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Parag Bawaskar

@paragbawaskar.bsky.social
625 followers 182 following 33 posts

Cardiologist, Post Doctoral Research Associate, Cardiovascular Division, University of Minnesota Medical School.

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Reposted by Parag Bawaskar
TCTMD @tctmd.bsky.social · 29/04/2026
Autopsy Studies Turn Sudden Cardiac Death Wisdom on Its Head
tctmd.com
Autopsy Studies Turn Sudden Cardiac Death Wisdom on Its Head
Autopsy Studies Turn Sudden Cardiac Death Wisdom on Its Head cmacahilig@crf.org Wed, 04/29/2026 - 16:47 Michael O'Riordan New data hint that MI is not the main driver of SCD and that many patients have undetected cardiac disease.
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Reposted by Parag Bawaskar
TCTMD @tctmd.bsky.social · 23/04/2026
Eugene Braunwald, ‘Icon’ of Modern Cardiology, Dies at 96
tctmd.com
Eugene Braunwald, ‘Icon’ of Modern Cardiology, Dies at 96
Eugene Braunwald, ‘Icon’ of Modern Cardiology, Dies at 96 hdellabella@crf.org Thu, 04/23/2026 - 17:08 Yael L. Maxwell With a career in medicine spanning eight decades, Braunwald will be remembered for his impact on every corner of the field.
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Reposted by Parag Bawaskar
Duke Clinical Research Institute @dcrinews.bsky.social · 29/03/2026
Misinformation reaches 1 billion people in seconds. Debunking it takes work. At #ACC26, former FDA Commissioner and DCRI founder, Rob Califf encouraged clinicians to engage in new media — or risk losing the battle for public trust without ever competing. #HealthPolicy #CardioSky
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Parag Bawaskar @paragbawaskar.bsky.social · 01/04/2026
True, but what's the cost? Normal CMR = 3.5% 10-yr MACE. CMR+ MI = 47% MACE (Konst 2023, n=252). If we're missing small MIs, they're clinically benign. www.ahajournals.org/doi/10.1161/...
ahajournals.org
Prognostic Value of Cardiac Magnetic Resonance Imaging in Patients With a Working Diagnosis of MINOCA—An Outcome Study With up to 10 Years of Follow-Up | Circulation: Cardiovascular Imaging
BACKGROUND: Patients with a working diagnosis of myocardial infarction with unobstructed coronary arteries (MINOCA) represent a heterogeneous cohort. The prognosis could vary substantially depending o...
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Parag Bawaskar @paragbawaskar.bsky.social · 01/04/2026
Bottom line: Maybe “vulnerable plaque” features (rupture, erosion, intraplaque hemorrhage) are just common findings in CAD patients and don’t necessarily identify THE culprit that caused THIS event? Are we over-interpreting OCT? Under-trusting CMR? Thoughts? 7/7
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Parag Bawaskar @paragbawaskar.bsky.social · 01/04/2026
ISSUE #4: Ischemic CMR Without OCT Culprit 31% had definite infarction on CMR but NO identifiable culprit on OCT. Possible explanations: a) OCT missed it (sensitivity issue) b) The culprit already healed/resolved c) Vasospasm d) Embolism e) It wasn’t atherothrombotic 6/7
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Parag Bawaskar @paragbawaskar.bsky.social · 01/04/2026
ISSUE #3: The Discordant Cases 17 patients had OCT culprit + NON-ISCHEMIC CMR (myocarditis pattern, Takotsubo, etc.) Final diagnosis: • 7 → MINOCA mimic (CMR as arbiter) • 10 → MI (Despite non ischemic CMR findings) How is this “complementary”? 5/7
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Parag Bawaskar @paragbawaskar.bsky.social · 01/04/2026
ISSUE #2: OCT Culprit + Normal CMR 35% (43/124) had OCT “culprit” lesions but COMPLETELY NORMAL CMR - no infarction, no injury, nothing. If there’s a “culprit” that caused MI, where’s the infarct? Are these just bystander plaques? 4/7
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Parag Bawaskar @paragbawaskar.bsky.social · 01/04/2026
ISSUE #1: Territory Mismatch When BOTH OCT culprit AND ischemic CMR were present, they matched only 81% of the time. 19% had the OCT “culprit” in a DIFFERENT coronary territory than the actual infarct. How is the OCT lesion the “culprit” if it’s not in the infarcted territory? 3/7
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Parag Bawaskar @paragbawaskar.bsky.social · 01/04/2026
First, the "good news": 79% had an abnormality on one or both tests, vs 44% with OCT alone or 63% with CMR alone. Sounds complementary, right? But let's look closer... 2/7
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Parag Bawaskar @paragbawaskar.bsky.social · 01/04/2026
🧵 Are OCT and CMR really "complementary" in MINOCA? Or are they telling us conflicting stories? Reynolds et al (Circulation 2026) combined both modalities in 284 MINOCA patients. The results raise more questions than answers. 📄 www.ahajournals.org/doi/abs/10.1... 1/7
ahajournals.org
American Heart Association Journals
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Parag Bawaskar @paragbawaskar.bsky.social · 02/03/2026
The paradox: if baseline screening had used CMR and truly excluded ALL pre-existing LVT, I'd expect the 1-month incident rate to be lower than 16.6%, not higher. The high rate despite TTE exclusion is itself indirect evidence that prevalent CMR-occult thrombi entered the trial.
