bluuebunny/crossref_metadata_2025 huggingface dataset:
The practice of reporting transfusion‐related acute lung injury: a national survey among clinical and preclinical disciplines
Authors: Vlaar Alexander P. , Wortel Kim , Binnekade Jan M. , Van Oers Marinus H.J. , Beckers Erik , Gajic Ognjen , Schultz Marcus J. , Juffermans Nicole P.
Published: October 2009

BACKGROUND: Transfusion‐related acute lung injury (TRALI) is hypothesized to be a “two‐hit” entity, in which an inflammatory condition (e.g., sepsis) predisposes to TRALI. TRALI is a clinical diagnosis. Disciplines involved in managing TRALI may differ in decision‐making on the reporting of TRALI.

STUDY DESIGN AND METHODS: A survey was conducted among critical care physicians, hematologists, hemovigilance workers, and transfusion medicine physicians, using case vignettes and a questionnaire. The vignettes varied in patient‐ and blood product–related factors that may influence the decision to report a TRALI case. Multiple linear regression analysis was performed. A positive β‐coefficient is in favor of reporting.

RESULTS: Ninety‐two questionnaires were returned (response rate, 68%). For all disciplines, preferences in favor of reporting TRALI were onset of symptoms within 1 hour (β = 0.4), after transfusion of a single unit of FFP (β = 0.5), and in the absence of acute lung injury before transfusion (β = 1.3). An admission diagnosis of sepsis was a negative preference (β = −0.3). Massive transfusion (6 RBC plus 4 FFP units) was a negative preference for transfusion medicine physicians (β = −0.3), but a positive preference for the other disciplines. The questionnaire revealed that massive transfusion and the age of blood products were considered relatively more important reasons to report TRALI by critical care physicians compared to the other disciplines (p < 0.05).

CONCLUSION: A pretransfusion inflammatory condition is a reason to withhold from reporting of a suspected TRALI case. Disciplines involved in managing TRALI differ in decision‐making of reporting TRALI, which may contribute to variance in incidence.
Permanent Pacemaker Implantation Following Aortic Valve Replacement: Current Prevalence and Clinical Predictors
Authors: HUYNH HIEU , DALLOUL GHASSAN , GHANBARI HAMID , BURKE PETER , DAVID MARIAM , DACCARETT MARCOS , MACHADO CHRISTIAN , DAVID SHUKRI
Published: October 2009

Background:

The incidence of conduction disease requiring permanent pacemaker (PPM) implantation following aortic valve replacement (AVR) ranges from 3% to 6%. Data concerning the potential risks for PPM requirement associated with certain valve types have been conflicting and controversial. We sought to evaluate the prevalence, predictors for PPM implantation, and PPM dependency during follow‐up in patients undergoing AVR.

Methods:

A total of 214 consecutive patients undergoing AVR were studied retrospectively. A total of 207 patients were included in the statistical analysis. Clinical variables including valve size and types were catalogued and the incidence of PPM evaluated. Cardiac rhythm device clinic records were examined and PPM dependency status was catalogued. Multivariate analyses were performed to determine predictors of PPM implantation and PPM dependency during follow‐up.

Results:

Fifteen patients (7.2%) required PPM postoperatively. After controlling for clinical and surgical characteristics, predictors for PPM included preoperative first‐degree atrioventricular block with and without left anterior fascicular block or intraventricular conduction delay [odd ratios (OR) = 12.5, P = 0.001], cardiac arrest postoperatively (OR = 9.4, P = 0.012), and combined aortic and mitral valve surgery (OR = 11.5, P = 0.027). Aortic valve types did not predict complete heart block (CHB) and PPM implantation. Of those patients who underwent PPM implantation, 70% were classified as PPM dependent during long‐term follow‐up.

Conclusion:

CHB and PPM implantation continue to be common complications of AVR. Preexisting atrioventricular with intrafascicular or intraventricular conduction disease along with cardiac arrest and dual valve surgery are the most important significant predictors of PPM implantation and PPM dependency during follow‐up. The selection of valve types did not predict conduction disease requiring PPM implantation.
Idiopathic Left Ventricular Arrhythmias Originating Adjacent to the Left Aortic Sinus of Valsalva: Electrophysiological Rationale for the Surface Electrocardiogram
Authors: YAMADA TAKUMI , MCELDERRY H. THOMAS , OKADA TARO , MURAKAMI YOSHIMASA , DOPPALAPUDI HARISH , YOSHIDA NAOKI , YOSHIDA YUKIHIKO , INDEN YASUYA , MUROHARA TOYOAKI , EPSTEIN ANDREW E. , PLUMB VANCE J. , KAY G. NEAL
Published: October 2009

IVT Arising Adjacent to the Left Sinus of Valsalva.

Background:
Idiopathic ventricular arrhythmias (VAs) may be amenable to catheter ablation within or adjacent to the left sinus of Valsalva (LSOV). However, features that discriminate these sites have not been defined. The purpose of this study was to determine the electrocardiographic and electrophysiological features of VAs originating within or adjacent to the LSOV.

Methods and Results:
We studied 48 consecutive patients undergoing successful catheter ablation of idiopathic VAs originating from the left coronary cusp (LCC, n = 29), aortomitral continuity (AMC, n = 10) and great cardiac vein or anterior interventricular cardiac vein (Epi, n = 9). A small r wave, or rarely an R wave, was typically observed in lead I during the VAs and pacing in these regions. An S wave in lead V5 or V6 occurred significantly more often during both the VAs and pacing from the AMC than during that from the LCC and Epi (p < 0.05 to 0.0001). For discriminating whether VA origins can be ablated endocardially or epicardially, the maximum deflection index (MDI = the shortest time to the maximum deflection in any precordial lead/QRS duration) was reliable for VAs arising from the AMC (100%), but was less reliable for LCC (73%) and Epi (67%) VAs. In 3 (33%) of the Epi VAs, the site of an excellent pace map was located transmurally opposite to the successful ablation site (LCC = 1 and AMC = 2).

