Role of artificial intelligence in cardiology

Artificial intelligence(AI)is the process of having a computational program that can perform tasks of human intelligence by mimicking human thought processes.AI is a rapidly evolving transdisciplinary field which integrates many elements to develop algorithms that aim to simulate human intuition,decision-making,and object recognition.The overarching aims of AI in cardiovascular medicine are threefold:To optimize patient care,improve efficiency,and improve clinical outcomes.In cardiology,there has been a growth in the potential sources of new patient data,as well as advances in investigations and therapies,which position the field well to uniquely benefit from AI.In this editorial,we highlight some of the main research priorities currently and where the next steps are heading us.

Value of cardiac magnetic resonance on the risk stratification of cardiomyopathies

Cardiomyopathies represent a diverse group of heart muscle diseases with varying etiologies,presenting a diagnostic challenge due to their heterogeneous manifestations.Regular evaluation using cardiac imaging techniques is impera-tive as symptoms can evolve over time.These imaging approaches are pivotal for accurate diagnosis,treatment planning,and optimizing prognostic outcomes.Among these,cardiovascular magnetic resonance(CMR)stands out for its ability to provide precise anatomical and functional assessments.This manuscript ex-plores the significant contributions of CMR in the diagnosis and management of patients with cardiomyopathies,with special attention to risk stratification.CMR’s high spatial resolution and tissue characterization capabilities enable early detec-tion and differentiation of various cardiomyopathy subtypes.Additionally,it offers valuable insights into myocardial fibrosis,tissue viability,and left ven-tricular function,crucial parameters for risk stratification and predicting adverse cardiac events.By integrating CMR into clinical practice,clinicians can tailor patient-specific treatment plans,implement timely interventions,and optimize long-term prognosis.The non-invasive nature of CMR reduces the need for invasive procedures,minimizing patient discomfort.This review highlights the vital role of CMR in monitoring disease progression,guiding treatment decisions,and identifying potential complications in patients with cardiomyopathies.The utilization of CMR has significantly advanced our understanding and management of these complex cardiac conditions,leading to improved patient outcomes and a more personalized approach to care.

Current role and future perspectives of artificial intelligence in echocardiography

Echocardiography is an essential tool in diagnostic cardiology and is fundamental to clinical care.Artificial intelligence(AI)can help health care providers serving as a valuable diagnostic tool for physicians in the field of echocardiography specially on the automation of measurements and interpretation of results.In addition,it can help expand the capabilities of research and discover alternative pathways in medical management specially on prognostication.In this review article,we describe the current role and future perspectives of AI in echocardiography.

Subclinical carotid atherosclerosis predicts all-cause mortality and cardiovascular events in obese patients with negative exercise echocardiography

BACKGROUND Obesity is a major health problem due to its high prevalence. The relationship between obesity and cardiovascular disease is unclear. Some studies agree that certain conditions associated with obesity, such as physical inactivity or cardiovascular risk factors, are responsible for cardiovascular risk excess among obese people. Carotid intima-media thickness and carotid plaques(CP) have been associated with cardiovascular adverse events in healthy populations, and recent data suggest a higher prevalence of subclinical carotid atherosclerosis in obese and metabolically unhealthy patients. However, there are no studies correlating subclinical atherosclerosis and adverse events(AE) in obese subjects.AIM To determine the association between carotid disease and AE in obese patients with negative exercise echocardiography(EE).METHODS From January 1, 2006 to December 31, 2010, 2000 consecutive patients with a suspicion of coronary artery disease were submitted for EE and carotid ultrasonography. Exclusion criteria included previous vascular disease, left ventricular ejection fraction < 50%, positive EE, significant valvular heart disease and inferior to submaximal EE. An AE was defined as all-cause mortality,myocardial infarction and cerebrovascular accident. Subclinical atherosclerosis was defined as CP presence according to Manheim and the American Society of Echocardiography Consensus.RESULTS Of the 652 patients who fulfilled the inclusion criteria, 226(34.7%) had body mass indexes ≥ 30 kg/m2, and 76 of them(33.6%) had CP. During a mean follow-up time of 8.2(2.1) years, 27 AE were found(11.9%). Mean event-free survival at 1, 5 and 10 years was 99.1%(0.6), 95.1%(1.4) and 86.5%(2.7), respectively. In univariate analysis, CP predicted AE [hazard ratio(HR) 2.52, 95% confidence interval(CI) 1.17-5.46; P = 0.019]. In multivariable analysis, the presence of CP remained a predictor of AE(HR 2.26, 95%CI 1.04-4.95, P = 0.041). Other predictors identified were glomerular filtration rate(HR 0.98, 95%CI 0.96-0.99; P= 0.023), peak metabolic equivalents(HR 0.83, 95%CI 0.70–0.99, P = 0.034) and moderate mitral regurgitation(HR 5.02, 95%CI 1.42–17.75, P = 0.012).CONCLUSION Subclinical atherosclerosis defined by CP predicts AE in obese patients with negative EE. These patients could benefit from aggressive prevention measures.

