Felix Mahfoud, MD on the ESC’s new guidance supporting renal denervation for some patients with hypertension.

Artificial Intelligence

Creating A Novice Heart Failure Screening Pathway

We hear a lot about AI’s potential to expand echocardiography to far more users and clinical settings, and a new study out of Singapore suggests that echo’s AI-driven expansion might go far beyond what many of us had in mind.

The PANES-HF trial set up a home-based echo heart failure screening program that equipped a team of complete novices (no experience with echo, or in healthcare) with EchoNous’s AI-guided handheld ultrasound system and Us2.ai’s AI-automated echo analysis and reporting solution.

After just two weeks of training, the novices performed at-home echocardiography exams on 100 patients with suspected heart failure, completing the studies in an average of 11.5 minutes per patient.

When compared to the same 100 patients’ NT-proBNP blood test results and reference standard echo exams (expert sonographers, cart-based echo systems, and cardiologist interpretations), the novice echo AI pathway…

• Yielded interpretable results in 96 patients 
• Improved risk prediction accuracy versus NT-proBNP by 30% 
• Detected abnormal LVEF <50% scans with an 0.880 AUC (vs. NT-proBNP’s 0.651-0.690 AUCs)
• Achieved good agreement with expert clinicians for LVEF<50% detection (k=0.742)

These findings were strong enough for the authors to suggest that emerging ultrasound and AI technologies will enable healthcare organizations to create completely new heart failure echocardiography pathways. That might start with task-shifting from cardiologists to primary care, but could extend to novice-performed exams and home-based care.

The Takeaway

Considering the rising prevalence of heart failure, the recent advances in HF treatments, and the continued sonographer shortage, there’s clearly a need for more accessible and efficient echo pathways — and this study is arguably the strongest evidence that AI might be at the center of those new pathways.

Reducing ECG Background Noise

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Optimizing Your Post-Processing Workflow

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Cardiovascular Structured Reporting Adoption Benefits

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The Wire

• Renal Denervation’s Comeback: An expert consensus statement in the European Heart Journal determined that renal denervation (RDN) is now a treatment option for patients with high blood pressure. Initial excitement for RDN waned following the underwhelming SYMPLICITY HTN-3 trial in 2014, but the latest panel reviewed newer RCTs involving the Symplicity Spyral (Medtronic) and Paradise (ReCor Medical) RDN systems. The expert panel determined that the RDN therapy safely and effectively lowers blood pressure, and can be considered as a BP-lowering treatment option.

• Erythritol’s CV Risks: New Cleveland Clinic research shows that the popular artificial sweetener erythritol comes with an increased risk of cardiovascular disease. Among 1,157 people, those with higher blood erythritol levels were more likely to experience a major adverse cardiac event within three years, and the association was confirmed in two independent cohorts (n=2,149 & n=833). The authors also found adding erythritol to both whole blood and isolated platelets made the platelets more likely to clot. 

• Hospitals’ Corporate Boards: Less than 15% of board members overseeing the nation’s top 20 hospitals have a professional background in healthcare, according to a study published in the Journal of General Internal Medicine. Of the 529 board members included in the analysis, the largest share had a background in finance (44%), with nearly all of those members coming from private equity, wealth management firms, or multinational banks.

• Heart-Kidney Transplant Mortality: Compared to heart transplant alone, a heart and kidney transplant together led to better survival for recipients with kidney dysfunction. Researchers compared long-term mortality in recipients who underwent heart-kidney transplantation (n = 1,124) versus isolated heart transplantation (n = 12,415), finding that mortality was lower among heart-kidney recipients (26.7% vs 38.6% at 5 years). This mortality benefit continued up to a GFR of 40 mL/min/1.73 m2. However, the mortality advantage came at the cost of increased kidney allograft loss (14.7% vs 4.5% at 1 year).

• Inflammatory Cytokines and Cardiac Arrhythmias: Inflammatory activation is increasingly recognized as a nonconventional risk factor for arrhythmias. A new review in JACC discusses the mechanisms underlying arrhythmogenic effects of proinflammatory cytokines, and how that may look in a clinical setting. The authors also supported the creation of large randomized clinical trials to verify whether anticytokine-targeted therapies can represent a new avenue to treat arrhythmias.

