Ziyad Al-Aly, MD on the outcome of his GLP-1 study.

Last week we published a top story about AI-CCTA vs. SPECT and an eagle-eyed reader caught some mathematical issues with the study. We’ve since updated our coverage to address these issues, and you can read the updated story here.

Obesity Care

The Potential Risks of GLP-1s

Although GLP-1s have proven to significantly help with weight loss and cardiometabolic disorders, a new Nature Medicine study shed light on the drugs’ potential side-effects.

• GLP-1s have skyrocketed in popularity due to their weight loss impact, while their potential heart benefits could make GLP-1s a common cardiology drug.
• However, little is known about the long-term risks of this “wonder drug” class due to its relatively short time on the market and a lack of studies on the topic.

To tackle this problem, researchers compared Veteran’s Affairs data on 2 million T2D patients (2017-2023) taking either GLP-1s, DPP4is, SGLT2is, or usual care antihyperglycemics over a 3.68 year follow-up.

Starting with the good news, GLP-1s lowered risks for 42 health outcomes while increasing risks for 19 outcomes.

• As expected, GLP-1s reduced MI risk by 9%, cardiac arrest by 22%, incident HF by 11%, ischemic stroke by 7%, and hemorrhagic stroke by 14%.
• GLP-1s also led to an 8% lower risk of dementia and 12% lower risk of Alzheimer’s disease.

The less good news? There’s still no free lunch in healthcare.

• The risk of GERD, gastritis, noninfectious gastroenteritis, gastroparesis, diverticulosis, and diverticulitis all increased with GLP-1s.
• Other risks like hypotension, syncope, and nephritis also increased, as well as a 2.46X higher risk for drug-induced acute pancreatitis.

On the clinical side, these outcomes can help physicians make more personalized patient treatment decisions, as the researchers pointed out “people without diabetes and obesity likely wouldn’t experience many of these benefits.”

• It’s also worth noting that the data came from military veterans who were older and mainly white, so the outcomes might not apply to other populations.

The Takeaway

Bearing in mind the current benefits of GLP-1s, it’s not likely that the side-effects examined by this study will slow down the pace of adoption. That said, it could serve as an early look into the long-term health outcomes of using GLP-1s to treat obesity and T2D.

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.

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.

Addressing Coronary Artery Disease

Learn how the AGENT™ Drug-Coated Balloon provides a new treatment option for in-stent restenosis in the U.S. Rx Only. (Sponsored by Boston Scientific)

The Wire

• ESC vs. AHA CABG Guidelines: Several cardiac surgery organizations around the world (including STS and AATS) united to endorse the 2024 ESC guidelines for chronic coronary syndrome management. The unified organizations dispute the 2021 AHA/ACC coronary revascularization guidelines, which downgraded CABG from a class I to IIb recommendation for patients with stable three-vessel CAD, preserved LV function, and no left-main coronary artery stenosis. Instead, the organizations support ESC’s guidelines which keep CABG as a class I recommendation to improve survival in this patient group.

• LMI’s Amyloid Radiotracer: Life Molecular Imaging received FDA Fast Track Designation for its [18F]florbetaben radioactive diagnostic agent used for detecting cardiac amyloid light-chain and ATTR amyloidosis in PET scans. Earlier studies demonstrated [18F]florbetaben’s capability to identify AL and ATTR amyloid deposits in the heart, leading to its Orphan Drug Designation by the European Commission and FDA in 2020 for AL amyloidosis diagnosis. The radiotracer is also already approved for brain amyloid detection, supporting its potential cardiac pivot.

• Combo AI Model Predicts MACE: An AI model that uses a combination of CCTA and stress cardiac MRI scans was able to predict MACE in patients with obstructive CAD with good accuracy. French researchers developed the model and tested it in 2k patients, achieving an AUC of 0.86, which was higher than traditional methods (AUC=0.55-0.71) and CCTA or stress MRI alone (AUC=0.76 & 0.83). 

• No Need for Aspirin with HM3: New analysis of the ARIES-HM3 trial suggests prior PCI, stroke, PVD, or CABG should not compel physicians to use aspirin as part of the antithrombotic regimen with Abbott’s Heartmate 3 left ventricular assist device. Among the study’s examined patients, 41% had a history of an atherosclerotic vascular condition and experienced no benefit from aspirin compared to placebo. As a result, researchers believe aspirin may be safely eliminated from the antithrombotic regimen after HM3 LVAD implantation.

• Getinge/Maquet HemoPro Recall: The FDA announced that Getinge/Maquet Cardiovascular issued an additional recall for its endoscopic vessel harvesting devices over significant safety concerns. The recall covers all unexpired lots of Getinge/Maquet’s VasoView HemoPro 2 EVH due to issues with heater wires bending and silicone peeling from the device. New guidelines suggest inspecting the devices for signs of damage, rough surfaces, and sharp edges. The company similarly recalled its VasoView HemoPro 1 and 1.5 EVH devices in November.

• Dietary Inflammation & HF: What you eat could be even more important if your heart is failing, as new research suggests higher dietary inflammation scores could increase the risk of HF events. Researchers studied ~18k patients without HF at baseline and found that over an 11.1 year follow-up, 900 incident HF events (752 hospitalizations and 148 deaths) occurred, while patients with the top 25% of dietary inflammation scores faced a 26% greater risk of HF.

