Prevalence of Subclinical Coronary Atherosclerosis in General Population
@CircAHA

1/x
🇸🇪 25K randomly invited individuals w/o known CAD underwent CCTA
🇸🇪 51% women
🇸🇪 50 to 64 yrs
🇸🇪 #SCAPIS (the Swedish Cardiopulmonary Bioimage Study)

ahajournals.org/doi/10.1161/CI… 2/x
🇸🇪 42.1% any CCTA-detected atherosclerosis

🇸🇪 5.2% any significant stenosis (≥50%)

🇸🇪 1.9% LM, prox LAD or 3VCAD

🇸🇪 8.3% any non-calcified plaque

🇸🇪 plaques most common in prox LAD

🇸🇪 Participants with only non-Ca plaques were rare (2.4%)

ahajournals.org/doi/10.1161/CI…

9/19
#Tweetorial #CMD #ACC21

#CMD shares similar RFs w epicardial atherosclerosis (traditional ASCVD RFs) & is associated with several biomarkers of inflammation, oxidative stress & coagulation

🔗futuremedicine.com/doi/10.2217/fc…
🔗sciencedirect.com/science/articl…
🔗atherosclerosis-journal.com/article/S0021-… 10/19
#Tweetorial #CMD #ACC21

There is significant overlap between #CMD & epicardial disease

Large number of patients w/ #CMD also have epicardial atherosclerosis (obstructive or non-obstructive) & epicardial endothelial dysfunction

🔗onlinelibrary.wiley.com/doi/abs/10.100…

#CMD #Tweetorial

⚡ Coronary Microvascular Dysfunction ⚡

1/19

📌 What Is #CMD❓
📌 Why Is #CMD Important❓

Based on my #ACC21 #ACCImaging presentation 2/19
#Tweetorial #CMD #ACC21

Let’s start by talking about angina

✅ Angina w/o obstructive CAD is very prevalent 

🔗ahajournals.org/doi/full/10.11…

Join us at #ACC21 to learn about #CMD

✅ What Is #CMD & Why Is It Important?
✅ Dx & Risk Stratification of #CMD: Stress Testing & Noninvasive Imaging
✅ Catheter-Based Techniques in Dx of #CMD
✅ Emerging Link Between #CMD & #HFpEF
✅ Phenotype-Based Mngmt of #CMD #ACC21 #CMD session details 👇

📅 Sat, May 15
⏰ 2PM

#Tweetorial on #ASNC2020 session

⚡Selecting Between Different Functional Tests⚡

☢ vs 🧲 vs ⏺ ❓

🔘 Strengths/Limits of Lesion Specific vs Myocardial Ischemia
🔘 Comparing Dx Accuracy of Tests
🔘 Ischemia Testing in #INOCA
🔘 How to Select Best Noninvasive Test

1/9

https://twitter.com/coronarydoc/status/1309649449162092544

#ASNC2020 #cvNuc
2/9
Dr Di Carli

☢ Issues with proposed #FFR threshold 0.8
☢ Exercise MPI correlates well with FFR but not at 0.8
☢ Benefit of FFR-guided revasc dominantly occurs w/ thresholds <0.8
☢ Quantification of lesion-specific #ischemia insufficient for patient mgmt

☢ Selecting Between Different Functional Tests in 2020? ☢

This should be most interesting session of virtual #ASNC2020

I am excited to be virtual moderator w/ expert speakers Dan Berman, Keon Nieman, Paul Knaapen, @mdicarli, @VTaqMD

#cvImaging #cvNuc #CardioTwitter Are you ready for most exciting #ASNC2020 session?

⚡Selecting Between Different Functional Tests⚡

☢ vs 🧲 vs ⏺ ❓

Let’s hear from #cvImaging giants
Keon Nieman, Paul Knaapen, @mdicarli @VTaqMD @danielbermanmd

📆 Sat, Sept 26
⏰ 2:15 to 3:30PM
🗒 bit.ly/333dRNO

Did you know?

