<International Circulation>:Heart failure is one of the hot topics in this congress， are there any updates on this topic?

Prof. Zannad: There’re several sections on heart failure in this meeting， but there is no single very important news in heart failure. There are a lot of overviews of what is going on. But one interesting topic is the difference between systolic dysfunction and heart failure with preserved systolic dysfunction. So there is a emerging concept now that it is the same disease with some different degrees of severity. But obviously medications which work on systolic dysfunction would work also in heart failure with diastolic dysfunction. But diastolic dysfunction has not been studied extensively. And there are trials which I’m going to be delivering the result in some month of the year. But we have much less evidence based medicine for diastolic heart failure than systolic heart failure. And the second hot topic in this meeting was about BNP. 

<International Circulation>:About BNP?

Prof. Zannad: BNP was now being validated as a tool for prognosis， what important is that it is increasingly used as a diagnosis tool especially in patient with preserved systolic function. A number of patients have signs or symptoms of heart failure which are very unspecific， fatigue， dyspnea， and congestion are not specific to heart failure. So you know in order to make the diagnosis of heart failure we need to have the signs and symptoms on the one hand， but we need to have at least some sort of cardiac involvement. Usually this was done by echocardiography to find out， but still even if echocardiography may miss diastolic dysfunction. And this is the reason why BNP may be very helpful in diagnosis of heart failure. You know， in Europe there is very large variation in the healthcare systems form one country to another. And for example， in United Kingdom they do not have as many cardiologists as in many other European countries. Therefore， their heart failure patient do not have echocardiography as frequently as we have that in France or Germany. So UK are relying heavily on BNP. 

<International Circulation>:So you just suggest that there’s strong relationship between BNP and diastolic heart failure?

Prof. Zannad: Yes!

 <International Circulation>:We all know ARB(ACEI) and beta-blocker are very useful for the long prognosis of heart failure， but some heart failure patients have very lower blood pressure， for example 90/60， how to use those drugs in such clinical scenario?

Prof. Zannad: Blood pressure itself is not the problem if the patient is not symptomatic. There are patient have 85 mmHg systolic pressure，do well! So it’s not the problem! But in some patients it is a problem， even that 95 or 100 mmHg， patient are symptomatic. And in this case if they are symptomatic we can not update risk rate or sometimes even initiate beta-blocker or angiotensin-converting enzyme inhibitor. And in this case these patients are severe enough and these are really the patients who would need resynchronization.

<International Circulation>:Yes， CRT.

Prof. Zannad: Device therapy. Otherwise there are majority of drugs available for heart failure led to lower blood pressure， so if the patients don’t tolerate treatment because of very low blood pressure， this is the pump failure， and we need to resynchronize them. 

There had been other important discussion in this meeting and one very important is ADVANCE trial. 

<International Circulation>:Yes， I heard about it. One of our hospital’s departments take part in this trial. 

Prof. Zannad: Good， good， So I’m sure that you have interviewed the doctors who have involved in this trial. And it is pertaining to your discussion early on the combination therapy and how well we can control the risk of the patients. The other information important in this meeting is how poor life style is changing this part of the world in Europe. From a trial of Europe， the results are very disappointing， although we have smoke drugs， and investing a lot of money in healthcare. In Europe we are doing a lot of job controlling blood pressure and decreasing LDL level with drugs. But patients still smoke a lot.

<International Circulation>:Yes， it is a problem!

Prof. Zannad: They do not think the size， weight is on the rise， and diabetes is on the rise. And this is really a issue and I know， that in china， this is also a very important issue， because you used to have healthy life and now you are adopted to a poor western style life.