GivingTuesday is a global day of giving celebrated the Tuesday after Thanksgiving. This year, it falls on November 29, and we are asking you to mark your calendars from November 27 – December 3 to make a contribution to the ASE Foundation. ASEF will be participating for the 10th year in a row, and we need your help to reach our fundraising goal of $30,000 USD.

Karla Kurrelmeyer, MD, FASE, has already pledged her support of our GivingTuesday fundraiser. Will you join her in making an early pledge? Our generous donors have helped us surpass our goal every year except one. Mark your calendars now and plan to donate or better yet, join Dr. Kurrelmeyer by pledging a donation today! Any contribution, big or small, brings us one step closer to our goal.

Donations for GivingTuesday 2022 will be accepted on the ASE Foundation website from November 27 – December 3.

Contact the Foundation at Foundation@ASEcho.org with any questions or to make your pledge.

October 31, 2022

The Honorable Ami Bera, M.D.                                 The Honorable Larry Bucshon, M.D.
U.S. House of Representatives                                   U.S. House of Representatives

The Honorable Kim Schrier, M.D.                             The Honorable Michael C. Burgess, M.D.
U.S. House of Representatives                                   U.S. House of Representatives

The Honorable Earl Blumenauer                               The Honorable Brad R. Wenstrup, D.P.M.
U.S. House of Representatives                                   U.S. House of Representatives

The Honorable Bradley Scott Schneider                  The Honorable Mariannette Miller-Meeks, M.D.
U.S. House of Representatives                                   U.S. House of Representatives

Dear Members of Congress:

The American Society of Echocardiography (ASE) appreciates the opportunity to respond to your request for feedback on actions Congress could take to stabilize the Medicare physician payment system, including reforming the current payment structure so it supports a system that provides greater value to patients and to physicians. The ASE is the Society for Cardiovascular Ultrasound Professionals™️. ASE is the largest global organization for cardiovascular ultrasound imaging serving physicians, sonographers, nurses, veterinarians, and scientists and as such is the leader and advocate, setting practice standards and guidelines for the field. Since 1975, the Society has been committed to advancing cardiovascular ultrasound to improve lives.

The increasing cost to physician practices to provide care without adequate inflationary updates, along with the new threat of annual cuts to the Medicare physician payment conversion factor due to the restraints of budget neutrality, point to the need to re-evaluate the physician payment system, and, specifically, the Medicare Access and CHIP Reauthorization Act (MACRA). The COVID-19 pandemic also uncovered weaknesses in our nation’s healthcare infrastructure and payment systems that have led to significant healthcare consolidation further threatening patient care in many areas.

On behalf of its members and the patients they serve, ASE is grateful for your outreach to healthcare providers, advocacy organizations and others for feedback on the current state of MACRA and associated payment mechanisms and ideas for reform. ASE is pleased to provide its perspective on the following topics:

• Medicare Physician Payment
• Barriers to Timely Care for Medicare Beneficiaries
• Medicare’s Quality Payment Program

Medicare Physician Payment

Inflationary Updates and Payment Adequacy

When MACRA was passed, it replaced the sustainable growth rate (SGR) formula and ended roughly 12 years of repeated congressional intervention to prevent Medicare physician payment cuts that were triggered by the SGR when overall physician costs exceeded target expenditures that were pegged to growth in the national economy.

In its place, MACRA was intended to create payment stability and provide incentives to physicians for performing efficiently while delivering high-quality care. MACRA statutorily set modest Medicare physician payment updates, starting at 0.5 in 2015 through 2019, and 0 percent for 2020 through 2025. For 2026 and beyond, it is 0.75 percent for eligible alternative payment model (APM) participants and 0.25 percent for all others.

Over a 12-year period, during which the SGR was in effect, annual payment increases to physicians averaged about 0.3 percent, while the cost of running a medical practice increased about 3 percent annually.^[1] The fact is that physicians are still paying for nearly two decades of insufficient payment updates. Taking inflation in practice costs into account, Medicare physician payment plunged 20 percent from 2001 to 2021.

