Lawyer Elizabeth Crawford, who’s leading three legal cases alleging that Panera’s highly-caffeinated Charged Lemonade led to cardiac events and deaths.

There’s a convergence taking place in enterprise imaging that’s bringing a major evolution to cardiology workflows. Check out the latest Cardiac Wire show with Tara Martyres and see how Intelerad Medical Systems is working to streamline that convergence across cardiology and radiology teams.

Cardiovascular Disease

Lipoprotein(a)’s Outsized Per-Particle Risks

A pair of JACC studies laid what might be a new scientific foundation for all that research showing that people with high lipoprotein(a) have elevated cardiovascular risks.

The first study analyzed 502k UK Biobank participants, identifying two clusters of genetic variants that either raise apoB by increasing Lp(a) or LDL, showing that the Lp(a) cluster faced far greater cardiovascular risks:

• Each 50 nmol/L higher Lp(a)-apoB brought a 28% greater risk for coronary heart disease, versus 4% with LDL-apoB.
• Based on polygenic scores, subjects in the Lp(a) cluster had a 47% higher risk of  coronary heart disease per 50 nmol/L apoB, versus 4% again in the LDL cluster.
• With that, the researchers estimated that Lp(a)’s per-particle atherogenicity is 6.6-times greater than LDL.

A second study analyzed data from 356k UK Biobank participants, finding that apoB-containing Lp(a) particles have far greater cardiovascular event risks:

• Lp(a) particles carry 5-times greater risks than non-Lp(a) apoB particles (e.g LDL-C apoB particles).
• Each 100 nmol/L increase in Lp(a) brought a 24% greater risk, while 100 nmol/L increases in non-Lp(a) apoB came with just a 5% higher risk.

These results underscore the need to develop effective LP(a)-lowering therapies, and there appears to be some promising options on the horizon:

• Amgen’s injectable siRNA olpasiran slashed Lp(a) by as much as 100% in its Phase II trial, and has moved on to Phase III.
• Lilly’s injectable siRNA lepodisiran’s Phase II is underway, its other injectable siRNA LY3819469 is in Phase II trials, and its oral small molecule inhibitor muvalaplin performed well in its Phase I trial.
• Silence Therapeutics’ injectable siRNA zerlasiran cut Lp(a) levels by 90% in a Phase 1 trial, and has progressed to Phase II.

More candidates are surely on the way, noting that Lilly has entered into a Lp(a)-targeted gene editing alliance with Verve Therapeutics, and Novartis and Ionis Pharmaceuticals recently expanded their antisense-based Lp(a) therapy alliance.

The Takeaway

Years of studies have shown that people with high Lp(a) have worse cardiovascular outcomes, and this new research adds solid particle-level evidence showing why this is the case, while further supporting the need for Lp(a)-lowering therapies. In fact, these studies suggest that it might be more beneficial to target Lp(a) reduction rather than prescribing a second or third LDL therapy, even if cutting LDL remains the primary focus.

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. 

AI-Powered Home Ultrasound

The recently published CUMIN study shows the technical feasibility of AI-POCUS in the hands of novice nurses and opens new possibilities for redefining how we approach cardiac care. Learn more on this page from Us2.ai.

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

• PFA’s Kidney Injury Risks: There’s a lot of buzz surrounding pulsed field ablation’s potential to become a safer and faster AFib ablation option, but a new study revealed that PFA patients might be more likely to experience haemolysis, potentially leading to severe acute kidney injury (AKI). After noting two AKI cases in patients who experienced haemolysis after PFA, the researchers analyzed 68 consecutive PFA patients, finding that 19 of the patients indeed developed haemolysis. The haemolysis patients generally received more PFA applications than those who didn’t experience haemolysis.

• Us2.ai’s Echo AI Platform Play: Last week’s news of Children’s National and Us2.ai’s rheumatic heart disease screening initiative, also revealed Us2.ai’s promising new pathway for bringing custom echo AI applications into widespread clinical and commercial use, which is historically a challenge for algorithms produced by health systems and academic institutions (or even smaller startups). In this case, Children’s National was able to leverage Us2.ai’s proven echo AI software platform to deploy its RHD algorithm across the Ugandan screening program, but Us2.ai’s platform approach could apply to a far larger list of echo solutions and clinical challenges.

• MV + AFib Surgery: In a study of 1,442 AFib patients undergoing mitral valve surgery, those who simultaneously underwent AFib surgery achieved an 80.7% 10-year survival rate, surpassing the 75.9% survival rate of patients who only underwent MV surgery. The concomitant MV/AFib procedures were also associated with lower MACCE rates and reduced stroke or TIA incidence up to 15 years post-surgery. Despite guidelines favoring AFib ablation in MV surgery patients, only a few studies have enrolled such a large patient cohort with long-term follow-up.

• Occlutech’s ASD FDA: Occlutech announced the FDA approval of the Occlutech SD Occluder and Occlutech Pistol Pusher, its minimally invasive cardiac device and delivery system for the treatment of atrial septal defects (ASD). The newly approved products will be offered in the US through Occlutech’s exclusive distribution alliance with B. Braun Interventional Systems, which might find solid momentum given that Occlutech has already sold 90k of these ASD devices outside of the U.S.