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Parag Bawaskar @paragbawaskar.bsky.social · 02/03/2026
Your point about early thrombus formation actually reinforces this concern. If thrombi form within days of MI — before they're TTE-visible but already CMR-detectable — then the 1-month CMR is capturing a mix of truly incident and pre-existing but occult thrombi.
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Parag Bawaskar @paragbawaskar.bsky.social · 02/03/2026
Great point — but APERITIF actually did enroll high-risk patients. The control arm LVT rate was 16.6% on CMR at 1 month — well above the ~6% all-comer STEMI and ~12% anterior STEMI background rates from the Bulluck 2018 meta-analysis.
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Parag Bawaskar @paragbawaskar.bsky.social · 28/02/2026
Although the use of an ultrasound-enhancing agent improves the sensitivity of echocardiography, it is still substantially lower compared with LGE CMR. www.ahajournals.org/doi/10.1161/...
ahajournals.org
Long-Term Embolic Outcomes After Detection of Left Ventricular Thrombus by Late Gadolinium Enhancement Cardiovascular Magnetic Resonance Imaging | Circulation: Cardiovascular Imaging
Background: Late gadolinium enhancement (LGE) cardiovascular magnetic resonance (CMR) imaging is more sensitive than echocardiography for the detection of intracardiac thrombus because of its unique a...
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Parag Bawaskar @paragbawaskar.bsky.social · 28/02/2026
Takeaway: Before concluding low-dose rivaroxaban doesn't prevent LVT post-anterior STEMI, we need a trial gating enrollment on baseline LGE CMR — not TTE. Using a ~30% sensitivity screen to test a CMR-detected endpoint is a fundamental design mismatch. The question remains open.
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Parag Bawaskar @paragbawaskar.bsky.social · 28/02/2026
The trial was already underpowered (lower-than-expected event rates, wide CIs: −8.9% to +3.2%). Add in LGE CMR-occult baseline LVT contaminating both arms, and the null result becomes even harder to interpret. A negative trial ≠ no effect.
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Parag Bawaskar @paragbawaskar.bsky.social · 28/02/2026
If patients with pre-existing LVT were inadvertently enrolled, you've essentially randomized established thrombus to treatment vs. no treatment — a fundamentally different question than prevention. This dilutes the treatment effect and biases toward the null.
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Parag Bawaskar @paragbawaskar.bsky.social · 28/02/2026
Eligibility required no LVT on baseline TTE. The authors themselves cite TTE sensitivity for LVT detection at just ~29% vs LGE CMR. That means up to 70% of pre-existing thrombi could have been missed at enrollment — and those patients randomized anyway.
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Parag Bawaskar @paragbawaskar.bsky.social · 28/02/2026
APERITIF tested low-dose rivaroxaban+ DAPT vs DAPT alone to prevent LV thrombus after anterior STEMI. Primary endpoint: LVT on contrast-enhanced CMR at 1 month. Result: no significant difference (13.7% vs 16.6%, p=.34).But there's a screening problem worth discussing. jamanetwork.com/journals/jam...
jamanetwork.com
Low-Dose Rivaroxaban to Prevent Left Ventricular Thrombosis After Anterior Myocardial Infarction
This multicenter randomized clinical trial conducted in France determines whether the addition of low-dose rivaroxaban to dual antiplatelet therapy reduces the incidence of left ventricular thrombus a...
