IV. Intermezzo. Andante Molto - Magda Tagliaferro - The Early Years (CD)

Tagliaferro shows a real affinity with the composers music and indeed the recording of the 1st Violin Sonata with Denise Soriano won a Grand Prix du Disque in An award Tagliaferro had previously gained in for the Mompou disc also included here. Michael Dinnebier - Prokofiev, S. Four different voices from the melting-pot of early twentieth-century America come together to create a fascinating snapshot of a time of great change and innovation, ranging from melodious Romanticism to uncompromising atonality.

The American conductor talks to Katherine about his recordings of the complete Prokofiev symphonies with the Bergen Philharmonic Orchestra, released as a box-set tomorrow on BIS. Elena Urioste and Tom Poster talk about their wide-ranging album of arrangements for violin and piano, which grew out of a project to reconnect with audiences during quarantine in Four different voices from the melting-pot of early 20th-century America come together to create a fascinating IV.

Intermezzo. Andante Molto - Magda Tagliaferro - The Early Years (CD) of a time of great change and innovation, ranging from melodious Romanticism to uncompromising atonality. So don't be shy! Many of our volunteers have never recorded anything before LibriVox.

The roles involved in making a LibriVox recording. Not all volunteers read for LibriVox. If you would prefer not to lend your voice to LibriVoxyou could lend us your ears. Proof listeners catch mistakes we may have missed during the initial recording and editing process.

Acute myocarditis can be detected using cardiovascular magnetic resonance CMR using multiple tissue characterization techniques, especially T2-weighted T2W imaging for edema and late gadolinium enhancement LGE [ 1 — 3 ]. LGE is especially powerful in generating excellent contrast between diseased and normal myocardium, allowing visualization of LGE patterns and distribution to differentiate between ischemic and non-ischemic etiologies of myocardial disease [ 45 ].

However, there are some limitations in using LGE alone in the diagnosis of acute myocarditis. Very small areas of myocarditis may not always be detected. Some patients demonstrate predominant global edema rather than frank myocyte necrosis, resulting in negative findings on LGE imaging [ 1 ]. Diffuse myocarditis may not be objectively detectable given that the image analysis of LGE requires normal myocardium as a reference region of interest ROI for comparison. Additionally, although the risk is low, gadolinium-based contrast agents are associated with the rare but serious complication of nephrogenic systemic fibrosis in patients with significant renal impairment [ 6 ].

Thus, it would be useful if there were a method which is sensitive to displaying the different changes in myocarditis without the need for exogenous contrast agents. Native or pre-contrast T1-mapping directly estimates the T1 proton spin—lattice relaxation time of tissues on a pixel-by-pixel basis. Native myocardial T1 values have recently been validated in a large, multicentre normal cohort study to have a tight normal range [ 7 ], and shown to be superior to T2-weighted imaging in detecting edema [ 8 ] as well as acute myocarditis [ 9 ].

In addition to providing a single numeric average myocardial T1 value for a subject, T1-maps should be fully utilized for visual and spatial characterization of changes in the left ventricular myocardium.

In this study, the hypothesis is two-fold: 1 given that T1-mapping is highly sensitive compared to conventional CMR techniques in detecting changes in myocarditis [ 9 ], we propose that it should be able to directly locate the areas of myocardial involvement on a pixel-wise basis, including additional areas of injury; 2 T1-mapping may be able to detect the non-ischemic patterns of injury typically seen on LGE images as areas with higher T1 values compared to the rest of the myocardium.

We demonstrate novel approaches for visualizing the extent and patterns of myocardial injury in acute myocarditis using topographic T1-maps and incremental T1 thresholds. In a previously published study, we demonstrated the superior sensitivity of native T1-mapping to T2W and LGE imaging in detecting acute myocarditis [ 9 ].

The cumulative CMR data derived from this study and new patient material were utilized for the present analysis to generate topographic and incremental threshold T1-maps. Exclusion criteria included contraindications to CMR, previous myocardial infarction, previous myocarditis or any chronic cardiac conditions. Patients who demonstrated myocardial infarction as evidenced by an ischemic pattern of LGE i.

