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Previous data showed that PFOs not detected by high-quality transthoracic echocardiography are smaller and associated with small right-to-left shunts (4); therefore, they are far less likely to be associated with embolic stroke features (5)

Quantification of Myocardial Perfusion in Human Subjects Using 82Rb and Wavelet-Based Noise Reduction

Quantification of myocardial perfusion with 82Rb has been difficult to achieve because of the low signal-to-noise ratio of the dynamic data curves. This study evaluated the accuracy of flow estimates after the application of a novel multidimensional wavelet-based noise-reduction protocol. Methods: Myocardial perfusion was estimated using 82Rb and a two-compartment model from dynamic PET scans on 11 healthy volunteers at rest and after hyperemic stress with dipyridamole. Midventricular planes were divided into eight regions of interest, and a wavelet transform protocol was applied to images and time–activity curves. Flow estimates without and with the wavelet approach were compared with those obtained using H215O. Results: Over a wide flow range (0.45–2.75 mL/g/min), flow achieved with the wavelet approach correlated extremely closely with values obtained with H215O (y = 1.03 x -0.12; n = 23 studies, r = 0.94, P < 0.001). If the wavelet noise-reduction technique was not used, the correlation was less strong (y = 1.11 x + 0.24; n = 23 studies, r = 0.79, P < 0.001). In addition, the wavelet approach reduced the regional variation from 75% to 12% and from 62% to 11% (P < 0.001 for each comparison) for resting and stress studies, respectively. Conclusion: The use of a wavelet protocol allows near-optimal noise reduction, markedly enhances the physiologic flow signal within the PET images, and enables accurate measurement of myocardial perfusion with 82Rb in human subjects over a wide range of flows

Absolute quantitation of coronary steal induced by intravenous dipyridamole

AbstractOBJECTIVESThe study was done to determine whether coronary steal (defined as an absolute decrease in perfusion from resting blood flow) is induced by intravenous (IV) dipyridamole in patients with severe coronary artery disease (CAD).BACKGROUNDMyocardial ischemia during coronary vasodilation is usually attributed to coronary steal. However, there is limited data on the absolute magnitude of coronary steal in humans.METHODSEighteen patients with multivessel CAD underwent dynamic positron emission tomography (PET) imaging with 13NH3at rest and after infusion of IV dipyridamole. Eight myocardial sectors were analyzed per short axis slice and myocardial blood flow calculated with a two-compartment model in absolute terms.RESULTSCoronary steal occurred in 8 of the 18 patients. In the 8 patients with coronary steal, myocardial blood flow decreased from 90 ± 18 ml/100 g/min at rest to 68 ± 27 ml/100 g/min following dipyridamole in the segments with steal, and increased from 87 ± 19 to 138 ± 16 ml/100 g/min following dipyridamole in the segments without steal. Significant clinical correlates of coronary steal were either ST elevation or the combination of ST depression and angina.CONCLUSIONSCoronary vasodilation with IV dipyridamole is associated with significant reductions in blood flow to collateral-dependent myocardium consistent with coronary steal in about 45% of patients with severe CAD

Correlating perceived arrhythmia symptoms and QoL in the elderly with Heart Failure in an urban clinic: A prospective, single center study

Aims and objectives To determine the relationship between quality of life and perceived self-reported symptoms in an older, ambulatory, urban population living with heart failure. Background While arrhythmias in older individuals with heart failure are well documented, the association between perceived arrhythmia symptoms and quality of life is not well-defined. Design Prospective, cross-sectional single-centre study. Methods A single-centre, prospective study was conducted with heart failure patients recruited from an urban outpatient cardiology clinic in the United States. Fifty-seven patients completed a baseline quality of life survey with 42 of these completing the six-month follow-up survey. Quality of life was evaluated with the SF-36v2™ and frequency of symptoms with the Atrial Fibrillation Severity Scale. Subjects wore an auto triggered cardiac loop monitor (LifeStar AF Express®) for two weeks to document arrhythmias. Data analysis utilised Spearman's rank correlation and logistic regression. Results Baseline and six-month quality of life measures did not correlate with recorded arrhythmias. However, perceptions of diminished general health correlated significantly with symptoms of exercise intolerance, lightheadedness/dizziness, palpitations and chest pain/pressure. By multivariable logistic regression, more severe perceived episodes, symptoms of exercise intolerance and lightheadedness/dizziness were independently associated with diminished quality of life. Conclusion Quality of life was significantly worse in patients with perceptions of severe arrhythmic episodes and in those with symptoms of dizziness and exercise intolerance. Relevance to clinical practice The findings of this study indicate that symptomatic heart failure patients suffer from poor quality of life and that interventions are needed to improve quality of life and decrease symptom severity. Nurses who care for heart failure patients play an essential role in symptom evaluation and management and could significantly improve overall quality of life in these patients by carefully evaluating symptomatology and testing interventions and educational programmes aimed at improving quality of life

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

Relationship Between Cardiovascular Disease Knowledge and Race/Ethnicity, Education, and Weight Status

Background: Inadequate cardiovascular disease (CVD) knowledge has been cited to account for the imperfect decline in CVD among women over the last 2 decades. Hypothesis: Due to concerns that at-risk women might not know the leading cause of death or symptoms of a heart attack, our goal was to assess the relationship between CVD knowledge race/ethnicity, education, and body mass index (BMI). Methods: Using a structured questionnaire, CVD knowledge, socio-demographics, risk factors, and BMI were evaluated in 681 women. Results: Participants included Hispanic, 42.1% (n = 287); non-Hispanic white (NHW), 40.2% (n = 274); non-Hispanic black (NHB), 7.3% (n = 50); and Asian/Pacific Islander (A/PI), 8.7% (n = 59). Average BMI was 26.3 ± 6.1 kg/m2. Hypertension was more frequent among overweight (45%) and obese (62%) than normal weight (24%) (P 12 years (both P < 0.0001). Conclusions: Effective prevention strategies for at-risk populations need to escalate CVD knowledge and awareness among the undereducated and minority women

