Overview and Meeting Theme
During the ongoing COVID-19 crisis, we express our heartfelt respect for all the frontline healthcare-related workers who are working hard on COVID-19 measures, in addition to providing regular medical care, striving to bring this situation to a resolution as quickly as possible.
Under these challenging circumstances, the 85th
Annual Scientific Meeting of the Japanese Circulation Society (JCS) was held from March 26 to 28, 2021, in a hybrid format on-site in Yokohama, Japan, and online for the first time in its history. In accordance with the policy of the JCS, which promotes internationalization, this meeting was held with the World Congress of Cardiology (WCC), operated by the World Heart Federation (WHF), as JCS together with WCC 2021, for the first time in the history of the JCS. The Congress Co-Chairperson was Professor Karen Sliwa, Heart Institute for Cardiovascular Research in Africa, University of Cape Town, South Africa. The on-site presentations were live-streamed from the venue, Pacifico Yokohama North, and delivered on-demand until June 30, 2021, together with all the general abstracts and some designated prerecorded presentations. Due to the large scale of the meeting, the board of the JCS decided to hold the annual scientific meeting at 3 designated cities in Japan, and this meeting was the first to be held at one of these cities. Twenty presentation rooms were arranged in the venue, with the same number of live-streaming tracks available online. In addition, this meeting was the first in JCS history to be hosted by a public university.
The central theme of this meeting was “NEXT STAGE – Future of Medicine and Community –”. This theme was selected for the following reasons. As the Japanese calendar changes from the Heisei to Reiwa era, a period of significant change is coming not only in cardiology, but also across the entire medical community and in society. In the research field, there have been remarkable technological innovations, such as induced pluripotent stem (iPS) cells, genome editing, whole-genome analysis, RNA sequencing, Big Data, and artificial intelligence (AI), and research methods are changing drastically in the cardiovascular field. The latest technologies of catheter intervention, ablation, and implantable devices, including transcatheter aortic valve implantation (TAVI), have been clinically applied in the medical field, and regenerative medicine for the heart has advanced to the next step of actual clinical practice. Furthermore, in Japan, which has become a super-aging society, the concept of medical care has changed from “cure” to “care”, from doctor-centered to multidisciplinary medical care, and from hospital-completed medical care to seamless community-based comprehensive medical care. On December 1, 2019, the
Basic Law for Stroke and Cardiovascular Disease Control, a long-cherished law of all those involved in cardiovascular medical care, including stroke, came into effect. With such a significant change, we should not stick to established concepts. To contribute to the health and wellbeing of the people, it was necessary to consider how the JCS should think and act.
From these points of view, we decided that the central theme of the Scientific Meeting should be “NEXT STAGE – Future of Medicine and Community –”. The COVID-19 pandemic has also forced significant changes across the world, and, unexpectedly, we are in an actual “next stage”.
Despite the challenging situation, which saw the 84th
annual scientific meeting of the JCS postponed until the end of July 2020 because of the COVID-19 pandemic, leaving only a few days between the 84th
meeting and the beginning of regular abstract submission for the 85th
meeting, we received as many as 2,197 submissions for the regular abstract sessions. After peer review by 5 referees for each abstract, 1,600 abstracts were accepted. From the perspective of preventing the spread of COVID-19 infection, it was planned that all general abstracts would be delivered as oral presentations on-demand after being prerecorded, except for some abstracts that were picked to be part of the live program. Five abstracts that were marked as having a perfect score were presented in the Super Featured Research Session (Super-FRS), and 22 abstracts with a high score were presented in FRS of the live program. The other regular abstracts were assigned to 234 sessions, of which 143 (61.1%) were presented in English and 91 were presented in Japanese, recorded in advance, and streamed on-demand. For the late-breaking sessions, 44 abstracts were submitted, 15 of which were accepted for presentation as part of the live program.
