Is Mobile Echocardiography On The Horizon?

Smartphone and tablet technology is advancing at a rapid rate, so it should come as no surprise that it is being used for a variety of different purposes. Healthcare companies are finding novel ways to encourage patients to take charge of their own health; peripherals allow for BP measurement and three lead ECG monitoring in one’s own home, and it’s possible to measure your heart rate at rest and during exercise now, with software that comes as a pre-installed fitness suite on most modern devices.

It stands to reason, then, that these same companies would create clinical grade applications and device extensions that would benefit practitioners, also. I covered the use of Google Glass in revascularisation, already, but another device is making its way to the market at the moment, too; mobile ultrasound.

After unveiling it in 2014, Philips were granted FDA approval of their Luimfy system only a couple of weeks ago and have announced that it is now available for purchase in the US.

A $199 per month subscription, an Android phone/tablet and a micro USB probe are all you need, as the app and it’s peripheral are designed to work with compatible devices off-the-shelf.

In its current form, the scanning app allows practitioners to examine the gall bladder, abdomen and lungs, in addition to having obstetric, vascular, superficial, musculoskeletal and soft tissue functionality, so the device isn’t suitable for echocardiography, but I’m certain that in the future, given the power already available in modern devices, it’s a real possibility.

In UK hospitals, where space is a deciding factor for treatment options, having an ultrasound monitor that can fit in a small case would be a real boon. Emergency and critical care ultrasound is actually what the system was designed for, so it makes sense that the most obvious impact relates to time and accessibility.

Streamlining the healthcare process is paramount, and the fact that this system is based around an app could be a real advantage. The images gained by the practitioner can be shared via the cloud, so the network of professionals involved with one patient can have near instant access to the relevant materials needed for diagnosis. Philips could also provide continued software support and provide updates based on user feedback, without the need for engineer call outs.

Now, I’m no app developer (I’m trying. It’s rather complex…), but I do use them, so I can identify some common problems in cloud storage and functionality.

Firstly, as this is an Android app, it may present issues in performance across devices. There are a number of latency issues with apps for this OS and further issues regarding app performance in general from one device to another, especially if the base OS differs slightly between manufacturers (if you’ve tried to compare performance between Samsung and Google Nexus, you’ll know what I mean). In this case, Philips would have to be fairly on the ball with their customer support, especially given the subscription costs for practitioners.

I guess the issue with cloud storage brings us to patient confidentiality, as the last couple of years have seen some high profile cloud hacks leak “sensitive” data to the public, but many hospitals are already digital, so surely it’s a case of ensuring the level of security is appropriate.

As far as echo goes, the advantage of switchable probes and live, cloud updating comes into its own; echo features could be added with an update, in theory. It’s a case of making it happen. It’s unlikely, but if I ever get a chance to try one, I’ll make sure to tell you of my experience.

For more information, go here: http://www.ifa.philips.com/news/digital-innovations/philips-lumify

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Virtual Reality In The Cath Lab

If you’ve kept abreast of tech news in the last few years, specifically with regard to Google Glass, you’ll probably be aware of two things: 1. it has been met with scepticism and apprehension, and 2. at present it’s largely pointless.

I’ll admit that the second point is subjective, but now, this (my) subjective view is likely to change. A team of cardiologists from Warsaw have used Glass’ virtual reality capabilities to tackle what is referred to as the “final frontier in interventional cardiology” by repairing a total occlusion of the right coronary artery.

An effective visualisation of the coronary arteries is often lacking using normal angiography radiology techniques, but by employing coronary computed tomography angiography (CTA), a smartphone app and a headset based on Google Glass, the team at the Institute of Cardiology have successfully restored blood flow in the right coronary artery of a 49y/o male, with two drug- eluting stents.

“This case demonstrates the novel application of wearable devices for display of CTA data sets in the catheterization laboratory that can be used for better planning and guidance of interventional procedures, and provides proof of concept that wearable devices can improve operator comfort and procedure efficiency in interventional cardiology,” says lead investigator Maksymilian P. Opolski, of the Department of Interventional Cardiology and Angiology at the Institute of Cardiology, Warsaw.

The set up itself projects the three- dimensional CTA images onto the Glass-based head mounted display via a mobile app featuring voice command and a zoom function. The combination allows for digital viewing of the coronary artery, the occlusion and the placement of the guide wire for stent implantation. Thanks to its basis in Google Glass, the device can record video, view images and also allow the practitioner to see the surrounding environment, simultaneously. The possibility for the lenses to be fitted with filters that protect the user from x-rays only cement this technology as one that cardiologists will look to use increasingly, after this first success.

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A. Surgeon using the Glass-based monitor to view CTA images on the lens. B & C. 3D images on lens show trajectory of distal right coronary and occlusion.

 

Virtual Reality might not be having the impact on video games that the industry had hoped, but it would appear to be having a profound impact on healthcare.

 

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Ref: Canadian Journal of Cardiology, Elsevier Health Sciences

Hydrogels As An Alternative To Reperfusion And Transplant.

“Cardiac failure is a critical condition that results in life-threatening consequences. Due to a limited number of organ donors, tissue engineering has emerged to generate functional tissue constructs and provide an alternative means to repair and regenerate damaged heart tissues.” 

