Charles Krauthammer

Between rising patient volumes, the emergence of AI, and rapid evolutions in structural heart, cardiac imaging teams are facing greater challenges than ever before. See how providers are leveraging enterprise imaging to respond to these challenges in this Cardiac Wire interview with Optum Insight’s CEO Tracy Byers and chief product officer Omer Schalit Cohen.

Heart Failure

Finerenone’s Early Heart Failure Impact

The FINEARTS-HF trial already showed that Bayer’s nsMRA finerenone (Kerendia) has the potential to slash mortality and event rates in HFpEF and HFmrEF patients, and new analysis suggests that its impact could be even greater if used earlier.

• Finerenone is a non-steroidal, selective mineralocorticoid receptor antagonist (nsMRA), blocking the mineralocorticoid receptor and its blood pressure effects.
• Finerenone is already approved to reduce cardiovascular and kidney disease risks in patients with type 2 diabetes-associated CKD, but not for HF.

The original FINEARTS-HF trial presented at ESC 2024 saw finerenone drive a 16% reduction in cardiovascular death and HF events over 32 months, while the new analysis suggests that finerenone’s benefits are greatest if started shortly after patients experience a worsening heart failure event.

• Compared to placebo, patients who received finerenone within 7 days of a WHF event saw their risk of future WHF events cut by 26%.

• Patients treated between 7 days and 3 months after a WHF event saw risks of further WHF events lowered by 21%.

• However, patients who were enrolled over 3 months after a WHF event or without prior WHF showed no changes in future WHF event risks.

Patients treated within 7 days of a WHF event also tended to achieve lower systolic blood pressure, lower EF, higher NT-proBNP, and worse NYHA functional class.

• Notably, the study found no increased risk of hyperkalemia or worsening renal function among finerenone users with recent WHF, a big change versus the entire study group which had an increased risk of hyperkalemia. 

This looks like more good news for Bayer, which has made huge research investments to establish finerenone’s role across an even wider spectrum of HF patients, and forecasts that finerenone’s revenue could jump from $295M in 2023 to $3.3B in the future.

The Takeaway

Although this dataset wasn’t large enough to confirm a definitive treatment-by-time interaction, it certainly suggests that finerenone might have its greatest impact shortly after patients heart failure begins to worsen. And with a new drug, knowing which patients to target is a good way to start.

Us2.ai’s Next Gen AI

Us2.ai recently scored FDA clearance for Us2.v2, the newest version of its flagship software featuring 45 automated echocardiography parameters, including strain analysis. See how the new version automates echo exams and improves cardiovascular disease detection.

PIA Medical Processes It All

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.

Identify and Treat Cardiovascular Disease

Complex care pathways make getting patients to the next step a challenge. See how Tempus Next, an AI enabled care pathway platform, helps providers identify and reduce under treatment in cardiovascular disease by adding an intelligent layer onto their routinely generated EHR data.

The Wire

• Rivus’ Obesity-Related HFpEF Potential: Promising results from Rivus Pharmaceuticals’ Phase 2a HuMAIN Trial found that patients treated with its HU6 controlled metabolic accelerator experienced fat-selective weight loss (-7.4 pounds), without sacrificing lean body mass. Patients also showed a trend toward a reduction in inflammation and significant decline in troponin levels (-84.94 ng/L). These results support HU6’s potential to treat obesity-related HFpEF, while preserving heart tissue and muscle mass.

• Metrics on Life-Support: Sometimes efforts to make you look better end up making you look much worse. Newark Beth Israel Medical Center is under scrutiny for keeping a patient on aggressive life support following an unsuccessful heart transplant that left him brain-dead. Newly released recordings suggest that the transplant program’s director pressured his staff to keep the patient on aggressive life-support, allowing the hospital to boost its declining post-surgery survival rate, but ignoring the fact that he had no chance of recovery.

• How Patiromer Helps HFrEF Patients: A post hoc analysis of the DIAMOND study found that patiromer (Vifor’s Veltassa) can help get HFrEF patients who have hyperkalemia to effective doses of RAAS inhibitors and MRAs. In 1,038 patients, 84.6% could be successfully treated with patiromer in a run-in phase, while patients with past or present hyperkalemia who continued patiromer treatments were able to increase their use of RAAS inhibitors (76.8% to 98.6%) and MRAs (35.9% to 98.6%).

• Bunkerhill’s Gated CAC Clearance: Bunkerhill Health expanded its CAC-scoring AI portfolio, landing FDA clearance for a new solution that analyzes gated CT exams to automatically identify patients with coronary artery calcium. Bunkerhill Health already has a solid list of customers using its non-gated CAC scoring solution, and the new clearance will allow health systems to analyze all gated and non-gated chest CTs that they perform, leading to earlier CVD detection and management.

• Calmodulinopathy Treatment on Horizon: Antisense oligonucleotide (ASO) therapy is showing early promise for treating calmodulinopathies – life threatening genetic arrhythmia syndromes. In a study of stem cell-derived cardiomyocte and mouse models, ASO was able to deplete pathogenic variants in the calmodulin 1 (CALM1) gene, while preserving CALM2 and CALM3 genes and therefore production of calmodulin. ASO therapy was also safe and effective for treating ventricular tachycardia in mice.

• Antiseizure Meds’ CV Event Link: Older patients with epilepsy have greater cardiovascular event risks, and a new study suggests that these risks are largely driven by use of enzyme-inducing antiseizure medications (EIASMs). Among 27k patients, including 431 with a history of epilepsy, new onset CV events were over two-times more likely in patients with epilepsy over six years (OR: 2.20). Notably, the use of “strong” EIASMs  – like carbamazepine and phenytoin – were the leading contributors to CV events in epileptic patients (24.6%).

