Matthew Fischer, MD

#echofirst ✅ TEE is superior to TTE for PFO diagnosis ✅ Saline contrast injection from lower extremity (LE) works better than upper extremity (UE) for PFO ✅ Reason: Eustachian valve (EV), a vestigial structure at IVC-RA junction when prominent might direct UE injection away from fossa ovalis (FO) region ✅ This TEE example ⬇️ w/out a PFO shows nicely how this works. IVC flow (negative contrast) in last clip shunts contrast away from FO @jaideeppatelmd @MMukherjeeMD @PWesslyMD @iamritu @HeartOTXHeartMD @argulian @alex1708ander @OungSavly @VLSorrellImages @EchoProsto

Bad news for enthusiasts of left atrial appendage closure from #AHA25. CLOSURE-AF is not yet published, but reports from New Orleans indicate inferiority compared with best medical care (the trial was designed for non-inferiority, making this the most unexpected and unfavorable scenario). In 888 patients with atrial fibrillation considered at high risk for stroke and bleeding, a composite endpoint of stroke, systemic embolism, cardiovascular or unexplained death, and major bleeding occurred in 16.83% of patients who underwent left atrial appendage closure and 13.27% of those receiving best medical care (whose exact definition remains unclear — we’ll hopefully find out once the paper is available). These appear to be patients in whom the appendage is perhaps closed somewhat lightly — the rationale often being “so they won’t need lifelong anticoagulation.” Well, lifelong benefit remains to be seen, but after a median follow-up of 3 years, the risk of events was 28% higher with appendage closure, with a 95% confidence interval for the hazard ratio indicating a potential 1 to 62% increase in risk. In short, the results are not definitely encouraging, and much remains to be understood. Which events increased? Likely ischemic ones. And further — was it appropriate for the trial to combine ischemic and bleeding events, along with cardiovascular death, into a single non-inferiority endpoint? Probably not, yet the findings have disrupted expectations and made the discussion quite compelling nonetheless. Finally, could the expected long-term reduction in events (beyond 3 years, potentially lifelong) eventually offset the initial, possibly procedural and hemorrhagic, risks — shifting the balance back in favor of closure for patients with longer life expectancy and prolonged exposure to anticoagulation? Hard to say without full data. And in any case, this is only one trial; at least three others are ongoing in high bleeding-risk populations (STROKECLOSE, CLEARANCE, and LAA-KIDNEY). Let’s also recall that somewhat more favorable data have been seen in anticoagulation-eligible populations, but at this stage it seems appropriate to pause and reflect. If you’d like to reflect with us, join the @escardio webinar on Monday, where I’ll also be participating — it feels perfectly timed. esc365.escardio.org/event/2097

Please donate to FAER to support new physician scientists that will make scientific progress in Anesthesiology for our patients! @FAERanesthesia @SobanUmar @UCLAAnes @dgsomucla secure.qgiv.com/event/faer-agc…

Interested in mentoring a #MedStudent over 8 weeks of focused #anesthesiology #research? The Medical Student Anesthesia Research Fellowship may be what you’re looking for! Host applications for the 2026 #FAERmsarf program are open through 10/31. Apply at FAER.org/MSARF!

Congratulations to Brittany Burton, MD for receiving the 2025 @SOAPHQ /@FAERanesthesia Mentored Research Training Grant at the Annual SOAP Meeting! Dr. Burton, thank you for all you do for our department and being a wonderful UCLA DAPM team member. 🎉

Ow. Everybody's Live with John Mulaney this Wednesday at 7pm PT | 10pm ET with Molly Shannon, Marc Maron, Ronny Chieng, Maggie Rogers and John Cale, and anesthesiologist Dr. Emily Methangkool.

#FAERagc has officially ended! Thanks to the outstanding work of our Team Captains & the wonderful generosity of our donors, we exceeded our goal & raised $365K in support of #anesthesiology’s early-career investigators! 🥳🎉🥳🎉 Check out FAER.org/AGC to learn more!

The FAER academic giving competition ends tonight! Please donate to support early career researchers in Anesthesiology: secure.qgiv.com/event/faer-agc…

Congratulations @DannyKim_MD !

#FAERagc is going strong as #ANES24 gets underway, with 50% / $175K of our goal raised! Let’s get this weekend started with a bang 🧨😊🎆 – donate at FAER.org/AGC & help us reach our $350K goal in support of #anesthesiology’s up-&-coming researchers! #TheFutureIsFAER

Help @UCLAAnes take home the trophy for the #FAERagc by donating at secure.qgiv.com/event/faer-agc…… today! Every $ donated helps support the early career investigators whose #research will lead #anesthesiology into the future! #TheFutureIsFAER #ANES24

Excited to serve as a Team Captain for @UCLAAnes for the @FAERanesthesia annual giving competition! Please donate to provide critical support to early stage researchers in Anesthesiology: secure.qgiv.com/event/faer-agc…

Last day of this summer’s Physiology Outreach Program, many thanks to hosting labs & support team... congratulations to the high school students who devoted their summer to doing science! @baljit_khakh @uclaanes @DOM_UCLA @ucla @dgsomucla #physiology @BC_UCLA

Please check out Adrian’s paper out now in @jbiolchem, Circadian control of histone turnover during cardiac development and growth @AdrianA69807039 @UCLAAnes @ucla @dgsomucla @ManuelRosaGarr1 @Toddzillaroo sciencedirect.com/science/articl…

Post-op AFib is common, but what causes it? Read how decreased left atrial FGF13 expression is associated with #AFib after mitral valve surgery. #AHAJournals #ResearchLetter @MattFischerMD @AdrianA69807039 @VondriskaLab @FAERanesthesia @UCLAAnes @dgsomucla ahajrnls.org/4bitqkt

Excited to share our publication in @jaha_aha which identifies that decreased left atrial cardiomyocyte FGF13 expression promotes postoperative #afib: ahajournals.org/doi/pdf/10.116… Thank you to my co-investigators, @FAERanesthesia and @UCLAanes for their support of this work!

🎉 Congratulations to John Park, MD, PHD for receiving the prestigious Foundation for Anesthesia Education and Research (FAER) Mentored Research Training Grant Award! Dr. Park will join the DAPM faculty as a physician scientist this year after completing residency training. 👏🌟

Congratulations to first author, Kyle Scranton, and corresponding author, Dr. Michela Ottolia, on their research article published in the journal, @Nature! 🎉 More info in comments. #NatureCommunications

Tricuspid Valve lecture #SCA2024 and #AATS2024 key references: bit.ly/TR_Review_EHJ , bit.ly/TEE_SHD, bit.ly/TricuspidReview, bit.ly/TVNomenclature. @escardio @ESC_Journals @JACCJournals @ASE360

Please have a look at our publication out today led by Dr Shuaishuai Hu. We are excited that these findings may open a new area of research into how cells couple force generation, nuclear organization and transcription via histone stoichiometry rdcu.be/dEkOL @NatureCVR