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Jinyang Yu Profile picture
@dritsyk
Jan 31 • 10 tweets • 4 min read • Read on X
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🚨Automatic measurement of LV function in #ICU is possible by automatic measurement of #MAPSE using TEE and AI #AutoMAPSE
🔓

1/🧵Still, many prefer EF for LV function. How does MAPSE compare to EF, and is MAPSE better?
#EchoFirst #POCUS #FOAMed rdcu.be/dxsEU
Image
2/ #MAPSE and EF are highly correlated. EF reflects SV/EDV, while MAPSE reflect SV/outer cross-sectional area.

Appreciate their relationship in this figure⬇️ doi.org/10.1152/ajphea…
Image
3/ In heart failure with⬇️EF, the LV dilates, and both EF and #MAPSE falls from increases EDV and outer cross-sectional area.

The figure shows that both EF and MAPSE falls during LV dilatation. #CardioTwitter Image
4/ In heart failure with preserved EF, LV dysfunction from concentric remodeling reduces #MAPSE. Since EDV is maintained or even reduced, EF is unaffected.

The figure shows that MAPSE is reduced, but EF is maintained when EDV is reduced. #CardioTwitter Image
5/ #MAPSE is reduced for both HFpEF and HFrEF. This was shown many years ago:
This relationship may also explain that MAPSE show superiority in #ICU: doi.org/10.1136/heart.…
doi.org/10.1186/1476-7…
Image
6/ In #ICU, EDV is commonly reduced from vasodilatation and hypovolemia. In this setting, EF is usually normal or even increased if ⬇️MAP. Despite a "hyperdynamic EF", hypovolemia decreases #MAPSE.

The figure shows reduced MAPSE and high EF during hypovolemia. #FOAMcc Image
7/ SV is normal or increased during vasodilatation. This would tend to increase #MAPSE. Perhaps normal MAPSE in shock could aid the diagnosis of vasodilatation.

The figure shows how normal MAPSE during shock suggests vasodilatation. However, patient data is lacking. Image
8/ EF by Simpson's is often unfeasible in #ICU, while #MAPSE is highly feasible. Thus, EF is usually qualitative, while MAPSE is quantitative, and quantitative data always offers more information and is necessary for true monitoring.
9/ #MAPSE is an underappreciated hero. #MAPSE measures LV longitudinal function (like GLS), and has shown better sensitivity than EF for detecting LV dysfunction.
...and #MAPSE can now be assessed automatically in #ICU😎📜

rdcu.be/dxsEU
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More from @dritsyk

Jinyang Yu Profile picture
Jul 20
🧵1/
A very interesting RCT by @MirjanaCihoric & @BangFoss in @BJSurgery show the importance of dexamethasone (DXM) in acute abdominal surgery! DXM ⬇️inflammation,⬇️vasodilation,⬇️pressor dependency, and improves fluid balance and even 90-day ☠️
doi.org/10.1093/bjs/zn…

Image
Image
2/
 DXM shows positive effects on various secondary endpoints with different levels of significance. Also, less fatigue, pain, immobilization and better peak exp flow.
https://doi.org/10.1093/bjs/znae130
Image
3/
 Interestingly, there were no more infections in the DXM-group; in fact, there were fewer infections of various subtypes, though statistically insignificant. However, DXM had more hyperglycemia. Image
Read 7 tweets
Jinyang Yu Profile picture
Jul 10
1/
 🧵Can the pulmonary artery catheter (PAC) guide massive transfusion?
Key ideas:
1⃣Continuous SvO2 may be useful for optimizing O2-delivery.
2⃣Continuous SvO2 & CO aids in detecting distributive shock physiology.
#FOAMed #MedTwitter #CritCare #ICU
2/ 1⃣Optimizing DO2
The goal of transfusion is to improve O2-delivery. SvO2 is an excellent measure O2-delivery. PAC allows continuous SvO2 monitoring.
3/ 1⃣Optimizing DO2
🩸SvO2 > 65% during bleeding suggests a need for transfusion.
🩸SvO2 > 65% suggests that resuscitation is adequate, avoiding unnessecary transfusions and potentially preventing transfusion-associated complications.
Read 9 tweets
Jinyang Yu Profile picture
Jun 14
1/🧵The history of #EchoFirst for hemodynamic monitoring in #ICU to put this new study on continuous #AutoMAPSE in perspective!

