Contrast-enhanced sonography as a novel tool for assessment of vascular malformations

Vascular malformations with arteriovenous shunt components can cause significant disability, chronic pain, and functional impairment. Effective treatment may require serial procedures, yet an imaging modality optimized to control cost and reduce radiation exposure in this predominantly pediatric population has not yet been identified. We describe the use of contrast-enhanced sonography as a novel tool to define vascular anatomy and localize arteriovenous shunting in a young patient with a symptomatic vascular malformation. This method may effectively reduce radiation exposure and cost, and additionally provide unique information about arteriovenous shunting, offering a novel imaging application for patients with these conditions

Alterations in Diastolic Function in Masked Hypertension: Findings from the Masked Hypertension Study

BACKGROUND In a prior study of patients with diabetes, diastolic function was similarly impaired in masked hypertension (MHT) and sustained hypertension (SHT). We evaluated whether MHT is associated with impaired diastolic function compared with SHT and sustained normotension (NT) in the general population. METHODS From February 2005 to December 2010, 798 participants without a history of cardiovascular disease or treated hypertension, were enrolled in the Masked Hypertension Study. Participants underwent clinic blood pressure (CBP) and 24-hour ambulatory blood pressure (ABP) measurements. A 2-dimensional Doppler echocardiogram was performed to evaluate diastolic function,s cardiac structure, volume, and systolic function. The 9 CBPs obtained across 3 clinic visits and awake ABP measurements were averaged. Clinic hypertension was defined as systolic/diastolic blood pressure (SBP/DBP) ≥ 140/90 mmHg. Ambulatory hypertension was defined as awake SBP/DBP ≥ 135/85mm Hg. MHT was defined as having ambulatory but not clinic hypertension. White-coat hypertensives (n = 8) were excluded from the analysis. RESULTS Of the 790 participants, 116 (14.7%) participants had MHT, 37 (4.7%) participants had SHT, and 637 (80.6%) participants had NT. After age, sex, race/ethnicity, and body mass index adjustment, compared with NT, E’-velocities were significantly lower in MHT (P < 0.01) and SHT (P < 0.05), and E/E’ ratios were significantly higher MHT (P < 0.05) and SHT (P < 0.05). These associations were independent of left ventricular mass. Diastolic function parameters did not significantly differ between MHT and SHT. CONCLUSIONS Diastolic function was impaired in MHT compared with NT independent of changes in left ventricular mass

Rizik neželjenih događaja kod bolesnika s otvorenim foramen ovale liječenih lijekovima: pregled literature

Patent foramen ovale is associated with stroke. However, the rate of recurrent events in medically treated patients with patent foramen ovale remains undefined. Estimates differ by the studies. In order to provide a more accurate estimate of the recurrent adverse event rates in medically treated patients with patent foramen ovale, we reviewed the literature and analyzed the results from a total of 1,108 patients combining 12 studies. We found the annual rate of stroke or death to be 3.12% (95% CI, 2.32-4.11%). This estimate will provide a valuable guideline for any future study to compare the efficacy of other modalities such as percutaneous device closure of patent foramen ovale with medical treatment.Otvoreni foramen ovale (OFO) udružen je s moždanim udarom. Međutim, učestalost rekurentnih neželjenih događaja u bolesnika liječenih lijekovima s otvorenim foramen ovale nije poznata, a procjene iz različitih studija se razlikuju. Stoga smo obavili pregled literature i analizirali rezultate za ukupno 1.108 bolesnika iz 12 studija, kako bismo dobili točniju procjenu učestalosti neželjenih događaja u bolesnika s otvorenim foramen ovale liječenih lijekovima. Utvrdili smo godišnju stopu moždanog udara ili smrti od 3,12% (95% CI, 2,32-4,11%). Ova će procjena poslužiti kao vrijedna smjernica za buduća ispitivanja u kojima će se uspoređivati učinkovitost drugih načina liječenja, primjerice, zatvaranje otvorenog foramen ovale pomoću perkutanog uređaja uz medikamentno liječenje