Hypertension pioneer, Dr. George Bakris, who passed away last week at age 72.

Artificial Intelligence

New Echo AI Model Could Streamline Mitral Regurgitation Diagnosis

Columbia and Cornell researchers developed an echo AI model that could improve the difficult task of mitral regurgitation diagnosis, and might even represent an AI-driven step towards enhancing all valvular regurgitation assessments.

• Transthoracic echocardiography is the go-to modality for mitral regurgitation diagnosis, but these exams are difficult to perform and prone to high variability.

The researchers set out to solve this problem using AI, and indeed showed that AI could perform MR exams at the same level as academic echo labs.

Using 52,702 Columbia-sourced TTEs for model training and validation, the researchers developed their end-to-end AI system to intake complete TTE studies, identify color MR Doppler videos, then accurately determine MR severity on a 4-step scale (none/trace, mild, moderate, and severe). 

They then tested their AI against 8,987 TTEs from an internal Columbia dataset and 8,208 TTEs from an external Cornell dataset, finding that the model achieved high…

• Agreement with cardiologist interpretations – 82% & 79% accuracy (k = 0.84 & 0.80)
• Performance for detecting moderate/severe MR – 0.98 & 0.98 AUROCs

Most misclassification disagreements between the AI and cardiologists involved exams with none/trace or mild MR, while the AI maintained robust performance across different MR types (slightly lower with eccentric MR cases).

• When the AI and cardiologist disagreed, an adjudication panel sided with the AI and cardiologists about a quarter of the time each, while half the time they thought the answer was in the middle.
• The researchers also found that AI trained to use multiple TTE views outperformed models using the apical 4-chamber view (82% vs. 80%).

Next up, the researchers plan to continue their echo AI efforts, including expanding to other valvular and cardiac assessments, and bringing their research into clinical settings.

The Takeaway

Echocardiography has long been an AI hotspot due to its importance, prevalence, and its challenges with efficiency and variability, but most clinical-level echo AI solutions have focused on heart failure and aortic stenosis so far. Although Columbia and Cornell’s new AI model is still in its early stages, this study makes a solid case for how much more echo AI can help, including across a full range of valvular regurgitation assessments.

Enterprise Imaging in Cardiology is Ultimately Human

Imagine having all patient imaging results, at your fingertips. See how GE HealthCare enterprise imaging makes this possible, enabling more precise, personalized, and ultimately human care.

AI-Driven Novice Heart Failure Screening

We hear a lot about AI’s potential to expand echocardiography to far more users and clinical settings, and a study using Us2.ai’s AI-automated echo analysis and reporting solution showed that echo AI might make novice-led heart failure screening possible.

Forging the Future of Cardiovascular Care

Cardiology is changing, and for the better. Get a view into Lee Health Heart Institute’s medical director Richard Chazal, MD’s vision for a new era in cardiology, driven by imaging, AI and personalized medicine.

The Wire

• BaroPace’s In-Human HFpEF Results: BaroPace announced positive results from its first in-human trial evaluating its PressurePace pacemaker control algorithm for the treatment of HFpEF. In the 7-week Phase I trial, PressurePace met its primary endpoints for quality of life and exercise tolerance, while also leading to notable blood pressure improvements, without any adverse events. The PressurePace system wirelessly links a pacemaker, a blood pressure cuff, and the PressurePace algorithm, to create a real-time closed-loop therapy system for HFpEF – making it the only known device-based HFpEF treatment.

• CardioFlow’s TAVI CE Mark: MicroPort CardioFlow’s VitaFlow Liberty TAVI system landed its EU CE-MDR Mark, adding a rare new competitor to Europe’s TAVI arena. Although likely viewed as unproven by many clinicians in Europe, the previous generation VitaFlow TAVI device has been used to treat over 10k patients across 10 countries (mainly China). CardioFlow appears to be poised to continue its European expansion, and has also filed CE Mark applications for new LAA closure and LAA access systems.

• Postpartum Worries for HTN Patients: A cohort study of 2,705 postpartum women who had hypertensive pregnancy disorder found that 81.8% had persistent hypertension after hospital discharge. Patients with severe hypertension had higher odds of ER visits (1.85x) and readmissions (6.75x) compared to those with normal BP. The findings support the need for BP monitoring programs and possibly lower thresholds for starting antihypertensive medication after childbirth.

