bluuebunny/crossref_metadata_2025 huggingface dataset:
Confluence or independence of microwave plasma bullets in atmospheric argon plasma jet plumes
Authors: Li Ping , Chen Zhaoquan , Mu Haibao , Xu Guimin , Yao Congwei , Sun Anbang , Zhou Yuming , Zhang Guanjun
Published: March 2018

Plasma bullet is the formation and propagation of a guided ionization wave (streamer), normally generated in atmospheric pressure plasma jet (APPJ). In most cases, only an ionization front produces in a dielectric tube. The present study shows that two or three ionization fronts can be generated in a single quartz tube by using a microwave coaxial resonator. The argon APPJ plumes with a maximum length of 170 mm can be driven by continuous microwaves or microwave pulses. When the input power is higher than 90 W, two or three ionization fronts propagate independently at first; thereafter, they confluence to form a central plasma jet plume. On the other hand, the plasma bullets move independently as the lower input power is applied. For pulsed microwave discharges, the discharge images captured by a fast camera show the ionization process in detail. Another interesting finding is that the strongest lightening plasma jet plumes always appear at the shrinking phase. Both the discharge images and electromagnetic simulations suggest that the confluence or independent propagation of plasma bullets is resonantly excited by the local enhanced electric fields, in terms of wave modes of traveling surface plasmon polaritons.
Making the ‘Marsupial Lion‘: Bunyips, Networked Colonial Knowledge Production between 1830–59 and the Description of Thylacoleo carnifex
Authors: Minard P.
Published: March 2018

This article explores the processes leading up to the description of Thylacoleo carnifex by Richard Owen in 1859. It argues that it resulted from thirty years of searching for extinct marsupial predators in Australian fossil sites, starting with the discovery of the first Australian marsupial megafauna fossils in 1830. Australian farmers, colonial and metropolitan scientists and anonymous indigenous informants conducted this search. Together these individuals formed a scientific network that found, shipped and inscribed fossils as marsupial carnivores. This network involved the constant movement of ideas, people and fossils to and from the Australian colonies as colonial investigators sought patronage, personal status and the incorporation of Australian deep time within European theoretical models. This networked model demonstrates the agency of colonial investigators without flattening the very real power differentials they had to negotiate when metropolitan experts sought out specimens, correspondents and supporters.
Pharmacological activation of estrogen receptor beta augments innate immunity to suppress cancer metastasis
Authors: Zhao Linjie , Huang Shuang , Mei Shenglin , Yang Zhengnan , Xu Lian , Zhou Nianxin , Yang Qilian , Shen Qiuhong , Wang Wei , Le Xiaobing , Lau Wayne Bond , Lau Bonnie , Wang Xin , Yi Tao , Zhao Xia , Wei Yuquan , Warner Margaret , Gustafsson Jan-Åke , Zhou Shengtao
Published: March 2018

Significance

Cancer metastases have caused the major mortality rate for cancer patients, with limited options of treatment and unsatisfactory therapeutic efficacy. Unlike the tumor-promoting role of estrogen receptor (ER)α, ERβ has shown potent antitumor effects in many cancers. In this study, we showed that the selective ERβ agonist LY500307 could potently suppress lung metastasis of cancer by recruitment of antitumor neutrophils to the metastatic niche. These chemotactic effects of LY500307 for neutrophils were primarily mediated by ERβ activation-induced IL-1β release by the tumor cells. Our study provides the rationale that pharmacological activation of ERβ could augment innate immunity to suppress cancer metastatic colonization to lung, implicating the potential use of selective ERβ agonists for the treatment of cancer patients with metastasis.
Rock Physics and Petrographic Parameters Relationship Within Siliciclastic Rocks: Quartz Sandstone Outcrop Study Case
Authors: Syafriyono S , Caesario D , Swastika A , Adlan Q , Syafri I , Abdurrokhim A , Mardiana U , Mohamad F , Alfadli M K , Sari V M
Published: March 2018

Rock physical parameters value (Vp and Vs) is one of fundamental aspects in reservoir characterization as a tool to detect rock heterogenity. Its response is depend on several reservoir conditions such as lithology, pressure and reservoir fluids. The value of Vp and Vs is controlled by grain contact and contact stiffness, a function of clay mineral content and porosity also affected by mineral composition. The study about Vp and Vs response within sandstone and its relationship with petrographic parameters has become important to define anisotrophy of reservoir characteristics distribution and could give a better understanding about local diagenesis that influence clastic reservoir properties. Petrographic analysis and Vp-Vs calculation was carried out to 12 core sample which is obtained by hand-drilling of the outcrop in Sukabumi area, West Java as a part of Bayah Formation. Data processing and interpretation of sedimentary vertical succession showing that this outcrop comprises of 3 major sandstone layers indicating fluvial depositional environment. As stated before, there are 4 petrographic parameters (sorting, roundness, clay mineral content, and grain contact) which are responsible to the differences of shear wave and compressional wave value in this outcrop. Lithology with poor-sorted and well- roundness has Vp value lower than well-sorted and poor-roundness (sub-angular) grain. For the sample with high clay content, Vp value is ranging from 1681 to 2000 m/s and could be getting high until 2190 to 2714 m/s in low clay content sample even though the presence of clay minerals cannot be defined neither as matrix nor cement. The whole sample have suture grain contact indicating telogenesis regime whereas facies has no relationship with Vp and Vs value because of the different type of facies show similar petrographic parameters after diagenesis.
Genome-by-genome approach for fast bacterial genealogical relationship evaluation
Authors: Zhang Ji , Xiong Yanwen , Rogers Lynn , Carter Glen P , French Nigel
Published: March 2018

