Dr. George Adams
Oct 6, 2020
How big is your heart?
The report from Israel of the dilation of the right ventricle (RV) in 39% of patients with COVID-19 is very troubling to cardiologists, who understand the capabilities and limitations of the RV. Both the left ventricle (LV) and RV naturally dilate in response to increased load (pressure or blood volume) or muscle damage due to an infection (virial or bacterial) or a heart attack (vasospasm, myocardial infarction, etc.). When the initial cause is alleviated either naturally or by therapy, the LV can shrink back to a normal size, a process called “remodeling”, and continue to function normally until the next event. However, the RV is not so elastic and once it has been dilated too much for a period of time, it cannot remodel. The literature has documented this phenomenon in patients with congenital heart disease, whose pulmonary valves often fail in their teenage years and as the valve fails, the RV dilates due to the backflow of blood (regurgitation) into the RV. Cardiologists have learned to replace these valves before the RV gets too large.
Patients with pulmonary hypertension have the same fate due to the increased pressure from increased resistance to blood through the lungs for a number of underlying causes. So, when it was observed a large fraction of people infected with COVID-19 had at least an acute dilated RV, it set off the alarm bells for cardiologists. What is needed now is detailed follow-up studies to monitor patients and accurately calculate the volume of the RV over time to see if this effect will be reversed or be permanent. The concern is that this dilation in COVID patients will persist and there will be a tsunami of patients with right heart failure in the coming years.
The VMS+3.0 is the only tool available to accurately and rapidly determinate the size of the RV from a 2D echocardiogram. It would seem our device will be needed more than ever as the pandemic spreads
Dr. George Adams
Sept 23, 2020
ET TU, COVID?
COVID carnage of the heart was the headline.
As a scientist, I spent many years studying cells and their cytoskeletons to try to understand how they moved. I made time-lapse videos of them - showing they are always moving - looking to fill in where they are needed. Like a human body, a cell without cytoskeleton and muscle cannot do much but be a blob. So when I saw the amazing pictures of heart cells that had been infected with COVID and the destruction of their cytoskeletons and muscle fibers, I was very concerned what this could mean. Sure it was just an experiment in a petri dish, but the article also found similar disrupted heart cells in post-mortem samples from COVID patients. So it is not so surprising that 50% of people with COVID have heart disfunction, even if they had mild to no symptoms. Never before has such a carnage been observed. This COVID virus is special in its ability to attack the heart's muscle.
We are now hearing of 35% of COVID patents reporting continuing and chronic problems associated with cardiovascular complications. So as you would expect some people overcome the heart damage while others struggle. I can see now why cardiologists are concerned about the possibility of patients with heart problems that go on for decades.
I hope we can assist in some way with the VMS+ 3.0’s unique ability to quickly, accurately and reproducibly analyze the heart and allow for the chronicling of the progression of the heart in healing or continued decline. It seems we are at the right place at the right time to help.
Dr. George Adams
September 10, 2020
PAST, PRESENT, FUTURE
I was attracted to the Company in 2010 as the first VMS1.0 was being clinically evaluated. Dr. Mertens, who is one of the top paediatric cardiologists in the world, had just written a review on the “forgotten ventricle” and published it in Nature*. Everyone was beginning to understand that only analyzing the left side of the heart was ignoring half of the information about how the heart was functioning. 10 years ago only MRI could give you right-heart information and as a cardiologist told me at that time, it was traumatic for the doctor, the parents and the child to suggest a child or infant have an MRI. From then on, I was dedicated to creating the VMS to address this need.
I am often asked if 10 years later, I regret this decision and I certainly do not. Back in the early 80s I invented an artificial medium for platelet storage and licensed it to a major blood transfusion company. It is just now becoming the standard, 35 years later! Significant change in medical practice takes a long time. The promise of 3D ultrasound being able to routinely yield useful information for the right heart has not materialized and so the VMS approach remains the only way to get reliable accurate measurements without waiting 3 months for an MRI appointment and spending at least an hour in the machine.
Ventripoint really pioneered the use of artificial intelligence (AI) with its KBR approach and no-one has been able to find another way to get MRI-grade measurements from regular 2D ultrasound exams. Yes, it has taken a lot of time and money to perfect the VMS+3.0 so it is user-friendly and fits exactly into the workflow of an echocardiography service, but now we have it and are set to change the world and stop the trauma.
*Mertens, L., Friedberg, M. Imaging the right ventricle—current state of the art. Nat Rev Cardiol 7, 551–563 (2010).
A major study published in one of the top medical journals (JAMA) reported COVID damages the heart even in asymptomatic patients. No one really knows how long lasting this damage will be, but Boston Red Sox left-hander Eduardo Rodriguez will miss the entire season because of heart inflammation caused by COVID-19.
Red Sox chief baseball officer Chaim Bloom said "We were optimistic that it would resolve in short order and that we would be progressing back to pitching. As we've continued to monitor it, it has not resolved. It is still there.”
The cardiology community is now very concerned that there will be a tsunami of heart patients due to COVID on top of the regular heart patients who have been waiting months to have their regular echo done. Consequently, they are looking for new faster and better ways to monitor patients. Obviously, the Ventripoint VMS+3.0 can help in this situation as few people have immediate and repeat access to an MRI to document heart damage. We are also hearing from cardiologist about a concern about the backlog and the future where it will be near impossible to have a MRI done as the machines will be needed to deal with other patients. With echo departments near capacity prior to COVID shutdowns, the future looks ominous.
Ventripoint has 4 leading cardiac teams around the world using our latest prototype VMS system to study COVID patients and determine the best way to monitor their progress. It is early days, but the more accurate and reproducible analysis the VMS provides will be needed to identify positive or negative changes in heart function as quickly as possible.
Ventripoint is in this with all of you!
Be healthy and safe!