Across healthcare today, clinicians have been handed a priority list so long as to border on the implausible.  Clinically, patient partnerships¹ are needed to improve outcomes. Economically, better care must be delivered without waste².  Societally, health equity³ is a continuous focus.  Technologically, advancements⁴ must be evaluated and, as appropriate, incorporated.  And all of this is required whilst the structures in which we work are rapidly transforming⁵, for better or worse.  Given the task at hand, even the most optimistic clinician may have moments where the deluge seems unmanageable.

However, during my time at the recent Annual Scientific Meeting of the Society for Cardiovascular Computed Tomography (SCCT), it was clear that clinicians are meeting these expanding demands with adaptation and focus which simultaneously recognize the need to serve each individual patient as well as the field of cardiovascular medicine itself.

Backed by ample clinical evidence^6-8 and the 2021 AHA/ACC Chest Pain Guideline⁹, the use of coronary CTA (CCTA) continues to grow both in terms of clinical volumes and impact on patients¹⁰.  Such growth presents challenges and opportunities, as changes are afoot for clinical services, patient population expansion, workflows, reimbursement, and imaging technology advancements.  All of these were active themes in the more than 200 new science presentations throughout the SCCT meeting.

A host of highly enabling scientific data presentations and discussions focused on (1) technological integration of artificial intelligence (AI)-enabled CCTA tools into daily clinical care and (2) assessment and quantification of coronary plaque burden via CCTA. These headlining topics at SCCT are representative of some of the most exciting opportunities and challenges¹¹ in the field of medicine today.

In the years leading up to and during the meeting itself, it was a great privilege for me to be involved in several scientific studies presented at the meeting, assessing the clinical performance and utility of the HeartFlow RoadMap^TM Analysis (an AI-enabled anatomic visualization to aid clinicians in the interpretation of CCTA images), and the HeartFlow Plaque Analysis, (an AI-enabled quantitative coronary plaque analysis technology):

The RoadMap Analysis

• Clinical performance: The RoadMap Accuracy study found AUCs of 0.93 and 0.88 in per-patient comparisons to QCA for >50% and >70% cutoffs for obstructive disease, respectively.
• Clinical utility: The SMART-CT study found that use of the RoadMap Analysis before or concurrent with CCTA interpretation led to a 25% reduction in time required to read CCTA, with no loss of the clinician’s diagnostic accuracy as compared to invasive QCA.

The Plaque Analysis

• Clinical performance: The REVEALPLAQUE study found that the HeartFlow AI-enabled quantitative Plaque Analysis demonstrated 95% agreement with invasive ultrasound (IVUS), a widely recognized reference standard for coronary plaque assessment, in the quantification of total, calcified, and noncalcified coronary plaque volumes.
• Clinical utility: The DECODE study found that physicians using the Plaque Analysis changed management decisions for 66% of their patients compared to what they had planned based on CCTA alone.

These studies will help clinicians to apply an evidence-first approach to the critical decisions regarding the integration of validated tools that would have sounded outlandish just a few years ago. By understanding both the diagnostic performance and the clinical utility of the technologies before us, we can better ascertain how they will impact our patients and our practices.

In order to move beyond the seemingly Sisyphean expectation laid before all clinicians to do more with less, we must adapt the technologies we employ to support our work. The technologies discussed at SCCT will require changes to our practice patterns, but the evidence is becoming increasingly clear that our adaptation to embrace better tools responsibly will set the stage for highly meaningful clinical breakthroughs.