Neil Floch, MD on proposed Medicaid cuts in the House Reconciliation Bill.

Surgeries & Interventions

Contrast Use During PCI on the Decline

New ACC registry data suggests interventional cardiologists are using less contrast for PCI procedures in the cath lab which helps reduce post-PCI acute kidney injury risks, but a deeper look tells us there’s still room for improvement.

• Iodinated contrast agents are commonly used for PCI with gadolinium-based contrast serving as an alternative but both can cause complications like acute kidney injury.
• However, the trend is shifting towards minimizing or avoiding contrast use, especially in high-risk patients, through techniques like “zero-contrast” or “ultra-low contrast” PCI.

Searching for cath lab trends, researchers examined 3.12M unique PCI procedures performed by 3.6k physicians from 2018 to 2022 and found that the average contrast volume used during PCI decreased modestly but consistently over the study’s four years.

• Overall mean PCI contrasts volumes decreased from 168.1 mL in 2018 to 71.2 mL by 2022.
• Encouragingly, patients at higher preprocedural AKI risk also consistently received less contrast than those at lower risk (160.5 mL vs. 171.3 mL in 2018 down to 143.4 mL vs. 150.4 mL in 2022). 

While the trend is in the right direction, researchers still highlighted that there’s plenty of room for improvement across the board.

• For example, 37.5% of physicians did not significantly decrease their contrast use during the four years they were followed, while 20% didn’t change volumes at all.
• When categorized by percent change, 77.1% did not significantly change the amount of contrast they used per procedure.
• Meanwhile, 1.9% of physicians actually increased their average contrast by >20%.

So what’s the answer? One recent RCT in Canada implemented preprocedural guidelines for safe contrast amounts and showed decreases in both contrast volume and AKI, particularly in higher-risk patients.

• However, the trial provided feedback at the individual operator level rather than at the site level, so it’s unknown if site-level feedback alone can reduce AKI rates.

The Takeaway

PCI contrast use is headed in the right direction, but there’s still work to be done when it comes to messaging and convincing physicians about reducing volumes during procedures. Whether that’s achieved by more research, a better contrast alternative, or stronger education remains to be seen.

How to Improve Cardiology Workflows and Get More Patient Time

Complex processes and reporting requirements can mean cardiologists spend more time with clinical systems than they do with their patients. See how Merge Hemo and Merge Cardio work together to help you streamline and scale your clinical and data management workflows, so you can have more time in front of your patients.

Configure Your PCI Study

See for yourself how cardiac imagers use GE HealthCare’s Centricity Cardio Enterprise Universal Viewer to do their PCI studies, including configurable viewport setup and side-by-side comparisons.

AI Analysis of ATTR-CM

ATTR-CM is a progressive and fatal cardiomyopathy with a rising number of diagnoses and a highly variable clinical course. See how Us2.ai’s fully automated machine learning algorithm analyzes echocardiographic DICOM images without human interaction to improve tracking ATTR-CM progression and treatment responses.

The Wire

• ECG Algorithm for AS: HeartSciences received FDA Breakthrough Device designation for its Aortic Stenosis ECG algorithm. The algorithm uses ECG data to detect moderate-to-severe AS up to 24 months earlier than confirmatory echocardiography, with diagnostic accuracy increasing as the disease progresses. HeartSciences hopes to add it to its MyoVista Insights cloud-based platform which would directly integrate with hospital EHR systems without additional hardware or testing.

• Making TAVR Safer: As TAVR gets more popular, cardiologists and device manufacturers keep working to make the procedure safer and more effective. For example, the Optimize PRO study found that following a standardized protocol and using the cusp overlap technique when implanting Medtronic’s Evolut TAVR valve led to a significantly lower rate of permanent pacemaker implantation (6.4% vs. 18.5%). Another factor that lowered PPMI rates was whether or not the procedure used the Lunderquist guide wire (9% vs. 19%).

• YUTREPIA for PAH: The FDA approved Liquidia’s YUTREPIA (treprostinil) inhalation powder for adults with PAH and interstitial lung disease pulmonary hypertension (PH-ILD) for improving exercise ability. YUTREPIA is a prostacyclin dry-powder formula that is designed to enhance deep-lung delivery via a low inspiration effort device. The drug’s approval stems from the Phase 3 INSPIRE trial which found YUTREPIA was safe and well-tolerated regardless of a patient’s previous exposure to treprostinil.

• J&J Antitrust Case: Johnson & Johnson will pay $442M in damages to settle its antitrust case with Innovative Health over cardiac mapping catheter reprocessing. The lawsuit goes back to 2019 when Innovative accused J&J of illegally combining access to its Carto 3 system specialists with the purchase of brand-new catheters, enabling the company to create a monopoly. As a result, a California federal jury ruled in favor of a $147M verdict, but federal law tripled it to $442M.

• The Cost of HF: New data analysis revealed just how expensive HF is for healthcare systems and societies. The EHJ study analyzed 32 HF studies across four databases and found that HF’s estimated economic burden was $284B across 179 countries in 2021. This included $136B in direct treatment costs and $147B in indirect costs. While highly developed countries accounted for the most absolute HF spending, less developed countries spent a greater percentage of GDP on HF (8.85% vs. 3.03%).

