Erasmo DLP

Cardiologist, CV Imager (L3 NUC/CMR/CT) Director CV Med Institute and CV Imaging @TecSalud Tec de Monterrey

[Erasmo DLP @ErasmoPA]

My research is available on @ResearchGate: https://t.co/H0kcFUAwOO

[Ritika Tuli @RitikaTuliMD]

#CardioNuggets 🫀

Why does SAM (systolic anterior motion) occur?

Fast LVOT flow “pulls” the anterior MV leaflet into the septum → dynamic obstruction + posterior MR

Classic settings:
HCM, hypovolemia, vasodilation, inotropes, post-MV repair, stress cardiomyopathy.

Worse: Valsalva, dehydration, nitrates
Better: fluids, β-blockers, ↑afterload

#CardioNuggets #SystolicAnteriorMotion #SAM #MedEd #CardioMed

[Lea Alhilali, MD @teachplaygrub]

1/Do radiologists sound like they are speaking a different language when they talk about MRI?

T1 shortening what? T2 prolongation who?

Here’s a translation w/an introductory thread to MRI.

[Dr. Filippo Cademartiri @FCademartiri]

🫀🔥 LDL is down. Therapy is optimal. And yet… plaque is still growing.
Report from the presentation of the HURRICANE study at the ECR2026

Proud to be part of this study that sheds more light into a very hot contemporary topic.

That’s the uncomfortable reality highlighted by new data presented at ECR 2026.

👉 Statins were working.
👉 Guidelines were followed.
👉 LDL was controlled.

And still:
📈 Atherosclerosis progressed.

💡 This is the blind spot we’ve been ignoring:
👉 Residual cardiovascular risk

Driven by:
✔��� Inflammation
✔️ Metabolic factors
✔️ Genetics

👉 Things LDL alone does NOT capture

🚀 Enter Photon-Counting CT (PCCT)

For the first time, we can:

✔ Quantify plaque volume
✔ Differentiate plaque components
✔ Track progression over time

👉 Not just detect disease…
👉 Measure its evolution

⚠️ And this is where it gets disruptive:

Patients who are “well-controlled” on paper
may still be:
👉 biologically active
👉 progressing silently

🧠 This changes the entire paradigm:
❌ Treat LDL → assume success
➡️ becomes
✅ Treat disease → verify with imaging

🎯 Clinical implication

We may need to move from:

Lipid targets
➡️ to
Plaque targets

From:
Surrogate biomarkers
➡️ to
Direct disease measurement

🚨 Bottom line

Statins treat risk.

👉 PCCT shows reality.

And sometimes…
they don’t match.

⚡ The future is not:
“Did we lower cholesterol?”

It’s:
👉 “Did we actually stop the disease?”

[Dr. Filippo Cademartiri @FCademartiri]

🧠 We optimized the stent. We forgot the disease.

Two major NEJM trials just dropped.
Both asked the same question:
👉 Does IVUS-guided PCI improve outcomes vs angiography alone?

The answer?
❌ No.

📊 Trial #1 – Complex High-Risk PCI (IVUS-CHIP)
IVUS: 13.9% events
Angio: 11.1% events
HR 1.25 → trending worse

📊 Trial #2 – Left Main PCI (OPTIMAL)
IVUS: 33.7% events
Angio: 30.9% events
HR 1.11 → no difference

Let’s be honest.
💡 IVUS did exactly what it’s supposed to do:
✔️ Better sizing
✔️ More post-dilation
✔️ More “optimized” stents

And yet…

👉 No clinical benefit.

⚠️ This is the uncomfortable truth:
We’ve been chasing procedural perfection,
thinking it would translate into patient outcomes.

It doesn’t
(and yes I know the comparator is highly skilled PCI operators/centers; but does this appears as inclusion criteria?)

Because events are NOT driven by:
❌ stent expansion
❌ lumen gain
❌ apposition metrics

They are driven by:
🔥 plaque biology
🔥 disease burden
🔥 patient-level risk

Even more interesting:
👉 The “inferior” arm (angiography) was already excellent
👉 Modern PCI is already optimized
👉 There’s very little left to gain mechanically

💥 So what did these trials really show?
Not that IVUS is useless.

But that:
👉 The paradigm is wrong.

🧬 We are:
✔️ optimizing millimeters
✔️ while events come from microns of biology

🚨 The future is NOT:
“optimize the stent more”

It is:
👉 identify disease earlier
👉 quantify plaque, not stenosis
👉 treat-to-plaque, not treat-the-lumen

💬 Final thought:
We spent 20 years perfecting PCI.
And almost none of that effort touched the disease that actually kills patients.

