One of several early-1990s rejection letters for paper on catheter-based treatment for aortic valve stenosis. Times have changed.

Artificial Intelligence

Us2.ai’s Echo Strain Validation

A new study in European Heart Journal – Digital Health showed that Us2.ai’s AI echo algorithm can interpret echocardiographic strain images with similar accuracy as conventional measurements, highlighting how AI can democratize cardiac strain exams and improve heart failure assessments.

• Echo strain imaging reflects myocardial deformation, and supports early heart failure diagnosis.
• However, echo strain workflows have plenty of room for improvement, given that current software uses semi-automated algorithms that “still require considerable human inputs” and measurements can vary widely with different operators.

An international research team used Us2.ai’s deep learning algorithm to measure LV global longitudinal strain (GLS) in echo exams from a real-world Taiwanese cohort (n=4,228 with & without HF) and a core-lab dataset from the PROMIS-HFpEF study (n=183 with HFpEF), and measured wall-motion abnormalities in a dataset from the HMC-QU-MI study (n= 158 with suspected MI). The Us2.ai echo AI workflow…

• Successfully analyzed 89%, 96%, and 98% of the datasets, omitting more exams from the Taiwanese cohort due to poor image quality 
• Showed good agreement with manual measurements made with commercially available software (avg: −18.9 vs. −18.2 in Taiwanese cohort; −15.4 vs. −15.9 in PROMIS-HFpEF)
• Accurately identified patients with heart failure in the Taiwanese cohort (AUCs: 0.89 for total HF, 0.98 for HFrEF)
• Identified regional wall-motion abnormalities in the HMC-QU-MI study (AUC: 0.80)

These results were strong enough for the authors to suggest that AI echo solutions like Us2.ai’s could “democratize the use of cardiac strain measurements” in settings where resources or expertise are limited, improve echo lab efficiency, and even support challenging HFpEF and AMI diagnoses.

These results also highlight the clinical potential of AI-based GLS measurements, and perhaps helping clinicians overcome limitations with LVEF-based HF classification (e.g. with HFpEF)

• That last part is notable from an echo AI adoption perspective, given that CMS recently approved an outpatient reimbursement code for AI-based HFpEF detection ($285 per use)
• It could also prove to be notable for Us2.ai, which uniquely measures both LVEF and strain (among other measurements)

The Takeaway

Echo-based heart failure assessments are widely considered one of the strongest candidates for AI-driven clinical and efficiency improvements, and these results show how a solution that supports both LVEF and strain (along with the new CMS reimbursements for HFpEF) could help drive the echo AI adoption that everyone has been predicting.

Optimizing Your Post-Processing Workflow

The growth of cardiac CT and CMRI volumes and continued shortages in the imaging technologist workforce can mean big challenges for imaging organizations. Join this Cardiac Wire Show starring Precision Image Analysis’ Jim Canfield and Cleveland Clinic’s Scott D. Flamm, MD, MBA to see how outsourcing cardiac image post-processing can solve this problem, while improving efficiency, accuracy, and standardization.

Clearly Transforming Cardiovascular Event Prevention

There’s been plenty of studies evaluating healthcare AI accuracy, but does AI improve patient care? Check out this Cardiac Wire show with Udo Hoffmann, MD, MPH and learn how Cleerly’s new TRANSFORM trial could prove that AI-guided cardiovascular care reduces heart attacks.

The Wire

• BP Drug Parity: Ultra-long-term data from the ALLHAT study further supports its initial findings: the three major classes of blood pressure drugs have similar outcomes. In a secondary analysis of 32.8k people over 23 years, CVD mortality rates per 100 persons were similar for all three medications (thiazide diuretics 23.7, calcium channel blockers 21.6, ACE inhibitors 23.8). Stroke mortality risk was 19% higher with ACE inhibitors, but after adjustments this result was statistically insignificant.

• Cortex EP Emerges: AFib mapping and ablation startup, Cortex EP, emerged last week with $90M in funding from Ajax Health and other investors, and with a vision to “enable more intelligent AFib treatment.” Cortex EP is not starting from scratch – it’s apparently absorbing Ablacon Inc. to further develop/validate its portfolio of EP mapping and ablation solutions. Cortex placed a significant emphasis on Ablacon’s Electrographic Flow (EGF) mapping technology, which allows physicians to detect AFib sources and supports personalized ablation strategies.

• Middle Age CV Health Disparities: Analysis of NHANES data from 1999 to 2020 shows striking cardiovascular health variations among middle-aged adults, depending on income. In the study of 20.8k people aged 40-64, hypertension prevalence in low-income adults rose from 37.3% to 44.7%, but diabetes and obesity rates didn’t change. Meanwhile, high income adults saw stable hypertension rates, and increases in diabetes (7.8% to 14.9%) and obesity (33% to 44%).

