Cardiac Magnetic Resonance to Detect the Underlying Substrate in Patients with Frequent Idiopathic Ventricular Arrhythmias

Background: A routine diagnostic work-up does not identify structural abnormalities in a substantial proportion of patients with idiopathic ventricular arrhythmias (VAs). We investigated the added value of cardiac magnetic resonance (CMR) imaging in this group of patients. Methods: A single-centre prospective study was undertaken of 72 patients (mean age 46 ± 16 years; 53% females) with frequent premature ventricular contractions (PVCs ≥ 500/24 h) and/or non-sustained ventricular tachycardia (NSVT), an otherwise normal electrocardiogram, normal echocardiography and no coronary artery disease. Results: CMR provided an additional diagnostic yield in 54.2% of patients. The most prevalent diagnosis was previous myocarditis (23.6%) followed by possible PVC-related cardiomyopathy (20.8%), non-ischaemic cardiomyopathy (8.3%) and ischaemic heart disease (1.4%). The predictors of abnormal CMR findings were male gender, age and PVCs/NSVT non-outflow tract-related or with multiple morphologies. Patients with VAs had an impaired peak left ventricular (LV) global radial strain (GRS) compared with the controls (28.88% (IQR: 25.87% to 33.97%) vs. 36.65% (IQR: 33.19% to 40.2%), p < 0.001) and a global circumferential strain (GCS) (−17.66% (IQR: −19.62% to −16.23%) vs. −20.66% (IQR: −21.72% to −19.6%), p < 0.001). Conclusion: CMR reveals abnormalities in a significant proportion of patients with frequent idiopathic VAs. Male gender, age and non-outflow tract PVC origin can be clinical indicators for CMR referral

CMR Native T1 Mapping Allows Differentiation of Reversible Versus Irreversible Myocardial Damage in ST-Segment–Elevation Myocardial Infarction

Background—CMR T1 mapping is a quantitative imaging technique allowing the assessment of myocardial injury early after ST-segment–elevation myocardial infarction. We sought to investigate the ability of acute native T1 mapping to differentiate reversible and irreversible myocardial injury and its predictive value for left ventricular remodeling. Methods and Results—Sixty ST-segment–elevation myocardial infarction patients underwent acute and 6-month 3T CMR, including cine, T2-weighted (T2W) imaging, native shortened modified look-locker inversion recovery T1 mapping, rest first pass perfusion, and late gadolinium enhancement. T1 cutoff values for oedematous versus necrotic myocardium were identified as 1251 ms and 1400 ms, respectively, with prediction accuracy of 96.7% (95% confidence interval, 82.8% to 99.9%). Using the proposed threshold of 1400 ms, the volume of irreversibly damaged tissue was in good agreement with the 6-month late gadolinium enhancement volume (r=0.99) and correlated strongly with the log area under the curve troponin (r=0.80) and strongly with 6-month ejection fraction (r=−0.73). Acute T1 values were a strong predictor of 6-month wall thickening compared with late gadolinium enhancement. Conclusions—Acute native shortened modified look-locker inversion recovery T1 mapping differentiates reversible and irreversible myocardial injury, and it is a strong predictor of left ventricular remodeling in ST-segment–elevation myocardial infarction. A single CMR acquisition of native T1 mapping could potentially represent a fast, safe, and accurate method for early stratification of acute patients in need of more aggressive treatment. Further confirmatory studies will be needed

Changes in the investigation and management of suspected myocardial infarction and injury during COVID-19: a multi-centre study using routinely collected healthcare data

Objective: The COVID-19 pandemic was associated with a reduction in the incidence of myocardial infarction (MI) diagnosis, in part because patients were less likely to present to hospital. Whether changes in clinical decision making with respect to the investigation and management of patients with suspected MI also contributed to this phenomenon is unknown. Methods: Multicentre retrospective cohort study in three UK centres contributing data to the National Institute for Health Research Health Informatics Collaborative. Patients presenting to the Emergency Department (ED) of these centres between 1st January 2020 and 1st September 2020 were included. Three time epochs within this period were defined based on the course of the first wave of the COVID-19 pandemic: pre-pandemic (epoch 1), lockdown (epoch 2), post-lockdown (epoch 3). Results: During the study period, 10,670 unique patients attended the ED with chest pain or dyspnoea, of whom 6,928 were admitted. Despite fewer total ED attendances in epoch 2, patient presentations with dyspnoea were increased (p < 0.001), with greater likelihood of troponin testing in both chest pain (p = 0.001) and dyspnoea (p < 0.001). There was a dramatic reduction in elective and emergency cardiac procedures (both p < 0.001), and greater overall mortality of patients (p < 0.001), compared to the pre-pandemic period. Positive COVID-19 and/or troponin test results were associated with increased mortality (p < 0.001), though the temporal risk profile differed. Conclusions: The first wave of the COVID-19 pandemic was associated with significant changes not just in presentation, but also the investigation, management, and outcomes of patients presenting with suspected myocardial injury or MI

