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Marat Fudim, MD MHS Profile picture
@FudimMarat
Mar 25, 2023 • 4 tweets • 4 min read • Read on X
‼️Reduction in cerebral blood flow (CBF) is found in various forms of #Dysautonomia and leads to a broad spectrum of symptoms such as dizziness, fatigue, shortness of breath, all the way out to syncope. Yet, CBF is often not monitored.
pubmed.ncbi.nlm.nih.gov/27525257/ ImageImageImage
sciencedirect.com/science/articl…

We tested the feasibility of a novel continuous monitoring of external carotid blood flow as a proxy for CBF using a novel in-ear device. An in-ear wearable device designed to measure blood flow and more. @HopkinsMedicine @VUMC_heart Tandri, Tripathi ImageImageImage
The device provided near-continuous data on eCBF both during baseline and during periods of syncope. Moreover, changes in the external carotid blood preceded syncope during tilt by several minutes. The in-ear device may improve the sensitivity or maybe even replace tilt testing?!
More to come on this technology. Hope this will provide an novel opportunity for the monitoring and management of patients with #Dysautonomia and #LongCovid

@statwearable

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More from @FudimMarat

Marat Fudim, MD MHS Profile picture
Nov 4, 2022
#1 Pressures do not equal volumes

▶️ What are the implications for heart failure management❓ Specific examples in patients co-managed with pressure and volume guided analysis are now online:
onlinelibrary.wiley.com/doi/10.1002/eh…

@ShahzebKhanMD @MGKhouri_md @DukeHeartCenter
#2 We previously shown that the most common phenotype of pressure/volume in the HF ambulatory setting are high pressures BUT normal or low blood volume (BLUE BOX)

onlinejcf.com/article/S1071-…
#3 To contextualize and provide concrete examples and impact on clinical management, we report two cases of heart failure (one in HFrEF and one in HFpEF) where pressure-based measurements did not accurately represent the intravascular status and affected clinical management.
Read 9 tweets
Marat Fudim, MD MHS Profile picture
Oct 9, 2022
Have you noted that patients with acute #heartfailure (AHF) hyperventilate? @JanBiegus et al. studied hyperventilation (defined by low pCO2 value) AHF and its link with potential triggers and prognosis👏nature.com/articles/s4159… @AlbertoGiannon8 @vbluml @RyanTedfordMD @yulnunezvill
1.Out of 241 AHF patients, 57 (24%) had low pCO2 (pCO2 ≤ 30 mmHg). Low pCO2 group had significantly lower HCO3- (22.3 ± 3.4 vs 24.7 ± 2.9 mmol/L, p < 0.0001) and significantly higher lactate level (2.53 ± 1.6 vs 2.14 ± 0.97 mmol/L, p = 0.03).
2.No differences between groups were observed in respect to following potential triggers: hypoxia (sO2, p = 0.57), infection (CRP, p = 0.47), dyspnea severity and pulmonary congestion
Read 5 tweets
Marat Fudim, MD MHS Profile picture
Oct 9, 2022
I am a cardiologist, and my work place is above the diaphragm?! Why should I care about the #liver and #NAFLD (non-alcoholic fatty liver disease)?
⚡️Our therapies in many cases reach well beyond the heart
⚡️In order to improve outcomes we have to tackle comorbidities
A🧵
🟦NAFLD (prevalence 25%) isn't only a hepatic disease but also a systemic & CV disease w/o effective pharmacotherapy
🟦We discuss the promising role of SGLT2i in NAFLD, propose mechanisms, & suggest future directions.

sciencedirect.com/science/articl…
The pathogenesis of NAFLD is multifactorial w/ parallel processes that involve insulin resistance, hepatic fat accumulation, increased lipotoxicity, mitochondrial dysfunction, oxidative stress, ER stress, abnormal autophagy, altered gut flora, & apoptosis.
Read 7 tweets
Marat Fudim, MD MHS Profile picture
Jul 30, 2022
Great thread on the link of Ehlers Danlos Syndrome (EDS) and Dysautonomia/POTS.

To extend on the observations some additional points 🧵:

#1 EDS is commonly associated with venous abnormalities such as nutcracker physiology of abdominal vessels or May Thurner syndrome.
#2 The issue with venous distension in the abdomen and pelvis is that it creates venous pooling/obstruction to blood return. Its mostly in the abdomen and not legs!
#3 The consequence are abdominal symptoms often reported by EDS and dysautonomia/POTS patients such as Chronic abdominal pain, Bladder fullness, Flank pain etc...

The Clinical Problem of Pelvic Venous Disorders
interventional.theclinics.com/article/S2211-…
Read 8 tweets
Marat Fudim, MD MHS Profile picture
Jul 15, 2022
📢COVID-19 and Incident Heart Failure in @NatureComms

🟥 COVID-19 hospitalization is associated w/ a 45% higher hazard of incident HF
🟥 More pronounced association among pts who are younger, White, or w/ established CVD

nature.com/articles/s4146…
🌟-team @HusamSalah @CaugheyPhD Image
🚨As of July 4, 2022, there were about 529 million pts who recovered from COVID-19. The association between COVID-19 recovery and incident HF has not been studied in a large scale, nationally representative sample.
🚨We examined post-recovery outcomes of 587,330 pts hospitalized in the US using data from the N3C study w/ a median F/U of 367 days. W/O adjustments, post-recovery COVID-19 was associated with a 69% higher hazard of post-discharge incident HF and 45% higher hazard W/ adjustment.
Read 6 tweets
Marat Fudim, MD MHS Profile picture
Feb 12, 2022
🔥🚨Pressures Do Not Equal Volumes🚨
#1
We present ➡️ Discordance of Pressure and Volume: Potential Implications for Pressure-Guided
Remote Monitoring in Heart Failure
➡️We explored pressure-volume relationship
in ambulatory HF pts. managed with CardioMEMS
onlinejcf.com/article/S1071-…
#2
⚡️Pulmonary arterial diastolic (PAD)/wedge pressure are surrogate markers for (intra-vascular) blood volume (BV) and are often used to guide volume adjusting therapy (aka diuretics)
⚡️We found no relationship between PAD pressure and intra-vascular BV
#3
⚡️Majority of patients had high pressures but low-normal volume (blue box)
⚡️Minority had high pressure/high volume (yellow)
⚡️We found a moderate relationship between PAD and stressed BV (fluid shifts) ▶️ Fluid shifts rather than fluid retention were driving force of high PAD
Read 8 tweets

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