Frederik H. Verbrugge @FH_Verbrugge Twitter profile | Pikagi

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Frederik H. Verbrugge

@FH_Verbrugge

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Cardiology & ICU @HeartBrussels @UZBrussel @VUBrussel | #ACVC @escardio board member | Deputy Editor EHJ ACVC | Editorial Consultant JACC Heart Fail

Brussels, Belgium

https://t.co/bQdMbes7Mu

Joined December 2019

Don't wanna be here? Send us removal request.

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@FH_Verbrugge

Frederik H. Verbrugge

4 years

Why #kidney function does not equal #GFR (and certainly not Cr), making it an elusive target in clinical practice & the latter a poor surrogate outcome, despite its robust correlation with prognosis. Caring for kidneys versus improving Cr/GFR. A thread below:

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@FH_Verbrugge

Frederik H. Verbrugge

2 years

Highlight of my career so far! From an idea conceptualised during my PhD, cultivated by 4 generations of PhD students after me under the watch of @WilfriedMullens , to a @NEJM publication and novel treatment for acute #HeartFailure #acetazolamide #advor

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Acetazolamide in Acute Decompensated Heart Failure with Volume Overload | NEJM

Whether acetazolamide, a carbonic anhydrase inhibitor that reduces proximal tubular sodium reabsorption, can improve the efficiency of loop diuretics, potentially leading to more and faster deconge...

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@FH_Verbrugge

Frederik H. Verbrugge

2 years

For those who can't get enough from #ADVOR , below the promised Tweetorial! Acetazolamide in acute #HeartFailure w volume overload on background high-dose loop diuretics: 👍Increases diuresis & natriuresis 👍More euvolemia after 3 days & discharge 👍⬇️LOS #ESCCongress #Cardiology

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@FH_Verbrugge

Frederik H. Verbrugge

3 years

Quite possibly the most important paper of my career so far @ESC_Journals One sentence summary: No cut-off for #NTproBNP is low enough to exclude clinically meaningful #HeartFailure ! Another one from the Barry Borlaug lab @yreddyhf Thread below...

Heart failure with preserved ejection fraction in patients with normal natriuretic peptide levels...

See the editorial comment for this article ‘BNP: Biomarker Not Perfect in heart failure with preserved ejection fraction’, by Sanjiv J. Shah, https://doi.o

academic.oup.com

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@FH_Verbrugge

Frederik H. Verbrugge

2 years

What is your take on #vasodilators in acute #HeartFailure ? The upcoming November issue of #EHJACVC will bring you a PRO/CON "Vasodilator therapy in acute heart failure revisited" As our PRO paper was published in advanced access, a sneak preview Tweetorial below... @EHJACVCEiC

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@FH_Verbrugge

Frederik H. Verbrugge

4 years

Very proud of our new review @CircAHA on end-organ damage by altered #hemodynamics in #heartfailure . A true honor to be in the company of 3 legends in the field (Dr. Guazzi, Dr. Testani & Dr. Borlaug). Tweetorial below!

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Altered Hemodynamics and End-Organ Damage in Heart Failure | Circulation

Heart failure is characterized by pathologic hemodynamic derangements, including elevated cardiac filling pressures (“backward” failure), which may or may not coexist with reduced cardiac output...

www.ahajournals.org

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@FH_Verbrugge

Frederik H. Verbrugge

2 years

Really proud moment for me today, presenting 1st time in a Featured Science session @AHAScience . Deeper insight in #ADVOR trial with key contributions from @WilfriedMullens @PieterMartensMD @JeroenDauw @petra_nijst @EvelyneMeekers among many others. Proudly 🇧🇪! Tweetorial below!

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@FH_Verbrugge

Frederik H. Verbrugge

2 years

Don't miss our monthly educational review #EHJACVC @ESC_Journals ! This month by the great @ArgaizR : fluids in #AKI Co-starring: @ThinkingCC @khaycock2 Extremely proud that our journal offers a platform to 3 great clinicians & Twitter educators. I always learn from them...

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@FH_Verbrugge

Frederik H. Verbrugge

1 year

Read our latest analysis from the #ADVOR trial @JACCJournals . Deeper dive into the relationship of #natriuresis with decongestion & clinical outcomes after diuretic therapy in acute #heartfailure ! Tweetorial below... @PieterMartensMD @WilfriedMullens

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@FH_Verbrugge

Frederik H. Verbrugge

2 years

Teaming up again with the great @VerwerftJan to share our experience with #echoCPET in #HFpEF . This hot-of-the-press paper @ESC_Journals demonstrates myriad of opportunities for diagnosis & treatment, far beyond #SGLT2i only. Tweetorial below! @SarahStroobant2 @HerbotsLieven

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@FH_Verbrugge

Frederik H. Verbrugge

7 months

Very proud moment in my career, taking up my first position as official @escardio board member within #ACVC ! Big thank you to all who have supported me! I will try to serve you well, don’t hesitate to reach out to me if you have ideas for our community. #ACVC2024

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@FH_Verbrugge

Frederik H. Verbrugge

2 years

Really excited to present our latest paper @JACCJournals on how to organize a #dyspnoeaclinic for #HFpEF ! Tweetorial below... Implementation perspective = new item in #JACCHeartFail under @BiykemB leadership! Really the clinician's voice, just love it!