Conclusions:
The MDI has limited value for discriminating endocardial from epicardial VA origins in sites adjacent to the LSOV probably due to preferential conduction, intramural VA origins or myocardium in contact with the LCC. (J Cardiovasc Electrophysiol, Vol. 21, pp. 170‐176, February 2010)
Magnetic Resonance Imaging‐Confirmed Ablative Debulking of the Left Atrial Posterior Wall and Septum for Treatment of Persistent Atrial Fibrillation: Rationale and Initial Experience
Authors: SEGERSON NATHAN M. , DACCARETT MARCOS , BADGER TROY J. , SHABAAN AKRAM , AKOUM NAZEM , FISH ERIC N. , RAO SWATI , BURGON NATHAN S. , ADJEI‐POKU YAW , KHOLMOVSKI EUGENE , VIJAYAKUMAR SATHYA , DIBELLA EDWARD V.R. , MACLEOD ROB S. , MARROUCHE NASSIR F.
Published: October 2009

LA Debulking for Atrial Fibrillation.

Introduction:
Though pulmonary vein (PV) isolation has been widely adopted for treatment of atrial fibrillation (AF), recurrence rates remain unacceptably high with persistent and longstanding AF. As evidence emerges for non‐PV substrate changes in the pathogenesis of AF, more extensive ablation strategies need further study.

Methods:
We modified our PV antrum isolation procedure to include abatement of posterior and septal wall potentials. We also employed recently described image‐processing techniques using delayed‐enhancement (DE) MRI to characterize tissue injury patterns 3 months after ablation, to assess whether each PV was encircled with scar, and to assess the impact of these parameters on procedural success.

Results:
118 consecutive patients underwent debulking procedure and completed follow‐up, of which 86 underwent DE‐MRI. The total left atrial (LA) radiofrequency delivery correlated with percent LA scarring by DE‐MRI (r = 0.6, P < 0.001). Based on DE patterns, complete encirclement was seen in only 131 of 335 PVs (39.1%). As expected, Cox regression analysis showed a significant relationship between the number of veins encircled by delayed enhancement and clinical success (hazard ratio of 0.62, P = 0.015). Also, progressive quartile increases in postablation posterior and septal wall scarring reduced recurrences rates with a HR of 0.65, P = 0.022 and 0.66, P = 0.026, respectively.

Conclusion:
Pathologic remodeling in the septal and posterior walls of the LA helps form the pathogenic substrate for AF, and these early results suggest that more aggressive treatment of these regions appears to correlate with improved ablation outcomes. Noninvasive imaging to characterize tissue changes after ablation may prove essential to stratifying recurrence risk. (J Cardiovasc Electrophysiol, Vol. 21, pp. 126‐132, February 2010)
Septal Dyskinesia and Global Left Ventricular Dysfunction in Pediatric Wolff‐Parkinson‐White Syndrome with Septal Accessory Pathway
Authors: KWON BO SANG , BAE EUN JUNG , KIM GI BEOM , NOH CHUNG IL , CHOI JUNG YUN , YUN YONG SOO
Published: October 2009

LV Dysfunction in WPW Syndrome. Introduction: Echocardiographic studies have shown that some patients with Wolff‐Parkinson‐White (WPW) syndrome have myocardial dyskinesia in the segments precociously activated by an accessory pathway (AP). The aim of the present study was to determine the extent to which the AP contributes to global left ventricular (LV) dysfunction.

Methods:
Electrophysiological and echocardiographic data from 62 children with WPW (age at diagnosis = 5.9 ± 4.2 years) were retrospectively analyzed.

Results:
The left ventricular ejection fraction (LVEF) of patients with septal APs (53 ± 11%) was significantly lower than that of patients with right (62 ± 5%) or left (61 ± 4%) APs (P = 0.001). Compared to patients with normal septal motion (n = 56), patients with septal dyskinesia (n = 6) had a reduced LVEF (61 ± 4% and 42 ± 5%, respectively) and an increased LV end diastolic dimension (P < 0.001 for both comparisons). Multivariate analysis identified septal dyskinesia as the only significant risk factor for reduced LVEF. All 6 patients with septal dyskinesia had right septal APs, and a preexcited QRS duration that was longer than that of patients with normal septal motion (140 ± 18 ms and 113 ± 32 ms, respectively; P = 0.045). After RFA there were improvements in both intraventricular dyssynchrony (septal‐to‐posterior wall motion delay, from 154 ± 91 ms to 33 ± 17 ms) and interventricular septal thinning (from 3.0 ± 0.5 mm to 5.3 ± 2.6 mm), and a significant increase in LVEF (from 42 ± 5% to 67 ± 8%; P = 0.001).

Conclusion:
The dyskinetic segment activated by a right septal AP in WPW syndrome may lead to ventricular dilation and dysfunction. RFA produced mechanical resynchronization, reverse remodeling, and improvements in LV function. (J Cardiovasc Electrophysiol, Vol. 21, pp. 290–295, March 2010)
Chronic Augmentation of the Parasympathetic Tone to the Atrioventricular Node: A Nonthoracotomy Neurostimulation Technique for Ventricular Rate Control During Atrial Fibrillation
Authors: MISCHKE KARL , ZARSE MARKUS , SCHMID MICHAEL , GEMEIN CHRISTOPHER , HATAM NIMA , SPILLNER JAN , DOHMEN GUIDO , RANA OBAIDA , SAYGILI EROL , KNACKSTEDT CHRISTIAN , WEIS JOACHIM , PAUZA DAINIUS , BIANCHI STEFANO , SCHAUERTE PATRICK
Published: October 2009

Long‐Term Cardiac Neurostimulation.

Introduction:
The right inferior ganglionated plexus (RIGP) selectively innervates the atrioventricular node. Temporary electrical stimulation of this plexus reduces the ventricular rate during atrial fibrillation (AF). We sought to assess the feasibility of chronic parasympathetic stimulation for ventricular rate control during AF with a nonthoracotomy intracardiac neurostimulation approach.