• Healthy Hearts Get Sick Too: Although we often consider athlete’s hearts healthier than the average, an EHJ study determined that athletes are not immune to CAD, even when traditional CV risk factors aren’t present. On the contrary, EHJ’s cardiac imaging data uncovered that long-term, high-volume, high-intensity endurance exercise could be associated with coronary atherosclerosis and that the potential for CAD should not be overlooked as it is the leading cause of sudden cardiac death in athletes >35 years of age. 

• Data Pooling Improves CABG: University of California Cardiac Surgery Consortium highlighted the benefits of pooling surgical data across its five health centers, including both financial and outcome improvements for its CABG procedures. UCCSC’s data sharing program improved several CABG markers from 2015 to 2023, including: decreased blood product utilization (-8.26%), increased early extubation (+22%), lower average initial ventilator time (-1.5 hours), and fewer 30-day readmissions (-3.96%) – leading to a financial margin improvement of about $15M.

• Retinal Scans Predict Stroke: UK Biobank analysis revealed that predicting strokes could be as simple as scanning retinal vasculature. The study examined the retinal vascular data (density, caliber, complexity, etc) of roughly 45k patients over a 12.5 year follow-up, of which 749 had strokes, with each standard deviation in retinal data increasing stroke risk by 9.8% to 19.0%. For stroke prediction, the retinal vascular model achieved an AUROC of 0.752, significantly outperforming traditional risk factor prediction.

• Fatty Muscles Raise Cardiac Risk: Researchers found that CT measurements of intermuscular fat can predict major cardiac events. In a new EHJ study, researchers performed PET/CT and CT scans of 669 patients and followed them for six years, finding that every 1% increase in the ratio of intermuscular fat to total muscle plus fat led to a 2% increase in coronary microvascular dysfunction and a 7% increase in future serious heart disease.

• When Breakthrough Devices Don’t Break Through: Medical device and software developers often tout their receipt of the FDA’s “breakthrough device” designation, but getting the stamp doesn’t necessarily mean the products will reach the market. Legal analyst Bradley Thompson breaks down the program, noting that only about 12% of breakthrough devices are ultimately cleared or approved. Thompson speculates that the FDA actually reviews breakthrough devices more closely than other products, which could stifle companies with “overly burdensome requests for data.”

Optum’s CV Imaging Pearls

As populations age, the increasing prevalence of cardiovascular disease means that pressure is mounting for healthcare providers. Watch Optum Insight enterprise imaging CEO Tracy Byers and Chief Product Officer Omer Shalit-Cohen discuss the important role enterprise imaging plays in cardiovascular imaging.

The Efficiency of the Kinetic Rhythms ECG Algorithm

See how you can interpret up to twenty-nine distinct rhythms by embedding the Kinetic Rhythms ECG Algorithm on your device or software suite. Ensure precise ECG interpretations regardless of whether they’re taken at the bedside or in an ambulatory setting.

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.

The Resource Wire

• Physician Perspectives on HeartFlow: Physicians worldwide are using the HeartFlow Analysis to help diagnose suspected coronary artery disease. Explore their perspectives on adopting HeartFlow’s technologies today.

• Circle CVI’s Cardiac CT Expansion: Watch this Cardiac Wire interview with Circle Cardiovascular Imaging’s Chief Product Officer, Scott Galbari as he sheds light on Circle CVI’s history with cardiac MRI and how the company is tackling the coming demand for cardiac CT.

• A Universal View of Your Patient: Think you’re getting the most out of your viewer? See how GE HealthCare’s Centricity Cardio Enterprise Universal Viewer allows you to quickly review exams, access and compare prior studies, and perform measurements in this 60-second video.

• Echo Automation’s Big Impact: Improving clinician efficiency and quality is the goal for most AI solutions, but we rarely see AI achieve both. See how Juntendo University’s Dr. Nobuyuki Kagiyama achieved both of those goals, while reducing sonographer fatigue in the process.

• 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!

• Predicting Coronary Events With Plaque Analysis: How can measuring non-calcified plaque burden change how we detect heart disease? Tune-in to Cleerly’s on-demand webinar featuring Sarah Bär, MD, PhD to discover how Cleerly’s AI-powered coronary CTA plaque analysis is reshaping CAD risk prediction, beyond standard tests. 

• Innovating AFib Care: The first manifestation of AFib is often stroke, but many hospitals aren’t set up to coordinate these patients’ post-stroke care. See how UCSD is leveraging Viz.ai’s Viz Connect solution to simplify neuro and EP collaboration in this HRX 2024 interview.

The Industry Wire

1. Trump orders U.S. to withdraw from World Health Organization.
2. GLP-1s make list of 15 drugs in second round of Medicare negotiations.
3. Key insights health system CIOs from JPM25.
4. Small Language Models (SLMs) could revolutionize healthcare AI.
5. Why not tie Medicare reimbursement to inflation?
6. HHS Inspector General raises concerns over FDA’s accelerated approvals.
7. CommonSpirit moving ‘fast and aggressively’ toward single EHR.
8. GOP eyes major cuts to healthcare.
9. State-by-state breakdown of new hospitals in 2024.
10. OpenAI transforms digital assistance with Tasks feature for ChatGPT.