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@FH_Verbrugge

Frederik H. Verbrugge

4 years

Very proud on our new paper from the Borlaug lab @MayoClinicCV @ESC_Journals . We compare the prognostic value of the HFA-PEFF & H2FPEF scores in patients hospitalised with decompensated #HFpEF @yreddyhf @MarcoMetra @kevin_damman

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@FH_Verbrugge

Frederik H. Verbrugge

1 year

It would be a big mistake to think that #HFpEF is really unlikely just based on NTproBNP <125 ng/L. As we have shown @ESC_Journals , 1/3 proven ambulatory #HFpEF patients are below this cut-off and have an increased risk of #mortality & #morbidity !

Heart failure with preserved ejection fraction in patients with normal natriuretic peptide levels...

See the editorial comment for this article ‘BNP: Biomarker Not Perfect in heart failure with preserved ejection fraction’, by Sanjiv J. Shah, https://doi.o

academic.oup.com

@HanCardiomd

Henry Han

1 year

Practical Algorithms for Early Diagnosis of #HeartFailure and Heart Stress using #NTproBNP : A Clinical Consensus Statement from the #HFA of the ESC @ESC_Journals @HFA_President @MarcoMetra @EJHFEiC @markcpetrie20 @JJheart_doc @mvaduganathan @JavedButler1

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@FH_Verbrugge

Frederik H. Verbrugge

4 years

Most comprehensive mechanistic study I have seen on the #renal effects of #SGLT2i now published @CircAHA by the Testani group from @YaleMed . My high-yield points below! @yaleHFdoc @DanielJacobyMD @Zac0x @methodsmanmd @JavedButler1

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Empagliflozin in Heart Failure | Circulation

Background: Sodium-glucose cotransporter-2 inhibitors improve heart failure–related outcomes. The mechanisms underlying these benefits are not well understood, but diuretic properties may contribute....

www.ahajournals.org

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@FH_Verbrugge

Frederik H. Verbrugge

2 years

Pulmonary vascular disease (PVR >3WU) in patients with group 2 pulmonary hypertension associated with more severe lung congestion, right heart failure & poorer O2 delivery during #exercise . Our new paper from the #BarryBorlauglab : @yreddyhf @MassarOmard

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@FH_Verbrugge

Frederik H. Verbrugge

4 years

How is diuretic efficiency changing with severity of #CKD ? What is its prognostic relevance? Read our new paper in CardioRenal Medicine! @WilsonTangMD @BammensBert Also thanks to Jeff Testani, Pieter Martens & Dirk Kuypers for their help with the paper...

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@FH_Verbrugge

Frederik H. Verbrugge

8 months

Reviewing current evidence on #hyponatremia in #heartfailure together with our bright visiting fellow @GiulioMonde ! Tweetorial 👇

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@FH_Verbrugge

Frederik H. Verbrugge

4 years

#ARNi has proven to be a gamechanger in left #HeartFailure ! But what is the perspective of the #PeoplesVentricle ? Read our editorial in @JAHA_AHA on mechanistic study testing ARNi in pulmonary artery banding model! RVP reduction despite fixed obstruction?

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@FH_Verbrugge

Frederik H. Verbrugge

4 years

Thanks to my friend @DmitryAbramovMD for inviting me to work together on this practical review: "Inpatient Diuretic Management of Acute Heart Failure: A Practical Review" Proud to achieve a career milestone of 100 Pubmed articles! #SSP

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@FH_Verbrugge

Frederik H. Verbrugge

4 years

Always nice to write an editorial together with partner-in-crime @kevin_damman ! We dig into the question: "Is spironolactone a disease-modifying drug or diuretic in #HFpEF ?" @ESC_Journals Comment on:

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@FH_Verbrugge

Frederik H. Verbrugge

2 years

Proud to share with you the latest paper on #ExerciseHemodynamics from the #BarryBorlauglab . Work by my co-fellow Dr. Omote, usual suspects @yreddyhf & @MassarOmard involved! This one examines prognostic impact of hemodynamic alterations with exercise...

Central haemodynamic abnormalities and outcome in patients with unexplained dyspnoea

Invasive exercise haemodynamic abnormalities currently used to diagnose or exclude heart failure (HF) with preserved ejection fraction (HFpEF) are useful for risk stratification in patients with...

onlinelibrary.wiley.com

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@FH_Verbrugge

Frederik H. Verbrugge

3 years

You might find this figure helpful for practical decision-making about starting/uptitrating the #heartfailure medications.

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@FH_Verbrugge

Frederik H. Verbrugge

4 years

Very proud to be given this opportunity & contribute as a part of the @ESC_Journals & ACVC family!

