Usha Tedrow, MD on the importance of the VANISH2 trial.

The Cardiac Wire Show made its AHA debut last weekend, capturing key insights into the latest cardiovascular breakthroughs in interviews with… 

• Juntendo University’s Dr. Nobuyuki Kagiyama on how Us2.ai’s echo AI solution led to significant improvements in echo exam efficiency, quality, and sonographer fatigue.
  
• AccurKardia’s Juan Jimenez and Moin Hussaini on ECG’s potential to serve as a broad biomarker – far beyond arrhythmia detection.

• Brigham and Women’s Hospital’s Christian Ruff, MD, MPH on how Anthos Therapeutics’ abelacimab might allow patients on antiplatelet drugs to also take anticoagulants without the typical bleeding concerns.

Cardiology

Ablation or Antiarrhythmics for Ventricular Tachycardia?

Late-breaking results from the VANISH2 trial presented at AHA 2024 showed that catheter ablation might be a better first-line treatment than antiarrhythmic drugs for ventricular tachycardia patients with ischemic cardiomyopathy.

• Previous research has shown that if antiarrhythmic drugs aren’t working for VT, those patients should receive ablation rather than more aggressive drug therapy.
• However, it’s unproven whether catheter ablation is more effective than antiarrhythmics as a first-line treatment.

To address this uncertainty, the VANISH2 trial recruited 416 patients with clinically significant VT, ischemic cardiomyopathy, previous MI, and an ICD, randomizing them to receive either ablation or antiarrhythmic drugs (sotalol and amiodarone).

Over a median of 4.3 years, ablation led to a lower risk of the study’s composite primary endpoint of death, VT storm, ICD shock, and unsuccessful treatment (50.7% vs. 60.6%), with ablation showing advantages across all metrics…

• Death – 22% ablation vs. 25% drug
• VT storm – 22% vs. 23.5% 
• ICD shock – 30% vs. 38%
• Treated VT below rate cutoff – 4% vs. 16%.

Ablation patients also experienced far lower rates of nonfatal adverse events within 30 days of treatment (11.3% vs. 21.6%), although treatment-related mortality was higher for the ablation group (1% vs. 0.5%; 2 vs. 1 patients).

Despite its strong design, VANISH2 had some caveats regarding its size, locations, and patient population.

• Ablation showed the greatest benefits among sotalol-eligible patients, who tended to be healthier, potentially skewing the overall results.
• The study enrolled a disproportionately low number of women, likely due to women experiencing heart attacks later in life than men.
• VANISH2 was held in 22 expert hospitals, likely increasing ablation success rates compared to if hospitals with less ablation experience were also included. 

The Takeaway

Ablation has traditionally been a backup plan for treating VT when antiarrhythmic drugs fail, but VANISH2 could help shift this approach after demonstrating that ablation is just as effective as antiarrhythmics as a first-line VT treatment (if not more effective) – and it’s often permanent.

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.

The Path To Modern Enterprise Imaging is in the Cloud

Healthcare needs are changing rapidly, and some imaging systems cannot adapt to an evolving technology landscape. Explore the factors forcing imaging and IT teams to look to the cloud, and what might be holding them back in this Optum infographic.

Monebo’s AF ECG Algorithm

Atrial fibrillation is often difficult to characterize with an automated algorithm due to the changing waveform morphology, system, or muscle noise. This is especially true given the size constraints of ambulatory devices to detect AFib. See how Monebo’s Kinetic AF ECG Algorithm overcomes these size limitations without sacrificing accuracy.

The Wire

• AI-ECHO Shows Us2.ai’s Promise: Notching a big win for automated echocardiography, the AI-ECHO RCT trial found that AI helps improve echo exam efficiency, quality, and operator fatigue. Using Us2.ai’s software and traditional methods on alternating days, the AI led to improvements in exam times (14.3 min vs. 13.0 min) and exams per day (14.1 vs. 16.7), while increasing the share of “excellent” quality exams (31% to 41%) and decreasing sonographer’s mental fatigue (from 4.7 to 4.1pts out of 5).