🫀📜

@ICMexperimental #POCUS #TEE #MAPSE #MedTwitter #CardioTwitter #FOAMed #CriticalCare rdcu.be/dKPgA
Image
2/
1⃣st report of TEE was in 1980, using M-mode from TGSAX during cardiac surgery. The rationale for this was: "Currently used monitoring techniques such as measurements of pressure and cardiac output provide an incomplete picture of LV function..."
doi.org/10.1016/0002-9…

Image
Image
3/
 A serious limitation is that all measurements required manual image acquisition and measurements.

Imagine using Korotkoff sounds for "monitoring" BP; manual methods requires too much time and attention to effectively serve as monitoring and guide patient management⏱️🧠 Image
Read 14 tweets
Jinyang Yu Profile picture
May 16
1/ 🎯Bland-Altman analysis is the common way to evaluate AI in #EchoFirst. However, BA analyses can be tricky to interpret. 🧵On the paradox of BA analysis for AI in #EchoFirst with examples from our studies on #AutoMAPSE 📜
#Foamed #Cardiotwitter rdcu.be/dH8aR
Image
2/ BA analysis is an important approach used for comparing 2⃣measuement methods for measuring the same unit, like #MAPSE (mm) and #AutoMAPSE (mm). ‼️Correlation (r) is inappropriate yet commonly used because it is seductive. Read the reasoning in their📜: doi.org/10.1016/S0140-…

Image
Image
3/ The output in BA analysis is 1⃣bias &2⃣limits of agreement (LOA). Bias is the avg difference across all paired measurements of manual MAPSE and autoMAPSE. LOA=+/- 2SD of the bias in the study. The bias and LOA is presented in a BA plot from 📜: rdcu.be/dH0mY
Image
Read 16 tweets
Jinyang Yu Profile picture
May 13
🧵1/ #AutoMAPSE had high feasibility for estimating MAPSE from ≥1⃣wall. Many worry that #MAPSE is limited by RWMA, such as acute MI - however, evidence suggests that regional MAPSE reflects global LV function.

#EchoFirst #POCUS #FOAMed #CardioTwitter rdcu.be/dHLxx
2/ Several studies have shown that in AMI, MAPSE is ⬇️even in walls remote to MI. This was confirmed experimentally by Berg et al, in an experiment occluding the LAD in pigs and measuring #MAPSE by #WhyCMR.
First paper:
Berg et al: doi.org/10.1080/140174…
doi.org/10.1152/japplp…
Image
3/ ⬇️MAPSE in remote walls is explained through the distribution of afterload. For a specific region to shorten, that region must overcome the opposing afterload imposed by its neighboring region, which is shortening in the opposite direction.
Read 9 tweets
Jinyang Yu Profile picture
Mar 25
🧵We have now refined AutoMAPSE.!
🔓
⬆️New paper on #autoMAPSE showing that the newest version achieves an optimal balance between feasibility, analysis speed, and agreement.
A🧵on the clinical importance of these findings
#echofirst #CardioTwitter #POCUS doi.org/10.1016/j.ultr…
1/ Our design involved measurements from 🔟beats per #EchoFirst recording. This is very different from the usual practice of measuring 1-3 beats. What are the advantages?
2/ Measuring 1-3 beats in #Echofirst involves huge physiological variability. How?
❤️🫁 interactions can cause serious beat-to-beat variations in any echo measurement. Often overlooked, these changes may be misinterpreted as real. Acting on wrong info ⬆️the risk of harm.
Read 9 tweets

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