Thomas Coelho Assmann

@GuiAttizzaniMD @SMPatelMD @HiteshRaheja3 @vinesteves @TonyMain6 @KopCardiologist @ACUkaigweMD USMLE needed?

Unexpected opening for our Structural Heart Fellowship 2025. Hands on, High volume center with > 450 TAVR, >120 TEER, > 400 LAAO, Tricuspid, PVL et al. Send CV to Guilherme.attizzani@uhhospitals.org @SMPatelMD @HiteshRaheja3 @vinesteves @TonyMain6 @KopCardiologist @ACUkaigweMD

@drjohnm @jedicath @OAB1967 @escardio @DGK_org @YoungDgk @AG14_DGK @EAPCPresident @ASPCardio

@jedicath @OAB1967 @escardio @DGK_org @YoungDgk @AG14_DGK @EAPCPresident @ASPCardio What is “disease”?

You've diagnosed atherosclerotic plaque in an asymptomatic 60 year old marathon runner w elevated LDL. You prescribe a statin! Is this PRIMARY or SECONDARY prevention? I'm confused. #CardioTwitter @escardio @DGK_org @YoungDgk @AG14_DGK @EAPCPresident #eapc @ASPCardio

@OAB1967 @escardio @DGK_org @YoungDgk @AG14_DGK @EAPCPresident @ASPCardio

@ramonlopezpalop There's something in LM pullback, seems like thrombus?

A f48 y. o with no risk factors admitted for isolated episode of typical rest angina. Minimal inferior ST changes and significant troponin elevation. CGA without significant lesions but with pressure damping on catheterization of the LMCA requiring subselecitve injections.

@LAzzaliniMD @anish_koka Just the same here 🙌

@anish_koka Curious to know how we got here… I’d PCI my RCA and take tons of rosuvastatin and PCSK9i. Hopefully 🤞🏼 the LAD lesion won’t progress. With my usual degree of physical exertion the RCA will give me problems and I’d want it fixed. Btw if iFR is borderline we should FFR…

It is 2023. You are a cardiologist and know what the ISCHEMIA trial says. You are asymptomatic but for some reason still end up getting a Cath. Ifr is borderline for everything. Nl EF. What do you do ? (Poll in reply )

@djc795 @kardioklick @mmamas1973 @OAB1967 @AslangerE @doc_ecmo @KardiologieHH @mirvatalasnag @DavidLBrownMD @Umair2017 @Obisht @DLBHATTMD @CMichaelGibson @InvasiveCardiol @DrJayMohan @GhanemAlexander @drjohnm Maybe, mayyyybe, if ctca is on cath lab table 😂

@kardioklick @mmamas1973 @OAB1967 @AslangerE @doc_ecmo @KardiologieHH @mirvatalasnag @DavidLBrownMD @Umair2017 @Obisht @DLBHATTMD @CMichaelGibson @InvasiveCardiol @DrJayMohan @GhanemAlexander @drjohnm 30 minute door to balloon delay is enormous.

Would it be unethical to run a trial testing CTCA in STEMI before PCI? @agik @mmamas1973 @OAB1967 @AslangerE @doc_ecmo @KardiologieHH @mirvatalasnag @DavidLBrownMD @Umair2017 @Obisht @DLBHATTMD @CMichaelGibson @djc795 @InvasiveCardiol @DrJayMohan @GhanemAlexander @drjohnm

@ISeropianMD @adrianocaixeta You're right about diagnosing in that reconstruction.

@thomascassmann @adrianocaixeta It’s not advisable to diagnose in curved MPR reconstruction… but in that bee doesnt’t look more than 50% to me (half of distal vessel). Maybe that was the reason for the LHC… which is 20% at most. Thanks for ur comment!

