Martin Grübler

Head of heart failure and cardiomyopathy service Hospital Wiener Neustadt. Clinical lead cardiac MRI.

[Martin Grübler @GrublerMartin]

#eXit will move to another platform soon.

Will use the same username and continue to post cases.

Blue skies in Austria today ;-)

[Martin Grübler @GrublerMartin]

Pt came in with 4 days of chest pain. EKG with inf. STEMI

PL-branch was occluded, due to hemodynamic instability the following echo image was obtained:

#pocus #TTE #cardiology #FOAMed

[Martin Grübler @GrublerMartin]

@lukasz_zydzik Deafness puts MELAS and other mitochondrial disease into the defferentials. Do an #CMR and #genetics incl mitochondrial panel 🦾

[Robert Manka @rmanka_]

❤️ Join us this Thursday for the next online lecture! Earn credits live. See you at 1pm CET : ➡️ DEEP PHENOTYPING OF CARDIOMYOPATHIES

[Martin Grübler @GrublerMartin]

@DFCapodanno That is a nice way of saying it. I don‘t see any value in this figure and I even wonder how such an abomination passed peer review.

[Anil Makam @AnilMakam]

2 years too late

no need to hedge either

Fine to just write "will NOT improve" for these populations

if you want to follow the science don't wait for committees & guidelines

they move like molasses & may never get it write

learn how to appraise or follow people who do

[Ross Prager @ross_prager]

(1/x) The inferior vena cava (IVC) is 'useless' is a phrase stated confidently and incorrectly by #pocus novices. ❌

The IVC is useless at:
- telling you what to eat for dinner
- acting as a fuel gauge for volume status
- predicting fluid responsiveness

HOWEVER.

The IVC is incredibly useful in helping us decide on the optimal fluid and decongestion strategy for your patients.

A 🧵

(With a bonus discussion of future of #VEXUS research at the end. )

#medtwitter #foamed #echofirst

[BiykemBozkurt @BiykemB]

2 year results of REVIVED-BCIS2 Trial: PCI did not improve the hierarchical composite of death, HHF, and health status at 2 years. PCI improved KCCQ-OSS at 6 months, but not sustained to 1- or 2-year follow-up.
https://t.co/6uchcXqunZ @JACCJournals #JACCHF

[Martin Grübler @GrublerMartin]

Important differential diagnosis to know and understand.

If you are in the cardiomyopathy business long enough, you will encounter a couple of cases.

@GTersalvi @stephandobner

Also, endomyocardial biopsies won‘t show much and can be quite misleading in mitochondrial CMP

[Cardiology USZ @CardioZurich]

#MELAS 🫀 What is the role of CMR, genetic testing & family screening in this challenging mitochondrial disorder? A rewarding summary with Dana Roxana Hiestand & colleagues at the #ESCCongress!
📺Full session https://t.co/ECs0rUuw59

@CTECresearch @AnastasiaSMihai @WomenAs1 @ISHBP @ESHypertension @HTNCanada @CotSwiss @YoungDgk @mmamas1973 @Hragy @JGrapsa @SilCastelletti @ShehabAnwer @FrancescoPaneni @CMichaelGibson @KristinaHaugaa @ErsozluSara @andgiannopmd @ASaguner @BoldiKovacsMD @maciejbanach @DrPascalMeier @HanCardiomd @domcbenz @DFCapodanno @HFA_President @mjschuuring @Chrigi_Schmied @DavidNiederseer @MarijaP14065283 @Drroxmehran @DrMarthaGulati @iamritu @Alkadhi_rad @EZancanaroMD #CardioEd #CardioX #WhyCMR

[Martin Grübler @GrublerMartin]

Totally agree.

LGE patterns and clinical context are key.

[Robert Manka @rmanka_]

Important topic: genetic testing in myocarditis patients

[Sanjay Kaul @kaulcsmc]

@DFCapodanno What are we to make of a trial with 36 quintuple composite outcome, wide NI margin and fewer observed PEP events than assumed?

[Sanjay Kaul @kaulcsmc]

@DFCapodanno No difference in CV death or all-cause death.

No difference in all cause hospitalization.
68 fewer HHF but 34 fewer all cause hospitalization which means there are 34 excess non-HHF.

This is a lower risk cohort c/w MITRA-FR with lower EOA, yet PEP was positive! Why?

[Martin Grübler @GrublerMartin]

It is a great achievement, nevertheless it is sad to see that academia is often just a paper, citation and impact counting profession

Shouldn‘t we all rather ask for one good paper that has a meaning (ie changes clinical practice) instead?

@GTersalvi @WilfriedMullens @rmanka_

[Kyle N. Kunze, MD @KyleKunzeMD]

Reaching 200 PubMed indexed articles was a goal I set prior to residency and one I am excited to announce that I have achieved. Thank you to all of my mentors and those who have helped me along the way!

@HSpecialSurgery @MOR_Docs #orthotwitter #research

[Martin Grübler @GrublerMartin]

I agree that this is an important piece if the puzzle, but the study lacks a proper control group.

We have no idea what #SAVR would do in similar patients. Maybe better, maybe similar, maybe worse ❓

We will need better data before we can draw any conclusions. @GTersalvi

[Richard Ferraro @RichardAFerraro]

Awesome piece in @JACCJournals on brain MRI lesions post-TAVR

No analysis I can offer above Dr. @tavrkapadia editorial, but wonder why not/if studies have been done on long term eval?

Especially as TAVR moves to younger populations, exec cognitive function is relevant right?

[Martin Grübler @GrublerMartin]

Case of the week

63y/o🧍‍♂️ NYHA III 😮‍💨
Fam Hx of #HCM 👨‍👩‍👦
Gene pos for MYBPC3 (path)
#CPET peak VO2 17mL/kg/min 💨
Non obstruktive on #TTE

CMR images below

Wwyd?

#whyCMR #CMRfirst #CMR

[Martin Grübler @GrublerMartin]

74y/o male diagnosed with #HFpEF 3 y ago

#DPD #spect was scheduled after severe progr LVH became obvious.

The #CMR LGE PSIR has all the hallmarks of cardiac #amyloidosis ECV>50%

I wonder why we wait so long to look for amyloid in older adults with HFpEF…

#WhyCMR #CMRfirst

[Martin Grübler @GrublerMartin]

@josecaferca @rmanka_ @GTersalvi @stephandobner Yes, would be great!

[Martin Grübler @GrublerMartin]

54y/o F ref to CMR bec of worsening #heartfailure

She was diagnosed w “ischemic” CMP 2022 w <35% LVEF
She had septal LVH, but after Perugini 0 on #DPD scan she was lost to follow-up

Due to eGFR 21 the pt declined contrast

T1 1233 and T2>60 ms on 1.5T

#CMR #whyCMR
#CMRfirst

[Martin Grübler @GrublerMartin]

@TruthinMindBody @rmanka_ @GTersalvi @saramoscatelli7 @AntonHaiden And left a T2 map

Upper row is dark blood LGE (left) and bright blood LGE (right)

[Martin Grübler @GrublerMartin]

Case of the week: the 48 y/o caucasian male is referred for the susp of #hcm with a ❤️ septum um 15mm on #echocardiography we referred him to CMR. Fam Hx is neg

Native T1 790ms (1.5T Siemens Aera) ‼️

In Haste the liver appeared normal

What is the diagnosis? 🧠

#CMR #whyCMR

[Martin Grübler @GrublerMartin]

@TruthinMindBody @rmanka_ @GTersalvi @saramoscatelli7 @AntonHaiden There are no perfusion images, the coloured image is a native T1 map (apologies, should have added that in the description)