#ASNC2020 @MyASNC Virtual is scheduled over several wks

☢ Bulk of sessions ➡ Friday & Saturday, Sept 25 & 26

☢ Cases with Aces sessions ➡ once a wk, Sept 9 to Oct 7

☢ 2 #SoMe sessions ➡ Sept 10 & 17 at 4:00pm

☢ Technologist sessions ➡ Oct 3 @SinghVasvi @mdicarli @MasriAhmadMD @almallahmo @RonBlankstein @sarahcud @RamiDoukky @RezaEmaminia @purviparwani @nishantshahmd @heartsmartpro @cardio10s @LPhillipsMD @lesleejshaw @SelmaFMohammed @AdiAJoshi @FarrisTimimi @onco_cardiology @ErinMichos @PanithayaC @ShelbyKuttyMD

Great talk on #CardioObstetrics
by @RBP0612 at #ASPC20
1/3 Great talk on #CardioObstetrics
by @RBP0612 at #ASPC20
2/3

⚡️ #SOA Imaging for Myocardial Viability⚡️

A Scientific Statement From @American_Heart

🙏 Incredibly honored to work with & learn from these giants in cardiology

Just published @CircImaging
#cvNuc #thinkPET #WhyCMR #YesCCT #cvImaging

👉 bit.ly/3frH34F @venkmurthy @purviparwani @ACC_Georgia @NitiCardio @RBP0612 @PanithayaC @RezaEmaminia @iamritu @RigolinVera @ChinnaiyanMD @gina_lundberg @DocStrom @ErinMichos @DrMarthaGulati @Michel_CorbanMD @jeffreygeske @NorthsideGaMD @NorthsideHosp @DorbalaSharmila @DrPascalMeier @AChoiHeart

On behalf of @ACC Imaging Section Leadership Council & @JACCJournals Imaging, I’d like to invite you to join us for this webinar:

Multimodality CV Imaging in #COVID19 Era: Ramping up safely to a New Normal

Friday, June 19th at Noon ET

bit.ly/37xCNh4 Safe reopening of #CVImaging labs

Indications?
PPE?
What modality?
What patient?

Great @ACCinTouch @JACCJournals #JACCImaging webinar by @WilliamZoghbi @RonBlankstein @salernomdphd @VTaqMD @RigolinVera @mdicarli

1/2 #EchoFirst & #CVNuc

⚡️ Happening Now ⚡️

#ACCImaging Council Webinar

Role of Multimodality Imaging in Dx & Management of Patients With #COVID19

#YesCCT #EchoFirst #WhyCMR #CVNuc

Join us👇
acc.org/education-and-… @JudyHungMD @DRCJWhite @Drroxmehran @mdicarli @ToddVillinesMD discussing Dx w/u & role of #YesCCT for abnl EKG & RWMA on echo

#ACCImaging Council presents an in-depth discussion of role of multimodality imaging in diagnosing & managing COVID-19 patients

Live #webinar
April 29, 2020 12:00PM ET

Register @
acc.org/education-and-… @RBP0612 @khurramn1 @JudyHungMD @DeeDeeWangMD @JWeirMcCall @jhfrudd @Drroxmehran @RonBlankstein @AChoiHeart @ChrisKramerMD @NadeenFaza @almallahmo @CMichaelGibson @ChinnaiyanMD @DorbalaSharmila @RigolinVera @SinghVasvi @HeartDocSharon @ErinMichos @DavidWienerMD @DrPascalMeier

1/7
Very important descriptive study 👇 expanding our understanding of burden of #CMD + endothelial dysfunction in #INOCA (angina) by @TomJFord @ColinBerryMD
@CircIntv

⚡️ Let’s have a short #Tweetorial ⚡️

https://twitter.com/CoronaryDoc/status/1206041505430999042

2/7
Pre-specified analysis of CorMicA
onlinejacc.org/content/72/23_…

Pts undergoing clinically indicated elective coronary angiography for angina & had definite (typical) or probable (atypical) angina based on Rose angina questionnaire

391 pts ➡ angiography:
47% #INOCA
53% #CAD

#ISCHEMIA
Red or Green?

Entire cardiology world is enthusiastically waiting to know the answer in 10 mins
#AHA19 And now results of $100 million #ISCHEMIA trial

Heading to Philly for #AHA19?

Interested in learning about #CMD?

