A tweet from Dr. Robert Ostfeld, Director of Preventive Cardiology at Montefiore.

Welcome to the first issue of Cardiac Wire! We’re excited to start sharing the top cardiology stories in the “Wire” style that makes it quick and easy to keep up with your industry. Thanks to all of you for joining us.

-Madeline

Cardiovascular Disease

Increased CVD Risk for Cancer Survivors

While breakthrough cancer treatments are helping cancer survivors live longer, researchers are learning that survivors face an increased risk of developing cardiovascular disease later in life. 

Johns Hopkins researchers tracked 12,414 study participants’ cardiovascular disease outcomes over a median of 13.6 years (3,250 with a history of cancer). When researchers adjusted for age, sex, race, and education level, they found that cancer survivors had: 

• 42% higher risk of cardiovascular disease.
• 59% higher risk of heart failure.

Traditional risk factors, like BMI, cholesterol levels, and drinking and smoking status, could not fully explain the excess risk. Even when adjusting for these variables, researchers found that cancer survivors demonstrated:

• 37% higher risk of cardiovascular disease.
• 52% higher risk of heart failure. 

Increased risk levels varied by cancer type. Breast, lung, colorectal, and hematologic/lymphatic cancers were significantly associated with CVD risk, while prostate cancer was not. 

The authors suspect a combination of cancer and noncancer factors is driving survivors’ elevated CVD risks. Possible culprits include genetic predisposition, exposure to toxicities during cancer therapy, and inflammation and oxidative stress associated with cancer.

The Takeaway

It appears that cancer survivors face a higher risk of developing CVD, suggesting that as cancer treatments continue to improve, cardiologists will see even more survivors in their exam rooms. 

A New Standard of Cardiovascular Care

Heart disease is the leading cause of death, so it might be time to change how we think about heart attack prevention. Read Cleerly’s manifesto on why our current approach is unsustainable, how Cleerly’s AI-based platform can transform care, and what it will take to improve today’s heart disease statistics.

Us2.ai’s Echo Evidence

Have more echo studies than sonographers? See how Us2.ai was able to classify, segment, and annotate echocardiographic videos with similar accuracy as expert sonographers. 

The Wire

• HF Care for English Learners: In a JACC study, researchers asked 20 medical interpreters how providers could improve heart failure care for patients with limited English proficiency. Interpreters emphasized these five practical steps: (1) briefly describe the patient’s condition to interpreters before discussing discharge instructions, (2) ensure a family member is present during discharge, (3) tailor nutrition referrals to the patient’s native cuisine, (4) include an interpreter service phone number on the discharge paperwork, and (5) integrate interpreters in the inpatient and outpatient heart failure care team. 

• Nordic Walking Beats HIIT: Nordic walking might be superior to HIIT and other workout regimens for people with coronary artery disease. Canada-based researchers randomized 86 participants with CAD into three 12-week regimens (high-intensity interval training, moderate-to-vigorous intensity continuous training, Nordic walking) and then observed the participants for 14 weeks. Researchers saw significant improvements in 6-minute walk test distance, quality of life, and depression symptoms. Nordic walking, which burns more calories and works more muscles than regular walking, resulted in the largest increase in functional capacity.

• ImaCor & Clarius’ TEE Solution: Hemodynamic ultrasound startup ImaCor and handheld ultrasound company Clarius launched a partnership that will make ImaCor’s FDA-cleared transesophageal echocardiography (TEE) system available in a handheld format. Previously only available with cart-based ultrasounds, ImaCor’s Zura Handheld Hemodynamic Ultrasound and ClariTEE transesophageal echo probe now operate with the Clarius Ultrasound App, allowing handheld operation and mobile device viewing. 

• CDT Boosts Survival: Nebraska-based researchers found that submassive pulmonary embolism patients experienced higher survival rates when treated with catheter-directed thrombolysis (CDT) than when treated with systemic anticoagulation alone. After reviewing 12 studies (9,789 patients), the authors found CDT was associated with lower in-hospital mortality (2% vs. 6%), 30-day mortality (3% vs. 10%) and 90-day mortality (3% vs. 8%). Major and minor bleeding, blood transfusions, and hospital stay lengths were similar between the two strategies.

