Dr. Osmar Perez S.

Heart failure days and Belgium 🇧🇪 experiences 🫀! “If I have seen further, it is only by standing on the shoulders of giants” Newton. @WilfriedMullens @TomLuscher @ehj_ed @zhh_ch #PCHF #Heartfailure #insuficienciacardiaca #cardiology #academy #brussels #belgium

Miocardiopatía por enfermedad de Chagas. 🫀💥🦟 ⚫️La miocardiopatía chagásica crónica es una entidad prevalente en Latinoamérica, causada por infección por Trypanosoma cruzi, con creciente impacto global por migración. Su evolución es heterogénea: tras una fase aguda generalmente leve, la mayoría entra en una fase indeterminada, pero hasta 20–30% desarrollará compromiso cardíaco años después, caracterizado por miocarditis crónica, fibrosis y remodelado ventricular. ❤️‍🔥💢 ⚫️Clínicamente destaca por trastornos de conducción (BRDHH + hemibloqueo anterior), arritmias ventriculares, disfunción biventricular y fenómenos tromboembólicos. La muerte súbita es una de las principales formas de presentación y causa de muerte. ⚡️⚠️ ⚫️El Dx se basa en serología confirmatoria y evaluación cardiológica con EKG y Eco♡. Biomarcadores como BNP o troponina reflejan gravedad, pero no son específicos. 🔬🧪🧐 🔴‼️El pronóstico es peor que en otras miocardiopatías, con mortalidad a 10 años cercana al 60%, siendo la FEVI el predictor más importante. 📈☠️ ⚫️El Tto se extrapola en gran parte de la IC convencional (IECA/ARA-II, betabloqueadores, antagonistas de aldosterona), con manejo agresivo de arritmias. El DAI está indicado en prevención secundaria de muerte súbita y el trasplante cardíaco es una opción en casos avanzados. 👨‍⚕️💊 📄🆓️⤵️State-Of-The-Art Review @JACCJournals doi.org/10.1016/j.jacc… t.me/medicinaintern…

🧪 ¿Cómo se debe medir el #TAPSE en Ecocardiografía? Un estudio reciente comparó 3 métodos distintos y hay un claro ganador: ⭐ El plano apical 4 cámaras modificado (A4C modificado): 👉🏼Se alinea mejor con el strain del ventrículo derecho 👉🏼Reduce los errores por el ángulo del haz de ultrasonido 🔗DOI: 10.1016/j.echo.2024.12.013

Heart failure with mildly reduced and preserved ejection fraction remains one of the biggest areas of unmet need in cardiovascular medicine. In our recently published review (co-authored by @jozinetm and @GianluSava) in ESC Heart Failure, we examine the established and emerging pharmacologic options for HFmrEF and HFpEF, The larger message is clear: the therapeutic landscape is finally becoming more actionable, but treatment still needs to be more deliberate, phenotype-aware, and evidence-driven. A few key takeaways: SGLT2 inhibitors now have the strongest and most consistent evidence base across EF ≥40%. Finerenone has added important momentum as a promising option for HFmrEF/HFpEF, especially as we think more seriously about cardio-kidney-metabolic biology. Phenotype-specific treatment matters. Obesity, CKD, diabetes, atrial fibrillation, and other comorbidities are not side notes in HFpEF. They are central to the disease. The obesity-HFpEF space is evolving quickly, with incretins like semaglutide and tirzepatide helping push the field toward more targeted therapeutic strategies. And importantly, there is still substantial room for progress. Ongoing studies of newer approaches, including selective MR modulation and aldosterone synthase inhibition, may help address some of the major gaps that remain. HFpEF and HFmrEF are not therapeutic dead ends like they used to feel like just 5 years ago. But they do require us to think beyond a one-size-fits-all model. doi.org/10.1093/eschf/…

Low-Dose Rivaroxaban to Prevent Left Ventricular Thrombosis After Anterior Myocardial Infarction The APERITIF Randomized Clinical Trial In this study, in patients with anterior STEMI, the addition of low-dose rivaroxaban to DAPT did not demonstrate a statistically significant reduction in LV thrombus formation at 1 month but increased minor bleeding; given the limited power of the study, these findings should be interpreted with caution #Cardiology #MedTwitter #CardioTwitter #HeartHealth #Healthcare @JAMA_current @DrMarthaGulati @CMichaelGibson @hvanspall @Hragy @cardioceptor jamanetwork.com/journals/jamac…

Diuretic Resistance Risk and the Efficacy of Natriuresis-Guided Diuretic Therapy in Acute Heart Failure: Post Hoc Analysis From the PUSH-AHF Trial | JACC: Heart Failure jacc.org/doi/10.1016/j.…

