Non-ischaemic cardiomyopathy, sudden death and implantable defibrillators: a review and meta-analysis

Objective: The recent Danish Study to Assess the Efficacy of ICDs in Patients with Non-ischemic Systolic Heart Failure on Mortality (DANISH) trial suggested that implantable cardioverter defibrillators (ICDs) do not reduce overall mortality in patients with non-ischaemic cardiomyopathy (NICM), despite reducing sudden cardiac death. We performed an updated meta-analysis to examine the impact of ICD therapy on mortality in NICM patients. Methods: A systematic search for studies that examined the effect of ICDs on outcomes in NICM was performed. Our analysis compared patients randomised to an ICD with those randomised to no ICD, and examined the endpoint of overall mortality. Results: Six primary prevention trials and two secondary prevention trials were identified that met the pre-specified search criteria. Using a fixed-effects model, analysis of primary prevention trials revealed a reduction in overall mortality with ICD therapy (RR 0.76, 95% CI 0.65 to 0.91). Conclusions: Although our updated meta-analysis demonstrates a survival benefit of ICD therapy, the effect is substantively weakened by the inclusion of the DANISH trial—which is both the largest and most recent of the analysed trials—indicating that the residual pooled benefit of ICDs may reflect the risk of sudden death in older trials which included patients treated sub-optimally by contemporary standards. As such, these data must be interpreted cautiously. The results of the DANISH trial emphasise that there is no ‘one size fits all’ indication for primary prevention ICDs in NICM patients, and clinicians must consider age and comorbidity on an individual basis when determining whether a defibrillator is appropriate

The Generalized Dirichlet to Neumann map for the KdV equation on the half-line

For the two versions of the KdV equation on the positive half-line an initial-boundary value problem is well posed if one prescribes an initial condition plus either one boundary condition if $q_{t}$ and $q_{xxx}$ have the same sign (KdVI) or two boundary conditions if $q_{t}$ and $q_{xxx}$ have opposite sign (KdVII). Constructing the generalized Dirichlet to Neumann map for the above problems means characterizing the unknown boundary values in terms of the given initial and boundary conditions. For example, if $\{q(x,0),q(0,t) \}$ and $\{q(x,0),q(0,t),q_{x}(0,t) \}$ are given for the KdVI and KdVII equations, respectively, then one must construct the unknown boundary values $\{q_{x}(0,t),q_{xx}(0,t) \}$ and $\{q_{xx}(0,t) \}$, respectively. We show that this can be achieved without solving for $q(x,t)$ by analysing a certain ``global relation'' which couples the given initial and boundary conditions with the unknown boundary values, as well as with the function $\Phi^{(t)}(t,k)$, where $\Phi^{(t)}$ satisifies the $t$-part of the associated Lax pair evaluated at $x=0$. Indeed, by employing a Gelfand--Levitan--Marchenko triangular representation for $\Phi^{(t)}$, the global relation can be solved \emph{explicitly} for the unknown boundary values in terms of the given initial and boundary conditions and the function $\Phi^{(t)}$. This yields the unknown boundary values in terms of a nonlinear Volterra integral equation.Comment: 21 pages, 3 figure

Chronic heart failure: epidemiology, investigation and management

Heart failure (HF) is a clinical syndrome characterized by dyspnoea, fatigue and fluid retention accompanied by objective evidence of cardiac dysfunction. The syndrome affects around 2% of the adult population, men more commonly than women (<80 years old), with the incidence and prevalence rising steeply with age. HF causes substantial morbidity and reduced life expectancy, and coronary artery disease accounts for two-thirds of cases in developed countries. Investigation is important to ascertain the diagnosis, identify the aetiology (which may be reversible) and give some indication of prognosis. The diagnosis of HF confers a significantly increased risk of hospital admission and death. Treatment has been revolutionized by large randomized controlled clinical trials studying the effects of antagonists of the renin–angiotensin–aldosterone, neutral endopeptidase and sympathetic nervous systems, and the effects of device therapy. Cardiac transplantation remains an option for patients who are severely symptomatic (and at high risk) despite optimal use of such therapy

Who benefits from a defibrillator—balancing the risk of sudden versus non-sudden death

Purpose of Review: Treatment with a defibrillator can reduce the risk of sudden death by terminating ventricular arrhythmias. The identification of patient groups in whom this function reduces overall mortality is challenging. In this review, we summarise the evidence for who benefits from a defibrillator. Recent Findings: Recent evidence suggests that contemporary pharmacologic and non-defibrillator device therapies are altering the potential risks and benefits of a defibrillator. Summary: Who benefits from a defibrillator is determined by both the risk of sudden death and the competing risk of other, non-sudden causes of death. The balance of these risks is changing, which calls into question whether historic evidence for the use of defibrillators remains robust in the modern era

