Examples of TrueView and GlassView 3D cardiac ultrasound visualization and artificial intelligence (AI) assisted automated measurements on the Philips Healthcare Epiq CV version 9.0 echo system. The latest version of the system was FDA cleared in October 2021 and shown at the 2021 Radiological Society of North America (RSNA) meeting for the first time. The Epiq is an AI-based platform, starting with anatomical intelligence to identify the anatomy being images automatically. The latest version of the system adds additional AI auto measurements and quantification to save time, speed workflow and reduce intra-operator variability. 

The short video shows photo-realistic rendering of the mitral valve and a new feature where the opacity of the tissue can be dialed in our out to show glass-like ghost view of the tissue. This can make it easier to navigate or see anatomical landmarks without rotating or slicing through the image planes in the 3D rendering.

Find more RSNA news and video

Find more cardiac echo technology news
 

Susan Cheng, M.D., MPH, director of the Institute for Research on Healthy Aging in the Department of Cardiology at Cedars-Sinai, moderated the Best Science in Cardiovascular Genetics and Genomics: Building Blocks to Better Outcomes, at the American Heart Association (AHA) 2021 meeting. She is an expert in cardiac genetic testing and said tailoring LDL-lowering drug therapy based on routine genetic tests is coming, but is still a few years off.

Find more AHA 2021 late-breaking studies and video

Dr. Simon Dixon, MBChB, chair of the Department of Cardiovascular Medicine at Beaumont Hospital Royal Oak, the Dorothy Susan Timmis Endowed Chair of Cardiology, and a professor of medicine at Oakland University William Beaumont School of Medicine, spoke at the 2021 Transcatheter Cardiovascular Therapeutics (TCT) meeting about a study Beaumont performed to lower radiation dose in the cath lab by more than 50%.

Using a new angiographic collimation technology from ControlRad, it helped cut radiation dose to interventional cardiologists by 57%. The device collimates the area of interest where the physicians are working, and reduces the dose significantly to peripheral areas in the image. This reduces exposure to ionizing X-ray radiation scatter from the imaging system. It is one of two new radiation protection systems used at Beaumont.

The ControlRad device, approved for commercial cath lab use by the FDA in December 2020, is retrofitted to X-ray equipment in the catheterization lab. It creates a type of aperture that collimates the image area being viewed. By using a touch pad attached to the table side rail, the cardiologist controls the aperture to narrow or widen the field of view on the X-ray, which in turn reduces the amount of radiation used to produce the images. It works with gloves on.

For the study, cath lab workers wore radiation-detecting badges near their thyroid and inside their lead apron during procedures. Another badge was placed on a wall inside the lab. The study detected a 55% to 57% decrease in radiation exposure at the thyroid position of the main cardiologist, or lead operator, and a 49% decrease in radiation exposure to the cardiologist assisting, or operator 2. The badge on the wall detected a 38% decrease in radiation exposure, reflecting the dose savings to other cath lab staff further away from the imaging system.

Beaumont is also using the the Protego system, which places a barrier wall between the imaging equipment and the operator and staff in the cath lab. While it does not protect the patient from radiation during their procedure, it is designed to allow staff to work in the cath lab without wearing a heavy lead apron.

Find links to all the TCT 2021 late-breakers

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Dr. Neil Moat, MBBS, chief medical officer of Abbott's structural heart business, was a cardiac surgeon specializing in the mitral valve prior to taking on his current role where he oversees Abbott's advancements in transcatheter valve technologies. 

He explains some of the evolution in the industry as surgical repairs now are offered side-by-side with transcatheter valve replacement and repair technologies. He notes that the number of heart valve patients being treated has increased with the introduction of transcatheter technologies, and that surgical volumes have not been impacted as much as people thing because more patients overall are now being treated for valve disease.

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Tiberio Frisoli, M.D., interventional structural cardiologist, senior staff physician, Henry Ford Hospital, explains how his center performs transcaval transcatheter aortic valve replacement (TAVR) access for patients who have suboptimal abdominal aortic and femoral vascular anatomy. Transcaval access was pioneered at Henry Ford Hospital and involves using femoral vein access and then using a surgical radio frequency cutter to bore a hole from the interior venacava into the aorta to allow the TAVR delivery catheter to path through. 