Motivation

Large-scale whole-genome sequencing dataset-based studies are becoming increasingly common in pathogen surveillance and outbreak investigations. A highly discriminative and time-efficient bioinformatics tool is needed to transform large amounts of sequencing data into usable biological information. To replace the intuitive, yet inefficient, way of gene-by-gene allele calling algorithm, a new algorithm using genome-by-genome approach was developed.

Results

Tests showed that the program equipped with the new algorithm achieved significant improvements in allele calling efficiency compared to a conventional gene-by-gene approach. The new program, Fast-GeP, rendered a fast and easy way to infer high-resolution genealogical relationships between bacterial isolates using whole-genome sequencing data.

Availability and implementation

FAST-GeP is freely available from: https://github.com/jizhang-nz/fast-GeP.

Supplementary information

Supplementary data are available at Bioinformatics online.
The ESC Textbook of Cardiovascular Medicine
Authors: Camm A. John , Lüscher Thomas F. , Maurer Gerald , Serruys Patrick W.
Published: March 2018

ESC CardioMed is a ground-breaking initiative from European Society of Cardiology together with Oxford University Press that transforms reference publishing in cardiovascular medicine in order to better serve the needs of this rapidly advancing specialty. ESC CardioMed is an encyclopedic online resource covering more than 60 disciplines within cardiology. It will be updated online 3 times a year by the world’s leading clinicians, scientists, and researchers to reflect the latest in global cardiology. More than 1000 of the world’s leading specialists, ranging from researchers to clinicians, have contributed to this vast publication, ensuring a comprehensive and authoritative treatment of the field. ESC CardioMed is highly illustrated, with over 350 videos, helping readers to visualise key concepts. The publication is also linked to the ESC Clinical Practice Guidelines in the European Heart Journal, providing the background information behind clinical practice.
Cardiovascular signs
Authors: Pringle Stuart D. , Fitzsimmons Samantha , Gudmundsdottir Ingibjorg J. , Esterson Joseph B.
Published: March 2018

Physical examination remains an important part of cardiology practice because it facilitates the further investigation and treatment of those in whom heart disease is confirmed or suspected and helps to reassure those without a heart condition. Clinical signs can provide accurate, valuable diagnostic and prognostic information of great relevance to patients with most cardiac conditions particularly heart failure, coronary heart disease, valvular heart disease, and adults with congenital heart disease. This chapter reviews the most useful clinical signs in cardiology and discusses their relevance and accuracy expressed, wherever possible, as likelihood ratios; the reader should, however, be aware of the limitations of this sort of evidence-based approach because clinical signs should never be interpreted in isolation.
Cardiac embryogenesis
Authors: Kelly Robert G.
Published: March 2018

The embryonic heart forms in anterior lateral splanchnic mesoderm and is derived from Mesp1-expressing progenitor cells. During embryonic folding, the earliest differentiating progenitor cells form the linear heart tube in the ventral midline. The heart tube extends in length and loops to the right as new myocardium is progressively added at the venous and arterial poles from multipotent second heart field cardiovascular progenitor cells in contiguous pharyngeal mesoderm. While the linear heart tube gives rise to the left ventricle, the right ventricle, outflow tract, and a large part of atrial myocardium are derived from the second heart field. Progressive myocardial differentiation is controlled by intercellular signals within the progenitor cell niche. The embryonic heart is the template for septation and growth of the four-chambered definitive heart and defects in progenitor cell deployment result in a spectrum of common forms of congenital heart defects.
The molecular basis of cardiac embryogenesis
Authors: Torres Miguel
Published: March 2018

The heart is the first organ to function in the mammalian embryo; however, heart development spans the whole intrauterine period and is only completed during the postnatal period. The ability of the mammalian fetal heart to provide circulatory support while preserving its proliferative and regenerative ability has stimulated interest in the molecular and cellular pathways underlying cardiac development and how they might be exploited in the design of regenerative strategies in the adult heart. Cardiac cell lineage specification and differentiation is regulated by an intricate network of molecular pathways that involve extracellular signals, transcription factors, and chromatin regulators. This chapter outlines current knowledge and the latest advances in understanding the molecular basis of cardiac lineage specification and differentiation during embryonic development.
Development of the ventricles and valves
Authors: Pérez-Pomares José M. , de la Pompa José L.
Published: March 2018

