Dr. Dan Karlsberg, MD

Big news, everyone – I’m happy to announce that Viktor Zarev is officially taking over as editor of Cardiac Wire, after writing just about every CW story you’ve read since early October.

Viktor has a solid medical education and journalism background, so he knows a thing or two about cardiology and will take great care of you. 

I’ll be shifting my focus towards Insight Links’ overall business, but before I go, I’d like to thank you all for your support over the last few years. It’s been amazing and I appreciate every last one of you.

Jake

Headed to HRS 2025?

Let us know if you’d like to attend AccurKardia and Cardiac Wire’s Heart Rhythm Rendezvous on the evening of April 26th, right across the street from the convention center. Come connect, unwind, and laugh—no speeches, just heart puns!

Artificial Intelligence

How AI is Expanding ECG and Echo’s Applications

Building stronger evidence for AI’s place in cardiology, this week brought several examples of how AI can improve ECG use cases and automate Echo for new disease detection methods.

Starting with AI improving ECG for coronary revascularization, a deep learning ECG model outperformed both clinician-led ECG and troponin T testing in predicting which ED patients needed coronary revascularization. 

• The model was trained on 145k U.S. cases and achieved an AUROC of 0.91 vs. 0.65 for clinician reads and 0.71 for TnT. 
• External validation in Europe (18k patients) showed strong results too, with an AUROC of 0.81 for revascularization and 0.85 for type 1 MI.

AI could also expand ECG into HF risk prediction as part of a recent JAMA study which found that a positive AI-ECG screening result predicted a potentially seven-fold higher HF risk.

• AI-ECG’s discrimination for new-onset HF was 0.723 in the U.S., 0.736 in the U.K., and 0.828 in Brazil. 
• When compared to the standard PCP-HF and PREVENT equations for classifying HF, AI-ECG showed net reclassification improvements of up to 47.2% and 47.5%.

A third study gave another example of how AI can automate echocardiography by using deep-learning to accurately detect clinically significant tricuspid regurgitation from full transthoracic echoes.

• The AI model detected moderate or severe TR with an AUC of 0.95 and severe TR with an AUC of 0.98.
• Researchers now hope this project can serve as the foundation for future AI–assisted Echo workflows in TR patients thanks to the model’s strong accuracy.

The Takeaway

While these studies might not sway all the AI skeptics in healthcare, they’re part of a growing trend that shows how AI can expand the functionality and efficiency of well-established modalities like ECG and Echo.

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.

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.

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 Wire

• Sniffles and Cardiomyopathy: Could a flu-like illness trigger idiopathic dilated cardiomyopathy (DCM) in people with genetic risk for the disease? One AHA study found that among 1.1k patients with DCM, 30.2% reported flu-like symptoms before being diagnosed. The study’s genome-wide analysis suggested that flu-like illness may increase DCM risk in more common gene variants, however it found no evidence of increased risk for rare DCM gene variants.

• TRYVIO’s Updated Label: The FDA approved an updated label for Idorsia’s TRYVIO (aprocitentan) following the drug’s release from its Risk Evaluation and Mitigation Strategy (REMS) requirement a month ago. The FDA determined the REMS wasn’t needed for ensuring the benefits of TRYVIO outweigh its embryo-fetal toxicity risks and that the updated label conveys enough safety information. TRYVIO is a dual endothelin receptor antagonist used for treating systemic hypertension alongside other antihypertensives in patients who are weak responders to other drugs.

• Cardiologist Salaries Dip -4%: Cardiologist salaries dropped 4% in 2024 based on the latest Medscape salary survey, with heart docs reporting an average salary of $506k vs. $526k in 2023. Cardiologists ranked fourth on Medcape’s list of 29 medical specialists, behind orthopedic surgeons, radiologists, and plastic surgeons. While that may sound discouraging, it’s more likely due to a shift in survey participants rather than a big systemic shift in physician pay.

• Cardiac Arrest, City or Country? A recent JAMA study underscored the importance of where you live when it comes to your health outcomes. The study examined 162k patients who had experienced out-of-hospital cardiac arrest and found that those who lived in rural areas had lower odds of achieving spontaneous circulation restoration upon ED arrival versus urban areas with better access to care. Meanwhile, urban areas with worse care access had lower survival rates and less favorable discharge destinations.

• Sapien M3 Lands CE Mark: In a big step toward broad commercialization, Edwards Lifesciences received CE mark approval for its Sapien M3 transcatheter mitral valve replacement system for patients with symptomatic MR. The Sapien M3 implant procedure delivers a dock around the native mitral leaflets and then guides the valve through the patient’s femoral vein using a steerable sheath. Edwards plans on sharing Sapien M3’s safety and effectiveness results from the ENCIRCLE trial in late 2025 which could help with future FDA approval.

• SAVR or TAVR Debate Continues: A commentary in The Annals of Thoracic Surgery suggests TAVR has not been proven to be the best choice for patients under 70 with severe AS and bicuspid aortic valves. This stems from recent research that has shown SAVR often leads to lower 30-day new stroke rates (2% vs. 2.5%) and a much lower rate of permanent pacemaker implantation after treatment (2.3% vs. 12.4%). The commentary also emphasized that more TAVR RCTs are needed to understand its use with younger patients.

