Michael W. McConnell

2013 ACCF/ACR/ASE/ASNC/SCCT/SCMR appropriate utilization of cardiovascular imaging in heart failure: A joint report of the American college of radiology appropriateness criteria committee and the American college of cardiology foundation appropriate use criteria task force

Peter Alagona, MD[⁎][1] Gerard Aurigemma, MD[‡][2] Javed Butler, MD, MPH[§][3] Don Casey, MD, MPH, MBA[∥][4] Ricardo Cury, MD[#][5] Scott Flamm, MD[¶][6] Tim Gardner, MD[⁎⁎][7] Rajesh Krishnamurthy, MD[††][8] Joseph Messer, MD[⁎][1] Michael W. Rich, MD[‡‡][9] Henry

Spiral Magnetic Resonance Coronary Angiography—Direct Comparison of 1.5 Tesla vs. 3 Tesla

BACKGROUND MR coronary angiography (MRCA) has been demonstrated successfully at 3 Tesla (T). However, the advantages remain unclear. No systematic comparison of MRCA between 1.5 T and 3 T has been performed. Therefore, anatomic coverage, image quality, signal-to-noise ratio (SNR), contrast-to-noise ration (CNR), and susceptibility artifacts were compared in 23 subjects. METHODS AND RESULTS Identical real-time (RT) and high-resolution (HR) sequences were implemented on the GE 1.5 T (Signa Twinspeed) and 3.0 T (Signa VH/i) whole body systems (GE, Milwaukee, WI). Both scanners were equipped with high-performance gradient systems capable of 40 mT/m peak amplitude and 150 mT/m/ms slew rate. Real-time localization of the coronary arteries was followed by a cardiac-gated, breath-hold HR sequence. Twenty-three subjects were recruited consecutively and underwent both 3 T and 1.5 T MRCA within one week. Coronary coverage based on the number of coronary segments visualized, image quality using a grading scale, SNR, CNR, and presence of susceptibility artifacts were analyzed. A significant improvement in SNR (47%), CNR (30%), and image quality were seen in 3 T. However, a significant increase in susceptibility artifacts was also noted. CONCLUSION MRCA at 3 T significantly improves SNR, CNR, and image quality at the expense of susceptibility artifacts. Further optimization of the imaging parameters at 3 T may facilitate clinical implementation of MRCA.

Free Exercise Revisionism and the Smith Decision

For decades, the Free Exercise Clause of the First Amendment was largely uncontroversial. The great debates over the relation of religion to government in our pluralistic republic-over school prayer, aid to parochial schools, publicly sponsored religious symbols, and religiously inspired legislation-almost without exception were issues of establishment. Government support for religion, not government interference with religion, was the issue. Not that there was any shortage of free exercise cases or closely divided Supreme Court decisions. And not that there was any dearth of academic critics of the Courts doctrine.1 But free exercise doctrine in the courts was stable, the noisy pressure groups from the ACLU to the religious right were in basic agreement, and most academic commentators were content to work out the implications of the doctrine rather than to challenge it at its roots. There was, however, a peculiar quality to the consensus, which may or may not have contributed to its stability: the free exercise doctrine was more talk than substance. In its language, it was

Right Ventricular Function in Adult Patients with Eisenmenger Physiology: Insights from Quantitative Echocardiography

Background: The favorable outcomes of Eisenmenger syndrome (ES) relative to other forms of pulmonary arterial hypertension (PAH) have been partially attributed to a unique adaptation of the right ventricle (RV). However, conventional measures of RV function may not adequately express this adaptation. Methods: We studied 23 patients with ES (age 43 ± 17 years, 16 women, pulmonary artery systolic pressure [PASP] 93 ± 26 mmHg), 25 patients with PAH (age 44 ± 13 years, 17 women, PASP 92 ± 19 mmHg), and 25 subjects without known structural disease (age 45 ± 16 years, 17 women). We evaluated long‐ and short‐axis function of the RV with two‐dimensional strain and anatomical M‐mode echocardiography, respectively. Results: Long‐axis function of the RV was comparable between patients with ES and PAH although depressed relative to controls (global strain, −15.6 ± 4.7, −14.9 ± 4.3, and −22.4 ± 2.8%, respectively, P < 0.001; global RV systolic strain rate, −0.77 ± 0.26, −0.84 ± 0.24, and −1.11 ± 0.21 1/sec, respectively, P < 0.001). However, short‐axis RV function was significantly better in patients with ES versus those with PAH and preserved relative to controls (RV fractional shortening by anatomical M‐mode, median [interquartile range], 21%[14–33%], 14%[10–16%], and 26%[22–36%], respectively, P = 0.002 for ES vs. PAH, P = 0.09 for ES vs. controls). This differential was not reflected in conventional measures of RV function (fractional area change, 32 ± 10 vs. 29 ± 8% in ES and PAH, respectively, P = 0.26). Conclusion: In patients with ES, the RV is characterized by preserved short‐axis function, despite a depressed long‐axis function. Thus, conventional assessment of RV function might not be suitable for patients with ES. (Echocardiography 2010;27:937‐945)

