R to @anish_koka: 9/14: PLATFORM trial: CT FFR reduced invasive angio by 61%, but standard of care arm was not offered standard of care non-invasive tests before cath. Regardless, "Fewer caths" ≠ better care if test is inaccurate ~50% time.
R to @anish_koka: 10/14: Business model drives adoption. FDA clearance on accuracy, not outcomes. Guideline inclusion (Class IIa) led to reimbursement: $1,017 for FFRCT + $950 for Plaque Analysis (2026). Centers earn >$2k/patient. Lobbying by ACC/SCCT—overlaps w/ HeartFlow KOLs.
R to @anish_koka: 8/14: What the Diagnostic Performance Data Actually Show : Independent reviews confirm major scatter, weak performance near decision points of clinical interest (FFR 0.6-0.8)
R to @anish_koka: 7/14: It's a black box: proprietary algorithm, no independent audit. Validation vs. invasive FFR: NXT trial sensitivity 86%, specificity 79%. But correlation r=0.73—explains only 53% variance. PPV ~49% in UK audit; worse (35%) for 50-69% stenoses. Poor agreement near 0.80 threshold.
R to @anish_koka: 6/14: CT-FFR builds on this shaky base. From CCTA, it reconstructs 3D model, applies CFD to simulate hyperemia, outputs FFRCT. Assumptions: fixed microvascular resistance drop (~75%), myocardial mass-based flow, no collaterals. Fails in microvascular disease—common in CAD patients.
R to @anish_koka: 5/14: Replication issues: Trials without original FFR developers (Pijls/De Bruyne) failed. FUTURE trial stopped early for mortality signal in FFR group. FLOWER-MI: no benefit in STEMI multivessel. FAME 3: FFR-PCI inferior to CABG. Data anomalies in FAME papers raise questions—unexplained clustering at FFR=0.5.
R to @anish_koka: 4/14: FFR's mechanistic reasoning is weak, predicting weak clinical evidence. Key trials: FAME (2009) showed FFR-guided PCI better than angio-guided, but comparator was overly aggressive stenting. Investigators had IP stakes. FAME 2 (2012) vs. med therapy: benefit driven by fewer revasc, not death/MI; high crossover.
R to @anish_koka: 2/14: To see why CT-FFR is doubtful, understand invasive FFR first. FFR measures the physiological significance of a coronary stenosis: max blood flow with stenosis divided by max flow if artery were normal. During cath, a pressure wire passes the lesion, adenosine induces hyperemia, FFR = Pd/Pa (distal/aortic pressure).
3/14: Normal FFR=1.0; threshold=0.80 for "significant." But it assumes uniform minimal microvascular resistance during hyperemia. This fails in real patients w/ diabetes, hypertension, LVH, etc.—microvascular dysfunction blunts response, making FFR unreliable. Healthy microvasculature can make mild lesions look severe, and vice versa.
CT-Derived Fractional Flow Reserve (HeartFlow FFRCT): A Critical Look 🧵
1/14: There's a familiar pattern in cardiology: take a test of uncertain validity, layer sophisticated tech on top, and present it as a breakthrough. CT-derived fractional flow reserve (HeartFlow FFRCT) fits this template. It's a proprietary, off-site analysis approximating invasive FFR—a number with shaky foundations.
Official Israel government account, promising support for the Iranian uprising 👇
_
This is how I feel too.
https://www.facebook.com/share/r/1CFPE82WZ9/
This is amazingly clear and complete review of CT-FFR. Wow. Sobering when described like this 👇🏻
【ドイツ語版】
In diesem Sommer wird die Regierung Takaichi eine umfassende „Wachstumsstrategie für Japan“ formulieren, die Maßnahmen für 17 strategische Schlüsselbereiche und 8 sektorübergreifende Herausforderungen umfasst.
Wir werden wirtschaftliches Wachstum verwirklichen.
🔴The president of Iran has said mediation efforts to end the war have begun as the US and Israel continued to carry out air strikes on Tehran.