Methods and Results:
In 9 mongrel dogs, the small endocardial area inside the right atrium, which overlies the RIGP, was identified by 20 Hz stimulation over a guiding catheter with integrated electrodes. Once identified, an active‐fixation lead was implanted. The lead was connected to a subcutaneous neurostimulator. An additional dual‐chamber pacemaker was implanted for AF induction by rapid atrial pacing and ventricular rate monitoring. Continuous neurostimulation was delivered for 1–2 years to decrease the ventricular rate during AF to a range of 100–140 bpm. Implantation of a neurostimulation lead was achieved within 37 ± 12 min. The latency of the negative dromotropic response after on/offset or modulation of neurostimulation was <1 s. Continuous neurostimulation was effective and well tolerated during a 1–2 year follow‐up with a stimulation voltage <5 V. The neurostimulation effect displayed a chronaxie‐rheobase behavior (chronaxie time of 0.07 ± 0.02 ms for a 50% decrease of the ventricular rate during AF).

Conclusion:
Chronic parasympathetic stimulation can be achieved via a cardiac neurostimulator. The approach is safe, effective, and well tolerated in the long term. The atrioventricular nodal selectivity and the opportunity to adjust the negative dromotropic effect within seconds may represent an advantage over pharmacological rate control. (J Cardiovasc Electrophysiol, Vol. 21, pp. 193‐199, February 2010)
Electrocardiographic Findings, Device Therapies, and Comorbidities in Octogenarian Implantable Defibrillator Recipients
Authors: DANIELS JAMES D. , SAUNDERS JUSTIN , PARVATHANENI SUNTHOSH , BYRD AMANDA , JOGLAR JOSE A. , OBEL OWEN
Published: October 2009

Implantable Defibrillators in Octogenarians. 
Background: The use of implantable cardioverter‐defibrillators (ICDs) in octogenarians is poorly defined.

Objective: To assess baseline electrocardiographic (ECG) findings, arrhythmia episodes, and development of severe nonarrhythmic illness or death in patients aged ≥80 years at ICD implantation, and to compare them with younger patients.

Methods: Medical records and device interrogations for 199 patients ≥70 years old who underwent ICD implantation were reviewed. Patients were divided into 3 groups based on age at the time of implant: age 70–74 (group 1; 88 patients), age 75–79 (group 2; 67 patients), and age ≥80 (group 3; 44 patients).

Results: ECGs: Octogenarians were more likely to have sinus bradycardia (SB) (P = 0.047) and left bundle branch block (LBBB) (P = 0.043) compared to younger patients. There was no difference among groups in the proportion of patients with atrial fibrillation or any degree of AV block.

Therapies: There was no difference between age groups in any therapy (P = 0.78), appropriate therapy (P = 0.54), or inappropriate therapy (P = 0.21) per patient‐year. There was no difference between groups in time‐to‐first therapy of any type (P = 0.71).

Nonarrhythmic death/morbidity: There was no difference between groups in time to death or serious illness.

Conclusion: Our study is the first to evaluate in detail the therapies received by octogenarians after ICD placement. The higher incidence of SB and LBBB might influence the number of pacing sites in octogenarian patients. Very elderly patients have similar rates of arrhythmic episodes and development of severe comorbidities as septuagenarians, and they should not be denied ICD implantation based solely on age. (J Cardiovasc Electrophysiol, Vol. 21, pp. 236–241, March 2010)
Characteristics of Complex Fractionated Electrograms in Nonpulmonary Vein Ectopy Initiating Atrial Fibrillation/Atrial Tachycardia
Authors: LO LI‐WEI , LIN YENN‐JIANG , TSAO HSUAN‐MING , CHANG SHIH‐LIN , HU YU‐FENG , TSAI WEN‐CHIN , TUAN DA‐CHUN , CHANG CHIEN‐JUNG , LEE PI‐CHANG , TAI CHING‐TAI , TANG WEI‐HUA , SUENARI KAZUYOSHI , HUANG SHIH‐YU , HIGA SATOSHI , CHEN SHIH‐ANN
Published: October 2009

Background:
Nonpulmonary vein (PV) ectopy initiating atrial fibrillation (AF)/atrial tachycardia (AT) is not uncommon in patients with AF. The relationship of complex fractionated atrial electrograms (CFAEs) and non‐PV ectopy initiating AF/AT has not been assessed. We aimed to characterize the CFAEs in the non‐PV ectopy initiating AF/AT.

Methods:
Twenty‐three patients (age 53 ± 11 y/o, 19 males) who underwent a stepwise AF ablation with coexisting PV and non‐PV ectopy initiating AF or AT were included. CFAE mapping was applied before and after the PV isolation in both atria by using a real‐time NavX electroanatomic mapping system. A CFAE was defined as a fractionation interval (FI) of less than 120 ms over 8‐second duration. A continuous CFAE (mostly, an FI < 50 ms) was defined as electrogram fractionation or repetitive rapid activity lasting for more than 8 seconds.

Results:
All patients (100%) with non‐PV ectopy initiating AF or AT demonstrated corresponding continuous CFAEs at the firing foci. There was no significant difference in the FI among the PV ostial or non‐PV atrial ectopy or other atrial CFAEs (54.1 ± 5.6, 58.3 ± 11.3, 52.8 ± 5.8 ms, P = 0.12). Ablation targeting those continuous CFAEs terminated the AF and AT and eliminated the non‐PV ectopy in all patients (100%). During a follow‐up of 7 months, 22% of the patients had an AF recurrence with PV reconnections. There was no recurrence of any ablated non‐PV ectopy during the follow‐up.

