Jeffrey Marbach

@skat_ct @aayshacader @SimoneBiscaglia @abdellateefMohm @Ale_Gonzalez_Z @yeh_james3 @marcosdanilloMD @GraziellaPompei Much simpler to snare it and pull out the kink

@aayshacader @WaimeaUK @SimoneBiscaglia @abdellateefMohm @Ale_Gonzalez_Z @yeh_james3 @marcosdanilloMD I'm not aware if it was previously published, My colleague calls it also "Straw technique" 🥤🥤🥤 @Cristin22863430 @GraziellaPompei

1/5 When a diagnostic catheter likes to twist💃: #ldTRA #rdTRA #RadialFirst problem solving @abdellateefMohm @Ale_Gonzalez_Z @yeh_james3 @marcosdanilloMD @SimoneBiscaglia

@AdrianMercadoMD @ACCinTouch “Evidence only guides my practice when it confirms with my current beliefs” Terrible take.

@ACCinTouch 🤦🏻🤦🏻..... NOT changing my practice. Cassettes and polaroid cameras are coming back too, so why not bring back angio-only pci. Let's bring back bare metal stents acc2027

Results of IVUS-CHIP and OPTIMAL: When compared with angiography-guided #PCI, IVUS-guided PCI was found to be not superior in patients with 👇 ❇️ Complex coronary arteries ➡️ IVUS-CHIP ❇️ Unprotected LM-CAD ➡️ OPTIMAL More on these #ACC26 LBCT trials: bit.ly/3Q7OZiK

I hesitated to respond to this - but the beauty of X is hearing opposing points. 1. The response with a quote was addressing a tweet (done using a quote) suggesting that I was ignoring the data - after I clearly laid out my interpretation of the trial. In that interpretation, I acquiesced that stroke rate maybe a little higher - but it is clinically insignificant in absolute terms. You might disagree with that - but it isnt ignoring the data. I suggested (as with all therapies) that there are risks/biases and that patients should decide. 2. I am not a CHAMPION investigator - but I did enroll in CATALYST, I (tried) to enroll in ASAP, I am enrolling in LAAOS4. I spend a lot of time designing and running clinical trials - and I have yet to design one thats perfect. I have seen a lot of trials fail. It's just hard to predict all the variables - like event rates. It is 1000x easier to sit on the sideline and throw stones than commit to a design and execute. The quote I used is in relation to the fact that we should give kudos to the investigators for getting in the ring and doing the heavy lifting. I personally think it's insulting to insinuate that the investigators spent all this time on the trial "to design it to win" or to "sell more widgets". I know a lot of the trialists - they are good clinicians and scientists and wanted to answer a fundamental question in clinical cardiology. This is as good as it gets in trial design - it has warts (they all do) - but I choose to believe the investigators went in with the best of intentions to help move the field forward. 3. I do question the motives of people posting on X. I think it is disingenuous to hide behind the veil of "just a great clinician trying to do clinical trial appraisal" (and please come see my podcast and substack). COI comes in many forms - and likes/views/royalties is certainly one. It's not that I don't like reading everyone's thoughts - I have learned things from everyone. But sometimes the lady doth protest too much. I stand by it - at some point if people are genuinely interested in improving the science they need to get in the ring. And if you aren't willing to do that - I would hope at least not question the motives of the investigators that have the courage to do so.

Presented at #ACC26: Among patients with unprotected left main coronary artery disease, intravascular ultrasonography–guided PCI did not result in a lower risk of ischemic events or death than angiography-guided PCI. Full OPTIMAL trial results: nejm.org/doi/full/10.10… Editorial: Seeing the Left Main Coronary Artery Clearly — Is IVUS Always Necessary? nejm.org/doi/full/10.10… @ACCinTouch

@LAzzaliniMD ORBITA endpoint (change in exercise time after 6 weeks) was meaningless. Imprecise, variable, effort-driven metric for a therapy designed to reduce ischemia and angina. Weak endpoint, overstated takeaway.

