Matthew Shun-Shin
@mshunshin
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Clinical Senior Lecturer and Consultant Cardiologist: AI, Echocardiography, valvular heart disease, improving device therapies for heart failure
London, England
Joined August 2011
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@ProfDFrancis
Top tip for fellows:
If you are unable to freely access a PDF of a study say, conducted using public money, written by freely by researchers, and peer-reviewed for free by others…
Under no circumstance copy the Pubmed ID and then paste into
sci-hub. tw
to easily download
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All I want for Christmas is a....
#dontdisthehis
@JACCJournals
paper get it while it’s hot! His vs BiV in LBBB
@DrAhranArnold
@Dr_Keene
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ACC24 with two trials from Imperial TELE-ACS (
@rkhamis
), and ORBITA-COSMIC (
@rallamee
- who is telling me to stop tweeting and get back to R).
🚨
#ACC24
Breaking News 🚨
The ACC.24 Late-Breaking Clinical Trials are out! Some of the trials being presented are:
◼️ RELIEVE-HF
◼️ EMPACT-MI
◼️ AEGIS-II
◼️ VICTORION-INITIATE
◼️ Step-HFpEF Dm
◼️ TELE-ACS
Learn more & see the full list of trials:
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Thu 2nd Nov 2017. How to; tips and tricks; and, most excitingly - His Pacing for Heart Failure
#UKHisPacing
#dontdisthehis
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.
@RichardLehman1
's latest reviews features our SAMSON trial - n-of-1 trial for statin side effects.
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It’s out.
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@ProfDFrancis
@drjohnm
I can trump your video - with this video from when the UK rolled out thrombolysis for acute stroke. (Watch with sound). I used it in a presentation in 2006. Anyway - the data for thrombectomy looks good - I think the UK is working out how/who to provide the service
@LCC_DrMalik
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@venkmurthy
@f2harrell
@NEJM
1) Here is an R-notebook with the data and the “rms” style 7-level ordinal analysis. Hope I got it right!
2) You can customise the analysis to fit your personal ordering of the mRS (i.e. you may consider some states worse than death).
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Quick renal denervation meta-analysis. ABPM. Sham. From me in a BCN bar and
@j_p_howard
in LDN.
@DrAfzalSohaib
@escardio
#ESCcongress
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I often await Larry’s reviews almost as much as the trials. Some great comments and thoughts.
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Two failed LV lead attempts.
#UKHisPacing
- 15 minutes to pace His - narrowed QRS by 30ms.
#dontdisthehis
#
@ImperialEP
@DrAfzalSohaib
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It is well worth the 59.5Mb download.
This - angio images of all 200 lesions available in appendix
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@drjohnm
@skathire
@PrashSanders
@VinayPrasadMD
@AndrewFoy82
@SVRaoMD
@nmarrouche
@Loftus
In retrospect there was no point in changing the primary endpoint from mortality.
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Interesting editorial (and paper in circ).
Top tip for fellows. Don’t google the first two references in it for the back story. It’s not at all interesting.
#Editorial
: Undeniable evidence that the adult mammalian heart lacks an endogenous regenerative stem cell
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The late-breaking trial to watch is: ORBITA: A Randomized, Sham-Controlled Trial of PCI in Patients With Coronary Artery Disease.
TCT NEWS! The Lineup Is In! View the Selected TCT 2017 Late-Breaking Clinical Trials & More
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@JasonFoerst
@yuripridemd
@DLBHATTMD
@rwyeh
@lamelaspablo
@agtruesdell
@DrSethdb
@InovaHealth
@abiomedimpella
@mmamas1973
@DocSavageTJU
@mirvatalasnag
@GreggWStone
@SVRaoMD
@fischman_david
@ProfDFrancis
@SGuptaMD
@gabrielsteg
@samirpancholy
@SanjitSJolly
IABP-SHOCK2 enrolled 600 out of the 790 (76%) patients screened.
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Ok.
@DrJHoward
has won twitter.
Basically
#cardiotwitter
right now
@Yousifa19343425
@ProfDFrancis
@venkmurthy
@RicardoPetraco
@DavidLBrownMD
@SukhNijjer
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The first UK His Pacing Summit - Thu 2nd November 2017 @ RCP in London.
#UKHisPacing
#dontdisthehis
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Amazing - especially as
@ImperialEP
have probably done 1000 using the the research kit - phew.
Great to see Finapres based CRT optimization (TrueMax) on display at
#EHRA2018
. Brainchild of
@ProfDFrancis
and
@ZacharyWhinnett
and now built into new Finapres models
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Though if Santa would like to bring us funding for an RCT as well that would be great... we have all been very good this year and almost finished recruitment for HOPE-HF
#dontdisthehis
All I want for Christmas is a....