Conclusion:
The sites of the origin of the non‐PV ectopies were at the same location as those of the atrial continuous CFAEs. Those non‐PV foci were able to initiate and sustain AF/AT. By limited ablation targeting all atrial continuous CFAEs, the AF could be effectively eliminated.
The Impact of Catheter Ablation on the Dynamic Function of the Left Atrium in Patients with Atrial Fibrillation: Insights from Four‐Dimensional Computed Tomographic Images
Authors: TSAO HSUAN‐MING , HU WEI‐CHIH , WU MEI‐HAN , TAI CHING‐TAI , CHANG SHIH‐LIN , LIN YENN‐JIANG , LO LI‐WEI , HUANG CHIN‐CHOU , HU YU‐FENG , SHEU MING‐HUEI , CHANG CHENG‐YEN , CHEN SHIH‐ANN
Published: October 2009

Functional Evaluation of the LA by Dynamic CT. 
Introduction: Elucidating the functional properties and remodeling process of the entire left atrium (LA) is important not only for offering the mechanistic insight into atrial fibrillation (AF) but also for assessing the effectiveness of catheter ablation.

Methods: We included 65 patients with paroxysmal AF and 29 controls. Baseline multidetector computed tomography (MDCT) was acquired in all subjects and a follow‐up MDCT was available in 48 patients after pulmonary vein and LA ablation. The 3‐dimensional images at atrial end‐diastole (ED) and end‐systole (ES) were analyzed.

Results: The LA volume (ED: 61.11 ± 15.94 vs 54.12 ± 8.94 mL/m2, P = 0.03; ES: 45.29 ± 17.64 vs 33.38 ± 7.78 mL/m2, P < 0.001) was increased, and ejection fraction (EF) (26.93 ± 13.40 vs 38.09 ± 11.62%, P < 0.001) decreased in AF patients as compared to controls. After ablation, the ES LA volume (44.73 ± 14.93 vs 38.04 ± 11.51 mL/m2, P = 0.04) decreased and the LA EF (25.04 ± 13.13 vs 30.82 ± 7.85%, P = 0.03) increased in patients without any AF recurrence. The wall motion (WM) analysis of the 18 segments of LA revealed increased motional magnitudes of entire LA except for the anterior roof. In contrast, the volume, EF, and WM of LA remained similar in patients with recurrence.

Conclusion: Dilated LA with global hypokinesia was noted in AF patients. Improved LA transport function was demonstrated in patients without any recurrence after ablation. However, the anatomic and functional reverse remodeling was not significant in patients with AF recurrence. (J Cardiovasc Electrophysiol, Vol. 21, pp. 270–277, March 2010)
Influence of Heavy Cigarette Smoking on Heart Rate Variability and Heart Rate Turbulence Parameters
Authors: Cagirci Goksel , Cay Serkan , Karakurt Ozlem , Eryasar Neslihan , Kaya Veli , Canga Aytun , Yesilay Asuman Bicer , Kilic Harun , Topaloglu Serkan , Aras Dursun , Demir Ahmet Duran , Akdemir Ramazan
Published: October 2009

Background: Cigarette smoking increases the risk of cardiovascular events related with several mechanisms. The most suggested mechanism is increased activity of sympathetic nervous system. Heart rate variability (HRV) and heart rate turbulence (HRT) has been shown to be independent and powerful predictors of mortality in a specific group of cardiac patients. The goal of this study was to assess the effect of heavy cigarette smoking on cardiac autonomic function using HRV and HRT analyses.

Methods: Heavy cigarette smoking was defined as more than 20 cigarettes smoked per day. Heavy cigarette smokers, 69 subjects and nonsmokers 74 subjects (control group) were enrolled in this study. HRV and HRT analyses [turbulence onset (TO) and turbulence slope (TS)] were assessed from 24‐hour Holter recordings.

Results: The values of TO were significantly higher in heavy cigarette smokers than control group (−1.150 ± 4.007 vs −2.454 ± 2.796, P = 0.025, respectively), but values of TS were not statistically different between two groups (10.352 ± 7.670 vs 9.613 ± 7.245, P = 0.555, respectively). Also, the number of patients who had abnormal TO was significantly higher in heavy cigarette smokers than control group (23 vs 10, P = 0.006). TO was correlated with the number of cigarettes smoked per day (r = 0.235, P = 0.004). While LF and LF/HF ratio were significantly higher, standard deviation of all NN intervals (SDNN), standard deviation of the 5‐minute mean RR intervals (SDANN), root mean square of successive differences (RMSSD), and high‐frequency (HF) values were significantly lower in heavy smokers. While, there was significant correlation between TO and SDNN, SDANN, RMSSD, LF, and high frequency (HF), only HF was correlated with TS.

Conclusion: Heavy cigarette smoking has negative effect on autonomic function. HRT is an appropriate noninvasive method to evaluate the effect of cigarette on autonomic function. Simultaneous abnormal HRT and HRV values may explain increased cardiovascular event risk in heavy cigarette smokers.
Assessment of Microvolt T‐Wave Alternans in High‐Risk Patients with the Congenital Long‐QT Syndrome
Authors: Schmitt Jörn , Baumann Stefan , Klingenheben Thomas , Richter Sergio , Duray Gabor , Hohnloser Stefan H. , Ehrlich Joachim R.
Published: October 2009

Background: Microvolt T‐wave alternans (MTWA) has been used for arrhythmogenic risk stratification in cardiac disease conditions associated with increased risk of sudden cardiac death. Macroscopic T‐wave alternans has been observed in patients with congenital long‐QT syndrome (LQTS). The role of MTWA testing in patients with LQTS has not been established.

Objective: To determine the diagnostic value of MTWA testing in high‐risk patients with LQTS.

Methods and results: We assessed MTWA in 10 consecutive LQTS index patients who survived cardiac arrest or had documented torsade de pointes tachycardia and 6 first‐degree family members with congenital LQTS which had been genotyped in 13 of 16 subjects (7 index patients, 6 family members). No LQTS‐causing mutation was identified in 3 index patients with overt QT prolongation. MTWA was assessed during standardized bicycle exercise testing using the spectral method and yielded negative (n = 8) or indeterminate (n = 2) results in index patients, respectively. Similarly, all first‐degree family members tested MTWA negative except for one indeterminate result. Two genotype positive family members could not be tested (two children—4 and 9 years of age).

