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Why Every Cardiac Patient Needs a Virtual Heart

the_newsbeagle writes: In the latest high-tech approach to personalized medicine, cardiologists can now create a computer model of an individual patient's heart and use that simulation to make a treatment plan. In this new field of computational medicine, doctors use a patient's MRI scans to make a model showing that patient's unique anatomy and pattern of heart disease. They can then experiment on that virtual organ in ways they simply can't with a flesh-and-blood heart. Proponents say this tech can "improve therapies, minimize the invasiveness of diagnostic procedures, and reduce health-care costs" in cardiology.

48 of 62 comments (clear)

  1. Every patient? by Anonymous Coward · · Score: 1

    Or just those who can afford to pay for this?

    Oh, that's right, in America, the poor are expected to just hurry up and die instead of getting good treatment.

    And you clowns think this is the natural order of things.

    Assholes. It's your rich libertarians who need to be allowed to die.

    1. Re:Every patient? by Anonymous Coward · · Score: 1

      In America "the poor" get free healthcare.

    2. Re:Every patient? by i+kan+reed · · Score: 1

      By and large, better treatment options cost less, not more, than the status quo.

      Every once in a while, changes are things like "get an MRI scan as part of your lab work", which adds more than it takes(but saves lives). But things like this that prevent readmission is as good for the patient financially as it is medically.

    3. Re:Every patient? by jbmartin6 · · Score: 1

      Sorry, I know a couple families who are poor and get free preventative care through various government programs. Including prescription medicine. So in addition to being a coward, you are also a moron by your own criterion.

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      This posting is provided 'AS IS' without warranty of any kind, implied or otherwise.
    4. Re:Every patient? by Morpeth · · Score: 1

      Take a breath, have your coffee, and post trying posting again in a way people might actually engage you in actual conversation. While I may get where you're trying to go with your points, your delivery is severely lacking.

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      'The unexamined life is not worth living' - Socrates
    5. Re:Every patient? by Morpeth · · Score: 1

      He's right, and it's called Medicaid, though you have to be extremely poor to get on it, many working poor are 'too wealthy' to be eligible.

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      'The unexamined life is not worth living' - Socrates
    6. Re:Every patient? by jbmartin6 · · Score: 1

      There are also various state level programs, of course these vary by state. It is, though, generally easier for children than poor adults.

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      This posting is provided 'AS IS' without warranty of any kind, implied or otherwise.
    7. Re:Every patient? by ShanghaiBill · · Score: 2

      By and large, better treatment options cost less, not more, than the status quo.

      It is not clear that this treatment option is "better". So far there is no evidence that 3D heart models result in better health outcomes. Even if they do, it is not clear that this is the best way to spend healthcare dollars. Doctors love shiny new technology, patients like to feel they are getting the "best" care, and neither has much incentive to care about the cost.

    8. Re:Every patient? by hawkeyeMI · · Score: 2

      I'm working on the first clinical trial for this (the author is my former PhD advisor). There is good retrospective evidence in humans (described in the article) and I am trying very hard to start getting prospective data. Um. Ask me anything?

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    9. Re:Every patient? by AK+Marc · · Score: 1

      Yeah, America. The place where you show up at the hospital with Ebola and are sent home with aspirin and antibiotics. "Best in the world".

    10. Re:Every patient? by Skidborg · · Score: 1

      "A couple families" is not everybody. There are many, many people who are going without because they do not meet the specific requirements for government assistance.

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      Supporter of the +1 Over Dramatic mod option. In memory of apk.
    11. Re:Every patient? by AK+Marc · · Score: 2

      LOL, you expect us to believe you saw "wait times" advertised on billboards for hospitals in the US? I've never seen one in the US. Usually, if you need an ER, you don't drive around for hours shopping ERs. So there's no reason to advertise them.

      Seems much more likely that you are an American who found a canadian site (probably off a conservative blog rant) and are lying to make it seem like the care in the US is anything but poor. I've been to doctors on 5 continents. The US medical system is the worst, unless you are a billionaire with a rare disease.

      I looked online and could see lots of places listing Canadian or Australian wait times, but not the US. They don't list them, track them, or care about them. That you saw so many, when I've never seen one in the USA makes me think you are a liar.