A fundamental and critical step that Congress can take to create payment stability is to provide, beginning in 2023, a positive annual physician payment update that reflects inflation in practice costs.  It is indisputable that consolidation — vertical, horizontal, and cross-market — results in increased costs to the healthcare system which outweigh any suggestion that consolidation can lead to better care coordination and efficiency. In Medicare, vertical consolidation has been met with calls for site-neutral payment policies that are often focused on driving rates to levels that are unsustainable and that contributed to physician practices selling out to hospitals/health systems in the first place. It is time Congress understand the impact of consolidation and the increasing number of physicians who are choosing to forego independent practice for hospital employment — payment inadequacy and instability and regulatory burden.

Because it will take time to secure a massive, badly needed overhaul of the Medicare physician payment system, immediate action is needed to stop harmful cuts that will take effect on January 1, 2023 and to ensure future payment stability. ASE urges Congress to take action before the end of this year to:

• stop the scheduled 4.42 percent budget neutrality cut to 2023 Medicare physician fee schedule payments;
• end the statutory annual freeze and provide a Medicare Economic Index update for 2023; and
• waive the 4 percent PAYGO sequester triggered by passage of the American Rescue Plan Act.

Barriers to Timely Care for Medicare Beneficiaries

There are a number of contributors to physician burnout, but prior authorization is one of the biggest causes.  Medicare Advantage (MA) and other private insurance plans routinely subject diagnostic tests and procedures to cumbersome authorization processes that lead to substantial treatment and diagnosis delays.  Echocardiographers are not given rules or indications of how these authorizations will be adjudicated. Prior authorization protocols unnecessarily delay patient care and shift costs onto providers who are uncompensated for the administrative time and staff required for authorization and appeals.

Denials of prior authorization requests are raising concerns about beneficiary access to medically necessary care. A report from the Office of the Inspector General found, upon examination of a random sample of prior authorization denials by MA plans, that 13 percent met Medicare coverage rules and likely would have been approved for these beneficiaries under original Medicare.^[2] It is time that MA plans be held to some level of accountability when medically necessary appropriate treatment is withheld or delayed.

With nearly half the Medicare eligible population enrolled in a MA plan, legislation is urgently needed to reduce the burden of prior authorization on physician practices, as well as to improve patient outcomes by preventing delays in care and minimizing the number of patients who forego diagnostics and treatment altogether when it is denied or subjected to a lengthy appeal.

ASE endorses the Improving Seniors’ Timely Access to Care Act (S. 3018 / H.R. 3173) as a way to increase transparency and streamline prior authorization in the MA program and protect timely access to care for Medicare patients and calls upon Congress to pass the legislation this year.

Medicare’s Quality Payment Program

A goal of MACRA was to improve care for Medicare patients by shifting the payment system from volume to value. MACRA set up the Merit-based Incentive Payment System (MIPS) as a pathway to alternative payment models (APMs). The law lowered payment updates over time for MIPS participants to incentivize their move to APMs. For most specialties, including echocardiography, MIPS is a path to nowhere because of a lack of specialty APMs. As a result, physician practices are investing in MIPS participation to avoid payment penalties, but participation requires significant practice resources with little return on those investments amidst questions about whether MIPS even accurately captures quality or is incentivizing improvements in care delivery.

A recent published study on the costs for physician practices to participate in MIPS found physicians, clinical staff, and administrative staff together spent 201.7 hours annually on MIPS-related activities at a per-physician, per-year cost of $12,811.^[3]  According to a survey conducted by the Medical Group Management Association, 90 percent of physician practice respondents said positive payment adjustments did not cover the costs of time and resources spent preparing for and reporting under MIPS.^[4]

MIPS Value Pathways

Recently, CMS has begun a programmatic shift from MIPS to MIPS Value Pathways (MVPs). The MVP concept is a CMS iteration of the “Accountable Clinician Episodes” (ACE) concept developed and put forth to CMS by the AMA and other medical societies, including the ASGE. The intent behind the ACE option was to award MIPS credit to clinicians who engage in performance activities that satisfy the requirements of multiple MIPS performance categories (“multi-category credit”). For example, if a clinician reported quality measures electronically via a Qualified Clinical Data Registry (QCDR) that interfaces with their EHR, the clinician would receive full credit for the Promoting Interoperability category. The ACE concept was also envisioned as a long-run performance-based model or as a stepping stone for clinicians between participation in separate, unrelated MIPS measures and participation in an APM or Advanced APM.

MVPs, as currently designed, mirror many of the flaws in MIPS. If CMS moves ahead with MVPs as currently structured, it will be impossible to convince physicians that MVPs are anything more than a rebranding of MIPS with little-to-no benefit to physician practices or their patients.

