🧵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…

https://twitter.com/AndersTasken/status/1772268429241667845

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?

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 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…

🚨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…

🧵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.

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.

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.…

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.

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

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.