Parham Eshtehardi MD Profile picture
Sep 3, 2019 3 tweets 4 min read Read on X
A great move for patients with #CMD by @escardio

Definition, Dx & Rx are all addressed in new ESC 2019 Guidelines on Chronic Coronary Syndromes

✅ Invasive CFR/IMR: Class IIa rec
✅ Invasive Endo Fxn by ACh: Class IIb
✅ Non-invasive testing: Class IIb

escardio.org/Guidelines/Cli… ImageImage
Definition of “Microvascular Angina” & how to distinguish between angina from #CMD & #CAD
👇

I personally avoid using this term because even when we establish Dx of #CMD, many pts have concomitant epicardial dz &/or Endo Dysfxn; so angina might be multifactorial or 2/2 other 2 ImageImageImage
@escardio recommend Rx for #CMD:
BBlockers
ACEi
Statins

✅ Our practice (in order):
BBlockers
Statins
ASA (if any CAD)
Nitrates
CCB
Ranolazine
ACEi

(no strong evidence for any of these meds) Image

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More from @CardioOBDoc

Sep 21, 2021
Prevalence of Subclinical Coronary Atherosclerosis in General Population
@CircAHA

1/x
🇸🇪 25K randomly invited individuals w/o known CAD underwent CCTA
🇸🇪 51% women
🇸🇪 50 to 64 yrs
🇸🇪 #SCAPIS (the Swedish Cardiopulmonary Bioimage Study)

ahajournals.org/doi/10.1161/CI…
2/x
🇸🇪 42.1% any CCTA-detected atherosclerosis

🇸🇪 5.2% any significant stenosis (≥50%)

🇸🇪 1.9% LM, prox LAD or 3VCAD

🇸🇪 8.3% any non-calcified plaque

🇸🇪 plaques most common in prox LAD

🇸🇪 Participants with only non-Ca plaques were rare (2.4%)

ahajournals.org/doi/10.1161/CI…
3/x
🇸🇪 Prevalence of CCTA-detected atherosclerosis ⬆ w/ ⬆ #CAC scores

🇸🇪#CAC-positive participants:
- Most w/ low (11 - 100) or ultralow (1 - 10) scores
- median score 35 (IQR 8 - 126)

🇸🇪 participants w/ #CAC zero & interm 10-yr risk, 9.2% had CCTA-verified atherosclerosis
Read 7 tweets
May 16, 2021
9/19
#Tweetorial #CMD #ACC21

#CMD shares similar RFs w epicardial atherosclerosis (traditional ASCVD RFs) & is associated with several biomarkers of inflammation, oxidative stress & coagulation

🔗futuremedicine.com/doi/10.2217/fc…
🔗sciencedirect.com/science/articl…
🔗atherosclerosis-journal.com/article/S0021-…
10/19
#Tweetorial #CMD #ACC21

There is significant overlap between #CMD & epicardial disease

Large number of patients w/ #CMD also have epicardial atherosclerosis (obstructive or non-obstructive) & epicardial endothelial dysfunction

🔗onlinelibrary.wiley.com/doi/abs/10.100…
11/19
#Tweetorial #CMD #ACC21

In our IVUS study:
✅ Most patients with #CMD had significant plaque burden
✅ Patients with #CMD had higher plaque burden & more diffuse atherosclerosis as compared to patients w/o CMD

🔗jacc.org/doi/full/10.10…
Read 11 tweets
May 16, 2021
#CMD #Tweetorial

⚡ Coronary Microvascular Dysfunction ⚡

1/19

📌 What Is #CMD
📌 Why Is #CMD Important❓

Based on my #ACC21 #ACCImaging presentation
2/19
#Tweetorial #CMD #ACC21

Let’s start by talking about angina

✅ Angina w/o obstructive CAD is very prevalent 

🔗ahajournals.org/doi/full/10.11…
3/19
#Tweetorial #CMD #ACC21

✅ Angina ➡ poor prognosis
✅ Angina with no obstructive CAD = ⬆ risks of CV events compared to no angina, even after adjusting for traditional RFs & co-morbidities

🔗academic.oup.com/eurheartj/arti…
Read 9 tweets
May 6, 2021
Join us at #ACC21 to learn about #CMD

✅ What Is #CMD & Why Is It Important?
✅ Dx & Risk Stratification of #CMD: Stress Testing & Noninvasive Imaging
✅ Catheter-Based Techniques in Dx of #CMD
✅ Emerging Link Between #CMD & #HFpEF
✅ Phenotype-Based Mngmt of #CMD Image
#ACC21 #CMD session details 👇

📅 Sat, May 15
⏰ 2PM ImageImageImageImage
#ACC21 #ACCImaging #CMD session starting in 15 mins
Don’t miss this educational session Image
Read 8 tweets
Sep 26, 2020
#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
Sep 8, 2020
☢ 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

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