PLEASE NOTE: Beginning today, JASE will be available online only.

Assessment of left ventricular diastolic function remains one of the most persistent challenges in echocardiography. Read our @JournalASEcho article, "Reframing Diastolic Function: From Classification to Continuous Physiology." bit.ly/4xrrH8U

We've released a #new State-of-the-Art Review, "The Effect of General Anesthesia and Mechanical Ventilation on the Echocardiographic Evaluation of Cardiac Function!" Read it now: bit.ly/4eokgaT

Our June 2026 @JournalASEcho is online! bit.ly/3KabIZe This new issue features: 🔷 Our new #ASEGuideline 🔷 Sex Differences in LV Size & Function before & after MV Repair 🔷 Reframing Diastolic Function: From Classification to Continuous Physiology 🔷 And so much more!

#ASEchoJC The Pickelhaube sign: Lateral annular S′ ≥16 cm/s associated with ventricular arrhythmias in MVP ⚡️ #EPeeps 👉jacc.org/doi/epdf/10.1016/j.…

✨ 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. 🫀⚡️ 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! 💙🌍 @ASE360 @JournalASEcho

Our group also identified a novel Doppler sign —Bifid-E wave— 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 🫀 Is this patient a good candidate for M-TEER? #EchoFirst holds the answer 💡. 🔑 features that guide candidacy and device selection include: ✅ 3D mitral valve area ✅ Posterior leaflet length ✅ Baseline transmitral gradient ✅ Prolapse/flail location ✅ Flail gap and width ✅ Barlow’s disease ✅ Calcification in the grasping zone The procedure starts long before the procedure—at the #EchoFirst workstation. #CardioTwitter #Echofirst #MTEER🫀📸

clip away from clefts to avoid opening up the clefts and worsening the MR #ASEchoJC @ASE360

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 S’ 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

💎 #ASEchoJC Barlow's valves can be challenging for TEER. ⚠️ Multiple MR jets ⚠️ Excess leaflet redundancy ⚠️ Leaflet clefts ⚠️ Annular/PML calcification 🫀 Broad jets may require multiple clips. 🫀 Grasping near a cleft may worsen MR. 🫀 Calcification can limit usable leaflet tissue. 🎯 Anatomy determines complexity. #ASEchoJC #EchoFirst #CardioX #MVP @ASE360 @JournalASEcho

Very important -- flail =/= severe MR! In our data a flail leaflet had 81% specificity for severe MR as defined on CMR >60 mL/50% #ASEchoJC

💎 #ASEchoJC Imaging is central to MVP intervention planning. Before TEER or surgery, echo helps define: 🫀 Mechanism of MR 🫀 Mitral valve area 🫀 Leaflet length 🫀 Leaflet clefts 🫀 Mitral annular calcification 🎯 Successful intervention starts with understanding anatomy. #ASEchoJC #EchoFirst #CardioTwitter #MVP @ASE360 @JournalASEcho

Imaging is central to MVP management—defining leaflet pathology, MR severity, ventricular remodeling, and procedural feasibility. Echo, CMR, & CT guide surgical vs transcatheter repair strategies #ASEchoJC

#ASEchoJC Q 9 How does imaging guide surgical and transcatheter intervention in MVP, and what is the role of repair in arrhythmic MVP? @LucySafi @PriyaPanday27 @NadeenFaza @HeartToProve @ASE360 @JournalASEcho

We have shown that for the same amount of transvalvular MR, the LV volume increases with increasing prolapse volume. Be careful with using PISA in Barlow MR -- use volumetric methods instead. #ASEchoJC