Sahashi et al. on the advent of AI in CMR.

ICYMI: Huge thank you to Dr. Budoff and Dr. Leipsic for an invaluable webinar on the emerging role of cardiac CT for diagnosing and treating heart disease. You can watch the on-demand version here.

Thanks to all who attended and to all who read Cardiac Wire,

Vik

Cardiac Imaging

No Gadolinium Contrast? No Problem with VNE

The gold standard for spotting myocardial scarring requires injecting gadolinium contrast during cardiac MRI, which adds time, cost, and a barrier for patients who can’t receive it. Now a new study suggests AI may replace that injection in some cases.

• The technology, called virtual native enhancement (VNE), uses a generative AI model to combine precontrast images into simulated late gadolinium enhancement (LGE) images.
• VNE has been around since 2021, and was developed by an international team of researchers including leaders from the University of Oxford and UVA.
• This JACC study marks VNE’s first major prospective, multicenter, blinded, real-world validation clinical trial.

Researchers collected CMR data from two independent sites in the U.K. and China with each site’s team determining scar ground truth from LGE while a blinded Oxford team generated and scored VNE images using only precontrast data.

• The study focused on 136 patient cases across two common scenarios: ischemic heart disease and viability assessment.
• The AI model received no additional tuning, making the results more generalizable. 

When used on clear, high quality CMR images, VNE’s accuracy approached the gold standard.

• VNE detected myocardial infarction with 94.4% accuracy.
• Scar quantification was also very similar to LGE (R = 0.90) with 3.2% average difference.
• Agreement on which parts of the heart muscle were infarcted reached 90.0%.

Here’s the real headline: When four independent clinical readers assessed the images, they said no contrast imaging follow-up was needed in 69.7% of patients.

• In those cases, VNE achieved 93.7% diagnostic accuracy, compared to LGE’s 93.9%.

Now before you go pouring out your gadolinium bottles, there’s caveats. The impressive numbers above only hold true for high-quality scans.

• Across all image qualities, pooled VNE accuracy dropped to 81.1% versus 92.3% for LGE.
• The technique also showed a bias in quantifying small lesions and missed a small infarct.

The Takeaway

Is VNE going to completely replace gadolinium contrast? Probably not. However, this study provides a valuable assessment of what VNE can do, which is that it can effectively replace LGE for patients who can’t receive contrast so long as CMR scan quality is high.

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.

Merge Cardio 12.5 is Officially Available!

From AI-generated echo measurements to upgraded UI and reports, Merge Cardio 12.5 brings a long list of new innovations to the table. Find out more about how Merge Cardio’s latest version streamlines workflows to make your cardiovascular service line more cost-effective and patient-centered.

How Automated MRI Software Transformed Radiology Regional

Radiology Regional recently integrated automated MRI scanning software into their imaging practice imaging. Hear from their team how automating CMR scans streamlined their practice and enhanced patient care.

The Wire

• Opening the Gates for CAC Detection: Gated CT scans are more complex and far less common than nongated scans, which are used for lung screening, oncology monitoring, and now maybe for determining CAC scores. A Circulation study of 2.6k adults found patients with moderate (101–299) and severe (≥300) nongated CAC had higher CHD risk (2.67x and 5.22x, respectively) and CVD risk (1.32x and 2.89x) than zero CAC participants. These scores were nearly the same as gated CAC scores calculated the same day.

• MV Prolapse Dangers Linked to Fibrosis, Women: Mitral valve prolapse is not the benign abnormality it was once thought to be, at least not for women or those with fibrosis per a new Circulation study. Among 550 patients with MVP who underwent MR scans, female sex and fibrosis were associated with 3.33x and 3.17x higher risk of dangerous arrhythmias, respectively. Women were especially at-risk with a 5-year event-free survival rate of 76.5%, 22% lower than that seen in men. 

• FastWave’s Trial Fast-Tracked: The FDA approved an investigational device exemption to ignite FastWave’s SPARC trial. The Artero electric intravascular lithotripsy system will be used to treat peripheral artery disease in up to 125 patients across 30 sites. Artero has the potential to streamline workflows with a hands-free system that delivers pressure waves at 4 Hz, 4x faster than legacy technology. As FastWave’s trial begins and other competitors nab backing from giants, the IVL segment could become increasingly crowded.

• Could Cannabis Protect Against Cardiac Ectopy? Researchers from the aptly-named MARY-JANE study found cannabis users were less likely to have premature heartbeats on days they smoked. Among 108 participants, habitual smokers who maintained daily use had a 9% reduction in ectopic heartbeats, a nearly 2% reduction per inhalation of cannabis smoke. Though some results could be skewed by self-selected participants who tolerate the drug well, this new data continues to muddy the waters on the cardiac pros and cons of cannabis.

• Trump Aide Tapped to Lead FDA: President Donald Trump is expected to nominate Heidi Overton, MD, as the new head of the FDA, replacing Marty Makary, MD, who resigned earlier this year after refusing to grant FDA authorization for vaping products. Overton is a physician specializing in public health and preventive medicine, and has served as a domestic policy aide to Trump since 2025. Overton will inherit an agency that’s seen significant turmoil over the past two years, including the loss of nearly 3k staffers.

