Discover and read the best of Twitter Threads about #whycmr

Most recents (24)

Guias ACC/AHA 2020 de Miocardiopatia hipertrófica publicadas en @CircAHA

Abro hilo con algunos de los aspectos más interesantes tras una lectura inicial 👇👇

@secardiologia @SVCardio @SIAC_cardio @ResiSec @CardiopatiasS

ahajournals.org/doi/abs/10.116…
1) Cuando realizar un ecocardiograma. Destaco:

- Eco control cada 1/2 años para reevaluar el riesgo de MSC, insuficiencia mitral y grado obstrucción.

- Indicación clase I para eco de esfuerzo si no hay gradiente basal, también para el ETE en quirófano durante la miomectomía
2) Mayor valor de la #WhyCMR en la valoración diagnóstica y la estratificación de riesgo de MSC.

✔️Indicación clase I si eco no diagnostico, sospecha de fenocopias y para evaluar el riesgo de MSC si no hay clara indicación de DAI
✔️RTG clase IIb para indicación DAI
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
1/
Comprehensive talk by Dr. @JoaoLCavalcante who who patiently walked us through #WhyCMR in Mitral Regurgitation.
First: different etiologies of MR where #WhyCMR may be applicable:
🧲Primary MR
🧲Arrhythmogenic MVP phenotype (including MAD)
🧲Secondary MR (work in progress)
2/
Limitations of #echofirst:
🧲overestimation of MR by PISA, underestimation of eccentric MR.
🧲poor reproducibility if MR severity (inter- and intra-observer)
🧲Alas, there is no accuracy without reproducibility 👎🏻
3/
#WhyCMR for Primary MR➡️
🧲CIRC ‘17➡️CMR severe-TTE moderate MR outcomes similar to CMR severe-TTE-severe MR.
🧲JACC ‘15➡️👎🏻correlation of MR estimates by #whycmr & #echofirst in pts referred to MV Sx.
🧲💪🏻 correlation b/w post-op LV remodeling & baseline MR severity by CMR
Read 11 tweets
#ESCCongress has ended. A unique conference! An unforgettable conference! These are my highlights!

Firstly, an amazing DIGITAL experience... Brining everyone together, breaking all barriers, diminishing borders.

@Barbara_Casadei @Steph_Achenbach @mmamas1973 @DrMarthaGulati
In an earlier (still ongoing) Poll from today... 77% wished to have a hybrid Digital and In Person conference... That would certainly have lots of attractions especially for those who wouldn't other be able to afford it #ESCCongress



@MarziaRigolli
...& now the science! In random order (depending on which I could find in my twitter thread most easily!)

No 1. #Covid and the HEART

HTN, Lipids, Diabetes, CAD, heart failure, ALL associated with worse prognosis (critical events & deaths)

Women have it less severely

#EPeeps
Read 16 tweets
Excellent session on #Aortopathy by @michelenahector
#ESCCongress

#CVimaging

📌 Aortic root up to STJ
📌 Dilatation per Body size & Pathology
>45mm significant dilatation
📌 Use nomograms to define dilation
📌 Describe Dilatation/segment/accurate measurement in the 📰
Excellent session on #Aortopathy by
@michelenahector

#ESCCongress
📌 Look for RF in Bicuspid Aortopathy Sx cut off 50-54mm
📌 Bicuspid Aortopathy without RF Sx cut off 55mm
📌 Some example of Fusiform AA dilatation VS Root dilatation
#Aortopathy by @michelenahector
#ESCCongress

Dilatation Phenotypes
🎈Most common:AA dilatation in HTN, BAV
🎈 Marfanoid in Marfan, LDS, BAV root phenotype
Read 5 tweets
Check out the #MINOCA section in updated NSTE-ACS guidelines at #ESCcongress
bit.ly/3bcrixp

Here is a tweetorial on #MINOCA
🧲Class I Recommendations🧲

-> Use of Diagnostic algorithm
-> Use of #whyCMR
-> Use of working dx & Rx according to the underlying Dx
MINOCA has MI in it-> DOES the definition allows for the inclusion of non-ischemic causes of troponin elevation?

Given this limitation of the troponin bioassay, the “Fourth 4th Universal of MI" defined Injury from infarction

INJURY IS NECROSIS WITHOUT ISCHEMIA!
#ESCCongress
The hallmark of myocardial injury ⬆️ troponin, However, these entities differ conceptually
▶️ myocardial injury = nonischemic mechanisms of myocyte injury (eg, myocarditis),
▶️MI = ischemic mechanisms (eg,
plaque disruption or supply-demand mismatch).

#ESCCongress
Read 10 tweets
An EXCITING NEW guideline from @escardio at #ESCCongress on Atrial Fibrillation. It’s a long read of 126 but enjoyable! Here are my top tips from this guideline…#epeeps Link: bit.ly/2YRdX8S @mmamas1973 @pash22 @Hragy @DrMarthaGulati @ErinMichos @AnastasiaSMihai /THEAD
FOCUS is on CONFIRMING AF (12 lead >30s) and CHARACTERISING it…
The 4S….

