James Otton

Cardiologist. Cardiac imaging, simulation, prevention, cardio-oncology. The entire breadth of a complex issue is not meant to be captured in a single tweet!

[James Otton @DrJamesOtton]

@theproof This is a great, n=1, reminder of the limitations of this technology. I have seen worse: even different phases of the same scan can give vastly different results. I have done research plaque quantification manually. It’s very hard to do reproducibly and AI is not a panacea.

[James Otton @DrJamesOtton]

@OdedRechavi A recent coffee at Primary, Potts Point, Sydney. But there are so many to choose from… and DM me if you need an ocean swimming group!

[James Otton @DrJamesOtton]

@cremieuxrecueil Even now we have a drug that may substantially reduce risk in the setting of high Lp(a): aspirin. Multiple trials and cohorts show large reductions in events if Lp(a) raised. Post-hoc analyses, but multiple trials and populations suggests this is more than coincidental.

[James Otton @DrJamesOtton]

@drjohnm How do microplastics get into the bloodstream? Hard to see an oral route.
More likely IV meds, catheters, infusions and procedures.
Who are the sickest people who have the most CV events?
…people who have a lot of IV meds, catheters, infusions.
If in doubt, replicate!

[James Otton @DrJamesOtton]

@VPrasadMDMPH Great talk, Vinay. I’m glad you recommend exercise for general cardiovascular benefits. Unfortunately the largest RCT including exercise in high risk individuals was stopped after almost 10 years due to futility. I now recommend for general well-being!
https://t.co/KFcfiWCtEz

[James Otton @DrJamesOtton]

Nice work, @mugander !

[JACC Journals @JACCJournals]

#PulmonaryHypertension, defined by right heart catheterization, is more accurately detected & quantified by #whyCMR #4Dflow analysis (mPAP) than by #echofirst Doppler tricuspid regurgitant jet velocity. https://t.co/AwCsQfObOG

#JACCIMG #cvImaging #Hypertension #CardioTwitter

[JACC Journals @JACCJournals]

#PulmonaryHypertension, defined by right heart catheterization, is more accurately detected & quantified by #whyCMR #4Dflow analysis (mPAP) than by #echofirst Doppler tricuspid regurgitant jet velocity. https://t.co/AwCsQfObOG

#JACCIMG #cvImaging #Hypertension #CardioTwitter

[James Otton @DrJamesOtton]

@drjohnm @nntaleb Although it strongly contradicts my intuition and observational data, is it possible that exercise does not improve risk and mortality?
I note the 5000+ LookAHEAD NIH RCT of exercise (and a 'diet') did not show benefit (NEJM)
Another smaller RCT also: https://t.co/xIk3QEMug8

[Lady Glaucomflecken (she/her) @LGlaucomflecken]

In my 10+ years of co-survivorship, doing life with @DGlaucomflecken through 2 separate cancers, 1 SCA and fighting off his death with 10 mins of #CPR, only ONE (1) of the medical professionals we interacted with has ever asked how I was doing. Meet Roger. https://t.co/NR4F2mkcZC

[James Otton @DrJamesOtton]

@calebferg High tide. The best time to visit!

[James Otton @DrJamesOtton]

One of several reasons that “Non-compaction cardiomyopathy” is not a useful clinical entity:
Papillary muscles fragment as they insert into the myocardium. This is normal and not indicative of disease, irrespective of “pathological” C:NC ratio

[Dr. José Ángel Cabrera @jacabreracardio]

👨‍🎓👩‍🎓 Morning of ventricular tachycardia (29 september 2022) 👉Clinical anatomy of the papillary muscles @AbbottCardio

[Mamas A. Mamas @mmamas1973]

Has #Orbita or #Courage impacted on elective PCI in the UK? our work led by @drrashid05 suggests no! ➡️ https://t.co/ymD0nEJAdN @hwijeysundera @ncurzen @DrAsifQasim @rwyeh @SVRaoMD @GreggWStone @ShelleyWood2 @DavidLBrownMD @alaide_chief @ShrillaB @mirvatalasnag @cardiojaydoc02

[James Otton @DrJamesOtton]

Great to record my first podcast episode, on cardiac effects of radiotherapy.
Thanks to co-presenters @shalinivinod13 and @VickyJChin
And kudos to all the real podcasters out there. Tough work!
https://t.co/gtQLWEBgeP

[Markus Deserno @MarkusDeserno]

Why does increasing atmospheric CO₂ warm the planet?

