Giovanni Lorenz, DO, on how insufficient reimbursements are holding back cardiac MRI utilization.

Cardiac Imaging

Echo AI Model for CAC Scoring

A Cedars-Sinai-led team developed an echocardiography AI model that accurately assessed coronary artery calcium buildup, potentially revealing a safer, more economical, and more accessible approach to CAC scoring.

The researchers used 1,635 Cedars-Sinai patients’ transthoracic echocardiogram (TTE) videos paired with their CT-based Agatston CAC scores to train an AI model to predict patients’ CAC scores based on their PLAX view TTE videos. 

When tested against Cedars-Sinai TTEs that weren’t used for AI training, the TTE CAC AI model detected…

• Zero CAC patients with “high discriminatory abilities” (AUC: 0.81)
• Intermediate patients “modestly well” (≥200 scores; AUC: 0.75)
• High CAC patients “modestly well” (≥400 scores; AUC: 0.74)

When validated against 92 TTEs from an external Stanford dataset, the AI model similarly predicted which patients had zero and high CAC scores (AUCs: 0.75 & 0.85).

More importantly, the TTE AI CAC scores accurately predicted patients’ future risks. TTE CAC scores predicted one-year mortality similarly to CT CAC scores, and they even improved overall prediction of low-risk patients by downgrading patients who had high CT CAC scores and zero TTE CAC scores.

The Takeaway

CT-based CAC scoring is widely accepted, but it isn’t accessible to many patients, and concerns about its safety and value (cost, radiation, incidentals) have kept the USPSTF from formally recommending it for coronary artery disease surveillance. We’d need a lot more research and AI development efforts, but if TTE CAC AI solutions like this prove to be reliable, it could make CAC scoring far more accessible and potentially even more accepted.

User Experience and Cardiovascular Imaging Transformation

Check out this Change Healthcare video discussing the importance of user experience in the adoption of structured reporting, and how it can lead to improvements in imaging speed, quality, and cardiologist workflow. 

Personalized Care Pathway for Heart Attack Prevention

More than 50% of patients who suffer a heart attack are considered “low risk” based on symptoms, but in fact do have plaque build up. Cleerly tackles the matter head-on in their 5-step care pathway for early diagnosis, informed decision making, and personalized treatment.

Relieving The Burden of Post-Processing

With the advent of advanced imaging technologies like CCTA come added burdens to technologists and diagnostic imaging centers. See how PIA can relieve the burden of post-processing, saving you time while helping your bottom line.

The Wire

• CW’s SCMR Takeaways: Cardiac Wire spent a day at SCMR 2023 last week, discovering that it’s a vibrant conference given its relatively niche cardiac MRI focus. SCMR 2023’s roughly 1,500 attendees had plenty of sessions to choose from (including some attended by a stray cat) and a full exhibit hall that served as a reminder of how many CMR post-processing solutions exist. SCMR 2023’s most notable takeaway was the consensus that insufficient reimbursements are holding back cardiac MRI utilization, awareness, and access.

• Eli Lilly Bolsters Manufacturing for GLP-1 Agonists: Eli Lilly plans to invest an additional $450M to expand its manufacturing capacity to accommodate increased demand for its GLP-1 agonists, Mounjaro (also known as tirzepatide) and Trulicity. Mounjaro was approved for diabetes treatment in May 2022, and the company is expecting approval for its use in the multi-billion dollar weight management market this year. Last month the FDA listed Mounjaro as one of almost 200 drugs in a supply shortage, joining Trulicity as well as competing drugs Wegovy and Ozempic (Novo Nordisk). 

• Rural Living Tied to Increased HF Risk: A 13-year study of 27k Americans found that adults living in rural communities have a 19% higher risk of developing heart failure compared to their urban counterparts. The elevated risk in rural populations was independent of CV risk factors and socioeconomic status, and was greatest among Black men (HR: 1.34), White women (HR: 1.22), and Black women (HR: 1.18). Among White men, rurality was not tied to greater risk of incident HF. 