Such is the sentiment from Ali Khademhosseini and a team from Massachusetts. In fact, they reported here, that in 2009 an average of 77 U.S. citizens underwent transplant each day, but 20 died as a result of a lack of organ availability. The aim, then, in the absence of treatment, is to repair the damaged organ in-situ so as to negate the need for transplant at all.

Enter hydrogels.

Hydrogels are already used in the regeneration of a variety of tissues, and combined with some of the brightest minds in the field significant advances are being made in regenerative medicine: in May this year a team in Toronto have successfully repaired brain tissue after stroke and partially reversed blindness. These versatile substances are also used in disposable nappies, silica gel and contact lenses, so there’s a high chance you’ve already been exposed to them without even knowing it!

These polymers exhibit many desirable characteristics in regenerative medicine. They are relatively easy to synthesise, they can act as solute transports/drug-delivery systems, exhibit elastic properties as well as preventing thrombosis. Their structure also enables them to create a “scaffolding” for cells.

This last point is crucial when combined with the hydrogel’s other properties, but I’ll return to that shortly.

First, consider what happens to cardiac tissue after an acute myocardial infarction: during infarct, the oxygen supply to myocardial cells is reduced or diminished, causing irreversible cell death and necrosis around the occluded artery/arteries. The scar tissue that takes the place of the once-functioning cardiac muscle has none of its contractility and the heart is far less efficient as it once was. Cardiac output, systolic and diastolic functions are affected and whilst medication, reperfusion techniques a bit of luck regarding preserved left ventricle function all provide a better prognosis, heart failure is a serious risk and figures regarding mortality rates aren’t great: MI, specifically STEMI brings with it a 30% mortality rate, 50% of this figure dying before hospital admittance and 10-15% being re-hospitalised one year after the index event.

So, where do hydrogels come into the picture?

In the case of extreme loss of cardiac function and the inability of conventional treatment to improve the given prognosis, hydrogels provide an environment in which it is possible to introduce stem cells, growth factor, gene injection or therapeutic medication in an ‘artificial’ environment that simultaneously provides mechanical support to the infarcted area and aids in the replacement of necrotic tissue. As well as being a relatively non-invasive procedure when it comes to the injection of the treatment, the hydrogels scaffold itself is naturally degraded by the body when the process is complete.

According to another team in Massachusetts, published here, trials have shown significant success since they began in small animals, but their application isn’t as straightforward in large primates. They commenced in humans in 2008 (in an extremely truncated form), but in order for hydrogels to be viable in widespread clinical treatment, much more research is required. An example of this is that not much is known about the exchange of signals that take part in the movement of stem cells to an injured myocardial tissue post-hydrogel treatment. Optimum degradation time is a further issue in humans.

Despite these, and other setbacks, there remains great promise in hydrogels to lower global mortality rates as a result of MI. In recent years, significant advances in research are making the possibility of myocardial repair in humans an almost visible reality.

Thanks!

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Pacemaker Re-Use For The Developing World

To some of my experienced readers, the fact that pacemaker charities that recycle pacemakers exist may not be news at all, however if, like me, you had no idea, then hopefully this post will make for some heart-warming (sorry) reading.

I was interested in what happened to pacemakers when the user passed away, and after a quick internet search, I found that they were almost invariably stockpiled when cremation was requested, or buried with the deceased. Considering that there are over 34,000 pacing procedures performed in the UK alone, this seemed somewhat wasteful. Knowing that the average life of a standard pacemaker is currently anywhere between 6-10 years, I found it hard to believe that there would not be remaining battery life in the devices when they were no longer required.

Pacemaker research is advancing all the time; Medtronic released their “Micra” (pictured right), which is lead-less and no bigger than auntitled large multivitamin tablet, so with more advances, the price of a standard pacemaker is dropping. The current prices are still out of reach for the people who need them in many developing countries and that’s before the cost of the procedure and hospitals accommodation/ follow up care are considered.

A study at the Hospital of the University of Pennsylvania, led by Dr Payman Zamani discovered that of 27 pacemakers taken from a mortuary stockpile, 8 had a remaining battery life of at least 4 years. This is obviously 8×4 years of alleviated symptoms that are going to waste in this one mortuary alone, and it was estimated in 2011 that more than 1 million people from the developing world died as a result of not having access to pacemakers, so health organisations began looking at ways to reduce this waste.

Companies such as Heartbeat International and Heart to Heart have been recycling pacemakers since as far back as 1994, but in 2013, Pace4Life, a UK company run by Chemistry graduate Balasundaram Lavan began a partnership with the NHS and other healthcare organisations, and morgues to recycle as many viable pacing devices as possible. It’s against EU legislation for recycled pacemakers to be used domestically, but it is well within the confines of European guidelines for them to be taken from consenting individuals and used outside of its boundaries

Pace4Life only accept devices with >70% battery life remaining and during the refurbishing process, all former patient data is erased, so confidentiality is in no way compromised. Their website at http://www.pace4life.org contains a list of studies and guidelines with which they work as well as patient, next of kin and mortuary donation documents to enable people to help the less fortunate gain access to potentially life-saving medical equipment.

I’ll let Lavan himself explain a bit more:


Thanks!

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