Reality and possibilities in cardiology imaging

March 17, 2020
By Tom Watson

Cardiac imaging is an active and growing area for clinical and technological innovations. While you can subdivide these technologies into large, highly complex market segments, the major cardiovascular solutions we will look at here are ultrasound (echocardiography), interventional fluoroscopic imaging (angiography), CT and MR.

I believe the transition of healthcare delivery from fee per procedure to a value-based model has likely suppressed activity and interest in many medical capital decisions. The ongoing merger and acquisition activities also make this time period somewhat of an anomaly for healthcare organizations. That said, the following reflects what our extensive network of healthcare organizations are doing relative to cardiac imaging.

Cardiovascular Ultrasound (Echocardiography)
Based on the quote volume sent to TractManager for analysis, there has been about a 20% increase in requests for cardiac and cardiovascular ultrasound solutions. The largest increase (about 12%) came in the premium market segment. I believe this suggests healthcare organizations are looking for high-end, advanced imaging solutions. Other areas showing growth were compact/portable solutions for point-of-care. Stable, yet significant was the specialty area of intra-cardiac echocardiography (ICE) and Transesophageal (TEE) solutions or options.

As we move further into 2020, look for artificial Intelligence (AI) to grow in the ultrasound space. Reliance on ultrasound will grow as a lower-cost, highly portable and quick access and validation for guidance and positioning in many areas of clinical cardiology and even non-cardiac therapeutics. We may also see expanded applications in ultrasound contrast solutions.

Cardiovascular Interventional Fluoroscopic Imaging (Angiography)
Overall, last year reflected a relatively flat market for fluoroscopy with a variance of less than 1% from the prior year. There was a slight increase of 6–7% in sub-market sections such as cardiovascular imaging. Hybrid OR saw increased growth in the prior year but was flat-to-declining in 2019. A likely reason is that the first wave of hybrid OR considerations were spurred by the growing success of catheter-based valvular, congenital, and electrophysiological interventions.

Recent expansion of transcatheter aortic valve replacement (TAVR) into low-risk patient populations has been noted, along with the possibility that other catheter-based interventional applications will also become available to a larger patient population. I believe this will continue to be a strong market and will likely show some growth in the coming year and beyond. Certainly, longer-term studies will be necessary to determine long-range outcomes compared to surgery, but some early success has driven technology development and active equipment acquisition strategies in this area and will continue to do so.

Cardiac CT
Overall, quote analysis requests to TractManager declined by 15% in the past 12 months compared to the prior year. There appear to be some developing trends toward a dedicated cardiac CT scanner, with several vendors recently introducing products for that market niche. The overall CT market is still reflective of a multi-functional CT scanner with advanced cardiac software as part of the package. We have seen about 23% of the quotes for CT incorporating advanced cardiac software, and about 17% of the upgrades were either for or included advanced cardiac applications.

Fractional Flow Reserve — Computed Tomography (FFR-CT) is a growing area of interest. FFR-CT provides the ability to noninvasively evaluate the possible physiological impact of coronary artery disease. This may shift the paradigm for interventional X-ray further away from diagnostic to more of an interventional approach. The ability to not just suggest the presence of disease, but also to predict that disease has or will soon have a negative clinical impact on the patient’s risk of a cardiovascular event may drive further use of advanced Cardiac CT.

Cardiac MR
Although we saw about a 19% decline in quotes sent to TractManager for purchase consideration in 2019, we have seen a clear reflection of growing interest in the advance cardiac capabilities of MR. There is no clear delineation of 1.5T versus 3.0T systems, which seems to vary based on the vendor. Overall about 25% of new system quotes seen include advanced cardiac capabilities, with 14% of upgrades including advanced cardiac options.

The lack of radiation and ability to evaluate soft tissue and cardiac flow are key drivers behind the interest in cardiac MR. This solution begins to provide insight into cardiac function, blood flow, and motion. It offers the potential to begin to help formulate appropriate clinical responses for congestive heart failure (CHF) patients with decreased cardiac function. This is different from prior cardiac injury versus present cardiac risk based on yet-to-be-addressed disease (ischemia). Possible areas of interest are combined stress testing (physical or pharmaceutical) evaluation of ischemic impact on motion and heart function.

Tom Watson
It is likely cardiac MR workflow will heavily impact the concurrent evolution in AI. This may allow a workflow much more driven by large data analytics processing, reducing exam to conclusion time. It may also provide a more empiric, less judgment-based result. As the use of AI increases, it may provide a clearer path to the holy grail of healthcare, evidence-based medicine, driving proven clinical outcomes for patients.

About the author: Tom Watson, BS, RCVT, RDMS is senior clinical advisor/expert at TractManager. He has worked at MD Buyline for 30+ years. MD Buyline is now a part of the rebranded TractManager Inc.