Prospective study of insulin-like growth factor-I, insulin-like growth factor-binding protein 3, genetic variants in the IGF1 and IGFBP3 genes and risk of coronary artery disease.

Although experimental studies have suggested that insulin-like growth factor I (IGF-I) and its binding protein IGFBP-3 might have a role in the aetiology of coronary artery disease (CAD), the relevance of circulating IGFs and their binding proteins in the development of CAD in human populations is unclear. We conducted a nested case-control study, with a mean follow-up of six years, within the EPIC-Norfolk cohort to assess the association between circulating levels of IGF-I and IGFBP-3 and risk of CAD in up to 1,013 cases and 2,055 controls matched for age, sex and study enrolment date. After adjustment for cardiovascular risk factors, we found no association between circulating levels of IGF-I or IGFBP-3 and risk of CAD (odds ratio: 0.98 (95% Cl 0.90-1.06) per 1 SD increase in circulating IGF-I; odds ratio: 1.02 (95% Cl 0.94-1.12) for IGFBP-3). We examined associations between tagging single nucleotide polymorphisms (tSNPs) at the IGF1 and IGFBP3 loci and circulating IGF-I and IGFBP-3 levels in up to 1,133 cases and 2,223 controls and identified three tSNPs (rs1520220, rs3730204, rs2132571) that showed independent association with either circulating IGF-I or IGFBP-3 levels. In an assessment of 31 SNPs spanning the IGF1 or IGFBP3 loci, none were associated with risk of CAD in a meta-analysis that included EPIC-Norfolk and eight additional studies comprising up to 9,319 cases and 19,964 controls. Our results indicate that IGF-I and IGFBP-3 are unlikely to be importantly involved in the aetiology of CAD in human populations.

Pharmacogenetics of Antiviral Treatment

RESUME - FRANÇAISRésuméDans ce travail de thèse, l'importance de la pharmacogénétique des traitements antiviraux a été évaluée en déterminant, au moyen de trois différentes approches, l'impact de variations génétiques sur la pharmacocinétique de deux traitements antirétroviraux (à savoir l'efavirenz et le lopinavir) ainsi que sur la capacité de pouvoir éliminer le virus de l'hépatite C de façon naturelle ou suite à un traitement médicamenteux.L'influence des variations génétiques sur les taux plasmatiques de l'efavirenz et de ses métabolites primaires a été évaluée par l'analyse d'un seul gène candidat : le cytochrome P450 (CYP) 2A6, impliqué dans une voie métabolique accessoire de l'efavirenz. Cette étude a permis de démontrer que le génotype du CYP2A6 devient cliniquement déterminant en l'absence de fonction du CYP2B6, impliqué dans la voie métabolique principale, et que la perte simultanée des voies métaboliques principales et accessoires entraine une augmen¬tation du risque d'interruption du traitement, soulignant la valeur prédictive du génotypage.L'influence de la génétique sur la clairance du lopinavir a été évaluée par l'analyse à grande échelle de gènes candidats, à savoir les gènes potentiellement impliqués dans l'absorption, le métabolisme, la distribution et l'élimination d'un médicament. Cette étude a permis l'identification de 4 polymorphismes, dans des transporteurs et des enzymes métaboliques, associés à la clairance du lopinavir et expliquant 5% de la variabilité inter¬individuelle de ce phénotype.L'influence de la génétique sur la capacité d'éliminer le virus de l'hépatite C, de façon naturelle ou à la suite d'un traitement, a été évaluée par l'analyse du génome entier. Cette étude a permis l'identification d'un polymorphisme situé à proximité de l'interféron-X3. Quatre variations génétiques potentiellement causales ont ensuite pu être identifiées par reséquencage. Finalement, la contribution nette de ce gène sur l'élimination du virus a pu être évaluée dans une cohorte infectée par une seule et même source, permettant ainsi de contrôler l'effet de la diversité virale, du genre et de la présence de co-infections.Cette thèse a permis de mettre en évidence les diverses méthodes disponibles pour la recherche en pharmacogénétique, ainsi que l'importance du reséquencage pour l'identification de variations génétiques causales.SUMMARY - ENGLISHSummaryIn this thesis work the relevance of pharmacogenetics of antiviral treatment has been assessed by investigating, through three different approaches, the impact of host genetic variation on antiretroviral drug disposition (namely efavirenz and lopinavir) and on natural or treatment-induced clearance of hepatitis C virus.The influence of host genetic variation on efavirenz and its primary metabolite plasma levels was assessed by single candidate gene approach, through comprehensive analysis of cytochrome P450 (CYP) 2A6 - involved in efavirenz accessory metabolic pathway. The study could demonstrate that CYP2A6 genotype became increasingly relevant in the setting of limited CYP2B6 function - involved in efavirenz main metabolic pathway - and that individuals with both main and accessory metabolic pathways impaired were at higher risk for treatment discontinuation, overall emphasizing the predictive power of genotyping.The influence of host genetic variation on lopinavir clearance was assessed by large scale candidate gene approach, through analysis of genes involved in the absorption, distribution, metabolism and elimination. The study identified four genetic variants in drug transporters and metabolizing enzymes that explained 5% of the interindividual variability in lopinavir clearance.The influence of host genetic variation on hepatitis C virus (HCV) natural or treatment- induced clearance was assessed through genome-wide association study approach. This study identified an intergenic polymorphism, part of a linkage disequilibrium block encompassing the interferon-3 gene, as highly associated with treatment-induced and spontaneous HCV clearance. Resequencing and recombinant mapping lead to the identification of four potentially causal genetic variants. Finally, we could assess the net contribution of genetic variants in interferon-3 to clearance by controlling for viral diversity, gender and co-infection status in a single source infected cohort.This thesis highlights the various genetic tools available to pharmacogenetic discovery (candidate gene, pathway or and genome-wide approaches), and the importance of resequencing for mapping of causal variants.