Conclusion: In patients with congenital LQTS, free from structural heart disease and with a history of life‐threatening cardiac arrhythmias, assessment of MTWA does not yield diagnostic value. Hence, determination of MTWA in lower risk LQTS patients without spontaneous arrhythmic events is likely not to be useful for arrhythmia risk stratification.
Electrocardiographic Indices of Left Ventricular Hypertrophy and Repolarization Phase Share the Same Genetic Influences: A Twin Study
Authors: Mutikainen Sara , Ortega‐Alonso Alfredo , Alén Markku , Kaprio Jaakko , Karjalainen Jouko , Rantanen Taina , Kujala Urho M.
Published: October 2009

Background: Both left ventricular hypertrophy (LVH) and repolarization phase (RP) are known to be attributable to genetic influences, but less is known whether they share same genetic influences. The aim of this study was to investigate to what extent individual differences in electrocardiographic (ECG) LVH and RP are explained by genetic and environmental influences and whether these influences are shared between these two traits.

Methods: Resting ECG recordings were obtained from 186 monozygotic and 203 dizygotic female twin individuals, aged 63 to 76 years. Latent factors, called LVH and RP, were formed to condense the information obtained from LVH indices (Cornell voltage and Cornell product) and T‐wave amplitudes (leads V5 and II), respectively. Multivariate quantitative genetic modeling was used both to decompose the phenotypic variances into additive genetic, common environmental, and unique environmental influences, and for the calculation of genetic and environmental correlations between LVH and RP.

Results: Additive genetic influences explained 16% of individual differences in LVH and 74% in RP. The remaining individual differences were explained by both common and unique environmental influences. The genetic correlation and unique environmental correlation between LVH and RP were −0.93 and −0.05, respectively.

Conclusions: In older women without overt cardiac diseases, RP is under stronger genetic control than LVH. The majority of genetic influences are shared between LVH and RP whereas environmental influences are mainly specific to each.
Electrophysiologic Characteristics of Wide QRS Complexes during Pharmacologic Termination of Sustained Supraventricular Tachycardias with Verapamil and Adenosine: Observations from Electrophysiologic Study
Authors: Türkoğlu Cengizhan , Öztürk Muzaffer , Aliyev Farid , Firatli Inci , Incesoy Nilgün
Published: October 2009

Background: In this study we evaluate wide QRS complexes observed during pharmacologic termination of supraventricular tachycardias.

Methods: Patients with supraventricular tachycardia, undergoing electrophysiologic study were enrolled. 12 mg of adenosine or 10 mg of verapamil were administered during tachycardia, under continuous monitoring of intaracardiac and surface electrocardiograms. Electrocardiographic features of ventricular ectopy were noted.

Results: Seventy‐four patients were enrolled. 48 patients were randomized to adenosine and 26 to verapamil. Five different appearance patterns of ventricular ectopy were observed during termination of tachycardias. All wide QRS complexes were of ventricular origin and all of them were observed during the termination of tachycardia. Adenosine more frequently resulted in appearance of ventricular beats (15.4% vs 41.7%, P = 0.003), and this was more frequently observed in patients with atrioventricular nodal reentrant tachycardia. Patients with ventricular beats were younger than those without, in both, verapamil (47.5 ± 15.6 vs 65.0 ± 8.8 years, P = 0.04) and adenosine (40.9 ± 13.8 vs 49.7 ± 16.8, P = 0.03) groups. Left bundle branch block (LBBB)/superior axis morphology was most frequent morphology in adenosine group (55%). Two of 4 patients in verapamil group displayed LBBB/inferior axis QRS morphology and another 2 patients displayed LBBB/superior axis morphology.

Conclusions: Noncatheter induced, five different appearance patterns and four distinct morphologies of ventricular origin were observed. Most of them do not directly terminate tachycardia, but are associated with its termination and are not observed in ongoing tachycardia.
Correlation Relationship Assessment between Left Ventricular Hypertrophy Voltage Criteria and Body Mass Index in 41,806 Swiss Conscripts
Authors: Abächerli Roger , Zhou Lingchuan , Schmid Johann‐Jakob , Kobza Richard , Niggli Bernhard , Frey Franz , Erne Paul
Published: October 2009

Introduction: Electrocardiographic criteria for left ventricular hypertrophy (LVH) have been limited by low sensitivity at acceptable levels of specificity. A number of studies have demonstrated that body mass index (BMI) is associated with decreased sensitivity of ECG LVH classification in hypertensive patients. The objective of this study is to investigate the correlation relationship between LVH voltage criteria and BMI in Swiss conscripts.

Methods: A database of 41,806 young Swiss people, who underwent compulsory conscription for the Swiss Army, was compiled. Along with other medical data, an ECG was taken. Statistical analyses, such as linear regression and calculation of correlation coefficient, were carried out between LVH voltage criteria and BMI.

Results: The mean age in the studied population was 19.2 ± 1.1 years with a median age of 19 years (range from 17 to 38 years). We found an overweight prevalence of 25.1%. The results showed that body habitus had significant association with Sokolow‐Lyon voltages. A mean decrease of 13%, 5%, 19%, 14%, and 12% for the five studied Sokolow‐Lyon indexes were found between normal range subjects (18.5 ≤ BMI < 25) and obese subjects (25≤ BMI).

