By Tom Watson and Sabrina Newell, Clinical Analysts at MD Buyline

Prevention and early detection were key themes throughout the American College of Cardiology's recent scientific session and expo in Washington, D.C.

This emphasis is based on a growing desire to move health care toward a more proactive role and mindset rather than merely diagnosis and treatment. Once the disease is more established and must be managed or treated, it can get expensive and more interventional, hence disruptive to the patient’s life.



Early detection and risk factor modification continue to drive less invasive imaging and diagnostic techniques such as cardiac CT, cardiac MR, and ultrasound. New medical regimens to reduce known risk factors such as LDL cholesterol, along with new medications, are becoming a major focus for both technology and pharmacological manufacturers.

An emerging technology focus is on noninvasive assessment of the flow dynamics for coronary lesions via a measurement of Frequency Flow Reserve (FFR). A technique from HeartFlow provides this measurement as part of a cardiac CT. HeartFlow and Siemens announced a nonexclusive partnership at the ACC for this functionality.

HeartFlow will likely develop similar partnerships with other CT vendors in the future. This capability requires the data to be sent to HeartFlow for a 24-hour evaluation, but the company is working on reducing this time so this can become a mainstream option.

This technology could more accurately diagnose physiologically significant lesions noninvasively. As it is perfected, it could be a factor in a triage process to send patients to surgery, interventional therapy, or medical therapy/prevention, or to establish that there is no cardiac threat.

SURTAVI Clinical Trials
This was a newly released clinical trial that is continuing to show success in demonstrating that Transcatheter Aortic Valve Replacement/Intervention (TAVR/TAVI) is a safe and non-inferior option for patients with a moderate surgical risk profile. As more approved valve replacement options are becoming available, the consideration of TAVR versus surgical solutions is expanding to patients who would normally have only surgical options available.

This is a very positive move from the initial findings that focused on patients who had no options, as they were too high-risk for surgery. It will continue to expand the use and consideration of catheter-based aortic valve treatment to a wider patient population.

We are also seeing a gradual expansion of the concept to mitral valve repair and pulmonary valve repair/replacement. The growing interventional versus surgical approach will begin to offer less traumatic options to these patients. As the available device options increase, we will likely see a gradual reduction in device costs, which will also begin to reduce the cost of treatment and length of inpatient care, improving quality of life and ability to return to everyday life for these patients. Long-term findings remain to be seen, but the approach continues to show increasing promise for this patient population.

Echocardiography
Top imaging vendors in the cardiovascular ultrasound market showcased their premium-level systems that include advanced 3D/4D software and user-friendly applications for a more efficient workflow and better reproducibility. Vendors demonstrated their most recent software enhancements and promoted the economically priced models in their product portfolio. These systems provide excellent image quality with a smaller footprint. Ultrasound technology continues to provide these software enhancements as on-cart options that help to streamline the assessment of many cardiac diseases.

GE Healthcare
GE Healthcare showcased its premium E95 4D ultrasound system with advanced software applications, the high-level S60 and S70 systems, and the economically priced T8.

GE introduced the compact/portable Vivid iq with 4D advanced software and intracardiac echocardiography (ICE) as options. The company also introduced its point-of-care, handheld Vscan Extend with Dual probe.

Philips
The Philips Ultrasound booth showcased the Epiq 7 premium cardiac ultrasound system with HeartModel AI™ software. The HeartModel AI software uses anatomical intelligence ultrasound (AIUS) to automatically quantify 3-D left atrial and left ventricular volumes with a high level of reproducibility.

Philips introduced the X8-2t Live 3D TEE transducer for the Epiq 7 system for the first time since its recent FDA clearance. The transducer includes a new acoustic design with higher frequencies and bandwidth.

Siemens Healthineers
Siemens showcased the premium SC2000 cardiac ultrasound system with 3D TEE and intracardiac echocardiography (ICE) options. This system has been on the market for several years, and Siemens continues to improve the advance software applications. The SC2000 provides automated aortic and mitral valve modeling, one-click 2-D or 3-D ejection fraction quantification, and advanced strain rate analysis.

Siemens also displayed the economically priced point-of-care system, the P500. The P500 includes advanced imaging features with an intuitive interface and 30-second boot-up time, and can be used for intracardiac echocardiography (ICE).

Toshiba Medical Systems
Toshiba showcased the new Aplio i900 Cardiovascular Ultrasound system, and the Aplio 500. The Aplio i900 is part of the i-series systems that are designed with advanced software applications and automation tools for improved workflow efficiency and clarity.

Diagnostic ECG
Diagnostic ECG technology includes resting ECG equipment, Holter monitoring, and exercise (stress) testing equipment. At this year’s ACC vendors continue to promote their ability to upload DICOM information from other vendors into their systems for comparison, as well as the ability to communicate with EMRs for improved and efficient workflow solutions.