@ACVCPresident

ACVCPresident

4 years

Pascal Vranckx, Editor-in-Chief of @ESC_Journals #EHJACVC , proudly announces the appointment of two deputy editors: - David Morrow, director of the cardiac intensive care unit @BrighamWomens - @FH_Verbrugge , research fellow @MayoClinic and future staff @UZBrussel

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@FH_Verbrugge

Frederik H. Verbrugge

8 months

Great teamwork with @artschuermans reviewing contemporary evidence on decongestion strategies in acute #heartfailure ! Key points below 👇

Decongestion (instead of ultrafiltration?) : Current Opinion in Cardiology

mbination with other diuretic classes or molecules with diuretic properties should be considered. Mineralocorticoid receptor antagonists and sodium–glucose co-transporter-2 inhibitors are disease-m...

journals.lww.com

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@FH_Verbrugge

Frederik H. Verbrugge

4 years

Hopefully, we have learned it now & stop wasting money! #Creatinine is least important lab value at #ICU . No reason to give fluids, no reason for RRT! Keep #kidneys happy with perfusion pressure & avoidance of volume overload, ALWAYS irrespectively of Cr!

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Timing of Initiation of Renal-Replacement Therapy in Acute Kidney Injury | NEJM

Acute kidney injury is common in critically ill patients, many of whom receive renal-replacement therapy. However, the most effective timing for the initiation of such therapy remains uncertain. We...

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@FH_Verbrugge

Frederik H. Verbrugge

3 years

Very proud to present our new paper @CircHF on the limitless power of #ArtificialIntelligence in #Cardiology #HeartFailure ! From the @MayoClinicCV Borlaug group, a tweetorial below... @yreddyhf @zachia5 @drpaulfriedman @noseworthypeter @SurajKapa

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Detection of Left Atrial Myopathy Using Artificial Intelligence–Enabled Electrocardiography |...

Background: Left atrial (LA) myopathy is common in patients with heart failure and preserved ejection fraction and leads to the development of atrial fibrillation (AF). We investigated whether the...

www.ahajournals.org

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@FH_Verbrugge

Frederik H. Verbrugge

4 years

That's why I am not so worried at ICU if Cr rises, but urine output remains preserved! Actually, I don't care about Cr too much at all & do not try to prevent a rise. Instead, I'll try to keep good perfusion & get rid of congestion. This saves nephrons & kidney on the long run!

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@FH_Verbrugge

Frederik H. Verbrugge

2 years

Must be my hottest #AHA in the Windy City, beautiful skyline yesterday from Navy pier! Getting ready for my first LBT @AHAScience . Eager to learn results from TRANSFORM-HF! Some great science on #diuretics this meeting! Stay tuned for #ADVOR analyses tomorrow @PieterMartensMD

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@FH_Verbrugge

Frederik H. Verbrugge

2 years

Superproud on this paper. Treating #HFpEF is so much more than #SGLT2i only! In general, medicine needs people looking beyond the borders of a narrow specialty! #teambelgium @VerwerftJan @Ph_Bertrand @alexvdbruaene @HerbotsLieven @AndreasGevaert

@ehj_ed

EHJ Editor-in-Chief

2 years

Do we need dedicated heart failure with preserved ejection fraction clinics? Read more in #EHJ @escardio @ESC_Journals #CardioTwitter #heartfailure

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@FH_Verbrugge

Frederik H. Verbrugge

4 years

Please throw away every single paper on #AKI at #ICU if defined according to Cr only. Those serve to keep you warm in wintertime! Literature is massively flawed! #AKI correlates with prognosis, just like CO. Preventing AKI or increasing CO has never shown to be of any benefit!

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@FH_Verbrugge

Frederik H. Verbrugge

3 years

Reviewing the pathophysiology & treatments of #HFpEF together with Dr. Borlaug still feels like being a 7 y/o soccer player teaming up with Lionel Messi. Immense gratitude for such a great mentor!

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@FH_Verbrugge

Frederik H. Verbrugge

3 years

@Ph_Bertrand @petranijst 61 y/o woman PMH: Chronic HCV, hypertension, poorly controlled diabetes (HbA1c 9.6%), obesity (BMI 32 kg/m²) Currently no meds Found in apartment with motoric aphasia & right hemiplegia due to ischemic stroke (middle cerebral artery) R/No thrombolysis (subacute), thrombectomy!

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@FH_Verbrugge

Frederik H. Verbrugge

4 years

"Navigating the risks in acute heart failure" In my 1st Editorial as Deputy Editor for EHJ ACVC @ESC_Journals , I briefly highlight 7 manuscripts to be published in our dedicated #AHF issue (Print september). Topics indicated in red in Central Figure.

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@FH_Verbrugge

Frederik H. Verbrugge

3 years

Do You keep slamming Your face because You missed the 1st #HFA @escardio Clinical Practice Update Course on #HeartFailure , orchestrated masterfully by MC Mullens? Are You particularly disappointed to have missed the clinical pearls of #HFA giants @kevin_damman & @FinnGustafsson ?

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@FH_Verbrugge

Frederik H. Verbrugge

2 years

Heart failure with normal natriuretic peptide levels: more fat, and that is the main problem

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Heart failure with normal natriuretic peptide levels: more fat, and that is the main problem

This commentary refers to ‘Heart failure with preserved ejection fraction in patients with normal natriuretic peptide levels is associated with increased m

academic.oup.com

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@FH_Verbrugge

Frederik H. Verbrugge

3 years

Great to see this paper by my colleague Hidemi published @ESC_Journals : Stressed vs. unstressed blood volume in #HFpEF . The venous side is such an underappreciated item in #heartfailure . Tweetorial⬇️! #barryborlauglab @MayoClinicCV @yreddyhf @BurkhoffMd

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@FH_Verbrugge

Frederik H. Verbrugge

1 year

#aorticstenosis : The valve vs. #HFpEF ! Read the latest paper from our group @ESC_Journals : Exercise impairment & adverse hemodynamics correspond better w HFpEF phenotype than AS severity... @sarahhoed @VerwerftJan @yreddyhf @guido_claessen @Cosyns

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Cardiac dysfunction rather than aortic valve stenosis severity drives exercise intolerance and...

