Cardiologist and Us2.ai co-founder Dr Carolyn Lam talks to AIMed about the potential of AI to democratize heart ultrasound, her experience as an accidental entrepreneur, and the importance of championing women in cardiovascular science.

You serve as a senior consultant cardiologist at the National Heart Centre Singapore, a full professor at Duke-National University of Singapore, and co-founder of Us2.ai. How do you split your time between these demanding positions?

Time-wise I fortunately don’t have to struggle since my time commitments are spelled out very clearly for me (days in clinics, days in clinical research, etc.); the challenge is really in staying ultra-focused on delivering my very best in the time that I have. To do that, I have had to learn the hard lesson of saying “no” – in fact my mission this year is to focus on my “not to do” list rather than on my “to do” list.

What are the main challenges you face in your clinical practice, and to what extent do you see artificial intelligence helping to solve these?

Patients come to see me too late – when they’ve already developed heart failure, even though they have been struggling with symptoms for months and even years before being referred to a cardiologist. This delay in diagnosis represents an important “lost opportunity” to treat patients with effective medications that act very quickly to improve outcomes.

The problem is that the tool that we use most commonly to image the heart – ultrasound – is locked up in specialist centres when it should be widely available to generalists and primary practitioners to enable earlier diagnosis. AI helps in the democratization of ultrasound of the heart by allowing non-experts to interpret the ultrasound images with accuracy similar to experts.

Us2.ai is an award-winning startup applying AI to echocardiography. What led you to found the company? 

Running a tech company was never part of the plan; I’m more of an accidental entrepreneur. My husband James received a worrying diagnosis about his heart one day during a routine check, only to be told “you have nothing to worry about” by a second doctor. The discrepancy between the two diagnoses – along with the highly manual process and high margin for error – struck James, who immediately saw the potential of automating the measurements and turning a highly manual, error-prone process from 30 minutes, 250 clicks and with >20% variability per study to 1 minute, 0 clicks and 0% variability.

Admittedly, I was sceptical at first, having spent decades in this field and knowing there are so many different technical aspects to consider, but Us2’s AI is so advanced that it can automatically trace the heart’s borders, recognize widths, and all the other crucial measurements necessary to produce a full report.

What has been the most rewarding aspect of your experience as a startup founder?

Learning. I have been humbled by how much I didn’t know about developing a clinically usable product (witness the wide chasm between publishing great science or a novel algorithm and actually making things work in the clinic!). I am so grateful for the opportunity to learn from my beloved team at Us2.ai, and to be given a real opportunity to change clinical practice and improve patients’ lives at scale together!

You are well known as a champion for women in cardiovascular science. Why is this so important to you?

Cardiovascular diseases in women remain understudied, under recognized, under diagnosed and under treated, with women underrepresented in clinical trials. Similarly, only 14% of cardiologists in many developed nations are women – and that number drops significantly in less developed countries.

To tackle the impact of cardiovascular diseases on women, I’ve spent years researching sex differences in heart disease and building a Women’s Heart Clinic that addresses sex-specific considerations in heart health care. At Us2.ai there’s a big emphasis on diversity, equity, and inclusion so we’ve been developing a platform that’s inclusive.

What role do you see AI playing in the drive to address inequity in healthcare?

AI in healthcare has the potential to be a double-edged sword – on the one hand increasing access to, and improving standardisation/quality of, healthcare in underprivileged populations; and on the other hand widening the gap by targeting only highly developed regions. At Us2.ai, with awareness of this dichotomy, we have made the conscious decision to be fully dedicated to the former aim: using our solution to increase access for all and address existing inequities.

For example, in our development of Us2.ai we have been very aware of a historically male first approach to research and development. We have safeguarded our own product against this by ensuring that, if there are any sex-specific cut offs, we include both men’s and women’s information in the AI rather than defaulting to the male model as representative of both genders, which has traditionally been the approach. We have also included diverse global datasets in the development and validation of our algorithms, ensuring their applicability to minority ethnicities as well.

What advice would you give to other female physician-entrepreneurs seeking to launch a new business?

Believe. Don’t jeopardise your own success by self-doubt, even before beginning.

We all need to encourage and empower more female physicians to use their knowledge to take their specialisms forward with new technology and ideas. By empowering more women to do this we will see a much more gender-balanced approach to research and healthcare.

