This is the FUTURE of Heart Health | ClearCardio

Hello everybody, this is Dr. John Osborne, the Chief Medical Officer of Cleer Cardio, and today we have something very special for you. We're going to give you an insight into what happens when we do, and the data that we get when we do, a Cleer Cardio scan, and I'm going to walk you through it. So when we do the scan, we'll see something like this. So this is what we see. I know you really can't see the detail here, and that really doesn't matter. But what we've done with this is we've taken these beautiful, high-resolution, 3-dimensional images of the heart. We can see the heart sliced in all the different dimensions here. We can then isolate, with our AI technology, isolate just the blood vessels of the heart. That's what we're seeing here. And the yellow vessel you're seeing is one of the blood vessels of the heart. And what we're looking at here in this window is that vessel, now with the magic of computers, straightened out, and then we can look at that vessel basically rotating around the vessel. This is important because plaque doesn't behave like rust in your blood vessels. It's not concentric, sort of lining the vessel uniformly. It tends to be eccentric, that is, it can be at between 3 to 4 o'clock, or et cetera. The other important thing about plaque is that plaque always forms, as I like to say, in the donut and grows outwards, which most people don't know that. It actually forms in the donut, not in the hole, the donut hole. It forms in the donut and early on, literally for years, could be decades, grows outwards, which is why historically when we did tools like stress testing, Stress testing only begin to detect the disease of plaque when that plaque has already grown outward, which could be years to decades, then begins to grow inward and causes an over 70% blockage. That's when your stress test becomes abnormal or when we start having symptoms. So stress testing are very, very insensitive to detect early plaque. In fact, they Can't. Beyond that, stress tests also suffer from the problem, the fact that they don't visualize directly the blood vessels, as we are showing you here. Instead, they are looking for problems with blood flow, but problems with blood flow don't begin until we already have a 70% blockage. And by that point, we are probably ready for mechanical fixes, balloons, stents, bypasses. bypasses, those kinds of things, because the disease has literally a several-year drop on us, a several-year or even decade drop on us, if you will, long before that— we've already formed a severe blockage, and the plaque has been there literally for minimal years to even decades. When we actually directly measure the blood vessels and see the blood vessels, as we do on cardiac CT, we can see the earliest of plaque. We can also detect plaque at the very minimal level, as I like to say, a speck of plaque. And I'm going to walk you through all of the additional information we get about plaque that becomes very, very important for both diagnosis, for monitoring, and also for your own personalized treatment plan. So this is what the images look like. We're taking that vessel, we've straightened that vessel out. This image here is actually looking down the barrel of the vessel. So this is now a cross-section of that particular vessel located right where that red line is. And if this were live data, which it's not, we can literally move up and down that blood vessel, fly through the blood vessel, and literally fly through the blood vessel. The AI will detect the donut hole, but most importantly, will detect the plaque out in the doughnut or the wall of the vessel. What we're looking at here in the straightened versions of that blood vessel is we can see the plaque, and remember, it always starts out in the wall of the vessel and will grow outwards. So we can literally see these plaques out in the wall of the vessel. Also, what I'll show you here in a moment is that there really is a lot of plaque here. We'll talk about the different kinds of plaque, which become very, very important in a second. But there's a lot of plaque here in this blood vessel, but importantly, there are no severe narrowings. This is a person who would have a completely normal stress test. In fact, even when we used to do, because I stopped doing those 20 years ago, even when we used to do heart catheterizations or invasive angiograms, that's where we take you to the hospital, put catheters or tubes in the groin, now we put them in the wrist, put them up into the heart. It's invasive, it's expensive, risk of complications can ensue— heart attacks, strokes, bleeding, infection, etc. Those tests only show me the doughnut hole. They can't see what's happening in the wall where plaque always forms. With cardiac CT, we avoid that because we can see both the doughnut hole as well as what's happening out in the doughnut, and that really becomes critical for early detection. So here you can see areas of lots of plaque. You can see it's growing outwards. You can see how much it grows outwards, but the channel is really relatively normal. There is no severe blockage. This patient doesn't need mechanical therapy, balloons, stents, and bypass surgeries. What this patient needs is medical therapy, diet, exercise, lifestyle, getting the factors that cause plaque in a very personalized way addressed so that we can not only stop the plaque, but yes, we can reverse the plaque as well. So this is what the images look like here. I'll show you next on the next slide. This is a cross-section of the vessel. Now we're looking at it kind of under a microscope, which is what I like to think of cardiac CT with AI is. And you can see this is the channel, the lumen as we call it, or the channel. This is where the blood flows here. And if I, on a heart catheterization, an invasive heart catheterization, which again, I gave up 20 years