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VIDEO: Philips X5-1c Transducer, the Next Advancement in 3D Transthoracic Imaging

Cardiovascular Ultrasound | June 14, 2022

The X5-1c transducer from Philips provides enhanced clinical information in transthoracic imaging over a standard phased array transducer. When combined with nSIGHT Plus image formation on the EPIQ CVx cardiology ultrasound system, the X5-1c transducer enables image quality rarely seen from a transthoracic transducer. 

Watch the video to learn about the benefits which may include decreased exam time due to faster access to echo windows, increased confidence in quantification results and more. 

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Cardiovascular Ultrasound | June 14, 2022

The X5-1c transducer from Philips provides enhanced clinical information in transthoracic imaging over a standard phased array transducer. When combined with nSIGHT Plus image formation on the EPIQ CVx cardiology ultrasound system, the X5-1c transducer enables image quality rarely seen from a transthoracic transducer. 

Watch the video to learn about the benefits which may include decreased exam time due to faster access to echo windows, increased confidence in quantification results and more. 

Cardiovascular Ultrasound | May 31, 2022

Philips recently announced an update to their flagship EPIQ CVx premium cardiology ultrasound system. Watch the video to learn about the latest features including the next-generation nSIGHT Plus imaging architecture system that leverages both hardware and software to support sophisticated image formation and enhanced image quality.

Cardiac Imaging | February 01, 2022

Interview with Campbell Rogers, M.D., chief medical officer of HeartFlow which has developed a CT image-based fractional flow reserve (FFR-CT) algorithm. The technology was recently included as a recommendation for front line chest pain evaluations in the 2021 ACC/AHA chest pain evaluation guidelines.

The new guidelines gave high levels of evidence for the use of computed tomography and FFR-CT cardiac imaging as front line imaging modalities for chest pain evaluation.

Related Chest Pain Imaging Content:

First International Chest Pain Diagnosis Guidelines Released

VIDEO: Why the ASNC Did Not Endorse the 2021 Chest Pain Guidelines — Interview with ASNC President Dennis Calnon, M.D.

 

Coronavirus (COVID-19) | February 01, 2022

Campbell Rogers, M.D., chief medical officer of HeartFlow, explains how hospitals are using CT image-based fractional flow reserve (FFR-CT) assessments to speed throughput of patients in emergency rooms and reduce the need for diagnostic angiograms during the COVID-19 pandemic.

 

Cardiac Imaging | February 01, 2022

American Society of Nuclear Cardiology (ASNC) President Dennis Calnon, M.D., MASNC, FASE, FSCCT, director of cardiac imaging for McConnell Heart Hospital at Riverside Methodist Hospital, and director of nuclear imaging for Ohio Health Heart and Vascular Physicians in Columbus, explains why the society did not endorse the first-ever U.S. or international guideline for the evaluation and diagnosis of patients with acute or stable chest pain.

Nuclear myocardial perfusion imaging (MPI) has been a gold-standard for evaluation of coronary disease in patients for years, and it is included in the new guidelines. However, computed tomography angiography (CTA) has seen immense growth over the past decade and gained a prominent position in the guidelines as a front line imaging modality. This is due to nearly all hospital emergency rooms now having access to CT systems capable of performing immediate cardiac exams. CT has been seen mainly as an anatomical imaging test, but it also can be used for myocardial perfusion imaging using iodine contrast. While CT has had limits with its ability to image through heavily calcified vessels or stents, that is changing with new CT technologies now coming into service.

One new CT technology that is prominently included I the new chest pain guidelines is CT fractional flow reserve (FFR-CT) imaging.  This uses a computational fluid dynamics algorithm to analyze a patient's CTA. It sends back a report and an interactive 3D reconstruction of all the coronary vessels that shows a color coded drop in FFR ratios, which is a measure of blood flow. Past a certain threshold, the reduced flow needs to be treated with revascularization. Lower level blockages can be treated with drug therapies. FFR-CT is widely expected in the coming years to become a gate keeper for invasive diagnostic angiograms. The hope is it will eliminate the need for the majority of cath lab angiogram exams and only send patients to the lab that need a stent or angioplasty. 

However, the ASNC had major issues with FFR-CT being included in the chest pain guidelines. Its board members argued there is need for more evidence and there should have been more information contraindications for its use, which was included on other imaging modalities in the guidelines. They also argued access to the technology has been very limited. Calnon explains more detail in the video on why this was a sticking point and caused the ASNC to not endorse the guidelines.

