Pulm/CritCare | Division Chief | Chair Pulm Vascular Disease Section ACCP/CHEST | Right🫀Cath Connoisseur |🫀🫁 #Hemodynamics | CritCareEcho | My Opinions

Joined October 2020
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Hemodynamics and Right Heart Cath tweetorials collection. All in one place! Threads: 1. PA Catheter (PAC 101). The basics 2. Waveform recognition (PAC in ICU) 3. Quality control: 🔑troubleshooting before you use the data 4. Preventing the most dreadful PAC complication
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"I still struggle with cardiopulmonary hemodynamics in pulmonary hypertension." 😞 If this is you, answer these 2 questions: 1. Are you coming to ATS 2026 in Orlando, FL? 2. Will you be there by Saturday morning (5/16/26)? If you answer YES to both, join us for the Saturday, 12-4 PM Post Graduate course: 🔥 PG19 Wave Goodbye to Confusion: Right Heart Catheterization and Waveform Interpretation 🔹 Outstanding talks 🔹 Lots of practical case-based discussions and breakout sessions 🔹 An amazing group of experts from the cardiopulmonary fields But hurry up. Attendance is limited! Registration link 👇 ats2026.d365.events/educatio… @atscommunity @ATS_PC #ATS2026
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Colleague: “Pulmonary vascular disease is changing too fast. I can’t keep up anymore.😞😞 Wish there was a meeting in the NY area for me to catch up...” Me: “Wait! Did you just say, New York?” Colleague: “Yes. Why?” Me: “Say no more. You’re in luck! ✅✅ Next Saturday, April 18, the PVD symposium by @NorthwellHealth and @TempleHealth brings together key PVD experts to share updates. I'll be helping with two talks." You'll learn about: 🔹 PE risk stratification 🔹 Echocardiography in PE 🔹 The 2026 multi-society PE guidelines 🔹 PE treatment (invasive and non-invasive) 🔹 Post PE syndrome 🔹 PH and PAH classification 🔹 PAH risk stratification and treatment 🔹 Imaging in PH 🔹 Group 2 PH (including sotatercept/CADENCE insights) 🔹 And more! Colleague: “Wow. This thread somehow sounds like a cheap infomercial, but I’m in. Where do I sign up?” Me: “Check the link below👇to sign up and see the brochure. And yes. I am counting on your applause.” 😏 cmetracker.net/NORTHWELL/Pub… 🔥Great activity for: 🔸Physicians 🔸Fellows/Residents 🔸Medical students (Free!!) 🔸Nurse practitioners 🔸Physician Assistants 🔸Nurses 🔸Other health care team members interested in PVD Course directors: @ParthRali @mina_bushra @chadkligermd @ScheinerMD #medtwitter *No virtual attendance or recorded sessions options
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Key question (and answer) for what to do if you cannot get a wedge 👇🏻 It helps in many cases…
Replying to @FSotoMD
What if you don’t have access to the wedge? Would you stop it?