Participation Incentives

In addition to making MIPS participation more cohesive and, ideally, more meaningful, ASE asks Congress to re-examine the incentive structure for participation.

MACRA’s $500 million exceptional performance bonus expires with payment year 2024 (performance year 2022). Because of the budget neutral redistributive nature of MIPS, there is very little return on investment, and therefore incentive, for MIPS participation. Budget neutrality is the fundamental flaw of the entire MIPS program – it needs winners and losers. A physician or physician practice can fully engage and still lose. Ideally, financial incentives for participation in MIPS would help practices build the infrastructure to move to APMs when they become available.  ASE asks Congress to allocate additional funds to extend the exceptional performance bonus beyond the 2024 payment year.

Future MVPs should have a better participation incentive structure. Physicians who participate in MVPs should also be held harmless from downside risk for at least the first two years of participation while they gain familiarity with a model that is more consistent with an APM and while CMS collects and shares data about whether MVPs are meeting their goal to improve quality and reduce unnecessary costs for the Medicare program and beneficiaries.

MIPS Performance Threshold

CMS should lower the MIPS performance threshold to a degree that avoids penalizing one-third of MIPS eligible clinicians.^[5]  Sec. 101(c)(6)(D) of the statute requires CMS to set the performance threshold at the mean or median of the composite performance scores for all MIPS eligible professionals, and CMS proposes to maintain it at 75 points for the 2023 performance period.

As opposed to a pre-set formula, CMS is in a better position to determine each year whether physicians are ready to move to an increased performance threshold given the agency has access to all the previous year’s performance data. CMS may also decide to establish different thresholds for small and large practices.

Physician Access to Timely, Actionable Data

Physicians should be held accountable for the costs that are within their control and should have access to their claims data analysis to identify and reduce avoidable costs. Though Congress has taken action to give physicians access to their claims data, to this day physicians do not receive timely, actionable feedback on their resource use and attributed costs in Medicare. What is a lower-cost physician doing differently from a high-cost physician? For example, is it that they are better at care coordination? If we do not know the answer, we cannot achieve the goal of reducing avoidable costs and overuse. Physicians and specialty societies need access to their claims data analysis to identify variations in spending that are not accounted for by differences in patient needs and to eliminate unnecessary costs.

Furthermore, CMS needs to provide more detailed, specialty-specific and site-of-service specific breakdowns of MIPS performance data in the Experience Report or accompanying Appendix. The Public Use File (PUF) is not usable for national medical specialty societies that are evaluating opportunities for improvements in quality, cost, Promoting Interoperability, and Improvement Activities, nor in developing MVPs. The 2020 QPP PUF provides some site-of-service information, such as whether the physician bills in an Ambulatory Surgery Center or is considered hospital-based, but it is too limited.

Conclusion

Over time, underlying problems with the physician payment system and challenges with the QPP, and MIPS in particular, have revealed themselves much to the frustration of physicians and with a negative impact on patient care. Many of the issues outlined above cannot be addressed administratively and, therefore, require congressional action.  We appreciate that reaching consensus on solutions to these problems will not be an easy task. However, there is consensus on actions that Congress can take immediately that will better allow MACRA to fulfill its purpose of increasing value in the U.S. healthcare system.

Should you have questions or require additional information, please contact Irene Butler, ASE’s Vice President of Health Policy and Member Relations, at ibutler@asecho.org.

Sincerely,

Stephen Little, MD, FASE
President, American Society of Echocardiography

^[1] Parke DW 2nd. The SGR Fix: Was It? Mo Med. 2015 Nov-Dec;112(6):408-9. PMID: 26821437; PMCID: PMC6168105.