• LAAC or Anticoagulants for AFib? Among patients who received AFib ablation, left atrial appendage closure (LAAC) using Boston Scientific’s Watchman could lower long-term bleeding risks versus traditional anticoagulation therapy. After 36 months, the OPTION trial showed that non-procedure-related major bleeding or clinically relevant nonmajor bleeding occurred in far fewer LAAC recipients than anticoagulation patients (8.5% vs. 18.1%), positioning LAAC as noninferior to oral anticoagulation. 

• A Case for Intensive BP Care: Reasserting the connection between blood pressure and CVD risk, results from the BROAD trial in China found intensive systolic BP lowering significantly reduced MACE in patients with T2D. Of BROAD’s nearly 13k participants, half received intensive treatment to bring their SBP below 120 mmHg, while half received traditional therapies. After one year, the intensive treatment group’s MACE risk was 21% lower (1.65 vs. 2.09 events per 100 person-years), but they had higher risks of hypotension and hyperkalemia.

• Omron’s BP + AF Authorization: Omron Healthcare announced the FDA De Novo authorization of its AI-powered home blood pressure monitor, which uniquely adds AFib detection. Although AFib monitoring isn’t generally what comes to mind with a cuff-based BP monitoring device, the Omron systems use AI to identify signs of AFib in pulse pressure waves as the cuff inflates, detecting AFib with 95% sensitivity and 98% specificity in a recent study.

• Tirzepatide Lowers HFpEF Risk: Late-breaking results from the SUMMIT trial added reduced HFpEF risk to Eli Lilly tirzepatide’s growing list of cardiac benefits. The study found tirzepatide treatment in patients with an ejection fraction of ≥50% and BMI ≥30 decreased the risk of worsening HF and death by 5.4% compared to placebo and led to a better KCCQ-CSS score (19.5 vs. 12.7). The results build on tirzepatide’s recent SURMOUNT-1 trial, where it prevented diabetes in 99% of prediabetic patients.

• BrightHeart’s Fetal Ultrasound Clearance: French startup BrightHeart received FDA clearance for its AI application for detecting congenital heart defects on fetal ultrasound exams. BrightHeart suggests that its software will help clinicians detect abnormalities that can be signs of CHDs, so they can initiate therapeutic interventions. BrightHeart emerged from stealth last year, and now plans to expand into the U.S. market.

• CRISPR for ATTR-CM: Providing hope for ATTR-CM patients, Phase 1 results showed that a single dose of Nexiguran ziclumeran (nex-z) led to consistent reductions in serum TTR levels. By targeting the transthyretin gene, nex-z decreased serum TTR levels by an average of 89%. However, 34 out of 36 patients experienced some level of adverse events, including transient infusion-related reactions and transient liver-enzyme elevations.

• TeraRecon’s Cardiac MRI Clearance: TeraRecon received FDA 510(k) clearance for auto-contouring on cardiac MRI exam, helping to improve workflows in cardiac MRI, which historically has been more challenging to perform than other cardiac imaging modalities. The solution helps users achieve more efficient and precise results, and is another sign of the company’s growing focus on cardiac imaging, following the introduction of new cardiac MRI modules in its Intuition 4.10 release.

• Omecamtiv’s Ageless Impact: New analysis of Cytokinetics’ phase 3 GALACTIC-HF trial highlighted omecamtiv mecarbil’s potential for treating HF regardless of patient age. During the study’s 21.8 month follow-up, the primary composite endpoint of cardiovascular death or heart failure events occurred at similar rates among patients <65 and ≥65 years (21.4 & 28.8 per 100 patient years). Omecamtiv treatment also reduced overall risk of CV death or HF events by 23% and 17% in patients with severe HF. 

• Aficamten’s VO2 Increase: Cytokinetics also announced data supporting aficamten’s ability to increase peak VO2 and improve quality of life in patients with HCM. The SEQUOIA-HCM data analysis showed that aficamten shortened post-exercise oxygen-uptake recovery times by eight seconds for a 12.5% reduction, seven seconds for a 25% reduction, and eight seconds for a 50% reduction. This has positive implications for aficamten’s overall impact, as faster VO2 reductions were linked to improvements in NT-proBNP, hs-cTnI, and resting left ventricular outflow tract gradient.