#dontdisthehis
@JACCJournals
paper get it while it’s hot! His vs BiV in LBBB
@DrAhranArnold
@Dr_Keene
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@RicardoPetraco
@MGtberg
@rkhamis
@rallamee
@SukhNijjer
@DrShaiSen
@ghazala_yasin
@MikhailGhada
@DrIqbalMalikUK
@drgrahamcole
A patient coughing is an aerosol generating procedure. That is kind of how these respiratory diseases spread.
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The interventional trial of 2017 - ORBITA - the first placebo controlled trial of PCI in stable angina.
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@strain_rate
@TorBiering
@Matte_Cameli
@lpbadano
@denisamuraru
@EchofirstB
@ThorEdvardsen
If you assume outcome is solely dependent on the AV plane motion - studies would still show that outcome were also associated with LV strain, LA Strain, and LA strain when LV strain were included in the model. Demonstration:
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Hey EPpeeps. Does anyone have the link to the real HRS abstract submission site? I can only find this one that changes $75 per abstract.
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Making slides for
#UKHisPacing
summit.
@ImperialEP
+
@TheBHF
’s X-over RCT of DHBP for Heart Failure + long PR + narrow QRS
#dontdisthehis
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@f2harrell
@NEJM
Hypothetical numbers: No treatment - 50% have events; Rx A -10%, Rx B - 5%. A is tablet, needs monitoring; B is injection, painful. If C has event rate of 7.5% (or even 10%); but oral and no monitoring patient may prefer. The unknown anchoring rate of no treatment may be key.
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@venkmurthy
@f2harrell
@NEJM
The raw data for the outcome would be a table of TrialID, the treatment arm, and the mRS at 30 days. This can be constructed from the figure and analysed. Click my notebook link -> took me 5 mins
P.s Amazing Trial.
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@venkmurthy
@jhfrudd
@ProfDFrancis
@DrJHoward
@cecilejanssens
@f2harrell
@ihtanboga
@EpiEllie
@statsepi
@rallamee
This paper may help.
But as we discuss here - odd distributions often reflect that good clinical practice may be bad research practice, not fraud. You have to make sure the measurement protocol is fully specified.
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@mirvatalasnag
@jedicath
No. Effective half life of Ticagrelor much shorter as reversible binding with P2Y reception. Stick with OD ASA and Clopi.
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@statsepi
@ADAlthousePhD
Nice line snuck in at the end - “In summary, authors should not attempt to get cute when performing survival analysis using composite endpoints. “
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Tune in today. 6pm U.K. time. With plenty of time for discussion!
📌 This Friday, Dec 18, Dr.
@mshunshin
of
@ImperialNHLI
will present findings from
#SAMSONtrial
, an n-of-1 trial to assess side effects of
#statins
compared with placebo and no treatment. Join us for our final Grand Rounds of the year!
🔗
#pctGR
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@AdeMarvao
@ProfDFrancis
@drgrahamcole
@DrJHoward
Either way I am sticking to my Mediterranean diet of daily Pizza and Birra Moretti
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Yet, I'm sure I saw
@ProfDFrancis
eat a salad the other day...
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@ProfDFrancis
x = num min past 8
20 - x/12 = num mins to 12 on hour hand
Then
x = 20 - x/12
So
x = 240 / 13 = 18 6 /13 mins.
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👍
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CASTLE-AF. Looking forward to paper - why (in unblinded trial) curves similar until 36mo then sudden deterioration in control
#ESCcongress
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@ProfDFrancis
@venkmurthy
@ethanjweiss
@HeartFlow
@CCook_MD
@jerd10
@DrJHoward
@SukhNijjer
Nope - too early - private company.
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We are doing that in our SAMSON n-of-1 trial of statin side effects - - at Imperial College London 2/2
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@barttels2
@anupampom
@f2harrell
@venkmurthy
@NEJM
In this case I think it is for the intellectual exercise. More interesting to learn with actual data, and practice techniques + methods so that you can pre-specify them in your own work before you see the data. Message is 1) Amazing work by authors 2) Don’t have an OOH arrest.
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@drandrewsharp
@DavidLBrownMD
@venkmurthy
@rallamee
@dsutter111
@rwyeh
@ProfDFrancis
@SVRaoMD
Well, ISIS-2 had good luck with sub-groups and birth star sign.
@f2harrell
- does Hmisc have a date to zodiac sign converter?