AbstractAims. To study the impact of heart failure with preserved ejection fraction (HFpEF) vs. aortic stenosis (AS) lesion severity on left ventricular (L

academic.oup.com

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@FH_Verbrugge

Frederik H. Verbrugge

2 years

First, know your drugs, not all #vasodilators are alike... Organic nitrates: mainly preload reduction, afterload at higher dose Hydralazine: pure afterload reduction Nitroprusside: balanced preload/afterload reduction (my favorite in AHF)

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@FH_Verbrugge

Frederik H. Verbrugge

1 year

Meeting the #VExUS legends in a Cardiorenal workshop… #cardiorenal @HandRConference !

@NephroP

NephroPOCUS

1 year

Who said cardiologists and nephrologists can’t be friends?! Honored to be a part of the #cardiorenal session at #HR2023 alongside @FH_Verbrugge and @ArgaizR

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@FH_Verbrugge

Frederik H. Verbrugge

6 months

I wholeheartedly support @WilfriedMullens as a candidate to become our new #HFA @escardio president! Being his first PhD student, I experienced from the first row his talent to get things done! Many of us talk the talk, I am sure he will walk the walk! Every vote counts!!!

@WilfriedMullens

Wilfried Mullens

@WilfriedMullens

6 months

Honored, humbled and very excited to be selected as candidate for position of president-elect for the #HFA board elections! To all members, please don’t forget to vote for these fantastic people! Here are my top six priorities....together we can make it

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@FH_Verbrugge

Frederik H. Verbrugge

2 years

Which upcoming trial are You looking forward to the most? Easy choice for me: #ADVOR ☑️largest #diuretic RCT ever ☑️finally high quality data on #acetazolamide in #heartfailure ☑️real-world streamlined trial in 🇧🇪 Going to be a “wet” summer 😉!

@WilfriedMullens

Wilfried Mullens

@WilfriedMullens

2 years

Results of the randomized #ADVOR trial are soon coming your way! It's the largest diuretic trial in acute #heartfailure ever conducted (N=519) and will test acetazolamide on top of loop diuretics. Recruitment is finished and full database lock is anticipated. Find out more (1/9).

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@FH_Verbrugge

Frederik H. Verbrugge

5 years

@DanielleTBurton @sargsyanz UNa: so easy and helpful! Train your nurses to take spot samples after every diuretic administration as they check BP after changing vasopressor dose. >100 mmol/L: excellent diuretic response 70-100 mmol/L: acceptable <70 mmol/L: will not end up with 2L!

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@FH_Verbrugge

Frederik H. Verbrugge

3 years

Finally, the game changer we were craving for in #HFpEF ! This makes #SGLT2i indicated in almost EVERYBODY (at risk of) #HeartFailure ! Time to focus upon implementation…

@GiuseppeGalati_

Giuseppe Galati

@GiuseppeGalati_

3 years

☝️ #EMPEROR_PRESERVED 🎉🎉🎉 @ShelleyZieroth @hvanspall @escardio @JavierdeJuan1 @JTLLERGO @AndreasGevaert @kevin_damman @FH_Verbrugge @iamritu @lucreciamburgos @Dr_Manito @Hragy @BWGHF @HeartFailureFrm @HeartOTXHeartMD @JBauersachsMD @KardiologieHH @AnnaKateBarton @markcpetrie20

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@FH_Verbrugge

Frederik H. Verbrugge

2 years

Reporting of the #ADVOR trial will follow very soon! Here are the baseline characteristics of the world’s largest #RCT on #diuretics !

@WilfriedMullens

Wilfried Mullens

@WilfriedMullens

2 years

Baseline characteristics paper of #ADVOR published which is largest RCT on diuretic therapy in AHF. Compared with other diuretic RCT: more elderly population, ↑congestion - NT-proBNP > 6000, 82% CKD = patient profile observed in clinical practice (1/4)

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@FH_Verbrugge

Frederik H. Verbrugge

2 years

What are you doing with 4-pillar therapy when BP is low? Here is my approach: - MRA: hardly any impact of low-dose spironolactone, just continue - SGLT2i: usually no problem either, but careful if low output state - BB: keep, might decrease if electrically stable. STOP if low CO!