#Cardiology #PCI #IVUS #CardiacImaging #PhotonCountingCT #PreventiveCardiology #TreatToPlaque

[Palak Patel @palakpatel96]

What a wonderful session on PVCs at #ACC26 ⚡🫀

❓Should every patient with frequent PVCs get a cardiac MRI?
❓What to do with Asymptomatic PVCs?

Key insights below 👇

#CardioTwitter #EPeeps #ACCEP

[Erasmo DLP @ErasmoPA]

@OnlyTruthBombs @LaSportivaSpain @lasportiva_jp

[Erasmo DLP @ErasmoPA]

@OnlyTruthBombs La Sportiva

[Vicente Jimenez-Franco MD 🇲🇽🫀 @vicentejmzmd]

Just published: 📄 protocol of the Mexican Cardiogenic Shock Registry (REMECHOQUE). A national, multi-institutional collaborative effort with impact across Mexico and Latin America.
@ErasmoPA @GTorreAmione @TecSaludMX @TecCardiology
https://t.co/b481mHydDK

[Erasmo DLP @ErasmoPA]

@TwindadFrank @Artedeingenio Same question, Found this
In AI image generation, SREF stands for Style Reference.Used in platforms like Midjourney that allows users to apply overall artistic aesthetic (colors, textures, lighting, etc.) of a reference image or a specific numerical code to their generated images

[Keith Siau @drkeithsiau]

The scariest thing in academia 😅

[Vicente Jimenez-Franco MD 🇲🇽🫀 @vicentejmzmd]

Wrapping up two inspiring days in Cancun at the 3rd Cardiogenic Shock LATAM Symposium!
An incredible gathering dedicated to one of cardiovascular care’s greatest challenges.
Grateful to our speakers & participants for driving collaboration, innovation, and progress in CS

[Babar Basir @Babar_Basir]

@vicentejmzmd @hfdocbhimaraj @EdeObesoG @ErasmoPA @drricalde @JHMontfort10 @TecSaludMX @TecCardiology @cardiotecdemty @GTorreAmione Congratulations on a wonderful meeting. You all are making such a huge impact in Mexico and beyond! Keep up the great work!

[Erasmo DLP @ErasmoPA]

@EsDeMamador r/LinkedInLunatics

[Vicente Jimenez-Franco MD 🇲🇽🫀 @vicentejmzmd]

Fellows and early careers: Please submit you challenging CS case and get a chance to win a trip to present it in person this year at the Cardiogenic Shock LATAM Symposium in Cancun, Mexico.
@TecSaludMX @cardiotecdemty @TecdeMonterrey

[Erasmo DLP @ErasmoPA]

Flow abnormalities are rarely seen on #cardiacct , when a contrast gradient occurs in the presence of a flow abnormality,it can be seen, use color to enhance it L-R Shunt ASD #CardioTwitter #CardioEd #CardioX #accimaging #accfit
@Heart_SCCT @escardio @ACCinTouch @American_Heart

[Vicente Jimenez-Franco MD 🇲🇽🫀 @vicentejmzmd]

It was an honor to lead the Cardiogenic Shock Symposium with TecSalud at #CITIC2025—bringing together top national & international experts to tackle one of the biggest challenges in cardiovascular care.
Thanks to the organizing committee!
See you at #CITIC2026.

[Erasmo DLP @ErasmoPA]

@ipostrandom21 @PicturesFoIder “I needed you more than you ever knew”

[Vicente Jimenez-Franco MD 🇲🇽🫀 @vicentejmzmd]

Sesión de utilidad de IVUS en ICP contemporánea por ⁦@CardioMty⁩
Excelente charla! #PrecisionPCI ⁦@BSCCardiology⁩ ⁦@bostonsci⁩ ⁦@JGParedesMD⁩ ⁦@ErasmoPA⁩ ⁦@EdeObesoG⁩ ⁦@cardiotecdemty⁩ ⁦@TecSaludMX⁩ ⁦@TecCardiology⁩

[Michael J. Ackerman MD,PhD @MJAckermanMDPhD]

Thank you Dr Abbas Zaidi from Wales, UK. Probably the best talk that I have ever heard on imaging features that distinguish #Athlete #Heart from #cardiac #disease! Was worth staying here @AHAScience #AHA24 for the final session to hear his talk. 🤗