Leonardo E. Saavedra, MD, FACC

Los analfabetas del siglo 21 no serán quienes no puedan leer y escribir,sino quienes no puedan aprender, borrar y reaprender..Toffler 1970!!

🫀 SPORTS CARDIOLOGY: what every cardiologist should know New review just out 👉 Exercise is medicine… but not always harmless. ⚠️ Key message: Sudden cardiac death (SCD) in athletes is rare (~1:50,000) but often the first manifestation of underlying disease 🔍 What really matters in practice? 1. Screening works (but not perfectly) ✔️ ECG-based screening can reduce SCD by up to 90% ❗ Still misses ~20% of conditions (e.g. coronary disease, fibrosis) 2. Athlete’s heart ≠ cardiomyopathy The biggest challenge is NOT finding disease… 👉 it’s not overcalling disease Physiological adaptations can mimic: HCM DCM ARVC LV non-compaction ➡️ Requires multimodality approach (ECG + imaging + exercise + genetics) 3. Red flags you should never ignore 🚩 Exertional syncope Chest pain Family history of SCD Abnormal ECG (TWI lateral, ST depression, Q waves) 4. CMR is your best friend 👉 Especially when ECG is abnormal 👉 Detects fibrosis and subtle cardiomyopathy (Yes… this aligns perfectly with what we see in ACM/arrhythmogenic phenotypes 👀) 5. Exercise prescription is evolving ❌ Old approach: “stop sport” ✅ New approach: shared decision-making Some key points: ARVC / desmosomal variants → avoid high-intensity exercise Low-risk HCM/DCM → may still participate Myocarditis → no sport for ≥3 months 6. The new frontier: master athletes 🏃‍♂️ ↑ atrial fibrillation (3–5x) ↑ coronary calcium ↑ myocardial fibrosis 👉 Long-term effects still unclear 🧠 Take-home message Sports cardiology is not about restricting athletes. It’s about: ✔️ Identifying risk ✔️ Avoiding misdiagnosis ✔️ Enabling safe exercise 💡 My reflection: This is exactly where imaging + genetics + phenotype integration becomes critical — especially in early/arrhythmogenic cardiomyopathies. doi.org/10.1136/heartj…

@jpcostabel “Left ventricular outpouching” / Igualmente con el adelgazamiento septal basal, sarcoidosis estaría en mis diferenciales.

Qué le pasa a este septum? Los escucho

Review Right Ventricular Function in Patients With Significant Tricuspid Regurgitation doi.org/10.31083/RCM47… #cardiophile #MedEd #Cardiology #Pocus #Echofirst #echofirst

Among patients with anterior myocardial infarction, adding low-dose rivaroxaban to dual antiplatelet therapy did not significantly reduce left ventricular thrombus formation at 1 month but increased minor bleeding. ja.ma/4cF3mo4

The 🆕 ACC/AHA Guideline for the Evaluation & Management of Acute Pulmonary Embolism (PE) in Adults is a de novo document offering comprehensive, evidence‑based recommendations for the evaluation, management & follow‑up of adults w/ acute PE. Read more: bit.ly/4aE5gmi

⭕Ya disponible la nueva traducción al español de la Guía ESC 2025 sobre el manejo de la miocarditis y la pericarditis. Descargártela: secardiologia.es/publicaciones/… @rafaelglezm @ICardiacaSEC @Smirabet1

How often have you encountered simultaneous acute thrombosis of proximal RCA and LAD. 57yo M. Exercises regularly. No risk factors. Sudden onset of chest pain/syncope while motorcycling and at the top of a hill. Thoughts? @torresviera @DrRajeshG1 @mmamas1973 @Hragy @mandeep_mayo

🧵 Golden Thread: Dr Nishimura’s Stepwise Approach to Right Heart Catheterization - IVC / RA Entry Step 1: Start in the IVC → RA Advance & turn away from the hepatic veins. Obtain a venous sat early to exclude a major left-to-right shunt. #ICSC2026

