From AI Imaging to ‘Leave Nothing Behind’: How New Cardiology Tech Is Transforming Heart Care

Recent advancements in interventional cardiology have significantly transformed the way we approach coronary artery disease. Artificial intelligence is aiding doctors in interpreting advanced imaging tools, such as intravascular ultrasound (IVUS) and optical coherence tomography (OCT), which provide detailed views of the coronary arteries and enhance stent placement accuracy.

Intravascular lithotripsy (IVL) utilizes sound waves to delicately fragment calcium deposits within blocked arteries, facilitating safer artery expansion and stent insertion. Furthermore, drug-coated balloons now deliver medication to arteries without permanently leaving metal stents behind, a technique known as the 'leave nothing behind' approach, which is increasingly being used for selected patients.

Over the last five to ten years, a significant shift has occurred in heart procedures, favoring minimally invasive catheter-based techniques over traditional open-heart surgery. Transcatheter aortic valve implantation (TAVI) enables doctors to replace narrowed aortic valves using a catheter, typically inserted through an artery in the groin.

This procedure now caters to a wider range of patients, allowing many to be discharged within a day or two. Mitral valve repair has also evolved to be less invasive, with transcatheter edge-to-edge repair (TEER) allowing a catheter to be introduced through a vein in the groin to address leaking mitral valves without opening the chest.

Several risk factors for heart disease often go unrecognized in patients today. In addition to well-known factors like smoking, high blood pressure, diabetes, high LDL cholesterol, and obesity, lipoprotein(a) (Lp(a)), a largely inherited cholesterol-related risk, apoB (apolipoprotein B) to measure harmful cholesterol-carrying particles, sleep apnea, and chronic kidney disease can all contribute to increased heart risk.

South Asian ancestry is associated with a higher predisposition to premature heart disease, while chronic stress and poor sleep can negatively impact blood pressure, blood sugar levels, weight, and overall heart health.

Common misconceptions about heart disease among patients include the notion that one must feel unwell to have a healthy heart, when in reality, heart disease and high blood pressure can develop silently for years. Another misconception is that heart disease primarily affects older men, whereas women and younger adults can also develop the condition, often presenting with atypical symptoms.

Lastly, many believe that having normal LDL cholesterol levels means they have no risk, but this overlooks the importance of other factors such as Lp(a), apoB, blood pressure, diabetes, smoking, and family history, as well as the potential impact of chronic stress and poor sleep on heart health.