Vulnerable plaque in pt with unstable angina. By AngioCT (A) positive remodeling, low-attenuation plaque, and spotty calcification (asterix) in pRCA, correspondent angio showing moderate plaque (arrows in B). OCT images shows necrotic core covered by a thin fibrous cap (B to G). Intact thin fibrous plaque cap (arrows) with high signal shadowing, suggesting a cluster of macrophages (arrowheads). Spotty calcification (asterix) is also notice (H). Subtle neovascularization or microchannelis also seen as no-signal tubuloluminal structures (arrows in C). Findings of a typical thin-cap fibroatheroma (TCFA). Image from our paper journals.lww.com/coronary-arter… @GreggWStone @CoronaryArteryD @hect2701 @Giora_Weisz_MD #CardioTwitter @mmamas1973 @ziadalinyc

@ISeropianMD @adrianocaixeta CTA looks severe to me

@adrianocaixeta Congrats on the paper!! Very interesting 👏 Now back to the pic… why would you cath an ACS pt that you first did CTA and ruled out severe stenosis?

@djc795 @fischman_david @SVRaoMD @DocSavageTJU @mmamas1973 @mirvatalasnag @GreggWStone @cardioPCImom @DLBHATTMD @Drroxmehran @SandeepNathanMD @Pooh_Velagapudi @Costa_F_8 @SrihariNaiduMD @Hragy @aymanka Not bad at all.👌

@fischman_david @SVRaoMD @DocSavageTJU @mmamas1973 @mirvatalasnag @GreggWStone @cardioPCImom @DLBHATTMD @Drroxmehran @SandeepNathanMD @Pooh_Velagapudi @Costa_F_8 @SrihariNaiduMD @Hragy @aymanka That's a very nuanced description. Not bad.

OSH cath report “There was a 20% in-stent restenosis”. This statement is… #CardioTwitter #ACCFIT @mmamas1973 @mirvatalasnag @djc795 @GreggWStone @cardioPCImom @DLBHATTMD @Drroxmehran @SandeepNathanMD @Pooh_Velagapudi @Costa_F_8 @SrihariNaiduMD @Hragy @aymanka @fischman_david

@jl35wilsonMD @DavidLBrownMD @LACUSCMedCenter Why not? "Who would pay?!" 😫😫😔

Summary of 2 weeks in the @LACUSCMedCenter CCU: Saw lots of end stage heart failure Used lots of digoxin Saw Chagas cardiomyopathy Saw VT storm break after replacing metoprolol with propranolol Learned how to refer an uninsured non-US citizen for heart transplant

@w_jyg @evandrofilhobr @mirvatalasnag @mmamas1973 @KambisMashayek1 @mornei2011 @KardiologieHH @LAzzaliniMD @HadyLichaaMD @BotPci @RadialFirstBot @KPujdak @nyalborgesmd @iamritu @PCRonline 👏👏 have you imaged cx ostium after stent and POT? No KB, right?

#NotTheTypicalTypeALesion 60s angina #CAG➡️filling defect🤷‍♂️#Wire1st then #Think #Scan #Stent #LM😌@evandrofilhobr @mirvatalasnag @mmamas1973 @KambisMashayek1 @mornei2011 @KardiologieHH @LAzzaliniMD @HadyLichaaMD @BotPci @RadialFirstBot @KPujdak @nyalborgesmd @iamritu @PCRonline

@skat_ct @ab_medica @Balt_Group @MilaKovaevi1 What about balloon coming out from radial? Any issues?

Third international #RadialBAV COURSE in #Ferrara #Italy. Always thanks to @ab_medica @Balt_Group and to the amazing guests! Pics of a double distal radial BAV bridge to #TAVR in a pt with #COVID #CentroCardiologicoFerrara @MilaKovaevi1

@djc795 @DrIHHashmi1 @MatthiesenTimm Really?! Nice to know. I'd go for upfront 2 stents. Would you KB in provisional for this one?

@DrIHHashmi1 @MatthiesenTimm Provisional.

What would be your preferred strategy for this LAD/D1. 1 Provisional. 2 upfront 2 stent. 2a DKC or it's variants, micro, mini or nano. 2b culotte or its variant DK culotte.