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You walk into the ICU 🏥. 100 mg IV Lasix about to be 💉. PA 51/22 (mean 32) Wedge 30 Do you 🛑✋ it? 7 practical ✅ I use to whether I can trust the wedge 👇🏻
“The wedge.” The holy grail of RHC and hemodynamics Hate it or love it, major decisions are made based on it Whether you: • Perform the procedure yourself • Review someone else’s tracings • Review someone else's report   Learn 7 tips to ensure “the wedge” accuracy
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CADENCE study Very encouraging PVR reduction results (and several other positive signals) Phase 2 trial, Sotatercept in CpcPH (Group 2 PH) Congratulations: @mardigomberg @RyanTedfordMD @jeanlucvachiery @CircAHA ahajournals.org/doi/10.1161/…
1/6 Sotatercept in Combined Pre/Post Capillary PH (CpcPH): CADENCE (Gomberg-Circulation 2026) A🧵 (8 min read) But first. 🔹Pulm vasodilators NOT approved for PH with ⬆️ left ♥️ pressures (wedge >15; Group 2 PH). Individualized approach recommended. Humbert (2022) 🔹In group 2 PH (PH LHD), pulmonary vasodilation risks “flooding” the left ♥️ and lungs, d/t ⬆️ wedge and impaired LA relaxation 🔹Studies: no benefit or ⬆️ risks (table 👇🏻)
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1/6 Sotatercept in Combined Pre/Post Capillary PH (CpcPH): CADENCE (Gomberg-Circulation 2026) A🧵 (8 min read) But first. 🔹Pulm vasodilators NOT approved for PH with ⬆️ left ♥️ pressures (wedge >15; Group 2 PH). Individualized approach recommended. Humbert (2022) 🔹In group 2 PH (PH LHD), pulmonary vasodilation risks “flooding” the left ♥️ and lungs, d/t ⬆️ wedge and impaired LA relaxation 🔹Studies: no benefit or ⬆️ risks (table 👇🏻)
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6/6 Take home: 🔹 No dose response seen (0.3 mg/kg actually had better profile and response) 🔹 Improvement likely mediated by pulmonary vascular remodeling (and not by pulmonary vasodilation) 🔹 Decrease in left-heart pressures (encouraging finding) 🔹 6MWD improvement likely not clinically significant (exploratory outcome, though) 🔹 Concerns about clinical impact of drop in cardiac output (and reason). However, 6MWD increased in 0.3 mg/kg group. Recent study (Reddy et al) found similar CO results.
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If you enjoyed the post, please repost the first post in the🧵 #medtwitter #pulmonaryhypertension #sotatercept *No conflicts of interest Other graphs 👇🏻
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2nd Annual Chicago Hemodynamic Forum @ChiHForum Outstanding hemodynamic meeting 🔹Not only for Cardiologists, but also 🔹Pulmonologists with interest in Cardiopulmonary Physiology and Interaction Learning from the masters: @RyanTedfordMD @JonGrinsteinMD @HFpEF and many more
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Francisco Soto, MD, MS, MBA retweeted
The only reason a chatbot can provide correct medical advice is because doctors/scientists did original research & wrote it up, and others synthesized that research — informed by & and integrated with their clinical education & experiences — and wrote it down.
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Great pulmonary vascular and cardiovascular network meeting this morning at #chest2025 @accpchest Lots of accomplishments and inspiration!
Great attendance and meeting of the Pulmonary Vascular and Cardiovascular Network this morning. Dr Shlobin led the session and updated the audience on the superb lectures and activities put together by the network for #chest2025 @accpchest
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Great insight from @msiuba presentation on invasive CO talk. Regardless of the love/hate relationship with PAC, can’t expect change in outcomes unless there is an intervention. If no intervention, remove PAC. See other pearls 👇🏻 #chest2025 #chestsome @accpchest @CHESTPulmCardio
21 Oct 2025
Key point from my invasive CO talk the other day #CHEST2025
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Colleague: “I wish I’d find a lecture explaining hemodynamics and cardiopulmonary interaction in an easier way…” Me: “Wait, aren’t you going to Chicago’s #CHEST2025? Colleague: “I am, but I don’t want generic concepts. I want to learn how the experts do it.” Me: Say no more! We put together an amazing session just for you! Join us: 👇 🎯 Session Title: "Pulmonary Circulation Advanced Interrogation — How I Do It" 💡 Go beyond routine caths: unmask hidden shunts, interpret difficult wedge pressures, and master fluid/exercise challenges like the experts do. 📅 Tuesday, Oct 21 — 8-9 AM 📍 South Building 503 — Session ID 1067 @accpchest @ChestPulmCardio @ChestCritCare
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Francisco Soto, MD, MS, MBA retweeted
Outstanding Pulmonary CCM (and Cardiology) Fellowship Match Day at the University of Tennessee Graduate School of Medicine, Knoxville Excited faculty and fellows showed up to support our incoming fellows: • Dr Mohamed Mohamed • Dr Mandvi Pandey • Dr Christy Smith
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