    12. Re:Every patient? by Stan92057 · · Score: 1

      My mom was on medicare they get the least expensive treatments because they don't have expendable income 1543.00 i believe a ss recipient gets before medicare payments and or penalties.

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      Jack of all trades,master of none
    13. Re:Every patient? by tomhath · · Score: 1

      The guy showed up at the hospital with a fever. Doctor wasn't told that he might have been exposed to Ebola. It has nothing to do with whether he intended to pay for the care or not.

    14. Re:Every patient? by GungaDan · · Score: 1

      OK - I'll bite. Dollars seem to be pretty negligible here. Equipment to capture the images? Already there. Hardware to generate the model? Sunk cost - re-up every 3 years to keep it fresh. Software development? More or less done, not that it is a prohibitive cost in the first place. Administration of the hardware? They still pay sysadmins somewhere? Training on how to use it? Surely not much more than the cost of a hospital aspirin per trainee.

      What's the huge financial burden here?

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      Eloi are stupid, throw morlocks at them!
    15. Re:Every patient? by ShanghaiBill · · Score: 1

      Um. Ask me anything?

      1. How much does the system cost for one installation?
      2. What is the incremental cost of using it for one additional patient?
      3. How much training is required to use the system, and to interpret the results?

    16. Re:Every patient? by LifesABeach · · Score: 1

      The thing I noticed when I RTFA was a total lack of hardware used. I cannot help but wonder if this modeling technology couldn't be applied to some type of i7 mother board and Blender3D?

      The other thing I noticed was I RTFA.

    17. Re:Every patient? by AK+Marc · · Score: 1

      Doctor wasn't told that he might have been exposed to Ebola.

      The nurse was told when she gathered the patient history.

      Are you saying that process incompetence is fine, so long as it's bad for the patient, but medical malpractice is not ok, even when they get the same result?

    18. Re:Every patient? by hawkeyeMI · · Score: 3, Informative

      1. The system is run offsite, it doesn't currently have any installation costs.
      2. It depends on what you factor in. There are a lot of costs to cover engineering and so on. The patient needs an MRI if they weren't already going to have one. That's the biggest cost depending on the hosptial (~US$2k). It's not currently being sold and pricing will have to be determined.
      3. We operate the backend, all the doctors have to do is upload the MRI. Minimal training is required to interpret the results. We're working on presenting the data to EPs in forms they are already familiar with.

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    19. Re:Every patient? by hawkeyeMI · · Score: 3, Informative

      The largest financial burden per-patient is the imaging. An MRI can cost over $2k. The rest of the cost is going to have to do with getting a software-based medical device approved, which requires substantial software re-engineering and clinical trials to satisfy the FDA.

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    20. Re:Every patient? by LifesABeach · · Score: 1

      I've got a 92% blocked at the mouth of a "Y" artery on my heart. Doc Ashokar Gupta says a By-Pass won't work, nothing to by pass to. I also said to him, "don't at the veins on my leg for a solution either." I'm thinking put a tube/shunt in it to open the "Y" up; gambling that it will seat properly. Would this be a good test case? I dead serious.

      Off topic question, "what is the hardware configuration that's being used for the testing and imaging?" That would be cool to know.

    21. Re:Every patient? by AK+Marc · · Score: 1

      From your link: "there was a large difference in predicted vs. actual ED wait times. "

      Great. I haven't seen them, and they are not recommended by the article you posted that referenced them, and in fact what you posted indicated the times were wrong and misleading.

    22. Re:Every patient? by hawkeyeMI · · Score: 1

      Imaging is done on hospital MRI scanners. Image processing is done on normal Linux workstations using COTS and OS software. Simulations are run on Penguin on Demand at the moment (Beowulf cluster... yes really).

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    23. Re:Every patient? by LifesABeach · · Score: 1

      Oh crap! I thought someone was sketching out a sit-com for middle schoolers. All the sudden the I get paid to do just got more interesting.

