Benigno Valderrábano Salas

Cardiologist and echocardiographer at @RespiraINER #Echofirst #POCUS

[HFAPresident @HFA_President]

🫀Pharmacological treatment strategies to prevent #heartfailure across the cardiovascular-kidney-metabolic spectrum, an EJHF expert consensus statement:

📍Identify individuals at risk of developing HF:
- Type 2 diabetes
- Chronic kidney disease ± albuminuria
- Hypertension and obesity
- Atherosclerotic cardiovascular disease
- Metabolic dysfunction-associated steatotic liver disease

📍Four foundational pharmacological strategies:
💊RAS inhibitors (ACEi/ARBs)
💊SGLT2 inhibitors
💊Non-steroidal MRAs (finerenone)
💊Incretin-based therapies (GLP-1 RAs and dual GLP-1/GIP agonists)

📍Early, accelerated treatment implementation:
- Initiate complementary therapies early rather than delaying until clinical deterioration
- Titrate rapidly and avoid unnecessary discontinuation
- Individualize treatment according to clinical phenotype, risk, and tolerability

📍Structured monitoring and multidisciplinary care:
- Laboratory monitoring at 1-4 weeks
- Reintroduce therapies following temporary interruption when appropriate
- Support nurse/pharmacist-led titration, digital monitoring, and patient education

📍Overcome implementation barriers:
- Clinical inertia and polypharmacy
- Renal safety concerns
- Treatment costs and inequities
- Fragmented healthcare delivery

Read more in #EJHF @EJHFEiC : https://t.co/mgYEwmuNHh

@escardio #HFA_ESC #HF #CKM

[Critical Care Reviews @CritCareReviews]

Comprehensive Echocardiographic Assessment of Right Ventricular Afterload and Right Ventricular–Pulmonary Arterial Coupling in the Intensive Care Unit

CCR Journal Watch
https://t.co/Sp06oA6IDG

[Eddy J. Gutierrez, MD @eddyjoemd]

Your patient's RV is dilating while the MAP sags. Do you give fluids, pressors/inotropes, an inhaled pulmonary vasodilator, or reach for a device? This long, thorough review sorts it out by phenotype. 🎩 tip to the authors.
https://t.co/sSr8PFAqru

[@giovolpicelli @giovolpicelli]

A concise overview of the most significant new recommendantions on clinical lung ultrasound #LungUltrasound #PoCUS #CriticalCare
https://t.co/nMz5pnyh3h

[Jorge Faerron @cardiopedhnn]

Acute #heart_failure in emergency settings.

https://t.co/eIKVxiaHVb

[Gregg Fonarow MD @gcfmd]

💊 Does stopping cardiovascular meds make patients feel better?

🔬 6 deprescribing RCTs, 3,748 older/frail patients

😐 QoL better in just 1 of 5

⚠️ Adverse events reduced: 0 of 6

⚖️ Death/hospitalization better: 0 of 6

🚫 Rarely helpful 😳

#Deprescribing

[Henry Han @HanCardiomd]

Temporary mechanical circulatory support in cardiogenic shock: A clinical consensus statement of the (#EAPCI) and the (#ACVC) of the ESC

https://t.co/N14Z31rizh

@ESC_Journals #MCS

[Ross Prager @ross_prager]

Being "intravascularly dry" in the ICU is way rarer than most clinicians think.

Most of the time its mistaking other conditions/circumstances 👇

[Carlos El-Tallawi, MD, FACC, FASE @HeartToProve]

🎯 Less is more in mitral regurgitation assessment

In 177 patients undergoing near-simultaneous Echo & CMR, just 2 ASE criteria identified significant MR with 91–95% specificity.