Read more in the article — First International Chest Pain Diagnosis Guidelines Released

Nuclear Imaging | February 01, 2022

American Society of Nuclear Cardiology (ASNC) President Dennis Calnon, M.D., MASNC, FASE, FSCCT, director of cardiac imaging for McConnell Heart Hospital at Riverside Methodist Hospital, and director of nuclear imaging for Ohio Health Heart and Vascular Physicians in Columbus, offers a concise overview of new technologies that are enhancing cardiac nuclear imaging. He also explains some of the new developments and uses for PET and SPECT imaging technology.

Find more nuclear imaging technology news

 

Coronavirus (COVID-19) | January 25, 2022

Siddharth Singh, M.D., director of the COVID-19 heart program, staff cardiologist and echocardiographer, Cedars-Sinai Hospital, explains what has been learned in the first year of the hospital's long-COVID clinic. Cedar-Sinai was one of the first hospitals in the U.S. to create a cardiac long-COVID clinic. As of January 2022, the clinic has been more than 120 long-COVID patients with cardiac specific complains. 

"Depending on what study you read, a percentage of patients with acute COVID infection will go on to develop long-lasting sequelae, but typically the percentage falls over time," explained Siddharth Singh, M.D., director of the COVID heart program, staff cardiologist and echocardiographer, Cedars-Sinai Hospital.

He said studies show between 10-25 percent of COVID patients will experience at least one disabling long-COVID symptom six months after their acute infection.

Cedars-Sinai long-COVID has seen over 500 patients since late 2020. Of these, 120 were referred for cardiac evaluations. The most common presentations in those patients include:
   • Shortness of breath
   • Exertional intolerance
   • Chest pain
   • Heart palpitations  
   • Sensations of light-headedness and dizziness
   • Insomnia
   • Brain fog 
   • Constipation
   • Diarrhea
   • Numbness or tingling in the extremities
   • Longer lasting issues with smell and taste

Singh also said many patients experience anxiety and depression due to the continued symptoms, and are concerned the issues they have from COVID may be permanent. Both Baggish and Trivax also reported seeing these issues in many of their patients.

In a smaller subset of patients these clinics have found lingering pericarditis or myocarditis. Most of these patients reported developing chest pain within two week or so after their acute infection. Singh said abnormalities can be imaged using echo and MRI.

"They do typically have abnormalities on imaging. But reassuringly, of all the patients who came to our clinic with these issues, we did not see any decline in left ventricular ejection fraction or systolic function," Singh stressed.

Patients with lingering pericarditis or myocarditis issues are treated with anti-inflammatories. Singh reinforced that the number of patients treated for this have been very low.

Singh said the arrhythmias he has seen include atrial fibrillation (AF) and supraventricular tachycardia. He noted ventricular tachycardia is very rare in these patients. In discussions with his electrophysiology (EP) colleagues, Singh believes the issues with post-COVID arrhythmias often comes down to the substrate of the patient's heart. He said the more cardiovascular disease, cardiomyopathy, scarring, or previous AF a patient has, the more predisposed they are to developing an arrhythmia after a COVID infection. 

Watch more of the interview with Singh in the VIDEO: Examination of Cardiac COVID Long-Haulers
 

Related Long-COVID Content:

What We Know About Cardiac Long-COVID Two Years Into the Pandemic 

VIDEO: Long-term Cardiac Impacts of COVID-19 Two Years Into The Pandemic — Interview with Aaron Baggish, M.D.

VIDEO: Long-COVID Presentations in Cardiology at Beaumont Hospital — Interview with Justin Trivax, M.D.

VIDEO: Examination of Cardiac COVID Long-Haulers — Interview with Siddharth Singh, M.D.

Find more COVID news and video

 

Coronavirus (COVID-19) | January 25, 2022

Siddharth Singh, M.D., director of the COVID-19 heart program, staff cardiologist and echocardiographer, Cedars-Sinai Hospital, explains how they work up cardiac patients in the Cedars-Sinai long-COVID clinic. He goes through the list of exams  and labs they use in these patients.

Cardiac patients at the Cedar-Sinai long-COVID clinic are evaluated with a basic physical exam, extensive family and medical history, an ECG, basic labs that include troponin and BNP, D-dimer, A1C, lipid panel and a metabolic profile since many patients have become much less active during the pandemic. Patients with symptoms are evaluated with an echocardiogram, including global longitudinal strain. If patients have abnormalities on the echo, or if there is suspected pericarditis or myocarditis, the patient is referred for a cardiac MRI with contrast. 

