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BACKGROUND: Microvascular ischemia is one of the hallmarks of hypertrophic cardiomyopathy (HCM) and has been associated with poor outcome. However, myocardial fibrosis, seen on cardiovascular magnetic resonance (CMR) as late gadolinium enhancement (LGE), can be responsible for rest perfusion defects in up to 30% of patients with HCM, potentially leading to an overestimation of the ischemic burden. We investigated the effect of left ventricle (LV) scar on the total LV ischemic burden using novel high-resolution perfusion analysis techniques in conjunction with LGE quantification.
METHODS: 30 patients with HCM and unobstructed epicardial coronary arteries underwent CMR with Fermi constrained quantitative perfusion analysis on segmental and high-resolution data. The latter were corrected for the presence of fibrosis on a pixel-by-pixel basis.
RESULTS: High-resolution quantification proved more sensitive for the detection of microvascular ischemia in comparison to segmental analysis. Areas of LGE were associated with significant reduction of myocardial perfusion reserve (MPR) leading to an overestimation of the total ischemic burden on non-corrected perfusion maps. Using a threshold MPR of 1.5, the presence of LGE caused an overestimation of the ischemic burden of 28%. The ischemic burden was more severe in patients with fibrosis, also after correction of the perfusion maps, in keeping with more severe disease in this subgroup.
CONCLUSIONS: LGE is an important confounder in the assessment of the ischemic burden in patients with HCM. High-resolution quantitative analysis with LGE correction enables the independent evaluation of microvascular ischemia and fibrosis and should be used when evaluating patients with HCM.
Stifter-Gänge
(2007)
Ist 'das Ding' Stifters liebstes Substantiv, so darf 'gehen' als sein bevorzugtes Verb gelten. In der Erzählung 'Der Waldgänger' sieht sich etwa der an einem lebensweltlichen und geographischen "Scheidepunkte" innehaltende Wanderer von einer Landschaft umgeben, in der die Dinge buchstäblich ihren Gang gehen:
'Ganz oben, wo das Thal mit noch geringer Tiefe anfängt, begann auch ein winziges Wasserfädlein, neben dem Wanderer abwärts zu gehen. Es ging in dem Rinnsale neben dem Wege unhörbar und nur glizzernd vorwärts, bis es durch die Menge des durch die Höhen sickernden Wassers gestärkt vor ihm plaudernd und rauschend einher hüpfte, als wolle es ihm den Weg durch die Thalmündung hinaus zeigen [...]. Sie gingen an manchem Waldabhange, an mancher schattigen Stelle vorbei [...], sie gingen an manchen zerstreuten Häuschen, an mancher Mühle, an mancher auf einem tiefgelegenen Wiesenflecken weidenden Kuh vorüber, bis endlich nach einigen Stunden Wanderns [...] die hingebreitete große Ebene begann. Der Bach ging breit und wallend links gegen die Felder und Bäume [...]. (WG, 98f)'
Dem Gang der Dinge untersteht der Lauf der Welt. Diese Identität von Naturvorgängen und Lebensläufen immer neu, allen Irrwegen und Katastrophen, allen Sprüngen und Brüchen zum Trotz, unter Beweis stellen zu wollen, tritt Stifters Autorschaft an. Trauma und Trost seines Universums liegen beschlossen in dem fast stereotyp wiederkehrenden Satz: "Und so ging es immer fort."
Does an increase in competition increase or decrease bank stability? I exploit how the state-specific process of interstate banking deregulation lowered barriers to entry into urban banking markets and find that greater competition significantly increases bank stability. This result is robust to the inclusion of additional fixed effects and other influences, such as merger and acquisitions or diversification. Moreover, I find that greater competition reduces banks' nonperforming loans and increases bank profitability. These findings suggest that competition increases stability as it improves bank profitability and asset quality.
Returns to experience for U.S. workers have changed over the post-war period. This paper argues that a simple model goes a long way towards replicating these changes. The model features three well-known ingredients: (i) an aggregate production function with constant skill-biased technical change; (ii) cohort qualities that vary with average years of schooling; and crucially (iii) time-invariant age-efficiency profiles. The model quantitatively accounts for changes in longitudinal and cross-sectional returns to experience, as well as the differential evolution of the college wage premium for young and old workers.
We reconsider the role for human capital in accounting for cross-country income differences. Our contribution is to bring to bear new data on the pre- and post- migration labor market experiences of immigrants to the U.S. Immigrants from poor countries experience wage gains that are only 40 percent of the GDP per worker gap, which implies that “country" accounts for 40 percent of income differences, while human capital accounts for 60 percent. Our approach handles selection by comparing the wage of the same individual in two different countries. We also provide evidence on and a correction for skill transfer.