John Mandrola, MD

Wire-based coronary imaging improves outcomes and lowers costs, but it’s still underused because it slows procedures down. Read about how CathWorks FFRangio changes that by using AI and advanced computing to pull physiological insights from routine angiograms in the latest Cardiac Wire exclusive.

Population Health

Masters Athletes’ Hearts are Different, Especially When Imaged

A recent JACC state-of-the-art review suggests that older athletes might face some unique cardiovascular changes, and although medical imaging can help identify their risk, the results need to be carefully interpreted.

• Masters athletes (ages 35 and up) are now a growing patient group within competitive or high-intensity exercise.
• These athletes often show cardiac changes that blur the line between sport-driven adaptations and early disease.
• Making things even more complex, cardio-intensive exercise provides CV protection but it doesn’t completely get rid of the naturally occurring risks that come with aging.

To better understand these patients, researchers looked at how physicians interpret multiple cardiac imaging modalities for masters athletes especially for changes in heart structure and how this complicates disease detection.

• For example, older athletes commonly have larger heart chambers (atria) and ventricular shapes which differ from the average patient.
• These structural changes likely start when the athlete is young and are then later influenced by aging and cardiovascular disease onset.

Looking past big changes in the heart’s shape, researchers also looked for subtle signs like…

• Myocardial fibrosis (often associated with AFib in normal patients) was common in endurance athletes and may be a positive adaptation rather than a negative one.
• Slight atherosclerosis in the form of coronary artery calcification from lifetime high-intensity exercise was also often elevated in masters athletes.

While these changes might seem alarming to some cardiologists, the study’s authors clarify that there is a big difference between the average masters athlete and an older person in the general population.

• This means that what we would typically think of as a “red flag” on a cardiac scan probably needs a second look using a patient’s athletic history as context.
• Masters athletes also differ in the way they experience heart symptoms, so things like classic angina might be less of a clue than a sudden drop in athletic performance.

It’s also important to remember that the “masters athlete” category is broad and includes everything from lifelong competitors to weekend warriors, so ultimately each heart patient deserves a tailored approach.

The Takeaway

This study is a reminder to physicians that a patient’s athletic history can vastly change the way their heart looks in cardiac images, so context is key. It’s also a reminder to the average non-athlete just how much staying active can change your heart (for the better).

Heart Failure Hospitalization Doubles Risk of Cardiovascular Death

21% of patients with symptomatic heart failure escalate to hospitalization for heart failure or cardiovascular death, and 25% of those who experience hospitalization are readmitted due to heart failure within one year of discharge. Watch Bayer’s Dr. Alanna Morris-Simon discuss heart failure hospitalizations and when to assess care plans.

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

A Solution for Your Entire Cardiology Service Line

The pace of change in healthcare can be dizzying, creating new and more complex challenges for cardiology departments to overcome. See how Merge Cardio and Merge Hemo can turn those challenges into opportunities for greater workflow efficiency and improved care.

The Wire

• CathWorks FFRangio Goes Beyond Physiology: Even though evidence shows that wire-based coronary physiology improves outcomes and lowers costs, it’s still underused because it slows down procedures. In the latest Cardiac Wire exclusive, we explored how CathWorks FFRangio changes that by using AI and advanced computing to pull physiologic insights from routine angiograms, with no pressure wire or drug stimulation. CathWorks’ technology also maps FFR across the coronary tree, simulates pullback, estimates lesion impact, and provides sizing for PCI planning.

• Impulse Raises Funds for CCM: Impulse Dynamics raised over $158M to expand the commercialization and development of its cardiac contractility modulation (CCM) therapy that treats HF using an implant to deliver electrical signals to the heart muscle. The investment comes after CMS issued a National Coverage Determination for CCM therapy, expanding access to over 66M individuals. The fresh funds will be used to advance Impulse’s CCM-D HF System while supporting clinical trials including INTEGRA-D and AIM HIGHer studying treatment for underserved HF populations.

• Put The Facts in Front: The ACC released new guidance supporting front-of-package nutrition labels to help consumers make heart-healthy food choices. The labels would highlight three to five critical nutrients like saturated fat, added sugar, and sodium in an easy-to-understand format. The best part? This isn’t a new idea, and has already been proven to improve consumer awareness, encourage healthier purchasing, and prompt manufacturers to reformulate products in 44 different countries. The FDA proposed front-of-package labeling in January but still hasn’t finalized the rule.

• Heartflow Predicts Cardiac Risk: New data from the FISH&CHIPS study in the U.K. underscores the value of Heartflow’s FFR-CT AI software for predicting future cardiovascular events in patients with suspected stable coronary artery disease (angina). Data presented at EACVI 2025 found that among 7.8k patients getting FFR-CT analysis, those with severely reduced fractional flow reserve had over 5X the rate of myocardial infarction than those with normal FFR-CT (5.2% vs. 1%).

• Healthcare AI Use Lags, But Is Growing: Healthcare lags other industries in adopting AI, but it’s picking up steam. A new JAMA Health Forum study analyzed AI deployment in five business sectors from September 2023 to May 2025, finding at the start of the study fewer than 5% of healthcare organizations were using AI, but the percentage began growing in December 2024 and reached nearly 10% by the study’s end. Still, healthcare lagged the other four sectors in AI adoption through the study period.