Watch more of this interview in the VIDEO: Cardiac Presentations in COVID Long-haulers at Cedars-Sinai Hospital 

Related Long-COVID Content:

What We Know About Cardiac Long-COVID Two Years Into the Pandemic 

VIDEO: Long-term Cardiac Impacts of COVID-19 Two Years Into The Pandemic — Interview with Aaron Baggish, M.D.

VIDEO: Long-COVID Presentations in Cardiology at Beaumont Hospital — Interview with Justin Trivax, M.D.

VIDEO: Cardiac Presentations in COVID Long-haulers at Cedars-Sinai Hospital — Interview with Siddharth Singh, M.D.

Find more COVID news and video

 

Coronavirus (COVID-19) | January 24, 2022

Justin Trivax, M.D., an interventional cardiologist who works with long-COVID patients at Beaumont Hospital, explains some of the common symptoms and their prevalence in the Beaumont long-COVID clinic. 

COVID long hauler syndrome is no longer seen as a big mystery because large numbers of these patients have been seen and treated. The bottom line is that while long-hauler symptoms are an issue for patients, they do not appear to be life-threatening and the big fear of large numbers of new heart failure patients post infection has not materialized.

"Interestingly, the patients do get better. It is a slow process, but by the one-year point we do see improvement in patients with this prolonged syndrome," reassured Trivax.

Many of the patients Trivax has seen only had a mild case of COVID, but presenting months later with cardiac issues. Trivax said these patients often test troponin positive. The question as to what is causing this often results in a cardiac MRI.

"There are also patients who had very mild symptoms [during their COVID infection] and those patients don't have a major event, however, they may have those prolonged symptoms," Trivax said. "We see this in the MRI studies that have been performed. But, what these abnormal cardiac MRIs really mean, we don't quite know. We don't have any long-term data for these COVID patients."

Read more of his observations in the article What We Know About Cardiac Long-COVID Two Years Into the Pandemic

Related Long-COVID Content:

What We Know About Cardiac Long-COVID Two Years Into the Pandemic 

VIDEO: Cardiac Presentations in COVID Long-haulers at Cedars-Sinai Hospital — Interview with Siddharth Singh, M.D.

VIDEO: Long-term Cardiac Impacts of COVID-19 Two Years Into The Pandemic — Interview with Aaron Baggish, M.D.

VIDEO: Long-COVID Presentations in Cardiology at Beaumont Hospital — Interview with Justin Trivax, M.D.

VIDEO: Examination of Cardiac COVID Long-Haulers — Interview with Siddharth Singh, M.D.

Find more COVID news and video

Coronavirus (COVID-19) | January 20, 2022

Aaron Baggish, M.D., director of the cardiovascular performance program, Mass General Hospital, has been involved in the care of cardiac COVID-19 long-hauler patients and monitoring athletes recovering from COVID the past two years.

He spoke to DAIC a year ago in late 2020 about the beginning of the Mass General monitoring of long-COVID patients and he shares what they have learned over the past year. He said the common long-term issues include arrhythmias, brain fog and other issues. Baggish also explains what they do to evaluate post-COVID infection patients with complaints or odd presentations weeks or months after their acute phase of infection ended.

Watch the 2020 interview with Baggish on long-COVID — VIDEO: Lingering Myocardial Involvement After COVID-19 Infection

 

Related Long-COVID Content:

What We Know About Cardiac Long-COVID Two Years Into the Pandemic 

VIDEO: Long-term Cardiac Impacts of COVID-19 Two Years Into The Pandemic — Interview with Aaron Baggish, M.D.

VIDEO: Long-COVID Presentations in Cardiology at Beaumont Hospital — Interview with Justin Trivax, M.D.

VIDEO: Examination of Cardiac COVID Long-Haulers — Interview with Siddharth Singh, M.D.

VIDEO: What Are The Long-term Cardiac Impacts of COVID-19 Infection — Interview with Todd Hurst, M.D.

VIDEO: Cardiac Presentations in COVID Long-haulers at Cedars-Sinai Hospital — Interview with Siddharth Singh, M.D.

Find more COVID news and video

Magnetic Resonance Imaging (MRI) | January 18, 2022

Orlando Simonetti, Ph.D., professor, cardiovascular medicine, worked with Siemens to help develop a new, lower-field magnetic resonance imaging (MRI) system, the Magnetom Free.Max. It can scan patients that previously may have been contraindicated because of implantable medical devices. The first system installed in the U.S. is at The Ohio State University Wexner Medical Center. It has a much lower magnetic field and a larger patient opening, removing barriers to MRI imaging for many patients.

