Novel insights into diminished cardiac reserve in non-obstructive hypertrophic cardiomyopathy from four-dimensional flow cardiac magnetic resonance component analysis

Aims: Hypertrophic cardiomyopathy (HCM) is characterized by hypercontractility and diastolic dysfunction, which alter blood flow haemodynamics and are linked with increased risk of adverse clinical events. Four-dimensional flow cardiac magnetic resonance (4D-flow CMR) enables comprehensive characterization of ventricular blood flow patterns. We characterized flow component changes in non-obstructive HCM and assessed their relationship with phenotypic severity and sudden cardiac death (SCD) risk. Methods and results: Fifty-one participants (37 non-obstructive HCM and 14 matched controls) underwent 4D-flow CMR. Left-ventricular (LV) end-diastolic volume was separated into four components: direct flow (blood transiting the ventricle within one cycle), retained inflow (blood entering the ventricle and retained for one cycle), delayed ejection flow (retained ventricular blood ejected during systole), and residual volume (ventricular blood retained for >two cycles). Flow component distribution and component end-diastolic kinetic energy/mL were estimated. HCM patients demonstrated greater direct flow proportions compared with controls (47.9 ± 9% vs. 39.4 ± 6%, P = 0.002), with reduction in other components. Direct flow proportions correlated with LV mass index (r = 0.40, P = 0.004), end-diastolic volume index (r = −0.40, P = 0.017), and SCD risk (r = 0.34, P = 0.039). In contrast to controls, in HCM, stroke volume decreased with increasing direct flow proportions, indicating diminished volumetric reserve. There was no difference in component end-diastolic kinetic energy/mL. Conclusion: Non-obstructive HCM possesses a distinctive flow component distribution pattern characterised by greater direct flow proportions, and direct flow-stroke volume uncoupling indicative of diminished cardiac reserve. The correlation of direct flow proportion with phenotypic severity and SCD risk highlight its potential as a novel and sensitive haemodynamic measure of cardiovascular risk in HCM

Stylistic Devices in Articles about Retail Industry

Šajā darbā tiek pētīta mākslinieciskās izteiksmes līdzekļu izmantošana mazumtirdzniecības nozares rakstos. Pētījuma mērķis ir noskaidrot, vai biznesa žurnāla Forbes autori, izskaidrojot vienu izplatītu mazumtirdzniecības tēmu, mēdz izmantot mākslinieciskās izteiksmes līdzekļus savos rakstos, kā arī atklāt galvenos mērķus mākslinieciskās izteiksmes līdzekļu izmantošanai tajos. Pētījuma metode bija diskursa analīze kopā ar biežuma analīzi, izmantojot kvalitatīvo pieeju, īstenojot Skrebņeva klasifikāciju (2003). Analīze parādīja, ka šajos rakstos tika izmantoti daudzi dažādi mākslinieciskās izteiksmes līdzekļi; atkārtošana un anafora bija kopīgas visiem rakstiem. Autori mēdz izmantot mākslinieciskās izteiksmes līdzekļus dažādiem stilistiskajiem mērķiem. Lai iegūtu precīzākus rezultātus, ir ieteicams veikt vairāk pētījumu par šo tēmu, izmantojot citus biznesa žurnālus.The paper explores the use of stylistic devices in articles about the retail industry. The study is aimed at establishing whether authors of the Forbes business magazine describing a similar retail topic tend to use stylistic devices in their articles, as well as discovering the main purposes for using stylistic devices there. The research method was discourse analysis together with the frequency analysis using the qualitative approach by implementing Skrebnev’s classification (2003). The analysis has shown that eighteen stylistic devices were applied in these articles; repetition and anaphora being the most common among them. The authors tend to use stylistic devices for various stylistic purposes. To obtain more precise results, additional research should be conducted on this topic with other business magazines

Assessment of mitral valve regurgitation by cardiovascular magnetic resonance imaging

10.1038/s41569-019-0305-zNature Reviews Cardiology175298-31

Altered Diastolic Flow Patterns and Kinetic Energy in Subtle Left Ventricular Remodeling and Dysfunction Detected by 4D Flow MRI.

4D flow magnetic resonance imaging (MRI) allows quantitative assessment of left ventricular (LV) function according to characteristics of the dynamic flow in the chamber. Marked abnormalities in flow components' volume and kinetic energy (KE) have previously been demonstrated in moderately dilated and depressed LV's compared to healthy subjects. We hypothesized that these 4D flow-based measures would detect even subtle LV dysfunction and remodeling.We acquired 4D flow and morphological MRI data from 26 patients with chronic ischemic heart disease with New York Heart Association (NYHA) class I and II and with no to mild LV systolic dysfunction and remodeling, and from 10 healthy controls. A previously validated method was used to separate the LV end-diastolic volume (LVEDV) into functional components: direct flow, which passes directly to ejection, and non-ejecting flow, which remains in the LV for at least 1 cycle. The direct flow and non-ejecting flow proportions of end-diastolic volume and KE were assessed. The proportions of direct flow volume and KE fell with increasing LVEDV-index (LVEDVI) and LVESV-index (LVESVI) (direct flow volume r = -0.64 and r = -0.74, both P74 ml/m2 compared to patients with LVEDVI <74 ml/m2 and controls (both P<0.05).Direct flow volume and KE proportions diminish with increased LV volumes, while non-ejecting flow proportions increase. A decrease in direct flow volume and KE at end-diastole proposes that alterations in these novel 4D flow-specific markers may detect LV dysfunction even in subtle or subclinical LV remodeling