The heart is the first functional organ of the vertebrate embryo, beginning to beat at around 4 weeks of gestation in humans. Tissue interactions orchestrate the complex patterning, proliferation, and differentiation processes that transform the embryonic cardiac primordium into the adult heart. During heart embryogenesis, cardiac mesoderm progenitor cells originate bilaterally during gastrulation and move rostrally to form the primitive heart tube, which will then loop towards the right and initiate septation to give rise to the mature four-chambered heart. Experimental studies in animal models have revealed the crucial role that a number of highly conserved signalling pathways, involving active molecular cross-talk between adjacent tissues, play in cardiac development, and how the alterations in these signalling mechanisms may cause congenital heart disease affecting the neonate or adult. Here, we describe briefly the knowledge gained on the molecular and cellular mechanisms underlying cardiac chamber and valve development and its implication in disease. This knowledge will ultimately facilitate the design of diagnostic and therapeutic strategies to treat congenital heart disease.
Development of the cardiac conduction system
Authors: van Weerd Jan Hendrik , Christoffels Vincent M.
Published: March 2018

The contraction of the heart is orchestrated by the components of the cardiac conduction system (CCS), which initiate and propagate the electrical impulses to coordinately activate the cardiac chambers. In the adult heart, the impulse is generated in the sinoatrial node and activates the atrial myocardium. Slow conduction of the impulse through the atrioventricular node allows for emptying of the atria and filling of the ventricles prior to ventricular contraction. Subsequent fast conduction through the atrioventricular bundle, bundle branches, and Purkinje fibre network activates the ventricular myocardium and causes the ventricles to contract. The development and function of the CCS involves complex regulatory networks of transcription factors acting in stage-, tissue-, and dose-dependent manners. Disrupted function or expression of these factors might lead to impaired development or function of the CCS components, associated with heart failure and sudden death. It is therefore crucial to understand the molecular and cellular mechanisms controlling the complex regulation of CCS development. This chapter summarizes current insight in the development and function of the different compartments of the CCS, and discusses the transcriptional networks underlying these processes.
Epicardial and coronary vascular development
Authors: Cahill Thomas J. , Riley Paul R.
Published: March 2018

The coronary circulation is essential for human life. In embryonic development, abnormal formation of the coronary vasculature can cause death in utero or after birth. In adulthood, atherosclerosis of the coronary arteries is the commonest cause of death worldwide. The last decade has witnessed significant strides forward in our understanding of coronary development. Multiple sources of coronary endothelial cells have been identified using genetic tools for fate mapping. The epicardium, the outermost layer of the developing heart, has emerged as both a source of cell progenitors and key signalling mediators. Knowledge of the specific genes underlying formation, function, and heterogeneity of the epicardium is expanding. Significant challenges remain, however, in understanding the spatiotemporal signalling patterns required for organized migration, differentiation, and patterning of the vasculature. In addition, dissecting how coronary development is perturbed in patients with congenital coronary anomalies is a major ongoing focus of research.
The ageing heart
Authors: Bäck Magnus , Joly Laure , Sadoul Nicolas , Benetos Athanase
Published: March 2018

The ageing heart is faced with age-related structural alterations of the coronary circulation, myocardium, valves, conductive system, and aorta, as well as the cumulative exposure to various cardiovascular risk factors over a lifetime. Coronary ageing in terms of atherosclerosis and coronary calcifications and the resulting ischaemic heart disease, imply specific diagnostic and therapeutic challenges in the elderly. In addition to a higher risk of ischaemic damage, the myocardial ageing per se is associated with left ventricular hypertrophy and increased stiffening, resulting in typical diastolic filling patterns with ageing. The myocardium may be further affected by the consequences of valvular ageing and an increased prevalence of either stenotic or regurgitant valvular heart disease. The conductance system also experiences age-related changes resulting in conduction abnormalities and arrhythmias. It should be emphasized that age-dependent arterial stiffening and hypertension may account for a heart–vessel coupling to further deteriorate the ageing heart. Ultimately all those factors participate in an age-related increased risk of cardiovascular events and heart failure. Finally, it is important to also consider extra-cardiac co-morbidities, frailty, and the cognitive and functional status of the older patient when evaluating the ageing heart.
Renin–angiotensin system and neprilysin
Authors: Ferreira João Pedro , Rossignol Patrick
Published: March 2018

The advent of drugs able to modulate the renin–angiotensin system (RAS), and more recently the neprilysin inhibitor sacubitril in combination with a RAS blocker, has improved the outcome of many cardiovascular and renal conditions. In particular, heart failure, post-myocardial infarction, and hypertension are the cardiovascular clinical syndromes in which RAS inhibition (and in heart failure, in combination with neprilysin inhibition) has greatly improved morbidity and mortality. This chapter aims to provide an appraisal of RAS and neprilysin inhibitors regarding their pharmacological properties with respect to mechanism(s) of action, pharmacokinetics, monitoring, adverse effects, and drug interactions.
Oral diabetes treatments and cardiovascular disease
Authors: Saulnier Pierre-Jean , Hadjadj Samy
Published: March 2018