🫀 Smarter integration, less quantification, greater diagnostic confidence

https://t.co/iFv3BRTsQJ

[Daniel Pita, MD @danpita]

🫀My Approach to Echocardiographic Assessment of Left Ventricular Filling Pressures: From Ambiguity to Precision With New Guidelines @DICSBC #echofirst #cardiology #diastolic

🔗 https://t.co/KeDGr0XG9u

[JACC Journals @JACCJournals]

The 2026 ACC Expert Consensus Decision Pathway on Management of Heart Failure With Preserved Ejection Fraction is here! What’s new in #HFpEF management? Read here: https://t.co/HEg6SDfzVo

#JACC #CardioX

[Johann Bauersachs @JBauersachsMD]

Now fully published ‼️

@EJHFEiC @ehj_ed @ESC_Journals @WilfriedMullens @DavidDuncker @HenrikeHillmann @Sliwa1Karen @markcpetrie20 @luedike @MG_Crespo_Leiro @TRassafMD @SamuelSossalla @PfefferMD @Herzmedizin_de @Herzstiftung

[Jorge Faerron @cardiopedhnn]

The Athletes #ECG
State of the art review

https://t.co/0wmQYAbd4S

[Edgar Argulian @argulian]

An elderly patient with frequent falls in the emergency room. Is a single echo clip diagnostic?

[AHA Science @AHAScience]

Antiplatelet therapy is foundational for acute coronary syndromes (ACS) and chronic coronary disease (CCD), but medication selection, dose, and duration should be individualized by thrombotic and bleeding risk.

Guideline-based therapy remains the foundation of antiplatelet management, with dual antiplatelet therapy (DAPT) duration and P2Y12 inhibitor selection tailored to the clinical scenario.

This scientific statement reviews contemporary antiplatelet management in ACS and chronic coronary disease, emphasizing individualized thrombotic and bleeding risk assessment, multidisciplinary care, and antithrombotic stewardship across the care continuum.

📷 Multidisciplinary care in antithrombotic management of acute coronary syndrome and CCD.

Link in replies.

[Jorge Faerron @cardiopedhnn]

State of the Art Review

https://t.co/PjjdWxBjcE

[Ross Prager @ross_prager]

Its not about more or less fluids. Its about giving patients the right hemodynamic support based on their physiology!

Some patients in early septic shock are:
1. Fluid responsive with low SV --> fluids
2. Fluid unresponsive with low SV --> pressors, inotropes
3. Fluid responsive with high SV --> pressors
4. Fluid unresponsive with high SV --> pressors
5. Congested --> inotropes + diuresis
6. Impaired microcirculation with hemodynamic coherence --> fix macrohemodynamics
7. Impaired microcirculation with hemodynamic incoherence --> MAP target, avoid edema, other? (anticoagulation)

We need to stop treating "septic shock" as hemodynamic paradigm.

[Benigno Valderrábano Salas @MDBeni]

The most likely pattern is S < D. The antegrade wave with the higher velocity is also the longer one, which is typical of diastole. Moreover, this wave precedes the retrograde wave with the highest velocity and longest duration, which usually corresponds to the A wave (atrial contraction). In addition, during the second cardiac cycle, both the S and D waves increase in velocity, and the retrograde wave increases concomitantly. This suggests elevated right-sided filling pressures, which would explain both the S < D pattern and the larger inspiratory A-wave reversal, as the right ventricle cannot accommodate the inspiratory increase in venous return

[Dr. Purvi Parwani @purviparwani]

🫀 Are we measuring pericardial effusions the wrong way?

We routinely classify pericardial effusions as small, moderate, or large based on linear measurements.

But does a single measurement in millimeters accurately represent the actual volume of pericardial fluid?
Study in @JournalASEcho challenges this

https://t.co/rRPvXe1xMI

🔬 245 patients undergoing pericardiocentesis

Median drained volume: 500 mL (range 50–4,300 mL)
76.7% had cardiac tamponade
Actual drained volume served as the reference standard.

📊 How did different echo methods perform?

Between end diastolic thickness, plax and PSAx area- apical 4 chamber Simpson’s volumetric estimation performed the best

✅ Accuracy: 80.4% vs 49.4%

Perhaps it is time to rethink how we quantify pericardial effusions!

💡 if volumetric assessment is substantially more accurate, should we move from millimeters to milliliters in routine echocardiography?

And more importantly, would this change clinical decision-making—or simply improve the precision of our reports?

#EchoFirst #CardioTwitter #CVImaging

[Yogesh Reddy @yreddyhf]

Historically we compute PVR in HF by ignoring the V wave, but this makes little sense since it is an important component of downstream LA pressure. @CircAHA we show how accounting for this dramatically decreases prevalence of cpc PH HFpEF - much rarer than prior estimates