The epithelial sodium channel and the control of sodium balance.

Studies aiming at the elucidation of the genetic basis of rare monogenic forms of hypertension have identified mutations in genes coding for the epithelial sodium channel ENaC, for the mineralocorticoid receptor, or for enzymes crucial for the synthesis of aldosterone. These genetic studies clearly demonstrate the importance of the regulation of Na(+) absorption in the aldosterone-sensitive distal nephron (ASDN), for the maintenance of the extracellular fluid volume and blood pressure. Recent studies aiming at a better understanding of the cellular and molecular basis of ENaC-mediated Na(+) absorption in the distal part of nephron, have essentially focused on the regulation ENaC activity and on the aldosterone-signaling cascade. ENaC is a constitutively open channel, and factors controlling the number of active channels at the cell surface are likely to have profound effects on Na(+) absorption in the ASDN, and in the amount of Na(+) that is excreted in the final urine. A number of membrane-bound proteases, kinases, have recently been identified that increase ENaC activity at the cell surface in heterologous expressions systems. Ubiquitylation is a general process that regulates the stability of a variety of target proteins that include ENaC. Recently, deubiquitylating enzymes have been shown to increase ENaC activity in heterologous expressions systems. These regulatory mechanisms are likely to be nephron specific, since in vivo studies indicate that the adaptation of the renal excretion of Na(+) in response to Na(+) diet occurs predominantly in the early part (the connecting tubule) of the ASDN. An important work is presently done to determine in vivo the physiological relevance of these cellular and molecular mechanisms in regulation of ENaC activity. The contribution of the protease-dependent ENaC regulation in mediating Na(+) absorption in the ASDN is still not clearly understood. The signaling pathway that involves ubiquitylation of ENaC does not seem to be absolutely required for the aldosterone-mediated control of ENaC. These in vivo physiological studies presently constitute a major challenge for our understanding of the regulation of ENaC to maintain the Na(+) balance.

Network governance and the domestic adoption of soft rules

European regulatory networks (ERNs) are in charge of producing and disseminating non-bindings standards, guidelines and recommendations in a number of important domains, such as banking and finance, electricity and gas, telecommunications, and competition regulation. The goal of these soft rules is to promote 'best practices', achieve co-ordination among regulatory authorities and ensure the consistent application of harmonized pro-competition rules across Europe. This contribution examines the domestic adoption of the soft rules developed within the four main ERNs. Different factors are expected to influence the process of domestic adoption: the resources of regulators; the existence of a review panel; and the interdependence of the issues at stake. The empirical analysis supports hypotheses about the relevance of network-level factors: monitoring and public reporting procedures increase the final level of adoption, while soft rules concerning highly interdependent policy areas are adopted earlier.