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@venkmurthy
@rwyeh
@ProfDFrancis
@VinayPrasadMD
@johnwmcevoy
@rallamee
@f2harrell
@DavidLBrownMD
@ADAlthousePhD
People may be very accurate when saying that something has not happened, but if it has happened, very bad at remembering how many times / often (so is effectively a random number). Consequently, only useful information may be absence/presence.
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@rallamee
@AdeMarvao
@AlmaIacob
@ProfDFrancis
@richardbogle
@DrPascalMeier
@drandrewsharp
@SukhNijjer
@JGrapsa
@TheBJCA
@sarahhudsonuk
@DrAfzalSohaib
@BritishCardioSo
,and we thought, early morning slot, last day. No one will notice.
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@f2harrell
@GreggWStone
Ask patients the relative (dis)utility of each end-point and re-weight existing RCTs of coronary intervention using those results. is one attempt (by us).
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@rwyeh
@skathire
@rallamee
@ProfDFrancis
I’m sitting next to
@rallamee
- she is signing up with new nom de plume as we speak :-)
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Errrr if 100% were abnormal it would also be unnecessary. If ~50% are abnormal then the referrals are mathematically perfect.
Moreover as 40% of cardiac CTs are normal, going forward we better pretest prediction to reduce unecessary testing
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@AdeMarvao
@rafavidalperez
@DrAfzalSohaib
@rladeiraslopes
Probably a few factors. 1)statistical 2) difficultly classifiying cause - can die of pump failure and then go into VT/VF 3) bulky vest reminds them to take 2ndry prevent Rx
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@DavidLBrownMD
@rwyeh
@venkmurthy
@EpiEllie
@boback
@ethanjweiss
@ajaykirtane
@anish_koka
@rallamee
@mmamas1973
@fischman_david
@DocSavageTJU
@metrics52
Censor the patients when you lose to follow-up rather than exclude all those site’s data. You still want their early data in your analysis.
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@omaclaren
@stephensenn
If you want to have a neurosurgery hobby, start with this paper - Emergency burr holes “how to do it”. It features the invaluable advice "It may be useful to nominate a person to read out the components of this guide as the procedure is being performed”
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Great first post.
Check out - a new project from
@f2harrell
for longer, more detailed discussions about
#MedStats
+ Trials + more.
Provocative interpretation of PARAMEDIC2 trial - inviting your participation in the discussion @
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@AdeMarvao
@drgrahamcole
@ProfDFrancis
@DrJHoward
Well, it should be in the guideline, but as something you shouldn’t do.
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@rwyeh
@skathire
@rallamee
@ProfDFrancis
@rallamee
will be presenting ANCOVA results at EuroPCR, with a little help from
@f2harrell
along the way.
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ORBITA-HQ Research meeting. Smiling faces after an evening of food, drink, and arguing about physiology, trials, and statistics.
@rallamee
@jerd10
@Yousifa19343425
@DrShaiSen
@henselig
@CCook_MD
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@DrAfzalSohaib
@RicardoPetraco
@MGtberg
@rkhamis
@rallamee
@SukhNijjer
@DrShaiSen
@ghazala_yasin
@MikhailGhada
@DrIqbalMalikUK
@drgrahamcole
Anyway, you should be able to get a PLAX and a few apical views in the length of time you can hold your breath. So nothing really to worry about.
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@dr_benoy_n_shah
@venkmurthy
@vass_vassiliou
@MarcDweck
2) That people may actually believe these cut-offs, denying care to those just about a cut-point, and giving it to those just below. These “cut-offs” really reflect, by chance, the median value in the population (a
@ProfDFrancis
and
@f2harrell
gem). 8/n
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@GreggWStone
@f2harrell
If this were true for all hypersensitivity reactions, then desensitisation protocols - e.g. for Asprin pre-PCI; or test doses of amphotericin - wouldn't work. Thanks to
@JKAronson
(who taught me this at medschool) -
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@AdeMarvao
@DrAfzalSohaib
Mechanism, haemodynamics, and physiology make sense - but need RCT. Our HOPE-HF trial for HF with long PR - but need more RCT for other Dz
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@EJSMD
@SchakrabartiEP
@SergioPinski
@MDT_Cardiac
To be fair to the trialists and
@MDT_Cardiac
it was a fantastic idea for a trial, but they estimated they would need to randomise 2300 subjects and only got 44 patients in 13 months. It showed willingness to fund and try - but sometimes you have to stop and re-consider.
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@BSHeartFailure
Here is a clickable link - open access as well - so no need to sign in.
Uses non-invasive, beat-by-beat finger BP to optimise CRT. Now built into the
@finapres
machine - so easy-peasy.
