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Interpretation for both LR+ and ILR- in terms of how conclusive the test changes pretest to posttest likelihood of a positive (or negative) finding: >10 = large 5-10 = moderate 2-5 = small but sometimes important <2 = inconclusive

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Inverse negative likelihood ratio (ILR-) = 1/LR- = specificity / (1-sensitivity) = 92.3% / (1-41.2%) = 1.6 = how many more times likely it is that you do NOT have the disease in question thanks to the test

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Positive likelihood ratio (LR+) = sensitivity / (1-specificity) = 41.2% / (1-92.3%) = 5.4 = how many more times likely it is that you have the disease in question thanks to the test

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However, sens and spec values are highly dependent on disease prevalence in the population being studied. The measures of test performance that are independent of population disease prevalence are likelihood ratios, which tell us how many times more likely a diagnosis is after applying a test.

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In Apple’s white paper on their Hypertension Notification Feature for Apple Watch, they report low sensitivity (41.2%) and high specificity (92.3%). They rightfully chose a threshold for notification while seeking to keep the false positive rate low. The white paper: www.apple.com/health/pdf/H...

apple.com

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Read on if you are interested in (the Apple Watch) diagnostic test performance. It's all about the likelihood ratios.

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I still applaud Apple and think the Hypertension Notification feature will be useful for the individual and society. Any nudge that can help early identification of hypertension is valuable, especially when it is passively integrated into everyday use of a consumer device as implemented by Apple.

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In other words, you should NOT rest on your laurels and assume that you don't have hypertension. Get your blood pressure tested regularly regardless, because hypertension is very common, deadly in the long term, and highly treatable.

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If you do NOT get a Hypertension Notification despite using your watch, then you are NO MORE LIKELY to be free of hypertension than before you used your watch (inverse negative likelihood ratio 1.6, which is inconclusive).

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Martin Ugander @mugander.bsky.social · 13/09/2025

If you get an Apple Watch Hypertension Notification, then you are 5 TIMES MORE LIKELY to have hypertension than if you didn't use your watch (LR+ 5.4). This is moderately useful test information. You should definitely get your blood pressure tested. A thread.. #CardioSky #MedSky #Apple #AppleWatch

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Very much so, in a way that has surprised me. We are currently studying this prospectively.

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Martin Ugander @mugander.bsky.social · 22/08/2025

In our experience, "accelerated aging" measured in years of healthy human aging is a unit of measurement that has unsurpassed clarity of understanding among the general public (patients). We need to be more 'tabloid' to get our message across, imho.

Martin Ugander @mugander.bsky.social · 15/08/2025

John Greenwood bringing it home on #WhyCMR vs #CVnuc for myocardial perfusion imaging. #CardioSky

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rebeccakozor.bsky.social @rebeccakozor.bsky.social · 14/08/2025

Imaging of aortic regurgitation presented eloquently by @JoaoLCavalcante #CSANZ2025 🤝poor agreement b/t echo & CMR 💰big price to pay when AR labelled moderate 🧲use CMR to accurately assess AR #ANZCMR #whyCMR @scmrorg.bsky.social

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rebeccakozor.bsky.social @rebeccakozor.bsky.social · 10/08/2025

Thursday #CSANZ2025 is packed with so many great meetings! I’ll be going between the imaging, heart failure and genetics meetings. Which one will you attend? @anastasiasmihaili.bsky.social @mugander.bsky.social

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Martin Ugander @mugander.bsky.social · 20/07/2025

We don’t yet have definitive data on it, but the non-LAVI (c) formula is likely best for short-term changes in PAWP, whereas (b) is just as good in stable hemodynamics, and (a) is good enough if you haven’t acquired PV velocities.

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Martin Ugander @mugander.bsky.social · 20/07/2025

We have actually have three formulas for estimating PAWP. From Lindow 2024 using: a) E + LAVI b) E + PVs + LAVI and from Lindow 2025 using c) E + PVs + PVd Their accuracy, precision and prognostic association are presented in each paper.

Martin Ugander @mugander.bsky.social · 22/06/2025

Beware the Four Fallacies of (Dis)Loyalty. In providing career guidance, mentoring and coaching to academics, aspects of loyalty and holding grudges (disloyalty) often come up. This has provided structure to some of these conversations. #AcademicSky #PhDSky #LeadershipSky #MentorSky #CoachSky

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David Winchester @drdavemd.bsky.social · 18/06/2025

Tirzepatide reduces LV mass and paracardiac adipose tissue, a potential mechanism for reduced HF events in SUMMIT @jaccjournals.bsky.social @chriskramermd.bsky.social www.jacc.org/doi/10.1016/...

jacc.org

Tirzepatide Reduces LV Mass and Paracardiac Adipose Tissue in Obesity-Related Heart Failure: SUMMIT CMR Substudy

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Martin Ugander @mugander.bsky.social · 14/06/2025

Our latest work, led by Thomas Lindow, on estimating wedge pressure by #EchoFirst. #Cardiosky LA volume is not necessarily needed. LA inflow (PVs, PVd) and outflow (E) velocities, which are proportional to pressure gradients, perform just as well. A multi-institutional collaborative effort 🇦🇺🇸🇪

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Martin Ugander @mugander.bsky.social · 09/06/2025

Elegant TTE color Doppler visualization of what looks to me like blood flow between aortic root and left atrium.

