Efrain Castillo

My first interview today was 10/10. I am extremely grateful with everyone involved in the process. Excited and hopeful for the rest of the season! 🇵🇦🙌🏻 #Match2024 #internalmedicine #IM #insidethematch #MedTwitter

🧬 LMNA cardiomyopathy: not all patients progress the same. Now we can quantify who will. We’ve become good at predicting: 👉 sudden death 👉 arrhythmic risk But heart failure? 👉 Still a blind spot in laminopathies 💥 This paper changes that. For the first time: 👉 a dedicated risk model for HF progression in LMNA patients 📊 The reality (and it’s not reassuring): • HF-MACE in ~10% at 5 years • ~45% lifetime risk by age 70 And if LVEF <30%: 👉 50% events within 1 year ehag104 ⚡ Four variables. That’s it. Independent predictors of HF progression: • Male sex • LVEF <50% • Missense variants (head/rod domains) • Complete LBBB 🔥 Translation: 👉 Genetics + conduction + early LV dysfunction = the HF trajectory is already written 📉 What’s really striking (Figure 4): • 0 risk factors → ~1.5% at 5 years • 1 factor → ~5% • ≥2 factors → ~22% ➡️ Not a spectrum ➡️ A stepwise risk escalation 🧠 And here’s the key insight: 👉 Even with preserved EF, risk is not low Patients with LVEF ≥50% + risk factors: → still meaningful HF risk (~11% at 5 years) ehag104 ⚠️ This challenges our mindset: We wait for EF to drop 👉 But the disease is already progressing 💡 Clinical implication (this is the real shift): Risk stratification in LMNA should not be: ❌ reactive ❌ EF-driven But: 👉 proactive + genotype-informed 🚀 What this enables: • Earlier follow-up intensification • Earlier HF therapy • Earlier referral for advanced HF pathways • Better selection for trials 🎯 Take-home message LMNA cardiomyopathy is predictable. 👉 Not just arrhythmias 👉 Heart failure too And if we wait for severe dysfunction… 👉 we are already late 💬 Should we start treating LMNA patients before EF declines? #Cardiology #LMNA #Cardiomyopathy #HeartFailure #Genetics #PrecisionMedicine #EPeeps #CardioTwitter 🧬🫀 doi.org/10.1093/eurhea…

¿Las enfermedades autoinmunes ocultan un factor de riesgo cardiovascular frecuentemente ignorado? Una reciente revisión sistemática revela el papel crucial de la Lipoproteína(a) en estos pacientes. 🧵👇🏻 doi.org/10.1016/j.jacl… @GEAS_SEMI_ @gt_rcv @GAELPaArg @drpablocorral @MaximaMendez15 @anymzcs @joraltron @alavallecobo @maciejbanach @alejoromanmd @gonzaeperez @LipidoSeen

Just in press 📝 at Journal of Clinical Lipidology “ Lipoprotein(a) in Selected Autoimmune Diseases: A Systematic Review of Cardiovascular Implications and Anti-Inflammatory Interventions”

Dofetilide's use is often limited by 💵 A recent analysis of prescription copayment data for those prescribed #Dofetilide evaluated whether patients are overpaying. Learn more spr.ly/6014B6UAbm @andresenriqueza @Dr_Nazarian_EP @davidcallans @dr_markman #arrhythmias

My eyes are IVUS crowd wins today 👀!!!

🚨 IMPEDANCE-HFpEF — #ACC26 One of the most anticipated trials delivers striking results 🔑 Noninvasive lung fluid monitoring: • ↓ 81% HF hospitalizations • ↓ 65% all-cause mortality • Earlier and more frequent treatment adjustments 🧠 Detecting congestion before symptoms may change how we manage HFpEF

Presented at #ACC26: Among patients with unprotected left main coronary artery disease, intravascular ultrasonography–guided PCI did not result in a lower risk of ischemic events or death than angiography-guided PCI. Full OPTIMAL trial results: nejm.org/doi/full/10.10… Editorial: Seeing the Left Main Coronary Artery Clearly — Is IVUS Always Necessary? nejm.org/doi/full/10.10… @ACCinTouch

🚨Built for shock → works in shock Not for routine prophylactic use. Hats off to all investigators—practice-changing evidence for better care👏🏼👏🏼👏🏼

MOMENTUM study revealed high prevalence of hypercortisolism & hyperaldosteronism in U.S. resistant HTN patients, suggesting the importance of screening for both. #ACC26 View Slides Here: clinicaltrialresults.org/wp-content/upl…

#ACC26 What an incredibly challenging RCT. ORBITA CTO. Simple question with amazing blinding and patient reported angina frequency based on app (much better than recall). CTO PCI DOES improve angina much more than meds in JCTO 3 or less.

Good to know - I feel like I still haven't seen this as standard practice and so I haven't always been 100% consistent in doing for my patients, but now data really leaning in favor of p2y12 monotheraly

📌 After #LAAocclusion, major #bleeding 👉 is frequent, especially within the first 6 mths 👉 is predicted by older age, female sex, diabetes, prior bleeding & kidney disease 👉 is associated to ⬆️ stroke & mortality #EPeeps #afib #CardioTwitter #MedTwitter @DrPascalMeier @Hragy

#ACC26 CHAMPION-AF Watchman-FLX vs NOAC.

La prescripción de Sacubitril/valsartan en personas con enfermedad renal crónica G4 y falla cardiaca es más permisiva en las guías KDIGO, comparada a la guía de cardio ESC. Así lo describen los expertos en el nuevo consenso Kidney Int 2026 doi.org/10.1016/j.kint…

🧵 1/ First ever AHA/ACC/multi-society guidelines re: diagnosis & management of acute PE released today! 2 year effort with 38 authors from 10 specialties. Link attached & summary in this thread: jacc.org/doi/10.1016/j.…

Congrats @efracastil on a great abstract at Miami Valves 2026 ! 🔑 points • BMI and race independently influence lipid-rich plaque burden • “Obesity paradox” with higher maxLCBI₄mm was noted, more research needed to shed light on these association

After 30 years of primary PCI we now have an objective definition of the most common #ECG pattern of STEMI. Hyperacute T-waves specific for acute coronary occlusion now defined using #AI in @JACCJournals!

En pacientes candidatos a TAVI, Angiotac 🫀es suficiente para descartar enfermedad coronaria. Tac coronaria se recomienda por encima de CCG previo a cirugía valvular en pacientes de hasta riesgo intermedio. @SISIACOficial @paomorejon #ESCCongress #yesct

2025 ESC Guidelines for the management of #myocarditis and #pericarditis #ESCCongress #HeartFailure #HFA_ESC @escardio @slumberbell @DrMarthaGulati @rafavidalperez @Hragy @JavedButler1 @mmamas1973

New @ASE360 Diastology guidelines now published (tinyurl.com/2698zcsk). New algorithm below, now with LARS and IVRT. Also new recs for OHT, MAC, and AF patients. Congrats @SNagueh @dysanborn and coauthors @JaeKOh2 @BonitaEcho @KristenBillick @AllanLKleinMD1 et al.