^[2] Some Medicare Advantage Organization Denials of Prior Authorization Requests Raise Concerns About Beneficiary Access to Medically Necessary Care. U.S. Department of Health and Human Services, Office of Inspector General. April 2022. https://oig.hhs.gov/oei/reports/OEI-09-18-00260.pdf

^[3] Khullar D, Bond AM, O’Donnell EM, Qian Y, Gans DN, Casalino LP. Time and Financial Costs for Physician Practices to Participate in the Medicare Merit-based Incentive Payment System: A Qualitative Study. JAMA Health Forum. 2021;2(5):e210527. doi:10.1001/jamahealthforum.2021.0527

^[4] MGMA Annual Regulatory Burden Report – 2022. https://www.mgma.com/practice-resources/government-programs/mgma-annual-regulatory-burden-report-2022

^[5] Centers for Medicare & Medicaid Services CMS–1770–P

October 25, 2022

The Honorable Charles Schumer                                                      The Honorable Mitch McConnell
Majority Leader                                                                                    Republican Leader
U.S. Senate                                                                                             U.S. Senate

Dear Leaders Schumer and McConnell,

The American Society of Echocardiography (ASE) writes today in strong support of the Cardiovascular Advances in Research and Opportunities Legacy (CAROL) Act (H.R. 1193/S. 1133). This bipartisan legislation, which passed the House of Representatives unanimously last year, would help heart patients through expanded research, education, and investments into valvular heart disease. We thank you Leader McConnell for your co-sponsorship, and we urge the Senate to act before the 117^th Congress adjourns to pass this important legislation.

Founded in 1975, ASE is the Society for Cardiovascular Ultrasound Professionals™️ and represents the largest global organization for cardiovascular ultrasound imaging. ASE is the leading advocate for physicians, sonographers, nurses, veterinarians, scientists, students, and all those with an interest in echocardiography, setting practice standards and guidelines for the field. The Society is committed to advancing cardiovascular ultrasound to improve lives.

According to the CDC, valvular heart disease affects 2.5% of the U.S. population. As many as 11 million Americans are living with heart valve disease and, each year, five million additional Americans are diagnosed with it. The CAROL Act would authorize significant investments into improving the health outcomes for those diagnosed with valvular heart disease by supporting education and awareness concerning the disease, and  investing in research through the National Institutes of Health (NIH) to improve treatment. It also requires the Department of Health and Human Services (HHS) to develop best practices to treat valvular heart disease and encourages the agency to implement other projects to increase education and awareness of the disease.

Over 25,000 Americans die each year from valvular heart disease. The CAROL Act pledges the necessary investments in research and prevention to aid the millions of American lives affected by this disease. Please make heart valve research a priority by passing this legislation.

Sincerely,

Stephen Little, MD, FASE
President, American Society of Echocardiography

October 24, 2022

House Speaker Nancy Pelosi                                                   Senate Majority Leader Chuck Schumer
U.S. House of Representatives                                                U.S. Senate
1236 Longworth House Office Building                                 322 Hart Senate Office Building
Washington, D.C. 20515                                                           Washington, D.C.  20510

House Minority Leader Kevin McCarthy                                Senate Minority Leader Mitch McConnell
U.S. House of Representatives                                                U.S. Senate
2468 Rayburn House Office Building                                     317 Russell Senate Office Building
Washington, D.C. 20515                                                           Washington, D.C.  20510

Dear Speaker Pelosi, Leader McCarthy, Leader Schumer, and Leader McConnell:

On behalf of the American Society of Echocardiography (ASE), I write to thank the Congress for the enactment of previous legislation that averted significant provider payment reductions in the 2022 Medicare Physician Fee Schedule (MPFS). These actions increased fiscal stability for clinicians and enabled Medicare beneficiaries to continue accessing medically necessary and appropriate care. I write now to urge the Congress to enact new legislation prior to year’s end that prevents implementation of scheduled 10 percent payment cuts to Medicare providers beginning 2023. If left unaddressed, these substantial payment reductions will have a profoundly adverse impact on Medicare beneficiary access to high-quality care delivery.

The ASE represents medical specialists dedicated to improving patient health and quality of life through the use of cardiovascular ultrasound. While physicians comprise the majority of ASE’s membership, the society also represents allied health professionals in the entire echo lab team. Reflecting our commitment to advancing high-quality patient care, the ASE has published over 65 evidence-based guidelines and standards that have become essential and integral to the medically appropriate practice and use of echocardiography.

