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Advancements in Tricuspid Regurgitation Treatment

An Insightful Conversation with Dr. Attila Kovács

In this interview, we discuss with Attila Kovács, MD, PhD, med. habil., a Cardiologist and Assistant Professor of Medicine at Semmelweis University who also serves as the Chief Medical Officer of Argus Cognitive, Inc. and General Manager of CardioSight, Inc. Dr. Kovács offers insights into his research and development efforts on right heart diagnostics and treatment, highlighting the challenges, recent technological advancements, and collaborative efforts that can shape the future of treating tricuspid regurgitation.


Can you describe the specific cardiovascular disease you are researching? What makes it a significant public health concern?

Tricuspid regurgitation is a type of valvular heart disease in which the valve between the right atrium and the right ventricle is insufficient, letting blood flow backward, resulting in a hemodynamic burden for the circulation, the liver, the kidneys, etc. With the progressive aging of the general population associated with an increase in comorbidities (atrial fibrillation, chronic obstructive pulmonary disease, heart failure, etc.), the prevalence of moderate/severe tricuspid regurgitation has increased: it is estimated at 3–6% in the general population representing 240-480 million people worldwide.


What are the main challenges in diagnosing this cardiovascular disease, and how does the Argus software help address these challenges?

Diagnosing right heart failure associated with tricuspid regurgitation can be challenging due to its complex nature. At Argus, we have developed an award-winning, FDA-cleared 3D echocardiography-derived software, called ReVISION. It offers a more comprehensive characterization of right ventricular dysfunction, which can be both the cause and consequence of tricuspid regurgitation.  ReVISION provides more granular information that other techniques and parameters clearly miss, thus allowing better diagnosis and risk stratification for these patients.


How is this cardiovascular disease typically treated?

The treatment landscape for severe tricuspid regurgitation has evolved with the advent of transcatheter tricuspid valve interventions. However, quantifying right ventricular (RV) function non-invasively remains critical and challenging. Conventional echocardiographic parameters are often insufficient for patient selection and procedure planning. ReVISION is clearly a step forward, and several prospective studies are underway to establish its added value. However, the toolkit of interventional cardiology is also in an early development phase: what works for the left heart does not necessarily work for the right heart. Thus, there is a huge space for innovative interventional devices and procedures in tricuspid valve interventions. This is precisely where pioneering solutions, such as CardioSight, come into play.


How does the Medres-designed Cardiosight tool specifically enhance the treatment process?

CardioSight is an advanced intracardiac visualization and intervention platform that provides minimally invasive guidance and delivery of intracardiac devices under direct, near-field optical visualization. This contact optical visualization technology can be a huge advantage in proper visualization and provides substantial advantages, such as improved accuracy during the procedures, enhanced instrument to tissue contact detection, and reliable verification of procedural success.


How effective is your collaboration with the Medres team during the development process?

Our collaboration with the Medres team is exceptionally productive. We work closely together throughout every stage of the development process, allowing us to dynamically respond to challenges and quickly iterate on our prototypes. The Medres engineers are skilled and dedicated, and their enthusiasm, flexibility, and professionalism significantly propel our project’s progress.


Looking towards the future, what advancements do you foresee in the field of cardiology concerning diagnostic and therapeutic tools?

My vision is to integrate innovative, state-of-the-art hardware and software tools. I can foresee that in the near future, we will routinely use ReVISION for patient selection and procedure planning, while a CardioSight-guided minimally invasive procedure will be used to repair the valve. Then, procedural success and further risk for deterioration could be further specified by a postoperative ReVISION analysis. We are working with great hardware and software engineering teams to fulfill these ambitious goals. We are confident that our collaborations will bring further advancements and improvements to cardiac care.