Discover and read the best of Twitter Threads about #WhYCMR
Most recents (24)
Out ahead of print in @CircAHA and displaying the first 2.5 years of my DPhil @RDMOxford @UniofOxford : EMPA-VISION RCT, investigating the hypothesis that #sglt2i mediate their benefits in #heartfailure via augmentation of cardiac energy metabolism
doi.org/10.1161/CIRCUL…
doi.org/10.1161/CIRCUL…
As SGLT2i induce glucosuria and thus, increase lipolysis and formation of ketone bodies like b-OHB, it was assumed that this effect might mediate their benefits in HF. But is this true? Well, we’ve tested it
We enrolled 36 patients with #HFrEF and 36 with #HFpEF and randomly assigned them #empagliflozin or placebo. 
1/5
#ESCardioEd challenge correct answer is D: Arrhythmogenic Cardiomyopathy: #echofirst shows right ventricle dilatation & dysfunction.
#whyCMR confirmed #RV dilatation & dysfunction. Also shows #RV fibrofatty infiltration & #LV late gadolinium enhancement. 👇
#ESCardioEd challenge correct answer is D: Arrhythmogenic Cardiomyopathy: #echofirst shows right ventricle dilatation & dysfunction.
#whyCMR confirmed #RV dilatation & dysfunction. Also shows #RV fibrofatty infiltration & #LV late gadolinium enhancement. 👇
2/5
As such, can he participate in competitive sports? Follow #ESCPREV2023 to discover more in #SportsCardiology 😊
As such, can he participate in competitive sports? Follow #ESCPREV2023 to discover more in #SportsCardiology 😊
3/5
Why correct answer is not A: CPVT is an inherited ion channel disorder characterised by polymorphic ventricular #arrhythmias & normal structural heart. The patient has structural abnormalities.
Why correct answer is not A: CPVT is an inherited ion channel disorder characterised by polymorphic ventricular #arrhythmias & normal structural heart. The patient has structural abnormalities.
📌GUIDELINE 2023🇯🇵. Diagnóstico y Tto de Angina Vasoespástica y Disfunción Microvascular Coronaria.
🔸INOCA: Angina y/o isquemia sin lesiones coronarias epicárdicas fijas ≥50% x angio/CT o FFR≤0.8.
🔹≈ 50%👥derivados a angiocoro x angina y/o isquemia👉no tienen lesiones signif
🔸INOCA: Angina y/o isquemia sin lesiones coronarias epicárdicas fijas ≥50% x angio/CT o FFR≤0.8.
🔹≈ 50%👥derivados a angiocoro x angina y/o isquemia👉no tienen lesiones signif
📌INOCA
💡Principales mecanismos fisiopatológicos: vasoespasmo epicárdico & disfunción microvascular (⬇️CFR o ⬆️IMR).
🔸Importante superposición entre ambos.
💡Principales mecanismos fisiopatológicos: vasoespasmo epicárdico & disfunción microvascular (⬇️CFR o ⬆️IMR).
🔸Importante superposición entre ambos.
📌INOCA. Endotipos y mecanismos de isquemia.
🪸2020 EAPCI expert consensus propone 5⃣endotipos en base a estudios funcionales invasivos coronarios.
🪸2020 EAPCI expert consensus propone 5⃣endotipos en base a estudios funcionales invasivos coronarios.
