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Role of artificial intelligence and machine learning in interventional cardiology. Curr Probl Cardiol 2023; 48:101698. [PMID: 36921654 DOI: 10.1016/j.cpcardiol.2023.101698] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 03/08/2023] [Indexed: 03/16/2023]
Abstract
Directed by two decades of technological processes and remodeling, the dynamic quality of healthcare data combined with the progress of computational power has allowed for rapid progress in artificial intelligence (AI). In interventional cardiology, AI has shown potential in providing data interpretation and automated analysis from electrocardiogram (ECG), echocardiography, computed tomography angiography (CTA), magnetic resonance imaging (MRI), and electronic patient data. Clinical decision support has the potential to assist in improving patient safety and making prognostic and diagnostic conjectures in interventional cardiology procedures. Robot-assisted percutaneous coronary intervention (R-PCI), along with functional and quantitative assessment of coronary artery ischemia and plaque burden on intravascular ultrasound (IVUS), are the major applications of AI. Machine learning (ML) algorithms are used in these applications, and they have the potential to bring a paradigm shift in intervention. Recently, an efficient branch of ML has emerged as a deep learning algorithm for numerous cardiovascular (CV) applications. However, the impact DL on the future of cardiology practice is not clear. Predictive models based on DL have several limitations including low generalizability and decision processing in cardiac anatomy.
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Hofmann FJ, Dörr O, Blachutzik F, Boeder NF, Elsässer A, Möllmann H, Nef HM. First case report of fully robotically assisted lithotripsy in heavily calcified left main stenosis. Eur Heart J Case Rep 2022; 7:ytac427. [PMID: 36694869 PMCID: PMC9856338 DOI: 10.1093/ehjcr/ytac427] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 05/17/2022] [Accepted: 10/26/2022] [Indexed: 11/12/2022]
Abstract
Background Percutaneous coronary intervention (PCI) is the standard-of-care treatment for left main stenosis as an alternative to bypass surgery. In addition, severe coronary lesion calcification can be modified by intravascular lithotripsy (IVL). However, with PCI and debulking treatment options, there are inherent limitations. PCI poses an increased health burden for the treating physician that is associated with wearing a heavy, lead-lined apron and being exposed to radiation. To overcome these issues, a robotically assisted angioplasty system (rPCI) was established that enables the operator to perform PCI remotely in routine clinical procedures. Furthermore, IVL have not been used remotely. Case summary Here, we report the use of this technique for treating a heavily calcified left main stenosis in an 82-year-old male with previously diagnosed two-vessel coronary artery disease, progressive symptoms of dyspnoea at high cardio-vascular risk profile. The decision of the local heart team declined surgery. To the best of our knowledge, this is the first report of successful rPCI combined with IVL. Discussion In the case presented, rPCI was feasible and safe even in a complex lesion of the left main coronary artery requiring IVL. rPCI is a revolutionary new technique that may be applied to various types of coronary artery lesions.
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Affiliation(s)
- Felix J Hofmann
- Department of Cardiology and Angiology, University Hospital of Giessen and Marburg, Klinikstraße 33, 35392 Giessen, Germany
| | - Oliver Dörr
- Department of Cardiology and Angiology, University Hospital of Giessen and Marburg, Klinikstraße 33, 35392 Giessen, Germany
| | - Florian Blachutzik
- Department of Cardiology and Angiology, University Hospital of Giessen and Marburg, Klinikstraße 33, 35392 Giessen, Germany
| | - Niklas F Boeder
- Department of Cardiology and Angiology, University Hospital of Giessen and Marburg, Klinikstraße 33, 35392 Giessen, Germany
| | - Albrecht Elsässer
- Department of Cardiology, Klinikum Oldenburg, Rahel-Straus-Straße 10 26133 Oldenburg, Germany
| | - Helge Möllmann
- Department of Internal Medicine, St. Johannes-Hospital, Johannesstraße 9-13, 44137 Dortmund, Germany
| | - Holger M Nef
- Corresponding author. Tel: +49 641 985 42212, Fax: + 49 641 985 42219,
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Gutierrez-Barrios A, Cañadas-Pruaño D, Noval-Morillas I, Gheorghe L, Zayas-Rueda R, Calle-Perez G. Radiation protection for the interventional cardiologist: Practical approach and innovations. World J Cardiol 2022; 14:1-12. [PMID: 35126868 PMCID: PMC8788173 DOI: 10.4330/wjc.v14.i1.1] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 09/06/2021] [Accepted: 12/23/2021] [Indexed: 02/06/2023] Open
Abstract
Use of ionizing radiation during cardiac catheterization interventions adversely impacts both the patients and medical staff. In recent years, radiation dose in cardiac catheterization interventions has become a topic of increasing interest in interventional cardiology and there is a strong interest in reducing radiation exposure during the procedures. This review presents the current status of radiation protection in the cardiac catheterization laboratory and summarizes a practical approach for radiation dose management for minimizing radiation exposure. This review also presents recent innovations that have clinical potential for reducing radiation during cardiac interventions.
