Thomas F Lüscher is professor and chairman of Cardiology at the University Heart Center, University Hospital Zurich (Switzerland) and the director of Cardiovascular Research, Institute of Physiology, University of Zurich, Switzerland. He has been involved in many pivotal studies, including research that defined the role of endothelial mediators and changed the view of how cardiovascular systems function. He spoke to Cardiovascular News about this research and other highlights of his career.
Why did you decide to become a doctor and why in particular, did you choose to specialise in interventional cardiology?
I was largely inspired by my father, who was a dedicated physician, to study medicine. Following his sudden death after seeing a patient, I became extremely interested in myocardial infarction and its risk factors. This motivated me to become a cardiologist.
Also as a child, I loved to use my hands to build model aeroplanes and boats among other things. Therefore, interventional cardiology offered me an opportunity to combine my two passions of using my hands and my brain. Furthermore, the seminal intervention by Andreas R Grüntzig at our institution stimulated me further to pursue this subspecialty.
Who have been your career mentors?
Walter Siegenthaler asked me to join his department. He assigned me to hypertension research without asking me and therefore, I pursued research in this area. Interestingly, my recent interest in renal nerve ablation took advantage of this early training, closing the loop in a long career.
In hypertension, it was Wilhelm Vetter who taught me clinical research. After my training in Zurich, I moved to the Mayo Clinic to work with Paul M Vanhoutte in cardiovascular research. With Paul, who became a close friend, I truly learned what research meant, how to pursue questions, how to publish results and—last but not least—how to have fun as a researcher. In Paul’s research group, I learned novel and fascinating things about blood vessels, including how they function and how they become diseased. The endothelium was at the centre stage then and we discovered new things almost every day and had the privilege to get to know Robert Furchgott, Louis Ignarro and Ferid Murad who worked in this area and later became Nobel prize winners.
Upon my return to Switzerland working with Fritz R Bühler, I was able to translate these basic findings to patients with hypertension and other conditions and to demonstrate that vascular function and endothelial dysfunction in particular may be an early and important step in the development of cardiovascular disease. When I was called by Bernhard Meier to join him as a co-director of Cardiology at the University Hospital in Bern, he gave me the opportunity to become a true interventional cardiologist and he has been a role model in this regard for me ever since. I am most grateful to all these mentors of mine who allowed be to pursue an exciting career in the USA and Europe and to become chairman of an important department in my country.
In your view, what has been the most important development in interventional cardiology?
As chairman of cardiology at the University Hospital Zurich, Switzerland, obviously, I am proud to say that the first coronary angioplasty performed by Andreas R Grüntzig on September 16, 1977 was the most important development in interventional cardiology. In fact, it created interventional cardiology as a discipline and we are all proud in Zurich that this was done at our institution.
Of all the research you have been involved with, which piece of research are you most proud of and why?
As a consultant, I was able to characterise the human cardiovascular system and the role of endothelial mediators in particular in many papers that we published in the best medical journals. This has changed the view on how the cardiovascular system functions and has established endothelial mediators as important regulators of cardiovascular health. Also, their dysfunction is now seen as an early and crucial cause of cardiovascular disease in the coronary circulation and the cardiovascular system at large. There are not many occasions where you can make an impact in science and I am proud that I was able to do so.
What are your current research interests?
Currently, my collaborators and I are pursuing four major research interests: effects of renal nerve ablation in patients with hypertension and beyond (ie. heart failure and kidney disease); the alterations of high density lipoprotein (HDL) cholesterol in cardiovascular patients (the so-called HDL-dysfunction); the role of ageing and longevity genes in the development of cardiovascular disease and atherosclerosis as well as stroke in particular; and the role of progenitor cells for regenerative medicine and stem cell therapy after acute myocardial infarction. All these projects can only be pursued effectively thanks to the fact that we were able to recruit excellent clinical researchers to our department and to work together productively in these areas.
What do you think has been the most interesting paper in the past year?
A study, which was published in The Lancet this year by Thompson et al, of mummies that showed that atherosclerosis of the coronary and cerebrovascular arteries was already very common even at a younger age 4,000 years ago. This truly shows that this disease is not a mere reflection of modern lifestyle, but a genuine disease of the human race. Thus, genetic causes, which so far were difficult to find, must be our major aim in future research.
You were involved in the COMFORTABLE AMI study, which evaluated a biolimus-eluting stent with a biodegradable polymer. What data do you have for stents with a biodegradable polymer and what data is still needed?
The COMFORTABLE AMI study was done together with our friends at the University Hospital in Berne and was successfully published in the Journal of the American Medical Association last year. I am convinced that this is an important piece of work demonstrating that in patients with acute coronary syndromes, drug-eluting stents are superior to bare metal stents. This clearly will and has already influenced clinical practice in many countries.