Ethical approval was granted for all study procedures and all subjects gave written informed consent. CMR studies were performed on a single 1. Briefly, cine images were obtained in three long-axis views, and in the short-axis plane covering the base to apex of the heart.

Tissue characterization covering the left ventricle from base to apex was performed for T2W, T1-mapping and LGE imaging in matching short-axis slices. LGE imaging was acquired in the long and short-axis planes using a T1-weighted phase-sensitive inversion recovery PSIR sequence [ 12 ] 8—12 minutes after intravenous administration of contrast agent Gadodiamide, Omniscan, GE Healthcare, total 0.

Typical imaging parameters were as previously published [ 89 ] see Additional file 1. Image analysis of left ventricular ejection fraction was performed using Argus software Siemens Medical Solutions on cine images.

Remote myocardium in acute myocarditis may be challenging to identify as the process may be global; thus a region IV. Intermezzo. Andante Molto - Magda Tagliaferro - The Early Years (CD) the myocardium with no obvious visual increase in relative T2 SI and no LGE was chosen to represent myocardium least affected by the disease process, taking care to also avoid regions with abnormally low signal.

Results of T1-mapping were based on quantitative analysis of all T1-maps rather than visualization of color maps. Care was taken when placing the endo- and epicardial contours to avoid contamination by blood-pool and extra-myocardial structures to minimize the partial volume effect on myocardial T1 values [ 7 ]. To calculate the extent of myocardial injury in a subject detected by the tissue characterization IV.

Intermezzo. Andante Molto - Magda Tagliaferro - The Early Years (CD), the percentage of abnormal myocardium as defined above was determined for each segment and then averaged for that subject. In addition to quantitative image analyses, qualitative visual IV. Intermezzo. Andante Molto - Magda Tagliaferro - The Early Years (CD) for T2W and LGE images were performed by at least 2 expert CMR cardiologists; any difference in opinion IV.

Intermezzo. Andante Molto - Magda Tagliaferro - The Early Years (CD) resolved by presenting the case to at least one additional expert CMR cardiologist before reaching a final interpretation. Each LV myocardial segment was strictly assessed for image quality before inclusion into the final analyses and only segments with no or minimal artifacts were included, as previously published [ 8 ].

To avoid bias towards or against any single technique, main analyses were repeated with all artifacts re-included and results provided in the main text or Additional file 1. Normality of data was tested using the Kolmogorov-Smirnov test. Any segmental analysis was averaged on a per-subject basis before any inter-individual and group comparisons to control for clustering of segments within each subject. All statistical tests were two-tailed, with p-values of less than 0.

To determine the presence of significant differences in subject groups when using multiple CMR methodologies, ANOVA analysis was performed with Bonferroni corrected post-hoc comparisons for parametric data; for non-parametric data, the Kruskal-Wallis one-way analysis of variance was performed with post-hoc pairwise comparisons. For comparisons of the extent of myocardial injury measured by multiple CMR methodologies within the same patient subgroup, the Friedman test was used for non-parametric data with post-hoc comparisons.

Receiver operator characteristic ROC analysis was performed to compare the diagnostic performance of the CMR methods in detecting myocardial changes in patients compared to controls. Significance IV. Intermezzo. Andante Molto - Magda Tagliaferro - The Early Years (CD) ROC analyses was assessed using the method of Delong et al.

Statistical analyses were performed using MedCalc version An example of whole-heart multiparametric tissue characterization is shown in Figure 1. CMR findings are presented in Table 1. None of the 60 patients demonstrated an isolated ischemic subendocardial pattern of LGE to suggest myocardial infarction as the etiology of the acute presentation. Whole-heart multiparametric cardiovascular magnetic resonance CMR tissue characterization in acute myocarditis.

Left to right Short-axis slices covering the left ventricle from base to apex. Repeat analysis including all image artifacts showed preservation of all relative relationships and statistical significance AUC of 0. These results are closely comparable to our previous results using the same techniques in patients with suspected acute myocarditis [ 9 ].

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