An Assessment ofFatigue Strength of Load Carrying Welded Joints with Lack of Penetration

On yleisesti tiedossa, että väsyttävän kuormituksen alaisena olevat hitsatut rakenteet rikkoutuvat juuri hitsausliitoksista. Täyden tunkeuman hitsausliitoksia sisältävien rakenteiden asiantunteva suunnittelu janykyaikaiset valmistusmenetelmät ovat lähes eliminoineet väsymisvauriot hitsatuissa rakenteissa. Väsymislujuuden parantaminen tiukalla täyden tunkeuman vaatimuksella on kuitenkin epätaloudellinen ratkaisu. Täyden tunkeuman hitsausliitoksille asetettavien laatuvaatimuksien on määriteltävä selkeät tarkastusohjeet ja hylkäämisperusteet. Tämän diplomityön tarkoituksena oli tutkia geometristen muuttujien vaikutusta kuormaa kantavien hitsausliitosten väsymislujuuteen. Huomio kiinnitettiin pääasiassa suunnittelumuuttujiin, joilla on vaikutusta väsymisvaurioiden syntymiseen hitsauksen juuren puolella. Nykyiset määräykset ja standardit, jotka perustuvat kokeellisiin tuloksiin; antavat melko yleisiä ohjeita hitsausliitosten väsymismitoituksesta. Tämän vuoksi muodostettiin kokonaan uudet parametriset yhtälöt sallitun nimellisen jännityksen kynnysarvon vaihteluvälin, ¿¿th, laskemiseksi, jotta vältettäisiin hitsausliitosten juuren puoleiset väsymisvauriot. Lisäksi, jokaiselle liitostyypille laskettiin hitsin juuren puolen väsymisluokat (FAT), joita verrattiin olemassa olevilla mitoitusohjeilla saavutettuihin tuloksiin. Täydentäviksi referensseiksi suoritettiin useita kolmiulotteisia (3D) analyysejä. Julkaistuja kokeellisiin tuloksiin perustuvia tietoja käytettiin apuna hitsausliitosten väsymiskäyttäytymisen ymmärtämiseksi ja materiaalivakioiden määrittämiseksi. Kuormaa kantavien vajaatunkeumaisten hitsausliitosten väsymislujuus määritettiin käyttämällä elementtimenetelmää. Suurimman pääjännityksen kriteeriä hyödynnettiin murtumiskäyttäytymisen ennakoimiseksi. Valitulle hitsatulle materiaalille ja koeolosuhteille murtumiskäyttäytymistä mallinnettiin särön kasvunopeudella da/dN ja jännitysintensiteettikertoimen vaihteluvälillä, 'K. Paris:n yhtälön numeerinen integrointi suoritettiin FRANC2D/L tietokoneohjelmalla. Saatujen tulosten perusteella voidaan laskea FAT tutkittavassa tapauksessa. ¿¿th laskettiin alkusärön jännitysintensiteettikertoimen vaihteluvälin ja kynnysjännitysintensiteettikertoimen, 'Kth, perusteella. ¿Kth arvoa pienemmällä vaihteluvälillä särö ei kasva. Analyyseissäoletuksena oli hitsattu jälkikäsittelemätön liitos, jossa oli valmis alkusärö hitsin juuressa. Analyysien tulokset ovat hyödyllisiä suunnittelijoille, jotka tekevät päätöksiä koskien geometrisiä parametreja, joilla on vaikutusta hitsausliitosten väsymislujuuteen.

The analysis of ecstasy tablets in a forensic drug intelligence perspective

The use by police services and inquiring agencies of forensic data in an intelligence perspective is still fragmentary and to some extent ignored. In order to increase the efficiency of criminal investigation to target illegal drug trafficking organisations and to provide valuable information about their methods, it is necessary to include and interpret objective drug analysis results already during the investigation phase. The value of visual, physical and chemical data of seized ecstasy tablets, as a support for criminal investigation on a strategic and tactical level has been investigated. In a first phase different characteristics of ecstasy tablets have been studied in order to define their relevance, variation, correlation and discriminating power in an intelligence perspective. During 5 years, over 1200 cases of ecstasy seizures (concerning about 150000 seized tablets) coming from different regions of Switzerland (City and Canton of Zurich, Cantons Ticino, Neuchâtel and Geneva) have been systematically recorded. This turned out to be a statistically representative database including large and small cases. During the second phase various comparison and clustering methods have been tested and evaluated, on the type and relevance of tablet characteristics, thus increasing knowledge about synthetic drugs, their manufacturing and trafficking. Finally analytical methodologies have been investigated and formalised, applying traditional intelligence methods. In this context classical tools, which are used in criminal analysis (like the I2 Analyst Notebook, I2 Ibase, ?) have been tested and adapted to address the specific need of forensic drug intelligence. The interpretation of these links provides valuable information about criminal organisations and their trafficking methods. In the final part of this thesis practical examples illustrate the use and value of such information.