The ASE is deeply concerned that the reductions contained in the 2023 Medicare Physician Fee Schedule proposed rule coupled with the expiration of previous Congressional interventions will result in a more than 10 percent Medicare payment cut to providers next year. Specifically, in 2023, clinicians are set to face a 4.42 percent cut to the MPFS conversion factor, a 4 percent PAYGO reduction, and the end of the 2 percent Medicare sequestration moratorium. Absent legislative action, these severe payment reductions will further jeopardize the financial stability and operations of providers caring for Medicare beneficiaries care who continue to experience significant instability from statutory payment cuts, lack of inflationary payment updates, and the ongoing impacts from the COVID-19 pandemic. Therefore, to prior to the end of 2022, ASE urges the Congress to:

• Eliminate the scheduled -4.42 percent conversion factor cut in the 2023 Medicare Physician Fee Schedule;
• Waive the 4 percent PAYGO cut;
• Provide relief from the Medicare sequester; and
• Eliminate the statutory annual payment freeze and provide an update to the MPFS in 2023 that reflects the high rate of inflation.

These legislative actions will provide the relief necessary to foster stability and prevent further strain on our health care system, thereby better enabling Medicare beneficiaries to continue accessing the medically appropriate care they need that improves patient health outcomes and quality of life.

Sincerely,

Stephen Little, MD, FASE
President, American Society of Echocardiography

Human Deep Hypothermic Cooling versus Animal Hibernation: Echocardiographic Insights

October 27, 2022 | 5:00 – 6:00 PM ET

The cardiovascular changes that occur during deep anesthesia in people may be mirrored in animals that hibernate: hypothermia, bradycardia, etc. In one context, these changes occur in a medical environment whereas in the other, they are a part of normal life. This session proposes that knowledge can be gained by pairing the perspectives of a human cardiothoracic anesthesiologist, Dr. Burkhard Mackensen, and a veterinary cardiologist with expertise in hibernating bears, Dr. Lynne Nelson. This is the first webinar offered by the ASE Veterinary Specialty Interest Group.

Moderator

• Etienne Côté DVM, DACVIM (Cardiology, SAIM), FACC, FCAHS

Speakers

• G. Burkhard Mackensen, MD, PhD, FASE
• O. Lynne Nelson, DVM, MS, DACVIM (Cardiology, SAIM)

Learning Objectives

• Better understand selected cardiovascular aspects of deep hypothermic anesthesia in humans, including echocardiographic aspects
• Better understand selected cardiovascular aspects of hibernation in large mammals, including echocardiographic aspects
• Gain additional insights into human cardiovascular physiology through understanding the changes that occur during hibernation, and into veterinary cardiovascular physiology through understanding the changes that occur during human deep hypothermic anesthesia

Earn 1 AMA PRA Category 1 Credit™ (CME/MOC) (pending approval).

This activity is FREE for ASE members and nonmembers. Remember to log in to the Member Portal.

Knowledge is Power: Considerations Before Signing an Employment Contract

November 07, 2022 | 7:00 – 8:00 PM ET

This webinar is a talk by employment attorney Renu Thamman on the key items to consider and negotiate before signing an agreement. With the increase in corporate medicine, doctors can no longer blindly sign these agreements that can have a serious impact on their future.

Moderator

• Ritu Thamman, MD, FASE, FACC

Speaker

• Renu Thamman

Learning Objectives

• Learn the key items to consider before signing an agreement
• Learn what things to negotiate before signing an agreement

No CME is offered for this webinar.

This activity is FREE for ASE members and nonmembers. Remember to log in to the Member Portal.

Assessment of Diastolic Function in Pediatric and Congenital Heart Disease

November 17, 2022 | 8:00 – 9:30 PM ET

This webinar will consist of two didactic lectures followed by debate on assessment of diastolic function in pediatric population. The webinar will highlight the need for accurate assessment of diastolic dysfunction in patients with congenital heart disease as well as children with acquired heart disease while acknowledging the lack of validation in children of parameters used in assessment of diastolic dysfunction in pediatrics.

Speakers

• Mihn Nguyen, MD, Assistant Professor, Texas Children’s Hospital, Baylor College of Medicine
• Keri Shafer, MD, Department of Cardiology, Boston Children’s Hospital & Assistant Professor of Pediatrics, Harvard Medical School
• Andreea Dragulescu, MD, Professor of Pediatrics, The Hospital for Sick Children, University of Toronto
• Piers Barker, MD, FASE, Professor of Pediatrics and Obstetrics and Gynecology, Duke University Medical Center

Learning Objectives

• Understand the measures routinely used to assess diastolic dysfunction.
• Understand the comprehensive assessment of diastolic dysfunction in adult congenital heart disease.
• Recognize the limitations to assessment of diastolic dysfunction in pediatric population.

