Discover and read the best of Twitter Threads about #ischemia

Most recents (21)

Thank u @Heart_SCCT @jolson106

Was an honor serving on #ASM committee #SCCT2022 & congrats @ghoshhajra for leading this team

My takeaways:
1) #ISCHEMIA captured current landscape of functional testing & put anatomy vs ischemia discussions in the center

ahajournals.org/doi/10.1161/CI…
2) We learned from those excluded from the trial as much as we did from those included #CIAO-ISCHEMIA

#SCCT2022

ahajournals.org/doi/10.1161/CI…
3) #DISCHARGE trial will make way for cathlabs to focus on complex procedures as #YesCCT assumes most diagnostic evaluations

nejm.org/doi/full/10.10…

#SCCT2022 @NEJM
Read 9 tweets
1) Welcome to our new #accredited #tweetorial on the Pathophysiology of #DKD in #T2D: Traditional Teaching and New Insights. Our expert author is Hans-Joachim Anders, MD, @hjanders_hans from @LMU_Uniklinikum of @LMU_Muenchen
2) This #accredited #tweetorial series on the foundations of #kidneydisease #DKD through the lens of #T2D is supported by an independent educational grant from the Boehringer Ingelheim/Lilly Alliance and is intended for healthcare providers.
3) This activity is accredited for #physicians #physicianassociates #nurses #NPs #pharmacists 🇺🇸🇪🇺🇬🇧🇨🇦. Past programs still eligible for credit are at ckd-ce.com. Faculty disclosures are at ckd-ce.com/disclosures/. FOLLOW US for regular programs by expert faculty!
Read 48 tweets
Top 10 paper in #yesCCT by @ToddVillinesMD

1st paper

📝 Italian COVID 19 registry
N=1625
📝 Increasing #CAC associated with worse covid 19 outcomes of hospital death, MI and CVA
#YesCCT
2nd paper #Top10 papers #yesCCT
#SCCT2021
danish heart registry
📝 Plaque burden, not stenosis the main predictor of MACE
📝 patients with a comparable calcified atherosclerosis burden generally carry a similar risk for CVD events
jacc.org/doi/abs/10.101…
3rd paper #Top10 papers #yesCCT
#SCCT2021

CREDENCE trial
📝 Stress MPI vs #yesCCT for diagnosis of coronary physiology
📝 #yesCCT superior to stress MPI in the diagnosis of invasive FFR
jamanetwork.com/journals/jamac…

@lesleejshaw @RonBlankstein @AChoiHeart @ghoshhajra
Read 10 tweets
#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
☢ Selecting Between Different Functional Tests in 2020? ☢

This should be most interesting session of virtual #ASNC2020

I am excited to be virtual moderator w/ expert speakers Dan Berman, Keon Nieman, Paul Knaapen, @mdicarli, @VTaqMD

#cvImaging #cvNuc #CardioTwitter ImageImageImage
Are you ready for most exciting #ASNC2020 session?

⚡Selecting Between Different Functional Tests⚡

☢ vs 🧲 vs ⏺ ❓

Let’s hear from #cvImaging giants
Keon Nieman, Paul Knaapen, @mdicarli @VTaqMD @danielbermanmd

📆 Sat, Sept 26
⏰ 2:15 to 3:30PM
🗒 bit.ly/333dRNO ImageImageImageImage
☢ This super exciting session starts in 3 hours ☢

📺 Tune in #cvNuc peeps to learn who benefits from ischemia testing & how to select best non-invasive test

⏰ 2:15 to 3:30PM
#ASNC2020 Image
Read 9 tweets
The #ISCHEMIA trial has been popular again in recent days on Twitter, but amongst all the controversies & criticisms, it got me thinking about the #STICH trial.

These two trials actually have quite a lot in common and it's worth exploring that in a little detail

A thread...1/
STICH was a government funded trial designed to answer definitively - for once and for all - the role of revascularization in ischaemic cardiomyopathy. Numerous observational and/or retrospective studies suggested benefit on 'hibernating myocardium' but the jury was still out 2/
It was a well-intentioned study with enormous amount of thought put into planning methodology, ensuring only experienced surgeons with proven good outcomes took part, OMT had to be maximized etc etc

Tragically, like other RCTs, STICH suffered from enormous enrollment bias...3/
Read 16 tweets
Time for my first Twitter Poll!

I believe we should abandon the terms 'sensitivity' and 'specificity' of non-invasive imaging tests. 20th century language, no longer fit for purpose! I'll explain why after poll closes.

