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Jinyang Yu Profile picture
@dritsyk
May 13 • 9 tweets • 4 min read • Read on X
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🧵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.
4/ Thus, if a region is not shortening (yellow segment), its neighboring region (red segment) has less opposing afterload and will shorten MORE. However.....
Figure from @strain_rate Image
5/ ...the total afterload is only redistributed, and not changed: ⬇️myocardium must now overcome the total afterload. Therefore, remote regions (orange segments) experience ⬆️afterload and therefore shorten less.
Figure from @strain_rate Image
6/ The total shortening is translated to the mitral annulus because all the walls are tethered to the mitral annulus. Thus, regional function from any wall affect #MAPSE of any other walls, and MAPSE = global LV function.
Fig from: folk.ntnu.no/stoylen/strain…
Image
7/ This suggests that changes in regional MAPSE reflect changes in global LV function. Good for #AutoMAPSE! However, it also means that regional #MAPSE cannot detect regional dysfunction such as ischemia.
Fig shows the feasibility of #AutoMAPSE: rdcu.be/dHLxx
Image
8/ This is also good news for #MAPSE using #POCUS. MAPSE from one wall is faster, simpler, and highly feasible in poor images. Also, several beats can easily be averaged, increasing the precision needed for monitoring by #EchoFirst.

end 🧵
How to #MAPSE.
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More from @dritsyk

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
Jinyang Yu Profile picture
Feb 11
The RVOT or PA Doppler has a lot of underutilized potential for hemodynamic monitoring of the RV #ThePeoplesVentricle

🧵On the physiology of the RVOT/PA Doppler. Simplified understandings. Corrections are welcome!😃
#FOAMcc #EchoFirst #Cardiotwitter #FOAMed #Medtwitter #POCUS Image
VTI reflects stroke volume, but values are much lower than for LVOT. Lower cut-off for 60-79 year olds is actually around 10 cm.
Monitoring changes are likely more useful. doi.org/10.1016/j.jcmg…
Image
AcT and Vmax/AT both reflects RV afterload. Increased afterload reduces AT and Vmax/AT.
➡️AcT correlates with mPAP and PVR.
doi.org/10.1161/01.CIR…
Image
Read 10 tweets
Jinyang Yu Profile picture
Jan 31
🚨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
Read 10 tweets
Jinyang Yu Profile picture
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
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.
Read 12 tweets
Jinyang Yu Profile picture
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
Jinyang Yu Profile picture
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

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