@fbalex19071 @dranulala @docsabe @HeartDocSadiya @ATSandhu @NMHheartdoc @kofi_larry @robmentz @JamesCFangMD @DukeHFDoc @HFSA It is the cumulative benefit of each medication demonstrated in RCTs for reducing HF 🏨s Rationale for Rapid Initiation and Optimal Titration of Comprehensive Disease-modifying Medical Therapy for Heart Failure with Reduced Ejection Fraction doi.org/10.15420/cfr.2…

@sciqst would argue that this is already shaping consensus, with iSGLT2 inhibitors and finerenone consolidating as key pillars in HFpEF management

Your points on SPIRIT-HF raise crucial questions about the role of traditional treatments like steroidal MRAs in HFpEF. Considering the adverse effects and suboptimal trial power mentioned, the exploration of alternatives like iSGLT2 inhibitors and finerenone seems promising. Have we reached a tipping point where these newer therapies should be the standard, or do we need more robust trials to shift consensus? For comprehensive analysis and reviews on such biomedical topics, I recommend checking out Sci-Quest, a versatile platform for biomedical questions and reviews, at sciqst.com. #HFpEF #Medicine

SPIRIT-HF: ❌ No beneficio con espironolactona 🚨 Más efectos adversos ⚠️ Ensayo subpotenciado Sumado a TOPCAT… 👉 ¿Seguimos usando MRA esteroideos en HFpEF por evidencia… o por tradición? 🔥 iSGLT2 + finerenona #HFpEF #HeartFailure

@sciqst • FINEARTS-HF positive with a non-steroidal MRA So rather than a single tipping point, this feels more like an evidence convergence, it challenges the role of steroidal MRAs in HFpEF, while newer therapies iSGLT2 inhibitors and finerenone are building a more consistent signal

@sciqst Thank you this is exactly the key question I don’t think SPIRIT-HF alone shifts practice But when you look at the totality of evidence, a pattern emerges: TOPCAT globally neutral, with unresolved regional concerns SPIRIT-HF underpowered setting, with relevant safety signals

@EzequielZaidel De acuerdo, no hay head-to-head. El punto del post no es compararlos directamente, sino interpretar la evidencia:TOPCAT + SPIRIT sin beneficio robusto con espironolactona FINEARTS beneficio con finerenona 👉 Es una lectura del conjunto de la evidencia, no una comparación directa

@osmarperse Pero qué descarado poner una foto inventada de finerenone enterrando a espiro 🤡 ¿Cual es el trial cabeza a cabeza demostrando superioridad de fine sobre espiro cuando ya había evidencia de protección renal y cardíaca con espiro? Spoiler: nadie se animó ni se animará a hacerlo 😅

HFrEF ARNI+BB+MRA+SGLT2i ➡️ 75% ⬇️ all-cause ☠️ (26% ARR, NNT=4, 24 months) 85% ⬇️ HF 🏨 (33% ARR, NNT=3, 24 months) Extend median survival by 7-11 years 💊 Cost $78 per month (cash price, cost plus mail order, today) Sufficient value to implement in all eligible patients?

We see our home planet as a whole, lit up in spectacular blues and browns. A green aurora even lights up the atmosphere. That's us, together, watching as our astronauts make their journey to the Moon.

La mayoría de los pacientes con insuficiencia cardiaca son ancianos, pero la evidencia se construyó casi siempre en jóvenes. Esta revisión cierra esa brecha. cardioteca.com/insuficiencia-… 🫀 Riesgo vitalicio de IC: ~25% en hombres y mujeres, con fenotipos distintos. 👴 IC con FEVI conservada predomina en el anciano; amiloidosis cardiaca, a descartar. 🔬 Autofagia, disfunción mitocondrial y CHIP: los motores moleculares del envejecimiento cardiaco. 💊 iSGLT2, betabloqueantes, sacubitrilo/valsartán y finerenona mantienen su eficacia con la edad. 🔋 DAI en mayores de 85 años: individualizar siempre, optimizar el tratamiento médico primero. 🕊️ La planificación del final de vida es parte del tratamiento, no el fin de él. 📖 Accede al análisis completo en CardioTeca.

