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of Ecc is good for tagging, excellent for FT and TT at 1.5 T, and good for all three methods at 3.0 T. The repeatability of PEDSR is good to moderate at 1.5 T and moderate at 3.0 T. Cine-based methods to assess Ecc following STEMI may be preferable to tagging.Studies have shown that the quantitative flow ratio (QFR), recently introduced to assess lesion severity from coronary angiography, provides useful prognostic information; however the additive value of this technique over intravascular imaging in detecting lesions that are likely to cause events is yet unclear. We analysed data acquired in the PROSPECT and IBIS-4 studies, in particular the baseline virtual histology-intravascular ultrasound (VH-IVUS) and angiographic data from 17 non-culprit lesions with a presumable vulnerable phenotype (i.e., thin or thick cap fibroatheroma) that caused major adverse cardiac events or required revascularization (MACE) at 5-year follow-up and from a group of 78 vulnerable plaques that remained quiescent. The segments studied by VH-IVUS were identified in coronary angiography and the QFR was estimated. The additive value of 3-dimensional quantitative coronary angiography (3D-QCA) and of the QFR in predicting MACE at 5 year follow-up beyond plaque characteristics was examined. It was found that MACE lesions had a greater plaque burden (PB) and smaller minimum lumen area (MLA) on VH-IVUS, a longer length and a smaller minimum lumen diameter (MLD) on 3D-QCA and a lower QFR compared with lesions that remained quiescent. By univariate analysis MLA, PB, MLD, lesion length on 3D-QCA and QFR were predictors of MACE. In multivariate analysis a low but normal QFR (> 0.80 to  less then  0.97) was the only independent prediction of MACE (HR 3.53, 95% CI 1.16-10.75; P = 0.027). In non-flow limiting lesions with a vulnerable phenotype, QFR may provide additional prognostic information beyond plaque morphology for predicting MACE throughout 5 years.PURPOSE Ascent to high altitude increases right ventricular (RV) afterload and decreases myocardial energy supply. This study evaluates physiologic variables and comprehensive echocardiographic indices of RV and right atrial (RA) function following rapid ascent to high altitude. METHODS Fifty healthy volunteers actively ascended from 1130 to 4559 m in  less then  22 h. All participants underwent 2D echocardiography during baseline examination at low altitude (424 m) and at three study time-points (7, 20 and 44 h) after arrival at high altitude. In addition to systolic pulmonary artery pressure (sPAP), comprehensive 2D planimetric-, tissue Doppler- and speckle-tracking-derived strain indices of RA and RV function were obtained. RESULTS sPAP increased from baseline (24 ± 4 mmHg) to the first altitude examination (39 ± 8 mmHg, p  less then  0.001) and remained elevated during the following 44 h. Global RV function did not change. RA reservoir strain showed a trend towards increase from baseline (50.2 ± 12.1%) to the first altitude examination (53.8 ± 11.0%, p = 0.07) secondary to a significant increase of RA contraction strain (19.2 ± 6.4 vs. 25.4 ± 9.6%, p  less then  0.001). Volumetric RA data largely paralleled RA strain results and RA active emptying volume was increased throughout the 44 h stay at high altitude. CONCLUSION Active and rapid ascent of healthy individuals to 4559 m is associated with an increased contractile performance of the RA that compensates for the increased workload of the RV.PURPOSE To review literature surrounding transversus abdominis release (TAR) for incisional hernia repair, with the aim of describing key preoperative and technical considerations for this procedure. METHODS Existing literature on TAR was reviewed and synthesized with the clinical experience and approach to TAR from a high-volume hernia center. RESULTS Recommendations regarding patient selection, optimization and technique for TAR are presented. CONCLUSIONS While published outcomes of TAR from expert centers are favorable, potentially devastating complications may result when TAR is performed incorrectly or in suboptimal clinical situations. Appropriate patient selection, optimization, and surgeon expertise are necessary if TAR is to be performed.PURPOSE Patient-reported outcome measures (PROMs) have been increasingly accepted to evaluate the quality of surgery. The impact of a hernia on PROMs and the indication for elective ventral hernia mesh repair are poorly researched. The primary objective in this systematic review was to provide evidence for PROM changes at least 3 months after elective ventral hernia mesh repair. Secondarily, a critical appraisal of the study quality was undertaken. METHODS Ovid MEDLINE, PubMed, Ovid Embase, and CENTRAL were searched (year 2000-May 12, 2019) for studies reporting any of 21 predefined PROMs pre- and ≥ 3 months postoperatively following adult ventral hernia mesh repair. A pre-study defined analysis method was used to assess pre- vs. postoperative PROM changes. Quality assessment was guided by criteria formulated by the National Institutes of Health. RESULTS The search yielded 11,438 potentially eligible studies of which 24 met the inclusion criteria. Most studies were of poor or moderate quality and one study was of high quality. There was no evidence for a clinically relevant postoperative improvement in any PROM following umbilical hernia repair or medium-sized incisional hernia repair. A clinically relevant postoperative improvement of pain, physical impairment, and social involvement was seen in patients with a large-sized incisional hernia repair and stoma-related complaints in patients with a medium-sized parastomal hernia repair. Vorinostat CONCLUSION This analysis suggested that a minor subset of PROMs improved in patients undergoing large-sized incisional and medium-sized parastomal hernia repair. High-quality studies are imperative in this extremely often conducted surgical procedure. TRIAL REGISTRATION The review was registered at PROSPERO (CRD42018096671, https//www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=96671).
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