Cleveland Clinic cardiologist Luke Laffin, MD on fish oil brands’ unproven cardiovascular health marketing claims.

Cardiology Testing

Simplifying CVD and Renal Assessments with Multimarker Blood Testing

Blood biomarker tests play a key role in assessing cardiovascular and renal risks in diabetic patients, but a recent AHA study out of Harvard Medical School suggests that a “simple” new multimarker test could significantly improve these assessments and downstream treatment decisions.

Using plasma samples from 2,627 CREDENCE trial participants with type 2 diabetes and kidney disease, the researchers first measured median baseline levels of four blood-based biomarkers:

• NT-proBNP: 180 ng/L 
• high-sensitivity cardiac troponin T: 19 ng/L 
• growth differentiation factor-15: 2595 ng/L
• IGFBP7: 121.8 ng/mL 

The participants’ individual biomarker levels proved to be “strongly predictive of cardiac and renal outcomes,” with 50% increases to any biomarker over one year significantly increasing their risk of experiencing the study’s primary endpoint (a composite of end-stage kidney disease, doubling serum creatinine level, renal death, or cardiovascular death):

• NT-proBNP: Hazard ratio 1.11
• hs-TnT: Hazard ratio 1.86
• GDF-15: Hazard ratio 1.45
• IGFBP7: Hazard ratio 3.76

When these four biomarkers were combined into a multimarker panel, participants with moderate and high multimarker scores had far greater risks of experiencing a primary outcome compared to participants with low scores (Hazard ratios: 2.39 & 4.01, both P < .001).

They also found that the sodium-glucose cotransporter-2 inhibitor canagliflozin slowed increases to biomarker levels.

• Canagliflozin group: 3% to 10% biomarker increases
• Placebo group: 6% to 29% biomarker increases

Canagliflozin’s biomarker improvements are promising, but the study authors were most excited about how the adoption of a simple blood-based multimarker test could improve care and outcomes for diabetic patients with CKD – especially if these combined biomarkers evolved into a single standardized risk score.

• That might come sooner than some expect, noting that three of these individual biomarkers are available clinically (IGFBP7 is on the way), although more research will be needed to assign weights to each biomarker.

The Takeaway

Biomarker testing already has a solid foundation in cardiology and diabetes care, but a simple and effective multimarker test like this could drive even greater advances in clinical adoption, accuracy, and personalized treatments.

Cardiovascular Structured Reporting Adoption Benefits

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The Wire

• Mouth Rinse CVD Testing: A mouth rinse test could bring CVD risk evaluations to dentist and primary care offices, potentially creating a new early detection pathway. Researchers analyzed mouth rinse tests and ECG results from 28 healthy non-smokers, finding that participants with high levels of white blood cells in their saliva had lower flow-mediated dilation levels (6% vs. 10%). This is the latest example of efforts to bring CVD testing into new healthcare pathways, joining efforts to assess CVD risks among eye care, mammography, and erectile dysfunction patients, and even grocery shoppers.

• Fish Oil Claims: Fish oil is used by one-fifth of US adults older than 60yrs, often due to perceived heart health benefits that are commonly marketed on product labels – but haven’t been scientifically proven. In a JAMA study analyzing 2,819 fish oil supplements, 73.9% of product labels had at least one health claim, most commonly focused on heart health (followed by brain and joint health), and 80% of those labels made structure/function claims that aren’t FDA-approved.

• Echo IQ’s Platform Expansion: Echocardiography AI startup Echo IQ took a major step towards its goal of creating a “whole heart” platform, unveiling six new solutions for diastolic dysfunction, heart failure, hypertension, and heart valve disorders. Echo IQ’s EchoSolv platform got its start with aortic stenosis and recently added mitral regurgitation, while its six newest solutions will launch over the coming months.

• SGLT2is’ Afib Impact: A JACC study showed that SGLT2 inhibitors help prevent recurrent AF in type 2 diabetes patients who undergo catheter ablation. In the study of 4,450 patients, those on SGLT2is had a 32% lower risk of requiring AF interventions three to 12 months after ablation (composite of: new cardioversion, new antiarrhythmic therapy, repeat AF ablation), and had a 15% higher event-free survival rate after 12 months.

• ChatGPT Differential Diagnoses Struggles: A Mass General Brigham-led study found that ChatGPT is about 72% accurate in overall clinical decision making, but struggles to make differential diagnoses between similar conditions (60% accuracy). As the study authors put it, that’s an important finding because it tells us “where physicians are truly experts and adding the most value – in the early stages of patient care with little presenting information, when a list of possible diagnoses is needed.”

