High sensitivity-cardiac #Troponin I and high sensitivity-cardiac Troponin T provide comparable diagnostic information regarding exercise-induced myocardial #ischemia. Overall, their diagnostic accuracy seems moderate. #hsTroponin #Cardiology #Biomarker sciencedirect.com/science/ar…

💥 Answer these 3 questions before tomorrow's #ASEchoJC! Q1. Which echocardiographic feature is MOST characteristic of the arrhythmic #MVP phenotype ⚡️? #EchoFirst @HeartToProve @PWesslyMD @LucySafi 🧵(1/3)

In a new blog post, Dr. Michelle Kittleson writes that clinical decisions should be driven by the patient’s medical needs, not by physician concerns about their status, expectations, or perceptions. Read “Very Important Patients”: voices.nejm.org/doi/full/10.…

Posted With permission. Male, age 94, retired surgeon, lean, walks daily. Asymptomatic, brought in by visiting worried daughter who lives in North America. BP 150/70(he confirms is accurate) LDL 170 HbA1C 7.1, FBS 124 Refusing any treatment Poll in 🧵 If I insist he’ll comply

Very hard!

@twj1974 this complication is not about you fixing it to show it in a meeting later, this is about saving a patient, patients die from complications… Profound teaching! #EuroPCR @PCRonline

Austin flint

⚠️ Low BP in HFrEF — should it stop us from using GDMT? Data says: probably not. From COPERNICUS, PARADIGM-HF, RALES/EMPHASIS-HF & DAPA-HF: ✅ Carvedilol beneficial even at SBP 85–95 mmHg ✅ Sacubitril/Valsartan consistent across all BP strata ✅ MRA & SGLT2i similarly effective in low BP groups Low SBP is a reason to be careful — not a reason to stop. 💡 #HeartFailure26 #HF2026 #HFrEF #GDMT #Cardiology

📚🤖 Congratulations.
 We finally industrialized fake science. And apparently… we even peer-review it now. Basically AI is doing what human do ( 😁 ). Fake it til you make it. We will need AI to vet what AI did in science. This Lancet audit analyzed: 👉 2.5 million biomedical papers 👉 125 million references And found something absolutely spectacular: Thousands of completely fabricated citations inside peer-reviewed biomedical literature. Not “slightly wrong.” Not “formatting issues.” I mean: 👉 studies that literally do not exist. And the trend is exploding. 📈 Fabricated-reference rate: ~4 per 10,000 papers in 2023 → ~57 per 10,000 papers by 2026 That’s a >12-fold increase. But here’s the funniest part. These fake citations were: ✅ correctly formatted ✅ scientifically plausible ✅ assigned to real researchers ✅ with believable publication years Basically: AI became the world’s most confident pathological liar. And peer review apparently responded with: 👉 “Looks academic enough to me.” One masterpiece highlighted in the paper: A surgical oncology article had: 18 fabricated references out of 30. SIXTY (60%) PERCENT !!!!!!!!!. At that point it’s not a bibliography anymore. It’s speculative fiction with DOI formatting. Even better A rheumatology biomarker paper cited: 👉 a nematode worm study Which honestly feels spiritually accurate for some biomarker papers. The deeper problem Medicine runs on citation chains. Paper → review → meta-analysis → guideline → clinical decision. So when fake citations enter the system: we are no longer practicing evidence-based medicine. We are practicing: 👉 autocomplete-based medicine. And let’s be honest This didn’t happen because AI is evil. It happened because: 👉 productivity became more important than verification 👉 publication became more important than understanding 👉 quantity became more important than truth AI simply exposed the system. My favorite line in the paper (basically) Most fabricated references: 👉 looked perfectly real 👉 survived peer review 👉 received no publisher action 98.4% remained untouched. Translation The system is currently optimized for: ❌ publication velocity —not— ✅ epistemological integrity My take We are entering a dangerous phase of science: plausible knowledge inflation Where papers increasingly sound scientific… without guaranteeing that the underlying evidence even exists. Bottom line The future of scientific publishing may depend less on: 👉 generating content and much more on: 👉 verifying reality ⚡ Because once fake references become scalable… fake certainty becomes scalable too. One more thing: REAL EXPERTS (HUMAN) WILL BE EVEN MORE NEEDED AND BECOME EVEN MORE CENTRAL IN THE MANAGEMENT OF SCIENCE. #AI #Science #ResearchIntegrity #MedicalPublishing #LLM #EvidenceBasedMedicine #AcademicMedicine #PeerReview