Simonetti and his colleagues developed new techniques to boost the signal-to-noise ratio in MRI machines, which allowed the creation of a machine with a lower magnetic field strength that still enables high quality images.

The system gained FDA clearance in July 2021 and was featured by Siemens at the Radiological Society of North America (RSNA) 2021 meeting.

The interview and footage was provided by The Ohio University State University Wexner Medical Center.

Read more in the article New FDA-approved MRI Expands Access to Life-saving Imaging.

 

Artificial Intelligence | January 13, 2022

Here are two examples of artificial intelligence (AI) driven pulmonary embolism (PE) response team apps featured by vendors Aidoc and Viz.AI at the 2021 Radiological Society of North America (RSNA) 2021 meeting.

The AI scans computed tomography (CT) image datasets as they came off the imaging system and looked for evidence of PE. If detected by the algorithm, it immediately sends an alert to the stroke care team members via smartphone messaging. This is done before the images are even loaded into the PACS. The radiologist on the team can use a link on the app to open the CT dataset and has basic tools for scrolling, windowing and leveling to determine if there is a PE and the severity. The team can then use the app to send messages, access patient information, imaging and reports. This enabled them all to be on the same page and can communicate quickly via mobile devices, rather than being required to use dedicated workstations in the hospital. 

Both vendors showed similar apps for stroke at RSNA 2019. That idea for rapid alerts, diagnosis and communications for acute care teams has now expanded to PE and also for aortic dissection and abdominal aortic aneurysms (AAA). AI.Viz and Aidoc are looking at expanding this type of technology for other acute care team rolls, including heart failure response. 

Read more about this technology in the article AI Can Facilitate Automated Activation of Pulmonary Embolism Response Teams.

Find more AI news

Find more RSNA news and video

 

 

Cath Lab | January 13, 2022

Advancements in analytics and data visualizations are helping to streamline operations and improve productivity at cath labs across the country. Kootenai Health in Coeur d'Alene Idaho has a single cath lab performing more than 2,000 cases per year. Diane Penkert, executive director of heart and vascular services, discusses how the implementation of the Philips Performance Bridge analytics platform has enabled them to better leverage cardiovascular procedure data.

Heart Failure | January 11, 2022

The University of Maryland Medical Center (UMMC) announced the first successful transplant of a genetically modified pig’s heart into a human patient took place Jan. 9, 2022. The innovative procedure may pave the way to eliminating the current heart transplant wait lists. The cardiologists who developed this procedure believe in the near future, an unlimited number of pig hearts could be used to allow heart transplants in any patients who need them on demand, and regardless of the medical requirements that currently limit access to human heart transplants.

Cardiac surgeons Muhammad M. Mohiuddin, M.D., scientific and program director, Cardiac Xenotransplantation Program, University of Maryland, and Bartley P. Griffith, M.D., M.D., explain how the procedure and technology works. They surgically transplanted a pig heart into the human patient after the patient had no options left and did not qualify for the heart transplant list. The patient was surviving in the hospital only through the use of an ECMO heart-lung machine.

The patient, 57-year-old Maryland resident David Bennett, was granted a FDA emergency authorization for the surgery on New Year’s Eve through its expanded access (compassionate use) provision. It is used when an experimental medical product, in this case the genetically-modified pig’s heart, is the only option available for a patient faced with end-stage heart failure, a serious or life-threatening medical condition. The authorization to proceed was granted in the hope of saving the patient’s life.

“This was a breakthrough surgery and brings us one step closer to solving the organ shortage crisis. There are simply not enough donor human hearts available to meet the long list of potential recipients,” said Griffith, the Thomas E. and Alice Marie Hales Distinguished Professor in Transplant Surgery at UMSOM. “We are proceeding cautiously, but we are also optimistic that this first-in-the-world surgery will provide an important new option for patients in the future.”

This video includes video footage from the historic procedure and interviews with Griffith, Mohiuddin and other officials at University of Maryland Medical Center and the University of Maryland School of Medicine.

Read more in the article First Human Receives a Pig Heart Transplant.

Transplanting Pig Hearts Into Humans One Step Closer

Coronavirus (COVID-19) | December 14, 2021

Jean Jeudy, M.D., professor of radiology and vice chair of informatics at the University of Maryland School of Medicine, presented a late-breaking study at the 2021 Radiological Society of North America (RSNA) meeting on COVID-19 linked myocarditis in college athletes. 

