PRE-INTERVENTIONAL LEFT VENTRICULAR 2D STRAIN PREDICTS THE RECOVERY OF MYOCARDIAL DYSFUNCTION AND IMPROVEMENT IN FUNCTIONAL CAPACITY AFTER TRANSCATHETER AORTIC VALVE IMPLANTATION

International audienceAn extended literature analyzes the accumulation foreign exchange holding observed in many developing and emerging countries since the 2000s. Empirical studies on the self-insurance motive suggest that high-reserves economies are more resilient to financial crises and to international capital inflows volatility. They show also that pre-crisis foreign reserve accumulation explains post-crisis growth. However, some papers suggest that the relationship between international reserves holding and reduced vulnerability is nonlinear, meaning that reserve holding is subject to diminishing returns. This paper devotes more attention to the potential nonlinear relationship between the foreign reserves holding and macroeconomic resilience to shocks. For a sample of 9 emerging economies, we assess to what extent the accumulation of international reserves allows to mitigate negative impacts of external shocks on the output gap. While a major part of the literature focuses on the global financial crisis, we investigate this question by considering two sub-periods: 1995-2003 and 2004-2013. We implement threshold VAR (TVAR) model in which the structure is allow to change if the threshold variable crosses a certain estimated threshold. We find that the effectiveness of reserve holding to improve the resilience of domestic economies to shocks has increased over time. Hence, the diminishing returns of foreign reserve holding stressed in the previous literature must be qualified

Quantification of biventricular myocardial function using cardiac magnetic resonance feature tracking, endocardial border delineation and echocardiographic speckle tracking in patients with repaired tetralogy of fallot and healthy controls

BACKGROUND: Parameters of myocardial deformation have been suggested to be superior to conventional measures of ventricular function in patients with tetralogy of Fallot (ToF), but have required non-routine, tagged cardiovascular magnetic resonance (CMR) techniques. We assessed biventricular myocardial function using CMR cine-based feature tracking (FT) and compared it to speckle tracking echocardiography (STE) and to simple endocardial border delineation (EBD). In addition, the relation between parameters of myocardial deformation and clinical parameters was assessed. METHODS: Overall, 28 consecutive adult patients with repaired ToF (age 40.4 ± 13.3 years) underwent standard steady-state-free precession sequence CMR, echocardiography, and cardiopulmonary exercise testing. In addition, 25 healthy subjects served as controls. Myocardial deformation was assessed by CMR based FT (TomTec Diogenes software), CMR based EBD (using custom written software) and STE (TomTec Cardiac Performance Analysis software). RESULTS: Feature tracking was feasible in all subjects. A close agreement was found between measures of global left (LV) and right ventricular (RV) global strain. Interobserver agreement for FT and STE was similar for longitudinal LV global strain, but FT showed better inter-observer reproducibility than STE for circumferential or radial LV and longitudinal RV global strain. Reproducibility of regional strain on FT was, however, poor. The relative systolic length change of the endocardial border measured by EBD yielded similar results to FT global strain. Clinically, biventricular longitudinal strain on FT was reduced compared to controls (P < 0.0001) and was related to the number of previous cardiac operations. In addition, FT derived RV strain was related to exercise capacity and VE/VCO(2)-slope. CONCLUSIONS: Although neither the inter-study reproducibility nor accuracy of FT software were investigated, and its inter-observer reproducibility for regional strain calculation was poor, its calculations of global systolic strain showed similar or better inter-oberver reproducibility than those by STE, and could be applied across RV image regions inaccessible to echo. ‘Global strain’ calculated by EBD gave similar results to FT. Measurements made using FT related to exercise tolerance in ToF patients suggesting that the approach could have clinical relevance and deserves further study

Quantification of biventricular myocardial function using cardiac magnetic resonance feature tracking, endocardial border delineation and echocardiographic speckle tracking in patients with repaired tetralogy of fallot and healthy controls