Follow the latest ⬇️
https://www.telegraph.co.uk/world-news/2026/03/06/iran-war-latest-news-trump-israel-hezbollah/?WT.mc_id=tmgoff_tw_post_latest-news-trump-israel-hezbollah/
When you send a CT scan to HeartFlow and receive an FFRCT value, you are receiving output from a system you cannot audit, based on models you cannot inspect, run on servers you cannot access. The clinician is expected to trust the number. This is a significant departure from the usual epistemic standards of medical evidence.
x.com/i/article/202988478984…
Langsam dämmert es… der CO2 Preis wird nicht lange überleben
Ballaststoffe sorgen für ein langes Sättigungsgefühl und fördern die Verdauung. Sie kommen in Samen, Hülsenfrüchten, Gemüse und Früchten vor – 15 Rezepte. https://bellevue.nzz.ch/kochen-geniessen/rezepte/15-rezepte-mit-ballaststoffen-gesund-essen-verdauung-foerdern-ld.1927362?utm_campaign=mrf-twitter-NZZ&mrfcid=20260306699bfcf444c4e21fcfd7d04c
💬 Viewpoint: A proposed FDA “yellow book” could publicly aggregate medical device patent data, supporting oversight, research on device innovation, and detection of industry trends and device-related risks.
https://ja.ma/4ralIkn
Skilled nursing facility operating capacity in the US declined by 5% since 2019, with the largest losses in rural counties and areas reporting staff shortages, impacting hospital discharge and access to facility-based postacute care. https://ja.ma/46SUebZ
🆕 Editorial: “there are differences in health needs, risks of exposure, access to care...and health outcomes by gender and sex [...] Attempting to ignore or hide this reality through academic censorship will not make these effects go away”
http://spkl.io/6012Axe4G
New healthcare priorities:
-High patient throughput (so corner-cutting)
-AI templates (distract from bigger picture)
-QOF incentives/Regulators (motivates defensive, non-individualised care)
Result: Inflexible, protocolised approach, more easily delegated to cheaper PAs.
Durch den Angriff Israels und der Vereinigten Staaten auf den #Iran tun sich für Moskau plötzlich neue Absatzmöglichkeiten für Rohstoffe wie Öl und Gas auf. Doch beim näheren Blick zeigt sich: Ganz so einfach wird die Rechnung nicht aufgehen. https://www.cicero.de/wirtschaft/auswirkungen-des-iran-kriegs-auf-russland
Herr Özdemir lobt allen Ernstes seinen fairen und anständigen Wahlkampf in Baden-Württemberg - seine grüne Partei macht das Gegenteil. Herr Özdemir ist ein Virtuose der Fassade.
https://youtu.be/Asdij6AZLYs?is=hyUE-u8jhZQ_F8gJ
Pinned: Peer-Reviewed Publications Set Medical History
Manuscripts memorialize data and opinions at that time. COVID-19 vaccines were determined to be unsafe and market removal was urged by physicians with medical authority. @McCulloughFund @mdbreathe
#Emirates Airlines says it expects to resume its #flights at 100 percent capacity in the coming days.
Soll das Volk zuerst über das Ständemehr abstimmen und erst danach über die neuen EU-Verträge? Ganz knapp ist im Ständerat ein Vorstoss gescheitert, der frühzeitig Fakten schaffen wollte. https://www.nzz.ch/schweiz/streit-um-die-reihenfolge-der-europa-abstimmungen-der-staenderat-will-die-kompass-initiative-nicht-vorziehen-ld.1927927?utm_campaign=mrf-twitter-NZZ&mrfcid=2026030669a7760138899b1522817ddc
Wenn Auf1 jetzt die Sendelizent gekündigt oder der Laden dicht gemacht werden würde, wären Nius – und auch die JF – die ersten, die sich solidarisieren. Wie auch bei Compact. Umgekehrt aber nutzen die jede Chance, um auf Kosten anderer "alternativer Medien" noch den letzten schäbigen Klick rauszuholen.
And.....it's making no difference to road deaths which are already lower than low.
This ain't about safety.