Endothelial dysfunction is associated with carotid plaque: a cross-sectional study from the population based Northern Manhattan Study

BACKGROUND: Impaired vascular function occurs early in atherogenesis. Brachial flow mediated dilatation (FMD) is a non-invasive measure of vascular function and may be an important marker of preclinical atherosclerosis. Data on the association between FMD and carotid plaque in multi-ethnic populations are limited. The objective of this study was to determine whether endothelial dysfunction is independently associated with carotid plaque in a community of northern Manhattan. METHODS: In the population-based Northern Manhattan Study (NOMAS), high-resolution B-mode ultrasound images of the brachial and carotid arteries were obtained in 643 stroke-free subjects (mean age 66 years; 55% women; 65% Caribbean-Hispanic, 17% African-American, 16% Caucasian). Brachial FMD was measured during reactive hyperemia. Maximum carotid plaque thickness (MCPT) was measured at the peak plaque prominence. RESULTS: The mean brachial FMD was 5.78 ± 3.83 %. Carotid plaque was present in 339 (53%) subjects. The mean MCPT was 1.68 ± 0.82 mm, and the 75(th )percentile was 2.0 mm. Reduced FMD was significantly associated with increased MCPT. After adjusting for demographics, vascular risk factors, and education, each percent of FMD decrease was associated with a significant 0.02 mm increase in MCPT (p = 0.028). In a dichotomous adjusted model, blunted FMD was associated with an increased risk of MCPT ≥ 2.0 mm (OR, 1.11 for every 1% decrease in FMD; 95% CI, 1.03–1.19). CONCLUSION: Decreased brachial FMD is independently associated with carotid plaque. Non-invasive evaluation of endothelial dysfunction may be a useful marker of preclinical atherosclerosis and help to individualize cardiovascular risk assessment beyond traditional risk factors

Clinical outcome after first and recurrent hemorrhage in patients with untreated brain arteriovenous malformation

Background and Purpose: The morbidity from spontaneous hemorrhage of untreated brain arteriovenous malformations(AVM) is not well described.Methods: The 241 consecutive AVM patients (mean age 3716 years, 52% women) from the prospective ColumbiaAVM Databank initially presenting with hemorrhage were evaluated using the Rankin Scale (RS) and the NationalInstitute of Health Stroke Scale (NIHSS). From the 241 AVM patients, 29 (12%) had subsequent intracranialhemorrhage during follow-up. For further comparisons, 84 non-AVM patients with intracerebral hemorrhage from theNorthern Manhattan Study (NOMAS) served as a control group.Results: In 241 AVM patients presenting with hemorrhage the median RS was 2 and the median NIHSS was 1 (49% RS0 to 1, 61% NIHSS 2). The median time between hemorrhage and clinical evaluation was 11 days (mean 219 days).Recurrent AVM hemorrhage during follow-up resulted in no significant increase in morbidity (median RS 2, P0.004;median NIHSS 3, P0.322; time between hemorrhage and study evaluation: median 55 days, mean 657 days). AmongAVM-hemorrhage subtypes, parenchymatous AVM hemorrhage was associated with higher stroke morbidity (oddsratio, 2.9; 95% CI, 1.5 to 5.8 for NIHSS 2) than nonparenchymatous hemorrhages. Parenchymatous AVM hemorrhagehad a significantly better outcome (median NIHSS 1) than non-AVM related hemorrhage (median NIHSS 12;P0.0001).Conclusions: Hemorrhage, either at initial presentation or during follow-up of untreated AVM patients appears to carr

Gaia Focused Product Release: A catalogue of sources around quasars to search for strongly lensed quasars

Context. Strongly lensed quasars are fundamental sources for cosmology. The Gaia space mission covers the entire sky with the unprecedented resolution of $0.18$" in the optical, making it an ideal instrument to search for gravitational lenses down to the limiting magnitude of 21. Nevertheless, the previous Gaia Data Releases are known to be incomplete for small angular separations such as those expected for most lenses. Aims. We present the Data Processing and Analysis Consortium GravLens pipeline, which was built to analyse all Gaia detections around quasars and to cluster them into sources, thus producing a catalogue of secondary sources around each quasar. We analysed the resulting catalogue to produce scores that indicate source configurations that are compatible with strongly lensed quasars. Methods. GravLens uses the DBSCAN unsupervised clustering algorithm to detect sources around quasars. The resulting catalogue of multiplets is then analysed with several methods to identify potential gravitational lenses. We developed and applied an outlier scoring method, a comparison between the average BP and RP spectra of the components, and we also used an extremely randomised tree algorithm. These methods produce scores to identify the most probable configurations and to establish a list of lens candidates. Results. We analysed the environment of 3 760 032 quasars. A total of 4 760 920 sources, including the quasars, were found within 6" of the quasar positions. This list is given in the Gaia archive. In 87\% of cases, the quasar remains a single source, and in 501 385 cases neighbouring sources were detected. We propose a list of 381 lensed candidates, of which we identified 49 as the most promising. Beyond these candidates, the associate tables in this Focused Product Release allow the entire community to explore the unique Gaia data for strong lensing studies further.Comment: 35 pages, 60 figures, accepted for publication by Astronomy and Astrophysic