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	Highlights From the Literature

AI-Based Platform May Predict Rheumatic Heart Disease Development

A novel artificial intelligence (AI)-based machine-learning platform may effectively detect latent rheumatic heart disease on echocardiograms, according to a recent study published by Brown et al in the Journal of the American Heart Association. Researchers used the platform to analyze 511 echocardiograms in pediatric patients by focusing on color Doppler images of the mitral valves. To harmonize the echocardiograms to localize the left atrium during systole and disease detection, they utilized convolutional neural networks as well as mitral regurgitation jet analysis alongside deep-learning models with attention mechanisms, respectively. Following the analyses, the echocardiograms were further reviewed by cardiologists. The researchers found that 282 of the patients presented with rheumatic heart disease, whereas 229 of them had normal echocardiograms. The platform demonstrated an average accuracy of 0.99 for identifying the correct view, an average accuracy of 0.94 (apical) and 0.93 (parasternal long axis) for identifying the correct systolic frame, and an average Dice coefficient of 0.88 (apical) and 0.90 (parasternal long axis) for localizing the left atrium. The researchers reported that the platform's maximum mitral regurgitation jet measurements were comparable to the cardiologists' measurements. Additionally, after conducting a nine-feature mitral regurgitation analysis, the area under the receiver operating characteristics curve was 0.93, precision was 0.83, recall was 0.92, and the F1 score was 0.87 for the platform. The novel AI model achieved an area under the receiver operating characteristics curve of 0.84, precision of 0.78, recall of 0.98, and an F1 score of 0.87. The researchers hope to automate the diagnosis of patients with latent rheumatic heart disease and reduce disease mortality—especially in low- and middle-income countries where rheumatic heart disease is endemic, underdiagnosed, and undertreated. In March 2024, they plan to initiate a pilot program in Uganda to integrate the novel technology into rheumatic heart disease screening for pediatric patients. In a companion press release on the findings from Children's National Hospital, the study authors concluded: "Once this technology is built and distributed at a scale to address the need, we are optimistic that it holds great promise to bring highly accurate care to economically disadvantaged countries and help eradicate [rheumatic heart disease] around the world."

Representation of Women in Cardiology Fellowships Up; Black and Hispanic Trainees Still Face Underrepresentation

The proportion of women taking part in cardiovascular fellowships increased over the last decade, according to a recent study published by Snow et al in JAMA Cardiology. In a cross-sectional study, investigators examined the change in percentages of women and underrepresented racial and ethnic group trainees placed in cardiovascular disease and cardiology subspecialty fellowships between 2008 and 2022. The investigators used data from the Accreditation Council for Graduate Medical Education's publicly available online source to analyze the sex and race and ethnicity of all residents, internal medicine residents, general surgery residents, and fellows for each year. They found that the percentage of women trainees participating in cardiovascular disease fellowships increased from 17.6% in 2008 to 25.5% in 2022, and the percentage in interventional cardiology fellowships increased from 6.3% in 2008 to 20.1% in 2022. Comparatively, the proportion of women trainees in general surgery fellowships increased from 27.4% to 45.2%, and the proportion in internal medicine fellowships was 43.8% in 2022—demonstrating greater representation in fellowships across medical specialties. The percentage of Black or Hispanic trainees in cardiovascular disease fellowships increased from 8.3% in 2012 to 13.8% in 2022, and the percentage in interventional cardiology fellowships increased from 3.8% in 2012 to 13.4% in 2022. The investigators noted that the proportion of Black or Hispanic trainees in internal medicine fellowships increased from 8.6% in 2012 to 15.6% in 2022, and the proportion in general surgery fellowships increased from 9.7% to 16.1%—which was deemed to be not statistically significant. The investigators suggested that recent initiatives to promote a diverse cardiology workforce may have contributed positively to the representation of women in the field as well as to the increase of representation among Black and Hispanic trainees. However, they emphasized that the percentages of minority racial and ethnic groups remained low across all residencies, and that more work may be needed to boost diversity in cardiovascular fellowships.

