Bryan E. Tan, MD

2025 has been an amazing year for our family! Some highlights: ✨Had a blast in Portugal 🇵🇹 for baby moon 🌙 ✨The arrival of our 1st baby 👶🏼 ✨ Matched at 1st choice for Advanced Imaging Fellowship 🩻 ✨Aced Echo boards (95 percentile) Looking forward to another great year!

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Honored to received the Trainee Excellence Award 🏅from the Academy of Resident and Fellow Educators at @bcmhouston. I’m thankful to my wife & family, program director @arunima_misra and my mentors at @BCMHeart for their unwavering support in my career and in life 😇 #ACCFIT

@CASivaram1 @argulian @iamritu @purviparwani @swatigar @hvanspall @HeartOTXHeartMD @PWesslyMD @alex1708ander @OungSavly Ebstein Anomaly with associated Secundum ASD. Transgastric view and M mode showing prolapse of a sail-like anterior leaflet of tricuspid valve.

#echofirst ✅ An uncommon condition in adult CV practice ✅ What is the diagnosis? ✅ What does m-mode show? ✅ Transgastric view findings? @argulian @iamritu @purviparwani @BryanTanMD @swatigar @hvanspall @HeartOTXHeartMD @PWesslyMD @alex1708ander @OungSavly @JohnHenryDean

@HamZaNav83 @UChicago @SarswatNitasha @BaylorCardio @chadialraies @jeevsmd @SCAI @Heart_SCCT @ACCinTouch @SCMRorg 👏👏👏 Congratulations Hamza

Thrilled to share that I’ll be joining @UChicago as a Cardiac Amyloidosis Fellow! 🫀 Immensely grateful to my PD Dr. @SarswatNitasha for this incredible opportunity. Can’t wait to learn from the best. Excited for what this academic year holds! #Cardiology #MedTwitter #Amyloidosis

@sudarshanballa @WvuCvFellows @CASivaram1 @iamritu @Pooh_Velagapudi @a_l_bailey @alex1708ander Ebstein anomaly. Apical displacement of tricuspid septal leaflet insertion point, >8mm/m2.

Uncommon in the adult echo world. 80 yo male. Classic echo board question - diagnosis and criteria - @WvuCvFellows @CASivaram1 @iamritu @Pooh_Velagapudi @a_l_bailey @alex1708ander #echofirst

@sudarshanballa @iamritu @WvuCvFellows @argulian @CASivaram1 @alex1708ander @a_l_bailey @BritoCardio I have seen systolic flow into the LAA similar to this, but in the setting of severe eccentric MR with MR jet directed to the LAA.

Interesting TEE LAA Doppler. I have not seen the LAA filling wave this prominent. Color Doppler also shown. Thoughts? #echofirst @WvuCvFellows @argulian @CASivaram1 @alex1708ander @a_l_bailey @BritoCardio

Special issue this week in @JNCjournal on cardiovascular imaging in amyloidosis! Congratulations @mdicarli on putting together this essential guide for all things amyloidosis and to @premsoman123 for leading the paper we wrote on state of the art imaging with technetium-labeled tracers like PYP, DPD, HMDP. sciencedirect.com/science/articl… sciencedirect.com/journal/journa…

Thank you, Dr. Goyal! That was an incredible talk. Really enjoyed the discussion about Ikigai and growth mindset!

Academic publisher Elsevier's profit margin compared to Apple, Google, and Microsoft Apple: 28% Google: 25% Microsoft: 34% Elsevier: 37% with a revenue of $3.9 billion. Elsevier's payment to academic authors and reviewers: $0

@GamerPhilDoc Thank you sir!

@BryanTanMD @JSlivnickMD @UCCardsFellows @BCMHeart @BCMDeptMedicine @BCM_CVRI Excellent work. These AUC values confirm why we still rely on bone marrow and light chain data in haematology. Echo metrics alone miss too many early AL amyloidosis cases. Congrats to the team!

