1b) Our all-star distinguished faculty includes Prof Thor Edvardsen @ThorEdvardsen 🇳🇴, Assoc Prof @unimib Denisa Muraru @denisamuraru 🇮🇹, & Prof Leyla Elif Sade @leylaelifsade 🇹🇷🇺🇸#FOAMed #cardiotwitter @MedTweetorials #HCM pic.twitter.com/dxEp4xn1s6
— cardio-met (@cardiomet_CE) June 21, 2023
2) The #EACVI2023 program is available for on-demand viewing now at https://t.co/vq3TMpZcE9, where 🆓 #CME credit can also be earned. After the symposium, a number of questions were addressed to the faculty, the most interesting of which they have curated and answered here.
— cardio-met (@cardiomet_CE) June 21, 2023
3b) Response from @denisamuraru: The most likely reason would be operator’s limited experience & insufficient understanding of apical #HCM disease.
— cardio-met (@cardiomet_CE) June 21, 2023
4a)❓to the faculty: while we are talking about apical #aneurysms, what is the most frequent #Doppler pattern observed in the majority of patients with apical aneurysm and mid LV obstruction?
— cardio-met (@cardiomet_CE) June 21, 2023
5a)❓to the faculty: What is the most important #echocardiographic #riskstratification parameter for end-stage #HCM?
— cardio-met (@cardiomet_CE) June 21, 2023
6a)❓to the faculty: in the symposium you spoke a great deal about #HCM #phenocopies. What is the best imaging method to differentiate among hypertrophy phenocopies?
— cardio-met (@cardiomet_CE) June 21, 2023
(Table from 🔓 https://t.co/8NlRiPne67) pic.twitter.com/xbxhlXRfNk
6c) #CMR can accurately quantify the extent and distribution of hypertrophy, assess the presence and severity of myocardial #fibrosis, and detect associated abnormalities.
— cardio-met (@cardiomet_CE) June 21, 2023
6e) It’s c, tissue characterization. #echo can provide the other 3! And, in the context of phenocopies, #CMRcan aid in differentiating between #HCM & other diseases that with HCM-like features, such as cardiac #amyloidosis, #Anderson_Fabry dz, & mitochondrial cardiomyopathies.
— cardio-met (@cardiomet_CE) June 21, 2023
7a)❓to the faculty: still on #pheonocopies. What is be the best #CMR imaging tool to differentiate Fabry’s disease from #HCM?
— cardio-met (@cardiomet_CE) June 21, 2023
8a) Symposium chairperson @ThorEdvardsen was asked bluntly, “Is #mavacamten a safe drug?”
— cardio-met (@cardiomet_CE) June 21, 2023
8c) Not surprisingly, special attention has been paid to eventual negative effects on #LVEF, but it seems to me that only a minority of the patients will need to terminate the medication for that reason.
— cardio-met (@cardiomet_CE) June 21, 2023
9a) Let’s conclude this session with a case study! First:
— cardio-met (@cardiomet_CE) June 21, 2023
🫀 73 ♂️, asymptomatic (walking 10 km/day, cycling)
🫀 Smoker, obese (102 kg, BMI 34.6 kg/m2), #HTN, #T2D, #dyslipidemia
🫀 No family history of #CAD or #SCD
9c)
— cardio-met (@cardiomet_CE) June 21, 2023
🗓️2017 – ECG: #RBBB, flipped T waves in anterior leads, positive stress echo at LV apex, but coronary angio: negative . . . then repeated echo exams: normal #LVEF, no #WMA
🗓️ 2021 – Cardiologist ordered stress #echo, first image: pic.twitter.com/mTVjV5Mcdk
9e) These two images show, however, suboptimal acoustic windows: pic.twitter.com/SxUgk9oipJ
— cardio-met (@cardiomet_CE) June 21, 2023
10a) So a wider imaging net was cast, taking a closer look at the #RV . . . Here we see pic.twitter.com/RxQovru0yL
— cardio-met (@cardiomet_CE) June 21, 2023
10c) So, in the spirit of #multimodality imaging, this patient moved on to #CMR with #gadolinium to look for #LGE, and here is what was found: pic.twitter.com/j85beMfNPT
— cardio-met (@cardiomet_CE) June 21, 2023
10e) . . . showing apical #LVH. A subsequent study would evaluate the extent of #LGE. pic.twitter.com/5MLyMrAcQ9
— cardio-met (@cardiomet_CE) June 21, 2023
11b) His HCM risk score is 0.84%. Is an #ICD indicted?
— cardio-met (@cardiomet_CE) June 21, 2023
11d) The patient will be treated medically. He does not warrant #mavacamten at this time. He is instead treated with valsartan, bisoprolol, aspirin, & simvastatin and will be followed up in one year.
— cardio-met (@cardiomet_CE) June 21, 2023
12b) Your choices:
— cardio-met (@cardiomet_CE) June 21, 2023
a. ⬇️mava to next lower dose, reeval in 4w
b. 🛑mava, reeval in 4w
c. ⬇️mava to next lower dose, reeval in 2w
d. 🛑mava, reeval in 2w
13) Thank you for following this 🧵! You can now go to https://t.co/jBveOj9kba and claim 0.5h 🆓CE/#CME 🇺🇸🇬🇧🇪🇺🇨🇦 #physicians #physicianassociates #nurses #nursepractitioners #pharmacists. Pick up even more 🆓CE/#CME by viewing the symposium archive at https://t.co/vq3TMpZcE9.
— cardio-met (@cardiomet_CE) June 21, 2023
14) Expert authors Prof Thor Edvardsen @ThorEdvardsen 🇳🇴, Assoc Prof @unimib Denisa Muraru @denisamuraru 🇮🇹, & Prof Leyla Elif Sade @leylaelifsade 🇹🇷🇺🇸 all 🙏for joining us and encourage you to FOLLOW @cardiomet_ce for more expert #cardiometabolic #MedEd right here on Twitter!
— cardio-met (@cardiomet_CE) June 21, 2023