• Cardiologist Integration & Patient Outcomes: As cardiologists increasingly move to direct hospital employment, a JACC study found no significant differences in outcomes for acute MI and HF patients. The analysis sampled Medicare fee-for-service beneficiaries hospitalized with AMI or HF from 2008 to 2019, during which the proportion of U.S. cardiologists employed by hospitals increased from 26% to 63%. Although this employment shift didn’t worsen outcomes in the study, the researchers found “…minimal evidence that cardiologist employment by hospitals improves care quality or outcomes.”

Cardiology AI: From Research to Clinical Practice

Explore how AI algorithms are reshaping cardiology with insights from Tempus’ recent webinar, featuring Dr. David Ouyang of UCLA and Cedars-Sinai, alongside Tempus’ Dr. John Pfeifer and Dr. Brandon Fornwalt. This expert panel dives into how AI can bridge diagnostic gaps, enhance patient outcomes, and streamline workflows for conditions like AFib and pulmonary hypertension. Read the full recap to glimpse the future of AI-driven cardiology.

PRECISE Trial Rewrites the Patient Pathway

HeartFlow’s landmark PRECISE trial found that their precision approach for evaluating people with stable chest pain avoided unnecessary testing and improved care without putting patients at risk of a missed heart disease diagnosis.

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)

The Resource Wire

• Automate Your Echo Reporting: It’s a good feeling when your echo report is already 83% complete before you even sit down to work on it. See how Centricity Cardio Enterprise’s echo automation features make this “good feeling” an everyday occurrence in this quick GE HealthCare demo video.

• Assessing CAD with Circle CVI: Did you know that Circle CVI offers a suite of cardiac CT tools for the assessment of coronary artery disease? See how Circle combines heart function segmentation, automated plaque analysis, CAC scoring, reporting, and viewing in a single dedicated Cardiac CT package.

• Echo AI for HFpEF: New research comparing Us2.ai to gold-standard invasive hemodynamic measurement showed that in patients with HFpEF, echo AI measurements are interchangeable with manual core-lab measures to diagnose increased filling pressures – and could improve HFpEF detection.

• A Better Way to Coordinate Post-Stroke Care: Think your EHR messaging system might be holding back your post-stroke care? See how UC San Diego Medical Center streamlined its neuro and EP teams’ post-stroke workflow with Viz Connect, and the impact it had on cardiac monitor placements in inpatient and outpatient settings.

• The Benefits of Outsourced Post-Processing: Using an outsourced cardiac image post-processing solution doesn’t have to mean sacrificing control of the results. Discover how PIA’s customizable post-processing workflow can help you get the most out of your images.

• Transforming Ischemia Detection: CCTA AI is poised to transform ischemia detection, leading to far greater diagnostic efficiencies and far fewer unnecessary invasive procedures. See how ischemia’s AI transformation is unfolding in this Cardiac Wire Show interview with Cleerly’s chief medical officer James Earls, MD.

• From CPACS to CVIS: Cardiovascular imaging has come a long way from CPACS. Explore the evolution of cardiology image and data management in this Merge by Merative executive brief, and see what makes CVIS such a significant advancement.

• 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 Industry Wire

1. New rules for TV and radio drug ads.
2. MGB primary care docs look to unionize.
3. Texas med school asked to stop liquefying cadavers.
4. University of Illinois nurses end strike after tentative deal.
5. How home oxygen leader became “Multibillion-Dollar Medicare Scofflaw.”
6. OIG (again) rates HHS’s information security program “not effective.” 
7. ProPublica: Insurance directories are full of wrong information.
8. DEA and HHS extend telemedicine flexibilities through 2025.
9. Woman arrested for posing as nurse and treating patients.
10. Trump nominates Dr. Mehmet Oz to lead CMS.