Validation study of the Spanish Version of the Work-Family Conflict Questionnaire (CCTF)

In this study, a brief Work-Family Conflict (WFC) Questionnaire in the Spanish language is proposed that takes into account the two directions commonly reported in the literature: work interference with family (WIF), and family interference with work (FIW). The results obtained through exploratory factor analyses (EFA) and confirmatory factor analyses (CFA) with two independent samples, carried out for women and men, showed acceptable validity and reliability. A copy of the instrument in Spanish language is provided, together with the Amos 4 syntax to perform the factor invariance analysis for women and men. The suggested Work-Family Conflict Questionnaire (in Spanish, abbreviated as CCTF) may be useful in studies performed in the work setting, considering the special relevance of the concept in this line of research.

Indications for cardiovascular magnetic resonance in children with congenital and acquired heart disease: an expert consensus paper of the Imaging Working Group of the AEPC and the Cardiovascular Magnetic Resonance Section of the EACVI.

This article provides expert opinion on the use of cardiovascular magnetic resonance (CMR) in young patients with congenital heart disease (CHD) and in specific clinical situations. As peculiar challenges apply to imaging children, paediatric aspects are repeatedly discussed. The first section of the paper addresses settings and techniques, including the basic sequences used in paediatric CMR, safety, and sedation. In the second section, the indication, application, and clinical relevance of CMR in the most frequent CHD are discussed in detail. In the current era of multimodality imaging, the strengths of CMR are compared with other imaging modalities. At the end of each chapter, a brief summary with expert consensus key points is provided. The recommendations provided are strongly clinically oriented. The paper addresses not only imagers performing CMR, but also clinical cardiologists who want to know which information can be obtained by CMR and how to integrate it in clinical decision-making.

The evolution of alternative splicing patterns and regulatory mechanisms

Alternative splicing produces multiple isoforms from the same gene, thus increasing the number of transcripts of the species. Alternative splicing is a virtually ubiquitous mechanism in eukaryotes, for example more than 90% of protein-coding genes in human are alternatively spliced. Recent evolutionary studies showed that alternative splicing is a fast evolving and highly species- specific mechanism. The rapid evolution of alternative splicing was considered as a contribution to the phenotypic diversity between species. However, the function of many isoforms produced by alternative splicing remains unclear and they might be the result of noisy splicing. Thus, the functional relevance of alternative splicing and the evolutionary mechanisms of its rapid divergence among species are still poorly understood. During my thesis, I performed a large-scale analysis of the regulatory mechanisms that drive the rapid evolution of alternative splicing. To study the evolution of alternative splicing regulatory mechanisms, I used an extensive RNA-sequencing dataset comprising 12 tetrapod species (human, chimpanzee and bonobo, gorilla, orangutan, macaque, marmoset, mouse, opossum, platypus, chicken and frog) and 8 tissues (cerebellum, brain, heart, kidney, liver, testis, placenta and ovary). To identify the catalogue of alternative splicing eis-acting regulatory elements in the different tetrapod species, I used a previously defined computational approach. This approach is a statistical analysis of exons/introns and splice sites composition and relies on a principle of compensation between splice sites strength and the presence of additional regulators. With an evolutionary comparative analysis of the exonic eis-acting regulators, I showed that these regulatory elements are generally shared among primates and more conserved than non-regulatory elements. In addition, I showed that the usage of these regulatory elements is also more conserved than expected by chance. In addition to the identification of species- specific eis-acting regulators, these results may explain the rapid evolution of alternative splicing. I also developed a new approach based on evolutionary sequence changes and corresponding alternative splicing changes to identify potential splicing eis-acting regulators in primates. The identification of lineage-specific substitutions and corresponding lineage-specific alternative splicing changes, allowed me to annotate the genomic sequences that might have played a role in the alternative splicing pattern differences among primates. Finally, I showed that the identified splicing eis-acting regulator datasets are enriched in human disease-causing mutations, thus confirming their biological relevance.

Recruitment of Matrix Metalloproteinase-9 (MMP-9) to the Fibroblast Cell Surface by Lysyl Hydroxylase 3 (LH3) Triggers Transforming Growth Factor-β (TGF-β) Activation and Fibroblast Differentiation.