The aims of treatment in diabetes are not only to normalize and control blood glucose levels, but also to delay or prevent its short-term and long-term complications. Since the synthesis of metformin in the early 1920s and its clinical use in the late 1950s by J. Stern, there is now have an extensive range of approved oral antidiabetic agents. During this period, diabetes was transformed towards a major global epidemic disease. In 2015 in Europe, about 42 million patients, representing 70% of the 60 million adults diagnosed with diabetes, received an oral antidiabetic agent. This chapter reviews the seven approved classes of oral antidiabetic drugs beyond their glycaemic effect, according to their mechanism of action, and cardiovascular and safety profiles.
Bivalirudin and argatroban
Authors: Capodanno Davide
Published: March 2018

The central role of thrombin in the process of clot formation makes it an important therapeutic target. Heparin is a potent anticoagulant, but has a number of limitations, in that—for example—it does not bind clot-bound thrombin, activates platelets, and may determine heparin-induced thrombocytopenia (HIT). Bivalirudin and argatroban, which belong to the class of intravenous direct thrombin inhibitors, overcome many of the limitations of heparin. Bivalirudin is currently indicated for patients undergoing percutaneous coronary intervention, patients with non-ST-segment elevation acute coronary syndromes planned for urgent or early intervention, and patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention. Both argatroban and bivalirudin can be used as an alternative to heparin in patients with HIT and HIT-thrombosis syndrome. This chapter describes the current clinical applications of bivalirudin and argatroban.
The NOACs: pharmacodynamics and pharmacokinetics
Authors: Vanassche Thomas , Verhamme Peter
Published: March 2018

The non-vitamin K antagonist oral anticoagulants (NOACs) (or direct-acting oral anticoagulants) are a novel class of direct-acting oral anticoagulants developed to offer more predictable pharmacodynamic and pharmacokinetic properties compared to vitamin K antagonists. Due to their predictable relation between drug dose and anticoagulant effect, NOACs are used at a fixed dose, without routine monitoring of coagulation parameters. While the use of a fixed dose greatly enhances the convenience of anticoagulant therapy, physicians need to understand the pharmacokinetic and pharmacodynamic aspects of NOACs to identify those patients for whom a dosage adjustment is required.
The NOACs: clinical pharmacology
Authors: Weitz Jeffrey
Published: March 2018

The limitations of vitamin K antagonists prompted the development of new oral anticoagulants that could be administered in fixed doses without routine coagulation monitoring. Focusing on thrombin and factor Xa because of their prominent roles in coagulation, structure-based design led to the development of small molecules that bind to the active site pockets of these enzymes with high affinity and specificity. Four non-vitamin K antagonist oral anticoagulants are now licensed: dabigatran, which inhibits thrombin, and rivaroxaban, apixaban, and edoxaban, which inhibit factor Xa. In phase III randomized clinical trials that included over 100,000 patients these agents have proven to be at least as effective as vitamin K antagonists for prevention of stroke in patients with non-valvular atrial fibrillation and for treatment of venous thromboembolism, and to produce less bleeding, particularly less intracranial bleeding.
Epidemiology and global burden of arrhythmias
Authors: Aro Aapo L. , Chugh Sumeet S.
Published: March 2018

The last two decades have witnessed significant developments in the diagnosis and management of supraventricular and ventricular arrhythmias, especially in the high-income countries. Due to several factors that include the dynamic nature of these conditions, epidemiology and surveillance have not advanced to the same extent. In this chapter, the goal is to collate the existing literature on epidemiology and global burden of arrhythmias, recognizing that these data are also available from only a few of the world regions, mostly the high-income nations.
Ventricular hypertrophy
Authors: Bacharova Ljuba , Estes Harvey
Published: March 2018

The term ‘ventricular hypertrophy’ encompasses changes seen in a variety of cardiac pathological processes as well as in some physiological ones. The traditional concept involved in the electrocardiographic (ECG) diagnosis of ventricular hypertrophy assumes that an enlarged ventricular mass generates a stronger electrical field: in left ventricular hypertrophy the resultant electrical forces oriented posteriorly and leftward are augmented, resulting in an increase in amplitude in corresponding leads. An increased contribution of the right ventricle to the electric field enhances anterior and rightward-oriented forces. In spite of multiple attempts to improve the performance of ECG criteria, the classical ECG criteria for ventricular hypertrophies suffer from low sensitivity and questionable specificity. Traditionally, the strongest arguments advanced in favour of continued use of the ECG have been those related to convenience, availability, and low cost; nevertheless, they are inadequate justification for its use. However, the main problem is the effort to estimate the size/dimensions of ventricles by measuring the electric field. Valid justification must emphasize the added clinical value of the unique information provided by the ECG. The electrical information is a strong predictor of future cardiovascular disease and mortality, and the individual ECG abnormalities may be predictive of specific clinical presentations of disease. The anatomical measure of left ventricular hypertrophy by echocardiogram and magnetic resonance imaging, and functional measure by ECG are complementary information, and they are neither contradictory nor competing measures.
Intraventricular conduction disturbances
Authors: Luna Antoni Bayés de , Elizari Marcelo V.
Published: March 2018

