Cardiac Imaging in the Diagnosis of Coronary Artery Disease: The Value of Quantitative Imaging of Myocardial Perfusion and Deformation

Atherosclerosis is a chronic and progressive disease of the vasculature. Increasing coronary atherosclerosis can lead to obstructive coronary artery disease (CAD) or myocardial infarction. Computed tomography angiography (CTA) allows noninvasive assessment of coronary anatomy and quantitation of atherosclerotic burden. Myocardial blood flow (MBF) can be accurately measured in absolute terms (mL/g/min) by positron emission tomography (PET) with [15O] H O as a radiotracer. We studied the coronary microvascular dysfunction as a risk factor for future coronary calcification in healthy young men by measuring the coronary flow reserve (CFR) which is the ratio between resting and hyperemic MBF. Impaired vasodilator function was not linked with accelerated atherosclerosis 11 years later. Currently, there is a global interest in quantitative PET perfusion imaging. We established optimal thresholds of [15O] H O PET perfusion for diagnosis of CAD (hyperemic MBF of 2.3 mL/g/min and CFR of 2.5) in the first multicenter study of this type (Turku, Amsterdam and Uppsala). In myocardial bridging a segment of the coronary artery travels inside the myocardium and can be seen as intramural course (CTA) or systolic compression (invasive coronary angiography). Myocardial bridging is frequently linked with proximal atherosclerotic plaques. We used quantitative [15O] H O PET perfusion to evaluate the hemodynamic effects of myocardial bridging. Myocardial bridging was not associated with decreased absolute MBF or increased atherosclerotic burden. Speckle tracking allows quantitative echocardiographic imaging of myocardial deformation. Speckle tracking during dobutamine stress echocardiography was feasible and comparable to subjective wall motion analysis in the diagnosis of CAD. In addition, it correctly risk stratified patients with multivessel disease and extensive ischemia.

Emerging markets and the international financial architecture: a blueprint for reform

If emerging markets are to achieve their objective of joining the ranks of industrialized, developed countries, they must use their economic and political influence to support radical change in the international financial system. This working paper recommends John Maynard Keynes's "clearing union" as a blueprint for reform of the international financial architecture that could address emerging market grievances more effectively than current approaches. Keynes's proposal for the postwar international system sought to remedy some of the same problems currently facing emerging market economies. It was based on the idea that financial stability was predicated on a balance between imports and exports over time, with any divergence from balance providing automatic financing of the debit countries by the creditor countries via a global clearinghouse or settlement system for trade and payments on current account. This eliminated national currency payments for imports and exports; countries received credits or debits in a notional unit of account fixed to national currency. Since the unit of account could not be traded, bought, or sold, it would not be an international reserve currency. The credits with the clearinghouse could only be used to offset debits by buying imports, and if not used for this purpose they would eventually be extinguished; hence the burden of adjustment would be shared equally - credit generated by surpluses would have to be used to buy imports from the countries with debit balances. Emerging market economies could improve upon current schemes for regionally governed financial institutions by using this proposal as a template for the creation of regional clearing unions using a notional unit of account.

Recueil de costumes étrangers formé par M. de Gaignières, faisant suite aux costumes de france - Allemagne 16e siècle

Collectionneur : Gaignières, Roger de (1642-1715)

Recueil de costumes étrangers formé par M. de Gaignières, faisant suite aux costumes de france - Suisse 1572

Collectionneur : Gaignières, Roger de (1642-1715)

Recueil de costumes étrangers formé par M. de Gaignières, faisant suite aux costumes de france - Pays-Bas - 1572

Collectionneur : Gaignières, Roger de (1642-1715)

Monumens [sic] recueillis pour l'histoire de France par Mr de Gaignières - Maisons étrangères - 1ère Partie : Maison d'Anjou-Sicile. Ayant pour auteur Charles de France 7° fils de Louis VIII et frère de St Louis par son mariage avec Beatrix de Provence en 1246

Collectionneur : Gaignières, Roger de (1642-1715)

Monumens [sic] recueillis pour l'histoire de France par Mr de Gaignières - Maisons étrangères - 1ère Partie : Maison de Savoye

Collectionneur : Gaignières, Roger de (1642-1715)

Rois et Reines de France et personnes de différentes qualités dessinés d'après des monumens. T. II, Philippe-le-Hardi - Philippe-le-Bel

Collectionneur : Gaignières, Roger de (1642-1715)

Rois et Reines de France et personnes de différentes qualités dessinés sur des monumens. T. III, Louis X à Jean II

Collectionneur : Gaignières, Roger de (1642-1715)

Rois et Reines de France et personnes de différentes qualités - Dessinés sur des Monumens [sic] - Règne de Charles V - Années 1364 à 1375. T. IV

Collectionneur : Gaignières, Roger de (1642-1715)

Rois et Reines de France et Personnes de différentes qualités Dessinés d'après des Monumens [sic] - Règne de Charles VI - Années 1380 à 1419. T. V, Charles VI le bien aimé 1380 à 1422

Collectionneur : Gaignières, Roger de (1642-1715)

Rois et Reines de France et Personnes de différentes qualités Dessinés d'après des Monumens [sic]. T. VI, Règne de Charles VII - Années 1422 à 1461

Collectionneur : Gaignières, Roger de (1642-1715)

Rois et Reines de France et personnes de différentes qualités dessinés d'après des monumens [sic] : [dessin]. T. VII, Règnes de Louis XI, Charles VIII, Louis XII Années 1461 à 1525

Collectionneur : Gaignières, Roger de (1642-1715)

Rois et Reines de France et personnes de différentes qualités dessinés sur des monumens [sic] : [dessin]. T. VIII, Règnes de François Ier-Henry II Années 1514 à 1550

Collectionneur : Gaignières, Roger de (1642-1715)

Almanach // pour 30. ans // Dedié à la Reine. // Par son très humble très soumis et fidel sujet Leguin [sic] : [estampe]

Destinataire de l'envoi : Marie-Antoinette (reine de France ; 1755-1793)