Uma promenade nos trópicos: os barões do café sob as palmeiras-imperiais, entre o Rio de Janeiro e São Paulo

This paper proposes to discuss the transformation of urban landscapes in the Paraíba River Valley as members of the coffee elite emerged in this area and a specific landscape configuration was projected there based on the use of imperial palms (Roystonea oleracea). Chronologically speaking, the paper covers a period from 1808 to 1911; with regard to space, it focuses on the stretch between Rio de Janeiro and São Paulo, with a closer look at the case of the city of Lorena (SP), so as to encompass all the changes that took place in this region from the introduction to the decline of coffee growing as an economic activity. The urban changes during this period were accompanied by the advent and consolidation of landscapes typical of the society of coffee growers: streets lined with palm trees, a token of their close connections with the royal court, a display of their adherence to "Frenchified customs". Such configurations were used to characterize public areas and raise them to the same status as the new buildings that gradually replaced those built in colonial style. The paper is structured around three key moments, namely: the introduction of imperial palms in Rio de Janeiro and their association with the idea of nobility and rank, and consequently with neoclassical architecture, which was brought to the colony by the 1816 French Mission; the dissemination of the use of imperial palms as a landscaping resource typical of public spaces from the royal court to the capital of São Paulo, particularly by the coffee barons during the second period of monarchic rule; and, finally, the hypothesis that the use of imperial palms to embellish public areas in São Paulo may have been introduced by a Lorena citizen associated with the coffee elite, albeit later, when Brazil was already a republic.O presente trabalho propõe-se a discutir a transformação da paisagem urbana das cidades vale-paraibanas, a partir do estabelecimento de uma elite ligada à cultura do café nessa região e do surgimento de uma configuração paisagística específica, apoiada na utilização da palmeira-imperial (Roystonea oleracea). Seu recorte cronológico abrange o período entre 1808 e 1911, enquanto espacialmente seu foco direciona-se para o eixo Rio de Janeiro-São Paulo, com estudo mais aproximado do caso da cidade de Lorena, São Paulo, de modo a cobrir as transformações aí ocorridas desde a chegada do café até o esgotamento dessa cultura. Acompanhando as transformações urbanas do período, surgiram e consolidaram-se exemplos paisagísticos próprios da sociedade do café: ruas arborizadas com renques de palmeiras, a demonstrar a proximidade com a Corte, a sinalizar os novos "modos afrancesados". Utilizaram-se tais configurações com o propósito de qualificar os logradouros públicos, a fim de equipará-los aos novos edifícios que substituíam aqueles da tradição colonial. O texto desenvolve-se em três momentos principais: a introdução da palmeira-imperial no Rio de Janeiro, sua vinculação à idéia de nobreza e classe, e conseqüente aproximação com a arquitetura neoclássica trazida pela Missão Francesa de 1816; a difusão de sua utilização como recurso paisagístico qualificador dos espaços públicos desde a Corte até a capital paulista, principalmente pelo baronato do Segundo Império; e, finalmente, a possibilidade de sua introdução nos espaços públicos paulistanos ter sido viabilizada por um lorenense, vinculado à elite cafeeira, embora já sob a República

Grading mitral regurgitation using 4D flow CMR: comparison to transthoracic echocardiography

Abstract Funding Acknowledgements Type of funding sources: None. BACKGROUND Mitral Regurgitation (MR) is currently primarily assessed using multiple transthoracic echocardiography (TTE) parameters. Two-dimensional Cardiac Magnetic Resonance (CMR) can be used in difficult cases but has limited agreement with TTE for quantifying MR. We hypothesized that 4D Flow CMR may help to quantify MR. OBJECTIVES To determine the 4D Flow CMR thresholds that achieve the best agreement with TTE for grading MR. METHODS  We conducted a single-center prospective study of patients evaluated for chronic primary MR in 2016-2020. MR was evaluated blindly by TTE and 4D Flow CMR respectively by two cardiologists and two radiologists with decades of experience. MR was graded with both methods as mild, moderate or severe. 4D Flow CMR measurements included MR regurgitant volume per beat (RV) and mitral anterograde flow per beat (MF). RF was obtained as the ratio RV/MF. Additionally, MF was compared to left ventricular stroke volume (LVSV) by cine-CMR. RESULTS  We included 33 patients in the initial cohort and 33 in the validation cohort. Inter-observer agreement was good for TTE and excellent for 4D Flow CMR. Agreement between MF and LVSV was excellent. Using recommended TTE thresholds (30 mL, 60 mL, 30%, 50%), agreement was moderate for RV and RF. The best agreement between 4D Flow CMR and TTE was obtained with CMR thresholds of 20 mL and 40 mL for RV (κ=0.93; 95%CI, 0.8-1) and 20% and 37% for RF (κ=0.90; 95%CI, 0.7-0.9). In the validation cohort, agreement between TTE and 4D Flow CMR was good with the optimal thresholds (κ= 0.78; 95%CI, 0.61-0.94). CONCLUSION We propose CMR thresholds that provide a good agreement between TTE and CMR for grading MR. Further studies are needed to fully validate 4D-Flow CMR accuracy for primary MR quantification. </jats:sec