We decided to hold a hybrid format of live streaming and on-demand distribution on the web of the designated presentations. The Mikamo Lecture was presented by Professor Eric Olson (Department of Molecular Biology, University of Texas Southwestern Medical Center, Dallas, TX, USA), currently the world’s leader in basic cardiovascular research. Professor Tasuku Honjo (Kyoto University Institute for Advanced Study, Kyoto, Japan) and Professor Shinya Yamanaka (Center for iPS Cell Research and Application, Kyoto University, Kyoto, Japan), both of whom have received Nobel Prizes in Physiology or Medicine, delivered the Mashimo Memorial Lecture and the WCC Special Lecture, respectively (Figure 1). Furthermore, 3 international honorary members, Professor Thomas F. Luscher, Professor Peter Libby, and Professor Valentin Fuster, and 15 world-renowned researchers presented special lectures as part of the live program.
In the Congress Chairperson’s lecture, entitled “Balance of Humoral Factors and Cardiovascular Diseases”, Professor Yoshihiko Saito (Nara Medical University, Kashihara, Japan) presented his outstanding scientific achievement as a clinician-scientist, ranging from basic research to clinical studies focusing on humoral factors, such as natriuretic peptides1
and Fms-like tyrosine kinase-1 (Flt-1).2
There were many other presentations and speeches, including 3 symposia focused on the Second Five-Year Plan for Overcoming Stroke and Cardiovascular Disease announced on March 2, 2021, 6 education sessions, 15 plenary sessions, 25 symposia, 9 joint symposia with overseas cardiovascular societies, 10 team medical sessions, 13 JCS committee sessions, 8 symposia by the Japan Cardio-Vascular Alliance, JCVA (an alliance of cardiovascular-related organizations), 2 symposia related to COVID-19, 8 new JCS guidelines, sessions run by the U40 Heart Failure Network and International Society for Heart Research U45, and Special Sessions.
Because of the spread of COVID-19 throughout the world, we decided not to accept on-site participants from overseas. Therefore, the scale of the WCC, which we had expected to have many participants from all over the world, had to be reduced and we could have only 15 WCC jurisdiction sessions: a special lecture from Professor Shinya Yamanaka, a Round Table Discussion, 5 WHF-JCS joint symposia, and 8 WHF with national member sessions. In addition, the lecture on medical ethics, education sessions, and public lectures were shifted to on-demand streaming.
In all, there were 288 live sessions (including 73 sponsored seminars) and 298 on-demand sessions (including 15 WCC programs), with a total number of participants of 16,022. The main form was web participation, with the number of on-site participants as little as approximately 1,000 over the 3 days. This probably reflects the prohibition by some facilities of business trips outside their area as part of the policy to prevent the spread of COVID-19, and the fact that many participants had already experienced the convenience of a conference held on the web.
All sessions were streamed on-demand until the end of June 2021, except for some presentations where the presenter did not agree to on-demand distribution. The total number of views of the sessions throughout the entire period was 312,908 (Table).
Table.