Solid tumor growth triggers a wound healing response. Similar to wound healing, fibroblasts in the tumor stroma differentiate into myofibroblasts (also referred to as cancer-associated fibroblasts) primarily, but not exclusively, in response to transforming growth factor-β (TGF-β). Myofibroblasts in turn enhance tumor progression by remodeling the stroma. Among proteases implicated in stroma remodeling, matrix metalloproteinases (MMPs), including MMP-9, play a prominent role. Recent evidence indicates that MMP-9 recruitment to the tumor cell surface enhances tumor growth and invasion. In the present work, we addressed the potential relevance of MMP-9 recruitment to and activity at the surface of fibroblasts. We show that recruitment of MMP-9 to the fibroblast cell surface occurs through its fibronectin-like (FN) domain and that the molecule responsible for the recruitment is lysyl hydroxylase 3 (LH3). Functional assays suggest that both pro- and active MMP-9 trigger α-smooth muscle actin expression in cultured fibroblasts, reflecting myofibroblast differentiation, possibly as a result of TGF-β activation. Moreover, the recombinant FN domain inhibited both MMP-9-induced TGF-β activation and α-smooth muscle actin expression by displacing MMP-9 from the fibroblast cell surface. Together our results uncover LH3 as a new docking receptor of MMP-9 on the fibroblast cell surface and demonstrate that the MMP-9 FN domain is essential for the interaction. They also show that the recombinant FN domain inhibits MMP-9-induced TGF-β activation and fibroblast differentiation, providing a potentially attractive therapeutic reagent toward attenuating tumor progression where MMP-9 activity is strongly implicated.

Disruption of embryonic blood-CSF barrier in chick embryos reveals the actual importance of this barrier to control E-CSF composition and homeostasis in early brain development

In vertebrates, early brain development takes place at the expanded anterior end of the neural tube. After closure of the anterior neuropore, the brain wall forms a physiologically sealed cavity that encloses embryonic cerebrospinal fluid (E-CSF), a complex and protein-rich fluid that is initially composed of trapped amniotic fluid. E-CSF has several crucial roles in brain anlagen development. Recently, we reported the presence of transient blood-CSF barrier located in the brain stem lateral to the ventral midline, at the mesencephalon and prosencephalon level, in chick and rat embryos by transporting proteins, water, ions and glucose in a selective manner via transcellular routes. To test the actual relevance of the control of E-CSF composition and homeostasis on early brain development by this embryonic blood-CSF barrier, we block the activity of this barrier by treating the embryos with 6-aminonicotinamide gliotoxin (6-AN). We demonstrate that 6-AN treatment in chick embryos blocks protein transport across the embryonic blood-CSF barrier, and that the disruption of the barrier properties is due to the cease transcellular caveolae transport, as detected by CAV-1 expression cease. We also show that the lack of protein transport across the embryonic blood-CSF barrier influences neuroepithelial cell survival, proliferation and neurogenesis, as monitored by neurepithelial progenitor cells survival, proliferation and neurogenesis. The blockage of embryonic blood-CSF transport also disrupts water influx to the E-CSF, as revealed by an abnormal increase in brain anlagen volume. These experiments contribute to delineate the actual extent of this blood-CSF embryonic barrier controlling E-CSF composition and homeostasis and the actual important of this control for early brain development, as well as to elucidate the mechanism by which proteins and water are transported thought transcellular routes across the neuroectoderm, reinforcing the crucial role of E-CSF for brain development.

Environmental Structural Decomposition Analysis of Italian Emissions, 1995-2005

[spa] El estudio analiza la evolución de los gases de efecto invernadero (GEI) y las emisiones de acidificación para Italia durante el periodo 1995-2005. Los datos muestran que mientras las emisiones que contribuyen a la acidificación han disminuido constantemente, las emisiones de GEI han aumentado debido al aumento de dióxido de carbono. El objetivo de este estudio es poner de relieve cómo diferentes factores económicos, en particular el crecimiento económico, el desarrollo de una tecnología menos contaminante y la estructura del consumo, han impulsado la evolución de las emisiones. La metodología propuesta es un análisis de descomposición estructural (ADE), método que permite descomponer los cambios de la variable de interés entre las diferentes fuerzas y revelar la importancia de cada factor. Por otra parte, este estudio considera la importancia del comercio internacional e intenta incluir el “problema de la responsabilidad”. Es decir, a través de las relaciones comerciales internacionales, un país podría estar exportando procesos de producción contaminantes sin una reducción real de la contaminación implícita en su patrón de consumo. Con este fin, siguiendo primero un enfoque basado en la “responsabilidad del productor”, el ADE se aplica a las emisiones causadas por la producción nacional. Sucesivamente, el análisis se mueve hacia un enfoque basado en la “responsabilidad del consumidor" y la descomposición se aplica a las emisiones relacionadas con la producción nacional o la producción extranjera que satisface la demanda interna. De esta manera, el ejercicio permite una primera comprobación de la importancia del comercio internacional y pone de relieve algunos resultados a nivel global y a nivel sectorial.

