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Martin Ugander Profile picture
@mugander
Nov 1, 2022 • 5 tweets • 3 min read • Read on X
#EchoFirst & diastolic dysfunction - what do you know about:
✅hydraulic forces
✅myocardial stiffness
✅damping

Learn more in this talk I recently gave at Echo Australia 2022.

🫀🔊
#BoingBoing

Did you know that #HydraulicForces:
✅are related to the relative size of the LA in relation to the LV?
✅contribute to left ventricular diastolic function?
✅associate independently with survival?
Myocardial #stiffness and #damping are mechanistic ⚙️properties of the LV that can be estimated by measuring the Doppler 🔊 E wave peak velocity, acceleration time ⏲️, and deceleration time ⏲️.

More in this separate thread:

Not all diastolic dysfunction manifests in the same way. HFpEF has increased damping, whereas HFrEF has increased stiffness.

#SameSameButDifferent
All this an more are touched upon in this talk:

• • •

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More from @mugander

Martin Ugander Profile picture
Nov 9, 2023
For #EchoFirst measure of the LV, LA, aortic size, what is the best body size measure to index by?

New paper (PMID 37938592): We used CV mortality in 200,000+ pts in the Natl Echo Database Australia #NEDA to determine the best indexation measure.

🧵

1/n Image
First question - does any body size indexation improve the prognosis of echocardiographic measures?

Answer: Yes

2/n Image
This key figure shows how different body size indexation metrics affect survival (C-statistic) across all echo measures. Indexing a measure by weight [w] alone, or height*weight [hw], or BSA by Mosteller [BSA_M] all improve C-stat vs unindexed.

3/n Image
Read 14 tweets
Martin Ugander Profile picture
Nov 17, 2022
What's the best 🫀 imaging method to detect & quantify pulmonary hypertension?

Just out in JACC Cardiovasc Imaging:

Ramos JG, et al, "Pulmonary hypertension by catheterization is more accurately detected by #WhyCMR 4D-Flow than #EchoFirst"

🧵
Firstly, starting back in 2008, co-authors Gert Reiter and Ursula Reiter pioneered the method for estimating mPAP by vortex duration by #WhyCMR #4Dflow. Image
Vortex duration, or t_vortex, is the percent of the cardiac cycle during which a vortex can be visualized in the main pulmonary artery. Image
Read 18 tweets
Martin Ugander Profile picture
Feb 10, 2022
Do you routinely measure #MAPSE?

Did you know that MAPSE beats #GLS and #LVEF regarding prognosis?

A new multicenter collab study out, led by @KellmanPeter

Ref:

#WhyCMR 🫀🧲 #EchoFirst 🫀🔊

A thread 🧵. 1/n pubmed.gov/35132872
Image
We know that GLS is a composite measure correlated w LVEF, LVEDV, LVESV, LV mass, infarction, non-ischemic scar, aortic stenosis, mitral regurg, ECV.

So, not surprisingly, GLS associates with poor prognosis.

Ref: Suppl Table 2

2/n pubmed.gov/32563637
Notably, mitral annular plane systolic excursion #MAPSE has been measurable by #EchoFirst since 1986 by M-mode ().

3/n pubmed.gov/3464160
From pubmed.gov/3464160, Figure 3-4B, M-mode recording of the mitral valve annulus by echocardiography.
Read 13 tweets
Martin Ugander Profile picture
Oct 28, 2020
When it comes to LV diastolic (dys)function, let's think of the LV like a spring, which is compressed during systole, and recoils during diastole.

A thread 🧵
1/n
@strain_rate @load_dependent @DrWillWatson @shaunrobinson02 @leoshmu
The physics governing the recoil of a spring are well described as a damped harmonic oscillator, and it is well validated that the Doppler E-wave is governed by these same physics, aka parameterized diastolic filling (PDF) [pubmed.gov/3812709].
2/n
This means that the shape of the E-wave can be excellently curve fit to a function that describes the behavior of a damped harmonic oscillator. Figure from pubmed.gov/33066772
3/n
Read 15 tweets

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