Vladyslav Kavalerchyk 🇺🇦

Please subscribe my YouTube channel: bit.ly/2DWogkJ I would like to present my project (echocardiography step by step®). With my project, I want to take you into the world of echocardiography through the prism of my experience.

📄 Can we trust automated LVEF in hypertrophic cardiomyopathy? 🔗 DOI: doi.org/10.1093/ehjimp… 🫀 AI-powered echocardiography promises faster, scalable assessment of LV function—but does it work in complex phenotypes like HCM? This study raises important concerns. ✨ Study design: 🔹 50 patients with hypertrophic cardiomyopathy 🔹 Comparison between: automated ML-based software (HeartModel®) expert echocardiography CMR (when available) ✨ Key findings: 🔻 Automated LVEF is systematically lower ➡️ −8% vs expert echo ➡️ −12% vs CMR 🔺 LV volumes are overestimated ➡️ EDV +20% ➡️ ESV +43% 🔹 Only modest agreement with standard methods (low R²) ⚠️ Clinical impact: 👉 22% classified as LVEF <50% by AI vs 12% by expert readers 🚨 This translated into: ➡️ wrong treatment decisions in 18% of patients (when applied to myosin inhibitor management) 🧠 Why does AI struggle here? 👉 HCM-specific challenges: abnormal LV geometry hypertrophy hyperdynamic function 👉 Likely underrepresented in training datasets 💡 Clinical take-home message: 👉 AI tools are not yet ready for unsupervised use in HCM ⚠️ Especially when decisions depend on thresholds (e.g. LVEF 50%) 👉 Expert oversight remains essential 🤖 Bigger picture: 👉 AI performance is context-dependent 👉 Validation must be disease-specific—not generic 🚨 Bottom line: In HCM, automated LVEF may mislead—and clinical decisions still require expert interpretation. #Cardiology #HCM #Echocardiography #AIinMedicine #MachineLearning #CardiacImaging #PrecisionMedicine #HeartFailure #DigitalHealth 🫀📊

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#EHJCVI 🫀🧠 Beyond LA volume in cryptogenic stroke? 🔍 LA strain and sphericity on #echofirst independently predicted recurrent stroke and new #AFib in ESUS ‼️ ⏩Read more: doi.org/10.1093/ehjci/…

🫀 Myocardial perfusion imaging (MPI) is routinely used to assess ischaemia in CTO patients—but does it actually predict outcomes after PCI? This large registry study provides an important answer. ✨ Study at a glance: 🔹 319 patients undergoing CTO-PCI 🔹 65% had moderate–severe ischaemia (≥10% LV) 🔹 Follow-up: 90 days + 5 years ✨ Key findings: 🔹 No difference in hard outcomes between groups: ➡️ all-cause mortality ➡️ MACCE (MI, stroke, HF, CV death) 🔹 At both 90 days and 5 years: 👉 ischaemia burden did NOT predict prognosis 📊 But here’s the nuance: 🔹 Patients with higher ischaemic burden had: ➡️ lower risk of angina hospitalisation at 5 years 👉 Suggesting a greater symptomatic benefit from CTO-PCI ⚠️ Important considerations: 👉 Ischaemia defined globally (≥10% LV), not vessel-specific 👉 Mix of SPECT and PET imaging 👉 No comparison with medical therapy alone 💡 Clinical take-home message: 👉 Ischaemia is not a prognostic marker after CTO-PCI 👉 But it may help identify patients: ✔ more likely to benefit symptomatically ✔ with greater improvement in quality of life 🧠 This reinforces a growing concept: 👉 CTO-PCI should be: symptom-driven, not ischaemia-driven 👉 Imaging should guide selection—but not dictate it 🚨 Bottom line: More ischaemia ≠ better outcomes—only better symptom relief. #Cardiology #CTO #PCI #Ischaemia #CardiacImaging #PET #SPECT #CoronaryArteryDisease #InterventionalCardiology #QualityOfLife 🫀📊

Hot off the press 📑 Recommendations for the Identification and Mitigation of Cardiac Ultrasound Artifacts: A Guideline from the American Society of #Echocardiography #POCUS #Nephpearls 🔗onlinejase.com/article/S0894-…

#EHJCVI 🫀 Time to refine #echofirst quantification of aortic regurgitation? 🔍 Using #whyCMR as reference, a 2-step TTE algorithm (RegVol≥45 mL + LVEDVi≥93 mL/m²) outperformed traditional criteria for severe AR definition‼️ #VHD ⏩Read more: doi.org/10.1093/ehjci/…