AHA Scientific Statement: New Emergency Cardiovascular 2030 Impact Goals

In a new Scientific Statement published by Merchant et al in Circulation, the American Heart Association (AHA) detailed its new emergency cardiovascular care 2030 Impact Goals to improve cardiac arrest outcomes by 2030. In the new statement, the AHA identified cardiovascular care priorities, focusing on bystander cardiopulmonary resuscitation, early defibrillation, and neurologically intact survival. The organization also outlined aspirational goals such as establishing cardiac arrest as a reportable disease, mandating the reporting of standardized outcomes from different sources, expanding data sets and the ability to track all outcomes, enhancing the recognition and knowledge of cardiac arrest, improving dispatch system response and access to comprehensive resuscitation training, and increasing defibrillator accessibility and affordability. The AHA plans to collaborate with local, state, and national organizations to better collect data on cardiac arrest outcomes.

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	In the News

Majority of U.S. Adults May Not Fully Recognize Impact of Cardiovascular Disease

According to a press release from the AHA, a concerning proportion of adults may be unaware that cardiovascular disease is currently the leading cause of death in the United States. In a recent Harris Poll survey, researchers asked respondents to answer questions related to cardiovascular disease. Fifty-one percent of the respondents didn't know that cardiovascular disease was the leading cause of death in the United States, 16% didn't know the leading cause of death, and 18% stated that cancer was the leading cause of death. The researchers stressed that the significant knowledge gap demonstrated in the survey poses a threat to the estimated 48.6% of U.S. individuals who may have cardiovascular disease. Recent findings published by Martin et al in Circulation identified cardiovascular disease as the leading cause of death in the United States since 1921. Further, cardiovascular disease and stroke result in more deaths in the United States compared with all types of cancer and chronic lower respiratory disease combined. However, a large portion of individuals with cardiovascular disease and high blood pressure—a common risk factor for cardiovascular disease—may not be formally diagnosed with conditions. Although the rate of cardiovascular disease mortality has declined over the last 75 years, the AHA revealed that rates have recently increased because of the COVID-19 pandemic, representing an ongoing need for public health programs and clinical interventions that reduce the burden of cardiovascular disease. "The first step toward reducing any risk factor for cardiovascular disease is awareness. I cannot stress enough how important it is for people to fully recognize just how much cardiovascular disease … impacts each of us as individuals and communities. [Individuals] should arm [themselves] with knowledge that can help [them] reduce [their] risk of becoming a future statistic," concluded Joseph C. Wu, MD, PhD, FAHA, the Simon H. Stertzer Professor of Medicine and Radiology and Director of the Stanford Cardiovascular Institute at the Stanford School of Medicine, as well as Volunteer President of the AHA.

Disparities in Coronary Artery Bypass Grafting Faced by Female Patients

In an article published in The New York Times, experts warned of the potential risks of coronary artery bypass grafting in female patients. During the procedure, surgeons use arteries from the arms or chest and veins from the legs to bypass blocked arteries and restore blood flow. However, male and female patients may experience different outcomes following coronary artery bypass grafting. Previous studies have found that female patients who undergo the procedure have a mortality rate of 2.8% vs 1.7% for male patients, and a postsurgical complication rate of 28% vs 20%—statistics that incorporate repeat surgeries, prolonged ventilator use, longer hospital visits, sternal wound infections, strokes, and kidney failure. These sex-related inequalities in patient outcomes have been known for about 40 years and have persisted in female patients despite advancements in technology.

One such patient, 61-year-old Cynthia Mosson, explained that she felt pain in her left shoulder that began to migrate down her left arm. After alerting her family, she was rushed to the hospital, where she was told she had experienced a mild heart attack. Her physicians discovered severe blockages in her coronary arteries and recommended a quadruple bypass. Although the procedure was successful, Ms. Mosson was readmitted to the hospital to resolve fluid in her lungs and was enrolled in a cardiac rehabilitation program to help her recover. She currently struggles with depression, anxiety, and fear that she will experience another heart attack.

The experts noted that because female patients present with different symptoms than male patients—differences that are not often taught in medical schools—they tend to be up to 5 years older when undergoing coronary artery bypass grafting. As a result, female patients may be more likely to have preexisting comorbidities that increase the procedure's risks. Further, female patients only comprise about 20% of those participating in clinical trials related to the procedure, representing a critical research gap. A team of researchers recently discovered that almost 40% of female patients who died during coronary artery bypass grafting may have experienced intraoperative anemia. "This is something modifiable," the researchers emphasized, recommending that surgeons consider using smaller cardiopulmonary bypass machines while maintaining blood oxygenation in female patients. Since the discovery, researchers have launched new clinical trials with the aim of improving outcomes in female patients undergoing coronary artery bypass grafting.