Background: Parameters of myocardial deformation have been suggested to be superior to conventional measures of ventricular function in patients with tetralogy of Fallot (ToF), but have required non-routine, tagged cardiovascular magnetic resonance (CMR) techniques. We assessed biventricular myocardial function using CMR cine-based feature racking (FT) and compared it to speckle tracking echocardiography (STE) and to simple endocardial border delineation (EBD). In addition, the relation between parameters of myocardial deformation and clinical parameters was assessed. Methods: Overall, 28 consecutive adult patients with repaired ToF (age 40.4 ± 13.3 years) underwent standard steadystate- free precession sequence CMR, echocardiography, and cardiopulmonary exercise testing. In addition, 25 healthy subjects served as controls. Myocardial deformation was assessed by CMR based FT (TomTec Diogenes software), CMR based EBD (using custom written software) and STE (TomTec Cardiac Performance Analysis software). Results: Feature tracking was feasible in all subjects. A close agreement was found between measures of global left (LV) and right ventricular (RV) global strain. Interobserver agreement for FT and STE was similar for longitudinal LV global strain, but FT showed better inter-observer reproducibility than STE for circumferential or radial LV and longitudinal RV global strain. Reproducibility of regional strain on FT was, however, poor. The relative systolic length change of the endocardial border measured by EBD yielded similar results to FT global strain. Clinically, biventricular longitudinal strain on FT was reduced compared to controls (P<0.0001) and was related to the number of previous cardiac operations. In addition, FT derived RV strain was related to exercise capacity and VE/VCO2-slope. Conclusions: Although neither the inter-study reproducibility nor accuracy of FT software were investigated, and its interobserver reproducibility for regional strain calculation was poor, its calculations of global systolic strain showed similar or better inter-oberver reproducibility than those by STE, and could be applied across RV image regions inaccessible to echo. ‘Global strain’ calculated by EBD gave similar results to FT. Measurements made using FT related to exercise tolerance in ToF patients suggesting that the approach could have clinical relevance and deserves further study

Kardiovaskuläre Phänotypisierung eines Kleintiermodells mit autosomal dominanter polyzystischer Nierenerkrankung Typ 2 (ADPKD2)

Die autosomal dominante polyzystische Nierenerkrankung (ADPKD) ist die häufigste hereditäre Nierenerkrankung. Bei dieser Erkrankung kommt es im höheren Alter zu Veränderungen der kardiovaskulären Funktion. Unter dieser Voraussetzung untersuchte diese Arbeit die kardiovaskulären Veränderungen bei Pkd2+/-LacZ+/- Mäusen und Wildtyp-Pkd2+/+LacZ-/- Mäusen. Ausgangspunkt für diese Untersuchung war die Hypothese, dass es bei heterozygoten Mäusen zu ähnlichen kardiovaskulären Veränderungen kommen würde, wie sie bei Menschen mit ADPKD auftreten. Die zugrunde liegende Hypothese konnte nicht bestätigt werden. Es wurden 104 Echokardiographisch untersucht. Alle Mäuse hatten eine ähnliche Herzfrequenz und ähnliche linksventrikuläre Parameter. Fraktionelle Verkürzung und Ejektionsfraktion waren bei den männlichen Tieren höher als bei den Weiblichen. Im Genotypenvergleich konnten bis auf tendenziell höhere E- und A-Wellen Werte bei den Wildtyp-Mäusen keine signifikanten Unterschiede ermittelt werden

Nowa metoda pomiaru odkształcenia mięśnia sercowego na podstawie techniki śledzenia cech obrazów ruchomych CMR. Porównanie z echokardiograficzną metodą śledzenia markerów akustycznych u zdrowych ochotników i u chorych z przerostem lewej komory