Conclusions: Our study confirms the hypothesis that people with higher BMI, a growing section of the population, have lower ECG amplitudes. Therefore, the Sokolow‐Lyon voltage criteria may underestimate the presence of LVH for subjects with higher BMI, which is not the case for the Cornell voltage. Our analysis suggests that computerized electrocardiography for the diagnosis of left ventricular hypertrophy based on Sokolow‐Lyon voltages should incorporate the BMI factor.
Termination of Recurrent Ventricular Tachycardia by Continuous Positive Airway Pressure Ventilation
Authors: Shimada Yuichi J. , Sato Kazutoshi , Hanon Sam , Schweitzer Paul
Published: October 2009

We report a case of hypertrophic cardiomyopathy with recurrent ventricular tachycardia that resolved after initiating continuous positive airway pressure therapy.
Progressive Cerebral Disease in Lymphomatoid Granulomatosis Causes Anterograde Amnesia and Neuropsychiatric Disorder
Authors: Carone Dominic A. , Benedict Ralph H. B. , Zivadinov Robert , Singh Baljinder , Ambrus Julian L.
Published: October 2009

The authors report neuropsychological (NP) and serial quantitative magnetic resonance imaging (MRI) findings of a 29‐year‐old woman with lymphomatoid granulomatosis (LG). Disease course was characterized by acute psychosis, tremor, fever, seizures, and progressive cognitive impairment. At the time of symptom onset, brain MRI revealed mild lesion volume and normal parenchymal volume. This was followed by dramatic progression of brain lesions and atrophy over 2 years, at which point the patient expired. Atrophy was most prominent in the mesial temporal lobes. NP testing revealed marked amnesia and mild impairments in other cognitive domains. To our knowledge, this is the first recorded case of LG in which bilateral temporal lobe atrophy is evident and accompanied by anterograde amnesia. We speculate that temporal lobe atrophy was influenced by the established susceptibility of this region in various neurological diseases.
Lhermitte‐Duclos Disease: Case Report
Authors: Carlson Jeffrey J. , Milburn James M. , Barré Gregg M.
Published: October 2009

Lhermitte‐Duclos disease is a rare disorder with an unknown pathogenesis. A single report of a pathological proven case of Lhermitte‐Duclos disease is presented with clinical, imaging, and histopathological findings. A brief review of the condition is provided with an emphasis on imaging description.
Unusual Case of 2 Renal Cell Carcinoma Metastases Ipsilateral to an Occluded Internal Carotid Artery
Authors: Erbay Sami H. , O'Callaghan Mark G. , Bhadelia Rafeeque A. , Polak Joseph F.
Published: October 2009

Hemodynamic factors may play a role in the seeding and subsequent growth of cerebral metastasis. The authors present a case with 2 foci of cerebral metastasis in the same vascular territory ipsilateral to an occluded internal carotid artery. A 65‐year‐old man with chronic left frontal lobe infarct and left internal carotid artery occlusion was diagnosed with 2 large hemorrhagic metastases in the left middle cerebral artery territory. Diminished flow signals were seen in the trunk and branches of the left middle cerebral artery on magnetic resonance angiography. This case illustrates preferential seeding and growth of cerebral metastases in a region of the brain with diminished blood flow.
Comparison of Asymmetry in Cerebral Blood Flow Between Brain Hemispheres Using Digital Subtraction Angiography
Authors: Divani Afshin A. , Qureshi Adnan I. , Hoffman Kenneth R. , Suri M. Fareed K. , Kirmani Jawad F.
Published: October 2009

Background and Purpose. Recently, endovascular techniques have gained significant therapeutic potential for both treatment and prevention of stroke. Cerebral angiography, which is an essential component of these procedures, has been used to provide morphological information regarding condition of blood vessels. In this study, we propose to determine the possibility of acquiring information regarding cerebral blood flow (CBF) in addition to morphologic information from data routinely available during angiography. Methods. Digital subtraction angiography sequences were obtained for eight patients having occlusive disease in internal carotid artery (ICA) territories. Two regions‐of‐interest (ROIs) corresponding to the two brain hemispheres on AP view were delineated. For each image, the average pixel value within each ROI was calculated and used to generate time‐density curves. Indices obtained from each curve were compared with each other and with the results obtained from the single photon emission computed tomography (SPECT) studies performed a pre‐ or postangiography procedure. Results. Comparison between ICA stenosis and cerebral perfusion measurements revealed that cerebral perfusion deficit can be independent of arterial occlusive disease. The indices obtained from the time‐density curves exhibit a correlating trend with the results from SPECT studies. However, lack of sufficient sample data prevented any meaningful statistical analysis to be conducted. Conclusions. We have developed a technique for utilizing the angiographic data for the important task of routinely and easily measuring CBF. Availability of CBF measurements during cerebral angiography may favorably impact upon the appropriate use of endovascular procedures and potentially contribute to the reduction of morbidity and mortality associated with stroke.
Neuroimaging of Focal Cortical Dysplasia
Authors: Widdess‐Walsh Peter , Diehl Beate , Najm Imad
Published: October 2009

Focal cortical dysplasia (FCD) is a common cause of pharmacoresistant epilepsy that is amenable to surgical resective treatment. The identification of structural FCD by magnetic resonance imaging (MRI) can contribute to the detection of the epileptogenic zone and improve the outcome of epilepsy surgery. MR epilepsy protocols that include specific T1 and T2 weighted, and fluid‐attenuated inversion recovery (FLAIR) sequences give complementary information about the characteristic imaging features of FCD; focal cortical thickening, blurring of the gray‐white junction, high FLAIR signal, and gyral anatomical abnormalities. Novel imaging techniques such as magnetic resonance spectroscopy (MRS), magnetization transfer imaging (MTI), and diffusion tensor imaging (DTI) can improve the sensitivity of MR to localize the anatomical lesion. Functional/metabolic techniques such as positron emission tomography (PET), ictal subtraction single photon emission computed tomography (SPECT), functional MRI (fMRI), and magnetic source imaging (MSI) have the potential to visualize the metabolic, vascular, and epileptogenic properties of the FCD lesion, respectively. Identification of eloquent areas of cortex, to assist in the surgical resection plan, can be obtained non‐invasively through the use of fMRI and MSI. Although a significant number of FCD lesions remain unidentified using current neuroimaging techniques, future advances should result in the identification of an increasing number of these cortical malformations.
Topographic Patterns of Small Subcortical Infarcts Associated with MCA Stenosis: A Diffusion‐Weighted MRI Study
Authors: Wang Xin , Lam Wynnie W. M. , Fan Yu Hua , Graham Colin A. , Rainer Timothy H. , Wong Ka Sing
Published: October 2009

