The Serifos Metamorphic Core Complex (Greece) — kinematic investigations of the southern detachment mylonites

The island of Serifos is situated about 100km SSE of Athens in the Aegean Sea and belongs to the Attic-Cycladic massif. The geology of Serifos is largely characterized by a shallow hornblendebiotite granodiorite pluton that intruded in the late Miocene into a previously deformed (under blueschist conditions) sequence mainly consisting of ortho- and paragneisses, calc-silicate marbles, amphibolites and schists. The pluton has a dome-shaped body occupying the central and southern parts of the island (Salemink 1985). The Serifos MCC is the very western continuation of a zone of syn- to post tectonic intrusions younging from the East (Naxos, Paros ?12Ma) to the West (Serifos 9– 8Ma). Whereas the older intrusions in the East show a top to the North geometry, the Serifos MCC has developed a South-directed low-angle detachment fault...conferenc

Extensional crustal-scale shear zones in the Western Cyclades (Kea, Greece)

Intense seismicity and intensely developed active and ancient fault systems are common to the Aegean Region. Extending/ thinning crust involves a complex interplay of (1) Gulf of Corinth riftexpansion, (2) west- and south-ward retreat of the Hellenic Trench, (3) westward impingement of the Anatolian Platen, and/or (4) propagation of the Anatolian Fault system into the Aegean. New geological/structural investigations on Kea (also known as Tzia), in the Western Cyclades reveal a low angle crustal-scale, detachment-type ductile shear zone probably formed during Miocene extension and thinning of the continental crust...conferenc

Late stage evolution of the Serifos Metamorphic Core Complex (Cyclades, Greece)

The island of Serifos is located in the Western Cyclades within the Attic- Cycladic metamorphic belt. It represents the westward continuation of an arcuate belt of Metamorphic Core Complexes with intrusions of late syn-post tectonic intrusions younging from East (e.g. Naxos main activity ca. 12Ma) to West (e.g. Serifos with 9–8Ma). In scientific discussions the dominance of probably continuous extension since ca. 30Ma (e.g. Jolivet & Faccenna, 2000) and the presence of Metamorphic Core Complexes (Lister et al. 1984) is accepted. The speculated roll-back of the subducting plate possibly started due to the slowing down of absolute plate convergence rate between Africa and Eurasia. This model is attractive, because it would also explain the shift from a compressional Andean-type regime to an extensional Mariana-type regime (Jolivet & Faccenna 2000). Contrary to the kinematic directions reported from the Central and Eastern Cyclades, the movement of the hanging wall of the Serifos Metamorphic Core Complex is south directed. The island’s main part is occupied by an undeformed granodiorite. Early granitic intrusions intruded into low-grade M2-crystalline rocks that have been overprinted to as high as amphibolite facies conditions due to contact metamorphism. Parts of these rocks (gneisses and amphibolites) as well as the early intrusions are deformed to mylonites (Grasemann et al. 2004).conferenc

Myocardialis Infarctus Regiszter – 2010 : Tapasztalatok – első eredmények = Myocardial Infarction Registry – 2010. Feasibility and first results