GE Healthcare
GE exhibited the MUSE ECG Management technology with a new analytics dashboard that can be used for asset utilization, workflow efficiency, and quality improvement metrics. This is an upgrade option for MUSE V8 and V9 users. The MUSE V9 software uses DICOM for test orders and resulting, provides the ability to upload a facility's active directory for faster installation of the system, and allows for uploading test data from third-party vendors using various formats.GE also showcased the popular MAC 5500 HD ECG and MARS V8 system.

Philips
Philips displayed the flagship PageWriter TC70 cardiogram with advanced ECG interpretation and simplified touchscreen panel for more accurate analysis and streamlined acquisition. The PageWriter ECG systems offer standardized DICOM, XML, and PDF reporting for smooth integration into existing IT infrastructure.

Mortara
Mortara displayed its extensive noninvasive cardiology product line that includes ECG, stress, and Holter technologies. Mortara showcased the Q-Stress 6 with Windows 10, which represents the combination of the Quinton and Mortara stress technologies. The Q-Stress has been a market leader in stress testing technology for many years, and the Q-stress 6 system includes the same features that we have seen on the older models, including Mortara’s VERITAS interpretation and analysis algorithm and the wireless acquisition module. Mortara also showcased a full line of ECG systems, which included systems configured for office and hospital use. The ELI380 Electrocardiograph system includes advanced application for critical value alerts, offers a touchscreen, ergonomic display for workflow efficiency, and is designed with infection control in mind. The ELI380 also includes advanced security settings and DICOM, XML, HL7, and PDF reporting for smooth integration into existing IT infrastructure.

Interventional X-Ray
Several vendors such as General Electric and Toshiba were highlighting existing solutions and software with workstations on display. Two significant introductions were from Philips Medical and Siemens Healthineers.

Philips
Philips, which had its new platform, the Azurion series, was the only vendor with an actual system on display at the show. It offers the core imaging and software technology that has been available in the Allura Xper and AlluraClarity solutions, with expanded features for improving the efficiency and workflow of procedures, both in terms of tableside functionality and intuitive interaction with the system. Philips also introduced a new 12-inch detector offering a larger field of view compared to its 10-inch option, with only a minimal increase in the external housing size. This is designed to provide quicker and more complete diagnostic and therapeutic imaging to positively impact procedure times and outcomes.

The Azurion will be offered in two versions, the Azurion 3 and Azurion 7. Most customers will consider the 7, as it is the solution with access to the full spectrum of features and advanced imaging options. The Azurion 3 will be a consideration for more basic diagnostic and limited interventional studies for facilities looking for a lower-cost but well-featured system. At present the Azurion is available only in single-plane configurations. Any applications requiring biplane would still consider the Allura Xper or AlluraClarity solutions. Philips intends to continue to offer all three solutions to the marketplace.

Siemens Healthineers
Siemens also had a new product, the Artis pheno. The vendor received FDA 510k approval just a few days before the ACC so it did not have a significant booth release planned. The Artis pheno represents Siemens’ next-generation solution for the Artis zeego. This is a unique, robotic gantry C-arm that is floor-mounted but has flexibility to be mounted away from the head of the table for better access in the hybrid OR setting, pediatric, and other applications where access to the patient at the top of the table is an important factor.

This will continue to be a premium solution for Siemens targeting the hybrid OR. A new special coating and gantry are designed to reduce the chance of contamination in the OR. All cables are now enclosed in the gantry arm, and the table now offers a much higher table weight capacity. This continues Siemens’ focus on high-end specialty application solutions that address a broad range of applications: cardiac, cardiovascular, vascular, oncology, electrophysiology, and neurology.

Other significant a technology highlighted at the meeting

Siemens Healthineers
Cardiovascular ecosystem – TeamPlay and a comprehensive dashboard to view all aspects of data being acquired through Siemens’ technology as well as other vendors’ technology. The vendor envisions third-party applications being developed that could be used with the TeamPlay solution to expand data analytics and data evaluation capabilities. This would assist the physicians and clinicians with efficiencies and diagnostic determinations and metrics to more accurately and comprehensively impact positive workflow and patient outcomes. Siemens introduced a new advance to its MR, Compressed Sensing, which is designed to provide cardiac MR in a fraction of the time previously required. It will continue to move noninvasive cardiac MR toward a more mainstream solution.

Philips
Significant clinical studies, DEFINE-FLAIR and iFR-SWEDEHART, provided findings that suggest instantaneous Frequency Flow (iFR) is shown to be non-inferior to Frequency Flow Reserve (FFR) measurements. This is a significant factor because FFR requires longer measurement times and the use of Adenosine (vaso-dilator), which increases cost and has some patient-related side effects. This specialized measurement technique is exclusive to Volcano, a division of Philips. However, the technology is available and can be used with any imaging vendor’s technology.

Meanwhile, on the show floor...
This year’s ACC Scientific Session and Expo was held in Washington, D.C., and included more than 300 sessions organized into 10 specialized learning pathways. These learning pathways included the diagnosis and treatment of various cardiovascular diseases, as well as guidelines to improve patient outcomes. The expo center housed more than 275 vendors, which included many imaging vendors and device manufacturers showcasing the latest advancements and solutions in cardiovascular technology.