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Affiliation(s)
| | | | | | - Livia Gheorghe
- Department of Cardiology, Hospital Puerta del Mar, Cadiz 11009, Spain
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Zhang P. A Novel Robotic Control System Mimics Doctor’s Operation to Assist Percutaneous Coronary Intervention. CARDIOVASCULAR INNOVATIONS AND APPLICATIONS 2022. [DOI: 10.15212/cvia.2022.0003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Objectives: The use of current robotic systems to assist in percutaneous coronary intervention (PCI) fundamentallydiffers from performing conventional PCI. To overcome this problem, we developed a novel master-slave roboticcontrol system to assist in PCI, and evaluated its safety and feasibility in the delivery and manipulation of coronaryguidewires in vitro and in vivo.Methods: The novel robotic assist PCI system is composed of three parts: 1) a master actuator, which imitates thetraditional torque used by surgeons in conventional PCI, 2) a slave actuator, including a guidewire delivery system andforce monitoring equipment, and 3) a local area network based communication system.Results: The experiment was performed in six pigs. Both robotic and manual control completed the operation with no device- or procedure-associated complications. An experienced interventional cardiologist who was a first-time userof the novel robotic PCI system was able to advance the guidewire into a distal branch of a coronary artery within asimilar time to that required with the manual procedure.Conclusion: This early in vivo experiment with the novel robotic assisted PCI control system demonstrated that its feasibility, safety, and procedural effectiveness are comparable to those of manual operation. The novel robotic-assisted PCI control system required significantly less time to learn than other currently available systems.
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Périer DM, Seret DG, Morelle DJF, Amabile DN, Duheil DG, Monségu PJ, Durel DN, Tixier DV, Honton DB, Py DA, Barone-Rochette PG, Chanseaume DS, Rias DS, Adjedj DJ, Shararah DA, Motreff PP, Rangé DG, Benamer DH. [X-Ray, false friend of the interventional cardiologist - Risks, evaluation, quality improvement - Status report from France-PCI registry]. Ann Cardiol Angeiol (Paris) 2021; 70:416-424. [PMID: 34732280 DOI: 10.1016/j.ancard.2021.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 10/02/2021] [Indexed: 11/25/2022]
Abstract
Although indispensable, radiation exposure during cardiac catheterization procedures can cause specific radiation-induced diseases. These affect the patient but also the interventional cardiologist. Exposure to high or repeated radiation doses causes deterministic effects. Moreover, even low-dose exposure, especially when repeated, produces a risk of stochastic effets. In that respect, it is crucial to improve the radiation safety of cardiac angiography and interventions, to promote radiation protection and to maintain this exposure « As Low As Reasonably Achievable ». Thus, there is a necessity to spread knowledge about safety standards and recommandations to reduces the dose among interventionalists. Data collection and comparaison of practices are precious to this quality improvement process. For the year 2020, France-PCI registry had collected dosimetric datas related to 55 783 coronary angiographic and interventional procedures from 30 centers in France. Mean fluoroscopy time was 4,4 minutes for diagnostic procedures. Mean PDS was 1 767cGy.Cm2 and mean Air Kerma de 257Gy. Coronary percutaneous angioplasty procedures were related to approximately two to three times higher mean exposures. Mean exposure related to chronic coronary total occlusion treatment procedures was also two times higher than exposure related to non-CTO interventions. These data also highlighted wide disparities between centers.