A szerzők ismertetik a 2010. január 1-jén megkezdett Infarctus Regiszter Pilóta Vizsgálatot. A nemzetközileg elfogadott diagnosztikus kritériumokat alkalmazó és előre meghatározott adatokra kiterjedő, prospektív, epidemiológiai adatgyűjtés hosszas és széles körű szakmai egyeztetése után indult el Budapest öt kerületében és Szabolcs-Szatmár-Bereg megyében. Budapesten öt szívkatéteres centrumban és három – ilyen lehetőséggel nem rendelkező – kardiológiai osztályon, Szabolcs-Szatmár-Bereg megyében egy szívkatéteres centrumban és három belgyógyászati osztályon kezdődött el a vizsgálat. A lakosok száma a szóban forgó területen 997 324 fő. A vizsgálat megkezdését követően – a program fontosságát felismerve – további 16 centrum csatlakozott a vizsgálathoz. A program indulásától 2011. május 1-jéig 4293 beteg adatait rögzítették. A regisztrált betegek 52,1%-ánál ST-elevációval járó (STEMI), 42,1%-ánál nem ST-elevációval járó myocardialis infarctust (NSTEMI), 3%-ánál instabil angina pectorist, 2,8%-ban egyéb diagnózist állapítottak meg a kórházi elbocsátás idején. A szerzők vizsgálják a programba tartozó STEMI miatt kezelt betegek ellátásának jellemzőit Budapesten és Szabolcs-Szatmár-Bereg megyében. A 301 budapesti beteg ellátásában öt, a 402 vidéki beteg ellátásában egy szívkatéteres centrum vett részt. A STEMI miatt kórházba került budapesti betegek 79,7%-a szívkatéteres centrumba került, és ezen betegek 84,6%-ánál intervenció történt. Szabolcs-Szatmár-Bereg megyében a STEMI miatt kezelt betegek 62,9%-a került szívkatéteres centrumba, és a betegek 77%-ánál történt katéterterápiás beavatkozás. A 301 budapesti beteg esetén 8%-os, a 402 vidéki beteg esetén 10%-os kórházi halálozást észleltek. A kórházból eltávozott betegek esetén a szekunder prevenció szempontjából fontos gyógyszereket a Budapesten ellátott beteg esetén javasolták gyakrabban. A szerzők megállapítják, hogy az egységes diagnosztikus kritériumokat alkalmazó, prospektív adatgyűjtésen alapuló Infarctus Regiszter Pilóta Vizsgálat kivihető, az adatok népegészségügyi szempontból fontosak. A program országos bevezetése a finanszírozás során nyert adatoknál pontosabb képet adhatna az infarktusos betegek ellátásának helyzetéről. Orv. Hetil., 2011, 152, 1278–1283. | Authors present the methodology and first data of Hungarian Myocardial Infarction Register Pilot Study started 1st of January, 2010. The aim of the study is to collect epidemiological data on myocardial infarction, to examine the natural history of the disease and to investigate the main characteristics on patient care in the pilot area. The program is using standardized diagnostic criteria and predefined electronic data record forms (eCRF). The pilot area consists of 5 districts in the capital, and Szabolcs-Szatmár-Bereg county. The area has 997 324 inhabitants. Eight cardiology departments, 5 with heart catheterization facility (C) in Budapest, four hospitals with one C in Szabolcs-Szatmar-Bereg county have been responsible of the patients’ care. After starting the program 16 other hospitals joined the program from different parts of Hungary. Between 1st of January 2010 and 1st of May 2011 4293 patients were registered, among them 52.1% with ST segment elevation myocardial infarction (STEMI), 42.1% with non-ST segment elevation myocardial infarction (NSTEMI), while 3% of the patients had unstable angina, and 2.8% of the cases had other diagnosis or the hospital diagnosis was missing in the eCRF. Authors compare the patients care with STEMI in five districts of Budapest and Szabolcs-Szatmár-Bereg county. In Budapest 79.7% of the 301 STEMI patients were treated in C and 84.6% of them were treated with primary percutaneous intervention (pPCI). In Szabolcs-Szatmár-Bereg county 402 patients were registered with STEMI, 62.9% of them were treated in C, where 77% of them were treated with pPCI. The drugs (beta blockers, ACE inhibitors, statins) important for secondary prevention were given more often to patients treated in the capital, however no difference was found in the platelet aggregation inhibitors therapy. Hospital mortality of STEMI patients was 8% in the capital, and 10% in Szabolcs- Szatmár-Bereg county. Authors conclude that the web based myocardial infarction register is feasible and important to have reliable data on patient care and a necessary quality control tool. Authors propose to broaden this pilot program and to start a nationwide myocardial infarction register. Orv. Hetil., 2011, 152, 1278–1283