• Cardio Diagnostic’ CMS Determination: Cardio Diagnostics’ PrecisionCHD and Epi+Gen CHD tests received preliminary pricing determinations from CMS. The two AI-powered blood tests evaluate genetic and epigenetic markers to support CHD diagnosis, while Epi+Gen CHD also assesses three-year CHD event risks. If finalized, the new determination would be effective after January 1, 2025, allowing Medicare contractors to determine pricing for PrecisionCHD and Epi+Gen CHD based on Cardio Diagnostics’ actual cost data.

• AI Links BAC to Cardiovascular Risk: Last week brought yet another study linking breast arterial calcifications to cardiovascular risk, this time using AI to calculate BAC. Researchers leveraged CureMetrix’s cmAngio AI algorithm to calculate BAC in 18k women’s screening mammograms. Women with BACs had higher hazard ratios for mortality (HR=1.49) and a composite of cardiovascular events that included mortality (HR=1.56), while each 10-point increase in cmAngio score was associated with 8% higher risk of mortality. 

• Story Health + Kettering: Story Health expanded its heart failure digital health network to Kettering Health, giving Kettering’s HF patients who opt-in access to personalized virtual medication management, home heart monitoring, and clinical care teams with the goals of reducing readmission rates and increasing provider capacity. The partnership also highlights Story Health’s continued HF care expansion, which got its start at ChristianaCare in 2021 and has since added Intermountain and WVU.

• Cordella’s 1yr Safety and Efficacy: Endotronix announced one-year results from its Cordella PA Sensor System’s PROACTIVE-HF trial. All 456 patients managed with Cordella experienced meaningful reductions in all-cause mortality (-49%) and one-year HF hospitalization (36 vs. 70 events per 100 patients), while quality of life and key biomarkers also improved significantly. These results come just a few months after Edwards Lifesciences’ acquisition of Endotronix, giving the Cordella Sensor a solid path towards commercialization.

• TRL More Atherogenic than LDL: A new JACC study found that triglyceride-rich lipoproteins and TRL/remnants are about 4 times more atherogenic than LDL. The study organized 1,357 single nucleotide polymorphisms into 10 clusters according to their genetic effect on TRL/remnant-C and LDL-C levels. With TRL’s causal relationship now quantified, researchers can focus on the genetic risk factors of TRL/remnant concentrations rather than previously prominent LDL and HDL indications.

Connecting the Dots in the Care Pathway

Streamline your path to patient care with this GE HealthCare Cardiology Coffee Break (Wednesday, October 16 at 12:00 PM EDT), exploring how integrated enterprise imaging solutions can empower healthcare organizations to provide precision care, achieve operational efficiency, and enhance patient satisfaction.

Streamline Your Cardiology Imaging Workflows

See how cardiologists and their teams can streamline imaging workflows to make their cardiovascular service line more efficient, cost-effective, and patient-centered, using Merge’s cardiology solutions.

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!

The Resource Wire

• A Single Cardiac Service Line Platform: Transitioning across multiple imaging platforms is a daily reality for many cardiologists, but it doesn’t have to be. See how three leading cardiac imagers are leveraging Circle CVI’s unified multi-modal software across their diverse caseloads, without switching to other platforms.

• 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.

• How UCSD Improved Post-Stroke Care: Viz Connect improves the monitoring of stroke patients with suspected AFib without adding layers of complexity to the clinical workflow. Hear from Brett C. Meyer, MD, on the impact it has had on post-acute stroke patient care at UCSD.

• An All-in-One Coronary Care Solution: See how HeartFlow ONE is transforming precision heart care as the first all-in-one CCTA pathway, combining FFRCT, stenosis, and plaque analysis in a single workflow.

• Discover Innovation in Intervention: Explore how the AGENT™ Drug-Coated Balloon from Boston Scientific is advancing U.S.-based treatment options for patients with coronary artery disease. Rx Only. (Sponsored by Boston Scientific)

• Tracking Your Post-Treatment Plaque: Tune-in to this on-demand Cleerly webinar where preventative cardiologist John Osborne, MD, PhD, FACC, FNLA explores how to use CTA to track plaque progression and identify residual risk post-treatment.

• The Bunkerhill Blueprint: Advancing an AI solution from concept to clinic used to take years, but Bunkerhill Health is closing that gap at lightning speed. See how Bunkerhill is streamlining AI training, validation, approval, and commercialization to get better AI tools into clinical practice, faster.

• Welcome to the New Change Healthcare Cardiology: Explore Change Healthcare Cardiology’s web-enabled cardiovascular imaging platform that lets you access patient records anytime from anywhere, and brings better security, industry-leading structured reporting, and easy EMR integration.

• 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.

The Industry Wire

1. Hospitals grapple with hurricane aftermath: 15 things to know.
2. Healthcare CEOs cut their compensation in 2023, still made $3.5B.
3. Newsom vetoes move to allow CA to ban PE in healthcare.
4. UnitedHealth sues CMS over Medicare Advantage star ratings.
5. Biden rolls out global Cancer Moonshot effort targeting cervical cancer.
6. Trinity Health plans to grow outpatient care services.
7. Median physician productivity changes vary by specialty area.
8. Two longtime healthcare CEOs retire.
9. California’s healthcare workers to see minimum wage increase.
10. The ‘long-term vision’ of AI at Mass General Brigham.