Such a privilege to hear @Jose_Diaz_Gomez discuss the forefront of POCUS for RV assessment.
Thank you @MGHanesthesia @JuanGRipoll1 for hosting and inviting @MGH_PCCM @HarvardPulm!
Top 10 key points 🧵⤵️
Thank you @MGHanesthesia @JuanGRipoll1 for hosting and inviting @MGH_PCCM @HarvardPulm!
Top 10 key points 🧵⤵️
2⃣ Check out the @SCCM Comprehensive Critical Care Ultrasound book for algorithm for RV systolic function in CCE (I think that's where it is?), based on:
1. RVEDA/LVEDA
2. Apex-forming ventricle
3. RV vs. LV base to apex contraction
4. RV free wall movement
5. IVS flattening
1. RVEDA/LVEDA
2. Apex-forming ventricle
3. RV vs. LV base to apex contraction
4. RV free wall movement
5. IVS flattening
3⃣ Learn to differentiate acute RV failure from:
- "compensated early" PH (hypertrophy + ⬆️ contractility + preserved SV)
- "advanced" PH (hypertrophy + dilation + loss of SV).
- "compensated early" PH (hypertrophy + ⬆️ contractility + preserved SV)
- "advanced" PH (hypertrophy + dilation + loss of SV).
5⃣ Of the many *advanced* techniques to measure systolic function, assessing RV S' is among the most straightforward and simple to perform.
6⃣ @Jose_Diaz_Gomez et. al. also developed SEATAK (subcostal echocardiographic assessment of tricuspid annular kick) - essentially a TAPSE from the subcostal view. Useful, validated, and also an example of thinking critically about what we see on echo to develop new techniques.
7⃣ You can determine PVR on POCUS using the TR Vmax and RVOT VTI, although not recommended for routine use
onlinejase.com
onlinejase.com
8⃣ RVOT *shape* (no notch, mid-systolic notch/MSN, or late-systolic notch/LSN) can predict hemodynamics and R heart function in PH.
RV dysfunction + notching = 😨😱 watch that afterload atsjournals.org
RV dysfunction + notching = 😨😱 watch that afterload atsjournals.org
9⃣ Future directions? Strain...
("that's it, that's the tweet")
("that's it, that's the tweet")
🔟 If you're going to do echo/US research, be familiar with the PRICES statement/consensus on methodology for conducting and reporting CCUS research. pubmed.ncbi.nlm.nih.gov
That's a wrap. Thank you again @Jose_Diaz_Gomez for sharing your time & expertise! Any misrepresentation/errors in this thread is my own misunderstanding.
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