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A new era in cardiac imaging
How AI is transforming heart care at Sentara Heart Hospital
Cardiology has long faced a unique diagnostic challenge. Coronary artery disease (CAD) can progress silently. Many individuals live with severe arterial blockages without symptoms, a condition known as asymptomatic CAD, placing them at risk for sudden and life-threatening events such as a heart attack.
Over the past five decades, cardiology has developed a wide range of tools to evaluate heart structure and function. These include stress tests, echocardiograms, MRI scans, PET scans, invasive coronary angiography, and cardiac CT scans. Each offers a different balance of accuracy, cost, and risk. Among these, coronary computed tomography angiography (CCTA) has emerged as one of the most advanced non-invasive methods for visualizing coronary arteries.
CCTA allows physicians to identify narrowed segments in coronary arteries and estimate the degree of blockage, often expressed as a percentage (for example, a “70% stenosis”). While useful, this approach has limitations. Human interpretation is inherently selective, and it is not feasible for even the most skilled clinician to analyze every millimeter of plaque throughout the entire coronary artery network.
This gap has opened the door for a major advancement: artificial intelligence.
At Sentara Heart Hospital, physicians are now using Cleerly, a cutting-edge AI platform that has been FDA-approved since 2019. Over the past year, Sentara has integrated this technology into its cardiac imaging workflow.
Artificial intelligence is not replacing traditional imaging; it is enhancing it. After a patient undergoes a CCTA, the images are sent to Cleerly’s AI platform. Within less than a day, clinicians receive a comprehensive, highly detailed analysis.
One of Cleerly’s most important contributions is its ability to analyze plaque composition, not just its size or location. This distinction is critical because not all plaques carry the same risk:
• Soft, non-calcified plaque: Lipid-rich and unstable, this type is more prone to rupture. When it does, it can trigger a clot that abruptly blocks blood flow, causing a heart attack.
• Calcified plaque: More stable and long-standing, this type indicates chronic disease but is less likely to rupture suddenly.
“The holy grail of cardiology is to determine which patients are at highest risk so you can treat them and determine what part of the vessel is most vulnerable,” said Deepak Talreja, M.D., Sentara clinical chief of cardiology. “That is the goal of Cleerly.”
This deeper level of insight is transforming clinical decision-making in several ways:
• Reducing unnecessary procedures: Patients without high-risk plaque may avoid invasive interventions.
• Guiding treatment intensity: Physicians can tailor therapies based on a patient’s total plaque burden and composition.
• Advancing early intervention: The new technology supports a shift toward primary prevention, treating disease before a cardiac event occurs, rather than reacting afterward.
Although still in its early stages, this approach represents a move away from focusing solely on symptoms and toward understanding the underlying disease.
“We have historically reserved our most aggressive treatments for patients who have already suffered a heart attack, but this type of imaging allows us to see the disease before the catastrophe,” said Joshua Cohen, M.D., Sentara structural heart imaging specialist. “AI-enhanced plaque analysis gives us the opportunity to act earlier and/or more aggressively, and with the precision each patient deserves.”
One of the most impactful aspects of Cleerly is its ability to create detailed, 3D images of a patient’s coronary arteries. These visuals highlight areas of plaque buildup and differentiate between high-risk and stable plaque.
For patients, this can be transformative. Abstract numbers like cholesterol levels or percentage blockages become tangible and personal. Seeing their own arteries, and the disease within them, often leads patients to stronger engagement and adherence to treatment plans, whether that involves a procedure, medication, and/or lifestyle changes.
At Sentara Heart Hospital, the adoption of AI-driven tools like Cleerly reflects a broader shift in medicine: toward precision, personalization, and proactive care. With user-friendly reports and physician-guided recommendations, both patients and referring providers are better equipped to understand and act on complex cardiac information.
As this technology continues to mature, it may redefine what it means to truly “see” the heart, not just as a structure, but as a dynamic system whose risks can be understood, quantified, and managed with unprecedented clarity.
Over the past five decades, cardiology has developed a wide range of tools to evaluate heart structure and function. These include stress tests, echocardiograms, MRI scans, PET scans, invasive coronary angiography, and cardiac CT scans. Each offers a different balance of accuracy, cost, and risk. Among these, coronary computed tomography angiography (CCTA) has emerged as one of the most advanced non-invasive methods for visualizing coronary arteries.
CCTA allows physicians to identify narrowed segments in coronary arteries and estimate the degree of blockage, often expressed as a percentage (for example, a “70% stenosis”). While useful, this approach has limitations. Human interpretation is inherently selective, and it is not feasible for even the most skilled clinician to analyze every millimeter of plaque throughout the entire coronary artery network.
This gap has opened the door for a major advancement: artificial intelligence.
At Sentara Heart Hospital, physicians are now using Cleerly, a cutting-edge AI platform that has been FDA-approved since 2019. Over the past year, Sentara has integrated this technology into its cardiac imaging workflow.
Artificial intelligence is not replacing traditional imaging; it is enhancing it. After a patient undergoes a CCTA, the images are sent to Cleerly’s AI platform. Within less than a day, clinicians receive a comprehensive, highly detailed analysis.
One of Cleerly’s most important contributions is its ability to analyze plaque composition, not just its size or location. This distinction is critical because not all plaques carry the same risk:
• Soft, non-calcified plaque: Lipid-rich and unstable, this type is more prone to rupture. When it does, it can trigger a clot that abruptly blocks blood flow, causing a heart attack.
• Calcified plaque: More stable and long-standing, this type indicates chronic disease but is less likely to rupture suddenly.
“The holy grail of cardiology is to determine which patients are at highest risk so you can treat them and determine what part of the vessel is most vulnerable,” said Deepak Talreja, M.D., Sentara clinical chief of cardiology. “That is the goal of Cleerly.”
This deeper level of insight is transforming clinical decision-making in several ways:
• Reducing unnecessary procedures: Patients without high-risk plaque may avoid invasive interventions.
• Guiding treatment intensity: Physicians can tailor therapies based on a patient’s total plaque burden and composition.
• Advancing early intervention: The new technology supports a shift toward primary prevention, treating disease before a cardiac event occurs, rather than reacting afterward.
Although still in its early stages, this approach represents a move away from focusing solely on symptoms and toward understanding the underlying disease.
“We have historically reserved our most aggressive treatments for patients who have already suffered a heart attack, but this type of imaging allows us to see the disease before the catastrophe,” said Joshua Cohen, M.D., Sentara structural heart imaging specialist. “AI-enhanced plaque analysis gives us the opportunity to act earlier and/or more aggressively, and with the precision each patient deserves.”
One of the most impactful aspects of Cleerly is its ability to create detailed, 3D images of a patient’s coronary arteries. These visuals highlight areas of plaque buildup and differentiate between high-risk and stable plaque.
For patients, this can be transformative. Abstract numbers like cholesterol levels or percentage blockages become tangible and personal. Seeing their own arteries, and the disease within them, often leads patients to stronger engagement and adherence to treatment plans, whether that involves a procedure, medication, and/or lifestyle changes.
At Sentara Heart Hospital, the adoption of AI-driven tools like Cleerly reflects a broader shift in medicine: toward precision, personalization, and proactive care. With user-friendly reports and physician-guided recommendations, both patients and referring providers are better equipped to understand and act on complex cardiac information.
As this technology continues to mature, it may redefine what it means to truly “see” the heart, not just as a structure, but as a dynamic system whose risks can be understood, quantified, and managed with unprecedented clarity.
By: Jen Lewis