Discover and read the best of Twitter Threads about #WhyCMR

Most recents (24)

Dr. Karen Stout - presenting the 7 rules to evaluate #Congenital #HeartDisease by #yesCCT at #SCCT2022

Rule - 1: ALWAYS be prepared. Check cases a day prior & PLAN the imaging

@Heart_SCCT @FiRSTSCCT @SinghVasvi @AChoiHeart
KNOW the anatomy.
If you don’t understand the repair- LOOK up. #Google

@Fentanes_MD @JWeirMcCall @Nidhi_Madan9
Rule - KNOW the surgical history
#SCCT2022

@Heart_SCCT @SandeepHedgire @JWeirMcCall
Read 9 tweets
#Immunosuppressive therapy in virus-negative inflammatory CMP : 20-year follow-up of the #TIMIC trial

Immunosuppressive Tx of virus-negative inflammatory #CMP is associated to a persistent improvement of LV
function and better outcomes during long-term follow-up

#HeartFailure
#Immunosuppressive Tx promoted an improvement in cardiac function in 88% of the cases compared the placebo group

A persistent ⤴️ in the #LVEF is seen in long -term (up to 20 years) clinical outcomes of the whole cohort of 85 patients originally enrolled in the #TIMIC trial
Recurring virus-negative myocarditis responding to #immunosuppressive therapy

EKG showing LBBB (A) resolving after therapy (B)

(C and D) Echo apical view showing recovery of LV dysfunction from EF -28% ➡️ up to 51%

#HeartFailure #EchoFirst @ESC_Journals academic.oup.com/eurheartj/adva…
Read 6 tweets
Many faces of HCM! Crazy #WhyCMR case | 50 yo female, very mild LVH (IVS 11-12 mm) | Follow me | I think @MasriAhmadMD will like this one! #Cardiotwitter @SCMRorg @scmrchd
3Ch Mild LVH
2C | WOW looking deep inferior CRYPTS 🧐
Read 8 tweets
📌REVIEW. MIOCARDIOPATÍA HIPERTRÓFICA💪

🔹Prevalencia 1:200-1:500, ≈ 20M🌐, 10%-20% se identifica 🩺
🔸Tratable y consistente c/longevidad normal
🔹⚠️Diagnóstico oportuno y preciso ⚠️
🔸#echofirst y #WhyCMR 👉 sinérgicos

🧵👇
🆓sciencedirect.com/science/articl…

#CardioTwitter @SAC_54 Image
🚩4⃣ Perfiles Clínicos:
🔹Estable benigno, no requiere tto (46%)
🔸Obstrucción del TSVI con signos de IC, candidato a intervención (43%)
🔹FA con indicación de ACO (17%)
🔸Riesgo de MS☠️, eventual CDI⚡️(6%)
🔹Etapa final IC (4%)

⚠️10% ptes tienen mas de un perfil clínico Image
🚩Evaluación inicial de MCH:
🔸Morfología y función VI💔
🔹Severidad de síntomas
🔸Riesgo de Muerte Súbita☠️
🔹Antecedentes familiares
🔸Modificación del estilo de vida
Read 9 tweets
📕Month Review on Fabry Disease (FD) via @RCMjournal

🟡Mechanisms Beyond Storage & Forthcoming Therapies
🟡Cardiac Imaging
🟡Echocardiography #echofirst
🟡Cardiac Magnetic Resonance #WhyCMR

📂OPEN LINKS⬇️ & Thread🧵(1/13)
@mauripieroni72 @torresviera @SVCardio @DeBakeyCVedu
✅FD X-Linked inherited Lysosomal Storage disorder
✅Mutations (>900) alfa-GAL gene (GLA)
✅🚫or⬇️ alfa-GAL A enzyme activity
✅Incidence 1/40,000-1/117,000
✅Newborn Screening 🇮🇹🇹🇼 1/8,800
✅FD storage GB3
✅Intracellular glycosphingolipids organize➡️concentric lamellar bodies (🦓bodies)
✅lysoGB3➡️Pathogenic factor
✅Ion Channel Dysfunction
✅⬆️conduction velocity (atrial 🫀ventricular🫀)➡️short PR in absence of an accessory pathway
Read 17 tweets
#whyCMR and Implantable devices:

👉Increasing rates of cardiac device implantation
👉Expanding indications for CMR

Need to deal with:
🥇Device compatibility
🥈Artifacts
🥉Stress perfusion

…where are we?
💫Here a tweetorial on CMR and devices!
Conditional or non conditional?