    24. Re:Every patient? by Anonymous Coward · · Score: 2, Interesting

      I got my Ph.D. in this industry as well(patient-specific cardiovascular modeling). I'm posting AC, but I'm not HawkeyeMI. There is definitely some work in this field that is probably not going to improve outcomes. Maybe the uncertainties of CT/MRI images produce simulated "outcomes" that don't match reality. Or maybe you get a good image, and do a simulation for a patient that needs a bypass graft. You find that the 'best' angle for the bypass graft in patient A is to be stitched on at 17 degrees from the native tissue, but that an error of more than a degree or two negates all benefit of your simulated result. Really, there are all kinds of reasons that efforts like this end up not being practical. Some work is so impractically expensive in terms of computational time that it will never see clinical usage for that fact alone. In defense of a lot of this, you can't really know what's workable without trying, and a lot of research codes are readily admitted to be more of a 'proof-of-concept' rather than 'ready-for-clinical-use-and-patents'. But I digress.

      I've had the pleasure of hearing Dr. Trayanova speak at conferences. Conferences held in medical facilities with clinicians and surgeons speaking as well, not just computer modeling wonks. Her work really is very promising and appears to be further along than many others in this field. She has the respect of computer modellers and surgeons alike. I for one trust her if she says this is getting ready for a larger-scale rollout. She does comes off as a bit arrogant, but I'll afford her that.

      Not all that response was intended for you, ShanghaiBill, but there were a couple other posts accusing her of being a walled-off engineer working in a vacuum. Thought I'd just post my point of view all in one place.

    25. Re:Every patient? by pnutjam · · Score: 1

      I pass one all the time.
      http://en.wikipedia.org/wiki/Lutheran_Health_Network

      http://www.lutheranhealth.net/...

    26. Re:Every patient? by LifesABeach · · Score: 1

      Cool, what do I tell Doc Ashokar when I go under the knife in 50 days so that the information can be transfered to the data base of test patients. I'm dead serious.

    27. Re:Every patient? by AK+Marc · · Score: 1

      I've not been to IN for 10 + years, never saw one then. And I've been in Alaska for a while, they must be a new trend.

    28. Re:Every patient? by LifesABeach · · Score: 1

      I will.

    29. Re:Every patient? by tomhath · · Score: 1

      Nope. I'm saying one mistake is not representative of healthcare in the US. And if I went to a hospital feeling sick a few days after being with someone who had Ebola I'd sure as heck make sure the doctor I talked to knew it.

    30. Re:Every patient? by AK+Marc · · Score: 1

      Nope. I'm saying one mistake is not representative of healthcare in the US.

      I'm saying that mistakes are representative of healthcare in the US, and that's just one of many examples.

      And if I went to a hospital feeling sick a few days after being with someone who had Ebola I'd sure as heck make sure the doctor I talked to knew it.

      He did. Would you repeat your medical history to everyone that you see? Or would you tell it once to the person that asks, and assume that everyone who sees you saw your chart? If you repeated your medical history to everyone in the hospital, they'd put you in the psych ward, rather than the Ebola ward.

  2. Cost less? Doubtful. by Overzeetop · · Score: 2

    The cost of alternative treatments is set based on the cost of the original treatment. Just because it is cheaper to produce doesn't mean that the cost to the end recipient is going to reflect that. If there is a $200,000 surgery to correct your defect, and for $180,000 we can cure you without surgery, that $18,000 sounds like a bargain. There is no effective competition, so whether that cure costs $100 or $10,000, the $180k price will stick. Of course, if surgery isn't necessary, we could do the procedure to more borderline cases - ones that might never need surgery. If we catch just 15% extra people that would have opted out of surgery, we have spent more money.

    I'm not convinced that a cardiac surgeon is going to cost less if he spends 8 hours experimenting on a heart and 4 hours in surgery vs 2 hours reviewing current imaging data and 6 hours in surgery.