• Philips’ Motorized C-Arm Cleared: Philips is taking its C-arm platform mobile, following the 510(k) clearance of its Zenition 90 Motorized. The new C-arm largely targets interventional vascular procedures, but also supports cardiac, pain management, and urology interventions. It includes features first launched on Philips’ Azurion angiography system, including tableside controls and automated workflows. 

• RESPECTing Icosapent Ethyl for Heart Disease: The RESPECT-EPA trial suggests that icosapent ethyl may lower cardiovascular events for heart disease patients who have low EPA/AA ratios and are already on statins. In 2,506 patients, icosapent ethyl reduced the primary endpoint (cardiovascular death, heart attacks, etc.) by 21% although not significantly (p=0.055), and cut secondary coronary events by 27% (p=0.017). While promising, new-onset AFib was higher in patients who were administered icosapent ethyl (3.1% vs. 1.6%, p=0.017).

• Verily’s Metabolic Pivot: For the second time in as many years, Alphabet’s healthcare subsidiary Verily is pivoting its business with the introduction of a new chronic disease management solution named Lightpath. Slated to debut in early 2026, Lightpath is an “evolved” version of Verily’s soon-to-be-phased-out Onduo platform, and leads with two of the hottest tools in healthcare: AI and GLP-1s. Lightpath will target diabetes, hypertension, obesity, and hyperlipidemia, with program options ranging from prevention, to intensive treatment, and monitoring/support.

• Fast Tracking MI with 2-hr Trops: A new analysis suggests that 2-hour POC high-sensitivity cardiac troponin I (hs-cTnI) can streamline emergency care for suspected heart attack patients. In two international studies, this strategy identified 66% of the 3,282 patients as low risk and ruled out heart attacks with 99.9% accuracy. For high-risk patients, it showed 98.5% specificity. Given hs-cTnI’s wide availability and short turnaround time, this could mean faster, more efficient treatment for many emergency MI cases.

• Wrongful MI Death Suit Rejected: Jurors rejected a $6M wrongful death lawsuit against Missouri’s CoxHealth hospital for allegedly missing a preventable heart attack. A 73-year-old woman had cardiologist and ED visits during August 2015, and returned to the CoxHealth ED in early September due to shortness of breath, before visiting the cardiologist again two days later and dying that same day. The lawsuit argued that the ED docs didn’t consult with her previous providers and the cardiologist didn’t address her “clear signs” of a cardiac emergency, but without an autopsy there wasn’t enough evidence to support the suit.

• Cardiol’s Cannabidiol Phase 2 Data: Cardiol Therapeutics reported that its CardiolRx (oral cannabidiol) was safe and effective in patients with recurrent symptomatic pericarditis in the Phase 2 MAvERIC-Pilot study. In the open label study of 27 patients treated for eight weeks, the drug brought a 3.7-point reduction on a numerical pain scale (5.8 to 2.1), while CRP dropped from 5.7 mg/dL to 0.3 mg/dL and was normalized in 80% of patients who had elevated CRP at baseline.

• New AI Transparency Guidelines: The FDA issued new guidelines to ensure transparency into machine learning-enabled medical device development. The agency has been working with Health Canada and UK regulatory authorities on a coordinated approach to medical AI regulation, with a particular focus on AI transparency (how and why AI makes decisions), which has been a major point of concern for AI watchers. While the guidelines are a bit vague, they should give AI developers some insight into the FDA’s approach to regulation.

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. 

Advance Your Cardiac MR Visualization

Ready to advance your CMRI assessments? See how you could leverage TeraRecon’s Intuition Cardiac MR package for a range of cardiac anatomy and physiology evaluations, and how your peers are already benefiting from it.

The Resource Wire

• 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. 

• Taking AI from Idea to the Clinic: There are few areas of healthcare with more innovation than artificial intelligence, but most of those solutions never make it past being published in a medical journal – providing no additional value to medical care or the solutions’ developers. In this Cardiac Wire Show, Bunkerhill Health CEO Nishith Khandwala discusses Bunkerhill’s unique approach to solving this problem and the impact they are having in cardiology and beyond.

• 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.

• 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!

• Transform CVIS Workflows: See why Merge Cardio is a 2024 Best in KLAS cardiology solution, and how it can help improve your cardiology workflows, simplify data collection, and automate cardiology reporting.