• Pulmonary Embolism AI: Imaging AI-based pulmonary embolism detection had a busy week, after RapidAI announced the FDA clearance of its new Rapid RV/LV ratio algorithm and Avicenna.AI and contextflow both unveiled solutions for incidental PE detection. RapidAI’s new RV/LV ratio algorithm works in combination with the company’s existing Rapid PE solution to help provider teams detect PE and then assess right heart strain in CTAs. Meanwhile, Avicenna.AI’s new CINA-iPE solution and contextflow’s core ADVANCE Chest CT product both analyze incoming chest CTs for signs of iPE.

• MitraClip’s Performance in Younger Populations: Transcatheter mitral valve repair (TMVR) using Abbott’s MitraClip is a well-established interventional therapy for elderly patients, and new research suggests that it also produces “satisfactory” outcomes in younger patients. Among 36 patients under 65 years, TMVR led to decreased NT-proBNP levels during the two-year follow-up (9,870 pg/mL vs. 7,645 pg/mL), and nearly 70% of the patients achieved functional class improvement. Overall, all-cause mortality was 19.4% and cardiovascular death was 11.1%.

• Dynamic Radiography for Heart Failure: A new EJR study highlighted dynamic chest radiography’s (DCR, a novel moving X-ray technique) potential to serve as a less invasive hemodynamic imaging method for heart failure patients. The study compared 20 HF patients’ DCR exams and right heart catheterization exams, finding high correlations across some key hemodynamic parameters (not all), and showing that DCR was able to identify patients with a low cardiac index (AUC: 0.792) and patients with low cardiac index and high pulmonary artery wedge pressure (AUC: 0.902).

• Apple No-Prick Glucose Tracking: Apple reportedly hit a major milestone in adding no-prick blood glucose tracking to the Apple Watch. While that would certainly be a major addition to the world’s most popular wearable, the new technology reportedly still requires wearing an iPhone-sized device on the arm, and it’s likely that we’re still years away from seeing anything resembling an Apple Watch that can track blood glucose hit the market.

• Declining In-Hospital Pediatric Cardiac Arrest: A meta-analysis of 18 studies revealed that the rate of children with cardiac disease who experienced cardiac arrest while in the ICU fell dramatically over the last 20 years, highlighted by a 7% incidence in studies before 2010 to 3% afterward. In-hospital mortality for these children dropped from 62% to 46% over the same period, which researchers credited to better education and preventive interventions, as well as post-arrest care and the use of extracorporeal membrane oxygenation.

• Interventional Cardiology Training Guidance: The ACC/AHA/SCAI outlined the first official training requirements for adult interventional cardiology (IC). The committee recommends completing at least 250 IC procedures, 200 of which should be coronary procedures, with the remaining 50 specialized in coronary, peripheral vascular or structural heart. The committee also suggests performing 25 physiologic assessment procedures and 25 intracoronary imaging procedures.

Revolutionizing Heart Attack Prevention

Cleerly founder and CEO Dr. James Min talks with preventive cardiologist Dr. Erica Jones about Cleerly’s groundbreaking new pathway for heart attack prevention. Watch their conversation to learn about Cleerly’s impact on cardiac health outcomes.

Democratizing Echocardiography with AI

We talk a lot about AI’s potential to expand echo access, and this Imaging Wire Show reveals that ultrasound’s AI-driven expansion might go far beyond what many of us had in mind. Check out our discussion with Duke Health’s Madhav Swaminathan, MBBS, MD and Us2.ai’s Carolyn Lam MBBS, PhD and James Hare, to see how AI is democratizing echo exams.

Evolving Coronary Disease Imaging Pathways

HeartFlow’s PRECISE trial showed that their precision approach for evaluating stable chest pain avoids unnecessary testing and improves care – without risking missed heart disease diagnoses. In this Cardiac Wire Show, HeartFlow’s Chief Medical Officer Dr. Campbell Rogers dives into the PRECISE trial results and its implications for clinical practice.