Lynn  Zoiopoulos, DO, from JACC’s collection of cardiology quotes.

Hello Heart Heads, 

We launched Cardiac Wire one month ago. I hope you’ve enjoyed reading these cardiology stories as much as I’ve enjoyed writing them. 

To mark our one-month anniversary, consider sharing this newsletter with a friend or colleague who also loves heart news. (Heck, maybe even share it on your social media!)

As always, thank you for reading and being part of the conversation. 

Cheers,

Madeline

Cardiogenetics

For Genetic Tests, Size Matters 

A study in JAMA Cardiology found that broader genetic tests are better at identifying patients with cardiomyopathies and arrhythmias than disease-specific tests, despite perceived drawbacks. 

Currently, physicians typically use tests that are designed to find a specific type of cardiomyopathy or a specific type of arrhythmia. This is because examining a larger slice of a person’s genome will inherently capture a greater number of genetic mutations, and sometimes clinicians do not know what the impact of a genetic change will be on the patient’s risk. 

This uncertainty can create confusion for both the clinician and the patient. The authors of an editorial on the study explain that these “gray zone” variants are often seen as the price you pay for broader tests. 

But this retrospective study challenges that outlook. Physicians ordered combined cardiomyopathy and arrhythmia genetic testing for 4,789 patients and found that the combined testing identified clinically relevant variants for 1 in 5 patients:

• 954 of 4,789 (20%) were flagged as a “positive” result.
  
• 66% of these positives (630 patients) provided meaningful information that could inform clinical decision-making.
  
• If testing had been restricted to panels associated with the clinician-provided diagnostic indications, 75 of 689 positive results (11%) would have been missed.

The Takeaway

In contrast to typical practice, it appears that more comprehensive genetic panels produce meaningful insights that could guide physician decision-making. When it comes to testing for cardiomyopathies and arrhythmias, the added burden of uncertainty may be worth it.

Protecting Your Cardiovascular Imaging Data

Are you sure about your cardiovascular imaging data security? Tune-in to this Change Healthcare webinar discussing how hospital systems and healthcare providers can strategically improve their data security.

Pivoting to Population Health AI

Check out this interview with Nanox AI strategy leader, Dr. Orit Wimpfheimer, where she discusses building an international telerad practice, what’s wrong with triage AI, and pivoting to population health AI.

The Wire

• Reva’s Revival: Fifteen years after going public and two years after filing Chapter 11 bankruptcy, bioresorbable stent manufacturer Reva Medical has re-emerged with $45M in Series B funding. The MOTIV sirolimus-eluting stent for patients with severe peripheral artery disease is at the heart of the company’s resurrection, and the new funding will go toward the device’s pre-market clinical evaluation. Preliminary results released earlier this year were promising, and a fruitful clinical trial may pave the way for FDA approval. 

• Brain Bleeds from TAVR: France-based researchers found that nearly one-quarter of patients (19 of 184) developed cerebral microbleeds just two to four days after undergoing TAVR. Two key factors that independently contributed to the elevated risk: (1) longer procedures increased the patient’s exposure to anticoagulation medication, which was tied to new bleeds, and (2) acquired von Willebrand factor defects – a blood clotting disorder that can be caused by aortic stenosis. The authors did not identify any short-term harm associated with the acute bleeds.

• J&J Partners with HCA Healthcare: Two major healthcare players, Johnson & Johnson and HCA Healthcare, are partnering to address key industry challenges associated with health equity, nursing support, and cardiovascular research. J&J and HCA’s cardiovascular initiatives will include a retrospective analysis of arrhythmia patients, as well as a project to understand digital health’s influence on coronary and peripheral artery disease patient outcomes.

• Virtual Wards for HF Patients: In a meta-analysis of 24 randomized clinical trials (10,876 patients), heart failure patients who went to a “virtual ward” after medical discharge – consisting of at-home visits, telehealth appointments, and/or clinic visits – saw 14% fewer deaths and 16% fewer readmissions. Virtual wards didn’t appear to be helpful for patients with chronic obstructive pulmonary disease. 

• Pain is Gain for PAD Patients: A study published in JAHA found that peripheral artery disease (PAD) patients who walk at a pain-inducing pace show greater improvements over time. The authors compared 109 people with PAD who pushed through pain while walking versus 101 PAD patients who walked comfortably. After one year, the pain group improved their usual-pace walking velocity by 0.084m/s and their Short Physical Performance Battery score by nearly one full point. On the other hand, the comfortable group slowed their walking speed during daily life and worsened their SPPB score.

• Cost-Effective Afib Screening Tool: Wrist-worn wearable AFib devices may help prevent stroke while also being cost-effective. Boston-based researchers evaluated 30M simulated older US adults and found that AFib screening through wearable devices cost $58k per additional quality-adjusted life-year – well below the acceptable $100k threshold. 

• May Telehealth Use: The correlation between telehealth use and COVID cases remained strong in May, with virtual visits rising 10.2% compared to April. The CDC’s weekly COVID case count climbed from 59k on May 1 to over 104k on May 31, which contributed to telehealth’s 5.4% share of all medical claim lines during the month (vs. 4.9% in April). Assuming the trend continues, expect another uptick in virtual visits when FAIR Health reports the June data in a few weeks.

• MedAlliance’s IDE Approval: MedAlliance’s sirolimus-eluting balloon, SELUTION SLR, received conditional FDA investigation device designation approval last week. The device (CE-marked for PAD & CAD) provides a controlled, sustained release of sirolimus, much like drug-eluting stents. With the new approval, MedAlliance will initiate a clinical trial for the treatment of occlusive disease of the superficial femoral artery.

• Selexipag for CTEPH: Patients with chronic thromboembolic pulmonary hypertension (CTEPH) saw improvements in blood flow dynamics after taking selexipag (an oral, selective prostacyclin receptor agonist for pulmonary arterial hypertension). Researchers had 78 patients with inoperable CTEPH take either a placebo or 200-1600µg of selexipag twice daily for 20 weeks. The selexipag group saw significant improvements in pulmonary vascular resistance (−98.2 vs. −4.6 dyn·s·cm⁻⁵), which was paralleled by improvements in cardiac index score and Borg Dyspnea scale score. 

• Deep Pockets: Medscape’s 2022 Cardiologist Wealth & Debt report (over 13k physicians in 29 specialties) revealed that cardiologists have higher net worths, larger homes, and less debt than many other physicians. Nearly one in four cardiologists have a family net worth over $5M, and only 16% of cardiologists have a net worth under $500k. Also, 20% of cardiologists live in a house that is over 5,000 square feet (#3 among all specialties), and only 16% are still paying off their medical school loans (the fifth-lowest of any specialty). 

• Heart Air Care: Keystone Perfusion’s AirECMO subsidiary announced a partnership with air ambulance provider REVA, making ECMO air transportation globally available. ECMO (extracorporeal membrane oxygenation) is a technique that pumps blood outside of the body to a machine that removes CO2 and sends oxygen-filled blood back to the body (similar to the heart-lung-by-pass machine). airECMO will utilize REVA’s 16 medically configured aircrafts to help provide safe between-hospital travel for critically ill patients all over the world. 

When it’s Good to Find Something Bad

We’re happy to share a special interview detailing how Cleerly’s CCTA AI solution allowed one of its own team members to catch and treat his asymptomatic, life-threatening atherosclerosis.

Us2.ai Launches Globally

Us2.ai recently announced the global launch of its flagship echocardiography AI solution, leveraging a new $15M Series A round, and its unique abilities to completely automate echo reporting (complete editable/explainable reports in 2 minutes) and analyze every chamber of the heart (vs. just left ventricle with some vendors).