👇 Here is complete list of #CMD sessions @AHAMeetings 👇 Session #1
Diagnosis and Characterization of Coronary Microvascular Disease:
Role of Imaging

Nov 16, 7:15-8:30 AM

⚡️ #YesCCT Coronary Plaque Assessment #Tweetorial ⚡️

By @CoronaryDoc + @AChoiHeart

✅ Why Plaque Assessment?
✅ High Risk Plaque Features
✅ Plaque Characterization/Quantification
✅ Supporting Clinical Data

#CardioTwitter #ACCImaging #SCCT2019 @heart_scct @journalCCT
1/14 2/14
As #SCD or #MI is 1st symptom of #atherosclerosis in 2/3 of pts, early ID of #CAD is of paramount importance

#YesCCT allows for
✅ ID of plaque
✅ Quant. of plaque
✅ Characterization of plaque
✅ Arterial remodeling

Lin, @LubbDup & @lesleejshaw: bit.ly/2x1b5Yz

1/5
This knowledge check 👇 shows over half of us didn’t read Type 2 MI paper @JACCJournals by @yadersandoval

⚡️ Major definition and/or terminology issue here

Let’s discuss this case & then have a 3-slide #Tweetorial on Type 2 MI
#ACCFIT #CardioTwitter

https://twitter.com/CoronaryDoc/status/1122992293852659712

2/5
Our patient had normal coronaries & LV thrombus 👇
Most likely Dx is Type 2 MI 2/2 coronary embolism

✅ Do we have enough evidence to use #CAC zero in pts with stable angina?

✅ What about pts with new Dx of #HF? What’s probability of ischemic cardiomyopathy (obs #CAD) with #CAC zero?

@Heart_SCCT @khurramn1 @MichaelJBlaha @RonBlankstein @lesleejshaw
bit.ly/2IscVbS

https://twitter.com/Open_HeartBMJ/status/1117744666479407105

@AChoiHeart @DrRumberger @FiRSTSCCT @MarcDweck @joshmitchellmd @SuhnyAbbara @jameschilee @jeffreygeske @arnavkumar @Fentanes_MD @ErinMichos @HeartOTXHeartMD @gina_lundberg @purviparwani @onco_cardiology @RBP0612 @mdmiedema @DrRyanPDaly @mmamas1973 @DrMarthaGulati
@ghoshhajra

⚡️ Classic mitral & aortic nonbacterial thrombotic endocarditis AKA Libman-Sacks or marantic endocarditis
#echofirst #ACCFIT #cardiotwitter

1/4 Aorta
@MasriAhmadMD @onco_cardiology @iamritu @RezaEmaminia @rajdoc2005 @HeartOTXHeartMD @DavidWienerMD @mswami001
@MusaSharkawi 2/4 Aortic valve
@ErinMichos @ASE360 @DocStrom @WilliamZoghbi @ash71us @robertomlang @tiffchenMD @hahn_rt

Sub-study of WISE @JACCJournals by @ahmedalbadrimd @lesleejshaw:

In women with signs & symptoms of ischemia
✅ low CFR (microvascular dysfunction) ➡️ ⬆️ major CV events
✅ endothelial dysfunction ➡️ ⬆️ angina hospitalization
onlinejacc.org/content/73/6/6…
@emorywomenheart @venkmurthy In this relatively large & very well-done study, 4 indices of coronary dz were invasively measured:

✅ CFR (adenosine): non-endo dependent CMD

✅ CBF (ACh): endo dependent CMD

✅ Nitro Δ CSA: non-endo dependent epicardial dz

✅ ACh Δ CSA: endo depedent epicardial dz

What’s Your “Shear Stress”?

Want to Know More?

Relax & Read ⤵️ #Tweetorial by @CoronaryDoc + @arnavkumar

⚡️Coronary Wall Shear Stress in 12 Tweets ⚡️

1/12
Main Readings:
1) interventions.onlinejacc.org/content/early/…
2) ow.ly/XmD130mc9X8
3) link.springer.com/article/10.100…
#ACCImaging @ACCCardioEd 2/12
Wall shear stress (#WSS) is the frictional force of blood exerted tangential to endothelial surface of vessel wall & expressed in variety of units (1Pa=1N/m2=10 dynes/cm2)

It is derived from
• luminal geometry
• flow rate
• blood viscosity
• near wall velocity values