New Chapter in Heart Care: Angiograms Using AI and Science

A revolutionary way of evaluating heart artery narrowing and blockages that combines angiograms and artificial intelligence (AI) is being evaluated at Lehigh Valley Heart and Vascular Institute and the early experience is promising.

Shailendra Singh, MD, Co-Director of Interventional Vascular Cardiology for the Heart and Vascular Institute, says the new technology from CathWorks has the potential to affect how we evaluate heart disease in the hospital catheterization lab, where heart anatomy and function are assessed. “This has the potential to make the process safer without increased cost,” Singh says.

Singh says the Heart and Vascular Institute is one of just a few health care providers on the East Coast to be evaluating the new technology, CathWorks FFRangio, which received Food and Drug Administration approval in late 2018.

In a conventional diagnostic angiogram, a patient with suspected narrowing or blockages in the arteries that supply blood to their heart has a catheter inserted into an artery, most commonly in the groin or arm. Doctors inject contrast dye into the catheter and imaging shows conditions in real time.

Doctors then perform a test known as fractional flow reserve (FFR) to measure pressure and blood flow on each side of a narrowed area, or blockage. The FFR data drive the decision on whether a problem can be treated with medication or whether a stent or bypass surgery is required. If a stent is needed, it’s usually inserted during this procedure.

Traditionally, doctors perform a wire-based FFR in which they feed a wire into a catheter that provides flow and pressure data. Doctors use a new catheter and a new wire for each cardiac artery. There are two main coronary arteries, each with branches.

The CathWorks FFRangio® System uses the same diagnostic angiograms to provide a 3D reconstruction of the entire coronary tree, without using the invasive wire used in the traditional FFR. Its software then combines AI and computational science to produce findings about blockages or narrowing without wires or multiple catheters, Singh says.

Using FFRangio also eliminates the need for blood thinners during the procedure. The increased safety also springs from not having to use wires, which in rare cases can dislodge plaque in an artery and risk a stroke. Doctors also don’t have to use multiple catheters since different catheters are used to inject the contrasting dye and feed the pressure-sensing wire into an artery.

“It’s really impressive,” Singh says of the CathWorks system. “Not a lot of places are equipped to do this. We were selected to be among the first sites in the country.”

Singh has designed an in-house study to evaluate CathWorks accuracy, using both the CathWorks system and the traditional wire-based technology in selected cases. “So far, it (CathWorks) has been extremely accurate,” Singh says.

Eric Elgin, MD, Chief of Cardiology for the Heart and Vascular Institute, says LVHN’s expertise and reputation mean it has a leg up in helping pioneer emerging technologies like CathWorks.

Elgin says CathWorks is another example of how AI is becoming more integrated into medical technology. “It’s super exciting how it’s (AI) continuing to improve how we care for patients. This (CathWorks) allows us to be less invasive, yet still answer critical health questions,” Elgin says.

Not everyone who needs an angiogram will be a fit for CathWorks right now, Elgin says. Certain patients’ blood vessel anatomy – the way their blood vessels are positioned – is not conducive to the technology. Elgin says there always will be a place for the existing wire-based angiogram technology, but notes he expects the wireless version to diagnose the lion’s share of heart patients as more catheterization labs across Lehigh Valley Health Network (LVHN) are eventually outfitted with the technology.

In addition to Lehigh Valley Hospital (LVH)–Cedar Crest, that would include LVH–Muhlenberg and LVH–Pocono. “As we get more comfortable with the technology, this will be a bigger and bigger piece of how we evaluate heart patients and potential next steps,” Elgin says. Heart and Vascular Institute doctors perform about 4,000 angiograms each year.

“World-class care is foundational here at LVHN and heart health research and testing are part and parcel of that,” Elgin says. “We’re excited about the CathWorks system and what it can mean for our patients going forward.”