Top 20 Most-Watched Sessions
| Rank |
Session name |
Number of
viewing |
| 1 |
JCS Committee Session: Lecture on medical safety |
9,895 |
| 2 |
Cardiovascular Education Session I-1: Treatment and prevention of ischemic heart disease |
9,768 |
| 3 |
JCS Committee Session: Lecture on ethics |
8,098 |
| 4 |
Mashimo Memorial Lecture (Professor Tasuku Honjo) |
6,206 |
| 5 |
Cardiovascular Education Session I-2: The latest advances in arrhythmia treatment |
6,136 |
| 6 |
Cardiovascular Education Session II-1: Evaluation and understanding of hemodynamics in heart failure
treatment |
5,696 |
| 7 |
JCS Committee Session: Learn from the guidelines 1 |
5,471 |
| 8 |
WCC Special Lecture (Professor Shinya Yamanaka) |
4,951 |
| 9 |
Opening Ceremony |
4,159 |
| 10 |
Symposium 02: How to treat Atrial functional MR? |
3,282 |
| 11 |
WHF-JCS Joint Symposium1: Cardiovascular Diseases and COVID-19 |
3,198 |
| 12 |
Round Table Discussion 03: Treatment strategy for heart failure with atrial fibrillation |
2,972 |
| 13 |
Cardiovascular Education Session III-2: Explanation of Resuscitation Guideline 2020 |
2,790 |
| 14 |
JCS Committee Session: Learn from the guidelines 2 |
2,735 |
| 15 |
Japanese Circulation Union Joint Session 01: Utilizing cardiac rehabilitation for cardiovascular disease control |
2,650 |
| 16 |
MIRAI 01: The future of utilizing real-world data |
2,606 |
| 17 |
JCS Committee Session: Learn from the guidelines 3 |
2,236 |
| 18 |
MIRAI 02: AI hospital project in Japan |
2,217 |
| 19 |
Topic 03: Why can SGLT2i prevent and treat heart failure? |
2,179 |
| 20 |
Congress Chairperson’s lecture (Professor Yoshihiko Saito) |
2,127 |
AI, artificial intelligence; JCS, Japanese Circulation Society; MR, mitral regurgitation; SGLT2i, sodium-glucose cotransporter 2 inhibitor; WCC, World Congress of Cardiology; WHF, World Heart Federation.
Countdown and Opening Ceremony
As a project counting down from 100 days before the JCS 85th
annual scientific meeting, 100 facilities and communities nationwide cooperated by providing heartfelt messages for the meeting. Beginning at the end of December 2020, we distributed one message each day via SNS until the day before the meeting. In addition, we delivered 8 news emails and 12 recommended session guides regularly to vitalize the momentum for the conference. COVID-19 infection countermeasures were also discussed in detail with the venue, following the guidelines of Kanagawa Prefecture and the opinions of infectious disease experts.
On March 26, 2021, the live program of the 3-day scientific meeting started. The opening was a live broadcast of “Tomo Prayer; pray together” from Kinpusen-Ji Temple, the headquarters of Shugendo, a religion of the harmony between Japanese ancient mountain worship and Buddhism, in Yoshino, Nara Prefecture, to pray for the early termination of COVID-19 and the comfort of all people. The on-site performance of the shell horns by 5 Yamabushi, mountain priests, made the Goma prayer more realistic, as if we were in the temple. After opening remarks from the Congress Chairperson, Professor Yoshihiko Saito and the Representative Director of JCS, Professor Kenichi Hirata (Kobe University Graduate School of Medicine, Kobe, Japan), we listened to the words from Her Imperial Highness Princess Takamado in a video message. Video messages of greetings were also received from the WHF President Professor Fausto Pinto, the European Society of Cardiology President Professor Stephan Achenbach, the American Heart Association President Professor Mitchell S.V. Elkind, the Chinese Society of Cardiology President Professor Yaling Han, and the Asian Pacific Society of Cardiology President Professor Jack Tan Wei Chieh. At the end of the ceremony, there was an excellent opening commemorative concert performed by Ms. Mayu Kishima, a violinist who has received numerous awards (Figure 2).
Special Symposium
In this meeting, a special symposium, “MIRAI: Future HealthTech for Life”, the most prominent feature of the program, was held with the cooperation of many universities, companies, and the Cabinet Office, Government of Japan. The aim of this special symposium was to discuss future medical care, systems, and technologies. Opinion leaders not only in the medical and pharmaceutical fields, but also from information and mechanical technologies, industry, and politics gave us special lectures on cutting-edge medical care:
• Mr. Shogo Arai, the governor of Nara Prefecture, talked about the policy of having a long, healthy life expectancy through the cooperation between medical care and the community
• Professor Ryozo Nagai, President of Jichi Medical University, Japan, talked about using big data for medical treatment
• Professor Jun Miyake, Graduate School of Engineering, Osaka University, Japan, talked about the next-generation medical systems created by AI
• Professor Yoshiyuki Sankai, Center for Cybernics Research, University of Tsukuba, Japan, introduced the medical application of robots, which are already used
• Professor Yusuke Nakamura, program director of the AI Hospital Project of the Cabinet Office Strategic Innovation Promotion Program, SIP, gave a lecture on the AI hospital concept
• Professor Masahiro Jinzaki, Department of Radiology, Keio University School of Medicine, Japan, introduced the initiatives of the AI hospital at Keio University.