@lamelaspablo @ISeropianMD @GilbertTangMD @djc795 @PedroMDMSc @RodrigoBagur @didier_tchetche @msztejfman @omendiz @Almanfi_Cardio @MGtberg @JLVelianou Which size/length? What atm? LM needed pos dilatation?

@thomascassmann @ISeropianMD @GilbertTangMD @djc795 @PedroMDMSc @RodrigoBagur @didier_tchetche @msztejfman @omendiz @Almanfi_Cardio @MGtberg @JLVelianou Onyx

Native tricuspid #TAVR. Stable. PCI vs IC imaging vs physiology ? @GilbertTangMD @djc795 @PedroMDMSc @RodrigoBagur @didier_tchetche @msztejfman @omendiz @ISeropianMD @Almanfi_Cardio @MGtberg @JLVelianou

@lamelaspablo @ISeropianMD @GilbertTangMD @djc795 @PedroMDMSc @RodrigoBagur @didier_tchetche @msztejfman @omendiz @Almanfi_Cardio @MGtberg @JLVelianou What stent did you use?

@ISeropianMD @GilbertTangMD @djc795 @PedroMDMSc @RodrigoBagur @didier_tchetche @msztejfman @omendiz @Almanfi_Cardio @MGtberg @JLVelianou CT moderate risk: LM 9 mm, sinuses 27, 23 mm valve, bulky valve at the base, long but fibrotic at the tip… suggested IC imaging as an option, but team was pretty convinced about enough info to pci When stent was advanced, occluded LM flow… no collapse (proceeded fast though)

@Hragy @CMichaelGibson 4

Took my 4th Pfizer booster, thats six doses since the beginning counting my first two AZ boosters, all well spaced as recommended, anyone else took 6? @CMichaelGibson

@SanjayGill1 @kevin_tijerina @DavidLBrownMD @Hragy @ColletCarlos @PCRonline @TCTMD And show me that patient.. here in Brazil, he is a rare entity. (Not saying that stents are the solution... but OMT in my real world, is something really, really, really difficult)

@kevin_tijerina @DavidLBrownMD @Hragy @ColletCarlos @PCRonline @TCTMD While y’all figure that out, I’m gonna save my energy and “patient trust capital” to get their LDL into the ground with Max Rosuva, Ezetimibe, PCSK9i; getting their A1C down with Sema/Tirzy, SGLT2i; BP control; diet and exercise = all proven to ⬇️ mortality.

Summary of RCT comparing PCI vs. OMT looking at spontaneous MI A consistent effect of revascularization reducing heart attacks We are now trying to understand which is the lesion subset that benefits the most from PCI #VIPclub @PCRonline @TCTMD

@GreggWStone @CMichaelGibson Wow. What a nice story!! Really cool!!

@CMichaelGibson I took care of him as a resident when he was hospitalized once at NY Hospital. Got to know him well - he gave me a signed album I cherish to this day. He was a special person and revolutionized jazz (my passion).

Miles Davis Oil on 10 x 10 inch clayboard by @CMichaelGibson 2022 #cmgsees Miles often played with sunglasses on or with his back to the audience I wanted his eyes … and his embouchure that is hidden behind the trumpets 🎺 mouthpiece

@ShariqShamimMD @AYSoomro My choice too.

@AYSoomro Similar sized branches, not much Ca, culotte bifurcation like below.

65 YO 🧔‍♂️referred to ER due recent abnormal stress Echo, WMA abnormalities in anterior wall. CP has been progressively worsening, on BB. Cath shows this beast of a lesion. How to proceed?

@mmamas1973 @ajaykirtane Nice One point, here in Brazil, it has become much much easier to get in Med school. But I agree, we have to update our way of teaching... the problem of bad grades, it's not just the students...

Off Script: Is the Next Generation ‘Weak’ or Do We Need Higher Standards for Ourselves? Great blog by @ajaykirtane tctmd.com/news/script-ne…