Batman-Echo

“Spread the echo, not the virus”

[Batman-Echo @echo_batman]

@kaulcsmc Progress:
1. symptoms causal? (HFpEF, …)
2. will pseudomoderate AS be excluded?
3. most likely neg study unless “subtraction anxiety-symptoms” in control seen as event

[Batman-Echo @echo_batman]

@argulian Biggest weakness is that it lacks pre discharge CMR. Second, testing post aSTEMI may need more granular approach as systematic testing will inevitable lead to unneccesary antocoagulants (in combination with DAPT), ie. clinically false positives…

[Batman-Echo @echo_batman]

Regarding PISA on ecc. jets: what about Mayo data showing strong outcome data in prim MR using PISA ( including many ecc jets).. in the limitations session of Antoine C. et al Circulation, the following is mentioned: “with the flow convergence method method used in 2622 patients, quantitative Doppler in 1193, and both in 1155, which reflects routine practice. Nevertheless, by either method, EROA was independently linked to survival (both P<0.01)”‘

Like many echo methods-parameters work well on population level, the “number needed to echo” to demonstrate predictive power remains unknown/difficult to address.
Fully aware of the limitations on PISA Nicolas and much appreciate your opinion and experience., but we need more echo-based comparative studies in consecutive pts to better shape and instruct clinical practice in this era before we throw the kid with the bathwater. As for now, multi method and parameter appraches remains the golden approach.

[Batman-Echo @echo_batman]

Yet, the proof of the pudding will be in the eating and by now, volumetrics need further prove; on the other hand, most previous prim MR studies have used the mathematical average EROA/RegVol obtained from combined methods (Doppler, volumetric and PISA). I think only 3-4 studies have used PISA as stand alone in prim MR outcome studies. Volumetric method as stand alone in prim MR demonstrating association with outcomes: I think only one small study (comparing with PISA)….

[Batman-Echo @echo_batman]

@jaumeaguero @NMerke @argulian @Ph_Bertrand @dr_benoy_n_shah The main Q is when one method may be or may not feasible at individual level.

[Batman-Echo @echo_batman]

We betalen her gelag van (1) decennia lang uit de hand gelopen TLC-beleid, (2) een ziek politiek systeem, (3) het feit dat we veel uitbesteed (verkocht) hebben zoals onze maak en doe -economie, (4) een geldverslindende, disprportionele overheidsdienst, (5) de groeiende economische concurrentie die ons doet kraken en (6) het geld dat Europeanen in Belgie komen verdienen maar hier niet uitgeven.

[Batman-Echo @echo_batman]

@GeertNoels Alleen al afschaffen van kinderbijslag voor deze welke het echt niet nodig hebben (= nutteloze uitgaven) lost al een miljarden vraagstuk op. Hoe het ‘gelijkheidsprincipe” pbsoleet werkt.

[Batman-Echo @echo_batman]

My highlights on this study:
1. Statistical sign. # biolog or clinical sign
2. How can such a paper be accepted when guidelines strongly state to perform bicycle stress testing to ensure non obstructive nature of HCM in LVOT?
3. MVO pts are categorized as non-obstructive but are to me obstructive pts and were included, whatever the gradient.
So, is this a paper playing with stats and terminology to favor a farnacon?

[Batman-Echo @echo_batman]

In many pts, M mode does not achieve perpendicularity; in addition many LV’s have inhomogenous shapes which does not allow accurate neasures; also, it can sometimes be tricky to delineate the true LV border with M mode. Finally, measuring at MV tips may seriously underestinate true dinension/LV mass estimation in non homogenous LVs (a JASE paper found better CMR LV mass correlates with midventr measures vs. MV tips).
So: is M-mode bad? Not at all, use or choose it when most convenient, but in those cases, 2D also 👌. Because I encounter more unconvenient ones —> 2D is better option.

[Batman-Echo @echo_batman]

@Becho2106 @BiancaJudyC @iamritu @NMerke @DocStrom @dr_benoy_n_shah After all, align with rhe motion of annulus to apex I would say!

[Batman-Echo @echo_batman]

@Becho2106 @BiancaJudyC @iamritu @NMerke @DocStrom @dr_benoy_n_shah In this reconnendarion documenr from 2010, they say 4CH view, but the example shown is a focused RV view …

[Batman-Echo @echo_batman]

@Becho2106 @BiancaJudyC @iamritu @NMerke @DocStrom @dr_benoy_n_shah Yes, but one should stick to the approach used in the papers from which rhe cutt offs are derived, and the only way to know is ro retrieve their recordings, whatever stated in the merhods…😉. I guess there will be big variability between pts and srudies..

[Batman-Echo @echo_batman]

BMW will fire 20% of all managers and replace them with…AI. The destructive nature of AI will be a dramatic societal Tsunami.
https://t.co/Ea1zUYIPYO

[Batman-Echo @echo_batman]

@drflett This enters the era of futile therapy…

[Batman-Echo @echo_batman]

What information is hidden in the AR Doppler signal?

[Batman-Echo @echo_batman]

See my post in 2025 and 2026 👇
AI is one of the end-points in humanity, both from a positive and negative prespective. It is the dehuminization of civilization. Positivos hint towards “efficiency” “novelty” “accuracy” and “innovative” and “opportunities”: agreed from a tunnel vision point of view. Yet similar to the invention of combustion engines, human beings compressed the time dimension at individual and global level with tremendous impact and rebalancing “quality of live”. How AI will change the world, including another way of compression of the energy & time dimension may have serious implications for humanity, our brains and our well-being. I’m more pessimistic than optimistic from a societal point of view as it will change the environment quicker than we can meet. Yet, as generations go by, the discussion will attenuate I guess.

[Batman-Echo @echo_batman]

@dr_benoy_n_shah @alex1708ander @NMerke @echo_stepbystep @alexsfelixecho @iamritu @AnkurKalraMD 🙈

[Batman-Echo @echo_batman]

@gcfmd @mvaduganathan @SJGreene_md @JavedButler1 @KSharmaMD @AndrewJSauer @ShelleyZieroth @hvanspall @AndrewPAmbrosy @texhern Not very strong, but sign to me..,

[Batman-Echo @echo_batman]

@MasriAhmadMD Pretty tricky to draw conclusion on iPSC technology, which can generates significant heterogeneity in cell lines obtained.