Top Tweets for #ASEchojc
๐ #ASEchoJC What is systolic curling?
๐ซ Normally, the posterior mitral annulus moves downward and anteriorly during systole.
โ ๏ธ In MVP, excessive leaflet mobility and loss of normal annular mechanics can alter this motion, producing a characteristic "curling" of the basal inferolateral LV wall.
๐ฏ A marker increasingly linked to the arrhythmogenic MVP phenotype.
#EchoFirst #CardioTwitter #EPeeps #MVP @ASE360 @JournalASEcho
Excellent infographic, @HeartToProve
One of the most practical imaging pearls in MVP:
๐ฏ Don't diagnose MAD from a single systolic frame.
โ
True MAD persists in diastole
โ Pseudo-MAD disappears in diastole
#ASEchoJC #EchoFirst #CardioX #MVP @ASE360 @JournalASEcho
@PWesslyMD @LucySafi @PriyaPanday27 @NadeenFaza @ASE360 @JournalASEcho @DavidWienerMD @iamritu @purviparwani @SIwa23288585 @boegel_kelly MAD is a true separation between the LV crest & posterior mitral leaflet/LA junction. Pseudo-MAD mimics this during systole when a voluminous leaflet presses against the LA wall, but it vanishes in diastole. Distinguishing them is key! #ASEchoJC
Great point, @LucySafi !
A TEE pearl we should all practice:
For laterally directed eccentric MR jets, use the TG view to better align CW Doppler with the jet.
๐ฏ Better alignment = more accurate velocity measurement and MR quantification.
#ASEchoJC #EchoFirst #CardioX #MVP @ASE360 @JournalASEcho
@PWesslyMD @PriyaPanday27 @NadeenFaza @HeartToProve @ASE360 @DavidWienerMD @iamritu @purviparwani @SIwa23288585 @boegel_kelly @JournalASEcho for eccentric jets that are directed laterally (towards the LAA), when attempting to quantify, I like to get the Doppler velocity from the TG view on TEE. It aligns with the get and avoids underestimation of the peak velocity (avoids overestimation of EROA by pisa)
๐ MR Timing matters.
โ ๏ธ In late-systolic MR, EROA reflects only the peak moment of regurgitation.
๐ซ Regurgitant volume often better reflects the true MR burden because it accounts for the entire systolic period.
#ASEchoJC #EchoFirst #CardioTwitter #MVP @ASE360 @JournalASEcho
๐ MR jets in MVP tell a story.
๐ซ MR jets are typically directed away from the prolapsing or flail leaflet.
โ ๏ธ But not alwaysโcentral jets can occur.
๐ Understanding jet direction helps localize the underlying pathology.
#ASEchoJC #EchoFirst #CardioX #MVP @ASE360 @JournalASEcho
๐Key Takeaways on MVP, MR, MAD & Arrhythmic Risk ๐ซ #ASEchoJC
โ
MVP affects ~2.5% of the population and is the leading cause of primary MR.
โ
Diagnosis requires โฅ2 mm leaflet displacement in the PLAX/long-axis view.
โ
Barlowโs disease โ FED:
โข Barlow = redundant bileaflet prolapse
โข FED = isolated segment prolapse with chordal rupture
โ
MR assessment is trickyโeccentric, multiple, commissural, and late-systolic jets can underestimate severity.
โ
Not all MAD is created equal:
True MAD persists in systole and diastole; pseudo-MAD does not.
โ
MAD and prolapse volume add to LV volume overload beyond MR alone.
โ ๏ธ Arrhythmic MVP can occur even without severe MR.
๐ฉ Echo markers of increased VA/SCD risk:
โข Bileaflet prolapse
โข MAD >8.5 mm
โข Pickelhaube sign
โข Curling
โข Mechanical dispersion
โข Double-peak strain pattern
๐ฏ CMR is critical for risk stratificationโfibrosis by LGE or elevated ECV identifies patients at higher arrhythmic risk.
See you next #ASEchoJC!
@PWesslyMD @HeartToProve @LucySafi @CASivaram1 @iamritu @purviparwani @ASE360 @JournalASEcho
@PWesslyMD @LucySafi @PriyaPanday27 @HeartToProve @ASE360 @JournalASEcho #ASEchoJC The Pickelhaube sign: Lateral annular Sโฒ โฅ16 cm/s associated with ventricular arrhythmias in MVP โก๏ธ
#EPeeps
๐https://t.co/1nt0u3KMBZ
โจ Huge thank you to everyone who joined tonight's #ASEchoJC!
What an incredible discussion on MVP, MR, MAD, ventricular arrhythmias, and the evolving concept of arrhythmic MVP. ๐ซโก๏ธ
Grateful to our outstanding guest authors Dr. Jeffrey Silbiger @LucySafi, @priyaPanday27, and for sharing their expertise and insights, and to my wonderful co-moderators @NadeenFaza and @HeartToProve. A special thank you to our #EchoFirst enthusiasts and engaged audience for contributing to such a lively, thoughtful, and high-yield discussion.
Proud to be part of this amazing global #EchoFirst community! ๐๐ @ASE360 @JournalASEcho
@PWesslyMD @LucySafi @PriyaPanday27 @NadeenFaza @ASE360 @JournalASEcho Our group also identified a novel Doppler sign โBifid-E waveโ that could represent an additional echocardiographic marker of advanced MVP and myocardial fibrosis. Keep an eye out for this next time you're reading a Barlow Echo. #ASEchoJC
#ASEchoJC ๐ซ Is this patient a good candidate for M-TEER?
