B a c k g r o u n d: A novel paradigm of diastolic heart failure with preserved ejection fraction (HFpEF) proposed the induction of coronary microvascular dysfunction by HFpEF comorbidities via a systemic pro-infl ammatory state and associated oxidative stress. Th e consequent nitric oxide deficiency would increase diastolic tension and favor fi brosis of adjacent myocardium, which implies not only left ventricular (LV), but all-chamber myocardial stiff ening. Our aim was to assess relations between low-grade chronic systemic infl ammation and left atrial (LA) pressure-volume relations in real-world HFpEF patients.
Me t h o d s: We retrospectively analyzed medical records of 60 clinically stable HpEFF patients in sinus rhythm with assayed high-sensitive C-reactive protein (CRP) during the index hospitalization. Subjects with CRP >10 mg/L or coexistent diseases, including coronary artery disease, were excluded. LV and LA diameters and mitral E/E’ ratio (an index of LA pressure) were extracted from routine echocardiographic 46 Cyrus M. Sani, Elahn P.L. Pogue, et al. records. A surrogate measure of LA stiff ness was computed as the averaged mitral E/e’ ratio divided by LA diameter.
R e s u l t s: With ascending CRP tertiles, we observed trends for elevated mitral E/e’ ratio (p <0.001), increased relative LV wall thickness (p = 0.01) and higher NYHA functional class (p = 0.02). Th e LA stiffness estimate and log-transformed CRP levels (log-CRP) were interrelated (r = 0.38, p = 0.003). On multivariate analysis, the LA stiff ness index was independently associated with log-CRP (β ± SEM: 0.21 ± 0.07, p = 0.007) and age (β ± SEM: 0.16 ± 0.07, p = 0.03), which was maintained upon adjustment for LV mass index and relative LV wall thickness.
C o n c l u s i o n s: Low-grade chronic infl ammation may contribute to LA stiff ening additively to age and regardless of the magnitude of associated LV hypertrophy and concentricity. LA stiff ening can exacerbate symptoms of congestion in HFpEF jointly with LV remodeling.
Industry 4.0 and the associated idea of society 4.0 pose specific challenges for the concept of sustainable development. These challenges relate, inter alia, to responsibility, in which the changes to date have overall entailed:
• a transition from ex post responsibility to ex ante responsibility (H. Jonas);
• a transition from individual responsibility to corporate social responsibility.
In the context of society 4.0 there is a need for shared responsibility. The problem of justice and therefore the implementation of sustainable development not only becomes an open problem, but also requires constant updating and specifi c optimisation.
The article focuses, with a comparative perspective, on the economic reforms that were implemented in Germany during and after the unification in 1990. The fact is stressed that after the collapse of communism, most politicians and economists considered neoliberal reforms based on deregulation, liberalization and privatization as the only viable model. Although the reforms in East Gemany were not labelled as such, they amounted to a „shock therapy“, much like in neighboring Poland. The result of the radical and hasty liberalization and privatization, in combination with the currency union of Juli 1990, was the closure of many factories and mass unemployment. The government tried to compensate the losers of the transformation with welfare payments, but that resulted in a systemic crisis of united Germany, leading eventually to a second round of neoliberal reforms under the center-left coalition government under Chancellor Gerhard Schröder from 2001 to 2005. The widening social gaps and the fear of social dislocation eventually contributed to the rise of right-wing populist parties in Germany.
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