Discover and read the best of Twitter Threads about #ffr

Most recents (8)

#Tweetorial on #ASNC2020 session

⚡Selecting Between Different Functional Tests⚡

☢ vs 🧲 vs ⏺ ❓

🔘 Strengths/Limits of Lesion Specific vs Myocardial Ischemia
🔘 Comparing Dx Accuracy of Tests
🔘 Ischemia Testing in #INOCA
🔘 How to Select Best Noninvasive Test

1/9
#ASNC2020 #cvNuc
2/9
Dr Di Carli

☢ Issues with proposed #FFR threshold 0.8
☢ Exercise MPI correlates well with FFR but not at 0.8
☢ Benefit of FFR-guided revasc dominantly occurs w/ thresholds <0.8
☢ Quantification of lesion-specific #ischemia insufficient for patient mgmt
#ASNC2020 #cvNuc
3/9
Dr Di Carli

Lesion-specific #ischemia measurements (FFR/#FFRCT)

☢ Strength
Validated against ETT/MPI
Strong outcome data
Guidelines supported

☢ Limit
Controversial threshold (0.80 vs MPI-validated 0.66)
⬆ microvasc resist causes FFR pseudonormalization
Read 11 tweets
DOI: doi.org/10.1016/j.ijca…

Drs @SukhNijjer, @jerd10 and @RicardoPetraco. What are your views on @DavidLBrownMD fallacies of FFR?

As a budding interventional cardiologist, I like to hear all opinions and sides to the story :)
“In conclusion, FFR in isolation is of no proven clinical value in the evaluation of patients with suspected ischemia. The ESC guidelines continue to promote an outdated paradigm for the evaluation of suspected ischemia that focuses on the focal epicardial stenosis.”
The 4 fallacies

1/4 - The first fallacy is the foundational premise of FFR that ischemia caused by a focal obstructive epicardial coronary stenosis is on the direct pathway to death or MI and therefore should be a target of revascularization
Read 7 tweets
Let us talk about the #FED #FOMC's 1st #MonetaryPolicy meeting of 2020. Specifically, let us talk about the puzzle that is a flatter #PhillipsCurve...
The #FederalOpenMarketCommittee (#FOMC) of the #FederalReserveBank (#FED) of the #US concluded its 1st meeting of 2020 on the 29th January 2020. As expected, the FED did not change rates but left the #KeyPolicyRate, the #FederalFundsRate (#FFR) in the 1.5%-1.75% range...
Indeed, if one considers the #FED #Dotplot of December 2019, the decision to keep rates unchanged would not come as a surprise. What I wanted to focus on today is some key passages in the statement, highlighted in yellow in the screenshot below...its all #PhillipsCurve...
Read 17 tweets
Lets talk about the upcoming 1st meeting of the #FED #FOMC (28-29 January 2020). Specifically, lets talk about the #DOTS...
The #FED #FOMC developed the so called #DotPlot in 2011 as a chart to record each FED's official forecast for the FED's key short-term interest rate (federal funds rate - #FFR). Currently, the FFR, following the December 2019 meeting is in the target range between 1.5% and 1.75%
The most recent #DotPlot is attached below. Each dot represents one #FED official, from the Chairman to fellow Governors. It is anonymous & as such, no one knows which official is responsible for what dot...
Read 10 tweets
⚡️ Coronary Microvascular Dysfunction is Associated with Significant Plaque Burden & Diffuse Epicardial Atherosclerotic Disease
@JACCJournals

interventions.onlinejacc.org/content/12/15/…
#JACCINT #CMD #CardioTwitter

Let's discuss this paper in 2 Tweets 👇 Image
2/3
First demonstration that majority of pts with #CMD, but with no evidence of significant #CAD by angiography & #FFR, have significant plaque burden by #IVUS ImageImageImageImage
3/3
Take home message:

✅ Large portion of patients with #CMD who have normal looking coronaries or mild #CAD on angiography, have indeed significant atherosclerosis & plaque burden on #IVUS

✅ These findings have important implications in management & prognosis in #CMD ImageImageImageImage
Read 3 tweets
⚡️ #YesCCT Coronary Plaque Assessment #Tweetorial ⚡️

By @CoronaryDoc + @AChoiHeart

✅ Why Plaque Assessment?
✅ High Risk Plaque Features
✅ Plaque Characterization/Quantification
✅ Supporting Clinical Data

#CardioTwitter #ACCImaging #SCCT2019 @heart_scct @journalCCT
1/14
2/14
As #SCD or #MI is 1st symptom of #atherosclerosis in 2/3 of pts, early ID of #CAD is of paramount importance

#YesCCT allows for
✅ ID of plaque
✅ Quant. of plaque
✅ Characterization of plaque
✅ Arterial remodeling

Lin, @LubbDup & @lesleejshaw: bit.ly/2x1b5Yz
3/14
Serial angiographic studies have demonstrated an accelerated & rapid plaque progression before most cases of ACS

Rapid plaque growth ➡️ plaque rupture ➡️ thrombus formation ➡️ MI

@LubbDup & @JonathonLeipsic et al: bit.ly/2WIt5Bj
Read 14 tweets
What’s Your “Shear Stress”?

Want to Know More?

Relax & Read ⤵️ #Tweetorial by @CoronaryDoc + @arnavkumar

⚡️Coronary Wall Shear Stress in 12 Tweets ⚡️

1/12
Main Readings:
1) interventions.onlinejacc.org/content/early/…
2) ow.ly/XmD130mc9X8
3) link.springer.com/article/10.100…
#ACCImaging @ACCCardioEd
2/12
Wall shear stress (#WSS) is the frictional force of blood exerted tangential to endothelial surface of vessel wall & expressed in variety of units (1Pa=1N/m2=10 dynes/cm2)

It is derived from
• luminal geometry
• flow rate
• blood viscosity
• near wall velocity values
3/12
In vivo WSS calculations are derived from computational fluid dynamic (#CFD) simulations created from reconstructed 3D vessel geometries (from biplane angio/IVUS/OCT/CT/MR) combined with patient-specific pulsatile inlet/outlet velocity values (Doppler wire or other methods)
Read 12 tweets
Intro/10 #STEMI #tweetorial #FITSurvivalGuide for #ACCFIT. Organized by @dr_chirumamilla. @ACCCardioEd @ACCinTouch
1/10 #STEMI from ruptured plaque, less plaque erosion. @BraunwaldEugene pic demonstrates LDL oxidized, glycated➡️cytokines release express adhesion molecules➡️monocytes roll, diapedesis➡️ingest LDL, become foam cell➡️SMC migrate, proliferate➡️some apoptosis➡️plaque Image
2/10 Why #STEMI on #ECG
1. Diastolic current of injury: current away from relatively depolarized injury➡️TQ depression➡️normalized on ECG➡️ST elevation
2. Systolic current of injury: current towards injury due to early repol➡️ST elevation Image
Read 19 tweets

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