• FDA AI Approvals Pass 1k: The FDA authorized 1,356 AI-enabled medical devices through September 2025, up 8.5% since its last report in 2024. Among these device approvals, medical imaging dominated with 1,039 approvals (77% of total), maintaining its historical lead since 1998. The FDA is exploring ways to tag and identify which devices use foundation models and large language models, though it’s worth noting that an LLM-based medical device has yet to be approved. You can read a deeper dive into this data over at The Imaging Wire.

• Konica Minolta & ASCEND: ASCEND Cardiovascular and Konica Minolta Healthcare partnered to create a unified enterprise imaging solution for cardiology departments. The collaboration combines Konica Minolta’s cloud-based Exa Enterprise platform with ASCEND’s cardiovascular imaging expertise to improve workflows across invasive, non-invasive, adult, and pediatric care, without the need for single-vendor systems.

• JAX Snags Digital Heart Funding: The Jackson Laboratory received up to $30M from ARPA-H for CARDIOVERSE, an initiative to create AI-powered “digital twins” of human hearts. The project uses mice and human stem cells to predict a drug’s cardiotoxicity, which causes over 90% of drug failures and 15% of FDA-approved drug withdrawals. The AI models will simulate virtual hearts to identify rare toxic reactions across different populations before human trials, potentially replacing expensive large-animal studies and enabling safer, faster drug development while improving personalized treatment predictions.

• TAVR is Safe, Even Without an Immune System: A recent AJC meta-analysis found that TAVR is safe and effective for immunocompromised patients. According to the analysis, all-cause mortality rates were comparable at 30 days between immunocompromised and non-immunocompromised patients, but increased for immunocompromised patients at two years. However, researchers clarified that the increased mortality relates to the patients’ immune conditions rather than cardiovascular causes. New pacemaker implantation and complication rates also weren’t significantly different between the two groups.

• Cardiac Societies Weigh-In on CyberSec Policy: The ACC, CHIME, AMA, and other healthcare organizations declared that they oppose a proposed cybersecurity policy update from the former Biden administration. They argue the rule would increase costs, waste resources, and require serious infrastructure redesigns. The groups believe the policy’s “one-size-fits-all” approach is inflexible and could negatively impact patient care. The organizations have since asked HHS to withdraw the proposal and requested a risk-based approach instead.

• LDL Management Isn’t Up to Par: New research from the Family Heart Foundation found major gaps in cholesterol management among U.S. adults with cardiovascular disease during 2022-23. Per the FHF, only 13% of adults with ASCVD met the three key LDL-C management criteria: (1) receiving recommended therapy, (2) taking it consistently, and (3) reaching LDL-C below 70 mg/dL. Just 41% of adults received high-intensity therapy, with 28% receiving no treatment, while only 35% received therapy for more than 20 out of 24 months.

The Largest Registry on Plaque Analysis in CAD

What if 50% of your CCTA patients could benefit from an adjustment to their treatment plan? Read more about Heartflow’s DECIDE registry that demonstrates how Heartflow Plaque Analysis using its Plaque Staging software empowers physicians with clinical insights that lead to real-world impact.

5,600 Ways to Improve Your Cardiac Ultrasound Workflow

AI-powered measurements can enhance the way you acquire and interpret cardiac ultrasound. Learn how AI-powered ultrasound can help you overcome everyday limitations in echo. Read Siemens Healthineers’ white paper on how its AI software provides 5,600+ automated measurements to help improve workflow efficiency, consistency, and clinical confidence.

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.

The Resource Wire

• 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.

• 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.

• Us2.ai’s AI HF Now Possible with Handheld Echo: The latest research shows Us2.ai’s software can take handheld echocardiography beyond its standard applications. Read this EHJ study about how swiftly and accurately Us2.ai’s HF detection software detects LVEF, closely matching expert human analysis of standard cart based echocardiograms.

• Vista AI Grows CMR Volume: Are your patients waiting weeks or months for cardiac MRIs? See Brigham and Women’s Hospital’s real-world results showing how Vista AI’s software for automated MRI scanning led to 50% more scan slots, without adding more scanners or staff. 

• RoR in the Real World with Monebo and UNCG: Strenuous exercise can significantly reduce people’s heart relaxation reserve, putting them at risk without preliminary warning signs. Find out how Monebo’s new Reserve of Relaxation technology provides a crucial tool for anyone looking to enhance their physical performance without harm.

The Industry Wire

1. Trump halts state AI regulations with executive order.
2. ACA subsidies set to expire after extensions fail in Senate.
3. RFK Jr. targeted by latest Democratic impeachment effort.
4. Texas sues Epic over its “anticompetitive playbook” to maintain a monopoly.
5. Digital health investors are getting creative with exits.
6. Cedars-Sinai’s top AI innovations of 2025.
7. Debate over state AI laws is heating up.
8. Health systems applaud CMS’ rollback of nursing home staffing rule.
9. Hospitals required to take outpatient drug cost surveys by end of Q1.
10. Henry Ford Health reports data breach.