📄 CTO-PCI: is ischaemia still the key for patient selection? 🔗 DOI: doi.org/10.1093/ehjimp… 🫀 Chronic total occlusion (CTO) PCI has evolved significantly, with high success rates—but patient selection remains the real challenge. This editorial questions a long-standing paradigm: 👉 Is ischaemia enough to guide revascularization? ✨ Key insights: 🔹 CTO-PCI is associated with: ✔ improved symptoms and quality of life ❗ but no clear reduction in mortality or major events 🔹 Randomized trials show: ➡️ similar hard outcomes vs optimal medical therapy ➡️ benefit mainly in angina relief 📊 Role of ischaemia: 👉 Imaging confirms ischaemia—but: ❗ baseline ischaemic burden does NOT predict outcomes after CTO-PCI 🔹 Even patients with ≥10% ischaemia: ➡️ no difference in mortality or MACCE ➡️ but fewer angina hospitalisations ⚠️ Why ischaemia alone is insufficient: 👉 CTO physiology is complex: collateral circulation multivessel disease microvascular dysfunction 👉 SPECT may underestimate disease 👉 PET provides better quantification (MBF, MFR) 💡 Clinical paradigm shift: 👉 From “ischaemia-driven” → “symptom-driven” selection ✔ Revascularize when: refractory angina significant functional limitation 👉 Imaging role: ➡️ confirm viable, ischaemic myocardium ➡️ support—not dictate—the decision 🧠 Future directions: 🔹 PET-based quantification (MBF/MFR) 🔹 Territory-specific ischaemia assessment 🔹 Integration of patient-reported outcomes 🚨 Bottom line: CTO-PCI is a tool to improve symptoms—not to change prognosis. 👉 Treat the patient, not just the ischaemia. #Cardiology #CTO #PCI #Ischaemia #CardiacImaging #PET #CoronaryArteryDisease #InterventionalCardiology #PrecisionMedicine 🫀📊

#EHJCVI 🫀 LA strain by #whyCMR refines risk stratification in #HCM with low SCD risk 💡 LVEF>50% + LGE<5% + LA-GLS>37.6% identified an ultra-low-risk subgroup with MACE rate of just 2% ‼️ ⏩ Read more: doi.org/10.1093/ehjci/…

#echofirst limits of 3D. Not all “limitations” are real—many come down to technique and interpretation: - Incomplete reference planes - Poor 2D image quality - Low gain → missing or unclear structures - Low frame rate → NOT ALWAYS TRUE - Uncorrected artifacts - Suboptimal color Doppler 👉 Key point: These are operator- and technique-dependent, not true limitations of 3D echo

What are the findings? A Patient in Cardiogenic Shock.

The ventricular-structure relationship:: the #Torrent_Guasp_ventricular_myocardial_band (Part I: normal heart) doi.org/10.1093/ejcts/…

📄 Heart rate matters: rethinking how we interpret LV function on echocardiography 🔗 DOI: doi.org/10.1093/ehjimp… 🫀 We routinely interpret LVEF, GLS, and LV volumes as markers of cardiac function… 👉 But how much do they depend on heart rate itself? This study provides a clear and clinically relevant answer. ✨ Study design: 🔹 50 patients with pacemakers 🔹 Controlled heart rate (60 → 140 bpm) via atrial pacing 🔹 >10,000 cardiac cycles analysed using fully automated deep learning ✨ Key findings: 📉 As heart rate increases: 🔹 GLS ↓ by 32% 🔹 LVEF ↓ by 33% 🔹 LVEDV ↓ by 31% 🔹 LVESV ↓ (less pronounced) 👉 Changes are near-linear and highly consistent 📊 Important physiological insight: 👉 Higher heart rate → reduced diastolic filling → lower preload ➡️ drives apparent reduction in LV function metrics 👉 Despite this: ✔ Cardiac output remains relatively stable 🤖 Role of AI: ✔ 97% feasibility ✔ Full automation of >10,000 cycles ✔ Huge reduction in analysis time (hours vs months manually) 👉 Demonstrates how deep learning enables new physiological insights 💡 Clinical take-home message: 👉 LV function parameters are heart rate–dependent ⚠️ A reduced LVEF or GLS at high HR may not reflect true dysfunction 👉 Always: ✔ consider heart rate ✔ standardise conditions ✔ interpret trends, not isolated values 🚨 Bottom line: Heart rate is not just a variable—it’s a determinant of how we read echocardiography. #Cardiology #Echocardiography #HeartRate #GLS #LVEF #CardiacImaging #AIinMedicine #DeepLearning #PrecisionMedicine 🫀📊

#EHJCVI 🫀 🔍 Should stage 3-4 cardiac damage flag futility in #TAVI? In the COMPARE-TAVI 1 sub-study (n=985), all CD stages benefited from TAVI, with similar 1-year futility (death/NYHA 3-4) across groups ‼️ #echofirst #VHD ⏩ Read more: doi.org/10.1093/ehjci/…

A minimally invasive alternative to open heart surgery is gaining popularity—but some find ​their new valves don’t work as well or last as long as they hoped. 🔗 on.wsj.com/4cvGJSH

Aorta can be surprisingly interesting.