    As someone who works with computational models, knowing the exact answer is not always going to lead to a more effective or useful result in the field. Knowing you need a 1.77245 mm incision has little value over knowing that a 1.8mm incision will work with a scalpel operator which is only accurate to 0.2mm. There will always be shoulder cases where it may make a difference, but are you willing to pay 3X the cost for every procedure to cover the 10% in which it might make a difference? (That's a trick question, by the way, because you aren't paying, your insurance company is - and I can almost guarantee what their answer will be)

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    Is it just my observation, or are there way too many stupid people in the world?
    1. Re:Cost less? Doubtful. by hawkeyeMI · · Score: 3, Informative

      The difference in procedure time will be substantial. Right now most of the time spent on a VT ablation is for mapping the rhythms and scar. We can pretty much eliminate that (trials ongoing), meaning the procedure can be cut from 4-12 hours down to 2-3 hours, reliably. Considering the cost of time in the EP lab, the savings can be quite large. When it comes to ICDs, risk stratification is really important. If we can avoid putting in unnecessary devices which cost (not counting implantation) $25k-$55k, that's a big savings.

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    2. Re:Cost less? Doubtful. by AK+Marc · · Score: 2

      As someone who works with computational models, knowing the exact answer is not always going to lead to a more effective or useful result in the field. Knowing you need a 1.77245 mm incision has little value over knowing that a 1.8mm incision will work with a scalpel operator which is only accurate to 0.2mm.

      You are presuming the only use is surgical accuracy. You are wrong. It could be choosing between an shunt and a stent. Or determining if a leak or defect is bad enough that it requires surgery, or if alternative treatments would be effective, forgoing surgery completely.

      It's not about optimizing the surgery, but determining whether it's even needed, or what to do if it's done.

    3. Re:Cost less? Doubtful. by Anonymous Coward · · Score: 1

      > I'm not convinced that a cardiac surgeon is going to cost less if he spends 8 hours experimenting on a heart and 4 hours in surgery vs 2 hours reviewing current imaging data and 6 hours in surgery.

      As someone who has had 3 open heart surgeries from age 2 to 40 with some less severe procedures along the way. My first memory is being wheeled into an operating room and my last surgery was a few years ago. This is obviously not for everyone (as the article suggests), but it's important for many people as heart surgery becomes more routine. My story, multiple heart surgeries by the age of 10, is no longer an unthinkable occurrence.

      It is a necessity to get every image you can of a traumatized heart that has been cut up and sewn together a number of times. The body repairs the tissues in unpredictable ways and forms aberrant structures. Any imaging or modeling is a leg up. This breakthrough does not address the invisible electrical pathways that allow the heart to properly regulate. Cut the wrong patch of tissue and a section of the heart will basically stop (woot, you get a pacemaker for life). Modeling can only help with the gross deformities, which is also a danger in a geriatric organ.

      The imaging does open the door to more extreme and experimental procedure research, and that's also worth something. The cost savings are in survival rates. Survival rates increase the stats of the doctors, which keeps insurance costs lower and results in higher donations and better grant opportunities. I usually get the best surgeons Kaiser Permanente has to offer.

      Prior to a surgery, I work out for 2 hours pretty much every day to build mass, strengthen the heart as gently as physically possible (my mantra is, I'm doing this so I don't die). Sometimes it's a large window (you'll need surgery sometime in this decade) so it's a long road. My surgeries usually cost 1 million and my Lexus sized payment has been looming over me, my whole life (I rent, have a reasonable car, make less than 100k/yr) . I gladly pay my (reduced!) obama care platinum and every day I don't need to exercise it is another win.

    4. Re:Cost less? Doubtful. by LifesABeach · · Score: 1

      My Nitro is within arms reach. I understand

      Everyday you exercise beats the alternative. After reading the article, my first question was, "Is there an App for that?" It can't come fast enough.

  3. Re:Computational Medicine by hawkeyeMI · · Score: 1

    These are preliminary results. They have not been published yet.

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  4. Re:Computational Medicine by hawkeyeMI · · Score: 2

    However, here is a peer-reviewed paper using the same technology. http://www.heartrhythmjournal....

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  5. if this had been posted on October 31st... by swschrad · · Score: 1

    the headline would have been, "Researchers improve their simulations significantly when perfecting their vision on random patients' live, beating hearts."

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    if this is supposed to be a new economy, how come they still want my old fashioned money?
    1. Re:if this had been posted on October 31st... by LifesABeach · · Score: 1

      That sounds like a great idea for a movie plot, and a game idea; cool.