Using this technique in the HOPE-HF trial
#dontdisthehis
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Watching NN learn to segment LV. Power of open code+data
@tensorflow
library,
@sunnybrook
CMR, SegNet
@alexgendall
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@ncurzen
If you have lot (9 segments!) of ischaemia and you don’t get sent for revasc it likely means there is something else very wrong with you - hence higher mortality. If you force the lines to be linear - then they will cross.
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@DavidLBrownMD
@wpentz
@drjohnm
The audience might like to read the authors’ reply to the Letters to the Editor. Both educational and entertaining, and deals with some of these “issues"
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@angioplastyorg
@DavidLBrownMD
@willsuh76
@SVRaoMD
@GreggWStone
@CardiacConsult
@philgenereux
@MartyMleon
@mirvatalasnag
@chadialraies
@DrSheilaSahni
@drdevireddy
@ekgpdx
@ProfDFrancis
@rallamee
Methods paper is available here (open access):
Whilst it reports the use of headphones (+eye mask or GA) for blinding - dissapointingly no details on the music played.
@rallamee
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If your blood pressure has recovered from the England penalties, it’s time for another
#ORBITA
article - Author replies to
@TheLancet
letters.
"Applying a positive spin could have smoothed the reception of the trial, but as authors we have a duty to preserve scientific integrity."
#ORBITA
authors respond to critical letters in
@TheLancet
@ProfDFrancis
@DrVikasSaini
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@DanMarkMD
@ajaykirtane
Change seen in the placebo group is not the placebo effect, just as the change seen in the intervention group is not the intervention effect
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@f2harrell
@ProfDFrancis
We have three blocks (each x4) - (1) Taking nothing (2) Placebo (3) Active Statin. Daily symptoms via smartphone.
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@ProfDFrancis
@hIPS_CM_lab
@DrJHoward
@rajkumar_chris
@CCook_MD
@LizaChacko
Twitter now allows us to always be at work with the Prof.
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10 minutes into his new job as health secretary, Matt Hancock starts to get to know the doctors...
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@ADAlthousePhD
@boback
@JeremySussman
STS and similar typically will be calculated away from the patient - e.g. the fellow prepping the MDT form in the evening for the following day. CHADS2-VASc calculated in head whilst taking history in clinic with patient with new AF. Hence the difference in complexity.
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@venkmurthy
@ethanjweiss
@ProfDFrancis
@HeartFlow
@CCook_MD
@jerd10
@DrJHoward
@SukhNijjer
Yep - CT-FFR costs a lot on this side of the Atlantic too:
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Wonderful Monday journal roundup as ever from
@RichardLehman1
and great to see another viewpoint on
#ORBITA
@rallamee
Astronaut brain, and the "hidden iceberg" of Type 2 diabetes in the US: It's
@RichardLehman1
's journal reviews
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@statsepi
the give away is that they talk about selecting the right patient for the procedure rather than the right procedure for the patient after a non-positive RCT.
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The SDD (how much it may vary from one reading to another) for SBP on a 24h holter is around 11mmhg (e.g. from placebo arm of spyral off-med). Titrating to a 10 mmHg range will lead to chasing your tail.
#ESH
#ESH
New European HT guidelines: Narrow window to aim for in Coronary patients of 120-130/70-80. Harm outside of that window on both sides
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@VinayPrasadMD
@venkmurthy
@orbita
@rallamee
@ProfDFrancis
@drjohnm
@adamcifu
ORBITA-HQ has. Though mainly over a few pints and tears (interventional fellows) and laughs (imaging fellows) at a pub in West London rather than on twitter.
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@f2harrell
Ha! Another lie learnt at medical school. As posting I had a feeling it was going to be one of those.
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@dr_benoy_n_shah
@venkmurthy
@vass_vassiliou
@MarcDweck
Re: RCTs - to really show that the marker should guide therapy you want to recruit all-comers (those with high and low marker values), randomise them to the therapy, then at analysis show there is an interaction between the biomarker at baseline and treatment effect. 1/n
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@ProfDFrancis
@drcplymen
@adamcifu
@kaszfj
@mmamas1973
@ProfDConnelly
@cpgale3
@signindoc
@DrWillWatson
@hvanspall
@drgrahamcole
@willsuh76
Best place for the NHS Drug Tariff Price is the BNF: - even cheaper
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@DavidLBrownMD
@drandrewsharp
@onco_cardiology
@RogueRad
@willsuh76
@venkmurthy
@bjcromerd
@mmamas1973
@iamritu
@VietHeartPA
@DrSuzyFeigofsky
@DrMarthaGulati
@RodrigoBagur
@wonkie12
@DrQuinnCapers4
@InaJaki
@WCHwomenshearts
@thevibrantbeat
@fitmslax
@rahatheart1
@DrDeborahFisher
@AlainBouchardmd
@AnastasiaSMihai
@CardioIAN
@purviparwani
@HeartOTXHeartMD
@MustafaAhmedMD
@DrPascalMeier
@BethFratesMD
@SimonMDLord
You joke
@drandrewsharp
, but it was part of co-ordinated lobbying by the car industry to effectively criminalise walking in the US.
