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Excited to see #Cardiacast #HeartVision #ACCImaging podcast episode on “Update on HCM Imaging” published on the acc.org homepage! Thank you Christopher Kramer MD for discussing HCM guidelines 2024 and beyond with me on this episode. Listen in today:

Beware of color splay in apical views when assessing aortic regurgitation, as lateral jet dispersion can overestimate severity due to the Coandă effect or off-axis imaging. Use multiple views and quantitative measures (like vena contracta, flow convergence, or CMR) for accurate

#ASEchoJC Zoom in to look at Aortic valve #Echofirst

Nadeen N. Faza, M.D. American Society of Echocardiography JASE Dr.Patricia Pellikka Vidhu Ritu Thamman MD Enrique Garcia-Sayan, MD, FACC, FASE David H. Wiener, MD Dr. Purvi Parwani IWASHIMA Satoru岩島覚.MD, PhD.ﾔｰ KELLY BOEGEL Raj Janardhanan, MD, MRCP, FACC, FASE Chittur Sivaram Maan Malahfji 📌 Tips: Semi-Quantitative AR Assessment – Vena Contracta Width (VCW) • Align beam perpendicular to jet for axial accuracy • Use narrow color sector to improve resolution • VC <1 cm → small errors = big impact #EchoFirst #ASEchoJC American Society of Echocardiography

Dr.Patricia Pellikka Nadeen N. Faza, M.D. American Society of Echocardiography JASE Vidhu Ritu Thamman MD Enrique Garcia-Sayan, MD, FACC, FASE David H. Wiener, MD Dr. Purvi Parwani IWASHIMA Satoru岩島覚.MD, PhD.ﾔｰ KELLY BOEGEL Raj Janardhanan, MD, MRCP, FACC, FASE Chittur Sivaram Maan Malahfji Quantitative AR Assessment – Continuity Equation 🔢 LVOT SV = 0.785 × (LVOT diameter)² × LVOT TVI (PW Doppler) 🔢 RVOT SV = 0.785 × (RVOT diameter)² × Ao VTI (PW Doppler) 📊 Regurgitant Volume (mL) = LVOT SV – RVOT SV 📈 Regurgitant Fraction (%) = Reg Vol / LVOT SV ✅ Same

Nadeen N. Faza, M.D. American Society of Echocardiography JASE Dr.Patricia Pellikka Vidhu Ritu Thamman MD Enrique Garcia-Sayan, MD, FACC, FASE Chittur Sivaram Renu David H. Wiener, MD KELLY BOEGEL Nishath Quader, MD Maan Malahfji Raj Janardhanan, MD, MRCP, FACC, FASE Challenges in AR Assessment – Eccentric & Multiple Jets 🌊 Eccentric jets (wall-hugging) appear smaller than central jets of similar severity ⚠️ Often associated with structural valve abnormalities 📉 CWD density may be reduced due to poor alignment—try parasternal view ❌ Jet

Question 5- How do sex-related differences in left ventricular remodeling influence the management of aortic regurgitation (AR) in women? #ASEchoJC American Society of Echocardiography JASE Priscilla Wessly Dr.Patricia Pellikka Vidhu #CardioX #CardioTwitter #EchoFirst

end-diastolic flow reversal velocity in descending aorta of ≥ 20 cm/s is cutoff in descending aorta for severe AR #ASEchoJC #echofirst

Nadeen N. Faza, M.D. American Society of Echocardiography JASE Priscilla Wessly Vidhu Ritu Thamman MD Dr. Purvi Parwani Raj Janardhanan, MD, MRCP, FACC, FASE Chittur Sivaram Enrique Garcia-Sayan, MD, FACC, FASE Maan Malahfji David H. Wiener, MD IWASHIMA Satoru岩島覚.MD, PhD.ﾔｰ Renu Remember to index volumes and dimensions for women and smaller patients #ASEchoJC