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Reposted by Parag Bawaskar
Chetan Shenoy @cshenoy.bsky.social · 24/05/2025
academic.oup.com/eurheartj/ad... @escardio.bsky.social #Cardiosky #WhyCMR #Epeeps #Medsky Please DM me if you would like a full-text PDF of the paper!
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Reposted by Parag Bawaskar
Chetan Shenoy @cshenoy.bsky.social · 11/06/2025
Thank you, @toddneale.bsky.social, for your excellent reporting on our EHJ paper! @tctmd.bsky.social @escardio.bsky.social @paragbawaskar.bsky.social
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Reposted by Parag Bawaskar
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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Reposted by Parag Bawaskar
Chetan Shenoy @cshenoy.bsky.social · 21/03/2025
Read our accompanying editorial for our thoughts on the important paper – academic.oup.com/ehjcimaging/... @paragbawaskar.bsky.social #CardioSky #MedSky #Sarcoidosis
academic.oup.com
Cardiac FDG-PET imaging in patients with suspected cardiac sarcoidosis and no late gadolinium enhancement on cardiovascular magnetic resonance imaging: the emperor has no clothes!
This editorial refers to ‘The Role of FDG PET/CT in Assessing Cardiac Sarcoidosis with No High-Risk Cardiac Features and Normal CMR’, by F. Shuduyeva et al
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Reposted by Parag Bawaskar
Chetan Shenoy @cshenoy.bsky.social · 21/03/2025
In patients with suspected cardiac sarcoidosis, cardiac FDG-PET is recommended after a normal CMR if there is a high clinical suspicion. What are the data supporting this recommendation? #CardioSky #MedSky #Sarcoidosis
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Reposted by Parag Bawaskar
Chetan Shenoy @cshenoy.bsky.social · 23/01/2025
This paper reports the coexistence of cardiac sarcoidosis and arrhythmogenic cardiomyopathy in 5 patients. heart.bmj.com/content/earl... #CardioSky #MedSky
heart.bmj.com
Coexistence of cardiac sarcoidosis and arrhythmogenic cardiomyopathy-associated genetic variants: a multicentre case-control study
Background Cardiac sarcoidosis (CS) is a chronic inflammatory disease characterised by non-caseating granulomas, while arrhythmogenic cardiomyopathy (ACM) is a genetic condition mainly affecting desmo...
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Reposted by Parag Bawaskar
Pradeep Natarajan @pnatarajanmd.bsky.social · 23/11/2024
In honor of Dr. Braunwald’s 95th birthday. The number of areas he has touched in cardiology is staggering, and number of cardiovascular professionals is unquantifiable. @harvardmed.bsky.social
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Reposted by Parag Bawaskar
Chetan Shenoy @cshenoy.bsky.social · 17/11/2024
Amazing achievement by rising star and post-doc in my lab @paragbawaskar.bsky.social, winner of the prestigious 2024 Melvin Judkins Early Career Investigator Award at #AHA24!! Congratulations!!! @ahascience.bsky.social
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Lars Mølgaard Saxhaug @load-dependent.eurosky.social · 13/11/2024
It’s great that journals are coming over here, but what I have really missed after my departure from Twitter 2 years ago is this, the authors themselves presenting their works and discussing it with peers. #cardiosky #medsky #emimcc
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Parag Bawaskar @paragbawaskar.bsky.social · 13/11/2024
jamanetwork.com/journals/jam...
jamanetwork.com
Prehospital Pulse-Dose Glucocorticoid in STEMI
This randomized clinical trial investigates if prehospital pulse-dose glucocorticoid treatment has a cardioprotective effect in patients with ST-segment elevation myocardial infarction (STEMI).
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Reposted by Parag Bawaskar
Chetan Shenoy @cshenoy.bsky.social · 12/11/2024
In 2019, we wrote a paper showing that patients with left ventricular thrombus have a long-term risk of embolism, extending to at least 8 years. We were puzzled by the finding… #CardioSky www.ahajournals.org/doi/10.1161/...
Figure 2 from the paper. Incidence of embolism in left ventricular (LV) thrombus patients compared with matched non-LV thrombus patients. Kaplan-Meier curves demonstrate the cumulative incidence of the composite embolic end point in the LV thrombus (in red) and in the matched non-LV thrombus (in blue) groups. Note the significant difference in the cumulative incidence of embolic events between the 2 groups.
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Parag Bawaskar @paragbawaskar.bsky.social · 11/11/2023
Finally, many thanks to @cshenoy.bsky.social for his mentorship, our outstanding team for their contributions, and the editors and reviewers at Circulation for all their efforts to make our paper better!