@radcliffeCARDIO

Radcliffe Cardiology

@radcliffeCARDIO

2 years

How does low BP impact your management strategy in #HFrEF ? 👉USE #HFARME TO JOIN THE CONVERSATION AT #HEARTFAILURE2022 👈 @FH_Verbrugge @ValleAlfonso @GiuseppeGalati_ #HeartFailure #Cardiology #Cardiologist

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@FH_Verbrugge

Frederik H. Verbrugge

5 months

Further evidence on the role of UNa in #AHF , greatly presented by @EvelyneMeekers 👇🏻

@HanCardiomd

Henry Han

5 months

Readily available urinary sodium analysis in patients with acute decompensate #HeartFailure #EASY -HF study: first nurse-led, natriuresis-guided #diuretic protocol via POC UNa sensor-feasible and safe #HeartFailure2024 @WilfriedMullens @ESCardioNews #ESC_HFA @ShelleyZieroth

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@FH_Verbrugge

Frederik H. Verbrugge

3 years

Read our new consensus paper on the renal effects of guideline directed medical therapies in #heartfailure ! Proud to be part of a great team in the #cardiorenal working group of the HFA @escardio !

@FudimMarat

Marat Fudim, MD MHS

3 years

🚨Renal effects of guideline directed medical therapies in heart failure – a consensus document from the #HFA of the @escardio Led by: @WilfriedMullens @PieterMartensMD 👏 @FH_Verbrugge @kevin_damman @MarcoMetra @paomorejon @HFA_President etc..

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@FH_Verbrugge

Frederik H. Verbrugge

2 years

We could decrease length of stay with 1 day, imagine the impact if this strategy would be employed on a more systematic base worldwide? My only concern: very cheap drug produced by one generic company, please don't let this become an expensive medicine #acetazolamideforall

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@FH_Verbrugge

Frederik H. Verbrugge

1 year

Magnificent performance by @JeroenDauw on Center Court, slamming aces with the first proof that an UNa based diuretic strategy improves natriuresis! #classact

@WilfriedMullens

Wilfried Mullens

@WilfriedMullens

1 year

BREAKING NEWS #HeartFailure2023 ENACT-HF = UNa-guided vs SOC: ⬆️ in natriuresis + diuresis and ⬇️ LOS @HFA_President @HanCardiomd @FH_Verbrugge @jozinetm @_antocannata @DjawidHashemi @doctorchecho @h_arfsten @SotiriaLiori @LauraMeems @JeroenDauw @PieterMartensMD @escardio

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Frederik H. Verbrugge

3 years

Fantastic concept elaborated by my friend and partner in crime @FudimMarat ! More & more people start to realise that filling pressures and blood volume are not the same, although both are important & valid treatment targets! Spread the word of @FudimMarat !

@FudimMarat

Marat Fudim, MD MHS

3 years

🔥🚨Pressures Do Not Equal Volumes🚨 #1 We present ➡️ Discordance of Pressure and Volume: Potential Implications for Pressure-Guided Remote Monitoring in Heart Failure ➡️We explored pressure-volume relationship in ambulatory HF pts. managed with CardioMEMS

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Frederik H. Verbrugge

2 years

Just listened to an amazing talk from Carsten Tschöpe on treatment of #myocarditis . So many #HF pearls. • No inflammation: HF therapy, consider differential, genetics Tricky: HHV (<200 copies) & parvoB19 (<500 copies) innocent bystanders 🚩ALWAYS immunohistochemistry (CD3, CD68)

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@FH_Verbrugge

Frederik H. Verbrugge

2 years

Great to see a definition on exercise #PulmonaryHypertension in the new @escardio guidelines! I am a little bit in doubt about the lower PVR threshold, this is really a lot of the population I do right heart cath on! @radcliffeCARDIO #ESCCongress

@AndrewJSauer

Andrew J Sauer MD

2 years

Big changes in proposed hemodynamics definition of pulmonary hypertension. 😮

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@FH_Verbrugge

Frederik H. Verbrugge

4 years

Nice work by my friend @AliAhmadMD1 (one of the guys who got me on Twitter) in @ESC_Journals ! Proud to be involved. Coronary microvascular dysfunction is associated with higher cardiac filling pressures in #HFpEF , in particular during exercise :

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@FH_Verbrugge

Frederik H. Verbrugge

9 months

Privileged to be in this fantastic meeting organised by @NMerke ! Great discussions. Learning a lot on 3D as well here!

@iamritu

Ritu Thamman MD

9 months

@FH_Verbrugge #3DEchoBerlin #Assess Decongestion 1 Diastolic Fxn(if not ⬇️to grade 1, ?CardioMEMS #echofirst 2 Continuous or minimally variable portal vein flow by VEXUS 3 No B lines on🫁u/s 4 Post-diuretic urine UNa+ <80 mmol/L #UEA for TR signal/PASP #GDMT MRA & SGLT2i Add

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Frederik H. Verbrugge

2 years

Preparing for #HFA kick-off... Big late-breakers upcoming! GALACTIC-HF: is omecamtiv mecarbil more than just expensive digoxin? FIDELITY: non-steroidal MRA the next pharmacological frontier in #HF ? DAPA-VO2 & EMPULSE: further incentive for my fav drugs? #HFARME @radcliffeCARDIO

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Frederik H. Verbrugge

4 years

#SGLT2i are the greatest advance in cardiovascular pharmacology since #statins ! Great summary slide by @Kevin_damman !

