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PRECISION CARDIOLOGY IN 2018

From genetics to smart watches: developments in precision cardiology

Precision cardiology is a vision of a health-care approach that identifies the optimal course of care for each patient. Although precision cardiology is still in its nascent stage, new approaches and methodologies are being developed to achieve this goal and to overcome technical and implementation barriers. In 2018, several high-impact studies made progress in this direction.

Key advances

  • The utility of genomic data to risk-stratify individuals susceptible to coronary artery disease (CAD) has been demonstrated in a study of 480,000 adults, underscoring the importance of identifying the heritable component of CAD risk early in life2.

  • The mSToPS trial demonstrated that a home-based, self-applied, wearable electrocardiogram patch could improve diagnosis of atrial fibrillation (AF) and reduce the risk of stroke compared with routine care; similarly, early detection of AF could be achieved by a commercially available smart watch coupled with a deep neural network4,5.

  • The feasibility of using a personalized virtual-heart methodology to determine the optimal ablation targets for infarct-related ventricular tachycardia and to directly guide patient treatment has been demonstrated6.

  • Computational modelling has been utilized to guide tissue-engineering of cardiac valves that uses patient cells, helping to overcome the limitations of earlier engineered valves8.

  • The concept of utilizing individualized, 3D-printed occluders for the left atrial appendage has been proven, bringing us a step closer to the fabrication of durable, personalized cardiovascular implants9.

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References

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    Fishman, G. I. et al. Sudden cardiac death prediction and prevention: report from a National Heart, Lung, and Blood Institute and Heart Rhythm Society Workshop. Circulation 122, 2335–2348 (2010).

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    Inouye, M. et al. Genomic risk prediction of coronary artery disease in 480,000 adults: implications for primary prevention. J. Am. Coll. Cardiol. 72, 1883–1893 (2018).

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    Andrade, J., Khairy, P., Dobrev, D. & Nattel, S. The clinical profile and pathophysiology of atrial fibrillation: relationships among clinical features, epidemiology, and mechanisms. Circ. Res. 114, 1453–1468 (2014).

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    Steinhubl, S. R. et al. Effect of a home-based wearable continuous ECG monitoring patch on detection of undiagnosed atrial fibrillation: the mSToPS randomized clinical trial. JAMA 320, 146–155 (2018).

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    Tison, G. H. et al. Passive detection of atrial fibrillation using a commercially available smartwatch. JAMA Cardiol. 3, 409–416 (2018).

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    Prakosa, A. et al. Personalized virtual-heart technology for guiding the ablation of infarct-related ventricular tachycardia. Nat. Biomed. Eng. 2, 732 (2018).

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    Yacoub, M. H. & Takkenberg, J. J. Will heart valve tissue engineering change the world? Nat. Clin. Pract. Cardiovasc. Med. 2, 60–61 (2005).

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    Emmert, M. Y. et al. Computational modeling guides tissue-engineered heart valve design for long-term in vivo performance in a translational sheep model. Sci. Transl Med. 10, eaan4587 (2018).

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    Robinson, S. S. et al. Patient-specific design of a soft occluder for the left atrial appendage. Nat. Biomed. Eng. 2, 8 (2018).

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    Yu, C. M. et al. Mechanical antithrombotic intervention by LAA occlusion in atrial fibrillation. Nat. Rev. Cardiol. 10, 707–722 (2013).

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Acknowledgements

N.T. acknowledges funding from the NIH (PD1 HL123271, R01 HL126802 and U01 HL141074) and a grant from Foundation Leducq. N.T. is grateful to Ashish Doshi (Johns Hopkins University, USA) for help in preparing this manuscript.

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Competing interests

N.T. is a founder of CardioSolv, holds an equity ownership interest in the company and acts as its Chief Scientific Officer.

Correspondence to Natalia Trayanova.

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https://doi.org/10.1038/s41569-018-0149-y

Fig. 1: Computational modelling to guide tissue engineering of personalized replacement valves.