Glad to share our latest publication on #WhyCMR with T1 and T2 mapping in #takotsubo syndrome 😊with @lucarlimite @beamusumeci1 @c_eike @v_puntmann academic.oup.com/ehjcimaging/ad…
Myocardial edema largely represented, correlations with interstitial expansion, ECG changes and systolic function. Some considerations below 🧵
1/ In #takotsubo syndrome myocardial edema features the acute phase: #WhyCMR T1 and T2 mapping have the advantage of a parametric quantification of edema. T2 specific for water, but native T1 can read it too (ahajournals.org/doi/full/10.11…) and ECV not water-independent in this setting
#Imaging In #Athletes from @mmartinezheart’s phenomenal talk at @LLUHealth
➡️ physiological adaption in athletes common
➡️ not every “abnormal” finding is a pathology #Echofirst #whyCMR must to evaluate
➡️ ekg interpretation jacc.org/doi/abs/10.101…
➡️ physiological adaption in athletes common
➡️ not every “abnormal” finding is a pathology #Echofirst #whyCMR must to evaluate
➡️ ekg interpretation jacc.org/doi/abs/10.101…
➡️ type of cardiac remodeling depend on the sports and activity
Eccentric
Nondilated concentric
LV concentric
➡️ increased LV size and lower EF not uncommon- Stroke volume
Eccentric
Nondilated concentric
LV concentric
➡️ increased LV size and lower EF not uncommon- Stroke volume
31yo F, brother sudden cardiac death at 34yo, father sudden cardiac death at 45yo
Should she be worried??
#radtwitter #medtwitter #cardiotwitter #whyCMR
Should she be worried??
#radtwitter #medtwitter #cardiotwitter #whyCMR
Patient also had basal septal hypertrophy up to 21mm (left), associated with delayed enhancement (right)
Dad was thought to have died from MI. Brother had suspicion of ARVD on echo, died before CMR, no autopsy. Her CMR was requested to rule out ARVD.
1) Welcome to a new #accredited #tweetorial on #hypertrophic #cardiomyopathy #HCM. Our expert author is Ahmad Masri MD @MasriAhmadMD of @OHSUCardio where he leads the Hypertrophic Cardiomyopathy Ctr. See a previous program from him, on #Fabry disease, at cardiometabolic-ce.com/cardiorenal-fa….
2a) This program is intended for #healthcare providers and is supported by an educational grant from Bristol-Myers Squibb. Statement of accreditation and faculty disclosures at cardiometabolic-ce.com/disclosures/. FOLLOW US for the most timely expert education in #cardiometabolic care!
2b) #Physicians #Nurses #PhysicianAssociates #NursePractitioners #Pharmacists earn a full 1⃣ hour of 🆓CE/#CME credit from following this 🧵. For educational purposes, Twitter still works!! 😁
🔥 New Cases of @SCMRorg
🫀🧲 Rapid Recurrence of Primary Cardiac Sarcoma seen by #WhyCMR
👇Click here for a link to the case
scmr.org/page/case22-10…
🙏 Please follow here for highlights of the case 1/
#SCMRCases @vass_vassiliou @vineetao17 @achdDoc12 @purviparwani
🫀🧲 Rapid Recurrence of Primary Cardiac Sarcoma seen by #WhyCMR
👇Click here for a link to the case
scmr.org/page/case22-10…
🙏 Please follow here for highlights of the case 1/
#SCMRCases @vass_vassiliou @vineetao17 @achdDoc12 @purviparwani
👨24 yo male w/ hx of cardiac tumor s/p resection
✅Hemoptysis w/ bright red blood