@kevin_damman

Kevin Damman

4 years

#heartfailure readmissions are strongly reduced with #SGLT2i accross the #CV continuum: from #T2DM with relatively low risk, to #CKD , to high risk acute and chronic HF! Quick and Dirty graph showing #HRs for HF rehosp! #gliflozins

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Frederik H. Verbrugge

2 years

- RAASi: I titrate down/stop when MAP <60-65 mmHg One tip, always look at pulse pressure to assess low CO! 95/75 mmHg = low CO, high SVR ➡️ temporarily withhold BB & SGLT2i, fix hemodynamics first 95/60 mmHg = ok, no worries

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Frederik H. Verbrugge

3 years

Fantastic honour to speak on the @ClevelandClinic critical care grand rounds! Thanks to my friends @Thind888 & @msiuba for the invitation!

@Thind888

Aman Thind

3 years

@FH_Verbrugge recently shared his wisdom on diuretic therapy in acute heart failure in our @CCF_PCCM grand rounds. This lecture is not to be missed!

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Frederik H. Verbrugge

1 year

Tension building towards kick-off of prime #heartfailure event of the year! MC: the legendary @WilfriedMullens Venue: the historic capital of Bohemia Program: exquisite Impossible to miss out! Register: Proud to be #HeartFailure2023 Twitter ambassador!

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Frederik H. Verbrugge

2 years

Want to have an in-depth view on the #ADVOR data? Stay tuned for the upocoming @AHAMeetings in Chicago! Proud to present #natriuresis data with #acetazolamide during Featured Science Session! Partner-in-crime @PieterMartensMD will show prespecified analysis according to EF...

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Frederik H. Verbrugge

7 months

Upcoming issue of #cardiorenalmedicine with guest editor @AmirKazory discusses some #cardiorenal controversies. Together with @JefVandenEynde reviewed "Sodium Avidity in Heart Failure", for physiology fans...

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Frederik H. Verbrugge

4 years

#SGLT2i in #heartfailure : Class effect or not all created equal? What's Your take on it? My comments on DAPA-HF vs. EMPEROR-REDUCED below...

Definitely class effect!

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No molecule is the same!

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Frederik H. Verbrugge

2 years

Proud that from now on we can offer #cardioMEMS to patients with #HeartFailure at our center! Exciting technology with a lot of potential for patient engagement & telemonitoring! #proudtobebrussels @HeartBrussels @MarcNoppen

@UZBrussel

UZ Brussel

2 years

Cardioloog @FH_Verbrugge implanteerde deze week voor het eerst in het #UZBrussel een cardioMEMS-sensor bij een patiënt met hartfalen. Deze sensor laat de arts toe de patiënt op afstand te volgen. Op die manier pakken we #hartfalen proactief én preventief aan. @HeartBrussels

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Frederik H. Verbrugge

8 months

Team @UZBrussel enjoying Athens with local legend Dr. Kalpakos! Work hard, play hard! #ACVC2024 @TimBalthazar @BertPopelier @RaesMatthias

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Frederik H. Verbrugge

2 years

Moreover, kidneys are smart organs: Proximal = leaky➡️keeps distal nephron flow 🟰 Distal = waterproof ➡️homeostasis Proximal diuretics ➡️more distal flow➡️give kidneys back control on homeostasis (they are far better than cardiologists)

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Frederik H. Verbrugge

4 years

Effect of elevated CVP on the kidney:

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Frederik H. Verbrugge

2 years

Thus, as the Great Guyton has teached us: Blood pressure is not the same as #Perfusion So we need to employ vasodilators in patients who are very vasoconstricted with low #CardiacOutput , typically w low SBP, low #PulsePressure & preserved MAP 90/70 mmHg means MAP=77 mmHg!!!

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Frederik H. Verbrugge

4 years

The kidneys in essence have 3 functions: 1. Glomerular function = Clearance 2. Tubular function = Homeostasis 3. Neurohumoral function GFR mainly reflects 1. So why do we take GFR (or its estimate Cr) as a surrogate for renal function?

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Frederik H. Verbrugge

4 years

Biggest problem in #ICU is often homeostasis (volume, electrolytes) rather than clearance (uremia). Remember, homeostasis is mostly a tubular rather than glomerular function. Even with GFR 15 mL/min, one filters >20 L & 184 g salt per day! More than enough to get rid of those!

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Frederik H. Verbrugge

2 years

Also, more chloride from proximal to the macula densa sensor acts like a break on the neurohumoral system. Read everything about it in our review @ESC_Journals @JACCJournals :

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Frederik H. Verbrugge

2 years

Getting ready for #HeartFailure2022 in Madrid. It will be a great meeting with so many friends & colleagues to see! Looking forward to have some great #cardiotwitter #HF discussions @ValleAlfonso @GiuseppeGalati_ @radcliffeCARDIO

@radcliffeCARDIO

Radcliffe Cardiology

@radcliffeCARDIO

2 years

For #HeartFailure2022 , join the conversation with #HFARME for LBAs & insights with leading #HeartFailure specialists @FH_Verbrugge @ValleAlfonso @GiuseppeGalati_ Learn more about Heart Failure - ❌Not intended for US or UK HCPs #CardioTwitter

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Frederik H. Verbrugge

2 years

The CON party, will undoubtedly point towards failing trials with vasodilators in AHF, but look who they recruited, this is no low output #Heartfailure !