Dr Lam graduated from the Faculty of Medicine, National University of Singapore, completed advanced specialty training in Cardiology in Singapore, and pursued a Research Fellowship at the Cardiorenal Laboratory, Heart Failure Fellowship at the Division of Cardiovascular Diseases, and Advanced Cardiology and Master of Biomedical Sciences at Mayo Clinic, Rochester MN. She underwent further training in epidemiology at the Framingham Heart Study in Boston, MA before returning to Singapore in 2010 on the National Medical Research Council’s Clinician Scientist Award. Clinically, she serves as a Senior Consultant Cardiologist at the National Heart Centre Singapore, having pioneered the first Women’s Heart Clinic in Singapore. Academically, she serves as a tenured Full Professor at Duke-National University of Singapore, having also graduated from the Stanford Executive Program in 2015, and obtained a PhD at the University Medical Centre Groningen, the Netherlands in 2016. In the field of MedTech, Dr Lam is co-founder of Us2.ai, an award-winning startup dedicated to the automation of the fight against heart disease by applying artificial intelligence to echocardiography (ultrasound of the heart). 

Dr Lam is world-renown for her expertise in heart failure, and particularly heart failure with preserved ejection fraction (HFpEF) — the type of heart failure that affects mostly elderly women and is the predominant type of heart failure in ageing societies worldwide; yet until very recently without an effective treatment and thus representing one of the largest unmet needs in cardiovascular medicine. Her research has been focused on understanding the epidemiology and pathophysiology of HFpEF, in order to identify novel therapeutic targets and design effective clinical trials. Her publications have ranged from fundamental animal disease models to comprehensive hemodynamic characterization (including echocardiographic and circulating biomarkers) of human disease and large cohort studies; with her PhD highlighting “Novel insights into HFpEF”. Most notably, her work as part of the global steering committee of the PARAGON and EMPEROR-Preserved trials contributed to the first FDA-approved treatment for HFpEF, as well as the first robustly positive clinical outcomes trial in HFpEF to date. 

Dr Lam’s leadership in the field is recognized in her appointment to the 2021 European Society of Cardiology Heart Failure Guidelines Task Force, and as International Honorary Fellow of the Heart Failure Society of America 2021. Her accomplishments are also recognized in numerous awards and grants: She is a recipient of the NMRC Senior Investigator Clinician Scientist Award, Founding Programme Lead of A*STaR’s Asian neTwork for Translational Research and Cardiovascular Trials (ATTRaCT), Principal Investigator of ASIAN-HF (multinational study across 11 Asian countries) and Executive Committee member/ Lead of multiple global clinical trials. She has published >350 articles in journals including NEJM, JAMA, Lancet, Circulation, and European Heart Journal; and has been recognized as a World Expert by Expertscape’s PubMed-based algorithms (top 0.1% of scholars writing about Heart Failure over the past 10 years; Heart Failure: Worldwide – Expertscape.com). She is lead author of the chapter on HFpEF for Braunwald’s Heart Disease: A Textbook of Cardiovascular Medicine, 12th Edition — the award-winning textbook trusted by generations of cardiologists for the latest, most reliable guidance in the field. She serves as Associate Editor for Circulation (top Cardiology Journal) and Eur J Heart Fail.

Dr Lam is also well-known for championing women in cardiovascular science. She is passionate about about investigating sex differences in cardiovascular disease, including the role of gender disparities. She has spoken and published widely on the predominance of women suffering from HFpEF, and the need for sex-specific approaches to heart disease. She established the first Women’s Heart Clinic in 2011 – the first in Singapore and Asia — a unique clinical service addressing the top killer among Asian women (cardiovascular disease), tailored to the specific needs of women, and recognizing important sex differences in cardiovascular risk that impact clinical care. She is a long-standing advocate for women’s heart health, and the only Commissioner from Asia appointed in an international team for The Lancet’s Commission for Women and Cardiovascular Disease (www.womencvdcommission.org).

As co-founder of Us2.ai, Dr Lam was responsible for setting the medical direction of the company, ensuring its market leading position in the field of machine learning applied to cardiovascular disease detection. She formulated the company’s strategic vision for clinical research and development, leading to FDA clearance and creating new revenue sources and collaborations with the world’s leading pharmaceutical companies. Us2.ai clinched top prize at SLINGSHOT 2019, is listed as Forbes Asia 100 to Watch, and won the FedEx Small Business Grant Contest 2021. Finally, Dr Lam is familiar to the Singapore public as the Resident Doctor of the health television programme “Body and Soul” by MediaCorp Singapore for 8 seasons, and familiar to the medical community at large as the host of the weekly worldwide podcast “Circulation On The Run”.