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MR Intervention, Worsening AS, and Cardiology Claude
By Viktor Zarev, Jack Troy, Virginia Hunt
July 30, 2026
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Together with
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The general theme of today’s issue is that sooner is better for patients, providers, and health systems alike.
Thanks for reading,
Vik
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A common question in structural heart cardiology is “when do we know to intervene?” and recently released 25-year mitral regurgitation data might just have given us an answer.
- While we have access to structural metrics like regurgitant orifice area (ERO) for when to intervene, long-term prognosis and optimal MR treatment timing remain elusive.
- ERO is a way of measuring the size of the opening or “hole” left by a heart valve when it fails to close all the way, which is what allows blood to leak backward.
Using ERO as a North Star, researchers followed 449 asymptomatic degenerative MR patients for a median of 26 years, and used the metric to determine the severity of their MR progression, as well as when to move from medical therapy to surgery.
- As patients’ ERO got larger, medical therapy survival rates decreased.
- For example, the 5-year survival rate for the smallest ERO category was 88% versus 55% for the largest.
- During the follow-up, 57% of patients underwent mitral valve surgery.
When extending the follow-up to include post-surgery outcomes, the survival gap between operated and non-operated patients also widened as ERO increased.
- Critically, that divergence began at ERO values above 30 mm².
That’s below the current guideline directed threshold for severe MR (40 mm²), putting the benefit squarely in the upper-moderate range.
- Of course, there’s far more to defining when to intervene in MR than ERO.
- Rather, this cutoff discovery is most useful when combined with other echo parameters, and the broader heart’s response to therapy.
Zooming out a bit also gives us insight into a consistent structural heart trend, which is that earlier intervention is better than watchful waiting or medical therapy.
- That’s because past a certain point, the structural damage from a leaky mitral or aortic valve is irreversible.
The Takeaway
With the pace of modern cardiology, it’s pretty rare to get 25-year data for anything, and this study tells us that ERO serves as a mathematical cutoff for understanding how much the outcomes of MR surgery will be impacted by waiting too long.
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cvi42’s Real World Results
Consistency of measurements over time is of utmost importance for clinical interpretation and follow-up. Read about how cardiac imagers are using Circle Cardiovascular Imaging’s cvi42 platform to dramatically reduce manual segmentation by up to 60%.
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State-of-the-Art Cardiac Monitoring at Scale
Cleared for 13 different heart rhythm interpretations, AccurKardia’s AccurECG 2.0 shortens the time from an arrhythmia incident to clinical intervention. Watch here to find out how AccurKardia and Specialized Medical are teaming up to bring the AccurECG 2.0 technology to clinicians across the U.S.
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How AI Expands the Role of CMR Experts
If you’re an MRI technologist, AI could be the best thing that ever happened to your career. Read here to learn about the benefits of AI for CMR experts and how it can accelerate both your training and opportunities.
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- Waiting for Symptoms Increases AS Spending: Severe AS is usually marked by worsening pain and exhaustion, but waiting for those symptoms can harm someone’s health — and their wallet. A Structural Heart study monitoring 1.2k asymptomatic AS patients found that hospital visits rose by 500% after symptoms developed. Those visits contributed to a swell in average annual care costs from $7.3k to $26k. While current guidelines don’t recommend procedures like TAVR for asymptomatic patients, the new data may raise some questions about early intervention.
- Caristo’s Fat Attenuation Clearance: Caristo Diagnostics received FDA de novo marketing authorization for CaRi-Heart, which quantifies coronary inflammation using CCTA scans. Alongside this inflammation quantification, CaRi-Heart produces a fat attenuation index score (FAI-Score) as well as a CaRi-Heart Risk score estimating a patient’s mortality risk over the next 10 years. That fat-centric approach seems even more apt considering the ACC’s recent heart-fat hypotheses for inflammation and negative cardiovascular outcomes.
- CorVista Scores Another Clearance: CorVista Health received a third FDA clearance for their cardiopulmonary CorVista System, this time for an addition that estimates if a patient has elevated PCWP. The add-on collects data on electrical signals and blood flow, then uses AI to estimate the likelihood of high PWCP, a key indicator of HFpEF and HFrEF. Catching HFpEF early has proven to be a challenge, but CorVista hopes to change that. The system is already used to noninvasively detect CAD and hypertension.
- SimonMed Debuts CV Longevity Program: Imaging center giant SimonMed continued its expansion in the longevity medicine space, now with a focus on cardiac health. The company launched its Cardiovascular Longevity program that combines coronary plaque analysis from CCTA scans with data from blood biomarker studies to detect and predict cardiovascular disease before symptoms occur. The move fits nicely within the cardiac imaging trend of software plus CCTA for better prevention.
- Claude the Cardiologist: A new Anthropic report shows 1.2% of professional Claude usage in the U.S. is cardiology related, more than any other part of healthcare. That could speak to a preference for Anthropic’s platform among cardiologists (especially since the top directive use is hemodynamic calculations), but across the broad category of combined clinicians and technicians, healthcare workers aren’t really Claude junkies, making up just 4.3% of the country’s work-related usage.
