Unprecedented new diagnostic insights in a single heartbeat

Jack Coats

Problem Tech Solves

There is presently no high resolution, 4D diagnostic imaging test that can deliver quantitative results to assess contractile (heart) function, the key to diagnosis for cardiovascular disease. CardioWise SQuEEZ™ indicates the presence and severity of an individual patient's pathologic cardiac dysfunction that is currently addressed using qualitative methods and surrogate tests. The ability to both quantify and localize the left ventricular contractile dysfunction will improve clinical outcomes by addressing limitations of the current non-quantitative metrics. SQuEEZ™ is an objective standard that will increase consistency and accuracy by reducing user variability that previously plagued echocardiographic interpretation of left ventricular function. This produces uncertainty in diagnosis and additional imaging tests are ordered, delaying interventions, reducing efficiency and increasing healthcare costs. Leveraging patented machine learning (ML) algorithms, CardioWise SQuEEZ™ software accepts cardiac CT imaging data sets in a highly-secure, cloud-based system that provides easy-to-interpret, quantitative images of heart function that can be transmitted to cardiologists and referring physicians. CardioWise’s SQuEEZ™ is the first ML solution that provides caregivers with cardiac CT data analysis in a single set of quantitative images needed to accurately and easily assess heart function thereby eliminating the need for additional testing. CardioWise's non-invasive Cardiac Computed Tomography (cCT) analysis software, SQuEEZTM, is uniquely capable of identifying those patients with heart function injury which is the top comorbidity factor for COVID-19. COVID-19 can cause severe heart damage from myocardial inflammation. SQuEEZ™ can help doctors quickly and accurately identify those patients who have the highest risk and thereby save lives.

Tech Brief

Recent advances in computed tomography (CT) imaging technology allow fine anatomical structures such as endocardial trabeculae to be resolved. The CT scanner is used to obtain an image sequence that is then processed using a computer program. The program is configured to create an endocardial mesh formed from triangular components that represents at least the region of the subject’s heart. We have developed a method and system to detect and track the endocardial trabeculae on the endocardium at least at two time points. A displacement map can be modeled and further analyzed to extract a metric that reflects local myocardial contraction with minimal human operator interaction. The relative motion of these surface features can be used to represent the local contraction of the endocardial surface with a metric we termed “stretch quantifier of endocardial engraved zones” (SQUEEZ). Myocardial strain, and torsion are calculated; and the displacement map can be used to create a visual representation of the function of the subject’s heart. CT SQUEEZ is a simple, robust, operator independent method for measuring 4D regional wall function over the entire human left ventricle. We have demonstrated that SQUEEZ can be obtained rapidly from standard ECG gated CT protocols on scanners from three different vendors. A normal range of values of regional strain derived from SQUEEZ can be used to characterize normal local LV function as well as hypokinetic regions in the human heart, making it easy for physicians to identify areas of concern in a color coded 4D display.

Tech Differentiators

The use of cardiac CT Angiography (CCTA) is rapidly gaining international acceptance in cardiology as numerous clinical trials show its effectiveness at ruling out coronary syndromes in patients with chest pain, and it has superior sensitivity to the existence of coronary disease and seen on Xray-angiography. It has been shown in ROMICAT clinical trials that adding regional LV function results in a 10% increase in sensitivity to detect Acute Coronary Syndrome (ACS) by cardiac CT and significantly improved the overall accuracy. For patients experiencing chest pain, a concomitant accurate measurement of regional LV function over the entire left ventricle provides important clinical information and can be obtained easily during the same data acquisition and the same heartbeat using SQuEEZ. Resting wall motion abnormalities observed with CT in these subjects has been shown to increase the likelihood of ACS significantly. The acquisition of LV function with SQuEEZ during CCTA would eliminate the need for immediate diagnostic echo or SPECT in these patients if a wall motion abnormality is found which is combined with moderate to severe coronary lesion. Since LV function with SQUEEZ can be measured during the same heartbeat as the CCTA acquisition, it may be easily included as part of the exam with no more radiation dose. Today, the cost of diagnosis for a patient averages $3600 worldwide and requires 22-24 hours to complete. Use of CCTA with SQuEEZ would reduce the cost of diagnosis to $700 and would reduce the time required to obtain results to 2 hours.


CardioWise SQuEEZ has been validated in animal and human clinical studies and can be viewed in several peer-reviewed papers from various journals. A New Method for Cardiac Computed Tomography Regional Function Assessment: Stretch Quantifier for Endocardial Engraved Zones (SQUEEZ), Pourmorteza, A., Chen, M.Y., van der Pals, J. et al. Int J Cardiovasc Imaging (2016) 32: 817. doi:10.1007/s10554-015-0831-7 https://pubmed.ncbi.nlm.nih.gov/22342945/ Correlation Of CT-Based Regional Cardiac Function (SQUEEZ) With Myocardial Strain Calculated From Tagged MRI: An Experimental Study Amir Pourmorteza, Ph.D, Marcus Y. Chen, M.D., Jesper van der Pals, M.D., Ph.D, Andrew E. Arai, M.D., Elliot R. McVeigh, Ph.D. https://pubmed.ncbi.nlm.nih.gov/26706935/ Regional Cardiac Function Assessment In 4D CT: Comparison between SQUEEZ and Ejection Fraction Amir Pourmorteza, Karl H. Schuleri, Daniel A. Herzka, Albert C. Lardo, and Elliot R. McVeigh, 34th Annual International Conference of the IEEE EMBS San Diego, California USA, 28 August - 1 September, 2012 https://pubmed.ncbi.nlm.nih.gov/23367042/ A novel method for evaluating regional RV function in the adult congenital heart with low-dose CT and SQUEEZ processing, International Journal of Cardiology 249 (2017) 461-466, Francisco J. Contijoch, Daniel W. Groves , Zhennong Chen, Marcus Y. Chen, Elliot R.McVeigh https://pubmed.ncbi.nlm.nih.gov/28970037/ Regional myocardial strain measurements from 4DCT in patients with normal LV function, Elliot R. McVeigh, Amir Pourmorteza, Michael Guttman, Veit Sandfort, Francisco Contijoch, Suhas Budhiraja, Zhennong Chen, David A. Bluemke, Marcus Y. Chen https://pubmed.ncbi.nlm.nih.gov/29784623/

Why Us

CardioWise's SQuEEZTM is capable of identifying patients with heart dysfunction including the left and right ventricles and atria. In addition SQuEEZ can help to diagnose pulmonary hypertension. CardioWise’s SQuEEZ can help doctors to quickly and accurately identify those patients who have the highest risk and thereby save lives.

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