Earn 1.5 AMA PRA Category 1 Credit™ (CME/MOC) (pending approval).

This activity is FREE for ASE members and nonmembers. Remember to log in to the Member Portal.

ASE released its newest online educational tool echoCORE! The new echocardiography review and evaluation tool helps practitioners of echocardiography review a broad array of topics, key concepts, formulas, and the latest echo advancements in an interactive multiple-choice question and answer format. Special introductory pricing for a one-year subscription is $250 for ASE members and $300 for nonmembers.

Some key product highlights:

• Developed by 24 experts in the field.
• Over 38 topics covered.
• 150 questions
• Customized feedback with external resource links to ASE guidelines, full lectures on topics, JASE articles, and more.
• User receives a performance summary on each topic.

Learn more and purchase this product at ASEcho.org/echoCORE. Questions regarding the content? Contact Products@ASEcho.org.

Please note, this activity does not offer CME/MOC at this time.

Enroll in the first webinar offered by the ASE Veterinary Specialty Interest Group! This free webinar titled Human Deep Hypothermic Cooling versus Animal Hibernation: Echocardiographic Insights, will take place on October 27, 5:00 – 6:00 PM ET, and will explore the cardiovascular changes that occur during deep anesthesia in people and how these changes may be mirrored in animals that hibernate.

Attendees can earn 1 AMA PRA Category 1 Credits™ (pending approval). In addition to offering 1.0 CME credit, this activity has been developed and registered with ACCME to provide MOC, MOC Part 2, and MOCA 2.0 points in alignment with AMA PRA Category 1 Credit™.

The latest issue of CASE, ASE’s open access case reports journal, is available and packed with educational material to share with trainees and colleagues. CASE Editor-in-Chief Dr. Vince Sorrell commented, “It seems like every issue of CASE includes at least one report you need to keep handy as an image-reference in your echo reading room. This issue includes a CASE series demonstrating the normal and pathologic variations of caval and coronary sinus venous anomalies. This is an important report that includes outstanding 3D-CCT image correlations.”

This issue also includes another Congenital Heart Disease article (authored by a sonographer), two cases highlighting the value of Multimodality Imaging, two Hemodynamic Corner cases, and two reports on Cardiac Tumors & Pseudotumors. Dr. Sorrell noted, “Most of us have seen patients with severe mitral annular calcification with or without associated echo-free spaces commonly referred to as liquefaction or caseous necrosis. Some of us have also seen the rare pathologic transformation to fistula formation. Fujiwara and coauthors provide us with an excellent surgically correlated case series of these patients with an absolutely striking video taken in the OR that you simply must see to believe!” Dr. Sorrell’s editorial, “Interpreting the Interpretation,” challenges clinical echocardiographers to continually improve their communication of echo findings to non-specialist colleagues to help improve outcomes.

REMINDER: There are still fee waivers available for sonographer lead authors, sponsored by the Sonography Council, waiting to be claimed by you. Submit your case today! Email Debbie Meyer, Director of Publications (JASE, CASE), or Andie Piddington, Deputy Managing Editor (JASE, CASE), with any questions or to request a case-writing mentorship from an ASE sonographer.

ASE is pleased to share the following news release, provided by Ultromics, highlighting the recently published research initiatives funded through the ASE Foundation, with support from the University of Chicago and MedStar Health, and in-kind support from Ultromics. 

Ultromics’ AI technology analyzes echocardiogram images and predicts cardiac-related mortality better than human analysis.

OXFORD, England, 10^th October, 2022

A new study from the World Alliance Societies of Echocardiography (WASE), a major international research initiative led by the American Society of Echocardiography (ASE), says artificial intelligence (AI) is superior to human experts when it comes to predicting cardiac-related death₁, a capability that could revolutionize cardiovascular care.

The AI platform, EchoGo by Ultromics, is FDA-cleared, CE Marked and in-use by a growing number of provider organizations across the US and UK. Ultromics is moving quickly and innovatively to help develop novel approaches to improve heart failure detection. The company recently announced a partnership with The Foundation for the National Institutes of Health (FNIH)₂ that will use their upcoming FDA breakthrough designated product to improve heart failure detection₃, looking specifically at heart failure with preserved ejection (HFpEF).

