A tweet from Yuri Pride, MD, interventional cardiologist.

Cardiac Imaging

Echo Clues: When to Suspect Amyloidosis

Aortic stenosis and cardiac amyloidosis cause similar functional and morphological changes in the heart, and discerning between the two conditions can be difficult. But in this European Heart Journal meta-analysis, researchers brought to light key differences in a large number of conventional echo criteria that can predict the presence of cardiac amyloidosis (CA) in aortic stenosis (AS) patients. 

The authors reviewed observational data from 1,449 patients (160 AS-CA and 1,289 AS-only) and found that the following features were significantly higher in patients with AS-CA compared with AS-only patients:

• interventricular septal thickness (standardized mean difference: 0.74)
• relative wall thickness (SMD: 0.74) 
• posterior wall thickness (SMD: 0.74
• LV mass index (SMD: 1.62)
• E/A ratio (SMD: 4.18)
• LA dimension (SMD: 0.73)

In contrast, these attributes were significantly lower in AS-CA patients:

• myocardial contraction fraction (SMD: −2.88)
• average mitral annular S′ (SMD: −1.14)
• tricuspid annular plane systolic excursion (SMD: −0.36)
• tricuspid annular S′ (SMD: −0.77)

The Takeaway

As the study’s editorial put it, the authors have revealed a “fundamental principle.” Routine echocardiographic parameters may prove to be “the key” to spotting cardiac amyloidosis in the presence of aortic stenosis. 

A New Standard of Heart Care

Open to a more personalized and proactive approach to cardiovascular care? Check out this video detailing Cleerly’s unique approach to heart disease risk assessments and care.

Automating Echo AI

Check out this Imaging Wire Show featuring Us2.ai’s co-founders, James Hare and Carolyn Lam MBBS, PhD, detailing Us2.ai’s unique origins, impressive capabilities, and big goals to automate echocardiography reporting across the world.

The Wire

• Promising Ventricular Tachycardia Treatment: Circulation published results from a first-in-human trial that used Thermedical’s novel ablation technique to treat patients with ventricular tachycardia. The method uses in-catheter, heated, saline-enhanced radio frequency energy (SERF) to increase heat transfer and produce deeper lesion scars inside the heart muscle, where ventricular tachycardia arrhythmias often originate. Of 32 patients with treatment-resistant ventricular tachycardia, 31 saw their tachycardia eliminated immediately after the procedure. Device therapies, such as shock or pace regulation, were reduced by 89% during the five-month follow-up period.

• Connected BP Monitors: Despite the rapid rise in smartphone-linked blood pressure monitors, a JAMA Internal Medicine study found that connected devices aren’t superior to traditional BP cuffs for treating hypertension or improving patient satisfaction. The study of 2.1k patients revealed that the change in systolic blood pressure from baseline to six months was almost identical in users of smartphone-linked BP monitors compared to traditional cuffs (10.8mm Hg vs. 10.6 mm Hg), and there was equally little difference in their willingness to recommend the device to a friend (70% vs. 69%).

• Do-Not-Resuscitate Preferences Overridden: A new study from the University of Washington found that patients’ documented do-not-resuscitate (DNR) preferences are often suspended while they undergo TAVR. They also found that the timeframe for reinstating DNR status post-procedure varied markedly across health programs (38% < 48 h post-TAVR; 44% 48 h-to-discharge; 18% > 30 days post-discharge). Only 26% of the programs studied had formal policies addressing DNR code status during and immediately after the procedure. 

• Cardiac AI Surge: Signify Research forecasts that the global medical imaging AI market will maintain a 27.6% CAGR through 2026 when it reaches $1.4B (up from $400M in 2021), driven by continued VC investments, regulatory approvals, and emergence of new technologies. Cardiology has been imaging AI’s largest clinical segment by revenue for the last few years (primarily CT AI), and is poised to expand that lead over the next four years when it might nearly double the size of the next-largest AI segments (neuro & pulmonology).

• AHA Recommends In-Home Dialysis: The American Heart Association is recommending wider adoption of in-home dialysis in order to improve outcomes for patients with kidney failure and cardiovascular disease. As emerging evidence points to in-home dialysis improving several cardiovascular risk factors compared with thrice-weekly in-center dialysis, the AHA suggests incorporating interdisciplinary care models to enable equitable use of in-home dialysis therapies.

• Detecting Afib with CTA Bolus-Tracking: A new study out of South Korea suggests that carotid CTA-based bolus-tracking data could be used to detect atrial fibrillation. Using data from 716 patients who underwent carotid CTA and a 24-h Holter test (80 w/ Afib), the researcher found that Afib patients had significantly longer total bolus-tracking times (TTT; 23.8 vs. 18.7 seconds) and significantly lower bolus-tracking graph average slopes (0.8 vs. 1.38). TTT was also associated with a significantly higher risk of Afib and left atrial pressure (odds ratios: 1.36 & 1.46).

• Prolocor’s Seed & NIH Funding: Thrombosis prediction startup Prolocor completed a $3.2M Seed round and $2M NIH grant that it will use to validate its thrombosis risk prediction technique, which quantifies FcγRIIa on the surface of platelets. Prolocor’s FcγRIIa technique would be used to help guide thrombosis prevention treatment decisions, noting the high stakes involved with deciding between powerful therapies (w/ higher risk of bleeding) and less-intensive approaches (w/ higher risk of future thrombotic events).

• AHA and CRF’s Education Alliance: The American Heart Association and the Cardiovascular Research Foundation launched a new collaboration to produce joint education programs. The new alliance will begin with the organizations’ annual scientific meetings this fall, where the organizations will lead presentations focused on clinical guidelines, vascular care, and health technology and innovation. 

• Smartphone Stroke Screening: New research published in the Journal of the American Heart Association found that smartphone videos paired with video-based motion analysis (VMA) were “excellent” at screening for a leading cause of stroke, carotid artery stenosis (CAS). The researchers captured 30-second smartphone videos of 202 patients’ necks (54% w/ CAS) and then used VMA to quantify skin motion changes, identifying CAS with a 0.914 AUC. 

• Caregility + Eko: Telehealth solution provider Caregility is partnering with Eko to enable physicians to perform auscultation (heart, lung, and other body sounds) on patients during virtual physical exams. Eko’s smart stethoscopes now integrate with Caregility’s iConsult application, giving users access to a live stream of stethoscope sounds with real-time phonocardiogram and electrocardiogram waveform visualization.

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.

A New Cardiac Population Health Pathway

Nanox.ai’s cardiac solution analyzes already-existing non-gated CT scans and quantifies each patient’s CAC, giving clinicians a valuable tool for detecting cardiovascular disease and predicting future cardiovascular events.