Clinical quantitative cardiac imaging for the assessment of myocardial ischaemia.

Cardiac imaging has a pivotal role in the prevention, diagnosis and treatment of ischaemic heart disease. SPECT is most commonly used for clinical myocardial perfusion imaging, whereas PET is the clinical reference standard for the quantification of myocardial perfusion. MRI does not involve exposure to ionizing radiation, similar to echocardiography, which can be performed at the bedside. CT perfusion imaging is not frequently used but CT offers coronary angiography data, and invasive catheter-based methods can measure coronary flow and pressure. Technical improvements to the quantification of pathophysiological parameters of myocardial ischaemia can be achieved. Clinical consensus recommendations on the appropriateness of each technique were derived following a European quantitative cardiac imaging meeting and using a real-time Delphi process. SPECT using new detectors allows the quantification of myocardial blood flow and is now also suited to patients with a high BMI. PET is well suited to patients with multivessel disease to confirm or exclude balanced ischaemia. MRI allows the evaluation of patients with complex disease who would benefit from imaging of function and fibrosis in addition to perfusion. Echocardiography remains the preferred technique for assessing ischaemia in bedside situations, whereas CT has the greatest value for combined quantification of stenosis and characterization of atherosclerosis in relation to myocardial ischaemia. In patients with a high probability of needing invasive treatment, invasive coronary flow and pressure measurement is well suited to guide treatment decisions. In this Consensus Statement, we summarize the strengths and weaknesses as well as the future technological potential of each imaging modality.

Hamilton meets causal decision theory.

In this paper, I contrast two mathematically equivalent ways of modeling the evolution of altruism, namely the classical inclusive fitness approach and a more recent, "direct fitness" approach. Though both are usually considered by evolutionists as mere different ways of representing the same causal process (i.e. that of kin selection), I argue that this consensus is misleading, for there is a fundamental ambiguity concerning the causal interpretation of the DF approach. Drawing on an analogy between the structure of inclusive fitness theory and that of causal decision theory (Stalnaker, 1972), I show that only the inclusive fitness framework can provide us with a proper, and unambiguous causal partition of the relevant variables involved in the evolution of altruism.