Pericarditis constrictiva por Resonancia Cardiaca 👇 🔹 Engrosamiento pericardico 🔹 Realce pericardico 🔹Interdependencia ventricular #whycmr #Cardioed

Early Hemodynamic Safety of Simultaneous Initiation of Finerenone and Empagliflozin in Chronic Kidney Disease and Type 2 Diabetes: The CONFIDENCE Trial The simultaneous initiation of finerenone and empagliflozin modestly reduced blood pressure over 180-day follow-up, with minimal immediate hemodynamic effects and few episodes of hypotension #Cardiology #MedTwitter #CardioTwitter #HeartHealth #Healthcare @mvaduganathan @DrMarthaGulati @hvanspall @brendonneuen @ehj_ed @EJHFEiC @ShelleyZieroth @JACCJournals jacc.org/doi/10.1016/j.…

New science🚨 Early initiation & uptitration of Sac/Val💊 vs ACEI/ARB in pts w/AHF led to ⬆️NT-proBNP reduction w/o AEs. Sac/Val💊 uptitration linked to: ⬇️kidney dysfunction ⬆️NYHA class. Results support timely Sac/Val initiation & thoughtful uptitration🚀 🧵

Cardiovascular–Kidney–Metabolic Syndrome Stages, Echocardiographic Characteristics, and Heart Failure Risk: The Atherosclerosis Risk in Communities Study Poor CKM health was widespread among community-dwelling older adults, with higher CKM stage associated with adverse myocardial remodeling and increased risk of incident HF #Cardiology #MedTwitter #CardioTwitter #HeartHealth #Healthcare @mvaduganathan @ShelleyZieroth @hvanspall @DrMarthaGulati @dranulala @brendonneuen ahajournals.org/doi/10.1161/CI…

🫀The failing right ventricle: the most misunderstood chamber in critical care For years, we focused on the left ventricle. But in the ICU, the real killer is often the right ventricle. ->What is acute RV failure? 👉 Not just “weak contraction” It’s a hemodynamic collapse syndrome: RV dilation ↓ LV preload ↓ cardiac output ↑ venous congestion ➡️ → multi-organ failure ->The key pathophysiology (the vicious cycle) 1. ↑ Afterload (PE, ARDS, PH) 2. → RV dilation 3. → Septal shift → LV underfilling 4. → ↓ CO → hypotension 5. → ↓ RCA perfusion 6. → RV ischemia 👉 And the cycle accelerates ->The most important concept 👉 The RV does NOT tolerate pressure Handles preload very well Fails rapidly with afterload ➡️ Even small ↑ PVR → collapse ->Main causes you MUST think first 🔴 Pulmonary embolism 🔴 RV myocardial infarction 🔴 ARDS / mechanical ventilation 🔴 Decompensated pulmonary hypertension 🔴 Post-cardiac surgery ->Diagnosis is NOT obvious There is no single sign. 👉 It requires suspicion + integration: Clinical: congestion + hypoperfusion ECG + biomarkers POCUS (your best friend 🤓) Hemodynamics ->Echo mindset (fast ICU approach) 👉 Don’t overcomplicate Look for: ✔ RV dilation ✔ Septal shift (D-sign) ✔ TAPSE ↓ ✔ Venous congestion The real ICU mistake ❌ Treating RV failure like LV failure ->Management principles 👉 Think in 4 pillars: 1. Preload — “not too much, not too little” Hypovolemic → small fluid Congested → REMOVE fluid 👉 CVP is not a target, it’s a warning 2. Afterload, THE key target ✔ Treat PE ✔ Optimize ventilation ✔ Reduce PVR 👉 If afterload stays high → RV will fail 3. Contractility Dobutamine Milrinone Levosimendan 👉 Choose based on context 4. Perfusion pressure 👉 Norepinephrine is your anchor ✔ Maintains coronary perfusion ✔ Supports RV function ->Ventilation: the silent killer ⚠️ Positive pressure = ↑ PVR 👉 Over-ventilate → worsen RV failure ->When nothing works 👉 Think early: VA-ECMO RV assist devices 🤓Key insight This is NOT just a cardiac problem. 👉 It is a ventriculo–arterial coupling failure When: Ees / Ea ↓ → RV collapses 🤓Bottom line ✔ RV failure is preload dependent BUT afterload sensitive ✔ Small mistakes → rapid collapse ✔ Early recognition + physiology-based treatment saves lives ->Clinical mindset 👉 Don’t ask: “Is the RV failing?” 👉 Ask: “Why is the RV failing and, what is driving the afterload?” 📃Reference Giannakoulas G. et al. European Heart Journal (2025) 00, 1–16 doi.org/10.1093/eurhea…

SPIRIT-HF ACC26 ❌ Espironolactona no redujo CV death/HF hosp ⚠️ Trial subpotenciado + alta discontinuación 🚨 > eventos adversos (hiperkalemia, hipotensión, renales) 📌 TOPCAT: negativo global 📌 SPIRIT: negativo, underpowered 👉 Hoy: iSGLT2 + finerenona #HFpEF #HeartFailure