Luis Paredes

[Luis Paredes @LParedes7972]

Como optimizar las imágenes del ultrasonido pulmonar?
Effect of Machine Settings on Ultrasound Assessment of B‐lines https://t.co/5UKEi07TD0

[Luis Paredes @LParedes7972]

@BangkokSkyRain https://t.co/CFygS82J5m

[Ahmed Bennis MD 🫀 @drbennisahmed]

🤯 A striking stat from Pau Llacer at #HeartFailure26
91.9% of advanced CKD patients (eGFR 15-45) attending routine nephrology visits have already entered the heart failure continuum.
Breakdown in 453 outpatients with NO prior HF diagnosis:
• Stage A (at risk): 9.1%
• Stage B (pre-HF, asymptomatic): 53.3%
• Stage C (symptomatic HF): 38.6%
Over 9 in 10. Routine nephrology visits. No known HF.
The cardiorenal overlap isn’t a niche — it’s the rule.
Nephrologists ARE heart failure doctors whether they know it or not. Time to act like it. 🪲❤️
(de la Espriella R et al. JACC Heart Fail. 2025 Sep;13(9):102581)
#CardioTwitter #HeartFailure #Nephrology #CardiorenalSyndrome #CKD

[Ahmed Bennis MD 🫀 @drbennisahmed]

📋 Practical algorithm for reinitiation of GDMT in symptomatic low BP HF — because stopping therapy isn’t the answer.
Key decision points:
🔵 Low eGFR (<30) → reduce RASI & MRA
🔵 High K+ (>5.0) → reduce RASI & MRA
🔵 Low HR (<60) → reduce/stop BB, consider ivabradine or CRT
🔵 Arrhythmia history → decrease RASI & MRA
🟢 SGLT2i → maintain throughout (very limited BP effect)
If BP improves → structured reinitiation based on eGFR & HR combinations
⚠️ Persistent low BP + major symptoms = refer to HF team for advanced therapy
Don’t stop — sequence, reduce, and restart. 🔄
#HeartFailure26 #HF2026 #GDMT #HFrEF #Cardiology #HeartFailure
📚 Skouri et al. EJHF (2025) 27, 707–722

[Ahmed Bennis MD 🫀 @drbennisahmed]

💊 Practical algorithm for diuretic resistance in acute HF from #HeartFailure26— this is the slide to save!
Start: Furosemide 120-160 mg
↓ Still congested?
Add Chlortalidone 12.5-50 mg/24h
↓ Still congested?
Tailor to the problem:
• Metabolic alkalosis → Acetazolamide 120-500 mg/24h
• Hyponatremia → Tolvaptan 15-50 mg/24h
• rLVEF + hypopotassemia → MRA 25-100 mg/24h
And running through the whole algorithm:
➕ Add iSGLT2 throughout
➕ Add sacubitril/valsartan if LVEF <49%
➕ Consider parenteral route if oral absorption is the issue
Clean. Practical. Evidence-based. 💯
(Adapted from de la Espriella R et al. Nefrologia 2021)
#CardioTwitter #HeartFailure #Cardiology #Diuretics #HFrEF

[Mushtaq Bilal, PhD @MushtaqBilalPhD]

Evil websites like Libgen, Z-library, and Sci-Hub had pirated millions of academic books and papers.

They've been shut down, and rightly so.

We shouldn't use them anyway. We should make billion-dollar academic publishers richer.

Anyway, here's how to access these libraries:

🚨DO NOT DO THIS!

[Joruno @wsl8297]

通勤路上想听自己喜欢的书？可惜大多数电子书没有音频版。

推荐一个 GitHub 上的开源免费工具：Audiblez。它能把 epub 电子书自动转成有声书，几分钟输出 m4b，语音自然顺滑，支持中文、英文、日语等 9 种语言。

GitHub：https://t.co/3mIjeKN5hz

亮点功能：
- CUDA 加速：GPU 转换提速约 10 倍
- 50+ 语音可选：覆盖多语言与不同风格
- 自定义朗读：0.5–2.0 倍速，支持指定章节
- m4b 输出：兼容主流播放器，管理更方便

安装也很省心：Windows、Mac、Linux 都支持，同时提供命令行和图形界面。

[Luis Paredes @LParedes7972]

@Ilescasivan 👀👇

[AYi @AYi_AInotes]

OpenAI今天干了一件，
可能改变未来10年医疗格局的大事。

没有发布会，也没有铺天盖地的宣传，就一条平平淡淡的推文。

他们给全世界的医生，免费开放了专属的临床版ChatGPT！

一款专门给医生减负的超级助手
写转诊信，填保险授权，查最新文献，整理病例，
甚至连医生每年要修的继续教育学分，用它查病例都能自动算，
所有医生最痛恨的行政垃圾活，AI全包了。