Background: Left ventricular longitudinal strain (LV-LS) and strain rate (SR) are sensitive markers of early systolic dysfunction.Aim: To evaluate the feasibility of a novel, cardiac magnetic resonance (CMR) based method known as feature tracking (FT) for the assessment of strain and SR, and to compare the CMR based results to those obtained on standard transthoracic echocardiography (TTE) in healthy volunteers and in patients with left ventricular hypertrophy cardiomyopathy (HCM).Methods: Overall, 20 healthy volunteers (ten male, mean age 24 ± 3 years) and 20 consecutive patients with HCM (12 male, mean age 47 ± 19 years) were included. Longitudinal and circumferential strain and SR of the left ventricle were measured on CMR at 1.5 Tesla and TTE and interobserver variability was assessed.Results: FT measurements were feasible in all subjects. A good agreement between global LV-LS measured on CMR (controls: 20.8 ± 3.0; HCM: 17.6 ± 3.8) and TTE (controls: 19.4 ± 2.1; HCM: 16.6 ± 2.9) was found, while the agreement was worse for circumferential strain and all SR measurements. For the left and right ventricles, interobserver reproducibility was higher for strain measurements compared to SR. Coefficients of variation were lowest for LV-LS (13.2%) by CMR.Conclusions: FT analysis is a novel CMR based method for the analysis of myocardial strain and SR that is simple and correlates well with the echocardiographic measurements. Since CMR is unaffected by inadequate acoustic windows, FT may represent an attractive alternative to echocardiography in assessing the increasingly important parameters of myocardial deformation.Wstęp: Odkształcenie podłużne lewej komory (LV-LS) i prędkość odkształcenia (SR) są czułymi wskaźnikami wczesnej dysfunkcji skurczowej.Cel: Celem niniejszej pracy były: ocena nowej metody pomiaru odkształcenia mięśnia sercowego na podstawie techniki śledzenia cech (FT, feature tracking) obrazów ruchomych rezonansu magnetycznego serca (CMR) oraz porównanie wyników uzyskanych w CMR do rezultatów standardowej przezklatkowej echokardiografii (TTE) przeprowadzonej u zdrowych ochotników i u chorych z kardiomiopatią przerostową (HCM).Metody: Do badania włączono 20 zdrowych ochotników (10 mężczyzn, średnia wieku 24 ± 3 lata) i 20 kolejnych pacjentów z HCM (12 mężczyzn, średnia wieku 47 ± 19 lat). Odkształcenie podłużne i okrężne oraz SR lewej komory zmierzono w CMR przy natężeniu pola magnetycznego 1,5 tesli. Oceniono również TTE i zmienność zależną od obserwatora.Wyniki: Pomiar FT był możliwy u wszystkich badanych. Stwierdzono dużą zgodność między całkowitym LV-LS mierzonym przy użyciu CMR (grupa kontrolna: 20,8 ± 3,0; HCM: 17,6 ± 3,8) i za pomocą TTE (grupa kontrolna: 19,4 ± 2,1; HCM:16,6 ± 2,9), natomiast pomiary odkształcenia okrężnego i wszystkie pomiary SR charakteryzowały się mniejszą zgodnością. Powtarzalność wyników dotyczących lewej i prawej komory uzyskiwanych przez różnych obserwatorów była większa w przypadku pomiarów odkształceń w porównaniu z SR. Najniższe współczynniki zmienności stwierdzono w przypadku pomiarów LV-LS (13,2%) metodą CMR.Wnioski: Analiza FT, będącego nową metodą oceny odkształceń mięśnia sercowego oraz SR opartą na badaniu CMR, jest prosta i dobrze koreluje z pomiarami echokardiograficznymi. Ze względu na to, że na CMR nie ma wpływu niewłaściwe okno akustyczne, FT może być atrakcyjną alternatywą dla badania echokardiograficznego w ocenie bardzo ważnych parametrów deformacji miokardium

Frequency, Mortality, and Predictors of Adverse Outcomes for Endocarditis in Patients with Congenital Heart Disease: Results of a Nationwide Analysis including 2512 Endocarditis Cases

Background: Infective endocarditis (IE) represents a major complication in patients with congenital heart disease (CHD) and is associated with high morbidity and mortality. The aim of this study was to analyse the frequency and outcome of IE in contemporary CHD patients based on all IE hospital admissions in Germany over a 10-year period. Methods: Based on data of all hospital admissions in Germany from 2009 to 2018, we identified all CHD cases with a diagnosis of IE. The data contained information on patient demographics, diagnoses, surgical procedures, and mortality. The primary endpoint of the study was endocarditis-associated mortality as well as major adverse events (defined as death or myocardial infarction, stroke, pulmonary embolism, sepsis, renal dialysis, resuscitation, or intubation). Results: Overall, 309,245 CHD inpatient cases were included in the analysis (underlying heart defects of simple complexity 55%, moderate complexity 23%, and complex heart defects 22%, respectively). Of those, 2512 (0.8% of all inpatient cases) were treated for IE. The mortality rate of IE inpatient cases was 6% with a major adverse events rate of 46%, and 41.5% of cases required surgical intervention. The overall IE associated mortality was lower in adult CHD cases compared to the 153,242 in adult IE cases without CHD (7.1% vs. 16.1%, p &lt; 0.001). After adjustments using multivariable logistic regression analysis, the presence or complexity of CHD was not associated with the outcomes. Meanwhile, age, male sex, and co-morbidities emerged as significant predictors of adverse outcomes. Conclusions: IE accounts for a minority of CHD related hospitalizations but remains a deadly disease, and major adverse events are common in this setting. Due to different demographic and co-morbidity spectrums, adult CHD patients tend to have better survival prospects when compared to non-CHD IE patients. Acquired co-morbidities emerged as the main predictors of adverse outcomes