This procedure was developed to enable more patients to receive TAVR via the preferred femoral access route. Some patients are not candidates for femoral artery access because of calcified lesions and heart atherosclerotic plaque, which narrows the vessel lumen, and makes it difficult to thread catheters through. The transcaval access technique can bypass the restricted arteries or heavy calcified plaques to still enable a minimally invasive procedure without the need for surgery. 

This video was produced in partnership from Henry Ford Hospital.

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Khaldoun Tarakji, M.D., MPH, associate section head, cardiac electrophysiology, Heart and Vascular Institute at Cleveland Clinic, was the lead author on a followup study to the landmark WRAP-IT trial that showed the Tyrx bioresorbable antibacterial envelope was shown it significantly lower infection risk for patients who receive cardiac implantable electronic devices (CIED) and develop hematomas.[1] 

The study results showed an 82% reduction in major infection among patients with hematoma in patients who had received the Tyrx. It is a antimicrobial envelope that is used to place implantable electrophysiology (EP) devices inside prior to closing the device pocket. While the envelope itself did not prevent hemotomas, as the rate was the same in the control group with out it, the Tyrx did lower infection rates in patients with hemotomas.

Read more in the article Tyrx Absorbable Antibacterial Envelope Effectively Reduces Infections in Cardiac Device Patients with Hematomas.

Reference:

1. Khaldoun G. Tarakji, Panagiotis Korantzopoulos, Francois Philippon, Jeff D. Lande, Swathi Seshadri, Bruce L. Wilkoff, et al. Infectious consequences of hematoma from cardiac implantable electronic device procedures and the role of the antibiotic envelope: A WRAP-IT Trial Analysis. Heart Rhythm. Punlished online July 16, 2021. DOI:https://doi.org/10.1016/j.hrthm.2021.07.011.

Dr. Neil Moat, MBBS, chief medical officer of Abbott's structural heart business, explains the latest advances in Abbott's structural heart device program. He discusses data on the MitraClip G4 device, the Global EXPAND registry study looking at its use in a real-world population, and the large amount of interest in treating heart failure patients with this device following the COAPT Trial, which showed dramatically improve outcomes. Moat also discusses advances using the TriClip G4 system, a tricuspid valve version of the MitraClip tailored for this valve position.  

Moat also discusses some of the other new technologies Abbott is developing in the structural heart space. This includes the Tendyne transcatheter mitral valve replacement (TMVR) device, the Portico transcatheter aortic valve replacement (TAVR) device, and the second generation Navitor TAVR valve. He also mentioned Abbott's Amulet transcatheter left atrial appendage (LAA) occlusion device, which gained U.S. FDA clearance this past summer.
 

Hear more about Dr. Moat's views in the VIDEO: Abbott Structural Heart CMO Shares Views on Future of Valve Interventions.

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About 80% of cardiovascular diseases (CVD) are preventable. This is why it is important to identify the people at highest risk of CVDs and ensue they receive appropriate treatment to prevent premature deaths. A simple, inexpensive test could be a big help. A computed tomography (CT) calcium score test measures calcium buildup in the arteries that supply blood to the heart. It can help patients and doctors better understand a person’s risk for cardiovascular diseases, and may help guide treatment for those with low to moderate risk of heart disease or help those whose heart disease risk is not clear. This includes the ability to determine if statins will benefit a patient, or if they do not need them.

This video is designed as an information graphical presentation for patients explaining calcium scoring and what it means for them.

We are especially grateful to Anthony C. Pearson, M.D., FACC from the Saint Louis University School of Medicine. His clinical expertise helped guide us in making a movie we hope will become a conversation starter for people everywhere. Tremendousness created the video. The design firm believes in the power of visual storytelling to inspire change. It works with a variety of corporate and non-profit clients, helping to make complex ideas understandable and engaging by using visual storytelling, information design and co-creation to empower people and organizations to humanize transformation and change, accelerate innovation, and power sales, marketing, and thought leadership. Learn more about the company http://tremendo.us.

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The vendor MediCardia demonstrated smart software to aggregate cardiology patient data from numerous locations into one place at the 2021 Healthcare Information Management Systems Society (HIMSS) conference. This enables one dashboard view of the patient's relevant cardiac history, prior exams, imaging, ECGs, labs and procedures. It also uses artificial intelligence (AI) to pull key data elements about the patient to automatically create risk assessments based on current guidelines in a graphical format.

The interactive system also allows the cardiologist to adjust parameters in the patient risk score to immediately show the patient any impact on their score. This includes if they stopped smoking, began taking statins, etc. The dynamic graphics of the system are also designed to be more engaging with a patient during consultations, rather than plain white pages of reports.