This chapter highlights the key concepts related to the electrocardiogram (ECG) diagnosis of intraventricular conduction disturbances, including right and left bundle branch block. In both cases, but especially in left bundle branch block, the chapter discusses the diagnosis when the block is at a proximal level and in the fascicles. This includes the ECG diagnosis of the superoanterior and inferoposterior fascicles of the left bundle (the hemiblocks). The possible diagnosis of the block of middle fibres (septal fascicle) of left bundle is briefly mentioned. Finally, the ECG criteria for the diagnosis of bifascicular and trifascicular block are described. In all cases, the most important clinical implications of each diagnosis are discussed.
The abnormal ECG without apparent heart disease and the normal ECG in serious heart diseases: two extremes
Authors: Luna Antonio Bayés de , Breithardt Günter
Published: March 2018

It is clear that the electrocardiogram (ECG) must be evaluated within the clinical context. Therefore, this chapter can be summarized with the following sentence: a normal ECG is not a guarantee of cardiovascular health, nor is a pathological ECG an unequivocal sign of heart disease. This must always be remembered when interpreting an ECG.
Stress echocardiography
Authors: Karogiannis Nikolaos , Senior Roxy
Published: March 2018

Stress echocardiography is a well-established imaging modality that combines echocardiography with exercise or pharmacologic or electrical stress to diagnose coronary artery disease, assess severity of valve disease and investigate potential viability of the cardiac muscle. In the era of tissue harmonic imaging and ultrasound contrast agents, stress echocardiography has established itself as an accurate technique with diagnostic images obtained in almost all patients.
Heart failure
Authors: Neglia Danilo , Gaemperli Oliver
Published: March 2018

Heart failure (HF) has turned into an increasing global socioeconomic issue associated with a high morbidity and mortality. Cardiac radionuclide imaging offers important clinical information for risk stratification and tailored treatment strategies in patients with HF. Ischaemic cardiomyopathy is the most common cause of HF. Left and right ventricular function can be assessed and quantified with radionuclide ventriculography (RNV) or gated scintigraphic studies. Additionally, radionuclide imaging may help to assess functional and metabolic integrity of dysfunctional myocardium. Chronic myocardial ischaemia can lead to variable reversible states of contractile impairment termed myocardial stunning or hibernation. Radionuclide techniques including positron emission tomography with 18F-fluorodeoxyglucose or myocardial perfusion scintigraphy can identify viable myocardium with the potential for functional recovery, and thereby guide revascularization procedures. Increased sympathetic myocardial innervation assessed by 131I-metaiodobenzylguanidine (MIBG) single-photon emission tomography (SPECT) is associated with poorer HF outcomes and higher rates of sudden cardiac death or arrhythmia. Finally, left ventricular mechanical dyssynchrony can be evaluated using Fourier-transformed phase analysis of RNV or gated myocardial perfusion SPECT. This approach could potentially be useful to guide targeted resynchronization therapy in the future.
Endocarditis and device infection
Authors: Hyafil Fabien , Guludec Dominique Le , Gaemperli Oliver
Published: March 2018

The diagnosis of infective endocarditis (IE) is often challenging and based on careful integration of clinical, microbiological, and imaging findings. The classical diagnostic scores (e.g. Duke criteria) have drawbacks as they leave clinicians with a considerable number of uncertain cases, in which further management is unclear and important therapeutic actions possibly delayed. Transoesophageal echocardiography is the preferred imaging technique for the diagnosis of IE as it can visualize valvular vegetations and paravalvular complications with high accuracy. However, transoesophageal echocardiography has limitations in the case of device-associated endocarditis (i.e. prosthetic valve (PVE) or cardiovascular implantable electronic device (CIED) infection). Radionuclide imaging techniques using 18F-fluorodeoxyglucose positron emission tomography (FDG PET) or white blood cell single-photon emission computed tomography (WBC SPECT) are accurate techniques to pick-up inflammatory cells. They have shown incremental diagnostic value for detecting PVE and CIED infection. Adding computed tomography angiography allows accurate co-registration of inflammatory signal and anatomical structure, and improves the detection of paravalvular complications such as abscesses or pseudoaneurysms. Current European Society of Cardiology guidelines have recently adopted the use of FDG PET/CT or WBC SPECT/CT in their recommendations for the work-up of suspected or uncertain PVE.
Infiltrative disease (amyloidosis/sarcoidosis)
Authors: Fuchs Tobias A. , Gaemperli Oliver
Published: March 2018