A small but significant percentage of college athletes with COVID-19 develop myocarditis, a potentially dangerous inflammation of the heart muscle, that can only be seen on cardiac MRI, according to the study Jeudy presented. Myocarditis, which typically occurs as a result of a bacterial or viral infection, can affect the heart’s rhythm and ability to pump and often leaves behind lasting damage in the form of scarring to the heart muscle. It has been linked to as many as 20% of sudden deaths in young athletes. The COVID-19 pandemic raised concerns over an increased incidence of the condition in student-athletes.

For the new study, clinicians at schools in the highly competitive Big Ten athletic conference collaborated to collect data on the frequency of myocarditis in student-athletes recovering from COVID-19 infection. Conference officials had required all athletes who had COVID-19 to get a series of cardiac tests before returning to play, providing a unique opportunity for researchers to collect data on the athletes’ cardiac status.

Jeudy serves as the cardiac MRI core leader for the Big Ten Cardiac Registry. This registry oversaw the collection of all the data from the individual schools of the Big Ten conference. He reviewed the results of 1,597 cardiac MRI exams collected at the 13 participating schools. 

Thirty-seven of the athletes, or 2.3%, were diagnosed with COVID-19 myocarditis, a percentage on par with the incidence of myocarditis in the general population. However, an alarmingly high proportion of the myocarditis cases were found in athletes with no clinical symptoms. Twenty of the patients with COVID-19 myocarditis (54%) had neither cardiac symptoms nor cardiac testing abnormalities. Only cardiac MRI identified the problem.

Read more details in the article COVID-19 Linked to Heart Inflammation in College Athletes.

Related COVID-19 Imaging and Myocarditis Content:

Overview of Myocarditis Cases Caused by the COVID-19 Vaccine

COVID-19 Linked to Heart Inflammation in College Athletes — RSNA 2021 late-breaker

VIDEO: Cardiac MRI Assessment of Non-ischemic Myocardial Inflammation Caused by COVID-19 Vaccinations — Interview with Kate Hanneman, M.D.

Cardiac MRI of Myocarditis After COVID-19 Vaccination in Adolescents

Large International Study Reveals Spectrum of COVID-19 Brain Complications - RSNA 2021 late-breaker

COVID-19 During Pregnancy Doesn’t Harm Baby’s Brain

VIDEO: Large Radiology Study Reveals Spectrum of COVID-19 Brain Complications — Interview with Scott Faro, M.D.

FDA Adds Myocarditis Warning to COVID mRNA Vaccine Clinician Fact Sheets

Small Number of Patients Have Myocarditis-like Illness After COVID-19 Vaccination

Radiation Dose Management | December 10, 2021

The vendor Radiaction introduced a new type of scatter radiation protection shielding system that mounts to the angiography system in the cath lab. It was shown for the first time at the 2021 Radiological Society of North America (RSNA) annual meeting.

The system uses a motorized series of tungsten-polymer radiation shield plates that extend down from the detector, and up from the X-ray source, to the patient and bottom of the table. This greatly reduces scatter radiation in the lab, by as much as 92% according to the company's research. 

The shields are deployed using a table-side controller. The shield has sensors to stop extending when it comes close to the patient or the table. The shield can be partly pulled back to enable panning the table. The company said the shield can be mounted on existing angiography C-arms.

It has CE mark and is installed clinically in two cath labs in Israel. The company hopes to submit for U.S. FDA review in 2022.

Related Cath Lab Radiation Dose Reduction Content:

Defining the Cath Lab Workplace Radiation Safety Hazard

VIDEO: Minimizing X-ray Exposure to Physicians During Interventional Procedures With the ControlRad System — Interview with Dr. Simon Dixon

Medical Imaging Radiation Levels in U.S. Dropped Over Past Decade

Philips Developing X-ray Free Cath Lab Imaging to Replace or Supplement Angiography

VIDEO: Reducing Cath Lab Radiation Dose at Henry Ford Hospital

VIDEO: Technologies and Techniques to Reduce Radiation Dose in the Cardiac Cath Lab — Interview with Akshay Khandelwal, M.D.

Dose-Lowering Practices for Cath Lab Angiography

5 Technologies to Reduce Cath Lab Radiation Exposure

VIDEO: Heart Surgeon Shares Effects of Fluoroscopic Radiation Exposure

Helping Interventional Cardiologists Reduce Exposure to Ionizing Radiation

14 Ways to Reduce Radiation Exposure in the Cath Lab

Coronavirus (COVID-19) | December 06, 2021

Kate Hanneman, M.D., MPH FRCPC, director of cardiac imaging research JDMI, and the medical imaging site director at Toronto General Hospital, Women’s College Hospital, was an author on a recent overview of cardiac MRI assessments of non-ischemic myocardial inflammation caused by the COVID-19 vaccine. She presented this study and other related data at the 2021 Radiological Society of North America (RSNA) meeting. 