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Frederik H. Verbrugge

2 years

First some background... Current @escardio guidelines state (IIb, B): "In patients with AHF and a systolic blood pressure (SBP) >110 mmHg, intravenous vasodilators may be considered as an initial therapy to improve symptoms and reduce congestion." Only 1 flowchart has them in...

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Frederik H. Verbrugge

2 years

Talk on #HeartFailure2022 today, sharing for the first time the podium with my former mentor @WilfriedMullens who has had such an important role in my career development. Still grateful for the many wonderful opportunities he has provided me. Let’s keep exploring the kidneys!

@WilfriedMullens

Wilfried Mullens

@WilfriedMullens

2 years

So rewarding to notice your previous phd student @FH_Verbrugge has become role model helping to improve HF care worldwide during #HeartFailure2022 @HFA_President @HanCardiomd @_antocannata @HillLoreena @ARakisheva @LauraMeems

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Frederik H. Verbrugge

4 years

Intriguing paper by Milton Packer @CircAHA ! Need to be in love with energy metabolism & able to digest some complex molecular pathways, but very insightful information on the metabolic effects of #SGLT2i . It’s not only a smart diuretic...

@CircAHA

Circulation

4 years

#WhitePaper : Role of deranged energy deprivation signaling in the pathogenesis of cardic and renal diseaes in states of perceived nutrient overabdundance #AHAJournals

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Frederik H. Verbrugge

4 years

Look at GFR determinants (=N x snGFR). In stable circumstances, GFR mainly reflects the number of functional nephrons. Starting from 1 million per kidney at birth, one loses 5,000-10,000 per year with aging: age-related GFR decline <1 mL/min/1.73m²/y

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Frederik H. Verbrugge

4 years

@Thind888 @NephroGuy @aishaikh @threadreaderapp @MedTweetorials @msiuba @ArgaizR @concernecus I always go through the same steps:

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Frederik H. Verbrugge

2 years

If You remember 1 thing from our paper, let it be: "SBP = awful marker of #afterload or ventriculo-arterial coupling, making it pretty useless in decision to employ #vasodilators " If anything vasodilators work best in patients with LOW SBP: @AlexMebazaa

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Short-term survival by treatment among patients hospitalized with acute heart failure: the global...

Intensive Care Medicine - To date, treatment with intravenous (IV) agents such as vasodilators, diuretics, and inotropes has shown marginal or mixed benefits in acute heart failure (AHF) trials....

link.springer.com

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Frederik H. Verbrugge

2 years

What a great day at #HeartFailure2022 . So many familiar faces and great talks. Getting interviewed by my former mentor who is now Twitter ambassador for the congress! Stay tuned, much more to come!

@WilfriedMullens

Wilfried Mullens

@WilfriedMullens

2 years

Frederik Verbrugge @FH_Verbrugge commenting in the "Ask your question #HeartFailure2022 " initiative on his impressive research on ‘How to diagnose HFpEF?’. Feel free to keep on sending your questions @HFA_President @HanCardiomd @_antocannata @HillLoreena @ARakisheva @LauraMeems

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Frederik H. Verbrugge

2 years

Will do an invite extensive tweetorial later today!

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Frederik H. Verbrugge

2 years

Team #Heartfailure @UZBrussel @HeartBrussels conquers Madrid! After an intensive crash course in education, our heart failure nurses explore the city! #heartfailure = #teamwork ! Proud to be Brussels!

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Frederik H. Verbrugge

2 years

How did we come up with the idea? Actually, cause we all love #physiology . Credits go to Prof. Em. Paul Steels who teached us all how kidneys work. @GLW_UHasselt 65% of sodium is reabsorbed in the proximal tubules, can be up to 85% in #HeartFailure

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Frederik H. Verbrugge

1 year

Amazing crowd & interesting discussions in beautiful Milan for my first @ERAkidney congress! Thanks to the colleagues from #nephrology for inviting a cardiologist to their meeting talking about #diuretics in #heartfailure ! Need to join forces in the Cardiorenal world!

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Frederik H. Verbrugge

4 years

Great to see this paper finding its home @ESC_Journals ! @JLGrodin @WilsonTangMD Key messages: 1. Many #HFrEF patients do not achieve target HR 2. Poor correlation between beta blocker dose and HR reduction achieved (hyper-responders do better!)

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Frederik H. Verbrugge

4 years

Honoured to be in this nephrology hall of fame as a cardiologist! Greatly appreciated!

@nephondemand

Tejas Desai, MD, MBA

4 years

@hswapnil @CPSolvers @thecurbsiders @kidney_boy @Neph_SIM Five great tweetorials on AKI in the

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Frederik H. Verbrugge

2 years

Why is this? Need pressure-volume loops in here: In preserved CO/SV (steep Ees~contractility), reducing afterload (Ea) has little impact on stroke volume (SV), which is already high. However, marked impact on BP (preload dependency!)