很多人说OpenAI在做慈善，
我认为不是这样的，
这应该是他们有史以来最聪明的一次交换。

用一个免费的工具，
换全世界最珍贵的医疗临床数据，
换几百万医生的日常使用习惯，
换整个医疗行业对AI的信任，
这笔买卖，怎么算都赚翻了。

为什么这么说呢？
因为AI永远不会取代医生，
但不会用AI的医生，一定会被会用AI的医生彻底淘汰。

一个会用AI的医生，
一天能看原来三倍的病人，
能查到任何一个角落的最新研究
能把所有浪费在文档上的时间，全部还给病人，

所以我相信未来最好的医生，
一定是最会用AI的医生。

他们还顺便发布了一个新的医疗基准测试HealthBench，这才是最狠的一步。

以前的AI医疗评测都是做选择题考试，现在他们直接用真实医生的日常对话当考题。
谁能过这个测试，谁才有资格进医院，OpenAI自己给整个行业定了新的游戏规则。

这已经不是一次普通的产品更新，更像是OpenAI正式从娱乐玩具公司变成核心基础设施公司的标志性时刻。

以前他们做的是写文案，画图，做游戏，现在他们要进医疗，进教育，进所有人类最核心的行业。

当然也有无法回避的问题，AI看错了病，谁来负责？
医生会不会过度依赖AI，
慢慢失去自己的判断力？
这些问题现在都没有答案。

但有一件事是确定的，
医疗行业的效率革命，
从今天起正式拉开序幕了～

[EchoNous @EchoNous_Inc]

Seminario web GRATUITO de una hora, organizado por EchoNous, pionero en ecografía en el punto de atención (POCUS), dirigido a nefrólogos, médicos de urgencias y otras especialidades médicas. Incluido Dr. José de la Flor Merino (@josedelaflora), Dr. Salvador López Gil (@salvadorlgil), Dr. Eduardo Rios Argaiz (@ArgaizR), y Dr. Abel Torrelles Fortuny.

Expertos destacados explicarán cómo la tecnología POCUS más reciente permite evaluar con precisión el estado del volumen de fluidos y realizar una monitorización dinámica no invasiva en los pacientes.
—
FREE one-hour webinar (in Spanish), organized by EchoNous, aimed at nephrologists, emergency physicians, and other
medical specialties. Including Dr. José de la Flor Merino (@josedelaflora), Dr. Salvador López Gil (@salvadorlgil), Dr. Eduardo Rios Argaiz (@ArgaizR), and Dr. Abel Torrelles Fortuny.

Leading experts will explain how the latest POCUS technology enables the precise assessment of fluid volume status and the performance of non-invasive dynamic monitoring in patients.

[鳥好き循内医@開業準備中 @yu_sh02084]

毎朝7時に最新医学論文の要約が届く仕組みを作った。

・PubMedから最新7日分を最大200本収集
・論文タイプ×ジャーナルランク×専門領域でスコアリング
・上位5本をGemini AIが日本語要約
・Word形式でGmailに自動送信
・日替わりでテーマ設定可

費用はほぼゼロ。
GitHub Actions + Gemini無料枠で動く。
導入方法はhttps://t.co/UMbxnQpJd2を参照。

どの専門科でも専門領域を入力するだけで設定生成。
GitHubでコード全部公開。

使ってみた感想や改善点があれば教えてほしいです。

[Luis Paredes @LParedes7972]

@lazy_fatima_ https://t.co/Ny0dbYeUaI

[Stephen W. Smith @smithECGBlog]

Introducing Dr. Smith’s ECG Blog 2.0!

The world’s #1 ECG Blog now features:
- smarter search (try “HATW in aVL”)
- email newsletter for new posts

Join over 200,000 monthly readers on our brand-new custom domain!

[Eduardo R Argaiz @ArgaizR]

Nos vemos el 14 de Mayo!

Webinar gratuito

Registro: https://t.co/TMO6CKvlXl

[Amitabh Yaduvanshi MD, DM, FACC, FSCAI @IntervnCardio]

🚨 𝗕𝗥𝗘𝗔𝗞𝗜𝗡𝗚 from #ACC2026: Two major RCTs just challenged everything we thought about Impella pumps in cardiac care.

The results? Surprising.
The implications? Massive.

A thread on what every cardiologist needs to know 🧵👇

[Time Lens | Tech, AI & World Stories @TimeLens_]

It's a momentous day for healthcare in India, China & Canada today.

With Novo Nordisk's patent for semaglutide officially expiring yesterday (March 20, 2026), several top Indian pharma companies have flooded the market today with generic versions, drastically slashing prices by 50% to 90% compared to innovator brands like Ozempic and Wegovy which traditionally cost between $95-$180 monthly.

[Luis Paredes @LParedes7972]

@drjaimerivera 👀👇

[CardioTeca @cardioteca]

Medio millón de pacientes han recibido un dispositivo Watchman en el mundo. El ensayo más riguroso realizado hasta la fecha acaba de cuestionar que sea la mejor opción para los que más parecían necesitarlo.

https://t.co/uGlj3VF43t

🫀 El CLOSURE-AF compara el cierre del apéndice auricular izquierdo frente al tratamiento médico optimizado en pacientes con FA de alto riesgo de ictus y sangrado.
📊 Resultado: el procedimiento no demostró no inferioridad, con 16,8 frente a 13,3 eventos por 100 pacientes-año en el endpoint compuesto.
⚠️ La tasa de complicaciones periprocedimiento fue del 5,7%, incluyendo taponamiento pericárdico y dos muertes en los primeros 7 días.
🔬 El debate está abierto: edad, fragilidad, dispositivos de nueva generación y seguimiento a largo plazo centran la discusión entre los expertos.
📖 Análisis completo con reacciones de la comunidad cardiológica internacional, en CardioTeca.

