Search

Little is known about the efficacy and safety of rivaroxaban in patients with atrial fibrillation (AF) who underwent percutaneous coronary intervention (PCI) in clinical practice. We therefore conducted a prospective observational study to determine the rate of ischemic, embolic, and bleeding events in patients with AF and PCI treated with rivaroxaban in a real-world experience. The RIVA-PCI ("rivaroxaban in patients with AF who underwent PCI") (clinicaltrials.gov NCT03315650) is a prospective, noninterventional, multicenter study with a follow-up until 14 months, including patients with AF who underwent PCI discharged with rivaroxaban. Between January 2018 and March 2020, 700 patients with PCI treated with rivaroxaban (elective in 50.1%, non-ST-elevation acute coronary syndrome 43.0%, ST-elevation myocardial infarction in 6.9%) were enrolled at 51 German hospitals. After PCI, a dual antithrombotic therapy consisting of rivaroxaban and a P2Y12 inhibitor was administered in 70.7% and triple antithrombotic therapy in 27.9%, respectively. Follow-up information could be obtained in 695 patients (99.3%). Rivaroxaban has been stopped prematurely in 21.6% of patients. Clinical events under rivaroxaban during the 14-month follow-up compared with those observed in the PIONEER-AF PCI trial included cardiovascular death (2.0% % vs 2.0%), myocardial infarction (0.9% vs 3.0%), stent thrombosis (0.2% vs 0.8%), stroke (1.3% vs 1.3%), International Society on Thrombosis and Haemostasis major (4.2% vs 3.9%), and International Society on Thrombosis and Haemostasis nonmajor clinically relevant bleeding (15.3% vs 12.9%). Therefore, in this real-world experience, rivaroxaban in patients with AF who underwent PCI is associated with ischemic and bleeding event rates comparable with those observed in the randomized PIONEER-AF PCI trial.

Notwithstanding a decrease in the incidence and mortality of cardiovascular diseases during the last decades, notable disparities in health outcomes depending on a patient´s socioeconomic position persist and are most visible in acute myocardial infarction and ischemic heart disease. Education is a pivotal indicator of the socioeconomic position. Effects of the social determinants of health on the incidence, prevalence and mortality of cardiovascular diseases were previously effectually investigated and shown to be inversely associated but evidence on non-fatal health outcomes such as heart failure, ability to return to work or rehospitalizations still remain insufficiently examined. We provide a literature review dealing with the impact that formal education has on non-fatal health outcomes including major adverse cardiovascular events, clinical outcomes, depression, use of cardiac rehabilitation, quality of life, self-perceived health and social participation after a myocardial infarction from a global and comprehensive perspective.

The serine–threonine phosphatase calcineurin is activated in cardiac myocytes in the diseased heart and induces pathological hypertrophy. Calcineurin activity is mainly triggered by calcium/calmodulin binding but also through calpain mediated cleavage. How controlled calcineurin activation is possible in cardiac myocytes, which typically show a 10-fold difference in cytosolic calcium concentration with every heartbeat, has remained enigmatic. It is now emerging that calcineurin activation and signaling occur in subcellular microdomains, in which it is brought together with target proteins and exceedingly high concentrations of calcium in order to induce downstream signaling. We review current evidence of subcellular calcineurin mainly at the sarcolemma and the nucleus, but also in association with the sarcoplasmic reticulum and mitochondria. We also suggest that knowledge about subcellular signaling could help to develop inhibitors of calcineurin in specific microdomains to avoid side-effects that may arise from complete calcineurin inhibition.

Hemodynamic improvement from biventricular pacing is well documented; however, its electrophysiologic effects have not been systematically studied. In this study, incidence and risk factors for electrical storm (ES) were investigated in 729 ICD and biventricular defibrillator (CRT-D) heart failure patients.168 consecutive CRT-D and 561 ICD patients were retrospectively analyzed for the occurrence of VT/VF and predisposing factors. Electrical storm was defined as ventricular tachycardia or fibrillation ≥3 times during 24 h. Mean follow-up was 41 months.In 168 CRT-D patients only one patient experienced electrical storm compared to 39 patients out of 561 ICD patients (0.6% vs. 7%, p0.01). 33% of the patients with electrical storm died within one year. In the CRT-D group 81 patients (48%) developed VT or VF and received at least one appropriate therapy, compared to 281 patients (50%) in the ICD group. Mean ejection fraction was 21.7% in the CRT-D group and 34.7% (p0.01) in the ICD group. Stratifying the patients according to primary or secondary prevention and ejection fraction demonstrated that VT/VF clusters were significantly associated with ICD indication for secondary prevention, previous myocardial infarction and LVEF30%.The development of electrical storm is accompanied with a highly increased mortality risk even if an ICD/CRT-D is implanted. In CRT-D patients electrical storm is much less common than in ICD patients. Secondary prevention and ejection fraction30% are predictors of electrical storm. Beside hemodynamic improvements cardiac resynchronization therapy may reduce the arrhythmia burden in heart failure patients.

