Discover and read the best of Twitter Threads about #ESCCongress

Most recents (7)

Regarding the #ESCCongress reaction on #DAPAHF I share the enthusiasm of most. For this very reason I made this thread which I hope will raise the curiosity of others.

It shows some shared pathways of medication and #Lifestyle that are obviously not mutually exclusive. (1/4)
Both Pathways ⬆️ Ketones
During #heartfailure mitochondrial oxidative metabolism is compromised and 3-OHB) is ⬆️ In HF pts Ketone bodies appear to be a more efficient alternative fuel and myocardial ketone oxidation as a key metabolic adaptation in the failing human heart. (2/4)
I honestly would not be surprised at all if in a near future we start using Exogenous Ketones, Esters, Salts and even MCT oil as a possible economical therapeutic approach. (3/4)

Ex. Think about #Alzheimer Type III DM & how patients can improve dramatically w diet change.
Read 4 tweets
1| Good #cardiotwitter on #SCOTHeart. Others have tweeted reasons y believable. Here is my reply tweetorial

@khurramn1 @AChoiHeart @MarcDweck @JWeirMcCall @rwyeh @drjohnm @venkmurthy @DavidLBrownMD @RogueRad
#ESCCongress
Linking my original tweetorial:
2| Let's start with MI def. Billing codes less accurate than adjudicated MI outcomes, yes? Could be nondiff misclassification which bias to null. But could also be diff w/ ascertainment bias (look harder, anchoring) knowing CCTA result, since 2/3rds normal or nonobstruct.
3| It is conjecture. But basis of clinical reasoning is to factor in test results. The posterior probability for this theory moves up much higher when we try to figure out by what mechanism did a diagnostic testing strategy lead to better outcomes, since the radiation did zilch
Read 11 tweets
1| follow for my critical appraisal tweetorial of #SCOTHEART trial in @NEJM #ESCCongress

Basics: RCT of upfront CTA vs standard of care for stable CP referred to Scottish cardiology clinics. 1.6% fewer had primary outcome with CTA

nejm.org/doi/full/10.10…
2| more basics: primary outcome is driven by nonfatal MI, not death. Authors did tremendous job at highlighting this

#ESCCongress #SCOTHEART
3| before diving in to methods/findings, how would a CTA first approach meaningfully change outcomes?

#ESCCongress
Read 12 tweets
Lots of headlines @escardio re CT-FFR. 1 of most prominent is ADVANCE multicenter registry from @manesh_patelMD & colleagues using @HeartFlow. I'd like to dissect this a bit to see how excitement in a field combined with lots of industry funding can blind us to basic problems.
Team worked across 38 international sites over >2 years to collect data from N=5083 patients w/ “symptoms concerning for CAD”. They had primary endpoint of change in management plan from coronary CTA. That happened in 67% of patients. Most impressive.
Is this a valid endpoint? I contend that this is a measurement of physician psychology rather than of anything objective.
Read 50 tweets
16/
Sorry @venkmurthy @onco_cardiology @IbrahimMSaeed1 and others but #WhyCMR is not on this algorithm. Though, it is used frequently as a “catch all” diagnostic test for various cardiomyopathies.
17/
I use cardiac MRI frequently for non-invasive evaluation in AL. Still, you will need biopsy proof of amyloid somewhere in the body before most hematologists will treat.

Amazing summary image by NAC group in London: ncbi.nlm.nih.gov/pubmed/29929616
18/
SPECIAL POPULATIONS

Aortic stenosis: ATTR and AS coexist in the elderly. Common cause of LFLG AS. We have described this @maz_hanna @ClevelandClinic as well as @JoaoLCavalcante, NAC, Columbia, +more. 16% of TAVRs and 30% of LFLG AS with EF<50% may have ATTR.
Read 9 tweets
1/
As #ESCCongress nears, I thought I would do a #tweetorial on amyloidosis. Exciting times for the field and new data/treatments expected next week.

#FITSurvivalGuide #CardioTwitter @tony_breu @rodney_falk @marthagrogan1 @amyloidosisfdn @AmyloidosisSupp @Amyloidosis_ARC
2/
What is amyloidosis?

A protein misfolding disorder in which one of thirty-five distinct proteins pathologically misfolds and aggregates extracellularly as insoluble amyloid fibrils, ultimately leading to organ dysfunction.
3/
You can see that other diseases like Alzheimer’s involve amyloid deposition. We will focus on two types of amyloidosis that affect the heart and nervous system: immunoglobulin light chain (AL) and transthyretin (ATTR) amyloidosis.
Read 16 tweets

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