Currently, we are pursuing another study in patients with cardiogenic shock who are rarely included into such trials. The SHOCK-DES trial that we are currently planning and hopefully starting in Q4 this year will address the same question in patients presenting with cardiogenic shock. Based on a registry analysis, we are very hopeful that we will again be able to show the superiority of drug-eluting stents in these high-risk patients and hopefully also a reduction in mortality as suggested by the propensity analysis we performed in our registry.
Do you think we are moving towards a future in which all stents will have a bioresorbable element (ie. stents with biodegradable polymers or bioresorbable scaffolds)?
Indeed, many patients do ask me whether a stent is there to stay and they usually are concerned about having a foreign body forever in their coronary circulation. Therefore, I do believe that the concept of bioresorbable scaffolds is visionary indeed. Furthermore, my work on the coronary vasomotion and endothelial function, in particular, strongly suggests that blood vessels continuously dilate and constrict depending on the needs of the myocardium and on whether we exercise or rest. To restore coronary vasomotion in the mid-term by using bioresorbable scaffolds, therefore, seems right in the first place. Whether the current scaffolds yield lactic acid truly represent the optimal solution remains to be shown in larger trials. However, initial studies in smaller patient populations provided very positive experiences and I, therefore, believe that we should pursue this area further.
We now have percutaneous interventions for coronary arteries, aortic stenosis and for resistant hypertension. What other cardiovascular conditions do you think could potentially be managed by interventional cardiology procedures?
Renal nerve ablation might not only be suitable for patients with hypertension, but most likely also in patients with heart failure and renal disease. Together with Michael Boehm from the Saarland University, we are currently setting up a trial in patients with heart failure using renal nerve ablation. Furthermore, we are planning a study in patients with cystic kidney disease to determine whether this procedure may also be useful in this condition. Indeed, early and small studies suggest that renal nerve ablation may actually preserve renal function in the long run. Importantly, however, we also have to show that renal nerve ablation reduces major cardiovascular events in hypertensive patients. To that end we are setting up the Enlightnment trial with 5,000 patients randomised to the procedure or medical therapy with Stuart Connolly and Michael Boehm supported by St Jude Medical. Finally, the mitral valve is the next target of interventional cardiology, currently we are using the MitraClip, but in the future we might see also percutaneously implanted mitral rings and possibly also mitral valves.
You have won several awards. Which one are you most proud of?
In 1990, I won the Young Investigator Award at the World Congress of Cardiology in the Philippines. At that stage of my career, this was the most important award and I, therefore, remember this one particularly dearly.
You are a course co-director of EuroPCR. In these times of austerity do you think it is still important to attend international conferences such as EuroPCR?
Sharing experiences, to receive information personally and to participate in discussions face-to-face is the main aspect of any congress and I strongly believe that humans as “social animals” will never completely withdraw from international meetings of high quality. Webinars will become more popular, but they are never a substitute for an on-site participation at a high quality congress.
Outside of medicine what are your hobbies and interests?
My main interest outside medicine is philosophy and I have written a book on this topic that obviously relates to medicine but looks at it from a different angle. The book “GedankenMedizin” (Springer, Heidelberg, FRG 2010) is written in German, but has sold quite well and brought me (for a change) a number of invitations to talk about the philosophy of health and other aspects of life.
1996–present Director of Cardiovascular Research, Institute of Physiology, University Hospital, University of Zurich, Zurich, Switzerland
1996–present Professor and chairman of Cardiology, University Hospital, University Hospital, University of Zurich, Zurich, Switzerland
2007–2009 Chairman, Department of Medicine, University Hospital, University Hospital, University of Zurich, Zurich, Switzerland
1986 Echocardiography Laboratory, Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic and Mayo Foundation, Rochester, USA
1984–1986 Research associate, Cardiovascular Physiology, Department of Physiology and Biophysics, Mayo Clinic and Mayo Foundation, Rochester, USA
1983–1984 Division of Cardiology, Department of Internal Medicine, Medical Policlinic, University Hospital, University of Zurich, Zurich, Switzerland
1982 Consultant service of Internal Medicine, Neurosurgical Postoperative and Intensive Care Unit, Neurosurgical Clinic, University Hospital, University Hospital, University of Zurich, Zurich, Switzerland
Intensive Care Unit, Department of Internal Medicine, Medical Clinic, University Hospital, University Hospital, University of Zurich, Zurich, Switzerland
1981–1983 Department of Internal Medicine, Medical Policlinic, University Hospital, University Hospital, University of Zurich, Zurich, Switzerland
2012 Mayo Clinic Distinguished Alumni Award
2008 The Khwarizmi International Award, Islamic Republic of Iran
2007 ESC Andreas Grüntzig Lecture on Interventional Cardiology and Silber Medal
2001 Theodor-Nägeli Award for Thrombosis Research, Basel, Switzerland (with M Eto)
2001 Björn Folkow Award of the European Society of Hypertension, Milan, Italy
1990 Young Investigator Award (First Prize), 11th World Congress of Cardiology, Philippines