[Oliverio @LuisOliverio]

Recién salidas del horno, las Guías AHA 2026, de Dislipidemia. Algunos cambios importantes:

🟢Se eliminan las calculadoras de cohortes, y ahora se prefiere PREVENT. Se reduce también el umbral para iniciar estatinas (algo agresivo a mi parecer): riesgo a 10 años de ≥3%
🟢 Adiós a Friedewald: para la estimación del LDL-C, las ecuaciones de Martin/Hopkins o Sampson/NIH son ahora la recomendación preferida.
🟢 El retorno de Metas absolutas. Muy alto riesgo: LDL <55 mg/dL. Prevención primaria (Riesgo alto ≥10%): LDL <70 mg/dL. Riesgo intermedio 5-<10%: LDL <100 mg/dL
🟢 Se indica medir Lp(a) al menos una vez en la vida en todos. +50 mg/dL aumentan el riesgo cardiovascular relativo en aproximadamente un 40%
🟢Se instaura el modelo CPR (Calculate, Personalize, Reclassify). Si después hay incertidumbre, Score de Calcio (Reclassify) es el desempate. CAC = 0: sin estatinas.

Voy a revisarlas a fondo para actualizar las apps (https://t.co/O3HpYX0dAx).
Pueden bajar el PDF en el canal (https://t.co/3O93s10lns).

[Brendon Neuen @brendonneuen]

Don’t stop SGLT2i when GFR falls below 20ml/min - continue until dialysis/transplantation

New analysis from CREDENCE led by @safchat in @JCardFail

https://t.co/zVCzjkFj4j

[Josh Farkas MD 💊 @PulmCrit]

new AHA/ACC guidelines on pulmonary embolism:

similiar to the Surviving Sepsis guidelines

- overall mediocre
- make some nice points
- most folks will accept them because they’re backed by so many societies
- will cause confusion &amp; delay progress

(blog incoming soon)

[ERM @Owner_X429]

⚠️ The beta-blocker paradox in HFpEF

[Jonathan Chávez @JonathanNefro]

Con diabetes, iniciar iSGLT2, comparado a aGLP1 durante 5 años; ↓19% el riesgo de evento renal mayor y ↓12% el de lesión renal aguda

Una vez más, se demuestra que iSGLT2 son lo mejor

En emulación de ensayo clínico

JAMA Intern Med 2026
10.1001/jamainternmed.2025.7409

[Dr. Filippo Cademartiri @FCademartiri]

🫀🧠 HFpEF is not just “diastolic dysfunction”: the microcirculation is the missing link

This 2025 JACC: Advances state-of-the-art review reframes heart failure with preserved ejection fraction (HFpEF)through a crucial, often underrecognized lens: coronary microvascular dysfunction (CMD) .

📊 How common is CMD in HFpEF? Very.
Up to 75% of HFpEF patients—even without obstructive coronary disease—have CMD. And this is not an innocent bystander:
CMD is independently associated with higher HF hospitalizations
Increased mortality and MACE
Worse quality of life

Yet, CMD is rarely sought and even more rarely diagnosed in routine HFpEF care.

🧠 Why CMD matters pathophysiologically
CMD disrupts the heart at multiple levels:
🔻 Reduced coronary flow reserve (CFR) → subendocardial ischemia
🔥 Microinfarctions & fibrosis → stiff myocardium
⚙️ Impaired cardiac–coronary coupling → blunted flow during stress
🧬 Inflammation & endothelial dysfunction → vicious cycle of ischemia and diastolic failure

HFpEF and CMD reinforce each other in a bidirectional loop, rather than a simple cause–effect relationship.

👩‍⚕️ A sex-specific disease
Women are disproportionately affected:
Higher CMD prevalence
Smaller coronary vessels, higher resting flow
Postmenopausal estrogen loss → inflammation, fibrosis, reduced CFR

This helps explain why HFpEF is more common and more complex in women.

🧪 Diagnosis: we’re under-testing
CMD can be assessed by:
PET or CMR perfusion
Invasive coronary functional testing (CFR, IMR, acetylcholine)

But there is no standardized diagnostic pathway in HFpEF—yet.

💊 Therapy: signals, not solutions
Some treatments show promise (SGLT2i, statins, RAAS modulation, lifestyle, GLP-1/GIP agonists), but no therapy specifically targets CMD in HFpEF so far.

🔮 Bottom line
HFpEF is not only a myocardial disease—it’s a microvascular disease.
If we keep ignoring CMD, we will keep failing HFpEF patients.

👉 Understanding and treating HFpEF may finally require looking beyond the ventricle—into the microcirculation.