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