• Detecting AS with 2D Echo AI: A Yale-led team developed a novel ultrasound AI model that can identify severe aortic stenosis using a single 2D echo view, rather than specialized doppler echo images typically used for AS diagnosis. The model’s use of 2D echos could allow AS screening using handheld ultrasounds in community settings. After training with 5,257 studies from Yale (17.5k videos), the model detected severe AS in three datasets from Yale, Cedars-Sinai, and four New England hospitals with consistently high AUCs (0.978, 0.952, 0.966).

• Ok to Return to Play? A multicenter retrospective study shows that elite athletes with the types of genetic heart diseases (GHD) that can cause sudden cardiac death are generally ok when they return to play, as long as they are carefully managed. Among 76 elite athletes with GHD (most commonly hypertrophic cardiomyopathy) who returned to play after diagnosis, only one experienced an exercise-related GHD adverse event and two experienced non-exercise adverse events. None of those events were fatal.

• Solo Brilinta Shines in Twilight: New analysis of the TWILIGHT study suggests that three months after PCI, monotherapy with AstraZeneca’s Brilinta (ticagrelor) is as effective as dual antiplatelet therapy combining ticagrelor and aspirin – but with less bleeding risks. Among almost 7,120 people, ticagrelor-only patients showed “a consistent reduction in bleeding events.” However, a corresponding editorial warned that the practical implications of this study are unclear and called for more research in high-risk populations.

• BioSig’s Pure EP Enhancements: BioSig Technologies announced a series of enhancements to its PURE EP Platform, which uses a combination of hardware and software to provide electrophysiologists with noise and interference-free cardiac signal data. The BioSig PURE EP Platform now supports Near-Field Tracking to monitor and report changes in local unipolar electrograms, and Automatic Tachycardia Characterization (ATC) to alert EPs of changes in tachycardia conduction patterns, while launching PURE EP with a new subscription-based model.

• Cardiac PET Reveals Coronary Disease: A new study in JNM shows that cardiac PET with an F-18 sodium fluoride radiotracer can reveal coronary microcalcification activity related to coronary artery disease. Among 111 people with CAD or a recent heart attack, the researchers found that those with chronic CAD had higher PET radiotracer uptake as measured in Agatston CAC score units (294 vs. 72) and more rapid progression of calcification scores (39 vs. 12). But scores didn’t change over a year, indicating stable disease.

• Aspirin Underuse: Aspirin is an effective and low-cost option for people with a history of CVD, but it’s still globally underutilized for secondary prevention. That’s from a JAMA study of 124k individuals across 51 countries (10,589 w/ CVD history), finding that aspirin was only used by 40.3% of participants with previous CVD events. As you might expect, aspirin use for secondary prevention was far lower in low and lower-middle-income countries (16.6% & 24.5%) than upper-middle and high-income countries (51.1% & 65%).

Reducing ECG Background Noise

Monebo’s Kinitec Rhythms ECG Algorithm separates true ECG signals from background noise, leading to more accurate diagnoses and improved operator efficiency. See for yourself how the algorithm measured up to a gold standard.

Automating Echo Strain Analysis

Check out this Cardiac Wire Q&A with Us2.ai president and co-founder Yoran Hummel, discussing how his career as a sonographer led him to echo AI, and how Us2.ai’s upcoming automated strain analysis feature brings the company even closer to democratizing echo.

A CCTA-Based Approach to Heart Attack Prevention

Cardiologists are increasingly relying on cardiac CT angiograms as a heart disease diagnostic tool. See what’s driving this trend in this Cleerly report detailing the key attributes of CCTA exams, evidence of its effectiveness, and CCTA’s medical guideline support.

The Resource Wire

• Need an analysis like calcium scoring, strain or even FFR? PIA Medical began as a Core Lab and can handle creative cardiac research and clinical trials along with the full breadth of clinical analyses available today.

• Join Dr. Nicolo Piazza for a five-session master class delving into chamber views, projection curves, and advanced imaging. The first session kicks off on September 18 at 7:30 p.m. ET. Don’t miss it!

• For years, world-renowned prevention expert Dr. Arthur Agatston, author of The South Beach Diet and developer of the “Agatston Score,” had been looking for technology that could accurately identify all types of plaque in the heart. Then, he was introduced to Cleerly. Hear from Dr. Agatston on why he believes “Cleerly really is the holy grail of prevention.”