Do you agree?

@BSEcho @ASE360 @BritishCardioSo @escardio
Read 11 tweets
Let’s do a quick one on #clinicaldecisionmaking and #neuroimaging. See bright spot on MRI T2 Brain just means increased water -could be any insult to the brain - #infection #inflammation #ischemia #neoplasm are the top 4 you gotta have in your brain. Pun intended. #MedTwitter
Then you think - active or inactive process? If it’s actively destroying the BBB, it’ll enhance on contrast enhancement. So get MRI with and without contrast. Why without? T2 shine-through - but that’s for another time. #MedStudentTwitter #neurology #neurologyresident
Now the important question here is what you do - remember that nice poem on #theroadnottaken by #robertfrost? 2 widely diverging choices - to immunosuppress or not to immunosuppress. #tobeornottobe #hamlet #MedTwitter #AcademicTwitter #MedStudentChat
Read 13 tweets
1/
⭐️How do we manage CAD in advanced CKD?

In this #Tweetorial, @BUMedicine classmates/future coresidents @RahulAggarwalMD and I review:

🔷#ISCHEMIA-CKD @NEJM #ACC2020
By @SripalBangalore @nyulangone & et al!

#MedTwitter #CardioTwitter #MedEd #COVID19 @MedTweetorials Image
2/
First off, a refresher pop-quiz on the #ISCHEMIA (Outcomes) trial @NEJM we summarized in last week's #Tweetorial!

Q: Patients with stable CAD and moderate/severe ischemia have better outcomes with which intervention?
3/
If you missed our #Tweetorial last week, here is the link to review our summary of the #ISCHEMIA Outcomes main trial results:

Read 15 tweets
@DavidLBrownMD @BobDreyfuss2017 @iamritu @mad_sters @ProfDFrancis @rallamee @DrJHoward @mshunshin @MikeTPhD @drjohnm @rwyeh @imperialcollege Yeah, analysis does not adjust for changes in diagnostic sensitivity over time. We have trials included that span 1992 to 2019 and diagnostic criteria were likely more sensitive for inclusion in recent trials.
@DavidLBrownMD @BobDreyfuss2017 @iamritu @mad_sters @ProfDFrancis @rallamee @DrJHoward @mshunshin @MikeTPhD @drjohnm @rwyeh @imperialcollege Overall, the meta-analysis doesn't change the predominant dogma that we cannot save lives or prevent cardiac events in a stable CAD population. However, there are situations defined by acute or recent myocardial injury/infarction that benefit from revascularization with PCI.
@DavidLBrownMD @BobDreyfuss2017 @iamritu @mad_sters @ProfDFrancis @rallamee @DrJHoward @mshunshin @MikeTPhD @drjohnm @rwyeh @imperialcollege I'll transition to the case report by patient and investigative reporter/editor for the @thenation @BobDreyfuss2017

Reminds me of uncomfortable M&Ms I've attended with the patient/family present to recap how medical decisions were made and managed.

ahajournals.org/doi/10.1161/CI…
Read 15 tweets
Today sharing my views on #ISCHEMIA trial @bmj_latest; the trial is post-presentation and prepublication. I talk about what we can take away so far. blogs.bmj.com/bmj/2020/01/07… Image
@bmj_latest One of my points about #ISCHEMIA trial is that, since they presented pre-peer review information publicly to with broad media dissemination, would have been nice to #preprint what they had at the time, to archive it, enable it to be cited in the meantime. @medrxivpreprint
@bmj_latest @medrxivpreprint Another point, #ISCHEMIA trial outcomes results same in 2 arms was expected…but what about quality of life findings. Eager anticipation for the quality of life papers. Secondary endpoint. Unblinded trial. No effect in CKD. But provocative in non-CKD. Lots to discuss/debate.
Read 3 tweets
1/SEQUEL TWEETORIAL: Historical Perspective on PCI for Stable Ischemic Heart Disease (aka chronic coronary syndromes – I got you @ESCardio 😉), specifically looking at #COURAGE as a prelude to #ISCHEMIA.

h/t @greggstone for several slides
2/Let’s start with question… knowing what you know now, what does revascularization do for patients with STABLE coronary artery disease and angina attributable to that disease?
3/ I sure hope that you answered #1 or #2 otherwise you’ve really been imbibing a tad too much of the eloquently evangelical (E-squared) @drjohnm’s Kool-Aid of fatigue/impotence-inducing betablockers, headache-causing nitrates, and pub fund-draining ranolazine.