• Carotid Plaque Progression: Subclinical carotid plaques with pre-existing calcification could be more likely to evolve into IPH than calcification-free plaques. Researchers used MRI to evaluate carotid plaques in 802 patients and found that plaques with calcification were independently associated with a higher incidence of intraplaque hemorrhage (OR: 2.00). The study then simulated continued plaque progression and found that most subclinical carotid plaques progressed to multicomponent plaques and that men were more likely to develop multicomponent plaques with IPH.

• Delayed vs. Immediate Angiography: Is immediate or delayed selective coronary angiography better for patients with out-of-hospital cardiac arrest without ST elevation? A new JAMA study analyzed 1k patients across two RCTs and found that immediate coronary angiography did not improve survival one year after cardiac arrest compared to delayed angiography (49.6% vs. 53.4%). The researchers also determined there was no subgroup of patients that showed a treatment effect.

• CVAUSA + HybridChart: PE-backed Cardiovascular Associates of America (CVAUSA) selected HybridChart as its mobile rounding and data solutions provider for scaling and tracking performance. The partnership will leverage HybridChart’s platform to streamline workflows for CVAUSA cardiologists while rounding and capturing critical patient data. CVAUSA will also use HybridChart’s software to build a centralized data platform for better performance visibility across its member practices.

• Dutch Hospitals Deploy Us2.ai: Two hospitals in the Netherlands have deployed AI echo technology from Us2.ai. Erasmus Medical Center and Wilhelmina Hospital installed the company’s software for automatically analyzing cardiac ultrasound images, with Erasmus MC being the first Dutch academic center to use Us2.ai and Wilhelmina the first general hospital. Us2.ai’s software automates echo tasks previously performed manually, giving clinicians more time to spend with patients.

• Fetal Echo Predicts Delivery Distress: A fetal echocardiography exam can predict clinical outcomes during delivery, in particular whether an infant will experience distress. Italian researchers performed echo scans of 208 pregnant women at the start of labor, with 20 experiencing fetal distress and converting to operative delivery (Caesarean or instrument-assisted vaginal birth). Of these, predictive factors included higher left ventricular ejection fraction (47% vs. 13%), increased right ventricular myocardial longitudinal strain (-16 vs. -13), and increased right ventricular endocardial longitudinal strain (-18 vs. -14).

• Healthcare Workforce Bounces Back: The healthcare workforce appears to be bouncing back after hitting rock bottom during the COVID-19 pandemic. A JAMA research letter documents how the number of healthcare jobs fell 6.9% from Q4 2019 to Q2 2020, but by Q3 2024 was only down 0.2% relative to predicted levels. For point of reference, non-healthcare employment fell 11.4% and 2.9%, respectively. Hospitals and skilled nursing facilities are still experiencing shortages, while physician offices have recovered more quickly.

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.

Left Ventricular Devices Have Received Level 1A Recommendation

Patients on long-term inotrope support have a median survival of under a year.

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The Resource Wire

• 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 workflow

• 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.

• 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.

• 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.

• CMR Access Is Broken—Here’s How to Fix It​: Cardiac MRI is one of the most powerful tools for diagnosing heart disease, yet it’s still out of reach for many patients. Download Vista AI’s new infographic to see what’s holding CMR adoption back—and how AI and automation can help make gold-standard imaging more accessible than ever.

• Explore the latest clinical evidence: SMART Trial 2-year results are in! Evolut™ TAVR maintains superior valve performance through two years in small annulus patients. Dive into the key findings from the latest SMART Trial results. View now!

• NMMC’s Pediatric and Fetal Echo Upgrade: North Mississippi Medical Center was struggling with long report turnaround times, inefficient workflows, data and documentation challenges, and inadequate reimbursement processes. Find out how they turned their situation around after adopting Optum’s pediatric and fetal echo workflows.

• Redefining Percutaneous Coronary Intervention: Learn about the AGENT™ Drug-Coated Balloon from Boston Scientific and how this technology is expanding the treatment options for patients with in-stent restenosis in the U.S. Rx only. (Sponsored by Boston Scientific)

• The Monebo Difference in Comprehensive Cardiac Mapping: Monitoring the heart 24/7 means being in tune with the body’s natural cycles. Read about how Monebo’s approach to cardiac monitoring provides visual representations of a patient’s heart rate, cardiac muscle relaxation, and electrical excitation throughout the day.

The Industry Wire

1. Senate GOP eyes Medicare reforms amid fiscal pressure.
2. Stanford pilots ChatEHR natural language interface. 
3. CEO of healthcare software company convicted in $1B fraud scheme.
4. The no good, very bad year for UnitedHealth.
5. HHS budget proposal cuts National Cancer Institute funding by 37%.
6. Health System CEO exits surge 150% month-over-month.
7. Hospital violence costs $18B a year.
8. Sutter Health receives $110M gift, largest in system’s history.
9. Northwestern and BayCare partner on research and access.
10. Atlantic Health System taps Novant exec as CEO.