This latest research from WASE builds on previous work which showed that AI–based analysis could accurately detect outcomes from echocardiographic images₁, including combining myocardial strain biomarkers to improve predictive accuracy, recommended as clinical best practice₄. With this, an interest in the AI’s ability to make outcome predictions was compared with conventional analysis by human experts.

Dr. Federico M. Asch, lead study author and Director of the Cardiovascular and Echo Core Labs at MedStar Health Research Institute, said: “AI derived results outperformed traditional manual analysis in the generation of Left Ventricular Ejection Fraction and Global Longitudinal Strain, as the AI proved to be a significant predictor of outcomes, which traditional reads by expert echocardiographers could not achieve.”

The study looked at 870 patients admitted to 13 hospitals in 9 countries (Asia, Europe, United States, Latin America), who had acute COVID-19 and underwent transthoracic echocardiography.

The research was supported in partnership by MedStar Health, University of Chicago, and Ultromics. Dr. Federico Asch, Director of the Cardiovascular and Echo Core Labs at MedStar Health Research Institute, and Dr. Roberto Lang, Director of the University of Chicago’s Non-invasive Cardiac Imaging Laboratory, served as principal investigators.

Echocardiographic left ventricular ejection fraction (LVEF) and left ventricular longitudinal strain (LVLS) were obtained manually by multiple expert readers and by the automated EchoGo AI platform from Ultromics. The ability of the manual and AI analyses to predict all-cause mortality was compared.

AI-derived LVEF and LVLS were predictors of mortality in univariable and multivariable regression analysis (odds ratio, 0.974 [95% CI, 0.956-0.991; P = .003] for LVEF; odds ratio, 1.060 [95% CI, 1.019-1.105; P = .004] for LVLS), but LVEF and LVLS obtained by manual analysis were not₁.

Direct comparison of the predictive value of AI versus manual measurements of LVEF and LVLS showed that AI was significantly better (P = .005 and P = .003, respectively)₁. In addition, AI-derived LVEF and LVLS had more significant and stronger correlations to other objective biomarkers of acute disease than manual reads. Lastly, , inter-operator agreement for LVEF and GLS was 23% and 44% (respectively) lower for manual measurements than that achieved by the AI₁.

Dr Ross Upton, CEO and Founder of Ultromics, said “Developing precision strategies for cardiovascular disease is more critical than ever, particularly heart failure, where patient cases and costs are expected to double between now and 2030⁵. We built our AI platform to improve the accuracy of heart failure detection and prevent worsening cardiac outcomes.” Upton continued: “The technology was built using deep learning, from 10 years’ worth of echocardiographic images tied to outcomes, to provide precision analysis independent of expert clinicians”.

This study demonstrates the prognostic value of AI for routine primary care and improved accuracy for prediction of cardiovascular disease. Ultromics will continue to explore how AI can contribute to the development of echocardiography and preventative care.

Click here to read the published paper in The Journal of the American Society of Echocardiography (JASE).

Dr. Asch will join Gary Woodward, pHD, Ultromics Chief Technology Officer,  on a webinar on November 3rd, 2022 to discuss these ground-breaking results. Visit www.ultromics.com to register for the online seminar.

About Ultromics:

Ultromics is the leader in artificial intelligence for echocardiography enabling earlier detection and risk stratification of heart failure for better outcomes, lower costs, and improved patient care. All providers, regardless of their care setting, can now make precise, accurate, and timely diagnoses of heart failure with Ultromics’ AI technology. The cloud-based platform, EchoGo, offers a simple, secure and seamless way to augment your existing technology and workflow with fully automated, advanced echo analysis including critical advanced measures recommended by guidelines.. The technology is FDA-cleared and trusted by world-renowned organizations such as Mayo Clinic and the NHS England. Learn more: https://www.ultromics.com

For media inquiries:

Ultromics VP of Marketing – Jeff.Zinger@ultromics.com

1. Asch J, et al, J Am Soc Echocardiogr. 2022;35:1-55

2. https://www.ultromics.com/press-releases/ultromics-joins-fnih-partnership-to-transform-heart-failure-detection

3. EchoGo Heart Failure is pending FDA 510k clearance

4. https://www.onlinejase.com/article/S0894-7317(21)00483-1/fulltext

5. Smiseth, OA, et al. European Heart Journal. 2015;37:1196–1207

6. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5494150/