University of Pittsburgh’s Salah Al-Zaiti, Ph.D., R.N. after his team’s ECG AI model outperformed the Heart Score (and other methods) for OMI detection.

The expansion of remote cardiac patient monitoring is creating more care opportunities, but also new operational challenges for cardiology teams. In this Cardiac Wire Show, Artella Solutions’ VP of Clinical and Quality Operations Jacinta Fitzsimons details how the right combination of technology and service can help physicians get the most out of their cardiac RPM programs – today and into the future.

Artificial Intelligence

Improving Occlusion MI Detection with ECG AI

A University of Pittsburgh-led team developed an ECG-based AI model capable of detecting occlusion myocardial infarction, showing that it improves both OMI detection and assessments, and finding that it has real clinical potential.

Up to 35% of non-STEMI patients have total coronary occlusion, also known as occlusion myocardial infarction (OMI). These patients require emergency catheterization, but ECG assessment challenges often lead to diagnostic and treatment delays, and greater mortality risks.

To address these OMI challenges, the researchers developed an AI model using 12-lead ECGs from 4,026 consecutive patients with chest pain, all sourced from three Pittsburgh-area hospitals. 

To externally validate the model, they analyzed ECGs from 3,287 patients from two other hospital systems, finding that their AI-based model…

• Classified patients with and without OMI with an 0.87 AUROC, well above assessments from experienced clinicians (0.80) and a commercial ECG algorithm (0.75).
• Correctly reclassified one in three patients with chest pain versus HEART score classifications, flagging 66% more patients as “low risk” for OMI and 50% fewer patients as “intermediate risk” (with similar or better false-negative rates)
• Detected patients with ACS more accurately than both a commercial system and practicing clinicians (AUROCs: 0.79 vs. 0.68 & 0.72)

The study’s authors and online commenters were bullish about these results, with the authors suggesting that it could help EMS and ED personnel improve OMI detection and care decisions, while reducing unnecessary care among low-risk patients.

Unlike many AI academic research initiatives, this ECG model appears to be destined for clinical use. The team has already partnered with the City of Pittsburgh Bureau of Emergency Medical Services to plan for future deployment, and is developing a cloud-based system to analyze incoming ECGs and route assessments to care teams.

The Takeaway

Although many AI insiders will want to wait to see how this model operates in the real world before predicting its clinical impact, this study suggests that it might be able to address current challenges with OMI detection, helping to improve care decisions and potentially outcomes. It’s also a great example of how AI could expand the value of ECG, in addition to the imaging modalities that are more commonly associated with AI-based disease detection and assessments.

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The Behavioral Science Behind Change Cardiology Hemo

When Change Healthcare set out to design its next-generation Cardiology Hemo monitoring system, they put behavior science at the heart of its product strategy. See how Change’s UX designers applied its behavioral science team’s findings to improve its Hemodynamics solution to help make physicians and technicians even more efficient.

The Wire

• Why First Successful Pig-To-Human Heart Transplant Failed: In January 2022, physician-scientists at the University of Maryland School of Medicine put a genetically modified pig heart into 57-year-old David Bennett, Sr. After forty-seven days of strong cardiac function, he suddenly died of heart failure. So, what happened? An analysis in The Lancet reveals that several overlapping factors likely led to Bennett’s death, such as antibody-mediated rejection and his poor health prior to the transplant. Lastly, a latent porcine virus in the pig heart may have, if activated, initiated an inflammatory response in Bennett causing cell damage. 

• Echo AI Lands HFpEF Reimbursements: Ultromics announced that CMS has established a new HCPCS outpatient reimbursement code (C9786) for computer-aided detection of heart failure with preserved ejection fraction (HFpEF), a difficult-to-diagnose condition that makes up some 50% of heart failure cases in the US. Ultromics said the code will apply to its EchoGo Heart Failure software, which landed FDA clearance in December 2022. Cardiac imaging continues to lead in imaging AI reimbursements, with the new echo HFpEF code following reimbursements for FFR-CT analysis and CT AI plaque assessments.

• Ezetimibe Does Not Increase Diabetes Risk: A substudy of the IMPROVE-IT trial found that adding the non-statin therapy ezetimibe to simvastatin treatment does not increase the risk of new-onset diabetes (NOD). The authors analyzed data from 9,500 patients, finding that 14.9% met the criteria for NOD, with an annual incidence of about 2.7%. Several factors increased NOD risk, including higher BMI, higher systolic BP, higher triglycerides, and having ≥3 components of metabolic syndrome. However, the addition of ezetimibe treatment to simvastatin did not alter NOD risks. 

• Us2.ai & Core Sound Imaging’s Mount Sinai Pilot: Echo AI company Us2.ai and PACS workflow company Core Sound Imaging announced that the Mount Sinai Health System will pilot Core Sound’s new Studycast Integration Program, bringing Us2.ai’s AI-automated analysis into Mount Sinai’s echo viewing and reporting workflows. Us2.ai’s echo analysis will be presented to clinicians directly within the Studycast interface, allowing them to review and apply results to their Studycast worksheets and reports. Core Sound Imaging is Mount Sinai’s longtime echo PACS provider.