Infiltrative cardiomyopathies such as sarcoidosis and amyloidosis are characterized by interstitial deposition of pathological acellular or cellular tissue within the myocardium. Nuclear cardiac imaging plays an important role in the assessment of infiltrative cardiac disease through direct visualization of infiltrative substrates or inflammation, or both, by radiolabelled compounds. Cardiac involvement from sarcoidosis is rather common, and appears to worsen the overall prognosis of the disease. Radionuclide imaging using 18F-fluorodeoxyglucose (FDG) positron emission tomography is a very sensitive method to detect cardiac sarcoidosis. Most importantly, it allows detecting early inflammatory stages previous to any morphological changes such as fibrosis or scar and thereby facilitates early preventive treatment. In order to suppress physiological FDG uptake and obtain good image quality, meticulous patient preparation including prolonged fasting, diet, and heparin load prior to FDG imaging is required. Cardiac amyloidosis is an infiltrative cardiomyopathy characterized by interstitial deposits of amyloid that can be visualized by scintigraphy using molecular-targeted radiolabelled compounds such as 99mTc-labelled pyrophosphate or 3,3-diphosphono-1,2-propanodicarboxylic acid (DPD). Because of the high sensitivity for transthyretin-type (ATTR) amyloidosis, scintigraphy may help to phenotype cardiac amyloidosis and separate ATTR from light-chain amyloidosis.
Future potential
Authors: Kaufmann Philipp A. , Gaemperli Oliver , Knuuti Juhani
Published: March 2018

The last years have witnessed important technological advances in cardiac radionuclide imaging driving research and clinical use and highlighting the potential of the technique for future applications. Among many fields under development, hardware design for dedicated small-footprint cardiac single-photon emission computed tomography (SPECT) scanners has made a huge leap forward. Particularly, the introduction of novel solid-state detector material (cadmium–zinc–telluride alloys) has improved detector sensitivity, reduced signal loss, enhanced spatial and energy resolution, and has opened avenues for novel ultrafast or low-dose imaging protocols. Positron emission tomography (PET) offers some advantages over SPECT with regard to spatial resolution and attenuation correction. Additionally, it allows the calculation of myocardial blood flow in tissue (in mL/min/g), which has emerged as a powerful marker of cardiovascular risk with incremental predictive value over traditional risk markers, perfusion variables, and ejection fraction. Moreover, hybrid PET/CT imaging allows a comprehensive assessment of coronary artery disease by a combination of anatomo-functional information. Recently, PET/magnetic resonance imaging has entered the clinical arena with the first fully integrated scanners now being commercially available. However, the clinical value of this promising technology has yet to be explored. Finally, the use of radionuclide imaging for molecular imaging allows ultraprecise targeting of culprit cells or molecules underlying pathophysiological processes of disease and, in the future, may possibly facilitate targeted delivery of bioengineered therapeutic nanoparticles.
Optical coherence tomography
Authors: Prati Francesco , Gatto Laura , Romagnoli Enrico , Vito Luca Di
Published: March 2018

Frequency domain optical coherence tomography (FD-OCT) uses infrared light waves, providing intracoronary images at a high resolution and enabling the characterization of the structure and extent of coronary artery disease in unprecedented detail. OCT can study plaque components such as fibrous tissue, calcium, and lipids with high accuracy. Furthermore, the technique is potentially able to depict inflammatory cells, crystals of cholesterol, and intimal vasculature, and can clarify the mechanism of acute coronary syndromes. OCT is therefore the most promising technique to study plaque vulnerability. FD-OCT, with its ability to distinguish fresh thrombus from other tissues, can also identify culprit lesions in patients with acute coronary syndromes. Some studies are encouraging the adoption of an OCT-guided approach of stent deployment, showing the superiority versus an angiography-guided strategy. The assessment of plaque composition pre-intervention is instrumental for device selection. Identification and quantification of calcium is key to decide whether to perform direct stenting or to proceed with tissue ablation in the presence of massive calcifications. Furthermore, FD-OCT can be used to size stent length and diameter. After intervention recent data established the OCT metrics to be adopted to fine-tune stenting procedures.
The implantable cardioverter defibrillator. Conclusions on sudden cardiac death and future perspective
Authors: Hindricks Gerhard , Kühl Michael , Dagres Nikolaos
Published: March 2018

This is a forthcoming chapter in ESC CardioMed. Please check back later for the full chapter.
Impact of psychological factors on outcomes
Authors: Kupper Nina , Denollet Johan
Published: March 2018

This is a forthcoming chapter in ESC CardioMed. Please check back later for the full chapter.
Introduction
Authors: Schunkert Heribert
Published: March 2018

The perception of genetic diseases of the heart and vascular system has dramatically changed over the last 10 years. Next-generation sequencing and arrays with millions of single nucleotide polymorphisms allowed significant advances in the understanding of monogenic and polygenic diseases. The chapters in ‘Genetics of cardiovascular diseases’, written by outstanding experts in the field, summarize the current knowledge and provide an overview of the clinical implications of mutations and genetic variants affecting the cardiovascular system.
Monogenic and oligogenic cardiovascular diseases: genetics of arrhythmias—long QT syndrome
Authors: Mazzanti Andrea , Maragna Riccardo , Priori Silvia G.
Published: March 2018

