Venk Murthy Profile picture
Rubenfire Prof of Preventive Cardiology @umichCVC; Multimodality #cvimaging; #cardiometabolic #prevention; Posts my opinions & not medical advice; RT≠endorse
Reza Hosseini ⚕️ Profile picture UnChatUnChat Profile picture Escajeda99 Profile picture 3 added to My Authors
24 Sep
Now @AmerAcadPeds has released guidance on return to sports for kids after COVID:

Lots of thoughts below

h/t @drjohnm

medscape.com/viewarticle/93…
Physical activity and sports participation can have many health benefits which is recognized in the guidance:

services.aap.org/en/pages/2019-…
They also make a clear statement that COVID19 testing prior to sports participation isn't necessary unless there are symptoms
Read 20 tweets
20 Sep
Science is quickly devolving into teams.

People who are fans of a technology, methodology or approach serve as cheerleaders even for flawed papers/preprints because they give result that fits desired narrative.

"Congratulations on an excellent job"

"Spectacular work"

🧵🧵
This leads those who are less savvy to believe that the paper/preprint is indeed excellent.
Given many people get their news from media outlets who may frame the tone based on what KOLs are tweeting, this may distort priorities by docs, scientists and most powerfully the general public and policy makers.
Read 6 tweets
13 Sep
I was reminded today that with all of the discussion about cardiac MRI, many folks may get the wrong idea about the test and when it is useful.

Let's do a mini thread on this!
Cardiac MRI (CMR) is an excellent and cost effective test when used appropriately. It can be among the lowest cost cardiac imaging tests and it delivers high quality images with very good record of accuracy and safety.
So what are some of the indications (applications) of CMR in medicine?
Read 15 tweets
12 Sep
Given how subtle the findings are on the OSU athlete COVID CMR paper, should all future COVID CMR papers include thumbnails of *all* cases, including orthogonal views?
The supplement to the ORBITA trial did this for angiograms.

pubmed.ncbi.nlm.nih.gov/29103656/
We were inspire to do the same for PET images in this paper:

Read 4 tweets
11 Sep
This study adds very, very little to the literature.

In addition to the anomaly listed below wherein LVEF of 33 is described as normal there are a few other things that caught my eye.
First, the pericardial effusions do not seem to be clearly more than physiologic.

Unlike Puntmann, there is no pericardial LGE identified.
There are 4 cases which meet Lake Louise criteria for myocarditis.

These were developed in people who have clinicial suspicion of myocarditis so their performance here is less clear.
Read 29 tweets
5 Sep
Big news! Prominent non-COVID related cardiac MRI paper retracted.

sciencedirect.com/science/articl…
The brilliant @drgrahamcole had spotted issues with this paper two years ago!

Read 4 tweets
4 Sep
Dear all, after a week or two of serious illness a respiratory illness can leave residual lung abnormalities (permanent or slowly resolving), loss of skeletal muscle (from lying in bed mostly, rarely from viral myositis), and in rare cases heart dysfunction.
Cardiac MRI is *not* the way to tease these apart.

Far more helpful could be exercise testing. This will help confirm the degree of limitation and whether there is an arrhythmic risk at high exercise levels.
It is an approach commonly used in patients with heart failure or recent heart attacks to determine how much exercise is safe for them to do while they are rehabilitating.
Read 11 tweets
3 Sep
@LehrerSteve @dennisdoddcbs @bigten @MJAckermanMDPhD Saw it. No information on the study but it appears to have no controls and unclear diagnostic criteria.

There is also zero consideration of what absolute risk increase a true case of myocarditis might have.
@LehrerSteve @dennisdoddcbs @bigten @MJAckermanMDPhD No consideration of whether student athletes will comply with detraining instructins.

No science behind what level of detraining would make sense.
@LehrerSteve @dennisdoddcbs @bigten @MJAckermanMDPhD They do state that they think VO2 max might be down by 10% post infection.

I'm not surprised by that. Any serious illness might have an effect in that range and would recover over time.
Read 4 tweets
30 Aug
As @ADAlthousePhD points out baseline differences in RCTs really are not a thing to worry about.

In this case, @ProfDFrancis isn't using them to look at "randomization failure" but to suggest blinding may have been violated.
I don't have my own conclusion yet, but it's a story worth following.
Read 4 tweets
14 Aug
The Big 10 report on COVID relies heavily on this paper which found rampant abnormalities among normal controls and had many statistic that make no sense.

Time to retract or correct this paper.
TBH I'm not a football guy so whether they put off a year doesn't really affect me, but the Big 10 is a majorly respected organization and many Americans get their news from @espn.

Unfortunately much of the messaging centers around a flawed paper.
More information about statistical aberrations here:

Read 17 tweets
5 Aug
Did you read that article in Lancet about predicting future Afib from a sinus rhythm ECG?

Here is the letter @bnallamo and I wrote in response to it.

Thanks to the authors for sharing info about age/sex in their appendix to response letter!

thelancet.com/journals/lance… Image
Read 4 tweets
23 Jul
Cool paper from @DavidLBrownMD and Conor Williams in @Heart_BMJ exploring what would happen if we deferred PCI in diabetics with SIHD!