#hetriessohard
Read 31 tweets
#ISCHEMIA Thread: I gave a quick hot take during #AHA presentation & haven’t had time to expand on it. Queue some collected thoughts (albeit without gifs & references) on some responses I've seen to the study. Hats off to @alenghat for the great graphic on applying the study
@alenghat Be warned, I am being reductive and, some may say, provocative. You may not agree with me because you practice in a different way, your local system, and “in your experience etc”. Also, your test is better, I’m sure. Accepting that, read on. #ISCHEMIA
@alenghat Everyone in #ISCHEMIA had “ischemia” measured by a variety of means, and some went to cath, and some had revasc with PCI and a good percentage of CABG. There’s a lot of crossover too.
Read 25 tweets
1/TWEETORIAL: A little primer on periprocedural MI.

This is relevant because there has been a fair amount of discussion on it post-#ISCHEMIA trial.

I thought it relevant to share some past knowledge here in case you weren’t around for it.
2/Let’s start with a poll and then go backwards in time because history lessons are more fun that way.

In ROUTINE CLINICAL PRACTICE (to distinguish from research studies), do you draw cardiac enzymes after PCI in your cath lab?
3/This poll will no doubt be skewed by those who are very smart/know what I’m getting at & will try to rig the poll to say “yes” to undermine me…

But I will tell you that MOST LABS HAVE ABANDONED THE MEASUREMENT OF CARDIAC ENZYMES post PCI.

But why????
Read 41 tweets
So #ISCHEMIA #AHA19 will take time to digest; lots presented and no peer-review pub or @medrxivpreprint yet. There is often drift from the big presentation to the publication. We should resist a rush to judgment. Yet…
@medrxivpreprint A couple of things occur to me from the presentations…reinforces the prior evidence that patients w/stable ischemic heart disease have little to lose by deferring procedures. The medical therapy strategy seems safe. The procedural strategy is not saving lives or events, to date.
@medrxivpreprint It seems to question value of myocardial perfusion imaging in patients w/stable ischemic heart disease. In aggregate large costs…and not clear, in many cases, what it is adding if the procedures are not saving lives or events. Combine that w/STICH, and the question gets bigger.
Read 5 tweets
No difference in primary endpoint #ISCHEMIA #AHA19 #EAPCI #ACCIC
Main driver of events MI
Single vessel
Proximal LAD
OMT
No heterogeneity
Read 7 tweets
#ISCHEMIA
Red or Green?

Entire cardiology world is enthusiastically waiting to know the answer in 10 mins
#AHA19 ImageImage
And now results of $100 million #ISCHEMIA trial Image
Image
Read 10 tweets
1/Lot's of angst about #ISCHEMIA and what it will mean for cardiology practice. For me, a positive trial is likely to mean more for changing my practice than a negative one. I'll try to explain (Thread). #AHA19
2/I was trained by conservative cardiologists in the post-COURAGE era. I don't offer PCI to stable patients with the idea that I am going to make them live longer or reduce hard endpoints. We offer PCI to stable patients for one predominant reason - symptoms despite meds.
3/However, it is VERY common for patients to be surprised that walking around with a blocked artery is safe. Even after a clear conversation about what the benefits of elective PCI are, post-PCI patients will often say, "Now I can walk around without worrying...".
Read 10 tweets
This month I revisit #COURAGE. The ultimate conversation starter among @JAMAInternalMed readers and interventional cardiologists. #CQOSpotlight

Quick someone tweet a concerning angiogram cine and ask if anyone else would refer a specific stable CAD patient to OMT!!
𝗕𝗮𝗰𝗸𝗴𝗿𝗼𝘂𝗻𝗱: The #COURAGE investigators provide longer survival follow-up on subset of the original study cohort to evaluate how the number of coronary lesions vs. amount of ischemia is prognostic for patients with stable CAD. ahajournals.org/doi/10.1161/CI…
The subset of patients received both quantitative coronary angiograms (QCA) and stress (SPECT) perfusion imaging.
Read 27 tweets
1/Given the reinvigorated discussion on the #ISCHEMIA trial, I thought I'd post selected slides from my #TCT2018 talk on some "predictions" for the trial.
2/This is the overall #ISCHEMIA trial design c/o @GreggWStone
3/Here are some basic questions that will influence interpretability of the trial. I'm sure there are others I left out...
Read 17 tweets

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