MR fluoroscopy in vascular and cardiac interventions (review)

Vascular and cardiac disease remains a leading cause of morbidity and mortality in developed and emerging countries. Vascular and cardiac interventions require extensive fluoroscopic guidance to navigate endovascular catheters. X-ray fluoroscopy is considered the current modality for real time imaging. It provides excellent spatial and temporal resolution, but is limited by exposure of patients and staff to ionizing radiation, poor soft tissue characterization and lack of quantitative physiologic information. MR fluoroscopy has been introduced with substantial progress during the last decade. Clinical and experimental studies performed under MR fluoroscopy have indicated the suitability of this modality for: delivery of ASD closure, aortic valves, and endovascular stents (aortic, carotid, iliac, renal arteries, inferior vena cava). It aids in performing ablation, creation of hepatic shunts and local delivery of therapies. Development of more MR compatible equipment and devices will widen the applications of MR-guided procedures. At post-intervention, MR imaging aids in assessing the efficacy of therapies, success of interventions. It also provides information on vascular flow and cardiac morphology, function, perfusion and viability. MR fluoroscopy has the potential to form the basis for minimally invasive image–guided surgeries that offer improved patient management and cost effectiveness

Persistence of strong silica-enriched domains in the Earth's lower mantle

The composition of the lower mantle—comprising 56% of Earth’s volume—remains poorly constrained. Among the major elements, Mg/Si ratios ranging from ∼0.9–1.1, such as in rocky Solar-System building blocks (or chondrites), to ∼1.2–1.3, such as in upper-mantle rocks (or pyrolite), have been proposed. Geophysical evidence for subducted lithosphere deep in the mantle has been interpreted in terms of efficient mixing, and thus homogenous Mg/Si across most of the mantle. However, previous models did not consider the effects of variable Mg/Si on the viscosity and mixing efficiency of lower-mantle rocks. Here, we use geodynamic models to show that large-scale heterogeneity associated with a 20-fold change in viscosity, such as due to the dominance of intrinsically strong (Mg, Fe)SiO3–bridgmanite in low-Mg/Si domains, is sufficient to prevent efficient mantle mixing, even on large scales. Models predict that intrinsically strong domains stabilize mantle convection patterns, and coherently persist at depths of about 1,000–2,200 km up to the present-day, separated by relatively narrow up-/downwelling conduits of pyrolitic material. The stable manifestation of such bridgmanite-enriched ancient mantle structures (BEAMS) may reconcile the geographical fixity of deep-rooted mantle upwelling centres, and geophysical changes in seismic-tomography patterns, radial viscosity, rising plumes and sinking slabs near 1,000 km depth. Moreover, these ancient structures may provide a reservoir to host primordial geochemical signatures

Update on hypertrophic cardiomyopathy and a guide to the guidelines

Hypertrophic cardiomyopathy (HCM) is the most common inherited cardiovascular disorder, affecting 1 in 500 individuals worldwide. Existing epidemiological studies might have underestimated the prevalence of HCM, however, owing to limited inclusion of individuals with early, incomplete phenotypic expression. Clinical manifestations of HCM include diastolic dysfunction, left ventricular outflow tract obstruction, ischaemia, atrial fibrillation, abnormal vascular responses and, in 5% of patients, progression to a 'burnt-out' phase characterized by systolic impairment. Disease-related mortality is most often attributable to sudden cardiac death, heart failure, and embolic stroke. The majority of individuals with HCM, however, have normal or near-normal life expectancy, owing in part to contemporary management strategies including family screening, risk stratification, thromboembolic prophylaxis, and implantation of cardioverter-defibrillators. The clinical guidelines for HCM issued by the ACC Foundation/AHA and the ESC facilitate evaluation and management of the disease. In this Review, we aim to assist clinicians in navigating the guidelines by highlighting important updates, current gaps in knowledge, differences in the recommendations, and challenges in implementing them, including aids and pitfalls in clinical and pathological evaluation. We also discuss the advances in genetics, imaging, and molecular research that will underpin future developments in diagnosis and therapy for HCM