Carlo Alberto Barcella

📄 Sex differences in moderate aortic stenosis: new longitudinal insights 🔗 doi.org/10.1093/ehjimp… 🫀 A longitudinal study of >500 patients with moderate aortic stenosis highlights important sex-specific differences in left ventricular remodeling. ✨ Key findings: 🔹 Women develop concentric hypertrophy and diastolic dysfunction at lower transvalvular gradients 🔹 They exhibit more pronounced diastolic dysfunction throughout follow-up 🔹 Dyspnoea is more common at presentation 🔹 Despite this, no differences in outcomes were observed: ➡️ symptom onset timing ➡️ aortic valve replacement ➡️ mortality 📊 These findings suggest greater sensitivity of the female myocardium to pressure overload, even at earlier stages of disease 💡 Clinical take-home message: 👉 Sex-specific differences emerge early (moderate AS stage) 👉 This may support: closer surveillance in women more tailored management strategies rethinking timing of intervention 🚺 Aortic stenosis is not the same disease in women and men: the pathophysiology differs—even when outcomes appear similar. #Cardiology #AorticStenosis #Echocardiography #SexDifferences #WomenInCardiology #HeartValveDisease #CardiacRemodeling #HFpEF #TAVR #PrecisionMedicine 🫀📊

@DrRajeshG1 Very likely VT (fusion beats, RS interval > 100ms)

VT or SVT with aberrancy ?

@VLSorrellImages @echogenics @CASEfromASE @ASE360 Probably A

#JADEL New in CASE @CASEfromASE doi.org/10.1016/j.case… 23M; serial TTEs; D1, D4 & W6. No fever. Culture neg. Newly diagnosed (deadly) large testicular mass: A. Non-bacterial thrombotic endocarditis B. Primary cancer C. Infective endocarditis D. Secondary cancer @ASE360

@sudarshanballa @WvuCvFellows @harshi_md @BritoCardio @CASivaram1 @argulian @alex1708ander Splay sign!

One view - what is the MR severity and why? #echofirst @WvuCvFellows @harshi_md @BritoCardio @CASivaram1 @argulian @alex1708ander

@DisrespectedThe He will die anyway of an overdose within a few months

Barcelona Spain.

● NOACs Overall Clinical Takeaways: ▪︎ Renal function is key for drug selection and dosing — Dabigatran has highest renal clearance. ▪︎ Apixaban is the most kidney-friendly. ▪︎ Rivaroxaban must be taken with food at higher doses. ▪︎ Dabigatran is unique: prodrug, dialysable, and acid-sensitive. ▪︎ CYP interactions most relevant for Apixaban and Rivaroxaban. ⚡ Quick Key Reminders 🧠 Only prodrug: Dabigatran 💊 Only thrombin inhibitor: Dabigatran 💧 Dialysable: Only Dabigatran ⚠️ Most CYP interactions: Apixaban, Rivaroxaban ⚕️ Safest in renal impairment: Apixaban 🍽️ Food required: Rivaroxaban 🔄 Balanced clearance: Edoxaban Table from EHRA practical guide What else would you like to add? 🤔

@DrRajeshG1 @syamkumarmd Fascicular VT

ECG for fellows. To teach you I recommend my friend ⁦@syamkumarmd⁩

@sudarshanballa @WvuCvFellows @CASivaram1 @argulian @DrRajeshG1 @iamritu Staph aureus?

Pt with bacteremia - a rare finding I think. @WvuCvFellows @CASivaram1 @argulian @DrRajeshG1 @iamritu #echofirst any takers for the diagnosis?

#EHJIMP: New State of Art Review on #PrimaryMR. The interaction of cardiac surgery and #transcatheter summarised. Which is the future direction? Ask to @EZancanaroMD @KP_Kresoja @jgrapsa ow.ly/z1Xn50Wn066 @EHJIMPEiC @s_e_petersen @shehabanwer

Diagnosing HFpEF (Heart Failure with Preserved Ejection Fraction)

Diuretics - Summary #medtwitter #foamed #usmle

How to Protect Kidneys During Contrast Procedures? Introducing the CI-AKI Risk Score to predict and prevent Contrast-Induced Acute Kidney Injury (CI-AKI)! What is CI-AKI? ➡️ CI-AKI is a sudden worsening of kidney function occurring within 48–72 hours after exposure to contrast media (CM), commonly used in procedures like angiography. It can lead to prolonged hospitalization, dialysis, or even worse outcomes if not prevented. Key Risk Factors: - CHF (5 pts) - Hypotension (IABP) (5 pts) - Age >75 years (4 pts) - eGFR (2–4 pts) - Diabetes Mellitus (3 pts) - Anemia (3 pts) - Contrast Volume (1 pt/100cc) Risk Stratification: 1️⃣ Low Risk (≤5) ➔ Oral/IV hydration 2️⃣ Intermediate Risk (6–10) ➔ Monitor creatinine daily, avoid back-to-back procedures 3️⃣ High/Very High Risk (≥10) ➔ Correct modifiable factors: - Treat/prevent hypotension - Manage anemia - Suspend nephrotoxic drugs - Explore procedures without CM Periprocedural Kidney Protection Tips: - Hydrate with crystalloids (1–1.5 mL/kg/hr) 3–12 hrs before & 12–24 hrs after - Adjust hydration by LVEDP when needed - Prefer IOCM/LOCM - Minimize contrast volume - Consider rosuvastatin to reduce risk Protecting kidneys = Protecting lives✍️ (Ref: Brauwald's heart disease, 12th Edition) #Cardiology #Nephrology #Kidney #PatientSafety #MedX

SGLT2 inhibitors: not for hypertension but exceedingly useful in hypertension. Read more in EHJ. doi.org/10.1093/eurhea… #SGLT2i #hypertension @ESCardio @ESC_Journals

The only diuretic that has demonstrated to reduce mortality is... 3% saline? A 🧵 TLDR: it's not about sodium (for once).

Distribution of IV fluids after infusion 💧💡 #4KMedEd #MedEd #MedTwitter (Courtesy of @bmj_latest)

@DrRajeshG1 You never write the solution to your cases. 😒

Quiz for fellows. Long back I have posted similar one.

HF vs. AF: "Incidence of atrial fibrillation in patients with an insertable cardiac monitor and symptomatic heart failure" Take a look in #ESCHeartFailure 👉 bit.ly/3Dp8cWP @EJHFEiC @JanBiegus @Ppponikowski #HFA_ESC @hvanspall @ShelleyZieroth @FudimMarat @gcfmd @AlexMebazaa @MarcoMetra @GianluSava

Moderate wine consumption, measured through an objective biomarker (tartaric acid), was prospectively associated with lower rate of cardiovascular disease in a Mediterranean population at high cardiovascular risk. Read more in #EHJ 👉 bit.ly/4j3OG2P @RoccoMontone @ehj_ed

Type 2 myocardial infarction is a challenging clinical entity: new paper discusses diagnosis and management strategies. doi.org/10.1093/eurhea… #MI #CAD #cardiotwitter, @ESC_Journals, @escardio

(1/x) What is the best diuretic to use for hospitalized patients? 🏥 (hint: its not just furosemide) A 🧵 on multimodal diuresis #foamed #medtwitter #diuretics