roberto waltrick

Cardiologist - Echocardiography- 🇧🇷

[roberto waltrick @WaltrickRoberto]

Carpentier's Classification - Severe Mitral Regurgitation Type IIIb. Systolic leaflet restriction of posterior leaflet secondary evolved inferior STEMI.

[Alexander Mladenow MD @alex1708ander]

@nihar_nayak2 @rohan_rohanhs12 https://t.co/ecbNkTamq4

[Brett Sperry, MD @BrettSperryMD]

Sharing our state-of-the-art review on beta blockers just published in @JACCJournals! Thanks @rcstarling @DLBHATTMD @WilfriedMullens @AndreaRussoEP @MAbdeljawadmd for your expertise!

Key points:
1. Beta-blockers should no longer be prescribed by reflex. The modern question is: Which beta-blocker, for which patient, for which indication, and for how long? We propose an indication- and phenotype-based approach.

2. Beta-blockers do more than slow the heart rate. Blocking cardiac β1 receptors reduces heart rate, contractility and oxygen demand, while blocking β1 receptors in the kidney’s juxtaglomerular apparatus suppresses renin release.

[Gregg Fonarow MD @gcfmd]

🫀💊 HF care has flipped

🚫 No more slow, one-drug-at-a-time titration over months

The new standard = all 4 pillars FAST 🚀 (Greene/Butler/Fonarow)

🔹ARNI 🔹β-blocker 🔹MRA 🔹SGLT2i

🏥 STRONG-HF (inpatient) + 🏡 SHORT (outpatient):
🎯 all 4 drugs ASAP

📉 >75% ⬇️ ☠️/HF🏨

[Alexander Mladenow MD @alex1708ander]

Valve imaging in TEE starts with the correct orientation. Keep in mind that during tricuspid valve surgery, the valve is typically oriented in the SURGEON’S view. This orientation differs slightly from that used for TEE-guided structural heart interventions #echofirst

[Dr. Gilbert Tang @GilbertTangMD]

JUST OUT @JCardFail Journal of Cardiac Failure! Our review on the latest evidence on pharmacotherapy in #aorticstenosis and #TAVR. Congrats @sunnygoelmd , #TakayukiOnishiMD, et al for leading this tremendous effort!

Download for FREE here:
https://t.co/kh9zpDSt64

@DoctorKini @georgedangas @AmithoodaMD @KHERA_MD @NoahMossMD @Jcontreras75 @DLBHATTMD @DrDavidReich
@MountSinaiHeart
@MountSinaiNYC
@IcahnMountSinai

[Ahmed Bennis MD 🫀 @drbennisahmed]

HFPEF 2026 ACC Expert Consensus Decision Pathway

Noncardiac mimics? — If a primary noncardiac condition explains symptoms → “symptoms primarily from” pulmonary disease, kidney disease, high-output states (liver disease, anemia), obesity, or frailty/deconditioning.

[Ahmed Bennis MD 🫀 @drbennisahmed]

This is a treatment algorithm for optimal therapy in HFpEF

Under SGLT2i:

Fluid retention → titrate diuretic agent

BMI ≥30 → add incretin-based therapy (e.g., GLP-1 agonists)

Women (any EF), men with LVEF <55–60%, or hypertension → add ARNI

https://t.co/LtDakOyxO1

[EHJ-IMP Editor-in-Chief @EHJIMPEiC]

🫀📡 The stethoscope is evolving… and it’s now an ultrasound probe.
A new review highlights how Point-of-Care Ultrasound (POCUS) is transforming bedside cardiopulmonary diagnosis 👇
✨ Key insights:
⚡ POCUS = real-time, bedside, physiology-driven imaging
🫁 Lung ultrasound (LUS) → detects congestion better than CXR & exam
🩸 VExUS score → quantifies systemic venous congestion
❤️ FoCUS + LVOT-VTI → assess structure, function & cardiac output
🔄 Enables dynamic monitoring and therapy guidance
💡 As shown in the graphical abstract (page 2):
👉 HF, STEMI, shock → one tool, multimodal assessment
👉 From congestion ➝ to perfusion ➝ to haemodynamics
🚨 Clinical message:
Traditional exam = limited sensitivity
POCUS = immediate + actionable information
Not a replacement… but a powerful extension of clinical reasoning
🎯 Big take-home:
From “suspecting haemodynamics”
➡️ to
“seeing haemodynamics at the bedside”
📄 Read the full paper:
👉
🔗 DOI: 10.1093/ehjimp/qyaf147
#Cardiology #POCUS #Echocardiography #HeartFailure #CriticalCare #Ultrasound #CardioTwitter #MedTech #BedsideMedicine #DigitalHealth 🩺📊

[Nicolas Merke @NMerke]

In #echofirst it is pivotal to be aware of the settings of the machine to ensure that our results can be trusted
In national & international meetings I do miss this in echo based talks almost always
@EACVIPresident @escardio
My Conflict of Image Quality
Frequency
•2D Imaging: 1.4/2.8 MHz
•2D Color: 2.3 MHz
Frame Rate
•2D Imaging: ~50 FPS
•2D Color: 25–30 FPS
•3D (LV EF): 20–25 FPS
•3D Valve : 20–30 FPS
•3D Color: 20–25 FPS
Image quality requires balancing frequency, frame rate, spatial resolution, and temporal resolution. Optimizing one parameter often comes at the expense of another.