- Why Winrevair Works: A JACC study is peeking behind the curtain to understand how Winrevair makes exercising easier for patients with pulmonary arterial hypertension. Data from 30 participants showed the medication’s mechanism wasn’t just improving the pulmonary vascular system (−2.1 mm Hg/L/min reduction in PA/CO), but also increasing hemoglobin levels (+1.7 g/dL) and femoral oxygen delivery (+1.1 mL/dL). Thus, Winrevair seems to work from head to toe, cascading across the musculoskeletal, circulatory, and cardiac systems.
- A Case Study to Clinical Practice Pipeline: A JACC meta-analysis showed anticoagulants reduced organ support/death by 19% for hospitalized COVID-19 patients — but the data came years too late. The first trial showed significance in 2021, but guideline shifts stalled as other trials were halted or terminated. Data from the seven included RCTs weren’t fully gathered until April 2024, nearly a year after the last U.S. lockdown ended. The authors recommend real-time data sharing and collaborative funding to reduce duplicated studies and delayed clinical implementation in future crises.
- How to Pay for AI? A new Peterson Health Technology Institute report calls for clinical AI reimbursement models that are deflationary, outcome-based, and favorable to early adopters. The recently launched CMS ACCESS Model pretty much checks these boxes, but it’s limited to care for Medicare beneficiaries with certain chronic conditions. Standard payment structures are mismatched to clinical AI, the report argues. Fee-for-service risks AI overuse, while fee-for-performance and capitation don’t do enough to incentivize rapid adoption of this technology.
- AI Assistance for AFib Screening: A large Circulation study conducted a performance review on FIND-AF 2.0, an AI model which uses EHR to guide AFib screening based on stroke risk. ECG data from 13M individuals across five countries showed that patients categorized as high risk were >8x more likely to be diagnosed with AFib than low-risk patients. Accuracy ranged from 75% (Canada) to 84% (Israel), with the model outperforming traditional AFib risk assessments like C2HEST.
- Reducing RPM False Alarms: Implicity received FDA 510(k) clearance for its next-generation ILR ECG Analyzer, a cloud-based AI algorithm designed to reduce false-positive alerts from implantable cardiac monitors. The software serves as a manufacturer-agnostic second layer for residual alerts remaining after initial device filters, and can analyze data from ICMs across all major manufacturers. The company expects the algorithm to become commercially available to U.S. customers in the coming months.
- Medtronic Bets on Better AFib Mapping: CoreMap closed a $37M Series C financing round led by medtech giant Medtronic to advance its data-driven tools for guiding AFib ablation. The company is currently developing an ablation mapping technology and analytics platform designed to guide physicians during procedures based on sets of electrical activation data. For Medtronic, the investment comes just weeks after it backed thrombectomy developer RapidPulse and is the latest example of its “try-before-you-buy” approach to start-up investing.
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Merge Hemo Expands to Puerto Rico
Merge partnered with Alpha Biomedical to bring Merge Hemo to Puerto Rico, marking the software’s first expansion outside the 50 U.S. states. Read more about the work Merge is doing to expand access to its award winning solutions beyond the United States.
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The Power of AI in Cardiovascular Imaging
Cardiac labs are under more pressure than ever to deliver more with greater speed and precision. Hear from Tony Gallagher, Director of Noninvasive Cardiology at Baptist Health Lexington about how Siemens Healthineers’ ACUSON Origin is reshaping daily practice and transforming the future of echocardiography.
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- Changes in Heart Failure Management: Heart failure is a complex condition with high heart failure hospitalization and cardiovascular mortality rates, especially among patients with HFpEF and HFmrEF, for whom treatment options have been limited. Read how Bayer’s Dr. Alanna Morris-Simon discusses the changing treatment landscape and strategies for improving patient outcomes.
- Tempus Receives FDA 510(k) Clearance for Tempus ECG-Low EF: Tempus announces the expansion of its Tempus ECG-AI portfolio with Tempus ECG-Low EF, software intended for use to analyze 12-lead ECG recordings and detect signs associated with having a low left ventricular ejection fraction (LVEF less than or equal to 40%) in patients 40 years of age or older at risk of heart failure. It is not intended as a stand-alone diagnostic and positive results may suggest the need for further clinical evaluation. For Full Indications for Use, visit here.
- Earlier Detection, Better Outcomes: When it comes to heart disease, early detection is crucial to a patient’s long-term health. Learn more about how Fujifilm helps clinicians achieve that with the Lisendo 880 cardiovascular ultrasound system’s unique solutions that detect early abnormalities seen in heart failure, while offering insight into cardiac functions and groundbreaking hemodynamic analysis.
- Redefining Cardiac Analytics: More data doesn’t equal deeper insight. There’s a fundamental distinction between measuring the timing of heart beats and understanding how the heart recovers electrically after each beat. Monebo is using that distinction to define the next frontier of cardiac analytics.
- 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.
- Harnessing the Power of AI to Improve Patient Care: Endeavor Health is one of the first healthcare providers in the Midwest to use AI in the echocardiography lab. Learn how they are harnessing echo AI’s tremendous potential to improve diagnoses in this report from Us2.ai.
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