Respective results from the REVEALPLAQUE, DECODE and SMART-CT clinical studies presented at the Society of Cardiovascular Computed Tomography (SCCT) 2023 meeting in Boston demonstrated how new levels of workflow efficiency and accuracy for cardiac CT can be achieved using artificial intelligence (AI) analysis. The three studies were for HeartFlow’s AI algorithms that move beyond FFR-CT to analysis of coronary plaque composition, and the ability to highlight areas of interest where radiologists or cardiologists should spend more time looking in coronary computed tomography angiography (CCTA).

HeartFlow is the first company to offer a suite of AI technologies to help clinicians noninvasively identify stenoses in the coronary arteries (RoadMap Analysis), assess coronary blood flow (FFR-CT Analysis), and characterize and quantify coronary atherosclerosis (Plaque Analysis). Together, this comprehensive solution offers valuable data not currently available with traditional noninvasive diagnostic tools, allowing clinicians to see the full picture of their patients’ coronary artery disease (CAD).

REVEAL PLAQUE Study shows good correlation with IVUS to identify high-risk plaques

The REVEALPLAQUE Study is a large, global, prospective study with independent, blinded, core lab adjudication that demonstrated the accuracy of HeartFlow’s AI-based Plaque Analysis compared to intravascular ultrasound (IVUS) — the current gold standard. The HeartFlow Plaque Analysis demonstrated a 95% agreement with IVUS in quantification and characterization of total plaque volume.

“The take-home message was that in addition to the FFR-CT by coronary CT angiogram, we can now also analyze luminal and plaque volumes and also the plaque morphology in an automated manner with the assistance of artificial intelligence,” explained Jagat Narula, MD, PhD, executive vice president and chief academic officer at UTHealth Houston, and president-elect of the World Heart Federation. “The time is ripe to extend the stenosis versus functional significance debate to include plaque morphology.”

With this new technology, Narula said it is possible to now more clearly identify patients who should be sent for revascularization and those who can be treated medically, with the technology allowing identification of high-risk plaques. 

DECODE Study shows AI plaque analysis can better classify patient risk

The DECODE Study evaluated changes in treatment management decisions made by clinicians using Heartflow’s Plaque Analysis alongside CCTA in comparison to decisions made with CCTA alone. Clinicians using the HeartFlow Plaque Analysis alongside CCTA changed their management decisions for 66% of patients compared to using CCTA alone across various patient presentations and disease stages. Furthermore, nearly 50% of patients with a calcium score of zero were reclassified following clinician review of the HeartFlow Plaque Analysis, highlighting the importance of quantifying total plaque beyond just calcium.

“I think the most important takeaway message is that this can be helpful in making decisions regarding medical therapy, and to identify those who are most likely to benefit from additional medical therapy that is more intense. I think the plaque analysis really surprised us in a way in that it identified noncalcified plaque in in such a subjective way that the reviewing cardiologist may not identify without this objective-based AI algorithm,” explained Amit Pursnani MD, director of advanced cardiac imaging, Northshore University Health System, who was the principle investigator of the study.