Straight out of science fiction: The future of heart disease care is here

It sounds a little like “Fantastic Voyage.” Instead of a submarine and crew inside the body, a camera inserted into a patient’s chest cavity shows a three-dimensional image, giving the surgeon a crisp view and guiding the repair of a heart valve.

“It’s really remarkable,” said Dr. Peter A. Knight, chief of the Division of Cardiac Surgery at the University of Rochester Medical Center.

The 3D endoscopic camera, which can be inserted through a small incision, was developed about six years ago and has made minimally invasive surgery more accessible for Rochester-area patients as increasing numbers of surgical residents and attending surgeons are trained in the procedure.

“You can see better, and because you see better, it’s easier for people to adopt the techniques,” he said.

A camera providing a 3D view is among advances in the prevention and treatment of heart disease. Wearables that can be purchased by consumers or provided by their doctors, technologies available to cardiologists and the growing field of AI are part of the arsenal against the conditions known as heart disease.

Heart disease remains the leading cause of death for men, women, and people of most racial and ethnic groups, according to data from 2018-2022 from the Centers for Disease Control and Prevention. In Monroe County, heart disease was the second-leading cause of death in 2020, behind cancer, according to the most-recent available data from the state Department of Health.

Coronary artery disease is the most common, affecting about 5% of people 20 and older, according to the CDC. Arrhythmias such as atrial fibrillation, valve disease, heart attacks and heart failure are other forms.

Heart attack may be most associated with surgery, but problems with valves or aortic aneurysm also require surgery.

Knight said aortic and mitral valve surgeries at URMC that don’t involve bypass are done through incisions measuring about 2 inches. The cut is made between ribs, and guided by a CT scan. “Obviously, if you’ve got a small incision, you have to put it in exactly the right spot.”

Knight said URMC surgeons can do double valve operations with a minimally invasive procedure. He said new instruments, such as a mechanical fastener that replaces knots, also have advanced the procedure.

Knight described himself as an early adopter of minimally invasive cardiac surgery and said URMC may be further along than other systems. “You don’t really know what’s capable unless you open up your mind to the potential.”

While there are advances in surgery, the first-line defense against heart disease continues to be lifestyle – controlling blood pressure and cholesterol, being physically active and eating healthy foods.

Over the past few years, individuals have been using smartwatches and apps to monitor risk factors such as heart rhythm and blood pressure. Sharing feedback from the devices with physicians has been common, but now doctors are starting to supply the apparatus.

URMC is in the preliminary stages of a wearables project where participating patients are sent home with a blood pressure cuff that links to an app. “We can monitor their blood pressures two or three times a week in their home setting, which is more accurate than the office setting,” said Dr. Neil Gupta, a cardiologist with URMC. “We can look at those values and we can make medication changes very quickly and get them to their blood pressure goal much more quickly.”

The devices are useful for people who have difficulty traveling to appointments, Gupta said. Instead of having people miss appointments and fall behind on their monitoring, the app and telehealth can keep them on track to reach their blood pressure goals.

Gupta said the project hopefully also will provide smartwatches so participants can track averages for their heart rate, oxygen levels and activity. Cardiologists can monitor trends and potentially identify risk factors.

“Sleep apnea is very prevalent in our community,” he said. “If they wear these watches to bed and they’re having some nocturnal dipping in their oxygen saturations,  that might clue us into, maybe they do have sleep apnea, maybe that’s something we should test for. We know that treating that long term helps prevent against strokes, heart attacks, high blood pressure, and atrial fibrillation.”

Dr. Gaurav Sharma, a cardiologist at Rochester Regional Health, said one tool being used more often to assess risk is a calcium score. The non-invasive test can measure the amount of calcium in heart arteries. Calcium represents cholesterol plague that has been in the arteries for many years.

The test is used on people who haven’t presented symptoms but can be part of a routine screening exam. “It’s a quick scan that takes me not even a minute.”

If there is blockage, the test doesn’t show the extent. “This helps to identify the people that are at highest risk. You can cater the treatment according to that.”

Sharma said the health system also is working on ways to use the information in a patient’s electronic medical record to assess risk of heart disease

. He said computer-based prompts are being used for management of congestive heart failure and he is trying to implement prompts for cholesterol management.

As AI makes headlines in other fields, it has inroads into cardiology. Sharma said AI-assisted EKG interpretation has become common, and now AI-assisted plaque analysis is reimbursed by insurance for certain tests.

Sharma said one of the speakers at a national cardiology conference last December presented research on using machine learning and AI to create a diagnostic algorithm that could tell more about heart function. Sharma isn’t affiliated with the work, and while he said it hasn’t been cleared for use, “The horizons are there to go in that direction.”

Data is being used in other predictive tools, said Dr. Uzma Iqbal, a clinical cardiologist with Rochester Regional Health.

One of these is a cardiovascular disease risk score. The patient’s blood pressure, cholesterol, age and race are factored into a calculator that gives the likelihood of a heart attack in 10 years.

“There’s tools that now we have, and I think that they’re only going to get better as data is being looked at with AI.”

Iqbal said AI needs to be trained with women-specific data because while the effects of heart disease don’t discriminate based on gender, the condition can present differently in women. Researchers are looking at the role of pregnancy complications, menopause before age 45 and auto-immune diseases in the development of heart disease, said Iqbal, medical director of the Center for Women’s Heart Health.

It’s been only in the last generation that efforts have been to include women in National Institutes of Health research. Among the unknowns is any differences in treatment response between women and men.

“We used to think that the same treatments that we were doing for men work in women,” she said. “Sex-specific research needs to be done to answer those questions.”

Patti Singer is a freelance writer in Rochester. Contact her at [email protected]