👧 Family: ECG+echo (CMR if equivocal); echo q1–2y, CMR q2–5y
🧩 Phenocopies: Amyloid (EF/GLS >4.1, high T1), Fabry (low T1, basal IL LGE), Athlete (balanced dilation, no LGE)
🤖 Future: AI, indexed wall thickness, DTI/FAPI

doi.org/10.1093/ehjc...

#CardioSky

🚦 Obstruction is dynamic: LVOTO >30 rest, >50 provoked
⏳ Mid-cavity HCM = hourglass LV & apical aneurysm; doppler underestimates pressures
🌫️ Ischemia w/o CAD is common: check CMR/PET for microvascular dysfunction
💊 Therapy monitoring: CMIs: start for EF ≥55–60%; hold <50%

🧭 Diagnosis ≠ MWT ≥15 mm alone: use phenotype, function, tissue characterization
🔥 LGE matters: ~65% have LGE; ≥15% LV mass can up-class ICD risk
🎯 EF can mislead: track GLS for systolic dysfunction
🫁 Diastolic assessment: EACVI/ASE 4-criteria + LA strain; exercise echo

🚀 CT perfusion can provide volumetric MBF maps that pair seamlessly with #CCTA for a single comprehensive exam. ?Could this offer a one-stop shop?

doi.org/10.1016/j.jc...

#cardiacimaging #cardioSky

🧱 Historically, there has been limited access to PET scans needed to quantify MBF. But this is changing.

👏 As described in this expert review, CT & MRI are now validated to deliver comprehensive/actionable reporting on MBF, bringing greater precision to the chest pain pathway.

🚀 If we start reporting even 3 of these opportunistic metrics (e.g. RV function, membranous septum length, frailty marker), we move CT-TAVR from procedural planning → phenotyping platform.

#TAVR #StructuralHeart #cardioSky @danilorenzatti @CardioMDPhD

🔹 Frailty on CT: psoas/skeletal muscle index + vertebral HU → osteosarcopenia → worse 1-year outcomes.
🔹 CAD beyond “is there calcium?”: better CCTA (PCCT) + CT-FFR can reduce the number of patients we send for invasive angio.

🔹 Amyloid signal: CT-ECV (esp. with dual/spectral or photon-counting) → separates AS remodeling from coexisting ATTR, which is not rare in this population.
🔹 Fat: EAT / peri-coronary fat volume + attenuation → inflammatory signature that tracks with MACE after TAVR.

🔹 Conduction risk: membranous septum length, LVOT/root/mitral annular calcium → helps predict who’s heading for a PPM.
🔹 Myocardial phenotype: full-cycle CT → RV function (often missed on echo), CT-GLS, “cardiac damage” staging → all tied to mortality after TAVR.

🌈 Spectral data paves the way for plaque phenotyping, perfusion mapping, myocardial characterization - a possible "one-stop" exam?

🤔 Still need: larger prospective clinical validation and cost-effectiveness data

📖 www.jacc.org/doi/10.1016/...

@ArthurShiyovich @RonBlankstein #cardioSky #CCTA

👉 Key strategies include: prospective gating, reduced field of view, BMI-tailored kVp, elimination of redundant phases, and hands-on training for techs.

🔬 Here, Chazal et al describe how a multicenter CCTA program used these strategies to lower mean radiation dose by 23%! doi.org/10.1016/j.ja...

❗ Impressively, only 1% of scans were indeterminate, and there was good diagnostic performance regardless of stent diameter.

@DoosupShin @ziadalinyc @OKhaliqueMD #cardiotwitter #CCTA

eurointervention.pcronline.com/article/phot...