Now, this explains the side effects 😉

Metformin, one of the most commonly prescribed drugs, was thought to work via the liver. Check that. It's primarily through the gut. @NatMetabolism nature.com/articles/s42255-0…

A consensus statement from @escardio today to limit intake of ultraprocessed foods for reduced risk of heart disease academic.oup.com/eurheartj/a…

Please listen to actual cardiologists. For 30 years, statin trials have repeatedly shown the same thing: after ~4–7 years, mortality was higher in the placebo group than in the statin group. Every. Single. Time. My sketch 👇🏻

50 plus slides of what you already know the word “alignment” = 15 million per hospital and the illusion of a “Strategy” … #cmgsays

Lp(a) risk factor, unaffected by lifestyle/statins New drugs:🧬 • Pela (ASO): ~80%⤵️'26 • Olpa (siRNA): 71-101%⤵️'26 • Lepo (siRNA): 94%⤵️ ↔️1.5y 1x💉 • Muva (oral): 86% Lp(a)⤵️ ⚠️ Very low Lp(a) may ⬆️T2D Until trials: 📏 Lp(a) once, ⬇️ LDL, 👀 📎 academic.oup.com/eurheartj/a…

👉 Oral PCSK9 Inhibition: High-Efficacy Lipid Lowering Moves to the Oral Era 📍 Randomized evidence shows substantial LDL-C reduction (~50%) with oral PCSK9 inhibitors vs placebo 📍 Consistent effects across atherogenic parameters: ApoB ↓ ~40–50% Non-HDL-C ↓ ~45% Lp(a) ↓ ~15–25% 📍 Safety profile comparable to placebo, including: No excess adverse events No signal for diabetes within available follow-up 1️⃣ MK-0616 (Enlicitide): Phase 3–Level Evidence 👆 LDL-C reduction ~60% at dose-aligned analyses 👆 ApoB reduction ~50%, supporting particle-level impact 👆 Minimal heterogeneity at consistent dosing 👆 Concordant reductions in non-HDL-C and Lp(a)  Pharmacodynamic profile: 👆 Tight coupling between LDL-C and ApoB reduction 👆 Consistent effect across study designs when exposure is standardized 2️⃣ AZD0780 (Laroprovstat): Mechanistic and Clinical Signal Demonstrates significant LDL-C lowering in randomized trials 👆 LDL-C reduction ~50% 👆 Directionally consistent reductions in ApoB and other lipid parameters 👆 Contributes to reproducibility of oral PCSK9 pathway inhibition  Pharmacological attributes: 👆 Oral delivery with measurable systemic effect 👆 Supports class-level biological validity 📍 Integrated Lipid Effects LDL-C reduction parallels ApoB lowering, consistent with enhanced clearance of ApoB-containing particles Non-HDL-C reduction reflects broad impact on atherogenic lipoproteins Lp(a) lowering is present but quantitatively smaller, aligning with partial LDL receptor–mediated clearance 📍 Conclusion Oral PCSK9 inhibition achieves high-intensity lipid lowering with consistent effects across atherogenic markers and a favorable short-term safety profile. 👆 Next step: demonstration of cardiovascular outcomes to define its role in risk reduction strategies. 🔓 Open Access 🔗sciencedirect.com/science/ar… @society_eas @nationallipid

Dr. Cadematiri's final thought: If your indication for CTO-PCI is: “there is ischaemia” You’re already outdated. The future is brutally simple: No symptoms → think twice Symptoms → act Because in modern cardiology: The most important endpoint is not the image. It’s the patient!

Honestly, AR, along with TR, is the most challenging valvular lesion to quantify. This will be so helpful!

🫀 Grading severe aortic regurgitation — time to upgrade our TTE approach. ASE criteria alone show an AUC of only 0.58 on prospective validation. This novel 2-step algorithm, benchmarked against CMR, does better: 1️⃣ AR regurgitant volume ≥ 45 mL (PISA or Doppler) 2️⃣ LVEDVi ≥ 93 mL/m² → Both met? Severe AR. AUC up to 0.76 with PISA method. Simple. Reproducible. CMR-validated. EHJ Cardiovascular Imaging — doi: 10.1093/ehjci/jeag012 #Cardiology #Echocardiography #AorticRegurgitation #ValvularHeartDisease #CMR #CardioTwitter #MedTwitter #EACVI

This is actually ground breaking. As far as I know there was NO screening recommendation for CV disease. There are many for cancer but this one is the first recommendation for CV reduction 👏🏻