Long QT syndrome (LQTS) is a collective term used for a group of inherited arrhythmogenic disorders characterized by a prolonged cardiac action potential duration that predisposes affected individuals to the development of life-threatening arrhythmias, especially during phases of adrenergic activation (exercise, emotions). From the genetic standpoint, LQTS is mainly transmitted as an autosomal dominant trait, caused by point mutations in genes coding for protein channels that regulate the duration of cardiac action potentials. To date, 17 genes have been associated with LQTS, but the first three genotypes discovered (LQT1, LQT2, and LQT3) account for the majority of genotype-positive cases. LQT1 and LQT2 (75% of LQTS cases) are caused by loss-of-function mutations in genes (KCNQ1 and KCNH2) coding for potassium channels (IKs and IKr) involved in the repolarization phase of cardiomyocytes, while LQT3 is caused by gain-of-function mutations affecting the gene SCN5A coding for the Nav1.5 sodium channel, which is the major determinant of depolarization of cardiomyocytes. Genetic testing has a great potential for the management of patients with LQTS and may contribute to better define the diagnosis, the risk stratification, and the choice of therapy.
Monogenic and oligogenic cardiovascular diseases: genetics of arrhythmias—short QT syndrome
Authors: Tülümen Erol , Borggrefe Martin
Published: March 2018

Short QT syndrome (SQTS) is a very rare, sporadic or autosomal dominant inherited channelopathy characterized by abnormally short QT intervals on the electrocardiogram and increased propensity to atrial and ventricular tachyarrhythmias and/or sudden cardiac death. Since its recognition as a distinct clinical entity in 2000, significant progress has been made in defining the clinical, molecular, and genetic basis of SQTS. To date, several causative gain-of-function mutations in potassium channel genes and loss-of-function mutations in calcium channel genes have been identified. The physiological consequence of these mutations is an accelerated repolarization, thus abbreviated action potentials and shortened QT interval with an increased inhomogeneity and dispersion of repolarization. Regarding other rare monogenetic arrhythmias, a genetic basis of atrial fibrillation was considered very unlikely until very recently. However, in the last decade the heritability of atrial fibrillation in the general population has been well described in several epidemiological studies. So far, more than 30 genes have been implicated in atrial fibrillation through candidate gene approach studies, and 14 loci were found to be associated with atrial fibrillation through genome-wide association studies. This genetic heterogeneity and the low prevalence of mutations in any single gene restrict the clinical utility of genetic screening in atrial fibrillation.
Genetics of cardiomyopathies: left ventricular non-compaction
Authors: Arbustini Eloisa , Toro Alessandro Di , Giuliani Lorenzo , Narula Nupoor , Favalli Valentina
Published: March 2018

Left ventricular non-compaction (LVNC) describes a ventricular wall anatomy characterized by prominent left ventricular trabeculae, a thin compacted layer, and deep intertrabecular recesses. Individual variability is extreme. The trabecular configuration represents a type of individual ‘cardioprinting’. By itself, the diagnosis of LVNC does not coincide with that of a ‘cardiomyopathy’ because it can be observed in healthy subjects with normal left ventricular size and function, and it can be acquired and reversible. Rarely, LVNC is intrinsically part of a cardiomyopathy: the paradigmatic examples are infantile tafazzinopathies. The prevalence of LVNC in healthy athletes, its possible reversibility, and increasing diagnosis in healthy subjects suggests cautious use of the term ‘LVNC cardiomyopathy’, which describes the morphology, but not the morpho-functional profile of the cardiomyopathy or the associated congenital disease. Therefore, when associated with left ventricular dilation and dysfunction, hypertrophy, or congenital heart disease, the leading diagnosis is the cardiomyopathy or the congenital heart disease followed by the addition of the descriptor LVNC.
Complex cardiovascular diseases: atherosclerosis—genetic factors
Authors: Schunkert Heribert
Published: March 2018

The elucidation of genetic mechanisms affecting the risk of atherosclerosis has largely benefited from recent technological breakthroughs in terms of high-throughput sequencing and genotyping. While a decade ago only a positive family history and mutations causing familial hypercholesterolaemia were proven to confer genetic risk of atherosclerosis, by now multiple genes have been implicated in monogenic and complex forms of accelerated atherosclerosis. At the population level, the discovery of hundreds of common variants, each affecting the risk of atherosclerosis by a small margin, may have even broader implications. A substantial finding from these studies is that the risk of atherosclerosis and its clinical manifestations, such as myocardial infarction, stroke, and peripheral arterial disease, is secondary to a much broader spectrum of underlying (genetic) mechanisms than previously thought, when only the classical risk factors, such as hypertension, dyslipidaemia, diabetes mellitus, and smoking were implicated in the disease aetiology. Currently, the systems biology of the multiple interacting factors contributing to the risk of atherosclerosis as well as respective therapeutic implications, in part addressed by Mendelian randomization studies, is subject to intensive research. Likewise, genetic risk scores are scrutinized to improve the prediction of coronary artery disease in asymptomatic individuals. This chapter gives a brief overview on the current understanding of the genetic underpinnings of atherosclerosis.
Likely developments over the next 5-10 years
Authors: Pedersen Susanne
Published: March 2018

This is a forthcoming chapter in ESC CardioMed. Please check back later for the full chapter.
Prevention and drug therapy in chronic kidney disease
Authors: Segerer Stephan , Seeger Harald
Published: March 2018