• Medtronic Acquires Acutus Property Rights: Acutus Medical sold the intellectual property rights to its entire portfolio of left-heart access devices (plus some manufacturing equipment) to Medtronic for $50M. The AcQCross Qx system for left-atrial appendage closure procedures is included in the portfolio and received FDA clearance just last week. Acutus may earn up to $37M more from Medtronic as it reaches certain manufacturing and regulatory milestones.

• Statins & COVID Hospitalizations: A study published in the Journal of the American Heart Association found that statin use may lower the risk of COVID-19 hospitalization. Researchers compared 2M adults who used statins for CVD prevention to 2M adults who did not, finding that statin users had a 16% lower risk of COVID-19 hospitalization than non-users. The trend persisted regardless of age, sex, and cardiac comorbidities. 

• Thigh Fat & Heart Failure: A JACC study found that higher intramuscular thigh muscle fat is independently associated with an increased risk of heart failure. Researchers used data from 2,399 adults with a median follow-up period of 12 years. After adjusting for demographic variables, cardiometabolic risk factors, and other adiposity measurements, they found that intramuscular (but not intermuscular) fat was linked to a 34% increased risk of heart failure. Interestingly, intramuscular fat only predicted the risk of HF with reduced ejection fraction, but not HF with preserved ejection fraction.

• CMR’s ACM Advantage: A review published in European Radiology highlighted the role of cardiac magnetic resonance (CMR) in diagnosing arrhythmogenic cardiomyopathy (ACM). The authors emphasized that CMR reveals crucial information about ACM, helping physicians risk-stratify patients, exclude phenocopies, and recognize biventricular and left-dominant CMR disease phenotypes. These advantages also led to the 2020 Padua Criteria establishing CMR as the diagnostic technique of choice for ACM.

• HF Care Costs Billions: The US healthcare system spends $22B on heart failure-related medical services every year, driving the total annual expenditure for adults with heart failure to nearly $180B. UCLA researchers pooled patient data from 2009-2018 (n=250,820) and discovered that the US spends about 5-times more on individuals with heart failure than those without it (~$28,950 vs. ~$5,727 annually). HF-related expenditure increased by 23% over the ten-year period, outpacing expenditure growth associated with other conditions like myocardial infarction, diabetes, and cancer. 

• Post-Op AF & Heart Failure: In a cohort study of 3M people, New York-based researchers found that patients who experience postoperative atrial fibrillation (POAF) have a higher risk of being hospitalized for incident heart failure within the next three years. Among 77,000 cardiac surgery patients, 18.8% developed POAF, which researchers found to be linked to incident HF hospitalization (HR: 1.33). Among 3M patients who underwent noncardiac surgery, 0.8% developed incident POAF, which was also associated with incident HF (HR: 2.02). These insights, while intuitive, underscore the importance of aggressively managing POAF and reinforce the adverse prognostic impact of POAF. 

• Us2.ai Joins Blackford: Echo AI software company Us2.ai is joining Blackford Analysis’ medical imaging AI platform, marking Us2.ai’s first platform partnership and providing Blackford its first echo AI reporting solution. The alliance continues Us2.ai’s recent momentum following its FDA and CE Mark clearances, Series A, and global commercial launch.

• Biolimus-Coated Balloons: China-based researchers published the first in-human study showing that a novel biolimus-coated balloon (BCB) was superior to an uncoated balloon during percutaneous coronary intervention (PCI) for the treatment of small-vessel coronary artery disease. In 212 patients randomized between BCB and plain balloon angioplasty, researchers found that angiographic late lumen loss was significantly lower in the BCB group than in the plain balloon group (0.16 vs. 0.3). The BCB group also demonstrated better late lumen enlargement rates (30% vs. 10%) and improved clinical outcomes at one year.

Cardiovascular Structured Reporting Adoption Benefits

Check out this Change Healthcare report detailing the benefits of cardiovascular structured reporting, and how to drive structured reporting adoption in your own organization.

Nanox AI’s CPT III Codes

The American Medical Association added new CPT III codes for quantitative CT tissue characterization, paving the way for more health systems to adopt Nanox AI’s HealthCCSng CAC scoring population health solution.