ago, because I could do this for 5% of the cost, get more accurate data, more precise data, better understanding plaque, and none of the risk of complications. I gave that heart catheterization up 20 years ago. Unfortunately, we still do a couple million of those every year in the United States. But on a heart cath, all I could see would be the donut hole, that is, the channel itself. But you can see there is extensive plaque out in the wall of the vessel, and as we saw before, it is growing outwards. And you can see how much it can grow outwards before it ever begins to grow inwards. So, these almost— pardon the expression— almost look like little pimples on the wall of the vessel. Again, heart catheterization, I can only see the channel. Cardiac CT, we see the whole cardiac vessel. enchilada, if you will. The other thing that we can do with cardiac CT, and this is critical, and up until we had cardiac CT with AI, the only way to understand this, to look at this, to detect it, measure it, literally was an autopsy. This was not detectable with any other technology until we had cardiac CT and AI. Most people, as you can understand, decline the opportunity for an autopsy. That's my little sick humor there. So with AI, we can see not just the plaque, we can see the wall of the vessel, we can see the plaque extending outwards, but in these cross-sections, we can see the important different kinds of plaque that make up the, the plaque itself, the different kinds of plaque. So easiest to see, I'll start with here. This is the calcified plaque. So if you ever had a calcium score, which is becoming more popular, and that's great. At least it is a tool that allows us to see the blood vessels to some degree. However, a calcium score can't show me the donut if there's any obstruction or narrowing or blockage. It can't see the donut hole, rather, and all it can see is calcified plaque, the hard plaque. Now, as it turns out, plaque always starts here on the left, and as it grows older, Yeah. Goes and becomes calcified. So it always starts out as what we call low-density, non-calcified plaque. That is the red plaque here. That is the really, really dangerous plaque. That is the rupture— most rupture-prone plaque. That is the plaque that most likely can rupture, pop, break down, flake off, whatever— pop like a pimple, whatever analogy you want to think of. That is the plaque. That causes heart attacks if that vessel is in the heart, or if it's in the neck, that's what causes strokes. That's how you go from, I feel fine, normal stress test last week, to, I'm having a heart attack, or, I'm having a stroke. When those plaques rupture and a blood clot forms in the vessel, we go from adequate blood flow to a clot in the vessel. This occurs within seconds to minutes. We go from, I feel fine, to, I'm having a heart attack or a stroke. But the plaque that caused that literally has been here for years to decades prior, and that is what we can detect with cardiac CT and AI with the Clear Cardio scan. So we actually end up with this: as this plaque gets older and matures, it actually will become calcified. The hard calcified plaque, the extinct volcano, the the extinct volcano or the cinder cone I call it. That is no longer active plaque. It's no longer growing. It's not really prone to rupture. It just sits there. Okay? The problem is that is the plaque we see on a calcium score. The lipid-rich plaque, the soft plaque, the cholesterol-rich plaque, the rupture-prone plaque, the active plaque, the deadly plaque is invisible on a calcium score. So when I do a calcium score, I can't tell you if there are blockages because I can only see the the calcium in the donut itself. I can't see the donut hole. And the other thing is I'm completely blind with respect to any of the lipid-rich plaque, which is the active growing plaque and the dangerous plaque. Calcium score, just the hard plaque here. And again, you can note how much it grows outwards, but how it really starts, literally decades before it ever becomes calcified, is over here. This is all invisible plaque. This is the soft plaque, the cholesterol-rich plaque, the lava as I call it, that is the cinder cone. And with the AI, it allows us to differentiate between these different kinds of plaque. The blue-colored plaque is the hard plaque, that's the end-stage plaque, no longer active, not causing trouble. The red is the most dangerous kind of plaque, it is called low-density non-calcified plaque. Again, you can see it's out in the wall of the vessel. The donut itself is fine, and this is really a beautiful example of what AI allows us to do. You can see the bright white—that's the calcium. However, the lipid-rich plaque, the soft plaque on cardiac CT, is actually dark, so it can be very difficult to see this with with one's eye. So when we see and visualize things, we can see red, green, and blue. On cardiac CT, we get what's called grayscale. On grayscale, we can see up between black and white about 50 shades of gray. Now, as it turns out, every one of the millions of pixels that make up the high-resolution 3-dimensional image of a cardiac CT, all of those pixels are actually encoded with over 2,000 shades of gray. So we can see red, green, and blue, But using AI allows us to see infrared, ultraviolet, X-rays, gamma rays, microwaves, etc. So it takes us from seeing red, green, and blue to the entire, if you will, analogous electromagnetic spectrum. It will then identify that, identify the different kinds of plaque, including the invisible plaque, which is invisible to our eye. And in addition, I'll show you in a moment, we can then importantly, quantify the plaque. We'll talk about that in a moment. So here's the red plaque, the low-density non-calcified plaque, very dangerous plaque. If you see the channel, you can see the channel, the computer will identify the outside of the donut, and then what's between