• Hello Heart, Hello Savings: According to an independent study, Hello Heart’s digital heart health program for self-insured employers could significantly reduce medical costs per member per year. The study found that employers experienced an average reduction of $1,434 per member per year for Hello Heart program participants compared to matched non-participants. Hello Heart specifically led to the greatest reductions in members with cardiovascular disease ($15,193 PMPY), diabetes ($5,343 PMPY), and hypertension ($2,499 PMPY).

• Cardiac Troponin Predicts CVD: Measuring cardiac troponin levels could help improve first-onset CVD prediction, which can then be used to prevent future disease. As part of a JACC study, researchers meta-analyzed data from 62k participants without prior CVD, finding that patients have a 26-31% higher risk of CVD for every standard deviation increase in cardiac troponin T/I levels. Researchers also found one additional CVD event would be prevented for every 408 individuals classified at risk due to troponin levels.

• Failing on Deaf Hearts: Hearing impairment could be related to heart failure due to the psychological distress involved with deafness. Researchers analyzed 164k patients in the UK Biobank without baseline HF and found that participants with insufficient hearing, poor hearing, or hearing aid use had higher HF risks compared to those with normal hearing (aHRs 1.15, 1.28, and 1.26, respectively). Psychological distress was involved in 16.9% of participants who developed HF, while social isolation and neuroticism was involved 3.0% and 3.1%.

• Skip the Salt? While we already know too much salt increases the risk of hypertension, one study has determined exactly at what serum sodium concentration the risk begins. Analyzing 407k patients, researchers found an increased risk of hypertension with higher serum sodium levels (+29% for levels over 143 mmol/l). The risk of heart failure also increased based on blood sodium level, reaching +20% for concentrations above 143 mmol/l and +15% for tonicity above 289 mosmol/kg.

• FDA Approves WiSE CRT: Adding another treatment option for HF patients, the FDA approved EBR Systems’, WiSE cardiac resynchronization therapy (CRT) system. The WiSE CRT system is designed for patients who can’t use lead-based pacing devices and offers left ventricular pacing in patients who already have pacemakers, defibrillators, or CRT for right ventricular pacing. It currently works with Medtronic’s Micra leadless pacemaker and is being tested with Abbott’s Aveir leadless pacemaker. EBR Systems is planning a full-scale release of the WiSE CRT system in early 2026.

The CardioMEMS HF System is Now Covered by Medicare Advantage

Find reimbursement resources and more information about the expanded coverage for your heart failure patients if coverage criteria is met.

Vista.ai’s Cardiac MRI Case Studies

It’s easy to claim AI improves Cardiac MRI workflows, but it’s a lot harder to back those claims up. Tune in to these discussions with imaging experts to see how Vista Cardiac lives up to its promise of faster, more consistent, and reliable CMR scans.

Cut Waste with GE HealthCare’s Inventory Management

Want to make your hospital’s inventory practices more efficient? Tune in to this webinar on how GE HealthCare’s data-driven insights can optimize inventory management and reduce cardiac procedure times by 30-45 minutes.

The Resource Wire

• 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!

• Optum’s Cloud ROI E-book: Learn how to measure costs, define your ROI, and what to look for in a potential vendor when moving your enterprise medical imaging to the cloud. Check out Optum’s e-book now!

• 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)

• Streamlining Cath Lab Hemodynamic Workflows: Is your hemodynamic solution keeping your cath lab efficient? Merge Hemo is a cath lab hemodynamic monitoring solution, providing a Best in KLAS user experience, while enhancing clinical workflows, automating data collection, and streamlining inventory management.

• 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.

• Patient Attitudes Towards Us2.ai’s AI-Echo: The medical imaging field is rapidly accepting AI, but how are patients feeling about the shift? Get the scoop on patients’ positive opinions toward Us2.ai’s software that supports task shifting from conventional echo to AI-echo.

• Heartflow Roadmap Analysis For Efficient Care: As Coronary CT scan volumes increase, your entire reading team needs to deliver efficient and consistent reads. Good thing Heartflow’s Roadmap Analysis can help you maintain accuracy and increase CCTA read speeds by up to 25%, with even level 3 readers seeing real efficiency benefits.

• Explore Vitrea Advanced Visualization: Discover Canon Medical Healthcare IT’s suite of advanced imaging workflows designed to increase efficiency in cardiovascular imaging, and facilitate the assessment, diagnosis, and treatment of cardiovascular diseases. These cutting-edge tools support the delivery of faster, more accurate care while integrating seamlessly into clinical workflows.

• 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 Industry Wire

1. Stem cells could help with Parkinson’s.
2. CDC scraps Texas measles response over layoffs.
3. UnitedHealth’s struggles with Medicare Advantage in Q1.
4. Staffing and funding cuts could impact physician shortage.
5. Budget draft plans to cut HHS funds by one-third.
6. CMS rejects Humana’s MA star ratings appeal.
7. Supreme Court braces for ACA coverage suit.
8. Harvard’s ALS research funding frozen.
9. Vaccine panel recommends expanded RSV use.
10. ‘Blue sky’ research most impacted by budget cuts.