HIGH LEFT VENTRICULAR EJECTION FRACTION IS ASSOCIATED WITH WORSE OUTCOMES IN PATIENTS WITH AND WITHOUT HEART FAILURE

Patients with low LV ejection fraction (LVEF) are known to have worse mortality compared to those with preserved LVEF. However, it is unclear if the benefit of higher LVEF extends to those with very high LVEF values. We investigated the relationship between high LVEF (≥70%) and outcomes. We

Hybrid referenceless and multi-baseline subtraction thermometry for monitoring thermal therapies in the heart

However, main field shifts due to lung and diaphragm motion can still cause large inaccuracies in multi-baseline subtraction. In contrast, referenceless thermometry methods [3-5] based on polynomial phase regression are immune to motion and susceptibility shifts. While referenceless methods can be accurate in localized regions of the heart, in general the background phase in the myocardial wall requires large polynomial orders to fit, leading to increased danger that the hot spot itself will be fit by the polynomial and thermal dose will be underestimated.

Establishment and Toleration in Edmund Burke's "Constitution of Freedom"

The most memorable voices in American Founding-era debates over relations between church and state were raised in support of disestablishment a d full and equal freedom of conscience. Statesmen such as James Madison and Thomas Jefferson, as well as evangelical leaders uch as John Leland and Isaac Backus, made arguments against establishment and in favor of full and equal rights of religious conscience in terms of enduring principles of civil and religious liberty. Their words continue to inspire and guide our consideration of these weighty and contentious questions. There were, of course, other voices. Some patriotic and revered leaders, such as George Washington and Patrick Henry, thought full disestablishment a dangerous course for a republic in need of every support for public virtue. But their arguments have had little ffect on the course of church-state affairs in the United States. A parallel debate proceeded in Great Britain at the same time (the 1760s to the 1790s), but it took on a different character and reached a different conclusion. In those debates, the outstanding figure was Edmund Burke. Burke presents a profound alternative

Introduction: Scalia on Education Law, Philosophy, and Pedagogy

Contributors to this collection explore the application of Scalia’s textualism and originalism to education law and reflect upon Scalia’s teachings and his pedagogy. Education law may seem to be an odd vehicle for considering Scalia’s constitutional approach, but thinking about schools requires attention to political fundamentals—freedom of speech, free exercise of religion, equality of opportunity, federalism, and the proper role of the expert.

Scalia and the Secret History of School Choice

Beginning with the Everson decision in 1947, the Supreme Court based its Establishment Clause jurisprudence about public aid to private (often religious) schools on an interpretation of the Virginia Assessment Controversy in 1784–1785. But that interpretation was seriously flawed, and the analogy the Court drew to school aid was misleading. The Virginia proposal targeted funds to ministers and teachers, and no other private activities, and its express purpose was to support religion. State and federal aid programs addressed by the Court went to schools for the purpose of improving educational opportunities (and saving money for the public schools), and distributed funds on a neutral basis, neither favoring nor disfavoring religion. In the early nineteenth century, public funds supported a broad range of schools, most of them religious in character, and Congress followed the same approach in its first major aid-to-education program, the Freedmen’s Bureau Act. Almost no one regarded these programs as raising a problem of church-state separation. These neutral programs came to an end only because of the rising tide of anti-Catholicism, which led many Americans to favor concentrating public funds on generically Protestant public schools. It is the public school monopoly on public support—not school choice—that genuinely resembles an establishment.

REPEAT PULMONARY VALVE REPLACEMENT: SIMILAR INTERMEDIATE-TERM OUTCOMES BETWEEN SURGICAL AND TRANSCATHETER PROCEDURES

There is no previous report comparing clinical or echocardiographic outcomes in patients with a history of prior surgical pulmonary valve replacement (SPVR) who undergo repeat SPVR or transcatheter pulmonary valve replacement (TPVR). We retrospectively identified patients who had previous SPVR and