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Pablo Perez Lopez @pabloplopez.bsky.social · 03/06/2025

#EHJCVI 🔎 What’s the link between ECV, scar burden, myocyte volume, and diastolic dysfunction in moderate AR? #whyCMR shows these parameters increase with worsening diastolic dysfunction 📉‌Is there an association with mortality? Read more 👉 doi.org/10.1093/ehjc... #CardioSky @jgrapsa.bsky.social

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Henry Han @hancardiomd.bsky.social · 07/12/2024

Accuracy of LV mechanical dyssynchrony indices for mechanical characteristics of left bundle branch block using #WhyCMR feature tracking academic.oup.com/ehjcimaging/... @sarahmoharem.bsky.social @purviparwani.bsky.social @vassv.bsky.social

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Parham Eshtehardi MD @cardioobdoc.bsky.social · 21/05/2025

Prognostic Relevance & Lower Limit of Reference Range of LV GLS: Clinical Validation Study #CardioSky #JACCIMG www.jacc.org/doi/10.1016/... @docstrom.bsky.social @davidwienermd.bsky.social @jgrapsa.bsky.social @vietheartpa.bsky.social @anastasiasmihaili.bsky.social @jaccjournals.bsky.social

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Society for Cardiovascular Magnetic Resonance @scmrorg.bsky.social · 15/05/2025

Last chance! Abstract submissions for the 2025 SCMR Mid-Year Meeting—Recent Advances in Imaging for Congenital Heart Disease CLOSE TOMORROW (May 16). Submit your research for a chance at FREE registration to #SCMR2026 in Rio! Hurry, before it's too late: buff.ly/y6BryKP @vassv.bsky.social

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Swapnil Hiremath 🍁🇨🇦 @hswapnil.medsky.social · 12/05/2025

There you have it: BEDMED published in @jama.com jamanetwork.com/journals/jam... h/t @drjmluther.bsky.social No difference in bedtime versus morning BP meds - as expected #NephSky #Hypertension 1/

Figure of survival curve showing no difference

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Parham Eshtehardi MD @cardioobdoc.bsky.social · 23/04/2025

Myocardial extracellular volume fraction by CT vs. CMR in patients with stable chest pain #CardioSky #YesCCT #WhyCMR academic.oup.com/ehjimp/artic... @escardio.bsky.social @cshenoy.bsky.social @victoriadelgadomd.bsky.social @katehanneman.bsky.social @mugander.bsky.social @vietheartpa.bsky.social

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Martin Ugander @mugander.bsky.social · 23/03/2025

Query sarcoid, normal #WhyCMR, so then should we do FDG-PET? Not much benefit.

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Parham Eshtehardi MD @cardioobdoc.bsky.social · 17/02/2025

Impact of Smoking on Coronary Volume–to–Myocardial Mass Ratio Myocardial Mass Drives Unfavorable Changes in Smokers’ Hearts #CardioSky #RadSky pubs.rsna.org/doi/10.1148/... @rsnasky.bsky.social @katehanneman.bsky.social @annakatebarton.bsky.social @chriskramermd.bsky.social @mugander.bsky.social

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Jodie Ingles @jodieingles27.bsky.social · 16/02/2025

We’ve been preprinting our work, but recognize this is not common practice in the world of cardiology. Love this stance from @hmkyale.bsky.social @jaccjournals.bsky.social encouraging open sharing of our work! #medsky #cardiosky www.jacc.org/doi/10.1016/...

jacc.org

Preprints: A Revolution in Cardiovascular Science

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This is esp true for those researchers from the many institutions worldwide (like mine, both Sydney and Karolinska) with established agreements with publishers to centrally cover open access article processing charges (APC). Ask your institution's library. Good luck - it's a jungle out there!

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"But we just need to get this published!" you say. There are plenty of open access journals that openly vet based on scientific quality and not priority or sexiness of the science, without ending up on the Predatory Journals list.

Rather, this is a question of how to move forward knowing that the publisher/journal has a predatory history, and deciding what kind of practices we wish to endorse and support moving forward. I choose to err on the side of not getting close to the grey zone, and I encourage you to do the same.

The problem with Frontiers, MDPI, and other publisher's journals is not that good science hasn't already been published in their journals by reputable researchers (including myself before becoming aware of the problem). The examples of already published articles with good science are many.

We as a scientific community have a responsibility to avoid supporting predatory models, especially in light of the changing landscape of scientific publishing along the whole spectrum from paper mills and questionable science to more subtle non-best-practice tactics.

Remember, just because something is published in a predatory journal, doesn't mean the science is bad. However, in a world where you have great choice on where to submit, I suggest avoiding journals and publishers with a predatory track record as you move forward.

Predatory publishing - Wikipedia

There are numerous other examples of predatory publishing tactics, and there is a continued evolution in this space. en.wikipedia.org/wiki/Predato...

en.wikipedia.org

One example is things like engaging researchers as guest editors who get paid to put together special issues with authors that they invite to submit and pay open access publishing fees out of pocket or via their institutions, without disclosing the financial incentives to recruit submissions.

Remember that predatory publishing practices span a range of practices that involve violations of established best practice in scientific publishing. This doesn't necessarily have to be a compromised scientific quality.

Rule number 1, always check the Predatory Journals list before considering submitting to a journal: predatoryjournals.org (click on "The List" at top) The publishers often question the validity of "lists" or claim that they no longer have predatory practices.