Association of pulse pressure and aortic root diameter in elderly Chinese patients with chronic heart failure

Terumo Health Outcomes And Medis Strike Cardiovascular Care Partnership

US-based Terumo Health Outcomes (THO) has entered a partnership with Netherlands-based Medis Medical Imaging (MMI) to enhance cardiovascular care in the US.

The companies plan to combine MMI's non-invasive quantitative flow ratio (QFR) technology, a software for angiography-derived coronary physiology assessment, with Terumo's ePRISM clinical decision platform and pilot them together at select clinical sites in the US.

Under the partnership, real-time data from electronic health records (EHRs), and data from Medis' PIONEER IV trial (NCT04923191) – a 2,540-patient study designed to evaluate the superiority of the company's next-generation QFR technology – will be integrated into THO's ePRISM platform.

The companies anticipate that the combined technologies will enhance clinical decision support capabilities, streamline workflows, and improve patient outcomes by providing interventional cardiologists with precise anatomical and physiological assessments of coronary artery disease (CAD).

Terumo's senior divisional vice president Ryan Graver commented: "This collaboration underscores Terumo's commitment to building an innovative care operating system that not only improves clinical outcomes but also streamlines the entire care pathway.

"By utilising our ePRISM platform alongside Medis' QFR technology, we are equipping clinicians with a comprehensive suite that enhances procedural efficiency and patient outcomes."

MMI CEO Maya Barley added: "We are thrilled to partner with THO to push the boundaries of cardiovascular imaging and decision support. This collaboration provides a comprehensive solution that enhances diagnostic accuracy and treatment planning."

MMI has already conducted several trials of its QFR technology in practical use during and after interventional CAD procedures.

The company's FAVOR III trial (NCT03656848) assessed whether QFR-guided percutaneous coronary intervention (PCI) yielded superior clinical outcomes and cost-effectiveness compared to a strategy of standard coronary angiography-guided PCI in the evaluation of CAD patients. The trial demonstrated a 34% reduction in major adverse cardiac events (MACE) in a one-year follow-up of patients treated with MMI's QFR-guided versus standard angiography-guided procedures.

It is estimated that CAD affects 250 million people worldwide.

In other CAD news, US-based digital healthcare company Cleerly recently completed a $106m funding round to develop its non-invasive AI-quantitative coronary CT technology, which analyses coronary computed tomography angiography images to measure atherosclerosis – plaque build-up in the heart's arteries – to aid clinicians in developing personalised treatment plans for patients.

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"Terumo Health Outcomes and Medis strike cardiovascular care partnership" was originally created and published by Medical Device Network, a GlobalData owned brand.

 

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Revolutionising Medical Imaging: A New Era

WE LIVE in an era where technological advancements in medical imaging have transformed the way doctors diagnose diseases, enabling earlier detection and significantly improving patient outcomes. Photon Counting Computed Tomography (PCCT) has emerged as a groundbreaking innovation, offering substantial improvements over traditional computed tomography (CT) systems. As a state-of-the-art imaging technique, PCCT is poised to revolutionise diagnostic medicine by enhancing the accuracy, efficiency and safety of medical assessments.

Photon Counting Computed Tomography (PCCT)

Traditional CT scanners use detectors that employ a two-step process to average the energy of photons (particles of electromagnetic radiation) generated during X-ray imaging. Imagine mixing different shades of yellow together to create a single, uniform yellow – this represents the averaging process in conventional CT.

In contrast, PCCT utilises specialised detectors capable of directly detecting individual photons during an X-ray scan, allowing for more precise energy discrimination. To extend the analogy, PCCT records all the variations of yellow, preserving their distinct differences, resulting in higher resolution images and more accurate tissue characterisation (multispectral imaging).

Enhanced image quality

One commonly ordered diagnostic test is the Coronary Artery Calcium Score, also known as the calcium score, which evaluates the amount of calcium build-up in coronary arteries. A calcium score above 400 indicates significant plaque buildup and the patient faces a high risk of heart attack or stroke. To better visualise coronary artery narrowing, a CT Coronary Angiogram (CTCA) may be used to produce three-dimensional (3D) images of the arteries.

The presence of calcium deposits in the coronary arteries can affect the accuracy of CTCA by causing "blooming artifacts" – where small, high-density objects, like artery calcifications, appear larger than their true size, potentially leading to an overestimation of narrowing.

One of the most significant advantages of PCCT is its ability to produce higher-resolution images, overcoming the limitations of traditional CT. This enables clearer and more accurate visualisation of coronary arteries, even in the presence of calcification, ultimately reducing the need for unnecessary invasive procedures.

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Improved diagnostic accuracy

PCCT outperforms traditional CT in its ability to distinguish between different types of tissues and materials. A key challenge in CTCA is evaluating coronary arteries that contain metal stents, which are often made from alloys or stainless steel. These materials can create multiple artifacts in conventional CT scans. With its higher resolution and artifact reduction, PCCT can provide a clearer image of coronary stents, improving diagnostic accuracy.

In oncology, PCCT holds promise for detecting and characterising tumours with greater precision. With the ability to detect tumours as small as 0.2 mm, PCCT helps identify cancers that might be missed by conventional CT. Its multispectral imaging capabilities are also a game-changer, capturing images at various energy levels and providing valuable information about tissue composition. This enables more accurate differentiation between benign and malignant tissues, aiding in improved staging and treatment planning.

The integration of artificial intelligence (AI) and machine learning with high-resolution, multispectral PCCT promises to further enhance image interpretation and diagnostic workflows. AI algorithms can assist radiologists in detecting patterns and anomalies in PCCT images, increasing diagnostic efficiency and accuracy.