👉1.5T or 3T
👉 no deaths, lead failures, losses of capture, or ventricular arrhythmias during CMR in patients with non-MR conditional pacemakers or ICDs
👉only decrease in 1% in p wave amplitude (no clinically relevant)
What about abandon leads?

👉No major tachicardia
👉No major device malfunctioning
👉reports show that this should not be a controindication anymore
Read 10 tweets
The DISCHARGE trial in online on the NEJM and it confirms what we all experience every day using CCT in a proper manner. CCT is safer, reliable and allows better management of stable patients with suspected obstructive CAD as compared to invasive strategy.
The main observation that comes to my mind however is still the very low prevalence of patients with obstructive CAD (25%) in both arms (CT and ICA). This is well known from previous studies and it is related to the selection criteria adopted for referral, partly.
The fact that still we send for an invasive and costly examination (CAG/ICA) this huge number of patients is simply astonishing in 2022. Healthcare cannot be managed like this, especially in universal systems like Italy, Germany, UK, Canada,...
Read 13 tweets
1/ Case of te day, classic #HCM @beamusumeci1 @TiniGiacomo @domitillarusso
2/ Bright area in the LV septum/anteriore wall, seen already from trufi scout ... #WhyCMR
3/ That is edema (T2 STIR)
Read 8 tweets
Do you routinely measure #MAPSE?

Did you know that MAPSE beats #GLS and #LVEF regarding prognosis?

A new multicenter collab study out, led by @KellmanPeter

Ref: pubmed.gov/35132872

#WhyCMR 🫀🧲 #EchoFirst 🫀🔊

A thread 🧵. 1/n
We know that GLS is a composite measure correlated w LVEF, LVEDV, LVESV, LV mass, infarction, non-ischemic scar, aortic stenosis, mitral regurg, ECV.

So, not surprisingly, GLS associates with poor prognosis.

Ref: pubmed.gov/32563637 Suppl Table 2

2/n
Notably, mitral annular plane systolic excursion #MAPSE has been measurable by #EchoFirst since 1986 by M-mode (pubmed.gov/3464160).

3/n From pubmed.gov/3464160, Figure 3-4B, M-mode recording of th
Read 11 tweets
#JACCCardioOnc #Tweetorial: Along the spectrum of cancer Tx, #YeSCCT has a lot to offer regarding identifying subclinical #ASCVD, excluding obstructive #cvCAD in cardiotoxicity when appropriate. #CardioOnc, as a field, can gain from incorporating CCT in practice.

🧵1/
#YeSCCT may identify subclinical #ASCVD in cancer patients & survivors. Reviewing previous non-gated thoracic CT scans for CAC may help identify subclinical #cvCAD and start prompt preventive Tx.

#JACCCardioOnc #CardioOnc #MedTwitter #CardioTwitter

2/
Several clinical scenarios in the context of cardiotoxicity may require ruling out obstructive #cvCAD. Cancer pts tend to have ⬆️ risk of complications from invasive procedures➡️ thrombocytopenia & hypercoagulable states. #YeSCCT may derive significant benefit. #JACCCardioOnc

3/ This table shows some possible clinical indications of #YeSC
Read 5 tweets
This is an interesting study by @amritlota et al.

“LGE has no prognostic value if LV volumes and EF are normal” is the wrong interpretation, @MAecocardio.

These are my thoughts…
#WhyCMR
First, was the LGE in this study an artifact ("overcalling")?

No, because:

- This paper comes from pioneers and some of the biggest names in CMR
- Our anecdotal experience matches these findings
- The images in the paper very clearly demonstrate LGE.

So why was LGE associated with a very low risk of SCD during follow-up in this study?

LGE is always bad at a group/population level compared to no LGE. Is it bad for every person? Like any risk marker, no.
Read 12 tweets
Multimodality imaging in patients with HFpEF: an expert consensus document of the European Association of Cardiovascular Imaging #EACVI #MMI #HFpEF academic.oup.com/ehjcimaging/ad… @ESC_Journals @Cosyns @alessia_gimelli @ThorEdvardsen @VDelgadoGarcia @bogdan_popescu1 @JaeKOh2
This expert consensus document from the #EACVI provides recommendations regarding how to determine elevated LV filling pressure in the setting of suspected #HFpEF and how to use multimodality imaging to determine specific aetiologies in patients with HFpEF @EACVIPresident
📌Mechanisms of LV diastolic dysfunction include impaired relaxation, attenuated restoring forces, and increased passive elastic stiffness that leads to elevated LV filling pressure

