Sunil Upadhaya, MD, FACP

Excellent Long-Term Outcomes in Mild Congenital Heart Disease after Intervention Although Need for Lifelong Surveillance Persists @mattoster ahajrnls.org/4lO5yMu

Interesting paper about the value of #complexity in CTO PCI: 👉overall anatomical burden drives benefit; 👉higher SYNTAX score, greater prognostic gain; 👉CTO-PCI may protect donor vessels. ‼️Mortality reduced by 1.5% per +10 SYNTAX points‼️ doi.org/10.1093/ehjope…

New online! ApoC-III inhibition: from regulatory approval to equitable implementation dlvr.it/TRgjFW

🫀 Less than 48 hours to go. The Coronary CT for PCI Academy is almost here. Hands-on. Practical. Interactive. Focused on how to bring CT-guided PCI into your practice tomorrow. Pre-#ACC26 workshop Walk-in registration available based on capacity 📍 Loews Hotel, New Orleans 🗓️ March 26–27 🌐 event.fourwaves.com/ctguidedpci/pa… @yadersandoval @esbrilakis @ColletCarlos

#JADEL TUSI-valves: Don't overlook this potential cause! doi.org/10.1016/j.case… - Mitral and tricuspid valves involved - Report includes surgical inspection and histopathology @ASE360 @CASEfromASE

Myocarditis can hide behind unexpected triggers. This case report highlights the diagnostic challenges of acute myocarditis presenting with chest pain and ECG changes mimicking acute coronary syndrome, emphasizing the key role of cardiac MRI for accurate diagnosis. A reminder of the importance of multimodality imaging in acute cardiac presentations. 🔗 ow.ly/IZnu50YxIFu #Cardiology #Myocarditis #CMR #CardiacImaging #EHJCR #EHJCaseReports @Phiso_de @TJ_Yeo @aayshacader @BoldiKovacsMD @SukritiBanthiya @ANazmiCalik @O_Azizy_MD @saramoscatelli7 @EHJCREiC #CardioX

Among patients with supraventricular tachycardia, use of a handheld Valsalva assist device resulted in greater rates of sinus rhythm restoration compared with the standard Valsalva maneuver (63% vs 29% within 1 minute after up to two attempts). ja.ma/4l4D3Kn

#NonInferiority RCT is not the same as #equivalence RCT NonInf: Is new product effective enough vs X? Considers 1 margin —> smaller sample size Equiv Trial: Is new product ~equivalent to X? 2 margins —> larger sample Different q’ns, different inference Margins matter BMJO 25

⚠️ Are we underestimating paravalvular leak after TTVR? In TRIPLACE, ≥Mod PVL occurred in 6.1% and was associated w/ 🔴39.7% 1-year mortality 🔴2.6X higher risk of death 🔴Less symptomatic improvement despite successful TTVR 🔗doi.org/10.1016/j.jcin… @azeemlatib Rishi Puri

Calcific aortic valve disease lacks effective pharmacotherapy and is tightly linked to ageing. New large study investigates the impact of senescence-associated metabolic alterations doi.org/10.1093/eurhea… #VHD #AS #cardiotwitter, @ESC_Journals, @escardio

⚡ Brugada syndrome… but not as we thought What happens when a patient carries an SCN5A variant… but has a negative sodium channel blocker test? 🫀 This large multicentre study challenges our assumptions. 💡 Key message: 👉 Not all SCN5A carriers are high arrhythmic risk 🔍 What did they find? 43% of carriers had a negative test (SCBC) 🚫 No ventricular arrhythmic events during long-term follow-up BUT… ⚠️ 52% developed progressive conduction disease over time ⚖️ A dual phenotype: 🟢 Excellent arrhythmic prognosis 🟡 Ongoing risk of conduction slowing (PR/QRS prolongation, AV block) 🧬 Genotype matters: Non-missense variants → more conduction disease Suggesting a stronger loss-of-function effect 🚨 Clinical implications: Negative SCBC ≠ “no disease” It identifies a lower-risk arrhythmic subgroup, but not a benign one These patients still need long-term follow-up (ECG progression, structural disease) ✨ Big takeaway: 👉 SCN5A disease is not just Brugada 👉 It’s a spectrum of electrical and structural phenotypes 📄 Read the full paper here: doi.org/10.1093/europa…

#CoronaryPhysiology #AngioDerivedPhysiology P I O N E E R I V interim: Angio-derived physiology (ADP) ➡️ QFR-guided PCI non-inferior to usual care 👋 @SerruysPatrick @NickCurzen @AndreasBaumbach @OnumaYoshinobu 👇 NCT04923191 doi.org/10.1093/eurhea…

Shoutout 📢 to Dr. @stefankmil for coming straight from a night on call to the NOLA Health Fair. We deeply appreciate your dedication to educating and supporting our community! More on Understanding Cardiac Amyloidosis ➡️ bit.ly/40LxQ0E

Not every ventricular arrhythmia has a structural substrate. This case report highlights the diagnostic pathway and management of idiopathic ventricular fibrillation, emphasizing the importance of comprehensive evaluation to exclude structural and genetic causes. A reminder of the challenges in diagnosing and managing unexplained VF. 🔗 ow.ly/ZLQB50YxnLx #Cardiology #VentricularFibrillation #Arrhythmia #EHJCR #Electrophysiology #EHJCaseReports @Phiso_de @TJ_Yeo @aayshacader @BoldiKovacsMD @SukritiBanthiya @ANazmiCalik @O_Azizy_MD @saramoscatelli7 @EHJCREiC #CardioX

When you sleep, A wave of cerebrospinal fluid flows out of the brain, helping to wash away waste products that have built up during the day. “If you don’t sleep, the CSF waves start to intrude into wakefulness where normally you wouldn’t see them. However, they come with an attentional tradeoff, where attention fails during the moments that you have this wave of fluid flow,” says MIT Professor Laura Lewis. news.mit.edu/2025/your-brai…

Only four days until #ACC26 - where team @UKheartresearch will be presenting the results of @CHIP_BCIS3 - Impella vs standard care in high risk PCI. What's your prediction for the results?

Proprotein convertase subtilisin/kexin Type 9 inhibitors: past, present, and future. Read this State-of-the-At review in #EHJ 👉 ow.ly/30lX50YxlyR @RoccoMontone @ehj_ed #PCSK9i

Zakarauskas-Seth et al identified a vital gut-brain-heart connection where a specific #microbiome-derived molecule, indole-3 acetic acid, protects against heart damage from high #BP by regulating brain activity. Learn more at ahajrnls.org/4bt5sq8

From @JAMANetworkOpen: Variability in #ECMO candidacy selection may result in inconsistent allocation; multidisciplinary review and clear guidelines are recommended to improve transparency and equity. #SCCM2026 #CriticalCare @SCCM ja.ma/4uKefLY

When heart failure has an unexpected cause. This case report highlights the diagnostic challenges of rare causes of cardiomyopathy, emphasizing the importance of multimodality imaging and thorough clinical evaluation to reach the correct diagnosis and guide management. A reminder that uncommon conditions can underlie common cardiac presentations. 🔗 ow.ly/qW5450YxmrG #Cardiology #HeartFailure #Cardiomyopathy #CardiacImaging #EHJCR #EHJCaseReports @Phiso_de @TJ_Yeo @aayshacader @BoldiKovacsMD @SukritiBanthiya @ANazmiCalik @O_Azizy_MD @saramoscatelli7 @EHJCREiC #CardioX