techniques have evolved over the course of his career, and the biggest developments he has witnessed in interventional cardiology.
Why did you choose to become a doctor and why, in particular, did you choose to specialise in cardiology?
While I initially set out to study physics, working in a hospital for a few weeks convinced me that medicine would be much better—so I dropped physics, signed up for medical school and never looked back! An enigmatic cardiology lecturer in medical school, Kurt Bachmann, got me so interested in the subject that I selected a cardiology topic for my doctoral thesis and it has been cardiology ever since. As usual, it was a mixture of the subject itself and the people I met which drew me in that direction.
Who have been your career mentors?
Werner Moshage, who was passionate about a thorough approach to patient care, was an early mentor in clinical cardiology. Also influential were the two department chairs under whom I received my cardiology training, Professor Kurt Bachmann and Professor Werner Daniel. I also owe a lot to Tom Brady (Massachusetts General Hospital, Boston, USA) and Christian Hamm (Bad Nauheim and Giessen, Germany), as well as my colleague Holger Nef who was inspirational in his enthusiastic attitude towards innovation in interventional cardiology. However, I find it particularly important to mention the countless peers and co-workers during my many years of training and practice and who, through thousands of encounters—directly or indirectly—taught me countless little lessons.
What has been the most important development in cardiology during your career?
There are so many important developments to mention. I was able to witness first-hand the development of interventional cardiology, from the availability of simply coronary balloon angioplasty, all the way up to transcatheter valve repair. Another very impactful development I have witnessed is the disappearance of thrombolysis, replaced by primary percutaneous coronary intervention (PCI). Also, I was lucky to be part of the tremendous development of cardiac imaging during the past quarter of a century. These more technological advances were accompanied by unimaginable developments in drug treatment—recognising the value of statins or the advent of new heart failure medications to mention just two. When I started my training in 1993, ACE inhibitors had just come out and prescribing them was a courageous adventure that included having to perfom a “captopril test” in every patient. Also, and hard to imagine today, statin therapy was not a given. The 4S study, establishing simvastatin for lipid-lowering treatment in patients with established coronary disease, was only published in 1994 and I witnessed the ever-deeper penetration of statins and ever decreasing goals for LDL-cholesterol. I would estimate that statins had the strongest impact on the outcome of heart disease patients during the three decades of my career.
What has been the biggest disappointment? Something you hoped would change practice but did not?
Lots of valuable lessons have been learned from bioresorbable vascular scaffolds. It is very difficult to improve something that is already very good. And, very early data is frequently also very optimistic data.
You have been a pioneer of cardiovascular imaging–what has been the biggest development in this area in the last decade, and what will be the biggest development of the next decade?
All imaging modalities continue to evolve—often quietly. I am convinced that echocardiography, magnetic resonance, and computed tomography will continue to do so, providing constant improvements in image quality. The biggest development will certainly be the use of artificial intelligence in image interpretation, detecting more than the human eye can see.
What are your current research interests?
Currently, my main areas of interest are a combination of cardiac imaging and coronary as well as structural heart intervention. Here, I can combine my research interests and clinical passion.
What are the key unanswered questions around the field that future research
There are so many, but I can name a few obvious ones: can we identify patients who benefit from revascularisation—maybe by combining information on ischaemia with “plaque vulnerability”? Who really needs a statin and how intensively? Who benefits from aspirin? Who is a good candidate for transcatheter aortic valve implantation (TAVI), and who is better served with open heart surgery? It all boils down to the use of imaging to allow us to practice “precision” or “personalised” medicine.
What has been the most important paper published in the past year?
Again, I can only name an example. EXPLORER-HCM impressed me deeply due to the fact that basic science taught the way to a targeted drug that seems to strongly influence patient outcome.
How has the COVID-19 pandemic impacted the field of cardiology?
In Germany, so far we have been able to practice cardiology and treat almost all of our patients according to usual practice in spite of the COVID-19 pandemic. I am very grateful for this and for the strength of the German healthcare system. Let´s hope we will still be able to say this when this winter is over.
You are currently serving as the president of the European Society of Cardiology (ESC)—what will be your main areas of focus in this role?
At the moment, we have to keep the ESC strong in the COVID-19 pandemic and we have to do whatever we can to serve and help our members as well as the cardiovascular community as a whole. The turn towards digital education is a small part of the issue. Otherwise, I will place focus on good communication and collaboration with the 57 national cardiac societies—from Iceland and Portugal to Russia and Kazakhstan, as well as from Sweden and Norway to Egypt and Morocco—that make up the ESC.
ESC has opted to host all of its events digitally in 2021. How has the advent
of digital congresses changed medical education?
We had 120,000 registrants at the digital ESC 2020 congress. Online education has, for now, substantially increased the reach of educational offers. We simply reach more people. But, once we learn to use digital formats to their full potential, they will also increase educational impact through new modes of delivery, interactive design, focused and higher-intensity learning. The process has only just started. It was not caused by, but substantially accelerated by the COVID-19 pandemic. However, I am certain that physical congresses will “come back”, even though it will take quite a few years. The group experience of exchanging and learning jointly with others is very much appreciated by many.
Looking back over your career what has been your most memorable case?
I do remember several specific patients, not so much as “cases”, usually because of specific circumstances or personalities.
What advice would you give to someone looking to start a career in
One does not have to be a genius to be a good doctor. It is those who are thorough, accurate and meticulous, and who show true empathy for their patients, who are the best doctors. And, if you are good at what you do, you will almost certainly enjoy it.
Outside of medicine, what are your hobbies and interests?
I have quite a few interests, which include photography, sports (running, swimming), and nature. And, I have good hopes for a future with enough spare time to enjoy all of these and more.