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Radiation-Free Interventions | High Protein and CVD February 26, 2024
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Together with
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“Life has a way of hitting you with a brick. But then it’s up to you whether you get up or just go down. So I just decided to fight back.”
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Interventional cardiologist, Dr. Surender Malhotra, on returning to the cath lab after losing an arm in an accident.
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Philips made interventional imaging headlines last week, announcing the US and European launch of its LumiGuide interventional imaging system, positioning it as a key step toward “bringing healthcare closer to entirely radiation-free surgery.”
Powered by Philips’ Fiber Optic RealShape (FORS) technology and exclusively compatible with Philips interventional systems, LumiGuide uses light reflected along an optical fiber inside a guidewire to generate 3D, high-resolution, color images of interventional devices (e.g. catheters) — in real time, from any angle, in multiple views, and without radiation.
- Philips was sure to contrast these capabilities versus X-ray guidance, particularly noting X-ray’s radiation risks, and ability to only produce 2D black and white images.
The LumiGuide is actually Philips’ second generation FORS-based imaging system, building upon a first gen FORS system that launched for (very) limited clinical use in 2018. Last week’s LumiGuide launch represents a step towards more widespread use, starting with major US and European Aortic Centers of Excellence for complex aortic repairs.
- Philips would then use the data it collects from this initial US and EU Aortic Center rollout to support a wider global launch.
- That could include adding to its list of compatible interventional systems and potentially expanding beyond aortic procedures to other interventions.
Bringing new technology into the cath lab is never easy, but the LumiGuide will enjoy the support of Philips’ massive presence in interventional cardiology, and the help of what appears to be solid benefits.
- As part of a limited late-2023 release at nine aortic centers (N=900), the LumiGuide system cut complex aortic procedure time and radiation exposure by 37% and 56% compared to X-ray.
It also launches amid recent momentum towards zero and low-fluoroscopy procedures, including major ultrasound-guided efforts from J&J’s Biosense Webster and Shifamed-backed startup Laza Medical.
The Takeaway
Bringing healthcare closer to “entirely radiation-free surgery” is a massive goal, and might even puzzle some Philips-watchers given that it’s the clear leader of X-ray based interventional cardiovascular imaging.
However, as Steve Jobs once said, “if you don’t cannibalize yourself, someone else will,” and it seems a lot smarter for Philips to focus on building around its cardiac fluoro leadership than just focusing on protecting it.
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HeartFlow FFRCT’s Real World Impact
See how HeartFlow FFRCT Analysis significantly improved NHS England’s patient outcomes and clinical efficiency in a massive real world implementation across 90k patients in this presentation by Newcastle University’s Professor Vijay Kunadian.
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Merge Cardiology is Best in KLAS
Merge Cardio and Merge Hemo continued their KLAS hot streak, ranking Best in KLAS 2024 for Cardiology and Hemodynamics for the 9th and 12th years. The Merge by Merative cardiology solutions further expanded their KLAS score leads this year, with Merge Cardio scoring 82.8 (up from 82.7 last year) and Merge Hemo surging to 91.5 (from 85.7 in 2023)
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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!
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- NLRP3is’ Obesity and CVD Potential: New data shows that NodThera’s brain-penetrant NLRP3 inhibitors – its lead Parkinson’s candidates – might also drive weight loss and reduce inflammatory CVD biomarkers. In a 28-day mouse study, NodThera’s NT-0796 drove similar weight loss to semaglutide and greater weight loss than calorie restriction diets (19% vs. 21.5% & 16.9%). Its NLRP3 inhibitor NT-0249 only drove 6.8% weight loss, but it reduced circulating levels of fibrinogen, sVCAM-1 and suPAR, while NT-0796 reduced PCSK9 levels.
- Ensight-AI’s ATTR-CM Breakthrough: Yale spin-off Ensight-AI announced that its ECGvision-TTR Technology landed FDA Breakthrough Device Designation for early detection of ATTR-Cardiomyopathy. ECGvision-TTR uses deep learning to detect signs of ATTR-CM in 12-lead ECG data, potentially allowing early detection and treatment. It’s also part of what appears to be an increased FDA focus on encouraging new ATTR-CM detection and treatment options, coming a few weeks after Ionis and AstraZeneca’s eplontersen landed Fast Track designation for ATTR-CM.
- Lipid Lowering Drugs & Aortic Aneurysms: A Mendelian-randomization analysis found that certain cholesterol-related genes (HMGCR, PCSK9, CETP) are associated with higher aortic aneurysm risk, while suggesting that some lipid-lowering drugs could be repurposed to prevent AA in high-risk people with dyslipidemia. Elevated expression of HMGCR came with a 58% increased risk of AA, while participants with greater expression of PCSK9 and CETP had 34% and 38% higher AA risks.