Risk Related to Pre-Diabetes Mellitus and Diabetes Mellitus in Heart Failure With Reduced Ejection Fraction: Insights From Prospective Comparison of ARNI With ACEI to Determine Impact on Global Mortality and Morbidity in Heart Failure Trial

BACKGROUND: The prevalence of pre-diabetes mellitus and its consequences in patients with heart failure and reduced ejection fraction are not known. We investigated these in the Prospective Comparison of ARNI With ACEI to Determine Impact on Global Mortality and Morbidity in Heart Failure (PARADIGM-HF) trial. METHODS AND RESULTS: We examined clinical outcomes in 8399 patients with heart failure and reduced ejection fraction according to history of diabetes mellitus and glycemic status (baseline hemoglobin A1c [HbA1c]: /=6.5% [>/=48 mmol/mol; diabetes mellitus]), in Cox regression models adjusted for known predictors of poor outcome. Patients with a history of diabetes mellitus (n=2907 [35%]) had a higher risk of the primary composite outcome of heart failure hospitalization or cardiovascular mortality compared with those without a history of diabetes mellitus: adjusted hazard ratio, 1.38; 95% confidence interval, 1.25 to 1.52; P6.5%) and known diabetes mellitus compared with those with HbA1c<6.0% was 1.39 (1.17-1.64); P<0.001 and 1.64 (1.43-1.87); P<0.001, respectively. Patients with pre-diabetes mellitus were also at higher risk (hazard ratio, 1.27 [1.10-1.47]; P<0.001) compared with those with HbA1c<6.0%. The benefit of LCZ696 (sacubitril/valsartan) compared with enalapril was consistent across the range of HbA1c in the trial. CONCLUSIONS: In patients with heart failure and reduced ejection fraction, dysglycemia is common and pre-diabetes mellitus is associated with a higher risk of adverse cardiovascular outcomes (compared with patients with no diabetes mellitus and HbA1c <6.0%). LCZ696 was beneficial compared with enalapril, irrespective of glycemic status. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT01035255

Angiotensin Receptor Neprilysin Inhibition Compared With Enalapril on the Risk of Clinical Progression in Surviving Patients With Heart Failure

BACKGROUND: -Clinical trials in heart failure have focused on the improvement in symptoms or decreases in the risk of death and other cardiovascular events. Little is known about the effect of drugs on the risk of clinical deterioration in surviving patients. METHODS AND RESULTS: -We compared the angiotensin-neprilysin inhibitor LCZ696 (400 mg daily) with the angiotensinconverting enzyme inhibitor enalapril (20 mg daily) in 8399 patients with heart failure and reduced ejection fraction in a double-blind trial. The analyses focused on prespecified measures of nonfatal clinical deterioration. In comparison with the enalapril group, fewer LCZ696-treated patients required intensification of medical treatment for heart failure (520 versus 604; hazard ratio, 0.84; 95% confidence interval, 0.74-0.94; P=0.003) or an emergency department visit for worsening heart failure (hazard ratio, 0.66; 95% confidence interval, 0.52-0.85; P=0.001). The patients in the LCZ696 group had 23% fewer hospitalizations for worsening heart failure (851 versus 1079; P<0.001) and were less likely to require intensive care (768 versus 879; 18% rate reduction, P=0.005), to receive intravenous positive inotropic agents (31% risk reduction, P<0.001), and to have implantation of a heart failure device or cardiac transplantation (22% risk reduction, P=0.07). The reduction in heart failure hospitalization with LCZ696 was evident within the first 30 days after randomization. Worsening of symptom scores in surviving patients was consistently more common in the enalapril group. LCZ696 led to an early and sustained reduction in biomarkers of myocardial wall stress and injury (N-terminal pro-Btype natriuretic peptide and troponin) versus enalapril. CONCLUSIONS: -Angiotensin-neprilysin inhibition prevents the clinical progression of surviving patients with heart failure more effectively than angiotensin-converting enzyme inhibition. Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique identifier: NCT01035255

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