THE FUTURE OF CARDIOLOGY
-Written by Dr. Sadiya Khan
According to the WHO, diseases such as stroke and ischaemic heart disease roughly account for 17.7 million deaths only in India. The diagnosis and management of cardiac conditions have undergone a significant transformation with AI and machine learning bringing in unprecedented changes. Here are some of the latest advancements in cardiac care-
Artificial intelligence in cardiology
Myocardial scars are usually assessed non-invasively using the gold standard investigation- cardiovascular magnetic resonance imaging late gadolinium enhancement (LGE). Assessing the scars is helpful for clinical decision-making regarding revascularization and the long-term prognosis of patients with ischaemic heart disease( IHD). LGE requires i.v contrast that increases scan time and is also contraindicated in certain populations. Virtual Native Imaging- a novel AI approach, uses deep learning to enhance the images to produce superior quality images to quantify scar size and transmurality in patients with previous MI. Being a contrast-free alternative, VNI can reduce scan time and costs, and the accessibility of MRI in the future.
The world’s first partial heart transplant
Surgeons at Duke Health, in Durham, North Carolina, have made history by performing the first-ever partial heart transplant in a neonate with congenital heart disease ( truncus arteriosus). The patient’s 2 main arteries are fused together along with a leaky valve. The combination made it unlikely for the patient to survive until a heart transplant. Dr. Joseph Turek used living tissue from the donor heart of an infant not suitable for a full transplant but with strong valves and fused them on the existing heart. The valve grows with the child as he ages and eliminates the need for multiple open heart surgeries, every time a child outgrows an old valve, hence extending the lifespan. This procedure also makes use of a donated heart that would otherwise not be transplantable.
Inclisiran- a novel lipid-lowering therapy
More than 200 million people around the world take statins to lower cholesterol levels. Leqvio (Inclisiran) is the first and the only FDA-approved small-interfering RNA therapy for LDL cholesterol reduction. It acts by reducing the production of a protein that degrades LDL receptors, thereby increasing receptor density and recycling in the hepatocytes. With its twice-yearly dosing, it is a great option for millions of people with clinical atherosclerotic cardiovascular disease. It is given via the subcutaneous route as an initial dose, followed by another dose at 3 months then every 6 months. The ORION 11 trial shows that it reduces LDL-C levels by 50% over 18 months.
MAVACAMTEN- First drug to specifically target obstructive hypertrophic cardiomyopathy( HCM)
HCM is a condition where changes in certain genes allow the heart muscle to get too thick and may obstruct the left ventricular outflow tract. Treatment for severe obstructive HCM symptoms has been a surgical septal reduction. As a selective allosteric inhibitor of cardiac myosin ATPase, mavacamten reduces actin-myosin cross-bridge formation and contractility. In the VALOR-HCM trial, presented at the American College of Cardiology Scientific Session in April, mavacamten reduced the need for septal reduction therapy and also improved symptoms, biomarker levels, and quality of life in HOCM patients.
References:
| 1. | Impact of inclisiran on LDL-C over 18 months in patients with ASCVD or risk-equivalent [Internet]. American College of Cardiology. [cited 2022 Nov 16]. Available from: http://www.acc.org/Latest-in-Cardiology/Clinical-Trials/2019/09/01/12/22/ORION-11 |
| 2. | Duke Health performs world’s first partial heart transplant [Internet]. Duke.edu. [cited 2022 Nov 16]. Available from: https://today.duke.edu/2022/09/duke-health-performs-world%E2%80%99s-first-partial-heart-transplant |
| 3. | Zhang Q, Burrage MK, Shanmuganathan M, Gonzales RA, Lukaschuk E, Thomas KE, et al. Artificial intelligence for contrast-free MRI: Scar assessment in myocardial infarction using deep learning-based virtual native enhancement. Circulation [Internet]. 2022;146(20):1492–503. Available from: https://www.ahajournals.org/doi/abs/10.1161/CIRCULATIONAHA.122.060137 4.https://www.healio.com/news/cardiology/20220701/patients-feel-better-new-hope-for-obstructive-hypertrophic-cardiomyopathy |