MediCardia HeartChart is a cardiology-focused virtual care platform that serves as a unified and common interface for EHRs and remote technologies including wearables, consumer home medical devices, and implanted cardiac rhythm devices. 

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Jass Brooks, vice president of global strategic marketing, Biosense Webster, explains four over-arching electrophysiology (EP) trends at the 2021 Heart Rhythm Society (HRS) meeting. The vendor is working on developing, or has introduced, new technologies in each of these four areas.  She said the key technology trends include:

   • Pulsed field ablation (also called electroporation) as a new way to ablate cardiac tissue without damaging underlying structures like the esophagus. 

   • The introduction of 3D/4D intra-cardiac echo (ICE) imaging to better guide procedures.

   • High-density electromapping systems that create more accurate maps of the electrical activity in the heart and can do so faster than previous generation mapping systems.

   • The introduction of artificial intelligence (AI) into EP systems to speed workflow.

Key among this company's new product introductions at HRS 2021 was the Octaray high-density electro-mapping catheter, which enables faster mapping with a larger number of points. This enables more detailed maps of the heart's electrical activity and may imporve ablation procedure guidance and outcomes. Recent changes to the Carto electro-mapping system now enables integration of this new technology.

Biosense Webster also introduced the Nuvision 4-D intra-cardiac echo (ICE) ultrasound catheter with imaging support from GE Healthcare Vivid Ultra Edition ultrasound systems. This moved ICE beyond 2-D imaging to real-time 3-D and 4-D imaging inside the heart to enable better procedural navigation and visualization of the catheters within in the heart.

Find additional HRS 2021 late breaking trials

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Nelson B. Schiller, M.D., FACC, professor of medicine and the John J. Sampson and Lucy Stearn Endowed Chair of Cardiology, University of California San Francisco (UCSF) and founder the Adult Echocardiography Laboratory and Adult Congenital Heart Disease Clinic at UCSF, explains the how he uses a digital stethoscope to improve the quality of his care. He said the digital stethoscope can record heart sounds more accurately and filter out ambient noise to improve diagnostics. The system he uses also integrates an ECG so the waveforms can help determine if noises are diastolic or systolic in patients with fast heart rates. 

Schiller explains key features clinicians should consider when buying a stethoscope and gives an overview of his digital HD Steth device.

The HD Steth combines three products into one. This includes a stethoscope, phonocardiograph and electrocardiograph (ECG), enabling clinicians to visualize heart sounds and ECG waveforms on a smart device and help detect multiple cardiac abnormalities while providing the unique ability to capture, record, and replay patient heart sounds for improved readings and analysis.

More Than 50,000 Children Screened for Congenital Heart Defects Using AI-enabled Stethoscopes 

Find more news on digital stethoscope technology
 

Federico Asch, M.D., FASE, director of cardiovascular core labs, cardiovascular imaging, MedStar Health Research Institute, Washington, D.C., was involved in a study that used artificial intelligence (AI) to evaluate echocardiograms to identify COVID-19 patients who were at high risk for complications and mortality. The study also compared human vs. AI variability in reading the stories and found much less variability with the machine reviews. He presented the results from the WASE-COVID Study at the American College of Cardiology (ACC) and American Society of Echocardiography (ASE) 2021 meetings. 

Asch also offers insights about AI applications in echocardiography and how the technology will help improve imaging and reduce the variability in how measurements are made, which will decrease the current level of variability in how exams are performed by human operators. He also explains AI is now available to help guide novice ultrasound users to get optimal cardiac ultrasound images.

Find more content on artificial intelligence in cardiology

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Ehtisham Mahmud, M.D., division chief of cardiovascular medicine, director of interventional cardiology and the cardiac cath lab at the University of California at San Diego Health, explains how cath lab robotic systems may soon enable interventionalists to perform emergency stroke thrombectomy in patients hundreds of miles away. Corindus/Siemens Healthineers is developing its Corpath GRX robotic system to enable remote telemedicine procedures. Mahmud said this could help significantly improve access to acute stroke care interventions in rural areas. 

Today, the standard of care for stroke is similar to STEMI heart attacks from 40 years ago where tissue plasminogen activator (tPA) is administered in attempts to break up the clot causing ischemic strokes. Outcomes in STEMI greatly improved in the late 1980s and 1990s with the proliferation of angioplasty and percutaneous coronary intervention (PCI) stenting procedures, which became the standard of care in cardiology. Mahmud said acute stroke interventions are following a similar path, but there just are not enough neuro-interventional operators to create large networks for stroke similar to what is now established for STEMI.