#CTO #PCI improved the primary endpoint of angina symptom score (and >10-point increase in SAQ) and patients undergoing CTO PCI experienced approximately 31 additional angina-free days over 6 months compared with placebo. How do we reconcile this with the other ORBITA trials?

Criticism of STEMI-DTU is revisionist. Biologically grounded strategy supported by years of preclinical work. We cannot claim to value innovation, then ridicule a rigorously tested hypothesis because the trial was neutral. Hypocrisy deserves to be called out. @NavinKapur4

@Hragy What a bad take. Many “CTO” skills that fellows learn make them better at non-CTO PCI. This point was well articulated in a JACC editorial several years ago by Dr. Hector Tamez, who taught me many of the skills I use on a daily basis

As chief of cardiology, who believed in value of CTO PCI in select patients who absolutely need it, I reigned the cath labs in our hospital to keep CTO from becoming a main stream “cult” practice, every hospital needs a couple of super operators, keep them busy- dont train more!

I was in a presentation as Dr Bill Lombardi told CTO fellows that even asymptomatic CTO patients don’t know that they in reality symptomatic,then he gave an anecdotal story of an asymptomatic patient who said he only realized he was symptomatic after Dr Lombardi did his CTO.

@serioustaurean acc.org/Latest-in-Card… CTO interventions?

For Cardiologists in India #ACC #AHA New Orleans should be marked as the most scientific meet. Disproved role of 1. Impella in STEMI 2. Impella in CHIP 3. LAAC vs OAC 4. CTO interventions All of us from the third world shouldn’t have FOMO. It’s all industry driven there

Today's Paper of the Day is: Macrovascular Hemodynamics & Peripheral Perfusion in Cardiogenic Shock: Exploring Current Targets & Future Directions criticalcarereviews.com/latest-evidenc… Join us to read 1 paper per day and stay up-to-date as we cover the spectrum of critical care across 2026

@iluminatibot This study was evaluating long covid and was not designed to evaluate COVID vaccines.

Amyloid microclots were found in the blood of EVERYONE who received a COVID-19 vaccine in a new peer-reviewed study.

@MGuglin Unfortunately, after heart failure training many of these IM docs match into cardiology and then pursue EP or IC.

Who agrees with me? There is a dire shortage of doctors signing up to heart failure fellowships with >60% programs unfilled. I propose the following: - allow the entry into HF training to general internists—including those who did not match to cardiology - if they then proceed to cardiology fellowship, allow them to sit for HF Boards after they are Board certified in Cardiology - If they remain internists with HF training, create an alternative certificate for them. This would yield immediate benefits: - all available fellowship slots would be filled with eager and capable trainees - teaching faculty will be teaching again - the market will be saturated with HF doctors Read my whole piece pubmed.ncbi.nlm.nih.gov/41238042/ @HFSA @JACCJournals @nikhilna @NirUrielMD @Aheartdoc @AHAScience @EMDeFilippisMD @DmitryAbramovMD @EiranGorodeski