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@SukhNijjer
@RicardoPetraco
@rallamee
@DrShaiSen
@ProfDFrancis
Wait, did you go for a 3D cubic spline without inviting me and
@DrJHoward
?
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@EricTopol
@MedtechReed
@matthewherper
@TheLancet
@nytimeshealth
@ginakolata
Exercise time has been positive in multiple placebo controlled trials of anti-angina agents - and their primary endpoint.
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@ProfDFrancis
did you take a look at Table 2 before you put in your bulk order of IPE?
#EVAPORATE
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@scleroplex
@ProfDFrancis
Exactly, when people e-mail me for a paper, because I 100% have them nicely organised on my computer, I can send it to them immediately.
I don’t, for example, have to then find my own paper in Pubmed, copy it into sci-hub, and then send it to the requester.
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@ProfDFrancis
@drjohnm
The irony is that it was posted on May 16, the same day the positive results of the WAKE-UP trial were presented at
#ESOC2018
and published in NEJM
#shouldhavegonetoesoc2018
#EUvsUS
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@GwilliamsPh
@PH_Evidence
We are looking forward to submitting a full paper soon - with a lot of more analysis of the individual patient results. We have some great graphs and visualisations ready!
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@ProfDFrancis
@rwyeh
@skathire
@rallamee
@f2harrell
@SmithBIDMC
@Changyushen312
Me and
@DrJHoward
have submitted a request to add this to everyones file; or perhaps
@f2harrell
could add to Hmisc.
t.test <- function(...){print("Banned, please use ANCOVA”)}
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For some variety put the higher blood pressures on the left hand side of the x-axis
BP too high or too low at presentation of aortic dissection associated with higher mortality: .
#JACC
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@MedCrisis
@EJSMD
@willsuh76
@True_EP
@raj_mehta
@venkmurthy
@f2harrell
@narrowQRS
@ProfDFrancis
@syrton71
@dr_chirumamilla
@OSUWexMed
@drjohnm
@DrQuinnCapers4
@fischman_david
@DocSavageTJU
@bcostelloMD
@haiderwarraich
@ADAlthousePhD
@andreanatalemd
@LuigiDiBiaseMD
@Zo_EP2
Yes. Fundamentally, RCTs are an experiment. Whether you think / believe / are sure a procedure “works” or "doesn’t work” is orthogonal to why you conduct an experiment. We were sure PCI worked - but were curious by how much - and how it interacted with stenosis parameters.
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Free registration. Consultants, SpRs, Nurses, and Physiologists welcome.
#UKHisPacing
#dontdisthehis
Thu 2nd Nov 2017. How to; tips and tricks; and, most excitingly - His Pacing for Heart Failure
#UKHisPacing
#dontdisthehis
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@lpbadano
@strain_rate
@TorBiering
@Matte_Cameli
@denisamuraru
@EchofirstB
@ThorEdvardsen
I think the message from the quick simulation should be that as we try at tease apart the mechanistic contribution of these imaging biomarkers we will need to take careful statistical advice.
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@DrFuSiongNg
@DrAfzalSohaib
Did patients at some centres really have to pay for assigned treatment? Primary source? If so that is all the more reason you cannot trust the ‘as treated’ analysis as the richer you are the better your outcomes are irrespective of treatment.
#CABANA
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@ADAlthousePhD
@DavidLBrownMD
@rallamee
@rwyeh
@ProfDFrancis
@RogueRad
@venkmurthy
@ajaykirtane
Ah. ‘Negative’ is a description of the study data+criteria; not interpretation of data. We can separate. Better to call these trials as negative as greater harm in medical history has come from use of poorly tested therapies with weak data than having ‘negative’ outlook.
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@drjohnm
@hswapnil
Re: ICD with NICM. It is likely that ICDs now are just (or more so) efficacious at terminating spontaneous otherwise fatal tachyarrhythmias. The RR/HR/OR (forgive me
@f2harrell
) for this specific death should be ~preserved. The baseline incidence will have decreased with time...
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We have some great
#dontdisthehis
science to submit. Just need the correct link for HRS abstracts.
@HRSonline
@drjohnm
Hey EPpeeps. Does anyone have the link to the real HRS abstract submission site? I can only find this one that changes $75 per abstract.
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