Stroke Risk…
Symptom Severity…
Severity Burden of AF
Substrate of AF

@KTamirisaMD @StavrosStavrak1 @StavrosDrakos @JonathanBehar @bogdienache @mencardio
#ESCCongress /3
AF ESC GUIDELINE Tweetorial

Stroke Risk – Simple – CHA2DS2-VASc Score
& HAS-BLED, to stratify bleeding
Symptom severity- Use the EHRA symptom scale
Burden- paroxysmal, persistent, permanent and if paroxysmal how frequently
Substrate of AF- comorbidities #ESCCongress /4
Read 15 tweets
Just published on @SciReports: disq.us/t/3qzu3fo,
Role of dyspnea at presentation in #Takotsubo. Thanks to
@FraSantoroMD @beamusumeci1 @lucarlimite @IngoEitel. Here it follows some considerations.
1- Dyspnea was associated with both worse in-hospital and long-term outcome. Similarly described in AMI (ref #12 and #13) in which heart failure symptoms at presentation might reflect wider myocardial damage. Why is it so even for a “transient” condition such as #Takotsubo?
2- Dyspnea was independently associated with both higher cardiac impairment and comorbidity burden, intuitively linked to the worse prognosis in the acute phase. And long-term, after recovery of cardiac function? We tried to give two possible explanations (just hypothesis).
Read 9 tweets
#SCCT2020: Lead & Not Just Read
Chaired by Drs. @appropriateuse & @FiRSTSCCT Chair-Elect @Nidhi_Madan9
[Thread]
@appropriateuse @FiRSTSCCT @Nidhi_Madan9 1/@RonBlankstein's advice to Trainees/Early Career:
-get good at what you do
-invest in your training
-multimodality
-work hard but maintain wellness
-read/stay updated
-research
-local champion
-communicate
-educate
-invest in techs
-dont be afraid to ask
-@Heart_SCCT community
@appropriateuse @FiRSTSCCT @Nidhi_Madan9 @RonBlankstein @Heart_SCCT 2/@ToddVillinesMD's advice in publishing in #YesCCT:
- compelling hypothesis - novelty, priority, educational, impactful
-✍️effectively - include limitations
- avoid common author pitfalls
- practice becoming a better peer-reviewer
- consider submission to @journalCCT
Read 8 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
On behalf of @ACC Imaging Section Leadership Council & @JACCJournals Imaging, I’d like to invite you to join us for this webinar:

Multimodality CV Imaging in #COVID19 Era: Ramping up safely to a New Normal

Friday, June 19th at Noon ET

bit.ly/37xCNh4 Image
Safe reopening of #CVImaging labs

Indications?
PPE?
What modality?
What patient?

Great @ACCinTouch @JACCJournals #JACCImaging webinar by @WilliamZoghbi @RonBlankstein @salernomdphd @VTaqMD @RigolinVera @mdicarli

1/2 #EchoFirst & #CVNuc ImageImageImageImage
Read 4 tweets
Here’s my first tweetorial inspired by @OKhaliqueMD. Tips and Tricks on LGE *stealing the title from @VLSorrellImages tinyurl.com/y9yc3ntj

Didn’t know I can tweet on my computer before this. 😀
For LGE imaging, we generally perform a TI scout, choose TI time to null the myocardium to evaluate for scar (bright). Here blood pool nulls at 145ms, and myocardium nulls at about 240ms
Alternatively we can use post-contrast T1 map: obtain normal myocardial T1 and multiply by 0.69 or ln(2). E.g. T1: Myo T1 = 422ms, 0.69 * 422 --> normal myocardium nulls at TI of 291ms
Read 12 tweets
18 y old male repaired CHD as a child
Dyspnea class III stable BP and O2 sat 95% LBBB
Echo No Shunt
What is the next step?
@AlkashkariWail @MasriAhmadMD @CincyACHD @purviparwani @cardiopedhnn
#cardiotwitter #whyCMR #echofirst
@iamritu @MayoClinic @ACHDatStanford
This is r-TOF in HF with severe biventricular dysfunction absence of residual valvular stenosis or regruge and no shunt or COA
Provided approach to ACHD patient with HF
sciencedirect.com/science/articl…
#cardiotwitter #whyCMR #echofirst @AHAMeetings
Read 5 tweets
16 y with Syncope /differential cyanosis / clubbing