• Appalachian Cath Lab Allegations: Appalachian Regional Healthcare (ARH) will pay $3M to settle allegations that one of its partner cardiologists submitted false claims to Medicare and Kentucky Medicaid. The cardiologist allegedly performed diagnostic catheterizations that weren’t supported with sufficient documentation, billed for medically unnecessary appointments before catheterizations, and admitted patients that didn’t meet severity requirements. ARH’s settlement would’ve been $6M, but it’s paying a smaller penalty because it self-reported these issues.

• Remnant Cholesterol’s Damage: Young adults with remnant cholesterol (RC) are vulnerable to left ventricular remodeling and dysfunction in middle age, suggesting a need for early and frequent screening. In the CARDIA study of 3,321 young adults followed for 25 years, higher baseline RC was associated with a higher LV mass index, worse global longitudinal strain, and worse global circumferential strain.

• COMBINE-CT Consortium: The Philips-led COMBINE-CT consortium emerged last week, after receiving a €6.5M grant to support its goal of enhancing coronary artery disease diagnosis and treatment through CT imaging. Noting widespread inconsistency across CAD care pathways, the COMBINE-CT consortium’s end goal is to develop an automated, vendor-agnostic CCTA-enabled workflow for patients with stable CAD covering all clinical stages (diagnosis, stratification, planning, intervention, follow-up). The consortium will also support five multicenter clinical trials to show CT’s CAD benefits.

• Two Sides to Text-Based HF Care: The MESSAGE-HF study shows the pros and cons of text message-based heart failure telemonitoring. Among 699 recently discharged HF patients, those who receive text-based advice daily to reinforce care plans and inform early interventions were satisfied with the intervention (78.5 net promoter score) and had better HF self-care scores. However, the two groups’ NT-proBNP levels (the primary endpoint) were similar at baseline (2593 pg/mL & 2396 pg/mL) and at 180 days (1313 pg/mL & 1319 pg/mL).

• CB Insights Digital Health 50: CB Insights released its annual Digital Health 50 rankings of the most promising private digital health startups (they previously ranked 150, sign of the times?), selected from a pool of over 10k applicants based on “proprietary Mosaic scores.” The list once again included a number of cardiology-involved startups (Cleerly, HealthSnap, Idoven, Story Health, Medipixel), thanks to momentum in the cardiac imaging AI and virtual cardiac care segments.

• Hydrogel Revolutionizes GLP-1 Delivery: Stanford researchers unveiled a hydrogel-based technology designed to extend the longevity of GLP-1 agonists. In rat models with type 2 diabetes, the injectable hydrogel depot delivered semaglutide or liraglutide, and sustained therapeutic exposure throughout the 42-day study period with just one injection. That could translate to a once-every-4-months GLP-1 therapy for humans (vs. weekly), allowing for more patient-friendly diabetes and obesity management.

• Edwards Spinning-Off Critical Care: Edwards Lifesciences is about to be even more focused on interventional cardiology, announcing plans to spin-off its Critical Care business in late 2024. The spin-off will allow Edwards to pursue “expanded opportunities for TAVR, TMTT and Surgical patients, as well as new investments in interventional heart failure technologies.”

• Lp(a) and Myocardial Fibrosis: In a study involving over 2,000 participants from the MESA cohort, elevated Lp(a) levels were associated with increased myocardial fibrosis and LA remodeling independent of age, sex, race, and traditional CV risk factors. The participants’ cardiac MRI exams revealed that those with high Lp(a) levels were more likely to have extracellular volume >30%, native T1 time >955 ms, and myocardial scar on LGE.

Relying on Echo AI for Heart Failure Management

The ESC has updated its heart failure guidelines, for the first time including a guideline-directed medical therapy for heart failure with preserved ejection fraction (HFpEF). See how cardiologists are trusting echo AI to find these cases earlier in this video from Us2.ai.

Unify Your Cardiovascular Data

In this era of interoperability, it’s time to focus on cardiology. See how Change Healthcare’s enterprise cardiology platform provides a single database for CPACS, Hemo, CVIS, and ECGM — helping to improve data access and integrity while simplifying your IT configuration.

The Resource Wire

• 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.

• Experience the future of learning: Medtronic Academy 2.0 is here! Unlock your ultimate destination for structural heart medical education with the newly redesigned Medtronic Academy 2.0. Gain access to expert-led courses, webinars, and a wealth of resources to stay ahead in cardiovascular care. Visit now!

• Merge and Duly Health Streamline Cardiology Reporting: Over the last 10 years, Dr. Sujith Kalathiveetil of Duly Health and Care has seen a significant evolution in cardiovascular imaging and experienced a similar evolution with Merge’s cardiology solutions. See how Merge Cardio has helped make cardiology reporting more consistent, accurate, and easier to obtain for Dr. Kalathiveetil and his colleagues.

• 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.

• Nothing Is More Expensive Than a Missed Opportunity: The emergence of AI CAC detection and new CVD treatments could transform preventative CVD care. Check out this Johns Hopkins editorial in JACC detailing how solutions like Bunkerhill Health’s Incidental CAC algorithm can create opportunities for more effective preventative CVD care, but only if providers seize that opportunity.