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Parag Bawaskar @paragbawaskar.bsky.social · 11/11/2023
Read our paper here –https://www.ahajournals.org/doi/abs/10.1161/CIRCULATIONAHA.123.067032 And if you will be at #AHA23, come visit the poster session on Monday, Nov 13, 10:00-11.30 am, Zone 2. eppro01.ativ.me/src/EventPil...
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Parag Bawaskar @paragbawaskar.bsky.social · 11/11/2023
An important trial related to this topic was just funded in the UK – Peter Swoboda at the University of Leeds is the PI of an RCT to identify the best initial test for newly diagnosed HF… we look forward to the results of CROSS-HF in a few years.
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Parag Bawaskar @paragbawaskar.bsky.social · 11/11/2023
And if NICM and dualCM do influence outcomes, the next trial should investigate whether the routine use of CMR to identify the cause of cardiomyopathy improves the selection of patients for coronary revascularization, and overall long-term outcomes.
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Parag Bawaskar @paragbawaskar.bsky.social · 11/11/2023
We need to investigate whether NICM or dualCM in patients with CAD influences outcomes after coronary revascularization. An ancillary study of the STICH3C trial by Mario Gaudino and Jonathan Weinsaft at Cornell will give us some answers in about 5 years.
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Parag Bawaskar @paragbawaskar.bsky.social · 11/11/2023
So what? Patients with CAD+NICM or dualCM should be treated with a statin, aspirin, and guideline-directed HF therapy the same as those with CAD+ICM. But do patients with CAD+ NICM or dualCM benefit from coronary revascularization in the same manner as those with CAD+ICM?
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Parag Bawaskar @paragbawaskar.bsky.social · 11/11/2023
Prior studies have found better outcomes for NICM vs. ICM. What explains worse outcomes for NICM in our study? We can only speculate, but it may be because patients in our study had 2-3 diseases – CAD+NICM… or CAD+ICM+NICM. Prior studies compared NICM without CAD to ICM+CAD.
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Parag Bawaskar @paragbawaskar.bsky.social · 11/11/2023
And we looked at their long-term outcomes. Patients with CAD+NICM or dualCM had a greater risk of all-cause death or heart failure hospitalization, all-cause death, and heart failure hospitalization compared with CAD+ICM. The risk of CV death was not different.
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Parag Bawaskar @paragbawaskar.bsky.social · 11/11/2023
We found NICM or dualCM in 1 of every 6 patients with CAD. CAD+NoCM - 18.2% CAD+ICM - 64.8% CAD+NICM - 9.3% CAD+dualCM - 7.7% The prevalence of CAD+NICM or dualCM was 16.9% or 1 in 6 patients with CAD.
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Parag Bawaskar @paragbawaskar.bsky.social · 11/11/2023
We looked at their CMRs and coronary angiography data and classified them into one of: 1. No cardiomyopathy (CAD+NoCM) – normal LVEF and no LGE 2. Ischemic cardiomyopathy (CAD+ICM) 3. Non-ischemic cardiomyopathy (CAD+NICM) 4. Dual cardiomyopathy (CAD+dualCM) – both ICM and NICM
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Parag Bawaskar @paragbawaskar.bsky.social · 11/11/2023
We did a large retrospective observational study of 3,023 patients with obstructive CAD who had CMR for any clinical indication at our health system.
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Parag Bawaskar @paragbawaskar.bsky.social · 11/11/2023
So how often do patients with CAD have NICM or dual (both ICM and NICM) cardiomyopathy? How do these patients do compared to patients with ICM? We tried to answer these questions.
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Parag Bawaskar @paragbawaskar.bsky.social · 11/11/2023
There has been interest in this topic of late because trials of coronary revascularization other than STICHES have not shown revascularization to be beneficial.
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Parag Bawaskar @paragbawaskar.bsky.social · 11/11/2023
Currently, we determine the cause of cardiomyopathy based on coronary angiography findings… CAD=ICM; No CAD=NICM However, pathology and small CMR studies have shown that NICM can occur with “bystander” CAD ICM can occur without CAD Both ICM and NICM can occur together
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Parag Bawaskar @paragbawaskar.bsky.social · 11/11/2023
Have you ever wondered whether your patient with CAD and cardiomyopathy truly has ischemic cardiomyopathy, or whether the CAD is a “bystander”? You might be interested in our paper now out in Circulation #simultaneouspublication #AHA23 #cardiosky #Medsky #WhyCMR
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