✅Cardiac tumor dx 3 mo prior w/ similar symptoms
❤️Echo → Large mass in LA
🔪Surg specimen pleomorphic sarcoma
❤️F/U Echo 1 mo → small mass in LA 2/
#WhyCMR @SCMRorg
✅Hemoptysis w/ bright red blood
✅Cardiac tumor dx 3 mo prior w/ similar symptoms
❤️Echo → Large mass in LA
🔪Surg specimen pleomorphic sarcoma
❤️F/U Echo 1 mo → small mass in LA 2/
#WhyCMR @SCMRorg
#WhyCMR → 2 wks after 1 mo f/u echo
🫀🧲 Large bilobed LA mass from R PVs
🫀🧲 Mass = iso T1, ↑ T2, ↑ LGE, avascular on perfusion
👇Click here for entire CMR
cloudcmr.com/0157-1973-5348… 3/
#SCMRCases @SCMRorg
🫀🧲 Large bilobed LA mass from R PVs
🫀🧲 Mass = iso T1, ↑ T2, ↑ LGE, avascular on perfusion
👇Click here for entire CMR
cloudcmr.com/0157-1973-5348… 3/
#SCMRCases @SCMRorg
#WhyCMR for the right heart is challenging! You must FINE TUNE your sequences and ideally be at the console when scanning a possible ARVC
HI RES partial SAX (1.7x1.7x5 mm) post GAD
#WhyCMR SMALL TIPS for scanning the RV
- Slice thickness 4.5-6 mm 🍕
- Pixel 1.7 x 1.7 or less depending on your machine
-🔼Signal by going post-GAD 🥷
-🔼SNR by decreasing any acceleration method as much as tolerated by the patient (apnea time)
- 🔼Flip Angle to brighten blood
- Slice thickness 4.5-6 mm 🍕
- Pixel 1.7 x 1.7 or less depending on your machine
-🔼Signal by going post-GAD 🥷
-🔼SNR by decreasing any acceleration method as much as tolerated by the patient (apnea time)
- 🔼Flip Angle to brighten blood
Tips and Tricks about Calcium and Coronary CT.
First of all: do not be scared about calcium.
- Calcium is par of the disease you are studying
- Calcium is significant information
- Calcium is not just a number (is a pattern, a phenotype, a study of the patient).
1
First of all: do not be scared about calcium.
- Calcium is par of the disease you are studying
- Calcium is significant information
- Calcium is not just a number (is a pattern, a phenotype, a study of the patient).
1
Coronary calcifications, then, are meaningful information. Describe them and use them to create the map for the CTA both imaging-wise and reporting-wise.
E.g.: a dominant pattern of calcifications is already pointing towards a therapeutic orientation.
2
E.g.: a dominant pattern of calcifications is already pointing towards a therapeutic orientation.
2
While looking at all these calcifications on the coronary arteries, do not forget to look at all the other structures in the scan. The correct diagnosis might already be there.
3
3
Subtle case for the #ACHD experts out there. What's the finding and what's the congenital anatomy? #4dflow #whyCMR @NASCISociety @thoracicrad @UCSDRadRes @UCSDCardFellows @ACHD_SanDiego @ACHDatStanford @StanfordRadCVI
@NASCISociety @thoracicrad @UCSDRadRes @UCSDCardFellows @ACHD_SanDiego @ACHDatStanford @StanfordRadCVI Additional views 1/2
2/2
Dr. Karen Stout - presenting the 7 rules to evaluate #Congenital #HeartDisease by #yesCCT at #SCCT2022
Rule - 1: ALWAYS be prepared. Check cases a day prior & PLAN the imaging
@Heart_SCCT @FiRSTSCCT @SinghVasvi @AChoiHeart
Rule - 1: ALWAYS be prepared. Check cases a day prior & PLAN the imaging
@Heart_SCCT @FiRSTSCCT @SinghVasvi @AChoiHeart
KNOW the anatomy.
