Jinyang Yu Profile picture
Jan 28 12 tweets 5 min read Read on X
🧵1/
Many try to monitor LV function using #POCUS or #EchoFirst, but echo does not work for monitoring.

Let's understand why #POCUS fails at monitoring LV function and how #AutoMAPSE can help.
#MAPSE

🔓

@JcmcSoMe #FOAMcc #FOAMed #CardioTwitter rdcu.be/dw7fT
Image
2/
The goal of monitoring is
1⃣to detecting small and early changes
2⃣so that therapies can help patients.

For successful monitoring, the measurements must be precise and acquired rapidly and effortlessly. Neither #EchoFirst nor #POCUS fulfil these criteria.
3/
Eyeballing is rapid, effortless, and OK for diagnosing LV dysfunction.

But eyeballing is NOT precise because it categorises LV function.

Changes in LVEF from 45 to 30% are important, yet still in the same category ➡️ undetectable by categorical assessment.
4/
The monitored measurements must be quantitative to be precise.

Manual measurements in #EchoFirst are quantitative, but human variability still render them imprecise.
📜

Imprecision causes 2⃣ problems during monitoring. rdcu.be/dw7fT
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5/
Problem1⃣: Busy doctors may be fooled by imprecision.

Its easy to misinterpret random changes as real and react to this randomness with interventions. Of course, the patient has no chance of benefitting from those interventions, and can only be harmed.
6/
Problem2⃣: When we use imprecise tools like #POCUS, we need much larger changes to be confident that the observed changes are real. Changes of that magnitude tend to be clinically obvious. Also, they tend to occur late. Either way, the point of monitoring is lost.
7/
Precision is always improved by averaging several measurements. Unfortunately, this requires more tedious measurements and is seldomly done in real life. #AutoMAPSE can easily take several measurements of LV function and improve the precision needed for effective monitoring. 📜https://rdcu.be/dw7fT
8/
Monitoring must be effortless, and #POCUS/#Echofirst is not. Manual measurements takes too much effort. This effort is better spent on important decision-making.
9/
#AutoMAPSE alleviates the effort in quantifying LV function by using AI. #AutoMAPSE also reduces the effort in image acquisition by using #TEE.
📜

This even allows for continuous, hands-free imaging: rdcu.be/dw7fT

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10/
Finally, LV function must also be quantified rapidly.
Measurements by #EchoFirst or #POCUS are too slow for #ICU, where changes in LV function can occur very fast. #AutoMAPSE helps by providing instantaneous measurements.
📜rdcu.be/dw7fT
11/
Effective monitoring of LV function requires precise, rapid and effortless measurements. Current practices fails to achieve this in #CriticalCare.

Our paper show that #autoMAPSE can rapidly quantify LV function and fill this need. #MAPSE
📜 rdcu.be/dw7fT
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More from @dritsyk

Jan 13
1/
Ventriculoarterial coupling (#VAC) determines the harms and benefits of hemodynamic therapies.

VAC describes cardiac efficiency, and offers a complementary perspective to CO, MAP and tissue perfusion.

Let’s try to understand it🧵
#FOAMcc #FOAMed #MedTwitter #CardioTwitter Image
2/
VAC is the matching afterload (Ea) to contractility (Ees) and reflect the heart's energy efficiency.

VAC can be understood using the analogy of riding a bicycle.
3/
The resistance in the pedals represent afterload (Ea). Your leg strength represent contractility (Ees).
With too⬆️resistance in the pedals, you spend a lot of energy without moving forward and eventually give up. This is analogous to poor VAC progressing into cardiac failure.
Read 13 tweets
Dec 5, 2023
1/
#MAPSE: an unappreciated treasure for assessing LV function? #EchoFirst #WhyCMR

#MAPSE is easy and feasible in almost every patient, also in #ICU. It is highly prognostic, yet unpopular. The reasons are not rational.
🧵👇

#CardioTwitter #POCUS #FOAMed #MedTwitter Image
2/
#MAPSE is easy to measure using #EchoFirst, and was described already in 1967:

However....doi.org/10.1093/cvr/1.…
3/
...during that era, physiologists were focused on cardiac pressure/volume relationships. LVEF emerged as a metric reflecting cardiac volumes, thus filling an unmet need.
doi.org/10.1161/01.cir…
Read 10 tweets
Oct 9, 2023
1/🧵Suppl. material for abstract @ESICM #LIVES2023
LV dysfunction in #ICU is bad, yet the LV is not monitored.

Can we use #TEE➕AI➕#MAPSE to monitor LV function in ICU? ✅Yes, #AutoMAPSE had excellent feasibility!

#FOAMcc #FOAMed #MedTwitter #CardioTwitter #EchoFirst #POCUS
2/  INTRODUCTION

As LV function is a crucial for effective hemodynamic management, one would expect it to be closely monitored in #ICU patients - but its not.

LV function is only assessed intermittently, and often assessed late and when LV dysfunction is severe and complicated.
3/
Therefore, we have developed a method for continuous monitoring of LV function in #ICU.

Our method combines #TEE and AI to automatically estimate #MAPSE. We call it #AutoMAPSE.

1st📜 on #AutoMAPSE:

#EHJIMP #EchoFirst #CardioTwitter doi.org/10.1093/ehjimp…
Figure. Automatic measurement of mitral annular plane systolic excursion (autoMAPSE) on a hands-free image.   Left: The mitral annulus is detected automatically using artificial intelligence (red and blue dots).  Right: The longitudinal motion of the mitral annulus for 10 heartbeats. For each heartbeat (vertical lines), MAPSE is the distance between the highest and the lowest point.   Brackets, demonstrating the MAPSE of one particular heartbeat; MAPSE, mitral annular plane systolic excursion
Read 15 tweets
Nov 7, 2022
MAPSE in #IntensiveCare (with examples)🧵#FOAMcc #FOAMed #MedTwitter #Hemodynamic #POCUS #EchoFirst #CriticalCare
Take homes:
1⃣ Redefining "the hyperdynamic heart" with #MAPSE
2⃣ MAPSE is better than EF in the #ICU
3⃣ Linking MAPSE with supply/demand-ischemia
1/n
1⃣ Can MAPSE redefine "the hyperdynamic heart?
The term "hyperdynamic LV" - EF > 55% - is misleading. It has no relation to a hyperdyanmic circulation; SV/CO. Someone bleeding to death has a hyperdynamic heart, but the circulation is life-threatening hypodynamic.
2/n
MAPSE is cardiac motion, and defining the hyperDYNAMIC heart as good cardiac motion makes perfect sense. Recent geometrical analysis of cardiac pumping shows that MAPSE is the main determinant of SV. Fig from @mugander: tinyurl.com/mxbfmcyk
Why?
3/n
Read 17 tweets
Nov 6, 2022
A case of low ScvO2 (60%), high PvaCO2 (8.2 mmHg), fluid intolerance (CVP 11) and fluid responsiveness (PPV 17). What's the physiology and what to do?
#FOAMcc #Hemodynamics #ThePeoplesVentricle #FOAMed #Fluidtolerance #Cardiotwitter #CriticalCare
Post-cardiac surgery. MAP 70, HR 95, low dose pressor. High CVP (11 mmHg) with pathologic waveform of x < y-descent. PPV > 17 despite low Vt (< 6 mL/kg). Normal blood gasses, normal lactate.
#EchoFirst #POCUS #TEE: Mildly reduced LV function; #MAPSE 5.75 mm. EF visually 45-50%. Small EDV.
Read 11 tweets

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