Dr. Alex Ezquerra

🩺 Internal medicine, cardiologist, coronary care unit //🚑 EMT // Proudly mexican 🇲🇽 // Tweets are my own….. ACVC_ESC Social Media Ambassador

[Juan Pablo Costabel MD 🇦🇷 @jpcostabel]

Buen trabajo que parece mostrar cuál es el nivel ideal de potasio seríco en pacientes con IC.
No parece lo mismo según el perfil del paciente
https://t.co/FXG28oX9Ju

[Cherska Mariia @cherskams]

CAC score or CCTA?
#eas2026 #eascongress2026

[Ahmed Bennis MD 🫀 @drbennisahmed]

The gap between evidence and practice:
• BB: proven 1996 → use rate 73%
• ARNI: proven 2014 → use rate 67%
• MRA: proven 1999 → use rate 36%
• SGLT2i: proven 2019 → use rate 34%
• All 4: use rate 18%

This is the defining implementation failure of modern cardiology.

[Dr. Kevin Buda @DrKevinBuda]

How do you handle patient selection for VA ECMO in pulmonary embolism? See our systematic review & guide to patient selection in @JCFINT!

🚦Green/Yellow/Red triage: Structured guidance to avoid futile cannulation while acting early.
🫁Why avoiding sedation/intubation is vital to prevent cardiovascular collapse.
🩸Hybrid ECMO with clot removal strategies.

👉https://t.co/s3BbsrTvp0

[Heart_BMJ @Heart_BMJ]

Intracoronary imaging plaque vulnerability characteristics predictors of adverse events: an updated meta-analysis of adjusted observational studies https://t.co/NAVc8f6uJV

[American Society of Echocardiography @ASE360]

We quantitatively assessed the degree of echogenicity in the proximal and mid segments of both coronary arteries to determine its additional diagnostic value in 109 patients with clinically suspected Kawasaki disease.

Read our @JournalASEcho article: https://t.co/fYoKY23ayt

[Ahmed Bennis MD 🫀 @drbennisahmed]

🌳 DECISION/DIGIT-HF/DIG — Study-level meta-analysis (~9,000 patients)

When you pool all the digitalis glycoside RCT evidence, the picture becomes much clearer. Presented by Kevin Damman at #HeartFailure26

📊 Primary endpoint (CV death or first worsening HF event):
• DIG (1997): HR 0.85 [0.79–0.91]
• DIGIT-HF (2025): HR 0.85 [0.71–1.02]
• DECISION (2026): HR 0.83 [0.66–1.05]
• OVERALL: HR 0.85 [0.80–0.90], P < 0.001 ✓
I² = 0% — zero heterogeneity

📊 Secondary endpoints:
✅ First worsening HF event: HR 0.75 (0.75–0.81), P < 0.001
❌ CV death: HR 0.99 (0.92–1.07), P = 0.81
✅ All-cause death or worsening HF: HR 0.85 (0.80–0.90), P < 0.001
❌ All-cause death: HR 0.97 (0.90–1.04), P = 0.41

🔑 The meta-analytic verdict:
✅ Digitalis reduces HF events & composite outcomes significantly
❌ No mortality benefit (CV or all-cause)
✅ Zero heterogeneity — consistent effect across all three trials, eras, and doses

The drug works for congestion & worsening HF. It doesn't extend life. That's the honest summary of ~30 years of evidence.

#Digoxin #DIG #DIGITHF #DECISION #MetaAnalysis #HeartFailure2026 #CardioTwitter

[Ahmed Bennis MD 🫀 @drbennisahmed]

Unexplained dyspnea? Here’s the new ESC framework for diagnosing HFpEF — and it goes way beyond a basic echo 🧵
From Landsteiner et al., Eur Heart J 2026, a stepwise domain-based approach

[Samuel Hume @DrSamuelBHume]

The new weight loss drugs are roughly as effective for blood pressure-lowering as anti-hypertensives:

[Beverly G. Tchang, MD @BevTchangMD]

Fantastic summary of #obesity care at the intersection of ❤️ disease and kidney disease from @MWeintraubMD at the @columbia @Weillcornell Obesity #Medicine Conference 👉 https://t.co/PglY7gk82X

If you missed this, on-demand recordings will be available after the course ends tomorrow!

#CKD #CVD #cardiotwitter #health #metabolism #CKM

[Novi Yanti Sari @slumberbell]

🫀 What happens when long-term low-dose #digoxin is suddenly withdrawn?
Blinded withdrawal analysis from the #DECISION trial presented at #HeartFailure26 by Prof. Peter van der Meer:

📍Digoxin withdrawal was associated with a ~7x increase in worsening HF events over just 6 weeks
📍14 worsening HF events occurred after digoxin withdrawal vs only 2 events in placebo withdrawal
📍Withdrawal was accompanied by: ⬆️HR,⬇️ SBP, ⬆️NT-proBNP, ⬇️eGFR
📍⚠️caution when stopping long-term low-dose digoxin in pts with HF & LVEF <=50%

@escardio @HFA_President @jozinetm

[Ahmed Bennis MD 🫀 @drbennisahmed]