Nadeen N. Faza, M.D. American Society of Echocardiography JASE Dr.Patricia Pellikka Vidhu Ritu Thamman MD Dr. Purvi Parwani Raj Janardhanan, MD, MRCP, FACC, FASE Chittur Sivaram Enrique Garcia-Sayan, MD, FACC, FASE Maan Malahfji David H. Wiener, MD IWASHIMA Satoru岩島覚.MD, PhD.ﾔｰ Renu 🔍 Key Findings on Sex-Based Remodeling in AR (Malahfji et al., Sci Rep. 2023 Jul) 🫀 LV Remodeling Differs by Sex in AR 👩 Women: • Smaller absolute & indexed LV volumes across all AR severities • ↓ LVEDV, ↓ LV mass (even when indexed) • ↑ Symptoms at similar AR severity

Nadeen N. Faza, M.D. American Society of Echocardiography JASE Dr.Patricia Pellikka Vidhu Ritu Thamman MD Enrique Garcia-Sayan, MD, FACC, FASE Dr. Purvi Parwani David H. Wiener, MD Renu Vera Rigolin Akhil Narang, MD KELLY BOEGEL IWASHIMA Satoru岩島覚.MD, PhD.ﾔｰ Maan Malahfji Identifying AR mechanism is key to surgical planning and outcome optimization: 🔹 Type 1 ➡️ Valve-sparing 🔹 Type 1 & select Type 2 ➡️ Repair 🔹 Irreparable valves ➡️ Replacement #EchoFirst #ASEchoJC American Society of Echocardiography

Sex-related differences in AR matter! Women with chronic severe AR often have smaller LV volumes & mass but more symptoms at similar severity. 🚨 Yet they’re referred later & undergo surgery less often. We need sex-specific thresholds & earlier intervention to close this gap!

Double contour sign of prolapsed Aortic leaflet #Echofirst #ASEchoJ called “partial prolapse” because it’s closer to edge of cusp & does not involve entire cusp

Nadeen N. Faza, M.D. American Society of Echocardiography JASE Dr.Patricia Pellikka Vidhu Ritu Thamman MD Enrique Garcia-Sayan, MD, FACC, FASE Renu IWASHIMA Satoru岩島覚.MD, PhD.ﾔｰ Raj Janardhanan, MD, MRCP, FACC, FASE Dr. Purvi Parwani Maan Malahfji Lucy Deepa David H. Wiener, MD Same patient CW Doppler from Apical(left) and RSB window(right). 📍Parasternal/RSB = better alignment for eccentric jets #EchoFirst #ASEchoJC American Society of Echocardiography Nadeen N. Faza, M.D. Dr.Patricia Pellikka Ritu Thamman MD

#ASEchoJC #echofirst Vena contracta >= 6mm is severe AR in zoomed PLAX view

Monte Carlo simulations used by Vecsey-Nagy Milán et al to simulate cost-effectiveness of ultrahigh-resolution photon-counting detector over energy-integrating detector-CT for CCTA in stable chest pain patients. doi.org/10.1016/j.jcct…

Excited to join Dr. Michael Salerno Dr. Michael Salerno M.D. P.h.D on the latest Heart Vision American College of Cardiology #CardiaCast! We dive into how stress #CMR is reshaping our understanding of coronary microvascular dysfunction—comparing it with stress PET & its real-world clinical impact. Listen here:

Growth in advanced #cvImaging? In this #iMail nugget of knowledge, Medicare data demonstrates 📈 in #YesCCT, #cvPET & #WhyCMR. %Change was highest for CT. #SPECT imaging has 📉 by a third over the last decade while #EchoFirst has remained stable. jacc.org/doi/10.1016/j.… #JACCIMG

Amazing keynote lecture on HCM by theodoreabraham at #CSEcho2025 - genetics, mechanics, #echofirst, #CMI all covered! Exciting times for continuing collaboration between Canadian Society of Echocardiography and American Society of Echocardiography. #HCM Hypertrophic Cardiomyopathy Medical Society David H. Wiener, MD Amer Johri Gillian Nesbitt Kibar Yared

In this multicenter prospective study by Marta Belmonte et al, health care resource utilization was compared between using non-invasive CCTA vs invasive coronary angiography in post-heart transplant patients. doi.org/10.1016/j.jcct…