The rare side effect from the COVID vaccine is seen mainly in young men between ages 12-29. It appears to resolve on its own after a couple days, but longer term monitoring is needed to show if there is any lasting cardiac damage. A small number of single cases with follow up MRI imaging so far have not shown long term damage. 

Hanneman noted the incidence of vaccine-related myocarditis is very rare and people have a much high probability of getting much more serious COVID-viral myocarditis is they are not vaccinated. She said so the risk-vs-benefit analysis currently shows it is better to get vaccinated to prevent or lessen the effects of COVID. 

Related COVID-19 Imaging Content:

Overview of Myocarditis Cases Caused by the COVID-19 Vaccine

COVID-19 Linked to Heart Inflammation in College Athletes — RSNA 2021 late-breaker

Cardiac MRI of Myocarditis After COVID-19 Vaccination in Adolescents

Large International Study Reveals Spectrum of COVID-19 Brain Complications - RSNA 2021 late-breaker

COVID-19 During Pregnancy Doesn’t Harm Baby’s Brain

VIDEO: Large Radiology Study Reveals Spectrum of COVID-19 Brain Complications — Interview with Scott Faro, M.D.

FDA Adds Myocarditis Warning to COVID mRNA Vaccine Clinician Fact Sheets

Small Number of Patients Have Myocarditis-like Illness After COVID-19 Vaccination

Cardiovascular Ultrasound | November 24, 2021

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
 

EP Lab | November 22, 2021

Christine Albert, M.D., MPH, professor, chair of the Department of Cardiology and the Lee and Harold Kapelovitz Distinguished Chair in Cardiology, and former president of the Heart Rhythm Society (HRS). She spoke at the American Heart Association (AHA) 2021 meeting on innovations in electrophysiology (EP) technologies. 

Advances she discusses include:
   • Leadless pacing and CRT systems  
   • Wearable patch heart monitors and that are largely replacing traditional Holter monitors.
   • Pulsed field ablation (also called electroporation) that may improve cardiac ablations and prevent damage to underlying tissues.
   • Cryo-ablation balloons.
   • Improved EP mapping technologies.
   • and left atrial appendage (LAA) occluders.

Find more EP lab technology news

Find More AHA 2021 Late-breaking News

Genetic Testing | November 22, 2021

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

Pharmaceuticals | November 22, 2021

Susan Cheng, M.D., MPH, director of the Institute for Research on Healthy Aging in the Department of Cardiology at Cedars-Sinai and the Erika J. Glazer Chair in Women's Cardiovascular Health and Population Science, led a discussion at the American Heart Association (AHA) 2021 meeting on novel therapeutics for the lipid lowering treatments. 

She discusses bempedoic acid, inclisiran to reduce LDL-C, icosapent ethyl and the use of genetic testing to further reduce high low-density lipoprotein (LDL) in patients were statin therapy is not enough.

Cheng discusses more in the VIDEO: Use of Genetic Testing to Tailor Lipid Lowering Therapies.

Find more AHA 2021 late-breaking studies and video

 

Radiation Dose Management | November 17, 2021

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

Find more TCT news

Structural Heart | October 15, 2021

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.

Related Transcatheter Valve Trends Content:

TAVR Expected to See Rapid Growth in Next 5 years

FDA Approves TAVR for Low-risk Patients Creates A Paradigm Shift in Cardiology

VIDEO: The Expansion of TAVR Following the FDA Clearing its Use in All Patients — Interview with Torsten Vahl, M.D.

VIDEO: Overview of the TAVR Program at Tufts Medical Center — Interview with Andrew Weintraub, M.D.

VIDEO: Tracking Transcatheter Valve Outcomes in the STS-ACC TVT Registry — John Carroll, M.D.

VIDEO: Overview of University of Colorado Structural Heart Program — Interview with John Carroll, M.D., Robert Quaife, M.D., and James Chen, Ph.D.

VIDEO: Abbott Structural Heart Technology Advances in 2021  — Interview with Neil Moat, MBBS
 

EP Mapping and Imaging Systems | October 14, 2021

An example of the Acutus Medical AcQMap High Resolution Imaging and Mapping System to guide electrophysiology (EP) cardiac ablations. The electrical mapping of the heart shows irregular atrial fibrillation (AFib) prior to an ablation. 