Environmental Structural Decomposition Analysis of Italian Emissions, 1995-2005

[spa] El estudio analiza la evolución de los gases de efecto invernadero (GEI) y las emisiones de acidificación para Italia durante el periodo 1995-2005. Los datos muestran que mientras las emisiones que contribuyen a la acidificación han disminuido constantemente, las emisiones de GEI han aumentado debido al aumento de dióxido de carbono. El objetivo de este estudio es poner de relieve cómo diferentes factores económicos, en particular el crecimiento económico, el desarrollo de una tecnología menos contaminante y la estructura del consumo, han impulsado la evolución de las emisiones. La metodología propuesta es un análisis de descomposición estructural (ADE), método que permite descomponer los cambios de la variable de interés entre las diferentes fuerzas y revelar la importancia de cada factor. Por otra parte, este estudio considera la importancia del comercio internacional e intenta incluir el “problema de la responsabilidad”. Es decir, a través de las relaciones comerciales internacionales, un país podría estar exportando procesos de producción contaminantes sin una reducción real de la contaminación implícita en su patrón de consumo. Con este fin, siguiendo primero un enfoque basado en la “responsabilidad del productor”, el ADE se aplica a las emisiones causadas por la producción nacional. Sucesivamente, el análisis se mueve hacia un enfoque basado en la “responsabilidad del consumidor" y la descomposición se aplica a las emisiones relacionadas con la producción nacional o la producción extranjera que satisface la demanda interna. De esta manera, el ejercicio permite una primera comprobación de la importancia del comercio internacional y pone de relieve algunos resultados a nivel global y a nivel sectorial.

Nanoparticle conjugation enhances the immunomodulatory effects of intranasally delivered CpG in house dust mite-allergic mice.

An emerging strategy in preventing and treating airway allergy consists of modulating the immune response induced against allergens in the lungs. CpG oligodeoxynucleotides have been investigated in airway allergy studies, but even if promising, efficacy requires further substantiation. We investigated the effect of pulmonary delivery of nanoparticle (NP)-conjugated CpG on lung immunity and found that NP-CpG led to enhanced recruitment of activated dendritic cells and to Th1 immunity compared to free CpG. We then evaluated if pulmonary delivery of NP-CpG could prevent and treat house dust mite-induced allergy by modulating immunity directly in lungs. When CpG was administered as immunomodulatory therapy prior to allergen sensitization, we found that NP-CpG significantly reduced eosinophilia, IgE levels, mucus production and Th2 cytokines, while free CpG had only a moderate effect on these parameters. In a therapeutic setting where CpG was administered after allergen sensitization, we found that although both free CpG and NP-CpG reduced eosinophilia and IgE levels to the same extent, NP conjugation of CpG significantly enhanced reduction of Th2 cytokines in lungs of allergic mice. Taken together, these data highlight benefits of NP conjugation and the relevance of NP-CpG as allergen-free therapy to modulate lung immunity and treat airway allergy.

Indications for cardiovascular magnetic resonance in children with congenital and acquired heart disease: an expert consensus paper of the Imaging Working Group of the AEPC and the Cardiovascular Magnetic Resonance Section of the EACVI.

This article provides expert opinion on the use of cardiovascular magnetic resonance (CMR) in young patients with congenital heart disease (CHD) and in specific clinical situations. As peculiar challenges apply to imaging children, paediatric aspects are repeatedly discussed. The first section of the paper addresses settings and techniques, including the basic sequences used in paediatric CMR, safety, and sedation. In the second section, the indication, application, and clinical relevance of CMR in the most frequent CHD are discussed in detail. In the current era of multimodality imaging, the strengths of CMR are compared with other imaging modalities. At the end of each chapter, a brief summary with expert consensus key points is provided. The recommendations provided are strongly clinically oriented. The paper addresses not only imagers performing CMR, but also clinical cardiologists who want to know which information can be obtained by CMR and how to integrate it in clinical decision-making.