Precision Medicine Transforms Cardiovascular Care
'Precision medicine plays an important role here because if we treat the actual cause of a disease, we have a better chance of slowing its progression. But in the coming years, we must also go one step further by identifying patients who are at high risk of developing cardiovascular disease earlier and, in some cases, even treating them before clinical manifestations occur,' said Landmesser.
Precision medicine is gaining attention in routine cardiovascular care due to improvements in imaging technology, artificial intelligence (AI), and a growing understanding of genetic risk factors. Landmesser noted that these developments are enabling more personalized and effective treatment of the four most common cardiovascular conditions — coronary artery disease, atrial fibrillation (AF), heart failure, and valvular insufficiency — according to the German Heart Report.
Advanced Imaging
He cited one example in the use of optical coherence tomography (OCT) during coronary artery interventions. OCT provides high-resolution imaging, which is analyzed using AI, allowing for more precise guidance for the procedures.
A 2023 study showed that OCT-guided percutaneous coronary intervention (PCI) reduces procedural risk. In the study, 2487 patients with diabetes or complex coronary lesions were randomized to undergo either OCT-guided PCI (n = 1233) or angiography-guided PCI (n = 1254).
The primary efficacy endpoints were the post-PCI minimum stent area assessed by OCT after PCI and failure after 2 years, defined as a combination of cardiac death, target vessel myocardial infarction, or ischemia-related revascularization of the target vessel.
The minimum stent area after PCI was larger in the OCT group than in the angiography group (5.72 ± 2.04 mm² vs 5.36 ± 1.87 mm²; mean difference, 0.36 mm²; P < .001). Target vessel failure within 2 years occurred in 88 and 99 patients in the OCT and angiography groups. Stent thrombosis within 2 years occurred in 6 patients (0.5%) in the OCT group and 17 patients (1.4%) in the angiography group.
A 2024 meta-analysis further confirmed that intravascular imaging with OCT compared with angiography during coronary stent implantation improves both the safety and efficacy of PCI by reducing the risks for death, myocardial infarction, repeat revascularization, and stent thrombosis.
AI-Guided Ablation for AF
AI-driven approaches are also proving more effective in managing persistent and long-standing AF.
The TAILORED-AF study population (n = 370) was randomly assigned to a tailored ablation procedure, as detected by an AI algorithm, in addition to PVI (tailored arm, n = 187) or to a conventional PVI-only procedure (anatomical arm, n = 183).
The primary efficacy endpoint was freedom from documented AF with or without antiarrhythmic drugs 12 months after a single ablation procedure. One year post-procedure, the trial met its primary efficacy endpoint, which was achieved in 88% of patients in the tailored arm compared with 70% of patients in the anatomical arm ( P < .0001 for superiority).
The use of AI for reproducible and reliable identification of ablation target areas was evidently crucial for the observed advantage over the standard treatment, which relies on the subjective assessment of electrograms.
Targeted Genetic Therapies
Landmesser also highlighted the growing role of genetics in precision cardiology. Approximately 10% of the population has elevated levels of lipoprotein(a), which is a genetic cause of coronary artery disease and morphologic calcification of the aortic valve.
'We expect to have specific therapies available in the near future to address this genetic cause of coronary artery disease,' he said. Diagnosis requires only a one-time measurement of lipoprotein(a) levels.
Enhancing Diagnosis With AI
A study in the United Kingdom showed that using large language models significantly improved diagnostic accuracy, particularly for heart failure with preserved ejection fraction (HFpEF). The study found that HFpEF was clinically undiagnosed in 75% of the cases. Patients with undiagnosed HFpEF had a worse prognosis and represented a high-risk group.
'Perhaps AI can also help us make more reliable diagnoses in everyday practice,' Landmesser suggested.
Gene Editing
Looking ahead, Landmesser pointed to gene editing as a potential breakthrough in treating the root causes of cardiovascular diseases. In one study, 36 patients with transthyretin amyloidosis with cardiomyopathy received a single dose of nexiguran ziclumeran (nex-z) based on CRISPR-Cas9. The treatment led to a sustained 90% reduction in serum transthyretin levels over 12 months, meeting both efficacy and safety endpoints. This example demonstrates that, ideally, the cause can be treated causally as early as possible.
'Gene editing studies are primarily conducted in New Zealand, Australia, the United Kingdom, and the United States, and similar trials are expected to begin in Germany within the next year,' Landmesser noted. However, the regulatory approval timeline remains uncertain.
A Promising Outlook
'There is tremendous innovation in cardiology,' concluded Landmesser. 'With more precise imaging, AI-guided interventions, and deeper insights into genetic causes, we are moving toward safer, more effective, and individualized treatments — improving our ability to predict and manage cardiovascular risk.'
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