He said the Corpath robotic interventions are already conducted remotely from across the room in the cath lab. The idea is that it does not matter if a patient is 10 feet away in the same room or 200 miles away at a smaller hospital to conduct these procedures. This could go a long way to overcoming vast healthcare disparities in smaller, rural hospitals that are far removed from larger centers that are better equipped, and more importantly, have the specialities needed for these procedures.

Once this technology is cleared for use, Mahmud said cardiologists already have the technical skills to perform emergency thrombectomies, but need to learn more about the neuro-vascular bed and how to deal with any adverse events during or after a procedure. He said this lays the ground for creating neuro-cardiology partnerships or care teams to enable this type of care in the near future. 

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Find more news from the SCAI 2021 virtual meeting

Tom Jones, M.D., director, cardiac catheterization laboratories, Seattle Children’s Hospital, and principle investigator of the Medtronic Harmony transcatheter pulmonary valve (TPV) trial 1-year results that were presented as a late breaking trial at  Society of Cardiovascular Angiography and Interventions (SCAI) 2021 Scientific Sessions.

New study results validate the effectiveness of the Harmony TPV system for patients with congenital heart disease (CHD) and severe pulmonary regurgitation (PR). The Harmony TPV is designed to be a less invasive treatment option for patients with a congenital heart defect irregularity in their right ventricular outflow tract (RVOT) that requires a pulmonary valve placement to restore valve function. 

Read more details in th article One-year Results of the Harmony Transcatheter Pulmonary Valve Trial Presented at SCAI 2021. 
 

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Arnold Seto, M.D., MPA, FSCAI, chief of cardiology, Long Beach Veterans Affairs Medical Center and director, interventional cardiology research, UCI Health, and Jordan Safirstein, M.D., FSCAI, director of transradial intervention, Atlantic Health's Morristown Medical Center, were involved in a physician-initiated study to find a new way to cut radial artery access site hemostasis by 50 percent. The late-breaking study presented at SCAI 2021 uses a combination of a StatSeal patch and the TR Band compression bracelet.

Cardiac catherization is increasingly bing performed using transradial approach, now making up 50 percent or more of the access used for U.S. interventional procedures. The Terumo TR Band is used to close the vascular access site. Standard protocols require the band to be left on for at least two hours following the procedure. 

Shorter compression times can help reduce complications with radial artery occlusion, so it is desirable to find ways to shorten compression times, Seto said. He explained clinicians often start to deflate the wrist band balloon after an hour and watch for ooze or blood. If there are signs the wound is not completely sealed, the band is reinflated. Reinflations occurs more that 67 percent of the time, he explained.

"We found with the Statseal, you almost never have to reinflate," Seto said. 

This study shows that time can be reduced in half and with fewer complications by using the additional patch device, which helps sped the clotting process. This can save staff time and possibly leading to faster patient discharge for same-day PCI programs. 

Read more in the article Radial Hemostasis Time Cut by 50 Percent With StatSeal in Combination With TR Band.

SCAI 2021 Late-breaking Clinical Study Results

Find more news from the SCAI 2021 virtual meeting

Ashwin Nathan M.D., a cardiology fellow in the division of Cardiovascular Medicine at the Hospital of the University of Pennsylvania, presented a late-breaking study at the Society of Cardiovascular Angiography and Interventions (SCAI) 2021 meeting that looked at hospital-level percutaneous coronary intervention (PCI) performance data and simulated if what would happen if hospitals removed their highest risk patients. The findings suggest this risk avoidance strategy does not necessarily mean the hospital will get higher performance scores.

Read more in the article Avoiding High-risk Cath Lab Procedures Does Not Necessarily Improve Hospital Scores.

SCAI 2021 Late-breaking Clinical Study Results

Find more news from the SCAI 2021 virtual meeting

William O’Neill, M.D., medical director of the Center for Structural Heart Disease at Henry Ford Hospital, Detroit, explains final data from the National Cardiogenic Shock Initiative Study (NCSI), The study, presented as a late-breaker at the  Society for Cardiovascular Angiography and Interventions (SCAI) 2021 Virtual Scientific Sessions today, showed NCSI protocols increased cardiogenic shock survival from 50% to 72%. This involves using Impella hemodynamic support prior to percutaneous coronary intervention (PCI).