• Lilly’s Retatrutide Cuts Weight, Improves Cardiometabolics: Eli Lilly added gas to the white hot weight loss segment, showing that its investigational retatrutide medication allowed 17.5% and 24.2% average weight reductions at 24 and 48 weeks (N=338). The weekly injection was also associated with a range of cardiometabolic improvements (BP, cholesterol, triglyceride, HbA1c, fasting glucose and insulin). Retatrutide uniquely targets glucagon (GCG) in addition to GLP-1 and GIP, compared to current options that only target GLP-1 (Novo Nordisk’s Ozempic and Wegovy) or GLP-1 and GIP (Lilly’s Mounjaro).

• Major Weight Loss with 50mg Semaglutide Pill: In other weight loss news, a phase 3 trial (667 participants, 68 weeks) published in The Lancet revealed that an oral form of semaglutide–the active compound in injectable diabetes/obesity drugs Ozempic and Wegovy–could effectively treat nondiabetic adults who are obese or overweight. Among oral semaglutide-takers, 85% lost at least 5% of their body weight during the study period, compared to just 26% of placebo-takers. Those who took oral semaglutide lost an average of 15% of their body weight, while the placebo group only lost 2.4%. 

• ESH’s New Hypertension Guidelines: The European Society of Hypertension issued simplified hypertension management guidelines, closely aligning with US guidelines. The new guidelines offer clear instructions for measuring BP, recommending out-of-office measurements for long-term management. The guide continues to prioritize BP-lowering rather than any specific antihypertensive drug class; a two-drug combination, preferably in a single pill, is appropriate for most patients. The guidelines also introduced the term “true resistant hypertension,” noting that renal denervation can be considered for patients with true resistant hypertension and healthy kidneys (earning applause from Medtronic).

• Chimpanzee Video Heart Checks: A team of German and Australian researchers used an AI-based video analysis technique to measure changes in chimpanzee heart rates, which could be used to spot early signs of CVD in captive primates, or support primate psychological research. By assessing heart rate changes detectable in videos of chimps’ faces and chests, they found that their heart rates decreased when shown relaxing videos (nature scenes) and increased when shown stressful or stimulating videos (chimps fighting or feeding).

• Virtual Therapy’s AFib Patient Impact: A randomized clinical trial of 127 patients with symptomatic paroxysmal AF suggests that online cognitive behavioral therapy (AF-CBT) improves their Quality of Life and reduces downstream care consumption. Participants either received 10 weeks of therapist guided AF-CBT or standard education about AF care. After 3 months, patients in the AF-CBT group achieved a “large” 15 point average QoL improvement and 56% lower health care consumption levels. The AF-CBT patients also maintained their QoL improvements over the following 12 months.

• Abbott’s Dual Chamber Leadless Pacemaker: Abbott announced the FDA approval of its AVEIR dual chamber leadless pacemaker system, a first of its kind system that provides synchronized pacing between two leadless pacemakers, with adjustments based on the patient’s clinical needs. The AVEIR dual chamber system combines Abbott’s previously-approved AVEIR VR single chamber device (paces the right ventricle) and the now-approved AVEIR AR single chamber device (paces the right atrium), which rely on Abbott’s i2i technology to support beat-to-beat communications.

• Early Liver Disease, a CVD Warning Sign: Chronic liver disease is known to come with increased CVD risks, and a new Journal of Hepatology study suggests that even early signs of liver disease are associated with significant future CVD event risks. The researchers analyzed liver MRIs and outcomes from 33,616 UK biobank participants, finding that early liver disease activity on MRI was associated with higher 2.5-year risks for any major CVD event, AF, heart failure, CVD hospitalization, and all-cause mortality (HRs: 1.14, 1.30, 1.30, 1.27, 1.19).

The First Step to Coronary Artery Disease Diagnosis

HeartFlow’s new RoadMap Analysis solution allows CT readers to accurately, efficiently, and consistently identify stenoses in the coronary arteries. See how RoadMap Analysis’ visual and quantitative insights into the narrowing of all major coronary arteries helps readers evaluate coronary CT angiograms before determining the need for an FFRCT.

Precision QRS Detection

QRS detection is essential for any ECG algorithm, and Monebo’s Kinetic QRS ECG Algorithm sets the standard for accuracy. Kinetic QRS accurately detects the QRS complex, no matter the amplitude, waveform, or noise levels.

The Resource Wire

• The University College London National Amyloidosis Centre is the world’s largest cardiac amyloidosis care provider, making their echo assessments both crucial and high-labor. See how UCL researchers used Us2.ai’s AI echo software to accurately analyze echos from 1,200 patients with ATTR Amyloidosis in 24 hours, without requiring human interaction.

• Pro triathlete Timothy O’Donnell recently spoke on the Rich Roll Podcast about surviving a heart attack mid-race and how getting a Cleerly analysis gave him confidence to compete again. Once he confirmed his heart was ready, he returned to racing and went on to win an Ironman at the age of 42.

• 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.