Aerosol radiative forcing from the 2010 Eyjafjallajökull volcanic eruptions

The data set from this article is available through Deep Blue Data: https://doi.org/10.7302/pz7e-r328Although the 2010 volcanic eruptions of Eyjafjallajökull did not exert a large climate forcing, several features of their emissions favored weaker aerosol cooling or stronger warming than commonly attributed to volcanic events. These features include a high ratio of fine ash to SO2, occurrence near reflective surfaces exposed to strong insolation, and the production of very little stratospheric sulfate. We derive plausible ranges of optical properties and top-of-atmosphere direct radiative forcing for aerosol emissions from these events and find that shortwave cooling from sulfate was largely offset by warming from ash deposition to cryospheric surfaces and longwave warming from atmospheric ash and sulfate. Shortwave forcing from atmospheric ash was slightly negative in the global mean under central estimates of optical properties, though this forcing term was uniquely sensitive to the simulated distribution of clouds. The forcing components sum to near climate-neutral global mean 2010 instantaneous (−1.9mW m−2) and effective (−0.5mW m−2) radiative forcing, where the latter is elevated by high efficacy of snow-deposited ash. Ranges in net instantaneous (−7.3 to +2.8mW m−2) and effective (−7.2 to +4.9mW m−2) forcing derived from sensitivity studies are dominated by uncertainty in ash shortwave absorptivity. Forcing from airborne ash decayed quickly, while sulfate forcing persisted for several weeks and ash deposits continued to darken snow and sea ice surfaces for months following the eruption. Despite small global forcing, monthly averaged net forcing exceeded 1 W m−2in some regions. These findings indicate that ash can be an important component of climate forcing from high-latitude volcanic eruptions and in some circumstances may exceed sulfate forcing.National Science Foundation (NSF)Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/162596/1/Flanner_AerosolRadiativeForcing_JGRa_2014.pdfDescription of Flanner_AerosolRadiativeForcing_JGRa_2014.pdf : ArticleSEL

Anticoagulation therapy in heart failure and sinus rhythm: a systematic review and meta-analysis

Objective: Heart failure is a prothrombotic state, and it has been hypothesised that thrombosis and embolism cause non-fatal and fatal events in heart failure and reduced ejection fraction (HFrEF). We sought to determine the effect of anticoagulant therapy on clinical outcomes in patients with HFrEF who are in sinus rhythm. Methods: We conducted an updated systematic review and meta-analysis to examine the effect of anticoagulation therapy in patients with HFrEF in sinus rhythm. Our analysis compared patients randomised to anticoagulant therapy with those randomised to antiplatelet therapy, placebo or control, and examined the endpoints of all-cause mortality, (re)hospitalisation for worsening heart failure, non-fatal myocardial infarction, non-fatal stroke of any aetiology and major haemorrhage. Results: Five trials were identified that met the prespecified search criteria. Compared with control therapy, anticoagulant treatment did not reduce all-cause mortality (risk ratio [RR] 0.99, 95% CI 0.90 to 1.08), (re)hospitalisation for heart failure (RR 0.97, 95% CI 0.82 to 1.13) or non-fatal myocardial infarction (RR 0.92, 95% CI 0.75 to 1.13). Anticoagulation did reduce the rate of non-fatal stroke (RR 0.63, 95% CI 0.49 to 0.81, p=0.001), but this was offset by an increase in the incidence of major haemorrhage (RR 1.88, 95% CI 1.49 to 2.38, p=0.001). Conclusions: Our meta-analysis provides evidence to oppose the hypothesis that thrombosis or embolism plays an important role in the morbidity and mortality associated with HFrEF, with the exception of stroke-related morbidity

Boundary value problems for the stationary axisymmetric Einstein equations: a disk rotating around a black hole

We solve a class of boundary value problems for the stationary axisymmetric Einstein equations corresponding to a disk of dust rotating uniformly around a central black hole. The solutions are given explicitly in terms of theta functions on a family of hyperelliptic Riemann surfaces of genus 4. In the absence of a disk, they reduce to the Kerr black hole. In the absence of a black hole, they reduce to the Neugebauer-Meinel disk.Comment: 46 page

Effects of site dilution on the magnetic properties of geometrically frustrated antiferromagnets

The effect of site dilution by non magnetic impurities on the susceptibility of geometrically frustrated antiferromagnets (kagome and pyrochlore lattices) is discussed in the framework of the Generalized Constant Coupling model, for both classical and quantum Heisenberg spins. For the classical diluted pyrochlore lattice, excellent agreement is found when compared with Monte Carlo data. Results for the quantum case are also presented and discussed.Comment: 5 pages, 3 figure

Low-temperature electrical transport in bilayer manganite La1.2_{1.2}Sr1.8_{1.8}Mn2_{2}O7_{7}

The temperature $T$ and magnetic field $H$ dependence of anisotropic in-plane $\rho_{ab}$ and out-of-plane $\rho_{c}$ resistivities have been investigated in single crystals of the bilayer manganite La$_{1.2}$Sr$_{1.8}$Mn$_{2}$O$_{7}$. Below the Curie transition temperature $T_c=$ 125 K, $\rho_{ab}$ and $\rho_{c}$ display almost the same temperature dependence with an up-turn around 50 K. In the metallic regime (50 K $\leq T \leq$ 110 K), both $\rho_{ab}(T)$ and $\rho_{c}(T)$ follow a $T^{9/2}$ dependence, consistent with the two-magnon scattering. We found that the value of the proportionality coefficient $B_{ab}^{fit}$ and the ratio of the exchange interaction $J_{ab}/J_c$ obtained by fitting the data are in excellent agreement with the calculated $B_{ab}$ based on the two-magnon model and $J_{ab}/J_c$ deduced from neutron scattering, respectively. This provides further support for this scattering mechanism. At even lower $T$, in the non-metallic regime ($T<$ 50 K), {\it both} the in-plane $\sigma_{ab}$ and out-of-plane $\sigma_{c}$ conductivities obey a $T^{1/2}$ dependence, consistent with weak localization effects. Hence, this demonstrates the three-dimensional metallic nature of the bilayer manganite La$_{1.2}$Sr$_{1.8}$Mn$_{2}$O$_{7}$ at $T<T_c$.Comment: 7 pages and 5 figures, accepted for publication in Phys. Rev.