Find more news from the SCAI 2021 virtual meeting

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Behnood Bikdeli M.D., a cardiologist at the Brigham and Women’s Hospital, Harvard Medical School, Boston, offers an overview of numerous trials in progress testing a variety of anticoagulants and antiplatelet agents at different doses for inpatient, outpatient and severely ill ICU, and long-hauler COVID-19 (SARS-CoV-2) patients. Bikdeli is a cardiologist at the Brigham and Women’s Hospital, Harvard Medical School, Boston, and is involved in the Clinical Trials Center, Cardiovascular Research Foundation, New York, and Center for Outcomes Research and Evaluation (CORE), Yale School of Medicine, New Haven, Conn.

He is a the principal investigator for a comprehensive overview of clinical trials looking at anti-thrombotic drug therapies and dosing in coronavirus patients. The article "Recent Randomized Trials of Antithrombotic Therapy for Patients With COVID-19: JACC State-of-the-Art Review" was published online March 16, 2021.

Bikdeli gives an overview of more than 70 studies that are underway or recently completed. He also discussed the need to tailor therapy to specific patients, since there is no "one-size-fits all" approach.

COVID causes thromboembolitic events in patients, including deep vein thrombosis (DVT), pulmonary embolism (PE), stroke, heart attacks, and clots that can cause ischemia or infarcts in various organs. While consensus statements on how to treat or protect patients from COVID clotting were published last year, they were based on opinions, not on hard, clinical evidence. The current studies are hoped to offer answers on how to prophylax specific types of COVID patients in the next couple months. 

Bikdeli also served as lead author on the INSPIRATION Randomized Clinical Trial, which was published in March and looked at the effect of intermediate-dose vs. standard-dose prophylactic anticoagulation for COVID patients on extracorporeal membrane oxygenation (ECMO). He discusses the results of this study as well in the video.

Read the article Overview of Randomized Trials of Antithrombotic Therapy for COVID-19 Patients.

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COVID-19 Changes Properties Blood Cells
 

This is a quick example of clinical use of the Shockwave Medical Intravascular Lithotripsy system that uses sonic wave pulses and a low pressure 4 atm compliant balloon to break up heavy calcium without vessel trauma. Intravascular lithotripsy gained FDA clearance for peripheral artery disease (PAD) in 2016, and the company began working toward an additional indication for the coronaries. It was granted FDA clearance in February 2021. The FDA also recognized this technology as a breakthrough technology because it offers a solution to a long-standing clinical problem.

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Surgeons at Penn State Heart and Vascular Institute were the second group in the nation to implant a newly-designed mechanical pump in a patient with severe heart failure. The EvaHeart2 Left Ventricular Assist System (LVAD), can be used as a destination therapy and as a bridge to transplant.

Rob Dowling, M.D., director of heart device research at Penn State Heart and Vascular Institute and Penn State College of Medicine, explains the benefits of the new  LVAD system. He was one of the cardiothoracic surgeons who implanted the pump and said the EvaHeart2 left ventricular assist system was designed to reduce the risk of post-implantation stroke, which affects approximately 8% of heart failure patients implanted with an LVAD.

The flush inflow ostium in the left ventricle, low profile inflow design, rotational apex suture cuff are designed to be forgiving on possible inflow cannula malposition and to minimize the risk of wedge thrombus.

“Imagine inserting the tip of a vacuum cleaner into the left ventricle of the heart to get the blood to the pump and out to the rest of the body,” Dowling said. “Sometimes the tip can move into an incorrect position even after proper surgical placement and can create suction against the walls of the heart. This may create blood clots that could cause strokes. This new device was designed in such a way that there is no tip, but rather the “vacuum” hose itself is surgically attached directly to into the lining of the walls of the heart, removing the need for a tip and thereby potentially reducing the risk of stroke.”

The procedure was part of the COMPETENCE Trial, a multi-center clinical study to evaluate EvaHeart2 that will include 40 clinical sites and 399 patients with severe heart failure through 2022.

Richard Huggins, 75, of Lock Haven, Pa., was the second patient in the nation to receive the EvaHeart2 Left Ventricular Assist System (LVAS). Surgeons at Penn State Heart and Vascular Institute implanted the device on Jan. 13.

Read more in the article Hershey Medical Center Second in the Nation to Implant EvaHeart2 LVAD.