• CCTA AI Cuts Processing Time: Using Shukun Technology’s CoronaryDoc AI algorithm, researchers slashed CCTA image processing and reporting turnaround times without a negative impact on accuracy. In a population of 1.8k patients, CoronaryDoc cut CCTA image processing times compared to conventional semi-automated mode (121 vs. 434 seconds) and also cut scan-to-report-release times (6.4 vs. 10.5 hours). Metrics like sensitivity, specificity, and patient outcomes at two years were largely the same between the AI and semi-automated approaches.

• Apple Pulls the Pulse Ox: Apple is removing the pulse oximetry technology from its latest Apple Watches to sidestep the import ban that was just upheld for the duration of its patent appeal with Masimo, a process that could take over a year. Following the US Court of Appeals’ refusal to grant a stay on the ban while the appeal takes place, Apple will revert to slimmed down versions of its Series 9 and Ultra 2 models, which its retail stores reportedly already have on hand. Consumers who already have the Watches will see their Pulse Ox disabled via an update.

• Ozaki Procedure Matches SAVR for AVD: In a recent study published in the Annals of Thoracic Surgery, the Ozaki procedure, a form of trileaflet aortic valve neocuspidization (AVN) using autologous pericardium, had comparable mid-term outcomes to SAVR procedures with bioprosthetic valves. With an expected survival rate of 95.7% and 91.5% at 1 and 5 years respectively, the Ozaki procedure proved safe for treatment of all aortic valve diseases with or without concomitant surgeries.

• Another Charged Lemonade Lawsuit: Panera’s highly-caffeinated Charged Lemonade once again has the breadmaker headed to the courtroom, after a reportedly heart-healthy 28 year-old woman developed AFib after consuming two and a half of the beverages. The new allegations follow two cases that blamed Charged Lemonade for fatal cardiac arrests. At 390 mg, Charged Lemonade has more caffeine than 3.5 cans of Red Bull.

• Unmotivated Hearts Find a Beat in HBCR: Patients who are unwilling to participate in traditional center-based cardiac rehabilitation (CBCR) and are instead enrolled in asynchronous home-based cardiac rehabilitation (HBCR), actually experienced better results than center-based patients. That’s from a new study that found that HBCR patients achieved a significant 10.2% improvement in peak oxygen uptake compared to those in traditional center-based programs, suggesting that HBCR could be a viable way to address barriers to participation and promote better cardiovascular outcomes.

• Withings Debuts BeamO Multiscope: Withings came to play at this month’s Consumer Electronics Show, debuting its BeamO “multiscope” that blurs the line between connected health device and mass appeal consumer product (and places a solid focus on cardiovascular metrics). The BeamO is designed to be a vitals monitoring multitool for home checkups, packing a thermometer, stethoscope, pulse oximeter, and ECG into a sleek package.

• Healthcare M&A Declines: Mergers and acquisitions across the healthcare industry have now fallen below pre-pandemic levels, according to a new KPMG report. KPMG points to the FTC’s aggressive posture on mergers for driving last year’s 14% drop to 857 acquisitions, as well as other factors such as inflation concerns and greater competition for a smaller number of high-value targets. Still, execs surveyed for the report were optimistic about a turnaround in 2024, with over 3 in 5 expecting more M&A, and only 9% expecting another decrease.

Making the Leap to Outsource Post-Processing

Interested in how to outsource cardiac image post-processing, but not sure where to start? PIA walks you through how to assess and compare vendors, understand pricing models and payment options, and outline your requirements to identify vendors who meet your clinical needs. 

Explore the Potential of Cardio AI

Explore the potential of AI-powered cardiology solutions in this on-demand TeraRecon webinar, detailing how its Cardio Suite solutions help expedite disease diagnosis, care coordination, and provide the data to support cardiac treatment decisions.

The Resource Wire

• 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!

• Your Cardiology Data is Valuable. Put it To Work. See how one major Midwest health system’s decision to implement Merge Cardio transformed physician and staff workflows, improved data entry speed and accuracy, and increased cost savings.

• HeartFlow’s FFRCT Milestone: HeartFlow had reason to celebrate as it entered 2024, surpassing 250,000 patients examined with its FFRCT Analysis solution, while helping to avoid a huge number of unnecessary invasive angiographies. 

• How to Identify and Treat More CVD Patients: Do you know how many patients with high CVD risks are in your chest CT archive? See how the Stanford Health Care System used Bunkerhill Health’s Incidental CAC algorithm to screen its previous non-gated chest CTs, identify patients with coronary calcium, and get them on statins.

• ECG Data You Can Trust: Noise and artifacts can make automated ECG analysis less reliable than what’s required for the exacting standards of cardiac safety trials. Monebo’s Kinetic Intervals ECG Algorithm provides precise interval measurements between any two points on the ECG waveform, allowing clinicians to utilize data they can trust.