#EchoFirst holds the answer ๐ก. ๐ features that guide candidacy and device selection include:
โ
3D mitral valve area
โ
Posterior leaflet length
โ
Baseline transmitral gradient
โ
Prolapse/flail location
โ
Flail gap and width
โ
Barlowโs disease
โ
Calcification in the grasping zone
The procedure starts long before the procedureโat the #EchoFirst workstation. #CardioTwitter #Echofirst #MTEER๐ซ๐ธ
@PWesslyMD clip away from clefts to avoid opening up the clefts and worsening the MR #ASEchoJC @ASE360
@PWesslyMD @LucySafi @PriyaPanday27 @NadeenFaza @ASE360 @JournalASEcho Prolapsing valves pull on chords/papillary muscles, stretching the LV wall inward. This causes "curling" (LV crest rotates posteriorly) & the Pickelhaube sign -- a sharp late-systolic Sโ wave >16 cm/s on TDI. Both are markers of increased arrhythmia risk! #ASEchoJC
#ASEchoJC Q 10 What are curling and the Picklehaube sign and how are these related to papillary muscle traction? @LucySafi @PriyaPanday27 @NadeenFaza @HeartToProve
#ASEchoJC #EchoFirst #CardioTwitter #EPeeps #MVP @ASE360 @JournalASEcho
๐ #ASEchoJC Barlow's valves can be challenging for TEER.
โ ๏ธ Multiple MR jets
โ ๏ธ Excess leaflet redundancy
โ ๏ธ Leaflet clefts
โ ๏ธ Annular/PML calcification
๐ซ Broad jets may require multiple clips.
๐ซ Grasping near a cleft may worsen MR.
๐ซ Calcification can limit usable leaflet tissue.
๐ฏ Anatomy determines complexity.
#ASEchoJC #EchoFirst #CardioX #MVP @ASE360 @JournalASEcho
@PWesslyMD @LucySafi @PriyaPanday27 @HeartToProve @ASE360 @JournalASEcho @DavidWienerMD @iamritu @purviparwani @SIwa23288585 @boegel_kelly @EACVIPresident ๐ฅ๐ฅClinical/demographic, electrocardiographic, & imaging findings associated with increased risk of ventricular arrhythmias โก๏ธ in patients with MVP. #EchoFirst #Epeeps #ASEchoJC
@PWesslyMD @LucySafi @PriyaPanday27 @NadeenFaza @ASE360 @JournalASEcho @DavidWienerMD @iamritu @purviparwani @argulian @boegel_kelly @SIwa23288585 @EACVIPresident #ASEchoJC Blood isn't just regurgitated; it also expands the prolapsing leaflets (prolapse volume) during systole. This "retained" volume drives LV volume overload independently of MR, leading to excess LV dilation that is disproportionate to the perceived trans-valvular MR.
#ASEchoJC Q 8 How do MAD and prolapse volume contribute to LV overload and MVP-related cardiomyopathy?
@LucySafi @PriyaPanday27 @NadeenFaza @HeartToProve
#ASEchoJC #EchoFirst #CardioX #MVP @ASE360 @JournalASEcho
@PWesslyMD @PriyaPanday27 @NadeenFaza @HeartToProve @ASE360 @JournalASEcho @DavidWienerMD @iamritu @purviparwani @SIwa23288585 @boegel_kelly @EACVIPresident don't forget strain on these patients! GLS may be normal but in arrhythmic MVP, regional strain maybe decreased in the location of the papillary muscles (inferior/inferolateral base) #ASEchoJC @ASE360 @JournalASEcho
#ASEchoJC Q 7 What defines arrhythmic MVP, and which findings are associated with higher ventricular arrhythmia risk?
@LucySafi @PriyaPanday27 @NadeenFaza @HeartToProve @ASE360 @JournalASEcho #EPeeps #ASEchoJC #EchoFirst #CardioX #MVP
Last Seen Hashtags on Sotwe
เธเธตเนเธเนเธญเธเนเธขเนเธเธเธฑเธ
Seen from Thailand
momson filter:videos until:2026-5-18
Seen from India
Buldhana Maharashtra
latina
Seen from Netherlands
teenageer(**)*************************** filter:videos since:2026-09-25
Seen from Netherlands
nsfw #radiostatic
Seen from Mexico
์ปคํ๋ง๋จ
Seen from Korea
ipcam()*+*+* filter:videos since:2026-05-11
Seen from Argentina
smlofibangla_08
gayintense
Seen from Mexico
Trends for you
Most Popular Users
Elon Musk 
@elonmusk
240.9M followers
Barack Obama
@barackobama
118.8M followers
Cristiano Ronaldo
@cristiano
114.5M followers
Donald J. Trump
@realdonaldtrump
111.9M followers
Narendra Modi
@narendramodi
107M followers
Rihanna
@rihanna
98.7M followers
NASA
@nasa
92.2M followers
Justin Bieber
@justinbieber
91.8M followers
KATY PERRY
@katyperry
90M followers
Taylor Swift
@taylorswift13
84M followers
Lady Gaga
@ladygaga
75.5M followers
Virat Kohli
@imvkohli
73.4M followers
Kim Kardashian
@kimkardashian
70.8M followers
YouTube
@youtube
68.7M followers
Neymar Jr
@neymarjr
66.4M followers
Bill Gates
@billgates
65.2M followers
Selena Gomez
@selenagomez
63.1M followers
The Ellen Show
@theellenshow
62.2M followers
CNN
@cnn
61.7M followers
X
@x
60.6M followers