📌The presence of LV hypertrophy and dilated LA provides support for the #HFpEF diagnosis
Read 5 tweets
It was so great to give a (virtual) talk to the Hellenic Society of Cardiology on #covid and #whycmr- hopefully next year in person with no more need 4 Covid talks! Short 🧵 on CMR use #epeeps #cardioed #echofirst #tavr #metaanalysis …/2
#covid is bad for many organs- including the heart. The role of ACE2 receptors to facilitate entry to the cells is well known! But for the heart Covid does lead to #infarction #arrhythmias #heartfailure #myopericarditis What can you do to avoid this? GET A #VACCINE
Hospitalized patients with high troponin are the sickest ones. Great study from #london hospitals showing that in this cohort - late gadolinium enhancement indicating scar (an adverse prognostic factor) is present in 1/2 patients. How to avoid it? GET A #VACCINE …4
Read 9 tweets
59 y with lymphoma, had an echo prior to chemotherapy.
patient reported mild lower limb edema over the prior month. Absolute Eosinophil Count 5.1 K/uL. ECG sinus tachycardia with LAE- no inverted T waves noted.
Read 10 tweets
Educational Thread (longish) on AORTIC STENOSIS on the new #ESCGuidelines #ESCCongress published at @escardio #EHJ academic.oup.com/eurheartj/adva… Another thread to follow on AR. So truly excited about these guidelines and here’s why @mirvatalasnag @mmamas1973 @DrMarthaGulati @Hragy …/2
First things first #ESCCongress - a patient centered approach recommended. 👏 but I thought we had long moved to a patient centred approach but nonetheless good to highlight #epeeps #cardio #echofirst #whycmr …/3
#ESCCongress valve guidelines - and the role of the Heart Team re- emphasized. This is crucial. But also defining who should be present to constitute a ‘Heart Team’ @milena_mate @MelissaLyleMD @drzgezdentok1 @AScatteia @RositaZakeri @pacman8it @dr_benoy_n_shah @tchaaban1 …/4
Read 11 tweets
#ESCCongress #ESCGuidelines This is a Long thread on Heart Failure Guidelines published @escardio #EHJ academic.oup.com/eurheartj/adva… LONG BUT EDUCATIONAL! Focus on CHRONIC HF #epeeps #CardioEd @AlexFrogoudaki @mmamas1973 @DrMarthaGulati @purviparwani @Filippatos @EkateriniL @Hragy …/2
#ESCCongress Firstly, no longer Mid Range, replace by MILDLY REDUCED LV EF. Makes a lot of sense - in fact for some time I thought the previous guidelines referred to ‘mildly reduced’ until @merinopoulos corrected me… otherwise no real change in the nomeculture …/3
#ESCCongress nice algorithm - assess risk factors… do BNPs (watch the caveats- AF ⬆️ , obesity ⬇️ value so bear this in mind. The #echofirst and classification into Reduced, mildly Reduced and Preserved. @SineadHughes19 @wordfinga @rahatheart1 @HEARTinMagnet @bp_halliday …/4
Read 12 tweets
Finally published on @journalofCMR!!! Cardiac biomarkers and #WhyCMR T1 and T2 mapping in people with chronic kidney disease - Thanks to @GoetheCVI @v_puntmann @c_eike jcmr-online.biomedcentral.com/articles/10.11… Few considerations below.
We found independent associations between increasing natriuretic peptide/hsTropT on one side and myocardial involvement as assessed by native T1 and T2 mapping on the other ➡️ cardiac biomarkers=cardiac involvement (not only reduced elimination). (1/3)
Is cardiac involvement characterized by diffuse fibrosis only? Likely not: increased T2=contribution of myocardial edema. ❗️❗️T2 decreases after hemodialysis, proportionally to revomed volume❗️❗️ (2/3)
Read 6 tweets
What is the most commonly performed imaging test for CAD in the U.K.?
The most common imaging test is #CVnuc, #yesCCT increasing after 2016 NICE CG95 but the treadmill is still the most common test whatever the guidelines say openheart.bmj.com/content/6/2/e0… Image
Myocardial perfusion #scintigraphy for the diagnosis and management of CAD was first assessed by NICE in 2003 nice.org.uk/guidance/ta73
Read 14 tweets
1/7
Heute durfte die @YoungDGK beim #DGKOnline2021 im RapidFire-Format Cardiac Imaging vorstellen. Tolle Referenten haben einen kompakten Streifzug durch die verschiedenen Modalitäten & deren Einsatzmöglichkeiten präsentiert. #cardiotwitter @DGK_org @kardiologie_org
2/7
@StephanStobe hat zu Beginn die verschiedenen technischen Möglichkeiten der Echokardiographie vorgestellt und die Frage beantwortet, bei welchen Indikationen diese sinnvoll eingesetzt werden können. @Echo_DGK_GER @thiele_holger @NMerke #echofirst
3/7
Caroline Morbach (Würzburg) fasste anschließend alles Wichtige zur Stress-Echokardiographie zusammen. @DZHI_Wuerzburg @YoungDZHK @DavidDuncker @jochen_dutzmann @vonBardelebenRS @PhSchlegel
Read 7 tweets
🗓️February, Amyloidosis month.
🏅5 Best Papers
💖Tips, Tricks & Thread/links 🧵(1/15)👇
#CardioEd #cardiotwitter #Cardiology #ENARM
🔴Diagnostic delays➡️3 years from symptom onset
👫 may be evaluated > 5 specialists prior to receiving the correct diagnosis
✅vast majority of cardiac amyloidosis➡️transthyretin amyloidosis or light chain amyloidosis
✅“red flag”🚩suspicion for this diagnosis👇
(2/15)
💟ECG⬇️voltage QRS amplitude limb leads (≤0.5 mV), pseudo-infarct pattern & relative⬇️voltage QRS (S wave in V1 + Rwave in V5 or V6 ≤15 mm) in the setting of LVH on #EchoFirst AV block
💟Echo concentric LVH, biatrial⬆️& small pericardial💦, apical sparing of LV strain (3/15)
Read 15 tweets
This fantastic review about Cardiac Involvement in Fabry Disease: JACC @ACCinTouch Review Topic of the Week by Maurizio Pieroni et al.