(From Our World in Data, UK Road Deaths)
Medical staff are leaving as IRGC and Police Commanders use Tehran hospitals as shields:
"I am a member of the medical staff at Labbafinejad Hospital. Today, many of the doctors and I left the hospital.
Einollahi and General Radan are currently stationed in a room in the basement of Labbafinejad Hospital. They only have two or three others with them and brought no additional forces to avoid drawing suspicion.
Dr. Nafar (Head of Internal Medicine) and Dr. Simforoush, both of whom constantly pressure staff with threats of forced attendance or dismissal, and who are said to have played a direct role in the events of January 8th and 9th، are also in the basement with them.
Unfortunately, the hospital is full of patients."
Holi Hoji a Modern Reinvention of Hojicha
Traditional roasted green tea as a functional botanical @pique https://open.substack.com/pub/petermcculloughmd/p/holi-hoji-a-modern-reinvention-of?utm_campaign=post-expanded-share&utm_medium=web
Monatelang lagen die Christdemokraten in Baden-Württemberg deutlich vor den Grünen, doch inzwischen liegen @cem_oezdemir (Grüne) und @HagelManuel (CDU) gleichauf. Die #Landtagswahl am Sonntag wird zum Duell, schreibt @Claudia_Kling. https://www.cicero.de/innenpolitik/die-spitzenkandidaten-bei-der-landtagswahl-in-baden-wurttemberg-ozdemir-oder-hagel-nur-einer-wird-gewinnen
"„Sie schüchterten meine Mitarbeiter ein, sprachen Kunden an und diffamierten und beleidigten mich.“ Das war erst der Anfang."
Auch Finanziers aus Kunst und Architektur gehörten zum Epstein-Netzwerk. Im Fokus: Tom Pritzker, aus der Familie hinter dem Pritzker-Preis, und Leon Black. https://www.nzz.ch/feuilleton/epstein-files-gefaehrdet-der-skandal-den-pritzker-preis-ld.1926542?utm_campaign=mrf-twitter-NZZ&mrfcid=2026030669a7760138899b1522817ddb
Just amazing how corrupt the academic system is, even in so-called independent testing facilities such as Cleerly, who fraudulently unblinded the lean mass hyperresponders study data and then altered it, making it appear as if there was an increase in cardiovascular plaque when in fact there was an overall reduction in the entire cohort. Just amazing as they were being paid to do an objective job, but for some reason they decided to corrupt the data for their own purposes. These people should be sued into oblivion, and hopefully will be.
So again to everybody who thinks that ketogenic and ketogenic carnivore diets with so-called elevated LDL and total cholesterol but high HDL, low triglycerides, and massive improvement in every other biomarker and physical marker are somehow at risk for developing cardiovascular disease, the evidence is in: ketogenic diets, like a carnivore diet, reduce arterial plaque, even with elevated LDL and ApoB. And in fact, both data sets, even the corrupted one, show that there is NO association whatsoever between plaque progression and LDL or ApoB. None. Zip. Zilch. Nada. Sorry cholesterol bros, you're wrong again!
Interessant, wie viele Reaktionen unter meinem letzten Tweet zeigen, wie schwer es manchen fällt, eine andere Meinung einfach zu respektieren.
Demokratie bedeutet nicht nur wählen zu dürfen – sondern auch auszuhalten, dass andere zu einem anderen Schluss kommen.
Mitten im Ukrainekrieg wird ein BND-Referatsleiter verhaftet. Der Vorwurf: Weitergabe von streng geheimen Dokumenten an den russischen Geheimdienst gegen Hunderttausende Euro. Seit mehr als zwei Jahren läuft ein Prozess, der wie ein Spionagethriller wirkt.
https://www.welt.de/politik/deutschland/plus69a91d7d563ae9c42dea4db0/russland-bnd-ein-spektakulaerer-spionageprozess-und-dann-wird-die-oeffentlichkeit-aus-dem-gerichtssaal-verbannt.html
🚨🇦🇺 Meanwhile in Australia
“Please be aware - they are going to ruin this country”
Iranian man is arrested by police.
His crime? He went to a protest with an Australian flag in Australia.
x.com/OS51388957/status/2029…