Physical activity and the reduction of all-cause mortality, from 2 very large prospective cohorts 1. The relationship is non-linear, suggesting a threshold effect for many types of exercise as seen below

Abnormal electrocardiogram findings in athletes: A consensus statement of the European Association of Preventive Cardiology of the European Society of Cardiology academic.oup.com/eurheartj/arti… #ECG #SCD #SportsCardiology

This statement provides guidance on the role of static, provocative, and serial assessments of invasive hemodynamics in phenotyping and management of patients with heart failure, pulmonary hypertension, left ventricular assist support devices, and cardiogenic shock. Further research is needed to better understand how to individualize care in response to dynamic testing. ✍🏼 @MarkBelkinMD @FudimMarat @cla_baratto @JonGrinsteinMD @IanBHollis @rachkataria @GLewisCardiol @MakLab_ @RyanTedfordMD @JTThibs @JP_HFpEF

@argulian Inspiration + constriction

An outpatient with lower extremity swelling. Properly aligned CW Doppler interrogation across the tricuspid valve in the RV inflow view is shown. What explains the transition from envelope A to envelope B in the same recording?

Get this: Coffee suppressed atrial fibrillation! Unexpected results for recurrence from a randomized trial in participants after cardioversion from AF #AHA25 @JAMA_current ☕️ jamanetwork.com/journals/jama/…

✅ RV Systolic Function – Key Echo Measures • TAPSE >1.7 cm – simple measure of longitudinal shortening; angle-dependent, affected by annular distortion or loading. • TDI S′velocity >9.5 cm/s – basal free-wall motion; angle- and gain-dependent. • FAC >35% – integrates longitudinal + radial contraction; excludes RVOT contribution. • 3D RVEF >45% – most accurate global index; depends on full-volume quality. • RV Free-Wall Strain > –20% (Global > –17%) – sensitive for early dysfunction; vendor variability. • TAPSE/PASP ratio 0.5–0.7 mm/mmHg = normal coupling; < 0.4 = RV–PA uncoupling and worse prognosis. • Key considerations: use RV-focused apical view, optimize alignment, interpret values in context of loading, geometry, and clinical state. ➡️ Always integrate ≥2 parameters for reliable assessment of RV systolic function. #ASEchoJC

Abnormal electrocardiogram findings in athletes: A consensus statement of the European Association of Preventive Cardiology. Discover more in #EHJ ow.ly/EPbK50X2Khc @RoccoMontone @ehj_ed

@DrRajeshG1 Marked basal septal thinning. Would have cardiac sarcoidosis in my DDx. Aortic valve involvement from sarcoid rare but can occur.

Echo challenge for fellows. What could be the likely aetiology of aortic regurgitation?

Early Withdrawal of Aspirin after PCI in Acute Coronary Syndromes: @NEJM 🥸 The slow decline of aspirin: #ESCCongress2025 😱 Here is the summary of the NEO-MINDSET Trial 👇👇👇

Can Reviewers Distinguish Al-Generated Scientific Abstracts? #ESCCongress 10% of abstracts Al-generated for a cardiology congress as an experiment reviewers blinded to Al Al abstracts rated non-inferior to human ones & ranked. #1 in 6 out of 19 categories ⬆️ Al-likeness trend in abstracts since 2022 @mmamas1973

@ecgandrhythmRoe Looks like junctional rhythm. When evaluating ECGs of athletes, always take a look at this chart to distinguish normal from abnormal or possibly abnormal.

Asymptomatic 50 yo athlete, resting ECG. 50 mm/s, heart rate about 56 bpm. What`s your take?

The new AHA/ACC/Multisociety #ClinicalGuideline on high blood pressure provides updated recommendations for clinicians on the prevention, detection, evaluation, and management of high blood pressure in adults. Get the details: jacc.org/doi/10.1016/j.… #Hypertension #JACC