Three major goals need to be addressed in the treatment of patients with chronic kidney disease: (1) progression of renal function loss needs to be inhibited by treatment of risk factors, (2) co-morbidities and vascular risk factors have to be treated, and (3) the patient must be educated about and prepared for renal replacement therapy. During the progressive loss of renal function, the treatment necessities and medication doses need to be adjusted. Therefore, the treatment of heart disease differs between patients with normal and decreased renal function.
Erectile dysfunction: definition and size of the problem
Authors: Doumas Michael , Boutari Chrysoula
Published: March 2018

Erectile dysfunction is currently considered a manifestation of vascular disease in the majority of cases. It is therefore of no surprise that erectile dysfunction is commonly found in patients with overt cardiovascular disease and/or cardiovascular risk factors. Indeed, more than 50% of patients with stable coronary artery disease or acute coronary syndromes suffer from erectile dysfunction, while the prevalence of erectile dysfunction in patients with heart failure is even higher. Likewise, erectile dysfunction is frequently encountered in patients with arterial hypertension, diabetes mellitus, obesity, and dyslipidaemia, as well as in smokers. The increased prevalence of erectile dysfunction in patients with heart disease mandates the active inquiry of this clinical entity in our patients.
Drugs
Authors: Kirby Mike , Coxon Jonny
Published: March 2018

It should not be presumed that male patients with cardiovascular disease are less sexually active than others, but they are more likely to have erectile dysfunction. It is therefore crucial to consider the impact on sexual function of medications commonly used to treat cardiovascular disease, because negative effects on erectile dysfunction can lead to problems with compliance and quality of life. Cardiovascular implications of phosphodiesterase type 5 inhibitors used to treat erectile dysfunction should be borne in mind. Effective treatment of the cardiac condition should always take priority.
Pulmonary hypertension: definitions, classification, diagnosis, and management
Authors: Dzudie Anastase , Thienemann Friedrich
Published: March 2018

Pulmonary hypertension is a devastating, progressive disease associated with increasingly debilitating symptoms and a poor prognosis due to narrowing of the pulmonary vasculature and consequential right heart failure. The epidemiological profile of pulmonary hypertension across the world is largely unknown. However, recent reports suggest that the incidence in developing countries is higher than in high-income countries due to a higher prevalence of antecedent risk factors and contributory diseases such as human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) and tuberculosis. HIV/AIDS is a global pandemic affecting approximately 37 million people. When HIV infection is diagnosed early and combination antiretroviral therapy is initiated in time, most patients experience acceptable immune recovery and can reach normal life expectancy. With the decline of HIV-related morbidity and mortality and increased life expectancy, non-HIV-related conditions and HIV-associated cardiovascular disease such as pulmonary hypertension continue to rise in this cohort. This chapter describes the burden, pathogenesis, and impact of combination antiretroviral therapy on HIV-associated pulmonary hypertension.
Development of myocardial infarction
Authors: Vranckx Pascal
Published: March 2018

Myocardial infarction is the irreversible myocardial cell death (necrosis) secondary to a prolonged lack of oxygen supply (ischaemia) caused by a complete occlusion of a major coronary in the absence of forward or collateral flow. Within the perfusion area of the occluded artery, flow deprivation and myocardial ischaemia are usually most severe subendocardially (apart from the innermost cell layers nourished from the cavity) and, at least in dogs, cell death progresses from the subendocardium to the subepicardium in a time-dependent fashion.
Treatment of ST-segment elevation acute coronary syndromes
Authors: Ibanez Borja , Halvorsen Sigrun
Published: March 2018

Over the last 50 years, the treatment of acute ST-segment elevation myocardial infarction (STEMI) has been considerably improved. The widespread implementation of reperfusion (initially pharmacological and later mechanical) resulted in a magnificent reduction in the rates of in-hospital mortality from about 25% in the 1970s to 5% in the late 2010s. Mortality in real life, however, is higher than these figures shown in clinical trials. There is compelling evidence showing the association between duration of ischaemia and mortality. This is the basis for the timely reperfusion in STEMI. All actions should be made to reduce all components of the ischaemic time. Despite these advances, STEMI survivors are still at high risk for developing repetitive events, including reinfarctions, heart failure, and sudden death. Evolving therapies beyond timely reperfusion are contributing to further reduce the morbidity associated with STEMI.
Incidence and definition of takotsubo syndrome
Authors: Prasad Abhiram
Published: March 2018

Takotsubo syndrome (TTS) is also commonly known as apical ballooning syndrome and stress cardiomyopathy. The incidence of TTS has consistently been estimated to be close to 2% of all patients presenting with an initial diagnosis of an acute coronary syndrome, and perhaps as high as about 5% of women. TTS is a diagnosis of exclusion and in the absence of a diagnostic test, there is the need for diagnostic criteria. The Mayo Clinic diagnostic criteria are the most widely cited. The Heart Failure Association of the European Society of Cardiology published the most recent criteria in 2015.