Welcome to our October 22 SPECIAL issue of #JACCCaseReports @JACCJournals focusing on #NYV2025 and multivalve disease submissions! jacc.org/journal/case-r… Full PDF here: jacc.org/doi/10.1016/S2… @MinnowWalsh @DeeDeeWangMD @hmkyale @Justine_Turco New York Valves Acute Hemodynamic Instability After Transcatheter Tricuspid Valve Replacement jacc.org/doi/10.1016/j.… First-in-Human Experience With Septal Occluder for Dehiscence of Anterior Mitral Valve Leaflet Patch: From Surgical to Percutaneous Closure jacc.org/doi/10.1016/j.… TAV-in-TAV to Rescue Suboptimal Index TAVR: The Critical Role of Anatomy jacc.org/doi/10.1016/j.… Transcatheter Tricuspid Valve Replacement in the Presence of Pacemaker Lead-Related Tricuspid Regurgitation and Complex Anatomy jacc.org/doi/10.1016/j.… Late Transcatheter Valve Migration Managed With Redo TAVR: A Case of Triple Aortic Valve Replacement jacc.org/doi/10.1016/j.… Late-Onset Embolization of a Mitral Transcatheter Edge-to-Edge Repair Device jacc.org/doi/10.1016/j.… Endocarditis After Redo TAVR Managed With Medical Treatment and Later TAVR-in-TAVR-in-TAVR jacc.org/doi/10.1016/j.… Transfemoral Retrograde Transcatheter Mechanical Thrombectomy of Massive Left Ventricular Thrombus jacc.org/doi/10.1016/j.… Transcatheter Treatment of Tricuspid Regurgitation Due to Surgical Ring Dehiscence: Combining Intravalvular and Paravalvular Approaches jacc.org/doi/10.1016/j.… Left Atrial Embolization During Transcatheter Mitral Valve in Mitral Annular Calcification: Successful Percutaneous Bailout Using an Atrial Septal Defect Occluder jacc.org/doi/10.1016/j.… Multivalvular Disease TAVR in Rheumatic Aortic Stenosis With Mechanical Mitral Prosthesis: Case Series on Short Annulus-Prosthesis Distance jacc.org/doi/10.1016/j.… Overcoming the Hurdle With Delicate Balance: TAVR in Prior Mechanical Mitral Prosthesis jacc.org/doi/10.1016/j.… How to Manage Double Obstructions: Stories of Aortic and Mitral Stenosis jacc.org/doi/10.1016/j.… Step Forward in Rheumatic Valve Disease: Simultaneous PTMC and TAVI as a Viable Treatment Strategy jacc.org/doi/10.1016/j.… Percutaneous Treatment of Multivalvular Disease Including Refractory Tricuspid Regurgitation in a Frail Elderly Patient jacc.org/doi/10.1016/j.… Concomitant Transapical Double Valve Replacement for Severe Native Mitral Regurgitation and Aortic Transcatheter Valve Degeneration jacc.org/doi/10.1016/j.… Aortic Prosthesis Endocarditis With Aorto-Mitral Fibrosa Abscess and Left Atrial Fistula: Commando Procedure as a Third Reintervention jacc.org/doi/10.1016/j.… Single Procedure of Transcatheter Aortic and Mitral Valve-in-Valve Implantation in a Patient With Cardiogenic Shock jacc.org/doi/10.1016/j.… Surgical Reintervention for Complex, Multivalvular Rheumatic Heart Disease jacc.org/doi/10.1016/j.… Predominant Rheumatic Tricuspid Stenosis jacc.org/doi/10.1016/j.… Combined Single-Access Left Atrial Appendage Occlusion and Transcatheter Edge-to-Edge Repair for Mitral and Tricuspid Regurgitation jacc.org/doi/10.1016/j.… Coronary, Peripheral and Structural Interventions Efficient Removal of Nascent Left Atrial Appendage Thrombus to Facilitate Left Atrial Appendage Closure jacc.org/doi/10.1016/j.… First Experience of Tricuspid Transcatheter-Edge-to-Edge Repair Using 3D Mini–Transesophageal Echocardiography and Intracardiac Echocardiography jacc.org/doi/10.1016/j.… Fundamental Anatomy and its Impact on Clinical Practice: The Membranous Septum and Conduction System in TAVI jacc.org/doi/10.1016/j.… Congenital Heart Disease Recurrent Right Atrial Thrombus After Percutaneous ASD Occlusion jacc.org/doi/10.1016/j.… Beating-Heart Pulmonary Valve Replacement for Isolated Monocuspid Valve jacc.org/doi/10.1016/j.… Valvular Heart Disease Septic Coronary Embolism and Myocardial Rupture After Valve-in-Valve TAVR Endocarditis jacc.org/doi/10.1016/j.… 30-Day Outcomes of a Controlled-Bending Delivery System for TAVR in Severe Aortic Stenosis jacc.org/doi/10.1016/j.… Heart Failure and Cardiomyopathies Rescue of Acute VSD in Takotsubo Cardiomyopathy: The Role of BiPella Support in High-Risk Recovery jacc.org/doi/10.1016/j.… Unpredictable Mechanical Mitral Valve Leaflet Motion in a Patient With Continuous-Flow LVAD jacc.org/doi/10.1016/j.… Rhythm Disorders and Electrophysiology Fluoroscopy-Assisted ICE-Guided Tricuspid Valve Vegetation Removal in CIED-Related Infective Endocarditis jacc.org/doi/10.1016/j.… @aroniskn @MiChen__ @FontanDoc @sarano_maurice @Miho_Fukui_ @Nishaki1 @ACHDocTMoe @AdityaParikhMD @M_Pompeu_Sa_MD @jsaef1 @JTSaxon @Kentso987 @m_taramasso @SyedZaidMD Authors’ handles: @hahn_rt @kp_rommel @npfam1 @DrOzanDemir @npfam1 @BryanTraynor6 @JoaoLCavalcant @g_giustinoMD @ChantalAsselin @PhilGenereuxMD @ChantalAsselin @NoahHaroian @kentso987 @AlexleeMD @AlexLee @myriam_akodad @andxro @jacabreracardio @cardiac_anatomy @JAMarbach @Anesthesist15 @ErricoRamirez @hkyounes