The system uses a basket catheter with 48 electrodes combined with 48 tiny ultrasound transducers. The basket can be manually rotated around inside the atrium to rapidly “paint” a very accurate combined electro- and anatomical map simultaneously in about five minutes. Conventional EP mapping systems can take 20 minutes or longer to complete the mapping process. The electrodes do not need to contact the walls of the heart because the vendor said they can detect the electrical field created by cardiac contractions. The system has both FDA and European CE mark approvals. 

Related EP Mapping Content:

FDA Clears Second-Generation AcQMap 3D EP Imaging and Mapping Catheter

What is New in Electrophysiology Technologies

Acutus Gains European CE Mark for Suite of Next Generation EP Products

New Technologies to Improve Atrial Fibrillation Ablation

Identifying Hubs of Re-entry Driving Persistent Atrial Fibrillation May Improve Treatment
 

Structural Heart | October 14, 2021

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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Stem Cell Therapies | October 04, 2021

Mechanical engineering Professor Nathan Sniadecki, associate chair for research and infrastructure, mechanical engineering, University of Washington, Seattle, explains his department's development of engineered heart tissue that can beat. The "heart or organ in a dish" technology allows cardiac myocytes to be tested in a lab with various drugs or other influences to see what the impact would be on the heart. 

This technology developed at UW was sent to the International Space Station in 2020 to help evaluate the impact of zero-gravity on the heart. This research plays a critical role in understanding the impact on the human heart in long-duration space flights to places like Mars or beyond. 

The bioengineered tissue is the length of a couple grains of rice set between two posts so the tightening and stretching of cardiac muscles can be measured. 

Read more details in the article Tiny Beating Hearts Created With Stem Cells at the University of Washington.

 

EP Lab | October 04, 2021

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.

 

Structural Heart | September 28, 2021

Tom Jones, M.D., director, cardiac cath labs, Seattle Children’s Hospital, and principle investigator of the Medtronic Harmony transcatheter pulmonary valve trial, explains the differences between the Melody and Harmony valves. He also explains the history of congenital heart transcatheter valve development over the past 20 years and how adult structural heart devices also developed side-by-side with these devices. 

Patients with tetralogy of fallot often received the ventricular outflow tract (RVOT) in an initial surgery and a second surgery in needed later for a pulmonary valve. As valves wear out, additional open heart surgeries are needed. The Harmony and Melody help reduce the number of open heart surgeries in these patients. Jones said the Harmony valve may help reduce or eliminate the need for open heart surgeries.

The Melody was the first transcatheter valve to gain approval for use in the United States. It was designed to treat patients who already had a surgically placed RVOT. The Harmony valve was then developed to address patients who also needed the RVOT. Between the two valves, Jones said the majority of congenital heart issues can now be treat.

Jones said about 40,000-50,000 babies are born each year in the United States with congenital heart defects that the Harmony and Melody valves might be used to help. He said the Melody valve was able to help about 25% of these patients, and the Harmony valve now can help the rest of these patients with a transcatheter solution. 
 

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Structural Heart | September 20, 2021

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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Congenital Heart | September 15, 2021

Tom Jones, M.D., director, cardiac cath labs, Seattle Children’s Hospital, explains the importance of the heart team approach on congenital heart interventions and explains the development of adult congenital interventional specialists. Jones explains the role of pediatric and adult congenital interventionists and structural heart specialists and the importance of the team approach with complex congenital heart patient cases.

He also explains the history of interventions and congenital heart disease over the last few decades and how these helped shape transcatheter adult structural heart interventions today. 

 

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September 13, 2021

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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Cardiovascular Information Systems (CVIS) | August 31, 2021

One of the trends in cardiovascular information system (CVIS) and radiology PACS at the Healthcare Information Management Systems Society (HIMSS) 2021 conference was the deeper integration of third-party image analysis software and artificial intelligence (AI) into these systems. This eliminates software sitting on top of the CVIS or PACS, separate logins or needing to us a different screen or manually transferring information from the third-party app in into the final report.

A good example of this was Siemens Healthineers, which demonstrated a deep integration with Epsilon Imaging’s echocardiography strain imaging analysis software. The integration eliminates the need for a separate login to the software, and automated quantification and images are carried over directly into the syngo echo report.