If you don’t understand the repair- LOOK up. #Google
@Fentanes_MD @JWeirMcCall @Nidhi_Madan9
If you don’t understand the repair- LOOK up. #Google
@Fentanes_MD @JWeirMcCall @Nidhi_Madan9
#Immunosuppressive therapy in virus-negative inflammatory CMP : 20-year follow-up of the #TIMIC trial
Immunosuppressive Tx of virus-negative inflammatory #CMP is associated to a persistent improvement of LV
function and better outcomes during long-term follow-up
#HeartFailure
Immunosuppressive Tx of virus-negative inflammatory #CMP is associated to a persistent improvement of LV
function and better outcomes during long-term follow-up
#HeartFailure
#Immunosuppressive Tx promoted an improvement in cardiac function in 88% of the cases compared the placebo group
A persistent ⤴️ in the #LVEF is seen in long -term (up to 20 years) clinical outcomes of the whole cohort of 85 patients originally enrolled in the #TIMIC trial
A persistent ⤴️ in the #LVEF is seen in long -term (up to 20 years) clinical outcomes of the whole cohort of 85 patients originally enrolled in the #TIMIC trial
Recurring virus-negative myocarditis responding to #immunosuppressive therapy
EKG showing LBBB (A) resolving after therapy (B)
(C and D) Echo apical view showing recovery of LV dysfunction from EF -28% ➡️ up to 51%
#HeartFailure #EchoFirst @ESC_Journals academic.oup.com/eurheartj/adva…
EKG showing LBBB (A) resolving after therapy (B)
(C and D) Echo apical view showing recovery of LV dysfunction from EF -28% ➡️ up to 51%
#HeartFailure #EchoFirst @ESC_Journals academic.oup.com/eurheartj/adva…
Many faces of HCM! Crazy #WhyCMR case | 50 yo female, very mild LVH (IVS 11-12 mm) | Follow me | I think @MasriAhmadMD will like this one! #Cardiotwitter @SCMRorg @scmrchd
3Ch Mild LVH
2C | WOW looking deep inferior CRYPTS 🧐
📌REVIEW. MIOCARDIOPATÍA HIPERTRÓFICA💪
🔹Prevalencia 1:200-1:500, ≈ 20M🌐, 10%-20% se identifica 🩺
🔸Tratable y consistente c/longevidad normal
🔹⚠️Diagnóstico oportuno y preciso ⚠️
🔸#echofirst y #WhyCMR 👉 sinérgicos
🧵👇
🆓sciencedirect.com/science/articl…
#CardioTwitter @SAC_54
🔹Prevalencia 1:200-1:500, ≈ 20M🌐, 10%-20% se identifica 🩺
🔸Tratable y consistente c/longevidad normal
🔹⚠️Diagnóstico oportuno y preciso ⚠️
🔸#echofirst y #WhyCMR 👉 sinérgicos
🧵👇
🆓sciencedirect.com/science/articl…
#CardioTwitter @SAC_54
🚩4⃣ Perfiles Clínicos:
🔹Estable benigno, no requiere tto (46%)
🔸Obstrucción del TSVI con signos de IC, candidato a intervención (43%)
🔹FA con indicación de ACO (17%)
🔸Riesgo de MS☠️, eventual CDI⚡️(6%)
🔹Etapa final IC (4%)
⚠️10% ptes tienen mas de un perfil clínico
🔹Estable benigno, no requiere tto (46%)
🔸Obstrucción del TSVI con signos de IC, candidato a intervención (43%)
🔹FA con indicación de ACO (17%)
🔸Riesgo de MS☠️, eventual CDI⚡️(6%)
🔹Etapa final IC (4%)
⚠️10% ptes tienen mas de un perfil clínico
🚩Evaluación inicial de MCH:
🔸Morfología y función VI💔
🔹Severidad de síntomas
🔸Riesgo de Muerte Súbita☠️
🔹Antecedentes familiares
🔸Modificación del estilo de vida
🔸Morfología y función VI💔
🔹Severidad de síntomas
🔸Riesgo de Muerte Súbita☠️
🔹Antecedentes familiares
🔸Modificación del estilo de vida
📕Month Review on Fabry Disease (FD) via @RCMjournal
🟡Mechanisms Beyond Storage & Forthcoming Therapies
🟡Cardiac Imaging
🟡Echocardiography #echofirst
🟡Cardiac Magnetic Resonance #WhyCMR
📂OPEN LINKS⬇️ & Thread🧵(1/13)
@mauripieroni72 @torresviera @SVCardio @DeBakeyCVedu
🟡Mechanisms Beyond Storage & Forthcoming Therapies