In addition to these excellent lectures, we had an exhibition of the remote intelligent treatment support system “Mobile Smart Cyber Operating Theater” (SCOT), developed by Tokyo Women’s Medical University with NTT Docomo, in which approximately 20 types of equipment, such as open magnetic resonance imaging, a robotic operating table, surgical navigation system, and surgical microscope, are interconnected to organize and integrate information such as the status of a patient during surgery in real time (Figure 3A). Participants were also treated to the latest medical experience, which allowed them to undergo virtual reality (VR) TAVI surgery, with the conference venue connected to multiple bases, such as remote islands in Amami or the US. At the venue, the humanoid service robot EMIEW 4, manufactured by Hitachi Ltd, welcomed the participants. On the website, the participants experienced an AI hospital (Figure 3B). In an AI hospital, an AI system helps with the advanced diagnosis and treatment, which is likely to be realized soon, and will contribute to supporting doctors, speeding up and improving the accuracy of clinical work. The system could also solve chronic labor shortages in modern medical practice.
In addition, a contest in medical data processing by AI was held for students and young doctors, supported by the Tokyo Medical and Dental University Medical IT/Mathematics Club, the M&D Data Science Center, and Osaka University AI and Machine Learning Society/AI Medical Society (AIMS), among others. There were 225 participants in the AI contest, including online participants, and the best and excellent methods in the contest were commended.
Corporate sponsorship sessions, such as luncheon and evening seminars, were also held with sponsorships from various companies, despite the COVID-19 pandemic. In addition, there were corporate exhibitions at the actual venue, as well as virtually on the website for the first time, so that online participants could receive and experience the latest information (Figure 3C,D). Although this was the first time the hybrid format had been used, we received a great deal of support from a total of 55 companies. We express our deep gratitude to all the sponsors and Ms. Satomi Nakano for dealing with the company’s sponsorship.
Arrhythmia
Three symposia, an educational lecture, and 11 Congress Chairperson’s select sessions were held in this category. In Symposium 6, entitled “Current Perspective on Precision Medicine of Inherited Arrhythmias”, Professor Arthur Wilde (Amsterdam UMC, Amsterdam, Netherlands) gave a keynote lecture about inherited arrhythmia. In Symposium 10, Professor Paul Friedman (Mayo Clinic, Rochester, MN, USA) introduced us to his novel achievements in the detection of heart disease using AI-related technology.3
Coronary Artery Disease
A plenary session, 4 symposia, an educational lecture, and 14 Congress Chairperson’s select sessions were held in this category. In Symposium 11, entitled “Front Lines of Optimal Management of Atherosclerosis Risks”, Professor Paul M. Ridker (Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA) underlined the importance of controlling not only low-density lipoprotein cholesterol, but also inflammation and triglyceride to treat atherothrombosis in a keynote lecture. In Symposium 20, entitled “Vulnerable Plaques and Vulnerable Patients: Up-to-Date”, Professor Ik-Kyung Jang (Massachusetts General Hospital, Harvard Medical School, USA) gave a keynote lecture about cutting-edge research on the topic using optical coherence tomography.4
In Symposium 05, Professor David P. Taggart (University of Oxford, Oxford, UK) highlighted the importance of the heart team in treating coronary artery disease.
