Developing Leading-Edge Computational Tools at the Center for Digital Cardiovascular Innovations

The renowned physician-scientist Yiannis S. Chatzizisis, M.D., Ph.D., has dedicated his career to addressing cardiovascular disease.

Now, the professor and chief of the Division of Cardiovascular Medicine at the University of Miami Miller School of Medicine is studying and deploying leading-edge computational tools to help interventional cardiologists deliver the highest level of patient care.

“We are bringing together artificial intelligence (AI), computational simulations and extended reality—collectively called AISER—at our Center for Digital Cardiovascular Innovations,” said Dr. Chatzizisis, who leads a multidisciplinary team at the only such laboratory in the United States. “The center’s goals are to provide support for early decision-making and accelerate cardiovascular procedures in order to improve patient outcomes.”

Technology to Create Digital Twin of Heart Arteries

Three-dimensional imaging, AI and powerful computational tools can create a “digital twin” of the patient’s heart arteries, allowing interventional cardiologists to clearly visualize the diseased area and model how well different stents could restore blood flow. Dr. Chatzizisis is also studying how AI applications could accelerate the process so interventional cardiologists can use these digital tools in real time at the cardiac catheterization laboratory to plan the procedures for each patient.

Currently, coronary artery interventions like stents to open blockages are highly effective in restoring blood flow. But up to 30 percent of patients require follow-up treatment.

“We have an opportunity to do a better job by using these advanced AISER computational tools,” Dr. Chatzizisis said.

The digital tools can also assist interventional cardiologists and cardiac surgeons by modeling heart valves in structural heart disease cases and supporting peripheral artery disease interventions.

“Along with helping physicians navigate through difficult procedures, a digital twin can also boost patients’ piece of mind,” Dr. Chatzizisis added. “Physicians can share digital twins with patients and families, showing high-resolution, 3D simulations of their specific anatomy and describing the upcoming procedure.”

Dr. Chatzizisis’ work is funded by grants from the National Institutes of Health (NIH), industry and philanthropy. He is also collaborating with industry to accelerate the research and development process for new cardiovascular devices.

“There is a big push by the U.S. Food and Drug Administration to find smarter and cost-effective ways to accelerate cardiovascular device research, development and regulatory approval, and these digital tools are exactly what we need,” he said. “Being able to find innovative solutions for cardiovascular disease and translate them to patient care keeps me energized and full of ideas for the future.”

Focus on Complex Coronary Cases

At the Miller School, Dr. Chatzizisis focuses his clinical practice on coronary bifurcations, where several diseased arteries come together.

“These cases require special skills and techniques to deliver multiple stents to the right location,” he said, adding that his current projects include working on treatment recommendations for these challenging cases.

Dr. Chatzizisis now serves as chair of the SCAI Bifurcation Club, a North American society of interventional cardiologists who focus on minimally invasive cardiovascular interventions, and is a board member of the European Bifurcation Club, which honored him with its “Bifurcation Person of the Year” award in 2021.

Through the years, Dr. Chatzizisis has written more than 200 manuscripts published in Circulation, Journal of the American College of Cardiology, Arteriosclerosis, Thrombosis and Vascular Biology, Cardiovascular Research and Atherosclerosis, among other journals. His research has received more than 10,000 citations and he has been honored with more than 40 international and national awards.

Drawing on his work at the Miller School’s center, Dr. Chatzizisis was the lead author of “First-in-Human Computational Preprocedural Planning of Left Main Interventions Using a New Everolimus-Eluting Stent,” and senior author of “Artificial Intelligence, Computational Simulations, and Extended Reality in Cardiovascular Interventions,” both published in the Journal of the American College of Cardiology family journals in 2022 and 2023, respectively.

“Patient-specific computational simulations have the potential to help interventional cardiologists pre-procedurally plan cardiovascular interventions,” he wrote in these publications.

Center for Digital Cardiovascular Innovations

To advance cardiovascular research and clinical care, Dr. Chatzizisis has brought together the disciplines of science, engineering and medicine at the Center for Digital Cardiovascular Innovations, with a team that includes biomedical engineers, computer scientists, AI and computer vision experts, physicians and biologists.

“Our first step is to build three-dimensional digital twins of the patient’s heart arteries from two-dimensional images,” said Wei Wu, Ph.D., assistant professor of medicine at the Miller School and chief engineer at the center. “This is truly a team approach, as physicians want to know the three-dimensional shape of the diseased areas and how the disease developed. At the same time, the engineers rely on the doctors’ knowledge as to where to focus their three-dimensional reconstructions.”

Next, the team develops patient-specific simulations for addressing complex coronary artery disease.

“Most stents are very small, so it can be difficult to know the exact shape and size to implant,” said Dr. Wu. “We can model different stents, drawing on our mechanical engineering knowledge to show how the stents will expand in the heart arteries.”

The team also conducts hemodynamic simulations to predict how the blood flow in the blocked arteries will be influenced by placing stents.

“We have the engineering and computer power to do both types of simulations at our center,” said Dr. Wu. “These simulations may allow the operators to predict the outcome of different stent implantation scenarios so they can choose what’s best for each particular blockage.”

Under Dr. Chatzizisis’ guidance, the center’s powerful combination of technology and medical skills are also being applied to help patients who need coronary artery bypass graft surgery (CABG) to treat advanced coronary artery disease. These open-chest surgical procedures use a patient’s own veins or arteries to bypass the blocked arteries.

“We can simulate different scenarios in advance for the surgeon, helping to better plan the procedure, reduce the time in the operating room, and hopefully improve the clinical outcomes for the patients,” said Dr. Wu.

AI to Expedite Heart Disease Treatments

The next stage in the center’s research involves bringing complex 3D scans and simulations to physicians in real time.

“When a patient is diagnosed with severe coronary artery disease, the cardiologists and surgeons can’t wait several hours to see a simulation to make decisions about the treatment plan,” said Dr. Wu. “So we are studying how AI-assisted technologies could reduce the computational time to a few minutes after the images are taken. This will help the operators tremendously.”

Another groundbreaking step involves bringing the 3D simulations, as well as enlarged images of the heart arteries and valves, to doctors wearing virtual or augmented reality headsets.

“Being able to see exactly the individual patient’s heart anatomy and steps of the interventional procedure is another way our research can help cardiologists and surgeons make good decisions for their patients,” Dr. Wu said.

AISER technologies can also be a great tool for medical education, giving physicians and students the ability to immerse themselves in the digital twins, said Dr. Chatzizisis.

“These powerful new tools can help train medical students, residents, fellows and early-career clinicians by allowing them to visualize the diseased heart arteries and valves, and devices used to treat these conditions,” he said. “It is another example of how our work at the Center for Digital Cardiovascular Innovations is helping to change the landscape of cardiovascular interventions and shape the cardiac catheterization laboratory of the future.”

Tags: artificial intelligence, Cardiovascular Division, Center for Digital Cardiovascular Innovations, coronary artery disease, Dr. Wei Wu, Dr. Yiannis Chatzizisis, heart disease, technology