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Affiliation(s)
- Dr Matthieu Périer
- Service de cardiologie, Hôpital Foch, 40, rue Worth, 92150 Suresnes, France.
| | - Dr Gabriel Seret
- Service de cardiologie, Hôpital Foch, 40, rue Worth, 92150 Suresnes, France
| | | | - Dr Nicolas Amabile
- Service de cardiologie, Institut Mutualiste Montsouris, 75014 Paris, France
| | - Dr Gérard Duheil
- Service de cardiologie, Clinique Bergouignan, 27000 Evreux, France
| | - Pr Jacques Monségu
- Service de cardiologie, Groupe Hospitalier Mutualiste de Grenoble, 38000 Grenoble, France
| | - Dr Nicolas Durel
- Service de cardiologie, Pôle santé République, 63050 Clermont Ferrand, France
| | - Dr Vincent Tixier
- Service de cardiologie, Centre Hospitalier Jacques-Lacarin, 03200 Vichy, France
| | | | - Dr Antoine Py
- Service de cardiologie, Clinique de l'Europe, 80090 Amiens, France
| | | | | | - Dr Stéphane Rias
- Service de cardiologie, Centre Hospitalier Métropôle Savoie, 73011 Chambéry, France
| | - Dr Julien Adjedj
- Service de cardiologie, Institut Arnault Tzanck, 06007 Saint-Laurent-du-Var, France
| | - Dr Ali Shararah
- Service de cardiologie, Clinique Saint Joseph, 49800 Trélazé, France
| | - Pr Pascal Motreff
- Service de cardiologie, Centre hospitalo-universitaire Gabriel-Montpied, 58, rue Montalembert, 63000 Clermont-Ferrand, France
| | - Dr Grégoire Rangé
- Service de cardiologie, Hôpitaux de Chartres, 4, rue Claude-Bernard 28630 Le Coudray, France
| | - Dr Hakim Benamer
- Service de cardiologie, Hôpital Foch, 40, rue Worth, 92150 Suresnes, France; Institut Jacques Cartier, Institut cardiovasculaire Paris Sud (ICPS) Ramsay Générale de santé, 6, avenue du Noyer-Lambert, 91300 Massy, France; Membre du Collège de Médecine des Hôpitaux de Paris, France
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Beyar R, Davies J, Cook C, Dudek D, Cummins P, Bruining N. Robotics, imaging, and artificial intelligence in the catheterisation laboratory. EUROINTERVENTION 2021; 17:537-549. [PMID: 34554096 PMCID: PMC9724959 DOI: 10.4244/eij-d-21-00145] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The catheterisation laboratory today combines diagnosis and therapeutics, through various imaging modalities and a prolific list of interventional tools, led by balloons and stents. In this review, we focus primarily on advances in image-based coronary interventions. The X-ray images that are the primary modality for diagnosis and interventions are combined with novel tools for visualisation and display, including multi-imaging co-registration modalities with three- and four-dimensional presentations. Interpretation of the physiologic significance of coronary stenosis based on prior angiographic images is being explored and implemented. Major efforts to reduce X-ray exposure to the staff and the patients, using computer-based algorithms for image processing, and novel methods to limit the radiation spread are being explored. The use of artificial intelligence (AI) and machine learning for better patient care requires attention to universal methods for sharing and combining large data sets and for allowing interpretation and analysis of large cohorts of patients. Barriers to data sharing using integrated and universal protocols should be overcome to allow these methods to become widely applicable. Robotic catheterisation takes the physician away from the ionising radiation spot, enables coronary angioplasty and stenting without compromising safety, and may allow increased precision. Remote coronary procedures over the internet, that have been explored in virtual and animal studies and already applied to patients in a small pilot study, open possibilities for sharing experience across the world without travelling. Application of those technologies to neurovascular, and particularly stroke interventions, may be very timely in view of the need for expert neuro-interventionalists located mostly in central areas.