Hot off the press! 🔥🔥 Meta-analysis exploring diagnostic accuracy of ASR for 🫀 Amyloidosis now out in Echocardiography! Congratulations to all co-authors on this important work!onlinelibrary.wiley.com/doi/10.1111/ec… @JSlivnickMD @UCCardsFellows @BCMHeart @BCMDeptMedicine @BCM_CVRI #ACCFIT

@AbdulMannan5465 Thanks Abdul!

@BryanTanMD @JSlivnickMD @UCCardsFellows @BCMHeart @BCMDeptMedicine @BCM_CVRI Congrats bro

@Umair2017 Thank you Dr. Khalid!

@BryanTanMD @JSlivnickMD @UCCardsFellows @BCMHeart @BCMDeptMedicine @BCM_CVRI Important paper with clinical implications. Thank you for sharing the results and congratulation on your work Bryan!

@AbdulMannan5465 Congratulations Abdul! 👏👏

Published in BMC Cardiovascular Disorders: Burden of cardiovascular disease in Pakistan - insight from global burden of disease study 2019 rdcu.be/ffqkW

🫀 Did you know where the recommendation to place the pulsed wave Doppler sample volume 0.5–1 cm from the aortic valve to measure LVOT VTI comes from? The answer is more interesting than it seems. It doesn’t come from a single study or an experiment designed for that purpose. It comes from a historical chain spanning nearly 40 years: 🔬 1982–1984 — The physical foundation Pasipoularides and Murgo demonstrated using invasive catheters and mathematical models that in aortic stenosis there is a real zone of flow acceleration in the LVOT, just proximal to the valve, without any second anatomic obstruction. Pure hemodynamics — no Doppler yet. 👉 Bird et al. Circulation 1982 → doi.org/10.1161/01.CIR… 👉 Pasipoularides et al. Am J Physiol 1984 → doi.org/10.1152/ajphea… 📐 1984 — The apical 5-chamber view Lewis, Kuo and Quinones were the first to validate cardiac output measurement using pulsed wave Doppler from the cardiac apex. They described placing the sample volume “immediately proximal to the aortic valve leaflets” — but without specifying any distance in centimeters. 👉 Lewis et al. Circulation 1984 → doi.org/10.1161/01.CIR… 📏 1985 — The first numerical distance Skjaerpe, Hegrenaes and Hatle (the Norwegian group) were the first to quantify this in Doppler: they empirically observed that flow acceleration began 0.5 to 1.5 cm proximal to the valve, and placed the sample volume just proximal to that zone. They directly cited Pasipoularides as supporting evidence. This was the first time a numerical distance appeared in the technique. 👉 Skjaerpe et al. Circulation 1985 → doi.org/10.1161/01.CIR… 📊 1986–1988 — Practical consolidation Otto et al. used ~1.0 cm. Oh, Tajik and the Mayo Clinic group explicitly established the range of 0.5 to 1.0 cm in 100 patients, justifying it as necessary to avoid the subvalvular acceleration zone. This is the figure we all recognize today. 👉 Otto et al. JACC 1986 → doi.org/10.1016/S0735-… 👉 Zoghbi et al. Circulation 1986 → doi.org/10.1161/01.CIR… 👉 Oh et al. JACC 1988 → doi.org/10.1016/0735-1… 📋 2002 — It becomes “official” Quinones, Otto, Zoghbi and colleagues codified it in the ASE guidelines as “~5 mm proximal to the aortic valve”… but without citing any specific study to support it. It had already become expert consensus. 👉 Quiñones et al. JASE 2002 → doi.org/10.1067/mje.20… ⚔️ 2017 — The debate reopens Baumgartner et al. (EACVI/ASE) maintained the 0.5–1 cm recommendation. However, Hahn and Pibarot responded with a critical letter pointing out that the original articles from the 1980s measured at the aortic annulus, not 0.5–1 cm below it, and that moving away from the annulus introduces errors due to the elliptical and irregular shape of the subannular LVOT. 👉 Baumgartner et al. Eur Heart J Cardiovasc Imaging 2017 → doi.org/10.1093/ehjci/… 👉 Hahn & Pibarot. JASE 2017 → doi.org/10.1016/j.echo… 💡 Bottom line: The 0.5–1 cm figure was never experimentally validated as the optimal distance. It emerged from empirical observations in the 1980s aimed at avoiding a flow acceleration zone that had been demonstrated with invasive catheters. It was adopted through accumulated clinical practice and later elevated to a formal recommendation by consensus. The debate over whether to measure at the annulus or 0.5–1 cm below it remains open to this day. One of those recommendations we all follow but few know where it actually came from 🙂 Dr Benigno Valderrábano Salas @MDBeni @JaeKOh2 @ottoecho @WilliamZoghbi @ASE360 @EACVIPresident @NephroP @iamritu @PPibarot @hahn_rt @MAecocardio @SISIACOficial @SONECOM_AC @VazyurVasquez @Cardiotweets83 @HEARTof_echo @echobasics

