Impact of Artificial

Intelligence on
Interventional Cardiology
From Decision-Making Aid to Advanced Interventional Procedure
Assistance
• Integrate and interpret complex biomedical data as well as advance
technological automation
AI in interventional cardiology (IC)

• Virtual
• informatics from ML/DL, NLP, and cognitive computing to control health
management systems (i.e., electronic health records and medical image
analysis software)
• Automated clinical decision support systems.

• Physical
• Eobotic interventional procedures
• Azzalini et al. (9) used generalized boosted regression (an ML
approach) to identify whether contrast media type was an inde-
pendent predictor of contrast-induced acute kidney injury after
percutaneous coronary intervention (PCI).
• supervised learning with models developed to successfully improve heart
failure readmission prediction and accurately grade echocardiographic
mitral regurgitation

• Al’Aref SJ, Anchouche K, Singh G, et al. Clinical applications of machine

learning in cardiovascular disease and its relevance to cardiac imaging.
Eur Heart J 2019;40:1975–86.
NLP
• Analysis of the electronic medical record (EMR) to detect adverse
events and post-operative complications from physi- cian
documentation, to achieve automated claims coding, and to improve
workflow
• Scan thousands of data sources (EMRs, image libraries, and so on) to
screen and identify patients with critical valvular or vascular stenosis,
hypertrophic cardiomyopathy, atrial septal defects, and so on.
Computer Vision
• Acquisition and interpretation of cardiac images, including computer-
aided diagnosis and image-guided procedures/ surgery.

• A real-time analysis of laparoscopic videos yielded 92.8% accuracy in

automated identification of the steps of sleeve gastrectomy and also
successfully identified missing or unexpected steps
• AI can be leveraged to process large amounts of interventional data to
identify or predict real-time adverse events and assist intraprocedural
clinical decision making.
VIRTUAL APPLICATION OF AI IN IC

• Image Interpretation
• detecting lesion characteristics, including diameter stenosis, calcification,
thrombus, and dissection,
• detecting lesion characteristics, including diameter stenosis, calcification,
thrombus, and dissection,
• Emory University has developed an ML method for segmenting intravascular
ultrasound images and automatically calculating lumen area and plaque burden
that showed excellent agreement with an expert analyst – online use in cath lab

Molony D, Hosseini H, Samady H. Deep IVUS: a machine learning framework for fully automatic IVUS segmentation. Paper presented at:
Trans- catheter Cardiovascular Therapeutics Symposium (TCT) 18; September 21–25, 2018; San Diego, CA.
• TrueFusion, a cardiovascular application that integrates advanced
ultrasound and angiographic imaging for improved navigation and
guidance during structural heart disease interventions – Siemens
• Co- registration of angiographic images and echo images into the
workflow via ML-based probe detection and automated registration
updates, enabling clinical teams to identify soft tissue–based
structures that are provided directly from the integrated ultrasound
system.
• TrueFusion can enable echocardiographers and interventionalists to
better communicate and achieve more intuitive anatomical
orientation during challenging procedures.
• Eesults in reduced contrast usage, procedure time, and radiation
exposure
 CLINICAL DECISION SUPPORT
• CEREBRIA-1 (Machine Learning vs Expert Human Opinion to
Determine Physiologically Optimized Coronary Revascularization
Strategies)
• Evaluated whether an ML algorithm based on computational interpretation of
pressure-wire pull back data would be similar to expert human interpretation
for treat- ment strategies in patients with stable coronary ar- tery disease
VIRTUAL REALITY, AUGMENTED REALITY
AND AI
• VR platforms are currently being used in periprocedural planning of structural
heart interventions, as well as pre-procedure patient experiences to decrease
to anxiety and stress
• The FDA-approved True 3D system developed by EchoPixel (Santa Clara, Califor-
nia) renders patient-specific anatomy in an intuitive, interactive VR format
• AR cardiac hologram technology that allows real-time viewing, measurement
and manipulation of patient anatomy in a holographic display for procedural
guidance
• AR systems can be used to overlay important infor- mation required during
procedures that is typically displayed on multiple monitors stacked around the
interventionist.
Future Catheterization Laboratory With Artificial Intelligence-
Enabled Technologies
 VOICE-POWERED VIRTUAL
ASSISTANTS.
• Apple’s Siri, Amazon’s Alexa, and Google’s Assistant, employ AI speech
recognition that has now improved to the point of exceeding human
accuracy in transcribing conversation.

• A voice-powered virtual assis- tant system in the catheterization

laboratory could help operators control equipment, navigate the EMR
system or access image libraries more effectively in a hands-free
fashion.
 “BIG DATA” RESEARCH AND
PREDICTIVE ANALYSIS
• Exploration of novel factors in score systems and better prediction analysis, or add hidden risk
factors to existing models
• This could lead to new models for antiplatelet/anticoagulant therapy, bleeding versus stroke risk,
mortality risk with procedures, and so on
• ML-based techniques also can highlight long-term outcomes or late complica- tions for patients who
have undergone a specific procedure or are prescribed a specific drug

Krittanawong C, Zhang H, Wang Z, Aydar M, Kitai T. Artificial intelligence in precision cardio- vascular medicine. J Am Coll Cardiol 2017;69:
2657–64.
• Previously, ML has been used in cardiology to predict 1-year mortality in heart
failure patients and 5-year mortality from coronary angiography datasets in pa-
tients with suspected coronary artery disease

Henglin M, Stein G, Hushcha PV, Snoek J, Wiltschko AB, Cheng S. Machine learning
approaches in cardiovascular imaging. Circ Car- diovasc Imaging 2017;10:e005614.