The greenhouse effect, duh.

But do you know how that works? I can *almost* guarantee you that you don’t quite have the right picture in mind—in a way that actually matters.

Interested? Here’s a new physics thread!

1/29

[James Otton @DrJamesOtton]

@mgwfriedrich Agree! Non compaction separate from EF has no robust bearing on prognosis, etiology or treatment. Non compaction cardiomyopathy does not exist as a distinct entity and serves only to confuse and misdirect those unfamiliar with the subject area.

[James Otton @DrJamesOtton]

Dear Siemens, I am sure the patient was informed that there is no evidence that stenting completely asymptomatic individuals is “life saving”. Nice marketing though, and the RCA is now more aesthetically pleasing!

(TBH management is much debated…)
@DavidLBrownMD @ProfDFrancis

[Siemens Healthineers @SiemensHealth]

Frank, 52, showed no signs that he was at high risk of having a heart attack. Thanks to his friend’s urging, he still had a check-up – and that same day, a life-saving intervention. https://t.co/grI7qH2BQFrank, 52, showed no signs that he was at high risk of having a heart attack. Thanks to his friend’s urging, he still had a check-up – and that same day, a life-saving intervention. https://t.co/grI7qH2BQFrank, 52, showed no signs that he was at high risk of having a heart attack. Thanks to his friend’s urging, he still had a check-up – and that same day, a life-saving intervention. https://t.co/grI7qH2BQz

[James Otton @DrJamesOtton]

Always hard to know what cardiac effects are from intensive strength training vs effects of anabolic steroids. Interesting that in this study septal thickness a relatively svelte 9-11mm in non steroid using controls.

[ctca_papers @ctcapapers1]

Cardiovascular phenotype of long-term anabolic-androgenic steroid abusers compared with strength-trained athletes https://t.co/vO3VPxFDkq

[James Otton @DrJamesOtton]

I recommend this great thread showing insights from a simple model of virus transmission and immunity.
Originally about Covid but applies to all viruses: Could recent suppression result in big spikes of RSV, hMPV etc?
Hospitals here already full…😒
H/t @MichaelSFuhrer

[James Ward @JamesWard73]

But maybe I didn’t make the controls strong enough. Instead of reducing risk by 25%, let’s reduce risk by 50% instead – still for that temporary period. That should make things better, right?….. oh. That doesn’t look so pretty. 9/n

[James Otton @DrJamesOtton]

Neuronal and neuroimmune effects on atherosclerosis. I certainly wasn’t expecting this! Perhaps related to pericoronary adipose tissue (PCAT) changes seen with high risk plaque at CT?

https://t.co/DKLHgpF0hP

[James Otton @DrJamesOtton]

@DavidLBrownMD @JAMAInternalMed @JAMANetwork 3. “Most participants reclassified as being at intermediate or high risk by CACS did not have a CVD event during follow-up” sounds bad…
But if 20% 10y risk is high, and your model is calibrated, of course most (~80%) do not have events!
Data=Data but interpretation is to taste!

[James Otton @DrJamesOtton]

@DavidLBrownMD @JAMAInternalMed @JAMANetwork The clinical role of coronary calcium needs careful consideration, but this study??
1. The C-statistic does not summarise utility, and especially not utility in selected circumstances.
2. C-statistic bump of 0.036 seems small? LDL cholesterol gives 0.01

https://t.co/JsN4XYHSI9