[Alexander Mladenow MD @alex1708ander]

@TrackYourHeart Nice overview. With 3D TEE, you can display all three standard views simultaneously. If you don’t have a 3D probe, you can systematically assess all three mitral valve scallops in 2D TEE by advancing and withdrawing the TEE probe #echofirst

[Vladyslav Kavalerchyk 🇺🇦 @echo_stepbystep]

Current #guidelines recommend the mitral inflow/LVOT VTI ratio as an easy-to-measure semiquantitative index for isolated primary MR (>1.4 severe, <1 mild). But how robust is the evidence behind it? Let's take a closer look at this widely cited parameter. #EchoFirst Part 1

[Munir S Janmohamed MD FACC, FHFSA @MunirJanmohamed]

🔥 New in @JACCJournals #HF — SMR Trajectories & GDMT in HFrEF

🔑
❤️ 32% had significant SMR at baseline
📉 GDMT optimization → dropped to 21%
✅ 57.5% of significant SMR improved
⚠️ Persistent SMR → 60% ↑ mortality
💡 GDMT first -TEER if SMR persist

https://t.co/ecK1z02gdE

[IP Capital Partners @IPCapitalPart]

O diagnóstico de Carnell é que o sistema de saúde foi construído para reagir a doenças, não para preveni-las. Cada etapa, da consulta à farmácia, foi desenhada para o paciente que já está doente. Não para o que ainda pode não ficar.

[Sara Moscatelli @saramoscatelli7]

🫀 New multicentre international study on HCM with apical aneurysms
A large cohort of 510 patients with hypertrophic cardiomyopathy (HCM) and left ventricular apical aneurysms has provided important insights into risk stratification and clinical management.
🔹 Key findings:
• The annual rate of life-threatening ventricular arrhythmic events was 2.1% per year.
• Risk increased progressively with aneurysm size:
<10 mm: 0.2%/year
10–19 mm: 2.3%/year
20–39 mm: 3.0%/year
≥40 mm: 8.2%/year
• Aneurysm size independently predicted ventricular arrhythmias, even after adjustment for traditional risk markers and ESC risk scores.
• Apical thrombus or thromboembolic events occurred in 13% of patients and were also strongly associated with larger aneurysm size.
• Small aneurysms (<10 mm) were associated with a relatively low arrhythmic risk, whereas aneurysms ≥10 mm identified a substantially higher-risk population.
📌 Clinical implications:
This study supports the concept that apical aneurysms are not all equal. Aneurysm size appears to be a key determinant of both arrhythmic and thromboembolic risk, potentially influencing decisions regarding ICD implantation, anticoagulation, and follow-up strategies.
#HCM #HypertrophicCardiomyopathy #Cardiology #CMR #CardiacImaging #SuddenCardiacDeath #Electrophysiology #JACCAdvances #RiskStratification

[Alexander Mladenow MD @alex1708ander]

In the rare world of mechanical tricuspid valve prostheses, leaflet orientation becomes the compass

Test your TEE orientation skills #echofirst

Based on this ME 4Ch view what is the leaflet position? 1️⃣2️⃣3️⃣
@iamritu @CASivaram1 @DrRajeshG1 @dr_benoy_n_shah @bwoody58 @argulian

[Alexander Mladenow MD @alex1708ander]

Think spatially #echofirst

The leaflet orientation of the mechanical mitral valve prosthesis on 3D echocardiography can be predicted from the 2D TEE image.

@CASivaram1

[Brian Wood @bwoody58]

Marantic Endocarditis #echofirst kissing lesions @iamritu @alex1708ander @StellEkaterina

[CardiovascularCorner @TrackYourHeart]

Ventricular Septal Defects (VSDs) Explained!

The ventricular septum is divided into four key regions: inlet, trabecular, outlet, and membranous. A VSD is an abnormal opening in this septum, allowing blood to shunt between the LV & RV.

Types of VSDs & Their Locations:
⚪ Perimembranous (pmVSD): Below the aortic valve, near the membranous septum
🔴 Muscular (mVSD): Located in the trabecular septum; can be multiple (Swiss-cheese VSD)
🟢 Inlet (iVSD): Near the AV valves, often linked to endocardial cushion defects
🔵 Supracristal (scVSD): Just below the pulmonic valve, may lead to aortic regurgitation

How Do We Diagnose VSDs?
Echocardiography plays a key role! Different echo views help identify VSDs:
🔺 Parasternal long-axis: Best for pmVSD & mVSD
🔺 Parasternal short-axis: Locates pmVSD (10 o’clock) & scVSD (1 o’clock)
🔺 Apical 4-chamber: Ideal for detecting inlet & apical muscular VSDs

Why does this matter?
VSD size, location, and associated defects determine hemodynamic impact & management! Some close spontaneously, while others require surgical or percutaneous closure.

Understanding VSDs = Better diagnosis & treatment!

[Corrado Fiore @fiore_corrado]

💡TIPS and TRICKS

2D/3D TOE : a mobile echodense mass (red arrow) within the transverse sinus of the pericardium (blue arrow, 3D Flexi-light)

•DIAGNOSIS: fat within the transverse sinus. NO left atrial appendage thrombosis! #echofirst

•Do not forget pericardial sinuses! --> https://t.co/9qgOjiyCym
--------------------------------------------
Do not miss our next course MICS Echo Lab & Live Surgery 6-7 June in Rome - Ospedale San Carlo di Nancy.

[Priscilla Wessly @PWesslyMD]

💎 Arrhythmic MVP is characterized by ventricular arrhythmias and sudden arrhythmic death.
This infographic 👇 highlights the 🔑 clinical, ECG, echocardiographic, and CMR markers associated with ⬆️arrhythmic risk in MVP.
🎯 Risk stratification requires looking beyond the valve.
#ASEchoJC #EchoFirst #CardioX #MVP @ASE360 #EPeeps