@AlkashkariWail @MasriAhmadMD @CincyACHD @purviparwani @AriCedars @FredWuMD
@PushpaShivaram
#cardiotwitter #whyCMR #echofirst
@RoyalFreeNHS @MayoClinic @ACHDatStanford
@threadreaderapp
@ResearchGate
Approach
PDA Eisenmenger (high risk)
Pulmonary Artery aneurysm(PAP) diameter >40 mm
Echo ( RVH- RVSP 81mmHg)
Sagittal CMRI confirm large PDA (R to L shunt)
Cath/hemodynamics and Acute vasoreactivity test (AVT) confirmed Elevated PVR (Non reactive )
#cardiotwitter
Read 4 tweets
It’s been over 2 months since the first descriptions of cardiac manifestations of Covid-19. There have been many papers and reviews on this topic. What have we learned about how SARS-CoV-2 can affect the heart? #whyCMR #cardiotwitter
Troponin elevations and low EFs are frequently described. Why do they happen? Most papers use the term Covid-19 myocarditis. But can SARS-CoV-2 cause fulminant myocarditis (= extensive focal myocardial necrosis, as seen with viral lymphocytic or giant cell myocarditis)?
I tried looking at published CMR images and autopsy studies to get some insights into what happens in the hearts of Covid-19 patients. I’ll share my thoughts on 10 papers with CMR images and 2 papers each with autopsy data in >10 patients:
Read 28 tweets
⚡️ Happening Now ⚡️

#ACCImaging Council Webinar

Role of Multimodality Imaging in Dx & Management of Patients With #COVID19

#YesCCT #EchoFirst #WhyCMR #CVNuc

Join us👇
acc.org/education-and-… Image
@JudyHungMD @DRCJWhite @Drroxmehran @mdicarli @ToddVillinesMD discussing Dx w/u & role of #YesCCT for abnl EKG & RWMA on echo ImageImage
Management algorithm of acute MI in #COVID19 by @ToddVillinesMD Image
Read 9 tweets
1/6 #Cardiotwitter - check out this #Tweetorial

"CV considerations & #COVID19"

💥Viral cell entry using ACE2
💥ACEi/ARB - don't stop - no evidence of harm/benefit

#ACCFIT #MedEd #Medtwitter #HMHFellow @HMHCardioFellow @HMethodistCV #StayHomeSaveLives #FlattenTheCurveTogether
2/6

💥Increased #COVID19 mortality with CVD
💥Association between elevated troponin and mortality
💥#COVID19 + elevated troponin -> older patients, more co-morbidities, higher acuity
3/6

💥ACC: Measure troponin & BNP if considering ACS / HF clinically
💥Based on studies, ?consider using troponin as prognostic marker
💥ACS: GDMT, consider cath lab staff exposure, ?fibrinolytics in low risk ACS

#COVID19
Read 6 tweets
@onco_cardiology @JStojanovskaMD @MichaelCoMD @DmitryAbramovMD @chiarabd @HeartDocSubha @larsgrowo @SarjuGanatraMD @AnaBaracCardio @AkhilNarangMD @krychtiukmd @vass_vassiliou @DrToniyaSingh @AChoiHeart @AnkurKalraMD @adityadoc1 Incidence of Cardiac Metastases: 1.23%
Primary Cardiac Tumors 0.056%

Can be benign, malignant or pseudotumor
Primary Cardiac tumor- mostly benign

#Cardiac Mass eval: detailed clinical presentation, History, Physical Exam, #echofirst to see the tumor characteristics
Read 13 tweets
With all the discussion about viability in the past few days, I would like to share how I interpret and report viability on CMR. I first look for LGE. Rarely, there’s no LGE and it’s all viable or more likely, a non-ischemic cardiomyopathy. #WhyCMR 1/18
When I see LGE, I confirm it’s in an ischemic pattern – subendocardial or transmural, and limited to a coronary territory, i.e., an MI. If not, it's again a non-ischemic cardiomyopathy and not a viability issue anymore. 2/18
Next, I try to identify how many and where the MIs are. For this, I look at the extent and locations of ischemic LGE and decide which of the 17 LV segments are likely to be supplied by each of the coronary arteries. 3/18
Read 18 tweets
Hypertrophic Obstructive Cardiomyopathy #HOCM🚧

#Symptoms
Profound exertional dyspnea

#Imaging
▪️SAM/LVOT obstruction #whyCMR
▪️Classic #Doppler🗡#echofirst

#Hemodynamics
▪️Brockenbrough-Braunwald-Morrow sign, explained

#Treatment
▪️Alcohol🍷septal ablation #RadialFirst
Question:
Why wouldn’t more filling time⏱ prior to post PVC beat lead to less obstruction, less gradient, & ↑ arterial pressure?

After all, doesn’t ↑LV volume in #HCM ↓gradient and improve symptoms?

Cornerstone tx is hydration/💊s that ↑ diastolic filling time ...
Read 6 tweets
For all those unable to make my 7 AM presentation on Speckle Science yesterday, here's the requested #Tweetorial on Strain basics #ASE2019 @ASE2019 as promised.
Read 27 tweets

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