Especial médicos🩺⚕️🏥👨🏻‍⚕️👩🏻‍⚕️. Os dejo esta carta en JAMA. Se la pondré a mis alumnos en la próxima clase: He elegido estas frases : 👇🏻⏰ «La medicina puede tener un significado extraordinario. Pero no puede sustituir el estar presente en tu propia vida. El mundo puede necesitarnos como médicos. Pero las personas que nos aman nos necesitan como nosotros mismos. Y ese es el rol que nadie más puede llenar.» «La residencia refuerza la lección de que las instituciones están diseñadas para perdurar más allá de los individuos. En cambio, las familias no.» «Creo en formar a la próxima generación. Creo en el significado de este trabajo. Lo que ha cambiado es mi disposición a absorber el desgaste sin cuestionarlo.» «Ya no estoy dispuesta a seguir posponiendo la vida. La medicina exige mucho. Y nosotros damos profundamente. Pero no puede tomarlo todo.» «El significado de mi trabajo es profundo. El significado de mi presencia en casa es irremplazable.»

Pericardial Tamponade vs Constrictive Pericarditis ➡️Spot the Difference Tamponade ⬇️ Accumulation of fluid in the pericardial space ⬇️ ↑ intrapericardial pressure ⬇️ impairs diastolic filling throughout the cardiac cycle (early and late diastole). Doppler shows blunted E and A waves due to restricted filling. Constrictive Pericarditis ⬇️ Thickened, non-compliant pericardium ⬇️ rapid early diastolic filling that abruptly halts once volume limit is hit. Doppler shows prominent E wave, reduced A wave, classic for constriction. Recognizing the echocardiographic filling patterns is essential for diagnosis. Ref: Catherine M. Otto, Textbook of Clinical Echocardiography

CWD through mitral valve in a patient with mitral regurgitation is shown. Why the MR signal is seen both above and below the baseline in CWD? ⁦@argulian⁩ ⁦@CASivaram1⁩ ⁦@iamritu⁩

@CASivaram1 Great case! Thank you for sharing!

#echofirst ✅ Ultrasound Enhancing Agents (UEA) are indicated for LVO (endocardial definition) & evaluation of cardiac masses ✅ An example ⬇️ where UEA showed unambiguous LV apical & apical septal mural thrombus, not seen on regular 2DE ✅ Thrombus seen ⬇️ in orthogonal views, the plane between endocardium & mass sharply delineated, reduced LVEF ✅ High value yield of UEA & also pretty images @iamritu @argulian @TWeickert78 @PWesslyMD @alex1708ander @DrRajeshG1 @BryanTanMD @AJamilTajik @VLSorrellImages @echo_stepbystep

Interesting #echofirst image. Looks like a pleural effusion (but it's not)! 🔗cvcasejournal.com/article/S2468-… #POCUS #FOAMed #FOAMcc