• Murj Makes RPM Moves: Murj announced the release of its Murj Remote Patient Monitoring Platform for cardiovascular care teams managing hypertension and heart failure patients between visits. The platform uses physiologic monitoring software to bring data from remote BP and weight monitoring devices into a single EHR-integrated workflow. Murj believes this will allow clinics to prioritize patients who need attention, review longitudinal trends, document care activity, and track billing readiness.

• A New AFib Performance Guide: The AHA/ACC released a joint report for how to define clinical performance and quality in atrial fibrillation treatment. Pulling from the strongest recommendations in the 2023 ACC/AHA/ACCP/HRS AFib guidelines, the authors outline five new performance measures and 16 quality measures. Some of the statement’s highlights include evaluation for new AFib, DOAC prescription, equitable AFib management, and AFib rhythm control in HFrEF. The statement comes at a time when EP technologies are booming in an effort to guide best practice.

• Electromechanical Ultrasound’s Potential: Researchers developed a new imaging modality based on echocardiography that measures electrical and mechanical activity in the heart for better mitral valve activation mapping. Dubbed Electromechanical Wave Imaging, the new modality uses high-frame-rate ultrasound to observe the timing of nerve impulses that control valve opening and closing. They tested its diagnostic ability on pediatric patients (n=21) with mitral valve prolapse, regurgitation, and controls, finding that it accurately captured the valve and ventricle patterns that would indicate those conditions alongside arrhythmic risk.

• COVID & HCM: One of the more unsettling artifacts of COVID-19 is its potential impact on heart conditions, although that may not be the case in HCM. A BMJ study analyzed CMR scans from 1.7k participants in the international HCM Registry and found that despite 767 reporting prior COVID infection, the presence of adverse features like hypertrophy, fibrosis and extracellular volume, did not lead to hospitalization or impaired recovery. So while prior COVID-19 infection was associated with negative symptoms, pre-existing CMR phenotype was not associated with adverse outcomes.

• Biopsychosocial Statin Intolerance: In an unsurprising turn of events, new research suggests that patients who hold negative views of medication are less likely to tolerate statins. Researchers examined roughly 1,000 patients on statins, finding 17% were “statin-intolerant” and categorized them by their medication beliefs, healthcare trust, and influential factors for treatment decisions. After applying a regression model to these categories, it turned out that statin-intolerant patients prioritize negative factors in treatment decisions when compared to statin tolerant ones.

• Philips Cardiac Workstation Recall: Philips issued a Class II recall covering nearly 800 Cardiac Workstation 5000 systems and more than 1,800 Cardiac Workstation 7000 systems. The recall stems from reports of inaccurate heart rate readings which would potentially compromise entire ECG reports. Troubleshooting has revealed that the issue appears when devices exit standby mode, thus Philips advises disabling automatic standby. Per the company, no adverse events have occurred with no returns needed. Philips will upgrade affected units to newer software to resolve the issue.

The Unified Cardiac Workflow

Cardiovascular disease remains the leading cause of global mortality, yet diagnostic workflows remain fragmented. That’s why it’s so important that Circle Cardiovascular Imaging’s cvi42 is the industry’s first unified platform for reading Cardiac MRI and Cardiac CT, and PCAT analysis within a single application.

A Cardiovascular Ultrasound Platform You Can Trust

Being able to provide premium diagnostic information for your pediatric patients every day, all day, is vital. Find out why cardiac imagers trust Fujifilm’s Lisendo 880, and how its premium imaging quality, efficiency tools, and reliability you can trust, have helped change workflows for clinicians and technologists alike.

The Resource Wire

• Outsourced Post-Processing with PIA: Behind each study is a patient whose care is a top priority. That’s why each PIA out-sourced imaging client is assigned a lead technologist responsible for ensuring study customization while allowing cases to be received 24/7 in a secure and scalable way. 

• Expand Your Cardiac Reporting with CCT and CMR Workflows: Cardiology imaging continues to grow in complexity, and reporting workflows must evolve to keep pace. Check out how Optum’s latest Change Healthcare Cardiology CPACS release enables cardiology teams to now report CCT and CMR studies natively within their software ecosystem.

• 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.

• 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.

• Diagnosing Cardiac Amyloidosis Using Echo AI: Catching cardiac amyloidosis early is critical to giving patients the best possible outcome. Read Us2.ai’s latest paper in Circulation to learn how their echocardiography AI solution and new Us2.ca model helped clinicians diagnose cardiac amyloidosis with higher sensitivity and specificity.

The Industry Wire

1. Epic UGM 2026 kicks off in Verona.
2. Luigi Mangione pleads guilty to shooting UnitedHealthcare CEO.
3. Mayo Clinic taps new CIO as it doubles down on AI.
4. Social Security expands record sharing to speed up claims adjudication.
5. White House has deleted, altered nearly 400 datasets.
6. Eighteen health systems warn of MyChart ‘Medicare Kit’ scam.
7. Ousted system CEO sues OHSU, alleges retaliation.
8. Congressman presses VA on Oracle EHR oversight recommendations.
9. Providence Health Plan shutters after Medicare Advantage falls through.
10. Congo’s Ebola outbreak reaches 5,000 cases.