ART DEMONSTRATES THAT FOOTBALL IS METASTASIZED, AND GIVES IT REFUGE

U ovom se radu problemski analiziraju obilježja nogometa u hit-romanu Alena Bovića Metastaze (2006) te u dvjema kasnijim obradama tog književnog djela – u kazališnoj predstavi Metastaze i istoimenom igranom filmu. Otuda ideja da se ondje zatečen, devijantnim pojavama obilježen nogomet, koji više baš i nema puno dodirnih točaka s igrom koja mu leži u korijenima, nazove metastaziralim. Umjetnička se stvarnost pritom promatra kao korespondentna društvenoj stvarnosti pa se za takvo etiketiranje nogometa prepoznaju razlozi na objema razinama. Na temelju takvog pristupa Metastazama, ali i na osnovi prethodno ponuđenog komparativnog uvida u nogometnu tematiku u nekim drugim književnim, kazališnim i filmskim ostvarenjima u Hrvatskoj i izvan nje, postavlja se teza o umjetnosti kao dokazu metastaziralog nogometa. No, još je izazovnije utvrditi može li umjetnost istodobno poslužiti i kao utočište metastaziralom nogometu tako da se njome revitalizira ponajprije estetska, ali istodobno i etička dimenzija tog sporta. Iz tih pobuda argumentacija u ovome radu uključuje tekstove i autore u širokom rasponu od književne kritike, antropologije igara i sociologije sporta do semiotike, kulturalnih studija i estetike. U ovom se radu problemski analiziraju obilježja nogometa u hit-romanu Alena Bovića Metastaze (2006) te u dvjema kasnijim obradama tog književnog djela – u kazališnoj predstavi Metastaze i istoimenom igranom filmu. Otuda ideja da se ondje zatečen, devijantnim pojavama obilježen nogomet, koji više baš i nema puno dodirnih točaka s igrom koja mu leži u korijenima, nazove metastaziralim. Umjetnička se stvarnost pritom promatra kao korespondentna društvenoj stvarnosti pa se za takvo etiketiranje nogometa prepoznaju razlozi na objema razinama. Na temelju takvog pristupa Metastazama, ali i na osnovi prethodno ponuđenog komparativnog uvida u nogometnu tematiku u nekim drugim književnim, kazališnim i filmskim ostvarenjima u Hrvatskoj i izvan nje, postavlja se teza o umjetnosti kao dokazu metastaziralog nogometa. No, još je izazovnije utvrditi može li umjetnost istodobno poslužiti i kao utočište metastaziralom nogometu tako da se njome revitalizira ponajprije estetska, ali istodobno i etička dimenzija tog sporta. Iz tih pobuda argumentacija u ovome radu uključuje tekstove i autore u širokom rasponu od književne kritike, antropologije igara i sociologije sporta do semiotike, kulturalnih studija i estetike.This article presents an analysis of the characteristics of football as depicted in the bestselling novel Metastaze (Metastases) (2006) by Alen Bović and in its two subsequent adaptations – the play Metastaze (Metastases) directed by Boris Svrtan and the film Metastaze (Metastases) directed by Branko Schmidt. Football as it appears in these three pieces is metastasized: it is deviant and in fact undergoes so many significant changes that it no longer has much in common with the original game. Artistic reality is seen as corresponding to social reality, and reasons for the metastasized nature of football are found on both levels. Based on the proposed analysis of Metastaze and a comparative analysis of descriptions of football in other books, plays and films in Croatia and abroad a hypothesis is put forward whereby art offers evidence as to the metastasized nature of football. A greater challenge still is to establish whether art might, at the same time, provide refuge to the metastasized football, revitalizing its aesthetic and ethical dimension. Given the scope of these claims, the arguments in the article are based on a wide array of texts and authors ranging from literary criticism, anthropology of games and sociology of sport to semiotics, cultural studies and aesthetics

Adenosine stress CMR T1-mapping detects early microvascular dysfunction in patients with type 2 diabetes mellitus without obstructive coronary artery disease

Background Type 2 diabetes mellitus (T2DM) is associated with coronary microvascular dysfunction in the absence of obstructive coronary artery disease (CAD). Cardiovascular magnetic resonance (CMR) T1-mapping at rest and during adenosine stress can assess coronary vascular reactivity. We hypothesised that the non-contrast T1 response to vasodilator stress will be altered in patients with T2DM without CAD compared to controls due to coronary microvascular dysfunction. Methods Thirty-one patients with T2DM and sixteen matched healthy controls underwent CMR (3 T) for cine, rest and adenosine stress non-contrast T1-mapping (ShMOLLI), first-pass perfusion and late gadolinium enhancement (LGE) imaging. Significant CAD (>50% coronary luminal stenosis) was excluded in all patients by coronary computed tomographic angiography. Results All subjects had normal left ventricular (LV) ejection and LV mass index, with no LGE. Myocardial perfusion reserve index (MPRI) was lower in T2DM than in controls (1.60 ± 0.44 vs 2.01 ± 0.42; p = 0.008). There was no difference in rest native T1 values (p = 0.59). During adenosine stress, T1 values increased significantly in both T2DM patients (from 1196 ± 32 ms to 1244 ± 44 ms, p < 0.001) and controls (from 1194 ± 26 ms to 1273 ± 44 ms, p < 0.001). T2DM patients showed blunted relative stress non-contrast T1 response (T2DM: ΔT1 = 4.1 ± 2.9% vs. controls: ΔT1 = 6.6 ± 2.6%, p = 0.007) due to a blunted maximal T1 during adenosine stress (T2DM 1244 ± 44 ms vs. controls 1273 ± 44 ms, p = 0.045). Conclusions Patients with well controlled T2DM, even in the absence of arterial hypertension and significant CAD, exhibit blunted maximal non-contrast T1 response during adenosine vasodilatory stress, likely reflecting coronary microvascular dysfunction. Adenosine stress and rest T1 mapping can detect subclinical abnormalities of the coronary microvasculature, without the need for gadolinium contrast agents. CMR may identify early features of the diabetic heart phenotype and subclinical cardiac risk markers in patients with T2DM, providing an opportunity for early therapeutic intervention