🟡Cardiac Imaging
🟡Echocardiography #echofirst
🟡Cardiac Magnetic Resonance #WhyCMR
📂OPEN LINKS⬇️ & Thread🧵(1/13)
@mauripieroni72 @torresviera @SVCardio @DeBakeyCVedu
✅FD X-Linked inherited Lysosomal Storage disorder
✅Mutations (>900) alfa-GAL gene (GLA)
✅🚫or⬇️ alfa-GAL A enzyme activity
✅Incidence 1/40,000-1/117,000
✅Newborn Screening 🇮🇹🇹🇼 1/8,800
✅FD storage GB3
✅Mutations (>900) alfa-GAL gene (GLA)
✅🚫or⬇️ alfa-GAL A enzyme activity
✅Incidence 1/40,000-1/117,000
✅Newborn Screening 🇮🇹🇹🇼 1/8,800
✅FD storage GB3
✅Intracellular glycosphingolipids organize➡️concentric lamellar bodies (🦓bodies)
✅lysoGB3➡️Pathogenic factor
✅Ion Channel Dysfunction
✅⬆️conduction velocity (atrial 🫀ventricular🫀)➡️short PR in absence of an accessory pathway
✅lysoGB3➡️Pathogenic factor
✅Ion Channel Dysfunction
✅⬆️conduction velocity (atrial 🫀ventricular🫀)➡️short PR in absence of an accessory pathway
#whyCMR and Implantable devices:
👉Increasing rates of cardiac device implantation
👉Expanding indications for CMR
Need to deal with:
🥇Device compatibility
🥈Artifacts
🥉Stress perfusion
…where are we?
💫Here a tweetorial on CMR and devices!
👉Increasing rates of cardiac device implantation
👉Expanding indications for CMR
Need to deal with:
🥇Device compatibility
🥈Artifacts
🥉Stress perfusion
…where are we?
💫Here a tweetorial on CMR and devices!
Conditional or non conditional?
👉1.5T or 3T
👉 no deaths, lead failures, losses of capture, or ventricular arrhythmias during CMR in patients with non-MR conditional pacemakers or ICDs
👉only decrease in 1% in p wave amplitude (no clinically relevant)
👉1.5T or 3T
👉 no deaths, lead failures, losses of capture, or ventricular arrhythmias during CMR in patients with non-MR conditional pacemakers or ICDs
👉only decrease in 1% in p wave amplitude (no clinically relevant)
What about abandon leads?
👉No major tachicardia
👉No major device malfunctioning
👉reports show that this should not be a controindication anymore
👉No major tachicardia
👉No major device malfunctioning
👉reports show that this should not be a controindication anymore
The DISCHARGE trial in online on the NEJM and it confirms what we all experience every day using CCT in a proper manner. CCT is safer, reliable and allows better management of stable patients with suspected obstructive CAD as compared to invasive strategy.
The main observation that comes to my mind however is still the very low prevalence of patients with obstructive CAD (25%) in both arms (CT and ICA). This is well known from previous studies and it is related to the selection criteria adopted for referral, partly.
The fact that still we send for an invasive and costly examination (CAG/ICA) this huge number of patients is simply astonishing in 2022. Healthcare cannot be managed like this, especially in universal systems like Italy, Germany, UK, Canada,...
State fo the Art CCT - 4D cineMPR of Thoracic Aorta in para-sagittal view in 4 different conditions from normal to severely diseased/type B dissection.
#WhyCMR #yesCCT #CardioTwitter #MedTwitter
#WhyCMR #yesCCT #CardioTwitter #MedTwitter
3/ That is edema (T2 STIR)
Do you routinely measure #MAPSE?
Did you know that MAPSE beats #GLS and #LVEF regarding prognosis?
A new multicenter collab study out, led by @KellmanPeter
Ref:
#WhyCMR 🫀🧲 #EchoFirst 🫀🔊
A thread 🧵. 1/n pubmed.gov/35132872
Did you know that MAPSE beats #GLS and #LVEF regarding prognosis?
