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Jinyang Yu

@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

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…

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

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

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…

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

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.

https://twitter.com/dritsyk/status/1751654442414276705

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.

https://twitter.com/dritsyk/status/1751654442414276705

https://twitter.com/dritsyk/status/1732144466499383795

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

https://twitter.com/dritsyk/status/1732144466499383795

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More from @dritsyk

Jinyang Yu

@dritsyk

Jan 28

🧵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

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.

Read 12 tweets

Jinyang Yu

@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

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

Jinyang Yu

@dritsyk

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

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

Jinyang Yu

@dritsyk

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…

Read 15 tweets

Jinyang Yu

@dritsyk

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

@mugander

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

Jinyang Yu

@dritsyk

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.