Myocardial infarction with non-obstructive coronary arteries: A comprehensive review and future research directions

Acute coronary syndromes constitute a variety of myocardial injury presentations that include a subset of patients presenting with myocardial infarction with non-obstructive coronary arteries(MINOCA).This acute coronary syndrome differs from type 1 myocardial infarction(MI)regarding patient characteristics,presentation,physiopathology,management,treatment,and prognosis.Two-thirds of MINOCA subjects present ST-segment elevation;MINOCA patients are younger,are more often female and tend to have fewer cardiovascular risk factors.Moreover,MINOCA is a working diagnosis,and defining the aetiologic mechanism is relevant because it affects patient care and prognosis.In the absence of relevant coronary artery disease,myocardial ischaemia might be triggered by an acute event in epicardial coronary arteries,coronary microcirculation,or both.Epicardial causes of MINOCA include coronary plaque disruption,coronary dissection,and coronary spasm.Microvascular MINOCA mechanisms involve microvascular coronary spasm,takotsubo syndrome(TTS),myocarditis,and coronary thromboembolism.Coronary angiography with non-significant coronary stenosis and left ventriculography are first-line tests in the differential study of MINOCA patients.The diagnostic arsenal includes invasive and non-invasive techniques.Medical history and echocardiography can help indicate vasospasm or thrombosis,if one finite coronary territory is affected,or specify TTS if apical ballooning is present.Intravascular ultrasound,optical coherence tomography,and provocative testing are encouraged.Cardiac magnetic resonance is a cornerstone in myocarditis diagnosis.MINOCA is not a benign diagnosis,and its polymorphic forms differ in prognosis.MINOCA care varies across centres,and future multi-centre clinical trials with standardized criteria may have a positive impact on defining optimal cardiovascular care for MINOCA patients.

Cardiovascular disease and COVID-19,a deadly combination:A review about direct and indirect impact of a pandemic

Coronavirus disease 2019(COVID-19) is known to present with respiratory symptoms,which can lead to severe pneumonia and respiratory failure.However,it can have multisystem complications such as cardiovascular manifestations.The cardiovascular manifestations reported comprise myocarditis,cardiogenic shock,arrhythmias,pulmonary embolism,deep vein embolism,acute heart failure,and myocardial infarction.There is also an indirect impact of the pandemic on the management of cardiovascular care that has been shown clearly in multiple publications.In this review,we summarize the deadly relation of COVID-19 with cardiovascular events and the wider impact on several cardiovascular care areas by the pandemic situation。

Diagnostic and prognostic value of cardiac imaging in amyloidosis

Amyloidosis is an infiltrative disease caused by extracellular protein deposition that has accumulated a lot of scientific production in recent years.Different types of amyloidosis can affect the heart.Transthyretin amyloidosis and light chain amyloidosis are the two most common types of cardiac amyloidosis.These entities have a poor prognosis,so accurate diagnostic techniques are imperative for determining an early therapeutic approach.Recent advances in cardiac imaging and diagnostic strategies show that these tools are safe and can avoid the use of invasive diagnostic techniques to histological confirmation,such as endomyocardial biopsy.We performed a review on the diagnostic and prognostic implications of different cardiac imaging techniques in cardiac amyloidosis.We mainly focus on reviewing echocardiography,cardiac magnetic resonance,computed tomography and nuclear imaging techniques and the different safety measurements that can be done with each of them.

ISCHEMIA trial:How to apply the results to clinical practice

During the last years two questions have been continuously asked in chronic coronary syndromes:(1)Do revascularization procedures(coronary artery bypass grafting or percutaneous coronary intervention)really improve symptoms of angina?and(2)Do these techniques improve outcomes,i.e.do they prevent new myocardial infarction events and cardiovascular death?Therefore,there was a need for a large definitive trial.This study was the ISCHEMIA trial,a large,multicentric trial sponsored by the National Heart,Lung,and Blood Institute.The main trial compared coronary revascularization and optimal medical treatment(OMT)vs OMT alone in 5179 patients enrolled after a stress test.During a median 3.2-year follow-up,318 primary outcome events occurred;the adjusted hazard ratio for the invasive strategy as compared with the conservative strategy was 0.93(95%confidence interval 0.80-1.08,P=0.34).The ISCHEMIA trial deeply disrupted many of our prior attitudes regarding management strategies for patients with stable coronary artery disease.The findings underscore the benefits of disease-modifying OMT for stable coronary artery disease patients.The main purposes of ischemia assessment before this trial were:Diagnostic purposes,assessment of outcome,and adding to decision-making processes.Obviously,this changed after the trial results.The results of ISCHEMIA might challenge the current diagnostic approach for stable angina patients recommended in the last European Society of Cardiology guidelines on chronic coronary disease that were based on studies published before the ISCHEMIA trial.In this editorial we propose our approach based on the ISCHEMIA study and the pretest probability for a positive test in patients with chronic coronary syndromes.

Social media in cardiology:Reasons to learn how to use it

Social media has changed the way we learn,educate,and interact with our peers.The dynamic nature of social media and their immediate availability through our portable devices(smartphones,tablets,smartwatches,etc.)is quickly transforming the way we participate in society.The scope of these digital tools is broad as they deal with many different aspects:Teaching and learning,case discussion,congresses coverage,peer to peer interaction,research are examples worth mentioning.The scientific societies considered more innovative,are promoting these tools between their members.These new concepts need to be known by the cardiologists to stay updated,as countless information is moving rapidly through these channels.We summarize the main reasons why learning how to use these tools to be part of the conversation is essential for the cardiologist in training or fully stablished.