  6. Re:Meaningless! by hawkeyeMI · · Score: 1

    This research is being done in cooperation with EPs at JHU and some other top insitutions. It's not being done in a vaccum. We have retrospective validation and prospective is ongoing.

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  7. Re:Computational Medicine by Anonymous Coward · · Score: 1

    Thanks. Is the code available somewhere so others can play with it?

    It looks like this was the software used, which appears impressive:
    http://research.cardiosolv.com/services/

  8. OK, here goes by marsu_k · · Score: 1

    <3 <3 <3 <3 <3 <3 <3 <3 <3 <3 <3 <3 <3 <3 <3 <3 <3 <3 <3 <3 <3 <3 <3 <3 <3 <3 <3 <3 <3 <3

    (virtual hearts for cardiac patients)

  9. Re:Computational Medicine by hawkeyeMI · · Score: 1

    Unfortunately it's not open source, but yes, you've got the right site. That's us. The services on that site are outdated, however.

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  10. Re:Computational Medicine by LifesABeach · · Score: 1

    OpenGL on a Smart Phone never looked so good as it does right now.

  11. Misses point: most heart disease nutritional by Paul+Fernhout · · Score: 2

    https://www.drfuhrman.com/libr...
    "Interventional cardiology and cardiovascular surgery is basically a scam based on a misunderstanding of the nature of heart disease. Searching for and treating obstructive plaque does not address the areas of the coronary vascular tree most likely to rupture and cause heart attacks. If there was never another CABG or angioplasty performed or stent placed, patients with heart disease would be better off. Doctors would be forced to educate our citizens that their heart disease risk is determined by what they place on their forks. Millions of lives would be dramatically extended. To abandon the theory of stretching and cutting out areas with plaque would shut down interventional cardiology, nearly all cardiovascular surgery, and many suppliers of the biotechnology. In many cases, interventional cardiology is the major income generator to hospitals. The ending of this ill-conceived, out-dated and ineffective technology would dramatically downsize hospitals in the United States and free up over $100 billion annually in medical care costs. Besides being ineffective, interventional cardiology places the responsibility in the hands of the doctor and not the patients. When patients finally realize they must take control of their heart problems with aggressive dietary modifications (and when needed medications for temporary periods) we will essentially solve the health crisis in America.
        The sad thing is surgical interventions and medications are the foundation of modern cardiology and both are relatively ineffective compared to nutritional excellence. My patients routinely reverse their heart disease, and no longer have vulnerable plaque or high blood pressure, so they do not need medical care, hospitals or cardiologists anymore. The problem is that in the real world cardiac patients are not even informed that heart disease is predictably reversed with nutritional excellence. They are not given the opportunity to choose and just corralled into these surgical interventions.
        Trying to figure out how to pay for ineffective and expensive medicine by politicians will never be a real solution. People need to know they do not have to have heart disease to begin with, and if they get it, aggressive nutrition is the most life-saving intervention. And it is free."

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    A 21st century issue: the irony of technologies of abundance in the hands of those still thinking in terms of scarcity.
  12. Re:Not really . . . by LifesABeach · · Score: 1

    Folks have to start somewhere. The cardial system is fairly pridictable. Maybe the use of the equipment was that it was the stuff available. Maybe porting this application to a smart phone? Other groups could use the same techniques as applied to their specialities. And we all have to change smart phones in couple years anyway; it would make a hell of a upgrade.

  13. Models of the Heart by ShakaUVM · · Score: 1

    I used to work in the "new" field of computational medicine about 15 years. (Is 15 years new? I don't think so - and some of those heart models well before my time.) The Cardiac Mechanics Computational Group at UCSD, if anyone cares.

    Personalized medicine was a very big driver for the models we were working on. You could introduce ischemias or other defects into the modeled heart tissue and observe how it changed the propagation of potentials across the tissue surfaces.

    I personally worked on smaller models of just one heart cell, with the purpose being that you could see what the impact various drugs would have without needing to do millions of dollars of testing. Got a drug you know will change the sodium permiability or whatever? Alter the constant in the model, and run it. Proctor and Gamble funded the research that funded me, and was pretty happy with the results, I think.