@rradgoski @schadjoe The most interceptions in the league might be contributing…

@schadjoe THIS IS why Miami is failing, not Tua. We are an incomplete team, the Oline sucks, the Defense is failing horribly and y'all expect Tua to pull miracles each week? The fact that we've been 'in' more games than not is because of him.

Dolphins rookies, PFF Jonah Savaiinaea 78th of 78 ranked guards Dante Trader 78th of 90 ranked safeties Jordan Phillips 92nd of 124 ranked defensive tackles Kenneth Grant 121st of 124 ranked defensive tackles *Ollie Gordon not enough snaps to qualify; around 26th RB

Advancing Cardiogenic Shock Research Dr. Sandeep Nathan (@SandeepNathanMD), Section of Cardiology at @UChicagoMed, co-authored the newly released SCAI Door to Lactate Clearance (DLC) Initiative with @SCAI. Published in JSCAI, this work highlights how lactate clearance can guide phenotypic profiling and improve prognostication in #CardiogenicShock — an urgent call to action for the field. 📖 Explore the article: jscai.org/article/S2772-… #CardioTwitter #Cardiology

Macrovascular perfusion targets (from MAP to CO) are a cornerstone of cardiogenic shock management. But what about the microvasculature? Read our #JACCAdvances review highlighting the emerging role of markers of peripheral and tissue perfusion in CS! tinyurl.com/yc6pfbad

Should treatments that improve peripheral perfusion take precedence over a focus on hemodynamics in cardiogenic shock management? We explore the evolving paradigm of shock care and why it’s time to rethink what truly matters jacc.org/doi/10.1016/j.… @benhibbertMDPhD

It’s currently associated with better outcomes. What I worry about more is targeting the lactate doesn’t necessarily mean outcomes are better. If it becomes a target ppl might do more things to normalize the lactate that actually harm patients. Don’t think it can happen - glucose is also associated with poor outcomes. We know now that targeting glucose control increases harm but did it for years. It took several trials to refute it. I love the enthusiasm but let’a set a target of shock centers enrolling 25% of their patients in shock rcts and we will do more good by figuring out what the right therapies are. That being said - it is a strong association. Here is the rates from doremi. @rebeccamathewmd

Special issue of @cardiacinterv just out with a sneak peak discussion of the @SCAI #DLC initiative. The full peer reviewed position statement will be out in @MyJSCAI during SCAI SHOCK Tampa! Sept 18-20 Link: citoday.com/articles/2025-… @Babar_Basir @agtruesdell @davebaran @SandeepNathanMD @mirvatalasnag