The Evolving Practice of Cardiovascular Precision Medicine – Live Course Recap

Abdullah Sarkar, MD

The ACC Health Care Innovation section successfully conducted a live course titled, "The Evolving Practice of Cardiovascular Precision Medicine Virtual," on April 16. I was fortunate to gain complimentary access through a Twitter campaign sponsored by the Health Care Innovation Section's Precision Health Work Group. The half day conference began with its keynote speaker, Clyde Yancy, MD, MSc, MACC, who raised several provocative questions, including "should we treat all black (self-described) patients with heart failure the same?" He continued with an explanation of genetic admixture and how it leads to a great amount of variability in responsiveness to medical therapy. Admixture analysis conducted on patients in the A-HeFT study showed patients with the lowest percentage European ancestry had the greatest responsiveness to the combination medical therapy (in reference to the Class 1 recommendation for African Americans with NYHA Class 3/4 HFrEF to be treated with Isosorbide Dinitrate and Hydralazine). Yancy in his speech proposed, "there may be a more precise way to think about this unique drug responsiveness that goes beyond self-described race and incorporates this phenomenon of genetic admixture." The conference continued with three core sessions:  1) Genomic Medicine in Cardiovascular Disease Prevention and Management; 2) Machine Learning Applications in Cardiovascular Imaging; and 3) Integration of Digital Health Tools for Personalization of Cardiovascular Care.

The first session, Genomic Medicine in Cardiovascular Disease Prevention and Management, started with a primer in genetics—from basics such as defining locus and polymorphisms to different types of mutations. Ultimately, Yancy describes the basics of how a polygenic risk score is calculated. A published example is a combination of the ACC/AHA ASCVD risk score + polygenic risk. To further elaborate on genomic risk prediction, Amit V. Kheram MD, MSc, shared how "DNA is not destiny." Studies have shown that individuals with the same monogenic mutations have varied clinical outcomes based on their polygenic risk. Essentially, a monogenic mutation + low polygenic risk score results in overall risk similar to the general population, whereas a monogenic mutation + high polygenic risk score results in significantly greater risk. Julie A. Johnson, PharmD, also shared her insight into pharmacogenomics — specifically regarding patients using the same drug but with varied efficacy. Guidelines are being developed to direct our use of such drugs including Clopidogrel. In her talk on direct to consumer genomics, Amy Curry Sturm, MS, discussed the associated benefits and risks of the latest products and services.

The second session, "Machine Learning Applications in Cardiovascular Imaging," was introduced by Partho Sengupta, MD, FACC. The first speaker, David Ouyang, MD, FACC, shared his answer to "What Is Artificial Intelligence (AI)/Machine Learning (ML) and How Will It Augment Cardiac Imaging?". This was followed by Neil J. Weissman, MD, FACC, who spoke about a prevalent topic: point-of-care ultrasound/echocardiography. He discussed how recent efforts are utilizing AI/ML to facilitate two key factors: acquisition and interpretation. James Min, MD, and Michael Salerno, MD, PhD, MS, then spoke about CT/nuclear and cardiac MRI, in relation to machine learning, respectively.

The third and final session focused on the "Integration of Digital Health Tools for Personalization of Cardiovascular Care" and despite the great work previous speakers shared, I enjoyed this session the most. Eric D. Perakslis, PhD, MS, spoke about real world evidence and digital therapeutics and how vast this arena really is. In her talk on wearable devices, Jacqueline Shreibati, MD, MS, FACC, from Google Health, described how frequently physicians have to appraise new devices as they are developed. It can be challenging to keep up with U.S. Food and Drug Administration regulations and to know what the device is cleared for and what it is being used for. John D. Halamka, MD, MS, then discussed how to integrate remote patient monitoring into clinical practice. Next, Nikki Batista, MEng, walked the audience through steps it takes to bring technologies to market in her talk on the regulatory environment.

Each session was followed by a panel discussion that encouraged audience questions. At the end of the afternoon, Regina Druz, MD, FACC, wrapped up the conference and highlighted key takeaways, including the importance for partnerships and training resources to engage in personalized cardiac care. This live course highlights the exciting potential of precision medicine as it applies to cardiology and the future of clinical practice. It is available on demand, with exclusive bonus content, until July 16.

Abdullah Sarkar, MD

The article was authored by Abdullah Sarkar, MD.

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