Heart Failure
There were 2 plenary sessions, 3 symposia, 2 educational lectures, and 29 Congress Chairperson’s select sessions held in this category. In Plenary Session 05, Professor John J.V. McMurray (University of Glasgow, Glasgow, UK) gave a state-of-the-art lecture about new drugs for chronic heart failure. In Plenary Session 07, entitled “Genomic Medicine Approach to Cardiomyopathy”, Professor Christine Seidman (Brigham and Women’s Hospital, Harvard Medical School) gave a state-of-the-art lecture entitled “Mutations, Mechanisms, and New Medicines for Cardiomyopathy”. In Symposium 09, entitled “Structural and Functional Abnormalities of the Atria in Heart Failure”, Professor Barry Borlaug (Mayo Clinic) highlighted the importance of left atrium function in left ventricular diastolic function.5
Imaging
Two plenary sessions, 1 symposium, and 10 Congress Chairperson’s select sessions were held in this category. In Plenary Session 10, entitled “Novel Aspects of Evaluating Multiple Organs in Heart Failure Management”, Professor Rudolf A. de Boer (University Medical Center Groningen, Groningen, Netherlands) pointed out the importance of heart disease on tumor growth as a state-of-the-art lecture.6
In Symposium 07, entitled “Early Diagnosis of Cardiomyopathies Using Multimodality Imaging”, Professor Raymond Kwong (Brigham and Women’s Hospital, Harvard Medical School) gave a keynote lecture entitled “Diagnosis and Risk Stratification of Patients With Cardiomyopathies Using Cardiac Magnetic Resonance Imaging”.
Structural Heart Disease and Cardiovascular Surgery
A plenary session, 2 symposia, and 5 Congress Chairperson’s select sessions were held in this category. In Plenary Session 12, entitled “Strategic Treatment for Heart Valve Disease”, Professor Joseph Woo (Stanford University School of Medicine, Stanford, CA, USA) gave a state-of-the-art lecture about the evolution of aortic and mitral valve surgery techniques under the competitive pressures of transcatheter therapeutics.
Stroke, Aortic and Vascular Diseases
Two plenary sessions, 2 symposia, and 2 Congress Chairperson’s select sessions were held in this category. In Plenary session 06, Professor Eric Isselbacher (Massachusetts General Hospital) gave a lecture entitled “State-of-the-Art in the Diagnosis and Management of An Aortic Disease”. In Symposium 13, Professor Mamoo Nakamura (Cedars-Sinai Medical Center, Los Angeles, CA, USA) gave a keynote lecture entitled “Percutaneous Catheter Intervention for Cardioembolic Stroke Prevention Under Multidisciplinary Approach”.
Prevention and Rehabilitation
Two plenary sessions, 1 symposium, and 4 Congress Chairperson’s select sessions were held in this category. In Plenary session 11, Professor Felix Mahfoud (Saarland University Medical Center, Homburg, Germany) gave a state-of-the-art lecture entitled “Renal Denervation Up-to-Date”. In Plenary Session 09, Professor John J.V. McMurray (University of Glasgow) presented a state-of-the-art lecture about diabetes and cardiorenal syndrome.
Basic Research
Three plenary sessions and 26 Congress Chairperson’s select sessions were held in this category. In Plenary Session 02, entitled “Cardiovascular Precision Medicine Based on GWAS findings”, the way to develop omics-based precision medicine of cardiovascular diseases in the post-genome-wide association studies (GWAS) era was discussed. In Plenary Session 08, entitled “Molecular Mechanisms of Cardiovascular Aging and Diseases Progression”, Professor Kenneth Walsh (University of Virginia School of Medicine, Charlottesville, VA, USA) pointed out the importance of clonal hematopoiesis on cardiovascular disease.7
Finally, in Plenary Session 15, entitled “Recent Advance of Cardiovascular Regeneration Research”, Professor Charles Murry (University of Washington, Seattle, WA, USA) introduced us to the modulation of engraftment arrhythmia following transplantation of stem cell-derived cardiomyocytes as a state-of-the-art lecture.