• Imricor and GE’s MRI Ablation Partnership: Imricor Medical Systems, a cardiac MRI ablation products developer, entered into an agreement with GE HealthCare in which the companies will combine Imricor’s Advantage-MR EP Recorder/Stimulator and Northstar-MR 3D Mapping System with GE HealthCare’s MRI scanners. The collaboration will help clinicians perform real-time MRI-guided EP ablation on the GE HealthCare MRI platform, and will give Imricor the opportunity to interface with GE’s new and currently installed scanners. 

• Exercise Intervention Improved AFib: A new randomized controlled trial of 120 AFib patients reveals that a 6-month exercise intervention improved symptoms and reduced arrhythmia recurrence. The exercise group received supervised exercise visits, as well as tailored advice to exercise for 210 minutes/week. The control group received standard advice to exercise for 150 minutes/week and were reminded of this goal 3 months in. By 12 months, the intervention group saw more arrhythmia-free participants (40% vs. 20%) and slight but significant improvements in symptom severity.

• Alleviant Medical Venture Round: Medical device company Alleviant Medical raised $75M in a venture round, bringing its total financing to $88M. The Texas-based startup will leverage the funding to further develop its premiere product–a no-implant interatrial shunt for heart failure with preserved ejection fraction–and plans to initiate a 400-700 patient trial. 

• HHS Health Coverage Boost: HHS data showed that the percentage of Americans without health coverage decreased to 10.5% in 2021 (down from 11.1% in 2019), due in part to changes in federal and state coverage policies for Medicaid and the Marketplace. The largest improvements were seen among young adults (percentage without coverage dropped to 15% from 16%), Latinos (down to 19.1% from 20.2%), American Indian/Alaska Natives (down to 21.5% from 22.4%), and non-English speakers (down to 27.3% from 28.8%).

• Broad Improvements in HCM with Mavacamten: A secondary analysis of the EXPLORER-HCM randomized trial (n=251) found that mavacamten (Camzyos) improved a range of CPET parameters beyond peak oxygen uptake–the main takeaway from the original trial–in people with obstructive HCM. Mavacamten led to significant improvements in both peak and subpeak exercise parameters including peak VE/VCO2 ratio, ventilatory efficiency, circulatory power, and more. 

• Photon Counting’s Aorta CTA Contrast Impact: A Swiss research team found that photon counting CT detectors allow aorta CTA exams to use 25% less imaging contrast, while maintaining equivalent image quality compared to current EID-based detector technology. The study adds to a growing field of evidence suggesting that photon counting technology can significantly reduce patient radiation and contrast exposure, in addition to its image quality attributes that often get the spotlight.

• Healthcare AI’s Cost Impact: A McKinsey and Harvard University report suggests that wider adoption of AI could reduce US healthcare costs by between $200B and $360B per year (5% to 10% of US healthcare spending). These cost reduction estimates are based on AI applications that are achievable within the next five years, but only if several barriers are addressed (lack of trust among patients and doctors, heterogeneous data, misaligned incentives).

• PHE Ending in May: Well… the day has finally come. The Biden administration announced plans to terminate the public health emergency this spring, ushering in a new chapter in the government’s pandemic response. The Kaiser Family Foundation put together a detailed look at the implications of the announcement, including hospital incentives for treating COVID patients, relaxed state licensure requirements, and cost-sharing for at-home tests.

The HeartFlow Story

Shifting the standard of care is a monumental undertaking, and yet physicians across the globe are embracing HeartFlow’s FFRct Analysis. Hear from the co-founder how HeartFlow got its start, and why physicians love it.  

Making Echo Accurate, Efficient, and Accessible

Check out this Imaging Wire Show featuring Us2.ai’s co-founders – James Hare and Dr. Carolyn Lam – for a great discussion about Us2.ai’s continued clinical and commercial expansion, and their efforts to improve echocardiography accuracy, efficiency, and accessibility.

How Precision Heart Therapy Advances the Business of Healthcare

Health systems continue to face economic and regulatory pressure to reduce care costs and improve outcomes. See how Cleerly’s precision heart care approach helps enhance patient care, avoid unnecessary and high-cost procedures, and improve the patient and provider experience.