Johnson KW, Torres Soto J, Glicksberg BS, et al. Artificial intelligence in cardiology. J
Am Coll Cardiol 2018;71:2668–79.
• A study by Ganim et al. assessed racial disparities in procedural complications after
transcatheter aortic valve replacement using ML-driven, backward propagation neural
networks.

• Topological data analysis within an ML framework can be helpful in large volume

multidimensional data interpreta- tion, such as describing new phenotypes of diseases or
combining imaging, clinical, and other nonstruc- tured data.

Ganim N, Monlezun D, Balan P. Racial disparities in procedural complications after trans- catheter aortic valve replacement (TAVR): a retrospective single-center case-control study. Paper
presented at: Transcatheter Cardiovascular Therapeutics Symposium (TCT) 18; September 21–25, 2018; San Diego, CA.
 INTEGRATION OF AI-BASED DECISION-MAKING
ACROSS ALL PHASES OF PATIENT CARE

• Future - AI analysis of population- and patient-specific data augmenting each phase of care

• In a pilot study, ML algorithms showed 94% accuracy for predicting a myocardial infarction in patients presenting
with chest pain in the emergency department.

• Automated analysis of all pre-operative mobile and clinical data will provide patient-specific risk scores for
procedural planning and yield valuable predictors to inform post-procedural care.
• Algorithms may be applied to patients with cardiogenic shock in order to deter- mine who might benefit from
mechanical circulatory support.
• DL prediction models will predict the periprocedural risk of death, bleeding, contrast nephropathy, and stroke

Lindholm D, Holzmann M. Machine learning for improved detection of myocardial infarction in patients presenting with chest pain in the emer- gency department (abstr). J Am Coll
Cardiol 2018; 71 Suppl:A225.
 Clinical decision making in catherization laboratory

• Predictive analytics with the use of cognitive computing may support clinical
decision-making and help prioritize tasks in the catheterization laboratory.
Intraprocedural monitoring of various data may lead to the real- time prediction
and avoidance of adverse events.

• Integration of pre-, intra-, and post-procedural data could help to monitor recovery,
predict com- plications, and recommend the optimal duration of medical therapy.

• After discharge, post- operative data from personal devices could continue to be
integrated with data from the hospitalization to optimize patient recovery and
decrease readmission rates.
 After discharge / follow - up
• AI-enabled applications and apps may encourage and incentivize
healthier behaviour in individuals and may help with the preventive
strategies of a healthy lifestyle and medication adherence.
 PHYSICAL APPLICATION OF AI -
ROBOTICS
• AI, through procedural automation, has the potential to increase the
value of robotics in the catheterization lab by reducing the variability
of procedure time and improving overall patient care
• Although truly autonomous robotic vascular procedures will remain
out of reach for some time, synergy across fields will likely accelerate
the capabilities of AI in augmenting interventional care.
 Corindus Vascular Robotics
• First automated robotic movement designed for the CorPath GRX
platform.

• The proprietary software feature, named “Rotate on Retract,” is an

automated robotic movement that allows the oper- ator to quickly
navigate to a targeted lesion by automatically rotating the guidewire
upon joystick retraction
• Preclinical data demonstrated a significant reduction in wiring time
among a highly experienced group of physicians when comparing
robotic wiring versus robotic wiring with Rotate on Retract enabled.
• Future generations of vascular robotic platforms will be more aware of the procedures being
performed and use that knowledge to provide intelligent assistance to interventional
cardiologists.

• Companies such as Verb Surgical, a collaboration between Google and Ethicon Endo-Surgery,
have indicated that their surgical robots will include ML and awareness, which will aim to
identify potential issues during a procedure.

• Link the robot to a cloud supercomputer service akin to IBM’s Watson, so that information on
thousands of similar procedures will be accessible to both the surgeon and the robot to
improve performance.

Two Industry Leaders Make for One Extraordinary Verb. Verb Surgical website. Available at:
http://www.verbsurgical.com/about/. Accessed October 19, 2018.
 Microbots
• Development of microbots that can travel through blood vessels to
deliver medications to a specific target. Future applications of such
microbots include the potential to repair damaged cells or perform
microprocedures, which might include a variety of vascular
interventions.

• Outside the catheterization lab, robots can help in post-procedural

rehabilitation, and can be useful in other areas of health care such as
pharmabotics, disinfectant robots, supply chain robots, and personal
assistance
 AI-based technologies in other areas of health care

• Virtual nurses, digital consultation, medication management by

patients, drug creation, health monitoring with wearable health
trackers and health care system analysis.
Applications of AI in IC