Background and Purpose. Small subcortical infarcts (SSI, maximum lesion diameter ≤2.0 cm) are usually considered as infarcts caused by small vessel disease. However, SSI can also be associated with large artery occlusive disease such as middle cerebral artery (MCA) stenosis. We performed a prospective study to investigate the relationship between MCA stenosis and SSI distribution and further to investigate the mechanism of SSI caused by MCA stenosis. Methods. Magnetic resonance angiography (MRA) and diffusion‐weighed MRI (DWI) of consecutive acute ischemic stroke patients with recent SSI were studied. The distribution of acute infarcts on DWI was categorized as cortical infarct (CI), border zone infarct (BI), or perforating artery infarct (PAI). Results. Totally, 93 cases were recruited, among which 12 had single SSI with MCA stenosis (group 1) and 26 patients had multiple SSI with MCA stenosis (group 2), while 55 patients without MCA stenosis had single SSI (group 3). For patients with single SSI and MCA stenosis, 6 had BI and 6 had PAI; for patients with multiple SSI and MCA stenosis, 25 had BI, 4 had PAI and 9 had CI (compared with group1: P= .001); for patients with single SSI but without MCA stenosis, 20 had BI and 35 had PAI (compared with group1: P= .58). Conclusion. Multiple acute infarcts along the border zone are the commonest pattern in small infarcts with MCA stenosis, especially among those with multiple acute infarcts. Our data suggest that hemodynamic compromise and artery‐to‐artery embolism may be both important factors for infarcts in patients with MCA stenosis.
Functional Brain Reorganization in Multiple Sclerosis: Evidence from fMRI Studies
Authors: Pantano Patrizia , Mainero Caterina , Caramia Francesca
Published: October 2009

In patients with multiple sclerosis (MS), the severity of clinical signs is not closely related to indices of structural brain damage provided by conventional magnetic resonance MR. Accordingly, patients with MS may show symptom recovery while progressively accumulating tissue damage.

Changes in functional organization of the cerebral cortex have been reported in functional magnetic resonance (fMRI) studies that have compared the activation patterns during motor, visual, and cognitive tasks of patients with MS with those of healthy controls.

fMRI studies on MS have provided the results that are difficult to compare and may be discrepant because of differences in the criteria used for patient selection, the activation paradigm, the experimental design, and the MR acquisition parameters. Nevertheless, they do provide a new, interesting tool that sheds light on how the brain changes its functional organization in response to MS.

In patients with MS, functional brain reorganization mainly consists of an increase in the extent of activation of the brain areas used by healthy subjects, as well as the recruitment of additional brain areas. These findings have been interpreted as adaptive or compensatory mechanisms that allow normal performance despite neural damage or loss. However, brain functional activity may also change in response to clinical disability, though the precise role of brain functional changes in MS has yet to fully undersand. Longitudinal studies designed to explore the effects of both rehabilitation and pharmacological agents on brain plasticity might shed light on this issue.
Relationship Between Cerebral Vasomotor Reactivity and White Matter Lesions in Elderly Subjects Without Large Artery Occlusive Disease
Authors: Fu Jian Hui , Lu Chuan Zhen , Hong Zhen , Dong Qiang , Ding Ding , Wong Ka Sing
Published: October 2009

Background and Purpose. The relationships between cerebral vasomotor reactivity (CVR) and white matter lesions (WMLs) were investigated mainly in patients with carotid stenosis. We aimed to study the relationship in asymptomatic elderly subjects without large artery occlusive disease.

Methods. A total of 33 elderly individuals (mean age was 76.2 years) who were free from neurological deficit or cognitive impairment were studied. Bilateral mean blood flow velocity was measured in the middle cerebral artery using a 2‐MHz pulsed transcranial Doppler (TCD) system together with intravenous administration of acetazolamide as vasodilatory stimuli. WMLs on a fluid‐attenuated inversion recovery (FLAIR) sequence of MRI were classified into two categories: subcortical deep white matter hyperintensity (SDWMH) and periventricular hyperintensity (PVH). The lesions in each category were then divided into three grades (grade 0‐I, grade II, grade III) according to the Fazekas scale.

Results. CVR was inversely associated with the extent of SDWMH and PVH. The differences in CVR were statistically significant among different severity of WMLs: for SDWMH (70%± 10% in grade 0‐I, 60%± 10% in grade II, and 40%± 10% in grade III, P < .001); for PVH (80%± 10% in grade 0‐I, 60%± 10% in grade II, and 40%± 10% in grade III, P < .001).

Conclusions. Impaired CVR is related to the extent of WMLs in asymptomatic elderly individuals without large artery stenosis. The findings in our study suggest that dysfunction of cerebral vascular autoregulation might be an important factor in the development of WMLs in the asymptomatic elderly without large artery occlusive disease.
CT and CT‐Perfusion Findings of Reversible Leukoencephalopathy During Triple‐H Therapy for Symptomatic Subarachnoid Hemorrhage‐Related Vasospasm
Authors: Wartenberg Katja E. , Parra Augusto
Published: October 2009

Background: Reversible leukoencephalopathy syndrome (RLS) is an acute neurological syndrome associated with altered mental status and visual disturbances described in patients with sudden elevations in systemic blood pressure and other medical conditions. In this process, neuroimaging studies usually demonstrate diffuse edema involving the subcortical structures of the posterior regions of the brain. Triple H (HHH) therapy is an established treatment for symptomatic vasospasm following subarachnoid hemorrhage (SAH). RLS has not been reported in the scientific literature as a complication of HHH therapy with perfusion computed tomography (CTP) imaging documentation. Case: A 73‐year‐old woman developed iatrogenic RLS during HHH therapy for SAH‐related vasospasm. The computed tomography (CT) revealed bilateral parieto‐occipital hypodensities. The CTP study showed increased cerebral blood volume and blood flow as well as decreased mean transit time in both parietal‐occipital regions, which is compatible with vasogenic edema. Conclusion: The induction of hypertension as part of HHH therapy for SAH‐related cerebral vasospasm may result in RLS. Therefore, it should be considered as a potentially reversible cause in the differential diagnosis of neurological deterioration in SAH patients while on HHH therapy. CTP study can offer an alternative for the assessment of this cerebrovascular syndrome.
Neuroimaging of Tuberculous Myelitis: Analysis of Ten Cases and Review of Literature
Authors: Wasay Mohammad , Arif Hiba , Khealani Bhojo , Ahsan Humera
Published: October 2009