The potassium concern with MRAs — how real is it? 🫀
#HeartFailure26 | Anne-Christine Ruwald
Jhund et al. Lancet 2024
Across RALES, EMPHASIS-HF, TOPCAT and FINEARTS-HF:
⚠️ Severe hyperkalaemia (>6.0 mmol/L):
• RALES: 4% vs 1% (OR 3.75)
• EMPHASIS-HF: 3% vs 2% (OR 1.37)
• TOPCAT: 2% vs 1% (OR 2.53)
• FINEARTS-HF: 3% vs 2% (OR 2.07)
Real signal — but absolute rates remain low (<5%) across all trials.
✅ The other side of the coin — hypokalaemia (<3.5 mmol/L):
• MRA halved hypokalaemia rates: 7% vs 14% (FINEARTS-HF: 5% vs 10%)
This matters. Hypokalaemia in HF is dangerous — arrhythmias, sudden death.
MRAs increase hyperkalaemia risk modestly, but significantly protect against hypokalaemia.
The net potassium balance may actually favour MRA use in selected patients — particularly those at risk of low potassium on loop diuretics.
Monitor potassium. Don’t fear MRAs.
#MRA #Finerenone #HFpEF #Hyperkalaemia #HeartFailure #Cardiology #ESC #HeartFailure26

[Ahmed Bennis MD 🫀 @drbennisahmed]

⚠️ Low BP in HFrEF — should it stop us from using GDMT? Data says: probably not.
From COPERNICUS, PARADIGM-HF, RALES/EMPHASIS-HF & DAPA-HF:
✅ Carvedilol beneficial even at SBP 85–95 mmHg
✅ Sacubitril/Valsartan consistent across all BP strata
✅ MRA & SGLT2i similarly effective in low BP groups
Low SBP is a reason to be careful — not a reason to stop. 💡
#HeartFailure26 #HF2026 #HFrEF #GDMT #Cardiology

[Pablo Corral MD @drpablocorral]

🙌 Our last manuscript is out.

👉“Safety of Very Low LDL-Cholesterol:
Ten Common Concerns, Misconceptions, and Evidence-Based Clarifications”

📍Very low LDL-C levels continue to generate debate, fear, and misinformation in clinical practice.

📍In this review, we critically examined 10 of the most frequent concerns related to intensive LDL-C lowering:
— Cognitive decline
— Hemorrhagic stroke
— Cancer
— Cataracts
— Hormonal dysfunction
— Diabetes risk
— Muscle symptoms
— Older adults
— Sex differences
— Overall cardiovascular benefit

📍The key message is clear:
RCTs, meta-analyses, and genetic evidence consistently support the safety profile of very low achieved LDL-C levels in appropriately selected high-risk patients.

📍Some adverse effects are real — particularly statin-associated dysglycemia and muscle symptoms — but their absolute risk is generally modest compared with the magnitude of ASCVD risk reduction.

📍Therapeutic inertia and misinformation remain major barriers in preventive cardiology. Evidence-based communication matters.

📍Lower LDL-C. Earlier. Longer. Safer than many still believe.

☝️Proud to collaborate with outstanding colleagues from Latin America, Europe, and beyond in this international effort.

🔗 https://t.co/zEMcECn9El

@society_eas
@ATHjournal

[Ahmed Bennis MD 🫀 @drbennisahmed]

Are all MRAs equal? Short answer: no. 🫀
#HeartFailure26 | Anne-Christine Ruwald
Harrington JL et al. JACC Heart Fail. 2025;13(10):102637
Steroidal MRAs (spironolactone, eplerenone) vs Non-steroidal MRAs (finerenone, balcinrenone, aparenone, esaxerenone)
Key differences:
🔵 Steroidal MRAs:
• Higher binding in kidneys vs heart
• More off-target binding → increased side effects (gynecomastia, hyperkalemia)
• Clinical data: benefit in HFrEF ✅ | Role in HFpEF unclear ❓
🟠 Non-steroidal MRAs:
• More even distribution between heart and kidneys
• More potent MR antagonism
• Clinical data: Role in HFrEF unclear ❓ | Benefit in HFpEF ✅
The pharmacological differences are not trivial — tissue distribution, specificity, potency, and tolerability all differ.
Fascinating inversion: sMRAs work in HFrEF, ns-MRAs work in HFpEF. Same target, different patients, different drugs.
The MRA class is not one-size-fits-all.
#MRA #Finerenone #HFpEF #HFrEF #HeartFailure #Cardiology #ESC #HeartFailure26

[International Journal of Stroke @IntJStroke]

🫀🧠Atrial fibrillation detected after stroke or TIA (AFDAS): A systematic review and meta-analysis

📊AFDAS common but prevalence varied depending on monitoring duration and modality

Read more here!👇 https://t.co/NJjK1CLz35 @ghassaba03

[European Society of Cardiology @escardio]

Vapes, pouches, heated tobacco, shisha, cigarettes: nicotine in all forms is toxic to the heart and blood vessels
Experts call for Europe-wide action to stem new wave of youth addiction https://t.co/rv6zpzUy04

#EHJ #cvprevention #Nicotine #CardiovascularHealth #PublicHealth #HeartDisease #HealthAwareness #TobaccoControl @ESC_President @sanjay_MD1 @ehj_ed

[JAMA Cardiology @JAMACardio]

RCT: Among patients with obstructive prosthetic heart valve thrombosis, tenecteplase achieved higher complete thrombolytic success (97.5%) than alteplase (81.5%) and a shorter hospital stay. https://t.co/5XoQ6k29v2

[Gonzalo Perez @gonzaeperez]

Congreso #SAC25

Los únicos fármacos que reducen triglicéridos y que demostraron beneficio 🫀 son aquellos que incluyen estatinas (⬇️LDL) e eicosapento de etilo
LOS FIBRATOS NO HAN DEMOSTRADO BENEFICIO CARDIOVASCULAR

Dr. @ezeforte

@SAC_54

[Dr. Alex Ezquerra @dr_ezquerra]

@anacazarest Estimada Anaaa! Gusto saludarte, no sabía que andabas por ahí 🚑 . Ya no estaremos escuchando.

Qué turnos tienes?