Brilliant presentation by Dr. @PPibarot on Aortic Valve Calcium Score @MonteHeart CT/CMR Lecture on 10/16/20.
💥Important to begin by appreciating burden of AS.
💥#echofirst remains primary modality to assess HEMODYNAMIC severity.
💥Need other tools to assess ANATOMIC severity!
💥JACC 2019➡️Review non-contrast CT to measure AVC in AS.
💥An example protocol by Dr. @PPibarot ⬇️ measuring calcium burden in en-face view of AV.
💥Pitfalls: inclusion of LVOT, sorta, mitral annulus & cors. Multi-planar reconstruction helps carefully exclude non-AV calcium.
💥Women & Men are different! For a given amount of AVC, 🚺 have a ⬆️ peak jet vel. by #echofirst. For a given peak vel. by #echofirst 🚹 have higher iAVC.
💥AVCd didn’t help resolve the discordance.
💥2017 ESC guidelines for severe AVC ➡️>1200 AU 🚺,>2000AU🚹.
💥Reason for sex disparity was recognized as being ⬆️ fibrosis in 🚺 compared to 🚹
💥In young patients w/ bicuspid AV(YBAV) ⬆️HEMODYNAMIC severity of AS was found in absence of significant AVC.
💥YBAV usually identified by #echofirst alone.Older pts w/ LFLG benefit from #yescct
💥But does our knowledge of ANATOMIC severity of AVC w/ #yesCCT impact outcomes?
💥YES ⬇️ severe AVC at baseline predicts outcome (survival) as well as rate of progression.
💥Moving on to using #yesCCT AVC as a tie-breaker in low-gradient AS. Beautifully outlined below.
💥Future perspectives 1
💥Contrast #yescct to assess AV fibro-calcific burden (FCB). Might be particularly useful in 🚺.
💥example: 3 cases with similar #echofirst. Calcification=3SD above mean attenuation in blood pool,rest= fibrous tissue.
💥FCB ⬆️⬆️ with severe AS & in 🚺.
💥Future perspectives 2
💥Use of non-con #yesCCT to assess bAV calcification aka structural valve deterioration (SVD) using the poly metric method.
💥isolates SVD by #yescct aka early stage a/w 2-fold ⬆️d risk of 💀 or re-intervention.
💥Future perspectives 3
💥Using NaF PET-CT to identify microcalcification and predict disease progression.
💥Concluding this incredible talk⬇️
💥🎥 with QA session can be found on @MonteHeart @YouTube channel➡️….

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More from @rachkataria

12 Sep
❤️Enjoyed watching the #HeartFailure: Looking Back and Moving Forward webinar.
❤️Dr. Braunwald summarized his 70 years of experience in ~20 minutes.
❤️So much has happened before I was even born!
❤️Yet, so much more to look forward to! Thank you for a tour back in time!
❤️I thoroughly enjoyed Dr. John McMurray’s overview of “the five alive” & his emphasis on moving away from vertical integration approach.
❤️Up-titrating each medication should not interfere w/ adding meds w/ complimentary benefits.
❤️No excuses, because #GDMTworks.
❤️Loved how Dr. Milton Packer went back in time to highlight the origin of LVEF cut-offs & the confusion that followed.
❤️He then advised using strain & myocardial contraction fraction, compared & contrasted common diseases using the same.
❤️HFpEF:disease of something else!
Read 5 tweets
4 Sep
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)
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 👎🏻
#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

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