From AI Imaging to ‘Leave Nothing Behind’: How New Cardiology Tech Is Transforming Heart Care

What recent innovations in interventional cardiology have most changed how you treat patients?

Several advances are changing the way we treat coronary artery disease. AI is helping doctors interpret IVUS and OCT - advanced imaging tools that allow us to see the inside of coronary arteries and place stents more accurately.

Intravascular lithotripsy (IVL) uses sound waves to gently crack hard calcium inside a blocked artery, making it easier to safely open the artery and expand a stent.

Meanwhile, drug-coated balloons deliver medication to the artery without leaving a permanent metal stent behind. This ‘leave nothing behind’ approach is becoming an option for selected patients.

How have minimally invasive heart procedures evolved in the last few years?

Over the last 5–10 years, the major change has been a move from open-heart surgery towards catheter-based procedures for appropriately selected patients.

TAVI, for example, allows doctors to replace a narrowed aortic valve through a catheter, usually inserted through an artery in the groin. It is now being offered to a broader range of patients, and many can leave hospital within a day or two.

Mitral valve repair has also become less invasive. With transcatheter edge-to-edge repair (TEER), a catheter is introduced through a vein in the groin to repair a leaking mitral valve without opening the chest.

Complex coronary blockages can also increasingly be treated through catheters using advanced imaging and calcium-modification techniques.

What are the most overlooked risk factors for heart disease you see in patients today?

Along with smoking, high blood pressure, diabetes, high LDL cholesterol and obesity, several important risk factors are often missed. These include:

1. Lipoprotein(a) or Lp(a) is a largely inherited cholesterol-related risk factor

2. ApoB: Helps measure the number of harmful cholesterol-carrying particles, even when LDL appears normal.

3. Sleep apnea: Can increase blood pressure and cardiovascular risk and is not always limited to people who are overweight.

4. Chronic kidney disease: Even early kidney disease can increase heart risk.

5. South Asian ancestry: Is associated with a higher risk of premature heart disease.

6. Poor sleep and chronic stress: Can negatively affect blood pressure, blood sugar, weight and overall heart health.

What are the most common misconceptions patients have about heart disease?

I feel fine, so my heart must be healthy.

• Reality: Heart disease and high blood pressure can develop silently for years.

Heart disease mainly affects older men.

• Reality: Women and younger adults can also develop heart disease, sometimes with less typical symptoms.

My LDL is normal, so I have no risk.

Reality: LDL is important, but Lp(a), ApoB, blood pressure, diabetes, smoking and family history also matter.

Chest pain is the only sign of a heart attack.

• Reality: Breathlessness, sweating, nausea, dizziness, unusual fatigue, or pain in the jaw, back, shoulder or arm can also be warning signs.