Lower radiation dose

An additional benefit of PCCT is its potential to reduce radiation exposure to patients. For instance, an adult, who had been vaping regularly, came in for a lung scan. The PCCT revealed early signs of lung damage. This scan had a minimal radiation dose equivalent to just two chest X-rays, which was far less than the radiation dose from a conventional CT. Early detection of lung damage helped the patient make the decision to quit vaping, preventing further harm to her lungs. 

High Tesla Magnetic Resonance Imaging (MRI)

Currently, the highest commercially available MRI scanner is the 7 Tesla MRI, approved by the US Food and Drug Administration in 2023 for brain and knee imaging. For context, a refrigerator magnet has a magnetic field strength of approximately 0.001 Tesla. While 7 Tesla MRIs are not yet widely used due to limitations, 3 Tesla (3T) MRIs are a clinically established option.

Improving accuracy with AI-powered MRI

AI-powered 3T MRI imaging, such as the Neuroquant system, offers significant advancements in the detection and early diagnosis of neurodegenerative diseases like Alzheimer's disease (AD). Early identification of cognitive impairment enables timely intervention and treatment. Neuroquant uses deep learning-based technology to accurately detect and quantify even the smallest brain lesions, and monitor treatment effects in AD patients. Given the rising prevalence of dementia in aging populations, this technology will play a crucial role in diagnosing and managing neurodegenerative diseases.

Another common condition among older adults is musculoskeletal degeneration, especially knee joint degeneration. AI-powered 3T MRI systems, such as Chondral Quant, offer precise 3D assessments of knee cartilage and can identify early cartilage degeneration. Early intervention in osteoarthritis can help maintain mobility and delay or even prevent the need for surgery.

Functional MRI (fMRI), which measures brain activity through blood flow changes, is another exciting development. FMRI is currently used for pre-surgical brain mapping, evaluating psychological changes and assessing the effects of therapy on the brain. It is also useful for studying depression in elderly individuals, as MRI scans can identify structural and functional changes in the brain associated with Major Depressive Disorder (MDD). While not diagnostic on its own, fMRI can provide crucial information that helps predict how patients will respond to treatment.

Furthermore, for elderly men experiencing urinary issues related to prostate enlargement, a 3T MRI using the internationally recognised PI-RADS protocol offers highly accurate assessments to differentiate between benign prostate enlargement and potential prostate cancer.

AI-powered future

A new era in medical imaging is upon us, driven by AI-powered PCCT and high Tesla MRI technologies. For patients suspected of heart artery blockage or those with heart stents, PCCT provides highly accurate scans that significantly reduce the need for invasive procedures. The exceptional resolution and multispectral capabilities of PCCT allow for early detection of tumours as small as 2 mm, better tissue characterisation, and more precise cancer detection.

For smokers at risk of lung disease, PCCT offers early detection of lung tumours with a minimal radiation dose, equating to only two chest X-rays. In older populations, high Tesla MRI technologies are enabling the early identification of conditions such as mild cognitive impairment, osteoarthritis, and other age-related ailments, ultimately improving quality of life through early intervention.

In conclusion, the integration of AI with advanced imaging technologies like PCCT and high Tesla MRI systems is ushering in a new era of medical diagnostics, offering more accurate, efficient and safer solutions to improve patient outcomes.

In my personal experience with PCCT and 3T MRI, it is clear that the full potential of these imaging innovations can only be fully realised if there is a dedicated, highly-driven imaging team constantly driven to ride the AI-powered medical imaging revolution. With the potential to detect diseases earlier, guide treatment decisions and reduce the need for invasive procedures, these innovations are poised to revolutionise the field of medical imaging.

This article is part of a monthly series on health and well-being, produced in collaboration with Royal Healthcare 

Cleerly Raises $106M To Commercialize AI-driven Heart Disease Tool

Dive Brief:

Cleerly said Wednesday it has raised $106 million to scale the commercialization of a machine learning tool that generates a 3D model of patients' coronary arteries.

The artificial intelligence-driven tool uses coronary computed tomography angiography (CCTA) to noninvasively measure plaque, vessel narrowing and the likelihood of insufficient blood flow.

Cleerly has generated evidence that shows its system is better than experts at assessing vessel narrowing, plaque volume and composition, helping it to secure Medicare coverage for the technology.

Dive Insight:

CCTA enables physicians to noninvasively assess the risk of patients with coronary artery disease. The imaging technique, which is recommended in clinical guidelines, facilitates evaluation of atherosclerosis to determine the likelihood of disease progression and cardiovascular events. However, whole heart quantitative CCTA analysis is a skilled and time-intensive task.

Cleerly has developed a tool to automate CCTA analysis using 10 million images of 40,000 patients. The company has validated the technology in multi-center trials, showing its equivalence to other techniques and ability to reduce the need for invasive testing. One study that used the technology as a gatekeeper to detect vessel narrowing tracked an 86% reduction in invasive coronary angiograms.

A recent analysis of more than 3,500 people enrolled in Cleerly's registry showed the potential for AI to provide a better understanding of plaque morphology. The insights could inform treatment strategies, but a randomized trial would be needed to show if tailoring therapy to the findings improves outcomes. 

Investors committed $223 million to Cleerly in 2022. The latest financing extends that round, giving the company a further $106 million from backers including Insight Partners and Battery Ventures. Cleerly will use the money to scale its commercial growth and clinical evidence generation.

The financing follows the initiation of coverage by several Medicare administrative contractors on Nov. 24 and the establishment of a current procedural terminology (CPT) service code that will take effect in January 2026.

Cleerly CEO James Min said in a statement that the use of the funding for commercialization "is especially germane" following the Medicare coverage and a CPT category I code for advanced plaque analysis.

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