We retrospectively reviewed the clinical and neuroimaging features of 10 patients with tuberculous myelitis. The most common presenting symptoms were fever (70%) and paraplegia (60%). Bladder and bowel symptoms were present in 90% patients. On MRI, the involvement of the cervical/thoracic segment of the spinal cord was most commonly seen (90%). The most consistent finding was hyperintense signals on T2‐weighted MRI. T1‐weighted images showed isointense (n= 5) and hypointense (n= 4) signals in the spinal cord lesions. Post‐contrast enhancement was present in 6 patients, epidural enhancement in 4 patients, and cord swelling in 2 patients.

We reviewed more than 250 published cases with the diagnosis of tuberculous myelitis and radiculomyelitis with special attention to MRI findings. It is predominantly a disease of the thoracic spinal cord. Most spinal cord lesions appear as hyperintense on T2 and iso‐ or hypointense on T1‐weighted images. MRI findings in patients with spinal cord tuberculosis have both diagnostic and prognostic significance. Cord atrophy or cavitation and the presence of syrinx on MRI may be associated with poor outcome.
Imaging Cerebral Activity in Recovery from Chronic Traumatic Brain Injury: A Preliminary Report
Authors: Lewis David H. , Bluestone Judith P. , Savina Maryann , Zoller William H. , Meshberg Emily B. , Minoshima Satoshi
Published: October 2009

People in chronic phase of traumatic brain injury (TBI) are often told that there will be no further recovery in brain function that they are in a “static phase.” Holistic Approach to NeuroDevelopment and Learning Efficiency (HANDLE®), an alternative therapy, aims to improve function by teaching a series of physical and mental activities that clients perform and encouraging changes in lifestyle. Five subjects (3 males) with chronic TBI (at least 3 years since ictus) completed the HANDLE Institute's program and were prospectively evaluated. Each had six regional cerebral blood flow (rCBF) single‐photon emission computed tomography (SPECT) scans over 7 months (scans n= 30). Paired scans were performed with injection of Tc‐99m ECD to image rCBF at rest and during the HANDLE “Crossed Arm Bounce” (CAB) exercise before the program, at 3‐4 months into the program, and at 6‐7 months, after the program had ended. SPECT images were analyzed statistically using Neurostat in which image sets were coregistered and warped into Talaraich atlas for pairwise subtraction between conditions. Group analysis of SPECT showed that CAB activated (increased rCBF) vermis and cerebellar hemispheres in first two paired scans and anterior cingulate and vermis on the final pair. Increased rCBF at rest occurred in cerebellar hemispheres, vermis, and right dorsomedial frontal cortex. These preliminary observations suggest that there may be a role of the hindbrain (vermis and cerebellum) with HANDLE treatment of chronic TBI.
Transcranial Doppler and Carotid Duplex Ultrasonography Findings in Bow Hunter's Syndrome
Authors: Iguchi Yasuyuki , Kimura Kazumi , Shibazaki Kensaku , Iwanaga Takeshi , Ueno Yuji , Inoue Takeshi
Published: October 2009

Bow hunter's syndrome (BHS) is caused by transient vertebro‐basilar ischemia on head rotation. We report a patient with BHS who was identified from dynamic changes to blood flow velocities in the posterior cerebral, basilar and vertebral arteries using carotid duplex ultrasonography and transcranial Doppler, simultaneously. Neurosonology appears to be useful for diagnosing and evaluating BHS.
Hematoma Size in Deep Intracerebral Hemorrhage and its Correlation with Dot‐Like Hemosiderin Spots on Gradient Echo T2*‐Weighted MRI
Authors: Imaizumi Toshio , Honma Toshimi , Horita Yoshifumi , Kohama Ikuhide , Miyata Kei , Kawamura Maiko , Niwa Jun
Published: October 2009

Background and Purpose. Dot‐like low intensity spots (dot‐like hemosiderin spots: dotHSs) on gradient echo T2*‐weighted MRI have been histologically diagnosed to represent old cerebral microbleeds associated with microangiopathies. They have also been correlated to the fragility of small vessels and the tendency to bleed. Therefore, a substantial number of dotHSs might be associated with a large‐sized, deep intracerebral hematoma (ICH). On the other hand, dotHSs may reflect old microbleeds that did not enlarge to symptomatic size.

Methods. To investigate how dotHSs are related to the size (maximal diameter) of primary deep ICH, we analyzed the diameter and the number of dotHSs in 151 patients with deep ICH not associated with subarachnoid hemorrhage or intraventricular hemorrhage (75 males and 76 females, age ranged from 37 to 90 [65.7 ± 11.3 years old] who were consecutively admitted to Hakodate Municipal Hospital. The hazard ratio (HR) for a maximal diameter of deep ICH ≤2 cm was estimated, using the number of dotHSs and risk factors for stroke.

Results. The number of dotHSs associated with the diameter ≤2 cm was 9.2 ± 11.5, significantly larger than that with the diameter ≥2 cm (4.7 ± 7.0, P= .012). Multivariate analysis revealed that a maximal diameter of deep ICH of ≤2 cm was found in patients with dotHS (HR, 3.7; 95% confidence interval [CI], 1.4‐10.1; P= .009). Conclusion. Though small sample size limited the power of our analyses, these findings suggest that the number of dotHSs may be associated with a small diameter of deep ICH.