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Frederik H. Verbrugge

2 years

Counting the days until the start of #ESC2022 ? No doubt which topic is on everybody’s mind: #HF a clear winner! Disclaimer: my vote might be slightly biased with #ADVOR reporting as a late-breaking trial! @radcliffeCARDIO @escardio

@radcliffeCARDIO

Radcliffe Cardiology

@radcliffeCARDIO

2 years

💭 What disease area is most likely to be impacted by data presented at #ESCCongress ? @drnvanmieghem @JoostDaemen @hvanspall @manalalasnag @purviparwani #PrimaryPrevention #HeartFailure #ACS #Arrhythmia #CardioTwitter #CardioEd

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Frederik H. Verbrugge

3 years

Honoured to be invited for the Russian Heart Failure congress to speak on urinary sodium & diuretic resistance in heart failure!

@SolovevaAnzhela

Anzhela Soloveva

@SolovevaAnzhela

3 years

❣️❣️❣️Excited about the sessions (🤝 @YMareev ) at 🇷🇺 #HF Congress and so thankful 🤗 to @FudimMarat @hvanspall @FH_Verbrugge @ARakisheva @bogdienache @PierpaoloPel @YuriLopatin1 #OSSN2021 #YoungHFA @GianluSava @HFA_President @escardio ▶️Live on YouTube (Dec 10-11), links below

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Frederik H. Verbrugge

1 year

Proud to team up with #VExUS master @ArgaizR for this one…

@ArgaizR

Eduardo R Argaiz

1 year

Hemodynamic Evaluation of Right-Sided Congestion With Doppler Ultrasonography in Pulmonary Hypertension @AmJCardio 50 days' free access link: 🧵of our findings 👇 (1/6)

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Frederik H. Verbrugge

2 years

@NephroP @Thind888 @ArgaizR This figure explains how low #cardiacoutput causes periodic breathing patterns. If interested, can read more in the full article @CircAHA

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Frederik H. Verbrugge

4 years

High expectations for this one! Journey is not over after #SGLT2i in #HeartFailure and #CKD ... The future is exciting!

@mvaduganathan

Muthu Vaduganathan

4 years

Finerenone Meets Primary Endpoint in Phase III FIDELIO-DKD Kidney Outcomes Trial in CKD & T2D (n~5,700) ✅ Kidney failure, sustained ↓ in eGFR by 40%, renal death ✅ CV death, MI, stroke, HF hosp Accelerating progress in few short yrs. @scottdsolomon

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Frederik H. Verbrugge

4 years

Coming in with a bang! Yesterday, this guy is joining us @HeartBrussels @UZBrussel , today he is publishing @JACCJournals , what an entrance! A must-read for anyone interested in #pVAD ! Welcome aboard @TimBalthazar , our first paper together, but I promise You it won't be our last!

@TimBalthazar

Tim Balthazar

4 years

pVAD's such as Impella work but it is the way we use these and the totality of patient care that make the final outcome...proud of our paper in @JACCJournals with @FH_Verbrugge @CVandenbriele @susannaprice @drnvanmieghem @abiomedimpella @DrSethdb

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Frederik H. Verbrugge

2 years

In low CO/SV (more flat Ees) however, despite lower SBP to start from, impact of reducing afterload (Ea) on BP is minimal, because lower vascular tonus is compensated by a massive increase in SV (afterload dependency!)

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Frederik H. Verbrugge

2 years

New paper from the Barry Borlaug lab explains how #sex determines predisposition to metabolic and hemodynamic abnormalities with central #obesity in #HFpEF . Great work by my colleague Hidemi Sorimachi @ESC_Journals ! @yreddyhf @MassarOmard @Grace_Lin_MD

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Sex and central obesity in heart failure with preserved ejection fraction

Aims Obesity is a risk factor for heart failure with preserved ejection fraction (HFpEF), particularly in women, but the mechanisms remain unclear. The present study aimed to investigate the impact...

onlinelibrary.wiley.com

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Frederik H. Verbrugge

4 years

Question to all #VExUS experts: "Do you ever diurese VExUS 0 ?" Thread below. I admit not being a #VExUS user, but learned much from your tweets and have been practicing many #DiuresisJedi concepts. @ArgaizR @msiuba @ThinkingCC @NephroP @load_dependent @khaycock2 @Thind888

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Frederik H. Verbrugge

3 years

Fantastic crash course in #HeartFailure organised by @escardio #HFA . Getting ready for the interactive cases... Proud to be part of this event! @Ph_Bertrand @petranijst Grab this opportunity!

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Frederik H. Verbrugge

4 years

Don't forget that CVP influences lung edema as well, as it impedes lymphatic flow, the main protective mechanism against lung edema. Acute rise more dangerous than slow rise (lymphatic adaptations take time). Chronic pressure overload: alveolar-capillary stress failure

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Frederik H. Verbrugge

5 months

Great work by @JefVandenEynde on the #ADVOR data 👇🏻

@JefVandenEynde

Jef Van den Eynde

@JefVandenEynde

5 months

Happy to see our #ADVOR analysis highlighted in the final session of #HeartFailure2024 ! Hypochloremia has a major impact on decongestion and deserves our attention! @FH_Verbrugge @WilfriedMullens @JeroenDauw @petra_nijst @PieterMartensMD @EvelyneMeekers @jozinetm @frankruschitzk1

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Frederik H. Verbrugge

2 years

For future #Heartfailure trials with #diuretics , remember: "The Key is in the Pee" #decongestion = #desalinization

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