To balance the steady decrease of conventional hydrocarbon resources, increased utilization of unconventional and new energy resources, such as shale gas and geothermal energy, is required. Also, the geological sequestration of carbon dioxide is being considered as a technology that may temporarily mitigate the effects of CO 2 emission. Sites suitable for shale gas production, geothermal exploration, or CO 2 sequestration are commonly characterized by electrical resistivities distinctly different from those of the surrounding rocks. Therefore, electromagnetic methods can be viable tools to help identify target sites suitable for exploration, and to monitor reservoirs during energy production or CO 2 injection. Among the wide variety of electromagnetic methods available, controlled-source magnetotelluric (CSMT) may be particularly suitable because of (i) its ability to resolve both electrically resistive and conductive structures, (ii) controlled sources offering noise control and thus facilitating surveys in populated regions, and (iii) the potential of penetration throughout the depth range accessible by drilling. Nevertheless, CSMT has not yet been widely employed because of logistical challenges of field operations and the requirement of complex and highly computer-intensive data processing. With these difficulties gradually being mitigated by recent technological developments, CSMT may now be reconsidered as an exploration tool. Here, we investigate by 1D and 3D numerical simulations the feasibility of detecting gas shales and identifying sites eligible for geothermal exploration or CO 2 sequestration from CSMT data. We consider surface-to-surface, borehole-to-surface, and cross-hole configurations of the sources and receivers. Results and conclusions on the detectability of the targets of interest are presented for various exploration and monitoring scenarios, which are roughly representative of the geological setting of the North German Basin.

Magnetotelluric (MT) observations at some sites in the vicinity of the Waterberg Fault/Omaruru Lineament (WF/OL), a major tectono-stratigraphic zone boundary in the Central Zone of the Damara Belt, show evidence for strong three-dimensional (3D) effects. We observe very high skew values, phases over 90°, and a strong correlation of parallel components of the electric and magnetic fields at long periods. Because of the dense site spacing and good spatial coverage, we can positively attribute these effects to local geology and are able to resolve structural detail within the WF/OL. Mapping LaTorraca’s electric characteristic vectors in form of ellipses proved particularly useful in identifying key elements of the conductivity structure for subsequent modelling. 3D and 2D anisotropic modelling can reproduce most of the observed 3D effects. The conductivity anomalies revealed in the area are: (i) a conductive ring structure in the shallow crust along the northern part of the profile; (ii) an anisotropic region in the upper crust with high conductivity parallel to the WF/OL; (iii) anisotropy in the lower crust with a different but undetermined strike direction; and (iv) a shallow elongated conductor sub-normal to the WF/OL. Modelling studies further suggest that the (anisotropic) fault zone is approximately 10 km wide and may reach down to a depth of 14 km or more.

The Namibian margin is dominated by the late Proterozoic to early Cambrian fold belts of the Damara Orogen, which wrap around and separate the Congo and Kalahari Cratons. This mosaic of relatively ‘soft’ fold belts and ‘hard’ cratons apparently controlled the path for the opening of the South Atlantic in the early Cretaceous. The continents split along the coast-parallel fold belts of the Damara Orogen while the inland fold belt (Damara Belt) was effected by extension and widespread igneous intrusion but never developed to the rift stage. This paper is concerned with the interpretation of magnetotelluric (MT) data along a 200 km NW–SE profile across the Damara Belt in NW Namibia. The regional, two-dimensional electrical resistivity model and the induction vector data exhibit three distinctive zones: (i) a generally very resistive upper crust which is typical for the granites and metasediments of the Damara Belt, (ii) two subvertical conductors in upper to mid-crustal levels which correlate with major tectonic zone boundaries and (iii) a highly conductive middle to lower crust in the southern part of the profile. The geometry of the conductive structures could reflect a regional shear system in which upper crustal listric faults pass into a detachment zone in the middle crust. We interpret the high electrical conductivity in terms of graphite (or other forms of mineralization) enrichment along the shear planes. This zone of crustal weakness may have originated in Pre-Damara times and had probably experienced several episodes of crustal reactivation before the intrusion of basaltic dike swarms during the Cretaceous rifting and magmatism associated with the opening of the South Atlantic.

From the *Department of Internal Medicine I – Cardiology, University Hospital Wurzburg, Wurzburg, Germany; Comprehensive Heart Failure Center, University Hospital Wurzburg, Wurzburg, Germany; Department of Experimental hysics V, University of Wurzburg, Wurzburg, Germany; Institute of Medical Physics, University Erlangen-Nurnberg, Erlangen, Germany; Erwin L. Hahn Institute for Magnetic Resonance Imaging, University Duisburg-Essen, Essen, Germany.

Audiomagnetotelluric and magnetotelluric measurements have been performed on the island of Milos. Importance was attached to robust processing techniques and to the distortion problem at longer periods. The geothermal anomaly displays extremely low resistivities (0.2 ohm.m) at 10 Hz, which corresponds to the upper 200 m. The central anomaly is still seen at periods around 1000 s. The joint mapping of apparent resistivity P ∗ by all groups participating in the experiment indicates the detailed outlines of the anomaly.