Thomas Lindow

Is measurement variability in AS still an issue with modern #echofirst equipment and how does reproducibility affect severity grading? Open access Brief Research Communication in JASE. A 🧵. 1/10

Determining heart age by ECG can be done even without the need for a P wave (read, applicable in #AF). Our latest paper led by @zaidoni

Postdoc job with @rebeccakozor & me in Sydney 😎🇦🇺 ✅Cardiac imaging clin research, no clin role ✅Req: MD and PhD or mult 1st author papers ✅Paid, 1 yr f/t, + option to extend ✅Apply by 22 Sept tinyurl.com/USydCMR #WhyCMR #EchoFirst #YeSCCT #ECG

🧵Atrial strain 1/ In Norway, we have an idiom: “The north wind is just as cold, from wherever it blows”, meaning the basic properties of something doesn’t change with the perspective you apply.

*Mitral valve assessment by TTE* Transthoracic echocardiography (TTE), when performed with care and diligence, can reveal a lot about the valve. TOE isn't necessary in all cases to determine leaflet pathology. A worked example below:

🫀Can #exercise systolic #blood #pressure response identify #hypertensive pts considered normotensive? Find out here👇 doi.org/10.1093/eurjpc… @m_piepoli @thomas_lindow @CauwNi @KristoferHedman @DrTiberi @FlavioDascenzi @md_pengo @El_Cavarretta @EAPCPresident @OxfordJournals

@dritsyk Nice thread @dritsyk! Do you know if there are any reports of variability/repeatability? I experimented with one of these single-beat methods to determine Ees. Seems highly variable and requires top quality images.

9/ Hemodynamic therapies affect VAC differently, so we the need to monitor VAC for hemodynamic optimization. VAC can be assessed noninvasively using #EchoFirst and the iElastance-app. However, it requires multiple measurements.

1/ Ventriculoarterial coupling (#VAC) determines the harms and benefits of hemodynamic therapies. VAC describes cardiac efficiency, and offers a complementary perspective to CO, MAP and tissue perfusion. Let’s try to understand it🧵 #FOAMcc #FOAMed #MedTwitter #CardioTwitter

55 yo male LVM 180g (90 g/m2) = upper range of normal LVEDV 125ml (63 ml/m2) = lower range of normal What is normal mass for a given EDV? 🚫LVM/EDV (mass/volume ratio, MVR) not good ✅ Global Thickness is much better! A new #LVH #WhyCMR paper 🧵 1/n

Pretty amazing. 🤯 No (zero!) false positive ischemia findings by exercise stress #ECG ⚡️when invasive coronary physiological testing of #CMD is the reference standard. So, all w pos stress ECG have some form of 🫀myocardial ischemia, incl CMD.

In conclusion, AVpeak/AVmean are preferred when assessing serial exam. Vigilance is needed when measurements are bordering severity cutoffs, and a second examiner should be engaged, if possible, to improve interpretability. /end doi.org/10.1016/j.echo…

Sacchi et al found that CoV was low for dimensionless index, suggesting that observers consistently over- or underread LVOT and AV VTI traces. This was in agreement w our findings, but ONLY when the same images were used. In the test-retest setting, CoV ⬆️substantially. 9/10

On a side-note, the maximal velocity was observed in right parasternal views in about one third of cases, similar to previous findings (doi.org/10.1093/ejecho…). This highlights the need for non-apical view in AS evaluation. 7/10

Importantly, AS severity based on the ECS/EACTS algorithm was different in almost one-third of patients due to measurement differences on the same examination. In the majority of cases, due differences in AVA measurements. 6/10

Is measurement variability in AS still an issue with modern #echofirst equipment and how does reproducibility affect severity grading? Open access Brief Research Communication in JASE. A 🧵. 1/10

Variability was substantially ⬇️for all measures when the 2 observers performed measurements on the same images in the test-retest subset. This suggests that variability in acquisition is an important element in variability in repeated examinations. 5/10

AVpeak had the lowest test-retest variability, while the largest variability was observed for AVA. Coefficients of variation (CoV) were similar among the 3 constituents of AVA suggesting that the combination of multiple measurements contributes to the large variability. 4/10

We assessed interobserver variability in 99 patients with moderate AS (2 observers, same examination, images freely chosen). To study test-rest variability, 30 of them underwent a repeat exam. Impact on severity grading (ECS/EACTS algorithm) was evaluated. 3/10

Reproducibility issues with AVA, in particular, are known but previous studies are limited either by being performed on out-dated equipment, small sample sizes, lack of info if images were freely chosen, or not using a test-retest design. 2/10

@NMerke @dr_benoy_n_shah

@NMerke @dr_benoy_n_shah Calculation of RF through VTI ratio in the left subclavian artery is an interesting additional approach. I have done it a few times but not yet made clinical decisions based on it. ncbi.nlm.nih.gov/pmc/articles/P…

#echofirst in difficult AR jet, how to grade? We always need to go for How Much? Why? And of course look at structural damage. But to decide the HOW MUCH is not easy in eccentric jets... So what is your way to go most of the times?#cardiotwitter #CardioX @dr_benoy_n_shah @echo_batman @eromerodorta @denisamuraru @iamritu @almasthela @FGraziani_Grace @alexsfelixecho @alex1708ander @AHagendorff