Sarah Hudson Profile picture
Oct 16 12 tweets 8 min read
💚Top Ten Slides from day 1 of #BSEcho2022 💚

A thread for all those who echo

1) Should we use the highest beat/signal in AF? Slide shown by Sanjeev Bhattacharyya

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2) Peripartum cardiomyopathy - don't miss it and remember need to counsel/risk stratisfy if considering future pregnancies. Slide shown by @BSE_President Claire Colebourn at #BSEcho2022

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3) The adult ACHD population is larger than the paediatric one, and 86% have biventricular anatomies. Interesting UK data shown by Liam Corbett at #BSEcho2022

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4) Exercise stress beats dobutamine for assessment of myocardial ischaemia by echo - reminder slide shown by Prof Roxy Senior at #BSEcho2022

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5) Schematic of how to approach assessment of prosthetic heart valves, shown by Jim Newton at #BSEcho2022

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6) Patient prosthesis mismatch - table of grading shown by @hothi_sandeep at #BSEcho2022 - note different ranges based on BMI.

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7) Chamber size changes in pregnancy - slide shown by Hannah Douglas at #BSEcho2022

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8) How often should a pt with a known regurgitant lesion and no complications have an echo when pregnant? Slide shown by Steph Curtis at #BSEcho2022

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9) A recap of the usual association of coronary arteries with echo segments, shown by Wendy Gamblin at #BSEcho2022

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10) When to routinely echo pts with prosthetic valves - slide shown by @hothi_sandeep at #BSEcho2022

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It was really hard to choose 10 as there were so many brilliant talks - thanks to all who worked hard to organise #BSEcho2022, and I'm sorry I couldn't be there in person.

@DrDanAugustine @DrEmmaRees @guyll @NavMasani @jwillis82 @nat_echo @The_echo_lady @Faffandtwig

11/11
Apologies to @wendyjg75 as I added an extra letter to her name 😳

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More from @sarahhudsonuk

Aug 29
💥My top 10 learning points from the #ESCCongress 2022💥

A thread for cardiologists/general physicians

1) Addition of IV acetazolamide to IV furosemide in AHF results in 46% higher incidence of successful decongestion after 3 days

EVIDENCE: ADVOR nejm.org/doi/full/10.10… ImageImageImageImage
2) Revascularization with PCI does not improve event-free survival in pts with severe LVSD over OMT alone
(HF cohort, not acute ACS pts or significant angina)

Evidence: REVIVED
nejm.org/doi/full/10.10…

#ESCCongress ImageImageImageImage
3) In pts with rheumatic heart disease and AF, RCT evidence supports VKA use over rivaroxaban, with decreased composite of CV events and death with VKA and no increase in bleeding.

Evidence: INVICTUS nejm.org/doi/full/10.10…

#ESCCongress ImageImageImageImage
Read 11 tweets
Aug 29
We have GDMT and CRT for HFrEF, we will soon also have BAT (Baroreflex Activation Therapy)?

See 🧵below to learn more about this treatment that has significantly improved QoL, exercised capacity and NTproBNP in a RCT...

#ESCCongress
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The #ESCCongress session started with @FudimMarat discussing how it worked – explaining how pts with HF have poor baroreflex sensitivity, that baroreflex down-regulation is related to worse HF symptoms & barostim provided chronic improvement in muscle sym nerve activity

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Next William Abraham talked about what has been learnt from clinical trials, focusing on BeAT-HF which was an RCT that showed BAT significantly improved exercise capacity, QoL, NYHA class and NTproBNP, and was safe

Paper: jacc.org/doi/10.1016/j.…

#ESCCongress

3/n
Read 7 tweets
Nov 17, 2021
💥The new NICE valve guidelines are out! 💥

When do they recommend intervention in severe non-symptomatic valve disease? And how does this compare to the ESC 2021 valve guidelines?

A thread...

References:
nice.org.uk/guidance/ng208…
escardio.org/Guidelines/Cli…

1/n Image
Indications for referral for surgery for severe asymptomatic AS:

❤️Some match ESC guidelines (Vmax >5m/s, LVEF <55%, symptoms on exercise testing)
❤️lower cut off for raised BNP (2x ULN compared to ESC’s 3x ULN)
❤️include valve area <0.6cm2 (not mentioned by ESC)

2/n Image
The NICE guidelines for referral for surgery for severe asymptomatic AS do NOT include a couple of criteria mentioned by the ESC guidelines:

▪️ progression ≥ 0.3m/s/yr not included
▪️ Sustained fall in BP >20mmHg on exercise testing not included

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Read 11 tweets
Aug 30, 2021
💥My top 10 learning points from the #ESCCongress 2021💥

A thread for cardiologists/general physicians

1) There is a treatment for HFpEF!

Empagliflozin significantly ⬇️composite of HF hospitalisation & CV death by 21%

Evidence: EMPEROR-Preserved nejm.org/doi/full/10.10…

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2) A more aggressive BP target (110 to 130 Vs 130 to 150) in elderly patients resulted in lower rates of cardiovascular events

Evidence: STEP study -nejm.org/doi/full/10.10…

2/n #ESCCongress ImageImageImageImage
3) Using a salt substitute ⬇️risk of stroke, major CV events and total mortality.

Evidence: SSaSS study - nejm.org/doi/full/10.10…

3/n #ESCCongress ImageImageImageImage
Read 10 tweets
Aug 28, 2021
Have there been changes in when to intervene with the new 2021 ESC/EACTS guidelines for the management of valvular heart disease?

Yes, and in general the bar for intervention is now lower

Thread follows...

#ESCCongress

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1)The indications for surgery in severe asym AR have changed

- LVEDD has disappeared from the summary table& diagram
- but LVEDD>65mm is mentioned in the text as a possible indicator for surgery (less than previous >70mm) if there is progressive LV size⬆️/⬇️EF

#ESCCongress

2/n Image
Surgery in asymp severe AR with LVESD>50mm or indexed >25mm/m2 has been upgraded from IIa to I

A new IIb recommendation has appeared for indexed LVESD >20mm/m2 or LVEF≤ 55% if surgery low risk

Valve repair for AR has been downgraded from I to IIb

#ESCCongress

3/n Image
Read 6 tweets
Sep 1, 2020
💥My top 10 learning points from the #ESCCongress💥

A thread for cardiologists/general physicians

1) Post acute MI, transfuse if ≤8g/dL

Evidence: REALITY trial- not yet published – summary reported acc.org/latest-in-card…

1/n
2) SGLT2i in addition to standard HF treatment significantly ⬇️CV death, including in non-diabetic pts

Evidence: EMPEROR-Reduced (nejm.org/doi/full/10.10…)
& metanalysis of DAPA-HF and EMPEROR-Reduced (thelancet.com/journals/lance…)

#ESCCongress
2/n
3) Colchicine 0.5mg od in pts with chronic coronary disease⬇️CV death/MI/CVA

Evidence: LoDoCo 2 -nejm.org/doi/full/10.10…

#ESCCongress

3/n
Read 10 tweets

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