A new multicenter collab study out, led by @KellmanPeter
Ref:
#WhyCMR 🫀🧲 #EchoFirst 🫀🔊
A thread 🧵. 1/n pubmed.gov/35132872
We know that GLS is a composite measure correlated w LVEF, LVEDV, LVESV, LV mass, infarction, non-ischemic scar, aortic stenosis, mitral regurg, ECV.
So, not surprisingly, GLS associates with poor prognosis.
Ref: Suppl Table 2
2/n pubmed.gov/32563637
So, not surprisingly, GLS associates with poor prognosis.
Ref: Suppl Table 2
2/n pubmed.gov/32563637
Notably, mitral annular plane systolic excursion #MAPSE has been measurable by #EchoFirst since 1986 by M-mode ().
3/n pubmed.gov/3464160
3/n pubmed.gov/3464160
#JACCCardioOnc #Tweetorial: Along the spectrum of cancer Tx, #YeSCCT has a lot to offer regarding identifying subclinical #ASCVD, excluding obstructive #cvCAD in cardiotoxicity when appropriate. #CardioOnc, as a field, can gain from incorporating CCT in practice.
🧵1/
🧵1/
#YeSCCT may identify subclinical #ASCVD in cancer patients & survivors. Reviewing previous non-gated thoracic CT scans for CAC may help identify subclinical #cvCAD and start prompt preventive Tx.
#JACCCardioOnc #CardioOnc #MedTwitter #CardioTwitter
2/
#JACCCardioOnc #CardioOnc #MedTwitter #CardioTwitter
2/
Several clinical scenarios in the context of cardiotoxicity may require ruling out obstructive #cvCAD. Cancer pts tend to have ⬆️ risk of complications from invasive procedures➡️ thrombocytopenia & hypercoagulable states. #YeSCCT may derive significant benefit. #JACCCardioOnc
3/
3/
This is an interesting study by @amritlota et al.
“LGE has no prognostic value if LV volumes and EF are normal” is the wrong interpretation, @MAecocardio.
These are my thoughts…
#WhyCMR
“LGE has no prognostic value if LV volumes and EF are normal” is the wrong interpretation, @MAecocardio.
These are my thoughts…
#WhyCMR
First, was the LGE in this study an artifact ("overcalling")?
No, because:
- This paper comes from pioneers and some of the biggest names in CMR
- Our anecdotal experience matches these findings
- The images in the paper very clearly demonstrate LGE.
No, because:
- This paper comes from pioneers and some of the biggest names in CMR
- Our anecdotal experience matches these findings
- The images in the paper very clearly demonstrate LGE.
So why was LGE associated with a very low risk of SCD during follow-up in this study?
LGE is always bad at a group/population level compared to no LGE. Is it bad for every person? Like any risk marker, no.
LGE is always bad at a group/population level compared to no LGE. Is it bad for every person? Like any risk marker, no.
Multimodality imaging in patients with HFpEF: an expert consensus document of the European Association of Cardiovascular Imaging #EACVI #MMI #HFpEF academic.oup.com/ehjcimaging/ad… @ESC_Journals @Cosyns @alessia_gimelli @ThorEdvardsen @VDelgadoGarcia @bogdan_popescu1 @JaeKOh2
This expert consensus document from the #EACVI provides recommendations regarding how to determine elevated LV filling pressure in the setting of suspected #HFpEF and how to use multimodality imaging to determine specific aetiologies in patients with HFpEF @EACVIPresident
📌Mechanisms of LV diastolic dysfunction include impaired relaxation, attenuated restoring forces, and increased passive elastic stiffness that leads to elevated LV filling pressure
📌The presence of LV hypertrophy and dilated LA provides support for the #HFpEF diagnosis
📌The presence of LV hypertrophy and dilated LA provides support for the #HFpEF diagnosis