Mini-thread below

heart.bmj.com/cgi/content/fu…
First, this is an example of data reuse from RCTs (in this case BARI-2D). Data are made available by @nih_nhlbi through BioLINCC repository. Some paperwork is required to ensure patient privacy, etc but process is usually straightforward & quick:

biolincc.nhlbi.nih.gov/studies/bari2d/
Another thing is this study reminded me that the outcomes of the PCI stratum in BARI-2D were actually numerically worse for the revasc arm vs. medical therapy:

nejm.org/doi/full/10.10… Image
Read 14 tweets
17 Jul
Major updates to NY Times COVID evidence tracker in first 24 hours.

But still lots of concerns.

**Thread**

nytimes.com/interactive/20… ImageImage
They have eliminated strong evidence category.

Ventilation & proning now called "Widely Used"

Dexamethasone & remdesivir are now the only 2 w/ "Promising Evidence"

Anticoag (previously strong evidence) moved to mixed evidence (two grades down) along with most everything else.
Dialysis is now gone.

Why list ventilation without dialysis?
Read 12 tweets
28 Jun
COVID19 is serious. We need to take it seriously.

*Nobody* manages MI in anyone on outpt basis. It's malpractice.

Vast majority of 40yo w/ COVID aren't sick enough to get admitted

Many not sick enough for ED visit

Wrong to compare sickest sliver vs entire spectrum
We admit people with MI to the hospital who aren't in that high risk of dying because we have specific hospital based therapies (anticoagulation, angiography) that can reduce mortality and morbidity.
We also do it because the sickest sliver of MI pts are sick as stink and we can't always tell 100% up front which are which.
Read 6 tweets
26 Jun
Nice coverage from @MassGeneralNews on our study of limitation of polygenic risk score for BMI in young adults in CARDIA study published in @JAMACardio w/ senior author @RaviShah_MD

Link to primary article in reply.

advances.massgeneral.org/cardiovascular…
Read 4 tweets
24 Jun
Honestly, given the infectious field of viral particles in COVID19 is essentially a radiation field, it's all pretty much Time-Distance-Shielding

Time - minimize duration of contacts

Distance - physical distancing

Shielding - masks and barriers
A few differences:

* Radiator is people's noses and mouths not x-ray machine

* Like most x-ray machines, radiation is not uniform in all directions - focus on nose and mouth

* For COVID 19, a thin layer of cloth is very effective shielding. X-rays need heavy lead shielding
* Like x-rays, dont let fear cause panic. We probably can manage risk-benefit in many cases.

* Like radioactive sources, assume they are active at all times - in other words assume everyone is infected for the purposes of when to use time-distance-shielding
Read 7 tweets
16 Jun
Just read a hot off the presses paper. Uses #MachineLearning to predict adverse outcome from medical scans.

Total N=32, cases=12

AUC=0.82

Sr author is full prof of BME at world renowed place

Journal IF=5

How would you describe this?
Now what if you heard the senior author has multiple (>2) simultaneous NIH grants totalling $2m in *annual* funding?
Are there a few papers and grantees like this or lots?
Read 4 tweets
27 May
So, Norway has decided not to engage in screening of asymptomatic people for COVID19.

They posted this figure to justify it.

Let's work through the math!

translate.google.com/translate?sl=a…
They tell us that right now they estimate the prevalence of COVID19 in Norway to be 0.01%.

This means out of every 10,000 people in Norway, 1 has COVID19.

This corresponds to the column on the right.
They give us three additional pieces of information:

#1 If you test a town with 12,250 people, 1 is a true positive (has COVID19 and is also PCR positive)

#2 For every true positive you will get 12.5 false positives(!)

#3 Probability of a positive response being true is 7.4%
Read 19 tweets
10 May
@hswapnil @boback @anish_koka @rfsquared @FT That is what he has effectively stated, repeatedly. He has repeatedly cast all disagreement as pro-death.

No dishonesty there.
@hswapnil @boback @anish_koka @rfsquared @FT But if you want to see putting words in peoples mouths see this:

@hswapnil @boback @anish_koka @rfsquared @FT Also see the casting of Sweden as a herd immunity goal, which their leaders have repeatedly stated is not their goal.
Read 4 tweets
24 Apr
So many folks are doubtful of specificity of the NYS test. The test probably has a specificity north of 97%

How do we know?

*Thread*
Let's start here.

Outside of NYC and suburbs, there were 32.8% of N=3000 tests done.

This means 984 tests.
3.6% of those 984 tests were positive.

This means 35 tests were positive.

Let's take essentially the worst case scenario that all 35 were false positives.
Read 14 tweets
8 Jan
New paper out today in @JAMACardio that originated from a question @RaviShah_MD had several years ago:

what are the relative contributions of genetics, fitness and physical activity to the development of obesity?

jamanetwork.com/journals/jamac…
We struggled for long time how best to capture impact of genetics. Fortunately, recent polygenic risk scores (PRS) offered an answer.

We used @skathire @amitvkhera genomewide PRS as most comprehensive measure of genetic risk of obesity to date:

sciencedirect.com/science/articl…
We decided to examine CARDIA cohort (Coronary Artery Risk Development in Young Adults), sponsored by @nih_nhlbi ~30 yrs ago to study black & white men & women age 18-30, followed serially for 30 yrs (though we only had 25 yr data for this analysis)

cardia.dopm.uab.edu
Read 21 tweets