Others
In Plenary Session 14, entitled “Revisiting School Cardiac Screening”, Jonathan Drezner (University of Washington) presented a state-of-the-art study about the cardiac screening of young athletes in the US. In Plenary Session 13, Professor Robert W. Neumar (University of Michigan, Ann Arbor, MI, USA) presented an update on intensive care for cardiogenic shock in the US as a state-of-the-art lecture. In Symposium 16, Professor Alexander Lyon (Royal Brompton Hospital and Imperial College London, London, UK) gave a keynote lecture about cancer chemotherapy and cardiovascular complications.8
JCS Awards
The ceremony for 16 JCS Awards was held before the closing ceremony. The winner of the Japan Heart Foundation Satoh Memorial Award was Dr. Shinsuke Yuasa (Department of Cardiology, Keio University School of Medicine, Tokyo, Japan). The title of Dr. Yuasa’s research was “The Elucidation of Pathogenesis and the Development of Therapeutics for Cardiovascular Diseases”.9
Fifteen other winners were also announced and commended for the awards.
Expanding Opportunities for Female and Young Doctors to Play Active Roles
The Diversity Committee gave us homework to aim for a female chair ratio of ≥20% at this meeting. To that end, the committee asked all female members of the JCS who are board-certified cardiologists to take a pre-questionnaire in October 2020 regarding whether they could chair a session, have a discussion in English, and the categories they could chair. The chairpersons of the general presentations were decided with reference to this list. Furthermore, the committee produced the first chairperson’s manual so that even young, inexperienced doctors could chair a session and actively participate in the conference, which was very helpful. As a result, there were 180 (38.8%) female chairpersons out of 464 chairs in 234 general presentations, and 235 (25.2%) female chairpersons out of 933 chairs in a total of 509 sessions, including designated presentations, which was above the original goal. However, few experienced women could take charge of the designated presentations, with only 39 (10.4%) of the 376 chairs in charge being females. It was thought that improving this number would be one of the future challenges for the JCS.
Regarding the 143 general English sessions, 275 relatively young experts in the field were assigned as a discussant with the hope that the discussions would be lively among the limited number of participants in the prerecorded sessions.
Closing Remarks
Since it became a hybrid meeting and all the invited speakers and chairpersons from overseas participated on the web, as many as 89 overseas participants could be invited to take part in the conference. We think the merit of the hybrid meeting was that it did not affect daily work, and participation was convenient, without traveling time and cost. Conversely, the venue was scaled down, and a large cancellation fee was incurred, but it was helpful to receive MICE (Meetings, Incentives, Conferences, and Exhibitions) assistance from Yokohama City.
Even under the turmoil caused by COVID-19, doctors and researchers from all over the world, including Japan, worked hard day and night to contribute to the development of cardiology and were able to share the results of their studies. We were able to learn a lot about the progress in each field, and felt that this meeting would be a driving force for future medical care. Although the scale of the WCC has been reduced, thanks to Professor Keiichi Fukuda (Keio University), who was supposed to be a Co-Congress Chairperson of JCS together with WCC 2021, we received a greeting from Her Imperial Highness Princess Takamado and a lecture from the Nobel laureate Professor Shinya Yamanaka. We express our deepest gratitude to the Nara Medical University medical staff, the doctors of the Alumni Association, the staff of the JCS secretariat, including Mr. Ichiro Tabuchi, the JCS Secretary-General, Ms. Kyoko Meguro, Ms. Shizuka Yamada, and Ms. Masae Yoshihama, and the staff of Linkage, the Professional Congress Organizer, especially Mr. Hitoshi Hane and Ms. Ruriko Miyagawa, for supporting this meeting (Figure 4). We also extend our sincere appreciation to the many companies that have continued to provide as much assistance as in past years in these difficult economic times.
We look forward to everyone’s continuing progress and, together, creating a future of vibrant medical care and community for the Next Stage.
Disclosures
Y.S. is a member of
Circulation Journal’s Editorial Team. The remaining authors have no conflicts of interest to disclose.
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