the donut hole and the, and the outside of the donut is the lipid-rich plaque. And you can see it's pretty black, so it's very hard to see this with eye, but when we use AI, It readily shows up. Here we see another form of lipid-rich or soft plaque called non-calcified plaque that is yellow. But again, here there's the doughnut hole, but the plaque actually extends extensively outside of the vessel, outside of the doughnut hole, into the doughnut itself. And again, we can differentiate these 2 kinds of plaque based on the AI analysis. And these 2 plaques are— this is really bad. This is bad, and this plaque, which is easy to see by eye, which is calcified plaque, is actually pretty harmless. It's not really active. This is not lava anymore. This is the lava. This is lava. This is really hot, bad, really nasty lava as well. Lastly, we can now with the AI not only see plaque that we could not see before, we can see the donut. We can see the donut hole. But in addition, now for the first time ever, we can very accurately quantify exactly how much plaque we have. As you'll see on the next slide, you can see we can look at that vessel, we can see all the plaque I showed you before in a qualitative sense, but down here we can determine exactly how much plaque there is located in this particular vessel, in the whole heart, per segment, However we want to slice it and dice it, here in this vessel we have 178 cubic millimeters of plaque divided up into 4.4 cubic millimeters of the low-density non-calcified plaque, the really, really bad plaque, the most rupture-prone plaque. Lots and lots of lipid-rich plaque, which is the yellow plaque, which again is very dangerous, active, growing plaque. You can see the majority of this plaque, the 178.9, is all the The dangerous growing active plaque, the lava. Only a small amount is calcified plaque. This is the only kind of plaque that one can see on a calcium score. So needless to say, calcium scores give us part of the answer, but they actually show us the most stable plaque, not the most vulnerable plaque or the most worrisome plaque as well. But now with the ability to quantify plaque very, very accurately, This is a major breakthrough because now, and I'm going to encourage everybody, ask your cardiologist or whoever is taking care of your heart, how much plaque do I have? And if they put you on medications, diet, exercise, quit smoking, or whatever tools they told you to do to attack the plaque, you need to say, well, how much plaque did I have to begin with? And how much plaque do I have now? Well, as it turns out, the only way you can answer those questions is with a clear cardio scan. So that is why this is the root of our entire practice, the, the upon which everything is leveraged, where we can identify plaque, we can stratify plaque, we can understand bad plaque, less bad plaque, and then quantify it. So down the road and in the future— and we could never do this before— we can know exactly how much plaque you have In the whole heart, in each vessel, in each segment. We can quantify that down to a 10th of a cubic millimeter. By the way, a 10th of a cubic millimeter— think of a period at the end of the sentence, think of that as a 3-dimensional sphere, take 10% of it— that is how much a 10th of a cubic millimeter is. As you can understand, it is infinitesimally small. We can measure that plaque down to a 10th of a cubic millimeter. We can do whatever we need to, and this is where it all becomes very personalized to you. What tools we need to do, what things we need to do to stop the plaque, and frankly, yes, reverse the plaque, which we can do. We have those tools. Then we can do that, bring you back depending upon how much plaque you have. If you have mild plaque, three years; moderate plaque, stage two, two years; severe plaque. Which means we need to throw the kitchen sink at this and make sure that that plaque is reacting and is beginning to be changed into the hard plaque. In those patients with severe plaque, stage 3, which by the way is 1/3 of our patients— I feel fine, no symptoms, normal stress test last week— 1/3 of our patients show up with stage 3 severe plaque. In those patients, We're going to be very aggressive, and then in those patients, we're going to look at again in a year to make sure not only are the numbers better, is the cholesterol better, is the weight better, is the blood pressure better, all of those variables and all those precision things that we're doing for you based on your background, medical history, etc., but we can now look for the first time ever and say, is my plaque better? That is an— That was an impossible feat before we had cardiac CT and AI, but now with cardiac CT coupled with AI, we can compare your Cleer Cardio scan at time A, do the right things for you, but also check our work and make sure, is that plaque better? That was impossible until we had Cleer Cardio. So it is a major breakthrough. I hope I gave you a big overview, a 30,000-foot view of kind of what this is, what the scan means. What we can detect, what we can see, what the plaques that we can detect that really were not detectable short of an autopsy, I like to say, until we had this, that we can then detect those, we can sort them out, what kinds of plaque they are, because that becomes very important. And then also, lastly, we can quantify it so that down the road we can say, not only are all my numbers better, but is my plaque better? So this is Dr. John Osborne, the Chief Medical Officer for Cleer Cardio, taking you on just a little trip down the Cleer Cardio experience and what these scans show us and why they are so incredibly important to detect heart disease, to monitor heart disease, to determine what is the right solution for you individually, so that ultimately my personal goal is that we eliminate heart disease. And it's going to take tools like this for us to do that.