Deleterious Effects of Cold Air Inhalation on Coronary Physiological Indices in Patients With Obstructive Coronary Artery Disease

Background Cold air inhalation during exercise increases cardiac mortality, but the pathophysiology is unclear. During cold and exercise, dual‐sensor intracoronary wires measured coronary microvascular resistance (MVR) and blood flow velocity (CBF), and cardiac magnetic resonance measured subendocardial perfusion. Methods and Results Forty‐two patients (62±9 years) undergoing cardiac catheterization, 32 with obstructive coronary stenoses and 10 without, performed either (1) 5 minutes of cold air inhalation (5°F) or (2) two 5‐minute supine‐cycling periods: 1 at room temperature and 1 during cold air inhalation (5°F) (randomized order). We compared rest and peak stress MVR, CBF, and subendocardial perfusion measurements. In patients with unobstructed coronary arteries (n=10), cold air inhalation at rest decreased MVR by 6% (P=0.41), increasing CBF by 20% (P<0.01). However, in patients with obstructive stenoses (n=10), cold air inhalation at rest increased MVR by 17% (P<0.01), reducing CBF by 3% (P=0.85). Consequently, in patients with obstructive stenoses undergoing the cardiac magnetic resonance protocol (n=10), cold air inhalation reduced subendocardial perfusion (P<0.05). Only patients with obstructive stenoses performed this protocol (n=12). Cycling at room temperature decreased MVR by 29% (P<0.001) and increased CBF by 61% (P<0.001). However, cold air inhalation during cycling blunted these adaptations in MVR (P=0.12) and CBF (P<0.05), an effect attributable to defective early diastolic CBF acceleration (P<0.05) and associated with greater ST‐segment depression (P<0.05). Conclusions In patients with obstructive coronary stenoses, cold air inhalation causes deleterious changes in MVR and CBF. These diminish or abolish the normal adaptations during exertion that ordinarily match myocardial blood supply to demand

Strange homelands: encountering the migrant on the contemporary Greek stage

This article examines three examples from recent Greek theatre which stage experiences of migrants and refugees against the backdrop of Greece’s growing internationalism and multiculturalism. In allowing migrants to author their own narratives of border-crossing and encountering their new “homeland”, those theatrical endeavours, I argue, attempt to break the monologism of Greek theatre and monolithic understandings of national identity thus opening up spaces for encountering diverse voices. In acknowledging the risks and tensions underpinning the migrant’s presence on stage, the article also applies pressure to questions of encounter, authenticity, representation and self-expression of migratory subjects and interrogates some ways in which they navigate their precarious space of belonging and author themselves in the context of contemporary Greek theatre

The socialist blues? Citizenship, class and civil society

This article seeks to explore the relationship between the British labour movement, the Left and the Labour party. It does so through the intellectual prism of debates around citizenship and civil society. In this respect, I seek to recover a critical politics around questions of class from the New Left who were always critical of more mainstream ideas of citizenship. However, I also point to the limitations of those who have argued that meaningful forms of citizenship can no longer be connected to political parties and only occurs outside of state organizations. Political parties continue to need intellectual narratives to legitimate their role in society and to connect with the broader civil order.The Labour Party in this respect has seemingly broken with ‘New Labour’ and is searching for a new narrative. The rise of an intellectual grouping around ‘Blue Labour’ has made considerable headway recently and I seek to take a critical view of some of their ideas and ethical frameworks. Here I argue that changing class formations and a more pluralistic society potentially ask difficult questions of those who seek to revive the labour movement in troubled times

Electrophysiological characterization of subclinical and overt hypertrophic cardiomyopathy by magnetic resonance imaging-guided electrocardiography

Background: Ventricular arrhythmia in hypertrophic cardiomyopathy (HCM) relates to adverse structural change and genetic status. Cardiovascular magnetic resonance (CMR)–guided electrocardiographic imaging (ECGI) noninvasively maps cardiac structural and electrophysiological (EP) properties. Objectives: The purpose of this study was to establish whether in subclinical HCM (genotype [G]+ left ventricular hypertrophy [LVH]−), ECGI detects early EP abnormality, and in overt HCM, whether the EP substrate relates to genetic status (G+/G−LVH+) and structural phenotype. Methods: This was a prospective 211-participant CMR-ECGI multicenter study of 70 G+LVH−, 104 LVH+ (51 G+/53 G−), and 37 healthy volunteers (HVs). Local activation time (AT), corrected repolarization time, corrected activation-recovery interval, spatial gradients (GAT/GRTc), and signal fractionation were derived from 1,000 epicardial sites per participant. Maximal wall thickness and scar burden were derived from CMR. A support vector machine was built to discriminate G+LVH− from HV and low-risk HCM from those with intermediate/high-risk score or nonsustained ventricular tachycardia. Results: Compared with HV, subclinical HCM showed mean AT prolongation (P = 0.008) even with normal 12-lead electrocardiograms (ECGs) (P = 0.009), and repolarization was more spatially heterogenous (GRTc: P = 0.005) (23% had normal ECGs). Corrected activation-recovery interval was prolonged in overt vs subclinical HCM (P &lt; 0.001). Mean AT was associated with maximal wall thickness; spatial conduction heterogeneity (GAT) and fractionation were associated with scar (all P &lt; 0.05), and G+LVH+ had more fractionation than G−LVH+ (P = 0.002). The support vector machine discriminated subclinical HCM from HV (10-fold cross-validation accuracy 80% [95% CI: 73%-85%]) and identified patients at higher risk of sudden cardiac death (accuracy 82% [95% CI: 78%-86%]). Conclusions: In the absence of LVH or 12-lead ECG abnormalities, HCM sarcomere gene mutation carriers express an aberrant EP phenotype detected by ECGI. In overt HCM, abnormalities occur more severely with adverse structural change and positive genetic status

Class politics and migrants: collective action among new migrant workers in Britain

This article addresses issues of class-based collective action. Through an ethnographic case study examining migrant workers’ political engagements, the article discusses the current relevance of class politics and the role that culture, identity and intersectionality seem to play in it. By focusing on the collective political practices observed among Latin American migrant workers in London, it seeks to contribute to the ‘new sociology of class’, an emerging strand within the discipline which has begun to explore the identity and cultural dimension of class. In particular, it aims to broaden the scope of this strand beyond the individual so as to include the collective and contentious dimension of class and to enhance its sensitivity to new migrants and to the ‘super-diverse’ nature of contemporary society