Strain can be used to assess cardiac function more precisely than regular cardiac ultrasound exams. It has grown in its use for cardio-oncology programs, assessing a baseline cardiac function and the. Performing serial exams over the course of a cancer patient’s chemotherapy. Strain has seen growing interest and has been a hot topic the past couple years at the American Society of Echocardiography (ASE) meeting. Interest also has expanded greatly recently with reimbursement now available in the U.S.

Siemens said there also has been increased interest in strain this past year because it can show early indicators of cardiac issues in COVID-19 patients and can be used to help monitor COVID myocarditis patients.
 

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Advances in CVIS and Enterprise iImaging at HIMSS 21

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Cardiovascular Information Systems (CVIS) | August 31, 2021

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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Cardiovascular Ultrasound | August 17, 2021

A new ultrasound imaging technology that may offer novel ways to diagnose and better understand cardiac diseases using dynamic blood flow imaging. This allows imaging of individual blood cells or contrast bubbles as they travel through the heart and vessels, showing detail in how the blood moves and swirls. These motions, including the formation of vortices, may offer new insight into different disease states and allow earlier diagnosis and a understand better when to intervene.

The examples shown in this short video are from Hitachi and GE Healthcare, both of which have highlighted this technology at the American Society of Echocardiography (ASE) annual meetings over the past four years.

Ultrasound vendors use different technology approaches, including vector flow imaging, particle imaging velocimetry and blood speckle tracking. All of them show small lines or arrows to indicate the direction the blood cells or bubbles are traveling, and color codes to indicate velocity. Some vendors offer quantification for some new measures of blood flow, but as of yet, there are no guidelines or standardized indexes as to what these numbers mean.

This technology has been discussed in research sessions at the IEEE and the ASE over the past several years. However, more research is needed to show the prognostic value of the technology. Research to date shows it is possible that the swirling of blood can indicate less efficient flow, which may have implications in the development of heart failure, pulmonary hypertension and advancement of valvular disease. In the coronary arteries, research has shown there may be a connection between sheer stresses and disrupted blood flow in the formation of plaques on artery walls.

Companies that have developed echo blood flow dynamics imaging on their ultrasound systems to date include Hitachi, GE Healthcare, Fujifilm, Mindray and BK Medical. 

Read more about this technology from ASE 2021 in the article Development of Echo Blood Flow Dynamics Imaging.
 

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EP Lab | August 02, 2021

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.

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EP Lab | August 02, 2021

Samir Saba, M.D., co-director of the University of Pittsburgh Medical Center Heart and Vascular Institute, and chief, Division of Cardiology, explains the SMART MSP (Multi-Site Pacing) study. This late-breaking clinical trial was presented at the 2021 Heart Rhythm Society (HRS) meeting. It evaluated the safety and effectiveness of multi-site pacing in initial non-responders to conventional cardiac resynchronization therapy with the goal of increasing response cardiac resynchronization therapy (CRT).

CRT nonresponders make up a sizable minority of patients, about one-third. Saba said this trial, was designed to try and chip away and reduce that number. Multi-site pacing has been debated as alternative to single site pacing for several years and this trial offers additional data in support of MSP.

The trial tested the efficacy and safety of the Boston Scientific Resonate X4 CRT-D system. This device allows multi-site pacing to be turned on or off at any time by the electrophysiologist. In the study, patients who did not respond had the multi-site pacing feature turned on, which resulted in 51% of the nonresponders to respond to therapy. 

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Stethoscopes | July 16, 2021

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 

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Structural Heart | July 14, 2021

Doctor Andreas Ruck, interventional cardiologist and head of the mitral/tricuspid program, Karolinska University Hospital, Stockholm, Sweden, explains the latest data on the Boston Scientific Acurate neo2 transcatheter aortic valve replacement (TAVR) system. It demonstrated positive procedural performance, including low rates of paravalvular leak (PVL) and permanent pacemaker implementation, in data presented in late-breaking sessions at the EuroPCR 2021 congress. These areas improved from the trials using the first generation valve. 

The Acurate neo2 valve design enhancements include a 60% larger outer sealing skirt to better conform to challenging anatomies to better minimized PVL.

Boston Scientific said the ACURATE IDE pivotal U.S. trial is currently enrolling patients to evaluate the safety of the ACURATE neo2 Aortic Valve System. In April 2021, the company received FDA approval to modify the trial design to study patients with severe, symptomatic aortic stenosis who are at low risk for open-heart surgery, in addition to those at intermediate, high and extreme risk.

 

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Artificial Intelligence | July 01, 2021

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.

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