Eby Daniel

Cardiology | CMC Vellore 🫀Passionate about Cardiac Imaging 👨‍👩‍👧 Father | Husband | A bit of #photography #aquascaping📍 🇮🇳 | #echofirst #whycmr

[Hany Ragy @Hragy]

As a cardiologist, I can see the organ I am specialized in in a most amazing way, in 1984 I saw my first ever 2 D Echo in mitral stenosis , I had been diagnosing it by auscultation till then, it was love at first sight, and a game changer… what do you see here?

[American College of Cardiology @ACCinTouch]

The cardiology community has lost a giant. We honor the extraordinary legacy of Eugene Braunwald, MD, MACC, a visionary leader and pioneer whose outstanding contributions shaped the foundation of cardiovascular medicine as we know it today.

Read more: https://t.co/uaC2n4m5gD

[Eby Daniel @EbyDan2007]

Take-home

• Not everyone needs CMR
• Use it selectively—but use it well
• Detect subclinical injury early
• Guide therapy decisions

⚠️ In ICI myocarditis → early diagnosis = life-saving

👉 Right patient. Right time. Right modality.

[Eby Daniel @EbyDan2007]

Practical use of CMR

Most patients → Echo + biomarkers

CMR in selected cases:
• Suspected myocarditis (esp. Immune check point inhibitors)
• Discordant findings
• Unexplained troponin rise
• Radiation / infiltrative disease

📌 Protocol: Cine + T1/T2 ± LGE (tailored to indication)

[Eby Daniel @EbyDan2007]

An interesting talk by @barthur_ashita on role of cardiac MRI in #cardioOncology
#Cardiooncology is not about more imaging—it’s about the right imaging.

With rising cancer survival → CV toxicity is increasing.

But we can’t do CMR for everyone.

👉 So where does CMR actually fit?

#CardioOncology #whycmr @IaciIndia @SCMRorg

[Eby Daniel @EbyDan2007]

CMR: where it adds value

✔ Gold standard volumes & function
✔ High reproducibility
✔ Tissue characterization (edema, fibrosis, inflammation)

👉 Not a screening tool—
👉 A precision tool for problem-solving

[Eby Daniel @EbyDan2007]

https://t.co/vpoCFGNI9k

[Eby Daniel @EbyDan2007]

Amazing work by @qzhang_cs
Cardiac MRI:
No contrast. No delay. Still LGE. 🤯

AI-powered Virtual Native Enhancement (VNE) reconstructs scar imaging from native CMR data.

→ Faster scans
→ No gadolinium
→ Strong agreement with LGE

We might be looking at the future of CMR workflows.

[Eby Daniel @EbyDan2007]

🧠 Why CMR is a game-changer

One scan gives:
✔ Morphology
✔ Function
✔ Tissue characterization
✔ Malignancy prediction

👉 Truly a “one-stop shop”

[Eby Daniel @EbyDan2007]

🫀 Cardiac masses on CMR by @vineetao17 — a simple algorithm that can save you from major diagnostic errors @SCMRorg

Most common cardiac mass?
👉 NOT tumor
👉 It’s thrombus

Here’s a practical way to approach every case 👇

#CardioTwitter #whyCMR

[Eby Daniel @EbyDan2007]

⚡ Step 3: Benign vs Malignant

🔴 Red flags for malignancy:
•Right-sided (RA 👀)
•Irregular, infiltrative
•Multi-chamber involvement
•Pericardial effusion
•Perfusion + heterogeneous LGE

👉 Score ≥5 (CMR mass score) = likely malignant

[Eby Daniel @EbyDan2007]

Pericarditis: where CMR really shines 🔥

✔ LGE = active inflammation
✔ ↓ LGE over time = treatment response

⚠️ Trick:
Pericardial fat ≠ inflammation

👉 Use fat-sat PSIR
•Signal disappears → fat
•Persists → inflammation

💡 CMR = diagnosis + disease activity + guidance

[Eby Daniel @EbyDan2007]

CMR in Myocarditis & Pericarditis — what actually matters in practice by Dr. Vanessa Ferreira #whycmr @SC@SCMRorg @vineetao17

From the #AdvancedCMR course 👇

👉 We’ve moved from qualitative imaging → quantitative tissue characterization

And CMR is now a pivotal test, not just supportive.

Let’s break it down 🧠⬇️

[Eby Daniel @EbyDan2007]

📊 ACC 2024:
👉 CMR = PIVOTAL diagnostic test
•Combines:
•Edema (T2)
•Injury (T1/LGE)
•Alongside biomarkers ± biopsy

💡 We’ve shifted from:
“Maybe CMR” → “Do CMR early”

[Eby Daniel @EbyDan2007]

Key takeaway:
👉 Don’t just treat the EF
👉 Don’t just label “DCM”
Diagnose the disease behind the dilated LV
Because sometimes—
you’re not treating heart failure…
you’re treating a curable condition.

[Eby Daniel @EbyDan2007]

From @chiarabd’s talk on approach to left ventricular dilatation and phenocopies in the advanced CMR Workshop #whycmr @SCMRorg @vineetao17

[Eby Daniel @EbyDan2007]

LV thinning doesn’t always mean non-viability in ischaemic cardiomyopathy