- Cleerly’s FFR Code: Cleerly announced that its ISCHEMIA solution is billable with the AMA’s new Category I CPT code for CCTA-based and AI-driven noninvasive fractional flow reserve estimations (75580). The AMA launched its new CPT I FFRCT code in January, replacing four existing Category III CPT codes (0501T-0504T), allowing RVU-based payments to physicians across a range of settings (hospital outpatient, physician offices, or imaging center), and apparently expanding AI solutions that qualify for FFRCT reimbursements.
- High Protein and CVD: The amino acid leucine, found in high-protein foods, is the likely culprit behind increased mTOR signaling in macrophages, which causes ischemic CVD. In two human studies with a total of 25 participants, consumption of a low-protein drink had no effect on mTOR signaling while a very-high protein drink activated mTOR quickly. Further research suggests that leucine’s bad effects start with over 25 grams of protein per meal and when protein represents more than 22% of dietary intake.
- To Understand Is To Believe: That adage holds true in a survey of U.K. cardiologists examining their perceptions of 25 cardiac interventions, which revealed a robust correlation (R=0.945) between a therapy’s mechanistic intuitiveness and how they perceive its effectiveness. As a result, some procedures remain rare despite strong RCT data, while others without RCT evidence are widely used. The study underscores the importance of balancing intuition with rigorous evidence and warns against leaving cognitive biases unchecked when evaluating a therapy.
- Change Hack: Healthcare cybersecurity dominated the headlines again last week after a cyberattack – allegedly perpetrated by a nation-state – forced Change Healthcare to shut down many of its services. Change Healthcare, which is part of UnitedHealth’s Optum business, identified the breach on Wednesday and quickly disconnected its services related to prescription processing, medical imaging, and payments. The AHA urged healthcare facilities to similarly disconnect from Optum until it is deemed safe to reconnect, and check their systems for vulnerabilities.
- Free-Breathing Cine Cardiac MRI: French researchers used a deep learning reconstruction algorithm to create cine cardiac MRI sequences (that show cardiac motion) using free-breathing scans, potentially revealing a new CMRI approach for patients who are unable to repeatedly hold their breath. In a study of 26 patients with suspected ischemic heart disease, the DL-ESPIRiT algorithm enabled the acquisition of high-quality cine CMR images for assessing left ventricular ejection fraction in far less time than standard protocols (0.6 vs. 2.4 minutes).
- UltraLinQ ECG: UltraLinQ is best known as a cloud PACS company, but it just took a big step beyond image viewing, launching its new Holter Program. The UltraLinQ Holter Program combines its wearable UbiqVue Holter and ECG Interpretation Software, allowing users to capture ECG data for up to 5 days, which is then uploaded for ECG viewing, analysis, and reporting.
- Michigan’s PCI Safety Improvements: A statewide initiative from 2016 to 2022 led to a 34% drop in PCI radiation doses across Michigan. Even after adjusting for variables that are known to influence radiation dosage, each year of the initiative brought a 7.6% average reduction in radiation exposure per procedure. The improvements were due to a combination of changes, but centered around reducing X-ray dose per pulse and X-ray pulse frequency.
- Digital Hypertension Programs Advance Equity: A meta-analysis in JAMA Network Open suggests that novel hypertension programs deserve more attention for their ability to address health disparities. After reviewing 28 studies involving digital hypertension interventions for people of color and low income patients (e.g. connected BP cuffs, app-based medication reminders), researchers found that participants experienced a statistically significant and clinically meaningful reduction in average systolic blood pressure compared to control groups.
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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.
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Automatic, Precise Analysis – From the First Beat
Monebo’s Kinetic ECG Algorithm leads with its versatility, precision, and efficiency, enabling a long list of use cases. See how it might impact your ECG monitoring clients here.
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- TeraRecon’s Structural Heart Enhancements: Detecting and addressing mitral valve and LAA conditions can be challenging. Check out TeraRecon’s Structural Heart white paper and discover how improving workflow and pretreatment planning can streamline these processes and potentially improve patient outcomes.
- 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.
- Transformation Through Structured Reporting: Ready to realize the benefits of cardiovascular imaging structured reporting? Check out these quick and powerful Change Healthcare videos detailing the efficiency gains provided by structured reporting and what it takes to drive adoption.
- You Can Bet on Cleerly: Cardiovascular AI leader Cleerly is one of Business Insider’s top 44 startups to bet your career on in 2024. See why their combination of mission and innovation earned them this prestigious listing.
- Relieving The Burden of Post-Processing: 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.
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