Myocardial tissue characterization: histological and pathophysiological correlation

Cardiovascular magnetic resonance imaging (CMR) has become the gold standard not only for cardiac volume and function quantification, but for a key unique strength: non-invasive myocardial tissue characterization. Several different techniques, separately or in combination, can detect and quantify early and established myocardial pathological processes permitting better diagnosis, prognostication and tracking of therapy. The authors will focus on the histological and pathophysiological evidence of these imaging parameters in the characterization of edema, infarction, scar and fibrosis. In addition to laying out the strengths and weaknesses of each modality, the reader will be introduced to rapid developments in T1 and T2 mapping as well as the use of contrast-derived extracellular volume for quantification of diffuse fibrosis

Myocardial Extracellular Volume Quantification by Cardiovascular Magnetic Resonance and Computed Tomography

PURPOSE OF REVIEW: This review article discusses the evolution of extracellular volume (ECV) quantification using both cardiovascular magnetic resonance (CMR) and computed tomography (CT). RECENT FINDINGS: Visualizing diffuse myocardial fibrosis is challenging and until recently, was restricted to the domain of the pathologist. CMR and CT both use extravascular, extracellular contrast agents, permitting ECV measurement. The evidence base around ECV quantification by CMR is growing rapidly and just starting in CT. In conditions with high ECV (amyloid, oedema and fibrosis), this technique is already being used clinically and as a surrogate endpoint. Non-invasive diffuse fibrosis quantification is also generating new biological insights into key cardiac diseases. CMR and CT can estimate ECV and in turn diffuse myocardial fibrosis, obviating the need for invasive endomyocardial biopsy. CT is an attractive alternative to CMR particularly in those individuals with contraindications to the latter. Further studies are needed, particularly in CT

Multimodality Imaging Markers of Adverse Myocardial Remodeling in Aortic Stenosis

Aortic stenosis (AS) causes left ventricular remodeling (hypertrophy, remodeling, fibrosis) and other cardiac changes (left atrial dilatation, pulmonary artery and right ventricular changes). These changes, and whether they are reversible (reverse remodeling), are major determinants of timing and outcome from transcatheter or surgical aortic valve replacement. Cardiac changes in response to AS afterload can either be adaptive and reversible, or maladaptive and irreversible, when they may convey residual risk after intervention. Structural and hemodynamic assessment of AS therefore needs to evaluate more than the valve, and, in particular, the myocardial remodeling response. Imaging plays a key role in this. This review assesses how multimodality imaging evaluates AS myocardial hypertrophy and its components (cellular hypertrophy, fibrosis, microvascular changes, and additional features such as cardiac amyloid) both before and after intervention, and seeks to highlight how care and outcomes in AS could be improved

Yasemin Karakaşoğlu / Paul Mecheril / Jeanette Goddar: Pädagogik neu denken! Die Migrationsgesellschaft und ihre Lehrer_innen. Weinheim/Basel: Beltz 2029 (136 S.) [Rezension]

Rezension von: Yasemin Karakaşoğlu / Paul Mecheril / Jeanette Goddar: Pädagogik neu denken! Die Migrationsgesellschaft und ihre Lehrer_innen. Weinheim/Basel: Beltz 2029 (136 S.; ISBN 978-3-407-25801-4; 24,95 EUR)

Fremde an unserer Tür: Zeitdiagnose und Appell - Zygmunt Baumans Blick auf die 'Migrationskrise'

Zygmunt Bauman: Die Angst vor den anderen - Ein Essay über Migration und Panikmache. Berlin: Suhrkamp 2016. 978-3-518-07258-

Moderate Aortic Stenosis: What is it and When Should We Intervene?

Current guidelines recommend aortic valve replacement in patients with severe aortic stenosis in the presence of symptoms or a left ventricular ejection fraction <50%. However, patients with less than severe aortic stenosis may also experience symptoms and recent literature suggests that the prognosis is not as benign as previously reported. There are no recommendations for patients with moderate aortic stenosis and left ventricular dysfunction, despite the high associated morbidity and mortality. There is also some evidence that these patients may benefit from early aortic valve intervention. It is recognised that aortic stenosis not only affects the valve but also has a complex myocardial response. This review discusses the natural history of moderate aortic stenosis along with the role of multimodality imaging in risk stratification in these patients

Aortic stenosis - a myocardial disease. Insights from myocardial tissue characterisation

Aortic stenosis (AS) is a disease of not just the valve, but also of the myocardium. Patient symptoms and outcome are determined by the myocardial response; a crucial but poorly understood process. Diffuse and focal myocardial fibrosis play a key role. Until recently, both could only be assessed using invasive histology, but now cardiovascular magnetic resonance (CMR) offers late gadolinium enhancement (LGE) and extracellular volume fraction (ECV) techniques. In this thesis, I developed new methods to quantify ECV by synthetic ECV and cardiac CT. I then explored myocardial remodelling and fibrosis in patients with severe AS undergoing aortic valve replacement (AVR) using myocardial biopsy, CMR, biomarkers and a wide range of clinical parameters. Prior to AVR, CMR in patients with severe AS revealed important differences in myocardial remodelling between sexes, otherwise missed on echocardiography alone. Given apparently equal valve severity, the myocardial response to AS appeared unexpectedly maladaptive in men compared to women. Intra-operative myocardial biopsy revealed three pattern of fibrosis: endocardial fibrosis, microscars (mainly in the subendomyocardium), and diffuse interstitial fibrosis. Biopsy best captured the transmural gradient of fibrosis and microscars, while on CMR, LGE captured mainly microscars and ECV captured mid-myocardial related functional changes beyond LGE. Combining LGE and ECV allowed better stratification of AS patients. Incidentally, I found that 6% of AS patients older then 65 years had wild-type transthyretin amyloid deposits on cardiac biopsy, which was associated with poor outcome. This is now the basis of a BHF research fellowship. Following AVR, I demonstrated for the first time non-invasively that diffuse fibrosis regresses (focal fibrosis did not), which is accompanied by structural and functional improvements suggesting that human diffuse fibrosis is plastic, measurable by CMR and a potential therapeutic target

Soziologie für die Öffentlichkeit

Der Beitrag nimmt die Initiative »DGS goes public« zum Anlass, das Verhältnis von Soziologie und Öffentlichkeit zu reflektieren. Unter Rückgriff auf jeweils durchaus widersprüchliche eigene Erfahrungen und die Konzeptionen einer Public Sociology plädieren die Autorin und der Autor übereinstimmend für mehr »Soziologie für die Öffentlichkeit«. Unterschiedliche Akzente und Präferenzen setzen sie dort, wo es um das wahrgenommene Desinteresse bzw. Interesse an Soziologie geht. Insgesamt wollen beide dazu beitragen, die Thematik im Fach systematisch und kontrovers zugleich zu diskutieren. The article takes the »DGS goes public« initiative as a prompt to consider the relationship of sociology and the general public. Drawing on their rather contradictory experiences and the concepts of a Public Sociology, the authors agree in arguing for more »Sociology for the General Public«. They put different emphasis concerning the perceived disinterest or interest in sociology. All in all, they both wish to contribute to a discussion, both systematic and controversial, of this topic in the subject of sociology