Nicolas Merke

Rules of #echofirst engagement  B4 showing & sharing knowledge on big stage be aware that attendees will take your images as example to follow so don’t show bad settings  👉 Color Doppler box too big  mention always why you have choosen (your goal should be best FPS, so color box not too big!) 👉 Vena contracta measurements need good resolution and gain setting optimization to avoid overestimating  👉 3D VCA must be explained with FPS! IF too low value not real! Show your settings  👉 Showing PISA EROA please make sure you have choosen correct settings with Nyquist and didn’t overestimate the radius! Mention that r > 0,9 is rarely seen  Always point out that Reg. Volume > 60 ml are rarely seen  Always show LV dimensions & Volume! Always explain that a certain high amount of Regurgitation let’s say > 60 ml is only possible if LV Volume and LVOT SV are making sense 👉🎯 please Never Show That you have stopped using only one parameter  👉 IF you use 3D Volume Show your settings (FPS) and point not only EF but also LV / RV Volumes out.  Volumes matter more than EF

Rules of #echofirst engagement  B4 showing & sharing knowledge on big stage be aware that attendees will take your images as example to follow so don’t show bad settings  👉 Color Doppler box too big  mention always why you have choosen (your goal should be best FPS, so color box not too big!) 👉 Vena contracta measurements need good resolution and gain setting optimization to avoid overestimating  👉 3D VCA must be explained with FPS! IF too low value not real! Show your settings  👉 Showing PISA EROA please make sure you have choosen correct settings with Nyquist and didn’t overestimate the radius! Mention that r > 0,9 is rarely seen  Always point out that Reg. Volume > 60 ml are rarely seen  Always show LV dimensions & Volume! Always explain that a certain high amount of Regurgitation let’s say > 60 ml is only possible if LV Volume and LVOT SV are making sense 👉🎯 please Never Show That you have stopped using only one parameter  👉 IF you use 3D Volume Show your settings (FPS) and point not only EF but also LV / RV Volumes out.  Volumes matter more than EF

I do agree 100% that we need to quantify and phenotype SMR in atrial vs ventricular using #echofirst But we need to look also always at volumes and using PISA EROA I would advocate caution if FCZ radius is > 10 mm and not switching off variance and go with Nyquist to 20 cm/s (although it is written in the guideline 20-40 cm/s) as in the GL seen never < 30 cm/s We need to have the courage to describe SMR as mild or moderate if the numbers say so....

🫀#MR in #HF is far more than “mild, moderate, severe”. ⚠️Accurate MR assessment directly influences HF management & outcomes. Excellent overview by @anatimoteo46040 at #HeartFailure26 on how we should assess secondary MR in HF: 📍Mechanism matters: Ventricular vs atrial MR, differentiate early 📍MR grading must be multiparametric, Never rely on a single number alone. 📍Secondary MR is dynamic, Severity may change after: GDMT optimization, CRT, rhythm/rate control, decongestion. ⚠️Reassess before intervention decisions. 📍Multimodality imaging matters, each provide complementary information on anatomy, mechanism, ventricular remodeling, procedural suitability 📍Heart Team discussion is essential. 📍Quantitative parameters matter most when deciding advanced therapies @escardio @EACVIPresident @VictoriaDe32503 #EchoFirst #whyCMR #YesCCT #3DEcho #HeartFailure