📄 2025 ESC/EACTS Valvular Guidelines: imaging perspective 🔗 DOI: doi.org/10.1093/ehjimp… 🫀 Core message The new guidelines mark a major shift: 👉 from a single decision (surgery vs transcatheter) 👉 to a lifetime management strategy ➡️ In this framework, imaging becomes central to Heart Team decision-making. 🔑 Key clinical updates Aortic stenosis: 👉 Age threshold for TAVI lowered to ~70 years 👉 Decisions now based on lifetime strategy (redo options, coronary access, anatomy) Primary mitral regurgitation: 👉 Surgery remains the gold standard 👉 Earlier intervention recommended in selected asymptomatic patients Atrial secondary MR: 👉 Recognised as a distinct entity 👉 New indications for surgery and transcatheter therapies Tricuspid regurgitation: 👉 Transcatheter therapies enter mainstream guidelines 👉 Strongly dependent on RV function and pulmonary hypertension 🧠 New role of imaging 👉 No longer just to “confirm severity” 👉 But to shape the entire clinical pathway Three key shifts: From single parameters → integrated phenotyping Right modality at the right time Standardisation and reproducibility 🖥️ Role of imaging modalities Echocardiography: first-line, now expected to be integrative (3D, stress) CT: crucial for anatomy, feasibility, and lifetime planning CMR: reference for volumes, regurgitation, and myocardial damage Multimodality imaging: essential for complex decision-making 🔄 Paradigm shift 👉 Imaging-driven pathway: DEFINE → SELECT → DELIVER → TRACK ➡️ Moving from thresholds → personalised, predictive care 🤖 Future: AI in imaging 👉 Not just automation, but: standardisation detection of discordance guideline-based decision support ⚠️ Must remain transparent, validated, and clinically accountable 🚨 Bottom line 👉 Imaging is now: a continuous, central, decision-making tool in valve disease 👉 Not just measuring valves ➡️ but guiding lifelong patient management strategies

🔍 Are you ready for your science to be seen? At #EACVI26, the expertise of EuroEcho, EuroCMR and ICNC-CT unite to bring cardiovascular imaging into focus – giving your work the visibility it deserves among a global community of experts and peers. Submit by 21 May for abstracts and by 2 June for clinical cases 👉 bit.ly/3Qku2l7 #EACVI #CVImaging #echofirst #whyCMR @EACVIPresident

Technically difficult transthoracic echo due to poor windows. Concern about right atrial echo density, the best view shown. Fact or artifact? What is the next step?

📄 Echocardiography in LVAD outflow graft complications: redefining the diagnostic paradigm 🔗 DOI: doi.org/10.1093/ehjimp… 🫀 Outflow graft (OG) abnormalities in LVAD patients are insidious and often clinically silent in early stages—making timely diagnosis challenging. This editorial highlights how transthoracic echocardiography (TTE) can reshape the diagnostic pathway. ✨ Key insights: 🔹 OG obstruction may initially present with: subtle LVAD parameter changes preserved flow minimal symptoms 🔹 Current gold standard: ➡️ CT ± invasive assessment ❗ Not ideal for routine surveillance 📊 Role of TTE: 👉 High feasibility and excellent specificity (~100%) 👉 Moderate sensitivity (~61%), improving in proximal graft lesions 👉 Most importantly: TTE is not a replacement—but a gatekeeper ⚙️ Why TTE matters: ✔ Non-invasive ✔ Widely available ✔ Low cost ✔ Ideal for longitudinal follow-up 👉 Helps identify patients who need: CT imaging invasive haemodynamic assessment 📈 Key concept shift: ❗ Absolute velocity cut-offs are limited 👉 Instead: focus on patient-specific trends over time ➡️ deviations from baseline are more informative 🧠 Future directions: 🔹 Device-specific thresholds needed 🔹 Integration with clinical + device data 🔹 Potential role of AI-guided echo to improve standardisation 🚨 Bottom line: TTE should be integrated as a first-line surveillance tool—not to replace CT, but to guide when to escalate. #Cardiology #Echocardiography #LVAD #HeartFailure #CardiacImaging #AdvancedHeartFailure #MechanicalSupport #PrecisionMedicine 🫀📊

Single valve regurgitation by #echofirst severity grading beyond vena contracta and PISA EROA 👉 recognize the problem 👉 very eccentric faint jet probably commissural 👉 look at LV dimension, LA volume, E Wave inflow 👊 always go for volumes