jacc.org/doi/10.1016/j.… @JACCJournals @iamritu @purviparwani @ShelleyZieroth @hvanspall @mmamas1973 @mswami001 @alessia_gimelli @WilliamZoghbi
📌The cardiomyopathy associated with FD manifests mainly as LVH.

📌In addition to glycosphingolipid accumulation, secondary mechanisms of cardiac damage in FD include inflammation and immune activation.
#CardioTwitter @JACCJournals @mmamas1973 @AllanLKleinMD1 @NadeenFaza
📌Cardiac imaging, particularly #whyCMR CMR imaging, is essential for diagnosis and staging of FD.

📌Early treatment can improve clinical outcomes in patients with FD and cardiomyopathy @purviparwani @chiarabd @mswami001 @onco_cardiology @alessia_gimelli @Cosyns @vass_vassiliou
Read 4 tweets
How is the #heart affected in severe #COVID19? Patients with a raised troponin have worse outcomes – but why? Our multicentre #whyCMR @ESC_Journals paper shows a variety of problems including infarction, ischaemia and a myocarditis-like injury. academic.oup.com/eurheartj/adva…
This was a very sick #COVID19 group: all admitted, all with raised troponin, 1 in 3 ventilated. Our findings DON’T tell us about the hearts of patients with mild illness who didn’t need admission to hospital or didn’t have raised troponin.
Even pre #COVID19 (remember that?) #whyCMR was useful to find the cause and implications of troponin elevation. Check out this paper from @DeepDastidar and @SCMRorg CEO @chiarabd sciencedirect.com/science/articl…
Read 13 tweets
This is a good review article about the advent of novel #WhyCMR mapping techniques allows us to glimpse some of the pathophysiological mechanisms underpinning #HF cfrjournal.com/articles/tissu… @radcliffeCARDIO @chiarabd @Sarah_Moharem @JSabatino86 @vass_vassiliou @DrHaniMahmoud @Cosyns
The Prognostic Role Of Tissue Characterisation Using Cardiovascular Magnetic Resonance In Heart Failure #WhyCMR #MMI @EACVIPresident @alessia_gimelli @JSabatino86 @SCMRorg @HFA_President @ShelleyZieroth @radcliffeCARDIO @mmamas1973 @AndrewJSauer
The Prognostic Role Of Tissue Characterisation Using Cardiovascular Magnetic Resonance In Heart Failure #WhyCMR #HF #MMI @almallahmo @Jessica_B_ @acreanTGH @Cardiac_MRI @JenJordanPhD @ThomasTreibel @erik_schelbert @radcliffeCARDIO @EACVIPresident @mswami001 @iamritu @purviparwani
Read 5 tweets

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