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Affiliation(s)
- Rafael Beyar
- Technion–Israel Institute of Technology, The Ruth & Bruce Rappaport Faculty of Medicine, B 9602, Rambam Health Care Campus, Haifa 3109601, Israel
| | - Justin Davies
- Hammersmith Hospital, Imperial College NHS Trust, London, United Kingdom
| | | | - Dariusz Dudek
- Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland,Maria Cecilia Hospital, GVM Care & Research, Cotignola (RA), Italy
| | - Paul Cummins
- Department of Cardiology, Erasmus MC, Rotterdam, the Netherlands
| | - Nico Bruining
- Clinical Epidemiology and Innovation, Thoraxcenter, Department of Cardiology, Erasmus MC, Rotterdam, the Netherlands
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Big data and new information technology: what cardiologists need to know. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2021; 74:81-89. [PMID: 33008773 DOI: 10.1016/j.rec.2020.06.036] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 06/15/2020] [Indexed: 12/24/2022]
Abstract
Technological progress in medicine is constantly garnering pace, requiring that physicians constantly update their knowledge. The new wave of technologies breaking through into clinical practice includes the following: a) mHealth, which allows constant monitoring of biological parameters, anytime, anyplace, of hundreds of patients at the same time; b) artificial intelligence, which, powered by new deep learning techniques, are starting to beat human experts at their own game: diagnosis by imaging or electrocardiography; c) 3-dimensional printing, which may lead to patient-specific prostheses; d) systems medicine, which has arisen from big data, and which will open the way to personalized medicine by bringing together genetic, epigenetic, environmental, clinical and social data into complex integral mathematical models to design highly personalized therapies. This state-of-the-art review aims to summarize in a single document the most recent and most important technological trends that are being applied to cardiology, and to provide an overall view that will allow readers to discern at a glance the direction of cardiology in the next few years.
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Baladrón C, Gómez de Diego JJ, Amat-Santos IJ. Big data y nuevas tecnologías de la información: qué necesita saber el cardiólogo. Rev Esp Cardiol 2021. [DOI: 10.1016/j.recesp.2020.06.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Abstract
The pandemic of coronavirus disease 2019 (COVID-19) has become a public health emergency of international concern. During this time, the management of people with acute coronary syndromes (ACS) and COVID-19 has become a global issue, especially since preexisting cardiovascular disease is a risk factor for the presence and the severity of COVID-19. The number of people with ST- elevation myocardial infarction (STEMI) has decreased during the pandemic and delays in the time looking for medical care have been reported. In addition, the diagnosis of ACS may have been difficult due to possible underlying myocarditis or other clinical entities. Regarding management of people with STEMI, although the superiority of primary percutaneous coronary intervention (PCI) over thrombolysis is well established, the notable exposure risks due to absence of negative pressure in catheterization rooms and the increased difficulty in fine manipulation on guidewires under proper protection equipment may contribute to the relatively secondary role of PCI during the COVID-19 pandemic; thus, fibrinolytic therapy or robotic-assisted PCI in early presenting STEMI patients may have an alternative role during this period if prevention measures cannot be taken. Healthcare stuff should take the proper measures to avoid the spread of and their exposure to the virus.
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Qanadli SD. Research in Vascular Medicine: Where We Are and Where We Are Going. Front Cardiovasc Med 2020; 7:45. [PMID: 32266295 PMCID: PMC7105770 DOI: 10.3389/fcvm.2020.00045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 03/09/2020] [Indexed: 11/13/2022] Open
Affiliation(s)
- Salah D Qanadli
- Cardiothoracic and Vascular Division, Department of Diagnostic and Interventional Radiology, Lausanne University Hospital (CHUV), Lausanne, Switzerland
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Nagaraja V, Khatri JJ. Hybrid Robotic Impella-Assisted Single Arterial Access ComplexHigh-Risk Percutaneous Coronary Intervention. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2020; 21:105-107. [PMID: 31948848 DOI: 10.1016/j.carrev.2019.12.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 11/06/2019] [Accepted: 12/03/2019] [Indexed: 10/25/2022]
Abstract
Robotic-assisted percutaneous coronary intervention (PCI) has become popular among operators due to substantial reduction in radiation dose. Complex coronary intervention often requires mechanical support and have long fluoroscopy time. Robotic PCI offers an elegant solution by reducing operator fatigue and offering better analysis in the robotic console. We report a hybrid robotic impella assisted single arterial access complex high-risk PCI to the left anterior descending artery via the left internal mammary artery.
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Affiliation(s)
- Vinayak Nagaraja
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, OH, United States
| | - Jaikirshan J Khatri
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, OH, United States.
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