Grading mitral regurgitation using 4D flow CMR: comparison to transthoracic echocardiography

Abstract Background Mitral Regurgitation (MR) is currently primarily assessed using multiple transthoracic echocardiography (TTE) parameters. Two-dimensional Cardiac Magnetic Resonance (CMR) can be used in difficult cases but has limited agreement with TTE for quantifying MR. We hypothesized that 4D Flow CMR may help to quantify MR. Purpose To determine the 4D Flow CMR thresholds that achieve the best agreement with TTE for grading MR. Methods We conducted a single-center prospective study of patients evaluated for chronic primary MR in 2016–2020. MR was evaluated blindly by TTE and 4D Flow CMR respectively by two cardiologists and two radiologists with decades of experience. MR was graded with both methods as mild, moderate or severe. 4D Flow CMR measurements included MR regurgitant volume per beat (RV) and mitral anterograde flow per beat (MF). RF was obtained as the ratio RV/MF. Additionally, MF was compared to left ventricular stroke volume (LVSV) by cine-CMR. Results We included 33 patients in the initial cohort and 33 in the validation cohort. Inter-observer agreement was good for TTE and excellent for 4D Flow CMR. Agreement between MF and LVSV was excellent. Using recommended TTE thresholds (30 mL, 60 mL, 30%, 50%), agreement was moderate for RV and RF. The best agreement between 4D Flow CMR and TTE was obtained with CMR thresholds of 20 mL and 40 mL for RV (κ=0.93; 95% CI, 0.8–1) and 20% and 37% for RF (κ=0.90; 95% CI, 0.7–0.9). In the validation cohort, agreement between TTE and 4D Flow CMR was good with the optimal thresholds (κ= 0.78; 95% CI, 0.61–0.94). Conclusion We propose CMR thresholds that provide a good agreement between TTE and CMR for grading MR. Further studies are needed to fully validate 4D-Flow CMR accuracy for primary MR quantification. Funding Acknowledgement Type of funding sources: None. Quantification of MR using 4D Flow CMR </jats:sec

P5874D Flow cardiac magnetic resonance quantification of mitral regurgitation, comparison with transthoracic echocardiography

Abstract Background Mitral valve regurgitation (MR) is currently primarily assessed by a multiparametric approach with transthoracic echocardiography (TTE) that can be further completed by 2D Cardiac Magnetic Resonance (2D CMR) in case of doubt or poor acoustic window. TTE and 2D CMR have nevertheless imperfect agreement in terms of MR quantification. Time-resolved phase-contrast cardiac magnetic resonance imaging with flow-encoding in three spatial directions (4D Flow CMR) could help in MR quantification. Purpose Compare 4D Flow CMR quantification of MR with TTE using a multiparametric approach. Methods We conducted a monocentric, prospective study at the Institut Mutualiste Montsouris in Paris between November 2016 and 2017 including patients with chronic primitive MR. MR was evaluated with a multiparametric approach by two cardiologists with TTE and quantitatively by two radiologists with 4D Flow CMR. MR was classified as mild, moderate or severe and evaluated blindly with consensus in case of disagreement. 4D Flow CMR measurements consisted in quantifying MR regurgitant volume (RV) and MR regurgitant fraction (RF). 4D anterograde mitral flow was compared to left ventricular stroke volume using 2D-cine CMR. Results 33 patients were included. Inter-observer agreement was good in TTE (kappa= 0.75 95% CI [0.57- 0.92]) and excellent in 4D Flow CMR (ICC= 0.94 95% CI [0.79–0.95]). Agreement with TTE was excellent using optimized thresholds (Mild: RV≤20mL RF≤20%, Moderate: RV=21–39mL RF=21–36%, Severe: RV≥40mL RF≥37%): kappa= 0.93 95% CI [0.8–1] for RV and kappa= 0.90 95% CI [0.7–0.9] for RF. A validation cohort confirmed that the 4D flow thresholds as determined were accurate for MR grading. Agreement between 4D anterograde mitral flow and 2D-cine CMR left ventricular stroke volume was also excellent (ICC= 0.92 95% CI [0.85–0.96]). Conclusion 4D Flow CMR is a reliable tool for MR quantification. It provides direct quantitative evaluation of MR with low inter-observer variability. It may therefore be used as a gatekeeper before therapeutic decisions such as surgery. </jats:sec